Row Number,Calculator ID,Calculator Name,Category,Output Type,Note ID,Note Type,Patient Note,Question,Relevant Entities,Ground Truth Answer,Lower Limit,Upper Limit,Ground Truth Explanation
1,2,Creatinine Clearance (Cockcroft-Gault Equation),lab test,decimal,pmc-7671985-1,Extracted,"An 87-year-old man was admitted to our hospital for anorexia for several days, high-grade fever from the previous day, and liver dysfunction. Of note, he had a history of hypertension, diabetes mellitus (DM), and angina. Physical examination findings included: clear consciousness; height, 163 cm; weight, 48 kg; blood pressure, 66/40 mmHg; heart rate, 75/min; respiratory rate, 22/min; oxygen saturation of peripheral artery, 96%; and body temperature, 38.1 °C. He had no surface lymphadenopathy. Laboratory findings included: white blood cell (WBC) count, 4.2 × 109/L; hemoglobin, 9.6 g/dL; platelet count, 106 × 109/L; lactate dehydrogenase (LDH), 1662 IU/L; aspartate aminotransferase (AST), 6562 IU/L; alanine aminotransferase (ALT), 1407 IU/L; alkaline phosphatase (ALP), 509 IU/L; γ-glutamyl transpeptidase (γ-GTP), 130 IU/L; total bilirubin, 2.7 mg/dL; prothrombin time (PT), 20.3 s; international normalized ratio (INR), 1.73; blood urea nitrogen (BUN), 34.4 mg/dL; and creatinine, 1.4 mg/dL. Serologic tests were all negative for hepatitis A, B, C, and E. Computed tomography (CT) performed at admission revealed no distinct nodules or masses in the liver, but mild splenomegaly, multiple hypodense splenic lesions, and para-aortic lymph node swelling (Fig. a–c). Antibiotics were administered intravenously for suspected acute cholangitis and sepsis, but the fever persisted. Abdominal ultrasonography (US) and magnetic resonance imaging (MRI) performed 2 days later newly depicted gallbladder wall thickening and ascites (Figs. , ). On the same night, the patient presented with grade II hepatic encephalopathy, with blood tests showing a decrease in platelet count and worsening liver function suggestive of “acute type” ALF with hepatic coma and disseminated intravascular coagulation (DIC). While consideration was being given to treating acute liver failure, the patient suddenly developed ventricular fibrillation and died despite immediate resuscitation measures on day 3 of hospitalization.
Given the rapid clinical course, an autopsy was performed in this patient with suspected ALF likely due to drug-induced liver injury, autoimmune hepatitis, hepatitis of indeterminate etiology, circulatory disturbance, metabolic disease, or malignant cells including malignant lymphoma. This led to the patient being diagnosed with malignant, diffuse large B-cell lymphoma, characterized by multiple lymph-node, as well as multi-organ (i.e., spleen, liver, lung, and prostate) involvement: (1) general swelling of lymph nodes in the para-abdominal aorta (Fig. a), peripancreatic, peribronchial, pulmonary hilar, subclavicular regions, as well as in the pelvis, especially around the iliac arteries, measuring up to 60 mm in diameter; (2) presence of multiple whitish splenic nodules (Fig. b) with the entire spleen shown to be microscopically infiltrated by tumor cells (Fig. a); (3) irregular geographical morphology of the liver (Fig. c) with the lymphoma cells mainly infiltrating the portal areas (Fig. b); (4) involvement of the right lobe of the lung; (5) involvement of both lobes of the prostate consequent to outer connective tissue involvement (Fig. c). Microscopically, the tumor cells in the lymph nodes were shown to have medium-sized irregular nuclei and small nucleoli with a high nuclear cytoplasmic ratio, thus showing diffuse proliferation characterized by the presence of large numbers of small T-cells (Fig. ). Immunohistochemistry revealed the tumor cells to be positive for CD20 (Fig. a), CD79a (Fig. b), bcl-2 (Fig. c), and MUM1 (Fig. d), but negative for CD3 (Fig. e), CD10, bcl-6, and cyclin D1, with a Ki-67 labeling index (Ki-67 LI) of 16% (Fig. f). The causes of death were thus determined as (1) DIC and (2) ALF associated with diffuse large B-cell lymphoma.","What is the patient's Creatinine Clearance using the Cockroft-Gault Equation in terms of mL/min? You should use the patient's adjusted body weight in kg instead of the patient's actual body weight if the patient is overweight or obese based on their BMI. If the patient's BMI's normal, set their adjusted body weight to the minimum of the ideal body and actual weight. If the patient is underweight, please set their adjusted body weight to their actual body weight. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'age': [87, 'years'], 'weight': [48.0, 'kg'], 'height': [163.0, 'cm'], 'creatinine': [1.4, 'mg/dL']}",25.2381,23.97619,26.50001,"The formula for computing Cockcroft-Gault is given by CrCl = ((140 - age) * adjusted weight * (gender_coefficient)) / (serum creatinine * 72), where the gender_coefficient is 1 if male, and 0.85 if female. The serum creatinine concentration is in mg/dL.
The patient's gender is male, which means that the gender coefficient is 1.
The patient is 87 years old. 
The concentration of creatinine is 1.4 mg/dL. 
The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 163.0 cm, which is 163.0 cm * 1 m / 100 cm = 1.63 m. The patient's weight is 48.0 kg. The patient's bmi is therefore 48.0 kg / (1.63 m * 1.63 m) = 18.06617 kg/m^2.The patient's BMI is 18.1, indicating they are underweight.
Because the patient is underweight, we take the patient's weight, 48.0 kg as the patient's adjusted weight needed for the Cockroft-Gault Equation. 
Using the Cockcroft-Gault equation:
CrCl = ((140 - age) * adjusted weight * gender_coefficient) / (serum creatinine * 72).
Plugging the patient's values gives us ((140 - 87) * 48.0 * 1) / (1.4 * 72) = 25.2381 mL/min. Hence, the patient's creatinine clearance is 25.2381 mL/min."
2,2,Creatinine Clearance (Cockcroft-Gault Equation),lab test,decimal,pmc-8605939-1,Extracted,"An 83-year-old man with a past medical history of two myocardial infarctions, chronic obstructive pulmonary disease, and hyperlipidemia presented to the emergency room shortly before midnight with sharp chest pain, nausea, and dyspnea. The patient states he has had chest discomfort and food intolerance for the past week, but that his symptoms were far worse tonight. He notes no inciting event, recent trauma, or aggravating factors. On exam he appears uncomfortable, anxious, and is in a semi-tripod position. Vitals are pertinent for a heart rate of 144, systolic blood pressure in the 180 s, and oxygen saturation of 89% on 1L O2 via nasal cannula. Of note, the patient weighed 67.2 kg, and was 173 cm tall. Chart review showed that he had lost approximately 4 kg (last recorded weight in chart was 71.2 kg), since his last medical visit.
Primary survey was overall unremarkable. Airway was secure, patient’s breathing improved with 3 L oxygen, breath sounds were present and equal bilaterally, vascular access was obtained, and GCS was 15. Intravenous pain medication was given which improved the patient’s blood pressure to systolic 140 s. Given this patient’s overall clinical picture, the most pressing disease processes included myocardial infarction (given history of coronary artery disease and prior infarcts), aortic dissection (given symptoms, hypertension, and medical history), pneumothorax, pulmonary embolism (the previous two diagnoses given his chest pain and decreased O2 even on 1 L of oxygen), and cardiac wall rupture (given multiple prior MIs). Other considerations include congestive heart failure, hypertensive crisis, and an underlying infection.
Labs were drawn to include a CBC, renal panel, cardiac panel, lactate, and a type and cross. EKG was unremarkable. A chest X-ray was obtained which revealed a widened mediastinum (Fig. ).
The patient was stabilized, but the underlying cause of his symptoms had not yet been identified. His widened mediastinum is troubling, and further drives the differential. Aortic (dissection, aneurysm), cardiac (tamponade, wall rupture), and esophageal pathology (rupture versus other masses) now move to the top of the list of diagnoses. Labs continued to be pending. Given his now overall hemodynamically stable status and clinical improvement, the decision was made to obtain a CT chest/abdomen/pelvis which revealed the following (Fig. ).
Along with the CT scan; the initial set of labs resulted and were pertinent for leukocytosis (white blood cell count/WBC) of 19,000/mcL, creatinine of 1.4 mg/dL, lactate of 3.94 mmol/L, and troponin of 0.101 ng/mL. Although no official read of the images were immediately available, a preliminary read by the team was concerning for mega-esophagus versus a strangulated hiatal hernia. Treatment of the pathology to limit the degree of heart strain (increased troponin), ischemia (as evidenced by the WBC and lactate), and possibility for future perforation were now the primary goals. Night Hawk radiology was contacted for an emergent read, who stated that the images were consistent with a severely dilated esophagus. No pulmonary emboli were visualized, and no other acute abnormalities were reported.
The findings, treatment modalities, risks, and benefits were discussed in depth with the patient. Given his dilated esophagus which was severe enough to cause him chest pain, dyspnea, alter his vitals, elevate his WBC, elevate lactate levels, and cause heart strain. Esophagogastroduodenoscopy (EGD) with possible video-assisted thoracoscopic surgery (VATS), possible thoracotomy, possible laparoscopy, and possible laparotomy were recommended to the patient. The goal was for direct visualization of area, decompression, and repair of any defects. The patient was in full agreement with the plan, and was taken to the operating room shortly thereafter. In the mean time, given the location of the pathology and concern for developing septic picture, the patient was started on broad spectrum antibiotics and an antifungal.
On EGD, the patient’s esophageal distention was found to be from a large bezoar which spanned from the broncho-aortic region of the esophagus to his lower esophageal sphincter. The bezoar was a phytobezoar, with evidence of medication and food particles (meat, vegetables) incorporated into it. The esophageal tissue appeared tenuous and appeared to be the cause of the patient’s lab derangements (Fig. ).
The decompression was done carefully and meticulously by fragmenting the bezoar endoscopically using a snare device. About 2 h into the procedure, a repeat set of labs were drawn which showed significant improvement in his labs showing a WBC of now 7600/mcL (from 19,000/mcL), creatinine of 0.9 mg/dL (from 1.4 mg/dL), lactate of 0.86 mmol/L (from 3.94 mmol/L), and a troponin of 0.046 ng/mL (from 0.101 ng/mL). A discussion between the surgical team, anesthesia, and gastroenterology (via telephone) was done in the operating room for planning. Given his hemodynamic stability, improving lab values, and previous CT scan which showed no gross evidence of a leak, the decision was made to end the procedure for further resuscitation with plans to return to the OR for interval endoscopy to re-assess the esophagus. In the meantime, the patient was continued on broad spectrum antibiotics (to include antifungal coverage). He was kept Nil per os (NPO) and was admitted to the intensive care unit.
The patient remained hemodynamically normal and clinically stable throughout the night. The multi-disciplinary team determined the best course of action to be complete bezoar debridement, placement of NG tube, nutrition and medical optimization, workup for possible underlying esophageal pathology (to include completion EGD, manometry, and pH probe), and eventual endoscopic versus surgical management of determined condition. The above was again relayed to the patient and his family who fully supported the plan. The bezoar debridement was completed, and the esophagus was inspected for luminal integrity. An NG tube was able to be carefully placed under direct visualization.
The patient did well and was eventually able to be downgraded to the regular surgical floor. During his stay, a gastrostomy tube was obtained for feeding access and nutritional optimization. He would undergo several follow-up EGDs during his hospitalization to completely clear the bezoar and assess the esophageal lumen (Figs. and ). After discharge, the patient was further worked up and was found to have achalasia and esophagitis. Thorough workup includes a barium swallow study (patient’s barium swallow shown in Fig. ), EGD, manometry, pH study, and a chest CT (for, among other things, surgical planning). He was followed up in the outpatient setting for further management.","What is the patient's Creatinine Clearance using the Cockroft-Gault Equation in terms of mL/min? You should use the patient's adjusted body weight in kg instead of the patient's actual body weight if the patient is overweight or obese based on their BMI. If the patient's BMI's normal, set their adjusted body weight to the minimum of the ideal body and actual weight. If the patient is underweight, please set their adjusted body weight to their actual body weight. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'age': [83, 'years'], 'weight': [67.2, 'kg'], 'height': [173.0, 'cm'], 'creatinine': [1.4, 'mg/dL']}",38,36.1,39.9,"The formula for computing Cockcroft-Gault is given by CrCl = ((140 - age) * adjusted weight * (gender_coefficient)) / (serum creatinine * 72), where the gender_coefficient is 1 if male, and 0.85 if female. The serum creatinine concentration is in mg/dL.
The patient's gender is male, which means that the gender coefficient is 1.
The patient is 83 years old. 
The concentration of creatinine is 1.4 mg/dL. 
The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 173.0 cm, which is 173.0 cm * 1 m / 100 cm = 1.73 m. The patient's weight is 67.2 kg. The patient's bmi is therefore 67.2 kg / (1.73 m * 1.73 m) = 22.45314 kg/m^2.The patient's BMI is 22.5, indicating they are normal weight.
Because the patient is normal, we take take minimum of the ideal body weight and the patient's body as the patient's adjusted weight for the Cockroft-Gault Equation. Hence, the adjusted body weight is the minimum of the two giving us an adjusted body weight of 67.2 kg.

Using the Cockcroft-Gault equation:
CrCl = ((140 - age) * adjusted weight * gender_coefficient) / (serum creatinine * 72).
Plugging the patient's values gives us ((140 - 83) * 67.2 * 1) / (1.4 * 72) = 38.0 mL/min. Hence, the patient's creatinine clearance is 38.0 mL/min."
3,2,Creatinine Clearance (Cockcroft-Gault Equation),lab test,decimal,pmc-4359532-1,Extracted,"A 62 year old Caucasian female patient (height - 1.60 m, weight 72 kg, BMI 28.1) was admitted to hospital with AKI (patient’s baseline serum creatinine was 85 μmol/L and eGFR was 63 ml/min/1.73 m2 by MDRD equation) whilst on treatment for mastoiditis. Her background medical history included hypertension, and type 2 diabetes for which she was on regular sitagliptin-metformin 50/1000 mg half tablet twice a day, metoprolol 25 mg twice daily, lisinopril 10 mg daily and simvastatin 40 mg daily. She had a long medical history of recurrent otitis media for which she required grommet insertion. She was managed as outpatient with topical and oral ciprofloxacin by her otolaryngologist. Trial of oral trimethoprim-sulphamethaxazole (Bactrim DS) was prescribed without much clinical improvement. Eight weeks prior to this admission, she had symptoms of earache, localised post auricular swelling and fever. A CT scan showed mastoiditis and a contiguous subperiosteal abscess. A brain Magnetic Resonance Imaging (MRI) scan and Technetium 99 m labelled bone scan which revealed osteomyelitis (OM) of the petrous temporal bone (Figure ). She underwent an emergency cortical mastoidectomy with drainage of the abscess and insertion of a new right ear grommet. Empirical therapy with ticarcillin-clavulanate (12.4 grams/day) was commenced.
A surface swab from the ear isolated Escherichia coli (which was sensitive to ticarcillin-clavulanate, piperacillin-tazobactam, cefepime and gentamicin, but resistant to ceftriaxone and ciprofloxacin). Susceptibilities were done using Vitek2 (Biomerieux, Marcy l’Etolie, France) using standard Gram negative card. Based on the antibiogram the isolate most likely had underlying extended spectrum beta lactamase, although confirmatory testing was not done as per current testing policy (non-sterile site isolate). The operative specimens of pus and tissue taken at the time of surgery remained sterile. Her antibiotic was changed to cefepime (6 grams/day).
She made good progress and was discharged with a plan of continuing cefepime for 6 weeks as treatment of OM on ambulatory care basis. After 2 weeks of therapy, she developed malaise and dysgeusia.","What is the patient's Creatinine Clearance using the Cockroft-Gault Equation in terms of mL/min? You should use the patient's adjusted body weight in kg instead of the patient's actual body weight if the patient is overweight or obese based on their BMI. If the patient's BMI's normal, set their adjusted body weight to the minimum of the ideal body and actual weight. If the patient is underweight, please set their adjusted body weight to their actual body weight. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'age': [62, 'years'], 'weight': [72.0, 'kg'], 'height': [1.6, 'm'], 'creatinine': [85.0, 'µmol/L']}",61.28291,58.21876,64.34706,"The formula for computing Cockcroft-Gault is given by CrCl = ((140 - age) * adjusted weight * (gender_coefficient)) / (serum creatinine * 72), where the gender_coefficient is 1 if male, and 0.85 if female. The serum creatinine concentration is in mg/dL.
The patient's gender is female, which means that the gender coefficient is 0.85.
The patient is 62 years old. 
The concentration of creatinine is 85.0 µmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of creatinine from µmol to mg. The mass of creatinine is 85.0 µmol. To convert 85.0 µmol of creatinine to mol, multiply by the conversion factor 1e-06, giving us 85.0 µmol creatinine * 1e-06 mol/µmol = 8e-05 mol creatinine. To convert from mol creatinine to grams, multiply by the molar mass 113.12 g/mol, which will give 8e-05 mol creatinine * 113.12 g/mol = 0.00905 g creatinine. To convert 0.00905 g of creatinine to mg, multiply by the conversion factor 1000.0, giving us 0.00905 g creatinine * 1000.0 mg/g = 9.05 mg creatinine. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 9.05 mg creatinine/10.0 dL = 0.905 mg creatinine/dL. The concentration value of 85.0 µmol creatinine/L converts to 0.905 mg creatinine/dL. 
The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 1.6 m. The patient's weight is 72.0 kg. The patient's bmi is therefore 72.0 kg / (1.6 m * 1.6 m) = 28.125 kg/m^2.The patient's BMI is 28.1, indicating they are overweight/obese.
Because the patient is overweight/obese, we use the adjusted body weight formula to get the adjusted weight used for Cockroft-Gault Equation. Shown below is the computation for IBW (ideal body weight).
For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Female.
The patient's height is 1.6 m, which is 1.6 m * 39.3701 in/m = 62.99216 in. 
Plugging in the values for the IBW formula for females gives us 45.5 kg + 2.3 kg * (62.99216 (in inches) - 60) = 52.38197 kg.
Hence, the patient's IBW is 52.38197 kg.Shown below is the computation for ABW (adjusted body weight).
To compute the ABW value, apply the following formula: ABW = IBW + 0.4 * (weight (in kg) - IBW (in kg)). ABW = 52.38197 kg + 0.4 * (72.0 kg  - 52.38197 kg) = 60.22918 kg. The patient's adjusted body weight is 60.22918 kg.
Using the Cockcroft-Gault equation:
CrCl = ((140 - age) * adjusted weight * gender_coefficient) / (serum creatinine * 72).
Plugging the patient's values gives us ((140 - 62) * 60.22918 * 0.85) / (0.905 * 72) = 61.28291 mL/min. Hence, the patient's creatinine clearance is 61.28291 mL/min."
4,2,Creatinine Clearance (Cockcroft-Gault Equation),lab test,decimal,usmle-1002,Extracted,"A 42-year-old woman comes to the physician for a routine health maintenance examination. She has generalized fatigue and has had difficulties doing her household duties for the past 3 months. She has eczema and gastroesophageal reflux disease. She has a history of using intravenous methamphetamine in her youth but has not used illicit drugs in 23 years. Her medications include topical clobetasol and pantoprazole. She is 160 cm (5 ft 3 in) tall and weighs 105 kg (231 lb); BMI is 42 kg/m2. Her temperature is 37°C (98.6°F), pulse is 95/min, and blood pressure is 145/90 mm Hg. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. Pelvic examination shows a normal vagina and cervix. Laboratory studies show:
Hemoglobin 13.1 g/dL
Leukocyte count 7,800/mm3
Platelet count 312,000/mm3
Serum
Na+ 141 mEq/L
K+ 4.6 mEq/L
Cl- 98 mEq/L
Urea nitrogen 12 mg/dL
Fasting glucose 110 mg/dL
Creatinine 0.8 mg/dL
Total cholesterol 269 mg/dL
HDL-cholesterol 55 mg/dL
LDL-cholesterol 160 mg/dL
Triglycerides 320 mg/dL
Urinalysis is within normal limits. An x-ray of the chest shows no abnormalities. She has not lost any weight over the past year despite following supervised weight loss programs, including various diets and exercise regimens.","What is the patient's Creatinine Clearance using the Cockroft-Gault Equation in terms of mL/min? You should use the patient's adjusted body weight in kg instead of the patient's actual body weight if the patient is overweight or obese based on their BMI. If the patient's BMI's normal, set their adjusted body weight to the minimum of the ideal body and actual weight. If the patient is underweight, please set their adjusted body weight to their actual body weight. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'age': [42, 'years'], 'weight': [105.0, 'kg'], 'height': [160.0, 'cm'], 'creatinine': [0.8, 'mg/dL']}",106.19185,100.88226,111.50144,"The formula for computing Cockcroft-Gault is given by CrCl = ((140 - age) * adjusted weight * (gender_coefficient)) / (serum creatinine * 72), where the gender_coefficient is 1 if male, and 0.85 if female. The serum creatinine concentration is in mg/dL.
The patient's gender is female, which means that the gender coefficient is 0.85.
The patient is 42 years old. 
The concentration of creatinine is 0.8 mg/dL. 
The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 160.0 cm, which is 160.0 cm * 1 m / 100 cm = 1.6 m. The patient's weight is 105.0 kg. The patient's bmi is therefore 105.0 kg / (1.6 m * 1.6 m) = 41.01562 kg/m^2.The patient's BMI is 41.0, indicating they are overweight/obese.
Because the patient is overweight/obese, we use the adjusted body weight formula to get the adjusted weight used for Cockroft-Gault Equation. Shown below is the computation for IBW (ideal body weight).
For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Female.
The patient's height is 160.0 cm, which is 160.0 cm * 0.393701 in/cm = 62.99216 in. 
Plugging in the values for the IBW formula for females gives us 45.5 kg + 2.3 kg * (62.99216 (in inches) - 60) = 52.38197 kg.
Hence, the patient's IBW is 52.38197 kg.Shown below is the computation for ABW (adjusted body weight).
To compute the ABW value, apply the following formula: ABW = IBW + 0.4 * (weight (in kg) - IBW (in kg)). ABW = 52.38197 kg + 0.4 * (105.0 kg  - 52.38197 kg) = 73.42918 kg. The patient's adjusted body weight is 73.42918 kg.
Using the Cockcroft-Gault equation:
CrCl = ((140 - age) * adjusted weight * gender_coefficient) / (serum creatinine * 72).
Plugging the patient's values gives us ((140 - 42) * 73.42918 * 0.85) / (0.8 * 72) = 106.19185 mL/min. Hence, the patient's creatinine clearance is 106.19185 mL/min."
5,2,Creatinine Clearance (Cockcroft-Gault Equation),lab test,decimal,pmc-4459668-1,Extracted,"A 45-year-old, 58 kg, 156 cm woman presented with increased and prolonged vaginal bleedings. A physical examination and an ultrasound showed a submucosal leiomyoma of the uterus. There were no other symptoms or pathological findings. Preoperative blood tests, which included electrolytes analyses, a full blood exam, and coagulation parameters, showed no anomalies. Most notably, both creatinine and sodium were within normal levels, i.e. 0.7 mg/dL and 137 mEq/L, respectively. The patient had a history of encephalopathy during childhood of an unknown origin without sequelae, an elective caesarean section (1997) due to leiomyoma, laparoscopic myomectomy and removal of an endometrial cyst of the ovary (1999), and a second caesarean section (2000) due to an uterine instability subsequent to the first caesarean section and myomectomy. The patient had no known allergies. She was taking daily doses of ethinyl estradiol (0.02 mg) and levonorgestrel (0.1 mg) continuously over a period of six months. The patient refused a hysterectomy but an endoscopic removal of the leiomyoma and an endometrial ablation was decided on, subsequent to which the patient gave written informed consent. The patient was administered with 7.5 mg midazolam orally 60 min preoperatively. Subsequent to placing the patient in the lithotomy position, the application of a peripheral venous catheter and the attachment of standard monitoring equipment (electrocardiogram, non-invasive blood pressure cuff and a peripheral capillary oxygen saturation analyzer), anaesthesia was induced intravenously with propofol (2 mg/kg) and sufentanil (0.3 μg/kg).
A laryngeal mask was inserted, and after the correct positioning was verified, the lungs were ventilated with a fraction of inspired oxygen (FiO2) of 0.5 and a minute volume (MV) of 74 mL/min/kg at a ventilation frequency of 10/min in volume controlled mode (IPPV). The positive end-expiratory pressure (PEEP) level was 0 Pa and the peak pressure was 900 Pa. Anaesthesia was maintained with propofol (8 mg/kg/h). After anaesthesiological clearance the endoscopy commenced. Purisole® SM (Fresenius Kabi Inc., Germany) was utilized as the distension medium. This standard hypotonic solution contains 27 g sorbitol and 5.4 g mannitol per liter. A pressure of 16 kPa (120 mmHg) was applied to unfold the uterine cavity. Endometrial ablation and dissection of the submucosal myoma were performed within 70 min by monopolar resection. The duration of the procedure was prolonged due to the reduced visibility caused by excessive bleeding and cervical leakage of distension medium, which impeded proper expansion of the uterine cavity. The ventilation pressure increased slowly and continuously 60 min subsequent to the start of surgery. The compliance of the lungs, as well as the achievable minute volume within the acceptable airway pressure limit of 2 kPa, decreased. It was presumed that the level of anaesthesia was insufficient and was followed by the increased administration of propofol (10 mg/kg/h). The additional inhalation of fenoterol did, however, not improve the situation. As ventilation continued to be difficult, the laryngeal mask was replaced by a 7.0 cm (inside diameter) cuffed tube subsequent to the administration of 100 mg succinylcholine as a muscle relaxant. Approximately 50 mL of a foamy, transparent liquid was aspirated from the trachea. Testing with litmus paper indicated an alkaline pH and, therefore, not the aspiration of gastric content. The amount of the pulmonary oedema increased and, despite high levels of peak airway pressures at this point approximately 3 kPa (= set peak pressure limit), adequate ventilation was not possible. Blood gas and electrolyte analyses indicated acidosis, as well as a severe hyponatremia (pH 7.11; Na 74 mEq/L; partial pressure of CO2 49.9 mmHg; saturation of O2 97 % at FiO2 1.0). Cardiopulmonary changes remained minimal. 40 mg of furosemide and 500 mL of 3 % NaCl solution were immediately administered at an infusion rate of 500 mL/h, with constant monitoring for electrolyte changes. As the patient showed clinical signs of impaired haemostasis, the operation procedure was stopped. The patient was admitted to the intensive care unit with continuous administration of 3 % NaCl at a rate of 50 mL/h and electrolyte control. Plasma sodium levels increased from 74 mEq/L to 103 mEq/L after one hour, and to 130 mEq/L after 7 h (Fig. ). All together 800 mL of 3 % NaCl solution were administered within 7 h totalling at 24 g. Subsequently, sodium replenishment was stopped and the patient was extubated without problems. Immediate neurological assessment revealed no detectable deficits. 20 h after the onset of hyponatremia, the patient’s sodium levels returned to within the normal range. Until then, the cumulative renal excretion was 8.5 L. 9 L of distension medium was used intraoperatively with a calculated uptake of 5 L. The patient was relocated to the gynaecologic ward the following day and was released from the hospital on the third postoperative day without any detectable sequelae.","What is the patient's Creatinine Clearance using the Cockroft-Gault Equation in terms of mL/min? You should use the patient's adjusted body weight in kg instead of the patient's actual body weight if the patient is overweight or obese based on their BMI. If the patient's BMI's normal, set their adjusted body weight to the minimum of the ideal body and actual weight. If the patient is underweight, please set their adjusted body weight to their actual body weight. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'age': [45, 'years'], 'weight': [58.0, 'kg'], 'height': [156.0, 'cm'], 'creatinine': [0.7, 'mg/dL']}",78.12231,74.21619,82.02843,"The formula for computing Cockcroft-Gault is given by CrCl = ((140 - age) * adjusted weight * (gender_coefficient)) / (serum creatinine * 72), where the gender_coefficient is 1 if male, and 0.85 if female. The serum creatinine concentration is in mg/dL.
The patient's gender is female, which means that the gender coefficient is 0.85.
The patient is 45 years old. 
The concentration of creatinine is 0.7 mg/dL. 
The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 156.0 cm, which is 156.0 cm * 1 m / 100 cm = 1.56 m. The patient's weight is 58.0 kg. The patient's bmi is therefore 58.0 kg / (1.56 m * 1.56 m) = 23.833 kg/m^2.The patient's BMI is 23.8, indicating they are normal weight.
Because the patient is normal, we take take minimum of the ideal body weight and the patient's body as the patient's adjusted weight for the Cockroft-Gault Equation. Hence, the adjusted body weight is the minimum of the two giving us an adjusted body weight of 48.75993 kg.

Using the Cockcroft-Gault equation:
CrCl = ((140 - age) * adjusted weight * gender_coefficient) / (serum creatinine * 72).
Plugging the patient's values gives us ((140 - 45) * 48.75993 * 0.85) / (0.7 * 72) = 78.12231 mL/min. Hence, the patient's creatinine clearance is 78.12231 mL/min."
6,2,Creatinine Clearance (Cockcroft-Gault Equation),lab test,decimal,pmc-5526772-1,Extracted,"A 41-year-old Japanese man was admitted to our hospital with liver damage, itchy skin, and pyrexia. His medical history was unremarkable, but one year previously his gamma-glutamyl transpeptidase levels had risen to 271 IU/L (normal: < 30 IU/L). Prior to this, the patient had consumed 540 mL of sake three times a week, and he had been reducing the amount of alcohol he consumed for about one year. He did not smoke or take any recreational drugs. He was single, was not homosexual, and he had not had sexual intercourse for over one year.
The patient had undergone treatment of his internal hemorrhoids as an outpatient at a nearby hospital that comprised an aluminum potassium sulfate and tannic acid (ALTA) injection. He developed a fever of 38 °C, dark colored urine, and itchy skin on postoperative day (POD) 1, and he took loxoprofen sodium, as required. He consulted another doctor on POD 7, because the symptoms had not improved, and his blood test results led to a diagnosis of liver dysfunction. His liver dysfunction had not improved by POD 14, and he was admitted to our hospital on POD 15.
The patient was 167 cm tall and weighed 52.5 kg. He presented with a blood pressure of 103/59 mmHg, a heart rate of 82 beats per minute, a temperature of 36.6 °C, and 99% oxygen saturation in room air. No specific physical findings were evident during the clinical examination on the day of hospitalization, but the patient had a rash, edema, hepatosplenomegaly, lymphadenopathy, and jaundice. The subjective symptoms, comprising the fever, dark colored urine, and itchy skin, had disappeared by POD 10.
The laboratory test results showed that the patient’s complete blood count was almost normal with a white blood cell count of 6900 cells/μL, a hemoglobin concentration of 14.7 g/dL, a hematocrit level of 43.1%, and a platelet count of 3.98 × 105 cells/μL, but a higher percentage of eosinophils was present (6.8%) (normal: 1.0%-5.0%), which peaked at 13.9% on POD 20. The patient’s serum liver enzyme and bilirubin levels were elevated at the time of admission. The aspartate aminotransferase (AST) level was 432 IU/L (normal: 10-40 IU/L), the alanine aminotransferase (ALT) level was 911 IU/L (normal: 10-40 IU/L), the alkaline phosphatase (ALP) level was 473 IU/L (normal: 115-359 IU/L), and the total bilirubin level was 1.3 mg/dL (normal: 0.2-1.2 mg/dL). Thus, compared with the ALP level, the AST and ALT levels showed greater magnitudes of elevation. The patient’s other blood test results were within the normal ranges, as follows: serum albumin: 4.0 g/dL (normal: 3.8-5.2 g/dL); serum creatinine: 0.86 mg/dL (normal: 0.65-1.09 mg/dL); C-reactive protein: 0.1 mg/dL (normal: 0-0.3 mg/dL); prothrombin time: 100% (normal: 80%-120 %); thyroid-stimulating hormone: 0.5 μIU/mL (normal: 0.34-4.04 μIU/mL); triiodothyronine: 2.98 pg/dL (normal: 2.36-5.00 pg/dL); and thyroxin: 1.18 ng/dL (normal: 0.88-1.67 ng/dL). The serological tests for autoantibodies generated weakly positive results (1:40) for anti-nuclear antibodies, and negative results for anti-smooth muscle and anti-mitochondrial antibodies. Negative results were obtained from the tests for the hepatitis B virus surface antigen, the hepatitis C virus antibody, rapid plasma reagin, the anti-Epstein-Barr virus immunoglobulin M (IgM) antibody, and the anti-cytomegalovirus IgM antibody, and from the Treponema pallidum hemagglutination test. The IgG level was within the normal range at 1415 mg/dL (normal: 800-1600 mg/dL) and the IgM level was within the normal range at 100 mg/dL (normal: 60-250 mg/dL). The IgE level was elevated at 1333 mg/dL (normal: < 250 mg/dL). Chest radiography did not reveal any abnormalities. No morphological changes were evident following abdominal ultrasonography, magnetic resonance cholangiopancreatography, and abdominal computed tomography (Figure ).
When the patient was hospitalized, we considered viral, alcohol-induced, autoimmune, drug-induced, biliary tract, and thyroid function-based diseases as frequent causes of acute liver dysfunction for the differential diagnosis, and, based on the patient’s medical history, and the serological and imaging results, we considered that alcohol and DILI were highly likely causes of the patient’s acute liver dysfunction. However, the patient had stopped drinking during the past year, so we thought that there was a high likelihood of DILI. Therefore, we began conservative treatment with a small amount of extracellular fluid replacement.
Figure presents the patient’s symptoms, laboratory test results, and treatment over the entire course. The liver transaminase and bilirubin levels decreased rapidly after admission, and the maximum levels were as follows: ALT: 950 IU/L on POD 15; AST: 470 IU/L on POD 17; and total bilirubin: 2.1 mg/dL on POD 17. The ALP and gamma-glutamyl transpeptidase levels showed consistent downward trends from POD 7. The patient's symptoms disappeared on POD 10, and no new symptoms appeared after hospitalization. We performed a liver biopsy on POD 25, and a drug-induced lymphocyte stimulation test (DLST) of the components of the ALTA injection and lidocaine on POD 28. The patient was discharged on POD 29, and he was managed as an outpatient without any prescriptions. At the time of the patient’s first outpatient appointment on POD 35, his liver transaminase and bilirubin levels had declined and were almost within the normal ranges.
Figure presents hematoxylin and eosin (H and E)-stained sections of the liver biopsy performed on POD 25. The H and E staining showed that the basic structure of the liver had been maintained without any hepatocyte dropout or disruption, and that the bile duct had not been disrupted. At a higher magnification, the H and E staining showed that the parenchymal cells were partially dilated and that a mild inflammatory cell infiltration was present in the area of the central vein. Neither eosinophil nor plasma cell infiltrations were detected within the liver tissue. Bile plugs were found at multiple sites within the parenchyma and sinusoids. Masson staining did not show the presence of liver tissue fibrosis.
The lymphocyte proliferation activity levels, which were determined from the DLST performed on POD 28, were 676 counts per minute (cpm) for the control and 871 cpm for the ALTA with lidocaine. The stimulation index, which was calculated as the ALTA with lidocaine cpm divided by the control cpm, was 1.29 (normal in Japanese people: < 1.8).","What is the patient's Creatinine Clearance using the Cockroft-Gault Equation in terms of mL/min? You should use the patient's adjusted body weight in kg instead of the patient's actual body weight if the patient is overweight or obese based on their BMI. If the patient's BMI's normal, set their adjusted body weight to the minimum of the ideal body and actual weight. If the patient is underweight, please set their adjusted body weight to their actual body weight. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'weight': [52.5, 'kg'], 'height': [167.0, 'cm'], 'creatinine': [0.86, 'mg/dL'], 'age': [41, 'years']}",83.93895,79.742,88.1359,"The formula for computing Cockcroft-Gault is given by CrCl = ((140 - age) * adjusted weight * (gender_coefficient)) / (serum creatinine * 72), where the gender_coefficient is 1 if male, and 0.85 if female. The serum creatinine concentration is in mg/dL.
The patient's gender is male, which means that the gender coefficient is 1.
The patient is 41 years old. 
The concentration of creatinine is 0.86 mg/dL. 
The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 167.0 cm, which is 167.0 cm * 1 m / 100 cm = 1.67 m. The patient's weight is 52.5 kg. The patient's bmi is therefore 52.5 kg / (1.67 m * 1.67 m) = 18.82463 kg/m^2.The patient's BMI is 18.8, indicating they are normal weight.
Because the patient is normal, we take take minimum of the ideal body weight and the patient's body as the patient's adjusted weight for the Cockroft-Gault Equation. Hence, the adjusted body weight is the minimum of the two giving us an adjusted body weight of 52.5 kg.

Using the Cockcroft-Gault equation:
CrCl = ((140 - age) * adjusted weight * gender_coefficient) / (serum creatinine * 72).
Plugging the patient's values gives us ((140 - 41) * 52.5 * 1) / (0.86 * 72) = 83.93895 mL/min. Hence, the patient's creatinine clearance is 83.93895 mL/min."
7,2,Creatinine Clearance (Cockcroft-Gault Equation),lab test,decimal,pmc-3830277-1,Extracted,"A 68-year-old Indian male patient presented with the complaints of generalized malaise, poor appetite, weight loss, headache and polyuria for last 2 months. He had a chronic ill-looking appearance, a dehydrated tongue and dry skin. Urine output was 5000-5500 mL/day with a history of nocturia and craving for cold fluids. No history of head injury, tubercular meningitis, central nervous system infections or chronic drug intake.
His physical findings on admission were height 156 cm; body weight, 44.5 kg and body mass index, 18.3. Blood pressure was 100/64 mmHg without postural change and pulse rate, 68/min with a regular rhythm. No edema was noted in his legs or feet. He had scant axillary and pubichair. Neurologic examination including visual field was found to be normal.
Laboratory findings were as follows: White blood cell count 6400/mm3 (neutrophils 51%, lymphocyte 42%, monocyte 5%, eosinophils 2%, basophils 0%); hemoglobin, 13.4 g/dL; hematocrit, 35.5%; red blood cell count, 3.4 × 106/mm3; and platelets, 3.3 × 105/mm3 Serum sodium was 137 mmol/L; potassium, 3.9 mmol/L; and chloride, 103 mmol/L. Blood urea nitrogen was 12 mg/dL; serum creatinine, 0.8 mg/dL; and uric acid, 6.1 mg/dL. Fasting plasma glucose was74 mg/dL; hemoglobin A1c, 4.9% and serum calcium of 9.4 mg/dL.
Anterior pituitary function tests revealed panhypopituitarism (serum cortisol 1.8 μg/dL, Adrenocorticotrophic hormone 15.6 pg/mL, total T3 56 ng/mL, total T4 4.2 μg/dL, thyroid stimulating hormone 1.86 mIU/mL, luteinizing hormone 0.8 mIU/mL, follicle stimulating hormone 1.67 mIU/mL, serum testosterone of 122 ng/dL and serum prolactin of 12 ng/mL. Water deprivation test revealed central diabetes insipidus [].
Magnetic resonance imaging (MRI) revealed [Figures and ] a well-defined sellar-suprasellar lesion, which was heterogenous and mildly hyperintense on T1-weighted images and brightly hyperintense on T2-weighted (T2W) images. Internal well-defined hypointense nodule was also seen on T2W images. No obvious post contrast enhancement was seen. Pituitary tissue was compressed and stalk was central. The mass was abutting chiasma, but no obvious mass effect/compression seen. Findings were highly suggestive of RCC.
Transsphenoidal surgery with complete excision of the mass was carried out and histopathological examination revealed cyst wall with columnar lining suggestive of RCC. Patient was started on replacement doses of levothyroxine, hydrocortisone tablets and testosterone injections. His symptoms improved and he was doing well in follow-up. Surprisingly his polyuria improved in postsurgical period without vasopressin replacement.","What is the patient's Creatinine Clearance using the Cockroft-Gault Equation in terms of mL/min? You should use the patient's adjusted body weight in kg instead of the patient's actual body weight if the patient is overweight or obese based on their BMI. If the patient's BMI's normal, set their adjusted body weight to the minimum of the ideal body and actual weight. If the patient is underweight, please set their adjusted body weight to their actual body weight. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'weight': [44.5, 'kg'], 'height': [156.0, 'cm'], 'creatinine': [0.8, 'mg/dL'], 'age': [68, 'years']}",55.625,52.84375,58.40625,"The formula for computing Cockcroft-Gault is given by CrCl = ((140 - age) * adjusted weight * (gender_coefficient)) / (serum creatinine * 72), where the gender_coefficient is 1 if male, and 0.85 if female. The serum creatinine concentration is in mg/dL.
The patient's gender is male, which means that the gender coefficient is 1.
The patient is 68 years old. 
The concentration of creatinine is 0.8 mg/dL. 
The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 156.0 cm, which is 156.0 cm * 1 m / 100 cm = 1.56 m. The patient's weight is 44.5 kg. The patient's bmi is therefore 44.5 kg / (1.56 m * 1.56 m) = 18.28567 kg/m^2.The patient's BMI is 18.3, indicating they are underweight.
Because the patient is underweight, we take the patient's weight, 44.5 kg as the patient's adjusted weight needed for the Cockroft-Gault Equation. 
Using the Cockcroft-Gault equation:
CrCl = ((140 - age) * adjusted weight * gender_coefficient) / (serum creatinine * 72).
Plugging the patient's values gives us ((140 - 68) * 44.5 * 1) / (0.8 * 72) = 55.625 mL/min. Hence, the patient's creatinine clearance is 55.625 mL/min."
8,2,Creatinine Clearance (Cockcroft-Gault Equation),lab test,decimal,pmc-7220329-1,Extracted,"A 71-year-old man, non-smoker (height: 155 cm; weight: 59 kg), was scheduled to receive video-assisted thoracoscopic extended thymectomy with the diagnosis of MG. Two months previously, he developed symptoms of right ptosis and progressive swallowing difficulty. Based on a positive response to edrophonium and increased titers of autoantibodies to acetylcholine receptor (19.3 nmol/L; normal < 0.2 nmol/L), he was diagnosed as having MG with severity belonging to Osserman's classification IIb (ie, generalized moderate weakness and/or bulbar dysfunction). Thoracic computed tomography demonstrated glandular hyperplasia of the thymus (Fig. A). The patient was started on prednisolone 20 mg daily and pyridostigmine 60 mg three times daily. His past history included hypertension without evidence of previous myasthenic crisis or thromboembolic events (eg, history of lower limb swelling). The results of electrocardiography, pulmonary function test [eg, vital capacity: 93%], echocardiography (eg, left ventricular ejection fraction: 85.1%), chest radiography (Fig. B), and laboratory studies (eg, coagulation test) were unremarkable. On the other hand, impaired renal function [i.e., serum creatinine: 1.42 mg/dL; eGFR: 49.1 mL/min/1.73 m2] was observed after admission.
Preoperative physical examination of the patient showed clear consciousness without respiratory distress. Vital signs included a blood pressure of 187/103 mm Hg, heart rate of 82 beats/min, and respiratory rate of 14 breaths/minute. Under real-time neuromuscular monitoring with a train-of-four (TOF) monitor (TOF-watch SX, N. V. Organon, Oss, Netherlands), anesthesia was induced with propofol (130 mg) and rocuronium (0.85 mg/kg). Following successful tracheal intubation with a double-lumen tracheal tube (Broncho-Cath; Mallinckrodt, Athlone, Ireland), general anesthesia was maintained with sevoflurane, rocuronium (total dosage: 40 mg), and a continuous infusion of remifentanil. An 18-gauge peripheral intravenous line and an arterial line were introduced. The surgical time was 4 hours 15 minutes with an estimated blood loss of 100 mL. Upon completion of surgery, sugammadex 4 mg/kg was administered to reverse neuromuscular blockade, with a maximum TOF ratio of 0.93 following reversal. Additionally, intravenous morphine 8 mg was given for postoperative analgesia. After successful extubation in the operating room and resumption of spontaneous breathing, he was transferred to the post-anesthesia care unit (PACU) for further care.
During the immediate postoperative period, the patient was hemodynamically stable without respiratory distress. Because of surgical pain with a numeric rating scale of 5 (scale of 0–10), intravenous morphine was titrated to a total dosage of 7 mg. Forty-five minutes later, respiratory distress with drowsiness was noted. Physical examination found pinpoint pupils with a TOF ratio of 0.9. Blood gas analysis demonstrated severe hypercapnia (arterial carbon dioxide pressure: 117.7 mm Hg) and acidosis (pH: 6.996, lactate levels: 3.3 mmol/L). On suspicion of morphine overdose, intravenous naloxone was administered twice (0.08 mg each time). After 20 minutes, the patient regained consciousness and normal respiratory pattern. Subsequent blood gas analysis demonstrated hyperlactatemia (lactate levels: 6.0 mmol/L) (Fig. ) despite improvement in arterial carbon dioxide pressure and arterial oxygen pressure after naloxone administration. Taking into account the overall clinical improvement, he was transferred to ward with spontaneous breathing and stable hemodynamics after observation for 100 minutes following initial reversal of opioid overdose.
However, one hour after being transferred to ward (ie, three hours after naloxone administration), he was found to exhibit consciousness loss, respiratory distress, and pinpoint pupils. Intravenous naloxone 0.4 mg was given, followed by endotracheal intubation and transfer to the intensive care unit for mechanical ventilatory support. Brain computed tomography showed no intracranial lesion. He regained consciousness two hours after naloxone administration in the intensive care unit without symptoms of opioid withdrawal (eg, pulmonary edema). As weaning from mechanical ventilation was difficult on POD 3, a diagnosis of POMC was made. Steroid therapy (prednisolone 40 mg twice daily) and pyridostigmine (60 mg 3 times a day) was initiated. The patient was extubated smoothly on POD 6 and was discharged from hospital on POD 12. The course of hyperlactatemia was shown in Figure . In addition, his eGFR increased from 49.1 mL/min/1.73 m2 at baseline to 88.9 ml/min/1.73m2 on POD 5. Pathological analysis of the specimen from thymectomy confirmed the diagnosis of type B2 thymoma according to the World Health Organization (WHO) classification.
The patient was readmitted on POD 24 because of left thigh swelling. Ultrasonographic examination showed evidence of DVT involving the left femoral and popliteal veins. Anticoagulant therapy with low-molecular-weight heparin (ie, subcutaneous Clexane 60 mg every 12 hours) was implemented immediately after hospitalization, and he was discharged without sequelae on POD 31. During hospitalization, his eGFR was 86.5 mL/min/1.73m2. There was no recurrence of myasthenic crisis or DVT up to 3 months of follow-ups.","What is the patient's Creatinine Clearance using the Cockroft-Gault Equation in terms of mL/min? You should use the patient's adjusted body weight in kg instead of the patient's actual body weight if the patient is overweight or obese based on their BMI. If the patient's BMI's normal, set their adjusted body weight to the minimum of the ideal body and actual weight. If the patient is underweight, please set their adjusted body weight to their actual body weight. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'age': [71, 'years'], 'weight': [59.0, 'kg'], 'height': [155.0, 'cm'], 'creatinine': [1.42, 'mg/dL']}",35.33309,33.56644,37.09974,"The formula for computing Cockcroft-Gault is given by CrCl = ((140 - age) * adjusted weight * (gender_coefficient)) / (serum creatinine * 72), where the gender_coefficient is 1 if male, and 0.85 if female. The serum creatinine concentration is in mg/dL.
The patient's gender is male, which means that the gender coefficient is 1.
The patient is 71 years old. 
The concentration of creatinine is 1.42 mg/dL. 
The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 155.0 cm, which is 155.0 cm * 1 m / 100 cm = 1.55 m. The patient's weight is 59.0 kg. The patient's bmi is therefore 59.0 kg / (1.55 m * 1.55 m) = 24.55775 kg/m^2.The patient's BMI is 24.6, indicating they are normal weight.
Because the patient is normal, we take take minimum of the ideal body weight and the patient's body as the patient's adjusted weight for the Cockroft-Gault Equation. Hence, the adjusted body weight is the minimum of the two giving us an adjusted body weight of 52.35442 kg.

Using the Cockcroft-Gault equation:
CrCl = ((140 - age) * adjusted weight * gender_coefficient) / (serum creatinine * 72).
Plugging the patient's values gives us ((140 - 71) * 52.35442 * 1) / (1.42 * 72) = 35.33309 mL/min. Hence, the patient's creatinine clearance is 35.33309 mL/min."
9,2,Creatinine Clearance (Cockcroft-Gault Equation),lab test,decimal,pmc-7785505-1,Extracted,"The patient was an 82-year-old woman who had a 3-year history of leg cramps and first had chest tightness for two years. She had been treated for ischemic cardiomyopathy with triple vessel disease at another hospital, but had been hospitalized for heart failure 12 times in the last two years. Echocardiography that was performed in the hospital reportedly revealed a left ventricular ejection fraction (LVEF) of 30%. The patient had a history of left thyroidectomy for thyroid cancer at the age of 67 years with no subsequent recurrence. Comorbidities included angina pectoris, chronic heart failure, hypertension, type 2 diabetes mellitus, chronic renal failure, and gastric ulcer (gastrointestinal bleeding with antithrombotic drugs). Her usual medications were tolvaptan 7.5 mg, azosemide 60 mg, furosemide 60 mg, rabeprazole 10 mg, amlodipine 5 mg, bisoprolol 0.625 mg, amiodarone 50 mg, levothyroxine sodium 50 μg, cremedin 6 g, and sodium ferrous citrate 100 mg. Her ability to perform activities of daily living was good, and there was no history of alcohol drinking, smoking, or allergy. She noticed shortness of breath and chest discomfort when she was about to go to the restroom in the morning, and was transported by ambulance to the emergency department of our hospital.
Physical findings on admission were: height, 153 cm; weight, 53 kg; body mass index, 22.6 kg/m2; body temperature, 36.9℃; blood pressure, 155/94 mmHg; heart rate, 83/min and regular; respiratory rate, 22/min; and SpO2, 98% (O2, 6 L). The palpebral conjunctiva was not pale, and jugular venous distention was observed. There were coarse crackles in both lung fields and no murmurs. There was no peripheral coldness in the limbs and lower leg edema was observed. A 12-lead electrocardiography (ECG) showed sinus rhythm at 71 beats/min, no ST elevation, and a negative T wave in leads V3-6 (Figure ). The corrected QT interval (QTc) was prolonged by 556 ms.
Chest radiography showed a cardiothoracic ratio of 70%, indicating cardiomegaly, pulmonary congestion, and bilateral pleural effusion (Figure ).
Echocardiography showed akinesis mainly at the apex and diffuse hypokinesis at the base, showing systolic dysfunction with LVEF of 15%. The blood tests revealed decreased renal function with a blood urea nitrogen (BUN) level of 88 mg/dL, creatinine level of 3.26 mg/dL, and estimated glomerular filtration rate (eGFR) of 11.1 mL/min/BSA. The serum albumin level was 3.3 g/dL and serum potassium level was 4.5 mmol/L. Creatine kinase (CK) was slightly elevated at 191 U/L, but the creatine kinase-myocardial band (2.8 ng/mL) and troponin I (0.02 ng/mL) levels were not elevated. The level of brain natriuretic peptide (BNP) was 802.7 pg/mL. A diagnosis of acute exacerbation of chronic heart failure was made, and treatment with oxygen and diuretics (furosemide 20mg) was started. The patient responded well and urine volumes in the initial three hours were 400 mL; however, 12 hours after admission, she experienced sudden onset chest pain and pain radiating to the neck. Consciousness at the time of the attack was clear, systolic blood pressure was 120 mmHg, heart rate was 80/min with sinus rhythm, and SpO2 was 89% (O2 10 L). The pain extended to the extremities. The 12-lead ECG at the time of the attack was not significantly different from that at the time of admission (Figure ). Chest radiography showed worsening pulmonary congestion (Figure ). Echocardiography and blood sampling showed no marked change from that on admission, no increase in cardiac enzymes, and no findings strongly suggestive of acute coronary syndrome. When respiratory management by noninvasive positive pressure ventilation was continued, symptoms improved after approximately one hour. Although serum calcium and magnesium levels were not measured at the time of admission, additional examinations revealed hypocalcemia with a calcium level of 4.9 mg/dL and hypomagnesemia with a magnesium level of 1.7 mg/dL. The phosphorus level was 6.3 mg/dL. It was considered that the symptoms were due to a tetanic seizure. The cause of hypocalcemia was thought to be chronic kidney disease (CKD) because parathyroid function, as reflected by intact parathyroid hormone (PTH), was preserved (122.7 pg/mL) despite prior operation on the thyroid gland. Since the level of consciousness and symptoms did not deteriorate, calcium correction was started by oral administration while magnesium was corrected by drip infusion. The patient rapidly responded to intravenous infusion of magnesium and oral administration of calcium and vitamin D preparations. Serum calcium normalized on day 6 of hospitalization and the corrected calcium level was 9.1 mg/dL at the time of discharge. The QTc on ECG decreased from 556 to 491 ms (Figure ). The electrolyte abnormality improved without subsequent recurrence of tetany. The LVEF by echocardiography improved from 15% to 27% at the time of discharge. Although coronary angiography was not performed because of renal dysfunction, the LV contraction failure may have been affected by hypocalcemia. Her heart failure was well controlled with tolvaptan 15 mg, azosemide 90 mg, furosemide 20 mg and and bisoprolol 0.625 mg (Figure ), and she left hospital on the 13th day of hospitalization.","What is the patient's Creatinine Clearance using the Cockroft-Gault Equation in terms of mL/min? You should use the patient's adjusted body weight in kg instead of the patient's actual body weight if the patient is overweight or obese based on their BMI. If the patient's BMI's normal, set their adjusted body weight to the minimum of the ideal body and actual weight. If the patient is underweight, please set their adjusted body weight to their actual body weight. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'age': [82, 'years'], 'weight': [53.0, 'kg'], 'height': [153.0, 'cm'], 'creatinine': [3.26, 'mg/dL']}",9.67083,9.18729,10.15437,"The formula for computing Cockcroft-Gault is given by CrCl = ((140 - age) * adjusted weight * (gender_coefficient)) / (serum creatinine * 72), where the gender_coefficient is 1 if male, and 0.85 if female. The serum creatinine concentration is in mg/dL.
The patient's gender is female, which means that the gender coefficient is 0.85.
The patient is 82 years old. 
The concentration of creatinine is 3.26 mg/dL. 
The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 153.0 cm, which is 153.0 cm * 1 m / 100 cm = 1.53 m. The patient's weight is 53.0 kg. The patient's bmi is therefore 53.0 kg / (1.53 m * 1.53 m) = 22.64086 kg/m^2.The patient's BMI is 22.6, indicating they are normal weight.
Because the patient is normal, we take take minimum of the ideal body weight and the patient's body as the patient's adjusted weight for the Cockroft-Gault Equation. Hence, the adjusted body weight is the minimum of the two giving us an adjusted body weight of 46.04337 kg.

Using the Cockcroft-Gault equation:
CrCl = ((140 - age) * adjusted weight * gender_coefficient) / (serum creatinine * 72).
Plugging the patient's values gives us ((140 - 82) * 46.04337 * 0.85) / (3.26 * 72) = 9.67083 mL/min. Hence, the patient's creatinine clearance is 9.67083 mL/min."
10,2,Creatinine Clearance (Cockcroft-Gault Equation),lab test,decimal,pmc-8062170-1,Extracted,"A 47-year-old female (height, 160 cm; weight, 60 kg) with a giant liver due to polycystic liver disease (PLD) was scheduled to undergo ABO-incompatible living donor liver transplantation because of worsening malnutrition, disability in activities of daily living, and abdominal distention, which were converted to 16 points by the model for end-stage liver disease score. In the past 3 years, coil embolization of the hepatic artery and percutaneous drainage of liver cysts had been performed. After the liver cyst drainage, biliary peritonitis occurred and she was treated with antibiotics.
Preoperative computed tomography revealed remarkable abdominal distension caused by an enlarged polycystic liver (). Results of laboratory tests were as follows: hemoglobin (Hb), 10.1 g/dL; platelet (Plt) count, 27.4 × 104/μL; albumin, 2.2 g/dL; blood urea nitrogen, 31.3 mg/dL; creatinine, 0.90 mg/dL; total bilirubin, 0.31 mg/dL; alanine transaminase, 13 U/L; aspartate transaminase, 15 U/L; prothrombin time-international normalized ratio (PT-INR), 1.18; activated partial thromboplastin time (APTT), 30.0 sec; fibrinogen, 573 mg/dL. An electrocardiogram (ECG) showed normal sinus rhythm, and transthoracic echocardiography showed normal cardiac function. Portal hypertension was not predicted. The surgeons pointed out a risk of bleeding because of surgical difficulties due to PLD and strong adhesion induced by peritonitis. Blood loss anticipated by the surgeon was 15000 ml. The transfusion unit was preoperatively informed about the possibility of massive transfusion. We ordered 5,600 mL of O type red blood cells (RBC), 4,800 mL of AB type fresh frozen plasma (FFP), and 800 mL of AB type platelet concentrate (PC).
After induction of general anesthesia, three 18-gauge peripheral catheters, a 12-gauge triple-lumen central venous catheter, and a pulmonary arterial catheter were placed. Since total clamping of the inferior vena cava requiring veno-veno bypass might be necessary, two 4-Fr introducer sheaths were placed at the femoral vein and the intrajugular vein. Soon after the start of surgery, massive bleeding of more than 4,000 mL/hr occurred (). We started massive transfusion of FFP at a ratio of about 1 : 1 with RBC. We also transfused 5% albumin and restricted the crystalloid solution. Reinfusion of salvaged blood and use of veno-veno bypass with retrieved blood from the operative field were avoided because many cysts of the PLD ruptured during surgery and the blood in the operative field was contaminated by the cystic content. We constantly ordered blood products and communicated with the transfusion unit.
The bleeding rate increased as the surgery progressed because bleeding occurred from the area where the tissue was detached from adhesion. Body temperature rapidly decreased despite the use of a rapid infusion and fluid warming system (Level 1 Fast Flow Fluid Warmer, Smiths Medical ASD Inc., Rockland, MA, USA) through 4-Fr introducer sheaths. Although catecholamine administration and massive transfusion from 5 venous lines including the introducer sheath were performed by many anesthesiologists, it was extremely difficult to maintain blood pressure and a critical situation with a risk of cardiac arrest continued due to hypotension. In addition, even though administration of insulin and calcium was performed, electrolyte disturbances of K+ of 6.3 mEq/L and Ca2+ of 2.1 mg/dL (normal range: 4.6–5.3 mg/dL) with peaked T wave and prolongation of QTc interval (557 msec) occurred (Figures and ). At that time, we visually noticed that the QT interval was shortened in response to bolus calcium administration, and we therefore displayed the QTc interval on a bedside monitor (CSM-1000 series Life Scope G, Nihon Kohden, Tokyo, Japan) and used the change of real-time QTc interval as a supportive indicator for calcium correction (maximum rate: 120 mEq/hr) combined with blood gas analysis. The hepatectomy was performed without veno-veno bypass 4.5 hours after the start of surgery and the bleeding rate at that time was 15,000 mL/hr (). The excised polycystic liver weighed 10.0 kg.
Until portal reperfusion, we continued massive transfusion (approximately 12,000 mL/hr) including 300 mL of PC and sodium bicarbonate with additional fluid warming systems. After portal reperfusion, the bleeding rate gradually decreased and the hemodynamic variables and electrolyte disturbance improved (Figures and ; ). After anastomosis of the hepatic artery, 1 g of tranexamic acid was administered. Except for PC, which was transported from transfusion centers in our region and/or neighboring regions, the supply of blood products was not interrupted and coagulation factors were maintained throughout the surgery by administration of FFP and 3 g of fibrinogen with at least 1.26 of PT-INR, 43.6 sec of APTT, and 116 mg/dL of fibrinogen (). The abdomen was packed with gauzes and closed because complete hemostasis was difficult. The patient was transferred to the intensive care unit (ICU). Soon after arrival at the ICU, she responded to command. On postoperative day (POD) 2, second-look surgery was performed for removal of packed gauzes. She was extubated on POD 3 without pulmonary edema or cardiac overload.
The duration of surgery was 16 hours and 53 minutes and the duration of general anesthesia was 22 hours and 27 minutes. Throughout the surgery, anesthesia was maintained with 1.5% sevoflurane, 0.16–0.33 μg−1 ・kg−1 ・min−1 of remifentanil, and intermittent fentanyl administration (total of 1.5 mg). Bispectral IndexTM (Aspect Medical Systems, Norwood, MA, USA) values were between 30 and 60. Cardiac index was between 1.2 and 2.8 L−1 ・min−1 ・m−2. A total of 742 mEq of calcium ion, 750 mL of 7% sodium bicarbonate, and 18 units of insulin were administered. Postoperative analysis of the relationship between QTc interval and Ca2+ during surgery showed a strong negative correlation (). Representative laboratory data are shown in . Total infusion volume was 88,560 mL (crystalloid solution: 3,450 mL; 6% hydroxyethyl starch: 3,500 mL; 5% albumin: 10,490 mL; RBC: 34,160 mL; FFP: 34,600 mL; PC: 2,400 mL), and total output volume was 86,350 mL (estimated volume of blood loss including ascites and cystic fluid: 81,600 mL; urine output: 4,750 mL); therefore, intraoperative fluid balance was +2,210 mL. Although she suffered from acute rejection and sepsis, she finally regained independent living by rehabilitation and was discharged on POD 156.","What is the patient's Creatinine Clearance using the Cockroft-Gault Equation in terms of mL/min? You should use the patient's adjusted body weight in kg instead of the patient's actual body weight if the patient is overweight or obese based on their BMI. If the patient's BMI's normal, set their adjusted body weight to the minimum of the ideal body and actual weight. If the patient is underweight, please set their adjusted body weight to their actual body weight. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'age': [47, 'years'], 'weight': [60.0, 'kg'], 'height': [160.0, 'cm'], 'creatinine': [0.9, 'mg/dL']}",63.90115,60.70609,67.09621,"The formula for computing Cockcroft-Gault is given by CrCl = ((140 - age) * adjusted weight * (gender_coefficient)) / (serum creatinine * 72), where the gender_coefficient is 1 if male, and 0.85 if female. The serum creatinine concentration is in mg/dL.
The patient's gender is female, which means that the gender coefficient is 0.85.
The patient is 47 years old. 
The concentration of creatinine is 0.9 mg/dL. 
The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 160.0 cm, which is 160.0 cm * 1 m / 100 cm = 1.6 m. The patient's weight is 60.0 kg. The patient's bmi is therefore 60.0 kg / (1.6 m * 1.6 m) = 23.4375 kg/m^2.The patient's BMI is 23.4, indicating they are normal weight.
Because the patient is normal, we take take minimum of the ideal body weight and the patient's body as the patient's adjusted weight for the Cockroft-Gault Equation. Hence, the adjusted body weight is the minimum of the two giving us an adjusted body weight of 52.38197 kg.

Using the Cockcroft-Gault equation:
CrCl = ((140 - age) * adjusted weight * gender_coefficient) / (serum creatinine * 72).
Plugging the patient's values gives us ((140 - 47) * 52.38197 * 0.85) / (0.9 * 72) = 63.90115 mL/min. Hence, the patient's creatinine clearance is 63.90115 mL/min."
11,2,Creatinine Clearance (Cockcroft-Gault Equation),lab test,decimal,pmc-7737526-1,Extracted,"In 2008, a 59-year-old Japanese woman was admitted for evaluation of renal disease. RA had been diagnosed at another hospital in 1972 when she presented with bilateral arthropathy of the hands, knees, ankles, and feet. Treatment was started with a combination of a gold preparation and nonsteroidal anti-inflammatory drugs (NSAIDs), but was not been effective. Prednisolone (PSL; 15 mg daily) and bucillamine (BUC; 200 mg daily) were started in 1987, but her disease remained active. Methotrexate (MTX; 5 mg daily) was started in 1995 but was discontinued because of nausea. In 2002, urinary protein was found to be positive by a dipstick urine test, and BUC was stopped. Then treatment was continued with PSL (5 mg/day) and loxoprofen (50 mg/day). However, urinary protein excretion increased in 2007, and serum creatinine (Cre) was elevated to 1.96 mg/dL.
On admission, the patient was 154.2 cm tall and weighed 44.0 kg, with a blood pressure of 128/60 mmHg and temperature of 36.4 °C. Physical examination did not reveal any abnormalities of the heart and lungs. The joints of her hands, knees, ankles, and feet showed bilateral swelling and deformity. In addition, the lower extremities were edematous. Her cervical spine was unstable, with flexion causing numbness in the upper limbs.
Laboratory findings were as follows: serum Cre was 4.2 mg/dL, the estimated glomerular filtration rate (eGFR) was 9.3 mL/min/1.73m3, C-reactive protein (CRP) was 0.9 mg/dL, and SAA was 43.2. In addition, rheumatoid factor (RF) was positive at 59 U/mL (normal: < 10), and cyclic citrullinated peptide (CCP) antibodies were positive at 218.5 (normal < 4.5). 24-hour urinary protein excretion was 6.5 g, and the urine sediment contained 1 – 5 red cells per high-power field (HPF). The disease activity score (DAS)-CRP was 7.1. Radiographs showed deformation of the finger and foot joints as well as atlantoaxial joint subluxation. Renal biopsy was performed for evaluation of her kidney disease.
Renal biopsy
Light microscopic examination of a biopsy specimen containing 4 glomeruli revealed global sclerosis in all 4. There was severe tubular atrophy, and tubulointerstitial fibrosis occupied ~ 95% of the entire renal cortex. All 4 glomeruli contained multinodular structures of amorphous material with a PAM-positive border. This material was positive for Congo-red and amyloid A, but was negative for κ and λ chains, β-2 microglobulin, and transthyretin (). Electron microscopy showed randomly arranged fibrils measuring 8 – 12 nm in diameter corresponding to the amyloid deposits (f). AA amyloidosis was diagnosed from these findings. In addition to the glomeruli, amyloid deposits were mainly observed in the interlobular artery walls and tubulointerstitium (e). Endoscopic biopsy of the stomach, duodenum, and colon revealed AA-positive deposits in the small arteries and tissues of the submucosal layer (a).
Clinical course
PSL was discontinued, and administration of a soluble tumor necrosis factor (TNF) receptor inhibitor (etanercept; 25 mg every 2 weeks) was started in May 2008, but it was not effective. By September 2008, Cre was increased to 6.0 mg/dL. She underwent surgery to prepare an arteriovenous fistula for hemodialysis. Etanercept was discontinued, and a humanized anti-interleukin-6 receptor antibody (tocilizumab; 8 mg/kg = 360 mg/month) was started in February 2009. After 3 months, her CRP decreased to 0.0 mg/dL, and the DAS28-CRP sore was 2.12. After 2 years of tocilizumab therapy, urinary protein excretion was decreased to 1.1 g/day, and Cre was 4.0 mg/dL. Subsequently, Cre remained in the range of 4.5 – 5.0 mg/dL until December 2017. While Cre increased to 7.1 mg/dL after initiation of treatment with denosumab (a human monoclonal antibody that binds to receptor activator of NFκB ligand) for osteoporosis in October 2018, it remained at 7.0 mg/dL in June 2019 ().
Gastroduodenal biopsy was performed in May 2013 and May 2017. On both occasions, no amyloid deposits were detected in the submucosal blood vessels (b).","What is the patient's Creatinine Clearance using the Cockroft-Gault Equation in terms of mL/min? You should use the patient's adjusted body weight in kg instead of the patient's actual body weight if the patient is overweight or obese based on their BMI. If the patient's BMI's normal, set their adjusted body weight to the minimum of the ideal body and actual weight. If the patient is underweight, please set their adjusted body weight to their actual body weight. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'age': [59, 'years'], 'weight': [44.0, 'kg'], 'height': [154.2, 'cm'], 'creatinine': [4.2, 'mg/dL']}",10.01786,9.51697,10.51875,"The formula for computing Cockcroft-Gault is given by CrCl = ((140 - age) * adjusted weight * (gender_coefficient)) / (serum creatinine * 72), where the gender_coefficient is 1 if male, and 0.85 if female. The serum creatinine concentration is in mg/dL.
The patient's gender is female, which means that the gender coefficient is 0.85.
The patient is 59 years old. 
The concentration of creatinine is 4.2 mg/dL. 
The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 154.2 cm, which is 154.2 cm * 1 m / 100 cm = 1.542 m. The patient's weight is 44.0 kg. The patient's bmi is therefore 44.0 kg / (1.542 m * 1.542 m) = 18.50478 kg/m^2.The patient's BMI is 18.5, indicating they are normal weight.
Because the patient is normal, we take take minimum of the ideal body weight and the patient's body as the patient's adjusted weight for the Cockroft-Gault Equation. Hence, the adjusted body weight is the minimum of the two giving us an adjusted body weight of 44.0 kg.

Using the Cockcroft-Gault equation:
CrCl = ((140 - age) * adjusted weight * gender_coefficient) / (serum creatinine * 72).
Plugging the patient's values gives us ((140 - 59) * 44.0 * 0.85) / (4.2 * 72) = 10.01786 mL/min. Hence, the patient's creatinine clearance is 10.01786 mL/min."
12,2,Creatinine Clearance (Cockcroft-Gault Equation),lab test,decimal,pmc-6787834-1,Extracted,"A 53-year-old man was referred to our hospital for evaluation and management of hypertension and hypokalemia. He was diagnosed with hypertension at the age of 40 years, and his blood pressure was poorly controlled with a calcium channel blocker (nifedipine at 40 mg/d). He also had a past medical history of vasospastic angina and was a nonsmoker and social drinker. In addition, he had no family history of cardiovascular diseases. On admission, the patient was 168 cm tall and weighed 59 kg. He was afebrile, with a blood pressure of 161/96 mm Hg and a regular pulse of 61 beats per minute. There was no evidence of lung rales, cardiac murmurs, or an abdominal bruit. His neurological examination was unremarkable. Laboratory tests revealed that his serum creatinine level was 1.1 mg/dL, urea nitrogen level was 19 mg/dL, and serum sodium level was 140 mEq/L. He also exhibited hypokalemia with a serum potassium concentration of 2.9 mEq/L; however, he had no subjective symptoms, including muscle weakness. Plasma renin activity (PRA), plasma aldosterone concentration (PAC), and aldosterone-to-renin ratio (ARR) were <0.1 ng/mL/h, 292 pg/mL, and >2920, respectively. Other adrenal hormone levels were within normal limits. A chest radiograph and transthoracic echocardiogram showed no significant findings. An electrocardiogram suggested nonspecific ST-T wave changes with premature atrial contractions.
Primary hyperaldosteronism was suspected, and therefore, a captopril challenge test and a saline infusion test were performed. All these investigations revealed positive test results (Table ), which confirmed a diagnosis of PA. A low-dose dexamethasone suppression test to exclude the diagnosis of subclinical Cushing's syndrome was negative. An abdominal computed tomography (CT) scan was performed, which showed a left adrenal mass (13 mm) (Figure ). In adrenocorticotropic hormone (ACTH)-stimulated AVS, although aldosterone hypersecretion was observed in the left adrenal gland, the lateralization of the disease was not determined due to incomplete cannulation of the right adrenal vein (Table ). The criteria of successful cannulation were based on the current Expert Consensus Statement.
131I-adosterol scintigraphy under dexamethasone suppression showed an equivalently increased uptake in both adrenal glands (Figure ). Because we could not exclude the bilateral PA, including aldosterone-producing adenoma (APA) with microadenoma in the right adrenal gland, we performed the medical therapy with mineralocorticoid receptor antagonists (MRA). Although we administrated multiple antihypertensive agents including an MRA (eplerenone at 100 mg/d), an angiotensin II receptor blocker (azilsartan at 40 mg/d), a dual action beta blocker/alpha-1 blocker (carvedilol at 20 mg/d), a calcium channel blocker with an increased dose (nifedipine at 80 mg/d), an alpha-1 blocker (doxazosin at 2 mg/d), and an alpha-2 agonist (guanabenz at 4 mg/d), a home reading of the patient's blood pressure was above 140/90 mm Hg. Moreover, he needed a large quantity of potassium chloride to compensate for his hypokalemia.
Despite intensive medical therapy, he underwent percutaneous coronary intervention due to stable angina. Following this, we performed AVS again, but the right adrenal vein was not successfully cannulated (Table ). We discussed further the indication for surgery and decided to remove the left adrenal gland. After laparoscopic left adrenalectomy, his blood pressure and serum potassium remained normal after the withdrawal of eplerenone, doxazosin, guanabenz, and potassium chloride and a dose reduction of azilsartan (at 20 mg/d), carvedilol (at 10 mg/d), and nifedipine (at 10 mg/d). The PRA and PAC were 0.8 ng/mL/h and 57.1 pg/mL, 3 months after the adrenalectomy, respectively. Macroscopic findings of the resected specimen showed a yellowish colored nodule (13 mm in diameter) in the adrenal gland. We confirmed a diagnosis of an adrenocortical adenoma based on a histopathologic examination (Figure ); we also confirmed that the tumor cells were rich in the cytoplasm and were eosinophilic without malignant cells.","What is the patient's Creatinine Clearance using the Cockroft-Gault Equation in terms of mL/min? You should use the patient's adjusted body weight in kg instead of the patient's actual body weight if the patient is overweight or obese based on their BMI. If the patient's BMI's normal, set their adjusted body weight to the minimum of the ideal body and actual weight. If the patient is underweight, please set their adjusted body weight to their actual body weight. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'weight': [59.0, 'kg'], 'height': [168.0, 'cm'], 'creatinine': [1.1, 'mg/dL'], 'age': [53, 'years']}",64.81061,61.57008,68.05114,"The formula for computing Cockcroft-Gault is given by CrCl = ((140 - age) * adjusted weight * (gender_coefficient)) / (serum creatinine * 72), where the gender_coefficient is 1 if male, and 0.85 if female. The serum creatinine concentration is in mg/dL.
The patient's gender is male, which means that the gender coefficient is 1.
The patient is 53 years old. 
The concentration of creatinine is 1.1 mg/dL. 
The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 168.0 cm, which is 168.0 cm * 1 m / 100 cm = 1.68 m. The patient's weight is 59.0 kg. The patient's bmi is therefore 59.0 kg / (1.68 m * 1.68 m) = 20.9042 kg/m^2.The patient's BMI is 20.9, indicating they are normal weight.
Because the patient is normal, we take take minimum of the ideal body weight and the patient's body as the patient's adjusted weight for the Cockroft-Gault Equation. Hence, the adjusted body weight is the minimum of the two giving us an adjusted body weight of 59.0 kg.

Using the Cockcroft-Gault equation:
CrCl = ((140 - age) * adjusted weight * gender_coefficient) / (serum creatinine * 72).
Plugging the patient's values gives us ((140 - 53) * 59.0 * 1) / (1.1 * 72) = 64.81061 mL/min. Hence, the patient's creatinine clearance is 64.81061 mL/min."
13,2,Creatinine Clearance (Cockcroft-Gault Equation),lab test,decimal,usmle-3434,Extracted,"A 48-year-old woman comes to the physician for the evaluation of 24-hour blood pressure monitoring results. Over the last 3 months, she has had intermittent nausea, decreased appetite, and increasing weakness and fatigue during the day. She has been treated twice for kidney stones within the past year. Her current medications include lisinopril, amlodipine, and furosemide. She is 178 cm (5 ft 10 in) tall and weighs 97 kg (214 lb); BMI is 31 kg/m2. Her blood pressure is 152/98 mm Hg. Physical examination shows no abnormalities. Serum studies show:
Na+ 141 mEq/L
Cl− 101 mEq/L
K+ 4.5 mEq/L
HCO3− 24 mEq/L
Calcium 12.9 mg/dL
Creatinine 1.0 mg/dL
Twenty-four-hour blood pressure monitoring indicates elevated nocturnal blood pressure.","What is the patient's Creatinine Clearance using the Cockroft-Gault Equation in terms of mL/min? You should use the patient's adjusted body weight in kg instead of the patient's actual body weight if the patient is overweight or obese based on their BMI. If the patient's BMI's normal, set their adjusted body weight to the minimum of the ideal body and actual weight. If the patient is underweight, please set their adjusted body weight to their actual body weight. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'age': [48, 'years'], 'weight': [97.0, 'kg'], 'height': [178.0, 'cm'], 'creatinine': [1.0, 'mg/dL']}",86.89835,82.55343,91.24327,"The formula for computing Cockcroft-Gault is given by CrCl = ((140 - age) * adjusted weight * (gender_coefficient)) / (serum creatinine * 72), where the gender_coefficient is 1 if male, and 0.85 if female. The serum creatinine concentration is in mg/dL.
The patient's gender is female, which means that the gender coefficient is 0.85.
The patient is 48 years old. 
The concentration of creatinine is 1.0 mg/dL. 
The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 178.0 cm, which is 178.0 cm * 1 m / 100 cm = 1.78 m. The patient's weight is 97.0 kg. The patient's bmi is therefore 97.0 kg / (1.78 m * 1.78 m) = 30.61482 kg/m^2.The patient's BMI is 30.6, indicating they are overweight/obese.
Because the patient is overweight/obese, we use the adjusted body weight formula to get the adjusted weight used for Cockroft-Gault Equation. Shown below is the computation for IBW (ideal body weight).
For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Female.
The patient's height is 178.0 cm, which is 178.0 cm * 0.393701 in/cm = 70.07878 in. 
Plugging in the values for the IBW formula for females gives us 45.5 kg + 2.3 kg * (70.07878 (in inches) - 60) = 68.68119 kg.
Hence, the patient's IBW is 68.68119 kg.Shown below is the computation for ABW (adjusted body weight).
To compute the ABW value, apply the following formula: ABW = IBW + 0.4 * (weight (in kg) - IBW (in kg)). ABW = 68.68119 kg + 0.4 * (97.0 kg  - 68.68119 kg) = 80.00871 kg. The patient's adjusted body weight is 80.00871 kg.
Using the Cockcroft-Gault equation:
CrCl = ((140 - age) * adjusted weight * gender_coefficient) / (serum creatinine * 72).
Plugging the patient's values gives us ((140 - 48) * 80.00871 * 0.85) / (1.0 * 72) = 86.89835 mL/min. Hence, the patient's creatinine clearance is 86.89835 mL/min."
14,2,Creatinine Clearance (Cockcroft-Gault Equation),lab test,decimal,pmc-5411626-1,Extracted,"In April 2011, an 81-year-old woman with a history of photosensitivity and hypertension was admitted to our hospital due to bilateral edema of the legs and nephrotic proteinuria (7.0 g/day). Her proteinuria was not detected before March 2011 by screening test by the family doctor. At admission, her height was 153 cm, weight was 40 kg, and blood pressure was 138/70 mmHg with treatment of candesartan 8 mg/day. Physical examination showed bilateral pitting edema of her legs and palpable superficial inguinal lymphadenopathies.
Laboratory results were as follows: serum creatinine 1.27 mg/dL; sodium 138.8 mEq/L; potassium 4.5 mEq/L; hemoglobin 14.6 g/dL; white blood cells 12,300/μL; platelet count 42,000/μL; serum total proteins 7.4 g/dL; and albumin 2.1 g/dL; total cholesterol 224 mg/dl, low-density lipoprotein cholesterol 119 mg/dL, high-density lipoprotein cholesterol 60 mg/dL, triglyceride 96 mg/dL. She had an antinuclear antibody (ANA) titer of 1:40, with a speckled pattern that was associated with the presence of anti-dsDNA antibody (28 IU/mL). Tests were negative for anti-Sm, anti-RNP, anti-SS-B, anti-SS-A, and anti-cardiolipin IgG antibodies. Her CH50 level was low (14.3 U/mL). Microscopic urinalysis showed 51–100 red blood cells and 3–5 white blood cells per hyper field. Proteinuria was 9.3 g/day and selectivity index was 0.01. Chest and abdominal CT revealed no abnormalities. She was diagnosed with SLE based on thrombocytopenia, proteinuria, positive ANA with anti-dsDNA antibody, and history of photosensitivity.
Before renal biopsy, we decided to treat her by prednisolone (PSL) 40 mg/day to normalize platelet count. Five days after the treatment, platelet count increased to 127,000/μL. Renal biopsy was performed 7 days after the treatment. The specimen for light microscopy contained 26 glomeruli; 8 exhibited global sclerosis, 2 revealed focal endocapillary hypercellularity superimposed on several foam cells (Fig. ).
Immunofluorescence (IF) showed low-intensity diffuse global granular capillary staining of IgG, IgA, IgM, C3, and C1q. Analysis by electron microscopy (EM) revealed electron-dense glomerular basement membrane deposits and foot process effacement (Fig. ).
This patient would have been diagnosed as LN class III (A) + V or III (A) because of scanty subepithelial immune deposition; however, we observed focal segmental foam cells closely resembling the cellular variant of FSGS. Based on experience with FSGS from July 2011, we added cyclosporine 100 mg/day on the initiated treatment with PSL. Within 3 months, the patient’s proteinuria rapidly improved from 9.3 to 1.8 g/day, and her leg edema completely disappeared. Her CH50 level gradually increased, and her anti-dsDNA antibody titer decreased below the normal limit (Fig. ). In March 2012, we performed a kidney re-biopsy. We observed focal segmental sclerotic lesions and endocapillary foam cells. IF with IgG, C3, and C1q showed bright granular staining, and EM showed electron-dense deposits at the same site. Diffuse foot process effacement was still present (Fig. ).","What is the patient's Creatinine Clearance using the Cockroft-Gault Equation in terms of mL/min? You should use the patient's adjusted body weight in kg instead of the patient's actual body weight if the patient is overweight or obese based on their BMI. If the patient's BMI's normal, set their adjusted body weight to the minimum of the ideal body and actual weight. If the patient is underweight, please set their adjusted body weight to their actual body weight. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'weight': [40.0, 'kg'], 'height': [153.0, 'cm'], 'creatinine': [1.27, 'mg/dL'], 'age': [81, 'years']}",21.93788,20.84099,23.03477,"The formula for computing Cockcroft-Gault is given by CrCl = ((140 - age) * adjusted weight * (gender_coefficient)) / (serum creatinine * 72), where the gender_coefficient is 1 if male, and 0.85 if female. The serum creatinine concentration is in mg/dL.
The patient's gender is female, which means that the gender coefficient is 0.85.
The patient is 81 years old. 
The concentration of creatinine is 1.27 mg/dL. 
The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 153.0 cm, which is 153.0 cm * 1 m / 100 cm = 1.53 m. The patient's weight is 40.0 kg. The patient's bmi is therefore 40.0 kg / (1.53 m * 1.53 m) = 17.08744 kg/m^2.The patient's BMI is 17.1, indicating they are underweight.
Because the patient is underweight, we take the patient's weight, 40.0 kg as the patient's adjusted weight needed for the Cockroft-Gault Equation. 
Using the Cockcroft-Gault equation:
CrCl = ((140 - age) * adjusted weight * gender_coefficient) / (serum creatinine * 72).
Plugging the patient's values gives us ((140 - 81) * 40.0 * 0.85) / (1.27 * 72) = 21.93788 mL/min. Hence, the patient's creatinine clearance is 21.93788 mL/min."
15,2,Creatinine Clearance (Cockcroft-Gault Equation),lab test,decimal,pmc-4886302-1,Extracted,"This is a case of an 83-year-old man who presented to the emergency department with a right-sided headache for 2 days. The headache was described as a pain level of 8/10, throbbing, and radiating to the back of the neck. No weakness, numbness, visual deficits, nausea, vomiting, dizziness, or lightheadedness was reported. He denied any difficulty in chewing or swallowing and denied any falls or trauma to the head. He has a history of hypertension, type 2 diabetes mellitus, osteoarthritis, and glaucoma.
His physical examination was significant for a nonfocal neurological examination, chronic poor visual acuity, and weak right palmar grasp secondary to his arthritis.
In the emergency department, his vital signs were as follows: height, 172.7 cm; weight, 72.6 kg; blood pressure, 188/109 mmHg; heart rate, 60 bpm; temperature, 36.8°C; respiratory rate, 18 bpm. The following laboratory data were remarkable: white blood cells, 8.8 109 cells/L; red blood cells, 3.04 M/µL; hematocrit, 30.3%; hemoglobin, 10.9 gm/dl; platelets 1,097 ×109/L; mean corpuscular volume, 99.8 fL; basic metabolic panel was notable for creatinine of 1.7 mg/dL and a normal glucose of 5.73 mmol/L. Coagulation studies were as follows: prothrombin time, 15.7 s; partial thromboplastin time, 33.7 s; international normalized ratio, 1.2.
His medications were famotidine 20 mg daily, amlodipine 10 mg daily, ultrashort-acting insulin 2–6 U subcutaneous four times a day, nicardipine, and lisinopril 20 mg daily. Initially, the management was focused on conservative blood pressure control and antiplatelet therapy with aspirin. A subsequent head computerized tomography (CT) revealed a right intraventricular hemorrhage (), which was managed with platelet transfusions, desmopressin acetate (DDAVP), and a nicardipine drip. The patient was admitted to the medical intensive care unit for frequent neurological examination and continuous blood pressure monitoring and control. The patient had an 11-day hospital stay and an extensive negative workup. Cardiac echocardiogram, vascular duplex of the lower extremities, and carotid duplex were negative. Follow-up imaging showed stable intraventricular hemorrhage (IVH) (), and the patient was ultimately discharged to Kessler Rehabilitation Center with zero neurological deficits.","What is the patient's Creatinine Clearance using the Cockroft-Gault Equation in terms of mL/min? You should use the patient's adjusted body weight in kg instead of the patient's actual body weight if the patient is overweight or obese based on their BMI. If the patient's BMI's normal, set their adjusted body weight to the minimum of the ideal body and actual weight. If the patient is underweight, please set their adjusted body weight to their actual body weight. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'age': [83, 'years'], 'weight': [72.6, 'kg'], 'height': [172.7, 'cm'], 'creatinine': [1.7, 'mg/dL']}",31.84454,30.25231,33.43677,"The formula for computing Cockcroft-Gault is given by CrCl = ((140 - age) * adjusted weight * (gender_coefficient)) / (serum creatinine * 72), where the gender_coefficient is 1 if male, and 0.85 if female. The serum creatinine concentration is in mg/dL.
The patient's gender is male, which means that the gender coefficient is 1.
The patient is 83 years old. 
The concentration of creatinine is 1.7 mg/dL. 
The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 172.7 cm, which is 172.7 cm * 1 m / 100 cm = 1.727 m. The patient's weight is 72.6 kg. The patient's bmi is therefore 72.6 kg / (1.727 m * 1.727 m) = 24.34176 kg/m^2.The patient's BMI is 24.3, indicating they are normal weight.
Because the patient is normal, we take take minimum of the ideal body weight and the patient's body as the patient's adjusted weight for the Cockroft-Gault Equation. Hence, the adjusted body weight is the minimum of the two giving us an adjusted body weight of 68.38197 kg.

Using the Cockcroft-Gault equation:
CrCl = ((140 - age) * adjusted weight * gender_coefficient) / (serum creatinine * 72).
Plugging the patient's values gives us ((140 - 83) * 68.38197 * 1) / (1.7 * 72) = 31.84454 mL/min. Hence, the patient's creatinine clearance is 31.84454 mL/min."
16,2,Creatinine Clearance (Cockcroft-Gault Equation),lab test,decimal,pmc-8474094-1,Extracted,"A 78-year-old man with a history of hypertension and benign prostatic hyperplasia, and no history of any infectious diseases, underwent endovascular stenting (S. M. A. R. T. Control C10060SL, Cordis, Santa Clara, CA, USA) at another hospital for chronic occlusion of the left iliac artery, which had been causing intermittent claudication. No prophylactic antibiotics were administered to the patient during the EVT procedure. The patient was discharged the next day without any complications. However, he developed fever and back pain 20 days later. Contrast-enhanced computed tomography (CT) was suggestive of an infected aneurysm at the site of the left iliac artery stent, and the patient was referred to our hospital.
The patient was 160 cm tall, weighed 62.8 kg, and had a blood pressure of 156/80 mmHg, a pulse of 66 beats/min, and a body temperature of 38°C. Blood tests revealed the following: white blood cells, 13130/µl; red blood cells, 3.33 million/µl; hemoglobin, 9.9 g/dl; platelet count, 190,000/µl; blood urea nitrogen, 26.7 mg/dl; creatinine, 0.93 mg/dl; albumin, 2.4 g/dl; and C-reactive protein, 24.76 mg/dl. CT findings revealed thickening of the arterial wall and an aneurysm of the left common iliac artery at the site of the stent (). On the basis of these findings, he was diagnosed with an infected aneurysm due to bare stent infection and underwent surgical treatment.
The terminal abdominal aorta and bilateral common iliac arteries were removed because the infection had extended to the aortic bifurcation (). The surrounding infected tissue was debrided, and the terminal aorta was replaced with a rifampicin-soaked bifurcated prosthesis. A pedicled omental flap based on the left gastroepiploic artery was then guided in a retrocolic fashion into the retroperitoneal cavity, to wrap the graft around its entire length.
The rifampicin-soaked prosthesis was prepared as follows. First, 300-mg rifampicin capsules (Sandoz Corporation, Tokyo, Japan) were dissolved in a mixture of 6-ml high-pressure sterilized polyoxyethylene sorbitan monooleate (Tween 80, Wako Seiyaku, Tokyo, Japan) and 54-ml distilled water. This solution was then sterilized in a Millex-HV Syringe Filter Unit (0.45 µm polyvinylidene difluoride, Merck Millipore, Carrigtwohill, County Cork, Ireland). Finally, an 18×10-mm prosthesis (Hemashield Platinum, Maquet, San Jose, CA, USA) was soaked in this rifampicin solution for 15 min.
Histopathology of the surgically excised artery specimen revealed many inflammatory cells infiltrating the intima, media, and adventitia. Abscesses and masses of Gram-positive cocci were found in all arterial layers, suggestive of an infected aneurysm ().
Staphylococcus aureus was detected by a bacterial culture of the surgical specimen. Based on the results of his antibiotic susceptibility test, the patient was administered tazobactam/piperacillin 13.5 g/day intravenously for 4 weeks, followed by amoxicillin 750 mg/day orally. However, oral medication was discontinued after 2 weeks due to a side effect, i.e., diarrhea.
Two postoperative complications were also treated. For adhesive bowel obstruction, partial small bowel resection was performed. For aspiration pneumonia, meropenem hydrate 1.5 g/day was administered for 1 week.
The patient was discharged and fully recovered from his illness. The patient still visits our hospital every 3–6 months for blood tests, Doppler ultrasonography, and CT. Postoperative CT images at the 2-year follow-up revealed no signs of reinfection (). At the 3-year follow-up, the graft remained patent, and no complications were observed.","What is the patient's Creatinine Clearance using the Cockroft-Gault Equation in terms of mL/min? You should use the patient's adjusted body weight in kg instead of the patient's actual body weight if the patient is overweight or obese based on their BMI. If the patient's BMI's normal, set their adjusted body weight to the minimum of the ideal body and actual weight. If the patient is underweight, please set their adjusted body weight to their actual body weight. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'age': [78, 'years'], 'weight': [62.8, 'kg'], 'height': [160.0, 'cm'], 'creatinine': [0.93, 'mg/dL']}",52.66849,50.03507,55.30191,"The formula for computing Cockcroft-Gault is given by CrCl = ((140 - age) * adjusted weight * (gender_coefficient)) / (serum creatinine * 72), where the gender_coefficient is 1 if male, and 0.85 if female. The serum creatinine concentration is in mg/dL.
The patient's gender is male, which means that the gender coefficient is 1.
The patient is 78 years old. 
The concentration of creatinine is 0.93 mg/dL. 
The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 160.0 cm, which is 160.0 cm * 1 m / 100 cm = 1.6 m. The patient's weight is 62.8 kg. The patient's bmi is therefore 62.8 kg / (1.6 m * 1.6 m) = 24.53125 kg/m^2.The patient's BMI is 24.5, indicating they are normal weight.
Because the patient is normal, we take take minimum of the ideal body weight and the patient's body as the patient's adjusted weight for the Cockroft-Gault Equation. Hence, the adjusted body weight is the minimum of the two giving us an adjusted body weight of 56.88197 kg.

Using the Cockcroft-Gault equation:
CrCl = ((140 - age) * adjusted weight * gender_coefficient) / (serum creatinine * 72).
Plugging the patient's values gives us ((140 - 78) * 56.88197 * 1) / (0.93 * 72) = 52.66849 mL/min. Hence, the patient's creatinine clearance is 52.66849 mL/min."
17,2,Creatinine Clearance (Cockcroft-Gault Equation),lab test,decimal,usmle-1896,Extracted,"A 55-year-old man comes to the physician for a follow-up examination. For the past 6 months, he has had fatigue, headaches, and several episodes of dizziness. Three months ago, he was diagnosed with hypertension and started on medications. Since the diagnosis was made, his medications have been adjusted several times because of persistently high blood pressure readings. He also has hypercholesterolemia and peripheral arterial disease. He smoked one pack of cigarettes daily for 34 years but quit two months ago. His current medications include aspirin, atorvastatin, losartan, felodipine, and hydrochlorothiazide. He is 188 cm (6 ft 2 in) tall and weighs 109 kg (240 lb); BMI is 31 kg/m2. His pulse is 82/min and blood pressure is 158/98 mm Hg. Physical examination shows bilateral carotid bruits and normal heart sounds. Serum potassium concentration is 3.2 mEq/L, plasma renin activity is 4.5 ng/mL/h (N = 0.3–4.2 ng/mL/h), and serum creatinine concentration is 1.5 mg/dL.","What is the patient's Creatinine Clearance using the Cockroft-Gault Equation in terms of mL/min? You should use the patient's adjusted body weight in kg instead of the patient's actual body weight if the patient is overweight or obese based on their BMI. If the patient's BMI's normal, set their adjusted body weight to the minimum of the ideal body and actual weight. If the patient is underweight, please set their adjusted body weight to their actual body weight. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'age': [55, 'years'], 'weight': [109.0, 'kg'], 'height': [188.0, 'cm'], 'creatinine': [1.5, 'mg/dL']}",73.14863,69.4912,76.80606,"The formula for computing Cockcroft-Gault is given by CrCl = ((140 - age) * adjusted weight * (gender_coefficient)) / (serum creatinine * 72), where the gender_coefficient is 1 if male, and 0.85 if female. The serum creatinine concentration is in mg/dL.
The patient's gender is male, which means that the gender coefficient is 1.
The patient is 55 years old. 
The concentration of creatinine is 1.5 mg/dL. 
The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 188.0 cm, which is 188.0 cm * 1 m / 100 cm = 1.88 m. The patient's weight is 109.0 kg. The patient's bmi is therefore 109.0 kg / (1.88 m * 1.88 m) = 30.83975 kg/m^2.The patient's BMI is 30.8, indicating they are overweight/obese.
Because the patient is overweight/obese, we use the adjusted body weight formula to get the adjusted weight used for Cockroft-Gault Equation. Shown below is the computation for IBW (ideal body weight).
For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Male.
The patient's height is 188.0 cm, which is 188.0 cm * 0.393701 in/cm = 74.01579 in. 
Plugging in the values for the IBW formula for males gives us 50 kg + 2.3 kg * (74.01579 (in inches) - 60) = 82.23632 kg.
Hence, the patient's IBW is 82.23632 kg.Shown below is the computation for ABW (adjusted body weight).
To compute the ABW value, apply the following formula: ABW = IBW + 0.4 * (weight (in kg) - IBW (in kg)). ABW = 82.23632 kg + 0.4 * (109.0 kg  - 82.23632 kg) = 92.94179 kg. The patient's adjusted body weight is 92.94179 kg.
Using the Cockcroft-Gault equation:
CrCl = ((140 - age) * adjusted weight * gender_coefficient) / (serum creatinine * 72).
Plugging the patient's values gives us ((140 - 55) * 92.94179 * 1) / (1.5 * 72) = 73.14863 mL/min. Hence, the patient's creatinine clearance is 73.14863 mL/min."
18,2,Creatinine Clearance (Cockcroft-Gault Equation),lab test,decimal,pmc-5411661-1,Extracted,"A 60-year-old male with end-stage kidney disease due to ADPKD was admitted to our hospital for an evaluation of diplopia and left hemiplegia in March 2012. He had started maintenance hemodialysis in 2005. He had hypertension, which was relatively under good control with antihypertensive agents. He had no other arteriosclerotic risks such as diabetes, dyslipidemia, or smoking. He had no past medical history of coronary artery disease, myocardial infarction, or peripheral artery disease. The patient’s father and three brothers were also under hemodialysis due to ADPKD. None of the family members had a vascular system complication such as cerebral aneurysm, or past medical history of stroke. A brain CT scan image showed dilatation of left vertebral artery, basilar artery, bilateral post cerebral artery, and middle cerebral artery (Fig. a, b). At the time, he was diagnosed as vertebrobasilar dolichoectasia and started antihypertensive agents. In 2010, he was once admitted to our hospital for dysarthria, dysphagia and right hemiplegia. Brain magnetic resonance imaging (MRI) revealed acute infarction in the left midbrain, and he was started treatment with anticoagulant and additional antihypertensive agents. Although he recovered from dysarthria and dysphagia, right mild hemiplegia remained. However, he did not have any new stroke events until the admission in 2012.
On admission in 2012, his height was 163.1 cm, weight was 58.5 kg, consciousness level was 13 on the Glasgow Coma Scale, blood pressure was 146/92 mmHg, and body temperature was 36.7 °C. His conjunctiva was anemic, abdomen showed hepatomegaly and bilateral kidney swelling, and lower extremities had bilateral pitting edema. Neurological examination revealed prompt light reflection, isocoric pupil, limitation of the adduction of the right eye when gazing to the left, dysarthria, and bilateral incomplete paralysis.
Laboratory data were as follows: serum Cr 10.7 mg/dL, BUN 48 mg/dL, estimated glomerular filtration rate (eGFR) 4.4 mL/min/1.73 m2, hemoglobin (Hb) 10.7 g/dL, white blood cell count (WBC) 5700/μL, C-reactive protein (CRP) 0.4 mg/dL, aspartate aminotransferase (AST) 6 IU/L, alanine aminotransferase (ALT) 6 IU/L and alkaline phosphatase (ALP) 164 IU/L. Brain MRI showed acute ischemia of bilateral pons and right temporal lobe. Brain magnetic resonance angiography (MRA) did not show significant change in vertebrobasilar dolichoectasia compared with MRA in 2010. We started urokinase 60,000 unit/day and argatroban hydrate 60 mg/day. He was once recovered, and continued rehabilitation and maintenance hemodialysis. After 3 months of admission, he suddenly showed impaired consciousness of 6 on the Glasgow Coma Scale, convulsion, and Cheyne-Stokes respiration. CT scan image did not show any cerebral hemorrhage. Exacerbation of cerebral infarction was suspected, and we started argatroban hydrate 60 mg/day, aleviatin, and non-invasive positive pressure (NPPV). Fourteen days after convulsion, he died of sudden fall in blood pressure (Fig. ).
An autopsy was performed, and the brain was pathologically examined. Macroscopically, massive hemorrhage in subarachnoid were seen due to rupture of basilar tip aneurysm (Fig. a, b). Autopsy diagnosis of his death was subarachnoid hemorrhage. Intravascular lumen of the basilar tip aneurysm was nearly obstructed by thrombi (Fig. c). Old cerebral infarctions were seen in the left temporal lobe and other areas. Basilar, left vertebral, bilateral carotid, bilateral middle, and bilateral post cerebral artery showed irregular dilatation of the vessel wall. A microscopic examination of the dilatation area had rupture of the internal elastic lamina and thinning of the media (Fig. d). A wide range of vertebrobasilar dolichoectasia was also confirmed pathologically. In other organs, systemic arteries also showed marked atherosclerosis, and bilateral iliac artery had an aneurysm-like dilatation.","What is the patient's Creatinine Clearance using the Cockroft-Gault Equation in terms of mL/min? You should use the patient's adjusted body weight in kg instead of the patient's actual body weight if the patient is overweight or obese based on their BMI. If the patient's BMI's normal, set their adjusted body weight to the minimum of the ideal body and actual weight. If the patient is underweight, please set their adjusted body weight to their actual body weight. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'age': [60, 'years'], 'weight': [58.5, 'kg'], 'height': [163.1, 'cm'], 'creatinine': [10.7, 'mg/dL']}",6.07477,5.77103,6.37851,"The formula for computing Cockcroft-Gault is given by CrCl = ((140 - age) * adjusted weight * (gender_coefficient)) / (serum creatinine * 72), where the gender_coefficient is 1 if male, and 0.85 if female. The serum creatinine concentration is in mg/dL.
The patient's gender is male, which means that the gender coefficient is 1.
The patient is 60 years old. 
The concentration of creatinine is 10.7 mg/dL. 
The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 163.1 cm, which is 163.1 cm * 1 m / 100 cm = 1.631 m. The patient's weight is 58.5 kg. The patient's bmi is therefore 58.5 kg / (1.631 m * 1.631 m) = 21.99115 kg/m^2.The patient's BMI is 22.0, indicating they are normal weight.
Because the patient is normal, we take take minimum of the ideal body weight and the patient's body as the patient's adjusted weight for the Cockroft-Gault Equation. Hence, the adjusted body weight is the minimum of the two giving us an adjusted body weight of 58.5 kg.

Using the Cockcroft-Gault equation:
CrCl = ((140 - age) * adjusted weight * gender_coefficient) / (serum creatinine * 72).
Plugging the patient's values gives us ((140 - 60) * 58.5 * 1) / (10.7 * 72) = 6.07477 mL/min. Hence, the patient's creatinine clearance is 6.07477 mL/min."
19,2,Creatinine Clearance (Cockcroft-Gault Equation),lab test,decimal,pmc-4641361-1,Extracted,"In November 2007, a 49-year-old Japanese woman was referred to our hospital from an orthopaedist complaining of a one year history of sustained difficulty walking and severe bilateral hip pain. Her height was 155.5 cm and body weight was 61.0 kg. Laboratory data showed a creatinine of 1.4 mg/dl, potassium 2.8 mmol/l, calcium 9.5 mg/dl, phosphorus 2.5 mg/dl, uric acid 1.5 mg/dl, normoglycaemic glycosuria and metabolic acidemia (pH 7.30, HCO3− 17.4 mmol/l) (Table ). Bilateral transcervical fractures were confirmed by MRI (Fig. ) and bone scintigraphy showed multiple hot spots in her joints and ribs, compatible with osteomalacia (Fig. ). Hypophosphatemic osteomalacia was diagnosed clinically from a low serum level of phosphorus, 1,25-dihydroxyvitamin D3 (11.0 pg/dl), high levels of bone specific alkaline phosphatase (67.5 IU/l), and the findings of bone scintigram, although a bone biopsy was not performed. Tumor-induced osteomalacia (TIO) was ruled out by total body survey with whole body computed tomography or endoscopic surveillances and a normal blood FGF23 (22.1 pg/ml, 10–50 pg/ml) level.
Urinalysis showed pH 6.0 and twenty four hour urine demonstrated a low renal fractional tubular reabsorption of phosphate (Tmp/GFR 0.91), increased fractional excretion of uric acid (FEUA 43.9 %) and generalized aminoaciduria.
The calculated anion gap was 12.4 meq/l, with an inappropriately alkaline urine (pH 6.0), suggestive of distal type of renal tubular acidosis (RTA). An intravenous bicarbonate loading test to assess the tubular dysfunction demonstrated that the increased fractional excretion of bicarbonate (FEHCO3− 13.25 %) and urine-blood (UB) Pco2 gradient (U-Bpco2 50.1 mmHg), suggesting the presence of proximal type of RTA. NH4Cl loading test was not performed because of the presence of apparent metabolic acidemia. These biochemical data of blood and urine indicated Fanconi syndrome with proximal type of RTA. Tests for anti-SSA and anti-SSB were negative and serum angiotensin converting enzyme levels were normal. Furthermore, serum and urine immunoelectrophoresis revealed no monoclonal component. Any of the patient’s medication did not seem to be related to Fanconi syndrome. Light microscopic examination of a kidney biopsy demonstrated cellular infiltration of interstitium and proximal tubular epithelium composed mainly of CD3+ lymphocytes without glomerular involvement, consistent with features of TIN (Fig. ,).
The patient was also suspected to be diagnosed as PBC because of high levels of alkaline phosphatase (663 IU/l), high serum IgM levels (1084 mg/dl) and the presence of anti-mitochondrial M2 antibody (1:10). Sequential liver biopsy demonstrated the presence of a periportal cellular infiltrate (Fig. ), compatible with PBC though biochemical liver function was normal. The combination of these findings led to the patient’s diagnosis of osteomalacia caused by TIN with Fanconi syndrome in asymptomatic PBC.
The patient was started on therapy with calcitriol (1 μg/day), neutral potassium phosphate and sodium bicarbonate (6 g/day). She was subsequently administered middle-dose corticosteroid (20 mg/day of predonisolone) and ursodeoxycholic acid (300 mg/day). One year after the treatment, the patient became asymptomatic and renal function remained stable. Furthermore, MRI showed the bilateral transcervical fractures of the femoral neck had almost fully repaired (Fig. ). Treatment is currently being continued in the outpatient clinic.","What is the patient's Creatinine Clearance using the Cockroft-Gault Equation in terms of mL/min? You should use the patient's adjusted body weight in kg instead of the patient's actual body weight if the patient is overweight or obese based on their BMI. If the patient's BMI's normal, set their adjusted body weight to the minimum of the ideal body and actual weight. If the patient is underweight, please set their adjusted body weight to their actual body weight. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'weight': [61.0, 'kg'], 'height': [155.5, 'cm'], 'creatinine': [1.4, 'mg/dL'], 'age': [49, 'years']}",40.96504,38.91679,43.01329,"The formula for computing Cockcroft-Gault is given by CrCl = ((140 - age) * adjusted weight * (gender_coefficient)) / (serum creatinine * 72), where the gender_coefficient is 1 if male, and 0.85 if female. The serum creatinine concentration is in mg/dL.
The patient's gender is female, which means that the gender coefficient is 0.85.
The patient is 49 years old. 
The concentration of creatinine is 1.4 mg/dL. 
The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 155.5 cm, which is 155.5 cm * 1 m / 100 cm = 1.555 m. The patient's weight is 61.0 kg. The patient's bmi is therefore 61.0 kg / (1.555 m * 1.555 m) = 25.2272 kg/m^2.The patient's BMI is 25.2, indicating they are overweight/obese.
Because the patient is overweight/obese, we use the adjusted body weight formula to get the adjusted weight used for Cockroft-Gault Equation. Shown below is the computation for IBW (ideal body weight).
For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Female.
The patient's height is 155.5 cm, which is 155.5 cm * 0.393701 in/cm = 61.22051 in. 
Plugging in the values for the IBW formula for females gives us 45.5 kg + 2.3 kg * (61.22051 (in inches) - 60) = 48.30717 kg.
Hence, the patient's IBW is 48.30717 kg.Shown below is the computation for ABW (adjusted body weight).
To compute the ABW value, apply the following formula: ABW = IBW + 0.4 * (weight (in kg) - IBW (in kg)). ABW = 48.30717 kg + 0.4 * (61.0 kg  - 48.30717 kg) = 53.3843 kg. The patient's adjusted body weight is 53.3843 kg.
Using the Cockcroft-Gault equation:
CrCl = ((140 - age) * adjusted weight * gender_coefficient) / (serum creatinine * 72).
Plugging the patient's values gives us ((140 - 49) * 53.3843 * 0.85) / (1.4 * 72) = 40.96504 mL/min. Hence, the patient's creatinine clearance is 40.96504 mL/min."
20,2,Creatinine Clearance (Cockcroft-Gault Equation),lab test,decimal,pmc-6713257-1,Extracted,"A 28-year-old woman presented to the emergency department with sudden-onset abdominal pain. She also had experienced multiple episodes of non-bloody vomitus during the previous 24 hours. One year earlier, she was diagnosed with uncontrolled T2DM but refused to start insulin treatment. Two months before presentation, her hemoglobin A1C concentration was 12%, and she was started on treatment with a combination of dapagliflozin and metformin.
At the time of presentation to the emergency department, the patient was afebrile with a mild increase in blood pressure to 138/86 mmHg. She was also tachypneic and tachycardiac, with a respiratory rate of 25 breaths/minute, a regular pulse with a heart rate of 116 beats/minute, and normal oxygen saturation. Her weight was 99 kg and her height was 179 cm with a body mass index (BMI) of 31 kg/m2. Physical examination revealed an obese dehydrated woman in mild distress and with mild diffuse abdominal tenderness, but no other remarkable findings. Her blood glucose concentration on Accu-check was 252 mg/dl. Laboratory testing showed an initial blood glucose concentration of 268 mg/dl, an anion gap of 18 mmol/l, and a pH of venous blood gases of 7.18. In addition, her bicarbonate concentration was 9 mmol/dl, her blood urea nitrogen was 50 mg/dl with creatinine 1.7 mg/dl, her acetone was elevated, and her hemoglobin A1C was 14.3%. Urinalysis showed moderate ketones with + 3 glucose. Her beta-human chorionic gonadotropin concentration and septic workup were negative, her cardiac enzymes were normal, and electrocardiography showed no signs of ischemia.
Following confirmation of DKA, the patient was admitted to the intensive care unit (ICU) and administered two liters of normal saline. Accu-check one hour later showed a blood glucose level of 55 mg/dl, a finding confirmed by a serum blood glucose concentration of 68 mg/dl, a significant reduction from the initial concentration of 268 mg/dl. The patient was administered 50 ml of a 50% dextrose solution; once her blood glucose stabilized, she was started on continuous insulin infusion along with the dextrose-containing intravenous solution. She was not treated with the dapagliflozin- metformin combination while in hospital. Her acidosis and anion gap were corrected over the following three days; because her hemoglobin A1C level remained elevated, she was discharged on the insulin regimen.","What is the patient's Creatinine Clearance using the Cockroft-Gault Equation in terms of mL/min? You should use the patient's adjusted body weight in kg instead of the patient's actual body weight if the patient is overweight or obese based on their BMI. If the patient's BMI's normal, set their adjusted body weight to the minimum of the ideal body and actual weight. If the patient is underweight, please set their adjusted body weight to their actual body weight. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'age': [28, 'years'], 'weight': [99.0, 'kg'], 'height': [179.0, 'cm'], 'creatinine': [1.7, 'mg/dL']}",63.27379,60.1101,66.43748,"The formula for computing Cockcroft-Gault is given by CrCl = ((140 - age) * adjusted weight * (gender_coefficient)) / (serum creatinine * 72), where the gender_coefficient is 1 if male, and 0.85 if female. The serum creatinine concentration is in mg/dL.
The patient's gender is female, which means that the gender coefficient is 0.85.
The patient is 28 years old. 
The concentration of creatinine is 1.7 mg/dL. 
The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 179.0 cm, which is 179.0 cm * 1 m / 100 cm = 1.79 m. The patient's weight is 99.0 kg. The patient's bmi is therefore 99.0 kg / (1.79 m * 1.79 m) = 30.89791 kg/m^2.The patient's BMI is 30.9, indicating they are overweight/obese.
Because the patient is overweight/obese, we use the adjusted body weight formula to get the adjusted weight used for Cockroft-Gault Equation. Shown below is the computation for IBW (ideal body weight).
For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Female.
The patient's height is 179.0 cm, which is 179.0 cm * 0.393701 in/cm = 70.47248 in. 
Plugging in the values for the IBW formula for females gives us 45.5 kg + 2.3 kg * (70.47248 (in inches) - 60) = 69.5867 kg.
Hence, the patient's IBW is 69.5867 kg.Shown below is the computation for ABW (adjusted body weight).
To compute the ABW value, apply the following formula: ABW = IBW + 0.4 * (weight (in kg) - IBW (in kg)). ABW = 69.5867 kg + 0.4 * (99.0 kg  - 69.5867 kg) = 81.35202 kg. The patient's adjusted body weight is 81.35202 kg.
Using the Cockcroft-Gault equation:
CrCl = ((140 - age) * adjusted weight * gender_coefficient) / (serum creatinine * 72).
Plugging the patient's values gives us ((140 - 28) * 81.35202 * 0.85) / (1.7 * 72) = 63.27379 mL/min. Hence, the patient's creatinine clearance is 63.27379 mL/min."
21,3,CKD-EPI Equations for Glomerular Filtration Rate,lab test,decimal,pmc-6605692-1,Extracted,"A 61-year-old Caucasian man presented to the emergency department in autumn with one week of dyspnea, productive cough, myalgia, and fever. He denied any chest pain or hemoptysis. His past medical history was significant for hypertension, diabetes mellitus, chronic kidney disease, and non-Hodgkin’s lymphoma with receipt of an allogeneic stem cell transplant 13 years prior. Given prior complications due to graft versus host disease, he was receiving prednisone at a maintenance dose of 15 mg daily for several years. He had multiple documented allergies to penicillin, sulfa drugs, macrolides and fluoroquinolones, with reported reactions including rash, hives, and anaphylaxis. Approximately one week prior to the onset of symptoms, he was traveling in the Midwest United States with his partner and staying in various hotels.
Upon arrival to the hospital, he was noted to have a heart rate of 130 beats per minute, a blood pressure of 128/76 mmHg, a respiratory rate of 30 breaths per minute with an oxygen saturation of 89% requiring eight liters of supplementary oxygen, and an oral temperature of 39.8°C (103.6°F). He was in acute respiratory distress and had evident decreased breath sounds and crackles bilaterally. He was noted to have normal heart sounds without any murmurs, rubs, or gallops. He did not have any rash on examination.
Laboratory investigations revealed a normal peripheral leukocyte count of 10.4 x 109 cells/L (10.4 x 103 cells/µL) , decreased hemoglobin of 110 g/L (11.0 g/dL), decreased platelet count of 96 x 109 cells/L (96 x 103 cells/µL), and increased creatinine of 676 µmol/L (7.65 mg/dL). His liver enzymes were normal. His initial chest radiograph revealed diffuse, bilateral air space opacities in the mid and lower lung zones (Figure ).
Two sets of blood cultures were collected and sputum samples were sent for culture as well as stains and polymerase chain reaction (PCR) testing for Pneumocystis jirovecii (P. jirovecii). A nasopharyngeal sample was collected for respiratory virus PCR testing for influenza A and B, respiratory syncytial virus A and B, coronavirus, parainfluenza virus, rhinovirus, enterovirus, adenovirus, bocavirus, and metapneumovirus. In addition, a serum cytomegalovirus (CMV) PCR and Legionella urine antigen were sent. He was empirically started on meropenem, vancomycin, oseltamivir, and intravenous pentamidine.
Despite initiation of broad spectrum antimicrobials, he continued to deteriorate with increasing oxygen demands, persistent fever, hemodynamic instability, and worsening radiographic infiltrates (Figure ).
Sputum and blood cultures were negative for any bacterial growth; sputum stains and PCR were negative for P. jirovecii. His serum CMV PCR was negative. His nasopharyngeal swab for respiratory virus testing was negative for influenza A and B, respiratory syncytial virus A and B, coronavirus, parainfluenza virus, rhinovirus, enterovirus, adenovirus, bocavirus, and metapneumovirus; however, his Legionella urine antigen was positive.
According to his pharmacy records, he had previously received and tolerated a five-day course of moxifloxacin approximately one year prior to this hospital admission. Given his diagnosis of Legionnaires' disease, intravenous moxifloxacin therapy was initiated. However, shortly following receipt of his first dose of moxifloxacin, he developed an allergic reaction with a generalized, erythematous, maculopapular rash and angioedema, necessitating administration of epinephrine.
Given his documented allergies to both fluoroquinolones and macrolides, hemodynamic instability, and concern for poor gastrointestinal absorption of oral antimicrobials, he was subsequently treated with intravenous tigecycline with an initial, loading dose of 100 mg, followed by 50 mg twice daily for a total of 14 days of therapy. Intravenous doxycycline is not readily available in our institution. His oxygen requirements decreased and fever resolved following 48 hours of treatment with tigecycline. All other antimicrobials were discontinued once the diagnosis of Legionnaires' disease was made. There was no recurrence of infection after three months of follow-up; his repeat chest radiograph showed resolution of his bilateral air space opacities.
Later in discussion with the North Dakota Department of Health and Centers for Disease Control and Prevention, it was determined that there was an ongoing outbreak of Legionnaires’ disease associated with five cases over a 13-month period; all cases including our patient had stayed at the same hotel. Subsequent environmental testing of the hotel was negative, but this may have been impacted by a recent deep clean of the hotel’s ventilation system.","Using the 2021 CKD-EPI Creatinine equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'age': [61, 'years'], 'creatinine': [676.0, 'µmol/L']}",7.40237,7.03225,7.77249,"The formula for computing GFR is 142 x (Scr/A)**B x 0.9938**age x (gender_coeffcient), where the ** indicates an exponent operation, Scr is the concentration of serum creatinine in mg/dL and gender_coefficient is 1.012 if the patient is female, else the coeffient is 1. The coefficients A and B are dependent on the patient's gender and the patient's creatinine concentration.
The patient is 61 years old. The patient's gender is Male, and so the patient's gender coefficient is 1.0.
The concentration of Serum Creatinine is 676.0 µmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of Serum Creatinine from µmol to mg. The mass of Serum Creatinine is 676.0 µmol. To convert 676.0 µmol of Serum Creatinine to mol, multiply by the conversion factor 1e-06, giving us 676.0 µmol Serum Creatinine * 1e-06 mol/µmol = 0.00068 mol Serum Creatinine. To convert from mol Serum Creatinine to grams, multiply by the molar mass 113.12 g/mol, which will give 0.00068 mol Serum Creatinine * 113.12 g/mol = 0.07692 g Serum Creatinine. To convert 0.07692 g of Serum Creatinine to mg, multiply by the conversion factor 1000.0, giving us 0.07692 g Serum Creatinine * 1000.0 mg/g = 76.92 mg Serum Creatinine. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 76.92 mg Serum Creatinine/10.0 dL = 7.692 mg Serum Creatinine/dL. The concentration value of 676.0 µmol Serum Creatinine/L converts to 7.692 mg Serum Creatinine/dL. Because the patient's gender is male and the creatinine concentration is greater than or equal to 0.9 mg/dL, A = 0.9 and B = -1.2.
Plugging in these values, we get 142 * (7.692/0.9)**-1.2 * 0.9938**61 * 1.0 = 7.40237.
Hence, the GFR value is 7.40237 ml/min/1.73 m²."
22,3,CKD-EPI Equations for Glomerular Filtration Rate,lab test,decimal,pmc-8173432-1,Extracted,"The patient, a 22-year-old woman of Chinese Han ethnicity, was admitted for severe edema of the facial region and two lower limbs over 3 mo.
The patient developed edema of the facial region and two lower limbs 3 mo ago without obvious cause. Her symptoms were mild in the morning and severe in the afternoon. At the same time, she experienced migratory pain of the small joints, which improved after movement, as well as decreased urinary volume, weakness, and poor appetite.
The patient had a free previous medical history.
The patient’s temperature was 36.6 °C, heart rate was 78 bpm, respiratory rate was 20 breaths per minute, blood pressure was 122/80 mmHg, and oxygen saturation in room air was 98%. The patient was conscious and she complied with the physician's physical examination. Her heart, lungs, and abdomen examinations showed no significant abnormalities, no percussion pain in her kidney area, and severe pitting edema in both lower extremities.
Routine urine examination revealed the following: Proteinuria +++, hematuria ++; phase of urinary red blood cells: Deformed erythrocytosis 70%, urine protein quantitation 4.2 g/24 h; urea nitrogen 15.7 mmol/L, and serum creatinine 141.4 μmol/L. Routine blood test results were as follows: Hemoglobin 92 g/L, white blood cells 4.8 × 109/L, blood platelets 218 × 109/L, antinuclear antibody 1:3200, cytoplasmic granules 1:1000, ds-DNA antibody > 1:3200, C3 0.56 g/L, and C4 0.22 g/L.
Pathological results showed 35 glomeruli in the punctured renal tissue, including one with global sclerosis, two with ischemic sclerosis, and the remaining glomeruli with diffuse proliferation of mesangial cells and endothelial cells, accompanied by segmental dual-track formation of a thickened basement membrane, segmental Meyer's loop, leukocyte infiltration, and segmental microthrombus formation. Fuchsinophilic protein deposition can be found at the mesangial region and subepithelial region, including fibrin crescent formation of one cell. The kidney tubular epithelium exhibited granular and vacuolar degeneration, as well as multifocal atrophy. The renal interstitium showed multishaped lymphocyte and monocyte infiltration, together with mild thickening of the arteriole wall. Paraffin immunofluorescence revealed: Immunoglobulin (Ig) G (++), IgA (++), IgM (++), C3 (+), fall risk assessment (+), C1q (++), and granular deposition along the mesangial region and capillary wall. Combined with clinical findings, this condition was considered diffuse proliferative lupus nephritis, with IV-G (A), AI = 11, and CI = 5. AI was scored as follows: Cellular proliferation (2 points), leukocyte infiltration (1 point), nuclear fragmentation/fibrinoid necrosis (2 points), cell crescent (0 points), Meyer's loop/thrombus (2 points), and interstitial monocyte infiltration (2 points). CI was scored as follows: Sclerosis (2 points), fibrin crescent (0 points), tubular atrophy (2 points), and interstitial fibrosis (2 points) (Figure ).
After consideration of the renal puncture results, oral administration of prednisone was begun at 50 mg/d, and meanwhile, cyclophosphamide was applied through intravenous injection at a dosage of 1.0 g monthly, which lasted for a consecutive 6 mo and was stopped after an accumulative use of 6 g. The serum creatinine fluctuated within an approximate range of 120-160 μmol/L, and blood albumin fluctuated from approximately 29-35 g/L. Then, the patient began to take AZA 50 mg/d as maintenance treatment but experienced extensive alopecia and shedding of pubic hair on the 13th day after oral administration. Pharyngalgia appeared on the 14th day, and fever with a body temperature up to 42 ℃ occurred on the 15th day. The patient came to the hospital for the second time. Physical examination revealed the following: Body temperature, 39.4 ℃; pulse, 92 times/min; breath rate, 22 times/min; blood pressure, 182/100 mmHg. The patient exhibited clear consciousness and emotional distress; she presented scattered chromatosis on her skin, and a rash was found on the inner surface of the bilateral thighs. Pharyngeal congestion was noted, and the breath sounds of the two lungs were clear. The heart rate was 92 times/min. The abdomen was flat, soft, and free from tenderness or rebound tenderness, and there was no liver or spleen involvement. Routine blood work showed the following: Hemoglobin 72 g/L, white blood cell count 1.25 × 109/L, blood platelet count 13 × 109/L, lymphocyte ratio 95.7%, neutrophil ratio 1.6%, and neutrophil count 0.01 × 109/L (Figure ). The results of the bone marrow biopsy were as follows: Myelodysplasia low in the myelogram and focal hyperplasia in bone marrow tissue with active hyperplasia in some areas (Figure ). Routine urinalysis results were as follows: Protein (+), occult blood 2+, and Epstein-Barr virus (EBV) positivity (3.58 × 104). TPMT genotyping testing (four single nucleotide polymorphisms, single base extension method) revealed the following: TPMT 3C gene polymorphism (719A>G) (this site is the most common gene mutation site in Asians) test result: A/A; TPMT 3B gene polymorphism (460G>A) test result: G/G; TPMT 2 gene polymorphism (238G>C) test result: G/G; no abnormity was found in any of the above results.","Using the 2021 CKD-EPI Creatinine equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [22, 'years'], 'creatinine': [141.4, 'µmol/L'], 'sex': 'Female'}",47.039,44.68705,49.39095,"The formula for computing GFR is 142 x (Scr/A)**B x 0.9938**age x (gender_coeffcient), where the ** indicates an exponent operation, Scr is the concentration of serum creatinine in mg/dL and gender_coefficient is 1.012 if the patient is female, else the coeffient is 1. The coefficients A and B are dependent on the patient's gender and the patient's creatinine concentration.
The patient is 22 years old. The patient's gender is Female, and so the patient's gender coefficient is 1.012.
The concentration of Serum Creatinine is 141.4 µmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of Serum Creatinine from µmol to mg. The mass of Serum Creatinine is 141.4 µmol. To convert 141.4 µmol of Serum Creatinine to mol, multiply by the conversion factor 1e-06, giving us 141.4 µmol Serum Creatinine * 1e-06 mol/µmol = 0.00014 mol Serum Creatinine. To convert from mol Serum Creatinine to grams, multiply by the molar mass 113.12 g/mol, which will give 0.00014 mol Serum Creatinine * 113.12 g/mol = 0.01584 g Serum Creatinine. To convert 0.01584 g of Serum Creatinine to mg, multiply by the conversion factor 1000.0, giving us 0.01584 g Serum Creatinine * 1000.0 mg/g = 15.84 mg Serum Creatinine. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 15.84 mg Serum Creatinine/10.0 dL = 1.584 mg Serum Creatinine/dL. The concentration value of 141.4 µmol Serum Creatinine/L converts to 1.584 mg Serum Creatinine/dL. Because the patient's gender is female and the creatinine concentration is greater than or equal to 0.7 mg/dL, A = 0.7 and B = -1.2.
Plugging in these values, we get 142 * (1.584/0.7)**-1.2 * 0.9938**22 * 1.012 = 47.039.
Hence, the GFR value is 47.039 ml/min/1.73 m²."
23,3,CKD-EPI Equations for Glomerular Filtration Rate,lab test,decimal,pmc-8521725-1,Extracted,"A 51-year-old woman from South America with a past medical history of anemia, hypertension, kidney stones, and COVID-19, 4 months prior (a positive antigen test without symptoms) was evaluated in the emergency department after being found to have calcium of 15.7 mg/dL in clinic. The patient endorsed fatigue, night sweats, lightheadedness, nausea, right flank pain with radiation to the right lower quadrant, urinary frequency, diffuse bone pain, constipation for the past 1 month, and weight loss of about 15 lb over the past 6 months. The patient denied any chest pain, shortness of breath, abdominal pain, or dysuria. Physical exam was benign except for severe tenderness to palpation over the buttocks and hips.
Laboratories on admission were significant for calcium 15.9 mg/dL (reference range: 8.6-10.2 mg/dL), creatinine 1.33 mg/dL (reference range: 0.5-1.20 mg/dL), 1-25 dihydroxyvitamin D 116.0 pg/mL (reference range: 19.9-79.3), and 25 hydroxyvitamin D 21.0 ng/mL (reference range: >30 ng/mL). Parathyroid hormone was low (15.3 pg/mL, reference range: 15.0-65.0), and alkaline phosphatase was within normal limits. Of note, ACE was found to be elevated to 139 U/L (reference range: 14-82 U/L).
The patient was hydrated and treated with calcitonin, decreasing her calcium to 11.3 mg/dL and her creatinine to 0.98 mg/dL. On further interviewing of this patient (admission Day 4), it was discovered that she had silicone injections in her buttocks approximately 23 years ago by a local doctor. Her calcium continued to be >11 mg/dL despite in vitro fertilization (IVF) and calcitonin. Computed tomography scan of the abdomen and pelvis showed no evidence of malignancy; however, it was significant for extensive bilateral granulomatous calcifications of the patient’s buttocks. The patient was started on steroid treatment with prednisone 60 mg daily. Ultimately, she was discharged after 5 days (once her calcium decreased to 10.6 mg/dL) and was given a 2-week course of prednisone; on return to clinic 3 weeks later (1 week after completion of her steroid taper), her calcium remained at 10.9 mg/dL. Four months later, this patient’s calcium was found to be only mildly elevated to 10.6 mg/dL ().","Using the 2021 CKD-EPI Creatinine equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [51, 'years'], 'creatinine': [1.33, 'mg/dL'], 'sex': 'Female'}",48.44101,46.01896,50.86306,"The formula for computing GFR is 142 x (Scr/A)**B x 0.9938**age x (gender_coeffcient), where the ** indicates an exponent operation, Scr is the concentration of serum creatinine in mg/dL and gender_coefficient is 1.012 if the patient is female, else the coeffient is 1. The coefficients A and B are dependent on the patient's gender and the patient's creatinine concentration.
The patient is 51 years old. The patient's gender is Female, and so the patient's gender coefficient is 1.012.
The concentration of Serum Creatinine is 1.33 mg/dL. Because the patient's gender is female and the creatinine concentration is greater than or equal to 0.7 mg/dL, A = 0.7 and B = -1.2.
Plugging in these values, we get 142 * (1.33/0.7)**-1.2 * 0.9938**51 * 1.012 = 48.44101.
Hence, the GFR value is 48.44101 ml/min/1.73 m²."
24,3,CKD-EPI Equations for Glomerular Filtration Rate,lab test,decimal,pmc-3101734-1,Extracted,"A 17-year-old male presented with a few days history of severe headache, visual disturbances, and a few episodes of vomiting. There was no history of fever, altered consciousness, seizures, or upper or lower limb weakness. The past medical history was unremarkable. At the time of examination, his BP was 240/130 mm Hg. The fundus examination revealed bilateral papilledema with grade 4 hypertensive changes. The neurological examination revealed normal grade 5 power in all four limbs with normally elicited deep tendon reflexes. The sensory examination was unremarkable with normal flexor plantar response bilaterally. Serum electrolytes were normal; kidney function tests were deranged (blood urea 86 mg/dL, serum creatinine 3.7 mg/dL). A renal biopsy revealed features of IgA nephropathy. MRI of the brain revealed a hyperintense signal of medulla and cervical cord on T2 and FLAIR images (Figures ); small hyperintense foci were also noted in the parieto-occipital regions and deep cerebellar white matter. The lesions were also hyperintense on diffusion-weighted imaging (because of T2 shine-through); there was no evidence of restricted diffusion on apparent diffusion co-efficient maps. As there was no clinical or lab evidence to support the diagnosis of encephalomyelitis or acute disseminating encephalomyelitis (ADEM) as suggested initially by the radiologist, an atypical variant of PRES was considered as the most plausible diagnostic possibility. Further investigations including CSF studies were not considered necessary in view of the strongly suggestive clinical and imaging features. The patient rapidly improved with antihypertensive treatment and a repeat MRI done 1 month afterward showed resolution of the earlier imaging findings.","Using the 2021 CKD-EPI Creatinine equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'age': [17, 'years'], 'creatinine': [3.7, 'mg/dL']}",23.42179,22.2507,24.59288,"The formula for computing GFR is 142 x (Scr/A)**B x 0.9938**age x (gender_coeffcient), where the ** indicates an exponent operation, Scr is the concentration of serum creatinine in mg/dL and gender_coefficient is 1.012 if the patient is female, else the coeffient is 1. The coefficients A and B are dependent on the patient's gender and the patient's creatinine concentration.
The patient is 17 years old. The patient's gender is Male, and so the patient's gender coefficient is 1.0.
The concentration of Serum Creatinine is 3.7 mg/dL. Because the patient's gender is male and the creatinine concentration is greater than or equal to 0.9 mg/dL, A = 0.9 and B = -1.2.
Plugging in these values, we get 142 * (3.7/0.9)**-1.2 * 0.9938**17 * 1.0 = 23.42179.
Hence, the GFR value is 23.42179 ml/min/1.73 m²."
25,3,CKD-EPI Equations for Glomerular Filtration Rate,lab test,decimal,pmc-5120253-5,Extracted,"A 40-year-old female with a 5-year history of opium abuse presented with 6-month history of fatigue, low back pain, and menometrorrhagia. She had no previous history of any specific medical condition. Physical examination was normal and no abdominal tenderness, organ enlargement, or palpable masses were identified.
Laboratory tests revealed an elevated ESR (70 mm/h) and anemia with hemoglobin of 10.2. Urine analysis was normal. Serum creatinine was elevated (2.5). The tumor markers (CEA, CA125, LDH, αFP, and βHCG) were within normal limits. The results of the other biochemical screenings and electrolyte tests were all within normal range.
Ultrasonography revealed bilateral moderate hydronephrosis without ureteral dilation. On abdominal and pelvic CT, fibrotic tissue was observed surrounding the abdominal aorta and common iliac arteries at the level of the sacral promontory. A double-J stent was inserted and the patient began taking an NSAID (ibuprofen 400 mg q 8 h) and prednisolone (1 mg/kg/day) for approximately 6 weeks. She was also advised to stop using opium. After 9 months, the NSAID and prednisolone were tapered off, and improvements in the patient’s clinical manifestation and radiologic and laboratory findings were observed.","Using the 2021 CKD-EPI Creatinine equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [40, 'years'], 'creatinine': [2.5, 'mg/dL'], 'sex': 'Female'}",24.32306,23.10691,25.53921,"The formula for computing GFR is 142 x (Scr/A)**B x 0.9938**age x (gender_coeffcient), where the ** indicates an exponent operation, Scr is the concentration of serum creatinine in mg/dL and gender_coefficient is 1.012 if the patient is female, else the coeffient is 1. The coefficients A and B are dependent on the patient's gender and the patient's creatinine concentration.
The patient is 40 years old. The patient's gender is Female, and so the patient's gender coefficient is 1.012.
The concentration of Serum Creatinine is 2.5 mg/dL. Because the patient's gender is female and the creatinine concentration is greater than or equal to 0.7 mg/dL, A = 0.7 and B = -1.2.
Plugging in these values, we get 142 * (2.5/0.7)**-1.2 * 0.9938**40 * 1.012 = 24.32306.
Hence, the GFR value is 24.32306 ml/min/1.73 m²."
26,3,CKD-EPI Equations for Glomerular Filtration Rate,lab test,decimal,pmc-6854950-1,Extracted,"A 35-year-old Japanese man with a history of renal disease presented to a dermatology clinic with sudden onset of a purpuric rash on his lower extremities () and was diagnosed with anaphylactoid purpura. Although he was asymptomatic, proteinuria, and haematuria were detected during a screening test when he was 20 years old, and he was diagnosed with IgAN based on renal biopsy. Histopathological examination of renal biopsy specimens revealed mild mesangial proliferation (). Immunohistochemical examination revealed mesangial IgA (), IgG and C3 () depositions, and he was treated with corticosteroids. Thereafter, he moved to our city and continued to be treated here. Corticosteroids treatment was continued for 7 years and was subsequently tapered.
Physical examination following the appearance of purpura revealed purpuric rash without any pitting oedema on his legs. Blood pressure was 147/78 mmHg. Urinalysis showed (+++) urinary protein, no urinary glucose, 6–10 red blood cells/high power field, urinary protein was 1.4 g/g creatinine (Cr). A peripheral blood smear showed a white blood cell (WBC) count of 12,100 cells/mm3, red blood cell of 5.16 million cells/mm3, and platelets 192,000 cells/mm3. Serum haemoglobin was 16.6 g/dL and haematocrit 45.4%. Blood chemistry showed total serum protein 7.2 g/dL, serum albumin 4.2 g/dL, serum sodium 141 mEq/L, potassium 4.3 mEq/L, chloride 105 mEq/L, serum Cr 1.35 mg/dL, serum aspartate aminotransferase 21 IU/L, serum alanine aminotransferase 28 IU/L, blood glucose 96 mg/dL, glycosylated haemoglobin 4.8%, and serum C-reactive protein (CRP) 1.57 mg/dL. Immunological examination showed an antistreptolysin O (ASO) titer 24 IU/mL, IgG 1095 mg/dL, IgA 315 mg/dL, IgM 133 mg/dL, C3 164 mg/dL, C4 35 mg/dL, and CH50 67.0 U/mL. A month before the appearance of purpura urinalysis revealed (++) protein, absence of haematuria, urinary protein level of 0.73 g/gCr, and serum Cr level of 1.10 mg/dL. Two months thereafter, purpura subsided, and his urinary protein level and serum Cr level were restored to the former levels. Skin biopsy was not performed because his purpura was typical for anaphylactoid purpura.","Using the 2021 CKD-EPI Creatinine equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [35, 'years'], 'creatinine': [1.35, 'mg/dL'], 'sex': 'Male'}",70.21721,66.70635,73.72807,"The formula for computing GFR is 142 x (Scr/A)**B x 0.9938**age x (gender_coeffcient), where the ** indicates an exponent operation, Scr is the concentration of serum creatinine in mg/dL and gender_coefficient is 1.012 if the patient is female, else the coeffient is 1. The coefficients A and B are dependent on the patient's gender and the patient's creatinine concentration.
The patient is 35 years old. The patient's gender is Male, and so the patient's gender coefficient is 1.0.
The concentration of Serum Creatinine is 1.35 mg/dL. Because the patient's gender is male and the creatinine concentration is greater than or equal to 0.9 mg/dL, A = 0.9 and B = -1.2.
Plugging in these values, we get 142 * (1.35/0.9)**-1.2 * 0.9938**35 * 1.0 = 70.21721.
Hence, the GFR value is 70.21721 ml/min/1.73 m²."
27,3,CKD-EPI Equations for Glomerular Filtration Rate,lab test,decimal,pmc-6559183-1,Extracted,"A 78-year-old man underwent open surgical repair of Crawford type III thoracoabdominal aortic aneurysm because its maximal diameter increased from 49 to 60 mm during 2 years of follow-up (). He had no major associated illness except for chronic renal dysfunction, with a serum creatinine concentration of 2.5 mg/dL. Under general anesthesia, the thoracoabdominal aorta was replaced via a left thoracoabdominal incision through the seventh intercostal space. Left femorofemoral partial cardiopulmonary bypass was performed for distal aortic perfusion, and the visceral branches were selectively perfused at the flow rate of 100 mL/min for each branch. As the most distal segment of the thoracic aorta had not experienced aneurysmal changes, the thoracic aorta and abdominal aorta were separately replaced with 2 grafts: a 26-mm tube graft (Gelweave; Vascutek, Inchinnan, UK) for the thoracic aorta and a 26-mm 4-branch graft (Gelweave Coselli, Vascutek) for the abdominal aorta (). The duration of cardiopulmonary bypass was 63 minutes and the entire operation took 280 minutes.
The patient quickly regained consciousness without any neurological deficits and could be extubated at 10 hours after the operation. However, oliguric renal failure developed, necessitating continuous renal replacement therapy, which was changed to intermittent hemodialysis starting on postoperative day (POD) 6. After being transferred to the general ward on POD 7, he had to remain in the hospital because of general weakness and poor oral intake. Postoperative computed tomographic (CT) imaging, which is usually taken before POD 7 at Seoul National University Bundang Hospital, was deferred for fear of aggravating the patient’s renal dysfunction, which could be reversible. An arteriovenous fistula for dialysis access was made at the left forearm on day 29.
On POD 49, the patient developed fever and abdominal pain. After noticing rapidly progressing abdominal distension, CT angiography was immediately performed, and revealed a large amount of retroperitoneal hematoma around the prosthetic graft. Extravasation of the contrast agent was noted (). The branch graft connected to the left renal artery was not visualized. With those findings, the most probable diagnosis was considered to be dehiscence of the left renal artery graft.
The patient was directly transferred to the operating room for exploration. In contrast to our interpretation of the CT images, a 2-mm-long linear tear was found at the prosthetic graft at a location in direct contact with a sharp bony spur protruding from the second lumbar vertebral body (). After repairing the tear with a pledget-buttressed 4-0 polypropylene suture in a horizontal mattress manner, a retroperitoneal fat flap was interposed between the graft and the bony spur. The patient stayed in the intensive care unit for 3 more days and then remained hospitalized for 4 months. There was no further event during 2 years of subsequent follow-up. On a retrospective review of the CT images, we confirmed the presence of the vertebral bony spur, which had not drawn any attention from the surgeons and radiologists before the second operation ().
Informed consent was acquired from the patient.","Using the 2021 CKD-EPI Creatinine equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [78, 'years'], 'creatinine': [2.5, 'mg/dL'], 'sex': 'Male'}",25.65504,24.37229,26.93779,"The formula for computing GFR is 142 x (Scr/A)**B x 0.9938**age x (gender_coeffcient), where the ** indicates an exponent operation, Scr is the concentration of serum creatinine in mg/dL and gender_coefficient is 1.012 if the patient is female, else the coeffient is 1. The coefficients A and B are dependent on the patient's gender and the patient's creatinine concentration.
The patient is 78 years old. The patient's gender is Male, and so the patient's gender coefficient is 1.0.
The concentration of Serum Creatinine is 2.5 mg/dL. Because the patient's gender is male and the creatinine concentration is greater than or equal to 0.9 mg/dL, A = 0.9 and B = -1.2.
Plugging in these values, we get 142 * (2.5/0.9)**-1.2 * 0.9938**78 * 1.0 = 25.65504.
Hence, the GFR value is 25.65504 ml/min/1.73 m²."
28,3,CKD-EPI Equations for Glomerular Filtration Rate,lab test,decimal,pmc-8454243-1,Extracted,"A 70-year-old man was referred to our institution because of abdominal distention and vomiting that started 2 days prior to admission. The patient was undergoing hemodialysis for chronic nephritis, and his past history included hypertension, chronic heart failure, and arterial sclerosis. He was never a smoker and had no history of abdominal surgery or nonsteroidal anti-inflammatory drug use. Upon hospitalization, the patient's blood pressure was 104/57 mm Hg, heart rate was 78 beats/min, and body temperature was 36.5°C. Physical examination revealed mild tenderness and swelling in the lower abdomen; the bowel sounds were enhanced. No purpura was found, which is characteristic of Henoch-Schönlein purpura.
A blood test performed on admission revealed mild anemia (hemoglobin 11.2 g/dL), hypoalbuminemia (2.6 g/dL), mildly elevated C-reactive protein (3.24 mg/dL), and elevated serum creatinine (5.24 mg/dL) levels. The stool culture test results were negative. Tuberculosis and anisakiasis were ruled out by interferon-gamma releasing assays and anisakis antibody tests, respectively.
Abdominal radiography in the standing position revealed dilatation of the small intestine and air-fluid levels in the intestine (shown in Fig. ); plain computed tomography (CT) showed a stenotic site with wall thickening and dilatation of the small intestine on the oral side from the stenosis (shown in Fig. ). After admission, we inserted an ileus tube to ameliorate the elevated intraluminal pressure. Contrast medium from the tube showed a stricture at the end of the ileum (shown in Fig. ). We conducted TUS using Sonazoid TM and elastography techniques, which demonstrated a thickened wall and unclear stratification of the intestinal wall in the lower right abdomen (shown in Fig. ). The length of stricture was 70 mm, and the minimum lumen diameter was 5 mm. The small intestine on the oral side of the lesion was markedly dilated. Contrast-enhanced ultrasonography showed sufficient mucosal blood flow in the stenotic lesion (Fig. ). Ultrasound elastography revealed lower elasticity of the intestinal lesion site than the elasticity of other intact parts of the small intestine that did not show wall thickening or stenosis (strain ratio [local deformation ratio under slight pressure]: 2.52) (Fig. ). Based on these findings, the patient was clinically diagnosed with IE. Conservative therapies including fasting and total parenteral nutrition were initiated after the diagnosis; however, the patient's condition did not improve.
Surgery was performed, and the stenotic lesion was surgically resected. Macroscopic findings of the resected ileum demonstrated circumferential ulceration and stricture. Microscopic findings demonstrated penetration of the surrounding tissue and infiltration of inflammatory cells mainly in the mucosal layer. The venules in the submucosal layer were occluded by hyalinization (shown in Fig. ). Two days after the operation, the patient started oral intake without the recurrence of IE and was discharged from our hospital 1 month later. There was no relapse when the patient was last assessed 1 year postoperatively.","Using the 2021 CKD-EPI Creatinine equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'age': [70, 'years'], 'creatinine': [5.24, 'mg/dL']}",11.09459,10.53986,11.64932,"The formula for computing GFR is 142 x (Scr/A)**B x 0.9938**age x (gender_coeffcient), where the ** indicates an exponent operation, Scr is the concentration of serum creatinine in mg/dL and gender_coefficient is 1.012 if the patient is female, else the coeffient is 1. The coefficients A and B are dependent on the patient's gender and the patient's creatinine concentration.
The patient is 70 years old. The patient's gender is Male, and so the patient's gender coefficient is 1.0.
The concentration of Serum Creatinine is 5.24 mg/dL. Because the patient's gender is male and the creatinine concentration is greater than or equal to 0.9 mg/dL, A = 0.9 and B = -1.2.
Plugging in these values, we get 142 * (5.24/0.9)**-1.2 * 0.9938**70 * 1.0 = 11.09459.
Hence, the GFR value is 11.09459 ml/min/1.73 m²."
29,3,CKD-EPI Equations for Glomerular Filtration Rate,lab test,decimal,pmc-6988719-1,Extracted,"A 53-year-old Hispanic male with poorly controlled diabetes, hemodialysis for two years, and coronary artery bypass grafting 10 months previously, developed redness pain and swelling of the medial aspect of both legs two days prior to admission. This occurred in a symmetrical fashion and extended from the upper one-third of the calf to the mid-thigh. The patient had difficulty walking secondary to pain. He had undergone saphenous vein harvesting from these areas for his coronary artery bypass graft (CABG). The patient denied trauma to the lower extremities, fevers, chills, and rigors. His medications include paricalcitol, sevelamer, calcium acetate, aspirin, amiodarone, amlodepine, simvastatin, and humilin 70/30.
Physical examination showed extensive erythema involving the inner aspect of the thighs down to the medial upper one-third of the calf on both sides (Figures -). Skin lesions were warm and very tender to touch, but there was no induration. Initial laboratory examination revealed white count 9,500 with 70% neutrophils, erythrocyte sedimentation rate of 87 mm/hr, C-reactive protein 11.6 mg/dl, blood urea nitrogen (BUN) 57 mg/dl, creatinine 11.3 mg/dl, calcium 9.8 mg/dl, albumin 3 gm/dl, prothrombin time (PT) 11.3 sec, international normalized ratio (INR) 1.1, and activated partial thromboplastin time (aPTT) 30.3 sec.
He was treated with intravenous vancomycin and ceftriaxone. By day three, moderate induration had developed, there were no signs of improvement, and the intensity of pain worsened. CT scan of both lower extremities was not consistent with necrotizing fasciitis and repeat labs showed a white count 15,700, with 75% neutrophils, and C-reactive protein 48 mg/dl, calcium 9.76 mg/dl, phosphorus 12.5 mg/dl (first time obtained). He required a patient-controlled analgesia (PCA) pump to control his pain with little improvement. His antibiotics were changed to linezolid, tobramycin, and levofloxacin. On the fourth day, there was an increased induration of the thighs with rock hard consistency of the tissue. Skin biopsy was performed showing deposition of calcium in the small blood vessels of the skin, areas of fat necrosis with foamy histiocytes, and neutrophils consistent with calciphylaxis (Figures -). Parathyroid hormone level (PTH) was 628 pg/ml.
He received daily dialysis with intravenous sodium thiosulfate given post dialysis for three days. His calcium-containing phosphate binders and paricalcitol were stopped; dosage was increased for sevelamer and lanthanum carbonate, another phosphate binder, was added to lower phosphorus levels. The patient’s pain, redness, swelling and induration improved over the next three days and his calcium was 8.5 gm/dl and phosphorus 7.3 mg/dl at the time of discharge.","Using the 2021 CKD-EPI Creatinine equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'age': [53, 'years'], 'creatinine': [11.3, 'mg/dL']}",4.90379,4.6586,5.14898,"The formula for computing GFR is 142 x (Scr/A)**B x 0.9938**age x (gender_coeffcient), where the ** indicates an exponent operation, Scr is the concentration of serum creatinine in mg/dL and gender_coefficient is 1.012 if the patient is female, else the coeffient is 1. The coefficients A and B are dependent on the patient's gender and the patient's creatinine concentration.
The patient is 53 years old. The patient's gender is Male, and so the patient's gender coefficient is 1.0.
The concentration of Serum Creatinine is 11.3 mg/dL. Because the patient's gender is male and the creatinine concentration is greater than or equal to 0.9 mg/dL, A = 0.9 and B = -1.2.
Plugging in these values, we get 142 * (11.3/0.9)**-1.2 * 0.9938**53 * 1.0 = 4.90379.
Hence, the GFR value is 4.90379 ml/min/1.73 m²."
30,3,CKD-EPI Equations for Glomerular Filtration Rate,lab test,decimal,pmc-2275218-1,Extracted,"A 35 year old female with SCD, presented with pedal and periorbital edema, distension of abdomen, decreased urine output and dyspnoea on exertion since 1 month. On examination, she was pale, with pulse rate of 100/minute, normal temperature, and blood pressure was 160/100 mm Hg. Her abdomen was distended due to moderate ascites however there was no organomegaly/scars. Cardio-respiratory and neurological examination was unremarkable. Ultrasonography showed right kidney, 10.9 × 6.0 cm, left kidney of 11.4 × 5.8 cm, with increased echogenicity and maintained cortico-medullary differentiation. Moderate ascites was present.
On investigations, urine albumin was 500 mg/24 hours, microscopy showed 30–40 pus cells and 3–5 granular casts/high power field, urine culture was sterile, serum creatinine, 7.0 mg/dL, serum proteins, 4.5 gm/dL; serum albumin, 1.8 gm%, serum bilirubin was 0.5 mg/dL, serum alanine amino transferase was 16 units/L, random blood sugar was 87 mg/dL, serum uric acid was 7.5 mg/dL, serum sodium was 134 meq/L and serum potassium, 5.5 meq/L and positive sickling test was noted at 24 hours. Her hemoglobin was 7.1 gm/dL; total leucocyte count was 7,700/cmm with differential count showing neutrophils, 76%, lymphocytes, 20% and eosinophils and monocytes, each, 2%. Peripheral smear showed few crenated and sickled cells with mild hypochromia and anisopoikylocytosis.
She was dialyzed and 2 units of packed cells were transfused. Renal biopsy was performed and after paraffin embedding, 3 micrometer sections were taken and stained using Hematoxylin and eosin, Periodic Acid Schiff, Jone's silver methaneamine and Gomori's trichrome stains. Indirect immunofluorescence studies were performed using anti-human IgG, IgM, IgA, C1q, C3, albumin and fibrinogen anti-sera (DAKO, USA). Histopathology revealed one core with 13 glomeruli. All of them were moderately enlarged in size and 11 had exuberant and occasionally circumferential cellular (rarely fibrocellular) crescents occupying 70–90% urinary spaces, occasionally replacing capillary tufts and shrinking or pushing the capillary tufts towards vascular poles (Figure ). Capillary tufts had fairly open lumina lined by membranes with occasional reduplication, thickening/rupture. There was uniform moderate mesangial prominence. Capillaries and crescents were infiltrated by few sickle shaped, dysmorphic RBCs, platelet/fibrin thrombi. Afferent and efferent arterioles were filled with sickled RBCs. Bowman capsules were segmentally thickened and occasionally ruptured evoking periglomerular leucocytic reaction. Tubules were moderately degenerated and filled with cellular casts and rarely RBCs. Focal atrophy was also evident. Interstitium was moderately prominent for focal fibrosis and overlying focal mononuclear cellular infiltration with admixed neutrophils. Peri-tubular capillaries were dilated and filled with sickled RBCs (Figure ). At least one medium caliber and two small caliber arteries showed lumina filled with trapped dysmorphic RBCs.
Immunofluorescence studies showed fine granular fluorescence (+2) across 60–80% mesangial regions and adjacent capillaries of all glomeruli on staining with anti-human C3 and (trace/+1) with anti-human IgG, C1q and fibrinogen antisera (Figure ). Subsequently she was investigated for vasculitis and lupus nephritis. Indirect immunofluorescence and ELISA revealed anti-nuclear antibodies, (normal index: <1, test: 8.5), anti-dsDNA antibodies were >200 IU/mL (normal <25 IU/mL, Orgentec, Germany). Anti-neutrophil cytoplasmic antibodies were absent. Final diagnosis was made as SCN with DPLN, ISN/RPS class IV-G (A).
Hemoglobin variant study using High Performance Liquid Chromatography (d-10, Biorad, USA) was performed 5 days after transfusion which showed HbSA of 6.9% (Figure ).
She was treated with Methylprednisolone 500 mg, intravenously for 3 days and Cyclophosphamide, 500 mg intravenously immediately and dose was repeated after 21 days. Then she was switched over to oral Prednisolone, 40 mg/day. Hemodialysis was done on alternate days for 21 days. At follow-up of 2 months, she is on maintenance dialysis with urine output of less than 400 ml/day.","Using the 2021 CKD-EPI Creatinine equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'age': [35, 'years'], 'creatinine': [7.0, 'mg/dL']}",7.29346,6.92879,7.65813,"The formula for computing GFR is 142 x (Scr/A)**B x 0.9938**age x (gender_coeffcient), where the ** indicates an exponent operation, Scr is the concentration of serum creatinine in mg/dL and gender_coefficient is 1.012 if the patient is female, else the coeffient is 1. The coefficients A and B are dependent on the patient's gender and the patient's creatinine concentration.
The patient is 35 years old. The patient's gender is Female, and so the patient's gender coefficient is 1.012.
The concentration of Serum Creatinine is 7.0 mg/dL. Because the patient's gender is female and the creatinine concentration is greater than or equal to 0.7 mg/dL, A = 0.7 and B = -1.2.
Plugging in these values, we get 142 * (7.0/0.7)**-1.2 * 0.9938**35 * 1.012 = 7.29346.
Hence, the GFR value is 7.29346 ml/min/1.73 m²."
31,3,CKD-EPI Equations for Glomerular Filtration Rate,lab test,decimal,pmc-3927191-1,Extracted,"A 28-year-old male patient presented with the complaints of generalized weakness and exertional dyspnea of 1 month duration. He did not give a history of frothing of urine, pedal edema, hematuria or breathlessness in the past. Clinically he appeared pale and dehydrated, blood pressure was 120/80 mmHg and systemic examination was unremarkable. Investigations revealed that he had normocytic normochromic anemia (hemoglobin: 7.5 g/dl), thrombocytopenia (80,000/cumm) with normal leukocyte count (7400/cumm), moderate renal failure (serum creatinine: 3 mg/dl), normal liver function tests (serum albumin: 4.92 g/dl and serum globulin: 2.4 g/dl), and normal serum electrolytes, serum calcium: 10 mg/dl, serum phosphorous: 4.7 mg/dl and elevated serum uric acid (9.5 mg/dl). Urine examination showed proteinuria 1+ on dipstick, 24 h urine protein was 8504 mg. With a high index of suspicion for a tubular proteinuria, along with a hypo proliferative marrow (reticulocyte productive index: 0.7%), the possibility of plasma cell dyscrasia was considered. Serum protein electrophoresis and urine Bence Jones protein were negative. Serum immunofixation using capillary method showed immunoglobulin G, kappa monoclonal immunoglobulin. Urine electrophoresis showed M band and serum free light chain (SFLC) assay showed a significantly elevated kappa level (4383 mg/l; normal range: 3.3-19.4) with a suppressed lambda level (4.5 mg/l; normal range: 5.7-26.3), kappa/lamba ratio was 974 (normal range in renal failure: 0.37-3.1). Skeletal survey did not show any evidence of lytic lesions. BM biopsy done showed 79% of plasma cells with plasmablastic morphology [], which were CD138 positive with kappa restriction. These atypical cells showed Ki 67% of 20-25% with very few cells positive for terminal deoxynucleotidyl transferase and CD79a was negative, which suggested plasmablastic myeloma phenotype. Fluorescence in-situ hybridization on BM was negative for del13q14.3, t (11;14), t (4;14), t (14;16). Renal function deteriorated rapidly; he underwent a renal biopsy, which showed pale eosinophilic, Schiff poor fractured casts in the renal tubules [], which were kappa restricted.
He was started on chemotherapy, with each 21 days cycle consisting of parenteral bortezomib (1.3 mg/m2/dose on days 1, 4, 8 and 11) and oral dexamethasone (40 mg/day on days 1-4, 9-12). After the first cycle of bortezomib and dexamethasone, his renal functions started to improve. He was started on lenalidomide 25 mg/day at cycle 2 (when renal function started to improve) along with bortezomib and dexamethasone. With this intensive chemotherapy, his renal functions improved further (serum creatinine 1.77 mg/dl at 6 weeks).
Patient was reevaluated after four cycles of chemotherapy with BM examination and free light chain assay. BM showed less than 1% of plasma cells and serum free kappa light chain was 67.69 mg/l. Serum creatinine improved to 1.4 mg/dl at 6 months and he was planned for autologous peripheral blood stem cell transplantation (APBSCT). However, due to technical delay, he was given additional two cycles of CyBorD chemotherapy (weekly cyclophosphamide, bortezomib and dexamethasone). Patient then underwent APBSCT with Melphalan conditioning 140 mg/m2. Post-transplant patient achieved neutrophil and platelet engraftment on day +9 and did not encounter any infections. Day +100 evaluation showed serum creatinine to be 1.3 mg/dl and he was in stringent complete remission (negative serum and urine immunofixation and normal SFLC ratio).","Using the 2021 CKD-EPI Creatinine equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'age': [28, 'years'], 'creatinine': [3.0, 'mg/dL']}",28.13233,26.72571,29.53895,"The formula for computing GFR is 142 x (Scr/A)**B x 0.9938**age x (gender_coeffcient), where the ** indicates an exponent operation, Scr is the concentration of serum creatinine in mg/dL and gender_coefficient is 1.012 if the patient is female, else the coeffient is 1. The coefficients A and B are dependent on the patient's gender and the patient's creatinine concentration.
The patient is 28 years old. The patient's gender is Male, and so the patient's gender coefficient is 1.0.
The concentration of Serum Creatinine is 3.0 mg/dL. Because the patient's gender is male and the creatinine concentration is greater than or equal to 0.9 mg/dL, A = 0.9 and B = -1.2.
Plugging in these values, we get 142 * (3.0/0.9)**-1.2 * 0.9938**28 * 1.0 = 28.13233.
Hence, the GFR value is 28.13233 ml/min/1.73 m²."
32,3,CKD-EPI Equations for Glomerular Filtration Rate,lab test,decimal,pmc-4381148-1,Extracted,"A 65-year-old woman was referred for colonoscopy because of abdominal pain and hematochezia. She had a history of end-stage renal disease, hypertension, and diabetes mellitus. She underwent hemodialysis three times per week. The patient's hemodynamic parameters were stable. On physical examination, she was found to have right abdominal pain and tenderness. Laboratory tests revealed a white blood cell (WBC) count of 13,900/mm2, a hemoglobin level of 9.4 g/dL, and a platelet count of 228,000/mm2. Serum biochemistry showed creatinine level, 6.6 mg/dL; albumin level, 3.0 g/dL; alanine aminotransferase level, 36 IU/L; aspartate aminotransferase level, 38 IU/L; bilirubin level, 1.2 mg/dL; and alkaline phosphatase level, 198 IU/L with normal electrolytes. Serum was negative for antinuclear antibody and HIV antibody. Anemia was associated with chronic renal failure. On stool examination, negative results were obtained for stool WBC, stool culture, and Clostridium difficile toxin A/B. The electrocardiogram showed normal results. An esophagogastroduodenoscopy revealed no evidence of bleeding. Colonoscopy was performed after standard bowel preparation and under sedation with 3 mg of midazolam. The colonoscopic findings showed diffuse bowel wall edema. Upon examination of the distal transverse colon, we found several deep linear red mucosal breaks resembling scratches ().
In the ascending colon, dark purple edematous mucosa and necrotic epithelial lesions were found (). Cecal intubation was not performed because of severe ischemic changes with necrosis. The remaining colorectal mucosa was grossly normal. Computed tomography (CT) scan showed moderate-to-severe diffuse bowel wall thickening and focally decreased mucosal enhancement in the right colon. The patient was diagnosed with ischemic colitis based on colonoscopic and CT findings, and clinical manifestations. The patient thus received supportive care. Intravenous fluids were administered to treat dehydration, and total parenteral nutrition with prophylactic antibiotics was provided. The patient was placed on bowel rest until the symptoms resolved. After 3 weeks, follow-up colonoscopy and CT were performed. On follow-up colonoscopy, the previous severe ischemic colonoscopic findings had disappeared, and ischemic mucosal change showed further resolution (). No further mucosal tearing was observed during the follow-up colonoscopy. On CT scans, improvement in ischemic colitis was noted. The patient no longer complained of abdominal pain or hematochezia.","Using the 2021 CKD-EPI Creatinine equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [65, 'years'], 'creatinine': [6.6, 'mg/dL'], 'sex': 'Female'}",6.49484,6.1701,6.81958,"The formula for computing GFR is 142 x (Scr/A)**B x 0.9938**age x (gender_coeffcient), where the ** indicates an exponent operation, Scr is the concentration of serum creatinine in mg/dL and gender_coefficient is 1.012 if the patient is female, else the coeffient is 1. The coefficients A and B are dependent on the patient's gender and the patient's creatinine concentration.
The patient is 65 years old. The patient's gender is Female, and so the patient's gender coefficient is 1.012.
The concentration of Serum Creatinine is 6.6 mg/dL. Because the patient's gender is female and the creatinine concentration is greater than or equal to 0.7 mg/dL, A = 0.7 and B = -1.2.
Plugging in these values, we get 142 * (6.6/0.7)**-1.2 * 0.9938**65 * 1.012 = 6.49484.
Hence, the GFR value is 6.49484 ml/min/1.73 m²."
33,3,CKD-EPI Equations for Glomerular Filtration Rate,lab test,decimal,pmc-5563407-1,Extracted,"A 70-year-old white woman with a renal transplant performed nine years ago arrived at the emergency room with a dry cough and minimal activity dyspnea. She had no fever, expectoration, or chest pain.
She had been diagnosed with hypertension and dyslipidemia and the origin of the kidney disease was unknown. Before transplantation in 2007, she received hemodialysis for two years due to a right brachiocephalic fistula. In 2012, the brachiocephalic fistula was closed as a consequence of an aneurysm and during the last year she suffered from local pain which was treated with pregabalin and opiates, with no local complications observed. The immunosuppression drugs administered to the patient were tacrolimus, mycophenolate mofetil, and steroids. The renal function remained stable with a serum creatinine level of 1.4 mg/dL (normal range: 0.6–1.2 mg/dL). After transplantation, she suffered from continuous urinary tract infections that were treated with antibiotics, and after a urologic evaluation in 2012, a left kidney nephrectomy was performed because of a pyelonephritis. In March 2015, an anterior colporrhaphy and posterior perineoplasty were also performed to correct a cystocele.
In March 2016, at admission, blood pressure was 159/92 mmHg, temperature was 36°C, and arterial oxygen saturation was 94%. A clinical examination revealed 20 breaths per minute, wheezing and basal hypoventilation, fistula pain, and ankle swelling. The rest of the physical examination was strictly normal with no local findings in the AV-fistula area. Lab tests showed normal C-reactive protein level of 0.77 mg/dL (normal range: 0.0–1.0 mg/dL), serum creatinine of 1.38 mg/dL, and leucocytes count of 7670 (normal range: 4000–11500); PCR herpes viruses 6, 7, and 8 were negative and so were galactomannan antigen, H1N1, and influenza B virus smear. Blood and urine culture were negative as well as cytomegalovirus PCR.
The initial workup showed a diffuse interstitial-alveolar pattern in the chest radiography and hence a piperacillin-tazobactam and a bronchodilator treatment was initiated. The first CT revealed peripheral bilateral infiltrates and minimum pleural effusion. After completing antibiotic therapy, the patient did not improve and a bronchoscopy was performed which showed no atypical cells or signs of infection. BAL and pleural effusion were also tested and were negative for infection and showed no malignancy. A second CT revealed worsening of the infiltrates and pleural thickening which suggested neoplasia. A pulmonary biopsy by videothoracoscopy was performed. It was of an excellent quality and revealed a good representation of the pleura (parietal and visceral), pulmonary parenchyma, vascular areas, and airways.
A first examination of the histologic sections showed a tumor characterized by atypical cells with vascular affectation that invaded the visceral pleura. There were multiple nodular neoformations with hemorrhagic areas showing a circumferential growth that affected blood vessels and bronchioles, which extended to adjacent areas and to the subpleural pulmonary interstitium. Vimentin stain, CD34, CD31, and VIII factor all resulted to be positive. The expression of herpes virus 8 was negative. These results suggested a metastatic mesenchymal tumor. Subsequently, a right arm arteriography revealed a 7 cm mass in the brachiocephalic fistula (Figures and ) and a biopsy was performed that was compatible with epitheliod angiosarcoma (). The diagnosis of an arteriovenous fistula angiosarcoma with pulmonary metastasis was carried out.","Using the 2021 CKD-EPI Creatinine equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [70, 'years'], 'creatinine': [1.38, 'mg/dL'], 'sex': 'Female'}",41.1776,39.11872,43.23648,"The formula for computing GFR is 142 x (Scr/A)**B x 0.9938**age x (gender_coeffcient), where the ** indicates an exponent operation, Scr is the concentration of serum creatinine in mg/dL and gender_coefficient is 1.012 if the patient is female, else the coeffient is 1. The coefficients A and B are dependent on the patient's gender and the patient's creatinine concentration.
The patient is 70 years old. The patient's gender is Female, and so the patient's gender coefficient is 1.012.
The concentration of Serum Creatinine is 1.38 mg/dL. Because the patient's gender is female and the creatinine concentration is greater than or equal to 0.7 mg/dL, A = 0.7 and B = -1.2.
Plugging in these values, we get 142 * (1.38/0.7)**-1.2 * 0.9938**70 * 1.012 = 41.1776.
Hence, the GFR value is 41.1776 ml/min/1.73 m²."
34,3,CKD-EPI Equations for Glomerular Filtration Rate,lab test,decimal,usmle-4906,Extracted,"A 58-year-old man presents to the emergency department with rapid onset of severe pain and swelling in his right great toe overnight. He reports experiencing a similar episode several years ago but cannot recall the diagnosis or the medication he was given for treatment. His medical history is significant for hyperlipidemia, poorly controlled diabetes, and stage 3 chronic kidney disease. Laboratory studies are ordered as seen below.

Serum:
Na+: 139 mEq/L
Cl-: 101 mEq/L
K+: 5.9 mEq/L
HCO3-: 22 mEq/L
BUN: 20 mg/dL
Glucose: 259 mg/dL
Creatinine: 3.1 mg/dL

The interphalangeal joint of the right great toe is aspirated, with the synovial fluid aspirate shown under polarized light microscopy in Figure A.","Using the 2021 CKD-EPI Creatinine equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'age': [58, 'years'], 'creatinine': [3.1, 'mg/dL']}",22.44331,21.32114,23.56548,"The formula for computing GFR is 142 x (Scr/A)**B x 0.9938**age x (gender_coeffcient), where the ** indicates an exponent operation, Scr is the concentration of serum creatinine in mg/dL and gender_coefficient is 1.012 if the patient is female, else the coeffient is 1. The coefficients A and B are dependent on the patient's gender and the patient's creatinine concentration.
The patient is 58 years old. The patient's gender is Male, and so the patient's gender coefficient is 1.0.
The concentration of Serum Creatinine is 3.1 mg/dL. Because the patient's gender is male and the creatinine concentration is greater than or equal to 0.9 mg/dL, A = 0.9 and B = -1.2.
Plugging in these values, we get 142 * (3.1/0.9)**-1.2 * 0.9938**58 * 1.0 = 22.44331.
Hence, the GFR value is 22.44331 ml/min/1.73 m²."
35,3,CKD-EPI Equations for Glomerular Filtration Rate,lab test,decimal,usmle-5468,Extracted,"A 33-year-old woman presents to the emergency department after she found out she had a blood pressure of 165/100 mmHg at a local pharmacy. The patient is not followed by a primary care physician and is not currently taking any medications. She has no other complaints at this time. A bedside ultrasound with Doppler of the abdomen is within normal limits. Laboratory values are ordered as seen below.

Serum:
Na+: 139 mEq/L
Cl-: 100 mEq/L
HCO3-: 33 mEq/L
BUN: 20 mg/dL
Glucose: 99 mg/dL
Creatinine: 1.1 mg/dL
Ca2+: 10.2 mg/dL

The patient is given hydrochlorothiazide and sent home. An ECG performed at a subsequent follow up appointment is seen in Figure A.","Using the 2021 CKD-EPI Creatinine equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [33, 'years'], 'creatinine': [1.1, 'mg/dL'], 'sex': 'Female'}",68.04278,64.64064,71.44492,"The formula for computing GFR is 142 x (Scr/A)**B x 0.9938**age x (gender_coeffcient), where the ** indicates an exponent operation, Scr is the concentration of serum creatinine in mg/dL and gender_coefficient is 1.012 if the patient is female, else the coeffient is 1. The coefficients A and B are dependent on the patient's gender and the patient's creatinine concentration.
The patient is 33 years old. The patient's gender is Female, and so the patient's gender coefficient is 1.012.
The concentration of Serum Creatinine is 1.1 mg/dL. Because the patient's gender is female and the creatinine concentration is greater than or equal to 0.7 mg/dL, A = 0.7 and B = -1.2.
Plugging in these values, we get 142 * (1.1/0.7)**-1.2 * 0.9938**33 * 1.012 = 68.04278.
Hence, the GFR value is 68.04278 ml/min/1.73 m²."
36,3,CKD-EPI Equations for Glomerular Filtration Rate,lab test,decimal,pmc-6919406-1,Extracted,"A 70-year-old male suffered progressive generalized edema after consuming stale crabs, with only mild abdominal discomfort and no fever or other symptoms. Before this, he was healthy and did not have a history of digestive diseases, diabetes, or chronic obstructive pulmonary disease. The man was a native of Chongqing, the subtropical area in southwest China. He used to be a soldier; he fought in the Vietnam War and joined the police force after returning to his hometown.
In the hospital, his initial vitals were BP 108/78 mmHg, HR 111, respiratory rate 22, and oxygen saturation 98%. Initial laboratories included white blood cells 13.32 × 109/L (neutrophils% 77.5%; lymphocytes% 13.31%; eosinophils% 0.5%), normal hemoglobin and platelets, albumin (ALB) 14.5 g/L, globulin (GLB) 19.9 g/L, alanine aminotransferase (ALT) 78.7 IU/L, aspartate aminotransferase (AST) 90.9 IU/L, creatinine (Cr) 134 μmol/L, 24-hour urine protein 9.61 g, and negative antinuclear antibody spectrum (ANAs) and anti-neutrophil cytoplasmic antibodies (ANCA). Chest X-ray showed mild emphysema but no sign of infection. The patient was diagnosed with nephrotic syndrome but was unable to undergo pathological biopsy due to a renal cyst. He was administered full-dose glucocorticoid therapy alone, with no other immunosuppression. Three weeks later, while still under this treatment, the patient suffered lower limb cellulitis. His procalcitonin (PCT) was 0.3 ng/ml, and he was administrated mupirocin ointment and IV cefuroxime. After those treatments, his status improved and he continued to take oral glucocorticoids after discharge from the hospital.
However, over the next ten days, the patient seemed to get worse and had to return to the hospital due to persistent fever, cough, and intermittent abdominal pain. Initial vitals on admission were temperature 37.8 °C, BP 90/60 mmHg, HR 125, respiratory rate 26, and oxygen saturation 95%. Laboratory tests showed white blood cells 12.36 × 109/L (neutrophils %: 83.5%; eosinophils %: 0.7%). Sputum smear and culture were negative. Imaging examinations included CT scans of the chest, which reported interstitial pneumonia (Fig. ), and the abdomen, which reported no specific findings. The patient was diagnosed with normal gastrointestinal discomfort and pulmonary bacterial infection. A proton pump inhibitor, cefoperazone sodium, and sulbactam sodium were administered. However, the patient then started display hemoptysis, passed occult blood-positive stool, and gradually fell into a state of hyperpyrexia and drowsiness. Soon, Klebsiella pneumoniae (which was sensitized to the previous antibiotic), and unexpectedly, a large number of S. stercoralis larvae (Fig. ) were found in repeated sputum specimens. Meanwhile, the parasite was also found in a repeated brown stool specimen. Blood samples showed eosinophils% reached 18.1% and PCT was 1.01 ng/ml. Because ivermectin is not available in our region, albendazole (400 mg/day) was administered for 3 consecutive days but there was no progress. Subsequently, a mechanical ventilator was administered due to continued severe hypoxia and respiratory failure. The patient was unable to maintain his blood pressure and eventually died after co-infection with S stercoralis hyperinfection and the K pneumoniae found 1 week later. The course of this case has been summarized in Figure . The authorized relative of patient has provided informed consent for publication of the case.","Using the 2021 CKD-EPI Creatinine equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [70, 'years'], 'creatinine': [134.0, 'µmol/L'], 'sex': 'Male'}",50.95345,48.40578,53.50112,"The formula for computing GFR is 142 x (Scr/A)**B x 0.9938**age x (gender_coeffcient), where the ** indicates an exponent operation, Scr is the concentration of serum creatinine in mg/dL and gender_coefficient is 1.012 if the patient is female, else the coeffient is 1. The coefficients A and B are dependent on the patient's gender and the patient's creatinine concentration.
The patient is 70 years old. The patient's gender is Male, and so the patient's gender coefficient is 1.0.
The concentration of Serum Creatinine is 134.0 µmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of Serum Creatinine from µmol to mg. The mass of Serum Creatinine is 134.0 µmol. To convert 134.0 µmol of Serum Creatinine to mol, multiply by the conversion factor 1e-06, giving us 134.0 µmol Serum Creatinine * 1e-06 mol/µmol = 0.00013 mol Serum Creatinine. To convert from mol Serum Creatinine to grams, multiply by the molar mass 113.12 g/mol, which will give 0.00013 mol Serum Creatinine * 113.12 g/mol = 0.01471 g Serum Creatinine. To convert 0.01471 g of Serum Creatinine to mg, multiply by the conversion factor 1000.0, giving us 0.01471 g Serum Creatinine * 1000.0 mg/g = 14.71 mg Serum Creatinine. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 14.71 mg Serum Creatinine/10.0 dL = 1.471 mg Serum Creatinine/dL. The concentration value of 134.0 µmol Serum Creatinine/L converts to 1.471 mg Serum Creatinine/dL. Because the patient's gender is male and the creatinine concentration is greater than or equal to 0.9 mg/dL, A = 0.9 and B = -1.2.
Plugging in these values, we get 142 * (1.471/0.9)**-1.2 * 0.9938**70 * 1.0 = 50.95345.
Hence, the GFR value is 50.95345 ml/min/1.73 m²."
37,3,CKD-EPI Equations for Glomerular Filtration Rate,lab test,decimal,pmc-6358402-1,Extracted,"A 62-year-old man with PL was found a right-side ureteral calculi by ultrasound in the routine health examination. Thirteen years ago, when he was diagnosed with PL, CT scan found a heavy hydronephrosis in the left side. So he had accepted an open surgery of uretero-vesical reimplantation in the left side, without necessary follow-up after the surgery. Three years ago, a severe hydronephrosis was observed in the left side and kidney stone in the right side in health examination, but he did not take any further treatment. This time, CT scan demonstrated a proliferation of adipose tissue predominantly in the pelvic space (Fig. ), a severe hydronephrosis in the left side and mild hydronephrosis along with a calculi in lower ureter in the right side (Fig. ). The intravenous urography showed that the upper urinary tract in left side was barely showed up, bladder was elevated and the upper urinary tract in right side was dilated slightly (Fig. ). Serum creatinine was 99 μmol/L, the count of white blood cell was 47 per microliter in urinalysis and the urine culture was negative.
During the surgery, patient in lithotomy position under general anesthesia, rigid ureteroscope was not able to reach into the bladder cavity due to the elongated bladder neck and elevated bladder base. So the cystoscopy was accomplished with flexible ureteroscope directly. However, the flexible ureteroscope failed to get into the right ureter with or without guidewire due to the stricture of uretero-vesical orifice. Finally, after several failed attempts of inserting a guidewire into kidney because of the tortuous lower ureter with calculi in right side and the difficulty to hold the position of flexible ureteroscope in bladder cavity, the guidewire passed the contortion of ureter and ureteral calculi. Then ureteral access sheath (UAS), in a size of 12/14Fr, was placed into the lower ureter in right side and the unbroken stone was basketed through UAS. The ureteral stent was placed routinely, and in consideration of the inconvenience to remove the stent, the wire on the stent was passed through the urethra and fixed on the catheter. Two weeks after the surgery, the catheter and the stent were removed together. A follow-up of 1 year showed that there was no progression of the hydronephrosis in right side and serum creatinine was stable.","Using the 2021 CKD-EPI Creatinine equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'age': [62, 'years'], 'creatinine': [99.0, 'µmol/L']}",73.4111,69.74054,77.08166,"The formula for computing GFR is 142 x (Scr/A)**B x 0.9938**age x (gender_coeffcient), where the ** indicates an exponent operation, Scr is the concentration of serum creatinine in mg/dL and gender_coefficient is 1.012 if the patient is female, else the coeffient is 1. The coefficients A and B are dependent on the patient's gender and the patient's creatinine concentration.
The patient is 62 years old. The patient's gender is Male, and so the patient's gender coefficient is 1.0.
The concentration of Serum Creatinine is 99.0 µmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of Serum Creatinine from µmol to mg. The mass of Serum Creatinine is 99.0 µmol. To convert 99.0 µmol of Serum Creatinine to mol, multiply by the conversion factor 1e-06, giving us 99.0 µmol Serum Creatinine * 1e-06 mol/µmol = 0.0001 mol Serum Creatinine. To convert from mol Serum Creatinine to grams, multiply by the molar mass 113.12 g/mol, which will give 0.0001 mol Serum Creatinine * 113.12 g/mol = 0.01131 g Serum Creatinine. To convert 0.01131 g of Serum Creatinine to mg, multiply by the conversion factor 1000.0, giving us 0.01131 g Serum Creatinine * 1000.0 mg/g = 11.31 mg Serum Creatinine. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 11.31 mg Serum Creatinine/10.0 dL = 1.131 mg Serum Creatinine/dL. The concentration value of 99.0 µmol Serum Creatinine/L converts to 1.131 mg Serum Creatinine/dL. Because the patient's gender is male and the creatinine concentration is greater than or equal to 0.9 mg/dL, A = 0.9 and B = -1.2.
Plugging in these values, we get 142 * (1.131/0.9)**-1.2 * 0.9938**62 * 1.0 = 73.4111.
Hence, the GFR value is 73.4111 ml/min/1.73 m²."
38,3,CKD-EPI Equations for Glomerular Filtration Rate,lab test,decimal,pmc-6309397-1,Extracted,"A 45-year-old male with a history of hypertension and chronic kidney disease (CKD) diagnosed concomitantly 2 years ago presented with acute onset rash [] and diffuse joint pains for 2 weeks. He denied any blood transfusions, intravenous drug abuse or high-risk sexual behavior. His medications included amlodipine and telmisartan. His blood pressure was 132/96 mm Hg, pulse rate 76/min and he had a diffuse erythematous maculopapular rash on the extensor surface of his lower extremities. His ankle joints were swollen, and movements were painful. He had 2+ bilateral pitting edema. His fundus examination was normal.
Initial laboratory investigations revealed hemoglobin of 9.4 g/dL with a normal platelet and white cell count. His S. Cr. was 1.9 mg/dL and electrolytes were normal. His liver enzymes were normal and serum albumin was 2.9 g/dL. His initial urinalysis showed 3 + protein, 6–10 red blood cell/hpf and 4–6 white blood cell/hpf. His ESR was mm in 1st hour 38 and C-reactive protein was normal. An ultrasound revealed normal sized kidneys and chest X-ray was normal. His 24 h urine showed protein excretion of 3.1 g. His anti-nuclear antibody (ANA), HBsAg and HIV antibody tests were negative. Complements C3 and C4 were both low at 0.63 and 0.03 g/L, respectively. His anti-HCV antibody was positive with an HCV RNA viral load of 4133209 IU/ml and HCV genotype 3a. Complement cryoglobulin and cryocrit was undetectable.
An ultrasound-guided kidney biopsy was performed which showed enlarged glomeruli, with a global increase in mesangial matrix and cellularity, along with lobular accentuation. There was thickening of glomerular basement membranes and double contouring []. Few hyaline thrombi were seen within the capillary lumen. Interstitium showed mild edema with foci of chronic mononuclear inflammatory infiltrate. Immunofluorescence showed strong granular staining for C3, IgG and IgM along the capillary wall and in mesangial areas. Electron microscopy (EM) could not be done. A diagnosis of immune-complex mediated MPGN pattern was made.
The patient was started on DAA drugs-sofosbuvir 400 mg and daclatasvir 60 mg once daily for 12 weeks. Telmisartan was increased to 40 mg twice a day. A repeat HCV RNA test done after 6 weeks was undetectable. His S. Cr. gradually decreased to 1–1.2 mg/dL range with spot urine protein: creatinine ratio being 0.3–0.5 mg and continued to be stable at 12-month follow-up. Repeat quantitative HCV RNA testing done at 6 months and 1 year follow-up continues to be in the undetectable level.","Using the 2021 CKD-EPI Creatinine equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'age': [45, 'years'], 'creatinine': [1.9, 'mg/dL']}",43.78544,41.59617,45.97471,"The formula for computing GFR is 142 x (Scr/A)**B x 0.9938**age x (gender_coeffcient), where the ** indicates an exponent operation, Scr is the concentration of serum creatinine in mg/dL and gender_coefficient is 1.012 if the patient is female, else the coeffient is 1. The coefficients A and B are dependent on the patient's gender and the patient's creatinine concentration.
The patient is 45 years old. The patient's gender is Male, and so the patient's gender coefficient is 1.0.
The concentration of Serum Creatinine is 1.9 mg/dL. Because the patient's gender is male and the creatinine concentration is greater than or equal to 0.9 mg/dL, A = 0.9 and B = -1.2.
Plugging in these values, we get 142 * (1.9/0.9)**-1.2 * 0.9938**45 * 1.0 = 43.78544.
Hence, the GFR value is 43.78544 ml/min/1.73 m²."
39,3,CKD-EPI Equations for Glomerular Filtration Rate,lab test,decimal,pmc-5394405-1,Extracted,"A healthy 18-year-old male was admitted due to kidney failure (serum creatinine: 3 mg/dL), proteinuria (1.89 g/day), and recent past episodes of intermittent macrohematuria. Urine smear disclosed 30–50 red blood cells per high power field (). Four months before admission, a routine blood exam had been within normal limits, except for a urinalysis that had shown 10 red blood cells per high power field. Past medical history was negative for prior upper respiratory tract infections or any infections of clinical relevance. At the time of admission, physical examination was normal; blood pressure was 110/70 mmHg. A renal ultrasound showed kidneys with normal shape and measurements with echogenic alterations, while all complementary serologic studies were noncontributory: blood, urine, and throat cultures, HIV, hepatitis B and C serologies, complement levels, p- and c-ANCA antibodies, antiglomerular basement membrane antibodies, and electrophoretic proteinogram. Podocyturia was performed as described previously []. Briefly, the podocyte count was assessed by counting in urinary smears the number of cells in 10 microscopy fields of ×20. The podocyte count was 2.1 cells per ×20 field and the number of podocytes per gram of urinary creatinine was 166 (). Podocytes were identified by tagging synaptopodin (ab109560 Alexa Fluor®, Abcam, Cambridge, UK), an specific marker of podocytes, to establish their identity by immunofluorescence techniques using a secondary antibody (Alexa Fluor 488, Abcam, Cambridge, Uk). The smears were analyzed employing an epifluorescence microscopy, Nikon Eclipse E200. This result was compared with 10 controls (6 males and 4 females; mean age: 20 ± 2.1 years, with no past history of morbidities: serum creatinine, 0.7 ± 0.1 mg/dL; mean 24-hour urinary albumin excretion, 66 ± 12 mg/day. The mean podocyte count was 0.11 ± 0.3 cells per ×20 field, while the mean number of podocytes per gram of urinary creatinine was 8.3. One day after admission, a kidney biopsy was performed and was consistent with IgA nephropathy, with the following Oxford score over 14 glomeruli: M1E0S0T0. The immunofluorescence was positive for IgA and mesangial C3 deposits +++/4 y C3. Due to the rapidly progressive course of the altered kidney function, oral methyl prednisone 1 mg/kg/day was started. Two weeks later when creatinine was 1.2 mg/dL, amiloride was started at 5 mg/day. Four weeks after initiation of therapy, proteinuria and hematuria were negative and serum creatinine dropped to 0.7 mg/dL (). Two consecutive podocyturia tests were similar to controls after one year of follow-up. Current therapy consists of amiloride 5 mg/day and valsartan 80 mg/day.","Using the 2021 CKD-EPI Creatinine equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [18, 'years'], 'creatinine': [3.0, 'mg/dL'], 'sex': 'Male'}",29.93751,28.44063,31.43439,"The formula for computing GFR is 142 x (Scr/A)**B x 0.9938**age x (gender_coeffcient), where the ** indicates an exponent operation, Scr is the concentration of serum creatinine in mg/dL and gender_coefficient is 1.012 if the patient is female, else the coeffient is 1. The coefficients A and B are dependent on the patient's gender and the patient's creatinine concentration.
The patient is 18 years old. The patient's gender is Male, and so the patient's gender coefficient is 1.0.
The concentration of Serum Creatinine is 3.0 mg/dL. Because the patient's gender is male and the creatinine concentration is greater than or equal to 0.9 mg/dL, A = 0.9 and B = -1.2.
Plugging in these values, we get 142 * (3.0/0.9)**-1.2 * 0.9938**18 * 1.0 = 29.93751.
Hence, the GFR value is 29.93751 ml/min/1.73 m²."
40,3,CKD-EPI Equations for Glomerular Filtration Rate,lab test,decimal,pmc-7523830-1,Extracted,"A 64-year-old Brazilian man was admitted to the emergency department of our institution in April 2019 claiming fatigue, malaise, intermittent fever, and weight loss. In the first physical exam he presented hypotension and mental confusion. Three months before he began with progressive prostration, unintentional weight loss of 15 kg, intermittent fever, and night sweats. He was evaluated at an external hematology clinic 2 weeks before to come at our service and was diagnosed with multiple myeloma based on laboratory tests and bone marrow biopsy.
At initial physical examination, he had a temperature of 36.3 °C, a pulse of 81 beats per minute, a respiratory rate of 16 incursions per minute, a peripheral oxygen saturation of 94% in ambient air, a blood pressure of 86/51 mmHg, and a slower peripheral perfusion (4 seconds). He had significant skin-mucous pallor, jaundice 2+/4+, lowered level of consciousness (Glasgow 14), mental confusion, and flapping in the upper extremities. The rest of the physical examination showed no other significant changes.
Initial laboratory evaluation revealed: hemoglobin (Hb) 9.7 g/L, hematocrit (Ht) 28.2%, mean corpuscular volume (MCV) 82.7 fl, white blood count (WBC) 3.02 × 109/L, neutrophils: 2.3 × 109/L, lymphocytes: 0.5 × 109/L, platelets: 39 × 109/L, Na++ 127 mEq/L, K+ 4.3 mEq/L, total Ca++ 9.3 mg/L, P 3.1 mg/L, creatinine 1.84 mg/dL, BUN 122 mg/dL, lactate dehydrogenase (LDH) 648 U/L, and C-protein reactive (CPR) 58.1 mg/L. Hepatic profile showed alanine aminotransferase (ALT) 258 U/L, aspartate aminotransferase (AST) 213 U/L, alkaline phosphatase 386 U/L, gamma GT 473 U/L, total bilirubin: 2.95 mg dL (direct bilirubin [DB]: 2.29 /indirect bilirubin [IB]: 0.66), albumin 2.4 g/dL, prothrombin time/international normalized ratio (PT/INR): 1.27, and activated partial thromboplastin time (aPTT) ratio = 1.23. Laboratory evolution throughout hospitalization is summarized in Table .
In the emergency department, peripheral blood and urine cultures were collected and intravenous saline fluid and ceftriaxone was administered for treatment of supposed infectious etiologies. After initial measurements, blood pressure was normalized and the patient was stabilized. In his previous medical history, he had systemic arterial hypertension, congestive heart failure, and chronic renal failure caused by recurrent nephrolithiasis. He used carvedilol 25 mg twice daily, spironolactone 25 mg once daily, ivabradine 5 mg twice daily, AAS 100 mg daily, and rosuvastatin 10 mg daily.
The patient had external laboratory tests showing 0.8 g/dL of monoclonal protein, IgA kappa paraprotein at serum immunofixation, serum IgA of 1038 mg/dL (70–400 mg/dL), and β2 microglobulin of 20.61 mg/L (0.8–2.2 mg/L). Bone marrow biopsy was hypercellular with monoclonal plasma cell proliferation CD56 (+), kappa light chain restriction, representing 30% of the total nucleated cells. A diagnosis of multiple myeloma (MM) Durie Salmon IIIA, ISS III was established in this moment.
Chest, abdomen, and pelvic computerized tomography (CT) revealed multiple lymphadenopathies up to 5.0 cm and splenomegaly. Positron emission CT with 18-fluoro deoxyglucose (18-FDG-PETCT) showed multiple lymphadenopathies in the neck, chest, abdomen, and pelvis with SUVmax 12.0, liver FDG uptake 15.8 (SUVmax), and 16.4 cm splenomegaly with 15.8 spleen FDG uptake (Fig. ). Echocardiography was negative for endocarditis.
There was negativity for viral hepatitis B and C serology as well as for HIV, HTLV1, chickenpox, toxoplasmosis, herpes, cytomegalovirus, adenovirus, Epstein-Barr virus, parvovirus B19, enterovirus, paraecovirus, and Mycobacterium tuberculosis. Blood cultures were negative. As the patient persisted with fever, ceftriaxone introduced at admission was replaced by Piperacillin/Tazobactam and Teicoplanin. However, the patient evolved quickly with multiorgan dysfunction characterized by liver and renal failure, LDH increase, and coagulopathy characterized by prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT), fibrinogen, and factor V reduction keeping factor VIII level between the normal range values (Table ).
As the clinician suspected of concurrent HLH further tests showed serum ferritin level of 47.502 ng/mL (30–400 ng/mL) and slight elevation of triglycerides. A new bone marrow aspiration confirmed the presence of 21.6% of aberrant plasma cells with significant macrophage activity with several haemophagocytosis pictures (Fig. ). Immunophenotyping demonstrated 4.9% of anomalous and monoclonal plasma cells expressing CD45dim, CD19partial, CD38bright, CD138bright, CD56dim, CD117dim, and kappa light chain restriction in cytoplasm. Thereafter, the patient was immediately transferred to the intensive care unit and pulse therapy with methylprednisolone 1 g/d for 3 days was administered to control HLH. Afterwards the patient received cyclophosphamide at dose of 500 mg once weekly and dexamethasone 20 mg once daily D1–D4 as anti-multiple myeloma treatment. We were not able to investigate lymphadenopathy because the patient became soon hemodynamically unstable, requiring mechanical ventilation support and renal replacement therapy with hemodialysis. Unfortunately, the patient died 15 days after hospitalization.","Using the 2021 CKD-EPI Creatinine equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'creatinine': [1.84, 'mg/dL'], 'age': [64, 'years']}",40.43277,38.41113,42.45441,"The formula for computing GFR is 142 x (Scr/A)**B x 0.9938**age x (gender_coeffcient), where the ** indicates an exponent operation, Scr is the concentration of serum creatinine in mg/dL and gender_coefficient is 1.012 if the patient is female, else the coeffient is 1. The coefficients A and B are dependent on the patient's gender and the patient's creatinine concentration.
The patient is 64 years old. The patient's gender is Male, and so the patient's gender coefficient is 1.0.
The concentration of Serum Creatinine is 1.84 mg/dL. Because the patient's gender is male and the creatinine concentration is greater than or equal to 0.9 mg/dL, A = 0.9 and B = -1.2.
Plugging in these values, we get 142 * (1.84/0.9)**-1.2 * 0.9938**64 * 1.0 = 40.43277.
Hence, the GFR value is 40.43277 ml/min/1.73 m²."
41,4,CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk,risk,integer,pmc-7196137-1,Extracted,"Our patient is a 38-year-old woman with a past medical history most significant for a Roux-en-Y gastric bypass surgery in March 2017, complicated by a marginal ulcer at the anastomosis site with subsequent perforation. The patient could not tolerate oral nutrition and became severely malnourished, and a PICC line was placed for TPN in December 2017. Chronic TPN use led to recurrent candidemia with blood cultures growing Candida albicans resistant to fluconazole and voriconazole. Over several months, her PICC line was replaced thrice, and she was ultimately treated with micafungin. The patient had multiple admissions over the past few months for workup of altered mental status and unsteady gait. Her other past medical history included systemic lupus erythematosus treated with mycophenolate mofetil and hydroxychloroquine, left portal vein branch thrombosis on enoxaparin therapy, type 2 diabetes mellitus not on insulin, fibromyalgia, depression, and anxiety. She presented to our hospital in July 2018 with complaints of tremors, impaired mobility, confusion, gait instability, falls, and lethargy.
On admission, she was noted to be confused, with horizontal nystagmus and dilated pupils as well as bradypnea. Dilated fundus examination was indicative of candida retinitis. She was lethargic but arousable. Her speech was difficult to understand, and the history of presenting illness was provided primarily by the patient's mother who relayed to the team that she had been having tremors, episodes of confusion, and numerous falls for the past several months. Her mother also noticed that she had increased irritability and emotional lability during this time. She was initially admitted to the intensive care unit for airway management due to her acute encephalopathy. Due to a lack of meningeal signs, a lumbar puncture was not performed.
The infectious disease service was consulted, and she was started on liposomal amphotericin B and flucytosine for a total of 6 weeks. MRI brain showed worsening T1 hyperintensities from June 2018 to July 2018 in the bilateral globus pallidi, as evidenced by the arrows in Figures and , which were thought to be secondary to manganese toxicity from chronic TPN use. Furthermore, a repeat MRI brain was performed in August 2018, one month after discontinuation of TPN, which showed improvement of the T1 hyperintensities in the bilateral globus pallidi, as evidenced by the white arrows in , approaching the intensity level noted in June 2018. Other supporting findings included T1 hyperintensities in the substantia nigra, as evidenced by the arrows in , and decreased signal in the bilateral globus pallidi on T2-weighted images, as evidenced by the arrows in . With antifungal treatment and cessation of TPN, her mentation and neurological symptoms improved within 3-4 days of cessation of TPN.
General surgery was consulted for gastrostomy tube placement in her remnant stomach, as the patient was unable to consume more than 500 calories by mouth per day due to complaints of nausea and vomiting. Although our patient presented to the hospital seven months after initiation of TPN therapy, her Parkinsonian symptoms had begun to manifest after three months on TPN.",What is the patient's CHA2DS2-VASc Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'sex': 'Female', 'age': [38, 'years'], 'Diabetes history': True, 'Thromboembolism history': True}",4,4,4,"The criteria for the CHA2DS2-VASc score are listed below:

1. Age: < 65 years = 0 points, 65-74 years = +1 point, ≥ 75 years = +2 points
2. Sex: Female = +1 point, Male = 0 points
3. Congestive Heart Failure (CHF) history: No = 0 points, Yes = +1 point
4. Hypertension history: No = 0 points, Yes = +1 point
5. Stroke, Transient Ischemic Attack (TIA), or Thromboembolism history: No = 0 points, Yes = +2 points
6. Vascular disease history (previous myocardial infarction, peripheral artery disease, or aortic plaque): No = 0 points, Yes = +1 point
7. Diabetes history: No = 0 points, Yes = +1 point

The CHA2DS2-VASc score is calculated by summing the points for each criterion.
    
The current CHA2DS2-VASc score is 0.
The patient is 38 years old. Because the age is less than 65 years, no points are added to the current total, keeping the total at 0.
The patient's gender is female and so one point is added to the score, making the current total 0 + 1 = 1.
Because the congestive heart failure history is not specified in the patient note, we assume it is absent from the patient. Because the patient does not have congestive heart failure, no points are added to the current total, keeping the total at 1.
Because hypertension history is not specified in the patient note, we assume that it is absent from the patient. Because the patient does not have hypertension, no points are added to the current total, keeping the total at 1.
One criteria of the CHA2DS2-VASc score is to check if the patient has had any history of stroke, transient ischemic attacks (TIA), or thromboembolism. Because stroke history is not specified in the patient note, we assume that it is absent from the patient. Because tia history is not specified in the patient note, we assume that it is absent from the patient. Based on the patient note, the patient history for thromboembolism is present. Because at least one of stroke, tia, or thromboembolism is present, two points are added to the score, making the current total 1 + 2 = 3.
Because vascular disease history is not specified in the patient note, we assume it to be absent.
Because the patient does not have vascular disease, no points are added to score, keeping the score at 3. Based on the patient note, the patient history for diabetes is present. Because the patient has diabetes, one point is added to the score, making the current total 3 + 1 = 4.
The patient's CHA2DS2-VASc Score is 4."
42,4,CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk,risk,integer,pmc-7099753-3,Extracted,"A 68-year-old woman was admitted to the hospital with dizziness, disequilibrium, and dysarthria, which she had had for about 2 weeks. She had a history of hypertension, but no history of diabetes or heart disease, no familial history of cardiovascular disease, and no use of preventive medication for stroke.
On admission, her neurological examination was normal except for the presence of dysarthria, right central facial and glossary palsy, and bilateral positive Babinski signs.
Laboratory tests, including blood routine test, serum electrolytes, renal and hepatic function, blood sugar, coagulation profile, syphilis and HIV tests, and blood fat, were all normal. There were no abnormalities on her ECG, TEE, or 24-hour Holter monitoring.
DWI showed multiple high signal intensities in the territories of both anterior and posterior circulations. MR angiography showed no stenosis of large vessels. Her chest CT scan showed lung cancer and multiple metastases in the lungs.",What is the patient's CHA2DS2-VASc Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'sex': 'Female', 'age': [68, 'years'], 'Hypertension history': True}",3,3,3,"The criteria for the CHA2DS2-VASc score are listed below:

1. Age: < 65 years = 0 points, 65-74 years = +1 point, ≥ 75 years = +2 points
2. Sex: Female = +1 point, Male = 0 points
3. Congestive Heart Failure (CHF) history: No = 0 points, Yes = +1 point
4. Hypertension history: No = 0 points, Yes = +1 point
5. Stroke, Transient Ischemic Attack (TIA), or Thromboembolism history: No = 0 points, Yes = +2 points
6. Vascular disease history (previous myocardial infarction, peripheral artery disease, or aortic plaque): No = 0 points, Yes = +1 point
7. Diabetes history: No = 0 points, Yes = +1 point

The CHA2DS2-VASc score is calculated by summing the points for each criterion.
    
The current CHA2DS2-VASc score is 0.
The patient is 68 years old. Because the age is between 65 and 74, one point added to the score, making the current total 0 + 1 = 1.
The patient's gender is female and so one point is added to the score, making the current total 1 + 1 = 2.
Because the congestive heart failure history is not specified in the patient note, we assume it is absent from the patient. Because the patient does not have congestive heart failure, no points are added to the current total, keeping the total at 2.
The patient history for hypertension is present. Because the patient has hypertension, one point is added to the score, making the current total 2 + 1 = 3.
One criteria of the CHA2DS2-VASc score is to check if the patient has had any history of stroke, transient ischemic attacks (TIA), or thromboembolism. Because stroke history is not specified in the patient note, we assume that it is absent from the patient. Because tia history is not specified in the patient note, we assume that it is absent from the patient. Because thromboembolism history is not specified in the patient note, we assume it to be absent. Because all of stroke, tia, or thromboembolism are absent, no points are added to score, keeping the score at 3.
Because vascular disease history is not specified in the patient note, we assume it to be absent.
Because the patient does not have vascular disease, no points are added to score, keeping the score at 3. Because diabetes history is not specified in the patient note, we assume it's value as 'absent'. Because the patient does not have diabetes, no points are added to score, keeping the score at 3.
The patient's CHA2DS2-VASc Score is 3."
43,4,CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk,risk,integer,pmc-8136881-1,Extracted,"An 86-year-old woman with a history of atrial fibrillation, aortic stenosis, and hypertension presented to the emergency department due to altered mental status. She was lethargic, confused, and was not answering questions appropriately for the past four days. On arrival, she was afebrile, and her vitals included a pulse of 139 beats per minute, blood pressure of 110/79 mmHg, and a respiratory rate of 16 breaths per minute with saturation of 96% on room air. Physical exam was significant for a slow to respond female, orientated to self, who was able to follow commands with no focal neurological deficit. Her skin was warm and well-perfused with normal capillary refill, with no rashes or petechiae. The cardiovascular exam was significant for tachycardia, an irregular heart rhythm, and a systolic murmur heard best at the right upper sternal border. She had lower extremity pitting edema bilaterally. Her lab results were notable for elevated white blood cell count (WBC) 25.2 x 103 μL (3.9-11.3 x 103 μL), hemoglobin 11.0 g/dL (11.3-15.1 g/dL), platelets 58.0 x 103 μL (165-366 x 103 μL), troponin 0.164 ng/mL (<0.010 ng/mL), lactic acid 2.5 mmol/L (0.5-2.0 mmol/L), and a basic chemistry panel was within normal limits. The urinalysis was remarkable for the presence of WBCs, leukocyte esterase, and bacteria with a urine culture pending. Additionally, two sets of blood cultures were obtained. Her electrocardiogram was significant for atrial fibrillation with a rapid ventricular rate (RVR). She was started on ceftriaxone for probable UTI and was admitted to the hospital for further management. Further diagnostics included lower extremity Doppler ultrasound, which revealed deep venous thrombosis (DVT). A bedside echocardiogram indicated right ventricular strain, and the N-terminal proB-type natriuretic peptide level was elevated at 8,215 pg/mL (<449 pg/mL). Due to concern for possible pulmonary embolism in the setting of known DVT, the patient was started on a continuous heparin infusion. A transthoracic echocardiogram revealed severe aortic valve calcification with new aortic insufficiency. Blood and urine cultures returned positive for Aerococcus urinae. A transesophageal echocardiogram further confirmed moderate to severe aortic regurgitation with findings suggestive of infective endocarditis (IE), see Figures , .
Antibiotics were expanded to include gentamicin with ceftriaxone for IE, and surgical evaluation was consulted. Given she was a high-risk surgical candidate, surgery intervention was not offered at this time unless evidence of further clinical decompensation. Additional surgical recommendations included re-evaluation after completion of antibiotic course. She was therefore discharged on intravenous antibiotics to complete a total of six weeks of treatment with ceftriaxone and two weeks of gentamicin. Soon after completion, the patient returned due to worsening thrombocytopenia that had previously improved upon discharge. On readmission, repeat labs were most notable for worsening thrombocytopenia, leukocytosis, acute kidney injury, and hyperkalemia. The patient was in atrial fibrillation with RVR and physical exam concerning for decompensated heart failure. Despite administration of broad-spectrum antibiotics and heart rate control, the patient continued to decline, and her clinical picture was consistent with cardiogenic shock. In addition to respiratory distress, the patient went into ventricular fibrillation arrest. Due to the patient's wishes to not be intubated or resuscitated, she was made comfortable and passed away.",What is the patient's CHA2DS2-VASc Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'sex': 'Female', 'age': [86, 'years'], 'Congestive Heart Failure': True, 'Thromboembolism history': False, 'Vascular disease history': False, 'Hypertension history': True}",5,5,5,"The criteria for the CHA2DS2-VASc score are listed below:

1. Age: < 65 years = 0 points, 65-74 years = +1 point, ≥ 75 years = +2 points
2. Sex: Female = +1 point, Male = 0 points
3. Congestive Heart Failure (CHF) history: No = 0 points, Yes = +1 point
4. Hypertension history: No = 0 points, Yes = +1 point
5. Stroke, Transient Ischemic Attack (TIA), or Thromboembolism history: No = 0 points, Yes = +2 points
6. Vascular disease history (previous myocardial infarction, peripheral artery disease, or aortic plaque): No = 0 points, Yes = +1 point
7. Diabetes history: No = 0 points, Yes = +1 point

The CHA2DS2-VASc score is calculated by summing the points for each criterion.
    
The current CHA2DS2-VASc score is 0.
The patient is 86 years old. Because the age is greater than 74, two points added to the score, making the current total 0 + 2 = 2.
The patient's gender is female and so one point is added to the score, making the current total 2 + 1 = 3.
The patient history for congestive heart failure is present. Because the patient has congestive heart failure, one point is added to the score, making the current total 3 + 1 = 4.
The patient history for hypertension is present. Because the patient has hypertension, one point is added to the score, making the current total 4 + 1 = 5.
One criteria of the CHA2DS2-VASc score is to check if the patient has had any history of stroke, transient ischemic attacks (TIA), or thromboembolism. Because stroke history is not specified in the patient note, we assume that it is absent from the patient. Because tia history is not specified in the patient note, we assume that it is absent from the patient. Based on the patient note, the patient history for thromboembolism is absent. Because all of stroke, tia, or thromboembolism are absent, no points are added to score, keeping the score at 5.
Based on the patient note, the patient history for vascular disease is absent. Because the patient does not have vascular disease, no points are added to score, keeping the score at 5. Because diabetes history is not specified in the patient note, we assume it's value as 'absent'. Because the patient does not have diabetes, no points are added to score, keeping the score at 5.
The patient's CHA2DS2-VASc Score is 5."
44,4,CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk,risk,integer,pmc-7294161-1,Extracted,"A 68-year-old man with the left hemiparesis from 2 h previously visited the emergency room. His medical history included hypertension and bilateral emphysema due to heavy smoking. Vital sign assessment revealed tachycardia; examination of the heart revealed atrial fibrillation (AF). Neurological examination revealed left hemiparesis and mild disturbance of consciousness. The National Institutes of Health Stroke Scale (NIHSS) score was 12. A magnetic resonance imaging (MRI) (diffusion-weighted image) showed right corona radiate infarction []. MR angiography (MRA) revealed right middle cerebral artery (MCA) occlusion []. Chest X-ray showed no remarkable findings on admission. Initial investigations performed included a white blood cell (13.9 × 109/L; normal 4–11 × 109/L), hemoglobin (14.6 g/dL; normal 13.1–17.3 g/dL), and platelet (147 × 109/L; normal 130–400 × 109/L) count. Prothrombin time (16 s; normal 11.5–14.5 s), activated partial thromboplastin time (40.1 s; normal 27.5–41 s), D-dimer (<0.5 mg/mL; normal <0.5 mg/mL), arterial blood gas (room air; pH 7.35), PaO2 (89.0 mmHg), and PaCO2 (45.1 mmHg) were also analyzed. The patient was negative for antineutrophilic cytoplasmic antibody. Intravenous tPA was administered according to the accelerated regimen (0.6 mg/kg) 3.5 h after onset. Four hours later, consciousness gradually improved, the right MCA recanalized [], and volume of infarction was not changed. The patient experienced hemoptysis and mild shortness of breath 18 h later, with no chest pain or fever. Oxygen saturation dropped from 97 to 90%. Chest computed tomography (CT) revealed multifocal diffuse ground-glass attenuation and patchy consolidation in both lungs [ and b]. Immediate chest X-ray revealed bilateral upper lobe intra-alveolar infiltrate []. The hemoptysis gradually improved after treatment with dopamine, corticosteroids, and bronchodilators, followed by fluid replacement, mechanical ventilation (MV), and administration of rFVIIa (75 mg/kg) with corticosteroids. The improvement was noted on day 3 and resolved completely by day 4. Hemoglobin dropped from 14.9 g/dl on admission to 11.7 g/dl on day 5, with no evidence of bleeding in other sites. Two weeks later, he was put off of the artificial respirator. After 1 month, the chest X-ray was normal []. He was transferred to a rehabilitation hospital after 6 weeks of hospitalization with modified Rankin scale (mRS) score of 3.",What is the patient's CHA2DS2-VASc Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'sex': 'Male', 'age': [68, 'years'], 'Hypertension history': True, 'Stroke': True, 'Vascular disease history': False}",4,4,4,"The criteria for the CHA2DS2-VASc score are listed below:

1. Age: < 65 years = 0 points, 65-74 years = +1 point, ≥ 75 years = +2 points
2. Sex: Female = +1 point, Male = 0 points
3. Congestive Heart Failure (CHF) history: No = 0 points, Yes = +1 point
4. Hypertension history: No = 0 points, Yes = +1 point
5. Stroke, Transient Ischemic Attack (TIA), or Thromboembolism history: No = 0 points, Yes = +2 points
6. Vascular disease history (previous myocardial infarction, peripheral artery disease, or aortic plaque): No = 0 points, Yes = +1 point
7. Diabetes history: No = 0 points, Yes = +1 point

The CHA2DS2-VASc score is calculated by summing the points for each criterion.
    
The current CHA2DS2-VASc score is 0.
The patient is 68 years old. Because the age is between 65 and 74, one point added to the score, making the current total 0 + 1 = 1.
The patient's gender is male and so no points are added to the current total, keeping the total at 1.
Because the congestive heart failure history is not specified in the patient note, we assume it is absent from the patient. Because the patient does not have congestive heart failure, no points are added to the current total, keeping the total at 1.
The patient history for hypertension is present. Because the patient has hypertension, one point is added to the score, making the current total 1 + 1 = 2.
One criteria of the CHA2DS2-VASc score is to check if the patient has had any history of stroke, transient ischemic attacks (TIA), or thromboembolism. Based on the patient note, the patient history for stroke is present. Because tia history is not specified in the patient note, we assume that it is absent from the patient. Because thromboembolism history is not specified in the patient note, we assume it to be absent. Because at least one of stroke, tia, or thromboembolism is present, two points are added to the score, making the current total 2 + 2 = 4.
Based on the patient note, the patient history for vascular disease is absent. Because the patient does not have vascular disease, no points are added to score, keeping the score at 4. Because diabetes history is not specified in the patient note, we assume it's value as 'absent'. Because the patient does not have diabetes, no points are added to score, keeping the score at 4.
The patient's CHA2DS2-VASc Score is 4."
45,4,CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk,risk,integer,pmc-6959961-2,Extracted,"The patient that admitted into our department was a 75-year-old male, diagnosed with osteoporosis by DXA examination, his serum CTX, P1NP and OC were 0.78 μg/L, 200.70 μg/L, and 24.47 μg/L, respectively. He had a history of 15-year hypertension and 10-year chronic AF. Ten months earlier, he suffered from abrupt dizziness accompanied with nausea and vomiting, right limb dysfunction when he went to the toilet at night. CT scans showed ‘the left basal ganglia infarction foci’. After that, warfarin sodium tablet was orally taken 3 mg/day. The patient's INR was 2.70 when he was admitted into our department. Alendronate sodium tablets were prescribed to the patient at 70 mg once a week. It turned out that the patient serum INR increased from 2.70 to 4.69 at the first 24 hours, the oral taken of alendronate sodium tablets was stopped immediately. Then the patient's serum INR fell to 4.34 at 48 hours; he also had spontaneous ecchymoses and petechiae in the skin during the fluctuation of INR. However, the ecchymoses and petechiae gradually vanished at the following days and INR decreased to 3.32 at the fifth day. The patients denied taken other medication except for warfarin sodium and alendronate sodium tablets, he also denied significant diet change.",What is the patient's CHA2DS2-VASc Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'sex': 'Male', 'age': [75, 'years'], 'Hypertension history': True, 'Thromboembolism history': True, 'Stroke': True}",5,5,5,"The criteria for the CHA2DS2-VASc score are listed below:

1. Age: < 65 years = 0 points, 65-74 years = +1 point, ≥ 75 years = +2 points
2. Sex: Female = +1 point, Male = 0 points
3. Congestive Heart Failure (CHF) history: No = 0 points, Yes = +1 point
4. Hypertension history: No = 0 points, Yes = +1 point
5. Stroke, Transient Ischemic Attack (TIA), or Thromboembolism history: No = 0 points, Yes = +2 points
6. Vascular disease history (previous myocardial infarction, peripheral artery disease, or aortic plaque): No = 0 points, Yes = +1 point
7. Diabetes history: No = 0 points, Yes = +1 point

The CHA2DS2-VASc score is calculated by summing the points for each criterion.
    
The current CHA2DS2-VASc score is 0.
The patient is 75 years old. Because the age is greater than 74, two points added to the score, making the current total 0 + 2 = 2.
The patient's gender is male and so no points are added to the current total, keeping the total at 2.
Because the congestive heart failure history is not specified in the patient note, we assume it is absent from the patient. Because the patient does not have congestive heart failure, no points are added to the current total, keeping the total at 2.
The patient history for hypertension is present. Because the patient has hypertension, one point is added to the score, making the current total 2 + 1 = 3.
One criteria of the CHA2DS2-VASc score is to check if the patient has had any history of stroke, transient ischemic attacks (TIA), or thromboembolism. Based on the patient note, the patient history for stroke is present. Because tia history is not specified in the patient note, we assume that it is absent from the patient. Based on the patient note, the patient history for thromboembolism is present. Because at least one of stroke, tia, or thromboembolism is present, two points are added to the score, making the current total 3 + 2 = 5.
Because vascular disease history is not specified in the patient note, we assume it to be absent.
Because the patient does not have vascular disease, no points are added to score, keeping the score at 5. Because diabetes history is not specified in the patient note, we assume it's value as 'absent'. Because the patient does not have diabetes, no points are added to score, keeping the score at 5.
The patient's CHA2DS2-VASc Score is 5."
46,4,CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk,risk,integer,pmc-3317869-1,Extracted,"A 56-year-old woman with a significant history of RCA stenosis with prior bare metal stenting, hypertension, diabetes, dyslipidemia, smoking, and paroxysmal atrial fibrillation presented to the emergency department with anginal chest pain. Initial work up showed significant elevation of cardiac troponin T with T-wave inversion in the inferior leads. She subsequently underwent cardiac catheterization. Coronary angiography revealed a 90% stenosis of the midportion of RCA with patent stent at distal portion of RCA (Figure , ) and only mild disease in left anterior descending coronary and left circumflex coronary arteries. An everolimus-eluting stent, 2.5 mm × 23 mm, was placed in the stenosis of midportion of RCA. Immediately after these interventions, thrombus developed and occluded SN artery. It originated from the proximal one third portion of RCA. Electrocardiographic monitoring showed junctional escape rhythm without P waves at a heart rate of 30 beats/min, suggesting sinus arrest (Figure ). To prevent severe bradycardia and hypotension, transvenous temporary pacemaker was placed. The patient remained asymptomatic and without hypotension. The clot in the SN artery was identified and thrombectomy was performed. Within five minutes after intervention, Thrombolysis In Myocardial Infarction (TIMI) flow 3 was observed in the SN artery within 5 minutes and the transvenous temporary pacer was removed. Electrocardiogram revealed persistent junctional escape rhythm for 5 days after revascularization, with restoration of sinus rhythm on the sixth day. Heart rate showed a gradual improvement and the patient maintained a stable heart rate at 60 beats per minute. The patient remained hemodynamically stable without further need for temporary pacing. Pre-discharge exercise stress test had shown 50% predicted heart rate at 100 beats per minute, without ST segment change.",What is the patient's CHA2DS2-VASc Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'sex': 'Female', 'age': [56, 'years'], 'Vascular disease history': True, 'Diabetes history': True, 'Hypertension history': True}",4,4,4,"The criteria for the CHA2DS2-VASc score are listed below:

1. Age: < 65 years = 0 points, 65-74 years = +1 point, ≥ 75 years = +2 points
2. Sex: Female = +1 point, Male = 0 points
3. Congestive Heart Failure (CHF) history: No = 0 points, Yes = +1 point
4. Hypertension history: No = 0 points, Yes = +1 point
5. Stroke, Transient Ischemic Attack (TIA), or Thromboembolism history: No = 0 points, Yes = +2 points
6. Vascular disease history (previous myocardial infarction, peripheral artery disease, or aortic plaque): No = 0 points, Yes = +1 point
7. Diabetes history: No = 0 points, Yes = +1 point

The CHA2DS2-VASc score is calculated by summing the points for each criterion.
    
The current CHA2DS2-VASc score is 0.
The patient is 56 years old. Because the age is less than 65 years, no points are added to the current total, keeping the total at 0.
The patient's gender is female and so one point is added to the score, making the current total 0 + 1 = 1.
Because the congestive heart failure history is not specified in the patient note, we assume it is absent from the patient. Because the patient does not have congestive heart failure, no points are added to the current total, keeping the total at 1.
The patient history for hypertension is present. Because the patient has hypertension, one point is added to the score, making the current total 1 + 1 = 2.
One criteria of the CHA2DS2-VASc score is to check if the patient has had any history of stroke, transient ischemic attacks (TIA), or thromboembolism. Because stroke history is not specified in the patient note, we assume that it is absent from the patient. Because tia history is not specified in the patient note, we assume that it is absent from the patient. Because thromboembolism history is not specified in the patient note, we assume it to be absent. Because all of stroke, tia, or thromboembolism are absent, no points are added to score, keeping the score at 2.
Based on the patient note, the patient history for vascular disease is present. Because the patient has vascular disease, one point is added to the score, making the current total 2 + 1 = 3. Based on the patient note, the patient history for diabetes is present. Because the patient has diabetes, one point is added to the score, making the current total 3 + 1 = 4.
The patient's CHA2DS2-VASc Score is 4."
47,4,CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk,risk,integer,pmc-3888688-1,Extracted,"DH 21-year-old primigravida presented for her booking visit at 11+2/40. Her history was notable for a background history of congenital biliary atresia (BA). She had undergone an early Kasai portoenterostomy with Roux-en-Y anastomosis in the early neonatal period. Her subsequent postoperative course was complicated by two episodes of cholangitis. By the age of two she had developed portal hypertension resulting in secondary thrombocytopenia due to hypersplenism. She had developed esophageal varices requiring annual sclerotherapy until the age of sixteen when she underwent variceal banding. Her vaccinations were up-to-date.
General findings on presentation at 11 weeks revealed icterus with scattered spider naevi. On abdominal inspection there was an upper abdominal scar from her prior surgery and on palpation the spleen was enlarged extending to below the level of the umbilicus; there was no evidence of ascites.
An ultrasound confirmed her estimated date of delivery. She was referred to the medical clinic at the hospital to provide a multidisciplinary team input to her care.
At sixteen weeks she developed an episode of cholangitis and she was treated with intravenous antibiotics for seven days. A liver ultrasound was performed. This revealed absence of intrahepatic dilatation with multiple periportal and peripancreatic varices and 14 cm splenomegaly. During the pregnancy her platelets remained low (29–55 × 109 L) and hemoglobin ranged from 8.8 to 10.5 g/dL. Her transaminases were marginally elevated (AST/ALT, 46/67) and coagulation parameters were normal. Significant concern remained about her thrombocytopenia and degree of hypersplenism.
A multidisciplinary meeting was convened with hepatology, hepatobiliary surgery, and interventional radiology. Concerns for this patient included her significant splenomegaly and thrombocytopenia, risk of recurrent cholangitis, potential for massive variceal hemorrhage, and potential for preterm delivery, either spontaneous or iatrogenic. Abdominal delivery would also be compromised by large venous anastomoses in the anterior abdominal wall. A plan for management of gastrointestinal hemorrhage was outlined. Further imaging of her portal vessels was recommended as this would inform the interventional radiologists as to which was the optimum surgical intervention should bleeding develop from intraabdominal varices. The option of a splenectomy in pregnancy was excluded as this was deemed likely to cause portal vein thrombosis and would compromise any future candidacy for liver transplantation. At twenty weeks she underwent MR venography of the portal vessels. Her spleen measured 23 cm, there was evidence of extensive splenic and esophageal varices, and no lienorenal shunt was identified.
She had bimonthly antenatal visits with her obstetrical and hepatology teams. Her anatomy scan was within normal limits with a well-grown fetus on the 31st centile. Due to the complexity of the case and the potential for preterm delivery she received two doses of betamethasone at twenty-six weeks of gestation to aid lung maturation.
At 26+3 she presented to the maternity hospital with vaginal bleeding, suprapubic pressure, and uterine contractions for 24 hours with increasing intensity and duration. The fundal height was consistent with 26 weeks of pregnancy and cardiotocography was reassuring. Sterile speculum examination confirmed that the cervix was 5 cm dilated and fully effaced and the amniotic membranes were bulging through the cervix. A bedside ultrasound scan confirmed a breech presentation. Her platelet count was 33 × 109/L. Following consultation with perioperative medicine, the hepatobiliary team, and neonatology the decision was made to perform an emergency caesarean section. It had been planned to perform her surgery in a general hospital; however, due to the acute nature of her presentation the caesarean section was undertaken in the obstetric facility, with hepatobiliary surgery and interventional radiology on standby in the general hospital. Pooled platelets were administered immediately prior to surgery. Magnesium sulphate was administered to provide fetal neuroprotection. The caesarean section was performed via a vertical subumbilical incision, with a lower segment transverse incision on the uterus. The vertical incision was utilized both to provide greater access to the abdominal cavity should bleeding occur, either from the uterus or the varices, and to avoid large venous collaterals running vertically in the abdominal wall. A live male baby was delivered by breech extraction and transferred to the pediatric team following delayed cord clamping of 45 seconds. Apgar's scores were 61, 65, and 710; the cord blood gases were pH 7.27 (arterial) 7.29 (venous). The infant weighed 890 grams. The remainder of the surgery was uneventful. Perioperatively she received a further pooled platelet transfusion with good hemostasis and no transfusion of packed red cells was required. Her baby was transferred to intensive care and initially required CPAP. He had an uncomplicated neonatal course. Histology of the placenta was unremarkable. The patient had an uneventful postpartum course. She was advised against further pregnancies in view of her significant risks and underwent insertion of a levonorgestrel coil at three months postpartum for contraceptive purposes and she is currently awaiting liver transplantation. Despite the premature gestational age, the infant had an essentially uneventful postnatal course. He was discharged home at ten weeks of age and as a one-year-old boy he has met all his expected developmental milestones.",What is the patient's CHA2DS2-VASc Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'sex': 'Female', 'age': [21, 'years'], 'Vascular disease history': False}",1,1,1,"The criteria for the CHA2DS2-VASc score are listed below:

1. Age: < 65 years = 0 points, 65-74 years = +1 point, ≥ 75 years = +2 points
2. Sex: Female = +1 point, Male = 0 points
3. Congestive Heart Failure (CHF) history: No = 0 points, Yes = +1 point
4. Hypertension history: No = 0 points, Yes = +1 point
5. Stroke, Transient Ischemic Attack (TIA), or Thromboembolism history: No = 0 points, Yes = +2 points
6. Vascular disease history (previous myocardial infarction, peripheral artery disease, or aortic plaque): No = 0 points, Yes = +1 point
7. Diabetes history: No = 0 points, Yes = +1 point

The CHA2DS2-VASc score is calculated by summing the points for each criterion.
    
The current CHA2DS2-VASc score is 0.
The patient is 21 years old. Because the age is less than 65 years, no points are added to the current total, keeping the total at 0.
The patient's gender is female and so one point is added to the score, making the current total 0 + 1 = 1.
Because the congestive heart failure history is not specified in the patient note, we assume it is absent from the patient. Because the patient does not have congestive heart failure, no points are added to the current total, keeping the total at 1.
Because hypertension history is not specified in the patient note, we assume that it is absent from the patient. Because the patient does not have hypertension, no points are added to the current total, keeping the total at 1.
One criteria of the CHA2DS2-VASc score is to check if the patient has had any history of stroke, transient ischemic attacks (TIA), or thromboembolism. Because stroke history is not specified in the patient note, we assume that it is absent from the patient. Because tia history is not specified in the patient note, we assume that it is absent from the patient. Because thromboembolism history is not specified in the patient note, we assume it to be absent. Because all of stroke, tia, or thromboembolism are absent, no points are added to score, keeping the score at 1.
Based on the patient note, the patient history for vascular disease is absent. Because the patient does not have vascular disease, no points are added to score, keeping the score at 1. Because diabetes history is not specified in the patient note, we assume it's value as 'absent'. Because the patient does not have diabetes, no points are added to score, keeping the score at 1.
The patient's CHA2DS2-VASc Score is 1."
48,4,CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk,risk,integer,pmc-6939804-1,Extracted,"A 75-year-old man with persistent AF, a CHA2DS2 VASc score of 4 and a HAS-BLED score of 4 with recurrent gastrointestinal bleedings was referred to a tertiary clinic for a LAAC. His medical history consisted of a chronic obstructive pulmonary disease (COPD), coronary artery disease, and a two-thirds gastric resection performed in the 1980s. The intervention was successfully performed with an ABBOTT® Amulet 18 mm device being implanted (). After the implantation, he received acetylsalicylic acid (ASA) and Clopidogrel for 6 months. Approximately 5 months post-intervention, the patient expressed acute dyspnoea and called the emergency medical services (EMS).
On arrival of the EMS, the patient was conscious, severely distressed and hypotensive with a blood pressure of 80/50 mmHg and a heart rate of 90/min. Peripheral oxygen saturation of 85% measured percutaneously was noted. After the administration of bronchodilator medication for a presumed COPD exacerbation, the patient’s clinical condition deteriorated with a resultant cardiac arrest with pulseless electrical activity. The patient received cardiopulmonary resuscitation including chest compressions, endotracheal intubation, and the administration of 3 mg Adrenaline. Return of spontaneous circulation occurred approximately 10 min later at which point he was transferred to a local hospital. During the transport, the cardiocirculatory parameters were relatively stable with a systolic pressure around 100 mmHg. The capnometry after return of spontaneous circulation measured a pCO2 of 60 mmHg. Upon arrival at the hospital, the physical examination showed jugular vein distension but no peripheral oedema.
Echocardiography performed in the emergency department revealed a pericardial tamponade requiring pericardiocentesis via the subxiphoidal route, 800 mL of blood were initially evacuated. The differential diagnosis included primary respiratory failure or a sudden cardiac death with secondary pericardial effusion induced by cardiac compressions under double antiplatelet therapy, a ruptured aortic aneurysm, a myocardial rupture, or a primary laceration of a cardiac structure by the LAA occluder. A ruptured aneurysm of the ascending aorta was excluded by ultrasound. Electrocardiogram examination did not demonstrate any ST-segment elevation or low voltage. Blood gas analysis documented a stable respiratory situation with a pO2 of 230 mmHg and a pCO2 of 55 mmHg, the pH was 7, 3 and Lactate elevated with 10 mmol/L (<2 mmol/L). The haemoglobin was measured at 9 g/dL (12–16 g/dL). The chest X-ray demonstrated the proper placement of the endotracheal and pericardial tube and ruled out a pneumothorax or pulmonary oedema.
In the hours following pericardiocentesis, approximately 2 L of blood were evacuated. Conventional methods of coagulopathy management including application of tranexamic acid, fresh frozen plasma, and fibrinogen did not stop the bleeding. To stabilize the patient a total of eight packs of red blood cells were transfused.
In preparation of cardiac surgery, a coronary angiogram was performed (). It revealed active leakage of contrast agent in the proximal circumflex artery and the patient was transferred to the cardiac surgery department immediately. Intra-operatively a perforation of the tissue at the basis of the LAA close to the left main coronary artery was discovered. Under protection of cold blood cardioplegia on cardiopulmonary bypass the occluder was excised through the opened left atrium. The LAA was closed by endocardial sutures and two pledget sutures were used to seal the epicardial lesion at the LAA basis which stopped the bleeding. Fortunately, after prolonged treatment in the intensive care unit and weaning ward the patient was discharged and alive 4 months after the event without neurological deficit and on ASA monotherapy. Transthoracic echocardiogram in the weaning ward ruled out a persistent pericardial effusion.",What is the patient's CHA2DS2-VASc Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'sex': 'Male', 'age': [75, 'years'], 'Vascular disease history': True}",3,3,3,"The criteria for the CHA2DS2-VASc score are listed below:

1. Age: < 65 years = 0 points, 65-74 years = +1 point, ≥ 75 years = +2 points
2. Sex: Female = +1 point, Male = 0 points
3. Congestive Heart Failure (CHF) history: No = 0 points, Yes = +1 point
4. Hypertension history: No = 0 points, Yes = +1 point
5. Stroke, Transient Ischemic Attack (TIA), or Thromboembolism history: No = 0 points, Yes = +2 points
6. Vascular disease history (previous myocardial infarction, peripheral artery disease, or aortic plaque): No = 0 points, Yes = +1 point
7. Diabetes history: No = 0 points, Yes = +1 point

The CHA2DS2-VASc score is calculated by summing the points for each criterion.
    
The current CHA2DS2-VASc score is 0.
The patient is 75 years old. Because the age is greater than 74, two points added to the score, making the current total 0 + 2 = 2.
The patient's gender is male and so no points are added to the current total, keeping the total at 2.
Because the congestive heart failure history is not specified in the patient note, we assume it is absent from the patient. Because the patient does not have congestive heart failure, no points are added to the current total, keeping the total at 2.
Because hypertension history is not specified in the patient note, we assume that it is absent from the patient. Because the patient does not have hypertension, no points are added to the current total, keeping the total at 2.
One criteria of the CHA2DS2-VASc score is to check if the patient has had any history of stroke, transient ischemic attacks (TIA), or thromboembolism. Because stroke history is not specified in the patient note, we assume that it is absent from the patient. Because tia history is not specified in the patient note, we assume that it is absent from the patient. Because thromboembolism history is not specified in the patient note, we assume it to be absent. Because all of stroke, tia, or thromboembolism are absent, no points are added to score, keeping the score at 2.
Based on the patient note, the patient history for vascular disease is present. Because the patient has vascular disease, one point is added to the score, making the current total 2 + 1 = 3. Because diabetes history is not specified in the patient note, we assume it's value as 'absent'. Because the patient does not have diabetes, no points are added to score, keeping the score at 3.
The patient's CHA2DS2-VASc Score is 3."
49,4,CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk,risk,integer,pmc-8096577-1,Extracted,"A 90-year-old African American female with a history of type 2 diabetes, essential hypertension, deep venous thrombosis, pulmonary embolism, and atrial flutter on chronic anticoagulation with apixaban presented for new-onset general tonic-clonic seizures, witnessed by her family. The patient had been bed-bound from arthritis in a nursing home, but her mental status had been intact. The patient had recently been hospitalized over 3 weeks ago for COVID-19 pneumonia and was discharged home with home hospice one week before readmission.
According to her family, the patient's mental status had severely declined during her previous hospitalization with COVID-19. She developed staring spells after discharge that culminated into generalized tonic-clonic seizures on the day of the current admission. The episode lasted two seconds. Per her hospice nurse, blood pressures and blood glucose were well controlled at home. The home medications were thoroughly reviewed and found not to have any typical pharmacologic culprits. When she presented to the emergency department, she had two more witnessed seizures. Her blood pressure during this episode was 227/95 mm Hg, her heart rate was 98 beats/min, the temperature was 36.7°C, her respiratory rate was 16 breaths/min, and oxygen saturation was 93% while she breathed room air. Intravenous labetalol, lorazepam, and levetiracetam were administered. Her blood pressure decreased to 160/70 mm Hg and remained well controlled during her hospitalization. Head CT and basic laboratory work () were unremarkable. Her physical exam was notable for postictal confusion. She was alert and only oriented to person. An electroencephalogram (EEG) detected no evidence of seizure or epileptiform discharges, but generalized slowing with an intermittent focal slowing in the bilateral temporal regions was noticed (). Brain MRI demonstrated subcortical and cortical FLAIR signal abnormality involving the left greater than right parieto-occipital lobes and the left temporal lobe, in a pattern most compatible with posterior reversible encephalopathy syndrome (PRES) (Figures –). There was no acute intracranial hemorrhage or infarction.
The patient had no further seizures after being treated with levetiracetam. Her mental state gradually returned to normal. She became more eager to participate in physical therapy and be more independent. She set a goal to walk without her walker and to cook for her family and friends. Her family was pleasantly surprised by this improvement in her mentation. She had no further seizure activity in the hospital and was discharged back home with home care services. She is doing well six months after discharge, is seizure-free, and follows her scheduled appointments. Follow-up MRI four months later after presentation showed complete or near resolution of the lesions (Figures –).
No written consent has been obtained from the patient as there is no patient identifiable data included in the case report.",What is the patient's CHA2DS2-VASc Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'sex': 'Female', 'age': [90, 'years'], 'Diabetes history': True, 'Thromboembolism history': True, 'Hypertension history': True}",7,7,7,"The criteria for the CHA2DS2-VASc score are listed below:

1. Age: < 65 years = 0 points, 65-74 years = +1 point, ≥ 75 years = +2 points
2. Sex: Female = +1 point, Male = 0 points
3. Congestive Heart Failure (CHF) history: No = 0 points, Yes = +1 point
4. Hypertension history: No = 0 points, Yes = +1 point
5. Stroke, Transient Ischemic Attack (TIA), or Thromboembolism history: No = 0 points, Yes = +2 points
6. Vascular disease history (previous myocardial infarction, peripheral artery disease, or aortic plaque): No = 0 points, Yes = +1 point
7. Diabetes history: No = 0 points, Yes = +1 point

The CHA2DS2-VASc score is calculated by summing the points for each criterion.
    
The current CHA2DS2-VASc score is 0.
The patient is 90 years old. Because the age is greater than 74, two points added to the score, making the current total 0 + 2 = 2.
The patient's gender is female and so one point is added to the score, making the current total 2 + 1 = 3.
Because the congestive heart failure history is not specified in the patient note, we assume it is absent from the patient. Because the patient does not have congestive heart failure, no points are added to the current total, keeping the total at 3.
The patient history for hypertension is present. Because the patient has hypertension, one point is added to the score, making the current total 3 + 1 = 4.
One criteria of the CHA2DS2-VASc score is to check if the patient has had any history of stroke, transient ischemic attacks (TIA), or thromboembolism. Because stroke history is not specified in the patient note, we assume that it is absent from the patient. Because tia history is not specified in the patient note, we assume that it is absent from the patient. Based on the patient note, the patient history for thromboembolism is present. Because at least one of stroke, tia, or thromboembolism is present, two points are added to the score, making the current total 4 + 2 = 6.
Because vascular disease history is not specified in the patient note, we assume it to be absent.
Because the patient does not have vascular disease, no points are added to score, keeping the score at 6. Based on the patient note, the patient history for diabetes is present. Because the patient has diabetes, one point is added to the score, making the current total 6 + 1 = 7.
The patient's CHA2DS2-VASc Score is 7."
50,4,CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk,risk,integer,pmc-4369977-1,Extracted,"A 55-year-old right-handed male presented to the emergency department after a syncopal episode. He was teaching a karate class when a coworker saw him fall to the ground. He spontaneously regained consciousness after a few seconds but was confused for ∼15–20 min. He had no recollection of the event, and was hemodynamically stable and neurologically intact. He denied illicit drug use. Vitals, physical examination and laboratory studies were within normal limits. ECG showed normal sinus rhythm with normal PR and QT intervals and no ST-T wave changes. He was on no AV blocking agents. Head CT showed no intracranial bleed or mass lesion.
He had a history of five similar episodes in the past. During the last episode, he had been noted to have sinus arrest on telemetry and underwent single atrial lead pacemaker placement. The pacemaker was programmed to AAI mode. AV conduction was tested and was normal. Coronary angiogram showed no evidence of coronary artery disease. EEG had been minimally abnormal with left temporal theta slowing, suggestive of an area of neurophysiologic dysfunction, but no epileptiform activity was noted. He had no history of febrile seizures, central nervous system infection or cranial trauma.
The patient was admitted for further work up. Continuous EEG monitoring was ordered to evaluate for seizure activity. At ∼7 min and 36 s, the patient started to have recurrent automatisms and became unresponsive, with the EEG showing complex partial seizure activity emanating from the left anterior temporal region with continued post-ictal right temporal delta slowing. The seizure lasted ∼1 min. The simultaneous ECG lead demonstrated heart rate slowing toward the end of the seizure episode, with the rhythm changing from sinus to atrially paced at 60 beats min−1 with 1:1 conduction, to atrially paced with 2:1 AV block, followed by complete heart block for 4 s, followed by resumption of the baseline atrially paced rhythm with 1:1 conduction (Fig. ).
Cardiac electrophysiology recommended treating the seizure episodes before considering upgrade of the pacemaker to a dual-chamber device. The patient was started and subsequently discharged on levetiracetam. More than 15 months later, he has had no seizures or syncopal events.",What is the patient's CHA2DS2-VASc Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'sex': 'Male', 'age': [55, 'years'], 'Vascular disease history': False}",0,0,0,"The criteria for the CHA2DS2-VASc score are listed below:

1. Age: < 65 years = 0 points, 65-74 years = +1 point, ≥ 75 years = +2 points
2. Sex: Female = +1 point, Male = 0 points
3. Congestive Heart Failure (CHF) history: No = 0 points, Yes = +1 point
4. Hypertension history: No = 0 points, Yes = +1 point
5. Stroke, Transient Ischemic Attack (TIA), or Thromboembolism history: No = 0 points, Yes = +2 points
6. Vascular disease history (previous myocardial infarction, peripheral artery disease, or aortic plaque): No = 0 points, Yes = +1 point
7. Diabetes history: No = 0 points, Yes = +1 point

The CHA2DS2-VASc score is calculated by summing the points for each criterion.
    
The current CHA2DS2-VASc score is 0.
The patient is 55 years old. Because the age is less than 65 years, no points are added to the current total, keeping the total at 0.
The patient's gender is male and so no points are added to the current total, keeping the total at 0.
Because the congestive heart failure history is not specified in the patient note, we assume it is absent from the patient. Because the patient does not have congestive heart failure, no points are added to the current total, keeping the total at 0.
Because hypertension history is not specified in the patient note, we assume that it is absent from the patient. Because the patient does not have hypertension, no points are added to the current total, keeping the total at 0.
One criteria of the CHA2DS2-VASc score is to check if the patient has had any history of stroke, transient ischemic attacks (TIA), or thromboembolism. Because stroke history is not specified in the patient note, we assume that it is absent from the patient. Because tia history is not specified in the patient note, we assume that it is absent from the patient. Because thromboembolism history is not specified in the patient note, we assume it to be absent. Because all of stroke, tia, or thromboembolism are absent, no points are added to score, keeping the score at 0.
Based on the patient note, the patient history for vascular disease is absent. Because the patient does not have vascular disease, no points are added to score, keeping the score at 0. Because diabetes history is not specified in the patient note, we assume it's value as 'absent'. Because the patient does not have diabetes, no points are added to score, keeping the score at 0.
The patient's CHA2DS2-VASc Score is 0."
51,4,CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk,risk,integer,pmc-3318870-1,Extracted,"A 63-year-old man with history of hypertension and glucose intolerance since age 59 years was emergently admitted to our Institution from a peripheral Hospital for evaluation of a severe, constant posterior chest pain, radiating forward, and dyspnoea with a suspected diagnosis of acute aortic dissection.
On physical examination the patient was not shocked, his pulse was 87 beats/min, blood pressure 150/105 mmHg. He had truncal obesity, a ""moon face"" and proximal muscle weakness. An electrocardiogram showed left ventricular hypertrophy. His laboratory work-up revealed anaemia (Hb 10.7 g/dl), hypokaliemia (3.4 mEq/L), metabolic alkalosis (HCO3- 35 mmol/L) and hyperglycaemia (170 mg/dl). A CT scan of thorax and abdomen demonstrated a dissection starting just below left succlavian artery and extending downward to the left renal artery, involving the celiac tripod and superior mesenteric artery (). The dissection was classified as Stanford B, De Bakey III. Moreover CT scan of abdomen revealed incidentally a left adrenal tumour of 25 mm of diameter.
The patient was pharmacologically treated and was felt at risk for impending aortic rupture. Therefore, an emergent endograft positioning was planned. Our goal was to exclude the damaged segment of the aorta and to obliterate the entry of blood into the false lumen (both at the initial intimal tear and at the secondary tears along the vessel). Through an inguinal incision, the right common, superficial and profunda femoral artery were dissected free. A prosthetic graft (Valiant, Medtronic, Sunnyvale, CA, USA 42 mm x 198 mm) was placed just below the origin of the left succlavian artery up to the diaphragmatic hiatus. A postoperative control CT scan demonstrated the correct graft positioning, not endoleaks and the closure of all secondary tears ().
This patient was evaluated for hypercortisolism and the plasma cortisol was increased to 33.9 μg/dl (vn, value of normal, 5.6-23 μg/dl) without circadian rhythm and not suppressed by the administration of 1 mg of dexamethasone (overnight text: 9.8 μg/dl; vn <1.8 μg/dl ). The plasma adrenocorticotropic hormone (ACTH) was less than 10 pg/ml (vn 12-60 pg/ml) and 24h urinary free cortisol excretion (UFC) was elevated 465.6 μg/24 h (vn 26-135 μg/24h ).
A MRI of abdomen was performed to have a more accurate evaluation of the adrenal mass, it was of 2 cm of diameter, well capsulated, hyperintense in T1 sequences with a normal reduction of signal in T2 weighted sequences ().
A diagnosis of CS was made on basis of the endocrinological tests and for the presence of left adrenocortical lesion. Via laparotomic approach, a left adrenalectomy was performed during intravenous replacement of hydrocortisone, ACE-inhibitor, aspirin and insulin therapy.
Six months after adrenalectomy, blood pressure was controlled (135/75 mmHg) with anti-hypertensive therapy, laboratory analysis revealed glycaemia 102 mg/dl, glycated haemoglobin (HbA1c) 5.7%, potassium 4.26 mEq/l, sodium 139.7 mEq/L, plasma creatinine 1.05 g/dl, a.m. plasma cortiso l9.7 μg/dl, plasma ACTH 28 pg/ml and UFC 45 μg/24h.",What is the patient's CHA2DS2-VASc Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'sex': 'Male', 'age': [63, 'years'], 'Vascular disease history': False, 'Diabetes history': False, 'Hypertension history': True}",1,1,1,"The criteria for the CHA2DS2-VASc score are listed below:

1. Age: < 65 years = 0 points, 65-74 years = +1 point, ≥ 75 years = +2 points
2. Sex: Female = +1 point, Male = 0 points
3. Congestive Heart Failure (CHF) history: No = 0 points, Yes = +1 point
4. Hypertension history: No = 0 points, Yes = +1 point
5. Stroke, Transient Ischemic Attack (TIA), or Thromboembolism history: No = 0 points, Yes = +2 points
6. Vascular disease history (previous myocardial infarction, peripheral artery disease, or aortic plaque): No = 0 points, Yes = +1 point
7. Diabetes history: No = 0 points, Yes = +1 point

The CHA2DS2-VASc score is calculated by summing the points for each criterion.
    
The current CHA2DS2-VASc score is 0.
The patient is 63 years old. Because the age is less than 65 years, no points are added to the current total, keeping the total at 0.
The patient's gender is male and so no points are added to the current total, keeping the total at 0.
Because the congestive heart failure history is not specified in the patient note, we assume it is absent from the patient. Because the patient does not have congestive heart failure, no points are added to the current total, keeping the total at 0.
The patient history for hypertension is present. Because the patient has hypertension, one point is added to the score, making the current total 0 + 1 = 1.
One criteria of the CHA2DS2-VASc score is to check if the patient has had any history of stroke, transient ischemic attacks (TIA), or thromboembolism. Because stroke history is not specified in the patient note, we assume that it is absent from the patient. Because tia history is not specified in the patient note, we assume that it is absent from the patient. Because thromboembolism history is not specified in the patient note, we assume it to be absent. Because all of stroke, tia, or thromboembolism are absent, no points are added to score, keeping the score at 1.
Based on the patient note, the patient history for vascular disease is absent. Because the patient does not have vascular disease, no points are added to score, keeping the score at 1. Based on the patient note, the patient history for diabetes is absent. Because the patient does not have diabetes, no points are added to score, keeping the score at 1.
The patient's CHA2DS2-VASc Score is 1."
52,4,CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk,risk,integer,pmc-4967640-1,Extracted,"A 59-year-old man diagnosed with obstructive hydrocephalus was scheduled for an ETV. The patient had a medical history of well-controlled diabetes mellitus and hypertension that was being treated with an angiotensin receptor blocker, a calcium channel blocker, and a beta blocker. The body mass index was 33.8, but he had no respiratory symptoms, including sleep apnea. A preoperative chest X-ray showed mild cardiomegaly but electrocardiography and echocardiogram findings were normal. The patient's symptoms were amnesia, gait disturbance, and urinary incontinence that had persisted for 5 months; preoperatively, he was alert and cooperative and had no problem communicating. The preoperative vital signs were: blood pressure, 110/70 mmHg; heart rate, 59 beats/min; respiratory rate, 18 breaths/min; and oxygen saturation, 96%. Since the appearance of the patient suggested a possible difficult intubation, a video laryngoscope was used for tracheal intubation after induction of general anesthesia with 150 mg propofol 1%, 40 mg lidocaine 2%, and 60 mg rocuronium. The vocal cord was clearly visible on the video laryngoscope and the intubation was accomplished without trauma or other difficulties. Anesthesia was maintained with 5% desflurane and 0.02 µg/kg/min remifentanil, and air with 50% oxygen. The surgery lasted 2 hours and required no additional muscle relaxants. During the surgery, there was sudden and sustained hypotension (mean blood pressure 52–57 mmHg) with bradycardia (heart rate 45–55 beats/min) that did not respond well to ephedrine; these complications began about 10 min after the beginning of the surgery and lasted for 25 min until a dopamine infusion was administered that restored normal blood pressure. Remifentanil infusion was discontinued at the onset of hypotension and bradycardia. After the purge of volatile agents at the end of the surgery, the train of four (TOF) count was 4, and the ratio was 50%, so 2 mg/kg of sugammadex was injected. The patient recovered muscle power within a few minutes, showing firm hand grip, head elevation, and mouth opening, and was fully obeying verbal commands, but was not opening his eyes. As he was alert and cooperative at that point and no other neurologic deficit was observed, the neurosurgeons thought that the inability to open his eyes was not related to the surgery. We relieved the bandage on the head in order to reduce the chance of unintended pressure or tension on the forehead, and suggested that further neurologic examinations be done after full recovery from anesthesia. Spontaneous respiration was present, showing expired tidal volumes reaching 500 ml each time, but was tachypneic; the patient's respiratory rate ranged from 40 to 50 breaths/min. This condition continued for 5 min, at which time the patient was extubated and transferred to the PACU under mask ventilation. The patient showed signs of inspiratory stridor, chest retractions, and hoarse voice after the extubation. The patient's accessory respiratory muscles were not involved in the hyperventilation. There was no crackle or wheezing clear on auscultation besides the inspiratory stridor, but the findings were not clear on account of the hoarse voice and the rapid and dynamic ventilation. An additional 2 mg/kg of sugammadex was injected in the PACU under the theory that the patient's upper airway was obstructed because of possible residual paralysis but the condition did not change. The patient was fully responsive to verbal commands but was still unable to open his eyes or hold his breath and he complained of feeling like he was choking despite the hyperventilation. Arterial blood gas analysis (ABGA) at that point showed: pH, 7.35; pCO2, 37 mmHg; pO2, 76 mmHg; HCO3, 20.4 mmol/L; and O2 saturation, 94%. The vital signs at that point were: blood pressure, 150/90 mmHg; heart rate, 110 beats/min; and respiratory rate, 44 breaths/min. Since tachypnea (40–50 breaths/min) persisted for 20 min in the PACU and oxygen saturation started to drop under 95%, 200 mg thiopental sodium and 100 mg succinylcholine were injected and endotracheal intubation was performed. Endotracheal suction was done immediately after intubation and there was no sputum or discharge. Auscultation right after the re-intubation sounded smooth, without crackle or wheezing, and the oxygen saturation rapidly corrected to 100%. Tachypnea persisted even under sedation after the succinylcholine wore off, so a central cause was suspected. Computed tomography (CT) revealed a massive pneumocephalus with pneumoventricle and hydrocephalus (). A chest X-ray taken after the brain CT showed no pathologic findings such as pulmonary edema, congestion, or pneumothorax. On the neurosurgeon's recommendation, the patient was transferred to the intensive care unit and was kept there for three days under mechanical ventilation with sedation with midazolam, cisatracurium, and rocuronium until the pneumocephalus and tachypnea spontaneously resolved. Follow-up chest radiographs were taken over the next 3 weeks and showed nothing abnormal. According to a pulmonology consultation, the tachypnea was not likely to have originated from pulmonary problems. ABGA results stayed within normal limits under fully controlled mechanical ventilation but showed hypoxemia when the patient gained spontaneous respiration during the sedative period before the resolution of the pneumocephalus. Since the follow-up chest X-rays showed no abnormal findings, pulmonary embolism evaluation including embolism CT and laboratory examinations, which also showed nothing abnormal, were done on the recommendation of a pulmonologist. When a follow-up brain CT showed resolution of the pneumocephalus on the 3rd day after the surgery, sedative and neuromuscular blocking agents were discontinued and the mechanical ventilation mode was switched to synchronized intermittent mandatory ventilation. The respiratory rate at that point ranged from 15 to 20 breaths/min and ABGA results remained normal when the patient gained consciousness and self-respiration, so the endotracheal tube was extubated. The patient is now (30 days post-operation) in the general ward; he is mentally alert and has stable vital signs but still is unable to open his eyes because of bilateral ptosis and is receiving conservative treatment.",What is the patient's CHA2DS2-VASc Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'sex': 'Male', 'age': [59, 'years'], 'Diabetes history': True, 'Hypertension history': True}",2,2,2,"The criteria for the CHA2DS2-VASc score are listed below:

1. Age: < 65 years = 0 points, 65-74 years = +1 point, ≥ 75 years = +2 points
2. Sex: Female = +1 point, Male = 0 points
3. Congestive Heart Failure (CHF) history: No = 0 points, Yes = +1 point
4. Hypertension history: No = 0 points, Yes = +1 point
5. Stroke, Transient Ischemic Attack (TIA), or Thromboembolism history: No = 0 points, Yes = +2 points
6. Vascular disease history (previous myocardial infarction, peripheral artery disease, or aortic plaque): No = 0 points, Yes = +1 point
7. Diabetes history: No = 0 points, Yes = +1 point

The CHA2DS2-VASc score is calculated by summing the points for each criterion.
    
The current CHA2DS2-VASc score is 0.
The patient is 59 years old. Because the age is less than 65 years, no points are added to the current total, keeping the total at 0.
The patient's gender is male and so no points are added to the current total, keeping the total at 0.
Because the congestive heart failure history is not specified in the patient note, we assume it is absent from the patient. Because the patient does not have congestive heart failure, no points are added to the current total, keeping the total at 0.
The patient history for hypertension is present. Because the patient has hypertension, one point is added to the score, making the current total 0 + 1 = 1.
One criteria of the CHA2DS2-VASc score is to check if the patient has had any history of stroke, transient ischemic attacks (TIA), or thromboembolism. Because stroke history is not specified in the patient note, we assume that it is absent from the patient. Because tia history is not specified in the patient note, we assume that it is absent from the patient. Because thromboembolism history is not specified in the patient note, we assume it to be absent. Because all of stroke, tia, or thromboembolism are absent, no points are added to score, keeping the score at 1.
Because vascular disease history is not specified in the patient note, we assume it to be absent.
Because the patient does not have vascular disease, no points are added to score, keeping the score at 1. Based on the patient note, the patient history for diabetes is present. Because the patient has diabetes, one point is added to the score, making the current total 1 + 1 = 2.
The patient's CHA2DS2-VASc Score is 2."
53,4,CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk,risk,integer,pmc-3286501-2,Extracted,"A 78-year-old female patient, temporarily admitted to the recovery department after ECT, developed atrial fibrillation and chest pain. Her medical history showed hypertension, severe depression and paroxysmal atrial fibrillation. Her ECG 3 months before ECT was completely normal. Immediately after ECT her blood pressure was 230/140 mmHg, but later decreased to 110/45 mmHg. Examination of heart and lungs revealed no abnormalities. The ECG showed atrial fibrillation with a ventricular rate of 140 beats/min and new negative T waves in leads I, II, aVL and V2-6. The second ECG showed sinus rhythm and persisting negative T-waves (Fig. ). Troponin T level was 0.02 μg/l (normal) and no other laboratory abnormalities were found. A differential diagnosis was made and the following possible causes were taken into account: post ECT, post tachycardia due to atrial fibrillation, severe hypertension or myocardial ischaemia. Since the patient reported to have had previous anginal complaints, coronary angiography was performed. In the left anterior descending artery two significant stenoses were identified in the proximal and the mid section, respectively. Furthermore, a stenosis was found in the right coronary artery. Due to her psychiatric condition, PCI was not performed and she was treated with anti-anginal medication and warfarin.",What is the patient's CHA2DS2-VASc Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'sex': 'Female', 'age': [78, 'years'], 'Vascular disease history': True, 'Hypertension history': True}",5,5,5,"The criteria for the CHA2DS2-VASc score are listed below:

1. Age: < 65 years = 0 points, 65-74 years = +1 point, ≥ 75 years = +2 points
2. Sex: Female = +1 point, Male = 0 points
3. Congestive Heart Failure (CHF) history: No = 0 points, Yes = +1 point
4. Hypertension history: No = 0 points, Yes = +1 point
5. Stroke, Transient Ischemic Attack (TIA), or Thromboembolism history: No = 0 points, Yes = +2 points
6. Vascular disease history (previous myocardial infarction, peripheral artery disease, or aortic plaque): No = 0 points, Yes = +1 point
7. Diabetes history: No = 0 points, Yes = +1 point

The CHA2DS2-VASc score is calculated by summing the points for each criterion.
    
The current CHA2DS2-VASc score is 0.
The patient is 78 years old. Because the age is greater than 74, two points added to the score, making the current total 0 + 2 = 2.
The patient's gender is female and so one point is added to the score, making the current total 2 + 1 = 3.
Because the congestive heart failure history is not specified in the patient note, we assume it is absent from the patient. Because the patient does not have congestive heart failure, no points are added to the current total, keeping the total at 3.
The patient history for hypertension is present. Because the patient has hypertension, one point is added to the score, making the current total 3 + 1 = 4.
One criteria of the CHA2DS2-VASc score is to check if the patient has had any history of stroke, transient ischemic attacks (TIA), or thromboembolism. Because stroke history is not specified in the patient note, we assume that it is absent from the patient. Because tia history is not specified in the patient note, we assume that it is absent from the patient. Because thromboembolism history is not specified in the patient note, we assume it to be absent. Because all of stroke, tia, or thromboembolism are absent, no points are added to score, keeping the score at 4.
Based on the patient note, the patient history for vascular disease is present. Because the patient has vascular disease, one point is added to the score, making the current total 4 + 1 = 5. Because diabetes history is not specified in the patient note, we assume it's value as 'absent'. Because the patient does not have diabetes, no points are added to score, keeping the score at 5.
The patient's CHA2DS2-VASc Score is 5."
54,4,CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk,risk,integer,pmc-7437123-4,Extracted,"The patient was a 64-year-old man affected by a persistent nodular lesion of the cheek mucosa. More precisely, he presented with a blue-violet, sessile, painless, and nonbleeding lesion of the cheek lasting one year (Figure ). He reported occasional biting trauma. Warfarin therapy had been prescribed for the patient for chronic atrial fibrillation. The clinical diagnosis was of venous malformation, as confirmed by ultrasound investigation. Following a careful explanation of the treatment, the patient agreed to transmucosal photocoagulation by DL without suspension of warfarin treatment. After a small amount of local anesthesia, we used the DL (wavelength 910 ± 10 nm; pulsed-wave; fiber of 400 microns; output energy 5 W) to directly photocoagulate the lesion, and the treatment ended when its color varied from blue-violet to grayish-white (Figure ). The irradiated area healed in 14 days without recurrence (Figure ).",What is the patient's CHA2DS2-VASc Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'sex': 'Male', 'age': [64, 'years']}",0,0,0,"The criteria for the CHA2DS2-VASc score are listed below:

1. Age: < 65 years = 0 points, 65-74 years = +1 point, ≥ 75 years = +2 points
2. Sex: Female = +1 point, Male = 0 points
3. Congestive Heart Failure (CHF) history: No = 0 points, Yes = +1 point
4. Hypertension history: No = 0 points, Yes = +1 point
5. Stroke, Transient Ischemic Attack (TIA), or Thromboembolism history: No = 0 points, Yes = +2 points
6. Vascular disease history (previous myocardial infarction, peripheral artery disease, or aortic plaque): No = 0 points, Yes = +1 point
7. Diabetes history: No = 0 points, Yes = +1 point

The CHA2DS2-VASc score is calculated by summing the points for each criterion.
    
The current CHA2DS2-VASc score is 0.
The patient is 64 years old. Because the age is less than 65 years, no points are added to the current total, keeping the total at 0.
The patient's gender is male and so no points are added to the current total, keeping the total at 0.
Because the congestive heart failure history is not specified in the patient note, we assume it is absent from the patient. Because the patient does not have congestive heart failure, no points are added to the current total, keeping the total at 0.
Because hypertension history is not specified in the patient note, we assume that it is absent from the patient. Because the patient does not have hypertension, no points are added to the current total, keeping the total at 0.
One criteria of the CHA2DS2-VASc score is to check if the patient has had any history of stroke, transient ischemic attacks (TIA), or thromboembolism. Because stroke history is not specified in the patient note, we assume that it is absent from the patient. Because tia history is not specified in the patient note, we assume that it is absent from the patient. Because thromboembolism history is not specified in the patient note, we assume it to be absent. Because all of stroke, tia, or thromboembolism are absent, no points are added to score, keeping the score at 0.
Because vascular disease history is not specified in the patient note, we assume it to be absent.
Because the patient does not have vascular disease, no points are added to score, keeping the score at 0. Because diabetes history is not specified in the patient note, we assume it's value as 'absent'. Because the patient does not have diabetes, no points are added to score, keeping the score at 0.
The patient's CHA2DS2-VASc Score is 0."
55,4,CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk,risk,integer,pmc-6533936-1,Extracted,"A 57-year-old man who had alcoholic liver disease and chronic hepatitis C-related Child-Pugh class C liver cirrhosis was brought to our emergency department by ambulance, exhibiting fever, short of breath and a localized wound pain over left ankle. The patient presented with dyspnea, lower extremity edema and some wounds over bilateral ankles area for 1 day before admission, but had no other symptoms, including a headache, sore throat, cough, and chest, abdominal, and back pain. He had alcohol and chronic hepatitis C- related liver cirrhosis, and took diuretics in the past 5 years. He drank approximately 60 g of alcohol per day for more than 20 years, but recently had been taking a bit more than usual.
His laboratory data 2 weeks before admission were 6.5 mg/ dl of total bilirubin, 2.1 g/dl of albumin, and 1.73 of international normalized ratio. In addition, he had moderate ascites, which was medically controlled. These findings were indicative of Child- Pugh class C liver cirrhosis. On arrival, he appeared to be in disturbance and distress that was classified as 13 (E3V4M6) on the Glasgow Coma Scale. His vital signs were 132/106 mmHg of blood pressure, 125 beats/minute of pulse rate, 24 breaths/minute of respiratory rate, and 38.4 °C of body temperature. Auscultation of the lung and heart revealed coarse breath sounds and rapid irregular heartbeats. His abdomen was soft and swollen. Two wounds with redness and swelling (measures 0.5 × 0.5 cm, left ankle; measures 1 × 1 cm, right ankle) were found on his lower extremities ( and ). Chest X-ray indicated a lower lobe infiltration and a mild blunting of C-P angle in the right side (). ECG showed atrial fibrillation.
Laboratory findings also included 8,990/ml of white blood cell count with 94% neutrophils and 3% lymphocytes, 11.1 g/dl of hemoglobin level, 104,000/ml of platelet count, 23 mg/dl of blood urea nitrogen, 1.42 mg/dl of creatinine, 121 mmol/L of sodium, and 4.6 mmol/L of potassium. Ascitic fluid analysis demonstrated 152 cells/mm3 of ascitic white blood cell count and 30 cells/mm3 of polymorphonuclear cell count 10 hours later after his arrival of emergency department. Arterial blood gas analysis demonstrated a severe metabolic acidosis (pH: 7.38, pCO2: 20.4 mmHg, pO2: 91.8 mmHg; base deficit: 11.2 mmol/L), which was indicative of septic shock.
Oxacillin treatment under the impression of cellulitis was administered 2 hours after his arrival; two sets of blood cultures were obtained. Rapid fluid resuscitation was performed and immediately developed by tracheal intubation and mechanical ventilation in the intensive care unit. Although there was no significant change of ankle wounds, antibiotic regimen with a combination of ceftriaxone and clindamycin was adjusted due to persistent hypotension unresponsive to fluid resuscitation and high dose vasopressor use and clinical suspicion of Vibrio vulnificus related necrotizing fasciitis.
One episode of upper gastrointestinal bleeding with manifestations of fresh blood in the nasogastric tube occurred on Day 2. Blood transfusion with 2 units of packed red blood cells was given. Despite intensive support efforts, the patient died on Day 3 after the sudden change. And after that, his blood and ascites cultures were positive for A. hydrophila.",What is the patient's CHA2DS2-VASc Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'sex': 'Male', 'age': [57, 'years'], 'Hypertension history': False}",0,0,0,"The criteria for the CHA2DS2-VASc score are listed below:

1. Age: < 65 years = 0 points, 65-74 years = +1 point, ≥ 75 years = +2 points
2. Sex: Female = +1 point, Male = 0 points
3. Congestive Heart Failure (CHF) history: No = 0 points, Yes = +1 point
4. Hypertension history: No = 0 points, Yes = +1 point
5. Stroke, Transient Ischemic Attack (TIA), or Thromboembolism history: No = 0 points, Yes = +2 points
6. Vascular disease history (previous myocardial infarction, peripheral artery disease, or aortic plaque): No = 0 points, Yes = +1 point
7. Diabetes history: No = 0 points, Yes = +1 point

The CHA2DS2-VASc score is calculated by summing the points for each criterion.
    
The current CHA2DS2-VASc score is 0.
The patient is 57 years old. Because the age is less than 65 years, no points are added to the current total, keeping the total at 0.
The patient's gender is male and so no points are added to the current total, keeping the total at 0.
Because the congestive heart failure history is not specified in the patient note, we assume it is absent from the patient. Because the patient does not have congestive heart failure, no points are added to the current total, keeping the total at 0.
The patient history for hypertension is absent. Because the patient does not have hypertension, no points are added to the current total, keeping the total at 0.
One criteria of the CHA2DS2-VASc score is to check if the patient has had any history of stroke, transient ischemic attacks (TIA), or thromboembolism. Because stroke history is not specified in the patient note, we assume that it is absent from the patient. Because tia history is not specified in the patient note, we assume that it is absent from the patient. Because thromboembolism history is not specified in the patient note, we assume it to be absent. Because all of stroke, tia, or thromboembolism are absent, no points are added to score, keeping the score at 0.
Because vascular disease history is not specified in the patient note, we assume it to be absent.
Because the patient does not have vascular disease, no points are added to score, keeping the score at 0. Because diabetes history is not specified in the patient note, we assume it's value as 'absent'. Because the patient does not have diabetes, no points are added to score, keeping the score at 0.
The patient's CHA2DS2-VASc Score is 0."
56,4,CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk,risk,integer,pmc-4157480-1,Extracted,"A 62-year-old male presented to Samsung Medical Center with a 40-year history of paroxysmal palpitations. Although diagnosed with atrial septal defect (ASD) 30 years previously, the patient elected not to undergo surgical repair. Approximately 1 year prior, he began to visit the pediatric ward of Samsung Medical Center more frequently with symptoms of palpitations and dyspnea lasting 2 to 3 days and occurring in 2- to 3-month intervals. An electrocardiogram showed paroxysmal atrial fibrillation, and secundum-type ASD (22.3 mm) with a left-to-right shunt was diagnosed by echocardiogram. Device closure (Amplatzer septal occlude 28 mm; AGA Medical, Golden Valley, MN, USA) was then performed; however, 1 week after the procedure, the patient continued to experience dyspnea and chest pain after 10 to 20 minutes of walking. Sustained atrial fibrillation was seen on the electrocardiogram and 24-hour Holter monitor. Cardioversion was performed following hospitalization with the opinion that the persistent atrial fibrillation was due to device closure. The patient was discharged from the hospital after cardioversion to sinus rhythm at 100 J; however, the symptoms recurred. Since it was difficult to perform radiofrequency catheter ablation (RFCA) due to the recent device closure, the patient was referred to the thoracic surgery department for totally thoracoscopic ablation. Surgery was performed under routine procedures. Intubation was performed using a double lumen endotracheal tube. For the surgery, a 10-mm trocar was inserted in the fourth intercostal space (ICS) of the right anterior axillary line, a 5-mm trocar in the third ICS along the anterior axillary line, and a 10-mm trocar in the sixth ICS on the mid-axillary line. Right pulmonary vein ablation, right ganglionated plexi ablation, and ablation of the right half of the space between the right lower pulmonary vein and the left lower pulmonary vein were performed. Between the procedures, we conducted a high-frequency stimulation test for finding ganglionated plexi. Sutures were placed after chest tube insertion. On the left side, ports were placed in the same positions, and ablations were performed in the same order as on the right side after dividing Marshall’s ligament (). A left atrial auricle resection was then performed using an Echelon Flex 60 articulating endoscopic linear cutter (Ethicon Endo-Surgery Inc., Cincinnati, OH, USA). Upon confirmation of the conversion to sinus rhythm, the patient was transferred to the intensive care unit. He was then transferred to the general ward on postoperative day 1 and discharged from the hospital on postoperative day 6. During this 6-day postoperative period, the sinus rhythm was maintained continuously. Six months later, the sinus rhythm was seen on the 24-hour Holter monitor; the patient showed none of the earlier symptoms, and therefore, amiodarone and warfarin were stopped. The patient is currently being followed as an outpatient, and his sinus rhythm has been well maintained as seen on the last electrocardiogram at the 8 month follow-up.",What is the patient's CHA2DS2-VASc Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'sex': 'Male', 'age': [62, 'years']}",0,0,0,"The criteria for the CHA2DS2-VASc score are listed below:

1. Age: < 65 years = 0 points, 65-74 years = +1 point, ≥ 75 years = +2 points
2. Sex: Female = +1 point, Male = 0 points
3. Congestive Heart Failure (CHF) history: No = 0 points, Yes = +1 point
4. Hypertension history: No = 0 points, Yes = +1 point
5. Stroke, Transient Ischemic Attack (TIA), or Thromboembolism history: No = 0 points, Yes = +2 points
6. Vascular disease history (previous myocardial infarction, peripheral artery disease, or aortic plaque): No = 0 points, Yes = +1 point
7. Diabetes history: No = 0 points, Yes = +1 point

The CHA2DS2-VASc score is calculated by summing the points for each criterion.
    
The current CHA2DS2-VASc score is 0.
The patient is 62 years old. Because the age is less than 65 years, no points are added to the current total, keeping the total at 0.
The patient's gender is male and so no points are added to the current total, keeping the total at 0.
Because the congestive heart failure history is not specified in the patient note, we assume it is absent from the patient. Because the patient does not have congestive heart failure, no points are added to the current total, keeping the total at 0.
Because hypertension history is not specified in the patient note, we assume that it is absent from the patient. Because the patient does not have hypertension, no points are added to the current total, keeping the total at 0.
One criteria of the CHA2DS2-VASc score is to check if the patient has had any history of stroke, transient ischemic attacks (TIA), or thromboembolism. Because stroke history is not specified in the patient note, we assume that it is absent from the patient. Because tia history is not specified in the patient note, we assume that it is absent from the patient. Because thromboembolism history is not specified in the patient note, we assume it to be absent. Because all of stroke, tia, or thromboembolism are absent, no points are added to score, keeping the score at 0.
Because vascular disease history is not specified in the patient note, we assume it to be absent.
Because the patient does not have vascular disease, no points are added to score, keeping the score at 0. Because diabetes history is not specified in the patient note, we assume it's value as 'absent'. Because the patient does not have diabetes, no points are added to score, keeping the score at 0.
The patient's CHA2DS2-VASc Score is 0."
57,4,CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk,risk,integer,pmc-8515802-1,Extracted,"A 73-year-old female presented with a chief complaint for evaluation of an incidental finding of peripancreatic lymph node.
She underwent computed tomography (CT) of the abdomen and pelvis as part of her routine surveillance for extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT-lymphoma) of the lung and was found to have peripancreatic lymph node. She denied any abdominal pain, change in bowel habit, weight loss, nausea, or vomiting.
Her medical history was significant for MALT-lymphoma, invasive lobular breast carcinoma, hypertension, atrial fibrillation, mitral valve prolapse, mitral valve stenosis, and actinic keratosis. Her surgical history included a mastectomy with sentinel lymph node dissection, laparoscopic cholecystectomy, tonsillectomy, left knee replacement, and bilateral carpal tunnel repair.
Her family history was significant for colon cancer in maternal grandmother at the age of 65 years, prostate cancer in brother at the age of 63 years, and melanoma in mother. She had no history of alcohol or tobacco abuse. She has 2 children and attained menopause at the age of 52 years. Her medications included aspirin, furosemide, carvedilol, rosuvastatin, amiodarone, digoxin, anastrozole, and Eliquis.
Her physical examination was unremarkable, and her abdomen was soft nontender, nondistended with no palpable mass.
Laboratory exam including fractionated metanephrines, chromogranin, and gastrin were negative.
CT of the abdomen and pelvis showed 2 cm × 1.1 cm lymph node adjacent to the pancreatic head (Figure ).
EUS showed a 19 mm × 11.5 mm hypoechoic lesion near the pancreatic head (Figure ). Two FNA passes using a 25-gauge needle were performed via transduodenal approach (Figure ).
Direct FNA smears showed tumor with neuroendocrine features. Initial immunoperoxidase stains performed on cell block sections were positive for synaptophysin and chromogranin, which seemed to confirm the morphologic impression of PNET. The pathologist was subsequently informed about the peripancreatic location and lack of a definite pancreatic lesion.",What is the patient's CHA2DS2-VASc Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'sex': 'Female', 'age': [73, 'years'], 'Hypertension history': True}",3,3,3,"The criteria for the CHA2DS2-VASc score are listed below:

1. Age: < 65 years = 0 points, 65-74 years = +1 point, ≥ 75 years = +2 points
2. Sex: Female = +1 point, Male = 0 points
3. Congestive Heart Failure (CHF) history: No = 0 points, Yes = +1 point
4. Hypertension history: No = 0 points, Yes = +1 point
5. Stroke, Transient Ischemic Attack (TIA), or Thromboembolism history: No = 0 points, Yes = +2 points
6. Vascular disease history (previous myocardial infarction, peripheral artery disease, or aortic plaque): No = 0 points, Yes = +1 point
7. Diabetes history: No = 0 points, Yes = +1 point

The CHA2DS2-VASc score is calculated by summing the points for each criterion.
    
The current CHA2DS2-VASc score is 0.
The patient is 73 years old. Because the age is between 65 and 74, one point added to the score, making the current total 0 + 1 = 1.
The patient's gender is female and so one point is added to the score, making the current total 1 + 1 = 2.
Because the congestive heart failure history is not specified in the patient note, we assume it is absent from the patient. Because the patient does not have congestive heart failure, no points are added to the current total, keeping the total at 2.
The patient history for hypertension is present. Because the patient has hypertension, one point is added to the score, making the current total 2 + 1 = 3.
One criteria of the CHA2DS2-VASc score is to check if the patient has had any history of stroke, transient ischemic attacks (TIA), or thromboembolism. Because stroke history is not specified in the patient note, we assume that it is absent from the patient. Because tia history is not specified in the patient note, we assume that it is absent from the patient. Because thromboembolism history is not specified in the patient note, we assume it to be absent. Because all of stroke, tia, or thromboembolism are absent, no points are added to score, keeping the score at 3.
Because vascular disease history is not specified in the patient note, we assume it to be absent.
Because the patient does not have vascular disease, no points are added to score, keeping the score at 3. Because diabetes history is not specified in the patient note, we assume it's value as 'absent'. Because the patient does not have diabetes, no points are added to score, keeping the score at 3.
The patient's CHA2DS2-VASc Score is 3."
58,4,CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk,risk,integer,pmc-7229273-1,Extracted,"The patient was a 76-year-old man with a history of mild dysphasia. He had a prior history of cerebral infarctions (x3) at the age of 66, 74 and 75 years, with a first instance of swallowing difficulties after the third stroke. At that time, dysphasia rehabilitation was initiated within 3 days of the stroke, and he recovered the ability to eat a regular meal within 2 weeks. In January 2018, 1-year after his last stroke, he underwent surgery for spinal stenosis, followed by a 10-day period of bedrest. His physical activity level subsequently declined due to back pain, and he lost 10 kg within the 10 months after surgery. Swallowing difficulties re-emerged in September 2018, with the patient only able to tolerate soft meals. His dysphasia worsened, with an increase in sputum and development of a chronic cough.
His medical history included cerebral infarctions (x3), diabetes mellitus, spinal stenosis, and hypertension. His height was 168.8 cm, with a body weight of 56.5 kg. He had a right hemiplegia, with the following functional measures: grip strength, 25 kg; gait speed, 0.7 m/s, assessed using the 5-m walk test; and skeletal mass index, 6.6 kg/m2. His score of 5 points on the Mini Nutritional Assessment Short Form was indicative of malnourishment. Absence of another cerebral infarct was confirmed by magnetic resonance imaging. Video-endoscopic swallowing assessment showed saliva pooling in the pharynx, widening of the pharyngeal space, vallecular and pyriform sinus residue, and aspiration (A). Video-fluorography revealed a decrease in the forward movement of the larynx, a widened pharyngeal space, weakened pharyngeal constriction, vallecular and pyriform sinus residue, and aspiration (A–C). Functional swallowing scores were as follows: Hyodo score, 9; Fujishima grade, 6; FILS, 8; and dysphasia severity scale, 4. A probable diagnosis of sarcopenic dysphagia was made, based on the criteria defined by Mori et al. [] Clinical management included swallowing training, a high-protein diet, and nutritional guidance. The patient declined additional rehabilitation, due to his previous experience post-stroke. Therefore, we presented laryngeal suspension as a possible alternative treatment, which was performed in December 2018.
Laryngeal suspension was performed via a minimally invasive thyromadibulopexy, using two skin incisions: one (2-cm) incision at the level of the mandible and the other (3-cm) between the hyoid bone and the superior border of the thyroid cartilage (A). Identified the white line, divided aside the anterior cervical muscles, and exposed the thyroid cartilage. Also the mandible was exposed. Two holes in the mandibular and six holes in the thyroid cartilage was made by using drill. The thyroid cartilage was fixed to the mandible using No. 2 nylon. No. 2 nylon thread was passed through the Gore-tex sheet cut to the size of thyroid cartilage. And it was passed through the thyroid cartilage, subcutaneous tunnel on the hyoid bone, mandible, subcutaneous tunnel on the hyoid bone, and tied to the other side of the nylon. As the two holes of the middle of the thyroid cartilage, two No. 2 nylons was crossed to fix the thyroid cartilage and mandible. The larynx was suspended about one vertebral body by totally using five No. 2 nylons (B), confirmed by X-ray fluoroscopy. A 1-cm incision was performed for tracheotomy, and cuffed tracheal cannula was inserted for airway management.
Maintaining some neck flexion for a period of 1-week was conducted. Nutritional support was initiated via gastrostomy tube feeding. The cuffed tracheal cannula was changed to an uncuffed cannula on postoperative day (POD) 1. The wound was stable and there was no pain. Swallowing was initiated using jelly and cold tea, with the patient in a flat lateral position. The tracheal cannula was removed on POD 4. Video-fluorography revealed contrast agent residue in the vallecular but with a decrease in residue in the pyriform sinus compared to pre-operative measures, with no evidence of aspiration on POD 6 (A–C). Anterosuperior movement of the larynx was improved, reaching one vertebral level higher than before surgery. The swallowing reflex was maintained, with sufficient opening of the esophageal orifice, avoiding the need for mandibular protrusion to swallow. Swallowing using modified food was initiated in a sitting position on POD 6 and the gastrostomy tube was removed on POD 7. Video-endoscopic examination confirmed his ability to eat a rice cracker and noodles without aspiration and no evidence of pharyngeal residue on POD 11 (B). The patient was able to eat soft meals on POD 14, and a regular meal on POD 18, and was discharged on POD 21. The patient gained 2 kg in the 2 months after surgery, with improvement in functional scores: Hyodo score, 5; Fujishima grade, 8; FILS, 8; and dysphasia severity scale, 6. There was no exacerbation of the condition over a 10-month period after surgery, and the patient has a normal diet and is able to travel. Neck movement restriction was not severe.",What is the patient's CHA2DS2-VASc Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'sex': 'Male', 'age': [76, 'years'], 'Diabetes history': True, 'Stroke': True, 'Hypertension history': True}",6,6,6,"The criteria for the CHA2DS2-VASc score are listed below:

1. Age: < 65 years = 0 points, 65-74 years = +1 point, ≥ 75 years = +2 points
2. Sex: Female = +1 point, Male = 0 points
3. Congestive Heart Failure (CHF) history: No = 0 points, Yes = +1 point
4. Hypertension history: No = 0 points, Yes = +1 point
5. Stroke, Transient Ischemic Attack (TIA), or Thromboembolism history: No = 0 points, Yes = +2 points
6. Vascular disease history (previous myocardial infarction, peripheral artery disease, or aortic plaque): No = 0 points, Yes = +1 point
7. Diabetes history: No = 0 points, Yes = +1 point

The CHA2DS2-VASc score is calculated by summing the points for each criterion.
    
The current CHA2DS2-VASc score is 0.
The patient is 76 years old. Because the age is greater than 74, two points added to the score, making the current total 0 + 2 = 2.
The patient's gender is male and so no points are added to the current total, keeping the total at 2.
Because the congestive heart failure history is not specified in the patient note, we assume it is absent from the patient. Because the patient does not have congestive heart failure, no points are added to the current total, keeping the total at 2.
The patient history for hypertension is present. Because the patient has hypertension, one point is added to the score, making the current total 2 + 1 = 3.
One criteria of the CHA2DS2-VASc score is to check if the patient has had any history of stroke, transient ischemic attacks (TIA), or thromboembolism. Based on the patient note, the patient history for stroke is present. Because tia history is not specified in the patient note, we assume that it is absent from the patient. Because thromboembolism history is not specified in the patient note, we assume it to be absent. Because at least one of stroke, tia, or thromboembolism is present, two points are added to the score, making the current total 3 + 2 = 5.
Because vascular disease history is not specified in the patient note, we assume it to be absent.
Because the patient does not have vascular disease, no points are added to score, keeping the score at 5. Based on the patient note, the patient history for diabetes is present. Because the patient has diabetes, one point is added to the score, making the current total 5 + 1 = 6.
The patient's CHA2DS2-VASc Score is 6."
59,4,CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk,risk,integer,pmc-6296059-1,Extracted,"An obese 42-year-old African American male with diabetes mellitus, hypertension, heart failure with reduced ejection fraction, coronary arterial disease, and atrial fibrillation presented with new onset right-sided chest pain and a palpable right chest mass. Ultrasound showed an anterior right chest, well-demarcated 7.5 × 6.5 × 4.8 cm, intramuscular mass, 0.6 cm deep to the skin. CT demonstrated a 9x9x9cm necrotic mass arising from the pectoralis major. CT-guided core biopsy was positive for high-grade spindle cell neoplasm (positive for smooth muscle actin, desmin, S100, and CD31; negative for CD34, PAX8, and beta-catenin) and verified by two independent pathologists.
Unfortunately, the patient was lost to follow up after referral to Oncology and Thoracic Surgery. He presented to oncology clinic with progressive symptoms including a rapidly enlarging chest mass, increasing pain, and new onset chest wall numbness. A repeat CT showed that the mass increased in size to 21.4 × 17.8 × 13.7 cm without evidence of metastatic disease over course of two months. MRI was consistent with 23 cm mass within the right pectoralis major without vascular or bony invasion. The patient chose to undergo neoadjuvant chemotherapy given his multiple comorbidities. He was hesitant to pursue resection and elected to attempt to shrink the tumor before resection.
Patient underwent neoadjuvant chemotherapy with gemcitabine and docetaxel for 2 cycles followed by radiation therapy (50Gy over 2 months to tumor bed + 3 cm margins). Restaging CT showed a stable tumor at 23 cm without any evidence of local or distant metastases.
The patient returned to Thoracic surgery clinic to discuss options for resection and reconstruction. He then underwent wide local surgical resection for definitive therapy. Tumor was removed en bloc with resection to the intercostal fascia including pectoralis major and minor (Fig. ). There did not appear to be any violation of the intercostal investing fascia and no entry into the thoracic cavity was made. Negative pressure dressing was used until post-operative day 7 when Plastic Surgery performed advancement flap coverage and skin grafting to the > 1,000cm2 defect (Fig. a, b).
Final pathology demonstrated 38x20x18 cm tumor with 70% gross necrosis and R0 resection. Microscopic examination confirmed high-grade sarcoma with smooth muscle differentiation (Fig. ). Final pathologic staging based on AJCC 7th edition was Stage III G3 pT2bNxMx.",What is the patient's CHA2DS2-VASc Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'sex': 'Male', 'age': [42, 'years'], 'Congestive Heart Failure': True, 'Vascular disease history': True, 'Diabetes history': True, 'Hypertension history': True}",4,4,4,"The criteria for the CHA2DS2-VASc score are listed below:

1. Age: < 65 years = 0 points, 65-74 years = +1 point, ≥ 75 years = +2 points
2. Sex: Female = +1 point, Male = 0 points
3. Congestive Heart Failure (CHF) history: No = 0 points, Yes = +1 point
4. Hypertension history: No = 0 points, Yes = +1 point
5. Stroke, Transient Ischemic Attack (TIA), or Thromboembolism history: No = 0 points, Yes = +2 points
6. Vascular disease history (previous myocardial infarction, peripheral artery disease, or aortic plaque): No = 0 points, Yes = +1 point
7. Diabetes history: No = 0 points, Yes = +1 point

The CHA2DS2-VASc score is calculated by summing the points for each criterion.
    
The current CHA2DS2-VASc score is 0.
The patient is 42 years old. Because the age is less than 65 years, no points are added to the current total, keeping the total at 0.
The patient's gender is male and so no points are added to the current total, keeping the total at 0.
The patient history for congestive heart failure is present. Because the patient has congestive heart failure, one point is added to the score, making the current total 0 + 1 = 1.
The patient history for hypertension is present. Because the patient has hypertension, one point is added to the score, making the current total 1 + 1 = 2.
One criteria of the CHA2DS2-VASc score is to check if the patient has had any history of stroke, transient ischemic attacks (TIA), or thromboembolism. Because stroke history is not specified in the patient note, we assume that it is absent from the patient. Because tia history is not specified in the patient note, we assume that it is absent from the patient. Because thromboembolism history is not specified in the patient note, we assume it to be absent. Because all of stroke, tia, or thromboembolism are absent, no points are added to score, keeping the score at 2.
Based on the patient note, the patient history for vascular disease is present. Because the patient has vascular disease, one point is added to the score, making the current total 2 + 1 = 3. Based on the patient note, the patient history for diabetes is present. Because the patient has diabetes, one point is added to the score, making the current total 3 + 1 = 4.
The patient's CHA2DS2-VASc Score is 4."
60,4,CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk,risk,integer,pmc-4464016-1,Extracted,"An 83-year-old male with a history of arterial hypertension and diabetes developed acute right-sided hemiparesis and fluent aphasia (NIHSS score on admission: 4). He arrived at our hospital 45 min later. On admission, his blood pressure was 160/70 mm Hg; atrial fibrillation was detected on electrocardiography. Cranial computed tomography (cCT) revealed no early signs of cerebral ischemia or intracranial hemorrhage (ICH). The patient was unable to self-report his drug history due to persisting aphasia. The INR measured by a commercial POC device was within normal range (1.00; normal 0.85-1.18). IVT (rt-PA 0.9 mg/kg) was initiated 80 min after symptom onset and before all laboratory findings were received. Around 20 min after IVT had commenced, coagulation parameters were normal [including INR (1.10), thrombin time (18.8 s; normal 14-21), partial thromboplastin time (34.8 s, normal 23-36) and platelet counts]. A follow-up cCT ruled out IVT-induced ICH and the patient fully recovered within 48 h (NIHS score: 0). At this stage, he was able to report regular intake of apixaban (Eliquis®, 2.5 mg t.i.d.) since April 2014 due to atrial fibrillation. The last apixaban tablet had been taken 13.5 h before IVT.",What is the patient's CHA2DS2-VASc Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'sex': 'Male', 'age': [83, 'years'], 'Stroke': True, 'Diabetes history': True, 'Hypertension history': True}",6,6,6,"The criteria for the CHA2DS2-VASc score are listed below:

1. Age: < 65 years = 0 points, 65-74 years = +1 point, ≥ 75 years = +2 points
2. Sex: Female = +1 point, Male = 0 points
3. Congestive Heart Failure (CHF) history: No = 0 points, Yes = +1 point
4. Hypertension history: No = 0 points, Yes = +1 point
5. Stroke, Transient Ischemic Attack (TIA), or Thromboembolism history: No = 0 points, Yes = +2 points
6. Vascular disease history (previous myocardial infarction, peripheral artery disease, or aortic plaque): No = 0 points, Yes = +1 point
7. Diabetes history: No = 0 points, Yes = +1 point

The CHA2DS2-VASc score is calculated by summing the points for each criterion.
    
The current CHA2DS2-VASc score is 0.
The patient is 83 years old. Because the age is greater than 74, two points added to the score, making the current total 0 + 2 = 2.
The patient's gender is male and so no points are added to the current total, keeping the total at 2.
Because the congestive heart failure history is not specified in the patient note, we assume it is absent from the patient. Because the patient does not have congestive heart failure, no points are added to the current total, keeping the total at 2.
The patient history for hypertension is present. Because the patient has hypertension, one point is added to the score, making the current total 2 + 1 = 3.
One criteria of the CHA2DS2-VASc score is to check if the patient has had any history of stroke, transient ischemic attacks (TIA), or thromboembolism. Based on the patient note, the patient history for stroke is present. Because tia history is not specified in the patient note, we assume that it is absent from the patient. Because thromboembolism history is not specified in the patient note, we assume it to be absent. Because at least one of stroke, tia, or thromboembolism is present, two points are added to the score, making the current total 3 + 2 = 5.
Because vascular disease history is not specified in the patient note, we assume it to be absent.
Because the patient does not have vascular disease, no points are added to score, keeping the score at 5. Based on the patient note, the patient history for diabetes is present. Because the patient has diabetes, one point is added to the score, making the current total 5 + 1 = 6.
The patient's CHA2DS2-VASc Score is 6."
61,5,Mean Arterial Pressure (MAP),physical,decimal,pmc-2567296-1,Extracted,"A 46 year old male, a known hypertensive on treatment for the past 10 years, was diagnosed to have chronic renal failure 3 years ago. Consequently he progressed to ESRD and hemodialysis was initiated in December 2006 for the same, with the creation of a brachiocephalic arteriovenous fistula over the left arm. He has been undergoing regular thrice weekly hemodialysis since then. He is a school teacher by occupation. He had no past history of diabetes mellitus, hypothyroidism, coronary artery disease, or hepatic disease. No past history of Tuberculosis or TB contact. He is married and has two sons. He was a non-smoker and a non-alcoholic.
Over the past year, the artificial AV fistula enlarged in size to attain its current dimensions (Figure ). On 3rd June 2008, he presented to the emergency department of our tertiary care hospital with complaints of progressive breathlessness over the past 15 days. There was no history of associated chest pain, palpitations, syncope, cough, expectoration, or orthopnea.
On examination, he had pallor and bilateral pitting pedal edema. He was afebrile, with a pulse rate of 108/min, BP of 140/80 mmHg, respiratory rate of 28/min. A giant arteriovenous fistula was seen extending from the cubital fossa of the left arm up to the left supraclavicular region (Figure ). Respiratory system examination revealed stony dullness over the left mammary, infra-axillary and sub-scapular areas on percussion. On auscultation, there was decreased intensity of breath sounds over the above mentioned areas. Normal vesicular breath sounds were heard over all other areas. Other systems examination was unremarkable.
His blood investigations showed hemoglobin of 4.5 g/dl, BUN – 13 mg/dl, creatinine- 2.6 mg/dl, with other parameters being within normal limits. His coagulation profile was slightly deranged with a raised INR (Table ). Chest X-ray revealed a massive pleural effusion on the left side (Figure ). USG guided pleural aspiration revealed a hemorrhagic fluid. Pleural fluid analysis showed no WBCs, RBC – 5000/mm3 (normocytic 22%, crenated 88%), sugar – 70 mgs/dl, protein – 4.3 g/dl. Doppler study of the AV fistula showed a high peak velocity of 350 cms/sec, with no evidence of thrombosis or stenosis. In order to drain the hemorrhagic pleural effusion, an intercostal drain was placed. Patient was managed with 5 units packed red cell transfusion, oxygen and other supportive measures. With this presentation the possible cause for the left hemothorax was suspected to be due to the AV fistula. Hence after the patient was stabilized, the giant AV fistula was ligated on the 6th day after admission. Following ligation of the fistula, the patient's left sided pleural effusion decreased. The chest drain was removed after 7 days and patient was discharged after 3 more days. On follow up 6 weeks later, the patient did not have a recurrence of pleural effusion (Figure ). For further hemodialysis, the creation of a new fistula on his right arm has been planned.",What is patient's mean arterial pressure in mm Hg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Systolic Blood Pressure': [140.0, 'mm hg'], 'Diastolic Blood Pressure': [80.0, 'mm hg']}",100,95,105,"The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 140.0 mm Hg + 2/3 * 80.0 mm Hg = 100.0 mm Hg.
Hence, the patient's mean arterial pressure is 100.0 mm Hg."
62,5,Mean Arterial Pressure (MAP),physical,decimal,usmle-4629,Extracted,"A 40-year-old unrestrained passenger is brought into the emergency room after a motor vehicle collision. The patient is awake and alert, though he complains of chest and back pain. Soon after he is brought in, the patient loses consciousness. His vitals are: Temperature 96 deg F (35.6 deg C), pulse 120/min, blood pressure 80/45 mmHg, and respirations 22/min. His physical exam is significant for bruising on his chest along with crepitus present with sternal palpation. His chest radiograph is shown in Figure A.",What is patient's mean arterial pressure in mm Hg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Diastolic Blood Pressure': [45.0, 'mm hg'], 'Systolic Blood Pressure': [80.0, 'mm hg']}",56.66667,53.83334,59.5,"The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 80.0 mm Hg + 2/3 * 45.0 mm Hg = 56.66667 mm Hg.
Hence, the patient's mean arterial pressure is 56.66667 mm Hg."
63,5,Mean Arterial Pressure (MAP),physical,decimal,pmc-7540180-1,Extracted,"We describe the case of a 70-year-old woman who developed sudden-onset vertical separation of images. This occurred only when she specifically gazed at a distance. For example, when she looked at a plant, she saw a double image that was completely vertically separated, without overlap. The bottom image was blurry and with color but of a similar size. It appeared ghostly and almost transparent. She could almost see through it; it was diaphanous. However, it did not disappear with either eye closed. The blurry second-bottom image disappeared only with the closure of both eyes or by looking away from the object. Hence, there was no evidence of palinopsia or bona fide diplopia. This phenomenon occurred for both stationary and moving objects. A moving truck was experienced as two vertically separated images, with the bottom image described as blurry. She knew that the bottom duplicated image was not real. The duplicated image was of the same size and receded as she approached it, as demonstrated by the patient's own original rendition (Figure ).
She denied any visual field loss or scotoma. The color perception was preserved. She denied photopsia, micropsia, macropsia, or metamorphopsia. Visual acuity was not diminished, and she was still able to read and write with ease. She denied a headache or weakness of the arms or legs. She saw an ophthalmologist who noted full ocular motion without any subtle ophthalmoparesis on double Maddox rod testing.
Her past medical history was significant for asthma and ulcerative colitis. Her medications included azathioprine, lansoprazole, mesalamine, and montelukast. Her mom had coronary artery disease and her dad had cerebrovascular disease. She was a non-smoker.
On examination, her blood pressure (BP) was 150/92 with a pulse of 71, which was regular. Her height is five feet with a weight of 185 pounds and a body mass index (BMI) of 36.1. The precordial examination was negative for a murmur and carotid bruits were absent in both internal carotid arteries. Her neurologic examination was non-revealing. Her gait station, cadence, and tandem walking were normal. Her cranial nerve examination was entirely normal. Specifically, the ocular motion was full without strabismus with a cover/uncover test and an alternate eye cover test. Accommodation was preserved without pupillary asymmetry, and visual field confrontation was normal. We were careful not to miss visual field neglect by sequential hemifield visual confrontation followed by simultaneous double hemifield confrontation. The rest of the cranial nerve function was normal. Visuomotor praxis was preserved with pantomime. No limb-kinetic or ideomotor apraxia was noted with coin deftness and transitive motor acts respectively. Ishihara plate color testing was normal. Power function was normal throughout and graded at 5/5 with the Medical Research Council (MRC) grading. Sensory examination was normal to graphesthesia and stereognosis in both hands. And deep tendon reflexes were symmetric and lively in the arms and legs. No dysmetria or intention tremor was noted in the arms. Heel to shin motion was normal in the legs bilaterally.
A magnetic resonance image (MRI) of the brain shows a diffusion-weighted image (DWI) hyperintensity involving the left mesial occipital lobe; striate cortex, V1, spilling over into the adjacent visual association cortex, V2, indicating an ischemic infarct (Figure ).
There was a corresponding hypointensity on gradient echo imaging (GRE) in the region of V2 (Figure ).
A carotid duplex scan was normal. A transcranial Doppler (TCD) with a two Megahertz crystal with the insonation of temporal, transorbital, and sub-occipital windows bilaterally showed monophasic waveforms with no high-velocity jets, which was normal. Due to the embolic nature of the ischemic infarct and a normal event monitor, a cardiac loop monitor was implanted to rule out paroxysmal atrial fibrillation. A transthoracic echocardiogram with a bubble study did not reveal a patent foramen ovale or any evidence of cardiac vegetations or intra-cavitary thrombus. The automated Humphrey visual field test showed a subtle and patchy incongruous right homonymous hemianopia (Figure ); the patient herself did not notice any visual field deficits.
The patient was defaulted to 81 milligrams (mg) of aspirin daily.",What is patient's mean arterial pressure in mm Hg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Systolic Blood Pressure': [150.0, 'mm hg'], 'Diastolic Blood Pressure': [92.0, 'mm hg']}",111.33333,105.76666,116.9,"The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 150.0 mm Hg + 2/3 * 92.0 mm Hg = 111.33333 mm Hg.
Hence, the patient's mean arterial pressure is 111.33333 mm Hg."
64,5,Mean Arterial Pressure (MAP),physical,decimal,pmc-3611911-1,Extracted,"A 10-year-old male patient was brought to our department with premature pubarche and onset of facial acne at the age of 8 years and increase in penis size at the age of 9 years. Concomitantly, he had a progressive, gradually worsening holocranial headache associated with drowsiness and loss of appetite. The patient denied deterioration of vision. Previously, he was a healthy patient, born by spontaneous vaginal delivery at term weighing 3510 g and measuring 50 cm. He was breastfed for 3 months and had normal neuropsychomotor development. The patient had no family history of endocrine disorders, sexual precocity, or consanguinity. The mother's and father's self-reported height was 155 cm and 175 cm respectively. Physical examination revealed height of 148 cm (90-95th percentile), weight of 39 kg (75-90th percentile), blood pressure of 90/60 mmHg, heart rate of 60 beats per minute, facial acne, abdominal fat deposition in the periumbilical region, bilateral, symmetrical and prepubertal sized (3 mL) testes within the scrotum, 8-cm long penis, and Tanner stage P3-G2. Papilledema was detected on fundoscopy.
Magnetic resonance imaging (MRI) of the brain showed a large, hyperintense tumor in the suprasellar region, with hypodense areas inside the tumor, which was located in the anterior third ventricle, measuring 3 cm in the largest diameter and causing triventricular dilatation []. Radiographs of the hands and wrists revealed significant acceleration of bone age (BA) in relation to chronological age (CA) (BA: 13 years; CA: 10 years and 8 months; standard deviation: 10 months). MRI of the abdomen yielded normal results. Laboratory tests revealed that the values for serum glucose, albumin, calcium, sodium, potassium, renal function, and liver function were within the normal limits. Hormonal tests showed increased hCG levels in both blood and cerebrospinal fluid (CSF), increased total testosterone levels, and hypopituitarism (unresponsiveness to gonadorelin stimulation test) []. The results of tumor marker tests are also described in .
The patient was diagnosed with an hCG- and testosterone-producing tumor associated with hypopituitarism and intracranial hypertension. Hormone replacement therapy was initiated with levothyroxine and hydrocortisone, and transcranial surgery was performed. Anatomopathologic examination confirmed the diagnosis of germinoma []]. Radiotherapy was performed after surgical resection of the tumor. The patient showed complete regression of sexual characteristics and acne, with normal laboratory tests post-operatively.",What is patient's mean arterial pressure in mm Hg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Systolic Blood Pressure': [90.0, 'mm hg'], 'Diastolic Blood Pressure': [60.0, 'mm hg']}",70,66.5,73.5,"The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 90.0 mm Hg + 2/3 * 60.0 mm Hg = 70.0 mm Hg.
Hence, the patient's mean arterial pressure is 70.0 mm Hg."
65,5,Mean Arterial Pressure (MAP),physical,decimal,pmc-8047735-1,Extracted,"A 79-year-old African American female presented to the emergency room for shortness of breath with exertion and grade 2+ bilateral lower limb edema. The patient denied dizziness, palpitation, fever, chills, productive cough, abdominal pain, nausea, vomiting, hematemesis, melena, and hematochezia.
On examination, the patient's blood pressure was 94/66 mmHg, the temperature was 97.6 °F, the heart rate was irregular with a rate of 78 beats per minute, respiratory rate was 20 breaths per minute, and she was saturating 100% on room air. Sinus pauses were noted, up to 10 seconds in length, on the telemetry monitor. ECG and telemetry monitoring demonstrated SSS with sinus bradycardia, pauses up to three seconds, and atrial fibrillation (AF) with a rate of 130 beats per minute (bpm; Figure ). Her other medical history included paroxysmal atrial tachycardia, lower extremity venous insufficiency, diastolic heart failure (ejection fraction of 70-75%), chronic obstructive pulmonary disease, and gastroesophageal reflux disease, and no other medical history reported. The patient's home medications included fluticasone propionate/salmeterol inhaler, albuterol sulfate inhaler, torsemide, metolazone, potassium chloride, vitamin D3, pantoprazole, sotalol, and no other heart rate modulating medication reported. Laboratory workup revealed a potassium of 4.5 (3.5-5.1 mM/L), magnesium of 2.3 (1.7-2.7 mg/dL), thyroid-stimulating hormone of 1.54 (0.34-5.60 µIU/mL), and troponin of 0.1 (0.0-0.5 ng/mL). The patient underwent urgent pacemaker placement to prevent further sinus pauses.
The patient was also complaining of dysphagia and difficulty swallowing, for which an esophagogastroduodenoscopy (EGD) was performed. The procedure identified both esophageal and duodenal ulcers. The biopsy was performed during the EGD and sent for histopathological review. The esophagus contained small columnar pieces of mucosa and collections of eosinophilic, amorphous material demonstrated on congo red staining. The congo red stain contained one fragment with blood vessels that exhibited mural deposition of amyloid. In the duodenal biopsy, the lamina propria also had amyloid on congo red staining. Videofluoroscopic swallowing examination revealed no tracheal aspiration and no motility disorder. Eventually, the patient required percutaneous endoscopic gastrostomy tube placement for feeding secondary to dysphagia. TTE findings were consistent with restrictive cardiomyopathy, raising the possibility of cardiomyopathy secondary to amyloidosis and SSS as the initial presenting feature in our patient.
The patient had also developed a bifascicular block, which was potentially consistent with an infiltrative amyloid disease. The patient had a Kappa free light chain drawn, and this was markedly elevated at 146 mg/dL (reference range 0.3-1.9 mg/dL), Lambda 1.97 (0.5-2.6 mg/dL), with a Kappa/Lambda ratio of 74.1. We performed electrophoresis to investigate further and found an elevated gamma globulin of 1.75 g/dL (reference range 0.70-1.50 mg/dL).
Two months later the patient presented with persistent, progressive shortness of breath on minimal exertion and persistent lower limb edema. Laboratory work-up was significant for brain natriuretic peptide (BNP) of 838 (2-100 pg/mL), BUN of 37, creatinine of 1.85, white blood cell count of 10.3 (4.5-11.0 × 103/µL), hemoglobin of 10.7 (12.0-15.7 g/dl), and platelet count of 178 (140-440 × 103/µL). ECG was obtained and demonstrated an atrial paced rhythm, bifascicular block, left anterior fascicular block, right bundle branch block, and a pronounced low voltage pattern throughout all leads (Figure ). She had three negative troponins, and her pacemaker was found to be functioning appropriately. The patient did not have any compelling cardiac symptoms aside from the dyspnea on exertion.
TTE demonstrated an ejection fraction of 60%, a small pericardial effusion, an increased left ventricular wall thickness (left ventricular posterior wall diastolic thickness 1.4 cm (0.6-1.0/0.6-0.9 cm), right ventricular systolic pressure (RVSP) 56 mmHg, and mild to moderate biatrial enlargement (Figure ).
A renal biopsy and bone marrow biopsy were performed to confirm the diagnosis of amyloidosis. The results of these biopsies were consistent with our hypothesis that the patient had AL amyloid. She was intermittently treated with Dexamethasone and Bortezomib but ultimately evaluated by palliative care for comfort measures due to the prognosis of her condition.",What is patient's mean arterial pressure in mm Hg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Systolic Blood Pressure': [94.0, 'mm hg'], 'Diastolic Blood Pressure': [66.0, 'mm hg']}",75.33333,71.56666,79.1,"The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 94.0 mm Hg + 2/3 * 66.0 mm Hg = 75.33333 mm Hg.
Hence, the patient's mean arterial pressure is 75.33333 mm Hg."
66,5,Mean Arterial Pressure (MAP),physical,decimal,usmle-8486,Extracted,"A 67-year-old woman has fallen from the second story level of her home while hanging laundry. She was brought to the emergency department immediately and presented with severe abdominal pain. The patient is anxious, and her hands and feet feel very cold to the touch. There is no evidence of bone fractures, superficial skin wounds, or a foreign body penetration. Her blood pressure is 102/67 mm Hg, respirations are 19/min, pulse is 87/min, and temperature is 36.7°C (98.0°F). Her abdominal exam reveals rigidity and severe tenderness. A Foley catheter and nasogastric tube are inserted. The central venous pressure (CVP) is 5 cm H2O. The medical history is significant for hypertension.",What is patient's mean arterial pressure in mm Hg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Systolic Blood Pressure': [102.0, 'mm hg'], 'Diastolic Blood Pressure': [67.0, 'mm hg']}",78.66667,74.73334,82.6,"The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 102.0 mm Hg + 2/3 * 67.0 mm Hg = 78.66667 mm Hg.
Hence, the patient's mean arterial pressure is 78.66667 mm Hg."
67,5,Mean Arterial Pressure (MAP),physical,decimal,usmle-529,Extracted,"A 47-year-old female comes to the emergency department because of increasing back pain for the past 2 weeks. She is unable to perform her daily chores. One month ago, she fell and hurt her back while working outside in the garden. The pain subsided with over-the-counter acetaminophen. She underwent a left mastectomy 1 year ago for breast cancer. She has type 2 diabetes mellitus. Current medications include metformin, sitagliptin, and a multivitamin. She appears uncomfortable. Her temperature is 38.9°C (102.0°F), pulse is 101/min, and blood pressure is 110/80 mm Hg. Examination of the back shows thoracic vertebral tenderness. She has mild stiffness on neck flexion. Muscle strength is decreased in the lower extremities. Deep tendon reflexes are 2+ bilaterally. Sensation to pain, fine touch, temperature, and proprioception is intact. Her hemoglobin concentration is 13.1 g/dL and leukocyte count is 19,300/mm3.",What is patient's mean arterial pressure in mm Hg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Diastolic Blood Pressure': [80.0, 'mm hg'], 'Systolic Blood Pressure': [110.0, 'mm hg']}",90,85.5,94.5,"The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 110.0 mm Hg + 2/3 * 80.0 mm Hg = 90.0 mm Hg.
Hence, the patient's mean arterial pressure is 90.0 mm Hg."
68,5,Mean Arterial Pressure (MAP),physical,decimal,pmc-6996699-1,Extracted,"A 50-year-old female patient with a known case of diabetes mellitus and end-stage renal disease due to hypertension was started on hemodialysis in March 2014. Permanent tunneled catheters were placed into the right internal jugular vein as the patient was not fit for AVF creation due to vascular occlusions.
On 7 April 2019, at the end of a dialysis session, the patient developed fever (39°C) and chills. Fever was documented at 39°C, was associated with chills and rigors, and was not responding to antipyretics. In the emergency department, the patient reported no change in weight, loss of appetite, or night sweats. She denied any history of respiratory, gastrointestinal, neurological symptoms. On examination, the temperature was 39°C, the blood pressure 150/75 mm Hg, the heart rate 110 beats per minute, and the respiratory rate 18 breaths per minute. The patient was fully conscious and oriented. The remainder of the general medical examination was normal.
She was admitted to our nephrology unit with possible source catheter-related blood stream infection. She was started on ceftazidime 2 gm IV once daily and vancomycin 1 gm IV Q HD as per the protocol. The white blood cell count was 13.3 × 103 cells, C-reactive protein was 278 mg/dl, and procalcitonin was 52.27. The electrocardiogram revealed sinus tachycardia, and chest radiography was negative.
Blood culture from venous and central catheters was sampled separately, and the causative microorganism was identified as a Gram-negative, motile, lactose-fermenting bacillus, which was identified by the Vitek MS automatic identification system using a GN card as Leclercia adecarboxylata. Antibiotic sensitivity testing using Vitek 2 showed that it is an extended-spectrum beta-lactamase producer. The results are summarized in (). The L. adecarboxylata strain was resistant to most beta-lactams, including narrow, expanded, and broad-spectrum cephalosporins. But it was susceptible to all quinolones and carbapenems tested.
The treatment regimen was changed to meropenem 500 mg IV once daily and gentamicin based on antibiotic susceptibility tests (ASTs) from blood cultures. This targeted therapy was successful, and the patient became afebrile. The patient received meropenem and gentamicin for two weeks, and then she was discharged in good condition.",What is patient's mean arterial pressure in mm Hg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Systolic Blood Pressure': [150.0, 'mm hg'], 'Diastolic Blood Pressure': [75.0, 'mm hg']}",100,95,105,"The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 150.0 mm Hg + 2/3 * 75.0 mm Hg = 100.0 mm Hg.
Hence, the patient's mean arterial pressure is 100.0 mm Hg."
69,5,Mean Arterial Pressure (MAP),physical,decimal,pmc-4641864-2,Extracted,"A 59-year-old man was admitted to the emergency department with a carrot in the rectum and mild lower abdominal discomfort. He had no specific history and denied homosexual identity. The patient's blood pressure was 132/78 mm Hg; pulse rate, 88/min; respiration rate, 18/min; and body temperature, 36.5℃. Abdominal examination revealed a soft and flat abdomen with normal bowel sounds. Digital rectal examination revealed the hard bottom of the carrot near the rectal angle and normal anal sphincter tone. His laboratory data were as follows: hemoglobin level, 14.7 g/dL; white blood cell count, 17,270/mm3; and CRP level, 6.55 mg/L. The results of evaluations for hepatitis B surface antigen, hepatitis C antibody, and HIV antibody were all negative. The foreign body was not observed on abdominal radiography, and no evidence of peritoneal or perirectal free air was observed ().
The carrot observed during endoscopy was deemed to be too large and heavy for removal using endoscopic devices. Hence, we decided to use tenaculum forceps from the start. By using the same techniques described previously, we were able to remove the carrot successfully (). The patient's abdominal discomfort subsided immediately, and he was discharged from the hospital.",What is patient's mean arterial pressure in mm Hg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Diastolic Blood Pressure': [78.0, 'mm hg'], 'Systolic Blood Pressure': [132.0, 'mm hg']}",96,91.2,100.8,"The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 132.0 mm Hg + 2/3 * 78.0 mm Hg = 96.0 mm Hg.
Hence, the patient's mean arterial pressure is 96.0 mm Hg."
70,5,Mean Arterial Pressure (MAP),physical,decimal,usmle-25,Extracted,"A 35-year-old man is brought to the emergency department 30 minutes after being involved in a motor vehicle collision. The patient was on his way to work before he lost control of his car and crashed into a tree. On arrival, the patient appears weak and lethargic. He has pain in his abdomen. His temperature is 37°C (98.6°F), pulse is 121/min, respirations are 22/min, and blood pressure is 85/60 mm Hg. He is oriented to person but not to place or time. The lungs are clear to auscultation. Cardiac examination shows tachycardia but no murmurs, rubs, or gallops. Abdominal examination shows several bruises above the umbilicus; there is diffuse abdominal tenderness. Focused assessment with sonography in trauma (FAST) is performed but the results are inconclusive.",What is patient's mean arterial pressure in mm Hg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Systolic Blood Pressure': [85.0, 'mm hg'], 'Diastolic Blood Pressure': [60.0, 'mm hg']}",68.33333,64.91666,71.75,"The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 85.0 mm Hg + 2/3 * 60.0 mm Hg = 68.33333 mm Hg.
Hence, the patient's mean arterial pressure is 68.33333 mm Hg."
71,5,Mean Arterial Pressure (MAP),physical,decimal,usmle-9720,Extracted,"A 56-year-old man presents to the family medicine office since he has been having difficulty keeping his blood pressure under control for the past month. He has a significant medical history of hypertension, coronary artery disease, and diabetes mellitus. He has a prescription for losartan, atenolol, and metformin. The blood pressure is 178/100 mm Hg, the heart rate is 92/min, and the respiratory rate is 16/min. The physical examination is positive for a grade II holosystolic murmur at the left sternal border. He also has diminished sensation in his toes.",What is patient's mean arterial pressure in mm Hg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Systolic Blood Pressure': [178.0, 'mm hg'], 'Diastolic Blood Pressure': [100.0, 'mm hg']}",126,119.7,132.3,"The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 178.0 mm Hg + 2/3 * 100.0 mm Hg = 126.0 mm Hg.
Hence, the patient's mean arterial pressure is 126.0 mm Hg."
72,5,Mean Arterial Pressure (MAP),physical,decimal,pmc-5930216-1,Extracted,"A 34-year-old Surinamese female was referred to the Department of Vascular Medicine of our hospital because of right-sided blurred vision, caused by ischemic retinopathy and neovascularisation (Fig. ). Her medical history was remarkable for heterozygote alpha-thalassemia, but negative for thrombotic and recurrent infectious events. The family history was also negative for thrombotic events or bleeding tendency. The patient was not treated with anticoagulants or platelet inhibitors. Physical examination was normal (BMI 23.0 kg/m2, blood pressure 125/70 mmHg, heart rate 85/min, normal heart sounds, and no vascular murmurs). After the exclusion of hypertension, diabetes mellitus, vasculitis, hyperviscosity, and sickle cell disease, a thrombophilia workup was performed. All hemostatic laboratory parameters were found normal except for an increased protein S activity (179%) with high free protein S level (207%), despite a normal total protein S antigen level (98%) (Table ). This suggested that, in contrast to normal conditions, all protein S was free protein S, instead of 30–40% free and 60–70% bound protein S. High activity and antigen levels of free protein S were confirmed in a separate sample 3 months later. Clinically, a protein S deficiency is considered as a possible cause of hypercoagulation, which in turn could have led to the retinopathy. The incidental finding of elevated protein S levels were not considered explanatory of the condition. We did not initiate anticoagulation or thrombocyte aggregation inhibition. The patient's vision did not improve remarkably, nor did it deteriorate in the subsequent months after her initial visit.
The high free protein S level in the proband was caused by a reduced level of C4BP (18%), as measured with an ELISA against the α-chain of C4BP. To identify a possible molecular defect underlying the C4BP deficiency, we sequenced the protein-coding regions and exon/intron boundaries of C4BPA (encoding C4BPα, ) and C4BPB (encoding C4BPβ, ).
We identified two previously reported non-synonymous variants in C4BPA, that is, c.719G>A (p. R240H), rs45574833 ((A=0.0140/1686 (ExAC), A = 0.0030/15 (1000 Genomes), A = 0.0095/124 (GO-ESP), A = 0.0078/227 (TOPMED)), and c.899T>C (p. I300T), rs4844573 (C = 0.4014/47780 [ExAC], C = 0.4898/2453 [1000 Genomes], C = 0.4841/6296 [GO-ESP], T = 0.4689/13653 [TOPMED]).
In addition, we screened the father and brother for these mutations. Both are also Surinamese. Only p. I300T was present in the father (Fig. ). Both father and brother had normal free protein S levels. Mother, second sister, and second brother were unavailable for testing.
Discordant data concerning the association between C4BP polymorphisms and atypical hemolytic uremic syndrome have been reported , . Furthermore, these two variants have also been identified in women experiencing recurrent miscarriages, but due to equally high frequencies between patients and controls, the importance of these variants in this particular clinical situation may be questionable . No mutations were found in the C4BPB gene.
Because we could not find clear molecular defect in the C4BP gene responsible for the reduced expression, and a recent report indicated that binding of protein S to C4BP promotes cellular secretion of C4BP , we also sequenced the sex hormone-binding globulin (SHBG)-like region of protein S (), responsible for binding to C4BP using the previously published primers , . No mutations explaining a reduced binding of protein S to C4BP were found in the SHBG-domain of protein S.
Although the medical records did not report any use of vitamin K antagonist, we excluded the interference of any form of vitamin K antagonists by the measurement of coagulation factors II, VII, and X which were all normal, except for factor X which was slightly increased (163%) (Table ). Furthermore, there was no indication of reduced capacity of liver synthesis with normal antithrombin and factor V levels. Furthermore, we also did not find a clear effect of decreased C4BP levels on the complement route, with normal complement pathway activities (Table ).",What is patient's mean arterial pressure in mm Hg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Systolic Blood Pressure': [125.0, 'mm hg'], 'Diastolic Blood Pressure': [70.0, 'mm hg']}",88.33333,83.91666,92.75,"The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 125.0 mm Hg + 2/3 * 70.0 mm Hg = 88.33333 mm Hg.
Hence, the patient's mean arterial pressure is 88.33333 mm Hg."
73,5,Mean Arterial Pressure (MAP),physical,decimal,pmc-4602709-1,Extracted,"A 21-year-old man presented to our emergency room with a complaint of right lower abdominal pain for 2 days. On physical examination, the vital signs were as follows: temperature, 37.3°C; heart rate, 94/min; respiratory rate, 20/min; blood pressure, 120/75 mm Hg. The abdominal examination was significant for tenderness and pain in the right lower quadrant upon palpation. There was no rebound tenderness or muscle rigidity. The remainder of the physical examination was normal. Laboratory testing revealed the following: white blood cell count, 9.54 × 109/L; neutrophilic granulocytes, 81.1%; hemoglobin, 136 g/L; platelet count, 232 × 109/L. Kidney function and other biochemical measures were normal. Computed tomography (CT, Figure A and B) showed pneumatosis in the appendix and fluid in the pelvic cavity. Based on the above findings, a diagnosis of acute appendicitis was made and a laparoscopic appendectomy was undertaken; however, the appendix was normal in appearance and an appendectomy was not performed. Intraoperatively, the terminal ileum was noted to be approximately 15 cm in diameter, hyperemic, and edematous (Figure ); there was no apparent inflammation of the appendix. Thus, terminal ileitis was diagnosed. Three days postoperatively, the patient had rose-colored petechiae and palpable purpura on the lower extremities, and HSP was diagnosed. Subsequently, methylprednisolone (2 mg/kg/d iv) was administered for 5 days. Seven days postoperatively, the abdominal pain and purpura resolved. There were no recurrences in the subsequent 8 months, and long-term follow-up in the clinic was recommended.",What is patient's mean arterial pressure in mm Hg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Diastolic Blood Pressure': [75.0, 'mm hg'], 'Systolic Blood Pressure': [120.0, 'mm hg']}",90,85.5,94.5,"The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 120.0 mm Hg + 2/3 * 75.0 mm Hg = 90.0 mm Hg.
Hence, the patient's mean arterial pressure is 90.0 mm Hg."
74,5,Mean Arterial Pressure (MAP),physical,decimal,usmle-976,Extracted,"A 44-year-old man comes to the physician for a routine health maintenance examination. He had not seen his primary care physician for 7 years. He has no complaints other than feeling easily fatigued. He has no significant medical history. He reports drinking half a pint of liquor a day. His temperature is 98.7°F (37.1°C), pulse is 65/min, respiratory rate is 15/min, and blood pressure is 120/70 mm Hg. Physical examination shows reddish color to both of his palms. His abdomen has no focal tenderness but is difficult to assess due to distention.",What is patient's mean arterial pressure in mm Hg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Systolic Blood Pressure': [120.0, 'mm hg'], 'Diastolic Blood Pressure': [70.0, 'mm hg']}",86.66667,82.33334,91,"The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 120.0 mm Hg + 2/3 * 70.0 mm Hg = 86.66667 mm Hg.
Hence, the patient's mean arterial pressure is 86.66667 mm Hg."
75,5,Mean Arterial Pressure (MAP),physical,decimal,pmc-3409401-1,Extracted,"A 72-year-old woman presented to the emergency room with dyspnea and myalgia that developed 2 weeks after undergoing acupuncture therapy on both knees due to arthralgia. Vital signs on admission showed hypotension (80/40 mm Hg), tachycardia (118 beats per minute), tachypnea (20 per minute), and hypothermia (35℃). On physical examination, the patient had multiple needle scars on both knees with dappled rashes on her entire body (). Her laboratory results showed elevated white blood cell counts (10100/mm3), with neutrophil 88%, elevated high sensitive C-reactive protein level of 36 mg/dL (reference range, 0-0.5 mg/dL), blood urea nitrogen/creatinine 71/4.5 mg/dL, myoglobin 5169 ng/mL (reference range, 16.3-96.5 ng/dL), creatine kinase myocardial band 9.7 U/L (reference range, 0-3.6 U/L), Troponin I 0.28 ng/mL (re-ference range, 0-0.1 ng/mL). A chest radiograph showed cardiomegaly and an electrocardiography showed atrial fibrillation with rapid ventricular response. A transthoracic echocardiogram demonstrated concentric left ventricular hypertrophy with fluid collection in the posterolateral wall of the pericardium with no evidence of valvular vegetation or tamponade physiology (). Pericardial aspiration of the fluid revealed a bloody material () and cultures grew Staphylococcus aureus. Blood cultures showed staphylococcal bacteremia (). Lab analysis of aspiration fluid showed elevated white blood cell counts >50000/mm3), with polymorph-onuclear neutrophil 90%, pH 7.3, glucose 5 mg/dL, lactate dehydrogenase 12397 U/L, albumin 2.4 g/dL and total protein 6.2 g/dL. Percutaneous drainage and empiric antibiotic treatment were started immediately. However, the patient expired due to refractory sepsis and organ failure.",What is patient's mean arterial pressure in mm Hg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Systolic Blood Pressure': [80.0, 'mm hg'], 'Diastolic Blood Pressure': [40.0, 'mm hg']}",53.33333,50.66666,56,"The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 80.0 mm Hg + 2/3 * 40.0 mm Hg = 53.33333 mm Hg.
Hence, the patient's mean arterial pressure is 53.33333 mm Hg."
76,5,Mean Arterial Pressure (MAP),physical,decimal,pmc-3180988-1,Extracted,"A 12-year-old girl, the youngest of three siblings, born of a nonconsanguineous marriage, and who had a normal perinatal history, was referred for evaluation of an incidentally detected cardiac murmur. There was failure to thrive but otherwise the patient was asymptomatic. There was no history of chest pain, syncope or palpitations. There was no family history of cardiac disease or genetic syndromes. The child had normal motor and mental development with normal intelligence. She had not attained menarche and her physical examination revealed short stature, craniofacial disproportion, shrunken facies, alopecia, prominent scalp veins, prominent eyes, micrognathia, a “beaked” nose, prominent and stiff joints, dystrophic nails, thin wrinkled skin and absent secondary sexual characteristics suggestive of a premature ageing syndrome [Figures and ]. The above-mentioned abnormal features were noted to appear after infancy.
The blood pressure was 128/92 mmHg, and all pulses were palpable, but feeble. There was bilateral carotid shudder. There was no brachiofemoral delay and clinical findings suggestive of severe aortic stenosis were present. Electrocardiography revealed left ventricular hypertrophy with a strain pattern. Echocardiography showed calcified aortic cusps with severe aortic stenosis (peak systolic gradient of 72 mmHg, mean gradient of 52 mmHg), mild aortic regurgitation and moderate mitral regurgitation []. There was concentric left ventricular hypertrophy with normal function (ejection fraction 57%). The aortic valve area was estimated to be 0.7 cm2. The patient's lipid profile revealed hypercholesterolemia with elevated low-density lipoprotein cholesterol and normal high-density lipoprotein cholesterol. It was decided to manage the patient conservatively as the outcome of aortic valve balloon dilatation/surgical replacement in this condition is not well documented and also because of the extremely fragile general condition of the patient.",What is patient's mean arterial pressure in mm Hg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Systolic Blood Pressure': [128.0, 'mm hg'], 'Diastolic Blood Pressure': [92.0, 'mm hg']}",104,98.8,109.2,"The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 128.0 mm Hg + 2/3 * 92.0 mm Hg = 104.0 mm Hg.
Hence, the patient's mean arterial pressure is 104.0 mm Hg."
77,5,Mean Arterial Pressure (MAP),physical,decimal,pmc-3691896-2,Extracted,"A 65-year-old African American woman was rushed to the hospital by ambulance following an episode of syncope at a community supermarket. She regained consciousness within a few minutes. There was no tongue biting, urinary incontinence, or postictal confusion. She reported some premonitory symptoms of warmth and sweating and gave a history of light-headedness, weakness, and fatigue over the last 2 weeks. She denied palpitations, chest pain, shortness of breath, fever, dizziness, or visual changes. She denied headache or weakness.
Over the last couple of months, she had multiple episodes of fall but no loss of consciousness. The falls were increasing in frequency over the last 2 weeks. She lived alone and had a history of hypertension for almost thirteen years for which she was noncompliant with her medications. She did not smoke, drink alcohol, or use any illicit drugs. Her mother had hypertension and died at the age of 80 years from heart disease.
On examination, her temperature was 37°C, the respiratory rate was 24 breaths per minute, and blood pressure while supine was 89/52 mm Hg, with a heart rate of 52 beats per minute. Her blood glucose level was 120 mg per deciliter. Oxygen saturation was 100 percent on 2 liters of oxygen via nasal cannula.
Physical evaluation showed no signs of head trauma. Her respiratory, cardiovascular, and abdominal examinations were unremarkable. Neurological examination showed decreased sensation to light touch in a stocking and glove distribution. Upper limb reflexes were brisk and lower limb reflexes were absent. Vibratory sensation and position sense were decreased in both upper and lower limbs. An extensor plantar response was noted bilaterally and Romberg's test was positive. There was hyperpigmentation of both palms with dark discoloration of the nails (). Axillary and pubic hair was normal in distribution and density. She was admitted to the hospital for further investigation and workup.
Contrast computed tomography (CT) of the head showed no obvious lesion. An electrocardiogram revealed sinus bradycardia at a rate of 50 beats per minute with no ST or T wave changes. A 24-hour holter monitoring was performed which revealed sinus bradycardia without other arrhythmias.
Her laboratory studies were as shown in .
Serum alcohol levels were undetectable and urine toxicology was negative. Esophagogastro-dudodenoscopy was performed and the gastric biopsy was suggestive of chronic atrophy of the body and fundus. The endoscopic findings were further reinforced by high serum levels of antibodies to intrinsic factor and gastric parietal cells confirming malabsorption of vitamin B12 due to lack of intrinsic factor. Thus, the diagnosis of pernicious anemia was established.
The patient was started on intramuscular injection of vitamin B12 (1,000 μg) daily for one week, then weekly for one month. She was later lost to followup, and posttreatment evaluation of the skin hyperpigmentation and neurological evaluation could not be done.",What is patient's mean arterial pressure in mm Hg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Systolic Blood Pressure': [89.0, 'mm hg'], 'Diastolic Blood Pressure': [52.0, 'mm hg']}",64.33333,61.11666,67.55,"The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 89.0 mm Hg + 2/3 * 52.0 mm Hg = 64.33333 mm Hg.
Hence, the patient's mean arterial pressure is 64.33333 mm Hg."
78,5,Mean Arterial Pressure (MAP),physical,decimal,pmc-3190515-1,Extracted,"A 48-year-old morbidly obese African-American male with a medical history of congestive heart failure, hypertension, obstructive sleep apnea on 2 l of home oxygen and non-complaint with continuous positive airway pressure at night presented to the emergency department (ED) with worsening shortness of breath and lower extremity oedema over one week. Vital signs in the ED were temperature, 98.7 degrees Fahrenheit; blood pressure, 116/66 mmHg; heart rate, 130 beats per minute; respiratory rate, 30; oxygen saturation, 85% on 2 l nasal cannula; weight, 162 kg and body mass index, 47. Physical examination revealed a morbidly obese male in acute respiratory distress with an irregularly irregular pulse and one plus lower extremity pitting oedema. Laboratory values in the ED include white blood cell count, 9 800/μl; haemoglobin, 14.2 g/dl; platelet count, 230 000/μl; sodium, 140 mEq/l; potassium, 4.5 mEq/l; chloride, 104 mEq/l; bicarbonate, 29 mEq/l; blood urea nitrogen (BUN), 38 mg/dl; creatinine, 1.4 mg/dl; glucose, 105 mg/dl; aspartate aminotransferase (AST), 51 U/l; alanine aminotransferase (ALT), 40 U/l; alkaline phosphatase, 68 U/l; total bilirubin, 1.5 mg/dl; albumin, 3.4 g/dl; total protein, 7.1 g/dl; international normalised ratio (INR), 1.2; myoglobin, 97 μg/l; troponin, 0.07 ng/ml and B-type natriuretic peptide, 934 pg/ml. Urine toxicology screen was positive for cocaine. Arterial blood gas showed a pH 7.33, paCO2 68.5 and paO2 88.6 on FiO2 of 40%. Electrocardiogram confirmed atrial fibrillation with a rapid ventricular response. Echocardiogram revealed a myopathic severely enlarged left ventricular chamber with moderate concentric left ventricular hypertrophy and severe global hypokinesis with an ejection fraction of 8 to 10%. The patient's work of breathing and oxygenation improved with Bipap. He was started on diltiazem and diuresis was initiated. The patient was admitted to the step-down unit with a new diagnosis of atrial fibrillation.
On hospital day number eight, the overnight nurse found the patient unresponsive. A code blue was called. His initial rhythm was ventricular fibrillation and he was shocked with 200 J twice before regaining pulses. When stabilised, he was transferred to the intensive care unit (ICU) where he regained consciousness and full neurologic function within one hour of the event. The following day, an automatic implantable cardioverter defibrillator (AICD) was placed. Intraoperatively, the patient had runs of ventricular tachycardia with hypotension to 80 mmHg systolic. Postoperatively, the patient was found to have a right fixed mid-dilated pupil, flaccid paralysis of the left arm and leg with hyperreflexia throughout the left side. Computed tomography (CT) of the head revealed a right midbrain and thalamic stroke thought to be secondary to transient arrhythmia-induced hypoperfusion, intraoperatively.
On postoperative day number three, after AICD placement and stroke, the patient acutely developed a rigid distended board-like abdomen with dullness to percussion. Vitals at that time were temperature, 98.4 degrees Fahrenheit; blood pressure, 112/67 mmHg; heart rate range, 55 beats per minute, and respiratory rate 26 on ventilator settings of assist control volume control with a rate of 26; tidal volume, 500 ml; FiO2, 40% and positive end-expiratory pressure of 5. His peak inspiratory pressure on the ventilator had risen from 26 to 72 mmHg; his plateau had risen from 15 to 48 mmHg with oxygen desaturation from 93 to 85%. The patient had received 1.5 l in and urinated 4.5 l over the 24 hours, leading up to this event. His laboratory values from that morning were unchanged from previous (white blood count, 10 400/μl; haemoglobin, 12.6 g/dl; platelets, 200 000/μl; sodium, 139 mEq/l; potassium, 4.7 mEq/l; chloride, 100 mEq/l; bicarbonate, 34 mEq/l; BUN, 36 mg/dl; creatinine, 1.41 mg/dl; glucose, 78 mg/dl; calcium, 8.3 mg/dl; magnesium, 2.0 mEq/l; phosphorus, 3.0 mg/dl; AST, 77 U/l; ALT, 94 U/l; alkaline phosphatase, 186 U/l; total bilirubin, 1.3 mg/dl). This constellation of findings prompted the team to measure an abdominal compartment pressure which was elevated to 53 cm H2O (40 mmHg) with an abdominal perfusion pressure (APP) of 42 mmHg. A CT scan of the abdomen and pelvis was performed which showed no dilated loops of bowel, no ileus, no evidence of free air, abscess or obstruction and minimal free fluid []. Pertinent labs from the event revealed a lactate of 1.0 mg/dl; lipase, 159 U/l; amylase, 76 U/l; creatinine, 1.53 mg/dl. Surgery was consulted and the FiO2 was increased to 100%, which improved his oxygen saturation to 96% despite his elevated peak inspiratory pressures.
Surgical recommendations were for an emergent bedside surgical abdominal decompression. The patient was administered 10 mg of intravenous cisatracurium besylate by anaesthesia in preparation for surgical management. Shortly following paralytic administration, his peak inspiratory pressure corrected from 72 to 23 mmHg, his plateau pressure from 48 to 16 mmHg and his oxygenation status tolerated a decrease in FiO2 down to 40% with his oxygen saturation returning to baseline. Measurement of his abdominal compartment pressure revealed a drop from 53 (40 mmHg) to 23 cm H2O (17 mmHg) and then normalised to 15 cm H20 (11 mmHg) over a three-hour period. During this entire event, the patient averaged 100 to 200 cc/hr of urine output and laboratory values from the following day showed a drop in creatinine from 1.53 to 1.29 mg/dl. Given this correction, surgical management was postponed and the patient was monitored. The patient remained hospitalised for an additional 73 days. He was ultimately transferred to a skilled nursing facility without return of symptoms.",What is patient's mean arterial pressure in mm Hg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Diastolic Blood Pressure': [66.0, 'mmhg'], 'Systolic Blood Pressure': [116.0, 'mmhg']}",82.66667,78.53334,86.8,"The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 116.0 mm Hg + 2/3 * 66.0 mm Hg = 82.66667 mm Hg.
Hence, the patient's mean arterial pressure is 82.66667 mm Hg."
79,5,Mean Arterial Pressure (MAP),physical,decimal,trec-ct-2021-46,Extracted,"Patient A is a 30-year-old male who was admitted to the hospital after 10 days of cough, profuse nocturnal sweating and loss of appetite. He had traveled to India 1 months ago and has not any positive history of TB vaccination. He is a previously healthy man, working as an engineer in a high tech company. He doesn't smoke o use any illicit drugs. He was febrile (38 c) with heart rate of 115 b/min, respiratory rate of 22, BP of 125/75 mmHg and O2 sat of 97%. Chest X-ray showed infiltrate in the middle of left lung with diameter of 1.8 cm with signs of cavitation. The sputum smear revealed positive sputum culture for Mycobacterium tuberculosis which are sensitive of the first-line TB drugs (isoniazid, streptomycin, rifampicin and ethambutol). Lab study is reported bellow:
Hgb: 13 g/dl
WBC: 14000 /mm3
Plt: 300000 /ml
AST: 13 U/L
ALT: 15 U/L
Alk P: 53 U/L
Bill total: 0.6 mg/dl
Na: 137 mEq/l
K: 4 mEq/l
Creatinine: 0.5 mg/dl
BUN: 10 mg/dl
ESR: 120 mm/hr",What is patient's mean arterial pressure in mm Hg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Diastolic Blood Pressure': [75.0, 'mm hg'], 'Systolic Blood Pressure': [125.0, 'mm hg']}",91.66667,87.08334,96.25,"The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 125.0 mm Hg + 2/3 * 75.0 mm Hg = 91.66667 mm Hg.
Hence, the patient's mean arterial pressure is 91.66667 mm Hg."
80,5,Mean Arterial Pressure (MAP),physical,decimal,pmc-7793211-1,Extracted,"A 76-year-old man presented with typical chest pain and ST-elevation inferior MI. He was a smoker with diabetes and chronic kidney disease Class 3a with a glomerular filtration rate (GFR) 48 mL/min/m2. The hospital had no coronary intervention facilities, so he received thrombolytic therapy. Two weeks later, he presented to our emergency department with typical chest pain and exertional dyspnoea (New York Heart Association Class III). He was on dual antiplatelet therapy, Bisoprolol, Atorvastatin, and Isosorbide dinitrates. There was no echocardiogram report with the patient.
Auscultation confirmed a harsh pansystolic murmur V/VI on his left parasternal area and across the precordium. He had bilateral, fine basal crepitations. His heart rate was 88 b.p.m. and blood pressure was 115/67 mmHg.
Transthoracic echocardiogram (TTE) and transoesophageal echocardiogram (TOE) demonstrated an akinetic inferior wall and inferior septum with an ejection fraction (EF) of 45%. A large, true aneurysm in the mid-cavity inferior wall was identified by its wide neck and contracting muscle layer ( and ). The inferior septum was ruptured and dissected with a large, left-to-right shunt ( and ). A TOE X-plane transgastric short-axis view in diastole showed an inferior wall aneurysm with a wide neck of 2 cm (). The aneurysm cavity connected to the RV through the ruptured part of the inferior septum, creating an LV-to-RV-to-aneurysm communication ( and ). We noted mild tricuspid regurgitation with an estimated systolic pulmonary artery pressure of 75 mmHg. RV function was mildly reduced (tricuspid annular plane systolic excursion of 1.6 cm). Cardiac magnetic resonance imaging showed non-viable inferior segments, and a 4.2 cm × 4.3 cm × 5.8 cm cavitary lesion. The LV showed a mid-inferior and inferoseptal wide-neck true aneurysm () with a focal area of ventricular septal rupture in the inferior aspect of the aneurysm with a turbulent high-velocity flow across it (). The patient’s coronary angiography displayed tight proximal and middle right coronary artery lesions, as well as a severe ostial left main, a severe mid-left anterior descending artery lesion, and severe ramus intermedius disease.
The patient was considered high surgical risk because of his age, general condition, renal impairment, and difficult anatomy of the post-infarct VSD and aneurysm. Transcatheter closure of the post-infarct VSD and inferior wall aneurysm was performed. Because of the two different pathologies, we closed the VSD first using an antegrade approach from the venous side. Next, we closed the neck of the aneurysm using a retrograde approach from the arterial side. A Terumo guidewire (260 cm) was introduced from the right common femoral vein. The wire passed from the RV to the inferior wall aneurysm to the LV and finally to the aorta. We then exchanged the Terumo guidewire with an Amplatzer stiff guidewire (260 cm).
We used an 8 French Amplatzer delivery sheath to deploy an 18-mm ASO (AGA Medical Corporation, USA) to close the VSD completely (, and ). We selected the size based on TOE measurements. The RV-to-aneurysm communication measured 14 mm, so we oversized the ASO device by 4 mm to fit inside the defect. The aneurysm was engaged in retrograde from the LV using a 6 French PG catheter introduced from the right common femoral artery and over the Terumo guidewire (260 cm), which was then replaced by a Confida stiff guidewire (Medtronic) of the same length. We cannulated the inferior aneurysm mouth with a Torque-Vue 10 F/45 delivery sheath. The ASO (26 mm) device was deployed with a large disc in the aneurysm (, and ). We selected the size based on the TOE measurement. The aneurysm mouth measured 20 mm, so we increased the ASO length by 6 mm to fit inside the aneurysm. We assured enough distance between the aneurysm mouth and the mitral valve so that the deployed disc would not affect the mitral valve. Both devices were established with the aneurysm device resting on the post-infarct VSD device ( and ).
Left ventricular (LV) injection and TOE showed complete occlusion of the post-infarct VSD and aneurysm. Both devices established contact and showed the angulated relation of their two different planes (, and ). The akinetic inferior wal procedure and fluoroscopy times were 60 min and 25 min, respectively, and the total contrast amount was 40 mL. The patient recovered uneventfully within 6 days in the intensive care unit. As EF was 45%, we selected to do full revascularization. The patient underwent complete revascularization for his right coronary artery, left main artery, proximal left anterior descending artery, and ramus intermedius (). The patient was discharged after 14 days. At his 3-month follow-up, he remained well with reasonable exercise tolerance, NYHA Class I. A repeat transthoracic echocardiogram demonstrated no flow across the devices, no residual shunt, and a left ventricular ejection fraction of 45%, akinetic inferior wall, and inferior septum (, and ). The systolic pulmonary artery pressure improved to 35 mmHg (). His renal function remained stable at follow-up with GFR 46 mL/min/m2.",What is patient's mean arterial pressure in mm Hg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Diastolic Blood Pressure': [67.0, 'mm hg'], 'Systolic Blood Pressure': [115.0, 'mm hg']}",83,78.85,87.15,"The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 115.0 mm Hg + 2/3 * 67.0 mm Hg = 83.0 mm Hg.
Hence, the patient's mean arterial pressure is 83.0 mm Hg."
81,6,Body Mass Index (BMI),physical,decimal,pmc-3866343-1,Extracted,"A 63-year-old male, 159 cm in height and 70 kg in weight, was scheduled to undergo resection of cervical epidural mass. The patient had a medical history of well-controlled hypertension and old healed pulmonary tuberculosis. The patient had facial and neck purpuras and ecchymoses, whose cause could not be identified at a private dermatologic clinic. Blood test results concerning platelet count, prothrombin time and activated partial thrombosplastin time were normal.
General anesthesia was induced with propofol 100 mg and remifentanil 0.5 µg/kg/min. Rocuronium 50 mg was administrated to facilitate tracheal intubation. Anesthesia was maintained with 6 vol% desflurane with 50% O2 in air, remifentanil, and rocuromium. After a change from a supine to a prone position, bleeding from the lacerated facial purpuras was recognized while identifying head position on a Mayfield headrest. Swollen purpuras and eyeballs hyperemia were evident. The operation was canceled in order to evaluate the facial lesions and the patient was transported to the postanesthetic care unit when fully conscious.
Skin biopsy from the facial lesions () and serum free light chain assay were performed during the stay at the general ward, and resulted in the diagnosis of systemic amyloidosis of monoclonal gammopathy with lambda type. Multiple myeloma, which usually accompanies systemic amyloidosis, was excluded after bone marrow biopsy and immunoprotein measurement of serum and urine.
The patient had complained of dyspnea since post-anesthesia day 16. Bilateral pleural effusion and interstitial pulmonary edema were identified by high resolution chest computed tomography. Pulmonary function test revealed moderate degree of chronic obstructive pulmonary disease. Cervical magnetic resonance imaging taken 48 days after the anesthesia showed spontaneous resolution of the epidural mass. Post-anesthetic echocardiograph showed thickened myocardium, which was not confirmatory of cardiac amyloidosis. According to abdominal ultrasound, there was no hepatomegaly or splenomegaly. Symptoms and signs suggesting the involvement of other organs, such as renal, neurologic, and hematologic abnormalities, were not observed. Treatment with chemotherapy and auto-peripheral blood stem cell transplantation was planned.",What is the patient's body mass mass index (BMI)? Your answer should be in terms of kg/m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'height': [159.0, 'cm'], 'weight': [70.0, 'kg']}",27.68878,26.30434,29.07322,"The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 159.0 cm, which is 159.0 cm * 1 m / 100 cm = 1.59 m. The patient's weight is 70.0 kg. The patient's bmi is therefore 70.0 kg / (1.59 m * 1.59 m) = 27.68878 kg/m^2."
82,6,Body Mass Index (BMI),physical,decimal,pmc-8131347-1,Extracted,"A 76-year-old woman presented at our outpatient clinic with symptomatic OA of the right knee. At admission her height was measured to be 139.8 cm and her weight was measured to be 46.5 kg. Her past medical history included NF, congenital pseudarthrosis, and combined deformities of the tibia and fibula that resulted in the shortening of the right lower limb. At presentation, her examination revealed a limited active range of motion at the right knee joint (from 0 to 90°), a valgus deformity of 14° using the femoro-tibial angle measurement, severe pain, and a progressively worsening antalgic gait due to the preexisting limb shortening. These deformities, including pseudoarthrosis, are consistent with skeletal deformities previously described in patients diagnosed with NF. She was diagnosed with Grade 4 OA as per the Kellgren-Lawrence (KL) classification based on the results of radiographic imaging and the physical examination (). Her walking distance was limited due to pain. Passive range of motion studies revealed significant hyperextension (−10°) consistent with an increased risk for dislocation. The physical exam also revealed peroneal nerve palsy and café au-lait spots across her entire body, the latter finding indicative of advanced NF. She had previously undergone a bone transplant at the fibula with a graft taken from the tibia approximately 50 years prior; as such, there was only a limited amount of viable bone remaining to support the successful implantation of a prosthesis. As there was not sufficient viable bone stock available to support the ready-made intramedullary stem used in total knee arthroplasty (TKA; ), our initial plan was to perform a bicompartmental knee arthroplasty (BKA). Furthermore, as part of the preoperative procedure at our hospital, we conducted a bone density test. This evaluation revealed a femoral bone density of 0.525 g/cm3, which affirmed our decision to avoid a TKA, as the quality of the available bone stock would unlikely be sufficient to support adequate fixation of the larger implants required in this procedure. Magnetic Resonance Imaging (MRI) was performed to provide maximum visualization of the lesion, given the discrepancies in the anatomical structures and also to evaluate the soft tissue condition (). Although a bicompartmental knee implant was templated, the cartilage on the medial side of the joint was found to be intact on the coronal MRI scan, thereby presenting a contraindication to this procedure (). Additional radiographic studies revealed that the patient had both femoral and tibial insufficiency and a significant reduction in the bone stock available for the positioning of an implant that required a tibial stem. As this patient also exhibited problems with osteogenesis due to NF, all procedures were planned with the goal of limiting the degree of tissue damage. With this in mind, we considered unicompartmental knee arthroplasty (UKA) as a minimally invasive procedure that might be used for the successful amelioration of her OA symptoms. A lateral UKA to fix the valgus deformity was discussed with the patient as a means to provide adequate relief from the pain resulting from the bone-on-bone contact at the lateral side as well as to address the problem of hyperextension. The patient agreed to this course of action. Preoperative planning focused on addressing the issues associated with bone-on-bone contact as well as repair of the valgus deformity with the goal of promoting stability at the knee. The range of motion was verified preoperatively, and femoral and tibial contact points were mapped across the full range of motion to determine the degree of the anterior slope. Unfortunately, the dimensions of the anterior slope precluded the use of an implant of the size that would be desirable given the patient’s tibial dimensions. We were also aware of the fact that the risks of dislocation are increased in NF patients due to characteristic joint hypermobility and problems with soft tissue in areas such as the skin, menisci, and musculature.
During surgery, the surrounding tissue was debrided, and a large fragment of debris was removed from the joint space. Visual inspection of the knee confirmed the diagnosis of isolated lateral OA with intact medial articulation (). A femoral unicompartmental knee system (Physica ZUK; size D) implant and a 29 mm × 50 mm tibial implant (Zimmer®) were inserted. Perioperative radiographs revealed that, although the trial implant was slightly larger than ideal, synchronous soft tissue balance of the knee was confirmed (). Unfortunately, as customized implants were not available, space remained between the femoral implant and the femoral condyle.
Prior to final fixation, the articulation site was copiously irrigated to facilitate the penetration of cement into the femur and tibia. The final implant was then inserted into small holes that were drilled into the tibia and femur that also facilitated cement adhesion. The cement was molded to fill the gap observed during the trial implantation ().
Postoperative imaging and physical examination revealed that the anterior tibial slope was repaired and that the valgus deformity was reduced to 5° from the 14° determined preoperatively (). The patient was capable of ambulation within 24 hours after completion of the procedure. However, the patient developed a varus thrust and continued to require epidural analgesia for 48 hours after the procedure. The rehabilitation plan included assisted range of motion and partial weight-bearing walking exercises. The patient exhibited a myopathic gait; this was deemed acceptable given her preexisting musculoskeletal condition. One week after the procedure, the patient continued to ambulate with the assistance of two walking poles and a knee brace. She reported that soreness developed after walking for approximately 20 meters; this was attributed to preoperative muscle stiffness (). The active range of motion extended from 0 to 110°; this represented a significant improvement over her preoperative range of 0 to 90°. Ankle movement was restricted due to preexisting peroneal nerve palsy and mild pain was present after the surgery. The most substantial functional gains from the lateral UKA procedure were the improvements in the knee alignment and the reduction in the valgus deformity. Both of these corrections contributed to significant improvements in patient ambulation.
Two weeks after the procedure, the patient experienced a fall that resulted in a stress fracture of the tibial plateau. The lesion was diagnosed as a proximal oblique fracture of the tibia. This was most likely due to a mismatch between the implant and patient-specific mechano-physiology which may have potentially resulted in sagittal overcutting. The tibial UKA component was not displaced (). Three days post-fracture, a surgical procedure involving a locking plate was planned. A distal tibia anterolateral plate (A. L. P. S®) with nine holes was rotated upside down to achieve successful fixation of the fracture. Eight locking cortical screws were inserted; postoperative imaging documented adequate fixation and support (). Given the high risk for dislocations, continuous passive motion therapy was contraindicated. Within five days after the second procedure, the patient reported only minimal pain and was able to undergo successful rehabilitation to improve her range of motion. We note that her participation in the standard rehabilitation program was interrupted due to the ongoing impact of the COVID-19 pandemic. This was unfortunate, as adequate postoperative rehabilitation can be critical for recovery. The patient was provided with a fixed knee brace to stabilize her leg during the first two months after the insertion of the locking plate. As the COVID-19 pandemic was then under adequate control in the region, the patient was able to follow a rehabilitation plan that included both passive and active progressive range of motion exercises, partial weight-bearing walking regimens, and measures designed to manage pain and swelling. The patient was put on a partial weight-bearing walking regimen (30% to start, gradually increased to 100% body weight every week) beginning at one week postoperatively. At the two-month postoperative checkup, the patient was able to walk with a full weight load without assistance (). Four months after the procedure, the patient reported significant improvements with respect to pain and active range of motion. The patient returned to her activities of daily life and did not need a knee brace or supporter (). Radiographic images revealed callus formation at the fracture site, indicative of new bone formation. We planned to follow this patient on a more long-term basis to manage pain and swelling and to maintain the improved range of motion and weight-bearing capability. However, the overall impact of COVID-19 limited the extent to which we could follow this patient after the five-month check-up. Nonetheless, the patient planned to continue with the prescribed rehabilitation plan. The patient presented for a 7-month postoperative checkup and reported some residual pain that she managed effectively with the pain medication regimen that was prescribed. She reported that she was able to walk on most days and carry out day-to-day activities without difficulty. On certain days, she noted some instability at her knee joint which is likely attributable to the postoperative fracture. Further radiographic studies revealed appropriate fracture healing, and her physical exam documented appropriate knee alignment.
Although the patient was capable of ambulation prior to the UKA procedure, she relied on external support and experienced substantial pain due to osteoarthritis and poor knee alignment. The contraindications to a conventional TKA outweighed the possible benefits that might be achieved in this case. A UKA seemed to be a more appropriate solution toward resolving the pain resulting from bone-on-bone contact and the valgus deformity. The UKA procedure is less invasive, maintains the kinematics at the knee, preserves more bone, and facilitates easier revision surgery if this becomes necessary.
The decision to perform a UKA was controversial due to the unique complexities associated with this patient. However, these therapeutic modalities resulted in a significant improvement in the patient’s quality of life. This outcome was evaluated quantitatively by the Knee injury and Osteoarthritis Outcome Score (KOOS) which is included in the (). An increase of 8–10 points on the KOOS total score has been clearly established as a clinically significant improvement. Our patient exhibited a 23.2-point increase in KOOS in response to treatment. This finding indicates that the patient experienced significant benefit from the complete treatment plan. Specifically, the patient reported improvements in areas including but not limited to, a reduction in pain, reduced stiffness, improved mobility, and a better quality of life.",What is the patient's body mass mass index (BMI)? Your answer should be in terms of kg/m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [46.5, 'kg'], 'height': [139.8, 'cm']}",23.79242,22.6028,24.98204,"The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 139.8 cm, which is 139.8 cm * 1 m / 100 cm = 1.398 m. The patient's weight is 46.5 kg. The patient's bmi is therefore 46.5 kg / (1.398 m * 1.398 m) = 23.79242 kg/m^2."
83,6,Body Mass Index (BMI),physical,decimal,pmc-6598109-2,Extracted,"When waking in the early morning (3:30 am), a 33-year-old male presented with persistent right limb weakness and verbal confusion. There was no record of special past history or family history. He smoked 2–5 cigarettes per day and had been drinking for 10 years. His height was 170 cm and weight 81 kg, while his blood pressure was 155/110 mmHg. The subject was alert and conscious and his speech was dysarthric with right central facial weakness. Found with extensor plantar response on right lower extremity was mild weakness of the right upper limb extensors and right lower limb flexors. Abnormal long signal of the left pontine was showed in brain MRI by FLAIR sequences (Fig. A). Conducting Computed Tomography Angiography (CTA) of neck and intracranial arteries revealed limited narrow on the right anterior cerebral artery A2 segment and the left anterior cerebral artery segment A3 and limited moderate stenosis on the initial segment of the right vertebral artery (Fig. B). Echocardiography on dynamic ECG, color Doppler ultrasound of the neck and echocardiography were found to be normal. Measurements of hemoglobin 170 g/L, hematocrit 46.1%, ALT 48 U/L, GOT 278 U/L, blood glucose 7.6 mmol/L, homocysteine 17.2 umol/L, triglyceride 10.5 mmol/L, LDL 3.38 mmol/L. Results of the examination of anti-neutrophil cytoplasmic antibodies, anticardiolipin antibodies, antinuclear antibodies, ENA spectrum and antithrombin III were all normal (Table ). Two emboli were detected during 9th cardiac cycle when the patient breathed quietly by c-TCD test. During the 8th cardiac cycle (rain curtain) after Valsalva action, a large number of embolus signals were revealed (Fig. C). After Valsalva action, embolism rain disappeared (Table ). TEE examination is not tolerated by patients. Sleep stage test reviewed normal sleep latency after whole night PSG examination. The lowest and average oxygen saturation was 72% and 93%, respectively. Snoring time accounted for 38.0% of sleep time. In summary, the diagnosis for the patient was “obstructive sleep apnea syndrome” (Table ).",What is the patient's body mass mass index (BMI)? Your answer should be in terms of kg/m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [81.0, 'kg'], 'height': [170.0, 'cm']}",28.02768,26.6263,29.42906,"The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 170.0 cm, which is 170.0 cm * 1 m / 100 cm = 1.7 m. The patient's weight is 81.0 kg. The patient's bmi is therefore 81.0 kg / (1.7 m * 1.7 m) = 28.02768 kg/m^2."
84,6,Body Mass Index (BMI),physical,decimal,pmc-3030060-1,Extracted,"A 50-year-old male patient visited the hospital to undergo synovectomy for left knee ostarthritis and tenosynovitis. The patient had suffered difficulties in walking from weakening of both lower limb muscles since 25 years ago, and recently the symptom of weakness of lower limb muscles became more serious and dyspnea at the level of ATS (American Thoracic Society) Dyspnea Grade I had occurred due to the weakening of the respiratory root. A molecular genetics examination conducted at another hospital discovered a deficit of the SMN1 gene, and considering the time of onset and clinical conditions, the patient was diagnosed with type IV spinal muscular atrophy. The patient stood 168 cm and weighed 63 kg, and there were no special opinions from ECG and simple radioactive examination before operation. Arterial blood gas analysis (ABGA) showed pH 7.435, PaO2 74.6 mmHg, PaCO2 36.9 mmHg, and HCO3- 24.2 mmHg. The patient was under drug treatment for hypertension. Administration before anesthesia was not conducted and vital signs examined after going into the operating room were blood pressure: 160/100 mmHg; respiration rate per minute: 20 times; ECG: normal sinus rhythm; and pulse oxymetry: 98%. From a manual muscle test before operation, both legs were at the 4th stage. At the genupectoral position, the epidural space was identified by loss of resistance technique using an 18 G Tuohy insertion needle in between the L2-L3 lumbar, and after a test dose injection of 1.5% lidocaine 3 ml containing 1 : 200,000 epinephrine, no increase of heart rate or spinal anesthesia symptom was detected. After injecting 0.75% ropivacaine 12 ml, a catheter was placed and maintained. To measure the level of motor block by time after anesthesia, a modified Bromage scale (0: One can stretch and raise his/her leg; 1: One cannot raise his/her leg and cannot bend his/her knee; 2: One cannot his/her knee but can bend his/her ankle; 3: One cannot bend his/her ankle) was applied.
The level of modified Bromage scale before anesthesia was 1, and 20 minutes after injecting ropivacaine, the level of modified Bromage scale was 3. The sensory nerves were blocked by T8 segment on pinprick examination. Vital signs during operation were blood pressure: 120-140/60-80 mmHg and pulse rate per minute: stable at 70-80 times. A Venti® mask with 35% of oxygen fraction in inspired air was used, and an ETCO2 capnometer was placed under the nose of the patient to monitor the end-tidal CO2. ETCO2 was stable at 35 mmHg and the pulse oxymetry was 100%. Due to the risk of aspiration of saliva or bronchial secretion during operation, sedation was not operated. The surgery was operated for an hour, and the epidural catheter was removed after operation. After finishing the operation, the level of modified Bromage scale was 3 and the sensory nerve block was decreased up to the T9 segment. Three hours after the operation, the level of modified Bromage scale was dropped to 2 and the sensory nerve block to the T11 segment; 5 hours after the operation, the stage of modified Bromage scale was 1, and the sensory nerve was declined to the L1 segment. Since the patient did not show adverse effects including vomiting, nausea, and dizziness in the recovery room, he was moved to a patient room. Twelve hours after finishing the operation, both the level of the modified Bromage scale and sensory nerve were recovered to the condition before operation, and also for the manual muscle test, both legs were maintained at the 4th stage. A physical exam conducted 24 hours after finishing surgery did not show special opinions. The patient recovered smoothly without complications and left the hospital 2 days after the operation.",What is the patient's body mass mass index (BMI)? Your answer should be in terms of kg/m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [63.0, 'kg'], 'height': [168.0, 'cm']}",22.32143,21.20536,23.4375,"The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 168.0 cm, which is 168.0 cm * 1 m / 100 cm = 1.68 m. The patient's weight is 63.0 kg. The patient's bmi is therefore 63.0 kg / (1.68 m * 1.68 m) = 22.32143 kg/m^2."
85,6,Body Mass Index (BMI),physical,decimal,pmc-5835299-1,Extracted,"A 48-year-old female patient (weight: 66 kg, height: 166 cm) with multiple millimetric gallstones was due to undergo intraoperative ERCP followed by LC. She had a history of caesarean section and appendectomy and had elevated transaminases plus hyperbilirubinemia. She was accepted as being American Anesthesiology Association (ASA) Class 1. ESP block was planned as part of her multimodal analgesia protocol.
After premedication (midazolam 1 mg), anesthesia induction was performed using lidocaine 1 mg/kg, fentanyl 100 mcg, propofol 3 mg/kg, and rocuronium bromide 0.6 mg/kg. Following intubation, anesthesia was maintained with 0.6 MAC sevoflurane in air-oxygen mixture and remifentanil infusion of 0.08–0.1μg/kg/min. After hemodynamic stability, the patient was placed in the prone position. Bilateral ESP block was performed. After completing ERCP, the patient was positioned supine and LC was performed. Total surgical time was 74 minutes and time under anesthesia was 93 minutes. Perioperative intravenous paracetamol (1 gr) and tenoxicam (20 mg) were given.
She was transferred to the postoperative recovery room after extubation. The patients numeric rating scale (NRS) was 1/10 at rest and when coughing. After follow-up of 1 hour the patient was transferred to the general ward. Postoperative analgesia was ordered as 1 gr intravenous paracetamol every 8 hours. Rescue analgesia was planned as being intramuscular diclofenac sodium 75 mg. The patient's NRS was <3/10 during the first 16 hours of follow-up. Planned analgesia was not applied during this time. At 17th hour, NRS scores were 5/10 when coughing and 4/10 at rest. Rescue analgesia was performed. The patient was externalised home at the 24th hour with prescription pain medication.",What is the patient's body mass mass index (BMI)? Your answer should be in terms of kg/m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [66.0, 'kg'], 'height': [166.0, 'cm']}",23.95123,22.75367,25.14879,"The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 166.0 cm, which is 166.0 cm * 1 m / 100 cm = 1.66 m. The patient's weight is 66.0 kg. The patient's bmi is therefore 66.0 kg / (1.66 m * 1.66 m) = 23.95123 kg/m^2."
86,6,Body Mass Index (BMI),physical,decimal,pmc-4885454-1,Extracted,"An 81-year-old, 77 kg, 183 cm man with a three-year history of muscle biopsy-proven IBM suffered a left intertrochanteric femoral fracture and a small parafalcine subdural hematoma as a result of falling down stairs in his home. The patient originally had progressive left proximal lower extremity and bilateral distal upper extremity weakness (left > right) that began several years before the diagnosis was definitively established with a muscle biopsy. The patient's serum creatine phosphokinase concentration was 748 U/L (normal < 170 U/L) at the time of the diagnosis. The patient had several near falls in the months preceding the accident. His left hand and wrist weakness affected his activities of daily living to some degree (fine motor skills), but physical and occupational therapy helped the patient remain active and he continued to live independently with occasional assistance from his wife. Because of worsening left quadriceps weakness, he had recently begun using a cane to help him rise from a seated position. The patient had a history of oropharyngeal dysphagia (solid food, pills) for which he was receiving care from an otolaryngologist. The patient also had chronic gastroesophageal reflux disease that was well controlled with a proton pump inhibitor. He did not have difficulty swallowing liquids and denied respiratory complaints associated with chronic aspiration. The patient did not lose consciousness after striking his head on the stairs and had no new neurological complaints. His other past medical history was notable for coronary artery disease, hyperlipidemia, chronic low back pain, and vertebral artery stenosis. He underwent coronary artery bypass graft surgery 16 years before the current admission. A previous transthoracic echocardiography revealed normal left ventricular systolic function. He denied chest pain, dyspnea, and exercise intolerance. The physical examination and radiographs of his femur revealed the left intertrochanteric fracture. The Glasgow coma scale was 15 and there were no new focal neurological deficits. A magnetic resonance imaging study demonstrated the small parafalcine subdural hematoma without a cerebral mass effect.
The patient was transported to the operating room for repair of the left intertrochanteric fracture. Because primary respiratory failure (, ) resulting, at least in part, from diaphragmatic dysfunction () has been previously reported in patients with IBM and prolonged duration of action of neuromuscular blockers may also occur, the authors opted to avoid the use of a neuromuscular blocker for endotracheal intubation and during maintenance of anesthesia in the current patient. After applying cricoid pressure, anesthesia was induced using intravenous lidocaine (0.5 mg.kg-1), propofol (1 mg.kg-1), and remifentanil (infusion of 0.1 mcg.kg-1.min-1). Manual positive-pressure ventilation with sevoflurane (inspired concentrations between 2% and 3%) in oxygen (100%) was used with sustained cricoid pressure to supplement to intravenous anesthetics after loss of consciousness. After uneventful endotracheal intubation, anesthesia was maintained with sevoflurane (end-tidal concentrations between 0.7% and 1.5%) and remifentanil (infusion rates of 0.05 to 0.15 mcg.kg-1.min-1). The orthopedic surgeon repaired the fracture with a trochanteric femoral nail. Intravenous acetaminophen and fentanyl were administered for postoperative analgesia. The patient tolerated the procedure well. He demonstrated vigorous spontaneous respiratory effort as he emerged from anesthesia and was extubated without difficulty in the operating room. The patient made an uncomplicated recovery from surgery and was subsequently transferred to a rehabilitation facility in stable condition.",What is the patient's body mass mass index (BMI)? Your answer should be in terms of kg/m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [77.0, 'kg'], 'height': [183.0, 'cm']}",22.99262,21.84299,24.14225,"The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 183.0 cm, which is 183.0 cm * 1 m / 100 cm = 1.83 m. The patient's weight is 77.0 kg. The patient's bmi is therefore 77.0 kg / (1.83 m * 1.83 m) = 22.99262 kg/m^2."
87,6,Body Mass Index (BMI),physical,decimal,pmc-7475287-1,Extracted,"A 33-year-old woman was referred to a university hospital for the evaluation of secondary amenorrhea for 4 months. The patient had spontaneous thelarche at age 11 years and menarche at age 13 years. She denied experiencing vasomotor symptoms. A human chorionic gonadotropin (hCG) urine test was negative. The results of the physical examination were as follows: height 165.0 cm, weight 60.2 kg, systolic blood pressure 132 mmHg, and diastolic blood pressure 77 mmHg. Breast development and pubic hair growth were both stage 5 according to the Tanner staging system. Basal hormonal tests revealed highly elevated serum FSH and luteinizing hormone (LH) levels (52.7 IU/L and 33.2 IU/L, respectively), a low estradiol (E2) level (17.8 pg/mL), and high AMH level (5.04 ng/mL). Serum levels of prolactin, thyroid-stimulating hormone, and free T4 were all normal. A transvaginal ultrasound revealed a normal-sized uterus with polycystic ovarian morphology (> 20 antral follicles measuring 2–9 mm) observed in the right ovary ().
The patient was unmarried and wanted to preserve her fertility; therefore, she was advised to visit an infertility hospital for oocyte cryopreservation. The repeated basal hormonal tests were unchanged, and serum levels of androgens including total testosterone, free testosterone, 17α-hydroxyprogesterone, and dehydroepiandrosterone sulfate were all normal. Induction of superovulation was attempted with a starting dose of 150 IU recombinant FSH (Follitrope®; LG, Iksan, Korea) daily for oocyte cryopreservation. The dose of recombinant FSH was increased to 225 IU after one week because follicular development was not observed on ultrasound. However, follicular development was not observed despite the increase in FSH dose, and cycle cancellation was determined at that time. Further evaluation included karyotype, FMR1 premutation, and 21-hydroxylase antibody tests. The karyotype analysis revealed 47,XXX[1]/46,XX[29]; however, it was read as a normal variant by the specialist in laboratory medicine. The FMR1 premutation test revealed no abnormal CGG trinucleotide repeat expansion. The patient tested negative for 21-hydroxylase antibodies. In addition, anti-thyroglobulin antibodies and anti-thyroid peroxidase antibodies were negative. She was prescribed oral contraceptives (Yaz®) for hypoestrogenism associated with POI.",What is the patient's body mass mass index (BMI)? Your answer should be in terms of kg/m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [60.2, 'kg'], 'height': [165.0, 'cm']}",22.11203,21.00643,23.21763,"The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 165.0 cm, which is 165.0 cm * 1 m / 100 cm = 1.65 m. The patient's weight is 60.2 kg. The patient's bmi is therefore 60.2 kg / (1.65 m * 1.65 m) = 22.11203 kg/m^2."
88,6,Body Mass Index (BMI),physical,decimal,pmc-7292160-1,Extracted,"The case we present was a 71-year-old Japanese man. When he was being treated for pneumonia at another hospital, CT image incidentally revealed a BT and mild right-sided hydronephrosis (Fig. ) without metastasis. After his pneumonia had been cured, the patient was referred to the SIMC to receive treatment for his BT (SIMC-Uro# 11116, a unique non-sequential patient control number issued at the Department of Uro-Oncology, SIMC). At his first visit, the patient's physical (height: 1.56 m, weight: 48.9 kg) and routine laboratory data were within the normal ranges. He had been diagnosed with diabetes mellitus, which required regular insulin injections. MRI showed many BTs (Figs –). The largest tumor detected on MRI is indicated by the blue arrowhead in Figure a. The tumor indicated by the yellow arrowhead was observed as it progressed between the right ureteral wall (white arrowhead in Figure a) and bladder wall (red arrowhead). Moreover, a tumor was found within the right orifice of the ureter (green arrowhead), which had presumably caused the mild right-sided hydroureter (“u” in Figure a, see also Figures –). Thus, the patient was diagnosed with bladder carcinoma, which was suspected to have infiltrated into the ureter (green arrowhead). No apparent muscle invasion, lymph node metastasis, or distant metastasis was observed (clinical classification: T1, N0, M0, according to the classification of the Union for International Cancer Control).
The patient underwent oral-PDD-TUR-BT (20 mg/kg of 5-ALA was administered 2 hours before surgery) using the D-LIGHT system (Table ). As suggested by MRI (blue arrowhead in Figure a), the main papillary tumor was located on the right ureteral orifice (blue arrowhead in Figure b), and it clearly emitted fluorescence under blue light (Fig. c). It had invaded the bladder neck, the prostatic urethra, and the right posterior wall of the bladder (Video ). In addition, three daughter tumors were found on the posterior wall of the bladder (Video ). Random bladder biopsy samples were obtained from the surrounding normal tissue (the posterior, left, and right walls) and the tumor-infiltrated tissue (the bladder neck and prostatic urethra). Subsequently, we deeply resected the largest tumor (Fig. b,c). The right ureteral orifice was exposed, and it was found to have been blocked by papillary tumors (the tumors in the ureter and the ureteral wall are indicated by green and white arrowheads, respectively; Fig. d,e). We deeply resected the tumors in the ureteral orifice; however, after the resection procedure residual tumors were identified within the ureteral orifice (green arrowhead in Figure f), which emitted potent fluorescence under blue light (Fig. g, see also Video ). We decided to attempt to remove the remaining tumors. After the second and third attempts to resect the ureteral tumors (deep resections, Video ), no tumors were visible under white light in the right ureter (Fig. h); however, marked fluorescence was observed from the ureteral mucosa (Fig. i), which was indicative of residual cancer. If the patient had undergone TUR without PDD, we would have finished the surgery at this point. Instead, we performed a biopsy of the fluorescence-emitting tissue. We then attempted to remove the suspected residual carcinoma. After the fourth resection of the ureteral orifice, the hydroureter-affected lumen was exposed, the mucosa of which was smooth and did not emit fluorescence (Fig. j,k). Subsequently, we performed a biopsy of the ureteral mucosa (Video ).
The pathological diagnosis of the BT was low-grade urothelial carcinoma, which had not invaded the muscular layer (pTa). No cancer cells were detected in random biopsy specimens. As expected from the PDD, low-grade cancer cells were detected in the ureteral mucosa after the third resection of the ureteral orifice, in which an irregular and fluorescent mucosa was identified (Fig. h,i). On the other hand, no cancer cells were found in the smooth and non-fluorescent mucosa after the fourth resection procedure. To prevent tumor recurrence, the patient is currently being treated with intravesically administered BCG via a right ureteral stent, which exposes both the ureter and the bladder to BCG. We concluded that the ureteral tumor was a BT that had infiltrated into the ureter because (i) preoperative MRI (Fig. a) showed that the main tumor was located in the bladder, (ii) the hydronephrosis was mild (CT findings, Figure ; the hydronephrosis would have been severe if the ureteral tumor had originated from the ureteral orifice), and (iii) the pathological analyses did not show muscular invasion. Thus, we succeeded in resecting the tumor in the ureteral orifice, which was accomplished via PDD using orally administered 5-ALA.",What is the patient's body mass mass index (BMI)? Your answer should be in terms of kg/m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [48.9, 'kg'], 'height': [1.56, 'm']}",20.09369,19.08901,21.09837,"The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 1.56 m. The patient's weight is 48.9 kg. The patient's bmi is therefore 48.9 kg / (1.56 m * 1.56 m) = 20.09369 kg/m^2."
89,6,Body Mass Index (BMI),physical,decimal,pmc-5371580-1,Extracted,"A 37-year-old female patient was referred to Hacettepe University, Pediatric Genetics Department following complaints of atypical facial features. She was the second child of non-consanguineous healthy parents. She was born at term by spontaneous vaginal delivery with a birthweight of 1,500 g (lower than 3rd centile). Her birth length and head circumference were not recorded. The patient had delayed psychomotor development and began to walk and speak after the age of 3 years. She has been able to read and write after attending a rehabilitation program. She was evaluated for developmental delay, short stature, learning disability, recurrent upper respiratory system infections, and constipation in childhood, but no diagnosis was made. Laboratory work-up, including cranial imaging, echocardiography, and blood biochemistry were all normal except for subclinical hypothyroidism and osteoporosis. The patient had generalized anxiety disorder and hypochondriasis since her adolescence and her symptoms had deteriorated over time. She started to suffer from difficulty falling asleep, especially during the last five years. She was described as over-friendly by her family members. On her admission, a physical examination revealed a weight of 42 kg (lower than 3rd centile), a height of 145 cm (lower than 3rd centile), and a head circumference of 52 cm (−2 standard deviations). Among the facial features, a long face, a long neck accentuated by sloping shoulders, low-set ears, periorbital fullness, a short nose, a wide mouth, a small jaw, and malar flattening were noted (). She was talkative and gregarious. The patient exhibited prolonged phases of staring into our faces and maintained eye contact throughout the physical examination. Based on these findings, the patient was clinically diagnosed with Williams syndrome. Fluorescence in situ hybridization analysis revealed 46,XX.ish del(7)(q11.2 q11.2) (ELN-), which confirmed the clinical diagnosis (). Genetic counseling was provided to the family and a follow-up plan was created. An informed consent was obtained from the patient.",What is the patient's body mass mass index (BMI)? Your answer should be in terms of kg/m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [42.0, 'kg'], 'height': [145.0, 'cm']}",19.97622,18.97741,20.97503,"The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 145.0 cm, which is 145.0 cm * 1 m / 100 cm = 1.45 m. The patient's weight is 42.0 kg. The patient's bmi is therefore 42.0 kg / (1.45 m * 1.45 m) = 19.97622 kg/m^2."
90,6,Body Mass Index (BMI),physical,decimal,pmc-5411553-3,Extracted,"A 51-year-old man was admitted to our hospital for renal biopsy. Proteinuria had been detected when the patient was approximately 30 years of age, and he had experienced tonsillitis several times. The patient had been diagnosed with PV with an abnormality of the JAK2 gene 3 years earlier. Renal biopsy was planned because his proteinuria had become more apparent over the past 2 years.
The patient’s height, weight, and blood pressure were 165 cm, 66 kg, and 120/73 mmHg, respectively. His consciousness level was alert, and he appeared healthy. No remarkable abnormalities were found in the heart, lungs, or abdomen, and pitting edema was not observed.
The laboratory data were as follows: hemoglobin, 15.3 g/dl; hematocrit, 48.1 %; platelets, 326,000/μl; white blood cells, 8,400/μl; C-reactive protein, <0.2 mg/dl; blood urea nitrogen, 22.2 mg/dl; serum creatinine, 1.4 mg/dl; total cholesterol, 194 mg/dl; total protein, 7.1 g/dl; albumin, 4.1 g/dl; globulin, 3.0 g/dl; lactate dehydrogenase, 169 IU/l; aspartate aminotransferase, 17 IU/l; alanine aminotransferase, 23 IU/l; total bilirubin, 0.5 mg/dl; γ-glutamyl transpeptidase, 21 IU/l; alkaline phosphatase, 276 IU/l; Na, 139 mmol/l; K, 4.7 mmol/l; and Cl, 106 mmol/l. Urinalysis showed 4+ proteinuria (1.2 g/day) and no evidence of hematuria.
Renal biopsy was performed (Fig. ) and 22 glomeruli could be evaluated, 5 of which showed global sclerosis. Histological findings included mesangial proliferative glomerulonephritis with crescents and focal segmental necrosis. Arteriosclerotic changes were also observed. Immunofluorescence staining was positive and revealed strong immunoreactivity for IgA and C3. Electron microscopy showed electron-dense deposits in the mesangium. He was diagnosed with IgA nephropathy. Tonsillectomy plus steroid pulse therapy and an angiotensin II receptor blocker were selected as treatments for the patient. His proteinuria and hematuria disappeared after 6 months.",What is the patient's body mass mass index (BMI)? Your answer should be in terms of kg/m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [66.0, 'kg'], 'height': [165.0, 'cm']}",24.24242,23.0303,25.45454,"The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 165.0 cm, which is 165.0 cm * 1 m / 100 cm = 1.65 m. The patient's weight is 66.0 kg. The patient's bmi is therefore 66.0 kg / (1.65 m * 1.65 m) = 24.24242 kg/m^2."
91,6,Body Mass Index (BMI),physical,decimal,pmc-6966935-1,Extracted,"An 8-year-old girl arrived at the emergency department with severe respiratory obstruction following interhospital transport. She weighed 42 kg and was 137 cm in height. Treatment for asthma that had been initiated about 1 month before had not improved her respiratory condition. She presented with marked stridor and cough, severe intercostal and subcostal chest retraction, and developed acute respiratory distress. Her parents mentioned that her respiratory condition might have been worsened by an external traumatic event at the neck that had been caused by her younger brother a few months earlier. At that time, while she had been playing with her younger brother, his elbow had bumped into her neck violently.
On admission, computed tomography (CT) of the neck showed that severe subglottic stenosis has developed with minimal cross-sectional diameters of 3.5 × 1.8 mm at the narrowest point (0.05 cm2) (Fig. ). Laryngoscopy revealed that her airway was almost completely obstructed by severe subglottic stenosis. Findings from other preoperative investigations including laboratory tests, chest X-ray, and electrocardiography were normal. The preoperative vital signs were blood pressure of 120/59 mmHg, temperature of 37.5 °C, respiratory rate of 20/min, and SpO2 of 98% (O2 5 L/min via mask). Because the cause of the severe subglottic stenosis was unclear and her symptoms were worsening day by day, we decided to perform emergency tracheostomy to prevent further worsening of her symptoms and a life-threatening condition.
The case was discussed in detail among otolaryngologists and anesthesiologists. Because we anticipated intubation to be impossible, emergency tracheostomy was planned. She was transferred to the operation room for emergency tracheostomy. Intraoperatively, the girl was monitored for oxygen saturation, end-tidal carbon dioxide, and non-invasive blood pressure, with electrocardiography performed as well.
We judged that it would be difficult to obtain the patient’s cooperation with only regional anesthesia. Emergent tracheostomy was therefore planned under general anesthesia. Sevoflurane was administered with sufficient titration to maintain spontaneous breathing. Anesthesia was maintained via the inhalation of air, oxygen, and sevoflurane. We considered that the use of a face mask instead of supraglottic airway devices during anesthesia might minimize the risk of tracheal injury or laryngospasm. The lungs were fully preoxygenated. The sevoflurane concentration was increased to 3%, at which point the patient was unresponsive.
The patient initially continued breathing spontaneously, but ventilation later became impossible because the otolaryngologists pulled her trachea. Before the oxygenation and hemodynamics became unstable, tracheostomy was successfully performed by the otolaryngologists. The patient was admitted to our pediatric intensive care unit (PICU) for postoperative airway management.
On postoperative day (POD) 3, because her airway had been stabilized by tracheostomy, she was discharged from the PICU. On POD 4, CT of the neck still showed narrowing of the subglottic portion. On POD 7, a laryngoscope under general anesthesia revealed severe edema at the subglottic stenosis (Fig. ). The otolaryngologists considered that the cause of the subglottic stenosis might be edema due to cricoid fracture, given her medical history.
At five months after surgery, a laryngoscope was again inserted under general anesthesia, revealing large granulomas surrounding an object in the subglottic wall. Surprisingly, this object turned out to be a circular plastic foreign body (cross-sectional diameter of 1.2 × 1.0 cm) (Fig. ). Surgery was performed to remove the object. On showing the foreign body to the patient and her parents, they did not remember her aspirating the object. She was discharged from our hospital and placed under home care after removal surgery.",What is the patient's body mass mass index (BMI)? Your answer should be in terms of kg/m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [42.0, 'kg'], 'height': [137.0, 'cm']}",22.37732,21.25845,23.49619,"The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 137.0 cm, which is 137.0 cm * 1 m / 100 cm = 1.37 m. The patient's weight is 42.0 kg. The patient's bmi is therefore 42.0 kg / (1.37 m * 1.37 m) = 22.37732 kg/m^2."
92,6,Body Mass Index (BMI),physical,decimal,pmc-5576131-1,Extracted,"A 30-year-old G4, P2 female, 160 cm tall, and weighing 68 kg, was admitted at 38 weeks of her third gestation for vaginal bleeding and hypogastralgia at her local hospital. Due to the combination of hypoxemia and abnormal electrocardiograph (ECG) findings, she was advised to transfer to our hospital; the patient did not receive prenatal obstetric care in our hospital. The admitting diagnosis was cardiac insufficiency, cyanotic CHD (dubious) and scarred uterus. The physical examination revealed blood pressure of 130/80 mmHg, a pulse of 90/min, a respiratory rate of 25/min, slightly cyanotic lips and the same on her cheeks, coarse breath sounds to auscultation in the lungs, and a regular heartbeat. A loud P2 and grade 3/6 systolic murmur was heard at the third and fourth ribs on the left edge of the sternum. The ECG showed sinus rhythm, complete right bundle branch block (CRBBB), first degree A-V block, inverted T wave, right ventricular hypertrophy, and severe cardiac clockwise rotation.
The obstetricians felt that the manifestations of cardiac insufficiency in the mother put her at high risk in a vaginal delivery. The fetus presented with abnormal heart rate variability, with no further evidence that the fetus was in a state of emergency. Considering that the mother had been in a condition of hypoxia, which would result in hypoxia in the baby, the obstetricians recommended emergency cesarean section for the benefit of both the mother and the baby.
The patient was transferred to the operating theater with a temperature of 36.8 °C, a heart rate of 92 beats/min, a respiratory rate of 23breaths/min, a blood pressure of 138/88 mmHg, and an oxygen saturation of 83-90% in air. With the administration of a fractional inspired concentration of oxygen (FiO2) of 0.5 to 0.6 via a Venturi mask, the patient’s oxygen saturation increased from 88 to 92%. Peripheral venous access was sited, and a 400-ml bolus of compound sodium chloride was commenced, after which a radial arterial line was placed under local anesthesia for beat-to-beat blood pressure monitoring.
Combined spinal-epidural anesthesia (single-shot spinal anesthesia) was administered in this case. The puncture point of spinal anesthesia was selected in the L2-3 interspace, and the procedure was performed using a needle-through-needle technique in the left lateral decubitus position. After cerebrospinal fluid (CSF) could be slowly aspirated through the needle, doses of 1.4 ml of 0.5% hyperbaric bupivacaine made up with 10% glucose for a hyperbaric solution that made it easy to adjust and control the anesthetic plane were injected into the subarachnoid space slowly towards the head, and an epidural catheter was inserted into the epidural space. The patient was then placed in the supine position with a left lateral tilt of at least 30 degrees; [] the patient’s abdomen could be raised softly if necessary to relieve vena caval compression. Within 20 min later of the anesthetic injection, we tested the block height every 1-2 min and adjusted the head-up or head-down tilt position to strictly control the blockade under the level of T6-8. Twenty minutes later, the level of spinal block was static at T8. One minute later, the patient was returned to the supine position, with a slight decrease arterial pressure to 122/82 mmHg and a heart rate of 97 beats/min. As small doses of metaraminol could resist the vasodilatation caused by anesthesia to maintain the afterload, 100 μg of metaraminol was administered, after which the patient’s arterial pressure increased to 130/84 mmHg, with a heart rate of 91 beats/min.
During the entire procedure, the key for safely administering anesthesia on such a patient was to keep her blood pressure stable and to carefully address the side effects of the changes in the hemodynamics []. Because the spinal anesthesia took action faster and due to the rapid sympathectomy in the intra-vertebral anesthesia, great care should be taken of the changes in arterial pressure and heart rate after puncture and injection.
A male baby was smoothly delivered 10 min after the surgery began; the baby had Apgar scores of 8 at 1 min and 9 at 5 min. In addition to the caution that must be paid due to the change in the patient’s venous return at the time of the delivery of the baby, some factors need to be given attention to avoid the occurrence of great amounts of intra-cardiac shunt changes and even heart failure. First, because the oppression of the inferior vena cava was relieved after childbirth, the lower limb venous blood flow increased rapidly, and the venous return increased in a short amount of time as a result. Abdominal sandbags were adopted to add pressure to reduce the returned blood volume. Further, the maternal “autologous blood transfusion effect” had to be considered: after the fetus was delivered, the myometrium contracted, and intrauterine blood flowed back to the blood vessels rapidly, thereby increasing the cardiac preload in a short amount of time. If the initial transfusion was too great, it could lead to heart failure. According to the patient’s fluctuations in blood pressure, a bolus of ephedrine 3 mg or metaraminol 100 μg was used to restore the blood pressure to 130 ~ 140/82 ~ 87 mmHg, with a heart rate of 90 ~ 98 beats/min and an SpO2 of 89 ~ 93% during the surgery. The goal was to balance the preload and afterload and to try to maintain the intra-cardiac shunt in the preoperative level of stability.
Uterine atony was noted by the surgeon after delivery of the placenta. Oxytocin is usually administered to increase the contractions so as to reduce bleeding; however, a rapid infusion of oxytocin could increase the patient’s heart rate, reduce the cardiac output and coronary blood flow, and break the balance of the intra-cardiac shunt, which could lead to cardiac insufficiency. Therefore, the application of oxytocin must begin with small doses, and the dosage should be adjusted over time. Thus, oxytocin (10 mIU/min) was intravenously infused, and the infusion was adjusted in accordance with the patient’s changes in heart rate and blood pressure. Continuous post-cesarean analgesia was provided through an epidural catheter. The patient was transferred to the intensive care unit (ICU) and was then sent to the ward in stable condition the following day.
We advised the patient to have an echocardiogram examination, which revealed CHD, a single atrium, and defects of the endocardial cushions (Fig. ). Thus, we made a complementary diagnosis of CHD: single atrium. The patient was in good condition at the 6-month follow-up.",What is the patient's body mass mass index (BMI)? Your answer should be in terms of kg/m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [68.0, 'kg'], 'height': [160.0, 'cm']}",26.5625,25.23438,27.89062,"The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 160.0 cm, which is 160.0 cm * 1 m / 100 cm = 1.6 m. The patient's weight is 68.0 kg. The patient's bmi is therefore 68.0 kg / (1.6 m * 1.6 m) = 26.5625 kg/m^2."
93,6,Body Mass Index (BMI),physical,decimal,pmc-5783153-1,Extracted,"A 67-year-old man with a height of 183 cm and a weight of 105 kg was admitted for urgent resection of a left atrial mass. He presented with progressive heart failure that could not be alleviated by inotropic or vasodilating drugs and had been coughing for 10 days. The symptoms had aggravated, and he had been unable to keep supine position for the last 3 days. He denied any previous heart disease. He had a history of right elbow leiomyosarcoma and underwent resection surgery 1 year previously.
On physical examination, the patient showed orthopnea and a compulsive position of slight left tilting. Wet rales could be heard on bilateral lung base. III/6 diastolic rumble was heard through the apex of the heart, which attenuated with upright position.
The preoperative laboratory data were within normal limits, except for NT-proBNP 1,190 pg/L. The electrocardiogram showed sinus tachycardia and minor ST segment change. Chest X-ray demonstrated prominent pulmonary patches infiltration, suggesting possible pulmonary edema. A mass was noted on the left lung. Combined with the malignancy history of the patient, pulmonary metastasis was suspected, whereas primary pulmonary tumor could not be ruled out (). Transthoracic echocardiography (TTE) showed a mobile isoechoic to hyperechoic lumpy mass (54×27 mm, ) and medium pulmonary hypertension (67 mmHg), and the ejection fraction of the left ventricle was 65%.
According to symptoms of left-sided heart failure, signs of mitral stenosis, and ultrasound imaging, myxoma was highly suspected. The TTE image indicated that the mass originated from the posterior wall of the left atrium (the typical myxoma is pedunculated with a stalk commonly attached to the fossa ovalis of interatrial septum). Differential diagnoses included idiopathic pulmonary arterial hypertension (IPAH), pulmonary embolism, pulmonary tumor thrombotic microangiopathy, and acute respiratory distress syndrome (ARDS). There is not enough evidence to support the differential diagnoses above.
In the operating room, monitors consisting of noninvasive blood pressure (NIBP), five-lead electrocardiogram, and pulse oximetry (SpO2) were applied. Radial arterial line and central venous catheter in the right subclavian vein were inserted, and then, arterial blood pressure (ABP) and central venous pressure (CVP) were monitored. Vital signs of the patient were basically stable with continuous intravenous nitroglycerin at the rate of 0.5 μg/kg/min. ABP was 121/82 mmHg, and CVP was 8 cmH2O, while heart rate (HR) was 111 bpm. His SpO2 was 92%–93% (fraction of inspired oxygen [FiO2] 60%). Airway assessment indicated several risk factors: obesity, short neck, impaired neck mobility, and Mallampati classification grade III. When the patient was awake with topical anesthesia of the tongue and pharynx, partial glottis was observed (Cormack–Lehane 2b) with direct laryngoscope. Thus, we considered the mask ventilation was feasible and anesthesia induction was conducted. After preoxygenation with oxygen (10 L/min) for 5 min via a face mask, general anesthesia was induced using Renfushufen® (sufentanil) 1 μg/kg, etomidate 0.15 mg/kg, and rocuronium 0.6 mg/kg (ideal body weight). Orotracheal intubation was performed with video laryngoscope when the patient was kept in the 60° Semi-Fowler’s position to avoid circulation collapse. Because mitral valve occlusion by left atrial mass may result in low cardiac output. Volume-controlled ventilation was applied (tidal volume of 8 mL/kg, frequency adjusted to maintain partial pressure of carbon dioxide in artery [PaCO2] between 35 and 45 mmHg, and inspiratory/expiratory (I/E) ratio 1:2). The airway peak pressure was 28–30 cmH2O. After intubation, the SpO2 was only 90%–93% (FiO2 60%). Arterial gas analysis during surgery is shown in . Abnormalities of airway, breathing, drug effects, and equipment were not found; thus, pulmonary edema was considered as the main reason for hypoxia. FiO2 100% was provided to improve oxygenation. Respiratory rate was increased to enhance minute ventilation volume. Positive end expiratory pressure (PEEP) was supplied to prevent alveoli from collapsing to improve pulmonary compliance and gas exchange and to decrease extravascular lung water. PEEP was titrated to 6 cmH2O to avoid high PEEP-related compromise preload. Then, SpO2 improved to 94%–95%. Vital signs and ventilation parameters during surgery are shown in . Anesthesia was maintained with sufentanil 20 μg/h and sevoflurane 2%–2.5% (concentration of sevoflurane was adjusted according to the patient’s increased age), and rocuronium was given intermittently.
After median sternotomy, 400 U/kg heparin was administered. Arterial cannulation was performed via ascending aorta. Venous cannulation was inserted via the right atrial appendage into the superior and inferior vena cava. After CPB was established, oxygenation of the patient improved significantly with the SpO2 improved to 99%–100%. The patient was kept anesthetized with midazolam 0.1 mg/kg/h, sufentanil 0.15 μg/kg/h, and rocuronium 0.15 mg/kg/h intravenously under hypothermic CPB, and nasopharyngeal and rectal temperature were maintained at 25°C and 28°C, respectively. Activated clotting time (ACT) was performed intermittently, and the results are shown in .
Under direct view, the mass was large and occupied nearly the entire left atrium. The right atrium and atrial septum were incised, and the mass was found attached by a stalk to the opening of the left superior pulmonary vein. The mass in the left atrium was totally resected, and was 15×2 cm. The tumor in the left superior pulmonary vein could not be completely resected, and palliative resection of the tumor around the opening of the left superior pulmonary vein was performed to ease tumor-related symptoms. As a result, preload was improved while pulmonary hypertension remained a problem. After rewarming and deairing of the heart, the aortic cross-clamp was removed. The heart came back into sinus rhythm with 20J intracardiac defibrillation, and then, the CPB was discontinued gradually. Weaning was facilitated with norepinephrine 0.05 μg/kg/min and dopamine 5 μg/kg/min to achieve goal mean arterial BP.65 mmHg. Nitroglycerin 0.5–0.8 μg/kg/min was used to decrease systemic vascular resistance. A total of 800 mL of packed red blood cells were gradually infused to increase preload. Vital signs showed an ABP of 110/70 mmHg, an HR of 110 bpm, a CVP of 12 cmH2O, and an SpO2 of 93%–95%. Heparin was neutralized with protamine (1 mg/100 U heparin). The total CPB time was 100 min, and the aortic occlusion time was 85 min. The overall fluid balance during CPB was −2,700 mL. The estimated blood loss was 800 mL. Arterial blood gas analysis after CPB discontinuation is also showed in .
After CPB, the partial pressure of oxygen in artery (PaO2) was 68 mmHg with FiO2 100% and PEEP 6 cmH2O and was increased from that before tumor resection (48 mmHg). After excluding bronchospasm and acute lung injury, we assumed that this was due to unrelieved cardiogenic pulmonary edema and pulmonary hypertension, as well as residual tumor in the pulmonary vessels. Inotropic agents including epinephrine 0.05 μg/kg/min, dopamine 5 μg/kg/min, and nitroglycerin 0.5–0.8 μg/kg/min were continuously used to improve cardiac output and facilitate stable hemodynamics, so as to alleviate pulmonary edema. Hyperventilation was applied to decrease PaCO2 and prevent acidosis. Hypoxia pulmonary vasoconstriction may have been partially inhibited, and pulmonary artery systolic pressure was decreased from 67 to <35 mmHg (postoperative TTE). The patient was transferred to the intensive care unit with BP 110/71 mmHg, HR 110 bpm, and SpO2 95% during admission. Oxygenation was improved compared to the level before left atrial tumor resection (91 vs 48 mmHg), and HR was decreased (103 vs 111 bpm), indicating that pulmonary edema was partially relieved. Increasing FiO2, decreasing O2 consumption, and optimizing acid–base balance and hemoglobin, together with protective ventilation, were provided and resulted in oxygenation improvement. Vasoactive medications and mechanical ventilation were gradually weaned, and vital signs remained stable. Chest X-ray performed 3 h postoperatively revealed significantly relieved pulmonary edema (). The patient was extubated on postoperative day 4 while he was conscious, and the vital signs showed BP 121/72 mmHg, HR 72 bpm, and SpO2 95%–97% with FiO2 85%. He was discharged 10 days after the surgery with symptoms ameliorated and SpO2 97% with FiO2 21%. Histopathological examination of the resected lesion revealed features consistent with leiomyosarcoma. Further management of the lung metastasis of leiomyosarcoma and possible radiation therapy are needed. Some authors suggest that multimodal therapy (surgical resection, radiation treatment, and chemotherapy) may result in reasonable survival improvement for patients. Isambert et al reported a mean survival of 18.2 months after incomplete resection and 11.2 months in nonresected patients. In our case, the patient received palliative treatment after surgery and died of tumor-related cardiopulmonary failure 6 months later. The timeline of history, interventions, and outcomes are summarized in .
Written informed consent was obtained from the patient’s next of kin for publication of this case report.",What is the patient's body mass mass index (BMI)? Your answer should be in terms of kg/m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'height': [183.0, 'cm'], 'weight': [105.0, 'kg']}",31.35358,29.7859,32.92126,"The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 183.0 cm, which is 183.0 cm * 1 m / 100 cm = 1.83 m. The patient's weight is 105.0 kg. The patient's bmi is therefore 105.0 kg / (1.83 m * 1.83 m) = 31.35358 kg/m^2."
94,6,Body Mass Index (BMI),physical,decimal,pmc-5073164-3,Extracted,"A 17-year-old female diagnosed with Down syndrome applied to pediatric cardiology outpatient clinic with swelling around the eyes and hands and dyspnea during sleep. Her height was 143 cm (25th–50th percentile according to growth chart for girls with Down syndrome), and her weight was 50 kg (25th–50th percentile according to growth chart for girls with Down syndrome). Bone age was 16 years. She had normal heart rate (76/min), respiratory rate (20/min), blood pressure (100/65 mmHg), and body temperature (36.8℃). Down syndrome stigmata (nasal eccentricity, simian line) were available on physical examination. Echocardiography revealed a PE exceeding 1 cm (). On laboratory evaluation, TSH was elevated (>100 µU/mL; normal range, 0.35–5 µU/mL), and fT4 was decreased (<0.25 ng/dL; normal range, 0.8–2 ng/dL). Thyroid autoantibodies were positive. After L-thyroxine therapy, facial edema and PE regressed within 15 days. fT4 and TSH levels before and after treatment were shown in . She grew in accordance with growth curves for children with Down syndrome.",What is the patient's body mass mass index (BMI)? Your answer should be in terms of kg/m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [50.0, 'kg'], 'height': [143.0, 'cm']}",24.45107,23.22852,25.67362,"The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 143.0 cm, which is 143.0 cm * 1 m / 100 cm = 1.43 m. The patient's weight is 50.0 kg. The patient's bmi is therefore 50.0 kg / (1.43 m * 1.43 m) = 24.45107 kg/m^2."
95,6,Body Mass Index (BMI),physical,decimal,pmc-5244004-1,Extracted,"The patient was a 17-year-old boy with hypopituitarism, autism, and a history of septooptic dysplasia with whom communication was difficult. He was receiving treatment with dexamethasone 100 μg and Levothyroxine sodium 1 mg per day. One month before admission, he experienced a fall, which resulted in difficulty in walking. At the first visit to the physician, because he could not describe any symptoms, only knee radiography was performed and there were no abnormalities. The pain in his right leg progressively worsened and he presented to our outpatient clinic after one month.
On physical examination, the patient was slightly obese with a height of 161 cm and weight of 63 kg noted. His right leg was externally rotated, and he hesitated to stand up. The passive range of motion of the right hip was limited, especially in adduction and internal rotation (right/left; flexion 90°/120°, extension 10°/10°, abduction 45°/45°, adduction 0°/30°, external rotation 60°/45°, and internal rotation 10°/30°). Serum insulin-like growth factor-1 and insulin-like growth factor-binding protein 3 levels were low, but free triiodothyronine, free thyroxine, and adrenocorticotropic hormone levels were almost normal. The radiographs of the hip joints showed a right atypical slippage of the epiphysis (). Both neck shaft angles were large (right/left; 160°/155°) and lateral tilts of the physis were normal on intact side (right/left; 35° lateral/13° medial). Three-dimensional computed tomography (3D CT) images showed lateral epiphyseal displacement on the right femoral head (Figures and ), indicating valgus SCFE.
The patient underwent in situ pinning of the hip on both sides. On the right side, the procedure was performed through a limited 5 cm longitudinal incision, positioned medially on the thigh (frog position), posterior to the femoral neurovascular bundle. A single φ5.5 mm partially threaded cannulated screw (Meira, Japan) was placed across the physis. In situ pinning on the left side was performed as a prophylactic pinning because of endocrine abnormalities (). Postoperatively, we had difficulty in limiting weight bearing due to communication difficulties.
One month after surgery, he could walk better than before the operation. At the 1-year follow-up, he could walk without difficulty and there were no signs of pain. The passive range of motion of the right hip joint was slightly improved in flexion, adduction, and internal rotation (100°, 20°, and 20°, resp.). Radiographs showed no signs of avascular necrosis or chondrolysis of the epiphysis; the physis showed no signs of early partial closure.",What is the patient's body mass mass index (BMI)? Your answer should be in terms of kg/m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'height': [161.0, 'cm'], 'weight': [63.0, 'kg']}",24.30462,23.08939,25.51985,"The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 161.0 cm, which is 161.0 cm * 1 m / 100 cm = 1.61 m. The patient's weight is 63.0 kg. The patient's bmi is therefore 63.0 kg / (1.61 m * 1.61 m) = 24.30462 kg/m^2."
96,6,Body Mass Index (BMI),physical,decimal,pmc-2729973-1,Extracted,"A 12-yr-old female presented to our outpatient department with a right winged scapula. Her height was 139 cm and her weight was 38 kg. This condition abruptly developed after climbing a mountain for 2 hr with a rucksack/back-pack weighing about 20 kg at 2 months previous to her hospital visit. At a certain moment, she felt the drooping shoulder with a popping sound. She was born via spontaneous full-term vaginal delivery with a normal APGAR score. She had no specific family history of nerve or muscle diseases. Her growth and developmental history was nonspecific before the onset of winged scapula. Upon the physical examination, a winging deformity of the right scapula was noticed with the lateral deviation and upward rotation of the inferior angle, as observed on the erect neutral posture (). This abnormality was not detected when both shoulders were abducted (), but it was aggravated by shoulder flexion (). The motor and sensory functions of the upper extremities were normal and no side to side differences were revealed. The deep tendon reflexes of the biceps and triceps muscles were normoactive and symmetrical. No significant muscle atrophy in the shoulder girdles and the upper extremities was observed. On the laboratory tests, the routine complete blood count with differential counting, erythrocyte sedimentation rate, C-reactive protein, rheumatoid arthritis factor and urinalysis were normal, and the muscle enzyme tests, including serum creatine kinase, lactate dehydrogenase and transaminase, were also normal. Simple radiological studies, including the chest posterior-anterior view, both the shoulder anterior-posterior views and the scapular view, were nonspecific except for the slight scapular asymmetry.
We examined the nerves by conducting an electrodiagnostic examination that included the long thoracic nerve, the dorsal scapular nerve and the spinal accessory nerves and the muscles including serratus anterior, levator scapula, trapezius and rhomboideus and so on; there were no definitive evidences that indicated any neuropathy or myopathy on electrodiagnosis.
When the pain and functional impairment persisted, surgical intervention then became appropriate. An explorative operation was done. A posterior longitudinal skin incision was made parallel to the vertebral border of the scapula. The subcutaneous tissue was divided. We can observed that the rhomboidius major was ruptured and trapezius lower thoracic bundle displayed thinning (). The right scapula was unstable to the chest wall. Rhomboideus major and trapezius muscle repair and reefing were performed. After the muscle repair, the scapula was stable to chest wall at the time of the operation.
Postoperatively, she achieved the anatomical restoration of her right shoulder and she received rehabilitative treatment for 2 weeks including range of motion exercise of the shoulder and strengthening exercise of the rhomboideus muscles. On the follow up examination, at 2 months after the operation, there was no weakness or deformity of the affected shoulder and no pain nor limitation of shoulder motion. She was satisfied with the recovery of her shoulder function ().",What is the patient's body mass mass index (BMI)? Your answer should be in terms of kg/m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [38.0, 'kg'], 'height': [139.0, 'cm']}",19.66772,18.68433,20.65111,"The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 139.0 cm, which is 139.0 cm * 1 m / 100 cm = 1.39 m. The patient's weight is 38.0 kg. The patient's bmi is therefore 38.0 kg / (1.39 m * 1.39 m) = 19.66772 kg/m^2."
97,6,Body Mass Index (BMI),physical,decimal,pmc-4052474-1,Extracted,"A 25-year-old man presented with pain in both knees for four consecutive years and, since 3 months, bilateral groin pain and pain in the gluteal region, radiating to both knees.
The patient has been diagnosed with HHR as a child and has been on potassium phosphate and calcitriol tablets ever since. A typical bowing and anteromedial rotation of the tibia was corrected with tibial shaft osteotomies and Ilizarov fixators of both tibias about 10 years ago []. After these procedures, very slow healing of the bone with multiple revisions due to delayed union was observed.
The patient has had pain in both knees for four years, more in the right than in the left knee. Initially, at 6 years of follow-up, approximately 4 years ago, MRI of both knees and pelvic X-ray did not reveal any pathological changes other than a strong coxa vara malformation of both hips (). Pain was described by the patient as start-up pain that disappeared or bettered after walking with full weight bearing for a while. Since about 3 months, the pain began to concentrate on both hips radiating in both knees; the same start-up character of the pain was described. Upon questioning, the patient admitted that he has not been taking his medication regularly the last 6 months.
Clinical examination revealed a patient with athletic build, weighting 53 kg and measuring 155 cm. Hip range of motion was (right side/left side) flexion/extension 120/0/0 and 130/0/0, endo-/exorotation 20/0/5 and 20/0/30, and ab-/adduction 10/0/30 and 15/0/30. Trendelenburg's sign was positive on both sides. The patient complained of pain by abduction and exorotation. The Harris and Oxford hip scores were 86 and 43, respectively. Haematological and biochemical parameters were within normal range except for a low phosphate of 1.7 mg/dL (norm: 2.3–4.7) and low potassium of 3.1 mmol/L (norm: 3.5–5.1). Radiographs of hips and pelvis () revealed fractures in both femoral necks. An MRI of the pelvis showed an atrophic nonunion of both fractures ().
Treatment options were discussed with the patient and a conservative treatment was decided on. The patient was advised to participate in sports that did not involve shock loading of the hip joint, for example, swimming, cycling, and aquajogging. The patient was informed that a prosthetic replacement of the hip could become necessary by further increase of symptoms or necrosis of the femoral head.",What is the patient's body mass mass index (BMI)? Your answer should be in terms of kg/m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [53.0, 'kg'], 'height': [155.0, 'cm']}",22.06035,20.95733,23.16337,"The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 155.0 cm, which is 155.0 cm * 1 m / 100 cm = 1.55 m. The patient's weight is 53.0 kg. The patient's bmi is therefore 53.0 kg / (1.55 m * 1.55 m) = 22.06035 kg/m^2."
98,6,Body Mass Index (BMI),physical,decimal,pmc-7808674-1,Extracted,"We describe a 20-year-old male from the Mbuyuni area of northern Tanzania who presented to Kilimanjaro Christian Medical Center (KCMC) in January 2020 with weight loss, splenomegaly, severe cachexia, and watery diarrhea. However, the leading symptom on presentation was watery diarrhea for 3 weeks.
The patient was accompanied by his father who reported that his son suffered from cachexia starting age 17. Prior to age 17, his medical history was unremarkable. His parents and 7 siblings are all healthy.
At the time of initial symptom onset, the patent lived in the Simanjiro district for cattle herding, while the rest of his family members lived in the suburban area of Arusha. He reported several insect bites during his period of working as a cattle herder. His symptoms gradually worsened with increasing weight loss and splenomegaly and as well as skin rashes and maculae in his face. After a year, he sought treatment from traditional healers. After another year of no improvement from consultation of the traditional healer, he presented to an outside hospital in the Arusha region (unknown diagnostic and treatment approach). Eventually, he was admitted at KCMC for further diagnostics.
On admission to KCMC, the patient’s primary complaints were abdominal pain and swelling. The laboratory tests on admission revealed white blood count of 1.51 × 109/L (neutrophils 37.3%, lymphocytes 58.4%, monocytes 3.7%, eosinophils 0.4%, and basophils 0.2%), red blood cell count 2.21 × 1012/L, hemoglobin 4.9 g/dL, thrombocytes 56 × 109/L, creatinine 41 μmol/L, aspartate aminotransferase (AST) 12.9 U/L, alanine aminotransferase (ALT) 7.6 U/L, sodium 124.6 mmol/L, potassium 2.9 mmol/L, and chloride 106 mmol/L. HIV test result is negative. The sputum polymerase chain reaction (PCR) for tuberculosis (GenXpert, Cepheid, Sunnyvale, California, United States of America) was negative; a chest X-ray investigation was normal; and ultrasound of the abdomen revealed hepatosplenomegaly.
On physical exam, he appeared pale and was wasted with a body weight of 39 kg and a height of 172 cm. On abdominal exam, his spleen was enlarged 18 cm below costal margin; the liver was enlarged 3 cm below costal margin; there were traditional healer marks throughout the abdomen; there were no palpable lymph nodes; and the lungs and heart were normal. His skin exam demonstrated hypopigmented maculae scattered on his face with accentuation in the perioral region () and skin-colored maculae on his trunk and arms. The latter occurred a few months before presentation in the hospital. Alopecia areata was also noted.
His travel history includes a 3-month stay in Mombasa (Kenya), approximately 1 year prior to presentation, where he worked as a merchant. Travels to other areas in Kenya or other countries, especially to endemic VL areas, has been denied by the patient as well as travels within Tanzania.
Due to pancytopenia, the patient was referred to the Hematology section of the Cancer Care Centre at KCMC, where we performed bone marrow aspirate and biopsy, revealing Leishmania amastigotes in macrophages (Figs and ). The rapid test for Leishmania antibody detection (IT LEISH) from the peripheral blood and the bone marrow aspirate remained negative.
After discussion with senior experts in tropical diseases, we decided to reperform bone marrow aspiration for PCR in a reference laboratory, which found the aspirate positive for Leishmania species DNA.
Due to the unavailability of liposomal Amphotericin, we initiated treatment with Amphotericin B (1 mg/kg IV). Unfortunately, the patient passed away on the fourth day of treatment due to sudden onset of respiratory insufficiency. Beside evidence of massive organ manifestations of VL (Figs –), the autopsy revealed pneumonia ().",What is the patient's body mass mass index (BMI)? Your answer should be in terms of kg/m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [39.0, 'kg'], 'height': [172.0, 'cm']}",13.1828,12.52366,13.84194,"The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 172.0 cm, which is 172.0 cm * 1 m / 100 cm = 1.72 m. The patient's weight is 39.0 kg. The patient's bmi is therefore 39.0 kg / (1.72 m * 1.72 m) = 13.1828 kg/m^2."
99,6,Body Mass Index (BMI),physical,decimal,pmc-2239218-1,Extracted,"A 57-year-old woman (180 cm, 60 kg) was presented to the emergency department with upper abdominal pain and left-sided chest discomfort for a couple of days. In addition, she reported of nausea. Upon physical examination, percussion sounds over the left lower thorax were a bit dull and cervical lymph nodes were palpable with a size of up to 1 cm. The abdomen was generally tender without signs of peritonitis; bowel sounds were normal. The ECG showed no abnormalities. Routine laboratory tests revealed mild leucocytosis and a slightly elevated C-reactive protein level. Troponin, myoglobine, and creatine kinase levels were within normal limits. An upper gastrointestinal endoscopy was performed. Whereas the oesophagus, the lower stomach, and the duodenum were
without abnormalities, a small hole in the fundus was visible after inversion of the scope ().
The “hole in the stomach” was intubated with a catheter and contrast dye was administered. Fluoroscopy revealed a diaphragmatic hernia with a large herniation of the gastric fundus (). Immediate laparotomy showed a 3 cm orifice of the
diaphragm (). The orifice was widened and a partial necrosis of the incarcerated fundus was resected (). The diaphragmatic orifice was covered with polydioxanone. The patient recovered fully and 
was discharged 12 days after laparotomy.",What is the patient's body mass mass index (BMI)? Your answer should be in terms of kg/m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [60.0, 'kg'], 'height': [180.0, 'cm']}",18.51852,17.59259,19.44445,"The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 180.0 cm, which is 180.0 cm * 1 m / 100 cm = 1.8 m. The patient's weight is 60.0 kg. The patient's bmi is therefore 60.0 kg / (1.8 m * 1.8 m) = 18.51852 kg/m^2."
100,6,Body Mass Index (BMI),physical,decimal,pmc-5687981-1,Extracted,"A 3-year-old girl visited the Emergency Department because she had not been able to eat well and had a fever since one day ago. She had no abdominal pain, vomiting, or diarrhea. She had taken only the prescribed acetaminophen one day before. According to her past medical history, she went to kindergarten, had not traveled recently, had no history of pancreatitis, autoimmune disease, choledochal cyst, or pancreatic ductal abnormalities, and her family history was negative for pancreatic disease. She has one older sister, and her sister did not have symptoms such as fever. Her vital signs at admission were as follows: blood pressure, 97/60 mmHg; heart rate, 104 beats/min; respiration rate, 24 breaths/min; and body temperature, 37.4℃. Her height was 98 cm (50th–75th percentile), and her weight was 15 kg (50th–75th percentile). On physical examination, multiple vesicles on the soft palate and maculopapular rashes were observed on both the hands and feet. She had a clear breathing sound, regular heartbeat without murmur, and soft abdomen with a normoactive bowel sound without an abdominal mass or abdominal tenderness. In initial laboratory studies, the serum glucose was decreased (41 mg/dL), erythrocyte sedimentation rate was slightly increased (17 mm/hr; reference range, 0–10 mm/hr), and C-reactive protein was slightly elevated (12.9 mg/L; reference range, 0.0–5.0 mg/L), and other laboratory studies were within the normal ranges. The white blood cell count was 7.8×103/µL, hemoglobin was 12.6 g/dL, platelet count was 252×103/µL, blood urea nitrogen was 15.0 mg/dL, creatinine was 0.42 mg/dL, cholesterol was 187 mg/dL, albumin was 4.3 g/dL, total bilirubin was 0.39 mg/dL, direct bilirubin was 0.11 mg/dL, aspartate aminotransferase was 34 IU/L, alanine aminotransaminase was 10 IU/L, sodium was 135 mmol/L, potassium was 4.4 mmol/L. Amylase and lipase tests were not performed at the time of admission. Urine ketone body was 3 positive in urinalysis. A chest X-ray showed no active lung lesions, cardiopulmonary angle blunting, or cardiomegaly. Abdomen X-rays showed a nonspecific bowel gas pattern without ileus or pancreatic calcification.
We treated the child conservatively with intravenous fluid. On the first hospital day (HD), her fever subsided. On the third HD, she complained of ear pain caused by acute otitis media and intravenous amoxicillin/clavulanate was administered at a dose of 90 mg/kg/day. On the fourth HD, she experienced severe epigastric pain and vomiting. Her vital signs were as follows: blood pressure, 107/80 mmHg; heart rate, 109 beats/min.; respiration rate, 24 breaths/min; and body temperature, 37.2℃. On physical examination, she complained of epigastric tenderness. The serum levels of amylase and lipase were remarkably elevated (amylase, 1,902 IU/L; reference range, 28–100 IU/L; lipase, >1,500 IU/L; reference range, 13–60 IU/L). Ultrasonography of the abdomen showed mild diffuse swelling of the pancreas from head to tail with a small amount of ascites (), which suggested acute pancreatitis.
Considering the patient's history of HFMD, we thought that enterovirus, which is a common cause of HFMD, could be a pathogen. We asked the Korea Centers for Disease Control and Prevention for enterovirus typing of her stool sample. In the first step, real-time reverse transcription polymerase chain reaction (RT-PCR) was performed on the specimens targeting the 5' noncoding region capable of detecting all 68 serotypes, and the result was enterovirus-positive. In the second step, 2-step RT-PCR was performed targeting viral protein 1, which has a different structural enterovirus protein for each subtype, and CA16 was detected in the sample.
After acute pancreatitis was diagnosed, the patient was fasted and given sufficient intravenous fluid. Acetaminophen and ibuprofen were given for pain control. Serum amylase and lipase were serially followed (). The fever, epigastric pain, and vomiting were recovered on the sixth HD. She was discharged on the 11th HD without pancreatitis-related complications. On the day of discharge, the serum levels of amylase and lipase were remarkably reduced (amylase, 289 IU/L; lipase, 893 IU/L).
She was followed up after discharge without any symptoms, and pancreatitis has not recurred yet. Laboratory tests performed 6 months after discharge showed normal levels of serum amylase and lipase ().",What is the patient's body mass mass index (BMI)? Your answer should be in terms of kg/m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [15.0, 'kg'], 'height': [98.0, 'cm']}",15.61849,14.83757,16.39941,"The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 98.0 cm, which is 98.0 cm * 1 m / 100 cm = 0.98 m. The patient's weight is 15.0 kg. The patient's bmi is therefore 15.0 kg / (0.98 m * 0.98 m) = 15.61849 kg/m^2."
101,7,Calcium Correction for Hypoalbuminemia,lab test,decimal,pmc-6521685-1,Extracted,"An 86-year-old male previously treated for hypertension presented to the emergency department with two days of sudden abdominal pain and nausea which resolved temporarily after self-induced emesis. Patient was examined and investigated thoroughly. Temperature was 36.3 C, blood pressure was 138/81, and pulse was 78. Physical examination revealed a tender, firm and distended abdomen with hyperactive sounds. Laboratory analysis revealed hemoglobin at 10.3 g/dL, leukocytes 3.1 K/cmm, urea nitrogen 19 mg/dl, creatinine 0.6 mg/dl, sodium 137 mmol/l, potassium 3.6 mmol/l, chloride 104 mmol/l, bicarbonate 24 mmol/l, calcium 8.6 mg/dl, total protein 6.3 g/dl, albumin 3.1 g/dl, total bilirubin 0.7 mg/dl, alkaline phosphatase 98 U/l, SGOT 20 U/l, SGPT 27 U/l. Laboratory values were consistent with patient’s previous clinic visits. Computed tomography (CT) of the abdomen revealed a fluid-filled, significantly dilated stomach as well as multiple dilated loops of small bowel with air-fluid levels consistent with mechanical small bowel obstruction caused by intussusception of small bowel (Fig. ). After initial fluid resuscitation and antibiotic administration, consent was obtained for emergent exploratory laparotomy. The exploratory laparotomy revealed a 3.0 × 2.5 cm intraluminal calculus in the ileum responsible for the small bowel obstruction, without evidence of intussusception (Fig. ). The obstructing enterolith was ‘milked’ proximally until it reached, and subsequently ‘fell into,’ an isolated 6.0 × 3.0 cm jejunal diverticulum which had not been previously noted on CT imaging. The enterolith was removed along with the segment of the jejunum containing the isolated diverticulum, which was the source of the enterolith (Fig. ). On histologic examination, the mucosa of the extracted diverticulum was found to be granular and erythematous; the remaining small bowel had marked mucosal ulceration and near-transmural inflammation with granulation tissue. Hospital course was complicated by decreased urine output that resolved after fluid resuscitation. On the fourth postoperative day, nasogastric tube was discontinued, diet was advanced and tolerated, and the patient was discharged. Review of the patient’s CT scan of the abdomen revealed the isolated jejunal diverticulum that was consistent with the excised diverticulum (Fig. ).","Using the Calcium Correction for Hypoalbuminemia formula, what is the patient's corrected calcium in mg/dL? Your may set your normal albumin concentration to be 4 g/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Calcium': [8.6, 'mg/dL'], 'Albumin': [3.1, 'g/dL']}",9.32,8.854,9.786,"To compute the patient's correct calcium level in mg/dL, the formula is  (0.8 * (Normal Albumin (in g/dL) - Patient's Albumin (in g/dL))) + Serum Calcium (in mg/dL).
The patient's normal albumin level is 4.0 g/dL.
The concentration of Albmumin is 3.1 g/dL. 
The concentration of Calcium is 8.6 mg/dL. 
Plugging these values into the formula, we get (0.8 * (4.0 g/dL - 3.1 g/dL)) + 8.6 mg/dL = 9.32 mg/dL.
The patient's corrected calcium concentration 9.32 mg/dL."
102,7,Calcium Correction for Hypoalbuminemia,lab test,decimal,pmc-6323504-1,Extracted,"A 73-year-old male veteran presented with recurrent syncope and falls. He had decreased appetite, thirst, and urine output in the setting of progressive abdominal distention, pruritus, and painless jaundice in the prior month. His past medical history was significant for obesity (BMI=40.1), hypertension, and benign prostatic hyperplasia (BPH) with pertinent medications of ibuprofen (200 mg QID), furosemide (40 mg BID), losartan, doxazosin, and finasteride. A detailed dietary history prior to admission was lacking. Physical exam was notable for diffuse jaundice, abdominal distention, and severe mid-thoracic back pain later confirmed to be T6/T7 vertebral fractures.
Initial laboratory results showed stage 3 AKI with serum creatinine (SCr) elevated to 8.98 mg/dL from a baseline of 1.04 mg/dL. Supporting laboratory findings included elevations in phosphorus (7.6 mg/dL), parathyroid hormone (319.7 pg/mL), and low calcium (7.6 mg/dL), ionized calcium (0.93 mmol/L), albumin (2.8 g/dL), and 25-hydroxy vitamin D (16.4 ng/mL). There was an anion gap (21 mEq/L) with pH= 7.145 confirmed with arterial blood gas. Jaundice workup revealed an obstructive pattern with elevated total bilirubin (5.4 mg/dL), direct bilirubin (3.7 mg/dL), AST (79 U/L), ALT (140 U/L), alkaline phosphatase (392 U/L), GGT (214 U/L), and lipase (690 U/L). Soon after admission, he developed hypotension necessitating vasopressors and broad-spectrum antibiotics for presumed septic shock. AKI workup revealed deteriorating kidney function and development of anuria, requiring intermittent hemodialysis.
The etiology of renal failure remained unclear. Urine testing showed nephrotic range proteinuria, many bacteria, no red blood cells, no crystals, few hyaline casts, and no granular casts. A renal biopsy was performed and showed diffuse calcium oxalate crystal deposition with severe acute tubular injury (ATN) and mild interstitial fibrosis (). An evident cause of oxalate nephropathy was unclear, although it was suspected that pancreatic insufficiency leading to fat malabsorption and increased intestinal absorption of oxalate were responsible. Fecal elastase returned low at 54 μg Elastase/g stool to support pancreatic insufficiency while abdominal computed tomography (CT) without contrast showed exocrine atrophy of the pancreas. Serum oxalate was 3.6 mmol/L (normal range 1.0-3.0 mmol/L). A low-fat, low-oxalate diet with calcium citrate and pancrelipase supplementation was started.
Concurrently, a jaundice workup began with abdominal ultrasound which showed hepatomegaly, splenomegaly, numerous gallstones, and no inferior vena cava or portal circulation thrombosis. Of note, the common bile duct was not visibly dilated, raising concern for an upstream malignant stricture. MRCP showed marked dilation of the left intrahepatic biliary tree with abrupt termination and mild dilation of the right intrahepatic biliary tree, further raising suspicion of malignancy. ERCP with stenting to the right intrahepatic biliary tree duct was performed. Cytology, a markedly elevated CA 19-9, and imaging confirmed the diagnosis of cholangiocarcinoma (Klatskin tumor). Medical oncology discussed chemotherapy and radiation as alternative treatments, but the patient elected to enter hospice. His kidney function ultimately improved with return of nonoliguric urine output, cessation of dialysis, and improved creatinine to 2.45mg/dL and eGFR of 26 ml/min/1.73m3 at discharge.","Using the Calcium Correction for Hypoalbuminemia formula, what is the patient's corrected calcium in mg/dL? Your may set your normal albumin concentration to be 4 g/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Albumin': [2.8, 'g/dL'], 'Calcium': [7.6, 'mg/dL']}",8.56,8.132,8.988,"To compute the patient's correct calcium level in mg/dL, the formula is  (0.8 * (Normal Albumin (in g/dL) - Patient's Albumin (in g/dL))) + Serum Calcium (in mg/dL).
The patient's normal albumin level is 4.0 g/dL.
The concentration of Albmumin is 2.8 g/dL. 
The concentration of Calcium is 7.6 mg/dL. 
Plugging these values into the formula, we get (0.8 * (4.0 g/dL - 2.8 g/dL)) + 7.6 mg/dL = 8.56 mg/dL.
The patient's corrected calcium concentration 8.56 mg/dL."
103,7,Calcium Correction for Hypoalbuminemia,lab test,decimal,pmc-8173516-2,Extracted,"A 78-year-old man presented with dyspnea on exertion. He had undergone resection of a left atrial myxoma 4 years prior to admission. He had a history of diabetes mellitus with onset at the age of 60; at the age of 71, he started undergoing dialysis for chronic renal failure due to diabetic nephropathy. He also had hypertension, hyperlipidemia, hypothyroidism, and secondary hyperparathyroidism, and was undergoing radiation therapy for prostate cancer. He had never smoked and his family history was unremarkable. He became aware of dyspnea on exertion in the previous 2 months, and was admitted to our hospital because his condition worsened. UCG revealed that the LVEF had decreased sharply from 73 to 44% (New York Heart Association class III). In this case, the inflammatory response remained low and stable at C-reactive protein levels of 0.3 to 0.5 mg/dL until the second operation.
His height and weight were 170.0 cm and 64.4 kg, respectively. His blood pressure was 86/48 mmHg and heart rate was 70 bpm (normal sinus rhythm). His laboratory data were as follows: hemoglobin, 10.2 g/dL; platelet count, 132 × 109/L; total protein, 5.7 mg/dL; albumin, 3.3 g/dL; triglycerides, 54 mg/dL; LDL-cholesterol, 44 mg/dL; HDL-cholesterol, 44 mg/dL; Ca, 8.1 mg/dL; P, 3.1 mg/dL; HbA1c, 7.0%; and BNP, 3461 pg/mL. His oral medications included aspirin (100 mg/day), furosemide (20 mg/day), carvedilol (2.5 mg/day), lansoprazole (15 mg/day), precipitated calcium carbonate (3000 mg/day), rosuvastatin calcium (5 mg/day), and nicorandil (15 mg/day).
ECG revealed normal sinus rhythm with Q waves in leads II, III, and aVF, and ST segment depression in V5-V6 (Fig. ). Chest radiography and CT revealed a CTR of 72% and severe calcified coronary arteries (Fig. ). UCG revealed poor left ventricular function (LVDd/Ds, 56/43 mm; LVEF, 44%; inferoposterior wall hypokinesis; and mild MR with RVP of 29 mmHg). Cineangiography 4 years ago had shown only 25% stenosis in the proximal LAD; at admission, it revealed 90% stenosis in the same proximal LAD, 99% stenosis in the proximal LCX, and 95% stenosis in the posterolateral branch (PL) of LCX (Fig. a, b). He had low blood pressure during dialysis and underwent emergency surgery (Euro II risk score 40.7%; STS risk score, 33.2%).
We performed a sternotomy similar to the one performed previously, and then performed CABG (LITA-LAD, and LITA-right internal thoracic artery [right internal thoracic artery, RITA-Diagonal branch-PL1-PL-2-PL3]). The duration of surgery and CPB was 514 and 172 min, respectively. The postoperative ventilator management was completed in 9 h. He stayed in the postoperative ICU for 4 days and was discharged on postoperative day 10. The LVEF had improved from 44 to 50%, and all grafts were well patent (Fig. ).","Using the Calcium Correction for Hypoalbuminemia formula, what is the patient's corrected calcium in mg/dL? Your may set your normal albumin concentration to be 4 g/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Albumin': [3.3, 'g/dL'], 'Calcium': [8.1, 'mg/dL']}",8.66,8.227,9.093,"To compute the patient's correct calcium level in mg/dL, the formula is  (0.8 * (Normal Albumin (in g/dL) - Patient's Albumin (in g/dL))) + Serum Calcium (in mg/dL).
The patient's normal albumin level is 4.0 g/dL.
The concentration of Albmumin is 3.3 g/dL. 
The concentration of Calcium is 8.1 mg/dL. 
Plugging these values into the formula, we get (0.8 * (4.0 g/dL - 3.3 g/dL)) + 8.1 mg/dL = 8.66 mg/dL.
The patient's corrected calcium concentration 8.66 mg/dL."
104,7,Calcium Correction for Hypoalbuminemia,lab test,decimal,pmc-4241285-1,Extracted,"A 66-year-old male was admitted to the ICU with complaints of chronic weakness, fatigue, myalgia, weight loss, and left flank pain. Comorbidities included hypertension, active smoking, and diabetes mellitus. Patient denied nausea, vomiting, diarrhea, hematemesis, melena, hematochezia, chest pain, or any shortness of breath. He had a recent admission due to community acquired pneumonia and was treated with antibiotics. He denied using any illicit drugs or alcohol abuse. He was retired truck driver by profession.
On examination, he was an elderly man with clinical signs of dehydration. Blood pressure was 155/56 mm Hg, heart rate was 67/min, respiratory rate was 16/min, was afebrile, and his oxygen saturation was 99% on room air. He had mild epigastric tenderness without guarding or rigidity. He had bilateral lower extremities chronic skin changes with scaling. The rest of the physical examination was normal.
Significant laboratory data revealed serum sodium 124 mEq/mL, potassium 5.1 mEq/mL, chloride 89 mEq/mL, bicarbonate 15 mEq/mL, blood urea nitrogen 44 mg/dL, creatinine 1.5 mg/dL, glucose 85 mg/dL, calcium 10.3 mg/dL, total protein 7.3 g/dL, and albumin 2.9 g/dL. The rest of the liver function tests were within normal limit. Anemia was with hemoglobin 9.4 g/dL, hematocrit 27%, platelets 558 k/μL, and white blood cells 10.4 k/μL. Arterial blood gas analysis showed pH of 7.36, pCO2 of 25 mm Hg, pO2 of 90.3 mm Hg, and oxygen saturation of 97% on room air. There was an anion gap of 20, lactic acid of 4.8 mmoles/L, serum lipase of 1540 U/L, amylase 406 unit/L, gamma GT 25 unit/L, INR 1.3, and lactate dehydrogenase (LDH) 950 unit/L; cancer antigen CA 19-9 was 49.9 μ/mL, TSH was 2.25 mIU/L, serum acetone was negative, and alcohol level was less than 10 mg/dL. His serial cardiac enzymes were negative and he was ruled out for an acute coronary event.
Chest X-ray (CXR) revealed bilateral patchy airspace disease. CT of abdomen and pelvis without contrast showed diffuse enlargement of the pancreas with homogeneous attenuation and without significant peripancreatic inflammation () with extensive retroperitoneal and pelvic adenopathy (). A para-aortic lymph node measuring 2.1 cm and retrocaval lymph node measuring 1.6 cm were seen. A soft tissue density surrounding the right common iliac vessels likely representing confluent adenopathy was seen. His echocardiogram showed an ejection fraction of 67%; right ventricle systolic pressure was estimated to be 44 mm Hg. Pericardium was normal without any pericardial effusion. There was no significant valvular abnormality.
Initially, the patients EKG showed 2nd degree Mobitz type I block which later progressed to complete heart block. Patient was given atropine without improvement; hence, a temporary pacemaker was inserted. He was started on IV hydration and IV antibiotics and all his electrolyte abnormalities were corrected. His temporary pacemaker lead came out and it was removed. Subsequently he became unresponsive, was orally intubated, had four cardiac arrests, and was successfully resuscitated. Due to persistent pulmonary infiltrates he underwent fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsies which showed evidence of pneumocystis jiroveci pneumonia (PJP). He was started on Bactrim for the treatment of PJP. He tested positive for HIV and was found to have a CD 4 count of 12/uL.
A temporary pacemaker wire was again placed after ruling out the relevant reversible causes of third degree heart block. A repeat echocardiogram was unchanged from prior one. CT-guided biopsy of the para-aortic lymph nodes was consistent with diffuse large B-cell lymphoma with marked tumor necrosis (). Immunoprofile showed that CD 20 (), CD 79a, and CD 10 were positive. CD 43, CD 3, CD 7, and BcL were negative. Upper endoscopy for percutaneous endoscopic gastrostomy placement showed gastric polyps which revealed gastric lymphoma on biopsy.
Patient was not a candidate for chemotherapy or ART due to critical condition. Hospital course was complicated by acute respiratory distress syndrome, acute kidney injury, and eventual death a month into his hospital stay.","Using the Calcium Correction for Hypoalbuminemia formula, what is the patient's corrected calcium in mg/dL? Your may set your normal albumin concentration to be 4 g/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Calcium': [10.3, 'mg/dL'], 'Albumin': [2.9, 'g/dL']}",11.18,10.621,11.739,"To compute the patient's correct calcium level in mg/dL, the formula is  (0.8 * (Normal Albumin (in g/dL) - Patient's Albumin (in g/dL))) + Serum Calcium (in mg/dL).
The patient's normal albumin level is 4.0 g/dL.
The concentration of Albmumin is 2.9 g/dL. 
The concentration of Calcium is 10.3 mg/dL. 
Plugging these values into the formula, we get (0.8 * (4.0 g/dL - 2.9 g/dL)) + 10.3 mg/dL = 11.18 mg/dL.
The patient's corrected calcium concentration 11.18 mg/dL."
105,7,Calcium Correction for Hypoalbuminemia,lab test,decimal,pmc-8036102-1,Extracted,"A 56-year old man presented to the Department of Internal Medicine with a deteriorated mental status. Laboratory tests performed in the emergency department demonstrated severe hypercalcemia at 17.95 mg/dl (reference range: 8.7–10.4), together with albumin levels of 3.2 g/dl, elevated levels of phosphor 5.9 mg/dl (reference range: 2.5–5), acute kidney injury with a creatinine level of 1.45 mg/dl (baseline creatinine level 0.9 mg/dl), urea, 73 mg/dl, uric acid, 12.8 mg/dl, estimated glomerular filtration rate 52 ml/minute, hemoglobin 11 mg/dl, and C-reactive protein 0.8 mg/dl. He was treated with an intravenous saline infusion, subcutaneous calcitonin, and intravenous glucocorticoids, followed by intravenous bisphosphonates. Due to his persistent hypercalcemia he was subsequently given 120 mg denosumab (Prolia). During hospitalization, there was significant improvement in his mental status concurrently with the normalization of his calcium level, which was 9.44 mg/dl at discharge.
His past history was remarkable for his 2016 diagnosis of Rai stage IV chronic lymphocytic leukemia. The fluorescence in situ hybridization reaction revealed the deletion of the short arm of chromosome 17 (del (17p)) in 20% of B-cell lymphocytes. In addition, in a bone marrow biopsy, the patient was found to have unmutated IGHV gene status and ZAP 70 expression in leukemia cells.
In 09/2017 he was admitted to the Department of Internal Medicine because of autoimmune hemolytic anemia. Treatment with a high dose glucocorticoid was started, followed by a slow tapering down of the dose. In 12/2017 he was again admitted to the Department of Internal Medicine with left hemiparesis, dysarthria, and left facial nerve palsy. Complete right carotid occlusion was found in the CT angiography.
After discharge, he was treated with 2 courses of a Rituximab + Bendamustine protocol with a significant decrease in lymphocytes counts. In September 2018 treatment with the second line agent Ibrutinib was started. One month later, he developed paroxysmal atrial fibrillation with spontaneous conversion to sinus rhythm. Six days before the present admission, the patient was hospitalized because of paroxysmal atrial fibrillation with no evidence of myocardial ischemia. Ibrutinib was stopped because it was presumed to be the cause of the arrhythmia. During his present hospitalization additional laboratory tests revealed an elevated LDH level of 2250 U/l (reference range: 230–480), an alkaline phosphatase level of 220 U/l (reference range: 30–120), and low levels of PTH: 4.8 pg/ml (reference range: 18.4–81), 25 hydroxyvitamin D level of 52 mmol/l (reference range: 75–220) with normal 1.25 dihydroxyvitamin D level of 61.3 nmol/l (reference range: 50–190), WBC 108.000 (reference range: 4.5–11.5 K/μl), Lymphocytes 57%, PLT count of 88.000 (reference range: 150–450 K/μl).
In the setting of his elevated LDH level, further decrease in his PLT level to 45.000 and severe hypercalcemia, it was decided to perform a positron emission tomography/computed tomography to assess the possibility of Richter transformation. The scan revealed a 1.3 cm nodule with an intensive uptake of tracer in the upper left lobe of the lung and in vertebra D 7, suspicious of metastasis (Fig. ).
He underwent a bronchoscopy with a transbronchial biopsy of the lesion. Non-small cell carcinoma displaying positive CK 7 and negative to TTF-1, napsin-A, and p 40 immunostaining was diagnosed. An epidermal growth factor genotype was negative for mutations. Immunohistochemical analysis was negative for ALK and ROS1 protein rearrangement as well as PDL1 expression. He underwent 1 course of chemotherapy in September 2019 that included carboplatin, paclitaxel, and pembroluzumab. Results of the molecular analysis of the tumor were negative for epidermal growth factor receptor (EGFR) genotype mutations, ALK and ROS 1 rearrangement, and PDL-1 protein expression. He then began treatment with venetoclax for his refractory CLL.
Ten days after starting therapy with venetoclax, he was admitted to the internal medicine department with large left upper lobe pneumonia. A chest CT revealed a large infiltrate with an air bronchogram. A subsequent urine antigen test was positive for legionella pneumonia. He completed treatment with respiratory quinolone for 21 days and was returned to oncological and hematological supervision.
The patient received a second course of chemotherapy, but 4 days later he was admitted with suspected pneumonia and despite the broad-spectrum antibiotic treatment, respiratory failure developed and he passed away.","Using the Calcium Correction for Hypoalbuminemia formula, what is the patient's corrected calcium in mg/dL? Your may set your normal albumin concentration to be 4 g/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Albumin': [3.2, 'g/dL'], 'Calcium': [17.95, 'mg/dL']}",18.59,17.6605,19.5195,"To compute the patient's correct calcium level in mg/dL, the formula is  (0.8 * (Normal Albumin (in g/dL) - Patient's Albumin (in g/dL))) + Serum Calcium (in mg/dL).
The patient's normal albumin level is 4.0 g/dL.
The concentration of Albmumin is 3.2 g/dL. 
The concentration of Calcium is 17.95 mg/dL. 
Plugging these values into the formula, we get (0.8 * (4.0 g/dL - 3.2 g/dL)) + 17.95 mg/dL = 18.59 mg/dL.
The patient's corrected calcium concentration 18.59 mg/dL."
106,7,Calcium Correction for Hypoalbuminemia,lab test,decimal,pmc-6693048-1,Extracted,"An 83-year-old female patient presented to our clinic with abdominal pain, lack of appetite, nausea, weight loss, and fatigue. The patient had lost nearly 12 kilograms in the past 6 months. Abdominal pain was localized in the right upper quadrant. She had obtuse pain that had no relation to food. It was found that the patient had osteoporosis in her history but did not receive any treatment. In the physical examination of the patient, who did not present any characteristics in her family history, the liver extended to 2 cm below the costal margin. She did not have ascites or splenomegaly. Heart and lung examinations were normal. Laboratory tests presented a normal hemogram. Biochemical tests revealed an aspartate aminotransferase (AST) level of 50 U/L, alanine aminotransferase (ALT) level of 20 U/L, total bilirubin level of 1.3 mg/dL, alkaline phosphatase (ALP) level of 101 U/L, gamma-glutamyltransferase level of 227 U/L, albumin level of 2.6 g/dL, total protein level of 4.9 g/dL, calcium level of 12.35 mg/dL, and a phosphate level of 2.6 mg/dL. The patient was hospitalized in order to investigate the etiology of hypercalcemia. The patient had a parathormone level of 9.5 pg/mL. These results excluded a diagnosis of primary hyperparathyroidism. The patient who was thought to have malignant hypercalcemia was started on intravenous fluid replacement and furosemide treatment. The patient who manifested a creatinine clearance of 55.5 mL/min/1.73 m2 was started on 2 mg zoledronic acid treatment. Tomography scans demonstrated no osteolytic bone lesions. During follow-up, the patient's calcium levels regressed to 9.7 mg/dL with the specified treatment. Abdominal ultrasonography performed due to right upper quadrant pain and hepatomegaly revealed multiple hypoechoic images in the liver, of which the largest was 1.5 cm in size, and a coarsely granular parenchyma. The dynamic CT of the patient demonstrated hypodense lesions with multiple areas of peripheral contrast enhancement that were particularly congregated in the right lobe, the largest of which had a size of 47 × 32 mm, and this was interpreted as metastasis (Figure ).
Levels of alpha-fetoprotein were determined as 91 ng/mL, cancer antigen (CA-125) as 258.6 U/mL, carcinoembryonic antigen (CEA) as 0.82 ng/mL, and cancer antigen 19-9 (CA19-9) as 2.1 U/mL. A biopsy was performed on the mass in the liver for diagnosis. Pathology result indicated cholangiocellular cancer (Figure ). The patient did not consent to surgical resection; therefore, a monthly zoledronic acid treatment was planned for pain palpation and hypercalcemia.","Using the Calcium Correction for Hypoalbuminemia formula, what is the patient's corrected calcium in mg/dL? Your may set your normal albumin concentration to be 4 g/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Albumin': [2.6, 'g/dL'], 'Calcium': [12.35, 'mg/dL']}",13.47,12.7965,14.1435,"To compute the patient's correct calcium level in mg/dL, the formula is  (0.8 * (Normal Albumin (in g/dL) - Patient's Albumin (in g/dL))) + Serum Calcium (in mg/dL).
The patient's normal albumin level is 4.0 g/dL.
The concentration of Albmumin is 2.6 g/dL. 
The concentration of Calcium is 12.35 mg/dL. 
Plugging these values into the formula, we get (0.8 * (4.0 g/dL - 2.6 g/dL)) + 12.35 mg/dL = 13.47 mg/dL.
The patient's corrected calcium concentration 13.47 mg/dL."
107,7,Calcium Correction for Hypoalbuminemia,lab test,decimal,pmc-6460971-1,Extracted,"A 68-yr-old female patient with body weight of 45 kg, having type-2 diabetes mellitus, hypertension, post-lumbar spine fixation (L2-L4) was posted for right-sided total hip replacement. She underwent coronary artery bypass grafting 4 years ago for ischaemic heart disease. Blood investigation showed haemoglobin 9.2 gm/dl, normal blood count, renal function and serum electrolytes. Serum calcium was 8.3 mg/dl and serum albumin was 3.2 g/dl. Glycosylated haemoglobin was 6.0, revealing adequate blood glucose control. Electrocardiogram showed evidence of old inferior wall myocardial infarction. Echocardiography showed normal left ventricular function with mild hypertrophy. She was on tablet aspirin 75 mg once daily (OD) orally for antithrombotic prophylaxis.
In view of her cardiac history, adequate perioperative analgesia was needed along with general anaesthesia. Thus, right sided continuous erector spinae block along was planned in combination with general anaesthesia.
Preoperative antibiotic prophylaxis was administered with injection cefuroxime 1.5 g intravenous (IV). Under ultrasound guidance, a continuous erector spinae block was performed at L3 level. After explaining the procedure, consent was taken from the patient. She was placed in left lateral position for right sided block since we found it ergonomically easy to hold the ultrasound probe (high frequency linear probe) with left hand and place it transversely. An 18-guage tuohy needle was approached in-plane lateral to medial. When the needle initially touched the transverse process of L3 vertebrae, the needle was gently withdrawn and hydrodissection of the plane was achieved, lifting the erector spinae muscle. A 20-guage catheter was introduced through the needle and total length inserted was 3 cm more than the tip of needle. The catheter was secured properly for perioperative use. The patient was hydrated with 10 ml/kg of ringer lactate before induction of anaesthesia. Anaesthesia was induced with injection fentanyl 75 mcg iv and injection propofol 100 mg iv and laryngeal mask airway (LMA) size 3 was inserted. Anaesthesia was maintained with FiO20.5 (nitrous oxide and oxygen mixture) and sevoflurane. A bolus dose of 20 ml of 0.25% bupivacaine was given through the catheter placed in erector spinae plane. The procedure was uneventful with no haemodynamic disturbances and minimal blood loss. After surgery, inhalational anaesthetics were stopped, and LMA was removed. Patient had an uneventful recovery. Post-operatively, the patient was comfortable with infusion of 0.25% bupivacaine at 6 ml/h as continuous erector spinae block. She did not require any rescue analgesics. She was discharged on the fifth post-operative day after removing the catheter.","Using the Calcium Correction for Hypoalbuminemia formula, what is the patient's corrected calcium in mg/dL? Your may set your normal albumin concentration to be 4 g/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Albumin': [3.2, 'g/dL'], 'Calcium': [8.3, 'mg/dL']}",8.94,8.493,9.387,"To compute the patient's correct calcium level in mg/dL, the formula is  (0.8 * (Normal Albumin (in g/dL) - Patient's Albumin (in g/dL))) + Serum Calcium (in mg/dL).
The patient's normal albumin level is 4.0 g/dL.
The concentration of Albmumin is 3.2 g/dL. 
The concentration of Calcium is 8.3 mg/dL. 
Plugging these values into the formula, we get (0.8 * (4.0 g/dL - 3.2 g/dL)) + 8.3 mg/dL = 8.94 mg/dL.
The patient's corrected calcium concentration 8.94 mg/dL."
108,7,Calcium Correction for Hypoalbuminemia,lab test,decimal,pmc-8342167-1,Extracted,"A 26-year-old African American female with a medical history of SLE, ESRD due to LN, remote history of Steven–Johnson Syndrome due to sulfa allergy, and resistant hypertension presented to the emergency department with painful, peeling, blistering, rash and fever. She reported that the rash developed over a period of 3 months with an intermittent response to prednisone therapy. Three weeks prior to presentation, the rash became progressively worse. She developed fevers came on one week prior to presentation. The rash started on her arms and progressively spread. She admitted associated shortness of breath accompanied by a productive cough with green, bloody sputum, as well as nausea and vomiting. Patient reported compliance with her home dose of prednisone but may have not taken her mycophenolate mofetil regularly. She missed two sequential hemodialysis sessions due to pain with walking from the blistering rash on her soles of the feet.
Her physical exam was significant for fever of 100.6°F and tachycardia with heart rate of 130 beats per minute. Skin exam was evident for brown plaques on the forehead and bilateral cheeks with sparing of the nasolabial folds, with erosions and hemorrhagic crust involving the philtrum, ears, forehead, nose, chin, and lips. There were dark brown plaques with few erosions and atrophic scars on bilateral forearms and lower legs with deep red to violaceous painful targetoid lesions on the palms and plantar surfaces (Figures and ). The skin over the trunk had pink eroded macules, and there were pink patches on the back within a background of dusky necrotic plaques. There were multiple full-thickness epidermal necroses with large areas of bleeding with the denuded skin on the arms and chest in the sun exposed distribution (). Oral mucosae were negative for any oral lesions.
Patient was found to be pancytopenic with white blood cell count (WBC) 2.03 (Ref: 3.4–10.8 × 103/UL), absolute neutrophil count (ANC) of 1.25 (Ref: 1.4–7.0 × 103/UL), hemoglobin (Hb) 8.8 g/dL (Ref: 11.1–15.9 g/dL), hematocrit (Hct) 28.9% (Ref: 34–46%), platelet 69 (150–450 × 103/UL), sodium 138 mmol/L, potassium 3.9 mmol/L, chloride 98 mmol/L, CO2 21 mmol/L, BUN 41 mg/dL (Ref: 6–20 mg/dL), Cr 5.49 mg/dL (Ref: 0.57–1.0 mg/dL), calcium 7.2 mg/dL (8.7–10.2 mg/dL), albumin 3.2 g/dL, phosphorous 5.0 mg/dL (Ref: 1.2–2.2 mg/dL), AST 286 IU/L (Ref 0–40 IU/L), ALT 31 IU/L (0–32 IU/L), total bilirubin 0.5 mg/dL, alkaline phosphatase 136 IU/L, CK 91 U/L, serum lactate was 0.80 mmol/L, and ferritin was 5885 ng/mL (Ref: 15–50 ng/mL). Electrocardiogram was consistent with sinus tachycardia. Chest X-ray did not show any lung infiltrates or effusions. Ultrasound of the abdomen did not show an acute abdominal process, and the liver demonstrated normal echogenicity, echotexture, and size; the spleen was not enlarged. Sputum gram stain and cultures were unremarkable. Blood cultures were negative for bacteria and yeast. Patient was anuric due to chronic dialysis. Evaluation of lupus activity showed double-stranded DNA (dsDNA) antibody 42 IU/mL (Ref: 0–9 IU/L). Complement 3 (C3) was 43 mg/dL (Ref: 90–180 mg/dL) and complement 4 (C4) was 9 mg/dL (Ref: 10–40 mg/dL). Rheumatoid factor was negative. Sjogren's anti-SSA was >8.0 AI (Ref: 0–0.9 AI) and Sjogren's anti-SSB was <0.2 AI (Ref: 0–0.9 AI). HIV screen was negative, and viral hepatitis panels for hepatitis A, B, and C were negative. Skin biopsies showed focal interface changes, and periodic acid Schiff (PAS) stain was negative for fungal microorganisms. Gram stain highlighted surface cocci bacteria. VZV and herpes I/II immunostains were negative. The direct immunofluorescence revealed that finely granular deposition of C3, IgM, and fibrinogen is consistent with lupus.
Given her presentation of a fever, shortness of breath, and productive cough, there was a concern for postinfectious erythema multiforme. The nucleic acid amplification tests for multiple respiratory pathogens such as Mycoplasma, influenza A, influenza H1, influenza H3, influenza A virus H1 2009, influenza B, respiratory syncytial virus, parainfluenza virus type 1, 2, 3, 4, human metapneumovirus, rhinovirus/enterovirus, adenovirus, Chlamydia pneumoniae, and Mycoplasma pneumoniae were negative. Blood cultures did not grow any bacteria or fungal organisms. Skin wound cultures were also negative for any organisms except for skin flora. Historically, there were no preceding infections reported. Our presumptive primary diagnosis was acute on chronic cutaneous lupus with epidermal necrolysis due to noncompliance with medications; differentials included Rowell syndrome, bullous lupus, Steven–Johnsons syndrome, and toxic epidermal necrolysis (TEN). Hemophagocytic lymphohistiocytosis/mast cell activation syndrome (HLH/MAS) was also a concern given pancytopenia, fevers, elevated transaminases, and elevated ferritin. However, after further evaluation by hematology, HLH/MAS was less likely given halving of ferritin after first dose of intravenous steroids, lack of hepatosplenomegaly, lack of elevation in bilirubin and triglycerides, patient did not have persistent fevers, and soluble IL-2 receptor was 2021 pg/mL (Ref: 175.3–858.2 pg/mL), needed to be greater than 2400 pg/mL (greater than 2 standard deviations of reference range) to meet criteria, and clinical picture was also not as critical as usually seen. The clinical picture of atypical EM-like lesions, presence of chilblains, speckled ANA pattern, elevated anti-Ro/SSA, and absence of infectious or pharmacologic triggers in a patient with SLE confirmed our suspicion for Rowell syndrome.
Due to the extensive skin surface area involvement, the patient was treated with vancomycin intravenously for primary and secondary skin infection. Gram-negative coverage was held due to severe allergy to penicillin and cephalosporin antibiotics. The pancytopenia was suspected due to an acute flare of systemic lupus erythematosus, and the patient was initially started on methylprednisolone 1.5 mg/kg intravenously daily. Given more than 60% of body surface area (BSA) involvement, the patient was transferred to the burn unit for extensive debridement and multifaceted wound care. Mycophenolate mofetil was held given the elevated transaminases. Pulse doses of intravenous methylprednisolone were escalated to 1000 mg intravenous daily for three days given the concern for acute cutaneous lupus erythematosus with epidermal necrosis and concomitant MAS. After normalization of transaminases, negative testing for latent tuberculosis and hepatitis B and C, and negative blood cultures, the patient was given rituximab 375 mg/m2 intravenously at day 0 and day 15 with excellent maintenance of remission of skin disease and cytopenias. This dose was chosen by the treating provider, given patient being dialysis dependent, thus more immunosuppressed state at baseline and recent elevation in transaminases.
It was reassuring that early suspicion for MAS appeared steroid-responsive to pulse intravenous methylprednisolone. The soluble IL-2 receptor alpha measurement was not elevated, and serum ferritin halved after the first dose of pulse steroids. Despite the improvements in serum and systemic symptoms, the skin manifestations were slow to respond. During 2-week and 12-week follow-up of the patient, there has been maintenance of clear skin without any active cutaneous lupus manifestations. Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) was 0 at 12-week follow-up.","Using the Calcium Correction for Hypoalbuminemia formula, what is the patient's corrected calcium in mg/dL? Your may set your normal albumin concentration to be 4 g/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Calcium': [7.2, 'mg/dL'], 'Albumin': [3.2, 'g/dL']}",7.84,7.448,8.232,"To compute the patient's correct calcium level in mg/dL, the formula is  (0.8 * (Normal Albumin (in g/dL) - Patient's Albumin (in g/dL))) + Serum Calcium (in mg/dL).
The patient's normal albumin level is 4.0 g/dL.
The concentration of Albmumin is 3.2 g/dL. 
The concentration of Calcium is 7.2 mg/dL. 
Plugging these values into the formula, we get (0.8 * (4.0 g/dL - 3.2 g/dL)) + 7.2 mg/dL = 7.84 mg/dL.
The patient's corrected calcium concentration 7.84 mg/dL."
109,7,Calcium Correction for Hypoalbuminemia,lab test,decimal,pmc-6536837-1,Extracted,"A 66-year-old Taiwanese man was admitted to our medical oncology ward with the chief complaint of progressive exertional dyspnea for twenty days in December 2017. He had been diagnosed with bony metastasis from prostate cancer for 8 years and failed various kinds of treatment including luteinizing hormone-releasing hormone agonist (leuprorelin), androgen receptor antagonist (bicalutamide), denosumab and docetaxel. He was brought to our hospital after starting on dexamethasone and abiraterone acetate without improvement of serum prostate specific antigen level for two months in a medical center nearby.
There was no obvious bone pain, chills or fever. He denied other major systemic disease except essential hypertension under regular medical control. His chest X-ray film disclosed right side costophrenic angle blunting and a little fluid accumulation in the minor fissure without extensive pulmonary edema. Blood chemistry showed that levels of alanine aminotransferase, gamma glutamyltransferase, blood urea nitrogen and creatinine were within normal ranges. Abnormal results included alkaline phosphatase of 123 iu/L (normal 32 to 91), albumin of 3.2 g/dL (normal 3.5 to 4.8) and calcium of 7.7 mg/dL (normal 8.6 to 10). Serum prostate specific antigen level was 905 ng/mL (normal 0 to 4). Prolonged activated partial thromboplastin time (41.2 sec, control 31.5) and prothrombin time (international normalized ratio 1.23) were noted. Although plasma fibrinogen level was still normal (335 mg/dL, normal 200 to 400), the concentration of D-dimer was extremely high (over 20,000 ng/mL, normal less than 500). Blood routine test revealed hemoglobin of 6.4 g/dL, mean corpuscular volume of 89.4 fl, platelet count of 1,1000/μL, and white cell count of 7,200/μL with extraordinary abnormal differential counts: segments 19%, lymphocytes 35%, monocytes 1%, eosinophils 3%, bands 19%, metamyelocytes 11%, myelocytes 6%, promyelocytes 4%, blasts 1%, and atypical lymphocytes 1%. There were 48 nucleated red cells per 100 white cells. A diagnosis of leukoerythroblastosis was thus established based on morphological evidence ().
Bone marrow aspiration from right side posterior superior iliac crest gave a smear of full-blown metastatic carcinoma with many clustered, dispersed or microacinar groups of epithelioid malignant cells. Bone marrow biopsy from the same area showed a picture of metastatic adenocarcinoma composed of highly pleomorphic tumor cells with hyperchromatic nuclei, prominent nucleoli, and vacuolated cytoplasm, infiltrating diffusely in the marrow with a sheeted pattern. The carcinoma cells were positive for prostate specific membrane antigen, negative for cytokeratin 7 and cytokeratin 20 on immunohistochemical stains using Bond Polymer Refine Detection Kit (Leica Biosystem, Milton Keynes, UK) performed on automated Leica Bond MAX stainer (Leica Biosystem, Melbourne, Australia) with three primary antibodies (Leica Biosystem) ().
There were only a few small metastatic lesions over skull, manubrium, and ribs in bone scan performed two months earlier but diffuse bone marrow involvement and destruction could be seen in magnetic resonance imaging of spine done one month prior to the present hospitalization (). The patient decided to receive palliative treatment upon knowing his incurable disease status and died of multiple organ failure resulting from fulminant disseminated intravascular coagulation two weeks later.","Using the Calcium Correction for Hypoalbuminemia formula, what is the patient's corrected calcium in mg/dL? Your may set your normal albumin concentration to be 4 g/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Albumin': [3.2, 'g/dL'], 'Calcium': [7.7, 'mg/dL']}",8.34,7.923,8.757,"To compute the patient's correct calcium level in mg/dL, the formula is  (0.8 * (Normal Albumin (in g/dL) - Patient's Albumin (in g/dL))) + Serum Calcium (in mg/dL).
The patient's normal albumin level is 4.0 g/dL.
The concentration of Albmumin is 3.2 g/dL. 
The concentration of Calcium is 7.7 mg/dL. 
Plugging these values into the formula, we get (0.8 * (4.0 g/dL - 3.2 g/dL)) + 7.7 mg/dL = 8.34 mg/dL.
The patient's corrected calcium concentration 8.34 mg/dL."
110,7,Calcium Correction for Hypoalbuminemia,lab test,decimal,pmc-7279913-1,Extracted,"A 43-year-old man with a medical history of hypertension and diabetes mellitus presented to the emergency department with complaints of shortness of breath and acute right leg pain. One week previously he had started to develop fever and exertional dyspnoea. On the day of presentation, he woke up with acute pain in his right leg. Vital signs on presentation were: heart rate 130/min, blood pressure 140/100 mmHg, oxygen saturation 80% on room air, and temperature 37.1°C. The patient had bilateral crackles on lung auscultation and an absent right dorsalis pedis pulse. His right foot was cold to the touch and mottled in appearance. Electrocardiography showed sinus tachycardia 130/min, left axis deviation, left ventricular hypertrophy with peaked T waves, and QTc 381 msec.
On initial laboratory evaluation, the following values were noted: haemoglobin 17.7 g/dl (reference: 12–16 g/dl), haematocrit 59% (reference: 36–46%), white blood cells 16 K/mm3 (reference: 4.5–11 K/mm3), platelets 484 K/mm3 (reference: 140–440 K/mm3), potassium 5.8 mEq/l (reference: 3.5–5 mEq/l), blood glucose 948 mg/dl (reference: 70–105 mg/dl), anion gap 27 mEq/l (reference: 8–16 mEq/l), small acetone, creatinine 2.74 mg/dl (reference: 0.6–1.30 mg/dl), blood urea nitrogen 88 mg/dl (reference: 7–23 mg/dl), lactic acid 8.7 mmol/l (reference: 0.5–2.2 mmol/l), troponin 0.497 ng/ml (reference: <0.03 ng/ml), D-dimer >20 (reference: <0.5), prothrombin time 16.2 sec (reference: 12.2–14.9 sec), INR 1.3 (reference: <1), partial thromboplastin time 51 sec (reference: 21.3–35.1 sec), fibrinogen 853 mg/dl (reference: 183–503 mg/dl), LDH 718 U/l (reference: 140–271 U/l), CRP 289.7 mg/l (reference: <10 mg/l), ferritin 1739 ng/ml (reference: 12–300 ng/ml), procalcitonin 67 ng/ml (reference: <2 ng/ml), interleukin-6 224 pg/ml (reference: 0–15.5 pg/ml), aspartate transaminase 39 U/l (reference: 13–39 U/l), calcium 8.6 mg/dl (reference: 8.6–10.3 mg/dl), and albumin 3.3 g/dl (reference: 3.5–5.0 g/dl).
The patient was intubated in the emergency department. Arterial blood gas analysis after intubation showed metabolic and respiratory acidosis with pH 6.96. A chest x-ray showed bilateral hazy infiltrates. Computed tomography angiography of the chest, abdomen and aorta with iliofemoral run-off showed thrombus within the proximal right superficial femoral artery and absent opacification of the right popliteal artery, posterior tibial artery, peroneal artery and anterior tibial arteries compatible with occlusion (). It also showed extensive peripheral ground-glass infiltration of both lungs. COVID-19 was diagnosed on the basis of RT-PCR testing. The patient was placed on airborne precautions and was started on ceftriaxone, azithromycin, hydroxychloroquine and therapeutic anticoagulation with heparin. The plan was to perform percutaneous thrombectomy after correction of metabolic derangements. Diabetic ketoacidosis was managed with intravenous fluids and an insulin drip. The patient was also started on haemodialysis. Unfortunately, 2 days after admission the patient had a cardiac arrest secondary to persistent hypoxia and died.","Using the Calcium Correction for Hypoalbuminemia formula, what is the patient's corrected calcium in mg/dL? Your may set your normal albumin concentration to be 4 g/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Albumin': [3.3, 'g/dL'], 'Calcium': [8.6, 'mg/dL']}",9.16,8.702,9.618,"To compute the patient's correct calcium level in mg/dL, the formula is  (0.8 * (Normal Albumin (in g/dL) - Patient's Albumin (in g/dL))) + Serum Calcium (in mg/dL).
The patient's normal albumin level is 4.0 g/dL.
The concentration of Albmumin is 3.3 g/dL. 
The concentration of Calcium is 8.6 mg/dL. 
Plugging these values into the formula, we get (0.8 * (4.0 g/dL - 3.3 g/dL)) + 8.6 mg/dL = 9.16 mg/dL.
The patient's corrected calcium concentration 9.16 mg/dL."
111,7,Calcium Correction for Hypoalbuminemia,risk,decimal,pmc-8293858-1,Extracted,"Our patient was a 48-year-old female with a past medical history of hyperlipidemia, hypertension, and gastroesophageal reflux disease (GERD) who presented to the hospital with a two-week history of dry cough, fever, red conjunctiva, chills, malaise, myalgias, and generalized weakness. She reported a weight loss of 15 pounds in the past year. She had been a smoker but had quit five years prior to the presentation. Prior to this hospital visit, she had consulted an outpatient clinic with complaints of fever, chills, and cough. She had received a flu vaccine a month prior. She had been thought to have a viral respiratory infection as an outpatient. Ibuprofen, and later azithromycin, had been prescribed, which had not alleviated her initial symptoms before the current presentation.
On physical exam, she had a temperature of 39.3 °C in the emergency department. She was tachycardic at 130 beats per minute and tachypneic with a respiratory rate of 24 breaths per minute. Her blood pressure was 149/74 mmHg. She had bilateral conjunctival injection, but her eyelids were grossly unremarkable. There was left axillary lymphadenopathy. A physical breast exam was normal with no palpable masses. There was no other palpable adenopathy, skin rashes, hepatomegaly, splenomegaly, clubbing, or edema. The respiratory and cardiovascular exams were otherwise unremarkable. Her ECG showed sinus tachycardia at 106 beats per minute but was otherwise unremarkable.
Relevant laboratory workup included a leukocytosis of 16.7 Thou/uL (normal range: 3.8-10.2) with a neutrophilic predominance of 82.9%. She had chronic anemia with a hemoglobin (Hb) level of 8.9 g/dl (11.9-15.1) and a mean corpuscular volume (MCV) of 76 fL (78.2-98.4). Her ferritin was more than 7,500 ng/ml (11-307), with a total iron-binding capacity of 204 (250-450), and a low iron level of 37 ug/dl (50-212). Her angiotensin-converting enzyme (ACE) level was 97 U/l (8-52). Her C-reactive protein (CRP) was 19.05 mg/dl (0.02-1.00), D-dimer was 13.46 ugFEU/ml (<0.50), aspartate aminotransferase (AST) was 54 U/L (13-39), and alanine aminotransferase (ALT) was 66 U/L (7-52); she had calcium of 9.0 mg/dl (8.6-10.2), albumin of 3.0 g/dl (3.5-5.0), serum 25-hydroxy vitamin D level of 22.4 ng/ml (30-100), creatinine of 1.11 mg/dl (0.49-1.01), and lactate dehydrogenase (LDH) of 344 U/L (140-271).
The patient had not undergone a prior mammogram. A CT angiography (CTA) was performed, which ruled out any pulmonary embolus. There was no evidence of a pulmonary embolus, or pulmonary nodules, or infiltrates. However, the CTA revealed right hilar lymphadenopathy of 1.3 cm in size and subcarinal lymphadenopathy of 1.1 cm (Figures , ).
A CT of the abdomen revealed a cystic mass of the left retroperitoneum measuring 14 x 11 x 6 cm. The official radiology report suggested that it was of a benign etiology, which could include cystic lymphangioma, mesenteric cyst, or duplication cyst. A cystic neoplasm was considered unlikely in the radiology report. The patient was placed on broad-spectrum antibiotics, including vancomycin, cefepime, metronidazole, and azithromycin as well as intravenous fluids to treat a possible unknown infective source while awaiting cultures and further investigation. It was initially thought that a respiratory or abdominal source was the possible infective foci, which guided the selection of antibiotics.
The infectious disease team suspected an intrabdominal or lung infective etiology. An initial differential by the infectious diseases specialists, aside from infection, also included lymphoma and autoimmune processes such as sarcoidosis. The pulmonology team later advised that there was no evidence of pneumonia or tracheobronchitis. The hematology team emphasized the need to rule out lymphoma. Blood cultures, sputum cultures, and urine cultures were all negative. Antibiotics were initially tapered to ceftriaxone and metronidazole and then completely discontinued on day six. Drainage of the abdominal cyst revealed 250 mL of pale straw-colored serous fluid. Fluid chemistries were negative for an infectious or malignant etiology.
The patient underwent extensive investigation. Serum thyroid-stimulating hormone (TSH) levels, serum creatine kinase levels, serum HIV tests, rapid plasma reagin (RPR) test, an acute hepatitis panel, three acid-fast sputum stains, QuantiFERON®-TB Gold test, anti-SS-A antibody levels, anti-SS-B antibody levels, and urinalysis were all normal. She did, however, test positive for an antinuclear antibody (ANA) speckled+ pattern. The ANA titer was 1:320. The double-stranded DNA antibody levels were within the normal range at 49 Iu/ml (<200 Iu/ml). A bone marrow biopsy of the iliac crest showed no evidence of malignancy or acid-fast bacilli.
Surgery was consulted for an excisional lymph node biopsy of the left axillary lymph node. The sample was a solid tan nodular-appearing tissue measuring 2.0 x 1.5 x 1.0 cm. Biopsy revealed numerous non-caseating epithelioid granulomas present in the lymphoid tissue. Stains were negative for acid-fast bacilli and fungus. The biopsy results were consistent with sarcoidosis. Flow cytometry later showed no evidence of B or T cell lymphoma.
A tentative diagnosis of sarcoidosis was made. The granulomatous disease is seen only in sarcoidosis, tuberculosis, or fungal infections. The non-caseating granulomatous disease in the lymph nodes pointed most closely to sarcoidosis. The pulmonologist considered this to be a case of extrapulmonary sarcoidosis because only hilar nodes were involved without any lung parenchymal involvement. It was thought conceivable that the ANA elevation may have been related to sarcoidosis, although we agreed to continue to monitor the patient for other collagen vascular diseases.
During the hospitalization, the patient had daily high-grade fevers. The fevers were intermittent, daily, variable, and went from 38.4 to a high of 39.4 °C. The patient was also seen by ophthalmology, and she was diagnosed with blepharitis. No uveitis or episcleritis was noted. She was treated with eye drops containing steroids, antimicrobials, and artificial tears. She was started on prednisone 40 mg PO daily with outpatient follow-up. Her fever and ocular symptoms resolved. She was seen in an outpatient clinic prior to the onset of the coronavirus disease 2019 (COVID-19) pandemic and then moved to a different location.","Using the Calcium Correction for Hypoalbuminemia formula, what is the patient's corrected calcium in mg/dL? Your may set your normal albumin concentration to be 4 g/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Albumin': [3.0, 'g/dL'], 'Calcium': [9.0, 'mg/dL']}",9.8,9.8,9.8,"To compute the patient's correct calcium level in mg/dL, the formula is  (0.8 * (Normal Albumin (in g/dL) - Patient's Albumin (in g/dL))) + Serum Calcium (in mg/dL).
The patient's normal albumin level is 4.0 g/dL.
The concentration of Albmumin is 3.0 g/dL. 
The concentration of Calcium is 9.0 mg/dL. 
Plugging these values into the formula, we get (0.8 * (4.0 g/dL - 3.0 g/dL)) + 9.0 mg/dL = 9.8 mg/dL.
The patient's corrected calcium concentration 9.8 mg/dL."
112,7,Calcium Correction for Hypoalbuminemia,lab test,decimal,pmc-6464285-1,Extracted,"A 74-year-old, avid female gardener and active smoker with a past medical history notable for chronic obstructive pulmonary disease (COPD) and hypertension presented to the hospital with one week of progressively worsening New York Heart Association (NYHA) class III dyspnea and fatigue. She endorsed associated cough productive of yellowish mucoid sputum. She denied chest pain/discomfort, palpitations, pre-syncope, syncope, orthopnea, or paroxysmal nocturnal dyspnea (PND). There was no history of fever, arthralgia, myalgia, or rashes.
In the emergency department, the patient was afebrile, blood pressure was 85/49 mm Hg, heart rate was 150 per minute, and respiratory rate was 22 per minute, with oxygen saturation of 94% on six liters of oxygen via a nasal cannula. The patient appeared lethargic and was using accessory muscles for respiration. General examination showed pallor. The oral mucosa was dry, with a thickly coated tongue. The neck veins were flat. Heart examination revealed a fast, irregular heart rate, variable first heart sound, and normal second heart sound without any murmurs or gallops. Lung examination revealed bilateral mid to late inspiratory crackles. The abdomen was soft, distended, non-tender, with normal bowel sounds. Extremities were noted to be cold, with 1+ pitting edema and normal capillary refill time.
Routine laboratory investigations revealed a white blood cell (WBC) count of 7.5 (4.0-10.5 k/uL), hemoglobin of 9.9 (12.5-16 g/dL), and hematocrit of 32.3 (37-47%). Her baseline hemoglobin concentration was around 15 g/dL. Mean corpuscular volume (MCV) was 101.9 (78-100 fL) with elevated mean cell hemoglobin (MCH) of 34 (25-33 pg) and normal mean cell hemoglobin concentration (MCHC) of 33.4 (32-36 g/dL). Platelet count was 34 (150-450 K/uL), with elevated mean platelet volume (MPV) of 12.4 (7.4-11.4 fL). Peripheral blood smear showed intracytoplasmic parasites suspicious for Babesia along with reduced platelets (Figure ). The parasitic level was found to be at 9.04%. Lactate dehydrogenase (LDH) was 1544 U/L (125-220 U/L), haptoglobin was <6 mg/dL (27-139 mg/dL), total bilirubin was 5.4 mg/dL (0.3-1.0 mg/dL), with a direct fraction of 3.5 mg/dL (0.0-0.2 mg/dL). Aspartate aminotransferase (AST) was 202 U/L (5-40 U/L), alanine aminotransferase (ALT) was 90 U/L (7-52 U/L), with albumin of 2.3 g/dL (3.5-5.0 g/dL). Blood urea nitrogen (BUN) was 51 mg/dL (7-17 mg/dL) with a normal creatinine of 0.8 mg/dL, sodium 129 (135-145 mmol/L), potassium 4 (3.5-5.1 mmol/L), chloride 103 (98-107 mmol/L), serum bicarbonate 19 (24-32 mmol/L), and calcium 7 (8.4-102 mg/dL).
The chest X-ray was remarkable for cardiomegaly with a small right pleural effusion and small airspace opacity within the right lower lobe concerning for consolidation or segmental atelectasis. Given her presentation, she was started on intravenous fluids along with empiric antibiotic coverage for community-acquired pneumonia with ceftriaxone and azithromycin. As the peripheral smear was remarkable for Babesia, she was started on atovaquone and doxycycline for a possible co-infection with Lyme. Blood titers for Anaplasma and Lyme were sent. Positive pressure ventilation was started to help with respiratory distress. She received intravenous fluids; however, she continued to remain hypotensive and required norepinephrine for hemodynamic support. Given the severity of her disease and parasitic load, a decision was made to do erythrocytapheresis.
Following erythrocytapheresis, the parasitic load decreased to 5.54%. The patient remained in shock and clindamycin was added to the regimen. Her renal function worsened, which was believed to be secondary to pigment-induced nephropathy from hemolysis. Due to the inadequate response and development of acute kidney injury, repeat erythrocytapheresis was performed, resulting in a reduction in parasite load to 1.75%. At this point, Lyme immunoglobulin M (IgM) immunoblot was found to be positive, with negative immunoglobulin G (IgG). Anaplasma titers also showed recent/current infection, with IgG >1:1024 (reference <1:64) and IgM 1:80 (reference <1:20). Atovaquone and azithromycin were discontinued and quinine was added. Her hemodynamic status improved and she was titrated off of vasopressor support along with an improvement in respiratory status. Her complete blood count and renal and hepatic function normalized after 14 days of antimicrobial therapy.","Using the Calcium Correction for Hypoalbuminemia formula, what is the patient's corrected calcium in mg/dL? Your may set your normal albumin concentration to be 4 g/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Albumin': [2.3, 'g/dL'], 'Calcium': [7.0, 'mg/dL']}",8.36,7.942,8.778,"To compute the patient's correct calcium level in mg/dL, the formula is  (0.8 * (Normal Albumin (in g/dL) - Patient's Albumin (in g/dL))) + Serum Calcium (in mg/dL).
The patient's normal albumin level is 4.0 g/dL.
The concentration of Albmumin is 2.3 g/dL. 
The concentration of Calcium is 7.0 mg/dL. 
Plugging these values into the formula, we get (0.8 * (4.0 g/dL - 2.3 g/dL)) + 7.0 mg/dL = 8.36 mg/dL.
The patient's corrected calcium concentration 8.36 mg/dL."
113,7,Calcium Correction for Hypoalbuminemia,lab test,decimal,pmc-3295540-1,Extracted,"A 58-year-old Asian female with a five-year history of depression presented to the emergency room with progressive generalized weakness, nausea, vomiting, and weight loss over the past three months. She stated her symptoms recently started worsening over the past two weeks. She complained of increased thirst, generalized bone pain, and weight loss of greater than 20 pounds in the past one month. Despite being on antidepressants, the patient presented with symptoms of depression. She denied any history of hypercalcemia, hyperparathyroidism, or cancer. She denied any history of smoking, alcohol, or use of illicit drugs. Family history was unremarkable.
On physical examination, she was afebrile, blood pressure 110/73, and pulse 82 beats per minute. Tongue was dry on examination. Neck revealed a 4 × 4 cm fluctuant smooth contour nodule that was nontender on palpation and moved with deglutition. The patient was subsequently worked up and found to have hypercalcemia, (serum calcium level, 23.3 mg/dL) (normal range 8.6–10.6 mg/dL), (phosphorous, 3.1 mg/dL) (normal range 2.4–4.4 mg/dL), albumin 2.8 g/dL (normal range 3.5–5.0 g/dL), BUN 52 mg/dL (normal range 7–21 mg/dL), creatinine 3.8 mg/dL (normal range 0.7–1.5), blood glucose 91 mg/dL (normal range 65–105 mg/dL) Blood work for ANA, Rheumatoid factor, ACTH, cortisol, liver functions were unremarkable.
Intravenous hydration and loop diuretics were administered to promote kalciuresis. After the patient was resuscitated, further evaluation revealed plasma level of intact parathyroid hormone (PTH) to be 1364 pg/mL (normal 10–65 pg/mL). Thyroid ultrasonography showed 3.5 × 4.5 × 3.2 cm complex cystic and solid lesion in the right thyroid gland. A parathyroid scan with Technitium-99-sestamibi scintigraphy revealed an “avid lesion with retained activity in the periphery” (). Fine needle aspiration of the cold mass revealed hemorrhagic fluid without evidence of malignant cells in the tissue. The tissue stained for PTH was negative for thyroid transcription factor-1 (TTF1). A CT scan of head and abdomen was unremarkable. Preoperatively, dual energy X-ray absorptiometry bone mineral density study (DEXA) showed osteopenia of the lumbar spine, left hip, and left femoral neck.
The patient underwent surgical exploration for the cyst twice by two different surgeons on two separate occasions. The first surgery was stopped half way with the postoperative diagnosis of parathyroid carcinoma that was not operable due to 2-3 cm mass underneath the strap muscles that was adherent to the right side of the trachea and dense fibrotic tissue (initially suspected to be a tumor) along the right side of the neck. The patient's condition was further complicated by paralysis of the right vocal cord from the first surgical exploration.
In the second surgical exploration, the following steps were taken.
The previous incision was reopened and the flap was raised in the superior direction with use of cautery. Sternohyoid muscles were ligated. There was dense inflammatory tissue involving the sternothyroid muscle, carotid, and jugular veins. The sternothyroid muscle was firmly adherent to the thyroid. Dissection began with incision of the median raphe and the isthmus muscle and proceeded in the medial to lateral direction. The thyroid was then elevated at the level of trachea medially and the right recurrent laryngeal nerve was identified inferiorly.
The patient was preoperatively documented to have paralysis of the right vocal cord. However, the right recurrent laryngeal nerve was later found to be intact after stimulation with a threshold of 1.7 mA. Following stimulation, the intact recurrent laryngeal nerve was dissected into the superior mediastinum and superiorly in its entry at the cricothyroid membrane. There was dense inflammatory tissue adhering to both the strap muscles and the right lobe of thyroid. Suspecting a tumor, an incision was made along the borders of the mass. In the attempt to resect the tumorlike mass, the right lobe of thyroid adhering to the dense mass was resected as well. The frozen section of the dense mass revealed only collagen and fibrous tissue. The sternothyroid muscle, the carotid artery, and the jugular vein were then freed from the dense inflammatory tissue in an en bloc dissection. Further into the dissection, a cystic mass with a glistening capsule was then found in the superior mediastinum near adjacent parathyroid tissue. The cyst was removed from the superior mediastinum and the specimen was sent for frozen section. Microcopic analysis of the cystic mass confirmed the diagnosis of an enlarged hypercellular parathyroid (330 mg). In addition to the hypercellular parathyroid tissue, the specimen contained hyalinized fibrous connective tissue scar, right thyroid lobe, and the cystic wall. Within the fibrous tissue there was hemorrhage and residual hypercellular parathyroid tissue with osteoid focus ().
After surgery, the patient had variable parathyroid hormone levels between 110 and 292 pg/mL (normal range 10–65 pg/mL) along with hypocalcaemia. The patient underwent MIB1 scintigraphy for detection of aberrant parathyroid tissue causing elevated parathyroid hormone levels. Postoperative MIBI scintigraphy study was negative for parathyroid tissue.
The patient was prescribed calcium 1 gram per day. Her symptoms of polyuria, polydipsia, and depression subsequently subsided after surgery. The patient restored her original voice with resolution of voice hoarseness. Renal functions improved (creatinine 1.1 mg/dL) (normal range 0.7–1.5 mg/dL). Repeat neck ultrasonography and 99 mTc methoxyisobutylisonitrile (MIBI) scintigraphy after six months did not reveal remaining active parathyroid tissue. However, she developed low T4 (0.5 ng/dL) and elevated TSH (14.2 uIU/mL) because of hemithyroidectomy. She was then maintained on Synthroid 50 mcg orally every day. After a 3-year follow-up, the patient remained asymptomatic.","Using the Calcium Correction for Hypoalbuminemia formula, what is the patient's corrected calcium in mg/dL? Your may set your normal albumin concentration to be 4 g/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Calcium': [23.3, 'mg/dL'], 'Albumin': [2.8, 'g/dL']}",24.26,23.047,25.473,"To compute the patient's correct calcium level in mg/dL, the formula is  (0.8 * (Normal Albumin (in g/dL) - Patient's Albumin (in g/dL))) + Serum Calcium (in mg/dL).
The patient's normal albumin level is 4.0 g/dL.
The concentration of Albmumin is 2.8 g/dL. 
The concentration of Calcium is 23.3 mg/dL. 
Plugging these values into the formula, we get (0.8 * (4.0 g/dL - 2.8 g/dL)) + 23.3 mg/dL = 24.26 mg/dL.
The patient's corrected calcium concentration 24.26 mg/dL."
114,7,Calcium Correction for Hypoalbuminemia,lab test,decimal,pmc-5051225-2,Extracted,"A 10-year-old Sudanese boy presented with frequent episodes of vomiting associated with epigastric pain and weight loss for 6 months. He had no respiratory, neurological, rheumatological, ophthalmologic, or dermatological symptoms. Physical examination showed a pale child with weight and height both below the 3rd percentile for age. Laboratory investigations were remarkable for anemia (hemoglobin 9.8 g/dL), ESR 114 mm/h, serum calcium 2.26 mmol/L, and low albumin level 28 g/L. Endoscopy revealed an erosive, friable, and nodular gastric mucosa over the entire stomach. Histopathology of biopsies revealed chronic noncaseating granulomatous inflammation []. Special stains and cultures for acid-fast and fungal microorganisms showed negative results. Colonoscopy was normal including terminal ileum. CT scan of the chest and abdomen demonstrated multiple, small, centrolobularly distributed nodules within the acini of both lungs and enlarged mesenteric lymph nodes. Ophthalmological examination showed evidence of uveitis. ACE level was elevated at 135 U/L. Similar to Case 1, extensive investigations for infectious, immunologic, and inflammatory conditions associated with GIT granulomatous inflammation were negative.
The combination of tissue findings of granulomatous disease from upper GIT, elevated ACE, systemic involvement, and negative workup for infectious disease suggested systemic sarcoidosis with significant GI involvement. The patient received corticosteroids at 1 mg/kg/day and omeprazole, resulting in resolution of GI symptoms and normalization of activity markers and ACE level. Tapering of corticosteroids over 3 months led to relapse of the disease. Again, remission was induced by a course of steroids supplemented by mesalamine (Pentasa 50 mg/kg/day) and azathioprine (up to 2.5 mg/kg/day) to maintain remission. Throughout the 4-year follow up, the course of the disease was punctuated by several relapses on tapering of corticosteroids and later development of vitamin B12 deficiency anemia: hemoglobin 10.6 gm/dL, macrocytosis (MCV 102, normal 80–91 fL), hyperchromasia (MCH 34.5, normal 20–31 pg), low serum vitamin B12 119.2 pmol/L (normal 162–638 pmol/L). Red blood cell folate level was normal at 16.2 nmol/L (normal, 10.4–42.2 nmol/L). Antigastric parietal cell antibodies were negative. The patient received weekly injections of vitamin B12 ( 1 mg weekly) for 6 weeks that raised the level to 231.8 pmol/L with correction of anemia and normalization of his peripheral blood picture.
Considering the steroid dependency of the disease and the short stature of the patient, he was commenced on infliximab 5 mg/kg administered intravenously at 0, 2 and 6 weeks and then every 8 weeks. The patient reported a significant subjective general improvement as well as resolution of his GI symptoms. ESR and ACE concentration returned to normal. A repeat of endoscopy after the 6th dose of infliximab infusion demonstrated loss of gastric folds pattern and loss of normal vascular pattern; otherwise there were no more erosions or friability. Biopsies from the gastric mucosa showed a marked reduction of inflammation, atrophic gastric glands, and absence of granulomas. At 5 years posttreatment with infliximab, the patient remains in remission off corticosteroids.","Using the Calcium Correction for Hypoalbuminemia formula, what is the patient's corrected calcium in mg/dL? Your may set your normal albumin concentration to be 4 g/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Albumin': [28.0, 'g/L'], 'Calcium': [2.26, 'mmol/L']}",10.018,9.5171,10.5189,"To compute the patient's correct calcium level in mg/dL, the formula is  (0.8 * (Normal Albumin (in g/dL) - Patient's Albumin (in g/dL))) + Serum Calcium (in mg/dL).
The patient's normal albumin level is 4.0 g/dL.
The concentration of Albmumin is 28.0 g/L. We need to convert the concentration to g/dL. The mass units of the source and target are the same so no conversion is needed. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of g/dL. This will result to 28.0 g Albmumin/10.0 dL = 2.8 g Albmumin/dL. The concentration value of 28.0 g Albmumin/L converts to 2.8 g Albmumin/dL. 
The concentration of Calcium is 2.26 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of Calcium from mmol to mg. The mass of Calcium is 2.26 mmol. To convert 2.26 mmol of Calcium to mol, multiply by the conversion factor 0.001, giving us 2.26 mmol Calcium * 0.001 mol/mmol = 0.00226 mol Calcium. To convert from mol Calcium to grams, multiply by the molar mass 40.08 g/mol, which will give 0.00226 mol Calcium * 40.08 g/mol = 0.09058 g Calcium. To convert 0.09058 g of Calcium to mg, multiply by the conversion factor 1000.0, giving us 0.09058 g Calcium * 1000.0 mg/g = 90.58 mg Calcium. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 90.58 mg Calcium/10.0 dL = 9.058 mg Calcium/dL. The concentration value of 2.26 mmol Calcium/L converts to 9.058 mg Calcium/dL. 
Plugging these values into the formula, we get (0.8 * (4.0 g/dL - 2.8 g/dL)) + 9.058 mg/dL = 10.018 mg/dL.
The patient's corrected calcium concentration 10.018 mg/dL."
115,7,Calcium Correction for Hypoalbuminemia,lab test,decimal,pmc-4352736-1,Extracted,"A 65-year-old female patient presented to our emergency room with abdominal pain, nausea, vomiting, and pain radiating towards the back. The patient history included nothing specific other than diabetes mellitus (DM) for 20 years and cholecystectomy a year ago. She did not have a history of alcohol consumption and she was on subcutaneous insulin treatment twice a day. During the physical examination, the patient was observed to be in a confused state and her general state was poor; her blood pressure was 90/55 mmHg, heart rate was 132/min, body temperature was 38.3°C, and the respiratory rate was 28/min. Her abdomen was slightly distended and epigastric tenderness was detected. No rebound or guarding was observed. The laboratory parameters were as follows: Hb: 17.1 g/dL, Hct: 45.7%, WBC: 8.9 K/uL, PLT: 505 K/uL, sedimentation: 37/hour, CRP: 24 mg/dL, glucose: 255 mg/dL, urea: 28 mg/dL, creatinine: 1.6 mg/dL, AST: 57 U/L, ALT: 34 U/L, LDH: 1995 U/L, amylase: 212 U/L, lipase: 349 U/L, triglycerides: 2148 mg/dL, albumin: 2.3 g/dL, calcium: 6.5 mg/dL, and HbA1c: 9.6%. The blood gas analyses gave the following results: pH: 7.32 mm/Hg, pCO2: 44 mm/Hg, PO2: 72 mm/Hg, HCO3: 19.6 mmol/L, and lactate: 0.9 mmol/L. The other laboratory parameters were normal. The abdominal ultrasonography was interpreted in favour of AP. In the abdominopelvic contrast-enhanced computed tomography (CT), the gall bladder could not be observed (excised) and the pancreas was diffusely enlarged (), while widespread increases of density and fluid retention were observed in the peripancreatic bilateral anterior renal fascia, splenic hilum, mesenteric adipose tissue, and the pelvic region. There was 19 × 18 mm necrosis area in the head of pancreas. Filling defects (thromboses) were observed in the splenic vein at the level of the tail of the pancreas. The patient's CT image shows the AP and splenic vein thrombosis (). A central venous catheter was placed and the patient was prescribed blood glucose tests every six hours and insulin treatment for the regulation of her blood glucose levels. After the consultation with the infectious diseases department, the patient was started on 4 × 500 mg/day of imipenem. She was administered 4 × 5000 units of low molecular weight heparin through the subcutaneous route and infused intravenously 5 units of regular insulin along with each 1000 mL 5% dextrose fluid and lipid apheresis was performed once a day for three days. After the three times lipid apheresis, the triglyceride values declined to 829 mg/dL. In addition to the low molecular weight heparin, the patient was started on warfarin treatment and the dose was adjusted to keep the patient's INR value over 2. When the patient's general condition was observed to improve after the treatment, she was discharged with the recommendation of a low-fat diet and fenofibrate and warfarin treatment.","Using the Calcium Correction for Hypoalbuminemia formula, what is the patient's corrected calcium in mg/dL? Your may set your normal albumin concentration to be 4 g/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Albumin': [2.3, 'g/dL'], 'Calcium': [6.5, 'mg/dL']}",7.86,7.467,8.253,"To compute the patient's correct calcium level in mg/dL, the formula is  (0.8 * (Normal Albumin (in g/dL) - Patient's Albumin (in g/dL))) + Serum Calcium (in mg/dL).
The patient's normal albumin level is 4.0 g/dL.
The concentration of Albmumin is 2.3 g/dL. 
The concentration of Calcium is 6.5 mg/dL. 
Plugging these values into the formula, we get (0.8 * (4.0 g/dL - 2.3 g/dL)) + 6.5 mg/dL = 7.86 mg/dL.
The patient's corrected calcium concentration 7.86 mg/dL."
116,7,Calcium Correction for Hypoalbuminemia,lab test,decimal,pmc-4595585-1,Extracted,"An 80-year-old woman was admitted to our hospital because of chest pain that developed 1 day prior to admission. She had been treated for bronchial asthma with a bronchodilator and leukotriene antagonist for 2 years but had no medical history related to hematologic malignancy. The patient's hemogram results at admission were as follows: white blood cell count, 0.95×109/L; hemoglobin level, 8.0 g/dL; mean corpuscular volume, 105.9 fL; and platelet count, 29.0×109/L. The patient's biochemical test results at admission were as follows: serum protein level, 6.8 g/dL; serum albumin level, 2.8 g/dL; serum creatinine level, 1.54 mg/dL; serum calcium level, 7.4 mg/dL; and serum lactate dehydrogenase level, 719 IU/L. In the examination of a peripheral blood smear, pancytopenia with rouleaux formation was observed. Bone marrow aspirates showed hypocellular marrow without an increase in the number of myeloblasts but showed increased infiltration of plasma cells at a frequency of 14.9% (). In addition, megakaryocytic dysplasias such as separated nuclei () and hypolobulated nuclei () were found, accounting for 30% of the total number of megakaryocytes. Erythroid dysplasias such as binucleation and delayed mitosis were also found (), as well as mild granulocytic dysplasias such as hyposegmentation, accounting for 15% and 10% of the total numbers of erythroid and granulocytic lineage cells, respectively. Examination of a bone marrow biopsy specimen () revealed 35% cellular marrow with diffuse infiltration of plasma cells in the immunohistochemical stain for CD138 expression (DAKO, Glostrup, Denmark; ).
Both serum and urine immunofixation analyses using Hydragel IF K20 kit (Sebia, Cedex, France) were performed, and the results showed the presence of monoclonal gammopathy of IgA and lambda type. The subsequently performed serum electrophoresis using Capillarys Protein(E) 6 kit (Sebia, France) showed the presence of monoclonal gammopathy accompanied by M-peaks of 1.27 g/dL. All radiological evaluation results did not show definite evidence of osteolytic lesion. The results of a subsequently performed karyotype analysis showed 46,XX, del(20)(q11.2)[15]/46,XX[5], indicating the presence of del(20)(q11.2) clone, at a frequency of 75%. Fluorescence in situ hybridization analysis results showed nuc ish(D20S108X1)[156/200], indicating the presence of heterozygous 20q12 deletion, at a frequency of 78%. As the patient showed pancytopenia accompanied with multilineage dysplasia, MDS-related chromosomal abnormality, and monoclonal gammopathy with an increase in serum creatinine level, she was finally diagnosed with the simultaneous presentation of symptomatic PCM and MDS and refractory cytopenia with multilineage dysplasia (RCMD) that were unrelated to prior chemotherapy. After the diagnosis, she developed gram-negative septicemia and died 8 days after the admission.","Using the Calcium Correction for Hypoalbuminemia formula, what is the patient's corrected calcium in mg/dL? Your may set your normal albumin concentration to be 4 g/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Albumin': [2.8, 'g/dL'], 'Calcium': [7.4, 'mg/dL']}",8.36,7.942,8.778,"To compute the patient's correct calcium level in mg/dL, the formula is  (0.8 * (Normal Albumin (in g/dL) - Patient's Albumin (in g/dL))) + Serum Calcium (in mg/dL).
The patient's normal albumin level is 4.0 g/dL.
The concentration of Albmumin is 2.8 g/dL. 
The concentration of Calcium is 7.4 mg/dL. 
Plugging these values into the formula, we get (0.8 * (4.0 g/dL - 2.8 g/dL)) + 7.4 mg/dL = 8.36 mg/dL.
The patient's corrected calcium concentration 8.36 mg/dL."
117,7,Calcium Correction for Hypoalbuminemia,lab test,decimal,pmc-5051225-1,Extracted,"An 8-year-old Saudi girl developed persistent daily fever, weight loss, and cough for two months. Her grandmother had pulmonary tuberculosis 15 months prior to the onset of symptoms. The family sought medical advice first in a local hospital where investigations revealed bilateral pneumonia, left-sided pleural effusion, and bilateral pulmonary nodules. There was a history of animal contact but no raw milk ingestion. She had normal bowel habits with no jaundice, dysphagia or any other GI symptoms. She had no neurological, rheumatological, ophthalmologic, or dermatological symptoms. Physical examination revealed a pale girl, at 10th percentile for weight and height, and hepatosplenomegaly. The laboratory examination was remarkable for anemia (hemoglobin 7.9 g/dL), erythrocyte sedimentation rate (ESR) of 120 mm/h, and an alanine aminotransferase of 75 U/L (normal, 0-35 U/L), serum calcium 2.6 mmol/L, and low albumin level 31 g/L. Abdominal computed tomography (CT) revealed hepatosplenomegaly and hypodense nonenhancing lesions throughout the liver (variable in size from a few millimeters to 3 centimeters), and multiple enlarged abdominal lymph nodes. Chest CT scan showed basal and peripheral nodular opacities. Tests for mycobacterium tuberculosis (MTB) including tuberculin skin test and serum QuantiFERON showed negative results. Liver biopsy showed noncaseating granulomas []. In light of the strong epidemiological exposure, antituberculous medications were initiated (combination of isoniazid, pyrazinamide, ethambutol, and refampicin). Despite compliance with treatment and proper dosing, the patient persisted to be febrile with further weight loss.
Three months later, the patient presented with repeated episodes of hematemesis and epigastric pain. Upper endoscopy revealed an erosive, hemorrhagic, nodular gastric mucosa over the entire stomach []. Histopathology of biopsies revealed chronic noncaseating granulomatous inflammation and tests for MTB, and fungal infection on the gastric biopsies were negative. Tests for antibodies associated with inflammatory bowel disease (perinuclear antineutrophil cytoplasmic antibodies, antiouter membrane protein C, and anti-Saccharomyces cerevisiae IgA and IgG) showed negative results. Oxidative burst test for chronic granulomatous disease was negative. Serum angiotensin-converting enzyme (ACE) level was 45 U/L (normal, 29-110 U/L).
Given the multisystem involvement with significant chest findings, tissue findings of granulomatous disease from the liver and upper GIT, together with exclusion of other causes of granulomatous inflammation, the patient was diagnosed with active disseminated sarcoidosis, and intravenous corticosteroids (methylprednisolone 2 mg/kg/day) and omeprazole were started. Ten days after steroid therapy, a repeat of upper endoscopy showed dramatic improvement in the esophageal and gastric appearance [], and a colonoscopy showed no colonic involvement and normal terminal ileum. Biopsies from the esophagus, stomach, and duodenum showed dramatic reduction in the inflammation and disappearance of the granulomatous changes. The corticosteroids were tapered over 3 months. At 6 months after diagnosis, chest and abdomen CT showed resolution of the hepatosplenomegaly, and clearance of the hypodense lesions. During the four years after the diagnosis, the child has remained in remission with normal growth and development.","Using the Calcium Correction for Hypoalbuminemia formula, what is the patient's corrected calcium in mg/dL? Your may set your normal albumin concentration to be 4 g/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Albumin': [31.0, 'g/L'], 'Calcium': [2.6, 'mmol/L']}",11.141,10.58395,11.69805,"To compute the patient's correct calcium level in mg/dL, the formula is  (0.8 * (Normal Albumin (in g/dL) - Patient's Albumin (in g/dL))) + Serum Calcium (in mg/dL).
The patient's normal albumin level is 4.0 g/dL.
The concentration of Albmumin is 31.0 g/L. We need to convert the concentration to g/dL. The mass units of the source and target are the same so no conversion is needed. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of g/dL. This will result to 31.0 g Albmumin/10.0 dL = 3.1 g Albmumin/dL. The concentration value of 31.0 g Albmumin/L converts to 3.1 g Albmumin/dL. 
The concentration of Calcium is 2.6 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of Calcium from mmol to mg. The mass of Calcium is 2.6 mmol. To convert 2.6 mmol of Calcium to mol, multiply by the conversion factor 0.001, giving us 2.6 mmol Calcium * 0.001 mol/mmol = 0.0026 mol Calcium. To convert from mol Calcium to grams, multiply by the molar mass 40.08 g/mol, which will give 0.0026 mol Calcium * 40.08 g/mol = 0.10421 g Calcium. To convert 0.10421 g of Calcium to mg, multiply by the conversion factor 1000.0, giving us 0.10421 g Calcium * 1000.0 mg/g = 104.21 mg Calcium. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 104.21 mg Calcium/10.0 dL = 10.421 mg Calcium/dL. The concentration value of 2.6 mmol Calcium/L converts to 10.421 mg Calcium/dL. 
Plugging these values into the formula, we get (0.8 * (4.0 g/dL - 3.1 g/dL)) + 10.421 mg/dL = 11.141 mg/dL.
The patient's corrected calcium concentration 11.141 mg/dL."
118,7,Calcium Correction for Hypoalbuminemia,lab test,decimal,pmc-7535632-1,Extracted,"A 55-year-old man was diagnosed with “lumbar muscle strain” at a local hospital after complains of low back pain for 3 months. However, no significant improvement was seen after symptomatic treatment (specific treatment unknown). Two months later, the patient developed back pain with bilateral pain in the rib area. On April 21, 2018, enhanced chest computed tomography (CT) showed a small amount of chronic inflammatory and fibroproliferative lesions in the lower lobe of both lungs; a small amount of effusion on both sides of the thoracic cavity, osteoporosis of the vertebrae, ribs, and sternum with multiple bone resorption and destruction, consider plasmacytoma possible. Blood biochemical tests suggest elevated globulin (88.2 g/L).
When the patient visited our hospital, there were no obvious positive findings on physical examination, except for pale lips, conjunctiva, and nail bed. Laboratory findings were as follows: white blood cell count, 3400 cells/μL; hemoglobin, 86 g/L; platelets,118,000 cells/μL; total protein, 113 g/L; albumin, 28 g/L; creatinine, 58 μmol/L; calcium, 2.24 mmol/L; β2-microglobin, 2.84 mg/L. Immunoglobulin G (IgG) was 66.79 g/L, but IgA and IgM were below normal levels, blood lambda light chain was 19.8 g/L, and the ratio of kappa/lambda was 0.01. Immunofixation electrophoresis showed an increase in monoclonal IgG and lambda in the blood. Bone marrow smear suggested elevated plasma cells (plasma cells 23%). Fluorescence in situ hybridization (FISH) results of CD138 monoclonal antibody sorting cells showed 8% positive for immunoglobulin heavy chain (IGH) rearrangement and 10% positive for 13q deletion. The diagnosis was multiple myeloma [subtype IgG/lambda Durie-Salmon stage IIIA, International Staging System (ISS) stage II]. This patient was a known carrier of HBV for more than 20 years. His elder brother had also been diagnosed with multiple myeloma (subtype IgG/kappa) in 2008 at the age of 56 years. Before initiation of treatment for multiple myeloma, the patient was seropositive for HBsAg (39 IU/mL), anti-HBe, and anti-HBc. Alanine aminotransferase (ALT) was 64 U/L (normal range <45 U/L) and aspartate aminotransferase (AST) was 69 U/L (normal range <50 U/L). Serum HBV-DNA was 161 IU/mL.
The patient received a 3-week cycle of PCD (Bortezomib 2.3 mg and Cyclophosphamide 0.4 g on day 1,4,8,11+ Dexamethasone 20 mg on day 1–2, 4–5, 8–9, 11–12). Entecavir was administered as a prophylaxis against HBV reactivation, and HBV-DNA was monitored since the start of PCD therapy. The patient tolerated the chemotherapy regimen well, and there were no obvious adverse effects. After 1 cycle of therapy, the serum HBV-DNA was undetectable. HBsAg turned negative after 2 months and was also negative during the 2 years of follow-up. However, anti-HBe and anti-HBc were still positive. After 4 courses of PCD therapy, the patient's immunofixation electrophoresis turned negative, and the free light chain returned to normal, indicating a stringent complete response (sCR). Subsequently, his peripheral blood hematopoietic stem cells (HSCs) were collected and he was consistently treated with high-dose chemotherapy followed by autologous HSC transplantation as consolidation treatment, 10 months after the initial diagnosis of multiple myeloma. The patient continues to remain in sCR at 26 months of follow-up. During subsequent treatment and follow-up, HBsAg continued to be negative and HBV-DNA continued to fall below the detection limit.","Using the Calcium Correction for Hypoalbuminemia formula, what is the patient's corrected calcium in mg/dL? Your may set your normal albumin concentration to be 4 g/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Albumin': [28.0, 'g/L'], 'Calcium': [2.24, 'mmol/L']}",9.938,9.4411,10.4349,"To compute the patient's correct calcium level in mg/dL, the formula is  (0.8 * (Normal Albumin (in g/dL) - Patient's Albumin (in g/dL))) + Serum Calcium (in mg/dL).
The patient's normal albumin level is 4.0 g/dL.
The concentration of Albmumin is 28.0 g/L. We need to convert the concentration to g/dL. The mass units of the source and target are the same so no conversion is needed. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of g/dL. This will result to 28.0 g Albmumin/10.0 dL = 2.8 g Albmumin/dL. The concentration value of 28.0 g Albmumin/L converts to 2.8 g Albmumin/dL. 
The concentration of Calcium is 2.24 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of Calcium from mmol to mg. The mass of Calcium is 2.24 mmol. To convert 2.24 mmol of Calcium to mol, multiply by the conversion factor 0.001, giving us 2.24 mmol Calcium * 0.001 mol/mmol = 0.00224 mol Calcium. To convert from mol Calcium to grams, multiply by the molar mass 40.08 g/mol, which will give 0.00224 mol Calcium * 40.08 g/mol = 0.08978 g Calcium. To convert 0.08978 g of Calcium to mg, multiply by the conversion factor 1000.0, giving us 0.08978 g Calcium * 1000.0 mg/g = 89.78 mg Calcium. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 89.78 mg Calcium/10.0 dL = 8.978 mg Calcium/dL. The concentration value of 2.24 mmol Calcium/L converts to 8.978 mg Calcium/dL. 
Plugging these values into the formula, we get (0.8 * (4.0 g/dL - 2.8 g/dL)) + 8.978 mg/dL = 9.938 mg/dL.
The patient's corrected calcium concentration 9.938 mg/dL."
119,7,Calcium Correction for Hypoalbuminemia,lab test,decimal,pmc-3433566-1,Extracted,"A 9-year-old girl presented with a history of gradually worsening abdominal distension, decreased urine output, and abdominal pain for 2 weeks. Two weeks prior to admission, she complained of nausea, vomiting, and abdominal pain without diarrhea several hours after eating bread. She had no signs of infection such as fever, rash, or sore throat. On admission, she was afebrile and had normal vital signs. Her weight was 32.2 kg (50th to 75th percentile), and height was 140 cm (75th to 90th percentile). She had a history of allergic rhinitis. A physical examination revealed periorbital swelling, pitting edema on both legs, and abdominal distension with mild diffuse tenderness and shifting dullness. Laboratory tests on admission showed hemoglobin level, 15.4 g/dL; hematocrit, 43%; peripheral leukocyte, 13.390/µL with an eosinophil count of 840/µL (6.3%); serum total protein, 2.3 g/dL; albumin, 1.3 g/dL; calcium, 7.3 mg/dL; erythrocyte sedimentation rate, 2 mm/hr; and C-reactive protein, 0.56 mg/dL. A urinalysis was normal without proteinuria. The multiple allergen simultaneous test showed positive responses to mites (class 2) and Acarus siro (class 3), with elevation of the total immunoglobulin (Ig) E value (>200 IU/mL). Anti-CMV IgM was negative. Chest and abdominal radiographs displayed pleural effusion on both sides. Abdominal ultrasonography revealed pleural effusion and massive ascites. Computed tomography (CT) of the abdomen confirmed marked thickening of the small intestinal wall. A pleural fluid analysis revealed lymphocytes, 25%; polymorphonuclear neutrophils, 7%; eosinophils, 0%; protein, 152 mg/dL; glucose, 116 mg/dL; and adenosine deaminase, 2 IU/L. An abdominal paracentesis was not performed. Alpha 1 anti-trypsin excretion in the stool was elevated to 1,204 mg/dL (normal, ≤54 mg/dL). A gastroscopic examination revealed large swollen gastric folds, erythema, erosion, and exudation in the body and fundus, although the antrum was normal (). A Campylobacter-like organism test was negative. Histological findings of the gastric mucosa showed moderate infiltration of eosinophils (20 to 38 per high power field) and neutrophils in the lamina propria, mucosal edema, and dilatation of the capillaries and lymphatics (). A cell with intranuclear and intracytoplasmic inclusions, characteristic of CMV infection, was not seen. Immunohistochemistry for CMV revealed negative finding. Microscopic findings of the duodenal mucosa revealed mild infiltration of lymphocytes and histiocytes with few eosinophils. The patient's symptoms of abdominal distension, pitting edema, and decreased urine output began to improve from the day 7 of hospitalization with conservative treatments such as fluid restriction, diuretics, albumin infusion, and avoidance of milk and bread. Peripheral eosinophils rose to 25.4% (1,520/uL) on the day 11 after admission. Total protein and albumin levels rose to 4.3 g/dL and 3 g/dL, respectively, and her weight reduced from 32.3 to 27.3 kg on the day of discharge, 17 days after admission.","Using the Calcium Correction for Hypoalbuminemia formula, what is the patient's corrected calcium in mg/dL? Your may set your normal albumin concentration to be 4 g/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Albumin': [1.3, 'g/dL'], 'Calcium': [7.3, 'mg/dL']}",9.46,8.987,9.933,"To compute the patient's correct calcium level in mg/dL, the formula is  (0.8 * (Normal Albumin (in g/dL) - Patient's Albumin (in g/dL))) + Serum Calcium (in mg/dL).
The patient's normal albumin level is 4.0 g/dL.
The concentration of Albmumin is 1.3 g/dL. 
The concentration of Calcium is 7.3 mg/dL. 
Plugging these values into the formula, we get (0.8 * (4.0 g/dL - 1.3 g/dL)) + 7.3 mg/dL = 9.46 mg/dL.
The patient's corrected calcium concentration 9.46 mg/dL."
120,7,Calcium Correction for Hypoalbuminemia,lab test,decimal,pmc-7001129-1,Extracted,"An 80-year-old Caucasian man presented to the emergency department (ED) with one-week history of ankle swelling and abdominal pain. Per family members, the patient was confused, having memory loss, increased urinary frequency, cough, mild dyspnea and generalized weakness. He had a prior history of hypertension, dyslipidemia, chronic kidney disease stage III, benign prostatic hyperplasia, transitional cell carcinoma of the urinary bladder for which he underwent transurethral resection of bladder tumor. His prescription medications included tamsulosin, benazepril, simvastatin and a multivitamin. He denied any intake of calcium supplements, antacids or vitamin D. He was a former alcoholic (quit 10 years ago) and an ex-smoker (quit 15 years ago) and denied any illicit drug use. He was recently discharged from the hospital a week ago when he was admitted for acute kidney injury, secondary to dehydration.
All his initial vital signs in the emergency department were within normal limits and physical examination was unremarkable with the exception of 2+ pitting pedal edema bilaterally up to mid-shins. Serum chemistries showed a white blood cell count (WBC) 15,600/mm3 (normal: 4,000-11,000), neutrophil count 12,900/mm3 (normal: 1500-8,000), monocytes 1300/mm3 (normal: 200-1000), hemoglobin 17.4 g/dl (normal: 13.5-17.0), red blood cell 5.78 million/mm3 (normal: 4.3-6.0), platelets 145,000/mm3 (normal: 150,000-450,000), blood urea nitrogen 31 mg/dl (normal: 7-20), creatinine 1.76 mg/dl (normal: 0.6-1.2), calcium 12.2 mg/dl (normal: 8.5-10.2), albumin 3.1 g/dl (normal: 3.5-5.5), total bilirubin 1.5 mg/dl (normal: 0.1-1.2), aspartate aminotransferase (AST) 73 IU/L (normal: <40), alanine aminotransferase (ALT) 33 IU/L (normal: <56), alkaline phosphatase (ALP) 218 IU/L (normal: 44-147), NT-proBNP 638 pg/ml (normal: <450) and serum procalcitonin 35.6 ng/ml (normal: <0.5).
Chest radiograph done in emergency department showed bilateral infrahilar and basilar subsegmental atelectasis though early infiltrate versus aspiration could not be ruled out. Ventilation-perfusion nuclear medicine scan showed low probability of pulmonary embolism. The patient was empirically started on piperacillin-tazobactam by ED physician for possible healthcare-associated pneumonia and admitted to the hospital for further care.
Suspecting the possibility of congestive heart failure, the admitting physician started patient on intravenous furosemide, ordered an echocardiogram and added intravenous vancomycin for empiric coverage as well. Echocardiogram showed a normal ejection fraction of 60% with no valvular abnormalities. Nephrology service was consulted by the admitting physician for management of hypercalcemia. Nephrologist ordered studies to evaluate the cause of hypercalcemia, discontinued furosemide and gave calcitonin to treat hypercalcemia. Investigative workup for hypercalcemia revealed parathyroid hormone level < 6 pg/ml (normal: 15-65), 25-hydroxy vitamin D 45 ng/ml (normal: 30-100), 1, 25-dihydroxy vitamin D 17 pg/ml (normal: 18-72), angiotensin converting enzyme level 11 U/L (normal: 9-67), 24-hour urinary calcium excretion 153 mg/dl (normal: 50-300), normal IgA, IgG, IgM levels, serum protein electrophoresis showed hypoalbuminemia without any evidence of monoclonal protein, serum and urine immunofixation was negative. Ordered serum parathyroid hormone-related peptide (PTHrP) revealed elevated levels of 62 pg/ml (normal: 14-27 pg/ml). As hypercalcemia did not respond to calcitonin, the patient was given intravenous pamidronate (twice). As his leukocytosis continued to worsen (19,100/mm3) along with procalcitonin (38.15 ng/ml) despite being on broad-spectrum antibiotics for one-week, infectious diseases service was consulted and leukemia/lymphoma flow cytometry panel, peripheral blood smear was ordered to evaluate for hematologic malignancy. Infectious disease physician discontinued vancomycin and ordered Indium-111 labeled whole body WBC scan which showed no abnormal areas of increased tracer uptake to suggest a focus of infection. Leukemia/lymphoma flow cytometry was negative for any specific phenotypic abnormality. Peripheral blood smear showed presence of neutrophilia without any evidence of malignant leukocytes.
Meanwhile, the patient went in to acute hypoxic respiratory distress with wheezing and so pulmonary service was consulted which transferred the patient to ICU, started him on intravenous methylprednisolone and initiated non-invasive positive pressure ventilation (bi-level positive airway pressure - BiPAP). As PTHrP had come back elevated, the patient underwent a CT scan of chest, abdomen and pelvis, which showed a hypodense mass in the right posterior lobe of liver measuring 9.3 cm x 8.3 cm in size with presence of moderate abdominal and severe pelvic ascites (Figure ). The patient underwent paracentesis with removal of 2.6 L of straw-colored fluid. Ascitic fluid did not show any malignant cells or evidence of spontaneous bacterial peritonitis. Ultrasound of the liver showed a 10.9-cm mass in the right lobe of liver along with portal vein occlusion. Hematology and oncology service was then consulted. Oncologist did not recommend anticoagulation for portal vein occlusion and ordered tumor markers evaluation which showed alpha-fetoprotein 14.7 ng/ml (normal: <8.7), CA 19-9 2907 U/ml (normal: < 35), carcinoembryonic antigen (CEA) 5.2 ng/ml (normal: <3.4). A possibility of hepatocellular carcinoma was discussed with the patient and he was scheduled to undergo CT-guided liver biopsy. Broad spectrum antibiotics were discontinued after 10 days of administration as they neither lowered procalcitonin nor WBC count. Blood, urine and other body fluid cultures remained negative during the entire hospital stay. Either partly because of being on intravenous steroids and/or due to underlying disease process, patient’s WBC count peaked at 40,100/mm3 during this hospital stay. Though he presented with polycythemia, his peak hemoglobin and hematocrit during admission was 19.7 g/dl and 57%. Serum erythropoietin level was found to be elevated 21.4 mIU/ml (normal: 2.6-18.5).
Patient’s liver profile worsened during his ICU stay with serum bilirubin escalating up to 12 mg/dl, ALP 470 IU/L, AST 429 IU/L, ALT 362 IU/L, international normalized ratio (INR) 2.8, albumin 1.8. MRI liver/magnetic resonance cholangiopancreatography (MRCP) abdomen was ordered which did not show any evidence of biliary obstruction. Viral hepatitis panel came back negative as well. Liver biopsy revealed moderately differentiated ductal adenocarcinoma of hepatobiliary origin reported as primary intrahepatic cholangiocarcinoma under current clinical settings (Figure ). Immunohistochemical stains revealed CK Oscar(+), CK7(+) (Figure ), CK20(-) (Figure ), Villin(+) (Figure ), CDX2(-) (Figure ), TTF-1(-), Napsin A(-), PSA(-) and NKX3.1(-).
Oncology service recommended no chemotherapy at the moment as the patient was thought to be too frail. Three weeks after his admission to the hospital, his blood pressure dropped in ICU requiring initiation of norepinephrine infusion. A temporary hemodialysis catheter was inserted and sustained-low efficiency dialysis (SLED) was initiated as well. Given his dismal prognosis in the setting of malignancy and multi-organ failure, a detailed discussion was held with the patient and his family members when it was decided to proceed with comfort care options and hospice. The patient was discharged to hospice the following day.","Using the Calcium Correction for Hypoalbuminemia formula, what is the patient's corrected calcium in mg/dL? Your may set your normal albumin concentration to be 4 g/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Albumin': [3.1, 'g/dL'], 'Calcium': [12.2, 'mg/dL']}",12.92,12.274,13.566,"To compute the patient's correct calcium level in mg/dL, the formula is  (0.8 * (Normal Albumin (in g/dL) - Patient's Albumin (in g/dL))) + Serum Calcium (in mg/dL).
The patient's normal albumin level is 4.0 g/dL.
The concentration of Albmumin is 3.1 g/dL. 
The concentration of Calcium is 12.2 mg/dL. 
Plugging these values into the formula, we get (0.8 * (4.0 g/dL - 3.1 g/dL)) + 12.2 mg/dL = 12.92 mg/dL.
The patient's corrected calcium concentration 12.92 mg/dL."
121,8,Wells' Criteria for Pulmonary Embolism,risk,decimal,pmc-8230162-2,Extracted,"A 68-year-old man presented to the the emergency system with severe dyspnea and hypoxia (SpO2: 87% in ambient air). His past medical history was significant for hypertension, obesity, diabetes, and chronic renal failure. On admission (day 1), he had a temperature of 39°C, high blood pressure (170/100 mmHg), and heart rate (110 bpm in sinus rhythm (SR)). Diffuse breath sounds (rales) were found on both lung fields and the chest HRCT [, Panel E] revealed bilateral GGOs consistent with interstitial inflammatory lung disease. Nasopharyngeal and oropharyngeal swabs were immediately obtained, confirming SARS-CoV-2 positivity. After a CPAP attempt (days 1 and 2), the patient was intubated (day 3) with ventilatory support parameters demonstrating a high (PEEP of 15 cm H2O), FiO2 80%, and driving pressure <15 cmH2O. Serum creatinine increased to 2.3 mg/dL (glomerular filtration rate of 31 mL/min), leukocytes were 8.3 × 109 U/L, lymphocytes were 0.9 × 109 U/L, and hemoglobin was 9.3 g/dL. The high-sensitivity troponin T curve was 59-43–35 ng/L (normal value <14), NT-proBNP reached to 10.650 pg/mL (normal value <153) and C-reactive protein peak was 29 mg/L (normal value <6) with procalcitonin peak of 6.3 ng/mL (normal value range: 0–0.15). Interleuchin-6 values were 91.83 pg/mL and 37.63 pg/mL and he was treated with intravenous tocilizumab. Coagulation markers demonstrated a pro-thrombotic status with a platelet count of 160 × 109 U/L, D-dimer of 17 mcg/mL, fibrinogen of 656 mg/dL, and an aPTT of 33.8 s. ECG [, Panel F] showed atrial fibrillation with high heart rate (111 bpm), mild ST depression, inverted T waves in V4–V6, and a QTc of 437 ms. TTE revealed a moderate left ventricular systolic dysfunction (LVEF 40%) with a mildly dilated left ventricle (end-diastolic diameter of 61 mm), normal right ventricle in size and function, and normal cardiac valves. There was a moderate pericardial effusion, anterior to the right ventricle (maximum 15 mm in diastole). A mobile and elongated (0.3 × 4 cm) clot was noted within the effusion (Panel G). The patient was treated with lopinavir/ritonavir (400 mg BID), hydroxychloroquine (200 mg BID), and enoxaparin (1 mg/kg BID). Metilprednisolone (1 mg/kg OD) was added (day 6) together with beta-blockers, diuretics, and nitrates. Due to persistent atrial fibrillation, enoxaparin was switched to edoxaban (30 mg OD) on day 9. To date (day 15), the clot continues to decrease as seen on the chest HRCT (Panel H).
The prone position was used for the first four nights in the ICU. He was extubated the 15th day after intubation; noninvasive ventilation and HFNC were used the following days to optimize oxygenation.
At 6-month follow-up, the patient was in good conditions, lung lesions appeared reduced on chest HRCT, but at TTE pericardial clot appeared unchanged [].",What is the patient's score of Wells' criteria for Pulmonary Embolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [110, 'beats per minute'], 'Pulmonary Embolism is #1 diagnosis OR equally likely': False}",1.5,1.5,1.5,"
The criteria for the Wells' Criteria for Pulmonary Embolism score are listed below:

1. Clinical signs and symptoms of DVT: No = 0 points, Yes = +3 points
2. PE is #1 diagnosis OR equally likely: No = 0 points, Yes = +3 points
3. Heart rate > 100: No = 0 points, Yes = +1.5 points
4. Immobilization at least 3 days OR surgery in the previous 4 weeks: No = 0 points, Yes = +1.5 points
5. Previous, objectively diagnosed PE or DVT: No = 0 points, Yes = +1.5 points
6. Hemoptysis: No = 0 points, Yes = +1 point
7. Malignancy with treatment within 6 months or palliative: No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.
   
The Well's score for pulmonary embolism is currently 0.
Clinical signs and symptoms of DVT are not reported and so we assume that this is missing from the patient, keeping the current total at 0. Whether Pulmonary Embolism is the #1 diagonsis or is equally likely to being the #1 diagnosis is not reported and so we assume this statement is false, keeping the total unchanged at 0.
The patient's heart rate is 110 beats per minute. The heart rate is more than 100 bpm, and so the score is increased by 1.5, making the total score, 0 + 1.5 = 1.5.
The report does not give an indication on whether the patient has had an immobilization for at least 3 days and so we assume this to be false.The report does not give an indication on whether the patient has had a surgery for the past 4 weeks and so we assume this to be false.Because the patient has not had an immobilization for at least 3 days, and the patient did not have a surgery in the past 4 weeks, the score remains at 1.5.
The report does not give an indication on if the patient has previously been diagnosed with deep vein thrombosis and so we assume this to be false.Because the patient has no previous diagnosis of pulmonary embolism (PE) or deep vein thrombosis (DVT), the score remains at 1.5.
Hemoptysis is not reported in the patient note and so we assume that it is missing from the patient, keeping the total score at 1.5.
Malignany with treatment within 6 months or palliative is not reported in the patient note and so we assume that this is absent for the patient, keeping the score at 1.5.
The patient's Well's score for pulmonary embolism is 1.5."
122,8,Wells' Criteria for Pulmonary Embolism,risk,decimal,pmc-8494530-1,Extracted,"A 14-year-old female presented to our pediatric tertiary hospital emergency department (ED) with acute dyspnea and pleuritic chest pain following a presyncopal episode while walking up a flight of stairs. She was persistently tachycardic with a heart rate of 120 beats per minute at rest and higher with minimal exertion, tachypneic (20 breaths per minute), normotensive (mean arterial pressure 80-88 mmHg) and had mild hypoxia with baseline saturations of approximately 90% at rest, decreasing to the mid-80s with mobilisation. She was commenced on supplemental low flow nasal oxygen at a flow rate of three litres per minute which improved her oxygen saturations.
The patient was otherwise well with no history of recent viral illness, surgery, trauma, or periods of immobilisation. She had however commenced a COCP consisting of ethinyloestradiol (20 micrograms) and levonorgestrel (100 micrograms) ten weeks prior. The COCP was prescribed by her local doctor for a sharp pelvic pain which started with menstruation and persisted for three weeks, with complete resolution while taking the COCP. The patient reached menarche at twelve years old and experienced dysmenorrhea for the first three days of menstruation with menorrhagia. Apart from her maternal grandmother having endometriosis, there was no significant family history including thrombophilia or thromboembolic events. The patient denied smoking or recreational drug use. She was a competitive sports player who, within a month of commencing the COCP, experienced dyspnea and intermittent chest pain on exertion. Although these symptoms initially resolved with rest, her time to recovery gradually increased.
In the ED, a chest X-ray (CXR) revealed mild prominence of the pulmonary arteries bilaterally. Blood tests revealed elevated levels of D-dimer, 5.01 mg/L (normal range 0.02–0.49) and cardiac troponin I (cTnI) of 194 Hng/L (normal < 10). Given the history and clinical findings, a computer tomography pulmonary angiogram (CTPA) was performed and confirmed the presence of a saddle PE () with thrombus occluding the right main pulmonary artery, left upper lobe segmental artery, and left interlobar artery. There was also evidence of right heart strain on the CTPA. An urgent echocardiogram revealed systolic dysfunction of the right ventricle (RV) and basal segment dyskinesia, and blood flow through the right pulmonary artery appeared absent. Given the presence of right heart strain, elevated troponin levels, and persistent tachycardia and hypoxia, urgent opinions were sought from multiple pediatric specialists including a respiratory physician, interventional cardiologist, haematologist, and cardiothoracic surgeon.
The patient was administered a 10 milligram (mg) bolus of intravenous alteplase, a recombinant tissue plasminogen activator (tPA), and admitted to the pediatric intensive care unit (PICU) where she then received an infusion of tPA (0.3 mg/kg/h) for 3 hours. The total dose of tPA administered was 80 mg. Following this, the patient was commenced on an unfractionated heparin (UHF) infusion, targeting an anti-Xa level of 0.3–0.7 U/mL. COCP administration was ceased.
Following thrombolysis, the patient's tachycardia resolved, although she remained tachypneic. A repeat echocardiogram within twelve hours showed improvement in the RV systolic dysfunction and definite blood movement through the right pulmonary artery, with ongoing presence of a significant filling defect occupying the vessel. UHF infusion was continued for 48 hours, after which time anticoagulation was changed to 80 mg subcutaneous enoxaparin, a low molecular weight heparin (LMWH), administered twice a day. Given the significant embolic material seen on the initial CTPA, further discussions ensued regarding the potential benefits and risks of catheter-directed intervention with the aim of decreasing clot burden and potentially reducing the risk of chronic thromboembolic pulmonary hypertension (CTEPH).
A repeat CTPA was performed on the fourth day of admission which revealed a substantial decrease in clot burden, no visible saddle embolus, and reduced right heart strain (). The patient no longer required supplemental oxygen and made a steady recovery. Eight days post admission, she was transitioned to a direct oral anticoagulant (DOAC), rivaroxaban, at standard adult dosing (15 mg twice a day for three weeks followed by 20 mg daily), prior to discharge home.
A thrombophilia screen performed was unremarkable (). She was referred to an adolescent gynaecologist to explore suitable alternatives to taking the COCP. Outpatient spirometry, body plethysmography, and diffusing capacity tests performed a month post discharge were unremarkable. She returned to her baseline function with resolution of the shortness of breath on exertion. A CTPA and echocardiogram performed six months post presentation revealed complete resolution of all pathological changes, and rivaroxaban therapy was stopped (). Written consent was obtained from the patient's parent for this case report.",What is the patient's score of Wells' criteria for Pulmonary Embolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [120, 'beats per minute'], 'Pulmonary Embolism is #1 diagnosis OR equally likely': True, 'Immobilization for at least 3 days': False, 'Surgery in the previous 4 weeks': False}",3,3,3,"
The criteria for the Wells' Criteria for Pulmonary Embolism score are listed below:

1. Clinical signs and symptoms of DVT: No = 0 points, Yes = +3 points
2. PE is #1 diagnosis OR equally likely: No = 0 points, Yes = +3 points
3. Heart rate > 100: No = 0 points, Yes = +1.5 points
4. Immobilization at least 3 days OR surgery in the previous 4 weeks: No = 0 points, Yes = +1.5 points
5. Previous, objectively diagnosed PE or DVT: No = 0 points, Yes = +1.5 points
6. Hemoptysis: No = 0 points, Yes = +1 point
7. Malignancy with treatment within 6 months or palliative: No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.
   
The Well's score for pulmonary embolism is currently 0.
Clinical signs and symptoms of DVT are not reported and so we assume that this is missing from the patient, keeping the current total at 0. Whether Pulmonary Embolism is the #1 diagonsis or is equally likely to being the #1 diagnosis is not reported and so we assume this statement is false, keeping the total unchanged at 0.
The patient's heart rate is 120 beats per minute. The heart rate is more than 100 bpm, and so the score is increased by 1.5, making the total score, 0 + 1.5 = 1.5.
Because the patient has not had an immobilization for at least 3 days, and the patient did not have a surgery in the past 4 weeks, the score remains at 1.5.
The report does not give an indication on if the patient has previously been diagnosed with deep vein thrombosis and so we assume this to be false.Because the patient has been previously diagnosed for pulmonary embolism (PE), but the patient has never been diagnosed for deep vein thrombosis (DVT), we increase the current total by 1.5 so that 1.5 + 1.5 = 3.0.
Hemoptysis is not reported in the patient note and so we assume that it is missing from the patient, keeping the total score at 3.0.
Malignany with treatment within 6 months or palliative is not reported in the patient note and so we assume that this is absent for the patient, keeping the score at 3.0.
The patient's Well's score for pulmonary embolism is 3.0."
123,8,Wells' Criteria for Pulmonary Embolism,risk,decimal,pmc-5597065-1,Extracted,"An 18-year-old lady presented with generalised fatigue and excessive bleeding per vaginum for a two-month period. She also had blurring of vision associated with fever and headache for 15 days. The patient complained of pain in the anal region while passing stools for the last one week.
On examination, she was severely pale with an initial pulse rate of 100/min and a blood pressure of 100/70mm Hg. On local examination, she was found to have anal fissures.
On investigating, her peripheral smear revealed pancytopenia with a haemoglobin of 4 g%, total leucocyte count of 490/cu mm and a platelet count of 13000/cu mm. Her bone marrow biopsy was diagnostic of aplastic anaemia. An ophthalmological examination by fundoscopy and a B-scan ultrasonography (USG) was done and she was found to have bilateral vitreous haemorrhage and retinopathy.
She was transfused with multiple units of packed red cells and platelets. She was started on medroxy-progesterone acetate and tranexamic acid for menorrhagia along with iron and folate tablets. She was given cyclosporine for aplastic anaemia. In view of high fever spikes of 103 to 104 degrees F, she was started on empirical ceftazidime and amikacin. Her fever could not be localised and her initial blood and urine cultures were sterile. She had persistent fever and was switched over to meropenam and then to vancomycin.
After one week her perianal pain worsened and she passed blood clots per rectum associated with pus discharge. Her anal canal was extremely tender. Computed tomography (CT) scan of her abdomen and pelvis showed features suggestive of perianal abscess with proctitis and sloughed out mucosa in the anal canal (Figure ).
On examination under anaesthesia, the following findings were noted: the entire anal canal from the anal verge to about 10 cm proximal appeared dark brown in colour with sloughed out mucosa, the sphincters appeared non-viable, the tone was lost, and there was no bleeding on cutting through the tissues. The anal canal was filled with foul-smelling necrotic tissues mixed with blood clots (Figure ).
Debridement of the necrotic devitalised tissues was done and the pus collection was drained (Figure ). A diversion transverse colostomy was made. She was started on piperacillin-tazobactam and clindamycin.
Gram stain of necrotic tissues revealed gram-positive bacilli suggestive of Clostridium along with budding yeast cells. Her subsequent blood cultures grew Clostridium spp and then Escherichia coli (intermediate sensitivity to imipenam) and Acinetobacter baumanii (resistant to all). Her total leucocyte count dropped down to 270/cu mm with an absolute neutrophil count of 30/cu mm. Her general condition worsened. She developed acidosis with the deterioration of vitals. She was resuscitated and was given mechanical ventilation. The patient died of severe sepsis on post-operative day 3.",What is the patient's score of Wells' criteria for Pulmonary Embolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [100, 'beats per minute'], 'Pulmonary Embolism is #1 diagnosis OR equally likely': False, 'Surgery in the previous 4 weeks': False, 'Clinical signs and symptoms of Deep Vein Thrombosis': False}",0,0,0,"
The criteria for the Wells' Criteria for Pulmonary Embolism score are listed below:

1. Clinical signs and symptoms of DVT: No = 0 points, Yes = +3 points
2. PE is #1 diagnosis OR equally likely: No = 0 points, Yes = +3 points
3. Heart rate > 100: No = 0 points, Yes = +1.5 points
4. Immobilization at least 3 days OR surgery in the previous 4 weeks: No = 0 points, Yes = +1.5 points
5. Previous, objectively diagnosed PE or DVT: No = 0 points, Yes = +1.5 points
6. Hemoptysis: No = 0 points, Yes = +1 point
7. Malignancy with treatment within 6 months or palliative: No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.
   
The Well's score for pulmonary embolism is currently 0.
Clinical signs and symptoms of DVT are repoted to be absent and so the total score remains unchanged, keeping the total score at 0. Whether Pulmonary Embolism is the #1 diagonsis or is equally likely to being the #1 diagnosis is not reported and so we assume this statement is false, keeping the total unchanged at 0.
The patient's heart rate is 100 beats per minute. The heart rate is less than 100 bpm, and so the score remains unchanged, keeping the total score at 0.
The report does not give an indication on whether the patient has had an immobilization for at least 3 days and so we assume this to be false.Because the patient has not had an immobilization for at least 3 days, and the patient did not have a surgery in the past 4 weeks, the score remains at 0.
The report does not give an indication on if the patient has previously been diagnosed with deep vein thrombosis and so we assume this to be false.Because the patient has no previous diagnosis of pulmonary embolism (PE) or deep vein thrombosis (DVT), the score remains at 0.
Hemoptysis is not reported in the patient note and so we assume that it is missing from the patient, keeping the total score at 0.
Malignany with treatment within 6 months or palliative is not reported in the patient note and so we assume that this is absent for the patient, keeping the score at 0.
The patient's Well's score for pulmonary embolism is 0."
124,8,Wells' Criteria for Pulmonary Embolism,risk,decimal,pmc-8647083-1,Extracted,"A woman in her 40s was diagnosed with ADPKD after a renal ultrasound was performed due to hypertension and deranged kidney function on a routine blood test. At that point, she had a slightly enlarged liver with normal liver function tests and massive renal cysts. She reached ESRD requiring RRT in 2005 and received a deceased donor kidney transplant 2 years later. She developed progressive graft dysfunction due to chronic allograft nephropathy that required starting PD in August 2014. In November 2014, she was admitted to our hospital with a 3-week history of lower limb edema with painful skin ulcers, symptomatic hypotension and tachycardia (118 bpm), anorexia, nausea, and incoercible vomiting. Physical examination revealed a blood pressure of 70/45 mm Hg and ulcers with necrotic areas and cellulitis in the external distal third of both legs. Laboratory findings revealed severe malnutrition (serum albumin 1.5 g/dL) and elevated inflammatory markers (C-reactive protein: 288 mg/L; procalcitonin: 1.9 μg/L). A Doppler ultrasound showed bilateral femoral vein thrombosis, and so pulmonary thromboembolism was ruled out and due to the extensive thrombosis, a complete hypercoagulability state check was done, but no abnormalities were detected and tumor markers were normal. An abdominal CT was then performed showing large liver and renal polycystic disease, both organs with giant cysts (>15 cm). A giant hepatic cyst producing an extrinsic compression of the intrahepatic inferior cava vein (ICV) and massive venous thrombosis from ICV to bilateral iliofemoral deep veins involving the kidney graft vein was observed. The CT also demonstrated displacement and extrinsic compression of the stomach, pylorus, and duodenum due to another enlarged liver cyst, shown in Figures and .
After the CT findings, we considered the clinical presentation was consistent with an ICV syndrome due to ICV compression and thrombosis. Furthermore, vomiting and oral intake intolerance with severe malnutrition were caused by a complete pyloric and duodenal collapse by the enlarged liver cyst.
Anticoagulation therapy was started, but vomiting with oral intolerance persisted and the patient remained dependent on parenteral nutrition. Thus, percutaneous drainage and alcohol sclerosis of the compressive liver cyst was decided, with successful return of the stomach to its normal location, shown in Figure . Nausea and vomiting resolved in a few days, and adequate oral intake was resumed. Severe hypotension and tachycardia gradually improved, and a repeated CT revealed complete stomach expansion, as shown in Figure . PD therapy was modified but not disrupted, and 1 year later, the patient remained asymptomatic. As she did not have any coagulation abnormalities nor any evidence of neoplasia, the massive thrombosis of the ICV was deemed secondary to the extrinsic compression of intrahepatic ICV by enlarged liver cysts.",What is the patient's score of Wells' criteria for Pulmonary Embolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [118, 'beats per minute'], 'Previously Documented Pulmonary Embolism': False, 'Clinical signs and symptoms of Deep Vein Thrombosis': True, 'Malignancy with treatment within 6 months or palliative': False, 'Pulmonary Embolism is #1 diagnosis OR equally likely': False, 'Previously documented Deep Vein Thrombosis': True}",6,6,6,"
The criteria for the Wells' Criteria for Pulmonary Embolism score are listed below:

1. Clinical signs and symptoms of DVT: No = 0 points, Yes = +3 points
2. PE is #1 diagnosis OR equally likely: No = 0 points, Yes = +3 points
3. Heart rate > 100: No = 0 points, Yes = +1.5 points
4. Immobilization at least 3 days OR surgery in the previous 4 weeks: No = 0 points, Yes = +1.5 points
5. Previous, objectively diagnosed PE or DVT: No = 0 points, Yes = +1.5 points
6. Hemoptysis: No = 0 points, Yes = +1 point
7. Malignancy with treatment within 6 months or palliative: No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.
   
The Well's score for pulmonary embolism is currently 0.
Clinical signs and symptoms of DVT are reported to be present and so three points are added to the score, making the current total 0 + 3 = 3. Whether Pulmonary Embolism is the #1 diagonsis or is equally likely to being the #1 diagnosis is not reported and so we assume this statement is false, keeping the total unchanged at 3.
The patient's heart rate is 118 beats per minute. The heart rate is more than 100 bpm, and so the score is increased by 1.5, making the total score, 3 + 1.5 = 4.5.
The report does not give an indication on whether the patient has had an immobilization for at least 3 days and so we assume this to be false.The report does not give an indication on whether the patient has had a surgery for the past 4 weeks and so we assume this to be false.Because the patient has not had an immobilization for at least 3 days, and the patient did not have a surgery in the past 4 weeks, the score remains at 4.5.
The patient not been diagnosed with pulmonary embolis (PE), but the patient has previously been diagnosed with deep vein thrombosis (DVT), we increase the current total by 1.5 so that 4.5 + 1.5 = 6.0.
Hemoptysis is not reported in the patient note and so we assume that it is missing from the patient, keeping the total score at 6.0.
Malignany with treatment within 6 months or palliative is reported to be absent and so the total score remains unchanged, keeping the total score at 6.0.
The patient's Well's score for pulmonary embolism is 6.0."
125,8,Wells' Criteria for Pulmonary Embolism,risk,decimal,pmc-8293858-1,Extracted,"Our patient was a 48-year-old female with a past medical history of hyperlipidemia, hypertension, and gastroesophageal reflux disease (GERD) who presented to the hospital with a two-week history of dry cough, fever, red conjunctiva, chills, malaise, myalgias, and generalized weakness. She reported a weight loss of 15 pounds in the past year. She had been a smoker but had quit five years prior to the presentation. Prior to this hospital visit, she had consulted an outpatient clinic with complaints of fever, chills, and cough. She had received a flu vaccine a month prior. She had been thought to have a viral respiratory infection as an outpatient. Ibuprofen, and later azithromycin, had been prescribed, which had not alleviated her initial symptoms before the current presentation.
On physical exam, she had a temperature of 39.3 °C in the emergency department. She was tachycardic at 130 beats per minute and tachypneic with a respiratory rate of 24 breaths per minute. Her blood pressure was 149/74 mmHg. She had bilateral conjunctival injection, but her eyelids were grossly unremarkable. There was left axillary lymphadenopathy. A physical breast exam was normal with no palpable masses. There was no other palpable adenopathy, skin rashes, hepatomegaly, splenomegaly, clubbing, or edema. The respiratory and cardiovascular exams were otherwise unremarkable. Her ECG showed sinus tachycardia at 106 beats per minute but was otherwise unremarkable.
Relevant laboratory workup included a leukocytosis of 16.7 Thou/uL (normal range: 3.8-10.2) with a neutrophilic predominance of 82.9%. She had chronic anemia with a hemoglobin (Hb) level of 8.9 g/dl (11.9-15.1) and a mean corpuscular volume (MCV) of 76 fL (78.2-98.4). Her ferritin was more than 7,500 ng/ml (11-307), with a total iron-binding capacity of 204 (250-450), and a low iron level of 37 ug/dl (50-212). Her angiotensin-converting enzyme (ACE) level was 97 U/l (8-52). Her C-reactive protein (CRP) was 19.05 mg/dl (0.02-1.00), D-dimer was 13.46 ugFEU/ml (<0.50), aspartate aminotransferase (AST) was 54 U/L (13-39), and alanine aminotransferase (ALT) was 66 U/L (7-52); she had calcium of 9.0 mg/dl (8.6-10.2), albumin of 3.0 g/dl (3.5-5.0), corrected calcium of 9.8 mg/dl, serum 25-hydroxy vitamin D level of 22.4 ng/ml (30-100), creatinine of 1.11 mg/dl (0.49-1.01), and lactate dehydrogenase (LDH) of 344 U/L (140-271).
The patient had not undergone a prior mammogram. A CT angiography (CTA) was performed, which ruled out any pulmonary embolus. There was no evidence of a pulmonary embolus, or pulmonary nodules, or infiltrates. However, the CTA revealed right hilar lymphadenopathy of 1.3 cm in size and subcarinal lymphadenopathy of 1.1 cm (Figures , ).
A CT of the abdomen revealed a cystic mass of the left retroperitoneum measuring 14 x 11 x 6 cm. The official radiology report suggested that it was of a benign etiology, which could include cystic lymphangioma, mesenteric cyst, or duplication cyst. A cystic neoplasm was considered unlikely in the radiology report. The patient was placed on broad-spectrum antibiotics, including vancomycin, cefepime, metronidazole, and azithromycin as well as intravenous fluids to treat a possible unknown infective source while awaiting cultures and further investigation. It was initially thought that a respiratory or abdominal source was the possible infective foci, which guided the selection of antibiotics.
The infectious disease team suspected an intrabdominal or lung infective etiology. An initial differential by the infectious diseases specialists, aside from infection, also included lymphoma and autoimmune processes such as sarcoidosis. The pulmonology team later advised that there was no evidence of pneumonia or tracheobronchitis. The hematology team emphasized the need to rule out lymphoma. Blood cultures, sputum cultures, and urine cultures were all negative. Antibiotics were initially tapered to ceftriaxone and metronidazole and then completely discontinued on day six. Drainage of the abdominal cyst revealed 250 mL of pale straw-colored serous fluid. Fluid chemistries were negative for an infectious or malignant etiology.
The patient underwent extensive investigation. Serum thyroid-stimulating hormone (TSH) levels, serum creatine kinase levels, serum HIV tests, rapid plasma reagin (RPR) test, an acute hepatitis panel, three acid-fast sputum stains, QuantiFERON®-TB Gold test, anti-SS-A antibody levels, anti-SS-B antibody levels, and urinalysis were all normal. She did, however, test positive for an antinuclear antibody (ANA) speckled+ pattern. The ANA titer was 1:320. The double-stranded DNA antibody levels were within the normal range at 49 Iu/ml (<200 Iu/ml). A bone marrow biopsy of the iliac crest showed no evidence of malignancy or acid-fast bacilli.
Surgery was consulted for an excisional lymph node biopsy of the left axillary lymph node. The sample was a solid tan nodular-appearing tissue measuring 2.0 x 1.5 x 1.0 cm. Biopsy revealed numerous non-caseating epithelioid granulomas present in the lymphoid tissue. Stains were negative for acid-fast bacilli and fungus. The biopsy results were consistent with sarcoidosis. Flow cytometry later showed no evidence of B or T cell lymphoma.
A tentative diagnosis of sarcoidosis was made. The granulomatous disease is seen only in sarcoidosis, tuberculosis, or fungal infections. The non-caseating granulomatous disease in the lymph nodes pointed most closely to sarcoidosis. The pulmonologist considered this to be a case of extrapulmonary sarcoidosis because only hilar nodes were involved without any lung parenchymal involvement. It was thought conceivable that the ANA elevation may have been related to sarcoidosis, although we agreed to continue to monitor the patient for other collagen vascular diseases.
During the hospitalization, the patient had daily high-grade fevers. The fevers were intermittent, daily, variable, and went from 38.4 to a high of 39.4 °C. The patient was also seen by ophthalmology, and she was diagnosed with blepharitis. No uveitis or episcleritis was noted. She was treated with eye drops containing steroids, antimicrobials, and artificial tears. She was started on prednisone 40 mg PO daily with outpatient follow-up. Her fever and ocular symptoms resolved. She was seen in an outpatient clinic prior to the onset of the coronavirus disease 2019 (COVID-19) pandemic and then moved to a different location.",What is the patient's score of Wells' criteria for Pulmonary Embolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [130, 'beats per minute'], 'Clinical signs and symptoms of Deep Vein Thrombosis': False, 'Malignancy with treatment within 6 months or palliative': False, 'Pulmonary Embolism is #1 diagnosis OR equally likely': False}",1.5,1.5,1.5,"
The criteria for the Wells' Criteria for Pulmonary Embolism score are listed below:

1. Clinical signs and symptoms of DVT: No = 0 points, Yes = +3 points
2. PE is #1 diagnosis OR equally likely: No = 0 points, Yes = +3 points
3. Heart rate > 100: No = 0 points, Yes = +1.5 points
4. Immobilization at least 3 days OR surgery in the previous 4 weeks: No = 0 points, Yes = +1.5 points
5. Previous, objectively diagnosed PE or DVT: No = 0 points, Yes = +1.5 points
6. Hemoptysis: No = 0 points, Yes = +1 point
7. Malignancy with treatment within 6 months or palliative: No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.
   
The Well's score for pulmonary embolism is currently 0.
Clinical signs and symptoms of DVT are repoted to be absent and so the total score remains unchanged, keeping the total score at 0. Whether Pulmonary Embolism is the #1 diagonsis or is equally likely to being the #1 diagnosis is not reported and so we assume this statement is false, keeping the total unchanged at 0.
The patient's heart rate is 130 beats per minute. The heart rate is more than 100 bpm, and so the score is increased by 1.5, making the total score, 0 + 1.5 = 1.5.
The report does not give an indication on whether the patient has had an immobilization for at least 3 days and so we assume this to be false.The report does not give an indication on whether the patient has had a surgery for the past 4 weeks and so we assume this to be false.Because the patient has not had an immobilization for at least 3 days, and the patient did not have a surgery in the past 4 weeks, the score remains at 1.5.
The report does not give an indication on if the patient has previously been diagnosed with deep vein thrombosis and so we assume this to be false.Because the patient has no previous diagnosis of pulmonary embolism (PE) or deep vein thrombosis (DVT), the score remains at 1.5.
Hemoptysis is not reported in the patient note and so we assume that it is missing from the patient, keeping the total score at 1.5.
Malignany with treatment within 6 months or palliative is reported to be absent and so the total score remains unchanged, keeping the total score at 1.5.
The patient's Well's score for pulmonary embolism is 1.5."
126,8,Wells' Criteria for Pulmonary Embolism,risk,decimal,usmle-9149,Extracted,"A 45-year-old man presents to the doctor’s office with shortness of breath, cough, and fatigue for 3 days. This has been progressively worsening. He has a medical history significant for chronic obstructive pulmonary disease and osteoarthritis. He takes albuterol, ipratropium and aspirin. He smoked 2 and a half packs per day, and had done so for the past 26 years. After ceasing tobacco use for 1 year, he has recently begun smoking again. The blood pressure is 138/88 mm Hg, the respiratory rate is 12/min, the heart rate is 76/min, and the pulse oximetry is 87% on room air. On physical examination, the patient appears disoriented and is only somewhat comprehensible. The pupils are equal, round, and reactive to light with extraocular movements intact. Cranial nerves VII-XII also intact. The auscultation of the heart is absent of murmur, rubs, or gallops. The auscultation of the lungs demonstrate audible rales in the bases bilaterally.",What is the patient's score of Wells' criteria for Pulmonary Embolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [76, 'beats per minute'], 'Pulmonary Embolism is #1 diagnosis OR equally likely': False}",0,0,0,"
The criteria for the Wells' Criteria for Pulmonary Embolism score are listed below:

1. Clinical signs and symptoms of DVT: No = 0 points, Yes = +3 points
2. PE is #1 diagnosis OR equally likely: No = 0 points, Yes = +3 points
3. Heart rate > 100: No = 0 points, Yes = +1.5 points
4. Immobilization at least 3 days OR surgery in the previous 4 weeks: No = 0 points, Yes = +1.5 points
5. Previous, objectively diagnosed PE or DVT: No = 0 points, Yes = +1.5 points
6. Hemoptysis: No = 0 points, Yes = +1 point
7. Malignancy with treatment within 6 months or palliative: No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.
   
The Well's score for pulmonary embolism is currently 0.
Clinical signs and symptoms of DVT are not reported and so we assume that this is missing from the patient, keeping the current total at 0. Whether Pulmonary Embolism is the #1 diagonsis or is equally likely to being the #1 diagnosis is not reported and so we assume this statement is false, keeping the total unchanged at 0.
The patient's heart rate is 76 beats per minute. The heart rate is less than 100 bpm, and so the score remains unchanged, keeping the total score at 0.
The report does not give an indication on whether the patient has had an immobilization for at least 3 days and so we assume this to be false.The report does not give an indication on whether the patient has had a surgery for the past 4 weeks and so we assume this to be false.Because the patient has not had an immobilization for at least 3 days, and the patient did not have a surgery in the past 4 weeks, the score remains at 0.
The report does not give an indication on if the patient has previously been diagnosed with deep vein thrombosis and so we assume this to be false.Because the patient has no previous diagnosis of pulmonary embolism (PE) or deep vein thrombosis (DVT), the score remains at 0.
Hemoptysis is not reported in the patient note and so we assume that it is missing from the patient, keeping the total score at 0.
Malignany with treatment within 6 months or palliative is not reported in the patient note and so we assume that this is absent for the patient, keeping the score at 0.
The patient's Well's score for pulmonary embolism is 0."
127,8,Wells' Criteria for Pulmonary Embolism,risk,decimal,pmc-7580750-1,Extracted,"A 12-year-old girl was referred to the dental department for the assessment of a long-standing nonhealing ulcer on the labial mucosa of the lower lip. The lesion was first observed by the patient 2 years ago; however, the lesion was brought to the notice of the parents 6 months back which prompted them to seek the treatment. The patient had no symptoms otherwise. The size of the ulcer has remained constant over the past 2 years. There was no history of cough, fever, hemoptysis, and weight loss. She did not have any systemic condition, had no history of allergy, and was not on any medications.
She had consulted two dental practitioners in her village and was treated conservatively with the help of topical medications over the past 6 months. The older prescriptions revealed the use of mucopain gel (benzocaine 1. P. 20%), zytee gel (benzalkonium chloride 0.02%, choline salicylate 9%), and candid mouth paint (clotrimazole 1%). However, there was no change (increase or decrease in the size of the ulcer) or improvement in her clinical condition for the past 6 months.
General physical examination revealed that she weighed 33 kg and was 150 cm tall. The calculated body mass index of 14.7 kg/m2 indicated that she was underweight. Vital signs (heart rate – 82 beats/min, respiratory rate – 16 breaths/min, blood pressure – 120/80 mmHg, body temperature – 98.6°F) were within the normal range. Submandibular and submental groups of lymph nodes were examined and they were nonpalpable and nontender.
Oral examination revealed a round nonhealing ulcer on the labial mucosa of the lower lip on the left side measuring 4 cm × 4 cm. The ulcer was grayish-white in color with irregular borders. The edges were thin and undermined with slight induration at the base []. There was no tenderness on palpation. An incisional biopsy was performed under local anesthesia. The microscopy section from the lower lip showed the hyperplastic squamous epithelium, multiple granulomas composed of epithelioid cells and Langhan's giant cells, surrounded by lymphocytes and plasma cells []. No caseous necrosis was seen in the biopsy sample obtained. A preliminary diagnosis of TB/sarcoidosis was made.
Blood tests revealed a normal erythrocyte sedimentation rate (18 mm in the 1st h). The serum angiotensin-converting enzyme level was 58.2 U/L. Interferon-gamma release assay (IGRA) (Quantiferon-TB [QFT]) was positive (3.43 IU/mL). Results of Mantoux test interpreted 48 h after tuberculin injection (10 T. U) revealed erythema of 16 mm and induration of 18 mm. The chest radiograph revealed the absence of foci of infection indicating no pulmonary involvement. Thus, the diagnosis of primary TB was confirmed.
Treatment with anti-tubercular drugs was initiated. The patient was prescribed isoniazid 150 mg, rifampin 300 mg, pyrazinamide 750 mg, and ethambutol 400 mg daily for 2 months. The second phase of the treatment consisted of isoniazid 150 mg and rifampin 300 mg daily for 4 months. Lesion almost resolved within 3 weeks of initiation of the treatment [].",What is the patient's score of Wells' criteria for Pulmonary Embolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [82, 'beats per minute'], 'Hemoptysis': False, 'Clinical signs and symptoms of Deep Vein Thrombosis': False, 'Pulmonary Embolism is #1 diagnosis OR equally likely': False}",0,0,0,"
The criteria for the Wells' Criteria for Pulmonary Embolism score are listed below:

1. Clinical signs and symptoms of DVT: No = 0 points, Yes = +3 points
2. PE is #1 diagnosis OR equally likely: No = 0 points, Yes = +3 points
3. Heart rate > 100: No = 0 points, Yes = +1.5 points
4. Immobilization at least 3 days OR surgery in the previous 4 weeks: No = 0 points, Yes = +1.5 points
5. Previous, objectively diagnosed PE or DVT: No = 0 points, Yes = +1.5 points
6. Hemoptysis: No = 0 points, Yes = +1 point
7. Malignancy with treatment within 6 months or palliative: No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.
   
The Well's score for pulmonary embolism is currently 0.
Clinical signs and symptoms of DVT are repoted to be absent and so the total score remains unchanged, keeping the total score at 0. Whether Pulmonary Embolism is the #1 diagonsis or is equally likely to being the #1 diagnosis is not reported and so we assume this statement is false, keeping the total unchanged at 0.
The patient's heart rate is 82 beats per minute. The heart rate is less than 100 bpm, and so the score remains unchanged, keeping the total score at 0.
The report does not give an indication on whether the patient has had an immobilization for at least 3 days and so we assume this to be false.The report does not give an indication on whether the patient has had a surgery for the past 4 weeks and so we assume this to be false.Because the patient has not had an immobilization for at least 3 days, and the patient did not have a surgery in the past 4 weeks, the score remains at 0.
The report does not give an indication on if the patient has previously been diagnosed with deep vein thrombosis and so we assume this to be false.Because the patient has no previous diagnosis of pulmonary embolism (PE) or deep vein thrombosis (DVT), the score remains at 0.
Hemoptysis is reported to be absent and so the total score remains unchanged, keeping the total score at 0.
Malignany with treatment within 6 months or palliative is not reported in the patient note and so we assume that this is absent for the patient, keeping the score at 0.
The patient's Well's score for pulmonary embolism is 0."
128,8,Wells' Criteria for Pulmonary Embolism,risk,decimal,pmc-8101672-1,Extracted,"A 15-year-old female presented to our emergency department with four episodes of generalized tonic-clonic seizures over the past 24 h. On examination, she was pale and drowsy, but devoid of any focal motor deficit. Her blood pressure was 130/80 mm Hg, pulse rate was 108/min, temperature was 36.8 degree Celsius, and random blood sugar level was 112 mg/dL. Two months prior to presenting to us, she started experiencing recurrent episodes of vague abdominal pain, which would last for several minutes to hours and resolve spontaneously. Two weeks earlier, she had a similar episode associated with acute urinary retention, for which she was treated with injection furosemide, injection amikacin, injection pantoprazole, and laxative elsewhere.
Evaluation in our hospital revealed anemia with hemoglobin of 9.2 g%, total white blood count of 10,300 cells/cu.mm, differential count showing 85% polymorphs, 13% lymphocytes, 2% eosinophils, and platelet count of 3.12 lakh cells/cu.mm. Peripheral smear study revealed normochromic normocytic anemia. Urinalysis was unremarkable. Her blood urea was 17 mg/dL and serum creatinine-1.1 mg/dL. Serum electrolytes showed presence of hyponatremia (Sodium = 103 mEq/dL) and hypokalemia (Potassium = 3.0 mEq/dL). Her magnesium was 3.9 mg/dL and phosphorus was 4.1 mg/dL. Initial computed tomography imaging of the brain was unremarkable.
She was euvolemic, and in view of acute severe symptomatic hyponatremia and hypokalemia, she was treated with intravenous 3% saline and potassium infusion. She was also initiated on intravenous phenytoin at a loading dose of 15 mg/kg followed by maintenance dose of 100 mg thrice a day for seizures. After 3 days of treatment, she recovered without any neurological deficit and her sodium and potassium levels gradually became normal.
Two days later, she developed status epilepticus again. Her electrolytes revealed sodium of 111 mEq/dL and potassium of 2.3 mEq/dL. She was again initiated on intravenous 3% saline and potassium supplements. She recovered without any neurological deficit. Her repeat urinalysis was normal.
Magnetic resonance imaging of the brain showed T2 fluid attenuated inversion recovery (FLAIR) hyperintensity in the right frontal lobe and subcortical U-fibers, in which case, the differentials thought of were posterior reversible encephalopathy, extra pontine myelinolysis, and post-ictal changes. However, in the absence of an acute rise in blood pressure and renal failure, posterior reversible encephalopathy was unlikely.
She was clinically euvolemic. Hyponatremia evaluation revealed serum sodium of 111 mEq/dL, serum osmolality of 244 mOsm/kg, urine osmolality of 440 mOsm/kg, urine sodium of 88 mEq/dL, serum uric acid of 2.8 mg/dL, serum creatinine of 0.9 mg/dL, serum cortisol of 15 mg/dL, and thyroid-stimulating hormone of 3.5 mIU/L. She was not on any diuretics. Hence, a diagnosis of syndrome of inappropriate anti-diuretic hormone (ADH) secretion was entertained. On evaluation, there was no evidence of any infection, organic neurological disorders, or malignancy. She was not on any antipsychotic therapy.
During the hospital stay, she continued to have muscle cramps with severe spasmodic episodes of abdominal pain, which now subsided on treatment with opioids. Ultrasonogram of the abdomen revealed sludge in the gall bladder, normal-sized kidneys, normal pelvicalyceal system, and a normal urinary bladder. Computed tomography of the abdomen revealed multiple tiny gall stones. Serum Amylase (275.9 U/L) and lipase (486.4 U/L) were elevated. During this episode of acute abdomen, her urine was noticed to have a reddish hue, which did not further change color on standing. Repeat urinalysis did not show any active sediments.
For the management of symptomatic gallstones, laparoscopic cholecystectomy was contemplated. Meanwhile, she again presented with acute abdominal pain and was treated with opioids. During this episode, her urine was noticed to be of port-wine color, which aroused a strong suspicion of porphyria. Hence we proceeded with the screening test for porphyria, i.e, the Watson Schwartz method which turned out to be positive [Figures and ] Also examination under ultraviolet lamp showed pink fluorescence at 410 nm. A 24-h urinary assay for porphobilinogen (PBG) and aminolevulinic acid (ALA) was done and they turned out to be normal, probably because it was done after the acute episode had subsided. However, with a strong suspicion of porphyria, analysis of the hydroxymethybilane synthase (HMBS) gene encoding HMBS was done using targeted next-generation sequencing. It revealed a heterozygous missense variant in exon 13 of the HMBS gene on chromosome 11 that resulted in the amino acid substitution of arginine for glycine at codon 280 (chr11:g. 118963657G>A; Depth of coverage: 60×) (p. Gly280Arg; ENST00000278715.3). The observed variant lies in the porphobilinogen deaminase and C-terminal domain of the HMBS protein and has previously been reported in a patient affected with acute intermittent porphyria, thus confirming the diagnosis in our patient.[] She was started on intravenous glucose following which she became better. Anticonvulsants were stopped. She was advised high carbohydrate diet with added salt, lifelong. She is currently doing well and is on an OPD basis follow-ups.",What is the patient's score of Wells' criteria for Pulmonary Embolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [108, 'beats per minute'], 'Pulmonary Embolism is #1 diagnosis OR equally likely': False}",1.5,1.5,1.5,"
The criteria for the Wells' Criteria for Pulmonary Embolism score are listed below:

1. Clinical signs and symptoms of DVT: No = 0 points, Yes = +3 points
2. PE is #1 diagnosis OR equally likely: No = 0 points, Yes = +3 points
3. Heart rate > 100: No = 0 points, Yes = +1.5 points
4. Immobilization at least 3 days OR surgery in the previous 4 weeks: No = 0 points, Yes = +1.5 points
5. Previous, objectively diagnosed PE or DVT: No = 0 points, Yes = +1.5 points
6. Hemoptysis: No = 0 points, Yes = +1 point
7. Malignancy with treatment within 6 months or palliative: No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.
   
The Well's score for pulmonary embolism is currently 0.
Clinical signs and symptoms of DVT are not reported and so we assume that this is missing from the patient, keeping the current total at 0. Whether Pulmonary Embolism is the #1 diagonsis or is equally likely to being the #1 diagnosis is not reported and so we assume this statement is false, keeping the total unchanged at 0.
The patient's heart rate is 108 beats per minute. The heart rate is more than 100 bpm, and so the score is increased by 1.5, making the total score, 0 + 1.5 = 1.5.
The report does not give an indication on whether the patient has had an immobilization for at least 3 days and so we assume this to be false.The report does not give an indication on whether the patient has had a surgery for the past 4 weeks and so we assume this to be false.Because the patient has not had an immobilization for at least 3 days, and the patient did not have a surgery in the past 4 weeks, the score remains at 1.5.
The report does not give an indication on if the patient has previously been diagnosed with deep vein thrombosis and so we assume this to be false.Because the patient has no previous diagnosis of pulmonary embolism (PE) or deep vein thrombosis (DVT), the score remains at 1.5.
Hemoptysis is not reported in the patient note and so we assume that it is missing from the patient, keeping the total score at 1.5.
Malignany with treatment within 6 months or palliative is not reported in the patient note and so we assume that this is absent for the patient, keeping the score at 1.5.
The patient's Well's score for pulmonary embolism is 1.5."
129,8,Wells' Criteria for Pulmonary Embolism,risk,decimal,pmc-4703166-1,Extracted,"A 37-year-old male presented to the emergency department (ED) in police custody for “medical clearance” before being taken to jail. The patient was approached by police officers for suspicion of selling illicit drugs. When approached by police he ran away and was witnessed to swallow several small plastic baggies suspected to contain heroin. He was apprehended and brought to the ED. On arrival, he was asymptomatic with a blood pressure 144/83mmHg, heart rate 67bpm, respiratory rate of 19bpm, oxygen saturation of 99% on room air and afebrile. A Glasgow coma score was 15 and he was alert and oriented to person, place and time. Patient had a negative review of systems. On physical examination pupils were 4mm and reactive to light, lungs clear to auscultation and had normal respiratory rate with normal cardiovascular exam. Abdomen was soft, non-tender and non-distended with present bowel sounds. The patient admitted to ingesting approximately 20 packets of heroin to avoid being charged with possession. The patient declined activated charcoal and whole bowel irrigation (WBI) with polyethylene glycol-electrolyte solution (PEG-ELS). The patient declined a urine toxicology immunoassay screen. A computed tomography (CT) of his abdomen with contrast was obtained and read as normal except for a cluster of foreign bodies within the distal stomach likely contained within a plastic bag ( and ).",What is the patient's score of Wells' criteria for Pulmonary Embolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [67, 'beats per minute'], 'Clinical signs and symptoms of Deep Vein Thrombosis': False, 'Immobilization for at least 3 days': False, 'Malignancy with treatment within 6 months or palliative': False, 'Pulmonary Embolism is #1 diagnosis OR equally likely': False, 'Hemoptysis': False}",0,0,0,"
The criteria for the Wells' Criteria for Pulmonary Embolism score are listed below:

1. Clinical signs and symptoms of DVT: No = 0 points, Yes = +3 points
2. PE is #1 diagnosis OR equally likely: No = 0 points, Yes = +3 points
3. Heart rate > 100: No = 0 points, Yes = +1.5 points
4. Immobilization at least 3 days OR surgery in the previous 4 weeks: No = 0 points, Yes = +1.5 points
5. Previous, objectively diagnosed PE or DVT: No = 0 points, Yes = +1.5 points
6. Hemoptysis: No = 0 points, Yes = +1 point
7. Malignancy with treatment within 6 months or palliative: No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.
   
The Well's score for pulmonary embolism is currently 0.
Clinical signs and symptoms of DVT are repoted to be absent and so the total score remains unchanged, keeping the total score at 0. Whether Pulmonary Embolism is the #1 diagonsis or is equally likely to being the #1 diagnosis is not reported and so we assume this statement is false, keeping the total unchanged at 0.
The patient's heart rate is 67 beats per minute. The heart rate is less than 100 bpm, and so the score remains unchanged, keeping the total score at 0.
The report does not give an indication on whether the patient has had a surgery for the past 4 weeks and so we assume this to be false.Because the patient has not had an immobilization for at least 3 days, and the patient did not have a surgery in the past 4 weeks, the score remains at 0.
The report does not give an indication on if the patient has previously been diagnosed with deep vein thrombosis and so we assume this to be false.Because the patient has no previous diagnosis of pulmonary embolism (PE) or deep vein thrombosis (DVT), the score remains at 0.
Hemoptysis is reported to be absent and so the total score remains unchanged, keeping the total score at 0.
Malignany with treatment within 6 months or palliative is reported to be absent and so the total score remains unchanged, keeping the total score at 0.
The patient's Well's score for pulmonary embolism is 0."
130,8,Wells' Criteria for Pulmonary Embolism,risk,decimal,pmc-3250605-1,Extracted,"A 13 year-old boy presented with fever and not swollen discomfort of the right elbow without swelling and tenderness. Four months previously, he had been diagnosed to have Ewing sarcoma of the right ilium and had undergone five cycles of preoperative chemotherapy. He had contracted a C. tropicalis urinary tract infection during a febrile neutropenia episode after chemotherapy, which was treated with itraconazole and broad spectrum antibiotics for 7 days. No growth was reported in the last urine culture after itraconazole treatment. Recently, he had been on preoperative chemotherapy (vincristine, ifosfamide, doxorubicin, and etoposide), which he had completed 9 days prior to presentation.
At presentation, his body temperature was 37.5℃, pulse rate 120 per minute, respiration rate 20 per minute, and blood pressure 130/70 mmHg. physical examination revealed a slight throat infection, but no sinus tenderness, nor tonsilar nor lymph node enlargement. Heart and lung sounds were normal, liver and spleen were non-palpable, and no edema or pain was found in the lower extremities. He complained of discomfort of the right elbow. Laboratory tests revealed pancytopenia, and complete blood count findings were leukocytes 160/mm3, absolute neutrophil count 40/mm3, hemoglobin 9.4 g/dL, and platelet count 8,000/mm3. Broad-spectrum antibiotics (piperacilin/tazobactam and isepacin) were immediately administered after obtaining blood and urine for culture studies.
After two days of antibiotic treatment, mild tenderness and swelling (without heating sensation) were detected on the right elbow. A simple radiograph obtained on the 3rd hospital day revealed soft tissue swelling with a positive fat pad sign (). Ultrasonography on the 4th hospital day showed soft tissue edema and articular effusion, and subsequently, 15 mL of yellowish fluid was aspirated from the joint and cultured (). A three phase bone scan () performed on the 6th hospital day for the differential diagnosis of tumor metastasis and infection showed a limited region of uptake on the right elbow, suggesting the possibility of arthritis.
The symptoms and signs of arthritis aggravated despite a 10-day course of broad-spectrum antibiotics. On the 11th hospital day, cultures of synovial fluid and tissue demonstrated the presence of C. tropicalis. However, blood and urine culture specimens were negative. Follow-up right upper elbow ultrasonography on the 11th hospital day showed elbow articular space effusion and hypertrophic synovium. Emergent decompression was performed on the same day, and a drain tube was placed in the right elbow articular space. During the operation, 2 mL of a yellowish-red turbid synovial fluid sample was obtained and submitted for culture, which later confirmed the presence of C. tropicalis. In addition, abdominal computed tomography on the same day showed no evidence of hepato-splenic candidiasis.
Intraveneous itraconazole 400 mg/day (5 mg/kg/day) was started on the 11th and 12th days. Intravenous itraconazole was decreased to 200 mg/day on the 13th day and then kept at the same dose. Fever, joint swelling, and arthralgia gradually resolved after itraconazole treatment, and after 2 weeks of intravenous itraconazole treatment on the 25th hospital day. Intravenous itraconazole 200 mg/day was substituted for oral itraconazole solution at 200 mg/day.
The antifungal treatment was maintained for three months, and from 14 days after treatment commencement the patient had no elbow pain and was without disability. Furthermore, no relapse of the fungal arthritis occurred during oral itraconazole therapy. Simple radiography and a bone scan carried out after 3 months of antifungal treatment showed no abnormal lesion related to septic arthritis, and oral itraconazole was discontinued.",What is the patient's score of Wells' criteria for Pulmonary Embolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [120, 'beats per minute'], 'Malignancy with treatment within 6 months or palliative': True, 'Pulmonary Embolism is #1 diagnosis OR equally likely': False, 'Clinical signs and symptoms of Deep Vein Thrombosis': False}",2.5,2.5,2.5,"
The criteria for the Wells' Criteria for Pulmonary Embolism score are listed below:

1. Clinical signs and symptoms of DVT: No = 0 points, Yes = +3 points
2. PE is #1 diagnosis OR equally likely: No = 0 points, Yes = +3 points
3. Heart rate > 100: No = 0 points, Yes = +1.5 points
4. Immobilization at least 3 days OR surgery in the previous 4 weeks: No = 0 points, Yes = +1.5 points
5. Previous, objectively diagnosed PE or DVT: No = 0 points, Yes = +1.5 points
6. Hemoptysis: No = 0 points, Yes = +1 point
7. Malignancy with treatment within 6 months or palliative: No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.
   
The Well's score for pulmonary embolism is currently 0.
Clinical signs and symptoms of DVT are repoted to be absent and so the total score remains unchanged, keeping the total score at 0. Whether Pulmonary Embolism is the #1 diagonsis or is equally likely to being the #1 diagnosis is not reported and so we assume this statement is false, keeping the total unchanged at 0.
The patient's heart rate is 120 beats per minute. The heart rate is more than 100 bpm, and so the score is increased by 1.5, making the total score, 0 + 1.5 = 1.5.
The report does not give an indication on whether the patient has had an immobilization for at least 3 days and so we assume this to be false.The report does not give an indication on whether the patient has had a surgery for the past 4 weeks and so we assume this to be false.Because the patient has not had an immobilization for at least 3 days, and the patient did not have a surgery in the past 4 weeks, the score remains at 1.5.
The report does not give an indication on if the patient has previously been diagnosed with deep vein thrombosis and so we assume this to be false.Because the patient has no previous diagnosis of pulmonary embolism (PE) or deep vein thrombosis (DVT), the score remains at 1.5.
Hemoptysis is not reported in the patient note and so we assume that it is missing from the patient, keeping the total score at 1.5.
Malignany with treatment within 6 months or palliative is reported to be present and so one point is added to the score, making the total score 1.5 + 1 =  2.5.
The patient's Well's score for pulmonary embolism is 2.5."
131,8,Wells' Criteria for Pulmonary Embolism,risk,decimal,pmc-8294994-1,Extracted,"A 58-year-old Caucasian woman with a past medical history of stage IV colon cancer being treated actively with FOLFOX and bevacizumab presented to the emergency department (ED) with complaint of left-sided chest pain and left shoulder pain which started over a year ago but acutely increased in intensity and frequency over the past three weeks. The pain was inconsistently worse with position, associated with dyspnea, left-sided neck pain, and belching, without fever, chills, cough, abdominal pain, nausea, vomiting, diarrhea, dysphagia, melena, or hematochezia. Her last chemotherapy treatment was five days prior. She was initially diagnosed with the cancer 2.5 years ago with metastasis to the liver and was treated initially with diverting colostomy and chemotherapy with bevacizumab, later modified to include FOLFOX. The patient denied nonsteroidal anti-inflammatory drug (NSAID) use or alcohol or illicit drug abuse.
In the ED, initial vital signs showed blood pressure 174/83 mmHg, heart rate 101/minute, respiratory rate 24/minute, SpO2 97% on room air, temperature 96.9°F. Physical examination was unremarkable except for decreased breath sounds and regular tachycardia. Labs showed hemoglobin (16 g/dL), alkaline phosphatase (299 U/L), and negative urine drug screen. Serial troponins six hours apart were negative, and initial ECG showed sinus rhythm without ischemic changes. Thoracic CT angiogram ruled out pulmonary embolism and showed pneumopericardium, gastropericardial fistula, and three liver lesions suspicious for metastatic disease, as shown in .
A transthoracic echocardiogram showed a left ventricular (LV) ejection fraction of 55-60%, no valvular disease, and a normal pulmonary pressure and suggested the presence of pericardial air due to significant acoustic attenuation in otherwise previously normal windows. A barium swallow was performed with no visible esophageal stricture or ulceration, but the field of view did not include the stomach.
An EGD was done and showed a normal esophagus and 3 cm penetrating gastric cardia ulcer with surrounding edema and nonbleeding vessel in the center; biopsy was negative for dysplasia, metaplasia, malignancy, or H. pylori.
Surgical intervention was performed by cardiothoracic and general surgery teams, including median sternotomy, laparotomy, intraoperative transesophageal echocardiogram (TEE) to delineate the area of ulceration, posterior pericardial debridement of tissue adhesions, gastric ulcer resection and primary repair with omental patch, gastrojejunostomy feeding tube insertion, diaphragmatic patch with mesh, pericardial washout, and pericardial/pleural chest tube placement. She was transferred to the intensive care unit (ICU) and placed on total parenteral nutrition. After a few days, she was discharged home without any postoperative complications.",What is the patient's score of Wells' criteria for Pulmonary Embolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [101, 'beats per minute'], 'Malignancy with treatment within 6 months or palliative': True, 'Pulmonary Embolism is #1 diagnosis OR equally likely': False, 'Surgery in the previous 4 weeks': False}",2.5,2.5,2.5,"
The criteria for the Wells' Criteria for Pulmonary Embolism score are listed below:

1. Clinical signs and symptoms of DVT: No = 0 points, Yes = +3 points
2. PE is #1 diagnosis OR equally likely: No = 0 points, Yes = +3 points
3. Heart rate > 100: No = 0 points, Yes = +1.5 points
4. Immobilization at least 3 days OR surgery in the previous 4 weeks: No = 0 points, Yes = +1.5 points
5. Previous, objectively diagnosed PE or DVT: No = 0 points, Yes = +1.5 points
6. Hemoptysis: No = 0 points, Yes = +1 point
7. Malignancy with treatment within 6 months or palliative: No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.
   
The Well's score for pulmonary embolism is currently 0.
Clinical signs and symptoms of DVT are not reported and so we assume that this is missing from the patient, keeping the current total at 0. Whether Pulmonary Embolism is the #1 diagonsis or is equally likely to being the #1 diagnosis is not reported and so we assume this statement is false, keeping the total unchanged at 0.
The patient's heart rate is 101 beats per minute. The heart rate is more than 100 bpm, and so the score is increased by 1.5, making the total score, 0 + 1.5 = 1.5.
The report does not give an indication on whether the patient has had an immobilization for at least 3 days and so we assume this to be false.Because the patient has not had an immobilization for at least 3 days, and the patient did not have a surgery in the past 4 weeks, the score remains at 1.5.
The report does not give an indication on if the patient has previously been diagnosed with deep vein thrombosis and so we assume this to be false.Because the patient has no previous diagnosis of pulmonary embolism (PE) or deep vein thrombosis (DVT), the score remains at 1.5.
Hemoptysis is not reported in the patient note and so we assume that it is missing from the patient, keeping the total score at 1.5.
Malignany with treatment within 6 months or palliative is reported to be present and so one point is added to the score, making the total score 1.5 + 1 =  2.5.
The patient's Well's score for pulmonary embolism is 2.5."
132,8,Wells' Criteria for Pulmonary Embolism,risk,decimal,usmle-7246,Extracted,"A 50-year-old man presents to the emergency department with pain and swelling of his right leg for the past 2 days. Three days ago he collapsed on his leg after tripping on a rug. It was a hard fall and left him with bruising of his leg. Since then the pain and swelling of his leg have been gradually increasing. Past medical history is noncontributory. He lives a rather sedentary life and smokes two packs of cigarettes per day. The vital signs include heart rate 98/min, respiratory rate 15/min, temperature 37.8°C (100.1°F), and blood pressure 100/60 mm Hg. On physical examination, his right leg is visibly swollen up to the mid-calf with pitting edema and moderate erythema. Peripheral pulses in the right leg are weak and the leg is tender. Manipulation of the right leg is negative for Homan’s sign.",What is the patient's score of Wells' criteria for Pulmonary Embolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [98, 'beats per minute'], 'Previously Documented Pulmonary Embolism': False, 'Immobilization for at least 3 days': False, 'Pulmonary Embolism is #1 diagnosis OR equally likely': False, 'Previously documented Deep Vein Thrombosis': False, 'Clinical signs and symptoms of Deep Vein Thrombosis': True}",3,3,3,"
The criteria for the Wells' Criteria for Pulmonary Embolism score are listed below:

1. Clinical signs and symptoms of DVT: No = 0 points, Yes = +3 points
2. PE is #1 diagnosis OR equally likely: No = 0 points, Yes = +3 points
3. Heart rate > 100: No = 0 points, Yes = +1.5 points
4. Immobilization at least 3 days OR surgery in the previous 4 weeks: No = 0 points, Yes = +1.5 points
5. Previous, objectively diagnosed PE or DVT: No = 0 points, Yes = +1.5 points
6. Hemoptysis: No = 0 points, Yes = +1 point
7. Malignancy with treatment within 6 months or palliative: No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.
   
The Well's score for pulmonary embolism is currently 0.
Clinical signs and symptoms of DVT are reported to be present and so three points are added to the score, making the current total 0 + 3 = 3. Whether Pulmonary Embolism is the #1 diagonsis or is equally likely to being the #1 diagnosis is not reported and so we assume this statement is false, keeping the total unchanged at 3.
The patient's heart rate is 98 beats per minute. The heart rate is less than 100 bpm, and so the score remains unchanged, keeping the total score at 3.
The report does not give an indication on whether the patient has had a surgery for the past 4 weeks and so we assume this to be false.Because the patient has not had an immobilization for at least 3 days, and the patient did not have a surgery in the past 4 weeks, the score remains at 3.
Because the patient has no previous diagnosis of pulmonary embolism (PE) or deep vein thrombosis (DVT), the score remains at 3.
Hemoptysis is not reported in the patient note and so we assume that it is missing from the patient, keeping the total score at 3.
Malignany with treatment within 6 months or palliative is not reported in the patient note and so we assume that this is absent for the patient, keeping the score at 3.
The patient's Well's score for pulmonary embolism is 3."
133,8,Wells' Criteria for Pulmonary Embolism,risk,decimal,pmc-2803837-1,Extracted,"An 80-year-old italian woman of Caucasian origin presented to the emergency room at the Catholic University of Rome with severe abdominal pain and bloody diarrhea. Her symptoms, which had developed over the last four months, consisted of unrelenting lower abdominal pain that began 30 minutes after eating and lasted for about three hours. It was unrelieved by bowel movements or changes in position. For this reason, the patient reduced her food intake, and her weight decreased by 5 kg. The day before admission, bloody diarrhea developed.
The patient had a history of arterial hypertension, hiatal hernia, bilateral hearing loss due to chronic otomastoiditis, and polyarthritis (cervical, dorsal, and lumbosacral spondylosis; bilateral osteoarthritis of the hip). She had undergone open surgical cholecystectomy for gallstones in 1959. In 1998, she was hospitalized for rectal bleeding caused by acute diverticulitis. In 2004, she was diagnosed with adenocarcinoma of the papilla of Vater and had a cephalic pancreaticoduodenectomy. The pathological examination revealed a moderately differentiated intestinal-type adenocarcinoma measuring 1.5 cm in diameter that had invaded the muscle layers of the duodenal wall. The margins were tumor-free, and two lymph nodes were negative for malignancy. During that hospitalization, she developed paroxysmal atrial fibrillation that was converted to a normal sinus rhythm with amiodarone. Her medications included zofenopril (7.5 mg/day), manidipine (10 mg/day), esomeprazole 20 mg/day, celecoxib (400-600 mg/day), and acetaminophen plus codeine (500 mg plus 30 mg/day). She had no known drug allergies.
During admission, she was alert and oriented with normal vital signs (blood pressure, 150/70 mm Hg; heart rate, 80 beats per minute; temperature, 36.8°C). The lower abdomen was tender, but there were no signs of peritonitis. Although the bowel sounds were decreased, passage of flatus and feces was normal. There was no palpable organomegaly. The patient's lungs were clear on auscultation and a systolic ejection murmur (2/6) was heard over her aortic area. Admission laboratory tests revealed: hemoglobin 12.1 g/dl; white-cell count 15,290/mm3 (neutrophils 86%); platelet count 317,000/mm3; total protein 5.6 g/dl; albumin 3.2 g/dl. Serum electrolytes, creatinine, glucose, bilirubin, alanine aminotransferase, gamma glutamyl transferase, and amylase levels were within normal limits, as were the prothrombin and partial thromboplastin time. Plain films of the abdomen revealed no free intraperitoneal air or air-fluid levels, and the chest x-ray excluded the presence of pneumonia or nodules. Immediately after admission she was placed on an NPO (nil per os) regimen with total parenteral nutrition, and within eight hours her symptoms completely disappeared.
Abdominal CT (Figure ) revealed a hypodense mass measuring 4 × 4 cm in the space between the vena cava and the aorta, at the level of the origin of the celiac trunk. The mass extended caudally for about 4 cm, enveloping the origin of the superior mesenteric artery, the left renal vein at its confluence into the inferior vena cava, and the origin of the right renal artery, and anteriorly to the confluence of the splenic and mesenteric veins. Enlarged lymph nodes (1 cm) were observed at the hepatic hilum and in the intercavoaortic and left para-aortic spaces. Thickened bowel loops were also seen. This picture was consistent with local recurrence of the neoplastic disease.
A week later, oral feedings were resumed and the patient once again experienced diffuse abdominal pain and diarrhea. The pain responded poorly to conventional analgesics (scopolamine 20 mg IV, acetaminophen 500 mg PO, tramadol 37.5 mg PO t.i.d., fentanyl 25 μg transdermally), but it disappeared promptly when oral feedings were withdrawn.
A duplex ultrasound examination was performed to assess the mesenteric circulation (Figure and Figure ). To the extent that it could be explored, the artery showed no evident stenoses on B-mode or color- and power-Doppler evaluation. The superior mesenteric artery was characterized by a high peak systolic velocity (283 cm/sec) that was consistent with vascular stenosis. Blood flow in the celiac artery was turbulent, and the peak systolic velocity was also high (118 cm/sec). The patient was started on subcutaneous enoxaparin (4000 U/day) and transdermal nitroglycerin (10 mg/day, from 08.00 to 20.00). Since oral feedings could not be resumed, a central venous catheter was inserted for prolonged parenteral nutrition.
In view of the tumor histotype and the age and general condition of the patient, there was no indication for systemic chemotherapy and the patient was transferred to a hospice. She remained pain-free without any form of analgesics and had a relatively good quality of life until her death three months later.",What is the patient's score of Wells' criteria for Pulmonary Embolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [80, 'beats per minute'], 'Clinical signs and symptoms of Deep Vein Thrombosis': False, 'Malignancy with treatment within 6 months or palliative': True, 'Pulmonary Embolism is #1 diagnosis OR equally likely': False}",1,1,1,"
The criteria for the Wells' Criteria for Pulmonary Embolism score are listed below:

1. Clinical signs and symptoms of DVT: No = 0 points, Yes = +3 points
2. PE is #1 diagnosis OR equally likely: No = 0 points, Yes = +3 points
3. Heart rate > 100: No = 0 points, Yes = +1.5 points
4. Immobilization at least 3 days OR surgery in the previous 4 weeks: No = 0 points, Yes = +1.5 points
5. Previous, objectively diagnosed PE or DVT: No = 0 points, Yes = +1.5 points
6. Hemoptysis: No = 0 points, Yes = +1 point
7. Malignancy with treatment within 6 months or palliative: No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.
   
The Well's score for pulmonary embolism is currently 0.
Clinical signs and symptoms of DVT are repoted to be absent and so the total score remains unchanged, keeping the total score at 0. Whether Pulmonary Embolism is the #1 diagonsis or is equally likely to being the #1 diagnosis is not reported and so we assume this statement is false, keeping the total unchanged at 0.
The patient's heart rate is 80 beats per minute. The heart rate is less than 100 bpm, and so the score remains unchanged, keeping the total score at 0.
The report does not give an indication on whether the patient has had an immobilization for at least 3 days and so we assume this to be false.The report does not give an indication on whether the patient has had a surgery for the past 4 weeks and so we assume this to be false.Because the patient has not had an immobilization for at least 3 days, and the patient did not have a surgery in the past 4 weeks, the score remains at 0.
The report does not give an indication on if the patient has previously been diagnosed with deep vein thrombosis and so we assume this to be false.Because the patient has no previous diagnosis of pulmonary embolism (PE) or deep vein thrombosis (DVT), the score remains at 0.
Hemoptysis is not reported in the patient note and so we assume that it is missing from the patient, keeping the total score at 0.
Malignany with treatment within 6 months or palliative is reported to be present and so one point is added to the score, making the total score 0 + 1 =  1.
The patient's Well's score for pulmonary embolism is 1."
134,8,Wells' Criteria for Pulmonary Embolism,risk,decimal,pmc-4119326-1,Extracted,"We report a case of 49-years-old male who received a kidney from a live unrelated donor since 7 years ago. During these seven years multiple low grade fevers was being appeared every year that healed without a diagnosis. On 29 May 2013, he presented with 39 °C fever associated with dysuria, oliguria, right lower quadrant abdominal pain, anorexia, cough and dyspnea. The patient had also history of diabetes mellitus, hypertension and gout. Blood pressure measured 130/90 mmHg, pulse rate 96 per minute, and respiratory rate 18 per minute. Laboratory tests were as follow: BUN= 19 mg/dl, Cr= 2 mg/dl, Na= 133 mEq/l, K=4.5 mEq/l, FBS=130 mg/dl, ESR= 50 mm/hour, CRP= 44.1 mg/dl, WBC= 5.8 ×106/µL, RBC= 4.02 × 106/µL, Hg= 11.3 g/dl, hematocrit= 33.6%, MCV 83.58 fl, and platelet= 171 × 106/µL. In sonography investigation, his kidney graft was 123×55 mm with normal parenchymal echo. The test for cytomegalovirus (CMV Ag-pp65) was negative and enterobacter growth was seen in the blood culture. In high resolution computed tomography (HRCT), an increase in heart size, mediastinum vascular swelling, reticular densities, septal thickness, bronchial wall thickness, mild bronchiectasis, patchy and nodular alveolar densities on the inferior lobe of both lungs were seen. Spiral CT scan showed micro-consolidation patchy lesions on the inferior lobe of both lungs (). Bronchoscopy showed hyper-vascularity in the trachea, and in broncho-alveolar lavage (BAL) growth of non-A, non-D streptococci were detected with no growth of acid fast bacilli or mycobacterium tuberculosis. After 17 days of antibiotic and antifungal therapy, his fever did not corrupt. Spirometry results, showed a decreased FEV1 to 75%. On June 23th, inferior lobe wedge resection of the left lung was performed. In macroscopic pathologic examinations, fragments of lung tissue measuring 5×2×2 cm and gray brown and soft tissue in serial cross sections were observed. Moreover, microscopic evaluations conducted on issue removed during a procedure (). Finally, the diagnosis of BOOP was reported with no evidence of malignancy. Sirolimus was withdrawn and cyclosporine was started and dosage of prednisolone was increased. His fever was discontinued and general condition as well as pulmonary symptoms were gradually improved.",What is the patient's score of Wells' criteria for Pulmonary Embolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [96, 'beats per minute'], 'Pulmonary Embolism is #1 diagnosis OR equally likely': False, 'Surgery in the previous 4 weeks': False}",0,0,0,"
The criteria for the Wells' Criteria for Pulmonary Embolism score are listed below:

1. Clinical signs and symptoms of DVT: No = 0 points, Yes = +3 points
2. PE is #1 diagnosis OR equally likely: No = 0 points, Yes = +3 points
3. Heart rate > 100: No = 0 points, Yes = +1.5 points
4. Immobilization at least 3 days OR surgery in the previous 4 weeks: No = 0 points, Yes = +1.5 points
5. Previous, objectively diagnosed PE or DVT: No = 0 points, Yes = +1.5 points
6. Hemoptysis: No = 0 points, Yes = +1 point
7. Malignancy with treatment within 6 months or palliative: No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.
   
The Well's score for pulmonary embolism is currently 0.
Clinical signs and symptoms of DVT are not reported and so we assume that this is missing from the patient, keeping the current total at 0. Whether Pulmonary Embolism is the #1 diagonsis or is equally likely to being the #1 diagnosis is not reported and so we assume this statement is false, keeping the total unchanged at 0.
The patient's heart rate is 96 beats per minute. The heart rate is less than 100 bpm, and so the score remains unchanged, keeping the total score at 0.
The report does not give an indication on whether the patient has had an immobilization for at least 3 days and so we assume this to be false.Because the patient has not had an immobilization for at least 3 days, and the patient did not have a surgery in the past 4 weeks, the score remains at 0.
The report does not give an indication on if the patient has previously been diagnosed with deep vein thrombosis and so we assume this to be false.Because the patient has no previous diagnosis of pulmonary embolism (PE) or deep vein thrombosis (DVT), the score remains at 0.
Hemoptysis is not reported in the patient note and so we assume that it is missing from the patient, keeping the total score at 0.
Malignany with treatment within 6 months or palliative is not reported in the patient note and so we assume that this is absent for the patient, keeping the score at 0.
The patient's Well's score for pulmonary embolism is 0."
135,8,Wells' Criteria for Pulmonary Embolism,risk,decimal,pmc-5837304-1,Extracted,"A 41-year-old female patient with a past medical history of bipolar disorder, cocaine use disorder, and tobacco use disorder, presented with increased respiratory distress and combativeness. On initial examination, her vital signs included a temperature of 100.9°F, heart rate of 140 beats per minute, respiratory rate of 30 breaths per minute and blood pressure of 103/66 mmHg. On physical examination, she was only able to speak in two-word sentences. There were bilateral coarse crackles all over the chest. She did not have any focal neurological deficits. Cardiovascular examination did not reveal abnormal heart sounds. Abdominal examination was unremarkable. The patient was immediately placed on a nonrebreather mask. However, the patient kept taking off her nonrebreather mask, continued to have worsening hypoxia, and eventually required tracheal intubation. Chest radiograph showed right upper lobe pneumonia (Figure ).
She was started on vancomycin, piperacillin-tazobactam and levofloxacin, and was transferred to the intensive care unit (ICU). Broad spectrum antibiotic therapy was chosen due to patient's critical condition and unclear etiology of the infecting pathogen. The patient had a white cell count of 11.8 x 103/microliter (µL) that trended to 2.2 x 103/µL, normal troponins, and a lactic acid of 1.8 mmol/Liter (L) initially that trended up to 2.5 mmol/L. Urine drug screen was positive for cocaine, benzodiazepine, and opiates. Urine Legionella antigen and Streptococcus pneumoniae antigen were negative. Influenza A was positive on rapid antigen testing and the patient was started on oseltamivir. This raised our concern for secondary bacterial pneumonia from MRSA as a complication of influenza virus infection. The patient had computed tomography (CT) of the chest that showed right upper, middle, and lower lobe consolidations with cystic destruction of the lung parenchyma (Figures , ).
Sputum culture and blood cultures grew MRSA that was sensitive to both vancomycin and clindamycin, confirming our diagnosis. Vancomycin had already been started on admission and was continued. Fluid resuscitation was also done early in the course, but eventually progressed to septic shock. The patient was then started on norepinephrine infusion and vasopressin infusion for blood pressure support. She then developed acute respiratory distress syndrome (ARDS). Her hypoxia became refractory to conventional ventilation, and extracorporeal membrane oxygenation (ECMO) was considered. She had a transesophageal echocardiogram which showed severe biventricular systolic dysfunction, global hypokinesis with an ejection fraction (EF) of 5%. Her cardiomyopathy was felt to be acute and related to sepsis. She was managed for septic and cardiogenic shock, and venous-arterial ECMO was started. She was also started on continuous renal replacement therapy (CRRT) for hypervolemia refractory to diuresis, inotropic and vasopressor support. A follow-up transthoracic echocardiogram (TTE) five days later showed that the EF recovered to 45%. She continued to remain intubated for 16 days and a repeat CT chest showed worsening and multiple cavitary lesions in the right lung (Figures , ).
A repeat TTE showed EF of 60% and normal left and right heart function. ECMO was stopped and she was decannulated on day 9, CRRT was stopped on day 9. Unfortunately, she did not tolerate withdrawal of ECMO and continued to deteriorate and became difficult to wean from the ventilator. Given her lack of response to vancomycin, she was switched to daptomycin and linezolid, and the vancomycin was discontinued. She did not improve with new antibiotic regimen, continued to accumulate volume, and could not tolerate being off CRRT that was resumed for volume removal. Her hypoxia continued to be refractory despite all efforts. The family eventually decided to transition to comfort care due to her poor prognosis.",What is the patient's score of Wells' criteria for Pulmonary Embolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [140, 'beats per minute'], 'Pulmonary Embolism is #1 diagnosis OR equally likely': False}",1.5,1.5,1.5,"
The criteria for the Wells' Criteria for Pulmonary Embolism score are listed below:

1. Clinical signs and symptoms of DVT: No = 0 points, Yes = +3 points
2. PE is #1 diagnosis OR equally likely: No = 0 points, Yes = +3 points
3. Heart rate > 100: No = 0 points, Yes = +1.5 points
4. Immobilization at least 3 days OR surgery in the previous 4 weeks: No = 0 points, Yes = +1.5 points
5. Previous, objectively diagnosed PE or DVT: No = 0 points, Yes = +1.5 points
6. Hemoptysis: No = 0 points, Yes = +1 point
7. Malignancy with treatment within 6 months or palliative: No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.
   
The Well's score for pulmonary embolism is currently 0.
Clinical signs and symptoms of DVT are not reported and so we assume that this is missing from the patient, keeping the current total at 0. Whether Pulmonary Embolism is the #1 diagonsis or is equally likely to being the #1 diagnosis is not reported and so we assume this statement is false, keeping the total unchanged at 0.
The patient's heart rate is 140 beats per minute. The heart rate is more than 100 bpm, and so the score is increased by 1.5, making the total score, 0 + 1.5 = 1.5.
The report does not give an indication on whether the patient has had an immobilization for at least 3 days and so we assume this to be false.The report does not give an indication on whether the patient has had a surgery for the past 4 weeks and so we assume this to be false.Because the patient has not had an immobilization for at least 3 days, and the patient did not have a surgery in the past 4 weeks, the score remains at 1.5.
The report does not give an indication on if the patient has previously been diagnosed with deep vein thrombosis and so we assume this to be false.Because the patient has no previous diagnosis of pulmonary embolism (PE) or deep vein thrombosis (DVT), the score remains at 1.5.
Hemoptysis is not reported in the patient note and so we assume that it is missing from the patient, keeping the total score at 1.5.
Malignany with treatment within 6 months or palliative is not reported in the patient note and so we assume that this is absent for the patient, keeping the score at 1.5.
The patient's Well's score for pulmonary embolism is 1.5."
136,8,Wells' Criteria for Pulmonary Embolism,risk,decimal,pmc-5039122-1,Extracted,"A 62-year-old man was admitted to our hospital. His vital signs were as follows: a blood pressure of 110/70 mm Hg, temperature of 38.4℃, heart rate of 115 beats/min, and respiration rate of 20 breaths/min. Bilateral costovertebral angle tenderness was noted. Laboratory data revealed a WBC count of 15,870/mm3, hemoglobin level of 9.6 g/dL, platelet count of 375,000/mm3, and CRP level of >12 mg/dL. Blood urea nitrogen, serum creatinine, alanine transaminase, and aspartate transaminase levels were within the normal range. Urinalysis showed a WBC count of 30–50/HPF with many bacteria and a red blood cell count of 5–10/HPF. A CT scan showed a multifocal decreased perfusion defect of both kidneys () with bladder distension. Urologic evaluation demonstrated a residual urine volume of 250 mL. Prostate-specific antigen levels were normal. He was therefore diagnosed with recurrent pyelonephritis and neurogenic bladder. An oral alpha blocking agent and intravenous ciprofloxacin (400 mg every 12 hours) were administered. Two days after readmission, his left lower flank pain persisted, despite a fentanyl patch (12 µg/h). Although there were no neurologic deficits, a neurosurgeon was consulted regarding his severe pain and the possibility of concomitant spinal disease. Magnetic resonance imaging (MRI) with gadolinium enhancement was performed, revealing epidural abscesses at L4–5 and paraspinal abscesses of the muscles at L3–S2 (). Ultrasound-guided aspiration of the paraspinal muscle layer was performed using an 18-gauge needle, and approximately 10 mL of yellow-white mucoid fluid was aspirated. The epidural abscesses were not drained, as there were no neurologic deficits. Cultures of blood and drained fluid revealed MSSA growth () with antimicrobial sensitivity identical to that of the initial culture. Urine cultures revealed growth of <1,000 colony forming units/mL, although the bacterial strain could not be identified. Transesophageal echocardiography revealed no evidence of infective endocarditis. Nafcillin was injected every 4 hours for 22 days. However, neutropenia occurred, and nafcillin was replaced with vancomycin for an additional 30 days. On day 57 after readmission, MRI showed the abscesses had decreased in size (). Residual urine volume was 40 mL, and no discomfort was observed. Laboratory data were nearly within the normal range (WBC count, 6,490/mm3; CRP level, 0.35 mg/dL). On day 59, he was discharged without neurologic sequelae and was prescribed ciprofloxacin (500 mg every 12 hours) until a repeat MRI showed no remnant abscesses.",What is the patient's score of Wells' criteria for Pulmonary Embolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [110, 'beats per minute'], 'Immobilization for at least 3 days': False, 'Clinical signs and symptoms of Deep Vein Thrombosis': False, 'Pulmonary Embolism is #1 diagnosis OR equally likely': False}",1.5,1.5,1.5,"
The criteria for the Wells' Criteria for Pulmonary Embolism score are listed below:

1. Clinical signs and symptoms of DVT: No = 0 points, Yes = +3 points
2. PE is #1 diagnosis OR equally likely: No = 0 points, Yes = +3 points
3. Heart rate > 100: No = 0 points, Yes = +1.5 points
4. Immobilization at least 3 days OR surgery in the previous 4 weeks: No = 0 points, Yes = +1.5 points
5. Previous, objectively diagnosed PE or DVT: No = 0 points, Yes = +1.5 points
6. Hemoptysis: No = 0 points, Yes = +1 point
7. Malignancy with treatment within 6 months or palliative: No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.
   
The Well's score for pulmonary embolism is currently 0.
Clinical signs and symptoms of DVT are repoted to be absent and so the total score remains unchanged, keeping the total score at 0. Whether Pulmonary Embolism is the #1 diagonsis or is equally likely to being the #1 diagnosis is not reported and so we assume this statement is false, keeping the total unchanged at 0.
The patient's heart rate is 110 beats per minute. The heart rate is more than 100 bpm, and so the score is increased by 1.5, making the total score, 0 + 1.5 = 1.5.
The report does not give an indication on whether the patient has had a surgery for the past 4 weeks and so we assume this to be false.Because the patient has not had an immobilization for at least 3 days, and the patient did not have a surgery in the past 4 weeks, the score remains at 1.5.
The report does not give an indication on if the patient has previously been diagnosed with deep vein thrombosis and so we assume this to be false.Because the patient has no previous diagnosis of pulmonary embolism (PE) or deep vein thrombosis (DVT), the score remains at 1.5.
Hemoptysis is not reported in the patient note and so we assume that it is missing from the patient, keeping the total score at 1.5.
Malignany with treatment within 6 months or palliative is not reported in the patient note and so we assume that this is absent for the patient, keeping the score at 1.5.
The patient's Well's score for pulmonary embolism is 1.5."
137,8,Wells' Criteria for Pulmonary Embolism,risk,decimal,usmle-9051,Extracted,"A 48-year-old woman presents with a 15-year history of long, painful menses that is only partially relieved with oral contraceptives. She desires definitive treatment. She denies weight loss or post-coital bleeding, and her husband has been her only sexual partner. She does not have a history of smoking, alcohol or illicit drug use, or sexually transmitted diseases. She sees her gynecologist annually. She takes no medications. An abdominal ultrasound shows a non-gravid uterus with hyperechoic islands and an irregular endometrial-myometrial junction, consistent with adenomyosis. A supracervical hysterectomy and left salpingo-oophorectomy are performed without incident. Later that day, the patient’s vitals are stable: temperature 36.8°C (98.2°F), heart rate 98/min, respiratory rate 15/min, blood pressure 100/75 mm Hg, breathing 100% oxygen on room air. The patient is not in acute distress with a Foley catheter in place. The physical exam is unremarkable. However, she has only excreted a minimal amount of urine output in the past several hours after surgery. Only 10cc or urine is produced over the next 12 hours. A bladder scan shows minimal residual urine. CBC, CMP, and urinalysis are ordered, and renal ultrasound is shown in the picture.",What is the patient's score of Wells' criteria for Pulmonary Embolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [98, 'beats per minute'], 'Pulmonary Embolism is #1 diagnosis OR equally likely': False, 'Immobilization for at least 3 days': False}",0,0,0,"
The criteria for the Wells' Criteria for Pulmonary Embolism score are listed below:

1. Clinical signs and symptoms of DVT: No = 0 points, Yes = +3 points
2. PE is #1 diagnosis OR equally likely: No = 0 points, Yes = +3 points
3. Heart rate > 100: No = 0 points, Yes = +1.5 points
4. Immobilization at least 3 days OR surgery in the previous 4 weeks: No = 0 points, Yes = +1.5 points
5. Previous, objectively diagnosed PE or DVT: No = 0 points, Yes = +1.5 points
6. Hemoptysis: No = 0 points, Yes = +1 point
7. Malignancy with treatment within 6 months or palliative: No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.
   
The Well's score for pulmonary embolism is currently 0.
Clinical signs and symptoms of DVT are not reported and so we assume that this is missing from the patient, keeping the current total at 0. Whether Pulmonary Embolism is the #1 diagonsis or is equally likely to being the #1 diagnosis is not reported and so we assume this statement is false, keeping the total unchanged at 0.
The patient's heart rate is 98 beats per minute. The heart rate is less than 100 bpm, and so the score remains unchanged, keeping the total score at 0.
The report does not give an indication on whether the patient has had a surgery for the past 4 weeks and so we assume this to be false.Because the patient has not had an immobilization for at least 3 days, and the patient did not have a surgery in the past 4 weeks, the score remains at 0.
The report does not give an indication on if the patient has previously been diagnosed with deep vein thrombosis and so we assume this to be false.Because the patient has no previous diagnosis of pulmonary embolism (PE) or deep vein thrombosis (DVT), the score remains at 0.
Hemoptysis is not reported in the patient note and so we assume that it is missing from the patient, keeping the total score at 0.
Malignany with treatment within 6 months or palliative is not reported in the patient note and so we assume that this is absent for the patient, keeping the score at 0.
The patient's Well's score for pulmonary embolism is 0."
138,8,Wells' Criteria for Pulmonary Embolism,risk,decimal,pmc-6020350-1,Extracted,"A 43-year old, asymptomatic woman was admitted to our hospital by her family doctor after receiving a chest-x-ray during routine clinical examination. The x-ray showed a mediastinal mass overlapping the aortic arch region (Fig. ). For verification a computed tomography (CT) was performed and revealed incidentally a type B dissection, which was most likely chronic without information of the index date, originating from an aneurysm of a left cervical arch with a maximum diameter of 6 cm (Fig. ). The left renal artery, the coeliac trunc and the main part of the superior mesenteric artery branched from the false lumen without a sign of malperfusion of the organs. Because of the huge diameter and the potential risk of rupture, an urgent surgical repair was planned. Before intervention the patient got a blood pressure adjustment by ACE inhibitor. Betablocker was not necessary because of a resting pulse of 60 beats per minute. For neurological online monitoring, sensitive and motor evoked potentials were monitored. Spinal drainage was installed 1 day before the procedure. Surgical access was carried out through median sternotomy and an additional left lateral thoracic incision through the fourth intercostal space (Hemi-Clemshell). Simultaneously to the preparation of the aneurysm, partial cardiopulmonary bypass was installed in the left groin by cannulation of the femoral artery and vein under echocardiographic guidance. During selective ventilation of the right side, the left lung was mobilized by transsection of the Ligamentum pulmonale and preparation of the perianeurysmatic tissue and adhesions. After identification and preparation of the recurrent and phrenic nerve and the supraaortal branches, the descending aorta was clamped and a distal anastomosis performed with a straight graft (20 mm). The visceral arteries partially branched from the false and true lumen without a sign of malperfusion. Before the final distal anastomosis, we performed a fenestration of the dissection membrane about a length of 5 cm to keep the perfusion of both lumina. The left carotid artery originated from the aortic arch with a distance of only 1 cm from the aneurysm. The left axillary artery branched directly from the aneurysm and was dissected and reimplanted with a separate 8 mm sidegraft to the 20 mm straight graft between the distal arch and proximal descending aorta. (Fig. ). The procedure was performed with partial cardiopulmonary bypass (CPB) of 87 min, aortic clamp time of 62 min under normothermic condition. The patient was extubated on first postoperative day and recovered well.
Biopsy of aortic tissue showed a picture consistent with arteriosclerosis and loss of smooth muscle cells, rupture of the elastic fibres and fibrosis of the media. The intima could not be visualized in detail.
The patient was discharged to cardiac rehabilitation at 13th postoperative day and recovered well. Last follow up with computed tomography was performed 3, 5 years after initial operation with a good and stable result of the dissection membrane and a perfusion of both lumina. The patient is able to resume a normal life without limitations.",What is the patient's score of Wells' criteria for Pulmonary Embolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [60, 'beats per minute'], 'Pulmonary Embolism is #1 diagnosis OR equally likely': False, 'Immobilization for at least 3 days': False, 'Surgery in the previous 4 weeks': False}",0,0,0,"
The criteria for the Wells' Criteria for Pulmonary Embolism score are listed below:

1. Clinical signs and symptoms of DVT: No = 0 points, Yes = +3 points
2. PE is #1 diagnosis OR equally likely: No = 0 points, Yes = +3 points
3. Heart rate > 100: No = 0 points, Yes = +1.5 points
4. Immobilization at least 3 days OR surgery in the previous 4 weeks: No = 0 points, Yes = +1.5 points
5. Previous, objectively diagnosed PE or DVT: No = 0 points, Yes = +1.5 points
6. Hemoptysis: No = 0 points, Yes = +1 point
7. Malignancy with treatment within 6 months or palliative: No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.
   
The Well's score for pulmonary embolism is currently 0.
Clinical signs and symptoms of DVT are not reported and so we assume that this is missing from the patient, keeping the current total at 0. Whether Pulmonary Embolism is the #1 diagonsis or is equally likely to being the #1 diagnosis is not reported and so we assume this statement is false, keeping the total unchanged at 0.
The patient's heart rate is 60 beats per minute. The heart rate is less than 100 bpm, and so the score remains unchanged, keeping the total score at 0.
Because the patient has not had an immobilization for at least 3 days, and the patient did not have a surgery in the past 4 weeks, the score remains at 0.
The report does not give an indication on if the patient has previously been diagnosed with deep vein thrombosis and so we assume this to be false.Because the patient has no previous diagnosis of pulmonary embolism (PE) or deep vein thrombosis (DVT), the score remains at 0.
Hemoptysis is not reported in the patient note and so we assume that it is missing from the patient, keeping the total score at 0.
Malignany with treatment within 6 months or palliative is not reported in the patient note and so we assume that this is absent for the patient, keeping the score at 0.
The patient's Well's score for pulmonary embolism is 0."
139,8,Wells' Criteria for Pulmonary Embolism,risk,decimal,pmc-8209631-1,Extracted,"A 59-year-old woman attended her General Practitioner (GP) with a 3-week history of lethargy, myalgia, pyrexia and night sweats. She had no significant past medical history and was not on any regular medications. Her most recent travel had been to Spain a few months previously, and she lived at home with her husband and dog, who were in good health. Her GP performed some blood tests, shown in , which prompted urgent referral for admission to hospital due to the notably raised white cell count and CRP.
In the Emergency Department the patient was pyrexic with a temperature of 39.4 °C. Otherwise, her observations were normal. She had no audible murmurs and the rest of her examination was unremarkable.
Chest X-ray was normal and ECG showed sinus rhythm with a rate of 76 beats per minute and first-degree AV block. One set of blood cultures and urine cultures were sent and she was started on IV piperacillin/tazobactam for pyrexia of unknown origin. She was tested for influenza by PCR of a nasopharyngeal swab, which was negative.
Transthoracic echocardiography (TTE), carried out on day 2 of admission, demonstrated a mass on the aortic valve, which was further characterized by trans-oesophageal echocardiography (TOE), identifying a 1.8×0.9 cm mass with thickening of the aortic root, suspicious for root abscess.
On day 2 of admission, when the TTE raised the suspicion of endocarditis, she had seven further sets of blood cultures sent over a period of 72 h and was changed to IV amoxicillin 2 g 4 hourly, and gentamicin 3 mg kg−1 OD, as empirical treatment for native valve infective endocarditis.
She was transferred to cardiac surgery on day 4 of admission and underwent aortic valve replacement surgery (). Procedure note from Cardiothoracics as follows: ‘Via oblique aortotomy, tri-leaflet valve was seen with a huge vegetation and perforation at the annulus. There was a small abscess cavity in the annulus at the non-coronary cusp. The native valve was excised, and the cavity was debrided easily, with rifampicin washout. A size 21 Inspiris Reslia bioprosthetic valve was implanted in annular position with 15× Ethibond 2/0 interrupted technique (5 Teflon pledgeted at the Non coronary cusp area). Aorta closed in single layer, using Haemoseal pledgeted sutures. De-aired. Cross-clamp off. Right Ventricular pacing wire inserted and checked. Weaned off Cardio-Pulmonary Bypass. Good valve function with no paravalvular leak and adequate de-airing confirmed on Trans-oesophageal ECHO. Mediastinal and pericardial drains inserted. Protamine given, haemostasis checked/effected.’
The valve was sent by the cardiac surgeons to the microbiology laboratory for culture, and sent away for 16s PCR testing. It was not sent to histopathology.
On day 5 of admission, the aerobic bottle of the first set of blood cultures taken flagged positive after being incubated in Bact T/Alert 3-D (bioMérieux, France) for 3.5 days. Gram-negative rods were observed on Gram stain (). Given this information, the patient’s antibiotics were changed to ceftriaxone, vancomycin and gentamicin, whilst waiting for culture and identification of this organism. Subculture on Columbia blood agar yielded fine smooth, creamy white and non-haemolytic colonies. Species identification was performed using Vitek MS [matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS)], which confirmed the organism as C. carnimorsus. As there were no recommended European Committee on Antimicrobial Susceptibility Testing (EUCAST) antibiotic breakpoints, E-test strips were set up and minimum inhibitory concentrations (MICs) were measured against EUCAST PK-PD (non-species-related) breakpoints. This organism was susceptible to gentamicin, ceftriaxone, penicillin, ciprofloxacin and meropenem. The remaining sets of blood cultures were all negative after 5 days of incubation.
Given the identification of this organism, the patient’s antibiotic therapy was changed to Meropenem, Vancomycin and Gentamicin pending susceptibility testing. The heart valve was cultured and was negative after 7 days of incubation in enrichment broth. The valve was also sent to the Public Health England reference laboratory for 16S rDNA real-time PCR identification. Report: this identified species, with data indicating a 99 % sequence homology to C. cynodegmi, C. canimorsus and C. stomatis, providing robust evidence to confirm the responsible pathogen. The patient’s treatment was, therefore, targeted towards C. canimorusus, based on the antibiotic susceptibility test results () obtained through E-test, which were interpreted using EUCAST non-species-specific PK-PD breakpoints. Her antibiotic therapy was changed to IV benzylpenicillin, to complete 4 weeks of treatment.
The patient improved clinically and was discharged home after completion of treatment and a repeat ECHO prior to discharge showed normal left ventricular function and prosthetic aortic valve, with a repeat ECHO and follow-up planned in 1 year.",What is the patient's score of Wells' criteria for Pulmonary Embolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [76, 'beats per minute'], 'Surgery in the previous 4 weeks': False, 'Immobilization for at least 3 days': False, 'Malignancy with treatment within 6 months or palliative': False, 'Pulmonary Embolism is #1 diagnosis OR equally likely': False}",0,0,0,"
The criteria for the Wells' Criteria for Pulmonary Embolism score are listed below:

1. Clinical signs and symptoms of DVT: No = 0 points, Yes = +3 points
2. PE is #1 diagnosis OR equally likely: No = 0 points, Yes = +3 points
3. Heart rate > 100: No = 0 points, Yes = +1.5 points
4. Immobilization at least 3 days OR surgery in the previous 4 weeks: No = 0 points, Yes = +1.5 points
5. Previous, objectively diagnosed PE or DVT: No = 0 points, Yes = +1.5 points
6. Hemoptysis: No = 0 points, Yes = +1 point
7. Malignancy with treatment within 6 months or palliative: No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.
   
The Well's score for pulmonary embolism is currently 0.
Clinical signs and symptoms of DVT are not reported and so we assume that this is missing from the patient, keeping the current total at 0. Whether Pulmonary Embolism is the #1 diagonsis or is equally likely to being the #1 diagnosis is not reported and so we assume this statement is false, keeping the total unchanged at 0.
The patient's heart rate is 76 beats per minute. The heart rate is less than 100 bpm, and so the score remains unchanged, keeping the total score at 0.
Because the patient has not had an immobilization for at least 3 days, and the patient did not have a surgery in the past 4 weeks, the score remains at 0.
The report does not give an indication on if the patient has previously been diagnosed with deep vein thrombosis and so we assume this to be false.Because the patient has no previous diagnosis of pulmonary embolism (PE) or deep vein thrombosis (DVT), the score remains at 0.
Hemoptysis is not reported in the patient note and so we assume that it is missing from the patient, keeping the total score at 0.
Malignany with treatment within 6 months or palliative is reported to be absent and so the total score remains unchanged, keeping the total score at 0.
The patient's Well's score for pulmonary embolism is 0."
140,8,Wells' Criteria for Pulmonary Embolism,risk,decimal,pmc-6984815-1,Extracted,"An 80-year-old male with past medical history of hypertension, dyslipidemia, and diabetes mellitus non-compliant to the prescribed medications, presented to the emergency department with 1-hour complaint of right-sided chest pain that was described as aching, non-radiating, without any aggravating or relieving factors, 10/10 in intensity, and was accompanied by nausea and two episodes of maroon-colored emesis. The patient denied any ingestion of toxic substances and any prior similar episodes. On presentation, the patient was afebrile, and blood pressure of 109/45, heart rate 75, respiratory rate of 18, and room air oximetry of 98%. Physical examination, including fundoscopy was unrevealing. Labs workup revealed serum sodium of 125 mEq/L [135-145 mEq/L], potassium 5.1 mEq/L [3.5-5.0 mEq/L], chloride 91 mEq/L [98-107 mEq/L], bicarbonate 24 mEq/L [21-24 mEq/L], urea 145,7 mg/dL [14.9 – 51.4 mg/dL], creatinine 2.95 mg/dL [0.6-1.30 mg/dL], blood glucose 492 mg/dL [70-110], WBC 13.5 [4.5-11.0 × 103/mm3], Hb 12.3 g/dL [13.5-17.5 g/dL], platelets 242,000/mm3 [140k-440k/mm3], BNP 154 pg/mL [125-450 pg/mL], and troponin 0.062 ng/mL [0.01-0.30 ng/mL]. Electrocardiogram showed normal sinus rhythm at the rate of 94 beats per minute without ST or T-wave abnormalities. Morphine was administered along with nitroglycerine for the chest pain without any improvement in symptoms. Therefore, given the persistent chest pain and concern for non-ST-segment elevation myocardial infarction, the patient was started on a heparin drip and antiplatelet therapy in the emergency department. Cardiology was consulted who performed a cardiac catheterization which did not show any critical stenosis with an estimated ejection fraction of 55%. They recommended medical therapy including anti-hypertensives, statin, and blood glucose control. The computed tomography of the abdomen and pelvis without contrast was unremarkable. Gastroenterology was then consulted due to abdominal symptoms of nausea, vomiting, and hematemesis. Patient underwent an esophagogastroduodenoscopy (EGD), which showed circumferential, black-appearing, necrotic esophageal mucosa without active bleeding extending from the mid to distal esophagus (). There was also mild chronic gastritis without any evidence of active bleeding. The patient was treated with a proton pump inhibitor and sucralfate. Patient had an uneventful hospital course lasting 5 days and was discharged with close follow up.",What is the patient's score of Wells' criteria for Pulmonary Embolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [75, 'beats per minute'], 'Pulmonary Embolism is #1 diagnosis OR equally likely': False}",0,0,0,"
The criteria for the Wells' Criteria for Pulmonary Embolism score are listed below:

1. Clinical signs and symptoms of DVT: No = 0 points, Yes = +3 points
2. PE is #1 diagnosis OR equally likely: No = 0 points, Yes = +3 points
3. Heart rate > 100: No = 0 points, Yes = +1.5 points
4. Immobilization at least 3 days OR surgery in the previous 4 weeks: No = 0 points, Yes = +1.5 points
5. Previous, objectively diagnosed PE or DVT: No = 0 points, Yes = +1.5 points
6. Hemoptysis: No = 0 points, Yes = +1 point
7. Malignancy with treatment within 6 months or palliative: No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.
   
The Well's score for pulmonary embolism is currently 0.
Clinical signs and symptoms of DVT are not reported and so we assume that this is missing from the patient, keeping the current total at 0. Whether Pulmonary Embolism is the #1 diagonsis or is equally likely to being the #1 diagnosis is not reported and so we assume this statement is false, keeping the total unchanged at 0.
The patient's heart rate is 75 beats per minute. The heart rate is less than 100 bpm, and so the score remains unchanged, keeping the total score at 0.
The report does not give an indication on whether the patient has had an immobilization for at least 3 days and so we assume this to be false.The report does not give an indication on whether the patient has had a surgery for the past 4 weeks and so we assume this to be false.Because the patient has not had an immobilization for at least 3 days, and the patient did not have a surgery in the past 4 weeks, the score remains at 0.
The report does not give an indication on if the patient has previously been diagnosed with deep vein thrombosis and so we assume this to be false.Because the patient has no previous diagnosis of pulmonary embolism (PE) or deep vein thrombosis (DVT), the score remains at 0.
Hemoptysis is not reported in the patient note and so we assume that it is missing from the patient, keeping the total score at 0.
Malignany with treatment within 6 months or palliative is not reported in the patient note and so we assume that this is absent for the patient, keeping the score at 0.
The patient's Well's score for pulmonary embolism is 0."
141,9,MDRD GFR Equation,lab test,decimal,pmc-6007257-1,Extracted,"A 55-year-old female patient was examined in the emergency department with abdominal pain that had been persistent for ~10 days and having been aggravated for the last 3–4 days. Her past history was notable for diabetes mellitus (DM) for ~25 years. Additionally, she had undergone a coronary by-pass operation 10 years ago and a left infrapatellar amputation 4 years ago. Chronic renal failure had been diagnosed 2 years ago and she had been receiving hemodialysis treatment three times a week for the last 1 year. She had no history of abdominal trauma. Laboratory tests resulted with; White Blood Cell: 15 100/mm3, Hemoglobin: 8.5 g/dL, C-reactive protein: 40 mg/dL, Urea: 37.9 mg/dL, Creatinine: 2.25 mg/dL, Albumin: 2.4 g/dL, Sodium: 134 mmol/L, Potassium: 3.1 mmol/L, Calcium: 7.9 mg/dL, Glucose: 329 mg/dL and other biochemical parameters were normal. The abdomen was diffusely tender, and she also had guarding and rebound tenderness during the physical examination. Blood temperature was 38.7°C. An abdominal ultrasonography (US) showed diffuse intraabdominal free fluid collection. On an abdominal computed tomography (CT) there were free fluid collections in all abdominal quadrants; there also existed intraabdominal minimal free air images. There were air-fluid images in the splenic parenchyma (abscess?, perforation?) (Fig. a). The radiology department reported that it may be a gastrointestinal perforation. Based on the current findings, the patient was urgently operated according for a preliminary diagnosis of acute abdomen. Intraabdominal seropurulent fluid of ~2000 ml was aspirated perioperatively. There were diffuse fibrin matrixes in the entire peritoneum. No intestinal perforation was noted during exploration. There was a perforated abscess pouch with a size of ~8 × 6 cm2, which expanded posteriorly from splenic hilus and partly contained necrotic foci (Fig. b). Splenectomy and drainage were performed and the abdominal cavity was irrigated with abundant isotonic saline. Patient was postoperatively monitored in intubated state at intensive care unit. No proliferation occurred in her blood culture. Escherichia coli was isolated from the abscess culture, however, and Meropenem 500 mg I. V. (three times a day) and Metronidazole 500 mg I. V. (three times a day) treatment was commenced as recommended by the infectious diseases department. Her dialysis program was maintained according to blood parameters. The patient died on postoperative Day 25 due to septic shock and multiple organ failure. Histopathologic examination revealed suppurative inflammation and abscess formation of the splenic tissue (Fig. ). Informed consent was obtained from her son who participated in this case.","Using the MDRD GFR Equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? If the patient is black, please use the MDRD GFR Equation for Blacks. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [55, 'years'], 'creatinine': [2.25, 'mg/dL'], 'sex': 'Female'}",22.5803,21.45128,23.70932,"The patient's estimated GFR is calculated using the MDRD equation as:
GFR = 175 * creatinine^(-1.154) * age^(-0.203) * race_coefficient * gender_coefficient. The creatinine concentration is mg/dL. The race coefficient is 1.212 if the patient is Black and 1.0 otherwise. The gender coefficient is 0.742 if the patient is female and 1.0 otherwise.
The patient is 55 years old. The concentration of Creatinine is 2.25 mg/dL. 
The race of the patient is not provided, so the default value of the race coefficient is 1.0.
The patient is female, so the gender coefficient is 0.742.
Plugging in these values will give us: 175 * 2.25^(-1.154) * 55^(-0.203) * 1 * 0.742=22.5803.
Hence, the patient's GFR is 22.5803 mL/min/1.73m²."
142,9,MDRD GFR Equation,lab test,decimal,pmc-6902272-1,Extracted,"A 73-year-old Caucasian male presented with longstanding chronic kidney disease (CKD) G2
related to arterial hypertension stage II. Past medical history: prostate cancer and
monoclonal gammopathy of undetermined significance (MGUS) IgG k, rosacea dermatitis, right
hand arthritis.
Laboratory tests () showed normal
complete blood count (CBC), normal serum calcium value, creatinine 1.4 mg/dL, B type
natriuretic peptide (BNP) 161 pg/mL, proteinuria 946 mg/24 h, albuminuria 200 mg/dL. His
serum protein electrophoresis (SPEP) and immunofixation (IFE) revealed a monoclonal IgG k
M-protein at 2 g/dL. Twenty-four-hour urine protein electrophoresis (UPEP) demonstrated
positive k light chain proteinuria, Bence Jones Proteinuria (BJP). Kappa serum free light
chain (FLC) was 126 mg/dL (normal range 0,330-1,940 mg/dL) and lambda serum FLC was 0.858
mg/dL (normal range 0.571-2.630 mg/dL) with kappa/lambda ratio at 146 (normal range
0.26-1.65).
Bone skeletal survey didn’t detect osteolytic bone lesion.
Bone marrow biopsy revealed plasmocytosis with scatted CD138+ plasma cells at 30% (Congo
red staining not evaluated). We assessed amyloidosis as a concomitant CKD’s cause:
Congo red staining test on fat pad biopsy was positive. Immunogold on fat pad sample
revealed transthyretin (ATTR) and serum amyloid A (SAA) amyloidosis. We screened for genetic
mutations: the patient was affected by wild type form of the disease (wtATTR) ().
The patient didn’t have systemic AL amyloidosis. The value of FLC ratio above 100
was confirmed in serial testing. This is an IMWG criteria for treatment (FLC ratio >100 with
concomitant FLC k >100 mg/L), but in this case, treatment was delayed and FLC ratio
monitored.
In clinical practice it is a common error to assume AL primary amyloidosis in patients
presenting with monoclonal gammopathy. Rheumatologic assessment in order to identify
underlying cause of SAA amyloid will be needed, considering patient history of rosacea
dermatitis and hand arthritis. As a result of the correct diagnosis being made, the
prognosis was much more favorable. It is known the high prevalence of coexistent MGUS with
ATTR amyloidosis in the elderly population. The incidence of MGUS in wild type TTR cardiac
amyloidosis is 23%; moreover, it could be not uncommon to discover a plasma cell
disorder in patients with SAA amyloid, given the increasing incidence of both conditions
with chronic inflammatory disease.","Using the MDRD GFR Equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? If the patient is black, please use the MDRD GFR Equation for Blacks. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [73, 'years'], 'creatinine': [1.4, 'mg/dL'], 'sex': 'Male', 'Race': 'White'}",49.67659,47.19276,52.16042,"The patient's estimated GFR is calculated using the MDRD equation as:
GFR = 175 * creatinine^(-1.154) * age^(-0.203) * race_coefficient * gender_coefficient. The creatinine concentration is mg/dL. The race coefficient is 1.212 if the patient is Black and 1.0 otherwise. The gender coefficient is 0.742 if the patient is female and 1.0 otherwise.
The patient is 73 years old. The concentration of Creatinine is 1.4 mg/dL. 
The patient is not Black, so the race coefficient is defaulted to 1.0.
The patient is male, so the gender coefficient is 1.
Plugging in these values will give us: 175 * 1.4^(-1.154) * 73^(-0.203) * 1 * 1=49.67659.
Hence, the patient's GFR is 49.67659 mL/min/1.73m²."
143,9,MDRD GFR Equation,lab test,decimal,pmc-6691829-1,Extracted,"A 70-year-old man was admitted to the hospital because he had been suffering from edema of the lower extremities for 1 month. He had a 5-year history of renal dysfunction, bile duct stenosis, and an inflammatory pancreatic mass. Additionally, 5 years prior to the presentation, he had a baseline serum creatinine level of 200 μmol/L. At that time, the patient had undergone choledochal stent implantation. Three years ago, the stent had been removed, and he had begun to take oral prednisone 30 mg/day. The bile duct stenosis and pancreatic mass had been successfully eliminated, so the prednisone treatment had been discontinued 3 months prior to presentation. In the past month, he had experienced rapid progression of renal function. His medical history also included hypertension and diabetes. With the exception of bilateral lower limb edema, the findings from the physical examination conducted at the time of presentation were unremarkable.
Laboratory tests showed that his white blood cell count was 5.06 × 109/L; hemoglobin, 87 g/L; platelet count, 126 × 109/L; CRP, 30.23 mg/L; erythrocyte sedimentation rate, 80 mm/H; serum nitrogen, 32.79 mmol/L; serum creatinine, 555.8 μmol/L; and serum albumin, 32.7 g/L. He had normal liver function with normal amylase and lipase levels. Urine analysis showed that the protein level was 2+; red blood cell count, 80/μL; urine gravity, 1.010; urinary albumin/creatinine ratio, 330; 24-h urine protein, 0.98–1.22 g; and urine neutrophil gelatinase-associated lipocalin (NGAL), 236 ng/mL.
Immunological tests showed that the concentrations of serum C3 (complement 3) and serum C4 (complement 4) were lower than normal at 0.355 and <0.066 g/L respectively. Further, the patient had polyclonal hypergammaglobulinemia, as the total serum immunoglobulin G (IgG) level had increased to 31.7 g/L. However, the serum IgA and IgM concentrations were normal. The patient was negative for anti-self-antibodies, including antinuclear antibody, anti-double-stranded antibody, anti-Sjogren’s syndrome A antibody, anti-Sjogren’s syndrome B antibody, anti-proteinase 3, and anti-myeloperoxidase anti-neutrophil cytoplasmic antibody. Analysis of the IgG subtypes showed that the serum IgG1 level and the serum IgG4 level were obviously elevated at 23.7 g/L (4.90–11.40) and 10.90 g/L (0.08–1.40), respectively. The mCRP autoantibodies level was also elevated at 64.25%.
Kidney ultrasound examination showed that both kidneys were of normal size (10.6 × 5.2 cm and 10.6 × 5.6 cm), with uniform echo frequency and clear corticomedullary boundaries; moreover, there were no mass lesions. Chest computed tomography showed that there were multiple nodules in the both lungs. The abdominal radiography findings were unremarkable.
The renal biopsy specimen exhibited severe tubulointerstitial changes, but the glomerulus shows no specific finding (). In particular, storiform fibrosis () and inflammatory cells infiltration including plasma cells () were marked in the interstitium. Immunofluorescence staining revealed that IgM, IgA, and C3 were present at low levels in the granular mesangial area. Electron microscopy demonstrated that there were no electron-dense deposits in the glomeruli. Immunohistochemical staining showed that most plasma cells in the interstitium were positive for CD138, and there were seven IgG4-positive plasma cells and thirteen IgG-positive plasma cells in the same area of serial sections). So, the percentage of IgG4-positive plasma cells among the total IgG-positive plasma cells was 53%.
We prescribed 25 mg/day oral prednisone and 0.6 g of cyclophosphamide (CTX) every month by intravenous infusion. The patient had been followed up for 6 months at the time of writing this paper. In the most recent follow-up examination, the serum creatinine level had decreased to 194 μmol/L, the serum C3 and serum C4 levels had increased to 0.668 and 0.209 g/L, respectively, and were close to normal, the serum IgG1 level was normal at 10.2 g/L, and the IgG4 level had considerably decreased to 3.72 g/L. Therefore, the dose of prednisone was decreased to 12.5 mg/day, and the cumulative dose of CTX was 3.6 g until to the time of writing this paper. Changes in renal function, as indicated by the serum creatinine level, during the follow-up are depicted in .","Using the MDRD GFR Equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? If the patient is black, please use the MDRD GFR Equation for Blacks. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [70, 'years'], 'creatinine': [555.8, 'µmol/L'], 'sex': 'Male'}",8.77541,8.33664,9.21418,"The patient's estimated GFR is calculated using the MDRD equation as:
GFR = 175 * creatinine^(-1.154) * age^(-0.203) * race_coefficient * gender_coefficient. The creatinine concentration is mg/dL. The race coefficient is 1.212 if the patient is Black and 1.0 otherwise. The gender coefficient is 0.742 if the patient is female and 1.0 otherwise.
The patient is 70 years old. The concentration of Creatinine is 555.8 µmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of Creatinine from µmol to mg. The mass of Creatinine is 555.8 µmol. To convert 555.8 µmol of Creatinine to mol, multiply by the conversion factor 1e-06, giving us 555.8 µmol Creatinine * 1e-06 mol/µmol = 0.00056 mol Creatinine. To convert from mol Creatinine to grams, multiply by the molar mass 113.12 g/mol, which will give 0.00056 mol Creatinine * 113.12 g/mol = 0.06335 g Creatinine. To convert 0.06335 g of Creatinine to mg, multiply by the conversion factor 1000.0, giving us 0.06335 g Creatinine * 1000.0 mg/g = 63.35 mg Creatinine. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 63.35 mg Creatinine/10.0 dL = 6.335 mg Creatinine/dL. The concentration value of 555.8 µmol Creatinine/L converts to 6.335 mg Creatinine/dL. 
The race of the patient is not provided, so the default value of the race coefficient is 1.0.
The patient is male, so the gender coefficient is 1.
Plugging in these values will give us: 175 * 6.335^(-1.154) * 70^(-0.203) * 1 * 1=8.77541.
Hence, the patient's GFR is 8.77541 mL/min/1.73m²."
144,9,MDRD GFR Equation,lab test,decimal,pmc-4652317-1,Extracted,"A 24-year-old man was admitted to our hospital with the signs of advanced chronic renal failure (CRF) in 2006. In his past history, he had developed kidney and bladder stones since he was 5-year-old. In his family history, his sister exhibited an elevated urine Ox concentration and his brother presented with kidney stones and renal failure. Unfortunately, they refused to cooperate with physicians to perform required tests until transplantation. Immediately in 1st day of admission, blood urea nitrogen (BUN) and serum creatinine (Cr) were determined 165 and 16.5 mg/dl, respectively, and also protein and glucose were detected in urine. The diagnostic findings indicate shrunken hyper-echogenic kidneys with hydronephrosis. Multiple stones with different sizes were observed in calyces of both kidneys. The bladder wall was thickened (4.7 mm), and urinalysis did not reveal any crystals. The patient underwent hemodialysis (HD) three times per week for 4 months. Four months after admission, the patient underwent bilateral nephrectomy. Based on the findings obtained in bilateral radical nephrectomy, chronic pyelonephritis with nephrolithiasis was confirmed. Microscopic examination revealed glomerulosclerosis and tubulointerstitial fibrosis. About 2 years later (September 2008), the patient underwent living kidney transplantation with a diagnosis of ESRD. The primary graft function was acceptable? but 3 days after transplantation, the urine output suddenly dropped to 30-50 cc a day. Therefore, a renal biopsy was taken. Tissue sections containing glomeruli and tubules were obtained. The following histopathological data were gathered: The glomeruli showed no conspicuous changes, mild to moderate atrophy with mononuclear inflammatory cells and occasional eosinophilic infiltration of interstitium, some tubules contained marked Ox crystals, and some contained granular and white blood cells casts. Following the acute rejection, anti-thymocyte globulin (ATG) was administered for the patient. After few days of ATG administration, the drug was discontinued because of fever. The possibility of PH1 was considered when a lot of Ox crystals were observed in the renal allograft biopsy and also by ruling out the other causes of hyperoxaluria. Therefore, pyridoxine therapy was commenced (dose, interval, and route of admin).
In January 2009, the patient's serum Cr and BUN levels were 4.8 and 38 mg/dl, respectively. The patient's computed tomography (CT) scan and radiography demonstrated cardiomegaly, bilateral pleural effusion with congestion, and calcification at the right pulmonary hilum and parenchyma. The molecular diagnostic polymerase chain reaction test revealed the persistence of cytomegalovirus. After few months, the patient refused to continue the treatment and finally he died 1-year later.","Using the MDRD GFR Equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? If the patient is black, please use the MDRD GFR Equation for Blacks. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [24, 'years'], 'creatinine': [16.5, 'mg/dL'], 'sex': 'Male'}",3.61309,3.43244,3.79374,"The patient's estimated GFR is calculated using the MDRD equation as:
GFR = 175 * creatinine^(-1.154) * age^(-0.203) * race_coefficient * gender_coefficient. The creatinine concentration is mg/dL. The race coefficient is 1.212 if the patient is Black and 1.0 otherwise. The gender coefficient is 0.742 if the patient is female and 1.0 otherwise.
The patient is 24 years old. The concentration of Creatinine is 16.5 mg/dL. 
The race of the patient is not provided, so the default value of the race coefficient is 1.0.
The patient is male, so the gender coefficient is 1.
Plugging in these values will give us: 175 * 16.5^(-1.154) * 24^(-0.203) * 1 * 1=3.61309.
Hence, the patient's GFR is 3.61309 mL/min/1.73m²."
145,9,MDRD GFR Equation,lab test,decimal,pmc-6485150-1,Extracted,"A 94-year old woman presented with high fever associated with decreased oral intake and appetite loss and was admitted to our institute. She had been diagnosed as having diabetes mellitus, mild chronic kidney disease, chronic heart failure and stayed at a nursing home. She was a wheelchair-user. At the initial presentation, the patient had a body temperature of 40.2 °C, blood pressure of 183/81 mmHg, and pulse of 74 beats per min. Hypoxemia was not confirmed. The physical examination was unremarkable. Chest X-ray and urine test were normal. Laboratory tests revealed an elevation of blood urea nitrogen 23.8 mg/dl, creatinine 1.14 mg/dl and C-reactive protein 1.93 mg/dl. Platelet count was low at 105,000/μl. White cell count, hemoglobin and liver function tests were within normal range as shown in supplementary file. Two sets of blood cultures for aerobic and anaerobic bacteria, mycobacteria and fungi were drawn. Then, the patient was started empirically on meropenem and teicoplanin for broad-spectrum antibiotic coverage. In addition to blood cultures, a urinalysis with culture and a chest X-ray and CT were performed and found to be normal. The patient had no clinically evident sites of infection by history or physical examination. On day 2, a coryneform organism was recovered for 32 h by BACTEC (BD, Tokyo, Japan) from both the aerobic and anaerobic tubes of all blood cultures. Brevibacterium species were identified by Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). The score value was 2.36. On gram-stained smears from the culture plates, the organisms appeared as Gram-positive, club-shaped, slightly curved rods, and some coccal forms were present (Fig. a). The bacteria were subcultured on Trypticase Soy Agar II with 5% Sheep Blood (BD, Tokyo, Japan) at 35 °C in 5% CO2, which resulted in a gray-white, smooth, non-hemolytic colonies after a 48-incubation (Fig. b). Subsequently, genetic investigation by 16S ribosomal RNA analysis was performed in order to identify the organism. Finally, the result identified this pathogen as Brevibacterium paucivorans with 99.5% homology on the Ez taxon database ().
For comparison of a hydrolysis of casein in the organism, we obtained a type strain of B. casei, JCM 2594T and of B. paucivorans, JCM 11567T, from the Japan Collection of Microorganisms (JCM). Pyrazinamidase test was performed using PZA broth (Kyokuto Pharmaceutical Inc., Tokyo, Japan). Casein hydrolysis test was performed as follows. 1) inoculate the organism on a skim milk agar, 2) incubate the plate at 37 °C, 3) examine the plate for zone of hydrolysis following incubation. Both the organism and JCM 11567T showed a lack of hydrolysis of casein, while a hydrolysis of casein was confirmed in JCM 2594T as shown in Fig. . The organism had an absence of pyrazinamidase, while JCM 2594T showed a presence of pyrazinamidase. Additional microbiological tests by API 50CH showed that utilization of D-arabinose and gluconate was negative. These results were consistent with the organism as B. paucivorans. Antimicrobial susceptibility testing revealed that the organism was susceptible to MEPM. Although the peripheral venous catheter site showed no erythema or tenderness, the catheter was removed without culture, and a follow-up blood culture remained negative after therapy lasting for 7 days. The patient’s fever finally abated and labs were also improved. On day 14, the antibiotic therapy was discontinued. On day 28 from admission, fever recurred and blood cultures were performed. Candida parapsilosis was isolated by 2 sets of blood cultures, and she was diagnosed as having candidemia. While L-AMB was started for Candida parapsilosis bacteremia, she died by candidemia on day 35.
Antimicrobial susceptibility testing was performed for the strain using the broth microdilution method (Dry Plate®, Eiken Chemical co., Ltd., Tokyo, Japan) according to the Clinical and Laboratory Standards Institute guidelines []. The isolate was susceptible to gentamicin [minimum inhibitory concentration (MIC) = 1 μg/ml], ciplofloxacin (MIC = 0.25 μg/ml), vancomycin (MIC≦0.5 μg/ml), meropenem (MIC≦0.5 μg/ml) and rifampicin (MIC≦0.12 μg/ml), and was resistant to clindamycin (MIC> 4 μg/ml), and was intermediately resistant to ceftriaxone (MIC = 2 μg/ml),and cefepim (MIC = 2 μg/ml) as shown in Table .","Using the MDRD GFR Equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? If the patient is black, please use the MDRD GFR Equation for Blacks. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [94, 'years'], 'creatinine': [1.14, 'mg/dL'], 'sex': 'Female'}",44.38424,42.16503,46.60345,"The patient's estimated GFR is calculated using the MDRD equation as:
GFR = 175 * creatinine^(-1.154) * age^(-0.203) * race_coefficient * gender_coefficient. The creatinine concentration is mg/dL. The race coefficient is 1.212 if the patient is Black and 1.0 otherwise. The gender coefficient is 0.742 if the patient is female and 1.0 otherwise.
The patient is 94 years old. The concentration of Creatinine is 1.14 mg/dL. 
The race of the patient is not provided, so the default value of the race coefficient is 1.0.
The patient is female, so the gender coefficient is 0.742.
Plugging in these values will give us: 175 * 1.14^(-1.154) * 94^(-0.203) * 1 * 0.742=44.38424.
Hence, the patient's GFR is 44.38424 mL/min/1.73m²."
146,9,MDRD GFR Equation,lab test,decimal,pmc-4381148-1,Extracted,"A 65-year-old woman was referred for colonoscopy because of abdominal pain and hematochezia. She had a history of end-stage renal disease, hypertension, and diabetes mellitus. She underwent hemodialysis three times per week. The patient's hemodynamic parameters were stable. On physical examination, she was found to have right abdominal pain and tenderness. Laboratory tests revealed a white blood cell (WBC) count of 13,900/mm2, a hemoglobin level of 9.4 g/dL, and a platelet count of 228,000/mm2. Serum biochemistry showed creatinine level, 6.6 mg/dL; albumin level, 3.0 g/dL; alanine aminotransferase level, 36 IU/L; aspartate aminotransferase level, 38 IU/L; bilirubin level, 1.2 mg/dL; and alkaline phosphatase level, 198 IU/L with normal electrolytes. Serum was negative for antinuclear antibody and HIV antibody. Anemia was associated with chronic renal failure. On stool examination, negative results were obtained for stool WBC, stool culture, and Clostridium difficile toxin A/B. The electrocardiogram showed normal results. An esophagogastroduodenoscopy revealed no evidence of bleeding. Colonoscopy was performed after standard bowel preparation and under sedation with 3 mg of midazolam. The colonoscopic findings showed diffuse bowel wall edema. Upon examination of the distal transverse colon, we found several deep linear red mucosal breaks resembling scratches ().
In the ascending colon, dark purple edematous mucosa and necrotic epithelial lesions were found (). Cecal intubation was not performed because of severe ischemic changes with necrosis. The remaining colorectal mucosa was grossly normal. Computed tomography (CT) scan showed moderate-to-severe diffuse bowel wall thickening and focally decreased mucosal enhancement in the right colon. The patient was diagnosed with ischemic colitis based on colonoscopic and CT findings, and clinical manifestations. The patient thus received supportive care. Intravenous fluids were administered to treat dehydration, and total parenteral nutrition with prophylactic antibiotics was provided. The patient was placed on bowel rest until the symptoms resolved. After 3 weeks, follow-up colonoscopy and CT were performed. On follow-up colonoscopy, the previous severe ischemic colonoscopic findings had disappeared, and ischemic mucosal change showed further resolution (). No further mucosal tearing was observed during the follow-up colonoscopy. On CT scans, improvement in ischemic colitis was noted. The patient no longer complained of abdominal pain or hematochezia.","Using the MDRD GFR Equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? If the patient is black, please use the MDRD GFR Equation for Blacks. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [65, 'years'], 'creatinine': [6.6, 'mg/dL'], 'sex': 'Female'}",6.30474,5.9895,6.61998,"The patient's estimated GFR is calculated using the MDRD equation as:
GFR = 175 * creatinine^(-1.154) * age^(-0.203) * race_coefficient * gender_coefficient. The creatinine concentration is mg/dL. The race coefficient is 1.212 if the patient is Black and 1.0 otherwise. The gender coefficient is 0.742 if the patient is female and 1.0 otherwise.
The patient is 65 years old. The concentration of Creatinine is 6.6 mg/dL. 
The race of the patient is not provided, so the default value of the race coefficient is 1.0.
The patient is female, so the gender coefficient is 0.742.
Plugging in these values will give us: 175 * 6.6^(-1.154) * 65^(-0.203) * 1 * 0.742=6.30474.
Hence, the patient's GFR is 6.30474 mL/min/1.73m²."
147,9,MDRD GFR Equation,lab test,decimal,pmc-7787914-1,Extracted,"A 78-year-old man with a history of hepatitis C and surgical resection of HCC was followed up for end-stage renal disease (ESRD) due to diabetes. The patient’s medical history included hepatic steatosis, hypertension, diabetes mellitus type 2 and ESRD. He had been prescribed metformin, pantoprazole, enalapril, felodipine, metoprolol. The patient was a non-smoker and non-drinker. At the age of 74 years, the patient was introduced to our hospital for HCC surgery (). His physical examination on admission was unremarkable. Liver enzymes and function tests, namely bilirubin (0.44 mg/dL), albumin (4.0 mg/dL), and International Normalized Ratio (1.06) were within the normal range, while creatinine was slightly elevated at 1.74 mg/dL. The patient underwent right lobectomy of the liver for HCC, and dialysis was initiated after surgery. At 5 months after the hepatic resection, computed tomography and chest radiography revealed multiple tumors in the lung, indicating metastatic disease (). At that time, serum protein induced by vitamin K absence or antagonist II (PIVKA-II) was abnormally elevated (648 mAU/mL). The serum alpha fetoprotein (AFP) level was 5.7 ng/mL. The patient did not receive any anticancer therapy because of his ESRD and the advanced stage of HCC. We subsequently followed up on his natural course with serial imaging. Chest radiography revealed an increase in the size and number of lung metastases, and tumor markers were significantly elevated 4 months after recurrence (AFP, 1198 ng/mL; PIVKA-II, 214155 mAU/mL). However, 13 months after recurrence, the metastatic lesions suddenly decreased in size and number without receiving any specific treatment or herbal medicine (). Follow-up imaging showed no evidence of disease progression, and tumor makers were significantly decreased (AFP, <1.0 ng/mL; PIVKA-II, 46 mAU/mL) (). There were no signs of new lesions on imaging or an increase in tumor markers over 41 months after the recurrence.","Using the MDRD GFR Equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? If the patient is black, please use the MDRD GFR Equation for Blacks. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [78, 'years'], 'creatinine': [1.74, 'mg/dL'], 'sex': 'Male'}",38.13722,36.23036,40.04408,"The patient's estimated GFR is calculated using the MDRD equation as:
GFR = 175 * creatinine^(-1.154) * age^(-0.203) * race_coefficient * gender_coefficient. The creatinine concentration is mg/dL. The race coefficient is 1.212 if the patient is Black and 1.0 otherwise. The gender coefficient is 0.742 if the patient is female and 1.0 otherwise.
The patient is 78 years old. The concentration of Creatinine is 1.74 mg/dL. 
The race of the patient is not provided, so the default value of the race coefficient is 1.0.
The patient is male, so the gender coefficient is 1.
Plugging in these values will give us: 175 * 1.74^(-1.154) * 78^(-0.203) * 1 * 1=38.13722.
Hence, the patient's GFR is 38.13722 mL/min/1.73m²."
148,9,MDRD GFR Equation,lab test,decimal,pmc-1847820-1,Extracted,"A 40-year-old para four obese Caucasian woman with two-year history of lower abdominal pain was referred from a peripheral hospital for the further management of bilateral adnexal masses. The computerised tomography (CT) scan of abdomen and pelvis revealed a complex cystic lesion of 7–8 cm in the right adnexum and bilateral ureteric obstruction. All baseline blood tests including haematology and tumour markers (CA 125 -26 IU/ml) were normal. The serum tests showed normal liver function and moderately impaired renal function with a creatinine concentration of 10 mg/dL and urea >200 mg/dL.
She had a complex medical history including obstructive sleep apnoea, asthma, glaucoma, hypothyroidism, hypertensive cardiomyopathy and bipolar disorder; registered disabled. She also had a copper intra uterine contraceptive device in situ for the past three years. Given her body habitus (BMI 42), abdominal and pelvic examination was difficult and non-specific. The only finding of relevance was bilateral adnexal fullness.
She was managed within the gynaecological oncology multi disciplinary framework (MDT). On reviewing the CT films the features noted include bilateral basal pleural thickening, bilateral hydronephrosis, retroperitoneal lymphadenopathy associated with retroperitoneal fibrosis and bilateral adnexal cystic masses. There was a small volume of ascites.
Magnetic resonance imaging (MRI) was performed for further characterisation of the adnexal masses. The right adnexal complex cystic lesion measured 8 × 7 × 7 cm in diameter and had a thick wall (up to 2 cm), which was irregular. There were several septations, some of which measured 3 – 4 mm. There were no enhancing papillary formations, although the wall and septa enhanced. The appearance suggested an ovarian lesion with possible involvement of the Fallopian tube. The left adnexal cyst measured 5 × 6 × 4 cm, had a smooth wall and contained a single thin septation, consistent with a benign ovarian cyst. Both cysts contained fluid, which was low on T1 and high on T2, with no evidence of fat or blood. Surrounding the cysts posteriorly, the fat was streaky in appearance and there was marked thickening of the adjacent fascial planes, with thickening of the mesorectal fascia up to 1 cm. The fascial thickening extended up the pre-sacral space and along the posterior aspect of the pelvic sidewalls, resulting in the obstruction of the ureters. Enlarged lymph nodes (up to 1.8 cm in short axis) were present along both pelvic sidewalls, which were striking due to the very high T2 signal intensity (Figure ). Nodes were also seen in the inguinal and para-aortic regions. Although the imaging appearances could not rule out an ovarian neoplasm, the features noted above were suggestive of an inflammatory process. In view of the woman's medical history and clinical status the MDT recommendation was clinical review and imaging guided biopsy of lymph nodes.
The woman underwent CT guided right inter iliac node biopsy, following an unyielding biopsy of inguinal nodes. Histology revealed non-caseating granulomatous lymphadenitis with negative stains for acid-fast bacilli and fungi. There was no foreign body seen. Given the histological findings our attention was directed towards an inflammatory process. She was subsequently referred to respiratory physicians, with a working diagnosis of sarcoidosis. She was also referred to urologists for the management of retroperitoneal fibrosis and bilateral hydronephrosis. Abdominal pain prompted insertion of bilateral JJ ureteric stents. The physicians initiated a (step-down) course of prednisolone. Symptomatic improvement was observed but the renal function did not change. Repeat imaging demonstrated resolution of hydronephrosis.
The woman was reviewed again clinically after the course of steroids. During this interval the physicians ordered an autoantibody screen as autoimmune disease can co-exist with sarcoidosis; the screen was negative (Rheumatoid factor, anti-DNA antibody and antinuclear antibody). On examination there was no evidence of any palpable lymphadenopathy. An ultra sonographic examination six months later demonstrated a bulky uterus and reduction in the size of the right adnexal cyst. Repeat imaging (MRI axial T2W image) a further two months later demonstrated resolution of the left adnexal cyst. There was a small residual cyst on the right and marked decrease in the thickening of the mesorectal fascia. The lymph nodes appeared normal (Fig ). The retroperitoneal fibrosis on imaging had resolved. Her CA125 remained normal. Currently the patient is under joint care between the respiratory and renal physicians with symptomatic improvement.","Using the MDRD GFR Equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? If the patient is black, please use the MDRD GFR Equation for Blacks. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [40, 'years'], 'creatinine': [10.0, 'mg/dL'], 'sex': 'Female', 'Race': 'White'}",4.30749,4.09212,4.52286,"The patient's estimated GFR is calculated using the MDRD equation as:
GFR = 175 * creatinine^(-1.154) * age^(-0.203) * race_coefficient * gender_coefficient. The creatinine concentration is mg/dL. The race coefficient is 1.212 if the patient is Black and 1.0 otherwise. The gender coefficient is 0.742 if the patient is female and 1.0 otherwise.
The patient is 40 years old. The concentration of Creatinine is 10.0 mg/dL. 
The patient is not Black, so the race coefficient is defaulted to 1.0.
The patient is female, so the gender coefficient is 0.742.
Plugging in these values will give us: 175 * 10.0^(-1.154) * 40^(-0.203) * 1 * 0.742=4.30749.
Hence, the patient's GFR is 4.30749 mL/min/1.73m²."
149,9,MDRD GFR Equation,lab test,decimal,pmc-3104662-1,Extracted,"The patient was a 97 years old Hispanic male who was admitted to the hospital with shortness of breath and increasing fatigue. Two weeks prior to the current symptoms, the patient had been admitted, diagnosed with pneumonia, treated with antibiotics and then discharged home. Pertinent past medical history included hypertension, chronic obstruction pulmonary disease, anemia, recurrent clostridium difficile colitis, chronic kidney disease, osteoarthritis, cerebrovascular accident without deficit, hyperlipidemia, cholelithiasis, nephrolithiasis, abdominal aortic aneurysm, and colon polyps. Of note, the patient had been hospitalized 9 times in the past 12 months. Past surgical history included an appendectomy, repair of abdominal aortic aneurysm, and colonoscopy 2 years prior with unknown results. He had an allergy to penicillin. Family history was noncontributory. Current medications included moxifloxacin day 5, metroniadazole, amlodipine, omeprazole and losartan. Review of systems revealed weight loss, abdominal pain, and back, hip and leg pain.
Vital signs on admission were unremarkable. Remarkable examination findings included cachexia, scleral icterus, white coating on tongue, bibasilar rhonchi, rales and wheezes, diffuse bilateral lower quadrant pain, guiaic positive stool, and tenderness in the lumbar and gluteal regions. There was no evidence of lymphadenopathy.
Initial laboratory data revealed white blood cell count 12,200, hemoglobin 7.1, hematocrit 22.7, and platelets 291,000. Chemistry profile revealed BUN (blood urea nitrogen) 24, creatinine 1.34, glucose 134, and calcium 10.9. The remainder was unremarkable.
Chest radiograph on admission noted mild bilateral pleural effusions, left greater than right with bibasilar air disease not significantly changed from the week prior.
The patient was admitted with the following diagnoses: acute on chronic anemia secondary to a gastrointestinal bleed, pneumonia, chronic kidney disease, chronic obstructive pulmonary disease exacerbation, and oral candidiasis.
Over the next several days, as his multiple medical problems were addressed, the team noted a persistent left pleural effusion. A pulmonology consult was requested and thoracentesis performed. Pleural fluid analysis returned with features consistent with mantle cell lymphoma. FISH analysis was positive for a clonal BCL-1/IgH gene rearrangement. Flow cytometry revealed Kappa monoclonal B-lymphocytes co-expressing CD5 and CD19 with no CD23 expression. Cyclin D1 translocation was positive as well. At this point, hematology and palliative care consults were requested.
Computed tomography (CT) scan of chest, abdomen and pelvis revealed mediastinal adenopathy, diffuse gastric, pyloric and proximal duodenal wall thickening, as well as possible metastatic lesions in the pelvis with multiple ill-defined lucencies. Final diagnosis was metastatic Stage IV (Ann Arbor) Mantle cell lymphoma. With our patient’s advanced age, debilitated state and multiple medical problems, all members of the medical care team agreed with a hospice referral. The care team presented the recommendation to the patient’s caregiver.
The primary care and the palliative care team met with the patient’s daughter several times during the hospitalization to discuss her father’s diagnosis and prognosis. The team struggled to elucidate the role of hospice for her and, through her, for the family members not present. Family dynamics played a major role in the primary caregiver’s ambivalence toward hospice. Hospice was presented as a way for her father to stay at home and continue to be comfortable. She would have to help as necessary. The patient was discharged home to the care of his daughter and hospice. He is currently still alive and receiving regular physician home visits. He has not been told about the nature of his diagnosis. When the patient was asked by his PCP if he wanted to know the diagnosis, he continued to refer to his oldest daughter.","Using the MDRD GFR Equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? If the patient is black, please use the MDRD GFR Equation for Blacks. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [97, 'years'], 'creatinine': [1.34, 'mg/dL'], 'sex': 'Male', 'Race': 'Hispanic'}",49.32243,46.85631,51.78855,"The patient's estimated GFR is calculated using the MDRD equation as:
GFR = 175 * creatinine^(-1.154) * age^(-0.203) * race_coefficient * gender_coefficient. The creatinine concentration is mg/dL. The race coefficient is 1.212 if the patient is Black and 1.0 otherwise. The gender coefficient is 0.742 if the patient is female and 1.0 otherwise.
The patient is 97 years old. The concentration of Creatinine is 1.34 mg/dL. 
The patient is not Black, so the race coefficient is defaulted to 1.0.
The patient is male, so the gender coefficient is 1.
Plugging in these values will give us: 175 * 1.34^(-1.154) * 97^(-0.203) * 1 * 1=49.32243.
Hence, the patient's GFR is 49.32243 mL/min/1.73m²."
150,9,MDRD GFR Equation,lab test,decimal,pmc-6454930-1,Extracted,"A 66-year-old male was admitted with a 1-week history of fever and treated for urinary tract infection. His creatinine level upon presentation was 16.4 mg/dL. His past medical history included stroke and end-stage renal disease, for which he was on continuous ambulatory peritoneal dialysis (CAPD) for the past 2 years. He was started on intravenous (IV) ceftriaxone 1 g daily for 3 days and subsequently escalated to IV cefepime 1 g bd (non-CAPD dose) as fever remained unsettled. Fever resolved with day 2 of cefepime, and he felt better in general. On day 3 of cefepime, he was found to be less responsive and confused. In total, he had received 5 g of cefepime before he became neurotoxic.
He did not obey commands and had no verbal output on examination. His vital signs were stable with no fever. He had myoclonic jerks. His pupils were bilaterally equal and reactive. He had no neck stiffness or long-tract signs. Apart from stable anemia, repeated full blood count did not show any leukocytosis. C-reactive protein level was not elevated. There were no electrolyte imbalances. Renal function profile was static. Urgent brain computed tomography showed no new infarcts or hemorrhage. Lumbar puncture was performed with an opening pressure of 15 cm H2O. The cerebrospinal fluid count and biochemistry were within normal limits. His electroencephalography (EEG) [] showed background slow activity with generalized triphasic waves. Cefepime was identified as the culprit of confusion and immediately stopped. He was resumed with his CAPD regime.
On day 7 of admission, he became drowsier with Glasgow Coma Scale (GCS) of 9/15 with E2, V2, and M5, and was transferred to the intensive care unit (ICU) for closer observation. Urgent magnetic resonance imaging of the brain revealed no significant abnormalities apart from his old infarcts.
CAPD was converted to hemodialysis on admission to ICU. Postdialysis, he became more alert and responsive. In subsequent days, his GCS returned to full. A repeated EEG [] on day 8 of illness showed theta activity with resolution of triphasic waves. He was subsequently transferred back to the general ward and resumed with CAPD. He remained well upon clinic review.","Using the MDRD GFR Equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? If the patient is black, please use the MDRD GFR Equation for Blacks. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [66, 'years'], 'creatinine': [16.4, 'mg/dL'], 'sex': 'Male'}",2.96306,2.81491,3.11121,"The patient's estimated GFR is calculated using the MDRD equation as:
GFR = 175 * creatinine^(-1.154) * age^(-0.203) * race_coefficient * gender_coefficient. The creatinine concentration is mg/dL. The race coefficient is 1.212 if the patient is Black and 1.0 otherwise. The gender coefficient is 0.742 if the patient is female and 1.0 otherwise.
The patient is 66 years old. The concentration of Creatinine is 16.4 mg/dL. 
The race of the patient is not provided, so the default value of the race coefficient is 1.0.
The patient is male, so the gender coefficient is 1.
Plugging in these values will give us: 175 * 16.4^(-1.154) * 66^(-0.203) * 1 * 1=2.96306.
Hence, the patient's GFR is 2.96306 mL/min/1.73m²."
151,9,MDRD GFR Equation,lab test,decimal,pmc-8432418-1,Extracted,"A 52-year-old man was referred to our hospital because of abnormal accumulation at the distal metaphysis of the left radius on an 18F-fluorodeoxyglucose-position emission tomography (FDG-PET) scan taken for follow-up after renal cancer. The patient had a history of CKD due to microvascular nephrotic syndrome and diabetic nephropathy. The patient had undergone a unilateral partial nephrectomy for renal cancer three years before and had not experienced any recurrence or metastasis.
At the time of the initial examination, there was no obvious swelling or tenderness in the distal part of his left forearm and no restriction in the range of wrist motion. Laboratory data showed slightly low levels of various electrolytes in addition to renal dysfunction, consistent with the hemodialysis state, with no other noteworthy findings: Na 134mEq/L, K 3.2mEq/L, Cl 92mEq/L, Ca 7.4mg/dL, BUN 75.0mg/dL, Cr 10.01mg/dL.
A geographic radiolucent lesion with sclerotic margins was found in the radiographs taken at the initial consultation (Figure ). The tumor measured about 5 cm, and the bone cortex was thinned and expanded due to tumor growth. Computed tomography (CT) images showed no calcification inside the tumor, and the bone cortex appeared to be partially disrupted (Figure ). Magnetic resonance imaging (MRI) showed homogeneous isointense signals in the T1-weighted images and heterogeneously mixed iso- and high-signals in the T2-weighted images (Figure ). The FDG-PET scan revealed high accumulation in the left distal radial metaphysis (Figure ).
One month after the initial visit, an incisional biopsy of the tumor was performed with the possibility of a low-grade malignancy based on the imaging findings. Tissue samples were collected by making a hole on the bone cortex just subjacent to the first compartment of the extensor tendon sheath. After the biopsy, the bone hole was filled with cement, the tendon sheath was repaired, and the procedure was completed. The collected samples were brownish (Figure ). The pathological findings of the tissue revealed numerous multinucleated giant cells and no atypical cells, leading to the diagnosis of GCTB (Figure ).
The patient was scheduled to undergo tumor curettage. Administration of denosumab may be a treatment option, but was not indicated because of the frequent hypocalcemia at different times caused by CKD. However, X-rays and CT images taken again before surgery showed osteogenic signs in the tumor (Figure ). Usually, GCTB do not show osteogenesis in their natural course. Therefore, it was necessary to reconsider the diagnosis of the biopsy specimen.
Reviewing the laboratory data, the intact parathyroid hormone (PTH) level was abnormally high (915.4 pg/mL) at the time of the initiation of peritoneal dialysis four months before the initial visit. Thereafter, the value of intact PTH decreased to within the normal range (20.0 pg/mL). These laboratory data are shown in Table . These data suggested a possible association between PTH and tumor behavior.
We decided to perform a re-biopsy instead of curettage in order to confirm the pathological diagnosis. The newly collected samples were white tissue with a light pinkish color (Figure ), differing from those of the previous biopsy. The pathological findings of re-biopsy specimens showed the almost complete disappearance of multinucleated giant cells and mature bone tissue, with no obvious neoplastic changes or malignant images (Figure ). The osteogenic changes and the disappearance of the giant cells indicated that the tumor was a BT. The patient was followed up by clinical images every six months. One year after the biopsy, the radiographic images showed further osteogenesis and the lesion was considered almost healed (Figure ).","Using the MDRD GFR Equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? If the patient is black, please use the MDRD GFR Equation for Blacks. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [52, 'years'], 'creatinine': [10.01, 'mg/dL'], 'sex': 'Male'}",5.49779,5.2229,5.77268,"The patient's estimated GFR is calculated using the MDRD equation as:
GFR = 175 * creatinine^(-1.154) * age^(-0.203) * race_coefficient * gender_coefficient. The creatinine concentration is mg/dL. The race coefficient is 1.212 if the patient is Black and 1.0 otherwise. The gender coefficient is 0.742 if the patient is female and 1.0 otherwise.
The patient is 52 years old. The concentration of Creatinine is 10.01 mg/dL. 
The race of the patient is not provided, so the default value of the race coefficient is 1.0.
The patient is male, so the gender coefficient is 1.
Plugging in these values will give us: 175 * 10.01^(-1.154) * 52^(-0.203) * 1 * 1=5.49779.
Hence, the patient's GFR is 5.49779 mL/min/1.73m²."
152,9,MDRD GFR Equation,lab test,decimal,pmc-3635627-1,Extracted,"A 62-year-old diabetic woman on chronic hemodialysis for 7 months was admitted to our hospital because of general weakness and constipation for 1 week. She was bed-ridden for 1 month because of a fracture of L3-L4 spine due to a pedestrian traffic accident. Her vital signs were within normal ranges, and she had no fever. Physical examination revealed soft but distended abdomen and hypoactive bowel sounds. Plain abdominal radiographs showed large bowel distension with stool impaction (). Laboratory data showed hemoglobin of 8.6 g/dL, hematocrit 25.8%, random glucose 258 mg/dL, blood urea nitrogen 24.8 mg/dL, serum creatinine 4.1 mg/dL, sodium 129 mEq/L, potassium 4.5 mEq/L, calcium 8.0 mg/dL, phosphorus 1.7 mg/dL, and C-reactive protein 48.1 mg/L. The serum magnesium level was 3.0 mg/dL, and was 2.2 mg/dL 1 week ago (normal range, 1.8-2.6 mg/dL). She had taken magnesium-containing laxative (magnesium hydroxide 1500 mg per day) for a month, which was prescribed by another clinic. Therefore, magnesium hydroxide was discontinued and other laxatives were given.
On the 3rd hospital day, the patient became lethargic and showed somnolence. Physical examination showed generally hypoactive deep tendon reflex, abdominal distension with no bowel sounds, and severe tenderness on the lower abdomen. Her vital signs were; blood pressure: 90/60 mm Hg, pulse rate: 90 beats/minute, and body temperature: 37.0℃. Electrocardiogram revealed normal sinus rhythm. The serum magnesium level was rapidly increased to 6.0 mg/dL. Plain abdominal radiographs showed more distended large bowel loops compared with those on admission. Computed tomography (CT) showed diffuse and marked dilatation of large bowel loops with fecal impaction, compatible with megacolon. The clinical course and the serum magnesium level are shown in . Calcium gluconate was infused for a temporary antagonizing effect of hypermagnesemia. Nasogastric tube and rectal tube were inserted for gastrointestinal decompression. Hemodialysis was performed daily for hypermagnesemia correction. After three consecutive hemodialyses, the serum magnesium decreased to 3.3 mg/dL and vital signs became normal. The patient started to have bowel movements, and abdominal distension subsided slightly with defecation. On the 11th hospital day, she complained of severe abdominal pain again. Diffuse abdominal tenderness and rebound tenderness were noticed. She was hypotensive (blood pressure 90/50 mm Hg) with a rapid pulse of 100/minute and febrile (37.5℃). The serum magnesium level was 3.1 mg/dL. Follow-up abdominal CT showed large air fluid levels in the upper pelvic cavity, representing gastrointestinal perforation (). Emergent Hartmann's operation was performed. Operative finding was necrosis of the transverse colon and rectum, and histologic findings were gangrenous colitis with microperforation and serosal abscess of the colon and rectum. After the operation, her abdominal pain was resolved and vital signs became normal.","Using the MDRD GFR Equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? If the patient is black, please use the MDRD GFR Equation for Blacks. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [62, 'years'], 'creatinine': [4.1, 'mg/dL'], 'sex': 'Female'}",11.0264,10.47508,11.57772,"The patient's estimated GFR is calculated using the MDRD equation as:
GFR = 175 * creatinine^(-1.154) * age^(-0.203) * race_coefficient * gender_coefficient. The creatinine concentration is mg/dL. The race coefficient is 1.212 if the patient is Black and 1.0 otherwise. The gender coefficient is 0.742 if the patient is female and 1.0 otherwise.
The patient is 62 years old. The concentration of Creatinine is 4.1 mg/dL. 
The race of the patient is not provided, so the default value of the race coefficient is 1.0.
The patient is female, so the gender coefficient is 0.742.
Plugging in these values will give us: 175 * 4.1^(-1.154) * 62^(-0.203) * 1 * 0.742=11.0264.
Hence, the patient's GFR is 11.0264 mL/min/1.73m²."
153,9,MDRD GFR Equation,lab test,decimal,usmle-453,Extracted,"Two hours after admission to the hospital for dialysis, a 63-year-old woman has severe pain in her lower back. The pain is 8 out of 10 in intensity and radiates down the legs. She underwent a laparoscopic cholecystectomy 4 years ago. She has hypertension, chronic kidney disease, type 2 diabetes mellitus, and major depressive disorder. She lives with her daughter and reports frequent fights with her at home. Her current medications include sertraline, insulin, enalapril, sodium bicarbonate, and sevelamer. She appears uncomfortable. Her temperature is 37.3°C (99.1°F), pulse is 102/min, respirations are 15/min, and blood pressure is 132/94 mm Hg. There is severe tenderness on palpation over the L2 vertebra; range of motion is limited. Neurologic examination shows no focal findings. Laboratory studies show:
Hemoglobin 10.1 g/dL
Leukocyte count 8,700/mm3
Platelet count 130,000/mm3
Serum
Na+ 136 mEq/L
Cl- 101 mEq/L
K+ 5.1 mEq/L
Calcium 8.2 mg/dL
Urea nitrogen 33 mg/dL
Glucose 190 mg/dL
Creatinine 3.8 mg/dL
An x-ray of the spine shows a wedge compression fracture of the L2 vertebra.","Using the MDRD GFR Equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? If the patient is black, please use the MDRD GFR Equation for Blacks. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [63, 'years'], 'creatinine': [3.8, 'mg/dL'], 'sex': 'Female'}",11.99791,11.39801,12.59781,"The patient's estimated GFR is calculated using the MDRD equation as:
GFR = 175 * creatinine^(-1.154) * age^(-0.203) * race_coefficient * gender_coefficient. The creatinine concentration is mg/dL. The race coefficient is 1.212 if the patient is Black and 1.0 otherwise. The gender coefficient is 0.742 if the patient is female and 1.0 otherwise.
The patient is 63 years old. The concentration of Creatinine is 3.8 mg/dL. 
The race of the patient is not provided, so the default value of the race coefficient is 1.0.
The patient is female, so the gender coefficient is 0.742.
Plugging in these values will give us: 175 * 3.8^(-1.154) * 63^(-0.203) * 1 * 0.742=11.99791.
Hence, the patient's GFR is 11.99791 mL/min/1.73m²."
154,9,MDRD GFR Equation,lab test,decimal,pmc-6210852-1,Extracted,"A 68-year-old diabetic and hypertensive female patient was admitted to the hospital with chronic kidney disease and referred for Double J-stent insertion. She was a known case of chronic kidney disease and ischemic heart disease. Her blood parameters were as follows: hemoglobin = 8 g/dl, total leukocyte count = 12,800/ml, urea = 150 mg/dl, creatinine = 3.9 mg/dl, and random glucose = 127 mg/dl.
During the stay in the hospital, the patient had an indwelling catheter. The catheter was inserted using sterile technique. She was treated with meropenem, ciprofloxacin along with antacids and multivitamins. After 5 days of stay, she developed UTI. She had pyrexia of 102°F.
Patient's urine collected using universal precautions. Urine wet mount showed plenty of pus cells, 2–4 epithelial cells and budding yeast cells. The urine sample was inoculated with a standard loop on blood agar and Urichrom agar (Himedia Laboratories, India) and incubated at 37°C. On blood agar tiny, white, dry, wrinkled colonies were observed [], and on urichrom agar blue, dry, wrinkled colonies were observed [] with a colony count of >105 cfu/ml. The Gram stain of the colony revealed septate hyphae with arthrospores and few budding yeast cells []. The colony was subcultured on to Potato Dextrose Agar and incubated at 22°C and 37°C. At both, the temperatures colonies of yeast-like fungus were obtained in pure culture. After 5 days of incubation on Corn Meal Agar (CMA), abundant rectangular arthroconidia were seen []. When the patient was on the same urinary catheter, two more samples were collected. Both the samples revealed the same picture. The yeast was identified as T. asahii with Gram stain, morphology on CMA, hydrolysis of urea, carbohydrate fermentation, and assimilation tests. The same was identified by Vitek 2 compact automated system (bioMeriux). For molecular identification, the isolate was sent to the National Culture Collection of Pathogenic Fungi (NCCPF), Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, which confirmed our identification.
Antifungal susceptibility testing was done by using Mueller-Hinton Agar with 2% Glucose and methylene blue (Himedia, India) for fluconazole, Itraconazole, voriconazole, Ketoconazole, and Amphotericin-B. The susceptibility of the strain was evaluated by the disk-diffusion method, in accordance with protocol M44-A of the clinical and laboratory standards institute. It was found that this isolate was sensitive to Itraconazole and voriconazole and resistant to fluconazole, Ketoconazole, and Amphotericin-B. Antifungal therapy with voriconazole and change of indwelling catheter subsequently lead to negative fungal growth in urine cultures.","Using the MDRD GFR Equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? If the patient is black, please use the MDRD GFR Equation for Blacks. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [68, 'years'], 'creatinine': [3.9, 'mg/dL'], 'sex': 'Female'}",11.46447,10.89125,12.03769,"The patient's estimated GFR is calculated using the MDRD equation as:
GFR = 175 * creatinine^(-1.154) * age^(-0.203) * race_coefficient * gender_coefficient. The creatinine concentration is mg/dL. The race coefficient is 1.212 if the patient is Black and 1.0 otherwise. The gender coefficient is 0.742 if the patient is female and 1.0 otherwise.
The patient is 68 years old. The concentration of Creatinine is 3.9 mg/dL. 
The race of the patient is not provided, so the default value of the race coefficient is 1.0.
The patient is female, so the gender coefficient is 0.742.
Plugging in these values will give us: 175 * 3.9^(-1.154) * 68^(-0.203) * 1 * 0.742=11.46447.
Hence, the patient's GFR is 11.46447 mL/min/1.73m²."
155,9,MDRD GFR Equation,lab test,decimal,pmc-3841498-1,Extracted,"A 17-year-old female was admitted for living donor (LD) RTx. Her earlier medical history included renal biopsy proven malignant hypertension, and end stage renal disease (ESRD). She was on maximum dosage of three types of antihypertensive drugs [nifedipine, clonidine, metoprolol] to control blood pressure. She was on regular hemodyalisis of 4 hrs duration two to three times per week since three months.
She developed headaches, altered consciousness, visual disturbances and seizures. A seizure was the presenting manifestation. Seizures were generalized tonic clonic leading to status epilepticus. It was succeeded by visual blurring. The headache was typically constant, nonlocalized, moderate to severe, and unresponsive to analgesia. Altered consciousness ranged from mild somnolence to confusion and agitation, progressing to stupor/coma. The deep tendon reflexes were brisk with Babinski signs present. The patient had weakness and incoordination of the limbs. No other focal neurologic deficits were present. Physical assessment revealed blood pressure of 210/110 mmHg, temperature 38.3°C, respiratory rate of 30 breaths per minute, heart rate of 100 beats per minute.
Arterial blood gas showed PaO2 137 mm of Hg, PCO2 43 mm of Hg, pH 7.37 and bicarbonate 24.6 mmol/L, potassium 4.3 mmol/L, sodium 143 mmol/L, choride 103 mmol/L, anion gap 19 mmol/l, calcium 1.12 mmol/l, glucose 108 mg/dl, lactic acid 3.4 mmol/l.
The fundoscopic examination revealed hypertensive retinopathy without papilledema. A non contrast brain computed tomography revealed bilateral symmetrical white matter hypodensity in the parietal, temporal, and occipital regions suggesting PRES []. No other abnormalities were noted. There was no history of cytotoxic immunosuppressive therapy or eclampsia. Laboratory investigations revealed hemoglobin, 9.2 gm/L; total white cell count, 5.65 × 103/μl (differential count: 55% neutrophils, 42% lymphocytes, 2% monocytes, and 1% eosinophils); platelet count, 1.5 × 105/μl; serum creatinine (SCr), 7.2 mg/dl; blood urea, 92 mg/dL; serum calcium, 8.7 mg/dl; serum phosphorus, 5.7 mg/dl; serum magnesium, 2 mg/l; alanine aminotransferase, 34 units/l (normal range: 0-40 units/l); aspartate aminotransferase, 30 units/l (normal range: 5-34 units/l); serum bilirubin, 1 mg/dl; and serum albumin, 3.8 gm/dl. Multiple blood, urine, and sputum cultures were sterile. With control of hypertension, the patient improved dramatically.
Intravenous lorazepam was given for acute control of seizures and she went on to require phenytoin, valproic acid and levetiracetam. She was started on more frequent HD. She required five different types of antihypertensive drugs to control blood pressure. Initially she was started on intravenous nitroprusside and nytroglycerine to rapidly control blood pressure. Cardiac monitoring, frequent measurement of blood pressure, and pulse oximetry were instituted. She recovered clinically within one week. The resolution of findings on neuroimaging occurred gradually. Subsequently, she underwent successful LD RTx without recurrence of PRES.","Using the MDRD GFR Equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? If the patient is black, please use the MDRD GFR Equation for Blacks. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [17, 'years'], 'creatinine': [7.2, 'mg/dL'], 'sex': 'Female'}",7.48685,7.11251,7.86119,"The patient's estimated GFR is calculated using the MDRD equation as:
GFR = 175 * creatinine^(-1.154) * age^(-0.203) * race_coefficient * gender_coefficient. The creatinine concentration is mg/dL. The race coefficient is 1.212 if the patient is Black and 1.0 otherwise. The gender coefficient is 0.742 if the patient is female and 1.0 otherwise.
The patient is 17 years old. The concentration of Creatinine is 7.2 mg/dL. 
The race of the patient is not provided, so the default value of the race coefficient is 1.0.
The patient is female, so the gender coefficient is 0.742.
Plugging in these values will give us: 175 * 7.2^(-1.154) * 17^(-0.203) * 1 * 0.742=7.48685.
Hence, the patient's GFR is 7.48685 mL/min/1.73m²."
156,9,MDRD GFR Equation,lab test,decimal,usmle-3514,Extracted,"A 48-year-old woman with chronic tension headaches comes to the physician because of several episodes of bilateral flank pain and reddish urine within the past month. Current medications include aspirin, which she takes almost daily for headaches. Her temperature is 37.4°C (99.3°F) and her blood pressure is 150/90 mm Hg. Physical examination shows costovertebral tenderness to percussion bilaterally. Laboratory studies show a hemoglobin concentration of 10.2 g/dL and serum creatinine concentration of 2.4 mg/dL. Urine studies show:
Urine
Protein
3+
RBC > 16/hpf
WBC 2/hpf
There are no casts or dysmorphic RBCs visualized on microscopic analysis of the urine.","Using the MDRD GFR Equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? If the patient is black, please use the MDRD GFR Equation for Blacks. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [48, 'years'], 'creatinine': [2.4, 'mg/dL'], 'sex': 'Female'}",21.54697,20.46962,22.62432,"The patient's estimated GFR is calculated using the MDRD equation as:
GFR = 175 * creatinine^(-1.154) * age^(-0.203) * race_coefficient * gender_coefficient. The creatinine concentration is mg/dL. The race coefficient is 1.212 if the patient is Black and 1.0 otherwise. The gender coefficient is 0.742 if the patient is female and 1.0 otherwise.
The patient is 48 years old. The concentration of Creatinine is 2.4 mg/dL. 
The race of the patient is not provided, so the default value of the race coefficient is 1.0.
The patient is female, so the gender coefficient is 0.742.
Plugging in these values will give us: 175 * 2.4^(-1.154) * 48^(-0.203) * 1 * 0.742=21.54697.
Hence, the patient's GFR is 21.54697 mL/min/1.73m²."
157,9,MDRD GFR Equation,lab test,decimal,pmc-5971350-1,Extracted,"A 63-year-old female who was visitor from Veracruz, Mexico, presented to the emergency room with complaints of progressively worsening abdominal pain and distention for three days. She also had fever and altered mentation. Her past medical history was significant for hypertension, diabetes mellitus, hyperlipidemia, and end-stage renal disease. She had been on PD for four years and denied any recent changes in technique. She had two episodes of peritonitis in the past while in Mexico but was unaware of the details of those episodes. Her surgical history was significant for appendectomy, cholecystectomy, and tubal ligation and she denied any recent abdominal procedure. She denied smoking, alcohol intake, or use of recreational drugs.
On examination, her blood pressure was 172/85 mm of Hg, pulse 88/min, oral temperature 39.5°C (103.1°F), respiratory rate 14/min, and oxygen saturation on room air 94%. She was lethargic and confused. She had abdominal distention and diffuse tenderness without any rebound or guarding. Her PD catheter exit site was clean and dry. Laboratory studies showed white blood cell count of 14.5 × 103/μL with 87.1% granulocytes, hemoglobin of 6.3 g/dL, and hematocrit of 18.4%. Serum chemistries showed sodium of 130 mmol/L, potassium of 2.7 mmol/L, chloride of 90 mmol/L, bicarbonate of 27 mmol/L, blood urine nitrogen of 30 mg/dL, and creatinine of 7.7 mg/dL. Her liver function tests were within normal limits. Computed tomography of abdomen and pelvis without intravenous or oral contrast showed peritoneal thickening consistent with peritonitis, and there was no evidence of perforation or obstruction (). PD fluid analysis showed white cell count of 2173 per mm3 with 96% neutrophils and red blood cells of <3000 per mm3.
Blood and PD fluid cultures were sent, and she was empirically treated for bacterial peritonitis with intraperitoneal cefazolin and ceftazidime. PD fluid gram stain revealed budding yeast; blood and PD fluid cultures did not reveal bacterial growth. Given the high suspicion of fungal peritonitis, immediate removal of the PD catheter was discussed with the patient. She chose not to have the catheter removed, leave to Mexico, and get treated by her own nephrologist. Hence oral fluconazole was started for presumed Candida peritonitis. However, six days later, the fungal culture [Mycosel Agar and Brain Heart Infusion Agar] of the PD fluid grew H. Capsulatum.","Using the MDRD GFR Equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? If the patient is black, please use the MDRD GFR Equation for Blacks. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [63, 'years'], 'creatinine': [7.7, 'mg/dL'], 'sex': 'Female'}",5.31087,5.04533,5.57641,"The patient's estimated GFR is calculated using the MDRD equation as:
GFR = 175 * creatinine^(-1.154) * age^(-0.203) * race_coefficient * gender_coefficient. The creatinine concentration is mg/dL. The race coefficient is 1.212 if the patient is Black and 1.0 otherwise. The gender coefficient is 0.742 if the patient is female and 1.0 otherwise.
The patient is 63 years old. The concentration of Creatinine is 7.7 mg/dL. 
The race of the patient is not provided, so the default value of the race coefficient is 1.0.
The patient is female, so the gender coefficient is 0.742.
Plugging in these values will give us: 175 * 7.7^(-1.154) * 63^(-0.203) * 1 * 0.742=5.31087.
Hence, the patient's GFR is 5.31087 mL/min/1.73m²."
158,9,MDRD GFR Equation,lab test,decimal,usmle-3704,Extracted,"A 55-year-old woman comes to the physician because of a 6-month history of worsening shortness of breath on exertion and fatigue. She has type 1 diabetes mellitus, hypertension, hypercholesterolemia, and chronic kidney disease. Her mother was diagnosed with colon cancer at the age of 65 years. Her blood pressure is 145/92 mm Hg. Examination shows conjunctival pallor. Laboratory studies show:
Hemoglobin 9.2 g/dL
Mean corpuscular volume 88 μm3
Reticulocyte count 0.6 %
Serum
Ferritin 145 ng/mL
Creatinine 3.1 mg/dL
Calcium 8.8 mg/dL
A fecal occult blood test is pending.","Using the MDRD GFR Equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? If the patient is black, please use the MDRD GFR Equation for Blacks. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'creatinine': [3.1, 'mg/dL'], 'age': [55, 'years']}",15.59972,14.81973,16.37971,"The patient's estimated GFR is calculated using the MDRD equation as:
GFR = 175 * creatinine^(-1.154) * age^(-0.203) * race_coefficient * gender_coefficient. The creatinine concentration is mg/dL. The race coefficient is 1.212 if the patient is Black and 1.0 otherwise. The gender coefficient is 0.742 if the patient is female and 1.0 otherwise.
The patient is 55 years old. The concentration of Creatinine is 3.1 mg/dL. 
The race of the patient is not provided, so the default value of the race coefficient is 1.0.
The patient is female, so the gender coefficient is 0.742.
Plugging in these values will give us: 175 * 3.1^(-1.154) * 55^(-0.203) * 1 * 0.742=15.59972.
Hence, the patient's GFR is 15.59972 mL/min/1.73m²."
159,9,MDRD GFR Equation,lab test,decimal,pmc-3008952-1,Extracted,"A 60-year-old homosexual man was admitted with complaints of generalized edema and pallor. There was no history of any drug addiction – oral or intravenous. General physical examination revealed temperature of 99°F, pulse rate of 80/min, respiratory rate of 14/min, and BP of 130/80 mmHg. Patient had pallor and generalized edema. Chest examination revealed decreased breath sounds in the right infrascapular area. Abdominal wall edema was seen and patient had ascites too. CVS and CNS examination was normal.
Laboratory tests revealed a white cell count of 11,000/mm3 (69% neutrophils, 20% lymphocytes, 11% monocytes), a hemoglobin concentration of 8.7 g/dL, a platelet count of 164,000/mm3, serum urea and creatinine concentration of 67 and 2.8 mg/dL, respectively, serum albumin concentration of 1.8 g/dL, and total protein of 4.3g/dL. Liver enzymes were normal. Pulmonary function tests were within normal limits. Urine examination showed the presence of albumin and casts, RBCs 12–15, polymorphs 8–10 per high power field, and no sugar. And 24-h urinary protein was 5 g. ultrasound of abdomen revealed enlarged kidneys with loss of corticomedullary differentiation. Chest X-ray revealed right-sided pleural effusion. ECG was within normal limits. The patient was then evaluated for HIV, hepatitis B surface antigen (HBsAg), and hepatitis C virus (HCV) infection. An enzyme-linked immunosorbent assay (ELISA) and a Western blot assay for HIV-1 antibodies was positive. CD4 counts were 192/μL and HIV viral load was found to be >4000/mL. Tests for HBV, HCV, CMV, and HTLV-1 were negative. Serum urea and creatinine rose to 74 and 3.3 g/dL after admission.
Renal biopsy was done. Light microscopic examination of the renal biopsy revealed nine glomeruli with five glomeruli showing global collapse of the capillary tuft, obliteration of the capillary lumens, increase in the mesangial matrix, expansion of the urinary space, and focal glomerulosclerosis. There was proliferation of visceral epithelial cells and showed cytoplasmic vacuolization, associated with microcystic dilatation of tubules, focal tubular atrophy, and the presence of large dense periodic acid-Schiff (PAS)-positive tubular casts. Interstitium showed severe inflammatory infiltration, comprising of both acute and chronic inflammatory cells, and interstitial fibrosis resulting in destruction of tubules at places. Vessels showed features of vasculitis [Figures and ]. PAS staining showed areas of focal glomerulosclerosis and casts within the tubules []. Immunofluorescence showed only weak nonspecific glomerular IgM deposits. The diagnosis of FSGS collapsing variant was arrived at.
In the hospital, patient was managed for generalized anasarca and anemia while being investigated. He was put on highly active antiretroviral therapy (HAART), ACE inhibitors, and corticosteroids. At 1 month follow-up, he had some improvement in kidney function tests with creatinine dropping to 2.1 mg/dL and 24-h urine protein dropping to 3.6 g/day. Volume overload state had regressed and patient had only edema feet. He failed to collect his course of HAART at third month from ART center located in our institution.","Using the MDRD GFR Equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? If the patient is black, please use the MDRD GFR Equation for Blacks. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [60, 'years'], 'creatinine': [2.8, 'mg/dL'], 'sex': 'Male'}",23.2302,22.06869,24.39171,"The patient's estimated GFR is calculated using the MDRD equation as:
GFR = 175 * creatinine^(-1.154) * age^(-0.203) * race_coefficient * gender_coefficient. The creatinine concentration is mg/dL. The race coefficient is 1.212 if the patient is Black and 1.0 otherwise. The gender coefficient is 0.742 if the patient is female and 1.0 otherwise.
The patient is 60 years old. The concentration of Creatinine is 2.8 mg/dL. 
The race of the patient is not provided, so the default value of the race coefficient is 1.0.
The patient is male, so the gender coefficient is 1.
Plugging in these values will give us: 175 * 2.8^(-1.154) * 60^(-0.203) * 1 * 1=23.2302.
Hence, the patient's GFR is 23.2302 mL/min/1.73m²."
160,9,MDRD GFR Equation,lab test,decimal,pmc-8294440-1,Extracted,"A 40-year-old male presented with complaints of anasarca, dyspnea, anuria, and left-sided pleural effusion was admitted with provisional diagnosis of chronic kidney disease. He also had history of headache, loss of appetite, fatigue, orthopnea, and on and off chest pain and occasional vomiting after food intake. He had a history of hypertension since 3 months but was not on any medication. His blood pressure at presentation was 170/100 mm of Hg but all other vitals were stable. His initial investigations showed hemoglobin - 6.6 gm%, white blood cell (WBC) - 7370/uL, platelet count - 60,000, red blood cell - 124 mg/dL, blood urea nitrogen - 142 mg/dL, creatinine - 8.0 mg/dL, serum K+- 5.6 mEq/L, chest X-ray showed mild left-sided pleural effusion, arterial blood gas showed metabolic acidosis with respiratory compensation and electrocardiogram was normal. Ultrasonography kidneys, ureters, and bladder showed poor corticomedullary differentiation and decreased size of bilateral kidneys suggestive of chronic kidney disease. The patient was taken up for hemodialysis. The patient had no history of previous transfusions. After pretransfusion testing one unit of buffy coat-poor, nonleucofiltered, coombs cross-match compatible, fresh (<7-days old) saline-adenine-glucose-mannitol (SAGM) packed red blood cell (PRBC) unit was issued but transfusion was started almost 4 h after the issue of PRBC with no cold chain maintenance during this period. After around 20 ml of transfusion, the patient developed sudden onset of excruciating pain in the lower back and hip joints, tachypnea, and shortness of breath with oxygen saturation dropping to 82%. Patient's vitals did not vary much from the predialysis levels and remained afebrile throughout. Transfusion was stopped immediately and supplemental oxygen and injection tramadol 50 mg and injection diphenhydramine 25 mg were given intravenously. Hemodialysis was completed uneventfully after the reaction subsided. A complete posttransfusion reaction work-up was initiated as per blood bank protocol beginning with bedside confirmation of correct product and patient identification. Clerical errors were ruled out. Hemolysis check in the returned PRBC unit (3 days old) was done. No hemolysis in the returned PRBC unit was obvious as well as in the posttransfusion sample. The postreaction patient grouping was matching with the patient's pretransfusion sample with a negative direct antiglobulin test. Repeat grouping of the PRBC unit matched the unit label. Repeat testing of the full-cross match to both the patient's prereaction sample and postreaction sample confirmed compatibility of the unit. Peripheral blood smear did not show any schistocytes and serum indirect bilirubin was in normal range. Thus, hemolytic transfusion reaction was ruled out. Culture of the PRBC unit causing the reaction and posttransfusion reaction blood sample from the patient was also sterile. Chest X-ray showed no features suggestive of pulmonary edema. Second session of hemodialysis was completed uneventfully after an interval of 48 h without blood transfusion which rules out the pain manifestation and the reaction occurring due to hemodialysis-related factors. Other causes of lower back pain including spinal disorders/nerve compression, blood clots, varicose veins, and poor circulation had been ruled out before admitting the patient in the hospital as well as soon after the reaction by the concerned treating physician.","Using the MDRD GFR Equation, what is the patient's Glomerular Filtration Rate (GFR) in terms of mL/min/1.73 m²? If the patient is black, please use the MDRD GFR Equation for Blacks. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'age': [40, 'years'], 'creatinine': [8.0, 'mg/dL'], 'sex': 'Male'}",7.51024,7.13473,7.88575,"The patient's estimated GFR is calculated using the MDRD equation as:
GFR = 175 * creatinine^(-1.154) * age^(-0.203) * race_coefficient * gender_coefficient. The creatinine concentration is mg/dL. The race coefficient is 1.212 if the patient is Black and 1.0 otherwise. The gender coefficient is 0.742 if the patient is female and 1.0 otherwise.
The patient is 40 years old. The concentration of Creatinine is 8.0 mg/dL. 
The race of the patient is not provided, so the default value of the race coefficient is 1.0.
The patient is male, so the gender coefficient is 1.
Plugging in these values will give us: 175 * 8.0^(-1.154) * 40^(-0.203) * 1 * 1=7.51024.
Hence, the patient's GFR is 7.51024 mL/min/1.73m²."
161,10,Ideal Body Weight,physical,decimal,pmc-7364813-1,Extracted,"Our patient was a 47-year-old man who was diagnosed with tetralogy of Fallot 3 months after birth. He had a Waterston operation at 9 months of age and a Blalock–Taussig procedure at 1 year, 10 months of age. At age 10, the patient underwent surgery to ligate the ascending aorta–right pulmonary artery shunt path. He did not undergo intracardiac repair. The main pulmonary artery was completely occluded from the right ventricular outflow tract. The right-to-left shunted blood ejected from the left ventricle through the ventricular septal defect and merged with oxygenated blood via the shunt path from the left subclavian artery to the left pulmonary artery.
Renal function decreased when the patient was 38 years of age. Home oxygen therapy at night was initiated 1 year before the patient presented at our hospital; a β-blocker (carvedilol, 2.5 mg/day) was started 6 months before presentation. The patient did not experience breathing difficulty in his daily life (New York Heart Association Class II) and was able to work. A PD catheter was inserted in April 2015. Renal function gradually decreased and exacerbation of lower leg edema was observed, so PD was started. The patient’s height was 158 cm, his weight was 54 kg, his body temperature was 36.3 °C, his blood pressure was 136/69 mmHg, his pulse rate was 81 beats/min, and his oxygen saturation was 81% in room air.
Laboratory testing was performed on admission. Urinalysis dipstick examination indicated 4+ protein (8 g/g Cr) and was negative for blood. Arterial blood gas analysis showed a pH of 7.278, PaCO2 of 43 mmHg, PaO2 of 52 mmHg, bicarbonate of 19.7 mmol/L, and base excess of − 6.9 mmol/L. Chest X-ray showed a cardiothoracic ratio of 63%, indicating cardiac enlargement. Abdominal ultrasonography showed mild atrophy of the bilateral kidneys, increased cortical brightness, and cysts. Left ventricular findings of cardiac ultrasonography included a left ventricular end-diastolic diameter of 44 mm, left ventricular end-systolic diameter of 28 mm, left ventricular ejection fraction of 71%, septal thickness of 26 mm, and rear wall thickness of 11 mm. The valve findings were mild aortic regurgitation, trivial mitral regurgitation, moderate tricuspid regurgitation, and pulmonary artery closure. The main pulmonary artery was not visible from the right ventricular outflow tract. The ventricular septal defect was 19–22 mm in diameter; there was almost right-to-left shunting across the defect, with only a slight left-to-right shunt. After Waterston operation there was good flow through the shunt from the ascending aorta to the right pulmonary artery. After left Blalock–Taussig shunt operation there was decreased flow velocity from the left subclavian artery to the left pulmonary artery.
In July 2015, PD was started. Serum creatinine (Cr) at the start of PD was 5.5 mg/dl. The fast peritoneal equilibrium test (PET) result was low average. From November 2015 (4 months after the start of PD), B-type natriuretic peptide (BNP) gradually increased, water removal was 200–300 mL/day, and body weight increased. In March 2016 (8 months after starting PD), the PD fluid protocol was changed. In February 2017, the patient developed lower leg edema and his BNP increased to 1300 pg/mL, so treatment was changed to continuous cycling PD. With increased water removal, the edema resolved and BNP rapidly decreased. Changes associated with cyanosis included a hemoglobin level of 18–20 g/dL, indicating polycythemia; the patient also experienced headache. Phlebotomy treatment was performed four times. Because of concerns about iron deficiency resulting from phlebotomy, hemostasis therapy was discontinued, after which the patient’s headache improved (Fig. ).
The serum bicarbonate level at the start of PD in July 2015 was 20 mmol/L. This value increased to 25–30 mmol/L with the change in PD fluid protocol, and venous blood PCO2 increased with the start of PD (Fig. ).
The target SpO2 was adjusted to 70–85%; SpO2 was unchanged after PD. SpO2 decreased with the complication of heart failure, but improved with fluid management. Periodic echocardiography showed that PD initiation had little effect on hemodynamics.
There were no PD-related complications.","Using the Ideal Body Weight Formula, what is the patient's ideal body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'height': [158.0, 'cm']}",55.07095,52.3174,57.8245,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Male.
The patient's height is 158.0 cm, which is 158.0 cm * 0.393701 in/cm = 62.20476 in. 
Plugging in the values for the IBW formula for males gives us 50 kg + 2.3 kg * (62.20476 (in inches) - 60) = 55.07095 kg.
Hence, the patient's IBW is 55.07095 kg."
162,10,Ideal Body Weight,physical,decimal,pmc-3623538-1,Extracted,"A 26-year-old man who appeared healthy was transferred to our facility for persistent intermittent low abdominal and perineal pain for the previous 2 months. The patient had also experienced urinary symptoms including frequency, urgency, gross hematuria, and dysuria for a month and had no history of any medical or surgical procedures prior to the visit. He was treated with antibiotics for 2 months under a diagnosis of cystitis and Meckel's diverticulum or Crohn's disease at local clinics; however, there were no pathologic findings on colonoscopy and no complaint about bowel symptoms. His family history was not notable for Crohn's disease.
He was 177 cm in height and 72 kg in weight with no acute distress. On physical examination, there were no abnormal findings. There was pyuria and microscopic hematuria on urine analysis; however, the other laboratory findings were within normal range. Cystoscopy showed diffuse erythematous mucosal thickening on the right side wall of the bladder dome (). However, there was no stool debridement no any fistulous opening in the bladder. A computed tomography (CT) scan showed that there was a tubular structure connected with the right side wall of the bladder, suggesting Meckel's diverticulum with fistula formation to the bladder as well as a mass-like bladder wall thickening ().
With an impression of Meckel's diverticulum with fistula with the bladder, a laparoscopic operation was performed through 3 abdominal ports (one 10 mm port placed at 10 mm above the umbilicus [camera] (KARL STORZ GmbH & Co. KG, Mittelstr, Tuttlingen, Germany), one 12 mm port for the right pararectal trocar, and one 5 mm port placed between the left anterior iliac spine and the umbilicus). The distal tip of the long appendix, which had a normal shape on its body and base was found to be densely adhered to the right side wall of the bladder (). Laparoscopic appendiceal ligation was performed with 10 mm Hem-O-Lok clips (Teleflex Medical, Research Triangle Park, NC, USA) and 2-0 Vicryl (Ethicon Inc., Somerville, NJ, USA). After removing the proximal appendix, dissection of the bladder around the tip of the appendix was performed. There was a dense fibrotic change around the tip of the appendix. Partial cystectomy was performed and laparoscopic two-layered bladder repair was done with 3-0 Vicryl (Ethicon). The total surgical time was 75 minutes and the estimated intraoperative blood loss was minimal.
On the 7th postoperative day, cystography was performed and no urinary leakage around the bladder was demonstrated. The urinary symptoms including gross hematuria, dysuria, and frequency improved and abdominal discomfort symptoms also subsided. The other laboratory findings were within normal range. The surgical specimen showed a 9.2×1.2 cm appendix attached to a 4.3×3.2 cm bladder with dense fibrotic change without any malignancy.
At 1 month postoperatively, he had no symptoms including frequency, urgency, sense of residual urine, or intermittent gross hematuria. Nor were there any abnormal findings by CT which was performed 1 year postoperatively.","Using the Ideal Body Weight Formula, what is the patient's ideal body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'height': [177.0, 'cm']}",72.27568,68.6619,75.88946,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Male.
The patient's height is 177.0 cm, which is 177.0 cm * 0.393701 in/cm = 69.68508 in. 
Plugging in the values for the IBW formula for males gives us 50 kg + 2.3 kg * (69.68508 (in inches) - 60) = 72.27568 kg.
Hence, the patient's IBW is 72.27568 kg."
163,10,Ideal Body Weight,physical,decimal,pmc-3780833-1,Extracted,"A 73-year-old male patient had lower back and both buttock pain that was occurred after fall from standing position 2 weeks before, the symptoms progressed and became intolerable in spite of analgesia. In the past medical history, no special diseases such as diabetes, hypertension and cerebrovascular diseases were present and he was a non-smoker and a non-drinker. He had 171 cm of height, 70 kg of body weight, 23.9 kg/m2 of body mass index. Laboratory test showed the result of white blood cell (WBC) count of 4,440/mm3, erythrocyte sedimentation rate (ESR) 33 mm/hr, C-reactive protein (CRP) 0.04 mg/dL, uric acid 2.1 mg/dL, RA factor 12.29 U/mL, and HLA-B27 positive. BMD was measured utilizing peripheral-quantitative computed tomography (P-QCT; Somatom sensation 16, Simens, Erlangen, Germany). In result, severe osteoporosis was considered with BMD and T-score of lumbar vertebrae (L1-4) were 11.2 mg/cm3 and -6.17 (). At the time of visiting, simple spine radiography showed syndesmophytes of the spine, suggesting a bamboo spine coexist with ankylosis, but spine fracture was not clearly depicted in lumbar spine (). Three dimensional (3-D) CT and magnetic resonance imaging (MRI) of the lumbar spine reveled ankylosed of ligaments, intervertebral discs, endplate, and of apophyseal structures and 2 column compression fracture on L3 through the vertebral body ().
Kyphoplasty polymethylmetacrylate (PMMA) vertebral augmentation procedure was performed because of progressive vertebral collapsing during the follow-up. Patients were placed in the prone position under bi-plane fluoroscopic guidance and local anesthesia with bilateral transpedicular approach using simultaneous anteroposterior and lateral fluoroscopy. The balloon tamp was situated under collapsed end plate and slowly inflated until it abutted the cortical margins. PMMA was then injected into void of the vertebral body, 3 mL of PMMA was used (). Post-operative thoracolumbosacral orthosis (TLSO) applying, patients encourage to resume all his normal daily activities without any restrictions. The visual analogue scale (VAS) was 10 for the first time. The last VAS was 3 after post-operative 9 months, there were no complication. Last follow-up after post-operative 12 months, the patient is active and satisfied with the treatment including osteoporosis medication. This report was informed to a patient.","Using the Ideal Body Weight Formula, what is the patient's ideal body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'height': [171.0, 'cm']}",66.8426,63.50047,70.18473,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Male.
The patient's height is 171.0 cm, which is 171.0 cm * 0.393701 in/cm = 67.32287 in. 
Plugging in the values for the IBW formula for males gives us 50 kg + 2.3 kg * (67.32287 (in inches) - 60) = 66.8426 kg.
Hence, the patient's IBW is 66.8426 kg."
164,10,Ideal Body Weight,physical,decimal,pmc-5548950-1,Extracted,"A 30-year-old male who was 161 cm tall and weighed 91 kg (morbid obesity, body mass index 35.0 kg/m2) underwent WLL as treatment for PAP (). The patient had been suffering dyspnea on exertion for three years. His vital signs were blood pressure (BP) 130–150/70–80 mmHg, heart rate (HR) 80–100 beats/min, respiratory rate (RR) 18–22 rates/min, and body temperature 36.2℃. The patient's oxygen saturation by pulse oximeter (SpO2) while receiving air was 75–89%, which was partially corrected to 91–98% while receiving 2 L/min of oxygen via nasal prong (VNP). Arterial blood gas analysis (ABGA) under oxygen administration revealed the following: pH 7.39, arterial CO2 partial pressure (PaCO2) 44.6 mmHg, arterial O2 partial pressure(PaO2) 65.3 mmHg, and bicarbonate (HCO3–) 26.1 mEq/L.
During induction, both mask ventilation and intubation were difficult (laryngeal view: Cormack-Lehane grade IV). Intubation trials with a 37-Fr. left-sided double lumen tube (DLT) (Mallinckrodt™, Covidien, Dublin, Ireland) and laryngoscopy, followed by a videostylet (Optiscope®, Pacific Medical, Seoul, Korea) failed. Hence, a flexible fiberoptic bronchoscope (FOB) was used to intubate a single lumen tube (SLT) (ID 8.0), and then the SLT was changed to a DLT using a tube exchanger.
Left one-lung ventilation (OLV) was maintained with an SpO2 of 86–90% at an inspired oxygen fraction (FIO2) of 1.0 during right-lung lavage. We performed external percussion physiotherapy with an automatic mechanical percussion device (The Vest™ Model 205 [Airway Clearance System], frequency 10 Hz, duration 3 minutes, Hill-Rom, Charleston, SC, USA) rather than manual chest percussion. After right-lung lavage, we resumed two-lung ventilation (TLV) with intermittent suction for 20 minutes (FIO2 1.0). For left-lung lavage, right OLV was started with an FIO2 of 1.0, but it was impossible to maintain SpO2 > 80% (). Therefore, we decided to postpone left-lung lavage until conditions in the right lung improved (). A chest X-ray taken after intensive care unit (ICU) transfer showed no specific findings, including pneumothorax. One day after the lavage, while in the ICU, the patient was weaned from mechanical ventilation, extubated, and transferred to the general ward.
Three days later, the patient was returned to the operating room for left-lung lavage. The patient's SpO2 was 91–96% with O2 3 L/min VNP. We intubated the trachea with a SLT via Glide-Scope (Verathon Medical, British Columbia, Canada) and then changed the SLT to a DLT with a tube exchanger because the previous intubation was difficult. We confirmed breath sounds from both lungs, and right and left lung ventilation during separation through auscultation. The proper tube location was confirmed using an FOB.
TLV was performed in volume-controlled mode: FIO2 1.0, tidal volume of 400 ml, RR of 15 rates/min, peak inspiratory pressure (PIP) of 31 cmH2O, and positive end-expiratory pressure (PEEP) of 5 cmH2O. PaO2 was 57 mmHg (SpO2 86%) on ABGA examination. Fifty minutes after induction, we started right OLV in pressure-controlled mode: FIO2 1.0, inspiratory pressure of 25 cmH2O above PEEP 5 cmH2O, tidal volume of 200 ml, and RR of 20 /min. Within a few minutes of starting right OLV, the patient's SpO2 plunged below 80%, so we rapidly resumed TLV and re-confirmed the proper position of the DLT using an FOB. We did not observe any bronchial secretion or obstruction. Right OLV was tried again, but the patient's SpO2 rapidly decreased to < 80% within a few minutes. After resuming TLV, 2.5 mg of salbutamol was nebulized to relieve any bronchial constriction, and 100 mg of hydrocortisone was injected intravenously to improve symptoms. During manual ventilation, we detected very poor lung compliance. In auscultation, the patient's breath sounds from the right lung were very distant and nearly inaudible. Therefore, we suspected he had a right-side pneumothorax, which was confirmed on chest X-ray (). A chest tube was inserted by a thoracic surgeon, and a follow-up chest X-ray showed that the pneumothorax had decreased (). Two hours after induction, lung compliance and arterial oxygenation improved: FIO2 1.0, tidal volume of 450 ml, RR of 18/min, PIP of 24 cmH2O, and PEEP of 5 cmH2O. PaO2 improved to 93 mmHg on the following ABGA examination ().
We re-tried right OLV and were finally able to maintain SpO2 > 90%: FIO2 1.0, inspiratory pressure of 23 cmH2O above PEEP 5 cmH2O, tidal volume of 320 ml, and RR of 20 /min, without any severe air leakage or tidal-volume loss. The left-lung lavage was started along with right OLV with the chest tube inserted state. During the remaining lavage period, we maintained SpO2 > 85% without further deterioration.
After lavage, the patient was transferred to the ICU and received mechanical ventilation. On postoperative day (POD) 1, the patient developed a high fever (38.8℃) and was diagnosed as having pneumonia with parapneumonic effusion in the right lower lobe, so antibiotics were administered. The chest tube was removed on POD 3, and extubation was performed on POD 4. The patient was transferred to the general ward on POD 7 and discharged on POD 19. Follow-up chest computed tomography was performed 40 days after the left-lung lavage; it showed interval decreases in the extent of PAP in both lungs, resolved parenchymal consolidation in the right lung, and decreased right pleural effusion ().","Using the Ideal Body Weight Formula, what is the patient's ideal body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'height': [161.0, 'cm']}",57.78748,54.89811,60.67685,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Male.
The patient's height is 161.0 cm, which is 161.0 cm * 0.393701 in/cm = 63.38586 in. 
Plugging in the values for the IBW formula for males gives us 50 kg + 2.3 kg * (63.38586 (in inches) - 60) = 57.78748 kg.
Hence, the patient's IBW is 57.78748 kg."
165,10,Ideal Body Weight,physical,decimal,pmc-2876933-1,Extracted,"A 52-year-old male, weighing 54 kg, height 164 cm, with a 22-year-old history of ankylosing spondylitis was admitted in the Urology Department, for percutaneous nephrolithotomy.
During preanesthetic assessment his history revealed that the he required three pillows to support his head due to the disease process and involvement of the cervical spines []. A physical examination suggested that there was severe cervical spondylitis involving thoracolumbar vertebral column, without lower limb neurological involvement. No cardiovascular system abnormality was detected.
The airway examination showed adequate mouth opening with artificial dentures, Mallampati grade III restricted neck mobility. A preoperative assessment for difficult intubation was made.
Radiographs of the vertebral column revealed ankylosis of the cervical, thoracic, and lumbar spinous processes showing posterior joint involvement, resorption of the anterior surfaces of the vertebral bodies and calcification and ossification of the posterior ligaments and surrounding soft tissues.
Following the traditional anesthetic approach to ankylosing patients, we decided to opt for securing the airway using awake endotracheal intubation; however, the patient did not give his consent for this. A difficult intubation cart, which had a selection of oropharyngeal, nasopharyngeal airway, gum elastic bougie, fiberoptic bronchoscope, cricothyroidotomy, and other aids, was kept ready.
On the day of the surgery, the patient was premedicated with oral ranitidine 150 mg and diazepam 5 mg, two hours before surgery, with a sip of water, and injection glycopyrrolate 0.2 mg intramuscularly one hour before surgery. Preparation for fiberoptic intubation was done. Nasal patency was checked and the nasal cavity prepared with oxymetazoline nasal drops. In the operation room the patient was made to lie supine with the head adequately supported on three pillows and routine monitors, such as, the electrocardiogram, non-invasive blood pressure, and pulse oximeter and capnograph were placed. The IV line, with a 18 Gauge canula, was started. Anesthesia was induced with IV injection propofol 2 mg/kg, slowly, in titrated doses, with fentanyl 2 μg/kg. The anesthetist had to use a higher footstep than normal to get the desired level. We opted for fiberoptic bronchoscopy, but as the heart rate increased to 144/min and the blood pressure increased to 180/118 mmHg, we administered a further bolus dose of 50 mg of propofol to increase the depth of anesthesia. The patient's heart rate, and blood pressure stabilized, but the patient started desaturating with apneic spells, so we decided to abandon the procedure. The patient was allowed to wake up. Regional anesthesia was taken as the next option. Even after three attempts by expert hands no cerebrospinal fluid (CSF) was obtained through the spinal needle.
Taylor's approach was attempted. Clear CSF was obtained through the spinal needle and 3 ml of 0.5% bupivacaine and 25μg/kg fentanyl was injected intrathecally. Due to the spinal deformity, we were not able to achieve the appropriate position for intrathecal block. Therefore, we carried out some maneuvres; we placed a pillow beneath the left shoulder to make the spine of the scapula perpendicular to the table, and the operating table (OT) was tilted 20° to the right, to straighten the spine and to make it parallel to the floor.
The block was adequate with sensory block up to T4 and adequate motor blockade upto T6. The vital signs remained stable. Fluid calculations and management of blood pressure were very important in this patient with severe lung disease. Prone position had to be given carefully, with bolsters confirming to the contours of the patient, to avoid fractures.
There were no intraoperative problems throughout the procedure, which was completed within three hours. Hemostasis was adequate. Supplementary oxygen was administered continuously during the surgical procedure. There were no postoperative sequelae to the spinal technique.","Using the Ideal Body Weight Formula, what is the patient's ideal body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'height': [164.0, 'cm']}",60.50401,57.47881,63.52921,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Male.
The patient's height is 164.0 cm, which is 164.0 cm * 0.393701 in/cm = 64.56696 in. 
Plugging in the values for the IBW formula for males gives us 50 kg + 2.3 kg * (64.56696 (in inches) - 60) = 60.50401 kg.
Hence, the patient's IBW is 60.50401 kg."
166,10,Ideal Body Weight,physical,decimal,pmc-4236960-1,Extracted,"A fifteen-year-old female adolescent was admitted to the child and adolescent acute psychiatric unit of our hospital for the first time after remaining isolated in her home for four months. She had initiated treatment in the outpatient clinic of her district in June 2013, attending only one visit and refusing all psychiatric treatment thereafter.
There was a family history of schizophrenia in second degree relative on her mother's side. The patient's medical history, according to her family, included recurrent acute bronchitis until 10 years of age. No history of alcohol or tobacco consumption or psychoactive substance use was reported. The patient was very selective and restrictive in her meals since her childhood. She only ate biscuits, ham croquettes, bread, and omelettes.
Regarding school, she described acceptable performance until the previous academic year when she presented some difficulties, and her teachers decided to change her to another classroom with a lower academic level.
Her premorbid personality was described as quiet and shy, with some difficulty in social relationships, but with a group of friends at the beginning of the episode. She lived with her parents and an 18-year-old sister in a mid-size city (with a population of about 216,000 inhabitants).
The patient reported that during the previous academic year she had been separated from her friends due to the change of classroom and at the same time she had begun to suffer digestive cramps and headaches, and as a result she stopped going to school. She stayed at home, with no interest in leaving the house, playing computer games and surfing the internet all day from April 2013 until her admission in our department 6 months later. The family explained that she had also become withdrawn from them, showing little interest in conversation, giving only monosyllabic answers, and gesturing in response to her parents' questions. She showed neglect in her personal hygiene and apathy regarding her physical appearance.
At the time of her admission, the mental status examination showed she was conscious and oriented in time, place, and person, though unkempt and exhibiting psychomotor retardation, poor eye contact, and limited language, answering questions with monosyllables or gestures. She also displayed emotional lability when discussing sensitive issues like friends and school and showed hypothymia, poorly reactive mood, apathy, weakness, and anhedonia and was only interested in computer usage. She did not exhibit impaired sensory perception, self-referentiality, or psychotic behavior, though she was sleeping from 4:00 am to noon. Her food intake was very selective, limited to certain specific foods, but there was no loss of appetite. The patient denied having suicidal ideation.
In the first interview, apathy and depressive moods were observed when she spoke about life events related to her friends at school and how this situation interfered with her functioning. Physical examination revealed a weight of 83.1 kg, height of 1.63 m, body mass index of 31.3, body mass index standard deviation score of 2.689, and blood pleasure of 120/80 mmHg. She denied muscular pain and no goiter or myxedema.
Soon after admission, a blood test and electrocardiogram (EKG) were performed. EKG, liver function tests, electrolytes, and whole blood count were within normal limits. Due to her isolation at home and selective food intake, levels of some vitamins were analyzed; vitamin D3 and folic acid levels were insufficient (vitamin D3: 20.9 ng/mL insufficient with levels above 30 ng/mL and folic acid: 2.3 ng/mL insufficient with levels above 3 ng/mL). The thyroid function test showed thyroid-stimulating hormone (TSH) levels of 24.159 mIU/L (reference range: 0.400–4.00), free thyroxine (FT4) 0.93 ng/dL (reference range: 0.80–2.00), and triiodothyronine (T3) 1.08 ng/mL (reference range: 0.70–1.90), with antithyroid peroxidase antibodies >1300 IU/mL (reference range: <35).
We requested interconsultation with the endocrinology department where hypothyroidism secondary to Hashimoto's thyroiditis was diagnosed, and treatment with levothyroxine 50 micrograms/day was recommended. We began folic acid (5 mg/day) and vitamin D (0.266 mg/alternate days) supplementation too.
During her hospital stay, the patient adapted well to the rules of the unit, was sociable with peers, and showed no behavioural disturbances at any time.
After 8 days in our acute unit, the patient showed significant improvement in mood and social interaction and was discharged. Monitoring continued in the outpatient clinic, while the patient maintained the same pharmacological treatment. At six weeks, the patient was asymptomatic; she had returned to school showing acceptable performance and socialization with family and classmates. The new thyroid function test showed TSH 9.096 mIU/L and FT4 1.21 ng/dL. Six-months after discharge, the improvement persisted, and thyroid function was TSH 6.935 mIU/L and FT4 1.35 ng/dL and antithyroid peroxidase antibodies decreased, with 75 micrograms/day of levothyroxine.","Using the Ideal Body Weight Formula, what is the patient's ideal body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'height': [1.63, 'm']}",55.0985,52.34358,57.85343,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Female.
The patient's height is 1.63 m, which is 1.63 m * 39.3701 in/m = 64.17326 in. 
Plugging in the values for the IBW formula for females gives us 45.5 kg + 2.3 kg * (64.17326 (in inches) - 60) = 55.0985 kg.
Hence, the patient's IBW is 55.0985 kg."
167,10,Ideal Body Weight,physical,decimal,usmle-8635,Extracted,"A 38-year-old woman is brought to the emergency department because of 3 1-hour episodes of severe, sharp, penetrating abdominal pain in the right upper quadrant. During these episodes, she had nausea and vomiting. She has no diarrhea, dysuria, or hematuria and is asymptomatic between episodes. She has hypertension and hyperlipidemia. Seven years ago, she underwent resection of the terminal ileum because of severe Crohn's disease. She is 155 cm (5 ft 2 in) tall and weighs 79 kg (175 lb). Her BMI is 32 kg/m2. Her temperature is 36.9°C (98.5°F), pulse is 80/min, and blood pressure is 130/95 mm Hg. There is mild scleral icterus. Cardiopulmonary examination shows no abnormalities. The abdomen is soft, and there is tenderness to palpation of the right upper quadrant without guarding or rebound. Bowel sounds are normal. The stool is brown, and a test for occult blood is negative. Laboratory studies show:
Laboratory test
Blood  
Hemoglobin 12.5 g/dL
Leukocyte count 9,500 mm3
Platelet count 170,000 mm3
Serum  
Total bilirubin 4.1 mg/dL
Alkaline phosphatase 348 U/L
AST 187 U/L
ALT 260 U/L
Abdominal ultrasonography shows a normal liver, a common bile duct caliber of 10 mm (normal < 6 mm), and gallbladder with multiple gallstones and no wall thickening or pericholecystic fluid.","Using the Ideal Body Weight Formula, what is the patient's ideal body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'height': [155.0, 'cm']}",47.85442,45.4617,50.24714,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Female.
The patient's height is 155.0 cm, which is 155.0 cm * 0.393701 in/cm = 61.02366 in. 
Plugging in the values for the IBW formula for females gives us 45.5 kg + 2.3 kg * (61.02366 (in inches) - 60) = 47.85442 kg.
Hence, the patient's IBW is 47.85442 kg."
168,10,Ideal Body Weight,physical,decimal,pmc-4805055-1,Extracted,"We present a 15-year-old boy who was admitted to our hospital with significant weight loss, malaise, and cold intolerance. Written informed consent for presentation was obtained from the patient and his parents.
The patient weighed 102 kg until four years ago, at which time, with the help of a dietitian, he started to lose weight. However, after losing 2 kg, he discontinued the dietary regime. Two years later, when he weighed 100 kg, he decided to lose weight again because he felt uncomfortable with the way he looked and felt very overweight. Within a year, he lost 20 kg by eating less and playing basketball every day for approximately two hours a day. At that time, he had to quit basketball due to a busy school schedule which led to a fear of gaining weight, causing him to restrict his diet even more. By restricting his daily intake to 500 kcal, he had lost 17.5 kg within the last two months before presenting to our clinic. The patient denied having body image problems but agreed that he had an intense fear of gaining weight. Past medical history was unremarkable except for an appendectomy performed when he was 7 years old. The family history revealed that two of his aunts have Hashimoto thyroiditis.
At admission, the patient’s body weight was 60.7 kg (50-75th percentile). Height was 186 cm (>97th percentile) and body mass index was 17.55 kg/m2 (<3rd percentile). His body temperature was 36.1 °C and respiratory rate was 22/min. His supine blood pressure was 100/60 mmHg and heart rate was 40 bpm. His standing blood pressure was 95/60 mmHg and heart rate was 66 bpm. Cardiac examination was normal except for the bradycardia, and other systems were also normal on his physical examination. Meeting the diagnostic criteria of the fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM IV), he was diagnosed with AN-restrictive type and hospitalized due to bradycardia. His laboratory investigations which included complete blood count, liver and kidney function tests, glucose and electrolyte levels, sedimentation rate, cortisol, cholesterol levels, and urinary analysis were all within normal ranges. Thyroid function tests revealed very low TSH levels (0.025 uIU/mL, normal range: 0.27-4.20 uIU/mL), low free T3 (fT3) levels (2.87 pmol/L, normal range 3.10-6.70 pmol/L), and normal free T4 (fT4) levels (21.9 pmol/L, normal range: 12.00-22.00 pmol/L). Thyroid peroxidase antibodies and thyroglobulin antibodies were high, while TSH receptor antibodies were negative. With these findings, he was additionally diagnosed with Hashimoto thyroiditis. Thyroid ultrasonography confirmed the diagnosis.
In the inpatient unit, the patient was followed by an interdisciplinary team consisting of a child and adolescent psychiatrist, an adolescent medicine specialist, a pediatric endocrinologist, and a dietitian with special training and experience in adolescent EDs. During his three-week stay, he gained 4 kg. Despite the weight gain and the improvement in his nutritional status, bradycardia continued (40-50 bpm). Echocardiography findings were normal, and Holter monitoring only revealed sinus bradycardia. Thyroid functions were monitored closely without any medical treatment, along with his vitals. Before discharge, while TSH levels were still low (0.018 uIU/mL), fT3 levels were thought to be relatively high (3.76 pmol/L) considering his metabolic status. The patient was discharged with a weight of 64.7 kg. At his follow-up visit 2 months later, the boy had gained weight and weighed 75.1 kg. Due to the gradual increase noted in his TSH levels (from 8.91 to 28.84 uIU/mL), levothyroxine treatment was started. At that time, fT3 and fT4 levels were measured as 7.74 and 4.42 pmol/L, respectively. Two months later, it was learned that he had been using levothyroxine in doses three times higher than the recommended dose. Although monitored closely, due to the drug compliance problems and weight changes with severe body image issues, it was hard to maintain the thyroid levels within a stable course. Stabilization occurred after ten months of therapy when he started using a proper medication schedule and succeeded in preserving his target weight. The course of the thyroid function tests is given in . Bradycardia also improved with the recovery in thyroid hormone levels.","Using the Ideal Body Weight Formula, what is the patient's ideal body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'height': [186.0, 'cm']}",80.4253,76.40403,84.44656,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Male.
The patient's height is 186.0 cm, which is 186.0 cm * 0.393701 in/cm = 73.22839 in. 
Plugging in the values for the IBW formula for males gives us 50 kg + 2.3 kg * (73.22839 (in inches) - 60) = 80.4253 kg.
Hence, the patient's IBW is 80.4253 kg."
169,10,Ideal Body Weight,physical,decimal,pmc-5482957-1,Extracted,"A 35-year-old African American man with a history of hypertension, carpal tunnel syndrome, osteoarthritis of the knee, and glucose-6-phosphate deficiency (G6PD) was scheduled for removal of keloids found in the occipital region of his head. His medications include amlodipine, hydrochlorothiazide, lisinopril, and cholecalciferol. He was 1.85 m (73 inches) tall, weighed 134 kg with a body mass index of 39. An airway examination on the day of surgery showed a prominent mandible, limited mouth opening, macroglossia, positive prognathism, Mallampati IV classification, and thyromental distance (thyroid notch to the tip of the jaw with the head extended) >6 cm; a thyromental distance <6 cm serves as a predictor for difficult intubation. He also had other distinct skeletal features that included prominent supraciliary arches and nose bridge, as well as large hands and feet.
Following induction of general anesthesia with lidocaine, fentanyl, and propofol and muscle relaxation with succinylcholine, an elective Airtraq device was used for intubation with moderate difficulty. Following a second attempt, a 7.0 endotracheal tube was passed blindly into his trachea because of large immobile epiglottis that resulted in a grade IV indirect view. His surgical procedure was uneventful and he was extubated without difficulty. After full recovery in the post-anesthesia recovery unit, he was informed that he had a difficult airway and advised to inform all future anesthesia providers. In addition, because of the high index of suspicion for acromegaly he was educated about the possibility of having this disorder and was advised to follow up with his primary care provider for further evaluation.
Endocrine tests performed subsequently included serum cortisol, adrenocorticotropic hormone, thyroid-stimulating hormone, prolactin, hemoglobin A1C, insulin-like growth factor 1 (IGF-1), GH, and parathyroid hormone levels. All of his biochemical markers were normal except for his serum IGF-1 and GH (Table ) that were 700 ng/ml and 22.5 ng/ml, respectively: twofold greater than the reference normal upper limit. A transthoracic echocardiogram showed moderate left ventricular hypertrophy with preserved systolic left ventricular function. Magnetic resonance imaging of his brain showed a large mass arising from the sella and extending into the suprasellar cistern (19 × 12 × 20 mm), consistent with pituitary macroadenoma (Fig. ).
A neurosurgical evaluation was performed and he underwent a transsphenoidal resection of his pituitary tumor 3 months later. Given his known difficult airway, he was intubated using an awake oral fiberoptic technique. His perioperative period was uneventful. Pathological evaluation showed the resected pituitary adenoma to be focally reactive for prolactin and GH, and was negative for adrenocorticotropic hormone, thyroid-stimulating hormone, follicle-stimulating hormone, and luteinizing hormone. Serum laboratory tests performed 3 weeks postoperatively showed normalization of his prolactin, IGF-1, and GH levels (Table ).","Using the Ideal Body Weight Formula, what is the patient's ideal body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'height': [1.85, 'm']}",79.51979,75.5438,83.49578,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Male.
The patient's height is 1.85 m, which is 1.85 m * 39.3701 in/m = 72.83469 in. 
Plugging in the values for the IBW formula for males gives us 50 kg + 2.3 kg * (72.83469 (in inches) - 60) = 79.51979 kg.
Hence, the patient's IBW is 79.51979 kg."
170,10,Ideal Body Weight,physical,decimal,pmc-8045308-1,Extracted,"A 47-year-old woman presented with lower extremity weakness and paresthesia, gait disorder, and bladder and rectal disorder. Four months after the onset of numbness and motor weakness of the lower extremities, she presented to our hospital without any trauma. One week before presentation, the gait disorder and bladder and rectal disorder became apparent. The patient’s history included hypertension. There was no family history of acromegaly or OPLL.
She weighed 72 kg, her height was 162.0 cm, and her BMI was 27.4 kg/m2. Blood pressure at admission was 160/90 mmHg. Her facial appearance was acromegaly-like, with a frontal protrusion, nose and lip enlargement, and mandibular protrusion (Fig. a). We also observed thickening of the soft tissue of the palm and fingers and thickening of the Achilles tendon. There was no history of headache, sweating, or fatigue, and we did not observe Raynaud’s phenomenon or carpal tunnel syndrome.
In the upper extremities, no abnormal neurological findings were observed. However, weakness in both lower extremities (iliopsoas muscle MMT4, quadriceps femoris MMT4) was observed. Both lower extremity tendon reflexes were enhanced, and clonus was observed. Hypo-sensation (5/10) was observed below the umbilicus. These neurological findings suggested spinal cord lesions below the T10 level. She was barely able to walk on flat ground using two canes, and the Japanese Orthopedic Association score was 9 points (4–1–2-0-0-2).
The complete blood count was normal. An evaluation of glycemic status revealed a fasting plasma glucose level of 115 mg/dL. The glycosylated hemoglobin level was 5.9%, and the plasma glucose level during the OGTT (75 g glucose) at 2 h was 153 mg/dL. These results ruled out type 2 diabetes. Hepatic function tests and renal function tests revealed no abnormalities except for high alkaline phosphatase (ALP) (432 IU/L). Estimations of serum electrolytes, including sodium, potassium, calcium, and phosphorous were within normal limits. Hormonal evaluation showed raised serum IGF-1 (1914 ng/mL, reference range by age for IGF-I levels is 83 ~ 221 ng/mL) and GH (80.3 ng/mL) levels. GH was not suppressed with 75 g glucose loading, (after 60 min: 131 ng/mL; after 120 min: 46.9 ng/mL).
X-ray images showed characteristic findings of acromegaly. Scalloping in some vertebrae was observed, as indicated by arrowheads on a lateral view of the lumbar X-ray in Fig. a []. On thoracic spine X-ray there were no findings of diffuse idiopathic skeletal hyperostosis (DISH) such as more than three successive bone bridges, and there were no anterior or posterior osteophytes with a biconcave appearance such as Erdheim spondylosis in the thoracic spine (Fig. b, c).
On computed tomography (CT) images of the whole spine, isolated OPLL was observed from the lower cervical vertebra to the middle thoracic vertebra. At T6/7, a beak-shaped protrusion into the spinal canal was observed (Figs. a, c).
Magnetic resonance imaging (MRI) of the whole spine revealed stenosis with an intensity change in spinal cord at C6/7 and extensive spinal cord compression in the thoracic spine (Figs. b, d). Contrast-enhanced MRI of the brain showed a mass without contrast enhancement on the right side of the anterior pituitary gland (size, 10 mm × 12 mm × 10 mm) with suprasellar and parasailer extension; the image revealed a pituitary macroadenoma (Fig. ).
The patient’s most remarkable symptom was paraplegia, and we diagnosed myelopathy due to thoracic OPLL. Furthermore, we suspected acromegaly because of the characteristic facial features and blood test findings (ALP 432 IU/L, GH 80.3 ng/ml, IGF-1914 ng/ml). Contrast-enhanced MRI of the brain performed by the endocrinology department showed a pituitary adenoma (Fig. ). The patient’s symptoms satisfied the diagnostic criteria for acromegaly. Neurosurgery was scheduled for the pituitary adenoma, but spinal surgery was prioritized due to fear of exacerbation of neurological symptoms.
The neurological findings suggested spinal cord lesions below the T10 level, and T6/7 was judged to be the location of the primary lesion. T1–3 and T6–11 laminectomy and T1–11 posterior fixation were performed. Additionally, there was severe spinal cord compression in C6/7, and open-door laminoplasty with a lamina plate was performed for C5–7 (Fig. ).
On the third day after the operation, rehabilitation was started with a cervical collar and hard thoracolumbar corset. The postoperative course was good, the paralysis gradually improved, and the patient was able to walk alone indoors. She was discharged 3 weeks after the operation. There have been no adverse or unanticipated events. Two months after the spinal surgery, resection of the pituitary adenoma was performed in the neurosurgery department, and the patient is still under observation. A pathological image (H&E, × 400) is provided and showed a sheet of monotonous cells with round nuclei and loss of normal lobular patterns of the pituitary adenoma (Fig. ). Staining for TSH and ACTH was negative. Staining for PRL was positive in 10% of the resected pituitary tissue. Staining for CAM5.2 was diffusely positive in many cells and several cells had fibrous bodies. These findings are consistent with growth hormone-secreting pituitary adenomas. We did not have other antibodies, so it was difficult to classify the pituitary adenoma in detail.","Using the Ideal Body Weight Formula, what is the patient's ideal body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'height': [162.0, 'cm']}",54.19299,51.48334,56.90264,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Female.
The patient's height is 162.0 cm, which is 162.0 cm * 0.393701 in/cm = 63.77956 in. 
Plugging in the values for the IBW formula for females gives us 45.5 kg + 2.3 kg * (63.77956 (in inches) - 60) = 54.19299 kg.
Hence, the patient's IBW is 54.19299 kg."
171,10,Ideal Body Weight,physical,decimal,pmc-8716215-1,Extracted,"We obtained Institutional Review Board (IRB) approval (Dankook University Hospital IRB 2021-02-015) and written informed consent from patient's legal representative for the publication of this report.
A 42-year-old male (American Society of Anaesthesiologists class II; weight, 59 kg; height, 165 cm) with a malignant melanoma in the left side of the oral cavity, gingiva, and buccal mucosa was scheduled for mass excision and reconstruction with a fibular free flap (). Preoperative magnetic resonance imaging (MRI) showed an ill-defined mass lesion that was 2.6 × 2.4 × 1.8 cm in size in the left lateral part of the oral cavity (Figures and , stage III, T2N1). He was previously healthy and had no history of systemic disease or medication. Preoperative evaluations, including laboratory tests, electrocardiography, and chest radiography, were unremarkable.
Patient monitors were instituted, including standard monitors and continuous arterial blood pressure monitoring with radial artery catheter insertion. General anaesthesia was induced with intravenous injections of fentanyl (100 μg), lidocaine (60 mg), propofol (120 mg), and rocuronium (50 mg) and maintained with 7–10 vol% desflurane. After the induction of anaesthesia, nasal packing was performed with cotton swabs moistened with a 0.01% epinephrine solution. Nasotracheal intubation was performed using fibreoptic bronchoscopy (FI-10RBS, Pentax, Japan), and a 6.5 mm reinforced tube was inserted. After intubation, a central venous catheter (CVC, Bio Line, 7 F double lumen catheter, Ewha Biomedics, Republic of Korea) was inserted into the right subclavian vein using the anatomical landmark technique.
Partial mandibulectomy (from # 21 to the mandibular angle), radical neck dissection, and reconstruction with a fibular free flap were performed (). The operation time was approximately 13 hours and 25 minutes. The infused volume was crystalloid 7200 ml, colloid 1700 ml, packed red blood cells (pRBC) 5 units, and fresh frozen plasma 5 units. The urine output was 3800 ml, and the estimated blood loss was approximately 1800 ml. The patient was transferred to the intensive care unit and was kept sedated with endotracheal intubation.
The patient recovered from anaesthesia 3 hours after the surgery. Ventilator weaning was initiated at 8 AM on the first postoperative day (POD 1), the ventilator was stopped at 1 PM, and oxygen (5 L/min) was administered via a T-piece. The patient did not complain of respiratory difficulties. The patient was evaluated before extubation, and his mental status was alert, muscle tone was intact, surgical wound condition was visually acceptable, and the endotracheal tube cuff leak test was fair. No bleeding was noted from the surgical wound. Blood pressure was maintained between 110/60 mmHg and 140/90 mmHg. Postoperative pain was treated with an intravenous infusion of patient-controlled analgesia with fentanyl and nefopam. There was no dyspnoea, and arterial oxygen saturation was 100%.
At 8 AM POD 2, the patient was extubated (approximately 36 hours postsurgery), and oxygen (3 L/min) was administered via a nasal prong. Four hours after extubation, his haemoglobin level decreased to 8.9 ml/dl. One unit of pRBC was transfused.
Seven hours after extubation (POD 2, 3 PM), the patient complained of dyspnoea, and arterial oxygen saturation decreased from 100% to 87%. Bag-mask ventilation was initiated but was ineffective. Oral and nasal airway insertion was not sufficient to open the airway. Conventional direct laryngoscopy, video laryngoscopy, and laryngeal mask insertion were not successful because the structures in the oral cavity were severely distorted due to operation site oedema and haematoma. An otolaryngologist performed an emergency TT while performing bag-mask ventilation. During TT, the heart rate decreased from 90 bpm to 42 bpm. Intravenous atropine (0.5 mg) and epinephrine (200 μg) were administered. Ten minutes after the initiation of bag-mask ventilation, cardiopulmonary resuscitation was initiated to treat cardiac arrest, and epinephrine (1 mg) was administered every 5 minutes. The TT tube was secured 28 minutes after the initiation of bag-mask ventilation. Blood pressure was 80/30 mmHg, and dopamine, dobutamine, and norepinephrine infusion (20 μg/kg/min each) were administered. The patient was connected to a ventilator and was sedated with midazolam. On POD 3, midazolam sedation was stopped; however, patient's mental status was semicomatose, and he showed seizure-like movements. A neurology consult was obtained, and postoperative computed tomography showed severe swelling and increased soft tissue density with airway compression in the left side of the face and neck (). On POD 4, a brain MRI showed a diffusely restricted lesion involving the whole cerebral cortex and basal ganglia. The patient received conservative treatment but his mental status did not recover. On POD 67, a recurring tumour was found. Further chemotherapy or radiotherapy was considered; however, it was decided that it would not be beneficial. On POD 103, the patient was transferred to a hospice.","Using the Ideal Body Weight Formula, what is the patient's ideal body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'height': [165.0, 'cm']}",61.40954,58.33906,64.48002,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Male.
The patient's height is 165.0 cm, which is 165.0 cm * 0.393701 in/cm = 64.96067 in. 
Plugging in the values for the IBW formula for males gives us 50 kg + 2.3 kg * (64.96067 (in inches) - 60) = 61.40954 kg.
Hence, the patient's IBW is 61.40954 kg."
172,10,Ideal Body Weight,physical,decimal,pmc-7549567-1,Extracted,"The case history of our 15-year-old male patient revealed a seven-year history of intermittent paroxysmal episodic involuntary movement and a six-year history of episodes involving the loss of consciousness with convulsions. The involuntary movement, primarily in the right hemibody, presented as dystonia involving: the internal pronation and rotation of the shoulder joint; torsion and flexion of the wrist, knee, metacarpophalangeal, and interphalangeal joints; and tonic lower limb extension. During the episodes, the patient was conscious; however, he stared into the distance and experienced facial spasms, trismus, and aphasia. These conscious episodes lasted approximately 10 seconds and occurred up to 10 times per day before spontaneously resolving. And they could be induced by stretching the arms or legs.
Six years prior to admission, the patient developed a different seizure type in addition to the involuntary movement episodes. Prior to the onset of these seizures, he experienced warning symptoms (also known as an ‘aura’) including brain swelling or dizziness. These started with the repetitive and rigid act of chewing and swallowing. This was accompanied by a throwing motion of the right arm and a confused mental state. The duration of each episode was approximately 2–3 minutes and they occurred once or twice a month. During some of these episodes, the patient was found to have generalized tonic-clonic seizures resulting in a loss of consciousness. This sometimes (2–3 times per year) led to him falling forwards. Records also showed an eight-year history of tetany.
The patient was 162 cm in height, weighed 54 kg. Apart from febrile convulsions at 6 months old, there was no history of neurological disease, brain tumor, or trauma. In his family history, there were no similar instances of involuntary movements. A physical examination was completed but revealed no typical positive signs. Serum analysis indicated a calcium concentration of 1.91 mmol/L (reference: 2.13–2.7 mmol/L), a phosphorus concentration of 2.68 mmol/L (reference: 0.74–2.7 mmol/L), an alkaline phosphatase concentration of 114 IU/L (reference: 42–390 IU/L), a parathyroid hormone (PTH) concentration of 109 pg/ml (reference: 7–13 pg/ml), and a urine calcium concentration of 1.6 mmol/24 h (reference: 2.7–7.5 mmol/24 h). Results for electrolyte concentration and markers of liver, kidney, and thyroid function were all within the acceptable ranges. Computerized tomography (CT) and magnetic resonance imaging (MRI) imaging of the brain revealed bilateral calcium deposition in the cortex of the frontal and parietal lobes, and in the thalamus (Figure ). Electroencephalography (EEG) data showed paroxysmal low and medium amplitude slow waves, isolated sharp waves, and sharp slow wave release in the right prefrontal temporal lobe (Figure , supporting Figure ). Neither mutations nor copy number variations were detected in the genes of interest during genetic analysis (eg. GNAS, STX16, GNAS-AS1, etc. [Reference Sequence: NC_000020.11]); however, GNAS methylation abnormalities were present. No abnormalities were found during an abdominal B-mode ultrasound or following an X-ray of the hands.
Following treatment with carbamazepine (400 mg/day), calcium supplements (1000 mg/day) and vitamin D (10,000 U/day), there was no recurrence of abnormal movements or seizures during a 3-month follow-up period and the blood calcium returned to normal.","Using the Ideal Body Weight Formula, what is the patient's ideal body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'height': [162.0, 'cm']}",58.69299,55.75834,61.62764,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Male.
The patient's height is 162.0 cm, which is 162.0 cm * 0.393701 in/cm = 63.77956 in. 
Plugging in the values for the IBW formula for males gives us 50 kg + 2.3 kg * (63.77956 (in inches) - 60) = 58.69299 kg.
Hence, the patient's IBW is 58.69299 kg."
173,10,Ideal Body Weight,physical,decimal,pmc-7297919-1,Extracted,"A 28-year-old woman was admitted to the hospital with progressive ocular symptoms as well as newly developed hemianesthesia and mental signs. Half a month before hospitalization, she complained of double eyelid droop and diplopia; the ocular weakness and fatigue was stable throughout the day and had nothing to do with physical activity. The local hospital suspected myasthenia gravis, a computed tomography scan of her brain revealed nothing, and her serum was collected to detect the acetylcholine antibody. While waiting for a hospital bed, she developed numbness in her right upper and lower extremities. At the same time, she presented with prolonged sleep duration and mental symptoms. She was then transferred to our institution. On admission, she was noted to have difficulty walking by herself due to truncal ataxia. There was no cold, fever, or diarrhea before her symptom onset.
She had been suffering from chronic anemia, and her family reported that she had dietary deficiencies due to poor appetite although she denied it herself. She was on no other medications, not pregnant, and did not use alcohol or illicit drugs.
On physical examination, the patient presented obviously unbalanced nutrition; she was 1.65 m in height yet only weighed 40 kg. She was conscious and oriented and scored 23 in the MMSE, mainly due to impaired memory and calculation performance. Eye signs were obvious; she had drooping eyelids (both 5 mm). The ophthalmoplegia was remarkable; she demonstrated bilateral abducens nerve palsies and adduction deficit of both eyes. Limitation and nystagmus on vertical gaze were also noted. There was slight dysmetria on both finger–nose and heel–shin testing. Limb dysdiadochokinesia was also observed. Bilateral pyramidal signs were positive. Sensory examination indicated hyperesthesia on the right side. Findings on muscle tone and strength tests were normal.
She had an abnormal Hb level of 92 g/L, accompanied by low levels of serum folate and ferritin; vitamin B12 level was normal. Laboratory tests also revealed elevated levels of CA199 and CA242; both were gastrointestinal tumor markers although an abdominal enhanced CT scan reported no findings. The CSF revealed an increased white blood cell count of 28/mL (dominantly lymphocytes); other routine analyses of the cerebrospinal fluid (CSF) were normal, including protein level and IgG index (0.49). Also, no oligoclonal bands were found. Additional laboratory workup—including rheumatology analysis—was negative.
Magnetic resonance imaging of the brain () showed symmetric T2 hyperintensities predominantly located within periaqueductal gray matter and periventricular regions of the fourth ventricles. A diffusion-weighted sequence also showed a hyperintense signal along the floor of the fourth ventricle. The presence of a lateral ventricle lesion was also noted. All brain lesions did not show contrast enhancement. Nerve conduction studies and visual evoked potentials were normal.
In view of the possible diagnosis of WE, thiamine was started intramuscularly (300 mg 12-h). However, poor clinical recovery was observed. Her mental status worsened and exhibited hallucination, and the ocular palsy also progressed.
Then came the crucial result that her serum and cerebral fluid tested positive for NMOSD-IgG (1:32 and 1:3.2, respectively). Thereafter, the spinal cord was evaluated, and MRI of the spine revealed a suspicious enhanced T2-weighted signal at the lower thoracic cord region ().
We corrected the diagnosis, and the patient started with treatment of high-dose intravenous steroids, but still little improvement was detected. The patient then experienced bilateral visual loss, but MRI results of the optic nerve reported no findings. After that, intravenous immunoglobulin treatment was given, followed by intravenous cyclophosphamide therapy. On discharge, she showed moderate improvement in eye movement and ataxia although her vision remained unchanged.","Using the Ideal Body Weight Formula, what is the patient's ideal body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'height': [1.65, 'm']}",56.90952,54.06404,59.755,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Female.
The patient's height is 1.65 m, which is 1.65 m * 39.3701 in/m = 64.96066 in. 
Plugging in the values for the IBW formula for females gives us 45.5 kg + 2.3 kg * (64.96066 (in inches) - 60) = 56.90952 kg.
Hence, the patient's IBW is 56.90952 kg."
174,10,Ideal Body Weight,physical,decimal,pmc-6314998-1,Extracted,"A male in his early 60s had been living in his car. He was found dead in the car approximately 1 month after he had last been seen alive. A police officer stated that he frequently consumed potatoes in the car. On external examination, the man was 178 cm in height and 69.2 kg in weight. Toxicological evaluation of postmortem cardiac blood was performed by using the LC/MS/MS rapid toxicology screening system ver. 2 (Shimadzu); drugs that could have directly caused his death were not detected. For the qualitative and quantitative analyses of α-solanine and α-chaconine, the validated method described in the present report was used.","Using the Ideal Body Weight Formula, what is the patient's ideal body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'height': [178.0, 'cm']}",73.18119,69.52213,76.84025,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Male.
The patient's height is 178.0 cm, which is 178.0 cm * 0.393701 in/cm = 70.07878 in. 
Plugging in the values for the IBW formula for males gives us 50 kg + 2.3 kg * (70.07878 (in inches) - 60) = 73.18119 kg.
Hence, the patient's IBW is 73.18119 kg."
175,10,Ideal Body Weight,physical,decimal,pmc-5035782-1,Extracted,"A 73-year-old man was referred to our hospital by his primary care doctor because of a bulge in his right inguinal region. The patient reported this bulge had been present since his adolescence. The hernia had been reducible until age 55, and had become irreducible, thereafter. Medical history included hypertension, diabetes mellitus, asthma and cerebral infarction. He was currently taking one aspirin daily. The patient was 159 cm tall and weighed 84 kg, with a body mass index of 32.2 kg/m2. On physical examination, the bulge in his right inguinal region was roughly the size of an infant's head and the bottom of scrotum descended to his knees in the upright position (Fig. ). Laboratory tests indicated a hemoglobin A1C (HbA1C) concentration of 7.0% and a urine glucose concentration of 4+. Lung function tests identified restrictive lung function and pre-operative cardiac ultrasound revealed no local asynergy. Abdominal computed tomography (CT) imaging identified the sigmoid colon with a large amount of feces and the great omentum as part of the contents of the hernia (Fig. ). Although the hernia was irreducible, the patient was planned to undergo an elective surgery for hernia repair due to absence of symptoms of incarceration. Informed consent was obtained from the patient. The patient achieved a weight reduction of 3 kg within 3 months prior to surgery.
CT on the day of admission showed a hernia sac of 2263 ml, with an intra-abdominal volume of 12 021 ml. Pre-operative bowel preparation with Magcorol P reduced the volume of the hernia contents to 1604 ml, representing a 71% reduction. The intra-abdominal volume was decreased to 10 485 ml.
The TAPP procedure was performed under general anesthesia with the patient placed in a slight Trendelenburg position. In the aeroperitoneum, no adhesion between the orifice of the hernia and the abdominal content was identified. With four laparoscopic ports in place (Fig. ), the prolapsed intestine was slowly reduced by applying external pressure to the hernia from outside of the body. Following this procedure, complete reduction of the hernia contents was achieved, with an operative time of 2 h 50 min and a blood loss of approximately 700 ml. The loss of 700 ml of blood was mainly due to the injury caused by forceps when we sought to reduce the incarcerated omentum. We did not dissect the hernia sac, leaving it with the cord distally.
CT imaging before hernia reduction indicated the diameter of the hernia orifice to be approximately 50 mm, with the posterior wall of the hernia orifice strengthened. A mesh of sufficient area was placed to cover the orifice of the hernia, completely detaching the dorsal aspect of the hernia from the peritoneal membrane up to the dorsal ileocecal region. Given the possibility of tearing of the peritoneal membrane, a VentralightTM ST mesh (Bard Davol Inc., RI, USA), 15 cm in diameter, was used.
The patient followed a satisfactory post-operative course. The scrotum on post-operative Day 2 is shown in Fig. . On post-operative Day 2, the patient complained of mild abdominal fullness, which disappeared by post-operative Day 4 (Fig. ). Ultrasonography of the lower limbs indicated absence of deep vein thrombophlebitis. The patient was discharged from the hospital on post-operative Day 12, with no recurrence of herniation, 12 months post-surgery (Fig. ).","Using the Ideal Body Weight Formula, what is the patient's ideal body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'height': [159.0, 'cm']}",55.97646,53.17764,58.77528,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Male.
The patient's height is 159.0 cm, which is 159.0 cm * 0.393701 in/cm = 62.59846 in. 
Plugging in the values for the IBW formula for males gives us 50 kg + 2.3 kg * (62.59846 (in inches) - 60) = 55.97646 kg.
Hence, the patient's IBW is 55.97646 kg."
176,10,Ideal Body Weight,physical,decimal,pmc-7501933-1,Extracted,"A 57-year-old woman with a known history of EA with moderate TR and systemic hypertension became symptomatic with progressive dyspnoea and angina-like chest pain, occurring primarily on exertion or after meals. The patient denied syncope and dizziness but had occasional palpitations on exertion.
The patient was taking bendroflumethazide only for hypertension, having found her chest pain worsened on losartan.
On examination, height was 163 cm, weight 57 kg, blood pressure was 157/74 mmHg, heart rate 75 b.p.m., and oxygen saturations were 98%. Her jugular venous pressure was not elevated, chest was clear and there was no peripheral oedema. There was a grade 2/6 pansystolic murmur at the left sternal edge.
Electrocardiogram (ECG) showed normal sinus rhythm with a prolonged PR interval (220 ms) and right bundle branch block (QRS duration 160 ms) (). A 24 h Holter monitoring showed sinus rhythm with first degree heart block throughout, 54–104 b.p.m., with occasional runs of ventricular bigeminy and premature ventricular complexes. Full blood count, renal and liver function tests were normal.
Transthoracic echocardiography performed in 2014 showed a small, non-hypertrophied left ventricle with normal function. The commissure of the posterior and septal leaflets of the tricuspid valve was significantly apically displaced (42 mm), resulting in a large atrialized component of the right ventricle. The anterior leaflet was large and redundant. There was severe TR. Aortic and mitral valve morphology was normal. There was no systolic anterior motion of the mitral valve. The aortic annulus was small and there was turbulent flow through the left ventricular outflow (LVOT) due to the abnormal motion of the atrialized portion of the right ventricle in systole, resulting in a peak velocity through the LVOT of 2.6 m/s at rest, increasing to 3.5 m/s post-Valsalva (peak gradient 27 mmHg at rest and 48 mmHg post-Valsava) (, Video S1).
Given the patient’s cardiovascular risk profile, computed tomography of the coronary arteries was undertaken, which was normal.
Symptoms persisted and worsened with an objective deterioration in functional capacity over a 5-month period, based on cardiopulmonary exercise testing done (VO2max: 24.3 mL/kg/min—METS 6.9 in July vs. VO2max: 18.7 mL/kg/min—METS 5.3 in December with a reduced oxygen pulse).
A year later a cardiac magnetic resonance imaging showed an increase in the right ventricular end-diastolic volume over a 12-month period, from 123 mL/m2 (ejection fraction 64%) to 146 mL/m2 (ejection fraction 57%). The tricuspid regurgitant fraction increased from 32% to 52%.
Transoesophageal echocardiography (TOE) was performed to explore the LVOT anatomy in 2015. Post-TOE, transthoracic echocardiography demonstrated a resting peak velocity of 1.9 m/s across the LVOT, which increased to 5.2 m/s (incomplete Doppler envelope) with leg raising (). No atrial septal defects were identified. In the same year, an exercise stress echocardiography showed a significant increase in peak gradient to 157 mmHg and a peak flow velocity through the LVOT from 2.1 m/s (mean gradient 12 mmHg) at rest to 6.3 m/s (mean gradient 95 mmHg) at peak stress at very low workload (25 W) ().
Losartan was switched to verapamil 80 mg three times daily due to the chest pain being worse on losartan. The mechanism for this was felt to be myocardial ischaemia due to exacerbation of the LVOTO secondary to reduction of the systemic vascular resistance and therefore reduction in coronary blood flow. We felt that verapamil might reduce any dynamic LVOTO in a manner similar to that in hypertrophic obstructive cardiomyopathy. She was also prescribed indapamide 2.5 mg once a day instead of bendroflumethazide with good blood pressure control.
The patient’s case was reviewed at the multidisciplinary meeting and the decision was made to proceed to cardiac surgery for tricuspid valve repair or replacement in the hope that this would reduce the LVOTO and some LVOTO resection if possible.
Due to the rarity of the condition, the patient has chosen not to have surgery and is currently seeking several opinions worldwide.","Using the Ideal Body Weight Formula, what is the patient's ideal body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'height': [163.0, 'cm']}",55.0985,52.34358,57.85343,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Female.
The patient's height is 163.0 cm, which is 163.0 cm * 0.393701 in/cm = 64.17326 in. 
Plugging in the values for the IBW formula for females gives us 45.5 kg + 2.3 kg * (64.17326 (in inches) - 60) = 55.0985 kg.
Hence, the patient's IBW is 55.0985 kg."
177,10,Ideal Body Weight,physical,decimal,pmc-7433059-1,Extracted,"A 16-year-old female patient (weight: 56 kg, height: 165 cm) was referred to ophthalmic clinic of our hospital and reported sudden left eye pain and visual acuity reduction over the past 4 days. She was febrile (38 °C) and experienced malaise.
Ophthalmic examinations revealed that the patient’s left eye visual acuity was 0.8 (LogMAR scale, no improvement was achieved after correction) and the intraocular pressure (IOP) was 18.3 mmHg (non-contact tonometer). Slit-lamp microscope showed erythema and edema of the eyelids and chemosis (Fig. a). Color fundus photograph revealed two ERD lesions temporal and superior-nasal to the optic disk (Fig. b). The presence of ERD was further confirmed by SD-OCT (spectral-domain optical coherence tomography, Heidelberg Engineering, Heidelberg, Germany) (Fig. c).
Systemic laboratory tests were revealed by full blood count (WBC 10.54 × 109/L, 84% neutrophils) and assessment of erythrocyte sedimentation rate (ESR) (37 mm/h) and C-reactive protein (12 mg/L). Blood cultures were performed which identified Staphylococcus aureus. Orbital computed tomography (CT) scans identified left eye proptosis and swelling of the periorbital and postbulbar soft tissue, which all led to the diagnosis of orbital cellulitis. The presence of ERD was again verified by orbital CT scans (Fig. d). However, the cause for the orbital cellulitis was not idenitfied in this patient, such as trauma, periorbital cellulitis with local spread, paranasal sinusitis, or hematogenous spread of a remote infection.
Treatments in this patient were initiated soon after final diagnosis was made. Intravenous administration of antibiotics (cefatriaxone, 2.0 g, daily) was received, in addition to topical antibiotics (Lenofloxacin eye drops, Santen, Osaka, Japan) four times a day. The patient was closely followed up daily with routine ocular examinations. Considerable improvement of laboratory tests, including those revealed by the normalized blood test, was achieved after 1 week, when intravenous antibiotics were terminated. Complete recovery of ERD was evident about 1 month later (Fig. ), and the visual acuity improved to 0.6 (best-corrected visual acuity improved to 0.4, LogMAR scale).","Using the Ideal Body Weight Formula, what is the patient's ideal body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'height': [165.0, 'cm']}",56.90954,54.06406,59.75502,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Female.
The patient's height is 165.0 cm, which is 165.0 cm * 0.393701 in/cm = 64.96067 in. 
Plugging in the values for the IBW formula for females gives us 45.5 kg + 2.3 kg * (64.96067 (in inches) - 60) = 56.90954 kg.
Hence, the patient's IBW is 56.90954 kg."
178,10,Ideal Body Weight,physical,decimal,pmc-2978397-1,Extracted,"A 13-year-old female patient was referred to the GI outpatient department of our hospital from a pediatric clinic to undergo the esophagogastroduodenoscopy for the evaluation of recurrent vomiting that lasted for 8 days. The vomiting usually occurred in the afternoon and was bilious in nature. Although vomiting was not related to food intake, she had avoided eating because of recurrent vomiting. She also complained of nausea, boring epigastric pain and palpitation, but denied diarrhea or melena. She had lost 8 kg of weight over 4 months, and her weight was 39.4 kg (10-25 percentile) and height was 156 cm (50-75 percentile) at presentation. Past history and family history were not remarkable. She was in Tanner stage 4. Menarche occurred 6 months ago, and menstrual cycles were irregular. Physical examination revealed a dehydrated tongue, cachexic and anxious appearance. Her blood pressure was 100/80 mmHg, pulse rate was 110/min, respiratory rate was 20/min and body temperature was 36.6℃. There was no definite enlargement or palpable mass on the anterior neck, eye abnormality or lymphadenopathy. The abdomen was soft with normal bowel sound and there was no direct or rebound tenderness on the abdomen. Electrocardiography showed sinus tachycardia. Plain abdominal X-ray showed nonspecific findings. Because she had weight loss and palpitation with anxiety, thyroid stimulating hormone (TSH) was included in the initial laboratory test. Esophagogastroduodenoscopy at the first visit of GI outpatient department revealed mild mucosal erythema on Z-line and acute erythematous gastritis with large amount of duodenogastric reflux (). Helicobacter pylori rapid urease test was negative. She was prescribed a proton pump inhibitor, prokinetic and mucosal coating agent (sucralfate) on the basis of her endoscopic diagnosis with GI department follow up after 2 weeks. Her vomiting improved during the first 2 days after medication, however, she visited the emergency department (ED) 5 days later because of recurred vomiting and boring epigastric pain. Her blood pressure was 140/80 mmHg, pulse rate was 88/min, respiratory rate was 20/min and body temperature was 36.8℃. Physical examination revealed mild epigastric direct tenderness. The physician of the ED found that she already had blood tests including TSH at GI outpatient department and it revealed TSH < 0.01 µIU/mL (normal range 0.35-5.55 µIU/mL). Complete blood count with differential, electrolyte and glucose were within normal limit. A liver function tests showed albumin 4.34 g/dL (normal range 3.8-5.3 g/dL), total bilirubin 2.47 mg/dL (normal range 0.3-1.2 mg/dL), alkaline phosphatase 139 IU/L (normal range 25-100 IU/L), AST 30 IU/L (normal range 0-35 IU/L) and ALT 38 IU/L (normal range 0-35 IU/L). A repeated liver function test at ED showed total bilirubin 1.7 mg/dL, alkaline phosphatase 133 IU/L, AST 30 IU/L, ALT 42 IU/L and magnesium and calcium were within normal limit. Subsequent blood tests for the thyroid showed free triiodothyroxine (T3) > 8.0 ng/mL (normal range 0.60-1.81 ng/mL), free thyroxine (T4) > 12.0 ng/dL (normal range 0.89-1.76 ng/dL), TSH receptor antibody 37.4% (normal range ≤ 15.0%), anti-thyroid microsomal antibody 6.22 U/mL (normal range ≤ 3.0 U/mL) and thyroglobulin antibody 6.91 U/mL (normal range ≤ 3.0 U/mL). Thyroid ultrasonography revealed diffusely enlarged glands, decreased parenchymal echogenecity and increased vascularity of both glands (). Treatment was initiated with propylthiouracil (PTU) 3.75mg/kg/day and propranolol 1 mg/kg/day, after 4 days of treatment, vomiting, epigastric pain and palpitation were improved remarkably. She was discharged with a maintenance dose of PTU (3.75 mg/kg/day) without prokinetic or proton pump inhibitor.
She was hospitalized again 5 days later because vomiting had recurred. Liver function tests returned to normal limits, but thyroid function tests were still elevated (TSH < 0.01 µIU/mL, free T3 6.31 ng/mL and free T4 5.09 ng/dL). We switched treatment from PTU to methimazole 0.4 mg/kg/day and added inorganic iodine (Lugol's solution) for 5 days to prevent thyroid hormone release. After 3 days, there was no further vomiting, and free T3 and free T4 were decreased to 4.46 ng/mL and 2.24 ng/dL, respectively. She was discharged with a maintenance dose of methimazole (0.4 mg/kg/day) and propranolol (1 mg/kg/day).
After 2 months with methimazole and propranolol maintenance therapy, her symptoms were stable and free T4 returned to normal limits (1.27 ng/dL) despite still having low level of TSH (< 0.01 µIU/mL). Over next 16 months with methimazole monotherapy, vomiting has not recurred and she became euthyroid with normalized TSH receptor antibody.","Using the Ideal Body Weight Formula, what is the patient's ideal body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'height': [156.0, 'cm']}",48.75993,46.32193,51.19793,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Female.
The patient's height is 156.0 cm, which is 156.0 cm * 0.393701 in/cm = 61.41736 in. 
Plugging in the values for the IBW formula for females gives us 45.5 kg + 2.3 kg * (61.41736 (in inches) - 60) = 48.75993 kg.
Hence, the patient's IBW is 48.75993 kg."
179,10,Ideal Body Weight,physical,decimal,pmc-3643850-1,Extracted,"A 50-year-old woman patient without medical history and any cardiovascular risk factors was hospitalized for exertional dyspnea and palpitations from three months and signifiant weight loss. She related worsening of symptoms in the last week before admission.
On admission, she was in the poor condition, cachectic, weighing 45 kg for a height of 1, 65 m and a BMI 17 kg/ m2, blood pressure was 100/60 mm Hg, heart rate was regular 120/min, respiratory rate was 29 breaths/ min and she was afebrile. Oxygen saturation was 98%. Physical examination revealed bilateral lung crepitations. A full blood cell count showed a mild normocytic anemia (hemoglobin = 11.5 g/dl). A chest radiograph showed left atrial enlargement and data of left cardiac failure. The electrocardiogram showed sinusal tachycardia.
Transthoracic echocardiography performed in emergency showed a giant left atrial mobile mass (72× 53 mm) attached to the interatrial septum and confined to the left atrium in systole (Figure ). In diastole (Figure ) the tumor was seen prolapsing across the mitral valve into the left ventricle and partially obstructing it and causing severe functional mitral stenosis with a mean gradient of 21,3 mmHg. A mild mitral regurgitation was also found. Severe pulmonary hypertension was confirmed by Doppler PAPs =137 mmHg. The patient was scheduled for cardiac surgery. During the operation, the tumor was excised through a sternotomy from a transseptal approach with a small portion of the atrial wall and the histopathological analysis found atrial myxoma. The clinical course was uncomplicated and the patient was discharged after three weeks with good outcome.","Using the Ideal Body Weight Formula, what is the patient's ideal body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'height': [1.65, 'm']}",56.90952,54.06404,59.755,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Female.
The patient's height is 1.65 m, which is 1.65 m * 39.3701 in/m = 64.96066 in. 
Plugging in the values for the IBW formula for females gives us 45.5 kg + 2.3 kg * (64.96066 (in inches) - 60) = 56.90952 kg.
Hence, the patient's IBW is 56.90952 kg."
180,10,Ideal Body Weight,physical,decimal,pmc-8130080-1,Extracted,"A 68-year-old Japanese man (height: 160 cm, weight: 75 kg) was admitted to our hospital with chest pain and acute dyspnea. He worked as a truck driver and had never traveled abroad.
The chest pain and dyspnea had started a few days previously and had worsened over time. The patient had not received treatment prior to admission.
The patient’s medical history included type 2 diabetes mellitus and hypertension that were treated with oral metformin hydrochloride (750 mg daily) and valsartan (80 mg daily), respectively. His diabetes was poorly controlled, with a hemoglobin A1c of 7.7%.
He denied a history of similar diseases in close relatives.
On auscultation, his heart sounds were normal with no murmur. Coarse crackles were heard in both lungs. No other abnormalities were detected.
Laboratory data at the time of admission are shown in Table . In summary, his white blood cell count and C-reactive protein levels were high. Myocardial enzymes lactate dehydrogenase and aspartate aminotransferase were elevated, and troponin-T was positive. An anti-human immunodeficiency virus (HIV) antibody test result was negative.
His chest radiography on admission showed consolidation in the right upper lobe and bilateral congestion (Figure ).","Using the Ideal Body Weight Formula, what is the patient's ideal body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'height': [160.0, 'cm']}",56.88197,54.03787,59.72607,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Male.
The patient's height is 160.0 cm, which is 160.0 cm * 0.393701 in/cm = 62.99216 in. 
Plugging in the values for the IBW formula for males gives us 50 kg + 2.3 kg * (62.99216 (in inches) - 60) = 56.88197 kg.
Hence, the patient's IBW is 56.88197 kg."
181,11,QTc Bazett Calculator,physical,decimal,1,Template,A patient has a heart rate of 158 bpm and a QT interval of 402 msec.,"Using the Bazett Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [158, 'beats per minute'], 'QT Interval': [402, 'msec']}",652.34474,619.7275,684.96198,"The corrected QT interval using the Bazett formula is computed as  QTc = QT interval / √ (RR interval), where the QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 158 beats per minute.
The QT interval is 402 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/158 = 0.37975.
Hence, plugging in these values, we will get 402/√(0.37975) = 652.34474.
The patient's corrected QT interval (QTc) is 652.34474 msec."
182,11,QTc Bazett Calculator,physical,decimal,2,Template,A patient has a heart rate of 178 bpm and a QT interval of 244 msec.,"Using the Bazett Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [178, 'beats per minute'], 'QT Interval': [244, 'msec']}",420.26511,399.25185,441.27837,"The corrected QT interval using the Bazett formula is computed as  QTc = QT interval / √ (RR interval), where the QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 178 beats per minute.
The QT interval is 244 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/178 = 0.33708.
Hence, plugging in these values, we will get 244/√(0.33708) = 420.26511.
The patient's corrected QT interval (QTc) is 420.26511 msec."
183,11,QTc Bazett Calculator,physical,decimal,3,Template,A patient has a heart rate of 150 bpm and a QT interval of 406 msec.,"Using the Bazett Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [150, 'beats per minute'], 'QT Interval': [406, 'msec']}",641.94237,609.84525,674.03949,"The corrected QT interval using the Bazett formula is computed as  QTc = QT interval / √ (RR interval), where the QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 150 beats per minute.
The QT interval is 406 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/150 = 0.4.
Hence, plugging in these values, we will get 406/√(0.4) = 641.94237.
The patient's corrected QT interval (QTc) is 641.94237 msec."
184,11,QTc Bazett Calculator,physical,decimal,4,Template,A patient has a heart rate of 140 bpm and a QT interval of 217 msec.,"Using the Bazett Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [140, 'beats per minute'], 'QT Interval': [217, 'msec']}",331.47353,314.89985,348.04721,"The corrected QT interval using the Bazett formula is computed as  QTc = QT interval / √ (RR interval), where the QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 140 beats per minute.
The QT interval is 217 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/140 = 0.42857.
Hence, plugging in these values, we will get 217/√(0.42857) = 331.47353.
The patient's corrected QT interval (QTc) is 331.47353 msec."
185,11,QTc Bazett Calculator,physical,decimal,5,Template,A patient has a heart rate of 102 bpm and a QT interval of 471 msec.,"Using the Bazett Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [102, 'beats per minute'], 'QT Interval': [471, 'msec']}",614.10641,583.40109,644.81173,"The corrected QT interval using the Bazett formula is computed as  QTc = QT interval / √ (RR interval), where the QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 102 beats per minute.
The QT interval is 471 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/102 = 0.58824.
Hence, plugging in these values, we will get 471/√(0.58824) = 614.10641.
The patient's corrected QT interval (QTc) is 614.10641 msec."
186,11,QTc Bazett Calculator,physical,decimal,6,Template,A patient has a heart rate of 101 bpm and a QT interval of 462 msec.,"Using the Bazett Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [101, 'beats per minute'], 'QT Interval': [462, 'msec']}",599.41391,569.44321,629.38461,"The corrected QT interval using the Bazett formula is computed as  QTc = QT interval / √ (RR interval), where the QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 101 beats per minute.
The QT interval is 462 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/101 = 0.59406.
Hence, plugging in these values, we will get 462/√(0.59406) = 599.41391.
The patient's corrected QT interval (QTc) is 599.41391 msec."
187,11,QTc Bazett Calculator,physical,decimal,7,Template,A patient has a heart rate of 102 bpm and a QT interval of 412 msec.,"Using the Bazett Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [102, 'beats per minute'], 'QT Interval': [412, 'msec']}",537.18013,510.32112,564.03914,"The corrected QT interval using the Bazett formula is computed as  QTc = QT interval / √ (RR interval), where the QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 102 beats per minute.
The QT interval is 412 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/102 = 0.58824.
Hence, plugging in these values, we will get 412/√(0.58824) = 537.18013.
The patient's corrected QT interval (QTc) is 537.18013 msec."
188,11,QTc Bazett Calculator,physical,decimal,8,Template,A patient has a heart rate of 112 bpm and a QT interval of 413 msec.,"Using the Bazett Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [112, 'beats per minute'], 'QT Interval': [413, 'msec']}",564.26768,536.0543,592.48106,"The corrected QT interval using the Bazett formula is computed as  QTc = QT interval / √ (RR interval), where the QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 112 beats per minute.
The QT interval is 413 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/112 = 0.53571.
Hence, plugging in these values, we will get 413/√(0.53571) = 564.26768.
The patient's corrected QT interval (QTc) is 564.26768 msec."
189,11,QTc Bazett Calculator,physical,decimal,9,Template,A patient has a heart rate of 50 bpm and a QT interval of 440 msec.,"Using the Bazett Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [50, 'beats per minute'], 'QT Interval': [440, 'msec']}",401.66321,381.58005,421.74637,"The corrected QT interval using the Bazett formula is computed as  QTc = QT interval / √ (RR interval), where the QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 50 beats per minute.
The QT interval is 440 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/50 = 1.2.
Hence, plugging in these values, we will get 440/√(1.2) = 401.66321.
The patient's corrected QT interval (QTc) is 401.66321 msec."
190,11,QTc Bazett Calculator,physical,decimal,10,Template,A patient has a heart rate of 48 bpm and a QT interval of 201 msec.,"Using the Bazett Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [48, 'beats per minute'], 'QT Interval': [201, 'msec']}",179.77987,170.79088,188.76886,"The corrected QT interval using the Bazett formula is computed as  QTc = QT interval / √ (RR interval), where the QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 48 beats per minute.
The QT interval is 201 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/48 = 1.25.
Hence, plugging in these values, we will get 201/√(1.25) = 179.77987.
The patient's corrected QT interval (QTc) is 179.77987 msec."
191,11,QTc Bazett Calculator,physical,decimal,11,Template,A patient has a heart rate of 108 bpm and a QT interval of 431 msec.,"Using the Bazett Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [108, 'beats per minute'], 'QT Interval': [431, 'msec']}",578.24487,549.33263,607.15711,"The corrected QT interval using the Bazett formula is computed as  QTc = QT interval / √ (RR interval), where the QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 108 beats per minute.
The QT interval is 431 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/108 = 0.55556.
Hence, plugging in these values, we will get 431/√(0.55556) = 578.24487.
The patient's corrected QT interval (QTc) is 578.24487 msec."
192,11,QTc Bazett Calculator,physical,decimal,12,Template,A patient has a heart rate of 73 bpm and a QT interval of 490 msec.,"Using the Bazett Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [73, 'beats per minute'], 'QT Interval': [490, 'msec']}",540.48209,513.45799,567.50619,"The corrected QT interval using the Bazett formula is computed as  QTc = QT interval / √ (RR interval), where the QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 73 beats per minute.
The QT interval is 490 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/73 = 0.82192.
Hence, plugging in these values, we will get 490/√(0.82192) = 540.48209.
The patient's corrected QT interval (QTc) is 540.48209 msec."
193,11,QTc Bazett Calculator,physical,decimal,13,Template,A patient has a heart rate of 71 bpm and a QT interval of 205 msec.,"Using the Bazett Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [71, 'beats per minute'], 'QT Interval': [205, 'msec']}",223.00136,211.85129,234.15143,"The corrected QT interval using the Bazett formula is computed as  QTc = QT interval / √ (RR interval), where the QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 71 beats per minute.
The QT interval is 205 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/71 = 0.84507.
Hence, plugging in these values, we will get 205/√(0.84507) = 223.00136.
The patient's corrected QT interval (QTc) is 223.00136 msec."
194,11,QTc Bazett Calculator,physical,decimal,14,Template,A patient has a heart rate of 62 bpm and a QT interval of 418 msec.,"Using the Bazett Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [62, 'beats per minute'], 'QT Interval': [418, 'msec']}",424.90998,403.66448,446.15548,"The corrected QT interval using the Bazett formula is computed as  QTc = QT interval / √ (RR interval), where the QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 62 beats per minute.
The QT interval is 418 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/62 = 0.96774.
Hence, plugging in these values, we will get 418/√(0.96774) = 424.90998.
The patient's corrected QT interval (QTc) is 424.90998 msec."
195,11,QTc Bazett Calculator,physical,decimal,15,Template,A patient has a heart rate of 125 bpm and a QT interval of 403 msec.,"Using the Bazett Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [125, 'beats per minute'], 'QT Interval': [403, 'msec']}",581.6804,552.59638,610.76442,"The corrected QT interval using the Bazett formula is computed as  QTc = QT interval / √ (RR interval), where the QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 125 beats per minute.
The QT interval is 403 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/125 = 0.48.
Hence, plugging in these values, we will get 403/√(0.48) = 581.6804.
The patient's corrected QT interval (QTc) is 581.6804 msec."
196,11,QTc Bazett Calculator,physical,decimal,16,Template,A patient has a heart rate of 77 bpm and a QT interval of 305 msec.,"Using the Bazett Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [77, 'beats per minute'], 'QT Interval': [305, 'msec']}",345.5173,328.24143,362.79316,"The corrected QT interval using the Bazett formula is computed as  QTc = QT interval / √ (RR interval), where the QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 77 beats per minute.
The QT interval is 305 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/77 = 0.77922.
Hence, plugging in these values, we will get 305/√(0.77922) = 345.5173.
The patient's corrected QT interval (QTc) is 345.5173 msec."
197,11,QTc Bazett Calculator,physical,decimal,17,Template,A patient has a heart rate of 110 bpm and a QT interval of 470 msec.,"Using the Bazett Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [110, 'beats per minute'], 'QT Interval': [470, 'msec']}",636.38566,604.56638,668.20494,"The corrected QT interval using the Bazett formula is computed as  QTc = QT interval / √ (RR interval), where the QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 110 beats per minute.
The QT interval is 470 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/110 = 0.54545.
Hence, plugging in these values, we will get 470/√(0.54545) = 636.38566.
The patient's corrected QT interval (QTc) is 636.38566 msec."
198,11,QTc Bazett Calculator,physical,decimal,18,Template,A patient has a heart rate of 50 bpm and a QT interval of 304 msec.,"Using the Bazett Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [50, 'beats per minute'], 'QT Interval': [304, 'msec']}",277.51276,263.63712,291.3884,"The corrected QT interval using the Bazett formula is computed as  QTc = QT interval / √ (RR interval), where the QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 50 beats per minute.
The QT interval is 304 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/50 = 1.2.
Hence, plugging in these values, we will get 304/√(1.2) = 277.51276.
The patient's corrected QT interval (QTc) is 277.51276 msec."
199,11,QTc Bazett Calculator,physical,decimal,19,Template,A patient has a heart rate of 165 bpm and a QT interval of 283 msec.,"Using the Bazett Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [165, 'beats per minute'], 'QT Interval': [283, 'msec']}",469.30006,445.83506,492.76506,"The corrected QT interval using the Bazett formula is computed as  QTc = QT interval / √ (RR interval), where the QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 165 beats per minute.
The QT interval is 283 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/165 = 0.36364.
Hence, plugging in these values, we will get 283/√(0.36364) = 469.30006.
The patient's corrected QT interval (QTc) is 469.30006 msec."
200,11,QTc Bazett Calculator,physical,decimal,20,Template,A patient has a heart rate of 50 bpm and a QT interval of 316 msec.,"Using the Bazett Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [50, 'beats per minute'], 'QT Interval': [316, 'msec']}",288.46721,274.04385,302.89057,"The corrected QT interval using the Bazett formula is computed as  QTc = QT interval / √ (RR interval), where the QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 50 beats per minute.
The QT interval is 316 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/50 = 1.2.
Hence, plugging in these values, we will get 316/√(1.2) = 288.46721.
The patient's corrected QT interval (QTc) is 288.46721 msec."
201,15,Child-Pugh Score for Cirrhosis Mortality,severity,integer,pmc-8383539-1,Extracted,"We report a case of a 74-year-old woman with a history of chronic liver disease of alcoholic etiology with portal hypertension and esophageal varices and a history of upper digestive hemorrhage 5 years ago. Her regular medication included alprazolam and omeprazole. She was brought to the emergency department with a 1-week history of diffuse abdominal pain and increased abdominal perimeter, without any other symptoms. On physical examination, she had a body temperature of 37.8 °C and no remarkable changes in blood pressure, heart rate, respiratory rate and peripheral saturation. She had a significant abdominal distention and a positive fluid wave consistent with ascites. Blood analysis revealed hemoglobin of 12.8 g/dL, platelets of 371,000/µL, elevation of inflammatory markers: leukocytes of 16,090/µL and C-reactive protein (CRP) of 21.74 mg/dL, bilirubin of 2.5 mg/dL, hypoalbuminemia of 2.8 g/dL and international normalized ratio (INR) of 1.52. Abdominal ultrasound revealed large volume ascites and a subsequent diagnostic and therapeutic paracentesis was performed in which the peritoneal fluid cell count showed 3,136 leukocytes/mm3 with 86% neutrophils consistent with the diagnosis of SBP. The patient was hospitalized with the diagnosis of SBP and medicated with ceftriaxone 2 g/day. Despite initial clinical improvement, on the second day of antibiotics, the patient still presented fever and elevated inflammatory markers: leukocytes 14,940/µL and CRP 17.92 mg/dL. An abdominal computed tomography was performed to exclude secondary peritonitis. On the third day of hospitalization, new paracentesis was performed and showed an increase in the number of cells with 6,783 leukocytes/mm3 with 97% of neutrophils and on the next day the cultural peritoneal fluid of the first paracentesis revealed the presence of Listeria monocytogenes. The blood cultures were negative. Antibiotic therapy was changed according to in vitro sensibility test for ampicillin 2 g of 6/6 h and she completed 14 days of therapy. The patient presented clinical and laboratory improvement. After 48 h of targeted therapy, paracentesis showed a decrease in the number of cells with 3,753 leukocytes/mm3 with 98% of neutrophils and on the ninth day of therapy the peritoneal fluid no longer presented criteria of SBP and cultural negative.",What is the patient's Child-Pugh Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'international normalized ratio': 1.52, 'Ascites': 'moderate', 'Albumin': [2.8, 'g/dL'], 'Bilirubin': [2.5, 'mg/dL'], 'Encephalopathy': 'No Encephalopathy'}",9,9,9,"The criteria for the Child-Pugh Score are listed below:

1. Bilirubin (Total): <2 mg/dL (<34.2 μmol/L) = +1 point, 2-3 mg/dL (34.2-51.3 μmol/L) = +2 points, >3 mg/dL (>51.3 μmol/L) = +3 points
2. Albumin: >3.5 g/dL (>35 g/L) = +1 point, 2.8-3.5 g/dL (28-35 g/L) = +2 points, <2.8 g/dL (<28 g/L) = +3 points
3. INR: <1.7 = +1 point, 1.7-2.3 = +2 points, >2.3 = +3 points
4. Ascites: Absent = +1 point, Slight = +2 points, Moderate = +3 points
5. Encephalopathy: No Encephalopathy = +1 point, Grade 1-2 = +2 points, Grade 3-4 = +3 points 
(Grade 0: normal consciousness, personality, neurological examination, electroencephalogram
Grade 1: restless, sleep disturbed, irritable/agitated, tremor, impaired handwriting, 5 cps waves
Grade 2: lethargic, time-disoriented, inappropriate, asterixis, ataxia, slow triphasic waves
Grade 3: somnolent, stuporous, place-disoriented, hyperactive reflexes, rigidity, slower waves
Grade 4: unrousable coma, no personality/behavior, decerebrate, slow 2-3 cps delta activity)

The Child-Pugh Score is calculated by summing the points for each criterion.

The current child pugh score is 0.
The patient's INR is 1.52. Because the INR is less than 1.7, we add 1 to the score, making the current total 0 + 1 = 1.
The concentration of bilirubin is 2.5 mg/dL. Because the bilirubin concentration is between 2 mg/dL and 3 mg/dL, we add 2 to the score, making the current total 1 + 2 = 3.
The concentration of albumin is 2.8 g/dL. Because the albumin concentration is between 2.8 g/dL and 3.5 g/dL, we add 2 points to the score, making the current total 3 + 2 = 5.
The patient's ascites state is determined to be 'moderate' and so we add 3 points to the score, making the current total 5 + 3 = 8.
The patient is determined to not have any encephalopathy and so we add one point to the score, making the current total 8 + 1 = 9.
The patient's child pugh score is 9."
202,15,Child-Pugh Score for Cirrhosis Mortality,severity,integer,pmc-3712811-1,Extracted,"A 70-year-old Mongolian man was referred to our hospital suffering from high-grade fever and chills. He had a past medical history of esophageal varices rupture 20 years before. Since then, he had visited our hospital for alcoholic liver cirrhosis and diabetes mellitus. He received a treatment for ascites caused by liver cirrhosis. Urinary diuresis was not effective because of low Na level and dehydration. As liver function was relatively suppressed, he underwent Denver shunt implantation 9 months before presentation. After the operation of Denver shunt implantation, ascites rapidly disappeared. Diabetes mellitus was controlled well (HbA1c 6.3%) by a oral hypoglycemic agent (glimepiride 3 mg/day).
This time, he developed high-grade fever with chills and without gastrointestinal symptoms. His body temperature was 38.5°C, but he was hemodynamically stable. Initial laboratory results were as follows: white blood cell count 7,700/μl, hemoglobin 12.9 g/dl, platelets 5.6 × 104/μl PT-INR 1.43, CRP 5.0 mg/dl, aspartate aminotransferase (AST) 349 IU/l, alanine aminotransferase (ALT) 353 IU/l, alkaline phosphatase (ALP) 522 IU/l, gamma-glutamyl transferase (GGT) 104 IU/l, total bilirubin (T-bil) 4.3 mg/dl and albumin 4.1 g/dl. Abdominal ultrasonography (US) showed multiple small low-echoic lesions in the right lobe of the liver (fig. ). These findings were further confirmed by abdominal enhanced computed tomography (CT) that showed peripheral enhancement with central hypodense multiple small lesions in the right lobe of the liver with no ascites (fig. ). After admission to our hospital, he underwent echocardiography, chest CT, esophagogastroduodenoscopy and colonoscopy, however, no other sources of infection could be detected. Blood culture was negative and anti-amebic antibody was also negative. He was treated for pyogenic liver abscesses with sulbactam/cefoperazone for 2 weeks and subsequently changed to levofloxacin for 2 months. The liver abscesses disappeared after the antibiotic treatment and liver function normalized to original levels (AST 44 IU/l, ALT 37 IU/l, ALP 336 IU/l, GGT 85 IU/l and T-bil 0.9 mg/dl). However, 3 months later, he suffered from high-grade fever with chills and no other symptoms. Laboratory results were as follows: white blood cell count 7,400/μl, platelets 4.6 × 104/μl, CRP 9.2 mg/dl, AST 933 IU/l, ALT 1,202 IU/l, ALP 870 IU/l, GGT 93 IU/l and T-bil 4.0 mg/dl. Abdominal enhanced CT showed multiple small lesions in both lobes of the liver (fig. 2). Blood culture was negative. Sulbactam/cefoperazone had no effects. Meropenem was administered for 2 weeks, followed by levofloxacin for 2 months, and liver function rapidly normalized to original levels (AST 43 IU/l, ALT 30 IU/l, ALP 435 IU/l, GGT 87 IU/l and T-bil 1.8 mg/dl). After the levofloxacin treatment, the disappearance of liver abscess was confirmed (fig. ). We started selective intestinal decontamination by administering kanamycin (2 g/day) to prevent the occurrence of abdominal infection. Since then, he has had no recurrence of liver abscess for over a year.",What is the patient's Child-Pugh Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'international normalized ratio': 1.43, 'Ascites': 'absent', 'Albumin': [4.1, 'g/dL'], 'Bilirubin': [4.3, 'mg/dL'], 'Encephalopathy': 'No Encephalopathy'}",7,7,7,"The criteria for the Child-Pugh Score are listed below:

1. Bilirubin (Total): <2 mg/dL (<34.2 μmol/L) = +1 point, 2-3 mg/dL (34.2-51.3 μmol/L) = +2 points, >3 mg/dL (>51.3 μmol/L) = +3 points
2. Albumin: >3.5 g/dL (>35 g/L) = +1 point, 2.8-3.5 g/dL (28-35 g/L) = +2 points, <2.8 g/dL (<28 g/L) = +3 points
3. INR: <1.7 = +1 point, 1.7-2.3 = +2 points, >2.3 = +3 points
4. Ascites: Absent = +1 point, Slight = +2 points, Moderate = +3 points
5. Encephalopathy: No Encephalopathy = +1 point, Grade 1-2 = +2 points, Grade 3-4 = +3 points 
(Grade 0: normal consciousness, personality, neurological examination, electroencephalogram
Grade 1: restless, sleep disturbed, irritable/agitated, tremor, impaired handwriting, 5 cps waves
Grade 2: lethargic, time-disoriented, inappropriate, asterixis, ataxia, slow triphasic waves
Grade 3: somnolent, stuporous, place-disoriented, hyperactive reflexes, rigidity, slower waves
Grade 4: unrousable coma, no personality/behavior, decerebrate, slow 2-3 cps delta activity)

The Child-Pugh Score is calculated by summing the points for each criterion.

The current child pugh score is 0.
The patient's INR is 1.43. Because the INR is less than 1.7, we add 1 to the score, making the current total 0 + 1 = 1.
The concentration of bilirubin is 4.3 mg/dL. Because the bilirubin concentration is greater than 3 mg/dL, we add 3 to the score, making the current total 1 + 3 = 4.
The concentration of albumin is 4.1 g/dL. Because the albumin concentration is greater than 3.5 g/dL, we add 1 point to the score, making the current total 4 + 1 = 5.
The patient's ascites state is determined to be 'absent' and so we add 1 point to the score, making the current total 5 + 1 = 6.
The patient is determined to not have any encephalopathy and so we add one point to the score, making the current total 6 + 1 = 7.
The patient's child pugh score is 7."
203,15,Child-Pugh Score for Cirrhosis Mortality,severity,integer,pmc-5040539-1,Extracted,"A 54-year-old male patient, with previous diagnosis of alcoholic cirrhosis, presented with abdominal pain for 5 years, in the right hypocondrium, associated to jaundice, nausea, vomits and the loss of 12 kg of weight in the last year. The pain had no relation to eating. He reported a previous hospitalization in another hospital to perform a liver biopsy, which showed signs of FNH. He was referred to our service due to the lack of a proper structure to operate this patient. Upon the first consultation, we requested the slides of the biopsy to be brought to our service for a review, which revealed an altered lobular structure due to portal fibrosis, forming large fibrous septa, and no signs of a malignant tumor.
We performed a magnetic resonance imaging (MRI) exam (), which revealed a normal sized liver, and an expansive lesion originating from segments V and VI, heterogeneous and encapsulated, with well-defined limits, and heterogeneous enhancement by the contrast, similar to normal parenchyma. It also presented areas of central scar and some foci of necrosis.
Biochemical analyses performed at this time showed that his alpha-fetoprotein value was 6.4. With this finding, the biopsy and the imaging exam, his diagnosis was set as FNH.
Other biochemical analyses performed were aspartate transaminase: 34, alanine transaminase: 27, albumin: 2.8, total bilirubin: 0.8, international normalized ratio: 1.51. He had no signs of encephalopathy or ascites. Hepatitis B and C serologies were negative.
Surgical intervention was performed because of the symptoms. The tumor was successfully extirpated (). After his recovery in an intensive care unit, he was discharged with return appointment for 2 weeks later.
Macroscopically, the dimensions of the tumor were 14 × 10 × 9 cm, and weighed 701 g. Upon being sectioned in half (), a margin of normal parenchyma of 1.4 cm was observed, with nine satellite nodules inside the margin (), with the same characteristics of the main tumor. Microscopic examination revealed an HCC (), with pseudoglandular areas, moderately differentiated (stage two).",What is the patient's Child-Pugh Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'international normalized ratio': 1.51, 'Ascites': 'absent', 'Albumin': [2.8, 'g/dL'], 'Bilirubin': [0.8, 'mg/dL'], 'Encephalopathy': 'No Encephalopathy'}",6,6,6,"The criteria for the Child-Pugh Score are listed below:

1. Bilirubin (Total): <2 mg/dL (<34.2 μmol/L) = +1 point, 2-3 mg/dL (34.2-51.3 μmol/L) = +2 points, >3 mg/dL (>51.3 μmol/L) = +3 points
2. Albumin: >3.5 g/dL (>35 g/L) = +1 point, 2.8-3.5 g/dL (28-35 g/L) = +2 points, <2.8 g/dL (<28 g/L) = +3 points
3. INR: <1.7 = +1 point, 1.7-2.3 = +2 points, >2.3 = +3 points
4. Ascites: Absent = +1 point, Slight = +2 points, Moderate = +3 points
5. Encephalopathy: No Encephalopathy = +1 point, Grade 1-2 = +2 points, Grade 3-4 = +3 points 
(Grade 0: normal consciousness, personality, neurological examination, electroencephalogram
Grade 1: restless, sleep disturbed, irritable/agitated, tremor, impaired handwriting, 5 cps waves
Grade 2: lethargic, time-disoriented, inappropriate, asterixis, ataxia, slow triphasic waves
Grade 3: somnolent, stuporous, place-disoriented, hyperactive reflexes, rigidity, slower waves
Grade 4: unrousable coma, no personality/behavior, decerebrate, slow 2-3 cps delta activity)

The Child-Pugh Score is calculated by summing the points for each criterion.

The current child pugh score is 0.
The patient's INR is 1.51. Because the INR is less than 1.7, we add 1 to the score, making the current total 0 + 1 = 1.
The concentration of bilirubin is 0.8 mg/dL. Because the bilirubin concentration is less than 2 mg/dL, we add 1 to the score, making the current total 1 + 1 = 2.
The concentration of albumin is 2.8 g/dL. Because the albumin concentration is between 2.8 g/dL and 3.5 g/dL, we add 2 points to the score, making the current total 2 + 2 = 4.
The patient's ascites state is determined to be 'absent' and so we add 1 point to the score, making the current total 4 + 1 = 5.
The patient is determined to not have any encephalopathy and so we add one point to the score, making the current total 5 + 1 = 6.
The patient's child pugh score is 6."
204,15,Child-Pugh Score for Cirrhosis Mortality,severity,integer,pmc-6047565-1,Extracted,"A 55-year-old man with a past medical history of alcohol dependence, persistent atrial fibrillation, and severe biventricular systolic heart failure presented to the emergency department with complaints of weakness, cough, exertional dyspnea, and malaise. He denied any chest pain, palpitations, lightheadedness, fever, chills, sweats, nausea, vomiting, or diarrhea. He was found to have atrial fibrillation with a ventricular response rate of 173. On physical examination, he was alert but anxious with an irregular heart rate. The rest of the physical examination was unremarkable. He developed subsequent diltiazem-induced hypotension and resultant global ischemic organ injury requiring cardioversion, intubation, and vasopressor support. Laboratory studies at the time of presentation were significant for sodium of 130 mmol/L, potassium of 4.6 mmol/L, creatinine of 2.4 mg/dL, albumin of 2.4 g/dL, AST of 10,050 U/L, ALT of 3.056 U/L, alkaline phosphatase of 119 U/L, and total bilirubin of 3.6 mg/dL. His complete blood count was significant for hemoglobin of 11.0 g/dL, MCV of 97.1 fl, platelet count of 148 × 109/L, and WBC of 18.3/μl. He was also noted to be coagulopathic with an INR of 2.2. A CT scan of the thorax was performed to rule out pulmonary embolism, and this showed an incidental liver lesion measuring 2 × 2 cm with residual contrast in the noncontrast series and was read as a hemangioma (Fig. ). He presented to the emergency department 9 months later with syncopal episodes. CT angiography showed no signs of pulmonary embolism, but an enlarging liver lesion with intralesional calcifications measuring 4.3 × 3.9 cm with borderline enlarged lymph nodes in the porta hepatis (Fig. ). He was referred to our hepatobiliary neoplasia clinic for further management. An ultrasound-guided percutaneous biopsy of the lesion was obtained (Fig. ).
The liver biopsy showed a neoplasm with epithelioid and spindle cell features, prominent nucleoli, occasional intranuclear pseudoinclusions, and frequent mitotic activity. Immunostains showed the tumor cells to be positive for S100, Melan-A, and SOX10, but negative for keratins (AE1/AE3, Oscar), desmin, CD34, and arginase, consistent with a diagnosis of metastatic melanoma. Esophagogastroduodenoscopy and colonoscopy were performed to exclude other primitive malignant cancers. Complete skin and eye examination in addition to further imaging studies did not identify the primary site. His lesion was treated with stereotactic body radiation therapy (SBRT), which he tolerated well.",What is the patient's Child-Pugh Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'international normalized ratio': 2.2, 'Ascites': 'absent', 'Albumin': [2.4, 'g/dL'], 'Bilirubin': [3.6, 'mg/dL'], 'Encephalopathy': 'No Encephalopathy'}",10,10,10,"The criteria for the Child-Pugh Score are listed below:

1. Bilirubin (Total): <2 mg/dL (<34.2 μmol/L) = +1 point, 2-3 mg/dL (34.2-51.3 μmol/L) = +2 points, >3 mg/dL (>51.3 μmol/L) = +3 points
2. Albumin: >3.5 g/dL (>35 g/L) = +1 point, 2.8-3.5 g/dL (28-35 g/L) = +2 points, <2.8 g/dL (<28 g/L) = +3 points
3. INR: <1.7 = +1 point, 1.7-2.3 = +2 points, >2.3 = +3 points
4. Ascites: Absent = +1 point, Slight = +2 points, Moderate = +3 points
5. Encephalopathy: No Encephalopathy = +1 point, Grade 1-2 = +2 points, Grade 3-4 = +3 points 
(Grade 0: normal consciousness, personality, neurological examination, electroencephalogram
Grade 1: restless, sleep disturbed, irritable/agitated, tremor, impaired handwriting, 5 cps waves
Grade 2: lethargic, time-disoriented, inappropriate, asterixis, ataxia, slow triphasic waves
Grade 3: somnolent, stuporous, place-disoriented, hyperactive reflexes, rigidity, slower waves
Grade 4: unrousable coma, no personality/behavior, decerebrate, slow 2-3 cps delta activity)

The Child-Pugh Score is calculated by summing the points for each criterion.

The current child pugh score is 0.
The patient's INR is 2.2. Because the INR is between 1.7 and 2.3, we add two to the score, making the current total 0 + 2 = 2.
The concentration of bilirubin is 3.6 mg/dL. Because the bilirubin concentration is greater than 3 mg/dL, we add 3 to the score, making the current total 2 + 3 = 5.
The concentration of albumin is 2.4 g/dL. Because the albumin concentration is less than 2.8 g/dL, we add 3 points to the score, making the current total 5 + 3 = 8.
The patient's ascites state is determined to be 'absent' and so we add 1 point to the score, making the current total 8 + 1 = 9.
The patient is determined to not have any encephalopathy and so we add one point to the score, making the current total 9 + 1 = 10.
The patient's child pugh score is 10."
205,15,Child-Pugh Score for Cirrhosis Mortality,severity,integer,pmc-7678762-1,Extracted,"A 25-year old young female, with a known case of celiac disease for the last three years, presented in the out-patient department with primary complaints of progressive abdominal distension, abdominal pain and shortness of breath for one year. The abdominal distension started from the flank region bilaterally and then progressively became generalized. It was associated with abdominal pain which was constant, moderate in intensity, diffuse and dull in character. She also had a history of intermittent productive cough for past one year. It was associated with shortness of breath on exertion which had progressively increased and was now occurring at rest. According to the patient, she had several episodes of altered bowel movements and bloating for the past eight months which has increased in frequency over the time, as she has not been strictly adherent to a gluten-free diet over the last year.
On admission, the patient was responsive and alert but appeared to be in distress. Her pulse was 95 beats per minute (BPM), blood pressure (BP) was 110/70 mmHg and respiratory rate was 23/minute. The general physical examination revealed pallor, jaundice, and peripheral cyanosis. There was also evidence of clubbing, bilateral peripheral edema, palmar erythema and multiple hemangiomas diffusely present all over the body. On abdominal examination, the abdomen was diffusely distended, tense, and non-tender. The fluid thrill was positive, however, the size of spleen and liver could not be appreciated because of massive ascites. Bowel sounds were normoactive. No hepatic or renal bruits were audible. Pulmonary auscultation revealed harsh vesicular breathing all over the chest with decreased air entry in basal segments bilaterally and occasional crepitations. There was dullness to percussion and decreased resonance in the left basilar chest region. Cardiovascular examination was unremarkable.
Hematological investigation displayed normocytic anemia (hemoglobin level of 9.9 g/dL), platelet count of 191000/mm3, and WBC count of 7200/µL. Liver function tests revealed albumin level of 2.8 g/dL (normal: 3.5-5.0 g/dL), total bilirubin of 5.9 mg/dL (normal: 0.1-1.2 mg/dL), alkaline phosphatase of 674 U/L (normal: 0-240 U/L), and gamma-glutamyl transpeptidase of 65 U/L (normal: 6-42 U/L). Pro-thrombin (PT) time and international normalized ratio (INR) were elevated at 20 seconds and 1.93 seconds, respectively, while partial thromboplastin time was within normal limit. Serum iron levels were 33 mcg/dL (normal: 60-170 mcg/dL), while ferritin level was normal. Vitamin B12 level was at 163.8 pg/mL (normal: 208-964 pg/mL) and folate level was normal. Vitamin D (25-OH) was decreased at 12.89 ng/mL (normal: >29 ng/mL). Serum calcium levels were within normal limits. A complete serological screen for autoimmune hepatitis (anti-nuclear antibodies and anti-smooth muscle antibodies) produced normal results (antibodies were undetected). Hepatitis C antibodies and HBsAg were both non-reactive. Moreover, serum ceruloplasmin levels were also within the normal range. Fasting lipid profile, kidney, and thyroid function tests were also within normal limits. A full screen for all known thrombophilic factors turned out to be insignificant. Specifically, the homocysteine level was 9.7 µmol/L (normal: 4.9-11.6 µmol/L ) while anticardiolipin antibodies (IgG and IgA), lupus anticoagulant and Factor V Leiden were all negative. Levels of antithrombin III, protein C, protein S were also within reference range. The ascitic fluid analysis revealed total protein 1.3 g/dL, albumin 1g/dL, glucose 95 mg/dL and serum-ascitic albumin gradient of 1.8, features suggestive of portal hypertension. A duodenal biopsy performed via upper gastrointestinal endoscopy gave evidence of villous atrophy, crypt hyperplasia, and markedly increased intraepithelial lymphocyte (Marsh grade III). Furthermore, anti-tissue transglutaminase IgA levels were 154.6 IU/ml.
Thereafter, an abdominal ultrasound was performed which showed a liver span of 8.5 cm (normal: 10 cm-12 cm), small in size with coarse echotexture and irregular margins, no focal mass, and intrahepatic duct dilatation. The splenic span was 14.5 cm (normal: 10.5 cm-12 cm) and splenic vein measured 1.2 cm. On Doppler ultrasonography, portal vein measured 0.7 cm with the normal hepatoportal monophasic flow. The velocity of the portal vein was 16 cm/sec (normal: 20 cm/sec-40 cm/sec), and all hepatic veins were attenuated. Subsequently, a contrast computed tomography (CT) of the abdomen was pursued (Figures -) which displayed a cirrhotic liver with massive ascites and left-sided pleural effusion. No aneurysm, superior and inferior vena cava thrombosis or liver masses were seen. Caudate lobe hypertrophy and non-visualization of the hepatic vein confirmed the diagnosis of Budd-Chiari Syndrome.
The patient was managed conservatively with anticoagulants, diuretics, and a gluten-free diet in addition to oral vitamin D supplements and vitamin B12 injections. Within four weeks, there was a marked decrease in ascites with improvement in liver functions (total bilirubin was 1.9 mg/dL and albumin 3.8 g/dL).",What is the patient's Child-Pugh Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'international normalized ratio': 1.93, 'Ascites': 'moderate', 'Albumin': [2.8, 'g/dL'], 'Bilirubin': [5.9, 'mg/dL'], 'Encephalopathy': 'No Encephalopathy'}",11,11,11,"The criteria for the Child-Pugh Score are listed below:

1. Bilirubin (Total): <2 mg/dL (<34.2 μmol/L) = +1 point, 2-3 mg/dL (34.2-51.3 μmol/L) = +2 points, >3 mg/dL (>51.3 μmol/L) = +3 points
2. Albumin: >3.5 g/dL (>35 g/L) = +1 point, 2.8-3.5 g/dL (28-35 g/L) = +2 points, <2.8 g/dL (<28 g/L) = +3 points
3. INR: <1.7 = +1 point, 1.7-2.3 = +2 points, >2.3 = +3 points
4. Ascites: Absent = +1 point, Slight = +2 points, Moderate = +3 points
5. Encephalopathy: No Encephalopathy = +1 point, Grade 1-2 = +2 points, Grade 3-4 = +3 points 
(Grade 0: normal consciousness, personality, neurological examination, electroencephalogram
Grade 1: restless, sleep disturbed, irritable/agitated, tremor, impaired handwriting, 5 cps waves
Grade 2: lethargic, time-disoriented, inappropriate, asterixis, ataxia, slow triphasic waves
Grade 3: somnolent, stuporous, place-disoriented, hyperactive reflexes, rigidity, slower waves
Grade 4: unrousable coma, no personality/behavior, decerebrate, slow 2-3 cps delta activity)

The Child-Pugh Score is calculated by summing the points for each criterion.

The current child pugh score is 0.
The patient's INR is 1.93. Because the INR is between 1.7 and 2.3, we add two to the score, making the current total 0 + 2 = 2.
The concentration of bilirubin is 5.9 mg/dL. Because the bilirubin concentration is greater than 3 mg/dL, we add 3 to the score, making the current total 2 + 3 = 5.
The concentration of albumin is 2.8 g/dL. Because the albumin concentration is between 2.8 g/dL and 3.5 g/dL, we add 2 points to the score, making the current total 5 + 2 = 7.
The patient's ascites state is determined to be 'moderate' and so we add 3 points to the score, making the current total 7 + 3 = 10.
The patient is determined to not have any encephalopathy and so we add one point to the score, making the current total 10 + 1 = 11.
The patient's child pugh score is 11."
206,15,Child-Pugh Score for Cirrhosis Mortality,severity,integer,pmc-7707918-1,Extracted,"A 28-year-old female from Nepal who recently immigrated to the United States presented to the ED with complaints of abdominal distention, fatigue, and six weeks of progressive bilateral lower extremity weakness. She was recently discharged from an outside hospital with a new diagnosis of decompensated liver cirrhosis with ascites. She reported drinking homemade alcoholic beverages daily while in Nepal but was unable to quantify the amount, given inconsistent history due to language and cultural barrier. She was taking thiamine 100 mg oral daily, which was not continued on admission. On evaluation, she was extremely malnourished with a BMI of 14.6 due to lack of appetite and a diet consisting mostly of rice and beef broth soup. Physical exam demonstrated scleral icterus, abdominal distention with tenderness in the right upper quadrant, hepatosplenomegaly, and jaundice. Laboratory studies were notable for platelet count of 96,000/uL, albumin 2.8 g/dL, aspartate aminotransferase (AST) 52 U/L, alanine aminotransferase (ALT) 30 U/L, total bilirubin 34.5 mg/dL, international normalized ratio (INR) 1.8. Her initial model for end-stage liver disease (MELD) score was 26, and she was evaluated for liver transplantation. Other causes of cirrhosis, including viral, hemochromatosis, autoimmune, Wilson’s disease, primary biliary cirrhosis, and primary sclerosing cholangitis, were excluded, and it was determined that she had alcohol-induced cirrhosis. Due to her extreme malnutrition and weakness, she was listed inactive on the transplant list.
The patient had bilateral lower extremity weakness and paresthesias preventing her from standing unassisted. She also demonstrated areflexia, tenderness to palpation, and pain with movement of lower extremities. Initial workup for weakness included vitamin B12, folate, and vitamin B6 levels. Vitamin B12 and folate returned within normal limits, but she was found to be deficient in vitamin B6 at 11.7 nmol/L and was started on replacement therapy. After 10 days of supplemental vitamin B6 and physical therapy, she had not improved, and neurology was consulted. An electromyogram was performed and consistent with severe sensorimotor axonal polyneuropathy with active denervation. Cerebrospinal fluid (CSF) analysis was also recommended and showed a slightly elevated protein at 47 mg/dL but not elevated enough to be consistent with Guillain-Barré syndrome (GBS). Additional labs were drawn, and she was found to have a low thiamine level at 55 nmol/L (normal: 70-80 nmol/L). She was started on replacement therapy with slow improvement. By six months of aggressive thiamine replacement, she could walk 200 feet with a walker and stand without assistance.",What is the patient's Child-Pugh Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'international normalized ratio': 1.8, 'Ascites': 'moderate', 'Albumin': [2.8, 'g/dL'], 'Bilirubin': [34.5, 'mg/dL'], 'Encephalopathy': 'No Encephalopathy'}",11,11,11,"The criteria for the Child-Pugh Score are listed below:

1. Bilirubin (Total): <2 mg/dL (<34.2 μmol/L) = +1 point, 2-3 mg/dL (34.2-51.3 μmol/L) = +2 points, >3 mg/dL (>51.3 μmol/L) = +3 points
2. Albumin: >3.5 g/dL (>35 g/L) = +1 point, 2.8-3.5 g/dL (28-35 g/L) = +2 points, <2.8 g/dL (<28 g/L) = +3 points
3. INR: <1.7 = +1 point, 1.7-2.3 = +2 points, >2.3 = +3 points
4. Ascites: Absent = +1 point, Slight = +2 points, Moderate = +3 points
5. Encephalopathy: No Encephalopathy = +1 point, Grade 1-2 = +2 points, Grade 3-4 = +3 points 
(Grade 0: normal consciousness, personality, neurological examination, electroencephalogram
Grade 1: restless, sleep disturbed, irritable/agitated, tremor, impaired handwriting, 5 cps waves
Grade 2: lethargic, time-disoriented, inappropriate, asterixis, ataxia, slow triphasic waves
Grade 3: somnolent, stuporous, place-disoriented, hyperactive reflexes, rigidity, slower waves
Grade 4: unrousable coma, no personality/behavior, decerebrate, slow 2-3 cps delta activity)

The Child-Pugh Score is calculated by summing the points for each criterion.

The current child pugh score is 0.
The patient's INR is 1.8. Because the INR is between 1.7 and 2.3, we add two to the score, making the current total 0 + 2 = 2.
The concentration of bilirubin is 34.5 mg/dL. Because the bilirubin concentration is greater than 3 mg/dL, we add 3 to the score, making the current total 2 + 3 = 5.
The concentration of albumin is 2.8 g/dL. Because the albumin concentration is between 2.8 g/dL and 3.5 g/dL, we add 2 points to the score, making the current total 5 + 2 = 7.
The patient's ascites state is determined to be 'moderate' and so we add 3 points to the score, making the current total 7 + 3 = 10.
The patient is determined to not have any encephalopathy and so we add one point to the score, making the current total 10 + 1 = 11.
The patient's child pugh score is 11."
207,15,Child-Pugh Score for Cirrhosis Mortality,severity,integer,pmc-8118526-1,Extracted,"A forty-one-year-old man was admitted to our hospital with twelve hours of melena and non-bloody emesis. His medical history was significant for alcohol use disorder, prior acute pancreatitis complicated by splenic vein thrombosis, type II diabetes mellitus, and obstructive sleep apnea. A computerized tomography (CT) of the abdomen seventeen months earlier demonstrated splenic vein occlusion vs. marked narrowing with extensive collateral circulation in the upper abdomen. Prior to admission, he had been taking 1600 mg of ibuprofen daily and drinking six beers daily. On exam the patient was tachycardic (132 bpm), blood pressure was 120/70. He was pale, ill appearing and had mild epigastric tenderness on palpation. There were no stigmata of liver disease. On admission the hemoglobin and hematocrit were 8.4 g/dL and 25% respectively. The remaining laboratory results were significant for elevated lactate at 3.7 U/L, INR 1.3, PT 15.7 seconds, PTT 29 seconds, alkaline phosphatase 46 U/L, albumin 3.2 g/dL, total bilirubin 1.5 mg/dL, AST 34 U/L, ALT 30 U/L and platelets 178,000/mm3. He was resuscitated with IV fluids, started on IV proton pump inhibitor, IV octreotide, transfused 1 unit of packed red blood cells (pRBCs), and was admitted to the Medical Intensive Care Unit.
An upper endoscopy was performed on the evening of his admission which demonstrated mildly friable gastric mucosa but did not show any varices or other signs of portal hypertension. His IV pantoprazole and octreotide were stopped at that time. The patient was prepped for a colonoscopy scheduled the following day. Overnight he developed bright red blood per rectum. Despite two additional units of pRBCs, his hemoglobin and hematocrit remained low at 7.1 g/dL and 21.1% respectively. On hospital day (HD) 2, the patient underwent colonoscopy which demonstrated clotted blood throughout the colon and blood streaming down from the terminal ileum, but no bleeding source was identified.
The patient subsequently underwent a CT angiogram of the abdomen and pelvis which demonstrated pericecal-periappendiceal inflammatory changes with mild thickening of the cecal wall, but the angiogram was unable to localize the source of bleeding. The liver edge appeared slightly irregular, but there was no definitive evidence of cirrhosis or obvious signs of portal hypertension, such as ascites. The patient continued to have multiple voluminous episodes of bright red blood per rectum including numerous clots. He remained tachycardic with rates as high as 132 bpm and systolic blood pressure in the 100s. Labs were significant for a hemoglobin of 5.8 g/dL and hematocrit of 16.7%. Due to hemodynamic instability and ongoing bleeding, the patient was transferred to an outside facility for massive transfusion protocol.
Upon arrival at the outside facility massive transfusion protocol was initiated and interventional radiology performed a mesenteric angiogram with the goal of source embolization, however no source of bleeding was identified. Several hours later the patient underwent a CT angiogram of the abdomen and pelvis, which also was unrevealing. Repeat colonoscopy was normal without blood or source of bleeding identified. Due to the ongoing need for transfusion, an exploratory laparotomy was performed with intraoperative push enteroscopy. Enterotomy was performed in the small bowel and no obvious source of bleeding was found. Right hemicolectomy was performed.
Following surgery, the patient continued to pass bright red blood per rectum and required multiple additional pRBC transfusions. On HD 3 interventional radiology performed a transcatheter angiogram and venogram which demonstrated a portal systemic varix with prominent inflow into the mid-left renal vein (). The varix outflow was embolized with multiple 0.35 interlock coils (). After embolization, there was ongoing bleeding, but significantly decreased.
On HD 4 the patient underwent a TIPS procedure to decrease the risk of future hemorrhage. Once the TIPS procedure was placed there was a reduction in portal vein pressure from 22 mmHg to12 mmHg (reference normal; 5–10 mmHg) and a decrease in portosystemic gradient pressure from 10 mmHg to 6 mmHg (portal hypertension present if ≥ 6 mmHg, clinically significant if ≥10 mmHg) []. A superior mesenteric venogram was performed which failed to demonstrate the varix. However, after selecting a medial branch of the superior mesenteric vein, a direction microcatheter and fathom microwire were used to select the branch feeding the varix. Venography was then performed which demonstrated a medial branch of the superior mesenteric vein feeding the large duodenal left renal vein varix with active extravasation into the duodenum. The varix was then thrombosed with Gelfoam slurry and a microcil was deployed into the duodenal varix inflow. A repeat angiogram was performed of the superior mesenteric vein confirming thrombosis of the treated vessel (). Following the embolization, there was no blood flow through the varix.
Following the second embolization, the patient stabilized. On HD5 the patient returned to the operating room for ileocolonic anastomosis, fascial closure and placement of a wound vac. In total, during his hospitalization, he received over 80 units of blood products. He was discharged to home on HD 20.",What is the patient's Child-Pugh Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'international normalized ratio': 1.3, 'Ascites': 'absent', 'Albumin': [3.2, 'g/dL'], 'Bilirubin': [1.5, 'mg/dL'], 'Encephalopathy': 'No Encephalopathy'}",6,6,6,"The criteria for the Child-Pugh Score are listed below:

1. Bilirubin (Total): <2 mg/dL (<34.2 μmol/L) = +1 point, 2-3 mg/dL (34.2-51.3 μmol/L) = +2 points, >3 mg/dL (>51.3 μmol/L) = +3 points
2. Albumin: >3.5 g/dL (>35 g/L) = +1 point, 2.8-3.5 g/dL (28-35 g/L) = +2 points, <2.8 g/dL (<28 g/L) = +3 points
3. INR: <1.7 = +1 point, 1.7-2.3 = +2 points, >2.3 = +3 points
4. Ascites: Absent = +1 point, Slight = +2 points, Moderate = +3 points
5. Encephalopathy: No Encephalopathy = +1 point, Grade 1-2 = +2 points, Grade 3-4 = +3 points 
(Grade 0: normal consciousness, personality, neurological examination, electroencephalogram
Grade 1: restless, sleep disturbed, irritable/agitated, tremor, impaired handwriting, 5 cps waves
Grade 2: lethargic, time-disoriented, inappropriate, asterixis, ataxia, slow triphasic waves
Grade 3: somnolent, stuporous, place-disoriented, hyperactive reflexes, rigidity, slower waves
Grade 4: unrousable coma, no personality/behavior, decerebrate, slow 2-3 cps delta activity)

The Child-Pugh Score is calculated by summing the points for each criterion.

The current child pugh score is 0.
The patient's INR is 1.3. Because the INR is less than 1.7, we add 1 to the score, making the current total 0 + 1 = 1.
The concentration of bilirubin is 1.5 mg/dL. Because the bilirubin concentration is less than 2 mg/dL, we add 1 to the score, making the current total 1 + 1 = 2.
The concentration of albumin is 3.2 g/dL. Because the albumin concentration is between 2.8 g/dL and 3.5 g/dL, we add 2 points to the score, making the current total 2 + 2 = 4.
The patient's ascites state is determined to be 'absent' and so we add 1 point to the score, making the current total 4 + 1 = 5.
The patient is determined to not have any encephalopathy and so we add one point to the score, making the current total 5 + 1 = 6.
The patient's child pugh score is 6."
208,15,Child-Pugh Score for Cirrhosis Mortality,severity,integer,pmc-7808536-1,Extracted,"A 46-year-old female (height: 168.3 cm; weight: 53.6 kg; blood type B+) with liver-biopsy-proven autoimmune hepatitis (defined in accordance with the International Autoimmune Hepatitis Group criteria)[ and hepatitis B carrier status underwent elective ABOi LDLT. Her MELD (model for end-stage liver disease) score was 18 points, and she was being continuously treated with prednisolone and antiviral medication (Viread; Gilead, Foster City, CA, USA). Her laboratory findings were as follows: hemoglobin, 7.8 g/dl; white blood cell count, 4.12 × 109/L; creatinine, 0.93 mg/dl; albumin, 3.0 g/dl; aspartate and alanine aminotransferase, 64 U/L and 30 U/L, respectively; total bilirubin, 2.97 mg/dl, and lactic acid 2.0 mmol/L. Her coagulation values included an international normalized ratio (INR) of 2.2, activated partial prothrombin time of 57.7 second, and platelet count of 17.0 × 109/L. Abdominal computed tomography revealed advanced liver cirrhosis, partial thrombus in the main portal vein, moderate ascites, and marked splenomegaly and splenorenal shunt. Preoperative desensitization and immunosuppression were performed according to the ABOi LDLT protocol,[ and consisted of a single dose of intravenous rituximab (375 mg/m2 body surface area) administered 2 weeks before surgery (which reduced CD marker levels from 6.1%–0.1%) and multiple plasmapheresis (total 51 units of fresh frozen plasma [FPP]), to achieve an isohemagglutinin titer of ≤1:8 (Table ).
The piggyback method was employed during LT, using the right hepatic lobe of a 51-year-old male living donor (blood type A+, donor-recipient weight ratio: 1.91%, steatosis 9.83%) and reconstructing the middle hepatic vein such that the segmental hepatic veins (from liver segments V and VIII) of the recipient were anastomosed with the middle hepatic vein of the donor. The hepatic vessels, including the hepatic vein, portal vein, and hepatic artery, were serially anastomosed followed by biliary ductal reconstruction. The patency of hepatic blood flow was evaluated using spectral Doppler ultrasonography. The patient underwent simultaneous splenectomy, without bleeding complications due to severe thrombocytopenia or collateral shunt. Intraoperative management was performed with balanced anesthesia and hemodynamic homeostasis, with appropriate circulatory adjustment. In addition, a vasopressor was administered under multiple hemodynamic monitoring, including transesophageal echocardiography (TEE; Vivid S5 cardiovascular ultrasound; GE Healthcare, Milwaukee, WI, USA) and laboratory measurements. Transfused blood products consisted of 10 units of washed packed red blood cells (PRBCs; blood type O+), 5 units of FFP (blood type AB+) and 1 unit of single donor platelets (SDPs; blood type AB+). An acceptable hemodynamic status was achieved during surgery, including the absence of postreperfusion syndrome[ or evidence of cardiac or pulmonary thromboembolism, as determined by TEE. The endotracheal tube was removed in the operating room without respiratory complications. The patient was then transferred to the intensive care unit (ICU) for continued monitoring.
In ICU, her platelet counts largely increased from 15.0 to 263.0 (× 109/L) and her coagulation parameters acutely aggravated to hypercoagulable state as assessed by thromboelastography (maximal amplitude of 122 mm). Our patient suffered acute circulatory collapse (systolic blood pressure [SBP], 53 mm Hg; diastolic blood pressure [DBP], 21 mm Hg), and exhibited a gasping breathing pattern indicative of respiratory distress and a decline in mental status from alert to stupor. The ICU attending physicians immediately performed resuscitation management consisting of aggressive fluid therapy, blood product transfusion (3 units of PRBCs [blood type O+]), high-dose vasopressor infusion and endotracheal intubation with mechanical ventilation. Although her vital signs and mental status recovered thereafter, the patient required emergency exploratory abdominal surgery to repair the vessel injury incurred during surgery. During surgery, bleeding from the site of collateral vascular injury near the pancreas was detected and repaired. However, hypotension (SBP, 65 mm Hg; DBP, 50 mm Hg), bradycardia (<40 beats/minutes) and arrhythmia developed, accompanied by a large increase in central venous pressure (up to 30 mm Hg). Rescue TEE, urgently performed to evaluate cardiac structure and function, incidentally identified multiple, huge thromboembolic clots in both atrial chambers and a left-shifted deviation of the atrial wall (Fig. ). The large flapping thromboembolic clots on both cardiac valves severely impaired blood flow from the atrium to the ventricle (Fig. ) and caused severe mitral (Fig. ) and tricuspid regurgitation. Other large thromboembolic clots obstructed left ventricular outflow (Fig. ) and compressed the right and left pulmonary arteries (Fig. ), resulting in severe cardiac collapse. The patient therefore underwent emergency thromboembolectomy, including cardiopulmonary bypass and hypothermia therapy (body temperature, 34°C). Nonetheless, severe cardiac and respiratory distress continued, necessitating intraoperative venoarterial extracorporeal membrane oxygenation (VAECMO; maintained in the ICU). During emergency surgery, 25 units of PRBC and 5 units of FFP were transfused. In the ICU, despite fluid infusion, blood product transfusion (10 units of PRBCs) and high-dose vasopressor administration, our patient, while still on VAECMO, suffered severe hypotension and continued massive bleeding due to a deficiency and dilution of coagulation factors. The patient died 1 day after emergency surgery.",What is the patient's Child-Pugh Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'international normalized ratio': 2.2, 'Ascites': 'moderate', 'Albumin': [3.0, 'g/dL'], 'Bilirubin': [2.97, 'mg/dL'], 'Encephalopathy': 'No Encephalopathy'}",10,10,10,"The criteria for the Child-Pugh Score are listed below:

1. Bilirubin (Total): <2 mg/dL (<34.2 μmol/L) = +1 point, 2-3 mg/dL (34.2-51.3 μmol/L) = +2 points, >3 mg/dL (>51.3 μmol/L) = +3 points
2. Albumin: >3.5 g/dL (>35 g/L) = +1 point, 2.8-3.5 g/dL (28-35 g/L) = +2 points, <2.8 g/dL (<28 g/L) = +3 points
3. INR: <1.7 = +1 point, 1.7-2.3 = +2 points, >2.3 = +3 points
4. Ascites: Absent = +1 point, Slight = +2 points, Moderate = +3 points
5. Encephalopathy: No Encephalopathy = +1 point, Grade 1-2 = +2 points, Grade 3-4 = +3 points 
(Grade 0: normal consciousness, personality, neurological examination, electroencephalogram
Grade 1: restless, sleep disturbed, irritable/agitated, tremor, impaired handwriting, 5 cps waves
Grade 2: lethargic, time-disoriented, inappropriate, asterixis, ataxia, slow triphasic waves
Grade 3: somnolent, stuporous, place-disoriented, hyperactive reflexes, rigidity, slower waves
Grade 4: unrousable coma, no personality/behavior, decerebrate, slow 2-3 cps delta activity)

The Child-Pugh Score is calculated by summing the points for each criterion.

The current child pugh score is 0.
The patient's INR is 2.2. Because the INR is between 1.7 and 2.3, we add two to the score, making the current total 0 + 2 = 2.
The concentration of bilirubin is 2.97 mg/dL. Because the bilirubin concentration is between 2 mg/dL and 3 mg/dL, we add 2 to the score, making the current total 2 + 2 = 4.
The concentration of albumin is 3.0 g/dL. Because the albumin concentration is between 2.8 g/dL and 3.5 g/dL, we add 2 points to the score, making the current total 4 + 2 = 6.
The patient's ascites state is determined to be 'moderate' and so we add 3 points to the score, making the current total 6 + 3 = 9.
The patient is determined to not have any encephalopathy and so we add one point to the score, making the current total 9 + 1 = 10.
The patient's child pugh score is 10."
209,15,Child-Pugh Score for Cirrhosis Mortality,severity,integer,pmc-4236611-1,Extracted,"A 41-year-old man was initially evaluated in the emergency department for a 2-month history of shortness of breath, abdominal distension, scrotal swelling, and left inguinal pain. Past history included long-term use of intravenous drugs, extensive and current alcohol use with evidence of cirrhosis based on laboratory findings, and imaging and seropositivity for hepatitis C antibody without measurable viremia. He also had a history of sustaining an upper abdominal stab wound requiring exploratory laparotomy in the early 1990s. He denied fevers, rigors, night sweats, weight loss, or skin rashes.
Initial evaluation revealed an ill appearing man with tachycardia (heart rate 120 beats/min) with mild hypotension (blood pressure 85–105/50–60 mmHg), and tachypnea (respiratory rate 20–25/min) requiring 2 L/min supplemental oxygen by nasal cannula to maintain a blood oxygen saturation >95 %. He had distant heart sounds with tachycardia and regular rhythm without murmurs or gallops. He had jugular venous distension with a positive Kussmaul’s sign and pulsus paradoxus. There was significant abdominal distention present with a fluid wave. He had stigmata of chronic liver disease with spider angiomata noted and collateral venous distension in the abdominal wall. Furthermore, he had scrotal swelling and bilateral lower extremity edema. He was admitted to the hospital’s Medicine Service.
On admission, a chest radiograph revealed enlargement of the cardiac silhouette (Fig. ). A bedside echocardiogram illustrated a large pericardial effusion with evidence of hemodynamic compromise, including right atrial and right ventricular diastolic collapse, a >30 % respiratory variability in the tricuspid and mitral valve flow rates, and a swinging cardiac motion consistent with the presence of cardiac tamponade demanding urgent intervention.
Admission laboratory values revealed a normal white blood cell count, a mild macrocytic anemia (mean corpuscular volume 95 fL) with a hemoglobin of 12.1 g/dL, a hematocrit of 36 %, and thrombocytopenia with a platelet count of 84,000/μL. Tests of liver function revealed serum concentrations of albumin of 2.2 g/dL (N > 3.5 g/dL), total bilirubin of 3.1 mg/dL, with direct bilirubin of 1.9 mg/dL, an aspartate aminotransferase of 83 U/mL, an alanine aminotransferase of 37 U/mL, an alkaline phosphatase of 106 U/mL (upper limits of normal 150 U/mL), and a γ-glutamyl transpeptidase of 48 U/mL (upper limits of normal <98 U/L). Studies of coagulation revealed an elevated prothrombin time (PT) of 21 s and an international normalized ratio (INR) of 1.87. Abdominal paracentesis revealed a serum albumin-to-ascites gradient (SAAG) >1.1 g/dL, and a total protein concentration of <2.5 g/dL, consistent with portal hypertension: The total white blood cell count was 220/mm3, with 22 % neutrophils. These results were compatible with the diagnosis of an uninfected ascites due to portal hypertension as a probable consequence of his cirrhosis. The initial chest radiograph revealed cardiomegaly, bilateral pulmonary edema, and minimal pleural effusions (Fig. ). Ultrasound scan of the right upper quadrant revealed a nodular liver consistent with cirrhosis with evidence of portal hypertension such as mild splenomegaly and large volume ascites with no space-occupying lesion was identified. Admission pericardiocentesis had an opening pressure of 20 mmHg and, after removal of 1.5 L of serous pericardial fluid and placement of a drain, a closing pressure of 9 mmHg. Pericardial fluid analysis revealed protein concentrations and other characteristics identical to those found in the ascitic fluid: All pericardial cultures were negative, and no organisms were seen. Otherwise, the echocardiogram was relatively normal, as was cardiac function. Over the succeeding 24 h, 3 L of fluid drained from the pericardial sac, as did an additional 3 L during the subsequent 24-h period. It was suspected that ascitic fluid was exiting through the pericardial drain.
During investigation, a mildly elevated erythrocyte sedimentation rate (ESR) of 28 mm/h and serum concentrations of C-reactive protein of 1.1 mg/dL, creatine phosphokinase of 101 U/L, aldolase of 6.1 U/L, and lactate dehydrogenase of 398 U/L were all noted. Serum lipids and triglycerides were unremarkable. Investigation for the etiology of chronic liver disease revealed a serum ferritin of 113 ng/mL, negative anti-mitochondrial antibody, anti-smooth muscle antibody, antinuclear antibody, and anti-liver kidney microsomal antibodies, and negative virologic evidence for hepatitis A or B. Hepatitis C Ab was positive, but serum hepatitis C virus was undetectable. Serum α-1 anti-trypsin and ceruloplasmin, serum copper, and TSH concentrations were normal. Serological investigations for a possible rheumatological disease were unremarkable as well as infectious evaluation for HIV, Lyme disease, and Mycobacterium tuberculosis. A PET/CT scan revealed no FDG-avid focus in any area.
Since decreased pericardial fluid volume was noted on the fourth and fifth hospital days, the pericardial drain was removed. Two days later, he became progressively dyspneic with repeat chest X-ray showing bilateral pleural effusions, cardiomegaly, and diffuses pulmonary edema.
A radionuclide SPECT scan was then performed following injection of 5.11 mCi 99mTechnetium-labeled, macroaggregated albumin (MAA) into the peritoneal cavity. There was essentially no delay between the infusion of 99mTc-MAA and imaging. Although dynamic imaging was performed, the uptake in the pericardial sac was only faint at 15 min, but clearly visible at 1 h. The most impressive images were obtained at 4–24 h (Fig. ), where there was circumferential pericardial radiotracer distribution.",What is the patient's Child-Pugh Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'international normalized ratio': 1.87, 'Ascites': 'moderate', 'Albumin': [2.2, 'g/dL'], 'Bilirubin': [3.1, 'mg/dL'], 'Encephalopathy': 'No Encephalopathy'}",12,12,12,"The criteria for the Child-Pugh Score are listed below:

1. Bilirubin (Total): <2 mg/dL (<34.2 μmol/L) = +1 point, 2-3 mg/dL (34.2-51.3 μmol/L) = +2 points, >3 mg/dL (>51.3 μmol/L) = +3 points
2. Albumin: >3.5 g/dL (>35 g/L) = +1 point, 2.8-3.5 g/dL (28-35 g/L) = +2 points, <2.8 g/dL (<28 g/L) = +3 points
3. INR: <1.7 = +1 point, 1.7-2.3 = +2 points, >2.3 = +3 points
4. Ascites: Absent = +1 point, Slight = +2 points, Moderate = +3 points
5. Encephalopathy: No Encephalopathy = +1 point, Grade 1-2 = +2 points, Grade 3-4 = +3 points 
(Grade 0: normal consciousness, personality, neurological examination, electroencephalogram
Grade 1: restless, sleep disturbed, irritable/agitated, tremor, impaired handwriting, 5 cps waves
Grade 2: lethargic, time-disoriented, inappropriate, asterixis, ataxia, slow triphasic waves
Grade 3: somnolent, stuporous, place-disoriented, hyperactive reflexes, rigidity, slower waves
Grade 4: unrousable coma, no personality/behavior, decerebrate, slow 2-3 cps delta activity)

The Child-Pugh Score is calculated by summing the points for each criterion.

The current child pugh score is 0.
The patient's INR is 1.87. Because the INR is between 1.7 and 2.3, we add two to the score, making the current total 0 + 2 = 2.
The concentration of bilirubin is 3.1 mg/dL. Because the bilirubin concentration is greater than 3 mg/dL, we add 3 to the score, making the current total 2 + 3 = 5.
The concentration of albumin is 2.2 g/dL. Because the albumin concentration is less than 2.8 g/dL, we add 3 points to the score, making the current total 5 + 3 = 8.
The patient's ascites state is determined to be 'moderate' and so we add 3 points to the score, making the current total 8 + 3 = 11.
The patient is determined to not have any encephalopathy and so we add one point to the score, making the current total 11 + 1 = 12.
The patient's child pugh score is 12."
210,15,Child-Pugh Score for Cirrhosis Mortality,severity,integer,pmc-6715580-1,Extracted,"A 43-year-old male presented to the emergency department complaining of melena for three days.
He had two loose bowel movements with black tarry stool every day for the last three days with lightheadedness.
He denies any hematemesis, abdominal pain, or similar episodes in the past.
Past medical history was remarkable for liver cirrhosis due to untreated hepatitis C and alcohol abuse. Family history was unremarkable.
On presentation, vitals revealed a blood pressure of 100/60 mmHg; pulse rate of 110 per minute, temperature of 98.5 Fahrenheit, and respiratory rate of 18 per minute. Physical exam revealed an ill-looking patient with mild confusion, pale conjunctiva, non-icterus sclera, mildly distended abdomen with no tenderness, and trace pitting edema in both legs.
Laboratory findings displayed hemoglobin of 6.8 g/dL, leukocytes 10000/mm3, and platelet 105000/mm3. Serum biochemistry revealed creatinine 0.6 mg/dL, blood urea nitrogen 16 mg/dL, albumin 2.4 g/dL, total protein 4.8 g/dL, aspartate aminotransferase 34 IU/L, alanine aminotransferase 60 IU/L, alkaline phosphatase 95 IU/L, international normalized ratio 1.1 and total bilirubin 1.5 mg/dL.",What is the patient's Child-Pugh Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'international normalized ratio': 1.1, 'Ascites': 'slight', 'Albumin': [2.4, 'g/dL'], 'Bilirubin': [1.5, 'mg/dL'], 'Encephalopathy': 'Grade 1-2'}",9,9,9,"The criteria for the Child-Pugh Score are listed below:

1. Bilirubin (Total): <2 mg/dL (<34.2 μmol/L) = +1 point, 2-3 mg/dL (34.2-51.3 μmol/L) = +2 points, >3 mg/dL (>51.3 μmol/L) = +3 points
2. Albumin: >3.5 g/dL (>35 g/L) = +1 point, 2.8-3.5 g/dL (28-35 g/L) = +2 points, <2.8 g/dL (<28 g/L) = +3 points
3. INR: <1.7 = +1 point, 1.7-2.3 = +2 points, >2.3 = +3 points
4. Ascites: Absent = +1 point, Slight = +2 points, Moderate = +3 points
5. Encephalopathy: No Encephalopathy = +1 point, Grade 1-2 = +2 points, Grade 3-4 = +3 points 
(Grade 0: normal consciousness, personality, neurological examination, electroencephalogram
Grade 1: restless, sleep disturbed, irritable/agitated, tremor, impaired handwriting, 5 cps waves
Grade 2: lethargic, time-disoriented, inappropriate, asterixis, ataxia, slow triphasic waves
Grade 3: somnolent, stuporous, place-disoriented, hyperactive reflexes, rigidity, slower waves
Grade 4: unrousable coma, no personality/behavior, decerebrate, slow 2-3 cps delta activity)

The Child-Pugh Score is calculated by summing the points for each criterion.

The current child pugh score is 0.
The patient's INR is 1.1. Because the INR is less than 1.7, we add 1 to the score, making the current total 0 + 1 = 1.
The concentration of bilirubin is 1.5 mg/dL. Because the bilirubin concentration is less than 2 mg/dL, we add 1 to the score, making the current total 1 + 1 = 2.
The concentration of albumin is 2.4 g/dL. Because the albumin concentration is less than 2.8 g/dL, we add 3 points to the score, making the current total 2 + 3 = 5.
The patient's ascites state is determined to be 'slight' and so we add 2 points to the score, making the current total 5 + 2 = 7.
The encephalopathy state is determined to be 'Grade 1-2' and so we add two points to the score, making the current total 7 + 2 = 9.
The patient's child pugh score is 9."
211,15,Child-Pugh Score for Cirrhosis Mortality,severity,integer,pmc-3304613-1,Extracted,"A 62-year-old man with alcoholic cirrhosis visited outpatient clinic for unexplained weight loss. He had a good performance status (grade 0). Laboratory tests showed serum albumin level of 5.3 g/dL, bilirubin level of 1.3 mg/dL, and prothrombin time international normalized ratio of 1.1. Neither ascites nor hepatic encephalopathy was found, which corresponded with Child-Pugh class A. Serologic markers for hepatitis B and C were negative. Serum α-fetoprotein level was 311.7 ng/mL, and PIVKA-II level was over 2,000 mAU/mL. Other laboratory findings including tumor markers and thyroid function tests were within normal limits. About a 5 cm sized ovoid enhancing mass in arterial phase involving the caudate lobe with underlying cirrhotic configuration of the liver was shown on the dynamic computed tomography (CT) and magnetic resonance imaging (MRI) (, respectively). There was no vascular invasion and no intraabdominal lymphadenopathy. On positron emission tomography-CT, maximum standardized uptake value for the mass was 6.3 without evidence of distant metastasis. Overall, early stage of HCC was assigned according to the Barcelona-Clinic-Liver-Cancer (BCLC) HCC staging system.
Surgical resection was recommended for the treatment of the HCC, however, he refused the surgical treatment. TACE using DEB was performed after obtaining written informed consent for the procedure. During the first TACE session, hepatic angiogram revealed a definite hypervascular mass supplied by a small branch of the left hepatic artery without apparent arteriovenous shunt (). After positioning the microcatheter tip at the left hepatic artery close to the tumor-feeding branch, a mixture of DEB (DC Bead®, 1 vial of 300~500 µm diameter, Biocompatibles, UK) loaded with doxorubicin (50 mg) and contrast agent was infused until the flow through the tumor-feeding artery was slowed down. After the infusion, angiogram showed occluded tumor-feeding branch and no tumor staining ().
He had no serious adverse event after embolization except mild abdominal pain that was controlled with oral analgesic (tramadol 50 mg per os tid). One-month post-embolization CT () and six-month post-embolization MRI () showed complete necrosis without viable portions. Follow-up α-fetoprotein level was 3.89 ng/mL, and PIVKA-II level was 21 mAU/mL. This patient remains in good health without cancer recurrence 6 months after the procedure.",What is the patient's Child-Pugh Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'international normalized ratio': 1.1, 'Ascites': 'absent', 'Albumin': [5.3, 'g/dL'], 'Bilirubin': [1.3, 'mg/dL'], 'Encephalopathy': 'No Encephalopathy'}",5,5,5,"The criteria for the Child-Pugh Score are listed below:

1. Bilirubin (Total): <2 mg/dL (<34.2 μmol/L) = +1 point, 2-3 mg/dL (34.2-51.3 μmol/L) = +2 points, >3 mg/dL (>51.3 μmol/L) = +3 points
2. Albumin: >3.5 g/dL (>35 g/L) = +1 point, 2.8-3.5 g/dL (28-35 g/L) = +2 points, <2.8 g/dL (<28 g/L) = +3 points
3. INR: <1.7 = +1 point, 1.7-2.3 = +2 points, >2.3 = +3 points
4. Ascites: Absent = +1 point, Slight = +2 points, Moderate = +3 points
5. Encephalopathy: No Encephalopathy = +1 point, Grade 1-2 = +2 points, Grade 3-4 = +3 points 
(Grade 0: normal consciousness, personality, neurological examination, electroencephalogram
Grade 1: restless, sleep disturbed, irritable/agitated, tremor, impaired handwriting, 5 cps waves
Grade 2: lethargic, time-disoriented, inappropriate, asterixis, ataxia, slow triphasic waves
Grade 3: somnolent, stuporous, place-disoriented, hyperactive reflexes, rigidity, slower waves
Grade 4: unrousable coma, no personality/behavior, decerebrate, slow 2-3 cps delta activity)

The Child-Pugh Score is calculated by summing the points for each criterion.

The current child pugh score is 0.
The patient's INR is 1.1. Because the INR is less than 1.7, we add 1 to the score, making the current total 0 + 1 = 1.
The concentration of bilirubin is 1.3 mg/dL. Because the bilirubin concentration is less than 2 mg/dL, we add 1 to the score, making the current total 1 + 1 = 2.
The concentration of albumin is 5.3 g/dL. Because the albumin concentration is greater than 3.5 g/dL, we add 1 point to the score, making the current total 2 + 1 = 3.
The patient's ascites state is determined to be 'absent' and so we add 1 point to the score, making the current total 3 + 1 = 4.
The patient is determined to not have any encephalopathy and so we add one point to the score, making the current total 4 + 1 = 5.
The patient's child pugh score is 5."
212,15,Child-Pugh Score for Cirrhosis Mortality,severity,integer,pmc-4397630-2,Extracted,"A 28-year-old male who was regular at the gym for bodybuilding presented to us with 1-day history of epigastric pain radiating to back, recurrent vomiting and abdominal distension. On admission his heart rate was 160 per min regular, respiratory rate was around 40 per min, blood pressure 100/80 mmHg, abdomen was diffusely distended and mildly tender. Initial lab evaluation showed Hb 18.7 g/dL, total leukocycte count 6200, serum creatinine 0.8 mg/dL, urea 34 mg/dL, sodium 138, potassium 4.3 mmol/L, total protein 6.1 g/dL, albumin 3.7 g/dL, bilirubin 3.6 mg/dL, SGOT 29, SGPT 26, alkaline phosphatase 145, lipase 104, serum amylase 760 U/L, prothrombin time (international normalized ratio) 1.23, activated partial thromboplastin time 38 s, serum calcium 9.4 mg/dL, serum triglyceride 148 mg/dL. Arterial blood gas analysis reveal pH 7.33, pCO235, pO280 mmHg on oxygen through face mask at 8 L/min, lactate 3.7 mmol/L. On Ultrasonography abdomen, pancreas was swollen with mild peritoneal collection, diffuses inflammatory changes with no evidence of gall stones or biliary sludge.
On detailed history including alcohol intake and examination we could not find obvious reason of acute pancreatitis other than his history of taking androgenic anabolic steroids (AAS) and protein supplements for body building since other less common causes which includes hypercalcemia, hypertriglyceridemia or post-endoscopic retrograde cholangiopancreatography was also not there and corticosteroids are known etiological agent for acute pancreatitis.
After initial improvement over the period of 5–7 days patient's condition start worsening again, and he was shifted to bigger center where he died after 2–3 days.",What is the patient's Child-Pugh Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'international normalized ratio': 1.23, 'Ascites': 'slight', 'Albumin': [3.7, 'g/dL'], 'Encephalopathy': 'No Encephalopathy', 'Bilirubin': [3.6, 'mg/dL']}",8,8,8,"The criteria for the Child-Pugh Score are listed below:

1. Bilirubin (Total): <2 mg/dL (<34.2 μmol/L) = +1 point, 2-3 mg/dL (34.2-51.3 μmol/L) = +2 points, >3 mg/dL (>51.3 μmol/L) = +3 points
2. Albumin: >3.5 g/dL (>35 g/L) = +1 point, 2.8-3.5 g/dL (28-35 g/L) = +2 points, <2.8 g/dL (<28 g/L) = +3 points
3. INR: <1.7 = +1 point, 1.7-2.3 = +2 points, >2.3 = +3 points
4. Ascites: Absent = +1 point, Slight = +2 points, Moderate = +3 points
5. Encephalopathy: No Encephalopathy = +1 point, Grade 1-2 = +2 points, Grade 3-4 = +3 points 
(Grade 0: normal consciousness, personality, neurological examination, electroencephalogram
Grade 1: restless, sleep disturbed, irritable/agitated, tremor, impaired handwriting, 5 cps waves
Grade 2: lethargic, time-disoriented, inappropriate, asterixis, ataxia, slow triphasic waves
Grade 3: somnolent, stuporous, place-disoriented, hyperactive reflexes, rigidity, slower waves
Grade 4: unrousable coma, no personality/behavior, decerebrate, slow 2-3 cps delta activity)

The Child-Pugh Score is calculated by summing the points for each criterion.

The current child pugh score is 0.
The patient's INR is 1.23. Because the INR is less than 1.7, we add 1 to the score, making the current total 0 + 1 = 1.
The concentration of bilirubin is 3.6 mg/dL. Because the bilirubin concentration is greater than 3 mg/dL, we add 3 to the score, making the current total 1 + 3 = 4.
The concentration of albumin is 3.7 g/dL. Because the albumin concentration is greater than 3.5 g/dL, we add 1 point to the score, making the current total 4 + 1 = 5.
The patient's ascites state is determined to be 'slight' and so we add 2 points to the score, making the current total 5 + 2 = 7.
The patient is determined to not have any encephalopathy and so we add one point to the score, making the current total 7 + 1 = 8.
The patient's child pugh score is 8."
213,15,Child-Pugh Score for Cirrhosis Mortality,severity,integer,pmc-3959491-2,Extracted,"A 58-year-old male presented with melena, abdominal pain and fever. He was diagnosed to have EHPVO and had undergone splenectomy at the age of 19 years when he presented with massive variceal bleeding in 1973. Physical examination revealed pallor and moderate ascites. Laboratory investigations were as follows; hemoglobin 9.1 gm/dL, total leukocyte count 11700 cells/mm3, platelet count 4.04 lakhs/mm3 and INR of 1.1. Ascitic fluid analysis showed a total leukocyte count of 1600 cells/mm3, polymorphonuclear cell count of 1472 cells/mm3, total protein 2.5 g/dL, albumin 1.4 g/dL, bilirubin 2.2 mg/dL, and SAAG 1.9. Ascitic fluid culture yielded growth of E. coli. Ultrasound abdomen with Doppler study showed normal liver, cavernous transformation of the portal vein and moderate ascites. Upper gastrointestinal endoscopy revealed severe portal hypertensive gastropathy and gastric fundal varix. Computerized tomography of the abdomen was consistent with the diagnosis of EHPVO; there was no evidence of cirrhosis of the liver or any features of perforation or inflammation of other organs.
The liver and renal function tests, serum amylase and lipase levels, serum electrolytes and blood glucose levels were normal in both patients. Ascitic fluid glucose, lactate dehy-drogenase, triglycerides and adenosine deaminase were also within normal limits. Both patients did not show any features of perforation or obstruction on plain x-ray of the abdomen.
Both patients were managed with infusion of octreotide, proton pump inhibitors, transfusions, hematinics and beta blockers. SBP was treated with Cefotaxime 2 g IV t.i.d. Both patients had relief of fever, abdominal pain and abdominal distension. Repeat ascitic fluid analysis after 48 h of antibiotic therapy showed a decrease in polymorphonuclear cell count to 68 cells/mm3 and 165 cells/mm3 in the first and second case respectively. Antibiotics were continued for 5 days and both patients were discharged in a stable state.",What is the patient's Child-Pugh Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'international normalized ratio': 1.1, 'Ascites': 'moderate', 'Albumin': [1.4, 'g/dL'], 'Bilirubin': [2.2, 'mg/dL'], 'Encephalopathy': 'No Encephalopathy'}",10,10,10,"The criteria for the Child-Pugh Score are listed below:

1. Bilirubin (Total): <2 mg/dL (<34.2 μmol/L) = +1 point, 2-3 mg/dL (34.2-51.3 μmol/L) = +2 points, >3 mg/dL (>51.3 μmol/L) = +3 points
2. Albumin: >3.5 g/dL (>35 g/L) = +1 point, 2.8-3.5 g/dL (28-35 g/L) = +2 points, <2.8 g/dL (<28 g/L) = +3 points
3. INR: <1.7 = +1 point, 1.7-2.3 = +2 points, >2.3 = +3 points
4. Ascites: Absent = +1 point, Slight = +2 points, Moderate = +3 points
5. Encephalopathy: No Encephalopathy = +1 point, Grade 1-2 = +2 points, Grade 3-4 = +3 points 
(Grade 0: normal consciousness, personality, neurological examination, electroencephalogram
Grade 1: restless, sleep disturbed, irritable/agitated, tremor, impaired handwriting, 5 cps waves
Grade 2: lethargic, time-disoriented, inappropriate, asterixis, ataxia, slow triphasic waves
Grade 3: somnolent, stuporous, place-disoriented, hyperactive reflexes, rigidity, slower waves
Grade 4: unrousable coma, no personality/behavior, decerebrate, slow 2-3 cps delta activity)

The Child-Pugh Score is calculated by summing the points for each criterion.

The current child pugh score is 0.
The patient's INR is 1.1. Because the INR is less than 1.7, we add 1 to the score, making the current total 0 + 1 = 1.
The concentration of bilirubin is 2.2 mg/dL. Because the bilirubin concentration is between 2 mg/dL and 3 mg/dL, we add 2 to the score, making the current total 1 + 2 = 3.
The concentration of albumin is 1.4 g/dL. Because the albumin concentration is less than 2.8 g/dL, we add 3 points to the score, making the current total 3 + 3 = 6.
The patient's ascites state is determined to be 'moderate' and so we add 3 points to the score, making the current total 6 + 3 = 9.
The patient is determined to not have any encephalopathy and so we add one point to the score, making the current total 9 + 1 = 10.
The patient's child pugh score is 10."
214,15,Child-Pugh Score for Cirrhosis Mortality,severity,integer,pmc-4545308-1,Extracted,"A 42-year-old male patient presented with complaints of distension of abdomen, decreased urine output and edema of feet. He had a history of melena, paracentesis and upper GI endoscopy with banding of grade 3 varices. He had also history of type 2 diabetes mellitus. He was not alcoholic and his autoimmune antibody profile was negative. Twenty-four-hour urinary copper and serum ceruloplasmin were normal. Kayser Fleischer’s ring was not found on slit lamp examination. His lab findings on presentation included a total billirubin of 1.6 mg/dL (direct 1.0 mg/dL, indirect 0.6 mg/dL), alanine aminotransferase of 55 U/L, aspartate aminotransferase of 35 U/L, alkaline phosphatase of 120 U/L, international normalized ratio (INR) of 1.49, serum albumin of 2.8 g/dL, and a serum creatinine of 1.62 mg/dL. His Child-Turcotte-Pugh score was 8 and Modified End-stage Liver Disease (MELD) score was 11. Once diagnosed having decompensated cryptogenic cirrhosis of liver, he was placed on liver transplant waiting list. He was on diuretic on presentation. He was initially managed with plasma expander and omission of diuretics. Creatinine rose above 2 mg/dL. His urinalysis showed no evidence of microscopic proteinuria or microalbuminuria. All other possible causes of renal failure were ruled out. He was thus diagnosed with HRS type 1. The patient did not respond to combination therapy with albumin and terlipressin and his serum creatinine increased to 5 mg/dL. He was placed on hemodialysis. The patient was kept on hemodialysis for 10 weeks when he received a liver from a cadaver donor. Donor was a 50-year-old brain-dead woman who died of MVA. At that time, considering patient’s renal dysfunction, CLKT was carried out. The patient was maintained on continuous renal replacement therapy during perioperative period. The inferior epigastric artery was preserved to avoid wound-related complications. Postoperatively, the patient did not require any kinds of renal support. After two years of follow-up, the patient was maintained well on tacrolimus, mycophenolate mofetil and steroid.",What is the patient's Child-Pugh Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'international normalized ratio': 1.49, 'Ascites': 'moderate', 'Albumin': [2.8, 'g/dL'], 'Bilirubin': [1.6, 'mg/dL'], 'Encephalopathy': 'No Encephalopathy'}",8,8,8,"The criteria for the Child-Pugh Score are listed below:

1. Bilirubin (Total): <2 mg/dL (<34.2 μmol/L) = +1 point, 2-3 mg/dL (34.2-51.3 μmol/L) = +2 points, >3 mg/dL (>51.3 μmol/L) = +3 points
2. Albumin: >3.5 g/dL (>35 g/L) = +1 point, 2.8-3.5 g/dL (28-35 g/L) = +2 points, <2.8 g/dL (<28 g/L) = +3 points
3. INR: <1.7 = +1 point, 1.7-2.3 = +2 points, >2.3 = +3 points
4. Ascites: Absent = +1 point, Slight = +2 points, Moderate = +3 points
5. Encephalopathy: No Encephalopathy = +1 point, Grade 1-2 = +2 points, Grade 3-4 = +3 points 
(Grade 0: normal consciousness, personality, neurological examination, electroencephalogram
Grade 1: restless, sleep disturbed, irritable/agitated, tremor, impaired handwriting, 5 cps waves
Grade 2: lethargic, time-disoriented, inappropriate, asterixis, ataxia, slow triphasic waves
Grade 3: somnolent, stuporous, place-disoriented, hyperactive reflexes, rigidity, slower waves
Grade 4: unrousable coma, no personality/behavior, decerebrate, slow 2-3 cps delta activity)

The Child-Pugh Score is calculated by summing the points for each criterion.

The current child pugh score is 0.
The patient's INR is 1.49. Because the INR is less than 1.7, we add 1 to the score, making the current total 0 + 1 = 1.
The concentration of bilirubin is 1.6 mg/dL. Because the bilirubin concentration is less than 2 mg/dL, we add 1 to the score, making the current total 1 + 1 = 2.
The concentration of albumin is 2.8 g/dL. Because the albumin concentration is between 2.8 g/dL and 3.5 g/dL, we add 2 points to the score, making the current total 2 + 2 = 4.
The patient's ascites state is determined to be 'moderate' and so we add 3 points to the score, making the current total 4 + 3 = 7.
The patient is determined to not have any encephalopathy and so we add one point to the score, making the current total 7 + 1 = 8.
The patient's child pugh score is 8."
215,15,Child-Pugh Score for Cirrhosis Mortality,severity,integer,pmc-3177917-1,Extracted,"A 33-year-old Turkish man was admitted to our emergency department with complaints of nausea, vomiting, weakness, diarrhea, and fever up to 38.8°C which had lasted for one month. The patient, who had been diagnosed with FMF at 17 years of age, had been started on a regular hemodialysis program at 29 years of age upon the development of chronic renal failure due to amyloidosis. He was not taking any pills regularly except colchicine tablets.
At his physical examination, his general appearance was apathic and cachectic, his mucous membranes were dry and pale, and his skin was dry and rough with a urochromic color. His blood pressure was 110/70 mmHg, and his heart rate was 81 beats/minute. His heartbeat was rhythmic with auscultation, and there was no additional sound murmur. His abdominal examination showed that his liver extended 5 cm below the costal margin. The hepatic surface was rough and even and was painless on palpation. Traube's space was closed, and the spleen extended 2 cm below the costal margin. His muscles were atrophied at the extremities, and he had shedding hairs and an arteriovenous fistula on the left arm. No other pathological findings were detected during his systemic examinations.
At the time of his first admission to the hospital, his laboratory tests with abnormal values were hemoglobin 9.2 g/dL, hematocrit 26.9%, mean corpuscular volume 79fL, bilirubin 1.6 mg/dL, creatinine 8.3 mg/dL, urea 60 mg/dL, albumin 2.1 g/dL, sodium 132 mmol/L, International Normalized Ratio 1.30, and prothrombin time 15.6 seconds. Hemoculture, stool microscopy, and stool culture were carried out after we observed recurring high fever attacks during his regular hemodialysis sessions, but he did not have high fever at his follow-up examinations. When no pathogenic microorganisms were detected, intravenous ceftriaxone 1 g twice daily was started empirically. Doppler ultrasonography and echocardiography were performed to identify fistulas, but there was still no obvious explanation for his fever.
After a fever that persisted for more than five days, the patient was started on 1 g of intravenous vancomycin once every four days. Abdominal ultrasonography was performed, and hepatosplenomegaly was detected. The liver edge was regular with hepatic parenchyma and showed no pathological finding. His ductus choledochus (common bile duct), intra-hepatic bile ducts, and gallbladder were all normal. Minimal ascites was detected in the abdomen. Examination of the ascites puncture sample produced no findings in favor of tuberculosis. The patient was scheduled for gastroscopy and colonoscopy but had hypoglycemic attacks during the preparation phase. His esophagogastroscopic examination results were within normal ranges. Examination of rectal biopsy samples taken during colonoscopy revealed type AA amyloidosis.
The patient's fever was closely monitored for hypoglycemic episodes and decreased as a result of two weeks of antibiotic therapy. His ocular fundus examination and cranial MRI scans were normal, but he kept on vomiting frequently. During an attack of hypoglycemia, his laboratory results were blood glucose 36 mg/dL, insulin 0.2 μU/mL, C peptide 1.4 ng/mL, sodium 127 mmol/L, and cortisol 7.68 mcg/dL. A Synacthen stimulation test was planned with consultation by an endocrinologist to investigate for adrenal insufficiency. The maximum cortisol value measured was 8.87 μg/dL, and the patient was diagnosed with adrenal insufficiency, so he was started on prednisolone 40 mg per day administered intramuscularly. Subsequently, prednisolone tablets 10 mg/day were started. The patient's diarrhea came to an end, and his hypoglycemia did not recur. The patient's complaints of fatigue and loss of appetite decreased. He was discharged from the hospital with scheduled out-patient clinic monitoring. Three months later he died in the emergency department as a result of cardiac arrest caused by hypokalemia.",What is the patient's Child-Pugh Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'international normalized ratio': 1.3, 'Ascites': 'slight', 'Albumin': [2.1, 'g/dL'], 'Encephalopathy': 'No Encephalopathy', 'Bilirubin': [1.6, 'mg/dL']}",8,8,8,"The criteria for the Child-Pugh Score are listed below:

1. Bilirubin (Total): <2 mg/dL (<34.2 μmol/L) = +1 point, 2-3 mg/dL (34.2-51.3 μmol/L) = +2 points, >3 mg/dL (>51.3 μmol/L) = +3 points
2. Albumin: >3.5 g/dL (>35 g/L) = +1 point, 2.8-3.5 g/dL (28-35 g/L) = +2 points, <2.8 g/dL (<28 g/L) = +3 points
3. INR: <1.7 = +1 point, 1.7-2.3 = +2 points, >2.3 = +3 points
4. Ascites: Absent = +1 point, Slight = +2 points, Moderate = +3 points
5. Encephalopathy: No Encephalopathy = +1 point, Grade 1-2 = +2 points, Grade 3-4 = +3 points 
(Grade 0: normal consciousness, personality, neurological examination, electroencephalogram
Grade 1: restless, sleep disturbed, irritable/agitated, tremor, impaired handwriting, 5 cps waves
Grade 2: lethargic, time-disoriented, inappropriate, asterixis, ataxia, slow triphasic waves
Grade 3: somnolent, stuporous, place-disoriented, hyperactive reflexes, rigidity, slower waves
Grade 4: unrousable coma, no personality/behavior, decerebrate, slow 2-3 cps delta activity)

The Child-Pugh Score is calculated by summing the points for each criterion.

The current child pugh score is 0.
The patient's INR is 1.3. Because the INR is less than 1.7, we add 1 to the score, making the current total 0 + 1 = 1.
The concentration of bilirubin is 1.6 mg/dL. Because the bilirubin concentration is less than 2 mg/dL, we add 1 to the score, making the current total 1 + 1 = 2.
The concentration of albumin is 2.1 g/dL. Because the albumin concentration is less than 2.8 g/dL, we add 3 points to the score, making the current total 2 + 3 = 5.
The patient's ascites state is determined to be 'slight' and so we add 2 points to the score, making the current total 5 + 2 = 7.
The patient is determined to not have any encephalopathy and so we add one point to the score, making the current total 7 + 1 = 8.
The patient's child pugh score is 8."
216,15,Child-Pugh Score for Cirrhosis Mortality,severity,integer,pmc-7317128-1,Extracted,"A 67-year-old male with a past medical history of untreated hepatitis C and hypertension was admitted after experiencing nausea, lightheadedness and a syncopal episode resulting in trauma to his head. En route to the hospital, the patient had one episode of hematemesis, followed by two additional episodes in the emergency department. Vital signs were as follows: heart rate 100 beats per minute, respiratory rate 16 breaths per minute, blood pressure 131/71 mmHg and temperature 94.3°F. The patient was oriented to person, place and time. His abdomen was soft, non-distended and non-tender to palpation. Pertinent laboratory tests included hemoglobin 9.5 g/dl, hematocrit 29.5%, platelets 197 K/µL, blood urea nitrogen (BUN) 22 mg/dl, creatinine 0.8 U/L, aspartate aminotransferase (AST) 112 U/L, alanine aminotransferase (ALT) 76 U/L, total bilirubin 0.5 mg/dl, alkaline phosphatase 18 U/L, albumin 3.2 g/dl, lactic acid 3.1 mmol/L, prothrombin time 11.8 seconds and international normalized ratio (INR) 1.0. Octreotide infusion, ceftriaxone and a proton-pump inhibitor were promptly started, along with transfusion of three units of blood due to persistent bleeding.
Urgent endoscopy was performed, where a significant amount of red blood was seen in the gastric fundus with an area of active bleeding near the gastroesophageal junction. No esophageal varices were seen. Attempts to control the hemorrhage endoscopically were unsuccessful due to large amount of active bleeding obscuring visibility. CT scan of the abdomen showed a 6-cm mass in the right lobe of a cirrhotic liver (suspected to be hepatocellular carcinoma [HCC]) and one large gastric varix with a gastrorenal shunt (Figure ). Importantly, there was no evidence of portal vein or splenic vein thrombosis.
Initially, left-sided TIPS was attempted, but multiple attempts to pass from left portal vein to left hepatic vein were unsuccessful due to challenging anatomy. The patient required multiple blood products. Eventually, the patient underwent BRTO. His left renal vein was accessed via the right internal jugular vein, the balloon was inflated and a sclerosing agent was injected into the bleeding varix. This was followed by coiling of the same varix, resulting in occlusion of the portosystemic shunt (Figure ). The patient had no further episodes of bleeding and was discharged a few days later. He was ultimately diagnosed with HCC (Figure ).",What is the patient's Child-Pugh Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'international normalized ratio': 1.0, 'Ascites': 'absent', 'Albumin': [3.2, 'g/dL'], 'Bilirubin': [0.5, 'mg/dL'], 'Encephalopathy': 'No Encephalopathy'}",6,6,6,"The criteria for the Child-Pugh Score are listed below:

1. Bilirubin (Total): <2 mg/dL (<34.2 μmol/L) = +1 point, 2-3 mg/dL (34.2-51.3 μmol/L) = +2 points, >3 mg/dL (>51.3 μmol/L) = +3 points
2. Albumin: >3.5 g/dL (>35 g/L) = +1 point, 2.8-3.5 g/dL (28-35 g/L) = +2 points, <2.8 g/dL (<28 g/L) = +3 points
3. INR: <1.7 = +1 point, 1.7-2.3 = +2 points, >2.3 = +3 points
4. Ascites: Absent = +1 point, Slight = +2 points, Moderate = +3 points
5. Encephalopathy: No Encephalopathy = +1 point, Grade 1-2 = +2 points, Grade 3-4 = +3 points 
(Grade 0: normal consciousness, personality, neurological examination, electroencephalogram
Grade 1: restless, sleep disturbed, irritable/agitated, tremor, impaired handwriting, 5 cps waves
Grade 2: lethargic, time-disoriented, inappropriate, asterixis, ataxia, slow triphasic waves
Grade 3: somnolent, stuporous, place-disoriented, hyperactive reflexes, rigidity, slower waves
Grade 4: unrousable coma, no personality/behavior, decerebrate, slow 2-3 cps delta activity)

The Child-Pugh Score is calculated by summing the points for each criterion.

The current child pugh score is 0.
The patient's INR is 1.0. Because the INR is less than 1.7, we add 1 to the score, making the current total 0 + 1 = 1.
The concentration of bilirubin is 0.5 mg/dL. Because the bilirubin concentration is less than 2 mg/dL, we add 1 to the score, making the current total 1 + 1 = 2.
The concentration of albumin is 3.2 g/dL. Because the albumin concentration is between 2.8 g/dL and 3.5 g/dL, we add 2 points to the score, making the current total 2 + 2 = 4.
The patient's ascites state is determined to be 'absent' and so we add 1 point to the score, making the current total 4 + 1 = 5.
The patient is determined to not have any encephalopathy and so we add one point to the score, making the current total 5 + 1 = 6.
The patient's child pugh score is 6."
217,15,Child-Pugh Score for Cirrhosis Mortality,severity,integer,pmc-6598236-1,Extracted,"A 55-year-old man was on the waiting list for orthotopic liver transplant because of a decompensated HBV-related liver cirrhosis (MELD 16) complicated by intractable ascites for which a transjugular intrahepatic portosystemic shunt (TIPS) had been placed 5 months earlier. He was also affected by asymptomatic gallbladder stones and admitted to our unit because of sudden recurrence of abdominal distension. The patient reported a few days before severe epigastric pain that lasted for about 20 min and was spontaneously resolved; he, however, denied hematemesis or melena. At admission, physical examination revealed normal vital signs. Laboratory workup revealed a haemoglobin level of 6.4 g/dl (compared to that of 10.3 g/dl recorded 3 weeks earlier), leucocyte count of 4930/mm3, platelet count of 49/mm3, international normalised ratio of 1.44, bilirubin 3.2 mg/dl, alanine aminotransferase 25 UI/l, aspartate aminotransferase 47 UI/l, alkaline phosphatase 105 UI/l, gamma glutamyl transferase 27 UI/l, albumin 2.0 g/dl, creatinine 0.91 mg/dl and C reactive protein 48 mg/l. The patient was made to undergo urgent blood transfusion. An urgent gastroscopy revealed no varices, gastric ulcer or any other source of bleeding. An ultrasound sonography confirmed the presence of ascites and normal flow within the portal vein and the TIPS. The patient underwent diagnostic paracentesis with leakage of high-pressure blood-like fluid: the cell count analysis confirmed hemoperitoneum (haemoglobin 2.8 g/dl) and showed normal leucocyte count and no malignant cells. The analysis of the ascitic fluid also documented a transudate (total proteins < 2 g/dl, LDH 162 UI/l) with high serum-ascites albumin gradient (1.4 g/dl), bilirubin concentration of 2.9 mg/dl and ascitic culture as negative. A contrast-enhanced abdomen CT-scan showed a scleroatrophic gallbladder bearing only one stone inside and irregularity along the wall, but no frank interruption while numerous radiopaque elements were evident in the pelvis alongside dense ascites (Hounsfield Units 19; uncomplicated ascites normal value 0–15) [], configuring a picture like “starry sky” (Fig. ). No ectopic gallbladder varices have been recorded. Both abdominal CT and ultrasound performed a month before described contracted gallbladder, whose lumen was completely occupied by stones. A perforation of the gallbladder with occult bleeding was therefore diagnosed. Based on absence of fever, signs of peritoneal involvement, stability of haemoglobin levels and expected waitlist time, a conservative therapeutic strategy (antibiotic therapy and control of the coagulation parameters, haemoglobin and renal function) was chosen to avoid high-risk cholecystectomy before liver transplantation. In the following days, clinical and laboratory parameters remained stable and, particularly, no fever or exacerbation of hepatic encephalopathy were observed. The patient was discharged in 15 days, asymptomatic, with a stable level of haemoglobin. Two months later, the patient underwent a successful liver transplantation. During the transplantation, the surgeon visualised the stones that had migrated into the pelvis and decided not to remove them because of an unfavourable risk-benefit ratio. The pathological report documented a scleroatrophic gallbladder with chronic inflammation but did not identify any perforation.",What is the patient's Child-Pugh Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'international normalized ratio': 1.44, 'Ascites': 'moderate', 'Albumin': [2.0, 'g/dL'], 'Bilirubin': [3.2, 'mg/dL'], 'Encephalopathy': 'No Encephalopathy'}",11,11,11,"The criteria for the Child-Pugh Score are listed below:

1. Bilirubin (Total): <2 mg/dL (<34.2 μmol/L) = +1 point, 2-3 mg/dL (34.2-51.3 μmol/L) = +2 points, >3 mg/dL (>51.3 μmol/L) = +3 points
2. Albumin: >3.5 g/dL (>35 g/L) = +1 point, 2.8-3.5 g/dL (28-35 g/L) = +2 points, <2.8 g/dL (<28 g/L) = +3 points
3. INR: <1.7 = +1 point, 1.7-2.3 = +2 points, >2.3 = +3 points
4. Ascites: Absent = +1 point, Slight = +2 points, Moderate = +3 points
5. Encephalopathy: No Encephalopathy = +1 point, Grade 1-2 = +2 points, Grade 3-4 = +3 points 
(Grade 0: normal consciousness, personality, neurological examination, electroencephalogram
Grade 1: restless, sleep disturbed, irritable/agitated, tremor, impaired handwriting, 5 cps waves
Grade 2: lethargic, time-disoriented, inappropriate, asterixis, ataxia, slow triphasic waves
Grade 3: somnolent, stuporous, place-disoriented, hyperactive reflexes, rigidity, slower waves
Grade 4: unrousable coma, no personality/behavior, decerebrate, slow 2-3 cps delta activity)

The Child-Pugh Score is calculated by summing the points for each criterion.

The current child pugh score is 0.
The patient's INR is 1.44. Because the INR is less than 1.7, we add 1 to the score, making the current total 0 + 1 = 1.
The concentration of bilirubin is 3.2 mg/dL. Because the bilirubin concentration is greater than 3 mg/dL, we add 3 to the score, making the current total 1 + 3 = 4.
The concentration of albumin is 2.0 g/dL. Because the albumin concentration is less than 2.8 g/dL, we add 3 points to the score, making the current total 4 + 3 = 7.
The patient's ascites state is determined to be 'moderate' and so we add 3 points to the score, making the current total 7 + 3 = 10.
The patient is determined to not have any encephalopathy and so we add one point to the score, making the current total 10 + 1 = 11.
The patient's child pugh score is 11."
218,15,Child-Pugh Score for Cirrhosis Mortality,severity,integer,pmc-6497474-1,Extracted,"A male, 59 years old, complained blackish stool in the last 2 weeks. His abdomen had slowly enlarged over the previous 4 years, and he felt pain especially in the middle of the stomach. He denied consuming alcohol drink, smoking, or history of other diseases, such as hepatitis and congenital disorder of the blood. The patient’s condition gets weaker, but he can still eat and drink, and no vomiting. There is no swelling in the extremities.
Physical examination revealed pale of the eyelid, no icteric, no hepatomegaly, splenomegaly, and ascites. Rectal examination was positive of blackish stool, no fresh blood, and no palpable mass. Laboratory finding was anemia (hemoglobin 6.88 g/dL and haematocrit 22.02%), normal leukocyte and thrombocyte, hypoalbuminemia (albumin 2.8 g/dL), normal liver function (AST 14.7 U/L and ALT 11.1 U/L), and normal renal function (BUN 22.8 mg/dL and serum creatinine 0.79 mg/dL). Hemostatic test slightly elevated with APTT 30.9 s, PPT 16.7 s, and INR 1.43. We also found non-reactive at HBsAg and anti-HCV test, normal bilirubin serum (total 0.78 mg/dL, direct 0.31 mg/dL, and indirect 0.47 mg/dL), normal alkaline phosphatase (60 U/L), and normal gamma-GT (39 U/L), but high CRP count 23.39 mg/L (normal 0–5 mg/L).
The abdominal Doppler ultrasonography presented noncirrhotic liver with average size (13 cm), splenomegaly (13.9 cm), dilatation of portal vein (1.27 cm), low portal vein peak velocity (19.4 cm/s), and ascites (). This finding was confirmed with contrast-enhanced abdominal computed tomography (CT) scan, which revealed dilatation of portal vein with thrombus, normal liver parenchymal, normal biliary tract, splenomegaly with dilatation of splenic vein, and ascites (). He was examined used esophagogastroduodenoscopy, which revealed esophageal varices grade 3 with the positive red color sign and stomach varices ().
We transfused packed red cell two bags each day to improve hemoglobin level, but it cannot achieve until hemoglobin level was 10 g/dL. Every day he got melena, so it is indicated ongoing upper gastrointestinal bleeding. We decided to do Sugiura technique surgery with his baseline hemoglobin 5.29 g/dL. We performed the modified Sugiura technique through left subcostal incision () and proximal splenorenal shunt.
We performed splenectomy first () followed by devascularization of the distal esophagus using harmonic scalpel through hiatus of diaphragm. We made a small anterior gastrostomy. Then, we made a transection and end-to-end anastomosis of the lower esophagus () using a CDH29A stapling device (Ethicon curved intraluminal stapler). We performed separate Lembert suture to reinforce of the esophageal anastomosis and stitched the gastrostomy. We performed devascularization of the upper 2/3 of the lesser and major gastric curvature () and then pyloroplasty to facilitate gastric emptying (). The last procedure we anastomosed end-to-side of the splenic vein to left renal vein ().
His condition improved after surgery and overwhelming post-splenectomy infection (OPSI) did not occur. He can eat and normally drink, no pale, no fatigue, and no melena. He consumed medicine propranolol 60 mg per day to prevent portal hypertension and warfarin 5 mg per day to release the thrombus. Two months after surgery, we examined esophagogastroduodenoscopy and revealed esophageal varices grade 2 with the negative red color sign, cardia stomach edema, no gastric varices, and gastric snakeskin (). We evaluated esophagogastroduodenoscopy 6 months after surgery, the results were the same as the previous examination, but there was no edema in the gaster. One-year follow-up after surgery, his physical condition was better and no sign of complications.",What is the patient's Child-Pugh Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'international normalized ratio': 1.43, 'Ascites': 'slight', 'Albumin': [2.8, 'g/dL'], 'Bilirubin': [0.78, 'mg/dL'], 'Encephalopathy': 'No Encephalopathy'}",7,7,7,"The criteria for the Child-Pugh Score are listed below:

1. Bilirubin (Total): <2 mg/dL (<34.2 μmol/L) = +1 point, 2-3 mg/dL (34.2-51.3 μmol/L) = +2 points, >3 mg/dL (>51.3 μmol/L) = +3 points
2. Albumin: >3.5 g/dL (>35 g/L) = +1 point, 2.8-3.5 g/dL (28-35 g/L) = +2 points, <2.8 g/dL (<28 g/L) = +3 points
3. INR: <1.7 = +1 point, 1.7-2.3 = +2 points, >2.3 = +3 points
4. Ascites: Absent = +1 point, Slight = +2 points, Moderate = +3 points
5. Encephalopathy: No Encephalopathy = +1 point, Grade 1-2 = +2 points, Grade 3-4 = +3 points 
(Grade 0: normal consciousness, personality, neurological examination, electroencephalogram
Grade 1: restless, sleep disturbed, irritable/agitated, tremor, impaired handwriting, 5 cps waves
Grade 2: lethargic, time-disoriented, inappropriate, asterixis, ataxia, slow triphasic waves
Grade 3: somnolent, stuporous, place-disoriented, hyperactive reflexes, rigidity, slower waves
Grade 4: unrousable coma, no personality/behavior, decerebrate, slow 2-3 cps delta activity)

The Child-Pugh Score is calculated by summing the points for each criterion.

The current child pugh score is 0.
The patient's INR is 1.43. Because the INR is less than 1.7, we add 1 to the score, making the current total 0 + 1 = 1.
The concentration of bilirubin is 0.78 mg/dL. Because the bilirubin concentration is less than 2 mg/dL, we add 1 to the score, making the current total 1 + 1 = 2.
The concentration of albumin is 2.8 g/dL. Because the albumin concentration is between 2.8 g/dL and 3.5 g/dL, we add 2 points to the score, making the current total 2 + 2 = 4.
The patient's ascites state is determined to be 'slight' and so we add 2 points to the score, making the current total 4 + 2 = 6.
The patient is determined to not have any encephalopathy and so we add one point to the score, making the current total 6 + 1 = 7.
The patient's child pugh score is 7."
219,15,Child-Pugh Score for Cirrhosis Mortality,severity,integer,pmc-3622859-1,Extracted,"A 55-year-old woman with liver cirrhosis induced by the hepatitis C virus was admitted to Eul-ji University Hospital with a 20 day history of melena. Upon admission, her vital signs were as follows: blood pressure of 110/70 mmHg, heart rate of 70/min, respiratory rate of 18/min and body temperature of 36.8℃. Head and neck examinations were unremarkable except for anemic conjunctiva. Her abdomen was distended with shifting dullness and the spleen was palpable. Initial laboratory data were as follows: WBC 1,400/mm3, Hb 5.1 g/dL, platelet 63,000/mm3, BUN 19 mg/dL, creatinine 0.48 mg/dL, albumin 3.0 g/dL, AST 26 IU/L, ALT 20 IU/L, ALP 47 IU/L, total bilirubin 0.73 mg/dL, INR 1.45, CRP 0.08 mg/dL, AFP 2.4 ng/dL. The hepatitis B marker was negative and the anti HCV antibody was positive. A hepatitis C viral load was undetectable. The patient was treated with intravenous (IV) pantoprazole, IV terlipressin and IV ciprofloxacin and was transfused with fresh frozen plasma and packed red blood cells. Emergency esophagogastroduodenoscopy revealed the presence of grade 2 esophageal varices without stigmata of recent bleeding. No bleeding focus was found at colonoscopy up to the terminal ileum. Abdominal computed tomography (CT) showed liver cirrhosis with massive ascites, splenomegaly and esophagogastric varices with portosystemic collaterals. In addition, CT angiography revealed the presence of jejunal varices but no active bleeding was found (). Because she continued experiencing recurrent melena, a capsule endoscopy was performed on day five of hospitalization. It demonstrated fresh blood adjacent to varices in the jejunum (). On day six of hospitalization, a decision was made to perform the embolization of varices via the portal vein. The guidewire was manipulated into the superior mesenteric vein and the catheter tip was then positioned into tortuous, wide jejunal varices drained to the inferior vena cava. Five steel coils were placed into this vein. After that, injection of contrast under pressure did not demonstrate any retrograde flow, indicating that it was occluded ().
She received up to 21 units of packed red blood cells before the coiling embolization of the jejunal varices. Since that point in time, she has had a stable hemoglobin level and no recurrence of the melena has been recognized. She has been treated with a non-selective beta-blocker. A CT scan of the abdomen obtained 5 month after the embolization showed contrast-enhancing steel coils deposits within the varices. No further GI bleeding occurred during the 5 month follow-up.",What is the patient's Child-Pugh Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'international normalized ratio': 1.45, 'Ascites': 'moderate', 'Albumin': [3.0, 'g/dL'], 'Bilirubin': [0.73, 'mg/dL'], 'Encephalopathy': 'No Encephalopathy'}",8,8,8,"The criteria for the Child-Pugh Score are listed below:

1. Bilirubin (Total): <2 mg/dL (<34.2 μmol/L) = +1 point, 2-3 mg/dL (34.2-51.3 μmol/L) = +2 points, >3 mg/dL (>51.3 μmol/L) = +3 points
2. Albumin: >3.5 g/dL (>35 g/L) = +1 point, 2.8-3.5 g/dL (28-35 g/L) = +2 points, <2.8 g/dL (<28 g/L) = +3 points
3. INR: <1.7 = +1 point, 1.7-2.3 = +2 points, >2.3 = +3 points
4. Ascites: Absent = +1 point, Slight = +2 points, Moderate = +3 points
5. Encephalopathy: No Encephalopathy = +1 point, Grade 1-2 = +2 points, Grade 3-4 = +3 points 
(Grade 0: normal consciousness, personality, neurological examination, electroencephalogram
Grade 1: restless, sleep disturbed, irritable/agitated, tremor, impaired handwriting, 5 cps waves
Grade 2: lethargic, time-disoriented, inappropriate, asterixis, ataxia, slow triphasic waves
Grade 3: somnolent, stuporous, place-disoriented, hyperactive reflexes, rigidity, slower waves
Grade 4: unrousable coma, no personality/behavior, decerebrate, slow 2-3 cps delta activity)

The Child-Pugh Score is calculated by summing the points for each criterion.

The current child pugh score is 0.
The patient's INR is 1.45. Because the INR is less than 1.7, we add 1 to the score, making the current total 0 + 1 = 1.
The concentration of bilirubin is 0.73 mg/dL. Because the bilirubin concentration is less than 2 mg/dL, we add 1 to the score, making the current total 1 + 1 = 2.
The concentration of albumin is 3.0 g/dL. Because the albumin concentration is between 2.8 g/dL and 3.5 g/dL, we add 2 points to the score, making the current total 2 + 2 = 4.
The patient's ascites state is determined to be 'moderate' and so we add 3 points to the score, making the current total 4 + 3 = 7.
The patient is determined to not have any encephalopathy and so we add one point to the score, making the current total 7 + 1 = 8.
The patient's child pugh score is 8."
220,15,Child-Pugh Score for Cirrhosis Mortality,severity,integer,pmc-2729905-1,Extracted,"A 9-yr-old girl was admitted to Eul-Ji Hospital because of jaundice and right upper quadrant pain. Her height was 135 cm (75-90 percentile), and weight was 43 kg (over 97 percentile). The sclera was icteric, and the liver edge descended 4 cm below the right costal margin. The results of laboratory studies were as follows: aspartate aminotransferanse (AST) 1,106 IU/L, alanine aminotransferase (ALT) 1,888 IU/L, total bilirubin 25.7 mg/dL, direct bilirubin 18.2 mg/dL, total protein 6.9 g/dL, albumin 4.2 g/dL, serum alkaline phosphatase 1,160 IU/L, GGTP 71 IU/L, INR 2.4, aPTT >120 sec, antinuclear antibody (ANA) (+) speckled pattern, with 1:320 titer, anti-smooth muscle antibody (Ab) (-), anti-mitochondrial (AMA Ab) (-), IgG 1,397 mg/dL, anti-HAV IgM (-), anti-HBc IgM (-), HbsAg (-), EBV-VCA IgG/M (-/-), and ceruloplasmin 28 mg/dL. Liver biopsy results showed piecemeal necrosis at the portal-lobular interface accompaning mild to moderate infiltration of lymphocytes, moderate centrilobular cholestasis, moderate lobular inflammation, and moderate fibrosis (). According to the scoring system of International Autoimmune Hepatitis Group (), she had definite autoimmune hepatitis (score=16). Initially, on 40 mg of PD and 300 mg of UDCA daily, she gradually recovered both clinically and biochemically. PD was tapered gradually, and three months later, she was taking 15 mg of PD and 300 mg of UDCA daily. At eight months, her aminotransferase level had elevated to 400 IU/L, but reduced rapidly when PD was increased to 40 mg/day. At nine months, she was taking 15 mg/day of PD and 300 mg/day of UDCA, but she complained of hirsutism, striae, moon face, and buffalo hump, at ten months. The results of a second round of laboratory studies conducted at this time were; AST 21 IU/L, ALT 52 IU/L, total bilirubin 0.7 mg/dL, total protein 7.2 g/dL, albumin 4.7 g/dL, glucose 86 mg/dL, ANA (+) speckled pattern, with 1:160 titer. Accordingly, deflazacort (Calcort®, HanDok Pharm Co., Ltd, Eumseonggoon, Chungcheongbuk-do, Korea) was administered at dose of 18 mg a day, instead of PD at dose of 18 mg a day, and UDCA was continued. Her biochemical test remained within normal ranges on this regimen, and the PD-associated complications improved rapidly. Fourteen months later, deflazacort was reduced at dose of 15 mg a day, and after 19 months of deflazacort treatment, a follow-up liver biopsy was performed. This showed no lobular activity, no portal activity, near-normal periportal inflammation, and fibrosis (). ANA testing at this time also yielded a negative result (). Deflazacort was discontinued after 25 months and UDCA was discontinued a few months after this. The girl has been in clinical and biochemical remission for two years now, without therapy.",What is the patient's Child-Pugh Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'international normalized ratio': 2.4, 'Ascites': 'absent', 'Albumin': [4.2, 'g/dL'], 'Bilirubin': [18.2, 'mg/dL'], 'Encephalopathy': 'No Encephalopathy'}",9,9,9,"The criteria for the Child-Pugh Score are listed below:

1. Bilirubin (Total): <2 mg/dL (<34.2 μmol/L) = +1 point, 2-3 mg/dL (34.2-51.3 μmol/L) = +2 points, >3 mg/dL (>51.3 μmol/L) = +3 points
2. Albumin: >3.5 g/dL (>35 g/L) = +1 point, 2.8-3.5 g/dL (28-35 g/L) = +2 points, <2.8 g/dL (<28 g/L) = +3 points
3. INR: <1.7 = +1 point, 1.7-2.3 = +2 points, >2.3 = +3 points
4. Ascites: Absent = +1 point, Slight = +2 points, Moderate = +3 points
5. Encephalopathy: No Encephalopathy = +1 point, Grade 1-2 = +2 points, Grade 3-4 = +3 points 
(Grade 0: normal consciousness, personality, neurological examination, electroencephalogram
Grade 1: restless, sleep disturbed, irritable/agitated, tremor, impaired handwriting, 5 cps waves
Grade 2: lethargic, time-disoriented, inappropriate, asterixis, ataxia, slow triphasic waves
Grade 3: somnolent, stuporous, place-disoriented, hyperactive reflexes, rigidity, slower waves
Grade 4: unrousable coma, no personality/behavior, decerebrate, slow 2-3 cps delta activity)

The Child-Pugh Score is calculated by summing the points for each criterion.

The current child pugh score is 0.
The patient's INR is 2.4. Because the INR is greater than 2.3, we add three to the score, making the current total 0 + 3 = 3.
The concentration of bilirubin is 18.2 mg/dL. Because the bilirubin concentration is greater than 3 mg/dL, we add 3 to the score, making the current total 3 + 3 = 6.
The concentration of albumin is 4.2 g/dL. Because the albumin concentration is greater than 3.5 g/dL, we add 1 point to the score, making the current total 6 + 1 = 7.
The patient's ascites state is determined to be 'absent' and so we add 1 point to the score, making the current total 7 + 1 = 8.
The patient is determined to not have any encephalopathy and so we add one point to the score, making the current total 8 + 1 = 9.
The patient's child pugh score is 9."
221,16,Wells' Criteria for DVT,risk,integer,pmc-5295552-1,Extracted,"A 63-year-old male was admitted after sustaining an ST-elevation myocardial infarction (STEMI) just 10 days ago. Cardiovascular risk factors included diabetes mellitus type 2, hypertension, hyperlipidemia and smoking. Despite aggressive medical therapy, frequent rest angina and short of breath recurred at the time of admission to our hospital. Physical examination revealed fine wet rales in the bottom part of the lung. Laboratory values showed troponin I (TnI) of 1.17 ng/mL (normal range 0 - 0.05 ng/mL), low-density lipoprotein cholesterol of 4.6 mmol/L, creatinine of 93 μmol/L, fasting plasma glucose of 9.64 mmol/L, hemoglobin A1c (HbA1c) of 6.7%, and brain natriuretic peptide (BNP) of 1,958.5 pg/mL (normal range 0 - 125 pg/mL). Electrocardiogram (ECG) demonstrated normal sinus rhythm and anterior precordial leads ST-segment elevation and T waves inversion (). An echocardiogram revealed an enlarged left ventricular cavity (left ventricular end-diastolic dimension 61 mm, left ventricular end-systolic dimension 42 mm) and a nearly normal left ventricular ejection fraction (LVEF) of 53% with segmental wall-motion abnormalities: hypokinesis in anterior wall and the septum. The diagnosis of subacute anterior STEMI was made based on the history and clinical examination. Cardiac catheterization revealed a subtotal occlusion in the proximal and middle part of left anterior descending coronary artery (LAD), mild stenosis in the left main coronary artery (LM) () and diffuse lesion in the proximal and 85% stenosis in the distal part of right coronary artery (RCA) (). According to the patient’s SYNTAX score of 22, we decided to perform PCI for these lesions.
After predilation with 1.5 × 15 mm and 2.0 × 20 mm Ryujin balloons (Terumo, Tokyo, Japan), two sirolimus-eluting stents (SES) were implanted successfully: Firebird (MicroPort Medical, Shanghai, China) 2.75 × 23 mm in middle LAD and Excel (JW Medical, Shandong, China) 3.0 × 24 mm in the proximal LAD (2 to 3-mm overlap at the ends). Post-dilation was performed with a non-compliance 3.0 × 24 mm Maverick Quantum balloon (Boston Scientific, Boston, MA). TIMI-3 flow was noted and no significant residual stenosis remained (). After the procedure, daily oral DAPT of clopidogrel 75 mg and aspirin (ASA) 300 mg were prescribed. Glycoprotein IIb/IIIa receptor antagonist tirofiban was initially given as rapid intravenous infusion at a rate of 0.4 μg/kg/min for 30 min. Upon completion of the initial infusion, the rate is decreased to 0.15 μg/kg/min delivered as continuous infusion for about 36 h.
Approximately 2 h after the end of tirofiban administration, the patient developed severe chest pain and T-wave pseudonormalization in the anterior leads on ECG. He was immediately moved to the catheterization lab for repeat coronary angiography (CAG) and ST was found in LAD (). In consideration of the possibility of a dissection at the proximal stent edge (), an additional SES of Partner 3.0 × 21 mm (Lepu Medical, Beijing, China) was deployed, overlapping the previous proximal stent edge, with an excellent final result (). Then, Partner 4.0 × 15 mm (Lepu Medical, Beijing, China) and Taxus 4.0 × 38 mm (Boston Scientific, Natick, MA) were implanted in the distal and proximal segment of RCA, respectively (). The patient’s clopidogrel dose was increased to 75 mg twice a day because he was found to be hyporesponsive to clopidogrel when tested for adenosine diphosphate (ADP)-induced platelet aggregation utilizing with light transmission aggregometry (LTA). He did not taking any drugs that could deteriorate the platelet function, including proton pump inhibitor. Tirofiban was given as continuous infusion for about 72 h. The patient had an uneventful recovery in the following 5 days.
Unfortunately, the patient again underwent severe chest pain in the sixth day after the second PCI, and the ECG showed ST-segment elevation in V1-V5 leads (). Misgiving about the uncertainty of the reason for recurrent ST, surgeons refused to perform coronary artery bypass grafting (CABG). After failure of initial thrombolytic therapy, he underwent emergent salvage angiography by a different interventionalist. Emergency CAG showed total occlusion of the mid-LAD due to ST (). Thrombi were aspirated with the Diver CE aspiration catheter (Invatec, Brescia, Italy). Intravascular ultrasound (IVUS) revealed inadequate stent expansion due to elastic recoil (). This was repaired by repeated high-pressure post-dilation with 3.0 × 12 mm and 3.5 × 15 mm NC Sprinter balloons (Medtronic, Minneapolis, MN) (). Despite the double dose of clopidogrel therapy, ADP-induced platelet aggregation showed that she was still hyporesponsive to clopidogrel. The patient had an uncomplicated recovery and was discharged 1 week later with triple anti-platelet therapy (aspirin 300 mg qd, clopidogrel 75 mg bid, and cilostazol 100 mg bid).
The patient’s chest pain recurred again 6 days thereafter. Repeat emergent CAG revealed patent RCA stents and total occlusion of the mid-LAD due to ST (). Surgeons still refused to perform CABG for this patient. Diver CE aspiration catheter (Invatec, Brescia, Italy) was used again. Given the possibility of a dissection at the distal stent edge (), we deployed another SES of Firebird (MicroPort Medical, Shanghai, China) 2.5 × 29 mm in distal-LAD, overlapping the previous distal stent edge. The final result revealed no residual stenosis or dissection and excellent TIMI-3 flow (). Upon completion of continuous infusion of tirofiban for about 7 days, the patient was discharged. He was hemodynamically stable and symptom-free at the time of discharge. Echocardiogram revealed a decreased LVEF of 48%. Laboratory retest showed low-density lipoprotein cholesterol of 1.6 mmol/L, creatinine of 96 μmol/L, and fasting plasma glucose of 6.02 mmol/L. Although the patient has complied strictly with the triple anti-platelet therapy (aspirin 300 mg qd, clopidogrel 75 mg bid, and cilostazol 100 mg bid), ADP-induced platelet aggregation showed that she was still hyporesponsive to clopidogrel. Given the very complicated recent course, no further interventions were undertaken. Fortunately, the patient has been symptom-free at follow-ups.",What is the patient's score of Wells' criteria for Deep Vein Thrombosis? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Alternative diagnosis to Deep Vein Thrombosis as likely or more likely': True, 'Localized tenderness along the deep venous system': False, 'Major surgery within 12 weeks': True, 'Bedridden recently >3 days': True}",-1,-1,-1,"The criteria for the Wells' Criteria for Deep Vein Thrombosis (DVT) score are listed below:

1. Active cancer (treatment or palliation within 6 months): No = 0 points, Yes = +1 point
2. Bedridden recently >3 days or major surgery within 12 weeks: No = 0 points, Yes = +1 point
3. Calf swelling >3 cm compared to the other leg (measured 10 cm below tibial tuberosity): No = 0 points, Yes = +1 point
4. Collateral (nonvaricose) superficial veins present: No = 0 points, Yes = +1 point
5. Entire leg swollen: No = 0 points, Yes = +1 point
6. Localized tenderness along the deep venous system: No = 0 points, Yes = +1 point
7. Pitting edema, confined to symptomatic leg: No = 0 points, Yes = +1 point
8. Paralysis, paresis, or recent plaster immobilization of the lower extremity: No = 0 points, Yes = +1 point
9. Previously documented DVT: No = 0 points, Yes = +1 point
10. Alternative diagnosis to DVT as likely or more likely: No = 0 points, Yes = -2 points

The total score is calculated by summing the points for each criterion.
    
The current Well's DVT Score is 0.
The issue,'active cancer,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
From the patient's note, the criterion, 'bedridden recently >3 days,' is present. From the patient's note, the criterion, 'major surgery within 12 weeks,' is present. Based on the Well's DVT rule, at least one of the criteria, 'bedridden recently >3 days' or 'major surgery within 12 weeks' must be true for this criteria to be met for the score to increase by 1. Because this is the case, we incease the score by one making the total 0 + 1 = 1.
The issue,'calf swelling >3 cm compared to the other leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'collateral (nonvaricose) superficial veins present,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'entire leg swollen,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
From the patient's note, the criterion, 'localized tenderness along the deep venous system,' is absent. Hence, a point should not be given, and so total remains at 1.
The issue,'pitting edema, confined to symptomatic leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'paralysis, paresis, or recent plaster immobilization of the lower extremity,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'previously documented DVT,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
From the patient's note, the criterion, 'alternative diagnosis to DVT as likely or more likely,' is present. Hence, we decrease the score by 2 and so total is 1 - 2 = -1.
The Well's DVT score for the patient is -1."
222,16,Wells' Criteria for DVT,risk,integer,pmc-6959932-1,Extracted,"A 12-year-old girl received treatment in a maternal and child care service center on April 08, 2017 for frequent abdominal pain and diarrhea with a little blood. A diagnosis of bacterial infection was suspected and she was administered oral antibiotics like amoxicillin. Symptoms grew progressively worsen over time. Five days later, she was admitted to the same hospital for repeated fever and headache as well as bloody purulent stools. After treatment with cephalosporin, symptoms improved. Six days after admission, she presented a sudden left-sided hemiparesis and numbness, accompanied by intermittent convulsion. Urgent computed tomography (CT) showed an area of low density in the right frontal lobe. A further magnetic resonance imaging (MRI) showed an abnormal signal in the right frontal and left temporal area. Magnetic resonance venogram (MRV) showed the left venous sinus were not visualize with collateral circulation extensiveness formation. Electrocardiogram showed frequent ventricular premature beat. Abdominal ultrasonography revealed thrombus formation in the superior mesenteric arterial hypoechoic. A diagnosis of cerebral infarction was highly suspected. After reducing intracranial pressure and anticoagulant therapy, no improvement was found with her consciousness and hemiparesis, so she was transferred to our hospital on April 25, 2017.
On admission, she was moderately emaciated, hypotensive, and her body temperature was 37.8 °C. She did not have any vascular risk factor. Her personal and family history was normal besides. Neurological examination revealed hemiplegia with a positive Babinski sign on left side.
Biochemical tests revealed hyperleukocytosis (17.4 × 109/L), moderate anemia (hemoglobin, 88 g/L, hematocrit, 27.8%), hypoalbuminemia (albumin, 30.4 g/L), and elevated levels of C-reactive protein and procalcitonin. A coagulation test revealed an elevation of D-Dimer. Antinuclear antibodies, including anticardiolipin, antinuclear antibody, antismooth muscle antibodies, antineutrophil cytoplasm antibody, and rheumatoid factor were negative. A thrombophilia workup including anticardiolipin, antiphospholipid antibodies, homocysteine, antithrombin was performed and showed normal results.
After admission, due to severe hematochezia, colonoscopy was unable to perform to determine the cause. At that time the patient was only placed on omeprazole (20 mg QD) for protecting gastrointestinal mucosa. In surprise, symptoms of hematochezia disappeared when treated with frozen plasma and erythrocytes transfusion. The anticoagulation therapy with low-molecular-weight heparin (LMWH; 4000 IU BID) was started, and DSA was performed followed, which confirmed multiple thrombosis of the superior sagittal sinus with secondary hemorrhage (Fig. A). Interventional therapy with guide wire was administered simultaneously (Fig. B–D). After operation, the patient was treated with Warfarin Sodium Tablets (2.5 mg QD) and LMWH. CT scan (Fig. ) in 10 days demonstrated a residual left-sided forntal infarction. Twenty days after admission a follow-up MR venography showed partial recanalization of superior sagittal sinus, a filling defect of left sigmoid, and underdevelopment of left transverse sinus (Fig. A–B). MRI (Fig. ) at the same time showed infarctions in the left frontal and temporal lobes. Five days later, with clinical improvement, she was discharged home. She switched to Warfarin Sodium Tablets (2.5 mg QD) only which was withdrawn after a few days with no other recurrent strokes and a slow improvement of her neurological condition.
The patient received another hospitalization for recurrence after 1 year and a colonoscopy was taken (Fig. ), then ulcerative colitis was confirmed. A follow-up MR venography showed a similar situation as before (Fig. C). At that time she achieved a complete recovery of limb functions and did not present any other stroke recurrences.",What is the patient's score of Wells' criteria for Deep Vein Thrombosis? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Alternative diagnosis to Deep Vein Thrombosis as likely or more likely': True, 'Bedridden recently >3 days': True, 'Collateral (nonvaricose) superficial veins present': True, 'Paralysis, paresis, or recent plaster immobilization of the lower extremity': True}",1,1,1,"The criteria for the Wells' Criteria for Deep Vein Thrombosis (DVT) score are listed below:

1. Active cancer (treatment or palliation within 6 months): No = 0 points, Yes = +1 point
2. Bedridden recently >3 days or major surgery within 12 weeks: No = 0 points, Yes = +1 point
3. Calf swelling >3 cm compared to the other leg (measured 10 cm below tibial tuberosity): No = 0 points, Yes = +1 point
4. Collateral (nonvaricose) superficial veins present: No = 0 points, Yes = +1 point
5. Entire leg swollen: No = 0 points, Yes = +1 point
6. Localized tenderness along the deep venous system: No = 0 points, Yes = +1 point
7. Pitting edema, confined to symptomatic leg: No = 0 points, Yes = +1 point
8. Paralysis, paresis, or recent plaster immobilization of the lower extremity: No = 0 points, Yes = +1 point
9. Previously documented DVT: No = 0 points, Yes = +1 point
10. Alternative diagnosis to DVT as likely or more likely: No = 0 points, Yes = -2 points

The total score is calculated by summing the points for each criterion.
    
The current Well's DVT Score is 0.
The issue,'active cancer,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
From the patient's note, the criterion, 'bedridden recently >3 days,' is present. The issue,'major surgery within 12 weeks,' is missing from the patient note and so the value is assumed to be absent from the patient. Based on the Well's DVT rule, at least one of the criteria, 'bedridden recently >3 days' or 'major surgery within 12 weeks' must be true for this criteria to be met for the score to increase by 1. Because this is the case, we incease the score by one making the total 0 + 1 = 1.
The issue,'calf swelling >3 cm compared to the other leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
From the patient's note, the criterion, 'collateral (nonvaricose) superficial veins present,' is present. Hence, a point should be given, and so we increment the score by one, making the the total 1 + 1 =  2.
The issue,'entire leg swollen,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 2.
The issue,'localized tenderness along the deep venous system,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 2.
The issue,'pitting edema, confined to symptomatic leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 2.
From the patient's note, the criterion, 'paralysis, paresis, or recent plaster immobilization of the lower extremity,' is present. Hence, a point should be given, and so we increment the score by one, making the the total 2 + 1 =  3.
The issue,'previously documented DVT,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 3.
From the patient's note, the criterion, 'alternative diagnosis to DVT as likely or more likely,' is present. Hence, we decrease the score by 2 and so total is 3 - 2 = 1.
The Well's DVT score for the patient is 1."
223,16,Wells' Criteria for DVT,risk,integer,usmle-9119,Extracted,"A 68-year-old man presents with urinary retention for the past week. He says his symptoms onset gradually almost immediately after being prescribed a new medication for his depression. He states that he has increased his fluid intake to try to help the issue, but this has been ineffective. He also mentions that he has been having problems with constipation and dry mouth. His past medical history is significant for major depressive disorder, diagnosed 6 months ago. The patient denies any history of smoking, alcohol consumption, or recreational drug use. He is afebrile, and his vital signs are within normal limits. A physical examination is unremarkable. A urinalysis is normal.",What is the patient's score of Wells' criteria for Deep Vein Thrombosis? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,{'Alternative diagnosis to Deep Vein Thrombosis as likely or more likely': True},-2,-2,-2,"The criteria for the Wells' Criteria for Deep Vein Thrombosis (DVT) score are listed below:

1. Active cancer (treatment or palliation within 6 months): No = 0 points, Yes = +1 point
2. Bedridden recently >3 days or major surgery within 12 weeks: No = 0 points, Yes = +1 point
3. Calf swelling >3 cm compared to the other leg (measured 10 cm below tibial tuberosity): No = 0 points, Yes = +1 point
4. Collateral (nonvaricose) superficial veins present: No = 0 points, Yes = +1 point
5. Entire leg swollen: No = 0 points, Yes = +1 point
6. Localized tenderness along the deep venous system: No = 0 points, Yes = +1 point
7. Pitting edema, confined to symptomatic leg: No = 0 points, Yes = +1 point
8. Paralysis, paresis, or recent plaster immobilization of the lower extremity: No = 0 points, Yes = +1 point
9. Previously documented DVT: No = 0 points, Yes = +1 point
10. Alternative diagnosis to DVT as likely or more likely: No = 0 points, Yes = -2 points

The total score is calculated by summing the points for each criterion.
    
The current Well's DVT Score is 0.
The issue,'active cancer,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'bedridden recently >3 days,' is missing from the patient note and so the value is assumed to be absent from the patient. The issue,'major surgery within 12 weeks,' is missing from the patient note and so the value is assumed to be absent from the patient. Based on the Well's DVT rule, at least one of the criteria, 'bedridden recently >3 days' or 'major surgery within 12 weeks' must be true for this criteria to be met for the score to increase by 1. This is not the case for this patient, and so the score remains unchanged at 0.
The issue,'calf swelling >3 cm compared to the other leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'collateral (nonvaricose) superficial veins present,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'entire leg swollen,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'localized tenderness along the deep venous system,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'pitting edema, confined to symptomatic leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'paralysis, paresis, or recent plaster immobilization of the lower extremity,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'previously documented DVT,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
From the patient's note, the criterion, 'alternative diagnosis to DVT as likely or more likely,' is present. Hence, we decrease the score by 2 and so total is 0 - 2 = -2.
The Well's DVT score for the patient is -2."
224,16,Wells' Criteria for DVT,risk,integer,pmc-4341247-1,Extracted,"A 27-year-old man from Yasuj (central part of Iran) was hospitalized from 5th to 18th of March 2012 in surgery ward of Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran, due to intermittent episodes of acute lower extremity arterial thrombosis. Symptoms initiated three days prior to admission with a severe abrupt-onset entire left lower extremity pain and claudication not relieved by analgesics. He had a 10 pack-year history of cigarette smoking and a multipartner sexual relationship. Otherwise, his medical history showed a healthy young man up to the present illness. The patient’s family history was unremarkable for thrombophilia. In physical examination, he was afebrile with a good general appearance and his blood pressure, pulse rate and respiratory rate were 120/80 mmHg, 100 bpm and 16/min, respectively. His left lower extremity was cold from knee down and bluish discoloration of digits was noted.
Left femoral artery pulse was undetectable as well as its subsequent branches. Sensory and motor functions of the entire left lower extremity were intact. Other parts of physical examination had normal findings except for an oral aphthous lesion and a healing genital ulcer with a negative Pathergy test. Color-Doppler sonography of the left lower extremity arteries revealed a thrombus in the left common iliac artery, 5 cm in length, initiating from the abdominal aorta bifurcation. Trivial blood flow in the common iliac artery and decreased blood flow in the lower branches were found, so that the blood flow velocity was 27 cm/sec in the left common femoral artery compared to 58 cm/sec velocity of the normal opposite side. Evaluation of distal arteries including anterior and posterior tibialis arteries demonstrated a complete thrombosis in the lower halves of both with no blood flow. Anticoagulant therapy was promptly initiated and Fogarty catheter was inserted for proximal thrombectomy. After the operation, the patient’s end extremity was warm and he felt no pain anymore. Weak pulses of both dorsalis pedis and posterior tibialis arteries were also detectable. Forty-eight hours later, the patient developed another episode of cold end extremity and pulselessness in the same limb. In color-doppler sonography, despite establishment of triphasic blood flow of the left lower extremity arteries up to midpart of distal arteries, no flow was detected in the distal halves of anterior and posterior tibialis arteries due to an embolus/thrombus. Therefore, the patient underwent Fogarty insertion for thrombectomy again. After the second surgery, all previous symptoms and signs were removed and follow-up CT-angiography revealed normal course and caliber of all the arteries of the left lower extremity with no evidence of collateral formation in favor of chronic vascular insufficiency. Meanwhile, to find out the reason of recurrent thromboembolic events in an otherwise healthy young man, an extensive work-up was performed. Lab investigation revealed a CBC with Hg of 16.7 g/dL, WBC of 7000/mm3 and platelet count of 179000/mm3. PT, INR and PTT were 13 seconds, 1 and 25 seconds, respectively. Lipid profile showed total cholesterol of 202 gr/dL, TG of 146 gr/dL, HDL-c of 37 gr/dL and LDL-c of 136 gr/dL. Serum levels of antiphospholipid-antibodies, anticardiolipin antibody (ACLA), P- and C-ANCA and anti-β2 glycoprotein IgM and IgG were all within the normal ranges. Liver function test showed no abnormality and viral markers for hepatitis B and C had negative results. Homocysteine level was normal and LDH was 445 IU/L. Coagulation factor assay revealed no abnormal findings and results were not in favor of protein C/S or antithrombin deficiency. Investigations showed no factor V Leiden gene mutation. Other blood tests had normal findings. Regarding proximal involvement of lower extremity arteries, abdomen pelvic sonography, helical chest and abdomenopelvic CT-scan demonstrated no mass, organomegally or the third space fluid collection. EKG (electrocardiography) and trans esophageal echocardiography (TEE) excluded any cardiogenic source of emboli. Ultimately, we found a reactive HIV Ab ELISA with the same result in repetition. Western blot test confirmed the diagnosis of HIV infection. The patient was then discharged with antiplatelet and anticoagulant and referred to a HIV center to receive medical support. In outpatient follow-up, endogenous anticoagulants were rechecked two weeks after the acute phase with all results within the normal limits.",What is the patient's score of Wells' criteria for Deep Vein Thrombosis? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Alternative diagnosis to Deep Vein Thrombosis as likely or more likely': True, 'Paralysis, paresis, or recent plaster immobilization of the lower extremity': False, 'Bedridden recently >3 days': True, 'Major surgery within 12 weeks': False}",-1,-1,-1,"The criteria for the Wells' Criteria for Deep Vein Thrombosis (DVT) score are listed below:

1. Active cancer (treatment or palliation within 6 months): No = 0 points, Yes = +1 point
2. Bedridden recently >3 days or major surgery within 12 weeks: No = 0 points, Yes = +1 point
3. Calf swelling >3 cm compared to the other leg (measured 10 cm below tibial tuberosity): No = 0 points, Yes = +1 point
4. Collateral (nonvaricose) superficial veins present: No = 0 points, Yes = +1 point
5. Entire leg swollen: No = 0 points, Yes = +1 point
6. Localized tenderness along the deep venous system: No = 0 points, Yes = +1 point
7. Pitting edema, confined to symptomatic leg: No = 0 points, Yes = +1 point
8. Paralysis, paresis, or recent plaster immobilization of the lower extremity: No = 0 points, Yes = +1 point
9. Previously documented DVT: No = 0 points, Yes = +1 point
10. Alternative diagnosis to DVT as likely or more likely: No = 0 points, Yes = -2 points

The total score is calculated by summing the points for each criterion.
    
The current Well's DVT Score is 0.
The issue,'active cancer,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
From the patient's note, the criterion, 'bedridden recently >3 days,' is present. From the patient's note, the criterion, 'major surgery within 12 weeks,' is absent. Based on the Well's DVT rule, at least one of the criteria, 'bedridden recently >3 days' or 'major surgery within 12 weeks' must be true for this criteria to be met for the score to increase by 1. Because this is the case, we incease the score by one making the total 0 + 1 = 1.
The issue,'calf swelling >3 cm compared to the other leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'collateral (nonvaricose) superficial veins present,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'entire leg swollen,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'localized tenderness along the deep venous system,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'pitting edema, confined to symptomatic leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
From the patient's note, the criterion, 'paralysis, paresis, or recent plaster immobilization of the lower extremity,' is absent. Hence, a point should not be given, and so total remains at 1.
The issue,'previously documented DVT,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
From the patient's note, the criterion, 'alternative diagnosis to DVT as likely or more likely,' is present. Hence, we decrease the score by 2 and so total is 1 - 2 = -1.
The Well's DVT score for the patient is -1."
225,16,Wells' Criteria for DVT,risk,integer,pmc-3334262-1,Extracted,"A 17-year-old male was seen in the emergency department with 10-year history of abdominal colic which is relieved by vomiting, along with dehydration. There was no history of constipation over preceding few weeks. The patient had been vomiting on most morning with nausea persisting through the day. He had lost 2 kg in weight over previous 6 months. There was no history of jaundice, fever, steatorrhea, or bleeding per rectum. There was no other significant medical or surgical history.
The patient had been treated with proton pump inhibitors, prokinetic agents by general practitioners, without any relief. His ultrasound examination and standing X-ray of abdomen had not shown any abnormality.
Physical examination was normal except minimal abdominal tenderness in epigastric, right hypochondriac region along with mild dehydration. His liver function tests, renal function tests, amylase, hemogram, and urinalysis were normal. Upper GI endoscopy was normal. A chest radiograph did not reveal air under the diaphragm.
CT abdomen with contrast was done. In the study stomach and duodenum appeared connected to small intestine seen on right side giving a whirlpool appearance due to rotation of gut around the superior mesenteric artery. Superior mesenteric vein was seen on left of superior mesenteric artery [Figures and ]. Further distal bowel loops appeared collapsed. Thus the diagnosis of midgut malrotation with partial obstruction was confirmed.
Surgical referral was made; he was treated with four-port laparoscopic Ladd's procedure. The ceacum was situated high with peritoneal bands passing across the duodenum. The peritoneum to the right of the ascending colon and caecum was incised and the anteriorly situated bands were stripped to free the duodenum. The colon was placed to the left of the abdomen.
He was discharged within 2 days eating a normal diet and made a good postoperative recovery. At 3 months he was gaining weight and had no further vomiting.",What is the patient's score of Wells' criteria for Deep Vein Thrombosis? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Alternative diagnosis to Deep Vein Thrombosis as likely or more likely': True, 'Major surgery within 12 weeks': False}",-2,-2,-2,"The criteria for the Wells' Criteria for Deep Vein Thrombosis (DVT) score are listed below:

1. Active cancer (treatment or palliation within 6 months): No = 0 points, Yes = +1 point
2. Bedridden recently >3 days or major surgery within 12 weeks: No = 0 points, Yes = +1 point
3. Calf swelling >3 cm compared to the other leg (measured 10 cm below tibial tuberosity): No = 0 points, Yes = +1 point
4. Collateral (nonvaricose) superficial veins present: No = 0 points, Yes = +1 point
5. Entire leg swollen: No = 0 points, Yes = +1 point
6. Localized tenderness along the deep venous system: No = 0 points, Yes = +1 point
7. Pitting edema, confined to symptomatic leg: No = 0 points, Yes = +1 point
8. Paralysis, paresis, or recent plaster immobilization of the lower extremity: No = 0 points, Yes = +1 point
9. Previously documented DVT: No = 0 points, Yes = +1 point
10. Alternative diagnosis to DVT as likely or more likely: No = 0 points, Yes = -2 points

The total score is calculated by summing the points for each criterion.
    
The current Well's DVT Score is 0.
The issue,'active cancer,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'bedridden recently >3 days,' is missing from the patient note and so the value is assumed to be absent from the patient. From the patient's note, the criterion, 'major surgery within 12 weeks,' is absent. Based on the Well's DVT rule, at least one of the criteria, 'bedridden recently >3 days' or 'major surgery within 12 weeks' must be true for this criteria to be met for the score to increase by 1. This is not the case for this patient, and so the score remains unchanged at 0.
The issue,'calf swelling >3 cm compared to the other leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'collateral (nonvaricose) superficial veins present,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'entire leg swollen,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'localized tenderness along the deep venous system,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'pitting edema, confined to symptomatic leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'paralysis, paresis, or recent plaster immobilization of the lower extremity,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'previously documented DVT,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
From the patient's note, the criterion, 'alternative diagnosis to DVT as likely or more likely,' is present. Hence, we decrease the score by 2 and so total is 0 - 2 = -2.
The Well's DVT score for the patient is -2."
226,16,Wells' Criteria for DVT,risk,integer,pmc-6180957-1,Extracted,"A 66-year-old Caucasian woman with past medical history of dermatomyositis, dysphagia, gastro-esophageal reflux, and hypertension presented to the emergency department (ED) with several days of mid-epigastric, constant, moderate intensity, nonradiating abdominal pain. Additionally, she reported 4-5 days of erythematous rash that began on her face and chest that then spread to her arms and abdomen (Figures -). She also reported white “spots” in her mouth. At that time, CBC, CRP, ESR, CK, and UA were within normal limits. Lipase was 675 U/L and CMP was remarkable for sodium 129 mEq/L, amino alanine transferase (ALT) 158 U/L, and aspartate aminotransferase (AST) 111 U/L; the rest of the CMP including alkaline phosphatase (ALP) was normal. CXR was normal and abdominal radiograph showed evidence of constipation. An abdominal ultrasound was ordered due to elevated lipase and LFTs and showed no evidence of gallbladder dysfunction or liver lesions. She was diagnosed with pancreatitis, thrush, and folliculitis and was discharged home with clear liquid diet orders and prescriptions for nystatin oral solution and oral doxycycline for possible secondary skin infection. Two days later, she returned to the ED with persistent symptoms and decreased urine output. She reported nausea, constipation, and worsened dysphagia, but denied vomiting, weight change, night sweats, fever, chills, chest pain, cough, and shortness of breath. She also denied pertinent past surgeries, family history, recent travel, sexual activity, drug use, and alcohol and tobacco use. She reported allergy to penicillin. Her medication list included prednisone, mycophenolate mofetil (which she held since previous ED visit per doctor recommendations), trimethoprim/sulfamethoxazole (T/S), nystatin oral suspension, carvedilol, ranitidine, estradiol, calcium, and vitamin D. She was told by her dermatologist not to fill the doxycycline prescription from the ED and increase the dose of T/S.
On physical examination, the patient was alert and oriented with normal vital signs. The exam was significant for oral thrush, but normal heart, lung, and abdominal exams. Skin exam showed a diffuse maculopapular eruption with a few vesicles on face, trunk, and extremities. Significant laboratory data was as follows: AST 1389 U/L, ALT 1570 U/L, ALP 68 U/L, international normalized ratio (INR) 1.6, and prothrombin time (PT) 18 seconds. Complete abdominal ultrasound demonstrated normal gallbladder without stones, no biliary ductal dilation, no focal liver lesions, and no ascites or abnormal fluid collections. The patient's dermatologist had performed skin biopsies 2 days prior to admission that showed multinucleated giant cells with viral inclusions suggestive of some type of herpes virus infection (Figures –). The patient was initiated on intravenous (IV) acyclovir, micafungin, vancomycin, aztreonam, and stress dose steroids for presumed disseminated herpes simplex with possible secondary bacterial infection and sepsis. Over the subsequent 48-72 hours, AST and ALT increased to the 4000s, INR increased to 1.8 and PT to 20.6. Due to worsening acute liver failure, she was transferred to our facility for liver transplant evaluation.
On arrival to our hospital, her skin lesions were thought to be most consistent with VZV and skin biopsy cultures from the outpatient dermatologist later confirmed VZV. IV acyclovir and antibiotics for secondary bacterial sepsis were continued. As part of her liver transplant evaluation, extensive serologic investigation ensued. Acute hepatitis A-E serologies, ANA, IgG4, smooth muscle antibody (Ab), LKM-1 Ab, ceruloplasmin, a-1 antitrypsin, mitochondrial M2 Ab, AFP, HIV, HSV and EBV PCRs, blood cultures, galactomannan, and cryptococcal antigen were submitted and later found to be negative. She was also found to be pANCA MPO positive and PR3 negative. Liver biopsy was performed which revealed multiple areas of necrotic hepatocytes (up to 35% of liver parenchyma) (Figures -) in zones 2 and 3 of the liver. This was associated with some bile extravasation and acute inflammation. No signs of bridging or confluent necrosis were seen. A trichrome stain outlined regions of immature deposition of collagen near necrotic areas. This stain also showed increased perivenular fibrosis around the central veins but no evidence of periportal fibrosis. The portal triads showed nominal chronic inflammation with small lymphocytes, rare large lymphocytes, and a few scattered neutrophils. There was no bile duct injury, paucity, or vasculitis. The hepatocytes did not demonstrate significant steatosis, but there was bile stasis in a few canalicular spaces and hepatocytes. Viral inclusions were not seen. An iron stain showed no accumulation of hemosiderin within the hepatocytes. PCR was negative for HSV, EBV, and CMV and positive for VZV. The necrosis also abutted portal triads seen in the specimens (). A Periodic acid-Schiff stain with diastase did not show cytoplasmic globules. Blood PCRs were positive with high levels of VZV and low levels of CMV. The CMV viremia was attributed to secondary reactivation due to her severely immunosuppressed state. VZV immune globulin was considered as therapy, but IVIG was administered instead due to her severe coagulopathy and thrombocytopenia. Outpatient skin biopsy cultures later confirmed VZV; PCR was positive for VZV and negative for HSV.
Her hospital stay was complicated by multidrug-resistant Enterobacter cloacae hospital acquired pneumonia and bacteremia, respiratory failure requiring prolonged intubation, and multiple organ failure. VZV PCR copies decreased with treatment, but her severity of illness and active infection prevented liver transplantation. The patient's code status was eventually changed to “do not resuscitate” and she expired.",What is the patient's score of Wells' criteria for Deep Vein Thrombosis? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Alternative diagnosis to Deep Vein Thrombosis as likely or more likely': True, 'Bedridden recently >3 days': False, 'Previously documented Deep Vein Thrombosis': False, 'Major surgery within 12 weeks': False}",-2,-2,-2,"The criteria for the Wells' Criteria for Deep Vein Thrombosis (DVT) score are listed below:

1. Active cancer (treatment or palliation within 6 months): No = 0 points, Yes = +1 point
2. Bedridden recently >3 days or major surgery within 12 weeks: No = 0 points, Yes = +1 point
3. Calf swelling >3 cm compared to the other leg (measured 10 cm below tibial tuberosity): No = 0 points, Yes = +1 point
4. Collateral (nonvaricose) superficial veins present: No = 0 points, Yes = +1 point
5. Entire leg swollen: No = 0 points, Yes = +1 point
6. Localized tenderness along the deep venous system: No = 0 points, Yes = +1 point
7. Pitting edema, confined to symptomatic leg: No = 0 points, Yes = +1 point
8. Paralysis, paresis, or recent plaster immobilization of the lower extremity: No = 0 points, Yes = +1 point
9. Previously documented DVT: No = 0 points, Yes = +1 point
10. Alternative diagnosis to DVT as likely or more likely: No = 0 points, Yes = -2 points

The total score is calculated by summing the points for each criterion.
    
The current Well's DVT Score is 0.
The issue,'active cancer,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
From the patient's note, the criterion, 'bedridden recently >3 days,' is absent. From the patient's note, the criterion, 'major surgery within 12 weeks,' is absent. Based on the Well's DVT rule, at least one of the criteria, 'bedridden recently >3 days' or 'major surgery within 12 weeks' must be true for this criteria to be met for the score to increase by 1. This is not the case for this patient, and so the score remains unchanged at 0.
The issue,'calf swelling >3 cm compared to the other leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'collateral (nonvaricose) superficial veins present,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'entire leg swollen,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'localized tenderness along the deep venous system,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'pitting edema, confined to symptomatic leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'paralysis, paresis, or recent plaster immobilization of the lower extremity,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'previously documented DVT,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
From the patient's note, the criterion, 'alternative diagnosis to DVT as likely or more likely,' is present. Hence, we decrease the score by 2 and so total is 0 - 2 = -2.
The Well's DVT score for the patient is -2."
227,16,Wells' Criteria for DVT,risk,integer,pmc-7059892-1,Extracted,"A 69-year-old male presented to his primary care physician with an 8-year history of a slow-growing large mass protruding from the right anal verge. The patient’s past medical history included a previous basal cell carcinoma, coronary artery disease, atrial fibrillation and diverticular disease. The patient had previously undergone colonoscopic investigation of diverticulosis and underwent polypectomy of the three colonic and one rectal tubular adenoma with low-grade dysplasia a year before. There was no past medical history of trauma to the perineal region or previous perineal procedures. On assessment of the patient at the colorectal unit, the mass originated from the skin of the anal verge and was not involving the anal canal. It was cylindrical in shape, was soft and fluctuant with no irregularities and did not display any overlying cutaneous features. Magnetic resonance imaging (MRI) was undertaken and demonstrated a thin-walled homogenous cystic structure arising in the intersphincteric plane measuring 7 cm × 5 cm × 5 cm (). The cyst was well defined with no invasive features and demonstrated high signal on T2-weighted imaging suggestive of a fluid-filled structure.
The cyst was examined under anaesthesia in the lithotomy position and was mobilized into the intersphincteric space and excised preserving the perianal skin (). The cyst was excised entirely and macroscopically appeared to be a thin-walled 8-cm long sac containing a yellow fluid. The resulting skin defect was closed with interrupted 2-0 vicryl dissolvable suture material. Histological analysis of the mass confirmed a large hybrid epidermal inclusion cyst ().",What is the patient's score of Wells' criteria for Deep Vein Thrombosis? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Alternative diagnosis to Deep Vein Thrombosis as likely or more likely': True, 'Active cancer': False, 'Previously documented Deep Vein Thrombosis': False}",-2,-2,-2,"The criteria for the Wells' Criteria for Deep Vein Thrombosis (DVT) score are listed below:

1. Active cancer (treatment or palliation within 6 months): No = 0 points, Yes = +1 point
2. Bedridden recently >3 days or major surgery within 12 weeks: No = 0 points, Yes = +1 point
3. Calf swelling >3 cm compared to the other leg (measured 10 cm below tibial tuberosity): No = 0 points, Yes = +1 point
4. Collateral (nonvaricose) superficial veins present: No = 0 points, Yes = +1 point
5. Entire leg swollen: No = 0 points, Yes = +1 point
6. Localized tenderness along the deep venous system: No = 0 points, Yes = +1 point
7. Pitting edema, confined to symptomatic leg: No = 0 points, Yes = +1 point
8. Paralysis, paresis, or recent plaster immobilization of the lower extremity: No = 0 points, Yes = +1 point
9. Previously documented DVT: No = 0 points, Yes = +1 point
10. Alternative diagnosis to DVT as likely or more likely: No = 0 points, Yes = -2 points

The total score is calculated by summing the points for each criterion.
    
The current Well's DVT Score is 0.
From the patient's note, the criterion, 'active cancer,' is absent. Hence, a point should not be given, and so total remains at 0.
The issue,'bedridden recently >3 days,' is missing from the patient note and so the value is assumed to be absent from the patient. The issue,'major surgery within 12 weeks,' is missing from the patient note and so the value is assumed to be absent from the patient. Based on the Well's DVT rule, at least one of the criteria, 'bedridden recently >3 days' or 'major surgery within 12 weeks' must be true for this criteria to be met for the score to increase by 1. This is not the case for this patient, and so the score remains unchanged at 0.
The issue,'calf swelling >3 cm compared to the other leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'collateral (nonvaricose) superficial veins present,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'entire leg swollen,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'localized tenderness along the deep venous system,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'pitting edema, confined to symptomatic leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'paralysis, paresis, or recent plaster immobilization of the lower extremity,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'previously documented DVT,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
From the patient's note, the criterion, 'alternative diagnosis to DVT as likely or more likely,' is present. Hence, we decrease the score by 2 and so total is 0 - 2 = -2.
The Well's DVT score for the patient is -2."
228,16,Wells' Criteria for DVT,risk,integer,pmc-4676672-1,Extracted,"A 78-year-old woman with Parkinson’s disease, cerebral lacunar infarction, and hyperlipidemia presented to the emergency department of our hospital with a chief complaint of fever and general weakness. The Eastern Cooperative Oncology Group performance status for this patient was grade 3.
She had developed a cough with fever 2 days before admission, followed by anorexia, altered mental status, and general weakness. She visited the local medical clinic for treatment, at which time her blood pressure was 70/40 mm Hg, and her body temperature was 38.5°C. She was immediately transferred to our Emergency Department for advanced care. In the emergency room, her blood pressure was 90/48 mm Hg, pulse rate was 88 beats per minute, respiratory rate was 20 breaths per minute, body temperature was 38.0°C, and oxygen saturation was 91% in room air. Her mental status was drowsy. She complained of mild abdominal pain and dyspnea. Physical examination revealed crackles over the left lower lung field. The abdomen was massively distended with reduced bowel sounds. Diffuse mild tenderness was noted in the entire abdomen.
The initial laboratory evaluation provided the following results: white blood cell count, 8,850 cells/mm3 (neutrophils, 90.3%); hemoglobin, 10.2 g/dL; hematocrit, 30.6%; platelet count, 182×103 cells/mm3; erythrocyte sedimentation rate, 42 mm/hr; C-reactive protein, 19.41 mg/dL; blood urea nitrogen, 78.9 mg/dL; procalcitonin, 3.75 mg/mL; and creatinine, 2.46 mg/dL. Arterial blood gas analysis showed a pH of 7.502, pCO2 of 22 mm Hg, pO2 of 63.5 mm Hg, HCO3 of 17.4 mmol/L, and SaO2 of 94.5% with oxygen at a rate of 2 L/min via a nasal cannula. A thorax computed tomography (CT) scan without contrast revealed pneumonic infiltration in the lower lobe of the left lung () and severe distension of the stomach from the upper abdomen to the pelvis without the presence of free air (). The blood culture did not show any growth.
She was diagnosed with acute gastric dilatation in the presence of pneumonia. Intravenous fluid replacement, intravenous infusion of empirical antibiotics (400 mg moxifloxacin and 2 g cefotaxime sodium) once every 24 hours, vasopressor administration, and oxygen supply via a nasal cannula were initiated. A nasogastric tube was inserted, and 4 L of a dark brown liquid was drained through the tube.
After the initial treatment, her vital signs became relatively stable and her mental status improved. The drainage volume of the liquid from the stomach gradually decreased. An esophagogastroduodenoscopy (EGD) was performed 24 hours after admission, and the remnant food and liquid material in the stomach (1,500 mL) was drained. EGD revealed acute gastric mucosal erosion, multiple gastric superficial ulcers, and the absence of gastric outlet obstruction, duodenal ulcers, or necrosis ().
Approximately 36 hours after admission, the patient suddenly complained of severe dyspnea, chest pain, and aggravated abdominal pain. Her blood pressure was 90/50 mm Hg; pulse rate, 106 beats per minute; oxygen saturation, 86%; and breathing oxygen, 10 L/min through a non-rebreather mask. We immediately performed a follow-up plain chest radiography, which revealed free air in both subphrenic spaces and pulmonary edema in both lung fields (). Her general condition worsened rapidly with a dramatic decrease in her mental condition and blood pressure along with aggravated dyspnea, which resulted in the death of the patient.",What is the patient's score of Wells' criteria for Deep Vein Thrombosis? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Alternative diagnosis to Deep Vein Thrombosis as likely or more likely': True, 'Localized tenderness along the deep venous system': False, 'Bedridden recently >3 days': False}",-2,-2,-2,"The criteria for the Wells' Criteria for Deep Vein Thrombosis (DVT) score are listed below:

1. Active cancer (treatment or palliation within 6 months): No = 0 points, Yes = +1 point
2. Bedridden recently >3 days or major surgery within 12 weeks: No = 0 points, Yes = +1 point
3. Calf swelling >3 cm compared to the other leg (measured 10 cm below tibial tuberosity): No = 0 points, Yes = +1 point
4. Collateral (nonvaricose) superficial veins present: No = 0 points, Yes = +1 point
5. Entire leg swollen: No = 0 points, Yes = +1 point
6. Localized tenderness along the deep venous system: No = 0 points, Yes = +1 point
7. Pitting edema, confined to symptomatic leg: No = 0 points, Yes = +1 point
8. Paralysis, paresis, or recent plaster immobilization of the lower extremity: No = 0 points, Yes = +1 point
9. Previously documented DVT: No = 0 points, Yes = +1 point
10. Alternative diagnosis to DVT as likely or more likely: No = 0 points, Yes = -2 points

The total score is calculated by summing the points for each criterion.
    
The current Well's DVT Score is 0.
The issue,'active cancer,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
From the patient's note, the criterion, 'bedridden recently >3 days,' is absent. The issue,'major surgery within 12 weeks,' is missing from the patient note and so the value is assumed to be absent from the patient. Based on the Well's DVT rule, at least one of the criteria, 'bedridden recently >3 days' or 'major surgery within 12 weeks' must be true for this criteria to be met for the score to increase by 1. This is not the case for this patient, and so the score remains unchanged at 0.
The issue,'calf swelling >3 cm compared to the other leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'collateral (nonvaricose) superficial veins present,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'entire leg swollen,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
From the patient's note, the criterion, 'localized tenderness along the deep venous system,' is absent. Hence, a point should not be given, and so total remains at 0.
The issue,'pitting edema, confined to symptomatic leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'paralysis, paresis, or recent plaster immobilization of the lower extremity,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'previously documented DVT,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
From the patient's note, the criterion, 'alternative diagnosis to DVT as likely or more likely,' is present. Hence, we decrease the score by 2 and so total is 0 - 2 = -2.
The Well's DVT score for the patient is -2."
229,16,Wells' Criteria for DVT,risk,integer,pmc-3291722-1,Extracted,"A 52-year-old female with a history of SLE who had underdone percutaneous coronary intervention (PCI), initially presented to the emergency department a 2 hour history of continuous chest pain in the substernal area. For twenty years, she has been treated for lupus and its pulmonologic and renal complications at other hospitals. Two years ago, she underwent transarterial embolization of her bronchial artery due to hemoptysis. Two month later, she visited the cardiovascular department of this hospital with severe chest pain, and underwent PCI in the mid left anterior descending artery (LAD), and its diagonal branch with a 3.0×32 mm Taxus® Express2 paclitaxel-eluting stent (Boston Scientific Corp., Natick, MA, USA) for the mid LAD and a 2.5×24 mm Taxus® stent for the diagonal branch. Since the PCI, she has been taking aspirin, 100 mg; clopidogrel, 75 mg and cilostazol, 100 mg for coronary artery disease treatment and prednisolone, 5 mg and hydroxyquinolone for lupus treatment. On visiting the emergency department, her electrocardiogram (ECG) showed ST-segment elevation in V1-V4. Her laboratory data revealed 206 ng/mL of creatine phospho kinase, 17.8 ng/mL of creatine kinase-MB level and 1.69 ng/mL of troponin-I level. She was diagnosed with an anterior-septal ST-segment elevation myocardial infarction, and taken immediately to the catheterization laboratory. Coronary angiography (CAG) revealed total occlusion over the previous stent site of the mid LAD and the diagonal branch (), therefore we performed balloon angioplasty to treat the total occluded lesion of the mid LAD. However, we could not perform any intervention for the diagonal branch due to wiring failure. The final angiogram after balloon angioplasty showed thrombolysis in myocardial infarction (TIMI) grade III flow of the LAD and moderate stenosis of the proximal LAD (). The patient was discharged without complications.
However, five weeks later, the patient presented to our emergency department with severe chest pain associated with ST elevation on ECG on arrival. Under suspicion of recurrent stent thrombosis, we performed emergency CAG, which showed thrombotic re-occlusion of the LAD stent with TIMI grade 0 flow. We elected to perform balloon angioplasty and deployed a 3.0×18 mm XIENCE V stent (Abbott vascular, Redwood City, CA, USA) to cover the progressed lesion of the proximal LAD, overlapping the proximal part of the previous stent. Her final angiogram demonstrated a TIMI grade III flow of the LAD (). Subsequently, we checked her platelet function using a PFA 100® system (Dade International, Miami, FL, USA). The measured closure time with epinephrine cartridges was 178 seconds (normal range: 192-78), and with ADP cartridges, it was 92 seconds (normal range: 146-58). The patient recovered without cardiac complications. She was discharged five days later with aspirin (100 mg daily), clopidogrel (75 mg daily) and cilostazole (50 mg, twice a day).
The patient visited our emergency department again after 8 weeks with recurrent chest pain associated with ST elevation on her ECG. An emergency coronary angiogram showed thrombotic re-occlusion of the mid portion of the previous LAD stent, similar to the previous event. We then performed balloon angioplasty with a 3.0×15 mm VOYAGER(TM) NC balloon (Abbott vascular, Redwood City, CA, USA), which successfully established TMI grade III flow. Subsequent laboratory data on SLE disease and coagulation states revealed her stable lupus and no coagulation abnormalities: lupus anticoagulant: negative, Anti cardiolipin Ab IgG/M: negative, Anti Phospholipid Ab IgG: 3.8 GPLunit/mL, Anti Phospholipid IgM: 0.7 MPLunit/mL, C3: 119 ng/dL {Normal (N): 160-86}, C4: 20.34 ng/dL (N: 17-45), Homocystein 6 umol/L (N: 5-15), Protein C activity: 110% (N: 70-130), Protein S activity: 65% (N: 55-123). She was discharged with a double dose of aspirin (200 mg daily) and clopidogrel (150 mg daily).
Five months after her last discharge, she visited our emergency department again with recurrent chest pain. The ECG again showed ST elevation of the precordial lead and CAG showed stent thrombosis, similar to the previous event. However, after balloon angioplasty, multiple thrombi in the distal part of the stent and disease progression at the edge of stent were shown (). We therefore performed an intravascular ultrasound (IVUS), which showed eccentric plaque with thrombi in the stent and isoechoic plaque with significant stenosis at the distal edge of the stent (). After performing the IVUS, we deployed a 3.0×30 mm Endeavor® Resolute stent (Medtronic, Minneapolis, MN, USA) for this lesion, overlapping the previous stent. Final angiographic findings showed good distal flow (). On discharge, we increased her dosage of aspirin to 300 mg daily.",What is the patient's score of Wells' criteria for Deep Vein Thrombosis? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Alternative diagnosis to Deep Vein Thrombosis as likely or more likely': True, 'Bedridden recently >3 days': False, 'Active cancer': False, 'Major surgery within 12 weeks': False}",-2,-2,-2,"The criteria for the Wells' Criteria for Deep Vein Thrombosis (DVT) score are listed below:

1. Active cancer (treatment or palliation within 6 months): No = 0 points, Yes = +1 point
2. Bedridden recently >3 days or major surgery within 12 weeks: No = 0 points, Yes = +1 point
3. Calf swelling >3 cm compared to the other leg (measured 10 cm below tibial tuberosity): No = 0 points, Yes = +1 point
4. Collateral (nonvaricose) superficial veins present: No = 0 points, Yes = +1 point
5. Entire leg swollen: No = 0 points, Yes = +1 point
6. Localized tenderness along the deep venous system: No = 0 points, Yes = +1 point
7. Pitting edema, confined to symptomatic leg: No = 0 points, Yes = +1 point
8. Paralysis, paresis, or recent plaster immobilization of the lower extremity: No = 0 points, Yes = +1 point
9. Previously documented DVT: No = 0 points, Yes = +1 point
10. Alternative diagnosis to DVT as likely or more likely: No = 0 points, Yes = -2 points

The total score is calculated by summing the points for each criterion.
    
The current Well's DVT Score is 0.
From the patient's note, the criterion, 'active cancer,' is absent. Hence, a point should not be given, and so total remains at 0.
From the patient's note, the criterion, 'bedridden recently >3 days,' is absent. From the patient's note, the criterion, 'major surgery within 12 weeks,' is absent. Based on the Well's DVT rule, at least one of the criteria, 'bedridden recently >3 days' or 'major surgery within 12 weeks' must be true for this criteria to be met for the score to increase by 1. This is not the case for this patient, and so the score remains unchanged at 0.
The issue,'calf swelling >3 cm compared to the other leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'collateral (nonvaricose) superficial veins present,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'entire leg swollen,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'localized tenderness along the deep venous system,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'pitting edema, confined to symptomatic leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'paralysis, paresis, or recent plaster immobilization of the lower extremity,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'previously documented DVT,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
From the patient's note, the criterion, 'alternative diagnosis to DVT as likely or more likely,' is present. Hence, we decrease the score by 2 and so total is 0 - 2 = -2.
The Well's DVT score for the patient is -2."
230,16,Wells' Criteria for DVT,risk,integer,pmc-3876687-1,Extracted,"A 60-year-old woman with a history of lung cancer currently in remission was admitted with complaints of chest pain. She had recurrent substernal chest pain, increasing in severity, without radiation or associated symptoms during the preceding week. She denied any specific alleviating or provoking factors.
Past medical history was significant for hypertension and stage IIIA nonsmall cell lung carcinoma which was diagnosed eight years earlier. She had been treated with chemotherapy and radiotherapy. One year later she developed a malignant pericardial effusion, treated with a pericardial window, and recurrent pleural effusions, which were drained with pleural catheters. During the next six years, she was in full remission as confirmed by annual chest computed tomography (CT). Her medications included aspirin, metoprolol, iron, vitamin B12, and gefitinib. She was a nonsmoker and drinks alcohol occasionally.
At presentation, her physical exam was benign. Initial cardiac biomarkers (creatine phosphokinase, troponin) and fasting lipid panel were within normal limits. The 12-lead electrocardiogram (ECG) showed normal sinus rhythm without any significant ST-T changes. Chest radiograph showed left perihilar parenchymal scars, surgical clips, and postoperative changes in the chest (). Other laboratory studies, including two more sets of cardiac biomarkers, were normal.
She underwent an exercise nuclear stress test which demonstrated indeterminate electrocardiogram (ECG) changes with a small anteroseptal wall defect which appeared to be artifactual. Following the stress test, she developed retrosternal chest pain. Although her ECG did not show any acute changes, repeat serum troponin level was elevated at 0.42 ug/L. Coronary angiography was performed and demonstrated 90% stenosis of the left main coronary artery ostium, dominant right coronary artery, and no evidence of any atherosclerotic disease or stenosis in other coronary arteries (Figures , , and ). Left ventricular ejection fraction was 55% without any regional wall motion abnormalities.
Syntax score was calculated to be 12% which predicts comparable outcomes of surgical and angioplastic procedures. Taking into consideration patient's history that may complicate the surgical treatment including her previous surgical interventions, radiation therapy, and chemical therapy, the interventional cardiology team recommended percutaneous coronary intervention (PCI) with stenting of the lesion. Cardiothoracic surgeons were consulted as well for further evaluation and they agreed that surgery will be challenging in this patient, but at the same time they felt that she may tolerate the surgery well, given her functional status, remission from cancer, and the low operative risk (EuroScore is 1.23%), and they suggested coronary artery bypass graft (CABG) surgery as a reasonable option due to the high failure rate of stenting ostial lesions and to avoid the possible cardiac arrest associated with the intervention on the stenotic ostium of left main coronary artery.
After discussing both treatment options, the risks and benefits of each procedure with the patient, she decided to undergo surgical revascularization. Overnight, she experienced excruciating anginal chest pain without any elevation in cardiac enzymes; as a result she was taken to surgery the next day.
Intraoperatively she was noted to have dense adhesions surrounding the heart. As a result, she developed severe bleeding from the adhesions. Despite aggressive transfusion of red blood cells and platelets, bleeding could not be controlled and she died during surgery. The family refused to allow autopsy to confirm the diagnosis.",What is the patient's score of Wells' criteria for Deep Vein Thrombosis? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Alternative diagnosis to Deep Vein Thrombosis as likely or more likely': True, 'Active cancer': False, 'Major surgery within 12 weeks': True}",-1,-1,-1,"The criteria for the Wells' Criteria for Deep Vein Thrombosis (DVT) score are listed below:

1. Active cancer (treatment or palliation within 6 months): No = 0 points, Yes = +1 point
2. Bedridden recently >3 days or major surgery within 12 weeks: No = 0 points, Yes = +1 point
3. Calf swelling >3 cm compared to the other leg (measured 10 cm below tibial tuberosity): No = 0 points, Yes = +1 point
4. Collateral (nonvaricose) superficial veins present: No = 0 points, Yes = +1 point
5. Entire leg swollen: No = 0 points, Yes = +1 point
6. Localized tenderness along the deep venous system: No = 0 points, Yes = +1 point
7. Pitting edema, confined to symptomatic leg: No = 0 points, Yes = +1 point
8. Paralysis, paresis, or recent plaster immobilization of the lower extremity: No = 0 points, Yes = +1 point
9. Previously documented DVT: No = 0 points, Yes = +1 point
10. Alternative diagnosis to DVT as likely or more likely: No = 0 points, Yes = -2 points

The total score is calculated by summing the points for each criterion.
    
The current Well's DVT Score is 0.
From the patient's note, the criterion, 'active cancer,' is absent. Hence, a point should not be given, and so total remains at 0.
The issue,'bedridden recently >3 days,' is missing from the patient note and so the value is assumed to be absent from the patient. From the patient's note, the criterion, 'major surgery within 12 weeks,' is present. Based on the Well's DVT rule, at least one of the criteria, 'bedridden recently >3 days' or 'major surgery within 12 weeks' must be true for this criteria to be met for the score to increase by 1. Because this is the case, we incease the score by one making the total 0 + 1 = 1.
The issue,'calf swelling >3 cm compared to the other leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'collateral (nonvaricose) superficial veins present,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'entire leg swollen,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'localized tenderness along the deep venous system,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'pitting edema, confined to symptomatic leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'paralysis, paresis, or recent plaster immobilization of the lower extremity,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'previously documented DVT,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
From the patient's note, the criterion, 'alternative diagnosis to DVT as likely or more likely,' is present. Hence, we decrease the score by 2 and so total is 1 - 2 = -1.
The Well's DVT score for the patient is -1."
231,16,Wells' Criteria for DVT,risk,integer,pmc-2488320-1,Extracted,"A fifty-year-old Caucasian male sustained paraplegia at T-5 level in 1987 while driving his car, which skidded and crashed. He had been managing his bladder with long-term indwelling urethral catheter. He developed a false passage in posterior urethra. Therefore, he used undergo flexible cystoscopy and change of catheter over a guide wire. He used to have a size 16 Fr. silicone Foley catheters with 10 ml balloon.
In 2005, this patient underwent above-knee amputation for pressure sore over left knee joint. He was readmitted to Spinal Injuries Centre in February 2008 for revision of the stump. On one night during his stay in spinal unit, the patient felt that there had been a tug on the drainage tube while he was being turned as part of the routine care for relief of pressure. Next morning, a health professional noticed that a long segment of catheter was lying outside penis. (Figure ) There was no bleeding from urethral meatus. Catheter continued to drain urine, which was yellowish in colour. Urine output was satisfactory. This patient did not develop any clinical feature of autonomic dysreflexia nor was he feeling unwell.
In view of positive long catheter sign, radiological studies were performed to check the position of Foley catheter []. X-ray of urinary bladder, taken after injecting contrast both through balloon channel and main lumen of Foley catheter showed the Foley balloon to be lying in urethra. (Figure ) This radiological study confirmed the clinical impression of incorrectly positioned Foley catheter. The catheter was removed; flexible cystoscopy was performed. A 16 Fr, 20 ml balloon Foley catheter was inserted over a 0.032"" guide wire. Following this procedure, a considerably shorter length of Foley catheter remained outside the penis. (Figure ) Positive long catheter sign could be recognised readily when Figure is compared with Figure . Insertion of a Foley catheter with 20 ml balloon, and securing the drainage tube to thigh with two straps, helped to prevent inadvertent pull of Foley balloon into the urethra.",What is the patient's score of Wells' criteria for Deep Vein Thrombosis? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Alternative diagnosis to Deep Vein Thrombosis as likely or more likely': False, 'Paralysis, paresis, or recent plaster immobilization of the lower extremity': True, 'Bedridden recently >3 days': True, 'Major surgery within 12 weeks': True}",2,2,2,"The criteria for the Wells' Criteria for Deep Vein Thrombosis (DVT) score are listed below:

1. Active cancer (treatment or palliation within 6 months): No = 0 points, Yes = +1 point
2. Bedridden recently >3 days or major surgery within 12 weeks: No = 0 points, Yes = +1 point
3. Calf swelling >3 cm compared to the other leg (measured 10 cm below tibial tuberosity): No = 0 points, Yes = +1 point
4. Collateral (nonvaricose) superficial veins present: No = 0 points, Yes = +1 point
5. Entire leg swollen: No = 0 points, Yes = +1 point
6. Localized tenderness along the deep venous system: No = 0 points, Yes = +1 point
7. Pitting edema, confined to symptomatic leg: No = 0 points, Yes = +1 point
8. Paralysis, paresis, or recent plaster immobilization of the lower extremity: No = 0 points, Yes = +1 point
9. Previously documented DVT: No = 0 points, Yes = +1 point
10. Alternative diagnosis to DVT as likely or more likely: No = 0 points, Yes = -2 points

The total score is calculated by summing the points for each criterion.
    
The current Well's DVT Score is 0.
The issue,'active cancer,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
From the patient's note, the criterion, 'bedridden recently >3 days,' is present. From the patient's note, the criterion, 'major surgery within 12 weeks,' is present. Based on the Well's DVT rule, at least one of the criteria, 'bedridden recently >3 days' or 'major surgery within 12 weeks' must be true for this criteria to be met for the score to increase by 1. Because this is the case, we incease the score by one making the total 0 + 1 = 1.
The issue,'calf swelling >3 cm compared to the other leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'collateral (nonvaricose) superficial veins present,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'entire leg swollen,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'localized tenderness along the deep venous system,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'pitting edema, confined to symptomatic leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
From the patient's note, the criterion, 'paralysis, paresis, or recent plaster immobilization of the lower extremity,' is present. Hence, a point should be given, and so we increment the score by one, making the the total 1 + 1 =  2.
The issue,'previously documented DVT,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 2.
From the patient's note, the criterion, 'alternative diagnosis to DVT as likely or more likely,' is absent. Hence, a point should not be given, and so total remains at 2.
The Well's DVT score for the patient is 2."
232,16,Wells' Criteria for DVT,risk,integer,pmc-8168998-1,Extracted,"A 39-year-old male with a five-year history of moderate ulcerative colitis (UC), as per Montreal classification, was admitted to the emergency department with worsening abdominal and rectal pain secondary to a C. diff infection of one week. Patient had a multi-week history of diarrhea that was waking him up at night leading up to the C. diff diagnosis. One week prior to ED admission, his GI had ordered precautionary leukocytes and C. diff due to history of UC, and both returned positive. Per GI note, ""Vancomycin prescribed as this patient has IBD and patients with IBD can develop spontaneous C. diff infections and need to be treated regardless of toxin presence."" He had no prior history of antibiotic use over the past three months or triggering factor for C. diff infection.
Over the course of the week, his symptoms progressed, and he claimed to have nausea, vomiting, and hematochezia.
The patient presented with a past medical history of depression, post-traumatic stress disorder, and obstructive sleep apnea. His allergies included trazodone and amoxicillin/clavulanate. His family history was unrevealing. His surgical history included cholecystectomy and thyroglossal duct cyst removal in 2019.
This patient was a nonsmoker. He denied alcohol or drug use. He tried to maintain a healthy diet of lean proteins, fruits, and vegetables.
Initial vitals on presentation included: temperature: 98.6 F, pulse: 90 beats per minute, respiratory rate: 15 breaths per minute, pulse oximetry: 95%, blood pressure: 119/87 mmHg, weight: 217.16 lbs, and body mass index: 32.14.
General surgery was consulted upon CT scan with IV contrast revealing new extraluminal gas in the perineum surrounding the anus and distal rectum (Figures , , , ). He was examined and subsequently diagnosed with rectal perforation.
Preoperatively, the patient’s physical exam revealed an uncomfortable looking young man in mild distress due to abdominal pain. An abdominal exam revealed no distention, masses, rebound, or guarding. The absence of McBurney’s sign, Murphy’s sign, and peritoneal inflammation was noted. There was no active rectal bleeding at the time of physical examination. Laboratory data revealed an elevated c-reactive protein of 66.4. Complete blood count and complete metabolic panel were otherwise within normal limits. Despite infection and imaging reflecting perforation, white blood count was found to be 5.9 k/cmm.
After review of the available data, assessment of clinical condition, and deliberation with the emergency department physicians and the patient’s primary gastroenterology physician, the surgery team decided the patient would require an urgent exploratory laparotomy with total abdominal colectomy and end ileostomy due to the diagnosis of rectal perforation secondary to C. diff colitis on chronic UC.
The patient was immediately brought to the operating room. The primary incision was made from the subxiphoid to the pubic symphysis within two hours of initial presentation to the hospital. The colon was visualized and resected; thus, a total colectomy was undergone. The pre-rectal space was opened to identify signs of purulence or injury, which found crepitus and severe UC causing circumferential ulcerations and a deep ulcer in the midline anteriorly. These ulcers traversed all layers of the rectal wall. A drain was placed to drain potential abscess or infection from the pre-rectal space.
The patient left the OR in stable condition after enduring no complications intraoperatively. He remained in the inpatient surgical unit for five days, during which he continued to advance his diet and ambulate successfully. He was discharged after an education session on ostomy bag maintenance and told to follow up with the general surgery team and gastroenterology team in one week. At his one-week follow-up post-op visit, the patient was doing well, ostomy output was draining appropriately, and he denied fever, nausea, or vomiting. No secondary follow-up surgery was required.",What is the patient's score of Wells' criteria for Deep Vein Thrombosis? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Alternative diagnosis to Deep Vein Thrombosis as likely or more likely': True, 'Bedridden recently >3 days': False, 'Major surgery within 12 weeks': True}",-1,-1,-1,"The criteria for the Wells' Criteria for Deep Vein Thrombosis (DVT) score are listed below:

1. Active cancer (treatment or palliation within 6 months): No = 0 points, Yes = +1 point
2. Bedridden recently >3 days or major surgery within 12 weeks: No = 0 points, Yes = +1 point
3. Calf swelling >3 cm compared to the other leg (measured 10 cm below tibial tuberosity): No = 0 points, Yes = +1 point
4. Collateral (nonvaricose) superficial veins present: No = 0 points, Yes = +1 point
5. Entire leg swollen: No = 0 points, Yes = +1 point
6. Localized tenderness along the deep venous system: No = 0 points, Yes = +1 point
7. Pitting edema, confined to symptomatic leg: No = 0 points, Yes = +1 point
8. Paralysis, paresis, or recent plaster immobilization of the lower extremity: No = 0 points, Yes = +1 point
9. Previously documented DVT: No = 0 points, Yes = +1 point
10. Alternative diagnosis to DVT as likely or more likely: No = 0 points, Yes = -2 points

The total score is calculated by summing the points for each criterion.
    
The current Well's DVT Score is 0.
The issue,'active cancer,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
From the patient's note, the criterion, 'bedridden recently >3 days,' is absent. From the patient's note, the criterion, 'major surgery within 12 weeks,' is present. Based on the Well's DVT rule, at least one of the criteria, 'bedridden recently >3 days' or 'major surgery within 12 weeks' must be true for this criteria to be met for the score to increase by 1. Because this is the case, we incease the score by one making the total 0 + 1 = 1.
The issue,'calf swelling >3 cm compared to the other leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'collateral (nonvaricose) superficial veins present,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'entire leg swollen,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'localized tenderness along the deep venous system,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'pitting edema, confined to symptomatic leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'paralysis, paresis, or recent plaster immobilization of the lower extremity,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'previously documented DVT,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
From the patient's note, the criterion, 'alternative diagnosis to DVT as likely or more likely,' is present. Hence, we decrease the score by 2 and so total is 1 - 2 = -1.
The Well's DVT score for the patient is -1."
233,16,Wells' Criteria for DVT,risk,integer,pmc-8514746-2,Extracted,"A 77-year-old man was diagnosed with RA in 2006 with positive anti-CCP antibodies and RF; MTX was used but was changed to GLM in 2016 (the recent dose interval was 6–7 weeks; the last dose was 5 weeks before vaccine administration) and maintained in remission. The patient was receiving epoetin beta pegol and zinc acetate hydrate for hypertension and chronic renal failure. Four days after the first dose of the BNT162b2 vaccine, the patient developed left upper and lower limb paralysis and was rushed to the emergency room. The blood test revealed a platelet count of 5.6 × 104/μL despite the last count of 11.1 × 104/μL, and the brain CT showed right frontal lobe subcortical hemorrhage and subarachnoid hemorrhage in the central sulcus. There were no significant thrombotic findings. Transient thrombocytopenia recovered spontaneously after a few days, and the patient was transferred to the hospital for rehabilitation. The results of the PA-IgG test were negative.",What is the patient's score of Wells' criteria for Deep Vein Thrombosis? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Alternative diagnosis to Deep Vein Thrombosis as likely or more likely': True, 'Bedridden recently >3 days': False, 'Paralysis, paresis, or recent plaster immobilization of the lower extremity': True}",-1,-1,-1,"The criteria for the Wells' Criteria for Deep Vein Thrombosis (DVT) score are listed below:

1. Active cancer (treatment or palliation within 6 months): No = 0 points, Yes = +1 point
2. Bedridden recently >3 days or major surgery within 12 weeks: No = 0 points, Yes = +1 point
3. Calf swelling >3 cm compared to the other leg (measured 10 cm below tibial tuberosity): No = 0 points, Yes = +1 point
4. Collateral (nonvaricose) superficial veins present: No = 0 points, Yes = +1 point
5. Entire leg swollen: No = 0 points, Yes = +1 point
6. Localized tenderness along the deep venous system: No = 0 points, Yes = +1 point
7. Pitting edema, confined to symptomatic leg: No = 0 points, Yes = +1 point
8. Paralysis, paresis, or recent plaster immobilization of the lower extremity: No = 0 points, Yes = +1 point
9. Previously documented DVT: No = 0 points, Yes = +1 point
10. Alternative diagnosis to DVT as likely or more likely: No = 0 points, Yes = -2 points

The total score is calculated by summing the points for each criterion.
    
The current Well's DVT Score is 0.
The issue,'active cancer,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
From the patient's note, the criterion, 'bedridden recently >3 days,' is absent. The issue,'major surgery within 12 weeks,' is missing from the patient note and so the value is assumed to be absent from the patient. Based on the Well's DVT rule, at least one of the criteria, 'bedridden recently >3 days' or 'major surgery within 12 weeks' must be true for this criteria to be met for the score to increase by 1. This is not the case for this patient, and so the score remains unchanged at 0.
The issue,'calf swelling >3 cm compared to the other leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'collateral (nonvaricose) superficial veins present,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'entire leg swollen,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'localized tenderness along the deep venous system,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'pitting edema, confined to symptomatic leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
From the patient's note, the criterion, 'paralysis, paresis, or recent plaster immobilization of the lower extremity,' is present. Hence, a point should be given, and so we increment the score by one, making the the total 0 + 1 =  1.
The issue,'previously documented DVT,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
From the patient's note, the criterion, 'alternative diagnosis to DVT as likely or more likely,' is present. Hence, we decrease the score by 2 and so total is 1 - 2 = -1.
The Well's DVT score for the patient is -1."
234,16,Wells' Criteria for DVT,risk,integer,pmc-4918891-1,Extracted,"A 21-year-old male with a history of asthma and reactive airway disease since childhood, without recent hospitalizations and no prior ICU stays or intubations, was scheduled to undergo left shoulder arthroscopy and labral repair surgery at our institution. He had no known allergies. On physical examination, he was 188 cm and 100 kg (body mass index: 28.3) with a Mallampati score of 2, his lungs were clear to auscultation bilaterally without wheezes, and he had a regular rate and rhythm on a benign cardiac examination. The patient expressed his desire to be “asleep” throughout the duration of the surgery.
Intravenous (IV) access was obtained and 2 mg of midazolam with 50 mcg of fentanyl was administered. We performed a left interscalene and T2 nerve block and maintained anesthesia with a ketamine–propofol infusion. A total of 25 mL of 0.5% ropivacaine and 15 mL of 1.5% mepivacaine were injected around the trunks of the brachial plexus. An additional 7 mL of 1.5% mepivacaine was used for the T2 nerve block.
The patient was then brought into the operative suite, where standard American Society of Anesthesiologists (ASA) monitors and a nasal cannula were attached. Then, 3 mg of midazolam was administered for anxiolysis, anterograde amnesia, and prophylaxis against potential emergence delirium. The patient was positioned in the beach chair position (BCP), and a propofol infusion at 70 mcg/kg per minute was started with a low background dose of ketamine at 0.2 mg/kg per hour. During the case, the patient was administered an additional 30 mg of IV ketamine in 10 mg aliquots and an initial 30 mg dose of ketorolac toward the end of the procedure for multimodal pain control. At the end of the surgery, 4 mg of IV ondansetron was given; then, the patient woke up calm with no signs of emergence delirium, with adequate analgesia, and with no nausea. Postoperatively, the patient was transferred to the post-anesthesia care unit (PACU), where he was discharged home an hour and a half later after achieving PACU discharge criteria. Columbia University Privacy Office Guidelines do not require Institutional Review Board approval for single case reports as they do not constitute the federal definition of research. Columbia University Medical Center waived the requirements for obtaining written informed consent for single patient case reports. Verbal consent was obtained from the patient for use of this case report.",What is the patient's score of Wells' criteria for Deep Vein Thrombosis? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Alternative diagnosis to Deep Vein Thrombosis as likely or more likely': False, 'Bedridden recently >3 days': False, 'Previously documented Deep Vein Thrombosis': False, 'Major surgery within 12 weeks': True}",1,1,1,"The criteria for the Wells' Criteria for Deep Vein Thrombosis (DVT) score are listed below:

1. Active cancer (treatment or palliation within 6 months): No = 0 points, Yes = +1 point
2. Bedridden recently >3 days or major surgery within 12 weeks: No = 0 points, Yes = +1 point
3. Calf swelling >3 cm compared to the other leg (measured 10 cm below tibial tuberosity): No = 0 points, Yes = +1 point
4. Collateral (nonvaricose) superficial veins present: No = 0 points, Yes = +1 point
5. Entire leg swollen: No = 0 points, Yes = +1 point
6. Localized tenderness along the deep venous system: No = 0 points, Yes = +1 point
7. Pitting edema, confined to symptomatic leg: No = 0 points, Yes = +1 point
8. Paralysis, paresis, or recent plaster immobilization of the lower extremity: No = 0 points, Yes = +1 point
9. Previously documented DVT: No = 0 points, Yes = +1 point
10. Alternative diagnosis to DVT as likely or more likely: No = 0 points, Yes = -2 points

The total score is calculated by summing the points for each criterion.
    
The current Well's DVT Score is 0.
The issue,'active cancer,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
From the patient's note, the criterion, 'bedridden recently >3 days,' is absent. From the patient's note, the criterion, 'major surgery within 12 weeks,' is present. Based on the Well's DVT rule, at least one of the criteria, 'bedridden recently >3 days' or 'major surgery within 12 weeks' must be true for this criteria to be met for the score to increase by 1. Because this is the case, we incease the score by one making the total 0 + 1 = 1.
The issue,'calf swelling >3 cm compared to the other leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'collateral (nonvaricose) superficial veins present,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'entire leg swollen,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'localized tenderness along the deep venous system,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'pitting edema, confined to symptomatic leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'paralysis, paresis, or recent plaster immobilization of the lower extremity,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'previously documented DVT,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
From the patient's note, the criterion, 'alternative diagnosis to DVT as likely or more likely,' is absent. Hence, a point should not be given, and so total remains at 1.
The Well's DVT score for the patient is 1."
235,16,Wells' Criteria for DVT,risk,integer,pmc-6940349-1,Extracted,"A 52-year-old male patient presented in our emergency room with massive traumatic avulsion of the penile and scrotal skin following mishandling of an electric drill during work 9 h earlier. The missing skin was not retrievable.
The patient was taken to the local hospital immediately after the accident. The wound was quickly dressed and the patient was referred to the Emergency Department of our hospital.
The patient was healthy prior to the accident with no history of chronic disease.
Physical examination showed full-thickness skin of both scrota and the proximal part of the penis was denuded with active bleeding (Figure ). Urinary catheterization was successfully performed which indicated that there was no damage to the urethra.
Laboratory studies revealed a white blood cell count of 12.3 × 109/L (neutrophil percentage, 74.5%) which was higher than the normal level and was believed to be caused by the open trauma. Other results were normal.
A pelvic computed tomography scan revealed that the perineum skin had multiple spots of dense shadows, and the subcutaneous fat gap was slightly blurred.",What is the patient's score of Wells' criteria for Deep Vein Thrombosis? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Alternative diagnosis to Deep Vein Thrombosis as likely or more likely': True, 'Bedridden recently >3 days': False, 'Previously documented Deep Vein Thrombosis': False}",-2,-2,-2,"The criteria for the Wells' Criteria for Deep Vein Thrombosis (DVT) score are listed below:

1. Active cancer (treatment or palliation within 6 months): No = 0 points, Yes = +1 point
2. Bedridden recently >3 days or major surgery within 12 weeks: No = 0 points, Yes = +1 point
3. Calf swelling >3 cm compared to the other leg (measured 10 cm below tibial tuberosity): No = 0 points, Yes = +1 point
4. Collateral (nonvaricose) superficial veins present: No = 0 points, Yes = +1 point
5. Entire leg swollen: No = 0 points, Yes = +1 point
6. Localized tenderness along the deep venous system: No = 0 points, Yes = +1 point
7. Pitting edema, confined to symptomatic leg: No = 0 points, Yes = +1 point
8. Paralysis, paresis, or recent plaster immobilization of the lower extremity: No = 0 points, Yes = +1 point
9. Previously documented DVT: No = 0 points, Yes = +1 point
10. Alternative diagnosis to DVT as likely or more likely: No = 0 points, Yes = -2 points

The total score is calculated by summing the points for each criterion.
    
The current Well's DVT Score is 0.
The issue,'active cancer,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
From the patient's note, the criterion, 'bedridden recently >3 days,' is absent. The issue,'major surgery within 12 weeks,' is missing from the patient note and so the value is assumed to be absent from the patient. Based on the Well's DVT rule, at least one of the criteria, 'bedridden recently >3 days' or 'major surgery within 12 weeks' must be true for this criteria to be met for the score to increase by 1. This is not the case for this patient, and so the score remains unchanged at 0.
The issue,'calf swelling >3 cm compared to the other leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'collateral (nonvaricose) superficial veins present,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'entire leg swollen,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'localized tenderness along the deep venous system,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'pitting edema, confined to symptomatic leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'paralysis, paresis, or recent plaster immobilization of the lower extremity,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'previously documented DVT,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
From the patient's note, the criterion, 'alternative diagnosis to DVT as likely or more likely,' is present. Hence, we decrease the score by 2 and so total is 0 - 2 = -2.
The Well's DVT score for the patient is -2."
236,16,Wells' Criteria for DVT,risk,integer,pmc-8383636-1,Extracted,"A 34-year-old patient, gravida six para three, presented to our delivery suite at 37+0 weeks’ gestation in labor. She had two terminations of pregnancies, and three normal vaginal deliveries at 39 + 0, 36 + 4, and 38 + 6 weeks’ gestation in 2005, 2008, and 2016 respectively. Her babies were healthy and weighed between 2,500 to 2,925 g at birth. In May 2017, she underwent a laser cone biopsy for CIN 3 with clear margins achieved. Excisional biopsy was the treatment of choice as it was a type two transformational zone. A laser cone was performed instead of a loop electrosurgical excisional procedure (LEEP) in view of a large transformational zone. Subsequent follow up cervical smear and examination were normal. She had no other significant past medical history.
She conceived spontaneously in 2019 and presented at eight weeks gestation at her booking visit. A transvaginal cervical length scan, performed at 12 weeks’ gestation in view of her previous laser cone biopsy, estimated her cervical length to be 3.6 - 3.7 cm. She declined Down syndrome screening and her fetal anomaly scan at 20 weeks’ gestation was normal except for an aberrant right subclavian artery. Her pregnancy progressed uneventfully.
The patient presented at 37 weeks with spontaneous rupture of membranes followed by regular contraction pains. Speculum examination confirmed the presence of a definite pool of clear liquor but her cervical os was closed on vaginal examination. She was started on a Syntocinon infusion to augment labor, titrated to maintain her contractions every 2 - 3 min. Her cervix remained closed after 6 h and a decision was made to stop her Syntocinon infusion and insert a 3 mg dinoprostone (Prostin E2) tablet. A vaginal examination performed 6 h later revealed a full effaced and 1 cm dilated cervix. She was restarted on Syntocinon infusion thereafter but made no progress after 6 h of augmentation, with contractions felt and seen every 3 min. After discussion with the patient, another dinoprostone tablet was inserted, and Syntocinon augmentation recommenced 6 h later. However, after another 4 h, there was no change to her cervical findings despite regular contractions every 2 -3 min. A diagnosis of cervical stenosis was made.
She underwent an emergency cesarean section for failure to progress and delivered a healthy baby girl with a birthweight of 3,515 g and an estimated blood loss of 400 mL. Intraoperatively, her internal cervical os was found to be one cm dilated, thin and fibrotic. She had an uncomplicated recovery and was discharged well on the third postoperative day.",What is the patient's score of Wells' criteria for Deep Vein Thrombosis? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Alternative diagnosis to Deep Vein Thrombosis as likely or more likely': False, 'Bedridden recently >3 days': False, 'Previously documented Deep Vein Thrombosis': False, 'Active cancer': False, 'Major surgery within 12 weeks': True}",1,1,1,"The criteria for the Wells' Criteria for Deep Vein Thrombosis (DVT) score are listed below:

1. Active cancer (treatment or palliation within 6 months): No = 0 points, Yes = +1 point
2. Bedridden recently >3 days or major surgery within 12 weeks: No = 0 points, Yes = +1 point
3. Calf swelling >3 cm compared to the other leg (measured 10 cm below tibial tuberosity): No = 0 points, Yes = +1 point
4. Collateral (nonvaricose) superficial veins present: No = 0 points, Yes = +1 point
5. Entire leg swollen: No = 0 points, Yes = +1 point
6. Localized tenderness along the deep venous system: No = 0 points, Yes = +1 point
7. Pitting edema, confined to symptomatic leg: No = 0 points, Yes = +1 point
8. Paralysis, paresis, or recent plaster immobilization of the lower extremity: No = 0 points, Yes = +1 point
9. Previously documented DVT: No = 0 points, Yes = +1 point
10. Alternative diagnosis to DVT as likely or more likely: No = 0 points, Yes = -2 points

The total score is calculated by summing the points for each criterion.
    
The current Well's DVT Score is 0.
From the patient's note, the criterion, 'active cancer,' is absent. Hence, a point should not be given, and so total remains at 0.
From the patient's note, the criterion, 'bedridden recently >3 days,' is absent. From the patient's note, the criterion, 'major surgery within 12 weeks,' is present. Based on the Well's DVT rule, at least one of the criteria, 'bedridden recently >3 days' or 'major surgery within 12 weeks' must be true for this criteria to be met for the score to increase by 1. Because this is the case, we incease the score by one making the total 0 + 1 = 1.
The issue,'calf swelling >3 cm compared to the other leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'collateral (nonvaricose) superficial veins present,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'entire leg swollen,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'localized tenderness along the deep venous system,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'pitting edema, confined to symptomatic leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'paralysis, paresis, or recent plaster immobilization of the lower extremity,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'previously documented DVT,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
From the patient's note, the criterion, 'alternative diagnosis to DVT as likely or more likely,' is absent. Hence, a point should not be given, and so total remains at 1.
The Well's DVT score for the patient is 1."
237,16,Wells' Criteria for DVT,risk,integer,pmc-3127500-1,Extracted,"A 64-year-old woman presented to her general practitioner (GP) with a three-year history of a right frontal skull swelling. Over the past year this swelling had increased in size. The patient was referred to the neurosurgery clinic where examination revealed a sessile non-tender mass (approximately 4.3 x 1.6 cm). The overlying skin was intact with normal hair growth. There was no headache and there were no focal neurological signs or symptoms.
The initial skull X-ray was suggestive of an osteoma. Bone scintigraphy was normal. A CT scan of the head showed a sclerotic thickened area of the right frontal bone with no significant mass effect on the underlying cerebrum (). No brain or meningeal enhancement was noted on the scans. The findings were suggestive of an osteoma, with fibrous dysplasia as another possibility. Review of the scans by a second radiologist confirmed an area of sclerosis and non-destructive expansion of the right frontal bone. However, this was thought to represent an intraosseous meningioma.
The patient was treated surgically and underwent a small skin incision overlying the lesion. The latter was chiselled off and sent for pathological examination in order to obtain a tissue diagnosis. The contour of the skull was restored.
Histologically the sample contained fragments of mature bone, whereby some of the bone marrow spaces were replaced by a spindle cell tumour forming lobules and whorls (). It was composed of cells with oval nuclei, some nuclear pseudoinclusions, eosiniophilic cytoplasm and indistinct cytoplasmic borders. Mitotic figures were not present. The features were consistent with an intraosseous meningioma of meningothelial subtype (WHO Grade I).
The patient was subsequently readmitted and underwent a total excision of the tumour and cranioplasty. The involved right frontal bone was excised and replaced with a titanium mesh.",What is the patient's score of Wells' criteria for Deep Vein Thrombosis? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Alternative diagnosis to Deep Vein Thrombosis as likely or more likely': True, 'Active cancer': True, 'Major surgery within 12 weeks': True}",0,0,0,"The criteria for the Wells' Criteria for Deep Vein Thrombosis (DVT) score are listed below:

1. Active cancer (treatment or palliation within 6 months): No = 0 points, Yes = +1 point
2. Bedridden recently >3 days or major surgery within 12 weeks: No = 0 points, Yes = +1 point
3. Calf swelling >3 cm compared to the other leg (measured 10 cm below tibial tuberosity): No = 0 points, Yes = +1 point
4. Collateral (nonvaricose) superficial veins present: No = 0 points, Yes = +1 point
5. Entire leg swollen: No = 0 points, Yes = +1 point
6. Localized tenderness along the deep venous system: No = 0 points, Yes = +1 point
7. Pitting edema, confined to symptomatic leg: No = 0 points, Yes = +1 point
8. Paralysis, paresis, or recent plaster immobilization of the lower extremity: No = 0 points, Yes = +1 point
9. Previously documented DVT: No = 0 points, Yes = +1 point
10. Alternative diagnosis to DVT as likely or more likely: No = 0 points, Yes = -2 points

The total score is calculated by summing the points for each criterion.
    
The current Well's DVT Score is 0.
From the patient's note, the criterion, 'active cancer,' is present. Hence, a point should be given, and so we increment the score by one, making the the total 0 + 1 =  1.
The issue,'bedridden recently >3 days,' is missing from the patient note and so the value is assumed to be absent from the patient. From the patient's note, the criterion, 'major surgery within 12 weeks,' is present. Based on the Well's DVT rule, at least one of the criteria, 'bedridden recently >3 days' or 'major surgery within 12 weeks' must be true for this criteria to be met for the score to increase by 1. Because this is the case, we incease the score by one making the total 1 + 1 = 2.
The issue,'calf swelling >3 cm compared to the other leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 2.
The issue,'collateral (nonvaricose) superficial veins present,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 2.
The issue,'entire leg swollen,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 2.
The issue,'localized tenderness along the deep venous system,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 2.
The issue,'pitting edema, confined to symptomatic leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 2.
The issue,'paralysis, paresis, or recent plaster immobilization of the lower extremity,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 2.
The issue,'previously documented DVT,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 2.
From the patient's note, the criterion, 'alternative diagnosis to DVT as likely or more likely,' is present. Hence, we decrease the score by 2 and so total is 2 - 2 = 0.
The Well's DVT score for the patient is 0."
238,16,Wells' Criteria for DVT,risk,integer,pmc-4320908-1,Extracted,"A 54-year-old female patient was admitted to our outpatient clinic with complaints of left hip pain markedly increasing for 10 days and difficulty in walking. She stated that she had hip pain for about 2 months, and she was treated by many physicians. Patient had difficulty in load transfer during walking and therefore had ambulation difficulty. She defined loss of appetite and sometimes fever. She did not define low back pain, radicular symptoms, neuropathic complaints, trauma, rash, aphtha, diarrhea, arthritis, abdominal pain, a recent infection, a history of intramuscular injection, weight loss, history of eating fresh cheese, and history of tuberculosis. Patient received chemotherapy and radiotherapy 3 years ago due to cervical cancer, and she was a diabetes patient using insulin.
In patient's evaluation, her arterial blood pressure measurement was 110/70 mmHg, her fever was 37.1°C, and her pulse rate was 95/minute. Patient appeared to be pale and tired, and she was mobilized on wheelchair. Due to pain, she could not bear load on left lower extremity, she needed assistance in walking, and she had difficulty in transfer activities. Left hip joint was flexed to 50 degrees. Passive joint space could not be evaluated. She defined tenderness at trochanter major by palpation. Right hip and vertebral movements were extended and painless. Spasm was detected in left paravertebral muscles at lumbar region. No neurological deficit was detected, and no pathological reflex was present. She had no edema in lower extremities, and all pulses could be measured.
After initial evaluation, lumbar, pelvis, and left hip roentgenogram and ultrasonography (US) for hip joint and gluteal region were planned. Roentgenograms were normal except mild osteodegenerative findings at lumbar vertebra. Slight amount of fluid was observed at left trochanteric bursa in US. Hip magnetic resonance examination (MR) was requested for clear evaluation of hip joint and adjacent structures. However, it could not be performed since the patient could not be positioned due to pain. In her laboratory examination, the following was detected: leucocytes: 17.86 (4–10) k/uL, hemoglobin: 7.3 (11–16) g/dL, sedimentation (ESR): 110 mm/hour, creatinine: 1.56 (0.6–1.1) mg/dL, C-reactive protein (CRP): 31.18 (0.01–0.82) mg/dL, and brucella agglutination: negative. In her urinalysis, protein (+++) and leucocytes 1500 p/HPF were found. Patient had history of radiotherapy and chemotherapy due to cervical cancer, and urgent nonopaque abdominal computerized tomography (CT) was performed for the patient with current findings and prediagnosis of metastasis and abscess. Soft tissue lesion was observed consistent with abscess at left iliac fossa in iliopsoas muscle, filling paravertebral region with lucent gas inside (Figures and ). PA was detected and she was hospitalized in urology clinic for treatment. Blood culture was negative and, following preferred metronidazole and piperacillin/tazobactam treatment, patient had an operation. PA, ureter, and sigmoid colon perforation were detected. In pathological examination of nephroureterectomy and sigmoid colon resection material, ureter and sigmoid colon metastasis of squamous cell carcinoma were detected.",What is the patient's score of Wells' criteria for Deep Vein Thrombosis? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Alternative diagnosis to Deep Vein Thrombosis as likely or more likely': True, 'Localized tenderness along the deep venous system': False, 'Pitting edema, confined to symptomatic leg': False, 'Paralysis, paresis, or recent plaster immobilization of the lower extremity': False, 'Entire Leg Swollen': False, 'Active cancer': False, 'Major surgery within 12 weeks': False}",-2,-2,-2,"The criteria for the Wells' Criteria for Deep Vein Thrombosis (DVT) score are listed below:

1. Active cancer (treatment or palliation within 6 months): No = 0 points, Yes = +1 point
2. Bedridden recently >3 days or major surgery within 12 weeks: No = 0 points, Yes = +1 point
3. Calf swelling >3 cm compared to the other leg (measured 10 cm below tibial tuberosity): No = 0 points, Yes = +1 point
4. Collateral (nonvaricose) superficial veins present: No = 0 points, Yes = +1 point
5. Entire leg swollen: No = 0 points, Yes = +1 point
6. Localized tenderness along the deep venous system: No = 0 points, Yes = +1 point
7. Pitting edema, confined to symptomatic leg: No = 0 points, Yes = +1 point
8. Paralysis, paresis, or recent plaster immobilization of the lower extremity: No = 0 points, Yes = +1 point
9. Previously documented DVT: No = 0 points, Yes = +1 point
10. Alternative diagnosis to DVT as likely or more likely: No = 0 points, Yes = -2 points

The total score is calculated by summing the points for each criterion.
    
The current Well's DVT Score is 0.
From the patient's note, the criterion, 'active cancer,' is absent. Hence, a point should not be given, and so total remains at 0.
The issue,'bedridden recently >3 days,' is missing from the patient note and so the value is assumed to be absent from the patient. From the patient's note, the criterion, 'major surgery within 12 weeks,' is absent. Based on the Well's DVT rule, at least one of the criteria, 'bedridden recently >3 days' or 'major surgery within 12 weeks' must be true for this criteria to be met for the score to increase by 1. This is not the case for this patient, and so the score remains unchanged at 0.
The issue,'calf swelling >3 cm compared to the other leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
The issue,'collateral (nonvaricose) superficial veins present,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
From the patient's note, the criterion, 'entire leg swollen,' is absent. Hence, a point should not be given, and so total remains at 0.
From the patient's note, the criterion, 'localized tenderness along the deep venous system,' is absent. Hence, a point should not be given, and so total remains at 0.
From the patient's note, the criterion, 'pitting edema, confined to symptomatic leg,' is absent. Hence, a point should not be given, and so total remains at 0.
From the patient's note, the criterion, 'paralysis, paresis, or recent plaster immobilization of the lower extremity,' is absent. Hence, a point should not be given, and so total remains at 0.
The issue,'previously documented DVT,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
From the patient's note, the criterion, 'alternative diagnosis to DVT as likely or more likely,' is present. Hence, we decrease the score by 2 and so total is 0 - 2 = -2.
The Well's DVT score for the patient is -2."
239,16,Wells' Criteria for DVT,risk,integer,pmc-4882526-1,Extracted,"A 73-year-old man who worked as a live poultry seller and butcher in Beijing, China was diagnosed with an influenza A (H7N9) virus infection confirmed by detection of the H7N9 virus in the laboratory. The patient was an alcoholic with a past medical history of chronic bronchitis and coronary heart disease. The illness began with flu-like symptoms, including a high fever (38.3 °C), cough with yellow-white phlegm and feeling fatigued on 30 January 2014. Because the detection of the influenza A virus universal antigen was negative on the throat-swab by means of the immune colloidal gold technique and the radiologic findings revealed bronchitis, the patient was treated with anti-infective therapy by an intravenous injection of moxifloxacin. However, that treatment did not take effect, and the symptoms gradually worsened.
On 5 February 2014, the patient appeared with hyperpyrexia (maximum temperature 40.0 °C), coughing with bloody sputum and dyspnoea with a low oxygen saturation (88.8%). The H7N9 viral RNA was positive in the oropharynx swab confirmed by the real-time RT-PCR method according to the protocol of the Chinese CDC. The patient was transferred into the intensive care unit (ICU) of Beijing Ditan Hospital, Capital Medical University. The case was diagnosed as a laboratory-confirmed case of influenza A (H7N9) infection with severe pneumonia combined with the complications of acute respiratory failure, septic shock, stress ulcer and acute renal failure. Antiviral treatment (oseltamivir) with combination of antibiotics (Sulperazon), a gastric acid secretion inhibitor (omeprazole), mechanical ventilation, continuous renal replacement, supportive nutrition therapy and symptomatic treatment were given. On 12 February 2014, the H7N9 viral nucleic acid was negative when detecting the tracheal aspirate specimens by real-time RT-PCR. On 12 March 2014, the infection symptoms and the respiratory function improved, and the circulation situation tended to be stable. After approximately four months of treatment, the patient recovered and was discharged from hospital on 6 June 2014 ().",What is the patient's score of Wells' criteria for Deep Vein Thrombosis? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Alternative diagnosis to Deep Vein Thrombosis as likely or more likely': True, 'Bedridden recently >3 days': True}",-1,-1,-1,"The criteria for the Wells' Criteria for Deep Vein Thrombosis (DVT) score are listed below:

1. Active cancer (treatment or palliation within 6 months): No = 0 points, Yes = +1 point
2. Bedridden recently >3 days or major surgery within 12 weeks: No = 0 points, Yes = +1 point
3. Calf swelling >3 cm compared to the other leg (measured 10 cm below tibial tuberosity): No = 0 points, Yes = +1 point
4. Collateral (nonvaricose) superficial veins present: No = 0 points, Yes = +1 point
5. Entire leg swollen: No = 0 points, Yes = +1 point
6. Localized tenderness along the deep venous system: No = 0 points, Yes = +1 point
7. Pitting edema, confined to symptomatic leg: No = 0 points, Yes = +1 point
8. Paralysis, paresis, or recent plaster immobilization of the lower extremity: No = 0 points, Yes = +1 point
9. Previously documented DVT: No = 0 points, Yes = +1 point
10. Alternative diagnosis to DVT as likely or more likely: No = 0 points, Yes = -2 points

The total score is calculated by summing the points for each criterion.
    
The current Well's DVT Score is 0.
The issue,'active cancer,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 0.
From the patient's note, the criterion, 'bedridden recently >3 days,' is present. The issue,'major surgery within 12 weeks,' is missing from the patient note and so the value is assumed to be absent from the patient. Based on the Well's DVT rule, at least one of the criteria, 'bedridden recently >3 days' or 'major surgery within 12 weeks' must be true for this criteria to be met for the score to increase by 1. Because this is the case, we incease the score by one making the total 0 + 1 = 1.
The issue,'calf swelling >3 cm compared to the other leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'collateral (nonvaricose) superficial veins present,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'entire leg swollen,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'localized tenderness along the deep venous system,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'pitting edema, confined to symptomatic leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'paralysis, paresis, or recent plaster immobilization of the lower extremity,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'previously documented DVT,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
From the patient's note, the criterion, 'alternative diagnosis to DVT as likely or more likely,' is present. Hence, we decrease the score by 2 and so total is 1 - 2 = -1.
The Well's DVT score for the patient is -1."
240,16,Wells' Criteria for DVT,risk,integer,pmc-7111022-1,Extracted,"A 43-year-old man received an ABO-compatible living donor kidney transplant donated from his father in July 2012 for treatment of end-stage renal disease. The panel-reactive antibody test of the recipient and crossmatch were negative with two mismatches of HLA-A and HLA-DQ. Neither the recipient nor donor had a history of CD. Serum antibodies to HIV, EBV, and CMV were negative before the operation. The recipient received induction therapy with a 14-day course of antilymphocyte globulin (Pressimum; Behringwerke AG, Marburg, Germany). The immunosuppressive therapy started 3 days prior to transplantation. The immunosuppressive regimen consisted of tacrolimus at 3.5 mg twice daily, mycophenolate mofetil beginning at 750 mg twice daily and tapered off during a 4-week period, prednisone beginning at 20 mg daily and tapered off during a 6-week period, and valganciclovir at 450 mg daily for 3 months post-transplantation. The prednisone was withdrawn in the second month after transplantation because of gastrointestinal bleeding. At 4 years post-transplantation, the serum globulin level was found to have gradually increased without any patient discomfort. Physical examination revealed no abnormalities. The serum creatinine level was maintained at a normal level, fluctuating from 1.1 to 1.2 mg/dL, and the urine protein was negative. The white blood cell count was mildly elevated at 10,580 cells/mm3 (normal range, 4000–10,000 cells/mm3) with 61.5% neutrophils. Serum EBV and CMV immunoglobulin (Ig)M and IgG antibodies were positive, while serum HIV and HHV-8 antibodies were negative. The RNA qualification of EBV showed 4.6 × 104 copies/mL, and CMV-DNA was negative. The serum level of interleukin 6 (IL-6) was normal. B-mode ultrasonography and computed tomography showed multiple lymphadenectases, including the bilateral cervical, inguinal, and abdominal cavity lymph nodes. No visceral enlargement or bone marrow involvement was found. Furthermore, positron emission tomography showed no abnormal metabolic signals of organomegaly or extranodal masses. Serum protein electrophoresis showed a high serum free light chain κ/λ level and low κ/λ ratio. Serum protein electrophoresis also showed an elevated percentage of gamma globulin but did not identify the monoclonal gammopathy. Immunofixation electrophoresis showed M protein negativity ().
The patient underwent biopsy of the right inguinal lymph node in a local hospital. The pathologic examination revealed a follicular pattern with some hyperplastic germinal centers, most of which were small and similarly sized with a round or oval shape. Numerous mature plasma cells were seen in medullary cords (). Cohesive large cells were present mainly in sinuses, and monocytoid B-cell proliferation was scattered in the mantle zone of the follicles; these B cells exhibited features of immunoblasts or anaplastic large cells (). Focally, the architecture was entirely destroyed by sheets of large typical cells. The pathological diagnosis was reactive lymphoid tissue of proliferated lymph nodes and slightly increased plasma cells increased in the medulla of the lymph nodes. Immunohistochemistry showed positive staining of CD3, CD5, CD43, CD38, CD138, CD21, CD23, CD20, CD79, BCL2, and Ki-67 (<10%) in the large cells, with negative staining of CK, CD10, CD56, cyclin D1, SOX11, and IgG4. EBV-encoded early RNAs were found in the plasma cells based on in situ hybridization, while CMV inclusion bodies were not observed.
Because of the persistently elevated immunoglobulin level and generalized lymph node enlargement, another celiac lymph node biopsy was performed. Pathological evaluation of the celiac lymph node showed that multiple lymphoid follicles had been infiltrated by a large number of mature plasma cells. A few small blood vessels showed hyaline degeneration with “onion skin” like changes. The germinal centers were atrophied, and the proliferation of the sleeve cells and concentric round arrangement were not obvious. The pathological diagnosis was the characteristic plasma cell subtype of CD. The plasma cells were positive for CD3, CD20, CD38, CD138, and Ki-67 (<10%) (). CD138 showed strong positive expression in the plasma cells labeled by polyclonal anti-immunoglobulin kappa light chains and lambda antibodies (). Immunostaining for EBV and CMV was negative. We thereafter adjusted the dosage of immunosuppressants, adding prednisolone at 10 mg once a day, slowly tapering the tacrolimus down from 3.5 mg twice daily to 0.5 mg twice daily, and maintaining the mycophenolate mofetil at 500 mg twice daily. Two months after adjustment of the immunosuppression agents, the elevated immunoglobulin level and enlarged lymph nodes were not ameliorated. Because of the patient’s economic conditions and risk of infection, he did not receive rituximab to treat the multicentric CD. Instead, he received a CHOP chemotherapy regimen consisting of monthly cyclophosphamide (750 g/m2, day 1), vincristine (1.4 g/m2, day 1), doxorubicin (50 g/m2, day 1), and prednisone (60 mg/m2, once daily) for four cycles. After four cycles of chemotherapy, the enlarged lymph nodes had significantly decreased in size (). At the third month of follow-up, the serum globulins had dropped to a normal level (). At the ninth month of follow-up, the size of the lymph nodes located in the abdomen, axilla, and groin had significantly decreased. No acute rejection occurred during the post-transplantation follow-up. The serum creatinine level was maintained within the normal range, fluctuating from 1.1 to 1.2 mg/dL.",What is the patient's score of Wells' criteria for Deep Vein Thrombosis? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Alternative diagnosis to Deep Vein Thrombosis as likely or more likely': True, 'Localized tenderness along the deep venous system': False, 'Active cancer': True, 'Paralysis, paresis, or recent plaster immobilization of the lower extremity': False, 'Major surgery within 12 weeks': False}",-1,-1,-1,"The criteria for the Wells' Criteria for Deep Vein Thrombosis (DVT) score are listed below:

1. Active cancer (treatment or palliation within 6 months): No = 0 points, Yes = +1 point
2. Bedridden recently >3 days or major surgery within 12 weeks: No = 0 points, Yes = +1 point
3. Calf swelling >3 cm compared to the other leg (measured 10 cm below tibial tuberosity): No = 0 points, Yes = +1 point
4. Collateral (nonvaricose) superficial veins present: No = 0 points, Yes = +1 point
5. Entire leg swollen: No = 0 points, Yes = +1 point
6. Localized tenderness along the deep venous system: No = 0 points, Yes = +1 point
7. Pitting edema, confined to symptomatic leg: No = 0 points, Yes = +1 point
8. Paralysis, paresis, or recent plaster immobilization of the lower extremity: No = 0 points, Yes = +1 point
9. Previously documented DVT: No = 0 points, Yes = +1 point
10. Alternative diagnosis to DVT as likely or more likely: No = 0 points, Yes = -2 points

The total score is calculated by summing the points for each criterion.
    
The current Well's DVT Score is 0.
From the patient's note, the criterion, 'active cancer,' is present. Hence, a point should be given, and so we increment the score by one, making the the total 0 + 1 =  1.
The issue,'bedridden recently >3 days,' is missing from the patient note and so the value is assumed to be absent from the patient. From the patient's note, the criterion, 'major surgery within 12 weeks,' is absent. Based on the Well's DVT rule, at least one of the criteria, 'bedridden recently >3 days' or 'major surgery within 12 weeks' must be true for this criteria to be met for the score to increase by 1. This is not the case for this patient, and so the score remains unchanged at 1.
The issue,'calf swelling >3 cm compared to the other leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'collateral (nonvaricose) superficial veins present,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
The issue,'entire leg swollen,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
From the patient's note, the criterion, 'localized tenderness along the deep venous system,' is absent. Hence, a point should not be given, and so total remains at 1.
The issue,'pitting edema, confined to symptomatic leg,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
From the patient's note, the criterion, 'paralysis, paresis, or recent plaster immobilization of the lower extremity,' is absent. Hence, a point should not be given, and so total remains at 1.
The issue,'previously documented DVT,' is missing from the patient note and so the value is assumed to be absent from the patient. Hence, a point should not be given, and so total remains at 1.
From the patient's note, the criterion, 'alternative diagnosis to DVT as likely or more likely,' is present. Hence, we decrease the score by 2 and so total is 1 - 2 = -1.
The Well's DVT score for the patient is -1."
241,17,Revised Cardiac Risk Index for Pre-Operative Risk,risk,integer,pmc-8604462-1,Extracted,"A 62-year-old male woke up in the middle of the night with 10/10 substernal chest pain and tightness, non-radiating, which lasted for one hour and was associated with palpitations and shortness of breath, with no aggravating or alleviating factors. His chronic medical problems included essential hypertension, benign prostate hypertrophy, nicotine-dependent tobacco abuse with 42-pack-year, and remote history of bladder cancer which had been cured and currently tumor free. Six weeks ago, he developed a dry cough; 2 weeks ago, he presented to a walk-in clinic where chest x-ray and follow up CT chest with IV contrast revealed a right upper lobe mass, concerning for primary lung cancer. He endorsed 10 kg unintentional weight loss despite the same oral intake over 2 months. He denied a history of coronary artery disease, exertional chest pain, or shortness of breath. On admission, vital signs demonstrated temperature 99°F, pulse 101 bpm, respiration 19 per minute, BP 117/79 mmHg, SpO2 98% on 2 L nasal cannula of oxygen. Physical exam was unremarkable, including regular cardiac rhythm, S1 and S2 are present, no heart murmur or friction rub.
Laboratory studies showed WBC 13.2 × 103/μL, hemoglobin 12.8 g/dL, hematocrit 38.4%, platelet 246 × 103/μL; potassium 4.4 mEq/L, BUN 13 mg/dL, creatinine 0.88 mg/dL; Calcium 10.7 mg/dL; Magnesium 2.2 mg/dL; Total bilirubin 0.7 mg/dL, AST 15 U/L, ALT 9 U/L, ALP 126 U/L, total protein 7.2 g/dL, albumin 3.7 g/dL; LDH 707 IU/L (reference range, 100–245 IU/L); First set of troponin I, <0.01 ng/dL, 2nd set <0.01 ng/dL 7 hours later, 0.023 ng/dL 24 hours later; Triglycerides 79 mg/dL, total cholesterol 152 mg/dL, HDL 30 mg/dL, LDL 106 mg/dL.
CT chest with IV contrast 2 weeks prior to presentation showed spiculated right upper lobe masses of 2.4 × 1.7 cm and 2.7 × 1.7 cm; superior mediastinum mass of 5.4 × 4.1 cm, large right hilar mass of 5.5 × 3.7 cm with post-obstructive atelectasis or pneumonia; extensive mediastinal lymphadenopathy with narrowing of the superior vena cava likely representing primary lung cancer; small or moderate pericardial effusion; left adrenal nodule suspicious for metastasis. CTA chest on admission showed no evidence of pulmonary embolus; increased pericardial effusion.
On admission, ECG showed sinus rhythm, heart rate 95 bpm, ST elevation at lead II, aVF and III, no Q wave, with ST depression at lead aVR and V1 (). Prior ECG available 5 years ago revealed normal sinus rhythm without ST-T changes (not shown). The patient was diagnosed with presumed acute inferior STEMI, and underwent emergent cardiac catheterization, which revealed middle LAD 30% stenosis, middle LCx 30% stenosis, and distal RCA 30% stenosis, and no percutaneous intervention was warranted.
The initial differential diagnoses for the patient’s chest pain and inferior ST-elevation ECG changes included inferior STEMI, unstable angina, coronary artery spasm, regional pericarditis, and pulmonary embolism. Serial evaluation of troponin I, ECGs, and cardiac catheterization findings ruled out acute coronary syndrome. CT angiogram chest ruled out pulmonary embolism.
On hospital day 1, the patient developed positional pleuritic chest pain. Physical exam revealed no pericardial rub. Repeated ECG revealed persistent inferior lead ST elevations, no Q wave (not shown), similar to admission ECG; echocardiogram revealed pericardial effusion without tamponade. Laboratory studies showed WBC 13.2 × 103/μL, CRP 103.7 mg/L, and ESR 102 mm/hr. Given leukocytosis and elevated inflammatory markers of CRP and ESR, as well as echocardiogram evidence of pericardial effusion, the patient was diagnosed with inferior regional pericarditis.
A pericardiocentesis was performed with 680 mL serous fluid drained on hospital day 1. The pericardial catheter was left in place for 48 hours, when the drainage was less than 25 ml/day, the catheter was removed. Pericardial effusion cell count and differential showed WBC 29,855/mm3, RBC 473/mm3, and neutrophil 83%, lymphocytes 7%, monocyte 10%; pH 7.5, glucose 97 g/dL, triglycerides 25 mg/dL, cholesterol 98 mg/dL, protein 4.9 g/dL, LDH 896 IU/L.
Pericardial fluid culture revealed no bacterial, fungal or mycobacterial growth; Cytopathology showed atypical inflammatory cells and favor reactive, no malignant cells. The patient was treated with colchicine and ibuprofen, and his pleuritic chest pain resolved in 2 days. Patient was continued on colchicine and ibuprofen on discharge. Two weeks later, repeated ECG revealed normalized ST waves (not shown); repeat CT chest without contrast revealed significant improvement in the pericardial effusion.
As for patient’s newly diagnosed lung cancer, lung cancer staging revealed brain metastasis by MRI brain, and hepatic and bilateral adrenal metastasis by CT abdomen and pelvis. Bronchoscopy showed complete obstruction right upper lobe bronchus just distal to its origin by submucosal and mucosal infiltration of tumor. Biopsy and surgical pathology revealed poorly differentiated carcinoma.",What is the patient's score of the Revised Cardiac Risk Index for Pre-Operative Risk? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'History of ischemic heart disease': False, 'age': [62, 'years'], 'Pre-operative creatinine': [0.88, 'mg/dL']}",0,0,0,"The criteria for the Revised Cardiac Risk Index (RCRI) are listed below:

1. Elevated-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular): No = 0 points, Yes = +1 point
2. History of ischemic heart disease (history of myocardial infarction, positive exercise test, current chest pain due to myocardial ischemia, use of nitrate therapy, or ECG with pathological Q waves): No = 0 points, Yes = +1 point
3. History of congestive heart failure (pulmonary edema, bilateral rales or S3 gallop, paroxysmal nocturnal dyspnea, or chest x-ray showing pulmonary vascular redistribution): No = 0 points, Yes = +1 point
4. History of cerebrovascular disease (prior transient ischemic attack or stroke): No = 0 points, Yes = +1 point
5. Pre-operative treatment with insulin: No = 0 points, Yes = +1 point
6. Pre-operative creatinine >2 mg/dL (176.8 μmol/L): No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.

The current cardiac risk index is 0.
The patient note does not mention anything about an elevated risk surgery and is assumed to be absent. This means that the total score remains unchanged at 0.
Based on the patient note, a history of ischemetic heart disease is determined to be absent for the patient. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of congestive heart failure and is assumed to be absent. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of cerebrovascular disease and is assumed to be absent. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a pre-operative insulin treatment and is assumed to be absent. This means that the total score remains unchanged at 0.
The concentration of Pre-Operative Creatinine is 0.88 mg/dL. The patient's pre-operative creatinine is less than or equal to 2 mg/dL, so we keep the score the same at 0.

The cardiac risk index score is 0."
242,17,Revised Cardiac Risk Index for Pre-Operative Risk,risk,integer,pmc-5005698-1,Extracted,"A 62-year-old African American man was referred to a pharmacist-managed anticoagulation clinic for follow-up status post-extensive bilateral PE. The patient had received warfarin 10 mg daily for 2 days during the hospitalization, then was discharged with 5 mg daily. Six days after discharge, the patient presented for an initial anticoagulation clinic visit with an INR of 2.3 (goal INR 2.0–3.0). He was instructed to continue 5 mg daily and to return 7 days later. At the next visit, point-of-care testing revealed an INR of >8.0. His last dose was taken in the morning the same day. The patient denied extra warfarin doses. There was no suggestion of concurrent acute illness or recent alcohol intake. He initially denied any new prescription or supplemental medications, and stated adherence with his maintenance medications, including chlorthalidone and losartan. He denied signs and symptoms consistent with bruising and bleeding. His active problem list included hypertension, osteoarthritis, sleep apnea, and gout. Past medical history included a PE less than 3 years earlier. At that time, he was maintained on warfarin 22.5 mg weekly for a treatment duration of 18 months. Laboratory examination prior to hospital discharge revealed hemoglobin 11.1 g/dL, hematocrit 33.9 %, and platelets 134 K/mcL. Liver function tests were within the normal range. The creatinine level was 1.75 mg/dL with an estimated creatinine clearance of 46 mL/min (using ideal body weight).
On further questioning, the patient reported starting a new prescription medication 5 days earlier. The tablet was described as small and triangular shaped. The anticoagulation clinic contacted the patient’s community pharmacy and determined the medication was rivaroxaban 20 mg. Communication among the anticoagulation clinic staff revealed that this prescription had been placed after the initial visit because the patient inquired about the cost of rivaroxaban with his insurance plan. The community pharmacy placed the rivaroxaban prescription on hold rather than discontinue the order as the anticoagulation clinic staff had requested. When the patient presented to his pharmacy the next day to pick up a different medication refill, the rivaroxaban prescription had been filled and was included in the orders ready for pick up. He reportedly did not receive counseling when it was dispensed. He thought it was a new medication for neuropathy, as this problem had been recently discussed with his primary care physician. Despite reading the term ‘blood thinner’ in the medication guide, the patient did not clarify its indication with the dispensing pharmacist or anticoagulation clinic. He had picked up the original warfarin prescription 8 days earlier.
The patient had a prolonged coagulation time; however, the actual INR was uncertain given the limitations of the point-of-care device and the patient’s reluctance to visit the laboratory for a venous blood draw. One consideration was the initial warfarin dosing was excessive, based on the comparison of his current dosing (5 mg daily) with his previous dose requirements (22.5 mg weekly). There was also the possibility the coagulopathy was due to concurrent administration of rivaroxaban. When switching from warfarin to rivaroxaban, it is recommended to discontinue warfarin and start rivaroxaban when the INR is <3.0. The intent is to not only avoid inadequate anticoagulant effects during the transition but also to avoid duplication for an extended time interval [].
The anticoagulation clinic considered several ways to manage this patient. The patient did not desire to continue rivaroxaban, so this alternative was dismissed. The administration of vitamin K as a reversal strategy for warfarin was one option but could have placed the patient at high risk for recurrent VTE. For this same concern, the staff were reluctant to hold warfarin doses with the possibility of a resultant subtherapeutic INR. The patient was ultimately advised to take warfarin 2.5 mg daily for 3 days and then 5 mg for 1 day. He was counseled to monitor for signs and symptoms of bleeding and to seek emergent care if symptomatic. At a morning visit 5 days later, the INR was 4.3. He denied signs and symptoms of bleeding. INR monitoring occurred weekly to biweekly over the next 6 weeks. A total weekly dose of 22.5 mg was found to be sufficient to maintain INR in the goal range.",What is the patient's score of the Revised Cardiac Risk Index for Pre-Operative Risk? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Pre-operative creatinine': [1.75, 'mg/dL'], 'age': [62, 'years']}",0,0,0,"The criteria for the Revised Cardiac Risk Index (RCRI) are listed below:

1. Elevated-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular): No = 0 points, Yes = +1 point
2. History of ischemic heart disease (history of myocardial infarction, positive exercise test, current chest pain due to myocardial ischemia, use of nitrate therapy, or ECG with pathological Q waves): No = 0 points, Yes = +1 point
3. History of congestive heart failure (pulmonary edema, bilateral rales or S3 gallop, paroxysmal nocturnal dyspnea, or chest x-ray showing pulmonary vascular redistribution): No = 0 points, Yes = +1 point
4. History of cerebrovascular disease (prior transient ischemic attack or stroke): No = 0 points, Yes = +1 point
5. Pre-operative treatment with insulin: No = 0 points, Yes = +1 point
6. Pre-operative creatinine >2 mg/dL (176.8 μmol/L): No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.

The current cardiac risk index is 0.
The patient note does not mention anything about an elevated risk surgery and is assumed to be absent. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of ischemetic heart disease and is assumed to be absent. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of congestive heart failure and is assumed to be absent. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of cerebrovascular disease and is assumed to be absent. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a pre-operative insulin treatment and is assumed to be absent. This means that the total score remains unchanged at 0.
The concentration of Pre-Operative Creatinine is 1.75 mg/dL. The patient's pre-operative creatinine is less than or equal to 2 mg/dL, so we keep the score the same at 0.

The cardiac risk index score is 0."
243,17,Revised Cardiac Risk Index for Pre-Operative Risk,risk,integer,pmc-3905387-1,Extracted,"A 56-year-old man was transferred to nephrology department due to recurrent episodes of fever (38°C～39.2°C), cough, sputum, and thoracalgia for the past three months. The patient had been admitted previously to a local hospital where computer tomography (CT) revealed pleural effusion in both lungs. Laboratory tests showed serum creatinine (sCr) 221.9 μmol/L; proteinuria (3+); and 24 hour proteinuria 5.3g. The patient was diagnosed with chronic renal insufficiency, and pulmonary infection. He was treated with antibiotics for pulmonary infection, but infection-related symptoms gradually worsened and serum creatinine levels reached 434μmol/L within one week. Subsequently, the patient was transferred to our unit for further treatment.
On admission, physical examination showed T 38°C; R, 18 bpm; HR, 99 bpm; and BP 124/60 mmHg. Laboratory tests found hemoglobin (Hb) 81 g/L; WBC 18.27x109/L, ESR 49.0 mm/H, and sCr 611.0 μmol/L; Urea 22.90 mmol/L; antinuclear antibody (ANA) (−); extractable nucler antigen (ENA) (−); C-reactive protein (CRP) 231mg/L; IgG 10.1g/L; IgA 1650.0 mg/L; IgM 345.0 mg/L; IgE 227.95 IU/mL; RBC 30~40/HPF in the 
; and 24 hour proteinuria 2.9 g/L. Ultrasound examination of the urologic system showed enlarged kidneys. Additional laboratory tests found P-ANCA (1:10) (+); ANCA-MPO (+); anti-GBM antibody (−). The patient was diagnosed with ANCA-associated vasculitis, AAV associated glomerulonephritis and put on CVVH and antibiotic therapy. After one week, the patient’s infection-related symptoms gradually improved, and the patient was put on intravenous methylprednisolone therapy (80 mg/d).
Four days later, however, the patient developed melana mixed with bloody stool. Laboratory tests revealed Hb 87g/L, Cr 586.9 umol/L, PLT 355×109/L, Fib 2.48 g/L, PT 17.8s, Antithrombin III 92.2%. The gastroscopy and colonoscopy were normal. And capsule endoscopy revealed no obvious abnormalities, including bleeding of mucous membrane. Conventional therapy of GI bleeding (PPI and somatostatin) was ineffective. Finally selective mesenteric arterial angiography was performed, which indicated a hemorrhagic spot in a branch of the inferior mesenteric artery (). Selective transarterial embolization was performed with steel coils (Cook, Bloomington, USA.) (). After the procedure, GI bleeding was completely alleviated. However, two weeks later, the patient presented with hematochezia again and selective transarterial angiography was performed repeatedly, which revealed another hemorrhagic spot in a branch of IMA, and subsequently arterial embolization with coils was performed again (, ).
After TAE, the symptoms improved and three days later, the repeated fecal-occult-blood tests were negative, but the vasculitis was not completely controlled for the other symptoms were still existed. The patient was treated with a course of intravenous methylprednisolone pulse therapy (500 mg/d) followed by a course of intravenous cyclophosphamide (CTX) pulse therapy (600mg). Moreover, the patient underwent repeated plasma exchange (8 sections), blood products transfusion, cryoprecipitate therapy, and intravenous gamma globulin infusion (20 g/d for 5 days).",What is the patient's score of the Revised Cardiac Risk Index for Pre-Operative Risk? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Congestive Heart Failure criteria for the Cardiac Risk Index rule': False, 'Pre-operative creatinine': [611.0, 'µmol/L'], 'age': [56, 'years']}",1,1,1,"The criteria for the Revised Cardiac Risk Index (RCRI) are listed below:

1. Elevated-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular): No = 0 points, Yes = +1 point
2. History of ischemic heart disease (history of myocardial infarction, positive exercise test, current chest pain due to myocardial ischemia, use of nitrate therapy, or ECG with pathological Q waves): No = 0 points, Yes = +1 point
3. History of congestive heart failure (pulmonary edema, bilateral rales or S3 gallop, paroxysmal nocturnal dyspnea, or chest x-ray showing pulmonary vascular redistribution): No = 0 points, Yes = +1 point
4. History of cerebrovascular disease (prior transient ischemic attack or stroke): No = 0 points, Yes = +1 point
5. Pre-operative treatment with insulin: No = 0 points, Yes = +1 point
6. Pre-operative creatinine >2 mg/dL (176.8 μmol/L): No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.

The current cardiac risk index is 0.
The patient note does not mention anything about an elevated risk surgery and is assumed to be absent. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of ischemetic heart disease and is assumed to be absent. This means that the total score remains unchanged at 0.
Based on the patient note, a history of congestive heart failure is determined to be absent for the patient. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of cerebrovascular disease and is assumed to be absent. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a pre-operative insulin treatment and is assumed to be absent. This means that the total score remains unchanged at 0.
The concentration of Pre-Operative Creatinine is 611.0 µmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of Pre-Operative Creatinine from µmol to mg. The mass of Pre-Operative Creatinine is 611.0 µmol. To convert 611.0 µmol of Pre-Operative Creatinine to mol, multiply by the conversion factor 1e-06, giving us 611.0 µmol Pre-Operative Creatinine * 1e-06 mol/µmol = 0.00061 mol Pre-Operative Creatinine. To convert from mol Pre-Operative Creatinine to grams, multiply by the molar mass 113.12 g/mol, which will give 0.00061 mol Pre-Operative Creatinine * 113.12 g/mol = 0.069 g Pre-Operative Creatinine. To convert 0.069 g of Pre-Operative Creatinine to mg, multiply by the conversion factor 1000.0, giving us 0.069 g Pre-Operative Creatinine * 1000.0 mg/g = 69.0 mg Pre-Operative Creatinine. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 69.0 mg Pre-Operative Creatinine/10.0 dL = 6.9 mg Pre-Operative Creatinine/dL. The concentration value of 611.0 µmol Pre-Operative Creatinine/L converts to 6.9 mg Pre-Operative Creatinine/dL. The patient's pre-operative creatinine is greater than 2 mg/dL, so we increment the score by one and the current total will be 0 + 1 = 1.

The cardiac risk index score is 1."
244,17,Revised Cardiac Risk Index for Pre-Operative Risk,risk,integer,pmc-4605264-1,Extracted,"A 54-year-old Caucasian man presented to his infectious disease physician in October 2014 with fatigue, nausea, and anorexia for the last 5 days that had been preceded by several episodes of bloody diarrhea of 10 days' duration. He denied abdominal pain, diminished urine output, or macroscopic hematuria. His past medical history was significant for HIV infection for 10 years with the most recent CD4 count of 180; current treatment consisted of Atazanavir, Emtricitabine, Tenofovir, and Ritonavir. He also had a history of chronic hepatitis C infection. He had a previous history of injection drug use that had been complicated by 2 episodes of infective endocarditis requiring a mechanical mitral valve replacement in 1997. Since that time, he had been treated with warfarin anticoagulation, INR 2.5–3.5. He admitted taking additional doses of warfarin when he had migraine headaches as he thought this would improve blood flow. On physical examination, he was afebrile with a supine blood pressure (BP) of 109/65 mmHg but with postural drop to 95/55 mmHg. His JVP was flat with no evidence of lower extremity edema. He did not have a skin rash or detectable heart murmur. The remainder of his examination was otherwise unremarkable.
His laboratory data on admission are outlined in . His urinalysis was significant for 5–30 RBC/HPF and hyaline casts; no heme granular or red blood cell casts were seen. His urine albumin : creatinine ratio was 217 g/mol Cr. His creatinine which was 1.4 mg/dL in July 2014 had increased to 19.9 mg/dL. Abdominal ultrasonography showed normal-sized kidneys with slightly increased right renal parenchymal echogenicity.
After fluid resuscitation failed to improve his acute kidney injury (AKI), he underwent hemodialysis for metabolic acidosis. Other investigations included (1) anemia work-up for a declining hemoglobin [11.1 g/dL to 6.6 g/dL after fluid resuscitation without evidence of bleeding or falling platelet count (137 × 109/L)] included blood film review which showed polychromasia without schistocytes, LDH 153 (N: 100–205 units), haptoglobin < 0.08 (N: 0.3–2.0 units), total bilirubin of 43 (N: 3–17 units), direct bilirubin of 6 (N: 2–9 units), iron percent saturation 86 (N: 20–50), and ferritin 314 (N: 24–336), making TTP and HUS unlikely with the stable platelet count and absence of schistocytes on blood smear. Further investigations showed (1) a positive random urine for hemosiderin and (2) renal biopsy that showed severe acute tubular necrosis (ATN) caused by extensive renal hemosiderosis with extensive iron depositions in the tubules; the glomeruli were spared from deposition and damage (Figures and ). There was focal interstitial chronic inflammation, mild interstitial fibrosis, mild tubular atrophy, and mild-to-moderate arterial atherosclerosis. Immunofluorescent staining: IgG: Negative, IgA: negative, IgM: equivocal, complement (C3): equivocal, C1q: negative, albumin: negative, and Kappa/Lambda: negative. Special stains for iron show strong diffuse positivity in the tubules (). Electron microscopy showed segmental effacement of foot process with no evidence of electron dense deposits ().
(3) Clostridium difficile toxin B was detected by PCR, (4) normal genetic testing for HFE (human hemochromatosis protein gene) mutation excluding hemochromatosis, negative flow cytometry for PNH (paroxysmal nocturnal hemoglobinuria), a normal glucose-6-phosphate dehydrogenase screen (excluding hemolysis secondary to G6PD deficiency anemia), and (5) transesophageal echocardiogram which showed that the prosthetic mitral valve is functioning well without evidence of paravalvular leak or mitral valve regurgitation
The patient stabilized in hospital with treatment of his AKI and Clostridium difficile infection. He remained on 3-times-per-week hemodialysis for ten weeks when his AKI recovered and his central venous catheter was removed.",What is the patient's score of the Revised Cardiac Risk Index for Pre-Operative Risk? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Congestive Heart Failure criteria for the Cardiac Risk Index rule': False, 'Pre-operative creatinine': [19.9, 'mg/dL'], 'History of ischemic heart disease': False, 'age': [54, 'years']}",1,1,1,"The criteria for the Revised Cardiac Risk Index (RCRI) are listed below:

1. Elevated-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular): No = 0 points, Yes = +1 point
2. History of ischemic heart disease (history of myocardial infarction, positive exercise test, current chest pain due to myocardial ischemia, use of nitrate therapy, or ECG with pathological Q waves): No = 0 points, Yes = +1 point
3. History of congestive heart failure (pulmonary edema, bilateral rales or S3 gallop, paroxysmal nocturnal dyspnea, or chest x-ray showing pulmonary vascular redistribution): No = 0 points, Yes = +1 point
4. History of cerebrovascular disease (prior transient ischemic attack or stroke): No = 0 points, Yes = +1 point
5. Pre-operative treatment with insulin: No = 0 points, Yes = +1 point
6. Pre-operative creatinine >2 mg/dL (176.8 μmol/L): No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.

The current cardiac risk index is 0.
The patient note does not mention anything about an elevated risk surgery and is assumed to be absent. This means that the total score remains unchanged at 0.
Based on the patient note, a history of ischemetic heart disease is determined to be absent for the patient. This means that the total score remains unchanged at 0.
Based on the patient note, a history of congestive heart failure is determined to be absent for the patient. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of cerebrovascular disease and is assumed to be absent. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a pre-operative insulin treatment and is assumed to be absent. This means that the total score remains unchanged at 0.
The concentration of Pre-Operative Creatinine is 19.9 mg/dL. The patient's pre-operative creatinine is greater than 2 mg/dL, so we increment the score by one and the current total will be 0 + 1 = 1.

The cardiac risk index score is 1."
245,17,Revised Cardiac Risk Index for Pre-Operative Risk,risk,integer,pmc-5965104-1,Extracted,"A 52-year-old woman came to the emergency department (ED) for hemodialysis (HD) due to end-stage renal disease (ESRD). She had spent the preceding several weeks in an outside hospital being treated for pneumonia and bacteremia with daptomycin. She subsequently left against medical advice (AMA) after having her dialysis access catheter removed. She presented to our ED because she needed HD vascular access placement and re-initiation of dialysis treatments. Her medical history included chronic kidney disease secondary to hypertensive nephrosclerosis, anemia, hypertension, deep venous thromboses (DVT), systemic lupus erythematosus, and a seizure disorder of unknown etiology.
The patient, a Jehovah’s Witness, refused blood transfusions; therefore, her anemia was being treated with intravenous (IV) administration of iron, epoetin alfa, and folate. Other medications included nifedipine, clonidine, metoprolol, sevelamer, and prednisone. She was allergic to amoxicillin, azithromycin, hydralazine, labetolol, linezolid, morphine, and vancomycin. She reported previous IV heroin use many years earlier and previous cigarette smoking. She denied alcohol use or any current drug or tobacco use.
Upon arrival, she was alert and in no acute distress with a fever of 38.3° Celsius, heart rate of 87 beats per minute (bpm), blood pressure of 110/65 millimeters mercury (mmHg), respiratory rate of 17 breaths per minute, and pulse oximetry of 99% while breathing room air. She weighed 80 kilograms and was 5 feet 6 inches tall. Her head was normocephalic and atraumatic with moist mucous membranes. Pupils were anicteric, equal, round, and reactive to light and accommodation. The neck was supple and without lymphadenopathy or tenderness. Her lungs had coarse breath sounds with mild bibasilar crackles but no wheezes or rhonchi. There were no retractions or increased work of breathing. Her heart was of regular rate and rhythm without murmurs, rubs, or gallops. Her abdomen was soft with normal bowel sounds and without distention, tenderness, rebound, or guarding. There was no costovertebral angle tenderness. The lower extremities had 1+ pitting edema, 2+ dorsalis pedis pulses, and were without tenderness or deformity. The patient had normal strength and muscle tone throughout all extremities with intact sensation. Old fistulas were present in the left and right upper extremities without palpable thrills. She was alert and oriented to person, place, and time.
The patient’s initial laboratory values are shown in . These were significant for a slight leukocytosis, anemia to 5.3 g/dL, thrombocytopenia, hyperkalemia, and an elevated creatinine of 11.9 mg/dL. Her initial electrocardiogram (ECG) showed a sinus tachycardia with T-wave inversions in leads I and V6 (). This was unchanged from a prior ECG. The patient was admitted to the medicine team and was started on daptomycin. While awaiting bed placement, a non-tunneled left femoral dialysis catheter was inserted by the medical intensive care unit (ICU) fellow for initiation of HD. Placement was confirmed by the easy drawback of blood from all ports. During the consent process for catheter placement, it was documented that the patient stated she “would rather die than receive blood transfusions.” Following catheter placement, an attempt was made to start HD, but she became hypotensive and complained of weakness almost immediately. Her vital signs during the initial HD attempt were a blood pressure of 85/56 mmHg with a heart rate of 105 bpm.
Because the patient was symptomatic and hypotensive during HD, continuous renal replacement therapy (CRRT) was initiated. Shortly afterward, she became hypotensive, unresponsive, and had a tonic clonic seizure. Vital signs at that time were a heart rate of 113 bpm, blood pressure 75/48 mmHg, respiratory rate of 20 breaths per minute, and oxygen saturation of 78% on room air. A brief, repeat physical exam showed the patient was unresponsive to painful stimuli and her pupils were equal and reactive. She was given 4 mg of lorazepam and intubated for airway protection. A right arterial femoral line and a right femoral triple lumen venous central line were placed. A chest radiograph confirmed endotracheal tube placement (). CRRT was halted but the patient remained in shock despite bolus infusions of crystalloid, so vasopressors were started. She was receiving escalating doses of vasopressors when repeat laboratory values indicated a hemoglobin of 1.6 g/dL ().
Shortly thereafter she went into cardiac arrest with a rhythm of pulseless electrical activity (PEA). Return of spontaneous circulation was achieved after six minutes of cardiopulmonary resuscitation. Increased abdominal distention was noted during the resuscitation; therefore, a pressure-sensing urinary catheter was introduced. Her peak airway and bladder pressures were measured at greater than 60 cmH2O and 50 mmHg, respectively. Surgery was then consulted. A massive transfusion protocol was initiated after her next of kin agreed to allow the transfusion of blood products. A focused assessment with sonography for trauma (FAST) was performed, showing free fluid in Morrison’s pouch. As resuscitative measures were continued, an additional study was obtained and a diagnosis was made.",What is the patient's score of the Revised Cardiac Risk Index for Pre-Operative Risk? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Congestive Heart Failure criteria for the Cardiac Risk Index rule': False, 'Pre-operative treatment with insulin': False, 'Pre-operative creatinine': [11.9, 'mg/dL'], 'age': [52, 'years']}",1,1,1,"The criteria for the Revised Cardiac Risk Index (RCRI) are listed below:

1. Elevated-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular): No = 0 points, Yes = +1 point
2. History of ischemic heart disease (history of myocardial infarction, positive exercise test, current chest pain due to myocardial ischemia, use of nitrate therapy, or ECG with pathological Q waves): No = 0 points, Yes = +1 point
3. History of congestive heart failure (pulmonary edema, bilateral rales or S3 gallop, paroxysmal nocturnal dyspnea, or chest x-ray showing pulmonary vascular redistribution): No = 0 points, Yes = +1 point
4. History of cerebrovascular disease (prior transient ischemic attack or stroke): No = 0 points, Yes = +1 point
5. Pre-operative treatment with insulin: No = 0 points, Yes = +1 point
6. Pre-operative creatinine >2 mg/dL (176.8 μmol/L): No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.

The current cardiac risk index is 0.
The patient note does not mention anything about an elevated risk surgery and is assumed to be absent. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of ischemetic heart disease and is assumed to be absent. This means that the total score remains unchanged at 0.
Based on the patient note, a history of congestive heart failure is determined to be absent for the patient. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of cerebrovascular disease and is assumed to be absent. This means that the total score remains unchanged at 0.
Based on the patient note, a pre-operative insulin treatment is determined to be absent for the patient. This means that the total score remains unchanged at 0.
The concentration of Pre-Operative Creatinine is 11.9 mg/dL. The patient's pre-operative creatinine is greater than 2 mg/dL, so we increment the score by one and the current total will be 0 + 1 = 1.

The cardiac risk index score is 1."
246,17,Revised Cardiac Risk Index for Pre-Operative Risk,risk,integer,pmc-7440890-1,Extracted,"A 53-year-old woman presented to the emergency department with a 12-month history of menometrorrhagia and a one-week history of worsening nausea and vomiting. Her past medical history included a moderate developmental delay, severe valvular aortic stenosis, insulin-dependent diabetes mellitus, hypertension, morbid obesity, and hypothyroidism. She had no smoking history. On physical examination, the patient was 216 lbs with a BMI of 51.9 lbs/in2 and a blood pressure at 162/72 mmHg while tachycardic at 102 beats per minute. A 4/6 aortic systolic murmur was auscultated, and her abdomen was distended with mild tenderness to palpation, particularly in the lower quadrants. She was found to have a stage 3 acute kidney injury with a creatinine of 5.7 mg/dL (baseline 1.4 mg/dL), calcium of 9.3 mg/dL, lactic acid of 1.2 mmol/L, hemoglobin of 7.8 g/dL, and leukocytosis with a white blood cell count of 65,000/mm3. A CT scan of her abdomen and pelvis showed a 15.5-cm pelvic mass with areas of high attenuation noted within and extending into the adjacent ascites. A review of previous imaging (CT urogram from nine months prior) showed no previous evidence of these findings. A CT of her chest was unremarkable.
Her aortic valve area was measured to be 0.49 cm2 six months prior on an echocardiogram and precluded her from receiving a dilation and curettage for her menometrorrhagia. Cardiac intervention with a transcatheter aortic valve replacement (TAVR) was planned but had not yet been accomplished.
The patient was admitted, and a paracentesis removing 3 L was performed. The serum ascites albumin gradient was <1.1 g/dL with a protein level of 3.5 g/dL and an albumin of 1.90 g/dL, and ascites cytology showed no malignant cells. A CT scan of her abdomen and pelvis and a transvaginal ultrasound showed a heterogeneous mass in the pelvis, superior and to the right of the uterus measuring 17.3 x 15.9 x 11.3 cm; these radiological findings were thought to be “likely consistent with a large focus of hemorrhage/hematoma” or an undetermined malignancy. The uterus had a 10-mm endometrial stripe, the right ovary measured 5.0 x 6.8 x 3.4 cm and the left ovary measured 3.3 x 1.8 x 2.4 cm.
The patient was cognitively impaired due to developmental delay that prevented her from being able to make informed medical decisions. Due to a complicated social situation, it took nearly a week to establish her sister as her legal designated power of attorney (DPOA) that unfortunately delayed her treatment. A gynecology oncology consultant recommended an endometrial biopsy and resection of her pelvic mass by a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and tumor debulking. Anesthesiology and cardiology consultants recommended cardiac optimization for this surgery, which included a TAVR procedure.
The CA-125 (cancer-antigen 125) was found to be significantly elevated at 1,357 U/mL. An endometrial tissue biopsy was performed for which a pathology review determined it to be an endometrioid adenocarcinoma, Federation of Gynecology and Obstetrics (FIGO) grade 1. A bilateral uterine artery embolization was performed to mitigate her menometrorrhagia, during which a consultant interventional radiologist noted her uterus to be hypervascular with equal blood supply from bilateral uterine arteries along with “an enlarged right ovarian artery arising from the right uterine artery supplying the enhancing portions of the previously seen large pelvic mass.” This enlarged ovarian artery was also embolized. This was the first radiographic evidence that her pelvic mass may have been of ovarian origin.
Cardiology and cardiothoracic surgery performed a TAVR after a delay of several days due to scheduling issues. The patient was initiated on dual antiplatelet therapy with aspirin and clopidogrel with plans for one month of uninterrupted therapy, after which her surgery would be performed. A multidisciplinary meeting was arranged with consultants from radiology, gynecology oncology, medical oncology, and pathology for future treatment planning. It was concluded that (1) her pelvic mass most closely resembled a bulky uterine or ovarian malignancy with possible mesenteric implants, and no further biopsies were recommended due to the patient’s need for continual dual antiplatelet therapy; and (2) recommended preoperative treatment was megestrol acetate, as grade 1 endometrial adenocarcinoma is typically a hormonally responsive tumor, and the patient and her sister had chosen not to pursue any neoadjuvant chemotherapy. Recommendations for adjuvant chemotherapy or additional treatment would be based on final surgical pathology.
A leukocytosis is persistent throughout her admission, which was suspected to be secondary to tumor production of granulocyte colony stimulating factor (G-CSF); this has been documented in the medical literature to be associated with ovarian cancers. Her acute kidney injury resolved and her creatinine decreased to 1.18 mg/dL. Two paracenteses performed during her admission removed a total of 4 L. After a three-week hospital admission, she was discharged to a skilled nursing facility on her previous diuretic therapy, aspirin and clopidogrel for her aortic valve replacement, and megestrol acetate for her endometrial cancer with a close gynecology oncology follow-up for surgical planning.
Two days after her discharge, the patient returned to the emergency department with dyspnea, lower extremity pitting edema, worsened abdominal distension, significant constipation, and newly reported urinary retention. Her weight had increased to 240 lbs, a 24-lb increase since at her previous admission. She was afebrile with a blood pressure of 103/68 mmHg, yet tachycardic to 112 beats per minute and tachypneic to 24 respirations per minute. She appeared comfortable and was oxygenating appropriately on ambient air. Her abdomen appeared slightly more distended without any tenderness or peritoneal signs, and she denied any significant abdominal pain. She continued to have a leukocytosis of 44,000/mm3 and her creatinine was 1.26 mg/dL with a hemoglobin of 8.6 g/dL; there were no other significant lab findings. There was no evidence of any active infection and her lactic acid was 1.9 mmol/L. A foley catheter was placed, and 150 mL of urine was removed. An abdominal ultrasound showed only minimal abdominal ascites (an insufficient amount for a paracentesis) with an inaccessible ascites pocket in the pelvis along with a pelvic mass that appeared larger than during previous admission, confirmed by a CT scan (Figure ).
Cardiology was consulted along with gynecology oncology to coordinate her surgery as soon as possible, as her new symptoms were suspected to be secondary to mass effect from her pelvic tumor.
On the second hospital day, the patient was evaluated in the morning and reported no new symptoms other than difficulty sleeping. Her vital signs had stabilized overnight, and she reported no significant abdominal pain, though she continued to be oliguric despite a urinary catheter placement. Two hours later, she suffered an asystole cardiac arrest and expired despite attempts at cardiopulmonary resuscitation.
The patient’s sister requested an autopsy to further investigate for a cause of death and the primary medical team suspected a pulmonary embolism occurred due to her sudden demise, despite having received adequate subcutaneous heparin deep vein thrombosis (DVT) prophylaxis. During the autopsy, when incising the abdomen, approximately 2 L of blood-tinged fluid was ejected under high pressure. The patient’s diaphragm was found to be displaced upwards by abdominal contents and a large pelvic mass, around which there was a focal discoloration of the bowel and mesentery suggestive of ischemia (Figure ).
No thromboembolisms were found. The necrotic endometrium was found to be 0.1-0.5 cm in thickness and the right ovary measured 19 x 14.2 x 12 cm with a 10-cm central cavity containing 500 mL of bloody necrotic fluid; both uterine arteries were embolized in addition to an enlarged ovarian artery branching off the right uterine artery, which had resulted in this central necrosis. The left ovary was 6 x 8 x 4.2 cm. The massive right ovary was somewhat unexpected as on previous imaging it could not be clearly distinguished due to pelvic organs being so adherent and surrounded by abdominal ascites (Figure ).
On microscopic examination, the endometrium was found to be diffusely necrotic secondary to artery embolization and tissue from the right ovary appeared as small round blue cells with hyperchromatic chromatin on microscopy, most closely resembling ovarian small cell carcinoma of the pulmonary type (OSCCPT) (Figure ).
With OSCCPT being a rare malignancy, at the time of this report there is no established immunohistochemical profile and the diagnosis of OSCCPT was made based on the combination of histological pattern, clinical presentation, and supportive immunohistochemical staining. It was determined that a rapidly growing OSCCPT tumor and its associated ascites had resulted in ACS causing this patient’s untimely demise.",What is the patient's score of the Revised Cardiac Risk Index for Pre-Operative Risk? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Pre-operative creatinine': [5.7, 'mg/dL'], 'Elevated-risk surgery': True, 'Pre-operative treatment with insulin': True, 'age': [53, 'years']}",3,3,3,"The criteria for the Revised Cardiac Risk Index (RCRI) are listed below:

1. Elevated-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular): No = 0 points, Yes = +1 point
2. History of ischemic heart disease (history of myocardial infarction, positive exercise test, current chest pain due to myocardial ischemia, use of nitrate therapy, or ECG with pathological Q waves): No = 0 points, Yes = +1 point
3. History of congestive heart failure (pulmonary edema, bilateral rales or S3 gallop, paroxysmal nocturnal dyspnea, or chest x-ray showing pulmonary vascular redistribution): No = 0 points, Yes = +1 point
4. History of cerebrovascular disease (prior transient ischemic attack or stroke): No = 0 points, Yes = +1 point
5. Pre-operative treatment with insulin: No = 0 points, Yes = +1 point
6. Pre-operative creatinine >2 mg/dL (176.8 μmol/L): No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.

The current cardiac risk index is 0.
Based on the patient note, an elevated risk surgery is determined to be present for the patient. This means that we increment the score by one and the current total will be 0 + 1 = 1.
The patient note does not mention anything about a history of ischemetic heart disease and is assumed to be absent. This means that the total score remains unchanged at 1.
The patient note does not mention anything about a history of congestive heart failure and is assumed to be absent. This means that the total score remains unchanged at 1.
The patient note does not mention anything about a history of cerebrovascular disease and is assumed to be absent. This means that the total score remains unchanged at 1.
Based on the patient note, a pre-operative insulin treatment is determined to be present for the patient. This means that we increment the score by one and the current total will be 1 + 1 = 2.
The concentration of Pre-Operative Creatinine is 5.7 mg/dL. The patient's pre-operative creatinine is greater than 2 mg/dL, so we increment the score by one and the current total will be 2 + 1 = 3.

The cardiac risk index score is 3."
247,17,Revised Cardiac Risk Index for Pre-Operative Risk,risk,integer,pmc-2731873-1,Extracted,"A 77-year-old woman presenting with a one month history of progredient dyspnea underwent an unenhanced computed tomography (CT) scan of the chest, which incidentally revealed a largely hyperdense upper pole lesion in the left kidney with a maximum diameter of 5.3 cm (). Parts of the lesion attained the renal pelvis. This finding was confirmed by ultrasound. An ultrasound-guided fine needle aspiration biopsy revealed RCC of the clear cell type (T1b N0 M0) (). She also suffered from primary hypertension (BP [blood pressure] 140-150/100 mmHg), chronic obstructive pulmonary disease, dilated cardiomyopathy and implantation of a cardiac pacemaker, mitral insufficiency (NYHA [New York Heart Association] III), insulin-dependent diabetes mellitus (fasting glucose value: 100-110 mg/dl), chronic renal failure (creatinine level: 1.5 mg/dl), and alcoholic liver cirrhosis. Due to the markedly elevated perioperative risk (ASA [American Society of Anesthesiology] IV) the patient refused surgery.
Subsequently, the patient was referred for interventional treatment of the tumor. A percutaneous RF ablation was considered to be the most suitable therapeutic option. Due to the size of the lesion, the patient was scheduled for pre-interventional embolization of the central part of her tumor in order to achieve central necrosis and a more homogeneous heat distribution in the devascularized parts of the tumor. Iodinated oil (Lipiodol Ultra-Fluid®, Guerbet, Roissy, France) was considered for lesion tagging since it provides post-embolization contrast and allows for CT-guided placement of the RF-probe without use of additional contrast agent.
Embolization was performed via the right femoral approach using a 4 Fr introducer sheath. After selective catheterization of the left renal artery using a 4 Fr sidewinder catheter (Merit Medical, South Jordan, UT), a 3 Fr microcatheter (Progreat, Terumo, Tokyo, Japan) was placed in the tumor feeding vessels in the upper pole of the kidney. The tumor was subsequently embolized using 10 ml of iodinated oil (Lipiodol, Guerbet, Roissy, France) (). Considering the patient's delicate renal condition, the use of iodinated contrast agent was limited to 10 ml (Visipaque 320, GE Healthcare, Princeton, NJ).
Prior to the RF ablation, a single-J catheter was placed in the left ureter with its tip in the collecting system, to accomplish external renal pelvis cooling. Preliminary testing of the single-J catheter only allowed for a drop-by-drop injection, which was insufficient for cooling and protection from thermal damage. Since the patient rejected conscious sedation, the procedure was performed under general anesthesia. Accordingly, the patient was positioned in the right lateral decubitus position; and, following an unenhanced CT (SOMATOM Sensation 16, Siemens, Forchheim, Germany; 16 × 0.75 mm, 120 kV, 165 mAseff), a CT-guided nephrostomy was performed using the trocar technique with a 6.5 Fr drainage (Resolve, Merit Medical, South Jordan, UT) to achieve sufficient cooling via the anterograde approach. Continuous cooling of the upper calices was performed with pre-chilled (8℃) 0.9% saline infused at a flow rate of 500 ml/h.
For RF ablation, four grounding pads were placed on the patient's proximal thighs. The procedure was carried out using a monopolar RF system (RF 3000, Boston Scientific Corporation, Natick, MA) in combination with a 5 cm umbrella-shaped LeVeen probe (Boston Scientific). Prior to the RF probe placement, the distal 1 cm of the probe insulation was removed to allow for post-interventional coagulation of the puncture tract. The electrode was placed under CT-guidance in the centre of the lesion (). After the final probe position was confirmed, energy was applied according to the manufacturer's recommendations for soft tissue ablation. Ablation was performed using the pullback technique at two positions, and achieving two complete roll-offs at each position. The total time of ablation was 74 minutes. Arterial and venous phase CT scan (SOMATOM Sensation 16, Siemens, Forchheim, Germany; 16×0.75 mm, 120 kV, 165 mAseff) with a reduced amount of contrast agent (80 ml Iodixanol, Visipaque, GE Healthcare) showed a completely devascularized tumor, with no sign of any residual contrast enhancement. Thereafter, the RF probe was gradually retracted under continuous coagulation of the puncture tract by applying 20 W.
No early or delayed complications were noted; however, due to her general condition, the patient was temporarily admitted to the intermediate care unit for observation. She recovered well and the single-J splint was removed a day after and the nephrostomy five days after the ablation. The patient was discharged the following day in good condition. A CT performed at eight months after the procedure, showed residual Lipiodol in the area of the ablation without signs of local renal tumor recurrence ().",What is the patient's score of the Revised Cardiac Risk Index for Pre-Operative Risk? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Congestive Heart Failure criteria for the Cardiac Risk Index rule': True, 'Elevated-risk surgery': False, 'age': [77, 'years'], 'Pre-operative treatment with insulin': True, 'Pre-operative creatinine': [1.5, 'mg/dL']}",2,2,2,"The criteria for the Revised Cardiac Risk Index (RCRI) are listed below:

1. Elevated-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular): No = 0 points, Yes = +1 point
2. History of ischemic heart disease (history of myocardial infarction, positive exercise test, current chest pain due to myocardial ischemia, use of nitrate therapy, or ECG with pathological Q waves): No = 0 points, Yes = +1 point
3. History of congestive heart failure (pulmonary edema, bilateral rales or S3 gallop, paroxysmal nocturnal dyspnea, or chest x-ray showing pulmonary vascular redistribution): No = 0 points, Yes = +1 point
4. History of cerebrovascular disease (prior transient ischemic attack or stroke): No = 0 points, Yes = +1 point
5. Pre-operative treatment with insulin: No = 0 points, Yes = +1 point
6. Pre-operative creatinine >2 mg/dL (176.8 μmol/L): No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.

The current cardiac risk index is 0.
Based on the patient note, an elevated risk surgery is determined to be absent for the patient. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of ischemetic heart disease and is assumed to be absent. This means that the total score remains unchanged at 0.
Based on the patient note, a history of congestive heart failure is determined to be present for the patient. This means that we increment the score by one and the current total will be 0 + 1 = 1.
The patient note does not mention anything about a history of cerebrovascular disease and is assumed to be absent. This means that the total score remains unchanged at 1.
Based on the patient note, a pre-operative insulin treatment is determined to be present for the patient. This means that we increment the score by one and the current total will be 1 + 1 = 2.
The concentration of Pre-Operative Creatinine is 1.5 mg/dL. The patient's pre-operative creatinine is less than or equal to 2 mg/dL, so we keep the score the same at 2.

The cardiac risk index score is 2."
248,17,Revised Cardiac Risk Index for Pre-Operative Risk,risk,integer,pmc-7593214-1,Extracted,"A 72-year-old male with a past medical history of WM develops worsening renal function after cyclophosphamide/ prednisone plus rituximab (CP-R) treatment with partial remission. The patient does not have a history of diabetes, hypertension, or other comorbidities; he is a non-smoker. He used minimal nonsteroidal anti-inflammatory drugs (NSAIDs) and no recent or prior intravenous contrast use. HIV, syphilis, and hepatitis screens were unremarkable as possible contributors to worsening renal disease. Two months after completion of the CP-R regimen, creatinine started rising from baseline 1.0 mg/dL to 2.2 mg/dL over two years. Serum IgM decreased from 3414 to 2360 after CP-R treatment. Blood glucose, liver function panel, and albumin levels were normal. Renal ultrasound shows normal echogenicity without hydronephrosis. Kidney biopsy showed moderate diffuse and nodular glomerulosclerosis with focal cortical atrophy, hypoperfusion, and focal global and segmental glomerulosclerosis and moderate vascular sclerosis (Figure ). Biopsy showed stronger background staining for kappa light chains compared to lambda light chains, without Randall-type electron-dense deposits. There was no evidence of monoclonal immunoglobulin deposition, amyloidosis, light-chain tubulopathy, or light-chain cast nephropathy. After three rounds of chemotherapy, the patient’s IgM levels went to 2128. Serum kappa levels continued on a downward trend during the patient’s treatment interval but have risen from the 1600s to 3400 most recently. The patient is currently in partial remission for his WM and is being monitored every three to six months.",What is the patient's score of the Revised Cardiac Risk Index for Pre-Operative Risk? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Pre-operative treatment with insulin': False, 'Pre-operative creatinine': [2.2, 'mg/dL'], 'age': [72, 'years']}",1,1,1,"The criteria for the Revised Cardiac Risk Index (RCRI) are listed below:

1. Elevated-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular): No = 0 points, Yes = +1 point
2. History of ischemic heart disease (history of myocardial infarction, positive exercise test, current chest pain due to myocardial ischemia, use of nitrate therapy, or ECG with pathological Q waves): No = 0 points, Yes = +1 point
3. History of congestive heart failure (pulmonary edema, bilateral rales or S3 gallop, paroxysmal nocturnal dyspnea, or chest x-ray showing pulmonary vascular redistribution): No = 0 points, Yes = +1 point
4. History of cerebrovascular disease (prior transient ischemic attack or stroke): No = 0 points, Yes = +1 point
5. Pre-operative treatment with insulin: No = 0 points, Yes = +1 point
6. Pre-operative creatinine >2 mg/dL (176.8 μmol/L): No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.

The current cardiac risk index is 0.
The patient note does not mention anything about an elevated risk surgery and is assumed to be absent. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of ischemetic heart disease and is assumed to be absent. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of congestive heart failure and is assumed to be absent. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of cerebrovascular disease and is assumed to be absent. This means that the total score remains unchanged at 0.
Based on the patient note, a pre-operative insulin treatment is determined to be absent for the patient. This means that the total score remains unchanged at 0.
The concentration of Pre-Operative Creatinine is 2.2 mg/dL. The patient's pre-operative creatinine is greater than 2 mg/dL, so we increment the score by one and the current total will be 0 + 1 = 1.

The cardiac risk index score is 1."
249,17,Revised Cardiac Risk Index for Pre-Operative Risk,risk,integer,pmc-4563955-1,Extracted,"A 65-year-old 66 kg male patient presented to us with h/o fall followed by difficulty in opening the mouth of 10 days duration. He had no history of any prior systemic illness. On clinical examination, he was conscious, afebrile with stable vitals. The patient was an occasional wheezer. He had restricted mouth opening with an inter incisor distance of <0.5 cm. There was no clinical evidence of head, chest and abdominal injuries. Routine laboratory evaluation showed hemoglobin of 9 g%, random blood sugar of 93 mg%, serum creatinine of 0.8 mg%. A routine, electrocardiography, X-ray chest, an echo heart were normal. A computed tomography scan of the face showed bilateral mandibular condylar fracture dislocation. He was posted for reduction of dislocation with internal fixation in the dental chair. A preoperative nebulization with budesonide and levosalbutamol was done half an hour prior. Monitoring included pulse oximetry and noninvasive blood pressure. As the surgery involved reduction, screwing of both maxilla and mandible in both sides, a plan of bilateral maxillary and mandibular nerve blocks by extraoral approach was made. A local anesthetic solution of 20 ml of 0.5% bupivacaine with 0.1 ml of sodium bicarbonate was made. After aseptic precautions, with the patient sitting, the condylar notch was identified. The needle was inserted into the space below the midpoint of the zygomatic process till the needle hits the lateral pterygoid plate. After that, it was slided posterior and superior to get paresthesia of the mandibular region, and 3 ml was deposited. The needle then was withdrawn till subcutaneous plane to go back and hit the pterygoid plate. Then for accessing maxillary nerve, the needle was slided anterior and lower to deposit around 3–4 ml. The procedure was repeated for other side, but the right side had a distorted anatomy, which made identification of condylar notch difficult. Still we managed to elicit paresthesia and administer the block []. Anesthesia was complete on both nerves on two sides in around 10 min. The technique is similar to Braun's method of blocking these said nerves. The surgeon proceeded with vigorous pulling of the lower jaw to reduce the dislocation, followed by screws and wires both sides of upper and lower jaws to maintain the reduction []. The procedure which lasted for 30 min was absolutely painless. The ophthalmic nerve was spared. Complete recovery of the block was noticed in 3 h. There were no side effects.",What is the patient's score of the Revised Cardiac Risk Index for Pre-Operative Risk? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Congestive Heart Failure criteria for the Cardiac Risk Index rule': False, 'Elevated-risk surgery': False, 'Pre-operative creatinine': [0.8, 'mg/dL'], 'age': [65, 'years']}",0,0,0,"The criteria for the Revised Cardiac Risk Index (RCRI) are listed below:

1. Elevated-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular): No = 0 points, Yes = +1 point
2. History of ischemic heart disease (history of myocardial infarction, positive exercise test, current chest pain due to myocardial ischemia, use of nitrate therapy, or ECG with pathological Q waves): No = 0 points, Yes = +1 point
3. History of congestive heart failure (pulmonary edema, bilateral rales or S3 gallop, paroxysmal nocturnal dyspnea, or chest x-ray showing pulmonary vascular redistribution): No = 0 points, Yes = +1 point
4. History of cerebrovascular disease (prior transient ischemic attack or stroke): No = 0 points, Yes = +1 point
5. Pre-operative treatment with insulin: No = 0 points, Yes = +1 point
6. Pre-operative creatinine >2 mg/dL (176.8 μmol/L): No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.

The current cardiac risk index is 0.
Based on the patient note, an elevated risk surgery is determined to be absent for the patient. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of ischemetic heart disease and is assumed to be absent. This means that the total score remains unchanged at 0.
Based on the patient note, a history of congestive heart failure is determined to be absent for the patient. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of cerebrovascular disease and is assumed to be absent. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a pre-operative insulin treatment and is assumed to be absent. This means that the total score remains unchanged at 0.
The concentration of Pre-Operative Creatinine is 0.8 mg/dL. The patient's pre-operative creatinine is less than or equal to 2 mg/dL, so we keep the score the same at 0.

The cardiac risk index score is 0."
250,17,Revised Cardiac Risk Index for Pre-Operative Risk,risk,integer,pmc-4606587-1,Extracted,"A 52-year-old male patient presented to the urology outpatient department with a history of decreased urine passage along with burning, hematuria and pain lower back and abdomen. History of loss of appetite, vomiting was also elicited, he also gave a history of smoking and alcohol consumption. Patient was advised an ultrasonogram (USG) along with biochemical and hematological investigation. Routine examination of urine was done which revealed few red blood cells. No atypical or malignant cells are seen in three consecutive specimen of urine for cytology His renal function tests were markedly deranged, with blood urea 346 mg/dl, serum creatinine 25 mg/dl and deranged electrolytes. His blood pressure was raised 230/100 mmHg and fundoscopy showed hypertensive retinopathy. USG showed features of cystitis with hypoechoic areas extending into the thickened bladder wall with features of pyelonephritis. An infective pathology was offered as diagnosis on imaging. A clinical diagnosis of bilateral obstructive uropathy due to tumor with chronic kidney disease was made, and the patient was put on hemodialysis and cystoscopy planned at a later date. Cystoscopy findings were of a growth with small fronds/papillae, prominent at the bladder neck with a very rigid thickened bladder wall. Trans urethral resection of the bladder tumor was done and sent for histopathological evaluation. The microscopic evaluation showed a high-grade tumor arranged in discohesive cords and sheet with plasmacytoid features and prominent retraction artifact [] penetrating through the entire bladder wall into the serosa. Histopathological features of the malignant epithelial cells were uncommon and lead to a differential diagnosis of undifferentiated transitional carcinoma, metastatic or primary lymphoma plasmacytoma, lymphoepithelioma-like bladder carcinoma and a plasmacytoid variant of bladder tumor. Immunohistochemistry was done for CD138, cytokeratin (CK) CK7, leukocyte common antigen (LCA), κ and λ light chain, with positivity for CK7, CD138 [Figures and ] and negative for other markers. Based on these findings, a final histopathological diagnosis of PUC was made. The patient was advised to undergo palliative cystectomy, however he is lost to follow-up.",What is the patient's score of the Revised Cardiac Risk Index for Pre-Operative Risk? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [52, 'years'], 'Elevated-risk surgery': False, 'Pre-operative creatinine': [25, 'mg/dL']}",1,1,1,"The criteria for the Revised Cardiac Risk Index (RCRI) are listed below:

1. Elevated-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular): No = 0 points, Yes = +1 point
2. History of ischemic heart disease (history of myocardial infarction, positive exercise test, current chest pain due to myocardial ischemia, use of nitrate therapy, or ECG with pathological Q waves): No = 0 points, Yes = +1 point
3. History of congestive heart failure (pulmonary edema, bilateral rales or S3 gallop, paroxysmal nocturnal dyspnea, or chest x-ray showing pulmonary vascular redistribution): No = 0 points, Yes = +1 point
4. History of cerebrovascular disease (prior transient ischemic attack or stroke): No = 0 points, Yes = +1 point
5. Pre-operative treatment with insulin: No = 0 points, Yes = +1 point
6. Pre-operative creatinine >2 mg/dL (176.8 μmol/L): No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.

The current cardiac risk index is 0.
Based on the patient note, an elevated risk surgery is determined to be absent for the patient. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of ischemetic heart disease and is assumed to be absent. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of congestive heart failure and is assumed to be absent. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of cerebrovascular disease and is assumed to be absent. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a pre-operative insulin treatment and is assumed to be absent. This means that the total score remains unchanged at 0.
The concentration of Pre-Operative Creatinine is 25 mg/dL. The patient's pre-operative creatinine is greater than 2 mg/dL, so we increment the score by one and the current total will be 0 + 1 = 1.

The cardiac risk index score is 1."
251,17,Revised Cardiac Risk Index for Pre-Operative Risk,risk,integer,pmc-4556177-1,Extracted,"A 62-year-old woman presented to her family physician with a two-month history of a slowly growing left flank mass. She was previously well except for recurrent urinary tract infections; there was no recent travel or trauma. An ultrasound demonstrated a benign-appearing left renal cyst. Three weeks later, she began to develop flank pain, fevers, chills, night sweats and erythema of the skin over the flank mass. Cultures were not obtained at this time, and she was treated empirically with oral cloxacillin 500 mg four times daily for six weeks with minimal improvement. She developed nausea and vomiting with food consumption, and a 15 kg weight loss. One month later, the flank mass broke through the skin and began to drain serosanguinous fluid (). Review of systems and physical examination were otherwise unremarkable. Initial laboratory investigations demonstrated a normocytic anemia (hemoglobin level 115 g/L), leukocytosis (white blood cell count 15.4×109/L), elevated inflammatory markers (C-reactive protein level 171.0 mg/L and erythrocyte sedimentation rate 85 mm/h) and a normal creatinine level (71 µmol/L). Computed tomography imaging () revealed a large mass involving the left kidney, encasing other organs on the left side of the abdomen and protruding through the flank. A computed tomography-guided biopsy of the left renal mass was performed.",What is the patient's score of the Revised Cardiac Risk Index for Pre-Operative Risk? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Pre-operative creatinine': [71, 'µmol/L'], 'Elevated-risk surgery': False, 'age': [62, 'years']}",0,0,0,"The criteria for the Revised Cardiac Risk Index (RCRI) are listed below:

1. Elevated-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular): No = 0 points, Yes = +1 point
2. History of ischemic heart disease (history of myocardial infarction, positive exercise test, current chest pain due to myocardial ischemia, use of nitrate therapy, or ECG with pathological Q waves): No = 0 points, Yes = +1 point
3. History of congestive heart failure (pulmonary edema, bilateral rales or S3 gallop, paroxysmal nocturnal dyspnea, or chest x-ray showing pulmonary vascular redistribution): No = 0 points, Yes = +1 point
4. History of cerebrovascular disease (prior transient ischemic attack or stroke): No = 0 points, Yes = +1 point
5. Pre-operative treatment with insulin: No = 0 points, Yes = +1 point
6. Pre-operative creatinine >2 mg/dL (176.8 μmol/L): No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.

The current cardiac risk index is 0.
Based on the patient note, an elevated risk surgery is determined to be absent for the patient. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of ischemetic heart disease and is assumed to be absent. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of congestive heart failure and is assumed to be absent. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of cerebrovascular disease and is assumed to be absent. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a pre-operative insulin treatment and is assumed to be absent. This means that the total score remains unchanged at 0.
The concentration of Pre-Operative Creatinine is 71 µmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of Pre-Operative Creatinine from µmol to mg. The mass of Pre-Operative Creatinine is 71 µmol. To convert 71 µmol of Pre-Operative Creatinine to mol, multiply by the conversion factor 1e-06, giving us 71 µmol Pre-Operative Creatinine * 1e-06 mol/µmol = 7e-05 mol Pre-Operative Creatinine. To convert from mol Pre-Operative Creatinine to grams, multiply by the molar mass 113.12 g/mol, which will give 7e-05 mol Pre-Operative Creatinine * 113.12 g/mol = 0.00792 g Pre-Operative Creatinine. To convert 0.00792 g of Pre-Operative Creatinine to mg, multiply by the conversion factor 1000.0, giving us 0.00792 g Pre-Operative Creatinine * 1000.0 mg/g = 7.92 mg Pre-Operative Creatinine. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 7.92 mg Pre-Operative Creatinine/10.0 dL = 0.792 mg Pre-Operative Creatinine/dL. The concentration value of 71 µmol Pre-Operative Creatinine/L converts to 0.792 mg Pre-Operative Creatinine/dL. The patient's pre-operative creatinine is less than or equal to 2 mg/dL, so we keep the score the same at 0.

The cardiac risk index score is 0."
252,17,Revised Cardiac Risk Index for Pre-Operative Risk,risk,integer,pmc-8137800-1,Extracted,"Written patient consent was obtained, and our institutional ethical committee approved the publication of this case report.
A 56-year-old male (167 cm, 55.6 kg), who had undergone a David operation for type-A acute aortic dissection 7 months ago, was scheduled for a Bentall operation for a pseudo aortic aneurysm and perivascular abscess. The aneurysm had increased from 60 to 76 mm in 3 months before the operation and some blood flow was observed inside the aneurysm. The entry to the aneurysm was identified at the anastomosis with artificial blood vessels above the aortic valve. Blood flow showed a to-and-fro pattern between the left ventricle and the aneurysm. The blood flow from the aneurysm to the left ventricle during diastole was similar to aortic regurgitation (AR), and the degree of regurgitation was moderate to severe. Furthermore, we also found abnormal blood flow from the aneurysm to the main pulmonary artery. Other preoperative transthoracic echocardiography findings included normal systolic function, grade II diastolic function (E/A: pseudo-normalization pattern), mild to moderate tricuspid regurgitation, and moderate pulmonary hypertension. Three months before the operation, he developed heart failure due to perivascular abscess. His preoperative chest X-ray revealed cardiac dilatation (CTR 60%) and bilateral pleural effusion. The electrocardiogram showed sinus tachycardia and complete right bundle branch block. Routine laboratory data were within normal range except hemoglobin 10.4 g dL−1, platelet 281,000 μL−1, fibrinogen 460 mg dL−1, WBC 6200 μL−1, CRP 6.78 mg dL−1, brain natriuretic peptide (BNP) 1860 pg dL−1, and creatinine 1.25 mg dL−1. Coronary computed tomography showed no findings suggesting coronary stenosis. Thoracic computed tomography demonstrated the following: extensive adhesion between the aneurysm and the sternum, and angiectopia of the right subclavian artery originating from the distal aortic arch (Fig. ).
We discussed intraoperative management of the present case at a preoperative conference of anesthesiologists and cardiac surgeons and determined the following algorithm: (1) A left anterolateral small thoracotomy is performed and a left ventricle venting tube is placed to avoid left ventricle distension, because the patient has severe aortic regurgitation. (2) Nifekalant is administered slowly to prevent VF associated with cooling. (3) Institution of full-flow cardiopulmonary bypass (CPB) is done through the femoral vessels or combination of the right axial artery and femoral vessels. (4) Once CPB is established, cooling is initiated by monitoring the bladder temperature and the patient is cooled to 27 °C. (5) At the target bladder temperature of 27 °C, resternotomy is performed. (6) The temperature is maintained until the complete division of the sternum to prevent VF and to conserve contractility. (7) After completing dissection of retrosternal adhesions, aortic cross-clamping is performed, the pseudoaneurysm was incised, and cardioplegia was delivered selectively in the coronary ostia.
General anesthesia was induced with midazolam 5 mg, fentanyl 0.2 mg, and vecuronium 8 mg and maintained with sevoflurane, propofol, remifentanil, and vecuronium. The trachea was intubated with a 37-Fr left double-lumen tube for one-lung ventilation. A percutaneous DC pad was attached on his chest prophylactically. After induction of anesthesia, the left radial and femoral arteries were cannulated for arterial blood pressure monitoring. A central venous catheter and a pulmonary artery catheter were placed through the right internal jugular vein. A transesophageal echocardiography (TEE) probe was inserted for intraoperative cardiac monitoring. Regional cerebral oxygen saturation (rSO2) was measured with near-infrared spectroscopy. We detected the oxygen step-up in the pulmonary artery and calculated that pulmonary flow/systemic flow (Qp/Qs) was 1.7.
At first, we administered nifekalant, 10 mg, intravenously. Then, the vent tube was inserted into the left ventricle with a small left thoracotomy under one-lung ventilation. Extracorporeal circulation was established through the cannulation from the right femoral artery and vein, which provided full-flow CPB. Then, cooling was initiated by monitoring the bladder temperature. Resternotomy was initiated after the patient was cooled to 27 °C. The strong adhesion between the sternum and the aortic artery was completely exfoliated without damaging the pseudoaneurysm. Severe bradycardia, QT prolongation, and premature ventricular contraction (PVC) were observed, but VF did not occur under 27 °C (Fig. ). Bilateral rSO2 decreased with progression of bradycardia (left rSO2 54 to 36% and right rSO2 51 to 35%). Although we increased the blood flow of CPB and transfused red blood cell, the values remained low in 30s. The values continued to be 30s until the aortic clamping and after then improved to 40s. After exposure of the aortic clamp site was completed, we re-started cooling and clamped the aorta at the distal side of the aneurysm and induced asystole by selective cardioplegia. The Bentall operation scheduled was performed without any problem. Weaning from CPB was uneventful and the patient was transported to ICU without extubation. His trachea was extubated on the 5th postoperative day and he had no neurological sequelae.",What is the patient's score of the Revised Cardiac Risk Index for Pre-Operative Risk? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Congestive Heart Failure criteria for the Cardiac Risk Index rule': True, 'Elevated-risk surgery': True, 'History of ischemic heart disease': False, 'Pre-operative creatinine': [1.25, 'mg/dL'], 'age': [56, 'years']}",2,2,2,"The criteria for the Revised Cardiac Risk Index (RCRI) are listed below:

1. Elevated-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular): No = 0 points, Yes = +1 point
2. History of ischemic heart disease (history of myocardial infarction, positive exercise test, current chest pain due to myocardial ischemia, use of nitrate therapy, or ECG with pathological Q waves): No = 0 points, Yes = +1 point
3. History of congestive heart failure (pulmonary edema, bilateral rales or S3 gallop, paroxysmal nocturnal dyspnea, or chest x-ray showing pulmonary vascular redistribution): No = 0 points, Yes = +1 point
4. History of cerebrovascular disease (prior transient ischemic attack or stroke): No = 0 points, Yes = +1 point
5. Pre-operative treatment with insulin: No = 0 points, Yes = +1 point
6. Pre-operative creatinine >2 mg/dL (176.8 μmol/L): No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.

The current cardiac risk index is 0.
Based on the patient note, an elevated risk surgery is determined to be present for the patient. This means that we increment the score by one and the current total will be 0 + 1 = 1.
Based on the patient note, a history of ischemetic heart disease is determined to be absent for the patient. This means that the total score remains unchanged at 1.
Based on the patient note, a history of congestive heart failure is determined to be present for the patient. This means that we increment the score by one and the current total will be 1 + 1 = 2.
The patient note does not mention anything about a history of cerebrovascular disease and is assumed to be absent. This means that the total score remains unchanged at 2.
The patient note does not mention anything about a pre-operative insulin treatment and is assumed to be absent. This means that the total score remains unchanged at 2.
The concentration of Pre-Operative Creatinine is 1.25 mg/dL. The patient's pre-operative creatinine is less than or equal to 2 mg/dL, so we keep the score the same at 2.

The cardiac risk index score is 2."
253,17,Revised Cardiac Risk Index for Pre-Operative Risk,risk,integer,pmc-7059607-2,Extracted,"A 71-year-old hypertense woman underwent a DBD double kidney transplant. The iliac vessels of the recipient, a smoker, presented with severe atheromatous plaques such that it was difficult to find a suitable vessel to perform the arterial anastomoses; some plaques were fixed to the walls of the vessel with 6-0 prolene. The 81-year-old donor had died from a cerebral hemorrhage, had a KDPI of 99%, and a Karpinsky's score of 4 in both kidneys. Immunosuppressive therapy consisted of ATG, steroids, and tacrolimus. The graft function was prompt, with creatinine levels of 1.7 mg/dl on POD 4, and routine ultrasounds were normal. On POD 13, we observed an abrupt rise in creatinine (2.4 mg/dl), lactate dehydrogenase (LDH) 1,100 U/l, and a slight decrease in diuresis. A contrast-enhanced ultrasonography showed a lack of vascularization in the upper pole of one of the kidneys compatible with a partial infarction. Intravenous iloprost at a dose of 0.05 mg/kg/day was administered as a rescue therapy for 5 days. After 3 days, we started to see progressive recovery of kidney function; after 3 months, the creatinine level was 1.5 mg/dl (). No peripheral signs of embolism were observed on physical examination. In this case, the most likely source of embolization was the recipient's iliac artery.",What is the patient's score of the Revised Cardiac Risk Index for Pre-Operative Risk? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Pre-operative creatinine': [1.7, 'mg/dL'], 'Elevated-risk surgery': True, 'age': [71, 'years']}",1,1,1,"The criteria for the Revised Cardiac Risk Index (RCRI) are listed below:

1. Elevated-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular): No = 0 points, Yes = +1 point
2. History of ischemic heart disease (history of myocardial infarction, positive exercise test, current chest pain due to myocardial ischemia, use of nitrate therapy, or ECG with pathological Q waves): No = 0 points, Yes = +1 point
3. History of congestive heart failure (pulmonary edema, bilateral rales or S3 gallop, paroxysmal nocturnal dyspnea, or chest x-ray showing pulmonary vascular redistribution): No = 0 points, Yes = +1 point
4. History of cerebrovascular disease (prior transient ischemic attack or stroke): No = 0 points, Yes = +1 point
5. Pre-operative treatment with insulin: No = 0 points, Yes = +1 point
6. Pre-operative creatinine >2 mg/dL (176.8 μmol/L): No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.

The current cardiac risk index is 0.
Based on the patient note, an elevated risk surgery is determined to be present for the patient. This means that we increment the score by one and the current total will be 0 + 1 = 1.
The patient note does not mention anything about a history of ischemetic heart disease and is assumed to be absent. This means that the total score remains unchanged at 1.
The patient note does not mention anything about a history of congestive heart failure and is assumed to be absent. This means that the total score remains unchanged at 1.
The patient note does not mention anything about a history of cerebrovascular disease and is assumed to be absent. This means that the total score remains unchanged at 1.
The patient note does not mention anything about a pre-operative insulin treatment and is assumed to be absent. This means that the total score remains unchanged at 1.
The concentration of Pre-Operative Creatinine is 1.7 mg/dL. The patient's pre-operative creatinine is less than or equal to 2 mg/dL, so we keep the score the same at 1.

The cardiac risk index score is 1."
254,17,Revised Cardiac Risk Index for Pre-Operative Risk,risk,integer,pmc-7685016-1,Extracted,"An 89-year-old male presented with a 5-day history of worsening dyspnoea and cough. Past history included hypertension, ischaemic heart disease, permanent pacemaker implantation for complete heart block, chronic kidney disease stage 3 and atrial fibrillation. He was taking long-term Rivaroxaban therapy for stroke and systemic embolism prophylaxis. No compliance issues were reported. No antiplatelet or additional antithrombotic medication was being taken prior to hospital admission. Despite advanced age, the gentleman was fully independent with activities of daily living. Hospital admission was required due to hypoxia. Maximal oxygen requirements during the course of admission were 4 l/min. Reverse transcriptase viral polymerase chain reaction testing subsequently confirmed COVID-19 infection.
Admission blood testing demonstrated lymphopenia (0.82 × 109/l) and a markedly elevated C-reactive protein of 345 mg/l. Coagulation studies were prolonged (activated partial thromboplastin time 31.7 s, prothrombin time 14.4 s) due to concurrent anticoagulation with Rivaroxaban. Fibrinogen level was markedly elevated at 9 g/l. Creatinine (106 μmol/l) and estimated glomerular filtration rate (52 ml/min) were at the patient’s baseline level. Remaining biochemistry results returned within normal limits. Chest radiography confirmed new bi-basal and peripheral left mid zone pulmonary infiltrates suggestive of COVID-19 pneumonitis (). Oral doxycycline was commenced to cover for possible secondary superadded bacterial infection, in line with local institutional protocols during the early period of the COVID-19 pandemic.
On Day 4 of his hospital stay, and despite an improvement in COVID-19 symptoms with reducing oxygen requirements, the patient developed a rapid and dense left-sided hemiplegia with dysarthria, alongside clinical signs of left gaze palsy and left homonymous hemianopia. National Institutes of Health Stroke Scale was 21, signifying symptoms suggestive of acute severe stroke. Within 1 h of onset of neurological symptoms (Day 4 of hospital admission), computed tomography imaging of the brain was performed. This showed a region of low attenuation in the right basal ganglia and high density in the right M1 segment of the middle cerebral artery consistent with an acute infarct due to large-vessel occlusion (). Computed tomography angiography was requested to evaluate a potential target for mechanical thrombectomy. This demonstrated extensive thrombus occluding the right cervical internal carotid artery and a T occlusion affecting the right anterior and middle cerebral arteries ().
The patient was not a candidate for thrombolytic therapy due to concurrent anticoagulation with Rivaroxaban. Mechanical thrombectomy was discussed with interventional radiology colleagues, but it was decided that this would offer little clinical benefit given the patient’s age and comorbid status. Unfortunately, despite maximal ward-based medical treatment, the patient deteriorated and passed away 5 days later.",What is the patient's score of the Revised Cardiac Risk Index for Pre-Operative Risk? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'History of ischemic heart disease': True, 'Pre-operative creatinine': [106, 'µmol/L'], 'History of cerebrovascular disease': True, 'age': [89, 'years']}",2,2,2,"The criteria for the Revised Cardiac Risk Index (RCRI) are listed below:

1. Elevated-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular): No = 0 points, Yes = +1 point
2. History of ischemic heart disease (history of myocardial infarction, positive exercise test, current chest pain due to myocardial ischemia, use of nitrate therapy, or ECG with pathological Q waves): No = 0 points, Yes = +1 point
3. History of congestive heart failure (pulmonary edema, bilateral rales or S3 gallop, paroxysmal nocturnal dyspnea, or chest x-ray showing pulmonary vascular redistribution): No = 0 points, Yes = +1 point
4. History of cerebrovascular disease (prior transient ischemic attack or stroke): No = 0 points, Yes = +1 point
5. Pre-operative treatment with insulin: No = 0 points, Yes = +1 point
6. Pre-operative creatinine >2 mg/dL (176.8 μmol/L): No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.

The current cardiac risk index is 0.
The patient note does not mention anything about an elevated risk surgery and is assumed to be absent. This means that the total score remains unchanged at 0.
Based on the patient note, a history of ischemetic heart disease is determined to be present for the patient. This means that we increment the score by one and the current total will be 0 + 1 = 1.
The patient note does not mention anything about a history of congestive heart failure and is assumed to be absent. This means that the total score remains unchanged at 1.
Based on the patient note, a history of cerebrovascular disease is determined to be present for the patient. This means that we increment the score by one and the current total will be 1 + 1 = 2.
The patient note does not mention anything about a pre-operative insulin treatment and is assumed to be absent. This means that the total score remains unchanged at 2.
The concentration of Pre-Operative Creatinine is 106 µmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of Pre-Operative Creatinine from µmol to mg. The mass of Pre-Operative Creatinine is 106 µmol. To convert 106 µmol of Pre-Operative Creatinine to mol, multiply by the conversion factor 1e-06, giving us 106 µmol Pre-Operative Creatinine * 1e-06 mol/µmol = 0.00011 mol Pre-Operative Creatinine. To convert from mol Pre-Operative Creatinine to grams, multiply by the molar mass 113.12 g/mol, which will give 0.00011 mol Pre-Operative Creatinine * 113.12 g/mol = 0.01244 g Pre-Operative Creatinine. To convert 0.01244 g of Pre-Operative Creatinine to mg, multiply by the conversion factor 1000.0, giving us 0.01244 g Pre-Operative Creatinine * 1000.0 mg/g = 12.44 mg Pre-Operative Creatinine. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 12.44 mg Pre-Operative Creatinine/10.0 dL = 1.244 mg Pre-Operative Creatinine/dL. The concentration value of 106 µmol Pre-Operative Creatinine/L converts to 1.244 mg Pre-Operative Creatinine/dL. The patient's pre-operative creatinine is less than or equal to 2 mg/dL, so we keep the score the same at 2.

The cardiac risk index score is 2."
255,17,Revised Cardiac Risk Index for Pre-Operative Risk,risk,integer,pmc-8267016-1,Extracted,"The patient was a 45-year-old male with a past medical history of intermittent asthma, hypertension, and type 2 diabetes mellitus who presented to the emergency department (ED) via ambulance status post fall in the context of phencyclidine (PCP) intoxication. Initially in the ED the patient was urinating on the floor, attempting to fight staff members, and uncooperative with examination. Intravenous haloperidol 5 mg and midazolam 4 mg were administered for agitation, after which the patient was able to tolerate medical evaluation and management. Additional history was limited at this time given the patient’s intoxicated state. The patient was unable to participate in a formal review of systems given his altered mental status (AMS). Initial vital signs were blood pressure 146/83 mm Hg, pulse 104 beats per minute, temperature 98.4 °F, respiratory rate 18 breath per minute, and oxygen saturation 98%. Physical examination was grossly normal aside from a 3 cm stellate forehead laceration. Apart from a leukocytosis of 15 K/mm3, complete blood count, and comprehensive metabolic panel were within normal limits. Pertinent normal laboratory test results included a sodium of 140 mmol/L, blood urea nitrogen of 15, and a creatinine of 0.87 mg/dL. Urine drug screen was positive for benzodiazepines and PCP. Urinalysis was positive for only bacteria and nitrites along with 6 to 9 epithelial cells per high-power field suggesting possible contamination. Urine cultures were not obtained. Computerized tomography (CT) imaging demonstrated left zygomaticomaxillary complex fractures without acute intracranial pathology. CT imaging of the patient’s cervical spine did not demonstrate any acute pathology. While in the ED, the patient’s forehead laceration was sutured. The patient was admitted to an inpatient medicine unit for further management of his AMS and facial fracture.
On admission, the patient was somnolent, oriented only to self, and unable to engage with the admission assessment. An extensive AMS workup was completed, which included ammonia, vitamin B12 and folate levels, thyroid-stimulating hormone, blood cultures, C-reactive protein, repeat comprehensive metabolic panel/complete blood count, syphilis screen, and repeat head CT. Aside from a mildly elevated C-reactive protein of 2.6 mg/dL and leukocytosis of 14.2 K/mm3 the remainder of the patient’s laboratory test results was within normal limits. Specific laboratory tests of interest pertinent to a delirium workup returned within normal limits as follows: ammonia 15 µmol/L, thyroid-stimulating hormone 0.4, vitamin B12 576 pg/mL, and folate 22.9 ng/mL. The differential diagnosis for the patient’s AMS remained wide, so he was placed on the Clinical Institute Withdrawal Assessment for Alcohol protocol and started on intravenous thiamine as a history of alcohol use could not be ruled out. The patient was also given a 3-day course of intravenous ceftriaxone considering equivocal urinalysis findings. Plastic surgery was consulted and recommended nonemergent elective repair of the facial fractures, but treatment was deferred as the patient remained altered and could not consent to the procedure.
Per family collateral, the patient worked part-time as a mechanic, lived alone, performed all activities of daily living independently, and did not have any history of neurologic or psychiatric disease. Family was unable to provide any additional information regarding the patient’s substance use. The patient did not receive any additional lorazepam per Clinical Institute Withdrawal Assessment for Alcohol protocol or for vital sign abnormalities consistent with alcohol withdrawal. Aside from his tachycardia on initial presentation in the ED, the patient did not demonstrate tachycardia after admission to the inpatient medicine unit. On the third hospital day, the patient’s AMS persisted, and neurology was consulted and evaluated the patient for additional causes of encephalopathy.
On the consulting neurologist’s initial examination, the patient remained lethargic, oriented only to self, unable to follow complex commands, and hypophonic with increased speech latency. No focal cranial nerve deficit was appreciated; however, the patient exhibited hypertonicity with significant oppositional paratonias in all 4 extremities along with bilaterally upgoing plantar reflexes. Magnetic resonance imaging (MRI) and electroencephalography (EEG) were ordered per neurology recommendations. EEG did not demonstrate epileptiform activity or generalized slowing. However, MRI revealed a restricted diffusion/focal hyperintensity within the splenium of the corpus callosum on diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) images, respectively. MRI findings on FLAIR, DWI, and ADC (apparent diffusion coefficient) are highlighted in . In consideration of the patient’s recent exposure to neuroleptics, persistent encephalopathy, and significant oppositional paratonias, the possibility of an atypical variant of NMS contributing to the patient’s delirium was likely. Despite the likelihood of atypical NMS, in considering the wide differential diagnosis of callosal lesions the probability of the MRI lesion representing a new infarct remained. Therefore, the patient was placed on standing aspirin 325 mg along with atorvastatin 40 mg daily. CT angiography of the head and neck was completed and was unremarkable. The patient was also started on standing benztropine 1 mg twice daily for atypical NMS. Of note, lorazepam was not used as there was concern for additional central nervous system depression in an already somnolent and delirious patient.
By the seventh hospital day, the patient became more alert, had improved orientation, was able to complete 2 step commands with prompting, and had reduced cogwheeling on examination. Additionally, the patient’s leukocytosis had down-trended to 13.2 K/mm3. The scheduled benztropine was also discontinued. The patient did not require any physical restraints or tranquilizers for agitation after admission. The patient’s MRI was repeated 11 days after initial imaging, which redemonstrated the corpus callosum splenium hyperintensity on FLAIR imaging and without restricted diffusion on DWI. The patient was instructed to repeat imaging as an outpatient to confirm the diagnosis of subacute callosal infarct versus transient splenial lesion of another etiology. The patient was recommended to be discharged to a rehabilitation facility to further manage his physical deconditioning and was subsequently lost to follow-up.",What is the patient's score of the Revised Cardiac Risk Index for Pre-Operative Risk? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [45, 'years'], 'Elevated-risk surgery': False, 'Pre-operative treatment with insulin': False, 'Pre-operative creatinine': [0.87, 'mg/dL']}",0,0,0,"The criteria for the Revised Cardiac Risk Index (RCRI) are listed below:

1. Elevated-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular): No = 0 points, Yes = +1 point
2. History of ischemic heart disease (history of myocardial infarction, positive exercise test, current chest pain due to myocardial ischemia, use of nitrate therapy, or ECG with pathological Q waves): No = 0 points, Yes = +1 point
3. History of congestive heart failure (pulmonary edema, bilateral rales or S3 gallop, paroxysmal nocturnal dyspnea, or chest x-ray showing pulmonary vascular redistribution): No = 0 points, Yes = +1 point
4. History of cerebrovascular disease (prior transient ischemic attack or stroke): No = 0 points, Yes = +1 point
5. Pre-operative treatment with insulin: No = 0 points, Yes = +1 point
6. Pre-operative creatinine >2 mg/dL (176.8 μmol/L): No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.

The current cardiac risk index is 0.
Based on the patient note, an elevated risk surgery is determined to be absent for the patient. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of ischemetic heart disease and is assumed to be absent. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of congestive heart failure and is assumed to be absent. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of cerebrovascular disease and is assumed to be absent. This means that the total score remains unchanged at 0.
Based on the patient note, a pre-operative insulin treatment is determined to be absent for the patient. This means that the total score remains unchanged at 0.
The concentration of Pre-Operative Creatinine is 0.87 mg/dL. The patient's pre-operative creatinine is less than or equal to 2 mg/dL, so we keep the score the same at 0.

The cardiac risk index score is 0."
256,17,Revised Cardiac Risk Index for Pre-Operative Risk,risk,integer,pmc-3664473-1,Extracted,"A 51-year-old female visited us due to asymptomatic macroscopic hematuria persisting for two weeks. She had experienced discomfort, not pain, in the stomach. She had been followed up at another clinic for polycythemia for several years. Cystoscopy revealed a nonpapillary tumor about 2 cm in diameter, emanating from the left ureteral orifice (). Blood results at presentation showed Hb 14.8 g/dL, Cr 0.7 mg/dL, estimated GFR 68.1 mL/min, WBC 6.6 × 103/μL, CRP 5.35 mg/dL, LDH 184 IU/L, and Ca2+ 9.9 mg/dL. Urine cytology was negative for malignant cells. Contrast enhanced CT showed an unevenly contrasted tumor, infiltrating almost all renal parenchyma, filling the renal pelvis and ureter, and extending into the urinary bladder (). There were no apparent metastases to lung, liver, adrenal glands, or lymph nodes. With a tentative diagnosis of renal pelvic tumor, we didnot perform perioperative biopsy, and she underwent nephroureterectomy with hilar lymph node dissection. Macroscopically the tumor almost replaced the whole kidney. The renal pelvis and ureter were extensively packed with the tumor. Histological examination () revealed a clear cell RCC, grade 2 > 1, with microvascular invasion, Fuhrman grade 2, without any sarcomatoid elements. There was no evidence of a venous thrombus or metastasis to lymph nodes. Leibovich score was 6. Postoperative course was uneventful, but 6 months later multiple pulmonary metastases were detected.",What is the patient's score of the Revised Cardiac Risk Index for Pre-Operative Risk? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Pre-operative creatinine': [0.7, 'mg/dL'], 'Elevated-risk surgery': True, 'age': [51, 'years']}",1,1,1,"The criteria for the Revised Cardiac Risk Index (RCRI) are listed below:

1. Elevated-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular): No = 0 points, Yes = +1 point
2. History of ischemic heart disease (history of myocardial infarction, positive exercise test, current chest pain due to myocardial ischemia, use of nitrate therapy, or ECG with pathological Q waves): No = 0 points, Yes = +1 point
3. History of congestive heart failure (pulmonary edema, bilateral rales or S3 gallop, paroxysmal nocturnal dyspnea, or chest x-ray showing pulmonary vascular redistribution): No = 0 points, Yes = +1 point
4. History of cerebrovascular disease (prior transient ischemic attack or stroke): No = 0 points, Yes = +1 point
5. Pre-operative treatment with insulin: No = 0 points, Yes = +1 point
6. Pre-operative creatinine >2 mg/dL (176.8 μmol/L): No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.

The current cardiac risk index is 0.
Based on the patient note, an elevated risk surgery is determined to be present for the patient. This means that we increment the score by one and the current total will be 0 + 1 = 1.
The patient note does not mention anything about a history of ischemetic heart disease and is assumed to be absent. This means that the total score remains unchanged at 1.
The patient note does not mention anything about a history of congestive heart failure and is assumed to be absent. This means that the total score remains unchanged at 1.
The patient note does not mention anything about a history of cerebrovascular disease and is assumed to be absent. This means that the total score remains unchanged at 1.
The patient note does not mention anything about a pre-operative insulin treatment and is assumed to be absent. This means that the total score remains unchanged at 1.
The concentration of Pre-Operative Creatinine is 0.7 mg/dL. The patient's pre-operative creatinine is less than or equal to 2 mg/dL, so we keep the score the same at 1.

The cardiac risk index score is 1."
257,17,Revised Cardiac Risk Index for Pre-Operative Risk,risk,integer,pmc-4400487-1,Extracted,"A 22-year-old Caucasian male with Type 1 diabetes mellitus (T1DM), presented with acute kidney injury (AKI), serum creatinine (SCr) 387 μmol/L and nephrotic syndrome (timed urinary protein excretion 14 g/day, serum albumin 23 g/L (35–50 g/L), underwent a diagnostic kidney biopsy. Clinical assessment 1 year prior indicated minimal proteinuria (albumin-to-creatinine ratio 1.5 mg/mmol) and normal kidney function (eGFR [] >90 mL/min/1.73 m2) at that time. Antineutrophil cytoplasmic, extractable nuclear antigen (ENA) and anti-GBM antibodies were undetected. Urine studies showed protein-to-creatinine ratio 1.133 g/mmol, dysmorphic erythrocytes (>1000 × 106/L) and lipiduria.
T1DM was diagnosed at age 2 and insulin therapy delivered via insulin pump. Glycosylated haemoglobin (HbA1c) at presentation was 7.2%. The patient weighed 100 kg and had smoked 10 cigarettes per day for the past 7 years. There was no history of retinopathy or hypertension, illicit or non-steroidal anti-inflammatory drug use or alcohol dependence. He had been commenced on frusemide and irbesartan/hydrochlorothiazide 3 weeks earlier to treat oedema.
The kidney biopsy demonstrated a focal segmental necrotizing GN with cellular and fibrocellular crescents involving 29 of 40 glomeruli; another 6 glomeruli were sclerosed. Glomeruli had moderate nodular mesangial expansion and hypercellularity with several showing Kimmelstiel–Wilson nodules. Numerous tubular red blood cell casts were present. There was moderate interstitial fibrosis and tubular atrophy with a patchy interstitial mixed chronic inflammatory cell infiltrate (see A and B and A and B). Immunofluorescence showed strong linear GBM staining for IgG. Weaker anti-albumin staining localized in a linear fashion to the GBM, Bowman's capsule (BC) and tubular basement membrane (TBM) staining (A and B). Under oil immersion (×1000 magnification), a dual pattern of linear and granular glomerular peripheral capillary wall staining was seen. This was confirmed by confocal microscopy (A–C). Electron microscopy showed Stage 1 MN with small subepithelial electron-dense ‘immune-type’ deposits with early GBM spike formation (A and B). The overall diagnosis was that of anti-GBM GN and Stage 1 MN superimposed on Class III DN with Kimmelstiel–Wilson lesions.
The simultaneous diagnosis of seronegative anti-GBM GN, MN and DN was consistent with clinical presentation of proteinuria, haematuria and AKI, although unexpected, as anti-GBM antibody serology was negative (Orgentec, Mainz, Germany). A more sensitive biosensor assay was unavailable. The patient's human leucocyte antigens (HLA) were: A1, 24; B8, 39; DR4, 16. Screening for serum anti-secretory phospholipase A2 receptor (PLA2R) antibodies was not detected using an indirect immunofluorescence test (Euroimmun AG, Lubeck, Germany) []. In addition, PLA2R was not detected by immunofluorescence in the paraffin-embedded kidney biopsy using anti-rabbit PLA2R antibody (Atlas Antibodies).
Treatment included corticosteroids (3× intravenous methylprednisolone 1 g/day then 75 mg/day oral prednisolone), oral cyclophosphamide (2 mg/kg/day) after fertility protection measures and 10 alternate-daily plasmapheresis treatments (3 L volume exchanges, replacement albumin 4%). He was discharged with mildly improved stable kidney function, with SCr 253 μmol/L.
One week later, he developed small-volume haemoptysis that settled with oral antibiotics, cessation of smoking and cyclophosphamide reduction (1.5 mg/kg/day). Significant oedema persisted despite maximal oral diuretic therapy. Five weeks later, he developed neutropaenia necessitating withdrawal of cyclophosphamide. Prednisolone 60 mg/day was continued in light of further deterioration in kidney function, with SCr 383 μmol/L and worsening proteinuria at 19 g/day.
Another nine alternate-daily plasmapheresis treatments were initiated once neutropaenia resolved, attempting to salvage kidney function. The renal function remained severely impaired and proteinuria worsened to 21 g/day. His clinical course was complicated by H. Zoster reactivation (T7 dermatome) that resolved with valaciclovir treatment. Anti-GBM serology remained undetectable throughout.
Progressive renal disease and inability to monitor disease activity serologically led to a repeat kidney biopsy, which showed segmental sclerotic lesions and fibrous crescents in 13 of 22 glomeruli and another 3 glomeruli sclerosed. No segmental necrotizing lesions or cellular crescents were seen. Immunofluorescence showed a strong dual pattern of staining for IgG as described in the first biopsy (not illustrated). The overall diagnosis of the subsequent biopsy was inactive anti-GBM GN and MN superimposed on DN. Persistent strong linear GBM staining for IgG despite lack of active lesions in this biopsy.
The patient commenced maintenance haemodialysis 14 weeks after initial presentation when refractory fluid overload ensued, coupled with no renal recovery. Immunosuppression was discontinued. Currently, 5 months after presentation, he is training for home haemodialysis and suitability for combined kidney–pancreas transplant is being assessed.",What is the patient's score of the Revised Cardiac Risk Index for Pre-Operative Risk? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Pre-operative treatment with insulin': True, 'Elevated-risk surgery': False, 'Pre-operative creatinine': [387, 'µmol/L'], 'age': [22, 'years']}",2,2,2,"The criteria for the Revised Cardiac Risk Index (RCRI) are listed below:

1. Elevated-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular): No = 0 points, Yes = +1 point
2. History of ischemic heart disease (history of myocardial infarction, positive exercise test, current chest pain due to myocardial ischemia, use of nitrate therapy, or ECG with pathological Q waves): No = 0 points, Yes = +1 point
3. History of congestive heart failure (pulmonary edema, bilateral rales or S3 gallop, paroxysmal nocturnal dyspnea, or chest x-ray showing pulmonary vascular redistribution): No = 0 points, Yes = +1 point
4. History of cerebrovascular disease (prior transient ischemic attack or stroke): No = 0 points, Yes = +1 point
5. Pre-operative treatment with insulin: No = 0 points, Yes = +1 point
6. Pre-operative creatinine >2 mg/dL (176.8 μmol/L): No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.

The current cardiac risk index is 0.
Based on the patient note, an elevated risk surgery is determined to be absent for the patient. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of ischemetic heart disease and is assumed to be absent. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of congestive heart failure and is assumed to be absent. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of cerebrovascular disease and is assumed to be absent. This means that the total score remains unchanged at 0.
Based on the patient note, a pre-operative insulin treatment is determined to be present for the patient. This means that we increment the score by one and the current total will be 0 + 1 = 1.
The concentration of Pre-Operative Creatinine is 387 µmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of Pre-Operative Creatinine from µmol to mg. The mass of Pre-Operative Creatinine is 387 µmol. To convert 387 µmol of Pre-Operative Creatinine to mol, multiply by the conversion factor 1e-06, giving us 387 µmol Pre-Operative Creatinine * 1e-06 mol/µmol = 0.00039 mol Pre-Operative Creatinine. To convert from mol Pre-Operative Creatinine to grams, multiply by the molar mass 113.12 g/mol, which will give 0.00039 mol Pre-Operative Creatinine * 113.12 g/mol = 0.04412 g Pre-Operative Creatinine. To convert 0.04412 g of Pre-Operative Creatinine to mg, multiply by the conversion factor 1000.0, giving us 0.04412 g Pre-Operative Creatinine * 1000.0 mg/g = 44.12 mg Pre-Operative Creatinine. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 44.12 mg Pre-Operative Creatinine/10.0 dL = 4.412 mg Pre-Operative Creatinine/dL. The concentration value of 387 µmol Pre-Operative Creatinine/L converts to 4.412 mg Pre-Operative Creatinine/dL. The patient's pre-operative creatinine is greater than 2 mg/dL, so we increment the score by one and the current total will be 1 + 1 = 2.

The cardiac risk index score is 2."
258,17,Revised Cardiac Risk Index for Pre-Operative Risk,risk,integer,pmc-7396079-1,Extracted,"This patient was a 66-year-old male, with a BMI of 31 kg/m2, listed for deceased donor transplantation due to end-stage kidney disease (ESKD) secondary to membranous nephropathy. He commenced haemodialysis in 2018 and had a residual urine output of 500 mls per day. The patient received a curative allogenic bidirectionally incompatible stem cell transplant from his brother in 2007 (donor group A; recipient group B) for myelofibrosis. He also had a splenectomy for essential thrombocytosis and massive splenomegaly. His other comorbidities include type 2 diabetes mellitus, hypertension, dyslipidemia, paroxysmal atrial fibrillation, and x-linked ichthyosis.
Prior to listing for deceased kidney transplantation, the patient had a recurrence of myelofibrosis that did not respond to interferon or donor lymphocyte infusion. His haematological prognosis, however, was deemed to be reasonable (estimated minimum 80 months) with a bone marrow biopsy prior to transplant listing that showed a hypercellular bone marrow with patchy fibrosis without leukemic transformation. He was listed for kidney transplantation in January 2018. His pretransplant work-up was unremarkable with immunotyping confirming blood group A and mild sensitization (peak cPRA 12% attributed to HSCT and associated blood transfusions). His calculated PRA (cPRA) at time of transplant was 0%. He had normal cardiovascular assessment. He had a transthoracic echocardiogram showing normal left and right ventricular size and function without valve pathology and with estimated left ventricular ejection fraction (LVEF) of 75%, and a stress myocardial perfusion scan revealed no clinically significant abnormality. He had suitable anatomy for transplantation with a normal aortoiliac duplex scan; however, he did have central obesity.
In February 2019, after 1 year on the transplant waiting list, the patient was offered a donor kidney after circulatory death (DCD). The kidney was blood group A and HLA identical between the donor and recipient (HLA A1,1; A2,2; B7,7; DR 1515; DQ6,6), without donor-specific antibodies. The T cell and B cell CDC crossmatches were negative. The donor was CMV negative and EBV positive; the recipient was CMV positive and EBV positive.
Admission blood showed a haemoglobin level of 101 g/L and white cell count of 8.6 × 109/L corrected for promyelocytes. His biochemistry showed hyperkalemia (serum potassium 7.1 mmol/L) requiring preoperative dialysis with the remainder of his biochemical parameters being unremarkable. Routine blood group analysis, however, showed he was blood group B. Repeat redrawn blood testing confirmed blood group B. An urgent anti-A titre was performed and was 1 : 2. Due to excellent allelic matching and good kidney quality, the decision was made to proceed with an ABOi transplantation protocol.
The patient received standard immunosuppression regimen at our institution for standard immune risk patients (Basiliximab 20 mg at induction and on day 4, methylprednisolone 500 mg at induction and 12 hours post crossclamp release). The kidney transplant was performed in the right iliac fossa as previously described []. The warm ischaemic time was 45 minutes and cold ischaemic time was 17 hours. He was maintained on prednisolone, myfortic 720 mg twice daily, and tacrolimus with a target trough level of 8-10 μg/L. Standard prophylactic medications included piperacillin-tazobactam at induction, Bactrim® 400/80 mg daily, valganciclovir 450 mg adjusted to renal function, and amoxicillin 250 mg due to previous splenectomy.
His postoperative course was complicated by an episode of atrial fibrillation with rapid ventricular response, steroid-induced hyperglycaemia, and delayed graft function requiring haemodialysis on day 1 due to hyperkalemia (serum potassium 6.1 mmol/L). He required a blood transfusion of 1 unit of blood for a haemoglobin level of 69 g/L on day 2 post without stigmata of bleeding. His creatinine fell spontaneously on day 5, with progressively increasing urine output. No protocol biopsies were undertaken nor were they clinically indicated for this patient. Anti-A titres were 1 : 1 on day 1 with repeat titres consistently measured 1 : 1 postoperatively and at follow-up. At the time of last follow-up, 16 months posttransplant, he remains well with a stable renal function with creatinine of 135 μmoles and eGFR of 52 mL/min/1.73 m2.",What is the patient's score of the Revised Cardiac Risk Index for Pre-Operative Risk? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [66, 'years'], 'Elevated-risk surgery': False, 'Pre-operative treatment with insulin': False, 'Pre-operative creatinine': [135, 'µmol/L']}",0,0,0,"The criteria for the Revised Cardiac Risk Index (RCRI) are listed below:

1. Elevated-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular): No = 0 points, Yes = +1 point
2. History of ischemic heart disease (history of myocardial infarction, positive exercise test, current chest pain due to myocardial ischemia, use of nitrate therapy, or ECG with pathological Q waves): No = 0 points, Yes = +1 point
3. History of congestive heart failure (pulmonary edema, bilateral rales or S3 gallop, paroxysmal nocturnal dyspnea, or chest x-ray showing pulmonary vascular redistribution): No = 0 points, Yes = +1 point
4. History of cerebrovascular disease (prior transient ischemic attack or stroke): No = 0 points, Yes = +1 point
5. Pre-operative treatment with insulin: No = 0 points, Yes = +1 point
6. Pre-operative creatinine >2 mg/dL (176.8 μmol/L): No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.

The current cardiac risk index is 0.
Based on the patient note, an elevated risk surgery is determined to be absent for the patient. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of ischemetic heart disease and is assumed to be absent. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of congestive heart failure and is assumed to be absent. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of cerebrovascular disease and is assumed to be absent. This means that the total score remains unchanged at 0.
Based on the patient note, a pre-operative insulin treatment is determined to be absent for the patient. This means that the total score remains unchanged at 0.
The concentration of Pre-Operative Creatinine is 135 µmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of Pre-Operative Creatinine from µmol to mg. The mass of Pre-Operative Creatinine is 135 µmol. To convert 135 µmol of Pre-Operative Creatinine to mol, multiply by the conversion factor 1e-06, giving us 135 µmol Pre-Operative Creatinine * 1e-06 mol/µmol = 0.00014 mol Pre-Operative Creatinine. To convert from mol Pre-Operative Creatinine to grams, multiply by the molar mass 113.12 g/mol, which will give 0.00014 mol Pre-Operative Creatinine * 113.12 g/mol = 0.01584 g Pre-Operative Creatinine. To convert 0.01584 g of Pre-Operative Creatinine to mg, multiply by the conversion factor 1000.0, giving us 0.01584 g Pre-Operative Creatinine * 1000.0 mg/g = 15.84 mg Pre-Operative Creatinine. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 15.84 mg Pre-Operative Creatinine/10.0 dL = 1.584 mg Pre-Operative Creatinine/dL. The concentration value of 135 µmol Pre-Operative Creatinine/L converts to 1.584 mg Pre-Operative Creatinine/dL. The patient's pre-operative creatinine is less than or equal to 2 mg/dL, so we keep the score the same at 0.

The cardiac risk index score is 0."
259,17,Revised Cardiac Risk Index for Pre-Operative Risk,risk,integer,pmc-7748582-1,Extracted,"The patient discussed in this case report is a 53-year-old male with a past medical history of hypertension, hyperlipidemia, and diabetes mellitus type 2, managed on metformin and canagliflozin. After undergoing a routine laparoscopic appendectomy, his postoperative course remained uneventful. He started tolerating oral feeds, having bowel movements and remained hemodynamically stable. Therefore, he was discharged two days after the surgery. However, a few hours later, on the day of discharge, he presented to the emergency department with sudden onset generalized abdominal pain, non-exertional shortness of breath, and fever.
On presentation, he was febrile (temperature: 100.7°F), tachycardia (heart rate: 114 bpm), tachypneic (respiratory rate: 30/min), and hypoxic with an oxygen saturation of 87% on room air. His physical examination was benign; lungs were clear to auscultation bilaterally and soft, non-tender abdomen. The surgical site looked clean, without any discharge, and was non-tender to touch.
The patient’s initial laboratory measurements were all within normal limits: blood glucose 126 mg/dL, sodium 134 mmol/L, potassium 4.5 mmol/L, chloride 105 mmol/L, bicarbonate 17 mEq/L, blood urea nitrogen (BUN) 11 mg/dL, and creatinine 0.9 mg/dL. The exception was a high anion gap of 20.8 mEq/L and a pH of 7.21. The patient was started on four liters nasal cannula, switched to non-rebreather as he remained hypoxic, and was subsequently admitted to the hospital for further management. A septic workup was initiated, and the patient was placed on empiric antibiotics.
Further laboratory results revealed positive serum ketones (beta-hydroxybutyrate 2.69 mmol/L), whereas the urinalysis revealed glucosuria (urine glucose > 1500 mg/dL) and ketonuria and no proteins. A urine culture was negative for any infectious growth. Serum lactate was 13 mg/dL. A computerized axial tomography (CAT) scan of the patient’s chest showed bilateral lower lobe consolidations suggestive of probable pneumonia. A CAT scan of his abdomen showed probable postoperative ileus with no obstruction or abscess. On further questioning, the patient reported having resumed canagliflozin and his regular diet as instructed upon being discharged.
Due to a high anion gap and positive ketones in the blood with normal blood glucose levels, the patient was diagnosed with euglycemic diabetic ketoacidosis secondary to his SGLT2-inhibitor use. Thus, canagliflozin was stopped, and the patient was started on an insulin drip with 10% dextrose. Subsequently, he was transferred to the intensive care unit (ICU) for closer monitoring. The patient’s condition started improving after the treatment with insulin and dextrose. On day two, following admission, his symptoms improved, and subsequent laboratory results also looked better with a lower anion gap of 16.2 mEq/L. On day three following admission, he was switched from an insulin drip to subcutaneous insulin and sliding scale as his laboratory results approached normal, with an anion gap of 13.2 mEq/L and beta-hydroxybutyrate of 0.81 mmol/L. With symptom resolution, the patient was then returned to the floor. However, his urine glucose remained high (>1500 mg/dL).
Discharged the next day and advised to continue subcutaneous insulin for a week, the patient was asked to consult his endocrinologist for further management. He was also recommended against resuming canagliflozin.",What is the patient's score of the Revised Cardiac Risk Index for Pre-Operative Risk? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [53, 'years'], 'Elevated-risk surgery': False, 'Pre-operative treatment with insulin': False, 'Pre-operative creatinine': [0.9, 'mg/dL']}",0,0,0,"The criteria for the Revised Cardiac Risk Index (RCRI) are listed below:

1. Elevated-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular): No = 0 points, Yes = +1 point
2. History of ischemic heart disease (history of myocardial infarction, positive exercise test, current chest pain due to myocardial ischemia, use of nitrate therapy, or ECG with pathological Q waves): No = 0 points, Yes = +1 point
3. History of congestive heart failure (pulmonary edema, bilateral rales or S3 gallop, paroxysmal nocturnal dyspnea, or chest x-ray showing pulmonary vascular redistribution): No = 0 points, Yes = +1 point
4. History of cerebrovascular disease (prior transient ischemic attack or stroke): No = 0 points, Yes = +1 point
5. Pre-operative treatment with insulin: No = 0 points, Yes = +1 point
6. Pre-operative creatinine >2 mg/dL (176.8 μmol/L): No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.

The current cardiac risk index is 0.
Based on the patient note, an elevated risk surgery is determined to be absent for the patient. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of ischemetic heart disease and is assumed to be absent. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of congestive heart failure and is assumed to be absent. This means that the total score remains unchanged at 0.
The patient note does not mention anything about a history of cerebrovascular disease and is assumed to be absent. This means that the total score remains unchanged at 0.
Based on the patient note, a pre-operative insulin treatment is determined to be absent for the patient. This means that the total score remains unchanged at 0.
The concentration of Pre-Operative Creatinine is 0.9 mg/dL. The patient's pre-operative creatinine is less than or equal to 2 mg/dL, so we keep the score the same at 0.

The cardiac risk index score is 0."
260,17,Revised Cardiac Risk Index for Pre-Operative Risk,risk,integer,pmc-6141219-1,Extracted,"A 61-year-old woman with a history of treated pulmonary tuberculosis in childhood, bronchiectasis, hypertension, hypothyroidism, polymyalgia rheumatica, and hyperlipidemia presented to our clinic with two months of shortness of breath on exertion associated with worsening lower extremity edema, vomiting, subjective fever, and watery diarrhea three days prior to admission.
Upon admission, she presented hemodynamically stable. On physical examination, she had bibasilar lung crackles and pitting edema bilaterally. Her blood urea nitrogen level was 82 mg/dL, creatinine level was 11.91 mg/dL, sodium was 129 mmol/L, potassium was 8.6 mmol/L, bicarbonate was 19 mmol/L, and hemoglobin was 7.3 g/dL. She was admitted due to acute kidney injury (AKI) secondary to acute tubular necrosis, presumably from volume depletion. An attempt was made to manage the AKI medically, but oliguria and worsening acidosis and hyperkalemia prompted hemodialysis.
Further studies revealed the presence of serum myeloperoxidase (MPO)-anti-neutrophil cytoplasmic antibodies (ANCA), serum anti-glomerular basement membrane (GBM), and red blood cells in her urine. She received intravenous methylprednisolone 500 mg for three days. A renal biopsy showed MPO-ANCA mediated with concurrent anti-GBM disease crescentic necrotizing and focal sclerosing glomerulonephritis, establishing the diagnosis of Goodpasture syndrome with rapidly progressive glomerulonephritis. She received four cycles of rituximab and continued with prednisone 60 mg daily.
The hospital course was complicated by a Clostridium difficile infection and hospital-acquired pneumonia (HAP). Also, she acutely presented an episode of respiratory distress: her respiration rate was >24 breaths/minute, oxygen saturation was <90%, heart rate was >120, blood pressure was 180/100 mmHg, and we noted labored breathing via accessory muscles, expiratory wheezing, and expectoration of frothy secretions. The patient was intubated and transferred to the cardiac care unit. A 12-lead electrocardiogram (ECG) showed an ST and T wave abnormality (Figure ) compatible with anterolateral ischemia.
A transthoracic echocardiogram (TTE) revealed an ejection fraction (EF) of 20% to 25%, grade 2 diastolic dysfunction, systolic right atrial pressure (RAP) of 15 mmHg, and right ventricle systolic pressure (RVSP) of 59 mmHg. The left ventricle was normal in size, but there were regional wall motion abnormalities. Apical and basal segments contracted normally, but the mid-anteroseptal, inferolateral, and anteroapical walls were hypokinetic. The anteroapical wall appeared to be dyskinetic. She was started on carvedilol and lisinopril. A follow-up TTE three weeks later revealed an EF of 50%, grade 1 diastolic dysfunction, systolic RAP of 3 mmHg, and RVSP of 33 mmHg with an improvement in the previously described wall motion abnormalities, suggestive of resolving the mid-ventricular variant of Takotsubo cardiomyopathy (Video ). Pheochromocytoma was not ruled out given the absence of typical signs and symptoms.
Late in her hospital course, she presented two episodes of respiratory distress considered secondary to Goodpasture syndrome and fluid overload; these episodes were managed with nasal intermittent positive pressure ventilation and furosemide. The patient required resumed intermittent dialysis and was successfully discharged. On an 18-month follow-up office visit, she remained asymptomatic, cardiovascular wise. However, because of the chronic kidney disease, she underwent a kidney transplant.",What is the patient's score of the Revised Cardiac Risk Index for Pre-Operative Risk? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Congestive Heart Failure criteria for the Cardiac Risk Index rule': True, 'Pre-operative creatinine': [11.91, 'mg/dL'], 'History of ischemic heart disease': True, 'age': [61, 'years']}",3,3,3,"The criteria for the Revised Cardiac Risk Index (RCRI) are listed below:

1. Elevated-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular): No = 0 points, Yes = +1 point
2. History of ischemic heart disease (history of myocardial infarction, positive exercise test, current chest pain due to myocardial ischemia, use of nitrate therapy, or ECG with pathological Q waves): No = 0 points, Yes = +1 point
3. History of congestive heart failure (pulmonary edema, bilateral rales or S3 gallop, paroxysmal nocturnal dyspnea, or chest x-ray showing pulmonary vascular redistribution): No = 0 points, Yes = +1 point
4. History of cerebrovascular disease (prior transient ischemic attack or stroke): No = 0 points, Yes = +1 point
5. Pre-operative treatment with insulin: No = 0 points, Yes = +1 point
6. Pre-operative creatinine >2 mg/dL (176.8 μmol/L): No = 0 points, Yes = +1 point

The total score is calculated by summing the points for each criterion.

The current cardiac risk index is 0.
The patient note does not mention anything about an elevated risk surgery and is assumed to be absent. This means that the total score remains unchanged at 0.
Based on the patient note, a history of ischemetic heart disease is determined to be present for the patient. This means that we increment the score by one and the current total will be 0 + 1 = 1.
Based on the patient note, a history of congestive heart failure is determined to be present for the patient. This means that we increment the score by one and the current total will be 1 + 1 = 2.
The patient note does not mention anything about a history of cerebrovascular disease and is assumed to be absent. This means that the total score remains unchanged at 2.
The patient note does not mention anything about a pre-operative insulin treatment and is assumed to be absent. This means that the total score remains unchanged at 2.
The concentration of Pre-Operative Creatinine is 11.91 mg/dL. The patient's pre-operative creatinine is greater than 2 mg/dL, so we increment the score by one and the current total will be 2 + 1 = 3.

The cardiac risk index score is 3."
261,18,HEART Score for Major Cardiac Events,risk,integer,pmc-3466862-1,Extracted,"A 52-year-old man was referred to our hospital because of two episodes of syncope within a fortnight. He had suffered from pleuritic chest pain and dry coughs for the previous two weeks, and antibiotics prescribed for pneumonia by an internist failed to prevent the exacerbation of the symptoms. The internist subsequently referred the patient to a cardiologist, who subjected him to an exercise stress test (to rule out coronary artery disease), during which he developed non-sustained ventricular tachycardia. The following day, he suffered a one-minute syncope while talking a walk in his yard. He was, therefore, once more referred to our hospital by the internist to evaluate ventricular tachycardia as a cause of syncope. When the patient arrived at our hospital, he had anxiety and had a respiratory rate of 30/min, pulse rate of 120/min, and supine blood pressure of 100/60 mmHg. Additionally, the patient’s lungs were clear and his heart sound and lower limb were normal. Chest X-ray revealed mild cardiomegaly, dilated right descending pulmonary artery, and oligemia in the right lung ().
On echocardiography, the left ventricle was normal; however, the right heart was dilated and trabeculated and there was also right ventricular dysfunction. The pulmonary artery pressure was elevated to 45 mmHg. The patient denied any history of deep vein thrombosis and mentioned only a six-hour car travel more than three weeks earlier. His family history for venous thromboembolism was weakly positive and one of his nephews had a history of pulmonary thromboembolism.
At this point, lung CT angiography was performed to rule out pulmonary embolism as the main cause of acute right ventricular enlargement. The CT angiography demonstrated bilateral pulmonary artery thrombosis from the first division of the right and left pulmonary arteries to the distal ones ( & ).
With a diagnosis of pulmonary embolism, the patient underwent thrombolytic therapy with recombinant tissue plasminogen activator (r-TPA) 100mg over a 90-minute period, which brought about immediate improvement in the patient’s condition. The following day, his symptoms improved dramatically, his respiratory rate decreased, his O2 saturation rose from 85% to 98%, and his blood pressure remained stable in different positions.
CT angiography showed improved right ventricular function and decreased right ventricular size and pulmonary arteries (&).",What is the patient's score of the HEART Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [52, 'years'], 'Suspicion History': 'Highly suspicious', 'Electrocardiogram Test': 'Normal', 'parent or sibling with Cardiovascular disease before age 65': False}",3,3,3,"The HEART Score for risk stratification in patients with chest pain is shown below:

1. History: Slightly suspicious = 0 points, Moderately suspicious = +1 point, Highly suspicious = +2 points
2. EKG: Normal = 0 points, Non-specific repolarization disturbance = +1 point, Significant ST deviation = +2 points
3. Age: <45 years = 0 points, 45-64 years = +1 point, ≥65 years = +2 points
4. Risk factors (HTN, hypercholesterolemia, DM, obesity (BMI >30 kg/m²), smoking (current or cessation within 3 months), positive family history of cardiovascular disease before age 65, atherosclerotic disease such as prior MI, PCI/CABG, CVA/TIA, or peripheral arterial disease): No known risk factors = 0 points, 1-2 risk factors = +1 point, ≥3 risk factors or history of atherosclerotic disease = +2 points
5. Initial troponin level: ≤normal limit = 0 points, 1-3x normal limit = +1 point, >3x normal limit = +2 points

The total score is calculated by summing the points for each criterion.
    
The current HEART Score is 0.
The value of 'history' in the patient's note is determined to be 'Highly suspicious'. Based on the HEART Score criteria, 2 points are added for 'history', increasing the current total to 0 + 2 = 2.
The value of 'electrocardiogram' in the patient's note is determined to be 'Normal'. Based on the HEART Score criteria, 0 points are added for 'electrocardiogram', keeping the current total at 2.
The patient is 52 years old. The patient's age is between 45 and 65 years and so we increment the current total by 1, making the current total 2 + 1 = 3.
The following risk factor(s) are mentioned in the patient's note, but these risk factors are noted to be absent from the patient: family with cvd. The following risk factor(s) are missing from the patient's data: family with cvd. We will assume that these are all absent from the patient. Based on the HEART Score risk factors criteria, 0 risk factors are present and so 0 points are added for the risk factors criteria, keeping the current total at 3.
'initial troponin' is missing from the patient's data and so we assume it's value is less than or equal to normal limit.Based on the HEART Score criteria, 0 points are added for 'initial troponin', keeping the current total at 3.
Based on the patient's data, the HEART Score is 3."
262,18,HEART Score for Major Cardiac Events,risk,integer,pmc-8509094-1,Extracted,"A 47-year-old man presented to the emergency department (ED) in April 2021 for altered mental status. His medical history consisted of type 2 diabetes mellitus and hypertension, and there was no history of malignancy. Per Emergency Medical Services, the patient lives at home with a roommate who witnessed a seizure-like episode. He arrived at the ED with glucose in the 700s. Home medications included insulin glargine 25 units twice daily, gabapentin 800 mg three times daily, aspirin 81 mg daily, atorvastatin 40 mg daily, and metoprolol succinate 200 mg daily. He was treated for hyperosmolar hyperglycemic state in the ED and was admitted for further management. The patient was found to be COVID positive on SARS-CoV-2 RNA testing. He left against medical advice two days later.
Approximately two weeks later, the patient presented with pleuritic chest pain associated with shortness of breath. Vital signs at the time of admission: temperature 37.9° Celsius, heart rate 92 beats/minute, blood pressure 117/79 mmHg, respiratory rate 18 breaths/minute, and oxygen saturation 94% on room air. Cardiac examination revealed normal S1 and S2 and no murmurs, rubs, or gallops. Lung auscultation was clear to auscultation bilaterally, without wheezes, rhonchi, or rales. Bilateral 2+ pitting edema was present to the level of his knees. Initial troponin was 0.481 ng/ml (reference <0.012 ng/ml) but subsequently downtrended to <0.02 ng/ml, and pro B-type natriuretic peptide (pro-BNP) was 2800 pg/ml (reference 0-300 pg/ml). Electrocardiography (ECG) showed normal sinus rhythm with low voltages in the limb leads; there were no diffuse ST-segment elevations (Figure ). Transthoracic echocardiogram (TTE) showed a left ventricular ejection fraction of 30% with severe global hypokinesis, increased wall thickness of the right ventricle, and a small circumferential pericardial effusion without evidence of tamponade physiology. Unfortunately, the patient again left against medical advice.
Three months later, the patient presented to the hospital with shortness of breath and was found to be volume overloaded due to medication noncompliance. TTE showed a large pericardial effusion with diastolic compression of the right atrium, consistent with cardiac tamponade physiology. He underwent pericardiocentesis with the removal of 800 ml serosanguinous fluid that was negative for malignant cytology. Acid-fast bacilli culture and smear of the pericardial fluid were negative. Approximately one month later, the patient saw his cardiologist for follow-up. The patient was referred to the ED for bilateral lower extremity cellulitis. On this most recent ED visit, approximately four months after the initial presentation, the patient agreed to stay in the hospital and undergo a comprehensive diagnostic evaluation.
In addition to evaluation of his cellulitis, bedside ultrasonography showed that a moderate to large pericardial effusion had recurred, though without evidence of right ventricular diastolic collapse or right atrial systolic collapse. CT chest also confirmed an incidental large pericardial effusion (Figure ). Blood cultures were negative. Testing of human immunodeficiency virus (HIV) and antinuclear antibody (ANA) serology was negative. His ECG on this admission was unchanged from prior ECGs. Hemoglobin A1c was 8%, and low-density lipoprotein (LDL) was 58 mg/dl. Carcinoembryonic antigen (CEA), alpha fetoprotein (AFP), cancer antigens (CA 19-9), and prostate-specific antigen (PSA) were negative. Repeat TTE showed large pericardial effusion (2.3 cm) and evidence of tamponade physiology (exaggerated respiratory variation in mitral inflow velocity (E) on Doppler echocardiography).
Of note, a previous left heart catheterization with coronary angiography did not show significant obstructive coronary artery disease. A prior echocardiogram seven months prior revealed an ejection fraction of 65%, without pericardial effusion. The patient underwent placement of a pericardial window, and a chest tube was inserted. Repeat blood cultures were negative. The chest tube drained approximately 165 ml. The patient’s clinical presentation improved, and he was discharged home.",What is the patient's score of the HEART Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [47, 'years'], 'Hypertension history': True, 'Electrocardiogram Test': 'Normal', 'Diabetes mellitus': True, 'atherosclerotic disease': False, 'Suspicion History': 'Moderately suspicious', 'hypercholesterolemia': True, 'Initial troponin': 'greater than three times normal limit'}",5,5,5,"The HEART Score for risk stratification in patients with chest pain is shown below:

1. History: Slightly suspicious = 0 points, Moderately suspicious = +1 point, Highly suspicious = +2 points
2. EKG: Normal = 0 points, Non-specific repolarization disturbance = +1 point, Significant ST deviation = +2 points
3. Age: <45 years = 0 points, 45-64 years = +1 point, ≥65 years = +2 points
4. Risk factors (HTN, hypercholesterolemia, DM, obesity (BMI >30 kg/m²), smoking (current or cessation within 3 months), positive family history of cardiovascular disease before age 65, atherosclerotic disease such as prior MI, PCI/CABG, CVA/TIA, or peripheral arterial disease): No known risk factors = 0 points, 1-2 risk factors = +1 point, ≥3 risk factors or history of atherosclerotic disease = +2 points
5. Initial troponin level: ≤normal limit = 0 points, 1-3x normal limit = +1 point, >3x normal limit = +2 points

The total score is calculated by summing the points for each criterion.
    
The current HEART Score is 0.
The value of 'history' in the patient's note is determined to be 'Moderately suspicious'. Based on the HEART Score criteria, 1 point is added for 'history', increasing the current total to 0 + 1 = 1.
The value of 'electrocardiogram' in the patient's note is determined to be 'Normal'. Based on the HEART Score criteria, 0 points are added for 'electrocardiogram', keeping the current total at 1.
The patient is 47 years old. The patient's age is between 45 and 65 years and so we increment the current total by 1, making the current total 1 + 1 = 2.
The following risk factor(s) are present based on the patient's note: hypertension, diabetes mellitus. The following risk factor(s) are mentioned in the patient's note, but these risk factors are noted to be absent from the patient: atherosclerotic disease. The following risk factor(s) are missing from the patient's data: atherosclerotic disease. We will assume that these are all absent from the patient. Based on the HEART Score risk factors criteria, 2 risk factors are present and so 1 point is added for the risk factors criteria, making the current total, 2 + 1 = 3.
The value of 'initial troponin' in the patient's note is determined to be 'greater than three times normal limit'. Based on the HEART Score criteria, 2 points are added for 'initial troponin', increasing the current total to 3 + 2 = 5.
Based on the patient's data, the HEART Score is 5."
263,18,HEART Score for Major Cardiac Events,risk,integer,pmc-7997683-3,Extracted,"A 37-year-old African American female patient morbidly obese with no other significant medical history, presented to the ED complaining of chest pain. She described her chest pain as pressure like and tightness in the middle of chest, 7 out of 10 in severity, lasting for five to six minutes then gradually improving and lingering on for some more minutes before completely wearing off. Pain radiated to her back and was not related to activity. The patient denied shortness of breath, nausea, and vomiting. She denied history of heart disease, previous similar chest pain or substance abuse, and she stated that she is quite healthy otherwise.
Physical exam revealed stable vital signs -- blood pressure: 123/78 mmHg, heart rate: 73 beats/min, respiratory rate: 18 breaths/min, temperature: 36.5 degrees Celsius, SpO2: 97% on room air. Cardiovascular examination revealed a pulse with regular rate and rhythm, normal S1 and S2, with no murmurs or added sounds. Respiratory examination was normal with normal vesicular breath sounds heard bilaterally. The rest of physical examination was unremarkable. Urine toxicology and pregnancy test were negative, other laboratory tests were within normal limits.
The EKG showed normal sinus rhythm with no ischemic changes, serial high sensitivity troponin was elevated at 440>606>872 ng/mL (normal range 0-0.4 ng/mL). Due to concern of aortic dissection and PE, computed tomography angiography (CTA) and CT PE were performed and both were negative. Transthoracic echocardiogram (TTE) showed normal left ventricular ejection fraction and no regional wall motion abnormalities. Due to her significant chest pain and up trending of troponin, the patient had a LHC. LHC showed 70% stenosis of the first obtuse with type A dissection (Figure ).
Intravascular ultrasound (IVUS) showed type A spontaneous coronary dissection with no significant compromise in lumen as shown in Figure . The patient was monitored in the cardiac telemetry unit for one day, she was medically stable, and her chest pain resolved. The patient was discharged on aspirin, metoprolol, and atorvastatin.",What is the patient's score of the HEART Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [37, 'years'], 'Hypertension history': False, 'Electrocardiogram Test': 'Normal', 'Diabetes mellitus': False, 'smoking': False, 'parent or sibling with Cardiovascular disease before age 65': False, 'atherosclerotic disease': False, 'Suspicion History': 'Highly suspicious', 'hypercholesterolemia': False, 'obesity': True, 'Transient Ischemic Attacks History': False, 'Initial troponin': 'greater than three times normal limit'}",5,5,5,"The HEART Score for risk stratification in patients with chest pain is shown below:

1. History: Slightly suspicious = 0 points, Moderately suspicious = +1 point, Highly suspicious = +2 points
2. EKG: Normal = 0 points, Non-specific repolarization disturbance = +1 point, Significant ST deviation = +2 points
3. Age: <45 years = 0 points, 45-64 years = +1 point, ≥65 years = +2 points
4. Risk factors (HTN, hypercholesterolemia, DM, obesity (BMI >30 kg/m²), smoking (current or cessation within 3 months), positive family history of cardiovascular disease before age 65, atherosclerotic disease such as prior MI, PCI/CABG, CVA/TIA, or peripheral arterial disease): No known risk factors = 0 points, 1-2 risk factors = +1 point, ≥3 risk factors or history of atherosclerotic disease = +2 points
5. Initial troponin level: ≤normal limit = 0 points, 1-3x normal limit = +1 point, >3x normal limit = +2 points

The total score is calculated by summing the points for each criterion.
    
The current HEART Score is 0.
The value of 'history' in the patient's note is determined to be 'Highly suspicious'. Based on the HEART Score criteria, 2 points are added for 'history', increasing the current total to 0 + 2 = 2.
The value of 'electrocardiogram' in the patient's note is determined to be 'Normal'. Based on the HEART Score criteria, 0 points are added for 'electrocardiogram', keeping the current total at 2.
The patient is 37 years old. The patient's age is less than 45 years and so keep the current total at 2.
The following risk factor(s) are present based on the patient's note: obesity. The following risk factor(s) are mentioned in the patient's note, but these risk factors are noted to be absent from the patient: hypertension, diabetes mellitus, smoking, family with cvd, atherosclerotic disease. The following risk factor(s) are missing from the patient's data: hypertension, diabetes mellitus, smoking, family with cvd, atherosclerotic disease. We will assume that these are all absent from the patient. Based on the HEART Score risk factors criteria, 1 risk factors are present and so 1 point is added for the risk factors criteria, making the current total, 2 + 1 = 3.
The value of 'initial troponin' in the patient's note is determined to be 'greater than three times normal limit'. Based on the HEART Score criteria, 2 points are added for 'initial troponin', increasing the current total to 3 + 2 = 5.
Based on the patient's data, the HEART Score is 5."
264,18,HEART Score for Major Cardiac Events,risk,integer,pmc-8643279-1,Extracted,"The patient is a 44-year-old Caucasian female with a past medical history of anxiety who presented to the ED with a chief complaint of intermittent palpitations for the past four to six weeks. Her symptoms had acutely worsened in the 24 hours prior to presentation. Additional review of systems (ROS) was significant for four to six months of menopausal symptoms described as hot flashes, lack of menses, and vaginal dryness. She also endorsed a 10-pound unintentional weight loss over the past four weeks. She had recently been prescribed medroxyprogesterone by her primary care provider. Patient denied any history of thyroid disease, autoimmune disease, or atrial fibrillation/atrial flutter. Patient denied any drug or alcohol abuse.
In the ED, vitals were as follows: temperature of 98.1°F (36.7°C), heart rate 185 bpm, blood pressure of 133/100 mmHg, and oxygen saturation 96% on room air. Initial CBC was significant for hemoglobin 12.7 grams per deciliter (g/dL), hematocrit 40.4%, platelet count of 143,000 cells per microliter of blood (c/μL). Prothrombin time and international normalized ratio were 13.8 seconds and 1.22, respectively. Initial CMP was not significant. Initial troponin was 0.017 nanograms per milliliter (ng/mL), urine drug test (UDS) was negative, urine pregnancy test (UPT) was negative, TSH was less than 0.02 micro-international units per milliliter (μIU/mL), free thyroxine (T4) 6.99 nanograms per deciliter of blood (ng/dL), and free triiodothyronine (T3) 22.80 picograms per milliliter of blood (pg/mL). Electrocardiogram (EKG) showed atrial fibrillation (A. fib) with rapid ventricular response (RVR) at a rate of 182 bpm as seen below in Figure .
The patient was given 20 milligrams (mg) intravenous (IV) push of diltiazem, followed by continuous infusion of diltiazem. She was also started on apixaban 5 mg oral twice daily for stroke prophylaxis.
She was admitted to the intensive care unit (ICU) for closer monitoring. At the time of admission, she was hemodynamically stable and asymptomatic. Pertinent physical examination findings included a generally anxious appearing female with mildly increased work of breathing, irregularly irregular pulse, a non-tender diffusely enlarged thyroid gland without any appreciable nodularity, and mild non-pitting edema in the bilateral lower extremities.
Several hours after admission, the patient became acutely short of breath and diaphoretic. She endorsed orthopnea and dizziness, and her examination was significant for jugular venous distention and cool extremities. Vital signs at that time showed a temperature of 98.8°F (37.1°C), heart rate 114 bpm, blood pressure of 73/51 mmHg, mean arterial pressure (MAP) of 56 mmHg, respiration rate (RR) 41 b/m, and oxygen saturation 98% on room air. Diltiazem was stopped after patient’s MAP fell to less than 65 mmHg and an infusion of norepinephrine was initiated. Cardiology was consulted and dobutamine was added for ionotropic support. Transthoracic echocardiogram (TTE) revealed a severely depressed left ventricle (LV) with a calculated ejection fraction (EF) of 5-10% with global hypokinesis, with severely dilated right ventricle (RV), in addition to elevated right ventricular systolic pressure (RVSP) is consistent with mild pulmonary hypertension as seen in the four chamber view in Video .
Endocrinology evaluated the patient at bedside and began therapy with propylthiouracil (PTU) 200 mg oral every six hours, hydrocortisone 100 mg IV three times daily, and potassium iodide/iodine (Lugol’s solution) three times daily.
The patient improved clinically within 24 hours and all vasopressors were weaned off. She was transferred from the ICU to a regular floor bed under continued observation for 48 hours. Repeat TTE at that time showed marked improvement with the left ventricular EF of 35% as seen in Video .
The patient was discharged home on methimazole 50 mg daily in addition to propranolol 40 mg four times daily with appropriate clinic follow up with endocrinology and cardiology.",What is the patient's score of the HEART Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [44, 'years'], 'Electrocardiogram Test': 'Normal', 'Suspicion History': 'Moderately suspicious', 'Initial troponin': 'less than or equal to normal limit'}",1,1,1,"The HEART Score for risk stratification in patients with chest pain is shown below:

1. History: Slightly suspicious = 0 points, Moderately suspicious = +1 point, Highly suspicious = +2 points
2. EKG: Normal = 0 points, Non-specific repolarization disturbance = +1 point, Significant ST deviation = +2 points
3. Age: <45 years = 0 points, 45-64 years = +1 point, ≥65 years = +2 points
4. Risk factors (HTN, hypercholesterolemia, DM, obesity (BMI >30 kg/m²), smoking (current or cessation within 3 months), positive family history of cardiovascular disease before age 65, atherosclerotic disease such as prior MI, PCI/CABG, CVA/TIA, or peripheral arterial disease): No known risk factors = 0 points, 1-2 risk factors = +1 point, ≥3 risk factors or history of atherosclerotic disease = +2 points
5. Initial troponin level: ≤normal limit = 0 points, 1-3x normal limit = +1 point, >3x normal limit = +2 points

The total score is calculated by summing the points for each criterion.
    
The current HEART Score is 0.
The value of 'history' in the patient's note is determined to be 'Moderately suspicious'. Based on the HEART Score criteria, 1 point is added for 'history', increasing the current total to 0 + 1 = 1.
The value of 'electrocardiogram' in the patient's note is determined to be 'Normal'. Based on the HEART Score criteria, 0 points are added for 'electrocardiogram', keeping the current total at 1.
The patient is 44 years old. The patient's age is less than 45 years and so keep the current total at 1.
The following risk factor(s) are missing from the patient's data: . We will assume that these are all absent from the patient. Based on the HEART Score risk factors criteria, 0 risk factors are present and so 0 points are added for the risk factors criteria, keeping the current total at 1.
The value of 'initial troponin' in the patient's note is determined to be 'less than or equal to normal limit'. Based on the HEART Score criteria, 0 points are added for 'initial troponin', keeping the current total at 1.
Based on the patient's data, the HEART Score is 1."
265,18,HEART Score for Major Cardiac Events,risk,integer,pmc-7752799-1,Extracted,"A 53-year-old man with a history of congestive heart failure and alcohol use disorder presented to the ER with shortness of breath, abdominal distension, orthopnea, and a 20-pound weight gain in the prior two months. He reported that he had a 10 L paracentesis one year ago. He denied a history of coronary artery disease. The patient also reported that he used alcohol daily and was an active smoker. The patient’s home medications included carvedilol, furosemide, spironolactone, atorvastatin, metformin, and albuterol. The patient’s vital signs were within normal limits. Cardiac examination revealed a systolic murmur at the cardiac apex, however, jugular venous pulsation was unable to be observed because of body habitus. On pulmonary exam, the patient’s lungs were clear to auscultation in all lung fields. The patient had a distended abdomen with a positive fluid wave. The patient did not have lower extremity edema. His laboratory workup was notable for creatinine of 1 mg/dL, platelets of 33 x 103/mm3, INR of 1.1, albumin 3 g/dL, bilirubin 0.8 mg/dL, and pro-brain natriuretic peptide (BNP) of >5000 pg/mL. The chest X-ray was unremarkable (Figure ).
At this point the etiology of dyspnea was thought to be related to congestive heart failure or ascites. The history of congestive heart failure, elevated BNP, and orthopnea supported congestive heart failure as the etiology of his dyspnea, but he had a normal lung exam, a normal chest X-ray, and no lower extremity edema. Meanwhile, the abdominal distension, positive fluid wave, and history of a therapeutic paracentesis suggested the presences of marked ascites. Large volume ascites can compress the diaphragm and cause orthopnea and dyspnea. However, management of ascites and congestive heart differ, and it was important to accurately distinguish the two (Table ) [].
An attending with five years of POCUS experience then performed POCUS to further assess the patient. Abdominal ultrasound revealed only moderate ascites in the suprapubic region (Video ,B), but no other significant fluid pockets were found in the bilateral lower compartments. This moderate volume of ascites made diaphragmatic compression as the etiology of his dyspnea less likely. To further characterize the etiology of the ascites, the probe was moved to the subxiphoid position to identify the IVC. His IVC was distended more than 2.1 cm with less than 50% collapsibility consistent with an elevated CVP > 10 mmHg (Video ,B) []. In order to characterize the etiology of this high CVP, the probe was then moved to the parasternal position to assess for cardiac pathology. In the parasternal long axis view, the left ventricle demonstrated normal ejection fraction, but the right ventricle was severely dilated, and a moderate pericardial effusion was observed (Video ). In the parasternal short-axis view, the right ventricle was observed to be larger than the left ventricle, with septal flattening during diastole suggesting severe right ventricular dysfunction (Video ).
A paracentesis revealed 366 x 103/mm3 white blood cells with 61% monocytes and macrophages. The serum-ascites albumin gradient was 1.5, suggestive of portal hypertension. Finally, the ascites total protein was >2.5 g/dL, which confirmed the diagnosis of cardiac ascites. He was started on IV diuresis and had a 20-pound weight loss over the subsequent seven days with resolution of his shortness of breath and orthopnea.
The severe right heart dysfunction found on POCUS prompted a workup for pulmonary hypertension. A transthoracic echo confirmed the findings on POCUS including left ventricular ejection fraction of 55%-60%. There was moderate-to-severely dilated right ventricle with moderate-to-severe reduction in right ventricular systolic function. The right atrium was moderately dilated with moderate pulmonary hypertension (right ventricular systolic pressure = 60 mmHg). The IVC was dilated with less than 50% collapse with respiration, and a small pericardial effusion was seen. The patient underwent a right heart catheterization after aggressive IV diuresis which showed a right atrial pressure of 7 mmHg, pulmonary artery pressure of 73/26 mmHg, mean pulmonary artery pressure (mPAP) of 45 mmHg, and a pulmonary capillary wedge pressure of 13 mmHg, with a cardiac index of 2.7 L/min/m2 and pulmonary vascular resistance (PVR) of 498 dyn·s/cm5. His pulmonary hypertension workup included normal autoimmune serologies, normal diffusion on pulmonary function tests, normal high-resolution chest CT, and a normal V/Q scan. After ruling out secondary causes of pulmonary hypertension, he was diagnosed with Group 1 Pulmonary Arterial Hypertension due to PPH. He was enrolled into a sober living facility and is being followed closely by the liver transplant clinic.",What is the patient's score of the HEART Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [53, 'years'], 'Hypertension history': True, 'Diabetes mellitus': True, 'smoking': True, 'Suspicion History': 'Moderately suspicious', 'hypercholesterolemia': True, 'obesity': True}",4,4,4,"The HEART Score for risk stratification in patients with chest pain is shown below:

1. History: Slightly suspicious = 0 points, Moderately suspicious = +1 point, Highly suspicious = +2 points
2. EKG: Normal = 0 points, Non-specific repolarization disturbance = +1 point, Significant ST deviation = +2 points
3. Age: <45 years = 0 points, 45-64 years = +1 point, ≥65 years = +2 points
4. Risk factors (HTN, hypercholesterolemia, DM, obesity (BMI >30 kg/m²), smoking (current or cessation within 3 months), positive family history of cardiovascular disease before age 65, atherosclerotic disease such as prior MI, PCI/CABG, CVA/TIA, or peripheral arterial disease): No known risk factors = 0 points, 1-2 risk factors = +1 point, ≥3 risk factors or history of atherosclerotic disease = +2 points
5. Initial troponin level: ≤normal limit = 0 points, 1-3x normal limit = +1 point, >3x normal limit = +2 points

The total score is calculated by summing the points for each criterion.
    
The current HEART Score is 0.
The value of 'history' in the patient's note is determined to be 'Moderately suspicious'. Based on the HEART Score criteria, 1 point is added for 'history', increasing the current total to 0 + 1 = 1.
'electrocardiogram' is missing from the patient's data and so we assume it's value is Normal.Based on the HEART Score criteria, 0 points are added for 'electrocardiogram', keeping the current total at 1.
The patient is 53 years old. The patient's age is between 45 and 65 years and so we increment the current total by 1, making the current total 1 + 1 = 2.
The following risk factor(s) are present based on the patient's note: hypertension, diabetes mellitus, obesity, smoking. The following risk factor(s) are missing from the patient's data: . We will assume that these are all absent from the patient. Based on the HEART Score risk factors criteria, 4 risk factors are present and so 2 points are added as 3 or more risk factors are present, making the current total 2 + 2 = 4.
'initial troponin' is missing from the patient's data and so we assume it's value is less than or equal to normal limit.Based on the HEART Score criteria, 0 points are added for 'initial troponin', keeping the current total at 4.
Based on the patient's data, the HEART Score is 4."
266,18,HEART Score for Major Cardiac Events,risk,integer,pmc-6276522-1,Extracted,"A 77-year-old female with hypertension, untreated hyperlipidemia, hypothyroidism, but without prior history of CAD or angina symptoms was referred to a cardiologist's office for a treadmill exercise test secondary to new onset palpitations. She denied any chest pain or pressure, shortness of breath, exertional dyspnea, or leg swelling. She quit smoking 36 years ago and has no family history of early cardiovascular diseases. She has a very distant cardiac work-up years ago, including a stress test and an echocardiogram, which the patient reported were unremarkable. Vital signs prior to the test were a blood pressure of 140/78, heart rate of 80, and a respiratory rate of 14. Physical exam was unremarkable except for a systolic ejection murmur that was graded II/VI at the base. EKG was at baseline with a normal sinus rhythm, normal axis, and occasional premature ventricular complexes (PVCs).
The patient underwent an exercise stress test using the Bruce protocol and was able to complete stage 1 with exercise for three minutes at a speed of 1.7 mph and a 10% incline. The test was terminated due to dyspnea and fatigue without chest pain. She reached a heart rate of 141 beats per minute which was 98% of predicted for her age. She accomplished 4.5 metabolic equivalents of exertion. With exercise, she had occasional atrial premature complexes and PVCs with a ventricular couplet in recovery. She started to notice tightness in her chest. Her peak blood pressure at the time was 218/90.
The patient was transferred onto a stretcher, and an IV line was started. She was given sublingual nitroglycerin, 325 mg of aspirin to chew, and one 5 mg IV push of metoprolol tartrate. She then received nitroglycerin paste and metoprolol tartrate IV every 5 min for two more doses. At that time, her EKG on the stretcher showed ST elevations in leads I, aVL, V5, and V6 with ST depressions in leads III, aVF, and V1-V3 consistent with a lateral wall evolving myocardial infarction (). She was transferred urgently to our institution for cardiac catheterization.
The patient underwent an emergent cardiac catheterization with left ventriculography and intravascular ultrasound (IVUS) within 2 hours after onset of symptoms. Troponin-I levels prior to the catheterization increased to 11.17 (normal less than 0.05 ng/ml). The rest of the laboratories were within normal limits including a thyroid-stimulating hormone (TSH) level. Coronary angiography showed nonobstructive coronary artery disease (pLAD 40%) and highly tortuous coronary arteries. IVUS of the proximal LAD revealed a minimal lumen area of 5.2mm2, and no ruptured plaques. Left ventriculogram revealed a left ventricular ejection fraction (LVEF) of 20% and severe mid-cavitary hypokinesis with basal and apical hyperkinesis (Figures and ). To our knowledge, this is the first case of treadmill exercise testing-triggered mid-left ventricular ballooning variant of takotsubo cardiomyopathy, whereby obstructive epicardial CAD and ruptured plaques were excluded with angiography and IVUS, respectively.
The patient was started on medical management with standard therapy for heart failure. A follow-up echocardiogram was done two days after the event which redemonstrated mid-left ventricular ballooning, with an improved LVEF of 35%. The patient remained asymptomatic during the course of her hospitalization and troponin levels trended down from a postcardiac catheterization peak of 16.06 ng/ml. An echocardiogram was repeated during an outpatient follow-up two weeks later which showed resolution of wall motion abnormalities and an LVEF of 45-50%.",What is the patient's score of the HEART Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [77, 'years'], 'Hypertension history': True, 'Electrocardiogram Test': 'Significant ST deviation', 'smoking': False, 'parent or sibling with Cardiovascular disease before age 65': False, 'atherosclerotic disease': True, 'Suspicion History': 'Highly suspicious', 'hypercholesterolemia': True, 'Initial troponin': 'greater than three times normal limit'}",9,9,9,"The HEART Score for risk stratification in patients with chest pain is shown below:

1. History: Slightly suspicious = 0 points, Moderately suspicious = +1 point, Highly suspicious = +2 points
2. EKG: Normal = 0 points, Non-specific repolarization disturbance = +1 point, Significant ST deviation = +2 points
3. Age: <45 years = 0 points, 45-64 years = +1 point, ≥65 years = +2 points
4. Risk factors (HTN, hypercholesterolemia, DM, obesity (BMI >30 kg/m²), smoking (current or cessation within 3 months), positive family history of cardiovascular disease before age 65, atherosclerotic disease such as prior MI, PCI/CABG, CVA/TIA, or peripheral arterial disease): No known risk factors = 0 points, 1-2 risk factors = +1 point, ≥3 risk factors or history of atherosclerotic disease = +2 points
5. Initial troponin level: ≤normal limit = 0 points, 1-3x normal limit = +1 point, >3x normal limit = +2 points

The total score is calculated by summing the points for each criterion.
    
The current HEART Score is 0.
The value of 'history' in the patient's note is determined to be 'Highly suspicious'. Based on the HEART Score criteria, 2 points are added for 'history', increasing the current total to 0 + 2 = 2.
The value of 'electrocardiogram' in the patient's note is determined to be 'Significant ST deviation'. Based on the HEART Score criteria, 2 points are added for 'electrocardiogram', increasing the current total to 2 + 2 = 4.
The patient is 77 years old. The patient's age is greater than 65 years and so we increment the current total by 2, making the current total 4 + 2 = 6.
The following risk factor(s) are present based on the patient's note: hypertension, atherosclerotic disease. The following risk factor(s) are mentioned in the patient's note, but these risk factors are noted to be absent from the patient: smoking, family with cvd. The following risk factor(s) are missing from the patient's data: smoking, family with cvd. We will assume that these are all absent from the patient. Based on the HEART Score risk factors criteria, 2 risk factors are present and so 1 point is added for the risk factors criteria, making the current total, 6 + 1 = 7.
The value of 'initial troponin' in the patient's note is determined to be 'greater than three times normal limit'. Based on the HEART Score criteria, 2 points are added for 'initial troponin', increasing the current total to 7 + 2 = 9.
Based on the patient's data, the HEART Score is 9."
267,18,HEART Score for Major Cardiac Events,risk,integer,pmc-5741599-1,Extracted,"A 45-year-old white female with a long-standing history of uncontrolled gastroesophageal reflux disease presented for laparoscopic Nissen fundoplication. The patient had a 14-year history of cold urticaria in addition to osteoarthritis, diverticulitis, and restless leg syndrome. Prior triggers for the patient’s cold urticaria included consuming ice chips, being in cold environments and colonoscopy bowel preparation. She was also allergic to naproxen, guaifenesin, and menthol. Her previous cold exposures had led to complications as varied as extremity numbness to airway compromise, anaphylaxis, and cardiac arrest.
Her home medications included escitalopram, pramipexole, cetirizine, and ranitidine. Her surgical history consisted of a cesarean delivery and cholecystectomy, both prior to the diagnosis of cold urticaria. Neither she nor her family had a history of adverse reactions to anesthesia. At presentation for surgery, the patient’s physical exam was unremarkable, including a Mallampati class II oropharynx. Vital signs before induction were normal: heart rate 82 beats/min, blood pressure 122/80 mmHg, respiratory rate 16/min, SpO2 100% on room air.
Thirty minutes prior to induction, diphenhydramine 25 mg IV, famotidine 20 mg IV, hydrocortisone 100 mg IV, and midazolam 2 mg IV were administered. Intubation was uneventful after induction of general anesthesia with lidocaine, propofol, and fentanyl. Rocuronium was used for neuromuscular blockade, and anesthesia was maintained with desflurane. Normothermia was maintained with two warm blankets pre-intubation upon arriving to the OR and 2 separate forced air warming blankets over the lower and upper body after intubation. The OR temperature was maintained above 70°F. A fluid warmer was used on all intravenous fluids flowing into an 18-G peripheral venous catheter. Body temperature was monitored with both an oropharyngeal probe and a bladder probe. Epinephrine was prepared in advance and kept immediately on hand. Just before incision, the patient developed hypotension with a blood pressure of 69/30 mmHg, which was successfully treated with epinephrine. There was no evidence of urticarial rash or bronchospasm during this period. Hypertension and tachycardia resulting from epinephrine administration were treated with esmolol and by increasing the depth of anesthesia. There were no more episodes of hemodynamic instability for the remainder of the case.
The surgical procedure progressed without complication. Paralysis was reversed with neostigmine, and extubation was uneventful. Hydromorphone was used for pain control during and after the case. In the postoperative care unit, the patient initially showed delirious disorientation to time and place, but this resolved after haloperidol 2 mg IV. Her vital signs and temperature remained stable during the recovery period with no evidence of an urticarial rash. Warm blankets were utilized to maintain normothermia while recovering from general anesthesia.",What is the patient's score of the HEART Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [45, 'years'], 'Suspicion History': 'Moderately suspicious'}",2,2,2,"The HEART Score for risk stratification in patients with chest pain is shown below:

1. History: Slightly suspicious = 0 points, Moderately suspicious = +1 point, Highly suspicious = +2 points
2. EKG: Normal = 0 points, Non-specific repolarization disturbance = +1 point, Significant ST deviation = +2 points
3. Age: <45 years = 0 points, 45-64 years = +1 point, ≥65 years = +2 points
4. Risk factors (HTN, hypercholesterolemia, DM, obesity (BMI >30 kg/m²), smoking (current or cessation within 3 months), positive family history of cardiovascular disease before age 65, atherosclerotic disease such as prior MI, PCI/CABG, CVA/TIA, or peripheral arterial disease): No known risk factors = 0 points, 1-2 risk factors = +1 point, ≥3 risk factors or history of atherosclerotic disease = +2 points
5. Initial troponin level: ≤normal limit = 0 points, 1-3x normal limit = +1 point, >3x normal limit = +2 points

The total score is calculated by summing the points for each criterion.
    
The current HEART Score is 0.
The value of 'history' in the patient's note is determined to be 'Moderately suspicious'. Based on the HEART Score criteria, 1 point is added for 'history', increasing the current total to 0 + 1 = 1.
'electrocardiogram' is missing from the patient's data and so we assume it's value is Normal.Based on the HEART Score criteria, 0 points are added for 'electrocardiogram', keeping the current total at 1.
The patient is 45 years old. The patient's age is between 45 and 65 years and so we increment the current total by 1, making the current total 1 + 1 = 2.
The following risk factor(s) are missing from the patient's data: . We will assume that these are all absent from the patient. Based on the HEART Score risk factors criteria, 0 risk factors are present and so 0 points are added for the risk factors criteria, keeping the current total at 2.
'initial troponin' is missing from the patient's data and so we assume it's value is less than or equal to normal limit.Based on the HEART Score criteria, 0 points are added for 'initial troponin', keeping the current total at 2.
Based on the patient's data, the HEART Score is 2."
268,18,HEART Score for Major Cardiac Events,risk,integer,pmc-8161714-1,Extracted,"A 46-year-old athletic and otherwise healthy Caucasian male with a past medical history of mild hyperlipidemia was diagnosed with COVID-19 on March 17, 2020. He had symptoms of malaise, dry cough, anosmia, and a low-grade fever for 2 days prior to his test. His symptoms were self-limited and fully abated on day 5 after onset. He did not require supportive oxygen or hospitalization. Due to his self-limited illness, there were no laboratory data acquired such as cardiac biomarkers. He did not warrant nor was he treated with any pharmacotherapies or antibiotics. His baseline electrocardiogram (ECG) was reported normal including the QT interval. He resumed normal activity after resolution of his illness that month including vigorous aerobic exercise for the following 2–3 months and felt very close to his normal baseline functional status.
Approximately 3 months after resolution of illness (June 2020), he began having frequent palpitations and exertional dyspnea. He attributed his symptoms to anxiety and some deconditioning from prior quarantine. He had COVID-19 antibodies checked at that time, which showed high titers. On month 4 after his diagnosis (July 2020), he had a chest x-ray, electrocardiogram, and echocardiogram which were all unremarkable. He underwent continuous Holter monitoring which showed frequent premature ventricular beats and multiple brief paroxysms of non-sustained ventricular tachycardia. His baseline ECG remained normal, as shown (Fig. ). In September of the same year (month 7 following illness), his repeat ECG showed subtle abnormalities (Fig. ).
At 5 months and 28 days after his illness, he underwent CMR using the General Electric Signa Artist 1.5 Tesla with field of view 36 x 32 mm, slice thickness 8 mm, 0 mm spacing, matrix 200 x 200 pixels mm, number of excitations 1. Gadolinium-enhanced imaging was performed approximately 10 min after administration of 0.1 mmol/kg body weight of gadobutrol (Gadovist; Bayer). Findings showed normal left and right ventricular systolic function with mild left ventricular hypertrophy, with prominent LGE involving epicardial and pericardial fibrosis of the basal to apical anterior wall and at the basal to mid anterior septum and right ventricular free wall with a trivial pericardial effusion (Figs. , , ).",What is the patient's score of the HEART Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [46, 'years'], 'Suspicion History': 'Moderately suspicious', 'Electrocardiogram Test': 'Non-specific repolarization disturbance', 'Initial troponin': 'less than or equal to normal limit'}",3,3,3,"The HEART Score for risk stratification in patients with chest pain is shown below:

1. History: Slightly suspicious = 0 points, Moderately suspicious = +1 point, Highly suspicious = +2 points
2. EKG: Normal = 0 points, Non-specific repolarization disturbance = +1 point, Significant ST deviation = +2 points
3. Age: <45 years = 0 points, 45-64 years = +1 point, ≥65 years = +2 points
4. Risk factors (HTN, hypercholesterolemia, DM, obesity (BMI >30 kg/m²), smoking (current or cessation within 3 months), positive family history of cardiovascular disease before age 65, atherosclerotic disease such as prior MI, PCI/CABG, CVA/TIA, or peripheral arterial disease): No known risk factors = 0 points, 1-2 risk factors = +1 point, ≥3 risk factors or history of atherosclerotic disease = +2 points
5. Initial troponin level: ≤normal limit = 0 points, 1-3x normal limit = +1 point, >3x normal limit = +2 points

The total score is calculated by summing the points for each criterion.
    
The current HEART Score is 0.
The value of 'history' in the patient's note is determined to be 'Moderately suspicious'. Based on the HEART Score criteria, 1 point is added for 'history', increasing the current total to 0 + 1 = 1.
The value of 'electrocardiogram' in the patient's note is determined to be 'Non-specific repolarization disturbance'. Based on the HEART Score criteria, 1 point is added for 'electrocardiogram', increasing the current total to 1 + 1 = 2.
The patient is 46 years old. The patient's age is between 45 and 65 years and so we increment the current total by 1, making the current total 2 + 1 = 3.
The following risk factor(s) are missing from the patient's data: . We will assume that these are all absent from the patient. Based on the HEART Score risk factors criteria, 0 risk factors are present and so 0 points are added for the risk factors criteria, keeping the current total at 3.
The value of 'initial troponin' in the patient's note is determined to be 'less than or equal to normal limit'. Based on the HEART Score criteria, 0 points are added for 'initial troponin', keeping the current total at 3.
Based on the patient's data, the HEART Score is 3."
269,18,HEART Score for Major Cardiac Events,risk,integer,pmc-8053007-1,Extracted,"A 66-year-old male with a past medical history of hypertension presented to the emergency room with acute-onset chest pain and shortness of breath. He had been diagnosed with COVID-19 nine days prior after developing fever and cough, but those symptoms had since resolved. The patient complained of fatigue and reduced oral intake following his diagnosis of COVID-19. He had no family history of VTE, no recent travel, no recent surgery or immobilization, and was up to date with his cancer screening. On examination, the patient was in no distress. Vital signs on admission were as follows - temperature: 98 ℉; heart rate: 97 beats/minute; blood pressure: 92/64 mmHg; respiratory rate: 20 breaths/minute; and oxygen (O2) saturation: 87% on room air. The physical examination was normal except for elevated jugular venous pressure. Investigations including complete blood count, basic metabolic panel, lactate dehydrogenase, ferritin, and lactic acid levels were normal. D-dimer was elevated at 8,583 ng/mL, C-reactive protein was 62.4 mg/L, and troponin was 0.44 ng/mL. Chest CT angiogram (CTA) revealed large filling defects in the right and left main pulmonary arteries with right heart strain (Figure ). No lung infiltrates were present (Figure ). Ultrasound of lower extremities revealed DVT of the left proximal femoral vein (Figure ).
The patient was administered 500 ml of normal saline with improvement in blood pressure to 126/74 mmHg. O2 saturation improved to 96% on O2 at 3 L/minute via nasal cannula. Anticoagulation with intravenous heparin was started. Due to concern for additional PE burden from his extensive DVT, an inferior vena cava filter was placed. Over the next 24 hours, his symptoms and hypoxia improved, and he was subsequently discharged on apixaban.",What is the patient's score of the HEART Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [66, 'years'], 'Hypertension history': True, 'Suspicion History': 'Highly suspicious', 'Initial troponin': 'between the normal limit or up to three times the normal limit'}",6,6,6,"The HEART Score for risk stratification in patients with chest pain is shown below:

1. History: Slightly suspicious = 0 points, Moderately suspicious = +1 point, Highly suspicious = +2 points
2. EKG: Normal = 0 points, Non-specific repolarization disturbance = +1 point, Significant ST deviation = +2 points
3. Age: <45 years = 0 points, 45-64 years = +1 point, ≥65 years = +2 points
4. Risk factors (HTN, hypercholesterolemia, DM, obesity (BMI >30 kg/m²), smoking (current or cessation within 3 months), positive family history of cardiovascular disease before age 65, atherosclerotic disease such as prior MI, PCI/CABG, CVA/TIA, or peripheral arterial disease): No known risk factors = 0 points, 1-2 risk factors = +1 point, ≥3 risk factors or history of atherosclerotic disease = +2 points
5. Initial troponin level: ≤normal limit = 0 points, 1-3x normal limit = +1 point, >3x normal limit = +2 points

The total score is calculated by summing the points for each criterion.
    
The current HEART Score is 0.
The value of 'history' in the patient's note is determined to be 'Highly suspicious'. Based on the HEART Score criteria, 2 points are added for 'history', increasing the current total to 0 + 2 = 2.
'electrocardiogram' is missing from the patient's data and so we assume it's value is Normal.Based on the HEART Score criteria, 0 points are added for 'electrocardiogram', keeping the current total at 2.
The patient is 66 years old. The patient's age is greater than 65 years and so we increment the current total by 2, making the current total 2 + 2 = 4.
The following risk factor(s) are present based on the patient's note: hypertension. The following risk factor(s) are missing from the patient's data: . We will assume that these are all absent from the patient. Based on the HEART Score risk factors criteria, 1 risk factors are present and so 1 point is added for the risk factors criteria, making the current total, 4 + 1 = 5.
The value of 'initial troponin' in the patient's note is determined to be 'between the normal limit or up to three times the normal limit'. Based on the HEART Score criteria, 1 point is added for 'initial troponin', increasing the current total to 5 + 1 = 6.
Based on the patient's data, the HEART Score is 6."
270,18,HEART Score for Major Cardiac Events,risk,integer,pmc-7846195-1,Extracted,"A 33-year-old man, without known co-morbidities, was brought into the emergency department with sudden onset of headache and severe central chest pain, radiating to the back. The patient arrived 3.5 hours after the onset of symptoms and was still in severe pain.
The blood pressure was 180/125 mmHg, heart rate 105 beats per minute (bpm), temperature 36.1°C, oxygen-saturation 98% and the respiratory-rate was 28 per minute. An arterial blood gas (ABG) revealed significant lactate acidosis with pH 7.14, pO2 of 15.4 kPa, pCO2 of 4.5 kPa, bicarbonate of 12 mEq/L, base excess of −16 mmol/L and lactate value of 12 mmol/L. A 12 lead electrocardiography showed sinus rhythm with slight ST-depressions in the leads V4–6. 
Bedside echocardiography revealed regional hypokinesia in the lateral area of the left ventricle, and an estimated left ventricular ejection fraction (LVEF) of 20–30%.
The patients’ blood samples demonstrated abnormal with a troponin T of 300 ng/L, white blood cell count of 39 × 109/L and normal c-reactive protein.
An immediate thoracic/abdominal computed tomography (CT) scan was performed, testing negative for aortic dissection or large pulmonary embolism. However, a 6 cm large tumor in the left adrenal gland was found in .
During the first hours of observation, the patient’s symptoms spontaneously resolved. His vitals normalized and a repeated ABG showed a rising pH (7.33) and decreasing lactate (5.6 mmol/L). 
Meanwhile, the patient’s previous history was explored in more detail. The evening before his admission, he had consumed multiple energy drinks, but denies the intake of alcohol or any other substances. 
Nine years earlier, he presented with similar symptoms at another hospital, likewise had spontaneously recovered and was quickly discharged without a firm diagnosis. Similarly, 4 years prior to this admission, the patient was acutely hospitalized with headache, back pain, nausea, elevated lactate, white blood cell count and blood pressure. That admission summary described that all symptoms remitted, his vitals as well as blood values normalized over a few hours and the patient was discharged after a day of observation, without finding a plausible explanation to his symptoms. 
Due to these findings and the suspicion of pheochromocytoma-induced cardiomyopathy, the patient was admitted. During the 7-day admission, the patient’s vitals remained normal and blood samples including troponin T slowly normalized. 
A repeated transthoracic echocardiography showed a LVEF of 45% in .
Plasma cortisol, renin, aldosterone and a 24-hour urine sample for steroid metabolites were within normal range. 3-Metthoxyadrenalin was elevated to 2,5 nmol/L (normal range: < 0,46 nmol/L) as well as 3-Metthoxynoradrenalin at 29,6 nmol/L (normal range < 1,09 nmol/L). 
During this observation, the patient reported no symptoms and was discharged for planned surgery in an outpatient setting. 
Due to the size of the tumor (6 cm in diameter) and hence a slightly increased risk of malignancy, open left-sided adrenalectomy was performed []. 
The patient was discharged on the fifth postoperative day after uncomplicated surgery and observation period. Follow-up showed normalization of 3-metthoxyadrenalin and 3-metthoxynoradrenalin, and the patient had not experienced any symptoms or complications. 
The left adrenal gland was found with a well-defined pheochromocytoma with a maximum diameter of 25 mm. The tumor morphology was with the growth of large nests and solid areas, high cellularity and areas with spindle cells as well as areas with profound nuclear pleomorphism and nuclear hyperchromasia. Thus, the Pheochromocytoma of Adrenal Gland Scales (PASS) score was 8 in []. It is not possible to predict the malign potential of a pheochromocytoma from the histopathology, but a PASS score > 4 indicates potential for aggressive clinical behavior. Thus, the patient will be followed with annually blood tests (3-metthoxyadrenalin, 3-metthoxynoradrenalin) lifelong. [].",What is the patient's score of the HEART Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [33, 'years'], 'Hypertension history': True, 'Electrocardiogram Test': 'Significant ST deviation', 'Suspicion History': 'Highly suspicious', 'Initial troponin': 'greater than three times normal limit'}",7,7,7,"The HEART Score for risk stratification in patients with chest pain is shown below:

1. History: Slightly suspicious = 0 points, Moderately suspicious = +1 point, Highly suspicious = +2 points
2. EKG: Normal = 0 points, Non-specific repolarization disturbance = +1 point, Significant ST deviation = +2 points
3. Age: <45 years = 0 points, 45-64 years = +1 point, ≥65 years = +2 points
4. Risk factors (HTN, hypercholesterolemia, DM, obesity (BMI >30 kg/m²), smoking (current or cessation within 3 months), positive family history of cardiovascular disease before age 65, atherosclerotic disease such as prior MI, PCI/CABG, CVA/TIA, or peripheral arterial disease): No known risk factors = 0 points, 1-2 risk factors = +1 point, ≥3 risk factors or history of atherosclerotic disease = +2 points
5. Initial troponin level: ≤normal limit = 0 points, 1-3x normal limit = +1 point, >3x normal limit = +2 points

The total score is calculated by summing the points for each criterion.
    
The current HEART Score is 0.
The value of 'history' in the patient's note is determined to be 'Highly suspicious'. Based on the HEART Score criteria, 2 points are added for 'history', increasing the current total to 0 + 2 = 2.
The value of 'electrocardiogram' in the patient's note is determined to be 'Significant ST deviation'. Based on the HEART Score criteria, 2 points are added for 'electrocardiogram', increasing the current total to 2 + 2 = 4.
The patient is 33 years old. The patient's age is less than 45 years and so keep the current total at 4.
The following risk factor(s) are present based on the patient's note: hypertension. The following risk factor(s) are missing from the patient's data: . We will assume that these are all absent from the patient. Based on the HEART Score risk factors criteria, 1 risk factors are present and so 1 point is added for the risk factors criteria, making the current total, 4 + 1 = 5.
The value of 'initial troponin' in the patient's note is determined to be 'greater than three times normal limit'. Based on the HEART Score criteria, 2 points are added for 'initial troponin', increasing the current total to 5 + 2 = 7.
Based on the patient's data, the HEART Score is 7."
271,18,HEART Score for Major Cardiac Events,risk,integer,pmc-4857828-1,Extracted,"A 60-year-old female with past medical history significant for hypertension, DM, coronary artery disease, and hyperlipidemia presented to the emergency room with the chief complaint of chest pain. She also reported generalized weakness, myalgias, subjective fever, and chills progressively worsening over the past 7 days. Her physical examination showed stable vital signs and was otherwise unremarkable except for trace peripheral edema. The University of Florida does not require IRB approval or written informed consent for any case report with 3 or fewer patients as it is not a clinical study. 
Fearing a coronary event, she was given a dose of sublingual nitroglycerine and aspirin. An electrocardiogram showed sinus tachycardia, but otherwise no apparent abnormality. Laboratory workup was significant for elevated creatinine phosphokinase (CPK) of 13,456 U/L (reference range: 30–170 U/L), normal troponin-T, normal complete blood count, and basic metabolic panel except elevated creatinine of 1.20 mg/dL (reference range: 0.40–0.90 mg/dL). Her chest X-ray revealed no abnormality. CPK levels evaluated in 2012 on this patient while on statins were unremarkable (191 U/L, 165 U/L, and 197 U/L, with reference range of 30–170 U/L). 
She was admitted to the hospital due to concern for acute coronary event, rhabdomyolysis, acute renal insufficiency, and possible acute viral infection causing her symptoms. Her workup during hospital stay showed three normal serial troponin-T tests, and myocardial perfusion test revealed no abnormality. Her respiratory viral panel and thyroid stimulation hormone level were normal. Her creatinine also normalized with intravenous (IV) fluids. She had persistent elevated CPK levels, which also trended down with IV fluids. 
Common differential diagnoses for her rhabdomyolysis were explored by detailed history and laboratory workup. There was no history of recent trauma, crush injury, prolonged immobilization, recent surgery, seizures, drug abuse, or alcoholism. Her family history was negative for any kind of myopathy or other hereditary or genetic causes that could explain the elevated CPK value. Her laboratory workup, including thyroid function tests, was unremarkable and failed to explain this episode of rhabdomyolysis. She had been on a stable dose of atorvastatin (40 mg) for several years for hyperlipidemia and reported no myalgias, arthralgias, or abnormal CPK levels. Review of her medication list further revealed that she was started on sitagliptin (Januvia® 100 mg) almost a week before this presentation. She also correlated her symptoms with starting of this new medication. Sitagliptin and atorvastatin were stopped; her subsequent CPK value showed a decreasing trend and was recorded at 1,220 U/L on the day of discharge. The patient’s muscle aches and chest pain had reduced considerably following the discontinuation of these medications.",What is the patient's score of the HEART Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [60, 'years'], 'Hypertension history': True, 'Electrocardiogram Test': 'Normal', 'Diabetes mellitus': False, 'smoking': False, 'parent or sibling with Cardiovascular disease before age 65': False, 'atherosclerotic disease': False, 'Suspicion History': 'Moderately suspicious', 'hypercholesterolemia': True, 'obesity': False, 'Transient Ischemic Attacks History': False, 'Initial troponin': 'between the normal limit or up to three times the normal limit'}",4,4,4,"The HEART Score for risk stratification in patients with chest pain is shown below:

1. History: Slightly suspicious = 0 points, Moderately suspicious = +1 point, Highly suspicious = +2 points
2. EKG: Normal = 0 points, Non-specific repolarization disturbance = +1 point, Significant ST deviation = +2 points
3. Age: <45 years = 0 points, 45-64 years = +1 point, ≥65 years = +2 points
4. Risk factors (HTN, hypercholesterolemia, DM, obesity (BMI >30 kg/m²), smoking (current or cessation within 3 months), positive family history of cardiovascular disease before age 65, atherosclerotic disease such as prior MI, PCI/CABG, CVA/TIA, or peripheral arterial disease): No known risk factors = 0 points, 1-2 risk factors = +1 point, ≥3 risk factors or history of atherosclerotic disease = +2 points
5. Initial troponin level: ≤normal limit = 0 points, 1-3x normal limit = +1 point, >3x normal limit = +2 points

The total score is calculated by summing the points for each criterion.
    
The current HEART Score is 0.
The value of 'history' in the patient's note is determined to be 'Moderately suspicious'. Based on the HEART Score criteria, 1 point is added for 'history', increasing the current total to 0 + 1 = 1.
The value of 'electrocardiogram' in the patient's note is determined to be 'Normal'. Based on the HEART Score criteria, 0 points are added for 'electrocardiogram', keeping the current total at 1.
The patient is 60 years old. The patient's age is between 45 and 65 years and so we increment the current total by 1, making the current total 1 + 1 = 2.
The following risk factor(s) are present based on the patient's note: hypertension. The following risk factor(s) are mentioned in the patient's note, but these risk factors are noted to be absent from the patient: diabetes mellitus, obesity, smoking, family with cvd, atherosclerotic disease. The following risk factor(s) are missing from the patient's data: diabetes mellitus, obesity, smoking, family with cvd, atherosclerotic disease. We will assume that these are all absent from the patient. Based on the HEART Score risk factors criteria, 1 risk factors are present and so 1 point is added for the risk factors criteria, making the current total, 2 + 1 = 3.
The value of 'initial troponin' in the patient's note is determined to be 'between the normal limit or up to three times the normal limit'. Based on the HEART Score criteria, 1 point is added for 'initial troponin', increasing the current total to 3 + 1 = 4.
Based on the patient's data, the HEART Score is 4."
272,18,HEART Score for Major Cardiac Events,risk,integer,pmc-7305571-1,Extracted,"History of presentation and past medical history
A 39-year-old Kenyan male with no past medical history presented with midsternal chest pain. He had been residing within the USA for the last year and working as a long-distance truck driver. The patient described the pain as a heaviness which sometimes felt sharp and lasted several hours long. He had been experiencing this pain for two days and the pain usually started in the morning and worsened with exertion. On the day of presentation, he rated the pain 9 out of 10 on the severity scale and denied any symptoms of shortness of breath or pleuritic type chest discomfort associated with respiration. He was administered aspirin and sublingual nitroglycerin; the nitroglycerin did not relieve his chest pain and his presentation was worrisome for an ST-elevation myocardial infarction (STEMI). The patient was completely afebrile and vital signs were stable. Physical examination only revealed some elicited pain with range of motion of his left arm. He denied any alcohol use, tobacco use, or illicit drug use and denied any family history of cardiac disease.
Investigations
His ECG showed 1 to 2 mm ST elevations in lead I and aVL, ST depression in aVR, mild J-point elevation, and T-wave inversion in leads II, III and aVF (Figure ). His ECG was not entirely convincing of STEMI and his troponins were found to be elevated at 5.97 ng/mL and eventually peaked to 6.24 ng/mL. He was taken urgently for cardiac catheterization and it revealed completely normal coronaries so no intervention was performed (Figures -). There was no evidence of myocardial bridging either.
Given his profession of being a long-distance truck driver and traveling, he was tested via reverse transcription polymerase chain reaction (RT-PCR) for COVID-19 (SARS-CoV-2 virus) and was found to be positive. Subsequently, a CT scan was done to rule out pulmonary embolism as the cause of his chest pain since SARS-CoV-2 virus induces a hypercoagulable and thrombotic state in individuals []. CT scan was negative for any pulmonary embolism and revealed clear lungs without any typical respiratory characteristics of COVID-19. This was followed up with a transthoracic echocardiography (TTE) and it revealed no wall motion abnormalities and a completely normal ejection fraction at 55%-60% and no evidence of pericarditis or pericardial effusion.
The patient's blood work was consistent with biomarkers typically identified with COVID-19 (SARS-CoV-2): his d-dimer was elevated at 0.96 mcg/mL, erythrocyte sedimentation rate (ESR) elevated at 44 mm/hr, lactate dehydrogenase (LDH) elevated at 926 units/L, procalcitonin was negative at 0.04 ng/mL, C-reactive protein (CRP) elevated at 3.3 mg/dL, creatine phosphokinase (CPK) elevated at 366 units/L, amino-terminal pro-brain natriuretic peptide (NT-proBNP) elevated at 379 pg/mL, and mild to moderate liver enzyme elevation with aspartate aminotransferase (AST) elevated at 89 units/L and alanine aminotransferase (ALT) elevated at 152 units/L []. COVID-19 is commonly associated with elevated ferritin levels since ferritin is an acute phase reactant but interestingly, in our patient, the ferritin was within normal limits at 243 ng/mL [].
Differential diagnosis
Initially, STEMI was at the top of the differential given that he had an equivocal ECG and worsening chest pain. With cardiac catheterization revealing normal coronary arteries and no lesion inducing stenosis, myocarditis became the top differential given that he had evidence of myocardial injury with the troponin leak. Cardiac catheterization also ruled out any concern for myocardial bridging as the source of his chest pain.
Management and follow-up
The patient was managed conservatively during his hospitalization. Interestingly, after his cardiac catheterization, his chest pain resolved and the pain was well-controlled with acetaminophen alone. He was not on any medications prior to admission and was discharged in a stable condition with acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) were avoided for the concern of exacerbating myocardial inflammation due to COVID-19. The patient is scheduled for follow-up with repeat serial TTE to ensure that he is not developing heart failure with reduced ejection fraction or wall motion abnormalities.",What is the patient's score of the HEART Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [39, 'years'], 'Hypertension history': False, 'Electrocardiogram Test': 'Significant ST deviation', 'Diabetes mellitus': False, 'smoking': False, 'parent or sibling with Cardiovascular disease before age 65': False, 'atherosclerotic disease': False, 'Suspicion History': 'Highly suspicious', 'Initial troponin': 'greater than three times normal limit'}",6,6,6,"The HEART Score for risk stratification in patients with chest pain is shown below:

1. History: Slightly suspicious = 0 points, Moderately suspicious = +1 point, Highly suspicious = +2 points
2. EKG: Normal = 0 points, Non-specific repolarization disturbance = +1 point, Significant ST deviation = +2 points
3. Age: <45 years = 0 points, 45-64 years = +1 point, ≥65 years = +2 points
4. Risk factors (HTN, hypercholesterolemia, DM, obesity (BMI >30 kg/m²), smoking (current or cessation within 3 months), positive family history of cardiovascular disease before age 65, atherosclerotic disease such as prior MI, PCI/CABG, CVA/TIA, or peripheral arterial disease): No known risk factors = 0 points, 1-2 risk factors = +1 point, ≥3 risk factors or history of atherosclerotic disease = +2 points
5. Initial troponin level: ≤normal limit = 0 points, 1-3x normal limit = +1 point, >3x normal limit = +2 points

The total score is calculated by summing the points for each criterion.
    
The current HEART Score is 0.
The value of 'history' in the patient's note is determined to be 'Highly suspicious'. Based on the HEART Score criteria, 2 points are added for 'history', increasing the current total to 0 + 2 = 2.
The value of 'electrocardiogram' in the patient's note is determined to be 'Significant ST deviation'. Based on the HEART Score criteria, 2 points are added for 'electrocardiogram', increasing the current total to 2 + 2 = 4.
The patient is 39 years old. The patient's age is less than 45 years and so keep the current total at 4.
The following risk factor(s) are mentioned in the patient's note, but these risk factors are noted to be absent from the patient: hypertension, diabetes mellitus, smoking, family with cvd, atherosclerotic disease. The following risk factor(s) are missing from the patient's data: hypertension, diabetes mellitus, smoking, family with cvd, atherosclerotic disease. We will assume that these are all absent from the patient. Based on the HEART Score risk factors criteria, 0 risk factors are present and so 0 points are added for the risk factors criteria, keeping the current total at 4.
The value of 'initial troponin' in the patient's note is determined to be 'greater than three times normal limit'. Based on the HEART Score criteria, 2 points are added for 'initial troponin', increasing the current total to 4 + 2 = 6.
Based on the patient's data, the HEART Score is 6."
273,18,HEART Score for Major Cardiac Events,risk,integer,usmle-9492,Extracted,"A 29-year-old man presents to the emergency department due to central chest pain over the past 3 days which is constant and unrelated to exertion. The pain is sharp, severe, increases when lying down, and improves with leaning forward. The pain also radiates to his shoulders and neck. The patient has no past medical history. He has smoked 10 cigarettes per day for the past 7 years and occasionally drinks alcohol. He presents with vital signs: blood pressure 110/70 mm Hg, regular radial pulse of 95/min, and temperature 37.3°C (99.1°F). On physical exam, a scratching sound of to-and-from character is audible over the left sternal border at end-expiration with the patient leaning forward. His chest X-ray is normal and ECG is shown in the picture.",What is the patient's score of the HEART Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [29, 'years'], 'Hypertension history': False, 'smoking': True, 'Suspicion History': 'Slightly suspicious'}",1,1,1,"The HEART Score for risk stratification in patients with chest pain is shown below:

1. History: Slightly suspicious = 0 points, Moderately suspicious = +1 point, Highly suspicious = +2 points
2. EKG: Normal = 0 points, Non-specific repolarization disturbance = +1 point, Significant ST deviation = +2 points
3. Age: <45 years = 0 points, 45-64 years = +1 point, ≥65 years = +2 points
4. Risk factors (HTN, hypercholesterolemia, DM, obesity (BMI >30 kg/m²), smoking (current or cessation within 3 months), positive family history of cardiovascular disease before age 65, atherosclerotic disease such as prior MI, PCI/CABG, CVA/TIA, or peripheral arterial disease): No known risk factors = 0 points, 1-2 risk factors = +1 point, ≥3 risk factors or history of atherosclerotic disease = +2 points
5. Initial troponin level: ≤normal limit = 0 points, 1-3x normal limit = +1 point, >3x normal limit = +2 points

The total score is calculated by summing the points for each criterion.
    
The current HEART Score is 0.
The value of 'history' in the patient's note is determined to be 'Slightly suspicious'. Based on the HEART Score criteria, 0 points are added for 'history', keeping the current total at 0.
'electrocardiogram' is missing from the patient's data and so we assume it's value is Normal.Based on the HEART Score criteria, 0 points are added for 'electrocardiogram', keeping the current total at 0.
The patient is 29 years old. The patient's age is less than 45 years and so keep the current total at 0.
The following risk factor(s) are present based on the patient's note: smoking. The following risk factor(s) are mentioned in the patient's note, but these risk factors are noted to be absent from the patient: hypertension. The following risk factor(s) are missing from the patient's data: hypertension. We will assume that these are all absent from the patient. Based on the HEART Score risk factors criteria, 1 risk factors are present and so 1 point is added for the risk factors criteria, making the current total, 0 + 1 = 1.
'initial troponin' is missing from the patient's data and so we assume it's value is less than or equal to normal limit.Based on the HEART Score criteria, 0 points are added for 'initial troponin', keeping the current total at 1.
Based on the patient's data, the HEART Score is 1."
274,18,HEART Score for Major Cardiac Events,risk,integer,pmc-7290110-1,Extracted,"A 53-year-old white man with no significant past medical history presented to our facility with palpitations, dyspnea on exertion, and fatigue. He reported waking up at 2:00 am with sudden onset palpitation and shortness of breath upon minimal exertion, in addition to fatigue. There was no associated chest pain, cough, fevers, chills, sore throat, nausea, vomiting, or urinary symptoms on presentation, nor a history of previous similar symptoms. His symptoms persisted for six hours leading him to present to the emergency department (ED).
Physical examination on presentation revealed irregular tachycardia with pulse rate (PR) 136 beats/minute (bpm), blood pressure (BP) 134/90 mmHg, respiratory rate (RR) 16 breaths/minute, oxygen saturation 96%, temperature 37.3°C, and body mass index (BMI) 30.7 kg/m2. The findings from the rest of his physical exam were unremarkable. An initial 12-lead electrocardiogram (ECG) revealed atrial fibrillation with PR 134 bpm and abnormal R wave progression (Figure ).
Laboratory tests revealed an elevated N-terminal (NT)-pro hormone brain natriuretic peptide (NT-proBNP) of 1.834 pg/dl (0-134 pg/dl), and a D-Dimer of 0.57 µg/ml (<0.50 µg/ml). Other laboratory results, including troponin T, thyroid-stimulating hormone value (TSH), complete blood count (CBC), comprehensive metabolic panel (CMP), and glycated hemoglobin (HbA1c), were unremarkable. A computed tomography angiogram of the chest was unremarkable (Figure ).
He was treated with two doses of intravenous diltiazem (25 mg each) in the ED, which slowed his PR (to 90 from 99 bpm). He was also started on oral diltiazem (30 mg, every six hours) and admitted for observation. An echocardiogram performed the next morning revealed moderate Non-specific repolarization disturbance, left ventricular ejection fraction of 60%, healthy left atrial and ventricular size, and no other abnormalities.
Despite titrating up his diltiazem dose, his fatigue and dyspnea on exertion continued. His PR ranged from 90 to 110 bpm, increasing significantly with ambulation to over 130 bpm. A decision was made to pursue cardioversion after performing a transesophageal echocardiogram prior to discharge. However, that same evening he developed a fever (38.6°C) while his fatigue worsened. He was screened for sepsis and tested for severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), and while he was not septic, he was positive for SARS-CoV-2 and diagnosed with coronavirus disease (COVID-19). Special isolation including droplet, contact, and eye protection in addition and symptomatic treatment with antipyretic Tylenol was initiated. The following morning, the patient spontaneously reverted to sinus rhythm, with dramatic improvement in his symptoms. He was discharged home and advised self-isolation with close outpatient follow-up monitoring.",What is the patient's score of the HEART Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [53, 'years'], 'Hypertension history': False, 'Electrocardiogram Test': 'Non-specific repolarization disturbance', 'Diabetes mellitus': False, 'Suspicion History': 'Moderately suspicious', 'obesity': True, 'Initial troponin': 'less than or equal to normal limit'}",4,4,4,"The HEART Score for risk stratification in patients with chest pain is shown below:

1. History: Slightly suspicious = 0 points, Moderately suspicious = +1 point, Highly suspicious = +2 points
2. EKG: Normal = 0 points, Non-specific repolarization disturbance = +1 point, Significant ST deviation = +2 points
3. Age: <45 years = 0 points, 45-64 years = +1 point, ≥65 years = +2 points
4. Risk factors (HTN, hypercholesterolemia, DM, obesity (BMI >30 kg/m²), smoking (current or cessation within 3 months), positive family history of cardiovascular disease before age 65, atherosclerotic disease such as prior MI, PCI/CABG, CVA/TIA, or peripheral arterial disease): No known risk factors = 0 points, 1-2 risk factors = +1 point, ≥3 risk factors or history of atherosclerotic disease = +2 points
5. Initial troponin level: ≤normal limit = 0 points, 1-3x normal limit = +1 point, >3x normal limit = +2 points

The total score is calculated by summing the points for each criterion.
    
The current HEART Score is 0.
The value of 'history' in the patient's note is determined to be 'Moderately suspicious'. Based on the HEART Score criteria, 1 point is added for 'history', increasing the current total to 0 + 1 = 1.
The value of 'electrocardiogram' in the patient's note is determined to be 'Non-specific repolarization disturbance'. Based on the HEART Score criteria, 1 point is added for 'electrocardiogram', increasing the current total to 1 + 1 = 2.
The patient is 53 years old. The patient's age is between 45 and 65 years and so we increment the current total by 1, making the current total 2 + 1 = 3.
The following risk factor(s) are present based on the patient's note: obesity. The following risk factor(s) are mentioned in the patient's note, but these risk factors are noted to be absent from the patient: hypertension, diabetes mellitus. The following risk factor(s) are missing from the patient's data: hypertension, diabetes mellitus. We will assume that these are all absent from the patient. Based on the HEART Score risk factors criteria, 1 risk factors are present and so 1 point is added for the risk factors criteria, making the current total, 3 + 1 = 4.
The value of 'initial troponin' in the patient's note is determined to be 'less than or equal to normal limit'. Based on the HEART Score criteria, 0 points are added for 'initial troponin', keeping the current total at 4.
Based on the patient's data, the HEART Score is 4."
275,18,HEART Score for Major Cardiac Events,risk,integer,pmc-7780869-1,Extracted,"Patient 1: was an otherwise healthy 24 years old man presented with chief complaint of retrosternal chest pain in the past 5 days prior to the presentation. He did not have conventional risk factors for premature coronary artery disease. He described the pain radiates to his left arm and occurred in an intermittent fashion not related to exertion; each episode lasts about 2 hours. The pattern of chest pain was atypical. He mentioned sore throat and cold sweating without coughing. In the emergency room, his blood pressure was 120/60 mmHg and heart rate was 115 bpm. Oxygen saturation by pulse oximetry was 94% while breathing ambient air and tympanic temperature was 36.7°C.
Electrocardiography showed sinus tachycardia, mild ST segment elevation less than 1 mm in lead I and aVL and ST segment depression of about 1 mm in leads III and aVF (, panel A&B). First cardiac hs-TroponinT result was 911 ng/L (cut off <24ng/L). He was admitted with diagnosis of non ST elevation MI (NSTEMI) or myocarditis. Results of 1 hour cardiac Troponin T was 1155 ng/L. Other Baseline laboratory tests were presented in .
Because of symptoms of sore throat, sweating and also elevated CRP, nasopharyngeal sample was taken and sent for SARS-COV-2 RT-PCR. Lung computed tomography scan revealed bilateral ground glass peripheral densities in lower lobes which was compatible with CT findings of COVID-19 (, panel A). Echocardiography showed normal LV size and systolic function with ejection fraction of about 55%. There was neither regional wall motion abnormality nor pericardial effusion. Results of RT-PCR test became positive which was in concert with lung CT scan findings. Lopinavir/ritonavir was initiated. Coronary multi-detector CT scan was performed and revealed normal coronary arteries (, panel A). Based on findings mentioned, final diagnosis of myocarditis due to COVID19 was made. On the second day, ECG showed resolution of ST deviations and appearance of T wave inversion in lead I and aVL. Hospital course was uneventful. He was discharged after 6 days of admission and improvement of symptoms, with recommendation of self-isolation for at least 14 days. Metoral 25 mg bid was prescribed. In 1 week telephone follow up, he was in good clinical condition and his symptoms had been improved substantially.",What is the patient's score of the HEART Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [24, 'years'], 'Hypertension history': False, 'Electrocardiogram Test': 'Significant ST deviation', 'Diabetes mellitus': False, 'smoking': False, 'parent or sibling with Cardiovascular disease before age 65': False, 'atherosclerotic disease': False, 'Suspicion History': 'Highly suspicious', 'hypercholesterolemia': False, 'obesity': False, 'Initial troponin': 'greater than three times normal limit'}",6,6,6,"The HEART Score for risk stratification in patients with chest pain is shown below:

1. History: Slightly suspicious = 0 points, Moderately suspicious = +1 point, Highly suspicious = +2 points
2. EKG: Normal = 0 points, Non-specific repolarization disturbance = +1 point, Significant ST deviation = +2 points
3. Age: <45 years = 0 points, 45-64 years = +1 point, ≥65 years = +2 points
4. Risk factors (HTN, hypercholesterolemia, DM, obesity (BMI >30 kg/m²), smoking (current or cessation within 3 months), positive family history of cardiovascular disease before age 65, atherosclerotic disease such as prior MI, PCI/CABG, CVA/TIA, or peripheral arterial disease): No known risk factors = 0 points, 1-2 risk factors = +1 point, ≥3 risk factors or history of atherosclerotic disease = +2 points
5. Initial troponin level: ≤normal limit = 0 points, 1-3x normal limit = +1 point, >3x normal limit = +2 points

The total score is calculated by summing the points for each criterion.
    
The current HEART Score is 0.
The value of 'history' in the patient's note is determined to be 'Highly suspicious'. Based on the HEART Score criteria, 2 points are added for 'history', increasing the current total to 0 + 2 = 2.
The value of 'electrocardiogram' in the patient's note is determined to be 'Significant ST deviation'. Based on the HEART Score criteria, 2 points are added for 'electrocardiogram', increasing the current total to 2 + 2 = 4.
The patient is 24 years old. The patient's age is less than 45 years and so keep the current total at 4.
The following risk factor(s) are mentioned in the patient's note, but these risk factors are noted to be absent from the patient: hypertension, diabetes mellitus, obesity, smoking, family with cvd, atherosclerotic disease. The following risk factor(s) are missing from the patient's data: hypertension, diabetes mellitus, obesity, smoking, family with cvd, atherosclerotic disease. We will assume that these are all absent from the patient. Based on the HEART Score risk factors criteria, 0 risk factors are present and so 0 points are added for the risk factors criteria, keeping the current total at 4.
The value of 'initial troponin' in the patient's note is determined to be 'greater than three times normal limit'. Based on the HEART Score criteria, 2 points are added for 'initial troponin', increasing the current total to 4 + 2 = 6.
Based on the patient's data, the HEART Score is 6."
276,18,HEART Score for Major Cardiac Events,risk,integer,pmc-4793133-1,Extracted,"A 74-year-old normotensive, nondiabetic, male smoker (30-pack years) presented with progressively increasing shortness of breath, cough, white, mucoid expectoration, and retrosternal and right sided parasternal, oppressive chest pain for last 2 months. Chest pain and shortness of breath were increased in severity on exertion and were associated with palpitation, but there is no history of sweating, orthopnoea, paroxysmal nocturnal dyspnoea, unconsciousness, and convulsion. There was no radiation of chest pain. Chest pain was suddenly increased for last five days and the patient was admitted in the emergency department with a suspicion of acute myocardial infarction (AMI). There was no history of fever, hemoptysis, leg swelling, and facial puffiness. History of significant weight loss and anorexia were present. There was no history of household contact with the patient of sputum smear positive tuberculosis. The patient received formoterol + tiotropium metered dose inhaler (2 puffs once daily with spacer) and oral doxofylline (400 mg twice daily) for last five years, as he suffered from chronic bronchitis predominant chronic obstructive pulmonary disease (COPD) which resulted in persistent breathlessness, cough, and expectoration.
General survey revealed anemia and clubbing, but there was no cyanosis, edema, and engorged neck vein. There were multiple cervical and supraclavicular enlarged lymph nodes on left side, which were hard in consistency, discrete, nontender, and fixed to underlying structure, but not fixed to overlying skin, and there was no discharging sinus. His temperature was 37°C, respiratory rate 24 breaths/minute, pulse rate 120 beats/minute, regular blood pressure 94/64 mmHg, oxygen saturation in capillary blood (SpO2) 96% @ room air, and FiO2 0.21.
Examination of respiratory system revealed no abnormality, except vesicular breath sound with prolonged expiration on both sides, bilateral crackles, mainly over the bases of the lungs, and occasional wheezes. Examination of other system was normal. Complete hemogram showed anemia with hemoglobin concentration of 7.1 g/dL. Blood biochemistry was normal. Electrocardiogram (ECG) showed atypical ST segment elevation and T wave inversion in lateral chest leads (Lead V4, Lead V5, and Lead V6). Initial rapid troponin-t-test was inconclusive, but repeat one after 12 hours of first test was negative. Sputum for acid fast bacilli and Gram stain was negative, and pyogenic culture of sputum showed no growth. Chest X-ray posteroanterior (PA view) showed cardiothoracic ratio was more than 0.5; that is, size of the cardiac silhouette was increased, but lung parenchyma was normal. Contrast enhanced computed tomography (CECT) of thorax showed a large, nonhomogenous mass lesion in right lower lobe which invaded the left atrium and was compressing the adjacent ventricular walls (). There was also mediastinal and hilar lymphadenopathy. CT-guided fine needle aspiration cytology (FNAC) showed discrete clusters of malignant epithelial cells which showed nuclear pleomorphism, hyperchromasia, high nucleocytoplasmic ratio, pale cytoplasm, and ill-defined cell boundary—suggestive of non-small-cell carcinoma, possibly squamous cell variety (). FNAC of left sided supraclavicular lymph nodes showed metastatic squamous cell carcinoma. Sputum for malignant cell was negative and fibre optic bronchoscopy did not show any abnormality. Echocardiogram showed a large echogenic mass of 15 × 12 mm, attached to the roof of the left atrium adjacent to right pulmonary venous openings, encroaching to interatrial septum, an extension of the tumour from adjacent lung parenchyma. Ejection fraction was 66%. Ultrasound of abdomen and CECT scan of brain were normal. Hence the diagnosis was a non-small-cell carcinoma of lower lobe of right lung with invasion of the left atrium and compression of adjacent ventricular wall (T4 disease) with contralateral supraclavicular metastatic lymphadenopathy (N3 disease). First cycle chemotherapy regimen comprising intravenous cisplatin (100 mg on day 1) and etoposide (100 mg on days 1, 2, and 3) was given, but unfortunately he died just after completion of first cycle.",What is the patient's score of the HEART Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [74, 'years'], 'Hypertension history': False, 'Electrocardiogram Test': 'Significant ST deviation', 'Diabetes mellitus': False, 'smoking': True, 'Suspicion History': 'Highly suspicious', 'Initial troponin': 'less than or equal to normal limit'}",7,7,7,"The HEART Score for risk stratification in patients with chest pain is shown below:

1. History: Slightly suspicious = 0 points, Moderately suspicious = +1 point, Highly suspicious = +2 points
2. EKG: Normal = 0 points, Non-specific repolarization disturbance = +1 point, Significant ST deviation = +2 points
3. Age: <45 years = 0 points, 45-64 years = +1 point, ≥65 years = +2 points
4. Risk factors (HTN, hypercholesterolemia, DM, obesity (BMI >30 kg/m²), smoking (current or cessation within 3 months), positive family history of cardiovascular disease before age 65, atherosclerotic disease such as prior MI, PCI/CABG, CVA/TIA, or peripheral arterial disease): No known risk factors = 0 points, 1-2 risk factors = +1 point, ≥3 risk factors or history of atherosclerotic disease = +2 points
5. Initial troponin level: ≤normal limit = 0 points, 1-3x normal limit = +1 point, >3x normal limit = +2 points

The total score is calculated by summing the points for each criterion.
    
The current HEART Score is 0.
The value of 'history' in the patient's note is determined to be 'Highly suspicious'. Based on the HEART Score criteria, 2 points are added for 'history', increasing the current total to 0 + 2 = 2.
The value of 'electrocardiogram' in the patient's note is determined to be 'Significant ST deviation'. Based on the HEART Score criteria, 2 points are added for 'electrocardiogram', increasing the current total to 2 + 2 = 4.
The patient is 74 years old. The patient's age is greater than 65 years and so we increment the current total by 2, making the current total 4 + 2 = 6.
The following risk factor(s) are present based on the patient's note: smoking. The following risk factor(s) are mentioned in the patient's note, but these risk factors are noted to be absent from the patient: hypertension, diabetes mellitus. The following risk factor(s) are missing from the patient's data: hypertension, diabetes mellitus. We will assume that these are all absent from the patient. Based on the HEART Score risk factors criteria, 1 risk factors are present and so 1 point is added for the risk factors criteria, making the current total, 6 + 1 = 7.
The value of 'initial troponin' in the patient's note is determined to be 'less than or equal to normal limit'. Based on the HEART Score criteria, 0 points are added for 'initial troponin', keeping the current total at 7.
Based on the patient's data, the HEART Score is 7."
277,18,HEART Score for Major Cardiac Events,risk,integer,pmc-5654271-1,Extracted,"59-year-old African American heavy smoking male with past medical history of hypertension, diabetes, and dyslipidemia presented to our facility with sudden onset of palpitations, which were rapid and irregular and started 1 day prior to presentation associated with increased shortness of breath, and denied any history of orthopnea, PND, chest pain, or lower limb edema. EKG was done and showed typical atrial flutter with variable AV block and rapid ventricular response (). Transthoracic echocardiography (TTE) showed the left ventricular systolic function 40–45% with right atrial mass possibly a clot extending to right atrial appendage measuring 2 cm × 3.1 cm (). Transesophageal echocardiography (TEE) was done for further evaluation of the lesion which showed atrial mass at the conjunction between IVC and right atria (). Preoperative cardiac catheterization showed no obstructive coronary artery disease, except for coronary cameral fistula (). Surgical excision of the right atrial mass from base of the stalk was done and histopathology of the mass was consistent with PFE (). The patient had smooth postoperative course, ablation of the IVC isthmus was not done, hence the atrial arrhythmia was attributed to the compressive effect of the tumor, and the patient maintained sinus rhythm since then. The patient was discharged on anticoagulation; 6-month follow-up transthoracic echocardiogram was done and showed no residual mass.",What is the patient's score of the HEART Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [59, 'years'], 'Hypertension history': True, 'Electrocardiogram Test': 'Non-specific repolarization disturbance', 'smoking': True, 'parent or sibling with Cardiovascular disease before age 65': False, 'atherosclerotic disease': False, 'Suspicion History': 'Highly suspicious', 'hypercholesterolemia': False, 'Initial troponin': 'greater than three times normal limit'}",7,7,7,"The HEART Score for risk stratification in patients with chest pain is shown below:

1. History: Slightly suspicious = 0 points, Moderately suspicious = +1 point, Highly suspicious = +2 points
2. EKG: Normal = 0 points, Non-specific repolarization disturbance = +1 point, Significant ST deviation = +2 points
3. Age: <45 years = 0 points, 45-64 years = +1 point, ≥65 years = +2 points
4. Risk factors (HTN, hypercholesterolemia, DM, obesity (BMI >30 kg/m²), smoking (current or cessation within 3 months), positive family history of cardiovascular disease before age 65, atherosclerotic disease such as prior MI, PCI/CABG, CVA/TIA, or peripheral arterial disease): No known risk factors = 0 points, 1-2 risk factors = +1 point, ≥3 risk factors or history of atherosclerotic disease = +2 points
5. Initial troponin level: ≤normal limit = 0 points, 1-3x normal limit = +1 point, >3x normal limit = +2 points

The total score is calculated by summing the points for each criterion.
    
The current HEART Score is 0.
The value of 'history' in the patient's note is determined to be 'Highly suspicious'. Based on the HEART Score criteria, 2 points are added for 'history', increasing the current total to 0 + 2 = 2.
The value of 'electrocardiogram' in the patient's note is determined to be 'Non-specific repolarization disturbance'. Based on the HEART Score criteria, 1 point is added for 'electrocardiogram', increasing the current total to 2 + 1 = 3.
The patient is 59 years old. The patient's age is between 45 and 65 years and so we increment the current total by 1, making the current total 3 + 1 = 4.
The following risk factor(s) are present based on the patient's note: hypertension, smoking. The following risk factor(s) are mentioned in the patient's note, but these risk factors are noted to be absent from the patient: family with cvd, atherosclerotic disease. The following risk factor(s) are missing from the patient's data: family with cvd, atherosclerotic disease. We will assume that these are all absent from the patient. Based on the HEART Score risk factors criteria, 2 risk factors are present and so 1 point is added for the risk factors criteria, making the current total, 4 + 1 = 5.
The value of 'initial troponin' in the patient's note is determined to be 'greater than three times normal limit'. Based on the HEART Score criteria, 2 points are added for 'initial troponin', increasing the current total to 5 + 2 = 7.
Based on the patient's data, the HEART Score is 7."
278,18,HEART Score for Major Cardiac Events,risk,integer,pmc-2783103-1,Extracted,"A 60 year old Caucasian gentleman with rheumatoid arthritis on infliximab therapy for one year presented with acute onset palpitations. Which started within three hours after receiving the eight weekly infliximab infusion for his rheumatoid arthritis. There was no past medical history of diabtes mellitus, ischemic heart disease, hypertension or heart failure. He has never smoked cigarettes and there was no history of alcohol or illicit drug use. He had no known drug or food allergies. His medical therapy on admission included azathioprine, prednisolone, diclofenac, omeprazole, Dihydrocodeine, paracetamol, salbutamol inhaler and eight weekly Infliximab infusions.
On examination he was tachycardic at 168 beats per minute. Blood pressure was 110/90 and respiratory rate of 16 per minute; oxygen saturation was 99% on room air. Systemic examination was unremarkable. The electrocardiogram (Figure ) showed a supraventricular tachycardia (SVT), which reverted rapidly to sinus rhythm (Figure ) with intravenous adenosine therapy (9 milligrams). His complete blood count, cardiac enzymes, troponinI, serum electrolytes, renal functions and liver enzymes all were normal. Chest X-ray did not show any evidence of cardiomegaly or pulmonary congestion and 2-D echocardiogram revealed normal left ventricular systolic and diastolic functions.",What is the patient's score of the HEART Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [60, 'years'], 'Hypertension history': False, 'Electrocardiogram Test': 'Normal', 'Diabetes mellitus': False, 'smoking': False, 'Suspicion History': 'Moderately suspicious', 'Initial troponin': 'less than or equal to normal limit'}",2,2,2,"The HEART Score for risk stratification in patients with chest pain is shown below:

1. History: Slightly suspicious = 0 points, Moderately suspicious = +1 point, Highly suspicious = +2 points
2. EKG: Normal = 0 points, Non-specific repolarization disturbance = +1 point, Significant ST deviation = +2 points
3. Age: <45 years = 0 points, 45-64 years = +1 point, ≥65 years = +2 points
4. Risk factors (HTN, hypercholesterolemia, DM, obesity (BMI >30 kg/m²), smoking (current or cessation within 3 months), positive family history of cardiovascular disease before age 65, atherosclerotic disease such as prior MI, PCI/CABG, CVA/TIA, or peripheral arterial disease): No known risk factors = 0 points, 1-2 risk factors = +1 point, ≥3 risk factors or history of atherosclerotic disease = +2 points
5. Initial troponin level: ≤normal limit = 0 points, 1-3x normal limit = +1 point, >3x normal limit = +2 points

The total score is calculated by summing the points for each criterion.
    
The current HEART Score is 0.
The value of 'history' in the patient's note is determined to be 'Moderately suspicious'. Based on the HEART Score criteria, 1 point is added for 'history', increasing the current total to 0 + 1 = 1.
The value of 'electrocardiogram' in the patient's note is determined to be 'Normal'. Based on the HEART Score criteria, 0 points are added for 'electrocardiogram', keeping the current total at 1.
The patient is 60 years old. The patient's age is between 45 and 65 years and so we increment the current total by 1, making the current total 1 + 1 = 2.
The following risk factor(s) are mentioned in the patient's note, but these risk factors are noted to be absent from the patient: hypertension, diabetes mellitus, smoking. The following risk factor(s) are missing from the patient's data: hypertension, diabetes mellitus, smoking. We will assume that these are all absent from the patient. Based on the HEART Score risk factors criteria, 0 risk factors are present and so 0 points are added for the risk factors criteria, keeping the current total at 2.
The value of 'initial troponin' in the patient's note is determined to be 'less than or equal to normal limit'. Based on the HEART Score criteria, 0 points are added for 'initial troponin', keeping the current total at 2.
Based on the patient's data, the HEART Score is 2."
279,18,HEART Score for Major Cardiac Events,risk,integer,pmc-4980942-1,Extracted,"A 35-year-old man was hospitalized for acute chest pain and palpitation at rest with a presumed diagnosis of unstable angina. He also described an episode of syncope. He was prescribed chlorpheniramine 4 mg a couple of days ago for symptomatic treatment of upper respiratory tract infection, and he was also on propranolol 20 mg treatment for essential tremor and anxiety disorder for many years. He was used to take propranolol daily. His complaints appeared 1 h after intake of the second dosage of chlorpheniramine together with propranolol. He had no prior history of cardiac arrhythmias, valvular or congenital heart disease, and sudden cardiac death in family history. He smoked regularly up to 20 cigarettes a day. He denied the usage of legal or illegal other medications such as antidepressants and cocaine. Physical examination revealed irregular pulse, low blood pressure of 90/60 mmHg, and altered cloudy consciousness. He had no biochemical abnormality; magnesium and potassium level was in normal range. Electrocardiography (ECG) showed ST-segment depression in inferior leads and isolated ST elevation in leads D1-aVL []. Echocardiography showed normal systolic functions with no segmental wall motion abnormalities. The patient was given 300 mg of acetylsalicylic acid and underwent emergency coronary angiography that revealed normal coronary arteries. Whenever ischemic changes were observed in admission ECG, anti-ischemic therapy was not admitted to the patient due to the result of completely normal coronaries. After all the patient was followed by telemetry at coronary care unit. Control ECG showed ventricular bigeminy and R on T phenomenon. On the 2nd day of admission, the patient had polymorphic ventricular tachycardia (VT) attack which degenerated to ventricular fibrillation, immediately patient was defibrillated and sinus rhythm was restored successfully []. After defibrillation, the patient continued to have frequent premature ventricular beats and couplets on the monitor. On the 3rd day of his admission, an upper rib ECG was performed and showed a pattern of right bundle branch block with ST-segment elevation in leads V3. The present findings were thought to be compatible with Type 3 Brugada syndrome []. An ajmaline challenge test[] was then performed. Although the frequency of ventricular extrasystoles and couplets was increased during the test, no coved-type ECG pattern appeared in the right precordial leads []. Therefore, the diagnosis of Brugada syndrome was abandoned. Electrophysiological study was proposed, but the patient refused the test. Because the patient survived a sudden unexplained cardiac arrest, it was decided to implant an implantable cardioverter defibrillator for secondary prevention. The patient recovered and had no further complaints after implantation and he was discharged.",What is the patient's score of the HEART Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [35, 'years'], 'Suspicion History': 'Highly suspicious', 'Electrocardiogram Test': 'Significant ST deviation', 'smoking': True, 'parent or sibling with Cardiovascular disease before age 65': False, 'atherosclerotic disease': False}",5,5,5,"The HEART Score for risk stratification in patients with chest pain is shown below:

1. History: Slightly suspicious = 0 points, Moderately suspicious = +1 point, Highly suspicious = +2 points
2. EKG: Normal = 0 points, Non-specific repolarization disturbance = +1 point, Significant ST deviation = +2 points
3. Age: <45 years = 0 points, 45-64 years = +1 point, ≥65 years = +2 points
4. Risk factors (HTN, hypercholesterolemia, DM, obesity (BMI >30 kg/m²), smoking (current or cessation within 3 months), positive family history of cardiovascular disease before age 65, atherosclerotic disease such as prior MI, PCI/CABG, CVA/TIA, or peripheral arterial disease): No known risk factors = 0 points, 1-2 risk factors = +1 point, ≥3 risk factors or history of atherosclerotic disease = +2 points
5. Initial troponin level: ≤normal limit = 0 points, 1-3x normal limit = +1 point, >3x normal limit = +2 points

The total score is calculated by summing the points for each criterion.
    
The current HEART Score is 0.
The value of 'history' in the patient's note is determined to be 'Highly suspicious'. Based on the HEART Score criteria, 2 points are added for 'history', increasing the current total to 0 + 2 = 2.
The value of 'electrocardiogram' in the patient's note is determined to be 'Significant ST deviation'. Based on the HEART Score criteria, 2 points are added for 'electrocardiogram', increasing the current total to 2 + 2 = 4.
The patient is 35 years old. The patient's age is less than 45 years and so keep the current total at 4.
The following risk factor(s) are present based on the patient's note: smoking. The following risk factor(s) are mentioned in the patient's note, but these risk factors are noted to be absent from the patient: family with cvd, atherosclerotic disease. The following risk factor(s) are missing from the patient's data: family with cvd, atherosclerotic disease. We will assume that these are all absent from the patient. Based on the HEART Score risk factors criteria, 1 risk factors are present and so 1 point is added for the risk factors criteria, making the current total, 4 + 1 = 5.
'initial troponin' is missing from the patient's data and so we assume it's value is less than or equal to normal limit.Based on the HEART Score criteria, 0 points are added for 'initial troponin', keeping the current total at 5.
Based on the patient's data, the HEART Score is 5."
280,18,HEART Score for Major Cardiac Events,risk,integer,usmle-353,Extracted,"A 60-year-old male comes to the emergency department because of a 3-day history of intermittent shortness of breath and palpitations. The episodes are unprovoked and occur randomly. The day before, he felt lightheaded while walking and had to sit down abruptly to keep from passing out. He has hypertension and coronary artery disease. Cardiac catheterization 5 years ago showed occlusion of the left anterior descending artery, and he underwent placement of a stent. Current medications include aspirin, metoprolol, lisinopril, and clopidogrel. He does not drink alcohol or use any illicit drugs. He has smoked one-half pack of cigarettes daily for 20 years. He appears well. His temperature is 37°C (98.6°F), pulse is 136/min, respirations are 18/min, and blood pressure is 110/85 mm Hg. The lungs are clear to auscultation. Cardiac examination shows a rapid, irregular rhythm. Shortly after, an ECG is performed.",What is the patient's score of the HEART Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [60, 'years'], 'Hypertension history': True, 'Electrocardiogram Test': 'Normal', 'smoking': True, 'atherosclerotic disease': True, 'Suspicion History': 'Highly suspicious'}",5,5,5,"The HEART Score for risk stratification in patients with chest pain is shown below:

1. History: Slightly suspicious = 0 points, Moderately suspicious = +1 point, Highly suspicious = +2 points
2. EKG: Normal = 0 points, Non-specific repolarization disturbance = +1 point, Significant ST deviation = +2 points
3. Age: <45 years = 0 points, 45-64 years = +1 point, ≥65 years = +2 points
4. Risk factors (HTN, hypercholesterolemia, DM, obesity (BMI >30 kg/m²), smoking (current or cessation within 3 months), positive family history of cardiovascular disease before age 65, atherosclerotic disease such as prior MI, PCI/CABG, CVA/TIA, or peripheral arterial disease): No known risk factors = 0 points, 1-2 risk factors = +1 point, ≥3 risk factors or history of atherosclerotic disease = +2 points
5. Initial troponin level: ≤normal limit = 0 points, 1-3x normal limit = +1 point, >3x normal limit = +2 points

The total score is calculated by summing the points for each criterion.
    
The current HEART Score is 0.
The value of 'history' in the patient's note is determined to be 'Highly suspicious'. Based on the HEART Score criteria, 2 points are added for 'history', increasing the current total to 0 + 2 = 2.
The value of 'electrocardiogram' in the patient's note is determined to be 'Normal'. Based on the HEART Score criteria, 0 points are added for 'electrocardiogram', keeping the current total at 2.
The patient is 60 years old. The patient's age is between 45 and 65 years and so we increment the current total by 1, making the current total 2 + 1 = 3.
The following risk factor(s) are present based on the patient's note: hypertension, smoking, atherosclerotic disease. The following risk factor(s) are missing from the patient's data: . We will assume that these are all absent from the patient. Based on the HEART Score risk factors criteria, 3 risk factors are present and so 2 points are added as 3 or more risk factors are present, making the current total 3 + 2 = 5.
'initial troponin' is missing from the patient's data and so we assume it's value is less than or equal to normal limit.Based on the HEART Score criteria, 0 points are added for 'initial troponin', keeping the current total at 5.
Based on the patient's data, the HEART Score is 5."
281,19,Fibrosis-4 (FIB-4) Index for Liver Fibrosis,lab test,decimal,pmc-6925761-1,Extracted,"A 47-year-old man with a past medical history of alcoholic cirrhosis and ongoing alcohol abuse was brought to the emergency room after a syncopal episode. He complained of 7/10 epigastric pain associated with nonbloody emesis. He denied melena. He was tachycardic with a heart rate of 108 as well as hypotensive with a blood pressure of 64/34. His oxygen saturation was 96% on room air. He was alert with a Glasgow Coma Scale (GCS) of 14 but noted to be in severe distress, diaphoretic, and tremulous. His skin was cold and clammy and abdomen was noted to be distended and diffusely tender to palpation. A rectal exam was negative for gross blood. A FAST exam noted moderate ascites. A chest X-ray was performed and was negative for acute pathology.
Relevant laboratory data on admission included the following: white blood cell count of 7600 per mm3, bands of 38%, hemoglobin of 9.9 g/dl, platelet count of 149,000 per mm3, international normalized ratio (INR) of 2.5, aspartate aminotransferase (AST) of 213 U/liter, and alanine aminotransferase of 309 U/liter. Initial venous blood gas revealed a pH of 7.23, a venous bicarbonate level of 18 mmol/liter and a lactate of 6.62 mmol/liter.
Despite four liters of intravenous crystalloid fluid resuscitation the patient remained hypotensive at 75/58. Vasopressor support was initiated with intravenous norepinephrine titrated to a dose of 30 mcg/min and vasopressin at 0.04 units/min with minimal improvement in blood pressure to 94/76. Broad spectrum antibiotics consisting of vancomycin and piperacillin-tazobactam were administered due to concerns for septic shock. SBP was considered the cause of sepsis due to patient's abdominal pain, ascites, and bandemia.
The patient became increasingly more confused and agitated and the trachea was electively intubated for airway control. During this time, his abdomen was noted to be more distended. Patient was deemed too unstable for abdominal CT imaging as he was requiring multiple vasopressors. Postintubation he was transferred to the medical ICU for presumed septic shock.
On arrival to the ICU after initial stabilization of the patient a diagnostic paracentesis was performed in order to obtain culture for possible SBP. An appropriate pocket of fluid was visualized in the right lower abdominal quadrant. Approximately five ml of bloody ascites was aspirated. Concurrently, repeat lab results reported a hemoglobin level of 4.4 g/dl and an arterial blood gas with a lactate of 12.92 mmol/liter. General surgery was immediately consulted due to concerns for intraabdominal hemorrhage. At the same time the patient's girlfriend arrived to the hospital and stated that the patient had complained of falling in the bathroom earlier that day. General surgery recommended angiogram to locate the source of suspected intraabdominal bleeding. Interventional radiology was contacted for emergent angiogram to evaluate for a hepatic or splenic hemorrhage. Massive transfusion protocol was initiated and intravenous epinephrine was added to norepinephrine and vasopressin due to persistent hypotension. He was transferred to the IR suite.
The right common femoral artery was accessed and an angiogram was performed initially finding vague contrast blush in the right hepatic lobe which was empirically embolized with Gelfoam and detachable coils. There was extensive contrast extravasation from the distal splenic artery (). The splenic artery was embolized and angiogram postembolization demonstrated no further contrast extravasation (). Patient's blood pressure increased from 70 systolic to 100 immediately after embolization. On examination post angiogram, his abdomen was tense. Patient was also oliguric therefore, the decision was made to take him immediately for exploratory laparotomy for treatment of abdominal compartment syndrome. Exploratory laparotomy revealed a cirrhotic liver without signs of injury and a two-centimeter grade 1 splenic laceration at the lower pole which was not actively bleeding. A total of nine liters of bloody ascites were evacuated from the abdomen. The abdomen was left open and a Bogota bag was sutured to the fascia. He was transfused a total of 5 units of packed red blood cells, 4 units of fresh frozen plasma and a unit of platelets during the procedure.
He was brought back to the operating room (OR) two days later and was found to have active bleeding at the anterior surface of the hilum of the spleen. This was cauterized, stopping the bleeding. On hospital day four he was taken back to the OR and the abdomen was closed. He was extubated on hospital day seven. Hospital course was complicated by acute kidney injury which resolved, as well as seizures attributed to alcohol withdrawal treated with chlordiazepoxide. Patient was discharged home and at a clinic follow-up two months post hospitalization he was noted to be doing well and abstaining from alcohol.",What is the patient's score of the Fibrosis 4 Index? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [47, 'years'], 'Alanine aminotransferase': [309.0, 'U/L'], 'Aspartate aminotransferase': [213.0, 'U/L'], 'Platelet count': [149000.0, 'µL']}",3.82219,3.63108,4.0133,"The formula for computing Fibrosis-4 is Fib-4 = (Age * AST) / (Platelet count (in billions) * √ALT), where platelet count is the number of billions per L, and the units for AST and ALT are both U/L.
The patient's concentration of AST is 213.0 U/L.
The patient's concentration of ALT is 309.0 U/L.
The patient's concentration of platelets is 149000.0 count/µL. To convert 149000.0 count/µL of platelets to L, multiply by the conversion factor 1000000.0 µL/L which will give 149000.0 platelets count/µL * 1000000.0 µL/L = 149000000000.0 platelets count/L. This means that there are 149000000000.0/(10^9) = 149.0 billion platelet counts per liter.
Plugging these values into the formula, we get (47 * 213.0)/(149.0 * sqrt(309.0)) = 3.82219.Hence, the Fibrosis-4 score is 3.82219."
282,19,Fibrosis-4 (FIB-4) Index for Liver Fibrosis,lab test,decimal,pmc-7524929-1,Extracted,"A 36-year-old woman underwent a laparoscopic partial hepatectomy for HCC (20 mm in diameter) in liver segment 5 two and a half years ago during follow-up after having been identified as a hepatitis B virus carrier. She has been treated for hepatitis B with nucleoside analogue before the hepatectomy. A pathological diagnosis of moderately differentiated HCC was subsequently established. We followed up at interval of 2–3 months after the hepatectomy. During post-surgery follow-up, abdominal ultrasonography detected a 36-mm hypoechoic tumor in segment 7 of the liver. Abdominal contrast-enhanced computed tomography revealed a 40-mm tumor adjacent to the inferior vena cava (IVC) and right hepatic vein (RHV). The tumor was well enhanced in the arterial phase and washed out in the portal venous and delayed phases, suggesting HCC recurrence (Fig. ). No nodule suggesting HCC was identified elsewhere in the liver. Neither lymph-node swelling nor metastasis to other organs was detected. The following laboratory data were obtained: white blood cell count (3000/µL), hemoglobin (10.1 g/dL), platelet count (16.5 × 104/µL), C-reactive protein (2.98 mg/dL), urea nitrogen (9.2 mg/dL), creatinine (0.51 mg/dL), total protein (6.3 g/dL), albumin (3.1 g/dL), total bilirubin (0.4 mg/dL), aspartate aminotransferase (28 IU/L), alanine aminotransferase (30 IU/L), glutamyltransferase (16 IU/L), lactate dehydrogenase (179 U/L), alkaliphosphatase (192 U/L), prothrombin time (115.3%), and indocyanine green retention rate at 15 min (7.0%). α-Fetoprotein (AFP) (12,371.5 ng/mL; normal range < 10 ng/mL) and PIVKA-II (208 mAU/mL; normal range; < 40 mAU/mL) were both significantly elevated. Considering that the patient was still 20 weeks pregnant, delivery was not viable. However, surgery could not be delayed any longer given the rapid tumor growth, which could likely be associated with pregnancy. After discussion with at a cancer board consisting of experts from the departments of gastroenterology, obstetrics and gynecology, and surgery, as well as obtaining appropriate informed consent from the patient and her family, we decided to perform hepatic resection after abortion. Subsequently, abortion surgery was performed at 21 weeks and 2 days of pregnancy, followed by subsegmentectomy of liver segment 7 under general and epidural anesthesia 6 days later. Mental care for the patient was provided by obstetricians, surgeons, and nurses before and after abortion. After mobilizing the right lobe of the liver, we identified the Glissonian pedicle (G) 7 and injected indigo carmine under US guidance to mark the perfusion area. Thereafter, hepatic resection was initiated using an ultrasonic dissector under the Pringle’s maneuver. After identifying the G7, a clamp test was performed to reconfirming the ischemic area before ligating and cutting it. We continued hepatic resection along the RHV, exfoliated a tumor within the vicinity of a root of the RHV, and subsequently completed subsegmentectomy of liver segment 7 (Fig. ). The surgery lasted 274 min, with an estimated blood loss of 940 mL. Macroscopically, the whitish tumor with a maximum diameter of 4.0 cm was simple nodular type and showed expansive growth (Fig. ). A pathological diagnosis of moderately differentiated HCC, grade II, eg, fc (−), sf (+), s0, vp0, vv0, b0, im0, and sm (−) was thereafter established. Tumor cells showed a moderate degree of atypia, as well as a cord-like or pseudoglandular arrangement associated with abundant eosinophilic vesicles and a rich nucleoplasm. Given the good postoperative course, without particular complications, the patient was discharged 10 days after surgery. Approximately 2 years after surgery, the patient remains alive without recurrence, while both AFP and PIVKA-II were within normal limits.",What is the patient's score of the Fibrosis 4 Index? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [36, 'years'], 'Alanine aminotransferase': [30.0, 'U/L'], 'Aspartate aminotransferase': [28.0, 'U/L'], 'Platelet count': [165000.0, 'µL']}",1.11536,1.05959,1.17113,"The formula for computing Fibrosis-4 is Fib-4 = (Age * AST) / (Platelet count (in billions) * √ALT), where platelet count is the number of billions per L, and the units for AST and ALT are both U/L.
The patient's concentration of AST is 28.0 U/L.
The patient's concentration of ALT is 30.0 U/L.
The patient's concentration of platelets is 165000.0 count/µL. To convert 165000.0 count/µL of platelets to L, multiply by the conversion factor 1000000.0 µL/L which will give 165000.0 platelets count/µL * 1000000.0 µL/L = 165000000000.0 platelets count/L. This means that there are 165000000000.0/(10^9) = 165.0 billion platelet counts per liter.
Plugging these values into the formula, we get (36 * 28.0)/(165.0 * sqrt(30.0)) = 1.11536.Hence, the Fibrosis-4 score is 1.11536."
283,19,Fibrosis-4 (FIB-4) Index for Liver Fibrosis,lab test,decimal,usmle-325,Extracted,"A 51-year-old man is brought to the emergency department because of a 2-day history of fever, abdominal pain, and confusion. His wife states that he has been unable to recall his birthday or her name. He was diagnosed with hepatitis C 3 years ago but refused treatment. He has been treated twice in the past year for acute pancreatitis. There is no family history of serious illness. His only medication is a calcium supplement. He emigrated from India 15 years ago. He appears ill. His temperature is 38.3°C (100.9°F), pulse is 101/min, and blood pressure is 104/68 mm Hg. He is confused and oriented only to person. Examination shows scleral icterus and spider angiomas. There are fine tremors of the hands bilaterally. The abdomen is distended and shifting dullness is present. There is diffuse tenderness to palpation with no guarding. Bowel sounds are absent. Laboratory studies show:
Hemoglobin 12.6 g/dL
Leukocyte count 13,900/mm3
Platelet count 342,000/mm3
Serum
Albumin 2.6 g/dL
Total bilirubin 2.56 mg/dL
Alkaline phosphatase 54 U/L
AST 17 U/L
ALT 44 U/L
Paracentesis is performed. Ascitic fluid analysis shows an albumin concentration of 0.8 g/dL, glucose concentration of 62 mg/dL, and a leukocyte count of 1900/mm3 with 60% neutrophils.",What is the patient's score of the Fibrosis 4 Index? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [51, 'years'], 'Alanine aminotransferase': [44.0, 'U/L'], 'Aspartate aminotransferase': [17.0, 'U/L'], 'Platelet count': [342000.0, 'mm^3']}",0.38218,0.36307,0.40129,"The formula for computing Fibrosis-4 is Fib-4 = (Age * AST) / (Platelet count (in billions) * √ALT), where platelet count is the number of billions per L, and the units for AST and ALT are both U/L.
The patient's concentration of AST is 17.0 U/L.
The patient's concentration of ALT is 44.0 U/L.
The patient's concentration of platelets is 342000.0 count/mm^3. To convert 342000.0 count/mm^3 of platelets to L, multiply by the conversion factor 1000000.0 mm^3/L which will give 342000.0 platelets count/mm^3 * 1000000.0 mm^3/L = 342000000000.0 platelets count/L. This means that there are 342000000000.0/(10^9) = 342.0 billion platelet counts per liter.
Plugging these values into the formula, we get (51 * 17.0)/(342.0 * sqrt(44.0)) = 0.38218.Hence, the Fibrosis-4 score is 0.38218."
284,19,Fibrosis-4 (FIB-4) Index for Liver Fibrosis,lab test,decimal,pmc-3813587-1,Extracted,"The patient is a 56-year-old woman who underwent a surgical treatment of a lateral ventricle meningioma at the age of 29. A month later, she underwent CP shunt placement for cyst formation after resection. The postoperative course was uneventful and she was well without shunt-related problems for 26 years. She developed a brain abscess related to the shunt catheter at the age of 55. A surgical removal of the catheter was attempted, but was not technically possible, and only the segment from the clavicle to the breast was removed with ligation of the two remaining ends. The two disconnected catheter segments remained in situ and were not retrieved. A year later, she was taken to a local hospital with continuous right-breast pain. The diagnosis of acute mastitis was made and she was referred to our institution for further examination. On presentation, her right breast was swollen with erythema (Fig. ). There was no abdominal pain and change in bowel habits. Funduscopic evaluation was normal with no signs of increased intracranial pressure. Her temperature was 36.7°C, and laboratory tests revealed a decreased platelet count of 103 000/μl, elevated AST of 97 U/l, ALT of 72 U/l and C-reactive protein level of 1.4 mg/dl. The breast abscess was drained under local anesthesia. Cultures taken from the abscess showed enteric organisms including Enterococcus avium, Klebsiella oxytoca and Bacillus. Abdominal CT showed that the shunt catheter was in the splenic flexure of the transverse colon with no other abnormalities (Fig. ). Colonoscopy was performed to survey the colon and the shunt catheter was found inside the lumen at the splenic flexure (Fig. ). Acute mastitis caused by enteric organisms which had migrated through the shunt catheter after penetration into the transverse colon was the presumptive diagnosis, and the catheter removed under general anesthesia. The breast to the abdomen segment of the catheter was exteriorized through the right-anterior chest wall without laparotomy. The postoperative course was uneventful. She was transferred to local hospital 15 days later.",What is the patient's score of the Fibrosis 4 Index? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [56, 'years'], 'Alanine aminotransferase': [72.0, 'U/L'], 'Aspartate aminotransferase': [97.0, 'U/L'], 'Platelet count': [103000.0, 'µL']}",6.21522,5.90446,6.52598,"The formula for computing Fibrosis-4 is Fib-4 = (Age * AST) / (Platelet count (in billions) * √ALT), where platelet count is the number of billions per L, and the units for AST and ALT are both U/L.
The patient's concentration of AST is 97.0 U/L.
The patient's concentration of ALT is 72.0 U/L.
The patient's concentration of platelets is 103000.0 count/µL. To convert 103000.0 count/µL of platelets to L, multiply by the conversion factor 1000000.0 µL/L which will give 103000.0 platelets count/µL * 1000000.0 µL/L = 103000000000.0 platelets count/L. This means that there are 103000000000.0/(10^9) = 103.0 billion platelet counts per liter.
Plugging these values into the formula, we get (56 * 97.0)/(103.0 * sqrt(72.0)) = 6.21522.Hence, the Fibrosis-4 score is 6.21522."
285,19,Fibrosis-4 (FIB-4) Index for Liver Fibrosis,lab test,decimal,pmc-6244097-1,Extracted,"A 32-year-old female that has been a HCV carrier for the past 10 years came to our clinic for hepatitis C treatment. She had not received any treatment for hepatitis C in the past. She also had a history of thalassemia minor and SCD, requiring frequent hospitalizations for sickle cell crisis and multiple blood transfusions. She had undergone splenectomy in childhood and denied illicit drug use, smoking, or alcohol abuse. At the time of her visit, she was taking folic acid only. Her baseline blood workup showed hemoglobin 8.4 g/dL, platelets 297 K/μL, creatinine 0.33 mg/dL, albumin 3.9 g/dL, INR 1.1, AST 94 IU/l, ALT 35 IU/l, ALP 96 IU/l, and total bilirubin 2.6 mg/dL. Hepatitis C viral load was 38,907 IU/mL with genotype 1a. Recent abdominal CT revealed a mildly nodular hepatic contour with hypertrophied left hepatic lobe, indicative of cirrhosis, with no evidence of ascites. The FibroTest revealed severe fibrosis with a score of F4. Hepatitis B surface antigen and HIV antibodies were checked, and both were negative. As the patient had not been previously treated for hepatitis C and had Child-Pugh class A liver cirrhosis with no serologic evidence of HBV and HIV coinfection, once-daily ledipasvir 90 mg/sofosbuvir 400 mg was initiated for 12 weeks. At the 4-week follow-up, the patient complained of mild headache and fatigue. Repeat blood workup showed hemoglobin 7.8 g/dL, AST 93 IU/l, ALT 49 IU/l, and total bilirubin 2.9 mg/dL, with an undetectable HCV load. Her treatment continued for the remaining 8 weeks, during which headache and fatigue resolved completely. At the end of the 12-week ledipasvir/sofosbuvir course, hemoglobin stabilized at 8.4 g/dL, and no increase in LDH, total bilirubin or retic count was noted. HCV viral load remained undetectable 3 months after treatment completion.",What is the patient's score of the Fibrosis 4 Index? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [32, 'years'], 'Alanine aminotransferase': [35.0, 'U/L'], 'Aspartate aminotransferase': [94.0, 'U/L'], 'Platelet count': [297000.0, 'µL']}",1.71194,1.62634,1.79754,"The formula for computing Fibrosis-4 is Fib-4 = (Age * AST) / (Platelet count (in billions) * √ALT), where platelet count is the number of billions per L, and the units for AST and ALT are both U/L.
The patient's concentration of AST is 94.0 U/L.
The patient's concentration of ALT is 35.0 U/L.
The patient's concentration of platelets is 297000.0 count/µL. To convert 297000.0 count/µL of platelets to L, multiply by the conversion factor 1000000.0 µL/L which will give 297000.0 platelets count/µL * 1000000.0 µL/L = 297000000000.0 platelets count/L. This means that there are 297000000000.0/(10^9) = 297.0 billion platelet counts per liter.
Plugging these values into the formula, we get (32 * 94.0)/(297.0 * sqrt(35.0)) = 1.71194.Hence, the Fibrosis-4 score is 1.71194."
286,19,Fibrosis-4 (FIB-4) Index for Liver Fibrosis,lab test,decimal,usmle-9883,Extracted,"A 45-year-old African American man presents with nausea and severe abdominal pain. He denies vomiting. He says that, 2 days ago, his divorce was finalized, so he went to a bar and had multiple shots of tequila and vodka. This morning, upon waking, he noticed his urine was red, which lasted throughout the day. The patient denies any history of similar symptoms. Past medical history is significant for low blood counts diagnosed on routine laboratory work 6 months ago, which was not followed up due to the stress of the divorce. A review of systems is significant for erectile dysfunction and chronic fatigue. His temperature is 37.2°C (99.0°F), the heart rate is 90/min, the blood pressure is 136/88 mm Hg, and the respiratory rate is 20/min. Physical examination shows scleral icterus. Mucous membranes are pale. Cardiac auscultation reveals a systolic flow murmur loudest along the left sternal border. There is moderate right upper quadrant abdominal tenderness with no rebound or guarding. The remainder of the exam is unremarkable. Laboratory findings are significant for the following:
Hematocrit 27%
Mean corpuscular volume 81 µm3
Leukocytes 6,000/mm3
Platelets 130,000/µL
Haptoglobin 30 mg/dL (50–150 mg/dL)
Reticulocyte count 3%
  Total bilirubin 7.1 mg/dL
LDH 766 U/L
AST 150 U/L
ALT 195 U/L
HbA1 96%
HbA2 2%
HbF 2%
CD55 50% of expected
The peripheral smear is unremarkable.",What is the patient's score of the Fibrosis 4 Index? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [45, 'years'], 'Alanine aminotransferase': [195.0, 'U/L'], 'Aspartate aminotransferase': [150.0, 'U/L'], 'Platelet count': [130000.0, 'µL']}",3.71829,3.53238,3.9042,"The formula for computing Fibrosis-4 is Fib-4 = (Age * AST) / (Platelet count (in billions) * √ALT), where platelet count is the number of billions per L, and the units for AST and ALT are both U/L.
The patient's concentration of AST is 150.0 U/L.
The patient's concentration of ALT is 195.0 U/L.
The patient's concentration of platelets is 130000.0 count/µL. To convert 130000.0 count/µL of platelets to L, multiply by the conversion factor 1000000.0 µL/L which will give 130000.0 platelets count/µL * 1000000.0 µL/L = 130000000000.0 platelets count/L. This means that there are 130000000000.0/(10^9) = 130.0 billion platelet counts per liter.
Plugging these values into the formula, we get (45 * 150.0)/(130.0 * sqrt(195.0)) = 3.71829.Hence, the Fibrosis-4 score is 3.71829."
287,19,Fibrosis-4 (FIB-4) Index for Liver Fibrosis,lab test,decimal,pmc-6095933-1,Extracted,"A 55-year-old woman regularly visited our hospital as an outpatient because of hepatitis B occult infection. A liver tumor was point out by CT. CT revealed a protruding liver tumor located at segment 8 3 cm in size, which include cystic lesion (Fig. ). US and MRI reveal the same feature (Fig. ). There was no distant metastasis. The patient had no past or family history including gynecological illness. 18F-FDG PET revealed the accumulation of 18F-FDG, and maximum standard uptake value was 2.3. Laboratory results included a white blood cell count of 3200/μL and platelet count of 189,000/μL. Prothrombin time international normalized ratio was 1.02. Total serum bilirubin was 0.9 mg/dL, direct bilirubin 0.03 mg/dL, albumin 4.5 g/dL, aspartate aminotransferase 22 U/L, alanine aminotransferase 17 U/L, alkaline phosphatase 187 U/L, and gamma-glutamyltranspeptidase 49 U/L. Tumor markers such as CEA, CA19-9, AFP, and DCP were normal. HBs-antigen and HBc-antibody were positive, and HBs-antibody and HCV-antibody were negative. The Child–Pugh score was 5, grade A. She was diagnosed as intrahepatic cystadenocarcinoma and received extended posterior segmentectomy including diaphragm. Macroscopic findings revealed the tumor buried to the liver with the intracystic hemorrhage (Fig. ). The protruded comportment was closely touched to the diaphragm. Microscopic findings revealed the tumor and hemorrhage within the cyst (Fig. ). Tumor was located between the liver and diaphragm.
Histopathological evaluation revealed intracystic clear cell adenocarcinoma. The tumor has ductal structure including mucin and atypical nuclear with clear cytoplasm (Fig. ). The tumor was separated from the liver and the diaphragm (Fig. ). There is no traffic with the bile duct and ovarian stroma. PAS staining was positive. There was lack of ovarian clear cell carcinoma’s features such as hobnail appearance. The expression of Pax8 (Fig. ) was positive, but the expression CK7 and HNF1β(Fig. ) was positive and that of CD10 and ER was negative, which indicate that the tumor has the feature of clear cell carcinoma of the ovary, not renal cell carcinoma nor cholangiocarcinoma. The patient was discharged 13 days after surgery with no complication. According to the microscopic findings, gynecological interview and examinations after hepatic resection were performed, but there were no sign of menstrual irregularity and genital bleeding, and no endometriosis.",What is the patient's score of the Fibrosis 4 Index? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [55, 'years'], 'Alanine aminotransferase': [17.0, 'U/L'], 'Aspartate aminotransferase': [22.0, 'U/L'], 'Platelet count': [189000.0, 'µL']}",1.55274,1.4751,1.63038,"The formula for computing Fibrosis-4 is Fib-4 = (Age * AST) / (Platelet count (in billions) * √ALT), where platelet count is the number of billions per L, and the units for AST and ALT are both U/L.
The patient's concentration of AST is 22.0 U/L.
The patient's concentration of ALT is 17.0 U/L.
The patient's concentration of platelets is 189000.0 count/µL. To convert 189000.0 count/µL of platelets to L, multiply by the conversion factor 1000000.0 µL/L which will give 189000.0 platelets count/µL * 1000000.0 µL/L = 189000000000.0 platelets count/L. This means that there are 189000000000.0/(10^9) = 189.0 billion platelet counts per liter.
Plugging these values into the formula, we get (55 * 22.0)/(189.0 * sqrt(17.0)) = 1.55274.Hence, the Fibrosis-4 score is 1.55274."
288,19,Fibrosis-4 (FIB-4) Index for Liver Fibrosis,lab test,decimal,pmc-7184854-1,Extracted,"An 81-year-old man was admitted due to massive upper gastrointestinal hemorrhage for 2 h. He had epigastric pain and early satiety for 3 weeks. His past medical history was unremarkable except for heavy alcohol drinking, 1–2 bottles a day for over 30 years. He denied a history of exposure to thorotrast or vinyl chloride. Physical examination revealed mildly pale, icteric sclerae, hepatomegaly with a liver span of 14 cm, parotid gland enlargement and palmar erythema. Other examinations were unremarkable. Laboratory investigations on admission showed white blood cell (WBC) count 6,210/dL, hemoglobin (Hb) 5.8 g/dL, platelet count 283 × 103/µL, aspartate transaminase (AST) 116 U/L, alanine aminotransferase (ALT) 73 U/L, alkaline phosphatase (ALP) 192 U/L, albumin 2.7 g%, total bilirubin (TB) 5.74 mg%, direct bilirubin (DB) 5.3 mg%, prothrombin time (PT) 16.2 s (control 12.4), and international normalized ratio (INR) 1.23; serum alpha-fetoprotein (AFP) was within normal range.
Esophagogastroduodenoscopy was performed and revealed a 3-cm large ulcer with elevated border and necrotic tissue in the antrum of stomach; no varix was seen. The tissue biopsy was performed to exclude malignant ulcer. Liver ultrasonography revealed a cirrhotic liver and diffused multiple echogenic nodules size 7–9 mm in both lobes with a large echogenic mass 3.3 cm in size with a halo. A further CT scan demonstrated multiple large infiltrative masses with few arterial enhancements, no venous washout, size 1–4 cm in both lobes, osteolytic foci at the thoracic spine level T10 and T11, and small subpleural nodule at the right lower lung. Liver biopsy was performed for definite diagnosis. The specimen consisted of a few pieces of gray tan irregular soft tissue and disclosed the angiosarcoma; immunohistochemical study showed positive staining for CD34 and factor VIII. The specimen of gastric ulcer biopsy also revealed metastasis of angiosarcoma.
He was treated with a paclitaxel dose of 175 mg/m2. Unfortunately, 5 days after receiving chemotherapy, he developed febrile neutropenia with septic shock. His relatives refused further treatment and invasive procedures, and he died in the following days.",What is the patient's score of the Fibrosis 4 Index? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [81, 'years'], 'Alanine aminotransferase': [73.0, 'U/L'], 'Aspartate aminotransferase': [116.0, 'U/L'], 'Platelet count': [283000.0, 'µL']}",3.88593,3.69163,4.08023,"The formula for computing Fibrosis-4 is Fib-4 = (Age * AST) / (Platelet count (in billions) * √ALT), where platelet count is the number of billions per L, and the units for AST and ALT are both U/L.
The patient's concentration of AST is 116.0 U/L.
The patient's concentration of ALT is 73.0 U/L.
The patient's concentration of platelets is 283000.0 count/µL. To convert 283000.0 count/µL of platelets to L, multiply by the conversion factor 1000000.0 µL/L which will give 283000.0 platelets count/µL * 1000000.0 µL/L = 283000000000.0 platelets count/L. This means that there are 283000000000.0/(10^9) = 283.0 billion platelet counts per liter.
Plugging these values into the formula, we get (81 * 116.0)/(283.0 * sqrt(73.0)) = 3.88593.Hence, the Fibrosis-4 score is 3.88593."
289,19,Fibrosis-4 (FIB-4) Index for Liver Fibrosis,lab test,decimal,pmc-7279101-1,Extracted,"A 76-year-old male presented to the emergency department with recurrent painless bleeding from his ileal conduit site. This was his fifth visit to the hospital with similar complaints. He had a history of muscle invasive bladder cancer with peri-vesical tissue involvement, for which he underwent radical cystoprostatectomy with ileal conduit urinary diversion 7 years prior to presentation, after which he was lost to follow up. He did not take chemotherapy or radiation. He also had a history of Stage III chronic kidney disease, alcohol use of approximately 2–3 cans of beer daily for the last 40 years, and a history of medication non-compliance and non-compliance with follow-up appointments. He denied any history of nausea, vomiting, abdominal pain, back pain, blood in stools, hematemesis, or any other site of bleeding. He gave a history of fatigue, dizziness, and on and off painless bleeding from his ileal conduit site for over a year. At presentation, his heart rate was 103 beats/min, blood pressure was 126/60 mmHg, and respiratory rate was 18/min, saturating at 91% on room air. His examination was unremarkable except for gross bleed in his urostomy bag with blood clots. [His investigations revealed a hemoglobin of 3.8 g/dL (13.5–17.5), white blood cell count of 6.1 K/μL (4–11 K/μL), platelet count 114 K/μL (140–400), International Normalised ratio (INR) 1.38 (0.85–1.12), prothrombin time 17.6 s (12.1–15.0), total bilirubin 0.7 mg/dL (0–1.3), aspartate aminotransferase 40 U/L (14–59), alanine aminotransferase 36 U/L (11–66), and alkaline phosphatase 69 (38–126 U/L).] The patient's creatinine was elevated at presentation at 2.78 mg/dL (0.50–1.30), from his baseline creatinine of 1.32 mg/dL (estimated glomerular filtration rate = 56 ml/min/1.73 m2). After volume resuscitation, his creatinine improved to 1.4 mg/dL. He was transfused with packed red blood cells (PRBC's). His noncontrast computed tomography (CT) of the abdomen and pelvis showed subtle nodularity of liver contour and mild splenomegaly (14.1 cm in length). Flexible cystourethroscopy through ileal conduit showed a small area of hemorrhage in the anterior portion of the conduit just deep to the abdominal wall fascia. The hemorrhagic site was fulgurated without evidence of other bleeding sites. On further examination, purple discoloration of the ileal stomal site was noticed []. Given his recurrent episodes of bleeding from the stomal site, purplish discoloration of the skin around the stoma, and liver nodularity, there was a high degree of suspicion of underlying liver cirrhosis with portal hypertension and extrahepatic peristomal varices. He underwent CT abdomen and pelvis with contrast, which showed heterogeneous density and enhancement of the liver, nodularity of the liver edge, and parastomal varices with mild ascites []. He was treated conservatively with octreotide for variceal bleeding. During the evaluation of his liver cirrhosis, his hepatitis C antibody was reactive, and his hepatitis C RNA load was 121012 IU/mL. Evaluation for hepatitis B was negative; abdominal Doppler did not show any portal venous thrombosis. His model for end-stage liver disease score at the time of TIPS procedure was 16 points, 6% estimated 3-month mortality. He successfully underwent TIPS with portosystemic pressure gradient reduction from 10 to 4 mmHg in addition to the coil embolization of ileal conduit varices by an interventional radiologist. The patient was advised to follow up with hepatology and gastroenterology for further evaluation for cirrhosis and treatment of his hepatitis C infection, respectively, and with endoscopy for evaluation of esophageal varices. He was seen in the hepatology clinic at 5 months; at which time he did not have any new episode of bleeding He was lost to follow-up after that appointment.",What is the patient's score of the Fibrosis 4 Index? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [76, 'years'], 'Alanine aminotransferase': [36.0, 'U/L'], 'Aspartate aminotransferase': [40.0, 'U/L'], 'Platelet count': [114000.0, 'µL']}",4.44444,4.22222,4.66666,"The formula for computing Fibrosis-4 is Fib-4 = (Age * AST) / (Platelet count (in billions) * √ALT), where platelet count is the number of billions per L, and the units for AST and ALT are both U/L.
The patient's concentration of AST is 40.0 U/L.
The patient's concentration of ALT is 36.0 U/L.
The patient's concentration of platelets is 114000.0 count/µL. To convert 114000.0 count/µL of platelets to L, multiply by the conversion factor 1000000.0 µL/L which will give 114000.0 platelets count/µL * 1000000.0 µL/L = 114000000000.0 platelets count/L. This means that there are 114000000000.0/(10^9) = 114.0 billion platelet counts per liter.
Plugging these values into the formula, we get (76 * 40.0)/(114.0 * sqrt(36.0)) = 4.44444.Hence, the Fibrosis-4 score is 4.44444."
290,19,Fibrosis-4 (FIB-4) Index for Liver Fibrosis,lab test,decimal,pmc-5066381-2,Extracted,"A 60-year-old man diagnosed with CHC was referred to the outpatient clinic for antiviral therapy in January 13, 2004. Initial laboratory data were as follows: WBC of 6,200/μL, hemoglobin of 16.0 g/dL, platelet count of 106,300/μL, creatinine of 0.9 mg/dL, AST level of 182 IU/L, ALT level of 238 IU/L, total bilirubin level of 1.1 mg/dL, albumin level of 4.2 g/dL, and prothrombin time of 1.07 INR. The HBsAg and anti-HBs were negative, but anti-HCV was positive. The level of HCV RNA was 2.26×105 copies/ml and HCV genotype was 2a.
Esophagogastroduodenoscopy revealed presence of F1 esophageal varices on the lower esophagus and portal hypertensive gastropathy (). Abdominal ultrasonography showed coarse echogenicity of the liver parenchyma and mild splenomegaly (long axis of spleen, 10.2 cm) []. He was treated with interferon alpha and ribavirin combination for 24 weeks and achieved SVR. During follow up, esophageal varices decreased in size () and completely regressed after 8 years of SVR (). The spleen size decreased to 8.9 cm and platelet counts increased to 256,000/μL after 8 years of SVR.",What is the patient's score of the Fibrosis 4 Index? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [60, 'years'], 'Alanine aminotransferase': [238.0, 'U/L'], 'Aspartate aminotransferase': [182.0, 'U/L'], 'Platelet count': [106300.0, 'µL']}",6.65888,6.32594,6.99182,"The formula for computing Fibrosis-4 is Fib-4 = (Age * AST) / (Platelet count (in billions) * √ALT), where platelet count is the number of billions per L, and the units for AST and ALT are both U/L.
The patient's concentration of AST is 182.0 U/L.
The patient's concentration of ALT is 238.0 U/L.
The patient's concentration of platelets is 106300.0 count/µL. To convert 106300.0 count/µL of platelets to L, multiply by the conversion factor 1000000.0 µL/L which will give 106300.0 platelets count/µL * 1000000.0 µL/L = 106300000000.0 platelets count/L. This means that there are 106300000000.0/(10^9) = 106.3 billion platelet counts per liter.
Plugging these values into the formula, we get (60 * 182.0)/(106.3 * sqrt(238.0)) = 6.65888.Hence, the Fibrosis-4 score is 6.65888."
291,19,Fibrosis-4 (FIB-4) Index for Liver Fibrosis,lab test,decimal,pmc-8383533-4,Extracted,"A 51-year-old female with a history of primary myelofibrosis and dilated cardiomyopathy presented at the emergency room with acute abdominal pain. She was afebrile and hemodynamically stable. No signs of hepatic encephalopathy were present. Laboratory study at first evaluation revealed leucocytes of 25,570/µL, hemoglobin of 13.9 g/dL , platelets of 324,000/µL, sCr of 2.45 mg/dL, AST of 126 U/L, ALT of 131 U/L, ALP of 413 U/L, GGT of 220 U/L, TB of 11.5 mg/dL (DB of 9.67 mg/dL), albumin of 2.7 mg/dL, INR of 1.95 and configuring CP C score of 11 points and MELD and MELD-Na score of 31 and 33 points, respectively. Abdominal Doppler-US showed thrombus in all the three supra-hepatic veins and ascites, confirmed by CT scan. Spontaneous bacterial peritonitis was excluded. The patient was diagnosed with an ALI related to BCS secondary to primary myelofibrosis and she was started on Aco therapy with NFH along with an antiplatelet agent and cytoreductive therapy with hydroxyurea. At day 7, the patient developed ALF with grade 3 West-Haven encephalopathy. CP C score at that time was 13 points. Transjugular intra-hepatic portosystemic shunting (TIPS) was contraindicated due to cardiac failure, the presence of relevant encephalopathy and high MELD score (MELD 34/MELD-Na 35, under NFH). LT was considered as a high-risk surgery and contraindicated after multidisciplinary discussion. The patient died due to liver failure 2 days after beginning palliative care.",What is the patient's score of the Fibrosis 4 Index? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [51, 'years'], 'Alanine aminotransferase': [131.0, 'U/L'], 'Aspartate aminotransferase': [126.0, 'U/L'], 'Platelet count': [324000.0, 'µL']}",1.73285,1.64621,1.81949,"The formula for computing Fibrosis-4 is Fib-4 = (Age * AST) / (Platelet count (in billions) * √ALT), where platelet count is the number of billions per L, and the units for AST and ALT are both U/L.
The patient's concentration of AST is 126.0 U/L.
The patient's concentration of ALT is 131.0 U/L.
The patient's concentration of platelets is 324000.0 count/µL. To convert 324000.0 count/µL of platelets to L, multiply by the conversion factor 1000000.0 µL/L which will give 324000.0 platelets count/µL * 1000000.0 µL/L = 324000000000.0 platelets count/L. This means that there are 324000000000.0/(10^9) = 324.0 billion platelet counts per liter.
Plugging these values into the formula, we get (51 * 126.0)/(324.0 * sqrt(131.0)) = 1.73285.Hence, the Fibrosis-4 score is 1.73285."
292,19,Fibrosis-4 (FIB-4) Index for Liver Fibrosis,lab test,decimal,pmc-6940333-1,Extracted,"A 62-year-old man was admitted due to reduced appetite and abdominal distension, which he had reportedly been experiencing for the last month.
The patient had been followed up regularly since undergoing a liver transplant 15 years prior due to fulminant hepatic failure associated with hepatitis B, and he had been taking tacrolimus 2 mg regularly since that transplant. He had been taking linagliptin and metformin for the past 10 years due to diabetes mellitus. Abdominopelvic computed tomography (CT) had been conducted 6 months prior to the current presentation as part of a periodic check-up, and it had not depicted any abnormal findings. He had developed abdominal discomfort 1 month prior to the current admission, and 2 weeks after its initial onset he developed abdominal distension that was so severe that he could not eat. He then visited the hospital for testing.
There was no tenderness upon abdominal palpation but distension was severe, with fluid wave and shifting dullness indicating ascites.
Complete blood count results were as follows, with normal ranges in parentheses: white blood cells 2.1 × 103/μL (4.0–10.0 103/μL), hemoglobin 13.8 g/dL (12–16 g/dL), platelets 318 × 103/μL (150–400 103/μL). Blood biochemistry results were total bilirubin 0.6 mg/dL (0.2–1.1 mg/dL), aspartate aminotransferase 21 U/L (5–40 U/L), alanine aminotransferase 9 U/L (5–40 U/L), albumin 3.7 g/dL (3.5–5.2 g/dL), blood urea nitrogen 14.4 mg/dL (8.0–20.0 mg/dL), creatinine 0.9 mg/dL (0.5–1.3 mg/dL), C-reactive protein 10.8 mg/dL (0.0–0.5 mg/dL). Among the tumor markers tested for, carcinoembryonic antigen was normal (1.3 ng/mL; normal range 0.0–5.0 ng/mL) but lactate dehydrogenase was elevated (746 U/L; normal range 200–450 U/L).
Abdominopelvic CT depicted diffuse peritoneal thickening, omental masses and nodules, and ascites with omental fat infiltration, but no mass-like lesions or bowel obstruction were evident in the gastrointestinal tract (Figure ). A primary peritoneal disease such as tuberculous peritonitis or malignant mesothelioma was suspected. Positron emission tomography (PET)-CT was performed, and it did not depict abnormal hypermetabolism in solid organs, lymph nodes, or digestive organs but it did reveal diffuse hypermetabolism in the peritoneum and omentum (Figure ).",What is the patient's score of the Fibrosis 4 Index? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [62, 'years'], 'Alanine aminotransferase': [9.0, 'U/L'], 'Aspartate aminotransferase': [21.0, 'U/L'], 'Platelet count': [318000.0, 'µL']}",1.36478,1.29654,1.43302,"The formula for computing Fibrosis-4 is Fib-4 = (Age * AST) / (Platelet count (in billions) * √ALT), where platelet count is the number of billions per L, and the units for AST and ALT are both U/L.
The patient's concentration of AST is 21.0 U/L.
The patient's concentration of ALT is 9.0 U/L.
The patient's concentration of platelets is 318000.0 count/µL. To convert 318000.0 count/µL of platelets to L, multiply by the conversion factor 1000000.0 µL/L which will give 318000.0 platelets count/µL * 1000000.0 µL/L = 318000000000.0 platelets count/L. This means that there are 318000000000.0/(10^9) = 318.0 billion platelet counts per liter.
Plugging these values into the formula, we get (62 * 21.0)/(318.0 * sqrt(9.0)) = 1.36478.Hence, the Fibrosis-4 score is 1.36478."
293,19,Fibrosis-4 (FIB-4) Index for Liver Fibrosis,lab test,decimal,pmc-3326999-1,Extracted,"A 73-year-old man was admitted to our hospital for evaluation of severe back pain and right leg pain for 1 month. The medical history of patient revealed that he was diagnosed as a hepatitis B virus (HBV) carrier about 20 years earlier, but was lost to follow up. The patient was not a heavy drinker or smoker. There was no significant family history. On physical examination, a palpable and hard mass was noted in the right pelvic area. Hepatomegaly, liver masses, and ascites were absent. Initial laboratory findings were as follows: white blood cell count 4,830/µL, hemoglobin 15.2 g/dL, platelets 138,000/µL, total protein 7.8 g/dL, albumin 4.4 g/dL, aspartate aminotransferase (AST) 31 IU/L, alanine aminotransferase (ALT) 35 IU/L, total bilirubin 1.0 mg/dL, alkaline phosphate 98 IU/L, prothrombin time 14 second (INR 1.21), alpha-fetoprotein (AFP) 15.01 ng/mL, and protein induced by vitamin K absence or antagonist-II (PIVKA-II) 864 mAU/mL. Hepatitis B virus surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) were positive. Hepatitis B e antibody (HBeAb), HBV-DNA with polymerase chain reaction, and serological markers of hepatitis C were negative. He belonged to Child-Turcotte-Pugh class A.
For evaluation of the pelvic mass, computed tomography (CT) and magnetic resonance imaging (MRI) scans were performed. They demonstrated a 13×10 cm expansile mass that involved the right iliac bone (). The patient underwent an incisional biopsy with the impression of a malignant bone tumor. However, on pathological examination, the tumor was composed of polygonal cells with ample cytoplasm and trabecular pattern. In immunohistochemical stains, these tumor cells were positive for cytokeratin (AE1/AE3), hepatocyte paraffin 1 (HepPar1), and glypican-3, which confirmed the diagnosis of HCC (). Tumor cells were negative for CD56, chromogranin A and synaptophysin, which are the markers of neuroendocrine differentiation. To find the primary focus, abdominal CT, MRI, positron emission tomography (PET) scans and angiography were performed. However, no tumor was found in the liver in these radiologic examinations.
We diagnosed this case as an isolated metastatic HCC of the pelvic bone without the presence of a primary cancer in the liver. Surgical resection of the tumor was recommended, but the patient refused an operation because of old age and the large size of the tumor. Instead, we decided to treat him with combined modalities. He started radiotherapy in the pelvic area with a total dose of 5,100 cGy in 17 fractions. One week after the end of radiotherapy, transarterial chemoembolization (TACE) was performed in the metastatic HCC of the pelvic bone via the right internal iliac artery (adriamycin 50 mg and 20 mL of lipiodol). Then, the patient was treated with five cycles of systemic chemotherapy based on 5-Fluorouracil (5-FU, 1,000 mg/m2 on days 1, 2, and 3) and cisplatin (90 mg/m2 on day 2 every 4 weeks). After the completion of chemotherapy, the tumor became almost necrotic. The AFP and PIVKA-II levels decreased to the normal ranges (2.85 ng/mL and 28 mAU/mL, respectively). As the treatment resulted in near complete regression of the tumor, the patient underwent close follow-up without chemotherapy. However, 12 months after chemotherapy, a CT scan revealed multiple lung metastases in both lungs with increasing AFP and PIVKA-II levels (182 ng/mL and 38 mAU/mL, respectively). He was treated with two cycles of systemic chemotherapy with the same regimen (5-FU 1000 mg/m2 on days 1, 2 and 3 and cisplatin 90 mg/m2 on day 2). After two cycles of chemotherapy, the patient refused additional chemotherapy and we provided him with supportive care thereafter. Even though the lung metastases were newly developed, primary HCC had not been detected in the sequential radiological examinations, including abdominal CT and PET CT scans.",What is the patient's score of the Fibrosis 4 Index? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [73, 'years'], 'Aspartate aminotransferase': [31.0, 'U/L'], 'Alanine aminotransferase': [35.0, 'U/L'], 'Platelet count': [138000.0, 'µL']}",2.77186,2.63327,2.91045,"The formula for computing Fibrosis-4 is Fib-4 = (Age * AST) / (Platelet count (in billions) * √ALT), where platelet count is the number of billions per L, and the units for AST and ALT are both U/L.
The patient's concentration of AST is 31.0 U/L.
The patient's concentration of ALT is 35.0 U/L.
The patient's concentration of platelets is 138000.0 count/µL. To convert 138000.0 count/µL of platelets to L, multiply by the conversion factor 1000000.0 µL/L which will give 138000.0 platelets count/µL * 1000000.0 µL/L = 138000000000.0 platelets count/L. This means that there are 138000000000.0/(10^9) = 138.0 billion platelet counts per liter.
Plugging these values into the formula, we get (73 * 31.0)/(138.0 * sqrt(35.0)) = 2.77186.Hence, the Fibrosis-4 score is 2.77186."
294,19,Fibrosis-4 (FIB-4) Index for Liver Fibrosis,lab test,decimal,pmc-3236148-1,Extracted,"A 64-year-old man with a history of hypertension, chronic kidney disease, and liver failure secondary to hepatitis C, with status post liver transplant 13 years priorly, was brought in by ambulance to the emergency department for acutely altered mental status. The patient had been in his usual state of health, until he told his family 3 hours before that he “felt sick.” The family incidentally found him on the floor, confused and lethargic, and immediately called the ambulance.
Upon arrival, the patient had a temperature of 96.4°F; pulse, 117 beats per minute; blood pressure, 151/93 mmHg; respiratory rate, 22 breaths per minute; and oxygen saturation of 100% on nonrebreather. The patient was known to have a history of recurrent episodes of hepatic encephalopathy, and his last episode of hepatic encephalopathy was in the prior 3 months, which was treated and controlled with lactulose. The patient's family stated that the patient had run out of lactulose 4 days before presentation. Other than lactulose, the patient was compliant with all of his home medications, including amlodipine, buproprion, cyclosporine, hydrocodone, lasix, methocarbamol, and ramipril. The patient had no known history of seizure, recent illness, brain trauma, or recent surgical procedures.
Physical examination showed a male in no acute distress with a Glasgow Coma Scale of 12 (eyes, 4; verbal, 3; motor, 5). There were no signs of trauma found on his body. His pupils were equally round and reactive to light, and his neck was supple and soft with a cervical collar in place. Cardiopulmonary examination was unremarkable except for tachycardia. Abdominal examination was unremarkable. Because he was not following commands, the neurologic examination was limited. However, the patient was able to move all extremities equally and pulses were distally equal to all extremities. There was no posturing or clonus noted, and Babinski was downgoing in both feet.
Fingerstick glucose level was 210 mg/dL and bedside hemoglobin level was 13.1 g/dL. Noncontrast head and cervical spine computed tomography revealed no acute pathologic lesion. Chest radiography also showed no acute pathologic lesion. Laboratory tests showed white blood cell counts of 5.5 K/mm3 with 60% neutrophils, hematocrit of 36.5%, and platelets of 115 K/mm3. Electrolyte and liver function results were as follows: sodium, 141 mmol/L; potassium, 3.5 mmol/L; chloride, 104 mmol/L; bicarbonate, 22 mmol/L; calcium, 9.3 mg/dL; blood urea nitrogen, 71 mmol/L; creatinine, 1.9 mg/dL; total bilirubin, 2.1 mg/dL; aspartate aminotransferase, 128 U/L; alanine aminotransferase, 124 U/L; alkaline phosphatase, 231 U/L; albumin, 4.0 g/dL; lipase, 30 U/L; prothrombin time, 14.5 seconds; INR, 1.09; and ammonia, 501 μmol/L (reference range, 15–55 μmol/L). Toxicology serum screen results were negative for acetaminophen, salicylate, and ethanol. Urine toxicology screen results were positive only for opiates. Venous blood gas was pH 7.44.
Owing to the patient's obtunded condition and inability to protect his airway, the patient was electively intubated and given midazolam drip for sedation. The patient was admitted to the intensive care unit (ICU) for monitoring with a presumed diagnosis of hepatic encephalopathy. While administration of empiric antibiotics was started in the emergency department, it was discontinued after an infectious etiology was deemed unlikely and culture results were negative. Results of a magnetic resonance imaging brain scan were also negative, including no evidence of infarct.
During the ICU stay, the patient was readministered lactulose, and ammonia levels decreased to117 μmol/L by hospital day 2 and to 78 μmol/L by hospital day 4. Despite discontinuation of sedation, the patient remained unresponsive. A neurologist was consulted and a bedside electroencephalogram (EEG) revealed findings consistent with status epilepticus. However, the patient had no clinical manifestations of status epilepticus, leading to a diagnosis of nonconvulsive status epilepticus. A phenytoin load was immediately administered, while a midazolam infusion was restarted, ultimately leading to EEG resolution of the status epilepticus. The patient did not immediately improve neurologically during the hospitalization stay and was ultimately transferred to another facility for continued treatment and rehabilitation.",What is the patient's score of the Fibrosis 4 Index? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [64, 'years'], 'Alanine aminotransferase': [124.0, 'U/L'], 'Aspartate aminotransferase': [128.0, 'U/L'], 'Platelet count': [115000.0, 'mm^3']}",6.39707,6.07722,6.71692,"The formula for computing Fibrosis-4 is Fib-4 = (Age * AST) / (Platelet count (in billions) * √ALT), where platelet count is the number of billions per L, and the units for AST and ALT are both U/L.
The patient's concentration of AST is 128.0 U/L.
The patient's concentration of ALT is 124.0 U/L.
The patient's concentration of platelets is 115000.0 count/mm^3. To convert 115000.0 count/mm^3 of platelets to L, multiply by the conversion factor 1000000.0 mm^3/L which will give 115000.0 platelets count/mm^3 * 1000000.0 mm^3/L = 115000000000.0 platelets count/L. This means that there are 115000000000.0/(10^9) = 115.0 billion platelet counts per liter.
Plugging these values into the formula, we get (64 * 128.0)/(115.0 * sqrt(124.0)) = 6.39707.Hence, the Fibrosis-4 score is 6.39707."
295,19,Fibrosis-4 (FIB-4) Index for Liver Fibrosis,lab test,decimal,pmc-8383518-1,Extracted,"A 39-year-old Caucasian gentleman with a past medical history of alcohol abuse, anemia, gastroesophageal reflux disease (GERD), cirrhosis, hematemesis with nausea, and clotting disorder presented to the emergency department with complaints of sudden onset of severe abdominal pain. The patient has a history of decompensated hepatic cirrhosis that started 1 year ago complicated by ascites and a large umbilical hernia. The patient has had multiple paracentesis and had several episodes of spontaneous bacterial peritonitis. His medication list included tramadol and propranolol. Upon admission to the emergency department, he was found to be severely malnourished with significant loss of muscle mass, abdominal distention, and the presence of a large, tender, compressible umbilical hernia. Physical exam showed flank dullness, a fluid wave, and shifting dullness. Vital signs were normal, and he did not show signs of asterixis, hepatic encephalopathy, edema, or fluid overload elsewhere. His white blood cell (WBC) count was high at 10,270/µL and hemoglobin of 10.7 g/dL, hematocrit of 32.6%, and a platelet count of 130,000/µL. Further testing showed hyponatremia at 133 mmol/L and a total bilirubin of 1.9 mg/dL. Liver function test revealed an albumin of 2.9 g/dL, alkaline phosphatase of 149 IU/L, aspartate aminotransferase (AST) of 64 U/L and alanine aminotransferase (ALT) of 36 U/L. X-ray confirmed large-volume ascites and the presence of a ventral hernia. Abdominal ultrasound showed cirrhotic liver morphology with large-volume ascites and splenomegaly. Ascitic fluid was yellow, and analysis showed WBC count of 70/µL, but was otherwise unremarkable. After being admitted to the hospital, patient was given furosemide 40 mg tablet daily and spironolactone 100 mg tablet daily. The patient was admitted to the hospital for further management. Surgical consultation was sought, and since the patient was a very high-risk surgical candidate with loss of muscle mass, surgical intervention was not planned. The patient chose supportive care and prophylactic antibiotics based on infectious disease recommendations. An ostomy pouch was placed over the hernia to prevent bacterial contamination and peritonitis as well as to collect the ascitic fluid. The patient’s severe abdominal pain subsided and was discharged to follow up with his primary care physician.
Three months after the patient was discharged, he came back to the hospital with worsening symptoms because he could not afford the ostomy pouches. He was not compliant with his follow-ups. His umbilical hernia appeared to have worsened, and ascitic fluid was leaking out from multiple areas on his hernia, and there were also multiple areas of skin necrosis. Since the patient was deemed a high-risk surgical candidate, he was, again, not cleared for surgery. The patient opted for conservative care and prophylactic antibiotics according to infectious disease suggestions. After symptoms improved, he was instructed on being more compliant and then subsequently discharged.",What is the patient's score of the Fibrosis 4 Index? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [39, 'years'], 'Aspartate aminotransferase': [64.0, 'U/L'], 'Alanine aminotransferase': [36.0, 'U/L'], 'Platelet count': [130000.0, 'µL']}",3.2,3.04,3.36,"The formula for computing Fibrosis-4 is Fib-4 = (Age * AST) / (Platelet count (in billions) * √ALT), where platelet count is the number of billions per L, and the units for AST and ALT are both U/L.
The patient's concentration of AST is 64.0 U/L.
The patient's concentration of ALT is 36.0 U/L.
The patient's concentration of platelets is 130000.0 count/µL. To convert 130000.0 count/µL of platelets to L, multiply by the conversion factor 1000000.0 µL/L which will give 130000.0 platelets count/µL * 1000000.0 µL/L = 130000000000.0 platelets count/L. This means that there are 130000000000.0/(10^9) = 130.0 billion platelet counts per liter.
Plugging these values into the formula, we get (39 * 64.0)/(130.0 * sqrt(36.0)) = 3.2.Hence, the Fibrosis-4 score is 3.2."
296,19,Fibrosis-4 (FIB-4) Index for Liver Fibrosis,lab test,decimal,pmc-8212850-1,Extracted,"A 33-year-old woman with homozygous sickle cell disease complicated by multiple admissions for painful crises and autosplenectomy presented with a two-week history of nausea and vomiting. She also has a history of significant alcohol abuse and recently increased her alcohol intake to approximately 6-8 ounces of vodka daily. She began to have nausea and vomiting along with her more typical sickle cell crisis pain and was found to have profound anemia and hyperbilirubinemia.
​Physical examination revealed severe jaundice, hepatomegaly and mild encephalopathy. Pertinent laboratory findings included white blood cell count 33.6 K/mm3, hemoglobin 6.2 g/dL, platelets 275 K/mm3, pre-exchange hemoglobin S 72.1%, total bilirubin 52.9 mg/dL, direct bilirubin 33.3 mg/dL, alkaline phosphatase 231 units/L, aspartate transaminase (AST) 113 units/L, alanine transaminase (ALT) 32 units/L, haptoglobin <10 mg/dL. Further tests revealed nonreactive HIV antigen and antibody, negative hepatitis serology, negative autoimmune panel, iron level 188 mcg/dL, total iron-binding capacity (TIBC) 233 μg/dL, ferritin 9,636.6 ng/mL, and zinc 41 μg/dL (normal low 56 μg/dL). Ultrasound of the right-upper quadrant (RUQ) revealed hepatic steatosis (Figure ) and a patent portal vein. CT abdomen (Figure ) and abdominal MRI findings were consistent with hepatomegaly and iron overload with liver involvement but not cardiac. Her pain did not diminish during the first week of her admission, and she was complaining of increasing RUQ pain and tenderness on her physical examination.
​Treatment included red cell exchange leading to a post-exchange hemoglobin S of 15%, folic acid, hydroxyurea and opioids to manage the acute sickle cell crisis. A liver biopsy was deferred given the patient’s severe coagulopathy (INR 2.6). She was safely discharged from hospital in stable condition and with a reduction of her total bilirubin to 33 mg/dL. Prior to discharge, the patient was referred for alcohol counselling and education. Monthly red cell exchange, iron chelation therapy, and close monitoring of liver disease were planned upon discharge. A year later, in follow-up the patient was found to have tolerated red cell exchanges and iron chelation without any complications or emergent hospitalizations.",What is the patient's score of the Fibrosis 4 Index? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [33, 'years'], 'Alanine aminotransferase': [32.0, 'U/L'], 'Aspartate aminotransferase': [113.0, 'U/L'], 'Platelet count': [275000.0, 'µL']}",2.39709,2.27724,2.51694,"The formula for computing Fibrosis-4 is Fib-4 = (Age * AST) / (Platelet count (in billions) * √ALT), where platelet count is the number of billions per L, and the units for AST and ALT are both U/L.
The patient's concentration of AST is 113.0 U/L.
The patient's concentration of ALT is 32.0 U/L.
The patient's concentration of platelets is 275000.0 count/µL. To convert 275000.0 count/µL of platelets to L, multiply by the conversion factor 1000000.0 µL/L which will give 275000.0 platelets count/µL * 1000000.0 µL/L = 275000000000.0 platelets count/L. This means that there are 275000000000.0/(10^9) = 275.0 billion platelet counts per liter.
Plugging these values into the formula, we get (33 * 113.0)/(275.0 * sqrt(32.0)) = 2.39709.Hence, the Fibrosis-4 score is 2.39709."
297,19,Fibrosis-4 (FIB-4) Index for Liver Fibrosis,lab test,decimal,pmc-5842090-1,Extracted,"The patient's information released was permitted after discussion by the hospital ethics committee.
A 66-year-old woman with recurrent intermittent upper quadrant abdominal pain visited our hospital for further evaluation and treatment. Physical examination and initial vital signs were as follows: body temperature, 37.0℃; pulse rate, 66 beats/min; respiratory rate, 18 breaths/min; and blood pressure, 140/90 mmHg. Her height and body weight were 158 cm and 66 kg. She had a 10-year history of hypertension with good blood pressure control from oral Valsartan (40 mg/day). Her familial history was unremarkable. Laboratory examinations showed a low white blood cell count of 3,920/µL, a hemoglobin level of 11.8 g/L, and a platelet count of 124,000/µL. The liver function test results were as follows: serum aspartate transaminase: 14 U/L; alanine transaminase: 19 U/L; alkaline phosphatase: 88 IU/L; gamma-glutamyl transferase: 16 U/L; total bilirubin: 4.05 µmol/L; albumin, 35.7 g/L; and international normalized ratio: 0.93. CA 19-9 and α-FP were assayed for a malignancy workup, with results of 16.35 U/mL and 2.61 ng/mL, respectively. The results for viral markers including HBV surface antigen and anti-HCV were negative. Abdominal CT revealed an atrophic left lobar and dilated bile duct with the middle hepatic vein close to the cystic lesion (). Abdominal MRCP revealed irregular intrahepatic bile duct dilatation (IHBDD) of the left lobe with the left hepatic duct obstructed, while the common bile duct and right intrahepatic bile duct were normal (). However, we found that the irregular cystic dilatation of the bile duct was limited to the left liver and contained stones inside the cysts. No obvious abnormal dilated bile duct was found in the right liver. The common bile duct and the hepatic duct were normal, and no obvious dilatation was found. This patient was diagnosed with Caroli disease (type V). The surgical indication for the patient was explicit. However, the treatment prescription required consideration of the cystic wall being adjacent to the middle hepatic vein, the left hepatic atrophy and structure disorder, and the observation that the left hepatic vein was not visible. Although complete resection of the cysts may be a curative treatment for unilobar Caroli disease, this treatment was impossible for this patient due to the close adherence of the middle hepatic vein to the cystic wall. Therefore, we decided to perform laparoscopic left LR for the patient, while preserving a partial cystic wall close to the middle hepatic vein.
The standard laparoscopic equipment used to perform laparoscopic hepatectomy included a 30° 5-mm laparoscope, a hook dissector, 5-mm laparoscopic forceps, a 5-mm atraumatic grasper, a 10-mm GIA (Johnson & Johnson Medical, Shanghai, China), 5-mm harmonic (Johnson & Johnson Medical) and 10-mm locking pliers.
The conventional fully laparoscopic multiport approach was adopted. The patient was placed in a supine position, and the surgeon stood on the right side. Under general anesthesia, five 5- to 10-mm incisions were made in a “U” configuration. Division of the liver parenchyma was performed with Harmonic or Endo-GIA. Large pedicles were stapled or clipped.
Upon surgical exploration, the left lobe of the liver was found to be atrophied, and the right liver had developed compensatory hyperplasia with a red-brown and smooth surface. However, the left liver lobe was severely adherent. We gradually dissected the adhesion using harmonic pliers and exposed the atrophic left lobe (5 cm × 6 cm × 2 cm). The gallbladder was approximately 7 cm × 4 cm × 2 cm in size and was filled with bile and gallstones. Through intraoperative exploration, we confirmed the diagnosis of Caroli disease, limited to the left lobe of the liver. We obtained a biopsy from the edge of the lesion and performed a rapid intraoperative pathological examination to exclude malignant tumor. We then decided to perform a laparoscopic left liver and gallbladder resection. The difficulty was that the lesion was close to the middle hepatic vein. We opened the cysts and resected most of the lesion while retaining part of cystic wall close to the middle hepatic vein. After laparoscopic left half-liver and gallbladder resection, the liver lesion tissue and gallbladder were removed completely from the abdominal cavity. Histopathologic findings showed congenital dilatation of the intrahepatic bile ducts, confirming the preoperative diagnosis of Caroli disease (). Histopathology of the resected specimen revealed large, cystic dilations of the large intrahepatic bile ducts. This patient was seen regularly every 3 months at the outpatient department. There was no recurrence of abdominal pain, and no complications were discovered after 18 months of follow-up.",What is the patient's score of the Fibrosis 4 Index? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [66, 'years'], 'Alanine aminotransferase': [19.0, 'U/L'], 'Aspartate aminotransferase': [14.0, 'U/L'], 'Platelet count': [124000.0, 'µL']}",1.70952,1.62404,1.795,"The formula for computing Fibrosis-4 is Fib-4 = (Age * AST) / (Platelet count (in billions) * √ALT), where platelet count is the number of billions per L, and the units for AST and ALT are both U/L.
The patient's concentration of AST is 14.0 U/L.
The patient's concentration of ALT is 19.0 U/L.
The patient's concentration of platelets is 124000.0 count/µL. To convert 124000.0 count/µL of platelets to L, multiply by the conversion factor 1000000.0 µL/L which will give 124000.0 platelets count/µL * 1000000.0 µL/L = 124000000000.0 platelets count/L. This means that there are 124000000000.0/(10^9) = 124.0 billion platelet counts per liter.
Plugging these values into the formula, we get (66 * 14.0)/(124.0 * sqrt(19.0)) = 1.70952.Hence, the Fibrosis-4 score is 1.70952."
298,19,Fibrosis-4 (FIB-4) Index for Liver Fibrosis,lab test,decimal,pmc-8309678-1,Extracted,"A 48-year-old male with a history of ulcerative colitis (UC) and PSC presented with frequent and loose stools ever since total proctocolectomy with IPAA 10 years prior. Other symptoms include postprandial pelvic and abdominal pain, nausea, urgency, incontinence, nocturnal seepage, and weight loss of 15 pounds over the past 2 months. He was an active smoker. The patient washed had been diagnosed with having pouchitis and enteritis on pouchoscopy and histology. His past treatment regimen included metronidazole, ciprofloxacin, oral and topical mesalamines, hydrocortisone enemas, and oral prednisone with minimal relief of symptoms. He was on long-term oral budesonide with recurrent symptoms while tapering off the corticosteroid. He underwent multiple pouchoscopies that showed no improvement in mucosal inflammation in the pouch body and afferent limb.
At the time of his initial presentation at our Pouch Center, he reported urgency, bowel frequency 12–15 times per day, loose-to-watery stools, occasional bleeding, incontinence, and nocturnal seepage. The Pouchitis Disease Activity Index (PDAI) symptom subscore was 5. Laboratory evaluation showed white blood cell count 7,600/μL, hemoglobulin 11.3 g/dL, platelet count 110,000/μL, creatinine 0.8 mg/dL, albumin 3.4 g/dL, alkaline phosphatase 320 international unit/L, total bilirubin 0.8 mg/dL, aspartate transaminase 23 international unit/L, and alanine transaminase 14 international unit/L.
Pouchoscopy showed diffuse inflammation of both the pouch body and prepouch afferent limb with granularity, edema, loss of vascularity, and spontaneous bleeding. The PDAI endoscopy subscores of the pouch body and afferent limb were 4 and 2, respectively. The pouch inlet was widely patent. He was started on oral vancomycin 250 mg four times a day for the treatment of pouchitis, enteritis, and PSC. The patient responded with the PDAI symptom subscore reduced to 1. Fatigue also improved. Repeat pouchoscopy after 3 months showed mucosal healing with no active disease in the pouch body and afferent limb with PDAI endoscopy subscores of 0 and 1, respectively. The liver-function test showed that alkaline phosphatase was 120 international unit/L. He has been followed up for 4 years until now and a year later repeat pouchoscopy showed pouchitis and enteritis in remission (). Alkaline phosphatase was 127 international unit/L.",What is the patient's score of the Fibrosis 4 Index? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [48, 'years'], 'Alanine aminotransferase': [14.0, 'U/L'], 'Aspartate aminotransferase': [23.0, 'U/L'], 'Platelet count': [110000.0, 'µL']}",2.68233,2.54821,2.81645,"The formula for computing Fibrosis-4 is Fib-4 = (Age * AST) / (Platelet count (in billions) * √ALT), where platelet count is the number of billions per L, and the units for AST and ALT are both U/L.
The patient's concentration of AST is 23.0 U/L.
The patient's concentration of ALT is 14.0 U/L.
The patient's concentration of platelets is 110000.0 count/µL. To convert 110000.0 count/µL of platelets to L, multiply by the conversion factor 1000000.0 µL/L which will give 110000.0 platelets count/µL * 1000000.0 µL/L = 110000000000.0 platelets count/L. This means that there are 110000000000.0/(10^9) = 110.0 billion platelet counts per liter.
Plugging these values into the formula, we get (48 * 23.0)/(110.0 * sqrt(14.0)) = 2.68233.Hence, the Fibrosis-4 score is 2.68233."
299,19,Fibrosis-4 (FIB-4) Index for Liver Fibrosis,lab test,decimal,pmc-8240763-1,Extracted,"A 49-year-old Hispanic African American female was presented to the emergency department with diffuse pains involving the abdomen, chest, and limbs of one-day duration that resemble the symptoms of her previous pain crises. She was known to have HbSS SCD with chronic anemia and complicated by end-stage renal disease (ESRD) requiring hemodialysis. She is a post-cholecystectomy patient. She did not use tobacco, alcohol, or recreational drugs. Her home medications included metoprolol, mirtazapine, omeprazole, cinacalcet, aspirin, calcitriol, calcium acetate phosphate binder, epoetin alpha injections, folic acid, and multivitamins.
The patient’s review of systems was otherwise negative. On presentation, she had a blood pressure of 143/113 mmHg, a temperature of 36.1 °C, a heart rate of 101 beats per minute, and a SpO2 of 98% on room air. She was in mild distress and her abdomen was soft and diffusely tender. Besides the arteriovenous fistula in her left arm with a palpable thrill, her examination was otherwise unremarkable.
Her lab findings showed a white blood cell (WBC) count of 11.3 k/µL, a hemoglobin (Hb) level of 9.6 g/dL (close to baseline), and a platelet count of 166 k/µL. Her reticulocyte count was 0.21 M/µL at 7.3%. Na+ 137 mm/L, K+ 3.9 mmol/L, 30 mmol/L, Cl− 94 mmol/L, BUN 12 mg/dL, creatinine 2.67 mg/dL, Ca2+ 8.9 mmol/L, Mg2+ 2.1 mg/dL, lactic acid 1.9 mmol/L, albumin 4g/dL with a total protein of 6.9 g/dL, direct/total bilirubin 0.7/2.7 mg/dL, alkaline phosphatase 670 IU/L (variable chronic elevation), alanine transaminase (ALT) 17 IU/L, and aspartate transaminase (AST) 57 IU/L. She was admitted and treated with opiates for pain control. Intravenous (IV) fluids were held given her ESRD awaiting hemodialysis.
On her third day in the hospital, the patient was noted to be lethargic. Her blood glucose was too low to measure on a glucometer. She was given IV dextrose with an incomplete improvement of her mentation. Her blood glucose dropped again overnight with a measured blood glucose of 42 g/dL. She was treated with dextrose and transferred to the medical intensive care unit (ICU) in an obtunded state. She required 2 l/min O2 via nasal cannula to maintain a SpO2>90%. Her examination at that point was remarkable for worsening conjunctival icterus, palpable hepatomegaly, and diffuse abdominal tenderness. Her lab results showed dramatic new derangements with a lactic acid of 12.5 mmol/L, direct/total bilirubin of 15.6/22.5 mg/dL, alkaline phosphatase 496 IU/L, ALT 571 IU/L, and AST 1440 IU/L. Her prothrombin time was 60.9 seconds corresponding with an INR of 5.48. Activated prothrombin time was slightly prolonged at 43 seconds. An ammonia level was measured at 37 umol/L. A random cortisol level was appropriately elevated at 59 µg/dl. A continuous dextrose infusion was initiated. Viral hepatitis serologies were negative. Liver ultrasound with doppler was done showing trace fluid in the gallbladder fossa with increased echogenicity of the hepatic parenchyma with normal hepatic and portal vascular circulation flow (Figures -). The craniocaudal length of the liver was 17 cm.
The patient was hemodynamically stable throughout her course. Empirical broad-spectrum antibiotic coverage was initiated with cultures eventually negative. She had a blood exchange transfusion on her first day in the ICU. Her course over the next days was marked by a progressive, yet significant improvement of her mental status as she became easier to arouse, then was able to answer basic questions and obey command with waxing and waning levels of cognition over 72 hours. Her mentation normalized and she was transferred back to the regular ward. Her labs continued to improve.
Of note, her course was notable for acute thrombocytopenia with a nadir platelet count of 33 k/µL. Given the acuity of the platelet drop, with a concomitant right cephalic vein superficial thrombophlebitis, she was treated for heparin-induced thrombocytopenia with Argatroban for four days which was eventually stopped after the screen for antibodies to the platelet factor 4/heparin complex was negative.
She was discharged feeling well after 12 days in the hospital with plans for outpatient follow-up with hematology and her primary care provider.",What is the patient's score of the Fibrosis 4 Index? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [49, 'years'], 'Alanine aminotransferase': [17.0, 'U/L'], 'Aspartate aminotransferase': [57.0, 'U/L'], 'Platelet count': [166000.0, 'µL']}",4.08073,3.87669,4.28477,"The formula for computing Fibrosis-4 is Fib-4 = (Age * AST) / (Platelet count (in billions) * √ALT), where platelet count is the number of billions per L, and the units for AST and ALT are both U/L.
The patient's concentration of AST is 57.0 U/L.
The patient's concentration of ALT is 17.0 U/L.
The patient's concentration of platelets is 166000.0 count/µL. To convert 166000.0 count/µL of platelets to L, multiply by the conversion factor 1000000.0 µL/L which will give 166000.0 platelets count/µL * 1000000.0 µL/L = 166000000000.0 platelets count/L. This means that there are 166000000000.0/(10^9) = 166.0 billion platelet counts per liter.
Plugging these values into the formula, we get (49 * 57.0)/(166.0 * sqrt(17.0)) = 4.08073.Hence, the Fibrosis-4 score is 4.08073."
300,19,Fibrosis-4 (FIB-4) Index for Liver Fibrosis,lab test,decimal,pmc-8063940-1,Extracted,"A 52-year-old male patient, a chronic smoker and drinker, a welder (exposed to occupational respiratory hazards for about 20 years), presented to the emergency department for severe dyspnea with sudden onset on the previous day, cough and right posterior chest pain, chills, and high fever (39 °C). The patient had a series of comorbidities: hepatic steatosis, chronic alcohol liver disease, hypertensive and ischemic heart disease, and essential hypertension.
Objective examination showed an agitated, tachypneic patient, with congested facies, dry skin and mucosae, harsh vesicular murmur, right basal crepitant rales, with peripheral oxygen saturation 92%, blood pressure 200/160 mmHg, ventricular rate 106 bpm, afebrile at the time of examination.
Chest X-ray evidenced a pulmonary condensation area in the posterior inferior third of the right lung (A,B).
Laboratory tests revealed leukopenia with lymphopenia (white blood cells 1110/μL, lymphocytes 190/μL), thrombocytopenia (127,000/μL), prolonged prothrombin time (PT) (15.6 s), international normalized ratio (INR) 1.15, hepatocytolysis (aspartate aminotransferase 88.8 units/L, alanine aminotransferase 82.8 units/L), total bilirubin 2.88 mg/dL, reduced creatinine clearance (63.8 mL/min), nitrogen retention (creatinine 1.82 mg/dL), inflammatory syndrome (C-reactive protein 450 mg/L), antibodies against HIV-1 and HIV-2 were not detectable, nonreactive anti-SARS CoV-2 antibodies. Combined throat/nasal sampling (with collection device produced by Sanimed International Impex, Bucharest, Romania) was performed for real-time PCR (RT-PCR) SARS CoV-2 (QuantStudio v5 analysis method with TaqPath COVID-19 CE-IVD RT-PCR Kit, The QuantStudioTM Design & Analysis Software, Thermo Fisher Scientific, Pleasanton, CA, USA). The result was negative. Respiratory secretions were not collected for microbiological diagnosis.
The diagnosis of right basal pneumonia, acute respiratory failure, acute chronic liver dysfunction, and acute kidney injury was established. The patient was transferred to the intensive care unit. Anti-inflammatory steroid, antibiotic, antihypertensive, oxygen therapy was initiated. The patient died 17 h after presentation.
The necropsy was performed 12 h after death. Necropsy exam revealed the following: about 1700 mL of serous fluid in the right pleural cavity, with gray deposits, which were also present focally on the surface of the right pleura, and about 500 mL of serous citrine fluid in the left pleural cavity. The middle lower lobe of the right lung had a well-demarcated red-gray area, with small violaceous areas of increased consistency, having a dry, granular cross section surface. The adrenal glands showed bilateral medullary hemorrhage. No signs of autolysis were identified.
Given the persistence of the suspicion of SARS-CoV-2 infection, five lung fragments (0.5/0.3 cm) were collected by cutting with scalpel from the red-gray area, middle lower lobe (with collection device produced by Sanimed International Impex, Bucharest, Romania). RT-PCR testing was performed on these lung fragments and the result was positive. Total RNA isolation was performed with NucleoSpin RNA for tissue (Macherey-Nagel, Dueren, Germany) according to the manufacturer’s instructions. The E gene assay (Envelope gene) was used as the first line screening tool (Ct 23) then followed by confirmatory testing with an RdRp gene assay (Ct 25.3) (RNA-dependent RNA polymerase gene—inside the Orf1ab polyprotein gene) and N gene assay (Ct 26.5) according to the Charite/Berlin protocol [].
For the histopathological examination, we used an Olympus BX40 microscope (Tokyo, Japan) with an Olympus Camedia 4040 photo camera, hematoxylin-eosin (HE) stain (staining kit produced by Laboratorium, Bucharest, Romania), Giemsa stain (staining kit produced by Merck, Darmstadt, Germany), periodic acid–Schiff (PAS) stain (staining kit produced by Merck, Darmstadt, Germany), and Grocott stain (staining kit produced in our own laboratory). For immunohistochemistry, CD3 (Dako, polyclonal rabbit anti-human) and CD45 (Dako, monoclonal mouse antihuman, clone 2B11 + PD7/26) were used. The immunolabeling reaction was carried out by an automated immunostainer (Leica Bond-Max, Melbourne, Victoria, Australia) using a polymer-based detection system (Leica Biosystems, Melbourne, Victoria, Australia) with 3,3′-diaminobenzidin (DAB) as the chromogen.
The histopathological examination of the case evidenced preexisting lesions in various organs, which could be assigned to preexisting morbidities, favoring the severe evolution of COVID-19 infection. The histopathological examination also detected recent lesions occurring in the context of COVID-19 infection.
In the lung tissue, a background of lung fibrosis (A), with emphysematous areas (B) and thickened septa with myofibroblasts (C,D) was seen.
On this fibrosis background, the large and small arterial lung vessels show many thromboses (). The thromboses are accompanied by subpleural hemorrhagic foci (Tardieu spots, resulting from acute hypoxia), as well as by acute pulmonary edema foci in the rare alveoli unoccupied by inflammatory exudate. In the thrombosed vessels, lymphocytes adherent to the endothelium, with a significance of endotheliitis () but with low intensity, can be seen. In the dilated perivascular lymphatics, there is a cell-rich lymph fluid, with a cellularity similar to that of alveolar exudate (A).
Eosinophilic (A) and basophilic microthrombi (B) can also be observed, which represent aspects of disseminated intravascular coagulation (DIC).
The alveolar exudate is rich in foam cells ( and ). Alveolar exudate immunolabeling is positive for the leukocyte common antigen (CD45, a commonly used marker of hematopoietic cells except for erythrocytes and platelets) (A), but negative for CD3 (a common antibody for identifying T cells) (B). Immunolabeling of the innate immune system cells for induced nitric oxide (iNOS) is extremely weak ().
In the alveoli filled with macrophages, cystic forms with multinuclear content were also present (B). These proved to be positive by Giemsa stain (A,B), Grocott-Gomori’s methenamine silver stain (C), and PAS stain (D).
Giemsa stain also evidenced the fact that focally, some alveoli were invaded by a population of filamentous bacteria, in those areas the alveolar exudate having a bronchopneumonic, bacterial superinfection appearance ().
In the pleura, the whitish exudate described macroscopically was a mixture of fibrin and basophilic granular material, rich in round cells with vesicular nuclei. These cells were positive by Giemsa and Grocott staining, supporting the diagnosis of pneumocystosis (). Starting from these pleural images suggestive of Pneumocystis, it was inferred that the foamy alveolar material phagocyted by the activated macrophages was probably identical to this basophilic granular material, and the cystic forms described in were Pneumocystis cystic forms.
The myocardial muscle fibers are hypertrophied and fragmented, and in the medium intramyocardial venous vessels, rare microthrombi are present (A). In the liver, alcoholic steatosis is seen. In the medium and large branches of the suprahepatic veins, there is inflammatory infiltrate which allows the diagnosis of phlebitis (B). The kidney presents diffuse tubular necrosis (shock kidney) (C), and in the adrenal glands, massive medullary hemorrhage can be observed (D). The kidneys (mainly located within the interstitium) and liver (portal spaces and sinusoids) are CD45 positive.",What is the patient's score of the Fibrosis 4 Index? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [52, 'years'], 'Aspartate aminotransferase': [88.8, 'U/L'], 'Alanine aminotransferase': [82.8, 'U/L'], 'Platelet count': [127000.0, 'µL']}",3.99574,3.79595,4.19553,"The formula for computing Fibrosis-4 is Fib-4 = (Age * AST) / (Platelet count (in billions) * √ALT), where platelet count is the number of billions per L, and the units for AST and ALT are both U/L.
The patient's concentration of AST is 88.8 U/L.
The patient's concentration of ALT is 82.8 U/L.
The patient's concentration of platelets is 127000.0 count/µL. To convert 127000.0 count/µL of platelets to L, multiply by the conversion factor 1000000.0 µL/L which will give 127000.0 platelets count/µL * 1000000.0 µL/L = 127000000000.0 platelets count/L. This means that there are 127000000000.0/(10^9) = 127.0 billion platelet counts per liter.
Plugging these values into the formula, we get (52 * 88.8)/(127.0 * sqrt(82.8)) = 3.99574.Hence, the Fibrosis-4 score is 3.99574."
301,20,Centor Score (Modified/McIsaac) for Strep Pharyngitis,severity,integer,usmle-12605,Extracted,"A 15-year-old female presents to your office for evaluation of a painful neck mass. The family reports the patient has had a midline neck mass for many years, but had become painful over the past week with erythema at the overlying skin. The patient denies subjective fevers at home. The patient has an otherwise unremarkable past medical history. Her temperature is 100.1 deg F (37.8 deg C), blood pressure is 110/70 mmHg, pulse is 90/min, and respirations are 15/min. Clinical exam is seen in Figure A. The mass is noted to rise with deglutition and tongue protrusion.",What is the patient's Centor Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [15, 'years'], 'Temperature': [100.1, 'degrees fahreneheit'], 'Tender/swollen anterior cervical lymph nodes': False}",1,1,1,"The criteria listed in the Centor Score formula are listed below:

1. Age: 3-14 years = +1 point, 15-44 years = 0 points, ≥45 years = -1 point
2. Exudate or swelling on tonsils: No = 0 points, Yes = +1 point
3. Tender/swollen anterior cervical lymph nodes: No = 0 points, Yes = +1 point
4. Temperature >38°C (100.4°F): No = 0 points, Yes = +1 point
5. Cough: Cough present = 0 points, Cough absent = +1 point

The Centor score is calculated by summing the points for each criterion.
    
The current Centor score is 0.
The patient is 15 years old. Because the age is in between 15 and 44 years, the score does not change, keeping the score at 0.
The patient's temperature is 100.1 degrees fahrenheit. To convert to degrees celsius, apply the formula 5/9 * [temperature (degrees fahrenheit) - 32]. This means that the patient's temperature is 5/9 * 68.1 = 37.83333 degrees celsius. The patient's temperature is less than or equal to 38 degrees Celsius, and so we do not make any changes to the score, keeping the score at 0.
The patient note does not mention details about the patient coughing and so we assume it to be absent. Hence, we add 1 point to the score, making the current score 0 + 1 = 1.
The patient note reports 'tender/swollen anterior cervical lymph nodes' as absent for the patient. Hence, we do not change the score, keeping the current score at 1.
The patient note does not mention details about 'exudate or swelling on tonsils' and so we assume it to be absent. Hence, we do not change the score, keeping the current score at 1.
Hence, the Centor score for the patient is 1."
302,20,Centor Score (Modified/McIsaac) for Strep Pharyngitis,severity,integer,pmc-4681016-1,Extracted,"A 26-year-old Sri Lankan male was admitted to hospital with fever for 3 days and body aches. He did not have any other significant symptoms. He was diagnosed of having schizophrenia 4 years ago and was attending a psychiatric clinic. He was started on clozapine, 4 weeks ago (200 mg daily), because of inadequate control of symptoms with conventional antipsychotics. On examination he was febrile (102 °F), not pale or icteric. He did not have lymphadenopathy. Blood pressure was 130/80 mmHg and pulse rate was 110 bpm with good volume. His respiratory rate was 32 cycles per minute. Examination of the abdomen, cardiovascular and respiratory systems were unremarkable. His full blood count (FBC), which was done a day prior to hospital admission showed white blood cell count (WBC) 2.9 × 103/µl, absolute neutrophil count 667/µl (23 %), lymphocytes 2117/µl (73 %), Hemoglobin (Hb) 11.3 g/dl, platelet 188 × 103/µl. The first FBC during the hospital stay showed reduced blood counts, of which WBC 0.2 × 103/µl with absolute neutrophil count (ANC) 110/µl, lymphocyte count 80/µl, Hb 12.2 g/dl and platelet 972 × 103/µl. The C reactive protein was (CRP) 270 mg/L (<6 mg/L). His chest X ray, ultrasound scan (USS) of abdomen and pelvis, urine full report was normal. Serology for dengue virus, human immunodeficiency virus and parvo B19 virus were negative. Electrocardiogram (ECG) showed sinus tachycardia. Clinical diagnosis of neutropenic sepsis was made. He was treated with intravenous imipenum, vancomycin, clindamycin, metronidazole and fluconazole. His serial blood cultures, urine cultures and sputum cultures were negative. His FBC was monitored twice daily throughout hospital stay, showed severe neutropenia and thrombocytopenia which later complicated by anemia from the 3rd day of hospital stay (Table ; Fig. ). The reticulocyte count was 1.1 % (normal 0.5–2.5). The patient was transferred to intensive care unit (ICU) on the 3rd day and treated with granulocyte colony stimulating factors (G-CSF) 300 µg daily for 10 days. On the 5th day he developed swelling of his left inguinal region with mild skin induration. The initial USS of left groin showed only subcutaneous tissue oedema. This subsequently progressed to an abscess which was drained. His white cell count and platelet count improved with 10 days of treatment with G-CSF. Hemoglobin normalized in 4 weeks of treatment. At this stage his WBC count was 12 × 103/µl with absolute neutrophil count 7200/µl (60 %), hemoglobin 12.6 g/dl and platelets 212 × 103/µl. He was started on conventional antipsychotics without clozapine for his psychiatric condition.",What is the patient's Centor Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [26, 'years'], 'Temperature': [102, 'degrees fahrenheit'], 'Tender/swollen anterior cervical lymph nodes': False}",2,2,2,"The criteria listed in the Centor Score formula are listed below:

1. Age: 3-14 years = +1 point, 15-44 years = 0 points, ≥45 years = -1 point
2. Exudate or swelling on tonsils: No = 0 points, Yes = +1 point
3. Tender/swollen anterior cervical lymph nodes: No = 0 points, Yes = +1 point
4. Temperature >38°C (100.4°F): No = 0 points, Yes = +1 point
5. Cough: Cough present = 0 points, Cough absent = +1 point

The Centor score is calculated by summing the points for each criterion.
    
The current Centor score is 0.
The patient is 26 years old. Because the age is in between 15 and 44 years, the score does not change, keeping the score at 0.
The patient's temperature is 102 degrees fahrenheit. To convert to degrees celsius, apply the formula 5/9 * [temperature (degrees fahrenheit) - 32]. This means that the patient's temperature is 5/9 * 70 = 38.88889 degrees celsius. The patient's temperature is greater than 38 degrees Celsius, and so we add one point to the score, making the current score 0 + 1 = 1.
The patient note does not mention details about the patient coughing and so we assume it to be absent. Hence, we add 1 point to the score, making the current score 1 + 1 = 2.
The patient note reports 'tender/swollen anterior cervical lymph nodes' as absent for the patient. Hence, we do not change the score, keeping the current score at 2.
The patient note does not mention details about 'exudate or swelling on tonsils' and so we assume it to be absent. Hence, we do not change the score, keeping the current score at 2.
Hence, the Centor score for the patient is 2."
303,20,Centor Score (Modified/McIsaac) for Strep Pharyngitis,severity,integer,usmle-414,Extracted,"A 4-year-old boy is brought to the physician because of a 5-day history of sore throat and a painful swelling on the left side of his neck that has become progressively larger. He has had pain during swallowing and has refused to eat solid foods for the past 3 days. He immigrated to the United States one year ago from India. His immunization records are unavailable. His family keeps 2 cats as pets. He appears well. He is at the 60th percentile for height and 50th percentile for weight. His temperature is 37.7°C (99.9°F), pulse is 103/min, and blood pressure is 92/60 mm Hg. The oropharynx is erythematous; the tonsils are enlarged with exudates. There is a 3-cm warm, tender, nonfluctuant cervical lymph node on the left side of the neck. His hemoglobin is 12.6 g/dL, leukocyte count is 11,100/mm3, and platelet count is 180,000/mm3.",What is the patient's Centor Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [4, 'years'], 'Temperature': [37.7, 'degrees celsius'], 'Tender/swollen anterior cervical lymph nodes': True, 'Exudate or swelling on tonsils': True}",4,4,4,"The criteria listed in the Centor Score formula are listed below:

1. Age: 3-14 years = +1 point, 15-44 years = 0 points, ≥45 years = -1 point
2. Exudate or swelling on tonsils: No = 0 points, Yes = +1 point
3. Tender/swollen anterior cervical lymph nodes: No = 0 points, Yes = +1 point
4. Temperature >38°C (100.4°F): No = 0 points, Yes = +1 point
5. Cough: Cough present = 0 points, Cough absent = +1 point

The Centor score is calculated by summing the points for each criterion.
    
The current Centor score is 0.
The patient is 4 years old. Because the age is between 3 and 14 years, we add one point to the score making current score 0 + 1 = 1.
The patient's temperature is 37.7 degrees celsius. The patient's temperature is less than or equal to 38 degrees Celsius, and so we do not make any changes to the score, keeping the score at 1.
The patient note does not mention details about the patient coughing and so we assume it to be absent. Hence, we add 1 point to the score, making the current score 1 + 1 = 2.
The patient note reports 'tender/swollen anterior cervical lymph nodes' as present for the patient. Hence, we increase the score by 1, making the current score 2 + 1 = 3.
The patient note reports 'exudate or swelling on tonsils' as present for the patient. Hence, we increase the score by 1, making the current score 3 + 1 = 4.
Hence, the Centor score for the patient is 4."
304,20,Centor Score (Modified/McIsaac) for Strep Pharyngitis,severity,integer,pmc-7978146-1,Extracted,"A 65-year-old female with a history of chronic obstructive pulmonary disease, and hypothyroidism presented to the emergency department (ED) with shortness of breath which was progressively worsening two days prior to presentation. She also reported having a fever and nonproductive cough in the last two days. The patient denied exposure to sick contacts, recent travel outside the state, or recent immobilization. Her temperature on admission was 39 ͦC, blood pressure 132/80 mmHg, heart rate 110 beats per minute, respiratory rate of 18 per minute. Physical examination was significant for lethargy, bilateral rales on auscultation of lung fields. Her oxygen saturation was 88% while on 5 liters per minute delivered through nasal cannula so she was placed on noninvasive positive pressure ventilation. Chest X-ray showed bilateral interstitial opacities consistent with viral pneumonia. The patient tested positive for SARS-CoV-2. Laboratory results at the time of admission are presented in Table .
She was started on remdesevir and dexamethasone as per institutional guidelines for the treatment of COVID-19 viral pneumonia. A 12-lead electrocardiogram revealed atrial fibrillation with a ventricular rate of 120 per minute, so anticoagulation was started with low molecular weight heparin (LMWH) 1mg/kg dosing twice daily and rate-controlling medications were administered. 12 hours after admission to the hospital, right arm motor drift, facial droop, and dysarthria were noted. National Institute of Health Stroke Scale (NIHSS) was 3. Emergent CT of the head revealed age indeterminate lacunar infarct in the left basal ganglia, with no intracranial hemorrhage. CT perfusion study of head and neck showed occlusion of the supraclinoid segment of the left internal carotid artery (ICA) with occlusive thrombus extending into the proximal left anterior cerebral artery (ACA) and middle cerebral artery (MCA) (Figure ).
Left ACA opacified via an anterior communicating artery. Corresponding large 126 ccs of ischemic penumbra involving the left frontal, temporal and parietal lobes, basal ganglia were also seen. Anticoagulation was switched from LMWH to unfractionated heparin (UFH) in anticipation of the revascularization procedure. The case was discussed with an Interventional neurologist and the decision was made not to proceed with revascularization due to low NIHSS. While the patient was being monitored in the stroke unit, on day 3 of admission, she developed new right-sided hemiplegia, aphasia with altered mentation. The emergent CT of the head showed an increasing size of the infarct within the left basal ganglia and corona radiata. CT perfusion showed stable left ICA/MCA occlusion, however, due to progressive symptoms she underwent emergent left ICA/MCA thrombectomy. The weakness improved after revascularization with an increase in muscle strength from 1/5 to 3/5 in both right upper and lower extremities. UFH was discontinued due to an elevated risk of bleeding post revascularization.
On day 7 after the procedure, anticoagulation was restarted with LMWH due to coexisting atrial fibrillation and COVID-19 infection. At this point, the patient completed a 10-day course of remdesevir and dexamethasone and was saturating well with 3 liters per minute supplemental oxygen through the nasal cannula. two days after restarting anticoagulation, a stroke code was called due to sudden onset, left lower extremity weakness. CT perfusion of head and neck demonstrated new distal left M2 branch occlusion within the Sylvian fissure. Mural thrombi were noted in the distal aortic arch and descending aorta. A complete angiogram of the chest and abdomen was done to determine the extent of clot burden. CT angiogram of the chest confirmed the presence of mural thrombus (Figure ).
Along with that, a large filling defect was noted within the right interlobar pulmonary artery with extension into the right middle and lower lobe pulmonary artery as well as segmental and subsegmental branches of the right lower lobe compatible with pulmonary embolism (Figure ). CT angiogram of the abdomen showed thrombus in left common femoral artery extending into proximal internal iliac as well as left external iliac arteries (Figures , ). There is a reconstitution of flow within both arteries distally. Platelets dropped from 174 to 63 within few days after restarting anticoagulation (Figure ). 4T score for screening of HIT was 6 (2 each for greater than 50% drop and nadir >30, timing within 5-10 days of exposure and new thrombosis). LMWH was switched to argatroban infusion. Platelet factor 4 antibody test and serotonin release assay test (SRA) were positive (Table ).
The patient underwent a left lower extremity angiogram by vascular surgery and treated with tissue plasminogen activator catheter-directed thrombolysis (tPA-CDT). Revascularization was successful with three-vessel runoff and dopplerable pulses in the left lower extremity. Anticoagulation was subsequently switched to apixaban. The patient recovered from COVID-19 and was discharged to the nursing home for rehabilitation for stroke.",What is the patient's Centor Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [65, 'years'], 'Cough Absent': False, 'Temperature': [39, 'degrees celsius']}",0,0,0,"The criteria listed in the Centor Score formula are listed below:

1. Age: 3-14 years = +1 point, 15-44 years = 0 points, ≥45 years = -1 point
2. Exudate or swelling on tonsils: No = 0 points, Yes = +1 point
3. Tender/swollen anterior cervical lymph nodes: No = 0 points, Yes = +1 point
4. Temperature >38°C (100.4°F): No = 0 points, Yes = +1 point
5. Cough: Cough present = 0 points, Cough absent = +1 point

The Centor score is calculated by summing the points for each criterion.
    
The current Centor score is 0.
The patient is 65 years old. Because the age is greater than 44 years, we decrease the score by one point, making the score 0 - 1 = -1.
The patient's temperature is 39 degrees celsius. The patient's temperature is greater than 38 degrees Celsius, and so we add one point to the score, making the current score -1 + 1 = 0.
The patient note report reports that the patient is coughing and so we do not change the score, keeping the current score at 0.
The patient note does not mention details about 'tender/swollen anterior cervical lymph nodes' and so we assume it to be absent. Hence, we do not change the score, keeping the current score at 0.
The patient note does not mention details about 'exudate or swelling on tonsils' and so we assume it to be absent. Hence, we do not change the score, keeping the current score at 0.
Hence, the Centor score for the patient is 0."
305,20,Centor Score (Modified/McIsaac) for Strep Pharyngitis,severity,integer,usmle-12316,Extracted,"A 14-year-old male presents to his pediatrician complaining of a sore throat. His mother reports that he developed a fever two days ago that was immediately followed by a sore throat. He denies cough or rhinorrhea. His past medical history is notable for poorly controlled asthma and he currently takes albuterol and budesonide. Of note, the child immigrated to America from Vietnam three months ago. His temperature is 101.6°F (38.7°C), blood pressure is 130/85 mmHg, pulse is 110/min, and respirations are 18/min. Physical examination reveals a malnourished adolescent who is small for his age. No hepatosplenomegaly is noted. A notable physical examination finding is shown in Figure A. Serologic and throat swab studies are pending.",What is the patient's Centor Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [14, 'years'], 'Cough Absent': True, 'Temperature': [101.6, 'degrees fahrenheit']}",3,3,3,"The criteria listed in the Centor Score formula are listed below:

1. Age: 3-14 years = +1 point, 15-44 years = 0 points, ≥45 years = -1 point
2. Exudate or swelling on tonsils: No = 0 points, Yes = +1 point
3. Tender/swollen anterior cervical lymph nodes: No = 0 points, Yes = +1 point
4. Temperature >38°C (100.4°F): No = 0 points, Yes = +1 point
5. Cough: Cough present = 0 points, Cough absent = +1 point

The Centor score is calculated by summing the points for each criterion.
    
The current Centor score is 0.
The patient is 14 years old. Because the age is between 3 and 14 years, we add one point to the score making current score 0 + 1 = 1.
The patient's temperature is 101.6 degrees fahrenheit. To convert to degrees celsius, apply the formula 5/9 * [temperature (degrees fahrenheit) - 32]. This means that the patient's temperature is 5/9 * 69.6 = 38.66667 degrees celsius. The patient's temperature is greater than 38 degrees Celsius, and so we add one point to the score, making the current score 1 + 1 = 2.
The patient note reports an absence of cough and so we add 1 point to the score, making the current score 2 + 1 = 3.
The patient note does not mention details about 'tender/swollen anterior cervical lymph nodes' and so we assume it to be absent. Hence, we do not change the score, keeping the current score at 3.
The patient note does not mention details about 'exudate or swelling on tonsils' and so we assume it to be absent. Hence, we do not change the score, keeping the current score at 3.
Hence, the Centor score for the patient is 3."
306,20,Centor Score (Modified/McIsaac) for Strep Pharyngitis,severity,integer,usmle-8066,Extracted,"A 32-year-old man presents with a fever that has persisted for 3 days. He says that the fever was initially low at around 37.8°C (100.0°F), but, for the past 2 days, it has been around 38.9°C (102.0°F), regardless of his attempts to bring it down. He has also noticed some bumps on his neck. On further questioning, he mentions that he was recently out rabbit hunting with his friends. He is prescribed an antibiotic and requested to follow-up in 2 weeks. On follow-up, the patient seems better, however, he says he now has a slight hearing difficulty.",What is the patient's Centor Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [32, 'years'], 'Temperature': [38.9, 'degrees celsius'], 'Tender/swollen anterior cervical lymph nodes': True}",3,3,3,"The criteria listed in the Centor Score formula are listed below:

1. Age: 3-14 years = +1 point, 15-44 years = 0 points, ≥45 years = -1 point
2. Exudate or swelling on tonsils: No = 0 points, Yes = +1 point
3. Tender/swollen anterior cervical lymph nodes: No = 0 points, Yes = +1 point
4. Temperature >38°C (100.4°F): No = 0 points, Yes = +1 point
5. Cough: Cough present = 0 points, Cough absent = +1 point

The Centor score is calculated by summing the points for each criterion.
    
The current Centor score is 0.
The patient is 32 years old. Because the age is in between 15 and 44 years, the score does not change, keeping the score at 0.
The patient's temperature is 38.9 degrees celsius. The patient's temperature is greater than 38 degrees Celsius, and so we add one point to the score, making the current score 0 + 1 = 1.
The patient note does not mention details about the patient coughing and so we assume it to be absent. Hence, we add 1 point to the score, making the current score 1 + 1 = 2.
The patient note reports 'tender/swollen anterior cervical lymph nodes' as present for the patient. Hence, we increase the score by 1, making the current score 2 + 1 = 3.
The patient note does not mention details about 'exudate or swelling on tonsils' and so we assume it to be absent. Hence, we do not change the score, keeping the current score at 3.
Hence, the Centor score for the patient is 3."
307,20,Centor Score (Modified/McIsaac) for Strep Pharyngitis,severity,integer,pmc-7362490-1,Extracted,"On March 11, 2020, a 68-year-old woman attended the Tianjin Taida Hospital surgical Clinic mainly because of intermittent cough for > 1 month. She had a 2-year history of hypertension controlled by medication, and no history of smoking or alcohol consumption. She had an intermittent cough with white sticky sputum, without any other symptoms or signs. On the same day, the patient was referred to the Fifth Central Hospital of Tianjin. Here vital signs were: body temperature 36.2 °C, pulse 86 beats/min, respiration rate 18 breaths/min, blood pressure 142/85 mmHg, and she was fully conscious. There was no visible enlargement of her superficial lymph nodes. She had no cyanosis, percussion pain in the sternum, or abnormal respiratory movements. She had coarse breath sounds in both lungs, no pleural friction sounds, and audible inspiratory crackles in the left lung. Heart sounds were strong and regular, with no pathological murmurs in any valve auscultation area. Carcinoembryonic antigen (CEA) was 8 ng/ml (normal range 0–5 ng/ml) and non-small cell lung cancer associated antigenCYF21–1 was 13.31 ng/ml (normal range 0.1–3.3 ng/ml). Other biochemical indicators were within the normal range.
The patient underwent a series of imaging examinations (Fig. ). Chest radiography on March 11, 2020 showed several nodules in the upper and lower segments of the left lung (Fig. a). Chest computed tomography (CT) on March 12, 2020 showed multiple solid nodules in the upper and lower left lung (Fig. b). The nodules had irregular outlines, with a maximum diameter of 65 mm, and some had a central cavity. A diagnosis of lymphoma was considered. Enhanced chest CT on March 16, 2020 (Fig. c–e) showed multiple “cauliflower like”, soft tissue masses in the left lung, partially fused, with a maximum diameter of 71.3 mm and a CT value of ~ 36 HU. Enhanced CT showed enhancement with a maximum value of 60 Hu. The boundary between the mass and pleura was not clear, and the mass could not be separated from the pleura. There was irregular thickening of the pleura and no enlargement of lymph nodes. A malignant tumor could not be excluded.
To clarify the pathological diagnosis, the patient underwent ultrasound-guided percutaneous needle biopsy of the left lung under local anesthesia on March 16, 2020. After consultation with our own and other hospitals(diagnostics were performed by Tianjin Fifth Central Hospital, Tianjin Cancer Hospital and Peking Union Medical College Hospital), the biopsy specimen was finally diagnosed as BA according to histomorphology and immunophenotype.
Wedge resection with safe margins may be the best treatment option for BA patients. However, if the lung is full of diffuse nodules, the whole lung may need to be removed, which seriously affects quality of life. Our patient was treated conservatively and followed up regularly. She was discharged on March 28, 2020. Her symptoms were managed through regular normal activities of daily living, strengthening respiratory protection, avoiding respiratory infection, and drug treatment to relieve dyspnea and cough.
To clarify the diagnosis, a double needle lung biopsy specimen was removed, 15 mm long, 1 mm in diameter. It was solid and gray white. Microscopically, there were irregular adenoid structures in a background of fibrosis and inflammation (Fig. a). The lesion had a two-layer cellular structure consisting of a basal and luminal layer, and had a lack of papillary structures. The micropapillae occasionally formed by non-ciliated cells germinated and burrowed into the alveolar cavity(Fig. b). The luminal layer was composed of type II alveolar cells and club cells. However, ciliated columnar cells and mucous cells in some flat areas could still be identified (Fig. c). The appearance was similar to adenocarcinoma in some areas, with alveolar destruction and stromal widening. Through careful observation, we found that the main reason for the stromal widening was edema and inflammatory infiltration. Unlike adenocarcinoma, there was a lack of thick collagen fibers (Fig. d). Tumor cells lacked atypia, mitosis and necrosis. A layer of material resembling the basement membrane surrounded the basal layer. The most important feature was a continuous layer of basal cells around the luminal layer.
Immunohistochemical staining for p63, p40 and cytokeratin (CK)5/6 clearly showed the continuity of the basal cells (Fig. a, b). The luminal cells and some basal cells stained positive for thyroid transcription factor (TTF)-1. The luminal cells expressed immunological markers of the terminal bronchioles (CKpan, CK7, Napsin A and CEA). A small number of mucous cells stained positive for periodic acid Schiff. The tumor showed a < 10% Ki-67 proliferation index (Fig. ). Finally, the case was pathologically diagnosed as BA of distal type.",What is the patient's Centor Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [68, 'years'], 'Cough Absent': False, 'Temperature': [36.2, 'degrees celsius'], 'Tender/swollen anterior cervical lymph nodes': False}",-1,-1,-1,"The criteria listed in the Centor Score formula are listed below:

1. Age: 3-14 years = +1 point, 15-44 years = 0 points, ≥45 years = -1 point
2. Exudate or swelling on tonsils: No = 0 points, Yes = +1 point
3. Tender/swollen anterior cervical lymph nodes: No = 0 points, Yes = +1 point
4. Temperature >38°C (100.4°F): No = 0 points, Yes = +1 point
5. Cough: Cough present = 0 points, Cough absent = +1 point

The Centor score is calculated by summing the points for each criterion.
    
The current Centor score is 0.
The patient is 68 years old. Because the age is greater than 44 years, we decrease the score by one point, making the score 0 - 1 = -1.
The patient's temperature is 36.2 degrees celsius. The patient's temperature is less than or equal to 38 degrees Celsius, and so we do not make any changes to the score, keeping the score at -1.
The patient note report reports that the patient is coughing and so we do not change the score, keeping the current score at -1.
The patient note reports 'tender/swollen anterior cervical lymph nodes' as absent for the patient. Hence, we do not change the score, keeping the current score at -1.
The patient note does not mention details about 'exudate or swelling on tonsils' and so we assume it to be absent. Hence, we do not change the score, keeping the current score at -1.
Hence, the Centor score for the patient is -1."
308,20,Centor Score (Modified/McIsaac) for Strep Pharyngitis,severity,integer,usmle-6356,Extracted,"A 19-year-old male with a past medical history of surgical repair of a torn anterior cruciate ligament and seasonal allergies presents to the emergency department with a rash. He reports that he first noticed the rash on his torso when he woke up this morning, and it has spread down his legs over the last few hours. He also endorses fatigue, malaise, and sore throat for four days. The patient reports that he was seen yesterday at his college’s student health clinic for similar symptoms and was prescribed amoxicillin. He also reports that his younger sister was recently diagnosed with streptococcal pharyngitis, and his mother has psoriatic arthritis. He is a sophomore on the men’s soccer team, but he has had to sit out of practice for the last several days. His home medications include cetirizine and fluticasone nasal spray. He has no known drug allergies. His temperature is 100.8°F (38.2°C), blood pressure is 122/76 mmHg, pulse is 97/min, and respirations are 16/min. On physical exam, he has an erythematous oropharynx with posterior cervical lymphadenopathy. His rash can be seen in Figure A.",What is the patient's Centor Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [19, 'years'], 'Temperature': [100.8, 'degrees fahrenheit'], 'Tender/swollen anterior cervical lymph nodes': False}",2,2,2,"The criteria listed in the Centor Score formula are listed below:

1. Age: 3-14 years = +1 point, 15-44 years = 0 points, ≥45 years = -1 point
2. Exudate or swelling on tonsils: No = 0 points, Yes = +1 point
3. Tender/swollen anterior cervical lymph nodes: No = 0 points, Yes = +1 point
4. Temperature >38°C (100.4°F): No = 0 points, Yes = +1 point
5. Cough: Cough present = 0 points, Cough absent = +1 point

The Centor score is calculated by summing the points for each criterion.
    
The current Centor score is 0.
The patient is 19 years old. Because the age is in between 15 and 44 years, the score does not change, keeping the score at 0.
The patient's temperature is 100.8 degrees fahrenheit. To convert to degrees celsius, apply the formula 5/9 * [temperature (degrees fahrenheit) - 32]. This means that the patient's temperature is 5/9 * 68.8 = 38.22222 degrees celsius. The patient's temperature is greater than 38 degrees Celsius, and so we add one point to the score, making the current score 0 + 1 = 1.
The patient note does not mention details about the patient coughing and so we assume it to be absent. Hence, we add 1 point to the score, making the current score 1 + 1 = 2.
The patient note reports 'tender/swollen anterior cervical lymph nodes' as absent for the patient. Hence, we do not change the score, keeping the current score at 2.
The patient note does not mention details about 'exudate or swelling on tonsils' and so we assume it to be absent. Hence, we do not change the score, keeping the current score at 2.
Hence, the Centor score for the patient is 2."
309,20,Centor Score (Modified/McIsaac) for Strep Pharyngitis,severity,integer,usmle-4026,Extracted,"A 14-year-old boy is brought to the physician by his mother because of a 1-week history of fever, fatigue, and throat pain. He appears lethargic. His temperature is 38.5°C (101.3°F). Physical examination shows bilateral tender and swollen anterior cervical lymph nodes,. Oral examination shows the findings in the photograph. A peripheral blood smear shows lymphocytosis with atypical lymphocytes. A heterophile antibody test is positive.",What is the patient's Centor Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [14, 'years'], 'Temperature': [38.5, 'degrees celsius'], 'Tender/swollen anterior cervical lymph nodes': True}",4,4,4,"The criteria listed in the Centor Score formula are listed below:

1. Age: 3-14 years = +1 point, 15-44 years = 0 points, ≥45 years = -1 point
2. Exudate or swelling on tonsils: No = 0 points, Yes = +1 point
3. Tender/swollen anterior cervical lymph nodes: No = 0 points, Yes = +1 point
4. Temperature >38°C (100.4°F): No = 0 points, Yes = +1 point
5. Cough: Cough present = 0 points, Cough absent = +1 point

The Centor score is calculated by summing the points for each criterion.
    
The current Centor score is 0.
The patient is 14 years old. Because the age is between 3 and 14 years, we add one point to the score making current score 0 + 1 = 1.
The patient's temperature is 38.5 degrees celsius. The patient's temperature is greater than 38 degrees Celsius, and so we add one point to the score, making the current score 1 + 1 = 2.
The patient note does not mention details about the patient coughing and so we assume it to be absent. Hence, we add 1 point to the score, making the current score 2 + 1 = 3.
The patient note reports 'tender/swollen anterior cervical lymph nodes' as present for the patient. Hence, we increase the score by 1, making the current score 3 + 1 = 4.
The patient note does not mention details about 'exudate or swelling on tonsils' and so we assume it to be absent. Hence, we do not change the score, keeping the current score at 4.
Hence, the Centor score for the patient is 4."
310,20,Centor Score (Modified/McIsaac) for Strep Pharyngitis,severity,integer,pmc-4327960-1,Extracted,"A 32-year-old woman was diagnosed with acute tonsillitis by her family doctor. Microbiological examination was not performed at that time. Amoxicillin/clavulanic acid 875/125 mg twice daily for 5 days was prescribed empirically. The symptoms of tonsillitis resolved within five-day treatment, however, four days after completing the course of antibiotic therapy, sore throat, more prominent on the left side, reappeared. Two days later the patient presented to the Emergency Department with a two-day history of worsening sore throat, painful swallowing and fever. The patient was previously well, with no history of chronic diseases, recurrent tonsillitis or previous peritonsillar abscess. Seven months previously she gave birth to her second child and was still breastfeeding the baby. She denied smoking. On physical examination her temperature was 38°C, pulse rate: 80 beats/min, respiratory rate: 22 breaths/min and blood pressure: 120/80 mm Hg. Examination of the oral cavity and oropharynx showed enlarged and inflamed left tonsil as well as congested and bulging soft palate on the left side with contralateral displacement of the uvula. Both tonsils were covered with whitish exudate. No dental caries was noted. There was also bilateral, moderately tender submandibular lymphadenopathy. The remainder of physical examination was unremarkable. Blood tests results are shown in Table . Separate swabs were obtained from the surfaces of both tonsils. Next, under local anesthesia, diagnostic needle aspiration of left tonsil was performed by otolaryngologist, during which scanty amount of pus was obtained. This initial procedure was followed by incision and drainage. Tonsil swabs and abscess aspirate were sent to laboratory for microbiological examination. The patient refused hospitalization at the Otolaryngology Department, thus was discharged home on a 10-day course of cefuroxime (500 mg twice daily) and metronidazole (500 mg 3 times daily) with recommendation to discontinue breastfeeding for the duration of the antibiotic therapy and to present at follow-up visit to Otolaryngology Clinic after completing antibiotic therapy. The symptoms of peritonsillar abscess as well as fever were subsiding steadily during treatment, however on the last day of antibiotic therapy, swelling and pain of the left ankle appeared, thus the patient presented to her family doctor. Upon presentation she was afebrile and had marked oedema and pain of her left ankle. Her heart rate was 72 beats/min, she did not have an appreciable cardiac murmur. Her chest was clear to auscultation. Antibiotic therapy with cefuroxime (500 mg once daily) for next 5 days was prescribed, as well as pain relief medication with paracetamol. After completing antibiotic therapy the patient presented at follow-up visit to Otolaryngology Clinic. She was afebrile, with normal vital signs. Examination of oropharynx showed resolution of both, congestion and oedema of left tonsil and soft palate. There was no exudate on the tonsils. Cultures of throat swabs and abscess aspirate collected 2 weeks before revealed the presence of Streptococcus pyogenes in all three materials. According to the patient report, left ankle swelling with which she presented to her family doctor, resolved within 4 days. Upon presentation the patient only had moderate pain in the joint. She was consulted by rheumatologist. Her heart rate was 70 beats/min. She did not have a regurgitant murmur. Her chest was clear to auscultation. Antistreptolysin O (ASO) titer was evaluated and proved to be 412 IU/ml (normal 0–200 IU/ml). The level of C-reactive protein was 13,0 mg/L. Control throat swabs were collected for culture, which revealed normal oropharynx flora. The patient was recommended to continue pain relief medication with paracetamol and present at follow-up visit to Rheumatology Clinic after 2 weeks. Her only complaint was persisting slight pain in left ankle joint. The results of physical examination were analogous to those observed at previous follow-up. ASO titer was 503 IU/ml. Control throat swabs were collected and culture yielded normal flora. The patient was recommended to present at follow-up visit at Rheumatology Clinic after 2 months. At that time, she was well. Ankle pain, according to the patient report, disappeared shortly after last visit. The results of physical examination were analogous to those observed previously. ASO titer was 396 IU/ml. Six months after the presentation at Emergency Department, the patient was well, with ASO titer reaching 262 IU/ml. Table summarizes the chronology of clinical findings and blood tests results.
Cultures of PTA aspirate revealed Streptococcus pyogenes as a predominant species as well as Prevotella oralis and Haemophilus parainfluenzae. Tonsil swabs, collected at the time the patient presented with PTA, yielded copious growth of Streptococcus pyogenes as well as normal throat flora, namely Streptococcus viridians, Neisseria spp, and Haemophilus parainfluenzae. Two control throat swabs revealed only normal oropharynx flora. Bacterial species were identified with the use of routine microbiological methods, drug susceptibility of S. pyogenes was assessed using Vitek 2 Compact (bioMérieux). Antimicrobial susceptibility results were interpreted according to the European Committee on Antimicrobial Susceptibility Testing recommendations (EUCAST 2013, version 3.1) []. Streptococcus pyogenes strains isolated from tonsil swabs and abscess aspirate demonstrated identical susceptibility patterns. They were resistant to erythromycin, clindamycin, tetracycline and fully susceptible to all other antibiotics tested. MLSi phenotype (inducible coresistance to macrolide, lincosamide and streptogramine) was detected with the use of double-disc diffusion testing [].",What is the patient's Centor Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [32, 'years'], 'Temperature': [38.0, 'degrees celsius'], 'Tender/swollen anterior cervical lymph nodes': False, 'Exudate or swelling on tonsils': True}",2,2,2,"The criteria listed in the Centor Score formula are listed below:

1. Age: 3-14 years = +1 point, 15-44 years = 0 points, ≥45 years = -1 point
2. Exudate or swelling on tonsils: No = 0 points, Yes = +1 point
3. Tender/swollen anterior cervical lymph nodes: No = 0 points, Yes = +1 point
4. Temperature >38°C (100.4°F): No = 0 points, Yes = +1 point
5. Cough: Cough present = 0 points, Cough absent = +1 point

The Centor score is calculated by summing the points for each criterion.
    
The current Centor score is 0.
The patient is 32 years old. Because the age is in between 15 and 44 years, the score does not change, keeping the score at 0.
The patient's temperature is 38.0 degrees celsius. The patient's temperature is less than or equal to 38 degrees Celsius, and so we do not make any changes to the score, keeping the score at 0.
The patient note does not mention details about the patient coughing and so we assume it to be absent. Hence, we add 1 point to the score, making the current score 0 + 1 = 1.
The patient note reports 'tender/swollen anterior cervical lymph nodes' as absent for the patient. Hence, we do not change the score, keeping the current score at 1.
The patient note reports 'exudate or swelling on tonsils' as present for the patient. Hence, we increase the score by 1, making the current score 1 + 1 = 2.
Hence, the Centor score for the patient is 2."
311,20,Centor Score (Modified/McIsaac) for Strep Pharyngitis,severity,integer,pmc-5931247-2,Extracted,"A previously healthy 16-year-old woman had visited her primary care physician with a fever (39°C) and cough 2 days before presenting to our hospital. She was diagnosed with pneumonia (based on chest X-ray findings) and was prescribed tosufloxacin 150 mg thrice daily. However, her fever and cough persisted and she developed papules on both legs the next day (); this prompted her to visit our hospital. Lymphoid follicles with a maximum diameter of 9 mm were identified in the posterior pharyngeal wall (). A throat swab was positive for M. pneumoniae (loop-mediated isothermal amplification method), leading to a diagnosis of mycoplasmal pneumonia. The patient was prescribed oral azithromycin 500 mg daily and oral fexofenadine 60 mg twice daily for 3 days. One week later, her symptoms had resolved. An oral tosufloxacin challenge test, performed 2 months later, was negative. Therefore, the skin rash was determined to have been associated with M. pneumoniae infection.
Lymphoid follicles in the posterior pharyngeal wall can occur as a result of viral infections such as adenovirus and echovirus; these can be distinguished by shape from the characteristic influenza follicles as presented by Miyamoto and Watanabe. Although posterior pharyngeal wall lymphoid follicles do not normally occur with bacterial infections, we have presented two cases in which these lesions were observed in association with M. pneumoniae infection. These mycoplasma-associated lymphoid follicles were larger than those associated with influenza and other typical viral infections, which have a maximum diameter of approximately 10 mm. They were few in number, were teardrop-shaped with well-defined borders and exhibited flushing. Five characteristics—diameter, shape, presence or absence of agglutination, and colouration—are used to assess the typical lymphoid follicles seen in cases of influenza virus infection. The lesions in our cases matched all characteristics except for their diameter. The frequency of lymphoid follicles in the posterior pharyngeal wall in such cases is unknown; further case studies must be accumulated.",What is the patient's Centor Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [16, 'years'], 'Cough Absent': False, 'Temperature': [39.0, 'degrees celsius']}",1,1,1,"The criteria listed in the Centor Score formula are listed below:

1. Age: 3-14 years = +1 point, 15-44 years = 0 points, ≥45 years = -1 point
2. Exudate or swelling on tonsils: No = 0 points, Yes = +1 point
3. Tender/swollen anterior cervical lymph nodes: No = 0 points, Yes = +1 point
4. Temperature >38°C (100.4°F): No = 0 points, Yes = +1 point
5. Cough: Cough present = 0 points, Cough absent = +1 point

The Centor score is calculated by summing the points for each criterion.
    
The current Centor score is 0.
The patient is 16 years old. Because the age is in between 15 and 44 years, the score does not change, keeping the score at 0.
The patient's temperature is 39.0 degrees celsius. The patient's temperature is greater than 38 degrees Celsius, and so we add one point to the score, making the current score 0 + 1 = 1.
The patient note report reports that the patient is coughing and so we do not change the score, keeping the current score at 1.
The patient note does not mention details about 'tender/swollen anterior cervical lymph nodes' and so we assume it to be absent. Hence, we do not change the score, keeping the current score at 1.
The patient note does not mention details about 'exudate or swelling on tonsils' and so we assume it to be absent. Hence, we do not change the score, keeping the current score at 1.
Hence, the Centor score for the patient is 1."
312,20,Centor Score (Modified/McIsaac) for Strep Pharyngitis,severity,integer,usmle-6179,Extracted,"A 17-year-old male presents to the emergency department with a three-day history of sore throat. He reports that the sore throat seems to be getting worse and is starting to affect the character of his voice. He also endorses headache and decreased appetite secondary to difficulty swallowing. The patient’s past medical history is significant for infectious mononucleosis one year ago, which he reports has fully resolved. He denies any recent sexual activity. Several of his friends at school have also been ill recently. His temperature is 102.4°F (39.1°C), blood pressure is 119/83 mmHg, pulse is 107/min, and respirations are 18/min. On physical exam you note the findings in Figure A. He has cervical lymphadenopathy, and he speaks with a muffled voice.",What is the patient's Centor Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [17, 'years'], 'Temperature': [102.4, 'degrees fahrenheit'], 'Tender/swollen anterior cervical lymph nodes': True, 'Exudate or swelling on tonsils': False}",3,3,3,"The criteria listed in the Centor Score formula are listed below:

1. Age: 3-14 years = +1 point, 15-44 years = 0 points, ≥45 years = -1 point
2. Exudate or swelling on tonsils: No = 0 points, Yes = +1 point
3. Tender/swollen anterior cervical lymph nodes: No = 0 points, Yes = +1 point
4. Temperature >38°C (100.4°F): No = 0 points, Yes = +1 point
5. Cough: Cough present = 0 points, Cough absent = +1 point

The Centor score is calculated by summing the points for each criterion.
    
The current Centor score is 0.
The patient is 17 years old. Because the age is in between 15 and 44 years, the score does not change, keeping the score at 0.
The patient's temperature is 102.4 degrees fahrenheit. To convert to degrees celsius, apply the formula 5/9 * [temperature (degrees fahrenheit) - 32]. This means that the patient's temperature is 5/9 * 70.4 = 39.11111 degrees celsius. The patient's temperature is greater than 38 degrees Celsius, and so we add one point to the score, making the current score 0 + 1 = 1.
The patient note does not mention details about the patient coughing and so we assume it to be absent. Hence, we add 1 point to the score, making the current score 1 + 1 = 2.
The patient note reports 'tender/swollen anterior cervical lymph nodes' as present for the patient. Hence, we increase the score by 1, making the current score 2 + 1 = 3.
The patient note reports 'exudate or swelling on tonsils' as absent for the patient. Hence, we do not change the score, keeping the current score at 3.
Hence, the Centor score for the patient is 3."
313,20,Centor Score (Modified/McIsaac) for Strep Pharyngitis,severity,integer,pmc-4307710-1,Extracted,"A 59-year-old Caucasian man with past medical history significant for hypertension and hyperlipidemia presented to the emergency department with a four-day history of increasing throat pain and bilateral neck swelling. Associated symptoms included voice hoarseness, shortness of breath, dysphagia, and odynophagia. He denied recent dental procedures, upper respiratory tract infection or history of similar symptoms. Patient’s social history was negative for smoking, alcohol and illicit drug use. Initial vital signs were Blood Pressure 109/68, Pulse 101, Repiratory Rate 16, Temperature 98.1, and O2 saturation of 100% on room air. On exam, the patient was noted to have edema and tenderness to palpation of his entire right neck, with erythema tracking from the superior border of his right clavicle to the angle of the jaw on the right. No induration, crepitus or bullae were noted on the skin. Oral examination was remarkable for edema and erythema of the right anterior tonsil, without exudates or fluctuance, with mild deviation of the uvula to left. The laboratory values were significant for elevated leukocyte count of 29,000 with 89.9 % neutrophils and blood urea nitrogen and creatinine of 37 and 2.32, respectively. Computed tomography (CT) of the neck without contrast showed extensive edema in the oropharynx/hypopharynx, with edema and air within the retropharyngeal and danger space, as well as debris within the piriform sinus ( and ). Given the clinical exam, CT findings highly suspicious for “a gas-forming organism or necrotizing fasciitis,” and his laboratory results, blood cultures were drawn and intravenous clindamycin, vancomycin and ceftriaxone were empirically started. Otolaryngology was emergently consulted and the decision was made to immediately take the patient to the operating room for incision, drainage and washout.
Following nasotracheal intubation in the operating room (OR), the right neck was explored laterally into the retropharyngeal space. Purulent drainage was found to track via an overlying necrotic fascial plane into the parapharyngeal spaces as well as inferiorly into the superior mediastinum. Intraoperative gram stain showed gram positive cocci in both chains and clusters, gram negative rods and gram positive rods. The antibiotic regimen was changed to piperacillin/tazobactam and metronidazole (with discontinuation of clindamycin and ceftriaxone). Final wound culture grew Streptococcus anginosus and coagulase negative staphylococcus. The patient remained intubated postoperatively, and a repeat CT was performed on postoperative day 4 due to persistent leukocytosis. A residual phlegmon in the bilateral piriform sinuses was discovered, and the patient was then taken back to the OR for repeat right neck exploration, direct laryngoscopy, and bilateral incision and drainage of the peritonsillar space. Intra-operatively, cardiothoracic surgery was consulted to perform an open lateral thoracotomy to drain a posterior mediastinal phlegmon.
Despite repeat drainage, the patient began to decompensate, requiring multiple vasopressors to maintain adequate perfusion, and he suffered from persistent fevers, acute renal failure and transaminitis (aspartate aminotransferase 4202, alanine aminotransferase 1922). His leukocytosis continued to rise, peaking at 51,600. On postoperative day 7, the patient suffered a cardiac arrest requiring one round of chest compressions and epinephrine before return of spontaneous circulation. On postoperative day 9, his multisystem organ failure began to improve and the patient was slowly weaned off vasopressors, with successful extubation on postoperative day 12. He was discharged to a rehabilitation institution on postoperative day 21 with a peripherally inserted central catheter line to continue vancomycin, clindamycin and metronidazole for a total of four weeks. On recent follow-up with otolaryngology six weeks after his discharge, he was noted to be doing well and has elected to undergo cosmetic revision of right neck scar, the date of which is to be determined.",What is the patient's Centor Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [59, 'years'], 'Exudate or swelling on tonsils': True, 'Temperature': [98.1, 'degrees fahrenheit'], 'Tender/swollen anterior cervical lymph nodes': True}",2,2,2,"The criteria listed in the Centor Score formula are listed below:

1. Age: 3-14 years = +1 point, 15-44 years = 0 points, ≥45 years = -1 point
2. Exudate or swelling on tonsils: No = 0 points, Yes = +1 point
3. Tender/swollen anterior cervical lymph nodes: No = 0 points, Yes = +1 point
4. Temperature >38°C (100.4°F): No = 0 points, Yes = +1 point
5. Cough: Cough present = 0 points, Cough absent = +1 point

The Centor score is calculated by summing the points for each criterion.
    
The current Centor score is 0.
The patient is 59 years old. Because the age is greater than 44 years, we decrease the score by one point, making the score 0 - 1 = -1.
The patient's temperature is 98.1 degrees fahrenheit. To convert to degrees celsius, apply the formula 5/9 * [temperature (degrees fahrenheit) - 32]. This means that the patient's temperature is 5/9 * 66.1 = 36.72222 degrees celsius. The patient's temperature is less than or equal to 38 degrees Celsius, and so we do not make any changes to the score, keeping the score at -1.
The patient note does not mention details about the patient coughing and so we assume it to be absent. Hence, we add 1 point to the score, making the current score -1 + 1 = 0.
The patient note reports 'tender/swollen anterior cervical lymph nodes' as present for the patient. Hence, we increase the score by 1, making the current score 0 + 1 = 1.
The patient note reports 'exudate or swelling on tonsils' as present for the patient. Hence, we increase the score by 1, making the current score 1 + 1 = 2.
Hence, the Centor score for the patient is 2."
314,20,Centor Score (Modified/McIsaac) for Strep Pharyngitis,severity,integer,usmle-9610,Extracted,"A 64-year-old woman presents to the physician with fever and sore throat for 2 days. She was diagnosed with rheumatoid arthritis 15 years ago. She has had several flares necessitating admission to the hospital in recent years. She has developed deformity in her joints despite aggressive therapy. She is a candidate for surgical correction. Her temperature is 38.2°C (100.9°F), and the rest of her vital signs are stable. Physical examination of the hands reveals multiple swan-neck, boutonniere, and Z-line deformities. Ulnar deviation is evident in both hands. She has flat feet. There are 3 firm, nontender nodules palpated around the right elbow and one on the left Achilles tendon. The spleen is palpated 5 cm below the costal margin with a percussion span of 15 cm. Lymphadenopathy is absent on exam.",What is the patient's Centor Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [64, 'years'], 'Temperature': [38.2, 'degrees celsius'], 'Tender/swollen anterior cervical lymph nodes': False}",1,1,1,"The criteria listed in the Centor Score formula are listed below:

1. Age: 3-14 years = +1 point, 15-44 years = 0 points, ≥45 years = -1 point
2. Exudate or swelling on tonsils: No = 0 points, Yes = +1 point
3. Tender/swollen anterior cervical lymph nodes: No = 0 points, Yes = +1 point
4. Temperature >38°C (100.4°F): No = 0 points, Yes = +1 point
5. Cough: Cough present = 0 points, Cough absent = +1 point

The Centor score is calculated by summing the points for each criterion.
    
The current Centor score is 0.
The patient is 64 years old. Because the age is greater than 44 years, we decrease the score by one point, making the score 0 - 1 = -1.
The patient's temperature is 38.2 degrees celsius. The patient's temperature is greater than 38 degrees Celsius, and so we add one point to the score, making the current score -1 + 1 = 0.
The patient note does not mention details about the patient coughing and so we assume it to be absent. Hence, we add 1 point to the score, making the current score 0 + 1 = 1.
The patient note reports 'tender/swollen anterior cervical lymph nodes' as absent for the patient. Hence, we do not change the score, keeping the current score at 1.
The patient note does not mention details about 'exudate or swelling on tonsils' and so we assume it to be absent. Hence, we do not change the score, keeping the current score at 1.
Hence, the Centor score for the patient is 1."
315,20,Centor Score (Modified/McIsaac) for Strep Pharyngitis,severity,integer,usmle-4768,Extracted,"An 8-year-old girl is brought into your clinic with a 5 day history of decreased oral intake, body aches and lymphadenopathy. She has no significant medical history. Upon further questioning you find that the patient frequently plays outside, where she enjoys chasing the neighborhood cats and dogs. She has had no recent sick contacts or travel to foreign countries. The patients vital signs are: temperature 100.4F, HR 80, BP 105/75 and RR 15. Physical exam is significant for a 1-cm erythematous and tender lymph node in the right posterior cervical area (Figure 1). There is a nearly healed scratch in the right occipital region.",What is the patient's Centor Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [8, 'years'], 'Temperature': [100.4, 'degrees fahrenheit'], 'Tender/swollen anterior cervical lymph nodes': False}",2,2,2,"The criteria listed in the Centor Score formula are listed below:

1. Age: 3-14 years = +1 point, 15-44 years = 0 points, ≥45 years = -1 point
2. Exudate or swelling on tonsils: No = 0 points, Yes = +1 point
3. Tender/swollen anterior cervical lymph nodes: No = 0 points, Yes = +1 point
4. Temperature >38°C (100.4°F): No = 0 points, Yes = +1 point
5. Cough: Cough present = 0 points, Cough absent = +1 point

The Centor score is calculated by summing the points for each criterion.
    
The current Centor score is 0.
The patient is 8 years old. Because the age is between 3 and 14 years, we add one point to the score making current score 0 + 1 = 1.
The patient's temperature is 100.4 degrees fahrenheit. To convert to degrees celsius, apply the formula 5/9 * [temperature (degrees fahrenheit) - 32]. This means that the patient's temperature is 5/9 * 68.4 = 38.0 degrees celsius. The patient's temperature is less than or equal to 38 degrees Celsius, and so we do not make any changes to the score, keeping the score at 1.
The patient note does not mention details about the patient coughing and so we assume it to be absent. Hence, we add 1 point to the score, making the current score 1 + 1 = 2.
The patient note reports 'tender/swollen anterior cervical lymph nodes' as absent for the patient. Hence, we do not change the score, keeping the current score at 2.
The patient note does not mention details about 'exudate or swelling on tonsils' and so we assume it to be absent. Hence, we do not change the score, keeping the current score at 2.
Hence, the Centor score for the patient is 2."
316,20,Centor Score (Modified/McIsaac) for Strep Pharyngitis,severity,integer,usmle-4327,Extracted,"A 16-year-old male presents to his pediatrician with complaints of malaise, fatigue, sore throat, and fever over the last several days. His vital signs are as follows: T 39.1 C, HR 82, BP 122/76, RR 14, and SpO2 99%. Physical examination is significant for splenomegaly, tonsillar exudate, and posterior auricular lymphadenopathy. The tonsils are not notably enlarged. Laboratory work-up shows an elevated lymphocyte count, atypical lymphocytes on a peripheral blood smear, and a positive heterophile antibody screen.",What is the patient's Centor Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [16, 'years'], 'Exudate or swelling on tonsils': True, 'Temperature': [39.1, 'degrees celsius']}",3,3,3,"The criteria listed in the Centor Score formula are listed below:

1. Age: 3-14 years = +1 point, 15-44 years = 0 points, ≥45 years = -1 point
2. Exudate or swelling on tonsils: No = 0 points, Yes = +1 point
3. Tender/swollen anterior cervical lymph nodes: No = 0 points, Yes = +1 point
4. Temperature >38°C (100.4°F): No = 0 points, Yes = +1 point
5. Cough: Cough present = 0 points, Cough absent = +1 point

The Centor score is calculated by summing the points for each criterion.
    
The current Centor score is 0.
The patient is 16 years old. Because the age is in between 15 and 44 years, the score does not change, keeping the score at 0.
The patient's temperature is 39.1 degrees celsius. The patient's temperature is greater than 38 degrees Celsius, and so we add one point to the score, making the current score 0 + 1 = 1.
The patient note does not mention details about the patient coughing and so we assume it to be absent. Hence, we add 1 point to the score, making the current score 1 + 1 = 2.
The patient note does not mention details about 'tender/swollen anterior cervical lymph nodes' and so we assume it to be absent. Hence, we do not change the score, keeping the current score at 2.
The patient note reports 'exudate or swelling on tonsils' as present for the patient. Hence, we increase the score by 1, making the current score 2 + 1 = 3.
Hence, the Centor score for the patient is 3."
317,20,Centor Score (Modified/McIsaac) for Strep Pharyngitis,severity,integer,usmle-8175,Extracted,"A 6-year-old girl presents to the clinic for a general checkup before her last scheduled DTaP vaccination. Her mother is concerned about mild swelling and redness at the site of injection after her daughter’s previous DTaP administration. The patient has mild spastic cerebral palsy. She was diagnosed with epilepsy at the age of 5, and it is well-controlled with levetiracetam. She is allergic to penicillin. Currently, she complains of malaise and mild breathlessness. The mother noted that her daughter has been sluggish for the last 3 days. Her vital signs are as follows: the blood pressure is 100/60 mm Hg, the heart rate is 90/min, the respiratory rate is 22/min, and the temperature is 38.8°C (101.8°F). On physical examination, the patient has slightly enlarged submandibular lymph nodes bilaterally and oropharyngeal erythema. On auscultation, there are diminished vesicular breath sounds with a few respiratory crackles over the lower lobe of the left lung.",What is the patient's Centor Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [6, 'years'], 'Exudate or swelling on tonsils': False, 'Temperature': [38.8, 'degrees celsius'], 'Tender/swollen anterior cervical lymph nodes': False}",3,3,3,"The criteria listed in the Centor Score formula are listed below:

1. Age: 3-14 years = +1 point, 15-44 years = 0 points, ≥45 years = -1 point
2. Exudate or swelling on tonsils: No = 0 points, Yes = +1 point
3. Tender/swollen anterior cervical lymph nodes: No = 0 points, Yes = +1 point
4. Temperature >38°C (100.4°F): No = 0 points, Yes = +1 point
5. Cough: Cough present = 0 points, Cough absent = +1 point

The Centor score is calculated by summing the points for each criterion.
    
The current Centor score is 0.
The patient is 6 years old. Because the age is between 3 and 14 years, we add one point to the score making current score 0 + 1 = 1.
The patient's temperature is 38.8 degrees celsius. The patient's temperature is greater than 38 degrees Celsius, and so we add one point to the score, making the current score 1 + 1 = 2.
The patient note does not mention details about the patient coughing and so we assume it to be absent. Hence, we add 1 point to the score, making the current score 2 + 1 = 3.
The patient note reports 'tender/swollen anterior cervical lymph nodes' as absent for the patient. Hence, we do not change the score, keeping the current score at 3.
The patient note reports 'exudate or swelling on tonsils' as absent for the patient. Hence, we do not change the score, keeping the current score at 3.
Hence, the Centor score for the patient is 3."
318,20,Centor Score (Modified/McIsaac) for Strep Pharyngitis,severity,integer,pmc-5745701-1,Extracted,"A 66-year-old female patient was admitted to our Internal Medicine Unit on July 2016 with a two-month history of low fever, malaise, fatigue, night sweats, gradual decrease in appetite, and body weight loss of 4 kilograms. She also complained of painful right laterocervical lymph nodes for 1 month. Her clinical history was unremarkable except for a hypothyroidism diagnosed in 2013 and treated with a daily dose of levothyroxine. She had no past history of tuberculosis or contact with it. On admission, her heart rate was 90 bpm, blood pressure was 110/60 mmHg, respiratory rate was 16 breaths/minute, and body temperature was 37.5°C. Physical examination revealed two right nontender, fixed, and painful laterocervical lymph nodes. There were no hepatosplenomegaly or other clinically appreciable lymphadenopathy elsewhere. Examination of respiratory and other systems was normal. Laboratory analysis showed slight increase in C-reactive protein (CRP), lactate dehydrogenase (LDH), and erythrocyte sedimentation rate (ESR) values that were, respectively, of 20 mg/L (n.v. < 2.9), 705 UI/L (n.v. < 450), and 54 mm/h. Thyroid hormones and neoplastic markers were all within the normal range. Antinuclear antibody, anti ds-DNA, and rheumatoid factor were negative; HIV, cytomegalovirus IgM, herpes virus IgM, Epstein–Barr virus IgM, Brucella, and Toxoplasma were all negative. Quantiferon exam was also negative. Chest X-ray was unremarkable. Ultrasonography revealed enlarged right-sided hypoechoic laterocervical (maximum size of 1.7 cm) and submental lymph nodes (size 1 cm) with low peripheral flow, eccentric cortical thickening, and deviation of the hila. A total body CT scan was then performed to better assess lymphadenopathy, and it confirmed the results of the ultrasounds. Because of a dilemma in clinical diagnosis and the persistence of symptoms, an excision biopsy of the largest laterocervical lymph node was performed. Histological examination showed paracortical necrotic foci with the presence of small to large CD3+, CD5+/−, CD4−/+, CD8+/− T lymphocytes, in addition to numerous histiocytes expressing CD68PGM1/MPO and abundant apoptotic nuclear debris. No polymorphonuclear neutrophils and no caseous necrosis were observed (Figures and ). On the basis of these morphological and immunophenotype findings, a diagnosis of Kikuchi–Fujimoto disease was made.
The patient was treated symptomatically with NSAIDs, and at two-month follow-up, malaise, fatigue, and appetite were improved; she denied fever and night sweats, and ultrasonography showed a decrease in the size of laterocervical lymph nodes, whereas submental lymph nodes were not detected. ESR, CRP, and LDH were also restored at normal range. At six-month follow-up, the patient was free of symptoms, and laterocervical lymph nodes were no more detectable on ultrasonography.",What is the patient's Centor Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [66, 'years'], 'Temperature': [37.5, 'degrees celsius'], 'Tender/swollen anterior cervical lymph nodes': True}",1,1,1,"The criteria listed in the Centor Score formula are listed below:

1. Age: 3-14 years = +1 point, 15-44 years = 0 points, ≥45 years = -1 point
2. Exudate or swelling on tonsils: No = 0 points, Yes = +1 point
3. Tender/swollen anterior cervical lymph nodes: No = 0 points, Yes = +1 point
4. Temperature >38°C (100.4°F): No = 0 points, Yes = +1 point
5. Cough: Cough present = 0 points, Cough absent = +1 point

The Centor score is calculated by summing the points for each criterion.
    
The current Centor score is 0.
The patient is 66 years old. Because the age is greater than 44 years, we decrease the score by one point, making the score 0 - 1 = -1.
The patient's temperature is 37.5 degrees celsius. The patient's temperature is less than or equal to 38 degrees Celsius, and so we do not make any changes to the score, keeping the score at -1.
The patient note does not mention details about the patient coughing and so we assume it to be absent. Hence, we add 1 point to the score, making the current score -1 + 1 = 0.
The patient note reports 'tender/swollen anterior cervical lymph nodes' as present for the patient. Hence, we increase the score by 1, making the current score 0 + 1 = 1.
The patient note does not mention details about 'exudate or swelling on tonsils' and so we assume it to be absent. Hence, we do not change the score, keeping the current score at 1.
Hence, the Centor score for the patient is 1."
319,20,Centor Score (Modified/McIsaac) for Strep Pharyngitis,severity,integer,usmle-262,Extracted,"A 7-year-old boy is brought to the physician for the evaluation of sore throat for the past 2 days. During this period, he has had intermittent nausea and has vomited once. The patient has no cough, hoarseness, or rhinorrhea. He had similar symptoms at the age of 5 years that resolved spontaneously. He is otherwise healthy. His temperature is 37.9°C (100.2°F), pulse is 85/min, and blood pressure is 108/70 mm Hg. Head and neck examination shows an erythematous pharynx with grayish exudates overlying the palatine tonsils. There is no lymphadenopathy. Rapid antigen detection test for group A streptococci is negative.",What is the patient's Centor Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [7, 'years'], 'Cough Absent': True, 'Temperature': [37.9, 'degrees celsius'], 'Tender/swollen anterior cervical lymph nodes': False, 'Exudate or swelling on tonsils': True}",3,3,3,"The criteria listed in the Centor Score formula are listed below:

1. Age: 3-14 years = +1 point, 15-44 years = 0 points, ≥45 years = -1 point
2. Exudate or swelling on tonsils: No = 0 points, Yes = +1 point
3. Tender/swollen anterior cervical lymph nodes: No = 0 points, Yes = +1 point
4. Temperature >38°C (100.4°F): No = 0 points, Yes = +1 point
5. Cough: Cough present = 0 points, Cough absent = +1 point

The Centor score is calculated by summing the points for each criterion.
    
The current Centor score is 0.
The patient is 7 years old. Because the age is between 3 and 14 years, we add one point to the score making current score 0 + 1 = 1.
The patient's temperature is 37.9 degrees celsius. The patient's temperature is less than or equal to 38 degrees Celsius, and so we do not make any changes to the score, keeping the score at 1.
The patient note reports an absence of cough and so we add 1 point to the score, making the current score 1 + 1 = 2.
The patient note reports 'tender/swollen anterior cervical lymph nodes' as absent for the patient. Hence, we do not change the score, keeping the current score at 2.
The patient note reports 'exudate or swelling on tonsils' as present for the patient. Hence, we increase the score by 1, making the current score 2 + 1 = 3.
Hence, the Centor score for the patient is 3."
320,20,Centor Score (Modified/McIsaac) for Strep Pharyngitis,severity,integer,pmc-8240916-1,Extracted,"A 57-year-old Asian woman experienced an abnormal feeling on the left side of her neck and difficulty breathing 90 minutes after eating a Chinese noodle dish containing roasted pork, egg, spinach, seasoned bamboo shoots, laver, and garlic. She was advised to call an ambulance by our triage nurse after telephone consultation and was transported to our hospital by a physician-staffed helicopter due to the long distance from her house to the hospital. She had a history of removal of a left sphenoid ridge meningioma one year earlier. She had experienced limited rigidity of her left neck and limited peripheral cold sensation on her left side in winter since approximately 10 years of age. She had experienced limited peripheral swelling of her left side and limited lower back pain of unknown origin on her left side several times. She had been suffering from oral allergy syndrome since she was young. She sometimes experienced a tingling sensation on her lips and an unpleasant feeling in her throat after eating some types of fruit. Those fruits included mandarins, oranges, kiwis, bananas, and pineapples. She was married but did not have any children.
On arrival, 180 minutes after eating the noodles, she had clear consciousness, and her blood pressure was 130/90 mmHg, her heart rate was 80 beats per minute, her percutaneous oxygen saturation was 100% under room air, and her body temperature was 36.9°C. She had left neck and chest swelling without color change. Her breathing difficulty subsided spontaneously.
The results of a blood analysis were as follows: white blood cells, 6,000/mm3; hemoglobin, 14.8 g/dL; platelets, 38.3 × 104/mm3; aspartate aminotransferase, 15 IU/L; alanine aminotransferase, 11 IU/L; total bilirubin, 0.5 mg/dL; total protein, 6.7 g/dL; glucose, 118 mg/dL; blood urea nitrogen, 18.9 mg/dL; creatinine, 0.90 mg/dL; amylase, 63 IU/L; creatine phosphokinase, 89 IU/L; sodium, 142 mEq/L; potassium, 4.0 mEq/L; chloride, 106 mEq/L; C-reactive protein, 0.05 mg/dL; prothrombin time, 10.6 (control, 11.9) sec; activated partial thrombin time, 26.4 (control, 26.9) sec; fibrinogen, 310 mg/dL; fibrin degradation products, 0.8 μg/mL; troponin T, 0.06 (0-0.14) ng/mL; and immunoglobulin E (IgE), 429 (0-250) IU/mL. Chest roentgen, an electrocardiogram and cardiac echography findings were all negative. Neck computed tomography (CT) with contrast medium and magnetic resonance imaging (MRI) revealed left-side-limited edema in the subcutaneous area and surrounding esophagus and bronchus (Figures , ).
These radiological findings excluded hemorrhaging or pseudoaneurysm formation. She underwent observational admission. After her edema improved, she was discharged on the third hospital day. A follow-up examination one week later showed complete resolution of the neck and chest edema. The results of a blood allergen test analysis (0-1.39) showed an elevated immunoglobulin E (IgE) level as follows: Japanese cedar, 44.30; betula alba, 7.27; orchard grass, 3.42; Japanese cypress, 2.65; dermatophagoides farina, 3.03; house dust, 1.85; and mugwort, 1.70. The remaining allergens were within the normal ranges, as follows (0-1.39): alder 1.35, timothy 0.85, 0.33; cat skin, 0.25; and Candida, 0.22. The results for the following allergens were all zero: ragweed, Alternaria, dog skin, wheat, buckwheat, soybean, rice, tuna, salmon, lobster, crab, milk, beef, chicken, pork, albumen, ovomucoid, peanut, sesame, kiwi, banana and latex. We also obtained blood samples from the bilateral upper extremities at the same time. The examination items that showed ≥5% laterality were as follows: white blood cell count (6,500/mm3 vs. 6,100/mm3), platelets (40.8 × 104/mm3 vs. 38.0 × 104/mm3, aspartate aminotransferase (12 IU/L vs. 11 IU/L), lactate dehydrogenase (184 IU/L vs. 172 IU/L) and creatinine (0.63 mg/dL vs. 0.58 mg/dL). We could not obtain permission from the patient for further a genetic analysis by skin biopsy.",What is the patient's Centor Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [57, 'years'], 'Temperature': [36.9, 'degrees celsius'], 'Tender/swollen anterior cervical lymph nodes': False}",0,0,0,"The criteria listed in the Centor Score formula are listed below:

1. Age: 3-14 years = +1 point, 15-44 years = 0 points, ≥45 years = -1 point
2. Exudate or swelling on tonsils: No = 0 points, Yes = +1 point
3. Tender/swollen anterior cervical lymph nodes: No = 0 points, Yes = +1 point
4. Temperature >38°C (100.4°F): No = 0 points, Yes = +1 point
5. Cough: Cough present = 0 points, Cough absent = +1 point

The Centor score is calculated by summing the points for each criterion.
    
The current Centor score is 0.
The patient is 57 years old. Because the age is greater than 44 years, we decrease the score by one point, making the score 0 - 1 = -1.
The patient's temperature is 36.9 degrees celsius. The patient's temperature is less than or equal to 38 degrees Celsius, and so we do not make any changes to the score, keeping the score at -1.
The patient note does not mention details about the patient coughing and so we assume it to be absent. Hence, we add 1 point to the score, making the current score -1 + 1 = 0.
The patient note reports 'tender/swollen anterior cervical lymph nodes' as absent for the patient. Hence, we do not change the score, keeping the current score at 0.
The patient note does not mention details about 'exudate or swelling on tonsils' and so we assume it to be absent. Hence, we do not change the score, keeping the current score at 0.
Hence, the Centor score for the patient is 0."
321,22,Maintenance Fluids Calculations,physical,decimal,pmc-6176125-1,Extracted,"A 68-year-old Japanese female was transferred to the ED by ambulance because she had fainted after dizziness. Her past medical history was hypertension, diabetes mellitus and chronic kidney disease, and she was on multiple medications. She had been anorexic for ~1 month. She was an ex-smoker and a social drinker.
On admission, her mental status was recovered and her conscious levels were E4V5M6 (Glasgow Coma Scale (GCS)). Her physical findings and vital signs were as follows: height 139.0 cm, body weight 52.3 kg, body mass index 27.1 kg/m2, blood pressure 128/75 mmHg, heart rate 152 beats/min with irregularity, body temperature 36.8°C, oxygen saturation on room air 98% and respiratory rate 18 breaths/min. Her physical examinations, which included her conjunctiva, cervical lymph nodes, chest, heart and abdomen, revealed normal findings.
Baseline laboratory results were as follows: white blood cell count (WBC) 10 300/μL↑, hemoglobin 12.8 g/dL, blood urea nitrogen 34 mg/dL↑, creatinine 4.09 mg/dL↑, sodium 128 mEq/L↓, potassium 2.6 mEq/L↓, chlorides 87 mEq/L↓, total protein 7.1 g/dL, albumin 4.2 g/dL, C-reactive protein (CRP) 0.07 mg/dL, glucose 262 mg/dL↑ and β-glycated hemoglobin 5.9%. Urinalysis revealed protein (1+), sugar (4+) and ketones (+) with no blood cells or casts. Electrocardiogram revealed atrial fibrillation, but there were no abnormal findings on chest radiograph or on brain or thoracicoabdominal computed tomography (CT).
These findings suggested that her AMS might be caused by one or more conditions, namely, hyponatremia, ketonuria, hyperglycemia and acute kidney injury (uremia), which were presumably due to dehydration, diabetic ketosis and chronic kidney disease. She was hospitalized and treated with electrolytes, including sodium chloride and potassium chloride, and insulin.
Although her blood electrolytes, serum glucose and renal function gradually improved, general conditions, including her consciousness, deteriorated. On the third day after hospitalization, her cognitive function became impaired with reduced conscious levels to E4V3M4 (GCS). Abnormal breaths with apnea and tachypnea accompanied by a fever (37.8°C) appeared, and glossoptosis was found (Fig. ). Both an oropharyngeal airway and bite block were placed in order to maintain her airway, which is we realized that she suffered from multiple, painful dental caries, but no findings of within the oropharynx.
Laboratory results on the hospital Day 3 were as follows: WBC 14 800/μL with 94.1% neutrophils↑ and CRP 0.08 mg/dL. There were no abnormal findings on chest radiograph, brain or thoracicoabdominal CT, brain magnetic resonance imaging, or spinal fluid examination.
Because no abnormalities were detected in the central nervous system, empiric treatment was initiated with 2.25 g q6hr of piperacillin/tazobactam for fever of unknown origin presumably caused by bacterial infection(s).
On hospital Day 6, a dentist examined her teeth and found 15 dental caries, then dental extractions were performed on four teeth. In particular, pus was discharged from the left upper canine with gingival swelling, which was diagnosed with acute apical abscess.
On hospital Day 7, her mental status was completely normal (Fig. ), indicating that apical abscess was acute, severe inflammation of the dental pulp with minimal chance of spontaneous recovery [–] and may have caused her AMS and abnormal breathing. Although two sets of blood cultures sampled on hospital Day 3 were negative, bacterial culture from the dental pus sampled on hospital Day 6 yielded methicillin-sensitive Staphylococcus aureus. Antibiotic treatment was de-escalated to 1 g q8hr of cefazolin on hospital Day 13 and was completed on hospital Day 20. The patient fully recovered and was discharged on hospital Day 23.","Based on the patient's weight, what is the patient's maintenance fluid in mL/hr?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'weight': [52.3, 'kg']}",92.3,87.685,96.915,"For patient's with weight less than 10 kg, the rule for computing maintenance fluid is to multiply their weight by 4 mL/kg/hr to get the maintenance fluids per hour.
For patient's with weight between 10 kg and 20 kg, the formula for computing maintenance fluid is 40 mL/hr + 2 mL/kg/hr * (weight (in kilograms) - 10 kilograms).
For patient's with weight greater than 20 kg, the formula for computing the maintenance fluid is 60 mL/hr + 1 mL/kg/hr * (weight (in kilograms) - 20 kilograms).
The patient's weight is 52.3 kg. Hence, plugging into this formula, we get 60 mL/hr + 1 mL/kg/hr * (52.3 kg - 20 kg) = 92.3 mL/hr.
Hence, the patient's fluid maintenance is 92.3 mL/hr."
322,22,Maintenance Fluids Calculations,physical,decimal,pmc-3237159-1,Extracted,"A 56 year-old male patient, ASA I, weighing 64 kg, diagnosed as having right renal mass, was scheduled for elective laparoscopic nephrectomy. He had no past history of allergy to drugs and his physical examination and investigations (blood investigations, chest X-ray and electrocardiogram) were all within normal limits. General anaesthesia with endotracheal intubation was planned for the surgery. On arrival in the operation theatre, his non-invasive blood pressure was 120/80 mmHg, heart rate was 78/min and SpO2 100% on room air were recorded.
After insertion of an 18G intravenous cannula in the dorsum of the hand, Inj. Magnamycin (Sulbactam and Cefoperazone) 1 g diluted in 10 ml of normal saline was injected slowly over 10 min and injection Amikacin sulphate 500 mg was given intravenous over 15 min in 100 ml normal saline. Because of some technical reasons there was a delay of 45 min before the induction of anaesthesia. During this time, the patient was haemodynamically stable with pulse of 70–75/min and BP 120/70 mmHg. At induction, fentanyl citrate 100 mg, propofol 80 mg and vecuronium bromide 6 mg was given to aid intubation. During the time positive-pressure ventilation was being given, the blood pressure dropped to 60/30 mmHg with tachycardia of 130–150 beats/min. The intravenous fluid infusion rate was increased and ephedrine 3 mg, repeated twice, was given intravenous. The trachea was intubated and the patient was ventilated with 100% O2. Thereafter, a cutaneous rash was visible all over the body and the patient's lips, eyes, ears and hands appeared swollen and edematous. A provisional diagnosis of drug reaction was made and resuscitation was started. Injection adrenaline 0.2 mg intravenous bolus, Trendelenberg position, intravenous crystalloids 2–2.5 L over the next 2 h and injection hydrocortisone 200 mg intravenous were given. During this time, his systolic blood pressure was between 40 and 60 mmHg and diastolic blood pressure was 25–40 mmHg, even after a repeat dose of intravenous adrenaline 0.2 mg. Because the blood pressure was not responding, adrenaline infusion 0.05 mg/kg/min was started. After about 1.5 h, the patient's condition started improving and he became hemodynamically stable. The inotropic support was gradually withdrawn. The patient was mechanically ventilated till the blood pressure stabilized to 100/60 mmHg and pulse rate to 100/min. There was no evidence of bronchospasm and peak inspiratory pressure remained within normal limits. We confirmed absence of edema in the oral cavity, uvula and epiglottis by larygoscopic examination. When the patient was fully awake and there was sufficient leak around the deflated cuff, the trachea was extubated after 3 h with Cook's airway exchanger in trachea, which was subsequently removed after a few hours [].
The surgery was postponed. The patient was kept under observation for 24 h in the post post-anaesthesia care unit and discharged home after 48 h.
Blood samples for plasma levels of lgE antibody were sent and the reported value was 350 ng/ml (normal reference value in our lab is less than 50 ng/ml). The patient underwent a skin test 3 weeks after the event. The skin test included skin prick test and intradermal test using saline as negative control and histamine as positive control. The prick test was performed on the anterior aspect of the forearm using a drop of undiluted propofol, vecuronium, amikacin, magnamycin, 10% intralipid and diluted fentanyl (1 in 10 dilution). It showed a positive response with propofol only. The intradermal test was then performed on the other forearm by injection of 0.02–0.05 ml of the diluted drugs in saline starting with a dilution of 1 in 1000 progressing to a dilution of 1 in 10. The intradermal test of propofol showed a positive response at 1 in 1000 dilution thus confirming our suspicion of anaphylaxis to propofol.
The same patient was again taken up for surgery 4 weeks later. This time, injection thiopentone sodium was used for induction instead of propofol while all other drugs were the same as that used for induction during the first time. The surgery and anaesthesia were uneventful [] and the patient was discharged after 3 days.","Based on the patient's weight, what is the patient's maintenance fluid in mL/hr?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'weight': [64.0, 'kg']}",104,98.8,109.2,"For patient's with weight less than 10 kg, the rule for computing maintenance fluid is to multiply their weight by 4 mL/kg/hr to get the maintenance fluids per hour.
For patient's with weight between 10 kg and 20 kg, the formula for computing maintenance fluid is 40 mL/hr + 2 mL/kg/hr * (weight (in kilograms) - 10 kilograms).
For patient's with weight greater than 20 kg, the formula for computing the maintenance fluid is 60 mL/hr + 1 mL/kg/hr * (weight (in kilograms) - 20 kilograms).
The patient's weight is 64.0 kg. Hence, plugging into this formula, we get 60 mL/hr + 1 mL/kg/hr * (64.0 kg - 20 kg) = 104.0 mL/hr.
Hence, the patient's fluid maintenance is 104.0 mL/hr."
323,22,Maintenance Fluids Calculations,physical,decimal,pmc-6445561-1,Extracted,"A 26-year-old Caucasian female with a past medical history of bilateral lung transplant for cystic fibrosis, end-stage renal disease on hemodialysis, pancreatic insufficiency, diabetes mellitus, hypothyroidism, hypertension, insomnia, seizures, and chronic pain presented with complaints of chest pain for one day along with a left lower extremity painful swelling that started four days prior to presentation. The chest pain was left-sided, sharp, non-radiating, with no aggravating or relieving factors. Her left lower extremity swelling extended from the hip down to her foot with tenderness most pronounced in the left thigh. Classic symptoms/signs of hypothyroidism such as lethargy, cold intolerance, myxedematous facies, constipation, and/or bradycardia were absent. Her daily home medications included tacrolimus, prednisone 5 mg daily, voriconazole 200 mg every 12 hours, azithromycin, amlodipine, pantoprazole, levothyroxine, pancrelipase (CREON), oxcarbazepine, amitriptyline, gabapentin, sevelamer carbonate, cetirizine, montelukast, and correctional sliding scale insulin.
Investigation
On examination she was in pain, cachectic, and in no acute respiratory distress. She weighed 46 kilograms (kg) with a BMI of 15.3. Her blood pressure was 171/101 mmHg, respiratory rate 18, heart rate 90, temperature 98 F, and oxygen saturation 96% on 2 liters (L) nasal cannula oxygen. She had temporal and masseter muscles wasting, with moist mucous membranes, with no oral thrush or ulcers. On pulmonary auscultation, there was diminished air entry bilaterally. Her abdominal and cardiovascular examinations were unremarkable. Her lower extremities both had pitting edema but it was worse on the left. There was marked tenderness of the posterior left thigh with mild left calf tenderness. She had intact pulses bilaterally with no skin discoloration or darkening of the toes.
Bilateral lower extremity Doppler and chest computed tomography with intravenous contrast pulmonary embolism (PE) protocol scan showed no deep venous thrombosis or PE. Troponin T was mildly elevated with no delta and no evidence of ischemia on the electrocardiogram (ECG). Her labs showed a normal creatinine phosphokinase (CPK) level of 27 U/L, mildly elevated serum aldolase of 8.7 U/L, thyroid-stimulating hormone (TSH) of 11.42 mIU/ml, C-reactive protein of 1.5 mg/dL, lactate dehydrogenase of 204 U/L, serum creatinine of 4.3 mg/dl, blood urea nitrogen of 44 mg/dl, 25 hydroxyvitamin D of 24 ng/ml, HbA1c of 5.1%, serum IgE level of less than 2 KU/L, tacrolimus serum level of 7.6 ng/ml, and white blood cell count of 3 k/uL. Serology was negative for anti-Sm and anti-RNP. A viral polymerase chain reaction (PCR) test for human immunodeficiency virus (HIV), herpes simplex virus (HSV), cytomegalovirus (CMV), Epstein-Barr (EBV) was negative. Her aspergillus galactomannan, serum histoplasma antigen, serum cryptococcal antigen were negative with positive beta-glucan. Radiograph of the left femur showed no skeletal abnormalities. With the persistence of her left leg pain, magnetic resonance imaging (MRI) without intravenous contrast was obtained to evaluate her soft tissue. MRI results demonstrated diffuse subcutaneous edema and edema in thigh musculature that was most pronounced within the hamstring muscles (red arrow). These findings were most consistent with myositis (Figure ).
Muscle biopsy was subsequently performed for further assessment and refining the myopathy subtype. It showed A) degenerating myofibers with macrophage infiltration (white arrow). This morphologic appearance typically favors a toxic/drug-induced myopathic process, B) arterioles appear somewhat thickened and hyalinized (black arrow) that warranted a Congo red stain, and the Congo Red stain was negative for amyloid (Figure ).
Treatment
Muscle biopsy was mostly consistent with drug-induced myositis. Upon reviewing her home medications for any potential causative agent, voriconazole was recognized as a possible inciting factor of her myositis. Her voriconazole was discontinued, and her prednisone dose was increased from 5 mg daily to 40 mg daily. She was slowly tapered by 5 mg every five days and continued on 10 mg after that to help with muscle swelling and inflammation. The patient experienced clinical improvement in terms of reduced left lower extremity swelling and resolution of pain and tenderness of the left thigh on her follow-up visit as an outpatient. Documentation of this adverse drug reaction was made in her chart for references. Of note, as her TSH was slightly elevated, free T4 was checked during the follow-up visit and was found to be 0.6 ng/dl. A higher dose of Synthroid was prescribed and three months later her TSH was 3.7 uIU/ml.","Based on the patient's weight, what is the patient's maintenance fluid in mL/hr?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'weight': [46.0, 'kg']}",86,81.7,90.3,"For patient's with weight less than 10 kg, the rule for computing maintenance fluid is to multiply their weight by 4 mL/kg/hr to get the maintenance fluids per hour.
For patient's with weight between 10 kg and 20 kg, the formula for computing maintenance fluid is 40 mL/hr + 2 mL/kg/hr * (weight (in kilograms) - 10 kilograms).
For patient's with weight greater than 20 kg, the formula for computing the maintenance fluid is 60 mL/hr + 1 mL/kg/hr * (weight (in kilograms) - 20 kilograms).
The patient's weight is 46.0 kg. Hence, plugging into this formula, we get 60 mL/hr + 1 mL/kg/hr * (46.0 kg - 20 kg) = 86.0 mL/hr.
Hence, the patient's fluid maintenance is 86.0 mL/hr."
324,22,Maintenance Fluids Calculations,physical,decimal,pmc-8138236-1,Extracted,"The patient was an 18-year-old Japanese woman with a chief complaint of abdominal pain. The onset of steroid-sensitive NS was at 9 years of age, and renal biopsy was performed at 11 years of age. Pathological diagnosis was MCNS. NS was in complete remission with steroid therapy. Frequent relapses occurred, and cyclosporine (CsA) and mizoribine (MZR) were added, but the frequency of relapses did not reduce. Cyclophosphamide was administered at 13 years of age, but the leukocyte count decreased and the treatment was discontinued in 1 month. After that, NS did not relapse, and MZR and CsA were discontinued at 16 and 17 years of age, respectively. The patient has not visited our hospital for 10 months and had no immunosuppressants at the time described below.
The patient experienced fever, cough, and malaise for 5 days prior to visiting our hospital. She was diagnosed with type B influenza and took oseltamivir by a local physician 4 days prior to visiting our hospital. The fever subsided 2 days after consulting the local physician. The patient had vomiting and diarrhea 1 day prior to visiting our hospital. She had severe abdominal pain and came to our hospital by an ambulance.
The physical findings on admission were as follows: height, 155 cm; weight, 54.7 kg (+5.0 kg); body temperature, 36.2°C; blood pressure, 97/59 mm Hg; heart rate, 96 bpm; and oxygen saturation on room-air, 99%. In addition, the patient did not have facial edema but had pitting edema of both lower legs. The laboratory findings were as follows: total protein, 3.4 g/dL; albumin, 0.9 g/dL; blood urea nitrogen, 17.7 mg/dL; creatinine, 0.44 mg/dL; estimated glomerular filtration rate, 135.6 mL/min/1.73 m2; total cholesterol, 255 mg/dL; immunoglobulin G (IgG), 210 mg/dL. Her urine protein to creatinine ratio was 8.73 g/gCr, and urine sediments showed 1–4 red blood cells per high-power field without any abnormal casts. There were no notable abnormalities seen in abdominal computed tomography or chest X-ray images. The patient was diagnosed with relapse of NS. But it was not known whether the abdominal pain, vomiting, and diarrhea were due to NS or the gastrointestinal symptoms from influenza B infection, it was decided to inject albumin without prednisolone (PSL) treatment. The level of proteinuria was 8.51 g/gCr on day 2 of admission and 0.51 g/gCr on day 3. Proteinuria decreased to 0.03 g/gCr with rest alone on day 4. A complete remission from NS was observed at approximately 2 weeks after the onset of influenza B infection.","Based on the patient's weight, what is the patient's maintenance fluid in mL/hr?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'weight': [54.7, 'kg']}",94.7,89.965,99.435,"For patient's with weight less than 10 kg, the rule for computing maintenance fluid is to multiply their weight by 4 mL/kg/hr to get the maintenance fluids per hour.
For patient's with weight between 10 kg and 20 kg, the formula for computing maintenance fluid is 40 mL/hr + 2 mL/kg/hr * (weight (in kilograms) - 10 kilograms).
For patient's with weight greater than 20 kg, the formula for computing the maintenance fluid is 60 mL/hr + 1 mL/kg/hr * (weight (in kilograms) - 20 kilograms).
The patient's weight is 54.7 kg. Hence, plugging into this formula, we get 60 mL/hr + 1 mL/kg/hr * (54.7 kg - 20 kg) = 94.7 mL/hr.
Hence, the patient's fluid maintenance is 94.7 mL/hr."
325,22,Maintenance Fluids Calculations,physical,decimal,pmc-4383127-1,Extracted,"A 28-year-old man (height 158 cm, 45 kg) presented to the preanesthetic assessment clinic before an elective right total hip replacement. He had ankylosing spondylitis that severely restricted the range of motion in his cervical, thoracic and lumbar spine. There was no cardiopulmonary involvement, and his hematological and biochemical parameters were within normal limits. Radiological studies done 1 month previously, revealed solid ankylosis of the facet joints between all lumbar vertebrae [].
Airway was anticipated to be difficult because of the lack of any extension of the cervical spine, fixed cervical flexion resulting in chin on chest deformity leads to difficulty with forward vision and severe cervical kyphosis. Awake intubation with lighted stylet was planned.
The patient was evaluated and signed the informed consent to undergo total hip arthroplasty (THA) under posterior lumbar plexus continuous plexus nerve block (CPNB). Prolonged analgesia and potential risks of using both catheters were discussed with the patient and family members.
On the day of surgery, the patient was brought to the block room, where intravenous access was secured, and standard monitors were applied. After administration of 100 μg of fentanyl and 0.25 mg of atropine blockade of the bilateral superior laryngeal nerve with 2 mL 2% lidocaine each side and translaryngeal block with 1.5 mL 6% lidocaine (1.5 mL of 2% lidocaine + 1.5 mL 10% lidocaine) was performed. Immediately, after was performed awake tracheal intubation with the aid of a lighted stylet. Induction of anesthesia with propofol, sevoflurane and controlled ventilation.
The patient was placed in the right lateral decubitus being conducted continuous blockade of the lumbosacral plexus (psoas compartment and parasacral) with Tuohy continuous nerve block set, with the help of the neurostimulator. The stimulating current delivered was 0.5 mA, with a stimulation of 0.3 ms at 2 Hz. Quadriceps contraction and plantar flexion of the foot were detected in all patients. Injected 40 mL of 2% lidocaine solution with epinephrine plus bupivacaine 0.5% (50:50) in the lumbar plexus, and 20 mL of the same solution in parasacral. The contiplex catheter was advanced to a depth of 5 cm past the needle tip in both plexus. Approximately, 5 mL of contrast (iohexol with 300 mg/mL Ominipaque®) were injected in both catheters to study the dispersion of a local anesthetic [].
During the procedure, 1500 mL of crystalloids and 500 mL of Voluven® (6% hydroxyethyl starch 130/0.4 in 0.9% saline) were administered. The urinary catheter was not used during the procedure. The sensory and motor blocks were adequate, and the patient remained hemodynamically stable intraoperatively. The surgery lasted 2:15 h.
At the end of the procedure, the patient was placed in the supine position. He recovered from the general anesthesia and was extubated. Before his discharge, a disposable elastomeric pump (Easypump®, B. Braun, Germany) containing 400 mL of 0.1% bupivacaine was connected to the both catheters. The pump was programmed for infusion at a rate of 10 mL/h, patient was transferred to ward.
During the 40 postoperative hours, boluses were not necessary. Both catheters were removed without intercurrences. After catheter removal, pain was controlled with oral ketoprofen and dypirone.","Based on the patient's weight, what is the patient's maintenance fluid in mL/hr?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'weight': [45.0, 'kg']}",85,80.75,89.25,"For patient's with weight less than 10 kg, the rule for computing maintenance fluid is to multiply their weight by 4 mL/kg/hr to get the maintenance fluids per hour.
For patient's with weight between 10 kg and 20 kg, the formula for computing maintenance fluid is 40 mL/hr + 2 mL/kg/hr * (weight (in kilograms) - 10 kilograms).
For patient's with weight greater than 20 kg, the formula for computing the maintenance fluid is 60 mL/hr + 1 mL/kg/hr * (weight (in kilograms) - 20 kilograms).
The patient's weight is 45.0 kg. Hence, plugging into this formula, we get 60 mL/hr + 1 mL/kg/hr * (45.0 kg - 20 kg) = 85.0 mL/hr.
Hence, the patient's fluid maintenance is 85.0 mL/hr."
326,22,Maintenance Fluids Calculations,physical,decimal,pmc-4578041-3,Extracted,"A female patient, aged 4 years and 4 months, was admitted to the hospital with a 3-year history of vomiting small amounts following every meal. No obvious causes of the vomiting were identified. Approximately 2 years prior to admission, the patient exhibited hyperpigmentation of the lips, in addition to fatigue, with a slow/stagnating increase in weight and height.
One month prior to admission, the patient had a seizure and was diagnosed with secondary epilepsy, based on an abnormal EEG. The patient was successfully treated with Topamax but continued to vomit >10 times/day. The patient was G2P2 with full-term normal delivery and a birth weight of 3.35 kg. The intellectual and physical development of the patient was similar to that of healthy children of the same age. There was no family history of genetic diseases, and the parents were in a non-consanguineous marriage.
The findings of the physical examination were as follows: BP, 85/55 mmHg; height, 92.7 cm; weight, 12 kg. The patient was mentally alert, and no significant anomalies were observed in the heart, lungs, abdomen, nervous system or external genitalia. A generalized hyperpigmentation was observed. Esophagography showed achalasia of the lower esophagus at the cardia. In the hospital, the patient was observed not to produce tears when crying. The results of a bilateral Schirmer test were 0 mm, which led to the diagnosis of alacrima. Further medical history confirmed that the alacrima had manifested at birth. Following the diagnosis of AS, the patient was treated with hydrocortisone replacement therapy (25 mg/m2), and the vomiting was alleviated. Genetic testing confirmed a c.1366C>T mutation in exon 15 of the AAAS gene (). No additional follow-up information is available for this patient.","Based on the patient's weight, what is the patient's maintenance fluid in mL/hr?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'weight': [12.0, 'kg']}",44,41.8,46.2,"For patient's with weight less than 10 kg, the rule for computing maintenance fluid is to multiply their weight by 4 mL/kg/hr to get the maintenance fluids per hour.
For patient's with weight between 10 kg and 20 kg, the formula for computing maintenance fluid is 40 mL/hr + 2 mL/kg/hr * (weight (in kilograms) - 10 kilograms).
For patient's with weight greater than 20 kg, the formula for computing the maintenance fluid is 60 mL/hr + 1 mL/kg/hr * (weight (in kilograms) - 20 kilograms).
The patient's weight is 12.0 kg. Hence, plugging into this formula, we get 40 mL/hr + 2 mL/kg/hr * (12.0 kg - 10 kg) = 44.0 mL/hr.
Hence, the patient's fluid maintenance is 44.0 mL/hr."
327,22,Maintenance Fluids Calculations,physical,decimal,pmc-6384032-1,Extracted,"A thin (41 kg) 85-year-old female presented with a 10-hour history of severe RUQ pain, nausea and vomiting. Her background included multiple lower abdominal laparotomies for gynaecological procedures, hypertension and dyslipidaemia. There were no clinical features of systemic upset. Her examination revealed a tender and guarded RUQ. Liver function tests were normal, white cell count was mildly elevated. Ultrasound demonstrated a distended gallbladder, without cholelithiasis and an asymmetrical gallbladder wall thickening to 8.5 mm. CT scan confirmed the diagnosis of acalculous cholecystitis, V-shaped superior portion of the gallbladder, low and horizontal lying gallbladder with hypoattenuation of the gallbladder wall compared with surrounding visceral structures (Figures -). After 24 hours of observation whilst on broad-spectrum antibiotics and simultaneous fluid resuscitation, the patient failed to clinically improve. The decision was made to undergo laparoscopic cholecystectomy.
Intra-operative findings revealed a large, necrotic, completely torted and floating gallbladder. Its only attachment appeared to be the cystic duct and cystic artery on which the gallbladder had twisted 360 degrees in an anti-clockwise direction (Figures -). Principles of the operation include derotation then cholecystectomy and intra-operative cholangiogram. To establish the required critical view, it was necessary to unravel the torted pedicle before proceeding with the dissection. The cholecystectomy was otherwise routine. Gallbladder was retrieved in an endoscopic specimen retrieval bag and decompressed in the bag to allow delivery of the specimen and prevent spillage of bile intra-abdominally.
Our patient’s discharge was delayed by an asymptomatic demand-related cardiac ischaemia, requiring 24-hour period of observation. She was discharged day two post-operatively with a plan for cardiology follow-up. Histology showed acute gangrenous cholecystitis.","Based on the patient's weight, what is the patient's maintenance fluid in mL/hr?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'weight': [41.0, 'kg']}",81,76.95,85.05,"For patient's with weight less than 10 kg, the rule for computing maintenance fluid is to multiply their weight by 4 mL/kg/hr to get the maintenance fluids per hour.
For patient's with weight between 10 kg and 20 kg, the formula for computing maintenance fluid is 40 mL/hr + 2 mL/kg/hr * (weight (in kilograms) - 10 kilograms).
For patient's with weight greater than 20 kg, the formula for computing the maintenance fluid is 60 mL/hr + 1 mL/kg/hr * (weight (in kilograms) - 20 kilograms).
The patient's weight is 41.0 kg. Hence, plugging into this formula, we get 60 mL/hr + 1 mL/kg/hr * (41.0 kg - 20 kg) = 81.0 mL/hr.
Hence, the patient's fluid maintenance is 81.0 mL/hr."
328,22,Maintenance Fluids Calculations,physical,decimal,pmc-5784682-2,Extracted,"The patient is a 13-years old female referred to our center for evaluation of dysmorphic features and congenital heart disease. She was born at term with uneventful prenatal and peripartum period. She was noticed after birth to have hypoplastic right thumb. Her parents, who are not related, have 4 other normal children. When she was initially evaluated in our center at the age of 6 and ½ years, her examination showed a head circumference of 45 cm (4.7 SD below the mean), a weight of 14.6 kg (4 SD below the mean) and a height of 100.5 cm (3 SD below the mean). She had upslanting palpebral fissures, bulbous nose, malformed right ear, retrognathia, low posterior hairline, webbed neck, and widely spaced nipples. The chest and abdominal examination was unremarkable. The cardiovascular examination revealed normal first heart sound, fixed split of second heart sound, and a systolic murmur grade 3/6 over the left upper sternal border. She had normal tone, power and deep tendon reflexes. The musculoskeletal examination revealed right thumb hypoplasia with absent thenar muscles, absent extensor pollicis longus, and thumb extensors. There was significant instability of the metacarpophalangeal joints of the right thumb. Skeletal survey revealed ankylosis between C3, C4 and C5 spine. The thoraacolumbar spine and the long tubular bones of both upper limbs were osteopenic. The right fifth metacarpal bone was short with hypoplasia of the first right metacarpal bone. The epiphysis of the first metacarpal bone was absent bilaterally. There was mild bilateral subluxation of the hip joints. The tibia and fibula were normal bilaterally. Hallux valgus at the interphalangeal joint was seen bilaterally. There was coning of the epiphysis of the second to fourth toes bilaterally. Echocardiogram revealed large secundum atrial septal defect measuring 12 mm with left to right shunt. Ultrasound of abdomen and pelvis indicated that the left kidney was rotated and ectopic lying down into the pelvis.
As part of routine diagnostic procedures a high-resolution GTW-banding study was carried on the patient’s sample. No gross abnormality was detected. Then, an aCGH experiment was performed as a further clinical screening and indicated an interstitial duplication pointed by 33 oligonucleotide probes on 5q35.2-q35.3. An interphase FISH using a probe (CTD-2301A4) within the duplicated interval re-confirmed the findings. To better characterize the duplication a high-resolution array (Cytogenetics Whole-Genome 2.7 M) from Affymetrix Inc. (Affymetrix Inc., San Paolo, CA, US) was utilized to further delineate the gain missed during the initial standard microscope based-karyotyping. This particular chip array utilizes 2.7 million markers including 400,000 SNP probes that provide whole-genome coverage with the one of the highest density coverage among the present platforms. Based on Affymetrix’s cytogenetic assay results, the duplication extends from 175,349,728 to 177,347,753 bp (hg19) and comprises 58 genes targeted by more than 600 SNP and copy number (CN) probes covering approximately 2.0 Mb (Fig. ). In comparison to the previously published duplications this duplication seems novel and does not share breakpoints with the compared cases.","Based on the patient's weight, what is the patient's maintenance fluid in mL/hr?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'weight': [14.6, 'kg']}",49.2,46.74,51.66,"For patient's with weight less than 10 kg, the rule for computing maintenance fluid is to multiply their weight by 4 mL/kg/hr to get the maintenance fluids per hour.
For patient's with weight between 10 kg and 20 kg, the formula for computing maintenance fluid is 40 mL/hr + 2 mL/kg/hr * (weight (in kilograms) - 10 kilograms).
For patient's with weight greater than 20 kg, the formula for computing the maintenance fluid is 60 mL/hr + 1 mL/kg/hr * (weight (in kilograms) - 20 kilograms).
The patient's weight is 14.6 kg. Hence, plugging into this formula, we get 40 mL/hr + 2 mL/kg/hr * (14.6 kg - 10 kg) = 49.2 mL/hr.
Hence, the patient's fluid maintenance is 49.2 mL/hr."
329,22,Maintenance Fluids Calculations,physical,decimal,pmc-7522174-1,Extracted,"Medical history and demographics
A 26-year-old female presented to the emergency department (ED) with a one-day history of feeling unwell, nausea, and vomiting. She had previous ED visits where she was found to have multiple electrolyte disturbances as well as symptoms of intermittent abdominal pain and vomiting. Her past medical history also included a diagnosis of abdominal migraines after extensive investigation as well as a past history of eating disorder. Her regular medications included propranolol 80 mg daily, omeprazole 40 mg daily, prochlorperazine 3 mg twice a day, and haloperidol 0.5 mg three times a day for intermittent nausea. The general examination was unremarkable. At the time of her visit, she weighed 53.0 kg (body mass index (BMI) 21.5 kg/m2).
Investigations
Initial blood investigations revealed very low levels of multiple serum electrolytes with life-threatening hypokalemia. Urine investigations also revealed a low urine sodium level along with reduced urine osmolality (Table ). An electrocardiogram demonstrated life-threatening features in keeping with severe hypokalemia (Figure ).
Treatment
The patient was treated with intravenous potassium, phosphate, and magnesium in 0.9% sodium chloride solution while maintaining a 2 liter/day fluid restriction. Serum electrolytes returned to normal within 72 hours. She was discharged shortly afterwards with a short course of oral potassium.
Outcome and follow-up
The reason for her presentations remained undetermined because she denied excess fluid intake or a concurrent eating disorder. Historical results indicated chronic mild hypokalemia (range: 2.9-3.2 mmol/L) and hypochloremia (range: 67-94 mmol/L). Renin-aldosterone assay during normal potassium levels ruled out Conn’s syndrome. The patient’s serum electrolytes began to fall again but returned to normal after an overnight (12-hour) fluid fast. This confirmed reversibility of the patient's dyselectrolytemias (Table ).
After discussing the results, the patient admitted to drinking 4-6 liters of water a day to relieve intermittent abdominal pain. When severe, she would drink 6-8 liters of water within an hour. We discussed polydipsia and water intoxication and its detrimental effects on brain and cardiac function. The patient had no more admissions with electrolyte disturbance thereafter.","Based on the patient's weight, what is the patient's maintenance fluid in mL/hr?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'weight': [53.0, 'kg']}",93,88.35,97.65,"For patient's with weight less than 10 kg, the rule for computing maintenance fluid is to multiply their weight by 4 mL/kg/hr to get the maintenance fluids per hour.
For patient's with weight between 10 kg and 20 kg, the formula for computing maintenance fluid is 40 mL/hr + 2 mL/kg/hr * (weight (in kilograms) - 10 kilograms).
For patient's with weight greater than 20 kg, the formula for computing the maintenance fluid is 60 mL/hr + 1 mL/kg/hr * (weight (in kilograms) - 20 kilograms).
The patient's weight is 53.0 kg. Hence, plugging into this formula, we get 60 mL/hr + 1 mL/kg/hr * (53.0 kg - 20 kg) = 93.0 mL/hr.
Hence, the patient's fluid maintenance is 93.0 mL/hr."
330,22,Maintenance Fluids Calculations,physical,decimal,pmc-5548950-1,Extracted,"A 30-year-old male who was 161 cm tall and weighed 91 kg (morbid obesity, body mass index 35.0 kg/m2) underwent WLL as treatment for PAP (). The patient had been suffering dyspnea on exertion for three years. His vital signs were blood pressure (BP) 130–150/70–80 mmHg, heart rate (HR) 80–100 beats/min, respiratory rate (RR) 18–22 rates/min, and body temperature 36.2℃. The patient's oxygen saturation by pulse oximeter (SpO2) while receiving air was 75–89%, which was partially corrected to 91–98% while receiving 2 L/min of oxygen via nasal prong (VNP). Arterial blood gas analysis (ABGA) under oxygen administration revealed the following: pH 7.39, arterial CO2 partial pressure (PaCO2) 44.6 mmHg, arterial O2 partial pressure(PaO2) 65.3 mmHg, and bicarbonate (HCO3–) 26.1 mEq/L.
During induction, both mask ventilation and intubation were difficult (laryngeal view: Cormack-Lehane grade IV). Intubation trials with a 37-Fr. left-sided double lumen tube (DLT) (Mallinckrodt™, Covidien, Dublin, Ireland) and laryngoscopy, followed by a videostylet (Optiscope®, Pacific Medical, Seoul, Korea) failed. Hence, a flexible fiberoptic bronchoscope (FOB) was used to intubate a single lumen tube (SLT) (ID 8.0), and then the SLT was changed to a DLT using a tube exchanger.
Left one-lung ventilation (OLV) was maintained with an SpO2 of 86–90% at an inspired oxygen fraction (FIO2) of 1.0 during right-lung lavage. We performed external percussion physiotherapy with an automatic mechanical percussion device (The Vest™ Model 205 [Airway Clearance System], frequency 10 Hz, duration 3 minutes, Hill-Rom, Charleston, SC, USA) rather than manual chest percussion. After right-lung lavage, we resumed two-lung ventilation (TLV) with intermittent suction for 20 minutes (FIO2 1.0). For left-lung lavage, right OLV was started with an FIO2 of 1.0, but it was impossible to maintain SpO2 > 80% (). Therefore, we decided to postpone left-lung lavage until conditions in the right lung improved (). A chest X-ray taken after intensive care unit (ICU) transfer showed no specific findings, including pneumothorax. One day after the lavage, while in the ICU, the patient was weaned from mechanical ventilation, extubated, and transferred to the general ward.
Three days later, the patient was returned to the operating room for left-lung lavage. The patient's SpO2 was 91–96% with O2 3 L/min VNP. We intubated the trachea with a SLT via Glide-Scope (Verathon Medical, British Columbia, Canada) and then changed the SLT to a DLT with a tube exchanger because the previous intubation was difficult. We confirmed breath sounds from both lungs, and right and left lung ventilation during separation through auscultation. The proper tube location was confirmed using an FOB.
TLV was performed in volume-controlled mode: FIO2 1.0, tidal volume of 400 ml, RR of 15 rates/min, peak inspiratory pressure (PIP) of 31 cmH2O, and positive end-expiratory pressure (PEEP) of 5 cmH2O. PaO2 was 57 mmHg (SpO2 86%) on ABGA examination. Fifty minutes after induction, we started right OLV in pressure-controlled mode: FIO2 1.0, inspiratory pressure of 25 cmH2O above PEEP 5 cmH2O, tidal volume of 200 ml, and RR of 20 /min. Within a few minutes of starting right OLV, the patient's SpO2 plunged below 80%, so we rapidly resumed TLV and re-confirmed the proper position of the DLT using an FOB. We did not observe any bronchial secretion or obstruction. Right OLV was tried again, but the patient's SpO2 rapidly decreased to < 80% within a few minutes. After resuming TLV, 2.5 mg of salbutamol was nebulized to relieve any bronchial constriction, and 100 mg of hydrocortisone was injected intravenously to improve symptoms. During manual ventilation, we detected very poor lung compliance. In auscultation, the patient's breath sounds from the right lung were very distant and nearly inaudible. Therefore, we suspected he had a right-side pneumothorax, which was confirmed on chest X-ray (). A chest tube was inserted by a thoracic surgeon, and a follow-up chest X-ray showed that the pneumothorax had decreased (). Two hours after induction, lung compliance and arterial oxygenation improved: FIO2 1.0, tidal volume of 450 ml, RR of 18/min, PIP of 24 cmH2O, and PEEP of 5 cmH2O. PaO2 improved to 93 mmHg on the following ABGA examination ().
We re-tried right OLV and were finally able to maintain SpO2 > 90%: FIO2 1.0, inspiratory pressure of 23 cmH2O above PEEP 5 cmH2O, tidal volume of 320 ml, and RR of 20 /min, without any severe air leakage or tidal-volume loss. The left-lung lavage was started along with right OLV with the chest tube inserted state. During the remaining lavage period, we maintained SpO2 > 85% without further deterioration.
After lavage, the patient was transferred to the ICU and received mechanical ventilation. On postoperative day (POD) 1, the patient developed a high fever (38.8℃) and was diagnosed as having pneumonia with parapneumonic effusion in the right lower lobe, so antibiotics were administered. The chest tube was removed on POD 3, and extubation was performed on POD 4. The patient was transferred to the general ward on POD 7 and discharged on POD 19. Follow-up chest computed tomography was performed 40 days after the left-lung lavage; it showed interval decreases in the extent of PAP in both lungs, resolved parenchymal consolidation in the right lung, and decreased right pleural effusion ().","Based on the patient's weight, what is the patient's maintenance fluid in mL/hr?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'weight': [91.0, 'kg']}",131,124.45,137.55,"For patient's with weight less than 10 kg, the rule for computing maintenance fluid is to multiply their weight by 4 mL/kg/hr to get the maintenance fluids per hour.
For patient's with weight between 10 kg and 20 kg, the formula for computing maintenance fluid is 40 mL/hr + 2 mL/kg/hr * (weight (in kilograms) - 10 kilograms).
For patient's with weight greater than 20 kg, the formula for computing the maintenance fluid is 60 mL/hr + 1 mL/kg/hr * (weight (in kilograms) - 20 kilograms).
The patient's weight is 91.0 kg. Hence, plugging into this formula, we get 60 mL/hr + 1 mL/kg/hr * (91.0 kg - 20 kg) = 131.0 mL/hr.
Hence, the patient's fluid maintenance is 131.0 mL/hr."
331,22,Maintenance Fluids Calculations,physical,decimal,pmc-3710286-1,Extracted,"A 22-years-old female nurse was admitted because of myalgias since 10 days, vomiting and diarrhea since 4 days, and generalized weakness and dizziness since 3 days. She had a history of Raynaud’s disease and of a restless leg syndrome since 9 years. She reported to take no medication against these disorders. The family history was negative for renal and muscle disease. Clinical examination showed an alert young female with 160 cm length and 46 kg weight (Body mass index 18). Blood pressure was 115/80 mm Hg and the respiratory rate 12/min. No abnormalities were found at clinical examination. There were no abnormalities in the skin turgor. Blood tests revealed severe hypokalemia with a lowest value of 1.1 mmol/l, moderate hyponatremia, metabolic alkalosis, mild renal insufficiency and creatinphosphokinase (CK) elevation (Table ). Urine electrolytes on day 2 showed a decreased excretion of potassium (9 mmol/l, normal range 20–80 mmol/l) and sodium (29 mmol/l, normal range 54–150 mmol/l). Thyroid function tests were normal. The electrocardiogram showed ST-segment abnormalities and a prolonged QT interval (Figure ). Since the severe hypokalemia and alkalosis were not explained by the gastrointestinal problems, she was asked for intake of diuretics even 12 hours after admission. She confessed that she has taken 250 mg furosemide/day for the last 4 months in order to improve the shape of her muscles and to have a more brawny appearance. She had received the tablets from a physician who attended the same gym where she exercised. The patient was diagnosed as suffering from furosemide-induced hypokalemia and rhabdomyolysis. Parenteral and enteral substitution of potassium, sodium and magnesium was started. The serum electrolyte levels normalized within 4 days. CK levels gradually decreased, normalized after two weeks and the myalgias regressed. A psychiatric investigation excluded suicidality, depression or eating disorder, diagnosed an adjustment disorder and recommended psychotherapy. Her heart rhythm was monitored during 7 days and did not show any arrhythmias. Echocardiography did not disclose any cardiac abnormalities, and the electrocardiogram normalized (Figure ). After 7 days she left the hospital and returned for blood tests after one week.","Based on the patient's weight, what is the patient's maintenance fluid in mL/hr?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'weight': [46.0, 'kg']}",86,81.7,90.3,"For patient's with weight less than 10 kg, the rule for computing maintenance fluid is to multiply their weight by 4 mL/kg/hr to get the maintenance fluids per hour.
For patient's with weight between 10 kg and 20 kg, the formula for computing maintenance fluid is 40 mL/hr + 2 mL/kg/hr * (weight (in kilograms) - 10 kilograms).
For patient's with weight greater than 20 kg, the formula for computing the maintenance fluid is 60 mL/hr + 1 mL/kg/hr * (weight (in kilograms) - 20 kilograms).
The patient's weight is 46.0 kg. Hence, plugging into this formula, we get 60 mL/hr + 1 mL/kg/hr * (46.0 kg - 20 kg) = 86.0 mL/hr.
Hence, the patient's fluid maintenance is 86.0 mL/hr."
332,22,Maintenance Fluids Calculations,physical,decimal,pmc-8143824-1,Extracted,"A three-year-old male with a history of obstructive sleep apnea presented to the pediatric emergency department (PED) on postoperative day (POD) three with a chief complaint of hematemesis. The morning of presentation, the patient awoke fussy and subsequently began to vomit. His mother witnessed a clot in the emesis with frank hematemesis with continued bleeding coming from the oropharynx, and she transported him via personal vehicle to the hospital. Upon arrival, the patient was afebrile at 37.5ºC, with a heart rate of 137 beats per minute, respiratory rate of 28 breaths per minute, oxygen saturation of 98% on room air, blood pressure of 111/85 millimeters mercury (mm Hg), and weight of 12 kilograms (kg). On exam, the patient appeared pale and tachycardic with active retching, and with blood pooled in the posterior oropharynx that obscured visualization of the tonsillar beds.
A complete blood count (CBC), coagulation profile, and type and cross were obtained, and ondansetron was administered intravenously (IV). A cold-water rinse was attempted; however, the patient did not tolerate this intervention. Nebulized TXA was administered by using 250 milligrams (mg) (50mg/per milliliter) IV solution via direct nebulization at a flow rate of eight liters over four minutes without additive of normal saline solution. After administration of TXA, the patient had no obvious bleeding from the posterior pharynx and his retching improved. He was then admitted to the general pediatric inpatient service for further monitoring with pediatric otolaryngology (ENT) consultation. The CBC and coagulation studies were within the normal range on admission with hemoglobin 12.0 grams per deciliter (gm/dL) (normal range 11.5–14.5 gm/dL), prothrombin time (PT) 13.8 seconds (sec) (11.7–14.7 sec), and partial thromboplastin time (PTT) 33.3 sec (25–35 sec).
These lab tests were not repeated during his hospitalization. After an initial refusal of oral intake requiring maintenance IV fluids the patient was able to be transitioned to a soft diet, which he tolerated, and he was discharged on hospital day three. He had no further bleeding, and no adverse effects from nebulized TXA were documented. The patient’s initial surgery was performed at an outside facility, and no follow-up visits were done at our institution for review.","Based on the patient's weight, what is the patient's maintenance fluid in mL/hr?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'weight': [12.0, 'kg']}",44,41.8,46.2,"For patient's with weight less than 10 kg, the rule for computing maintenance fluid is to multiply their weight by 4 mL/kg/hr to get the maintenance fluids per hour.
For patient's with weight between 10 kg and 20 kg, the formula for computing maintenance fluid is 40 mL/hr + 2 mL/kg/hr * (weight (in kilograms) - 10 kilograms).
For patient's with weight greater than 20 kg, the formula for computing the maintenance fluid is 60 mL/hr + 1 mL/kg/hr * (weight (in kilograms) - 20 kilograms).
The patient's weight is 12.0 kg. Hence, plugging into this formula, we get 40 mL/hr + 2 mL/kg/hr * (12.0 kg - 10 kg) = 44.0 mL/hr.
Hence, the patient's fluid maintenance is 44.0 mL/hr."
333,22,Maintenance Fluids Calculations,physical,decimal,pmc-4377186-1,Extracted,"A 72-year-old woman with a 10-year history of hypertension visited a local hospital presenting with anasarca and 15-kg weight gain in the past 3 months. She did not have fever, appetite loss, night sweats, or dyspnea. Because of elevated liver enzymes and abdominal computed tomography (CT) abnormalities, including splenomegaly and multiple splenic tumors, she was referred to our hospital.
On admission, physical examination of the patient revealed the following: temperature, 36.3 °C; pulse rate, 84 beats per minute, regular; blood pressure, 132/74 mmHg; and respiration rate, 18 breaths per minute. Although she had remarkable anasarca, she seemed in no distress. Her height was 143.5 cm, body weight 71 kg, and body mass index 34.2. She had no jugular venous distention. Lymphadenopathy was not noted. No crackles were audible, but there were diminished breath sounds in the base of the right lung. She had remarkable nonpitting and slow pitting mixed edema of the legs. A delayed relaxation time of the Achilles tendon reflex was observed.
Laboratory test results revealed the following: white blood cell count, 7,400 cells/mm3; hemoglobin, 11.6 g/dL; platelet count, 103,000/μL; total protein, 6.0 g/dL; albumin, 2.9 g/dL; aspartate aminotransferase, 27 IU/L; alanine aminotransferase, 20 IU/L; lactate dehydrogenase, 707 IU/L; alkaline phosphatase, 629 IU/L; total-bilirubin, 0.69 mg/dL; blood urea nitrogen, 11 mg/dL; creatinine, 0.65 mg/dL; creatinine kinase, 15 IU/L; thyroid-stimulating hormone (TSH), 0.45 μU/mL (standard value: 0.45-3.33 μU/mL); free thyroxine (FT4), 0.37 ng/dL (standard value: 0.84-1.44 ng/dL); free triiodothyronine (FT3), 0.89 pg/mL (standard value: 2.11-3.51 pg/mL); and soluble interleukin-2 receptor, 6,660 U/mL (standard value: 124–466 U/mL). Urinary protein level was 0.2 g/g creatinine. A contrast-enhanced CT of the head, neck, chest, abdomen, and pelvis revealed splenomegaly and multiple spleen tumors (Figure ), whereas there was no lymphadenopathy. CT-guided biopsy of the spleen was performed, which showed aggregated large atypical cells. The individual cells had the chromatin-rich nuclei and relatively abundant intracytoplasmic eosinophilic inclusion bodies (Figure ). Immunohistochemistry showed that the atypical cells were positive for CD20 and CD79a, and negative for CD3 and CD10. Histopathology and immunohistochemistry of the spleen led to the diagnosis of DLBCL.
We assessed the central hypothyroidism because of anasarca, delayed Achilles tendon reflex, and low FT4.
Head magnetic resonance imaging (MRI) revealed swelling of pituitary gland, but a normal-size of pituitary gland was confirmed in a head MRI performed 1 year before (Figure a, b). Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were also at low levels (LH 0.3 mIU/mL [standard value: 6.7-38.0 mIU/mL] and FSH 3.4 mIU/mL [standard value: 26.2-113.3 mIU/mL]). Cortisol level was 21.6 μg/dL [standard value: 4.0-18.3μg/dL] and ACTH was 33.4 pg/mL [standard value: 7.2-63.3 pg/mL]. Prolactin was 9.2 ng/mL[standard value: 3.12-15.39 ng/mL(menopause women) ]. AVP level was not measured but there were no polyuria and hyponatremia. We diagnosed pituitary anterior lobe hormone insufficiency.
Positron emission tomography (PET) scan revealed a localized accumulation in the pituitary gland, spleen, and para-abdominal aorta lymph nodes (Figure ). Pituitary gland biopsy was not performed; however, we clinically diagnosed central hypothyroidism caused by pituitary gland infiltration of DLBCL (clinical stage IV in the Ann Arbor staging classification).
She received 25 μg per day of levothyroxine for one week before the chemotherapy. However, the dose and duration of levothyroxine were not enough. The first course of chemotherapy for DLBCL including methotrexate, vincristine, ifosfamide, and dexamethasone, which improved anasarca remarkably and the patient’s body weight returned to what it was 3 months before. Moreover, thyroid hormone, LH, and FSH levels normalized and the pituitary gland swelling improved (Figure c), although thyroid hormone replacement therapy was not effective before chemotherapy (Figure ). We chose a second course of chemotherapy that comprised cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisone (CHOP) because there were no atypical cells in the patient’s cerebrospinal fluid. This second course of chemotherapy led to remission and the same chemotherapy regimen was repeated.
Here, we describe a case of pituitary gland infiltration of DLBCL associated with central hypothyroidism, which caused remarkable anasarca. In this case, only a few clinical manifestation were anasarca and a delayed relaxation time of the Achilles tendon reflex, other than the typical symptoms of lymphoma (fever, night sweats, and weight loss).
Pituitary gland involvement as extranodal lymphoma is comparatively rare [,], and DLBCL is one of the most frequent histological types for pituitary gland involvement []. Infiltration of lymphoma cells to the pituitary gland lead to headache, opthalmoplegia, or hemianopia [], and often causes diabetes insipidus []. Anasarca is a rare symptom in patients with lymphoma [].
Moreover, lymphoma with pituitary gland infiltration seldom shows significant anasarca or weight gain caused by secondary central hypothyroidism. Some patients with lymphoma who have pituitary gland involvement have no symptom, and they are incidentally detected using PET or MRI []. We clinically diagnosed infiltration of a malignant lymphoma in the pituitary gland based on time-dependent changes in MRI findings, thyroid hormone, LH, and FSH levels before and after chemotherapy; and PET findings.
Infiltration of DLBCL cells to the pituitary gland caused secondary central hypothyroidism, and secondary central hypothyroidism led to anasarca and weight gain in our patient. Nonpitting edema was noted, provably caused by hypothyroidism, and slow pitting edema resulting from hypoalbuminemia was observed simultaneously.
Elderly people often have several disorders at the same time; however, we believe that, in explaining manifestations, one disorder should account for every symptom. In this case, the patient had remarkable anasarca because of DLBCL involvement of the pituitary gland. This case was very valuable because we could assess the patient’s abnormalities; that is to say, anasarca, weight gain, hypothyroidism, elevated lactate dehydrogenase and alkaline phosphatase, splenomegaly, and swelling of the pituitary gland caused by malignant lymphoma and its infiltration into the pituitary gland.
In this era of longevity, the prevalence of diseases increases, and we must anticipate the greater likelihood of multiple, simultaneous diagnoses []. Hickam’s dictum and Occam’s razor are well suited to this case. “A patient can have as many diagnoses as he darn well pleases” []. This is Hickam’s dictum. However, William of Ockham stated “Among competing hypotheses, favor the simplest one” []. This is known as Occam’s razor.
It was easy to assess laboratory abnormalities, splenomegaly, and multiple spleen tumors that resulted from the malignant lymphoma. It was also easy to assess anasarca that was due to hypothyroidism and hypoalbuminemia. In this case, however, we reached the correct diagnosis of pituitary gland involvement from DLBCL, which manifested significant anasarca, according to Occam’s razor. A pituitary gland lesion with central hypothyroidism should be considered as one of the differential diagnoses of edema, especially nonpitting edema in some cases.","Based on the patient's weight, what is the patient's maintenance fluid in mL/hr?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'weight': [71.0, 'kg']}",111,105.45,116.55,"For patient's with weight less than 10 kg, the rule for computing maintenance fluid is to multiply their weight by 4 mL/kg/hr to get the maintenance fluids per hour.
For patient's with weight between 10 kg and 20 kg, the formula for computing maintenance fluid is 40 mL/hr + 2 mL/kg/hr * (weight (in kilograms) - 10 kilograms).
For patient's with weight greater than 20 kg, the formula for computing the maintenance fluid is 60 mL/hr + 1 mL/kg/hr * (weight (in kilograms) - 20 kilograms).
The patient's weight is 71.0 kg. Hence, plugging into this formula, we get 60 mL/hr + 1 mL/kg/hr * (71.0 kg - 20 kg) = 111.0 mL/hr.
Hence, the patient's fluid maintenance is 111.0 mL/hr."
334,22,Maintenance Fluids Calculations,physical,decimal,pmc-6580827-1,Extracted,"A 23 year old male, first time donor, software engineer, weighing 56 kg with no abnormal medical history or physical examination findings came for voluntary blood donation at the blood donation drive near his office. He had adequate sleep, had taken meal 2 hour back and did not appear unduly anxious. A volume of 350 ml of whole blood was collected from him without any immediate adverse events. He was observed for 15 min postdonation. Following postdonation refreshment and proper postdonation instructions, the donor left the donation premises. Forty minutes later, he had an episode of the loss of consciousness (LOC) and fell on the road and injured himself. LOC lasted for nearly 2 min and was not associated with convulsion or incontinence. He was immediately attended to by blood collection team who were still present at the donation site.
On examination, the donor was conscious but confused. He was found to have a lacerated wound (3 cm × 1 cm) on the lower surface of the chin, fracture teeth, active bleeding from the mouth, tender swelling over the left tempero-mandibular joint area. His pulse rate was 82/min, regular with normal rhythm. The blood pressure was 110/66 mm Hg. Focal neurological deficits were ruled out. On auscultation, air entry into the lungs was bilaterally equal; the abdomen was soft and nontender.
Immediate management was initiated by maintaining the airway and elevation of the foot end. The donor was reassured. Hemostasis was achieved by compression and wound dressing. The donor with a bystander was immediately shifted to our hospital for further management. The laceration was sutured (See ). Neurosurgery and oro-maxillo-facial surgery consultation were taken. Computed tomography of the head and brain showed fracture neck of the left mandible, fracture left lower incisor, and left lower molar tooth (See Figures -). Fracture mandible was managed conservatively. He was advised restricted jaw movement and liquid diet for 3 weeks. Suture removal was done after 7 days. The donor was regularly followed up by the blood center to ensure his health status. The donor recovered from the injury with full medical support from the Department of Transfusion Medicine. Reaction and outcome were reported to the Hemovigilance Programme of India.","Based on the patient's weight, what is the patient's maintenance fluid in mL/hr?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'weight': [56.0, 'kg']}",96,91.2,100.8,"For patient's with weight less than 10 kg, the rule for computing maintenance fluid is to multiply their weight by 4 mL/kg/hr to get the maintenance fluids per hour.
For patient's with weight between 10 kg and 20 kg, the formula for computing maintenance fluid is 40 mL/hr + 2 mL/kg/hr * (weight (in kilograms) - 10 kilograms).
For patient's with weight greater than 20 kg, the formula for computing the maintenance fluid is 60 mL/hr + 1 mL/kg/hr * (weight (in kilograms) - 20 kilograms).
The patient's weight is 56.0 kg. Hence, plugging into this formula, we get 60 mL/hr + 1 mL/kg/hr * (56.0 kg - 20 kg) = 96.0 mL/hr.
Hence, the patient's fluid maintenance is 96.0 mL/hr."
335,22,Maintenance Fluids Calculations,physical,decimal,pmc-6414298-1,Extracted,"A 67-year-old, 115.3 kg, 157-cm female patient with papillary serous adenocarcinoma of the uterine adnexa and uterine masses was brought to the operating room for an exam under anesthesia, exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, debulking, and lymph node dissection. Her medical history included hypertension, hemorrhoids, morbid obesity (body mass index (BMI) 46.8), and a pulmonary embolism three months prior to surgery. Enoxaparin sodium was stopped two days prior to surgery. The patient’s functional capacity was moderate to excellent at greater than or equal to four metabolic equivalents (METS). She reported completion of all household chores, cycled three to five miles daily and was capable of climbing two flights of stairs. She reported no history of anesthetic complications and no family history of anesthetic complications. Her surgical history included one previous colonoscopy, for which she received deep sedation.
The patient's home medications included prochlorperazine 10 mg as needed after chemotherapy, dexamethasone 4 mg for three days only after chemotherapy, rivaroxaban 20 mg daily, and enoxaparin 120 mg/0.8 mL solution subcutaneous (held two days prior to surgery). In addition, hydrochlorothiazide-valsartan 12.5-320 mg was taken by the patient daily for control of essential hypertension. A non-smoker, the patient reported one alcoholic beverage an average of four times per month. Her medication allergies consisted of benazepril (tachycardia), ezetimibe (myalgias), simvastatin (myalgias), and triamterene (myalgias).
Premedication for anxiolysis was accomplished with 2 mg midazolam. In the operating room, standard anesthesia monitors were applied, including non-invasive blood pressure measurement, electrocardiogram, peripheral oxygen saturation, and a temperature-sensing Foley catheter. Her baseline vital signs were a temperature of 36.94 degrees Celsius, blood pressure 138/80 mm Hg, heart rate 81 beats/min, and oxygen saturation (SaO2) 99%. Induction of general anesthesia proceeded with the administration of 180 mg of 1% propofol, 70 mg lidocaine, and 50 mcg fentanyl after preoxygenation with 100% oxygen. Tracheal intubation was facilitated with the administration of 40 mg rocuronium. A 7.0 mm cuffed oral endotracheal tube was placed with one attempt and then secured at 22 cm. The maintenance of anesthesia with sevoflurane was initiated and the patient received 10 mg of intravenous (IV) dexamethasone after the start of surgery. Mechanical ventilation with volume control was selected with 6 mL/kg and a fraction of inspired oxygen (FiO2) of 0.5. A second 18 g IV was started in the left hand and an arterial line was placed in the right radial artery with one attempt.
At the conclusion of the surgery, 400 mg IV sugammadex (3.74 mg/kg) was given as reversal for the neuromuscular blockade (the train-of-four was 0/4). Within 60 seconds, her blood pressure dropped to 58/39 mm Hg, heart rate remained stable at 80, and SpO2 dropped to 94%. Phenylephrine was titrated in 0.2 mg doses for a total of 1 mg. Intravenous fluids were administered liberally and the surgical team notified of intractable hypotension. Ischemic changes were observed in electrocardiogram (ECG) leads II and V at the same time that the heart rate began to increase. Given the presentation of symptoms in close proximity to the administration of sugammadex, the possibility of anaphylaxis was considered. At this time, 150 mcg IV epinephrine was given followed an additional dose of 100 mcg. Vasopressin two units IV was then administered to restore the blood pressure to baseline in the setting of epinephrine-induced tachycardia. Auscultation revealed clear breath sounds and there was no increase in airway pressures noted. However, a maculopapular rash was noted over the upper thorax. Greater attention was given to the possibility of anaphylaxis at this point and diphenhydramine 50 mg and famotidine 20 mg were administered. A serum tryptase level was sent to the laboratory to assist with determining the cause of the patient's symptoms. After her condition was stabilized, the patient was successfully extubated and transferred to the recovery room. A 12-lead electrocardiogram showed sinus tachycardia and a prolongation of the corrected QT (QTc) interval (Figure ).
Cardiology was consulted and the patient was observed in the intensive care unit overnight as a precaution. Dermatological manifestations resolved within a few hours. Serum tryptase from the time of the episode returned at 62 ng/mL (normal < 11.4 ng/mL), which effectively confirms that the cause of this patient's symptoms was consistent with an anaphylactic reaction. She was discharged home on postoperative Day 4 with a recommendation for follow-up with her primary care physician.","Based on the patient's weight, what is the patient's maintenance fluid in mL/hr?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'weight': [115.3, 'kg']}",155.3,147.535,163.065,"For patient's with weight less than 10 kg, the rule for computing maintenance fluid is to multiply their weight by 4 mL/kg/hr to get the maintenance fluids per hour.
For patient's with weight between 10 kg and 20 kg, the formula for computing maintenance fluid is 40 mL/hr + 2 mL/kg/hr * (weight (in kilograms) - 10 kilograms).
For patient's with weight greater than 20 kg, the formula for computing the maintenance fluid is 60 mL/hr + 1 mL/kg/hr * (weight (in kilograms) - 20 kilograms).
The patient's weight is 115.3 kg. Hence, plugging into this formula, we get 60 mL/hr + 1 mL/kg/hr * (115.3 kg - 20 kg) = 155.3 mL/hr.
Hence, the patient's fluid maintenance is 155.3 mL/hr."
336,22,Maintenance Fluids Calculations,physical,decimal,pmc-4610930-1,Extracted,"A 25-year-old male (height 167.7 cm, weight 52.2 kg) was admitted for surgical resection of a 5.0 × 1.8 cm right-cheek mass, suspected to be a lymphangioma. The patient had undergone a tonsillectomy under general anesthesia 8 years previously without any perioperative complication. The medical history indicated no drug or food allergies. Preoperative examinations of the patient were within normal limits. Therefore, anesthesia was applied according to the American Society of Anesthesiologists physical status classification 1.
The patient received no premedication prior to admission to the operating theater. The blood pressure upon arrival in the operating theater was 158/76 mmHg, with a heart rate of 80 beats/min (BPM), and with a peripheral oxygen saturation of 99% of room air. Anesthesia was induced using an injection of 50 µg fentanyl, 150 mg propofol and 50 mg rocuronium. Endotracheal intubation was performed using a cuffed oral right-angle endotracheal tube. Anesthesia was maintained using oxygen, air and desflurane. As a prophylactic antibiotic, 1 g cefazoline was administered intravenously immediately after completion of induction.
One hour after commencing surgery, the surgeon requested a reversal of the neuromuscular blockade to monitor patency of the facial nerve. Anesthesia was consequently maintained using desflurane alone. At this time, the blood pressure was 105/74 mmHg and the heart rate 92 BPM. We administered 1 mg atropine and 1.5 mg neostigmine intravenously to reverse neuromuscular blockade. After approximately 5 min, the blood pressure was decreased to 75/42 mmHg and the heart rate was 104 BPM. We administered 10 mg ephedrine intravenously. After 5 min, the blood pressure was 67/36 mmHg and the heart rate was 94 BPM. To manage persistent hypotension, 200 µg phenylephrine were administered, followed by a rapid infusion of lactated Ringer's solution. However, the non-invasive blood pressure decreased further to 57/36 mmHg and the heart rate rose to 138 BPM. As we asked the surgeon, there was no drug administration at surgical field.
Invasive blood pressure monitoring was applied to the left dorsalis pedis artery and additional venous access was established. The arterial blood gas analysis showed all parameters to be within normal limits. Continuous infusion of norepinephrine at 0.03 µg/kg/min was initiated. Consequently, the blood pressure was restored to 99/51 mmHg and surgery was resumed.
Because the patient was covered with a drape, clinical manifestation of anaphylaxis, including skin rash, could not be observed. Approximately 1 h after the hypotension event, a skin rash was detected over the entire body. There were no respiratory symptoms, including wheezing or increased airway pressure. The patient was suspected to be suffering from an anaphylactic reaction. A 10 µg bolus of epinephrine was given and a continuous epinephrine infusion was initiated at 0.03 µg/kg/min. The patient responded to the epinephrine and soon maintained hemodynamic stability; with a blood pressure of 110/52 mmHg and a heart rate of 78 BPM. Norepinephrine infusion was discontinued and epinephrine infusion was tapered to maintain the restored blood pressure. The patient was treated using 4 mg chlorpheniramine together with 5 mg dexamethasone to prevent delayed reactions and halt any further histamine release. After 1.5 h, the blood pressure was 110/46 mmHg without any inotropic or vasopressor support. The skin lesion was improved and no respiratory symptoms were detected throughout the completion of the surgery. The total operation time was 200 min and the anesthesia time 245 min. The total infused crystalloid, colloid, estimated blood loss and urine output were 1,300 ml, 500 ml, 50 ml, and 450 ml, respectively ().
The patient was transferred to the intensive care unit for close monitoring and was placed on ventilatory support. An hour after arrival, the patient was extubated uneventfully without any neurologic deficit. Blood tests were obtained for the tryptase level, which was elevated to 37.9 µg/L (normal range: 0-11 µg/L) and the total serum immunoglobulin E (IgE) level, which was increased to 675 Ku/L (normal range: negative). The patient was transferred to a general ward 1 day later and was discharged after 1 week without any complications. The consultant allergist recommended that allergen tests be conducted.
Skin-prick and intradermal tests were performed after 1 month to determine the cause of the anaphylaxis. The skinprick tests were negative for all agents, whereas the intradermal tests were positive for atropine (wheal of 4 × 4 mm for a stock concentration of 0.5 mg/ml; wheal of 4 × 4 mm with 1 : 5 dilution) (). The intradermal skin tests also demonstrated a positive result for rocuronium (wheal of 5 × 5 mm for a stock concentration of 10 mg/ml; wheal of 4 × 4 mm with 1 : 10 dilution). The patient was advised to completely avoid atropine and is currently receiving regular check-ups at the outpatient department of plastic surgery.","Based on the patient's weight, what is the patient's maintenance fluid in mL/hr?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'weight': [52.2, 'kg']}",92.2,87.59,96.81,"For patient's with weight less than 10 kg, the rule for computing maintenance fluid is to multiply their weight by 4 mL/kg/hr to get the maintenance fluids per hour.
For patient's with weight between 10 kg and 20 kg, the formula for computing maintenance fluid is 40 mL/hr + 2 mL/kg/hr * (weight (in kilograms) - 10 kilograms).
For patient's with weight greater than 20 kg, the formula for computing the maintenance fluid is 60 mL/hr + 1 mL/kg/hr * (weight (in kilograms) - 20 kilograms).
The patient's weight is 52.2 kg. Hence, plugging into this formula, we get 60 mL/hr + 1 mL/kg/hr * (52.2 kg - 20 kg) = 92.2 mL/hr.
Hence, the patient's fluid maintenance is 92.2 mL/hr."
337,22,Maintenance Fluids Calculations,physical,decimal,pmc-3206412-1,Extracted,"A 12 year old female presents to the emergency department with a complaint of abdominal pain. She has a past medical history of Hirschsprung's disease with a staged repair. At day four of life she underwent colostomy with resection of the affected colon from the mid transverse colon to the junction of the sigmoid and descending colon. She returned two months later for the second stage of the repair where she underwent a Soave endorectal pull thru procedure with incidental appendectomy. Since that time she has had a good recovery without constipation or diarrhea and with normal bowel function. She had recurrent tonsillitis and underwent tonsillectomy. She takes no medications. The patient complains of a sharp bilateral lower abdominal pain for the past two days that is greatest in the suprapubic region. She has had three episodes of emesis. She denies a change in bowel habits. She does report a low grade fever to 101. She denies dysuria, frequency or hematuria. She denies any history of sexual activity. Her first menstrual period was six weeks ago and her second menstrual period was two weeks ago. She complains of a new watery vaginal discharge for less than one day.
Upon arrival her vitals are temperature 37.2 degrees Celsius by mouth, pulse 125 beats per minute, blood pressure 124/64 mm/Hg, and pulse ox 96% on room air. She weighs 45 kg. She is in obvious moderate distress due to her pain. Her bowel sounds are normal. Her abdomen is non distended and firm with voluntary guarding. It is diffusely tender, but worse in the bilateral lower quadrants without rebound tenderness. There is no CVA tenderness. On pelvic exam, there are normal external genitalia Tanner stage II-III with intact hymen from six o'clock to nine o'clock position. There are no obvious perineal or vaginal lacerations. A watery blood tinged discharge is present. The rest of her physical exam is unremarkable.
Initial labs showed a normal metabolic panel. The complete blood count had a normal hemoglobin and hematocrit with a white blood cell count of 14.5 thou/cu mm. There were 64 percent neutrophils and 18 percent lymphocytes with 11 percent bands. Her urinalysis had 219 red blood cells and 85 white blood cells with a large amount of squamous epithelial cells. It was nitrite negative and had large leukocyte esterase. Urine PCR for gonorrhea and chlamydia was negative. The urine pregnancy test was negative. CT scan of the abdomen and pelvis with IV and oral contrast showed normal lung bases, liver, spleen, pancreas, gallbladder, kidneys, and adrenal glands. There were no bowel obstruction noted. Bilateral dilated tubular structures were noted in the lower quadrants, adnexal regions, with wall enhancement and surrounding inflammatory changes consistent with bilateral pyosalpinx. There were no distinct drainable abscesses seen.
See Figures , , , and : CT scan of the abdomen and pelvis with intravenous and oral contrast showing bilateral dilated fallopian tubes with pronounced wall enhancement
She received IV fluids and morphine for pain control, and she was admitted to gynecology service for IV antibiotics. In the hospital she received IV Ampicillin, Gentamicin, and Flagyl for four days until she was afebrile for forty eight hours and had a normal white count. She was discharged on a ten day course of Doxycycline and Flagyl with Motrin for pain control. At six month telephone follow up she denies any recurrence of her symptoms.","Based on the patient's weight, what is the patient's maintenance fluid in mL/hr?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'weight': [45.0, 'kg']}",85,80.75,89.25,"For patient's with weight less than 10 kg, the rule for computing maintenance fluid is to multiply their weight by 4 mL/kg/hr to get the maintenance fluids per hour.
For patient's with weight between 10 kg and 20 kg, the formula for computing maintenance fluid is 40 mL/hr + 2 mL/kg/hr * (weight (in kilograms) - 10 kilograms).
For patient's with weight greater than 20 kg, the formula for computing the maintenance fluid is 60 mL/hr + 1 mL/kg/hr * (weight (in kilograms) - 20 kilograms).
The patient's weight is 45.0 kg. Hence, plugging into this formula, we get 60 mL/hr + 1 mL/kg/hr * (45.0 kg - 20 kg) = 85.0 mL/hr.
Hence, the patient's fluid maintenance is 85.0 mL/hr."
338,22,Maintenance Fluids Calculations,physical,decimal,pmc-6383478-1,Extracted,"A 53-year-old, 56 kg weight and 154 cm height female was having pseudomyxoma peritonei, diffusely deposited in the abdomen and peritoneal surfaces as well as in the left lung and pleural space. She was a case of hypothyroidism since last 4 years on oral thyroxine 50 mcg once a day. Her laboratory investigations were within normal limits except that liver function test showed serum albumin of 2.1 g/L initially which improved to 3.4 g/L with high protein formula feed for 1-month period of evaluation and optimization. Preoperative electrocardiogram and 2D-echocardiogram were normal. Her effort tolerance was more than 4 METs. Preoperative pulmonary function test (PFT) showed FEV1 1.13 Litres (47.3% of predicted) with moderate restriction due to the lung metastases with small airway obstruction. Patient was started on bronchodilator therapy for the same. Diffusion capacity (DLCO) was 81% of predicted. A written informed consent was taken for surgery and anaesthesia. She was kept fasting for solid food for 8 hours. She received clear carbohydrate drink in previous evening and morning of surgery as per institutional protocol. In the operating room, ECG, non-invasive blood pressure and pulse oximetry were attached and base line parameters noted. A 16G intravenous cannula was secured and epidural catheter was placed in T7-8 interspace in left lateral position. Anaesthesia was induced with fentanyl (100 mcg), propofol (110 mg) and vecuronium (6mg) and was maintained on sevoflurane in a gaseous mixture of oxygen with nitrous oxide. The monitoring was then advanced to include invasive arterial blood pressure with pulse pressure variation (PPV), central venous pressure and monitoring with the help of FloTrac including cardiac output, cardiac index, stroke volume (SV), stroke volume index and stroke volume variation (SVV), as well as oesophageal temperature monitoring. CRS phase was started and total peritonectomy with total abdominal hysterectomy plus omenectomy, splenectomy, cholecystectomy and liver portal metastasis clearance was done. Bilateral diaphragmatic stripping was done for metastatic deposits. Debulking surgery of left thorax (large deposits over left lung) through left phrenotomy was done for pleural and lung PMP. A small part of left lower lobe was also resected. During debulking of thorax, a very low tidal volume (4 ml/kg) ventilation was started. CRS phase lasted for 12 hours with a total volume loss (blood mixed) during CRS phase was 6.5 liter, mostly constituted by jelly-like mucinous material. During abdominal debulking, fluid therapy was guided by PPV and SVV but after opening of pleura fluid therapy was guided by delta SV with optimum SV and target SV (10% less than optimum SV) calculation. Six units of packed red cells, 4 units of fresh frozen plasma and 500 ml of 20% albumin was given along with 6 liters of crystalloids and low dose (<0.1 μg/kg/min) nor-adrenaline support was needed toward end of CRS phase. Urine output target during CRS was more than 0.5 ml/kg/h. Total peritoneal carcinomatosis index (PCI) was 39 with completion cytoreduction score of 1. HITAC in form of adriamycin 15 mg/m2 and mitomycin 15 mg/m2 was given in left side of thorax with open diaphragm and whole abdomen for 60 minutes with help of Belmont pump. A urine output of more than 2 ml/kg/h was targeted during HITAC phase by use of cold fluids. Temperature control was done with cold fluids at 6°C and ice packs on neck and axilla. The maximum temperature reached was 37.8°C after 40 minutes of starting HITAC. ScvO2 at end of CRS was 75.6% and at the end of HITAC phase it was 83.4%. Serum lactates increased from 1.10 mmol/L at the end of CRS phase to 8.02 mmol/L at the end of 60 minutes HITAC phase. Peak airway pressure increased from 23 to 30 cm of H2O during HITAC phase. At the end of procedure loop ileostomy was done and diaphragm was closed, drains were put in abdomen and bilateral chest tubes were placed and abdomen was closed. The patient maintained a moderate metabolic acidosis of pH 7.2-7.3 throughout the HITAC. The patient was transferred to the intensive care unit (ICU) mechanically ventilated and sedated. In the ICU, she was electively ventilated for 48 hours. The trachea was extubated on high flow nasal oxygenation by Optiflow™. On postoperative day (POD) 1, parenteral nutrition was started. Adequate pain relief was achieved by epidural infusion of local anaesthetic for 4 days along with intravenous paracetamol 1 g 6 hourly. She was shifted out from ICU on POD 7. PFT repeated on POD 13 showed severe restriction with small airway obstruction, FEV1 0.91 Liter (38% of predicted), and fall in DLCO from preoperative 81% to 59% in postoperative period. She was discharged from hospital on POD 15.","Based on the patient's weight, what is the patient's maintenance fluid in mL/hr?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'weight': [56.0, 'kg']}",96,91.2,100.8,"For patient's with weight less than 10 kg, the rule for computing maintenance fluid is to multiply their weight by 4 mL/kg/hr to get the maintenance fluids per hour.
For patient's with weight between 10 kg and 20 kg, the formula for computing maintenance fluid is 40 mL/hr + 2 mL/kg/hr * (weight (in kilograms) - 10 kilograms).
For patient's with weight greater than 20 kg, the formula for computing the maintenance fluid is 60 mL/hr + 1 mL/kg/hr * (weight (in kilograms) - 20 kilograms).
The patient's weight is 56.0 kg. Hence, plugging into this formula, we get 60 mL/hr + 1 mL/kg/hr * (56.0 kg - 20 kg) = 96.0 mL/hr.
Hence, the patient's fluid maintenance is 96.0 mL/hr."
339,22,Maintenance Fluids Calculations,physical,decimal,pmc-7461646-1,Extracted,"A 19-year-old female patient was admitted to our surgical unit with severe anemia (Hb 4.1 g/dL). Impaired growth was noted (weight 39.5 kg; height 146 cm; BMI 17.6 kg/m). She had a heart rate of 78 beats per minute, blood pressure of 226/136 mmHg, respiration rate of 16 breaths per minute and arterial oxygen saturation of 96%. Blood analysis showed a serum creatinine level of 10.97 mg/dl (nv 0.5-1.1) and urea 109 mg/dL (nv 16-46) mmol/L. The patient also presented with bilateral AMLs, hypertension and seizure disorder. Her relatives reported difficulty in managing her home medications (antihypertensive and antiepileptic drugs) due to her intellectual disability. The patient had been diagnosed with TSC in childhood; there was a paternal family history of TSC. Polycystic kidney disease (PKD) in end-stage renal failure appeared four years prior and the patient has been undergoing peritoneal dialysis since the diagnosis. At the age of 18 years, she underwent a prior unilateral endovascular embolization to treat renal aneurisms and the procedure successfully stopped a bleeding aneurism at the upper pole of the right kidney. Based on the patient’s medical history, clinical and biochemical findings, a ruptured renal artery aneurysm was diagnosed. An urgent renal AE was considered the treatment of choice to limit hemorrhage and the risk of damage to the peritoneal dialysis catheter. The multidisciplinary team, including pediatric surgeons, interventional radiologists, pediatric nephrologists and psychologists agreed upon the choice to perform a bilateral renal AE in this complex patient. Prior to the intervention, and after being informed on the nature of the intervention, the patient and the patient’s parents gave their written consent to undergo endovascular treatment. Under general anesthesia, ultrasound-guided right femoral common artery access was gained using a Terumo 6 FR 11 cm catheter. A diagnostic plain angiography scan revealed a double right renal artery. The major artery was easily catheterized with a 6 FR C2 Mac Boston-Scientific 6 F (65 cm) catheter. Through this catheter, a AMplatzer Plug-2 10 mm was released achieving artery occlusion (about 1 cm from the ostium, ). A Sim1 Boston-Scientific 5 fr was positioned in the lower right renal artery and several Terumo Azur coils were released (). Upon completion of the intervention, angiography confirmed the complete embolization of the vessels (). The same procedure was used for the left renal embolization using a Cobra C2 catheter and Terumo 4x10 mm Azur coils (). With the final angiography, bilateral renal arterialthrombosis was confirmed (about 1 cm from the ostium, ). The first cm of the renal artery was preserved to facilitate clamping during the future nephrectomy. After the procedure, the patient was transferred to the pediatric intensive care unit of our institution for observation and subsequently to the pediatric nephrology unit. Vital signs were monitored; her postoperative course was uneventful. Two months later, the patient underwent a bilateral lumbotomy and bilateral extraperitoneal nephrectomy to protect the peritoneal surface area and dialysis adequacy. Grossly, both kidneys were enlarged (left 14.5x7x6 cm; right 15x5x5.5 cm); macroscopically the tissue was almost entirely replaced by cysts alternating with solid grey and brown areas, on a background of soft and yellowish tissue with calcific deposits. Histologically, solid areas on the yellowish background were revealed to be angiomyolipoma, which extended to the adipose tissue, perirenal and the renal pelvis. Partially solid aspects (epithelioid angiomyolipoma) and partially cystic aspects (cysts with cubic or hobnail epithelium) were observed. In the right kidney, other solid greyish areas were observed (maximum diameter 15 mm); these were classified as renal cell carcinomas (RCC), with acinar, papillary and alveolar growth patterns and cribiform aspects, Furhrman grade III (). The patient was discharged on the fourth day of hospitalization in stable clinical condition. Her clinical condition and laboratory tests were stable at 12 months follow-up. The patient undergoes continuous peritoneal dialysis.","Based on the patient's weight, what is the patient's maintenance fluid in mL/hr?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'weight': [39.5, 'kg']}",79.5,75.525,83.475,"For patient's with weight less than 10 kg, the rule for computing maintenance fluid is to multiply their weight by 4 mL/kg/hr to get the maintenance fluids per hour.
For patient's with weight between 10 kg and 20 kg, the formula for computing maintenance fluid is 40 mL/hr + 2 mL/kg/hr * (weight (in kilograms) - 10 kilograms).
For patient's with weight greater than 20 kg, the formula for computing the maintenance fluid is 60 mL/hr + 1 mL/kg/hr * (weight (in kilograms) - 20 kilograms).
The patient's weight is 39.5 kg. Hence, plugging into this formula, we get 60 mL/hr + 1 mL/kg/hr * (39.5 kg - 20 kg) = 79.5 mL/hr.
Hence, the patient's fluid maintenance is 79.5 mL/hr."
340,22,Maintenance Fluids Calculations,physical,decimal,pmc-4052931-1,Extracted,"A 9-year-old male child with complaints of unproductive cough, dyspnea, and swelling on chest wall presented to our emergency department with his parents. He did not state an obvious chest pain. His complaints had started 12 hours ago. He does not have any trauma history. His history and family history were unremarkable and he had never been diagnosed with bronchial asthma before. He was conscious and in sitting position because of dyspnea and had expiratory wheezing. His weight was 33 kg (between 75th and 90th percentiles) and height was 138 cm (between 75th and 90th percentiles). His vital signs were blood pressure, 100/60 mmHg; pulse rate, 140 beats/minute; respiratory rate, 45/minute; temperature, 36,9°C; and oxygen saturation, 80% at room air. Bilateral subcutaneous emphysema was palpated on anterior chest wall from sternum to midaxillary regions. On auscultation he had rhonchus on both hemithoraces, prolonged expirium, and Hamman's sign. An intravenous line was inserted and 8 L/minutes oxygen and nebulized salbutamol were started. Arterial blood gas analysis revealed pH, 7.43; PaCO2, 45 mmHg; and PaO2, 75 mmHg. Other laboratory findings were as follows: white blood cell count, 5.40 K/uL; neutrophil count, 1.52 K/uL; hemoglobin, 13.5 mg/dL; platelet, 266 K/uL; C-reactive protein, 0.55 mg/dL; and immunoglobulin E, 419 IU/mL (normal range; 0–165 IU/mL). His saturation was elevated to 90%. His electrocardiogram showed sinus tachycardia. His anteroposterior and lateral chest radiogram revealed subcutaneous emphysema and pneumomediastinum (). His thorax computed tomography revealed bilateral subcutaneous, mediastinal, pericardial, and epidural emphysema without pneumothorax (). He consulted a pediatric surgeon and was transferred to pediatric intensive care unit for close monitorization and conservative treatment. He was administered oxygen, cold-vapor, nebulized salbutamol, and prophylactic antibiotics (ampicillin-sulbactam). He was followed-up by chest radiographs. He was relieved from symptoms and signs around the fifth day and he was discharged at the seventh day. His family stated that he usually had cough and dyspnea without fever in spring and summer but they did not seek any treatment before. He was referred to pediatric allergy department and diagnosed with seasonal allergic asthma one month later. He did not have any asthma attack during a 5-month period. His family migrated to another city and the patient lost follow-up.","Based on the patient's weight, what is the patient's maintenance fluid in mL/hr?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'weight': [33.0, 'kg']}",73,69.35,76.65,"For patient's with weight less than 10 kg, the rule for computing maintenance fluid is to multiply their weight by 4 mL/kg/hr to get the maintenance fluids per hour.
For patient's with weight between 10 kg and 20 kg, the formula for computing maintenance fluid is 40 mL/hr + 2 mL/kg/hr * (weight (in kilograms) - 10 kilograms).
For patient's with weight greater than 20 kg, the formula for computing the maintenance fluid is 60 mL/hr + 1 mL/kg/hr * (weight (in kilograms) - 20 kilograms).
The patient's weight is 33.0 kg. Hence, plugging into this formula, we get 60 mL/hr + 1 mL/kg/hr * (33.0 kg - 20 kg) = 73.0 mL/hr.
Hence, the patient's fluid maintenance is 73.0 mL/hr."
341,23,MELD Na (UNOS/OPTN),lab test,decimal,pmc-4528787-1,Extracted,"A 57-year-old man with a history of hypertension and right hip fracture called emergency medical services and complained of severe leg pain. When the emergency medical services team arrived on scene, the patient was found down on the floor with right leg weakness; he was confused and aphasic. No fumes or smoke was evident. Due to altered mental status, he was intubated and was subsequently transferred to our medical facility. Six hours after the incident, the patient was more alert and oriented and his leg pain had subsided. Details of smoking history could not be obtained due to the intubation. On physical examination, temperature was 35.8°C, heart rate 107 bpm, blood pressure 137/94 mm Hg, and respiratory rate 14 breaths/minute. He had regular heart rhythm, no murmur or pericardial rub. His abdomen was soft with active bowel sound. There were no symptoms and signs of limb ischemia on admission. He had no leg pain, pallor, poikilothermia, pulselessness, paresthesia, or paralysis. Motor power was at least grade 4 in all 4 extremities. His dorsalis pedis pulse was 2+ bilaterally. Initial investigations at our medical facility showed white blood cell 11400/µL, neutrophils 89%, hemoglobin 13.1 g/dL, hematocrit 38.6%, platelet 159000/µL, blood urea nitrogen 29 mg/dL, creatinine 2.0 mg/dL, sodium 142 mEq/L, potassium 3.9 mEq/L, chloride 102 mEq/L, bicarbonate 19 mEq/L, lactic acid 4.25 mmol/L, troponin T 0.1 ng/mL, and negative for acetone. Electrocardiogram showed sinus tachycardia and no ST-T change. The liver function test demonstrated aspartate aminotransferase 1697 IU/L, alanine aminotransferase 1263 IU/L, alkaline phosphatase 138 IU/L, total bilirubin 0.7 mg/dL, total protein 6.2 gm/dL, and albumin 3.5 mg/dL. Urinalysis showed white blood cell 5 to 10/high-power field, red blood cell 0 to 3/high-power field, moderate blood but negative for urine myoglobin. Coagulogram showed prothrombin time 17.5 seconds, partial thromboplastin time 25.8 seconds, and international normalized ratio 1.59. Calculated fractional excretion of sodium and urea were 2.11% and 43.67%, respectively, consistent with acute tubular necrosis. The viral hepatitis panel was negative except for a positive AntiHBc IgG antibody. Arterial blood gas analysis on admission depicted pH 7.319, PO2 130.3 mm Hg, PCO2 40.8 mm Hg, HCO3 20.5 mEq/L, and Sao2 100%, carboxyhemoglobin 0.2%, and methemoglobin 0.1% while on assist-control mode of mechanical ventilation with Fio2 100%. Computed tomography of head was performed and showed chronic right basal ganglion infarct. Transthoracic echocardiography was performed and showed severely depressed left ventricular function with ejection fraction of less than 20%, grade II/IV diastolic dysfunction with mild TR, mild MR, and mild PR. Akinesis of the septal wall and hypokinesis of the anterolateral wall were present. Moreover, computed tomography of abdomen, pelvis, and chest without contrast revealed right lower lung consolidation with small right pleural effusion, moderately bilateral nonspecific perinephric fat stranding, submucosal fatty infiltration, and mild wall thickening of the descending colon down to the rectum. Subtle perirectal fat stranding was also visualized. Initially, he was treated with empiric antibiotics for possible pneumonia with severe sepsis with piperacillin-tazobactam, levofloxacin, and vancomycin. Aspirin and full-dose enoxaparin were started to cover possible acute coronary syndrome. Surgery was consulted due to a concern of bowel ischemia. Proctoscopy was done and showed normal pink rectal mucosa without blood in the vault. Because the patient was hemodynamically stable, had no abdominal pain, and lactic acid level had returned to normal, the surgery service recommended continued fluid replacement for volume expansion.
His lactate levels decreased spontaneously from 15 mmol/L to 3.39, 2.52, and 1.28 mmol/L at 0, 10, 14, and 33 hours, respectively, after his initial symptoms, along with an improvement of arterial pH and anion gap (). After 24 hours of admission, he improved dramatically and was extubated on day 2 of admission. Five hours after extubation (42 hours after admission), he started to have left leg pain. His left leg turned bluish and became paler with prominent livedo reticularis throughout his left leg (). Therefore, a heparin drip was initiated promptly and vascular surgery was consulted. Soon after that, the patient developed sudden cardiac arrest with pulseless electrical activity. He had return of spontaneous circulation after 15 minutes of cardiopulmonary resuscitation. At that moment, his lactate level rebounded to 8.13 mmol/L. To rule out acute aortic dissection and acute massive pulmonary embolism as well as acute left limb gangrene from embolism, computed tomography of pulmonary artery with contrast and computed tomography angiogram of aorta were performed. He had no pulmonary emboli or abdominal aortic dissection. He did have high-grade stenosis of the infrarenal abdominal aorta just above the bifurcation, near total occlusion of the right common iliac artery, severe luminal narrowing of the left common iliac artery, bilateral external iliac arteries, and bilateral common femoral arteries by calcified and noncalcified plaques ( and ). Emergent revascularization was planned but the patient developed pulseless electrical activity/asystole again and passed away.",What is the patient's MELD Na score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'creatinine': [2.0, 'mg/dL'], 'Continuous veno-venous hemodialysis for ≥24 hours in the past week': False, 'Dialysis at least twice in the past week': False, 'international normalized ratio': 1.59, 'Sodium': [142.0, 'mEq/L'], 'Bilirubin': [0.7, 'mg/dL']}",18,17.1,18.9,"The formula for computing the MELD Na is to first apply the following equation: MELD(i) = 0.957 x ln(Cr) + 0.378 x ln(bilirubin) + 1.120 x ln(INR) + 0.643.
If the MELD(i) is greater than 11 after rounding to the nearest tenth and multiplying the MELD(i) by 10, we apply the following equation: MELD = MELD(i) + 1.32 x (137 - Na) -  [ 0.033 x MELD(i) x (137 - Na)]. The MELD Na score is capped at 40. The concentration of Na is mEq/L, the concentration of bilirubin is mg/dL, and the concentration of creatinine is mg/dL. If the patient's Na concentration is less than 125 mEq/L, we set it to 125 mEq/L and if the patient's the Na concentration is greater 137 mEq/L, we round it to 137 mEq/L.
The concentration of creatinine is 2.0 mg/dL. 
The patient has not went through dialysis at least twice in the past week.
Whether the patient has went through continuous veno-venous hemodialysis in the past 24 hours is not mentioned, and so we assume this to be false.
The concentration of bilirubin is 0.7 mg/dL. The patient's bilirubin concentration is less than 1.0 mg/dL, and so we set the bilirubin concentration to 1.0 mg/dL.
The patient's INR is 1.59. 
The concentration of sodium is 142.0 mEq/L. The sodium concentration is greater than 137 mEq/L, and so we set the sodium concentration to 137 mEq/L.
Applying the first equation gives us 0.957 x ln(2.0) + 0.378 x ln(1.0) + 1.120 x ln(1.59) + 0.643 = 1.8257239499758648. Rounding to the nearest tenth makes the MELD (i) score 1.8. We then multiply by 10, making the MELD(i) score 18.
Because the MELD (i) score is greater than 11, we then apply the second equation, giving us 18 + 1.32 x (137 - 137) -  [0.033 x 1.8257239499758648 x (137 - 137)] = 18.
The MELD Na score is less than 40, and so we keep the score as it is. The patient's MELDNa score, rounded to the nearest integer, is 18 points."
342,23,MELD Na (UNOS/OPTN),lab test,decimal,pmc-3094288-1,Extracted,"A 17-year-old Caucasian female presented to local hospital with a history of acute alcohol intoxication and ingestion of large quantities of acetaminophen. The patient complained of nausea for 2 days and subjective increase in thirst and urine output for a day. She did not notice any dysuria, abdominal pain or change in the colour of her urine. She did however report a remarkable increase in lower back pain that she had attributed to strenuous exercise.
Two days prior to her presentation to the emergency department, the young lady had attended a party where she consumed over 300 mL of vodka and ingested twenty 500 mg tablets of acetaminophen later that night.
Past medical history revealed that she had experienced an episode of rash after having taken liquid acetaminophen as a child. She had not taken acetaminophen since infancy and also denied regular use of any other analgesic. Family history was non-contributory for relevant physiological and psychological illness. The patient reported feeling stressed due to a recent slip in school grades, however denied any suicidal ideation.
Physical examination in the emergency department revealed blood pressure of 140/92 mmHg, pulse 80 bpm, temperature 36.9°C, respiratory rate of 16 breaths per minute and oxygen saturation of 100% at room air. Height and weight were recorded at 170 cm and 63 kg. Physical examination was otherwise unremarkable. No rash, joint swelling or sign of dehydration was detected.
Initial renal function tests at the local hospital revealed serum creatinine and BUN levels of 1.6 mg/dL and 19.3 mg/dL, respectively. Other laboratory results included: glucose 112 mg/dL, sodium 141 mEq/L, potassium 4.3 mEq/L, chloride 104 mEq/L, bicarbonate 29 mEq/L, albumin 43 g/L, aspartate transaminase 20 IU/L, alkaline phosphate 66 IU/L and total bilirubin 1.11 mg/dL. Her INR was reported to be normal at 0.9. Toxicity screens on admission showed acetaminophen level at 9.06 μg/mL. Urine dipstick showed trace amount of blood and 2 plus protein. Microscopy revealed 25 red blood cells per high power field and was otherwise non-contributory. Abdominal ultrasound revealed increased hepatic echogenicity and the kidneys were normal in appearance.
At the outside hospital, she was given morphine, ondansetron and lansoprazole for her back pain and gastrointestinal symptoms. Acetylcysteine was not administered as the patient presented more than 24 hours after the ingestion of acetaminophen.
Renal function tests were repeated later that evening and monitored frequently thereafter. Over the course of 36 hours, the patient's serum creatinine and BUN levels elevated from 1.6 mg/dL and 19.3 mg/dL to 5.7 mg/dL and 49.6 mg/dL, respectively. Urine output was reported to be 2.7 mL/kg/hour. At this time, the patient was transferred to our Children's Hospital for rapidly progressive renal insufficiency.
Physical examination upon admission showed normal vital signs: blood pressure 115/74 mmHg, pulse 60 bpm, temperature 36.6°C, respiratory rate 16 breaths per minute and 100% oxygen saturation at room air. Serum creatinine and BUN levels were measured at 6.3 mg/dL and 52.4 mg/dL, respectively. Furthermore, her electrolytes were recorded as follows: random glucose 86 mg/dL, sodium 134 mEq/L, potassium 5.7 mEq/L, chloride 104 mEq/L and bicarbonate 22 mEq/L. Coagulation study revealed an INR of 1.0 and an APTT of 28 seconds. Other investigations including blood counts and liver functions tests were within normal range. The patient's daily urine output was 3.3 mL/kg/hour at this time. Urinalysis revealed small amounts of protein and blood in her urine. Staining for eosinophils on the random urine sample was positive.
Renal biopsy was performed to further delineate the underlying cause of rapidly progressive renal insufficiency. Figure depicts the histological findings. The biopsy showed no evidence of glomerulonephritis. The interstitium was mildly edematous with small aggregates of inflammatory cells, mainly lymphocytes and eosinophils. Immunofluorescence and electron microscopy were both negative for immune deposits. The histological findings were compatible with acute interstitial nephritis.
The patient was managed supportively by careful monitoring of fluid intake and output. Corticosteroids therapy was considered if no improvement of her renal function was observed. However, her serum creatinine and BUN levels peaked at 7.0 mg/dL and 60 mg/dL two days after admission then began to improve without further medical intervention. Her serum creatinine and BUN levels upon discharge were 4.7 mg/dL and 48 mg/dL respectively. Outpatient follow-up at two weeks after discharge showed that she had completely recovered; her creatinine was 1 mg/dL and BUN was 18 mg/dL.",What is the patient's MELD Na score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'creatinine': [1.6, 'mg/dL'], 'Continuous veno-venous hemodialysis for ≥24 hours in the past week': False, 'Dialysis at least twice in the past week': False, 'international normalized ratio': 0.9, 'Sodium': [141.0, 'mEq/L'], 'Bilirubin': [1.11, 'mg/dL']}",11,10.45,11.55,"The formula for computing the MELD Na is to first apply the following equation: MELD(i) = 0.957 x ln(Cr) + 0.378 x ln(bilirubin) + 1.120 x ln(INR) + 0.643.
If the MELD(i) is greater than 11 after rounding to the nearest tenth and multiplying the MELD(i) by 10, we apply the following equation: MELD = MELD(i) + 1.32 x (137 - Na) -  [ 0.033 x MELD(i) x (137 - Na)]. The MELD Na score is capped at 40. The concentration of Na is mEq/L, the concentration of bilirubin is mg/dL, and the concentration of creatinine is mg/dL. If the patient's Na concentration is less than 125 mEq/L, we set it to 125 mEq/L and if the patient's the Na concentration is greater 137 mEq/L, we round it to 137 mEq/L.
The concentration of creatinine is 1.6 mg/dL. 
The patient has not went through dialysis at least twice in the past week.
Whether the patient has went through continuous veno-venous hemodialysis in the past 24 hours is not mentioned, and so we assume this to be false.
The concentration of bilirubin is 1.11 mg/dL. 
The patient's INR is 0.9. The patient's INR is less than 1.0, and so we set the INR to 1.0.
The concentration of sodium is 141.0 mEq/L. The sodium concentration is greater than 137 mEq/L, and so we set the sodium concentration to 137 mEq/L.
Applying the first equation gives us 0.957 x ln(1.6) + 0.378 x ln(1.11) + 1.120 x ln(1.0) + 0.643 = 1.1322415589807329. Rounding to the nearest tenth makes the MELD (i) score 1.1. We then multiply by 10, making the MELD(i) score 11.
The patient's MELD (i) score is less than 11, and so we do not apply the second equation, making the patient's MELD Na score, 11 points."
343,23,MELD Na (UNOS/OPTN),lab test,decimal,pmc-3741440-1,Extracted,"A 40 year-old-female
Altered mentality
This previously healthy 40-year-old female was transported to the emergency room by her neighbors, who heard her moaning in her house. She lived alone, and 1 month prior to her admission, she developed the paranoid idea that her water was poisoned, and did not drink any water or beverages since then.
Non-contributory
Non-contributory
Her blood pressure was 100/60 mmHg, pulse rate 106/min, respiration rate 16/min, and body temperature 36.5℃. She looked chronically ill, and her skin and mucosa were extremely dehydrated. There was no evidence of trauma. A chest examination revealed a regular heart beat and clear breathing sounds. The abdomen was soft and flat with no palpable mass.
She was light, drowsy and disorientated. Her pupils were intact and reactive. The Glasgow Coma Scale was 11. No cranial nerve problem or peripheral nerve dysfunction was found.
White blood cell count 21,900/mm3 (4000-10,000/mm3), hemoglobin 11.2 g/dL(men 13-17 g/dL: women 12-16 g/dL), hematocrit 51%(men: 42-50%: women 36-44%), and platelets 207,000/mm3 (150,000-400,000/mm3). Her coagulation profile showed an international normalized ratio of 1.71 (1.2 below) and activated partial thromboplastin time of 177.4 sec (24-33 sec). Laboratory chemistry showed blood urea nitrogen 208mg/dL (8.0-20 mg/dL), creatinine 4.90mg/dL(0.6-1.2mg/dL), serum osmolality 452mOsm/L(289-302mOsm/L), protein 7.5 g/dL (6.5-8.2mg/dL), albumin 4.5 g/dL(3.5-5.1 g/dL), ionized calcium 4.6mg/dL (4.2-5.4mg/dL), magnesium 4.5mg/dL (1.9-2.5 mg/dL), serum sodium 172mEq/L(135-145mEq/L), potassium 4.4mEq/L(3.5-5.5mEq/L), chloride 127mEq/L(98-110 mEq/L), total CO2 21mEq/L (24-31mEq/L), aspiratetransaminase 22 IU/L (0-40 IU/L), alanine aminotransferase 16 IU/L (0-40 IU/L), total bilirubin 1.1mg/dL(0.2-1.1 mg/dL), myoglobin 1,949 ng/mL (28-72 ng/mL), creatine phsphokanase 389 IU/L (190 below IU/L), anti-diuretic hormone 8.95 pg/mL(0.0-6.7 pg/mL), adrenocorticotropic hormone (ACTH) 111 pg/mL(10-60 pg/mL), and cortisol 71 g/mL (morning 9.4-26.1/evening 1.8-12.7 g/mL). Breathing room air, the arterial blood gas analysis revealed pH 7.422, PaCO2 35.4mmHg, PaO2 106mmHg, and bicarbonate 22.6mEq/L. Urinalysis showed specific gravity was >1.030, urine pH 5.0, urine osmolality 698mOsm/L (300-900mOsm/L), and urine sodium/potassium/chloride34/85.6/8mEq/L.
Brain computerized tomography (CT) was normal.
She was diagnosed with uremic encephalopathy due to severe prerenal acute renal failure. Her estimated water deficit was 5.94 L. We started intravenous dextrose for 4h, but the changein serum sodium was minimal (171mEq/L). We therefore started hemodialysis to treat the uremic encephalopathy. The dialysate sodium level was 150mEq/L. After dialysis, the serum sodium decreased to 160mEq/L, potassium was 4.2mEq/L, chloride 124 mEq/L, and total CO2 23mEq/L. After a second dialysis treatment, the sodium was 150mEq/L and she became alert without neurological sequelae. We continued an intravenous dextrose fluid infusion with oral hydration, and the sodium level normalized on day 3 of hospitalization (). After discharge, her sodium and chemistry profile remained normal.",What is the patient's MELD Na score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'creatinine': [4.9, 'mg/dL'], 'Continuous veno-venous hemodialysis for ≥24 hours in the past week': False, 'Dialysis at least twice in the past week': False, 'international normalized ratio': 1.71, 'Sodium': [172.0, 'mEq/L'], 'Bilirubin': [1.1, 'mg/dL']}",26,24.7,27.3,"The formula for computing the MELD Na is to first apply the following equation: MELD(i) = 0.957 x ln(Cr) + 0.378 x ln(bilirubin) + 1.120 x ln(INR) + 0.643.
If the MELD(i) is greater than 11 after rounding to the nearest tenth and multiplying the MELD(i) by 10, we apply the following equation: MELD = MELD(i) + 1.32 x (137 - Na) -  [ 0.033 x MELD(i) x (137 - Na)]. The MELD Na score is capped at 40. The concentration of Na is mEq/L, the concentration of bilirubin is mg/dL, and the concentration of creatinine is mg/dL. If the patient's Na concentration is less than 125 mEq/L, we set it to 125 mEq/L and if the patient's the Na concentration is greater 137 mEq/L, we round it to 137 mEq/L.
The concentration of creatinine is 4.9 mg/dL. 
The patient has not went through dialysis at least twice in the past week.
Whether the patient has went through continuous veno-venous hemodialysis in the past 24 hours is not mentioned, and so we assume this to be false.
The creatinine concentration is greater than 4.0 mg/dL, and so we set the creatinine concentration to 4.0 mg/dL.
The concentration of bilirubin is 1.1 mg/dL. 
The patient's INR is 1.71. 
The concentration of sodium is 172.0 mEq/L. The sodium concentration is greater than 137 mEq/L, and so we set the sodium concentration to 137 mEq/L.
Applying the first equation gives us 0.957 x ln(4.0) + 0.378 x ln(1.1) + 1.120 x ln(1.71) + 0.643 = 2.606583526534087. Rounding to the nearest tenth makes the MELD (i) score 2.6. We then multiply by 10, making the MELD(i) score 26.
Because the MELD (i) score is greater than 11, we then apply the second equation, giving us 26 + 1.32 x (137 - 137) -  [0.033 x 2.606583526534087 x (137 - 137)] = 26.
The MELD Na score is less than 40, and so we keep the score as it is. The patient's MELDNa score, rounded to the nearest integer, is 26 points."
344,23,MELD Na (UNOS/OPTN),lab test,decimal,pmc-3701851-1,Extracted,"A 71-year-old male, who had been diagnosed as alcoholic liver cirrhosis and chronic hepatitis C (genotype 1b) 7 years previously, was admitted for change of mental status. The patient had history of old pulmonary tuberculosis, a cataract operation 10 years ago and several orthopedic surgeries for the fracture of both lower extremities due to a traffic accident 20 years ago. The patient had no diabetes, and hypertension. Familial history was unremarkable. Smoking history was 40 pack years, and the patient stopped smoking 12 years ago. He had 135 g of daily alcohol (three bottles of raw rice wine) consumption for 30 years. Alcohol intake was discontinued four years ago.
Chronic ill appearance, drowsy mental status, crusts and bruises of lower extremities, and abdominal distension without fluid wave shifting were noted on physical examinations. The patient did not complain of claudication ordinarily. His cirrhosis status was Child-Pugh B without ascites and hypersplenism-related pancytopenia. The initial vital signs were blood pressure 150/70 mmHg, heart rate 64 beats/min, respiration rate 20 breaths/min, and body temperature 36℃. The initial laboratory evaluation revealed WBC 26240 (poly: 85.6%) cells/µL, hemoglobin 11.3 g/dL, platelet 1.76×105 cells/µL, prothrombin time 14.7 seconds, international normalized ratio 1.26 (71%), ammonia 168 µmol/L, blood urea nitrogen 27.3 mg/dL, creatinine 3.16 mg/dL, albumin 2.83 g/dL, total bilirubin 2.11 mg/dL, aspartate aminotransferase 34 U/L, alanine aminotransferase 16 U/L, γ-glutamyl transpeptidase 18 IU/L, alkaline phosphatase 220 IU/L, lactate dehydrogenase 605 IU/L, Na 137 mEq/L, K 4.7 mEq/L, Cl 114 mEq/L, HCV RNA 1.9×105 copies/mL and metabolic acidosis. Urine sodium was 61 mEq/L with no proteinuria. Chest X-ray showed mild cardiomegaly and emphysematous change. Non-enhanced abdominal CT was unremarkable. Before admission, he had difficulty in defecation for 4 days. The first impression was grade III (graded with the West Haven Criteria) hepatic encephalopathy caused by constipation. Lactulose enema and administration of empirical antibiotics for infection of unknown origin related to leukocytosis were applied. And six months previously, his creatinine level was only 1.63 mg/dL. We suspected of type II hepatorenal syndrome overlapped with hepatic encephalopathy.
Although the combination therapy of fluid replacement and diuretics started, his creatinine level was elevated to 4.02 mg/dL during 10 days. The urine output for 24 hours decreased to 500 mL. The patient was diagnosed with HRS on the basis of the criteria outlined by the International Ascites Club.
On the admission day 11, intravenous terlipressin along with albumin (20%, 100 mL) was administered for the management (1 mg q 4 hour) of HRS. He complained of severe cramping abdominal pain whenever a single injection of bolus terlipressin was administered. This complication was common, predictable, and thoroughly controlled by means of low-dose analgesics. Total urine output per 24 hours increased to 3,650 mL in 10 days when terlipressin was injected. On the admission day 22, the patient's clinical condition improved, and mentality changed to a clear state. The chemistry panel of the patient decreased: BUN to 30.63 mg/dL and creatinine to 1.29 mg/dL. However, on the day 11 after the terlipressin administration, the patient complained of severe tearing pain of both lower legs, and discoloration, necrosis, and gangrene were found in the 1st and 2nd toes of the right foot and the 1st, 2nd and 3rd toes of the left foot on physical examination. The terlipressin injection was discontinued immediately. These changes progressed to ischemia throughout the feet, accompanied by poor peripheral pulse and delayed wound healing as shown in .
The wounds in both feet were dressed with hydrocolloid solution. The patient still complained of continuous pain in both legs. A 3-phase bone scan showed an increased tracer uptake in the right 1st and 2nd toes, and the left toes and tarsal bone. The diagnosis assumed by the bone scan was osteomyelitis with osteonecrosis of the left foot, and osteomyelitis of the right foot (). However, 3-dimension angiographic CT of lower extremities was not taken due to the risk of contrast-induced nephropathy.
For prevention of the enlargement of gangrene or necrosis and healing tissue damage, intravenous alprostadil (prostaglandin E1, 10 µg/day) was administered continuously. The patient's serum creatinine stabilized during alprostadil administration. On the 6th day after the administration of alprostadil, an oral sildenafil (cGMP-specific phosphodiesterase type 5 inhibitor, 50 mg q 12 hour) was added to promote the peripheral circulation. Two days later, his urine output decreased to 445 mL/24h. Serum creatinine level was elevated to 2.8 mg/dL again. The combination therapy of alprostadil and sildenafil was withdrawn promptly. Intravenous furosemide was reintroduced. One week later, the creatinine level decreased again to 1.3 mg/dL, and urine output was held at 2,000 mL/24h. The mental status and clinical condition improved well ().
Though the lesions of the right 1st and 2nd toes were recovered completely by vigorous dressing and medication, the left three toes with severe necrosis and osteomyelitis needed to be amputated finally (). On the admission day 44, a 3-dimension angiographic CT of the lower extremities was taken. It showed moderate stenosis with multifocal calcified plaques at both femoral and popliteal arteries, and mild stenosis at both anterior tibial arteries. The orthopedic surgeons' final decision was amputation of the left leg below the knee including necrotic three toes.",What is the patient's MELD Na score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'creatinine': [3.16, 'mg/dL'], 'Continuous veno-venous hemodialysis for ≥24 hours in the past week': False, 'Dialysis at least twice in the past week': False, 'international normalized ratio': 1.26, 'Sodium': [137.0, 'mEq/L'], 'Bilirubin': [2.11, 'mg/dL']}",23,21.85,24.15,"The formula for computing the MELD Na is to first apply the following equation: MELD(i) = 0.957 x ln(Cr) + 0.378 x ln(bilirubin) + 1.120 x ln(INR) + 0.643.
If the MELD(i) is greater than 11 after rounding to the nearest tenth and multiplying the MELD(i) by 10, we apply the following equation: MELD = MELD(i) + 1.32 x (137 - Na) -  [ 0.033 x MELD(i) x (137 - Na)]. The MELD Na score is capped at 40. The concentration of Na is mEq/L, the concentration of bilirubin is mg/dL, and the concentration of creatinine is mg/dL. If the patient's Na concentration is less than 125 mEq/L, we set it to 125 mEq/L and if the patient's the Na concentration is greater 137 mEq/L, we round it to 137 mEq/L.
The concentration of creatinine is 3.16 mg/dL. 
The patient has not went through dialysis at least twice in the past week.
Whether the patient has went through continuous veno-venous hemodialysis in the past 24 hours is not mentioned, and so we assume this to be false.
The concentration of bilirubin is 2.11 mg/dL. 
The patient's INR is 1.26. 
The concentration of sodium is 137.0 mEq/L. 
Applying the first equation gives us 0.957 x ln(3.16) + 0.378 x ln(2.11) + 1.120 x ln(1.26) + 0.643 = 2.285190602041519. Rounding to the nearest tenth makes the MELD (i) score 2.3. We then multiply by 10, making the MELD(i) score 23.
Because the MELD (i) score is greater than 11, we then apply the second equation, giving us 23 + 1.32 x (137 - 137.0) -  [0.033 x 2.285190602041519 x (137 - 137.0)] = 23.
The MELD Na score is less than 40, and so we keep the score as it is. The patient's MELDNa score, rounded to the nearest integer, is 23 points."
345,23,MELD Na (UNOS/OPTN),lab test,decimal,pmc-4528898-1,Extracted,"A 47-year-old African American man came to the emergency department with complaints of 4 days of severe, colicky back pain with some radiation to the flanks, associated with nausea and vomiting and a noticeable decrease in urination. He denied any history of trauma, stones, dysuria, frequency, hesitancy, rash, constipation, diarrhea, fever, or previous similar pain. He denied any unusual food or sick contact. He denied taking any medications for the past 18 months, including nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and antacids. He denied smoking, alcohol, and drugs although it had been noted in the chart that he had a positive urinary toxicology screen in the past for cocaine. Although he had a history of hypertension, diabetes, and hyperlipidemia diagnosed 3 years previously during a brief hospital stay, he was not taking any of the recommended prescription medications. Family history was positive for premature atherosclerosis, yet negative for autoimmune diseases and tuberculosis. On physical examination, his vital signs included blood pressure of 235/125 mm Hg, pulse 90 beats/min, respiratory rate 20/min, temperature 37°C, O2 saturation 96% on room air. He was awake and alert, had clear lungs, a regular heart rate with no murmurs, gallops, or rubs, a soft abdomen with normal bowels sounds, bilateral costophrenic tenderness to percussion, a normal prostate, and neurologic examination.
Creatinine was 10.48 mg/dL, up from his previous level of 1.15 mg/dL at his previous visit 3 years prior. Blood urea nitrogen 63 mg/dL, Na 134 mEq/L, K 4.4 mEq/L, Cl 100 mEq/L, CO2 22 mEq/L, glucose 151 mg/dL, Ca 9.4 mg/dL, PO4 6.1 mg/dL, Mg 2.1 mg/dL, hemoglobin 15 g/dL, hematocrit 45%, white blood cells (WBC) of 9100 with neutrophils 75%, lymphocytes 12.5%, and eosinophils 0.9%, platelets of 167 000. His troponin was 0.02 ng/mL, CK-MB 2.6 ng/mL, BNP 53 pg/mL, amylase 70 U/L, lipase 69 U/L, international normalized ratio 1.1, prothrombin time 13 seconds, partial thromboplastin time 31 seconds, HbA1c 6.6%, aspartate transaminotransferase (AST) 25 IU/L, alanine aminotransferase (ALT) 20 IU/L, albumin 3.8 g/dL, total protein 7.3 g/dL, bilirubin 1.4 mg/dL, alkaline phosphatase 39 IU/L, C-reactive protein 25 mg/L. Urine toxicology screen was positive for cocaine. Urinalysis showed 2+ blood, no red blood cells, no WBCs, including no eosinophils by special stain, no casts, no albumin, negative for nitrates, negative leukocyte esterase and negative for bacteria, trace ketone, pH 5.5, and specific gravity 1.015. No pigmented granular casts. His hepatitis panel: C-ANCA (cytoplasmic–antineutrophil cytoplasm antibodies) Ag, P-ANCA (perinuclear–antineutrophil cytoplasm antibodies), anti–glomerular basement membrane Ag, anti-myeloperoxidase, antinuclear antibody and Helicobacter pylori IgA were all negative. Creatine phosphokinase was 127 mg/dL and his serum electrophoresis was normal. C3 was 119 mg/dL and C4 was 88.5 mg/dL (both normal). Anti-proteinase 3 (PR-3) antibodies were positive.
His chest and abdominal radiographs were normal, and computed tomography of the abdomen and pelvis without contrast showed no urinary obstruction. Transthoracic echocardiogram showed normal wall motion and ejection fraction. Electrocardiography showed nonspecific T-wave abnormalities, which were unchanged since 2010.
The patient’s blood pressure was initially controlled with intravenous labetalol and hydralazine. Over the first 3 days of admission, his urinary output decreased from 700 cm3/d to less than 400 cm3/d and his creatinine rose to 13.6 mg/dL. Nephrology was consulted early and after ruling out acute toxic nephropathy, urinary obstruction, and acute rhabdomyolsis, it was suspected, based on his initial positive toxicology screen for cocaine that he may have cocaine-induced interstitial nephritis and a renal biopsy was performed (see below). Indeed, on further questioning, the patient admitted to smoking crack cocaine. It was confirmed with the patient and his spouse that the cocaine was not mixed or combined with any other substance. At that point (day 4) the patient was started on intravenous methylprednisolone at 125 mg every 6 hours as well as daily or every other day hemodialysis for a total of 6 sessions. The methylprednisolone was tapered to 80 mg every 6 hours after 3 days and then changed to oral prednisone, which was furthered tapered over the next 12 days. The steroid was used roughly day 4 of admission, and 7 days after symptoms had started, it is hard to tag a response to the steroid separately as the patient was started on both hemodialysis and steroid at the same time after biopsy of kidney confirmed the diagnosis; nevertheless, we were able to see stable improvement on creatinine on days 8 and 9, with improvement of urine output (roughly 1000-1500 cm3/d). The patient stabilized with his creatinine at 3.54 mg/dL before being discharged home and follow-up 8 weeks later showed a normal creatinine.
Renal biopsy () showed normocellular glomeruli, interstitial atrophy, and fibrosis with tubular loss of 10% to 20%. There were foci of interstitial inflammation composed of lymphocytes, plasma cells, eosinophils, and edema with areas of severe arterioarterosclerosis. No immune complexes were detected.",What is the patient's MELD Na score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'creatinine': [10.48, 'mg/dL'], 'Continuous veno-venous hemodialysis for ≥24 hours in the past week': False, 'Dialysis at least twice in the past week': False, 'international normalized ratio': 1.1, 'Sodium': [134.0, 'mEq/L'], 'Bilirubin': [1.4, 'mg/dL']}",24,22.8,25.2,"The formula for computing the MELD Na is to first apply the following equation: MELD(i) = 0.957 x ln(Cr) + 0.378 x ln(bilirubin) + 1.120 x ln(INR) + 0.643.
If the MELD(i) is greater than 11 after rounding to the nearest tenth and multiplying the MELD(i) by 10, we apply the following equation: MELD = MELD(i) + 1.32 x (137 - Na) -  [ 0.033 x MELD(i) x (137 - Na)]. The MELD Na score is capped at 40. The concentration of Na is mEq/L, the concentration of bilirubin is mg/dL, and the concentration of creatinine is mg/dL. If the patient's Na concentration is less than 125 mEq/L, we set it to 125 mEq/L and if the patient's the Na concentration is greater 137 mEq/L, we round it to 137 mEq/L.
The concentration of creatinine is 10.48 mg/dL. 
The patient has not went through dialysis at least twice in the past week.
Whether the patient has went through continuous veno-venous hemodialysis in the past 24 hours is not mentioned, and so we assume this to be false.
The creatinine concentration is greater than 4.0 mg/dL, and so we set the creatinine concentration to 4.0 mg/dL.
The concentration of bilirubin is 1.4 mg/dL. 
The patient's INR is 1.1. 
The concentration of sodium is 134.0 mEq/L. 
Applying the first equation gives us 0.957 x ln(4.0) + 0.378 x ln(1.4) + 1.120 x ln(1.1) + 0.643 = 2.2036176104153977. Rounding to the nearest tenth makes the MELD (i) score 2.2. We then multiply by 10, making the MELD(i) score 22.
Because the MELD (i) score is greater than 11, we then apply the second equation, giving us 22 + 1.32 x (137 - 134.0) -  [0.033 x 2.2036176104153977 x (137 - 134.0)] = 24.
The MELD Na score is less than 40, and so we keep the score as it is. The patient's MELDNa score, rounded to the nearest integer, is 24 points."
346,25,HAS-BLED Score for Major Bleeding Risk,risk,integer,usmle-1741,Extracted,"A 45-year-old man with history of hypertension comes to the physician for a 2-day history of headache and breathlessness on exertion. During the same period, he has vomited twice and not passed urine. He also reports pain and stiffness in his fingers that has worsened progressively over the past 2 years. He does not smoke or drink alcohol. He is in moderate distress. His temperature is 37.2°C (98.9°F), pulse is 88/min, blood pressure is 170/100 mm Hg, and respirations are 24/min. Pulse oximetry on room air shows an oxygen saturation of 91%. Examination reveals pallor, 2+ pretibial edema, and jugular venous distention. The skin on the arms, chest, and upper back is coarse and thickened. Diffuse cutaneous hyperpigmentation and hypopigmented patches with perifollicular hypopigmentation are noted. Contractures are present in the proximal interphalangeal joints of both hands. Diffuse crackles are heard on auscultation of the chest. There is dullness to percussion and decreased breath sounds over both lung bases. S1 and S2 are normal. An S3 gallop is heard at the apex. The remainder of the examination shows no abnormalities. His hemoglobin concentration is 8.1 g/dL, and his serum creatinine is 5.3 mg/dL.",What is the patient's HAS-BLED score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [45, 'years'], 'Renal disease criteria for the HAS-BLED rule': True, 'Hypertension': True, 'Number of Alcoholic Drinks Per Week': '0.0', 'Stroke': False, 'Medication usage predisposing to bleeding': False, 'Prior major bleeding or predisposition to bleeding': False, 'Labile international normalized ratio': False}",2,2,2,"The criteria for the HAS-BLED score are listed below below:

1. Hypertension (Uncontrolled, >160 mmHg systolic): No = 0 points, Yes = +1 point
2. Renal disease (Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L): No = 0 points, Yes = +1 point
3. Liver disease (Cirrhosis or bilirubin >2x normal with AST/ALT/AP >3x normal): No = 0 points, Yes = +1 point
4. Stroke history: No = 0 points, Yes = +1 point
5. Prior major bleeding or predisposition to bleeding: No = 0 points, Yes = +1 point
6. Labile INR (Unstable/high INRs, time in therapeutic range <60%): No = 0 points, Yes = +1 point
7. Age >65: No = 0 points, Yes = +1 point
8. Medication usage predisposing to bleeding (Aspirin, clopidogrel, NSAIDs): No = 0 points, Yes = +1 point
9. Alcohol use (≥8 drinks/week): No = 0 points, Yes = +1 point

The total HAS-BLED score is calculated by summing the points for each criterion.
    
The current HAS-BLED score is 0.
The patient is 45 years old. Because the patient's age is less than 66 years, we don't change the score, keeping the current score at 0.
The patient has 0 drinks a week. Because the patient has less than 8 alcoholic drinks a week, we don't change the score, keeping the current score at 0.
The issue, hypertension, is reported to be present for the patient note and so we increase the score by 1, making the current score 0 + 1 = 1.
The issue, liver disease, is missing from the patient note and so we assume it to be absent and so we do not change the score, keeping the current score at 1.
The issue, renal disease, is reported to be present for the patient note and so we increase the score by 1, making the current score 1 + 1 = 2.
The issue, stroke history, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
The issue, prior bleeding, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
The issue, labile inr, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
The issue, medications for bleeding, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
Hence, the patient's HAS-BLED score is 2."
347,25,HAS-BLED Score for Major Bleeding Risk,risk,integer,usmle-12518,Extracted,"A 64-year-old man presents to his primary care clinic for a regular checkup. No history of stroke or any other major bleeding events. He reports feeling depressed since his wife left him 6 months prior and is unable to recall why she left him. He denies any sleep disturbance, change in his eating habits, guilt, or suicidal ideation. His past medical history is notable for hypertension, gout, and a myocardial infarction five years ago. He takes lisinopril, aspirin, metoprolol, and allopurinol. He has a 50 pack-year smoking history and was previously a heroin addict but has not used in over 20 years. He drinks at least 6 beers per day. His temperature is 98.6°F (37°C), blood pressure is 155/95 mmHg, pulse is 100/min, and respirations are 18/min. He appears somewhat disheveled, inattentive, and smells of alcohol. During his prior visits, he has been well-groomed and attentive.  INR was within normal range.",What is the patient's HAS-BLED score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Liver disease criteria for the HAS-BLED rule': False, 'age': [64, 'years'], 'Renal disease criteria for the HAS-BLED rule': False, 'Hypertension': True, 'Number of Alcoholic Drinks Per Week': '42.0', 'Stroke': False, 'Medication usage predisposing to bleeding': True, 'Prior major bleeding or predisposition to bleeding': False, 'Labile international normalized ratio': False}",3,3,3,"The criteria for the HAS-BLED score are listed below below:

1. Hypertension (Uncontrolled, >160 mmHg systolic): No = 0 points, Yes = +1 point
2. Renal disease (Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L): No = 0 points, Yes = +1 point
3. Liver disease (Cirrhosis or bilirubin >2x normal with AST/ALT/AP >3x normal): No = 0 points, Yes = +1 point
4. Stroke history: No = 0 points, Yes = +1 point
5. Prior major bleeding or predisposition to bleeding: No = 0 points, Yes = +1 point
6. Labile INR (Unstable/high INRs, time in therapeutic range <60%): No = 0 points, Yes = +1 point
7. Age >65: No = 0 points, Yes = +1 point
8. Medication usage predisposing to bleeding (Aspirin, clopidogrel, NSAIDs): No = 0 points, Yes = +1 point
9. Alcohol use (≥8 drinks/week): No = 0 points, Yes = +1 point

The total HAS-BLED score is calculated by summing the points for each criterion.
    
The current HAS-BLED score is 0.
The patient is 64 years old. Because the patient's age is less than 66 years, we don't change the score, keeping the current score at 0.
The patient has 42 drinks a week. Because the patient has at least 8 alcoholic drinks a week, we increment the score by 1, making the current score 0 + 1 = 1.
The issue, hypertension, is reported to be present for the patient note and so we increase the score by 1, making the current score 1 + 1 = 2.
The issue, liver disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
The issue, renal disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
The issue, stroke history, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
The issue, prior bleeding, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
The issue, labile inr, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
The issue, medications for bleeding, is reported to be present for the patient note and so we increase the score by 1, making the current score 2 + 1 = 3.
Hence, the patient's HAS-BLED score is 3."
348,25,HAS-BLED Score for Major Bleeding Risk,risk,integer,pmc-5798152-1,Extracted,"Case 1 was a 38-year-old male with a professional role in a large corporation. He was an ex-smoker of 14 years and had a low alcohol intake (14 units/week). No history of stroke or any prior hemorrhagic events. The patient’s mother and younger brother both had a clinical diagnosis of ADPKD. The mother had advanced to ESRD by the age of 61, while the brother (aged 40) had not yet reached ESRD. Due to the patient’s family history of ADPKD, the patient had undergone renal USS screening at age 14, whereupon polycystic kidneys consistent with a diagnosis of ADPKD were detected.
The patient presented with several comorbidities, including hypertension, which had been diagnosed at the age of 26 and was being controlled well using irbesartan. At the age of 15, the patient experienced an episode of severe flank pain associated with macrohaematuria. The patient’s extrarenal manifestations of ADPKD included sigmoid diverticulosis and a small intracranial aneurysm, which was managed conservatively. Echocardiography also revealed a concentric myocardial hypertrophy but without signs of valvular dysfunction.
The patient’s renal function showed an eGFR [CKD Epidemiology Collaboration (CKD-EPI)] of 41 mL/min/1.73 m2, with a documented decline from 58 mL/min/1.73 m2 2.5 years previous [eight creatinine values in between documenting the slope; (CKD-3b)]. Genetic testing had not been performed, hence a PROPKD score could not be calculated. A recent MRI had documented large kidneys with a htTKV of 1692 mL/m, putting the patient into Mayo class 1E. INR is within normal limits. 
The family history of ADPKD and the patient’s early onset of hypertension and urological complications, together with their documented CKD-3b disease and Mayo class 1E at age 38, put the patient at a high likelihood for rapid disease progression. Based on the fact that few patients in CKD stage 3b had been enrolled in TEMPO 3:4, the ERA-EDTA Working Groups on Inherited Kidney Disorders and European Renal Best Practice position statement suggests that only patients up to CKD stage 3a should be commenced on tolvaptan []. This fact and its implications were discussed with the patient. However, taking into account that he had just reached this threshold, as well as his young age, a decision was made to start treatment with tolvaptan, following counselling regarding possible impact on his work as a manager of a large company. The patient did not experience any major side effects and was able to plan his workday and meetings around the polyuria without any significant disruption.",What is the patient's HAS-BLED score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Liver disease criteria for the HAS-BLED rule': False, 'age': [38, 'years'], 'Renal disease criteria for the HAS-BLED rule': True, 'Hypertension': True, 'Number of Alcoholic Drinks Per Week': '14.0', 'Stroke': False, 'Medication usage predisposing to bleeding': False, 'Prior major bleeding or predisposition to bleeding': False, 'Labile international normalized ratio': False}",3,3,3,"The criteria for the HAS-BLED score are listed below below:

1. Hypertension (Uncontrolled, >160 mmHg systolic): No = 0 points, Yes = +1 point
2. Renal disease (Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L): No = 0 points, Yes = +1 point
3. Liver disease (Cirrhosis or bilirubin >2x normal with AST/ALT/AP >3x normal): No = 0 points, Yes = +1 point
4. Stroke history: No = 0 points, Yes = +1 point
5. Prior major bleeding or predisposition to bleeding: No = 0 points, Yes = +1 point
6. Labile INR (Unstable/high INRs, time in therapeutic range <60%): No = 0 points, Yes = +1 point
7. Age >65: No = 0 points, Yes = +1 point
8. Medication usage predisposing to bleeding (Aspirin, clopidogrel, NSAIDs): No = 0 points, Yes = +1 point
9. Alcohol use (≥8 drinks/week): No = 0 points, Yes = +1 point

The total HAS-BLED score is calculated by summing the points for each criterion.
    
The current HAS-BLED score is 0.
The patient is 38 years old. Because the patient's age is less than 66 years, we don't change the score, keeping the current score at 0.
The patient has 14 drinks a week. Because the patient has at least 8 alcoholic drinks a week, we increment the score by 1, making the current score 0 + 1 = 1.
The issue, hypertension, is reported to be present for the patient note and so we increase the score by 1, making the current score 1 + 1 = 2.
The issue, liver disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
The issue, renal disease, is reported to be present for the patient note and so we increase the score by 1, making the current score 2 + 1 = 3.
The issue, stroke history, is reported to be absent for the patient and so we do not change the score, keeping the current score at 3.
The issue, prior bleeding, is reported to be absent for the patient and so we do not change the score, keeping the current score at 3.
The issue, labile inr, is reported to be absent for the patient and so we do not change the score, keeping the current score at 3.
The issue, medications for bleeding, is reported to be absent for the patient and so we do not change the score, keeping the current score at 3.
Hence, the patient's HAS-BLED score is 3."
349,25,HAS-BLED Score for Major Bleeding Risk,risk,integer,pmc-3152737-1,Extracted,"A 63-year-old female was admitted to our hospital for radiofrequency catheter ablation (RFCA) to treat chronic atrial fibrillation. Her past medical history included hypertension and a cerebrovascular accident 1 year before for which she had been taking warfarin, amiodarone and an angiotension receptor blocker. There was no history of diabetes, cardiac valvular disease or thyroid disease. She did not smoke or consume alcohol. She was alert and oriented. Auscultation of the neck showed normal carotid upstrokes.
The next day after admission, RFCA for chronic atrial fibrillation was successfully performed without in-lab complication. Ten hours after RFCA, she started having shortness of breath as well as painful swelling on the anterior part of her right neck and the symptoms were getting worse. Her right CCA was accidentally ruptured while attempting needle and sheath insertion to the right internal jugular vein. She was hemodynamically unstable (blood pressure 83/53 mmHg) and mechanically ventilated. Hematocrit had dropped from 37% to 26.8% in 4 hours. A computed tomogram (CT) of the neck revealed extensive hemorrhage around the right CCA which expanded into the mediastinum (). We consulted with otolaryngologist for an emergency operation. They recommended elective operation the following morning because they believed intubation to keep her airway from obstruction. However, her symptoms and vital signs deteriorated rapidly during observation. The size of subcutaneous hematoma around neck and shoulder was getting bigger and we decided emergency stenting for the perforated carotid artery was necessary. INR is within therapeutic range at 2.5. 
A 7 French (F) sheath was inserted into the right femoral artery. Heparinization was performed during the intervention with an active clotting time kept between 250 to 300 seconds. A 5F Headhunter diagnostic catheter (Cook, Bloomington, IN, USA) was placed in the right CCA. Angiography showed bleeding from the proximal right CCA (). A 0.035inch stiff Amplatz wire (Cook, Bloomington, IN, USA) was used to exchange a 7F Shuttle guide sheath (Cook, Bloomington, IN, USA) into the right CCA. The 7F Shuttle guide sheath (Cook, Bloomington, IN, USA) was positioned at the proximal right CCA. A Jostent peripheral stent graft (5×28 mm; Abbott, Abbott Park, IL, USA) was hand-mounted onto an Ultrathin diamond balloon catheter (6×40 mm; Natick, Boston Scientific, MA, USA). The stent graft mounted balloon was advanced to the injured segment of the CCA () and was positioned at the level of the injured CCA. After a control angiogram was obtained, the stent graft mounted balloon was inflated to 15 atm (). The balloon was then deflated while negative pressure was applied, and the balloon was removed. A final angiogram showed total closure of the ruptured portion of the CCA () and the patient had no neurologic changes after the procedure. She was extubated in 5 days after stenting and discharged 10 days after stenting without any complications. She was followed carefully in the outpatient department and was given aspirin and clopidogrel. Follow-up CT showed a decrease in the extent of hematoma around CCA and in the mediastinum 25 days after procedure ().",What is the patient's HAS-BLED score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Liver disease criteria for the HAS-BLED rule': False, 'age': [63, 'years'], 'Renal disease criteria for the HAS-BLED rule': False, 'Hypertension': True, 'Number of Alcoholic Drinks Per Week': '0.0', 'Stroke': True, 'Medication usage predisposing to bleeding': True, 'Prior major bleeding or predisposition to bleeding': False, 'Labile international normalized ratio': False}",3,3,3,"The criteria for the HAS-BLED score are listed below below:

1. Hypertension (Uncontrolled, >160 mmHg systolic): No = 0 points, Yes = +1 point
2. Renal disease (Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L): No = 0 points, Yes = +1 point
3. Liver disease (Cirrhosis or bilirubin >2x normal with AST/ALT/AP >3x normal): No = 0 points, Yes = +1 point
4. Stroke history: No = 0 points, Yes = +1 point
5. Prior major bleeding or predisposition to bleeding: No = 0 points, Yes = +1 point
6. Labile INR (Unstable/high INRs, time in therapeutic range <60%): No = 0 points, Yes = +1 point
7. Age >65: No = 0 points, Yes = +1 point
8. Medication usage predisposing to bleeding (Aspirin, clopidogrel, NSAIDs): No = 0 points, Yes = +1 point
9. Alcohol use (≥8 drinks/week): No = 0 points, Yes = +1 point

The total HAS-BLED score is calculated by summing the points for each criterion.
    
The current HAS-BLED score is 0.
The patient is 63 years old. Because the patient's age is less than 66 years, we don't change the score, keeping the current score at 0.
The patient has 0 drinks a week. Because the patient has less than 8 alcoholic drinks a week, we don't change the score, keeping the current score at 0.
The issue, hypertension, is reported to be present for the patient note and so we increase the score by 1, making the current score 0 + 1 = 1.
The issue, liver disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, renal disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, stroke history, is reported to be present for the patient note and so we increase the score by 1, making the current score 1 + 1 = 2.
The issue, prior bleeding, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
The issue, labile inr, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
The issue, medications for bleeding, is reported to be present for the patient note and so we increase the score by 1, making the current score 2 + 1 = 3.
Hence, the patient's HAS-BLED score is 3."
350,25,HAS-BLED Score for Major Bleeding Risk,risk,integer,pmc-2808612-1,Extracted,"A 65-yr-old male patient was admitted to Chonnam National University Hospital because of fever and chills with drowsy mental status after hemodialysis. His symptoms and signs were acute onset. Fifteen years earlier, he was found to have diabetes and well controlled by insulin and oral hypoglycemics, and to have hypertension. Five years earlier, he had developed chronic renal failure due to diabetic complication. Three years earlier, he was operated native brachiocephalic arteriovenous fistula formation on his left arm and has been taken maintenance hemodialysis with 3 sessions in each week. Other past medical history including tuberculosis, hepatitis or abdominal surgery had not been known. He was non-smoker, and non-alcoholics. There was no history of trauma. His blood pressure was 130/80 mmHg and his body temperature was 38.1℃ on admission. On physical examination, there was diffuse tenderness on the abdomen, especially on the left hypochondrium. There was ecchymosis around the left brachiocephalic arteriovenous fistula area with tenderness and swelling. Auscultation of his chest revealed diastolic cardiac murmurs on apex. On chest radiography and electrocardiogram, there was cardiomegaly. Biochemical analysis revealed that hemoglobin level was 8.2 g/dL, white blood cell count 11,500/µL, platelet count 84,000/µL, blood urea nitrogen level 25.0 mg/dL, and serum creatinine level 4.6 mg/dL, sodium 140 mEq/L, potassium 4.7 mEq/L, chloride 97 mEq/L, aspartate aminotransferase 28 IU/L, alkaline phosphatase 81 IU/L, serum albumin 3.4 g/dL, C-reactive protein 25.97 mg/dL, erythrocyte sedimentation rate 31 mm/hr, fibrinogen degradation product <5 µg/mL, D-dimer 0.4 mg/L (reference value 0-0.3), aPTT 37.3 sec, PT 13.1 sec/INR 1.08, and fibrinogen 716 mg/dL. Abdominal sonography revealed two hypoechoic space occupying lesions and one cystic lesion in the spleen (). To differentiate splenic abscess or infarction, abdominal computed tomography (CT) was performed. Abdominal CT revealed multiple septated cystic lesions in the spleen, the largest 4.3 cm, and 2 cm low attenuated lesion in the left buttock area, compatible with multiple splenic abscesses and an abscess in the left buttock area (). We performed 2D-echocardiography, and found mobile hyperechoic mass on posterior mitral valve leflet tip with calcified valve. His brain CT was normal. We obtained blood samples at two different sites for bacteriologic culture and then started empirical antibiotics with ceftriaxone and aminoglycoside. He had continuous fever and left hypochondrial pain. Blood culture revealed methicillin sensitive Staphylococcus aureus (MSSA). We changed the antibiotics with cefazoline based on the drug sensitivity test. Inflammatory signs and hypoechoic lesions in the spleen did not respond to antibiotic therapy. On the 4th hospital day, emergency splenectomy was performed for the splenic abscess based on blood culture and abdominal CT. We aspirated blood from the evacuated spleen for bacteriologic culture and sent the evacuated spleen to pathologist for histologic diagnosis (). MSSA was cultured from the evacuated splenic blood, too. The pathologic findings showed splenic abscesses and infarction (). Antibiotic therapy was continued and he became afebrile. CBC findings and other chemical laboratory findings were returned to normal.",What is the patient's HAS-BLED score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Liver disease criteria for the HAS-BLED rule': False, 'age': [65, 'years'], 'Renal disease criteria for the HAS-BLED rule': True, 'Hypertension': False, 'Number of Alcoholic Drinks Per Week': '0.0', 'Stroke': False, 'Medication usage predisposing to bleeding': True, 'Labile international normalized ratio': False}",2,2,2,"The criteria for the HAS-BLED score are listed below below:

1. Hypertension (Uncontrolled, >160 mmHg systolic): No = 0 points, Yes = +1 point
2. Renal disease (Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L): No = 0 points, Yes = +1 point
3. Liver disease (Cirrhosis or bilirubin >2x normal with AST/ALT/AP >3x normal): No = 0 points, Yes = +1 point
4. Stroke history: No = 0 points, Yes = +1 point
5. Prior major bleeding or predisposition to bleeding: No = 0 points, Yes = +1 point
6. Labile INR (Unstable/high INRs, time in therapeutic range <60%): No = 0 points, Yes = +1 point
7. Age >65: No = 0 points, Yes = +1 point
8. Medication usage predisposing to bleeding (Aspirin, clopidogrel, NSAIDs): No = 0 points, Yes = +1 point
9. Alcohol use (≥8 drinks/week): No = 0 points, Yes = +1 point

The total HAS-BLED score is calculated by summing the points for each criterion.
    
The current HAS-BLED score is 0.
The patient is 65 years old. Because the patient's age is less than 66 years, we don't change the score, keeping the current score at 0.
The patient has 0 drinks a week. Because the patient has less than 8 alcoholic drinks a week, we don't change the score, keeping the current score at 0.
The issue, hypertension, is reported to be absent for the patient and so we do not change the score, keeping the current score at 0.
The issue, liver disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 0.
The issue, renal disease, is reported to be present for the patient note and so we increase the score by 1, making the current score 0 + 1 = 1.
The issue, stroke history, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, prior bleeding, is missing from the patient note and so we assume it to be absent and so we do not change the score, keeping the current score at 1.
The issue, labile inr, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, medications for bleeding, is reported to be present for the patient note and so we increase the score by 1, making the current score 1 + 1 = 2.
Hence, the patient's HAS-BLED score is 2."
351,25,HAS-BLED Score for Major Bleeding Risk,risk,integer,pmc-7026384-1,Extracted,"A 44-year-old Chinese male was admitted to our hospital with headache, dizziness, nausea, and vomit for 6 days, and right limbs weakness for 2 h. He felt tearing pain on the right face and right temporal occipital. The pain most of time lasted about 10–180 s, less than 300 s. The headache frequency was more than 10 times per day. He had right drooping eyelid and right face decreased sweating, accompanied by right-sided redness of eye, lacrimation, and nasal congestion. He also felt numbness of right face and left half of his body and limbs, paraesthesia in right side of body, difficulty in swallowing, dysarthria, hiccups, hoarseness, and unsteady gait with multiple episodes of falls always to his right side. He had no history of diabetes, hypertension, or coronary artery disease. There was no history of trauma in the past. He never smoked or consumed alcohol. His family history was not significant.
General examination, vital parameters (T, P, BP, R), cardiovascular, respiratory, and abdominal examinations were unremarkable. His blood pressure was found to be 100–120/56–85 mmHg, and his heart was in normal sinus rhythm. Neurological examination revealed that he was somnolent. Right Horner's syndrome (ptosis, myosis, and anhydrosis) and clockwise rotational nystagmus were detected. His gag reflex was reduced. He had right-sided hemiparesis, muscle strength was diminished, MRC (Medical Research Council) grade muscle strength was 4/5 power and Babinski sign was present on the right. Right limbs showed incoordination and there was loss of pain and temperature sensation on the right side of his face and left side of his body. The finger-nose test and heel-knee-tibia test revealed ataxia on the right side of his body. Neurological findings suggested that right hemiparesis accompanied the typical findings of LMS (). The rest of the exam was unremarkable. Laboratory blood tests showed no other abnormalities except mildly elevated levels of urea and creatinine. No pathological findings were detected in computed tomography of the brain. DWI of MR imaging of the brain showed acute ischemic infarction of the right dorsolateral medulla. The area of infarction extends anteriorly within the medulla. Oxygen (2–3 L/min) was delivered through a T-piece in tracheostomy. rt-PA was administered in compliance with the standard dose, 0.9 mg/kg. Then antiplatelet treatment (asprin and clopidogrel) and statin were initiated. The cranial and cervical magnetic resonance angiography (MRA) revealed advanced stenosis in the basilar artery and right vertebral artery (). Further digital subtraction angiography (DSA) confirmed this (). Vertebral artery dissection (VAD) and aneurysms were excluded.
The patient gradually improved and was discharged with remarkable improvements after 2 weeks after conventional treatment for lateral medullar infarction. He had a 90% improvement in pain intensity and frequency from brief pain inventory. He was fully conscious without diplopia and nystagmus, eating by himself, and walking independently for a short distance, although unsteady. The symptoms of headache resolved 1 month later. After 5 months, an MRI brain scan and a MRA of the cerebral circulation were performed for follow up. High resolution MR images of the wall of the vertebrobasilar artery showed localized stenoses of both vertebral arteries due to unstable appearing atheromatous plaque (). One year later the patient still had some residual neurological symptomatology, including a mild deficit in pain and temperature sensation on the right side of his face and left side of body, mild dizziness, right face anhydrosis, mild right limbs numbness, and widened step base. He could walk independently and even run a little bit  INR was between 2-3.",What is the patient's HAS-BLED score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Liver disease criteria for the HAS-BLED rule': False, 'age': [44, 'years'], 'Renal disease criteria for the HAS-BLED rule': False, 'Hypertension': False, 'Number of Alcoholic Drinks Per Week': '0.0', 'Stroke': True, 'Medication usage predisposing to bleeding': True, 'Prior major bleeding or predisposition to bleeding': True, 'Labile international normalized ratio': False}",3,3,3,"The criteria for the HAS-BLED score are listed below below:

1. Hypertension (Uncontrolled, >160 mmHg systolic): No = 0 points, Yes = +1 point
2. Renal disease (Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L): No = 0 points, Yes = +1 point
3. Liver disease (Cirrhosis or bilirubin >2x normal with AST/ALT/AP >3x normal): No = 0 points, Yes = +1 point
4. Stroke history: No = 0 points, Yes = +1 point
5. Prior major bleeding or predisposition to bleeding: No = 0 points, Yes = +1 point
6. Labile INR (Unstable/high INRs, time in therapeutic range <60%): No = 0 points, Yes = +1 point
7. Age >65: No = 0 points, Yes = +1 point
8. Medication usage predisposing to bleeding (Aspirin, clopidogrel, NSAIDs): No = 0 points, Yes = +1 point
9. Alcohol use (≥8 drinks/week): No = 0 points, Yes = +1 point

The total HAS-BLED score is calculated by summing the points for each criterion.
    
The current HAS-BLED score is 0.
The patient is 44 years old. Because the patient's age is less than 66 years, we don't change the score, keeping the current score at 0.
The patient has 0 drinks a week. Because the patient has less than 8 alcoholic drinks a week, we don't change the score, keeping the current score at 0.
The issue, hypertension, is reported to be absent for the patient and so we do not change the score, keeping the current score at 0.
The issue, liver disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 0.
The issue, renal disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 0.
The issue, stroke history, is reported to be present for the patient note and so we increase the score by 1, making the current score 0 + 1 = 1.
The issue, prior bleeding, is reported to be present for the patient note and so we increase the score by 1, making the current score 1 + 1 = 2.
The issue, labile inr, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
The issue, medications for bleeding, is reported to be present for the patient note and so we increase the score by 1, making the current score 2 + 1 = 3.
Hence, the patient's HAS-BLED score is 3."
352,25,HAS-BLED Score for Major Bleeding Risk,risk,integer,pmc-6726349-1,Extracted,"An 80-year-old male patient with a 4-year history of chronic NV-AF, type 2 diabetes mellitus and a history of dyslipidaemia presented to the emergency department with general weakness, nausea, vomiting of blood-tinged material, vague abdominal pain and black stool of 1 day’s duration. He denied fever or diarrhoea. His regular medications included dabigatran 110 mg twice daily for 4 years to prevent thromboembolic events, metformin 1,000 mg twice daily and insulin glargine 20 units at night. The last dose of dabigatran was on the morning of presentation. There were no previous episodes of bleeding or decreases in haemoglobin since dabigatran was started 4 years previously. No new medications had been administered recently. The patient denied alcohol or tobacco consumption. However, he mentioned the recent use, without physician counselling, of 200 ml of a boiled mixture of ginger and cinnamon twice daily for 3 days before presentation to hospital. Physical examination was remarkable for overweight (body mass index 28 kg/m2), skin pallor, irregular tachycardia (115–125 bpm), tachypnoea (respiratory rate of 28/minute), low blood pressure (80/60 mmHg) and dry oral mucosa. His oxygen saturation was 94% on room air. Cardiovascular examination was remarkable for irregular tachycardia, chest examination was normal, and abdominal examination revealed mild tenderness all over the abdomen. His extremities were cold. Digital rectal examination showed melena. The remainder of the examination was unremarkable. On presentation, the patient had a haemoglobin (Hb) of 8 g/dl (normal 13.5–17 g/dl), haematocrit (Hct) of 24% (normal 45–52%) microcytic hypochromic anaemia, reticulocyte index >2, platelet count of 600,000 (normal range 150,000–450,000/l), International Normalized Ratio (INR) of 1.9 (normal INR 1.1 or less), and activated partial thromboplastin time (aPTT) of 45 sec (normal 30–40 sec). His blood glucose level was 142 mg/dl (normal 70–140 mg/dl) and kidney function was normal (eGFR 90 ml/min/1.73 m2, estimated by CKD-EPI). Serum sodium was 140 mEq/l, serum potassium was 4.5 mEq/l, and a liver function test was normal. As the history and clinical picture were suggestive of gastrointestinal bleeding with an element of haemorrhagic shock, resuscitation measures were started in the emergency department with administration of intravenous fluid and the patient was moved to the intensive care unit. He later developed severe haematemesis after which the trachea was intubated and the patient was mechanically ventilated. Packed red blood cell transfusion was started. As the patient had taken his last dose of dabigatran 110 mg on the morning of admission, idarucizumab, a reversal agent of dabigatran, was administered (5 g intravenously according to protocol). Urgent upper endoscopy was performed and showed diffuse haemorrhage of the mucosal membrane with fresh blood and blood clots in the oesophagus, stomach and duodenum; no definite ulcers or oesophageal varices were identified. The resuscitation measures were continued with intravenous fluid (crystalloid and colloid) and blood products, but bleeding persisted with fresh blood from the nasogastric tube. Haemorrhagic shock continued despite volume replacement (fluid and blood) and vasopressor support, and the patient died within 24 hours. The history of recent combination of herbal products (ginger and cinnamon) with DOACs (dabigatran) and the presence of diffuse haemorrhage of the mucosal membrane of the upper gastrointestinal tract raised the possibility of a herb–drug interaction leading to severe gastrointestinal bleeding.",What is the patient's HAS-BLED score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Liver disease criteria for the HAS-BLED rule': False, 'age': [80, 'years'], 'Renal disease criteria for the HAS-BLED rule': False, 'Hypertension': False, 'Number of Alcoholic Drinks Per Week': '0.0', 'Stroke': False, 'Medication usage predisposing to bleeding': True, 'Labile international normalized ratio': False}",2,2,2,"The criteria for the HAS-BLED score are listed below below:

1. Hypertension (Uncontrolled, >160 mmHg systolic): No = 0 points, Yes = +1 point
2. Renal disease (Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L): No = 0 points, Yes = +1 point
3. Liver disease (Cirrhosis or bilirubin >2x normal with AST/ALT/AP >3x normal): No = 0 points, Yes = +1 point
4. Stroke history: No = 0 points, Yes = +1 point
5. Prior major bleeding or predisposition to bleeding: No = 0 points, Yes = +1 point
6. Labile INR (Unstable/high INRs, time in therapeutic range <60%): No = 0 points, Yes = +1 point
7. Age >65: No = 0 points, Yes = +1 point
8. Medication usage predisposing to bleeding (Aspirin, clopidogrel, NSAIDs): No = 0 points, Yes = +1 point
9. Alcohol use (≥8 drinks/week): No = 0 points, Yes = +1 point

The total HAS-BLED score is calculated by summing the points for each criterion.
    
The current HAS-BLED score is 0.
The patient is 80 years old. Because the patient's age is greater than 65 years, we increment the score by 1, making the current score 0 + 1 = 1.
The patient has 0 drinks a week. Because the patient has less than 8 alcoholic drinks a week, we don't change the score, keeping the current score at 1.
The issue, hypertension, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, liver disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, renal disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, stroke history, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, prior bleeding, is missing from the patient note and so we assume it to be absent and so we do not change the score, keeping the current score at 1.
The issue, labile inr, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, medications for bleeding, is reported to be present for the patient note and so we increase the score by 1, making the current score 1 + 1 = 2.
Hence, the patient's HAS-BLED score is 2."
353,25,HAS-BLED Score for Major Bleeding Risk,risk,integer,pmc-7967959-1,Extracted,"The first patient was a 54-year-old woman, on insulin therapy since discovery of type 1 diabetes in 2000 in context of polyuria-polydipsia syndrome. Since then, her diabetes was poorly controlled, with multiple hospitalizations for ketoacidosis and chronically elevated HbA1c level between 11 and 15% (97 and 140 mmol/mol respectively). Diabetes complications therefore developed, including laser-required diabetic retinopathy and end stage chronic kidney disease requiring dialysis. However, this patient had not experienced any history of impaired cardiac or respiratory condition. She was non-smoking and her last cardiovascular evaluation in 2015 reported no evidence of supra aortic trunks atheroma and a low coronary calcium score of 14.",What is the patient's HAS-BLED score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Liver disease criteria for the HAS-BLED rule': False, 'age': [54, 'years'], 'Renal disease criteria for the HAS-BLED rule': True, 'Hypertension': False, 'Number of Alcoholic Drinks Per Week': '0.0', 'Stroke': False, 'Medication usage predisposing to bleeding': False}",1,1,1,"The criteria for the HAS-BLED score are listed below below:

1. Hypertension (Uncontrolled, >160 mmHg systolic): No = 0 points, Yes = +1 point
2. Renal disease (Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L): No = 0 points, Yes = +1 point
3. Liver disease (Cirrhosis or bilirubin >2x normal with AST/ALT/AP >3x normal): No = 0 points, Yes = +1 point
4. Stroke history: No = 0 points, Yes = +1 point
5. Prior major bleeding or predisposition to bleeding: No = 0 points, Yes = +1 point
6. Labile INR (Unstable/high INRs, time in therapeutic range <60%): No = 0 points, Yes = +1 point
7. Age >65: No = 0 points, Yes = +1 point
8. Medication usage predisposing to bleeding (Aspirin, clopidogrel, NSAIDs): No = 0 points, Yes = +1 point
9. Alcohol use (≥8 drinks/week): No = 0 points, Yes = +1 point

The total HAS-BLED score is calculated by summing the points for each criterion.
    
The current HAS-BLED score is 0.
The patient is 54 years old. Because the patient's age is less than 66 years, we don't change the score, keeping the current score at 0.
The patient has 0 drinks a week. Because the patient has less than 8 alcoholic drinks a week, we don't change the score, keeping the current score at 0.
The issue, hypertension, is reported to be absent for the patient and so we do not change the score, keeping the current score at 0.
The issue, liver disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 0.
The issue, renal disease, is reported to be present for the patient note and so we increase the score by 1, making the current score 0 + 1 = 1.
The issue, stroke history, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, prior bleeding, is missing from the patient note and so we assume it to be absent and so we do not change the score, keeping the current score at 1.
The issue, labile inr, is missing from the patient note and so we assume it to be absent and so we do not change the score, keeping the current score at 1.
The issue, medications for bleeding, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
Hence, the patient's HAS-BLED score is 1."
354,25,HAS-BLED Score for Major Bleeding Risk,risk,integer,pmc-7887466-1,Extracted,"A patient is a right-handed 59-year-old male, a regular alcohol consumer, and a chronic smoker, who noticed a sudden onset unable to extend right wrist and fingers one hour after waking up from an uneventful night sleep. He had Type IIb dyslipidemia for two years on atorvastatin with no other comorbidities. He admitted to having a binge of alcohol the night before, and he was referred to us as retrohumeral radial nerve palsy. No history of major hemorrhagic events.
On neurologic examination, he was alert and oriented and cooperated well during the entire examination. Motor examination demonstrated weakness of the right wrist and finger extensor muscles with a muscle strength grading of 2? Medical Research Council Scale (MRC), with normal strength right brachioradialis, triceps, biceps, flexors of the fingers and wrist as well as the thenar and hypothenar muscles []. Sensory examination did not reveal any impairment in sensation over the dorsal aspect of the right hand. Since neurologic examination did not show any evidence of a central origin of his neurologic deficits, a nerve conduction study and needle electromyography (EMG) were done immediately upon admission which were normal.
The constellation of sudden onset of distal radial motor weakness without any accompanying upper motor neuron signs, a normal neurography and EMG, history of dyslipidemia, a 20-year history of alcohol consumption (4 units/day), and 20 pack-years of tobacco smoking prompted us to undertake an emergent magnetic resonance imaging (MRI) brain with diffusion-weighted imaging (DWI) and magnetic resonance angiography (MRA) on the same day, considering the stroke masquerader of pseudoradial peripheral palsy. INR was within normal limits. The MRI revealed an acute left precentral gyrus infarction, hyperintense on T2, FLAIR, and T1 hypointense with restricted diffusion on DWI along with watershed left MCA-PCA (middle cerebral artery-posterior cerebral artery) left parietal area infarction []. Intracranial MRA, carotid artery Doppler ultrasonography, echocardiography, complete blood picture, vasculitis screen, HIV and treponema serology, antiphospholipid antibodies, and relevant stroke workup were normal except for hyperhomocysteinemia of 18.9 mmol/L. He was initiated on Triple therapy with dual antiplatelet agents, atorvastatin, and ramipril along with folate. Over the ensuing 2 weeks of admission, he demonstrated improvement in his right-hand weakness with the strength of the extensor of the wrist and fingers graded as 3+ MRC at the time of his discharge. During the subsequent neurology follow-up over a 2-month period, he has made a complete motoric recovery.",What is the patient's HAS-BLED score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Liver disease criteria for the HAS-BLED rule': False, 'age': [59, 'years'], 'Renal disease criteria for the HAS-BLED rule': False, 'Hypertension': False, 'Number of Alcoholic Drinks Per Week': '28.0', 'Stroke': True, 'Medication usage predisposing to bleeding': True, 'Prior major bleeding or predisposition to bleeding': False, 'Labile international normalized ratio': False}",3,3,3,"The criteria for the HAS-BLED score are listed below below:

1. Hypertension (Uncontrolled, >160 mmHg systolic): No = 0 points, Yes = +1 point
2. Renal disease (Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L): No = 0 points, Yes = +1 point
3. Liver disease (Cirrhosis or bilirubin >2x normal with AST/ALT/AP >3x normal): No = 0 points, Yes = +1 point
4. Stroke history: No = 0 points, Yes = +1 point
5. Prior major bleeding or predisposition to bleeding: No = 0 points, Yes = +1 point
6. Labile INR (Unstable/high INRs, time in therapeutic range <60%): No = 0 points, Yes = +1 point
7. Age >65: No = 0 points, Yes = +1 point
8. Medication usage predisposing to bleeding (Aspirin, clopidogrel, NSAIDs): No = 0 points, Yes = +1 point
9. Alcohol use (≥8 drinks/week): No = 0 points, Yes = +1 point

The total HAS-BLED score is calculated by summing the points for each criterion.
    
The current HAS-BLED score is 0.
The patient is 59 years old. Because the patient's age is less than 66 years, we don't change the score, keeping the current score at 0.
The patient has 28 drinks a week. Because the patient has at least 8 alcoholic drinks a week, we increment the score by 1, making the current score 0 + 1 = 1.
The issue, hypertension, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, liver disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, renal disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, stroke history, is reported to be present for the patient note and so we increase the score by 1, making the current score 1 + 1 = 2.
The issue, prior bleeding, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
The issue, labile inr, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
The issue, medications for bleeding, is reported to be present for the patient note and so we increase the score by 1, making the current score 2 + 1 = 3.
Hence, the patient's HAS-BLED score is 3."
355,25,HAS-BLED Score for Major Bleeding Risk,risk,integer,pmc-2475515-1,Extracted,"A 74-year-old Caucasian man presented with a one-week history of gradual onset, sharp epigastric and left-sided lower chest pain. The pain radiated to his left shoulder and was exacerbated by movement and coughing. The patient denied any history of trauma, foreign travel and was not on anticoagulants. His past medical history included mild ischaemic heart disease and depression. He was an active man, still in employment, who did not smoke or drink alcohol. No history of stroke.
On examination he was tachycardic at 110 beats per minute, normotensive and had a temperature of 37.8°C. He was tachypnoeic with oxygen saturation of 91% on air. There was dullness to percussion and decreased air entry at the left base. Examination of the abdomen revealed mild generalised tenderness to palpation, worst in the epigastrium. There was no guarding, rebound tenderness or evidence of bruising.
Routine admission blood tests revealed a haemoglobin of 16.3 g/dl, a normal white cell count and C-reactive protein. His urea and creatinine were 19.1 mmol/l and 117 μmol/l respectively. His liver function tests were deranged with a bilirubin of 61 μmol/l, alanine aminotransferase 97 U/l, alkaline phosphatase 436 U/l and gamma glutamic transpeptidase 398 U/l. A chronic liver disease screen was normal, and there was no serological evidence of viral infection (including hepatitis and Epstein Barr virus).
Chest x-ray showed a left pleural effusion and consolidation. He was initially treated for pneumonia.
Chest and abdominal ultrasound scans showed a large amount of free fluid surrounding the spleen suggesting splenic rupture and a moderate left sided pleural effusion. The spleen was otherwise normal in size and appearance, and no other intra-abdominal abnormality was found.
He was referred to the surgeons who felt that the most appropriate line of management was conservative and suggested a follow-up ultrasound scan in four months time to monitor progress. Draining the pleural effusion was thought to be too risky due to its proximity to the haematoma.
During the subsequent week the patient developed pleuritic chest pain and a CT pulmonary angiogram and upper abdominal CT scan were performed. These showed no evidence of pulmonary embolism but revealed a splenic laceration with a peri-splenic subcapsular haematoma, measuring 16 × 14 cm in axial dimension (Figure ), with a reactive pleural effusion. Once again, there was no other abnormality seen in the liver or spleen.
Unfortunately, before the patient could be re-reviewed regarding surgical intervention, he had an unwitnessed cardiac arrest and died. The family declined a post-mortem examination.",What is the patient's HAS-BLED score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Liver disease criteria for the HAS-BLED rule': True, 'age': [74, 'years'], 'Renal disease criteria for the HAS-BLED rule': False, 'Hypertension': False, 'Number of Alcoholic Drinks Per Week': '0.0', 'Stroke': False, 'Medication usage predisposing to bleeding': False, 'Prior major bleeding or predisposition to bleeding': False, 'Labile international normalized ratio': False}",2,2,2,"The criteria for the HAS-BLED score are listed below below:

1. Hypertension (Uncontrolled, >160 mmHg systolic): No = 0 points, Yes = +1 point
2. Renal disease (Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L): No = 0 points, Yes = +1 point
3. Liver disease (Cirrhosis or bilirubin >2x normal with AST/ALT/AP >3x normal): No = 0 points, Yes = +1 point
4. Stroke history: No = 0 points, Yes = +1 point
5. Prior major bleeding or predisposition to bleeding: No = 0 points, Yes = +1 point
6. Labile INR (Unstable/high INRs, time in therapeutic range <60%): No = 0 points, Yes = +1 point
7. Age >65: No = 0 points, Yes = +1 point
8. Medication usage predisposing to bleeding (Aspirin, clopidogrel, NSAIDs): No = 0 points, Yes = +1 point
9. Alcohol use (≥8 drinks/week): No = 0 points, Yes = +1 point

The total HAS-BLED score is calculated by summing the points for each criterion.
    
The current HAS-BLED score is 0.
The patient is 74 years old. Because the patient's age is greater than 65 years, we increment the score by 1, making the current score 0 + 1 = 1.
The patient has 0 drinks a week. Because the patient has less than 8 alcoholic drinks a week, we don't change the score, keeping the current score at 1.
The issue, hypertension, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, liver disease, is reported to be present for the patient note and so we increase the score by 1, making the current score 1 + 1 = 2.
The issue, renal disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
The issue, stroke history, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
The issue, prior bleeding, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
The issue, labile inr, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
The issue, medications for bleeding, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
Hence, the patient's HAS-BLED score is 2."
356,25,HAS-BLED Score for Major Bleeding Risk,risk,integer,usmle-302,Extracted,"A 52-year-old man comes to to the emergency department with fatigue and shortness of breath that has become progressively worse over the past week. He had an upper respiratory tract infection 2 weeks ago, for which he was given an antibiotic. He has hypertension, type 2 diabetes mellitus, and colonic polyps diagnosed on screening colonoscopy 2 years ago. His mother has systemic lupus erythematosus and his brother has a bicuspid aortic valve. He does not smoke cigarettes or drink alcohol. Current medications include lisinopril and metformin. His temperature is 37.3°C (99.1°F), pulse is 91/min, respirations are 18/min, and blood pressure is 145/84 mm Hg. His conjunctivae are pale. Cardiac examination shows a late systolic crescendo-decrescendo murmur at the right upper sternal border. Laboratory studies show:
Leukocyte Count 9,500/mm3
Hematocrit 24%
Platelet Count 178,000/mm3
LDH 215 U/L
Haptoglobin 22 mg/dL (N=41–165 mg/dL)
Serum
Na+ 140 mEq/L
K+ 4.6 mEq/L
CL- 100 mEq/L
HCO3- 25 mEq/L
Urea nitrogen 21 mg/dL
Creatinine 1.2 mg/dL
Total bilirubin 1.9 mg/dL
A peripheral blood smear is shown.",What is the patient's HAS-BLED score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Liver disease criteria for the HAS-BLED rule': False, 'age': [52, 'years'], 'Renal disease criteria for the HAS-BLED rule': False, 'Hypertension': True, 'Number of Alcoholic Drinks Per Week': '0.0', 'Labile international normalized ratio': False, 'Medication usage predisposing to bleeding': False}",1,1,1,"The criteria for the HAS-BLED score are listed below below:

1. Hypertension (Uncontrolled, >160 mmHg systolic): No = 0 points, Yes = +1 point
2. Renal disease (Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L): No = 0 points, Yes = +1 point
3. Liver disease (Cirrhosis or bilirubin >2x normal with AST/ALT/AP >3x normal): No = 0 points, Yes = +1 point
4. Stroke history: No = 0 points, Yes = +1 point
5. Prior major bleeding or predisposition to bleeding: No = 0 points, Yes = +1 point
6. Labile INR (Unstable/high INRs, time in therapeutic range <60%): No = 0 points, Yes = +1 point
7. Age >65: No = 0 points, Yes = +1 point
8. Medication usage predisposing to bleeding (Aspirin, clopidogrel, NSAIDs): No = 0 points, Yes = +1 point
9. Alcohol use (≥8 drinks/week): No = 0 points, Yes = +1 point

The total HAS-BLED score is calculated by summing the points for each criterion.
    
The current HAS-BLED score is 0.
The patient is 52 years old. Because the patient's age is less than 66 years, we don't change the score, keeping the current score at 0.
The patient has 0 drinks a week. Because the patient has less than 8 alcoholic drinks a week, we don't change the score, keeping the current score at 0.
The issue, hypertension, is reported to be present for the patient note and so we increase the score by 1, making the current score 0 + 1 = 1.
The issue, liver disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, renal disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, stroke history, is missing from the patient note and so we assume it to be absent and so we do not change the score, keeping the current score at 1.
The issue, prior bleeding, is missing from the patient note and so we assume it to be absent and so we do not change the score, keeping the current score at 1.
The issue, labile inr, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, medications for bleeding, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
Hence, the patient's HAS-BLED score is 1."
357,25,HAS-BLED Score for Major Bleeding Risk,risk,integer,usmle-1979,Extracted,"A 49-year-old man is brought to the emergency department by his wife because he is vomiting blood. No history of CKD. His wife reports that he has been nauseous for the past day and that he has had 2 episodes of vomiting bright red blood over the past 2 hours. This has occurred prior. He has never experienced this before. He has not had any bloody stool, melena, or abdominal pain. He was diagnosed with alcoholic cirrhosis 6 months ago. He drank approximately 5 drinks of vodka over the past day, which is typical for him. He takes no medications. He is confused and disoriented to place and time. Physical examination shows ascites. Vital signs are within normal limits. His hemoglobin concentration is 9.5 g/dL. Intravenous fluid resuscitation is begun. He starts to vomit bright red blood again intermittently, which continues for 10 minutes. When vital signs are measured again, his pulse is 95/min and blood pressure is 109/80 mm/Hg.",What is the patient's HAS-BLED score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Liver disease criteria for the HAS-BLED rule': True, 'age': [49, 'years'], 'Renal disease criteria for the HAS-BLED rule': False, 'Hypertension': False, 'Number of Alcoholic Drinks Per Week': '35', 'Stroke': False, 'Medication usage predisposing to bleeding': False, 'Prior major bleeding or predisposition to bleeding': True, 'Labile international normalized ratio': False}",3,3,3,"The criteria for the HAS-BLED score are listed below below:

1. Hypertension (Uncontrolled, >160 mmHg systolic): No = 0 points, Yes = +1 point
2. Renal disease (Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L): No = 0 points, Yes = +1 point
3. Liver disease (Cirrhosis or bilirubin >2x normal with AST/ALT/AP >3x normal): No = 0 points, Yes = +1 point
4. Stroke history: No = 0 points, Yes = +1 point
5. Prior major bleeding or predisposition to bleeding: No = 0 points, Yes = +1 point
6. Labile INR (Unstable/high INRs, time in therapeutic range <60%): No = 0 points, Yes = +1 point
7. Age >65: No = 0 points, Yes = +1 point
8. Medication usage predisposing to bleeding (Aspirin, clopidogrel, NSAIDs): No = 0 points, Yes = +1 point
9. Alcohol use (≥8 drinks/week): No = 0 points, Yes = +1 point

The total HAS-BLED score is calculated by summing the points for each criterion.
    
The current HAS-BLED score is 0.
The patient is 49 years old. Because the patient's age is less than 66 years, we don't change the score, keeping the current score at 0.
The patient has 35 drinks a week. Because the patient has at least 8 alcoholic drinks a week, we increment the score by 1, making the current score 0 + 1 = 1.
The issue, hypertension, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, liver disease, is reported to be present for the patient note and so we increase the score by 1, making the current score 1 + 1 = 2.
The issue, renal disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
The issue, stroke history, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
The issue, prior bleeding, is reported to be present for the patient note and so we increase the score by 1, making the current score 2 + 1 = 3.
The issue, labile inr, is reported to be absent for the patient and so we do not change the score, keeping the current score at 3.
The issue, medications for bleeding, is reported to be absent for the patient and so we do not change the score, keeping the current score at 3.
Hence, the patient's HAS-BLED score is 3."
358,25,HAS-BLED Score for Major Bleeding Risk,risk,integer,usmle-12464,Extracted,"A 65-year-old man with a history of hypertension, obesity, and alcoholic cirrhosis is seen in clinic for follow-up. No history of stroke. He feels well and currently drinks 5 glasses of wine each night. Medications include atenolol and lisinopril. On physical exam, temperature is 98.1 deg F (36.7 deg C), blood pressure is 151/82 mmHg, pulse is 71/min, and respirations are 14/min. He has spider angiomata on his chest; no asterixis, jaundice, ascites, or peripheral edema is noted. Screening ultrasound reveals a new liver nodule, and follow up CT demonstrates a 2 cm right hepatic lobe lesion with enhancement in the arterial phase. No hypodense attenuation is seen on the venous or delayed phase. INR is elevated. No history of major bleeding events.",What is the patient's HAS-BLED score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Liver disease criteria for the HAS-BLED rule': True, 'age': [65, 'years'], 'Renal disease criteria for the HAS-BLED rule': False, 'Hypertension': True, 'Number of Alcoholic Drinks Per Week': '35', 'Stroke': False, 'Medication usage predisposing to bleeding': False, 'Prior major bleeding or predisposition to bleeding': False, 'Labile international normalized ratio': False}",3,3,3,"The criteria for the HAS-BLED score are listed below below:

1. Hypertension (Uncontrolled, >160 mmHg systolic): No = 0 points, Yes = +1 point
2. Renal disease (Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L): No = 0 points, Yes = +1 point
3. Liver disease (Cirrhosis or bilirubin >2x normal with AST/ALT/AP >3x normal): No = 0 points, Yes = +1 point
4. Stroke history: No = 0 points, Yes = +1 point
5. Prior major bleeding or predisposition to bleeding: No = 0 points, Yes = +1 point
6. Labile INR (Unstable/high INRs, time in therapeutic range <60%): No = 0 points, Yes = +1 point
7. Age >65: No = 0 points, Yes = +1 point
8. Medication usage predisposing to bleeding (Aspirin, clopidogrel, NSAIDs): No = 0 points, Yes = +1 point
9. Alcohol use (≥8 drinks/week): No = 0 points, Yes = +1 point

The total HAS-BLED score is calculated by summing the points for each criterion.
    
The current HAS-BLED score is 0.
The patient is 65 years old. Because the patient's age is less than 66 years, we don't change the score, keeping the current score at 0.
The patient has 35 drinks a week. Because the patient has at least 8 alcoholic drinks a week, we increment the score by 1, making the current score 0 + 1 = 1.
The issue, hypertension, is reported to be present for the patient note and so we increase the score by 1, making the current score 1 + 1 = 2.
The issue, liver disease, is reported to be present for the patient note and so we increase the score by 1, making the current score 2 + 1 = 3.
The issue, renal disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 3.
The issue, stroke history, is reported to be absent for the patient and so we do not change the score, keeping the current score at 3.
The issue, prior bleeding, is reported to be absent for the patient and so we do not change the score, keeping the current score at 3.
The issue, labile inr, is reported to be absent for the patient and so we do not change the score, keeping the current score at 3.
The issue, medications for bleeding, is reported to be absent for the patient and so we do not change the score, keeping the current score at 3.
Hence, the patient's HAS-BLED score is 3."
359,25,HAS-BLED Score for Major Bleeding Risk,risk,integer,usmle-6091,Extracted,"A 55-year-old man presents to his primary care physician for leg pain. The patient works as a mailman but states he has had difficulty completing his deliveries for the past month. He complains of a burning and tingling pain in his legs when he walks that goes away when he sits down and takes a break. The patient has a past medical history of obesity, diabetes, stable angina, and constipation. No history of stroke. No prior major hemorrhagic events.  INR within normal limits. His current medications include insulin and metformin. The patient has a 22-pack-year smoking history and he drinks 2 alcoholic beverages per day. Physical exam reveals a stout man with a ruddy complexion. His gait is stable and he demonstrates 5/5 strength in his upper and lower extremities.",What is the patient's HAS-BLED score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Liver disease criteria for the HAS-BLED rule': False, 'age': [55, 'years'], 'Renal disease criteria for the HAS-BLED rule': False, 'Number of Alcoholic Drinks Per Week': '14', 'Stroke': False, 'Medication usage predisposing to bleeding': False, 'Prior major bleeding or predisposition to bleeding': False, 'Labile international normalized ratio': False}",1,1,1,"The criteria for the HAS-BLED score are listed below below:

1. Hypertension (Uncontrolled, >160 mmHg systolic): No = 0 points, Yes = +1 point
2. Renal disease (Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L): No = 0 points, Yes = +1 point
3. Liver disease (Cirrhosis or bilirubin >2x normal with AST/ALT/AP >3x normal): No = 0 points, Yes = +1 point
4. Stroke history: No = 0 points, Yes = +1 point
5. Prior major bleeding or predisposition to bleeding: No = 0 points, Yes = +1 point
6. Labile INR (Unstable/high INRs, time in therapeutic range <60%): No = 0 points, Yes = +1 point
7. Age >65: No = 0 points, Yes = +1 point
8. Medication usage predisposing to bleeding (Aspirin, clopidogrel, NSAIDs): No = 0 points, Yes = +1 point
9. Alcohol use (≥8 drinks/week): No = 0 points, Yes = +1 point

The total HAS-BLED score is calculated by summing the points for each criterion.
    
The current HAS-BLED score is 0.
The patient is 55 years old. Because the patient's age is less than 66 years, we don't change the score, keeping the current score at 0.
The patient has 14 drinks a week. Because the patient has at least 8 alcoholic drinks a week, we increment the score by 1, making the current score 0 + 1 = 1.
The issue, hypertension, is missing from the patient note and so we assume it to be absent and so we do not change the score, keeping the current score at 1.
The issue, liver disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, renal disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, stroke history, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, prior bleeding, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, labile inr, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, medications for bleeding, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
Hence, the patient's HAS-BLED score is 1."
360,25,HAS-BLED Score for Major Bleeding Risk,risk,integer,pmc-7869650-1,Extracted,"The index patient is a 23-year-old male who presented with complaints of fever, chills, left flank pain of 4 days duration. He did not give a history of dysuria, hematuria, cough, vomiting, loose stools, breathlessness, chest pain, joint pains, oral ulcers, or dryness of eyes. The patient was non-smoker and non-alcoholic. No history of stroke or other major hemorrhagic events. Clinical examination revealed a BP of 160/100 mm Hg and mild left lumbar tenderness. Computed tomography (CT) urography revealed absent contrast in the left urinary system, left renal artery thrombosis, and multiple renal infarcts []. The laboratory workup revealed, Hb-13 gm/dl, total leukocyte count (TLC)-13710/cmm, platelet-4,17000/cmm, creatinine - 1.46 mg/dL, blood urea nitrogen (BUN) -27.37 mg/dL, normal electrolytes and normal prothrombin time/international normalized ratio (PT/INR) and activated partial thromboplastin time (aPTT). The homocysteine levels were high (170 mmoL/L), serum antinuclear antibody (ANA) was negative. Patient was started on injection heparin (5000 IU bolus, followed by 1000 IU/hr). Diethylene-triamine-pentaacetate (DTPA) (Tc 99m) scan confirmed the absence of tracer uptake in the left kidney. Urine examination showed 2–3 rbc/hpf, no pus cells, and absent protein. Lipid profile showed elevated LDL (190 mg/dL), 2D ECHO was normal, and cardiac monitoring did not reveal arrhythmia. The serum C3 and C4 were normal. Protein C, protein S, anti-thrombin III were within normal range & factor V Leiden mutation, and APLA antibodies were negative. The fundus examination did not reveal retinal infarction. Computed tomography head did not reveal any area of infarction. Left nephrectomy was performed. In view of hyperhomocysteinemia, the patient was started on tab folic acid (10 mg/day). His serum creatinine reduced to 1.1 mg/dL, and he was discharged on warfarin and folic acid.
One week after getting discharged, the patient now developed right-sided flank pain associated with vomiting and decreased urine output, with no c/o fever, or chest pain. On physical examination, he had a BP of 154/100 mm Hg and a mild right lumbar and pelvic tenderness. Non-contrast CT abdomen did not show any significant abnormality. His creatinine increased to 3.2 mg/dL within 24 hrs. The INR was 2.1, and the DTPA scan now showed reduced tracer uptake in the right kidney. The ultrasound renal doppler showed resistive flow in the right renal segmental artery. The patient was restarted on anticoagulation (heparin 1000 IU/hr). His creatinine increased to 9.0 mg/dL, and he became anuric. He was started on hemodialysis and a repeat CT renal angiography [] was suggestive of right renal segmental artery thrombosis with multiple renal infarcts. Urgent renal angiography and intra-arterial thrombolysis were done with alteplase, infused intravenously as an initial dose of 5 mg over 10 min, followed by 1 mg/hr for 36 hrs. He was continued on heparin (500 IU/hr) to avoid clotting in the arterial sheath. Check renal angiography revealed improved blood flow in the thrombosed vessel []. The patient required alternate day hemodialysis. Subsequently, in the next 2 weeks, the patient's urine output started improving gradually. After 3 weeks, the patient had 2.0 L/day of urine output, and his creatinine decreased to 2.8 mg/dL. In his family, his father had undergone coronary reperfusion (Percutaneous transluminal coronary angioplasty (PTCA)) at the age of 45 years. His grandfather and grandmother died due to myocardial infarction and stroke, respectively. On further investigations, the patient's thrombophilic profile revealed plasminogen activator inhibitor factor deficiency, and genetic mutation studies revealed a methylene-tetrahydrofolate reductase (MTHFR) mutation. These two defects predisposed him to a thrombotic state. His paternal aunt and uncle both were also found to have elevated homocysteine levels but no thrombotic event so far. The genetic analysis for hyperhomocysteinemia did not reveal any mutations in other family members. He was discharged on heparin (5000 IU twice per day), folic acid, aspirin, and statin. His serum creatinine came down to 2.4 mg/dL. It was proposed to start novel anticoagulants.",What is the patient's HAS-BLED score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Liver disease criteria for the HAS-BLED rule': False, 'age': [23, 'years'], 'Renal disease criteria for the HAS-BLED rule': True, 'Hypertension': True, 'Number of Alcoholic Drinks Per Week': '0.0', 'Stroke': False, 'Medication usage predisposing to bleeding': True, 'Prior major bleeding or predisposition to bleeding': False, 'Labile international normalized ratio': False}",3,3,3,"The criteria for the HAS-BLED score are listed below below:

1. Hypertension (Uncontrolled, >160 mmHg systolic): No = 0 points, Yes = +1 point
2. Renal disease (Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L): No = 0 points, Yes = +1 point
3. Liver disease (Cirrhosis or bilirubin >2x normal with AST/ALT/AP >3x normal): No = 0 points, Yes = +1 point
4. Stroke history: No = 0 points, Yes = +1 point
5. Prior major bleeding or predisposition to bleeding: No = 0 points, Yes = +1 point
6. Labile INR (Unstable/high INRs, time in therapeutic range <60%): No = 0 points, Yes = +1 point
7. Age >65: No = 0 points, Yes = +1 point
8. Medication usage predisposing to bleeding (Aspirin, clopidogrel, NSAIDs): No = 0 points, Yes = +1 point
9. Alcohol use (≥8 drinks/week): No = 0 points, Yes = +1 point

The total HAS-BLED score is calculated by summing the points for each criterion.
    
The current HAS-BLED score is 0.
The patient is 23 years old. Because the patient's age is less than 66 years, we don't change the score, keeping the current score at 0.
The patient has 0 drinks a week. Because the patient has less than 8 alcoholic drinks a week, we don't change the score, keeping the current score at 0.
The issue, hypertension, is reported to be present for the patient note and so we increase the score by 1, making the current score 0 + 1 = 1.
The issue, liver disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, renal disease, is reported to be present for the patient note and so we increase the score by 1, making the current score 1 + 1 = 2.
The issue, stroke history, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
The issue, prior bleeding, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
The issue, labile inr, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
The issue, medications for bleeding, is reported to be present for the patient note and so we increase the score by 1, making the current score 2 + 1 = 3.
Hence, the patient's HAS-BLED score is 3."
361,25,HAS-BLED Score for Major Bleeding Risk,risk,integer,pmc-3141705-2,Extracted,"A 69-year-old Japanese man visited our hospital seven years ago because of repeated tarry stools. In the previous year, he had developed a gastric ulcer and underwent Hp eradication therapy. He did not take NSAIDs or aspirin or drink alcohol, but he smoked an average of 20 cigarettes daily. Before he noticed tarry stools, he had been requested to edit a booklet for a community meeting. He was computer-illiterate and totally unaccustomed to such a task. He could manage to finish it by the deadline, but he developed tarry stools. He reported that his smoking pattern, including the number of cigarettes per day, was unchanged during the stressful period. Laboratory data demonstrated mild anemia (hemoglobin 11.1 g/dL), elevated BUN (33.1 mg/dL) and normal gastrin (25 pg/mL), suggesting the possible presence of gastrointestinal bleeding. INR is elevated/labile. Esophagogastroduodenoscopy revealed a recurrent gastric ulcer without active bleeding (Figure ). The absence of Hp infection was confirmed by negative 13C-urea breath test, histology and Hp antibody. The psychological assessment of the patient profile demonstrated that he was strict with regard to punctuality and had a strong sense of responsibility. These characteristics forced him to complete the task in which he was inexperienced by the deadline. It was therefore considered that his intense emotional stress resulted in his recurrent gastric ulcer.",What is the patient's HAS-BLED score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Liver disease criteria for the HAS-BLED rule': False, 'age': [69, 'years'], 'Renal disease criteria for the HAS-BLED rule': False, 'Hypertension': False, 'Number of Alcoholic Drinks Per Week': '0.0', 'Stroke': False, 'Medication usage predisposing to bleeding': False, 'Prior major bleeding or predisposition to bleeding': True, 'Labile international normalized ratio': True}",3,3,3,"The criteria for the HAS-BLED score are listed below below:

1. Hypertension (Uncontrolled, >160 mmHg systolic): No = 0 points, Yes = +1 point
2. Renal disease (Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L): No = 0 points, Yes = +1 point
3. Liver disease (Cirrhosis or bilirubin >2x normal with AST/ALT/AP >3x normal): No = 0 points, Yes = +1 point
4. Stroke history: No = 0 points, Yes = +1 point
5. Prior major bleeding or predisposition to bleeding: No = 0 points, Yes = +1 point
6. Labile INR (Unstable/high INRs, time in therapeutic range <60%): No = 0 points, Yes = +1 point
7. Age >65: No = 0 points, Yes = +1 point
8. Medication usage predisposing to bleeding (Aspirin, clopidogrel, NSAIDs): No = 0 points, Yes = +1 point
9. Alcohol use (≥8 drinks/week): No = 0 points, Yes = +1 point

The total HAS-BLED score is calculated by summing the points for each criterion.
    
The current HAS-BLED score is 0.
The patient is 69 years old. Because the patient's age is greater than 65 years, we increment the score by 1, making the current score 0 + 1 = 1.
The patient has 0 drinks a week. Because the patient has less than 8 alcoholic drinks a week, we don't change the score, keeping the current score at 1.
The issue, hypertension, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, liver disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, renal disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, stroke history, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, prior bleeding, is reported to be present for the patient note and so we increase the score by 1, making the current score 1 + 1 = 2.
The issue, labile inr, is reported to be present for the patient note and so we increase the score by 1, making the current score 2 + 1 = 3.
The issue, medications for bleeding, is reported to be absent for the patient and so we do not change the score, keeping the current score at 3.
Hence, the patient's HAS-BLED score is 3."
362,25,HAS-BLED Score for Major Bleeding Risk,risk,integer,pmc-6600126-1,Extracted,"On November 6, 2018, a 68-year-old female patient was admitted to the emergency room with altered level of consciousness. She has not history of stroke or any major bleeding events. At the time of admission, her blood pressure was 80/60 mm Hg, pulse rate was 112 beats/min, respiratory rate was 24 breaths/min and body temperature was 34.9°C. She had chronic kidney disease (stage 4) and an 18-year history of type 2 diabetes mellitus treated with insulin over the past 10 years. She had been admitted for acute pyelonephritis in February 2015, December 2016 and August 2018. Following the three admissions, she resided in a nursing hospital. The patient was a non-smoker and had no previous history of pulmonary disease. On admission, her blood results showed an elevated white blood cell (WBC) count (18 990/uL), a low hemoglobin (8.3 g/dL) and normal platelets (317 000/uL). The patient’s blood urea nitrogen level and serum creatinine (Cr) level were markedly elevated (160 mg/dl and 11.59 mg/dl, respectively). Despite fluid resuscitation and catecholaminergic therapy, the patient deteriorated and developed septic shock with metabolic acidosis (lactate: 5.9 mmol/L; blood pH: 6.965; and bicarbonate: 5.5 mmol/L). Urine microscopy showed many WBCs per high power field, and the urine dipstick test was positive for nitrite. She was transferred to a medical intensive care unit and received continuous renal replacement therapy and antibiotics at a dose adjusted for renal impairment (piperacillin/tazobactam 2.25 g every 6 hours). On November 23, 2018, the patient developed dyspnea, and a chest X-ray examination showed atelectasis in the upper lobe of the right lung.
Urine cultures showed more than 100 000/ml of Escherichia coli, but no bacteria grew in the blood culture. On November 23, 2018, chest computed tomography (CT) scan showed partial atelectasis in the right upper lobe (RUL) and prominent wall thickening and enhancement in the proximal portion of the RUL bronchus (Fig. ). INR within normal limits. There was no evidence of other pulmonary diseases like bronchiectasis. On November 26, 2018, bronchoscopy showed inflammation of the RUL bronchus accompanied by necrosis (Fig. ). Acid fast bacilli (AFB) stain, Mycobacterium tuberculosis (MTB) DNA detection with polymerase chain reaction (PCR) technique and the culture for MTB were all negative. Bronchoscopic biopsy showed fungal infection with necrosis and yeast-like fungus with positive periodic acid–Schiff (PAS) stain (Fig. ).
Candida albicans grew from the endobronchial aspirate (WBC: >25; epithelial cell: <10). The EBFI was treated with one dose of intravenous fluconazole 400 mg for induction followed by 200 mg once daily by mouth. The patient’s electrolyte imbalance and uremia worsened during hospitalization. We considered dialysis treatment, but the patient rejected it because of cost. She signed a do-not-resuscitate order and died on December 13, 2018.",What is the patient's HAS-BLED score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Liver disease criteria for the HAS-BLED rule': False, 'age': [68, 'years'], 'Renal disease criteria for the HAS-BLED rule': True, 'Hypertension': False, 'Number of Alcoholic Drinks Per Week': '0.0', 'Stroke': False, 'Medication usage predisposing to bleeding': False, 'Prior major bleeding or predisposition to bleeding': False, 'Labile international normalized ratio': False}",2,2,2,"The criteria for the HAS-BLED score are listed below below:

1. Hypertension (Uncontrolled, >160 mmHg systolic): No = 0 points, Yes = +1 point
2. Renal disease (Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L): No = 0 points, Yes = +1 point
3. Liver disease (Cirrhosis or bilirubin >2x normal with AST/ALT/AP >3x normal): No = 0 points, Yes = +1 point
4. Stroke history: No = 0 points, Yes = +1 point
5. Prior major bleeding or predisposition to bleeding: No = 0 points, Yes = +1 point
6. Labile INR (Unstable/high INRs, time in therapeutic range <60%): No = 0 points, Yes = +1 point
7. Age >65: No = 0 points, Yes = +1 point
8. Medication usage predisposing to bleeding (Aspirin, clopidogrel, NSAIDs): No = 0 points, Yes = +1 point
9. Alcohol use (≥8 drinks/week): No = 0 points, Yes = +1 point

The total HAS-BLED score is calculated by summing the points for each criterion.
    
The current HAS-BLED score is 0.
The patient is 68 years old. Because the patient's age is greater than 65 years, we increment the score by 1, making the current score 0 + 1 = 1.
The patient has 0 drinks a week. Because the patient has less than 8 alcoholic drinks a week, we don't change the score, keeping the current score at 1.
The issue, hypertension, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, liver disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, renal disease, is reported to be present for the patient note and so we increase the score by 1, making the current score 1 + 1 = 2.
The issue, stroke history, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
The issue, prior bleeding, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
The issue, labile inr, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
The issue, medications for bleeding, is reported to be absent for the patient and so we do not change the score, keeping the current score at 2.
Hence, the patient's HAS-BLED score is 2."
363,25,HAS-BLED Score for Major Bleeding Risk,risk,integer,pmc-7641022-1,Extracted,"A 55-year-old male, previously known to be healthy, presented to the emergency department with a 30-minute history of oppressive chest pain radiating to the upper extremities. Upon arrival, his vital signs were as follows: Blood pressure, 112/76 mmHg; pulse rate, 84 beats per minute; and peripheral oxygen saturation on room air, 96%. The patient did not have any family history of coronary artery disease or any other risk factors such as smoking or alcohol abuse. The physical examination was completely normal with no S3 or S4 sounds documented. Electrocardiography (ECG) before securing venous route showed ST segment elevations in leads V1 to V5 and aVL ().
The patient underwent an immediate cardiac catheterization which revealed an ectatic proximal left anterior descending (LAD) coronary artery with critical (90–99%) stenosis at the mid segment, mild ostial disease (20%) in the circumflex artery, and mild ectasia in the right coronary artery (). A drug-eluting stent was successfully inserted in the LAD without any residual stenosis (). Left ventriculogram showed an ejection fraction of 60–64% with a hypokinetic anterior myocardial wall. The results of a biochemical blood analysis performed upon presentation were significant for elevated troponin T levels of 11294 pg/mL and creatine kinase myocardial band (CK-MB) of 876 IU/L. His haemoglobin, white blood count, platelet count, liver function tests, thyroid function tests, lipid levels, fasting blood sugar, prothrombin time, activated partial thromboplastin time, fibrinogen, and D-dimer were all within normal limits. Patient showed prompt recovery and had a good follow-up course.
Four days prior to the event of myocardial infarction, the patient was complaining of 3-day history of acute polyarthritis and morning stiffness in the MCP joints of both hands that improves within 2 hours. No pain or other systemic symptoms were reported. Work-up to rule out reactive arthritis or new onset inflammatory arthritis showed a strongly positive anti-CCP of 500 u/ml (Normal <20), negative rheumatoid factor (RF), negative Brucella serology, and an elevated C-Reactive Protein (CRP) of 46 mg/dL. The patient did not report taking any non-steroidal anti-inflammatory drugs (NSAIDs) or pain-killer pending the blood tests and did not initiate any disease-modifying anti-rheumatic drugs (DMARDs) except after recovery of the acute myocardial infarction (AMI) event. The patient did not meet RA diagnostic criteria after a 6-month period of follow-up.",What is the patient's HAS-BLED score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Liver disease criteria for the HAS-BLED rule': False, 'age': [55, 'years'], 'Renal disease criteria for the HAS-BLED rule': False, 'Hypertension': False, 'Number of Alcoholic Drinks Per Week': '0.0', 'Stroke': False, 'Medication usage predisposing to bleeding': False, 'Prior major bleeding or predisposition to bleeding': False, 'Labile international normalized ratio': False}",0,0,0,"The criteria for the HAS-BLED score are listed below below:

1. Hypertension (Uncontrolled, >160 mmHg systolic): No = 0 points, Yes = +1 point
2. Renal disease (Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L): No = 0 points, Yes = +1 point
3. Liver disease (Cirrhosis or bilirubin >2x normal with AST/ALT/AP >3x normal): No = 0 points, Yes = +1 point
4. Stroke history: No = 0 points, Yes = +1 point
5. Prior major bleeding or predisposition to bleeding: No = 0 points, Yes = +1 point
6. Labile INR (Unstable/high INRs, time in therapeutic range <60%): No = 0 points, Yes = +1 point
7. Age >65: No = 0 points, Yes = +1 point
8. Medication usage predisposing to bleeding (Aspirin, clopidogrel, NSAIDs): No = 0 points, Yes = +1 point
9. Alcohol use (≥8 drinks/week): No = 0 points, Yes = +1 point

The total HAS-BLED score is calculated by summing the points for each criterion.
    
The current HAS-BLED score is 0.
The patient is 55 years old. Because the patient's age is less than 66 years, we don't change the score, keeping the current score at 0.
The patient has 0 drinks a week. Because the patient has less than 8 alcoholic drinks a week, we don't change the score, keeping the current score at 0.
The issue, hypertension, is reported to be absent for the patient and so we do not change the score, keeping the current score at 0.
The issue, liver disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 0.
The issue, renal disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 0.
The issue, stroke history, is reported to be absent for the patient and so we do not change the score, keeping the current score at 0.
The issue, prior bleeding, is reported to be absent for the patient and so we do not change the score, keeping the current score at 0.
The issue, labile inr, is reported to be absent for the patient and so we do not change the score, keeping the current score at 0.
The issue, medications for bleeding, is reported to be absent for the patient and so we do not change the score, keeping the current score at 0.
Hence, the patient's HAS-BLED score is 0."
364,25,HAS-BLED Score for Major Bleeding Risk,risk,integer,pmc-6858797-1,Extracted,"A 23-year-old Caucasian male teacher presented to the Andrology Clinic, Alexandria University Hospital, Alexandria, Egypt for a pre-marital check-up on his reproductive potential. He was 116 kg body weight, 172 cm length, and 39.2 body mass index. He was a non-smoker and with no history of the intake of recreational drugs. He was practicing masturbation on regular basis and denied any sexual partnership. He had no history of scrotal trauma or testicular pain. Male secondary sexual characters were intact. Scrotal examination showed normally placed testes in the scrotum with normal configuration of both epididymides and vasa deferentia. Testicular volumes were equal on either side, 15 cc, as detected by Prader orchidometer. No clinically detectable varicocele or hydrocele was existent. However, a deep exploration of the medical history indicated the past existence of AOSD for 30 months, based on the major diagnostic criteria of Yamaguchi which included spiking fever (39°C), skin rash, arthralgia >2 weeks and neutrophilic leukocytosis. Prednisolone (12.5 mg/d), methotrexate (MXT) (10 mg/w), folic acid (5 mg/w), and vitamin D3 (25-Hydroxy Cholecalciferol) (5000 IU/d) were given during the early days of the disease and kept until the moment. The patient at the current presentation was symptom-free. His lipid profile, fasting and post-prandial blood sugars, glycosylated hemoglobin (HbA1c), liver enzymes, renal function, blood proteins, serum ferritin (4580 then 77.47 ng/mL - N:17.9–464 ng/mL), C-reactive protein (24 mg/L then negative - Negative <5 mg/L), antistreptolysin O (ASO) titer (200 IU/L then negative - Negative <200 IU/L), erythrocyte sedimentation rate (ESR) (80 then 20 mm/h - N: 0–15 mm/h) and WBC (13.3 then 7 K/mL - N: 4–11 K/mL) were within normal ranges. Vitamin D3 was 38.3ng/mL (Sufficiency: 30–100 ng/mL). Abdominal ultrasonography was irrelevant. No history of intake of any medications was given like non-steroidal anti-inflammatory or salicylates for joint pains during the early days of the disease.
Male reproductive hormones, testosterone (T), luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin (PRL) were ordered. The patient gave a peripheral venous blood sample at 9:00 AM. The hormonal assay was expedited using an automated analyzer (Cobas e411, Roche Diagnostics, Mannheim, Germany). The results showed normal levels of all requested hormones [T: 2.75 ng/mL (N: 2.49–8.36 ng/mL), LH: 4.19 mIU/mL (N: 2.4–12.6 mIU/mL), FSH: 4.7 mIU/mL (N: 3.5–12.5 mIU/mL), and PRL: 288.7 mIU/mL (N: 86–324 mIU/mL)]. Semen analysis was also requested after abstinence for 3 days and the sample was retrieved by masturbation in the laboratory. The analysis was repeated three times. At the first time, the analysis was done manually. The data showed normal semen parameters where the volume was 5cc (N: >1.5 cc), pH was 8 (N: 7.2–8), liquefaction happened after 30 mins (N: within 60 mins), viscosity was normal, white blood cells 3-5/HPF (N: 0-5/HPF), sperm count was 31 M/cc (N: ≥20M/cc), total sperm per ejaculate was 155 M (N: ≥39/ejaculate), motility was (rapid progression: 25%, N: ≥25%, total motility: 60%, N; ≥50%), and normal forms were 63% (N: ≥30%). Seven months later, the second semen analysis was done followed by the third check-up with 3 weeks interval in between. These two assessments were expedited using computer-assisted analysis (Mira 9000 sperm analyzer, Mira Laboratory, Cairo, Egypt) as based on WHO criteria. The semen parameters of these two analyses showed normal values. The averages of these values were as follows: volume (3.9cc), pH (7.8), count (34.16 M/cc), normal forms (5.68%) and white blood cells (0-2/HPF). Both liquefaction and viscosity in these last two tests were normal. Regarding motility, the second semen analysis revealed normal forward progression (51.88%), total motility (69.12%) and total motile spermatozoa (156.41/ejaculate). In the third semen analysis, motility could not be assessed as the patient was away from the automated semen machine. An aliquot of semen was taken, kept refrigerated and sent by express mail in association with fixed semen smears to assess the other semen parameters.",What is the patient's HAS-BLED score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Liver disease criteria for the HAS-BLED rule': False, 'age': [23, 'years'], 'Renal disease criteria for the HAS-BLED rule': False, 'Hypertension': False, 'Number of Alcoholic Drinks Per Week': '0.0', 'Stroke': False, 'Medication usage predisposing to bleeding': False, 'Prior major bleeding or predisposition to bleeding': False, 'Labile international normalized ratio': False}",0,0,0,"The criteria for the HAS-BLED score are listed below below:

1. Hypertension (Uncontrolled, >160 mmHg systolic): No = 0 points, Yes = +1 point
2. Renal disease (Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L): No = 0 points, Yes = +1 point
3. Liver disease (Cirrhosis or bilirubin >2x normal with AST/ALT/AP >3x normal): No = 0 points, Yes = +1 point
4. Stroke history: No = 0 points, Yes = +1 point
5. Prior major bleeding or predisposition to bleeding: No = 0 points, Yes = +1 point
6. Labile INR (Unstable/high INRs, time in therapeutic range <60%): No = 0 points, Yes = +1 point
7. Age >65: No = 0 points, Yes = +1 point
8. Medication usage predisposing to bleeding (Aspirin, clopidogrel, NSAIDs): No = 0 points, Yes = +1 point
9. Alcohol use (≥8 drinks/week): No = 0 points, Yes = +1 point

The total HAS-BLED score is calculated by summing the points for each criterion.
    
The current HAS-BLED score is 0.
The patient is 23 years old. Because the patient's age is less than 66 years, we don't change the score, keeping the current score at 0.
The patient has 0 drinks a week. Because the patient has less than 8 alcoholic drinks a week, we don't change the score, keeping the current score at 0.
The issue, hypertension, is reported to be absent for the patient and so we do not change the score, keeping the current score at 0.
The issue, liver disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 0.
The issue, renal disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 0.
The issue, stroke history, is reported to be absent for the patient and so we do not change the score, keeping the current score at 0.
The issue, prior bleeding, is reported to be absent for the patient and so we do not change the score, keeping the current score at 0.
The issue, labile inr, is reported to be absent for the patient and so we do not change the score, keeping the current score at 0.
The issue, medications for bleeding, is reported to be absent for the patient and so we do not change the score, keeping the current score at 0.
Hence, the patient's HAS-BLED score is 0."
365,25,HAS-BLED Score for Major Bleeding Risk,risk,integer,usmle-10057,Extracted,"A 62-year-old woman presents with abdominal pain and blood in her urine. Since the acute onset of symptoms 3 days ago, there has been no improvement. She describes the pain as moderate, sharp and burning in character, non-radiating, and localized to the suprapubic region. She also has noted some mild urinary frequency and urgency for the past 5 days, which has been getting progressively worse. She denies any flank pain, fever, chills, night sweats, dysuria, or pain on urination. The patient has a history of an abdominal leiomyosarcoma, which was diagnosed 6 months ago. The course of her disease is complicated by hepatic metastases, for which she recently started receiving a new therapy. The patient reports a 15-pack-year smoking history, but no alcohol or recreational drug use. Her temperature is 37.0℃ (98.6℉), pulse is 84/min, respiratory rate is 18/min, and blood pressure is 110/75 mm Hg. On physical examination, there is some mild suprapubic tenderness to palpation. The remainder of the exam is unremarkable. Laboratory findings include a mild leukopenia of 3,000/mm3. A urine dipstick reveals 3+ blood.",What is the patient's HAS-BLED score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Liver disease criteria for the HAS-BLED rule': True, 'age': [62, 'years'], 'Renal disease criteria for the HAS-BLED rule': False, 'Hypertension': False, 'Number of Alcoholic Drinks Per Week': '0.0', 'Stroke': False, 'Medication usage predisposing to bleeding': False, 'Prior major bleeding or predisposition to bleeding': False, 'Labile international normalized ratio': False}",1,1,1,"The criteria for the HAS-BLED score are listed below below:

1. Hypertension (Uncontrolled, >160 mmHg systolic): No = 0 points, Yes = +1 point
2. Renal disease (Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L): No = 0 points, Yes = +1 point
3. Liver disease (Cirrhosis or bilirubin >2x normal with AST/ALT/AP >3x normal): No = 0 points, Yes = +1 point
4. Stroke history: No = 0 points, Yes = +1 point
5. Prior major bleeding or predisposition to bleeding: No = 0 points, Yes = +1 point
6. Labile INR (Unstable/high INRs, time in therapeutic range <60%): No = 0 points, Yes = +1 point
7. Age >65: No = 0 points, Yes = +1 point
8. Medication usage predisposing to bleeding (Aspirin, clopidogrel, NSAIDs): No = 0 points, Yes = +1 point
9. Alcohol use (≥8 drinks/week): No = 0 points, Yes = +1 point

The total HAS-BLED score is calculated by summing the points for each criterion.
    
The current HAS-BLED score is 0.
The patient is 62 years old. Because the patient's age is less than 66 years, we don't change the score, keeping the current score at 0.
The patient has 0 drinks a week. Because the patient has less than 8 alcoholic drinks a week, we don't change the score, keeping the current score at 0.
The issue, hypertension, is reported to be absent for the patient and so we do not change the score, keeping the current score at 0.
The issue, liver disease, is reported to be present for the patient note and so we increase the score by 1, making the current score 0 + 1 = 1.
The issue, renal disease, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, stroke history, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, prior bleeding, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, labile inr, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
The issue, medications for bleeding, is reported to be absent for the patient and so we do not change the score, keeping the current score at 1.
Hence, the patient's HAS-BLED score is 1."
366,26,Sodium Correction for Hyperglycemia,lab test,decimal,pmc-7232043-1,Extracted,"A 37-year-old man with a past medical history of pancreatitis, type 2 diabetes
mellitus on insulin, and ulcerative colitis was brought to the emergency department
with complaints of nausea, vomiting, and diarrhea for a 1-week duration followed by
anuria for 48 hours prior to this presentation. Vital signs on presentation include
a temperature of 36.3°C, blood pressure of 103/60 mm Hg, heart rate of 79 beats per
minute, and respiratory rate of 16 breaths per minute, saturating at 100% on room
air. On examination, the patient appeared somnolent with dry mucous membranes and
loss of skin turgor. Limited neurologic examination was unremarkable. Comprehensive
serum drug screen was negative. Laboratory data are relevant for serum blood urea
nitrogen 160 mg/dL, creatinine 8.4 mg/dL, Na 107 mEq/L, potassium 6.1 mEq/L,
bicarbonate 7 mEq/L, anion gap of 33, glucose 169 mg/dL, and measured serum
osmolality of 297 mOsm/L. Electrocardiogram showed normal sinus rhythm with peak
T-waves. Urine studies revealed Na <10 mEq/L, creatinine 286 mg/dL, and
osmolality of 311 mOsm/L, with hyaline casts and fractional excretion of sodium of
0.6%. No prior history of renal disease noted, and renal ultrasound was
unremarkable. Given refractory and worsening hyperkalemia, worsening uremia, and
acidosis, emergent dialysis was planned. However, the lowest sodium bath available
for dialysis being 130 mEq, 0.45% normal saline was infused during the dialysis
session to prevent rapid sodium correction. He received one session of hemodialysis
and serum Na increased to 124 mEq/L and blood urea nitrogen decreased to 87 mg/dL
during the 5-hour dialysis session. The patient’s mentation gradually improved,
fully alert, awake, and oriented without any immediate neurological deficits.
Detailed neurological examination performed prior to discharge was also
unremarkable, including normal cranial nerve examination, muscle strength, and deep
tendon reflexes, sensory function, gait, and coordination. Both T1- and T2-weighted
imaging sequences on magnetic resonance imaging (MRI) scan performed 7 days after
the rapid correction event was unremarkable. The patient’s neurological examination
remained unremarkable on his 4-week posthospital clinic follow-up.","What is the patient's corrected sodium concentration for hyperglycemia in terms of mEq/L? Use the sodium correction equation based on the one derived in Hillier, 1999. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Glucose': [169.0, 'mg/dL'], 'Sodium': [107.0, 'mEq/L']}",108.656,103.2232,114.0888,"The formula for Sodium Correction for Hyperglycemia based on Hiller, 1999 is Measured sodium + 0.024 * (Serum glucose - 100), where Measured Sodium is the sodium concentration in mEq/L and the Serum glucose is the concentration of glucose in mg/dL.
The concentration of sodium is 107.0 mEq/L. 
The concentration of glucose is 169.0 mg/dL. 
Plugging in these values into the formula gives us 107.0 mEq/L + 0.024 * (169.0 - 100) = 108.656 mEq/L.
Hence, the patient's corrected concentration of sodium is 108.656 mEq/L."
367,26,Sodium Correction for Hyperglycemia,lab test,decimal,pmc-6311974-1,Extracted,"A 38-year-old man presented to an emergency department with progressive weakness and decreased urine output after having vomited up to 20 times per day over a period of 7 days. The patient was referred to our intensive care unit. Before medical consultation, he was healthy, and no other symptoms were reported. Diarrhea, fever, chills, or abdominal pain was absent.
Clinical examination revealed a patient of normal weight (height: 180 cm, weight: 70 kg). Blood pressure and heart rate were elevated (150/80 mmHg, 105/min); the respiratory rate was normal (13/min), but oxygen saturation was low (89%). During blood pressure measurement, a positive Trousseau sign was noted. The mucous membranes were dry, and the physical examination was otherwise unremarkable.
Arterial blood gas analysis revealed a metabolic alkalosis with partial respiratory compensation (pH: 7.71 [7.35–7.45], base excess: 40.5 mmol/l [-2-3 mmol/l], pCO2: 56.1 mmHg [32–45 mmHg], pO2: 43.5 mmHg [83–108 mmHg], bicarbonate: 72.2 mmol/l [21–26 mmol/l], lactate: 2.8 mmol/l [0.5–1.6 mmol/l], chloride: 52 mmol/l [98–106 mmol/l], sodium: 130 mmol/l [136–146 mmol/l], potassium: 2.4 mmol/l [3.5–5.1 mmol/l], ionized calcium: 0.77 mmol/l [1.15–1.29 mmol/l] and glucose: 165 mg/dl [70–105 mg/dl]).
Ultrasound revealed a distended and full stomach; the inferior vena cava was collapsing on inspiration. Otherwise, the ultrasound was unremarkable. The electrocardiography [] showed a prolonged QT interval (QTc 547 ms).
Laboratory tests were consistent with acute kidney injury (creatinine: 5.2 mg/dl, urea: 176 mg/dl); liver function tests, coagulation tests, albumin, lipase, procalcitonin, total calcium, hemoglobin, and thyroid-stimulating hormone were normal. Leukocytes were minimally elevated (11500/μl).
We suspected a prerenal acute kidney injury and a hypochloremic metabolic alkalosis due to gastric losses of HCl and fluids. Initial management consisted of oxygen therapy to correct hypoxemia and intravenous fluid therapy with normal saline and potassium chloride. Initially, a balanced crystalloid solution was infused, and later normal saline with KCl (40 mmol/l) was used because of the higher chloride content. Metoclopramide was administered to promote gastric emptying. To prevent further gastric losses of HCl, a proton-pump inhibitor was given. The patient was put on nihil per os for 24 h.
After 24 h, a total of 4.5 l of crystalloid fluid was infused. There was no further vomiting. A repeated bedside ultrasound revealed an empty stomach. The pH was corrected to 7.49, bicarbonate was reduced to 48.6 mmol/l, base excess was 23.4, chloride was 69 mmol/l, and potassium was still low at 2.8 mmol/l. There was hypoventilation with a pCO2 of 68.4 mmHg. We noted onset of diuresis. After 72 h of fluid therapy, the acid-base and electrolyte status was normal. Creatinine had decreased to 3.5 mg/dl. Small meals were tolerated.
Since there was no evidence of an infectious etiology for the excessive vomiting and the ultrasound had shown a distended stomach, an upper gastrointestinal endoscopy was performed []. A significant stenosis of the duodenum was diagnosed. Although there was no ulcer visible, an occult ulcer was deemed to be possible. A portal hypertensive gastropathy was diagnosed while esophageal varices were absent. Helicobacter pylori testing was positive, so an eradication therapy was initiated. A repeated endoscopy confirmed the stenosis, but again, no ulcer was seen. Since a focused abdominal ultrasound did not reveal the reason for the stenosis, a magnetic resonance imaging scan was performed to rule out malignancy such as pancreatic or gallbladder cancer or a thrombosis of the mesenteric vein. There was no evidence of malignancy or cirrhosis. An endosonography was done without evidence of malignancy or mesenteric vein thrombosis. At that point, the stenosis had partly resolved, and endoscopic passage was possible. We concluded that the temporary duodenal stenosis was caused most likely by portal hypertension of unknown etiology, and our differential diagnosis included idiopathic noncirrhotic portal hypertension after exclusion of cirrhosis and portal vein obstruction.","What is the patient's corrected sodium concentration for hyperglycemia in terms of mEq/L? Use the sodium correction equation based on the one derived in Hillier, 1999. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Glucose': [165.0, 'mg/dL'], 'Sodium': [130.0, 'mmol/L']}",131.56,124.982,138.138,"The formula for Sodium Correction for Hyperglycemia based on Hiller, 1999 is Measured sodium + 0.024 * (Serum glucose - 100), where Measured Sodium is the sodium concentration in mEq/L and the Serum glucose is the concentration of glucose in mg/dL.
The concentration of sodium is 130.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 130.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 130.0 mmol * 1 mEq/mmol = 130.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 130.0 mmol sodium/L converts to 130.0 mEq sodium/L. 
The concentration of glucose is 165.0 mg/dL. 
Plugging in these values into the formula gives us 130.0 mEq/L + 0.024 * (165.0 - 100) = 131.56 mEq/L.
Hence, the patient's corrected concentration of sodium is 131.56 mEq/L."
368,26,Sodium Correction for Hyperglycemia,lab test,decimal,usmle-5686,Extracted,"A 14-year-old male presents to the emergency department with altered mental status. His friends who accompanied him said that he complained of abdominal pain while camping. They denied his consumption of anything unusual from the wilderness, or any vomiting or diarrhea. His temperature is 100.5°F (38.1°C), blood pressure is 95/55 mmHg, pulse is 130/min, and respirations are 30/min. His pupils are equal and reactive to light bilaterally. The remainder of the physical exam is unremarkable. His basic metabolic panel is displayed below:

Serum:
Na+: 116 mEq/L
Cl-: 70 mEq/L
K+: 4.0 mEq/L
HCO3-: 2 mEq/L
BUN: 50 mg/dL
Glucose: 1010 mg/dL
Creatinine: 1.2 mg/dL

While the remainder of his labs are pending, the patient becomes bradypneic and is intubated. His ventilator is adjusted to volume control assist-control with a respiratory rate (RR) of 14/min, tidal volume (Vt) of 350 mL, positive end-expiratory pressure (PEEP) of 5 cm H2O, and fractional inspired oxygen (FiO2) of 40%. His height is 5 feet 5 inches. Intravenous fluids and additional medical therapy are administered.","What is the patient's corrected sodium concentration for hyperglycemia in terms of mEq/L? Use the sodium correction equation based on the one derived in Hillier, 1999. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Glucose': [1010.0, 'mg/dL'], 'Sodium': [116.0, 'mEq/L']}",137.84,130.948,144.732,"The formula for Sodium Correction for Hyperglycemia based on Hiller, 1999 is Measured sodium + 0.024 * (Serum glucose - 100), where Measured Sodium is the sodium concentration in mEq/L and the Serum glucose is the concentration of glucose in mg/dL.
The concentration of sodium is 116.0 mEq/L. 
The concentration of glucose is 1010.0 mg/dL. 
Plugging in these values into the formula gives us 116.0 mEq/L + 0.024 * (1010.0 - 100) = 137.84 mEq/L.
Hence, the patient's corrected concentration of sodium is 137.84 mEq/L."
369,26,Sodium Correction for Hyperglycemia,lab test,decimal,pmc-7455384-1,Extracted,"A 57-year-old man was admitted to the ED with complaints of syncope and weakness. We noticed that in his medical history, leeches were applied to treat the diabetic wounds on his feet two hours before he attended our clinic. After this, the leeches spontaneously detached but he observed bleeding from his bites and bleeding did not stop in spite of compression with tight bandages. A review of the patient’s past medical history revealed hypertension, diabetes mellitus, diabetic foot, ischemic heart disease and coronary artery bypass surgery.
Vital signs were as follows; fever: 36.6°C, blood pressure: 85/50 mmHg, heart rate: 112/min and respiratory rate: 28/min. Physical examination revealed tenderness in the whole abdomen. Ampulla was empty with rectal examination. There was an ulcerative lesion with size 5x3 cm on the site of the amputated first toe. Additionally, there were multiple bites due to leech therapy on both feet (Figure ).
Laboratory tests indicated the following: hemoglobin: 7.6 g/dL, white blood cells: 9370/mm3, platelets: 147000/mL, blood urea nitrogen: 29.1 mg/dL, creatinine: 1.98 mg/dL, glucose: 527 mg/dL, Na: 127 mmol/L, K: 6 mmol/L, CL: 94.5 mmol/L, C-reactive protein: 1.27 mg/dL and other routine blood tests and coagulation functions were all normal. Blood gas analysis revealed pH: 7.26, pO2: 86 mmHg, and bicarbonate: 20.2 mmol/L. Abdominal ultrasonography (USG) showed gas in the intrahepatic biliary ducts. No obstructive pathology was found to mesenteric blood flow on Doppler USG. CT without intravenous contrast was performed because of abnormal renal function tests. CT revealed gas near the stomach, among colon segments (pneumatosis cystoides intestinalis, PSI) and intrahepatic biliary ducts in central and left hepatic lobe (hepatic portal venous gas, HPVG) (Figure , Figure , respectively).
The patient was referred to another hospital that had an intensive care unit and started conservative treatment with antibiotics and intravenous fluid. Twelve hours after treatment, his general condition did not improve and signs of diffused peritonitis were observed on abdominal examination. The patient underwent exploratory laparotomy. Necrosis was found in the terminal ileum and the entire colon during laparotomy. Doppler USG detected low flow in the vessels supplying these necrotic segments. However, resection was decided due to necrosis of these segments. These necrotic intestinal segments were resected and an end-ileostomy was performed. He had an uneventful recovery and was discharged on the 17th postoperative day.","What is the patient's corrected sodium concentration for hyperglycemia in terms of mEq/L? Use the sodium correction equation based on the one derived in Hillier, 1999. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Glucose': [527.0, 'mg/dL'], 'Sodium': [127.0, 'mmol/L']}",137.248,130.3856,144.1104,"The formula for Sodium Correction for Hyperglycemia based on Hiller, 1999 is Measured sodium + 0.024 * (Serum glucose - 100), where Measured Sodium is the sodium concentration in mEq/L and the Serum glucose is the concentration of glucose in mg/dL.
The concentration of sodium is 127.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 127.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 127.0 mmol * 1 mEq/mmol = 127.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 127.0 mmol sodium/L converts to 127.0 mEq sodium/L. 
The concentration of glucose is 527.0 mg/dL. 
Plugging in these values into the formula gives us 127.0 mEq/L + 0.024 * (527.0 - 100) = 137.248 mEq/L.
Hence, the patient's corrected concentration of sodium is 137.248 mEq/L."
370,26,Sodium Correction for Hyperglycemia,lab test,decimal,pmc-4541682-1,Extracted,"A 47-year-old man visited the emergency room because of decreased mentality. He was diagnosed with diabetes mellitus (DM), but had not received regular treatment. His blood pressure was 60/30 mm Hg and body temperature was 38.5℃. Laboratory data showed white blood cell of 13.150×109/L, with a differential count of 90.7% neutrophils and 8.5% lymphocytes, hemoglobin of 14.3 g/dL, platelet count of 507×109/L, glucose levels of 443 mg/dL, blood urea nitrogen of 52.5 mg/dL, serum creatinine concentrations of 1.9 mg/dL, aspartate aminotransferase of 69 IU/L, alanine transaminase of 38 IU/L, sodium of 125.7 mmol/L, potassium of 5.4 mmol/L, C-reactive protein (CRP) levels of 19.42 mg/dL, ketone bodies in the blood 3 positive and HbA1c of 18.20%. Arterial blood gas analysis revealed a pH of 7.032, pCO2 of 21.8 mm Hg, pO2 of 83.3 mm Hg, and HCO3 of 5.8 mmol/L. Chest X-ray and computed tomography (CT) scans showed multiple consolidation and ground glass opacities in both lung fields (). The patient was initially diagnosed with diabetic ketoacidosis as a result of severe pneumonia. An immediate hydration and insulin therapy were started, and dose-adjusted piperacillin and tazobactam sodium were also administered for pneumonia. The patient was admitted to the intensive care unit (ICU) for mechanical ventilator therapy. The ketoacidosis had improved with hydration and insulin therapy, but on the second day of hospitalization, diuretic-resistant pulmonary edema developed and continuous renal replacement therapy was started. Klebsiella pneumonia was identified in sputum cultures. After 8 days of treatment, the lung lesions had regressed (). The patient was finally moved to the general ward. However, on the 5th day in the general ward, he started complaining of vague abdominal pain. His pain had aggravated with severe tenderness. An erect abdominal X-ray showed gaseous distention of small bowel loops with suspicious stepladder sign, suggesting mechanical obstruction (). Subsequent abdominal CT suggested multiple perforation of the transverse colon with panperitonitis ().
An emergency laparotomy was performed. Necrotic intestines were observed from the distal ascending colon to the proximal transverse colon. Necrotic portions were resected and the Periodic Acid Schiff and Grocott's methenamine silver staining of the resected specimen showed septated fungal hyphae with acute angle branching, suggesting aspergillus species (). The patient was finally diagnosed with colonic IA. Intravenous liposomal amphotericin-B (3 mg/kg/day) was additionally administered for 35 days. He was discharged with oral voriconazole to treat his reported remaining, abdominal discomfort and mildly elevated CRP levels. Voriconazole was discontinued at a follow-up visit to the outpatient department 2 weeks after discharge when his abdominal discomfort had relieved and CRP levels normalized.","What is the patient's corrected sodium concentration for hyperglycemia in terms of mEq/L? Use the sodium correction equation based on the one derived in Hillier, 1999. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Glucose': [443.0, 'mg/dL'], 'Sodium': [125.7, 'mmol/L']}",133.932,127.2354,140.6286,"The formula for Sodium Correction for Hyperglycemia based on Hiller, 1999 is Measured sodium + 0.024 * (Serum glucose - 100), where Measured Sodium is the sodium concentration in mEq/L and the Serum glucose is the concentration of glucose in mg/dL.
The concentration of sodium is 125.7 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 125.7 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 125.7 mmol * 1 mEq/mmol = 125.7 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 125.7 mmol sodium/L converts to 125.7 mEq sodium/L. 
The concentration of glucose is 443.0 mg/dL. 
Plugging in these values into the formula gives us 125.7 mEq/L + 0.024 * (443.0 - 100) = 133.932 mEq/L.
Hence, the patient's corrected concentration of sodium is 133.932 mEq/L."
371,26,Sodium Correction for Hyperglycemia,lab test,decimal,pmc-6029742-1,Extracted,"A 25-year-old man with no past medical history presented to the emergency department (ED) with two days of intractable vomiting, increasing confusion, and progressive difficulty breathing. The patient denied tobacco or recreational drug use.
Upon arrival to the ED, vital signs were within normal range with a blood pressure of 123/61 mmHg, a temperature of 36.8 degree Celsius, a heart rate of 92 beats per minute, and a respiratory rate of 19 respirations per minute. The physical exam showed an obese, lethargic patient, responsive to verbal stimuli. The lung, heart, and abdomen exam were unremarkable and there was no neck crepitus noted. The laboratory evaluation showed leukocytosis of 25.96 x 1000/mm3, elevated creatinine of 2.17 mg/dL, hyperglycemia of 836 mg/dL, hyponatremia of 128 mEq/L, hyperkalemia of 5.2 mEq/L, and bicarbonate of 5 mEq/L. The anion gap was 25 and a venous blood gas showed a pH of 6.91. Urinalysis was positive for 2+ ketones and 1+ protein.
The patient was admitted to the intensive care unit with a new diagnosis of diabetes mellitus complicated with DKA. Intravenous normal saline, bicarbonate, and insulin drip were initiated. The chest X-ray on admission suggested findings compatible with pneumomediastinum (Figure ). Chest computed tomography (CT) was obtained and reaffirmed the findings (Figures -). Pneumomediastinum in the setting of intractable vomiting was worrisome for esophageal rupture and since our facility was not staffed to manage this clinical entity, the patient was emergently transferred to another facility. The patient was treated conservatively with analgesia and respiratory support and was discharged several days later without any complications.","What is the patient's corrected sodium concentration for hyperglycemia in terms of mEq/L? Use the sodium correction equation based on the one derived in Hillier, 1999. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Glucose': [836.0, 'mg/dL'], 'Sodium': [128.0, 'mEq/L']}",145.664,138.3808,152.9472,"The formula for Sodium Correction for Hyperglycemia based on Hiller, 1999 is Measured sodium + 0.024 * (Serum glucose - 100), where Measured Sodium is the sodium concentration in mEq/L and the Serum glucose is the concentration of glucose in mg/dL.
The concentration of sodium is 128.0 mEq/L. 
The concentration of glucose is 836.0 mg/dL. 
Plugging in these values into the formula gives us 128.0 mEq/L + 0.024 * (836.0 - 100) = 145.664 mEq/L.
Hence, the patient's corrected concentration of sodium is 145.664 mEq/L."
372,26,Sodium Correction for Hyperglycemia,lab test,decimal,pmc-2943705-1,Extracted,"A 20-year-old female in her third month of pregnancy presented to us following 3-4 episodes of vomiting and unconsciousness. On presentation, her Glasgow Coma Scale was 10/15 and was found to have heart rate and blood pressure of 110/min and 110/55 mmHg, respectively. Her respiration was spontaneous and regular at the rate of 18 breaths/min. Her pupils were normal in size and reacting to light and neck rigidity and Kernig’s sign were absent. Bilateral chest was clear on auscultation. Following admission, she had generalised tonic clonic convulsions which was unresponsive to 4 mg Intravenous (IV) Lorazepam. Immediately Inj. Thiopentone was given and her airway was secured with a tracheal tube. Her initial arterial blood gas (ABG) was as follows: pH - 6.86, PaCO2 - 72 mm Hg, PaO2 - 108 mm Hg, HCO3 - 12.7, Base deficit - 21.3, Na+ - 132 meq/l, K+ - 3 meq/l, Ca2+ - 9.3 mg/dl and glucose of 200 mg/dl. Immediately, she was provided with 100 meq of sodium bicarbonate (7.5%) and was put on controlled mandatory mode ventilation with FiO2 0.5, tidal volume 400 ml and respiratory rate of 20 breaths per minute. The ventilatory settings were periodically adjusted to achieve normocapnoea and normooxaemia. We corrected the hypokalemia with intravenous inj. potassium chloride at the rate of 20 meq/hr. Renal function test, coagulation profile and urine examination of the patient were within normal limits. Liver function test of the patient showed an ALT (Alanine transferase) and AST (Aspartate transferase) of 63 IU/L and 83 IU/L, respectively, with out any other abnormalities.
Detailed history revealed that the patient was a diagnosed case of pulmonary tuberculosis and was on antitubercular therapy and had consumed nearly 10 tablets of some medication. We strongly suspected an acute intoxication of isoniazide (due to the clinical presentation) and immediately gastric lavage was done with 100 g charcoal mixed with 50 g of sorbitol through a nasogastric tube. Intravenous pyridoxine (3,000 mg) was then administered slowly over 15 minutes. After three hours, her ABG was: pH - 7.41, PaCO2 -31 mmHg, PaO2 - 109 mmHg, HCO3-18.7, Base deficit - 4.9. Twelve hours afterward her blood gases were: pH - 7.43, PaCO2 - 36 mmHg, PaO2 - 105 mmHg, HCO3− - 23.6, Base deficit - 1.0. On second day, she regained consciousness and her blood biochemistry, cerebrospinal fluid examination, coagulation profile and blood gas parameters were within normal limit. Ultrasound abdomen for assessment of fetal status was within normal limit. Patient was extubated on the second day. On day three, her liver function test (ALT and AST) were within normal limit and patient was discharged from the ICU.","What is the patient's corrected sodium concentration for hyperglycemia in terms of mEq/L? Use the sodium correction equation based on the one derived in Hillier, 1999. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Glucose': [200.0, 'mg/dL'], 'Sodium': [132.0, 'mEq/L']}",134.4,127.68,141.12,"The formula for Sodium Correction for Hyperglycemia based on Hiller, 1999 is Measured sodium + 0.024 * (Serum glucose - 100), where Measured Sodium is the sodium concentration in mEq/L and the Serum glucose is the concentration of glucose in mg/dL.
The concentration of sodium is 132.0 mEq/L. 
The concentration of glucose is 200.0 mg/dL. 
Plugging in these values into the formula gives us 132.0 mEq/L + 0.024 * (200.0 - 100) = 134.4 mEq/L.
Hence, the patient's corrected concentration of sodium is 134.4 mEq/L."
373,26,Sodium Correction for Hyperglycemia,lab test,decimal,pmc-5224414-1,Extracted,"A 58-year-old Saudi diabetic female presented with left-sided involuntary movements. Unilateral movement was continuous, choreoathetotic, purposeless, non-stereotyped, and involved the face (twitching) and upper and lower extremities. It developed subacutely over 2 weeks. The movement was distressful to the patient and interfered with her activities of daily living and gait, causing recurrent falls. However, it ceased during sleep. She had poorly controlled diabetes for approximately 20 years, and was maintained on oral hypoglycemic agents. She was not on hormone replacement therapy or any other medications to which these symptoms could be attributed. There was no family history of movement disorders, and no clinical features suggestive of connective tissue diseases. Past medical history was of no relevance. Apart from the hemichorea involving the left side of the face and upper and lower extremities, her neurological examination was unremarkable; with normal higher mental function, and normal cranial and sensory nerve examination.
On admission, she was hyperglycemic with a random serum glucose of 30.3 mmol/L, (normal level <6.5 mmol/L); and her glycosylated hemoglobin was 13.5%, normal level=4-6%. Urine was negative for ketones. Expectedly, serum potassium was 5.6 mmol/L (normal level=3.5-5.0 mmol/L), and sodium was 133 mmol/L, (normal level=135-145 mmol/L), but other electrolytes were normal. Her blood count, coagulation profile, liver function tests, vitamin B12, and thyroid-stimulating hormone were all within normal. Lipid profile showed dyslipidemia (cholesterol 9.81 mmol/L, triglycerides 4.61 mmol/L, high-density lipoprotein 1.1 mmol/L, and low-density lipoprotein 6.61 mmol/L). Further workup reinforced the evidence of poor diabetic control; her ophthalmologic examination revealed moderate to severe nonproliferative diabetic retinopathy, and her protein to creatinine ratio was 2000.
A CT scan taken on admission was normal. Non-enhanced brain MRI () was obtained the next day and demonstrated an area of hyperintensity on T1 weighted images; involving the left caudate, putamen, and internal globus pallidus. There was no restriction on diffusion-weighted images (DWI) and the apparent diffusion coefficient (ADC) map was normal. For glycemic control, she was started on an insulin regimen (bedtime insulin glargine and preprandial insulin aspart) with sitagliptin.
Initially she was treated with lorazepam (2-6 mg/day) to control her HH. While lorazepam improved the quality of her sleep, it had no effect on the chorea in her waking hours. Valproic acid (400 mg/day) had no clear effect on chorea and was discontinued due to intolerance. She was then given haloperidol (gradually titrated from 1 mg/day to 8 mg/day) and clonazepam (titrated from 1.5 mg/day to 6 mg/day). She showed clinical improvement after a few days with improvement in her daily activities and gait. Initially, there was more improvement in her lower extremities than upper extremities and the face over a period of 2 weeks. However, she achieved a satisfactory glycemic control, with a fasting serum glucose ranging from 6 to 7.8 mmol/L. With the initiation of neuroleptics and the glycemic control, the hemichorea steadily improved. She was discharged and followed up at an outpatient clinic. Three months later, she was in stable condition and had no recurrence of chorea.","What is the patient's corrected sodium concentration for hyperglycemia in terms of mEq/L? Use the sodium correction equation based on the one derived in Hillier, 1999. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Glucose': [30.3, 'mmol/L'], 'Sodium': [133.0, 'mmol/L']}",143.70124,136.51618,150.8863,"The formula for Sodium Correction for Hyperglycemia based on Hiller, 1999 is Measured sodium + 0.024 * (Serum glucose - 100), where Measured Sodium is the sodium concentration in mEq/L and the Serum glucose is the concentration of glucose in mg/dL.
The concentration of sodium is 133.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 133.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 133.0 mmol * 1 mEq/mmol = 133.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 133.0 mmol sodium/L converts to 133.0 mEq sodium/L. 
The concentration of glucose is 30.3 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of glucose from mmol to mg. The mass of glucose is 30.3 mmol. To convert 30.3 mmol of glucose to mol, multiply by the conversion factor 0.001, giving us 30.3 mmol glucose * 0.001 mol/mmol = 0.0303 mol glucose. To convert from mol glucose to grams, multiply by the molar mass 180.16 g/mol, which will give 0.0303 mol glucose * 180.16 g/mol = 5.45885 g glucose. To convert 5.45885 g of glucose to mg, multiply by the conversion factor 1000.0, giving us 5.45885 g glucose * 1000.0 mg/g = 5458.85 mg glucose. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 5458.85 mg glucose/10.0 dL = 545.885 mg glucose/dL. The concentration value of 30.3 mmol glucose/L converts to 545.885 mg glucose/dL. 
Plugging in these values into the formula gives us 133.0 mEq/L + 0.024 * (545.885 - 100) = 143.70124 mEq/L.
Hence, the patient's corrected concentration of sodium is 143.70124 mEq/L."
374,26,Sodium Correction for Hyperglycemia,lab test,decimal,pmc-8110288-1,Extracted,"A 48-year-old female with a past medical history of diabetes mellitus presented with complaints of fever, chills, headaches, fatigue, myalgia, and weakness of one-week duration. She did not have any other contributory past medical, surgical, social, or family history. On physical examination, she was in mild distress secondary to her myalgias. Vital signs showed a temperature of 36.6°C, blood pressure of 175/105 mmHg, pulse of 80 beats/minute, respiratory rate of 18/minute, and pulse oxymetry at 100% on room air. Pulmonary, cardiac, and abdominal examinations were unremarkable on admission. Notably, the neurologic examination was also unremarkable on admission.
The patients’ initial labs revealed a positive SARS-CoV-2 polymerase chain reaction (PCR), sodium of 129 mmol/L (normal range: 135-145 mmol/L), potassium of 3.4 mmol/L (normal range: 3.4-4.7 mmol/L), glucose of 337 mg/dL (normal range: 70-99 mg/dL), and calcium of 9.3 mg/dL (normal range: 8.6-10.2 mg/dL). Other labs showed C-reactive protein of 0.14 mg/dL, D-dimer of 0.67, creatinine kinase of 28, and hemoglobin A1C of 10.9%. The chest X-ray of the patient was unremarkable, but computed tomography (CT) of the chest did reveal ground-glass opacities in the upper and lower bilateral lung fields consistent with a COVID-19 presentation (Figure ).
The patient was placed on observation status secondary to her SARS-CoV-2 infection. Her hyperglycemia, hyponatremia, and elevated blood pressure resolved on follow-up. On day two, the patient had a complaint of “dry eye” on the left. Examination of the face revealed asymmetric forehead folds, inability to raise the left eyebrow, and left facial droop. There was no bilateral component. The remainder of the neurologic examination was within normal limits. Therefore, a diagnosis of Bell’s palsy was made and the patient was started on empiric steroids (prednisone 20 mg daily for five days), valacyclovir (1 g TID for seven days), and doxycycline (100 mg BID). The doxycycline was discontinued once the Lyme disease titers returned negative and the patient finished her course of empiric valacyclovir and steroids. Upon discharge, there was a marked improvement in her facial asymmetry.","What is the patient's corrected sodium concentration for hyperglycemia in terms of mEq/L? Use the sodium correction equation based on the one derived in Hillier, 1999. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Glucose': [337.0, 'mg/dL'], 'Sodium': [129.0, 'mmol/L']}",134.688,127.9536,141.4224,"The formula for Sodium Correction for Hyperglycemia based on Hiller, 1999 is Measured sodium + 0.024 * (Serum glucose - 100), where Measured Sodium is the sodium concentration in mEq/L and the Serum glucose is the concentration of glucose in mg/dL.
The concentration of sodium is 129.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 129.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 129.0 mmol * 1 mEq/mmol = 129.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 129.0 mmol sodium/L converts to 129.0 mEq sodium/L. 
The concentration of glucose is 337.0 mg/dL. 
Plugging in these values into the formula gives us 129.0 mEq/L + 0.024 * (337.0 - 100) = 134.688 mEq/L.
Hence, the patient's corrected concentration of sodium is 134.688 mEq/L."
375,26,Sodium Correction for Hyperglycemia,lab test,decimal,pmc-8383553-1,Extracted,"A 13-year-old previously healthy female presented to a local hospital with a 1-month history of polydipsia and polyphagia and a 1-day history of fatigue, pallor, and Kussmaul breathing. On arrival to the PICU, the patient was tachycardic (heart rate of 166), tachypneic (respiratory rate of 41) with Kussmaul breathing, and disoriented. Her capillary blood gas revealed metabolic acidosis with respiratory compensation with a pH 7.10, pCO2 11.1 mm Hg, and HCO3 3.5 mmol/L. Her metabolic panel was remarkable for hyponatremia (sodium 121 mmol/L, uncorrected for hyperglycemia and hyperlipidemia), hypochloremia (chloride 85 mmol/L), acidosis (bicarbonate 6 mmol/L) with an anion gap of 30 mmol/L, hyperglycemia (glucose 533 mg/dL), and acute kidney injury with a blood urea nitrogen 25 mg/dL and creatinine 1.51 mg/dL. Potassium level was normal (4.5 mmol/L). Triglycerides were 7,556 mg/dL (85.4 mmol/L). Due to concern for cerebral edema, an intravenous dose of mannitol (0.5 g/kg) was given that resulted in improvement in her neurological status. She became more alert, oriented, and interactive and quickly returned to her neurological baseline.
The patient was treated with appropriate fluid replacement and insulin infusion of 0.1 U/kg/h. She had an uneventful resolution of her electrolyte abnormalities and hyperglycemia and successfully transitioned to subcutaneous insulin after 24 h. Her triglyceride levels initially increased to 22,228 mg/dL (251.2 mmol/L) but then trended down to 4,876 mg/dL (55.1 mmol/L). She was allowed to have a low-fat diet and her triglyceride levels rebounded to 14,443 mg/dL (163.2 mmol/L). She was noted to have scattered yellow-tinged papules on her upper and lower extremities, which were diagnosed by dermatology as eruptive xanthomas in the setting of hypertriglyceridemia (). She was also found to have mild pancreatitis with a lipase level of 272 U/L (normal 11 - 82 U/L). Liver transaminase levels were normal. An abdominal ultrasound revealed hepatosplenomegaly that was thought to be resulting from acute systemic metabolic abnormalities.
Due to severe and worsening hypertriglyceridemia, she was placed back on insulin and glucose infusions with restricted oral intake. Lipid-lowering treatment was started with oral fenofibrate 54 mg daily and omega-3-acid ethyl esters 4 g daily. After 7 days her triglyceride level had decreased to 1,337 mg/dL (15.1 mmol/L) and she transitioned back to subcutaneous insulin and a low-fat diet. Her triglyceride levels remained stable for 2 days on that regimen. The fenofibrate was increased to 145 mg daily and the omega-3-acid ethyl esters were discontinued. She was discharged to home with a triglyceride level of 1,187 mg/dL (13.4 mmol/L). Her treatment course and triglyceride levels are presented in .
At follow-up in diabetes clinic one month later, her triglycerides were normal at 65 mg/dL (0.73 mmol/L). She was complaining of vague musculoskeletal and abdominal discomfort intermittently and, therefore, the fenofibrate treatment was discontinued with close follow-up with a lipid specialist.","What is the patient's corrected sodium concentration for hyperglycemia in terms of mEq/L? Use the sodium correction equation based on the one derived in Hillier, 1999. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Glucose': [533.0, 'mg/dL'], 'Sodium': [121.0, 'mmol/L']}",131.392,124.8224,137.9616,"The formula for Sodium Correction for Hyperglycemia based on Hiller, 1999 is Measured sodium + 0.024 * (Serum glucose - 100), where Measured Sodium is the sodium concentration in mEq/L and the Serum glucose is the concentration of glucose in mg/dL.
The concentration of sodium is 121.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 121.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 121.0 mmol * 1 mEq/mmol = 121.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 121.0 mmol sodium/L converts to 121.0 mEq sodium/L. 
The concentration of glucose is 533.0 mg/dL. 
Plugging in these values into the formula gives us 121.0 mEq/L + 0.024 * (533.0 - 100) = 131.392 mEq/L.
Hence, the patient's corrected concentration of sodium is 131.392 mEq/L."
376,26,Sodium Correction for Hyperglycemia,lab test,decimal,pmc-7374206-1,Extracted,"A 67-year-old male with a history of nonischemic cardiomyopathy, non-insulin–dependent diabetes mellitus, and hypertension presented with progressively worsening dyspnea and cough of three weeks duration. Two months prior to presentation, the patient had undergone cardiac resynchronization therapy-defibrillator (CRT-D) placement for nonischemic cardiomyopathy and left bundle branch block with a left ventricular ejection fraction of less than 35%. No operative complications were reported.
Vital signs were within normal limits (pulse: 84 beats per minute; blood pressure: 132/68 mmHg; temperature: 36.1°C; respiratory rate: 18; oxygen saturation: 94% on room air). Physical examination was significant only for bibasilar rales; no pericardial friction rub or elevated jugular venous pressure were appreciated, and there were no clinical signs or symptoms concerning for tamponade. Laboratory studies demonstrated hyponatremia (sodium: 123 mEq/L), hyperglycemia (glucose: 260 mg/dL), and normocytic anemia (hemoglobin: 11.0 g/dL, mean corpuscular volume: 86.7 fL). N-terminal pro b-type natriuretic peptide (NT-proBNP) was elevated to 239 pg/mL, which was near the patient's baseline. Serum potassium, bicarbonate, blood urea nitrogen, and creatinine were within normal limits. Electrocardiogram (ECG) showed an atrial-paced ventricular rhythm consistent with prior pacemaker placement. Two-view chest radiography revealed an enlarged cardiac silhouette, minimal bibasilar atelectasis, and appropriate placement of the pacemaker leads ().
The patient was started on a fluid restriction of 1500 milliliters per day for hyponatremia and suspected heart failure exacerbation. However, subsequent laboratory studies showed significant worsening of the hyponatremia; by the second hospital day, the patient's serum sodium had decreased from 123 to 119 mEq/L (corrected for hyperglycemia: 123 mEq/L). Further investigation revealed serum blood urea nitrogen of 12 mg/dl, serum glucose of 264 mg/dl, calculated serum osmolality of 256 mOsm/kg, urine osmolality of 310 mOsm/kg H2O, and urine sodium of 42 mEq/L. Hypothyroidism was ruled out with a thyroid-stimulating hormone of 2.340 μIU/mL.
An echocardiogram demonstrated a large circumferential pericardial effusion with right atrial collapse (). Left ventricular ejection fraction was estimated at 55% with normal diastolic function. Diastolic right ventricular collapse was absent. Echocardiographic features were consistent with early signs of cardiac tamponade. However, there were no clinical signs of tamponade and vital signs remained within normal limits.
An urgent pericardiocentesis was performed with removal of approximately 1200 milliliters of sanguineous fluid. A follow-up echocardiogram was obtained one day after the procedure and demonstrated complete resolution of the effusion (). Serum electrolytes were monitored and showed a gradual improvement of the hyponatremia; serum sodium had increased from 120 to 123 mEq/L on the first postoperative day and to 131 mEq within 36 hours of the procedure (). Calculated serum osmolality also increased to 278 mOsm/kg. Analysis of the pericardial fluid was negative for malignant cells and pathogens. Our patient's pericardial effusion was presumed to be secondary to his previous CRT-D placement. The patient was discharged home in stable condition on the third postoperative day. Outpatient follow-up four weeks later showed no recurrence of the pericardial effusion.","What is the patient's corrected sodium concentration for hyperglycemia in terms of mEq/L? Use the sodium correction equation based on the one derived in Hillier, 1999. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Glucose': [260.0, 'mg/dL'], 'Sodium': [123.0, 'mEq/L']}",126.84,120.498,133.182,"The formula for Sodium Correction for Hyperglycemia based on Hiller, 1999 is Measured sodium + 0.024 * (Serum glucose - 100), where Measured Sodium is the sodium concentration in mEq/L and the Serum glucose is the concentration of glucose in mg/dL.
The concentration of sodium is 123.0 mEq/L. 
The concentration of glucose is 260.0 mg/dL. 
Plugging in these values into the formula gives us 123.0 mEq/L + 0.024 * (260.0 - 100) = 126.84 mEq/L.
Hence, the patient's corrected concentration of sodium is 126.84 mEq/L."
377,26,Sodium Correction for Hyperglycemia,lab test,decimal,pmc-6549199-1,Extracted,"A 46-year-old man was admitted to the emergency department with complaints of fever and skin lesions in the right leg since 3 days before. Moreover, he revealed a history of 5 years of poorly controlled diabetes mellitus despite being on oral medication. On physical examination, he was oriented and the following vital signs were observed: blood pressure: 80/60 mmHg; pulse rate: 90 beats/min; respiratory rate: 18 breaths/min; and oral temperature: 38 °C.
Two large erythematous lesions with central necrosis in the upper segment of the right leg were noticed. Further examination revealed crepitation of the same right leg segment.
Laboratory findings revealed the following: white blood cell (WBC) count, 17,000/mm3; hemoglobin, 15 g/dl; sodium, 125 meq/l; potassium, 3.8 meq/l; blood glucose, 400 mg/dl; blood urea nitrogen, 45 mg/dl; creatinine, 2.4 mg/dl; and bicarbonate,13 meq/l.
Plain X-ray of right leg revealed gas formation in the soft tissues, which was a diagnostic criterion for necrotizing fasciitis (). The patient was treated immediately with intravenous fluid, broad spectrum empiric antibiotics (meropenem plus vancomycin), and insulin infusion; moreover, urgent surgical consultation was requested. He underwent emergency debridement within few hours of hospitalization.","What is the patient's corrected sodium concentration for hyperglycemia in terms of mEq/L? Use the sodium correction equation based on the one derived in Hillier, 1999. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Glucose': [400.0, 'mg/dL'], 'Sodium': [125.0, 'mEq/L']}",132.2,125.59,138.81,"The formula for Sodium Correction for Hyperglycemia based on Hiller, 1999 is Measured sodium + 0.024 * (Serum glucose - 100), where Measured Sodium is the sodium concentration in mEq/L and the Serum glucose is the concentration of glucose in mg/dL.
The concentration of sodium is 125.0 mEq/L. 
The concentration of glucose is 400.0 mg/dL. 
Plugging in these values into the formula gives us 125.0 mEq/L + 0.024 * (400.0 - 100) = 132.2 mEq/L.
Hence, the patient's corrected concentration of sodium is 132.2 mEq/L."
378,26,Sodium Correction for Hyperglycemia,lab test,decimal,pmc-7410512-1,Extracted,"A 66-year-old African American male with a past medical history of hypertension, alcohol use, and asthma presented with facial swelling. He was discharged two months prior for a similar event related to lisinopril. On initial presentation, the patient's vitals were significant for heart rate of 104 beats per minute, respiratory rate of 30 breaths per minute, blood pressure of 190/100 mmHg, and oxygen saturation of 99% with a non-rebreather mask at 15 liters. Physical exam was significant for moderate to severe respiratory distress, inspiratory stridor, and subcostal and intercostal retractions. Lungs were clear to auscultation. The patient was otherwise alert and oriented. Arterial blood gas showed pH 7.447, pCO2 39, pO2 197, and HCO3 27 on 60% FiO2. His initial metabolic panel was significant for sodium 104 mmol/L, potassium 2.6 mmol/L, chloride 66 mmol/L, blood urea nitrogen (BUN) 5 mg/dL (baseline 20 mg/dL), and creatinine 0.6 mg/dL (baseline 1.0 mg/dL). Glucose was 165 mg/dL. Magnesium and phosphorus were 1.1 and 2.1 mg/dL, respectively. Serum uric acid was low at 2.7 mg/dL. Complete blood count showed no leukocytosis or anemia. Urinalysis had a specific gravity of 1.010, moderate blood, and 15-29 red blood cells. Urine electrolytes were notable for a sodium of 48 mmol/L and osmolality of 217 mOsm/kg. Serum osmolality was 215 mOsm/kg. Urine and serum toxicology were negative for any substances. Alcohol level was negative.
Due to concern for airway protection, the patient was intubated and admitted to the intensive care unit. Initial chest x-ray held concern for infectious process, but antibiotics were stopped after infectious workup was negative. The patient was given two units of fresh-frozen plasma, famotidine, and Benadryl, and started on methylprednisolone 60 mg every six hours for angioedema. Lisinopril was held at this time. For his hyponatremia, the patient's labs were suspicious for syndrome of inappropriate antidiuretic hormone (SIADH) and a one-liter fluid restriction was initiated with nephrology consult. Thyroid and adrenal workup to rule out other causes of SIADH was unremarkable. A CT chest scan was done to evaluate for malignancy as a cause of SIADH, but did not demonstrate overt suspicious lung pathology (Figure ). The patient's hyponatremia appropriately corrected over the course of one week and was 130 mmol/L upon discharge. Lisinopril was discontinued and marked as an allergy for the patient. On follow-up approximately nine months later, the patient's sodium had corrected and remained within normal limits.","What is the patient's corrected sodium concentration for hyperglycemia in terms of mEq/L? Use the sodium correction equation based on the one derived in Hillier, 1999. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Sodium': [104.0, 'mmol/L'], 'Glucose': [165.0, 'mg/dL']}",105.56,100.282,110.838,"The formula for Sodium Correction for Hyperglycemia based on Hiller, 1999 is Measured sodium + 0.024 * (Serum glucose - 100), where Measured Sodium is the sodium concentration in mEq/L and the Serum glucose is the concentration of glucose in mg/dL.
The concentration of sodium is 104.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 104.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 104.0 mmol * 1 mEq/mmol = 104.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 104.0 mmol sodium/L converts to 104.0 mEq sodium/L. 
The concentration of glucose is 165.0 mg/dL. 
Plugging in these values into the formula gives us 104.0 mEq/L + 0.024 * (165.0 - 100) = 105.56 mEq/L.
Hence, the patient's corrected concentration of sodium is 105.56 mEq/L."
379,26,Sodium Correction for Hyperglycemia,lab test,decimal,pmc-8675592-1,Extracted,"A 54-year-old Caucasian female, without significant past medical history, unvaccinated for COVID-19 presented with shortness of breath, cough, myalgias, nausea, vomiting, diarrhea, and fevers a week starting with headache. Upon initial evaluation in the emergency room, vital signs were as follows: blood pressure (BP) was 115/77 mmHg, heart rate (HR) was 103 beats per minute (bpm), temperature was 99.0°F, and oxygen saturation was 84% on room air. Lab work showed nasopharyngeal swab positive for SARS-CoV-2, elevated D-dimer (772 ng/mL), elevated international normalized ratio (INR) (1.3), hyperglycemia (117 mg/dL), hyponatremia (130 mmol/L), hypokalemia (3.3 mmol/L), hypochloremia (91 mmol/L), elevated liver enzymes (aspartate aminotransferase {AST}: 157 U/L, alanine aminotransferase {ALT}: 87 U/L), elevated N-terminal pro b-type natriuretic peptide (NT-proBNP) (508 pg/mL), and elevated troponin (13 ng/L). Chest x-ray showed bilateral infiltrates. CT chest with contrast showed bilateral pneumonia. The patient was admitted to the telemetry unit and started on ceftriaxone, azithromycin, dexamethasone, and remdesivir. Initial EKG on admission showed sinus tachycardia and left axis deviation with HR of 101 bpm (Figure ). After three days of remdesivir, EKG was repeated and showed sinus bradycardia with nonspecific intraventricular conduction delay, with HR of 57 bpm (Figure ). Third day after discontinuing remdesivir, the patient developed a transient arrhythmia noted on telemetry which resolved within a few seconds. This prompted nurse to get an EKG which showed normal sinus rhythm (Figure ). Potassium levels were low initially and after repletion potassium normalized on day two of hospital stay. Magnesium levels were normal throughout the hospital stay.","What is the patient's corrected sodium concentration for hyperglycemia in terms of mEq/L? Use the sodium correction equation based on the one derived in Hillier, 1999. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Glucose': [117.0, 'mg/dL'], 'Sodium': [130.0, 'mmol/L']}",130.408,123.8876,136.9284,"The formula for Sodium Correction for Hyperglycemia based on Hiller, 1999 is Measured sodium + 0.024 * (Serum glucose - 100), where Measured Sodium is the sodium concentration in mEq/L and the Serum glucose is the concentration of glucose in mg/dL.
The concentration of sodium is 130.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 130.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 130.0 mmol * 1 mEq/mmol = 130.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 130.0 mmol sodium/L converts to 130.0 mEq sodium/L. 
The concentration of glucose is 117.0 mg/dL. 
Plugging in these values into the formula gives us 130.0 mEq/L + 0.024 * (117.0 - 100) = 130.408 mEq/L.
Hence, the patient's corrected concentration of sodium is 130.408 mEq/L."
380,26,Sodium Correction for Hyperglycemia,lab test,decimal,pmc-2860402-1,Extracted,"A 44-year-old Bangladeshi male was admitted to Hamad General Hospital on 31 December 2004 with progressive shortness of breath, fever, and productive cough with yellowish sputum of four days duration. His past history was remarkable for chronic obstructive pulmonary disease (COPD), secondary polycythemia, pulmonary hypertension, and old pulmonary tuberculosis. He was maintained on salbutamol inhaler, fluticasone, and salmetrol discus inhaler, theophylline and home oxygen therapy. He denied receiving systemic corticosteroids in the preceding year. He was an ex-smoker and alcohol drinker. Physical examination on admission revealed an ill looking, dyspneic patient with a temperature 38.4°C, blood pressure 135/90 mm Hg, pulse rate 160/minute, and respiratory rate 36/minute. Chest examination revealed expiratory wheezes and bilateral basal crepitations. Otherwise, physical examination was unremarkable. Laboratory investigations revealed hemoglobin 13 mg/dL, white blood cell count (WBC) 14.6×109 /L (neutrophils 82%, lymphocytes 10%), platelets 25×109 /L, glucose 11.4 mmol/L, creatinine 135 mmol/L, sodium 129 mmol/L, potassium 3.8 mmol/L. Arterial blood gases revealed pH 7.19, PCO2 74.8 mm Hg, PO2 96 mm Hg. Chest radiograph showed no lung infiltrates. Sputum culture grew Pseudomonas aeruginosa, sensitive to cefipime and ciprofloxacin; however, it was thought to represent colonization. A diagnosis of COPD with acute exacerbation was made, for which he was given intravenous ceftriaxone 2 gm once daily, azithromycin 500 mg once daily, methylprednisolone 40 mg three times daily, and salbutamol and ipratropium bromide nebulizers. He made a gradual improvement, and after seven days he was shifted to oral prednisolone 40 mg once daily and oral amoxicillin/clavulanic acid to complete two weeks of antibiotics. Prednisolone was given for a total of 13 days. Three weeks after admission he developed hemoptysis, chest tightness, and worsening cough. Sputum culture grew P aeruginosa for which he was given intravenous cefepime and ciprofloxacin. Sputum smear for acid fast bacilli (AFB) was negative. Because of worsening respiratory status and a chest radiograph showing an infiltrate involving the whole left lung and part of the right lung, bronchoscopy was performed on 27 January 2005. No endobronchial lesion was found. Antituberculous drugs in the form of isoniazid, rifampin, pyrazinamide, and ethambutol were started. Bronchioalveolar lavage and bronchial wash were negative for AFB but bacterial culture grew P aeruginosa, Escherichia coli, and Klebisella pneumoniae. Cytologic examination of the bronchial wash and lavage revealed bronchial epithelial cells, few squamous cells in the background of numerous S stercoralis worms () and bacteria with inflammatory cells and blood. Transbronchial biopsy showed only intraalveolar hemorrhage with anthracotic pigments, but was negative for granuloma, viral inclusions, or malignancy. He was treated with oral ivermectin 12mg once daily. Two days later he complained of vomiting, lower abdominal pain, abdominal distention, and constipation. Physical examination revealed abdominal distention, lower abdominal tenderness, and sluggish bowel sounds. A plain radiograph of the abdomen revealed distended bowel loops but no air fluid levels. Lapratomy was done. The findings at surgery were a dilated jejunum and ileum filled with stool. Microscopic examination of the resected part of the ileum bowel revealed acute inflammation, mucosal hemorrhage, and focal ulceration with abundant S stercoralis larvae (Figures and ). Postoperatively, he was mechanically ventilated. His postoperative course was complicated by hypotension and multiorgan failure and he expired after two days.","What is the patient's corrected sodium concentration for hyperglycemia in terms of mEq/L? Use the sodium correction equation based on the one derived in Hillier, 1999. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Sodium': [129.0, 'mmol/L'], 'Glucose': [11.4, 'mmol/L']}",131.52917,124.95271,138.10563,"The formula for Sodium Correction for Hyperglycemia based on Hiller, 1999 is Measured sodium + 0.024 * (Serum glucose - 100), where Measured Sodium is the sodium concentration in mEq/L and the Serum glucose is the concentration of glucose in mg/dL.
The concentration of sodium is 129.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 129.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 129.0 mmol * 1 mEq/mmol = 129.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 129.0 mmol sodium/L converts to 129.0 mEq sodium/L. 
The concentration of glucose is 11.4 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of glucose from mmol to mg. The mass of glucose is 11.4 mmol. To convert 11.4 mmol of glucose to mol, multiply by the conversion factor 0.001, giving us 11.4 mmol glucose * 0.001 mol/mmol = 0.0114 mol glucose. To convert from mol glucose to grams, multiply by the molar mass 180.16 g/mol, which will give 0.0114 mol glucose * 180.16 g/mol = 2.05382 g glucose. To convert 2.05382 g of glucose to mg, multiply by the conversion factor 1000.0, giving us 2.05382 g glucose * 1000.0 mg/g = 2053.82 mg glucose. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 2053.82 mg glucose/10.0 dL = 205.382 mg glucose/dL. The concentration value of 11.4 mmol glucose/L converts to 205.382 mg glucose/dL. 
Plugging in these values into the formula gives us 129.0 mEq/L + 0.024 * (205.382 - 100) = 131.52917 mEq/L.
Hence, the patient's corrected concentration of sodium is 131.52917 mEq/L."
381,26,Sodium Correction for Hyperglycemia,lab test,decimal,pmc-7402551-1,Extracted,"A 50-year-old male with history of type I diabetes mellitus presented with nausea, non-bloody emesis, and diffuse abdominal pain. He was not able to take insulin for a week as he ran out of his prescriptions. Vital signs revealed a heart rate of 120 beats per minute, blood pressure of 127/85 mmHg, and the patient was afebrile with normal oxygen saturation (SaO2) of 95% on room air. Abdominal examination revealed generalized tenderness and dry mucous membranes. Initial blood work revealed a white cell count of 24 k/mcL and hemoglobin and hematocrit of 19 g/dl and 53%, respectively, suggesting severe hemoconcentration. Comprehensive metabolic panel showed a blood glucose of 425 mg/dl, the anion gap was elevated at 27 and serum sodium was 127 meq/L with a remarkably elevated calcium of 17.3 mg/dl (normal range 8.5 to 10.5 mg/dl) and serum phosphorous level of 5.9 mmol/L (normal range 2.5 to 4.5 mmol/L). Serum bicarbonate was decreased at 20 meq/L, beta-hydroxybutyrate was elevated at 4.96 mmol/L (normal range of 0.02 to 0.27 mmol/L) and serum potassium level was normal. This combination of laboratory findings suggested a diagnosis of DKA. A thorough infectious workup to evaluate the cause of DKA was unremarkable. An electrocardiogram (ECG) was done which revealed ST-segment elevation in leads V2-V4 and avL with J-point elevations, no reciprocal ST-T wave changes, and normal QTc interval of 440 milliseconds (normal QT interval range 400 to 440 milliseconds) (Figure ).
These EKG changes were thought to be due to high calcium level as the patient denied any ischemic symptoms and cardiac troponin was minimally elevated at 0.04 ng/ml (reference range of acute myocardial infarction greater than 0.11 ng/ml). Transthoracic echocardiogram suggested a normal cardiac function. The patient was started on intravenous crystalloid boluses of normal saline with a regular insulin drip. Close monitoring of the basal metabolic panel including calcium level was performed. On day two of admission, patients anion gap close to 10 and he was bridged to multiple daily insulin injections. Serum calcium levels trended down to a normal level of 9.5 mg/dl with the resolution of DKA. An extensive workup to evaluate the cause of hypercalcemia was non-revealing. Random urine calcium levels were appropriately elevated at > 17.8 mg/dL while urinalysis showed glucosuria and ketonuria but was otherwise unremarkable. The serum parathyroid hormone was decreased at 5 pg/ml (reference range of 8-54 pg/ml) suggesting a parathyroid independent process, vitamin D, 1,25-dihydroxy was decreased at 17.3 pg/ml (reference range of 19.9-84 pg/ml) and parathyroid hormone-related peptide was normal. In addition, the patient denied taking vitamin D or calcium supplements at home. CT of chest, abdomen, and pelvis was normal excluding malignancy as the cause of hypercalcemia. As a result, the likely cause of this hypercalcemia was attributed to severe DKA and dehydration which corrected with hydration and treatment of DKA. Although the patient was given a dose of zoledronic acid but the calcium corrected before the effects of bisphosphonates could be seen (normally after 48 hours of administration). Due to the rapid correction of serum calcium level back to normal, other medical management (including calcitonin or diuretics) was not warranted. ECG changes also reverted back to normal with the correction of serum calcium levels (Figure ).","What is the patient's corrected sodium concentration for hyperglycemia in terms of mEq/L? Use the sodium correction equation based on the one derived in Hillier, 1999. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Glucose': [425.0, 'mg/dL'], 'Sodium': [127.0, 'mEq/L']}",134.8,128.06,141.54,"The formula for Sodium Correction for Hyperglycemia based on Hiller, 1999 is Measured sodium + 0.024 * (Serum glucose - 100), where Measured Sodium is the sodium concentration in mEq/L and the Serum glucose is the concentration of glucose in mg/dL.
The concentration of sodium is 127.0 mEq/L. 
The concentration of glucose is 425.0 mg/dL. 
Plugging in these values into the formula gives us 127.0 mEq/L + 0.024 * (425.0 - 100) = 134.8 mEq/L.
Hence, the patient's corrected concentration of sodium is 134.8 mEq/L."
382,26,Sodium Correction for Hyperglycemia,lab test,decimal,pmc-7934795-1,Extracted,"A 36-year-old previously healthy man presented to the emergency room with acute onset abnormal movements involving face and upper limbs for 10 days and gradually developing altered sensorium for last 6 hours. He was hospitalized in a rural health facility where his clinical picture was initially considered as due to prolonged seizure activity for which he received multiple anti-epileptic drugs. As he was progressively deteriorating, he was referred to a tertiary center. As per the caregiver’s description and medical records received from the previous hospital, he was having abnormal, involuntary, rapid, brief and jerky movements involving face and upper limbs (predominantly right sided). Although there was no history of headache, fever, vomiting, and any focal weakness, the patient had significant involuntary weight loss in last 4 months. Family history and drug history were non-contributory.
Clinical examination revealed the patient was drowsy, dehydrated, cachectic, afebrile, tachycardic (130/min), normotensive (100/60 mmHg) and tachypneic (36/min). He had faciobrachial myoclonic jerks with asymmetric involvement of right upper limb more than left upper limb (distal more than proximal), with tonic neck deviation to left side withoutany abnormal movement of bilateral lower limbs (). The myoclonic jerks were not associated with any external cues or voluntary action. The tone and deep tendon reflexes of upper limbs could not be assessed due to persistent abnormal involuntary movements. The tone and deep tendon reflexes of lower limbs were normal; the plantar reflexes were flexor. Complete assessment of cranial nerves, sensory, cerebellar and autonomic functions could not be done. There was no sign of meningeal irritation and papilledema.
Acute onset multifocal myoclonus associated with encephalopathy with a background of addiction and recent onset progressive involuntary weight loss had narrowed the differential diagnoses to toxic-metabolic and neuro-infectious etiologies. Bedside CBG was measured immediately and was found to be 695 mg/dL (normal, <200). Arterial blood gas (ABG) analysis revealed metabolic acidosis (pH- 7.28 [normal, 7.35–7.45], HCO3- -18 mEq/L [normal, 22–26], Na+- 117 mEq/L [normal, 135–145] [131 mEq/L when corrected for hyperglycemia], anion gap- 18 mmol/L (normal<12), with normal serum osmolality, pO2, pCO2, K+, and ionic Ca2+). Urine examination showed glycosuria (3+) and ketonuria (2+); plasma beta-hydroxy-butyrate level was found to be 3.6mmol/L (normal, <1.5). Thus, a diagnosis of DKA was confirmed. Adequate hydration was ensured with normal saline followed by treatment with continuous intravenous regular insulin (at a rate of 8 IU/h)., Once CBG came down to less than 400 mg/dL, approximately 3 h after therapy, all movements disappeared. His metabolic derangements were completely corrected by next 2 days and CBG was fairly controlled with basal-bolus regimen.
After stabilization he had absolutely normal hemodynamic and hydration status. Detailed neurological and other systemic examinations were within normal limits. His HbA1c was 10.62% (normal, <5.6), fasting and post-prandial blood glucose were 137 mg/dL (normal, <100) and 250 mg/dL (normal, <140) respectively. C peptide level was low [0.1 ng/ml (normal, 0.5–2.7)] with positive anti-glutamic acid decarboxylase (GAD)-65 antibodies that established the diagnosis of T1DM. The patient’s oropharyngeal swab test for SARS-CoV-2, by qualitative real-time reverse-transcriptase–polymerase-chain-reaction assay, was negative.
All other tests of the metabolic panel (complete hemogram, lipid profile, renal, liver, thyroid function tests) were within normal limits. Autoimmune and paraneoplastic encephalitis profile [anti-nuclear antibodies, anti-thyroid antibodies, antibodies against leucine-rich glioma-inactivated 1 (anti-LGl1), contactin-associated protein-like 2 (Caspr2), and N-methyl-D-aspartate receptor (NMDA-R)] were negative. Serological tests for HIV 1&2, and hepatitis B and C were negative. Brain magnetic resonance imaging (MRI), interictal electroencephalogram (EEG), and cerebrospinal fluid analysis were normal. The rest of his hospital stay was uneventful and did not have any recurrence of involuntary movements during a 2-month follow-up.","What is the patient's corrected sodium concentration for hyperglycemia in terms of mEq/L? Use the sodium correction equation based on the one derived in Hillier, 1999. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Glucose': [695.0, 'mg/dL'], 'Sodium': [117.0, 'mEq/L']}",131.28,124.716,137.844,"The formula for Sodium Correction for Hyperglycemia based on Hiller, 1999 is Measured sodium + 0.024 * (Serum glucose - 100), where Measured Sodium is the sodium concentration in mEq/L and the Serum glucose is the concentration of glucose in mg/dL.
The concentration of sodium is 117.0 mEq/L. 
The concentration of glucose is 695.0 mg/dL. 
Plugging in these values into the formula gives us 117.0 mEq/L + 0.024 * (695.0 - 100) = 131.28 mEq/L.
Hence, the patient's corrected concentration of sodium is 131.28 mEq/L."
383,26,Sodium Correction for Hyperglycemia,lab test,decimal,pmc-8601313-1,Extracted,"A 52-year-old man with a history of alcohol-induced acute pancreatitis and diabetes mellitus was transferred to our hospital for treatment of sepsis and multiorgan failure associated with emphysematous pancreatitis.
A day earlier, the patient was admitted to an outside hospital with fever and severe abdominal pain. Based on an abdominal computed tomography (CT) scan and laboratory findings, the patient was diagnosed with sepsis and multiorgan failure associated with emphysematous pancreatitis and subsequently transferred to our hospital for treatment.
The patient had a history of alcohol-induced acute pancreatitis event 2 years ago. He was also taking medications for diabetes and hypertension.
The patient was an alcohol abuser, but not a smoker. There was no significant medical history in the family.
On arrival, the patient was receiving inotropic agents and had a body temperature of 36.5°C, heart rate of 120 beats/min, and blood pressure of 80/50 mm Hg. The patient's mental status was confused. Physical examination revealed a rigid and distended abdomen, severe tenderness with muscle guarding upon palpation, and tympanic sounds with percussion. The examination was otherwise unremarkable.
The results of the complete blood count test were as follows: white blood cell count, 8.1 × 103/L; red blood cell count, 3.22 × 106/L; hemoglobin, 9.1 g/dL; platelet count, 263 × 103/L and prothrombin time (INR), 1.49 (reference range 0.8–1.12). Blood chemistry testing revealed the following data: serum blood urea nitrogen, 42.0 mg/dL (reference range 6–20 mg/dL); serum creatinine, 3.46 mg/dL (reference range 0.5–1.2 mg/dL); high-sensitivity C-reactive protein, 36.12 mg/dL (reference range 0–0.3 mg/dL); serum glucose, 378 mg/dL (reference range 70–99 mg/dL); serum ketone body, 266.30 nmol/mL (reference range 0–120 nmol/mL); serum aspartate aminotransferase, 33 IU/L (reference range 8–40 IU/L); serum alanine aminotransferase, 12 IU/L (reference range 5–41 IU/L); serum amylase, 57 IU/L (reference range 41–134 IU/L); serum sodium, 125 mEq/L (reference range 136–145 mEq/L); and serum potassium, 3.9 mEq/L (reference range 3.5–5.1 mEq/L).
An axial CT scan revealed extensive gas bubbles in and around the pancreatic necrosis (Fig. A) and in the mesenteric root and left anterior pararenal space. A coronal CT scan also revealed scattered gas bubbles along with the mesenteric root and fat (Fig. B). A sagittal CT scan showed better visualization of the extensive gas in the left anterior pararenal space (Fig. C).
A Gastrografin swallow study conducted to rule out perforations did not demonstrate any leakage. Upper endoscopy also revealed no evidence of gastroduodenal lesions, such as ulcers or perforations.
Culture of the pus obtained from the catheter drainage grew Escherichia coli. An antibiotic susceptibility test demonstrated that the microorganism was sensitive to aztreonam, cefepime, cefotaxime, cefoxitin, ceftazidime, cefuroxime, chloramphenicol, colistin, ertapenem, and fosfomycin but resistant to ampicillin, ciprofloxacin, gentamicin, piperacillin, and tetracycline.","What is the patient's corrected sodium concentration for hyperglycemia in terms of mEq/L? Use the sodium correction equation based on the one derived in Hillier, 1999. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Glucose': [378.0, 'mg/dL'], 'Sodium': [125.0, 'mEq/L']}",131.672,125.0884,138.2556,"The formula for Sodium Correction for Hyperglycemia based on Hiller, 1999 is Measured sodium + 0.024 * (Serum glucose - 100), where Measured Sodium is the sodium concentration in mEq/L and the Serum glucose is the concentration of glucose in mg/dL.
The concentration of sodium is 125.0 mEq/L. 
The concentration of glucose is 378.0 mg/dL. 
Plugging in these values into the formula gives us 125.0 mEq/L + 0.024 * (378.0 - 100) = 131.672 mEq/L.
Hence, the patient's corrected concentration of sodium is 131.672 mEq/L."
384,26,Sodium Correction for Hyperglycemia,lab test,decimal,pmc-6559115-1,Extracted,"A 35-year-old gentleman presented with complaints of diffuse pain abdomen and shortness of breath of 1 day duration associated with drowsiness of 4 hours duration. Patient was a known case of Type 1 Diabetes Mellitus on Injection Mixtard (70:30) 45 units/day and he had missed his insulin for last 5 days. On presentation, his Glasgow coma scale was E1V2M4, systolic blood pressure was 70 mm of Hg with feeble pulse, respiratory rate of 36 per minute, blood sugar of 490 mg/dL, and serum ketones of 5.6 with calculated serum osmolality of 308.68 mosm/L. Blood gas analysis showed pH of 6.785, bicarbonate 4.3 meq/dL, anion gap of 8.7 and lactate of 0.16 mmol/L []. On chest radiography, there was consolidation in the left lung field. Computed tomography of head showed cerebral edema. His other investigations showed serum sodium of 137 mmol/L, potassium 4.4 mmol/L and chloride 124 mmol/L, blood urea 54 mg/dL, serum creatinine 1.2 mg/dL with urine output of 1.6 litres in first 24 hours. His haemoglobin was 12.5 g/dL, total leucocyte count of 4600 per mm3 and platelet count 103000 per mm3. Patient was started on treatment with normal saline at initial rate of 15-25 ml/kg/h and regular insulin at 0.1 U/kg/hour. Later on, intravenous antibiotics were added in view of consolidation. His urine routine examination, urine culture sensitivity, blood culture sensitivity were normal. Vasopressors were added (nor adrenaline, adrenaline and vasopressin) because of persistent shock, he was put on mechanical ventilation due to persistent altered sensorium and respiratory failure. Due to severe metabolic acidosis, he was given intravenous bicarbonate of 260 Meq in the initial 24 hours. However, his metabolic acidosis and shock persisted, so, he was started on peritoneal dialysis. After 12 hours of peritoneal dialysis, his arterial blood pH improved to 7.118 with bicarbonate of 15.1 meq/dl. So his peritoneal dialysis was continued and his arterial blood pH improved to 7.311 with bicarbonate of 14.0 meq/dL after 36 hours. His peritoneal dialysis was given for total of 80 cycles. Vasopressors were tapered off and he was subsequently extubated on day 5 of admission. Patient required 4 more cycles of haemodialysis for persistent oliguria with rising serum creatinine levels – which was probably due to persistent shock related acute cortical necrosis. He was discharged on day 16 of illness.","What is the patient's corrected sodium concentration for hyperglycemia in terms of mEq/L? Use the sodium correction equation based on the one derived in Hillier, 1999. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Glucose': [490.0, 'mg/dL'], 'Sodium': [137.0, 'mmol/L']}",146.36,139.042,153.678,"The formula for Sodium Correction for Hyperglycemia based on Hiller, 1999 is Measured sodium + 0.024 * (Serum glucose - 100), where Measured Sodium is the sodium concentration in mEq/L and the Serum glucose is the concentration of glucose in mg/dL.
The concentration of sodium is 137.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 137.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 137.0 mmol * 1 mEq/mmol = 137.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 137.0 mmol sodium/L converts to 137.0 mEq sodium/L. 
The concentration of glucose is 490.0 mg/dL. 
Plugging in these values into the formula gives us 137.0 mEq/L + 0.024 * (490.0 - 100) = 146.36 mEq/L.
Hence, the patient's corrected concentration of sodium is 146.36 mEq/L."
385,26,Sodium Correction for Hyperglycemia,lab test,decimal,pmc-6096929-1,Extracted,"In April 2017, a 72-year-old homeless male patient was admitted to the emergency department at the Ramos Mejia Hospital, Ciudad Autónoma de Buenos Aires, Argentina. The patient was in very poor hygienic condition, malnourished and dehydrated. He presented a deep necrotic ulcer in the anterior aspect of his left tibia of 9-months’ evolution, with exposure of both tibia and fibula, complete loss of muscle mass, severe ischaemia, foul discharge and heavy burden myiasis. Unfortunately, maggots had been rapidly discarded, allowing neither bacterial analysis nor entomological identification.
The patient had a history of alcohol abuse and pulmonar tuberculosis in 1980 which resolved after complete treatment.
On physical examination, his blood pressure was 100/60 mmHg, his heart rate 97 and his respiratory rate 20 breaths min−1. His body temperature was 36 °C. Haematological and biochemical exams on admission showed: leucocytes 24750 K µl−1, with 92.5 % neutrophils; glucose level of 237 mg dl−1, haematocrit 40 %, haemoglobin 13.3 g dl−1, uraemia 126 mg dl−1, creatinine 2017 mg dl−1; sodium 127 mmol l−1; potassium 5.5 mmol l−1; chloride 87 mmol l−1.
Two blood culture sets were taken at the time of admission, at two different times. Gram-negative rods were obtained in pure culture. With this preliminary report, the case was described as sepsis caused by skin and soft tissue infection. Intravenous therapy with ciprofloxacin 400 mg/12 h and clindamicin 600 mg/12 h was initiated.
Conventional phenotypic test and MALDI-TOF-MS (Bruker Daltonics) failed to identify the bacteria isolated.
In order to confirm genus and species identification, PCR amplification of the 16S rRNA was performed. The nearly complete sequence of the 16S rRNA gene was amplified by PCR with the conserved primers 8F (5′-AGAGTTTGATYMTGGCTCAG-3′) and 1942R (5′-ACCTTGTTACGACTT-3′), as described previously []. The sequence obtained showed a 100 % identity with the sequence corresponding to the 16S RNA ribosomal gene of I. indica, type strain FFA1 (GenBank accession number. EU008088.2). The 16S rRNA sequence obtained was deposited in GenBank under number MF062521.
Due to the severity of the lesions, a supracondylar amputation had to be performed in order to allow for adequate and prompt infection source control, and antibiotic treatment for 14 days was completed, which led to resolution of sepsis and normalization of laboratory parameters. The patient had a favourable outcome, with no surgical complications.
Members of the genus Ignatzschineria are difficult to identify using traditional methods, including classical biochemical tests and commercial bacterial identification systems. Even MALDI-TOF MS analysis has been unsuccessful. 16S ARNr gene sequencing has proved to be useful for identification, and is currently the most accurate method for clinical diagnostic laboratories.","What is the patient's corrected sodium concentration for hyperglycemia in terms of mEq/L? Use the sodium correction equation based on the one derived in Hillier, 1999. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'Glucose': [237.0, 'mg/dL'], 'Sodium': [127.0, 'mmol/L']}",130.288,123.7736,136.8024,"The formula for Sodium Correction for Hyperglycemia based on Hiller, 1999 is Measured sodium + 0.024 * (Serum glucose - 100), where Measured Sodium is the sodium concentration in mEq/L and the Serum glucose is the concentration of glucose in mg/dL.
The concentration of sodium is 127.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 127.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 127.0 mmol * 1 mEq/mmol = 127.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 127.0 mmol sodium/L converts to 127.0 mEq sodium/L. 
The concentration of glucose is 237.0 mg/dL. 
Plugging in these values into the formula gives us 127.0 mEq/L + 0.024 * (237.0 - 100) = 130.288 mEq/L.
Hence, the patient's corrected concentration of sodium is 130.288 mEq/L."
386,27,Glasgow-Blatchford Bleeding Score (GBS),risk,integer,pmc-6518441-1,Extracted,"A 57 year old female from Sindhuli, Nepal, with no known medical comorbidities other than smoking, presented to the emergency department with two episodes of hematemesis over 24 hours. She had a 4-month history of dyspepsia, melena and fatigability. On physical exam, she was pale, blood pressure was 90/50 mm Hg with a heart rate of 130 beats per minute. Other examinations, including abdominal exam, were unremarkable. She was resuscitated with intravenous fluids and packed cell transfusion.
Laboratory parameters with normal ranges in parenthesis, are as follow:
Complete blood count before transfusion: white cell count 7.9 (4–10) × 10
9/L; neutrophils 70%; lymphocytes 26%; monocytes 4%; red blood cells 2.8 (4.2–5.4) × 10
12/L; haemoglobin 9 (12–15) g/dL; platelets 295 (150–400) × 10
9/L.
Biochemistry: random blood sugar 124 (65–110) mg/dL; blood urea nitrogen 49 (17–45) mg/dL; creatinine 0.9 (0.8–1.3) mg/dL; sodium 140 (135–145) mmol/L and potassium 4 (3.5–5) mmol/L.
Hepatic panel: bilirubin total 1 (0.1–1.2) mg/dL and direct 0.6 (0–0.4) mg/dL; alanine transaminase 35 (5–30) units/L; aspartate transaminase 40 (5–30) units/L; alkaline phosphatase 98 (50–100) IU/L; albumin 3.5 (3.5–5) g/dL
After stabilization, she underwent upper gastrointestinal endoscopy the same day which revealed an ulcer (10 mm × 6 mm) in lesser curvature of the stomach without active bleeding. The provisional diagnosis was gastric ulcer due to
H. pylori infection. The main differential diagnosis was gastric carcinoma, hence biopsy was taken from the ulcer.
She was started on triple therapy regimen empirically for
H. pylori eradication containing clarithromycin 500 mg, amoxicillin 1 gm and pantoprazole 40 mg twice daily for 14 days, and discharged. When she returned for follow-up, the histopathology showed fungi with broad ribbon like morphology, fruiting bodies consistent with mucor in the ulcer, as well as in granulation tissue but no necrosis or vascular thrombi (
). It was also positive for
H. pylori in Giemsa staining. She was diagnosed with gastric mucormycosis with
H. pylori coinfection. But the confirmation of mucormycosis via culture or molecular tests could not be done because of unavailability of these tests in our facility. The abdominal imaging was not done because there was no evidence of invasive form of the disease in histopathology.
She was readmitted and started on liposomal amphotericin B, 5 mg/kg on the first day followed by 10 mg/kg for the next 13 days. She completed a total of 2 weeks of therapy without any complication. She had no dyspepsia, melena or hematemesis by then. She was then discharged with posaconazole 300 mg once daily, as an oral step-down therapy. However the blood level of posaconazole to ensure the therapeutic level was not tested due to its unavailability in resource- limited setup in Nepal.
On repeat follow up in 1 month, she was asymptomatic. Repeat endoscopy showed a healing ulcer in lesser curvature of stomach. Repeat biopsy showed absence of fungal hyphae. She took posaconazole for total 2 months and stopped the medicine due to financial constraints. She was doing well when she was last followed up 4 months later.",What is the patient's Glasgow-Blatchford Bleeding score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [130, 'beats per minute'], 'Blood Urea Nitrogen (BUN)': [49, 'mg/dL'], 'sex': 'Female', 'Hemoglobin': [9, 'g/dL'], 'Melena present': True, 'Systolic Blood Pressure': [90, 'mm Hg']}",14,14,14,"The criteria for the Glasgow-Blatchford Score are listed below:

1. BUN (mg/dL): <18.2 = 0 points, 18.2-22.3 = +2 points, 22.4-28 = +3 points, 28-70 = +4 points, >70 = +6 points
2. Hemoglobin (g/dL) for men: >=13 = 0 points, <=12-13 = +1 point, <=10-12 = +3 points, <10 = +6 points
3. Hemoglobin (g/dL) for women: >=12 = 0 points, <=10-12 = +1 point, <10 = +6 points
4. Systolic blood pressure (mm Hg): ≥110 = 0 points, 100-109 = +1 point, 90-99 = +2 points, <90 = +3 points
5. Pulse ≥100 (per minute): No = 0 points, Yes = +1 point
6. Melena present: No = 0 points, Yes = +1 point
7. Presentation with syncope: No = 0 points, Yes = +1 point
8. Liver disease history: No = 0 points, Yes = +1 point
9. Cardiac failure present: No = 0 points, Yes = +1 point

The total Glasgow-Blatchford Score is calculated by summing the points for each criterion.
The current glasgow bleeding score is 0. The patient's gender is Female.
The concentration of hemoglobin is 9 g/dL. Because the patient is a female and her hemoglobin concentration is less than 10 mg/dL, we add six points, making the current score 0 + 6 = 6.
The concentration of BUN is 49 mg/dL. The BUN concentration is between 28 and 70 mg/dL, and so we add four points, making the current score 6 + 4 = 10.
The patient's blood pressure is 90 mm Hg. Because the patient's systolic blood pressure is greater than or equal to 90 mm Hg, but less than 100 mm Hg, we increase the score by two points, making the current score 10 + 2 = 12.
The patient's heart rate is 130 beats per minute. Because the heart rate is greater or equal to than 100 beats per minute, we increase the score by one point, making the current score 12 + 1 = 13.
The patient has melena and so we add one point to the current total, making the current total 13 + 1 =  14.
The patient's status for recent syncope is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 14.
The patient's status for hepatic disease history is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 14.
The patient's status for cardiac failure is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 14.
The patient's Glasgow Bleeding Score is 14."
387,27,Glasgow-Blatchford Bleeding Score (GBS),risk,integer,pmc-8054800-1,Extracted,"A 35-year-old male presented with severe abdominal pain and vomiting for 3 days. There was no history of fever or jaundice in the past. He was chronic alcoholic; consuming 400–500 mL country liquor daily for the past 10 years. On examination, he was afebrile with a pulse rate of 124/min and blood pressure of 110/80 mmHg. He had pallor, icterus, and diffuse abdominal tenderness. The first differential diagnosis was alcoholic hepatitis and pancreatitis. Ryle's tube (RT) was inserted for gastric decompression. Initial management consisted of intravenous fluids, rabeprazole, and broad-spectrum antibiotics. Investigations revealed the following: hemoglobin: 10 g/dl, white blood cell count 13,000/mm3, platelet count 210,000/mm3, serum bilirubin 6 mg/dl, direct bilirubin 4.2 mg/dl, aspartate aminotransferase 242 U/L, alanine aminotransferase 188 U/L, gamma-glutamyltransferase 121 U/L, alkaline phosphatase 52 IU/L, serum creatinine 1.2 mg/dl, blood urea nitrogen 30 mg/dl, serum amylase 189 U/L, serum lipase 490 U/L, and normal chest X-ray. Ultrasound (USG) abdomen showed hepatomegaly with increased echotexture and a bulky pancreas. CT scan abdomen showed diffuse enlargement of the pancreas with heterogeneous enhancement and shaggy contour, blurring of peripancreatic fat planes with fat stranding, thickening of fascial planes, and the presence of intraperitoneal fluid collections. While on supportive medical management, his hemoglobin dropped to 8 g/dl in the next 2 days. RT aspiration was clear. Upper gastrointestinal (UGI) endoscopy was performed to identify the bleed source. UGI endoscopy showed no varices and no peptic ulcer, but oozing of fresh blood was identified from the ampulla of Vater []. As hemoglobin was low on admission also, the patient must have GI bleeding since the onset of acute pancreatitis. Computed tomography (CT) angiography identified aneurysms at the distal end of the splenic artery []. Continuous bleed from ruptured splenic artery aneurysm resulted in hemorrhagic shock. The patient was resuscitated with multiple units of packed red cell transfusions. In view of deteriorating general condition of the patient and suspected infected peripancreatic collection, open surgery was planned. Distal pancreatectomy and splenectomy were performed for the ruptured splenic artery aneurysm. Pathological examination showed giant cell reaction surrounded by fibrosis nearby a polymorphonuclear infiltrate suggestive of acute inflammation in a setting of chronic pancreatitis. It also confirmed peripancreatic hematoma and splenic artery pseudoaneurysm communicating with the pancreatic duct consistent with hemosuccus pancreaticus (HP). Postoperative course was uneventful, and the patient was discharged in stable condition after 2 weeks of surgery.",What is the patient's Glasgow-Blatchford Bleeding score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [124, 'beats per minute'], 'Blood Urea Nitrogen (BUN)': [30, 'mg/dL'], 'sex': 'Male', 'Hemoglobin': [10, 'g/dL'], 'Systolic Blood Pressure': [110, 'mm Hg'], 'Hepatic disease history': True}",10,10,10,"The criteria for the Glasgow-Blatchford Score are listed below:

1. BUN (mg/dL): <18.2 = 0 points, 18.2-22.3 = +2 points, 22.4-28 = +3 points, 28-70 = +4 points, >70 = +6 points
2. Hemoglobin (g/dL) for men: >=13 = 0 points, <=12-13 = +1 point, <=10-12 = +3 points, <10 = +6 points
3. Hemoglobin (g/dL) for women: >=12 = 0 points, <=10-12 = +1 point, <10 = +6 points
4. Systolic blood pressure (mm Hg): ≥110 = 0 points, 100-109 = +1 point, 90-99 = +2 points, <90 = +3 points
5. Pulse ≥100 (per minute): No = 0 points, Yes = +1 point
6. Melena present: No = 0 points, Yes = +1 point
7. Presentation with syncope: No = 0 points, Yes = +1 point
8. Liver disease history: No = 0 points, Yes = +1 point
9. Cardiac failure present: No = 0 points, Yes = +1 point

The total Glasgow-Blatchford Score is calculated by summing the points for each criterion.
The current glasgow bleeding score is 0. The patient's gender is Male.
The concentration of hemoglobin is 10 g/dL. Because the patient is a male and his hemoglobin concentration is greater than or equal to 10 g/dL, but less than 12 g/dL, we add three points, making the current score 0 + 3 = 3.
The concentration of BUN is 30 mg/dL. The BUN concentration is between 28 and 70 mg/dL, and so we add four points, making the current score 3 + 4 = 7.
The patient's blood pressure is 110 mm Hg. Because the patient's systolic blood pressure is greater than or equal to 110 mm Hg, we do not add points to the score, keeping the current score at 7.
The patient's heart rate is 124 beats per minute. Because the heart rate is greater or equal to than 100 beats per minute, we increase the score by one point, making the current score 7 + 1 = 8.
The patient's status for melena is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 8.
The patient's status for recent syncope is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 8.
The patient has a hepatic disease history, and so we add two points to the current total, making the current total 8 + 2 =  10.
The patient's status for cardiac failure is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 10.
The patient's Glasgow Bleeding Score is 10."
388,27,Glasgow-Blatchford Bleeding Score (GBS),risk,integer,pmc-2924565-1,Extracted,"An 84-year-old man presented to our department with a 12-hour history of painless gross hematuria. This was his first ever episode. His past medical history included anemia, benign prostatic hyperplasia, appendicectomy, duodenal ulcer (treated surgically 40 years ago), and an abdominal aortic aneurysm. He was taking tamsulosin, finasteride, levocarnitine, and ferrous sulphate. The physical examination revealed a soft, nontender abdomen and isolated left leg edema. His blood pressure was 140/85 mmHg and his pulse was 75 beats/min. The per rectum examination revealed a smooth, slightly enlarged prostate. Laboratory investigations on admission showed the following: hemoglobin 10 g/dl, hematocrit 31.5%, platelets 162×109/l, BUN 36 mg/dl, and creatinine 1.5 mg/dl. Midstream urine (MSU) sample investigations revealed the following: specific weight 1,030, pH 5.5, white cells 2-4, and red cells >200 per optic field. Culture showed mixed growth of 104-105 cfu. Bladder irrigation was instigated, and urine samples for cytological examination were also taken. Cystoscopy showed decreased expansion suggesting compression from outside the bladder. At the point of compression, increased vascularization was noted in the bladder mucosa with no evidence of active bleeding. No trace of blood was identified coming from the ureteric orifices, the bladder neck, or the prostate. There was no evidence of intra-vesicular masses or other inflammatory changes. The kidney-ureter-bladder X-ray revealed no abnormalities.
The abdominal computed tomography (CT) scan with intravenous contrast revealed left-sided hydronephrosis and dilation of the upper third of the left ureter with no evidence of stones or related peri-ureteric mass. There was an abdominal aortic aneurysm starting 3 cm below the origin of the renal vessels and involving the aortic bifurcation and both internal iliac arteries (, ). The greatest diameter of the aortic aneurysm was 8.0 cm, and the left internal iliac artery's diameter was 11.5 cm (). The iliac artery aneurysm contained a peripheral thrombus, whereas the aortic aneurysm was partly calcified (). Inflammatory changes were present in the lower right peri-renal area. The right iliopsoas muscle was enlarged and of a heterogeneous texture. There was adjacent soft tissue swelling.
The cytological examination was negative for malignant cells. The hematuria was controlled by the fourth day of admission. The patient was discharged awaiting review by the vascular surgical team.",What is the patient's Glasgow-Blatchford Bleeding score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [75, 'beats per minute'], 'Blood Urea Nitrogen (BUN)': [36, 'mg/dL'], 'sex': 'Male', 'Systolic Blood Pressure': [140, 'mm Hg'], 'Hemoglobin': [10, 'g/dL']}",7,7,7,"The criteria for the Glasgow-Blatchford Score are listed below:

1. BUN (mg/dL): <18.2 = 0 points, 18.2-22.3 = +2 points, 22.4-28 = +3 points, 28-70 = +4 points, >70 = +6 points
2. Hemoglobin (g/dL) for men: >=13 = 0 points, <=12-13 = +1 point, <=10-12 = +3 points, <10 = +6 points
3. Hemoglobin (g/dL) for women: >=12 = 0 points, <=10-12 = +1 point, <10 = +6 points
4. Systolic blood pressure (mm Hg): ≥110 = 0 points, 100-109 = +1 point, 90-99 = +2 points, <90 = +3 points
5. Pulse ≥100 (per minute): No = 0 points, Yes = +1 point
6. Melena present: No = 0 points, Yes = +1 point
7. Presentation with syncope: No = 0 points, Yes = +1 point
8. Liver disease history: No = 0 points, Yes = +1 point
9. Cardiac failure present: No = 0 points, Yes = +1 point

The total Glasgow-Blatchford Score is calculated by summing the points for each criterion.
The current glasgow bleeding score is 0. The patient's gender is Male.
The concentration of hemoglobin is 10 g/dL. Because the patient is a male and his hemoglobin concentration is greater than or equal to 10 g/dL, but less than 12 g/dL, we add three points, making the current score 0 + 3 = 3.
The concentration of BUN is 36 mg/dL. The BUN concentration is between 28 and 70 mg/dL, and so we add four points, making the current score 3 + 4 = 7.
The patient's blood pressure is 140 mm Hg. Because the patient's systolic blood pressure is greater than or equal to 110 mm Hg, we do not add points to the score, keeping the current score at 7.
The patient's heart rate is 75 beats per minute. Because the heart rate is less than 100 beats per minute, we do not change the score, keeping the current score at 7.
The patient's status for melena is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 7.
The patient's status for recent syncope is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 7.
The patient's status for hepatic disease history is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 7.
The patient's status for cardiac failure is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 7.
The patient's Glasgow Bleeding Score is 7."
389,27,Glasgow-Blatchford Bleeding Score (GBS),risk,integer,usmle-458,Extracted,"A 22-year-old white woman comes to the physician because of a 6-month history of lower abdominal pain. She has also had multiple episodes of loose stools with blood during this period. She has had painful bowel movements for 1 month. Over the past year, she has had a 10-kg (22-lb) weight loss. She was treated for streptococcal pharyngitis last week. Her maternal grandfather died of colon cancer at the age of 52 years. She does not smoke. She drinks three to five beers on social occasions. She is 162 cm (5 ft 4 in) tall and weighs 52 kg (115-lb); BMI is 19.7 kg/m2. Her temperature is 37°C (98.6°F), pulse is 60/min, respirations are 13/min, and blood pressure is 110/70 mm Hg. Cardiopulmonary examination shows no abnormalities. The abdomen is soft and there is tenderness to palpation of the left lower quadrant. There is no guarding or rigidity. Rectal examination shows no masses. Laboratory studies show:
Hemoglobin 10.4 g/dL
Leukocyte count 10,800/mm3
Platelet count 450,000/mm3
Serum
Na+ 138 mEq/L
Cl- 103 mEq/L
K+ 4.9 mEq/L
HCO3- 22 mEq/L
Urea nitrogen 18 mg/dL
Creatinine 0.6 mg/dL
Antinuclear antibodies negative
Perinuclear antineutrophil cytoplasmic antibodies positive
Anti-Saccharomyces cerevisiae antibodies negative
A colonoscopy is scheduled for the next day.",What is the patient's Glasgow-Blatchford Bleeding score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [60, 'beats per minute'], 'Blood Urea Nitrogen (BUN)': [18, 'mg/dL'], 'sex': 'Female', 'Hemoglobin': [10.4, 'g/dL'], 'Systolic Blood Pressure': [110, 'mm Hg']}",1,1,1,"The criteria for the Glasgow-Blatchford Score are listed below:

1. BUN (mg/dL): <18.2 = 0 points, 18.2-22.3 = +2 points, 22.4-28 = +3 points, 28-70 = +4 points, >70 = +6 points
2. Hemoglobin (g/dL) for men: >=13 = 0 points, <=12-13 = +1 point, <=10-12 = +3 points, <10 = +6 points
3. Hemoglobin (g/dL) for women: >=12 = 0 points, <=10-12 = +1 point, <10 = +6 points
4. Systolic blood pressure (mm Hg): ≥110 = 0 points, 100-109 = +1 point, 90-99 = +2 points, <90 = +3 points
5. Pulse ≥100 (per minute): No = 0 points, Yes = +1 point
6. Melena present: No = 0 points, Yes = +1 point
7. Presentation with syncope: No = 0 points, Yes = +1 point
8. Liver disease history: No = 0 points, Yes = +1 point
9. Cardiac failure present: No = 0 points, Yes = +1 point

The total Glasgow-Blatchford Score is calculated by summing the points for each criterion.
The current glasgow bleeding score is 0. The patient's gender is Female.
The concentration of hemoglobin is 10.4 g/dL. Because the patient is a female and her hemoglobin concentration is greater than or equal to 10 g/dL, but less than 12 g/dL, we add one point, making the current score 0 + 1 = 1.
The concentration of BUN is 18 mg/dL. The BUN concentration is less than 18.2 mg/dL, and so we do not make any changes to the score, keeping the score at 1.
The patient's blood pressure is 110 mm Hg. Because the patient's systolic blood pressure is greater than or equal to 110 mm Hg, we do not add points to the score, keeping the current score at 1.
The patient's heart rate is 60 beats per minute. Because the heart rate is less than 100 beats per minute, we do not change the score, keeping the current score at 1.
The patient's status for melena is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 1.
The patient's status for recent syncope is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 1.
The patient's status for hepatic disease history is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 1.
The patient's status for cardiac failure is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 1.
The patient's Glasgow Bleeding Score is 1."
390,27,Glasgow-Blatchford Bleeding Score (GBS),risk,integer,pmc-2955230-1,Extracted,"A 58-year-old female presented to the emergency room with two-week history of melena, hemetemesis, generalized fatigue, and dizziness. She denied recent use of over-the-counter or nonsteroidal anti-inflammatory medications. Physical examination revealed a cachectic pale look. Blood pressure was 80/60 mm Hg, heart rate was 120 beats/min Abdominal examination revealed mild epigastric tenderness to deep palpation. There was no rebound tenderness or guarding or palpable masses. Laboratory tests revealed hemoglobin of 5.8 g/dl with microcytic picture, hematocrit of 16.5%, blood urea nitrogen of 24 mg/dl, creatinine of 0.8 mg/dl. Urinalysis did not reveal any red blood cells. White blood count, platelets, and coagulation studies were all normal. After initial resuscitation and blood transfusion, an emergent esophagogastroduodenoscopy was performed. A 3-5cm vascular polypoid mass was noted in the antrum of the stomach [], which was biopsied. No other lesions were noted in the oesophagus and the duodenum. Histology from the stomach mass revealed small, vacuolated, clear cells []. Subsequent computed tomography (CT) of the abdomen revealed a well-defined mass in the superior pole of the left kidney [Figure and ]. Her chest X-ray shows multiple pulmonary nodules, suggestive of primary renal cancer with metastatic disease. She underwent subtotal gastrectomy and with Roux-en-Y gastrojejunal reconstruction to prevent further episodes of re-bleeding. Because of the extensive metastatic disease, palliative therapy options were discussed with the patient but she declined any further interventions and died because of her disease two months later.",What is the patient's Glasgow-Blatchford Bleeding score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [120, 'beats per minute'], 'Blood Urea Nitrogen (BUN)': [24, 'mg/dL'], 'sex': 'Female', 'Cardiac failure present': False, 'Hemoglobin': [5.8, 'g/dL'], 'Melena present': True, 'Systolic Blood Pressure': [80, 'mm Hg'], 'Recent syncope': False}",14,14,14,"The criteria for the Glasgow-Blatchford Score are listed below:

1. BUN (mg/dL): <18.2 = 0 points, 18.2-22.3 = +2 points, 22.4-28 = +3 points, 28-70 = +4 points, >70 = +6 points
2. Hemoglobin (g/dL) for men: >=13 = 0 points, <=12-13 = +1 point, <=10-12 = +3 points, <10 = +6 points
3. Hemoglobin (g/dL) for women: >=12 = 0 points, <=10-12 = +1 point, <10 = +6 points
4. Systolic blood pressure (mm Hg): ≥110 = 0 points, 100-109 = +1 point, 90-99 = +2 points, <90 = +3 points
5. Pulse ≥100 (per minute): No = 0 points, Yes = +1 point
6. Melena present: No = 0 points, Yes = +1 point
7. Presentation with syncope: No = 0 points, Yes = +1 point
8. Liver disease history: No = 0 points, Yes = +1 point
9. Cardiac failure present: No = 0 points, Yes = +1 point

The total Glasgow-Blatchford Score is calculated by summing the points for each criterion.
The current glasgow bleeding score is 0. The patient's gender is Female.
The concentration of hemoglobin is 5.8 g/dL. Because the patient is a female and her hemoglobin concentration is less than 10 mg/dL, we add six points, making the current score 0 + 6 = 6.
The concentration of BUN is 24 mg/dL. The BUN concentration is greater than equal to 22.4 mg/dL, but less than 28 mg/dL, and so we add three points, making the current score 6 + 3 = 9.
The patient's blood pressure is 80 mm Hg. Because the patient's systolic blood pressure is less than 90 mm Hg, we increase the score by three points, making the current score 9 + 3 = 12.
The patient's heart rate is 120 beats per minute. Because the heart rate is greater or equal to than 100 beats per minute, we increase the score by one point, making the current score 12 + 1 = 13.
The patient has melena and so we add one point to the current total, making the current total 13 + 1 =  14.
The patient's status for recent syncope is reported to be absent for the patient, and so we do not add any points, keeping the current total at 14.
The patient's status for hepatic disease history is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 14.
The patient's status for cardiac failure is reported to be absent for the patient, and so we do not add any points, keeping the current total at 14.
The patient's Glasgow Bleeding Score is 14."
391,27,Glasgow-Blatchford Bleeding Score (GBS),risk,integer,pmc-8252205-1,Extracted,"A 28-year-old man was brought to the Emergency Department (ED) by his father due to acute altered mental status and shortness of breath since earlier that morning. His medical history was significant for poorly controlled Type I Diabetes Mellitus with multiple hospitalizations due to diabetes ketoacidosis (DKA), severe chronic alcohol abuse for 8 years, and chronic pancreatitis. He was also diagnosed with nasopharyngeal carcinoma at age 18, for which he underwent concurrent chemoradiotherapy. According to his father, he had not eaten food since the night prior but consumed large amounts of alcohol. Upon arrival at the ED, the patient was stuporous, tachypneic at 26 breaths per minute, blood pressure 134/109 mmHg, heart rate 85 beats per minute, and afebrile. Initial blood work showed glucose of 420 mg/dL, high levels of alcohol (222.7 mg/dL), metabolic acidosis, elevated ketones (5.4 mmol/L), pancytopenia (WBC: 1.03 × 103/uL, Hemoglobin: 9.9 g/dL, Platelet count: 32 × 103/uL) prolonged prothrombin time (19.8 s) and activated partial prothrombin time (> 180 s), hyperammonemia (876 ug/dL), elevated lactate (19.9 mmol/L), elevated liver enzymes (AST 3112 U/L, ALT 328 U/L, Gamma-glutamyl-transferase 1100 U/L), elevated creatinine (2.8 mg/dL) and Blood urea nitrogen (22.0 mg/dL). Initial treatment for his DKA state was given at the ED. However, 3 h later, the patient developed hypotension (BP = 82/42). Norepinephrine was given and the patient was subsequently admitted to the Intensive Care Unit (ICU) for further workup and treatment.
At the ICU, the patient was intubated due to hypoxemic respiratory failure. He underwent continuous renal replacement therapy owing to acute kidney injury and severe metabolic acidosis. Empiric antibiotics were prescribed because of suspected sepsis (Sequential Organ Failure Assessment Score: 9). His blood culture further confirmed growth of Pseudomonas Aeruginosa and Acinetobacter Baumannii. Antibiotics were adjusted according to susceptibility. Additional blood work revealed negative HBV, HCV, and HIV antibodies. His condition gradually improved and was successfully extubated on day 10.
However, on day 11 of admission, massive hematochezia of 1500 mL was noted, and his hemoglobin dropped from 9.5 to 8.2 g/dL. Blood transfusion, vitamin K, and tranexamic acid were immediately administered. Being hemodynamically stable the next day, the patient underwent colonoscopy. During the procedure, other than blood clots and stool visualized along the proceeding scope, a deep ulcer covered with mucus with peripheral elevation was noted at the transverse colon (Fig. ). A biopsy was done and the specimen was sent to pathology. Histopathology of the biopsy revealed nonpigmented, wide (5–20 µm in diameter), thin-walled, ribbon-like hyphae with few septations and right-angle branching suggestive of mucormycosis demonstrated by Periodic acid–Schiff (PAS) stain (Fig. ). Blood cultures taken at that time were negative and upper endoscopy did not reveal similar lesions.
Upon receiving the pathology report 5 days after the colonoscopy, the patient was started on oral Posaconazole therapy. No hematochezia was observed after starting the treatment and his c-reactive protein levels continued to decline (from 3.2 to 0.16). The patient’s condition gradually stabilized and was subsequently stepped down from the ICU to the ward and discharged 2 weeks later. He received a total of 2 months of Posaconazole therapy. One month post treatment, a follow up colonoscopy did not reveal any lesions (Fig. ).",What is the patient's Glasgow-Blatchford Bleeding score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [85, 'beats per minute'], 'Blood Urea Nitrogen (BUN)': [22.0, 'mg/dL'], 'sex': 'Male', 'Hemoglobin': [9.9, 'g/dL'], 'Systolic Blood Pressure': [134, 'mm Hg'], 'Hepatic disease history': True}",10,10,10,"The criteria for the Glasgow-Blatchford Score are listed below:

1. BUN (mg/dL): <18.2 = 0 points, 18.2-22.3 = +2 points, 22.4-28 = +3 points, 28-70 = +4 points, >70 = +6 points
2. Hemoglobin (g/dL) for men: >=13 = 0 points, <=12-13 = +1 point, <=10-12 = +3 points, <10 = +6 points
3. Hemoglobin (g/dL) for women: >=12 = 0 points, <=10-12 = +1 point, <10 = +6 points
4. Systolic blood pressure (mm Hg): ≥110 = 0 points, 100-109 = +1 point, 90-99 = +2 points, <90 = +3 points
5. Pulse ≥100 (per minute): No = 0 points, Yes = +1 point
6. Melena present: No = 0 points, Yes = +1 point
7. Presentation with syncope: No = 0 points, Yes = +1 point
8. Liver disease history: No = 0 points, Yes = +1 point
9. Cardiac failure present: No = 0 points, Yes = +1 point

The total Glasgow-Blatchford Score is calculated by summing the points for each criterion.
The current glasgow bleeding score is 0. The patient's gender is Male.
The concentration of hemoglobin is 9.9 g/dL. Because the patient is a male and his hemoglobin concentration is less than 10 and 12 g/dL, we add six points, making the current score 0 + 6 = 6.
The concentration of BUN is 22.0 mg/dL. The BUN concentration is greater than equal to 18.2 mg/dL, but less than 22.4 mg/dL, and so we add two points, making the current score 6 + 2 = 8.
The patient's blood pressure is 134 mm Hg. Because the patient's systolic blood pressure is greater than or equal to 110 mm Hg, we do not add points to the score, keeping the current score at 8.
The patient's heart rate is 85 beats per minute. Because the heart rate is less than 100 beats per minute, we do not change the score, keeping the current score at 8.
The patient's status for melena is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 8.
The patient's status for recent syncope is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 8.
The patient has a hepatic disease history, and so we add two points to the current total, making the current total 8 + 2 =  10.
The patient's status for cardiac failure is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 10.
The patient's Glasgow Bleeding Score is 10."
392,27,Glasgow-Blatchford Bleeding Score (GBS),risk,integer,pmc-6204027-1,Extracted,"A 69-year-old Japanese man underwent treatment for liver dysfunction 3 years after aortic valve replacement. Later, rapid elevation in his serum alkaline phosphatase (ALP) level was recorded and he was readmitted to determine the etiology. His body temperature was 36 °C, blood pressure 164/65 mmHg, and pulse rate was 66/minute. Laboratory data revealed mild anemia and liver-renal injury: white blood cells (WBC) 4600/uL, hemoglobin 9.7 g/dL, platelet 18.9 × 104/dL, C-reactive protein (CRP) 0.29 mg/dL, ALP 1138 U/L, aspartate aminotransferase (AST) 40 U/L, alanine aminotransferase (ALT) 37 U/L, and γ glutamyl transpeptidase (γ-GTP) 298 U/L. His blood urea nitrogen (BUN) was 22.4 mg/dL, creatinine 1.14 mg/dL, activated partial thromboplastin time (APTT) 45.6 seconds, and prothrombin time-international normalized ratio (PT-INR) 2.67. He also had a past history of duodenal ulcer perforation and was currently being treated with warfarin, angiotensin receptor blocker, and proton pump inhibitor. In addition, he was taking orally administered ursodeoxycholic acid for unknown liver function disorder. He had no alcohol consumption or tobacco smoking history and no relevant family history.
A plain radiograph showed no significant findings, but computed tomography (CT) revealed an enhanced tumor within the hilar bile duct and dilatation of the left hepatic duct (Fig. ), which are typical findings for hilar cholangiocarcinoma. In addition, endoscopic retrograde cholangiopancreatography (ERCP) revealed tumor shadow in his bile duct, and the cytology confirmed malignant cells in the bile (Fig. ). As no lymph node and distant metastases were detected, we inserted endoscopic nasobiliary drainage (ENBD) to reduce jaundice as preparation for surgery. We performed extended left hepatectomy with resection of his bile duct; his postoperative course was good without severe complications. After 3 months postoperatively, he was readmitted for subacute cholangitis and obstructive jaundice. Immediately, percutaneous transhepatic cholangiography drainage (PTCD) was performed, followed by cholangiography that exhibited the intrabiliary tumor growth in the remnant liver.
Simultaneously, histological examination of resected specimens revealed tumor growth in the hilar duct across the left hepatic duct (Fig. ). Microscopic findings at the same site revealed a dilated bile duct filled with well-differentiated tubular adenocarcinoma (Fig. ). On immunohistochemical examination, tumor cells were positive for cytokeratin (CK) 20 (Fig. ) but negative for CK7 (Fig. ). Furthermore, CK18 (Fig. ) as control and CDX2 (Fig. ) were stained. Although these findings were not typical of intrahepatic cholangiocarcinoma, hepatic metastasis from another primary lesion was strongly suspected [, ]. Furthermore, CT revealed an enhanced tumor-like lesion at the descending colon, followed by diagnosis of type 2 cancer in total colonography. Then, left hemicolectomy was performed; the immunohistochemical-identified feature matched with an intrabiliary tumor. Meanwhile, the PTCD fluid turned bloody, which was considered to indicate bleeding from a residual bile duct tumor (Fig. ). Accordingly, we planned chemotherapy with orally administered capecitabine but our patient experienced a spike fever because of refractory cholangitis. Thus, we abandoned chemotherapy and initiated radiotherapy to stop the tumor bleeding around the hilar bile duct. After completing radiotherapy (total 50 Gy) for approximately 1 month, we observed an improvement in his liver function because of tumor shrinkage. Unfortunately, the effects were short-lived, intrabiliary growth and cholangitis rebooted after 1 month leading to his death due to septic liver failure (Fig. ). Autopsy revealed a remnant tumor in the bile duct (Fig. ), but no noticeable nodular metastasis was observed, except for a single small metastasis in the lower lobe of his left lung.",What is the patient's Glasgow-Blatchford Bleeding score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [66, 'beats per minute'], 'Blood Urea Nitrogen (BUN)': [22.4, 'mg/dL'], 'sex': 'Male', 'Hemoglobin': [9.7, 'g/dL'], 'Systolic Blood Pressure': [164, 'mm Hg'], 'Hepatic disease history': True}",11,11,11,"The criteria for the Glasgow-Blatchford Score are listed below:

1. BUN (mg/dL): <18.2 = 0 points, 18.2-22.3 = +2 points, 22.4-28 = +3 points, 28-70 = +4 points, >70 = +6 points
2. Hemoglobin (g/dL) for men: >=13 = 0 points, <=12-13 = +1 point, <=10-12 = +3 points, <10 = +6 points
3. Hemoglobin (g/dL) for women: >=12 = 0 points, <=10-12 = +1 point, <10 = +6 points
4. Systolic blood pressure (mm Hg): ≥110 = 0 points, 100-109 = +1 point, 90-99 = +2 points, <90 = +3 points
5. Pulse ≥100 (per minute): No = 0 points, Yes = +1 point
6. Melena present: No = 0 points, Yes = +1 point
7. Presentation with syncope: No = 0 points, Yes = +1 point
8. Liver disease history: No = 0 points, Yes = +1 point
9. Cardiac failure present: No = 0 points, Yes = +1 point

The total Glasgow-Blatchford Score is calculated by summing the points for each criterion.
The current glasgow bleeding score is 0. The patient's gender is Male.
The concentration of hemoglobin is 9.7 g/dL. Because the patient is a male and his hemoglobin concentration is less than 10 and 12 g/dL, we add six points, making the current score 0 + 6 = 6.
The concentration of BUN is 22.4 mg/dL. The BUN concentration is greater than equal to 22.4 mg/dL, but less than 28 mg/dL, and so we add three points, making the current score 6 + 3 = 9.
The patient's blood pressure is 164 mm Hg. Because the patient's systolic blood pressure is greater than or equal to 110 mm Hg, we do not add points to the score, keeping the current score at 9.
The patient's heart rate is 66 beats per minute. Because the heart rate is less than 100 beats per minute, we do not change the score, keeping the current score at 9.
The patient's status for melena is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 9.
The patient's status for recent syncope is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 9.
The patient has a hepatic disease history, and so we add two points to the current total, making the current total 9 + 2 =  11.
The patient's status for cardiac failure is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 11.
The patient's Glasgow Bleeding Score is 11."
393,27,Glasgow-Blatchford Bleeding Score (GBS),risk,integer,pmc-7805200-1,Extracted,"A 53 year-old man with hematemesis consulted the emergency department. He underwent distal gastrectomy and Billroth II reconstruction for duodenal ulcers 32 years ago. He had bronchial asthma and had been taking steroids for a long time. He had a history of relatively high alcohol consumption, and he smoked 15 cigarettes a day. A general examination revealed that he had anemia. The pulse rate was 126 beats per minute, and the blood pressure was 92/46 mmHg. Regarding his laboratory test, his hemoglobin and blood urea nitrogen levels were 12.1 g/dL and 29.0 mg/dL, respectively, with negative Helicobacter pylori infection serologically. Although a large amount of blood clot was found in the remnant stomach, the source of bleeding could not be determined in the first emergency upper gastrointestinal endoscopy (Fig. a, b). On the 3rd day of hospitalization, melena was observed; hence, follow-up endoscopy was performed, which revealed bleeding from the reddened mucosa at the anastomosis site, and tentative endoscopic hemostasis was performed by clipping the bleeding site (Fig. c, d). Despite medical treatment with transfusion, upper gastrointestinal bleeding symptoms, including hematemesis, melena, and progression of anemia, persisted with significant hemodynamic impairment. On the 4th day of hospitalization, vigorous bleeding was observed when endoscopy was repeated (Fig. e). Because it was difficult to secure a suitable endoscopic view due to bleeding, we decided that performing endoscopic hemostasis was impossible and switched to interventional radiology (IVR). The bleeding had subsided spontaneously when IVR was performed, and re-bleeding was not observed during the IVR procedure although endoscopic stimulation was applied to the predicted bleeding site. Arterial embolization with coiling was performed prophylactically on the distribution area, which was predicted as the bleeding site, using an endoclip as a landmark. However, bleeding symptoms persisted, requiring a total of > 20 units of packed red blood cell transfusion. Based on discussions among physicians, surgeons, and radiologist, surgical treatment was necessary because of the uncertainty whether endoscopic hemostasis and IVR could achieve hemostasis and concerns regarding the deteriorating general conditions caused by frequent severe bleeding. With a written informed consent provided, the patient underwent partial resection of the anastomosis site with Roux-en-Y reconstruction. Consequently, he achieved excellent postoperative recovery.
Histopathological examination revealed the presence of massive hemorrhage. The resected specimen was macroscopically examined, showing a caterpillar-shaped elevated lesion with a maximum diameter of 70 mm on the greater curvature of the remnant stomach. Some of the elevated lesions had erosion, which was observed near the endoclip and was considered as the bleeding site (Fig. a, b). Histopathological findings of the resected specimen detected thickening of the mucosa and hyperplasia of the crypt epithelium, as shown in a weakly magnified image (Fig. a). In the highly magnified image, the mucosa exhibited pseudopyloric gland proliferation with cystic dilation. The muscularis mucosa was entangled and elevated radially into the ridge, and glandular structures penetrated into the submucosal layer from the gap. Hence, a histopathological diagnosis of GCP was considered. We also observed mucosal damages, such as fibrin exudation along with necrosis. Moreover, the resected specimen had no atypical cells (Fig. b, c). However, Elastica van Gieson-stained images showed abnormal muscular vessels that had developed with an irregularly thickened lumen occluded by the fibrous tissue (Fig. d–h). Although we could not detect the culprit blood vessels that triggered massive hemorrhage pathologically, we believe that the blood vessel occlusion caused by fibrous tissue buildup resulted from massive bleeding.",What is the patient's Glasgow-Blatchford Bleeding score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [126, 'beats per minute'], 'Blood Urea Nitrogen (BUN)': [29.0, 'mg/dL'], 'sex': 'Male', 'Hemoglobin': [12.1, 'g/dL'], 'Melena present': False, 'Systolic Blood Pressure': [92, 'mm Hg']}",8,8,8,"The criteria for the Glasgow-Blatchford Score are listed below:

1. BUN (mg/dL): <18.2 = 0 points, 18.2-22.3 = +2 points, 22.4-28 = +3 points, 28-70 = +4 points, >70 = +6 points
2. Hemoglobin (g/dL) for men: >=13 = 0 points, <=12-13 = +1 point, <=10-12 = +3 points, <10 = +6 points
3. Hemoglobin (g/dL) for women: >=12 = 0 points, <=10-12 = +1 point, <10 = +6 points
4. Systolic blood pressure (mm Hg): ≥110 = 0 points, 100-109 = +1 point, 90-99 = +2 points, <90 = +3 points
5. Pulse ≥100 (per minute): No = 0 points, Yes = +1 point
6. Melena present: No = 0 points, Yes = +1 point
7. Presentation with syncope: No = 0 points, Yes = +1 point
8. Liver disease history: No = 0 points, Yes = +1 point
9. Cardiac failure present: No = 0 points, Yes = +1 point

The total Glasgow-Blatchford Score is calculated by summing the points for each criterion.
The current glasgow bleeding score is 0. The patient's gender is Male.
The concentration of hemoglobin is 12.1 g/dL. Because the patient is a male and his hemoglobin concentration is greater than or equal to 12 g/dL, but less than 13 g/dL, we add one point, making the current score 0 + 1 = 1.
The concentration of BUN is 29.0 mg/dL. The BUN concentration is between 28 and 70 mg/dL, and so we add four points, making the current score 1 + 4 = 5.
The patient's blood pressure is 92 mm Hg. Because the patient's systolic blood pressure is greater than or equal to 90 mm Hg, but less than 100 mm Hg, we increase the score by two points, making the current score 5 + 2 = 7.
The patient's heart rate is 126 beats per minute. Because the heart rate is greater or equal to than 100 beats per minute, we increase the score by one point, making the current score 7 + 1 = 8.
The patient's status for melena is reported to be absent for the patient, and so we do not add any points, keeping the current total at 8.
The patient's status for recent syncope is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 8.
The patient's status for hepatic disease history is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 8.
The patient's status for cardiac failure is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 8.
The patient's Glasgow Bleeding Score is 8."
394,27,Glasgow-Blatchford Bleeding Score (GBS),risk,integer,usmle-47,Extracted,"A 58-year-old woman comes to the emergency department because of a 2-day history of worsening upper abdominal pain. She reports nausea and vomiting, and is unable to tolerate oral intake. She appears uncomfortable. Her temperature is 38.1°C (100.6°F), pulse is 92/min, respirations are 18/min, and blood pressure is 132/85 mm Hg. Examination shows yellowish discoloration of her sclera. Her abdomen is tender in the right upper quadrant. There is no abdominal distention or organomegaly. Laboratory studies show:
Hemoglobin 13 g/dL
Leukocyte count 16,000/mm3
Serum
Urea nitrogen
25 mg/dL
Creatinine 2 mg/dL
Alkaline phosphatase 432 U/L
Alanine aminotransferase 196 U/L
Aspartate transaminase 207 U/L
Bilirubin
Total 3.8 mg/dL
Direct 2.7 mg/dL
Lipase 82 U/L (N = 14–280)
Ultrasound of the right upper quadrant shows dilated intrahepatic and extrahepatic bile ducts and multiple hyperechoic spheres within the gallbladder. The pancreas is not well visualized. Intravenous fluid resuscitation and antibiotic therapy with ceftriaxone and metronidazole is begun. Twelve hours later, the patient appears acutely ill and is not oriented to time. Her temperature is 39.1°C (102.4°F), pulse is 105/min, respirations are 22/min, and blood pressure is 112/82 mm Hg.",What is the patient's Glasgow-Blatchford Bleeding score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [92, 'beats per minute'], 'Blood Urea Nitrogen (BUN)': [25, 'mg/dL'], 'sex': 'Female', 'Hemoglobin': [13, 'g/dL'], 'Systolic Blood Pressure': [132, 'mm Hg'], 'Hepatic disease history': True}",5,5,5,"The criteria for the Glasgow-Blatchford Score are listed below:

1. BUN (mg/dL): <18.2 = 0 points, 18.2-22.3 = +2 points, 22.4-28 = +3 points, 28-70 = +4 points, >70 = +6 points
2. Hemoglobin (g/dL) for men: >=13 = 0 points, <=12-13 = +1 point, <=10-12 = +3 points, <10 = +6 points
3. Hemoglobin (g/dL) for women: >=12 = 0 points, <=10-12 = +1 point, <10 = +6 points
4. Systolic blood pressure (mm Hg): ≥110 = 0 points, 100-109 = +1 point, 90-99 = +2 points, <90 = +3 points
5. Pulse ≥100 (per minute): No = 0 points, Yes = +1 point
6. Melena present: No = 0 points, Yes = +1 point
7. Presentation with syncope: No = 0 points, Yes = +1 point
8. Liver disease history: No = 0 points, Yes = +1 point
9. Cardiac failure present: No = 0 points, Yes = +1 point

The total Glasgow-Blatchford Score is calculated by summing the points for each criterion.
The current glasgow bleeding score is 0. The patient's gender is Female.
The concentration of hemoglobin is 13 g/dL. Because the patient is a female and her hemoglobin concentration is greater than or equal to 12 mg/dL, we do not add any points, keeping the current score at 0.
The concentration of BUN is 25 mg/dL. The BUN concentration is greater than equal to 22.4 mg/dL, but less than 28 mg/dL, and so we add three points, making the current score 0 + 3 = 3.
The patient's blood pressure is 132 mm Hg. Because the patient's systolic blood pressure is greater than or equal to 110 mm Hg, we do not add points to the score, keeping the current score at 3.
The patient's heart rate is 92 beats per minute. Because the heart rate is less than 100 beats per minute, we do not change the score, keeping the current score at 3.
The patient's status for melena is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 3.
The patient's status for recent syncope is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 3.
The patient has a hepatic disease history, and so we add two points to the current total, making the current total 3 + 2 =  5.
The patient's status for cardiac failure is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 5.
The patient's Glasgow Bleeding Score is 5."
395,27,Glasgow-Blatchford Bleeding Score (GBS),risk,integer,pmc-8683165-1,Extracted,"A 33-year-old male presented to our center with chief complaints of profuse per rectal bleed mixed with stool for three days that was associated with easy fatigability for one week prior to the initial presentation. He also had one episode of black tarry stool. However, he had no complaints of blood in vomit, purpuric rashes, or petechiae. He also had no hematuria, weight loss, night sweats, evening rise of temperature or loss of appetite, cough, chest pain, dyspnea, palpitation, limb edema, loose stools, jaundice, and abdominal distension. Bleeding was absent from other orifices. He had no history of diabetes mellitus, hypertension, cardiac diseases, and pulmonary tuberculosis in the past. He consumed 80 grams of alcohol per day for 15 years, but he did not smoke.
On examination, he was ill looking, conscious, and was well oriented to time place and person. He had pallor and was dehydrated. However, he had no icterus, clubbing, cyanosis, or edema. His pulse rate was 110 beats/minute, blood pressure was 80/60 mm of Hg, body temperature was 98°F (36.6°C), respiratory rate was 19 breaths/minute, and oxygen saturation was 95% in room air. The digital rectal examination showed fresh blood over the examining finger and otherwise normal findings. Abdominal and cardiac examination was normal.
Laboratory investigations showed hemoglobin 10.8 g/dl and hematocrit 31.6%. The total leukocyte count was 11510/mm3, neutrophils were 78%, and platelet count was 291000/mm3. The prothrombin time was 14 seconds, and the International normalized ratio was 1.08. The albumin level in the blood was 2.4 gm/dl, and total protein was 6.1 gm/dl, total and direct bilirubin were 0.7 and 0.1 mg/dl in the blood. Alanine aminotransferase and aspartate aminotransferase level was 97 U/L and 114 U/L, respectively. HbA1C level in the blood was 7.2. The level of blood urea nitrogen (33 mg/dl), creatinine (1.1 mg/dl), sodium (132 mEq/l), and potassium (3.6 mEq/l) were within normal range. Traces of sugar and albumin (++) were present in the urine examination. The fecal occult blood was found in the stool. Mycobacterium tuberculosis was not detected in sputum in the acid-fast bacilli (AFB) stain.
The chest X-ray was normal. Ultrasonography (USG) of the abdomen and pelvis and upper gastrointestinal endoscopy showed normal findings. A Computed Tomography (CT) scan of chest and abdomen showed asymmetric circumferential thickening in the ileocaecal region with lobulated thickened caecum, soft-tissue stranding and necrotic mesenteric lymphadenopathy, and indeterminate lobule in the lung (). Colonoscopy showed multiple transverse ulcers with overlying exudates in terminal ileum and ascending and transverse colon. Histopathological examination of the ileum and colon showed patchy ulcers with exudates, granulation tissue, fibrosis, deep lymphoplasmocytic inflammation, and crypt regenerative changes with fibrinoid changes in scattered capillaries and venules and was inconclusive. However, gene XPERT was positive for Mycobacterium tuberculosis.
He was diagnosed with ileocaecal tuberculosis. The hemoglobin level dropped to 6.1 g/dl after two days of admission, and he had an episode of weakness associated with profuse sweating and rigor. Fluid resuscitation followed by two pints of whole blood transfusion was performed. After that, his hemoglobin was increased to 10.2 mg/dl. He was managed with four antitubercular drugs and showed significant improvement. Following this, he was discharged on oral antitubercular medications (isoniazid, rifampicin, pyrazinamide, ethambutol, and pyridoxine) after 10 days of admission. On follow-up after two weeks, he was responding well to antitubercular medications with improved symptoms, i.e., no per rectal bleeding, and his liver function test was within the normal range.",What is the patient's Glasgow-Blatchford Bleeding score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [110, 'beats per minute'], 'Blood Urea Nitrogen (BUN)': [33, 'mg/dL'], 'sex': 'Male', 'Hemoglobin': [10.8, 'g/dL'], 'Melena present': True, 'Systolic Blood Pressure': [80, 'mm Hg'], 'Recent syncope': False}",12,12,12,"The criteria for the Glasgow-Blatchford Score are listed below:

1. BUN (mg/dL): <18.2 = 0 points, 18.2-22.3 = +2 points, 22.4-28 = +3 points, 28-70 = +4 points, >70 = +6 points
2. Hemoglobin (g/dL) for men: >=13 = 0 points, <=12-13 = +1 point, <=10-12 = +3 points, <10 = +6 points
3. Hemoglobin (g/dL) for women: >=12 = 0 points, <=10-12 = +1 point, <10 = +6 points
4. Systolic blood pressure (mm Hg): ≥110 = 0 points, 100-109 = +1 point, 90-99 = +2 points, <90 = +3 points
5. Pulse ≥100 (per minute): No = 0 points, Yes = +1 point
6. Melena present: No = 0 points, Yes = +1 point
7. Presentation with syncope: No = 0 points, Yes = +1 point
8. Liver disease history: No = 0 points, Yes = +1 point
9. Cardiac failure present: No = 0 points, Yes = +1 point

The total Glasgow-Blatchford Score is calculated by summing the points for each criterion.
The current glasgow bleeding score is 0. The patient's gender is Male.
The concentration of hemoglobin is 10.8 g/dL. Because the patient is a male and his hemoglobin concentration is greater than or equal to 10 g/dL, but less than 12 g/dL, we add three points, making the current score 0 + 3 = 3.
The concentration of BUN is 33 mg/dL. The BUN concentration is between 28 and 70 mg/dL, and so we add four points, making the current score 3 + 4 = 7.
The patient's blood pressure is 80 mm Hg. Because the patient's systolic blood pressure is less than 90 mm Hg, we increase the score by three points, making the current score 7 + 3 = 10.
The patient's heart rate is 110 beats per minute. Because the heart rate is greater or equal to than 100 beats per minute, we increase the score by one point, making the current score 10 + 1 = 11.
The patient has melena and so we add one point to the current total, making the current total 11 + 1 =  12.
The patient's status for recent syncope is reported to be absent for the patient, and so we do not add any points, keeping the current total at 12.
The patient's status for hepatic disease history is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 12.
The patient's status for cardiac failure is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 12.
The patient's Glasgow Bleeding Score is 12."
396,27,Glasgow-Blatchford Bleeding Score (GBS),risk,integer,pmc-6971427-1,Extracted,"A 78-year-old man presented to our emergency department (ED) with a complaint of melena for 2 days. He had a medical history of cerebral infarction, which had been treated with 100 mg/day aspirin, hypertension, and duodenal ulcer. He stopped taking aspirin on the day before arrival at our ED. His blood pressure was 77/53 mmHg, with a heart rate of 90 b.p.m. and a respiratory rate of 18 breaths/min. The Glasgow Coma Scale score was E4V4M6, and his body temperature was 36.7°C on arrival. Physical examination showed significant facial and conjunctival pallor. Laboratory findings revealed anemia (Hb, 6.4 g/dL) and high blood urea nitrogen to creatinine ratio (62 mg/dL and 1.25 mg/dL, respectively). Given his symptoms of anemia and melena, upper gastrointestinal bleeding was suspected as the cause of hemorrhagic shock.
Transfusion with 2 units of red blood cells was initiated in the ED. An esophagogastroduodenoscopy (EGD) revealed a gastric ulcer with a visible vessel. The heat probe coagulation method was undertaken immediately to treat the visible vessel in the base of the gastric ulcer (Fig. ).
On day 6 and day 8 following his admission, the patient suffered massive hematemesis. He underwent a repeat EGD accordingly, the result of which was unremarkable. On day 11 after admission, he had recurrent massive hematemesis along with passing of black stools. He had no nasopharyngeal symptoms. His circulatory status was again compromised with blood pressure of 74/56 mmHg and heart rate of 124 b.p.m. Hb decreased from 8.9 to 7.6 g/dL, but no coagulopathy developed. He was intubated, and 6 units of red blood cells and 8 units of fresh frozen plasma were given. Esophagogastroduodenoscopy did not reveal any obvious source of bleeding in the upper gastrointestinal tract. However, fresh blood was incidentally noticed to be dripping from the pharynx into the esophagus and stomach. Posterior nasal bleeding was strongly suspected, and we carried out posterior nasal packing on both sides with Foley catheters. Transnasal endoscopy revealed nasal polyps with bleeding in the right superior nasal meatus. Endoscopic sinus surgery for cauterizing the bleeding sites was carried out (Fig. ). He developed a hemorrhage again and underwent endoscopic sinus surgery for radical treatment to the nasal polyps on day 16. The pathological diagnosis was “nasal polyp,” characterized by an infiltration of inflammatory cells including neutrophilic leukocytes, lymphocytes, and plasma cells, and epithelial metaplasia. It is important to note that, throughout his hospitalization, he did not have coagulopathy or thrombocytopenia.
The patient had an uneventful postoperative course during the rest of his hospital stay and was discharged on day 26.",What is the patient's Glasgow-Blatchford Bleeding score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [90, 'beats per minute'], 'Blood Urea Nitrogen (BUN)': [62, 'mg/dL'], 'sex': 'Male', 'Hemoglobin': [6.4, 'g/dL'], 'Melena present': True, 'Systolic Blood Pressure': [77, 'mm Hg']}",14,14,14,"The criteria for the Glasgow-Blatchford Score are listed below:

1. BUN (mg/dL): <18.2 = 0 points, 18.2-22.3 = +2 points, 22.4-28 = +3 points, 28-70 = +4 points, >70 = +6 points
2. Hemoglobin (g/dL) for men: >=13 = 0 points, <=12-13 = +1 point, <=10-12 = +3 points, <10 = +6 points
3. Hemoglobin (g/dL) for women: >=12 = 0 points, <=10-12 = +1 point, <10 = +6 points
4. Systolic blood pressure (mm Hg): ≥110 = 0 points, 100-109 = +1 point, 90-99 = +2 points, <90 = +3 points
5. Pulse ≥100 (per minute): No = 0 points, Yes = +1 point
6. Melena present: No = 0 points, Yes = +1 point
7. Presentation with syncope: No = 0 points, Yes = +1 point
8. Liver disease history: No = 0 points, Yes = +1 point
9. Cardiac failure present: No = 0 points, Yes = +1 point

The total Glasgow-Blatchford Score is calculated by summing the points for each criterion.
The current glasgow bleeding score is 0. The patient's gender is Male.
The concentration of hemoglobin is 6.4 g/dL. Because the patient is a male and his hemoglobin concentration is less than 10 and 12 g/dL, we add six points, making the current score 0 + 6 = 6.
The concentration of BUN is 62 mg/dL. The BUN concentration is between 28 and 70 mg/dL, and so we add four points, making the current score 6 + 4 = 10.
The patient's blood pressure is 77 mm Hg. Because the patient's systolic blood pressure is less than 90 mm Hg, we increase the score by three points, making the current score 10 + 3 = 13.
The patient's heart rate is 90 beats per minute. Because the heart rate is less than 100 beats per minute, we do not change the score, keeping the current score at 13.
The patient has melena and so we add one point to the current total, making the current total 13 + 1 =  14.
The patient's status for recent syncope is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 14.
The patient's status for hepatic disease history is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 14.
The patient's status for cardiac failure is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 14.
The patient's Glasgow Bleeding Score is 14."
397,27,Glasgow-Blatchford Bleeding Score (GBS),risk,integer,pmc-7249933-1,Extracted,"The patient was a 76-year-old woman who presented to our emergency room with a 3-day history of general weakness, fever, and oliguria and a 7-day history of nausea, and vomiting. The patient was bedridden due to a compression fracture of the 1st lumbar vertebra sustained 5 days prior to presentation. The patient had been taking appropriate oral medications for DM and hypertension for the past 40 years and had not developed any specific renal disease. Her prescribed oral hypoglycemic agents at the time of presentation were metformin (500 mg twice per day) and dapagliflozin (10 mg/day). Other daily medications included ezetimibe/rosuvastatin calcium (10 mg/5.2 mg), clopidogrel (75 mg), nicorandil (5 mg), imipramine (25 mg), tolterodine (4 mg), and tamsulosin (0.2 mg). Blood pressure, pulse rate, respiration rate, and body temperature at presentation were 160/80 mmHg, 120/min, 20/min, and 37.5°C, respectively. The patient was alert but experiencing malaise. Her oral mucosa was dry and skin turgor had decreased. Chest auscultation results were normal, but her abdomen was distended with decreased bowel sounds. A peripheral blood test at admission showed a white blood cell (WBC) count of 11,800/μL (neutrophils 85.3%), hemoglobin of 13 g/dL, a platelet count of 173,000/μL, and an erythrocyte sedimentation rate of 12 mm/hour. Serum biochemical examination showed the following: glucose, 410 mg/dL; blood urea nitrogen, 41.7 mg/dL; creatinine (Cr), 3.2 mg/dL; albumin, 3.8 g/dL; total cholesterol, 93 mg/dL; calcium, 8.1 mg/dL; phosphorus, 4.7 mg/dL; uric acid, 6.1 mg/dL; C-reactive protein, 54 mg/L; glycated hemoglobin (HbA1C), 8.1%; insulin, 3.3 μIU/mL (reference range, 2.6–24.9 μIU/mL); and C-peptide, 1 ng/mL (reference range, 1.1–4.4 ng/mL). Urinalysis with microscopic examination showed albumin 3+, occult blood 2+, a WBC count of 20–30/high power field, and a red blood cell count of 10–30/high power field (dysmorphic 90%). Spot urine protein to Cr ratio was 1.14 g/g. After urinary catheterization, her urine output was 1950 mL suggesting azotemia due to postrenal acute kidney injury. Abdominal computed tomography scan showed diffuse paralytic ileus and bilateral pyeloureteritis (Fig. A, B). Treatment with empirical broad-spectrum antibiotics (ceftriaxone) was initiated along with fluid therapy and total parenteral nutrition after insertion of a nasogastric tube. Fasting was prescribed. The oral hypoglycemic agents were discontinued. On day 3 of hospitalization, the patient was transitioned to a full-liquid diet through a nasogastric tube because she showed improvement in renal function (serum Cr, 0.7 mg/dL); paralytic ileus was also less severe. Treatment with metformin (1000 mg/day) and dapagliflozin (10 mg/day) was reinstituted. Previous outpatient medications were also retained and no new medications were added. Extended spectrum beta-lactamase negative, ceftriaxone–sensitive Escherichia coli was isolated from urine cultures. However, on day 6 of hospitalization, she developed consciousness alterations, including confusion, lethargy, and stupor, along with nausea, vomiting, and abdominal pain. Arterial blood gas analysis showed a pH of 6.904, partial pressure of carbon dioxide of 12.0 mmHg, and HCO3− of 3.1 mmol/L, suggestive of high anion gap metabolic acidosis with respiratory compensation. Based on the results of serum biochemical examination (Table ), we suspected eu-DKA accompanied by hypovolemia, hypernatremia, and hypokalemia. For the first 6 hours after discontinuation of dapagliflozin, we performed intravenous fluid therapy with 0.9% saline at a rate of 250 mL/hour (h) for 2 hours followed by 100 mL/h, 5% dextrose in water (5% D/W) (100 mL/h), and KCl (40 mEq/L). Regular insulin (RI) and sodium bicarbonate were not administered considering the blood glucose levels (range, 150–250 mg/dL) and arterial blood pH (>6.9). Because disturbances in serum electrolyte levels continued for 6 hours after intravenous fluid resuscitation (Table ), administration of 0.45% saline (100 mL/h) with KCl (20 mEq/L), 5% D/W (50 mL/h), and RI (2.5 U/h, 0.05 U/kg/h) was maintained. Brain magnetic resonance imaging of the patient showed no specific abnormalities, including the absence of acute ischemic brain lesions. Eventually, the patient started enteral feeding of free water through a nasogastric tube while being administered a mixed solution of 0.45% saline and 5% D/W with RI. Additional biochemical results are described in Table . After the 8th day of hospitalization, consciousness and laboratory findings improved; however, dapagliflozin was not resumed. The patient was discharged on the 14th hospital day because of resolution of consciousness impairment and laboratory abnormalities, and the patient is currently receiving insulin (glargine/insulin lispro) and metformin for management of DM.",What is the patient's Glasgow-Blatchford Bleeding score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [120, 'beats per minute'], 'Blood Urea Nitrogen (BUN)': [41.7, 'mg/dL'], 'sex': 'Female', 'Hemoglobin': [13, 'g/dL'], 'Systolic Blood Pressure': [160, 'mm Hg']}",5,5,5,"The criteria for the Glasgow-Blatchford Score are listed below:

1. BUN (mg/dL): <18.2 = 0 points, 18.2-22.3 = +2 points, 22.4-28 = +3 points, 28-70 = +4 points, >70 = +6 points
2. Hemoglobin (g/dL) for men: >=13 = 0 points, <=12-13 = +1 point, <=10-12 = +3 points, <10 = +6 points
3. Hemoglobin (g/dL) for women: >=12 = 0 points, <=10-12 = +1 point, <10 = +6 points
4. Systolic blood pressure (mm Hg): ≥110 = 0 points, 100-109 = +1 point, 90-99 = +2 points, <90 = +3 points
5. Pulse ≥100 (per minute): No = 0 points, Yes = +1 point
6. Melena present: No = 0 points, Yes = +1 point
7. Presentation with syncope: No = 0 points, Yes = +1 point
8. Liver disease history: No = 0 points, Yes = +1 point
9. Cardiac failure present: No = 0 points, Yes = +1 point

The total Glasgow-Blatchford Score is calculated by summing the points for each criterion.
The current glasgow bleeding score is 0. The patient's gender is Female.
The concentration of hemoglobin is 13 g/dL. Because the patient is a female and her hemoglobin concentration is greater than or equal to 12 mg/dL, we do not add any points, keeping the current score at 0.
The concentration of BUN is 41.7 mg/dL. The BUN concentration is between 28 and 70 mg/dL, and so we add four points, making the current score 0 + 4 = 4.
The patient's blood pressure is 160 mm Hg. Because the patient's systolic blood pressure is greater than or equal to 110 mm Hg, we do not add points to the score, keeping the current score at 4.
The patient's heart rate is 120 beats per minute. Because the heart rate is greater or equal to than 100 beats per minute, we increase the score by one point, making the current score 4 + 1 = 5.
The patient's status for melena is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 5.
The patient's status for recent syncope is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 5.
The patient's status for hepatic disease history is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 5.
The patient's status for cardiac failure is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 5.
The patient's Glasgow Bleeding Score is 5."
398,27,Glasgow-Blatchford Bleeding Score (GBS),risk,integer,pmc-3849536-1,Extracted,"A 64-year-old Taiwanese woman presented with a history of well-controlled type 2 diabetes mellitus and hypertension. She had been self-treating regularly with NSAIDs from pharmacy (diclofenac, 50 mg three times daily) for more than two years because of chronic low back pain caused by intervertebral disc herniation. General malaise, poor appetite, intermittent postprandial nausea, urinary urgency and frequency were present one month before admission. She visited local clinics and received no specific diagnosis. Due to progressive shortness of breath and drowsiness for one week, she was sent to a medical center. She appeared acutely ill but afebrile, with a blood pressure of 74/34 mmHg, a pulse rate of 86/min, a respiratory rate of 22/min, and an oxygen saturation level of 93% in ambient air. Physical examination revealed no specific local findings. A blood assay revealed the following findings: leukocyte count, 44,400/μL with 85% neutrophils; hemoglobin, 12.3 g/dL; platelet count, 466, 000/μL; C-reactive protein, 235.76 mg/L; total bilirubin, 1.17 mg/dL; direct bilirubin, 0.17 mg/dL; aspartate aminotransferase, 38 IU/L; alanine aminotransferase, 21 IU/L; blood urea nitrogen, 96.77 mg/dL; creatinine, 7.8 mg/dL; sodium, 140 mmol/L; potassium, 8.6 mmol/L; and lactate, 20.3 mmol/L. The arterial blood gas analysis revealed severe metabolic acidosis (pH, 7.02; HCO3, 7.1 mmol/L). A chest radiograph revealed no pulmonary lesions. Urine analysis via catheterization revealed only mild hematuria.
She was admitted to the intensive care unit due to septic shock, acute respiratory failure, acute renal failure, and hyperkalemia. She received mechanical ventilation, intravenous vasopressors, continuous veno-venous hemofiltration, and cefmetazole (2 g/day) was prescribed empirically. All blood cultures yielded K. pneumoniae. The urine culture was sterile. Contrast-enhanced abdominal computed tomography (CT) revealed multiple abscesses in the spleen and bilateral kidneys, with the largest lesion (approximately 5.2 cm in diameter) located in the right kidney (Figure ). In addition, CT also revealed segmental bowel wall edema in the submucosal layer over the terminal ileum, cecum, ascending colon, and descending colon with perifocal fat stranding. The hyperemic change was compatible with the inflammatory reaction in the bowel. The CT also revealed more intense wall enhancement at the terminal ileum (Figure ). A colonoscopy revealed diffuse ulceration with exudation in the distal terminal ileum and segmental ulceration in the colon, with a reduction in the lumen caliber in the sigmoid colon (Figure ). The pathological analysis of colon biopsy specimens revealed ulcers, necrotic debris, and the infiltration of lymphocytes into the edematous lamina propria (Figure ). Three weeks later, a follow-up abdominal ultrasonography demonstrated partial resolution of the renal and splenic abscesses.
The patient was treated in the outpatient department with 500 mg of oral cephradine, four times daily; 500 mg of metronidazole, three times daily; and balsalazide (2.25 g daily) for two months. The follow-up abdominal CT scan revealed complete resolution of the abscesses two months later, and the colonoscopy revealed multiple segmental longitudinal ulceration with skip lesions in the rectum, sigmoid, and terminal ileum. A colon biopsy showed necrotizing inflammation with the infiltration of mixed inflammatory cells ,including neutrophils, histiocytes, and lymphocytes. Moreover, focal ulcerated colonic mucosa with inflammatory infiltration was found in the edematous, fibrous lamina propria. Some distorted glands were observed, but no crypt abscesses were noted. Balsalazide was discontinued after a course of four months. She had an uneventful course in the out-patient department, and a follow-up colonoscopy two years later revealed melanosis coli and internal hemorrhoid only, without ulcers or stenosis over the entire colon.",What is the patient's Glasgow-Blatchford Bleeding score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [86, 'beats per minute'], 'Blood Urea Nitrogen (BUN)': [96.77, 'mg/dL'], 'sex': 'Female', 'Systolic Blood Pressure': [74, 'mm Hg'], 'Hemoglobin': [12.3, 'g/dL']}",9,9,9,"The criteria for the Glasgow-Blatchford Score are listed below:

1. BUN (mg/dL): <18.2 = 0 points, 18.2-22.3 = +2 points, 22.4-28 = +3 points, 28-70 = +4 points, >70 = +6 points
2. Hemoglobin (g/dL) for men: >=13 = 0 points, <=12-13 = +1 point, <=10-12 = +3 points, <10 = +6 points
3. Hemoglobin (g/dL) for women: >=12 = 0 points, <=10-12 = +1 point, <10 = +6 points
4. Systolic blood pressure (mm Hg): ≥110 = 0 points, 100-109 = +1 point, 90-99 = +2 points, <90 = +3 points
5. Pulse ≥100 (per minute): No = 0 points, Yes = +1 point
6. Melena present: No = 0 points, Yes = +1 point
7. Presentation with syncope: No = 0 points, Yes = +1 point
8. Liver disease history: No = 0 points, Yes = +1 point
9. Cardiac failure present: No = 0 points, Yes = +1 point

The total Glasgow-Blatchford Score is calculated by summing the points for each criterion.
The current glasgow bleeding score is 0. The patient's gender is Female.
The concentration of hemoglobin is 12.3 g/dL. Because the patient is a female and her hemoglobin concentration is greater than or equal to 12 mg/dL, we do not add any points, keeping the current score at 0.
The concentration of BUN is 96.77 mg/dL. The BUN concentration is greater than 70 mg/dL, and so we add six points, making the current score 0 + 6 = 6.
The patient's blood pressure is 74 mm Hg. Because the patient's systolic blood pressure is less than 90 mm Hg, we increase the score by three points, making the current score 6 + 3 = 9.
The patient's heart rate is 86 beats per minute. Because the heart rate is less than 100 beats per minute, we do not change the score, keeping the current score at 9.
The patient's status for melena is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 9.
The patient's status for recent syncope is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 9.
The patient's status for hepatic disease history is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 9.
The patient's status for cardiac failure is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 9.
The patient's Glasgow Bleeding Score is 9."
399,27,Glasgow-Blatchford Bleeding Score (GBS),risk,integer,pmc-5471576-1,Extracted,"A 33-year-old female presented to the emergency room complaining of painful lesions on her right upper extremity that began approximately two days prior to presentation. She also noted generalized malaise, chills, subjective fever, nausea, vomiting, abdominal pain, and dyspnea on exertion. She became short of breath with minimal activity. Past medical history was significant for hepatitis C, polysubstance abuse, and nicotine dependence. Approximately six months prior to current illness, she was hospitalized and treated for staphylococcal left knee septic arthritis.
Initial vital signs were BP 144/71 mmHg, pulse 107 beats/min, temperature 98.1°F (36.7°C), respiratory rate 20 breaths/min, and oxygen saturation 99% breathing ambient air. Physical examination demonstrated petechiae and ecchymosis on all four extremities along with several tender erythematous nodules. She also had jugular venous distention to the angle of the mandible. There were bibasilar rales on pulmonary examination and a 2/6 intensity holodiastolic murmur was present at the 2nd right interspace on cardiac examination. There was mild bilateral lower extremity pitting edema. The remainder of the physical exam was unremarkable. Laboratory data demonstrated serum sodium 131 mEq/L, potassium 3.0 mEq/L, chloride 97 mEq/L, bicarbonate 24 mEq/L, BUN 21 mg/dl, creatinine 1.01 mg/dl, and glucose of 110 mg/dL. Cardiac troponin was undetectable. White blood cell count was 9.3 k/μl, hemoglobin 14.3 g/dl, hematocrit 41.5%, and platelet count 99 k/μl. Blood cultures grew Methicillin Sensitive Staphylococcus aureus (MSSA). Electrocardiogram demonstrated accelerated junctional rhythm at 99 beats/minute with retrograde P waves ().
Transthoracic echocardiogram revealed normal LV chamber dimension, wall motion, and left ventricular ejection fraction estimated at 60–65%. The aortic valve was not clearly visualized but aortic regurgitation was noted with continuous wave and color flow Doppler. Transesophageal echocardiogram revealed severe aortic regurgitation; pressure half-time of the regurgitant jet was 320 ms. A large mobile mass measuring 1.3 cm by 1.0 cm was attached to the septal wall of the left ventricular outflow tract (LVOT) (Figures and ). The mass was attached at the site of a jet lesion where the aortic valve regurgitant jet contacted the LVOT wall ().
She was treated with intravenous antibiotics. Due to the size and location of the vegetation, she was referred for aortic valve replacement and resection of the LVOT vegetation. Pathologic analysis of the native aortic valve revealed a 0.6 × 0.4 cm ovoid perforation of the noncoronary leaflet likely due to prior endocarditis with acute vegetation on the septal surface of the LVOT under the right coronary leaflet. The patient did well postoperatively and was treated adequately with a six-week course of intravenous antibiotics.",What is the patient's Glasgow-Blatchford Bleeding score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [107, 'beats per minute'], 'Blood Urea Nitrogen (BUN)': [21, 'mg/dL'], 'sex': 'Female', 'Cardiac failure present': True, 'Hemoglobin': [14.3, 'g/dL'], 'Systolic Blood Pressure': [144, 'mm Hg'], 'Hepatic disease history': True}",7,7,7,"The criteria for the Glasgow-Blatchford Score are listed below:

1. BUN (mg/dL): <18.2 = 0 points, 18.2-22.3 = +2 points, 22.4-28 = +3 points, 28-70 = +4 points, >70 = +6 points
2. Hemoglobin (g/dL) for men: >=13 = 0 points, <=12-13 = +1 point, <=10-12 = +3 points, <10 = +6 points
3. Hemoglobin (g/dL) for women: >=12 = 0 points, <=10-12 = +1 point, <10 = +6 points
4. Systolic blood pressure (mm Hg): ≥110 = 0 points, 100-109 = +1 point, 90-99 = +2 points, <90 = +3 points
5. Pulse ≥100 (per minute): No = 0 points, Yes = +1 point
6. Melena present: No = 0 points, Yes = +1 point
7. Presentation with syncope: No = 0 points, Yes = +1 point
8. Liver disease history: No = 0 points, Yes = +1 point
9. Cardiac failure present: No = 0 points, Yes = +1 point

The total Glasgow-Blatchford Score is calculated by summing the points for each criterion.
The current glasgow bleeding score is 0. The patient's gender is Female.
The concentration of hemoglobin is 14.3 g/dL. Because the patient is a female and her hemoglobin concentration is greater than or equal to 12 mg/dL, we do not add any points, keeping the current score at 0.
The concentration of BUN is 21 mg/dL. The BUN concentration is greater than equal to 18.2 mg/dL, but less than 22.4 mg/dL, and so we add two points, making the current score 0 + 2 = 2.
The patient's blood pressure is 144 mm Hg. Because the patient's systolic blood pressure is greater than or equal to 110 mm Hg, we do not add points to the score, keeping the current score at 2.
The patient's heart rate is 107 beats per minute. Because the heart rate is greater or equal to than 100 beats per minute, we increase the score by one point, making the current score 2 + 1 = 3.
The patient's status for melena is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 3.
The patient's status for recent syncope is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 3.
The patient has a hepatic disease history, and so we add two points to the current total, making the current total 3 + 2 =  5.
The patient has a cardiac failure, and so we add two points to the current total, making the current total 5 + 2 =  7.
The patient's Glasgow Bleeding Score is 7."
400,27,Glasgow-Blatchford Bleeding Score (GBS),risk,integer,pmc-3970313-1,Extracted,"A 71-year-old male was admitted due to headache, dizziness, and nausea for three days. He was healthy, except that he had been diagnosed with hypertension two years before. His past medical history was unremarkable. His social history included intermittent alcohol consumption without smoking. The initial vital signs revealed blood pressure of 120/80 mmHg, heart rate of 76 beats per minute, respiration rate of 18 breaths per minute and body temperature of 36.9℃. He was alert upon admission. Physical examination revealed clear lung sound without rale or wheezing. The heart beat was regular without any murmur. There was no tenderness or rebound tenderness in the abdomen. Findings from other physical and neurological examinations were normal. There were no other symptoms such as fever, neck stiffness, photophobia, papilledema or other abnormalities. The initial peripheral blood count showed a white blood cell count of 11,200/mm3 (neutrophils 64.6%, lymphocytes 24.5%, monocytes 6.8%), hemoglobin level of 13.0 g/dL, platelet count of 211,000/mm3, erythrocyte sedimentation rate of 38 mm/hr, and C-reactive protein level of 1.11 mg/dL. Blood chemistry showed a total protein level of 7.6 g/dL, albumin level of 4.3 g/dL, total bilirubin level of 0.9 mg/dL, aspartate aminotransferase/alanine aminotransferase 27/16 IU/L, alkaline phosphatase 77 IU/L, BUN/Cr 9.2/0.8 mg/dL, Na/K 136/3.8 mEq/L, and Ca/P 9.0/4.7 mg/dL. Result of urinalysis was normal. Human immunodeficiency virus (HIV) antibody, hepatitis B surface antigen and hepatitis C antibody were all negative. Chest and abdomen radiographs were normal. Brain CT scan and magnetic resonance (MR) imaging showed multiple rim enhancing lesions with surrounding edema, which was presumed to be a brain abscess ().
After admission, the patient underwent a craniotomy with stereotactic aspiration of the abscess. During the operation, yellowish and turbid pus was aspirated and a cerebral abscess was diagnosed. Empirical parenteral antibiotics were started with ceftriaxone 2 g bid and metronidazole 500 mg tid. Gram stain of the pus showed beaded branching gram-positive bacilli. Urease test, esculin hydrolysis test, citrate test, and modified acid-fast stain using 1% acid alcohol were all positive and the bacteria grew at 42℃. Nocardia species were suggested by colonial morphology, Gram-stain, and modified acid fast bacillus (AFB) stain (). By manual, culture was identified as Nocardia species. For the accurate identification of Nocardia species, 16S ribosomal RNA (rRNA) gene-based polymerase chain reaction (PCR) and sequencing was carried out. Primers of 27F (5'-AGA GTT TGA TCM TGG CTC AG-3') and 1492R (5'-TAC GGY TAC CTT GTT ACG ACT T-3') were used for 16S rRNA gene amplification. Size of 1466 bp 16S rRNA gene amplification sequencing was carried out by Solgent (Solgent Co, Daejeon, Korea) company which uses Big Dye Terminator Cycle Sequencing Kit and ABI PRISM 3730 DNA analyzer (PE Applied Biosystem, Foster, CA, USA). It showed 100% concordance to N. farcinica (GenBank accession number: KC478309) by BLAST Similarity Searching in GenBank. The organism was susceptible to amikacin, imipenem, trimethoprim-sulfamethoxazole (TMP-SMX), ciprofloxacin, and resistant to erythromycin, kanamycin, ampicillin, gentamicin. After identifying the result of pus culture, the antibiotic regimen was changed to TMP-SMX (15 mg/kg of the TMP component per day) and imipenem 500 mg qid. Due to the persistence of the patient's symptoms, re-imaging was performed two weeks later. On day 24 of admission, the patient underwent a repeated craniotomy with stereotactic aspiration of the abscess because the abscess and surrounding edema have increased than before. Ciprofloxacin (400 mg every 12 h, intravenous) was added to the TMP-SMX treatment and changed from imipenem to meropenem. After performance of repeated surgery and administration of additional antibiotics, we observed improvement of the patient's symptoms. Contrast-enhanced brain CT scan performed three weeks after reoperation, showed substantial resolution of the brain lesion. Meropenem and ciprofloxacin were continued for six weeks. On hospital day 67, he was discharged to go home to complete four months of oral TMP-SMX therapy. On three-month follow-up brain CT after discharge, resolution of the brain abscess was confirmed.",What is the patient's Glasgow-Blatchford Bleeding score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [76, 'beats per minute'], 'Blood Urea Nitrogen (BUN)': [9.2, 'mg/dL'], 'sex': 'Male', 'Cardiac failure present': False, 'Hemoglobin': [13.0, 'g/dL'], 'Hepatic disease history': False, 'Systolic Blood Pressure': [120, 'mm Hg']}",0,0,0,"The criteria for the Glasgow-Blatchford Score are listed below:

1. BUN (mg/dL): <18.2 = 0 points, 18.2-22.3 = +2 points, 22.4-28 = +3 points, 28-70 = +4 points, >70 = +6 points
2. Hemoglobin (g/dL) for men: >=13 = 0 points, <=12-13 = +1 point, <=10-12 = +3 points, <10 = +6 points
3. Hemoglobin (g/dL) for women: >=12 = 0 points, <=10-12 = +1 point, <10 = +6 points
4. Systolic blood pressure (mm Hg): ≥110 = 0 points, 100-109 = +1 point, 90-99 = +2 points, <90 = +3 points
5. Pulse ≥100 (per minute): No = 0 points, Yes = +1 point
6. Melena present: No = 0 points, Yes = +1 point
7. Presentation with syncope: No = 0 points, Yes = +1 point
8. Liver disease history: No = 0 points, Yes = +1 point
9. Cardiac failure present: No = 0 points, Yes = +1 point

The total Glasgow-Blatchford Score is calculated by summing the points for each criterion.
The current glasgow bleeding score is 0. The patient's gender is Male.
The concentration of hemoglobin is 13.0 g/dL. Because the patient is a male and his hemoglobin concentration is greater than or equal to 13 g/dL, we do not add any points, keeping the current score at 0.
The concentration of BUN is 9.2 mg/dL. The BUN concentration is less than 18.2 mg/dL, and so we do not make any changes to the score, keeping the score at 0.
The patient's blood pressure is 120 mm Hg. Because the patient's systolic blood pressure is greater than or equal to 110 mm Hg, we do not add points to the score, keeping the current score at 0.
The patient's heart rate is 76 beats per minute. Because the heart rate is less than 100 beats per minute, we do not change the score, keeping the current score at 0.
The patient's status for melena is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 0.
The patient's status for recent syncope is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 0.
The patient's status for hepatic disease history is reported to be absent for the patient, and so we do not add any points, keeping the current total at 0.
The patient's status for cardiac failure is reported to be absent for the patient, and so we do not add any points, keeping the current total at 0.
The patient's Glasgow Bleeding Score is 0."
401,27,Glasgow-Blatchford Bleeding Score (GBS),risk,integer,pmc-7358196-1,Extracted,"A 72-year-old Caucasian (white) man with a history of diffuse large B-cell lymphoma (DLBCL), immunoglobin M (IgM) monoclonal gammopathy of undetermined significance (MGUS), and chronic back pain secondary to osteoarthritis presented with dyspnea and a left pleural effusion. His social history was notable for a 60 pack-year cigarette smoking, and he had cut down to five cigarettes a day after diagnosis of non-Hodgkin’s lymphoma (NHL). He denied any significant past alcohol abuse, illicit drug abuse, or prescription drug abuse and reported consuming a beer or two on rare social occasions. Our patient was adopted so he is unaware of any past family history in regard to his parents. His brother has high blood pressure; otherwise he reported no other known malignancy or cardiopulmonary disease in the family. He worked as a mechanic and retired 20 years ago. He denied any known environmental exposures or allergies. Home medications included a daily probiotic, florastor 250 mg 2 tablets once daily, and acetaminophen/oxycodone – 325 mg/5 tablets once a day as needed for severe back pain. Our patient explained that he took opiate pain medication two to three times a week. Seven years prior, a bone marrow (BM) biopsy had revealed DLBCL, stage IVB, and he achieved complete remission (CR) with rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone (R-CHOP). Two years prior, he was diagnosed with monoclonal IgM kappa MGUS and BM biopsy revealed B-cell lymphoma with plasmacytic differentiation (10% of the marrow cellularity). The differential diagnosis at this time included LPL and marginal zone lymphoma. Given that he was asymptomatic at this time, he was monitored without treatment.
In the Emergency Department (ED), his vital signs were a pulse of 88 beats per minute, his blood pressure was 145/62, and temperature was 98.7 degrees Fahrenheit. His oxygen saturation was 95% on room air and he was mildly tachypneic with a respiratory rate of 24 breaths per minute. At physical examination, he appeared well, he was well nourished, awake, and in no apparent distress. An ear, nose, mouth and throat examination showed clear nasal mucosa and normal mouth mucosa. His head was atraumatic/normocephalic. His heart rate was normal, with a regular rhythm, heart sounds were S1, S2, and there were no murmurs, rubs or gallops. There were rales in his left lung base without wheeze or rhonchi. His abdomen was soft, non-distended, and non-tender. His lumbar spine showed a mild reduction in range of motion. He showed superficial bilateral inguinal lymphadenopathy. He was alert and oriented × 4, with no focal deficits, and no motor or sensory deficits. His CN II-XII were intact, extremities showed no cyanosis or edema, and his skin was dry, intact, with no rash. Our patient was given one ipratropium bromide/albuterol nebulizer treatment and two doses of morphine 1 mg for back pain. During the admission, our patient received tramadol 50 mg once for back pain and required no other medication. His complete blood count showed a white blood cell count of 6.2 × 109/L, hemoglobin of 13.8 g/dL, platelet count of 156 × 109/L with normal differential. The complete metabolic panel showed sodium of 141 mEq/L, potassium of 3.8 mEq/L, blood urea nitrogen of 18 mg/dL and creatinine of 1.0 mg/dL, glucose of 95 mg/dL, calcium of 9.2, albumin 3.8 g/dL, aspartate aminotransferase of 23 IU/L, and alanine aminotransferase of 32 IU/L, alkaline phosphatase of 46, and total bilirubin of 0.6. The urinalysis was within normal limits with no evidence of hematuria, pyuria, nitrates were not detected, and there were no bacteria. A computed tomography scan of his chest (Fig. ), abdomen, and pelvis showed layering left pleural effusion and para-aortic retroperitoneal lymphadenopathy extending to the iliacs and superficial inguinal nodes. Pleural fluid (PF) cytology was positive for malignant cells consistent with B-cell lymphoma and positive for MYD88 L265P mutation.
PF flow cytometry showed monoclonal kappa B-cell population with moderate CD19, CD20, CD22, and CD38 expression (Fig. ).
Inguinal lymph node biopsy showed lymphoplasmacytic, monoclonal B-cell population, CD20-positive, CD5-negative, CD10-negative B-cells, consistent with LPL/WM (Fig. ).
In comparison to his BM biopsy 2 years prior, the current study shows an increase in marrow involvement by B-cell lymphoma with plasmacytic differentiation. The findings in conjunction with IgM monoclonal paraprotein favor LPL, and the positive MYD88 L265P mutation analysis supports this impression. Congo red stain was negative for amyloid (Fig. ).
The pleural effusion recurred post-thoracentesis and 420 mg ibrutinib was initiated, but due to intolerance with nausea and vomiting, required a dose reduction to 240 mg. He achieved a lasting CR as defined by National Comprehensive Cancer Network (NCCN) guidelines []. Seven months after initial presentation to the ED, he remains in CR and is tolerating a reduced dose of imantinib without any side effects.",What is the patient's Glasgow-Blatchford Bleeding score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [88, 'beats per minute'], 'Blood Urea Nitrogen (BUN)': [18, 'mg/dL'], 'sex': 'Male', 'Systolic Blood Pressure': [145, 'mm Hg'], 'Hemoglobin': [13.8, 'g/dL']}",0,0,0,"The criteria for the Glasgow-Blatchford Score are listed below:

1. BUN (mg/dL): <18.2 = 0 points, 18.2-22.3 = +2 points, 22.4-28 = +3 points, 28-70 = +4 points, >70 = +6 points
2. Hemoglobin (g/dL) for men: >=13 = 0 points, <=12-13 = +1 point, <=10-12 = +3 points, <10 = +6 points
3. Hemoglobin (g/dL) for women: >=12 = 0 points, <=10-12 = +1 point, <10 = +6 points
4. Systolic blood pressure (mm Hg): ≥110 = 0 points, 100-109 = +1 point, 90-99 = +2 points, <90 = +3 points
5. Pulse ≥100 (per minute): No = 0 points, Yes = +1 point
6. Melena present: No = 0 points, Yes = +1 point
7. Presentation with syncope: No = 0 points, Yes = +1 point
8. Liver disease history: No = 0 points, Yes = +1 point
9. Cardiac failure present: No = 0 points, Yes = +1 point

The total Glasgow-Blatchford Score is calculated by summing the points for each criterion.
The current glasgow bleeding score is 0. The patient's gender is Male.
The concentration of hemoglobin is 13.8 g/dL. Because the patient is a male and his hemoglobin concentration is greater than or equal to 13 g/dL, we do not add any points, keeping the current score at 0.
The concentration of BUN is 18 mg/dL. The BUN concentration is less than 18.2 mg/dL, and so we do not make any changes to the score, keeping the score at 0.
The patient's blood pressure is 145 mm Hg. Because the patient's systolic blood pressure is greater than or equal to 110 mm Hg, we do not add points to the score, keeping the current score at 0.
The patient's heart rate is 88 beats per minute. Because the heart rate is less than 100 beats per minute, we do not change the score, keeping the current score at 0.
The patient's status for melena is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 0.
The patient's status for recent syncope is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 0.
The patient's status for hepatic disease history is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 0.
The patient's status for cardiac failure is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 0.
The patient's Glasgow Bleeding Score is 0."
402,27,Glasgow-Blatchford Bleeding Score (GBS),risk,integer,pmc-4421692-1,Extracted,"A 34-year-old Caucasian female with prior history of hypertension was admitted at the Department of Ophthalmology of our hospital for bilateral red eye. She had no previous ocular trauma or surgery, and no other complaints. Ophthalmological examination showed bilateral diffuse anterior scleritis. Visual acuity was preserved. On admission, blood pressure was of 150/100 mmHg, and heart rate was of 72 beats per minute. Ear, nose and mouth examination was normal, and cardiac, pulmonary, abdominal, neurological and lower limbs examination also revealed no changes. Neither joint tenderness or effusion nor rash, nor peripheral lymphadenopathies were detected. There was no genital ulceration. The laboratory disclosed normal renal function (creatinaemia 1.18 mg/dL; blood urea nitrogen 40 mg/dL) and normal haemoglobin (12.9 g/dL). Urinalysis featured microscopic haematuria (150 erythrocytes/microlitre) and proteinuria of 3.59 g/day. Serum albumin was 3.4 g/dL, and there was evidence of high total cholesterol level (total cholesterol, 254 mg/dL). Serum protein electrophoresis, serum protein immunoelectrophoresis, hepatic function tests, erythrocyte sedimentation rate and C-reactive protein were normal. Serology for lupus (antinuclear, anti-double strand deoxyribonucleic acid, anti-Smith, extractable nuclear and anti-ribonucleoprotein antibodies) and vasculitis (anti-neutrophil cytoplasmic antibodies) as well as the search for cryoglobulins was negative. Rheumatoid factor was negative, and serum C3 and serum C4 were on the normal range. Serology for human immunodeficiency virus types 1 and 2, hepatitis B, hepatitis C, syphilis, and Lyme disease was also negative. Chest X-ray was normal. Renal ultrasound revealed normal-sized and normoechoic kidneys, normal differentiation, and no hydronephrosis. A kidney biopsy was performed, and revealed diffuse mesangial hypercellularity () and diffuse granular mesangial deposits of IgA (). According to these, the diagnosis of IgAN was established. She started oral prednisolone (1 mg/kg/day), lisinopril (20 mg/day), losartan (50 mg/day) and simvastatin (20 mg/day). Six months later, she was asymptomatic, and no other episodes of scleritis occurred. Ophthalmological examination was normal. Proteinuria decreased but still persisted in non-nephrotic range (2.3 g/24 h). Renal function still remains normal.",What is the patient's Glasgow-Blatchford Bleeding score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [72, 'beats per minute'], 'Blood Urea Nitrogen (BUN)': [40, 'mg/dL'], 'sex': 'Female', 'Cardiac failure present': False, 'Hemoglobin': [12.9, 'g/dL'], 'Systolic Blood Pressure': [150, 'mm Hg'], 'Hepatic disease history': False}",4,4,4,"The criteria for the Glasgow-Blatchford Score are listed below:

1. BUN (mg/dL): <18.2 = 0 points, 18.2-22.3 = +2 points, 22.4-28 = +3 points, 28-70 = +4 points, >70 = +6 points
2. Hemoglobin (g/dL) for men: >=13 = 0 points, <=12-13 = +1 point, <=10-12 = +3 points, <10 = +6 points
3. Hemoglobin (g/dL) for women: >=12 = 0 points, <=10-12 = +1 point, <10 = +6 points
4. Systolic blood pressure (mm Hg): ≥110 = 0 points, 100-109 = +1 point, 90-99 = +2 points, <90 = +3 points
5. Pulse ≥100 (per minute): No = 0 points, Yes = +1 point
6. Melena present: No = 0 points, Yes = +1 point
7. Presentation with syncope: No = 0 points, Yes = +1 point
8. Liver disease history: No = 0 points, Yes = +1 point
9. Cardiac failure present: No = 0 points, Yes = +1 point

The total Glasgow-Blatchford Score is calculated by summing the points for each criterion.
The current glasgow bleeding score is 0. The patient's gender is Female.
The concentration of hemoglobin is 12.9 g/dL. Because the patient is a female and her hemoglobin concentration is greater than or equal to 12 mg/dL, we do not add any points, keeping the current score at 0.
The concentration of BUN is 40 mg/dL. The BUN concentration is between 28 and 70 mg/dL, and so we add four points, making the current score 0 + 4 = 4.
The patient's blood pressure is 150 mm Hg. Because the patient's systolic blood pressure is greater than or equal to 110 mm Hg, we do not add points to the score, keeping the current score at 4.
The patient's heart rate is 72 beats per minute. Because the heart rate is less than 100 beats per minute, we do not change the score, keeping the current score at 4.
The patient's status for melena is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 4.
The patient's status for recent syncope is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 4.
The patient's status for hepatic disease history is reported to be absent for the patient, and so we do not add any points, keeping the current total at 4.
The patient's status for cardiac failure is reported to be absent for the patient, and so we do not add any points, keeping the current total at 4.
The patient's Glasgow Bleeding Score is 4."
403,27,Glasgow-Blatchford Bleeding Score (GBS),risk,integer,pmc-5081674-1,Extracted,"A 93-year old man was brought to the emergency room for recent neurological deterioration. His past medical history was relevant for hypertension, diabetes mellitus, dyslipidemia, coronary artery disease, chronic atrial fibrillation and mild memory loss. He had no history of kidney disease. His chronic medication included clopidogrel, acenocoumarol, amlodipine, atorvastatin, molsidomine and furosemide; he was on levofloxacin since two weeks for pneumonia. On admission, the patient’s physical examination revealed obnubilation with episodes of agitation, a blood pressure of 160/80 mmHg, an irregular heart rate of 50 beats per minute (bpm), jugular venous distention, decreased bilateral basal breath sounds, no fever and no leg edema. He was not obese. Initial abnormal serum laboratory results included: white blood cell (WBC) count of 12630/mm3 (84 % neutrophils), international normalized ratio (INR) of 4.5, creatinine of 2.3 mg/dL (203 μmol/L), blood urea nitrogen (BUN) of 80 mg/dL (28.5 mmol/L), albumin of 3.2 g/dL (32 g/L), phosphorus of 5.9 mg/dL (1.96 mmol/L) and gamma glutamyl transferase of 275 UI/L. He had a positive troponin I of 0.27 ng/mL but normal CPK and CPK-MB. C-reactive protein was 19 mg/L. He had no electrolytes’ disturbance (potassium 4.9 mmol/L, sodium 144 mmol/L, chloride 110 mmol/L, bicarbonate 23 mmol/L), no hypocalcemia (corrected calcium 8.9 mg/dL) nor anemia (hemoglobin 13.4 g/dL, hematocrit 42 %). Urinalysis showed 3+ protein.
Further investigations revealed left lung basal consolidation with bilateral effusion on chest X-ray. The arterial blood gas (ABG) showed: pH 7.27, PaO2 91 mmHg, PaCO2 52 mmHg, HCO3ˉ 23 mmol/L. Electrocardiogram (ECG) on admission showed a slow atrial fibrillation of 55 bpm (Fig. ). Brain computed tomography (CT) scanning ruled out possible ischemic or hemorrhagic stroke.
The patient was admitted to the intensive care unit (ICU). An echocardiography showed a left ventricular ejection fraction (LVEF) of 40 %, ventricular hypertrophy, pulmonary arterial pressure of 40 mmHg, dilated right ventricle and slightly enlarged left atrium. Renal ultrasound was normal.
Empiric antibiotics were started combining ceftriaxone and levofloxacin; fluconazole was added at day 2 after sputum cultures grew Candida albicans. Urine culture was sterile.
During cardiac monitoring in the ICU, episodes of extreme bradycardia were noticed as low as 32 bpm with maintained systolic blood pressure at 100–120 mmHg and very low diastolic blood pressure of 30–40 mmHg.
On day 3, the patient became unconscious and developed severe respiratory acidosis with ABG showing: pH 7.16, PaCO2 64 mmHg, PaO2 75 mmHg, HCO3ˉ 22 mmol/L and he was intubated. He concomitantly became oligoanuric and serum creatinine started to increase. A spot urine test revealed a sodium (Na) of 22 mmol/L and potassium (K) of 34 mmol/L with a ratio Na/K <1. He received sodium bicarbonate whenever his bicarbonate level was less than 22.
Complete AV block was then identified on ECG. A temporary pacemaker was implanted on day 5 and the patient was extubated. Serum creatinine decreased and urine output improved considerably. Table illustrates the heart rate (HR), urine output, systolic and diastolic blood pressure values, serum creatinine and potassium variations before and after the pacemaker insertion.
The patient finally got a permanent single chamber pacemaker VVIR and improved considerably his consciousness and renal function. At discharge he had a serum creatinine of 1.6 mg/dL and he was conscious, alert and well oriented.",What is the patient's Glasgow-Blatchford Bleeding score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [50, 'beats per minute'], 'Blood Urea Nitrogen (BUN)': [80, 'mg/dL'], 'sex': 'Male', 'Cardiac failure present': True, 'Hemoglobin': [13.4, 'g/dL'], 'Systolic Blood Pressure': [160, 'mm Hg']}",8,8,8,"The criteria for the Glasgow-Blatchford Score are listed below:

1. BUN (mg/dL): <18.2 = 0 points, 18.2-22.3 = +2 points, 22.4-28 = +3 points, 28-70 = +4 points, >70 = +6 points
2. Hemoglobin (g/dL) for men: >=13 = 0 points, <=12-13 = +1 point, <=10-12 = +3 points, <10 = +6 points
3. Hemoglobin (g/dL) for women: >=12 = 0 points, <=10-12 = +1 point, <10 = +6 points
4. Systolic blood pressure (mm Hg): ≥110 = 0 points, 100-109 = +1 point, 90-99 = +2 points, <90 = +3 points
5. Pulse ≥100 (per minute): No = 0 points, Yes = +1 point
6. Melena present: No = 0 points, Yes = +1 point
7. Presentation with syncope: No = 0 points, Yes = +1 point
8. Liver disease history: No = 0 points, Yes = +1 point
9. Cardiac failure present: No = 0 points, Yes = +1 point

The total Glasgow-Blatchford Score is calculated by summing the points for each criterion.
The current glasgow bleeding score is 0. The patient's gender is Male.
The concentration of hemoglobin is 13.4 g/dL. Because the patient is a male and his hemoglobin concentration is greater than or equal to 13 g/dL, we do not add any points, keeping the current score at 0.
The concentration of BUN is 80 mg/dL. The BUN concentration is greater than 70 mg/dL, and so we add six points, making the current score 0 + 6 = 6.
The patient's blood pressure is 160 mm Hg. Because the patient's systolic blood pressure is greater than or equal to 110 mm Hg, we do not add points to the score, keeping the current score at 6.
The patient's heart rate is 50 beats per minute. Because the heart rate is less than 100 beats per minute, we do not change the score, keeping the current score at 6.
The patient's status for melena is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 6.
The patient's status for recent syncope is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 6.
The patient's status for hepatic disease history is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 6.
The patient has a cardiac failure, and so we add two points to the current total, making the current total 6 + 2 =  8.
The patient's Glasgow Bleeding Score is 8."
404,27,Glasgow-Blatchford Bleeding Score (GBS),risk,integer,pmc-4446924-1,Extracted,"A 38-year-old man presented with nausea, vomiting and loose stools of 2 days duration. Patient gave history of consumption of a tuber taken from the nearby forest with the intent of deliberate self-harm. Patient has consumed the tuber 6 days prior to the presentation. It was followed by nausea, vomiting, loose stools and haematochezia on 4th day. He also complained haematuria and bleeding from gums and rectum on 5th day. On 6th day he observed scalp hair fall, and easy pluckability of beard, moustache and body hair. He also complained oliguria on day 6. Patient's wife has brought the tuber. It was identified as G. superba. Patient revealed that he had consumed 250 g of the tuber along with water.
Patient had no history of any illness. He was apprehensive, with pulse rate of 120 bpm, blood pressure 70/40 mmHg, febrile, with congestion of conjunctivae. The pillow and bed were full of his hair. Patient himself demonstrated easy pluckability of hair. His investigations were, haemoglobin 6.0 g/dl, total leucocyte count 14,000/mm3, differential count: polymorphs: 60, lymphocytes 30, monocytes 5, eosinophils 5%, erythrocyte sedimentation rate 40 mm after first hour, platelet counts 0.24 lakhs/mm3, peripheral smear showed no abnormal cells and no features of haemolysis, there was thrombocytopenia, random blood glucose 120 mg/dl, serum creatinine 5.4 mg/dl, blood urea nitrogen 87.85 mg/dl, serum sodium 127 mEq/L, serum potassium 3.9 mEq/L, serum chloride 88 mEq/L, serum bicarbonate 12.0 mmol/L, serum bilirubin 1.0 mg/dl, serum glutamic oxaloacetic transaminase 45 U/L, serum glutamic pyruvic transaminase: 65 U/L, serum alkaline phosphatase 125 U/L, serum proteins 6.9 g/dl, serum albumin 4.3 g/dl, serum creatinine kinase 65 IU/L (reference range: 40–200 IU/L), fractional excretion of sodium <1%, urine microscopy showed plenty of red blood cells and urine myoglobin was negative. Ultrasound abdomen revealed normal sized kidneys. Electrocardiogram showed T inversion in V4, V5, and V6. Chest radiograph was normal.
He was initiated on intravenous fluids, sodium bicarbonate supplementation and ionopressors. He was transfused with two units of whole blood. Blood pressure improved after 24 h. The bleeding manifestations subsided over next 72 h. Serum creatinine fell over next 6 days. Hair loss continued for next 10 days. He lost entire scalp hair. Patient regained scalp hair after 4 months.",What is the patient's Glasgow-Blatchford Bleeding score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [120, 'beats per minute'], 'Blood Urea Nitrogen (BUN)': [87.85, 'mg/dL'], 'sex': 'Male', 'Hemoglobin': [6.0, 'g/dL'], 'Melena present': False, 'Systolic Blood Pressure': [70, 'mm Hg']}",16,16,16,"The criteria for the Glasgow-Blatchford Score are listed below:

1. BUN (mg/dL): <18.2 = 0 points, 18.2-22.3 = +2 points, 22.4-28 = +3 points, 28-70 = +4 points, >70 = +6 points
2. Hemoglobin (g/dL) for men: >=13 = 0 points, <=12-13 = +1 point, <=10-12 = +3 points, <10 = +6 points
3. Hemoglobin (g/dL) for women: >=12 = 0 points, <=10-12 = +1 point, <10 = +6 points
4. Systolic blood pressure (mm Hg): ≥110 = 0 points, 100-109 = +1 point, 90-99 = +2 points, <90 = +3 points
5. Pulse ≥100 (per minute): No = 0 points, Yes = +1 point
6. Melena present: No = 0 points, Yes = +1 point
7. Presentation with syncope: No = 0 points, Yes = +1 point
8. Liver disease history: No = 0 points, Yes = +1 point
9. Cardiac failure present: No = 0 points, Yes = +1 point

The total Glasgow-Blatchford Score is calculated by summing the points for each criterion.
The current glasgow bleeding score is 0. The patient's gender is Male.
The concentration of hemoglobin is 6.0 g/dL. Because the patient is a male and his hemoglobin concentration is less than 10 and 12 g/dL, we add six points, making the current score 0 + 6 = 6.
The concentration of BUN is 87.85 mg/dL. The BUN concentration is greater than 70 mg/dL, and so we add six points, making the current score 6 + 6 = 12.
The patient's blood pressure is 70 mm Hg. Because the patient's systolic blood pressure is less than 90 mm Hg, we increase the score by three points, making the current score 12 + 3 = 15.
The patient's heart rate is 120 beats per minute. Because the heart rate is greater or equal to than 100 beats per minute, we increase the score by one point, making the current score 15 + 1 = 16.
The patient's status for melena is reported to be absent for the patient, and so we do not add any points, keeping the current total at 16.
The patient's status for recent syncope is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 16.
The patient's status for hepatic disease history is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 16.
The patient's status for cardiac failure is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 16.
The patient's Glasgow Bleeding Score is 16."
405,27,Glasgow-Blatchford Bleeding Score (GBS),risk,integer,pmc-7924906-1,Extracted,"A 91-year-old male with hypertension, coronary artery disease, and a longstanding history of CD, noncompliant with a gluten-free diet, presented to the ED for evaluation of intermittent upper abdominal pain and unintentional weight loss of 10 pounds over a period of two months. His vital signs were initially normal, however, after an episode of hematemesis followed by hematochezia, he became hypotensive to 80/60 mmHg and tachycardic to 100 beats/min. Physical examination was notable for pale conjunctiva and tenderness to palpation in the upper abdomen. Laboratory evaluation revealed a white blood cell count of 13.2 x 103/uL (reference (R): 4.5-11.0 x 103/uL), hemoglobin of 5.9 g/dL (R: 12-17 g/dL), blood urea nitrogen of 34 mg/dL (R: 5-25 mg/dL), and creatinine of 0.8 mg/dL (R: 0.6-1.8 mg/dL). CT of the abdomen and pelvis demonstrated a 6.8 cm dilated proximal jejunum (Figure ).
The patient was resuscitated with four units of packed red blood cells and two liters of normal saline. Intravenous pantoprazole was administered. Surgery was consulted and a nasogastric tube was placed for gastric decompression. Small bowel enteroscopy discovered two nonbleeding superficial clean-based ulcers in the duodenum and an ulcerated jejunal mass, which appeared to be the source of bleeding. Biopsies from the mass showed an invasive, poorly differentiated adenocarcinoma. Subsequently, exploratory laparotomy revealed additional masses in the ileum and transverse colon suspicious for malignancy; thus, partial small bowel and partial colonic resection with end colostomy and Hartmann’s pouch were performed. The mass in the jejunum measured 1.7 cm x 1 cm x 0.2 cm. Pathologic evaluation revealed invasive, poorly differentiated carcinoma with gland formation only in the lesion resected from jejunum (Figure ). Cytokeratin was immunoreactive (Figure ). CK7, CK20, TTF-1, LCA, CD56, synaptophysin, and chromogranin stains were negative. Regional resected lymph nodes and other resected lesions were devoid from cancer. The American Joint Committee of Cancer (AJCC) stage was pT2N0. The patient’s post-operative course was uncomplicated, and he was discharged with outpatient oncology follow up. On follow up visit four weeks after surgery, the patient was recovering well and without any complaints. He was offered chemotherapy, but declined any treatment.",What is the patient's Glasgow-Blatchford Bleeding score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [100, 'beats per minute'], 'Blood Urea Nitrogen (BUN)': [34, 'mg/dL'], 'sex': 'Male', 'Hemoglobin': [5.9, 'g/dL'], 'Melena present': False, 'Systolic Blood Pressure': [80, 'mm Hg']}",14,14,14,"The criteria for the Glasgow-Blatchford Score are listed below:

1. BUN (mg/dL): <18.2 = 0 points, 18.2-22.3 = +2 points, 22.4-28 = +3 points, 28-70 = +4 points, >70 = +6 points
2. Hemoglobin (g/dL) for men: >=13 = 0 points, <=12-13 = +1 point, <=10-12 = +3 points, <10 = +6 points
3. Hemoglobin (g/dL) for women: >=12 = 0 points, <=10-12 = +1 point, <10 = +6 points
4. Systolic blood pressure (mm Hg): ≥110 = 0 points, 100-109 = +1 point, 90-99 = +2 points, <90 = +3 points
5. Pulse ≥100 (per minute): No = 0 points, Yes = +1 point
6. Melena present: No = 0 points, Yes = +1 point
7. Presentation with syncope: No = 0 points, Yes = +1 point
8. Liver disease history: No = 0 points, Yes = +1 point
9. Cardiac failure present: No = 0 points, Yes = +1 point

The total Glasgow-Blatchford Score is calculated by summing the points for each criterion.
The current glasgow bleeding score is 0. The patient's gender is Male.
The concentration of hemoglobin is 5.9 g/dL. Because the patient is a male and his hemoglobin concentration is less than 10 and 12 g/dL, we add six points, making the current score 0 + 6 = 6.
The concentration of BUN is 34 mg/dL. The BUN concentration is between 28 and 70 mg/dL, and so we add four points, making the current score 6 + 4 = 10.
The patient's blood pressure is 80 mm Hg. Because the patient's systolic blood pressure is less than 90 mm Hg, we increase the score by three points, making the current score 10 + 3 = 13.
The patient's heart rate is 100 beats per minute. Because the heart rate is greater or equal to than 100 beats per minute, we increase the score by one point, making the current score 13 + 1 = 14.
The patient's status for melena is reported to be absent for the patient, and so we do not add any points, keeping the current total at 14.
The patient's status for recent syncope is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 14.
The patient's status for hepatic disease history is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 14.
The patient's status for cardiac failure is missing from the patient note and so we assume it is absent from the patient.
Hence, we do not add any points to the score, keeping it at 14.
The patient's Glasgow Bleeding Score is 14."
406,30,Serum Osmolality,lab test,decimal,pmc-8684410-1,Extracted,"A 74-year-old male with a history of two transient ischemic attacks was brought into our facility for altered mental status after being found unconscious by a relative. His social history was significant for 55 pack-years of smoking. Due to his mentation on arrival, no further history was obtained. Vital signs were normal on admission. Physical examination on admission showed non-responsiveness to sternal rub, dry mucous membranes, decreased skin turgor, and thick white plaques around the corners of his mouth. Examination of the extremities showed 1+ bilateral lower leg edema, and pulmonary examination revealed right-sided wheezes and rales.
On admission, the patient had an elevated blood glucose of 662 mg/dL (normal: 70-110 mg/dL), an anion gap of 15, ß-hydroxybutyrate of 1.86 mmol/L (normal: 0.02-0.27 mmol/L), point-of-care (POC) lactate of 3.3 mmol/L (normal: 0.5-2.0 mmol/L), serum potassium of 3.8 mEq/L, urine volume of 850 mL, and no ketones on urinalysis. The arterial blood gas (ABG) showed a pH of 7.48, HCO3 of 24.6, and PCO2 of 33 meq/L. The slightly elevated anion gap on admission is likely multifactorial. It could have been caused by the increase in the negative charge for albumin and enhanced production of lactate seen in metabolic alkalosis []. Conversely, it is also possible that scant ketones, which are produced in a hyperosmolar hyperglycemic state, as seen by mildly elevated β-hydroxybutyrate and the absence of ketones in the urine, could have contributed to the elevated anion gap [].
Additionally, the patient had hypernatremia (sodium of 185 mEq/L corrected for hyperglycemia), acute kidney injury (blood urea nitrogen [BUN] of 49 mg/dL, creatinine [Cr] of 1.55 mg/dL, from a previous baseline Cr of 1.01 mg/dL), and hemoconcentration (hemoglobin [Hb] 17.1 g/dL, hematocrit [Hct] 51.6%). Chest X-ray indicated a potential right lower lung zone infiltrate. Computed tomography (CT) of the chest indicated right lower lobe mass or consolidation, with multiple mediastinal and hilar masses as well as enlarged left axillary nodes compatible with lymphadenopathy, suggestive of malignancy and metastatic disease (Figures , ). CT of the abdomen showed heterogeneous liver attenuation but could not differentiate between nonocclusive disease and metastatic disease. Adrenal nodules and kidney nodular densities were also present (Figure ). CT of the brain showed a suprasellar mass measuring 1.2 x 1.1 x 0.9 cm (Figure ). The patient was started on half normal saline and insulin, and the acute kidney injury significantly improved on day 3; however, no significant improvement in sodium level was noticed after correction for elevated glucose levels (Figure and Table ).
Additional investigations for the refractory hypernatremia showed a urine osmolarity of 699 (normal: 50-1,400), urine sodium of 10 mEq/L (normal: 20 mEq/L), serum AM cortisol of 61.3 ug/dL (normal AM: 6.2-19.4 ug/dL), 1-mg dexamethasone suppression test cortisol of 6.06 ug/dL (normal: <1.8ug/dL) and ACTH of 228 pg/mL (normal: 7.2-63.3 pg/mL) (Table ). MRI of the brain revealed a 1.1 x 1.2 x 1.1 cm enhancing lesion of the optic chiasm without evidence of mass effect (Figure ) and small lymph nodes in deep portions of the bilateral parotid glands that were potential metastasis. Throughout the admission, the patient’s arterial blood gas (ABG) showed a primary respiratory alkalosis with secondary metabolic alkalosis (pH of 7.48, HCO3 of 24.6, PCO2 of 33 meq/L), which was persistent until discharge (pH of 7.48, HCO3 of 27.6 meq/L, PCO2 of 37 mmHg). Additional endocrine investigations demonstrated an follicle-stimulating hormone (FSH) of 0.3 miU/L (normal: 1.5-12.4 miU/L), luteinizing hormone (LH) < 0.3 miU/L (normal: 1.7-8.6 miU/L), testosterone of 27 ng/dL (normal: 264-916 ng/dL), thyroid-stimulating hormone (TSH) of 0.01 u/iU/L (normal: 0.34-5.60 u/iU/L), and prolactin of 9.7 ng/mL (normal: 4.0-15.2 ng/mL). The plan was to obtain a lung biopsy to determine whether the mass was cancerous or not and to conduct a high dexamethasone suppression test for ectopic ACTH production. However, the patient declined further workup or treatment, opting for hospice instead.
Despite initial fluid resuscitation with half normal saline followed by dextrose water, the hypernatremia did not correct. The hypernatremia later resolved after the patient was started on desmopressin on day 7 of admission. The patient was sent home on hospice and was advised to increase his water intake.",What is the patient's serum osmolality in terms of mOsm/kg? You may take the alcohol content as 0 mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Blood Urea Nitrogen (BUN)': [49.0, 'mg/dL'], 'Glucose': [662.0, 'mg/dL'], 'Sodium': [185.0, 'mEq/L']}",424.27778,403.06389,445.49167,"The formula for computing serum osmolality is 2 * Na + (BUN / 2.8) + (glucose / 18), where Na is the concentration of sodium in mmol/L, the concentration of BUN is in mg/dL, and the concentration of glucose is in mg/dL.
The concentration of sodium is 185.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 185.0 mEq. To convert from 185.0 mEq to mmol, convert from mEq to mmol. The compound 185.0 has a valence of 1, and so divide the valence by the value of mEq to get, 185.0 mEq/(1 mEq/mmol) = 185.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 185.0 mEq sodium/L converts to 185.0 mmol sodium/L. 
The concentration of bun is 49.0 mg/dL. 
The concentration of glucose is 662.0 mg/dL. 
Plugging these values into the equation, we get 2 * 185.0 + (49.0 / 2.8) + (49.0 / 18) = 424.27778 mmol/L.The patient's calculated serum osmolality concentration is 424.27778 mmol/L. This is equalivalent to 424.27778 mOsm/kg."
407,30,Serum Osmolality,lab test,decimal,pmc-3856144-1,Extracted,"An 18-year-old man was brought to the emergency department (ED) because of altered mental status. Family reported that he had nausea and vomiting before presenting to the ED. Past medical history was significant for diabetes, diabetic ketoacidosis (DKA), and hypothyroidism. Past surgical and social histories were unremarkable. Home medication was insulin glargine.
Physical exam revealed a lethargic patient. Vitals were blood pressure 130/70 mmHg, pulse 96/minute, respiration 28/minute, temperature was normal. Lung auscultation showed left basal crackles.
Chest radiograph (CXR) showed lower lobe infiltrates and pneumomediastinum (PM). Laboratory results: Arterial blood gas: PH 6.930 (7.350–7.450), PCO2 16 mmHg (35–45), PO2 138 mmHg (81–110), and serum bicarbonate 3 mmol/L (22–26); serum electrolytes: sodium 129 mmol/L (136–144), potassium 6.4 mmol/L (3.3–5.1), and chloride 100 mmol/L (101–111); glucose 1087 mg/dL (60–250), blood urea nitrogen 40 mg/dL (8–26), and creatine 2.68 mg/dL (0.70–1.20). Blood counts were normal.
The patient was intubated for airway protection because of altered mental status. A postintubation CXR showed PM, lower lobe infiltrates, and an air-filled distended stomach. An oral-gastric (OG) tube was placed easily, to decompress the air-filled distended stomach after bagging prior to intubation and in view of nausea and vomiting. A chest computed tomography scan showed multilobar infiltrates suggestive of aspiration pneumonia, PM, and the tip of the OG tube to be in the right hemithorax. The patient underwent a right thoracotomy with the intention to repair the esophageal rupture. Intraoperatively, the tip of the OG tube was found to be retracted into the esophageal lumen. Inspection of the esophagus did not reveal a clear rupture. An OG tube was placed intraoperatively, and a chest tube was placed into the right pleural space.
The patient was given intravenous (IV) fluid for hydration, IV insulin drip, IV metronidazole, and IV levofloxacin. Serial CXRs showed clearing of pneumonic infiltrates and PM. The chest tube was discontinued, and the patient was successfully extubated. After extubation, an esophagogram was performed and showed no extravasation of contrast.",What is the patient's serum osmolality in terms of mOsm/kg? You may take the alcohol content as 0 mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Blood Urea Nitrogen (BUN)': [40.0, 'mg/dL'], 'Glucose': [1087.0, 'mg/dL'], 'Sodium': [129.0, 'mmol/L']}",332.6746,316.04087,349.30833,"The formula for computing serum osmolality is 2 * Na + (BUN / 2.8) + (glucose / 18), where Na is the concentration of sodium in mmol/L, the concentration of BUN is in mg/dL, and the concentration of glucose is in mg/dL.
The concentration of sodium is 129.0 mmol/L. 
The concentration of bun is 40.0 mg/dL. 
The concentration of glucose is 1087.0 mg/dL. 
Plugging these values into the equation, we get 2 * 129.0 + (40.0 / 2.8) + (40.0 / 18) = 332.6746 mmol/L.The patient's calculated serum osmolality concentration is 332.6746 mmol/L. This is equalivalent to 332.6746 mOsm/kg."
408,30,Serum Osmolality,lab test,decimal,usmle-1763,Extracted,"A 35-year-old African American woman comes to the physician because of intermittent palpitations over the past 2 weeks. During this period she has also had constipation and has felt more tired than usual. She was diagnosed with hypertension 4 weeks ago and treatment with chlorthalidone was begun. Her temperature is 36.5°C (97.7°F), pulse is 75/min, and blood pressure is 158/97 mm Hg. Physical examination shows a soft and nontender abdomen. There is mild weakness of the upper and lower extremities. Deep tendon reflexes are 1+ bilaterally. Laboratory studies show:
Hemoglobin 13.5 g/dL
Leukocyte count 5,000/mm3
Serum
Na+ 146 mEq/L
Cl− 100 mEq/L
K+ 2.8 mEq/L
HCO3− 30 mEq/L
Glucose 97 mg/dL
Blood Urea nitrogen 10 mg/dL
Creatinine 0.8 mg/dL
Test of the stool for occult blood is negative. An ECG shows premature atrial complexes. Chlorthalidone is discontinued and oral potassium chloride therapy is begun. One week later, the patient's plasma aldosterone concentration is 26 ng/dL (N=3.6 to 24.0 ng/dL) and plasma renin activity is 0.8 ng/mL/h (N=0.3 to 4.2 ng/mL/h).",What is the patient's serum osmolality in terms of mOsm/kg? You may take the alcohol content as 0 mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Blood Urea Nitrogen (BUN)': [10.0, 'mg/dL'], 'Glucose': [97.0, 'mg/dL'], 'Sodium': [146.0, 'mEq/L']}",300.96032,285.9123,316.00834,"The formula for computing serum osmolality is 2 * Na + (BUN / 2.8) + (glucose / 18), where Na is the concentration of sodium in mmol/L, the concentration of BUN is in mg/dL, and the concentration of glucose is in mg/dL.
The concentration of sodium is 146.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 146.0 mEq. To convert from 146.0 mEq to mmol, convert from mEq to mmol. The compound 146.0 has a valence of 1, and so divide the valence by the value of mEq to get, 146.0 mEq/(1 mEq/mmol) = 146.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 146.0 mEq sodium/L converts to 146.0 mmol sodium/L. 
The concentration of bun is 10.0 mg/dL. 
The concentration of glucose is 97.0 mg/dL. 
Plugging these values into the equation, we get 2 * 146.0 + (10.0 / 2.8) + (10.0 / 18) = 300.96032 mmol/L.The patient's calculated serum osmolality concentration is 300.96032 mmol/L. This is equalivalent to 300.96032 mOsm/kg."
409,30,Serum Osmolality,lab test,decimal,pmc-4901012-1,Extracted,"A 51-year old man had a breakfast cooked with wild mushrooms that he had gathered one day earlier during summer vacation in August, 2010 at the Jujak mountain located on the province of Jeollanam-do, the southern area of Korea. He was a bus driver. He had no particular past medical or social history other than the occasional ingestion of wild mushrooms during recreational hiking. He was healthy before this admission. He did not have a history of trauma, infection, other known underlying cause, or medication use that could explain the occurrence of rhabdomyolysis. He shared the meal with his wife and son who did not eat any more mushrooms due to nausea after ingesting a single piece of mushroom. However, he ate the mushrooms without immediate symptom. Six hours later, he began to complain of vomiting, diarrhea, and myalgia. He visited a local hospital where his general condition worsened and systolic BP fell to 60 mmHg requiring dopamine treatment and endotracheal intubation. Twenty-eight hours after ingestion of the mushrooms, he was transferred to the intensive care unit of our hospital. At the time of admission, he was alert, but acute ill-looking. He complained of generalized myalgia, chest discomfort, palpitations, and dyspnea. Blood pressure was 80/56 mmHg, heart rate 121/min, respiratory rate 25/min, and body temperature 36.3oC. Oliguria was noted with no response to intravenous fluid and furosemide. Systolic murmurs were present on auscultation. Laboratory tests showed the following: hemoglobin 15.9 g/dL, hematocrit 45.9%, leukocyte count 20,740/μL with neutrophil 89.6%, platelet 253,000/μL, C-reactive protein (CRP) 8.36 mg/dL, blood urea nitrogen (BUN) 38.5 mg/dL, serum creatinine 2.84 mg/dL, sodium 140 mEq/L, potassium 4.7 mEq/L, chloride 100 mEq/L, ionized calcium 0.75 mmol/L, glucose 187 mg/dL, cholesterol 221 mg/dL, albumin 4.0 g/dL, aspartate aminotransferase (AST) 1,214 U/L, alanine aminotransferase (ALT) 343 U/L, total bilirubin 0.51 mg/dL, alkaline phosphatase 92 IU/L, creatine kinase (CK) 69,121 U/L, CK-MB > 500 ng/mL, lactate dehydrogenase (LDH) 2,196 U/L, troponin I 1.86 ng/mL, N-terminal pro brain natriuretic peptide (NT-pro BNP) 7,414 pg/mL, amylase 1,930 U/L, lipase 18 U/L, prothrombin time (PT) 10.2 seconds. (INR 0.86), activated partial thromboplastin time (aPTT) 28.2 seconds, urine osmolarity 341 mOsm/kg, sodium 22 mEq/L, potassium 59.2 mEq/L, chloride 14 mEq/L, creatinine 123.8 mg/dL, myoglobin 51.7 ng/mL, and fractional excretion of sodium 0.36%. Urine analysis showed pH 5.0, specific gravity 1.020, protein 2+, ketone 2+, blood 4+, RBC 5-9/high-power field, and WBC 0-1/high-power field. Blood and urine cultures were all negative for microorganism. Arterial blood gas analysis was pH 7.04, PaCO2 69 mmHg, PaO2 172 mmHg, and HCO3
- 18.7 mmol/L. Chest radiographs revealed mild cardiomegaly without lung lesion. Electrocardiogram (ECG) showed sinus tachycardia with QT prolongation. The enlarged left ventricle (LV), severe LV systolic dysfunction (ejection fraction 30%), and akinesia of LV mid to apex wall suggesting stress induced cardiomyopathy were noted on echocardiography. He received ventilator support, hemodynamic monitoring, continuous venovenous hemodiafiltration, and conservative care including intravenous fluid and electrolyte repletion. Seventy hours after ingestion of the mushrooms, BUN 41.9 mg/dL, serum creatinine 3.46 mg/dL, AST 3,271 U/L, ALT 1,254 U/L, total bilirubin 1.55 mg/dL, CK 121,397 U/L, CK-MB >500 ng/mL, LDH 6,102 U/L, troponin I 11.77 ng/mL, amylase 2,779 U/L, lipase 601 U/L, PT 42.1 seconds. (INR 3.34), and aPTT > 150 seconds. Blood pressure continued to decrease despite intravenous fluid and inotropics. Ventricular tachycardia developed, and he died due to cardiogenic shock 72 hours after ingestion of the mushrooms.
The leftover samples of the mushrooms that he had ingested were sent to Agricultural Microbiology Division, National Academy of Agricultural Science, Rural Development Administration, Suwon, Korea. Those were identified as R. subnigricans by their gross morphology (). Further examination by microscopy also confirmed the presence of spores from R. subnigricans.",What is the patient's serum osmolality in terms of mOsm/kg? You may take the alcohol content as 0 mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Blood Urea Nitrogen (BUN)': [38.5, 'mg/dL'], 'Glucose': [187.0, 'mg/dL'], 'Sodium': [140.0, 'mEq/L']}",304.13889,288.93195,319.34583,"The formula for computing serum osmolality is 2 * Na + (BUN / 2.8) + (glucose / 18), where Na is the concentration of sodium in mmol/L, the concentration of BUN is in mg/dL, and the concentration of glucose is in mg/dL.
The concentration of sodium is 140.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 140.0 mEq. To convert from 140.0 mEq to mmol, convert from mEq to mmol. The compound 140.0 has a valence of 1, and so divide the valence by the value of mEq to get, 140.0 mEq/(1 mEq/mmol) = 140.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 140.0 mEq sodium/L converts to 140.0 mmol sodium/L. 
The concentration of bun is 38.5 mg/dL. 
The concentration of glucose is 187.0 mg/dL. 
Plugging these values into the equation, we get 2 * 140.0 + (38.5 / 2.8) + (38.5 / 18) = 304.13889 mmol/L.The patient's calculated serum osmolality concentration is 304.13889 mmol/L. This is equalivalent to 304.13889 mOsm/kg."
410,30,Serum Osmolality,lab test,decimal,pmc-7544303-1,Extracted,"We present the case of a 45-year-old gentleman, known diabetic for 6 years on metformin 1 g, twice a day, with reasonable control (hemoglobin A1c 6.4%). He was admitted to our emergency feeling unwell with 2 days’ history of vomiting and watery diarrhea, also associated crampy periumbilical pain. He denied a history of similar complaints in his companions, no change in his dietary habits preceding symptoms’ onset. He drinks alcohol occasionally; the last drink was 6 months before the presentation—no illicit drug use history. The initial vital signs were normal. Soon later, he became tachycardic with heart rate reaching 120 bpm, blood pressure 127/70 mmHg, and a normal temperature. He looked dehydrated; otherwise, his examination was unremarkable.
Laboratory workup was significant for initially low glucose 2.5 mmol/L (3.3–5.5 mmol/L), high serum creatinine 632 μmol/L (62–106 umol/L), and high blood urea nitrogen of 21 mmol/L (2.8–8 mmol/L). Serum electrolytes were as follows: potassium (K+) 6.3 mmol/L (3.5–5.1 mmol/L), sodium (NA) 144 mmol/L (135–145mmol/L), bicarbonate (HCO3) 5.8 mmol/L (23–29 mmol/L), and serum chloride 99 mmol/L (99–107 mmol/L). Serum aminotransferases were normal (ALT 31 U/L, AST 27 U/L). He had significant high AG metabolic acidosis with PH of 6.8 (7.35–7.45) and AG of 40, lactic acid (LA) strikingly high reaching up to 24 mmol/L (0.5–2.2 mmol/L). Toxicology screening, including serum ethanol, acetaminophen, salicylate, and urine for oxalate crystal, was negative.
Acidosis failed to respond to initial fluid hydration, including intravenous bicarbonate. Thus, the patient underwent 2 sessions of sustained low-efficiency hemodialysis (HD). After HD, his electrolyte disturbances improved, and intravenous fluid hydration continued. Acute kidney injury (AKI) workup, including antinuclear antibodies (ANA), antinuclear cytoplasmic antibodies, creatinine kinase level, and sepsis workup were unremarkable. Starting day 3, the patient was in a polyuric phase, suggestive of acute tubular necrosis (ATN), producing between 3 and 6 L per day, and his serum creatinine was decreasing. He was discharged after 8 days of hospitalization in good condition with a serum creatinine of 140 μmol/L (62–106 μmol/L). Figure shows serum creatinine trend during the hospitalization, Figure depicts serum lactic acid clearance during hospitalization.
Our patient had an AKI with significant lactic acidosis and an OG. Given the significant level of lactic acid, MALA was the likely diagnosis. Our patient was on metformin for a long time, and he did not attempt an overdose; hence, we think that MALA was likely precipitated by dehydration leading to prerenal insult and AKI. Eventually, his prerenal insult led to acute tubular necrosis, as evident by the polyuric phase the patient exhibited on day three.",What is the patient's serum osmolality in terms of mOsm/kg? You may take the alcohol content as 0 mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Blood Urea Nitrogen (BUN)': [21.0, 'mmol/L'], 'Glucose': [2.5, 'mmol/L'], 'Sodium': [144.0, 'mmol/L']}",311.51722,295.94136,327.09308,"The formula for computing serum osmolality is 2 * Na + (BUN / 2.8) + (glucose / 18), where Na is the concentration of sodium in mmol/L, the concentration of BUN is in mg/dL, and the concentration of glucose is in mg/dL.
The concentration of sodium is 144.0 mmol/L. 
The concentration of bun is 21.0 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of bun from mmol to mg. The mass of bun is 21.0 mmol. To convert 21.0 mmol of bun to mol, multiply by the conversion factor 0.001, giving us 21.0 mmol bun * 0.001 mol/mmol = 0.021 mol bun. To convert from mol bun to grams, multiply by the molar mass 28.02 g/mol, which will give 0.021 mol bun * 28.02 g/mol = 0.58842 g bun. To convert 0.58842 g of bun to mg, multiply by the conversion factor 1000.0, giving us 0.58842 g bun * 1000.0 mg/g = 588.42 mg bun. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 588.42 mg bun/10.0 dL = 58.842 mg bun/dL. The concentration value of 21.0 mmol bun/L converts to 58.842 mg bun/dL. 
The concentration of glucose is 2.5 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of glucose from mmol to mg. The mass of glucose is 2.5 mmol. To convert 2.5 mmol of glucose to mol, multiply by the conversion factor 0.001, giving us 2.5 mmol glucose * 0.001 mol/mmol = 0.0025 mol glucose. To convert from mol glucose to grams, multiply by the molar mass 180.16 g/mol, which will give 0.0025 mol glucose * 180.16 g/mol = 0.4504 g glucose. To convert 0.4504 g of glucose to mg, multiply by the conversion factor 1000.0, giving us 0.4504 g glucose * 1000.0 mg/g = 450.4 mg glucose. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 450.4 mg glucose/10.0 dL = 45.04 mg glucose/dL. The concentration value of 2.5 mmol glucose/L converts to 45.04 mg glucose/dL. 
Plugging these values into the equation, we get 2 * 144.0 + (58.842 / 2.8) + (58.842 / 18) = 311.51722 mmol/L.The patient's calculated serum osmolality concentration is 311.51722 mmol/L. This is equalivalent to 311.51722 mOsm/kg."
411,30,Serum Osmolality,lab test,decimal,pmc-4720855-1,Extracted,"A 66 year-old female patient was admitted to the emergency room for progressive shortness of breath and poor health condition for 1 week. Her blood pressure was 80/50 mmHg and arterial blood gas analysis was pH; 6.98, pCO2; 99 mmHg, pO2; 66 mmHg. She was immediately intubated and transferred to the coronary intensive care unit. Echocardiography revealed massive pericardial effusion with cardiac tamponade (posteriorly 3 cm, anteriorly 2.5 cm, laterally 2 cm and 2.7 cm in adjacency with the right ventricle). The patient had non valvular AF and been receiving dabigatran etexilate 150 mg twice daily for one year. In addition to dabigatran, the other medications included verapamil, budesonide, valsartan, and hydrochlorotiazide. She had a history of chronic obstructive pulmonary disease, hyperthyroidism, hypertension and gastroesophageal reflux disease. Her blood tests performed 1 year ago showed serum creatinine 0.5 mg/dL (normal range 0.5-0.9 mg/dL) and estimated creatinine clearance 136 mL/minute (using the Cock-croft-Gault equation).
On admission her blood tests showed blood urea nitrogen 163.9 mg/dL (normal range 16.6-48.5 mg/dL), creatinine 3.99 mg/dL (normal range 0.5-0.9 mg/dL), estimated creatinine clearance 16 mL/minute (using the Cock-croft-Gault equation), fasting glucose 83.9 mg/dL (normal range 74-109 mg/dL), sodium 130 mmol/L (normal range 136-145 mmol/L), potassium 5.3 mmol/L (normal range 3.5-5.1 mmol/L), prothrombin time (PT) 44.5 s (normal range 11.5-15 s), activated partial thromboplastin time (aPTT) 123.7 s (normal range 26-32 s), international normalized ratio (INR) 4.79, white blood cell count 10.59 103/uL (normal range 4.4-11.3 103/uL), hemoglobin 7.7 g/dL (normal range 11.7-16.1 g/dL), hematocrit 25.7% (normal range 35-47%), and platelet count 183 103/uL (normal range 152-396 103/uL).
Urgent pericardiocentesis was performed with echocardiographic guidance and 1500 mL of hemorrhagic fluid was removed. Pericardial fluid analysis showed hemoglobin 7 g/dL and plasma hemoglobin level of the patient was 7.7 g/dL. Cytologic exam was negative for malignancy. Biochemical tests showed total protein 5.4 mg/dL, lactate dehydrogenase 707 mg/dL and albumin 2.98 mg/dL.
Six hours after pericardiocentesis, the patients' blood pressure was over 100 mmHg systolic and she began to urinate. Red blood cell and fresh frozen plasma transfusions were made and post-transfusion hemoglobin level was 12 g/dL, PT 36.4 s (normal range 11.5-15 s), aPTT 100.5 s (normal range 26-32 s), and INR 4.1. On the second day after pericardiocentesis, hemorrhagic fluid flow via drainage catheter persisted and additional fresh frozen plasma transfusion was administered. Subsequently, PT was 25.3 s, aPTT 77,5 and INR was 2.3. Pericardial drainage was terminated after achievement of no flow through catheter and no pericardial effusion on control echocardiography.
Laboratory tests repeated on the fourth day of admission were as follows: blood urea nitrogen 109 mg/dL, creatinine 1.4 mg/dL, INR 1.4 and hemoglobin 12 g/dL. The patient was extubated after improved ventilation parameters. Dabigatran etexilate was omitted and other medications were continued. She was discharged 10 days after admission. Warfarin was initiated and the follow-up was uneventful.",What is the patient's serum osmolality in terms of mOsm/kg? You may take the alcohol content as 0 mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Blood Urea Nitrogen (BUN)': [163.9, 'mg/dL'], 'Glucose': [83.9, 'mg/dL'], 'Sodium': [130.0, 'mmol/L']}",323.19683,307.03699,339.35667,"The formula for computing serum osmolality is 2 * Na + (BUN / 2.8) + (glucose / 18), where Na is the concentration of sodium in mmol/L, the concentration of BUN is in mg/dL, and the concentration of glucose is in mg/dL.
The concentration of sodium is 130.0 mmol/L. 
The concentration of bun is 163.9 mg/dL. 
The concentration of glucose is 83.9 mg/dL. 
Plugging these values into the equation, we get 2 * 130.0 + (163.9 / 2.8) + (163.9 / 18) = 323.19683 mmol/L.The patient's calculated serum osmolality concentration is 323.19683 mmol/L. This is equalivalent to 323.19683 mOsm/kg."
412,30,Serum Osmolality,lab test,decimal,pmc-8202440-1,Extracted,"An 80-year-old man with a history of type II diabetes mellitus presented to the ER via ambulance with the chief complaint of generalized body aches and acute difficulty with ambulation. The patient received his second Moderna COVID-19 vaccine two days prior to admission. The next day he developed generalized body aches, nausea, and an episode of vomiting. He denied any fevers or chills. Though he normally ambulates independently, he was unable to stand or get out of bed due to weakness and generalized pain when he woke up the morning of admission. His admission medications included alogliptin, empagliflozin, insulin aspart, insulin glargine, losartan, metformin, pioglitazone, and tamsulosin. He reports no recent changes in medications or intake of over-the-counter medications. Past medical history was significant for COVID-19 infection three months prior, which required hospitalization for 13 days and treatment with convalescent plasma, remdesivir, and dexamethasone, according to institutional standard treatment protocols at the time.
On exam, vital signs were stable with a blood pressure of 120/70 mmHg, heart rate of 87/minute, temperature of 98.4° F, and respiratory rate of 16/minute. He was in no acute distress. His strength was normal and symmetric bilaterally, cranial nerves II-XII were grossly intact, and sensory was intact to light touch bilaterally. An electrocardiogram (EKG) was negative for ischemia. Troponins, a respiratory polymerase chain reaction (PCR) panel including influenza, and COVID-19 PCR were negative. Initial laboratory findings are summarized below (Table ). His serum creatinine kinase (CK) was 6,546 U/L. Complete metabolic panel revealed potassium 3.6 meq/L, sodium 130 meq/L, chloride 96 meq/L, glucose 219 mg/dL, blood urea nitrogen (BUN) 23 mg/dL, creatinine 1.1 mg/dL, aspartate aminotransferase (AST) 112 U/L, and alanine aminotransferase (ALT) 47 U/L. His inflammatory markers were elevated with lactate dehydrogenase (LDH) 359 U/L, erythrocyte sedimentation rate (ESR) 52 mm/Hr, and C-reactive protein (CRP) 146.8 mg/dL. Urinalysis excluded myoglobinuria and creatinine remained in his baseline range.
Rhabdomyolysis was diagnosed based on acute muscular pain and elevated CK. He is a diabetic elderly who had some nausea and vomiting but common causes of rhabdomyolysis were excluded as the patient denied trauma, recent surgery, strenuous exercise, alcohol use, or illicit drug use. He was not taking medications known to cause rhabdomyolysis including statins. No infections were identified. His serum glucose level was not elevated to a level that would point to a hyperosmolar hyperglycemic state.
Given the timeline of events, lack of alternate explanation, and known correlation of COVID-19 and rhabdomyolysis, the patient was felt to have vaccine-related rhabdomyolysis. The Naranjo score is a causality assessment tool validated to determine the likelihood of an adverse drug reaction []. For this patient, positive findings included the adverse event that appeared after the drug was given, the adverse event improved after the drug was discontinued, alternative causes were ruled out, and objective evidence of the adverse event was available (CK). The Naranjo Score was 6, which indicates the rhabdomyolysis was probably an adverse reaction to vaccination.
He received IV fluids overnight. His CK improved over the course of his hospital stay, and he did not develop significant acute kidney injury or electrolyte abnormalities. The patient regained his ability to ambulate independently, had improved myalgias, and was discharged in stable condition.",What is the patient's serum osmolality in terms of mOsm/kg? You may take the alcohol content as 0 mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Sodium': [130.0, 'mEq/L'], 'Glucose': [219.0, 'mg/dL'], 'Blood Urea Nitrogen (BUN)': [23.0, 'mg/dL']}",280.38095,266.3619,294.4,"The formula for computing serum osmolality is 2 * Na + (BUN / 2.8) + (glucose / 18), where Na is the concentration of sodium in mmol/L, the concentration of BUN is in mg/dL, and the concentration of glucose is in mg/dL.
The concentration of sodium is 130.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 130.0 mEq. To convert from 130.0 mEq to mmol, convert from mEq to mmol. The compound 130.0 has a valence of 1, and so divide the valence by the value of mEq to get, 130.0 mEq/(1 mEq/mmol) = 130.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 130.0 mEq sodium/L converts to 130.0 mmol sodium/L. 
The concentration of bun is 23.0 mg/dL. 
The concentration of glucose is 219.0 mg/dL. 
Plugging these values into the equation, we get 2 * 130.0 + (23.0 / 2.8) + (23.0 / 18) = 280.38095 mmol/L.The patient's calculated serum osmolality concentration is 280.38095 mmol/L. This is equalivalent to 280.38095 mOsm/kg."
413,30,Serum Osmolality,lab test,decimal,pmc-7294477-1,Extracted,"A 60-year-old man presented with fever and productive cough for 2 days. He had a history of type 2 diabetes for 12 years and received peritoneal dialysis for diabetic nephropathy for 5 years. He also received antihypertensive drugs for hypertension for 10 years. There was no personal or family history of coagulopathy or stroke, trauma, chest pain, or illicit intravenous drug use.
Admission physical examination revealed the patient to be febrile (39.1°C), tachycardic with a pulse of 112/min, a respiratory rate of 22/min, and hypertensive with a blood pressure of 170/80 mm Hg. Bibasilar crackles were heard on auscultation. The peritoneal dialysis catheter was correctly positioned in the right lower abdomen, with no local erythema. There was no exudate buildup in catheter dressings. His systemic examination was otherwise unremarkable, with no tenderness, ecchymosis, or other external signs of trauma.
Initial blood workup showed neutrophilic leukocytosis with a white blood cell count of 12.8 × 109/L (normal reference: 4.0–10 × 109/L) and 82.6% neutrophils (normal reference: 50%–70%). The patient was anemic (hemoglobin 95 g/L; normal reference: 120–160 g/L), with a normal platelet count (181 × 109/L; normal reference: 100–300 × 109/L). Both his prothrombin time (PT; 12.1 s, normal reference: 10–14 s) and activated partial thromboplastin time (aPTT; 34.1 s, normal reference: 20–40 s) were normal. Blood chemistry showed elevated blood urea nitrogen (20.5 mmol/L; normal reference: 3.2–7.1 mmol) and creatinine (1125 µmol/L; normal reference: 53–106 µmol/L). Blood glucose was 6.4 mmol/L (normal reference: 3.9–6.1 mmol/L), K+ 4.14 mmol/L (normal reference: 3.5–5.5 mmol/L), Na+ 145 mmol/L (normal reference: 135–145 mmol/L), Cl+ 108 mmol/L (normal reference: 95–105 mmol/L), and Ca++ 2.1 mmol/L (normal reference: 2.25–2.58 mmol/L). Liver function test was normal. Arterial blood gas analysis showed pH 7.40 (normal reference: 7.35–7.45), PaO2 60.1 mm Hg (normal reference: 95–100 mm Hg), PaCO2 44.8 mm Hg (normal reference: 35–45 mm Hg), and HCO3– 29.6 mmol/L (normal reference: 22–27 mmol/L). Chest X ray revealed patchy opacities in the right lower lung. The right diaphragmatic surface and costophrenic angle were also blurred. Furthermore, the cardiac silhouette was enlarged.
Treatment for pulmonary infection with cefoperazone-sulbactam (1.5 g every 12 h) was initiated. The patient also received subcutaneous insulin (30 units/day) and oral nifedipine sustained release tablet (30 mg daily). Peritoneal dialysis continued with 2.5% low calcium peritoneal dialysate.
At day 3 post admission, the patient became disoriented. He was still febrile (40.3°C). SPO2 declined to 88% despite of 5 L/min oxygen via a nasal cannula. Blood gas analysis showed pH 7.30, PaO2 53.10 mm Hg, PaCO2 58.50 mm Hg, and HCO3– 29.3 mol/L. Blood chemistry revealed that blood urea nitrogen (22.7 mmol/L) and serum creatinine (1345 µmol/L) continued to rise, and his plasma glucose also increased (8.4 mmol/L). K+, Na+, Cl+, and Ca++ were within normal range. His C-Reactive Protein (CRP) was 183 mg/L (normal reference: <8 mg/L), and procalcitonin 66.06 ng/mL (normal reference: <0.5 ng/mL). The liver function, platelet count, aPTT, and PT were normal. Thromboelastogram showed normal coagulation factor reaction time (9.9 min; normal reference: 5–10), fibrinogen reaction time (1.9 min; normal reference: 1–3), α (alpha) angle (64.9°; normal reference: 53°–72°), shear stress coefficient strength (19,233 d/s; normal reference: 4500–11,000 d/s), and hyperfibrinolysis (0.0%; normal reference: <8%) with increased platelet function (79.4 mm; normal reference: 50–70).
The patient was diagnosed with respiratory failure (type II) and pulmonoencephalopathy, and transferred to the intensive care unit (ICU) and placed on mechanical ventilation. Imipenem (0.5 g every 6 h) was added, and low-molecular-weight heparin (enoxaparin, 3500–5500 Da, 5–10 IU/kg/h) and insulin were delivered continuously by pumps. Peritoneal dialysis was discontinued and CVVH was undertaken at 32 mL/kg/h for renal insufficiency. The patient became oriented. Arterial blood gases showed normal pH (7.43), improved PaO2 (88.6 mm Hg), normal PaCO2 (36.5 mm Hg), and HCO3– (23.5 mmol/L). However, fever persisted (39.5°C), and the patient had difficulty weaning off mechanical ventilation.
Abdominal computed tomography (CT) at day 5 showed a hypointense shadow in the left hepatic lobe (61 mm × 56 mm) with an indistinct border (). Liver abscess was confirmed upon ultrasound-guided drainage. The culture revealed Klebsiella pneumonia that was sensitive to third-generation cephalosporin and imipenem. Imipenem (1.0 g every 8 h) and metronidazole (0.5 g every 8 h) were given, and mechanical ventilation and CVVH continued.
At day 12, the patient complained left back pain, which improved the next day without treatment. Platelet count (243 × 109/L) was normal, but both aPTT (67.5 s) and PT (17.3 s) were prolonged; his thromboelastogram (heparin cup) was normal. No cutaneous and mucosal bleeding was observed. The patient had no hemoptysis and his fecal occult blood test was negative. Abdominal CT scan at day 16 revealed left iliopsoas swelling, about 61.7 mm × 64.1 mm, with inhomogeneous densities, and occasional hyperintense opacities and an indistinct border (). A diagnosis of iliopsoas hematoma was made. Anticoagulation therapy with low-molecular-weight heparin was discontinued and switched to ex vivo anticoagulation with citrate. Mechanical ventilation and anti-infection therapy (imipenem 1.0 g every 8 h, metronidazole 0.5 g every 8 h) continued. No improvement was seen, and 3 days later, the patient died after his family decided to terminate therapy.",What is the patient's serum osmolality in terms of mOsm/kg? You may take the alcohol content as 0 mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Sodium': [145.0, 'mmol/L'], 'Glucose': [6.4, 'mmol/L'], 'Blood Urea Nitrogen (BUN)': [20.5, 'mmol/L']}",316.92031,301.07429,332.76633,"The formula for computing serum osmolality is 2 * Na + (BUN / 2.8) + (glucose / 18), where Na is the concentration of sodium in mmol/L, the concentration of BUN is in mg/dL, and the concentration of glucose is in mg/dL.
The concentration of sodium is 145.0 mmol/L. 
The concentration of bun is 20.5 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of bun from mmol to mg. The mass of bun is 20.5 mmol. To convert 20.5 mmol of bun to mol, multiply by the conversion factor 0.001, giving us 20.5 mmol bun * 0.001 mol/mmol = 0.0205 mol bun. To convert from mol bun to grams, multiply by the molar mass 28.02 g/mol, which will give 0.0205 mol bun * 28.02 g/mol = 0.57441 g bun. To convert 0.57441 g of bun to mg, multiply by the conversion factor 1000.0, giving us 0.57441 g bun * 1000.0 mg/g = 574.41 mg bun. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 574.41 mg bun/10.0 dL = 57.441 mg bun/dL. The concentration value of 20.5 mmol bun/L converts to 57.441 mg bun/dL. 
The concentration of glucose is 6.4 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of glucose from mmol to mg. The mass of glucose is 6.4 mmol. To convert 6.4 mmol of glucose to mol, multiply by the conversion factor 0.001, giving us 6.4 mmol glucose * 0.001 mol/mmol = 0.0064 mol glucose. To convert from mol glucose to grams, multiply by the molar mass 180.16 g/mol, which will give 0.0064 mol glucose * 180.16 g/mol = 1.15302 g glucose. To convert 1.15302 g of glucose to mg, multiply by the conversion factor 1000.0, giving us 1.15302 g glucose * 1000.0 mg/g = 1153.02 mg glucose. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 1153.02 mg glucose/10.0 dL = 115.302 mg glucose/dL. The concentration value of 6.4 mmol glucose/L converts to 115.302 mg glucose/dL. 
Plugging these values into the equation, we get 2 * 145.0 + (57.441 / 2.8) + (57.441 / 18) = 316.92031 mmol/L.The patient's calculated serum osmolality concentration is 316.92031 mmol/L. This is equalivalent to 316.92031 mOsm/kg."
414,30,Serum Osmolality,lab test,decimal,pmc-3614763-1,Extracted,"A previously healthy 7-year-old boy was brought to the emergency department by his mother with complaints such as vomiting, fatigue and colicky abdominal pain associated with diffuse, self-limiting arthralgias, and petechial rash of both legs. His medical history revealed having throat infection one month before admission. Complete blood count was within normal range for his age, as were his serum electrolytes. Blood examinations revealed an elevation of C-reactive protein and revealed both normal white blood cell and platelet counts. Serum IgA, C3 and C4 levels were all within normal limits and a urine examination also showed normal findings. Physical examination revealed mild proteinuria, hypertension and moderate anasarca (periorbital edema, ascites, and lower-extremity pitting edema). No medication and renal biopsy were performed because of the silent findings. However, two weeks later, after the admission for HSP, he complained of polydipsia and polyuria complaints and a physical examination revealed a 10-kg decrease in his baseline weight. There was no parental history of diabetes. In physical examinaTion weight: 16 kg (3rd percentile); height: 115 cm (25–50th percentile); pulse rate: 80/min; respiratory rate: 24/min; blood pressure: 100/60 mmHg; temperature: 36°C, his general state was poor and his consciousness was lethargic. Skin turgor and tonus were also diminished. There were petechial rashes on his abdomen and lower extremities that progressed to nonblanchable macules (Figure ). He also had a fruity breath smell, dry mucous membranes, and tachypnea. Other examinations were normal. Laboratory studies yielded the following values (normal ranges were given in brackets): white blood cell count; 14.200/mm3 (6000–17500) with a normal differential formula; blood urea nitrogen, 9.34 mg/dL (5.7–20.1); serum creatinine, 0.6 mg/dL (0.1–0.9); albumin, 4.2 g/dL (3.5-5); sodium, 127 mmol/L (139–146); potassium, 4.51 mmol/ L (3.5–6.0); phosphorus, 2.8 mg/dL (4.9–7.9); and glucose, 27.83 mmol/L (3.3–5.0). Arterial blood gas values showed a pH of 7.10 (7.35–7.45); and bicarbonate: 8.4 mmol/L (21–28). Urine and serum ketones were positive. Urinalysis showed glycosuria. HbA1c was 11.7% (4.2-6.4). C-peptid level was 0.7 ng/mL (1.1-3.2). Insulin level was 4.28 μIU/mL (1.9-23). Autoantibodies including insulin, islet cell, glutamic acid decarboxylase were negative. Thyroid function tests were normal. Prothrombine time and partial thromboplastin time, immunoglobulin A, complement proteins C3 and C4, anti-DNA, antinuclear antibodies, and ASO levels were normal, as were serological tests for EBV and TORCH. Serum antigliadin and anti-endomysium antibodies were negative for the diagnosis of Celiac disease. Occult blood test in stool, urine and throat cultures were negative. The diagnosis of type 1 DM which presented with diabetic ketoacidosis accompanied by HSP was clinically made. A bolus of normal saline (20 mL/kg) was given intravenously, after which intravenous fluids were continued. Regular insulin via a continuous infusion at 0.1 IU/kg/h was started, and potassium was administered at 1 mEq/kg/day. The patient subsequently recovered and was followed by the Pediatric Diabetes Unit and given continued insulin treatment.",What is the patient's serum osmolality in terms of mOsm/kg? You may take the alcohol content as 0 mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Blood Urea Nitrogen (BUN)': [9.34, 'mg/dL'], 'Glucose': [27.83, 'mmol/L'], 'Sodium': [127.0, 'mmol/L']}",285.19044,270.93092,299.44996,"The formula for computing serum osmolality is 2 * Na + (BUN / 2.8) + (glucose / 18), where Na is the concentration of sodium in mmol/L, the concentration of BUN is in mg/dL, and the concentration of glucose is in mg/dL.
The concentration of sodium is 127.0 mmol/L. 
The concentration of bun is 9.34 mg/dL. 
The concentration of glucose is 27.83 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of glucose from mmol to mg. The mass of glucose is 27.83 mmol. To convert 27.83 mmol of glucose to mol, multiply by the conversion factor 0.001, giving us 27.83 mmol glucose * 0.001 mol/mmol = 0.02783 mol glucose. To convert from mol glucose to grams, multiply by the molar mass 180.16 g/mol, which will give 0.02783 mol glucose * 180.16 g/mol = 5.01385 g glucose. To convert 5.01385 g of glucose to mg, multiply by the conversion factor 1000.0, giving us 5.01385 g glucose * 1000.0 mg/g = 5013.85 mg glucose. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 5013.85 mg glucose/10.0 dL = 501.385 mg glucose/dL. The concentration value of 27.83 mmol glucose/L converts to 501.385 mg glucose/dL. 
Plugging these values into the equation, we get 2 * 127.0 + (9.34 / 2.8) + (9.34 / 18) = 285.19044 mmol/L.The patient's calculated serum osmolality concentration is 285.19044 mmol/L. This is equalivalent to 285.19044 mOsm/kg."
415,30,Serum Osmolality,lab test,decimal,pmc-5292295-1,Extracted,"A 77-year-old woman lost consciousness 6 hours before being admitting to a local clinic where she underwent brain CT. The patient was promptly referred to our department with suspected basal ganglion ICH based on the brain CT. The patient had no medical history other than diabetes. Her premorbid Eastern Cooperative Oncology Group score was 3 due to dementia but she had normal cognitive functioning. The patient had stopped taking her diabetic medication 2 months earlier, on her own volition, and had been suffering progressive debilitation. No other symptoms were present. The patient did not take any sedatives or tranquilizers. The initial vital signs were blood pressure 180/98 mmHg, pulse rate 110/min, respiratory rate 18/min, and body temperature 36.8°C. A neurological examination revealed stupor, intact brainstem signs, and greater than grade III motor strength in all four extremities without lateralizing signs. She did not exhibit any abnormal movements of the extremities. No specific abnormalities were found on a systemic physical examination. The initial serum laboratory test results were blood glucose 607 mg/dL, hemoglobin 12.8 g/dL, white blood cells 6,720/mm3, platelets 193,000/mm3, aspartate aminotransferase 32 IU/L, alanine aminotransferase 38 IU/L, blood urea nitrogen 17 mg/dL, serum creatinine 1.2 mg/dL, sodium 120 mEq/L, potassium 5.0 mEq/L, chloride 89 mEq/L. No serum ethanol was detected, and an arterial blood gas analysis revealed the following: pH 7.454, pCO2 37.0 mmHg, pO2 78.1 mmHg, HCO3 25.4 mmol/L, and base excess 1.6 mmol/L. No ketones were detected in the urinalysis. Barbiturates, benzodiazepines, and tricyclic antidepressants were not found during a toxin-screening test. The initial brain CT showed a hyperdense lesion in the right basal ganglion (). On magnetic resonance imaging, T1-weighted images revealed high signal intensity indicative of changes due to nonketotic hyperglycemia; diffusion weighted imaging (DWI) and an apparent diffusion coefficient map showed restricted diffusion (). Blood glucose level was controlled with regular insulin, and conservative treatment and fluid resuscitation were provided. Electroencephalography revealed findings compatible with diffuse encephalopathy, but no signs of seizure were detected. After admission to the intensive care unit, the patient gradually recovered consciousness and was alert after 24 hours, as blood glucose and sodium were controlled. No abnormal movement disorder was noted after a return to consciousness. The patient was discharged 10 days after admission without any complications.",What is the patient's serum osmolality in terms of mOsm/kg? You may take the alcohol content as 0 mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Blood Urea Nitrogen (BUN)': [17.0, 'mg/dL'], 'Glucose': [607.0, 'mg/dL'], 'Sodium': [120.0, 'mEq/L']}",279.79365,265.80397,293.78333,"The formula for computing serum osmolality is 2 * Na + (BUN / 2.8) + (glucose / 18), where Na is the concentration of sodium in mmol/L, the concentration of BUN is in mg/dL, and the concentration of glucose is in mg/dL.
The concentration of sodium is 120.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 120.0 mEq. To convert from 120.0 mEq to mmol, convert from mEq to mmol. The compound 120.0 has a valence of 1, and so divide the valence by the value of mEq to get, 120.0 mEq/(1 mEq/mmol) = 120.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 120.0 mEq sodium/L converts to 120.0 mmol sodium/L. 
The concentration of bun is 17.0 mg/dL. 
The concentration of glucose is 607.0 mg/dL. 
Plugging these values into the equation, we get 2 * 120.0 + (17.0 / 2.8) + (17.0 / 18) = 279.79365 mmol/L.The patient's calculated serum osmolality concentration is 279.79365 mmol/L. This is equalivalent to 279.79365 mOsm/kg."
416,30,Serum Osmolality,lab test,decimal,pmc-5750440-1,Extracted,"An 85-year-old female with a past medical history significant for type 2 diabetes mellitus presented to the emergency room for progressively altered mental status and difficulty walking. She was increasingly lethargic and was less interactive with family for 3 weeks before presentation. She also had urinary incontinence and gait instability for the same period.
Accompanying family reported a fall 3 weeks before admission with significant facial bruising. A computed tomography (CT) scan without contrast posttrauma was reported to have central nervous system (CNS) atherosclerosis with ventricular dilatation that was out of proportion to the degree of cortical atrophy []. A working diagnosis of NPH was made and she was scheduled to see a neurosurgeon for further management.
On admission, the patient had flat affect and poor cooperation. There was no papilledema. She was unable to follow commands for a complete neurological examination. Serum chemistry revealed sodium - 142 mmol/L, potassium - 2.9 mmol/L, HCO3 - 25 mmol/L, chloride - 102 mmol/L, glucose - 298 mg/dL, blood urea nitrogen - 21 mg/dL, and creatinine - 0.7 mg/dL. Magnetic resonance scan of the brain revealed subtle debris layering the occipital horns of the lateral ventricles without restricted diffusion, consistent with either intraventricular hemorrhage or pus [Figures and ].
She was febrile to 103°F. Blood and respiratory cultures were obtained and she was started on a broad-spectrum coverage for possible meningitis. She developed diabetic ketoacidosis, which was addressed. She had two episodes of seizure-like activity. A lumbar puncture was initially deferred, whereas NPH had remained the most probable diagnosis, and the patient had a high international normalized ratio (INR). It was performed emergently following clinical deterioration, with development of fever.
The cerebrospinal fluid (CSF) collected had increased protein, decreased glucose, and mononuclear pleocytosis. It was subjected to Gram-stain, which showed yeast and the species of the yeast were confirmed to be C. neoformans on culture. India ink preparation of the CSF was positive for Cryptococcus along with a positive cryptococcal antigen test. The patient was dozed with intravenous liposomal amphotericin B and oral flucytosine. HIV test was negative.
The patient continued to deteriorate further and had a cardiac arrest on the same day. She underwent cardiopulmonary resuscitation but could not be revived. Blood culture bottles subsequently grew C. neoformans.",What is the patient's serum osmolality in terms of mOsm/kg? You may take the alcohol content as 0 mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Sodium': [142.0, 'mmol/L'], 'Glucose': [298.0, 'mg/dL'], 'Blood Urea Nitrogen (BUN)': [21.0, 'mg/dL']}",308.05556,292.65278,323.45834,"The formula for computing serum osmolality is 2 * Na + (BUN / 2.8) + (glucose / 18), where Na is the concentration of sodium in mmol/L, the concentration of BUN is in mg/dL, and the concentration of glucose is in mg/dL.
The concentration of sodium is 142.0 mmol/L. 
The concentration of bun is 21.0 mg/dL. 
The concentration of glucose is 298.0 mg/dL. 
Plugging these values into the equation, we get 2 * 142.0 + (21.0 / 2.8) + (21.0 / 18) = 308.05556 mmol/L.The patient's calculated serum osmolality concentration is 308.05556 mmol/L. This is equalivalent to 308.05556 mOsm/kg."
417,30,Serum Osmolality,lab test,decimal,pmc-3950226-1,Extracted,"The patient was a 20-year-old previously healthy woman. She was a university student. Her height and body weight were 168.1 cm and 52.2 kg, respectively. She ingested bamboo salt (about 150 grams ) in a day for the purpose of digestion and weight reduction. After that, she had more than ten episodes of vomiting and diarrhea for 2-3 hours. On arrival at our emergency department, vital signs were blood pressure of 128/81mmHg, heart rate of 75 beat/min, respiration rate of 20/min, and body temperature of 37.3℃. Her consciousness was clear but she complained of generalized weakness. The complete blood counts showed hemoglobin 11.3 g/dL, WBC 10,000 cells/µL, and platelet 196,000/µL. The results of her blood chemistry were as follows: Aspartate transaminase 11 IU/L, Alanine transaminase 9 IU/L, total protein 6.4 g/dL, albumin 4.5 g/dL, blood urea nitrogen 5.2mg/dL, and creatinine 0.57mg/dL. Serum sodium, potassium, chloride, and glucose were 174mEql/L, 3.6mEq/L,135mEq/L, and 315 mg/dL respectively. Urine sodium, potassium, and chloride were 440mEq/L, 125.7 mEq/L, and 314mEq/L respectively. On arterial blood gas analysis, pH was 7.32, PaCO2 36mmHg, bicarbonate 18.5mEq/L, PaO2 93mmHg and O2 saturation 97%. On the 1st day, total input and urine output was 3,700ml and 2,100ml, respectively. Her symptoms such as nausea, vomiting and diarrhea improved rapidly with 0.45% saline infusion and supportive care. On the 2nd day, her serum sodium concentration dropped to 152 mEq/L and urine output was 2,200ml/day. On the 3rd day, serum sodium concentration returned to normal range (). She recovered completely without any sequelae in 3 days.",What is the patient's serum osmolality in terms of mOsm/kg? You may take the alcohol content as 0 mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Sodium': [174.0, 'mEq/L'], 'Glucose': [315.0, 'mg/dL'], 'Blood Urea Nitrogen (BUN)': [5.2, 'mg/dL']}",367.35714,348.98928,385.725,"The formula for computing serum osmolality is 2 * Na + (BUN / 2.8) + (glucose / 18), where Na is the concentration of sodium in mmol/L, the concentration of BUN is in mg/dL, and the concentration of glucose is in mg/dL.
The concentration of sodium is 174.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 174.0 mEq. To convert from 174.0 mEq to mmol, convert from mEq to mmol. The compound 174.0 has a valence of 1, and so divide the valence by the value of mEq to get, 174.0 mEq/(1 mEq/mmol) = 174.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 174.0 mEq sodium/L converts to 174.0 mmol sodium/L. 
The concentration of bun is 5.2 mg/dL. 
The concentration of glucose is 315.0 mg/dL. 
Plugging these values into the equation, we get 2 * 174.0 + (5.2 / 2.8) + (5.2 / 18) = 367.35714 mmol/L.The patient's calculated serum osmolality concentration is 367.35714 mmol/L. This is equalivalent to 367.35714 mOsm/kg."
418,30,Serum Osmolality,lab test,decimal,pmc-2783075-1,Extracted,"A 42-year-old African-American man with HIV/AIDS, not taking any medications including HAART and pneumocystis jiroveci prophylaxis since January 2007, presented in August 2007 with complaints of progressing shortness of breath, right-sided pleuritic chest pain, non-productive cough, and low-grade fever for last several weeks. He was diagnosed with HIV initially in 1999, during hospitalization for community-acquired pneumonia. The patient also had a history of facial herpes simplex virus type 2 (HSV-2) which has been recurrent and a history of pneumocystis pneumonia in June 2005. Previous laboratory studies from November 2006 revealed a CD4+ lymphocyte count of 20 and viral load HIV RNA of 65,833 copies/ml. He was a social drinker and had never used illicit drugs or tobacco products. HIV was presumed to be acquired sexually.
On initial assessment in the emergency department, he was cachectic but was in no acute distress. He had a fever of 38°C, blood pressure of 92/60 mmHg and regular pulse of 85 beats per minute. He was breathing at 20 breaths per minute. Oxygen saturation was 95% on room air, which decreased to 90% during ambulation. There were no oral lesions. His neck was supple. Examination of the lungs revealed bilateral expiratory wheezes and rare rhonchi. Cardiac examination demonstrated normal first sound, second sound with a regular rhythm and no murmurs. His abdomen was soft, nontender, nondistended with normoactive bowel sounds. His extremities were warm and his skin was dry with multiple small herpetic ulcers on the left ear and the left side of the face.
Laboratory tests revealed the following concentrations: sodium 138 mmol/L, potassium 4.5 mmol/L, chloride 103 mmol/L, bicarbonate 26 mmol/L, BUN 2.9 mmol/L, creatinine 61 μmol/L, glucose 4.78 mmol/L, white blood cell 3.4 × 109/L, neutrophils 86%, hemoglobin 7.1 mmol/L, hematocrit 33%, platelets 322 × 109/L, LDH 497 U/L, CD4+ lymphocyte count of 2. Chest X-ray was negative for infiltrate (Figure ), but high resolution CT of the chest revealed subtle right middle lobe and right upper lobe ground-glass opacity (Figure ).
The patient was admitted to the medical ward with a working diagnosis of pneumocystis pneumonia. A sputum sample was collected spontaneously for a culture work-up (Bartlett score: +3). No sputum sample was collected for mycobacterial stains. Empiric treatment with trimethoprim-sulfamethoxazole (1 tablet double-strength × 3 per day) and prednisone (40 mg × 2 per day) was started. The patient was also placed on treatment for HSV with acyclovir (400 mg × 3 per day). The prednisone doses were reduced as part of initial therapy for pneumocystis pneumonia. On the third day, direct fluorescent antibody test for Pneumocystis jiroveci was negative, but the culture was positive for Bordetella bronchiseptica. The patient was placed on droplet precautions; treatment was switched to levofloxacin (400 mg per day). Trimethoprim-sulfamethoxazole dose was modified to (1 tablet single-strength per day) for pneumocystis prophylaxis and azithromycin (1200 mg once per week) for Mycobacterium avium complex prophylaxis began. The patient subsequently improved on levofloxacin and on the seventh day was discharged home on levofloxacin, trimethoprim-sulfamethoxazole, azithromycin, and acyclovir. After eleven days, the patient visited our office. The patient had no complaints, no fever and no cough and his shortness of breath was fully resolved. On retrospect, the patient reported that he had been visited by his brother and his brother's dog at his home about a week prior to the illness.",What is the patient's serum osmolality in terms of mOsm/kg? You may take the alcohol content as 0 mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Sodium': [138.0, 'mmol/L'], 'Blood Urea Nitrogen (BUN)': [2.9, 'mmol/L'], 'Glucose': [4.78, 'mmol/L']}",283.68637,269.50205,297.87069,"The formula for computing serum osmolality is 2 * Na + (BUN / 2.8) + (glucose / 18), where Na is the concentration of sodium in mmol/L, the concentration of BUN is in mg/dL, and the concentration of glucose is in mg/dL.
The concentration of sodium is 138.0 mmol/L. 
The concentration of bun is 2.9 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of bun from mmol to mg. The mass of bun is 2.9 mmol. To convert 2.9 mmol of bun to mol, multiply by the conversion factor 0.001, giving us 2.9 mmol bun * 0.001 mol/mmol = 0.0029 mol bun. To convert from mol bun to grams, multiply by the molar mass 28.02 g/mol, which will give 0.0029 mol bun * 28.02 g/mol = 0.08126 g bun. To convert 0.08126 g of bun to mg, multiply by the conversion factor 1000.0, giving us 0.08126 g bun * 1000.0 mg/g = 81.26 mg bun. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 81.26 mg bun/10.0 dL = 8.126 mg bun/dL. The concentration value of 2.9 mmol bun/L converts to 8.126 mg bun/dL. 
The concentration of glucose is 4.78 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of glucose from mmol to mg. The mass of glucose is 4.78 mmol. To convert 4.78 mmol of glucose to mol, multiply by the conversion factor 0.001, giving us 4.78 mmol glucose * 0.001 mol/mmol = 0.00478 mol glucose. To convert from mol glucose to grams, multiply by the molar mass 180.16 g/mol, which will give 0.00478 mol glucose * 180.16 g/mol = 0.86116 g glucose. To convert 0.86116 g of glucose to mg, multiply by the conversion factor 1000.0, giving us 0.86116 g glucose * 1000.0 mg/g = 861.16 mg glucose. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 861.16 mg glucose/10.0 dL = 86.116 mg glucose/dL. The concentration value of 4.78 mmol glucose/L converts to 86.116 mg glucose/dL. 
Plugging these values into the equation, we get 2 * 138.0 + (8.126 / 2.8) + (8.126 / 18) = 283.68637 mmol/L.The patient's calculated serum osmolality concentration is 283.68637 mmol/L. This is equalivalent to 283.68637 mOsm/kg."
419,30,Serum Osmolality,lab test,decimal,pmc-4663776-1,Extracted,"A 17-year-old male presented with shortness of breath, swelling of feet and oliguria of 2 months duration. He was found to have severe hypertension with impairment of renal functions and pulmonary edema. Pulse rate was 80 min, regular. Blood pressure (BP) in right upper and lower limbs were 270/120 mmHg and 210/120 mmHg, and the left upper and lower limb was 260/140 mmHg and 260/130 mmHg respectively. Abdominal examination revealed bilateral systole-diastolic renal bruit. Fundus examination showed hypertensive neuroretinopathy. Investigations showed serum creatinine 2.1 mg/dl, blood urea nitrogen 29 mg/dl, sodium 139 mmol/l, potassium 3.1 mmol/l, blood sugar 86 mg/dl, haemoglobin 9.4 g/dl, total leucocyte count 7200/mm3, erythrocyte sedimentation rate: 20 mm, serum uric acid 6.6 mg/dl, serum calcium 10.6 mg/dl, serum phosphorus 4.9 mg/dl, serum proteins: 7.1 g/dl, serum albumin 3.1 g/dl. Thyroid function tests were normal. Urine examination showed protein: +, 4–6 white blood cell/hpf and 2–4 red blood cells/hpf. Twenty-four hours urine examination showed a total urine volume of 4900 ml. Urine protein: creatinine ratio was 0.27.
Ultrasound showed right kidney measuring 8.9 cm × 3.4 cm and left kidney 9.2 cm × 4.0 cm with normal echotexture.
Two-dimensional echocardiogram revealed moderate concentric left ventricular hypertrophy. Left atrium was dilated, valves were normal. There was aortic regurgitation, moderate left ventricular systolic dysfunction and Grade I left ventricular diastolic dysfunction.
Renal Doppler showed diffuse wall thickening with more than 90% diffuse luminal stenosis bilaterally. Distal renal arteries were poorly visualized and show decreased flow velocities. Intrarenal parenchymal arteries showed reverse flow pattern. Right renal artery showed a peak systolic velocity of 31 cm/s while the left renal artery had a peak systolic velocity of 46 cm/s. Proximal aorta showed diffuse wall thickening and decreased caliber (aorto arteritis with B/L proximal RAS of > 90%).
Computed tomography (CT) angiogram showed 60–70% stenosis of renal arteries at origin bilaterally []. Proximal abdominal aorta showed decreased caliber with thickened wall. The coronary arteries were normal.
Conventional angiogram showed diffuse concentric thickening of distal thoracic and upper abdominal aorta with bilateral long-segment occlusion of main renal arteries with distal renal arteries filling through collaterals.
Patient was on clonidine 0.2 mg tid, nifedipine retard 20 mg tid, prazosin XL 5 mg bid, carvedilol 3.125 mg bid and torsemide 20 mg bid. With above medications, BP was 160/110 mmHg. The patient was initially treated with steroids, but there was no improvement.
As both renal arteries had long-segment stenosis proximally with good distal caliber, splenrenal arterial anastomosis was planned. Intraoperative findings revealed that left renal artery was replaced by fibrous cord till hilum. One centimeter stump of the renal artery (6 mm diameter) was felt in the hilum, dividing into upper and lower divisions. The abdominal aorta was encased by thick inflammatory tissue and lymph nodes. The splenic artery was identified and anastomosed with left renal artery end to end (splenorenal anastomosis).
On 2nd postoperative day BP was 140/84 mmHg with nifedipine 20 mg 1 tablet tid. Postoperative Doppler showed good filling of left distal renal artery through the splenic artery with good renal perfusion. CT angiogram was performed on 10th postoperative day that demonstrated patent splenorenal arterial anastomosis []. Patient was discharged on 10th postoperative day with advice for right kidney revascularization after 2 months. Serum creatinine at discharge was 1.2 mg/dl. At 6 months, postoperation patient's BP was 120/80 without any drugs.",What is the patient's serum osmolality in terms of mOsm/kg? You may take the alcohol content as 0 mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Blood Urea Nitrogen (BUN)': [29.0, 'mg/dL'], 'Glucose': [86.0, 'mg/dL'], 'Sodium': [139.0, 'mmol/L']}",293.13492,278.47817,307.79167,"The formula for computing serum osmolality is 2 * Na + (BUN / 2.8) + (glucose / 18), where Na is the concentration of sodium in mmol/L, the concentration of BUN is in mg/dL, and the concentration of glucose is in mg/dL.
The concentration of sodium is 139.0 mmol/L. 
The concentration of bun is 29.0 mg/dL. 
The concentration of glucose is 86.0 mg/dL. 
Plugging these values into the equation, we get 2 * 139.0 + (29.0 / 2.8) + (29.0 / 18) = 293.13492 mmol/L.The patient's calculated serum osmolality concentration is 293.13492 mmol/L. This is equalivalent to 293.13492 mOsm/kg."
420,30,Serum Osmolality,lab test,decimal,pmc-4554223-1,Extracted,"A 29-year-old female with no significant past medical history presented to the emergency department with complaints of shortness of breath and productive cough consisting of green phlegm. The symptoms started a month prior for which she visited her primary medical doctor and was treated for pneumonia. Her symptoms continued to persist and gradually worsen at which point she was also treated with tamiflu for influenza. Her other symptoms however continued to progress and consisted of fever, chills, cough, body aches, and shortness of breath. The patient is a non-smoker, drinks alcohol socially, and works in a pharmacy.
On physical examination, the patient was tachycardia with a heart rate of 118, blood pressure of 111/72, respiratory rate of 24, and was saturating 88% on room air. At the time, she was afebrile with a temperature of 99.1 °F. Significant findings on examination showed diffuse rhonchi bilaterally with crackles on lung examination. Laboratory data demonstrated hemoglobin of 13, hematocrit of 39, white blood cell of 10.9, and platelets of 344,000. Sodium was 136 mEq/L, potassium 3.8 mEq/L, chloride 98 mEq/L, bicarbonate 21 mEq/L, blood urea nitrogen 15 mg/dL, creatinine 1.0 mg/dL, and glucose of 113 mg/dL. Troponins were negative. D-dimer was elevated at 0.71 and CT angiogram (CTA) was conducted to rule out pulmonary embolism. CTA of the chest was negative for pulmonary embolism but showed tree-in bud changes in the right upper lobe suspicious for an infectious or inflammatory process (). Similar findings were also seen in the right lower lobe. There were linear changes in the lower lobes bilaterally which most likely represented atelectasis and there was a 7.6 mm nodule in the left lower lobe.
The patient was admitted to telemetry for the management of pneumonia with azithromycin and ceftriaxone initially. Patient was found to be positive for Mycoplasma pneumonia and medications were adjusted accordingly. Patient continued to have persistent hypoxia and continued to desaturate to 88% upon ambulation. She was later found to have hemophilus influenza growth in sputum culture, which was properly being managed by her antibiotic regimen. During her hospital stay, although the patient was receiving solumedrol and antibiotics she continued to have diffuse bilateral crackles and productive cough. Patient was found to have leukocytosis as high as 19.6, but this could be attributed to her steroid treatment. However, this train of thought remained unclear as the patient was also found to have a bandemia of 21. Her antibiotics for methicillin-resistant Staphylococcus aureus (MRSA) were adjusted to consist of doxycycline, zyvox, and fluconazole. The patient continued to deteriorate and systemic workup including allergy test, antineutrophil cytoplasmic autoantibody (cANCA), perinuclear anti-neutrophil cytoplasmic antibodies (pANCA), antinuclear antibody (ANA), purified protein derivative (PPD), QuantiFERON, and human immunodeficiency virus (HIV) test was all conducted. Full systemic workup returned negative for any findings. After completing her course of antibiotics, she was also removed from her steroids but would continue to desaturate and lung findings remained unchanged. Patient underwent bronchoscopy but no significant mass or lesion was found to biopsy and her postoperative diagnosis remained as non-resolving pneumonia. Repeat CT scan was performed which showed minimal improvement and continue to suggest pneumonia and possibly underlying interstitial lung disease ().
The patient was scheduled for video-assisted thoracoscopic surgery (VATS) procedure with biopsy of the right middle and lower lobes. Right lower lobe wedge biopsy on pathology showed lung parenchyma with consolidation, atelectasis, and areas of fibrosis (). Right mid lung biopsy also showed foci of consolidation but also consisted of varying stages of questionable emphysema (). As the findings were highly unusual and emphysematous changes were not found on patient’s CT scans, the pathology was sent to a specialist, who confirmed the results but again noted them to be very non-specific. The patient’s post-operative status was complicated and patient desaturated overnight and required intubation. Alpha-1 antitrypsin was sent but returned elevated. The patient was successfully extubated after 2 days. She was placed back on steroids and was clinically improving over the course of another 1 week. Her pulse oximetry however on room air remained around 86% even after a week of steroids and thus the patient would be discharged on home oxygen therapy. Pulmonary function tests were significant for a forced vital capacity (FVC) moderately reduced at 1.65 L (60%), forced expiratory volume in 1 second (FEV1) severely reduced at 0.98 L (40%), FEV1/FVC ratio reduced at 59%, and MVV severely reduced at 28%. Flow volume loop demonstrated a combined obstructive and restrictive contour (). Lung volumes showed a vital capacity reduced at 1.65 L (60%), total lung capacity (TLC) reduced at 2.08 L (56%), and residual volume (RV) reduced at 0.43 L (43%). Her diffusion capacity (DLCO) was also severely reduced at 38%. These findings were suggestive of combined severe, irreversible obstructive and restrictive lung disease with severely reduced diffusion capacity. She would follow up with infectious disease and a pulmonary specialist as an outpatient for further workup and repeat CT scan in 3 weeks with further discussion with regard to possible lung transplant options.",What is the patient's serum osmolality in terms of mOsm/kg? You may take the alcohol content as 0 mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Blood Urea Nitrogen (BUN)': [15.0, 'mg/dL'], 'Glucose': [113.0, 'mg/dL'], 'Sodium': [136.0, 'mEq/L']}",283.63492,269.45317,297.81667,"The formula for computing serum osmolality is 2 * Na + (BUN / 2.8) + (glucose / 18), where Na is the concentration of sodium in mmol/L, the concentration of BUN is in mg/dL, and the concentration of glucose is in mg/dL.
The concentration of sodium is 136.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 136.0 mEq. To convert from 136.0 mEq to mmol, convert from mEq to mmol. The compound 136.0 has a valence of 1, and so divide the valence by the value of mEq to get, 136.0 mEq/(1 mEq/mmol) = 136.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 136.0 mEq sodium/L converts to 136.0 mmol sodium/L. 
The concentration of bun is 15.0 mg/dL. 
The concentration of glucose is 113.0 mg/dL. 
Plugging these values into the equation, we get 2 * 136.0 + (15.0 / 2.8) + (15.0 / 18) = 283.63492 mmol/L.The patient's calculated serum osmolality concentration is 283.63492 mmol/L. This is equalivalent to 283.63492 mOsm/kg."
421,30,Serum Osmolality,lab test,decimal,pmc-5687981-1,Extracted,"A 3-year-old girl visited the Emergency Department because she had not been able to eat well and had a fever since one day ago. She had no abdominal pain, vomiting, or diarrhea. She had taken only the prescribed acetaminophen one day before. According to her past medical history, she went to kindergarten, had not traveled recently, had no history of pancreatitis, autoimmune disease, choledochal cyst, or pancreatic ductal abnormalities, and her family history was negative for pancreatic disease. She has one older sister, and her sister did not have symptoms such as fever. Her vital signs at admission were as follows: blood pressure, 97/60 mmHg; heart rate, 104 beats/min; respiration rate, 24 breaths/min; and body temperature, 37.4℃. Her height was 98 cm (50th–75th percentile), and her weight was 15 kg (50th–75th percentile). On physical examination, multiple vesicles on the soft palate and maculopapular rashes were observed on both the hands and feet. She had a clear breathing sound, regular heartbeat without murmur, and soft abdomen with a normoactive bowel sound without an abdominal mass or abdominal tenderness. In initial laboratory studies, the serum glucose was decreased (41 mg/dL), erythrocyte sedimentation rate was slightly increased (17 mm/hr; reference range, 0–10 mm/hr), and C-reactive protein was slightly elevated (12.9 mg/L; reference range, 0.0–5.0 mg/L), and other laboratory studies were within the normal ranges. The white blood cell count was 7.8×103/µL, hemoglobin was 12.6 g/dL, platelet count was 252×103/µL, blood urea nitrogen was 15.0 mg/dL, creatinine was 0.42 mg/dL, cholesterol was 187 mg/dL, albumin was 4.3 g/dL, total bilirubin was 0.39 mg/dL, direct bilirubin was 0.11 mg/dL, aspartate aminotransferase was 34 IU/L, alanine aminotransaminase was 10 IU/L, sodium was 135 mmol/L, potassium was 4.4 mmol/L. Amylase and lipase tests were not performed at the time of admission. Urine ketone body was 3 positive in urinalysis. A chest X-ray showed no active lung lesions, cardiopulmonary angle blunting, or cardiomegaly. Abdomen X-rays showed a nonspecific bowel gas pattern without ileus or pancreatic calcification.
We treated the child conservatively with intravenous fluid. On the first hospital day (HD), her fever subsided. On the third HD, she complained of ear pain caused by acute otitis media and intravenous amoxicillin/clavulanate was administered at a dose of 90 mg/kg/day. On the fourth HD, she experienced severe epigastric pain and vomiting. Her vital signs were as follows: blood pressure, 107/80 mmHg; heart rate, 109 beats/min.; respiration rate, 24 breaths/min; and body temperature, 37.2℃. On physical examination, she complained of epigastric tenderness. The serum levels of amylase and lipase were remarkably elevated (amylase, 1,902 IU/L; reference range, 28–100 IU/L; lipase, >1,500 IU/L; reference range, 13–60 IU/L). Ultrasonography of the abdomen showed mild diffuse swelling of the pancreas from head to tail with a small amount of ascites (), which suggested acute pancreatitis.
Considering the patient's history of HFMD, we thought that enterovirus, which is a common cause of HFMD, could be a pathogen. We asked the Korea Centers for Disease Control and Prevention for enterovirus typing of her stool sample. In the first step, real-time reverse transcription polymerase chain reaction (RT-PCR) was performed on the specimens targeting the 5' noncoding region capable of detecting all 68 serotypes, and the result was enterovirus-positive. In the second step, 2-step RT-PCR was performed targeting viral protein 1, which has a different structural enterovirus protein for each subtype, and CA16 was detected in the sample.
After acute pancreatitis was diagnosed, the patient was fasted and given sufficient intravenous fluid. Acetaminophen and ibuprofen were given for pain control. Serum amylase and lipase were serially followed (). The fever, epigastric pain, and vomiting were recovered on the sixth HD. She was discharged on the 11th HD without pancreatitis-related complications. On the day of discharge, the serum levels of amylase and lipase were remarkably reduced (amylase, 289 IU/L; lipase, 893 IU/L).
She was followed up after discharge without any symptoms, and pancreatitis has not recurred yet. Laboratory tests performed 6 months after discharge showed normal levels of serum amylase and lipase ().",What is the patient's serum osmolality in terms of mOsm/kg? You may take the alcohol content as 0 mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Blood Urea Nitrogen (BUN)': [15.0, 'mg/dL'], 'Glucose': [41.0, 'mg/dL'], 'Sodium': [135.0, 'mmol/L']}",277.63492,263.75317,291.51667,"The formula for computing serum osmolality is 2 * Na + (BUN / 2.8) + (glucose / 18), where Na is the concentration of sodium in mmol/L, the concentration of BUN is in mg/dL, and the concentration of glucose is in mg/dL.
The concentration of sodium is 135.0 mmol/L. 
The concentration of bun is 15.0 mg/dL. 
The concentration of glucose is 41.0 mg/dL. 
Plugging these values into the equation, we get 2 * 135.0 + (15.0 / 2.8) + (15.0 / 18) = 277.63492 mmol/L.The patient's calculated serum osmolality concentration is 277.63492 mmol/L. This is equalivalent to 277.63492 mOsm/kg."
422,30,Serum Osmolality,lab test,decimal,usmle-1945,Extracted,"A previously healthy 8-year-old boy is brought to the physician by his mother because of 6 months of progressive fatigue and weight loss. His mother reports that during this time, he has had decreased energy and has become a “picky eater.” He often has loose stools and complains of occasional abdominal pain and nausea. His family moved to a different house 7 months ago. He is at the 50th percentile for height and 25th percentile for weight. His temperature is 36.7°C (98°F), pulse is 116/min, and blood pressure is 85/46 mm Hg. Physical examination shows tanned skin and bluish-black gums. The abdomen is soft, nondistended, and nontender. Serum studies show:
Na+ 134 mEq/L
K+ 5.4 mEq/L
Cl- 104 mEq/L
Bicarbonate 21 mEq/L
Blood Urea nitrogen 16 mg/dL
Creatinine 0.9 mg/dL
Glucose 70 mg/dL
Intravenous fluid resuscitation is begun.",What is the patient's serum osmolality in terms of mOsm/kg? You may take the alcohol content as 0 mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Sodium': [134.0, 'mEq/L'], 'Glucose': [70.0, 'mg/dL'], 'Blood Urea Nitrogen (BUN)': [16.0, 'mg/dL']}",277.60317,263.72301,291.48333,"The formula for computing serum osmolality is 2 * Na + (BUN / 2.8) + (glucose / 18), where Na is the concentration of sodium in mmol/L, the concentration of BUN is in mg/dL, and the concentration of glucose is in mg/dL.
The concentration of sodium is 134.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 134.0 mEq. To convert from 134.0 mEq to mmol, convert from mEq to mmol. The compound 134.0 has a valence of 1, and so divide the valence by the value of mEq to get, 134.0 mEq/(1 mEq/mmol) = 134.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 134.0 mEq sodium/L converts to 134.0 mmol sodium/L. 
The concentration of bun is 16.0 mg/dL. 
The concentration of glucose is 70.0 mg/dL. 
Plugging these values into the equation, we get 2 * 134.0 + (16.0 / 2.8) + (16.0 / 18) = 277.60317 mmol/L.The patient's calculated serum osmolality concentration is 277.60317 mmol/L. This is equalivalent to 277.60317 mOsm/kg."
423,30,Serum Osmolality,lab test,decimal,pmc-6288861-1,Extracted,"A 47-year-old female patient presented to the dialysis unit with decreased level of consciousness and sleepiness of two days duration. Her past medical history is end stage renal disease and regular hemodialysis 3 times/week for 2.5 years, controlled hypertension. She is non-diabetic. Her past surgical history included arteriovenous fistula before 2.5 years, appendectomy and tonsillectomy long time ago.
The patient was in her usual state of health of moderate exercise tolerance until two days before admission when she started to experience lower back and bilateral knee pain that was vague in nature and associated with insomnia. That time, she received one tablet of baclofen 25 mg from her sister. Her sister used to ingest baclofen for chronic neck pain. The patient fell into a deep sleep throughout that night and entire next day without any wakefulness periods. Two days later, she went to her usual hemodialysis session and there the medical personnel noticed her high blood pressure and a state of unconsciousness for which she was sent back to the emergency department after the hemodialysis session. The family denied any previous similar episodes or limb weakness, numbness, dysarthria, dysphagia or mouth deviation before the event. There is no history of fever, photophobia, neck stiffness, falling down or any psychosocial problems. She had not travelled or had any contact with sick people. She was compliant to her hemodialysis sessions. She is a 20 pack-year smoker but does not use any illegal drugs or consume alcoholic drinks. Her home medications were: Atenolol 50 mg/day, Amlodipine 5 mg/ day, CaCO3 600 mg /day and alfacalcidol 0.25 ugm/day.
On examination, the vital signs were as follows: Temperature: 36.4 °C, Blood pressure: 220/110, pulse: 95 beat/minute, respiratory rate: 14/min, oxygen saturation: 95% on room air. On admission, the Glasgow Coma Scale was 9/15. She was unconscious. Deep tendon reflexes were absent. There was no obvious facial asymmetry, left pupil was round and reactive to light (right eye is artificial due to previous trauma). Gag reflex was intact but the cranial nerves could not be assessed. The fundus was examined and no papilledema or hemorrhage were seen. The breathing sounds were heard bilaterally on the chest with no added sounds. Abdominal examination was unremarkable.
Lab results at admission were: Hemoglobin: 16.1 g/dL, White blood cells: 6.8 K/ul, platelets: 155 K/ul, Sodium: 138 mEq/L, potassium: 4.4 mEq/L, chloride: 95 mEq/L, CRP: 1.6 mg/L, Glucose: 99 mg/dL, ABG’s: pH:7.44, pCO2: 36.6 mmHg, pO2: 88 mmHg, HCO3: 24.4 mEq/L, albumin: 4.4 g/dL, alkaline phosphatase:88, total bilirubin: 0.5 mg/dL, direct bilirubin: 0.2 mg/dL, BUN: 27 mg/dL, Creatinine: 5.5 mg/dL. Liver function tests were within normal ranges. To rule out any brain ischemia or hemorrhage, brain computed topography (CT scan) was done on the day of admission and Magnetic resonance imaging (MRI) of the brain was done on the second day of admission. CT scan showed no significant lesions, no hemorrhage or any other defects. MRI showed no signs of recent ischemic stroke, intracranial hemorrhage, space-occupying lesion or midline shift. The hypertension was controlled by labetalol IV infusion pump.
After ruling out all possible causes of her decreased level of consciousness, including Posterior reversible encephalopathy syndrome (PRES), baclofen toxicity was considered as the cause. She was started on flumazenil 0.25 mg and on intensive daily ultrafiltration hemodialysis sessions since the first day of admission with total of three extra hemodialysis sessions. The improvement started to be noticed at the second day when she was semi-conscious, hallucinating, obeying commands as ordered but still not oriented to time, place or person. GCS was 10/15. The dramatic improvement was on the next day after a total of two extra hemodialysis sessions, she was fully awake, GCS 15/15, able to obey commands but still not well oriented so a third extra session was considered. After three days of admission and a total of five hemodialysis sessions, she was discharged after she had returned to her previous baseline state of health and she was instructed not to receive baclofen again.",What is the patient's serum osmolality in terms of mOsm/kg? You may take the alcohol content as 0 mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Blood Urea Nitrogen (BUN)': [27.0, 'mg/dL'], 'Glucose': [99.0, 'mg/dL'], 'Sodium': [138.0, 'mEq/L']}",291.14286,276.58572,305.7,"The formula for computing serum osmolality is 2 * Na + (BUN / 2.8) + (glucose / 18), where Na is the concentration of sodium in mmol/L, the concentration of BUN is in mg/dL, and the concentration of glucose is in mg/dL.
The concentration of sodium is 138.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 138.0 mEq. To convert from 138.0 mEq to mmol, convert from mEq to mmol. The compound 138.0 has a valence of 1, and so divide the valence by the value of mEq to get, 138.0 mEq/(1 mEq/mmol) = 138.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 138.0 mEq sodium/L converts to 138.0 mmol sodium/L. 
The concentration of bun is 27.0 mg/dL. 
The concentration of glucose is 99.0 mg/dL. 
Plugging these values into the equation, we get 2 * 138.0 + (27.0 / 2.8) + (27.0 / 18) = 291.14286 mmol/L.The patient's calculated serum osmolality concentration is 291.14286 mmol/L. This is equalivalent to 291.14286 mOsm/kg."
424,30,Serum Osmolality,lab test,decimal,pmc-6425342-1,Extracted,"A 64-year-old woman with no past medical history and no prescribed medications was found unresponsive at home after ingestion of 208 tablets of Tylenol PM™ (APAP 500 mg with diphenhydramine 25 mg) approximately three hours prior to transportation to the ED. She was endotracheally intubated by prehospital staff due to decreased level of consciousness, vomitus, and agonal respiration. On arrival to the ED, vital signs included temperature of 33.9°C, heart rate of 57 bpm, blood pressure of 139/102 mmHg, respiratory rate of 19 rpm, and oxygen saturation of 99% on 100% FiO2. Physical examination demonstrated a Glasgow Coma Scale score 3 without spontaneous respiration. The patient subsequently became hypotensive requiring five IV push-dose epinephrine doses (total 100 µg), followed by dopamine (10 µg/kg/min increased to 15 µg/kg/min), and then a norepinephrine infusion (10 µg/min). An electrocardiogram (ECG) showed sinus rhythm of 58 bpm, PR of 144 ms, QRS of 112 ms, and QTc of 659 ms. Serum chemistries measured as follows: lactate 7.6 mmol/L (0.5-1.0 mmol/L), glucose 193 mg/dL (70-100 mg/dL), Na+ 142 mEq/L (136-144 mEq/L), K+ 3.2 mEq/L (3.7-5.2 mEq/L), Cl− 110 mmol/L (96-106 mmol/L), CO2 18 mmol/L (20-29 mmol/L), BUN 16 mg/dL (7-20 mg/dL), Cr 1.17 mg/dL (0.6-1.1 mg/dL), AST 21 IU/L (10-34 IU/L), ALT 99 IU/L (8-37 IU/L), and INR 1.2 (0.8-1.1). Initial ABG measured as follows: pH 7.32 (7.35-7.45), pCO2 30 mmHg (35-45 mmHg), pO2 249 mmHg (80-100 mmHg), and HCO3 16 (CMV FiO2 65%, PEEP 6, RR 16, and TV 500 mL). Initial serum APAP concentration measured 1,017 µg/mL. Serum salicylate and ethanol concentrations measured 7 mg/dL and negative, respectively. A preliminary urine drug screen of abuse detected only methadone. Expanded serum liquid chromatography/mass spectroscopy detected caffeine, dihydrocodeine/hydrocodol, lidocaine, monoethylglycinexylidide, and diphenhydramine. A chest X-ray revealed mild interstitial edema. Head computed tomography was unremarkable. The patient was admitted to the intensive care unit. There was no repeat ECG performed prior to transfer to transplant center; however, no dysrhythmias were observed on telemetry monitoring.
The medical toxicology service was consulted and recommended IV sodium bicarbonate (for prolonged QRS interval), IV NAC, IV 4-MP (15 mg/kg), and immediate HD. APAP concentration decreased to 825 µg/mL after initiation of IV NAC, and serial concentrations exponentially decreased during “triple therapy” (Figures and ). During HD, the IV NAC rate of administration was doubled to 200 mg/kg and then tripled to 300 mg/kg, and a subsequent dose of IV 4-MP 10 mg/kg was administered; these were performed due to concern of HD removal of both antidotes.
The patient's mental status improved during HD; however, she did not follow commands. Due to concern for potential severe liver injury given the massive initial APAP concentration and lack of institutional transplant services, she was transferred to a liver transplant center on hospital day one. On arrival to the liver transplant center, she was maintained on IV NAC and received an additional HD treatment. 4-MP was not readministered. IV NAC was discontinued when APAP concentrations were undetectable. The patient was awake and following commands but failed extubation due to respiratory distress and pneumonia. She was ultimately extubated to BiPAP and discharged to an inpatient psychiatry unit approximately eight days after ED presentation in a normal state of health.",What is the patient's serum osmolality in terms of mOsm/kg? You may take the alcohol content as 0 mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Blood Urea Nitrogen (BUN)': [16.0, 'mg/dL'], 'Glucose': [193.0, 'mg/dL'], 'Sodium': [142.0, 'mEq/L']}",300.43651,285.41468,315.45834,"The formula for computing serum osmolality is 2 * Na + (BUN / 2.8) + (glucose / 18), where Na is the concentration of sodium in mmol/L, the concentration of BUN is in mg/dL, and the concentration of glucose is in mg/dL.
The concentration of sodium is 142.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 142.0 mEq. To convert from 142.0 mEq to mmol, convert from mEq to mmol. The compound 142.0 has a valence of 1, and so divide the valence by the value of mEq to get, 142.0 mEq/(1 mEq/mmol) = 142.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 142.0 mEq sodium/L converts to 142.0 mmol sodium/L. 
The concentration of bun is 16.0 mg/dL. 
The concentration of glucose is 193.0 mg/dL. 
Plugging these values into the equation, we get 2 * 142.0 + (16.0 / 2.8) + (16.0 / 18) = 300.43651 mmol/L.The patient's calculated serum osmolality concentration is 300.43651 mmol/L. This is equalivalent to 300.43651 mOsm/kg."
425,30,Serum Osmolality,lab test,decimal,pmc-6549199-1,Extracted,"A 46-year-old man was admitted to the emergency department with complaints of fever and skin lesions in the right leg since 3 days before. Moreover, he revealed a history of 5 years of poorly controlled diabetes mellitus despite being on oral medication. On physical examination, he was oriented and the following vital signs were observed: blood pressure: 80/60 mmHg; pulse rate: 90 beats/min; respiratory rate: 18 breaths/min; and oral temperature: 38 °C.
Two large erythematous lesions with central necrosis in the upper segment of the right leg were noticed. Further examination revealed crepitation of the same right leg segment.
Laboratory findings revealed the following: white blood cell (WBC) count, 17,000/mm3; hemoglobin, 15 g/dl; sodium, 125 meq/l; potassium, 3.8 meq/l; blood glucose, 400 mg/dl; blood urea nitrogen, 45 mg/dl; creatinine, 2.4 mg/dl; and bicarbonate,13 meq/l.
Plain X-ray of right leg revealed gas formation in the soft tissues, which was a diagnostic criterion for necrotizing fasciitis (). The patient was treated immediately with intravenous fluid, broad spectrum empiric antibiotics (meropenem plus vancomycin), and insulin infusion; moreover, urgent surgical consultation was requested. He underwent emergency debridement within few hours of hospitalization.",What is the patient's serum osmolality in terms of mOsm/kg? You may take the alcohol content as 0 mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Blood Urea Nitrogen (BUN)': [45.0, 'mg/dL'], 'Glucose': [400.0, 'mg/dL'], 'Sodium': [125.0, 'mEq/L']}",288.29365,273.87897,302.70833,"The formula for computing serum osmolality is 2 * Na + (BUN / 2.8) + (glucose / 18), where Na is the concentration of sodium in mmol/L, the concentration of BUN is in mg/dL, and the concentration of glucose is in mg/dL.
The concentration of sodium is 125.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 125.0 mEq. To convert from 125.0 mEq to mmol, convert from mEq to mmol. The compound 125.0 has a valence of 1, and so divide the valence by the value of mEq to get, 125.0 mEq/(1 mEq/mmol) = 125.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 125.0 mEq sodium/L converts to 125.0 mmol sodium/L. 
The concentration of bun is 45.0 mg/dL. 
The concentration of glucose is 400.0 mg/dL. 
Plugging these values into the equation, we get 2 * 125.0 + (45.0 / 2.8) + (45.0 / 18) = 288.29365 mmol/L.The patient's calculated serum osmolality concentration is 288.29365 mmol/L. This is equalivalent to 288.29365 mOsm/kg."
426,31,HOMA-IR (Homeostatic Model Assessment for Insulin Resistance),lab test,decimal,pmc-6167688-1,Extracted,"A 44-year-old male was emergently admitted to our hospital because of hematemesis due to the rupture of gastroesophageal varices. Prior to admission, he had no remarkable medical history. There was no family history of liver diseases. He was not a habitual drinker and did not take other drugs. Two years before admission, his height was 172.2 cm, his body weight was 120.1 kg, and his BMI was 40.5. On admission, his body weight was 116.7 kg and his BMI was 39.4. Physical examination demonstrated mild anemia in the palpebral conjunctiva and hepatosplenomegaly in the abdomen. Neurological findings were not remarkable. Laboratory data are shown in Table . White blood cell count was increased (15,100/µL), and platelet count was within normal limits (18.3 × 104/µL), while hemoglobin was 7.0 g/dL due to bleeding. Biochemical examination showed serum total bilirubin 0.8 mg/dL, albumin 2.9 g/dL, aspartate aminotransferase (AST) 19 U/L, alanine aminotransferase (ALT) 18 U/L, alkaline phosphatase 135 U/L, and gamma-glutamic transpeptidase 65 U/L, respectively. C-reactive protein was slightly elevated (1.33 mg/dL). Hyaluronic acid (187 ng/mL), type 4 collagen (248 ng/mL), and Mac2-binding protein (2.71 COI) were increased. Aspartate aminotransferase to platelet ratio index (APRI) [] and fibrosis-4 (FIB4) index [] were not elevated (APRI = 0.346 and FIB4 index = 1.08, respectively). APRI and FIB4 were calculated according to the following formula; APRI = AST level (IU/L) / upper limit of normal AST × 100 / platelet count (109/L), and FIB4 = age (year) × AST (IU/L) / {platelet count (109/L) × [ALT (U/L)]1/2}. Serum ferritin and ceruloplasmin were within normal limits. Hepatitis B surface antigen, hepatitis B virus core antibody, and hepatitis C virus antibody were all negative. Antinuclear antibody was elevated (×160), whereas antimitochondrial antibody and antiglutamic acid decarboxylase antibody were negative. Immunoglobulins, including IgG, IgM, and IgA, were within normal limits. Coagulation tests revealed a decrease in the percentage of prothrombin time (53.6%). Hemoglobin A1c was 8.1%, glycoalbumin was 16.7%, fasting plasma glucose (FPG) was 298 mg/dL, immunoreactive insulin (IRI) was 14.5 μIU/mL. Quantitative insulin sensitivity check index (QUICKI) was 0.28. The QUICKI was a novel and accurate method for determining insulin resistance; QUICKI = 1 / (log fasting IRI [μU/mL] + log FPG [mg/dL]) []. Abdominal ultrasonography examination showed brightness, mild hepatorenal echo contrast, surface irregularity, dullness of the edge of the liver, and splenomegaly (Fig. –c). Contrast-enhanced computed tomography (CT) demonstrated enlargement of the left hepatic lobe and splenomegaly, which corresponded to liver cirrhosis (Fig. ). Active contrast material extravasation was also seen, which represented active bleeding from gastroesophageal varices (Fig. , f). Esophagogastroduodenoscopy (EGD) showed gastroesophageal varices (Fig. , h). White plug, which seemed to be the bleeding lesion, was also seen in gastric varices (Fig. ). The varices were treated by endoscopic injection sclerotherapy and endoscopic variceal ligation. The histological findings of liver biopsy were mild steatosis, mild chronic inflammatory cell infiltrate, and severe fibrosis in the expanded portal areas with bridging fibrosis and spotty or focal necrosis (Fig. –d). Vacuolation of the nucleus (Fig. ) and MDBs (Fig. ) were also seen. Immunostaining using anti-p62/SQSTM1 antibody (Medical and Biological Laboratories, Nagoya, Japan) demonstrated MDBs, which were irregularly shaped cytoplasmic inclusions (Fig. , d) typically located in proximity to the nucleus (Fig. arrows). Based on these findings, the patient was diagnosed with portal hypertension and liver cirrhosis due to NASH. He was also diagnosed, for the first time, with T2DM based on the following findings: FPG exceeding 126 mg/dL, random glucose level over 200 mg/dL, and hemoglobin A1c over 6.5%. Because hyperglycemia persisted after admission, we started insulin therapy. After starting insulin treatment, hyperglycemia immediately improved. Subsequently, we started the administration of tofogliflozin, a sodium glucose cotransporter 2 (SGLT2) inhibitor.",What is the patient's HOMA-IR score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Glucose': [298, 'mg/dL'], 'Insulin': [14.5, 'µIU/mL']}",10.66914,10.13568,11.2026,"The formula for computing HOMA-IR score is (insulin (µIU/mL) * glucose mg/dL)/405.
The concentration of insulin is 14.5 µIU/mL.
The concentration of glucose is 298 mg/dL. 
Plugging into the formula will give us 14.5 * 298/405 = 10.66914. Hence, the patient's HOMA-IR score is 10.66914."
427,31,HOMA-IR (Homeostatic Model Assessment for Insulin Resistance),lab test,decimal,pmc-6128601-1,Extracted,"A 31-year-old Asian American female with past medical history of chewing of betel leaf with betel nuts and non-smoker, who immigrated to the USA from Burma four years previously, was referred to the Digestive Health Center at the University of Virginia for evaluation of elevated transaminases discovered upon routine testing. She reported no previous history of liver test abnormality or liver disease. She was not using any hepatotoxic prescription or over the counter medications or supplements and reported rare consumption of alcohol. Besides, she had no family history of liver disease, hepatocellular carcinoma, autoimmune disorders or diabetes mellitus.
The physical examination was significant for obesity with weight 66 kg, height 146 cm, body mass index (BMI) 31, hepatomegaly, nonpalpable spleen, and lack of stigmata of chronic liver disease. Extensive laboratory workup revealed normal complete blood count, renal function, serum electrolytes, iron studies, serum immunoglobulin levels, and ceruloplasmin. Also, hepatitis B and C serologic tests and autoimmune markers were negative. Fasting lipid profile revealed dyslipidemia (total cholesterol 260 mg/dL, triglycerides 267 mg/dL, high density lipoprotein 45 mg/dL, and low density lipoprotein 170 mg/dL). Fasting blood glucose was 165 mg/dL with simultaneous fasting insulin level of 4.8 mill international units/liter, thus has insulin resistance. Hemoglobin (Hgb) A1c level at this time was 6.8% which was higher than previous values from eight months prior (6.1%), 16 months prior (6.1%) and 39 months prior (4.8%).
Ultrasonographic evaluation of the abdomen revealed hepatomegaly, hyperechogenic liver indicative of severe hepatic steatosis, an ill-defined liver mass, and standard spleen size. Magnetic resonance examination defined the liver mass as hemangioma in addition to hepatomegaly and severe hepatic steatosis. Ultrasound-guided liver biopsy (sample size of 3.5 cm) showed severe macrosteatosis with mild lobular and periportal inflammation associated with focal hepatocyte damage (Figure , Panel A). Trichrome staining revealed focal portal, periportal and perisinusoidal fibrosis consistent with stage II (Figure , Panel B) with a NASH activity score (NAS) of 7. The patient was instructed to exercise routinely and follow a healthy diet. She was seen in follow-up for three months at which time her weight was unchanged. Physical examination revealed dark brownish red pigment on the teeth, tongue, and oral mucosa. Upon questioning the patient about this finding, she admitted to chewing betel on an average of 10 times per day for the last eight years. The patient reported an associated weight gain of around 16 kg from her baseline weight maintained for many years at 50 kg (BMI 23.5). This significant weight gain could not be reversed despite daily physically demanding work and following a healthy diet recommended by her primary care physician.",What is the patient's HOMA-IR score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Glucose': [165.0, 'mg/dL'], 'Insulin': [4.8, 'µIU/mL']}",1.95556,1.85778,2.05334,"The formula for computing HOMA-IR score is (insulin (µIU/mL) * glucose mg/dL)/405.
The concentration of insulin is 4.8 µIU/mL.
The concentration of glucose is 165.0 mg/dL. 
Plugging into the formula will give us 4.8 * 165.0/405 = 1.95556. Hence, the patient's HOMA-IR score is 1.95556."
428,32,Charlson Comorbidity Index (CCI),risk,integer,pmc-8356001-1,Extracted,"A Caucasian 59-year-old woman, current smoker (10 pack-years), presented with symptomatic dry eye and mouth and inflammatory arthralgia. The patient had no known personal or family history of rheumatic disease. Physical examination at rheumatology consultation revealed bilateral conjunctival congestion and symmetrical polyarthritis affecting proximal interphalangeal and metacarpophalangeal joints. Although sicca symptoms are commonly present in smokers [], this patient also had polyarthritis on physical examination, and for this reason, the investigation for SS was performed. Serum levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), C3 and C4, IgA, IgM, and proteinogram were normal. IgG1, IgG3, and IG4 were normal; IgG2 was equal to 787 (normal range, 171 to 632 mg/dL). Rheumatoid factor (RF), antinuclear antibodies, and anti-SSA/B antibodies were negative. Hands conventional radiography revealed no erosions. Additional investigation for SS showed decreased parotid gland function on salivary glands scintigraphy, and ophthalmologic examination with Schirmer's test and tear break-up time confirmed severe dry eye. Lower labial mucosa biopsy revealed focal chronic sialadenitis characterized by intense lymphocytic inflammatory infiltrate (1 focus/4 mm2 of glandular tissue). These findings (Schirmer's test and focal labial mucosa biopsy) were consistent with the classification of primary SS according to the American College of Rheumatology/European League Against Rheumatism criteria (2016). The patient did not tolerate hydroxychloroquine and was treated with prednisolone 5 mg/daily and pilocarpine 5 mg four times a day. The patient was evaluated every 6 months, and her symptoms partially improved under these medications.
About two years after the diagnosis of primary SS, the patient started complaining of epigastric pain, nausea, and severe low back pain. She also had asthenia and weight loss (15 kg in 5 months). After a long-haul flight, she developed lower limb deep vein thrombosis and was hypocoagulated with dabigatran. Ten days later, the patient was admitted in the emergency department with an ischemic stroke in multiple vascular territories (). Physical examination revealed a left lower facial paresis and dysarthria. From the stroke study, electrocardiogram revealed sinus rhythm, cervical and transcranial Doppler ultrasound, a total occlusion of the right middle cerebral artery, and transthoracic echocardiography, a redundant oval foramen membrane with a positive right-left shunt. Additional investigation showed normocytic anemia (Hb 10.4 g/dL), leukocytosis (18.000/μL) with neutrophilia (90.3%/13.500/μL), thrombocytosis (510.000/μL), and elevated CRP (73 mg/L) and ESR (62 mm in the first hour). Over time, a progressive elevation of liver cholestasis enzymes occurred: gamma-glutamyl transferase 534 (normal range, 7 to 32 U/L) and alkaline phosphatase 357 (normal range, 30 to 120 U/L), with no cytolysis. Pancreatic enzymes, renal function, proteinogram, and urinalyses were normal. Viral serologies were negative. Abdominal ultrasound and upper and lower gastrointestinal endoscopies revealed no pathological findings. Subsequent cervical, chest, abdomen, and pelvic computed tomography scan (TC CCAP) showed non-specific scattered pulmonary micronodules in lung lower lobes, liver parenchyma with several nodules, and retroperitoneal ganglion cluster in the hepatic hilum.
According to these findings, the diagnostic hypotheses postulated were neoplastic metastasis of a solid tumor or lymphoproliferative disease. In this regard, mammography, peripheral blood immunophenotyping, and bone marrow biopsy were performed which showed no evidence of a neoplastic disorder. Liver biopsy was subsequently performed, and pathologic analysis revealed an adenocarcinoma.
In accordance with the European Society for Medical Oncology and considering the diagnosis of an occult primary neoplasm with unfavorable histological subtype, the patient started an empirical chemotherapy protocol with carboplatin and paclitaxel. After the first cycle, treatment was suspended because the patient experienced a deterioration of her general clinical condition with progressive worsening of cytocholestasis parameters. The patient performed a new TC CCAP that revealed moderate ectasia of biliary tract and pancreatic duct, demonstrating one mass adjacent to the pancreatic head, which may indicate the epicenter of the neoplastic process. About one month after the first chemotherapy cycle, the patient died with a diagnosis of probable metastatic pancreatic adenocarcinoma.",What is the patient's Charlson Comorbidity Index (CCI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [59, 'years'], 'Peripheral vascular disease': True, 'Cerebrovascular Accident': True, 'Connective tissue disease': True, 'Liver disease severity': 'mild', 'Hemiplegia': False, 'Moderate to severe Chronic Kidney Disease': False, 'Solid tumor': 'metastatic'}",11,11,11,"The Charlson Comorbidity Index (CCI) are listed below:

1. Age: <50 years = 0 points, 50-59 years = +1 point, 60-69 years = +2 points, 70-79 years = +3 points, ≥80 years = +4 points
2. Myocardial infarction (history of definite or probable MI with EKG changes and/or enzyme changes): No = 0 points, Yes = +1 point
3. Congestive heart failure (CHF) (exertional or paroxysmal nocturnal dyspnea, responsive to digitalis, diuretics, or afterload reducing agents): No = 0 points, Yes = +1 point
4. Peripheral vascular disease (intermittent claudication, past bypass for chronic arterial insufficiency, history of gangrene or acute arterial insufficiency, untreated thoracic or abdominal aneurysm ≥6 cm): No = 0 points, Yes = +1 point
5. Cerebrovascular accident (CVA) or transient ischemic attack (TIA) (history with minor or no residuals): No = 0 points, Yes = +1 point
6. Dementia (chronic cognitive deficit): No = 0 points, Yes = +1 point
7. Chronic pulmonary disease (CPD): No = 0 points, Yes = +1 point
8. Connective tissue disease: No = 0 points, Yes = +1 point
9. Peptic ulcer disease (any history of treatment for ulcer disease or ulcer bleeding): No = 0 points, Yes = +1 point
10. Liver disease: None = 0 points, Mild = +1 point, Moderate to severe = +3 points
11. Diabetes mellitus: None or diet-controlled = 0 points, Uncomplicated = +1 point, End-organ damage = +2 points
12. Hemiplegia: No = 0 points, Yes = +2 points
13. Moderate to severe chronic kidney disease (CKD): No = 0 points, Yes = +2 points
14. Solid tumor: None = 0 points, Localized = +2 points, Metastatic = +6 points
15. Leukemia: No = 0 points, Yes = +2 points
16. Lymphoma: No = 0 points, Yes = +2 points
17. AIDS: No = 0 points, Yes = +6 points

The total score is calculated by summing the points for each criterion.
    
The current CCI is value is 0.
The patient is 59 years old. Because the patient's age is between 50 and 59, we add 1 point to the score, making the current total = 0 + 1 = 1.
The issue, 'Myocardial infarction,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The issue, 'Congestive heart failure,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
 The issue,'Peripheral vascular disease,' is present for the patient and so we add 1 point to the score, making the current total 1 + 1 = 2.
At least one of transient ischemic attack or cerebral vascular accident must be present in the patient for a point to be added to the current total.
Transient ischemic attacks is not mentioned for the patient and so we assume it to be absent.
Cerebral vascular accident is determined to be present for the patient.
Because at least one of the issues is determined to be present for the patient, we add 1 point to the score, making the current total 2 + 1 = 3.
 The issue,'Connective tissue diease,' is present for the patient and so we add 1 point to the score, making the current total 3 + 1 = 4.
The issue, 'Dementia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 4.
The issue, 'Chronic obstructive pulmonary disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 4.
The issue, 'Hemiplegia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 4.
The issue, 'Peptic ulcer disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 4.
The patient's liver disease is determined to be 'mild' and so we add 1 point to the score, making the current total 4 + 1 = 5.
The patient's diabetes mellitus status is not determined and so we assume the value to be 'none or diet-controlled.' No points are added to the score, keeping the current total at 5.
The issue, 'Moderate to severe chronic kidney disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 5.
The patient's solid tumor is determined to be 'metastatic' and so we add 6 points to the score, making the current total 5 + 6 = 11.
The issue, 'Leukemia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 11.
The issue, 'Lymphoma,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 11.
The issue, 'AIDS,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 11.
The patient's CCI score is 11 points."
429,32,Charlson Comorbidity Index (CCI),risk,integer,pmc-6263463-2,Extracted,"This was a 64-year-old female patient, with no prior comorbidities, who was
followed by the Hematology team with a diagnosis of ECD, with bone, lymph node
and cardiovascular involvement, demonstrated by 18-FDG PET-CT examination. She
showed radiotracer hyper-uptake with a heterogeneous pattern in the RA walls
(SUVmax: 5.8) and right ventricle (SUVmax: 5.8) and
discreet pericardial thickening/effusion. The TTE performed in the Cardiology
department showed atrial pseudotumor in an echogenic image in the interatrial
septum, measuring 2.2 cm x 1.2 cm, suggestive of lipomatous infiltration. The
coronary artery angiotomography showed a calcium score (Agatston) of 4, at the
58th percentile of the MESA (Multi-Ethnic Study of
Atherosclerosis) study, with no significant coronary luminal reduction. As an
additional finding, it showed a soft tissue density expansive lesion in the RA
roof related to the interatrial septum and opening into the inferior vena cava.
The sinus node artery, the right coronary artery branch, had a partial
trajectory through the mass, in addition to atheromatosis in the descending
thoracic aorta ().",What is the patient's Charlson Comorbidity Index (CCI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [64, 'years'], 'Lymphoma': True}",4,4,4,"The Charlson Comorbidity Index (CCI) are listed below:

1. Age: <50 years = 0 points, 50-59 years = +1 point, 60-69 years = +2 points, 70-79 years = +3 points, ≥80 years = +4 points
2. Myocardial infarction (history of definite or probable MI with EKG changes and/or enzyme changes): No = 0 points, Yes = +1 point
3. Congestive heart failure (CHF) (exertional or paroxysmal nocturnal dyspnea, responsive to digitalis, diuretics, or afterload reducing agents): No = 0 points, Yes = +1 point
4. Peripheral vascular disease (intermittent claudication, past bypass for chronic arterial insufficiency, history of gangrene or acute arterial insufficiency, untreated thoracic or abdominal aneurysm ≥6 cm): No = 0 points, Yes = +1 point
5. Cerebrovascular accident (CVA) or transient ischemic attack (TIA) (history with minor or no residuals): No = 0 points, Yes = +1 point
6. Dementia (chronic cognitive deficit): No = 0 points, Yes = +1 point
7. Chronic pulmonary disease (CPD): No = 0 points, Yes = +1 point
8. Connective tissue disease: No = 0 points, Yes = +1 point
9. Peptic ulcer disease (any history of treatment for ulcer disease or ulcer bleeding): No = 0 points, Yes = +1 point
10. Liver disease: None = 0 points, Mild = +1 point, Moderate to severe = +3 points
11. Diabetes mellitus: None or diet-controlled = 0 points, Uncomplicated = +1 point, End-organ damage = +2 points
12. Hemiplegia: No = 0 points, Yes = +2 points
13. Moderate to severe chronic kidney disease (CKD): No = 0 points, Yes = +2 points
14. Solid tumor: None = 0 points, Localized = +2 points, Metastatic = +6 points
15. Leukemia: No = 0 points, Yes = +2 points
16. Lymphoma: No = 0 points, Yes = +2 points
17. AIDS: No = 0 points, Yes = +6 points

The total score is calculated by summing the points for each criterion.
    
The current CCI is value is 0.
The patient is 64 years old. Because the patient's age is between 60 and 69, we add 2 points to the score, making the current total = 0 + 2 = 2.
The issue, 'Myocardial infarction,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Congestive heart failure,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Peripheral vascular disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
At least one of transient ischemic attack or cerebral vascular accident must be present in the patient for a point to be added to the current total.
Transient ischemic attacks is not mentioned for the patient and so we assume it to be absent.
Cerebral vascular accident is not determined for the patient and so we assume it to be absent.
Neither of the issues are determined to be present for the patient and so we add 0 point to the score, keeping the current total at 2.
The issue, 'Connective tissue diease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Dementia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Chronic obstructive pulmonary disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Hemiplegia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Peptic ulcer disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Liver disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The patient's diabetes mellitus status is not determined and so we assume the value to be 'none or diet-controlled.' No points are added to the score, keeping the current total at 2.
The issue, 'Moderate to severe chronic kidney disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The patient's solid tumor status is not determined and so we assume that it is 'none.' Hence, do not add any points to the score, keeping the current total at 2.
The issue, 'Leukemia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Lymphoma,' is determined to be present for the patient and so we add 2 points to the score, making the current total 2 + 2 = 4.
The issue, 'AIDS,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 4.
The patient's CCI score is 4 points."
430,32,Charlson Comorbidity Index (CCI),risk,integer,pmc-6982502-1,Extracted,"A 71-year-old male diagnosed in 2010 with prostate adenocarcinoma, gleason score of 3 + 3 = 6, PSA of 4 µg/L and no metastases on bone scan. Patient declined radical prostatectomy and opted for active surveillance. He was also known with chronic kidney disease secondary to hypertension and diabetes and had no previous or current history of tuberculosis. He has been voiding well on doxazocin XL 8 mg po nocte. Due to progressive rising in PSA from 4 (2010) to 9.5 µg/L(2018), a repeat prostate biopsy was planned. Digital rectal examination revealed an enlarged firm and nodular prostate (T2c). Transabdominal ultrasound outlined a lobular heterogeneous prostate measuring 90 cm3 (Figure A,B). Uroflowmetry did not show any features of bladder outlet obstruction with a maximal flow of 15.1 mLs/s, and there was no post void residual volume on ultrasound. In the absence of multiparametric magnetic resonance imaging (mpMRI) facility, systematic transrectal ultrasound guided sextant biopsy was performed and with tissue fragmentation a total of 20 cores were sent. The histopathology diagnosis was of an extensive xanthogranulomatous prostatitis (Figure ) with all the cores involved. The Ziehl Neelsen on the specimen was negative for acid-fast bacilli.",What is the patient's Charlson Comorbidity Index (CCI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [71, 'years'], 'Diabetes mellitus': 'uncomplicated', 'Moderate to severe Chronic Kidney Disease': True, 'Solid tumor': 'localized'}",8,8,8,"The Charlson Comorbidity Index (CCI) are listed below:

1. Age: <50 years = 0 points, 50-59 years = +1 point, 60-69 years = +2 points, 70-79 years = +3 points, ≥80 years = +4 points
2. Myocardial infarction (history of definite or probable MI with EKG changes and/or enzyme changes): No = 0 points, Yes = +1 point
3. Congestive heart failure (CHF) (exertional or paroxysmal nocturnal dyspnea, responsive to digitalis, diuretics, or afterload reducing agents): No = 0 points, Yes = +1 point
4. Peripheral vascular disease (intermittent claudication, past bypass for chronic arterial insufficiency, history of gangrene or acute arterial insufficiency, untreated thoracic or abdominal aneurysm ≥6 cm): No = 0 points, Yes = +1 point
5. Cerebrovascular accident (CVA) or transient ischemic attack (TIA) (history with minor or no residuals): No = 0 points, Yes = +1 point
6. Dementia (chronic cognitive deficit): No = 0 points, Yes = +1 point
7. Chronic pulmonary disease (CPD): No = 0 points, Yes = +1 point
8. Connective tissue disease: No = 0 points, Yes = +1 point
9. Peptic ulcer disease (any history of treatment for ulcer disease or ulcer bleeding): No = 0 points, Yes = +1 point
10. Liver disease: None = 0 points, Mild = +1 point, Moderate to severe = +3 points
11. Diabetes mellitus: None or diet-controlled = 0 points, Uncomplicated = +1 point, End-organ damage = +2 points
12. Hemiplegia: No = 0 points, Yes = +2 points
13. Moderate to severe chronic kidney disease (CKD): No = 0 points, Yes = +2 points
14. Solid tumor: None = 0 points, Localized = +2 points, Metastatic = +6 points
15. Leukemia: No = 0 points, Yes = +2 points
16. Lymphoma: No = 0 points, Yes = +2 points
17. AIDS: No = 0 points, Yes = +6 points

The total score is calculated by summing the points for each criterion.
    
The current CCI is value is 0.
The patient is 71 years old. Because the patient's age is between 70 and 79, we add 3 points to the score, making the current total = 0 + 3 = 3.
The issue, 'Myocardial infarction,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Congestive heart failure,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Peripheral vascular disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
At least one of transient ischemic attack or cerebral vascular accident must be present in the patient for a point to be added to the current total.
Transient ischemic attacks is not mentioned for the patient and so we assume it to be absent.
Cerebral vascular accident is not determined for the patient and so we assume it to be absent.
Neither of the issues are determined to be present for the patient and so we add 0 point to the score, keeping the current total at 3.
The issue, 'Connective tissue diease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Dementia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Chronic obstructive pulmonary disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Hemiplegia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Peptic ulcer disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Liver disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The patient's diabetes mellitus is determined to be 'uncomplicated' and so we add 1 point to the score, making the current total 3 + 1 = 4.
The issue, 'Moderate to severe chronic kidney disease,' is determined to be present for the patient and so we add 2 points to the score, making the current total 4 + 2 = 6.
The patient's solid tumor is determined to be 'localized' and so we add 2 points to the score, making the current total 6 + 2 = 8.
The issue, 'Leukemia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 8.
The issue, 'Lymphoma,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 8.
The issue, 'AIDS,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 8.
The patient's CCI score is 8 points."
431,32,Charlson Comorbidity Index (CCI),risk,integer,pmc-7797576-1,Extracted,"A 40-year-old man was referred to gastrointestinal surgeons for pancreatic mass pointed out by an abdominal ultrasonography in a medical check-up. The patient did not show any symptoms. Abdominal contrast-enhanced computed tomography (CT) revealed dissection from the CA (), DPA, and splenic artery (SA). This aneurysm was not seen on an abdominal unenhanced CT taken 6 years ago in a medical check-up. The enhancing inner lumen of the DPA was derived from false lumen and that of the SA was derived from true lumen. The stenosis of proximal side of SA, an aneurysm measuring 2.5 cm on DPAA with unenhanced mural thrombus, and the connection of the distal side of the DPAA to transverse pancreatic artery (TPA) with stenotic change were confirmed (). A connection with DPA and the superior mesenteric artery (SMA) was undetermined. The current diagnosis was the dissection of the CA to DPA and SA, resulting in DPAA and SA stenosis. After the diagnosis was made, the patient was referred to the department of radiology by a vascular surgeon for the consultation of endovascular surgery to prevent aneurysm rupture because open surgery was thought to be quite invasive as it required distal pancreatectomy with splenectomy and CA repair. He had received medications for hypertension. There were no remarkable findings in his initial laboratory data. We planned to embolize DPAA, SA, and dissected area of CA that allow to preserve vascular supply to hepatic artery from SMA via peripancreatic arcade and to distal side of SA via gastroduodenal artery (GDA) to TPA. An angiography from the CA revealed the enhancing inner lumen of DPAA from false lumen of dissected CA connecting to TPA (). TPA was revealed between the peripancreatic arcade from GDA and pancreatic tail artery that connected to the distal side of SA. A 4.5 Fr. Shepherd hook–type guiding sheath (Parent Plus 45: Medikit, Tokyo, Japan), carrying a triple coaxial system, consisted of a 4 Fr. intermediate catheter (Cerulean G: Medikit, Tokyo, Japan), 2.6 Fr. high-flow catheter (Masters HF: Asahi Intech, Aichi, Japan), 1.9 Fr. microcatheter (Carnelian Marvel: Tokai Medical Products, Aichi, Japan), was hooked on the CA. To prevent the coil migration into the TPA, a microballoon catheter (Logos: Piolax, Yokohama, Japan) was advanced to the distal side of the DPAA via the GDA to pancreatoduodenal artery and inflated at the sufficient point of the TPA through the additional 4 Fr. shepherd hook catheter placed in the CA from the contralateral groin site (). The 4.5 Fr guiding sheath and the 4 Fr. Shepherd hook catheter were inserted from the right and left side of the common femoral artery, respectively. Under microballoon catheter inflation, the distal side of the DPAA was embolized with detachable coils (PRESIDIO 6 mm × 20 cm, GALAXY 6 mm × 15 cm) through a 1.9 Fr microcatheter (). Afterward, the microballoon catheter was deflated. Then, intra-aneurysmal coil embolization was performed with detachable coils (Interlock-35 10 mm × 40 cm, 2 of 8 mm × 40 cm, 6 mm × 20 cm) through the 4 Fr. intermediate catheter (). Later, the microcatheter in the intermediate catheter was carefully advanced through the dissected portion of the SA and embolization of the affected area was performed with detachable coils (Penumbra POD 6 mm × 50 cm, Penumbra 6 mm × 15 cm, 4 mm × 8 cm, GALAXY 2 of 7 mm × 21 cm, 2 of 4 mm × 15 cm) (). Finally, coil embolization of the dissected CA was performed using detachable coils (Interlock-35 10 mm × 40 cm, 2 of 8 mm × 40 cm, 6 mm × 10 cm, 4 mm × 10 cm, 6 mm × 10 cm, Penumbra coil 400 2 of 10 mm × 30 cm) (). The final angiography from SMA after pulling out all the systems revealed complete occlusion of the DPAA, the proximal side of SA, preserving GDA to the TPA to the distal side of SA and preserving GDA to common hepatic artery to left gastric artery (). No complication including post-coiling ischemia or transient laboratory abnormalities in transaminases, amylases, or lipase was observed during and after the endovascular surgery. The patient was followed up for 2 years at the near hospital; however, DPAA has not shown regrowth by contrast enhancement CT.",What is the patient's Charlson Comorbidity Index (CCI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [40, 'years'], 'Solid tumor': 'localized', 'Peripheral vascular disease': False}",2,2,2,"The Charlson Comorbidity Index (CCI) are listed below:

1. Age: <50 years = 0 points, 50-59 years = +1 point, 60-69 years = +2 points, 70-79 years = +3 points, ≥80 years = +4 points
2. Myocardial infarction (history of definite or probable MI with EKG changes and/or enzyme changes): No = 0 points, Yes = +1 point
3. Congestive heart failure (CHF) (exertional or paroxysmal nocturnal dyspnea, responsive to digitalis, diuretics, or afterload reducing agents): No = 0 points, Yes = +1 point
4. Peripheral vascular disease (intermittent claudication, past bypass for chronic arterial insufficiency, history of gangrene or acute arterial insufficiency, untreated thoracic or abdominal aneurysm ≥6 cm): No = 0 points, Yes = +1 point
5. Cerebrovascular accident (CVA) or transient ischemic attack (TIA) (history with minor or no residuals): No = 0 points, Yes = +1 point
6. Dementia (chronic cognitive deficit): No = 0 points, Yes = +1 point
7. Chronic pulmonary disease (CPD): No = 0 points, Yes = +1 point
8. Connective tissue disease: No = 0 points, Yes = +1 point
9. Peptic ulcer disease (any history of treatment for ulcer disease or ulcer bleeding): No = 0 points, Yes = +1 point
10. Liver disease: None = 0 points, Mild = +1 point, Moderate to severe = +3 points
11. Diabetes mellitus: None or diet-controlled = 0 points, Uncomplicated = +1 point, End-organ damage = +2 points
12. Hemiplegia: No = 0 points, Yes = +2 points
13. Moderate to severe chronic kidney disease (CKD): No = 0 points, Yes = +2 points
14. Solid tumor: None = 0 points, Localized = +2 points, Metastatic = +6 points
15. Leukemia: No = 0 points, Yes = +2 points
16. Lymphoma: No = 0 points, Yes = +2 points
17. AIDS: No = 0 points, Yes = +6 points

The total score is calculated by summing the points for each criterion.
    
The current CCI is value is 0.
The patient is 40 years old. Because the patient's age is less than 50, we do not add any points to the score, keeping the current total at 0.
The issue, 'Myocardial infarction,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Congestive heart failure,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Peripheral vascular disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
At least one of transient ischemic attack or cerebral vascular accident must be present in the patient for a point to be added to the current total.
Transient ischemic attacks is not mentioned for the patient and so we assume it to be absent.
Cerebral vascular accident is not determined for the patient and so we assume it to be absent.
Neither of the issues are determined to be present for the patient and so we add 0 point to the score, keeping the current total at 0.
The issue, 'Connective tissue diease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Dementia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Chronic obstructive pulmonary disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Hemiplegia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Peptic ulcer disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Liver disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The patient's diabetes mellitus status is not determined and so we assume the value to be 'none or diet-controlled.' No points are added to the score, keeping the current total at 0.
The issue, 'Moderate to severe chronic kidney disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The patient's solid tumor is determined to be 'localized' and so we add 2 points to the score, making the current total 0 + 2 = 2.
The issue, 'Leukemia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Lymphoma,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'AIDS,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The patient's CCI score is 2 points."
432,32,Charlson Comorbidity Index (CCI),risk,integer,pmc-4381148-1,Extracted,"A 65-year-old woman was referred for colonoscopy because of abdominal pain and hematochezia. She had a history of end-stage renal disease, hypertension, and diabetes mellitus. She underwent hemodialysis three times per week. The patient's hemodynamic parameters were stable. On physical examination, she was found to have right abdominal pain and tenderness. Laboratory tests revealed a white blood cell (WBC) count of 13,900/mm2, a hemoglobin level of 9.4 g/dL, and a platelet count of 228,000/mm2. Serum biochemistry showed creatinine level, 6.6 mg/dL; albumin level, 3.0 g/dL; alanine aminotransferase level, 36 IU/L; aspartate aminotransferase level, 38 IU/L; bilirubin level, 1.2 mg/dL; and alkaline phosphatase level, 198 IU/L with normal electrolytes. Serum was negative for antinuclear antibody and HIV antibody. Anemia was associated with chronic renal failure. On stool examination, negative results were obtained for stool WBC, stool culture, and Clostridium difficile toxin A/B. The electrocardiogram showed normal results. An esophagogastroduodenoscopy revealed no evidence of bleeding. Colonoscopy was performed after standard bowel preparation and under sedation with 3 mg of midazolam. The colonoscopic findings showed diffuse bowel wall edema. Upon examination of the distal transverse colon, we found several deep linear red mucosal breaks resembling scratches ().
In the ascending colon, dark purple edematous mucosa and necrotic epithelial lesions were found (). Cecal intubation was not performed because of severe ischemic changes with necrosis. The remaining colorectal mucosa was grossly normal. Computed tomography (CT) scan showed moderate-to-severe diffuse bowel wall thickening and focally decreased mucosal enhancement in the right colon. The patient was diagnosed with ischemic colitis based on colonoscopic and CT findings, and clinical manifestations. The patient thus received supportive care. Intravenous fluids were administered to treat dehydration, and total parenteral nutrition with prophylactic antibiotics was provided. The patient was placed on bowel rest until the symptoms resolved. After 3 weeks, follow-up colonoscopy and CT were performed. On follow-up colonoscopy, the previous severe ischemic colonoscopic findings had disappeared, and ischemic mucosal change showed further resolution (). No further mucosal tearing was observed during the follow-up colonoscopy. On CT scans, improvement in ischemic colitis was noted. The patient no longer complained of abdominal pain or hematochezia.",What is the patient's Charlson Comorbidity Index (CCI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [65, 'years'], 'Liver disease severity': 'none', 'Diabetes mellitus': 'uncomplicated', 'Moderate to severe Chronic Kidney Disease': True, 'AIDS': False}",5,5,5,"The Charlson Comorbidity Index (CCI) are listed below:

1. Age: <50 years = 0 points, 50-59 years = +1 point, 60-69 years = +2 points, 70-79 years = +3 points, ≥80 years = +4 points
2. Myocardial infarction (history of definite or probable MI with EKG changes and/or enzyme changes): No = 0 points, Yes = +1 point
3. Congestive heart failure (CHF) (exertional or paroxysmal nocturnal dyspnea, responsive to digitalis, diuretics, or afterload reducing agents): No = 0 points, Yes = +1 point
4. Peripheral vascular disease (intermittent claudication, past bypass for chronic arterial insufficiency, history of gangrene or acute arterial insufficiency, untreated thoracic or abdominal aneurysm ≥6 cm): No = 0 points, Yes = +1 point
5. Cerebrovascular accident (CVA) or transient ischemic attack (TIA) (history with minor or no residuals): No = 0 points, Yes = +1 point
6. Dementia (chronic cognitive deficit): No = 0 points, Yes = +1 point
7. Chronic pulmonary disease (CPD): No = 0 points, Yes = +1 point
8. Connective tissue disease: No = 0 points, Yes = +1 point
9. Peptic ulcer disease (any history of treatment for ulcer disease or ulcer bleeding): No = 0 points, Yes = +1 point
10. Liver disease: None = 0 points, Mild = +1 point, Moderate to severe = +3 points
11. Diabetes mellitus: None or diet-controlled = 0 points, Uncomplicated = +1 point, End-organ damage = +2 points
12. Hemiplegia: No = 0 points, Yes = +2 points
13. Moderate to severe chronic kidney disease (CKD): No = 0 points, Yes = +2 points
14. Solid tumor: None = 0 points, Localized = +2 points, Metastatic = +6 points
15. Leukemia: No = 0 points, Yes = +2 points
16. Lymphoma: No = 0 points, Yes = +2 points
17. AIDS: No = 0 points, Yes = +6 points

The total score is calculated by summing the points for each criterion.
    
The current CCI is value is 0.
The patient is 65 years old. Because the patient's age is between 60 and 69, we add 2 points to the score, making the current total = 0 + 2 = 2.
The issue, 'Myocardial infarction,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Congestive heart failure,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Peripheral vascular disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
At least one of transient ischemic attack or cerebral vascular accident must be present in the patient for a point to be added to the current total.
Transient ischemic attacks is not mentioned for the patient and so we assume it to be absent.
Cerebral vascular accident is not determined for the patient and so we assume it to be absent.
Neither of the issues are determined to be present for the patient and so we add 0 point to the score, keeping the current total at 2.
The issue, 'Connective tissue diease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Dementia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Chronic obstructive pulmonary disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Hemiplegia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Peptic ulcer disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The patient's liver disease is determined to be 'none' and so we do not add any points to the score, keeping the current total at 2.
The patient's diabetes mellitus is determined to be 'uncomplicated' and so we add 1 point to the score, making the current total 2 + 1 = 3.
The issue, 'Moderate to severe chronic kidney disease,' is determined to be present for the patient and so we add 2 points to the score, making the current total 3 + 2 = 5.
The patient's solid tumor status is not determined and so we assume that it is 'none.' Hence, do not add any points to the score, keeping the current total at 5.
The issue, 'Leukemia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 5.
The issue, 'Lymphoma,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 5.
The issue, 'AIDS,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 5.
The patient's CCI score is 5 points."
433,32,Charlson Comorbidity Index (CCI),risk,integer,pmc-5547505-1,Extracted,"The patient was a 75-year-old Japanese male who had prostate cancer with bone metastasis and high serum PSA level (7040 ng/ml, reference range < 4 ng/dL) that responded well to luteinizing hormone-releasing hormone (LH-RH) agonist for 8 months. Abdominal CT scan revealed no evidence of prostate cancer progression. He was referred to our department due to a 4-week history of epigastric discomfort. Physical examination was not remarkable. Laboratory work-up was not significant except for elevated ALP, LDH and PSA levels, which were improved compared to values before hormone therapy (Table ).
Esophagogastroduodenoscopy (EGD) was performed and revealed a slightly depressed, discolored lesion with sharp margin against non-atrophic mucosa on the anterior wall of the middle gastric body (Fig. ). Magnifying endoscopy (ME) with blue laser imaging (BLI) and linked color imaging (LCI) demonstrated a sparse and partially absent microsurface pattern with irregular microvessels in the depressed area. These findings are compatible with UD-EGC. Biopsy showed moderately differentiated adenocarcinoma and immunohistochemistry with PSA was negative. Contrasted computed tomography demonstrated absence of significantly enlarged perigastric lymph nodes and also there were no new sites of metastatic disease. Thus, we initially diagnosed it as a primary early gastric cancer. Considering his prostate cancer and estimated prognosis of several years, endoscopic submucosal dissection was performed. En bloc resection was successfully achieved without complication. Histopathologic findings from the resected specimen were remarkable for moderately to poorly differentiated adenocarcinoma, which predominantly existed in the superficial layer of the submucosa. Atrophy of the gastric fundic glands, which were replaced with fibrous tissue, were observed focally near the tumor infiltration site (Fig. ). As metastasis was suspected, immunochemical staining was performed. The tumor was negative for PSA, cytokeratin (CK) 7, CK 20, and positive for PSAP (Fig. ). Consequently, the lesion was finally confirmed as a metastatic gastric lesion of the prostate cancer.
At the time when the pathological diagnosis of the gastric metastases was made, patient’s extragastric lesions were responding to endocrine therapy, and because of this we did not change his systemic treatment for prostate cancer.",What is the patient's Charlson Comorbidity Index (CCI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [75, 'years'], 'Solid tumor': 'metastatic'}",9,9,9,"The Charlson Comorbidity Index (CCI) are listed below:

1. Age: <50 years = 0 points, 50-59 years = +1 point, 60-69 years = +2 points, 70-79 years = +3 points, ≥80 years = +4 points
2. Myocardial infarction (history of definite or probable MI with EKG changes and/or enzyme changes): No = 0 points, Yes = +1 point
3. Congestive heart failure (CHF) (exertional or paroxysmal nocturnal dyspnea, responsive to digitalis, diuretics, or afterload reducing agents): No = 0 points, Yes = +1 point
4. Peripheral vascular disease (intermittent claudication, past bypass for chronic arterial insufficiency, history of gangrene or acute arterial insufficiency, untreated thoracic or abdominal aneurysm ≥6 cm): No = 0 points, Yes = +1 point
5. Cerebrovascular accident (CVA) or transient ischemic attack (TIA) (history with minor or no residuals): No = 0 points, Yes = +1 point
6. Dementia (chronic cognitive deficit): No = 0 points, Yes = +1 point
7. Chronic pulmonary disease (CPD): No = 0 points, Yes = +1 point
8. Connective tissue disease: No = 0 points, Yes = +1 point
9. Peptic ulcer disease (any history of treatment for ulcer disease or ulcer bleeding): No = 0 points, Yes = +1 point
10. Liver disease: None = 0 points, Mild = +1 point, Moderate to severe = +3 points
11. Diabetes mellitus: None or diet-controlled = 0 points, Uncomplicated = +1 point, End-organ damage = +2 points
12. Hemiplegia: No = 0 points, Yes = +2 points
13. Moderate to severe chronic kidney disease (CKD): No = 0 points, Yes = +2 points
14. Solid tumor: None = 0 points, Localized = +2 points, Metastatic = +6 points
15. Leukemia: No = 0 points, Yes = +2 points
16. Lymphoma: No = 0 points, Yes = +2 points
17. AIDS: No = 0 points, Yes = +6 points

The total score is calculated by summing the points for each criterion.
    
The current CCI is value is 0.
The patient is 75 years old. Because the patient's age is between 70 and 79, we add 3 points to the score, making the current total = 0 + 3 = 3.
The issue, 'Myocardial infarction,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Congestive heart failure,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Peripheral vascular disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
At least one of transient ischemic attack or cerebral vascular accident must be present in the patient for a point to be added to the current total.
Transient ischemic attacks is not mentioned for the patient and so we assume it to be absent.
Cerebral vascular accident is not determined for the patient and so we assume it to be absent.
Neither of the issues are determined to be present for the patient and so we add 0 point to the score, keeping the current total at 3.
The issue, 'Connective tissue diease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Dementia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Chronic obstructive pulmonary disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Hemiplegia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Peptic ulcer disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Liver disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The patient's diabetes mellitus status is not determined and so we assume the value to be 'none or diet-controlled.' No points are added to the score, keeping the current total at 3.
The issue, 'Moderate to severe chronic kidney disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The patient's solid tumor is determined to be 'metastatic' and so we add 6 points to the score, making the current total 3 + 6 = 9.
The issue, 'Leukemia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 9.
The issue, 'Lymphoma,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 9.
The issue, 'AIDS,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 9.
The patient's CCI score is 9 points."
434,32,Charlson Comorbidity Index (CCI),risk,integer,pmc-6451183-1,Extracted,"A 56-year-old male was referred in our Hospital’s Emergency Department (ED) with a firm and tender two-month old abdominal wall lump lying underneath the skin, in the subcutaneous fat, resembling an inflamed abdominal cyst.
Patient’s history includes a primary cancer of the left parotid 4 years ago. He underwent a left parotidectomy, with positive margins of resection (R1). Histology confirmed an epithelial neoplasia with a solid acinar cell pattern. Initial oncologic management conducted 25 courses of postoperative radiotherapy. The follow up recommended was six monthly for the first 4 years from initial diagnosis, and remained disease free until his presentation in our ED.
Clinical examination confirmed the mass, which was localized on the left midclavicular, subcostal and lateral to the umbilicus. It was palpable, firm with signs of tenderness. Laboratory tests were normal but clinical suspicion was high and so a computerized tomography (CT) scan with intravenous contrast (IV) was performed. This revealed a 1.8 cm × 2 cm lesion within the subcutaneous fat (Fig. ), resembling an inflamed cyst.
The patient was given a 7-day course of antibiotics prior to excision. The mass was then oncologically excised under local anesthesia. Histology identified infiltration of fatty abdominal wall tissue from acinic cells cancer and coagulative tumor necrosis, which led to the cystic formation of the lesion (Fig. ). Immunohistochemistry revealed positive tumor cells for Keratin 8/18, trypsin and Chymotrypsin (Fig. ). Further follow up scans revealed no metastasis, local recurrence or any other local growth.
Patient did not undergo further treatment and only scheduled for regular three monthly follow up.",What is the patient's Charlson Comorbidity Index (CCI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [56, 'years'], 'Solid tumor': 'localized'}",3,3,3,"The Charlson Comorbidity Index (CCI) are listed below:

1. Age: <50 years = 0 points, 50-59 years = +1 point, 60-69 years = +2 points, 70-79 years = +3 points, ≥80 years = +4 points
2. Myocardial infarction (history of definite or probable MI with EKG changes and/or enzyme changes): No = 0 points, Yes = +1 point
3. Congestive heart failure (CHF) (exertional or paroxysmal nocturnal dyspnea, responsive to digitalis, diuretics, or afterload reducing agents): No = 0 points, Yes = +1 point
4. Peripheral vascular disease (intermittent claudication, past bypass for chronic arterial insufficiency, history of gangrene or acute arterial insufficiency, untreated thoracic or abdominal aneurysm ≥6 cm): No = 0 points, Yes = +1 point
5. Cerebrovascular accident (CVA) or transient ischemic attack (TIA) (history with minor or no residuals): No = 0 points, Yes = +1 point
6. Dementia (chronic cognitive deficit): No = 0 points, Yes = +1 point
7. Chronic pulmonary disease (CPD): No = 0 points, Yes = +1 point
8. Connective tissue disease: No = 0 points, Yes = +1 point
9. Peptic ulcer disease (any history of treatment for ulcer disease or ulcer bleeding): No = 0 points, Yes = +1 point
10. Liver disease: None = 0 points, Mild = +1 point, Moderate to severe = +3 points
11. Diabetes mellitus: None or diet-controlled = 0 points, Uncomplicated = +1 point, End-organ damage = +2 points
12. Hemiplegia: No = 0 points, Yes = +2 points
13. Moderate to severe chronic kidney disease (CKD): No = 0 points, Yes = +2 points
14. Solid tumor: None = 0 points, Localized = +2 points, Metastatic = +6 points
15. Leukemia: No = 0 points, Yes = +2 points
16. Lymphoma: No = 0 points, Yes = +2 points
17. AIDS: No = 0 points, Yes = +6 points

The total score is calculated by summing the points for each criterion.
    
The current CCI is value is 0.
The patient is 56 years old. Because the patient's age is between 50 and 59, we add 1 point to the score, making the current total = 0 + 1 = 1.
The issue, 'Myocardial infarction,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The issue, 'Congestive heart failure,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The issue, 'Peripheral vascular disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
At least one of transient ischemic attack or cerebral vascular accident must be present in the patient for a point to be added to the current total.
Transient ischemic attacks is not mentioned for the patient and so we assume it to be absent.
Cerebral vascular accident is not determined for the patient and so we assume it to be absent.
Neither of the issues are determined to be present for the patient and so we add 0 point to the score, keeping the current total at 1.
The issue, 'Connective tissue diease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The issue, 'Dementia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The issue, 'Chronic obstructive pulmonary disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The issue, 'Hemiplegia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The issue, 'Peptic ulcer disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The issue, 'Liver disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The patient's diabetes mellitus status is not determined and so we assume the value to be 'none or diet-controlled.' No points are added to the score, keeping the current total at 1.
The issue, 'Moderate to severe chronic kidney disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The patient's solid tumor is determined to be 'localized' and so we add 2 points to the score, making the current total 1 + 2 = 3.
The issue, 'Leukemia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Lymphoma,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'AIDS,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The patient's CCI score is 3 points."
435,32,Charlson Comorbidity Index (CCI),risk,integer,pmc-7263708-1,Extracted,"A 68-year-old non-smoking Caucasian man initially transferred from a different hospital for evaluation of a brain lesion found on imaging. The patient has a medical history pertinent to BPH, and his family history was relevant for a father with colon cancer.
Six months earlier, his primary care physician (PCP) evaluated him for worsening urinary symptoms and subsequently referred him to a urologist. Upon further evaluation, his prostate-specific antigen (PSA) level was normal at 3 ng/mL, and his digital rectal examination was normal, for which a cystoscopy with prostate GreenLight™ (Boston Scientific, Marlborough, MA) enucleation was performed for BPH diagnosis. Five months later and one month before this admission, he discerned progressive worsening of double vision. His PCP examined and referred him to an ophthalmologist, who diagnosed him with third cranial (oculomotor) and sixth cranial (abducens) nerve palsy, which was subsequently confirmed by a neurologist.
Subsequently, the patient was admitted to the other hospital, and upon admission, he was found to have an acute kidney injury (AKI) and hyperkalemia. Laboratory studies showed white blood cells of 27 x 10^3/µL, hemoglobin of 11.5 g/dL, and platelet count of 201 K/µL. His chemistry was pertinent for sodium of 134 mmol/L, potassium of 6.5 mmol/L, chloride of 103 mmol/L, bicarbonate level of 10 mmol/L, a glucose of 159 mg/dL, creatinine of 13 mg/dL, uric acid of 19.6 µmol/L, chromogranin A of 656 µg/L, and PSA of 22.67 ng/mL. He received hemodialysis and underwent bilateral percutaneous nephrostomy, after which his AKI resolved. An abdominal CT scan showed findings consistent with diffuse metastatic disease to the lungs, liver, and peritoneum, and brain MRI showed brain lesions. Therefore, he was, subsequently, transferred to our hospital for further care.
Upon evaluation in our hospital, imaging showed findings consistent with earlier recognized lesions at the other hospital (Figures -). The patient was, therefore, seen by a multidisciplinary team of a neurosurgeon, an ophthalmologist, a medical oncologist, and a radiation oncologist. Biopsies of a perirectal mass showed a high-grade neuroendocrine tumor. The oncologist who saw him diagnosed him with metastatic SCC of the lung; therefore, he was started on one cycle of carboplatin/etoposide chemotherapy during his hospitalization, which he tolerated well and was discharged home.
A senior oncologist saw the patient, reviewed all his radiographic images, and questioned the initial diagnosis of lung SCC based on the patient’s clinical presentation of urinary obstruction, hydronephrosis, and AKI. Hence, the original tumor location speculated to be consistent with a high-grade neuroendocrine tumor/SCC originating from the urinary tract. The senior oncologist, therefore, advised cystoscopy for prostate biopsy, which was declined by consulting urologist because the “prostate exam was normal.” Consequently, the senior oncologist sent the patient to a second urologist who performed cystoscopy and informed the patient that everything was normal. The senior oncologist had a thorough discussion to explain the necessity of a meticulous endoscopic urethral examination and prostate biopsy. Subsequently, the patient took the senior oncologist’s advice, went back to the urologist, and underwent a repeat diagnostic cystoscopy. This time, biopsies of the urethra were taken and confirmed a high-grade large cell neuroendocrine carcinoma. 
 
The tissue specimen from this case was compared to the patient’s previous perirectal mass biopsy and was found to have similar features. Immunohistochemical (IHC) stains were negative for CK7, CK20, PSA, and prostate-specific acid phosphatase. Scattered individual cells were positive for nuclear NKX 3.1 and cytoplasmic CK5. Moreover, there was diffuse variable positivity for nuclear p63 with greater than 80% of nuclei were positive for p53 and diffuse strong positivity for CD56, thyroid transcription factor 1 (TTF-1), and synaptophysin (Figure ).
Based on the clinical history of disease distribution, the pathologist considered the neoplasm to be likely of either prostate or urinary bladder origin. Subsequently, the senior oncologist reviewed the urethral biopsy, remained suspecting the primary site of cancer to be originating from the prostate. Therefore, he advised for prostate biopsy. Finally, the patient underwent transrectal ultrasound-guided prostate biopsy, which confirmed that all 12 cores were positive for prostate SCC (Figure ). The pathology findings confirmed the senior oncologist’s initial surmise that the metastatic cancer origin was from the genitourinary tract, likely involving prostate extending into the urethra.",What is the patient's Charlson Comorbidity Index (CCI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [68, 'years'], 'Moderate to severe Chronic Kidney Disease': True, 'Solid tumor': 'metastatic'}",10,10,10,"The Charlson Comorbidity Index (CCI) are listed below:

1. Age: <50 years = 0 points, 50-59 years = +1 point, 60-69 years = +2 points, 70-79 years = +3 points, ≥80 years = +4 points
2. Myocardial infarction (history of definite or probable MI with EKG changes and/or enzyme changes): No = 0 points, Yes = +1 point
3. Congestive heart failure (CHF) (exertional or paroxysmal nocturnal dyspnea, responsive to digitalis, diuretics, or afterload reducing agents): No = 0 points, Yes = +1 point
4. Peripheral vascular disease (intermittent claudication, past bypass for chronic arterial insufficiency, history of gangrene or acute arterial insufficiency, untreated thoracic or abdominal aneurysm ≥6 cm): No = 0 points, Yes = +1 point
5. Cerebrovascular accident (CVA) or transient ischemic attack (TIA) (history with minor or no residuals): No = 0 points, Yes = +1 point
6. Dementia (chronic cognitive deficit): No = 0 points, Yes = +1 point
7. Chronic pulmonary disease (CPD): No = 0 points, Yes = +1 point
8. Connective tissue disease: No = 0 points, Yes = +1 point
9. Peptic ulcer disease (any history of treatment for ulcer disease or ulcer bleeding): No = 0 points, Yes = +1 point
10. Liver disease: None = 0 points, Mild = +1 point, Moderate to severe = +3 points
11. Diabetes mellitus: None or diet-controlled = 0 points, Uncomplicated = +1 point, End-organ damage = +2 points
12. Hemiplegia: No = 0 points, Yes = +2 points
13. Moderate to severe chronic kidney disease (CKD): No = 0 points, Yes = +2 points
14. Solid tumor: None = 0 points, Localized = +2 points, Metastatic = +6 points
15. Leukemia: No = 0 points, Yes = +2 points
16. Lymphoma: No = 0 points, Yes = +2 points
17. AIDS: No = 0 points, Yes = +6 points

The total score is calculated by summing the points for each criterion.
    
The current CCI is value is 0.
The patient is 68 years old. Because the patient's age is between 60 and 69, we add 2 points to the score, making the current total = 0 + 2 = 2.
The issue, 'Myocardial infarction,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Congestive heart failure,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Peripheral vascular disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
At least one of transient ischemic attack or cerebral vascular accident must be present in the patient for a point to be added to the current total.
Transient ischemic attacks is not mentioned for the patient and so we assume it to be absent.
Cerebral vascular accident is not determined for the patient and so we assume it to be absent.
Neither of the issues are determined to be present for the patient and so we add 0 point to the score, keeping the current total at 2.
The issue, 'Connective tissue diease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Dementia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Chronic obstructive pulmonary disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Hemiplegia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Peptic ulcer disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Liver disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The patient's diabetes mellitus status is not determined and so we assume the value to be 'none or diet-controlled.' No points are added to the score, keeping the current total at 2.
The issue, 'Moderate to severe chronic kidney disease,' is determined to be present for the patient and so we add 2 points to the score, making the current total 2 + 2 = 4.
The patient's solid tumor is determined to be 'metastatic' and so we add 6 points to the score, making the current total 4 + 6 = 10.
The issue, 'Leukemia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 10.
The issue, 'Lymphoma,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 10.
The issue, 'AIDS,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 10.
The patient's CCI score is 10 points."
436,32,Charlson Comorbidity Index (CCI),risk,integer,pmc-7322417-1,Extracted,"Epigastric pain for 5 d and acute onset oliguria.
A 39-year-old man with diabetes mellitus was admitted at Seoul National University Bundang Hospital for evaluation and management of acute kidney injury (AKI). He consulted at the emergency room due to epigastric pain that started five days prior and decreased urine volume noted on the day of the visit. There was no accompanying vomiting, diarrhea, or fever.
The patient has been on insulin for diabetes mellitus since 5 years ago and has a history of being hospitalized for chronic pancreatitis and alcoholic hepatitis one year ago. He had no previous surgeries. He denied use of angiotensin converting enzyme inhibitor or angiotensin receptor blocker, and herbal or dietary supplements.
The patient had recently travelled to Japan. He worked as a chef, and upon detailed history taking, the patient claimed his diet only consisted of tomato meatball pasta and carbonara for nine consecutive days prior to his hospitalization. Each serving of meatball pasta contained 100 g shredded mozzarella cheese (656 mg phosphorus/100 g) and 1 slice of cheddar cheese (936 mg phosphorus/100 g), while each serving of carbonara included 100 g mozzarella cheese and 125 g camembert cheese (347 mg phosphorus/100 g). Pasta also has 253 mg phosphorus for every 100 g. The amount of phosphorus he consumed is estimated to be more than twice the recommended intake for adult men.
Upon admission, vital signs were normal. Physical examination showed signs of volume overload.
Laboratory test results showed azotemia (serum creatinine 12.85 mg/dL and urea nitrogen 85 mg/dL) and elevated potassium (6.7 mmol/L), uric acid (9.0 mg/dL) and phosphorus (3.62 mmol/L) levels. Patient was hypocalcemic at 1.65 mmol/L (corrected calcium 1.79 mmol/L). Serum magnesium (0.66 mmol/L) was normal. Parathyroid hormone was within acceptable limits for chronic kidney disease (CKD) patients. He also presented with uncompensated metabolic acidosis (pH 7.147, bicarbonate 11.8 mmol/L). Patient’s latest serum creatinine before hospitalization was 1.68 mg/dL three months prior (estimated glomerular filtration rate 50.8 mL/min per 1.73 m2). Due to the rapid deterioration of renal function, further work-up was requested to establish other possible causes of AKI and/or CKD progression. Antineutrophil cytoplasmic antibodies (ANCA), fluorescent antinuclear antibody (FANA), and anti-streptolysin O (ASO) were negative. Patient had normal C3 and C4 levels (95 mg% and 26.30 mg%, respectively). Random urine protein/creatinine ratio was 1322.81 mg/g.
On ultrasound, the kidneys were normal-sized (right 12.1 cm and left 11.6 cm), with increased cortical echogenecity. No suspicious focal lesions or signs of urinary obstruction were noted.
Kidney biopsy under ultrasound guidance was performed (Figure ) on the fourth hospital day. The kidney biopsy revealed normal to mildly enlarged glomeruli, but with partially shrinked glomerular tufts; marked focal atrophy, tubular cell injury with some transparent crystal casts. There was also marked focal interstitial fibrosis and focal infiltration of mononuclear cells and a few eosinophils. Fibrointimal thickening of blood vessels were also noted. The immunofluorescence was negative for immunoglobulins and complement factors. The tubular crystal materials were positive for von Kossa staining, which established the diagnosis of APN (Figure ).",What is the patient's Charlson Comorbidity Index (CCI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [39, 'years'], 'Liver disease severity': 'mild', 'Diabetes mellitus': 'uncomplicated', 'Moderate to severe Chronic Kidney Disease': True}",4,4,4,"The Charlson Comorbidity Index (CCI) are listed below:

1. Age: <50 years = 0 points, 50-59 years = +1 point, 60-69 years = +2 points, 70-79 years = +3 points, ≥80 years = +4 points
2. Myocardial infarction (history of definite or probable MI with EKG changes and/or enzyme changes): No = 0 points, Yes = +1 point
3. Congestive heart failure (CHF) (exertional or paroxysmal nocturnal dyspnea, responsive to digitalis, diuretics, or afterload reducing agents): No = 0 points, Yes = +1 point
4. Peripheral vascular disease (intermittent claudication, past bypass for chronic arterial insufficiency, history of gangrene or acute arterial insufficiency, untreated thoracic or abdominal aneurysm ≥6 cm): No = 0 points, Yes = +1 point
5. Cerebrovascular accident (CVA) or transient ischemic attack (TIA) (history with minor or no residuals): No = 0 points, Yes = +1 point
6. Dementia (chronic cognitive deficit): No = 0 points, Yes = +1 point
7. Chronic pulmonary disease (CPD): No = 0 points, Yes = +1 point
8. Connective tissue disease: No = 0 points, Yes = +1 point
9. Peptic ulcer disease (any history of treatment for ulcer disease or ulcer bleeding): No = 0 points, Yes = +1 point
10. Liver disease: None = 0 points, Mild = +1 point, Moderate to severe = +3 points
11. Diabetes mellitus: None or diet-controlled = 0 points, Uncomplicated = +1 point, End-organ damage = +2 points
12. Hemiplegia: No = 0 points, Yes = +2 points
13. Moderate to severe chronic kidney disease (CKD): No = 0 points, Yes = +2 points
14. Solid tumor: None = 0 points, Localized = +2 points, Metastatic = +6 points
15. Leukemia: No = 0 points, Yes = +2 points
16. Lymphoma: No = 0 points, Yes = +2 points
17. AIDS: No = 0 points, Yes = +6 points

The total score is calculated by summing the points for each criterion.
    
The current CCI is value is 0.
The patient is 39 years old. Because the patient's age is less than 50, we do not add any points to the score, keeping the current total at 0.
The issue, 'Myocardial infarction,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Congestive heart failure,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Peripheral vascular disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
At least one of transient ischemic attack or cerebral vascular accident must be present in the patient for a point to be added to the current total.
Transient ischemic attacks is not mentioned for the patient and so we assume it to be absent.
Cerebral vascular accident is not determined for the patient and so we assume it to be absent.
Neither of the issues are determined to be present for the patient and so we add 0 point to the score, keeping the current total at 0.
The issue, 'Connective tissue diease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Dementia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Chronic obstructive pulmonary disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Hemiplegia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Peptic ulcer disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The patient's liver disease is determined to be 'mild' and so we add 1 point to the score, making the current total 0 + 1 = 1.
The patient's diabetes mellitus is determined to be 'uncomplicated' and so we add 1 point to the score, making the current total 1 + 1 = 2.
The issue, 'Moderate to severe chronic kidney disease,' is determined to be present for the patient and so we add 2 points to the score, making the current total 2 + 2 = 4.
The patient's solid tumor status is not determined and so we assume that it is 'none.' Hence, do not add any points to the score, keeping the current total at 4.
The issue, 'Leukemia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 4.
The issue, 'Lymphoma,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 4.
The issue, 'AIDS,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 4.
The patient's CCI score is 4 points."
437,32,Charlson Comorbidity Index (CCI),risk,integer,pmc-8127773-1,Extracted,"A 46-year-old woman with recurrent left flank pain for the previous 5 months was admitted to the Cancer Hospital of Guangxi Medical University and Guangxi Cancer Research Institute in October 2020. She presented with the following symptoms: absence of urinary frequency, urinary urgency, painful urination, and haematuria visible to the naked eye. The patient had undergone right radical mastectomy 5 years previously, and pathological examination had confirmed a non-specific type of invasive breast cancer with no vascular or nerve invasion within the slice. Immunohistochemistry results at that time were as follows: E-cadherin (+), cytokeratin (CK)5/6 (–), epidermal growth factor receptor (–), androgen receptor (+, 90%), oestrogen receptor (ER) (+, 80%), progestin receptor (PR) (+, 80%), and proliferation marker protein Ki-67 (+, 40%). With human epidermal growth factor receptor (HER)-2 (2+), a diagnosis of invasive breast cancer T1N1M0 stage II was established. Adjuvant chemotherapy after surgery and at least 5 years of endocrine therapy were the treatment modalities advised to this patient, with local radiotherapy as an alternative; however, she declined chemotherapy and local radiotherapy and received endocrine therapy with tamoxifen only for 5 years. Physical examination during the latest hospital admittance revealed pressure pain in the left upper middle ureter. Serum tumour marker tests showed the following elevated values: carcinoembryonic antigen: 39.61 ng/ml (normal value, ≤ 5.0 ng/ml); cancer antigen 125, 57.2 U/ml (normal value, ≤ 35.0 U/ml); carbohydrate antigen 15-3, 258.9 U/ml (normal value, ≤ 31.3 U/ml); and CK19 fragment, 4.58 ng/ml (normal value, ≤ 3.3 ng/ml). No significant abnormalities were found in other laboratory tests. Ultrasonography revealed that the left renal collecting system was separated by approximately 2.0 cm, indicating that left hydronephrosis was not obvious. Abdominal CT and MRI showed tumours in the pancreas, left adrenal gland, and upper part of the left ureter, and showed folding back of the double J stent at the lesion, suggesting narrowing of the ureter lumen (). The wall adjacent to the upper part of the left ureter was slightly thickened. 18F-FDG PET/CT revealed multiple lymph node metastases in the thoracic cavity and abdomen, and larger lymph nodes of approximately 3.5 × 2.2 cm were located next to the abdominal aorta with radioactive concentration. The maximum standardized uptake value (SUVmax) was 10.7. The tumours invaded the pancreas and the transition area between the left ureter and renal pelvis. Radioactive concentration was observed in the ureteral lesion (), but no radioactive concentration was found in the urine of the left dilated renal pelvis. The tumour in the upper ureter and the hilum of the kidney showed increased metabolism; however, the shape, contour, and path of the left upper ureter was not significantly altered (). Transurethral ureteroscopy showed a rigid upper and middle ureteral wall, narrow lumen, and no endogenous tumour. Ureteral stenting was challenging to perform, and a viable route for obtaining tumour tissue using fine-needle aspiration could not be found for pathological examination. Thus, tumour tissue was obtained from the hilum of the kidney and the upper segment of the ureter using laparoscopy. Postoperative immunohistochemistry results were as follows: CK7 (+), CK20 (–), villin (–), GATA-3 (+), ER (+, 80%), PR (+, 90%), HER-2 (–), and Ki-67 (+, 40%), and the primary tumour was confirmed to be breast cancer. Based on the advice of chemotherapists, systemic chemotherapy was recommended to the patient, however, the patient did not return to the hospital for treatment and was lost to follow-up.",What is the patient's Charlson Comorbidity Index (CCI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [46, 'years'], 'Solid tumor': 'metastatic'}",6,6,6,"The Charlson Comorbidity Index (CCI) are listed below:

1. Age: <50 years = 0 points, 50-59 years = +1 point, 60-69 years = +2 points, 70-79 years = +3 points, ≥80 years = +4 points
2. Myocardial infarction (history of definite or probable MI with EKG changes and/or enzyme changes): No = 0 points, Yes = +1 point
3. Congestive heart failure (CHF) (exertional or paroxysmal nocturnal dyspnea, responsive to digitalis, diuretics, or afterload reducing agents): No = 0 points, Yes = +1 point
4. Peripheral vascular disease (intermittent claudication, past bypass for chronic arterial insufficiency, history of gangrene or acute arterial insufficiency, untreated thoracic or abdominal aneurysm ≥6 cm): No = 0 points, Yes = +1 point
5. Cerebrovascular accident (CVA) or transient ischemic attack (TIA) (history with minor or no residuals): No = 0 points, Yes = +1 point
6. Dementia (chronic cognitive deficit): No = 0 points, Yes = +1 point
7. Chronic pulmonary disease (CPD): No = 0 points, Yes = +1 point
8. Connective tissue disease: No = 0 points, Yes = +1 point
9. Peptic ulcer disease (any history of treatment for ulcer disease or ulcer bleeding): No = 0 points, Yes = +1 point
10. Liver disease: None = 0 points, Mild = +1 point, Moderate to severe = +3 points
11. Diabetes mellitus: None or diet-controlled = 0 points, Uncomplicated = +1 point, End-organ damage = +2 points
12. Hemiplegia: No = 0 points, Yes = +2 points
13. Moderate to severe chronic kidney disease (CKD): No = 0 points, Yes = +2 points
14. Solid tumor: None = 0 points, Localized = +2 points, Metastatic = +6 points
15. Leukemia: No = 0 points, Yes = +2 points
16. Lymphoma: No = 0 points, Yes = +2 points
17. AIDS: No = 0 points, Yes = +6 points

The total score is calculated by summing the points for each criterion.
    
The current CCI is value is 0.
The patient is 46 years old. Because the patient's age is less than 50, we do not add any points to the score, keeping the current total at 0.
The issue, 'Myocardial infarction,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Congestive heart failure,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Peripheral vascular disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
At least one of transient ischemic attack or cerebral vascular accident must be present in the patient for a point to be added to the current total.
Transient ischemic attacks is not mentioned for the patient and so we assume it to be absent.
Cerebral vascular accident is not determined for the patient and so we assume it to be absent.
Neither of the issues are determined to be present for the patient and so we add 0 point to the score, keeping the current total at 0.
The issue, 'Connective tissue diease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Dementia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Chronic obstructive pulmonary disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Hemiplegia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Peptic ulcer disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Liver disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The patient's diabetes mellitus status is not determined and so we assume the value to be 'none or diet-controlled.' No points are added to the score, keeping the current total at 0.
The issue, 'Moderate to severe chronic kidney disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The patient's solid tumor is determined to be 'metastatic' and so we add 6 points to the score, making the current total 0 + 6 = 6.
The issue, 'Leukemia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 6.
The issue, 'Lymphoma,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 6.
The issue, 'AIDS,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 6.
The patient's CCI score is 6 points."
438,32,Charlson Comorbidity Index (CCI),risk,integer,pmc-5592189-1,Extracted,"In March 2014, a 39-year-old Korean professional male soldier presented with a 6-month history of various nonspecific symptoms. He received hospital treatment and underwent several health examinations; however, no specific findings were observed. The symptoms were dizziness, fatigue, asthenia, irritability, elevated blood pressure (above systolic 160 mmHg), palpitation, eyestrain, and tinnitus, which aggravated with time.
The patient had an unremarkable medical history and was a current smoker (0.7 pack/day for 15 years). He consumed 700 mL of beer once a week. The patient had worked for 13 months in a newly constructed indoor firing range. He performed general management of the indoor firing range. His work included setting the firing range (preparing the bullets and targets) before the firing exercises, and cleaning and handling the disposed warheads after the firing exercises. There was much gray-black dust during the cleaning process; however, he did not wear any special protective equipment.
His BLL was measured owing to suspicion of heavy metal poisoning; 0.1 mL of whole blood was diluted with 0.8 mL 1%Triton™ X-100 (Sigma-Aldrich, St. Louis, MO, USA) and analyzed for BLL using graphite furnace atomic absorption spectrometry (novAA 400p;Analytik Jena AG, Jena, Germany). The BLL was estimated at 64 µg/dL; therefore, the patient was diagnosed with lead poisoning and immediately withdrawn from his work to avoid further lead exposure. The standard for elevated BLL among adults is 10 µg/dL, as determined by the Adult Blood Lead Epidemiology & Surveillance from the National Institute for Occupational Safety and Health (NIOSH) (). The Occupational Safety and Health Administration (OSHA)'s occupational exposure limit for BLL is 40 µg/dL (). Korean blood-lead criteria for the diagnosis of lead poisoning in workers is 40 μg/dL (). The patient was immediately admitted to the military hospital and investigated thoroughly. His examination revealed elevated blood pressure (150/110 mmHg), and the peripheral blood smear showed poikilocytosis. The liver function test, renal function test, complete blood count, and differential count were within normal ranges. His urine tested negative for microproteinuria. According to the examination by the neurologist, there were no significant findings in the electromyography, nerve conduction velocity, brain magnetic resonance imaging, and neurologic tests. The hearing test indicated mild hearing loss (hearing threshold: right/left = 35/35 dB) at 4 kHz, and he was diagnosed with dry eye by the ophthalmologist; he received treatments from the respective departments.
The treatment for lead poisoning included avoidance of the harmful factor (prohibition of work) for 3 weeks following which he underwent BLL measurement. The BLL was 39 µg/dL and the blood zinc protoporphyrin (ZPP) level was 45.1 µg/dL (reference range: 10–38 µg/dL). He showed no improvement of symptoms; hence, for an intensive BLL decrease chelation treatment was administered. For the chelation treatment, 1 gram of calcium-disodium ethylenediaminetetraacetic acid (CaNa2 EDTA) was mixed with 250 mL of 5% dextrose (JW Life Science Corp, Seoul, Korea) in water and was administered intravenously over 6 hours. The chelation treatment was given for 5 days, and the renal functions and liver functions were assessed daily. He completed 5 days of chelation treatment with no adverse effects. He was discharged after his blood pressure normalized (130/85 mmHg) and the subjective symptoms improved. Three weeks after the discharge (7 weeks after lead exposure avoidance), the BLL was 9.7 µg/dL ().
As evident from the workplace environmental monitoring (April 2 to April 15, 2014), the exposure in the air was an 8hours, time-weighted average of 0.015–0.387 mg/m3, which exceeded the acceptable standards (0.05 mg/m3) () (). From the field investigations, it was confirmed that a swirl formed in the indoor firing range from inappropriate filter use (using a charcoal filter instead of a dust filter) and poor design of the ventilation system. The dust accumulated as it was not discharged outside the indoor firing range, and entered the body through the respiratory tract and oral intake before and after the firing and during cleaning and disposal of the warheads.",What is the patient's Charlson Comorbidity Index (CCI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [39, 'years'], 'Liver disease severity': 'none', 'Moderate to severe Chronic Kidney Disease': False}",0,0,0,"The Charlson Comorbidity Index (CCI) are listed below:

1. Age: <50 years = 0 points, 50-59 years = +1 point, 60-69 years = +2 points, 70-79 years = +3 points, ≥80 years = +4 points
2. Myocardial infarction (history of definite or probable MI with EKG changes and/or enzyme changes): No = 0 points, Yes = +1 point
3. Congestive heart failure (CHF) (exertional or paroxysmal nocturnal dyspnea, responsive to digitalis, diuretics, or afterload reducing agents): No = 0 points, Yes = +1 point
4. Peripheral vascular disease (intermittent claudication, past bypass for chronic arterial insufficiency, history of gangrene or acute arterial insufficiency, untreated thoracic or abdominal aneurysm ≥6 cm): No = 0 points, Yes = +1 point
5. Cerebrovascular accident (CVA) or transient ischemic attack (TIA) (history with minor or no residuals): No = 0 points, Yes = +1 point
6. Dementia (chronic cognitive deficit): No = 0 points, Yes = +1 point
7. Chronic pulmonary disease (CPD): No = 0 points, Yes = +1 point
8. Connective tissue disease: No = 0 points, Yes = +1 point
9. Peptic ulcer disease (any history of treatment for ulcer disease or ulcer bleeding): No = 0 points, Yes = +1 point
10. Liver disease: None = 0 points, Mild = +1 point, Moderate to severe = +3 points
11. Diabetes mellitus: None or diet-controlled = 0 points, Uncomplicated = +1 point, End-organ damage = +2 points
12. Hemiplegia: No = 0 points, Yes = +2 points
13. Moderate to severe chronic kidney disease (CKD): No = 0 points, Yes = +2 points
14. Solid tumor: None = 0 points, Localized = +2 points, Metastatic = +6 points
15. Leukemia: No = 0 points, Yes = +2 points
16. Lymphoma: No = 0 points, Yes = +2 points
17. AIDS: No = 0 points, Yes = +6 points

The total score is calculated by summing the points for each criterion.
    
The current CCI is value is 0.
The patient is 39 years old. Because the patient's age is less than 50, we do not add any points to the score, keeping the current total at 0.
The issue, 'Myocardial infarction,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Congestive heart failure,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Peripheral vascular disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
At least one of transient ischemic attack or cerebral vascular accident must be present in the patient for a point to be added to the current total.
Transient ischemic attacks is not mentioned for the patient and so we assume it to be absent.
Cerebral vascular accident is not determined for the patient and so we assume it to be absent.
Neither of the issues are determined to be present for the patient and so we add 0 point to the score, keeping the current total at 0.
The issue, 'Connective tissue diease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Dementia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Chronic obstructive pulmonary disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Hemiplegia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Peptic ulcer disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The patient's liver disease is determined to be 'none' and so we do not add any points to the score, keeping the current total at 0.
The patient's diabetes mellitus status is not determined and so we assume the value to be 'none or diet-controlled.' No points are added to the score, keeping the current total at 0.
The issue, 'Moderate to severe chronic kidney disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The patient's solid tumor status is not determined and so we assume that it is 'none.' Hence, do not add any points to the score, keeping the current total at 0.
The issue, 'Leukemia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Lymphoma,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'AIDS,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The patient's CCI score is 0 points."
439,32,Charlson Comorbidity Index (CCI),risk,integer,pmc-5337855-1,Extracted,"An otherwise healthy 61-year-old Caucasian woman presented in 2010 with anemia and thrombocytopenia after one month of recurrent upper respiratory infections. White blood cell (WBC) count at the time of presentation was 8.7 with 48% circulating blasts, hemoglobin was 9.6, and platelets were 39,000. Bone marrow biopsy was consistent with a diagnosis of acute myeloid leukemia (AML) with translocation of chromosomes 11 and 19 involving the MLL locus [t(11:19)(q23; p13.1); MLL-ENL]. She received two rounds of induction therapy with idarubicin and cytarabine with complete response. She then received one cycle of High-Dose Cytarabine (HiDAC) consolidation. She also received 1 cycle of decitabine as there were significant delays in identifying a suitable stem cell donor.
She underwent a matched unrelated donor (MUD) hematopoietic cell transplantation (HCT) with fludarabine, busulfan, and thymoglobulin conditioning seven months following the initial diagnosis from a presumably healthy male donor. Graft versus Host Disease (GvHD) prophylaxis regimen consisted of methotrexate, tacrolimus, and mycophenolate mofetil. Day +30 post-HCT bone marrow showed complete remission with complete donor cell engraftment. Her immediate posttransplant course was complicated by mild acute gastrointestinal GvHD and human polyomavirus (BK) cystitis. Post-HCT bone marrow biopsy on days +100 and +180 again showed complete remission with complete donor cell engraftment. In the absence of any evidence of ongoing GvHD, at 18 months after HCT all immunosuppressive agents were discontinued after a prolonged taper schedule.
Five hundred and sixty days following her transplant, the patient was found to have abnormally high IgG levels during routine follow-up (3080; normal range 700–1450). Serum protein electrophoresis (SPEP) showed two abnormal restricted peaks in gamma region (a = 0.1, b = 2.4). Serum protein immunofixation classified the protein as IgG lambda monoclonal protein. Additional laboratory work-up was significant for increased lambda free light chain (FLC) (6.54; normal range: 0.57–2.63), normal kappa FLC (1.49; 0.33–1.94), low kappa/lambda FLC ratio (0.23; 0.26–1.65), and a raised beta-2-microglobulin (3.6; normal range: 1.10–2.50). Bone marrow biopsy revealed a normocellular bone marrow with trilineage hematopoiesis with no excess blasts but was significant for infiltrating plasma cells. An immunohistochemical stain for CD138 was performed to better quantify the plasma cells in a tissue context and showed singly dispersed and clustered plasma cells comprising approximately 10% of the marrow cellularity. Flow cytometric analysis showed approximate 1% of total events to be lambda light chain restricted plasma cells that did not express CD56. In situ hybridization for EBV (EBER) on the bone marrow biopsy was performed and was negative. Patient's hemoglobin, calcium level, and kidney function were within normal limits. A bone survey was performed and did not identify any lytic or blastic lesions. To further characterize the origin of plasma cells, CD138+ cells were isolated using a Miltenyi autoMACS device (Miltenyi Biotech) and then short tandem repeat (STR) polymorphic DNA markers were amplified by polymerase chain reaction (PCR), labeled with fluorescent markers, and used to distinguish patient and donor cells as different on a Capillary Electrophoresis Fluorescence Detection instrument. The results were consistent with complete donor cell engraftment (<5% recipient cells present).
Given the presence of monoclonal gammopathy and 10% bone marrow plasma cells in the absence of end-organ damage (lytic lesions, anemia, renal disease, or hypercalcemia) that could be attributed to the underlying plasma cell disorder or other myeloma defining events, a diagnosis of donor-derived smoldering multiple myeloma (SMM) was established. The National Marrow Donor Program (NMDP) was notified. The NMDP has confirmed that the donor does not have a diagnosis of SMM or MM. It is unclear if the donor has ever had a bone marrow biopsy or SPEP to confirm or if he simply lacks the diagnosis.
We continued to observe our patient regularly for changes in her myeloma markers. At the time of preparation of this manuscript, her myeloma markers have been stable for over four years. With regard to AML, she is almost 6 years out of MUD-HCT and has been in remission ever since.",What is the patient's Charlson Comorbidity Index (CCI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [61, 'years'], 'Leukemia': True, 'Moderate to severe Chronic Kidney Disease': False}",4,4,4,"The Charlson Comorbidity Index (CCI) are listed below:

1. Age: <50 years = 0 points, 50-59 years = +1 point, 60-69 years = +2 points, 70-79 years = +3 points, ≥80 years = +4 points
2. Myocardial infarction (history of definite or probable MI with EKG changes and/or enzyme changes): No = 0 points, Yes = +1 point
3. Congestive heart failure (CHF) (exertional or paroxysmal nocturnal dyspnea, responsive to digitalis, diuretics, or afterload reducing agents): No = 0 points, Yes = +1 point
4. Peripheral vascular disease (intermittent claudication, past bypass for chronic arterial insufficiency, history of gangrene or acute arterial insufficiency, untreated thoracic or abdominal aneurysm ≥6 cm): No = 0 points, Yes = +1 point
5. Cerebrovascular accident (CVA) or transient ischemic attack (TIA) (history with minor or no residuals): No = 0 points, Yes = +1 point
6. Dementia (chronic cognitive deficit): No = 0 points, Yes = +1 point
7. Chronic pulmonary disease (CPD): No = 0 points, Yes = +1 point
8. Connective tissue disease: No = 0 points, Yes = +1 point
9. Peptic ulcer disease (any history of treatment for ulcer disease or ulcer bleeding): No = 0 points, Yes = +1 point
10. Liver disease: None = 0 points, Mild = +1 point, Moderate to severe = +3 points
11. Diabetes mellitus: None or diet-controlled = 0 points, Uncomplicated = +1 point, End-organ damage = +2 points
12. Hemiplegia: No = 0 points, Yes = +2 points
13. Moderate to severe chronic kidney disease (CKD): No = 0 points, Yes = +2 points
14. Solid tumor: None = 0 points, Localized = +2 points, Metastatic = +6 points
15. Leukemia: No = 0 points, Yes = +2 points
16. Lymphoma: No = 0 points, Yes = +2 points
17. AIDS: No = 0 points, Yes = +6 points

The total score is calculated by summing the points for each criterion.
    
The current CCI is value is 0.
The patient is 61 years old. Because the patient's age is between 60 and 69, we add 2 points to the score, making the current total = 0 + 2 = 2.
The issue, 'Myocardial infarction,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Congestive heart failure,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Peripheral vascular disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
At least one of transient ischemic attack or cerebral vascular accident must be present in the patient for a point to be added to the current total.
Transient ischemic attacks is not mentioned for the patient and so we assume it to be absent.
Cerebral vascular accident is not determined for the patient and so we assume it to be absent.
Neither of the issues are determined to be present for the patient and so we add 0 point to the score, keeping the current total at 2.
The issue, 'Connective tissue diease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Dementia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Chronic obstructive pulmonary disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Hemiplegia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Peptic ulcer disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Liver disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The patient's diabetes mellitus status is not determined and so we assume the value to be 'none or diet-controlled.' No points are added to the score, keeping the current total at 2.
The issue, 'Moderate to severe chronic kidney disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The patient's solid tumor status is not determined and so we assume that it is 'none.' Hence, do not add any points to the score, keeping the current total at 2.
The issue, 'Leukemia,' is determined to be present for the patient and so we add 2 points to the score, making the current total 2 + 2 = 4.
The issue, 'Lymphoma,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 4.
The issue, 'AIDS,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 4.
The patient's CCI score is 4 points."
440,32,Charlson Comorbidity Index (CCI),risk,integer,pmc-7289330-1,Extracted,"The patient is a 90-year-old female with past medical history including a left sacral insufficiency fracture, thoracic vertebral compression fracture, and degenerative left medial meniscus tear, who presented with stabbing left lateral hip pain. The pain was chronic but had been progressing in severity over the past month. There was no inciting event or fall. The pain was exacerbated by lying on her left side and was affecting her sleep. At baseline, she ambulated with a rollator walker, but the pain was starting to limit her ability to walk. She had a history of low back and posterior left buttock pain, but she denied current pain in these regions. She also denied weakness or pain radiation into her lower extremities.
On examination, she had no pain with lumbar or hip range of motion. She had full, symmetric, and pain-free lower extremity strength, and deep tendon reflexes and sensation to light touch were intact and symmetric in her lower extremities. She had a positive Trendelenburg sign with single-leg stance bilaterally, and she was tender to palpation over the left greater trochanter but not the right. Ober’s, seated slump, and straight leg raise tests were negative. (See and for descriptions of Ober’s and the seated slump test.)
Focused ultrasound performed by a musculoskeletal physiatrist with ultrasound training revealed evidence of bursitis of the left greater trochanter, which correlated with the patient’s point of maximal tenderness.
The patient was diagnosed with greater trochanteric pain syndrome (GTPS) that included an inflammatory component as evidenced by bursitis seen on ultrasound. She was educated on hip abductor strengthening exercises, but she was not interested in performing the exercises regularly. Instead she requested a corticosteroid injection, so an ultrasound-guided greater trochanteric bursa injection was performed by the ultrasound-trained physiatrist.",What is the patient's Charlson Comorbidity Index (CCI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [90, 'years']}",4,4,4,"The Charlson Comorbidity Index (CCI) are listed below:

1. Age: <50 years = 0 points, 50-59 years = +1 point, 60-69 years = +2 points, 70-79 years = +3 points, ≥80 years = +4 points
2. Myocardial infarction (history of definite or probable MI with EKG changes and/or enzyme changes): No = 0 points, Yes = +1 point
3. Congestive heart failure (CHF) (exertional or paroxysmal nocturnal dyspnea, responsive to digitalis, diuretics, or afterload reducing agents): No = 0 points, Yes = +1 point
4. Peripheral vascular disease (intermittent claudication, past bypass for chronic arterial insufficiency, history of gangrene or acute arterial insufficiency, untreated thoracic or abdominal aneurysm ≥6 cm): No = 0 points, Yes = +1 point
5. Cerebrovascular accident (CVA) or transient ischemic attack (TIA) (history with minor or no residuals): No = 0 points, Yes = +1 point
6. Dementia (chronic cognitive deficit): No = 0 points, Yes = +1 point
7. Chronic pulmonary disease (CPD): No = 0 points, Yes = +1 point
8. Connective tissue disease: No = 0 points, Yes = +1 point
9. Peptic ulcer disease (any history of treatment for ulcer disease or ulcer bleeding): No = 0 points, Yes = +1 point
10. Liver disease: None = 0 points, Mild = +1 point, Moderate to severe = +3 points
11. Diabetes mellitus: None or diet-controlled = 0 points, Uncomplicated = +1 point, End-organ damage = +2 points
12. Hemiplegia: No = 0 points, Yes = +2 points
13. Moderate to severe chronic kidney disease (CKD): No = 0 points, Yes = +2 points
14. Solid tumor: None = 0 points, Localized = +2 points, Metastatic = +6 points
15. Leukemia: No = 0 points, Yes = +2 points
16. Lymphoma: No = 0 points, Yes = +2 points
17. AIDS: No = 0 points, Yes = +6 points

The total score is calculated by summing the points for each criterion.
    
The current CCI is value is 0.
The patient is 90 years old. Because the patient's age is greater than or equal to 80 years, we add 4 points to the score, making the current total = 0 + 4 = 4.
The issue, 'Myocardial infarction,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 4.
The issue, 'Congestive heart failure,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 4.
The issue, 'Peripheral vascular disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 4.
At least one of transient ischemic attack or cerebral vascular accident must be present in the patient for a point to be added to the current total.
Transient ischemic attacks is not mentioned for the patient and so we assume it to be absent.
Cerebral vascular accident is not determined for the patient and so we assume it to be absent.
Neither of the issues are determined to be present for the patient and so we add 0 point to the score, keeping the current total at 4.
The issue, 'Connective tissue diease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 4.
The issue, 'Dementia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 4.
The issue, 'Chronic obstructive pulmonary disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 4.
The issue, 'Hemiplegia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 4.
The issue, 'Peptic ulcer disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 4.
The issue, 'Liver disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 4.
The patient's diabetes mellitus status is not determined and so we assume the value to be 'none or diet-controlled.' No points are added to the score, keeping the current total at 4.
The issue, 'Moderate to severe chronic kidney disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 4.
The patient's solid tumor status is not determined and so we assume that it is 'none.' Hence, do not add any points to the score, keeping the current total at 4.
The issue, 'Leukemia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 4.
The issue, 'Lymphoma,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 4.
The issue, 'AIDS,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 4.
The patient's CCI score is 4 points."
441,32,Charlson Comorbidity Index (CCI),risk,integer,pmc-6532307-1,Extracted,"A 73-year-old Caucasian male with a past medical history of coronary artery disease, heart failure, atrial fibrillation, chronic obstructive pulmonary disease, and type-2 diabetes mellitus was admitted after having a witnessed seizure at his nursing rehabilitation facility. When emergency medical services arrived, the patient was found to be hypoglycemic with blood glucose (BG) of 21 mg/dL. He was administered 25 g of dextrose 50% (D50) resulting in some improvement in his mental status. He was then transferred to our emergency department (ED).
In the ED, the patient was minimally responsive to both verbal and physical cues. The initial laboratory results were significant for hypokalemia with potassium of 2.9 mmol/L (normal 3.6-5.1 mmol/L), acute kidney injury with serum creatinine at 2.52 mg/dL (normal 0.7-1.3 mg/dL; baseline approximately 1.5 mg/dL), albumin of 2 g/dL (normal 3.5-5.7 g/dL), and hypoglycemia with a BG of 34 mg/dL (normal 70-105 mg/dL). Liver function tests (LFTs) were all within normal limits. The patient was immediately given 50 g of D50 resulting in a repeat BG of 134 mg/dL. Review of the patient's home medication list identified that the patient was prescribed levofloxacin 750 mg daily for pneumonia on discharge from a hospitalization three days prior with no other medication changes. Chronic medications were inclusive of aspirin 81 mg daily, atorvastatin 80 mg daily, glipizide 10 mg daily, losartan 25 mg daily, mometasone 220 mcg/inhalation three times daily, spironolactone 25 mg daily, torsemide 100 mg daily, and warfarin. The patient required four additional boluses of D50 and a continuous dextrose 10% (D10) infusion to maintain euglycemia before transfer to the intensive care unit (ICU).
In the ICU, the patient continued to experience multiple episodes of severe rebound hypoglycemia despite an additional four boluses of D50, increasing the D10 infusion rate to 100 mL/hr (see ) and withholding home medications. Glucagon 1 mg intramuscularly only led to a transient increase in BG. Given the patient's refractory hypoglycemia to standard supportive care therapies, octreotide 50 mcg subcutaneously was administered every six hours for a total of three doses. Within three hours of administration of the first dose of octreotide, there was a significant increase in BG levels (ranging from 170 to 237 mg/dL) and no further D50 boluses were required. Due to persistent hyperglycemia (BG >250 mg/dL), the D10 infusion was discontinued 5.5 hours after the second dose of octreotide. The patient eventually required an insulin infusion the following day and was transferred to the floor. The patient was ultimately discharged to his nursing rehabilitation facility in stable condition.",What is the patient's Charlson Comorbidity Index (CCI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [73, 'years'], 'Myocardial infarction': True, 'Congestive Heart Failure': True, 'Chronic Pulmonary Disease': True, 'Liver disease severity': 'none', 'Diabetes mellitus': 'uncomplicated', 'Moderate to severe Chronic Kidney Disease': False}",7,7,7,"The Charlson Comorbidity Index (CCI) are listed below:

1. Age: <50 years = 0 points, 50-59 years = +1 point, 60-69 years = +2 points, 70-79 years = +3 points, ≥80 years = +4 points
2. Myocardial infarction (history of definite or probable MI with EKG changes and/or enzyme changes): No = 0 points, Yes = +1 point
3. Congestive heart failure (CHF) (exertional or paroxysmal nocturnal dyspnea, responsive to digitalis, diuretics, or afterload reducing agents): No = 0 points, Yes = +1 point
4. Peripheral vascular disease (intermittent claudication, past bypass for chronic arterial insufficiency, history of gangrene or acute arterial insufficiency, untreated thoracic or abdominal aneurysm ≥6 cm): No = 0 points, Yes = +1 point
5. Cerebrovascular accident (CVA) or transient ischemic attack (TIA) (history with minor or no residuals): No = 0 points, Yes = +1 point
6. Dementia (chronic cognitive deficit): No = 0 points, Yes = +1 point
7. Chronic pulmonary disease (CPD): No = 0 points, Yes = +1 point
8. Connective tissue disease: No = 0 points, Yes = +1 point
9. Peptic ulcer disease (any history of treatment for ulcer disease or ulcer bleeding): No = 0 points, Yes = +1 point
10. Liver disease: None = 0 points, Mild = +1 point, Moderate to severe = +3 points
11. Diabetes mellitus: None or diet-controlled = 0 points, Uncomplicated = +1 point, End-organ damage = +2 points
12. Hemiplegia: No = 0 points, Yes = +2 points
13. Moderate to severe chronic kidney disease (CKD): No = 0 points, Yes = +2 points
14. Solid tumor: None = 0 points, Localized = +2 points, Metastatic = +6 points
15. Leukemia: No = 0 points, Yes = +2 points
16. Lymphoma: No = 0 points, Yes = +2 points
17. AIDS: No = 0 points, Yes = +6 points

The total score is calculated by summing the points for each criterion.
    
The current CCI is value is 0.
The patient is 73 years old. Because the patient's age is between 70 and 79, we add 3 points to the score, making the current total = 0 + 3 = 3.
 The issue,'Myocardial infarction,' is present for the patient and so we add 1 point to the score, making the current total 3 + 1 = 4.
 The issue,'Congestive heart failure,' is present for the patient and so we add 1 point to the score, making the current total 4 + 1 = 5.
The issue, 'Peripheral vascular disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 5.
At least one of transient ischemic attack or cerebral vascular accident must be present in the patient for a point to be added to the current total.
Transient ischemic attacks is not mentioned for the patient and so we assume it to be absent.
Cerebral vascular accident is not determined for the patient and so we assume it to be absent.
Neither of the issues are determined to be present for the patient and so we add 0 point to the score, keeping the current total at 5.
The issue, 'Connective tissue diease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 5.
The issue, 'Dementia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 5.
 The issue,'Chronic obstructive pulmonary disease,' is present for the patient and so we add 1 point to the score, making the current total 5 + 1 = 6.
The issue, 'Hemiplegia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 6.
The issue, 'Peptic ulcer disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 6.
The patient's liver disease is determined to be 'none' and so we do not add any points to the score, keeping the current total at 6.
The patient's diabetes mellitus is determined to be 'uncomplicated' and so we add 1 point to the score, making the current total 6 + 1 = 7.
The issue, 'Moderate to severe chronic kidney disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 7.
The patient's solid tumor status is not determined and so we assume that it is 'none.' Hence, do not add any points to the score, keeping the current total at 7.
The issue, 'Leukemia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 7.
The issue, 'Lymphoma,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 7.
The issue, 'AIDS,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 7.
The patient's CCI score is 7 points."
442,32,Charlson Comorbidity Index (CCI),risk,integer,pmc-3651988-1,Extracted,"A previously healthy, 39-year-old woman was admitted to our hospital with generalized edema lasting 1 month and with sudden-onset pain in her right lower leg, particularly when walking. On admission, her general appearance was acutely ill and generally edematous. A physical examination revealed that her blood pressure was 120/80 mmHg, her heart rate was 90/min, her respiratory rate was 22/min, and her body temperature was 36.5℃. Her breathing sounds were clear, and her heartbeat was regular without murmur. A subsequent examination of her lower limbs showed asymmetric bilateral pretibial pitting edema predominantly in the left lower limb. In contrast, the right lower limb was less edematous and had very weak popliteal and pedal pulses. Delayed capillary refilling was also found in the right toes. The Homan's sign was negative.
Serum laboratory findings at admission were as follows: white blood cell count of 5,300/mm3, hematocrit of 39.5% with hemoglobin of 13.1 g/dl, and platelet count of 286,000/mm3. The serum sodium concentration was 141 mEq/L, the potassium concentration was 4.1 mEq/L, the chloride concentration was 104 mEq/L, and total CO2 was 28 mEq/L. The blood urea nitrogen concentration was 12.1 mg/dl, the creatinine concentration was 0.86 mg/dl, the serum total protein concentration was 4.3 g/dl, the albumin concentration was 2.2 g/dl, the total cholesterol concentration was 349.4 mg/dl, the low-density lipoprotein cholesterol concentration was 214.4 mg/dl, the high-density lipoprotein cholesterol concentration was 111 mg/dl, and the triglyceride concentration was 120.1 mg/dl. The results of liver function tests were normal. The coagulation profile showed an activated partial thromboplastin time of 32.0 s, prothrombin time of 9.7 s, anti-thrombin III value of 82% (70-120%), protein C activity of 143% (70-130%), and protein S activity of 65% (58.7-119.2%). The anti-nuclear antibody titer was less than 1:40, the anti-double-stranded DNA titer was 30.9 IU/ml, the C3 level was 158 mg/dl, and the C4 level was 19 mg/dl. Anti-cardiolipin immunoglobulin G, anti-cardiolipin immunoglobulin M, and lupus anticoagulant were all negative. Urinalysis revealed 3+ proteinuria (spot urine protein-to-creatinine ratio was 10.9 g/g creatinine; spot urine albumin-to-creatinine ratio was 7,406.2 mg/g creatinine) and trace hematuria (1-3 red blood cells/high-power field). To investigate the etiology of nephrotic syndrome, an urgent renal biopsy was performed.
Thereafter, although she had no risk factors for thrombosis such as immobilization, heart failure, atrial fibrillation, morbid obesity, or a recent orthopedic or gynecologic surgery, to rule out arterial thrombosis of the right lower extremity, lower extremity computed tomography (CT) angiography was performed. The CT imaging revealed that the right superficial femoral artery was occluded and there was no identifiable proximal source of thromboembolism in other large arteries (). On the basis of these CT angiographic findings, right lower extremity angiography was performed, which revealed a total occlusion of the right superficial femoral artery (). For the treatment of this condition, balloon dilatation was initially tried at the distal superficial femoral artery but failed. Hence, thrombectomy was performed with the Fogarty balloon catheter and the thrombi were successfully aspirated. After the interventional treatment, a good distal arterial flow was reestablished (). Thereafter, warfarin (5 mg/day) as an anticoagulant and corticosteroid treatments were initiated.
Subsequent transthoracic and transesophageal echocardiographic studies showed no evidence of intracardiac thrombus, vegetation, or other structural abnormalities including patent foramen ovale. Quantitation of proteinuria was confirmed by using a 24-hour urine collection that showed 10.2 g/day of protein excretion and 7.8 g/day of albumin excretion, respectively. Afterwards, with administration of warfarin and corticosteroid, the patient had nearly completely recovered from the edema and claudication and was discharged. The renal pathologic results were consistent with minimal change disease ( and ). Two months after discharge, her urine protein-to-creatinine ratio decreased to less than 0.1 g/g creatinine, her serum albumin level was maintained at 4.1 g/dl, and she had no further symptoms or signs of arterial thrombosis.",What is the patient's Charlson Comorbidity Index (CCI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [39, 'years'], 'Chronic Pulmonary Disease': False, 'Congestive Heart Failure': False, 'Peripheral vascular disease': True, 'Liver disease severity': 'none', 'Moderate to severe Chronic Kidney Disease': False}",1,1,1,"The Charlson Comorbidity Index (CCI) are listed below:

1. Age: <50 years = 0 points, 50-59 years = +1 point, 60-69 years = +2 points, 70-79 years = +3 points, ≥80 years = +4 points
2. Myocardial infarction (history of definite or probable MI with EKG changes and/or enzyme changes): No = 0 points, Yes = +1 point
3. Congestive heart failure (CHF) (exertional or paroxysmal nocturnal dyspnea, responsive to digitalis, diuretics, or afterload reducing agents): No = 0 points, Yes = +1 point
4. Peripheral vascular disease (intermittent claudication, past bypass for chronic arterial insufficiency, history of gangrene or acute arterial insufficiency, untreated thoracic or abdominal aneurysm ≥6 cm): No = 0 points, Yes = +1 point
5. Cerebrovascular accident (CVA) or transient ischemic attack (TIA) (history with minor or no residuals): No = 0 points, Yes = +1 point
6. Dementia (chronic cognitive deficit): No = 0 points, Yes = +1 point
7. Chronic pulmonary disease (CPD): No = 0 points, Yes = +1 point
8. Connective tissue disease: No = 0 points, Yes = +1 point
9. Peptic ulcer disease (any history of treatment for ulcer disease or ulcer bleeding): No = 0 points, Yes = +1 point
10. Liver disease: None = 0 points, Mild = +1 point, Moderate to severe = +3 points
11. Diabetes mellitus: None or diet-controlled = 0 points, Uncomplicated = +1 point, End-organ damage = +2 points
12. Hemiplegia: No = 0 points, Yes = +2 points
13. Moderate to severe chronic kidney disease (CKD): No = 0 points, Yes = +2 points
14. Solid tumor: None = 0 points, Localized = +2 points, Metastatic = +6 points
15. Leukemia: No = 0 points, Yes = +2 points
16. Lymphoma: No = 0 points, Yes = +2 points
17. AIDS: No = 0 points, Yes = +6 points

The total score is calculated by summing the points for each criterion.
    
The current CCI is value is 0.
The patient is 39 years old. Because the patient's age is less than 50, we do not add any points to the score, keeping the current total at 0.
The issue, 'Myocardial infarction,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Congestive heart failure,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
 The issue,'Peripheral vascular disease,' is present for the patient and so we add 1 point to the score, making the current total 0 + 1 = 1.
At least one of transient ischemic attack or cerebral vascular accident must be present in the patient for a point to be added to the current total.
Transient ischemic attacks is not mentioned for the patient and so we assume it to be absent.
Cerebral vascular accident is not determined for the patient and so we assume it to be absent.
Neither of the issues are determined to be present for the patient and so we add 0 point to the score, keeping the current total at 1.
The issue, 'Connective tissue diease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The issue, 'Dementia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The issue, 'Chronic obstructive pulmonary disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The issue, 'Hemiplegia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The issue, 'Peptic ulcer disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The patient's liver disease is determined to be 'none' and so we do not add any points to the score, keeping the current total at 1.
The patient's diabetes mellitus status is not determined and so we assume the value to be 'none or diet-controlled.' No points are added to the score, keeping the current total at 1.
The issue, 'Moderate to severe chronic kidney disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The patient's solid tumor status is not determined and so we assume that it is 'none.' Hence, do not add any points to the score, keeping the current total at 1.
The issue, 'Leukemia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The issue, 'Lymphoma,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The issue, 'AIDS,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The patient's CCI score is 1 points."
443,32,Charlson Comorbidity Index (CCI),risk,integer,pmc-8094596-1,Extracted,"In September 2016, a 28-year-old Vietnamese male patient visited the National Geriatric Hospital in Hanoi due to epigastric pain, weight loss, and painful swollen lymph nodes in his neck for the past 5 months. He had no history of gastric disease. The subsequent workup included a gastroscopy that revealed an ulcer in the body of the stomach measuring more than 3 cm in diameter. The biopsy from gastroscopy was assessed for Helicobacter pylori by the Campylobacter-like organism (CLO) test and histopathological examination. Histopathology results for the ulcer were negative for H. pylori and revealed stage IV diffuse-type gastric cancer (DGC), characterized by signet ring cells. Unfortunately, for financial reasons, the patient refused additional diagnosis including neck lymph node biopsy, computed tomography (CT) scan, and positron emission tomography (PET)/CT to evaluate distant metastasis, and also refused to follow up on further treatments. The patient's health deteriorated, and he died 4 months post-diagnosis.
The patient’s family history did not show DGC. However, because of the clinicopathological presentation including early onset, severe clinical symptoms, and histopathological test results showing diffuse-type characteristics, we performed genetic screening for mutations in the CDH1 gene by E-cadherin protein expression.
With the patient’s consent, we used the Exgene™ Blood SV kit (GeneAll Biotechnology, Korea) to extract DNA from the whole blood sample according to the instruction manual. This was followed by polymerase chain reaction (PCR) amplification and DNA sequencing using both forward and reverse primers for all exons and introns of the CDH1 gene. The primers were designed using National Center for Biotechnology Information (NCBI) Primer-BLAST [Basic Local Alignment Search Tool] and the QIAGEN CLC Main Workbench (version 8.1.2.) and were reanalyzed using the OligoAnalyzer tool. After the polymerase chain reaction (PCR), we separated the DNA by size using gel electrophoresis (1.5% agarose gel). Finally, we performed gel analysis using the UVP GelDoc-It2 Imaging System (Fisher Scientific). The determination of DNA sequences for all samples was done on Applied Biosystems ABI 3500 (JP0 and ABI 3730xl; Thermo Fisher) deoxyribonuclease acid (DNA) analyzers, followed by gene analysis using BioEdit (version 2.0) and ApE (version 1.0) software.
We found a novel heterozygous nonsense mutation that resulted in a premature termination codon (PTC) UGA at p.213 in exon 5 (CDH1 c.639G>A, p. W213) (Fig. ). The mutation shortened the CDH1 gene length from 882 aa to 213 aa. The immunohistochemical staining of the patient’s tissue sample showed decreased expression of E-cadherin (Fig. ).
We collected blood samples from the patient’s family members (11 participants) for mutation screening in the CDH1 gene exon 5. The participants included three first cousins once removed (III-1, III-2, III-3), two uncles (III-4, III-5), the father (III-6), the mother (III-7), a male first cousin (IV-1), a female first cousin (IV-2), an older sister (IV-3), and a younger brother (IV-7) (Fig. ). At the time of testing, no participants showed any symptoms of HDGC. Upon analysis of the pedigree, we found the patient’s parents to be healthy, and there was no family history of the disease. The DNA sequencing in CDH1 exon 5 showed a similar mutation (c.639G>A, p. W213*) in two members of the family: the father (III-6, 59 years old) and an uncle (III-4, 65 years old), with both heterozygous. Gastroscopy performed on the patient’s father revealed inflammation and antral gastritis. Six-core biopsy specimens showed chronic gastritis, intestinal metaplasia, and low-grade dysplasia. High iron diamine staining for metaplasia typing was negative.",What is the patient's Charlson Comorbidity Index (CCI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [28, 'years'], 'Peptic ulcer disease': True, 'Solid tumor': 'metastatic'}",7,7,7,"The Charlson Comorbidity Index (CCI) are listed below:

1. Age: <50 years = 0 points, 50-59 years = +1 point, 60-69 years = +2 points, 70-79 years = +3 points, ≥80 years = +4 points
2. Myocardial infarction (history of definite or probable MI with EKG changes and/or enzyme changes): No = 0 points, Yes = +1 point
3. Congestive heart failure (CHF) (exertional or paroxysmal nocturnal dyspnea, responsive to digitalis, diuretics, or afterload reducing agents): No = 0 points, Yes = +1 point
4. Peripheral vascular disease (intermittent claudication, past bypass for chronic arterial insufficiency, history of gangrene or acute arterial insufficiency, untreated thoracic or abdominal aneurysm ≥6 cm): No = 0 points, Yes = +1 point
5. Cerebrovascular accident (CVA) or transient ischemic attack (TIA) (history with minor or no residuals): No = 0 points, Yes = +1 point
6. Dementia (chronic cognitive deficit): No = 0 points, Yes = +1 point
7. Chronic pulmonary disease (CPD): No = 0 points, Yes = +1 point
8. Connective tissue disease: No = 0 points, Yes = +1 point
9. Peptic ulcer disease (any history of treatment for ulcer disease or ulcer bleeding): No = 0 points, Yes = +1 point
10. Liver disease: None = 0 points, Mild = +1 point, Moderate to severe = +3 points
11. Diabetes mellitus: None or diet-controlled = 0 points, Uncomplicated = +1 point, End-organ damage = +2 points
12. Hemiplegia: No = 0 points, Yes = +2 points
13. Moderate to severe chronic kidney disease (CKD): No = 0 points, Yes = +2 points
14. Solid tumor: None = 0 points, Localized = +2 points, Metastatic = +6 points
15. Leukemia: No = 0 points, Yes = +2 points
16. Lymphoma: No = 0 points, Yes = +2 points
17. AIDS: No = 0 points, Yes = +6 points

The total score is calculated by summing the points for each criterion.
    
The current CCI is value is 0.
The patient is 28 years old. Because the patient's age is less than 50, we do not add any points to the score, keeping the current total at 0.
The issue, 'Myocardial infarction,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Congestive heart failure,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Peripheral vascular disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
At least one of transient ischemic attack or cerebral vascular accident must be present in the patient for a point to be added to the current total.
Transient ischemic attacks is not mentioned for the patient and so we assume it to be absent.
Cerebral vascular accident is not determined for the patient and so we assume it to be absent.
Neither of the issues are determined to be present for the patient and so we add 0 point to the score, keeping the current total at 0.
The issue, 'Connective tissue diease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Dementia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Chronic obstructive pulmonary disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
The issue, 'Hemiplegia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 0.
 The issue,'Peptic ulcer disease,' is present for the patient and so we add 1 point to the score, making the current total 0 + 1 = 1.
The issue, 'Liver disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The patient's diabetes mellitus status is not determined and so we assume the value to be 'none or diet-controlled.' No points are added to the score, keeping the current total at 1.
The issue, 'Moderate to severe chronic kidney disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The patient's solid tumor is determined to be 'metastatic' and so we add 6 points to the score, making the current total 1 + 6 = 7.
The issue, 'Leukemia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 7.
The issue, 'Lymphoma,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 7.
The issue, 'AIDS,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 7.
The patient's CCI score is 7 points."
444,32,Charlson Comorbidity Index (CCI),risk,integer,pmc-2878686-1,Extracted,"A 60-year-old female presented to emergency services (ER) reporting a 6-hour history of myalgia, suprapubic pain, and febrile morbidity (38.9°C/102°F). The patient was considered to be of her normal state of health prior to the onset of symptoms. Her gynecologic history was noncontributory and her medical comorbidities consisted of stable hypertension and chronic obstructive pulmonary disease. Initial significant physical examination findings and laboratory results were as follows: lower abdominal pain without rebound or guarding and leukocytosis (WBC 22,000/mm3 and 39% bands). The patient was initially admitted with sepsis (not otherwise specified) to the general medicine service and was prescribed intravenous antimicrobial therapy (ampicillin sodium/sulbactam sodium). Within 6 hours after admission, the patient complained of increasing abdominopelvic pain and developed clinical signs of sepstic shock. Intravenous gentamycin and clindamycin were added to the antimicrobial regimen, and the patient was transferred to the medical intensive care unit (MICU). Computed tomography (CT) revealed normal abdominal anatomy except for a uterus measuring 21 cm × 16 cm with fluid within the endometrial cavity and multiple leiomyomas (no evidence of myometrial gas). Gynecology was consulted and further examination confirmed a pelvic mass with suprapubic and cervical motion tenderness. After bedside endometrial biopsy was unable to be performed secondary to cervical stenosis, an ultrasound-guided transvaginal endometrial biopsy was performed as previously described []. The patient's condition continued to worsen and clinical management was complicated by the development of anemia, hyperbilirubinemia, hemoglobinemia, hemoglobinuria, and hypotension requiring blood transfusion and vasoactive support. Gram stain of the intrauterine fluid revealed gram-positive rods. Because of evidence suggestive of an intrauterine clostridial infection, an emergent total abdominal hysterectomy and bilateral salpingooophorectomy was performed without operative complications. Intraoperative findings revealed an enlarged fibroid uterus with inflammatory changes involving the uterine serosa, no evidence of tubo-ovarian abscess or infection involving the extrauterine structures. Postoperatively, the patient recovered fully after 4 days of MICU support and 13 days of hospitalization. Final pathology of the surgical specimen revealed a degenerating leiomyoma with intramural myonecrosis without evidence of malignancy. Final culture of blood and intrauterine specimens revealed Clostridium perfringens.",What is the patient's Charlson Comorbidity Index (CCI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [60, 'years'], 'Chronic Pulmonary Disease': True}",3,3,3,"The Charlson Comorbidity Index (CCI) are listed below:

1. Age: <50 years = 0 points, 50-59 years = +1 point, 60-69 years = +2 points, 70-79 years = +3 points, ≥80 years = +4 points
2. Myocardial infarction (history of definite or probable MI with EKG changes and/or enzyme changes): No = 0 points, Yes = +1 point
3. Congestive heart failure (CHF) (exertional or paroxysmal nocturnal dyspnea, responsive to digitalis, diuretics, or afterload reducing agents): No = 0 points, Yes = +1 point
4. Peripheral vascular disease (intermittent claudication, past bypass for chronic arterial insufficiency, history of gangrene or acute arterial insufficiency, untreated thoracic or abdominal aneurysm ≥6 cm): No = 0 points, Yes = +1 point
5. Cerebrovascular accident (CVA) or transient ischemic attack (TIA) (history with minor or no residuals): No = 0 points, Yes = +1 point
6. Dementia (chronic cognitive deficit): No = 0 points, Yes = +1 point
7. Chronic pulmonary disease (CPD): No = 0 points, Yes = +1 point
8. Connective tissue disease: No = 0 points, Yes = +1 point
9. Peptic ulcer disease (any history of treatment for ulcer disease or ulcer bleeding): No = 0 points, Yes = +1 point
10. Liver disease: None = 0 points, Mild = +1 point, Moderate to severe = +3 points
11. Diabetes mellitus: None or diet-controlled = 0 points, Uncomplicated = +1 point, End-organ damage = +2 points
12. Hemiplegia: No = 0 points, Yes = +2 points
13. Moderate to severe chronic kidney disease (CKD): No = 0 points, Yes = +2 points
14. Solid tumor: None = 0 points, Localized = +2 points, Metastatic = +6 points
15. Leukemia: No = 0 points, Yes = +2 points
16. Lymphoma: No = 0 points, Yes = +2 points
17. AIDS: No = 0 points, Yes = +6 points

The total score is calculated by summing the points for each criterion.
    
The current CCI is value is 0.
The patient is 60 years old. Because the patient's age is between 60 and 69, we add 2 points to the score, making the current total = 0 + 2 = 2.
The issue, 'Myocardial infarction,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Congestive heart failure,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Peripheral vascular disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
At least one of transient ischemic attack or cerebral vascular accident must be present in the patient for a point to be added to the current total.
Transient ischemic attacks is not mentioned for the patient and so we assume it to be absent.
Cerebral vascular accident is not determined for the patient and so we assume it to be absent.
Neither of the issues are determined to be present for the patient and so we add 0 point to the score, keeping the current total at 2.
The issue, 'Connective tissue diease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Dementia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
 The issue,'Chronic obstructive pulmonary disease,' is present for the patient and so we add 1 point to the score, making the current total 2 + 1 = 3.
The issue, 'Hemiplegia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Peptic ulcer disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Liver disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The patient's diabetes mellitus status is not determined and so we assume the value to be 'none or diet-controlled.' No points are added to the score, keeping the current total at 3.
The issue, 'Moderate to severe chronic kidney disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The patient's solid tumor status is not determined and so we assume that it is 'none.' Hence, do not add any points to the score, keeping the current total at 3.
The issue, 'Leukemia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Lymphoma,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'AIDS,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The patient's CCI score is 3 points."
445,32,Charlson Comorbidity Index (CCI),risk,integer,pmc-6079552-1,Extracted,"A 75-year-old man was admitted to our hospital due to exertional dyspnea that had been manifesting for several months. The patient had coronary risk factors, including hypertension, dyslipidemia, family history of coronary disease, and past history of smoking, and was taking medication prescribed by his regular physician (nifedipine 20 mg/day for hypertension; bezafibrate 400 mg/day for hyperlipidemia). On admission, physical examination and laboratory data revealed no specific findings: white blood cell count, 3990 cells/μL; hemoglobin, 14.8 g/dL; platelets, 26.7 × 104 cells/μL; glucose, 95 mg/dL; blood urea nitrogen, 14 mg/dL; creatinine, 0.71 mg/dL; estimated glomerular filtration rate, 81.7 mL/min; uric acid, 6.0 mg/dL; aspartate transaminase, 21 U/L; alanine aminotransferase, 15 U/L; total bilirubin, 0.6 mg/dL; creatine kinase, 85 IU/L; creatine kinase-MB, 8 IU/L; C-reactive protein, 0.1 mg/dL; low-density lipoprotein cholesterol, 150 mg/dL; high-density lipoprotein cholesterol, 63 mg/dL; triglycerides, 113 mg/dL; glycated hemoglobin, 5.4%; brain-type natriuretic peptide, 24 pg/mL. However, the exercise stress test revealed slight ST depression in leads V4-6 on electrocardiography. Based on the clinical symptoms, the patient was suspected of coronary artery disease. Adenosine triphosphate-stress radionuclide myocardial perfusion imaging revealed inferolateral wall ischemia. Coronary computed tomography indicated that the RCA originated from the left coronary sinus and passed between the aorta and the pulmonary artery (). Total occlusion in the midportion of the abnormal RCA and 90% stenosis of the left anterior descending coronary artery (LAD) were suspected. The RCA lesion had atherosclerotic findings such as spotty calcification and mild positive remodeling (). The patient was diagnosed with effort angina pectoris and underwent coronary angiography, which revealed tight stenosis at the LAD-D1 bifurcation and a completely occluded RCA originating from the left coronary sinus. The abnormal RCA had multiple collaterals from the LAD and left circumflex branch (Figures and ). Because the patient had a coronary artery anomaly and multivessel stenosis, coronary artery bypass grafting was proposed for revascularization, but the patient refused any surgically invasive treatment. Therefore, percutaneous coronary intervention (PCI) was performed for revascularization. The following revascularization systems were used: right femoral artery approach; guiding catheter, 7-Fr Amplatz Left 2 Mach 1 (Boston Scientific, Natick, MA, USA); guide wire, Grand Slam, XT-R, and Sion blue (both from Asahi Intecc, Aichi, Japan); microcatheter, Mizuki (Kaneka Medical, Osaka, Japan) and Caravel (Asahi Intecc); balloon, Ikazuchi 1.0 × 10 mm (Kaneka Medical), Tazuna 2.0 × 15 mm (Terumo Corporation, Tokyo, Japan), and Raiden 3.5 × 10 mm (Kaneka Medical); stent, Ultimaster 3.0 × 18 mm (Terumo Corporation); and intravascular ultrasound (IVUS) catheter, 40 MHz rotational OptiCross (Boston Scientific). Cannulating the guiding catheter to the anomalous orifice of the RCA was difficult, and it was not possible to achieve adequate backup support (). Using the XT-R guide wire, the Mizuki microcatheter could not be passed though the chronic total occlusion lesion until it was replaced with a Caravel microcatheter. The wire was then changed to Sion blue (). IVUS revealed diffuse eccentric calcified plaque. The intramural course of the proximal ectopic artery was elliptical with some lateral compression. However, the stenosis of the proximal intramural course was not so severe that we did not deploy the stent in the proximal portion (). Multiple ballooning and angioplasty with a drug-eluting stent were performed (), and an optimal result was obtained (). At the same time, PCI was performed for LAD revascularization, and an optimal result was obtained (). No exertional dyspnea was noted following PCI. At approximately one year after intervention, exercise stress radionuclide myocardial perfusion imaging and coronary angiography revealed no in-stent restenosis or ischemia. The patient expressed satisfaction with the outcome of the intervention.",What is the patient's Charlson Comorbidity Index (CCI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [75, 'years'], 'Myocardial infarction': False, 'Congestive Heart Failure': False, 'Moderate to severe Chronic Kidney Disease': False}",3,3,3,"The Charlson Comorbidity Index (CCI) are listed below:

1. Age: <50 years = 0 points, 50-59 years = +1 point, 60-69 years = +2 points, 70-79 years = +3 points, ≥80 years = +4 points
2. Myocardial infarction (history of definite or probable MI with EKG changes and/or enzyme changes): No = 0 points, Yes = +1 point
3. Congestive heart failure (CHF) (exertional or paroxysmal nocturnal dyspnea, responsive to digitalis, diuretics, or afterload reducing agents): No = 0 points, Yes = +1 point
4. Peripheral vascular disease (intermittent claudication, past bypass for chronic arterial insufficiency, history of gangrene or acute arterial insufficiency, untreated thoracic or abdominal aneurysm ≥6 cm): No = 0 points, Yes = +1 point
5. Cerebrovascular accident (CVA) or transient ischemic attack (TIA) (history with minor or no residuals): No = 0 points, Yes = +1 point
6. Dementia (chronic cognitive deficit): No = 0 points, Yes = +1 point
7. Chronic pulmonary disease (CPD): No = 0 points, Yes = +1 point
8. Connective tissue disease: No = 0 points, Yes = +1 point
9. Peptic ulcer disease (any history of treatment for ulcer disease or ulcer bleeding): No = 0 points, Yes = +1 point
10. Liver disease: None = 0 points, Mild = +1 point, Moderate to severe = +3 points
11. Diabetes mellitus: None or diet-controlled = 0 points, Uncomplicated = +1 point, End-organ damage = +2 points
12. Hemiplegia: No = 0 points, Yes = +2 points
13. Moderate to severe chronic kidney disease (CKD): No = 0 points, Yes = +2 points
14. Solid tumor: None = 0 points, Localized = +2 points, Metastatic = +6 points
15. Leukemia: No = 0 points, Yes = +2 points
16. Lymphoma: No = 0 points, Yes = +2 points
17. AIDS: No = 0 points, Yes = +6 points

The total score is calculated by summing the points for each criterion.
    
The current CCI is value is 0.
The patient is 75 years old. Because the patient's age is between 70 and 79, we add 3 points to the score, making the current total = 0 + 3 = 3.
The issue, 'Myocardial infarction,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Congestive heart failure,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Peripheral vascular disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
At least one of transient ischemic attack or cerebral vascular accident must be present in the patient for a point to be added to the current total.
Transient ischemic attacks is not mentioned for the patient and so we assume it to be absent.
Cerebral vascular accident is not determined for the patient and so we assume it to be absent.
Neither of the issues are determined to be present for the patient and so we add 0 point to the score, keeping the current total at 3.
The issue, 'Connective tissue diease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Dementia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Chronic obstructive pulmonary disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Hemiplegia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Peptic ulcer disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Liver disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The patient's diabetes mellitus status is not determined and so we assume the value to be 'none or diet-controlled.' No points are added to the score, keeping the current total at 3.
The issue, 'Moderate to severe chronic kidney disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The patient's solid tumor status is not determined and so we assume that it is 'none.' Hence, do not add any points to the score, keeping the current total at 3.
The issue, 'Leukemia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Lymphoma,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'AIDS,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The patient's CCI score is 3 points."
446,32,Charlson Comorbidity Index (CCI),risk,integer,pmc-8708478-1,Extracted,"A 55-year-old man was first evaluated in a nephrology unit because of hypertension associated with progressive kidney failure and proteinuria. At that time, the patient presented a history of hypertension since the age of 42, hypoacusia, a superficial venous thrombosis event, and incidental evidence of cerebral ischemia.
Blood and urine tests revealed a IIIb CKD stage renal insufficiency (serum creatinine 1.92 mg/dL, MDRD GFR 39 mL/min/1.73 mq) with mild proteinuria (0.821 g/24 h). Urine sediment was clear. A kidney biopsy was performed to explore renal disease etiology, showing non-specific advanced chronic lesions (global glomerulosclerosis in 70% of glomeruli and segmental glomerulosclerosis in 10% of glomeruli, moderate interstitial fibrosis/tubular atrophy, and severe arteriolosclerosis). Therapy with ACE-inhibitor was hence started.
Two years later, at the age of 57, a significant concentric LVH (basal septum region 18 mm) was detected during an echocardiographic evaluation for hypertension.
Renal follow-up showed a progressive decline in renal function reaching end-stage renal disease (ESRD) at the patient’s age of 61. Chronic peritoneal dialysis was started, and one year later, he underwent renal transplantation from a deceased donor without complications.
When the patient was 63 years old, he began complaining of dyspnea during intense exercise. Echocardiography showed worsening LVH (maximum wall thickness of 24 mm) associated with pronounced tissue hyperechogenicity and right ventricular hypertrophy, finally raising the suspicion of Fabry disease. The diagnosis was confirmed by the detection of reduced α-galactosidase A activity measured on dried blood spots (DBS) (0.5 µmol/L/h (reference values > 2.8)) and with molecular analysis revealing the N215S GLA mutation. Increased levels of lysoGb3 on DBS (6.4 ng/mL (reference values 0.0–3.5)) were detected. At diagnosis, serum creatinine was 1.23 mg/dL, and proteinuria was 0.3 g/24 h.
Thus, in March 2019, the patient was referred to our Rare Disease Center for Fabry disease management and follow-up. The Mainz Severity Score Index (MSSI) was 40/76 (General score—3; Neurological score—3; Cardiovascular score—16; and Renal score—18), and the total assessment Fabry Disease Severity Scoring System (DS3) was 46/80 (Peripheral Nervous System domain—0; Renal domain—23; Cardiac domain—18; Central Nervous System domain—1; and Patient-Reported domain 4).
Cardiac magnetic resonance (CMR) showed severe biventricular hypertrophy with reduced native T1 values, suggesting myocardial glycosphingolipid storage. The left ventricular mass index was 198.4 g/m2. Extensive late gadolinium enhancement was also detected in the infero-lateral wall, with an increased T2 value indicating myocardial edema ().
An initial 24-h Holter monitoring revealed two runs of atrial fibrillation, which required the introduction of anticoagulant therapy.
One year later, in 2020, two runs of monomorphic non-sustained ventricular tachycardia were detected during a further 24-h Holter monitoring. Thus, an ICD was implanted.
Therapy with agalsidase beta at a standard dose of 1 mg/kg every two weeks, administered at our center, was initiated in June 2019. In March 2020, the outbreak of the Coronavirus pandemic dramatically affected the Northern regions of Italy. Thus, the patient asked to switch to oral therapy to avoid hospital access or contact with health care workers in the case of home treatment activation. No contraindications to chaperone therapy were found (serum creatinine 1.28 mg/dL, MDRD GFR 60 mL/min/1.73 mq). We thereby started migalastat at a standard dose of 123 mg orally every other day. The patient did not show any side effects of migalastat such as headache, runny or stuffy nose, urinary tract infection, nausea, or fever. After one year of migalastat treatment, the patient was stable in terms of symptoms, renal function (serum creatinine 1.30 mg/dL, proteinuria 0.275 g/24 h), and cardiac function (CMR in March 2021 showed substantially stable cardiac features). No adjustments in the immunosuppressor dosage, namely prednisone, mycophenolate mofetil, and tacrolimus, were required. In addition, we detected a reduction in lysoGb3 levels (4.3 ng/mL; a reduction of 33% from the patient’s basal values) and an increase in α-galactosidase A activity measured on dried blood spots (1.1 µmol/L/h; an increase of 120% compared to the patient’s basal values).
To confirm the kidney disease etiology, we recently analyzed the residual material from the native kidney biopsy by electron microscopy, finding abundant electron-lucent microvacuoles in many cell types and multivacuolized appearance of podocytes ().",What is the patient's Charlson Comorbidity Index (CCI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [63, 'years'], 'Moderate to severe Chronic Kidney Disease': True, 'Congestive Heart Failure': False, 'Peripheral vascular disease': False, 'Cerebrovascular Accident': True}",5,5,5,"The Charlson Comorbidity Index (CCI) are listed below:

1. Age: <50 years = 0 points, 50-59 years = +1 point, 60-69 years = +2 points, 70-79 years = +3 points, ≥80 years = +4 points
2. Myocardial infarction (history of definite or probable MI with EKG changes and/or enzyme changes): No = 0 points, Yes = +1 point
3. Congestive heart failure (CHF) (exertional or paroxysmal nocturnal dyspnea, responsive to digitalis, diuretics, or afterload reducing agents): No = 0 points, Yes = +1 point
4. Peripheral vascular disease (intermittent claudication, past bypass for chronic arterial insufficiency, history of gangrene or acute arterial insufficiency, untreated thoracic or abdominal aneurysm ≥6 cm): No = 0 points, Yes = +1 point
5. Cerebrovascular accident (CVA) or transient ischemic attack (TIA) (history with minor or no residuals): No = 0 points, Yes = +1 point
6. Dementia (chronic cognitive deficit): No = 0 points, Yes = +1 point
7. Chronic pulmonary disease (CPD): No = 0 points, Yes = +1 point
8. Connective tissue disease: No = 0 points, Yes = +1 point
9. Peptic ulcer disease (any history of treatment for ulcer disease or ulcer bleeding): No = 0 points, Yes = +1 point
10. Liver disease: None = 0 points, Mild = +1 point, Moderate to severe = +3 points
11. Diabetes mellitus: None or diet-controlled = 0 points, Uncomplicated = +1 point, End-organ damage = +2 points
12. Hemiplegia: No = 0 points, Yes = +2 points
13. Moderate to severe chronic kidney disease (CKD): No = 0 points, Yes = +2 points
14. Solid tumor: None = 0 points, Localized = +2 points, Metastatic = +6 points
15. Leukemia: No = 0 points, Yes = +2 points
16. Lymphoma: No = 0 points, Yes = +2 points
17. AIDS: No = 0 points, Yes = +6 points

The total score is calculated by summing the points for each criterion.
    
The current CCI is value is 0.
The patient is 63 years old. Because the patient's age is between 60 and 69, we add 2 points to the score, making the current total = 0 + 2 = 2.
The issue, 'Myocardial infarction,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Congestive heart failure,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
The issue, 'Peripheral vascular disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 2.
At least one of transient ischemic attack or cerebral vascular accident must be present in the patient for a point to be added to the current total.
Transient ischemic attacks is not mentioned for the patient and so we assume it to be absent.
Cerebral vascular accident is determined to be present for the patient.
Because at least one of the issues is determined to be present for the patient, we add 1 point to the score, making the current total 2 + 1 = 3.
The issue, 'Connective tissue diease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Dementia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Chronic obstructive pulmonary disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Hemiplegia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Peptic ulcer disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The issue, 'Liver disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 3.
The patient's diabetes mellitus status is not determined and so we assume the value to be 'none or diet-controlled.' No points are added to the score, keeping the current total at 3.
The issue, 'Moderate to severe chronic kidney disease,' is determined to be present for the patient and so we add 2 points to the score, making the current total 3 + 2 = 5.
The patient's solid tumor status is not determined and so we assume that it is 'none.' Hence, do not add any points to the score, keeping the current total at 5.
The issue, 'Leukemia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 5.
The issue, 'Lymphoma,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 5.
The issue, 'AIDS,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 5.
The patient's CCI score is 5 points."
447,32,Charlson Comorbidity Index (CCI),risk,integer,pmc-8020123-1,Extracted,"The patient was a 58-year-old non-smoking male Ohio native with hyperlipidemia, environmental allergies and no other known medical problems who presented to the emergency department within hours of his return from a ski trip to Breckenridge, Colorado (altitude 2926 m) complaining of dyspnea, orthopnea, dizziness, chest tightness and weakness in the pre-Covid-19 era. He developed mild dyspnea within 48 hours of arrival to Colorado but returned to Ohio after five days with increasing dyspnea that did not improve with descent. His initial evaluation revealed a pale mildly diaphoretic adult in severe respiratory distress who was able to speak in short sentences. His initial vital signs were blood pressure 189/101mmHG, temperature 37°C, respirations of 40 breaths per minute, and pulse rate of 112 beats per minute. Physical exam was significant for normal cardiac exam except tachycardia, increased work of breathing, conversational dyspnea, bibasilar rales, normal heart sounds, 2+ distal pulses without peripheral edema and mildly diaphoretic cool skin. Oxygen saturation on room air was 72% and chest X-ray demonstrated pulmonary edema without cardiomegaly (). Electrocardiogram revealed sinus tachycardia of 104 beats per minute with minimal flattening of the T-waves in V5 and V6. Lab work revealed an elevated white blood cell count of 21.6 Reference Interval (RI) (4.5–11.5E9/L), a normal hemoglobin of 13.7 RI (12.5–16.5g/dl) and an elevated brain natriuretic peptide level of 1031 RI (0–125pg/dl), three serial troponin levels were less than 0.01 RI (0.00–0.03ng/mL). D-dimer level was not obtained due to the pulmonary infiltrates and a basic metabolic panel was normal, as was a viral respiratory film array panel, and two sets of blood cultures. A trans-thoracic echocardiogram revealed normal valvular function and an ejection fraction of 65% with normal diastolic function. The echocardiogram did not include a pulmonary ultrasound and B-lines were not assessed. Pulmonary consultation noted rapid resolution of the pulmonary infiltrates as well as hypoxia with the emergency department treatment and a decision not to perform bronchoscopy was made. In the emergency department, nitroglycerine 0.4mg sublingually, extended-release nifedipine 30 mg orally, and dexamethasone 10mg intravenously were administered. A brief emergency department literature review led to this therapeutic regimen. Due to persistent dyspnea despite resolving hypoxia, he was placed on bilevel positive airway pressure (BIPAP) at 15/5 cmH2O with further improvement in his dyspnea. Due to the local lack of familiarity with HAPE, he was admitted to the intensive care unit where the BIPAP was continued until he could be weaned to room air and was subsequently discharged on no medications. He was counseled against further trips to high altitude without acclimatization.",What is the patient's Charlson Comorbidity Index (CCI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [58, 'years'], 'Chronic Pulmonary Disease': False, 'Congestive Heart Failure': False, 'Moderate to severe Chronic Kidney Disease': False}",1,1,1,"The Charlson Comorbidity Index (CCI) are listed below:

1. Age: <50 years = 0 points, 50-59 years = +1 point, 60-69 years = +2 points, 70-79 years = +3 points, ≥80 years = +4 points
2. Myocardial infarction (history of definite or probable MI with EKG changes and/or enzyme changes): No = 0 points, Yes = +1 point
3. Congestive heart failure (CHF) (exertional or paroxysmal nocturnal dyspnea, responsive to digitalis, diuretics, or afterload reducing agents): No = 0 points, Yes = +1 point
4. Peripheral vascular disease (intermittent claudication, past bypass for chronic arterial insufficiency, history of gangrene or acute arterial insufficiency, untreated thoracic or abdominal aneurysm ≥6 cm): No = 0 points, Yes = +1 point
5. Cerebrovascular accident (CVA) or transient ischemic attack (TIA) (history with minor or no residuals): No = 0 points, Yes = +1 point
6. Dementia (chronic cognitive deficit): No = 0 points, Yes = +1 point
7. Chronic pulmonary disease (CPD): No = 0 points, Yes = +1 point
8. Connective tissue disease: No = 0 points, Yes = +1 point
9. Peptic ulcer disease (any history of treatment for ulcer disease or ulcer bleeding): No = 0 points, Yes = +1 point
10. Liver disease: None = 0 points, Mild = +1 point, Moderate to severe = +3 points
11. Diabetes mellitus: None or diet-controlled = 0 points, Uncomplicated = +1 point, End-organ damage = +2 points
12. Hemiplegia: No = 0 points, Yes = +2 points
13. Moderate to severe chronic kidney disease (CKD): No = 0 points, Yes = +2 points
14. Solid tumor: None = 0 points, Localized = +2 points, Metastatic = +6 points
15. Leukemia: No = 0 points, Yes = +2 points
16. Lymphoma: No = 0 points, Yes = +2 points
17. AIDS: No = 0 points, Yes = +6 points

The total score is calculated by summing the points for each criterion.
    
The current CCI is value is 0.
The patient is 58 years old. Because the patient's age is between 50 and 59, we add 1 point to the score, making the current total = 0 + 1 = 1.
The issue, 'Myocardial infarction,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The issue, 'Congestive heart failure,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The issue, 'Peripheral vascular disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
At least one of transient ischemic attack or cerebral vascular accident must be present in the patient for a point to be added to the current total.
Transient ischemic attacks is not mentioned for the patient and so we assume it to be absent.
Cerebral vascular accident is not determined for the patient and so we assume it to be absent.
Neither of the issues are determined to be present for the patient and so we add 0 point to the score, keeping the current total at 1.
The issue, 'Connective tissue diease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The issue, 'Dementia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The issue, 'Chronic obstructive pulmonary disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The issue, 'Hemiplegia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The issue, 'Peptic ulcer disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The issue, 'Liver disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The patient's diabetes mellitus status is not determined and so we assume the value to be 'none or diet-controlled.' No points are added to the score, keeping the current total at 1.
The issue, 'Moderate to severe chronic kidney disease,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The patient's solid tumor status is not determined and so we assume that it is 'none.' Hence, do not add any points to the score, keeping the current total at 1.
The issue, 'Leukemia,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The issue, 'Lymphoma,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The issue, 'AIDS,' is determined to be absent for the patient and so we do not add any points to the score, keeping the current total at 1.
The patient's CCI score is 1 points."
448,33,FeverPAIN Score for Strep Pharyngitis,diagnosis,integer,usmle-3456,Extracted,"A 17-year-old girl comes to the physician because of a sore throat, fevers, and fatigue for the past 3 weeks. Her temperature is 37.8°C (100°F), pulse is 97/min, and blood pressure is 90/60 mm Hg. Examination of the head and neck shows cervical lymphadenopathy, pharyngeal erythema, enlarged tonsils with exudates, and palatal petechiae. The spleen is palpated 2 cm below the left costal margin. Her leukocyte count is 14,100/mm3 with 54% lymphocytes (12% atypical lymphocytes). Results of a heterophile agglutination test are positive.",What is the patient's FeverPAIN score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Symptom onset <=3 days': False, 'Purulent tonsils': True, 'Fever in past 24 hours': True, 'Severe tonsil inflammation': True}",4,4,4,"The criteria for the FeverPAIN score are listed below:
    
1. Fever in past 24 hours: No = 0 points, Yes = +1 point
2. Absence of cough or coryza: No = 0 points, Yes = +1 point
3. Symptom onset ≤3 days: No = 0 points, Yes = +1 point
4. Purulent tonsils: No = 0 points, Yes = +1 point
5. Severe tonsil inflammation: No = 0 points, Yes = +1 point

The FeverPAIN score is calculated by summing the points for each criterion.
    
The patient's current FeverPain score is 0.
The patient is reported to have a fever in the past 24 hours and so we increment the score by 1, making the current total 0 + 1 = 1.
Whether the patient has an absence of cough or coryza is not reported and so we assume that it is absent for the patient. Because of this, we add one point to the score, making the current total 1 + 1 =  2.
The patient is reported to not have a symptom onset ≤3 days and so we do not increment the score, keeping the current total at 2.
The patient is reported to have purulent tonsils and so we increment the score by 1, making the current total 2 + 1 = 3.
The patient is reported to have severe tonsil inflammation and so we increment the score by 1, making the current total 3 + 1 = 4.
The patient's FeverPain score is 4 points."
449,33,FeverPAIN Score for Strep Pharyngitis,diagnosis,integer,usmle-6072,Extracted,"A 16-year-old female presents to her primary care provider for fatigue. She reports feeling well until two weeks ago, when she became unusually tired and developed a sore throat. Her mother took her temperature at home and reports that it was as high as 101.8°F (38.8°C). The patient reports that her sore throat has started to improve in the last few days, but her mother continues to be concerned that her daughter is missing school. The patient endorses heavy periods, soaking two menstrual pads per day and lasting for seven days. Her last menstrual period began two days ago. She denies sick contacts but has two younger siblings, and her father was recently diagnosed with multiple myeloma. Her temperature is 100.4°F (38.0°C), blood pressure is 115/72 mmHg, pulse is 106/min, and respirations are 20/min. On physical exam, the patient is tired appearing with cervical lymphadenopathy and the physical exam finding seen in Figure A.",What is the patient's FeverPAIN score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Purulent tonsils': False, 'Symptom onset <=3 days': False, 'Severe tonsil inflammation': False, 'Fever in past 24 hours': True}",2,2,2,"The criteria for the FeverPAIN score are listed below:
    
1. Fever in past 24 hours: No = 0 points, Yes = +1 point
2. Absence of cough or coryza: No = 0 points, Yes = +1 point
3. Symptom onset ≤3 days: No = 0 points, Yes = +1 point
4. Purulent tonsils: No = 0 points, Yes = +1 point
5. Severe tonsil inflammation: No = 0 points, Yes = +1 point

The FeverPAIN score is calculated by summing the points for each criterion.
    
The patient's current FeverPain score is 0.
The patient is reported to have a fever in the past 24 hours and so we increment the score by 1, making the current total 0 + 1 = 1.
Whether the patient has an absence of cough or coryza is not reported and so we assume that it is absent for the patient. Because of this, we add one point to the score, making the current total 1 + 1 =  2.
The patient is reported to not have a symptom onset ≤3 days and so we do not increment the score, keeping the current total at 2.
The patient is reported to not have purulent tonsils and so we do not increment the score, keeping the current total at 2.
The patient is reported to not have severe tonsil inflammation and so we do not increment the score, keeping the current total at 2.
The patient's FeverPain score is 2 points."
450,33,FeverPAIN Score for Strep Pharyngitis,diagnosis,integer,pmc-8628097-1,Extracted,"The patient is a 23-year-old with a temperature of  101°F female presented with acute tonsillitis. The patient has no personal illness and no drug allergy. Throat examination reveals red enlarged tonsils with exudate (the patient did not allow taking a photo of her throat).
The patient has a history of repeated visits to the physicians for more than ten times per year with the same problem of acute tonsillitis. In each previous visit, the patient received penicillin as the antibiotic for the treatment, and the clinical problem was resolved, but the recurrence occurred within a few weeks.
The patient consulted with the physician in charge, who is a family physician, and gave the history that she was a prostitute and has to perform oral sexual intercourse with many different males. Nevertheless, she has no history of sexually transmitted infection, and her annual blood check, according to the legal regulation for the prostitute, for HIV serology and VDRL was negative. Furthermore, her annual gynecological examination result is within the normal limit. The differential diagnosis of recurrent tonsillitis in this patient is Group A beta-hemolytic Streptococcus pyogenes infection that requires microbiological examination for discrimination. In this case, the tonsil and throat swab were done, and the microbiological study revealed gonorrhea infection. The patient was treated with dual-therapy regimen with single-dose ceftriaxone intramuscular injection and single dose 1 g oral azithromycin according to the 2015 STDs Treatment Guidelines of CDC (). Her clinical symptoms disappeared within 1 week. In this case, health education on safe sex was also given to the patient. However, the patient lost follow-up, and it cannot verify the success and impact of health education. Whether there is any impact on her profession, a prostitute is still questionable.",What is the patient's FeverPAIN score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Purulent tonsils': True, 'Symptom onset <=3 days': True, 'Severe tonsil inflammation': True, 'Fever in past 24 hours': True}",5,5,5,"The criteria for the FeverPAIN score are listed below:
    
1. Fever in past 24 hours: No = 0 points, Yes = +1 point
2. Absence of cough or coryza: No = 0 points, Yes = +1 point
3. Symptom onset ≤3 days: No = 0 points, Yes = +1 point
4. Purulent tonsils: No = 0 points, Yes = +1 point
5. Severe tonsil inflammation: No = 0 points, Yes = +1 point

The FeverPAIN score is calculated by summing the points for each criterion.
    
The patient's current FeverPain score is 0.
The patient is reported to have a fever in the past 24 hours and so we increment the score by 1, making the current total 0 + 1 = 1.
Whether the patient has an absence of cough or coryza is not reported and so we assume that it is absent for the patient. Because of this, we add one point to the score, making the current total 1 + 1 =  2.
The patient is reported to have a symptom onset ≤3 days and so we increment the score by 1, making the current total 2 + 1 = 3.
The patient is reported to have purulent tonsils and so we increment the score by 1, making the current total 3 + 1 = 4.
The patient is reported to have severe tonsil inflammation and so we increment the score by 1, making the current total 4 + 1 = 5.
The patient's FeverPain score is 5 points."
451,33,FeverPAIN Score for Strep Pharyngitis,diagnosis,integer,pmc-3603656-1,Extracted,"A 32-year-old lady presented to our emergency ENT service complaining of a sore throat. She had a temperature of  101.6°F. This had developed over a 2-day period and was associated with a fever and odynophagia of solids and liquids. Her symptoms had failed to improve despite a four-day course of benzylpenicillin 500 mg qds and a two-day course of metronidazole 400 mg tds. The patient reported no past medical history but revealed that she had suffered from bulimia for 15 years although general practitioner review had declined further contact with the psychiatric services because of difficult previous experiences with them. She described fortnightly purging following eating during the previous 6 months, which was followed by episodes of tonsillitis. She used no regular medications. ENT examination revealed bilaterally enlarged, erythematous tonsils, and jugulodigastric lymphadenopathy. No peri-tonsillar abscess was present. Ear examination and nose examination were normal. Blood testing was normal throughout. IgM screen was negative. The patient was admitted to our ENT service for intravenous antibiotic therapy. The patient declined followup for consideration of a tonsillectomy as she was moving to a different region. The patient was advised to contact her new local otolaryngology service for tonsillectomy consideration.",What is the patient's FeverPAIN score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Symptom onset <=3 days': False, 'Purulent tonsils': True, 'Fever in past 24 hours': True, 'Severe tonsil inflammation': True}",4,4,4,"The criteria for the FeverPAIN score are listed below:
    
1. Fever in past 24 hours: No = 0 points, Yes = +1 point
2. Absence of cough or coryza: No = 0 points, Yes = +1 point
3. Symptom onset ≤3 days: No = 0 points, Yes = +1 point
4. Purulent tonsils: No = 0 points, Yes = +1 point
5. Severe tonsil inflammation: No = 0 points, Yes = +1 point

The FeverPAIN score is calculated by summing the points for each criterion.
    
The patient's current FeverPain score is 0.
The patient is reported to have a fever in the past 24 hours and so we increment the score by 1, making the current total 0 + 1 = 1.
Whether the patient has an absence of cough or coryza is not reported and so we assume that it is absent for the patient. Because of this, we add one point to the score, making the current total 1 + 1 =  2.
The patient is reported to not have a symptom onset ≤3 days and so we do not increment the score, keeping the current total at 2.
The patient is reported to have purulent tonsils and so we increment the score by 1, making the current total 2 + 1 = 3.
The patient is reported to have severe tonsil inflammation and so we increment the score by 1, making the current total 3 + 1 = 4.
The patient's FeverPain score is 4 points."
452,33,FeverPAIN Score for Strep Pharyngitis,diagnosis,integer,usmle-585,Extracted,"A 43-year-old man comes to the physician because of nasal congestion and fatigue for 12 days. During this period, he has had fevers and severe pain over his cheeks. His nasal discharge was initially clear, but it has turned yellowish over the last couple of days. He has no visual complaints. He has been taking an over-the-counter nasal decongestant and acetaminophen without much relief. He has type 2 diabetes mellitus and hypertension. He underwent an appendectomy 23 years ago. He does not smoke or drink alcohol. His current medications include metformin, sitagliptin, and enalapril. He appears tired. His temperature is 38.5°C (101.3°F), pulse is 96/min, and blood pressure is 138/86 mm Hg. Examination shows purulent discharge in the nose and pharynx and normal appearing ears. The left maxillary sinus is tender to palpation.",What is the patient's FeverPAIN score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Purulent tonsils': True, 'Fever in past 24 hours': True, 'Symptom onset <=3 days': False, 'Severe tonsil inflammation': False}",3,3,3,"The criteria for the FeverPAIN score are listed below:
    
1. Fever in past 24 hours: No = 0 points, Yes = +1 point
2. Absence of cough or coryza: No = 0 points, Yes = +1 point
3. Symptom onset ≤3 days: No = 0 points, Yes = +1 point
4. Purulent tonsils: No = 0 points, Yes = +1 point
5. Severe tonsil inflammation: No = 0 points, Yes = +1 point

The FeverPAIN score is calculated by summing the points for each criterion.
    
The patient's current FeverPain score is 0.
The patient is reported to have a fever in the past 24 hours and so we increment the score by 1, making the current total 0 + 1 = 1.
Whether the patient has an absence of cough or coryza is not reported and so we assume that it is absent for the patient. Because of this, we add one point to the score, making the current total 1 + 1 =  2.
The patient is reported to not have a symptom onset ≤3 days and so we do not increment the score, keeping the current total at 2.
The patient is reported to have purulent tonsils and so we increment the score by 1, making the current total 2 + 1 = 3.
The patient is reported to not have severe tonsil inflammation and so we do not increment the score, keeping the current total at 3.
The patient's FeverPain score is 3 points."
453,33,FeverPAIN Score for Strep Pharyngitis,diagnosis,integer,pmc-5661752-1,Extracted,"A previously healthy 3-year-old boy is evaluated for a 3-day history of fever and swelling on both sides of his neck. He was found to have acute otitis media and was started on amoxicillin by his pediatrician. Since 2 days ago, the patient presents drooling, loud snoring, noisy breathing, hoarseness, inability to eat solids, persistant cough, and persistence of fever. There is no history of rash, weight loss, night sweats, neck stiffness, sick contacts, recent travel, or exposure to animals.
Physical examination reveals an alert, sick-looking child. His temperature is 39.6°C, heart rate is 130 beats per minute, respiratory rate is 28 breaths per minute, blood pressure is 96/54 mm Hg, and oxygen saturation is 99% on room air. He has nasal congestion, bilaterally enlarged tonsils with mild erythema, and white exudates. The uvula is not deviated. There are multiple 2- to 3-cm mobile, nonerythematous, nontender anterior cervical lymph nodes bilaterally. The remainder of his physical findings is unremarkable.
His initial laboratory results show a hemoglobin level of 12.6 g/dL (126 g/L); white blood cell count of 14.2 × 103/µL (14.2 × 109/L) with 37% neutrophils, 52% lymphocytes; and platelet count of 208 × 103/µL (208 × 109/L). His serum electrolyte values are within normal range. His aspartate transaminase level is 38 U/L, alanine transaminase level is 50 U/L, and C-reactive protein level is 17.17 mg/dL. Rapid strep test is negative. A neck ultrasound () reveals multiple lymph nodes ranging from 1.8 to 3.6 cm over the right subauricular and left subauricular regions without fluid collection. Neck computed tomography without contrast () ruled out any retropharyngeal mass and confirmed level II and level V lymphadenopathy.
The patient is admitted and additional tests reveal the diagnosis.",What is the patient's FeverPAIN score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Purulent tonsils': True, 'Fever in past 24 hours': True, 'Symptom onset <=3 days': True, 'Severe tonsil inflammation': True}",5,5,5,"The criteria for the FeverPAIN score are listed below:
    
1. Fever in past 24 hours: No = 0 points, Yes = +1 point
2. Absence of cough or coryza: No = 0 points, Yes = +1 point
3. Symptom onset ≤3 days: No = 0 points, Yes = +1 point
4. Purulent tonsils: No = 0 points, Yes = +1 point
5. Severe tonsil inflammation: No = 0 points, Yes = +1 point

The FeverPAIN score is calculated by summing the points for each criterion.
    
The patient's current FeverPain score is 0.
The patient is reported to have a fever in the past 24 hours and so we increment the score by 1, making the current total 0 + 1 = 1.
Whether the patient has an absence of cough or coryza is not reported and so we assume that it is absent for the patient. Because of this, we add one point to the score, making the current total 1 + 1 =  2.
The patient is reported to have a symptom onset ≤3 days and so we increment the score by 1, making the current total 2 + 1 = 3.
The patient is reported to have purulent tonsils and so we increment the score by 1, making the current total 3 + 1 = 4.
The patient is reported to have severe tonsil inflammation and so we increment the score by 1, making the current total 4 + 1 = 5.
The patient's FeverPain score is 5 points."
454,33,FeverPAIN Score for Strep Pharyngitis,diagnosis,integer,pmc-7219994-1,Extracted,"A 45-year-old African-American female presented to the emergency department (ED) of a rural, academic medical center with a three-day history of “sore throat.” The patient rated her pain as a 7/10 and described the pain as a “burning pain and a raw sensation,” which was exacerbated by eating and drinking. She stated that she had tried over-the-counter (OTC) ibuprofen, lozenges, and oral benzocaine throat spray without any improvement in her symptoms. The patient admitted to a past medical history of hypertension, gastroesophageal reflux disease (GERD), depression, and bipolar disorder. However, she denied taking any medications for her medical conditions. She admitted to a one-pack-per-day smoking history and occasional alcohol use, but denied illicit drug use, specifically intravenous drug use (IVDU). The patient informed the practitioners that she had recently moved to the area; therefore she did not have a primary care physician, hence coming to the ED.
A review of her systems was negative for nausea, vomiting, diarrhea, shortness of breath (SOB), pain while taking a breath, cough, chest pain (CP), and skin lesions. She also denied any muscular pain, muscular weakness, or joint pain. The patient also denied any vaginal ulcerations or vaginal discharge. She did, however, admit to fevers and chills, and stated that the highest recorded temperature at home was 39.2°C. Vital signs upon presentation were as follows: temperature 38.1°C; blood pressure 108/73 millimeters of mercury; pulse 108 beats per minute; respiratory rate 16 breaths per minute, and oxygen saturation 99% on room air.
Physical examination revealed an African-American female sitting comfortably on the stretcher in no apparent respiratory distress. The patient appeared non-toxic, and conversation revealed no evidence of hoarse or muffled speech. A focused head, eyes, ears, nose, and throat exam revealed no oropharyngeal masses or uvular deviation, and no submental induration or tenderness were appreciated on examination. A bluish discoloration was appreciated on the tongue, but the patient admitted to using lozenges just prior to examination.
A focused examination of her oropharynx demonstrated mildly dry mucous membranes with confluent plaques and a white, patchy, ulcerative appearance of the uvula, tonsils, tonsillar pillars, hard palate, anterior one-third of the soft palate, and the side of her tongue ( and ).
Given the patient’s pyrexia and symptomology, rapid streptococcal antigen and a mononucleosis spot (Monospot) test were obtained. The results for the Monospot test and rapid group A strep antigen screen were negative. KOH testing was performed on the posterior pharyngeal lesion for a possible fungal etiology and was found to be negative. Given the negative test results and appearance of the lesion, the patient was interviewed again. We specifically inquired about high-risk sexual behavior, IVDU, and using immunosuppressive medication, all of which the patient denied. She was then offered basic lab work consisting of a complete blood count (CBC) with differential and complete metabolic profile (CMP) ().
Based upon those results, a diagnosis was made in the ED, the patient was started on medications, and further laboratory work was ordered to confirm the diagnosis.",What is the patient's FeverPAIN score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Purulent tonsils': True, 'Fever in past 24 hours': True, 'Symptom onset <=3 days': True, 'Severe tonsil inflammation': True}",5,5,5,"The criteria for the FeverPAIN score are listed below:
    
1. Fever in past 24 hours: No = 0 points, Yes = +1 point
2. Absence of cough or coryza: No = 0 points, Yes = +1 point
3. Symptom onset ≤3 days: No = 0 points, Yes = +1 point
4. Purulent tonsils: No = 0 points, Yes = +1 point
5. Severe tonsil inflammation: No = 0 points, Yes = +1 point

The FeverPAIN score is calculated by summing the points for each criterion.
    
The patient's current FeverPain score is 0.
The patient is reported to have a fever in the past 24 hours and so we increment the score by 1, making the current total 0 + 1 = 1.
Whether the patient has an absence of cough or coryza is not reported and so we assume that it is absent for the patient. Because of this, we add one point to the score, making the current total 1 + 1 =  2.
The patient is reported to have a symptom onset ≤3 days and so we increment the score by 1, making the current total 2 + 1 = 3.
The patient is reported to have purulent tonsils and so we increment the score by 1, making the current total 3 + 1 = 4.
The patient is reported to have severe tonsil inflammation and so we increment the score by 1, making the current total 4 + 1 = 5.
The patient's FeverPain score is 5 points."
455,33,FeverPAIN Score for Strep Pharyngitis,diagnosis,integer,usmle-1376,Extracted,A 4-year-old boy is brought to the physician by his father because of a 3-day history of generalized rash. The rash is not pruritic. He has no cough. He has had a fever and a sore throat for 4 days. He was born at term and has been healthy except for an episode of tonsillitis 6 months ago treated with erythromycin. His immunizations are up-to-date. His temperature is 38.5°C (101.3°F). Examination shows cervical lymphadenopathy. The tongue is bright red. There is tonsillar erythema without any exudate. A photograph of the rash is shown.,What is the patient's FeverPAIN score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Purulent tonsils': False, 'Symptom onset <=3 days': False, 'Severe tonsil inflammation': False, 'Absence of cough or coryza': True, 'Fever in past 24 hours': True}",2,2,2,"The criteria for the FeverPAIN score are listed below:
    
1. Fever in past 24 hours: No = 0 points, Yes = +1 point
2. Absence of cough or coryza: No = 0 points, Yes = +1 point
3. Symptom onset ≤3 days: No = 0 points, Yes = +1 point
4. Purulent tonsils: No = 0 points, Yes = +1 point
5. Severe tonsil inflammation: No = 0 points, Yes = +1 point

The FeverPAIN score is calculated by summing the points for each criterion.
    
The patient's current FeverPain score is 0.
The patient is reported to have a fever in the past 24 hours and so we increment the score by 1, making the current total 0 + 1 = 1.
The patient is determined to have an absence of cough or coryza. Because of this, we add one point to the score, making the current total 1 + 1 =  2.
The patient is reported to not have a symptom onset ≤3 days and so we do not increment the score, keeping the current total at 2.
The patient is reported to not have purulent tonsils and so we do not increment the score, keeping the current total at 2.
The patient is reported to not have severe tonsil inflammation and so we do not increment the score, keeping the current total at 2.
The patient's FeverPain score is 2 points."
456,33,FeverPAIN Score for Strep Pharyngitis,diagnosis,integer,usmle-262,Extracted,"A 7-year-old boy is brought to the physician for the evaluation of sore throat for the past 2 days. During this period, he has had intermittent nausea and has vomited once. The patient has no cough, hoarseness, or rhinorrhea. He had similar symptoms at the age of 5 years that resolved spontaneously. He is otherwise healthy. His temperature is 38°C (100.4°F), pulse is 85/min, and blood pressure is 108/70 mm Hg. Head and neck examination shows an erythematous pharynx with grayish exudates overlying the palatine tonsils. There is no lymphadenopathy. Rapid antigen detection test for group A streptococci is negative.",What is the patient's FeverPAIN score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Purulent tonsils': True, 'Symptom onset <=3 days': False, 'Absence of cough or coryza': True, 'Severe tonsil inflammation': True, 'Fever in past 24 hours': True}",4,4,4,"The criteria for the FeverPAIN score are listed below:
    
1. Fever in past 24 hours: No = 0 points, Yes = +1 point
2. Absence of cough or coryza: No = 0 points, Yes = +1 point
3. Symptom onset ≤3 days: No = 0 points, Yes = +1 point
4. Purulent tonsils: No = 0 points, Yes = +1 point
5. Severe tonsil inflammation: No = 0 points, Yes = +1 point

The FeverPAIN score is calculated by summing the points for each criterion.
    
The patient's current FeverPain score is 0.
The patient is reported to have a fever in the past 24 hours and so we increment the score by 1, making the current total 0 + 1 = 1.
The patient is determined to have an absence of cough or coryza. Because of this, we add one point to the score, making the current total 1 + 1 =  2.
The patient is reported to not have a symptom onset ≤3 days and so we do not increment the score, keeping the current total at 2.
The patient is reported to have purulent tonsils and so we increment the score by 1, making the current total 2 + 1 = 3.
The patient is reported to have severe tonsil inflammation and so we increment the score by 1, making the current total 3 + 1 = 4.
The patient's FeverPain score is 4 points."
457,33,FeverPAIN Score for Strep Pharyngitis,diagnosis,integer,pmc-8380012-1,Extracted,"The case is of a 69-year-old man with HNPCC (Lynch Syndrome, mutation in exon 15 of hMSH2), with a history of pancolectomy and Ileo-rectal anastomosis in 2004, completion proctectomy and ileostomy for pT1 adenocarcinoma in the rectal remnant in 2012 and nephroureterectomy for pT1 grade 3 transitional cell carcinoma of the left ureter in 2014. In 2016, he received radical external beam radiotherapy for T3aN0M0 prostate adenocarcinoma.
On January 17th, 2018, he underwent a Whipple’s procedure and a small bowel resection for synchronous pT3aN1(1/21) M0 adenocarcinoma of the ampulla and pT3 adenocarcinoma of the duodenum. He was left with a high output stoma. His body mass index (BMI) was 25, he was on anticoagulants for recurrent venous thromboembolism (VTE) and had no other comorbidities.
Surveillance imaging in June 2019 demonstrated metastases to the aortocaval lymph nodes. He received FOLFOX chemotherapy until October 2019 and subsequently remained stable.
On April 4th, 2020, he presented with recurrent bleeding episodes per ileostomy and a 2-day history of fever, lethargy and dry cough. His highest recorded temperature was 37.5 °C, he was not breathless and his oxygen saturation was 99% on air. His CURB-65 score was 3 [Urea 8.8 mmol/l, diastolic blood pressure (BP) 60 mm (Hg) and age > 65], and he was anaemic (haemoglobin 80 g/l), leukopenic (WBC 3.3 × 109/L) and lymphopenic (0.75 × 109/L). His coagulation screen was normal and his blood type was A-positive. He tested positive (cycle threshold [CT] 16.25) for SARS-CoV-2 PCR nasopharyngeal swab (NPS). Computed tomography of the chest/abdomen/pelvis showed peripheral patchy ground-glass appearance, primarily in the right lower lobe of the lung. There was evidence of disease progression with enlarged aortocaval nodes that were now invading the adjacent Roux limb. He received red blood cell transfusions, intravenous fluids and antibiotics and his anticoagulation was withheld. He continued to manifest melena with tachycardia (100/min) and hypotension (BP 96/56 mmHg), and therefore received a further transfusion, tranexamic acid for two days and palliative haemostatic radiotherapy (20 Gy in 5 fractions) to the aortocaval mass. A SARS-CoV-2 PCR NPS on day 24 was positive (CT 34.6), and once his symptoms improved he was discharged.
He was readmitted 3 weeks later with dehydration, reduced stoma output and acute kidney injury. There were no symptoms of COVID-19; however, his NPS was still positive (CT 33.4) for SARS-CoV-2 (Day 54). He improved with supportive treatment and was discharged after five days.
In June 2020, he was seen for short-lived pyrexia. The chest X-ray was normal and no apparent infective cause was found. SARS-CoV-2 PCR (day 63) from NPS was negative at this time. His COVID-19 total antibody level was consistent with the exposure to SARS-CoV-2.",What is the patient's FeverPAIN score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Symptom onset <=3 days': True, 'Severe tonsil inflammation': False, 'Purulent tonsils': False, 'Fever in past 24 hours': True}",3,3,3,"The criteria for the FeverPAIN score are listed below:
    
1. Fever in past 24 hours: No = 0 points, Yes = +1 point
2. Absence of cough or coryza: No = 0 points, Yes = +1 point
3. Symptom onset ≤3 days: No = 0 points, Yes = +1 point
4. Purulent tonsils: No = 0 points, Yes = +1 point
5. Severe tonsil inflammation: No = 0 points, Yes = +1 point

The FeverPAIN score is calculated by summing the points for each criterion.
    
The patient's current FeverPain score is 0.
The patient is reported to have a fever in the past 24 hours and so we increment the score by 1, making the current total 0 + 1 = 1.
Whether the patient has an absence of cough or coryza is not reported and so we assume that it is absent for the patient. Because of this, we add one point to the score, making the current total 1 + 1 =  2.
The patient is reported to have a symptom onset ≤3 days and so we increment the score by 1, making the current total 2 + 1 = 3.
The patient is reported to not have purulent tonsils and so we do not increment the score, keeping the current total at 3.
The patient is reported to not have severe tonsil inflammation and so we do not increment the score, keeping the current total at 3.
The patient's FeverPain score is 3 points."
458,33,FeverPAIN Score for Strep Pharyngitis,diagnosis,integer,usmle-7961,Extracted,"A 6-year-old boy is presented to a pediatric clinic by his mother with complaints of fever, malaise, and cough for the past 2 days. He frequently complains of a sore throat and has difficulty eating solid foods. The mother mentions that, initially, the boy’s fever was low-grade and intermittent but later became high grade and continuous. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. The past medical history is noncontributory. The boy takes a multivitamin every day. The mother reports that he does well in school and is helpful around the house. The boy’s vital signs include blood pressure 110/65 mm Hg, heart rate 110/min, respiratory rate 32/min, and temperature 38.3°C (101.0°F). On physical examination, the boy appears uncomfortable and has difficulty breathing. His heart is mildly tachycardic with a regular rhythm and his lungs are clear to auscultation bilaterally. Oropharyngeal examination shows that his palatine tonsils are covered with pus and that there is erythema of the surrounding mucosa.",What is the patient's FeverPAIN score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Purulent tonsils': True, 'Symptom onset <=3 days': True, 'Severe tonsil inflammation': True, 'Absence of cough or coryza': False, 'Fever in past 24 hours': True}",4,4,4,"The criteria for the FeverPAIN score are listed below:
    
1. Fever in past 24 hours: No = 0 points, Yes = +1 point
2. Absence of cough or coryza: No = 0 points, Yes = +1 point
3. Symptom onset ≤3 days: No = 0 points, Yes = +1 point
4. Purulent tonsils: No = 0 points, Yes = +1 point
5. Severe tonsil inflammation: No = 0 points, Yes = +1 point

The FeverPAIN score is calculated by summing the points for each criterion.
    
The patient's current FeverPain score is 0.
The patient is reported to have a fever in the past 24 hours and so we increment the score by 1, making the current total 0 + 1 = 1.
The patient is determined to have a cough or corzyea at the time of admission. Because of this, we do not add any points to the current total, keeping the current total at 1.
The patient is reported to have a symptom onset ≤3 days and so we increment the score by 1, making the current total 1 + 1 = 2.
The patient is reported to have purulent tonsils and so we increment the score by 1, making the current total 2 + 1 = 3.
The patient is reported to have severe tonsil inflammation and so we increment the score by 1, making the current total 3 + 1 = 4.
The patient's FeverPain score is 4 points."
459,33,FeverPAIN Score for Strep Pharyngitis,diagnosis,integer,pmc-3034928-1,Extracted,"A 28-year-old man presented with severe neck pain mainly on the left side with painful swallowing for 5 days. The patient initially had asked for medical advice at a primary health care facility and was treated with antibiotics and anti-inflammatory drugs, but there was no improvement and the pain was increasing in severity. On detailed history, the patient reported that he had an attack of choking and coughing, while he was eating chicken during dinner one day before the onset of symptoms.
On examination, there was a low-grade fever and tenderness in the left side of the neck, and the pain was exaggerated by swallowing attempts. A telescopic laryngeal examination was performed. Frothy saliva was detected accumulating in the left pyriform fossa. After giving the patient some few sips of water, the examination was repeated. A white linear chicken bone was seen impacted at the left pyriform fossa with a relatively free broad base pointing anteriorly, and the other tapering end was impacted in the posterior wall of the pyriform fossa (). To rule out development of a retropharyngeal abscess, anteroposterior and lateral X-ray views of the neck were performed for the patient. Apart from the chicken bone that was poorly visualized in the lateral X-ray view of the neck, there was no evidence of retropharyngeal abscess formation.
The bone was removed in an office-based setting under guidance of video laryngeal rigid telescopic examination. In this procedure, a video laryngeal examination was carried out using a 70-degree rigid telescope, 3CCD camera, LCD monitor, and a light source. The patient was seated in the upright position with his head supported from the back. Using a cotton swab soaked with Xylocaine 10% and held by a Magill's forceps, the patient's oro- and hypopharynx were adequately anesthetized. The patient was instructed to protrude his tongue and hold it by his hand with a piece of gauze. The telescope was held by the physician's left hand and introduced carefully into the oropharynx. When the foreign body was identified in the left pyriform fossa and clearly visualized on the monitor, it was carefully removed by a curved laryngeal forceps held by the right hand of the physician (). After that, the patient was prescribed oral antibiotics in the form of Amoxycillin-Clavulanic acid (1 gm b.i.d. for 10 days) to control possible infection and an analgesic and anti-inflammatory drug in the form of Diclofenac Sodium (50 mg b.i.d. for 10 days). Then, he was discharged with a scheduled followup appointment after 7 days. On the followup visit, the patient was completely improved with disappearance of the constitutional symptoms, no pain or tenderness on the neck and normal swallowing function.",What is the patient's FeverPAIN score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Symptom onset <=3 days': False, 'Fever in past 24 hours': True, 'Absence of cough or coryza': False}",1,1,1,"The criteria for the FeverPAIN score are listed below:
    
1. Fever in past 24 hours: No = 0 points, Yes = +1 point
2. Absence of cough or coryza: No = 0 points, Yes = +1 point
3. Symptom onset ≤3 days: No = 0 points, Yes = +1 point
4. Purulent tonsils: No = 0 points, Yes = +1 point
5. Severe tonsil inflammation: No = 0 points, Yes = +1 point

The FeverPAIN score is calculated by summing the points for each criterion.
    
The patient's current FeverPain score is 0.
The patient is reported to have a fever in the past 24 hours and so we increment the score by 1, making the current total 0 + 1 = 1.
The patient is determined to have a cough or corzyea at the time of admission. Because of this, we do not add any points to the current total, keeping the current total at 1.
The patient is reported to not have a symptom onset ≤3 days and so we do not increment the score, keeping the current total at 1.
Whether the patient has purulent tonsils is not reported and so we assume that it is absent for the patient. Because of this, we do not increment the score, keeping the current total at 1.
Whether the patient has severe tonsil inflammation is not reported and so we assume that it is absent for the patient. Because of this, we do not increment the score, keeping the current total at 1.
The patient's FeverPain score is 1 points."
460,33,FeverPAIN Score for Strep Pharyngitis,diagnosis,integer,usmle-1375,Extracted,"A 17-year-old boy comes to the physician because of body aches and sore throat for 1 week. He has no history of serious illness and takes no medications. He lives with his parents; they recently adopted a cat from an animal shelter. He is sexually active with one female partner, and they use condoms consistently. His temperature is 38.7°C (101.7°F), pulse is 99/min, and blood pressure is 110/72 mm Hg. Examination shows bilateral posterior cervical lymphadenopathy. The pharynx is very red and swollen. Laboratory studies show:
Hemoglobin 15 g/dL
Leukocyte count 11,500/mm3
Segmented neutrophils 48%
Band forms 2%
Basophils 0.5%
Eosinophils 1%
Lymphocytes 45%
Monocytes 3.5%
When the patient's serum is added to a sample of horse erythrocytes, the cells aggregate together.",What is the patient's FeverPAIN score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Purulent tonsils': False, 'Symptom onset <=3 days': False, 'Severe tonsil inflammation': True, 'Fever in past 24 hours': True}",3,3,3,"The criteria for the FeverPAIN score are listed below:
    
1. Fever in past 24 hours: No = 0 points, Yes = +1 point
2. Absence of cough or coryza: No = 0 points, Yes = +1 point
3. Symptom onset ≤3 days: No = 0 points, Yes = +1 point
4. Purulent tonsils: No = 0 points, Yes = +1 point
5. Severe tonsil inflammation: No = 0 points, Yes = +1 point

The FeverPAIN score is calculated by summing the points for each criterion.
    
The patient's current FeverPain score is 0.
The patient is reported to have a fever in the past 24 hours and so we increment the score by 1, making the current total 0 + 1 = 1.
Whether the patient has an absence of cough or coryza is not reported and so we assume that it is absent for the patient. Because of this, we add one point to the score, making the current total 1 + 1 =  2.
The patient is reported to not have a symptom onset ≤3 days and so we do not increment the score, keeping the current total at 2.
The patient is reported to not have purulent tonsils and so we do not increment the score, keeping the current total at 2.
The patient is reported to have severe tonsil inflammation and so we increment the score by 1, making the current total 2 + 1 = 3.
The patient's FeverPain score is 3 points."
461,33,FeverPAIN Score for Strep Pharyngitis,diagnosis,integer,usmle-11773,Extracted,"A 16-year-old boy is brought to the clinic for a sore throat and fever. He began feeling a dull, 5/10 pain in his throat 2 days ago and had a documented fever today of 101.4°F (38.5°C). He also endorses fatigue and headache, but denies chills, cough, congestion, rhinorrhea, chest pain, ear pain, ulcerations, tonsillar exudate or gastrointestinal symptoms. He just returned from a hiking trip in the Rocky Mountains 1 week ago and reports taking some old antibiotics he had received for an ear infection when he began feeling sick. A physical examination demonstrates enlarged posterior cervical lymph nodes and a rash on the torso shown in Figure A.",What is the patient's FeverPAIN score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Symptom onset <=3 days': True, 'Fever in past 24 hours': True, 'Absence of cough or coryza': True}",3,3,3,"The criteria for the FeverPAIN score are listed below:
    
1. Fever in past 24 hours: No = 0 points, Yes = +1 point
2. Absence of cough or coryza: No = 0 points, Yes = +1 point
3. Symptom onset ≤3 days: No = 0 points, Yes = +1 point
4. Purulent tonsils: No = 0 points, Yes = +1 point
5. Severe tonsil inflammation: No = 0 points, Yes = +1 point

The FeverPAIN score is calculated by summing the points for each criterion.
    
The patient's current FeverPain score is 0.
The patient is reported to have a fever in the past 24 hours and so we increment the score by 1, making the current total 0 + 1 = 1.
The patient is determined to have an absence of cough or coryza. Because of this, we add one point to the score, making the current total 1 + 1 =  2.
The patient is reported to have a symptom onset ≤3 days and so we increment the score by 1, making the current total 2 + 1 = 3.
Whether the patient has purulent tonsils is not reported and so we assume that it is absent for the patient. Because of this, we do not increment the score, keeping the current total at 3.
Whether the patient has severe tonsil inflammation is not reported and so we assume that it is absent for the patient. Because of this, we do not increment the score, keeping the current total at 3.
The patient's FeverPain score is 3 points."
462,33,FeverPAIN Score for Strep Pharyngitis,diagnosis,integer,pmc-7979303-1,Extracted,"On Nov 28th, 2020, a 28-year-old man was referred to our emergency department (ED) in Amir Alam Hospital, Tehran, with fever, sore throat, and dysphagia within the previous seven days. The patient had no significant medical history. He received intramuscular penicillin G followed by oral levofloxacin 500 mg/day without improvement before the admission.
His vital signs were noted for a temperature of 39.4°C, pulse rate of 105 beats/min, blood pressure of 110/60 mmHg, and respiratory rate of 18 per minute. Blood oxygen saturation on room air was 97%. He had bilateral tonsillar enlargement, covered by white exudation. Furthermore, bilateral and tender anterior cervical adenopathy was palpable. The abdominal examination revealed splenomegaly without tenderness. Other physical examinations were unremarkable. The result of complete blood count (CBC) showed 15,600/μL leucocytes with 38% polymorphonuclears and 57% lymphocytes. The peripheral blood smear displayed 37% of atypical lymphocytosis without any blast cells. The liver function tests were within normal limits. The erythrocyte sedimentation rate (ESR) was 90 mm/hr, and C-reactive protein (CRP) was 127 mg/L. Polymerase chain reaction (PCR) test of COVID-19 was negative. The blood culture was negative.
The patient was admitted with the diagnosis of infectious mononucleosis (IM). Acute EBV infection was confirmed by the positive IgM viral capsid Ag (VCA Ag). The patient's abdominal sonography showed splenomegaly.
Due to the severity of the patient's dysphagia and the high risk of upper airway obstruction, he received intravenous (IV) dexamethasone 8 mg twice a day. His condition improved partially after three days and was discharged from the hospital with oral prednisolone 30 mg/day.
Two days after discharge, the patient returned with high-grade fever, throat pain worsening, and dysphagia. Pharyngeal examination showed erythema and bilateral tonsillar swelling with whitish exudate. The ESR was 85 mm/hr.
The head and neck computed tomography (CT) scan with IV contrast demonstrated bilateral peritonsillar abscess (PTA) (measuring 23 × 45 mm on the right and 14 × 17 mm on the left side) (Figures and ). A chest and abdominal CT scan was done for ruling out lymphoma, which showed splenic enlargement with a wedge-shaped, low-density defect in the peripheral area of the spleen in favor of splenic infarction (). The results of electrocardiography and transthoracic echocardiography were unremarkable.
Since the patient was treated with various antibiotics before the admission and the history of the first hospitalization, considering resistance organisms such as Fusobacterium necrophorum, IV piperacillin-tazobactam was administered. Also, a bilateral tonsillectomy was performed with no subsequent complications.
The histopathologic examination of the tonsils showed reactive follicular hyperplasia and abscess formation. Despite negative abscess culture results, IV antibiotic therapy was continued for seven days. As the splenic infarction was asymptomatic, it was managed conservatively. The patient was discharged by oral amoxicillin-clavulanic acid with the favorable condition and recommended to perform an abdominal CT scan two weeks later to follow up splenic infarction. The splenic infarction resolved entirely in the following abdominal CT scan ().",What is the patient's FeverPAIN score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Symptom onset <=3 days': False, 'Purulent tonsils': True, 'Fever in past 24 hours': True, 'Severe tonsil inflammation': True, 'Absence of cough or coryza': True}",4,4,4,"The criteria for the FeverPAIN score are listed below:
    
1. Fever in past 24 hours: No = 0 points, Yes = +1 point
2. Absence of cough or coryza: No = 0 points, Yes = +1 point
3. Symptom onset ≤3 days: No = 0 points, Yes = +1 point
4. Purulent tonsils: No = 0 points, Yes = +1 point
5. Severe tonsil inflammation: No = 0 points, Yes = +1 point

The FeverPAIN score is calculated by summing the points for each criterion.
    
The patient's current FeverPain score is 0.
The patient is reported to have a fever in the past 24 hours and so we increment the score by 1, making the current total 0 + 1 = 1.
The patient is determined to have an absence of cough or coryza. Because of this, we add one point to the score, making the current total 1 + 1 =  2.
The patient is reported to not have a symptom onset ≤3 days and so we do not increment the score, keeping the current total at 2.
The patient is reported to have purulent tonsils and so we increment the score by 1, making the current total 2 + 1 = 3.
The patient is reported to have severe tonsil inflammation and so we increment the score by 1, making the current total 3 + 1 = 4.
The patient's FeverPain score is 4 points."
463,33,FeverPAIN Score for Strep Pharyngitis,diagnosis,integer,usmle-965,Extracted,"A 6-year-old boy is brought to the physician because of headache, cough, runny nose, and a low-grade fever since waking up that morning. He has been healthy except for a urinary tract infection one week ago that has resolved with trimethoprim-sulfamethoxazole therapy. Both parents have a history of allergic rhinitis. His temperature is 38°C (100.4°F). Physical exam shows rhinorrhea and tenderness over the frontal and maxillary sinuses. There is cervical lymphadenopathy.",What is the patient's FeverPAIN score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Symptom onset <=3 days': True, 'Fever in past 24 hours': True, 'Absence of cough or coryza': False}",2,2,2,"The criteria for the FeverPAIN score are listed below:
    
1. Fever in past 24 hours: No = 0 points, Yes = +1 point
2. Absence of cough or coryza: No = 0 points, Yes = +1 point
3. Symptom onset ≤3 days: No = 0 points, Yes = +1 point
4. Purulent tonsils: No = 0 points, Yes = +1 point
5. Severe tonsil inflammation: No = 0 points, Yes = +1 point

The FeverPAIN score is calculated by summing the points for each criterion.
    
The patient's current FeverPain score is 0.
The patient is reported to have a fever in the past 24 hours and so we increment the score by 1, making the current total 0 + 1 = 1.
The patient is determined to have a cough or corzyea at the time of admission. Because of this, we do not add any points to the current total, keeping the current total at 1.
The patient is reported to have a symptom onset ≤3 days and so we increment the score by 1, making the current total 1 + 1 = 2.
Whether the patient has purulent tonsils is not reported and so we assume that it is absent for the patient. Because of this, we do not increment the score, keeping the current total at 2.
Whether the patient has severe tonsil inflammation is not reported and so we assume that it is absent for the patient. Because of this, we do not increment the score, keeping the current total at 2.
The patient's FeverPain score is 2 points."
464,33,FeverPAIN Score for Strep Pharyngitis,diagnosis,integer,usmle-6762,Extracted,"A 15-year-old girl presents to her primary care physician with her parents. She is complaining of fever and a sore throat for the past 4 days. She was born at 39 weeks gestation via spontaneous vaginal delivery and is up to date on all vaccines and is meeting all developmental milestones. Her boyfriend at school has the same symptoms including fever and sore throat. Today, her heart rate is 90/min, respiratory rate is 17/min, blood pressure is 110/65 mm Hg, and temperature is 38.2°C (100.8°F). Examination revealed cervical lymphadenopathy and mild hepatosplenomegaly. Oral exam reveals focal tonsillar exudate. A monospot test is positive.",What is the patient's FeverPAIN score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Symptom onset <=3 days': False, 'Severe tonsil inflammation': False, 'Purulent tonsils': True, 'Fever in past 24 hours': True}",3,3,3,"The criteria for the FeverPAIN score are listed below:
    
1. Fever in past 24 hours: No = 0 points, Yes = +1 point
2. Absence of cough or coryza: No = 0 points, Yes = +1 point
3. Symptom onset ≤3 days: No = 0 points, Yes = +1 point
4. Purulent tonsils: No = 0 points, Yes = +1 point
5. Severe tonsil inflammation: No = 0 points, Yes = +1 point

The FeverPAIN score is calculated by summing the points for each criterion.
    
The patient's current FeverPain score is 0.
The patient is reported to have a fever in the past 24 hours and so we increment the score by 1, making the current total 0 + 1 = 1.
Whether the patient has an absence of cough or coryza is not reported and so we assume that it is absent for the patient. Because of this, we add one point to the score, making the current total 1 + 1 =  2.
The patient is reported to not have a symptom onset ≤3 days and so we do not increment the score, keeping the current total at 2.
The patient is reported to have purulent tonsils and so we increment the score by 1, making the current total 2 + 1 = 3.
The patient is reported to not have severe tonsil inflammation and so we do not increment the score, keeping the current total at 3.
The patient's FeverPain score is 3 points."
465,33,FeverPAIN Score for Strep Pharyngitis,diagnosis,integer,usmle-414,Extracted,"A 4-year-old boy is brought to the physician because of a 5-day history of sore throat and a painful swelling on the left side of his neck that has become progressively larger. He has had pain during swallowing and has refused to eat solid foods for the past 3 days. He immigrated to the United States one year ago from India. His immunization records are unavailable. His family keeps 2 cats as pets. He appears well. He is at the 60th percentile for height and 50th percentile for weight. His temperature is 37.7°C (99.9°F), pulse is 103/min, and blood pressure is 92/60 mm Hg. The oropharynx is erythematous; the tonsils are enlarged with exudates. There is a 3-cm warm, tender, nonfluctuant cervical lymph node on the left side of the neck. His hemoglobin is 12.6 g/dL, leukocyte count is 11,100/mm3, and platelet count is 180,000/mm3.",What is the patient's FeverPAIN score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Purulent tonsils': True, 'Symptom onset <=3 days': False, 'Severe tonsil inflammation': True}",3,3,3,"The criteria for the FeverPAIN score are listed below:
    
1. Fever in past 24 hours: No = 0 points, Yes = +1 point
2. Absence of cough or coryza: No = 0 points, Yes = +1 point
3. Symptom onset ≤3 days: No = 0 points, Yes = +1 point
4. Purulent tonsils: No = 0 points, Yes = +1 point
5. Severe tonsil inflammation: No = 0 points, Yes = +1 point

The FeverPAIN score is calculated by summing the points for each criterion.
    
The patient's current FeverPain score is 0.
Whether the patient has a fever in the past 24 hours is not reported and so we assume that it is absent for the patient. Because of this, we do not increment the score, keeping the current total at 0.
Whether the patient has an absence of cough or coryza is not reported and so we assume that it is absent for the patient. Because of this, we add one point to the score, making the current total 0 + 1 =  1.
The patient is reported to not have a symptom onset ≤3 days and so we do not increment the score, keeping the current total at 1.
The patient is reported to have purulent tonsils and so we increment the score by 1, making the current total 1 + 1 = 2.
The patient is reported to have severe tonsil inflammation and so we increment the score by 1, making the current total 2 + 1 = 3.
The patient's FeverPain score is 3 points."
466,33,FeverPAIN Score for Strep Pharyngitis,diagnosis,integer,usmle-7401,Extracted,"A 28-year-old man presents to the office complaining of a sore throat, difficulty swallowing, and difficulty opening his mouth for the past 5 days. He states that he had symptoms like this before and ""was given some antibiotics that made him feel better"". He is up to date on his immunizations. On examination, his temperature is 39.5°C (103.2°F) and he has bilateral cervical lymphadenopathy. An oropharyngeal exam is difficult, because the patient finds it painful to fully open his mouth. However, you are able to view an erythematous pharynx as well as a large, unilateral lesion superior to the left tonsil. A rapid antigen detection test is negative.",What is the patient's FeverPAIN score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Symptom onset <=3 days': False, 'Purulent tonsils': False, 'Fever in past 24 hours': True, 'Severe tonsil inflammation': True, 'Absence of cough or coryza': True}",3,3,3,"The criteria for the FeverPAIN score are listed below:
    
1. Fever in past 24 hours: No = 0 points, Yes = +1 point
2. Absence of cough or coryza: No = 0 points, Yes = +1 point
3. Symptom onset ≤3 days: No = 0 points, Yes = +1 point
4. Purulent tonsils: No = 0 points, Yes = +1 point
5. Severe tonsil inflammation: No = 0 points, Yes = +1 point

The FeverPAIN score is calculated by summing the points for each criterion.
    
The patient's current FeverPain score is 0.
The patient is reported to have a fever in the past 24 hours and so we increment the score by 1, making the current total 0 + 1 = 1.
The patient is determined to have an absence of cough or coryza. Because of this, we add one point to the score, making the current total 1 + 1 =  2.
The patient is reported to not have a symptom onset ≤3 days and so we do not increment the score, keeping the current total at 2.
The patient is reported to not have purulent tonsils and so we do not increment the score, keeping the current total at 2.
The patient is reported to have severe tonsil inflammation and so we increment the score by 1, making the current total 2 + 1 = 3.
The patient's FeverPain score is 3 points."
467,33,FeverPAIN Score for Strep Pharyngitis,diagnosis,integer,pmc-7463145-1,Extracted,"A boy named D, 15 years old, with a diagnosis of LMA, 5th day of care. At the time of assessment, the main complaint was that of fever for two days. The parents said the peak of body temperature was 38.4°C. Presence of bruises in the right knee and both hands of the child. Hemoglobin (Hb) value: 6.9 gr/dL, platelets: 5000/mm3, hematocrit (Ht): 19.2%, leukocytes: 2740/mm3, ANC: 81/mm3, BP: 107/85 mmHg, HR: 115 x/minute, RR: 20 x/minute, body temperature: 38.0°C, SpO2 98%, BW: 55, 6 kg, BH: 165 cm. There were complaints of nausea. The child had good nutritional status and his hydration status was adequate, with a positive fluid balance and no signs of overload. The child’s rest and sleep statuses were adequate.",What is the patient's FeverPAIN score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Symptom onset <=3 days': True, 'Fever in past 24 hours': True, 'Absence of cough or coryza': True}",3,3,3,"The criteria for the FeverPAIN score are listed below:
    
1. Fever in past 24 hours: No = 0 points, Yes = +1 point
2. Absence of cough or coryza: No = 0 points, Yes = +1 point
3. Symptom onset ≤3 days: No = 0 points, Yes = +1 point
4. Purulent tonsils: No = 0 points, Yes = +1 point
5. Severe tonsil inflammation: No = 0 points, Yes = +1 point

The FeverPAIN score is calculated by summing the points for each criterion.
    
The patient's current FeverPain score is 0.
The patient is reported to have a fever in the past 24 hours and so we increment the score by 1, making the current total 0 + 1 = 1.
The patient is determined to have an absence of cough or coryza. Because of this, we add one point to the score, making the current total 1 + 1 =  2.
The patient is reported to have a symptom onset ≤3 days and so we increment the score by 1, making the current total 2 + 1 = 3.
Whether the patient has purulent tonsils is not reported and so we assume that it is absent for the patient. Because of this, we do not increment the score, keeping the current total at 3.
Whether the patient has severe tonsil inflammation is not reported and so we assume that it is absent for the patient. Because of this, we do not increment the score, keeping the current total at 3.
The patient's FeverPain score is 3 points."
468,38,Free Water Deficit,lab test,decimal,pmc-8531789-1,Extracted,"We report a 23-year-old African American male with a medical history of pediatric DDRT secondary to left-sided dysplastic kidney and right-sided obstructive uropathy. He presented to the emergency department with a one-week history of decreasing urine output, increased shortness of breath, generalized weakness, and nausea. He initially received his DDKT in 2010, which has been complicated by multiple episodes of both acute T cell-mediated and acute antibody-mediated rejection. The patient admitted to a two-month history of immunosuppressive medication nonadherence with tacrolimus, mycophenolate, and prednisone.
Physical examination revealed a young male, in no distress, weighing 142 pounds. He had a blood pressure of 153/102 mmHg and a heart rate of 77 beats/min. Exam findings are as follows: pale conjunctiva, lungs clear to auscultation, regular heart rate and rhythm, active bowel sounds, no abdominal tenderness, and no focal neurological deficit. Admission labs included a serum creatinine of 64.6 mg/dL (0.67–1.17 mg/dL) with a blood urea nitrogen (BUN) of 212 mg/dL (6–20 mg/dL), which increased to a serum creatinine of 73.8 mg/dL and BUN of 244 mg/dL prior to initiation of emergent dialysis. Serum chemistry included sodium 137 mmol/L (136–145 mmol/L), potassium 6.0 mmol/L (3.5–5.1 mmol/L), chloride 98 mmol/L (98–107 mmol/L), total carbon dioxide 7 mmol/L (22–29 mmol/L), glucose 68 mg/dL (74–106 mg/dL), and phosphorus 14.7 mg/dL (2.7–4.5 mg/dL).
The patient was initiated on emergent dialysis via a temporary dialysis catheter. Dialysis was complicated by new onset of seizures, initially thought to be secondary to dialysis disequilibrium syndrome. An electroencephalogram (EEG) was performed showing right temporal spikes epileptiform discharges with intermittent slow waves lateralized to the right hemisphere. Patient was thought to have epilepsy with initial seizure exacerbation secondary to severe metabolic derangements in setting of acute renal failure and severe azotemia. He was initiated on daily levetiracetam with resolution of seizures.
Patient received continuous renal replacement therapy (CRRT) while in the intensive care unit. After stabilization of his acute medical issues, a tunneled dialysis catheter was placed in his right internal jugular vein prior to discharge. Ultimately, the patient was diagnosed with renal allograft failure secondary to medication nonadherence and was discharged home on intermittent hemodialysis with improvement in serum creatinine to 23.8 mg/dL and BUN of 76 mg/dL at time of discharge, after completion of four hemodialysis sessions.",What is the patient's free water deficit in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [23, 'years'], 'weight': [142.0, 'lbs'], 'sex': 'Male', 'Sodium': [137.0, 'mmol/L']}",-0.82813,-0.78672,-0.86954,"The formula for computing the free water deficit is (total body water percentage) * (weight) * (sodium/140 - 1), where the total body water percentage is a percentage expressed as a decimal, weight is in kg, and the sodium concentration is in mmol/L.
The total body water percentage is based on the patient's age and gender.
Adult male: 60% (i.e., use 0.6 in the equation)
Adult female: 50% (0.5)
Elderly male: 50% (0.5)
Elderly female: 45% (0.45)
Child: 60% (0.6)
The patient is 23 years old. The patient's is a Male.
The patient's age is between 18 and 64 and so the patient is an adult. For adult male's the total body water percentage value is 0.60.
The patient's weight is 142.0 lbs so this converts to 142.0 lbs * 0.453592 kg/lbs = 64.41006 kg. The concentration of sodium is 137.0 mmol/L. Plugging in these values into the equation, we get 0.6 * 64.41006 * (137.0/140 - 1) = -0.82813 L. The patient's free body water deficit is -0.82813 L."
469,38,Free Water Deficit,lab test,decimal,pmc-7050167-1,Extracted,"An 11-year-old male patient presented to a healthcare facility with fever and cough for 2 days and had been referred to our hospital for a preliminary diagnosis of complicated pneumonia. On physical examination, he weighed 30 kg, body temperature was 39°C, maximum heart rate was 125 bpm, respiratory rate was 30 breaths per minute, and a blood pressure reading of 115/77 mm Hg was noted. On auscultation, he had diminished breath sounds over the right hemithorax. There were palpable submandibular lymph nodes of 1.5 cm × 0.5 cm on both sides and palpable right axillary lymph node of 1 cm × 0.5 cm in size. Other physical examination findings were normal. Complete blood count results were as follows: leukocyte count, 8290/mm3; hemoglobin, 9.8 g/dL; and platelet count, 545000/mm3. The sedimentation rate was 38 mm/hour. A thoracic ultrasonography revealed septated pleural fluid with a dense content, which reached a depth of up to 30 mm. A thoracic catheter was placed, and intrapleural tissue plasminogen activator was administered three times. Intravenous ceftriaxone and clindamycin were administered. A thoracic computed tomography was taken, showing multiple lymph nodes having a conglomerated appearance, the largest of which measured 18 mm × 13 mm, in the mediastinal pretracheal, subcarinal, and right hilar regions. There existed a dense pleural effusion with a depth of up to 35 mm in the basal part of the right hemithorax. We also observed intensive pleural fluid in the right hemithorax from apex to the basale in coronal and sagittal images ( and ). As the pleural biopsy material was necrotic and mycobacteria polymerase chain reaction was positive, pathological examination could not be done. An echocardiogram revealed normal findings. As the patient's fever and respiratory difficulty persisted and his radiological signs did not improve, his antibiotic therapy was switched to piperacillin plus teicoplanin. Pleural fluid and blood cultures were negative. Serological tests for human immunodeficiency virus, Epstein–Barr virus, cytomegalovirus, hepatitis B and C, chlamydia, and mycoplasma were all negative. His clinical symptom did not improve with nonspecific therapy, and he was started on pyrazinamide, isoniazid, rifampicin, and ethambutol as antituberculosis treatment empirically. He could not use antituberculous therapy for the first week due to vomiting.
Purified protein derivative measured 10 mm; acid-resistant bacilli were negative in the sputum and fasting gastric juice. He had QuantiFERON positive. His family screen for tuberculosis turned negative. He was noted to have bicytopenia in full blood count on the 35th day of follow-up, and a bone marrow aspiration was performed, which revealed signs of dysplasia in normoblasts and two hemophagocytosis. His laboratory results were as follows: ferritin: 11.735 ng/mL (N: 5.6–216), fibrinogen: 159 mg/dL (N: 200–400), alanine aminotransferase (ALT): 154 U/L (N: 0–55), aspartate aminotransferase (AST): 1,196 U/L (N: 5–34), gamma-glutamyl transferase: 464 U/L (38–54), cholesterol: 102 mg/dL, triglyceride: 164 mg/dL, lactic acid dehydrogenase (LDH): 2936 U/L (N: 110–295), albumin: 2.4 g/dL (3.5–5), direct bilirubin (D. Bil): 1.78 mg/dL, c-reactive protein (CRP): 6.6 mg/dL (N: 0–0.5), procalcitonin: 16.4 ng/mL (N: <0.05), sodium: 132 mEq/L (N: 138–145), and international normalized ratio (INR): 1.62. A hemophagocytic syndrome secondary to tuberculosis infection was primarily considered. As his fever did not subside and his tachypnea persisted, he was transferred to the pediatric intensive care unit. There he was started on intravenous immunoglobulin (IVIG) 400 mg/kg/day for 5 days. An 11.5 Fr hemodialysis catheter was placed, and 10 sessions of TPE with adjunctive fresh frozen plasma were performed. A cervical lymph node biopsy was taken, which was consistent with tuberculosis infection. As his clinical condition did not improve, dexamethasone 10 mg/m2 was commenced. Subsequently, during follow-up, his fever subsided, rash, tachypnea eliminated, and appetite returned to normal. Subsequent laboratory values were as follows: ferritin: 297 ng/mL, fibrinogen: 356 mg/dL, ALT: 26 U/L, AST: 22 U/L, triglyceride: 164 mg/dL, LDH: 295 U/L, albumin: 23.8 g/dL, D. Bil: 0.3 mg/dL, CRP: 0.2 mg/dL, procalcitonin: 0.14 ng/mL, sodium: 138 mEq/L, and INR: 0.99. The patient was transferred to the Department of Pediatrics. Sequencing of PRF1 from peripheral blood mononuclear cells showed heterozygous mutation (Exon 2, codon 91 GCG/GTG, and Ala/Val).",What is the patient's free water deficit in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [11, 'years'], 'weight': [30.0, 'kg'], 'sex': 'Male', 'Sodium': [132.0, 'mEq/L']}",-1.02857,-0.97714,-1.08,"The formula for computing the free water deficit is (total body water percentage) * (weight) * (sodium/140 - 1), where the total body water percentage is a percentage expressed as a decimal, weight is in kg, and the sodium concentration is in mmol/L.
The total body water percentage is based on the patient's age and gender.
Adult male: 60% (i.e., use 0.6 in the equation)
Adult female: 50% (0.5)
Elderly male: 50% (0.5)
Elderly female: 45% (0.45)
Child: 60% (0.6)
The patient is 11 years old. The patient's is a Male.
The patient is less than 18 years old and so the patient is a child. This means total body water percentage value is 0.6.
The patient's weight is 30.0 kg. The concentration of sodium is 132.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 132.0 mEq. To convert from 132.0 mEq to mmol, convert from mEq to mmol. The compound 132.0 has a valence of 1, and so divide the valence by the value of mEq to get, 132.0 mEq/(1 mEq/mmol) = 132.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 132.0 mEq sodium/L converts to 132.0 mmol sodium/L. Plugging in these values into the equation, we get 0.6 * 30.0 * (132.0/140 - 1) = -1.02857 L. The patient's free body water deficit is -1.02857 L."
470,38,Free Water Deficit,lab test,decimal,pmc-6834714-1,Extracted,"A 16-year-old boy with KFS presented to our hospital's oral and maxillofacial surgery department with complaints of an inability to bite and chew food, lisping speech, and chronic jaw pain. He was born through cesarean section to nonconsanguineous parents and had no complications. His identical twin brother was absolutely normal. His past surgical history included two surgeries immediately after birth for anorectal agenesis and left orchidopexy at 3 years of age for undescended testis. On examination, he had grossly restricted neck movements, a low hair line at the back of the neck, malaligned teeth, marked mandibular prognathism, an extensive anterior open bite, and psychological disturbances. He had marked kyphoscoliosis of the thoracic spine and a right Sprengel deformity ().
An airway examination revealed Mallampati II with normal mouth opening and an inability to flex or extend the neck. Electrocardiography (ECG) showed normal sinus rhythm and echocardiography findings were normal. Radiography of the neck revealed fusion of the upper six cervical vertebrae (). Chest radiography revealed thoracic kyphoscoliosis with Cobb angle>35° (). His exercise tolerance was good and he had a metabolic equivalent of task value of 8. He had a weight of 50 kg and height of 150 cm. His heart rate was 78 beats per minute and regular, blood pressure was 110/70 mmHg, and respiratory rate was 14 breaths per minute. Laboratory findings included: hemoglobin, 13 gm%; platelets, 2.34 lakhs/mm3; serum glucose, 99 mg/dL; sodium, 142 mEq/L; potassium, 4.2 mEq/L; serum urea, 18.0 mg/dL; and serum creatinine, 0.67 mg/dL. A pulmonary function test revealed moderately restrictive lung disease. Nasal endoscopy revealed a leftward deviated nasal septum (DNS) and compensatory hypertrophy of the right inferior turbinate. Computed tomography of the paranasal sinuses confirmed those findings ().
After his parents provided informed consent, he underwent elective bilateral sagittal slip osteotomy of the mandible and a genioplasty. Oral ranitidine 150 mg was administered the night before and the morning of the surgery, and he fasted for 6 hours prior to the surgery. To avoid a secondary cervical spine injury, he was self-positioned on the table with proper padding of the right elevated scapula and pressure points. His neck and head were properly padded and supported. His basal oxygen saturation was 98%; an arterial blood gas analysis on room air revealed: pH, 7.35; PaCO2, 43 mmHg; PaO2, 107 mmHg; bicarbonate, 24 mmol/L; and arterial oxygen saturation, 99%. An 18-gauge intravenous cannula was inserted on the dorsum of the left hand and a Ringers lactate infusion was started. Cephalexin 1 g was given intravenously.
The patient was connected to a multipara monitor displaying the ECG, noninvasive arterial pressure, invasive arterial pressure, end-tidal carbon dioxide (ETCO2), pulse oximetry, and core temperature. ECG showed sinus rhythm with: heart rate, 89 beats/min; a normal axis; blood pressure, 120/60 mmHg; and respiratory rate, 16 breaths/min. His right radial artery was cannulated and connected to a pressure transducer for blood gas sampling and continuous blood pressure monitoring. Considering his fairly reasonable metabolic equivalent of task value and hemodynamic parameters, an invasive central venous pressure line was considered unnecessary. Glycopyrrolate 0.2 mg and ondansetron 4 mg were given intravenously.
Awake fiber optic bronchoscopy-guided orotracheal intubation was planned to secure the airway, followed by submental intubation to ensure unhindered surgical access (). A backup emergency surgical airway kit was kept in case of failure of the first method. The oropharynx was nebulized with 4% lignocaine. The larynx and trachea were anesthetized by nebulization with lignocaine. Supplemental oxygen was administered via a nasal catheter. A 5.5-mm fiber optic bronchoscope was used and a 7.5-mm cuffed reinforced endotracheal tube was slid up the full length of the shaft and gently secured to the beveled end of the bronchoscope. The tube was passed over the bronchoscope into the trachea just above the carina. Tube position was confirmed by capnographic trace and bilateral equal air entry. The cuff was inflated to seal the airway and the tube was securely fixed. Fentanyl 50 µg (1 µg/kg), propofol 100 mg, and atracurium 25 mg were administered intravenously. Anesthesia was maintained using a mixture of 50% oxygen and 50% air and 1–1.5% isoflurane through a closed circuit with intermittent doses of atracurium. Intermittent positive pressure ventilation was instituted and ETCO2 was maintained at 35 mmHg.
The throat was packed with sterile tape gauze. Temporary draping of the mouth and chin were performed after standard skin preparation with 10% povidone-iodine solution. The surgeon made a 1.5-cm incision in the left submental triangle after local infiltration of the skin with 2% xylocaine with adrenaline. A Kelly's forceps was introduced through the skin incision and into the floor of the mouth by blunt dissection. The tube cuff was first introduced into the mouth after deflation and pulled inferiorly to pass through the intraoral tunnel and emerge through the submental incision. The proximal end of the reinforced tube was then disconnected from the circuit and connector and pulled extraorally through the submental incision. The connector was reattached and the circuit was re-established. Endotracheal tube position was checked again to ensure bilateral equal air entry. The cuff was inflated and the tube was sutured to the overlying skin and fixed with plaster tape to prevent accidental extubation. A fresh pharyngeal pack was then reinserted after removing the existing soaked throat pack. Intermittent positive pressure ventilation was instituted through a closed circuit with a circle absorber.
Perioperatively, no significant changes in blood pressure or heart rate were noted (systolic pressure 95–110 mmHg, diastolic pressure 70–90 mmHg, and heart rate 80–110 beats/min). The mean arterial pressure was maintained at 90–100 mmHg. The surgery lasted for 3 hours and a total of 1200 mL of Ringers lactate was given. His arterial blood gas values during the perioperative period showed: pH 7.38; PaO2, 158 mmHg; and PaCO2, 35 mmHg. Intravenous dexamethasone 8 mg and ondansetron 4 mg was given toward the end of the procedure.
At the end of the surgical procedure, the stay sutures around the tube were removed and the deflated cuff and tube were pulled in reverse order from the tunnel to the oral cavity. The oropharynx and nasopharynx were adequately suctioned and the throat pack was removed. The submental incision was sutured externally and a dressing was applied to the external wound. The intraoral incision was allowed for secondary healing and the residual neuromuscular blockade was reversed with neostigmine 2.5 mg and glycopyrrolate 0.5 mg until neuromuscular transmission recovered to a train of four ratio of 0.9.
He was extubated awake with all protective airway reflexes and shifted to the postoperative recovery area. In this case, apnea during the circuit disconnection was 35 seconds and the total submental intubation was around 5 minutes. He was shifted to the high dependency unit for observation. The postoperative period was uneventful and he recovered well.",What is the patient's free water deficit in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [16, 'years'], 'sex': 'Male', 'weight': [50.0, 'kg'], 'Sodium': [142.0, 'mEq/L']}",0.42857,0.40714,0.45,"The formula for computing the free water deficit is (total body water percentage) * (weight) * (sodium/140 - 1), where the total body water percentage is a percentage expressed as a decimal, weight is in kg, and the sodium concentration is in mmol/L.
The total body water percentage is based on the patient's age and gender.
Adult male: 60% (i.e., use 0.6 in the equation)
Adult female: 50% (0.5)
Elderly male: 50% (0.5)
Elderly female: 45% (0.45)
Child: 60% (0.6)
The patient is 16 years old. The patient's is a Male.
The patient is less than 18 years old and so the patient is a child. This means total body water percentage value is 0.6.
The patient's weight is 50.0 kg. The concentration of sodium is 142.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 142.0 mEq. To convert from 142.0 mEq to mmol, convert from mEq to mmol. The compound 142.0 has a valence of 1, and so divide the valence by the value of mEq to get, 142.0 mEq/(1 mEq/mmol) = 142.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 142.0 mEq sodium/L converts to 142.0 mmol sodium/L. Plugging in these values into the equation, we get 0.6 * 50.0 * (142.0/140 - 1) = 0.42857 L. The patient's free body water deficit is 0.42857 L."
471,38,Free Water Deficit,lab test,decimal,pmc-3862585-2,Extracted,"A 17-year-old, 47 kg female patient with a diagnosis of FMF was admitted to a local hospital with the complaints of nausea and vomiting after taking 9.5 mg or 0.2 mg/kg (19 tablets of 0.5 mg) colchicine for suicide attempt. She underwent stomach lavage and treatment with activated charcoal at that facility, and was transferred to our hospital an hour after ingestion. She was conscious, responsive, and cooperative, and she had diarrhea. On physical examination she had a blood pressure of 125/55 mmHg, body temperature 36.5°C, respiratory rate 15 breaths/minute, and heart rate 70 beats/minute. The patient was pale and cold, and she had abdominal tenderness on palpation. Other system examinations were unremarkable. She was admitted to the intensive care unit. Her initial laboratory findings in the intensive care unit were WBC, 6.640 (103 μL); hemoglobin, 13 gr/dL; hematocrit, 40.3%; PLTs, 428,000/mm3; AST, 32 U/L; ALT, 21 U/L; sodium, 139 mmol/L; K, 4.1 mmol/L; Ca, 9.5 mmol/L; Total-CK, 112 U/L; CK-MB, 25 U/L; LDH, 156 U/L; troponin I, 0.00 ng/ml; D-dimer, 1,833.78 ng/L; INR, 1.14; BUN, 13 mg/dL; Cr, 0.7 mg/dL. Blood gas values were: pH, 7.48; pCO2, 21.2 mmHg; HCO3, 20.0 mmol/L; BE, −5.9 mmol/L. Following the recommendation of the contacted poison control center, gastric lavage was performed again and activated charcoal was given every hour for 6 hours (0.25 g/kg per hour) to reduce the intestinal colchicine absorption. Blood gas analyses were performed every 12 hours (). On follow-up of the patient, AST, ALT, Total-CK, CK-MB, troponin I, LDH, and INR remained normal (). Normal sinus rhythm was determined by electrocardiography, and echocardiography revealed the left ventricle had normal systolic function and an ejection fraction of 60%. She did not need hemodialysis and was transferred to the internal medicine service on the fifth day of her admission. The consultant psychiatrist diagnosed a depressive episode as the underlying cause for her suicide attempt. She recovered without sequelae and was discharged on the seventh day of her follow-up.",What is the patient's free water deficit in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [17, 'years'], 'weight': [47.0, 'kg'], 'sex': 'Female', 'Sodium': [139.0, 'mmol/L']}",-0.20143,-0.19136,-0.2115,"The formula for computing the free water deficit is (total body water percentage) * (weight) * (sodium/140 - 1), where the total body water percentage is a percentage expressed as a decimal, weight is in kg, and the sodium concentration is in mmol/L.
The total body water percentage is based on the patient's age and gender.
Adult male: 60% (i.e., use 0.6 in the equation)
Adult female: 50% (0.5)
Elderly male: 50% (0.5)
Elderly female: 45% (0.45)
Child: 60% (0.6)
The patient is 17 years old. The patient's is a Female.
The patient is less than 18 years old and so the patient is a child. This means total body water percentage value is 0.6.
The patient's weight is 47.0 kg. The concentration of sodium is 139.0 mmol/L. Plugging in these values into the equation, we get 0.6 * 47.0 * (139.0/140 - 1) = -0.20143 L. The patient's free body water deficit is -0.20143 L."
472,38,Free Water Deficit,lab test,decimal,pmc-8059042-1,Extracted,"A 53-year-old man (height, 170 cm; weight, 89 kg) was admitted to the hospital because of a 1-year history of shortness of breath after exercise. The patient was a smoker, had a history of hypertension, and was taking captopril and nimodipine. Breathing was reduced in the left lung. However, neither rhonchus nor moist rales were heard during auscultation. Chest computed tomography revealed a GEB, and the left lung was compressed by about 95% with a right mediastinal shift (). An electrocardiogram showed normal findings, and echocardiography revealed that the heart was located in the right thoracic cavity. The left ventricular diastolic function was decreased, and the left ventricular ejection fraction was 64%. Laboratory tests showed no obvious abnormalities. Arterial blood gas analysis showed the following: pH: 7.43, PaCO2: 41 mmHg, PaO2: 94 mmHg, lactate: 1.4 mmol/L, potassium: 3.6 mmol/L, sodium: 138 mmol/L, calcium: 1.10 mmol/L, FiO2: 21%, and SpO2: 98%.
On the day of surgery, the patient’s electrocardiogram, blood pressure, SpO2, and bispectral index were monitored upon entry into the operating room. A radial artery catheter and right internal jugular venous catheter were placed. The patient’s arterial blood pressure was 175/109 mmHg, heart rate was 90 beats/minute, and SpO2 was 94%. Before anesthesia, 40 µg of dexmedetomidine was infused within 10 minutes. The thoracic surgeon then created a small incision at the intersection of the sixth intercostal space and the left mid-axillary line to puncture the lung bulla and insert an indwelling catheter (14 Ga, 16 cm in length; Arrow International/Teleflex, Wayne, PA, USA) into the GEB to drain it for 15 minutes. The patient was preoxygenated with 100% oxygen at 6 L/minute for 5 minutes. Anesthesia was administered using 100 mg of propofol, 30 µg of sufentanil, and 50 mg of rocuronium. A 37-Fr right double-lumen endotracheal tube was inserted with the help of a visual laryngoscope, and single-lung ventilation was performed after proper alignment had been confirmed by fiberoptic bronchoscopy. The tidal volume was set at 5 to 6 mL/kg, the respiratory rate was 15 to 17 breaths/minute, the positive end-expiratory pressure was set at 5 cmH2O, and the inhalation:expiration ratio was 1:2. Propofol, remifentanil, and sevoflurane were used to maintain anesthesia. The intraoperative bispectral index was maintained at 40 to 50. After resecting the GEB (), one-lung ventilation was switched to two-lung ventilation and the lungs slowly expanded with a low tidal volume until complete lung re-expansion was observed. During the 3-hour surgery, the patient experienced 50 mL of blood loss, was administered 1300 mL of lactated Ringer’s solution, and excreted 500 mL of urine. After the operation, the double-lumen endotracheal tube was replaced with a single-lumen endotracheal tube and the patient was sent to the intensive care unit for monitoring and further treatment. Two hours after entering the intensive care unit, the patient was fully awake and the tracheal tube was smoothly removed. The following day, the patient was transferred to the thoracic surgery ward, where he recovered; he was discharged 12 days later. Postoperative chest computed tomography showed that the lungs were well inflated with no abnormalities ().",What is the patient's free water deficit in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [53, 'years'], 'weight': [89.0, 'kg'], 'sex': 'Male', 'Sodium': [138.0, 'mmol/L']}",-0.76286,-0.72472,-0.801,"The formula for computing the free water deficit is (total body water percentage) * (weight) * (sodium/140 - 1), where the total body water percentage is a percentage expressed as a decimal, weight is in kg, and the sodium concentration is in mmol/L.
The total body water percentage is based on the patient's age and gender.
Adult male: 60% (i.e., use 0.6 in the equation)
Adult female: 50% (0.5)
Elderly male: 50% (0.5)
Elderly female: 45% (0.45)
Child: 60% (0.6)
The patient is 53 years old. The patient's is a Male.
The patient's age is between 18 and 64 and so the patient is an adult. For adult male's the total body water percentage value is 0.60.
The patient's weight is 89.0 kg. The concentration of sodium is 138.0 mmol/L. Plugging in these values into the equation, we get 0.6 * 89.0 * (138.0/140 - 1) = -0.76286 L. The patient's free body water deficit is -0.76286 L."
473,38,Free Water Deficit,lab test,decimal,pmc-7859974-2,Extracted,"A 46-year-old man, weighing 50 kg, with Crohn's disease from adolescence and short bowel syndrome was admitted to the gastroenterology general ward due to fever. He received total parenteral nutrition and developed a catheter-related bloodstream infection. On the third day of hospitalization, he was transferred to our ICU due to hypotension and multiple organ impairment. On examination, he was alert, and his blood pressure, heart rate, respiratory rate, oxygen saturation, and body temperature were 74/44 mmHg, 130 beats/min, 16 breaths/min, 92% (under ambient air), and 37.5 °C, respectively. Arterial blood gas findings were as follows: pH of 7.44; PaO2 of 75; PaCO2 of 37; HCO3 of 25.1, and lactate of 32 mg/dL. His lactate level was elevated, and he developed septic shock. The WBC count was 13,000/μL, the Hb level was 13.5 g/dL, and the PLT count was 142,000/μL. The BUN level was 40.5 mg/dL, the Cre level was 3.78 mg/dL, the ALT level was 834 U/L, the AST level was 12,743 U/L, the T-bil level was 2.3 mg/dL, the Na level was 130 mEq/L, and the K level 4.8 mEq/L. The CRP and PCT levels were both abnormal at 6.00 mg/dL and 5.24 ng/dL, respectively. Coagulation abnormalities were also present, with an APTT of 55.0 seconds, a PT of only 28.8% of the normal range, FDP of 103.0 μg/mL, a D-dimer level of 52.05 μg/mL, a fibrinogen level of 222.0 mg/dL, and an AT-III level of only 38.7% of the normal range. β-d-glucan was within the normal limit of 4.77 pg/mL. The SOFA score [] was 10 points, and the JAAM DIC diagnostic criteria score [] was 5 points. In the ICU, he received 0.5 g meropenem intravenous every 12 hours, 100 mg micafungin intravenous every 24 hours, recombinant human soluble thrombomodulin, antithrombin gamma, and 200 mg/day of hydrocortisone intravenously; norepinephrine was initiated at approximately 0.15 μg/kg/min. We started CHDF on the first day of ICU and switched to cPED the next day. After one session of cPED, CHDF was reintroduced and terminated on day seven of the ICU. Candida parapsilosis was later detected in his blood culture. The patient was retransferred to the general gastrointestinal ward on the eighth day in a stable condition.",What is the patient's free water deficit in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [46, 'years'], 'weight': [50.0, 'kg'], 'sex': 'Male', 'Sodium': [130.0, 'mEq/L']}",-2.14286,-2.03572,-2.25,"The formula for computing the free water deficit is (total body water percentage) * (weight) * (sodium/140 - 1), where the total body water percentage is a percentage expressed as a decimal, weight is in kg, and the sodium concentration is in mmol/L.
The total body water percentage is based on the patient's age and gender.
Adult male: 60% (i.e., use 0.6 in the equation)
Adult female: 50% (0.5)
Elderly male: 50% (0.5)
Elderly female: 45% (0.45)
Child: 60% (0.6)
The patient is 46 years old. The patient's is a Male.
The patient's age is between 18 and 64 and so the patient is an adult. For adult male's the total body water percentage value is 0.60.
The patient's weight is 50.0 kg. The concentration of sodium is 130.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 130.0 mEq. To convert from 130.0 mEq to mmol, convert from mEq to mmol. The compound 130.0 has a valence of 1, and so divide the valence by the value of mEq to get, 130.0 mEq/(1 mEq/mmol) = 130.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 130.0 mEq sodium/L converts to 130.0 mmol sodium/L. Plugging in these values into the equation, we get 0.6 * 50.0 * (130.0/140 - 1) = -2.14286 L. The patient's free body water deficit is -2.14286 L."
474,38,Free Water Deficit,lab test,decimal,pmc-4531576-1,Extracted,"A 61-year-old woman was admitted because of weakness and polydipsia. Polydipsia suddenly began one month earlier, followed by progressive general weakness. She was initially evaluated at another hospital for the possibility of diabetes mellitus, but laboratory data were not diagnostic for the disease. She had no history of systemic disease or trauma. A physical examination showed her height to be 150 cm and body weight to be 50 kg. The chest and heart conditions were normal. A breast examination was also normal. The neurological examination on admission was normal. The laboratory tests on admission showed serum sodium at 152 mEq/L, serum potassium at 4.1 mEq/L, fasting blood glucose at 103 mg/dL, and hemoglobin A1c at 4.9%. The results of the liver and thyroid function tests, as well as the chest X-ray were all within normal limits. We performed the water deprivation test under the impression of diabetes insipidus. Urine osmolarity, after a pitressin injection, was markedly increased (>50%) and the results revealed complete pituitary diabetes insipidus (). A brain MRI was performed to demonstrate abnormal findings in the posterior pituitary gland, but it showed multiple enhanced nodules with surrounding edema in the entirety of the cerebral hemisphere, suggesting brain metastases (). To determine the origin of the brain metastasis, we performed the following diagnostic procedures: mammography, abdominal CT scan, gastroscopy, and bone scintigraphy. The abdominal CT scan showed a 3.5-cm heterogenous mass of the right adrenal gland, which separated the kidney. The mass was suggested grossly as metastases and no other intra-abdominal mass was seen There was no abnormal finding detected by mammography. Two round-shaped, elevated lesions with central umblications were noticed on the antrum and low body of the stomach (). We performed a percutaneous needle biopsy of the right adrenal mass. Histologic examinations of both the gastric tissue and right adrenal mass showed malignant tumors composed of anaplastic cells (). Smears and a cell block from the right adrenal mass showed pleomorphic cells having bizarre nuclei and abundant eosinophilic cytoplasm, which were strongly positive for vimentin and weakly positive for cytokeratin immunostains, but were negative for synaptophysin. Thus, the right adrenal mass was suggested as a metastatic lesion from anaplastic carcinoma. The results of the immunohistochemical studies (cytokeratin, vimentin, desmin, smooth muscle actin, alpha-fetoprotein, and human chorionic gonadotropin) on the gastric tissues favored anaplastic carcinoma rather than sarcoma. The results of the c-kit from adrenal and gastric tissues were negative. The malignant cells of the adrenal mass were closely similar to the malignant cells from gastric tissues. Using an electron microscopy examination, the tumor cells of the gastric tissues were composed of a mixture of round oval cells and pleomorphic cells; and the tumor cells were occasionally joined by desmosome, which is suggested to be the origin of epithelial cells. However, there was no evidence of steroidogenic cells in the adrenal cortical carcinoma including in the well developed SER and mitochondria with tubular cisternae. The ultrastructural findings of the tumor cells were compatible with anaplastic carcinoma, including sarcomatoid carcinoma, rather than cortical carcinoma (). Therefore, the metastatic lesions of the brain and right adrenal gland were assumed to have originated from gastric carcinoma. Further evaluation with bone scintigraphy showed multiple hot uptakes in the patients bones. She was managed with conservative treatment including desmopressin. After the desmopressin treatment, diabetes insipidus was greatly ameliorated. However, she died 3 months after the diagnosis.",What is the patient's free water deficit in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'sex': 'Female', 'age': [61, 'years'], 'weight': [50.0, 'kg'], 'Sodium': [152.0, 'mEq/L']}",2.14286,2.03572,2.25,"The formula for computing the free water deficit is (total body water percentage) * (weight) * (sodium/140 - 1), where the total body water percentage is a percentage expressed as a decimal, weight is in kg, and the sodium concentration is in mmol/L.
The total body water percentage is based on the patient's age and gender.
Adult male: 60% (i.e., use 0.6 in the equation)
Adult female: 50% (0.5)
Elderly male: 50% (0.5)
Elderly female: 45% (0.45)
Child: 60% (0.6)
The patient is 61 years old. The patient's is a Female.
The patient's age is between 18 and 64 and so the patient is an adult. For adult female's the total body water percentage value is 0.50.
The patient's weight is 50.0 kg. The concentration of sodium is 152.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 152.0 mEq. To convert from 152.0 mEq to mmol, convert from mEq to mmol. The compound 152.0 has a valence of 1, and so divide the valence by the value of mEq to get, 152.0 mEq/(1 mEq/mmol) = 152.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 152.0 mEq sodium/L converts to 152.0 mmol sodium/L. Plugging in these values into the equation, we get 0.5 * 50.0 * (152.0/140 - 1) = 2.14286 L. The patient's free body water deficit is 2.14286 L."
475,38,Free Water Deficit,lab test,decimal,pmc-6321693-1,Extracted,"A 63-year-old Japanese woman was referred to our department because of an abnormal shadow at the left side of her chest wall on computed tomography. She had undergone total hysterectomy and radiotherapy for cervical carcinoma 4 years prior. One year after the first surgery, three metastatic lung nodules appeared at the upper lobe of her right lung, the lower lobe of her right lung, and the lower lobe of her left lung. Wedge resection for upper and lower lobe of her right lung was initially performed via three-port thoracoscopic surgery. Then, wedge resection for the lower lobe of her left lung was performed via eighth intercostal single incisional thoracoscopic surgery. After the surgery, an intrathoracic chest wall mass developed which increased in size gradually. Her gynecologist introduced her to our department for surgical resection of the mass. Her family, including her parents and two sisters, had been healthy and had no inheritable diseases. She had no symptom, drug history, tobacco smoking history, or psychosocial history, and she was a social drinker. She had not received any medications since the mass developed and until admission to our hospital. She had undergone an operation three times as mentioned above and had been a carrier of type B hepatitis.
After her admission to our department, her general condition was good, and there were three operative scars at both sides of her chest and lower abdomen. Her chest sounds were clear and there was no neurological abnormality. She was 151.1 centimeters tall and weighed 49.8 kilograms. Her heart rate was 77/minute, blood pressure was 135/87 mmHg, and body temperature was 36.1 °C. The laboratory findings were white blood cells 5.25 × 103/μL, hemoglobin 12.7 g/dL, and platelets 156 × 103/μL. A liver function test revealed: albumin 4.6 g/dL, aspartate aminotransferase 15 U/L, alanine aminotransferase 13 U/L, and total bilirubin 0.3 mg/dL. A renal function test revealed blood urea nitrogen 13.6 mg/dL and creatinine 0.79 mg/dL. An electrolyte test revealed sodium 143 mEq/L, potassium 3.8 mEq/L, and chlorine 106 mEq/L. A tumor marker test revealed carcinoembryonic antigen 3.4 ng/mL and squamous cell carcinoma antigen 0.80 ng/mL. Another test revealed positive reaction to type B hepatitis surface antigen and C-reactive protein < 0.1 mg/dL. Computed tomography demonstrated a gradually increasing low-density mass measuring 2.0 × 1.8 cm in diameter (Fig. ). Magnetic resonance imaging demonstrated a low-intensity mass in T1-weighted imaging and a high-intensity mass in T2-weighted imaging (Fig. ). The mass was thought to be a singular cyst; however, this type of cyst was rare and the mass was increasing. Therefore, dissemination of cervical carcinoma could not be excluded, and surgical removal of a part or tissue of the mass was performed.
In the right lateral position, thoracoscopic excision of the mass was done with two ports (3 mm and 2 cm access ports) by two general thoracic surgeons (Fig. ). First the 3 mm port was set at the sixth intercostal space on the inframammary line. Most of her left lung was attached to her chest wall; therefore, the second port was set above the cyst and lysis of adhesions was done. After the lysis, the cystic mass was found adhering to the upper lobe of her left lung. The adhesion of the mass to her lung was not strong and could be separated without injury to the visceral pleura. Therefore, the mass was thought to derive from the chest wall pleura and was resected by adhesiolysis.
The mass was a unilocular cyst containing mucinous fluid. On microscopic examination, the cyst was lined with a single layer of cuboidal epithelium (Fig. ); immunohistochemistry showed positive staining of calretinin and D2-40 (Fig. ). Thus, the cyst was diagnosed as mesothelial cyst derived from the chest wall pleura. Five years after the surgery, our patient had no evidence of cyst or cervical carcinoma on computed tomography.",What is the patient's free water deficit in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [63, 'years'], 'weight': [49.8, 'kg'], 'sex': 'Female', 'Sodium': [143.0, 'mEq/L']}",0.53357,0.50689,0.56025,"The formula for computing the free water deficit is (total body water percentage) * (weight) * (sodium/140 - 1), where the total body water percentage is a percentage expressed as a decimal, weight is in kg, and the sodium concentration is in mmol/L.
The total body water percentage is based on the patient's age and gender.
Adult male: 60% (i.e., use 0.6 in the equation)
Adult female: 50% (0.5)
Elderly male: 50% (0.5)
Elderly female: 45% (0.45)
Child: 60% (0.6)
The patient is 63 years old. The patient's is a Female.
The patient's age is between 18 and 64 and so the patient is an adult. For adult female's the total body water percentage value is 0.50.
The patient's weight is 49.8 kg. The concentration of sodium is 143.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 143.0 mEq. To convert from 143.0 mEq to mmol, convert from mEq to mmol. The compound 143.0 has a valence of 1, and so divide the valence by the value of mEq to get, 143.0 mEq/(1 mEq/mmol) = 143.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 143.0 mEq sodium/L converts to 143.0 mmol sodium/L. Plugging in these values into the equation, we get 0.5 * 49.8 * (143.0/140 - 1) = 0.53357 L. The patient's free body water deficit is 0.53357 L."
476,38,Free Water Deficit,lab test,decimal,pmc-6699429-1,Extracted,"A 7-year-old girl presented with malaise. She was anemic with increased creatinine
level. There was no history of arthritis, arthralgia, infection, drug use, or
accompanying systemic symptoms. Her medical and family histories were unremarkable.
The parents were not relatives. On physical examination, her weight was 27 kg
(50th percentile) and the height 135 cm (50th percentile).
Body temperature was 36°C, pulse 75/minute, breath rate 26/minute, and blood
pressure 106/77 mmHg (<90 p). Laboratory tests revealed BUN: 27 mg/dL,
creatinine: 1.19 mg/dL, GFR (according to Schwartz formula): 59
mL/min/1.73m2, Na: 141 mEq/L, K: 5.5 mEq/L, uric acid: 5.65 mg/dL,
albumin: 3.26 gr/dL, cholesterol: 162 mg/dL, triglyceride: 161 mg/dL, and leucocyte:
7324/mm3. Peripheral blood smear showed normochromic normocytic
erythrocyte dominance and no signs of hemolysis. The urinalysis density was 1018,
pH: 6, protein: 2+, blood: 3+ and there was abundance of dysmorphic erythrocytes in
microscopic evaluation.
Twenty-four-hour urine protein excretion was 71 mg/m2/hr. Serological
tests revealed C3: 183 mg/dL, C4: 40.8 mg/dL, ASO: 104, ANA (-), antiDNA (-), ANCA
4+, HbsAg (-), AntiHbs (+), anti HCV (-). Renal ultrasound revealed normal sized
kidney and parenchymal thickness with bilaterally increased echogenicity of grade
1-2. Echocardiography and ophthalmologic examination were normal. Kidney biopsy
revealed pauci-immune crescentic GN with 12 cellular, 4 fibrocellular, and 4
globally sclerotic crescents (20/25; 80%) out of 25 glomeruli. Tubular atrophy and
interstitial inflammation with predominantly lymphocytic infiltration were observed.
Vessels and perivascular areas were normal (). Immunofluorescence microscopy did not show significant immune
deposition. As for the treatment, the patient received three pulses of intravenous
methylprednisolone (MP) (30 mg/kg) and oral cyclophosphamide (CYC) 2 mg/kg/day for 3
months with oral prednisone 1 mg/kg/day. In the following one month, remission was
achieved with normal serum creatinine and was 0.65 mg/dL in the 3rd month
of follow-up (). Serum p-ANCA titer
decreased from 4+ to 1+. Then, oral prednisone was decreased to 10 mg/day. In the
clinical follow-up, the patient continues in remission.",What is the patient's free water deficit in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [7, 'years'], 'weight': [27.0, 'kg'], 'sex': 'Female', 'Sodium': [141.0, 'mEq/L']}",0.11571,0.10992,0.1215,"The formula for computing the free water deficit is (total body water percentage) * (weight) * (sodium/140 - 1), where the total body water percentage is a percentage expressed as a decimal, weight is in kg, and the sodium concentration is in mmol/L.
The total body water percentage is based on the patient's age and gender.
Adult male: 60% (i.e., use 0.6 in the equation)
Adult female: 50% (0.5)
Elderly male: 50% (0.5)
Elderly female: 45% (0.45)
Child: 60% (0.6)
The patient is 7 years old. The patient's is a Female.
The patient is less than 18 years old and so the patient is a child. This means total body water percentage value is 0.6.
The patient's weight is 27.0 kg. The concentration of sodium is 141.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 141.0 mEq. To convert from 141.0 mEq to mmol, convert from mEq to mmol. The compound 141.0 has a valence of 1, and so divide the valence by the value of mEq to get, 141.0 mEq/(1 mEq/mmol) = 141.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 141.0 mEq sodium/L converts to 141.0 mmol sodium/L. Plugging in these values into the equation, we get 0.6 * 27.0 * (141.0/140 - 1) = 0.11571 L. The patient's free body water deficit is 0.11571 L."
477,38,Free Water Deficit,lab test,decimal,pmc-4541194-1,Extracted,"A female patient aged 18 years weighing 35 kg was admitted to the Intensive Care Unit (ICU) in our hospital with complains of diffused dull aching abdominal pain, not related to food habit with occasional nausea and vomiting from 2 months. She was treated with proton pump inhibitors (tablet pentoprazole 40 mg twice daily) and antispasmodic medication (dicyclomin). Gradually she also developed diarrhea, vomiting and progressive weakness of her lower limbs and finally flaccid quadriparesis. At the time of presentation to ICU, she was conscious, oriented, Glasgow coma score (GCS) 15/15, pulse rate 100/min, blood pressure (BP)-130/80 mmHg, normal respiratory and cardiovascular system and flaccid quadriplegia. There was also a history of two episodes of seizure last night. She gave no history of accidental or intentional ingestion of any poisonous substances. Her family history was unremarkable. Initial laboratory investigations showed total leucocyte count 12.0 × 109/L with neutrophil 80%, sodium 128 meq/L, chloride 96 meq/L and normal magnetic resonance imaging cervical spine and cerebrospinal fluid analysis. Treatment was started with anticonvulsants (injection phenytoin 100 mg 3 times a day), antibiotics (injection ceftriaxone 1 g twice daily) and correction of the electrolyte imbalance. Over the next 15 days, she developed respiratory muscle paralysis, was intubated and put on mechanical ventilation. Despite all measures she continued to have seizures and labile BP. Gradually she also became delirious with deterioration of GCS to 10. No improvement was observed in her laboratory parameters also. Finally urine PBG was done which was found positive. Electromyography results also demonstrated the presence of severe sensory motor axonal polyneuropathy. Immediately, all porphyrogenic drugs were stopped, phenytoin was replaced by gabapentin and a high-carbohydrate diet (400 to 450 g/day) was started. Treatment with hematin could not be started, due to the difficulty in obtaining the drug. Even after 1-week of therapy there was no improvement in her clinical condition and a decision was made to try hemodialysis. However, eventually she developed sepsis requiring high-ionotropic support which precluded further leading to her demise.",What is the patient's free water deficit in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'sex': 'Female', 'age': [18, 'years'], 'weight': [35.0, 'kg'], 'Sodium': [128.0, 'mEq/L']}",-1.5,-1.425,-1.575,"The formula for computing the free water deficit is (total body water percentage) * (weight) * (sodium/140 - 1), where the total body water percentage is a percentage expressed as a decimal, weight is in kg, and the sodium concentration is in mmol/L.
The total body water percentage is based on the patient's age and gender.
Adult male: 60% (i.e., use 0.6 in the equation)
Adult female: 50% (0.5)
Elderly male: 50% (0.5)
Elderly female: 45% (0.45)
Child: 60% (0.6)
The patient is 18 years old. The patient's is a Female.
The patient's age is between 18 and 64 and so the patient is an adult. For adult female's the total body water percentage value is 0.50.
The patient's weight is 35.0 kg. The concentration of sodium is 128.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 128.0 mEq. To convert from 128.0 mEq to mmol, convert from mEq to mmol. The compound 128.0 has a valence of 1, and so divide the valence by the value of mEq to get, 128.0 mEq/(1 mEq/mmol) = 128.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 128.0 mEq sodium/L converts to 128.0 mmol sodium/L. Plugging in these values into the equation, we get 0.5 * 35.0 * (128.0/140 - 1) = -1.5 L. The patient's free body water deficit is -1.5 L."
478,38,Free Water Deficit,lab test,decimal,pmc-2848063-1,Extracted,"A 24-year-old Caucasian woman was admitted to the Accident and Emergency Department of our hospital with a sudden episode of nausea, vomiting and collapse, having become acutely unwell whilst at work. There was no past medical history and she was not taking any regular medication. On examination she was of normal body weight (weight 53 kg and body mass index 21 kg/m2), afebrile and her blood pressure was 103/56 with no postural change measured. Although she appeared drowsy and unwell, her systemic examination was unremarkable and no focal abnormalities were found on neurological examination of the central or peripheral nervous system. Initial biochemical analysis revealed sodium 127 mmol/l, potassium 3.2 mmol/l, urea 3.8 mmol/l, creatinine 77 and glucose 4.1 mmol/l. Inflammatory markers (white cell count and C-reactive protein) were normal. A computerised tomography (CT) and magnetic resonance (MR) of the brain demonstrated normal ventricles, no focal lesion or mass effect and normal sagittal sinus flow. Upon lumbar puncture, performed in the lateral decubitus position, an opening pressure of 40 mm of water was documented. Cerebrospinal fluid (CSF) microscopy revealed two white blood cells (WBCs) per mm3, <1 red blood cell (RBC) per mm3 and no organisms. CSF chemistry was unremarkable: protein 0.4 g/l and glucose 3.2 mmol/l. The patient had remained drowsy and she was managed in the Intensive Care Unit with a presumptive diagnosis of acute meningoencephalitis with a secondary syndrome of inappropriate anti-diuretic hormone (SIADH). No measurements of serum or urine osmolality were made. She was treated with antibiotics and acyclovir and was also supported with intravenous fluids and, within 24 hours, had improved such that she was transferred back to the ward.
During subsequent review she admitted to several months of generalised fatigue, sometimes falling asleep at work, and of intermittent headaches. With subsequent neurology specialist input to review the grossly elevated intracranial pressure, accompanied by normal imaging and CSF analysis, the patient was commenced on acetazolamide 250 mg daily for presumed idiopathic intracranial hypertension (IIH). Visual acuity and visual field (Goldman perimetry) testing was unremarkable. On endocrine review, generalised hyperpigmentation with facial melasma were noted and, although she had no buccal pigmentation, she did have marked pigmentation of a recent scar over her left shoulder (Figure ). A short synacthen (250 mcg) test (SST) was performed and demonstrated adrenal insufficiency with basal cortisol at 231 nmol/l, 30 minute cortisol 265 nmol/l and 60 minute at 200 nmol/l. A repeat SST showed basal cortisol at 138 nmol/l and 30 minute cortisol at 159 nmol/l and confirmed adrenal insufficiency. Adrenal antibodies were negative. Her plasma adrenocorticotropic hormone (ACTH) was raised at >278 pmol/l consistent with primary adrenal failure. She was commenced on glucocorticoid (hydrocortisone 10 mg bd) and mineralocorticoid (fludrocortisone 50 mcg) replacement therapy and discharged. On subsequent review two weeks later, she was feeling much better with CSF pressure reduced to 25 mm of water on repeat lumbar puncture. Acetazolamide was discontinued after three months and on subsequent reviews at six and 12 months, she continued to remain well on hydrocortisone and fludrocortisone replacement.",What is the patient's free water deficit in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [24, 'years'], 'weight': [53.0, 'kg'], 'sex': 'Female', 'Sodium': [127.0, 'mmol/L']}",-2.46071,-2.33767,-2.58375,"The formula for computing the free water deficit is (total body water percentage) * (weight) * (sodium/140 - 1), where the total body water percentage is a percentage expressed as a decimal, weight is in kg, and the sodium concentration is in mmol/L.
The total body water percentage is based on the patient's age and gender.
Adult male: 60% (i.e., use 0.6 in the equation)
Adult female: 50% (0.5)
Elderly male: 50% (0.5)
Elderly female: 45% (0.45)
Child: 60% (0.6)
The patient is 24 years old. The patient's is a Female.
The patient's age is between 18 and 64 and so the patient is an adult. For adult female's the total body water percentage value is 0.50.
The patient's weight is 53.0 kg. The concentration of sodium is 127.0 mmol/L. Plugging in these values into the equation, we get 0.5 * 53.0 * (127.0/140 - 1) = -2.46071 L. The patient's free body water deficit is -2.46071 L."
479,38,Free Water Deficit,lab test,decimal,pmc-2633322-1,Extracted,"We are presenting a case with acute abdomen, i.e. ileum perforation, caused by accidentally ingesting a chicken wishbone.
A fifty-year-old male was presented in the surgical emergency clinic with abdominal pain, nausea, and vomiting. The symptoms had started two days earlier. He used tobacco, but denied having consumed alcohol. The patient's height was 170 cm and his weight was 120 kg. His vital signs were: blood pressure 120/80 mmHg; pulse rate 90 beats/min.; respiration rate 19/min.; body temperature 38.5°C. His past medical history consisted of surgery for a thrombophlebitis in his right arm one year earlier.
Upon physical examination, a distended and diffusely tender abdomen with right lower abdomen rebound was revealed. The patient's skin and mucosa were pale.
The emergent laboratory tests revealed as follow: white blood cells (WBC): 12.6 × 109/liter; serum creatinine: 126 mol/L; blood urea nitrogen: 8.6 mmol/L; blood sugar: 11.6 mmol/L; Na: 141 mmol/L; K: 4.0 mmol/L; Ca++: 1.08 mmol/L; urinalysis: a lot of mucus, 4–6 Leucocytes; some epithelial cells. Plain abdominal radiography showed mechanical obstruction. Urgent abdominal ultrasound revealed mechanical obstruction, dilated small bowels and free liquid in the peritoneal cavity.
Laparotomy was performed in general anesthesia on the day the patient was admitted. Intra operative findings revealed diffuse fibro purulent peritonitis with adhesions between small bowels; and about 40 cm from Bauchini valve the presence of a sharp chicken wishbone perforated the ileum at the ante mesenteric site (Figure ). The wall of that part of the ileum was thick and succulent. The patient was treated after the adhesiolisis with resection of the perforated distal ileum and ileum stoma. The postoperative treatment went well; the wound healed per secundum. Clebsiela spp. was isolated in the stained abdominal liquid and treated with the proper antibiotics. Four months after the first operation and losing 25 kg, the patient underwent reconstruction of bowel continuity, and discharged on the tenth postoperative day with normal bowel movements.
Retrospectively, after the first operation the patient admitted that four days earlier he had rapidly eaten and swallowed several mouthfuls of chicken meat without chewing and accidentally ingested a chicken bone.",What is the patient's free water deficit in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Sodium': [141.0, 'mmol/L'], 'sex': 'Male', 'weight': [120.0, 'kg'], 'age': [50, 'years']}",0.51429,0.48858,0.54,"The formula for computing the free water deficit is (total body water percentage) * (weight) * (sodium/140 - 1), where the total body water percentage is a percentage expressed as a decimal, weight is in kg, and the sodium concentration is in mmol/L.
The total body water percentage is based on the patient's age and gender.
Adult male: 60% (i.e., use 0.6 in the equation)
Adult female: 50% (0.5)
Elderly male: 50% (0.5)
Elderly female: 45% (0.45)
Child: 60% (0.6)
The patient is 50 years old. The patient's is a Male.
The patient's age is between 18 and 64 and so the patient is an adult. For adult male's the total body water percentage value is 0.60.
The patient's weight is 120.0 kg. The concentration of sodium is 141.0 mmol/L. Plugging in these values into the equation, we get 0.6 * 120.0 * (141.0/140 - 1) = 0.51429 L. The patient's free body water deficit is 0.51429 L."
480,38,Free Water Deficit,lab test,decimal,pmc-2771150-1,Extracted,"A 72-year-old woman was admitted to our hospital for surgery for esophageal cancer. At admission, her blood pressure was 120/70 mmHg and pulse rate was 76 beats per minute. She was 152 cm in height and weighted 62 Kg. Physical examination was unremarkable. Preoperatively, renal function was moderately decreased (creatinine, 0.95 mg/dL, blood urea nitrogen: 16.5 mg/dL, uric acid: 5.7 mg/dL, sodium: 144 mEq/L, potassium: 4.1 mEq/L, chloride 110 mEq/L, phosphorus 3.7 mg/dL). During the thoracoscopic esophagectomy, blood loss was 460 ml, and hemodynamics were stable.
Postoperatively, approximately 2 L of hypotonic fluid (0.2% saline with 4.3% dextrose) daily were administered, urine volume was stable (1.1–1.8 L), and plasma sodium levels were unchanged (140 mEq/L). However, on the third postoperative day, she suddenly developed polyuria (3.8 L/day) together with a decrease in CVP (). Serum sodium levels dropped to 124 mEq/L on the next day. Despite volume-to-volume correction with isotonic saline, the serum sodium levels dropped to a nadir of 112 mEq/L together with hyperkalemia (5.6 mEq/L) on the fifth postoperative day, and her consciousness level deteriorated. When her urine volume was 3.8 L and 3.5 L, there was a negative water balance (without including perspiration); −0.9 L and −0.5 L, respectively. The hematocrit value increased from 27.4% to 33.7% during the 2 days without blood transfusion. The next day, our department was consulted for further evaluation. She appeared dehydrated and there was an additional decrease in her CVP to a nadir of 1 cm of H2O. Laboratory findings on consultation are shown in . Urinary sodium concentrations were markedly high and serum uric acid levels were decreased from 5.7 mg/dL to 1.4 mg/dL. Urinary N-acetyl-β-glucosamininase (NAG) and β2-microglobulin were high and the calculated maximal tubular reabsorption of phosphorus per glomerular filtration rate (TmP/GFR) was relatively low (2.4 mg/dL), suggesting proximal tubule dysfunction. Furthermore, the calculated transtubular potassium gradient (TTKG) value was low (3.6) for her serum potassium levels (4.7 mEq/L), suggesting that aldosterone action at cortical collecting duct (CCD) was impaired. These features were not consistency with the diagnosis of a SIADH. Thus, she was diagnosed as having SLN due to renal tubular dysfunction. Sodium correction was done with 3% saline and fludrocortisone was started at a dose of 0.05 mg/day. Thereafter, urinary volume decreased and there was a gradual increase in serum sodium levels to 138 mEq/L and serum uric acid levels to 3.4 mg/dL. Her consciousness level completely recovered. On the 20th postoperative day fludrocortisone was discontinued and she was discharged. She has been followed as an outpatient without recurrence of the hyponatremia.",What is the patient's free water deficit in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [72, 'years'], 'weight': [62.0, 'kg'], 'sex': 'Female', 'Sodium': [144.0, 'mEq/L']}",0.79714,0.75728,0.837,"The formula for computing the free water deficit is (total body water percentage) * (weight) * (sodium/140 - 1), where the total body water percentage is a percentage expressed as a decimal, weight is in kg, and the sodium concentration is in mmol/L.
The total body water percentage is based on the patient's age and gender.
Adult male: 60% (i.e., use 0.6 in the equation)
Adult female: 50% (0.5)
Elderly male: 50% (0.5)
Elderly female: 45% (0.45)
Child: 60% (0.6)
The patient is 72 years old. The patient's is a Female.
The patient's age is greater than 64 years and so the patient is considered elderly. For elderly female's, the total body water percentage value is 0.45.
The patient's weight is 62.0 kg. The concentration of sodium is 144.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 144.0 mEq. To convert from 144.0 mEq to mmol, convert from mEq to mmol. The compound 144.0 has a valence of 1, and so divide the valence by the value of mEq to get, 144.0 mEq/(1 mEq/mmol) = 144.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 144.0 mEq sodium/L converts to 144.0 mmol sodium/L. Plugging in these values into the equation, we get 0.45 * 62.0 * (144.0/140 - 1) = 0.79714 L. The patient's free body water deficit is 0.79714 L."
481,38,Free Water Deficit,lab test,decimal,pmc-3668109-2,Extracted,"A 40-yr old man (body weight: 73 kg, height: 172 cm) was scheduled for living donor liver transplantation surgery due to acute liver failure. One week ago, he developed grade 1 hepatic encephalopathy. In the preoperative evaluation, electrocardiography and echocardiography were within normal range. Chest X-ray showed mild pleural effusion on both lungs. His laboratory examination showed Hb 9.9 g/dl, platelet count 107 × 109/L, prothrombin time 2.2 international normalized ratio, fibrinogen 82 mg/dl, antithrombin III 12%, sodium 135 mmol/L, potassium 3.0 mmol/L, creatinine 1.1 mg/dl, glucose 144 mg/dl, albumin 3.0 g/dl, total bilirubin 23.1 mg/dl, and ammonia 82 µmol/L. Her Child-Pugh and Model for End-Stage Liver Disease scores were 12 and 28, respectively.
Upon arrival at the operating room, his mental state was alert. His systolic/diastolic arterial blood pressure and heart rate were 132/68 mmHg and 98 beats/min, respectively. After establishing institutional standard monitoring, an ultrasound ONSD measurement was done by a physician well-trained in ocular ultrasonography. His ONSD just before anesthesia induction was 4.8 mm (). The bispectral index and suppression ratio were 98 and 0, respectively, and right and left regional cerebral oxygen saturations were 43 and 44%, respectively.
General anesthesia was induced and maintained by the standard protocol at our institute. His lungs were ventilated with a tidal volume of 8-10 ml/kg at a respiratory rate of 10 breaths/min (PaCO2, 35-40 mmHg). Intraoperative hemodynamics and laboratory data were shown . He experienced severe hypotension (systolic/diastolic arterial blood pressure: 62/48 mmHg) and bradycardia (56 beats/min) after graft reperfusion, and was treated with epinephrine (20 µg), after which systolic/diastolic arterial blood pressure (122/72 mmHg) and heart rate (92 beats/min) rapidly recovered to within the normal limit. His ONSD was dilated at 5.7 mm to 5 min after reperfusion (), and hyperventilation was performed with a tidal volume of 12 ml/kg at a respiratory rate of 13 breaths/min (PaCO2, 28 mmHg). His ONSD decreased to 5.1 mm at 30 min after reperfusion (), and ventilation was adjusted to maintain normocarbia until the end of surgery. He was moved to the surgical intensive care unit after surgery, and then transferred to a general ward without any complications on the seventh postoperative day.",What is the patient's free water deficit in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [40, 'years'], 'weight': [73.0, 'kg'], 'sex': 'Male', 'Sodium': [135.0, 'mmol/L']}",-1.56429,-1.48608,-1.6425,"The formula for computing the free water deficit is (total body water percentage) * (weight) * (sodium/140 - 1), where the total body water percentage is a percentage expressed as a decimal, weight is in kg, and the sodium concentration is in mmol/L.
The total body water percentage is based on the patient's age and gender.
Adult male: 60% (i.e., use 0.6 in the equation)
Adult female: 50% (0.5)
Elderly male: 50% (0.5)
Elderly female: 45% (0.45)
Child: 60% (0.6)
The patient is 40 years old. The patient's is a Male.
The patient's age is between 18 and 64 and so the patient is an adult. For adult male's the total body water percentage value is 0.60.
The patient's weight is 73.0 kg. The concentration of sodium is 135.0 mmol/L. Plugging in these values into the equation, we get 0.6 * 73.0 * (135.0/140 - 1) = -1.56429 L. The patient's free body water deficit is -1.56429 L."
482,38,Free Water Deficit,lab test,decimal,pmc-7327387-1,Extracted,"A 57-year-old female was presented to our emergency center with severe anxiety and general weakness. She was undergoing regular follow-up after concomitant chemoradiation therapy (CCRT) for cervical cancer 3 months ago. Also she was taking an amlodipine as an antihypertension drug. The patient usually consumed bay salt with her wrong belief that eating salt would be helpful to cure cancer. Two days before the hospital visit, her family member got to know that the patient had been taking 4 teaspoons of bay salt a day. In addition, the patient's oral intake had been markedly decreased, and had intermittent vomiting several days before the visit. On arrival on our hospital, the patient showed dehydrated features such as dry tongue and reduced skin turgor. Blood pressure was 210/100mmHg and heart rate was 74 beats/min in the supine position. Initial laboratory tests showed the following values: serum sodium 203mEq/L [135–145], potassium 2.9mEq/L [3.5–5.0], chloride 167 mEq/L [96–108], bicarbonate 26.7mEq/L [21–28], inorganic phosphorus 1.1mg/dL [2.5–5.5], blood urea nitrogen (BUN) 42.5 mg/dL [8–23], creatinine 2.21mg/dL [0.5–1.3], serum osmolality 415mOsm/kg [280–295], urine osmolality 369 mOsm/kg [300–900], urine sodium 158mEq/L [40–220]. Owing to the patient's inappropriately high BP and peripheral cyanosis, we checked transthoracic 2D-echocardiography. Echocardiography revealed markedly decreased the left ventricular (LV) chamber size and resultant concentric remodeling, which are caused by depletion of circulating volume. Kidney ultrasonography showed enlarged kidney (both kidney size about 12 cm) with increased corticomedullary differentiation, which was compatible findings with acute kidney injury. Brain CT showed no significant abnormal findings such as cerebral infarction, hemorrhage, hydrocephalus and infection. Hydration was initiated with hypotonic fluid (5% dextrose and 0.45% sodium chloride). During initial aggressive hydration serum sodium level was even more elevated to 238 mEq/L 2 hours later, therefore we increased the replacement rate of water deficit. After that, however, serum sodium was unintendedly corrected at rates above 1mEq/L per hour (203mEq/L to 177mEq/L for 24 hours) and after 72 hours, the serum sodium concentration was nearly corrected to the normal level (less than 155mEq/L) (). Serum creatinine level also decreased to normal (0.8mg/dL) at the fourth day of hospitalization. Despite the high correction rate of hypernatremia, but the patient was completely recovered without any significant neurologic complications, and was discharged to home. In an outpatient clinic conducted after discharge, the patient's serum sodium level was well maintained around 140mEq/L. And she did not show any neurological signs including headache in at least six months of outpatient care.",What is the patient's free water deficit in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [57, 'years'], 'weight': [73.0, 'kg'], 'sex': 'Female', 'Sodium': [203.0, 'mmol/L']}",16.425,15.60375,17.24625,"The formula for computing the free water deficit is (total body water percentage) * (weight) * (sodium/140 - 1), where the total body water percentage is a percentage expressed as a decimal, weight is in kg, and the sodium concentration is in mmol/L.
The total body water percentage is based on the patient's age and gender.
Adult male: 60% (i.e., use 0.6 in the equation)
Adult female: 50% (0.5)
Elderly male: 50% (0.5)
Elderly female: 45% (0.45)
Child: 60% (0.6)
The patient is 57 years old. The patient's is a Female.
The patient's age is between 18 and 64 and so the patient is an adult. For adult female's the total body water percentage value is 0.50.
The patient's weight is 73.0 kg. The concentration of sodium is 203.0 mmol/L. Plugging in these values into the equation, we get 0.5 * 73.0 * (203.0/140 - 1) = 16.425 L. The patient's free body water deficit is 16.425 L."
483,38,Free Water Deficit,lab test,decimal,pmc-5139799-1,Extracted,"A 12 years old female child was admitted with mild pain and deformity at both knee joints which was progressive over 6 months. There was no history of swelling or morning stiffness of joints, no history of repeated fractures or similar illness in family. She was admitted for jaundice 3 years back. She was given mega doses of vitamin D before she referred to our center.
On examination she was normally built and nourished with height 138 cm and weight 27 kg, and vital signs and parameters were normal. On Local examination, knee joint was normal and there was genu valgum with bimalleolar distance of 13 cm; angulations were more in right than left (). Rest of systemic examination was found to be normal.
Investigations revealed Hb10.4 gm/dl, TLC 4.8 x 103/µL, PC 208 x 103/µL, ESR 25 mm/ h, ALT 30 U/L, AST 22 U/L, bilirubin 0.8 mg/dl, Urea 28 mg/dL, Cratinine 1.1 mg/dL, Na 149 mEq/L, K 3.1 mEq/L, Ca 7.5 mg/dL, Phosphate 4.8 mg/dL (2.9 - 5.4), AlkPO4 203 units/L (105 - 420). X-ray local part (knee) was suggestive of mild osteoporotic changes.
Urine examination showed urine pH 7.5, urine anion gap +26, urinary calcium 700mg (100 - 250) and urinary phosphate 300mg (900 - 1300). ABG revealed pH 7.29, PO2 108 mmHg, PCO2 36 mmHg, and HCO3 17 mEq/L with anion gap of 14. Parathormone level was 25.5 pg/ml (12 - 95) and Vitamin D3 level was 27 ng/ml (5.9 - 59).
We suspected Wilson’s disease in this unexplained bone disease. Slit lamp examination of her eyes revealed Keyser-Fleisher ring. Ceruloplasmin level was 2.81 mg/dL (25 - 60). Urinary copper excretion was 1140 µg/day. USG abdomen revealed diffuse fatty infiltration of liver. MRI brain showed copper deposits in caudate nucleus and putamina. So diagnosis of Wilson’s disease with rickets due to renal tubular acidosis was made. She was given zinc acetate, D-penicillamine, sohl solution and oral calcium; and asked to follow up in OPD to observe improvement.",What is the patient's free water deficit in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'sex': 'Female', 'age': [12, 'years'], 'weight': [27.0, 'kg'], 'Sodium': [149.0, 'mEq/L']}",1.04143,0.98936,1.0935,"The formula for computing the free water deficit is (total body water percentage) * (weight) * (sodium/140 - 1), where the total body water percentage is a percentage expressed as a decimal, weight is in kg, and the sodium concentration is in mmol/L.
The total body water percentage is based on the patient's age and gender.
Adult male: 60% (i.e., use 0.6 in the equation)
Adult female: 50% (0.5)
Elderly male: 50% (0.5)
Elderly female: 45% (0.45)
Child: 60% (0.6)
The patient is 12 years old. The patient's is a Female.
The patient is less than 18 years old and so the patient is a child. This means total body water percentage value is 0.6.
The patient's weight is 27.0 kg. The concentration of sodium is 149.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 149.0 mEq. To convert from 149.0 mEq to mmol, convert from mEq to mmol. The compound 149.0 has a valence of 1, and so divide the valence by the value of mEq to get, 149.0 mEq/(1 mEq/mmol) = 149.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 149.0 mEq sodium/L converts to 149.0 mmol sodium/L. Plugging in these values into the equation, we get 0.6 * 27.0 * (149.0/140 - 1) = 1.04143 L. The patient's free body water deficit is 1.04143 L."
484,38,Free Water Deficit,lab test,decimal,pmc-7405338-1,Extracted,"A 44-year-old woman with 5-year history of Basedow’s disease had a total thyroidectomy. She had no past and family history and had no drug allergy. She was diagnosed as Basedow’s disease at 39 years old and after then she started taking 30 mg of thiamazole (MMI). In physical examination, she had no remarkable symptom such as palpitation, general fatigue and insomnia and did not have a goiter. Her height and body weight were 158.0 cm and 63.6 kg. Her vital signs were: heart rate 112 beats/min, blood pressure 132/86 mmHg. Laboratory data were as follows: white blood cell count, 4580 /μL (neutrophil 57.7%); red blood cell count, 476 × 104 /μL; hemoglobin, 12.7 g/dL; platelet, 26.5 × 104 /μL; Na, 142 mmol/L; K, 5.2 mmol/L. Renal and liver function was within normal range (creatinine (CRE), 0.38 mg/dL; blood urea nitrogen (BUN), asparate aminotransferase (AST), 25 U/L; alanine transaminase (ALT), 26 U/L; alkaline phosphatase (ALP), 231 U/L; γ-glutamyltranspeptidase (γ-GTP), 17 U/L; lactate dehydrogenase (LDH), 174 U/L). Thyroid-associated data were as follows: thyroid-stimulating hormone (TSH), < 0.010 μIU/mL; free triiodothyronine (FT3), 19.05 pg/mL; free thyroxine (FT4) 4.88 ng/dL; TRAb, 10.6 IU/L (electro chemiluminescence immunoassay (ECLIA), SRL Inc., Tokyo); TPOAb, 216.9 IU/mL (ECLIA, SRL Inc., Tokyo); TgAb antibody, 428.9 IU/mL (ECLIA, SRL Inc., Tokyo). Ultrasound examination revealed that the thyroid gland was hypervascular although it was not enlarged (Fig. ). Based on such findings, we finally diagnosed her as Basedow’s disease. Two weeks after starting MMI therapy, she had liver dysfunction (AST, 420 U/L; ALT, 368 U/L; ALP, 565 U/L; γ-GTP, 178 U/L; LDH, 337 U/L), and we changed the treatment of MMI to 300 mg of propylthiouracil (PTU) although her thyroid hormone levels were decreased (TSH, < 0.010 μIU/mL; FT3, 7.2 4 pg/mL; F T4 1.97 ng/dL). After then, her liver function was improved, and we tapered PTU. About 2 years later, her thyroid hormone levels were within normal range with 50 mg of PTU every other day, and her TRAb became negative. After then, we stopped PTU therapy.",What is the patient's free water deficit in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'sex': 'Female', 'age': [44, 'years'], 'weight': [63.6, 'kg'], 'Sodium': [142.0, 'mmol/L']}",0.45429,0.43158,0.477,"The formula for computing the free water deficit is (total body water percentage) * (weight) * (sodium/140 - 1), where the total body water percentage is a percentage expressed as a decimal, weight is in kg, and the sodium concentration is in mmol/L.
The total body water percentage is based on the patient's age and gender.
Adult male: 60% (i.e., use 0.6 in the equation)
Adult female: 50% (0.5)
Elderly male: 50% (0.5)
Elderly female: 45% (0.45)
Child: 60% (0.6)
The patient is 44 years old. The patient's is a Female.
The patient's age is between 18 and 64 and so the patient is an adult. For adult female's the total body water percentage value is 0.50.
The patient's weight is 63.6 kg. The concentration of sodium is 142.0 mmol/L. Plugging in these values into the equation, we get 0.5 * 63.6 * (142.0/140 - 1) = 0.45429 L. The patient's free body water deficit is 0.45429 L."
485,38,Free Water Deficit,lab test,decimal,pmc-3147132-1,Extracted,"A 28-year-old man was admitted to our hospital because of reduced livido and increased fatigability. He had been in good health until 1 year earlier, when he noticed reduced livido. Four months before admission, he noticed frequent headaches, thirst, polydipsia, and polyuria. Because he was voiding urine every hour, he visited his family doctor. Magnetic resonance imaging (MRI) revealed a suprasellar mass, and he was thus referred to our hospital for further evaluation and treatment. Although polydipsia and polyuria had been gradually relieved by the time of admission, he became aware of increased fatigability.
At the time of admission, he was 176 cm tall and weighed 72 kg. His temperature was 37.6°C, pulse rate was 60/min, and blood pressure was 110/60 mmHg. No goiter or enlargement of lymph nodes was noted. Axillar and pubic hair were lost and there was palpable erythematous rush on his forehead (). The remainder of the physical examination was unremarkable.
Laboratory results revealed the following results: blood urea nitrogen 9.6 mg/dL, creatinine 0.79 mg/dL, serum sodium 141 mEq/l, potassium 4.0 mEq/l, chloride 100 mEq/l, calcium 9.4 mg/dL, phosphate 3.7 mg/dL, fasting plasma glucose 80 mg/dL, and C-reactive protein 0.07 mg/dL. Endocrinologic data revealed a mild decrease in free T4 level (0.6 ng/dL) with normal thyroid-stimulating hormone (TSH) level (0.9106 μU/mL) and decreased cortisol (4.7 μg/mL), adrenocorticotropic hormone (ACTH; 6 pg/mL), luteinizing hormone (LH; 0.2 mIU/mL), follicle stimulating hormone (FSH; 1.3 mIU/mL), and testosterone (0.05 ng/mL) levels. Urinary cortisol was undetectable. Plasma osmolality was 288 mOsm/kgH2O, with a urinary osmolality of 239 mOsm/kgH2O, and arginine vasopressin (AVP) was undetectable (<0.15 pg/mL). Urinary output was from 1.5 to 2.2 L/day.
His clinical course and laboratory findings led us to suspect CDI with anterior pituitary dysfunction. We thus performed hormonal provocative tests. The patient was given an infusion of 5% saline at a rate of 0.05 mL/kg for 120 min. Although plasma AVP was undetectable before and after administration of hypertonic saline, urine osmolality (391 mOsm/kgH2O) increased above the plasma levels (296 mOsm/kgH2O) (). Hormonal provocative tests revealed that growth hormone (GH) response to GH-releasing hormone was normal, TSH response to TSH-releasing hormone was low and blunted, and FSH and LH response to LH-releasing hormone were low and blunted (). Although ACTH response to corticotrophin-releasing hormone (CRH) was normal, cortisol response to CRH was low (maximum 13.0 μg/mL). Cortisol response to rapid ACTH stimulation test was low (maximum 15.9 μg/mL). Results of these hormonal tests were compatible with the diagnosis of CDI with partial GC deficiency.
MRI revealed enhancing lesion centrally in the pituitary stalk, which spread continuously to the bottom of the third ventricle, and the high intensity of the posterior lobe was lost, compatible with the diagnosis of CDI (). Considering the patient's age, we first suspected of neurohypophysial germinoma. However, this was unlikely because cerebrospinal fluid was negative for malignant cells, and β-human chorionic gonadotropin (HCG) levels were normal. Next, we suspected sarcoidosis because chest X-ray revealed hilar enlargement. A biopsy from the skin of the forehead was performed, which revealed noncaseating granuloma composed of epithelioid cells (). Multinucleated giant cells were also present. Thus, the diagnosis of sarcoidosis was made.
While waiting for histologic confirmation of biopsy results, hydrocortisone replacement was begun with a dose of 20 mg daily. Soon after the replacement therapy was begun, moderate polyuria (3.5–4.0 liters daily) occurred (). After the diagnosis of sarcoidosis was confirmed, he was treated with 40 mg of prednisolone and his general condition improved. The hypertonic saline test was repeated while he was taking 40 mg of prednisolone. Plasma AVP was undetectable during the hypertonic saline test and urine osmolality was consistently below plasma levels, which was compatible with a diagnosis of CDI (). He was treated with 1-desamino-8-D-arginine vasopressin (dDAVP).
MRI following prednisolone therapy revealed a reduction in the size of the affected lesion. However, his pituitary function remained unchanged, and he is currently being treated with prednisolone, levothyroxine natrium, HCG, and dDAVP.",What is the patient's free water deficit in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [28, 'years'], 'weight': [72.0, 'kg'], 'sex': 'Male', 'Sodium': [141.0, 'mEq/L']}",0.30857,0.29314,0.324,"The formula for computing the free water deficit is (total body water percentage) * (weight) * (sodium/140 - 1), where the total body water percentage is a percentage expressed as a decimal, weight is in kg, and the sodium concentration is in mmol/L.
The total body water percentage is based on the patient's age and gender.
Adult male: 60% (i.e., use 0.6 in the equation)
Adult female: 50% (0.5)
Elderly male: 50% (0.5)
Elderly female: 45% (0.45)
Child: 60% (0.6)
The patient is 28 years old. The patient's is a Male.
The patient's age is between 18 and 64 and so the patient is an adult. For adult male's the total body water percentage value is 0.60.
The patient's weight is 72.0 kg. The concentration of sodium is 141.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 141.0 mEq. To convert from 141.0 mEq to mmol, convert from mEq to mmol. The compound 141.0 has a valence of 1, and so divide the valence by the value of mEq to get, 141.0 mEq/(1 mEq/mmol) = 141.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 141.0 mEq sodium/L converts to 141.0 mmol sodium/L. Plugging in these values into the equation, we get 0.6 * 72.0 * (141.0/140 - 1) = 0.30857 L. The patient's free body water deficit is 0.30857 L."
486,38,Free Water Deficit,lab test,decimal,pmc-3674643-1,Extracted,"A 99-year-old female (height 1.60 m; weight 45 kg, ASA III) was admitted to our hospital and underwent major abdominal surgery (sigmoid colon carcinoma resection with colorectal anastomosis) under general anesthesia, and the surgery duration was about 220 minutes. Her medical history revealed mild degree heart failure, chronic normocytic anemia, gastritis, and allergy for NSAIDs and penicillin antibiotics.
Her preoperative laboratory tests: hemoglobin 8.8 mg·dL−1, hematocrit 30.9%, leukocytes 11,500 mm−3 without deviation, platelets 453,000 mm−3, sodium 131 mg·dL−1, potassium 4 mg·dL−1, magnesium 0.58 mg·dL−1, creatinine 0.5 mg·dL−1, and total calcium 8.24 mg·dL−1.
In the preoperative room we prepared our patient by antibiotics prophylaxis: ciprofloxacin 2 gm; metronidazole 500 mg and an antiemetic agent; ondansetron 4 mg.
Our patient was monitored by pulse oximetry, expiratory capnography, invasive and noninvasive blood pressure, electrocardiogram, bispectral index (BIS), neuromuscular transmission (TOF Guard), and diuresis.
A peripheral venous access (20 G) was established in upper right limb, and also a central venous access was done immediately after the induction phase as it was needed for postoperative chemotherapy afterwards.
We induced our anesthesia by oxygen, propofol 50 mg, fentanil 100 mcg, and rocuronium bromide 30 mg, and then we proceeded to a rapid sequence endotracheal intubation (tube diameter was 6.5 mm),
The maintenance of the anesthesia was achieved by continuous infusion of remifentanil in a dose of 0.2 mcg/kg/min, rocuronium bromide 10 mg, xenon 60–65%, and O2 35–40%, the fluid replacement was calculated depending on her diuresis, plasma fluid, intraoperative blood loss, and anemia, and she was refunded by ringer lactate 1500 mL, Nacl 0.9% 1000 mL, fresh plasma fluids 1000 mL, and packed red cells 500 mL.
A closed-circuit anesthesia machine (Felix Dual, Taema) was used for xenon gas delivery. The ventilation parameters were the following: “pressure-cycled mechanical ventilation with inhalation pressure indexes of 19 cm H2O, respiratory frequency 12 incursions per minute, PEEP 5 cm H2O, FiO2 35–40%, and inspiratory/expiratory time ratio 1 : 2, and the exhaled tidal volume was around 380 mL.”
Blood gas analysis was performed twice: 30 minutes after the start and 30 minutes before the end of surgery.
We registered electrolyte disorders, and they were resolved by administration of KCL 40 mEq and Ca++ gluconate in dose of 1 g·10 m−1 (Tables and ).
After 5 minutes from the end of the surgery we noticed our patient starting a voluntary respiratory activity with a high BIS level, so we decided to proceed for the emergence phase and extubation reversing the neuromuscular blocking by sugammadex in a dose of 100 mg [] with careful monitoring for her cardiovascular and respiratory functions. Both modified Aldrete score and BIS values were recorded ().
After 13 minutes we got the complete recovery of our patient, she was awake without any confusion state, delirium, or cognitive dysfunction, also she had excellent and stabile both hemodynamic and respiratory functions, postoperative pain control was achieved by continuous intravenous infusion of morphine (5 mg over 24 h), and she was transferred to ICU for close monitoring.",What is the patient's free water deficit in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'sex': 'Female', 'age': [99, 'years'], 'weight': [45.0, 'kg'], 'Sodium': [131.0, 'mEq/L']}",-1.30179,-1.2367,-1.36688,"The formula for computing the free water deficit is (total body water percentage) * (weight) * (sodium/140 - 1), where the total body water percentage is a percentage expressed as a decimal, weight is in kg, and the sodium concentration is in mmol/L.
The total body water percentage is based on the patient's age and gender.
Adult male: 60% (i.e., use 0.6 in the equation)
Adult female: 50% (0.5)
Elderly male: 50% (0.5)
Elderly female: 45% (0.45)
Child: 60% (0.6)
The patient is 99 years old. The patient's is a Female.
The patient's age is greater than 64 years and so the patient is considered elderly. For elderly female's, the total body water percentage value is 0.45.
The patient's weight is 45.0 kg. The concentration of sodium is 131.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 131.0 mEq. To convert from 131.0 mEq to mmol, convert from mEq to mmol. The compound 131.0 has a valence of 1, and so divide the valence by the value of mEq to get, 131.0 mEq/(1 mEq/mmol) = 131.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 131.0 mEq sodium/L converts to 131.0 mmol sodium/L. Plugging in these values into the equation, we get 0.45 * 45.0 * (131.0/140 - 1) = -1.30179 L. The patient's free body water deficit is -1.30179 L."
487,38,Free Water Deficit,lab test,decimal,pmc-4595368-1,Extracted,"A 36-year-old female visited the emergency department with pain in the left upper abdominal quadrant. She brought her abdominal computed tomography (CT) scan taken in another hospital showing a 10×6.3×8.6 cm-sized left adrenal mass with hemorrhagic necrosis (). On admission, her systolic blood pressure was 150 to 170 mm Hg and her diastolic blood pressure was 100 to 110 mm Hg, higher than the standard values for her age. She had no previous history of hypertension. Her weight was 63 kg, and her height was 175 cm. The routine biochemical study, random urine analysis, and blood coagulation test results were all normal, and the serum electrolytes showed Na 141 mmol/L (normal range [NR], 135 to 145), K 3.3 mmol/L (NR, 3.5 to 5.5), and Cl 100 mmol/L (NR, 98 to 120). Hormone tests showed cortisol was reduced to 0.9 µg/dL (NR, 6.7 to 22.6) and ACTH was elevated slightly, to 75.94 pg/mL (NR, 7.2 to 63.6). Renin was reduced to 0.80 ng/mL/hr (NR, 1.31 to 3.95) and aldosterone was elevated to 183.31 pg/mL (NR, 29.9 to 158.8). The aldosterone renin ratio was 22.9. Chest X-ray and electrocardiography were normal. The results of 24-hour urine analysis were as follows: metanephrine 0.518 mg/day (NR, 0 to 1.3), epinephrine 2.3 µg/day (NR, 0 to 20), and vanillylmandelic acid 4.04 mg/day (NR, 0 to 8); all values were within the NR except those for 17-ketosteroids 2.77 mg/day (NR, 7 to 20) and urinary free cortisol 37.6 (NR, 55.5 to 286). Typical CT findings of a large adrenal mass with hemorrhagic necrosis led to the diagnosis of pheochromocytoma with biochemically burnt-out status.
To further evaluate the characteristics of the adrenal mass, metaiodobenzylguanidine-single-photon emission computed tomography (MIBG-SPECT) imaging was performed and showed no significant radiotracer uptake. Next, 18F-fluorodeoxyglucose positron emission tomography-CT (18F-FDG PET-CT) was performed, and the FDG uptake in the solid portion of the mass was elevated (). On CT scan, the contralateral right adrenal gland appeared relatively normal. The possibility of pheochromocytoma could not be excluded based on MIBG-negative and PET-positive findings. Thus, after proper premedication, the mass was surgically removed due its size. After laparoscopic adrenalectomy, a left hemorrhagic adrenal mass was pathologically confirmed as adrenal cortical adenoma 10×5×3 cm in size (). The patient complained of nausea and generalized weakness after the left adrenalectomy. Moreover, blood pressure remained at 190/119 mm Hg. After the operation, her ACTH was elevated to 406.9 pg/mL (NR, 7.2 to 63.6), and the low-dose ACTH stimulation test showed her cortisol was 1.0 µg/dL (NR, 6.7 to 22.6) at baseline, 1.6 µg/dL after 30 minutes, and 1.0 µg/dL after 1 hour showing blunted response. After reviewing her abdominal CT, we discovered that she had received plastic surgery on both breasts. We requested the patient regarding her medical history as she had failed to mention this procedure on the first visit. The patient had artificial prostheses inserted because she never developed breasts during puberty. She also lacked secondary sexual characteristics such as pubic and axillary hair (Tanner stage I). The patient confessed she experienced no menarche in puberty and had kept these facts secret even from her family members. Further hormone testing showed the followings: thyroid stimulating hormone 3.1 µIU/mL (NR, 0.4 to 4.9), prolactin 27.2 ng/mL (NR, 3.3 to 26.7), luteininzing hormone 25.0 mIU/mL (NR, 1.2 to 10.9), follicular stimulating hormone 51.5 mIU/mL (NR, 1.8 to 8.8), estradiol <20 pg/mL (NR, 27 to 433), progesterone 4.32 ng/mL (NR, 0.2 to 23), and 17-OH-progesterone 0.21 ng/mL (NR, 0.1 to 5.0). However, both dehydroepiandrosterone (DHEA) and renin were reduced to 0.41 µg/mL (NR, 1.3 to 9.8) and 0.7 ng/mL/hr (NR, 1.3 to 3.9), respectively, whereas aldosterone was elevated to 171.9 pg/mL (NR, 29.9 to 158.8) (). Furthermore, X-ray examination of the upper arm showed that the bone age was compatible with that of a 15-year-old female and bone mineral density was below the expected range for her actual age (Z-score -3.1 in the lumbar spine and Z-score -3.4 in the femoral neck), probably due to sex hormone deficiency. Chromosomal study of the patient was performed using peripheral blood leukocytes and showed a normal karyotype of 46, XX, female. We also conducted polymerase chain reaction for all intron sequences in the neighborhood of the CYP17A1 gene using appropriate primers. According to mutation analysis, we found a compound heterozygous mutation for p. Tyr329fs (c.985_987delTACinsAA) and missense mutation p. His373Leu (c.1118A>T) in exon 6. She was diagnosed with CAH caused by 17α-hydroxylase/17,20-lyase deficiency confirmed by the CYP17A1 gene mutation, presenting with lack of secondary sexual development, reduced production of cortisol and DHEA, increased aldosterone and ACTH as well as atypical huge adrenal mass. The patient was started on oral prednisolone, 7.5 mg in the morning and 5 mg in the afternoon, combined with estrogen. Finally, general weakness improved significantly, and the dose of oral prednisolone was reduced to 5 mg in the morning and 2.5 mg in the afternoon. To date, her hormone level has been monitored for 3 years. Due to her poor compliance and concerns of weight gain (although only 5 mg of prednisolone was prescribed), ACTH remained high. Inadequate suppression of ACTH resulted in the progression of hyperplasia of the right adrenal gland observed on the 3-year follow-up CT scan ().",What is the patient's free water deficit in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [36, 'years'], 'weight': [63.0, 'kg'], 'sex': 'Female', 'Sodium': [141.0, 'mmol/L']}",0.225,0.21375,0.23625,"The formula for computing the free water deficit is (total body water percentage) * (weight) * (sodium/140 - 1), where the total body water percentage is a percentage expressed as a decimal, weight is in kg, and the sodium concentration is in mmol/L.
The total body water percentage is based on the patient's age and gender.
Adult male: 60% (i.e., use 0.6 in the equation)
Adult female: 50% (0.5)
Elderly male: 50% (0.5)
Elderly female: 45% (0.45)
Child: 60% (0.6)
The patient is 36 years old. The patient's is a Female.
The patient's age is between 18 and 64 and so the patient is an adult. For adult female's the total body water percentage value is 0.50.
The patient's weight is 63.0 kg. The concentration of sodium is 141.0 mmol/L. Plugging in these values into the equation, we get 0.5 * 63.0 * (141.0/140 - 1) = 0.225 L. The patient's free body water deficit is 0.225 L."
488,39,Anion Gap,lab test,decimal,pmc-6476048-1,Extracted,"A 24-year-old female with a history of HIV/AIDS, nonischemic cardiomyopathy, and methamphetamine and marijuana abuse presented with acute onset lower extremity pain. The patient reported to have snorted methamphetamine overnight and woke up with severe lower extremity pain as well as inability to move. Surgical history was significant for excision of sublingual glands. Family history: mother was HIV positive; both mother and father had significant history of substance abuse. She drank one to two alcoholic drinks per week and was an everyday smoker, between 1/4 pack and 1/2 pack per day. Her vital signs were significant for tachycardia, tachypnea, and hypotension. Lower extremity examination was positive for tender lower extremities with no palpable dorsalis pedis, posterior tibial, and popliteal pulses bilaterally. Initial lab tests were significant for lactic acidosis, acute kidney injury, EKG with nonspecific ST-T wave changes (), elevated troponin, 1.08 ng/ml, peaked at 3.5 ng/ml and urine drug screen was positive for methamphetamine and marijuana. Hemoglobin 11.9 gm/dl, white blood cells 10.4, platelets 178, sodium 139 mmol/liter, potassium 4.1 mmol/liter, chloride 104 mmol/liter, bicarbonate 20 mmol/liter, BUN 11 mg/dl, creatinine 1.3 mg/liter, blood glucose 141 mg/dl, AST 68 units/liter, ALT 41 units/liter, total bilirubin 0.9 grams/dl, alkaline phosphatase 107 IU/liter, and INR 1.8. Arterial and venous duplex of the lower extremities revealed no blood flow. CT angiogram showed large segment aortic occlusion (4 cm) just beyond the renal arteries and partial occlusive thrombus in the superior mesenteric artery with early ischemia (Figures and ). There were also multiple areas of bilateral renal infarcts left greater than right with the main renal arteries patent bilaterally. Transthoracic echocardiogram showed an echo dense mass, 2.4 cm × 2.8 cm, 1.2 cm × 2.0 cm in size, in the left ventricle with defined margins that are distinct from the endocardium seen throughout systole and diastole, consistent with left ventricular thrombus (Figures –). Ejection fraction was estimated to be 15 %, with increased wall thickness and grade 3 diastolic dysfunction. There was mild to moderate mitral and tricuspid regurgitation with normal valve structure. CT head was obtained due to an altered mental status which was negative for acute bleeding. The patient became profoundly hypotensive which was likely due to cardiogenic shock despite being on maximum vasopressors. She developed limb ischemia due to compartment syndrome requiring fasciotomy. Interventional radiology and vascular surgery were consulted, surgical thrombectomy was done. The patient's status worsened developing rhabdomyolysis, shock liver, and acute kidney injury with severe metabolic acidosis. She could not tolerate continuous renal replacement therapy. The patient had an episode of ventricular fibrillation and expired after three days of being hospitalized.",What is the patient's anion gap in terms of mEq/L?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [104.0, 'mmol/L'], 'Bicarbonate': [20.0, 'mmol/L'], 'Sodium': [139.0, 'mmol/L']}",15,14.25,15.75,"The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 139.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 139.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 139.0 mmol * 1 mEq/mmol = 139.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 139.0 mmol sodium/L converts to 139.0 mEq sodium/L. 
The concentration of chloride is 104.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 104.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 104.0 mmol * 1 mEq/mmol = 104.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 104.0 mmol chloride/L converts to 104.0 mEq chloride/L. 
The concentration of bicarbonate is 20.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 20.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 20.0 mmol * 1 mEq/mmol = 20.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 20.0 mmol bicarbonate/L converts to 20.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 139.0 mEq/L - (104.0 mEq/L + 20.0 mEq/L) = 15.0 mEq/L. Hence, The patient's anion gap is 15.0 mEq/L."
489,39,Anion Gap,lab test,decimal,pmc-4020538-1,Extracted,"A 38-year-old man with a self-reported long-term history of standard cannabinoid use and K2 (a synthetic cannabis) presented to the emergency room with a 2-week history of nausea, vomiting, and severe abdominal pain. He smoked 3-4 times a day, occasionally up to 10 rolls a day with his last K2 use being the night before admission. He denied any other illicit drug use. He reported having similar episodes of nausea and vomiting in the past, which lasted 2-3 days and terminated without medical intervention. Past medical history was significant for nonulcer dyspepsia for which he took nonprescription antacids.
On physical examination, he was afebrile with temperature of 36.8°C, pulse of 89/min, a respiratory rate of 16/min, a blood pressure of 115/73 mmHg, and oxygen saturation of 98% while breathing ambient air. He appeared to be uncomfortable and was curled up in bed holding his abdomen. He was alert, active, and oriented to time, place, and person. He exhibited no nystagmus and had a nonfocal neurological exam. His abdomen was soft but exhibited tenderness in the epigastric and periumbilical regions with decreased bowel sounds but no rebound tenderness or guarding. He noted relief only with hot showering and, on follow-up, would often refuse to come out of the shower to meet the physicians.
Laboratory studies showed mild leukocytosis with a WBC count of 14 × 109/L (normal: 4–11 × 109/L). Serum electrolyte testing revealed a sodium of 123 mmol/L (normal: 135–153 mmol/L), potassium of 3.4 mmol/L (normal: 3.5–5.3 mmol/L), chloride of 74 mmol/L (normal: 98–109 mmol/L), and bicarbonate of 21 mmol/L (normal: 24–31 mol/L). Blood urea nitrogen was 160 mg/dL (normal: 5–26 mg/dL) and creatinine was 4.78 mg/dL (normal: 0.5–1.5 mg/dL). No baseline studies were available for comparison. Amylase, lipase, and liver function tests were normal. Plain abdominal imaging did not reveal any obstruction. Esophagogastroduodenoscopy (EGD) showed mild gastritis with unrevealing histology and microbiology. Conventional urine drug screen, which does not test for synthetic cannabinoids, was negative. His urinalysis was normal except for the presence of hyaline casts. His fractional excretion of sodium (FeNa) was 0.4 and urine sodium level was 10 mmol/L (normal: 10–60 mmol/L). Renal ultrasound was normal. Based on proposed diagnostic criteria for CHS, his self-reported synthetic cannabis use, and cyclic vomiting with negative organic evaluation, diagnosis of Cannabinoid Hyperemesis Syndrome with prerenal acute kidney injury was made. He was given intravenous fluids for his hypovolemia. Ondansetron was given for his nausea and vomiting, which offered no relief. His leukocytosis, nausea, and renal failure completely resolved 72 hours after admission; at that time his serum creatinine was 1.1 mg/dL. He was doing well and stayed off the K2 at outpatient follow-up 2 weeks later.",What is the patient's anion gap in terms of mEq/L?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [74.0, 'mmol/L'], 'Bicarbonate': [21.0, 'mmol/L'], 'Sodium': [123.0, 'mmol/L']}",28,26.6,29.4,"The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 123.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 123.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 123.0 mmol * 1 mEq/mmol = 123.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 123.0 mmol sodium/L converts to 123.0 mEq sodium/L. 
The concentration of chloride is 74.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 74.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 74.0 mmol * 1 mEq/mmol = 74.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 74.0 mmol chloride/L converts to 74.0 mEq chloride/L. 
The concentration of bicarbonate is 21.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 21.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 21.0 mmol * 1 mEq/mmol = 21.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 21.0 mmol bicarbonate/L converts to 21.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 123.0 mEq/L - (74.0 mEq/L + 21.0 mEq/L) = 28.0 mEq/L. Hence, The patient's anion gap is 28.0 mEq/L."
490,39,Anion Gap,lab test,decimal,pmc-5051109-1,Extracted,"A 53-year-old male presented with 1 day duration of acute severe right lower quadrant abdominal pain, sharp, non-radiating associated with fever, chills and nausea but no vomiting or weight loss. On physical exam, his vital signs were blood pressure 126/68 mm Hg, pulse 90/min, respiratory rate 14/min, and temperature 99.4 °F. Abdominal exam revealed distension tenderness to Mcburney’s point, with guarding and rigidity but bowel sounds were normal. Laboratory data showed hemoglobin 13.4 g/dL, hematocrit 40.1%, white count 8.1 × 103/µL, platelets 172 × 103/µL, sodium 133 mmol/L, potassium 4.6 mmol/L, chloride 99 mmol/L, bicarbonate 20 mmol/L, BUN 24 mg/dL, creatinine 2.1 mg/dL and glucose 181 mg/dL. Computed tomography (CT) scan of abdomen showed the perforated appendicitis with two appendicoliths seen in the right lower quadrant (). Laparoscopic appendectomy with drainage of periappendiceal abscess was performed. Surgical pathology of appendix showed moderately differentiated adenocarcinoma with signet-ring cell (< 50% signet ring component) and carcinoid features involving muscular wall (). Tumor was penetrating and perforating the visceral serosa and diffusely infiltrating > 4/5 wall of the proximal portion of appendix with lymphovascular invasion. Special studies showed that the tumor is immunoreactive to CK20 (), focal to CD56, chromogranin (), synaptophysin; negative to CK7 (), TTF-1, PSA and CDx2. Mucin stain is positive (). The immunostains support the diagnosis. Patient was started on chemotherapy and after 3 months, patient complained of abdominal pain for which CT abdomen was performed which showed findings suspicious for spreading cancer. Patient failed chemotherapy and underwent hemicolectomy and peritonectomy as there were seedings on the peritoneum.",What is the patient's anion gap in terms of mEq/L?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [99.0, 'mmol/L'], 'Bicarbonate': [20.0, 'mmol/L'], 'Sodium': [133.0, 'mmol/L']}",14,13.3,14.7,"The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 133.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 133.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 133.0 mmol * 1 mEq/mmol = 133.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 133.0 mmol sodium/L converts to 133.0 mEq sodium/L. 
The concentration of chloride is 99.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 99.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 99.0 mmol * 1 mEq/mmol = 99.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 99.0 mmol chloride/L converts to 99.0 mEq chloride/L. 
The concentration of bicarbonate is 20.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 20.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 20.0 mmol * 1 mEq/mmol = 20.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 20.0 mmol bicarbonate/L converts to 20.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 133.0 mEq/L - (99.0 mEq/L + 20.0 mEq/L) = 14.0 mEq/L. Hence, The patient's anion gap is 14.0 mEq/L."
491,39,Anion Gap,lab test,decimal,usmle-8623,Extracted,"A 36-year-old man is brought to the emergency department by a neighbor with signs of altered mental status. He was found 6 hours ago stumbling through his neighbor's bushes and yelling obscenities. The neighbor helped him home, but found him again 1 hour later slumped over on his driveway in a puddle of vomit. He is oriented to self, but not to place or time. His vitals are as follows: temperature, 36.9°C (98.5°F); pulse, 82/min; respirations, 28/min; and blood pressure, 122/80 mm Hg. Cardiopulmonary examination indicates no abnormalities. He is unable to cooperate for a neurological examination. Physical examination reveals muscle spasms involving his arms and jaw. Laboratory studies show:
Na+ 140 mEq/L
K+ 5.5 mEq/L
CI- 101 mEq/L
HCO3- 9 mEq/L
Urea nitrogen 28 mg/dL
Creatinine 2.3 mg/dL
Glucose 75 mg/dL
Calcium 7.2 mg/dL
Osmolality 320 mOsm/kg
The calculated serum osmolality is 294 mOsm/kg. The arterial blood gas shows a pH of 7.25 and a lactate level of 3.2 mmol/L. Urine examination shows oxalate crystals and the absence of ketones.",What is the patient's anion gap in terms of mEq/L?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [101.0, 'mEq/L'], 'Bicarbonate': [9.0, 'mEq/L'], 'Sodium': [140.0, 'mEq/L']}",30,28.5,31.5,"The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 140.0 mEq/L. 
The concentration of chloride is 101.0 mEq/L. 
The concentration of bicarbonate is 9.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 140.0 mEq/L - (101.0 mEq/L + 9.0 mEq/L) = 30.0 mEq/L. Hence, The patient's anion gap is 30.0 mEq/L."
492,39,Anion Gap,lab test,decimal,pmc-7544303-1,Extracted,"We present the case of a 45-year-old gentleman, known diabetic for 6 years on metformin 1 g, twice a day, with reasonable control (hemoglobin A1c 6.4%). He was admitted to our emergency feeling unwell with 2 days’ history of vomiting and watery diarrhea, also associated crampy periumbilical pain. He denied a history of similar complaints in his companions, no change in his dietary habits preceding symptoms’ onset. He drinks alcohol occasionally; the last drink was 6 months before the presentation—no illicit drug use history. The initial vital signs were normal. Soon later, he became tachycardic with heart rate reaching 120 bpm, blood pressure 127/70 mmHg, and a normal temperature. He looked dehydrated; otherwise, his examination was unremarkable.
Laboratory workup was significant for initially low glucose 2.5 mmol/L (3.3–5.5 mmol/L), high serum creatinine 632 μmol/L (62–106 umol/L), and high blood urea nitrogen of 21 mmol/L (2.8–8 mmol/L). Serum electrolytes were as follows: potassium (K+) 6.3 mmol/L (3.5–5.1 mmol/L), sodium (NA) 144 mmol/L (135–145mmol/L), bicarbonate (HCO3) 5.8 mmol/L (23–29 mmol/L), and serum chloride 99 mmol/L (99–107 mmol/L). Serum aminotransferases were normal (ALT 31 U/L, AST 27 U/L). He had significant high AG metabolic acidosis with PH of 6.8 (7.35–7.45) and AG of 40, lactic acid (LA) strikingly high reaching up to 24 mmol/L (0.5–2.2 mmol/L). With LA of 19 mmol/L, his OG measured 20 with serum osmolarity of 340 mmol/kg (275–295 mmol/kg). Toxicology screening, including serum ethanol, acetaminophen, salicylate, and urine for oxalate crystal, was negative.
Acidosis failed to respond to initial fluid hydration, including intravenous bicarbonate. Thus, the patient underwent 2 sessions of sustained low-efficiency hemodialysis (HD). After HD, his electrolyte disturbances improved, and intravenous fluid hydration continued. Acute kidney injury (AKI) workup, including antinuclear antibodies (ANA), antinuclear cytoplasmic antibodies, creatinine kinase level, and sepsis workup were unremarkable. Starting day 3, the patient was in a polyuric phase, suggestive of acute tubular necrosis (ATN), producing between 3 and 6 L per day, and his serum creatinine was decreasing. He was discharged after 8 days of hospitalization in good condition with a serum creatinine of 140 μmol/L (62–106 μmol/L). Figure shows serum creatinine trend during the hospitalization, Figure depicts serum lactic acid clearance during hospitalization.
Our patient had an AKI with significant lactic acidosis and an OG. Given the significant level of lactic acid, MALA was the likely diagnosis. Our patient was on metformin for a long time, and he did not attempt an overdose; hence, we think that MALA was likely precipitated by dehydration leading to prerenal insult and AKI. Eventually, his prerenal insult led to acute tubular necrosis, as evident by the polyuric phase the patient exhibited on day three.",What is the patient's anion gap in terms of mEq/L?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [99.0, 'mmol/L'], 'Bicarbonate': [5.8, 'mmol/L'], 'Sodium': [144.0, 'mmol/L']}",39.2,37.24,41.16,"The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 144.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 144.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 144.0 mmol * 1 mEq/mmol = 144.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 144.0 mmol sodium/L converts to 144.0 mEq sodium/L. 
The concentration of chloride is 99.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 99.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 99.0 mmol * 1 mEq/mmol = 99.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 99.0 mmol chloride/L converts to 99.0 mEq chloride/L. 
The concentration of bicarbonate is 5.8 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 5.8 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 5.8 mmol * 1 mEq/mmol = 5.8 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 5.8 mmol bicarbonate/L converts to 5.8 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 144.0 mEq/L - (99.0 mEq/L + 5.8 mEq/L) = 39.2 mEq/L. Hence, The patient's anion gap is 39.2 mEq/L."
493,39,Anion Gap,lab test,decimal,pmc-8571802-1,Extracted,"A 54-year-old female with a history of (Global Initiative for Chronic Obstructive Lung Disease stage 3 and group D) multiple COPD exacerbations and one with endotracheal intubation, without home oxygen, 16 pack-year cigarette smoking, and marijuana abuse came to the emergency department for worsening shortness of breath with nonproductive cough, myalgia, and watery diarrhea for three days. Other systems were normal.
At presentation, she was afebrile, with a heart rate of 112 beats per minute, respiratory rate of 30 breaths per minute, and saturation of 95-98% on 3 L of oxygen on nasal cannula. Bilateral wheezing with few crepitations was noted on the bilateral bases of the lungs. The rest of the examination was unremarkable. Labs at the time of admission showed leukocytosis of 15.6 × 109/L (reference range: 4.5-11 × 109/L) with a left shift of neutrophils at 88.3% and relative lymphopenia at 4.5% (0.7 × 109/L). The chemistry panel was near-normal with the following findings: Na+/K+ of 139/3.9 mmol/L, Cl- of 97 mmol/L, elevated HCO3 of 17 mEq/L. Blood urea nitrogen (BUN)/creatinine ratio was 13.0/0.66 mg/dL, with a slightly elevated glucose level of 173 mg/dL. Furthermore, calcium, phosphorus, and magnesium levels were 8.9 mg/dL, 5.3 mg/dL, and 1.9 mg/dL, respectively. Liver function tests showed total bilirubin of 0.5 mg/dL, aspartate transaminase of 14 U/L, alanine transaminase of 13 U/L, alkaline phosphatase of 119 U/L, total protein of 5.9 g/dL, albumin of 3.7 m/dL, and elevated bicarbonate of 35.7 mEq/L. Moreover, urine toxicology was positive for cannabinoids. Polymerase chain reaction (PCR) test for coronavirus disease 2019 (COVID-19) was negative, and influenza, mycoplasma, and Legionella antigen tests were also negative. Lactate dehydrogenase was elevated at 322 U/L (reference range: 125-220 U/L), and total creatine kinase was 43 U/L. D-dimer was 414 ng/mL with a normal coagulation profile with prothrombin time (PT) of 12.8 seconds and activated partial thromboplastin time of 31.3 seconds. PT/international normalized ratio was 1.09. Chest X-ray showed hyperinflation with mild perihilar congestion without any evidence of consolidation and no significant changes compared with the prior study. Computed tomography (CT) without contrast revealed mildly hyperinflated lungs with mild emphysematous changes predominating in the apices, along with scattered small areas of fibrotic changes. No convincing lung consolidation or acute infiltrate pleural effusion was noted, with normal mediastinum, heart size, and unremarkable hila with pericardial effusion (Figure ).
Arterial blood gas (ABG) on 2 L of oxygen via nasal cannula showed pH of 7.299, pCO2 of 75 mmHg, pO2 of 72.9 mmHg, HCO3- of 35 mmol/L, and oxygen saturation of 96%. Sequential Organ Failure Assessment (SOFA) score was less than 2 (less than 9 implies <33.3% mortality), and PaO2/FiO2 ratio was 260. She was admitted to the hospital for acute hypoxic and hypercapnic respiratory failure secondary to COPD exacerbation and was started on methylprednisolone along with albuterol and ipratropium nebulization and intravenous ceftriaxone and azithromycin. Her clinical course worsened on days two and three of admission with tachypnea, fatigue, as well as occasional and multiple episodes of desaturation of up to 86% on 2 L of oxygen via a nasal cannula. She was switched to bilevel positive airway pressure (BiPAP) with inspiratory positive airway pressure/expiratory positive airway pressure of 15/5 mmHg, with a respiratory rate of 15 breaths per minute and FiO2 of 40% due to worsening respiratory status. Two repeat PCR tests for COVID-19 were negative. Blood culture sent at the time of admission grew two organisms later identified as E. faecium and P. agglomerans.
She was fairly compliant with BiPAP, and on day four of admission, she started improving clinically and reported feeling comfortable on 2-3 L of oxygen via a nasal cannula with on and off BiPAP (approximately six to seven hours) during the night. Her ABG on BiPAP with FiO2 of 40% oxygen also showed improvement with pH of 7.339, pCO2 of 63.7 mmHg, pO2 of 87.2 mmHg, HCO3- of 33 mmol/L, and oxygen saturation of 97%. Antibiotic sensitivity analysis of E. faecium and P. agglomerans revealed that both were sensitive to ceftriaxone. Therefore, ceftriaxone and azithromycin were continued for five days, with a continued tapering dose of steroids.
Of note, another set of blood cultures sent on the day of admission and on days two and three during deterioration showed no growth in the subsequent follow-up. On day six of admission, the patient improved significantly and was discharged home with home oxygen therapy with proper instructions regarding the medication and oxygen therapy. On the two-week follow-up at the medical clinic, she reported remarkable improvement in respiratory symptoms and was using oxygen during nights with the occasional need for inhaler use.",What is the patient's anion gap in terms of mEq/L?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [97.0, 'mmol/L'], 'Bicarbonate': [17, 'mEq/L'], 'Sodium': [139.0, 'mEq/L']}",25,23.75,26.25,"The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 139.0 mEq/L. 
The concentration of chloride is 97.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 97.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 97.0 mmol * 1 mEq/mmol = 97.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 97.0 mmol chloride/L converts to 97.0 mEq chloride/L. 
The concentration of bicarbonate is 17 mEq/L. 
Plugging in these values into the anion gap formula gives us 139.0 mEq/L - (97.0 mEq/L + 17 mEq/L) = 25.0 mEq/L. Hence, The patient's anion gap is 25.0 mEq/L."
494,39,Anion Gap,lab test,decimal,pmc-7683122-1,Extracted,"The patient is a 19-year-old female with a history of 6q24-related TNDM and Hashimoto's thyroiditis who was diagnosed with neonatal diabetes mellitus at birth.
She was born to a 25-year-old G3P2 mother, with a weight of 1927 grams, at 36 weeks of gestation via vaginal delivery after induction due to IUGR at an outside hospital. The pregnancy was significant for intrauterine growth restriction noted at 5 months of gestation. The pediatrician was at the delivery, and no resuscitation was needed. Apgar scores were 8 at 1 minute and 9 at 5 minutes. Macroglossia was noted. Umbilical hernia and hypotonia were not found. The infant was noted to have hypoglycemia on day of life one and was given intravenous glucose and went on to develop hyperglycemia. Glucose levels were the 400 mg/dl, and an insulin drip was started. The infant was transferred to the NICU from the outside hospital due to hyperglycemia and concerns for necrotizing enterocolitis (NEC). Due to concerns for NEC, oral feeds were discontinued and she was placed on TPN, providing a steady glucose load. No surgical intervention was necessary for the NEC. Glucose was difficult to control even while on TPN with blood sugar levels ranging from the 100s to >200 mg/dl. At about 1 month of age, glucose levels started dropping and insulin was weaned. During this time, due to an IV infiltrate, IV insulin was briefly discontinued and blood glucose was 268 mg/dl. Insulin infusion was restarted and was discontinued at about 1 month of age. Blood sugar levels ranged between 80 and 150 mg/dl. The infant was discharged shortly afterward, feeding ad lib and checking blood sugar before meals. She required intermittent subcutaneous insulin at home, which was finally discontinued at approximately 4 months of age. Since then, the patient did not require insulin or have diabetes symptoms. All developmental milestones were on time. At 15 years of age, she chipped her tooth and went to the dentist for evaluation. The dentist noted extensive tooth decay. Jaw X-rays showed bone loss of nearly 80% in the left mandible. Due to her history of TNDM, she was sent to her primary care provider for further workup and diabetes screening where blood glucose was 369 mg/dl and urinalysis showed positive ketones. She was sent to the emergency department, and laboratory examination showed blood glucose of 361 mg/dl, Na+ of 131 mEq/L, K+ of 3.4 mmol/L, Cl- of 96 mmol/L, bicarbonate of 19 mmol/L, 2+ urine ketones, and pH of 7.4. HbA1c was 15.4% during her admission. The diabetes autoimmune panel was negative (ICA-512, GAD-65, and Insulin Antibodies).
She endorsed long-standing polydipsia, polyphagia, and polyuria. She denied weight loss, nausea, vomiting, abdominal pain, confusion, blurry vision, fatigue, fever, and difficulty breathing. Family history was negative for autoimmune diseases except for hypothyroidism in the paternal grandmother and maternal great-grandmother. Physical exam showed a weight of 58.4 kg (70th percentile), height of 163 cm (55th percentile), and BMI of 21.98 kg/m2 (70th percentile). She was a well-appearing adolescent without thyromegaly and acanthosis nigricans and had Tanner Stage 5 breast. She was started on basal bolus insulin regimen consisting of 23 units of Glargine at bedtime and fast-acting insulin Lispro 1 unit per 10 grams of carbohydrates with meals.
She received the appropriate diabetes education. Laboratory examination also noted a TSH of 66 IU/ml (reference range: 0.35–5.5 uIU/ml); free T4 was 0.94 ng/dl (reference range: 0.8–1.8 ng/dl), and positive antibodies to thyroid peroxidase was 8580 IU/ml. She was treated with 75 mcg Levothyroxine that was titrated to a dose of 100 mcg. The 6q24 methylation-specific multiplex ligation-dependent probe amplification (MPLA) genetic test for transient neonatal diabetes identified hypomethylation within the 6q24 region. Deletion/duplication analysis ruled out paternal duplication of 6q24. Therefore, the hypomethylation could be the result of either paternal uniparental disomy of chromosome 6 (UPD6) or hypomethylation of the maternal allele. Via testing, UPD6 has been confirmed, meaning both copies of the 6q24 chromosome region in our patient were paternally inherited. This results in an epigenetic phenomena where both copies are still active. Typically, the paternal copy is active and the maternal copy is methylated and turned off. Epigenetic changes are typically de novo, as they depend on the parent of origin and are reset with each pregnancy, rather than DNA sequencing changes. Thus, risk of recurrence for parents, siblings, and offspring is unlikely. After diagnosis and her initial HbA1c of 15.4%, her HbA1c has ranged since then from 6.3% to 6.8%.",What is the patient's anion gap in terms of mEq/L?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [96.0, 'mmol/L'], 'Bicarbonate': [19, 'mmol/L'], 'Sodium': [131.0, 'mEq/L']}",16,15.2,16.8,"The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 131.0 mEq/L. 
The concentration of chloride is 96.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 96.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 96.0 mmol * 1 mEq/mmol = 96.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 96.0 mmol chloride/L converts to 96.0 mEq chloride/L. 
The concentration of bicarbonate is 19 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 19 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 19 mmol * 1 mEq/mmol = 19 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 19 mmol bicarbonate/L converts to 19.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 131.0 mEq/L - (96.0 mEq/L + 19.0 mEq/L) = 16.0 mEq/L. Hence, The patient's anion gap is 16.0 mEq/L."
495,39,Anion Gap,lab test,decimal,pmc-2733967-2,Extracted,"A 26-day-old girl was referred for evaluation of renal failure. She was born at 38+5 weeks' gestational age with a birth weight of 3,200 g. She was well until two days before admission when she developed generalized tonic clonic seizure. At a local clinic, hypocalcemia, hyperkalemia and azotemia were detected and she was referred to us. On admission, generalized edema was noted. Her external genitalia were normal female. Laboratory findings showed: hemoglobin, 9.8 g/dL; cholesterol, 120 mg/dL; total serum protein, 3.7 g/dL; serum albumin, 1.5 g/dL; BUN, 75 mg/dL; serum creatinine, 4.1 mg/dL; total calcium, 5.9 mg/dL; phosphorus, 12.7 mg/dL; sodium, 136 mEq/L; potassium, 5.5 mEq/L; chloride, 113 mEq/L; HCO3- 7.8 mEq/L. Albuminuria and hematuria were detected. An ultrasonogram revealed enlarged kidneys with increased parenchymal echogenicity and poor corticomedullary differentiation. A renal biopsy was performed at the age of 29 days and light microscopy showed small glomeruli with various degrees of mesangial sclerosis (). The tubules were dilated with regenerative activity. Her karyotype was 46 XX. Analysis of the sequence of WT1 exon 9 revealed the presence of a heterozygous G to T base substitution, converting 396Asp to 396Tyr, and a heterozygous 395 Ser (TCC) > Ser (TCA) polymorphism (). Both parents showed normal sequence at these sites. Peritoneal dialysis was commenced with a temporary shift to hemodiafiltration because of dialysate leakage at the exit site. Sustained hypertension (120/80 mmHg) responded to an angiotensin-converting enzyme inhibitor. She was maintained on total parenteral nutrition due to uncontrolled chylothorax that resulted from internal jugular vein catheterization, and the patient died at the age of six months due to multiple serious infections and failure to thrive. Autopsy was not performed.",What is the patient's anion gap in terms of mEq/L?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [113.0, 'mEq/L'], 'Bicarbonate': [7.8, 'mEq/L'], 'Sodium': [136.0, 'mEq/L']}",15.2,14.44,15.96,"The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 136.0 mEq/L. 
The concentration of chloride is 113.0 mEq/L. 
The concentration of bicarbonate is 7.8 mEq/L. 
Plugging in these values into the anion gap formula gives us 136.0 mEq/L - (113.0 mEq/L + 7.8 mEq/L) = 15.2 mEq/L. Hence, The patient's anion gap is 15.2 mEq/L."
496,39,Anion Gap,lab test,decimal,pmc-4530922-1,Extracted,"A 56-year-old male was brought to the emergency department by paramedics for a syncopal episode and inability to move his lower extremities. He complained of abdominal pain and inability to move his legs beginning five hours prior to arrival. He awakened from a nap that afternoon and experienced numbness in both legs, which progressed to paralysis. At baseline, he was ambulatory without any history of weakness and was last ambulatory hours prior. He endorsed occasional pain in his legs when walking at baseline.
He also complained of abdominal pain with nausea and vomiting for two days. He had a history of alcohol use and reported dark-colored emesis and last bowel movement three days prior. On review of symptoms the patient denied any history of headache, dizziness, chest pain, back pain, trauma, fevers, or extremity weakness. He walked longer than a mile the day prior. History from the patient’s wife revealed that he had an episode of altered level of consciousness while on the couch and that finding combined with his abdominal pain and paralysis prompted her to call 911. The patient’s past medical history was significant for hypertension, peripheral arterial disease, and myocardial infarction 10 years prior. His past surgical history included “abdominal stents” and a left carotid stent. His social history was significant for a 25-pack/year history of smoking and daily alcohol. His medications included atenolol and ranitidine.
Physical exam showed an oral temperature of 36.7°C, blood pressure 107/65mmHg, heart rate 99 beats/minute and a respiratory rate of 30 breaths/min, with oxygen saturation on 15L non-rebreather mask of 94%. His weight was 72.5kg and he appeared older than his stated age. He was alert, cooperative and in moderate distress, primarily complaining of pain and cramping in his lower extremities and repeatedly asking staff to straighten out his legs although they were already lying straight and motionless on the gurney. His head exam was unremarkable with the exception of a dry oropharynx. Cervical spine, cardiac, and lung exams were unremarkable. His abdomen was firm and diffusely tender to palpation with generalized rebound and guarding. An irreducible left inguinal hernia was present. He had vomiting, and placement of a nasogastric tube revealed 1.5 liters of coffee-ground emesis. Lower extremities were thin, cool, and without any palpable or Dopplerable pulses in bilateral femoral, popliteal or pedal distribution. There was trace non-reproducible sensation to the mottled lower extremities, and no sensation distal to the ankles. Motor exam was significant for lower extremity paralysis.
Laboratory data consisted of sodium 121mEq/L (135–145), potassium 6.8mEq/L (3.3–4.8), chloride 89mEq/L (101–111), HCO3- 18mEq/L (25–34), BUN 31mg/dL (8–26), creatinine 1.5mg/dL (0.5–1.3), and blood glucose 367mg/dL (70–115). White blood cell 19.1thous/mcL (4.0–10.5), hemoglobin 12.8g/dL (13.5–16.9), lipase 107U/L (22–51), hematocrit 38.8% (39.5–50.0), and platelets 165thous/mcL (150–400). There was a left shift in the neutrophils 16.2thous/mcL (85%) (2.0–8.1). Alkaline phosphate 88IU/L (26–110), AST 84IU/L (8–40), ALT 38IU/L (0.0–60), total bilirubin 1mg/dL (0.0–1.4), total protein 5.4g/dL (6.1–8.2), albumin 2.6g/dL (3.2–5.5). Lactate 7.2mmol/L (0.7–2.1). ABG showed pH of 7.25 (7.38–7.42), pCO2 31.6mmHg (36–42), pO2 123.6mmHg (80–104), bicarbonate 13.5mmol/L (21–27). PT was 17.3sec (9.5–12.3), PTT 45.9sec (24.1–35.1), and INR 1.62 (0.87–1.14). B-type natriuretic peptide 1,950pg/mL (<100). Troponin 2.75ng/mL (<0.03).
Chest radiograph was unremarkable. Electrocardiogram (ECG) showed sinus rhythm at 95 beats/minute with ST elevation inferiorly, anteriorly and laterally (). Bedside ultrasound to evaluate the abdominal aorta was limited. Vascular surgery was consulted prior to CT for concern of a vascular catastrophe. Cardiology was consulted for the patient’s ECG findings consistent with myocardial infarction. The patient went for a non-contrast head CT that was unremarkable and a CT angiogram of the chest, abdomen and pelvis, which was significant for the abdominal aorta with no contrast opacification 2.2cm superior to the bifurcation (), high-grade stenosis of the right common iliac artery, complete occlusion of the left common iliac artery, stents in the celiac artery and superior mesenteric artery (SMA), evidence of occlusion of the proximal SMA and inferior mesenteric artery (IMA), hepatic, splenic, bilateral renal infarctions, left inguinal hernia, bowel obstruction, pneumatosis intestinalis with evidence of ischemic bowel, and aspiration in the right lower lung. General surgery was consulted.
The cardiology service stated that the patient was not a candidate for cardiac catheterization and to start anticoagulation and low-dose aspirin if there was no contraindication or planned surgery. They also recommended thrombolytics for the diffuse thrombotic disease. The patient did have an echocardiography study that revealed an ejection fraction of 35% and multiple regional wall motion abnormalities. General surgery recommended comfort measures as he was not a surgical candidate. Vascular surgery commented that bypass would be futile and if patient survived, would be a candidate for extra-anatomical axillo-bifemoral bypass in the future. The patient was admitted to the medical intensive care unit for broad-spectrum antibiotics and a heparin drip and succumbed to his illness the following day.",What is the patient's anion gap in terms of mEq/L?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [89.0, 'mEq/L'], 'Bicarbonate': [18.0, 'mEq/L'], 'Sodium': [121.0, 'mEq/L']}",14,13.3,14.7,"The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 121.0 mEq/L. 
The concentration of chloride is 89.0 mEq/L. 
The concentration of bicarbonate is 18.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 121.0 mEq/L - (89.0 mEq/L + 18.0 mEq/L) = 14.0 mEq/L. Hence, The patient's anion gap is 14.0 mEq/L."
497,39,Anion Gap,lab test,decimal,usmle-5230,Extracted,"A 35-year-old man is found unconscious outside his home by a passing neighbor and is brought to the emergency department by ambulance. Cardio-pulmonary resuscitation is performed and the patient awakens but remains somnolent and confused. He is unable to answer questions or provide any medical history. His temperature is 98.2°F (36.8°C), blood pressure is 108/62 mmHg, pulse is 110/min and respirations are 20/min. Physical exam shows decreased arousal. Pupils are round, symmetric, and reactive to light bilaterally. Fundoscopy is normal. The patient winces to palpation of the epigastric region and bilateral costovertebral angles. Initial labs are drawn and are shown below:

Serum:
Na+: 137 mEq/L
K+: 3.1 mEq/L
Cl-: 92 mEq/L
HCO3-: 6 mEq/L
BUN: 36 mg/dL
Glucose: 100 mg/dL
Creatinine: 1.7 mg/dL

Bladder catherization is notable for mildly bloody urine and microscopic analysis is shown in Figure A.",What is the patient's anion gap in terms of mEq/L?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [92.0, 'mEq/L'], 'Bicarbonate': [6.0, 'mEq/L'], 'Sodium': [137.0, 'mEq/L']}",39,37.05,40.95,"The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 137.0 mEq/L. 
The concentration of chloride is 92.0 mEq/L. 
The concentration of bicarbonate is 6.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 137.0 mEq/L - (92.0 mEq/L + 6.0 mEq/L) = 39.0 mEq/L. Hence, The patient's anion gap is 39.0 mEq/L."
498,39,Anion Gap,lab test,decimal,usmle-4969,Extracted,"A 38-year-old female presents to the emergency department for cough. She reports that two days ago she developed a nonproductive cough with moderate shortness of breath. On review of systems, the patient also endorses chills and sweats as well as several episodes of diarrhea over the past three days. Her husband also reports that the patient seemed confused this morning when he spoke to her before he left for work. The patient’s past medical history is significant for diabetes mellitus type II for which she takes metformin and glipizide. She drinks 8-10 beers per week and has a 15 pack-year smoking history. She works as a sales manager at a local retail company. Her temperature is 102.6°F (39.2°C), blood pressure is 126/72 mmHg, pulse is 82/min, and respirations are 18/min. On physical exam, she is alert and oriented to person and place only. She has crackles bilaterally extending up to the mid-lung fields. Her abdomen is soft and non-distended without rebound or guarding. Laboratory testing is performed and reveals the following:

Serum:
Na+: 129 mEq/L
K+: 3.6 mEq/L
Cl-: 99 mEq/L
HCO3-: 17 mEq/L
Urea nitrogen: 16 mg/dL
Creatinine: 1.1 mg/dL

Leukocyte count: 16,300/mm^3
Hemoglobin: 13.2 g/dL
Mean corpuscular volume: 87 µm^3
Platelet count: 348,000/mm^3

A chest radiograph is performed and can be seen in Figure A.",What is the patient's anion gap in terms of mEq/L?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [99.0, 'mEq/L'], 'Bicarbonate': [17.0, 'mEq/L'], 'Sodium': [129.0, 'mEq/L']}",13,12.35,13.65,"The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 129.0 mEq/L. 
The concentration of chloride is 99.0 mEq/L. 
The concentration of bicarbonate is 17.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 129.0 mEq/L - (99.0 mEq/L + 17.0 mEq/L) = 13.0 mEq/L. Hence, The patient's anion gap is 13.0 mEq/L."
499,39,Anion Gap,lab test,decimal,pmc-6191008-1,Extracted,"We present a case of 19-year-old male patient with no significant past medical history who presented with cough, greenish sputum, severe nausea, vomiting, and diarrhea for four days. It was associated with subconjunctival hemorrhage which prompted him to seek for emergent care. The patient reported sore throat for three weeks prior which was treated with over-the-counter cold medications. Initial vitals reported a temperature of 98.6°F, heart rate 82 beats per minute, blood pressure 156/85 mmHg, and respiratory rate 20 per minute. On physical exam, the oropharynx did not show erythema or exudates, no palpable lymphadenopathy. Chest and abdominal exams were benign. Labs showed white cell count 12,800/uL, hemoglobin 14.1 g/dL, and platelet 154,000/uL, sodium 133 mmol/L, potassium 4.5 mmol/L, chloride 97 mmol/L, bicarb 19 mmol/L, blood urea nitrogen (BUN) 95 mg/dL, creatinine 8.9 mg/dL, calcium 9.1 mg/dL, and liver function tests were normal. Urine analysis showed amber color urine, specific gravity >1.030, pH 5, protein >300 mg/dL, negative glucose, large blood, trace ketones, moderate bilirubin, negative nitrite, negative leukocytes, white blood cell (WBC) 10–25/HPF, red blood cell (RBC) 10–25/HPF, hyaline cast 10–25/LPF, and granular cast 0–2/LPF. Estimated 24-hour urinary protein excretion was 0.6 g/day. He was admitted and given volume resuscitation and broadly covered with antibiotics by his primary service. Nephrology was consulted in view of acute renal failure, proteinuria, and hematuria. Initial differential diagnoses of his acute kidney injury included PSGN, severe dehydration, IgA nephropathy, and vasculitis. Rapid strep A screening and throat swab culture were negative. C3 and C4 complements were <40 and <8 mg/dL, respectively. Total complement level was <10 U/mL. Anti-DNASE B antibody titer was 770 U/mL, and anti-streptolysin O titer was 285 IU/mL. Autoimmune workup was negative except antinuclear antibody titer of 1:160, and positive cryoglobulin with low cryoprecipitate. Computed tomography (CT) abdomen and pelvis without contrast showed small bilateral pleural effusions, no renal masses or obstruction as well as normal appearing ureters and bladder. With supportive measures, creatinine improved initially, but blood urea nitrogen got worse. On day three of admission, he developed pulmonary congestion and diuresis was tried without success. He subsequently developed uremic symptoms. Intermittent hemodialysis was started as supportive therapy for PSGN, volume overload, and uremic symptoms. In spite of aggressive conservative therapy, he continued to be hypoxemic with persistent bilateral pulmonary infiltrates. It was suspected that he had sequelae of pulmonary-renal syndrome despite negative serology. Thus, he underwent bronchoscopy and bronchoalveolar lavage which ruled out alveolar hemorrhage. He also underwent renal biopsy on day 22 of hospitalization. Renal biopsy identified acute tubular injury, enlarged glomeruli, endocapillary proliferation, neutrophils on light microscopy (Figure ), granular staining in capillary loops for C3 on direct immunofluorescence (Figure ), and subepithelial hump-like immune deposits on electron microscopy (Figure ). He had no evidence of tubular atrophy or interstitial fibrosis. The biopsy findings were consistent with PSGN. He was intubated for acute hypoxemic respiratory failure, and intravenous pulse dose steroids were initiated. He received three days of 1 g intravenous methylprednisolone followed by 500 mg daily for six days. The serum creatinine rapidly came down with daily improvement in urine output without further dialysis requirements. The trend of serum creatinine in relation to hemodialysis and steroids therapy is demonstrated in Figure . He was discharged with 20 days tapering course of oral prednisone. On the day of discharge, his serum creatinine was 1 mg/dL. On follow-up, renal function remained to be normal. He no longer required supplemental oxygen, and prednisone was tapered off. The degree of proteinuria and hypertension also improved significantly.",What is the patient's anion gap in terms of mEq/L?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [97.0, 'mmol/L'], 'Bicarbonate': [19.0, 'mmol/L'], 'Sodium': [133.0, 'mmol/L']}",17,16.15,17.85,"The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 133.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 133.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 133.0 mmol * 1 mEq/mmol = 133.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 133.0 mmol sodium/L converts to 133.0 mEq sodium/L. 
The concentration of chloride is 97.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 97.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 97.0 mmol * 1 mEq/mmol = 97.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 97.0 mmol chloride/L converts to 97.0 mEq chloride/L. 
The concentration of bicarbonate is 19.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 19.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 19.0 mmol * 1 mEq/mmol = 19.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 19.0 mmol bicarbonate/L converts to 19.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 133.0 mEq/L - (97.0 mEq/L + 19.0 mEq/L) = 17.0 mEq/L. Hence, The patient's anion gap is 17.0 mEq/L."
500,39,Anion Gap,lab test,decimal,pmc-3544066-1,Extracted,"A 60-year-old lady, a known case of type 2 diabetes mellitus for 15 years and hypertension for 3 years, presented to the clinic with fever, chills, and bilateral loin pain of 4 days duration. No other co-morbidities like chronic kidney disease or coronary artery disease were known in her in the past and she was apparently in normal state of health prior to the presenting illness.
She developed high-grade fever with chills and rigors. Fever was accompanied by dysuria and bilateral loin pain which was constant and aching in nature. Two days following the onset of fever and loin pain, she developed hematuria and subsequently her urine output started declining and she was anuric at the time of admission to the hospital. She also experienced severe generalized muscle ache. There was no arthralgia, skin rash or hemoptysis. Her medications included glipizide and multivitamin.
At the time of admission, she was conscious, irritable, febrile, and tachypneic. Her conjunctivae appeared suffused. There was no icterus, purpura, or lymphadenopathy. Muscle tenderness in limbs was noted. Her pulse was 104/min, BP–110/70 mm Hg, respiratory rate 23/min, temperature 101°F, oxygen saturation 95% at room air. Rales were appreciated in the basal regions of the chest. Examination of abdomen revealed no organomegaly, but both renal angles were tender on palpation.
Investigations revealed hemoglobin of 10.8 g/dL; leukocyte count of 28400 cells/μL; differential count revealed polymorphs 91%, lymphocytes 8%; platelet count 60000/μL. The blood film revealed normocytic normochromic RBCs, neutrophilic leucocytosis with toxic granulations. No hemoparasites were detectable. Urine analysis revealed 1+ protein, 40-50 WBCs/high power field, 20-25 RBCs/high power field, bile salts and pigments - negative, ketone-negative. Blood sugar on admission was 208 mg/dL; blood urea nitrogen 74 mg/ dL; serum creatinine 5.4 mg/dL; serum sodium 138 mmol/L; potassium 4.8 mmol/L; bicarbonate 7.0 mmol/L; chloride 104 mmol/L; pO290 mm Hg., pCO226 mm Hg. Serum total bilirubin measured 2.1 mg/dl; SGOT – 44 U/L; SGPT – 34 U/L; alkaline phosphatase – 242 U/L; serum total protein 6.5 g/L; and serum albumin measured 2.4 g/ dL. Urine culture revealed significant growth of E. Coli., (>105 colony forming units/ ml) sensitive to ciprofloxacin, amikacin, and ceftriaxone. However, blood culture grew no organism. Ultrasonogram of the abdomen revealed bilaterally enlarged kidneys with hydroureteronephrosis. No radioopaque lesion could be made out in the ultrasonogram or X-ray KUB region. An MR urogram performed to further evaluate the obstruction [] revealed bilateral renal papillary necrosis (RPN) with bilateral midureteric obstruction.
Thrombocytopenia and severe myalgia prompted a search for leptospirosis, a common cause of AKI in this part of the country. The organism could not be isolated from the urine or blood. However, the MAT (Microscopic Agglutination Test) done in the second week of the illness detected Leptospira icterohemorrhagica; serovar hardjo. Serologic investigations for dengue were negative.
She was subjected to a USG-guided renal biopsy which revealed acute tubular necrosis, interstitial inflammation, and mild mesangial proliferation [Figure –].
The patient was treated with hemodialysis and her antibiotics included benzyl penicillin and ceftriaxone. Gradually, the fever settled, her general condition stabilized, and renal function started to improve. By the 20th day of the illness, serum creatinine was 1.7 mg/ dL and platelet count was 190,000/μL and patient was discharged. Follow-up at 3 months revealed a serum creatinine of 1.4 mg/dL.",What is the patient's anion gap in terms of mEq/L?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [104.0, 'mmol/L'], 'Bicarbonate': [7.0, 'mmol/L'], 'Sodium': [138.0, 'mmol/L']}",27,25.65,28.35,"The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 138.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 138.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 138.0 mmol * 1 mEq/mmol = 138.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 138.0 mmol sodium/L converts to 138.0 mEq sodium/L. 
The concentration of chloride is 104.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 104.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 104.0 mmol * 1 mEq/mmol = 104.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 104.0 mmol chloride/L converts to 104.0 mEq chloride/L. 
The concentration of bicarbonate is 7.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 7.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 7.0 mmol * 1 mEq/mmol = 7.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 7.0 mmol bicarbonate/L converts to 7.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 138.0 mEq/L - (104.0 mEq/L + 7.0 mEq/L) = 27.0 mEq/L. Hence, The patient's anion gap is 27.0 mEq/L."
501,39,Anion Gap,lab test,decimal,pmc-7947333-1,Extracted,"A 16-year-old female with a five-day history of headache, fever, persistent vomiting, and complete loss of vision in both eyes was referred to the Ophthalmology unit from the children's emergency room of Abia State University Teaching Hospital. One month prior to presentation, she noticed a gradual, painless reduction in vision which was ignored.
The eye examination findings were as follows:
Visual acuity was no light perception in both eyes. A left divergent squint was noted with defective inward movement of the left eye. Also noted was a right nasal subconjunctival haemorrhage. Both corneas were clear. Both pupils were markedly dilated and not reactive to light (). On fundoscopy/slit lamp examination, there was a white pupil, marked disc, and retina oedema. () Soft and hard exudates were seen, left hazy media, and a macular scar was noted. The intraocular pressure (IOP) were 37mmHg and 28mmHg in the right and left eyes, respectively.
A diagnosis of ocular hypertension, and bilateral ERD was made, secondary to CRF and hypertensive complications. Senior Loken syndrome was the differential diagnosis.
A B-mode ocular ultrasound was requested.
She was placed on gutt 0.005% latanoprost/0.5% timolol, a drop in each eye, nocte; gutt 0.1% brimonidine, a drop in each eye, twice daily; gutt 0.1% diclofenac, vitreolent (0.3% potassium iodide and 0.3% sodium iodide) and 0.1% flurometholone, a drop in each eye, q.i.d.
The latanoprost/timolol and brimonidine are ocular antihypertensives used for the reduction of the IOP. Diclofenac was used for pain and inflammation. Fluorometholone is a low dose steroid used for its anti-inflammatory properties.
She was reviewed by the physicians and the following parameters were noted:
On presentation, her metabolic status showed the level of urea: 40.7 m/l (2.4–8.3), creatinine: 11.92mg/dl (0.6–1.1), potassium: 6.7 (3.4–5.2), chlorine: 91 (96–107), sodium: 133 (138–149), bicarbonate: 14 (24–30). Random blood sugar 245mg/dl; the urine specific gravity was 1.020, PH was 6.0, protein +++. Blood+++.
The systemic blood pressure (BP) was 220/140mmHg (>99 percentile for age). Systemic hypertension was managed with amlodipine 10mg daily, lisinopril 10mg daily, and intravenous furosemide 20mg daily. The hemoglobin level was 7g/dl on admission and she was transfused with 6 units of whole blood all through her stay in the hospital. A dialysis regimen of 3 times weekly was also recommended.
The B-mode ocular ultrasound scan showed normal sized and shaped globes. ( and ) The anterior chambers and the lenses were normal. There were thick echogenic membranes which are V-shaped, attached to the optic disc and ora serrata in the vitreous body on both sides. There were scattered ill-defined collections of slightly echogenic particles as well as a freely mobile membrane in the left vitreous body. The optic nerve shadows were normal. There was limited medial movement of the left eye. The movements of other extraocular muscles were within normal limits. An impression of bilateral retinal detachment with left-sided vitreous hemorrhage was made.
A renal ultrasound scan showed bilateral small kidneys measuring 8.61cm × 3.4cm and 8.31 × 4.28cm on the right and left sides respectively (). (Normal kidney sizes for her age are 10.74±1.35cm and 11.0 ±1.15cm on the right and left side, respectively.) There was a grade 3 increase in renal parenchymal echoes with the loss of corticomedullary echo differentiation. There were no renal cysts, calculi, or calyceal dilatation. Also noted was pelvic ascites. A diagnosis of bilateral chronic renal parenchymal disease with pelvic ascites was made.
She was discharged on request one month after admission and was placed on a weekly follow-up at the pediatric outpatient clinic.
In the third month of follow up, the ophthalmic review showed improvement of left eye visual acuity to hand movement. There was a reduction in the IOP to 35mmHg and 23mmHg in the right and left eyes, respectively. This recording was after her fourth hemodialysis. At this time, the systemic BP was 160/100mmHg.
The patient was inconsistent with hemodialysis due to financial constraints. She had only six hemodialysis treatments over seven months, prior to her demise.",What is the patient's anion gap in terms of mEq/L?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [91.0, 'mEq/L'], 'Bicarbonate': [14.0, 'mEq/L'], 'Sodium': [133.0, 'mEq/L']}",28,26.6,29.4,"The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 133.0 mEq/L. 
The concentration of chloride is 91.0 mEq/L. 
The concentration of bicarbonate is 14.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 133.0 mEq/L - (91.0 mEq/L + 14.0 mEq/L) = 28.0 mEq/L. Hence, The patient's anion gap is 28.0 mEq/L."
502,39,Anion Gap,lab test,decimal,pmc-4851541-1,Extracted,"A 6-year-old boy was admitted to our department due to vomiting, weakness, polyuria, polydipsia, irritability and weight loss in the last few weeks. The patient is the third child of the fourth pregnancy, one of which ended up with abortion. He was born at term, through Cesarean section, weighting 3400 g. Down syndrome was suspected clinically at birth and confirmed by karyotyping (47XX, t21).
The body weight on admission was 14.5 kg and the body height was 93 cm (20th and 5th percentile for sex and age in Down syndrome, respectively) ().
Typical features of Down syndrome were present, including typical facies and generalized hypotonia. A 3/6 heart murmur was heard on auscultation, and transthoracic echocardiography revealed a low grade aortic regurgitation. The rest of his physical examination was unremarkable.
Laboratory studies revealed red blood cell count 2.14 × 1012/l, Hb 6.1 gr/dL, Htc 17.5%, platelet count 272000/mm3, white blood cell count 7800/mm3, ESR 60 mm/h, CRP 26 mg/l, urea 12.7 mmol/1, creatinine 160 umol/1, Na 136 mEq/L, K 2.7 mEq/L, Cl 108 mEq/L, Ca 9.8 mg/dL, ionised Ca 1.28 mmol/1, Mg 1.0 mmol/1, total serum proteins 59.6 g/l, albumins 32.3 g/l, fasting blood glucose 5.6 mmol/l, cholesterol 6,1 mmol/l, triglycerides 2.3 mmol/l and alkaline phosphatase 49 U/l. Results of the capillary blood gas analysis were as follows: pH 7.25, PCO2 26 mmHg, HCO3 14 mEq/L.
Routine urine analysis showed mild proteinuria (+) and negative glucose. Urine microscopy showed 15 erythrocytes/hpf, 20 leucocytes/hpf and 20-30 bacteria/hpf; specific gravity was 1.005, and urinary pH was 7.0. Urine culture resulted positive for E. Coli.
Urinary uric acid was low at 774.0 umol/24h (normal values 1480-4430 umol/24h) as was citrate 21 mg/24h (normal value >115mg/24h). The urine calcium to creatinine ratio was 1.2 mmol/mmol (normal value < 1.1 mmol/mmol). In the view of normal anion gap hyperchloremic metabolic acidosis, alkaline urine and hypokalemia the diagnosis of dTRA was made.
Additional analysis searching for etiology of dTRA revealed serum 1,25-dihydroxyvitamin D 1.2 ng/ml (normal values 10.8-54 ng/ml), parathyroid hormone 27.2 pg/ml (normal values 6.5-36.8 pg/ml), free serum T4 2.20 pmol/l (normal values 10.3-25.8 pmol/l) and thyroid-stimulating hormone >1000.0 mU/l (normal values 0.54-4.21 mU/l). Prolactin was 163.9 ng/mL (normal values 3.2-20 ng/mL), while other hormonal profiles such as adrenocorticotropic hormone, luteinizing hormone, follicle-stimulating hormone and growth hormone were normal. Anti-thyroid peroxidase (TPO) antibody was >1000.0 IU/ml (normal value <50 IU/ml) and Thyroglobulin (hTg) was 3.41 ng/ml (normal values 0.2-70.0 ng/ml). Hence, Hashimoto thyroiditis as a possible cause was postulated. Moreover, antinuclear antibodies (ANA) test resulted negative.
The renal ultrasound showed hyper-echoic regions in the renal medulla consistent with bilateral nephrocalcinosis grade I (), also confirmed by abdominal CT (). Brain magnetic resonance imaging revealed pituitary enlargement ().
Treatment and follow up
Intravenous rehydration was started. The bicarbonate deficit was calculated, and KCl was added after the patient had his first urinary void. Blood gas analysis after 12 hours revealed increasing pH, HCO3 and K values. Packed red blood cells were then administered. The patient was put on potassium citrate and thyroid hormone substitution therapy. Also, intravenous antibiotherapy and oral ferrous supplements were started to treat urinary tract infection and anemia, respectively. On follow-up after six months, no evidence of metabolic acidosis and a nearly normal serum potassium level (3.4 mEq/L) were found. Urinary random analysis was normal. Patient’s weight was 16 kg and his height 98 cm (25th and 10th percetile, respectively). His thyroid hormone profile was within normal range. Also, prolactin, cholesterol, triglycerides and complete blood count analysis were normalizing. The patient is on regular follow-up.",What is the patient's anion gap in terms of mEq/L?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [108.0, 'mEq/L'], 'Bicarbonate': [14.0, 'mEq/L'], 'Sodium': [136.0, 'mEq/L']}",14,13.3,14.7,"The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 136.0 mEq/L. 
The concentration of chloride is 108.0 mEq/L. 
The concentration of bicarbonate is 14.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 136.0 mEq/L - (108.0 mEq/L + 14.0 mEq/L) = 14.0 mEq/L. Hence, The patient's anion gap is 14.0 mEq/L."
503,39,Anion Gap,lab test,decimal,pmc-4465706-1,Extracted,"A 76-year-old female with type 2 diabetes mellitus (hemoglobin A1c 6.3 on metformin therapy), overweight (BMI 28), and history of benzodiazepine and opiate use was found at home confused and lethargic, surrounded by water bottles containing pink fluid. A red-and-white pill with a #5 inscribed (likely acetaminophen/oxycodone) was next to her, along with dark brown emesis stains. She was taking high doses of acetaminophen (sometimes exceeding 8 Extra Strength tabs daily) for back and leg pain for the past year. She used to take hydrocodone/acetaminophen but was no longer being prescribed this medication. She had been depressed and was previously on sertraline but had self-discontinued the drug for unknown reasons. Although she was never formally diagnosed with dementia, her daughter mentioned she had difficulty taking care of herself and was not eating, drinking, and taking medications appropriately for several weeks at least. She became progressively somnolent and was admitted to the ICU.
On admission, venous blood gas revealed serum pH 6.84, serum bicarbonate 5.8 mmol/L, Na = 138 mmol/L, Cl = 110 mmol/L, consistent with an anion gap metabolic acidosis. Other laboratory values included BUN 52.6 mg/dL, creatinine = 2.1 mg/dL, elevated beta-hydroxybutyrate (4.2 mmol/L), normal lactate 1.5 mmol/L, and random blood sugar 213 mg/dL. See for additional laboratory values. Serum osmolality was elevated at 324 mOsm/kg. As her calculated osmolality was 306.6 mOsm/kg (Na = 138 mmol/L, BUN = 52.6 mg/dL, and glucose = 213 mg/dL), there was an osmolal gap of 17.4 mOsm/kg. Her potassium was 7.5 mmol/L, but an EKG showed no peaked T waves (). However, she was given intravenous bicarbonate, insulin, glucose, calcium, and nebulized albuterol to treat the hyperkalemia. Given the elevated anion and osmolal gap and suspicion for ethylene glycol or methanol ingestion, 2 doses of fomepizole (670 mg IV Q12H) and 2 hemodialysis sessions were initiated while drug levels of these alcohols were still pending.
Serum and urine drug screens returned negative for ethylene glycol, methanol, ethanol, isopropanol, acetaminophen, and salicylates, but there were elevated levels of acetone (11 mg/dL) in the urine. Serum acetone was however not detectable. Her daughter later reported seeing a bottle of nail polish remover in her mother's house, though a direct ingestion history was not available. Due to the elevated beta-hydroxybutyrate and acetone levels, starvation ketosis was also entertained, and the patient was given thiamine along with intravenous glucose followed by enteral nutrition with close monitoring for refeeding syndrome. After a 5-day stay in the ICU, her mental status improved with supportive care. She was unable to clearly recount what occurred prior to her hospital admission, however. Creatinine returned to baseline of 0.8 mg/dL. She was transferred to the general floor and discharged to a nursing facility.",What is the patient's anion gap in terms of mEq/L?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [110.0, 'mEq/L'], 'Bicarbonate': [5.8, 'mEq/L'], 'Sodium': [138.0, 'mEq/L']}",22.2,21.09,23.31,"The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 138.0 mEq/L. 
The concentration of chloride is 110.0 mEq/L. 
The concentration of bicarbonate is 5.8 mEq/L. 
Plugging in these values into the anion gap formula gives us 138.0 mEq/L - (110.0 mEq/L + 5.8 mEq/L) = 22.2 mEq/L. Hence, The patient's anion gap is 22.2 mEq/L."
504,39,Anion Gap,lab test,decimal,pmc-6031073-1,Extracted,"A 57-year-old African American male with past medical history of coronary artery disease, systolic heart failure, alcohol abuse, and stage-IV sarcoidosis on long-term oral prednisone at 10 mg daily for over two years presented with massive hematemesis and melena that started the night before his arrival to the Emergency Department. Upon physical examination, the patient appeared pale and was noted to have tachycardia, hypotension, and hematochezia. He denied any recent alcohol intake, chest pain, abdominal pain, and abdominal or rectal trauma. Vital signs consisted of a blood pressure of 84/33 mmHg, heart rate of 118 bpm, room air saturation of 92%, and temperature of 98.8 degrees Fahrenheit (37.1 degrees Celsius). He was admitted to the medical ICU for hypovolemic shock secondary to massive bleeding that required immediate endotracheal intubation for airway protection. An initial blood work showed a hemoglobin count of 13.9 g/dL, white blood cell count of 18.7 K/UL, platelet count of 159 K/UL, sodium of 140 mmol/L, potassium of 3.8 mmol/L, chloride of 101 mmol/L, bicarbonate of 9.0 mmol/L, calcium of 2.2 mmol/L, albumin of 2.7 g/dL, CRP of 233 mg/L, ESR of 36 mm/hr, BUN of 17 mg/dL (6.07 mmol/L), creatinine of 1.5 mg/dL (132.6 Umol/L), lactic acid of 17.0 mmol/L, BNP of 1140.63 pg/ml, total bilirubin of 0.4 mg/dL, troponins of 0.020 ng/mL, and CK-MB of 408 ng/mL. Resuscitation was initiated with administration of isotonic solutions, blood transfusions, and initiation of vasoactive medications, and pantoprazole drip was provided. An initial urgent endoscopy revealed a bleeding Dieulafoy lesion, which was immediately clipped. Acute kidney injury was addressed with aggressive fluid resuscitation as evident by increase in BUN of 33 mg/dL (11.78 mmol/L) and creatinine of 2.9 mg/dL (256.33 Umol/L). CT scan of abdomen performed to rule out ischemic colitis in the setting of progressive abdominal distention showed a diffuse pericolonic inflammation most pronounced at the rectosigmoid colon. Repeat endoscopy showed multiple ulcerated lesions of the gastric mucosa () with a biopsy that revealed necrotic debris with acute leukocytic exudate and numerous variably sized, 90-degree angulated fungal hyphae favoring mucormycosis (). Intravenous liposomal amphotericin-B (5 mg/kg/day at 60 kg weight) was started at a dose of 300 mg daily. Due to deterioration of renal function on the second day, treatment was switched to oral suspension of posaconazole at a dose of 400 mg twice a day for a total of 6 days (of note, no levels of posaconazole were drawn during hospital course). Repeat CT scan of the abdomen showed mild-to-moderate hydroureter with hydronephrosis and bladder wall thickening Figures and . Cystoscopy showed distorted anatomy of bladder lumen with multiple mounds of tissues all throughout the bladder most notable in the trigone with failure to locate ureteral orifices. Random biopsies taken from the bladder tissue also showed necrotic debris with active inflammatory and numerous variably sized angulated fungal hyphae consistent with Mucorales species. Once bladder biopsy confirmed Mucor spp, treatment was switched from posaconazole to intravenous isavuconazonium sulfate at a dose of 372 mg every eight hours for 48 hours as loading dose and then to an oral dose of 372 mg daily. Unfortunately, no sensitivity of the isolate to the newer triazoles was available. Surgical approach was considered; however, given patient's frail state and multiple comorbidities, such approach was deferred. Hydronephrosis significantly improved after placement of bilateral nephrostomy tubes. In addition, continuous bladder irrigation with amphotericin-B was given for localized bladder infection for a total of 5 days. A three-way Foley catheter was inserted for continuous amphotericin-B bladder irrigation where 200 ml of medication was administered via catheter; then, the catheter was clamped for 90 minutes and drained to gravity every six hours. After three weeks of systemic treatment with antifungals, a third endoscopy showed only inflammatory changes with a pathologic report, in which mucormycosis was no longer appreciated. His kidney function improved and remained stable after clamping and removal of his nephrostomy tubes. The patient completed 6 months of therapy with 372 mg of oral isavuconazonium sulfate per day. He is currently at home with resolution of his symptoms and no clinical evidence of relapse after 12 months since completion of his treatment.",What is the patient's anion gap in terms of mEq/L?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [101.0, 'mmol/L'], 'Bicarbonate': [9.0, 'mmol/L'], 'Sodium': [140.0, 'mmol/L']}",30,28.5,31.5,"The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 140.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 140.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 140.0 mmol * 1 mEq/mmol = 140.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 140.0 mmol sodium/L converts to 140.0 mEq sodium/L. 
The concentration of chloride is 101.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 101.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 101.0 mmol * 1 mEq/mmol = 101.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 101.0 mmol chloride/L converts to 101.0 mEq chloride/L. 
The concentration of bicarbonate is 9.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 9.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 9.0 mmol * 1 mEq/mmol = 9.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 9.0 mmol bicarbonate/L converts to 9.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 140.0 mEq/L - (101.0 mEq/L + 9.0 mEq/L) = 30.0 mEq/L. Hence, The patient's anion gap is 30.0 mEq/L."
505,39,Anion Gap,lab test,decimal,pmc-4400567-1,Extracted,"A 61-year-old woman with history of Type 2 diabetes, hypertension and gout developed worsening hypertension and new-onset hematuria. Evaluation by her cardiologist showed hypochromic and microcytic anemia with hemoglobin 9.4 mmol/L (normal range 8.4–10.9 mmol/L) and AKI with serum creatinine 710.0 µmol/L (baseline <133 µmol/L). The patient was transferred to a tertiary referral hospital for further evaluation of AKI.
On physical examination, she appeared acutely ill. Temperature was 37.4°C, blood pressure 176/89 mm Hg, pulse 63 and respirations 21/min. Physical examination demonstrated normal heart sounds with no murmur, clear lungs, a soft, nontender, obese abdomen with no organomegaly and 2+ pitting edema of the lower extremities bilaterally. There was no skin rash. Laboratory data demonstrated sodium 138 mmol/L, potassium 4.7 mmol/L, chloride 106 mmol/L, bicarbonate 18 mmol/L, calcium 2.2 mmol/L, phosphorus 1.1 mmol/L, BUN 8.8 mmol/L, creatinine 790 µmol/L, glucose 12.5 mmol/L, total serum protein 61.0 g/L and albumin 31.0 g/L. Serum titers of antinuclear antibody, antidouble-stranded DNA, c-antineutrophil cytoplasmic antibody and antiglomerular basement membrane (GBM) antibodies were negative. Complement levels (C3 1.5 g/L, C4 0.4 g/L) were within normal limits. Serum and urine protein electrophoresis revealed no monoclonal spike. However, p-ANCA was >100 kU/L (normal <2.8 kU/L) and antimyeloperoxidase was >1:640 (normal <6 kU/L). Urinalysis showed proteinuria and microscopic hematuria with dysmorphic red blood cells. Proteinuria was 15.0 g/24 h. Renal ultrasonography showed the right kidney 10.4 cm and the left 11.2 cm in length. There was no history of alcohol abuse or smoking. She had poorly controlled Type 2 diabetes and hypertension for 10 years, complicated by neuropathy. She had no familial history of kidney disease. A percutaneous renal biopsy was performed to assess the cause of her rapidly progressive glomerulonephritis.
The renal biopsy specimen included two pieces of cortex containing nine glomeruli, four of which were globally sclerosed. There was mild increase in mesangial matrix and cellularity but no endocapillary proliferation. The GBM showed very rare spikes and rare holes (), segmental corrugation and split appearance. Two glomeruli had fibrinoid necrosis with fibrocellular crescents and segmental sclerosis with adhesions (). There was ∼40% interstitial fibrosis with proportional tubular atrophy and mild lymphoplasmacytic infiltrate. There was ATI involving ∼20% of tubular profiles with sloughing off of tubular epithelial cells. There were rare proteinaceous casts. There were no crystals or polarizable material. Arterioles were unremarkable. Interlobular arteries showed mild tortuosity without fibrinoid necrosis or inflammation.
Five glomeruli were present in frozen sections processed for immunofluorescence microscopy. There was 1+ (0 to 3+ scale) segmental granular capillary loop and mesangial staining for immunoglobulin G (IgG) () and 1+ C3 and equal 1+ kappa and lambda light chain staining in a similar pattern as IgG. There was no glomerular staining for IgA, IgM and C1q. There was no tubular basement membrane staining for any antisera. Immunofluorescence studies for subclasses of IgG, namely IgG1, IgG2, IgG3 and IgG4 were performed. There was dominant IgG4 segmental granular capillary loop and mesangial staining. IgG1, IgG2 and IgG3 were negative.
On electron microscopy, GBM showed normal thickness of lamina densa with occasional to scattered small to medium subepithelial deposits (), very rare small subendothelial deposits and rare mesangial deposits. There was ∼60% podocyte foot process effacement. There were no fibrin tactoids, tubuloreticular arrays and no increase in mesangial matrix or cellularity. There were no tubular basement membrane deposits.
Early membranous glomerulopathy (MG), with superimposed pauci-immune necrotizing crescentic glomerulonephritis (PNCGN) and focal ATI.
The patient was treated with hemodialysis and plasmapheresis × 5, and begun on immunosuppression with intravenous cyclophosphamide and prednisone. Her renal function did not recover and she remained on dialysis 6 months after the renal biopsy. Currently, she is being evaluated for renal transplantation.",What is the patient's anion gap in terms of mEq/L?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [106.0, 'mmol/L'], 'Bicarbonate': [18.0, 'mmol/L'], 'Sodium': [138.0, 'mmol/L']}",14,13.3,14.7,"The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 138.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 138.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 138.0 mmol * 1 mEq/mmol = 138.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 138.0 mmol sodium/L converts to 138.0 mEq sodium/L. 
The concentration of chloride is 106.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 106.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 106.0 mmol * 1 mEq/mmol = 106.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 106.0 mmol chloride/L converts to 106.0 mEq chloride/L. 
The concentration of bicarbonate is 18.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 18.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 18.0 mmol * 1 mEq/mmol = 18.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 18.0 mmol bicarbonate/L converts to 18.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 138.0 mEq/L - (106.0 mEq/L + 18.0 mEq/L) = 14.0 mEq/L. Hence, The patient's anion gap is 14.0 mEq/L."
506,39,Anion Gap,lab test,decimal,pmc-4241285-1,Extracted,"A 66-year-old male was admitted to the ICU with complaints of chronic weakness, fatigue, myalgia, weight loss, and left flank pain. Comorbidities included hypertension, active smoking, and diabetes mellitus. Patient denied nausea, vomiting, diarrhea, hematemesis, melena, hematochezia, chest pain, or any shortness of breath. He had a recent admission due to community acquired pneumonia and was treated with antibiotics. He denied using any illicit drugs or alcohol abuse. He was retired truck driver by profession.
On examination, he was an elderly man with clinical signs of dehydration. Blood pressure was 155/56 mm Hg, heart rate was 67/min, respiratory rate was 16/min, was afebrile, and his oxygen saturation was 99% on room air. He had mild epigastric tenderness without guarding or rigidity. He had bilateral lower extremities chronic skin changes with scaling. The rest of the physical examination was normal.
Significant laboratory data revealed serum sodium 124 mEq/L, potassium 5.1 mEq/mL, chloride 89 mEq/L, bicarbonate 15 mEq/L, blood urea nitrogen 44 mg/dL, creatinine 1.5 mg/dL, glucose 85 mg/dL, calcium 10.3 mg/dL, total protein 7.3 g/dL, and albumin 2.9 g/dL. The rest of the liver function tests were within normal limit. Anemia was with hemoglobin 9.4 g/dL, hematocrit 27%, platelets 558 k/μL, and white blood cells 10.4 k/μL. Arterial blood gas analysis showed pH of 7.36, pCO2 of 25 mm Hg, pO2 of 90.3 mm Hg, and oxygen saturation of 97% on room air. There was a lactic acid of 4.8 mmoles/L, serum lipase of 1540 U/L, amylase 406 unit/L, gamma GT 25 unit/L, INR 1.3, and lactate dehydrogenase (LDH) 950 unit/L; cancer antigen CA 19-9 was 49.9 μ/mL, TSH was 2.25 mIU/L, serum acetone was negative, and alcohol level was less than 10 mg/dL. His serial cardiac enzymes were negative and he was ruled out for an acute coronary event.
Chest X-ray (CXR) revealed bilateral patchy airspace disease. CT of abdomen and pelvis without contrast showed diffuse enlargement of the pancreas with homogeneous attenuation and without significant peripancreatic inflammation () with extensive retroperitoneal and pelvic adenopathy (). A para-aortic lymph node measuring 2.1 cm and retrocaval lymph node measuring 1.6 cm were seen. A soft tissue density surrounding the right common iliac vessels likely representing confluent adenopathy was seen. His echocardiogram showed an ejection fraction of 67%; right ventricle systolic pressure was estimated to be 44 mm Hg. Pericardium was normal without any pericardial effusion. There was no significant valvular abnormality.
Initially, the patients EKG showed 2nd degree Mobitz type I block which later progressed to complete heart block. Patient was given atropine without improvement; hence, a temporary pacemaker was inserted. He was started on IV hydration and IV antibiotics and all his electrolyte abnormalities were corrected. His temporary pacemaker lead came out and it was removed. Subsequently he became unresponsive, was orally intubated, had four cardiac arrests, and was successfully resuscitated. Due to persistent pulmonary infiltrates he underwent fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsies which showed evidence of pneumocystis jiroveci pneumonia (PJP). He was started on Bactrim for the treatment of PJP. He tested positive for HIV and was found to have a CD 4 count of 12/uL.
A temporary pacemaker wire was again placed after ruling out the relevant reversible causes of third degree heart block. A repeat echocardiogram was unchanged from prior one. CT-guided biopsy of the para-aortic lymph nodes was consistent with diffuse large B-cell lymphoma with marked tumor necrosis (). Immunoprofile showed that CD 20 (), CD 79a, and CD 10 were positive. CD 43, CD 3, CD 7, and BcL were negative. Upper endoscopy for percutaneous endoscopic gastrostomy placement showed gastric polyps which revealed gastric lymphoma on biopsy.
Patient was not a candidate for chemotherapy or ART due to critical condition. Hospital course was complicated by acute respiratory distress syndrome, acute kidney injury, and eventual death a month into his hospital stay.",What is the patient's anion gap in terms of mEq/L?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [89, 'mEq/L'], 'Sodium': [124, 'mEq/L'], 'Bicarbonate': [15, 'mEq/L']}",20,19,21,"The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 124 mEq/L. 
The concentration of chloride is 89 mEq/L. 
The concentration of bicarbonate is 15 mEq/L. 
Plugging in these values into the anion gap formula gives us 124 mEq/L - (89 mEq/L + 15 mEq/L) = 20 mEq/L. Hence, The patient's anion gap is 20 mEq/L."
507,39,Anion Gap,lab test,decimal,usmle-6934,Extracted,"A 24-year-old woman is brought to the emergency room (ER) by her co-workers after they found her unconscious in her cubicle when they returned from lunch. They tell you that she has diabetes but do not know anything more about her condition. The woman’s vital signs include: pulse 110/min, respiratory rate 24/min, temperature 36.7°C (98.0°F), and blood pressure 90/60 mm Hg. On physical examination, the patient is breathing heavily and gives irrelevant responses to questions. The skin and mucous membranes appear dry. Examination of the abdomen reveals mild diffuse tenderness to palpation. Deep tendon reflexes in the extremities are 1+ bilaterally. Laboratory studies show:
Finger stick glucose 630 mg/dL
Arterial blood gas analysis:
pH 7.1
PO2 90 mm Hg
PCO2 33 mm Hg
HCO3 8 mEq/L
Serum:
Sodium 135 mEq/L
Potassium 3.1 mEq/L
Chloride 136 mEq/L
Blood urea nitrogen 20 mg/dL
Serum creatinine 1.2 mg/dL
Urine examination shows:
Glucose Positive
Ketones Positive
Leukocytes Negative
Nitrite Negative
RBCs Negative
Casts Negative
The patient is immediately started on a bolus of intravenous (IV) 0.9% sodium chloride (NaCl).",What is the patient's anion gap in terms of mEq/L?  You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [136.0, 'mEq/L'], 'Bicarbonate': [8.0, 'mEq/L'], 'Sodium': [135.0, 'mEq/L']}",-9,-8.55,-9.45,"The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 135.0 mEq/L. 
The concentration of chloride is 136.0 mEq/L. 
The concentration of bicarbonate is 8.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 135.0 mEq/L - (136.0 mEq/L + 8.0 mEq/L) = -9.0 mEq/L. Hence, The patient's anion gap is -9.0 mEq/L."
508,45,CURB-65 Score for Pneumonia Severity,risk,integer,usmle-4969,Extracted,"A 38-year-old female presents to the emergency department for cough. She reports that two days ago she developed a nonproductive cough with moderate shortness of breath. On review of systems, the patient also endorses chills and sweats as well as several episodes of diarrhea over the past three days. Her husband also reports that the patient seemed confused this morning when he spoke to her before he left for work. The patient’s past medical history is significant for diabetes mellitus type II for which she takes metformin and glipizide. She drinks 8-10 beers per week and has a 15 pack-year smoking history. She works as a sales manager at a local retail company. Her temperature is 102.6°F (39.2°C), blood pressure is 126/72 mmHg, pulse is 82/min, and respirations are 18/min. On physical exam, she is alert and oriented to person and place only. She has crackles bilaterally extending up to the mid-lung fields. Her abdomen is soft and non-distended without rebound or guarding. Laboratory testing is performed and reveals the following:

Serum:
Na+: 129 mEq/L
K+: 3.6 mEq/L
Cl-: 99 mEq/L
HCO3-: 17 mEq/L
Urea nitrogen: 16 mg/dL
Creatinine: 1.1 mg/dL

Leukocyte count: 16,300/mm^3
Hemoglobin: 13.2 g/dL
Mean corpuscular volume: 87 µm^3
Platelet count: 348,000/mm^3

A chest radiograph is performed and can be seen in Figure A.",What is the patient's CURB-65 score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Systolic Blood Pressure': [126.0, 'mm hg'], 'respiratory rate': [18.0, 'breaths per minute'], 'Blood Urea Nitrogen (BUN)': [16.0, 'mg/dL'], 'Confusion': True, 'Diastolic Blood Pressure': [72.0, 'mm hg'], 'age': [38, 'years']}",1,1,1,"The CURB-65 Score criteria are listed below:

1. Confusion: No = 0 points, Yes = +1 point
2. BUN >19 mg/dL (>7 mmol/L urea): No = 0 points, Yes = +1 point
3. Respiratory Rate ≥30: No = 0 points, Yes = +1 point
4. Systolic BP <90 mmHg or Diastolic BP ≤60 mmHg: No = 0 points, Yes = +1 point
5. Age ≥65: No = 0 points, Yes = +1 point

The total CURB-65 score is calculated by summing the points for each criterion.

The CURB-65 score is current at 0 points.
The patient is 38 years old. The patient's age is less than 65 years, and so we add 0 points to the score, keeping the current total at 0.
Because the patient has confusion, 1 point is added to score making the current total 0 + 1 = 1.
The concentration of BUN is 16.0 mg/dL. The patient's BUN concentration is less than or equal to 19 mg/dL and so 0 points are added to score, keeping the current total at 1.
The patient's respiratory rate is 18 breaths per minute. Because the respiratory rate is less than 30 breaths per minute, 0 points are added to the score, keeping the current total at 1.
The patient's systiolic blood pressure is 126 mm Hg. The patient's diastolic blood pressure is 72 mm Hg. For a point a point to be added, the systiolic blood pressure must be less than 90 mm Hg or the diastolic blood pressure must be less than or equal to 60 mm Hg. Because neither of these statements are true, 0 points are added to score, keeping the current total to 1.
The patient's CURB-65 score is 1."
509,45,CURB-65 Score for Pneumonia Severity,risk,integer,pmc-7038555-1,Extracted,"An 18-year-old Black female who had been diagnosed with SCD in childhood, subsequently suffering frequent pain crises and undergoing repeated transfusions, presented to the emergency room with a 21-day history of progressive lower limb oedema accompanied by dyspnoea and orthopnoea. In addition, she reported a 3-day history of severe chest pain, together with a productive cough and fever as high as 38 °C. She reported no reduction in urine volume and no recent history of skin infection or tonsillitis. On physical examination, she was found to be very pallid and normotensive (blood pressure, 130/80 mmHg), with a heart rate of 104 bpm, a respiratory rate of 28 breaths/min, and oxygen saturation of 94% on room air, as well as being found to have developed anasarca. One month prior, she had undergone outpatient laboratory tests, which had shown that her renal function was normal—with a serum creatinine concentration of 0.75 mg/dl and an estimated glomerular filtration rate (eGFR), as determined by the Chronic Kidney Disease–Epidemiology Collaboration (CKD–EPI) equation, of 134.9 ml/min/1.73 m2—urine analysis showing no haematuria or proteinuria.
Blood tests performed at admission to the emergency room revealed the following: haemoglobin, 6.1 g/dl; haematocrit, 18.8%; haptoglobin, < 10 mg/dl; reticulocyte fraction, 6.11%; no schistocytes; lactate dehydrogenase, 433 U/L; indirect bilirubin, 0.36 mg/dl; leucocyte count, 18,820 cells/mm3; neutrophil count, 13,630 cells/mm3; lymphocyte count, 2790 cells/mm3; platelet count, 622;000 cells/mm3; and BUN, 29 mg/dl. The patient showed signs of hyperfiltration, including a serum creatinine concentration of 0.49 mg/dl and a CKD–EPI-determined eGFR of 148.5 ml/min/1.73 m2, although no hydroelectrolytic or acid-base disorders were identified. A urine sample was found to contain 100 leucocytes/field and 70 erythrocytes/field. In addition, 24-h proteinuria was 8.99 g. Further analysis of the blood samples showed the following: total proteins, 3.9 g/dl; albumin, 1.2 g/dl; globulins, 2.7 g/dl; total cholesterol, 210 mg/dl, low-density lipoprotein, 114 mg/dl; high-density lipoprotein, 37 mg/dl; triglycerides, 205 mg/dl; C4, 26.1 mg/dl (normal range, 10–38 mg/dl); C3, 62 mg/dl (normal range, 73–149 mg/dl); C-reactive protein, 24.9 mg/dl (normal range, < 5 mg/dl). The serology was negative for HIV, hepatitis B, and hepatitis C. The patient also tested negative for antinuclear factor, anti-DNA, rheumatoid factor, and antineutrophil cytoplasmic antibodies. Serum protein electrophoresis showed hypoalbuminaemia and an anti-streptolysin O level of 816 IU/ml (normal range, < 200 IU/ml). Blood and urine cultures were negative. A chest X-ray showed mild congestion and infiltrate in the right lung base. Ultrasound of the kidneys and urinary tract showed that the kidneys were normal in size and appearance.
Given the clinical presentation, the diagnostic hypothesis was pneumonia and anasarca due to nephritic-nephrotic syndrome. The patient was started on ceftriaxone (1 g, twice daily). Computed tomography angiography of the chest ruled out pulmonary thromboembolism and acute chest syndrome, thus indirectly confirming the diagnosis of pneumonia.
After the infection had been controlled, the patient underwent renal biopsy. Light microscopy revealed 7 glomeruli with global endocapillary proliferation; neutrophil and macrophage infiltrate (Fig. a); synechiae in 10% of the glomeruli; occasional splitting of the glomerular basement membrane; and a preserved Bowman’s capsule. The tubules were dilated, with foci of epithelial regeneration and neutrophils within their lumina. There was focal oedema in the interstitium. The interlobular arteries had a normal aspect, with intimal proliferation in the arterioles. Immunofluorescence performed on frozen sections showed intensity of deposition of C3 (2+/3+), IgG (1+/3+), IgA (1+/3+) and lambda light chains (1+/3+), with a granular pattern, distributed diffusely throughout the capillary loop. Collectively, the histological findings were consistent with a diagnosis of APIGN accompanied by microangiopathic changes related to the underlying disease.
Treatment with a diuretic and an anti-proteinuric agent (angiotensin-converting enzyme inhibitor) was instituted, and the patient evolved to clinical improvement (normalisation of blood pressure, as well as resolution of the proteinuria and haematuria). However, the signs of hyperfiltration persisted even after resolution of the proteinuria. In the final evaluation, the serum creatinine concentration was 0.33 mg/dl and the CKD–EPI-determined eGFR was 187.8 ml/min/1.73 m2. Evolution of laboratorial tests are available in Fig. .",What is the patient's CURB-65 score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Systolic Blood Pressure': [130.0, 'mm hg'], 'Diastolic Blood Pressure': [80.0, 'mm hg'], 'age': [18, 'years'], 'respiratory rate': [28.0, 'breaths per minute'], 'Blood Urea Nitrogen (BUN)': [29.0, 'mg/dL'], 'Confusion': False}",1,1,1,"The CURB-65 Score criteria are listed below:

1. Confusion: No = 0 points, Yes = +1 point
2. BUN >19 mg/dL (>7 mmol/L urea): No = 0 points, Yes = +1 point
3. Respiratory Rate ≥30: No = 0 points, Yes = +1 point
4. Systolic BP <90 mmHg or Diastolic BP ≤60 mmHg: No = 0 points, Yes = +1 point
5. Age ≥65: No = 0 points, Yes = +1 point

The total CURB-65 score is calculated by summing the points for each criterion.

The CURB-65 score is current at 0 points.
The patient is 18 years old. The patient's age is less than 65 years, and so we add 0 points to the score, keeping the current total at 0.
Because the patient does not have confusion, 0 points are added to the score, keeping the score at 0.
The concentration of BUN is 29.0 mg/dL. The patient's BUN concentration is greater than 19 mg/dL and so we add 1 point to score making the current total 0 + 1 = 1.
The patient's respiratory rate is 28 breaths per minute. Because the respiratory rate is less than 30 breaths per minute, 0 points are added to the score, keeping the current total at 1.
The patient's systiolic blood pressure is 130 mm Hg. The patient's diastolic blood pressure is 80 mm Hg. For a point a point to be added, the systiolic blood pressure must be less than 90 mm Hg or the diastolic blood pressure must be less than or equal to 60 mm Hg. Because neither of these statements are true, 0 points are added to score, keeping the current total to 1.
The patient's CURB-65 score is 1."
510,45,CURB-65 Score for Pneumonia Severity,risk,integer,pmc-5519313-1,Extracted,"The patient is a 63-year-old man with a past medical history of MALToma of the lung who presented with generalized weakness for the past one month associated with cough, fever, night sweats, and shortness of breath. The patient also had anorexia and weight loss of 15 pounds over one month. He denied a history of smoking. The patient was under treatment with isoniazid and pyridoxine for latent tuberculosis based on a positive skin tuberculin test.
On physical examination, his blood pressure was 110/59 mmHg, heart rate 118 beats per minute (bpm), respiratory rate 18/min, saturating 99% on room air with a temperature of 98.9oF. The patient was in no cardiopulmonary distress. A cardiovascular examination revealed no jugular venous distension, normal S1-S2, and no murmurs. On lung auscultation, the patient had rales at the left lung base.
Laboratory data showed sodium 134 mEq/L, potassium 4.2 mEq/L, chloride 103 mEq/L, bicarbonate 25 mEq/L, blood urea nitrogen 17 mg/dl, creatinine 0.9 mg/dl, glucose 96 mg/dl, hemoglobin 6.6 g/dl, hematocrit 20.1%, white blood cell count 5.5 x 103/microliter, and platelets 128 x 103/microliter. The coagulation profile showed prothrombin time (PT) 17.2 sec, partial thromboplastin time (PTT) 44.3 sec, and international normalized ratio (INR) 1.38.
Chest X-ray (CXR) and computed tomography (CT) scan showed right middle lobe opacity (Figures -). Repeat imaging after six months showed multiple masses in the lung and an osteoblastic bone lesion involving the left ilium (Figures -). Esophagogastroduodenoscopy showed a normal gastro-esophageal junction with erythematous mucosa in the stomach. The gastric biopsy was normal.
A lung biopsy done at initial presentation from the right middle lobe mass showed dense lymphoid infiltrate with proliferation of monocytoid B lymphocytes consistent with extranodal marginal zone lymphoma (BALToma/MALToma).
A CT-guided core needle biopsy from the left posterior pelvic mass that was noted six months after the initial presentation showed high grade diffuse large B-cell lymphoma involving skeletal muscles. The pathology report showed diffuse proliferation of lymphocytes, which were positive for cluster of differentiation (CD) 20 and B-cell lymphoma (BCL)-2 by immunohistochemistry tests. He was started on chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) with subsequent complete clinical and radiologic remission (Figure ).",What is the patient's CURB-65 score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [63.0, 'years'], 'Systolic Blood Pressure': [110.0, 'mm hg'], 'Diastolic Blood Pressure': [59.0, 'mm hg'], 'Blood Urea Nitrogen (BUN)': [17.0, 'mg/dL'], 'respiratory rate': [18.0, 'breaths per minute']}",1,1,1,"The CURB-65 Score criteria are listed below:

1. Confusion: No = 0 points, Yes = +1 point
2. BUN >19 mg/dL (>7 mmol/L urea): No = 0 points, Yes = +1 point
3. Respiratory Rate ≥30: No = 0 points, Yes = +1 point
4. Systolic BP <90 mmHg or Diastolic BP ≤60 mmHg: No = 0 points, Yes = +1 point
5. Age ≥65: No = 0 points, Yes = +1 point

The total CURB-65 score is calculated by summing the points for each criterion.

The CURB-65 score is current at 0 points.
The patient is 63.0 years old. The patient's age is less than 65 years, and so we add 0 points to the score, keeping the current total at 0.
Whether the patient has confusion is not reported in the note. Hence, we assume this to be false, and so 0 points are added to the score, making the current total 0.
The concentration of BUN is 17.0 mg/dL. The patient's BUN concentration is less than or equal to 19 mg/dL and so 0 points are added to score, keeping the current total at 0.
The patient's respiratory rate is 18 breaths per minute. Because the respiratory rate is less than 30 breaths per minute, 0 points are added to the score, keeping the current total at 0.
The patient's systiolic blood pressure is 110 mm Hg. The patient's diastolic blood pressure is 59 mm Hg. For a point a point to be added, the systiolic blood pressure must be less than 90 mm Hg or the diastolic blood pressure must be less than or equal to 60 mm Hg. Because at least one of these statements is true, 1 point is added to score, making the current total 0 + 1 = 1.
The patient's CURB-65 score is 1."
511,45,CURB-65 Score for Pneumonia Severity,risk,integer,pmc-7425612-1,Extracted,"A 78-year-old man with high-grade T1 urothelial carcinoma status post-transurethral resection of bladder tumor who had been on once-weekly intravesical BCG instillation for 2 months presented to the emergency room (ER) with fever, rigors and altered mental status.111111 He also reported shortness of breath but denied cough or chest pain. He had no urinary or gastrointestinal symptoms. He had his most recent BCG instillation done the day before the index presentation. Vital signs revealed a temperature of 102.8 F, pulse rate of 92/min, respiratory rate of 40/min and blood pressure 78/45 mmHg with oxygen saturation of 93% on ambient air. On physical examination, he appeared toxic, dehydrated and in respiratory distress. Chest examination revealed asymmetric chest expansion with dullness to percussion, decreased tactile fremitus on the left side with reduced air entry on auscultation. The cardiovascular examination was however unremarkable.
Complete blood count revealed marked leukocytosis with a white cell count of 27,200/microliter (Normal 4,800–12,000/microliter) and hemoglobin of 11.5 g/dL (Normal 14.0–17.5 g/dL). Lactate was markedly elevated at 7.8 meq/L (Normal 0.6–1.4 meq/L) and arterial blood gas revealed high anion gap metabolic acidosis. Basic metabolic panel revealed creatinine of 2.31 mg/dL from normal baseline (Normal 0.6–1.3 mg/dL) and blood urea nitrogen of 28 mg/dL (Normal 7–25 mg/dL). Sputum culture with gram stain showed normal oral flora. Urinary streptococcal and legionella antigens were negative. Chest X-ray on admission revealed left basilar pneumonia with small left pleural effusion. CT head showed no acute intracranial abnormalities. The preliminary blood culture result was negative for any micro-organisms.
Due to altered mental status with increased work of breathing and acute hypoxemic respiratory failure, patient was intubated and placed on ventilation in the medical intensive care unit. He was commenced on vasopressors and intravenous Vancomycin and Piperacillin-Tazobactam for septic shock thought to be secondary to community-acquired pneumonia and possible urinary tract infection. Despite the completion of several courses of broad-spectrum antibiotics, he continued to have low-grade pyrexia and failed to improve clinically. Suspicion for rarer etiologies such as systemic BCG dissemination began to grow and blood cultures for acid-fast bacilli initially obtained on admission returned positive for acid-fast bacilli, specifically Mycobacteria bovis in the two sets of samples thus confirming our suspicion. Broad-spectrum antibiotics were immediately discontinued, and he was commenced on triple therapy with Isoniazid 300 mg daily, Ethambutol 1600 mg daily and Rifampicin 30 mg daily. He improved clinically and was discharged 5 days later to complete 2 months of triple therapy with Isoniazid, Rifampicin and Ethambutol followed by 4 months of maintenance therapy with Rifampicin and Isoniazid. He was planned to return for follow up with the infectious disease team.",What is the patient's CURB-65 score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [78.0, 'years'], 'Systolic Blood Pressure': [78.0, 'mm hg'], 'Diastolic Blood Pressure': [45.0, 'mm hg'], 'Blood Urea Nitrogen (BUN)': [28.0, 'mg/dL'], 'respiratory rate': [40.0, 'breaths per minute'], 'Confusion': True}",5,5,5,"The CURB-65 Score criteria are listed below:

1. Confusion: No = 0 points, Yes = +1 point
2. BUN >19 mg/dL (>7 mmol/L urea): No = 0 points, Yes = +1 point
3. Respiratory Rate ≥30: No = 0 points, Yes = +1 point
4. Systolic BP <90 mmHg or Diastolic BP ≤60 mmHg: No = 0 points, Yes = +1 point
5. Age ≥65: No = 0 points, Yes = +1 point

The total CURB-65 score is calculated by summing the points for each criterion.

The CURB-65 score is current at 0 points.
The patient is 78.0 years old. The patient's age is greater than or equal to 65 years, and so we add 1 point to the score, making the current total 0 + 1 = 1.
Because the patient has confusion, 1 point is added to score making the current total 1 + 1 = 2.
The concentration of BUN is 28.0 mg/dL. The patient's BUN concentration is greater than 19 mg/dL and so we add 1 point to score making the current total 2 + 1 = 3.
The patient's respiratory rate is 40 breaths per minute. Because the respiratory rate is greater than 30 breaths per minute, 1 point is added to the score, making the current total 3 + 1 = 4.
The patient's systiolic blood pressure is 78 mm Hg. The patient's diastolic blood pressure is 45 mm Hg. For a point a point to be added, the systiolic blood pressure must be less than 90 mm Hg or the diastolic blood pressure must be less than or equal to 60 mm Hg. Because at least one of these statements is true, 1 point is added to score, making the current total 4 + 1 = 5.
The patient's CURB-65 score is 5."
512,45,CURB-65 Score for Pneumonia Severity,risk,integer,pmc-8327293-1,Extracted,"A 67-year-old male with a 6-day history of fever and shortness of breath was admitted to the emergency department on August 15, 2019. This patient had a fever, chill, cough, and progressive dyspnea after being in the rain on August 9, 2019, without a sore throat, chest pain, hemoptysis, paroxysmal dyspnea, dizziness, nausea, abdominal distension, abdominal pain or diarrhea. He first went to a local clinic and was treated with “anti-inflammatory drugs (the specific name is unknown)”, but his symptoms became more severe and rapidly progressive. One day before admission, the patient started having aggravated dyspnea, listlessness, and difficulty talking while lying down, then this patient presented to our emergency room (ER).
The physical exam revealed the following: T 36°C, P 82bpm, RR 28/min, BP 107/64mmHg, SpO2 72%, WBC 20.36×10^9/L, N 18.31×10^9/L; arterial blood gas (ABG) showed PH 7.12, PO2 55mmHg, PCO2 56mmHg, SaO2 85%, Lactate 4.4mmol/L, BE-11.7mmol/L; BUN 18.1mmol/L, creatinine 166umol/L; BNP 249.83pg/mL with peripheral cyanosis and bilateral wheezing. Chest computed tomography (CT) showed a dense consolidation site in the right lung with scattered shadows in both lungs, accompanying by mediastinal and right hilar lymphadenopathy, the CT results indicated the infection lesion (). He had been healthy previously, but he was a smoker with a 30-year history. He did not use illicit drugs and had no known allergies to medications. He worked as a farmer and have no family history. He was diagnosed as follows: 1. Severe pneumonia 2. Sepsis 3. Septic shock 4. Multiple organ dysfunction syndrome (MODS) 5. Type II respiratory failure 6. Heart failure 7. Acute renal insufficiency 8. Metabolic acidosis 9. Chronic bronchitis.
Laboratory examinations were supplemented and the results were as follows (August 31, 2019): Blood routine: neutrophil count 7.29×10^9/L, lymphocyte count 0.97×10^9/L, monocyte count 0.82×10^9/L, neutrophil percentage 79.2%, lymphocyte percentage 10.5%, red blood cell count 3.01×10^12/L, hemoglobin 86 g/L, hematocrit 0.28 L/L, mean corpuscular hemoglobin 305 g/L, platelet distribution width 9.2fl, C-reactive protein (CRP) 106.44 mg/L; hepatorenal function: ALT 15U/L, AST 13U/L, Creatinine 75umol/L. Orotracheal intubation was applied to help the patient’s respiration, assisting with the PB840 ventilator. Combined with the examination results of chest CT, the patient was provided with imipenem and cilastatin sodium 1.0g q12h, linezolid 0.6g q12h, and moxifloxacin 0.4g qd for anti-infection therapy. After a 3-day treatment, this patient still had a high fever with a maximum body temperature of 38.5°C. Continuous invasive mechanical ventilation was performed to assist the respiration, meanwhile, continuous vasoactive drugs and intravenous nutrition support were given to him.
Sputum cultures were collected and Gram stain revealed no squamous epithelial cells, few neutrophils, and Gram-negative rods. Within one day, sputum sample results showed P. aeruginosa and multidrug-resistant Acinetobacter baumannii (). Besides, fiberscope secretion cultures showed P. aeruginosa, which is sensitive to amikacin, gentamicin and piperacillin sodium and tazobactam sodium, intermediate to ciprofloxacin and ceftazidime, but resistant to imipenem and meropenem (). Based on the culture results, we changed the treatment strategy to the combination of polymyxin B (50IU, q12h) and amikacin (0.6g, qd) for 30 days, instead of imipenem (1g q12h) and cilastatin sodium (500mg, q12h).
The patient’s body temperature was back to 37°C, measured by a clinical thermometer for armpit use for 10 minutes. His cough was significantly alleviated with white viscous sputum. On day 21, laboratory examinations demonstrated the erythrocyte sedimentation rate (ESR), CRP and procalcitonin were negative; AST 14U/L, total protein 63.2g/L, albumin 30.3g/L, total calcium 2.1mmol/L, phosphorus 0.84mmol/L, sialic acid 723mg/L. On day 23, chest CT was rechecked to confirm the curative effect, which showed the formation of a pulmonary thick-walled cavity in the apical segment of the left upper lobe, with multiple small opacities, branching signs, bronchial wall thickening, and fibrous lesion. The inflammation of the cavity wall was obviously reduced compared with the first CT images (). The patient was discharged in a stable condition on day 35, and he was given acetylcysteine tablets 0.6g/box, 1 tablet, bid. The final diagnoses on discharge were represented: 1. Severe pneumonia 2. Sepsis 3. Septic shock 4. MODS 5. Type II respiratory failure 6. Heart failure 7. Acute renal insufficiency 8. Metabolic acidosis 9. Chronic bronchitis 10. Hypoproteinemia.
After he was discharged, a regular follow-up of 2 weeks was performed to monitor his condition until most indicators came back to the normal level. The results of laboratory examinations showed as follows (September 17, 2019): Blood routine: white blood cell 9.57×10^9/L, neutrophil count 6.78×10^9/L, lymphocyte count 1.24×10^9/L, neutrophil percentage 70.8%, lymphocyte percentage 13%, red blood cell count 3.92×10^12/L, hemoglobin 111 g/L, hematocrit 0.35 L/L, mean corpuscular hemoglobin 318 g/L, platelet distribution width 9.2fl, C-reactive protein (CRP) 19.04 mg/L, PCT 0.19ng/mL; hepatorenal function: ALT 25U/L, AST 37U/L, Creatinine 75umol/L. As shown above, most laboratory results were improved, and the physical examination was normal.",What is the patient's CURB-65 score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [67, 'years'], 'Systolic Blood Pressure': [107.0, 'mm hg'], 'Diastolic Blood Pressure': [64.0, 'mm hg'], 'respiratory rate': [28.0, 'breaths per minute'], 'Blood Urea Nitrogen (BUN)': [18.1, 'mmol/L']}",2,2,2,"The CURB-65 Score criteria are listed below:

1. Confusion: No = 0 points, Yes = +1 point
2. BUN >19 mg/dL (>7 mmol/L urea): No = 0 points, Yes = +1 point
3. Respiratory Rate ≥30: No = 0 points, Yes = +1 point
4. Systolic BP <90 mmHg or Diastolic BP ≤60 mmHg: No = 0 points, Yes = +1 point
5. Age ≥65: No = 0 points, Yes = +1 point

The total CURB-65 score is calculated by summing the points for each criterion.

The CURB-65 score is current at 0 points.
The patient is 67 years old. The patient's age is greater than or equal to 65 years, and so we add 1 point to the score, making the current total 0 + 1 = 1.
Whether the patient has confusion is not reported in the note. Hence, we assume this to be false, and so 0 points are added to the score, making the current total 1.
The concentration of BUN is 18.1 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of BUN from mmol to mg. The mass of BUN is 18.1 mmol. To convert 18.1 mmol of BUN to mol, multiply by the conversion factor 0.001, giving us 18.1 mmol BUN * 0.001 mol/mmol = 0.0181 mol BUN. To convert from mol BUN to grams, multiply by the molar mass 28.02 g/mol, which will give 0.0181 mol BUN * 28.02 g/mol = 0.50716 g BUN. To convert 0.50716 g of BUN to mg, multiply by the conversion factor 1000.0, giving us 0.50716 g BUN * 1000.0 mg/g = 507.16 mg BUN. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 507.16 mg BUN/10.0 dL = 50.716 mg BUN/dL. The concentration value of 18.1 mmol BUN/L converts to 50.716 mg BUN/dL. The patient's BUN concentration is greater than 19 mg/dL and so we add 1 point to score making the current total 1 + 1 = 2.
The patient's respiratory rate is 28 breaths per minute. Because the respiratory rate is less than 30 breaths per minute, 0 points are added to the score, keeping the current total at 2.
The patient's systiolic blood pressure is 107 mm Hg. The patient's diastolic blood pressure is 64 mm Hg. For a point a point to be added, the systiolic blood pressure must be less than 90 mm Hg or the diastolic blood pressure must be less than or equal to 60 mm Hg. Because neither of these statements are true, 0 points are added to score, keeping the current total to 2.
The patient's CURB-65 score is 2."
513,45,CURB-65 Score for Pneumonia Severity,risk,integer,pmc-7725203-1,Extracted,"A 70-year-old man with a past medical history significant for hypertension, diabetes mellitus, chronic kidney disease stage 4, and prostate cancer stage 4 on outpatient chemotherapy at another facility presented to our emergency department with complaints of vomiting and nausea a day prior to admission. He had three episodes of nonbloody, non-bilious, and nonbloody diarrhea as well. The patient had one-day history of productive cough with whitish sputum and subjective fevers. Patient, though adherent with chemotherapy, had admitted that he was not able to take his other home medications. In the ED, patient had a temperature of 103.1degrees F, heart rate of 98 beats per minute, blood pressure of 102/55 mmHg, respiratory rate of 18 breaths per minute, glucose of 121 mg/dl. Physical exam was significant for conscious, alert and oriented to person, place, and time; pink and moist mucosa, right surgical scar at the right hypochondriac, soft, nontender, bowel sounds were present. Pertinent abnormal labs include: white blood cell count (WBC), 14.5 units/mcl (reference range: 4.80-10.80 units/mcl) with neutrophils of 82.1% (reference range: 44%-70%), blood urea nitrogen (BUN) 39 mg/dl (reference range: 7-18 mg/dl), creatinine (Cr) 3.8 mg/dl (reference range: 0.7-1.2 mg/dl), calcium (Ca) 7.7 mg/dl (reference range: 8.5-10.1 mg/dl). Chest x-ray showed a focal area of consolidation involving the left midlung. Patient was admitted and managed on the medical floor for sepsis likely secondary hospital acquired pneumonia especially given his immunocompromised state. Patient was started on IV vancomycin and piperacillin-tazobactam in the emergency department.
During the course of the hospitalization, infectious disease was consulted and they recommended to start the patient on IV cefepime 1 g Q24 hours, oral linezolid 600 mg Q12H, and oral clindamycin 450 mg Q8H. In addition, patient was started on calcium acetate for his hypocalcemia and was continued on sodium bicarbonate 1300 mg Q8H for his AKI on CKD. After two days the cefepime dose was increased to 2 mg. Two days after increasing the dose of cefepime, patient started developing altered mental status. Patient was alert and oriented only to person, incoherent and expressed thoughts like “I would kill myself if I had the chance” so the cefepime was discontinued and within one day the patient was more conversant, denied any suicidal ideations and was alert and oriented to person and place. In addition, the BUN and creatinine (Cr) levels trended up to 41 mg/dl and 5.4 mg/dl. So the calcium acetate was switched to calcium carbonate and calcitriol. After making these changes the Cr level trended down to 3.4 mg/dl. In addition, the corrected Calcium level was at normal levels based on the albumin level of the patient. The mental status improved and patient was subsequently discharged. Table provides the electrolyte levels.",What is the patient's CURB-65 score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Systolic Blood Pressure': [102.0, 'mm hg'], 'respiratory rate': [18.0, 'breaths per minute'], 'Blood Urea Nitrogen (BUN)': [39.0, 'mg/dL'], 'Confusion': False, 'Diastolic Blood Pressure': [55.0, 'mm hg'], 'age': [70.0, 'years']}",3,3,3,"The CURB-65 Score criteria are listed below:

1. Confusion: No = 0 points, Yes = +1 point
2. BUN >19 mg/dL (>7 mmol/L urea): No = 0 points, Yes = +1 point
3. Respiratory Rate ≥30: No = 0 points, Yes = +1 point
4. Systolic BP <90 mmHg or Diastolic BP ≤60 mmHg: No = 0 points, Yes = +1 point
5. Age ≥65: No = 0 points, Yes = +1 point

The total CURB-65 score is calculated by summing the points for each criterion.

The CURB-65 score is current at 0 points.
The patient is 70.0 years old. The patient's age is greater than or equal to 65 years, and so we add 1 point to the score, making the current total 0 + 1 = 1.
Because the patient does not have confusion, 0 points are added to the score, keeping the score at 1.
The concentration of BUN is 39.0 mg/dL. The patient's BUN concentration is greater than 19 mg/dL and so we add 1 point to score making the current total 1 + 1 = 2.
The patient's respiratory rate is 18 breaths per minute. Because the respiratory rate is less than 30 breaths per minute, 0 points are added to the score, keeping the current total at 2.
The patient's systiolic blood pressure is 102 mm Hg. The patient's diastolic blood pressure is 55 mm Hg. For a point a point to be added, the systiolic blood pressure must be less than 90 mm Hg or the diastolic blood pressure must be less than or equal to 60 mm Hg. Because at least one of these statements is true, 1 point is added to score, making the current total 2 + 1 = 3.
The patient's CURB-65 score is 3."
514,45,CURB-65 Score for Pneumonia Severity,risk,integer,pmc-7916639-1,Extracted,"A 70-year-old Caucasian male initially presented to the emergency department (ED) of our hospital with fever and chills, which began one hour prior to his presentation. He also reported nausea and a productive cough with greenish sputum. The patient had been previously admitted to our hospital for pneumonia a month prior to his presentation and was discharged to a rehabilitation facility for three weeks. His past medical history was significant for end stage renal disease (ESRD) with dialysis dependence, failed kidney transplant, coronary artery disease (CAD) status with four drug-eluting stents (DES), type 2 diabetes mellitus, chronic pneumonia, and hypertension.
On admission, his vital signs were as follow: temperature 39.4°C, blood pressure 87/55 mm Hg, pulse 100 beats per minute (bpm), oxygen saturation 88% on room air and respiratory rate 18 breaths per minute. Physical examination revealed coarse breath sounds bilaterally on auscultation, a left upper arm arteriovenous fistula as well as multiple superficial abrasions bilaterally on his lower extremities. His laboratory findings were as follows: white blood cells 15.12 K/µL, platelets 104 K/µL, sodium 134 mmol/L, blood urea nitrogen 39 mg/dl, creatinine 4.5 mg/dl, lactic acid 2.77 mmol/L and procalcitonin 25.24 ng/ml. Urine analysis was not performed because the patient was anuric. His chest X-ray showed evidence of small effusions and bibasilar airspace disease which were indicative of atelectasis or infection. An electrocardiogram showed normal sinus rhythm, a rate of 99 bpm, normal axis and no significant ST abnormalities, with paroxysmal ventricular contractions (PVCs). Blood cultures were drawn, and the patient received ceftriaxone and piperacillin/tazobactam empiric antibiotics and intravenous (IV) fluids. Gram stain of the blood specimen showed gram-negative rods.
He was initially admitted to the progressive care unit (PCU) with cardiac telemetry. He was found to have second-degree atrioventricular (AV) block and was subsequently transferred to the intensive care unit (ICU) for closer management. On the second day of admission, blood cultures grew Pasteurella multocida. The organism was sensitive to beta-lactams including ampicillin, amoxicillin, amoxicillin/clavulanic acid and ampicillin/sulbactam. The patient was treated with IV cefepime due to his comorbidities. At this time, the patient was further questioned about recent animal contact. He stated that he lived with his wife and 14 cats and admitted the cats usually scratched him when they laid on him. His subsequent hospital stay was unremarkable. He was discharged home six days after admission with amoxicillin/clavulanic acid for two weeks. The patient returned to the outpatient clinic two weeks after discharge and had made an uneventful recovery.",What is the patient's CURB-65 score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [70, 'years'], 'Systolic Blood Pressure': [87.0, 'mm hg'], 'Diastolic Blood Pressure': [55.0, 'mm hg'], 'Blood Urea Nitrogen (BUN)': [39.0, 'mg/dL'], 'respiratory rate': [18.0, 'breaths per minute']}",3,3,3,"The CURB-65 Score criteria are listed below:

1. Confusion: No = 0 points, Yes = +1 point
2. BUN >19 mg/dL (>7 mmol/L urea): No = 0 points, Yes = +1 point
3. Respiratory Rate ≥30: No = 0 points, Yes = +1 point
4. Systolic BP <90 mmHg or Diastolic BP ≤60 mmHg: No = 0 points, Yes = +1 point
5. Age ≥65: No = 0 points, Yes = +1 point

The total CURB-65 score is calculated by summing the points for each criterion.

The CURB-65 score is current at 0 points.
The patient is 70 years old. The patient's age is greater than or equal to 65 years, and so we add 1 point to the score, making the current total 0 + 1 = 1.
Whether the patient has confusion is not reported in the note. Hence, we assume this to be false, and so 0 points are added to the score, making the current total 1.
The concentration of BUN is 39.0 mg/dL. The patient's BUN concentration is greater than 19 mg/dL and so we add 1 point to score making the current total 1 + 1 = 2.
The patient's respiratory rate is 18 breaths per minute. Because the respiratory rate is less than 30 breaths per minute, 0 points are added to the score, keeping the current total at 2.
The patient's systiolic blood pressure is 87 mm Hg. The patient's diastolic blood pressure is 55 mm Hg. For a point a point to be added, the systiolic blood pressure must be less than 90 mm Hg or the diastolic blood pressure must be less than or equal to 60 mm Hg. Because at least one of these statements is true, 1 point is added to score, making the current total 2 + 1 = 3.
The patient's CURB-65 score is 3."
515,45,CURB-65 Score for Pneumonia Severity,risk,integer,pmc-3743519-1,Extracted,"An eighteen year old African American male presented to the emergency room with a 1-week history of sore throat, muscle aches, fever, headache, and photophobia. He also complained of nausea, one episode of vomiting, and abdominal pain. He was a college student and lived in a dormitory. He denied any recent travel or contact with ill people. Past medical history was significant for sickle cell trait and Osgood Schlatter’s disease. He was up to date on vaccinations.
Physical examination revealed a tall, thinly built young man, in mild pain with an oral temperature of 97.5°F, blood pressure of 114/69 mmHg, heart rate of 89 beats per minute (BPM) and respirations of 18/minute. He had injected conjunctiva of the right eye, and pharyngeal and tonsillar exudates. The examination of the central nervous system revealed neck stiffness; Kernig’s and Brudzinski’s signs were not elicited. Cranial nerves were intact. The power and deep tendon reflexes were essentially normal. The rest of the systemic examinations were unremarkable.
Hemoglobin was 17.5 g/dL, hematocrit 50.8 g/dL, and white count 20.3 × 109/L with 89% granulocytosis, and platelet count of 35 × 109/L. Basic metabolic profile was within normal limits, except for a potassium level of 3.2 meq/L, blood urea nitrogen of 44.9 mg/dL, and creatinine of 2.3 mg/dL. Chest X-ray revealed bilateral infiltrates in the middle and lower lung fields. Computed tomography (CT) of the head was unremarkable. The patient declined lumbar puncture. The blood culture grew penicillin sensitive Group C Streptococcus (GCS) within 24 hours of incubation. A few hours into the admission, he developed third and sixth nerve palsy. Further work-up revealed right cavernous and ophthalmic vein thrombosis on magnetic resonance imaging ( and ). Multiple patchy cavitary lesions on both lungs were seen in the chest CT. There was no vegetation on transesophageal echocardiogram. The oculomotor and abducens palsies resolved after medical management for 16 days.",What is the patient's CURB-65 score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Systolic Blood Pressure': [114.0, 'mm hg'], 'respiratory rate': [18.0, 'breaths per minute'], 'Blood Urea Nitrogen (BUN)': [44.9, 'mg/dL'], 'Confusion': False, 'Diastolic Blood Pressure': [69.0, 'mm hg'], 'age': [18, 'years']}",1,1,1,"The CURB-65 Score criteria are listed below:

1. Confusion: No = 0 points, Yes = +1 point
2. BUN >19 mg/dL (>7 mmol/L urea): No = 0 points, Yes = +1 point
3. Respiratory Rate ≥30: No = 0 points, Yes = +1 point
4. Systolic BP <90 mmHg or Diastolic BP ≤60 mmHg: No = 0 points, Yes = +1 point
5. Age ≥65: No = 0 points, Yes = +1 point

The total CURB-65 score is calculated by summing the points for each criterion.

The CURB-65 score is current at 0 points.
The patient is 18 years old. The patient's age is less than 65 years, and so we add 0 points to the score, keeping the current total at 0.
Because the patient does not have confusion, 0 points are added to the score, keeping the score at 0.
The concentration of BUN is 44.9 mg/dL. The patient's BUN concentration is greater than 19 mg/dL and so we add 1 point to score making the current total 0 + 1 = 1.
The patient's respiratory rate is 18 breaths per minute. Because the respiratory rate is less than 30 breaths per minute, 0 points are added to the score, keeping the current total at 1.
The patient's systiolic blood pressure is 114 mm Hg. The patient's diastolic blood pressure is 69 mm Hg. For a point a point to be added, the systiolic blood pressure must be less than 90 mm Hg or the diastolic blood pressure must be less than or equal to 60 mm Hg. Because neither of these statements are true, 0 points are added to score, keeping the current total to 1.
The patient's CURB-65 score is 1."
516,45,CURB-65 Score for Pneumonia Severity,risk,integer,pmc-7294477-1,Extracted,"A 60-year-old man presented with fever and productive cough for 2 days. He had a history of type 2 diabetes for 12 years and received peritoneal dialysis for diabetic nephropathy for 5 years. He also received antihypertensive drugs for hypertension for 10 years. There was no personal or family history of coagulopathy or stroke, trauma, chest pain, or illicit intravenous drug use.
Admission physical examination revealed the patient to be febrile (39.1°C), tachycardic with a pulse of 112/min, a respiratory rate of 22/min, and hypertensive with a blood pressure of 170/80 mm Hg. Bibasilar crackles were heard on auscultation. The peritoneal dialysis catheter was correctly positioned in the right lower abdomen, with no local erythema. There was no exudate buildup in catheter dressings. His systemic examination was otherwise unremarkable, with no tenderness, ecchymosis, or other external signs of trauma.
Initial blood workup showed neutrophilic leukocytosis with a white blood cell count of 12.8 × 109/L (normal reference: 4.0–10 × 109/L) and 82.6% neutrophils (normal reference: 50%–70%). The patient was anemic (hemoglobin 95 g/L; normal reference: 120–160 g/L), with a normal platelet count (181 × 109/L; normal reference: 100–300 × 109/L). Both his prothrombin time (PT; 12.1 s, normal reference: 10–14 s) and activated partial thromboplastin time (aPTT; 34.1 s, normal reference: 20–40 s) were normal. Blood chemistry showed elevated blood urea nitrogen (20.5 mmol/L; normal reference: 3.2–7.1 mmol) and creatinine (1125 µmol/L; normal reference: 53–106 µmol/L). Blood glucose was 6.4 mmol/L (normal reference: 3.9–6.1 mmol/L), K+ 4.14 mmol/L (normal reference: 3.5–5.5 mmol/L), Na+ 145 mmol/L (normal reference: 135–145 mmol/L), Cl+ 108 mmol/L (normal reference: 95–105 mmol/L), and Ca++ 2.1 mmol/L (normal reference: 2.25–2.58 mmol/L). Liver function test was normal. Arterial blood gas analysis showed pH 7.40 (normal reference: 7.35–7.45), PaO2 60.1 mm Hg (normal reference: 95–100 mm Hg), PaCO2 44.8 mm Hg (normal reference: 35–45 mm Hg), and HCO3– 29.6 mmol/L (normal reference: 22–27 mmol/L). Chest X ray revealed patchy opacities in the right lower lung. The right diaphragmatic surface and costophrenic angle were also blurred. Furthermore, the cardiac silhouette was enlarged.
Treatment for pulmonary infection with cefoperazone-sulbactam (1.5 g every 12 h) was initiated. The patient also received subcutaneous insulin (30 units/day) and oral nifedipine sustained release tablet (30 mg daily). Peritoneal dialysis continued with 2.5% low calcium peritoneal dialysate.
At day 3 post admission, the patient became disoriented. He was still febrile (40.3°C). SPO2 declined to 88% despite of 5 L/min oxygen via a nasal cannula. Blood gas analysis showed pH 7.30, PaO2 53.10 mm Hg, PaCO2 58.50 mm Hg, and HCO3– 29.3 mol/L. Blood chemistry revealed that blood urea nitrogen (22.7 mmol/L) and serum creatinine (1345 µmol/L) continued to rise, and his plasma glucose also increased (8.4 mmol/L). K+, Na+, Cl+, and Ca++ were within normal range. His C-Reactive Protein (CRP) was 183 mg/L (normal reference: <8 mg/L), and procalcitonin 66.06 ng/mL (normal reference: <0.5 ng/mL). The liver function, platelet count, aPTT, and PT were normal. Thromboelastogram showed normal coagulation factor reaction time (9.9 min; normal reference: 5–10), fibrinogen reaction time (1.9 min; normal reference: 1–3), α (alpha) angle (64.9°; normal reference: 53°–72°), shear stress coefficient strength (19,233 d/s; normal reference: 4500–11,000 d/s), and hyperfibrinolysis (0.0%; normal reference: <8%) with increased platelet function (79.4 mm; normal reference: 50–70).
The patient was diagnosed with respiratory failure (type II) and pulmonoencephalopathy, and transferred to the intensive care unit (ICU) and placed on mechanical ventilation. Imipenem (0.5 g every 6 h) was added, and low-molecular-weight heparin (enoxaparin, 3500–5500 Da, 5–10 IU/kg/h) and insulin were delivered continuously by pumps. Peritoneal dialysis was discontinued and CVVH was undertaken at 32 mL/kg/h for renal insufficiency. The patient became oriented. Arterial blood gases showed normal pH (7.43), improved PaO2 (88.6 mm Hg), normal PaCO2 (36.5 mm Hg), and HCO3– (23.5 mmol/L). However, fever persisted (39.5°C), and the patient had difficulty weaning off mechanical ventilation.
Abdominal computed tomography (CT) at day 5 showed a hypointense shadow in the left hepatic lobe (61 mm × 56 mm) with an indistinct border (). Liver abscess was confirmed upon ultrasound-guided drainage. The culture revealed Klebsiella pneumonia that was sensitive to third-generation cephalosporin and imipenem. Imipenem (1.0 g every 8 h) and metronidazole (0.5 g every 8 h) were given, and mechanical ventilation and CVVH continued.
At day 12, the patient complained left back pain, which improved the next day without treatment. Platelet count (243 × 109/L) was normal, but both aPTT (67.5 s) and PT (17.3 s) were prolonged; his thromboelastogram (heparin cup) was normal. No cutaneous and mucosal bleeding was observed. The patient had no hemoptysis and his fecal occult blood test was negative. Abdominal CT scan at day 16 revealed left iliopsoas swelling, about 61.7 mm × 64.1 mm, with inhomogeneous densities, and occasional hyperintense opacities and an indistinct border (). A diagnosis of iliopsoas hematoma was made. Anticoagulation therapy with low-molecular-weight heparin was discontinued and switched to ex vivo anticoagulation with citrate. Mechanical ventilation and anti-infection therapy (imipenem 1.0 g every 8 h, metronidazole 0.5 g every 8 h) continued. No improvement was seen, and 3 days later, the patient died after his family decided to terminate therapy.",What is the patient's CURB-65 score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Systolic Blood Pressure': [170.0, 'mm hg'], 'respiratory rate': [22.0, 'breaths per minute'], 'Blood Urea Nitrogen (BUN)': [20.5, 'mmol/L'], 'Confusion': False, 'Diastolic Blood Pressure': [80.0, 'mm hg'], 'age': [60.0, 'years']}",1,1,1,"The CURB-65 Score criteria are listed below:

1. Confusion: No = 0 points, Yes = +1 point
2. BUN >19 mg/dL (>7 mmol/L urea): No = 0 points, Yes = +1 point
3. Respiratory Rate ≥30: No = 0 points, Yes = +1 point
4. Systolic BP <90 mmHg or Diastolic BP ≤60 mmHg: No = 0 points, Yes = +1 point
5. Age ≥65: No = 0 points, Yes = +1 point

The total CURB-65 score is calculated by summing the points for each criterion.

The CURB-65 score is current at 0 points.
The patient is 60.0 years old. The patient's age is less than 65 years, and so we add 0 points to the score, keeping the current total at 0.
Because the patient does not have confusion, 0 points are added to the score, keeping the score at 0.
The concentration of BUN is 20.5 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of BUN from mmol to mg. The mass of BUN is 20.5 mmol. To convert 20.5 mmol of BUN to mol, multiply by the conversion factor 0.001, giving us 20.5 mmol BUN * 0.001 mol/mmol = 0.0205 mol BUN. To convert from mol BUN to grams, multiply by the molar mass 28.02 g/mol, which will give 0.0205 mol BUN * 28.02 g/mol = 0.57441 g BUN. To convert 0.57441 g of BUN to mg, multiply by the conversion factor 1000.0, giving us 0.57441 g BUN * 1000.0 mg/g = 574.41 mg BUN. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 574.41 mg BUN/10.0 dL = 57.441 mg BUN/dL. The concentration value of 20.5 mmol BUN/L converts to 57.441 mg BUN/dL. The patient's BUN concentration is greater than 19 mg/dL and so we add 1 point to score making the current total 0 + 1 = 1.
The patient's respiratory rate is 22 breaths per minute. Because the respiratory rate is less than 30 breaths per minute, 0 points are added to the score, keeping the current total at 1.
The patient's systiolic blood pressure is 170 mm Hg. The patient's diastolic blood pressure is 80 mm Hg. For a point a point to be added, the systiolic blood pressure must be less than 90 mm Hg or the diastolic blood pressure must be less than or equal to 60 mm Hg. Because neither of these statements are true, 0 points are added to score, keeping the current total to 1.
The patient's CURB-65 score is 1."
517,45,CURB-65 Score for Pneumonia Severity,risk,integer,pmc-8236776-1,Extracted,"The patient was a 42-year-old male with previous hypertension who presented with a 5-day history of shortness of breath, subjective fever, chills, and an occasional cough productive of clear sputum. Associated symptoms included generalized bone pain, intermittent headache, watery diarrhea, anorexia, and a home temperature recording of 105 °F. Review of systems was negative for chest pain, abdominal pain, numbness, tingling, or weakness. There was no history of pulmonary embolism (PE), deep vein thrombosis, or recent travel. The patient denied use of tobacco or drugs.
On arrival, vitals were as follows: temperature: 38.6 °C, heart rate: 109 beats per minute, respiratory rate 39 breaths per minute, SpO2: 57, blood pressure: 132/66 mm Hg. The patient was dyspneic and unable to speak in full sentences. On examination, breath sounds were equal, with symmetrical chest wall expansion. Cardiovascular examination showed regular rhythm, with strong and symmetrical peripheral pulses. Albeit distressed, the patient was alert and oriented, with no focal neurological deficits.
Initial workup included a chest X-ray, which revealed scattered bilateral airspace opacities. Pertinent laboratory values were as follows: sodium: 120 mEq/L (L), potassium: 4 mEq/L, blood urea nitrogen: 21 mg/dL (H), and creatinine: 1.1 mg/dL (H); white blood cell: 13 900/µL (H), neutrophil %: 89.4 (H), and lymphocyte %: 5.5 (L); hemoglobin: 13.3 g/dL, platelets: 250 000/µL; and Dimer 2.74 (H), C-reactive protein: 29.32 mg/dL (H), ferritin: 826.30 ng/mL (H), lactate dehydrogenase: 1883 U/L (H), interleukin-6: 224.35 pg/mL (H), and troponin <0.019 (ng/mL). RT-PCR (reverse transcriptase-polymerase chain reaction) nasopharyngeal swab returned positive for COVID.
The patient was managed on nonrebreather mask and nasal cannula; he received ceftriaxone, azithromycin, hydroxychloroquine, tocilizumab, and was enrolled in the ongoing remdesivir trial. After developing severe hypoxia on day 2 with oxygen saturation to the 60s off his non-rebreather mask, which he had removed, he was rapidly intubated. He had hypotension post-intubation which required vasopressor therapy; however, no overt shock was demonstrated. Lactate remained below 2.5, post intubation and serum creatinine remained below 0.8 mg/dL. Troponinemia worsened (0.194-0.682 ng/mL), and due to concern for acute PE, a heparin drip was initiated. The patient’s hospital course would continue with fluctuating hypoxia on ventilation while receiving heparin (intravenous), sedatives, and occasionally paralytics. He was continuously febrile and required pressor support for suboptimal blood pressures. Duplex study revealed no deep vein thrombosis in lower extremities and transthoracic echocardiography was without intracavitary thrombus.
On the morning of day 6, physical examination revealed diminished pupillary reflexes and mid-dilated pupils without corneal or oculocephalic reflexes, which persisted after withdrawing sedation. Computed tomography (CT) head revealed large ischemic infarcts involving bilateral occipital, left parietal, right temporal, and right frontal lobes with downward herniation into basal cisterns (). CT chest with angiography disclosed extensive multifocal dense ground-glass opacities in the lungs without PE. Taking the patient’s clinical deterioration, and severity of radiographic findings into consideration, no further workup was pursued. The patient was pronounced dead the following day.",What is the patient's CURB-65 score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Systolic Blood Pressure': [132.0, 'mm hg'], 'respiratory rate': [39.0, 'breaths per minute'], 'Blood Urea Nitrogen (BUN)': [21.0, 'mg/dL'], 'Confusion': False, 'Diastolic Blood Pressure': [66.0, 'mm hg'], 'age': [42, 'years']}",2,2,2,"The CURB-65 Score criteria are listed below:

1. Confusion: No = 0 points, Yes = +1 point
2. BUN >19 mg/dL (>7 mmol/L urea): No = 0 points, Yes = +1 point
3. Respiratory Rate ≥30: No = 0 points, Yes = +1 point
4. Systolic BP <90 mmHg or Diastolic BP ≤60 mmHg: No = 0 points, Yes = +1 point
5. Age ≥65: No = 0 points, Yes = +1 point

The total CURB-65 score is calculated by summing the points for each criterion.

The CURB-65 score is current at 0 points.
The patient is 42 years old. The patient's age is less than 65 years, and so we add 0 points to the score, keeping the current total at 0.
Because the patient does not have confusion, 0 points are added to the score, keeping the score at 0.
The concentration of BUN is 21.0 mg/dL. The patient's BUN concentration is greater than 19 mg/dL and so we add 1 point to score making the current total 0 + 1 = 1.
The patient's respiratory rate is 39 breaths per minute. Because the respiratory rate is greater than 30 breaths per minute, 1 point is added to the score, making the current total 1 + 1 = 2.
The patient's systiolic blood pressure is 132 mm Hg. The patient's diastolic blood pressure is 66 mm Hg. For a point a point to be added, the systiolic blood pressure must be less than 90 mm Hg or the diastolic blood pressure must be less than or equal to 60 mm Hg. Because neither of these statements are true, 0 points are added to score, keeping the current total to 2.
The patient's CURB-65 score is 2."
518,45,CURB-65 Score for Pneumonia Severity,risk,integer,pmc-7571607-1,Extracted,"A 65-year-old Hispanic male was brought to the emergency department (ED) complaining of worsening dyspnea, generalized malaise and weakness, and decreased oral intake for two weeks. His past medical history included systemic arterial hypertension, dyslipidemia, and COPD resulting from long-standing nicotine use. Previous pulmonary function test (PFT) results were not available, and the patient denied the use of supplemental oxygen therapy at home. The patient was alert, aware, and oriented to time, person, and place. He denied any recent travels or exposure to sick contacts. His vital signs on arrival to ED were as follows: blood pressure of 85/51 mmHg (mean arterial pressure of 58 mmHg), a respiratory rate of 28 breaths/minute, a heart rate of 114 beats/minute, a temperature of 102.8°F, and an oxygen saturation by pulse oximetry of 88% while breathing ambient air. Physical examination revealed decreased left lung air entry with rales on auscultation, and abdominal examination was unremarkable. Initial laboratory findings showed a white blood cell (WBC) count of 19,500 cells/mm3 (normal: 4,000-11,000 cells/mm3), a sodium level of 129 mEq/L (normal: 136-145 mEq/L), a bicarbonate level of 11 mEq/L (normal: 21-31 mEq/L), a blood urea nitrogen (BUN) level of 78 mg/dL (normal: 8-27 mg/dl), a serum ionized calcium level of 0.90 mg/dL (normal: 1.13-1.33 mg/dl), and a creatinine level of 7.7 mg/dL (normal: 0.8-1.3 mg/dl). Other abnormal laboratory results included an alanine aminotransferase (ALT) level of 80 U/L (normal: 7-52 U/L), a lipase level of 473 U/L (normal: 11-82 U/L), an alkaline phosphatase (AP) level of 173 U/L (normal: 34-104 U/L), a troponin level of 113 pg/mL (normal: 0-20 pg/ml), and a creatine phosphokinase (CPK) level of 1,103 U/L (normal: 38-174 U/L). Urine analysis showed large red-blood cells and proteinuria. Arterial blood gas (ABG) showed a pH of 7.22 (7.35-7.45), a pCO2 level of 25 mmHg (normal: 35-45 mmHg), and a paO2 level of 79 mmHg (normal: 75-100 mmHg), while patient receiving oxygen therapy through high-flow nasal canula at 60% fraction of inspired oxygen (FIO2). Lactic acid levels, lipid profile, total bilirubin, and coagulation studies were within normal limits, and urine toxicology screen was negative for recreational substances. Initial chest radiography (CXR) showed left lung opacity with consolidation (Figures , ). A critical care medicine evaluation was requested, and the patient was admitted to ICU with the diagnosis of severe sepsis with septic shock likely resulting from CAP. Aggressive intravenous fluids resuscitation and vasopressors (norepinephrine, vasopressin) were initiated on arrival to ICU, and the patient was subsequently intubated and placed on mechanical ventilation because of worsening tachypnea and increased FIO2 requirements. Empiric intravenous antimicrobial therapy with ceftriaxone (2 g daily) and azithromycin (500 mg daily) was initiated, along with steroids (hydrocortisone 50 mg intravenously every six hours) and intravenous sodium bicarbonate (NaHCO3) infusion.
Electrocardiogram (ECG) showed sinus tachycardia without ST-segment or T-wave abnormalities. Transthoracic echocardiogram (TTE) demonstrated a normal left ventricular ejection fraction (LVEF), with a normal right ventricular systolic function. Abdominal ultrasound (US) showed a normal gallbladder with a normal common bile duct. Abdominal computed tomography (CT) with oral contrast revealed mild peripancreatic fat stranding suggestive of non-complicated pancreatitis and duodenitis and confirmed the presence of a left lung base consolidation.
Blood culture and respiratory culture were negative. Severe acute respiratory syndrome-associated coronavirus (SARS-CoV-2) test by polymerase chain reaction (PCR) was negative. Legionella as well as Streptococcus pneumoniae urine antigens, by immunochromatographic assay, were reported to be positive.
On day three of ICU admission, vasopressors were titrated off, metabolic acidosis had resolved, and the patient's creatinine,liver chemistries, and CPK levels were trending downward. The patient's FIO2 requirements were decreased to 45%, and he was extubated on day five of ICU admission. After 48 hours, he was transferred to a medical ward. The patient completed a total of 10 days of intravenous antimicrobial therapy with azithromycin 500 mg daily.",What is the patient's CURB-65 score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [65, 'years'], 'Systolic Blood Pressure': [85.0, 'mm hg'], 'Diastolic Blood Pressure': [51.0, 'mm hg'], 'respiratory rate': [28.0, 'breaths per minute'], 'Blood Urea Nitrogen (BUN)': [78.0, 'mg/dL'], 'Confusion': False}",3,3,3,"The CURB-65 Score criteria are listed below:

1. Confusion: No = 0 points, Yes = +1 point
2. BUN >19 mg/dL (>7 mmol/L urea): No = 0 points, Yes = +1 point
3. Respiratory Rate ≥30: No = 0 points, Yes = +1 point
4. Systolic BP <90 mmHg or Diastolic BP ≤60 mmHg: No = 0 points, Yes = +1 point
5. Age ≥65: No = 0 points, Yes = +1 point

The total CURB-65 score is calculated by summing the points for each criterion.

The CURB-65 score is current at 0 points.
The patient is 65 years old. The patient's age is greater than or equal to 65 years, and so we add 1 point to the score, making the current total 0 + 1 = 1.
Because the patient does not have confusion, 0 points are added to the score, keeping the score at 1.
The concentration of BUN is 78.0 mg/dL. The patient's BUN concentration is greater than 19 mg/dL and so we add 1 point to score making the current total 1 + 1 = 2.
The patient's respiratory rate is 28 breaths per minute. Because the respiratory rate is less than 30 breaths per minute, 0 points are added to the score, keeping the current total at 2.
The patient's systiolic blood pressure is 85 mm Hg. The patient's diastolic blood pressure is 51 mm Hg. For a point a point to be added, the systiolic blood pressure must be less than 90 mm Hg or the diastolic blood pressure must be less than or equal to 60 mm Hg. Because at least one of these statements is true, 1 point is added to score, making the current total 2 + 1 = 3.
The patient's CURB-65 score is 3."
519,45,CURB-65 Score for Pneumonia Severity,risk,integer,usmle-1885,Extracted,"A 52-year-old man is brought to the emergency department with dry cough, shortness of breath, and low-grade fever that began 6 days ago. He also reports that he has had 3 episodes of watery diarrhea per day for the last 2 days. He appears slightly pale. His temperature is 38.0°C (100.4°F), pulse is 65/min, respirations are 15/min, and blood pressure is 140/78 mm Hg. Diffuse crackles are heard over bibasilar lung fields. Laboratory studies show:
Hemoglobin 13.8 g/dL
Leukocyte count 16,000/mm3
Platelet count 150,000/mm3
Serum
Na+ 131 mEq/L
Cl- 102 mEq/L
K+ 4.7 mEq/L
HCO3- 26 mEq/L
Urea nitrogen 18 mg/dL
Creatinine 1.2 mg/dL
An x-ray of the chest shows patchy infiltrates in both lungs.",What is the patient's CURB-65 score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Systolic Blood Pressure': [140.0, 'mm hg'], 'respiratory rate': [15.0, 'breaths per minute'], 'Blood Urea Nitrogen (BUN)': [18.0, 'mg/dL'], 'Diastolic Blood Pressure': [78.0, 'mm hg'], 'age': [52, 'years']}",0,0,0,"The CURB-65 Score criteria are listed below:

1. Confusion: No = 0 points, Yes = +1 point
2. BUN >19 mg/dL (>7 mmol/L urea): No = 0 points, Yes = +1 point
3. Respiratory Rate ≥30: No = 0 points, Yes = +1 point
4. Systolic BP <90 mmHg or Diastolic BP ≤60 mmHg: No = 0 points, Yes = +1 point
5. Age ≥65: No = 0 points, Yes = +1 point

The total CURB-65 score is calculated by summing the points for each criterion.

The CURB-65 score is current at 0 points.
The patient is 52 years old. The patient's age is less than 65 years, and so we add 0 points to the score, keeping the current total at 0.
Whether the patient has confusion is not reported in the note. Hence, we assume this to be false, and so 0 points are added to the score, making the current total 0.
The concentration of BUN is 18.0 mg/dL. The patient's BUN concentration is less than or equal to 19 mg/dL and so 0 points are added to score, keeping the current total at 0.
The patient's respiratory rate is 15 breaths per minute. Because the respiratory rate is less than 30 breaths per minute, 0 points are added to the score, keeping the current total at 0.
The patient's systiolic blood pressure is 140 mm Hg. The patient's diastolic blood pressure is 78 mm Hg. For a point a point to be added, the systiolic blood pressure must be less than 90 mm Hg or the diastolic blood pressure must be less than or equal to 60 mm Hg. Because neither of these statements are true, 0 points are added to score, keeping the current total to 0.
The patient's CURB-65 score is 0."
520,45,CURB-65 Score for Pneumonia Severity,risk,integer,pmc-5754342-1,Extracted,"A 78-year-old man presented to the emergency department with dyspnea and fever for 6 hours. He was not currently employed and had no history of cigarette smoking or alcohol ingestion. He had no underlying disease. Besides, he had no hospital admission, antimicrobial use history and healthcare institution visiting record in 1 year. On admission, he appeared acutely ill. His blood pressure was 104/57 mmHg, respiratory rate 20 breaths per minute, pulse rate 110 beats per minute, and body temperature 38.2°C. A regular heart rhythm was observed. There were coarse breath sounds with crackles in the right lung field.
The laboratory results were as follows: white blood cell count 3,900/mm3 (72.5% neutrophils, 20.4% lymphocytes, 4.7% monocytes, 2.82% eosinophils), hemoglobin 12.2 g/dL, platelet count 197,000/mm3, C-reactive protein 1.24 mg/dL, blood urea nitrogen 28.2 mg/dL, creatinine 1.24 mg/dL, aspartate aminotransferase 16 UI/L, alanine aminotransferase 10 IU/L, total bilirubin 0.9 mg/dL, total protein 6.0 g/dL, and albumin 3.5 g/dL. The arterial blood gas analysis breathing room air was pH 7.44, pCO2 24.1 mmHg, pO2 59.0 mmHg, HCO3– 17 mmol/L, and O2 saturation 87%. A plain chest radiograph showed patchy consolidations in the right middle and lower lobes (). Chest computed tomography (CT) showed lobar pneumonia in the right middle and lower lobes (). He was diagnosed with CAP. Intravenous piperacillin/tazobactam and ciprofloxacin were administered empirically.
Five hours after admission, his respiratory distress worsened, and he was treated with oxygen at 6 L/min via mask. On the second day after admission, intravenous teicoplanin was administered because of a persistent fever. On the third day, A. baumannii was identified in cultures of both sputum and in two of three pairs of blood samples taken on admission. A. baumannii was identified using Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS, Bruker Daltonics GmbH, Bremen, Germany) on a Microflex spectrometer (Bruker Daltonics GmbH, Germany). Antimicrobial susceptibilities were determined using VITEK-2 system (bioMerieux, Marcy I'Etoile, France). The bacterial isolate was resistant to multiple drugs, except colistin, tigecycline, minocycline, amikacin, and gentamicin (). Therefore, the antibiotics were changed to intravenous colistin and oral minocycline.
On the 6th day after admission, his vital signs stabilized and the fever subsided. Follow-up chest radiography and CT showed improved consolidation. No A. baumannii grew in the follow-up blood cultures. On the 26th day after admission, because of colistin-induced nephropathy, the antibiotics were switched to tigecycline. On the 48th day after admission, the chest radiograph and chest CT showed that the pneumonia had improved ( and ). The patient was discharged on day 56 and followed as an outpatient with no significant complications.",What is the patient's CURB-65 score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [78.0, 'years'], 'Systolic Blood Pressure': [104.0, 'mm hg'], 'Diastolic Blood Pressure': [57.0, 'mm hg'], 'Blood Urea Nitrogen (BUN)': [28.2, 'mg/dL'], 'respiratory rate': [20.0, 'breaths per minute'], 'Confusion': False}",3,3,3,"The CURB-65 Score criteria are listed below:

1. Confusion: No = 0 points, Yes = +1 point
2. BUN >19 mg/dL (>7 mmol/L urea): No = 0 points, Yes = +1 point
3. Respiratory Rate ≥30: No = 0 points, Yes = +1 point
4. Systolic BP <90 mmHg or Diastolic BP ≤60 mmHg: No = 0 points, Yes = +1 point
5. Age ≥65: No = 0 points, Yes = +1 point

The total CURB-65 score is calculated by summing the points for each criterion.

The CURB-65 score is current at 0 points.
The patient is 78.0 years old. The patient's age is greater than or equal to 65 years, and so we add 1 point to the score, making the current total 0 + 1 = 1.
Because the patient does not have confusion, 0 points are added to the score, keeping the score at 1.
The concentration of BUN is 28.2 mg/dL. The patient's BUN concentration is greater than 19 mg/dL and so we add 1 point to score making the current total 1 + 1 = 2.
The patient's respiratory rate is 20 breaths per minute. Because the respiratory rate is less than 30 breaths per minute, 0 points are added to the score, keeping the current total at 2.
The patient's systiolic blood pressure is 104 mm Hg. The patient's diastolic blood pressure is 57 mm Hg. For a point a point to be added, the systiolic blood pressure must be less than 90 mm Hg or the diastolic blood pressure must be less than or equal to 60 mm Hg. Because at least one of these statements is true, 1 point is added to score, making the current total 2 + 1 = 3.
The patient's CURB-65 score is 3."
521,45,CURB-65 Score for Pneumonia Severity,risk,integer,pmc-7220071-1,Extracted,"An 82-year-old Japanese man presented at the emergency department with 4 weeks of generalized weakness and 2 days of dyspnea. His medical history included hypertension and prostate cancer, which had been treated by radical prostatectomy 5 years earlier. He was taking losartan and amlodipine for the hypertension. An initial physical examination revealed bibasilar coarse crackles in both lungs, and scratch-like erythematous skin lesions on his back (Fig. A). On admission, his blood pressure, heart rate, respiratory rate, and oxygen saturation were 88/65 mmHg, 110 beats per minute, 22 breaths per minute, and 92% in ambient air, respectively. He was afebrile with a temperature of 36.3 °C. He had no signs of paralysis. Manual muscle testing revealed mild weakness of the iliopsoas and quadriceps muscles.
Laboratory evaluation revealed a white blood cell count (WBC) of 8900 cells/μL, hemoglobin (Hb) of 11.3 g/dL, and normal platelet counts (PLT). The level of creatine kinase (CK) was elevated at 924 U/L (normal range, 124–222 ng/mL). The levels of C-reactive protein (CRP), lactate dehydrogenase (LDH), aspartate aminotransferase, and alanine aminotransferase were elevated at 5.6 mg/dL, 682 U/L (normal range, 124–222 U/L), 305 U/L, and 180 U/L, respectively. Kidney dysfunction was also detected (creatinine [Cr] at 2.81 mg/dL, blood urea nitrogen [BUN] at 74.0 mg/dL). Chest radiography revealed multiple small pulmonary infiltrates in both lungs and additional high-resolution computed tomography (HRCT) of the chest revealed the presence of peripheral consolidation in the left lower lung base, and ground-glass opacities in all 6 lung fields (Fig. ). Expectorated sputum was not good quality, and the sputum culture results were unremarkable; however, a pneumococcal urinary antigen test was positive. The patient was initially diagnosed as having community-acquired pneumonia and severe sepsis, and was subsequently started on fluid replacement and antibiotic treatment with ceftriaxone and azithromycin.
After antibiotic and fluid replacement treatments, the patient's blood pressure and kidney function improved, but his symptoms of dyspnea and weakness worsened on the fourth day after admission. Physical examination revealed fine crackles at the lung base. The patient also developed slight skin thickening on the lateral side of the fingers (consistent with mechanic's hand) and ulcerated palmar papules (Fig. B) in addition to already-existing multiple vertical linear streaks with spotty crusting on his back (flagellate erythema). A chest HRCT scan revealed exacerbation of the ground-glass opacities in the bilateral lung fields, without improvement of peripheral consolidation in the left lower lung base (Fig. B). A bronchoscopy was performed to examine the possibility of an infectious cause, but no noteworthy colonies were isolated in bacterial or mycobacterial cultures from the bronchoalveolar lavage sample.
Based on the clinical suspicion of acute interstitial pneumonia due to DM, high doses of methylprednisolone pulses (1 g/d for 3 days), 1000 mg of intravenous cyclophosphamide (IVCY), and oral tacrolimus (6 mg/d) were administered on the fourth day after admission (Fig. ). The laboratory data showed the following results: white blood cell count (WBC 7400 cells/μL, Hb 14.3 g/dL, PLT 11.4 × 104/μL, LDH 728 U/L, CK 1208 U/L, CRP 5.78 mg/dL, and KL-6 1146 U/mL). The patient's ferritin level was also elevated at 1995 ng/mL (normal range, 30–300 ng/mL). Following immunological and serological testing, anti-MDA5 Ab was found to have a high titer index (>150; normal range, 0–39). Anti-aminoacyl tRNA synthetase (anti-ARS) antibody, anti-transcription intermediary factor 1-gamma (TIF1-γ) antibody, anti-Mi-2 antibody, antinuclear antibody (ANA), proteinase 3-anti-neutrophil cytoplasmic autoantibodies (PR3-ANCAs), and myeloperoxidase anti-neutrophil cytoplasmic autoantibodies (MPO-ANCAs) were all negative. The patient was eventually diagnosed as having anti-MDA5 Ab-positive DM with RPILD. The patient received intravenous immunoglobulin (IVIG) in addition to triple immunosuppressive therapy. However, his respiratory status exacerbated, and this was complicated by upper gastrointestinal bleeding without apparent coagulation abnormality on the ninth day after admission. Although the patient received intensive treatment with mechanical ventilatory support, continuous infusion of vasopressors, and continuous hemodiafiltration, he died of respiratory failure on the twelfth day after admission. The postmortem CT examination revealed widespread consolidations in both lung fields and dramatic loss of lung volume (Fig. C).
An autopsy was performed 2 hours after death. Both lungs revealed a congestive increase in weight (745 g for the left and 760 g for the right) with sporadic alveolar hemorrhages (Fig. A). Autopsy specimens taken from the lungs were consistent with DAD, with findings of hyaline membrane formation and fibrotic tissue covering the alveoli (Fig. B). A specimen taken from the right iliopsoas muscle showed intramuscular bleeding (Fig. C); however, a specimen from the quadriceps muscle showed no definitive presence of inflammatory cells (Fig. D). In addition, extensive intraparenchymal hemorrhages were observed, including the gastric and bowl mucosa, spleen (Fig. E and F), and left adrenal gland.",What is the patient's CURB-65 score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [82, 'years'], 'Systolic Blood Pressure': [88.0, 'mm hg'], 'Diastolic Blood Pressure': [65.0, 'mm hg'], 'Blood Urea Nitrogen (BUN)': [74.0, 'mg/dL'], 'respiratory rate': [22.0, 'breaths per minute'], 'Confusion': False}",3,3,3,"The CURB-65 Score criteria are listed below:

1. Confusion: No = 0 points, Yes = +1 point
2. BUN >19 mg/dL (>7 mmol/L urea): No = 0 points, Yes = +1 point
3. Respiratory Rate ≥30: No = 0 points, Yes = +1 point
4. Systolic BP <90 mmHg or Diastolic BP ≤60 mmHg: No = 0 points, Yes = +1 point
5. Age ≥65: No = 0 points, Yes = +1 point

The total CURB-65 score is calculated by summing the points for each criterion.

The CURB-65 score is current at 0 points.
The patient is 82 years old. The patient's age is greater than or equal to 65 years, and so we add 1 point to the score, making the current total 0 + 1 = 1.
Because the patient does not have confusion, 0 points are added to the score, keeping the score at 1.
The concentration of BUN is 74.0 mg/dL. The patient's BUN concentration is greater than 19 mg/dL and so we add 1 point to score making the current total 1 + 1 = 2.
The patient's respiratory rate is 22 breaths per minute. Because the respiratory rate is less than 30 breaths per minute, 0 points are added to the score, keeping the current total at 2.
The patient's systiolic blood pressure is 88 mm Hg. The patient's diastolic blood pressure is 65 mm Hg. For a point a point to be added, the systiolic blood pressure must be less than 90 mm Hg or the diastolic blood pressure must be less than or equal to 60 mm Hg. Because at least one of these statements is true, 1 point is added to score, making the current total 2 + 1 = 3.
The patient's CURB-65 score is 3."
522,45,CURB-65 Score for Pneumonia Severity,risk,integer,pmc-7142028-1,Extracted,"A 72-year-old female was referred to our hospital with unresolved dyspnea. She had a history of hypertension, diabetes, asthma, and cerebral infarction. Two weeks before admission, dyspnea and cough developed. She was admitted to the local hospital for 10 days and was on antibiotics, including a third generation cephalosporin (ceftriaxone) and carbapenem (meropenem), resulting from suspected pneumonia.
At admission, she had resting dyspnea. Her body temperature was 37.1°C, heart rate 108 beats/min, blood pressure 140/80 mmHg, respiratory rate 24 breaths/min, and oxygen saturation 84% while receiving oxygen via a nasal cannula at a rate of 5 L/min. Physical examination was notable for crackles without wheezing in the lungs and pitting edema in both lower legs. Arterial blood gas analysis showed pH 7.33, PCO2 52 mmHg, PO2 56 mmHg, HCO3- 20.6 mM/L, and O2 saturation 84.6%. Laboratory tests revealed the following values: white blood cell count 8,840/µL, hemoglobin 11.2 g/µL, platelet count 393 K/µL, total bilirubin 0.17 mg/dL, aspartate aminotransferase 20 IU/L, alanine aminotransferase 14 IU/L, alkaline phosphatase 97 IU/L (range, 30–120 IU/L), gamma glutamyl transferase 46 IU/L (range, 5–39 IU/L), blood urea nitrogen 29.9 mg/dL, creatinine 0.69 mg/dL, C-reactive protein 27.57 mg/L (range, 0–5 mg/L), activated partial thrombin time 25.8 sec (range, 23–35 sec), and international normalized ratio 1.15. The level of brain natriuretic peptide and D-dimer were 1,921 pg/mL (range, 0–150 pg/mL) and 5.8 μg/mL (range, 0–0.5 μg/mL), respectively; other laboratory results were unremarkable. Electrocardiogram showed sinus tachycardia at a rate of 110 beats/min, T wave inversion in V1-4, poor R-wave progression, and rightward axis deviation, known as ‘right ventricle (RV) strain.’
Transthoracic echocardiography (TTE) () showed RV dilatation with reduced systolic function, moderate tricuspid valve regurgitation (proximal isovelocity surface area radius, 5.1 mm; jet area, 7.5 cm2), left ventricle septal flattening during the systolic phase, inferior vena cava plethora, and moderate PH (pulmonary artery systolic pressure [PASP], 65.7 mmHg; mean pulmonary arterial pressure, 44 mmHg) without obvious atrial or ventricular septal defect. Left ventricular systolic function was preserved with an ejection fraction of 71%. Contrast–enhanced chest computed tomography (CT) with pulmonary arteriography was performed. CT showed the presence of multiple small consolidative lesions in both lung fields without evidence of pulmonary thromboembolism. A pulmonary function test showed moderate obstructive lung defect with good response to bronchodilator (forced expiratory volume in 1 sec [FEV1]/forced vital capacity [FVC] 78%, pre-FEV1 0.79 L, 43%→post-FEV1 0.99 L, 58%). A 15% decrease in the diffusing capacity of the lung for carbon monoxide was noted.
Given these findings, right-sided heart failure originating from untreated asthma and acute decompensation caused by community-acquired pneumonia was suggested as the initial diagnosis. However, despite antibiotics and proper diuretic-based heart failure therapy, her dyspnea gradually worsened. On the 12th hospital day (HD), oxygen was supplied using a high flow nasal cannula (FiO2, 0.4; flow, 40 L/min), and oxygen saturation was maintained within the range of 90%–95%.
On the 14th HD, contrast-enhanced whole-body CT and ventilation/perfusion lung scans were performed to determine the cause of clinical deterioration. Chest CT showed numerous centrilobular nodules with “tree-in-bud” sign and pleural-enhancing nodules (). Abdominopelvic CT showed a 3-cm less enhancing mass with ill-defined margins located at the pancreatic head and neck region, in addition to upstream pancreatic duct dilatation (). A ventilation lung scan showed no significant decreased activity while a perfusion lung scan revealed multifocal peripherally distributed small perfusion defects in the bilateral lung fields (). Moreover, serum carbohydrate antigen 19-9 level was elevated 77.9 U/mL (range, 0–35 U/mL); therefore, an endoscopic ultrasonographic-guided biopsy was needed for histopathological confirmation of pancreatic cancer. However, it was impossible to obtain the biopsy due to the unbearable severe dyspnea and opposition of the patient’s family. 18F-2-fluoro-2-deoxy-D-glucose-positron emission tomography integrated with computed tomography (FDG-PET/CT) was performed for diagnosis and staging of pancreatic cancer after discussion with the Pancreatobiliary Department (). This test showed an intensive hypermetabolic mass at the pancreatic head and neck portion with multiple common hepatic, portocaval, aortocaval, hepatoduodenal, para-aortic, left common iliac, mediastinum, right lower paratracheal, and right interlobar lymph node metastases in addition to numerous tiny bilateral lung and both pleural metastases.
According to these clinical and radiologic findings, PTTM secondary to advanced pancreatic cancer was suggested as the final diagnosis. The clinical stage was TxN2M1, stage IV according to the 8th edition of the American Joint Committee on Cancer staging system []. Since the disease continuously progressed to multi-organ failure, including respiratory failure and acute kidney injury, only supportive care could be provided, and the patient died on the 27th day after diagnosis.",What is the patient's CURB-65 score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [72, 'years'], 'Systolic Blood Pressure': [140.0, 'mm hg'], 'Diastolic Blood Pressure': [80.0, 'mm hg'], 'Blood Urea Nitrogen (BUN)': [29.9, 'mg/dL'], 'respiratory rate': [24.0, 'breaths per minute'], 'Confusion': False}",2,2,2,"The CURB-65 Score criteria are listed below:

1. Confusion: No = 0 points, Yes = +1 point
2. BUN >19 mg/dL (>7 mmol/L urea): No = 0 points, Yes = +1 point
3. Respiratory Rate ≥30: No = 0 points, Yes = +1 point
4. Systolic BP <90 mmHg or Diastolic BP ≤60 mmHg: No = 0 points, Yes = +1 point
5. Age ≥65: No = 0 points, Yes = +1 point

The total CURB-65 score is calculated by summing the points for each criterion.

The CURB-65 score is current at 0 points.
The patient is 72 years old. The patient's age is greater than or equal to 65 years, and so we add 1 point to the score, making the current total 0 + 1 = 1.
Because the patient does not have confusion, 0 points are added to the score, keeping the score at 1.
The concentration of BUN is 29.9 mg/dL. The patient's BUN concentration is greater than 19 mg/dL and so we add 1 point to score making the current total 1 + 1 = 2.
The patient's respiratory rate is 24 breaths per minute. Because the respiratory rate is less than 30 breaths per minute, 0 points are added to the score, keeping the current total at 2.
The patient's systiolic blood pressure is 140 mm Hg. The patient's diastolic blood pressure is 80 mm Hg. For a point a point to be added, the systiolic blood pressure must be less than 90 mm Hg or the diastolic blood pressure must be less than or equal to 60 mm Hg. Because neither of these statements are true, 0 points are added to score, keeping the current total to 2.
The patient's CURB-65 score is 2."
523,45,CURB-65 Score for Pneumonia Severity,risk,integer,pmc-4974841-1,Extracted,"Our patient is a 43-year-old male with no significant past medical history who presented to our emergency room with a chief complaint of shortness of breath for the duration of 2 weeks. Two weeks before presentation, the patient was prescribed azithromycin by his primary care provider for a presumed diagnosis of pneumonia. On further history, the patient endorsed a non-productive cough associated with subjective fevers, chills, weakness and malaise for 1 month. He denied any past medical history of autoimmune, systemic or immune-compromising conditions. He denied any sick contacts, recent travel, tuberculosis or chemical exposure. He denied any nausea, vomiting, diarrhea, muscular weakness or neurological symptoms, orthopnea or paroxysmal nocturnal dyspnea. At baseline, he was able to walk approximately five blocks without getting dyspneic. He had no known drug allergies, took no other medications and his social history was negative other than 20 pack year smoking history. His family history was unremarkable as well. Our patient worked a desk job and his occupational history was negative for any kind of environmental pollutants known to be associated with lung disease. On admission to the emergency room, the patient was afebrile, with a respiratory rate of 26 breaths/min, heart rate of 115 beats/min, with a room air saturation of 75% and blood pressure of 90/60 mm Hg. Physical exam was pertinent for hyperkeratosis over the index fingers and his thumbs bilaterally along with thickening noticed over the metacarpophalangeal joints and proximal interphalangeal joints. The rest of the physical exam was unremarkable. Early resuscitation was initiated and the patient was treated with 6 L of oxygen via nasal cannula and given 30 cc/kg of normal saline for fluid resuscitation with normalization of his blood pressure and heart rate prior to admission to the general medical telemetry unit.
On admission, his labs were remarkable for a white blood cell count of 25,000 units/L, hemoglobin level was 13.5 g/dL and platelet count of 385 × 109/L. On his metabolic panel, the patient’s sodium level was 133 mg/dL with a BUN of 13 mg/dL and creatinine of 0.69 mg/dL, with troponin being 0.09 μg/L and B-type natriuretic peptide being 79 pg/mL. His liver function was remarkable for a normal alkaline phosphatase and bilirubin level with aspartate transaminase and alanine transaminase of 259 units/L and 266 units/L, respectively with a CPK of 7,500 International Units/L. Albumin was measured at 2.4 g/dL with a globulin level of 4.2 g/dL. His arterial blood gas values were remarkable at 7.37/43/52 on 6 L nasal cannula oxygen. His lactic acid was elevated at 2.4 mg/dL. ESR on admission was 35 mm/h, CRP was 24 mg/L and procalcitonin level was 34 ng/mL. ANA showed a speckled patter with 1:320 titers, anti-Jo-1 antibody was also positive at 8 and anti-CCP antibody was positive at 153.
A CT scan of his chest on admission () showed a pericardial effusion measuring 1.3 cm in thickness. Non-confluent areas of ill defined opacities were also seen in both lungs with denser consolidations and air Broncho-grams mainly in the right middle lobe and both the lower lobes which were thought to be a combination of infiltrates and atelectasis. A chest X-ray () showed a small right-sided pleural effusion with a patchy right sided opacity. An echocardiogram (ECHO) evaluation revealed a moderate to large pericardial effusion (). A chest X-ray at the end of the course of treatment showed complete resolution of the prior findings ().
The patient required intensive care unit transfer 2 days into admission for worsening hypoxia and hypotension initially treated with 24 h of non-invasive positive pressure ventilation and subsequent mechanical ventilation. Despite maximal ventilator support and pulmonary artery catheterization for optimal fluid management, the patient continued to decline. A decision to pursue veno-venous (VV) extracorporeal membrane oxygenation (ECMO) was undertaken for a diagnosis of severe acute respiratory distress syndrome 4 days into admission.
Owing to the radiographic and clinical findings suspicious for acute interstitial pneumonia and diagnostically negative bronchoscopic, viral, fungal, bacterial and mycobacterial serology, the patient was treated with broad spectrum antibiotics, namely, vancomycin, zosyn and azithromycin. The radiographic appearance, serologic findings combined with physical exam findings like “mechanic’s hands”, non-specific interstitial pneumonia with a pattern of ILD with elevated CK and positive anti-Jo-1, heightened the suspicion of a rare form of acutely progressing AS. Hence, the decision was made to treat the patient with high dose methylprednisolone 1 g daily for 3 days, followed by 125 mg, four times a day for 4 days, followed by a taper of 60 mg, four times a day for 4 days. The steroid medication was further weaned down to prednisone 40 mg daily, a dosage which he was discharged on.
With regard to his cardiovascular status, the patient had minimal vasopressor requirements despite his initial shock physiology. Follow-up serial echocardiography noted worsening pericardial effusion, necessitating the need for both diagnostic and therapeutic pericardial window. Fluid analysis showed no signs of infection with discharge surveillance ECHO showing no re-accumulation of pericardial fluid.
The patient developed non-oliguric renal failure thought to be secondary to acute tubular necrosis from a combination of hypotension and sepsis. The patient did not require renal replacement therapy however. Rhabdomyolysis was not felt to contribute to renal failure with CPKs peaking at 7,500 International Units/L followed by a gradual fall.
The course was also complicated by an upper gastrointestinal bleed which endoscopically was attributed to erosive gastritis managed conservatively via proton pump inhibitors.
Over the course of his stay, the patient showed significant improvement in his respiratory, cardiovascular and renal status and was decannulated from ECMO in 2 days (yes sure it was 2 days) with transition to mechanical ventilation. The patient was extubated shortly afterwards and had significantly improved clinical dyspnea.",What is the patient's CURB-65 score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [43, 'years'], 'Systolic Blood Pressure': [90.0, 'mm hg'], 'Diastolic Blood Pressure': [60.0, 'mm hg'], 'Blood Urea Nitrogen (BUN)': [13.0, 'mg/dL'], 'respiratory rate': [26.0, 'breaths per minute']}",1,1,1,"The CURB-65 Score criteria are listed below:

1. Confusion: No = 0 points, Yes = +1 point
2. BUN >19 mg/dL (>7 mmol/L urea): No = 0 points, Yes = +1 point
3. Respiratory Rate ≥30: No = 0 points, Yes = +1 point
4. Systolic BP <90 mmHg or Diastolic BP ≤60 mmHg: No = 0 points, Yes = +1 point
5. Age ≥65: No = 0 points, Yes = +1 point

The total CURB-65 score is calculated by summing the points for each criterion.

The CURB-65 score is current at 0 points.
The patient is 43 years old. The patient's age is less than 65 years, and so we add 0 points to the score, keeping the current total at 0.
Whether the patient has confusion is not reported in the note. Hence, we assume this to be false, and so 0 points are added to the score, making the current total 0.
The concentration of BUN is 13.0 mg/dL. The patient's BUN concentration is less than or equal to 19 mg/dL and so 0 points are added to score, keeping the current total at 0.
The patient's respiratory rate is 26 breaths per minute. Because the respiratory rate is less than 30 breaths per minute, 0 points are added to the score, keeping the current total at 0.
The patient's systiolic blood pressure is 90 mm Hg. The patient's diastolic blood pressure is 60 mm Hg. For a point a point to be added, the systiolic blood pressure must be less than 90 mm Hg or the diastolic blood pressure must be less than or equal to 60 mm Hg. Because at least one of these statements is true, 1 point is added to score, making the current total 0 + 1 = 1.
The patient's CURB-65 score is 1."
524,45,CURB-65 Score for Pneumonia Severity,risk,integer,pmc-3991870-1,Extracted,"A delirious 44-year-old woman was brought to our emergency room complaining of shortness of breath and fever.
The patient had no past medical history until last week. She has been feeling “under the weather” for a couple of days. She presented a fever, a cough with some phlegm and chills. She also complained of some sharp chest pain when she took a breath. She denied smoking.
Physical examination revealed a patient with dyspnea in acute distress. Her temperature was 105 °F. Her blood pressure was 80/40 mm Hg (normally 120/80 mm Hg). Her heart rate was 140 beats per minute (normally 60–80 bpm) and regular. Her extremities felt cool to the touch and had mottled skin. She had decreased skin turgor.
After initial evaluation, she was put on 100% oxygen via a face mask. Even breathing 100% oxygen, her blood oxygen saturation was only 92% (normally >95% on room air and 100% on 100% inspired oxygen). Her respiratory rate was 35 breaths per minute (normally 15 breaths/min). Examination of the lungs revealed bilateral rales (crackly lung noises heard on inspiration that indicate fluid in the alveoli), which were more prominent at the bases. Her jugular veins were not distended and she had no hepatojugular reflux. The point of maximal impulse was in the fifth intercostal space along the left midclavicular line. She was tachycardic, with normal S1 and S2. There were no rubs, murmurs, or gallops. Peripheral pulses were weak on both sides. Her abdomen had some decreased bowel sounds but was otherwise normal.
After she was put on 100% oxygen, the laboratory assayed a sample of arterial blood from the patient and obtained the following values (normal values in parentheses): pH 6.98 (7.38-7.42), PCO2 50 mmHg (37-43), PO2 80 (>90 on room air), calculated HCO3 10 (22-32), creatinine 2.5 mg/dl (0.5-1.5), blood urea nitrogen 40 mg/dl (5-25), Na+ 145 mEq/L (133-147), K+ 3.7 mEq/L (3.2-5.2), Cl- 103 mEq/L (94-110), HCO3- 12 mEq/L (22-32), lactate 5 mEq/L (<1.5).
Her white blood cell count was elevated (normal 4 – 12 × 103 per microliter) and immature white cells were present. Her hemoglobin and hematocrit were normal, but her platelet count was low. Also, her urine output was low.
Chest X-ray showed pulmonary edema that was more pronounced at the bases and at the hila.
A lung CT scan showed extra density at the bases.
An ECG showed sinus tachycardia but was otherwise within normal limits.
The diagnosis was community-acquired pneumonia and septic shock. The patient was intubated and treated using lung protective ventilation. She was given vasopressors, antibiotics and normal saline.",What is the patient's CURB-65 score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [44, 'years'], 'Systolic Blood Pressure': [80.0, 'mm hg'], 'Diastolic Blood Pressure': [40.0, 'mm hg'], 'Blood Urea Nitrogen (BUN)': [40.0, 'mg/dL'], 'respiratory rate': [35.0, 'breaths per minute'], 'Confusion': True}",4,4,4,"The CURB-65 Score criteria are listed below:

1. Confusion: No = 0 points, Yes = +1 point
2. BUN >19 mg/dL (>7 mmol/L urea): No = 0 points, Yes = +1 point
3. Respiratory Rate ≥30: No = 0 points, Yes = +1 point
4. Systolic BP <90 mmHg or Diastolic BP ≤60 mmHg: No = 0 points, Yes = +1 point
5. Age ≥65: No = 0 points, Yes = +1 point

The total CURB-65 score is calculated by summing the points for each criterion.

The CURB-65 score is current at 0 points.
The patient is 44 years old. The patient's age is less than 65 years, and so we add 0 points to the score, keeping the current total at 0.
Because the patient has confusion, 1 point is added to score making the current total 0 + 1 = 1.
The concentration of BUN is 40.0 mg/dL. The patient's BUN concentration is greater than 19 mg/dL and so we add 1 point to score making the current total 1 + 1 = 2.
The patient's respiratory rate is 35 breaths per minute. Because the respiratory rate is greater than 30 breaths per minute, 1 point is added to the score, making the current total 2 + 1 = 3.
The patient's systiolic blood pressure is 80 mm Hg. The patient's diastolic blood pressure is 40 mm Hg. For a point a point to be added, the systiolic blood pressure must be less than 90 mm Hg or the diastolic blood pressure must be less than or equal to 60 mm Hg. Because at least one of these statements is true, 1 point is added to score, making the current total 3 + 1 = 4.
The patient's CURB-65 score is 4."
525,45,CURB-65 Score for Pneumonia Severity,risk,integer,usmle-8555,Extracted,"A 68-year-old man is admitted to the emergency department after 2 days of difficulty breathing and fever. His past medical history is significant for hypertension and benign prostate hypertrophy. He takes hydrochlorothiazide and tamsulosin.  He also admits to drinking alcohol on the weekends and a half pack a day smoking habit. Upon admission, he is found to have blood pressure of 125/83 mm Hg, pulse of 88/min, a respiratory rate of 28/min, and a temperature of 38.9°C (102°F). On physical exam breath sounds are decreased at the left pulmonary base. A chest x-ray reveals consolidation in the left lower lobe. Additional laboratory tests demonstrate leukocytosis, elevated C-reactive protein, a serum creatinine (Cr) of 8.0 mg/dL, and a blood urea nitrogen (BUN) of 32 mg/dL. The patient is admitted to the hospital and started on cefepime and clarithromycin. His dyspnea slowly improves after 48 hours, however, his body temperature remains at 39°C (102.2°F). Recent laboratory tests show reduced C-reactive protein levels, a Cr of 1.8 mg/dL and a BUN of 35 mg/dL. A urinalysis is ordered.",What is the patient's CURB-65 score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Systolic Blood Pressure': [125.0, 'mm hg'], 'respiratory rate': [28.0, 'breaths per minute'], 'Blood Urea Nitrogen (BUN)': [32.0, 'mg/dL'], 'Diastolic Blood Pressure': [83.0, 'mm hg'], 'age': [68.0, 'years']}",2,2,2,"The CURB-65 Score criteria are listed below:

1. Confusion: No = 0 points, Yes = +1 point
2. BUN >19 mg/dL (>7 mmol/L urea): No = 0 points, Yes = +1 point
3. Respiratory Rate ≥30: No = 0 points, Yes = +1 point
4. Systolic BP <90 mmHg or Diastolic BP ≤60 mmHg: No = 0 points, Yes = +1 point
5. Age ≥65: No = 0 points, Yes = +1 point

The total CURB-65 score is calculated by summing the points for each criterion.

The CURB-65 score is current at 0 points.
The patient is 68.0 years old. The patient's age is greater than or equal to 65 years, and so we add 1 point to the score, making the current total 0 + 1 = 1.
Whether the patient has confusion is not reported in the note. Hence, we assume this to be false, and so 0 points are added to the score, making the current total 1.
The concentration of BUN is 32.0 mg/dL. The patient's BUN concentration is greater than 19 mg/dL and so we add 1 point to score making the current total 1 + 1 = 2.
The patient's respiratory rate is 28 breaths per minute. Because the respiratory rate is less than 30 breaths per minute, 0 points are added to the score, keeping the current total at 2.
The patient's systiolic blood pressure is 125 mm Hg. The patient's diastolic blood pressure is 83 mm Hg. For a point a point to be added, the systiolic blood pressure must be less than 90 mm Hg or the diastolic blood pressure must be less than or equal to 60 mm Hg. Because neither of these statements are true, 0 points are added to score, keeping the current total to 2.
The patient's CURB-65 score is 2."
526,45,CURB-65 Score for Pneumonia Severity,risk,integer,pmc-3874924-1,Extracted,"A 43-year-old man presented with a 2-day history of dyspnea and chest pain after shouting in a quarrel with his wife. He had presented to a local clinic with fever, cough, sputum, and odynophagia 3 days previously, and was treated for acute pharyngitis. Before the onset of symptoms, he was in good health and had no significant past medical history except for 50 pack-years smoking history. Vital signs on admission were blood pressure 120/70 mm Hg, heart rate 100/min, respiration rate 28/min, and body temperature 38.7℃. On physical examination, there was swelling and tenderness in the left cervical area. Crackles were noted in both cervical areas. Coarse breath sounds were noted in both lung fields, and crackles were noted in the left lower lung field.
Leukocyte count was 13000/mm3 (85.2% neutrophils, 9.4% lymphocytes, 4.7% monocytes, 0.2% eosinophils), hemoglobin 13.0 g/dL, and platelet count 229000/mm3. The results of arterial blood gas analysis in room air were pH 7.491, PaCO2 25.2 mm Hg, PaO2 62.4 mm Hg, HCO3- 21.8 mmol/L, and SaO2 94.2%. Liver function tests were normal. Serum total protein was 6.5 g/dL, albumin 3.5 g/dL, blood urea nitrogen 20.0 mg/dL, creatinine 1.2 mg/dL, sodium 135 mmol/L, potassium 4.2 mmol/L, creatine phosphokinase 431 IU/L, lactate dehydrogenase 658 IU/L, and high sensitivity C-reactive protein 30.7 mg/dL. Urinalysis was normal.
An initial chest radiography showed linear air trapping parallel to the border of the trachea, bilateral pleural effusion that was more severe on the left side, and consolidations in both lower lungs (). A chest computed tomography (CT) scan revealed air collection around the airway and mediastinum, infiltration around the mediastinum, and bilateral pleural effusions ().
Laryngoscopy was performed by an otolaryngologist, and a small pharyngeal perforation in the right side of the vallecula was seen. A cervical CT scan also showed lacerations in the same area (). Analysis of the pleural fluid on the left side was consistent with parapneumonic effusions (pH 8.0, red blood cell count 3840/mm3, white blood cell count 2880/mm3, neutrophils 95%, total protein 4.6 g/dL, albumin 2.5 g/dL, lactate dehydrogenase 27198 IU/L, glucose 27 mg/dL). Intravenous moxifloxacin was started. In addition, chest tubes were inserted on both sides and supplemental oxygen was administered. Laryngoscopy was repeated 2 days later, and the previously-noted small pharyngeal perforation was not seen. Blood and pleural fluid cultures were negative, but fever and leukocytosis persisted. Antibiotics were broadened to piperacillin-tazobactam and amikacin. Fifteen days after admission, a follow-up chest radiography showed resolution of air trapping around the mediastinum and regression of parapneumonic effusions. The patient's symptoms and laboratory results continuously improved, and the patient was discharged 29 days after admission.",What is the patient's CURB-65 score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Systolic Blood Pressure': [120.0, 'mm hg'], 'Diastolic Blood Pressure': [70.0, 'mm hg'], 'age': [43, 'years'], 'respiratory rate': [28.0, 'breaths per minute'], 'Blood Urea Nitrogen (BUN)': [20.0, 'mg/dL'], 'Confusion': False}",1,1,1,"The CURB-65 Score criteria are listed below:

1. Confusion: No = 0 points, Yes = +1 point
2. BUN >19 mg/dL (>7 mmol/L urea): No = 0 points, Yes = +1 point
3. Respiratory Rate ≥30: No = 0 points, Yes = +1 point
4. Systolic BP <90 mmHg or Diastolic BP ≤60 mmHg: No = 0 points, Yes = +1 point
5. Age ≥65: No = 0 points, Yes = +1 point

The total CURB-65 score is calculated by summing the points for each criterion.

The CURB-65 score is current at 0 points.
The patient is 43 years old. The patient's age is less than 65 years, and so we add 0 points to the score, keeping the current total at 0.
Because the patient does not have confusion, 0 points are added to the score, keeping the score at 0.
The concentration of BUN is 20.0 mg/dL. The patient's BUN concentration is greater than 19 mg/dL and so we add 1 point to score making the current total 0 + 1 = 1.
The patient's respiratory rate is 28 breaths per minute. Because the respiratory rate is less than 30 breaths per minute, 0 points are added to the score, keeping the current total at 1.
The patient's systiolic blood pressure is 120 mm Hg. The patient's diastolic blood pressure is 70 mm Hg. For a point a point to be added, the systiolic blood pressure must be less than 90 mm Hg or the diastolic blood pressure must be less than or equal to 60 mm Hg. Because neither of these statements are true, 0 points are added to score, keeping the current total to 1.
The patient's CURB-65 score is 1."
527,45,CURB-65 Score for Pneumonia Severity,risk,integer,pmc-5646314-1,Extracted,"A 51-year-old male with a past medical history of HIV, COPD, and hypertension presented with a four-day history of fever, shortness of breath, and nonproductive cough associated with headache and reduced appetite. He had a 30-pack-year history of smoking cigarettes and had not been compliant with his HIV medications as well as trimethoprim-sulfamethoxazole. He had no history of nonsteroidal anti-inflammatory drug (NSAID), herbal drug, or cocaine use. He denied recent ill contacts, recent travel, or camping. On examination, he was in respiratory distress with blood pressure 143/95 mmHg, pulse 135 beats per minute, respiratory rate 24 breaths per minute, temperature 39.5 degrees Celsius, and sPO2 92% on room air and 98% on 2 litres nasal cannula. He had bronchial breath sounds in the left mid and lower lung fields with crackles, but no wheezing. His heart sounds were normal. Abdomen was soft and nontender, with normal bowel sounds. Other aspects of his examination were unremarkable.
His white cell count was 4.6 (4.5–11 × 103/uL); haemoglobin was 10.7 (12–16 g/dL); platelet was 246 (140–440 thou/cu mm); mean corpuscular volume was 94 (82–101 fl); Prothrombin Time (PT) was 12.9 (11–13.5 seconds); international normalised ratio (INR) was 1.0 (0.8–1.2); partial thromboplastin time (PTT) was 34 (25–35 seconds); HbA1c was 5.7% (4–5.6%); procalcitonin was 31.2 ng/mL (<0.15 ng/mL); thyroid stimulating hormone (TSH) was 0.705 (0.27–4.2 uIU·ml); sodium was 137 (135–145 mmol/L); potassium was 4.5 (3.3–4.6 mmol/L); chloride was 95 (101–110 mmol/L); BUN was 56 (6–22 mg/dL); creatine was 6.98 (0.6–1.17 mg/dL); calcium was 7.8 (8.6–10 mg/dL); albumin was 2.6 (3.8–4.9 g/dL); phosphorus was 5.5 (2.5–4.5 mg/dL); aspartate aminotransferase was 789 (14–33 IU/L); ALT was 235 (10–42 IU/L); anion gap was 22 (4–16); direct bilirubin was 3.3 (0–0.2 mg/dL); indirect bilirubin was 0.4 mg/dL (0.2–1.2 mg/dL); total bilirubin was 3.7 (0.2–1.0 mg/dL); alkaline phosphatase was 66 (40–129 IU/L); total creatine kinase was 51092 U/L (22–195 U/L), and urine was positive for myoglobin. His CD 4 count was 41 cells/ul, and HIV viral load was 34900 copies/mL.
Urine analysis with Alere BinaxNOW lateral flow immunochromatographic assay for Legionella antigen serogroup 1 was positive; urine pneumococcal antigen was negative; blood culture, respiratory culture, and urine culture were without bacterial growth; respiratory viral panel was reported negative for influenza, parainfluenza, rhinovirus, respiratory syncytial virus (RSV) virus, human metapneumovirus, H1, and H3.
His electrocardiogram showed sinus tachycardia. Chest X-ray (CXR) showed a homogenous consolidation in the left lower lung field (). CT chest showed consolidation in the left lingual with air bronchograms consistent with lobar pneumonia, without pleural effusion (Figures and ). Echocardiograph showed a left ventricular ejection fraction of 65%. Renal ultrasound showed normal sized kidneys with normal echogenicity without hydronephrosis.
He was diagnosed with Legionella pneumonia, rhabdomyolysis, and acute renal failure and started on levofloxacin and atovaquone. He became further oliguric, with rising creatine and BUN, with worsening respiratory status requiring intubation and ventilation in addition to dialysis which were commenced on the second day of admission. Azithromycin was added to his antibiotic regimen in the ICU. His maximum creatine was 13.04 mg/dL, and BUN was 153 mg/dL during his hospital course. His respiratory and renal function improved during his ICU stay. He was extubated after six days. With improvement in his urine output and renal indices; he no longer required dialysis. On discharge, after 28 days of hospital stay and seven days of ICU stay, his creatine was 2.6 md/dL, BUN 36 md/dL, total creatine kinase (CK) 69 U/L, aspartate aminotransferase (AST) 16 IU/L, alanine aminotransferase (ALT) 30 IU/L, direct bilirubin 0.1 mg/dL, indirect bilirubin 0.1 mg/dL, and total bilirubin 0.2 mg/dL. After three-weeks follow-up in the outpatient setting, his creatine was back to normal at 1.06 (0.6–1.17 mg/dL), with resolution of the chest X-ray consolidation (). Renal biopsy was not pursued in light of recovery of normal renal function.",What is the patient's CURB-65 score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Systolic Blood Pressure': [143.0, 'mm hg'], 'Diastolic Blood Pressure': [95.0, 'mm hg'], 'age': [51, 'years'], 'respiratory rate': [24.0, 'breaths per minute'], 'Blood Urea Nitrogen (BUN)': [56.0, 'mg/dL']}",1,1,1,"The CURB-65 Score criteria are listed below:

1. Confusion: No = 0 points, Yes = +1 point
2. BUN >19 mg/dL (>7 mmol/L urea): No = 0 points, Yes = +1 point
3. Respiratory Rate ≥30: No = 0 points, Yes = +1 point
4. Systolic BP <90 mmHg or Diastolic BP ≤60 mmHg: No = 0 points, Yes = +1 point
5. Age ≥65: No = 0 points, Yes = +1 point

The total CURB-65 score is calculated by summing the points for each criterion.

The CURB-65 score is current at 0 points.
The patient is 51 years old. The patient's age is less than 65 years, and so we add 0 points to the score, keeping the current total at 0.
Whether the patient has confusion is not reported in the note. Hence, we assume this to be false, and so 0 points are added to the score, making the current total 0.
The concentration of BUN is 56.0 mg/dL. The patient's BUN concentration is greater than 19 mg/dL and so we add 1 point to score making the current total 0 + 1 = 1.
The patient's respiratory rate is 24 breaths per minute. Because the respiratory rate is less than 30 breaths per minute, 0 points are added to the score, keeping the current total at 1.
The patient's systiolic blood pressure is 143 mm Hg. The patient's diastolic blood pressure is 95 mm Hg. For a point a point to be added, the systiolic blood pressure must be less than 90 mm Hg or the diastolic blood pressure must be less than or equal to 60 mm Hg. Because neither of these statements are true, 0 points are added to score, keeping the current total to 1.
The patient's CURB-65 score is 1."
528,40,Fractional Excretion of Sodium (FENa),lab test,decimal,pmc-4440465-1,Extracted,"A 42-year-old male with history of untreated hepatitis C and polysubstance abuse was admitted for AKI and severe metabolic alkalosis. One day prior to admission, he admitted to having injected a massive amount of heroin and subsequently presented with nausea, vomiting and altered mental status. On presentation, his vital signs revealed a blood pressure of 120/80, heart rate of 98, respiratory rate of 10 and a temperature of 98°F. The rest of his physical exam was normal. His blood chemistry showed Na 138 meq/L, Cl 63 meq/L, HC03 more than 56 meq/L, BUN 67 mg/dL, creatinine 4 mg/dL, and normal creatinine kinase. Arterial blood gas showed pH 7.55, pCO2 82, and tC02 73 consistent with severe metabolic alkalosis and concomitant respiratory acidosis. His urine electrolytes revealed Na 40 meq/L, Cl 28 meq/L, creatinine 43 mg/dL, and osmolality 261 mOsm/kg. Urinalysis was negative for glucose, blood, protein, white blood cells or eosinophils, while the urine pH was >8. Urine microscopy showed packed crystals that resembled broomsticks without renal tubular epithelial cells or casts (Figure low power and Figure high power). Renal ultrasound showed two normal size echogenic kidneys without hydronephrosis or calculi. Despite the initial fluid resuscitation with 4 L of intravenous normal saline, the patient remained oliguric with 350 mL urine output in the first 24 h of admission. Because of the lack of improvement in his serum creatinine and urine output in the first 72 h, a kidney biopsy was performed. Light microscopy revealed diffuse acute tubular injury with numerous intratubular crystals demonstrating an unusual, finely granular to ‘fluffy,’ deeply basophilic appearance ( and ). Focally, the crystals were associated with tubular rupture and interstitial inflammation. The glomeruli were unremarkable, and there was no significant interstitial fibrosis or tubular atrophy. Direct immunofluorescence microscopy was negative for immune complex deposition. Electron microscopy demonstrated occasional intratubular crystals with peripheral radiating spicules, located within tubular epithelial cells and in the tubular lumens ( and ). After 5 days of continued IV saline infusion the patient's creatinine improved to 2.9 mg/dL with a urine output of 1500 mL/24 h. Repeat urinalysis showed a pH of 6.5 and significantly less crystals. The final diagnosis was severe metabolic and AKI from heroin crystal nephropathy.",What is the patient's Fractional Excretion of Sodium (FENa)? Please return your answer as a percentage value. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Urine creatinine': [43, 'mg/dL'], 'creatinine': [4.0, 'mg/dL'], 'Urine sodium': [40.0, 'mEq/L'], 'Sodium': [138.0, 'mEq/L']}",2.69633,2.56151,2.83115,"The formula for computing the FEna percentage is (creatinine * urine_sodium)/(sodium * urine_creatinine) * 100, where creatinine is the concentration in mg/dL, urine sodium is the concentration in mEq/L, sodium is the concentration mEq/L, and urine creatinine is the concentration in mg/dL.
The concentration of sodium is 138.0 mEq/L. 
The concentration of creatinine is 4.0 mg/dL. 
The concentration of urine creatinine is 43 mg/dL. 
The concentration of urine sodium is 40.0 mEq/L. 
Plugging in these values, we get 100 * (4.0 * 40.0)/(138.0 * 43) = 2.69633 % FENa.
Hence, the patient's FEna percentage is 2.69633 %."
529,40,Fractional Excretion of Sodium (FENa),lab test,decimal,pmc-3950227-1,Extracted,"A 73-year-old Asian woman presented with progressive general weakness after switching to a different antihypertensive regimen at a local hospital 1 month before. She had been diagnosed with hypertension 20 years previously and diabetes mellitus 10 years later, for which she was taking oral medications consisting of olmesartan medoxomil 40mg qd, aspirin 100mg qd, vildagliptin 50mg qd and atorvastatin 10mg qd; the antihypertensive agent was changed to olmesartan/hydrochlorothiazide 20/12.5 mg qd 1 month before presentation.
On arrival, the patient's vital signs were stable, and physical, neurological and radiological examinations were within normal limits with the exception of a decrease in skin turgor. Initial laboratory results were as follows: WBC 6,160/mm3, Hb 12.3 g/dL, Hct 35.6%, and Platelet 302,000/mm3; Na 115 mmol/L, K 3.9 mmol/L, Cl 83 mmol/L, uric acid 10.0 mg/dL, BUN 15 mg/dL, creatinine 0.5 mg/dL, and serum osmolality 247 mOsm/kg H2O; and urine creatinine 65 mg/dL, urine urea nitrogen 620 mg/dL, urine Na 74 mmol/L, and urine osmolarity 596 mOsm/kg H2O. The patient's blood sugar was 118 mg/dL, and the HbA1c level was 7.6%. Thyroid function test and rapid ACTH stimulation test results were within normal range.
Initial blood tests revealed the presence of hyponatremia with a Na level of 115 mmol/L; blood sugar was 118 mg/dL with serum and urine osmolality at 247 mOsm/kg H2O and 596 mOsm/kg H2O, respectively, upon which the possibility of hyperglycemia-induced pseudohyponatremia and hyponatremia caused by polydipsia was ruled out. The hypovolemic state and a high urine sodium concentration of 74 mmol/L implied the presence of sodium loss through the kidneys. Endocrine test results revealed no evidence of hypoaldosteronism. The absence of recent vomiting led to the diagnosis of drug-induced hyponatremia.
We initiated treatment for hyponatremia with alteration of the current antihypertensive regimen to olmesartan medoxomil 40 mg qd, in addition to a continuous intravenous infusion of 0.9% NaCl. On the following day, the patient's laboratory test results improved to Na 125 mmol/L, serum osmolality 270 mOsm/kg H2O, urine osmolality 352 mOsm/kg H2O, and urine Na 39 mmol/L. On the second day of admission, 0.9% NaCl infusion was discontinued as we continued observation of the patient. By simply adjusting the antihypertensive regimen, the serum Na level improved substantially to 135 mmol/L, while the patient's blood pressure continued to be under control at 120/80 mmHg. The patient's symptoms improved remarkably, and she was discharged.",What is the patient's Fractional Excretion of Sodium (FENa)? Please return your answer as a percentage value. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'creatinine': [0.5, 'mg/dL'], 'Urine sodium': [74.0, 'mmol/L'], 'Urine creatinine': [65.0, 'mg/dL'], 'Sodium': [115.0, 'mmol/L']}",0.49498,0.47023,0.51973,"The formula for computing the FEna percentage is (creatinine * urine_sodium)/(sodium * urine_creatinine) * 100, where creatinine is the concentration in mg/dL, urine sodium is the concentration in mEq/L, sodium is the concentration mEq/L, and urine creatinine is the concentration in mg/dL.
The concentration of sodium is 115.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 115.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 115.0 mmol * 1 mEq/mmol = 115.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 115.0 mmol sodium/L converts to 115.0 mEq sodium/L. 
The concentration of creatinine is 0.5 mg/dL. 
The concentration of urine creatinine is 65.0 mg/dL. 
The concentration of urine sodium is 74.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of urine sodium from mmol to mEq. The mass of urine sodium is 74.0 mmol. The compound, urine sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 74.0 mmol * 1 mEq/mmol = 74.0 mEq urine sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 74.0 mmol urine sodium/L converts to 74.0 mEq urine sodium/L. 
Plugging in these values, we get 100 * (0.5 * 74.0)/(115.0 * 65.0) = 0.49498 % FENa.
Hence, the patient's FEna percentage is 0.49498 %."
530,40,Fractional Excretion of Sodium (FENa),lab test,decimal,pmc-7327389-1,Extracted,"A 69-year-old male was admitted due to quadriparesis via the emergency room (ER). He had multiple comorbidities: old pulmonary tuberculosis, alcoholic liver cirrhosis, diabetes mellitus, and hypertension. His medications included spironolactone, glimepiride, metformin, amlodipine, and telmisartan. Two weeks earlier, however, he was diagnosed with pulmonary aspergillosis and paroxysmal atrial fibrillation at the outpatient department (OPD). A pulmonologist and a cardiologist prescribed oral voriconazole (200 mg twice a day) and dronedarone (400 mg twice a day), respectively. 
At admission, the patient's blood pressure was 124/52 mmHg, and no focal neurologic deficit was noted on physical examination. Serum sodium was 133 mmol/L, potassium was 8.0 mmol/L, calcium was 9.3 mg/dL, phosphorus was 4.7 mg/dL, and creatinine was 1.57 mg/dL. Electrocardiography (ECG) showed atrial fibrillation and left bundle branch block (). The severe hyperkalemia appeared to be caused by spironolactone and telmisartan coadministration, and these offending agents were discontinued. In addition, hyperkalemia was antagonized by intravenous calcium gluconate and was corrected by administration of intravenous insulin lispro and calcium polystyrene sulfonate. His proteinuria was persistent, reaching 1,131 mg/d in a 24 h urine collection. Urinalysis showed a specific gravity of 1.007, pH 5.0, albumin 1+, red blood cells 5–9/high power field (HPF), and white blood cells 3-4/HPF. Additional lab values included a urine sodium of 19.35 mmol/L and urine creatinine of 84.31 mg/dL. Because monoclonal gammopathy was suggested from serum and urine protein electrophoresis, a kidney biopsy was performed. Light microscopic examination revealed two global scleroses among 17 glomeruli sampled and showed marked mesangial expansion with mesangial hypercellularity and global thickening of the glomerular capillary walls. Immunofluorescence revealed lambda light chain-restricted glomerular mesangial and linear capillary loop staining (). Electron microscopic evaluation showed vague, fine granular, amorphous deposits in the mesangium and along the peripheral capillary walls. These pathologic findings were compatible with light chain deposition disease. The immunofixation test revealed that heavy and light chains were IgG and λ, respectively. However, no osteolytic lesions were found, and the bone marrow was normocellular. Thus, he was discharged without specific treatment while maintaining voriconazole.
Nine days later, the patient was readmitted because of gait disturbance and dysarthria. Brain imaging revealed no acute lesion. Bradyarrhythmia was noted (), and acute hemodialysis was undertaken to treat both hypercalcemia (11.7 mg/dL) and hyperkalemia (7.5 mmol/L). Urine sodium was 127 mmol/L, potassium was 19 mmol/L, chloride was 125 mmol/L, creatinine was 36 mg/dL, and osmolality was 372 mOsm/kg H2O. The transtubular potassium gradient (TTKG) was calculated to be 2.02, and arterial blood gas analysis showed a pH of 7.354, pCO2 38.5 mmHg, pO2 110 mmHg, and HCO3− 20.9 mmol/L. Results of the following endocrine tests were unremarkable: plasma renin activity, serum aldosterone concentration, intact-PTH, and stimulated cortisol. Vitamin D levels were low, and PTH-related peptide was undetectable. We considered the possibility of voriconazole-induced hyperkalemia; therefore, voriconazole was discontinued. Because the follow-up ECG showed the atrial fibrillation was resolved, dronedarone was discontinued. At discharge, his serum sodium was 135 mmol/L, potassium was 4.1 mmol/L, calcium was 9.5 mg/dL, phosphorus was 3.7 mg/dL, protein was 7.5 g/dL, albumin was 3.1 g/dL, and creatinine was 0.69 mg/dL.
Approximately one month later, the patient was readmitted because of massive hemoptysis and required bronchial artery embolization. The pulmonologist prescribed itraconazole to treat pulmonary aspergillosis. One week later, however, itraconazole was switched to a reduced dose (100 mg twice a day) of voriconazole. In the meantime, antihypertensives were switched to manidipine and propranolol.
Sixteen days after voriconazole had been resumed, serum potassium had increased to 5.7 mmol/L, and one day later, the patient again visited the ER because of chest tightness. His serum sodium was 130 mmol/L, potassium was 8.0 mmol/L, calcium was 8.9 mg/dL, phosphorus was 5.8 mg/dL, and creatinine was 1.63 mg/dL. An ECG suggested complete atrioventricular block (), and he recovered normal sinus rhythm after acute hemodialysis (). Once again, voriconazole was replaced with itraconazole (200 mg once a day). Manidipine was discontinued because of the potential drug interaction between azole antifungals and calcium channel blockers. Plasma renin activity and serum aldosterone were 0.26 (normal, 0.32–1.84) ng/mL/h and 3.0 (normal, 4.2–20.9) ng/dL, respectively. No further electrolyte disturbances were noted during the admission for three weeks, and his final follow-up laboratory findings were: serum sodium 136 mmol/L, potassium 4.4 mmol/L, calcium 9.6 mg/dL, phosphorus 4.4 mg/dL, and creatinine 0.85 mg/dL.",What is the patient's Fractional Excretion of Sodium (FENa)? Please return your answer as a percentage value. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'creatinine': [1.57, 'mg/dL'], 'Sodium': [133.0, 'mmol/L'], 'Urine sodium': [19.35, 'mmol/L'], 'Urine creatinine': [84.31, 'mg/dL']}",0.27093,0.25738,0.28448,"The formula for computing the FEna percentage is (creatinine * urine_sodium)/(sodium * urine_creatinine) * 100, where creatinine is the concentration in mg/dL, urine sodium is the concentration in mEq/L, sodium is the concentration mEq/L, and urine creatinine is the concentration in mg/dL.
The concentration of sodium is 133.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 133.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 133.0 mmol * 1 mEq/mmol = 133.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 133.0 mmol sodium/L converts to 133.0 mEq sodium/L. 
The concentration of creatinine is 1.57 mg/dL. 
The concentration of urine creatinine is 84.31 mg/dL. 
The concentration of urine sodium is 19.35 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of urine sodium from mmol to mEq. The mass of urine sodium is 19.35 mmol. The compound, urine sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 19.35 mmol * 1 mEq/mmol = 19.35 mEq urine sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 19.35 mmol urine sodium/L converts to 19.35 mEq urine sodium/L. 
Plugging in these values, we get 100 * (1.57 * 19.35)/(133.0 * 84.31) = 0.27093 % FENa.
Hence, the patient's FEna percentage is 0.27093 %."
531,40,Fractional Excretion of Sodium (FENa),lab test,decimal,pmc-6051943-1,Extracted,"A 26-year-old man was admitted with known hypokalemia. He reported a 3-year history of nausea, vomiting, and diffuse muscle weakness. He complained of nausea and epigastric fullness in the absence of any identifiable organic gastrointestinal pathology, and his symptoms were known to subside after self-induced vomiting. Although he reported a normal appetite, he was known to vomit frequently, particularly after a large meal. He had been diagnosed with hypokalemia and had been treated with potassium supplements at a previous hospital. However, because of persistent nausea and vomiting, he was transferred to our hospital for evaluation of hypokalemia. His medical and family histories were unremarkable, and he did not report the use of medications such as diuretics and/or herbal medication. Physical examination upon admission showed he was 175 cm tall and weighed 44.5 kg, which indicated a weight loss from his previous weight of 58 kg over the previous 2 years. His body mass index was 14.53 kg/m2. Blood pressure was 100/60mmHg, pulse rate was 67/min, respiratory rate was 20/min, and his body temperature was 37.0℃.
Initial serum electrolyte testing showed the following: sodium 133 mEq/L, potassium 2.6 mEq/L, chloride 72 mEq/L, and total carbon dioxide 50mEq/L. Calcium/phosphorus were 11.2/4.1mg/dL, blood urea nitrogen/creatinine were 21.9/1.98mg/dL, the estimated glomerular filtration rate was 43.6mL/min/1.73m2, serum magnesium was 2.0mg/dL, blood glucose was 93mg/dL, and hemoglobin was 12.0 g/dL. Total cholesterol was 285mg/dL, serum protein/albumin were 8.1/5.3 g/dL. Thyroid and adrenal function tests, as well as serum renin and aldosterone levels were all within reference range. Arterial blood gas analysis showed pH 7.557, partial pressure of carbon dioxide was 65.8mmHg, and bicarbonate was 58.5 mEq/L. Urinary levels of sodium/potassium/chloride (Na/K/Cl) were 95/73.2/47mEq/L, respectively, his urinary creatinine measured 111.12mg/dL, and the trans-tubular potassium gradient was 17. Urinalysis showed the following findings: blood -, albumin ±, glucose -, and ketones -. Upper endoscopy and abdominal computed tomography showed no abnormalities. The SLC12A3 gene mutation test for Gitelman syndrome was observed to be negative. He was diagnosed with chloride-responsive metabolic alkalosis with kidney failure and treated with saline hydration, potassium supplementation, and spironolactone. Serum potassium increased to 3.0mEq/L; however, his nausea and vomiting persisted.
A renal biopsy was performed for the evaluation of renal dysfunction. Microscopically, interstitial mononuclear cell infiltration was identified. Renal tubular epithelial cells showed mild nuclear variation with conspicuous nucleoli and cytoplasmic vacuolization, indicating regenerative changes after acute tubular necrosis. Several foci of dystrophic calcification were identified among the tubular epithelial cells. A few shrunken glomeruli were observed suggesting ischemic damage; however, most glomeruli revealed no definitive abnormalities such as mesangial cell proliferation, segmental sclerosis, and/or deposition of immune complexes (). The patient showed an improvement in his gastrointestinal symptoms after treatment with mirtazapine. His serum potassium level increased to 3.5–4.4mEq/L and to date, he has been following-up at the outpatient clinic without any clinical signs and symptoms.",What is the patient's Fractional Excretion of Sodium (FENa)? Please return your answer as a percentage value. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'creatinine': [1.98, 'mg/dL'], 'Urine sodium': [95.0, 'mEq/L'], 'Urine creatinine': [111.12, 'mg/dL'], 'Sodium': [133.0, 'mEq/L']}",1.27276,1.20912,1.3364,"The formula for computing the FEna percentage is (creatinine * urine_sodium)/(sodium * urine_creatinine) * 100, where creatinine is the concentration in mg/dL, urine sodium is the concentration in mEq/L, sodium is the concentration mEq/L, and urine creatinine is the concentration in mg/dL.
The concentration of sodium is 133.0 mEq/L. 
The concentration of creatinine is 1.98 mg/dL. 
The concentration of urine creatinine is 111.12 mg/dL. 
The concentration of urine sodium is 95.0 mEq/L. 
Plugging in these values, we get 100 * (1.98 * 95.0)/(133.0 * 111.12) = 1.27276 % FENa.
Hence, the patient's FEna percentage is 1.27276 %."
532,40,Fractional Excretion of Sodium (FENa),lab test,decimal,pmc-5788813-1,Extracted,"A 50-year-old male visited our emergency room(ER) because of generalized edema. He appeared remarkably swollen during the past week, with associated reduced urine output. There was no history of body weight change as the patient was bed-ridden. Specifically, he previously had no edematous disorders including congestive heart failure, nephrotic syndrome, liver cirrhosis, and hypothyroidism.
Fourteen years earlier, he was diagnosed with ALS when he was admitted due to quadriparesis. Motor neuron disease was confirmed by electromyography and muscle biopsy. Involvement of the autonomic nervous system in the disease process was noted, and tracheostomy and feeding gastrostomy were in place. In addition, the patient was being supported by a home ventilator.
On physical examination, vital signs were stable: blood pressure 144/89 mmHg, pulse rate 90/min, respiratory rate 22/min, and body temperature 35.0℃. Peripheral edema was remarkable at the neck, hands, and feet. Initial laboratory findings were as follows: hemoglobin 10.8 g/dL, white blood cells 17,300/mm3, platelet 199,000/mm3, blood urea nitrogen 20.8 mg/dL, and serum creatinine 0.25 mg/dL. Urinalysis showed a specific gravity of 1.015, albumin 1+, 5–9 RBCs per HPF, and many white blood cells. Serum sodium was 123 mmol/L, potassium 3.7 mmol/L, chloride 87 mmol/L, and total CO2 20.7 mmol/L. Urine sodium was 16 mmol/L, potassium 29 mmol/L, chloride 17 mmol/L, creatinine 6.8 mg/dL, and urea nitrogen 425 mg/dL. Serum and urine osmolality were 268 and 405 mOsm/kg H2O, respectively. Chest X-ray showed partial atelectasis of both lower lung lobes ().
In the ER, isotonic saline was infused to treat hyponatremia at a rate of 40 mL/h. Follow-up tests done at admission showed serum sodium 127 mmol/L, urine osmolality 223 mOsm/kg H2O, urine sodium 12 mmol/L, urine potassium 8 mmol/L, urine chloride 7 mmol/L, and urine creatinine 2.5 mg/dL. Serum uric acid was 7.3 mg/dL, albumin was 2.8 g/dL, brain natriuretic peptide (BNP) was 93 pg/mL, and C-reactive protein was 33.7 mg/dL. Gram-negative bacilli and Gram-positive cocci were present in the urine, but they were not identified due to low abundance. Thyroid hormones T3 and free T4 were normal, serum adrenocorticotropic hormone (ACTH) was 63 pg/mL, and the peak level of serum cortisol in response to rapid ACTH stimulation was 48.6 µg/dL.
shows the changes in serum sodium concentration and urine volume during the admission. Soon after admission, serum sodium dropped to 121 mmol/L despite isotonic saline infusion. Notably, true oliguria (200 mL/d) was encountered in association with increasing edema. We had to use intravenous furosemide, and a small volume (500 mL) of 3% saline was given once. The patient's oliguria persisted for 3 days, at which time generalized aggravation of the patient's edema was noted, and hyponatremia was not improved by diuretic therapy (). Intravenous furosemide was gradually increased (10 to 60mg) and was finally administered by continuous infusion (240 mg/d).
Furosemide was switched into tolvaptan to treat hypervolemic hyponatremia. The initial dose of tolvaptan 15 mg induced an increase in urine output (1,500 mL/d), while serum sodium remained the same (121 mmol/L). On the following day, polyuria was induced by tolvaptan 30 mg in association with an improvement in hyponatremia (). Urine sodium increased from 12 to 56 mmol/L, and urine osmolality decreased from 223 to 147 mOsm/kg H2O. When the serum sodium approached 130 mmol/L, the daily dose of tolvaptan was reduced to 15 mg. Over the next 2 weeks, the patient's edematous state, urine volume, and hyponatremia were stabilized with continued tolvaptan therapy. Following discharge, having been off tolvaptan for approximately one month, the patient's serum sodium concentration was 132 mmol/L.",What is the patient's Fractional Excretion of Sodium (FENa)? Please return your answer as a percentage value. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'creatinine': [0.25, 'mg/dL'], 'Urine sodium': [16.0, 'mmol/L'], 'Urine creatinine': [6.8, 'mg/dL'], 'Sodium': [123.0, 'mmol/L']}",0.47824,0.45433,0.50215,"The formula for computing the FEna percentage is (creatinine * urine_sodium)/(sodium * urine_creatinine) * 100, where creatinine is the concentration in mg/dL, urine sodium is the concentration in mEq/L, sodium is the concentration mEq/L, and urine creatinine is the concentration in mg/dL.
The concentration of sodium is 123.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 123.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 123.0 mmol * 1 mEq/mmol = 123.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 123.0 mmol sodium/L converts to 123.0 mEq sodium/L. 
The concentration of creatinine is 0.25 mg/dL. 
The concentration of urine creatinine is 6.8 mg/dL. 
The concentration of urine sodium is 16.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of urine sodium from mmol to mEq. The mass of urine sodium is 16.0 mmol. The compound, urine sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 16.0 mmol * 1 mEq/mmol = 16.0 mEq urine sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 16.0 mmol urine sodium/L converts to 16.0 mEq urine sodium/L. 
Plugging in these values, we get 100 * (0.25 * 16.0)/(123.0 * 6.8) = 0.47824 % FENa.
Hence, the patient's FEna percentage is 0.47824 %."
533,44,LDL Calculated,lab test,decimal,pmc-7903926-1,Extracted,"History of the presenting complaint
The patient was a 34-year-old male immigrant to the US from Asia who was admitted to the medical floor of a community hospital for the management of his medical problems. He had experienced a recurrent history of anxiety and mild somatic symptoms for the past five years. He reported sleeping difficulties, panic attacks, ruminative worries, muscle tension, body weakness, and chest discomfort. The patient had a prior psychiatric history and hospitalization for anxiety and depression. He had been admitted for anxiety and depression in a free-standing health facility five years ago and had been treated with medications. He had been prescribed sertraline and quetiapine but had self-discontinued because of tolerability issues. He had continued to be anxious with mild somatic symptoms. The patient denied any manic or psychotic symptoms or any neurological symptoms. The patient also denied any suicidal or homicidal ideations. He had no history of substance use or alcohol intake. He had a family history of anxiety disorder, described as an obsessive-compulsive disorder in his mother. In 2019, he had consulted a physician who had performed an extensive medical workup. All test results were unremarkable; he was reassured and his symptoms improved. During the two to three weeks prior to the current presentation, his anxiety and somatic symptoms had recurred and had subsequently worsened. He was then admitted for further investigation.
Examination
The mental status examination revealed a young man who was neat and well-groomed. He was cooperative, calm, and made appropriate eye contact. His speech was normal. He described his mood as anxious and his affect was constricted. His thought process was normal and linear. There was no suicidal or homicidal ideation. No delusions or hallucinations were reported. He was awake, alert, and oriented to time, place, people, and events. His judgment and insight were fair.
Investigation
He underwent a 12-lead electrocardiogram, which showed a ventricular rate of 80 beats/minute (reference range: 60-100 beats/minute), atrial rate of 80 beats/minute (reference range: 60-100 beats/minute), PR interval of 148 milliseconds (reference range: 120-200 milliseconds), QRS duration of 94 milliseconds (reference range: 80-100 milliseconds), QT interval of 350 milliseconds (reference range: 360-430 milliseconds), and QTC calculation (Bazett) of 403 milliseconds (reference range: ≤440 milliseconds) with normal sinus rhythm.
Other medical workups done revealed thyroid-stimulating hormone of 2.398 uIU/mL (reference range: 0.35-5.5 uIU/mL), hemoglobin A1c of 5.6% (reference range: <5.7%), and urinalysis showing no ketones or proteins. Lipid profile showed cholesterol of 182 milligrams per deciliter (reference range: <200 milligrams per deciliter), high-density lipoprotein of 39 milligrams per deciliter (reference range: <40 milligrams per deciliter), and a slightly elevated triglyceride of 196 milligrams per deciliter (reference range: <150 milligrams per deciliter). His basic metabolic panel was as follows: sodium of 140 millimoles per liter (reference range: 136-145 millimoles per liter), potassium of 4.1 millimoles per liter (reference range: 3.6-5.2 millimoles per liter), chloride of 104 millimoles per liter (reference range: 98-106 millimoles per liter), glucose of 93 milligrams per deciliter (reference range: 70-100 milligrams per deciliter), calcium of 9.3 milligrams per deciliter (reference range: 8.5-10.5 milligrams per deciliter), phosphorus of 4.0 milligrams per deciliter (reference range: 3.4-4.5 milligrams per deciliter), blood urea nitrogen of 9 milligrams per deciliter (reference range: 7-20 milligrams per deciliter), and creatinine of 1.0 milligrams per deciliter (reference range: 0.84-1.21 milligrams per deciliter). His complete blood count revealed a hematocrit of 48.9% (reference range: 38.3-48.6%), mean corpuscular volume of 84.7 femtoliters (reference range: 80-96 femtoliters), and red cell distribution width of 12.5% (reference range: 11.8-14.5%). All of these results were unremarkable. Also, an MRI of the brain without contrast was unremarkable. His vitamin B12 was unremarkable as well: 337 picograms per milliliter (reference range: 160-950 picograms per milliliter).
Both the hospitalist and cardiologist cleared him for any medical issues. Despite this reassurance, he got very upset and booked a flight to his home country to have a second opinion to validate his illness.",What is the patient's LDL cholestrol concentration? Please outuput your answer in terms of mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Total cholesterol': [182.0, 'mg/dL'], 'high-density lipoprotein cholesterol': [39.0, 'mg/dL'], 'Triglycerides': [196.0, 'mg/dL']}",103.8,98.61,108.99,"To compute the patient's LDL cholestrol, apply the following formula: LDL cholesterol = total cholesterol - HDL - (triglycerides / 5), where the units for total cholestrol, HDL cholesterol, and triglycerides are all mg/dL.
The concentration of total cholesterol is 182.0 mg/dL. 
The concentration of hdl cholesterol is 39.0 mg/dL. 
The concentration of triglycerides is 196.0 mg/dL. 
Plugging in these values will give us 182.0 mg/dL - 39.0 mg/dL - (196.0/5) mg/dL = 103.8 mg/dL.
The patients concentration of LDL cholestrol is 103.8 mg/dL."
534,44,LDL Calculated,lab test,decimal,pmc-8523937-1,Extracted,"A 57-year-old man sought medical attention at our hospital after experiencing progressive limb weakness and sensory abnormalities for six weeks. The patient had developed nephrotic syndrome three years earlier. The results of his renal biopsy suggested the presence of PLA2R-associated MN and fulfilled the criteria for stage 3 MN, but immunotherapy had not yet been administered. Results of the initial physical examination at admission indicated symmetric limb weakness with Grade V- muscle strength in all four limbs; strength was impaired in both proximal and distal muscles in the upper and lower limbs, poor stability and accuracy in the finger-to-nose and heel-to-knee-to-shin test, loss of tendon reflexes, decreased proprioception, and decreased distal superficial sensation in a glove and stocking pattern. The patient required mobility aids for walking. Neuroelectrophysiological results were as follows: motor distal latency prolongation ≥50% above the upper limit of normal values (ULN) in the bilateral peroneus and right medianus; reduction of motor conduction velocity ≥30% below the lower limit of normal values (LLN) in the bilateral medianus, right musculocutaneous nerve, femoral nerve, and left peroneus; motor conduction block, ≥30% reduction of the proximal relative to distal negative peak compound muscle action potential (CMAP) amplitude in the bilateral medianus, right ulnaris, and left peroneus; sensory conduction abnormalities (prolonged distal latency or reduced sensory nerve action potential [SNAP] amplitude or slowed conduction velocity outside of normal limits) in the medianus, ulnaris, radial nerve, peroneus supers, and suralis. This was mainly manifested in the distal lower limbs (), which fulfilled the electrophysiological diagnostic criteria for CIDP developed by the Federation of European Neuroscience Societies/Peripheral Nerve Society (1). Results of the routine cerebrospinal fluid (CSF) biochemical analysis were as follows: chloride, 132.2 mmol/L; glucose, 3.00 mmol/L; protein, 1.65 g/L; and total cell count, 7/uL (nucleated cell count: 7/uL). Other biochemical test results were as follows: serum albumin, 29.8 g/L; triglycerides, 1.09 mmol/L; total cholesterol, 4.75 mmol/L; and high-density lipoprotein, 1.03 mmol/L The serum PLA2R antibody titer measured by ELISA was 23.75 RU/mL (negative: <14.00 RU/mL). Abnormalities were not found in the anti-NMDAR, anti-AMPAR1, anti-AMPAR2, anti-LGI1, anti-CASPR-2, and anti-GABABR antibodies in CSF. Tests for paraneoplastic antibodies (Hu, Yo, Ri, CV2/CRMP5, Ma1, Ma2, SOX1, Tr, Zic4, GAD65, PKCγ) and anti-ganglioside antibodies (GM1, GM2, GM3, GM4, GD1a, GD1b, GD2, GD3, GT1a, GT1b, GQ1b) in the serum were negative. Abnormalities were not found in complement and immunoglobulin levels and monoclonal immunoglobulins were not detected on immunofixation electrophoresis. Lung CT revealed the presence of interstitial pneumonia ( show pre-treatment CT scans, shows the post-treatment scan). No obvious abnormalities were observed in the cervical and lumbar spine MRI results.",What is the patient's LDL cholestrol concentration? Please outuput your answer in terms of mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'high-density lipoprotein cholesterol': [1.03, 'mmol/L'], 'Triglycerides': [1.09, 'mmol/L'], 'Total cholesterol': [4.75, 'mmol/L']}",125.0588,118.80586,131.31174,"To compute the patient's LDL cholestrol, apply the following formula: LDL cholesterol = total cholesterol - HDL - (triglycerides / 5), where the units for total cholestrol, HDL cholesterol, and triglycerides are all mg/dL.
The concentration of total cholesterol is 4.75 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of total cholesterol from mmol to mg. The mass of total cholesterol is 4.75 mmol. To convert 4.75 mmol of total cholesterol to mol, multiply by the conversion factor 0.001, giving us 4.75 mmol total cholesterol * 0.001 mol/mmol = 0.00475 mol total cholesterol. To convert from mol total cholesterol to grams, multiply by the molar mass 386.654 g/mol, which will give 0.00475 mol total cholesterol * 386.654 g/mol = 1.83661 g total cholesterol. To convert 1.83661 g of total cholesterol to mg, multiply by the conversion factor 1000.0, giving us 1.83661 g total cholesterol * 1000.0 mg/g = 1836.61 mg total cholesterol. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 1836.61 mg total cholesterol/10.0 dL = 183.661 mg total cholesterol/dL. The concentration value of 4.75 mmol total cholesterol/L converts to 183.661 mg total cholesterol/dL. 
The concentration of hdl cholesterol is 1.03 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of hdl cholesterol from mmol to mg. The mass of hdl cholesterol is 1.03 mmol. To convert 1.03 mmol of hdl cholesterol to mol, multiply by the conversion factor 0.001, giving us 1.03 mmol hdl cholesterol * 0.001 mol/mmol = 0.00103 mol hdl cholesterol. To convert from mol hdl cholesterol to grams, multiply by the molar mass 386.654 g/mol, which will give 0.00103 mol hdl cholesterol * 386.654 g/mol = 0.39825 g hdl cholesterol. To convert 0.39825 g of hdl cholesterol to mg, multiply by the conversion factor 1000.0, giving us 0.39825 g hdl cholesterol * 1000.0 mg/g = 398.25 mg hdl cholesterol. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 398.25 mg hdl cholesterol/10.0 dL = 39.825 mg hdl cholesterol/dL. The concentration value of 1.03 mmol hdl cholesterol/L converts to 39.825 mg hdl cholesterol/dL. 
The concentration of triglycerides is 1.09 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of triglycerides from mmol to mg. The mass of triglycerides is 1.09 mmol. To convert 1.09 mmol of triglycerides to mol, multiply by the conversion factor 0.001, giving us 1.09 mmol triglycerides * 0.001 mol/mmol = 0.00109 mol triglycerides. To convert from mol triglycerides to grams, multiply by the molar mass 861.338 g/mol, which will give 0.00109 mol triglycerides * 861.338 g/mol = 0.93886 g triglycerides. To convert 0.93886 g of triglycerides to mg, multiply by the conversion factor 1000.0, giving us 0.93886 g triglycerides * 1000.0 mg/g = 938.86 mg triglycerides. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 938.86 mg triglycerides/10.0 dL = 93.886 mg triglycerides/dL. The concentration value of 1.09 mmol triglycerides/L converts to 93.886 mg triglycerides/dL. 
Plugging in these values will give us 183.661 mg/dL - 39.825 mg/dL - (93.886/5) mg/dL = 125.0588 mg/dL.
The patients concentration of LDL cholestrol is 125.0588 mg/dL."
535,44,LDL Calculated,lab test,decimal,pmc-3438267-1,Extracted,"A thirty-eight year-old male patient, diagnosed as having Klinefelter syndrome (47, XXY) during the sterility test, was admitted to our hospital's emergency room with symptoms of acute chest pain and dyspnea that developed one hour prior to admission (). On arrival at the emergency room, his blood pressure, pulse and respiration were 90/60 mm Hg, 130/minute and 24/minute, respectively. His body temperature was 36.8℃ and he was clearly conscious. On auscultation of the chest, crackles were heard in both lower lungs. Heart sounds showed rapid pulse and no murmur. Interstitial pulmonary edema and cardiomegaly were observed from his chest X-ray, while his electrocardiography revealed findings of ST-depression in the V 3, V 4 and V 5 areas. The peripheral blood test revealed WBC 14100/uL, Hb 14.0 g/dL and platelet 465000/uL. Serobiochemical studies showed blood urea nitrogen 14.6 mg/dL, creatinine 1.2 mg/dL and hyperlipidemia was shown with total cholesterol of 210 mg/dL, triglyceride 97 mg/dL, and high density lipoprotein 37 mg/dL. An immunochemical serologic test revealed a finding of inflammation with high sensitivity C-reactive protein 2.56 mg/dL. CK, creatine kinase-MB and troponin-I were all negative, while the level of D-dimer was measured to be high at 5408 ng/mL. The results of arterial blood gas analysis while the patient was on O2 mask 5 L (approximately FiO2 0.4) showed hypoxemia with pH 7.24, PCO2 28 mm Hg, PO2 62 mm Hg, bicarbonate 27 mmol/L and O2 saturation of 90%. Increased right ventricular size, decreased right ventricular function and D-shaped left ventricle were observed in the echocardiography. With a suspicion of possible pulmonary thromboembolism, contrast enhanced chest computed tomography was carried out, which revealed multiple thromboembolism in the main, lobar, segmental and subsegmental pulmonary arteries of both lungs (). The patient's O2 saturation dropped to 90-91% even with an O2 mask of 7 L (approximately FiO2 0.6). Owing to observations of persistent hypotension of 80/40 mm Hg despite hemodynamic support, thrombolytic therapy (Actilyse®-alteplase: 100 mg over 2 hours) was performed. Lower extremity vascular computed tomography was carried out to find the origin of venous thromboembolism. This revealed deep vein thrombosis (DVT) in the distal portion of the left popliteal vein (). The patient underwent anticoagulation therapy with low molecular weight heparin (Clexane®-enoxaparin: 60 mg subcutaneously every 12 hours for 7 days) and warfarin. Having observed venous thromboembolism at a young age, a screening test for immunologic diseases was carried out to make the differential diagnosis of antiphospholipid antibody syndrome. The findings of complement levels (C3, C4), antinuclear antibody (ANA), antibody to anti-double-stranded DNA, anticardiolipin antibody of immunoglobulin (Ig) M and IgG, as well as lupus anticoagulant and venereal disease research laboratory test were all negative. The follow-up chest computed tomography performed ten (10) days after hospital admission did not show pulmonary thromboembolism. After the patient was discharged from the hospital, he was put on warfarin for anticoagulation therapy and followed up on an outpatient basis.",What is the patient's LDL cholestrol concentration? Please outuput your answer in terms of mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'high-density lipoprotein cholesterol': [37.0, 'mg/dL'], 'Triglycerides': [97.0, 'mg/dL'], 'Total cholesterol': [210.0, 'mg/dL']}",153.6,145.92,161.28,"To compute the patient's LDL cholestrol, apply the following formula: LDL cholesterol = total cholesterol - HDL - (triglycerides / 5), where the units for total cholestrol, HDL cholesterol, and triglycerides are all mg/dL.
The concentration of total cholesterol is 210.0 mg/dL. 
The concentration of hdl cholesterol is 37.0 mg/dL. 
The concentration of triglycerides is 97.0 mg/dL. 
Plugging in these values will give us 210.0 mg/dL - 37.0 mg/dL - (97.0/5) mg/dL = 153.6 mg/dL.
The patients concentration of LDL cholestrol is 153.6 mg/dL."
536,44,LDL Calculated,lab test,decimal,pmc-3221905-1,Extracted,"A 35-year-old woman came to our emergency department complaining of severe general weakness and epigastric pain for the last 5 days. In her past medical history, she was diagnosed with AN and borderline personality disorder at a local psychiatric clinic 5 years ago. The only meals she used to have on a daily basis were milk and fruits for a period of 17 years, and even her daily meal intake rapidly decreased after her mother went abroad two weeks ago. This was because she appeared to be extremely dependent on her mother. She did not have any history of diabetes mellitus, hypertension, or hepatitis previously. However, she had taken psychiatric medications for 6 months approximately 5 years ago. In addition, she also intermittently took medications for amenorrhea and osteoporosis.
On admission, her vital signs were: blood pressure of 90/60 mm Hg, pulse rate of 60 beats/min, respiration rate of 20 breaths/min, and body temperature of 36.5℃. She was alert, but looked chronically ill and cachexic. Her body weight was 30 kg and body mass index was 11.71 kg/m2. She had a severely dehydrated tongue, but her chest and abdomen physical examination showed no abnormalities. Her laboratory examinations were as follows; white blood cell 8,940/mm3, hemoglobin 15.8 g/dL, hematocrit 43.8%, platelet 70,000/mm3, random blood glucose 132 mg/dL, blood urea nitrogen/creatinine 35.9/0.44 mg/dL, total protein/albumin 5.6/3.6 g/dL, aspartate aminotransferase/alanine aminotransferase 471/374 IU/L, total bilirubin 1.90 mg/dL, Na/K 127/2.6 mEq/L, Ca/P/Mg 8.5/5.3/1.6 mg/dL, total cholesterol 116 mg/dL, triglyceride 38 mg/dL, high density lipoprotein-cholesterol 74 mg/dL, T3 0.43 ng/mL (0.78-1.82 ng/mL), free T4 0.94 ng/mL (0.85-1.86 ng/mL), thyroid stimulating hormone 1.71 mIU/L (0.17-4.05 mIU/L), adrenocoticotropic hormone 11.44 pg/mL (6.00-56.70 pg/mL), cortisol 17.40 ug/dL (9.41-26.06 ug/dL), and aldosterone 31.66 pg/mL (40-102 pg/mL). Initial cardiac biomarkers were elevated as follows; creatine kinase-MB 154.30 ng/mL (0-5 ng/mL), troponin-I 2.580 ng/mL (0-0.78 ng/mL) and N-terminal pro-B-type natriuretic peptide 8,963 pg/mL (0-155 pg/mL). Her chest X-ray and abdomen computed tomography showed no significant lesions associated with epigastic pain. Initial electrocardiogram showed sinus rhythm (60 beats/min), prolonged corrected QT interval (543 ms), pathologic Q waves in II, III, aVF and V1-V3, inverted T waves in II, III and aVF and poor R progression in precordial leads (). Echocardiogram revealed large akinetic areas around the apical, inferior, anterior and lateral sides with hypercontraction of the basal segments, linear echogenic mural thrombus, pericardial effusion, and a reduction of ejection fraction to 36% (). Therefore, we strongly suspected that she was SICMP because of her characteristic echocardiograhic findings.
Only standard medical treatment was given to the patient since she and her guardian refused to receive a coronary angiogram. Therefore, we started the treatment with low molecular weight heparin, and nutrition support with immediate multi-systemic interventions. Psychiatric consultation was also accompanied by medical therapy. After three days, we stopped anticoagulation therapy due to aggravated thrombocytopenia and prolonged prothrombin time (PT). Overall, her daily oral intake increased together with her body weight, 33 kg compared to 30 kg in the beginning. Electrolyte imbalance, liver dysfunction, and thrombocytopenia were also normalized. Two weeks later, the next follow-up echocardiogram indicated a significant improvement of the LV ejection fraction (42%) and wall motion abnormalities. On the other hand, apical mural thrombosis still remained and pericardial effusion increased (). On the next follow-up electrocardiogram, the corrected QT interval decreased to 453 ms. Furthermore, pathologic Q waves, inverted T waves and poor R progression observed in the initial ECG disappeared (). However, she and her guardian strongly insisted on discharging from the hospital against the clinician's recommendation. Although appointments with cardiology and psychiatry departments were arranged with continuing mental support and follow-up echocardiogram, she never came back to the hospital after her discharge.",What is the patient's LDL cholestrol concentration? Please outuput your answer in terms of mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'high-density lipoprotein cholesterol': [74.0, 'mg/dL'], 'Triglycerides': [38.0, 'mg/dL'], 'Total cholesterol': [116.0, 'mg/dL']}",34.4,32.68,36.12,"To compute the patient's LDL cholestrol, apply the following formula: LDL cholesterol = total cholesterol - HDL - (triglycerides / 5), where the units for total cholestrol, HDL cholesterol, and triglycerides are all mg/dL.
The concentration of total cholesterol is 116.0 mg/dL. 
The concentration of hdl cholesterol is 74.0 mg/dL. 
The concentration of triglycerides is 38.0 mg/dL. 
Plugging in these values will give us 116.0 mg/dL - 74.0 mg/dL - (38.0/5) mg/dL = 34.4 mg/dL.
The patients concentration of LDL cholestrol is 34.4 mg/dL."
537,44,LDL Calculated,lab test,decimal,pmc-3651988-1,Extracted,"A previously healthy, 39-year-old woman was admitted to our hospital with generalized edema lasting 1 month and with sudden-onset pain in her right lower leg, particularly when walking. On admission, her general appearance was acutely ill and generally edematous. A physical examination revealed that her blood pressure was 120/80 mmHg, her heart rate was 90/min, her respiratory rate was 22/min, and her body temperature was 36.5℃. Her breathing sounds were clear, and her heartbeat was regular without murmur. A subsequent examination of her lower limbs showed asymmetric bilateral pretibial pitting edema predominantly in the left lower limb. In contrast, the right lower limb was less edematous and had very weak popliteal and pedal pulses. Delayed capillary refilling was also found in the right toes. The Homan's sign was negative.
Serum laboratory findings at admission were as follows: white blood cell count of 5,300/mm3, hematocrit of 39.5% with hemoglobin of 13.1 g/dl, and platelet count of 286,000/mm3. The serum sodium concentration was 141 mEq/L, the potassium concentration was 4.1 mEq/L, the chloride concentration was 104 mEq/L, and total CO2 was 28 mEq/L. The blood urea nitrogen concentration was 12.1 mg/dl, the creatinine concentration was 0.86 mg/dl, the serum total protein concentration was 4.3 g/dl, the albumin concentration was 2.2 g/dl, the total cholesterol concentration was 349.4 mg/dl, the high-density lipoprotein cholesterol concentration was 111 mg/dl, and the triglyceride concentration was 120.1 mg/dl. The results of liver function tests were normal. The coagulation profile showed an activated partial thromboplastin time of 32.0 s, prothrombin time of 9.7 s, anti-thrombin III value of 82% (70-120%), protein C activity of 143% (70-130%), and protein S activity of 65% (58.7-119.2%). The anti-nuclear antibody titer was less than 1:40, the anti-double-stranded DNA titer was 30.9 IU/ml, the C3 level was 158 mg/dl, and the C4 level was 19 mg/dl. Anti-cardiolipin immunoglobulin G, anti-cardiolipin immunoglobulin M, and lupus anticoagulant were all negative. Urinalysis revealed 3+ proteinuria (spot urine protein-to-creatinine ratio was 10.9 g/g creatinine; spot urine albumin-to-creatinine ratio was 7,406.2 mg/g creatinine) and trace hematuria (1-3 red blood cells/high-power field). To investigate the etiology of nephrotic syndrome, an urgent renal biopsy was performed.
Thereafter, although she had no risk factors for thrombosis such as immobilization, heart failure, atrial fibrillation, morbid obesity, or a recent orthopedic or gynecologic surgery, to rule out arterial thrombosis of the right lower extremity, lower extremity computed tomography (CT) angiography was performed. The CT imaging revealed that the right superficial femoral artery was occluded and there was no identifiable proximal source of thromboembolism in other large arteries (). On the basis of these CT angiographic findings, right lower extremity angiography was performed, which revealed a total occlusion of the right superficial femoral artery (). For the treatment of this condition, balloon dilatation was initially tried at the distal superficial femoral artery but failed. Hence, thrombectomy was performed with the Fogarty balloon catheter and the thrombi were successfully aspirated. After the interventional treatment, a good distal arterial flow was reestablished (). Thereafter, warfarin (5 mg/day) as an anticoagulant and corticosteroid treatments were initiated.
Subsequent transthoracic and transesophageal echocardiographic studies showed no evidence of intracardiac thrombus, vegetation, or other structural abnormalities including patent foramen ovale. Quantitation of proteinuria was confirmed by using a 24-hour urine collection that showed 10.2 g/day of protein excretion and 7.8 g/day of albumin excretion, respectively. Afterwards, with administration of warfarin and corticosteroid, the patient had nearly completely recovered from the edema and claudication and was discharged. The renal pathologic results were consistent with minimal change disease ( and ). Two months after discharge, her urine protein-to-creatinine ratio decreased to less than 0.1 g/g creatinine, her serum albumin level was maintained at 4.1 g/dl, and she had no further symptoms or signs of arterial thrombosis.",What is the patient's LDL cholestrol concentration? Please outuput your answer in terms of mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Total cholesterol': [349.4, 'mg/dL'], 'Triglycerides': [120.1, 'mg/dL'], 'high-density lipoprotein cholesterol': [111.0, 'mg/dL']}",214.38,203.661,225.099,"To compute the patient's LDL cholestrol, apply the following formula: LDL cholesterol = total cholesterol - HDL - (triglycerides / 5), where the units for total cholestrol, HDL cholesterol, and triglycerides are all mg/dL.
The concentration of total cholesterol is 349.4 mg/dL. 
The concentration of hdl cholesterol is 111.0 mg/dL. 
The concentration of triglycerides is 120.1 mg/dL. 
Plugging in these values will give us 349.4 mg/dL - 111.0 mg/dL - (120.1/5) mg/dL = 214.38 mg/dL.
The patients concentration of LDL cholestrol is 214.38 mg/dL."
538,44,LDL Calculated,lab test,decimal,pmc-4534995-1,Extracted,"A 50-year-old postmenopausal woman was admitted to the hospital because of cresendo angina.
She was well except for tuberculous pleurisy experienced seven years earlier, when the onset of chronic stable angina pectoris took place, which, since then, responded to nitroglycerin. During the year or two before her admission, the angina became more frequent and occurred on minimal exertion. Pain radiating to both shoulders and upper arms frequently accompanied the angina episodes.
After admission, the angina was controlled by bed rest and intensive medical treatment with beta blocking and calcium channel blocking drugs and sublingual nitrates. There was no history of hypertention, cigarette smoking, use of alcohol, or birth control pills.
Upon admission, her temperature was 36.9°C, pulse per minute and respiration 16 per minute. The blood pressure was 130/90 mmHg.
On examination, the patient appeared acutely ill. However, the head and neck were normal; the jugular vein was not distended. The lungs were clear. The heart sounds were regular; no murmurs or pericardial friction rub was heard. The abdomen was normal; no organ or mass was palpated. There was no peripheral edema, clubbing or cyanosis. Neurologic examination was negative.
The urine was normal. The hematocrit was 37%; the white-cell count was 9,900 per cubic millimeter with 61% neutrophils, 6% band form, 35% lymphocytes and 2% basophils. The platelet count was 304,000 per cubic millimeter. The prothrombin time was 10.3 seconds with 100% of control; the bleeding time was 2.00 minutes; the clotting time was 7.00 minutes. The SGOT was 15 u, the LDH 120 u and the CPK 41 u per liter. The total cholesterol was 250 mg, the triglyceride 99 mg, and the HDL-cholesterol 59 mg per deciliter. The serologic test for VDRL was negative.
The electrocardiogram was normal at rest and showed slight depression of the ST segments and inverted T waves in Leads I, aVL and V4 through V6 during the angina episodes (). A chest X-ray showed that the lungs were clear and the heart size was normal; the pulmonary vascular pattern was normal.
A cardiac catheterization was performed through the right femoral vein and artery. The pulmonary artery pressure was 50/20 mmHg and PCWP 20 mmHg; the aortic pressure was 165/85 mmHg and the LVEDP 15 mmHg; the cardiac output using the Fick oxygen method and the ejection fraction were 7.831 liter perminute and 0.75, respectively.
On left coronary angiography, a profound decrease in distal coronary pressure after coronary engagement with angina and the appearance of ST-T wave changes in monitoring, the electrocardiogram were noticed ().
There was no abnormalities on the left coronary angiography on the routine LAO and RAO projection. But a shallow LAO projection with a mild craniocaudal tilt of the left coronary angiography demonstrated a critical stenosis of the left main coronary ostium (). There were no abnormalities on the right coronary angiography.
The patient underwent coronary bypass graft surgery and has been doing well without occurrence of angina since the surgery.",What is the patient's LDL cholestrol concentration? Please outuput your answer in terms of mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'high-density lipoprotein cholesterol': [59.0, 'mg/dL'], 'Triglycerides': [99.0, 'mg/dL'], 'Total cholesterol': [250.0, 'mg/dL']}",171.2,162.64,179.76,"To compute the patient's LDL cholestrol, apply the following formula: LDL cholesterol = total cholesterol - HDL - (triglycerides / 5), where the units for total cholestrol, HDL cholesterol, and triglycerides are all mg/dL.
The concentration of total cholesterol is 250.0 mg/dL. 
The concentration of hdl cholesterol is 59.0 mg/dL. 
The concentration of triglycerides is 99.0 mg/dL. 
Plugging in these values will give us 250.0 mg/dL - 59.0 mg/dL - (99.0/5) mg/dL = 171.2 mg/dL.
The patients concentration of LDL cholestrol is 171.2 mg/dL."
539,44,LDL Calculated,lab test,decimal,pmc-3386769-1,Extracted,"The patient is now 20 years old; she is the second child of healthy non-consanguineous parents. There was no family history of liver disease, diabetes, or hypercholesterolemia. Since birth, her general health had been good; however, hepatomegaly was noticed during a routine health care visit and therefore, at 5 years of age, the patient was referred to our hospital. At that time, her height was 100.6 cm (-2.0 SD as compared to a normal Japanese girl) and her weight was 14.1 kg (-1.8 SD as compared to a normal Japanese girl) (BMI= 14.1 kg/m2). A physical examination revealed hepatomegaly with moderate elevation of serum transaminases. Jaundice and splenomegaly were absent. She was admitted for further evaluation . Laboratory findings revealed liver dysfunction and hypercholesterolemia (AST 211 IU/L, ALT 321 IU/L, lactate dehydrogenase 914 IU/L , alkaline phosphatase 971 IU/L, leucine aminopeptidase 272 IU/L, ?-glutamyl transpeptidase 10 IU/L, total cholesterol 207 mg/dL, HDL-cholesterol 45 mg/dL, triglyceride 142 mg/dL, and total bile acid 5.5 mg/L). Serum anti-nuclear antibody, anti-smooth muscle antibody, and anti-DNA antibody were negative. Her fasting blood glucose was 91 mg/dL and within the normal range. Glucosuria was detected; however, an oral glucose tolerance test (OGTT) showed normal glucose levels and insulin responses (). Abdominal computed tomography (CT) revealed hepatomegaly with diffuse low density and no mass, suggesting fatty liver change. Ultrasonography and CT demonstrated no abnormalities in other organs. It was suspected that the patient had some degree of liver disease, and a liver biopsy was performed. Biopsy specimens showed vacuolar degeneration of individual hepatocytes and macrovesicular steatosis (). Hepatitis, drug-induced disease, and congenital metabolic diseases were excluded, and the origin of the liver disease remained unknown. As the cause of liver disease was not determined, we treated the patient for hypercholesterolemia with ethyl icosapentate, which is not hepatotoxic (). Post-treatment, her serum cholesterol level had decreased to almost within the normal range. Regarding hepatic dysfunction, the patient’s serum transaminase levels were reduced but continued to fluctuate at the upper end of the normal range. A CT scan showed improvement of fatty change in the liver. When the patients was 9 years of age, it was noticed during a routine laboratory evaluation that she had elevated HbA1c (7.3%) and she was reevaluated for diabetes. At this time, her height was 127.4 cm and her body weight was 25.7 kg (these measurements correspond to -1.0 SD for a normal Japanese girl). BMI was calculated as 15.9 kg/m2. The second OGTT showed reductions in both glucose tolerance and insulinogenic index (). The peak level of serum C-peptide after glucagon stimulation remained normal (3.9 ng/mL, normal range >2.0 ng/mL). Islet cell antibodies (ICAs) and glutamic acid decarboxylase (GAD) antibody were not detected in the serum. At this time, she was suspected to have MODY3 because of liver disease and negative auto-antibodies. It has been reported that sulphonylureas are effective in the treatment of patients with MODY3 (); however, the use of sulphonylureas in children is not approved by the health insurance authorities in Japan. Since the patient had a reduced insulinogenic index, insulin treatment in a total daily dose of 9 units prior to each meal was initiated. Since that time, the patient’s diabetes has been under good control and her liver dysfunction has been normalized. She is now 20 years old, and her total daily insulin requirement has increased to 36 units, while her HbA1c levels range from 6.5% to 7%. We could not obtain patient and parental consent for a second biopsy.
Because the clinical course led to a probable diagnosis of MODY, we analyzed HNF1A, 4A and -1B by polymerase chain reaction and direct sequencing, according to a previous report (). Sequence analysis of HNF1A identified a heterozygous mutation at the consensus splice donor site of intron 9, which has been previously reported in a MODY3 family (). Neither of the patient’s parents had this base change, indicating that the mutation occurred de novo. However, we could not perform an analysis of somatic mutations of HNF1A in liver tissue, which was previously biopsied, because we did not have access to the samples.",What is the patient's LDL cholestrol concentration? Please outuput your answer in terms of mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'high-density lipoprotein cholesterol': [45.0, 'mg/dL'], 'Triglycerides': [142.0, 'mg/dL'], 'Total cholesterol': [207.0, 'mg/dL']}",133.6,126.92,140.28,"To compute the patient's LDL cholestrol, apply the following formula: LDL cholesterol = total cholesterol - HDL - (triglycerides / 5), where the units for total cholestrol, HDL cholesterol, and triglycerides are all mg/dL.
The concentration of total cholesterol is 207.0 mg/dL. 
The concentration of hdl cholesterol is 45.0 mg/dL. 
The concentration of triglycerides is 142.0 mg/dL. 
Plugging in these values will give us 207.0 mg/dL - 45.0 mg/dL - (142.0/5) mg/dL = 133.6 mg/dL.
The patients concentration of LDL cholestrol is 133.6 mg/dL."
540,44,LDL Calculated,lab test,decimal,pmc-3158562-1,Extracted,"A 28 year old Caucasian woman was brought to our emergency department with a five hour history of progressive impairment in consciousness and slurred speech. Her past history was unremarkable, and she neither smoked nor drank alcohol. Her older brother said that she took no medications and she did not use illicit drugs as far as he knew. No history of head trauma was obtained. At the time of admission, her blood pressure was 140/70 mmHg with a pulse rate of 90 beats/minute, respiratory rate of 12 cycles/minute, and a temperature 37.1°C. Our patient was stuporous and there were no lateralizing signs or neck stiffness. Both planter reflexes were down. Our patient underwent a battery of investigations with the following results: hemoglobin 13.6 g/L; total white cell count 9100/mL3; platelets 270,000/mL3; mean corpuscular volume 84fL; mean corpuscular hemoglobin concentration 33 g/dL; erythrocyte sedimentation rate 19 mm/hour; blood urea 35 mg/dL; serum creatinine 0.9 mg/dL; serum sodium 139 mEq/L; serum potassium 4.1 mEq/L; serum calcium 8.9 mg/dL; serum total bilirubin 0.8 mg/dL; aspartate transaminase 21 u/L; alanine transaminase 19 u/L; alkaline phosphatase 190 u/L; serum total protein 7.3 g/dL; serum albumin 4.4 g/dL; thyroid stimulating hormone 2.9 u/L; serum total triiodothyronine 1.3 nmol/L; serum total thyroxin 89 nmol/L; serum total cholesterol 177 mg/dL; serum triglyceride 100 mg/dL; high density lipoprotein cholesterol 38 mg/dl; prothrombin time 12 seconds; activated partial thromboplastin time 31 seconds; a serum Venereal Disease Research Laboratory test was negative; and general urine examination and microscopy were unremarkable. Blood and urinary screening for cocaine, opioids and amphetamines was negative. A 12 lead electrocardiogram (ECG) was normal. A non contrast brain computed tomography (CT) scan showed bilateral hypodensities in her corpus striatum (Figure ). In addition, there was a small hyper dense area at the anterior part of her right globus pallidus. The physician suspected encephalitis, and managed our patient accordingly. He ordered serology for toxoplasma and human immunodeficiency virus, and a lumber puncture was done: all of these tests turned out to be negative. At day four of admission, our patient became comatose, and our neurology department was consulted. The Glasgow coma scale was 3/15, no neck stiffness was detected, and both planter reflexes were up. On day five, a brain magnetic resonance imaging (MRI) scan with gadolinium revealed hemorrhagic infarctions involving both basal ganglia (Figure ). Brain magnetic resonance angiography and magnetic resonance venography (MRV) were normal. Serum anti nuclear and rheumatoid factors as well as anti phospholipid antibodies were negative. Transthoracic and transesophageal echocardiographic examinations were normal, as was the carotid Doppler study.
Our patient was managed as ischemic stroke with secondary hemorrhagic transformation. Anti hypertensives and a statin were prescribed. Anti platelets and anticoagulation were not given. Gradually over a period of three weeks, our patient's consciousness improved to a degree of mild drowsiness. As for her language assessment, comprehension was intact but there was no speech output; she uttered few sounds, however, but no comprehensible words. She had generalized rigidity and hypokinesia. No abnormal movements were found and dystonic posturing was absent.",What is the patient's LDL cholestrol concentration? Please outuput your answer in terms of mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Total cholesterol': [177.0, 'mg/dL'], 'Triglycerides': [100.0, 'mg/dL'], 'high-density lipoprotein cholesterol': [38.0, 'mg/dL']}",119,113.05,124.95,"To compute the patient's LDL cholestrol, apply the following formula: LDL cholesterol = total cholesterol - HDL - (triglycerides / 5), where the units for total cholestrol, HDL cholesterol, and triglycerides are all mg/dL.
The concentration of total cholesterol is 177.0 mg/dL. 
The concentration of hdl cholesterol is 38.0 mg/dL. 
The concentration of triglycerides is 100.0 mg/dL. 
Plugging in these values will give us 177.0 mg/dL - 38.0 mg/dL - (100.0/5) mg/dL = 119.0 mg/dL.
The patients concentration of LDL cholestrol is 119.0 mg/dL."
541,44,LDL Calculated,lab test,decimal,pmc-2803825-1,Extracted,"A 68-year-old Caucasian man was referred to our cardiology clinic in February 2008 for further evaluation of a conspicuous new heart murmur. The patient did not have any cardiac complaints and did not suffer from angina pectoris or dyspnoea. The patient had advanced gonarthrosis of the left knee, advanced degeneration of the cervical spine and advanced bilateral omarthrosis. His medical history included kidney stone surgery (1988), diagnosis of ochronosis based on a biopsy of the knee joint (1995), total hip replacement (1997), Miller-Galante II prosthesis of the right knee (1997), periosteal rupture of the left Achilles tendon with transosseous re-fixation (1999), ventral corporectomy at C4 and discectomy at C3/C4 and C4/C5 after cervical spinal canal stenosis with myelopathy at C3-C5, and ventral and dorsal osteochondrosis (2001). Family history revealed that his brother also had ochronosis. The patient was not on any medication.
On physical examination, the patient was found to be in a moderately reduced general condition and in a regular nutritional status. His body mass index was 25.8 kg/m2. He had a blood pressure of 130/80 mmHg bilaterally and a pulse rate of 80 beats/min. Dyspnoea, cyanosis and liver skin spots were not observed. Bluish-black pigmentations were found on several parts of the sclera (Figure ). The patient's pupils were of average width and showed prompt response to light. No arcus lipoides, no goitre and no superior vena cava syndrome were noticed. His thorax and chest expansion were symmetrical. Breath sounds were vesicular and percussion resonant, with no crepitations or evidence of a pleural effusion. His heart beat was regular with a grade 2/6 diastolic murmur at the apex and a grade 2/6 systolic murmur over the mitral and tricuspid valves. His abdomen was soft and non-tender to palpation, liver and spleen were not enlarged, and there was no costo-vertebral-angular tenderness. Unilateral oedema on the left ankle was observed. Also, the left foot pulse was absent, while normal central and peripheral pulses were symmetrically palpable.
Results of the patient's laboratory examination showed 252 mg/dl total cholesterol, 84 mg/dl triglycerides, and 66 mg/dl high-density lipoprotein. Inflammatory markers were not elevated and anti-streptolysin O (ASO) titre was not raised. The patient's urine turned brownish black when left standing for some time.
An electrocardiogram (ECG) test showed a sinus rhythm of 72 beats/min with left axis deviation (-57 degrees). The patient's depolarisation and repolarisation phases were normal. During an exercise ECG using a treadmill set up to 125 watts workload, his blood pressure increased from 160/90 mmHg to 160/100 mmHg and his pulse rate from 68 to 158 beats/min. When the exercise ECG was stopped at the point of exhaustion, no angina pectoris, dyspnoea, significant ST segment depression or profound dysrhythmia were observed. His blood pressure and pulse rate normalised within 3 minutes of recovery.
An echocardiogram revealed that the patient's left atrium was normal in size while his left ventricle was slightly dilated (Figure ). The pumping function of the left heart was normal - there was no evidence of hypertrophy - and the aortic valve had three cusps. A Doppler echocardiogram showed a minor to moderate aortic insufficiency, a combined mitral valve defect with an opening size of 1.6 cm2 with mild to moderate regurgitation, and a mild tricuspid regurgitation. No pericardial effusion was detected. The patient's right heart was normal in size without any signs of stasis.
A histopathological analysis of the patient revealed brownish deposits between the collagen fibre bundles of a knee joint biopsy sample. The pigment was found both extracellularly and intracellularly. The appearance of the pigment was variable, being coarse, like haemosiderin and fine, like granules. Iron staining was negative and no inflammatory or post-inflammatory changes were observed. Taken together, the patient's histopathology was characteristic for ochronosis.
Based on cardiac investigations, an alkaptonuria-associated degenerative valve defect with aortic, mitral and tricuspid valve insufficiency was diagnosed. The decision for using conservative therapy was reached and the patient was treated with an angiotensin-converting enzyme (ACE) inhibitor (2.5 mg/day ramipril).
At follow-up examinations in April and November 2008, the patient presented in a stable condition. However, in February 2009, the patient was hospitalised because of cardiac decompensation.=",What is the patient's LDL cholestrol concentration? Please outuput your answer in terms of mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Total cholesterol': [252.0, 'mg/dL'], 'Triglycerides': [84.0, 'mg/dL'], 'high-density lipoprotein cholesterol': [66.0, 'mg/dL']}",169.2,160.74,177.66,"To compute the patient's LDL cholestrol, apply the following formula: LDL cholesterol = total cholesterol - HDL - (triglycerides / 5), where the units for total cholestrol, HDL cholesterol, and triglycerides are all mg/dL.
The concentration of total cholesterol is 252.0 mg/dL. 
The concentration of hdl cholesterol is 66.0 mg/dL. 
The concentration of triglycerides is 84.0 mg/dL. 
Plugging in these values will give us 252.0 mg/dL - 66.0 mg/dL - (84.0/5) mg/dL = 169.2 mg/dL.
The patients concentration of LDL cholestrol is 169.2 mg/dL."
542,44,LDL Calculated,lab test,decimal,pmc-4296242-1,Extracted,"A 25-year-old female nurse was referred to our diabetes outpatient clinic with poorly controlled type 2 diabetes, obesity and elevated LFTs. Her general practitioner had initiated treatment with metformin (1,000 mg twice-daily) and simvastatin (40 mg once-daily), but compliance was limited. At her first visit to our outpatient clinic her body weight was 90 kg and her body mass index 32.6 kg/m2. She was asymptomatic and clinical examination, fundus photography, filament testing and albumin/creatinine ratio revealed no signs of complications related to type 2 diabetes. Blood samples showed a glycated hemoglobin A1c (HbA1c) of 8.9% (74 mmol/mol) and a fasting plasma glucose of 7.3 mmol/l. LFTs showed an alanine aminotransferase (ALT) of 196 U/l (reference range 10–45 U/l), an aspartate aminotransferase (AST) of 132 U/l (reference range 15–35 U/l) and an alkaline phosphatase (ALP) of 127 U/l (reference range 35–105 U/l). Lipids were elevated: total cholesterol 4.5 mmol/l, high-density lipoprotein 0.84 mmol/l, and triglycerides 2.86 mmol/l. Bilirubin, international normalized ratio and albumin were within normal ranges. The patient had no history of alcohol abuse nor did she take any herbal drug. Abdominal ultrasound revealed increased echogenicity and poor visualization of the intrahepatic vessel walls, suggesting diffuse hepatic steatosis.
Statins were discontinued and the patient was strongly encouraged to be compliant with her metformin treatment (1,000 mg twice-daily). In addition neutral protamine Hagedorn insulin was initiated. The daily dose of basal insulin was gradually increased to 30 IU once daily.
After 8 weeks on metformin and insulin, HbA1c had markedly improved to 6.3%, but LFTs except for ALP remained elevated (ALT 133 U/l, AST 76 U/l, ALP 69 U/l). The patient was then scheduled for a liver biopsy, which showed hepatic fat infiltration involving more than 66% of hepatocytes, ballooned hepatocytes, lobular inflammation as well as pericellular and periportal fibrosis. The histological diagnosis was NASH with a NAFLD activity score of 5 (score range 0–8) and a fibrosis score of 2 (score range 0–4) (fig. ). Treatment with subcutaneous injections of the GLP-1R agonist liraglutide was initiated. The initial dose was 0.6 mg once daily subcutaneously. The dose was increased with weekly increments of 0.6–1.8 mg once daily during the following weeks. Liraglutide was well tolerated with no side effects such as nausea or vomiting. Insulin was gradually reduced and discontinued after 7 weeks.
After 46 weeks of treatment with liraglutide, total weight loss was 16 kg, LFTs were in the lower normal range (ALT 29 U/l, AST 25 U/l, ALP 67 U/l), glycemic control was excellent (HbA1c 5.6%) and the lipid profile was normalized without statin treatment. Repeat abdominal ultrasound showed diminished echogenicity, suggesting an overall reduction in steatosis. A repeated liver biopsy confirmed decreased hepatic fat infiltration (involving 40–50% of hepatocytes), no ballooned hepatocytes and only distinct lobular inflammation (fig. ). The histology was no longer consistent with NASH, but pericellular and periportal fibrosis were still present (NAFLD activity score 3, fibrosis score 2).
To investigate the expression of hepatic GLP-1Rs in the present case, the baseline and the post-treatment liver biopsy were compared to liver tissue from another patient with type 2 diabetes but without steatosis, using quantitative polymerase chain reaction. No biopsies showed expression of GLP-1Rs.",What is the patient's LDL cholestrol concentration? Please outuput your answer in terms of mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'high-density lipoprotein cholesterol': [0.84, 'mmol/L'], 'Triglycerides': [2.86, 'mmol/L'], 'Total cholesterol': [4.5, 'mmol/L']}",92.2464,87.63408,96.85872,"To compute the patient's LDL cholestrol, apply the following formula: LDL cholesterol = total cholesterol - HDL - (triglycerides / 5), where the units for total cholestrol, HDL cholesterol, and triglycerides are all mg/dL.
The concentration of total cholesterol is 4.5 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of total cholesterol from mmol to mg. The mass of total cholesterol is 4.5 mmol. To convert 4.5 mmol of total cholesterol to mol, multiply by the conversion factor 0.001, giving us 4.5 mmol total cholesterol * 0.001 mol/mmol = 0.0045 mol total cholesterol. To convert from mol total cholesterol to grams, multiply by the molar mass 386.654 g/mol, which will give 0.0045 mol total cholesterol * 386.654 g/mol = 1.73994 g total cholesterol. To convert 1.73994 g of total cholesterol to mg, multiply by the conversion factor 1000.0, giving us 1.73994 g total cholesterol * 1000.0 mg/g = 1739.94 mg total cholesterol. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 1739.94 mg total cholesterol/10.0 dL = 173.994 mg total cholesterol/dL. The concentration value of 4.5 mmol total cholesterol/L converts to 173.994 mg total cholesterol/dL. 
The concentration of hdl cholesterol is 0.84 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of hdl cholesterol from mmol to mg. The mass of hdl cholesterol is 0.84 mmol. To convert 0.84 mmol of hdl cholesterol to mol, multiply by the conversion factor 0.001, giving us 0.84 mmol hdl cholesterol * 0.001 mol/mmol = 0.00084 mol hdl cholesterol. To convert from mol hdl cholesterol to grams, multiply by the molar mass 386.654 g/mol, which will give 0.00084 mol hdl cholesterol * 386.654 g/mol = 0.32479 g hdl cholesterol. To convert 0.32479 g of hdl cholesterol to mg, multiply by the conversion factor 1000.0, giving us 0.32479 g hdl cholesterol * 1000.0 mg/g = 324.79 mg hdl cholesterol. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 324.79 mg hdl cholesterol/10.0 dL = 32.479 mg hdl cholesterol/dL. The concentration value of 0.84 mmol hdl cholesterol/L converts to 32.479 mg hdl cholesterol/dL. 
The concentration of triglycerides is 2.86 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of triglycerides from mmol to mg. The mass of triglycerides is 2.86 mmol. To convert 2.86 mmol of triglycerides to mol, multiply by the conversion factor 0.001, giving us 2.86 mmol triglycerides * 0.001 mol/mmol = 0.00286 mol triglycerides. To convert from mol triglycerides to grams, multiply by the molar mass 861.338 g/mol, which will give 0.00286 mol triglycerides * 861.338 g/mol = 2.46343 g triglycerides. To convert 2.46343 g of triglycerides to mg, multiply by the conversion factor 1000.0, giving us 2.46343 g triglycerides * 1000.0 mg/g = 2463.43 mg triglycerides. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 2463.43 mg triglycerides/10.0 dL = 246.343 mg triglycerides/dL. The concentration value of 2.86 mmol triglycerides/L converts to 246.343 mg triglycerides/dL. 
Plugging in these values will give us 173.994 mg/dL - 32.479 mg/dL - (246.343/5) mg/dL = 92.2464 mg/dL.
The patients concentration of LDL cholestrol is 92.2464 mg/dL."
543,44,LDL Calculated,lab test,decimal,pmc-3992346-1,Extracted,"A 36-year-old man presented to the emergency room with dyspnea of New York Heart Association functional class III/IV and fatigue. The patient had a 1-year-history of chief complaints of weakness of all four extremities, weight gain and bilateral lower extremity edema. For two months prior to admission, the patient had a progressive worsening of bilateral lower extremity edema. On physical examination, the patient had body mass index (BMI) 28.6 kg/m2 and vital signs such as blood pressure 130/90 mmHg, pulse rate 90 beats/min, respiratory rate 20 breaths/min and O2 saturation 96% in room air. In addition, the patient had pale and dry skin. Heart rate was regular and systolic murmur was heard at the apex. Breath sounds were decreased with inspiratory crackles on bilateral lung bases. The patient also had bilateral presence of non-pitting edema of the foot and ankle. On chest X-ray, the patient had cardiomegaly with perihilar congestion and blunting of both costophrenic angles. These findings are suggestive of pleural effusion (). On electrocardiographic findings, the patient had normal sinus rhythm with low voltage of limb leads, interventricular conduction delay and non-specific ST-segment and T-wave changes (). On clinical laboratory examinations, the patient showed elevated serum levels of N-terminal pro-brain natriuretic peptide (5026 pg/mL) and normal range of cardiac enzymes. Renal functions were normal with blood urea nitrogen of 14.8 mg/dL and creatinine of 1.2 mg/dL. Lipid panel showed total cholesterol 231 mg/dL, triglyceride 188 mg/dL, and high-density lipoprotein cholesterol 34 mg/dL. Liver function test showed elevated serum levels of transaminases with total bilirubin 1.34 mg/dL, aspartate transaminase 402 IU/L, alanine transaminase 340 IU/L and alkaline phosphatase 44 IU/L. On complete blood counts, the patient had white blood cell counts 9260/mm3 with 56% neutrophils, hemoglobin 10.8 g/dL and platelets 190000/mm3. Serum electrolytes showed [Na+] = 120 meq/L, suggesting hyponatremia, and [K+] = 4.3 meq/L. Serum creatinine kinase was elevated (2738 U/L). On echocardiography, the patient had a dilated left ventricular cavity with a diastolic dimension of 6.1 cm, a decreased global systolic function with an ejection fraction of 16% and functional mitral regurgitation of moderate grade (). The patient had a ratio of transmitral early peak velocity (E) to septal mitral annulus velocity (E') of 13. The patient was started on loop diuretic therapy using furosemide and angiotensin converting enzyme (ACE) inhibitor (enalapril) for heart failure. On day 2, the patient underwent thyroid function test. This showed that the patient had elevated serum levels of thyroid stimulating hormone (100 µIU/mL) (reference range: 0.5-5 µIU/mL), decreased serum levels of T3 (60 ng/dL) (reference range: 80-180 ng/dL) and decreased serum levels of free T4 (0.054 ng/dL) (reference range: 0.7-1.9 ng/dL). Furthermore, the patient underwent additional tests to reveal the cause of hypothyroidism. This showed that the patient was positive for thyroglobulin antibody but negative for anti-microsomal one. On thyroid ultrasonography, the patient had an atrophic thyroid gland with hypoechoic parenchyma with two small nodules of 5 mm and 8 mm in size in the right lobe. On Tc 99-mm radionuclide thyroid scan, there was an increased uptake in the above two small nodules. On fine-needle aspiration biopsy of the nodules, the patient had adenomatous hyperplasia on lymphocytic thyroiditis background (). These findings were suggestive of Hashimoto's thyroiditis accompanied by atrophic autoimmune thyroiditis. Based on these findings, the patient was started on thyroid hormone replacement with thyroxine. Thyroxine dose was titrated up to 50 µg/day after two weeks and then up to 100 µg/day. This was followed by the adjustment of thyroxine dose based on thyroid functions. At a 1-year follow-up, the patient had a gradual decrease in the enlarged left ventricular chamber and a normalization of the decreased left ventricular systolic functions (). Furthermore, the patient also had a normalization of clinical laboratory findings such as transaminases and creatinine kinase. Follow-up echocardiography findings are shown in . Three months after the treatment, the patient had a decrease in the BMI to 23.4 kg/m2. The patient discontinued use of loop diuretics (furosemide) but continued use of ACE inhibitor (enalapril), β-blockers (bisoprolol) and thyroid hormone replacement therapy.",What is the patient's LDL cholestrol concentration? Please outuput your answer in terms of mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Total cholesterol': [231.0, 'mg/dL'], 'Triglycerides': [188.0, 'mg/dL'], 'high-density lipoprotein cholesterol': [34.0, 'mg/dL']}",159.4,151.43,167.37,"To compute the patient's LDL cholestrol, apply the following formula: LDL cholesterol = total cholesterol - HDL - (triglycerides / 5), where the units for total cholestrol, HDL cholesterol, and triglycerides are all mg/dL.
The concentration of total cholesterol is 231.0 mg/dL. 
The concentration of hdl cholesterol is 34.0 mg/dL. 
The concentration of triglycerides is 188.0 mg/dL. 
Plugging in these values will give us 231.0 mg/dL - 34.0 mg/dL - (188.0/5) mg/dL = 159.4 mg/dL.
The patients concentration of LDL cholestrol is 159.4 mg/dL."
544,44,LDL Calculated,lab test,decimal,pmc-4663774-1,Extracted,"A 37-year-old male presented with progressive swelling of feet and facial puffiness for 6 months. On physical examination, he had mild pallor, moderate pedal edema and cloudy cornea with a peripheral arcus in both eyes [].
Laboratory investigations revealed hemoglobin of 8 g/dL with “target” erythrocytes in peripheral blood film examination; serum haptoglobin of 64 mg/dl (normal range: 70–200 mg/dl), total cholesterol 215 mg/dl, high-density lipoprotein cholesterol (HDL-C) 10 mg/dl, and triglycerides 385 mg/dl. Renal biopsy showed glomerulomegaly with mild mesangial expansion and foam cell infiltration in mesangium and glomerular basement membrane (GBM) []. Tubules also showed foamy changes with focal tubular atrophy, and interstitium showed the presence of foam cells.
In view of the clinical profile, characteristic dyslipidemia (high triglyceride, very low HDL) and histological changes, serum LCAT deficiency were suspected. Plasma LCAT activity was determined at Pacific Biomarkers, Seattle, USA. The cholesterol esterification rate was undetectable indicating complete lack of LCAT in plasma. Clinical evaluation of family members revealed corneal opacities and dyslipidemia in patient's mother and his younger sister. However, there was no renal, hematological or other systemic involvement in both of them. Genetic testing of the proband and serum LCAT activity of the other affected members could not be done due to financial constraints. Based on the clinical manifestations, the proband was diagnosed to have classic FLD while his mother and sister were diagnosed to have FED.",What is the patient's LDL cholestrol concentration? Please outuput your answer in terms of mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'high-density lipoprotein cholesterol': [10.0, 'mg/dL'], 'Triglycerides': [385.0, 'mg/dL'], 'Total cholesterol': [215.0, 'mg/dL']}",128,121.6,134.4,"To compute the patient's LDL cholestrol, apply the following formula: LDL cholesterol = total cholesterol - HDL - (triglycerides / 5), where the units for total cholestrol, HDL cholesterol, and triglycerides are all mg/dL.
The concentration of total cholesterol is 215.0 mg/dL. 
The concentration of hdl cholesterol is 10.0 mg/dL. 
The concentration of triglycerides is 385.0 mg/dL. 
Plugging in these values will give us 215.0 mg/dL - 10.0 mg/dL - (385.0/5) mg/dL = 128.0 mg/dL.
The patients concentration of LDL cholestrol is 128.0 mg/dL."
545,44,LDL Calculated,lab test,decimal,pmc-3472613-1,Extracted,"An 18-year-old girl presented with long-term diarrhea and enterocutaneous fistula. She was diagnosed with celiac disease 4 years ago, because of nonbloody low volume, yellow colored diarrhea with tenesmus occurring 3-4 times a day. She was given the appropriate diet for celiac disease.
Three months before admission, she developed pain and swelling in the left lower quadrant of the abdomen and erythema of the same area.
She underwent surgery with probable diagnosis of abscess or inguinal hernia, but she had no clinical documents of the results of the surgery. 45 days later, a fistula was formed at the site of surgery which had fecaloid secretions.
She also had primary amenorrhea and a history of hypothyroidism.
On examination, she had a marfanoid habitus, a tall stature, and increased joint laxity. Blood pressure was 90/60 mmHg.
Bumpy lip/neuromas were found on the distal part of the tongue as well as on the conjunctiva of both eyes ().
Thyroid examination revealed multinodular goiter with a large nodule (4 ∗ 1.5 cm in diameter) in the right lobe of the thyroid gland with lymphadenopathy (). Physical examination was otherwise normal.
Laboratory data was as follows:24 hrs urine metanephrine: 192 mcg/24 hr (normal: <350), 24 hrs urine normetanephrine: 93 mcg/24 hr (normal: <600), Hb: 13,1, WBC: 16600, Plt: 533 ∗103, ESR: 22, serum albumin: 4,4 g/dL (3,5–5), total cholesterol: 145 mg/dL, HDL: 51 mg/dL, TG: 175 mg/dL, iron: 71, TIBC: 406, 24 hrs urine calcium: 66 μg/dL, antiendomysial antibody: 0.1, BUN: 7, Cr: 0,7, Anti-TPO: 14,3, LFT: NL, antitTG IgA: 1,4 (−), calcitonin: >2000 (with normal limit up to 140), CEA: 3689 (with normal limit up to 37).
In consultation with endocrinologists, MEN2B was suggested due to the thyroid nodule, cervical lymphadenopathy, marfanoid appearance, mucosal neuromas, and gastrointestinal tract abnormalities.
Barium Enema revealed diverticulosis of sigmoid colon ().
Colonoscopy revealed hypervascular areas with several fistulae orifices in the sigmoid colon.
Thyroid ultrasound revealed multinodular goiter, one large nodule, and cervical lymphadenopathy.
EUS revealed several calcified lesions in the liver and multiple round hyperechoic lesions in the liver suggesting metastasis of MTC.
Abdominal CT scan revealed abscess formation in the site of previous surgery. Multiple calcified and noncalcified lesions were seen in the liver, suggestive of metastasis ().
Small bowel transition was normal.
Ophthalmologic consultant reported sclerotic neuropathy and large corneal nerves.
Fine needle aspiration of the thyroid nodule reported medullary thyroid carcinoma. Both lobes were involved; capsular invasion and lymphatic vessel invasion were noted. IHC staining was performed on the blocks; the results were as follows:TTF1: negative in tumor cells, calcitonin: positive in tumor cells, chromogranin: positive in tumor cells, synaptophysin: positive in tumor cells.
Genetic investigation: exon 16/RET mutation at codon 918. The patient has the following nucleotide changes: heterozygote T2307G in exon 13 which causes no AA change (Leu769leu), heterozygote T2753A in exon 16 which causes Met918Thr.
Change number 1 is a polymorphism in RET gene. Mutation in exon 16 is a common mutation that is found in 95% of MEN2B patients.
She went under total thyroidectomy and excision of the left anterior cervical lymphatic chain.
One week later, she was admitted again for the right lymphatic chain excision. She still had fecaloid secretions. One week after that, she was operated for the fistula and sigmoidectomy and appendectomy were performed.",What is the patient's LDL cholestrol concentration? Please outuput your answer in terms of mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'high-density lipoprotein cholesterol': [51.0, 'mg/dL'], 'Triglycerides': [175.0, 'mg/dL'], 'Total cholesterol': [145.0, 'mg/dL']}",59,56.05,61.95,"To compute the patient's LDL cholestrol, apply the following formula: LDL cholesterol = total cholesterol - HDL - (triglycerides / 5), where the units for total cholestrol, HDL cholesterol, and triglycerides are all mg/dL.
The concentration of total cholesterol is 145.0 mg/dL. 
The concentration of hdl cholesterol is 51.0 mg/dL. 
The concentration of triglycerides is 175.0 mg/dL. 
Plugging in these values will give us 145.0 mg/dL - 51.0 mg/dL - (175.0/5) mg/dL = 59.0 mg/dL.
The patients concentration of LDL cholestrol is 59.0 mg/dL."
546,44,LDL Calculated,lab test,decimal,pmc-6728653-1,Extracted,"The patient is a 13-year-old, previously healthy, nonobese female with no past
medical history who presented to a school-based cholesterol and diabetes screening.
Her height and weight were 155 cm and 39.5 kg, respectively, and her body mass index
was at the 20th percentile for age and sex. Her vital signs were within normal
limits, her blood pressure was not elevated, and she was well-appearing. Her
screening lipid panel was within normal limits (cholesterol 125 mg/dL, high-density
lipoprotein 49 mg/dL, and triglycerides 68 mg/dL).
Point-of-care screening HgbA1C was significant for a value of 8.5% with a repeat
value of 8.7%. The endocrinology team was consulted by phone and the patient denied
symptoms of weight loss, polydipsia, polyuria, nocturia, and polyphagia; however, a
strong family history of diabetes was reported ().
In the setting of a new diagnosis of diabetes, she was referred to the Cincinnati
Children’s Hospital Medical Center Emergency Department for further evaluation and
management. On evaluation in the emergency department additional laboratory studies
were sent to confirm the diagnosis of diabetes and evaluate its etiology. Laboratory
studies included a repeat serum HgbA1C, electrolytes, urinalysis, and an islet cell
autoantibody screen. Additionally, routine new-onset diabetes screening laboratory
tests, which included a thyroid stimulating hormone, immunoglobulin A (IgA), and
tissue transglutaminase IgA, were also sent. On laboratory evaluation, she had no
evidence of acidosis or urine ketones and a random serum glucose was within normal
limits (111 mg/dL) but with glycosuria. In the setting of a normal random serum
glucose and absence of acidosis in a well-appearing patient, she was discharged home
with the plan for close endocrine follow-up.
The repeat serum HgbA1C resulted after the patient was discharged and was elevated at
10.3% and her islet cell autoantibody screen and all other screening labs returned
as negative. On telephone follow-up, the patient remained asymptomatic and a family
history obtained was significant for diabetes spanning 4 generations (see for pedigree). To
further confirm a diagnosis of new-onset diabetes an oral glucose tolerance test was
performed. Fasting glucose (89 mg/dL) and insulin (3.8 µIU/mL) were both within
normal limits. However, her oral glucose tolerance test results were consistent with
the diagnosis of diabetes, with glucose elevation to 313 mg/dL at 2 hours. In the
setting of new-onset diabetes, a negative islet cell autoantibody screen and a
family history of autosomal dominant diabetes, a diagnosis of MODY was suspected.
Confirmatory gene sequencing was sent and revealed a heterozygous mutation in HNF4A
gene designated c.200G>A (p. Arg67Gln) consistent with MODY1. This variant has
been reported previously. Ophthalmic examination and renal function laboratory tests
were both within normal limits. To date, the patient’s glycemic control has been
successfully maintained to reduce microvascular comorbidities with glipizide and
diet without the need of intensive insulin therapy.",What is the patient's LDL cholestrol concentration? Please outuput your answer in terms of mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'high-density lipoprotein cholesterol': [49.0, 'mg/dL'], 'Triglycerides': [68.0, 'mg/dL'], 'Total cholesterol': [125.0, 'mg/dL']}",62.4,59.28,65.52,"To compute the patient's LDL cholestrol, apply the following formula: LDL cholesterol = total cholesterol - HDL - (triglycerides / 5), where the units for total cholestrol, HDL cholesterol, and triglycerides are all mg/dL.
The concentration of total cholesterol is 125.0 mg/dL. 
The concentration of hdl cholesterol is 49.0 mg/dL. 
The concentration of triglycerides is 68.0 mg/dL. 
Plugging in these values will give us 125.0 mg/dL - 49.0 mg/dL - (68.0/5) mg/dL = 62.4 mg/dL.
The patients concentration of LDL cholestrol is 62.4 mg/dL."
547,44,LDL Calculated,lab test,decimal,pmc-4621682-1,Extracted,"A 35-year-old male was diagnosed with dyslipidemia (total serum cholesterol = 195 mg/dL, serum triglyceride = 171 mg/dL, and serum high-density lipoprotein cholesterol = 24 mg/dL). Patient, a nonsmoker, nonalcoholic, did not suffer from any other illness and was not taking any medication. He was prescribed a fixed dose combination of atorvastatin and ezetimibe (10 mg each), once a day along with the lifestyle modification in the form of brisk walking for 30–40 min a day.
Two months after initiation of therapy and exercise, the patient presented with moderate to severe pain in both legs. History revealed that he had fleeting pain in back, chest, shoulder, and arms 5 days preceding the leg pain. The patient initially attributed the pain to exercise and had stopped going for the walks. However, the pain worsened, causing episodes of nocturnal awakening. Clinical examination did not reveal any abnormality. Laboratory investigations revealed high serum CPK (1991 U/L, normal = 39–308 U/L) and low serum Vitamin D (7.19 ng/mL; normal = 20–100 ng/mL) levels. Other laboratory parameters including blood count, erythrocyte sedimentation rate, blood urea nitrogen, serum lactate dehydrogenase, serum creatinine, serum electrolytes, serum Vitamin B12, and electrocardiogram were normal. Assessment for antinuclear antibody was negative.
Atorvastatin-ezetimibe combination was discontinued. Patient was treated with oral diclofenac (50 mg twice daily for 3 days), Vitamin D (50,000 IU once a week for 8 weeks), and calcium carbonate (500 mg twice daily for 8 weeks). Myalgia subsided in 3–4 days. Two weeks later, serum CPK level was 342 U/L.
Upon resolution of symptoms, patient resumed physical activity of similar intensity. Atorvastatin-ezetimibe therapy was not re-introduced. Three months after resuming physical activity, the patient did not complain of myalgia and serum CPK level was normal (155 U/L).
The adverse event was “probably” related to atorvastatin-ezetimibe combination, as assessed by WHO-UMC scale and Naranjo's score (7).[] The adverse event was moderately severe (i.e. level 3) as assessed by Modified Hartwig and Siegel Scale.[]",What is the patient's LDL cholestrol concentration? Please outuput your answer in terms of mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'high-density lipoprotein cholesterol': [24.0, 'mg/dL'], 'Triglycerides': [171.0, 'mg/dL'], 'Total cholesterol': [195.0, 'mg/dL']}",136.8,129.96,143.64,"To compute the patient's LDL cholestrol, apply the following formula: LDL cholesterol = total cholesterol - HDL - (triglycerides / 5), where the units for total cholestrol, HDL cholesterol, and triglycerides are all mg/dL.
The concentration of total cholesterol is 195.0 mg/dL. 
The concentration of hdl cholesterol is 24.0 mg/dL. 
The concentration of triglycerides is 171.0 mg/dL. 
Plugging in these values will give us 195.0 mg/dL - 24.0 mg/dL - (171.0/5) mg/dL = 136.8 mg/dL.
The patients concentration of LDL cholestrol is 136.8 mg/dL."
548,44,LDL Calculated,lab test,decimal,pmc-2767135-1,Extracted,"A 27-year-old Mexican man was admitted to our hospital after he was found in a deep stupor. He had no previous history of disease and did not smoke or take alcohol or illicit drugs. On admission, his vital signs were normal (blood pressure 125/70 mmHg, breath rate 18/minute, heart rate 78/minute, axillary temperature 37.2°C). On neurologic examination, we found ptosis, arreflectic mydriasis and exophthalmos of the right eye, suggesting that the right oculomotor nerve was affected. The left eye opened to the Foix maneuver with normal pupil reflexes. We further found symmetric facial responses and withdrawal of both arms and legs to painful stimuli. All brainstem reflexes were patent and Hoffman-Trömner and Babinski reflexes were negative on both sides. All blood tests were normal and illicit drug and toxic profiles were negative. The laboratory test results were as follows: complete blood cell count: hemoglobin 15.3, platelets 371; cholesterol profile: cholesterol 177 mg/dl, triglycerides 296, high-density lipoprotein (HDL) 35 mg/dl, ratio of cholesterol to HDL 5.1; anti-beta-2 glycoprotein I antibodies, anticardiolipin (immunoglobin G and M), activated partial thromboplastin time, Venereal Disease Research Laboratory, Factor V Leiden, activated protein C and S tests were all negative.
An urgent neuroimaging protocol for stroke including magnetic resonance imaging (MRI) and magnetic resonance image angiography (angio-MRI) was carried out. Axial and coronal trace diffusion-weighted images obtained 20 hours after the onset of symptoms showed bilateral areas of high signal intensity compatible with thalamic infarcts restricted to both paramedian thalamic territories and right periaqueductal gray matter (Figure ). The posterior circulation was patent on the angio-MRI, including the tip of the basilar artery and both posterior cerebral arteries. Further evaluation with an aim of defining the etiology of the stroke revealed a patent foramen ovale on transesophageal echocardiography with spontaneous passage of contrast bubbles from the right auricle to the left cavities. Clot formation was found in the wall of the right auricle.
The state of consciousness spontaneously resolved during the third week after the ictus, although fluctuant periods of somnolence and obtundation continued. Administration of modafinil (100 mg twice a day) markedly improved his state of alertness, evidencing important neuropsychologic impairment with hyperphagia, anosognosia and emotional lability with depressive symptoms. There was improvement in the right third cranial nerve function with adequate eye opening and orthophoric condition, although bilateral limitation in vertical gaze movement was persistent. The patient was discharged after two weeks of hospitalization and was being followed up by our outpatient clinic at the time of writing. He began medical treatment with oral anticoagulation and was referred to a national cardiology center for treatment of his congenital cardiopathy. No other embolic events have occurred while there is a pending procedure of percutaneous closure using an Amplatzer device.",What is the patient's LDL cholestrol concentration? Please outuput your answer in terms of mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'high-density lipoprotein cholesterol': [35.0, 'mg/dL'], 'Triglycerides': [296.0, 'mg/dL'], 'Total cholesterol': [177.0, 'mg/dL']}",82.8,78.66,86.94,"To compute the patient's LDL cholestrol, apply the following formula: LDL cholesterol = total cholesterol - HDL - (triglycerides / 5), where the units for total cholestrol, HDL cholesterol, and triglycerides are all mg/dL.
The concentration of total cholesterol is 177.0 mg/dL. 
The concentration of hdl cholesterol is 35.0 mg/dL. 
The concentration of triglycerides is 296.0 mg/dL. 
Plugging in these values will give us 177.0 mg/dL - 35.0 mg/dL - (296.0/5) mg/dL = 82.8 mg/dL.
The patients concentration of LDL cholestrol is 82.8 mg/dL."
549,44,LDL Calculated,lab test,decimal,pmc-3800306-1,Extracted,"A 32-year-old non-smoker, hypertensive male presented with angina on efforts of 2 months duration. A clinical examination was unremarkable. Electrocardiogram showed left ventricular hypertrophy without any ST and T changes. 2-D echocardiography showed no regional wall abnormality, left ventricular ejection fraction 0.60, and a concentric left ventricular hypertrophy. Exercise treadmill test with Bruce protocol showed a significant down-sloping ST depression in leads III, aVF, and V4-V6, at 10 Metabolic Equivalent of Task (METS) of exercise. An exercise stress thallium-201 single photon emission computed tomography (SPECT) showed reversible perfusion defect in septum of left ventricle []. His routine blood biochemistry was normal. Fasting lipid levels were-total cholesterol 145 mg/dL, high-density lipoprotein 37 mg/dL, and triglycerides 95 mg/dL. A coronary angiography revealed myocardial bridging of mid part of LAD [Figures and ]. Left circumflex and right coronary arteries were normal. He was put on atenolol 50 mg/day and had a favorable clinical outcome and continues to be followed.",What is the patient's LDL cholestrol concentration? Please outuput your answer in terms of mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'high-density lipoprotein cholesterol': [37.0, 'mg/dL'], 'Triglycerides': [95.0, 'mg/dL'], 'Total cholesterol': [145.0, 'mg/dL']}",89,84.55,93.45,"To compute the patient's LDL cholestrol, apply the following formula: LDL cholesterol = total cholesterol - HDL - (triglycerides / 5), where the units for total cholestrol, HDL cholesterol, and triglycerides are all mg/dL.
The concentration of total cholesterol is 145.0 mg/dL. 
The concentration of hdl cholesterol is 37.0 mg/dL. 
The concentration of triglycerides is 95.0 mg/dL. 
Plugging in these values will give us 145.0 mg/dL - 37.0 mg/dL - (95.0/5) mg/dL = 89.0 mg/dL.
The patients concentration of LDL cholestrol is 89.0 mg/dL."
550,44,LDL Calculated,lab test,decimal,pmc-6150762-1,Extracted,"A 24-year-old male presented with severe throbbing pain extending from the distal half of his left thigh to his left foot. The pain initially began four years prior, was mild, and was triggered by walking one-half to one mile. The pain progressed and is now triggered by walking one block and relieved by several minutes of rest. He delayed medical evaluation, because he believed he was having muscle cramps. He denied any history of chest pain, palpitations, shortness of breath, lower extremity swelling, skin discoloration, trauma, or prenatal/birth complications. He had no personal or family history of hypertension, hyperlipidemia, diabetes mellitus, deep vein thrombosis, hypercoagulability, malignant neoplasms, or autoimmune disorders. The family history was also negative for PAD and myocardial infarction. He was taking no medications at the time of evaluation. He does not consume alcohol and has never smoked cigarettes or used illicit drugs.
Physical examination revealed a heart rate of 72 beats per minute, left brachial blood pressure of 114/74 mmHg, and body mass index of 25.1 kg/m2. Lower extremities showed no pigment changes, edema, tenderness, and had full range of motion. The right femoral, popliteal, and posterior tibial pulses were palpable 2+. The left femoral artery was palpable 1+. The left popliteal, posterior tibial, and bilateral dorsalis pedis pulses were nonpalpable. The left popliteal and posterior tibial arteries had a weak, biphasic Doppler signal and the bilateral dorsalis pedis arteries had no appreciable Doppler signal. No carotid or abdominal bruits were noted, and the remainder of the physical exam was unremarkable. Laboratory values were within the normal range: total cholesterol 161 mg/dL, high-density lipoprotein 58 mg/dL, triglycerides 52 mg/dL, hemoglobin (Hb) 16.1 g/dL, platelet 218,000/uL, creatinine 0.79 mg/dL, glucose 80 mg/dL, HbA1c 5.2%, prothrombin time 12.8 seconds, and international normalized ratio 1.0. Left ABI was 0.76 at rest and 0.40 after five minutes of exercise. Arterial duplex demonstrated biphasic waveforms from the left common and profunda femoris arteries with no stenosis. The left superficial femoral artery had bi/monophasic waveforms with >75% stenosis at the proximal thigh. The popliteal and tibial arteries had bi/monophasic flow without stenosis. A computed tomography (CT) angiogram with contrast and bilateral lower extremity runoff demonstrated normal arteries of the abdomen and right lower extremity (Figure -C). The left common femoral artery was significantly smaller than the right but otherwise normal. The left proximal to mid superficial femoral artery was severely diseased with extensive calcifications causing near-complete occlusion with distal reconstitution (Figure -C). The left proximal profunda femoris artery was completely occluded with lack of flow for the first 45 mm with distal reconstitution (Figure -F). The left popliteal, tibial, peroneal, and dorsalis pedis arteries were normal with excellent runoff. There were no signs of embryological abnormalities.
Surgical exploration confirmed that the left common femoral artery was diminutive but soft with a palpable pulse. The origin of the profunda femoris artery was obstructed with a smooth, hard lesion (Figure ), which was removed with local endarterectomy and confirmed by pathology as a calcified plaque. The distal profunda femoris was followed and was found to be extensively full of the calcified plaque with no back bleeding, so a profundaplasty or complete profundal bypass was decided against, and a bovine pericardial patch was placed. Next, the left great saphenous vein was harvested and used for a left femoral to left above-knee popliteal artery bypass. A 2+ palpable pulse was noted in both the graft and the left above-knee popliteal artery. A 1+ weak pulse was noted at the left posterior tibial artery. The patient recovered excellently, beginning to walk in the unit by the next morning, and was discharged later that evening. Doppler on follow-up two weeks later demonstrated continued patency of the bypass graft and improvement in symptoms. His consent was obtained for publication of this report.",What is the patient's LDL cholestrol concentration? Please outuput your answer in terms of mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Total cholesterol': [161.0, 'mg/dL'], 'Triglycerides': [52.0, 'mg/dL'], 'high-density lipoprotein cholesterol': [58.0, 'mg/dL']}",92.6,87.97,97.23,"To compute the patient's LDL cholestrol, apply the following formula: LDL cholesterol = total cholesterol - HDL - (triglycerides / 5), where the units for total cholestrol, HDL cholesterol, and triglycerides are all mg/dL.
The concentration of total cholesterol is 161.0 mg/dL. 
The concentration of hdl cholesterol is 58.0 mg/dL. 
The concentration of triglycerides is 52.0 mg/dL. 
Plugging in these values will give us 161.0 mg/dL - 58.0 mg/dL - (52.0/5) mg/dL = 92.6 mg/dL.
The patients concentration of LDL cholestrol is 92.6 mg/dL."
551,44,LDL Calculated,lab test,decimal,pmc-3744738-1,Extracted,"A 35-year-old woman was transferred to the emergency room with acute onset chest pain radiating to the neck. She was a teacher of mathematics and her symptoms initially developed during a lecture. She had no past medical history of collagen tissue disease or blunt trauma to the chest, was not on any medication and had a family history of hypercholesterolemia. She reported no autoimmune disease, was not pregnant or in the early post-partum period, nor did she take an oral contraceptive pill or report any history of drug abuse. She was also not menstruating at time of admission. Risk factors for coronary artery disease were not found. At presentation, her blood pressure was 116/70 mm Hg and her heart rate was 75 beats/min. Her physical examination results were within normal limits without murmurs, rubs or gallops. There were no manifestations of connective tissue disease and the hematologic, renal parameters were normal. The initial electrocardiogram showed nonspecific T wave inversion in leads III, aVF () and the initial chest X-ray was normal without cardiomegaly or pulmonary edema. Cardiac enzymes were elevated with initial serum troponin T of 0.07 mcg/L (normal <0.014 mcg/L), creatinine kinase (CK) of 138 U/L (normal <215 U/L) and CK-MB of 8.49 mcg/L (normal <3.77 mcg/L). The total cholesterol, triglyceride, and high density lipoprotein-cholesterol results were 162 mg/dL (139-230 mg/dL), 33 mg/dL (48-177 mg/dL), and 64 mg/dL (40-81 mg/dL), respectively. Transthoracic echocardiography demonstrated normal left ventricular systolic function, with an ejection fraction of 73% and no regional wall motion abnormalities. We performed coronary angiography under suspicion of myocardial infarction. The right coronary artery (RCA) and left circumflex artery images were normal, but there was diffuse stenotic lesion of the mid left anterior descending artery (LAD) with up to 80% luminal narrowing. The lesion slightly improved after intracoronary injection of nitroglycerine (). To evaluate the etiology of the stenotic lesion, in terms of spasm, atherosclerosis or other cause, intravascular ultrasound (IVUS, Boston scientific Co., CA, USA) was performed. IVUS showed an isolated dissection flap composed of all of the intima and media, including the internal elastic lamina and external elastic lamina, compressed by hematoma in the false lumen at the bifurcation edge of the mid LAD and diagonal branch. The dissection entry tear site to the false lumen was not detected on angiogram. Furthermore, this site was not clearly detected even on IVUS, and there was no communication between the false and true lumen (). Atherosclerotic change was not detected in this vessel (LAD) on the IVUS. 3.0×28 and 2.5×23 mm sized two Xience Prime stents (Abbott Vascular, Santa Clara, CA, USA) were deployed over the dissection from the distal portion of the mid LAD for preventing any subsequent propagation of the dissection. Subsequent angiography revealed no residual stenosis without secondary dissection and restoration of Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow (). Subsequent IVUS demonstrated a fully covered dissection lesion ().
The patient had a favorable clinical course and was discharged on aspirin, clopidogrel, beta blocker and statin. She remained asymptomatic without any complications at six month follow-up.",What is the patient's LDL cholestrol concentration? Please outuput your answer in terms of mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Total cholesterol': [162.0, 'mg/dL'], 'Triglycerides': [33.0, 'mg/dL'], 'high-density lipoprotein cholesterol': [64.0, 'mg/dL']}",91.4,86.83,95.97,"To compute the patient's LDL cholestrol, apply the following formula: LDL cholesterol = total cholesterol - HDL - (triglycerides / 5), where the units for total cholestrol, HDL cholesterol, and triglycerides are all mg/dL.
The concentration of total cholesterol is 162.0 mg/dL. 
The concentration of hdl cholesterol is 64.0 mg/dL. 
The concentration of triglycerides is 33.0 mg/dL. 
Plugging in these values will give us 162.0 mg/dL - 64.0 mg/dL - (33.0/5) mg/dL = 91.4 mg/dL.
The patients concentration of LDL cholestrol is 91.4 mg/dL."
552,44,LDL Calculated,lab test,decimal,pmc-2770547-1,Extracted,"A previously healthy 3 year old girl presented to our Pediatric Dermatology Clinic in April of 2007 with a 6 month history of a papular skin eruption on the finger nail margins of her hands bilaterally, her scalp, and around the nares (fig ). These symptoms were associated with significant arthralgia affecting her wrists and knees. There were no other associated symptoms. Her family history was negative for lipid disorders, dermatologic conditions, and chronic inflammatory conditions.
The physical examination revealed multiple flesh colored to slightly pink, flat-topped, smooth papules lined up in a row in the periungual skin on every finger of both hands, as well as the margin of the nares, forehead, and scalp. The musculoskeletal examination demonstrated unequivocal polyarthritis. There was swelling, loss of range of motion, and pain with movement in both elbows. There was synovial thickening and pain with flexion in both wrists. There were flexion contractures of the second and third proximal interphalangeal joints of both hands. Effusions and synovial thickening were present in both knees.
Laboratory results showed a normal complete blood count, hepatic profile, renal profile, and lipid profile (cholesterol 128 mg/dL, high density lipoprotein 30 mg/dL, triglycerides 75 mg/dL). Lactate, uric acid, serum sterol, and urine organic acid levels (desmosterol, lathosterol, campesterol and sitosterol) were all within normal limits. ESR and CRP were within normal limits. Serum protein electrophoresis revealed no significant abnormalities. Lyme serology, anti-nuclear antibodies, and rheumatoid factor were negative. PPD was negative.
Bilateral hand X-rays demonstrated mild diffuse osteopenia without periosteal reaction, soft tissue swelling in the digits, most striking at the base of the fingernails and a radiolucency at the base of the left third proximal phalanx. A CT scan of the chest, abdomen and pelvis was unremarkable. CT scan of the neck showed multiple, less than 2 cm lymph nodes. A glenohumeral joint effusion was noted as well.
Skin biopsies were obtained from the nail fold and scalp. The histology sections showed a dome-shape lesion with dermal infiltrate composed of foamy histiocytes and a few admixed lymphocytes (fig ). Multinucleated giant cells and Touton type giant cells were not observed. There was upward migration of cells with clear, foamy, and vacuolated cytoplasm within the overlying epidermis. PAS stains were negative for glycogen deposition and fungal organisms. AFB stains were negative. Immunostaining with CD68 was positive, and CD1a stained only a few intraepidermal and rare dermal cells. Factor XIIIa stained a few scattered cells. These biopsies where read by multiple pathologists as consistent with papular xanthoma. Additional biopsies of synovium and additional skin nodule both showed foamy histiocytes with scattered lymphocytes arranged in sheets. Cytoplasm ranged from clear to bubbly to finely granular. CD68 and lysozyme stained strongly positive in histiocytes. Formal evaluation of the patient by an ophthalmologist, oncologist, and metabolic specialist revealed no additional findings.
The child was diagnosed with MRH based on her clinical presentation, even though histopathology was not classic for this disorder, and followed in pediatric rheumatology clinic. She was started on naproxen without major improvement in the joint complaints; methotrexate was then added at a dose of 5 mg (0.4 mg/kg) by mouth once a week and later increased to 7.5 mg (0.6 mg/kg) subcutaneously once a week without major improvement. Hydroxychloroquine 75 mg (6.25 mg/kg) by mouth per day was added. Subcutaneous nodules of about 2 × 1 × 2 cm were noted on the upper portion her arms bilaterally in the region of the axilla and diagnosed as synovial cysts by ultrasound. X ray of the shoulders revealed subtendinous erosion of bone in the humerus and distal clavicle remodeling (fig ). Oral prednisone 1.7 mg/kg/day was started, and there was almost complete resolution of the xanthomatous lesions and moderate improvement in her arthritis. Prednisone was tapered to 1 mg/kg.
However, she continued to have multiple joint effusions and decreased range of motion in her PIP joints. Therefore, etanercept was added at a dose of 20 mg (1.25 mg/kg) subcutaneously every week. Methotrexate was increased to 12.5 mg (0.8 mg/kg). She had a partial initial response to etanercept with some improvement in the range of motion of her MCP's and wrists. However, after 3 months on etanercept, the patient had significant ongoing polyarthritis, so the etanercept dose was increased to 25 mg (1.5 mg/kg), and methotrexate was increased to 15 mg (0.9 mg/kg). As her prednisone was tapered very slowly, a few tiny xanthomatous lesions reappeared. Due to worsening polyarthritis, etanercept was discontinued, and infliximab was started at a dose of 10 mg/kg intravenously. After 2 infusions given 2 weeks apart, the patient was noted to have improvement with resolution of multiple joint effusions and improved range of motion. In addition, all xanthomas disappeared. The infliximab infusions were continued every 4 weeks. Methotrexate was continued at 0.9 mg/kg subcutaneously per week. Prednisone was tapered further, but patient developed recurrent polyarthritis and new xanthomas over her fingers. Unfortunately, her synovitis did not improve further when infliximab was increased to 20 mg/kg.",What is the patient's LDL cholestrol concentration? Please outuput your answer in terms of mg/dL. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'high-density lipoprotein cholesterol': [30.0, 'mg/dL'], 'Triglycerides': [75.0, 'mg/dL'], 'Total cholesterol': [128.0, 'mg/dL']}",83,78.85,87.15,"To compute the patient's LDL cholestrol, apply the following formula: LDL cholesterol = total cholesterol - HDL - (triglycerides / 5), where the units for total cholestrol, HDL cholesterol, and triglycerides are all mg/dL.
The concentration of total cholesterol is 128.0 mg/dL. 
The concentration of hdl cholesterol is 30.0 mg/dL. 
The concentration of triglycerides is 75.0 mg/dL. 
Plugging in these values will give us 128.0 mg/dL - 30.0 mg/dL - (75.0/5) mg/dL = 83.0 mg/dL.
The patients concentration of LDL cholestrol is 83.0 mg/dL."
553,46,Framingham Risk Score for Hard Coronary Heart Disease,lab test,decimal,pmc-7871576-1,Extracted,"A 54-year-old, overweight (BMI 29), Caucasian man with a history of tobacco smoking and gastroesophageal reflux presented to the emergency department with chest pain. He described it as sudden in onset, while he was working on his laptop. Location was substernal, radiating to his left arm and jaw. Initially, the pain was 7/10 in intensity but it improved spontaneously even before he reached the hospital or received any medications. On further probing, he reported that he had experienced intermittent episodes of chest pain for the last 3 weeks but it was mostly exertional and was relieved with rest. The pain was not associated with shortness of breath, diaphoresis, or nausea/vomiting. He denied any fever, chills, cough, abdominal pain, urinary or bowel complaints. He did not have any family history of significant cardiac events.
On presentation, the patient was hemodynamically stable with a blood pressure of 139/85 mmHg and heart rate of 81 beats per minute. His EKG did not show any ischemic changes, no left ventricular hypertrophy, or left bundle branch block. Three sets of serial troponin enzyme were less than 0.010. Lipid panel showed total cholesterol of 235, triglycerides 408, HDL 26, and LDL could not be calculated. His pretest probability of CAD was intermediate on the basis of age and sex. Since the patient was chest pain free since admission and was able to exercise, an exercise treadmill EKG stress test was ordered. The patient achieved 95% of maximum predicted heart rate and 10 METs of exercise with normalization of slight T wave inversions that were seen in leads V2, V3, and V4 at rest. Thus, it was read as maximum asymptomatic stress test with intermediate probability of ischemia. Echocardiogram was obtained which showed normal left ventricular function and no significant valvular or wall motion abnormalities. At this point, cardiology was consulted to evaluate the patient and they recommended coronary computed tomography angiography (CCTA) for further risk stratification.
CCTA results showed approximate 70% stenosis of the origin of the left anterior descending artery (LAD) secondary to noncalcified plaque extending over a length of approximately 4 mm (Fig. ), approximate 40–50% stenosis of the proximal ramus intermedius branch secondary to mixed calcified and noncalcified plaque and scattered calcified and noncalcified plaque along the circumflex and obtuse marginal branches with 30–40% luminal diameter stenosis. Fractional flow reserve–computed tomography (FFR-CT) revealed a high likelihood of flow-limiting stenosis with a value of less than 0.5 secondary to the significant stenosis at the origin of the LAD and a low likelihood of flow-limiting stenosis in the left circumflex, ramus intermedius, and right coronary arteries.
The patient was then taken for cardiac catheterization which showed a 95% stenotic lesion of LAD with partial perfusion (TIMI grade 2 flow) giving rise to diagonal 1, which has an ostial and proximal 70% stenosis; ramus intermedius with proximal 70% segmental stenosis; circumflex, nondominant vessel, which has mild disease in proximal distal segments, giving rise to obtuse marginal 1, which has proximal 70% stenosis. Cardiothoracic surgery was consulted and the patient underwent bypass graft surgery.
The patient did well after the surgery. He stayed in the hospital for 4 days post-op without any complaints and was discharged home in stable condition. A referral to home care was made to provide for monitoring of the patient's progress and detection of any complications during the immediate post-op period. Cardiac rehabilitation referral was also provided and the patient was instructed to follow up with a cardiologist and cardiothoracic surgeon.","Based on the Framingham Risk Score for Hard Coronary Heart Disease, what is the likelihood of 10-year risk of MI or death for this patient? Please return your answer as a percentage value. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'age': [54, 'years'], 'Systolic Blood Pressure': [139.0, 'mm hg'], 'Smoker': True, 'Total cholesterol': [235.0, 'mg/dL'], 'high-density lipoprotein cholesterol': [26.0, 'mg/dL'], 'Blood pressure being treated with medicines': False}",29.023,27.57185,30.47415,"For males, the formula for computing the Framingham Risk Score is:
52.00961 * ln(age) + 20.014077 * ln(total_cholesterol) + -0.905964 * ln(hdl_cholesterol) + 1.305784 * ln(sys_bp) + 0.241549 * bp_medicine + 12.096316 * smoker + -4.605038 * ln(age) * ln(total_cholesterol) + -2.84367 * ln(age_smoke) * smoker + -2.93323 * ln(age) * ln(age) - 172.300168.
The patient's age is capped at 70 for the ln(age_smoke) * smoker term if greater than 70. The 10-year risk percentage is calculated as: [1 - 0.9402^exp(risk_score)] * 100.
For females, the formula for computing the Framingham Risk Score is:
31.764001 * ln(age) + 22.465206 * ln(total_cholesterol) + -1.187731 * ln(hdl_cholesterol) + 2.552905 * ln(sys_bp) + 0.420251 * bp_medicine + 13.07543 * smoker + -5.060998 * ln(age) * ln(total_cholesterol) + -2.996945 * ln(age_smoke) * smoker - 146.5933061.
The patient's age is capped at 78 for the ln(age_smoke) * smoker term if greater than 78. The 10-year risk percentage is calculated as: [1 - 0.98767^exp(risk_score)] * 100.
The patient's gender is Male.
The patient is 54 years old. The patient's age is 54, and the adjusted age for smoking-related terms is 54.
The patient is a smoker, so the smoker variable is 1.
The patient is not on medication for blood pressure, so the bp_medicine variable is 0.
The concentration of 386.654 is 235.0 mg/dL. The concentration of hdl cholesterol is 26.0 mg/dL. The patient's systolic blood pressure is 139.0 mm Hg.
Plugging in the values into the risk score formula, we get 52.00961 * ln(54) + 20.014077 * ln(235.0) + -0.905964 * ln(26.0) + 1.305784 * ln(139.0) + 0.241549 * 0 + 12.096316 * 1 + -4.605038 * ln(54) * ln(235.0) + -2.84367 * ln(54) * 1 + -2.93323 * ln(54) * ln(54) - 172.300168 = 1.716.
To obtain the 10-year risk percentage, we plug this into the formula as: [1 - 0.9402^exp(risk_score)] * 100 = 29.023439337549583.
Hence, the patient's 10-year risk percentage of MI or death is 29.023%."
554,46,Framingham Risk Score for Hard Coronary Heart Disease,lab test,decimal,pmc-8279282-1,Extracted,"A 49-year-old male presented to the emergency room with expressive aphasia and right facial droop noticed by his wife. His last known normal neurological status was 1 h prior to arrival to the hospital. He had also been experiencing cough, shortness of breath, diarrhea and abdominal pains for about 3 weeks. He had gone to a different emergency room 1 week ago and was diagnosed with an upper respiratory tract infection and was advised over the counter cough medicine after obtaining a chest X-ray that was normal. His past medical history included possible hypertension for which he was on medication at one point, but currently off medication. He is a non-smoker. His blood pressure was 131/86 mm Hg, heart rate was 120 beats per minute, temperature was 36.4 °C, respiratory rate of 15 breaths per minute, and pulse oxygenation was 99% on room air. His neurological examination was consistent with expressive aphasia with right sided facial weakness. His sensation and motor function was intact in all four extremities with no ataxia. His other physical examination was unremarkable. His lab work () including complete blood count and comprehensive metabolic panel were normal except for a creatinine of 1.58 mg/dL (normal: 0.61 - 1.24 mg/dL). His international normalized ratio (INR) was 1.18 (normal: 0.88 - 1.15), partial thromboplastin time (PTT) was 27 s (normal: 26 - 39 s), D-dimer was 1,221 ng/mL (normal: < 500 ng/mL). His hemoglobin A1c was 5.8% (normal: < 5.7%), total cholesterol was 191 mg/dL (normal: < 200 mg/dL), triglycerides were 242 mg/dL (normal: 0 - 150 mg/dL), high-density lipoprotein (HDL) was 25 mg/dL (normal: 39 - 79 mg/dL), and low-density lipoprotein (LDL) was 107 mg/dL (normal: < 100 mg/dL).
In the emergency room, he received 325 mg of aspirin, and was assessed by a code stroke team. He was not recommended tissue plasminogen activator (tpA) by the tele-neurologist as he had inconsistent symptoms. His chest X-ray was normal, carotid ultrasound showed no stenosis, and computed tomography of the head showed subtle area of diminished attenuation in the right cerebellar hemisphere and left frontoparietal lobe for which a subtle area of infarction could not be excluded. Magnetic resonance imaging (MRI) of the brain completed the following day revealed acute to subacute infarcts in the right cerebellum and left and right frontoparietal cortical regions. He was started on aspirin 81 mg daily and atorvastatin 40 mg daily.
He was also tested for COVID-19 and his test result came back with a positive SARS-CoV-2 PCR. He was started on azithromycin, zinc, and vitamin C. He had an echocardiogram of the heart which revealed an ejection fraction of 26-30% (normal: 55-60%) with abnormal left ventricular diastolic function, mildly increased left ventricular wall thickness, mild mitral regurgitation, and moderate global hypokinesis. A cardiologist evaluated him and deemed that he needed to have a transesophageal echocardiogram and left heart catheterization to determine the etiology of the newly diagnosed cardiomyopathy once he is recovered from his acute ischemic event and COVID-19.
On hospital day 4, he was found to have new global aphasia and left upper extremity weakness. He received a stat computed tomography of the brain (), which revealed a new right middle cerebral artery (MCA) infarction involving the right frontoparietal lobe and insular cortex. At that point, he was loaded with 600 mg of clopidogrel and transferred to the neuro-intensive care unit. It was decided that since he failed antiplatelet therapy, that the antiplatelet medications aspirin and clopidogrel would be stopped and full-dose anticoagulation was commenced with enoxaparin.
He had hypercoagulability testing done, including antithrombin III, homocysteine, antinuclear antibody, beta-2-glycoprotein, cryoglobulin, and functional protein C, all of which were negative. He did have further testing of lupus anticoagulant which was positive; however, this test was not reliable as he had it done after being started on anticoagulation, which invalidates the reliability of the result.
For his cardiomyopathy, he was placed on a beta-blocker, angiotensin receptor blocker, and a diuretic. He had workup done for non-ischemic cardiomyopathy including human immunodeficiency virus (HIV), thyroid function tests, hepatitis serologies, and ferritin levels which were all within normal limits except for slightly elevated ferritin of 523 ng/mL (normal: 24 - 336 ng/mL), which was not high enough to cause cardiomyopathy. He remained in normal sinus rhythm throughout the hospital stay. He was advised to have repeat echocardiogram done on an outpatient basis along with ischemic workup including left heart catheterization.
He recovered from the symptoms of COVID-19 including shortness of breath and cough and on the day of discharge, he was saturating 98% on room air and was stable from a pulmonary standpoint.
His hospital course was further complicated by dysphagia requiring a gastric feeding tube, healthcare-associated pneumonia, and staphylococcus bacteremia requiring prolonged antibiotics. He was discharged on the novel oral anticoagulant apixaban and advised repeat hypercoagulability testing in 3 months. He went to a rehabilitation center.","Based on the Framingham Risk Score for Hard Coronary Heart Disease, what is the likelihood of 10-year risk of MI or death for this patient? Please return your answer as a percentage value. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'high-density lipoprotein cholesterol': [25.0, 'mg/dL'], 'sex': 'Male', 'Systolic Blood Pressure': [131.0, 'mm hg'], 'Total cholesterol': [191.0, 'mg/dL'], 'Smoker': False, 'age': [49, 'years'], 'Blood pressure being treated with medicines': False}",6.732,6.3954,7.0686,"For males, the formula for computing the Framingham Risk Score is:
52.00961 * ln(age) + 20.014077 * ln(total_cholesterol) + -0.905964 * ln(hdl_cholesterol) + 1.305784 * ln(sys_bp) + 0.241549 * bp_medicine + 12.096316 * smoker + -4.605038 * ln(age) * ln(total_cholesterol) + -2.84367 * ln(age_smoke) * smoker + -2.93323 * ln(age) * ln(age) - 172.300168.
The patient's age is capped at 70 for the ln(age_smoke) * smoker term if greater than 70. The 10-year risk percentage is calculated as: [1 - 0.9402^exp(risk_score)] * 100.
For females, the formula for computing the Framingham Risk Score is:
31.764001 * ln(age) + 22.465206 * ln(total_cholesterol) + -1.187731 * ln(hdl_cholesterol) + 2.552905 * ln(sys_bp) + 0.420251 * bp_medicine + 13.07543 * smoker + -5.060998 * ln(age) * ln(total_cholesterol) + -2.996945 * ln(age_smoke) * smoker - 146.5933061.
The patient's age is capped at 78 for the ln(age_smoke) * smoker term if greater than 78. The 10-year risk percentage is calculated as: [1 - 0.98767^exp(risk_score)] * 100.
The patient's gender is Male.
The patient is 49 years old. The patient's age is 49, and the adjusted age for smoking-related terms is 49.
The patient is not a smoker, so the smoker variable is 0.
The patient is not on medication for blood pressure, so the bp_medicine variable is 0.
The concentration of 386.654 is 191.0 mg/dL. The concentration of hdl cholesterol is 25.0 mg/dL. The patient's systolic blood pressure is 131.0 mm Hg.
Plugging in the values into the risk score formula, we get 52.00961 * ln(49) + 20.014077 * ln(191.0) + -0.905964 * ln(25.0) + 1.305784 * ln(131.0) + 0.241549 * 0 + 12.096316 * 0 + -4.605038 * ln(49) * ln(191.0) + -2.84367 * ln(49) * 0 + -2.93323 * ln(49) * ln(49) - 172.300168 = 0.122.
To obtain the 10-year risk percentage, we plug this into the formula as: [1 - 0.9402^exp(risk_score)] * 100 = 6.732116762077456.
Hence, the patient's 10-year risk percentage of MI or death is 6.732%."
555,46,Framingham Risk Score for Hard Coronary Heart Disease,lab test,decimal,pmc-8583680-1,Extracted,"Case 1 is a 47-year-old male who recalls gradually worsening illness starting around the age of 25 that he partially attributes to poor food choices and opioid use. His current laboratory values as of 20 May 2021 include a total cholesterol of 103 mg/dL, HDL cholesterol 36 mg/dL, triglycerides 61 mg/dL, non-HDL cholesterol 67 mg/dL, and blood pressure 122/78. Post lifestyle change, he also notes significant improvement in his level of happiness and quality of life, specifically with respect to being able to enjoy time with his family, traveling, and gaining a new outlook on life.
Aside from the possibility of gastric bypass surgery (USD 18,000–35,000) [], Case 1 was a candidate for a Continuous Positive Airway Pressure (CPAP) machine for obstructive sleep apnea (USD 1000–3000) [] and a Transcutaneous Electrical Nerve Stimulator (TENS) machine for pain management (approximately USD 100–500) [] prior to his lifestyle change, highlighting an approximate average savings of USD 28,800 in discreet medical costs potentially avoided. Post lifestyle change, he reports spending only USD 61 per year on medications (B12 injections), as opposed to his previous approximated average spending of USD 7600+ in annual medication costs. Pharmaceutical costs covered by his insurance company decreased from USD 19,000+ in 2009 to USD 122.24 in 2015 and 2016 combined. In addition, his grocery costs are approximately half of what they were prior to his lifestyle change.","Based on the Framingham Risk Score for Hard Coronary Heart Disease, what is the likelihood of 10-year risk of MI or death for this patient? Please return your answer as a percentage value. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'high-density lipoprotein cholesterol': [36.0, 'mg/dL'], 'sex': 'Male', 'Total cholesterol': [103.0, 'mg/dL'], 'age': [47, 'years'], 'Blood pressure being treated with medicines': False, 'Systolic Blood Pressure': [122, 'mm Hg']}",0.896,0.8512,0.9408,"For males, the formula for computing the Framingham Risk Score is:
52.00961 * ln(age) + 20.014077 * ln(total_cholesterol) + -0.905964 * ln(hdl_cholesterol) + 1.305784 * ln(sys_bp) + 0.241549 * bp_medicine + 12.096316 * smoker + -4.605038 * ln(age) * ln(total_cholesterol) + -2.84367 * ln(age_smoke) * smoker + -2.93323 * ln(age) * ln(age) - 172.300168.
The patient's age is capped at 70 for the ln(age_smoke) * smoker term if greater than 70. The 10-year risk percentage is calculated as: [1 - 0.9402^exp(risk_score)] * 100.
For females, the formula for computing the Framingham Risk Score is:
31.764001 * ln(age) + 22.465206 * ln(total_cholesterol) + -1.187731 * ln(hdl_cholesterol) + 2.552905 * ln(sys_bp) + 0.420251 * bp_medicine + 13.07543 * smoker + -5.060998 * ln(age) * ln(total_cholesterol) + -2.996945 * ln(age_smoke) * smoker - 146.5933061.
The patient's age is capped at 78 for the ln(age_smoke) * smoker term if greater than 78. The 10-year risk percentage is calculated as: [1 - 0.98767^exp(risk_score)] * 100.
The patient's gender is Male.
The patient is 47 years old. The patient's age is 47, and the adjusted age for smoking-related terms is 47.
The patient's smoking status is not provided, so the smoker variable is set to 0.
The patient is not on medication for blood pressure, so the bp_medicine variable is 0.
The concentration of 386.654 is 103.0 mg/dL. The concentration of hdl cholesterol is 36.0 mg/dL. The patient's systolic blood pressure is 122 mm Hg.
Plugging in the values into the risk score formula, we get 52.00961 * ln(47) + 20.014077 * ln(103.0) + -0.905964 * ln(36.0) + 1.305784 * ln(122) + 0.241549 * 0 + 12.096316 * 0 + -4.605038 * ln(47) * ln(103.0) + -2.84367 * ln(47) * 0 + -2.93323 * ln(47) * ln(47) - 172.300168 = -1.924.
To obtain the 10-year risk percentage, we plug this into the formula as: [1 - 0.9402^exp(risk_score)] * 100 = 0.8959853138689633.
Hence, the patient's 10-year risk percentage of MI or death is 0.896%."
556,46,Framingham Risk Score for Hard Coronary Heart Disease,lab test,decimal,pmc-3651988-1,Extracted,"A previously healthy, 39-year-old woman was admitted to our hospital with generalized edema lasting 1 month and with sudden-onset pain in her right lower leg, particularly when walking. On admission, her general appearance was acutely ill and generally edematous. A physical examination revealed that her blood pressure was 120/80 mmHg, her heart rate was 90/min, her respiratory rate was 22/min, and her body temperature was 36.5℃. Her breathing sounds were clear, and her heartbeat was regular without murmur. A subsequent examination of her lower limbs showed asymmetric bilateral pretibial pitting edema predominantly in the left lower limb. In contrast, the right lower limb was less edematous and had very weak popliteal and pedal pulses. Delayed capillary refilling was also found in the right toes. The Homan's sign was negative.
Serum laboratory findings at admission were as follows: white blood cell count of 5,300/mm3, hematocrit of 39.5% with hemoglobin of 13.1 g/dl, and platelet count of 286,000/mm3. The serum sodium concentration was 141 mEq/L, the potassium concentration was 4.1 mEq/L, the chloride concentration was 104 mEq/L, and total CO2 was 28 mEq/L. The blood urea nitrogen concentration was 12.1 mg/dl, the creatinine concentration was 0.86 mg/dl, the serum total protein concentration was 4.3 g/dl, the albumin concentration was 2.2 g/dl, the total cholesterol concentration was 349.4 mg/dl, the low-density lipoprotein cholesterol concentration was 214.4 mg/dl, the high-density lipoprotein cholesterol concentration was 111 mg/dl, and the triglyceride concentration was 120.1 mg/dl. The results of liver function tests were normal. The coagulation profile showed an activated partial thromboplastin time of 32.0 s, prothrombin time of 9.7 s, anti-thrombin III value of 82% (70-120%), protein C activity of 143% (70-130%), and protein S activity of 65% (58.7-119.2%). The anti-nuclear antibody titer was less than 1:40, the anti-double-stranded DNA titer was 30.9 IU/ml, the C3 level was 158 mg/dl, and the C4 level was 19 mg/dl. Anti-cardiolipin immunoglobulin G, anti-cardiolipin immunoglobulin M, and lupus anticoagulant were all negative. Urinalysis revealed 3+ proteinuria (spot urine protein-to-creatinine ratio was 10.9 g/g creatinine; spot urine albumin-to-creatinine ratio was 7,406.2 mg/g creatinine) and trace hematuria (1-3 red blood cells/high-power field). To investigate the etiology of nephrotic syndrome, an urgent renal biopsy was performed.
Thereafter, although she had no risk factors for thrombosis such as immobilization, heart failure, atrial fibrillation, morbid obesity, or a recent orthopedic or gynecologic surgery, to rule out arterial thrombosis of the right lower extremity, lower extremity computed tomography (CT) angiography was performed. The CT imaging revealed that the right superficial femoral artery was occluded and there was no identifiable proximal source of thromboembolism in other large arteries (). On the basis of these CT angiographic findings, right lower extremity angiography was performed, which revealed a total occlusion of the right superficial femoral artery (). For the treatment of this condition, balloon dilatation was initially tried at the distal superficial femoral artery but failed. Hence, thrombectomy was performed with the Fogarty balloon catheter and the thrombi were successfully aspirated. After the interventional treatment, a good distal arterial flow was reestablished (). Thereafter, warfarin (5 mg/day) as an anticoagulant and corticosteroid treatments were initiated.
Subsequent transthoracic and transesophageal echocardiographic studies showed no evidence of intracardiac thrombus, vegetation, or other structural abnormalities including patent foramen ovale. Quantitation of proteinuria was confirmed by using a 24-hour urine collection that showed 10.2 g/day of protein excretion and 7.8 g/day of albumin excretion, respectively. Afterwards, with administration of warfarin and corticosteroid, the patient had nearly completely recovered from the edema and claudication and was discharged. The renal pathologic results were consistent with minimal change disease ( and ). Two months after discharge, her urine protein-to-creatinine ratio decreased to less than 0.1 g/g creatinine, her serum albumin level was maintained at 4.1 g/dl, and she had no further symptoms or signs of arterial thrombosis.","Based on the Framingham Risk Score for Hard Coronary Heart Disease, what is the likelihood of 10-year risk of MI or death for this patient? Please return your answer as a percentage value. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'age': [39, 'years'], 'Systolic Blood Pressure': [120.0, 'mm hg'], 'Smoker': False, 'Total cholesterol': [349.4, 'mg/dL'], 'high-density lipoprotein cholesterol': [111.0, 'mg/dL']}",0.668,0.6346,0.7014,"For males, the formula for computing the Framingham Risk Score is:
52.00961 * ln(age) + 20.014077 * ln(total_cholesterol) + -0.905964 * ln(hdl_cholesterol) + 1.305784 * ln(sys_bp) + 0.241549 * bp_medicine + 12.096316 * smoker + -4.605038 * ln(age) * ln(total_cholesterol) + -2.84367 * ln(age_smoke) * smoker + -2.93323 * ln(age) * ln(age) - 172.300168.
The patient's age is capped at 70 for the ln(age_smoke) * smoker term if greater than 70. The 10-year risk percentage is calculated as: [1 - 0.9402^exp(risk_score)] * 100.
For females, the formula for computing the Framingham Risk Score is:
31.764001 * ln(age) + 22.465206 * ln(total_cholesterol) + -1.187731 * ln(hdl_cholesterol) + 2.552905 * ln(sys_bp) + 0.420251 * bp_medicine + 13.07543 * smoker + -5.060998 * ln(age) * ln(total_cholesterol) + -2.996945 * ln(age_smoke) * smoker - 146.5933061.
The patient's age is capped at 78 for the ln(age_smoke) * smoker term if greater than 78. The 10-year risk percentage is calculated as: [1 - 0.98767^exp(risk_score)] * 100.
The patient's gender is Female.
The patient is 39 years old. The patient's age is 39, and the adjusted age for smoking-related terms is 39.
The patient is not a smoker, so the smoker variable is 0.
The information for whether the patient is taking medicine for blood pressure is not provided, so the bp_medicine variable is set to 0.
The concentration of 386.654 is 349.4 mg/dL. The concentration of hdl cholesterol is 111.0 mg/dL. The patient's systolic blood pressure is 120.0 mm Hg.
Plugging in the values into the risk score formula, we get 31.764001 * ln(39) + 22.465206 * ln(349.4) + -1.187731 * ln(111.0) + 2.552905 * ln(120.0) + 0.420251 * 0 + 13.07543 * 0 + -5.060998 * ln(39) * ln(349.4) + -2.996945 * ln(39) * 0 - 146.5933061 = -0.616.
To obtain the 10-year risk percentage, we plug this into the formula as: [1 - 0.98767^exp(risk_score)] * 100 = 0.6677108871927628.
Hence, the patient's 10-year risk percentage of MI or death is 0.668%."
557,46,Framingham Risk Score for Hard Coronary Heart Disease,lab test,decimal,pmc-3313753-1,Extracted,"Mrs. P. G., a 67-year-old housewife, got admitted to the hospital with a history of memory impairment, confusion, lethargy, generalized weakness and gait imbalance of 2 weeks duration. She did not give any history of fall or head injury. There was no history of fever, headache, cough, urinary symptoms or any focal weakness. She was hypertensive for last 20 years, which was well under control with Amlodipine (5 mg/day). Her part history revealed that she had undergone total right hip replacement 1 year back and had regular follow-up checkups with the orthopedic surgeon.
On examination, the patient was conscious and co- operative, oriented, but with cognitive impairment and some irrelevant talk and could not recollect recent events.
The other findings were as follows: BP 170/100, a febrile pulse 100/mt, RR 20/mt, chest clear. Cardiovascular examination did not reveal any abnormality. Abdomen showed no hepatosplenomegaly. Central nervous system (CNS) examination showed that there was generalized muscle weakness without any focal deficit. Jerks were normal. Planters were down.
MRI brain showed age-related diffuse cerebral cortical atrophy. There was no infarction or space-occupying lesion.
The laboratory investigations revealed the following results: Hb 11.7 g/dl, total count 10,900, poly 68%, lymphocytes 27%, monocytes 3%, eosinophils 2%, erythrocyte sedimentation rate (ESR) 18 mm/1 hour, urine R/E NAD, urea 42 mg/dl, creatinine 1.9 mg/dl, Na 140 mEq/l, potassium 3.5 mEq/l, FT4 1.38 ng/dl, thyroid stimulating hormone (TSH) 0.80 mIU/l, cholesterol 167 mg/dl, low density lipoprotein (LDL) 96 mg/dl, high density lipoprotein cholesterol (HDL-C) 40 mg/dl, triglyceride (TG) 154 mg/ dl, serum bilirubin 0.93 mg/dl, albumin 3.2 g/ dl, globulin 5.0 g/dl, alanine transaminase (ALT) 68 IU/l, aspartate transaminase (AST) 48 IU/l. Cerebrospinal fluid (CSF) study revealed normal results (glucose 100 mg/dl, protein 33.1 mg/dl); serum calcium level was 14.0 mg/dl and magnesium level was 1.7 mg/dl.
Electrocardiogram (ECG) showed bifasicular block. Echocardiography revealed concentric left ventricular hypertrophy. Ultrasound of the abdomen was normal. High-resolution computed tomography (HRCT) chest was essentially normal
On the 7th day of admission, repeat serum calcium revealed a level of 13.2 mg/dl. Parathormone (PTH) was 14.8 pg/ ml and vitamin D 25(OH) was 254.7 ng/ml.
Mammography results were normal.
Neurological exam and magnetic resonance imaging (MRI) brain ruled out any cerebral lesion. For hypercalcemia, she was investigated for any occult malignancy which was ruled out., She was treated with intravenous fluid, diuretics and glucocorticoid and was improving clinically. On the 7th day, a follow-up prescription from orthopedic surgeon revealed that she received inj. Arachitol 6 lacs IU intramuscularly, every week for the last 4 months On the 9th day of admission, her serum vitamin D 25(OH) was detected to be high and a diagnosis of hypervitaminosis D leading to hypercalcemia was considered. She was improving clinically and her serum calcium came down to normal in the next 2 weeks and was discharged with prescription of antihypertensive and with the advice to take food with no vitamin D and calcium. She continued to have high vitamin D level even after 4 months of discharge [vitamin D 25(OH) 215.52 ng/ml] which came down to normal (66.67 ng/ml) 6 months after discharge from the hospital.
At present, she is completely asymptomatic. A repeat vitamin D 25(OH) after 6 months showed a level of 77.67 ng/ml.","Based on the Framingham Risk Score for Hard Coronary Heart Disease, what is the likelihood of 10-year risk of MI or death for this patient? Please return your answer as a percentage value. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'age': [67, 'years'], 'Systolic Blood Pressure': [170.0, 'mm hg'], 'Smoker': False, 'Total cholesterol': [167.0, 'mg/dL'], 'high-density lipoprotein cholesterol': [40.0, 'mg/dL'], 'Blood pressure being treated with medicines': True}",10.402,9.8819,10.9221,"For males, the formula for computing the Framingham Risk Score is:
52.00961 * ln(age) + 20.014077 * ln(total_cholesterol) + -0.905964 * ln(hdl_cholesterol) + 1.305784 * ln(sys_bp) + 0.241549 * bp_medicine + 12.096316 * smoker + -4.605038 * ln(age) * ln(total_cholesterol) + -2.84367 * ln(age_smoke) * smoker + -2.93323 * ln(age) * ln(age) - 172.300168.
The patient's age is capped at 70 for the ln(age_smoke) * smoker term if greater than 70. The 10-year risk percentage is calculated as: [1 - 0.9402^exp(risk_score)] * 100.
For females, the formula for computing the Framingham Risk Score is:
31.764001 * ln(age) + 22.465206 * ln(total_cholesterol) + -1.187731 * ln(hdl_cholesterol) + 2.552905 * ln(sys_bp) + 0.420251 * bp_medicine + 13.07543 * smoker + -5.060998 * ln(age) * ln(total_cholesterol) + -2.996945 * ln(age_smoke) * smoker - 146.5933061.
The patient's age is capped at 78 for the ln(age_smoke) * smoker term if greater than 78. The 10-year risk percentage is calculated as: [1 - 0.98767^exp(risk_score)] * 100.
The patient's gender is Female.
The patient is 67 years old. The patient's age is 67, and the adjusted age for smoking-related terms is 67.
The patient is not a smoker, so the smoker variable is 0.
The patient is on medication for blood pressure, so the bp_medicine variable is 1.
The concentration of 386.654 is 167.0 mg/dL. The concentration of hdl cholesterol is 40.0 mg/dL. The patient's systolic blood pressure is 170.0 mm Hg.
Plugging in the values into the risk score formula, we get 31.764001 * ln(67) + 22.465206 * ln(167.0) + -1.187731 * ln(40.0) + 2.552905 * ln(170.0) + 0.420251 * 1 + 13.07543 * 0 + -5.060998 * ln(67) * ln(167.0) + -2.996945 * ln(67) * 0 - 146.5933061 = 2.181.
To obtain the 10-year risk percentage, we plug this into the formula as: [1 - 0.98767^exp(risk_score)] * 100 = 10.402263929927102.
Hence, the patient's 10-year risk percentage of MI or death is 10.402%."
558,46,Framingham Risk Score for Hard Coronary Heart Disease,lab test,decimal,pmc-7717085-1,Extracted,"A 73-year-old gentleman presented to the cardiology clinic with chest pain on moderate exertion for the last two weeks, which was relieved at rest. He also complained of shortness of breath on moderate exertion with no history of resting symptoms and was asymptomatic at the time of presentation. He was recently diagnosed to have chronic lymphocytic leukemia (CLL) and had not been started on any treatment yet. He did not have any risk factors for coronary artery disease except advanced age and male gender.
On examination, he had a heart rate of 84 beats per minute, blood pressure of 135/75 mmHg, respiratory rate of 16 breaths per minute and an oxygen saturation of 98% while breathing in room air. Resting electrocardiogram (ECG) revealed sinus rhythm with no significant ischemic changes (Figure ).
Other investigations revealed hemoglobin of 13.9 g/dl, total leukocyte count of 70.7x10E9/L, platelets count of 177 x10E9/L, serum creatinine of 0.7 mg/dl, serum sodium of 143 mmol/L, and hemoglobin A1c (HbA1c) was 5.8 %. His total serum cholesterol level was 159 mg/dl, high-density lipoprotein (HDL) was 28 mg/dl and low-density lipoprotein (LDL) level was 92 mg/dl. Trans-thoracic echocardiogram (TTE) showed an ejection fraction (EF) of 55% with no segmental wall motion abnormality and there was no structural abnormality.
He was advised to get a stress myocardial perfusion imaging (MPI) for the assessment of ischemia. He underwent single-photon emission cardiac tomography (SPECT) with Technetium 99-m (Tc-99). The patient exercised for four minutes on the Bruce protocol and achieved 84% of the maximum predicted heart rate. Technetium-99 was injected at 84% of the age-predicted maximum heart rate. The test was stopped due to exercise limiting chest pain and dyspnea. ECG at peak stress showed >1mm horizontal ST depressions in leads II, III, aVF, and V3 to V5 along with ST elevation in lead aVR (Figure ). ECG changes and symptoms were relieved at six minutes of recovery.
Myocardial perfusion imaging (MPI) revealed a small-sized fixed perfusion defect of moderate-intensity in the basal inferior segment (Figure ).
Although MPI did not show any ischemia, exercise ECG was positive for symptoms and electrocardiographic evidence of myocardial ischemia. He was started on aspirin, rosuvastatin, bisoprolol, and then underwent an invasive coronary angiogram, which revealed multi-vessel coronary artery disease (Figures -).
His current treatment was continued and long-acting isosorbide mononitrate added to his treatment regimen. After a detailed discussion with the patient and family members, he was referred to a cardiac surgeon for coronary artery bypass graft.","Based on the Framingham Risk Score for Hard Coronary Heart Disease, what is the likelihood of 10-year risk of MI or death for this patient? Please return your answer as a percentage value. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'age': [73, 'years'], 'Systolic Blood Pressure': [135.0, 'mm hg'], 'Smoker': False, 'Total cholesterol': [159.0, 'mg/dL'], 'high-density lipoprotein cholesterol': [28.0, 'mg/dL'], 'Blood pressure being treated with medicines': False}",24.904,23.6588,26.1492,"For males, the formula for computing the Framingham Risk Score is:
52.00961 * ln(age) + 20.014077 * ln(total_cholesterol) + -0.905964 * ln(hdl_cholesterol) + 1.305784 * ln(sys_bp) + 0.241549 * bp_medicine + 12.096316 * smoker + -4.605038 * ln(age) * ln(total_cholesterol) + -2.84367 * ln(age_smoke) * smoker + -2.93323 * ln(age) * ln(age) - 172.300168.
The patient's age is capped at 70 for the ln(age_smoke) * smoker term if greater than 70. The 10-year risk percentage is calculated as: [1 - 0.9402^exp(risk_score)] * 100.
For females, the formula for computing the Framingham Risk Score is:
31.764001 * ln(age) + 22.465206 * ln(total_cholesterol) + -1.187731 * ln(hdl_cholesterol) + 2.552905 * ln(sys_bp) + 0.420251 * bp_medicine + 13.07543 * smoker + -5.060998 * ln(age) * ln(total_cholesterol) + -2.996945 * ln(age_smoke) * smoker - 146.5933061.
The patient's age is capped at 78 for the ln(age_smoke) * smoker term if greater than 78. The 10-year risk percentage is calculated as: [1 - 0.98767^exp(risk_score)] * 100.
The patient's gender is Male.
The patient is 73 years old. The patient's age is 73, and the adjusted age for smoking-related terms is 70.
The patient is not a smoker, so the smoker variable is 0.
The patient is not on medication for blood pressure, so the bp_medicine variable is 0.
The concentration of 386.654 is 159.0 mg/dL. The concentration of hdl cholesterol is 28.0 mg/dL. The patient's systolic blood pressure is 135.0 mm Hg.
Plugging in the values into the risk score formula, we get 52.00961 * ln(73) + 20.014077 * ln(159.0) + -0.905964 * ln(28.0) + 1.305784 * ln(135.0) + 0.241549 * 0 + 12.096316 * 0 + -4.605038 * ln(73) * ln(159.0) + -2.84367 * ln(70) * 0 + -2.93323 * ln(73) * ln(73) - 172.300168 = 1.536.
To obtain the 10-year risk percentage, we plug this into the formula as: [1 - 0.9402^exp(risk_score)] * 100 = 24.903747699047372.
Hence, the patient's 10-year risk percentage of MI or death is 24.904%."
559,46,Framingham Risk Score for Hard Coronary Heart Disease,lab test,decimal,usmle-1128,Extracted,"A 67-year-old woman comes to the physician with a 4-month history of chest pain that occurs on exertion. The pain is dull, and she experiences retrosternal pressure when she walks up the stairs to her apartment on the fifth floor. The pain disappears shortly after stopping for one minute. She has hypertension, for which she takes lisinopril and metoprolol daily. She does not smoke or drink alcohol. She is 158 cm (5 ft 2 in) tall and weighs 82 kg (180 lb); BMI is 33 kg/m2. Her pulse is 72/min and blood pressure is 140/85 mm Hg. Cardiac examination shows no murmurs, rubs, or gallops. Fasting lipid studies show:
Total cholesterol 196 mg/dL
LDL 110 mg/dL
HDL 50 mg/dL
A resting ECG shows no abnormalities. A week after uneventful initiation of aspirin, the patient is started on atorvastatin.","Based on the Framingham Risk Score for Hard Coronary Heart Disease, what is the likelihood of 10-year risk of MI or death for this patient? Please return your answer as a percentage value. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'age': [67, 'years'], 'Systolic Blood Pressure': [140.0, 'mm hg'], 'Smoker': False, 'Total cholesterol': [196.0, 'mg/dL'], 'high-density lipoprotein cholesterol': [50.0, 'mg/dL'], 'Blood pressure being treated with medicines': True}",6.017,5.71615,6.31785,"For males, the formula for computing the Framingham Risk Score is:
52.00961 * ln(age) + 20.014077 * ln(total_cholesterol) + -0.905964 * ln(hdl_cholesterol) + 1.305784 * ln(sys_bp) + 0.241549 * bp_medicine + 12.096316 * smoker + -4.605038 * ln(age) * ln(total_cholesterol) + -2.84367 * ln(age_smoke) * smoker + -2.93323 * ln(age) * ln(age) - 172.300168.
The patient's age is capped at 70 for the ln(age_smoke) * smoker term if greater than 70. The 10-year risk percentage is calculated as: [1 - 0.9402^exp(risk_score)] * 100.
For females, the formula for computing the Framingham Risk Score is:
31.764001 * ln(age) + 22.465206 * ln(total_cholesterol) + -1.187731 * ln(hdl_cholesterol) + 2.552905 * ln(sys_bp) + 0.420251 * bp_medicine + 13.07543 * smoker + -5.060998 * ln(age) * ln(total_cholesterol) + -2.996945 * ln(age_smoke) * smoker - 146.5933061.
The patient's age is capped at 78 for the ln(age_smoke) * smoker term if greater than 78. The 10-year risk percentage is calculated as: [1 - 0.98767^exp(risk_score)] * 100.
The patient's gender is Female.
The patient is 67 years old. The patient's age is 67, and the adjusted age for smoking-related terms is 67.
The patient is not a smoker, so the smoker variable is 0.
The patient is on medication for blood pressure, so the bp_medicine variable is 1.
The concentration of 386.654 is 196.0 mg/dL. The concentration of hdl cholesterol is 50.0 mg/dL. The patient's systolic blood pressure is 140.0 mm Hg.
Plugging in the values into the risk score formula, we get 31.764001 * ln(67) + 22.465206 * ln(196.0) + -1.187731 * ln(50.0) + 2.552905 * ln(140.0) + 0.420251 * 1 + 13.07543 * 0 + -5.060998 * ln(67) * ln(196.0) + -2.996945 * ln(67) * 0 - 146.5933061 = 1.610.
To obtain the 10-year risk percentage, we plug this into the formula as: [1 - 0.98767^exp(risk_score)] * 100 = 6.017429708731637.
Hence, the patient's 10-year risk percentage of MI or death is 6.017%."
560,46,Framingham Risk Score for Hard Coronary Heart Disease,lab test,decimal,pmc-6118291-1,Extracted,"A 68-year-old man presented to our outpatient clinic for good health maintenance. He had a past medical history of vitamin B12 deficiency for which he was getting monthly parenteral therapy. A detailed history is taken and he reported that he had no fever, chills, diarrhea, cough, anorexia, weight loss, or rash. On physical examination, the heart rate was 85 beats/min and the blood pressure was 130/70 mmHg. The abdomen was soft, with normal bowel sounds and with no organomegaly. No peripheral edema was seen. No rash, petechiae, ecchymoses, oral lesions, or lymphadenopathy was found. The arms revealed no abnormalities and the legs were normal. Neurological examination was normal.
The levels of glucose, urea nitrogen, creatinine, calcium, phosphorus, and magnesium were normal; also the levels of total bilirubin, aminotransferase, and alkaline phosphatase were normal. Lipid panel showed total cholesterol (TC) 144 mg/dl, triglycerides (TG) 79 mg /dl, HDL-C 5 mg/dl, and low density lipoprotein (LDL) 123 mg/dl. Lipid panel done three years ago showed a HDL-C of 41 mg/dl. Further workup revealed serum apolipoprotein A1 (APO A1) 97 mg/dl (94-176), apolipoprotein B (APO B) 35 mg/dl (52-109), the ratio of APO B/ APO A 1 0.36 , lipoprotein A 19.0 nmol/l (<75), and direct LDL 28 mg/dl ( <130). Important laboratory investigations are given in Table .
The patient was treated with an incremental dose of extended-release nicotinic acid but his HDL remained low. The secondary causes of low HDL-C levels such as the use of androgens, progestins, cigarette smoking, obesity, low-fat diet, and drugs like beta-blockers were ruled out. This leads us to consider the less well-known but well-documented fact that monoclonal gammopathies have unusual specificity for apolipoprotein, and paraproteins may interfere with the measurement of HDL-C in some automated analyzers. To confirm our hypothesis we performed serum protein electrophoresis with immunofixation, which showed IgG 720 mg/dl (576-1782), IgA 116 mg/dl ( 59-484) and an abnormally high IgM at 3510 mg/dl (57-266). Bone marrow biopsy showed a paratrabecular and intertrabecular infiltrates of small noncleaved lymphocytes. Immunohistochemical studies showed B cell phenotype (CD 45, CD20 positive, and negative CD 3 and CD 10) consistent with Waldenstrom macroglobulinemia. He is being followed conservatively by hematology as has been stable thus far.","Based on the Framingham Risk Score for Hard Coronary Heart Disease, what is the likelihood of 10-year risk of MI or death for this patient? Please return your answer as a percentage value. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'high-density lipoprotein cholesterol': [5.0, 'mg/dL'], 'sex': 'Male', 'Systolic Blood Pressure': [130.0, 'mm hg'], 'Total cholesterol': [144.0, 'mg/dL'], 'Smoker': False, 'age': [68, 'years'], 'Blood pressure being treated with medicines': False}",61.022,57.9709,64.0731,"For males, the formula for computing the Framingham Risk Score is:
52.00961 * ln(age) + 20.014077 * ln(total_cholesterol) + -0.905964 * ln(hdl_cholesterol) + 1.305784 * ln(sys_bp) + 0.241549 * bp_medicine + 12.096316 * smoker + -4.605038 * ln(age) * ln(total_cholesterol) + -2.84367 * ln(age_smoke) * smoker + -2.93323 * ln(age) * ln(age) - 172.300168.
The patient's age is capped at 70 for the ln(age_smoke) * smoker term if greater than 70. The 10-year risk percentage is calculated as: [1 - 0.9402^exp(risk_score)] * 100.
For females, the formula for computing the Framingham Risk Score is:
31.764001 * ln(age) + 22.465206 * ln(total_cholesterol) + -1.187731 * ln(hdl_cholesterol) + 2.552905 * ln(sys_bp) + 0.420251 * bp_medicine + 13.07543 * smoker + -5.060998 * ln(age) * ln(total_cholesterol) + -2.996945 * ln(age_smoke) * smoker - 146.5933061.
The patient's age is capped at 78 for the ln(age_smoke) * smoker term if greater than 78. The 10-year risk percentage is calculated as: [1 - 0.98767^exp(risk_score)] * 100.
The patient's gender is Male.
The patient is 68 years old. The patient's age is 68, and the adjusted age for smoking-related terms is 68.
The patient is not a smoker, so the smoker variable is 0.
The patient is not on medication for blood pressure, so the bp_medicine variable is 0.
The concentration of 386.654 is 144.0 mg/dL. The concentration of hdl cholesterol is 5.0 mg/dL. The patient's systolic blood pressure is 130.0 mm Hg.
Plugging in the values into the risk score formula, we get 52.00961 * ln(68) + 20.014077 * ln(144.0) + -0.905964 * ln(5.0) + 1.305784 * ln(130.0) + 0.241549 * 0 + 12.096316 * 0 + -4.605038 * ln(68) * ln(144.0) + -2.84367 * ln(68) * 0 + -2.93323 * ln(68) * ln(68) - 172.300168 = 2.727.
To obtain the 10-year risk percentage, we plug this into the formula as: [1 - 0.9402^exp(risk_score)] * 100 = 61.02194297990633.
Hence, the patient's 10-year risk percentage of MI or death is 61.022%."
561,46,Framingham Risk Score for Hard Coronary Heart Disease,lab test,decimal,pmc-6530099-1,Extracted,"A 57-year-old man presented to the emergency room with a several-day history of shortness of breath, nausea, dizziness, bilateral limb discomfort, and unilateral hearing loss. He also complained of cold intolerance and sluggish speech and movement that started a few weeks earlier, as well as 2-kg weight gain over the past year. He started rosuvastatin (5 mg, once daily) a year ago, with no dose adjustment; the patient was diagnosed with hypothyroidism at the same time. He was recommended levothyroxine treatment but did not initiate treatment because he had no related symptoms or discomfort in his daily life.
General physical examination revealed dry skin, neck vein distension, nontender diffuse goiter around the neck, and myxedema with puffy face, bilateral periorbital and lower extremities edema. His pulse rate was 52 beats/minute, blood pressure was 114/82 mmHg, respiratory rate was 20 breaths/minute, and his body temperature was 37.1 °C. Muffled heart sounds without fine crackle were also detected.
The initial results of laboratory tests (Table ) were as follows: BUN 19.0 (7–23) mg/dL, creatinine 1.5 (0.7–1.4) mg/dL, creatine kinase 9300 (43–198) IU/L, lactate dehydrogenase 1876 (238–422) IU/L, myoglobulin 636 (28–72) ng/mL, alanine aminotransferase 357 (3–45) IU/L, aspartate aminotransferase 278 (3–45) IU/L, creatine kinase muscle-brain fraction (CK-MB) 52.07 (0–4.87) U/L, troponin I 0.057 (0–0.014) ng/mL, total cholesterol 222 (130–240) mg/dL, low density lipoprotein cholesterol (LDL-c) 136 (50–160) mg/dL, high density lipoprotein cholesterol (HDL-c) 74 (40–85) mg/dL, and triglycerides 127 (35–200) mg/dL. The results of thyroid function tests showed TSH > 100 (0.17–4.05) μIU/mL, fT4 0.32 (0.89–1.79) μIU/mL, and triiodothyronine (T3) 55.6 (78–182) ng/dL. On chest radiography, heart shadow was not blunted without pulmonary infiltration, and cardiomegaly was seen (cardiothoracic ratio, 66%; Fig. a). An electrocardiogram showed bradycardia with normal sinus rhythm and low QRS voltage, and transthoracic echocardiography revealed a moderate amount of pericardial effusion (posterior 15 mm) with preserved left ventricular systolic function (55–60%; Fig. c). On further investigation, pure tone audiometry revealed that the patient had profound unilateral sensorineural hearing loss (Fig. a), and thyroid sonography showed diffusely enlarged gland with a heterogeneous echotexture and decreased vascularity (Fig. ); these findings are consistent with Hashimoto thyroiditis together with elevated thyroid peroxidase antibodies (> 2000 [0–5.61] IU/mL) and antithyroglobulin antibodies (9143.72 [0–4.11] IU/mL).
Upon admission, we started aggressive intravenous fluid resuscitation to treat rhabdomyolysis with acute kidney injury and levothyroxine replacement (oral, 150 mcg/day) to treat hypothyroidism. We also started systemic corticosteroids and intratympanic steroid injection to treat sensorineural hearing loss. The patient did not require pericardiocentesis because there was no ventricular dysfunction, and his vital signs were comparatively stable. Over the next several days, the patient’s clinical symptoms, such as shortness of breath, general weakness, and lower limb discomfort, improved substantially. On consecutive laboratory tests, creatine kinase as well as lactate dehydrogenase began to decrease on hospital day (HD) 3 and continued to decline to 1530 IU/L and 1508 IU/L on HD 7, respectively. Creatinine also started to decrease by 1.11 mg/dL on HD 7 accompanied by creatine kinase decline. Further thyroid function testing showed that his TSH was 53.65 μIU/mL and fT4 was 0.63 μIU/mL on HD 7. The patient was discharged home on HD 10 with instructions to continue levothyroxine (150 mcg/day, oral).
The patient was examined in the outpatient clinic 2 weeks after discharge. We observed recovered creatinine and creatinine kinase (Table ) as well as improved cardiomegaly (Fig. b). Except for hearing loss, his clinical symptoms continued to improve, and he was compliant with levothyroxine treatment. His thyroid function was normalized at 5 months (TSH 0.10 μIU/mL, free T4 1.60 μIU/mL) and remained euthyroid status until one year after discharge (TSH 0.54 μIU/mL, free T4 1.52 μIU/mL). No pericardial effusion appeared on transthoracic echocardiography (Fig. d). Regarding hearing loss, there was slight improvement in follow-up pure tone audiometry after 1 year; nevertheless, profound unilateral hearing loss remained in this patient (Fig. b).","Based on the Framingham Risk Score for Hard Coronary Heart Disease, what is the likelihood of 10-year risk of MI or death for this patient? Please return your answer as a percentage value. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'age': [57, 'years'], 'Systolic Blood Pressure': [114.0, 'mm hg'], 'Smoker': False, 'Total cholesterol': [222.0, 'mg/dL'], 'high-density lipoprotein cholesterol': [74.0, 'mg/dL'], 'Blood pressure being treated with medicines': False}",5.197,4.93715,5.45685,"For males, the formula for computing the Framingham Risk Score is:
52.00961 * ln(age) + 20.014077 * ln(total_cholesterol) + -0.905964 * ln(hdl_cholesterol) + 1.305784 * ln(sys_bp) + 0.241549 * bp_medicine + 12.096316 * smoker + -4.605038 * ln(age) * ln(total_cholesterol) + -2.84367 * ln(age_smoke) * smoker + -2.93323 * ln(age) * ln(age) - 172.300168.
The patient's age is capped at 70 for the ln(age_smoke) * smoker term if greater than 70. The 10-year risk percentage is calculated as: [1 - 0.9402^exp(risk_score)] * 100.
For females, the formula for computing the Framingham Risk Score is:
31.764001 * ln(age) + 22.465206 * ln(total_cholesterol) + -1.187731 * ln(hdl_cholesterol) + 2.552905 * ln(sys_bp) + 0.420251 * bp_medicine + 13.07543 * smoker + -5.060998 * ln(age) * ln(total_cholesterol) + -2.996945 * ln(age_smoke) * smoker - 146.5933061.
The patient's age is capped at 78 for the ln(age_smoke) * smoker term if greater than 78. The 10-year risk percentage is calculated as: [1 - 0.98767^exp(risk_score)] * 100.
The patient's gender is Male.
The patient is 57 years old. The patient's age is 57, and the adjusted age for smoking-related terms is 57.
The patient is not a smoker, so the smoker variable is 0.
The patient is not on medication for blood pressure, so the bp_medicine variable is 0.
The concentration of 386.654 is 222.0 mg/dL. The concentration of hdl cholesterol is 74.0 mg/dL. The patient's systolic blood pressure is 114.0 mm Hg.
Plugging in the values into the risk score formula, we get 52.00961 * ln(57) + 20.014077 * ln(222.0) + -0.905964 * ln(74.0) + 1.305784 * ln(114.0) + 0.241549 * 0 + 12.096316 * 0 + -4.605038 * ln(57) * ln(222.0) + -2.84367 * ln(57) * 0 + -2.93323 * ln(57) * ln(57) - 172.300168 = -0.145.
To obtain the 10-year risk percentage, we plug this into the formula as: [1 - 0.9402^exp(risk_score)] * 100 = 5.196687405673595.
Hence, the patient's 10-year risk percentage of MI or death is 5.197%."
562,46,Framingham Risk Score for Hard Coronary Heart Disease,lab test,decimal,pmc-4429202-1,Extracted,"A 50-year-old male presented to the emergency department with a three-day history of progressive retrosternal chest pain. His medical history was significant only for acute diverticulitis one year prior to current presentation and a 3-pack year smoking history. He had no history of diabetes, hypertension, or dyslipidemia. He denied personal or family history of cardiovascular diseases, hypercoagulable states, or bleeding disorders. A review of systems was negative for headache, visual disturbances, pruritus, easy bruising, or erythromelalgia.
On presentation, the patient's blood pressure was 131/83 mm Hg and heart rate was 84 beats/minute. He was in moderate distress due to pain. Auscultation of the lungs revealed clear breath sounds. Cardiac exam was unremarkable. No hepatosplenomegaly was detected on palpation. There was no erythema or rash on skin exam.
The patient's initial CBC revealed a hemoglobin of 14.6 g/dL, hematocrit 43.9%, WBC count 13,100/mm3, and platelet count 1,026,000/mm3. During his previous emergency department visit for acute diverticulitis, his platelet count was 976,000/mm3. This was felt to be reactive due to acute inflammation, and he was discharged on a course of oral antibiotics. He had no subsequent outpatient follow-up.
An electrocardiogram showed a normal sinus rhythm with T wave inversions in leads III and aVF (). His initial troponin I was 0.15 ng/mL. A repeat level 6 hours later increased to 2.83 ng/mL, suggesting cardiac ischemia. His LDL was 107 mg/dL, HDL 43 mg/dL, triglycerides 98 mg/dL, and total cholestrol was 169.6 mg/dL. His electrolytes, BUN and creatinine, and liver enzymes were within normal limits.
The patient was transferred to the coronary care unit with a diagnosis of NSTEMI. A cardiac catheterization revealed a thrombus in the right coronary artery (RCA) with a 60% stenosis and a TIMI Grade II flow (). No percutaneous coronary intervention (PCI) was performed due to a perceived high risk of complications, specifically distal embolization, given the high platelet count. The patient was treated with aspirin 81 mg daily, prasugrel 10 mg daily, enoxaparin 1 mg/kg every 12 hours, and hydroxyurea 1,000 mg every 12 hours. Four days later, a repeat cardiac catheterization showed normal coronaries with dissolution of the previously found RCA thrombus and no underlying atherosclerotic plaques ().
A peripheral blood smear was significant for marked thrombocytosis without an increase in immature myeloid elements. Molecular studies were negative for JAK2 mutations in V617F and exon 12 and positive for a CALR mutation type 1 (del52). Testing for BCR/ABL translocations was negative. Hence, a diagnosis of ET was made on the basis of the clinical presentation, consistently high platelet count, and presence of a clonal marker.
The patient was discharged home in stable condition on hydroxyurea and low-dose aspirin. His platelet count on discharge was 821,000/mm3. Two months later, his platelet count normalized to 320,000/mm3. He continued to do well with no further thrombotic or hemorrhagic complications. A bone marrow biopsy then was hypocellular and revealed no fibrosis, dysplastic changes, or increase in blasts. Fluorescence in situ hybridization panel for myelodysplastic syndrome was also negative.","Based on the Framingham Risk Score for Hard Coronary Heart Disease, what is the likelihood of 10-year risk of MI or death for this patient? Please return your answer as a percentage value. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'age': [50, 'years'], 'Systolic Blood Pressure': [131.0, 'mm hg'], 'Smoker': False, 'Total cholesterol': [169.6, 'mg/dL'], 'high-density lipoprotein cholesterol': [43.0, 'mg/dL'], 'Blood pressure being treated with medicines': False}",3.647,3.46465,3.82935,"For males, the formula for computing the Framingham Risk Score is:
52.00961 * ln(age) + 20.014077 * ln(total_cholesterol) + -0.905964 * ln(hdl_cholesterol) + 1.305784 * ln(sys_bp) + 0.241549 * bp_medicine + 12.096316 * smoker + -4.605038 * ln(age) * ln(total_cholesterol) + -2.84367 * ln(age_smoke) * smoker + -2.93323 * ln(age) * ln(age) - 172.300168.
The patient's age is capped at 70 for the ln(age_smoke) * smoker term if greater than 70. The 10-year risk percentage is calculated as: [1 - 0.9402^exp(risk_score)] * 100.
For females, the formula for computing the Framingham Risk Score is:
31.764001 * ln(age) + 22.465206 * ln(total_cholesterol) + -1.187731 * ln(hdl_cholesterol) + 2.552905 * ln(sys_bp) + 0.420251 * bp_medicine + 13.07543 * smoker + -5.060998 * ln(age) * ln(total_cholesterol) + -2.996945 * ln(age_smoke) * smoker - 146.5933061.
The patient's age is capped at 78 for the ln(age_smoke) * smoker term if greater than 78. The 10-year risk percentage is calculated as: [1 - 0.98767^exp(risk_score)] * 100.
The patient's gender is Male.
The patient is 50 years old. The patient's age is 50, and the adjusted age for smoking-related terms is 50.
The patient is not a smoker, so the smoker variable is 0.
The patient is not on medication for blood pressure, so the bp_medicine variable is 0.
The concentration of 386.654 is 169.6 mg/dL. The concentration of hdl cholesterol is 43.0 mg/dL. The patient's systolic blood pressure is 131.0 mm Hg.
Plugging in the values into the risk score formula, we get 52.00961 * ln(50) + 20.014077 * ln(169.6) + -0.905964 * ln(43.0) + 1.305784 * ln(131.0) + 0.241549 * 0 + 12.096316 * 0 + -4.605038 * ln(50) * ln(169.6) + -2.84367 * ln(50) * 0 + -2.93323 * ln(50) * ln(50) - 172.300168 = -0.507.
To obtain the 10-year risk percentage, we plug this into the formula as: [1 - 0.9402^exp(risk_score)] * 100 = 3.646567583084215.
Hence, the patient's 10-year risk percentage of MI or death is 3.647%."
563,46,Framingham Risk Score for Hard Coronary Heart Disease,lab test,decimal,pmc-4114920-1,Extracted,"A 47-year-old female patient presented to our emergency department with chest pain. The pain was: retrosternal; of sudden onset, starting 2 hours prior to presentation at our hospital; continuous and worsening in severity; described as pressure; irradiating to the neck and left upper extremity; had no precipitating or alleviating factors; and was associated with nausea, diaphoresis, and shortness of breath. She denied headache, dizziness, syncope, palpitations, or vomiting. Prior to the pain beginning, the patient denied having any of the symptoms. Review of her system was negative except for the symptoms mentioned.
The patient had no significant medical history except that she was seen many years prior for mild thrombocytosis during her pregnancy. At that time, she was started on aspirin. She did not keep her follow-up appointments afterward. Her surgical history was significant for hysterectomy.
Her father had had coronary artery disease and MI at the age of 50; he died at the age of 67. Her mother had been diagnosed with chronic myelogenous leukemia and succumbed to blastic crisis after 7 years. Three of the patient’s four children were positive for Factor V Leiden and one daughter developed extensive deep-vein thrombosis after 4 weeks on the oral contraceptive pills and major bleeding on warfarin (severe hemorrhagic ovarian cysts).
The patient was a nonsmoker and denied any alcohol or drug use. She had no history of allergy. Her only medication was baby aspirin once daily.
On initial examination, the patient was awake, alert, and oriented. Her blood pressure was 90/60 mm Hg, and she had a pulse of 80 beats per minute, respiratory rate of 12 breaths per minute, and a temperature of 99°F. There was no jugular vein distention. Auscultation was clear throughout both lungs. Cardiac auscultation revealed an S4 gallop. No loud murmurs were appreciated. Abdominal exam was unremarkable, with no hepatosplenomegaly. There was no edema of the lower extremities. There was positive erythromelalgia of the hands.
Her electrocardiogram showed sinus rhythm and ST-segment elevation in the anterior leads from V1 to V6 consistent with a large anterior wall infarct ().
Initial blood work showed negative cardiac enzymes. Her hemoglobin was 13.7 g/dL, white blood cell count was 14.2 th/mm3, and platelet count was 935,000 th/mm3. The patient’s basic metabolic profile was normal. Her low-density lipoprotein and high-density lipoprotein were 148 mg/dL and 61 mg/dL, respectively. Here total cholestrol concentration was 229 mg/dL. 
The patient was transferred urgently to the catheterization lab. Left heart catheterization showed a total proximal left anterior descending artery (LAD) occlusion (), while her other coronary arteries were normal. A successful balloon angioplasty, with two bare metal stents, was performed on the 100% lesion in the proximal LAD, and an excellent result was attained (). The patient was started, in addition to aspirin (325 mg daily), on clopidogrel, a statin, and beta-blockers. Transthoracic echocardiography revealed a left ventricular ejection fraction of 35% with severe hypokinesia of the mid-apical anteroseptal and apical walls.
During her hospital stay, the patient was seen by the hematology-oncology team. Further workup was done and this showed a positive JAK-2 mutation. She was negative for the Factor V Leiden mutation (R506Q) and BCR-ABL genes translocation (Philadelphia chromosome). The rest of her blood work was within normal limits, including the erythrocyte sedimentation rate (1 mm/h), ferritin (151 ng/mL), thyroid-stimulating hormone (1.3 mIU/mL), folate (10.2 ng/mL), vitamin B12 (382 pg/mL) and bleeding time (1.1 min). Patient was diagnosed with ET and started on hydroxyurea 1,000 mg twice daily. Patient was discharged in a stable condition with the plan to follow up with the cardiologist and hematologist.
Two weeks later, during a follow-up at the hematology office, her complete blood count revealed a platelet count of 803 th/mm3, so the dose of hydroxyurea was increased to 2,500 mg twice daily. Subsequent follow-up a few weeks later indicated a platelet count of 310 th/mm3, so the patient was kept on the same dose for the next 3 years. Her platelet count four months ago was still within the normal range.
The patient has been followed-up in the outpatient cardiology office for the last 3 years. Within a few months, her left ventricular function was found to have improved to normal and has been normal since then. We managed her as a coronary artery disease (CAD) equivalent, continued on dual antiplatelet therapy (aspirin and clopidogrel) beyond 1 year.","Based on the Framingham Risk Score for Hard Coronary Heart Disease, what is the likelihood of 10-year risk of MI or death for this patient? Please return your answer as a percentage value. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'age': [47, 'years'], 'Systolic Blood Pressure': [90.0, 'mm hg'], 'Smoker': False, 'Total cholesterol': [229.0, 'mg/dL'], 'high-density lipoprotein cholesterol': [61.0, 'mg/dL'], 'Blood pressure being treated with medicines': False}",0.276,0.2622,0.2898,"For males, the formula for computing the Framingham Risk Score is:
52.00961 * ln(age) + 20.014077 * ln(total_cholesterol) + -0.905964 * ln(hdl_cholesterol) + 1.305784 * ln(sys_bp) + 0.241549 * bp_medicine + 12.096316 * smoker + -4.605038 * ln(age) * ln(total_cholesterol) + -2.84367 * ln(age_smoke) * smoker + -2.93323 * ln(age) * ln(age) - 172.300168.
The patient's age is capped at 70 for the ln(age_smoke) * smoker term if greater than 70. The 10-year risk percentage is calculated as: [1 - 0.9402^exp(risk_score)] * 100.
For females, the formula for computing the Framingham Risk Score is:
31.764001 * ln(age) + 22.465206 * ln(total_cholesterol) + -1.187731 * ln(hdl_cholesterol) + 2.552905 * ln(sys_bp) + 0.420251 * bp_medicine + 13.07543 * smoker + -5.060998 * ln(age) * ln(total_cholesterol) + -2.996945 * ln(age_smoke) * smoker - 146.5933061.
The patient's age is capped at 78 for the ln(age_smoke) * smoker term if greater than 78. The 10-year risk percentage is calculated as: [1 - 0.98767^exp(risk_score)] * 100.
The patient's gender is Female.
The patient is 47 years old. The patient's age is 47, and the adjusted age for smoking-related terms is 47.
The patient is not a smoker, so the smoker variable is 0.
The patient is not on medication for blood pressure, so the bp_medicine variable is 0.
The concentration of 386.654 is 229.0 mg/dL. The concentration of hdl cholesterol is 61.0 mg/dL. The patient's systolic blood pressure is 90.0 mm Hg.
Plugging in the values into the risk score formula, we get 31.764001 * ln(47) + 22.465206 * ln(229.0) + -1.187731 * ln(61.0) + 2.552905 * ln(90.0) + 0.420251 * 0 + 13.07543 * 0 + -5.060998 * ln(47) * ln(229.0) + -2.996945 * ln(47) * 0 - 146.5933061 = -1.502.
To obtain the 10-year risk percentage, we plug this into the formula as: [1 - 0.98767^exp(risk_score)] * 100 = 0.275941897002141.
Hence, the patient's 10-year risk percentage of MI or death is 0.276%."
564,46,Framingham Risk Score for Hard Coronary Heart Disease,lab test,decimal,usmle-1989,Extracted,"A 71-year-old man comes to the physician for a routine health maintenance examination. He feels well. He goes for a 30-minute walk three times a week and does not experience any shortness of breath or chest or leg pain on exertion. He has not had any weakness, numbness, or vision disturbance. He has diabetes that is well controlled with insulin injections. He had smoked one pack of cigarettes every day for 40 years but quit 5 years ago. He appears healthy and well nourished. His temperature is 36.3°C (97.3°F), pulse is 75/min, and blood pressure is 136/78 mm Hg. Physical examination shows normal heart sounds. There are systolic bruits over the neck bilaterally. Physical and neurologic examinations show no other abnormalities. Fasting serum studies show:
Total cholesterol 210 mg/dL
HDL cholesterol 28 mg/dL
LDL cholesterol 154 mg/dL
Triglycerides 140 mg/dL
Glucose 102 mg/dL
Duplex ultrasonography of the carotid arteries shows a 85% stenosis on the left and a 55% stenosis on the right side.","Based on the Framingham Risk Score for Hard Coronary Heart Disease, what is the likelihood of 10-year risk of MI or death for this patient? Please return your answer as a percentage value. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'age': [71, 'years'], 'Systolic Blood Pressure': [136.0, 'mm hg'], 'Smoker': False, 'Total cholesterol': [210.0, 'mg/dL'], 'high-density lipoprotein cholesterol': [28.0, 'mg/dL'], 'Blood pressure being treated with medicines': False}",25.274,24.0103,26.5377,"For males, the formula for computing the Framingham Risk Score is:
52.00961 * ln(age) + 20.014077 * ln(total_cholesterol) + -0.905964 * ln(hdl_cholesterol) + 1.305784 * ln(sys_bp) + 0.241549 * bp_medicine + 12.096316 * smoker + -4.605038 * ln(age) * ln(total_cholesterol) + -2.84367 * ln(age_smoke) * smoker + -2.93323 * ln(age) * ln(age) - 172.300168.
The patient's age is capped at 70 for the ln(age_smoke) * smoker term if greater than 70. The 10-year risk percentage is calculated as: [1 - 0.9402^exp(risk_score)] * 100.
For females, the formula for computing the Framingham Risk Score is:
31.764001 * ln(age) + 22.465206 * ln(total_cholesterol) + -1.187731 * ln(hdl_cholesterol) + 2.552905 * ln(sys_bp) + 0.420251 * bp_medicine + 13.07543 * smoker + -5.060998 * ln(age) * ln(total_cholesterol) + -2.996945 * ln(age_smoke) * smoker - 146.5933061.
The patient's age is capped at 78 for the ln(age_smoke) * smoker term if greater than 78. The 10-year risk percentage is calculated as: [1 - 0.98767^exp(risk_score)] * 100.
The patient's gender is Male.
The patient is 71 years old. The patient's age is 71, and the adjusted age for smoking-related terms is 70.
The patient is not a smoker, so the smoker variable is 0.
The patient is not on medication for blood pressure, so the bp_medicine variable is 0.
The concentration of 386.654 is 210.0 mg/dL. The concentration of hdl cholesterol is 28.0 mg/dL. The patient's systolic blood pressure is 136.0 mm Hg.
Plugging in the values into the risk score formula, we get 52.00961 * ln(71) + 20.014077 * ln(210.0) + -0.905964 * ln(28.0) + 1.305784 * ln(136.0) + 0.241549 * 0 + 12.096316 * 0 + -4.605038 * ln(71) * ln(210.0) + -2.84367 * ln(70) * 0 + -2.93323 * ln(71) * ln(71) - 172.300168 = 1.553.
To obtain the 10-year risk percentage, we plug this into the formula as: [1 - 0.9402^exp(risk_score)] * 100 = 25.274340260981532.
Hence, the patient's 10-year risk percentage of MI or death is 25.274%."
565,46,Framingham Risk Score for Hard Coronary Heart Disease,lab test,decimal,pmc-7887157-1,Extracted,"The patient was a 56-year-old white woman with a 4-year history of hypertension with uncontrolled BP. In addition, she had had Hashimoto’s thyroiditis for about 10 years. She denied a history of smoking or drinking. She was taking valsartan (320 mg/day), hydrochlorothiazide (75 mg/day), methyldopa (1,500 mg/day), atenolol (100 mg/day), spironolactone (25 mg/day), and levothyroxine sodium (300 µg/day) at initial consultation. She was intolerant to angiotensin-converting enzyme inhibitors because of cough and amlodipine due to lower-limb edema. The patient told us that she was taking all the medications correctly. The degree of adherence was determined using the eight-item Morisky Medication Adherence Scale (MMAS8) translated into Brazilian Portuguese, and the patient was considered to have high adherence (eight points) on this test.
Her physical examination revealed BP 230/160 mmHg, heart rate 80 bpm, body mass index 29.3 kg/m2, and waist circumference 94 cm. The BP measure in the lower limbs did not show a significant difference in relation to upper limbs. She had no abnormalities of the heart, lungs, or abdomen. According to initial complementary exams, the patient presented fasting glycemia 101 mg/dL, sodium 142 mEq/L, potassium 4.4 mEq/L, creatinine 0.8 mg/dL, estimated glomerular filtration rate (CKD-EPI) 89.3 mL/min/1.73 m2, normal routine urine, microalbuminuria 230 mg/24 h (normal <30 mg/24 h), total cholesterol 148 mg/dL, HDL cholesterol 38 mg/dL, LDL cholesterol 86 mg/dL, and triglycerides 122 mg/dL. The 24-hour urinary sodium measure was 164 mEq/L (ideal level <100 mEq/L). Other exam results were thyroid-stimulating hormone 40.89 mU/L, free T4 0.75 ng/dL, parathyroid hormone 58.86 pg/mL (normal 10–65 pg/mL), vitamin D 30.8 ng/mL, and serum calcium 9.2 mg/dL (normal 8–10 mg/dL).
Electrocardiography was normal, with sinus rhythm and heart rate of 74 bpm. Echocardiography showed structural and functional normality. BP monitoring revealed BP of 204/130 mmHg, with attenuated nocturnal dipping in systolic and diastolic BP. The patient had hypertensive retinopathy (grade 2 Keith–Wagener–Barker classification). All investigations for secondary hypertension were negative. Therefore, primary hyperaldosteronism, renovascular hypertension, renal disease, obstructive sleep apnea, pheochromocytoma, acromegaly, and Cushing’s disease were excluded, as shown in . Four weeks prior to investigation for hyperaldosteronism, her thiazide diuretic, renin–angiotensin system blocker, and mineralocorticoid-receptor antagonist were stopped for screening this condition, in accordance with guidelines.
During outpatient follow-up, hydrochlorothiazide was exchanged for chlorthalidone (25 mg/day), and nitrendipine (20 mg/day) was added to her antihypertensive treatment. Nevertheless, the patient had several BP elevations of up to 290/180 mmHg and a hospital admission with hypertensive encephalopathy, even with the use of valsartan (320 mg/day), chlortalidone (25 mg/day), nitrendipine (20 mg/day), methyldopa (1,500 mg/day), atenolol (100 mg/day), and spironolactone (150 mg/day). Moreover, she was also using diazepam (10 mg/day) and levothyroxine sodium (300 µg/day). On hospital discharge, methyldopa was exchanged for clonidine (600 µg/day), and hydralazine (150 mg/day) was added to the therapy regimen.
A careful interview and investigation of nonadherence was performed, and given that the patient stated that she had taken all the prescribed medications, a hypothesis of intestinal absorption disturbance was arrived at as the cause of the lack of control of hypertension and thyroid function. However, all functional, anatomic, and histopathologic investigation for malabsorption syndromes gave negative results (upper digestive endoscopy and colonoscopy, both with normal biopsies, antitissue transglutaminase IgA and IgG antibodies and antigliadin IgA antibodies were nonreagents upon testing for celiac disease).
Considering the difficulty in controlling the hypertension and due to the high cardiovascular risk presented by the patient (target-organ damage), the team opted to hospitalize her for the purpose of observing her evolution and performing other investigations. The usual biochemical tests were normal. She maintained her previous weight. During the hospitalization, there was a progressive control of BP levels around the fifth day of admission with administration of the same drugs previously used by the patient (valsartan 320 mg/day, chlortalidone 25 mg/day, nitrendipine 20 mg/day, atenolol 100 mg/day, clonidine (600 µg/day, hydralazine (150 mg/day, and spironolactone 150 mg/day); ). She was discharged after 10 days with controlled BP. The patient was referred for psychiatric evaluation, where she was diagnosed with recurrent depressive disorder and medicated. Subsequently, she was referred for follow-up with psychology. About 30 days after discharge, BP remained high with the same drugs used in hospital.","Based on the Framingham Risk Score for Hard Coronary Heart Disease, what is the likelihood of 10-year risk of MI or death for this patient? Please return your answer as a percentage value. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'age': [56, 'years'], 'Smoker': False, 'Total cholesterol': [148.0, 'mg/dL'], 'high-density lipoprotein cholesterol': [38.0, 'mg/dL'], 'Blood pressure being treated with medicines': True, 'Systolic Blood Pressure': [230, 'mm Hg']}",6.625,6.29375,6.95625,"For males, the formula for computing the Framingham Risk Score is:
52.00961 * ln(age) + 20.014077 * ln(total_cholesterol) + -0.905964 * ln(hdl_cholesterol) + 1.305784 * ln(sys_bp) + 0.241549 * bp_medicine + 12.096316 * smoker + -4.605038 * ln(age) * ln(total_cholesterol) + -2.84367 * ln(age_smoke) * smoker + -2.93323 * ln(age) * ln(age) - 172.300168.
The patient's age is capped at 70 for the ln(age_smoke) * smoker term if greater than 70. The 10-year risk percentage is calculated as: [1 - 0.9402^exp(risk_score)] * 100.
For females, the formula for computing the Framingham Risk Score is:
31.764001 * ln(age) + 22.465206 * ln(total_cholesterol) + -1.187731 * ln(hdl_cholesterol) + 2.552905 * ln(sys_bp) + 0.420251 * bp_medicine + 13.07543 * smoker + -5.060998 * ln(age) * ln(total_cholesterol) + -2.996945 * ln(age_smoke) * smoker - 146.5933061.
The patient's age is capped at 78 for the ln(age_smoke) * smoker term if greater than 78. The 10-year risk percentage is calculated as: [1 - 0.98767^exp(risk_score)] * 100.
The patient's gender is Female.
The patient is 56 years old. The patient's age is 56, and the adjusted age for smoking-related terms is 56.
The patient is not a smoker, so the smoker variable is 0.
The patient is on medication for blood pressure, so the bp_medicine variable is 1.
The concentration of 386.654 is 148.0 mg/dL. The concentration of hdl cholesterol is 38.0 mg/dL. The patient's systolic blood pressure is 230 mm Hg.
Plugging in the values into the risk score formula, we get 31.764001 * ln(56) + 22.465206 * ln(148.0) + -1.187731 * ln(38.0) + 2.552905 * ln(230) + 0.420251 * 1 + 13.07543 * 0 + -5.060998 * ln(56) * ln(148.0) + -2.996945 * ln(56) * 0 - 146.5933061 = 1.709.
To obtain the 10-year risk percentage, we plug this into the formula as: [1 - 0.98767^exp(risk_score)] * 100 = 6.625490050411786.
Hence, the patient's 10-year risk percentage of MI or death is 6.625%."
566,46,Framingham Risk Score for Hard Coronary Heart Disease,lab test,decimal,pmc-4709961-1,Extracted,"The patient was a 65-year-old woman who had undergone surgery at 19 years of age for appendicitis. Her medical history was otherwise unremarkable. Starting 3 years prior to the current presentation, the patient had gradually developed a gait disturbance, for which she consulted a local orthopedic surgery department, and upon diagnosis of knee osteoarthrosis received conservative therapy. At approximately 1 week before admissions, she had begun to experience loss of appetite and vomiting, and consulted a local physician. On suspicion of gastrointestinal disease, a thorough examination of the gastrointestinal tract was performed, but no organic disease was identified. Although the loss of appetite and vomiting resolved spontaneously, the gait disturbance gradually worsened, and magnetic resonance imaging (MRI) of the head revealed ventricular enlargement. The patient was thus referred to our department for suspected iNPH related to the gait disturbance.
Her height of 148.3 cm, weight of 54.4 kg, and body mass index of 24.8 were all within standard ranges. There was no medical history that could have led to secondary hydrocephalus. There were no abnormalities in vital signs with body temperature 36 °C, blood pressure 110/63 mm/Hg, and heart rate 83 beats per minute. Although the patient’s consciousness was clear, 15 on the Glasgow Coma Scale (GCS), and there was no muscle weakness, she walked with her legs apart in short quick steps, and required a walking aid. While muscle tonus was normal, the patient complained of mild pain when extending the knee. As to higher order brain functions, mini mental state examination (MMSE) results were 24/30, and the frontal assessment battery (FAB) results were 9/18. Blood test findings at the time of admission were within normal range apart from mild hypoalbuminemia (total protein 4.6 g/dL, albumin 2.7 g/dL, total cholesterol 147 mg/dL, HDL cholestrol 67 mg/dL, and LDL cholesterol 100 mg/dL), and elevated thyroid free T3 (TSH 4.333 μIU/mL, free T3 3.78 pg/mL, free T4 1.16 ng/dL). There were no blood-sugar or electrolyte (Na 140 mmol/L, Cl 106 mmol/, K 4.1 mmol/L, serum glucose 73 mg/dL) abnormalities. Head MRI revealed enlargement of all cerebral ventricles, with an Evan’s index of 0.4, and the Sylvian fissure appeared wide open consistent with iNPH. However, the specific feature of narrowing of the sulci at the high convexity area was not obvious (Fig. ). Single-photon emission computed tomography revealed reduced cerebral blood flow (CBF) surrounding the Sylvian fissure, with relatively increased CBF in the convexity, which was consistent with the pattern for iNPH (Fig. ). Findings for the sulci at the high convexity area were inconsistent with typical iNPH, however, and we thus reconsidered the possibility of other diseases that may have caused the gait disturbance.
Detailed tests were ultimately performed after hospital admission including a spinal tap. Following admission, the patient gradually became less active, and tended to stay in bed. Re-examination revealed blood sugar levels of 40 mg/dL and systolic blood pressure of 90 mm/Hg. On suspicion of impaired anterior pituitary function, scans were performed of the pituitary in the diencephalon, and baseline pituitary hormone levels were verified. The spinal tap results were negative. On MRI, pituitary gland was normal measuring 12 mm in maximum diameter with no enlargement or deviation of stalk, and there were no neoplastic lesions, inflammatory lesions in the pituitary area of the diencephalon, or changes suggesting that surgery had been performed in all sequences including contrast-enhanced dynamic images (Fig. ). Table presents baseline hormone levels, and Table the results of the anterior pituitary gland hormone loading test using corticotrophin releasing hormone, thyrotropin releasing hormone, luteinizing hormone releasing hormone, and growth hormone releasing hormone. Pituitary hormone results included ACTH <1.0 pg/ml (normal range: 7.2–63.3), and cortisol levels <1.0 μ/dL (normal range: 4.0–18.3), indicating pituitary adrenal insufficiency. There were no decreases in other hormone levels, with relatively mild elevations of growth hormone, prolactin and free T3 levels. We checked carefully again the medical history of the patient, but there were no recent history of exogenous glucocorticoid treatment. An additional pituitary stimulation test was performed, in which ACTH and cortisol responses only were found to have disappeared, and isolated ACTH deficiency was thus diagnosed (Fig. ). After initiation of hydrocortisone supplements, her gait quickly improved. While observing the clinical symptoms, hydrocortisone (Cortril ®) was adjusted to a daily dose of 15 mg, and after instructing the patient as to how to respond on sick days, she was discharged to return home. At approximately 6 months after discharge, although the ventricular enlargement on MRI was same as before, the patient scored 27/30 points on the MMSE and 15/18 points on the FAB.","Based on the Framingham Risk Score for Hard Coronary Heart Disease, what is the likelihood of 10-year risk of MI or death for this patient? Please return your answer as a percentage value. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'age': [65, 'years'], 'Systolic Blood Pressure': [110.0, 'mm hg'], 'Total cholesterol': [147.0, 'mg/dL'], 'high-density lipoprotein cholesterol': [67.0, 'mg/dL'], 'Blood pressure being treated with medicines': False}",0.904,0.8588,0.9492,"For males, the formula for computing the Framingham Risk Score is:
52.00961 * ln(age) + 20.014077 * ln(total_cholesterol) + -0.905964 * ln(hdl_cholesterol) + 1.305784 * ln(sys_bp) + 0.241549 * bp_medicine + 12.096316 * smoker + -4.605038 * ln(age) * ln(total_cholesterol) + -2.84367 * ln(age_smoke) * smoker + -2.93323 * ln(age) * ln(age) - 172.300168.
The patient's age is capped at 70 for the ln(age_smoke) * smoker term if greater than 70. The 10-year risk percentage is calculated as: [1 - 0.9402^exp(risk_score)] * 100.
For females, the formula for computing the Framingham Risk Score is:
31.764001 * ln(age) + 22.465206 * ln(total_cholesterol) + -1.187731 * ln(hdl_cholesterol) + 2.552905 * ln(sys_bp) + 0.420251 * bp_medicine + 13.07543 * smoker + -5.060998 * ln(age) * ln(total_cholesterol) + -2.996945 * ln(age_smoke) * smoker - 146.5933061.
The patient's age is capped at 78 for the ln(age_smoke) * smoker term if greater than 78. The 10-year risk percentage is calculated as: [1 - 0.98767^exp(risk_score)] * 100.
The patient's gender is Female.
The patient is 65 years old. The patient's age is 65, and the adjusted age for smoking-related terms is 65.
The patient's smoking status is not provided, so the smoker variable is set to 0.
The patient is not on medication for blood pressure, so the bp_medicine variable is 0.
The concentration of 386.654 is 147.0 mg/dL. The concentration of hdl cholesterol is 67.0 mg/dL. The patient's systolic blood pressure is 110.0 mm Hg.
Plugging in the values into the risk score formula, we get 31.764001 * ln(65) + 22.465206 * ln(147.0) + -1.187731 * ln(67.0) + 2.552905 * ln(110.0) + 0.420251 * 0 + 13.07543 * 0 + -5.060998 * ln(65) * ln(147.0) + -2.996945 * ln(65) * 0 - 146.5933061 = -0.312.
To obtain the 10-year risk percentage, we plug this into the formula as: [1 - 0.98767^exp(risk_score)] * 100 = 0.9041816733221353.
Hence, the patient's 10-year risk percentage of MI or death is 0.904%."
567,46,Framingham Risk Score for Hard Coronary Heart Disease,lab test,decimal,pmc-2813536-1,Extracted,"A 61-year-old male presented to our emergency department complaining of worsening shortness of breath associated with pleuritic chest pain for 3 days. His medical comorbidities included hypertension, type 2 diabetes mellitus, asthma, seizure disorder, obstructive sleep apnea, and a history of pulmonary embolism. His only surgery was an inguinal hernia repair in the past. He reported an allergy to angiotensin-converting enzyme inhibitors. He denied alcohol consumption, smoking, or recreational drug use. He had not travelled outside the United States, nor did he encounter any sick contacts. He denied the use of any herbal preparations or over-the-counter medications. Coumadin was the only prescription medication he was taking on a regular basis.
On examination, the patient was a well-built man in respiratory distress. He was tachypneic and hypoxic, saturating at 88% (SpO2) on room air. Blood pressure was 130/80, heart rate 88 bpm, and he was afebrile at 97 °F. On inspection, no icterus, lymphadenopathy, or peripheral edema was noted. On auscultation, his lungs were clear bilaterally, and no heart murmurs were appreciated. His abdomen was soft, non-tender with no hepatosplenomegaly, and bowel sounds were normal.
Initial troponin and pro-brain natriuretic peptide levels were elevated. A computerized tomography with contrast of the chest revealed multiple filling defects within the pulmonary arterial system, indicative of bilateral acute on chronic thromboembolic disease. The patient was started on enoxaparin 120 mg twice a day in addition to his coumadin, as an aim to bridge to a therapeutic international normalized ratio between 2 and 3.
On admission, his liver enzymes were within normal limits as per our institute laboratory values, with an alanine transaminase (ALT) of 28 units/L, aspartate transaminase (AST) of 13 units/L, alkaline phosphatase (ALP) of 95 units/L, albumin of 3.4 g/dL, total bilirubin of 0.4 mg/dL, and conjugated bilirubin of 0.1 mg/dL. His total cholestrol was 198 mg/dL and his HDL-C was 42 mg/dL. They remained as such, up until day 6, when a slight elevation was noted. On day 6, the AST was 72 units/L, ALT was 84 units/L, and ALP was 161 units/L. An R ratio, the initial step of the Roussel Uclaf Causality Assessment Method (RUCAM), was calculated to be 2.64, consistent with a mixed (hepatocellular and cholestatic) pattern of liver injury. At this point, no changes were made to the patient's treatment regimen. On day 7, his liver enzymes peaked with AST of 143 units/L, ALT of 231 units/L, and ALP of 123 units/L as shown in Table . R ratio from these laboratory values was 5.56, consistent with hepatocellular pattern of liver injury.
An ultrasound and computerized tomography of the abdomen was negative for any significant pathology. Echocardiogram of the heart revealed a normal ejection fraction and normal diastolic function. Serologies for hepatitis A, hepatitis B, hepatitis C, Epstein Barr virus, and cytomegalovirus were all negative. Antinuclear antibody screen, anti-mitochondrial antibody, anti-smooth muscle antibody, and anti-liver kidney microsomal antibody were also negative. Serum alpha-1 antitrypsin and serum ceruloplasmin levels were normal.
On day 7 of admission, enoxaparin was discontinued secondary to a therapeutic international normalized ratio. His liver function tests demonstrated a dramatic and steady decline thereafter. He was subsequently discharged on coumadin, and a 2-month follow-up revealed complete normalization of his liver enzymes.","Based on the Framingham Risk Score for Hard Coronary Heart Disease, what is the likelihood of 10-year risk of MI or death for this patient? Please return your answer as a percentage value. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'age': [61, 'years'], 'Systolic Blood Pressure': [130.0, 'mm hg'], 'Total cholesterol': [198.0, 'mg/dL'], 'Smoker': False, 'Blood pressure being treated with medicines': False, 'high-density lipoprotein cholesterol': [42.0, 'mg/dL']}",10.975,10.42625,11.52375,"For males, the formula for computing the Framingham Risk Score is:
52.00961 * ln(age) + 20.014077 * ln(total_cholesterol) + -0.905964 * ln(hdl_cholesterol) + 1.305784 * ln(sys_bp) + 0.241549 * bp_medicine + 12.096316 * smoker + -4.605038 * ln(age) * ln(total_cholesterol) + -2.84367 * ln(age_smoke) * smoker + -2.93323 * ln(age) * ln(age) - 172.300168.
The patient's age is capped at 70 for the ln(age_smoke) * smoker term if greater than 70. The 10-year risk percentage is calculated as: [1 - 0.9402^exp(risk_score)] * 100.
For females, the formula for computing the Framingham Risk Score is:
31.764001 * ln(age) + 22.465206 * ln(total_cholesterol) + -1.187731 * ln(hdl_cholesterol) + 2.552905 * ln(sys_bp) + 0.420251 * bp_medicine + 13.07543 * smoker + -5.060998 * ln(age) * ln(total_cholesterol) + -2.996945 * ln(age_smoke) * smoker - 146.5933061.
The patient's age is capped at 78 for the ln(age_smoke) * smoker term if greater than 78. The 10-year risk percentage is calculated as: [1 - 0.98767^exp(risk_score)] * 100.
The patient's gender is Male.
The patient is 61 years old. The patient's age is 61, and the adjusted age for smoking-related terms is 61.
The patient is not a smoker, so the smoker variable is 0.
The patient is not on medication for blood pressure, so the bp_medicine variable is 0.
The concentration of 386.654 is 198.0 mg/dL. The concentration of hdl cholesterol is 42.0 mg/dL. The patient's systolic blood pressure is 130.0 mm Hg.
Plugging in the values into the risk score formula, we get 52.00961 * ln(61) + 20.014077 * ln(198.0) + -0.905964 * ln(42.0) + 1.305784 * ln(130.0) + 0.241549 * 0 + 12.096316 * 0 + -4.605038 * ln(61) * ln(198.0) + -2.84367 * ln(61) * 0 + -2.93323 * ln(61) * ln(61) - 172.300168 = 0.634.
To obtain the 10-year risk percentage, we plug this into the formula as: [1 - 0.9402^exp(risk_score)] * 100 = 10.974821449849614.
Hence, the patient's 10-year risk percentage of MI or death is 10.975%."
568,46,Framingham Risk Score for Hard Coronary Heart Disease,physical,decimal,pmc-2902014-3,Extracted,"This 66-year-old male is 5′7′′ tall and weighs 179 lbs; his BMI is 28. He is a nonsmoker and is receiving treatment for hypertension. He has a BP of 139/85 mmHg, TC = 201 mg/dL, LDL-C = 119 mg/dL, HDL-C = 50.1 mg/dL, TGs = 150 mg/dL, and C-reactive protein (CRP) = 4.2 mg/L. The patient is very health conscious, has a good routine level of physical activity, and had his CRP level measured, at his own request, following media coverage of the Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) study []—the measurement was done only once at an off-site laboratory. His serum LDL-C level is reported to be relatively low. He is currently treated with aspirin 81 mg/d, lisinopril 20 mg/d, and a thiazide diuretic 25 mg/d. The findings of the ASCOT Blood Pressure Lowering Arm (ASCOT-BPLA) highlighted the importance of BP control in reducing CV risk []. In that study, many patients remained hypertensive despite receiving antihypertensive therapy prior to enrolment. Since this patient remains hypertensive with his current treatment regimen, the dose of lisinopril should be increased to 40 mg/d. In addition, the lipid-lowering arm of the ASCOT trial (ASCOT-LLA), in which hypertensive patients with a fasting LDL-C of ≤251 mg/dL were randomly assigned to treatment with atorvastatin 10 mg or placebo, showed a significant reduction in the risk of CV events with atorvastatin therapy []. Similar results were also obtained in a post hoc analysis of the ASCOT-LLA which showed that atorvastatin 10 mg significantly reduced the risk of CV events in patients 65 years of age or older []. Given the Framingham risk score of this patient, current guidelines and clinical trial evidence would support treating to an optional LDL-C goal of <100 mg/dL. As this corresponds to a 16% reduction in LDL-C, various lipid-lowering options are available (). The results of the JUPITER trial further confirmed the benefit of lipid-lowering in moderately high-risk initially healthy patients and supported the need to treat such patients even more intensively. Compared with placebo, rosuvastatin 20 mg/d led to a 43% reduction in the risk of major CV events in patients with LDL-C <130 mg/dL and persistently elevated CRP (>2.0 mg/dL) []. There was no difference in the benefit for patients aged <65 or ≥65 years. Although the patient in this case study is comparable to subjects enrolled in the JUPITER study, elevated CRP was only documented in a single measurement. Since CRP is an acute phase reactant and its concentration increases rapidly in response to inflammation, the finding could easily be explained by a variety of factors, including simple infection. It would be necessary to assess CRP based on the average of two independent measurements, as was done in the JUPITER trial. Nevertheless, while the results of the JUPITER trial are provocative, they have not been incorporated into guidelines. The relevance of CRP levels is also currently under consideration and it remains to be seen whether this parameter will be included in future guidelines. This patient should therefore receive treatment based on current recommendations [], to achieve the optional LDL-C goal of <100 mg/dL with an appropriate dose of statin. Importantly, the rule of sixes should be taken into account (the greatest lipid-lowering response is obtained at the initial statin dose, while incremental doubling of the dose leads to an approximately 6% additive reduction in LDL-C) and an appropriate starting dose used to achieve this target without a requirement for subsequent dose increase. However, if the LDL-C goal is not achieved after 6 to 8 weeks, the statin regimen should be changed accordingly.","Based on the Framingham Risk Score for Hard Coronary Heart Disease, what is the likelihood of 10-year risk of MI or death for this patient? Please return your answer as a percentage value. You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'age': [66, 'years'], 'Systolic Blood Pressure': [139.0, 'mm hg'], 'Total cholesterol': [201.0, 'mg/dL'], 'Smoker': False, 'Blood pressure being treated with medicines': True, 'high-density lipoprotein cholesterol': [50.1, 'mg/dL']}",16.526,15.6997,17.3523,"For males, the formula for computing the Framingham Risk Score is:
52.00961 * ln(age) + 20.014077 * ln(total_cholesterol) + -0.905964 * ln(hdl_cholesterol) + 1.305784 * ln(sys_bp) + 0.241549 * bp_medicine + 12.096316 * smoker + -4.605038 * ln(age) * ln(total_cholesterol) + -2.84367 * ln(age_smoke) * smoker + -2.93323 * ln(age) * ln(age) - 172.300168.
The patient's age is capped at 70 for the ln(age_smoke) * smoker term if greater than 70. The 10-year risk percentage is calculated as: [1 - 0.9402^exp(risk_score)] * 100.
For females, the formula for computing the Framingham Risk Score is:
31.764001 * ln(age) + 22.465206 * ln(total_cholesterol) + -1.187731 * ln(hdl_cholesterol) + 2.552905 * ln(sys_bp) + 0.420251 * bp_medicine + 13.07543 * smoker + -5.060998 * ln(age) * ln(total_cholesterol) + -2.996945 * ln(age_smoke) * smoker - 146.5933061.
The patient's age is capped at 78 for the ln(age_smoke) * smoker term if greater than 78. The 10-year risk percentage is calculated as: [1 - 0.98767^exp(risk_score)] * 100.
The patient's gender is Male.
The patient is 66 years old. The patient's age is 66, and the adjusted age for smoking-related terms is 66.
The patient is not a smoker, so the smoker variable is 0.
The patient is on medication for blood pressure, so the bp_medicine variable is 1.
The concentration of 386.654 is 201.0 mg/dL. The concentration of hdl cholesterol is 50.1 mg/dL. The patient's systolic blood pressure is 139.0 mm Hg.
Plugging in the values into the risk score formula, we get 52.00961 * ln(66) + 20.014077 * ln(201.0) + -0.905964 * ln(50.1) + 1.305784 * ln(139.0) + 0.241549 * 1 + 12.096316 * 0 + -4.605038 * ln(66) * ln(201.0) + -2.84367 * ln(66) * 0 + -2.93323 * ln(66) * ln(66) - 172.300168 = 1.075.
To obtain the 10-year risk percentage, we plug this into the formula as: [1 - 0.9402^exp(risk_score)] * 100 = 16.52644747913552.
Hence, the patient's 10-year risk percentage of MI or death is 16.526%."
569,48,PERC Rule for Pulmonary Embolism,diagnosis,integer,pmc-7315174-1,Extracted,"A 61-year-old male presented to our emergency department complaining of worsening shortness of breath associated with pleuritic chest pain for 3 days. His medical comorbidities included hypertension, type 2 diabetes mellitus, asthma, seizure disorder, obstructive sleep apnea, and a history of pulmonary embolism. His only surgery was an inguinal hernia repair 3 weeks ago. He reported an allergy to angiotensin-converting enzyme inhibitors. He denied alcohol consumption, smoking, or recreational drug use. He had not travelled outside the United States, nor did he encounter any sick contacts. He denied the use of any herbal preparations or over-the-counter medications. Coumadin was the only prescription medication he was taking on a regular basis.
On examination, the patient was a well-built man in respiratory distress. He was tachypneic and hypoxic, saturating at 88% (SpO2) on room air. Blood pressure was 130/80, heart rate 88 bpm, and he was afebrile at 97 °F. On inspection, no icterus, lymphadenopathy, or peripheral edema was noted. On auscultation, his lungs were clear bilaterally, and no heart murmurs were appreciated. His abdomen was soft, non-tender with no hepatosplenomegaly, and bowel sounds were normal.
Initial troponin and pro-brain natriuretic peptide levels were elevated. A computerized tomography with contrast of the chest revealed multiple filling defects within the pulmonary arterial system, indicative of bilateral acute on chronic thromboembolic disease. The patient was started on enoxaparin 120 mg twice a day in addition to his coumadin, as an aim to bridge to a therapeutic international normalized ratio between 2 and 3.
On admission, his liver enzymes were within normal limits as per our institute laboratory values, with an alanine transaminase (ALT) of 28 units/L, aspartate transaminase (AST) of 13 units/L, alkaline phosphatase (ALP) of 95 units/L, albumin of 3.4 g/dL, total bilirubin of 0.4 mg/dL, and conjugated bilirubin of 0.1 mg/dL. They remained as such, up until day 6, when a slight elevation was noted. On day 6, the AST was 72 units/L, ALT was 84 units/L, and ALP was 161 units/L. An R ratio, the initial step of the Roussel Uclaf Causality Assessment Method (RUCAM), was calculated to be 2.64, consistent with a mixed (hepatocellular and cholestatic) pattern of liver injury. At this point, no changes were made to the patient's treatment regimen. On day 7, his liver enzymes peaked with AST of 143 units/L, ALT of 231 units/L, and ALP of 123 units/L as shown in Table . R ratio from these laboratory values was 5.56, consistent with hepatocellular pattern of liver injury.
An ultrasound and computerized tomography of the abdomen was negative for any significant pathology. Echocardiogram of the heart revealed a normal ejection fraction and normal diastolic function. Serologies for hepatitis A, hepatitis B, hepatitis C, Epstein Barr virus, and cytomegalovirus were all negative. Antinuclear antibody screen, anti-mitochondrial antibody, anti-smooth muscle antibody, and anti-liver kidney microsomal antibody were also negative. Serum alpha-1 antitrypsin and serum ceruloplasmin levels were normal.
On day 7 of admission, enoxaparin was discontinued secondary to a therapeutic international normalized ratio. His liver function tests demonstrated a dramatic and steady decline thereafter. He was subsequently discharged on coumadin, and a 2-month follow-up revealed complete normalization of his liver enzymes.",What are the number of criteria met for the PERC Rule for Pulmonary Embolism (PE)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [61.0, 'years'], 'Heart Rate or Pulse': [88.0, 'beats per minute'], 'O₂ saturation percentage': [88.0, '%'], 'Unilateral Leg Swelling': False, 'Hormone use': False, 'Recent surgery or trauma': True, 'Previously Documented Pulmonary Embolism': True, 'Hemoptysis': False, 'Previously documented Deep Vein Thrombosis': False}",4,4,4,"The PERC Rule critiera are listed below:

1. Age ≥50: No = 0 points, Yes = +1 point
2. Heart Rate (HR) ≥100: No = 0 points, Yes = +1 point
3. O₂ saturation on room air <95%: No = 0 points, Yes = +1 point
4. Unilateral leg swelling: No = 0 points, Yes = +1 point
5. Hemoptysis: No = 0 points, Yes = +1 point
6. Recent surgery or trauma (within 4 weeks, requiring treatment with general anesthesia): No = 0 points, Yes = +1 point
7. Prior pulmonary embolism (PE) or deep vein thrombosis (DVT): No = 0 points, Yes = +1 point
8. Hormone use (oral contraceptives, hormone replacement, or estrogenic hormone use in males or females): No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the points for each criterion.
    
The current count of PERC criteria met is 0.
The patient is 61.0 years old. The patient's age is greater than or equal to 50 years, and so we increment the perc critieria met by 1, making the current total 0 + 1 = 1.
The patient's heart rate is 88.0 beats per minute. The patient's heart rate is less than 100 beats per minute, and so we do not increment the criteria count. The current total remains at 1.
The saturated oxygen percentage in the room is 88.0 percent. The saturated oxygen is less than 95%, and so we increment the perc critieria met by 1, making the current total 1 + 1 = 2.
The patient note reports 'unilateral leg swelling' to be absent in the patient and so we do not increment the criteria count. The current total remains at 2.
The patient note reports 'hemoptysis' to be absent in the patient and so we do not increment the criteria count. The current total remains at 2.
The patient note reports 'recent surgery or trauma' to be present for the patient and so we increment the criteria count by 1, making the current total 2 + 1  =  3.
The patient must be diagnosed with at least one of deep vein thrombosis or pulmonary embolism in the past for a PERC rule criteria to be met. The patient is not reported to have been diagnosed with deep vein thrombosis in the past. The patient is reported to have been diagnosed with pulmonary embolism in the past. At least one of the criteria is met and so we increment the criteria met by 1, making the current total 3 + 1 = 4.
The patient note reports 'hormonal use' to be absent in the patient and so we do not increment the criteria count. The current total remains at 4.
Hence, the number of PERC rule criteria met by the patient is 4."
570,48,PERC Rule for Pulmonary Embolism,diagnosis,integer,pmc-2840956-1,Extracted,"A 48-year-old non-smoking male, with past medical history of diabetes mellitus and aplastic anemia, was admitted to our hospital with fever, substernal chest pain and dyspnea of three-week duration. On examination, he was in mild respiratory distress. His vital signs were: temperature 38.8° C, pulse 92 bpm, respiratory rate 24 per minute, BP 115 / 64 mm Hg, and oxygen saturation of 95% on room air. He had right-sided chest dullness and crackles. The rest of his exam was negative. His medication included insulin and tacrolimus: 1 mg orally twice a day. His laboratory findings were: WBC 0.5×106/L, hemoglobin 79 g/l, platelets 9×106/L, glucose 13.7 mmol/l, sodium 125 mmol/l, bicarbonate 13 mmol/l, serum creatinine 143 micromol/l, INR 1.5, PT 13.3 sec. Cultures, including acid-fast bacilli, were negative. On his admission, chest x-ray showed a large round opacity adjacent to the right hilum []. Computerized Tomography (CT) scan of the chest confirmed the presence of a 9 × 9 cm mass, with air bronchograms, occupying most of the right upper lobe []. He was admitted with the working diagnosis of neutropenic fever and right upper lobe lung mass. He was started on broad antibiotic coverage with ceftazidime, vancomycin and caspofungin. The patient underwent transthoracic core biopsy of this mass, the histopathologic diagnosis was: pulmonary mucormycosis []. He was subsequently switched to intravenous liposomal amphotericin B therapy. His condition continued to deteriorate requiring transfer to the Intensive Care Unit for mechanical ventilation. His blood count never recuperated despite treatment with granulocyte-colony stimulating factor (G-CSF) and repetitive transfusions. He died 12 days after admission.",What are the number of criteria met for the PERC Rule for Pulmonary Embolism (PE)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [48, 'years'], 'Heart Rate or Pulse': [92.0, 'beats per minute'], 'O₂ saturation percentage': [95.0, '%'], 'Previously Documented Pulmonary Embolism': False, 'Hormone use': False, 'Previously documented Deep Vein Thrombosis': False}",0,0,0,"The PERC Rule critiera are listed below:

1. Age ≥50: No = 0 points, Yes = +1 point
2. Heart Rate (HR) ≥100: No = 0 points, Yes = +1 point
3. O₂ saturation on room air <95%: No = 0 points, Yes = +1 point
4. Unilateral leg swelling: No = 0 points, Yes = +1 point
5. Hemoptysis: No = 0 points, Yes = +1 point
6. Recent surgery or trauma (within 4 weeks, requiring treatment with general anesthesia): No = 0 points, Yes = +1 point
7. Prior pulmonary embolism (PE) or deep vein thrombosis (DVT): No = 0 points, Yes = +1 point
8. Hormone use (oral contraceptives, hormone replacement, or estrogenic hormone use in males or females): No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the points for each criterion.
    
The current count of PERC criteria met is 0.
The patient is 48 years old. The patient's age is less than 50 years, and so we do not increment the criteria count. The current total remains at 0.
The patient's heart rate is 92.0 beats per minute. The patient's heart rate is less than 100 beats per minute, and so we do not increment the criteria count. The current total remains at 0.
The saturated oxygen percentage in the room is 95.0 percent. The saturated oxygen is greater than or equal to 95% and so we do not increment the criteria count. The current total remains at 0.
The patient note does not report a status on 'unilateral leg swelling'. Hence, we assume it to be absent, and so we do not increment the criteria count. The current total remains at 0.
The patient note does not report a status on 'hemoptysis'. Hence, we assume it to be absent, and so we do not increment the criteria count. The current total remains at 0.
The patient note does not report a status on 'recent surgery or trauma'. Hence, we assume it to be absent, and so we do not increment the criteria count. The current total remains at 0.
The patient must be diagnosed with at least one of deep vein thrombosis or pulmonary embolism in the past for a PERC rule criteria to be met. The patient is not reported to have been diagnosed with deep vein thrombosis in the past. The patient is not reported to have been diagnosed with pulmonary embolism in the past. Neither criteria is met and so we do increment the criteria count, keep the current total at 0.
The patient note reports 'hormonal use' to be absent in the patient and so we do not increment the criteria count. The current total remains at 0.
Hence, the number of PERC rule criteria met by the patient is 0."
571,48,PERC Rule for Pulmonary Embolism,diagnosis,integer,pmc-7433124-1,Extracted,"A 21-year-old girl complaining of a six-month history of progressive dyspnoea and chest pain was transferred to our centre because of heart failure, without a history of any cardiovascular diseases, injuries or operations.
On examination, there was a grade 3/6 continuous machinery murmur that was maximal between the right 2nd and 3rd intercostal region and radiated to the right infraclavicular fossa. The patient had a normal saturation value at rest in ambient air (SPO2 95%) with non-cyanotic skin colour. Chest-X-ray revealed cardiomegaly. The electrocardiogram showed sinus rhythm with a heart rate of 95 bpm and a complete right bundle branch block and right ventricular hypertrophy. The respiratory tests were not abnormal.
Transthoracic echocardiography showed a dilated right subclavian artery with an 8-mm fistula to the SVC and obvious stenosis at the proximal initial site of the fistula, in addition to a markedly dilated right ventricle and right atrium and mild tricuspid regurgitation (Fig. a). Continuous wave Doppler showed a flow signal at 2.3 m/s that was continuously moving from the RSA to the SVC with a gradient of 22 mmHg, while the highest flow rate was 3.9 m/s at the stenosis site of the fistula with a gradient of 59 mmHg (Fig. b). Computed tomography angiography further delineated the anatomy of the arteriovenous fistula from the RSA to the SVC and stenosis of the fistula (Fig. c, d).
The patient underwent transcatheter occlusion for the fistula under local anaesthesia. Briefly, a 10/12 mm Amplatzer ductal occluder was delivered and deployed from the SVC side using a 5-F H1 catheter by angiogram guidance, and an 8F sheath was used to send the occluder to occlude the abnormal fistulous connection (Fig. e, f and ). The post-procedure angiogram revealed a completely occluded lumen of the fistula, and the echocardiogram showed no residual shunt. The patient had an uneventful course and a significant improvement in symptoms at the 3-month follow-up.",What are the number of criteria met for the PERC Rule for Pulmonary Embolism (PE)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [21, 'years'], 'Heart Rate or Pulse': [95.0, 'beats per minute'], 'O₂ saturation percentage': [95.0, '%'], 'Hormone use': False, 'Previously Documented Pulmonary Embolism': False, 'Hemoptysis': False, 'Recent surgery or trauma': False, 'Previously documented Deep Vein Thrombosis': False}",0,0,0,"The PERC Rule critiera are listed below:

1. Age ≥50: No = 0 points, Yes = +1 point
2. Heart Rate (HR) ≥100: No = 0 points, Yes = +1 point
3. O₂ saturation on room air <95%: No = 0 points, Yes = +1 point
4. Unilateral leg swelling: No = 0 points, Yes = +1 point
5. Hemoptysis: No = 0 points, Yes = +1 point
6. Recent surgery or trauma (within 4 weeks, requiring treatment with general anesthesia): No = 0 points, Yes = +1 point
7. Prior pulmonary embolism (PE) or deep vein thrombosis (DVT): No = 0 points, Yes = +1 point
8. Hormone use (oral contraceptives, hormone replacement, or estrogenic hormone use in males or females): No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the points for each criterion.
    
The current count of PERC criteria met is 0.
The patient is 21 years old. The patient's age is less than 50 years, and so we do not increment the criteria count. The current total remains at 0.
The patient's heart rate is 95.0 beats per minute. The patient's heart rate is less than 100 beats per minute, and so we do not increment the criteria count. The current total remains at 0.
The saturated oxygen percentage in the room is 95.0 percent. The saturated oxygen is greater than or equal to 95% and so we do not increment the criteria count. The current total remains at 0.
The patient note does not report a status on 'unilateral leg swelling'. Hence, we assume it to be absent, and so we do not increment the criteria count. The current total remains at 0.
The patient note reports 'hemoptysis' to be absent in the patient and so we do not increment the criteria count. The current total remains at 0.
The patient note reports 'recent surgery or trauma' to be absent in the patient and so we do not increment the criteria count. The current total remains at 0.
The patient must be diagnosed with at least one of deep vein thrombosis or pulmonary embolism in the past for a PERC rule criteria to be met. The patient is not reported to have been diagnosed with deep vein thrombosis in the past. The patient is not reported to have been diagnosed with pulmonary embolism in the past. Neither criteria is met and so we do increment the criteria count, keep the current total at 0.
The patient note reports 'hormonal use' to be absent in the patient and so we do not increment the criteria count. The current total remains at 0.
Hence, the number of PERC rule criteria met by the patient is 0."
572,48,PERC Rule for Pulmonary Embolism,diagnosis,integer,usmle-5963,Extracted,"A 23-year-old woman presents to the emergency department with pain and frequent urination. She states she has felt uncomfortable with frequent small-volume urinary voids for the past 3 days, which have progressively worsened. The patient has no past medical history. She currently smokes 1 pack of cigarettes per day and engages in unprotected sex with 2 male partners. Her temperature is 103°F (39.4°C), blood pressure is 127/68 mmHg, pulse is 97/min, respirations are 17/min, and oxygen saturation is 98% on room air. Cardiac, pulmonary, and abdominal exams are within normal limits. There is tenderness upon palpation of the left costovertebral angle and the left flank. Urine is collected and a pregnancy test is negative.",What are the number of criteria met for the PERC Rule for Pulmonary Embolism (PE)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [23.0, 'years'], 'Heart Rate or Pulse': [97.0, 'beats per minute'], 'O₂ saturation percentage': [98.0, '%'], 'Previously Documented Pulmonary Embolism': False, 'Hormone use': False, 'Previously documented Deep Vein Thrombosis': False}",0,0,0,"The PERC Rule critiera are listed below:

1. Age ≥50: No = 0 points, Yes = +1 point
2. Heart Rate (HR) ≥100: No = 0 points, Yes = +1 point
3. O₂ saturation on room air <95%: No = 0 points, Yes = +1 point
4. Unilateral leg swelling: No = 0 points, Yes = +1 point
5. Hemoptysis: No = 0 points, Yes = +1 point
6. Recent surgery or trauma (within 4 weeks, requiring treatment with general anesthesia): No = 0 points, Yes = +1 point
7. Prior pulmonary embolism (PE) or deep vein thrombosis (DVT): No = 0 points, Yes = +1 point
8. Hormone use (oral contraceptives, hormone replacement, or estrogenic hormone use in males or females): No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the points for each criterion.
    
The current count of PERC criteria met is 0.
The patient is 23.0 years old. The patient's age is less than 50 years, and so we do not increment the criteria count. The current total remains at 0.
The patient's heart rate is 97.0 beats per minute. The patient's heart rate is less than 100 beats per minute, and so we do not increment the criteria count. The current total remains at 0.
The saturated oxygen percentage in the room is 98.0 percent. The saturated oxygen is greater than or equal to 95% and so we do not increment the criteria count. The current total remains at 0.
The patient note does not report a status on 'unilateral leg swelling'. Hence, we assume it to be absent, and so we do not increment the criteria count. The current total remains at 0.
The patient note does not report a status on 'hemoptysis'. Hence, we assume it to be absent, and so we do not increment the criteria count. The current total remains at 0.
The patient note does not report a status on 'recent surgery or trauma'. Hence, we assume it to be absent, and so we do not increment the criteria count. The current total remains at 0.
The patient must be diagnosed with at least one of deep vein thrombosis or pulmonary embolism in the past for a PERC rule criteria to be met. The patient is not reported to have been diagnosed with deep vein thrombosis in the past. The patient is not reported to have been diagnosed with pulmonary embolism in the past. Neither criteria is met and so we do increment the criteria count, keep the current total at 0.
The patient note reports 'hormonal use' to be absent in the patient and so we do not increment the criteria count. The current total remains at 0.
Hence, the number of PERC rule criteria met by the patient is 0."
573,48,PERC Rule for Pulmonary Embolism,diagnosis,integer,pmc-4614570-1,Extracted,"The patient was a 23-year-old man referred to the emergency department (ED) with the chief complaint of palpitation. The patient experienced dizziness, cold sweating, and lightheadedness after getting up which started spontaneously. He had four episodes of the same problems seven months ago that felt better after taking 10 mg propranolol. However, in the current episode his problem was not solved by the same medication. He had no history of smoking, substance abuse, medication use, congenital heart disease, syncope, previous surgery, chest trauma, or any other known medical problems. As well, he had no any positive history of the same problems in his family. The patients’ on-arrival vital signs were as follow: systolic blood pressure (SBP): 90 mmHg, pulse rate (PR): 150/minute, respiratory rate (RR): 14/minute, oral temperature: 37◦C, oxygen saturation 96% with nasal cannula and 100% oxygen, Glasgow coma scale (GCS) 15/15. He did not experience any other concomitant problems such as ischemic chest discomfort, shortness of breath, or signs of circulatory shock such as paleness, mottling, etc. On general physical examination the patients’ lung and heart sounds, four limbs pulses, and capillary refill were normal. As well, focused neurological and abdominal examinations did not have any positive finding. The patient underwent close cardiac, vital sign monitoring and electrocardiography (ECG). shows the on-arrival patients’ ECG. Atrial fibrillation (AF) was diagnosed by the corresponding physician and digoxin (!?) prescribed that led to severe lethargy, weakness, sweating, and bradycardia. shows the post mediation ECG of patient.",What are the number of criteria met for the PERC Rule for Pulmonary Embolism (PE)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [23.0, 'years'], 'Heart Rate or Pulse': [150.0, 'beats per minute'], 'O₂ saturation percentage': [96.0, '%'], 'Previously Documented Pulmonary Embolism': False, 'Hemoptysis': False, 'Unilateral Leg Swelling': False, 'Hormone use': False, 'Recent surgery or trauma': False, 'Previously documented Deep Vein Thrombosis': False}",1,1,1,"The PERC Rule critiera are listed below:

1. Age ≥50: No = 0 points, Yes = +1 point
2. Heart Rate (HR) ≥100: No = 0 points, Yes = +1 point
3. O₂ saturation on room air <95%: No = 0 points, Yes = +1 point
4. Unilateral leg swelling: No = 0 points, Yes = +1 point
5. Hemoptysis: No = 0 points, Yes = +1 point
6. Recent surgery or trauma (within 4 weeks, requiring treatment with general anesthesia): No = 0 points, Yes = +1 point
7. Prior pulmonary embolism (PE) or deep vein thrombosis (DVT): No = 0 points, Yes = +1 point
8. Hormone use (oral contraceptives, hormone replacement, or estrogenic hormone use in males or females): No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the points for each criterion.
    
The current count of PERC criteria met is 0.
The patient is 23.0 years old. The patient's age is less than 50 years, and so we do not increment the criteria count. The current total remains at 0.
The patient's heart rate is 150.0 beats per minute. The patient's heart rate is greater than or equal to 100 beats per minute, and so we increment the perc critieria met by 1, making the current total 0 + 1 = 1.
The saturated oxygen percentage in the room is 96.0 percent. The saturated oxygen is greater than or equal to 95% and so we do not increment the criteria count. The current total remains at 1.
The patient note reports 'unilateral leg swelling' to be absent in the patient and so we do not increment the criteria count. The current total remains at 1.
The patient note reports 'hemoptysis' to be absent in the patient and so we do not increment the criteria count. The current total remains at 1.
The patient note reports 'recent surgery or trauma' to be absent in the patient and so we do not increment the criteria count. The current total remains at 1.
The patient must be diagnosed with at least one of deep vein thrombosis or pulmonary embolism in the past for a PERC rule criteria to be met. The patient is not reported to have been diagnosed with deep vein thrombosis in the past. The patient is not reported to have been diagnosed with pulmonary embolism in the past. Neither criteria is met and so we do increment the criteria count, keep the current total at 1.
The patient note reports 'hormonal use' to be absent in the patient and so we do not increment the criteria count. The current total remains at 1.
Hence, the number of PERC rule criteria met by the patient is 1."
574,48,PERC Rule for Pulmonary Embolism,diagnosis,integer,pmc-7306638-1,Extracted,"The patient is an 82-year-old Hispanic male with a past medical history of hyperlipidemia, hypertension, diabetes mellitus, and chronic kidney disease stage IV who presented to the emergency department complaining of bilateral upper extremity and lower extremity weakness and paresthesias for two weeks preceding admission. The patient had multiple falls recently after the onset of these symptoms. His symptoms had gotten to the point where he could not use his walker or even get up from a chair to walk. He denied headaches, diplopia, fevers, chest pain, shortness of breath, nausea, vomiting, hemoptysis, dizziness, bowel incontinence, or bladder incontinence. He also denied any recent travel or consumption of undercooked meats. Vital signs were as follows: temperature of 36.8 °C, heart rate of 58 beats per minute sinus rhythm, respiratory rate of 14 breaths/min, blood pressure of 152/65, saturating 97% on room air. His physical examination was most significant for motor weakness of the bilateral upper and lower extremity, +3/5 on the right versus +4/5 on the left. Grip strength was tested in the upper extremity while dorsiflexion and plantarflexion were tested in the lower extremity. Pronator drift exam was negative.
His laboratory studies were not significant for any acute findings. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were mildly elevated and a complete blood count with differential (CBC with diff) and coagulation profile were within normal limits (Table ). Serology for cysticercosis IgG resulted as negative. CT scan of the head without contrast was negative for acute intracranial abnormalities. There was an old infarct detected in the left internal capsule region. Also noted were chronic right frontal cortical calcifications and anterior right temporal lobe calcifications that were thought to be related to an old infection or hemorrhage. CT angiogram of the head and neck revealed 60% stenosis at the left common carotid artery (CCA) origin and proximal left internal carotid artery (ICA). MR imaging of the cervical spine (c-spine) with and without contrast showed multilevel cervical spondylosis with severe C3-C4 and moderate to severe C6-C7 thecal sac stenosis. Subtle increased cord signals at C3-C4 were concerning for compressive myelopathy. A neurosurgical consultation was obtained and C3-C4 anterior spinal fusion with intervertebral cage placement was performed. MRI of the brain with and without contrast showed multiple subcentimeter parenchymal and extra-axial enhancing lesions in the frontal lobes and along the right sylvian fissure with associated calcifications concerning for active neurocysticercosis (Figure ). The largest lesion along the right insula measured 7 mm with signal characteristics of a small abscess. An Infectious Disease consult was obtained and the patient was started on albendazole and praziquantal by mouth for ten days in total with dexamethasone. His hospital course was uncomplicated with no seizure activity reported. He worked well with physical therapy postoperatively and his bilateral upper and lower extremity weakness improved.",What are the number of criteria met for the PERC Rule for Pulmonary Embolism (PE)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [82.0, 'years'], 'Heart Rate or Pulse': [58.0, 'beats per minute'], 'O₂ saturation percentage': [97.0, '%'], 'Unilateral Leg Swelling': False, 'Previously Documented Pulmonary Embolism': False, 'Hemoptysis': False, 'Previously documented Deep Vein Thrombosis': False}",1,1,1,"The PERC Rule critiera are listed below:

1. Age ≥50: No = 0 points, Yes = +1 point
2. Heart Rate (HR) ≥100: No = 0 points, Yes = +1 point
3. O₂ saturation on room air <95%: No = 0 points, Yes = +1 point
4. Unilateral leg swelling: No = 0 points, Yes = +1 point
5. Hemoptysis: No = 0 points, Yes = +1 point
6. Recent surgery or trauma (within 4 weeks, requiring treatment with general anesthesia): No = 0 points, Yes = +1 point
7. Prior pulmonary embolism (PE) or deep vein thrombosis (DVT): No = 0 points, Yes = +1 point
8. Hormone use (oral contraceptives, hormone replacement, or estrogenic hormone use in males or females): No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the points for each criterion.
    
The current count of PERC criteria met is 0.
The patient is 82.0 years old. The patient's age is greater than or equal to 50 years, and so we increment the perc critieria met by 1, making the current total 0 + 1 = 1.
The patient's heart rate is 58.0 beats per minute. The patient's heart rate is less than 100 beats per minute, and so we do not increment the criteria count. The current total remains at 1.
The saturated oxygen percentage in the room is 97.0 percent. The saturated oxygen is greater than or equal to 95% and so we do not increment the criteria count. The current total remains at 1.
The patient note reports 'unilateral leg swelling' to be absent in the patient and so we do not increment the criteria count. The current total remains at 1.
The patient note reports 'hemoptysis' to be absent in the patient and so we do not increment the criteria count. The current total remains at 1.
The patient note does not report a status on 'recent surgery or trauma'. Hence, we assume it to be absent, and so we do not increment the criteria count. The current total remains at 1.
The patient must be diagnosed with at least one of deep vein thrombosis or pulmonary embolism in the past for a PERC rule criteria to be met. The patient is not reported to have been diagnosed with deep vein thrombosis in the past. The patient is not reported to have been diagnosed with pulmonary embolism in the past. Neither criteria is met and so we do increment the criteria count, keep the current total at 1.
The patient note does not report a status on 'hormonal use'. Hence, we assume it to be absent, and so we do not increment the criteria count. The current total remains at 1.
Hence, the number of PERC rule criteria met by the patient is 1."
575,48,PERC Rule for Pulmonary Embolism,diagnosis,integer,pmc-7061779-1,Extracted,"History
A 52-year-old African American male presented to the emergency department complaining of pleuritic, sharp pain in his right chest wall that had begun three days prior to arrival. The pain had since worsened in intensity and did not radiate. He had taken acetaminophen without relief of his symptoms. The patient denied any fever, coughing up blood, shortness of breath, headache, or rash. His review of symptoms was otherwise negative. The patient had no significant past medical history and was taking no medications. He denied any recent history of surgery or trauma, but did note weight lifting two days prior to the onset of symptoms. Family history was negative for coagulopathies and autoimmune conditions.
Exam findings
Vital signs on arrival were blood pressure 146/97, heart rate 97, temperature 36.2°C, respiratory rate 20, and SpO2 99% on room air. He was alert and oriented, and in no acute distress. Lung sounds were clear bilaterally and heart sounds were normal. A raised cord was visible crossing from the epigastrium across the right breast toward the axilla, that was tender to palpation and mobile. There was no warmth, erythema, or rash overlying the cord. Head/eyes/ears/nose/throat, abdominal, and neurological examinations were unremarkable.
Diagnostic evaluation
Basic metabolic panel and troponin levels were normal, and a complete blood count and differential was unremarkable with platelets of 212 bil/L. Chest radiograph showed clear lung fields but did reveal remote right-sided posterior fractures of ribs five through eight. Given the pleuritic nature of the pain, a computed tomography pulmonary angiogram was ordered to rule out pulmonary embolism. As shown in Figure , it revealed a subtle density in the right chest wall over the area of the palpable cord, with no evidence of a pulmonary embolism. The diagnosis of superficial chest wall thrombophlebitis, or Mondor’s disease, was made.
Patient course
The patient was treated with ibuprofen in the emergency department and discharged with a naproxen prescription. He was referred to his primary care physician for further work-up. The pain improved in the days following his emergency department visit, resolving within a week of discharge. The patient was contacted two months after his emergency department visit. He noted that he was still able to appreciate a firm mass in his chest wall with some reduction in size since it was first diagnosed.",What are the number of criteria met for the PERC Rule for Pulmonary Embolism (PE)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [52, 'years'], 'Heart Rate or Pulse': [97.0, 'beats per minute'], 'O₂ saturation percentage': [99.0, '%'], 'Unilateral Leg Swelling': False, 'Hormone use': False, 'Recent surgery or trauma': False, 'Previously Documented Pulmonary Embolism': False, 'Hemoptysis': False, 'Previously documented Deep Vein Thrombosis': False}",1,1,1,"The PERC Rule critiera are listed below:

1. Age ≥50: No = 0 points, Yes = +1 point
2. Heart Rate (HR) ≥100: No = 0 points, Yes = +1 point
3. O₂ saturation on room air <95%: No = 0 points, Yes = +1 point
4. Unilateral leg swelling: No = 0 points, Yes = +1 point
5. Hemoptysis: No = 0 points, Yes = +1 point
6. Recent surgery or trauma (within 4 weeks, requiring treatment with general anesthesia): No = 0 points, Yes = +1 point
7. Prior pulmonary embolism (PE) or deep vein thrombosis (DVT): No = 0 points, Yes = +1 point
8. Hormone use (oral contraceptives, hormone replacement, or estrogenic hormone use in males or females): No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the points for each criterion.
    
The current count of PERC criteria met is 0.
The patient is 52 years old. The patient's age is greater than or equal to 50 years, and so we increment the perc critieria met by 1, making the current total 0 + 1 = 1.
The patient's heart rate is 97.0 beats per minute. The patient's heart rate is less than 100 beats per minute, and so we do not increment the criteria count. The current total remains at 1.
The saturated oxygen percentage in the room is 99.0 percent. The saturated oxygen is greater than or equal to 95% and so we do not increment the criteria count. The current total remains at 1.
The patient note reports 'unilateral leg swelling' to be absent in the patient and so we do not increment the criteria count. The current total remains at 1.
The patient note reports 'hemoptysis' to be absent in the patient and so we do not increment the criteria count. The current total remains at 1.
The patient note reports 'recent surgery or trauma' to be absent in the patient and so we do not increment the criteria count. The current total remains at 1.
The patient must be diagnosed with at least one of deep vein thrombosis or pulmonary embolism in the past for a PERC rule criteria to be met. The patient is not reported to have been diagnosed with deep vein thrombosis in the past. The patient is not reported to have been diagnosed with pulmonary embolism in the past. Neither criteria is met and so we do increment the criteria count, keep the current total at 1.
The patient note reports 'hormonal use' to be absent in the patient and so we do not increment the criteria count. The current total remains at 1.
Hence, the number of PERC rule criteria met by the patient is 1."
576,48,PERC Rule for Pulmonary Embolism,diagnosis,integer,pmc-8088400-1,Extracted,"A 41-year-old female with a past medical history of hypertension, type 2 diabetes mellitus, and previous non-ST-elevation myocardial infarction with normal coronary arteries (MINOCA) three years prior presented with symptoms of sharp chest pain, dry cough, and shortness of breath, which had started two days prior to the presentation. Her vital signs were remarkable for a blood pressure of 122/91 mmHg, heart rate of 180 beats per minute with an irregular rate, a temperature of 36.4 °C, respiratory rate of 24 breaths per minute, and an oxygen saturation of 98% on 5 L nasal cannula. On examination, the patient appeared to be in mild distress. No jugular venous distention was appreciated. Her chest auscultation revealed bilateral crackles.
A nasopharyngeal swab polymerase chain reaction (PCR) was positive for COVID-19 and blood cultures showed no growth. Chest X-ray revealed patchy bilateral peripheral lung infiltrates (Figure ), and CT angiography of the chest showed no pulmonary embolism but revealed bilateral patchy ground-glass lung infiltrates consistent with COVID-19 pneumonia (Figure ). EKG showed a new atrial flutter with a rapid ventricular response (Figure ). Transthoracic echocardiogram revealed a new low left ventricular (LV) ejection fraction of 35-40%, with LV hypertrophy, as well as a granular appearance of LV myocardium suspicious for infiltrative cardiomyopathy (Figure ). Echocardiogram obtained one year prior had shown LV ejection fraction of 50-55% with LV hypertrophy.
The patient was started on intravenous (IV) diltiazem drip, but her heart rate was difficult to control; hence she was started on IV amiodarone and eventually converted to sinus rhythm. She was started on IV heparin for anticoagulation. Her respiratory status deteriorated, and she was subsequently intubated and mechanically ventilated. The COVID-19 pneumonia was treated with a combination of steroids, antibiotics, remdesivir, and convalescence plasma. She improved clinically and was discharged home on oral amiodarone, metoprolol succinate, and warfarin.
CMR obtained about two months from the date of admission showed extensive myocarditis with a typical pattern of sub-epicardial and mid-wall delayed enhancement (Figure ). There was no edema to indicate the acuteness of the disease. LV systolic function was normal with an ejection fraction of 60-65%. These findings confirmed that the patient had suffered from an acute illness at the time of her initial presentation, causing acute symptoms, a drop in LV ejection fraction, and the development of new arrhythmia, which had all resolved by the time of CMR acquisition.",What are the number of criteria met for the PERC Rule for Pulmonary Embolism (PE)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [41.0, 'years'], 'Heart Rate or Pulse': [180.0, 'beats per minute'], 'O₂ saturation percentage': [98.0, '%'], 'Hemoptysis': False, 'Previously Documented Pulmonary Embolism': False, 'Previously documented Deep Vein Thrombosis': False}",1,1,1,"The PERC Rule critiera are listed below:

1. Age ≥50: No = 0 points, Yes = +1 point
2. Heart Rate (HR) ≥100: No = 0 points, Yes = +1 point
3. O₂ saturation on room air <95%: No = 0 points, Yes = +1 point
4. Unilateral leg swelling: No = 0 points, Yes = +1 point
5. Hemoptysis: No = 0 points, Yes = +1 point
6. Recent surgery or trauma (within 4 weeks, requiring treatment with general anesthesia): No = 0 points, Yes = +1 point
7. Prior pulmonary embolism (PE) or deep vein thrombosis (DVT): No = 0 points, Yes = +1 point
8. Hormone use (oral contraceptives, hormone replacement, or estrogenic hormone use in males or females): No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the points for each criterion.
    
The current count of PERC criteria met is 0.
The patient is 41.0 years old. The patient's age is less than 50 years, and so we do not increment the criteria count. The current total remains at 0.
The patient's heart rate is 180.0 beats per minute. The patient's heart rate is greater than or equal to 100 beats per minute, and so we increment the perc critieria met by 1, making the current total 0 + 1 = 1.
The saturated oxygen percentage in the room is 98.0 percent. The saturated oxygen is greater than or equal to 95% and so we do not increment the criteria count. The current total remains at 1.
The patient note does not report a status on 'unilateral leg swelling'. Hence, we assume it to be absent, and so we do not increment the criteria count. The current total remains at 1.
The patient note reports 'hemoptysis' to be absent in the patient and so we do not increment the criteria count. The current total remains at 1.
The patient note does not report a status on 'recent surgery or trauma'. Hence, we assume it to be absent, and so we do not increment the criteria count. The current total remains at 1.
The patient must be diagnosed with at least one of deep vein thrombosis or pulmonary embolism in the past for a PERC rule criteria to be met. The patient is not reported to have been diagnosed with deep vein thrombosis in the past. The patient is not reported to have been diagnosed with pulmonary embolism in the past. Neither criteria is met and so we do increment the criteria count, keep the current total at 1.
The patient note does not report a status on 'hormonal use'. Hence, we assume it to be absent, and so we do not increment the criteria count. The current total remains at 1.
Hence, the number of PERC rule criteria met by the patient is 1."
577,48,PERC Rule for Pulmonary Embolism,diagnosis,integer,pmc-4280479-1,Extracted,"A 66-year-old man a past smoker with a medical history of acute myocardial infarction on the inferior wall due to coronary artery spasm 8 years ago (weight, 67.2 kg; height, 163.5 cm; American Society of Anesthesiologists physical status classification II) was scheduled to undergo laparoscopy-assisted distal gastrectomy with gastroduodenostomy. His functional capacity was higher than 4 metabolic equivalents and he had no previous experience of general anesthesia. Preoperative evaluation showed a normal electrocardiogram (ECG) and no specific lung lesion was found by chest radiography. There was no abnormal finding in a pulmonary function test or in conventional laboratory exams. Preoperative thallium single photon emission computerized tomography (SPECT) detected a perfusion defect on the inferior wall, and transthoracic echocardiography (TTE) showed a moderate degree of akinesia on the inferior wall. Both of these findings in thallium SPECT and TTE were detected for 8 years after the previous attack with no development of new ischemic lesions.
When the patient arrived in the operation room, his blood pressure (BP; systolic/diastolic), heart rate, and peripheral oxygen saturation (SpO2) were 166/94 mmHg, 76 beats/min, and 99% respectively. Preoxygenation with 80% oxygen was performed followed by intravenous administration of midazolam 2 mg and lidocaine 20 mg. Induction was started with a target controlled infusion (TCI; Asan Pump, version 2.0, BionetCo., Seoul, Korea) of propofol and remifentanil at 2 µg/ml and 3 ng/ml, respectively. Cisatracurium (12 mg) was administered and mask-valve ventilation was started after the patient lost his spontaneous breathing. During mask ventilation, a depression in ST segment of more than 3 mm was detected in ECG, and difficulty in manual ventilation was noted. Propofol and remifentanil infusion were immediately stopped, and the patient was promptly intubated followed by ventilation with 100% oxygen. A few minutes later, SpO2 rapidly decreased and his BP, initially 128/78 mmHg, dropped to 64/42 mmHg. Although vasoactive drugs including phenylephrine and epinephrine were administered, the BP continued to decrease to an undetectable level by a noninvasive BP cuff. Direct arterial pressure was monitored, and a central venous catheter was inserted to maintain fluid therapy and continuous drug administration. The patient quickly developed ventricular fibrillation and we thus initiated a sequential algorithm of cardiopulmonary cerebral resuscitation (CPCR). Immediate defibrillation (200J) followed by manual chest compression was performed with repeated intravenous administration of atropine (0.5 mg) and epinephrine (1 mg). A portable transesophageal echocardiography (TEE) was obtained 20 minutes after CPCR was initiated, which showed global hypokinesia in the myocardial wall with akinesia in the inferior wall. However, the patient had not return of spontaneous circulation for 40 minutes, and the patient showed repeated ventricular fibrillation refractory to defibrillation. An emergent consultation of cardiac surgeons was requested to apply veno-arterial type extracorporeal membrane oxygenation (ECMO) to substitute cardiac function. The patient was transferred to the intensive care unit (ICU) and remained intubated during the application of ECMO. In the ICU, sequential laboratory tests including cardiac enzymes were performed. Upon arrival in the ICU, the patient's serum troponin-I and creatine kinase-MB (CK-MB) levels were 6.292 ng/ml and 34.6 ng/ml respectively, and within 5 hours they were increased to 44.099 ng/ml and 107.3 ng/ml. After 8 hours of ICU admission, 12-lead ECG showed normal sinus rhythm with right bundle branch block. On the same day, the patient had return of drowsy consciousness level from comatose state. After showing improvement on serial ECG and the hemodynamic status of the patient, the ECMO circuit was successfully weaned on the following day. He was remain intubated and sedated for three more days to continue conventional therapies for recovery and discharged to the general ward on the day of extubation. Cardiac enzymes levels were normalized (troponin-I, 1.5 ng/ml;CK-MB, 3.7 ng/ml) 5 days after the incidence had occurred.
On suspicion of anaphylactic reaction as a cause of perioperative MI, serum tryptase level was measured and an intradermal skin test was performed to all anesthetic drugs that had been used during the induction period. The level of serum tryptase was detected on the day of the incidence occurred. Serum tryptase level was 28.6 µg/L, which was higher than normal value (13.5 µg/L). Three days after the incidence, an intradermal skin test was performed and a positive reaction was only seen in cisatracurium at a 1 : 100 dilution. All other drugs rendered negative results.",What are the number of criteria met for the PERC Rule for Pulmonary Embolism (PE)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [66.0, 'years'], 'Heart Rate or Pulse': [76.0, 'beats per minute'], 'O₂ saturation percentage': [99.0, '%'], 'Recent surgery or trauma': False, 'Previously Documented Pulmonary Embolism': False, 'Previously documented Deep Vein Thrombosis': False}",1,1,1,"The PERC Rule critiera are listed below:

1. Age ≥50: No = 0 points, Yes = +1 point
2. Heart Rate (HR) ≥100: No = 0 points, Yes = +1 point
3. O₂ saturation on room air <95%: No = 0 points, Yes = +1 point
4. Unilateral leg swelling: No = 0 points, Yes = +1 point
5. Hemoptysis: No = 0 points, Yes = +1 point
6. Recent surgery or trauma (within 4 weeks, requiring treatment with general anesthesia): No = 0 points, Yes = +1 point
7. Prior pulmonary embolism (PE) or deep vein thrombosis (DVT): No = 0 points, Yes = +1 point
8. Hormone use (oral contraceptives, hormone replacement, or estrogenic hormone use in males or females): No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the points for each criterion.
    
The current count of PERC criteria met is 0.
The patient is 66.0 years old. The patient's age is greater than or equal to 50 years, and so we increment the perc critieria met by 1, making the current total 0 + 1 = 1.
The patient's heart rate is 76.0 beats per minute. The patient's heart rate is less than 100 beats per minute, and so we do not increment the criteria count. The current total remains at 1.
The saturated oxygen percentage in the room is 99.0 percent. The saturated oxygen is greater than or equal to 95% and so we do not increment the criteria count. The current total remains at 1.
The patient note does not report a status on 'unilateral leg swelling'. Hence, we assume it to be absent, and so we do not increment the criteria count. The current total remains at 1.
The patient note does not report a status on 'hemoptysis'. Hence, we assume it to be absent, and so we do not increment the criteria count. The current total remains at 1.
The patient note reports 'recent surgery or trauma' to be absent in the patient and so we do not increment the criteria count. The current total remains at 1.
The patient must be diagnosed with at least one of deep vein thrombosis or pulmonary embolism in the past for a PERC rule criteria to be met. The patient is not reported to have been diagnosed with deep vein thrombosis in the past. The patient is not reported to have been diagnosed with pulmonary embolism in the past. Neither criteria is met and so we do increment the criteria count, keep the current total at 1.
The patient note does not report a status on 'hormonal use'. Hence, we assume it to be absent, and so we do not increment the criteria count. The current total remains at 1.
Hence, the number of PERC rule criteria met by the patient is 1."
578,48,PERC Rule for Pulmonary Embolism,diagnosis,integer,pmc-7890353-1,Extracted,"In October 2020, a 73-year-old man was admitted to the accident and emergency department of the University Hospital of Catania, Sicily, Italy, reporting fever, dry cough and diarrhea. Vital signs were recorded as the following: blood pressure of 160/87 mmHg, heart rate of 85 beats per minute, respiratory rate of 40 beats per minute and SPo2 of 78%. A chest X-ray showed bilateral infiltrates () and a nasopharyngeal swab sample was collected and tested positive for COVID-19 using molecular testing.
The patient was moved to the ICU with the diagnosis of Coronavirus-19 pneumonia. Clinical history was updated to include a previous diagnosis of diabetes and hypertension. Corticosteroid therapy with dexamethasone (12 mg/day) and C-PAP ventilation were immediately required. In the following days, laboratory tests showed significant increases of white blood cells (up to 30210/mm3) and lactate (up to 864 U/L), and low albumin (down to 2.27 g/dL). There was also a high increase of C-reactive protein up to 101.87 mg/L. On day 4, seric levels of the GM (Platelia Aspergillus; Biorad) and 1,3-β-D-glucan (Fungitell; Associates of Cape Cod Inc., Falmouth, Massachusetts, USA) were prescribed because of the patient's risk factors, which tested negative. On day 10 ventilator support with oro-tracheal intubation was implemented, due to a rapid decline of the patient's consciousness and respiratory quality. Because of a fever episode, antibiotic treatment with meropenem (3g/day) was started and a peripheral blood sample was taken for a microbiological culture, which tested negative. On the same day some surveillance exams were performed: cultures from rectal, nasal and pharyngeal swabs reported a normal microbiota, while a culture from a urinary sample revealed 100000 ufc/ml of Pseudomonas aeruginosa. Because of this positive result the urinary catheter was removed and a therapeutic lavage with antibiotics was carried out, with complete resolution. On day 16 a new chest X-ray was performed that showed a pulmonary worsening ().
At the same time, new seric dosages were required: β-glucan serum level was 84 pg/mL while galactomannan had a T index of 4.9, suggestive of probable fungal angioinvasion. A bronchoaspirate sample was collected for bacteriological and mycological examinations, because of the persistence of high inflammation indices. For the mycological examination conventional methods by microscopic and fungal culture in Sabouraud's dextrose agar medium supplemented with chloramphenicol and gentamycin were performed. Molecular methods were also used and real-time PCR assay for the detection of Aspergillus was carried out. The AsperGenius® multiplex PCR (PathoNostics, The Netherlands) was used for the detection of the most clinically relevant Aspergillus species. DNA was extracted by using the GenoXtract instrument (Hain Lifescience, Germany) following the manufacturer's instructions. PCR was performed adding 5 μl of DNA extract to the PCR mix and a Rotor-Gene Q (Qiagen) was used for amplification and melting curve analysis. The direct microscopic examination with 15% potassium hydroxide (KOH) showed several hyaline septate hyphae and Aspergillus sp. was detected by PCR. After 72 h of incubation at 32 °C, the growth of numerous colonies was observed ().
Identification of the isolate was performed by standard phenotypic methods, based on macroscopic and microscopic morphological studies. The pathogen was identified as Aspergillus section Nigri. Matrix-assisted laser desorption ionization time of flight mass spectrometry on a Microflex LT (Bruker Daltonics, Bremen, Germany) platform after ethanol-formic acid extraction, identified the isolate as Aspergillus niger (score: 2.155). The same sample reported negative results from bacteriological examinations. Surveillance cultures from oropharyngeal, rectal and nasal swabs also revealed the presence of Aspergillus niger. Susceptibility to fluconazole, itraconazole, voriconazole, posaconazole, flucytosine, caspofungin, anidulafungin, micafungin, and amphotericin B, was evaluated by the Sensititre®YeastOne method. MIC values of >256 μg/mL for fluconazole, 0.25 μg/mL for itraconazole, 1 μg/mL for voriconazole, 0.125 μg/mL for posaconazole, 2 μg/mL for flucytosine, and 0.12 μg/mL for amphotericin B were obtained. Echinocandins presented adequate minimum effective concentration (MEC) values: 0.03 μg/mL for micafungin, 0.015 μg/mL for caspofungin and 0.03 μg/mL for anidulafungin. Results showed various therapeutic options evaluated with dilution ranges and epidemiological cut-offs in the absence of clinical breakpoints []. Some literature reports evaluated the effectiveness of isavuconazole against the Aspergillus genus and the reliability of the MIC strip method for its susceptibility test [,]. According to these reports, the susceptibility test for isavuconazole was performed using the MIC strip method and showed a MIC value of 2 mg/L. The patient was put on voriconazole 800 mg/day. On day 19, the patient died in the ICU of heart failure, while he was still on ventilator support.",What are the number of criteria met for the PERC Rule for Pulmonary Embolism (PE)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [73.0, 'years'], 'Heart Rate or Pulse': [85.0, 'beats per minute'], 'O₂ saturation percentage': [78.0, '%'], 'Previously Documented Pulmonary Embolism': False, 'Recent surgery or trauma': False, 'Previously documented Deep Vein Thrombosis': False}",2,2,2,"The PERC Rule critiera are listed below:

1. Age ≥50: No = 0 points, Yes = +1 point
2. Heart Rate (HR) ≥100: No = 0 points, Yes = +1 point
3. O₂ saturation on room air <95%: No = 0 points, Yes = +1 point
4. Unilateral leg swelling: No = 0 points, Yes = +1 point
5. Hemoptysis: No = 0 points, Yes = +1 point
6. Recent surgery or trauma (within 4 weeks, requiring treatment with general anesthesia): No = 0 points, Yes = +1 point
7. Prior pulmonary embolism (PE) or deep vein thrombosis (DVT): No = 0 points, Yes = +1 point
8. Hormone use (oral contraceptives, hormone replacement, or estrogenic hormone use in males or females): No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the points for each criterion.
    
The current count of PERC criteria met is 0.
The patient is 73.0 years old. The patient's age is greater than or equal to 50 years, and so we increment the perc critieria met by 1, making the current total 0 + 1 = 1.
The patient's heart rate is 85.0 beats per minute. The patient's heart rate is less than 100 beats per minute, and so we do not increment the criteria count. The current total remains at 1.
The saturated oxygen percentage in the room is 78.0 percent. The saturated oxygen is less than 95%, and so we increment the perc critieria met by 1, making the current total 1 + 1 = 2.
The patient note does not report a status on 'unilateral leg swelling'. Hence, we assume it to be absent, and so we do not increment the criteria count. The current total remains at 2.
The patient note does not report a status on 'hemoptysis'. Hence, we assume it to be absent, and so we do not increment the criteria count. The current total remains at 2.
The patient note reports 'recent surgery or trauma' to be absent in the patient and so we do not increment the criteria count. The current total remains at 2.
The patient must be diagnosed with at least one of deep vein thrombosis or pulmonary embolism in the past for a PERC rule criteria to be met. The patient is not reported to have been diagnosed with deep vein thrombosis in the past. The patient is not reported to have been diagnosed with pulmonary embolism in the past. Neither criteria is met and so we do increment the criteria count, keep the current total at 2.
The patient note does not report a status on 'hormonal use'. Hence, we assume it to be absent, and so we do not increment the criteria count. The current total remains at 2.
Hence, the number of PERC rule criteria met by the patient is 2."
579,48,PERC Rule for Pulmonary Embolism,diagnosis,integer,pmc-2850855-1,Extracted,"A 40-year-old Hispanic woman called 911 for worsening chest tightness, generalized weakness and vomiting of two days. On arrival, paramedics performed an EKG that revealed sustained monomorphic ventricular tachycardia at 160–180 beats/minute. Blood pressure and oxygen saturation were normal. She was treated with 40 mg intravenous lidocaine after which she converted to normal sinus rhythm. In the emergency department (ED), she was alert and complained of weakness of all four extremities. She denied shortness of breath. She had a history of hyperthyroidism and hypertension but took no medicines or oral contraceptives. Vital signs were blood pressure of 126/70 mm of Hg, pulse of 90 beats/minute and respiratory rate of 18 breaths/minute. She was afebrile, and oxygen saturation was 96% in room air. Cardiac and lung examinations were normal. There was no thyromegaly. Neurological examination showed 2/6 strength and hypoactive reflexes in all four extremities. Cranial nerves and sensations were normal. Initial laboratory tests showed potassium of 2.3 mEq/L (normal: 3.5–5.5mEq/L) with normal anion gap. Magnesium, chloride, calcium and creatinine were normal. Urinary toxicology screen was negative. A 12-lead electrocardiogram showed normal sinus rhythm. In the ED the patient received 40 mEq of oral potassium chloride, and intravenous (IV) potassium was started at 20 mEq/hour. Repeat laboratory testing after three hours showed potassium of 1.9 mEq/L. Thyroid-stimulating hormone was low (0.01μunit/ml; normal: 0.5–5.0 μunit/ml) with high free thyroxine (7.77 ng/dL; normal: 0.75 to 1.8 ng/dL). The patient complained of worsening weakness in her legs. She was given additional 40 mEq of oral potassium. Potassium was increased to 30 mEq/hour IV, and the patient was admitted to medical intensive care unit.
A diagnosis of TPP was made based on clinical presentation and laboratory results. Blood drawn after eight hours showed potassium of 6.6 mEq/L. Intravenous potassium was stopped, and intravenous dose of 1 gm calcium, 50% solution of 50 ml dextrose, and 10 units of insulin were given urgently to correct hyperkalemia. Despite these, the patient developed episodes of ventricular fibrillation and despite several attempts at electrical cardioversion, she died. Her potassium level was 10.1 mEq/L at the time of her death.",What are the number of criteria met for the PERC Rule for Pulmonary Embolism (PE)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [40, 'years'], 'Heart Rate or Pulse': [90.0, 'beats per minute'], 'O₂ saturation percentage': [96.0, '%'], 'Previously Documented Pulmonary Embolism': False, 'Previously documented Deep Vein Thrombosis': False, 'Hemoptysis': False, 'Unilateral Leg Swelling': False, 'Hormone use': False, 'Recent surgery or trauma': False}",0,0,0,"The PERC Rule critiera are listed below:

1. Age ≥50: No = 0 points, Yes = +1 point
2. Heart Rate (HR) ≥100: No = 0 points, Yes = +1 point
3. O₂ saturation on room air <95%: No = 0 points, Yes = +1 point
4. Unilateral leg swelling: No = 0 points, Yes = +1 point
5. Hemoptysis: No = 0 points, Yes = +1 point
6. Recent surgery or trauma (within 4 weeks, requiring treatment with general anesthesia): No = 0 points, Yes = +1 point
7. Prior pulmonary embolism (PE) or deep vein thrombosis (DVT): No = 0 points, Yes = +1 point
8. Hormone use (oral contraceptives, hormone replacement, or estrogenic hormone use in males or females): No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the points for each criterion.
    
The current count of PERC criteria met is 0.
The patient is 40 years old. The patient's age is less than 50 years, and so we do not increment the criteria count. The current total remains at 0.
The patient's heart rate is 90.0 beats per minute. The patient's heart rate is less than 100 beats per minute, and so we do not increment the criteria count. The current total remains at 0.
The saturated oxygen percentage in the room is 96.0 percent. The saturated oxygen is greater than or equal to 95% and so we do not increment the criteria count. The current total remains at 0.
The patient note reports 'unilateral leg swelling' to be absent in the patient and so we do not increment the criteria count. The current total remains at 0.
The patient note reports 'hemoptysis' to be absent in the patient and so we do not increment the criteria count. The current total remains at 0.
The patient note reports 'recent surgery or trauma' to be absent in the patient and so we do not increment the criteria count. The current total remains at 0.
The patient must be diagnosed with at least one of deep vein thrombosis or pulmonary embolism in the past for a PERC rule criteria to be met. The patient is not reported to have been diagnosed with deep vein thrombosis in the past. The patient is not reported to have been diagnosed with pulmonary embolism in the past. Neither criteria is met and so we do increment the criteria count, keep the current total at 0.
The patient note reports 'hormonal use' to be absent in the patient and so we do not increment the criteria count. The current total remains at 0.
Hence, the number of PERC rule criteria met by the patient is 0."
580,48,PERC Rule for Pulmonary Embolism,diagnosis,integer,usmle-1611,Extracted,"A 69-year-old man comes to the physician with a 9-month history of worsening shortness of breath on exertion and need to urinate at night. He occasionally has palpitations but does not have chest pain. The patient had a transient ischemic attack 5 years ago for which he underwent right-sided carotid endarterectomy. He has hypertension and type 2 diabetes mellitus. Current medications include metformin, lisinopril, aspirin, and simvastatin. He appears fatigued. His pulse is 61/min, blood pressure is 120/75 mmHg, and respirations are 25/min. Pulse oximetry shows an oxygen saturation of 96%. Examination shows cold extremities. There are no murmurs or rubs on cardiac auscultation. Fine, bilateral crackles are heard at the lung bases. There is 2+ lower extremity edema. An ECG shows sinus rhythm and known T wave inversions in leads V1 to V4.",What are the number of criteria met for the PERC Rule for Pulmonary Embolism (PE)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [69.0, 'years'], 'Heart Rate or Pulse': [61.0, 'beats per minute'], 'O₂ saturation percentage': [96.0, '%'], 'Unilateral Leg Swelling': False, 'Hormone use': False, 'Recent surgery or trauma': False, 'Previously Documented Pulmonary Embolism': False, 'Hemoptysis': False, 'Previously documented Deep Vein Thrombosis': False}",1,1,1,"The PERC Rule critiera are listed below:

1. Age ≥50: No = 0 points, Yes = +1 point
2. Heart Rate (HR) ≥100: No = 0 points, Yes = +1 point
3. O₂ saturation on room air <95%: No = 0 points, Yes = +1 point
4. Unilateral leg swelling: No = 0 points, Yes = +1 point
5. Hemoptysis: No = 0 points, Yes = +1 point
6. Recent surgery or trauma (within 4 weeks, requiring treatment with general anesthesia): No = 0 points, Yes = +1 point
7. Prior pulmonary embolism (PE) or deep vein thrombosis (DVT): No = 0 points, Yes = +1 point
8. Hormone use (oral contraceptives, hormone replacement, or estrogenic hormone use in males or females): No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the points for each criterion.
    
The current count of PERC criteria met is 0.
The patient is 69.0 years old. The patient's age is greater than or equal to 50 years, and so we increment the perc critieria met by 1, making the current total 0 + 1 = 1.
The patient's heart rate is 61.0 beats per minute. The patient's heart rate is less than 100 beats per minute, and so we do not increment the criteria count. The current total remains at 1.
The saturated oxygen percentage in the room is 96.0 percent. The saturated oxygen is greater than or equal to 95% and so we do not increment the criteria count. The current total remains at 1.
The patient note reports 'unilateral leg swelling' to be absent in the patient and so we do not increment the criteria count. The current total remains at 1.
The patient note reports 'hemoptysis' to be absent in the patient and so we do not increment the criteria count. The current total remains at 1.
The patient note reports 'recent surgery or trauma' to be absent in the patient and so we do not increment the criteria count. The current total remains at 1.
The patient must be diagnosed with at least one of deep vein thrombosis or pulmonary embolism in the past for a PERC rule criteria to be met. The patient is not reported to have been diagnosed with deep vein thrombosis in the past. The patient is not reported to have been diagnosed with pulmonary embolism in the past. Neither criteria is met and so we do increment the criteria count, keep the current total at 1.
The patient note reports 'hormonal use' to be absent in the patient and so we do not increment the criteria count. The current total remains at 1.
Hence, the number of PERC rule criteria met by the patient is 1."
581,48,PERC Rule for Pulmonary Embolism,diagnosis,integer,pmc-6283766-1,Extracted,"A 47-year-old man presented with melena, abdominal pain, and syncope for two days. He had no prior history of gastrointestinal (GI) bleeding. The patient underwent IGB (ReShape Integrated Dual Balloon System; ReShape Medical, Inc., San Clemente, CA, USA) placement with the instillation of 900 mL of saline for weight loss five months prior to presentation. He had no past history of alcohol consumption, liver disease, or past surgeries. He was taking esomeprazole 40 mg delayed release oral capsules once daily and had recently taken ibuprofen 400 mg daily for the past five days for back pain. Vital signs included blood pressure 65/55 mm Hg, heart rate 98 beats/minute, O2 saturation 97% on room air, temperature 98.5°F, and respiratory rate 19 breaths/minute. His pre-Rockall score was 2. His hemoglobin dropped to a nadir of 7.1 gm/dL during hospitalization from a level of 14.3 gm/dL eight months prior to admission. The patient was admitted to the medical intensive care unit due to hemodynamic instability and was resuscitated with normal saline and one unit of packed red blood cells. Abdominal computed tomography showed two connected saline-filled gastric balloons (). He underwent esophagogastroduodenoscopy; a small 8 mm gastric ulcer Forrest class III) was found in the incisura, and the balloon was removed (). Biopsy revealed severe chronic gastritis and Helicobacter pylori on immunoperoxidase staining. He was discharged after a five-day hospital stay.",What are the number of criteria met for the PERC Rule for Pulmonary Embolism (PE)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [47, 'years'], 'Heart Rate or Pulse': [98.0, 'beats per minute'], 'O₂ saturation percentage': [97.0, '%'], 'Hormone use': False, 'Previously Documented Pulmonary Embolism': False, 'Hemoptysis': False, 'Recent surgery or trauma': False, 'Previously documented Deep Vein Thrombosis': False}",0,0,0,"The PERC Rule critiera are listed below:

1. Age ≥50: No = 0 points, Yes = +1 point
2. Heart Rate (HR) ≥100: No = 0 points, Yes = +1 point
3. O₂ saturation on room air <95%: No = 0 points, Yes = +1 point
4. Unilateral leg swelling: No = 0 points, Yes = +1 point
5. Hemoptysis: No = 0 points, Yes = +1 point
6. Recent surgery or trauma (within 4 weeks, requiring treatment with general anesthesia): No = 0 points, Yes = +1 point
7. Prior pulmonary embolism (PE) or deep vein thrombosis (DVT): No = 0 points, Yes = +1 point
8. Hormone use (oral contraceptives, hormone replacement, or estrogenic hormone use in males or females): No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the points for each criterion.
    
The current count of PERC criteria met is 0.
The patient is 47 years old. The patient's age is less than 50 years, and so we do not increment the criteria count. The current total remains at 0.
The patient's heart rate is 98.0 beats per minute. The patient's heart rate is less than 100 beats per minute, and so we do not increment the criteria count. The current total remains at 0.
The saturated oxygen percentage in the room is 97.0 percent. The saturated oxygen is greater than or equal to 95% and so we do not increment the criteria count. The current total remains at 0.
The patient note does not report a status on 'unilateral leg swelling'. Hence, we assume it to be absent, and so we do not increment the criteria count. The current total remains at 0.
The patient note reports 'hemoptysis' to be absent in the patient and so we do not increment the criteria count. The current total remains at 0.
The patient note reports 'recent surgery or trauma' to be absent in the patient and so we do not increment the criteria count. The current total remains at 0.
The patient must be diagnosed with at least one of deep vein thrombosis or pulmonary embolism in the past for a PERC rule criteria to be met. The patient is not reported to have been diagnosed with deep vein thrombosis in the past. The patient is not reported to have been diagnosed with pulmonary embolism in the past. Neither criteria is met and so we do increment the criteria count, keep the current total at 0.
The patient note reports 'hormonal use' to be absent in the patient and so we do not increment the criteria count. The current total remains at 0.
Hence, the number of PERC rule criteria met by the patient is 0."
582,48,PERC Rule for Pulmonary Embolism,diagnosis,integer,pmc-6994785-1,Extracted,"A 78-year-old man was referred to the Department of Cardiology of Matsushita Memorial Hospital for dyspnea. The patient had been stable at a nursing home until approximately 18 hours before presentation, when the staff noticed that his appetite decreased during dinner. The next morning, the patient reported difficulty breathing and exhibited pallor.
His medical history included heart failure, cerebral infarction, cognitive impairment, chronic kidney disease, and hypertension. Medications included carvedilol at a dose of 2.5 mg daily, furosemide at a dose of 40 mg daily, isosorbide dinitrate at a dose of 40 mg daily, and laxatives as needed. He quit smoking 10 years earlier after a 48-pack-year history, did not drink or use illicit drugs, and had no known allergies.
On examination, he was lethargic and drowsy, but responsive to simple commands. His blood pressure was 144/87 mmHg, pulse was 108 beats per minute, body temperature was 36.7 ºC, and respiratory rate was 28 breaths per minute; his oxygen saturation was 79% while breathing ambient air and 94% while receiving oxygen through a face mask with a reservoir bag at a rate of 10 liters per minute. The jugular venous pulse was high at 10 cm of water. Chest auscultation revealed a gallop rhythm and bibasilar lung crackles. The abdomen was soft and nondistended, and there was no edema of the legs.
An electrocardiogram demonstrated a normal sinus rhythm, right bundle branch block, small q waves in the inferior leads, slight ST-elevation in aVR, and ST-segment depressions in leads V3 to V6 (). Bilateral opacities in the lower lung fields were observed on an anteroposterior chest radiograph (), and diffusely decreased wall motion in the left ventricle was noted on bedside echocardiography. Arterial blood gases, obtained with supplemental oxygen, revealed a pH of 7.256, partial pressure of carbon dioxide of 29.5 mmHg, partial pressure of oxygen of 93.8 mmHg, and lactate of 121 mg/dL. His white blood cell count was 13,400 per cubic millimeter with 88.2% neutrophils. The levels of lactate dehydrogenase, total bilirubin, and creatinine were 687 U/L, 2.4 mg/dL, and 2.98 mg/dL, respectively. The levels of creatine kinase and its MB fraction were 1072 U/L and 146 U/L, respectively. The troponin T level was 3.800 ng/mL (reference value, ≤0.100) and brain natriuretic peptide level was 4256.4 pg/mL (reference value, ≤18.4).
A diagnosis of non-ST-segment elevation acute myocardial infarction accompanying heart failure was made. Emergency coronary angiography demonstrated total occlusion of the proximal portion of the right coronary artery and left circumflex coronary artery with collateral flow from the left anterior descending coronary artery, in which severe stenoses were present at the proximal site and the first branch (). Given his comorbidities and preferences, subsequent angioplasty was waived.
Myocardial imaging with thallium-201 (111 MBq) and 99mTc-PYP (740 MBq) was performed four days after admission. A total of 36 images over a 180-degree anterior arc were acquired 5 minutes and 3 hours after tracer injections, respectively, using a digital gamma camera equipped with a low-energy, high-resolution, parallel-hole collimator. The acquisition lasted 50 beats per projection, was stored in a matrix of 64×64 pixels, and the images were reconstructed using a Hanning filter without attenuation or scatter correction. Single-photon emission computed tomography () revealed slightly reduced thallium-201 uptake in the inferior wall and apex, and extensive uptake of 99mTc-PYP in the entire left ventricle and the free wall of the right ventricle. Of note, the uptake of 99mTc-PYP in the left ventricle was distributed to the inner layer with some overlap with that of thallium-201, a finding consistent with myocardial infarction and/or injury in the left ventricular subendocardial regions.",What are the number of criteria met for the PERC Rule for Pulmonary Embolism (PE)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [78.0, 'years'], 'Heart Rate or Pulse': [108.0, 'beats per minute'], 'O₂ saturation percentage': [79.0, '%'], 'Unilateral Leg Swelling': False, 'Hormone use': False, 'Recent surgery or trauma': False, 'Previously documented Deep Vein Thrombosis': False, 'Previously Documented Pulmonary Embolism': False}",3,3,3,"The PERC Rule critiera are listed below:

1. Age ≥50: No = 0 points, Yes = +1 point
2. Heart Rate (HR) ≥100: No = 0 points, Yes = +1 point
3. O₂ saturation on room air <95%: No = 0 points, Yes = +1 point
4. Unilateral leg swelling: No = 0 points, Yes = +1 point
5. Hemoptysis: No = 0 points, Yes = +1 point
6. Recent surgery or trauma (within 4 weeks, requiring treatment with general anesthesia): No = 0 points, Yes = +1 point
7. Prior pulmonary embolism (PE) or deep vein thrombosis (DVT): No = 0 points, Yes = +1 point
8. Hormone use (oral contraceptives, hormone replacement, or estrogenic hormone use in males or females): No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the points for each criterion.
    
The current count of PERC criteria met is 0.
The patient is 78.0 years old. The patient's age is greater than or equal to 50 years, and so we increment the perc critieria met by 1, making the current total 0 + 1 = 1.
The patient's heart rate is 108.0 beats per minute. The patient's heart rate is greater than or equal to 100 beats per minute, and so we increment the perc critieria met by 1, making the current total 1 + 1 = 2.
The saturated oxygen percentage in the room is 79.0 percent. The saturated oxygen is less than 95%, and so we increment the perc critieria met by 1, making the current total 2 + 1 = 3.
The patient note reports 'unilateral leg swelling' to be absent in the patient and so we do not increment the criteria count. The current total remains at 3.
The patient note does not report a status on 'hemoptysis'. Hence, we assume it to be absent, and so we do not increment the criteria count. The current total remains at 3.
The patient note reports 'recent surgery or trauma' to be absent in the patient and so we do not increment the criteria count. The current total remains at 3.
The patient must be diagnosed with at least one of deep vein thrombosis or pulmonary embolism in the past for a PERC rule criteria to be met. The patient is not reported to have been diagnosed with deep vein thrombosis in the past. The patient is not reported to have been diagnosed with pulmonary embolism in the past. Neither criteria is met and so we do increment the criteria count, keep the current total at 3.
The patient note reports 'hormonal use' to be absent in the patient and so we do not increment the criteria count. The current total remains at 3.
Hence, the number of PERC rule criteria met by the patient is 3."
583,48,PERC Rule for Pulmonary Embolism,diagnosis,integer,pmc-8520941-1,Extracted,"In October 2020, a 59-year-old man was admitted to our Internal Medicine inpatients unit because of the persistence for about 2 weeks of dyspnea, fatigue, and weight loss. The patient also reported right hypochondrium pain and loss of appetite. Past medical history was relevant for hypertension, type 2 diabetes and alcohol abuse (reported alcohol consumption: 3–5 drinks per day from the age of sixteen). In 2016 he was diagnosed with squamous cell lung carcinoma (stage T4N3M0) and treated with neoadjuvant polychemotherapy (cisplatine + vinorelbin) followed by right pneumonectomy. Despite a history of cancer, he was still an active smoker. His home therapy consisted of insulin and acetylsalicylic acid 100 mg/day.
At admission, blood pressure was 150/75 mmHg, heart rate 92 bpm, oxygen saturation 94% in room air, respiratory rate 20/min, body temperature was 36°C. Physical examination was non-significant apart from hepatomegaly. Acute phase reactants (e.g., fibrinogen, C-reactive protein, ferritin), transaminases, cholestasis enzymes and D-dimer were altered. Hepatitis B and C markers were negative. Sars-CoV-2 nasopharyngeal swab was negative. Chest X-ray showed opacification and volume loss of right hemi-thorax with consensual mediastinal shift, according to history of previous pneumonectomy; no signs of pulmonary consolidation in the left lung. Abdominal US-scan showed hyper-echogenicity of the liver compatible with steatosis and/or fibrosis and biliary sludge. No significant kidneys or spleen abnormalities nor ascites were found. The Esophago-Gastro-Duodenoscopy detected a grade B reflux disease (LA classification), congestive gastropathy and erosive bulb duodenitis. Basing on history, clinical features and Wells' score (0 points) (), PE was unlikely. An echocardiography showed a normal left ventricle ejection fraction, no right ventricle overload nor pulmonary hypertension. To rule out cancer recurrence, total body CT-scan with contrast injection was performed. Chest CT images showed a pulmonary thrombus within the right main artery stump, not present 1 year earlier (). Doppler US-scan of lower limbs was normal. Anticoagulant treatment with enoxaparin 100 ui/kg/bid was started, together with proton pump inhibitor (PPI). Tests for inherited and acquired thrombophilia were negative as well as antibodies against Sars-Cov-2. Patient's symptoms gradually improved and he was discharged 7 days after PAST diagnosis with anticoagulant prescription. Contrast-enhanced CT scan performed 4 months later demonstrated an almost complete resolution of right pulmonary thrombosis ().",What are the number of criteria met for the PERC Rule for Pulmonary Embolism (PE)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [59.0, 'years'], 'Heart Rate or Pulse': [92.0, 'beats per minute'], 'O₂ saturation percentage': [94.0, '%'], 'Previously Documented Pulmonary Embolism': False, 'Previously documented Deep Vein Thrombosis': False, 'Unilateral Leg Swelling': False, 'Hormone use': False, 'Recent surgery or trauma': False, 'Hemoptysis': False}",2,2,2,"The PERC Rule critiera are listed below:

1. Age ≥50: No = 0 points, Yes = +1 point
2. Heart Rate (HR) ≥100: No = 0 points, Yes = +1 point
3. O₂ saturation on room air <95%: No = 0 points, Yes = +1 point
4. Unilateral leg swelling: No = 0 points, Yes = +1 point
5. Hemoptysis: No = 0 points, Yes = +1 point
6. Recent surgery or trauma (within 4 weeks, requiring treatment with general anesthesia): No = 0 points, Yes = +1 point
7. Prior pulmonary embolism (PE) or deep vein thrombosis (DVT): No = 0 points, Yes = +1 point
8. Hormone use (oral contraceptives, hormone replacement, or estrogenic hormone use in males or females): No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the points for each criterion.
    
The current count of PERC criteria met is 0.
The patient is 59.0 years old. The patient's age is greater than or equal to 50 years, and so we increment the perc critieria met by 1, making the current total 0 + 1 = 1.
The patient's heart rate is 92.0 beats per minute. The patient's heart rate is less than 100 beats per minute, and so we do not increment the criteria count. The current total remains at 1.
The saturated oxygen percentage in the room is 94.0 percent. The saturated oxygen is less than 95%, and so we increment the perc critieria met by 1, making the current total 1 + 1 = 2.
The patient note reports 'unilateral leg swelling' to be absent in the patient and so we do not increment the criteria count. The current total remains at 2.
The patient note reports 'hemoptysis' to be absent in the patient and so we do not increment the criteria count. The current total remains at 2.
The patient note reports 'recent surgery or trauma' to be absent in the patient and so we do not increment the criteria count. The current total remains at 2.
The patient must be diagnosed with at least one of deep vein thrombosis or pulmonary embolism in the past for a PERC rule criteria to be met. The patient is not reported to have been diagnosed with deep vein thrombosis in the past. The patient is not reported to have been diagnosed with pulmonary embolism in the past. Neither criteria is met and so we do increment the criteria count, keep the current total at 2.
The patient note reports 'hormonal use' to be absent in the patient and so we do not increment the criteria count. The current total remains at 2.
Hence, the number of PERC rule criteria met by the patient is 2."
584,48,PERC Rule for Pulmonary Embolism,diagnosis,integer,pmc-7444888-1,Extracted,"A 77-year-old male patient presented to emergency department with complaints of shortness of breath and pain, discoloration, and swelling of the left leg. Vital signs on presentation were heart rate 110 per minute, blood pressure 155/85 mmHg, oxygen saturation 96% on room air, and temperature 36 degree Celsius. The patient had bilateral crackles on lung exam and absent left dorsalis pedis and posterior tibial pulses and foot was swollen, discolored, and cold. Electrocardiogram showed sinus tachycardia 110 per minute.
On initial laboratory evaluation, the following values were noted: hemoglobin 12.1 g/dl (reference: 12-16 g/dl), hematocrit 38.2% (reference: 36%-46%), white blood cells 41 K/mm3 (reference: 4.5-11 K/mm3), platelets 534 K/mm3 (reference: 140-440 K/mm3), potassium 4.1 meq/L (reference: 3.5-5 meq/L), glucose 126 mg/dl (reference: 70-105 mg/dl), creatinine 0.61 mg/dl (reference: 0.6-1.30 mg/dl), blood urea nitrogen 8 mg/dl (reference: 7-23 mg/dl), lactic acid 1.1 mmol/L (reference: 0.5-2.2 mmol/L), troponin 0.136 ng/ml (reference: less than 0.03 ng/ml), D-dimer 2.77 (reference: less than 0.5), prothrombin time 14.8 seconds (reference: 12.2-14.9 seconds), international normalized ratio (INR) 1.2 (reference: less than 1), partial thromboplastin time 39.8 seconds (reference: 21.3-35.1 seconds), lactate dehydrogenase (LDH) 392 U/L (reference: 140-271 U/L), C-reactive protein (CRP) 301 mg/L (reference: less than 10 mg/L), ferritin 1,396 ng/mL (reference: 12-300 ng/ml), procalcitonin 0.60 ng/ml (reference: less than 2 ng/ml), aspartate transaminase 134 U/L (reference: 13-39 U/L), calcium 8.5 mg/dl (reference: 8.6-10.3 mg/dl), and albumin 2.7 mg/dl (reference: 3.5-5.0 mg/dl). Chest X ray showed bilateral hazy infiltrates. CT angiography of the abdomen and aorta with Iliofemoral runoff showed thrombus within the mid left superficial femoral artery and occluded left anterior tibial artery, left posterior tibial artery, and left peroneal artery with no flow to the foot (Figure ).
Covid-19 was diagnosed on the basis of reverse transcription polymerase chain reaction (RT-PCR) testing. Echocardiogram showed an ejection fraction of 60%. The patient was placed on air-borne precautions and was started on ceftriaxone, azithromycin, hydroxychloroquine, and therapeutic anticoagulation with heparin. He underwent thrombectomy of left common femoral artery, profunda femoris, superficial femoral artery, popliteal artery, anterior tibial artery, posterior tibial artery, and peroneal artery.",What are the number of criteria met for the PERC Rule for Pulmonary Embolism (PE)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [77.0, 'years'], 'Heart Rate or Pulse': [110.0, 'beats per minute'], 'O₂ saturation percentage': [96.0, '%'], 'Unilateral Leg Swelling': True, 'Recent surgery or trauma': False, 'Previously documented Deep Vein Thrombosis': False, 'Previously Documented Pulmonary Embolism': False}",3,3,3,"The PERC Rule critiera are listed below:

1. Age ≥50: No = 0 points, Yes = +1 point
2. Heart Rate (HR) ≥100: No = 0 points, Yes = +1 point
3. O₂ saturation on room air <95%: No = 0 points, Yes = +1 point
4. Unilateral leg swelling: No = 0 points, Yes = +1 point
5. Hemoptysis: No = 0 points, Yes = +1 point
6. Recent surgery or trauma (within 4 weeks, requiring treatment with general anesthesia): No = 0 points, Yes = +1 point
7. Prior pulmonary embolism (PE) or deep vein thrombosis (DVT): No = 0 points, Yes = +1 point
8. Hormone use (oral contraceptives, hormone replacement, or estrogenic hormone use in males or females): No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the points for each criterion.
    
The current count of PERC criteria met is 0.
The patient is 77.0 years old. The patient's age is greater than or equal to 50 years, and so we increment the perc critieria met by 1, making the current total 0 + 1 = 1.
The patient's heart rate is 110.0 beats per minute. The patient's heart rate is greater than or equal to 100 beats per minute, and so we increment the perc critieria met by 1, making the current total 1 + 1 = 2.
The saturated oxygen percentage in the room is 96.0 percent. The saturated oxygen is greater than or equal to 95% and so we do not increment the criteria count. The current total remains at 2.
The patient note reports 'unilateral leg swelling' to be present for the patient and so we increment the criteria count by 1, making the current total 2 + 1  =  3.
The patient note does not report a status on 'hemoptysis'. Hence, we assume it to be absent, and so we do not increment the criteria count. The current total remains at 3.
The patient note reports 'recent surgery or trauma' to be absent in the patient and so we do not increment the criteria count. The current total remains at 3.
The patient must be diagnosed with at least one of deep vein thrombosis or pulmonary embolism in the past for a PERC rule criteria to be met. The patient is not reported to have been diagnosed with deep vein thrombosis in the past. The patient is not reported to have been diagnosed with pulmonary embolism in the past. Neither criteria is met and so we do increment the criteria count, keep the current total at 3.
The patient note does not report a status on 'hormonal use'. Hence, we assume it to be absent, and so we do not increment the criteria count. The current total remains at 3.
Hence, the number of PERC rule criteria met by the patient is 3."
585,48,PERC Rule for Pulmonary Embolism,diagnosis,integer,pmc-6075479-1,Extracted,"An 18-year-old male presented to the emergency department (ED) with a complaint of severe abdominal pain for three days along with painful urination, vomiting, diarrhea and subjective fever and chills. The patient reported brief, severe, colicky episodes of mid and left upper quadrant (LUQ) abdominal pain that radiated to his testicles. He vomited several times because of the pain, which he stated began suddenly while he was lying down. Notably, the patient had recently got over a diarrheal illness a few days prior, followed by constipation, and had recurrence of one loose stool on the day of presentation. He denied any flank pain or back pain, and had never experienced anything like this current illness before.
The patient had no prior medical or surgical history, and had no known family history. His family lived in Honduras, but the patient was currently incarcerated. He was previously a one-pack-per-day smoker, drank alcohol one to two times per month, but denied drug use. Review of systems was negative for weight loss, headaches, chest pain, shortness of breath, melena, hematemesis, rashes, or joint swelling.
The vital signs were as follows: temperature 37.0°C orally, pulse 103 beats per minute, respiratory rate 11 breaths per minute (bpm), blood pressure 122/67 mmHg, and oxygen saturation 100% on room air. Physical examination revealed an alert young man intermittently doubled over in pain with spontaneous resolution. The heart was tachycardic and regular without murmurs, rubs or gallops. The lungs were clear bilaterally with normal work of breathing and no wheezes, rhonchi or rales. His abdomen was soft and non-distended with normoactive bowel sounds, but he demonstrated diffuse tenderness and guarding to palpation. He had no midline or costovertebral angle tenderness, and no ecchymoses were present on inspection of his back. His skin was warm, dry and without any obvious rashes. His neurological examination was grossly intact throughout. The patient was uncircumcised, and his right testicle was lying higher than his left, but neither was tender or swollen. No masses or inguinal hernias were appreciated in the groin.
Laboratory studies were ordered (–), and a point-of-care focused assessment with sonography for trauma (FAST) exam and gallbladder ultrasound were normal. The patient had a formal scrotal ultrasound performed. ().
The patient’s pain was initially well controlled with hydrocodone/acetaminophen and non-steroidal anti-inflammatories; however, as more laboratory and imaging studies resulted, the patient continued to have intermittent pain episodes requiring morphine for analgesia. After two to three hours, the pain crises appeared more severe and the patient became more tachypneic to 18 bpm. It was at that point that an additional study was ordered, and the diagnosis was subsequently made.",What are the number of criteria met for the PERC Rule for Pulmonary Embolism (PE)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [18.0, 'years'], 'Heart Rate or Pulse': [103.0, 'beats per minute'], 'O₂ saturation percentage': [100.0, '%'], 'Hormone use': False, 'Unilateral Leg Swelling': False, 'Previously Documented Pulmonary Embolism': False, 'Hemoptysis': False, 'Recent surgery or trauma': False, 'Previously documented Deep Vein Thrombosis': False}",1,1,1,"The PERC Rule critiera are listed below:

1. Age ≥50: No = 0 points, Yes = +1 point
2. Heart Rate (HR) ≥100: No = 0 points, Yes = +1 point
3. O₂ saturation on room air <95%: No = 0 points, Yes = +1 point
4. Unilateral leg swelling: No = 0 points, Yes = +1 point
5. Hemoptysis: No = 0 points, Yes = +1 point
6. Recent surgery or trauma (within 4 weeks, requiring treatment with general anesthesia): No = 0 points, Yes = +1 point
7. Prior pulmonary embolism (PE) or deep vein thrombosis (DVT): No = 0 points, Yes = +1 point
8. Hormone use (oral contraceptives, hormone replacement, or estrogenic hormone use in males or females): No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the points for each criterion.
    
The current count of PERC criteria met is 0.
The patient is 18.0 years old. The patient's age is less than 50 years, and so we do not increment the criteria count. The current total remains at 0.
The patient's heart rate is 103.0 beats per minute. The patient's heart rate is greater than or equal to 100 beats per minute, and so we increment the perc critieria met by 1, making the current total 0 + 1 = 1.
The saturated oxygen percentage in the room is 100.0 percent. The saturated oxygen is greater than or equal to 95% and so we do not increment the criteria count. The current total remains at 1.
The patient note reports 'unilateral leg swelling' to be absent in the patient and so we do not increment the criteria count. The current total remains at 1.
The patient note reports 'hemoptysis' to be absent in the patient and so we do not increment the criteria count. The current total remains at 1.
The patient note reports 'recent surgery or trauma' to be absent in the patient and so we do not increment the criteria count. The current total remains at 1.
The patient must be diagnosed with at least one of deep vein thrombosis or pulmonary embolism in the past for a PERC rule criteria to be met. The patient is not reported to have been diagnosed with deep vein thrombosis in the past. The patient is not reported to have been diagnosed with pulmonary embolism in the past. Neither criteria is met and so we do increment the criteria count, keep the current total at 1.
The patient note reports 'hormonal use' to be absent in the patient and so we do not increment the criteria count. The current total remains at 1.
Hence, the number of PERC rule criteria met by the patient is 1."
586,48,PERC Rule for Pulmonary Embolism,diagnosis,integer,usmle-1199,Extracted,"A 12-year-old girl is brought to the physician because of fatigue, dyspnea, and mild chest pain on exertion for 1 week. She does not have a fever or a rash. She had an upper respiratory infection 3 weeks ago. She returned from summer camp in Colorado 3 days ago. She says they went hiking and camping as part of their activities. Her temperature is 36.9°C (98.4°F), heart rate is 96/min, and blood pressure is 106/74 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 96%. Physical examination reveals jugular venous distention and 1+ pitting edema on both ankles. A few scattered inspiratory crackles are heard in the thorax and an S3 is heard at the apex. Abdominal examination is unremarkable. Her hemoglobin concentration is 11.6 g/dL, leukocyte count is 8900/mm3, and ESR is 10 mm/hr. An x-ray of the chest shows mild cardiac enlargement.",What are the number of criteria met for the PERC Rule for Pulmonary Embolism (PE)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [12, 'years'], 'Heart Rate or Pulse': [96.0, 'beats per minute'], 'O₂ saturation percentage': [96.0, '%'], 'Unilateral Leg Swelling': False, 'Hemoptysis': False, 'Recent surgery or trauma': False, 'Previously documented Deep Vein Thrombosis': False, 'Previously Documented Pulmonary Embolism': False}",0,0,0,"The PERC Rule critiera are listed below:

1. Age ≥50: No = 0 points, Yes = +1 point
2. Heart Rate (HR) ≥100: No = 0 points, Yes = +1 point
3. O₂ saturation on room air <95%: No = 0 points, Yes = +1 point
4. Unilateral leg swelling: No = 0 points, Yes = +1 point
5. Hemoptysis: No = 0 points, Yes = +1 point
6. Recent surgery or trauma (within 4 weeks, requiring treatment with general anesthesia): No = 0 points, Yes = +1 point
7. Prior pulmonary embolism (PE) or deep vein thrombosis (DVT): No = 0 points, Yes = +1 point
8. Hormone use (oral contraceptives, hormone replacement, or estrogenic hormone use in males or females): No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the points for each criterion.
    
The current count of PERC criteria met is 0.
The patient is 12 years old. The patient's age is less than 50 years, and so we do not increment the criteria count. The current total remains at 0.
The patient's heart rate is 96.0 beats per minute. The patient's heart rate is less than 100 beats per minute, and so we do not increment the criteria count. The current total remains at 0.
The saturated oxygen percentage in the room is 96.0 percent. The saturated oxygen is greater than or equal to 95% and so we do not increment the criteria count. The current total remains at 0.
The patient note reports 'unilateral leg swelling' to be absent in the patient and so we do not increment the criteria count. The current total remains at 0.
The patient note reports 'hemoptysis' to be absent in the patient and so we do not increment the criteria count. The current total remains at 0.
The patient note reports 'recent surgery or trauma' to be absent in the patient and so we do not increment the criteria count. The current total remains at 0.
The patient must be diagnosed with at least one of deep vein thrombosis or pulmonary embolism in the past for a PERC rule criteria to be met. The patient is not reported to have been diagnosed with deep vein thrombosis in the past. The patient is not reported to have been diagnosed with pulmonary embolism in the past. Neither criteria is met and so we do increment the criteria count, keep the current total at 0.
The patient note does not report a status on 'hormonal use'. Hence, we assume it to be absent, and so we do not increment the criteria count. The current total remains at 0.
Hence, the number of PERC rule criteria met by the patient is 0."
587,48,PERC Rule for Pulmonary Embolism,diagnosis,integer,pmc-5412761-1,Extracted,"A 42-year-old African American woman with a history of hypertension, morbid obesity, and obstructive sleep apnea presented to the emergency department with a 12-hour history of left-sided abdominal pain, nausea, and vomiting. At presentation, her medications included hydrochlorothiazide, acetaminophen, ibuprofen, and lisinopril. The patient is married, has three children, and has never smoked, consumed alcohol, or used illicit drugs.
The patient had travelled to Ghana for 5 days, 1 month prior to presentation. She denies any symptoms during or since her trip until her current symptoms started. She was prescribed lisinopril for hypertension, and her first dose of lisinopril 5 mg was 12 h before the onset of her symptoms. She had never taken an ACE inhibitor (ACEi) or angiotensin II receptor antagonist (ARB) before.
On presentation, she had crampy abdominal pain that radiated to the left side of her abdomen. Her pain was constant and increasing but did wax and wane in severity. She also had persistent nausea with one bout of emesis. She had one nonbloody bowel movement of normal caliber within 24 h of presenting and denied any recent diarrhea, constipation, or recent sick contacts.
Vitals at presentation included a blood pressure of 187/122, pulse of 81, temperature of 36.7°C, respirations of 20, and an O2 saturation of 100% on room air. Physical examination showed a patient that appeared uncomfortable and at times sitting up and writhing in bed with her eyes closed. Her abdomen was tender to palpation in the left epigastric area and left mid-abdomen, with mild left suprapubic tenderness. She also had hyperactive bowel sounds but no rebound tenderness or significant guarding.
In the emergency department, the patient received intravenous fluids, as well as pain and nausea medications. The laboratories showed an unremarkable CBC. Her C1 esterase inhibitor functional assay was within normal limits along with a normal C4 concentration making type I and type II hereditary angioedema unlikely. Stool studies were negative for infectious diseases. CT of the abdomen showed segmented target-like enhancement of a dilated loop of ileum with relatively high attenuation ascites (Figs and ). The initial differential included inflammatory bowel disease, infectious enteritis, vasculitis intramural hemorrhage, and lymphoma.
Given her admission clinical and radiographic findings, drug-induced visceral angioedema due to ACEi was suspected. Lisinopril was discontinued and the patient's abdominal symptoms resolved completely in 48 h. The patient was discharged to home on 5 mg of amlodipine for blood pressure control and instructed to follow-up with her primary care provider. On follow-up 2 and 8 weeks later, her symptoms had not returned.",What are the number of criteria met for the PERC Rule for Pulmonary Embolism (PE)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [42.0, 'years'], 'Heart Rate or Pulse': [81.0, 'beats per minute'], 'O₂ saturation percentage': [100.0, '%'], 'Previously Documented Pulmonary Embolism': False, 'Previously documented Deep Vein Thrombosis': False, 'Hemoptysis': False, 'Unilateral Leg Swelling': False, 'Hormone use': False, 'Recent surgery or trauma': False}",0,0,0,"The PERC Rule critiera are listed below:

1. Age ≥50: No = 0 points, Yes = +1 point
2. Heart Rate (HR) ≥100: No = 0 points, Yes = +1 point
3. O₂ saturation on room air <95%: No = 0 points, Yes = +1 point
4. Unilateral leg swelling: No = 0 points, Yes = +1 point
5. Hemoptysis: No = 0 points, Yes = +1 point
6. Recent surgery or trauma (within 4 weeks, requiring treatment with general anesthesia): No = 0 points, Yes = +1 point
7. Prior pulmonary embolism (PE) or deep vein thrombosis (DVT): No = 0 points, Yes = +1 point
8. Hormone use (oral contraceptives, hormone replacement, or estrogenic hormone use in males or females): No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the points for each criterion.
    
The current count of PERC criteria met is 0.
The patient is 42.0 years old. The patient's age is less than 50 years, and so we do not increment the criteria count. The current total remains at 0.
The patient's heart rate is 81.0 beats per minute. The patient's heart rate is less than 100 beats per minute, and so we do not increment the criteria count. The current total remains at 0.
The saturated oxygen percentage in the room is 100.0 percent. The saturated oxygen is greater than or equal to 95% and so we do not increment the criteria count. The current total remains at 0.
The patient note reports 'unilateral leg swelling' to be absent in the patient and so we do not increment the criteria count. The current total remains at 0.
The patient note reports 'hemoptysis' to be absent in the patient and so we do not increment the criteria count. The current total remains at 0.
The patient note reports 'recent surgery or trauma' to be absent in the patient and so we do not increment the criteria count. The current total remains at 0.
The patient must be diagnosed with at least one of deep vein thrombosis or pulmonary embolism in the past for a PERC rule criteria to be met. The patient is not reported to have been diagnosed with deep vein thrombosis in the past. The patient is not reported to have been diagnosed with pulmonary embolism in the past. Neither criteria is met and so we do increment the criteria count, keep the current total at 0.
The patient note reports 'hormonal use' to be absent in the patient and so we do not increment the criteria count. The current total remains at 0.
Hence, the number of PERC rule criteria met by the patient is 0."
588,48,PERC Rule for Pulmonary Embolism,diagnosis,integer,usmle-4760,Extracted,"A 46-year-old woman presents to the emergency department with 1 day of painful leg swelling. She is otherwise healthy and takes only oral contraceptive pills. The patient does not regularly follow up with her primary doctor and is generally not medically compliant. Her temperature is 98.0°F (36.7°C), blood pressure is 122/78 mm Hg, pulse is 70/min, respirations are 13/min, and oxygen saturation is 99% on room air. Lower extremity examination shows mild calf swelling on her left leg, but otherwise is unremarkable. An ultrasound is performed as seen in Figure A.",What are the number of criteria met for the PERC Rule for Pulmonary Embolism (PE)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [46.0, 'years'], 'Hormone use': True, 'Unilateral Leg Swelling': True, 'Previously Documented Pulmonary Embolism': False, 'Heart Rate or Pulse': [70.0, 'beats per minute'], 'Hemoptysis': False, 'O₂ saturation percentage': [99.0, '%'], 'Recent surgery or trauma': False, 'Previously documented Deep Vein Thrombosis': False}",2,2,2,"The PERC Rule critiera are listed below:

1. Age ≥50: No = 0 points, Yes = +1 point
2. Heart Rate (HR) ≥100: No = 0 points, Yes = +1 point
3. O₂ saturation on room air <95%: No = 0 points, Yes = +1 point
4. Unilateral leg swelling: No = 0 points, Yes = +1 point
5. Hemoptysis: No = 0 points, Yes = +1 point
6. Recent surgery or trauma (within 4 weeks, requiring treatment with general anesthesia): No = 0 points, Yes = +1 point
7. Prior pulmonary embolism (PE) or deep vein thrombosis (DVT): No = 0 points, Yes = +1 point
8. Hormone use (oral contraceptives, hormone replacement, or estrogenic hormone use in males or females): No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the points for each criterion.
    
The current count of PERC criteria met is 0.
The patient is 46.0 years old. The patient's age is less than 50 years, and so we do not increment the criteria count. The current total remains at 0.
The patient's heart rate is 70.0 beats per minute. The patient's heart rate is less than 100 beats per minute, and so we do not increment the criteria count. The current total remains at 0.
The saturated oxygen percentage in the room is 99.0 percent. The saturated oxygen is greater than or equal to 95% and so we do not increment the criteria count. The current total remains at 0.
The patient note reports 'unilateral leg swelling' to be present for the patient and so we increment the criteria count by 1, making the current total 0 + 1  =  1.
The patient note reports 'hemoptysis' to be absent in the patient and so we do not increment the criteria count. The current total remains at 1.
The patient note reports 'recent surgery or trauma' to be absent in the patient and so we do not increment the criteria count. The current total remains at 1.
The patient must be diagnosed with at least one of deep vein thrombosis or pulmonary embolism in the past for a PERC rule criteria to be met. The patient is not reported to have been diagnosed with deep vein thrombosis in the past. The patient is not reported to have been diagnosed with pulmonary embolism in the past. Neither criteria is met and so we do increment the criteria count, keep the current total at 1.
The patient note reports 'hormonal use' to be present for the patient and so we increment the criteria count by 1, making the current total 1 + 1  =  2.
Hence, the number of PERC rule criteria met by the patient is 2."
589,51,SIRS Criteria,diagnosis,integer,pmc-6935617-1,Extracted,"A 56-year-old woman was referred to our center, with a complaint of abdominal pain and constipation, for a week. From the time of onset, the pain was categorized to be severe, not colic and was localized to the epigastric region only. The patient was alert and ill, while she has had nausea and anorexia, but was not been accompanied by vomiting. Her vital signs were as follows: BP: 85/50, PR: 130, T: 37.2, and RR: 18. Her head, neck, and chest (heart and lung) were normal, and abdomen was fatty and without scarlet and reduced intestinal sounds. She had generalized tenderness with maximum pain intensity in epigastric regions, where her organs were normal. Her medical and corresponding drug history was as follows: antiphospholipid antibody syndrome, DVT, a history of two abortions, and type II diabetes.
Her drug history included: prednisolone tablets, 5 mg: once a day; methotrexate: three pounds a week; hydroxychloroquine tablet: 3 days a week; and warfarin tablets: daily half a pill and insulin.
For further examination, her cardiac activity was monitored, and serum therapy was given to the patient. She was also provided a nasogastric tube, Foley catheter for urinary drainage along with hydrocortisone and antibiotics.
After about 60 minutes, her vitals were as follows: BP: 100/60 and PR: 120.
The result of the preliminary tests showed WBC: 4200, Hb: 7.7, PLT: 80 000, and INR: 4.7 and other tests: normal. Ultrasound from the patient's bedside showed free fluid in the abdomen. Following these tests, the therapeutic intervention was continued as follows: serum, wo packed cell (PC) units, and fresh frozen plasma (FFP) units. Meanwhile, the patient was prepared for laparotomy where, during the surgery, her sugar levels kept under control, control, stress-dose cortisol was provided, and she received 5 units of PC and 4 units of FFP.
During the laparotomy, about 3 L of blood and clot were removed from the abdomen. Following this, a cystic lesion was observed in the vicinity of the large stomach flexion that bled due to the invasion of the gastroepyloid vessels (Figure ). After controlling the bleeding, the lesion was fully resected, and samples were examined for pathology (Figure ).
Postoperatively, complete control of the bleeding was achieved with sustained vital signs. However, given the state of preoperative hemorrhagic shock, the patient was kept in ICU until satisfactory recovery was achieved. She also received 5 units of PC and 4 units of FFP, and the vital signs were maintained stable.
Despite there was no recurrence of hemorrhage, she presented pancytopenia perhaps due to the underlying disease (antiphospholipid antibody syndrome). She was hyper-coagulopathic, due to thrombocytopenia and hemorrhagic shock (cause of referral); therefore, anticoagulant administration was not possible.
After 24 hours and ensuring the stability of vital signs and the absence of Ileus, the patient oral feed was resumed. The postoperative examination for pancytopenia was as follows: WBC: 1500 (PMN: 60%), Hb: 11, PLT: 50 000, INR: 1.7, and K: 3.2. Granulocyte colony-stimulating factor (GCSF) therapy was prescribed to the patients after which, her platelets and WBCs showed improvement. The patient's general condition improved, she tolerated the diet, and the bleeding was controlled. Her hemoglobin level did not drop, and therefore, she was transferred to the general ward.
The continuation of treatment was as follows: hydroxychloroquine, prednisolone: half a tablet twice a day, methotrexate was discontinued for 2 weeks, and folic acid and GCSF for 3 days.
Laboratory results showed: platelet <100 000, potassium <3.5, and INR: 1.6. She was administered anticoagulant prophylaxis.
Nine days after the operation, the patient suffered from shortness of breath and tachypnea and a feeling of pressure in the chest. According to the history of the disease, the first diagnosis was a pulmonary embolism, for which anticoagulant therapy was immediately initiated and the patient was transferred to ICU. Her laboratory findings revealed: a decrease in platelets 20 000 and an increase in INR > 3 while ECG was normal. Anticoagulant therapy was restarted. Nonetheless, she went under respiratory distress and despite intubation, she expired.",What are the number of SIRS critiera met by the patient? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Temperature': [37.2, 'degrees celsius'], 'Heart Rate or Pulse': [130.0, 'beats per minute'], 'respiratory rate': [18.0, 'breaths per minute'], 'White blood cell count': [4200.0, 'µL']}",1,1,1,"The rules for SIRS Criteria are listed below:
    
1. Temperature >38°C (100.4°F) or <36°C (96.8°F): No = 0 points, Yes = +1 point
2. Heart rate >90: No = 0 points, Yes = +1 point
3. Respiratory rate >20 or PaCO₂ <32 mm Hg: No = 0 points, Yes = +1 point
4. White blood cell count (WBC) >12,000/mm³, <4,000/mm³, or >10% bands: No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the score for each criteria.
    
The current count of SIRS criteria met is 0.
The patient's temperature is 37.2 degrees celsius. Because the temperature is between 36 and 38 degrees celsius, this does not meet SIRS criteria for temperature, and so the current total remains at 0.
The patient's heart rate is 130.0 beats per minute. Because the heart rate is greater than 90 beats per minute, this meets SIRS criteria and so we increment the criteria count by 1 making the current total 0 + 1 = 1.
The patient's concentration of white blood cell is 4200.0 count/µL. To convert 4200.0 count/µL of white blood cell to mm^3, multiply by the conversion factor 1.0 µL/mm^3 which will give 4200.0 white blood cell count/µL * 1.0 µL/mm^3 = 4200.0 white blood cell count/mm^3. Because the white blood cell count is between 4000 and 12000 count per mm^3, this does not meet SIRS criteria for white blood cell count, and so the current total remains at 1.
The final SIRS criteria is whether the patient has a respiratory rate of more than 20 breaths per minute or if the patient's PaCO₂ partial pressure is less than 32 mm Hg. The patient's respiratory rate is 18.0 breaths per minute, which is less or equal to than 20 breaths per min. The patient's PaCO₂ partial pressure is not provided and so we assume that the patient's partial pressure is greater than or equal to 32 mm Hg. Neither criteria met and so keep the current total at 1.
Hence, the the number of SIRS criteria met by the patient is 1."
590,51,SIRS Criteria,diagnosis,integer,pmc-6311171-1,Extracted,"An 80-year-old male with hypertension and chronic kidney disease was admitted to our hospital because of epigastric pain that had begun after dinner 1 day before admission. The patient reported no use of nonsteroidal anti-inflammatory drugs.
On examination, the patient’s temperature was 37.0 °C, heart rate was 101 beats per minute, blood pressure was 185/93 mmHg, respiratory rate was 18 breaths per minute, and oxygen saturation was 96% while the patient was breathing ambient air. The patient’s body mass index was 26.3 kg/m2. Mild epigastric tenderness was present. The remainder of the physical examination was normal. The laboratory data on admission were as follows: white blood count 9400/mm3, the C-reactive protein level 7.53 mg/dl, red blood count 419 × 104/mm3, hemoglobin 13.4 g/dl, platelets 16.8 × 104/mm3, total bilirubin 0.8 mg/dl, aspirate aminotransferase 21 IU/l, alanine aminotransferase 16 IU/l, alkaline phosphatase 232 IU/l, γ-glutamyl transferase 15 IU/l, amylase 86 IU/l, blood urea nitrogen 32 mg/dl, and creatinine 1.99 mg/dl, and estimated glomerular filtration rate is 26 ml per minute per 1.73 m2 of body surface area. Chest and abdominal radiography showed no abnormalities. Computed tomography (CT) of the abdomen showed a linear, hyperdense, foreign body that appeared to penetrate through the posterior wall of the gastric antrum (Fig. a). There was no evidence of free air, abscess formation, migration of the foreign body into the pancreas, or pancreatitis (Fig. b).
As the patient had a history of fish bone ingestion, we made a diagnosis of localized peritonitis caused by fish bone penetration of the posterior wall of the gastric antrum. We first attempted to remove the foreign body endoscopically, but failed because it was not detected. Hence, an emergency laparoscopic surgery was performed. The patient was placed in a supine position. The operator stood on the left side of the patient, the assistant on the right side, and the scopist between the patient’s legs. Four trocars were placed: one above the navel for the laparoscopy (12 mm), two in the upper left abdominal quadrant (5 mm), and one in the upper right abdominal quadrant (5 mm). Laparoscopic gastrectomy techniques were used to separate the greater omentum from the transverse colon and open the lesser sac. A linear, hard, foreign body was found in the adhesive tissue between the gastric antrum and the pancreatic body (Fig. a). The foreign body was safely removed from both the pancreas and stomach laparoscopically. The foreign body was identified as a 2.5-cm-long fish bone, (Fig. b). The length of the fish bone embedded in the pancreas was about 2 cm. There was a minor laceration at the site of the pancreatic injury. Neither fat saponification nor hematoma around the pancreas was identified. We did not perform suture repair or local debridement for the site of the pancreatic injury. Because the site of the penetrated gastric wall was small and a leak was not observed, we did not perform suture repair or cover the site of the penetrated gastric wall with the omentum. Intraperitoneal lavage was performed, and a drain was placed in the lesser sac.
Clear fluid was drained, and the postoperative serum amylase levels were normal. The patient recovered without complications and was discharged on the seventh postoperative day.",What are the number of SIRS critiera met by the patient? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Temperature': [37.0, 'degrees celsius'], 'Heart Rate or Pulse': [101.0, 'beats per minute'], 'respiratory rate': [18.0, 'breaths per minute'], 'White blood cell count': [9400.0, 'mm^3']}",1,1,1,"The rules for SIRS Criteria are listed below:
    
1. Temperature >38°C (100.4°F) or <36°C (96.8°F): No = 0 points, Yes = +1 point
2. Heart rate >90: No = 0 points, Yes = +1 point
3. Respiratory rate >20 or PaCO₂ <32 mm Hg: No = 0 points, Yes = +1 point
4. White blood cell count (WBC) >12,000/mm³, <4,000/mm³, or >10% bands: No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the score for each criteria.
    
The current count of SIRS criteria met is 0.
The patient's temperature is 37.0 degrees celsius. Because the temperature is between 36 and 38 degrees celsius, this does not meet SIRS criteria for temperature, and so the current total remains at 0.
The patient's heart rate is 101.0 beats per minute. Because the heart rate is greater than 90 beats per minute, this meets SIRS criteria and so we increment the criteria count by 1 making the current total 0 + 1 = 1.
The patient's concentration of white blood cell is 9400.0 count/mm^3. Because the white blood cell count is between 4000 and 12000 count per mm^3, this does not meet SIRS criteria for white blood cell count, and so the current total remains at 1.
The final SIRS criteria is whether the patient has a respiratory rate of more than 20 breaths per minute or if the patient's PaCO₂ partial pressure is less than 32 mm Hg. The patient's respiratory rate is 18.0 breaths per minute, which is less or equal to than 20 breaths per min. The patient's PaCO₂ partial pressure is not provided and so we assume that the patient's partial pressure is greater than or equal to 32 mm Hg. Neither criteria met and so keep the current total at 1.
Hence, the the number of SIRS criteria met by the patient is 1."
591,51,SIRS Criteria,diagnosis,integer,pmc-2474644-1,Extracted,"A 67-year-old woman presented to the hospital complaining of fever, shortness of breath and dry cough during the previous month. She had been treated for presumed bronchitis with wide-spectrum antibiotics without response and her complaints had gradually worsened. Her past medical history was significant for bilateral hilar lymphadenopathy, which was incidentally diagnosed on a routine chest radiograph 8 years previously, a finding that was confirmed, together with right paratracheal node enlargement, by a chest computed tomography (CT) scan. She had then undergone a non-diagnostic bronchoscopy and was advised to repeat the chest CT scan after 6 months, advice she ignored. She had never smoked and she had not taken any medication in the past. She had no environmental or occupational history of beryllium or other metal exposure. She had never traveled outside Greece. She had never had a tuberculin test.
On physical examination, the patient appeared to be in good condition, mildly dyspneic with 22 breaths per minute, a temperature of 39.4°C, blood pressure of 110/70 mmHg and a heart rate of 100 beats per minute. Apart from mild bilateral inspiratory fine crackles in the lower lung fields, no other physical abnormalities were observed. There was no skin involvement. Laboratory investigations showed normocytic normochromic anemia (hemoglobin 11.8 g/dl), white blood count 6370/mm3 (neutrophils 67%), erythrocyte sedimentation rate 95 mm and C-reactive protein 90 mg/l (normal value <3 mg/l). Serum electrolyte levels and renal function indices were normal. A mild decrease in albumin levels was observed on serum protein electrophoresis. Serum concentrations of angiotensin-converting enzyme (ACE) were normal, as was a 24-hour urinary calcium excretion analysis. Arterial gas testing (while the patient was breathing in room air) indicated PaO2 70 mmHg, PaCO2 31 mmHg, pH 7.47 and bicarbonate 22.2 mmol/l. The tuberculin skin test was positive (20 mm). A chest X-ray on admission disclosed bilateral hilar lymphadenopathy together with bilateral interstitial lung densities in the lower lung fields (Figure ). A chest CT scan that was performed 3 days after her admission disclosed bilateral interstitial opacities in the middle and lower lung lobes and mediastinal lymphadenopathy, which was unaltered compared with that observed 8 years ago (Figure ).
An ophthalmologic evaluation was normal. The patient underwent bronchoscopy, which revealed slight mucosal edema in the bronchial tree. All endobronchial biopsies disclosed non-specific inflammation. Transbronchial biopsies were not performed because of the patient's intolerance. The bronchoalveolar lavage (BAL) cell differential count was total cell count 37 × 104/ml, neutrophils 2.8%, lymphocytes 61.2%, macrophages 34.5% and eosinophils 1.3%. The CD4 to CD8 ratio was 2.25 while the number of CD4 and CD8 cells was within normal levels. Multiple blood and urine cultures as well as bronchial washing cultures were negative for bacteria and fungi. Results from sputum, gastric fluid and BAL Ziehl-Neelsen staining were negative. Serology studies for human immunodeficiency virus (HIV), Brucella species, Legionella species, Coxiella burnetti, Chlamydia species, Mycoplasma species, Leismania species and Toxoplasma species were negative. A venereal disease research laboratory test was also negative. Antinuclear antibodies were 1/80 positive while anti-double-stranded DNA antibodies, anti-RO, anti-LA, antineutrophil cytoplasmic antibodies and antimitochondrial antibodies were all negative. The patient underwent mediastinoscopy, and histological examination from the biopsy of a right paratracheal lymph node showed a non-caseating granuloma formation compatible with sarcoidosis. Routine tissue bacterial, fungal and acid bacilli cultures were negative.
The patient received broad-spectrum antibiotic treatment without any response, while her dyspnea progressively increased and she was supported with oxygen therapy. A chest X-ray disclosed extended interstitial lung densities in both lungs as well as consolidation in the left lower lung field (Figure ). As she was clinically and radiologically deteriorating, treatment with the standard anti-TB drug regimen (isoniazid 300 mg daily, rifampin 600 mg daily, pyrazinamide 2 g daily and ethambutol 1 g daily) was started in addition to prednisolone 1 mg/kg daily. The patient's symptoms moderately improved but her fever continued to spike. During the second week of anti-TB therapy, initial BAL cultures turned out to be positive for M. tuberculosis and glucocorticoids were stopped. During the fourth week of treatment the fever declined and the patient became apyrexial 1 week later. After 2 months of therapy, pyrazinamide and ethambutol were stopped and a 7-month continuation regimen with isoniazide and rifampin was administered. During a 9 month period of follow-up, the patient continued to have the same chronic mediastinal lymphadenopathy with no parenchymal involvement and normal pulmonary function tests.",What are the number of SIRS critiera met by the patient? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Temperature': [39.4, 'degrees celsius'], 'Heart Rate or Pulse': [100.0, 'beats per minute'], 'PaCO2': [31.0, 'mm hg'], 'respiratory rate': [22.0, 'breaths per minute'], 'White blood cell count': [6370.0, 'mm^3']}",3,3,3,"The rules for SIRS Criteria are listed below:
    
1. Temperature >38°C (100.4°F) or <36°C (96.8°F): No = 0 points, Yes = +1 point
2. Heart rate >90: No = 0 points, Yes = +1 point
3. Respiratory rate >20 or PaCO₂ <32 mm Hg: No = 0 points, Yes = +1 point
4. White blood cell count (WBC) >12,000/mm³, <4,000/mm³, or >10% bands: No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the score for each criteria.
    
The current count of SIRS criteria met is 0.
The patient's temperature is 39.4 degrees celsius. Because the temperature is greater than 38 degrees celsius, we increment the criteria count by 1 making the current total 0 + 1 = 1.
The patient's heart rate is 100.0 beats per minute. Because the heart rate is greater than 90 beats per minute, this meets SIRS criteria and so we increment the criteria count by 1 making the current total 1 + 1 = 2.
The patient's concentration of white blood cell is 6370.0 count/mm^3. Because the white blood cell count is between 4000 and 12000 count per mm^3, this does not meet SIRS criteria for white blood cell count, and so the current total remains at 2.
The final SIRS criteria is whether the patient has a respiratory rate of more than 20 breaths per minute or if the patient's PaCO₂ partial pressure is less than 32 mm Hg. The patient's respiratory rate is 22.0 breaths per minute, which is greater than 20 breaths per minute. The patient's PaCO₂ partial pressure is 31.0 mm Hg, which is less than than 32 mm Hg. At least one of the criteria is met, and so we increment the criteria count by 1 giving us a total of 2 + 1 = 3 criteria met.
Hence, the the number of SIRS criteria met by the patient is 3."
592,51,SIRS Criteria,diagnosis,integer,pmc-5578525-1,Extracted,"A 28-year-old female patient was admitted to the emergency department with fever, fatigue, nausea. Although she used amoxicillin-clavulanic acid (1 gm) for 3 days due to high fever associated with malaise, her fever continued. She was hospitalized with a preliminary diagnosis of toxic hepatitis. A chronic systemic disease, smoking, alcohol, drug use could not be found in this patient.
On physical examination, fever was 37.8°C, pulse was 105/min, arterial blood pressure was 100/60 mm Hg, respiratory rate was 18/min, oropharynx was hyper-emic, there was 3 to 4 painful lymphadenopathies (LAP) (4-6 mm in diameter) at the beginning of scalp behind the right ear. There was minimal hepatosplenomegaly (HSM). Other findings were normal. In laboratory tests WBC: 10.78 × 103/μl, neutrophil could not be detected properly. The levels of other parameters are given; lymphocytes; 6.22 × 103/μl (1.3 to 3.5), hemoglobulin; 14.2 gm/dl, platelet: 174 × 103/μl, alanine aminotransferase (ALAT); 742 IU/l (10-50), aspartate aminotransferase (AST); 517 IU/l (10-50), alkaline phosphatase (ALP); 394 IU/l (40-130), GGT: 404 IU/l (10-71), total bilirubin; 6.7 mg/dl (<1.4), direct bilirubin; 4.73 mg/dl (<0.3), erythrocyte sedimentation rate (ESR); 19 mm (0-20), C-reactive protein (CRP): 14.54 mg/dl (< 5). There was a predominance of atypical lymphocytes in the peripheral blood smear. Upper abdomen ultrasonography which was done to investigate the etiology of LFT disorder was normal except minimal HSM. Antimitochondrial antibody, antinuclear antibody, antismooth muscle antibodies, antineutrophil cytoplasmic antibody, acute and chronic viral hepatitis markers were normal. Serological tests for salmonella and brucella were negative. In addition, iron, iron binding capacity, ferritin, 24-hour urine copper, ceruloplasmin, alpha-fetoprotein, alpha-1 antitrypsin levels were within normal limits. EBV parameters like EBV VCA IgM, VCA IgG and EBNA IgM were positive, also, CMV IgM was positive with high-titer. Cytomegalo-virus IgG titer and other parameters were negative. According to these findings, patient was diagnosed as acute hepatitis due to the EBV and CMV coinfection. Supportive treatment was given, liver function tests (LFTs) were normalized gradually after 3 weeks.",What are the number of SIRS critiera met by the patient? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Temperature': [37.8, 'degrees celsius'], 'Heart Rate or Pulse': [105.0, 'beats per minute'], 'respiratory rate': [18.0, 'breaths per minute'], 'White blood cell count': [10780.0, 'µL']}",1,1,1,"The rules for SIRS Criteria are listed below:
    
1. Temperature >38°C (100.4°F) or <36°C (96.8°F): No = 0 points, Yes = +1 point
2. Heart rate >90: No = 0 points, Yes = +1 point
3. Respiratory rate >20 or PaCO₂ <32 mm Hg: No = 0 points, Yes = +1 point
4. White blood cell count (WBC) >12,000/mm³, <4,000/mm³, or >10% bands: No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the score for each criteria.
    
The current count of SIRS criteria met is 0.
The patient's temperature is 37.8 degrees celsius. Because the temperature is between 36 and 38 degrees celsius, this does not meet SIRS criteria for temperature, and so the current total remains at 0.
The patient's heart rate is 105.0 beats per minute. Because the heart rate is greater than 90 beats per minute, this meets SIRS criteria and so we increment the criteria count by 1 making the current total 0 + 1 = 1.
The patient's concentration of white blood cell is 10780.0 count/µL. To convert 10780.0 count/µL of white blood cell to mm^3, multiply by the conversion factor 1.0 µL/mm^3 which will give 10780.0 white blood cell count/µL * 1.0 µL/mm^3 = 10780.0 white blood cell count/mm^3. Because the white blood cell count is between 4000 and 12000 count per mm^3, this does not meet SIRS criteria for white blood cell count, and so the current total remains at 1.
The final SIRS criteria is whether the patient has a respiratory rate of more than 20 breaths per minute or if the patient's PaCO₂ partial pressure is less than 32 mm Hg. The patient's respiratory rate is 18.0 breaths per minute, which is less or equal to than 20 breaths per min. The patient's PaCO₂ partial pressure is not provided and so we assume that the patient's partial pressure is greater than or equal to 32 mm Hg. Neither criteria met and so keep the current total at 1.
Hence, the the number of SIRS criteria met by the patient is 1."
593,51,SIRS Criteria,diagnosis,integer,pmc-6171780-1,Extracted,"A 66-year-old male with a past medical history of hypertension and pancreatic adenocarcinoma presented to our hospital with complaints of nausea, vomiting, and generalized weakness in the arms and legs. The patient was diagnosed with locally advanced, pancreatic cancer, T1 N0 M0 a year prior to presentation. Magnetic resonance cholangiopancreatography (MRCP) revealed a 1.7 cm mass at the head of his pancreas, locally invasive but without the involvement of lymph nodes, superior mesenteric artery, superior mesenteric vein or portal vein. Endoscopic biopsy revealed adenocarcinoma. The patient was a poor surgical candidate due to social issues, alcoholism, residence at a nursing home and was at a high-risk for post-surgical complications. The patient was treated palliatively with nine cycles of gemcitabine and paclitaxel. The initial dose of gemcitabine was 2000 mg. The tumor decreased in size and CA 19-9 level declined from an initial level of 2000 to 26 units/mL. Later the dose of gemcitabine was reduced to 1400 mg (20% reduction) after the sixth cycle due to pancytopenia.
On admission to our hospital, the patient reported abdominal pain that was sharp and located in the right lower quadrant (RLQ). He denied fevers or chills. The patients' vital signs were: temperature 99.3 °F, heart rate of 73 beats per minute, blood pressure 129/60 mmHg, respiratory rate of 17 breaths per minute and oxygen saturation 100% on room air. The physical examination was remarkable for RLQ tenderness. The laboratory data revealed hemoglobin (Hb) 6.5 g/dL, hematocrit (Hct) 19.8, mean corpuscular volume (MCV) 83.2fL /red cell, red cell distribution width (RDW) 19.1 %, white cell count of 9.44 x 109/L, platelets of 54 x 109/L, alanine transaminase (ALT) 133 IU/L, aspartate transaminase (AST) 222 IU/L, alkaline phosphatase (ALP) of 147 IU/L and a total bilirubin of 5 umol/L. BUN was 42 mg/dl, creatinine 2.12 mg/dl (baseline creatinine of 0.8), LDH was 1700 u/l, reticulocyte count was 7.8%. Peripheral smear showed microcytic anemia with frequent schistocytes consistent with a microangiopathic hemolytic process (Figures -). Urinalysis was positive for 1+ blood and 1+ albumin. Computed tomography (CT) scan of the abdomen without contrast showed a stable pancreatic mass and no signs of hydronephrosis (Figure ). ERCP revealed choledocholithiasis. Choledocholithotomy was performed and subsequently the bilirubin improved. Blood cultures grew Klebsiella. He was treated with piperacillin-tazobactam. The patient received intravenous (IV) fluids, blood and platelets when the Hb and platelets declined to Hb of 6.4 g/dl and platelet counts of 8 x 109. He was treated with methylprednisone 30 mg IV q24 and the platelet count increased to 20 x 109. His creatinine increased to 12 mg/dl and BUN to 112 mg/dl. ADAMTS13 activity was 34%. A diagnosis of GiHUS was made. The patient was offered plasmapheresis, but he opted for hospice.",What are the number of SIRS critiera met by the patient? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Temperature': [99.3, 'degrees fahrenheit'], 'Heart Rate or Pulse': [73.0, 'beats per minute'], 'respiratory rate': [17.0, 'breaths per minute'], 'White blood cell count': [9440000000.0, 'L']}",0,0,0,"The rules for SIRS Criteria are listed below:
    
1. Temperature >38°C (100.4°F) or <36°C (96.8°F): No = 0 points, Yes = +1 point
2. Heart rate >90: No = 0 points, Yes = +1 point
3. Respiratory rate >20 or PaCO₂ <32 mm Hg: No = 0 points, Yes = +1 point
4. White blood cell count (WBC) >12,000/mm³, <4,000/mm³, or >10% bands: No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the score for each criteria.
    
The current count of SIRS criteria met is 0.
The patient's temperature is 99.3 degrees fahrenheit. To convert to degrees celsius, apply the formula 5/9 * [temperature (degrees fahrenheit) - 32]. This means that the patient's temperature is 5/9 * 67.3 = 37.38889 degrees celsius. Because the temperature is between 36 and 38 degrees celsius, this does not meet SIRS criteria for temperature, and so the current total remains at 0.
The patient's heart rate is 73.0 beats per minute. Because the heart rate is less than 90 beats per minute, this does not meet SIRS criteria for heart rate, and so the current total remains at 0.
The patient's concentration of white blood cell is 9440000000.0 count/L. To convert 9440000000.0 count/L of white blood cell to mm^3, multiply by the conversion factor 1e-06 L/mm^3 which will give 9440000000.0 white blood cell count/L * 1e-06 L/mm^3 = 9440.0 white blood cell count/mm^3. Because the white blood cell count is between 4000 and 12000 count per mm^3, this does not meet SIRS criteria for white blood cell count, and so the current total remains at 0.
The final SIRS criteria is whether the patient has a respiratory rate of more than 20 breaths per minute or if the patient's PaCO₂ partial pressure is less than 32 mm Hg. The patient's respiratory rate is 17.0 breaths per minute, which is less or equal to than 20 breaths per min. The patient's PaCO₂ partial pressure is not provided and so we assume that the patient's partial pressure is greater than or equal to 32 mm Hg. Neither criteria met and so keep the current total at 0.
Hence, the the number of SIRS criteria met by the patient is 0."
594,51,SIRS Criteria,diagnosis,integer,pmc-6029742-1,Extracted,"A 25-year-old man with no past medical history presented to the emergency department (ED) with two days of intractable vomiting, increasing confusion, and progressive difficulty breathing. The patient denied tobacco or recreational drug use.
Upon arrival to the ED, vital signs were within normal range with a blood pressure of 123/61 mmHg, a temperature of 36.8 degree Celsius, a heart rate of 92 beats per minute, and a respiratory rate of 19 respirations per minute. The physical exam showed an obese, lethargic patient, responsive to verbal stimuli. The lung, heart, and abdomen exam were unremarkable and there was no neck crepitus noted. The laboratory evaluation showed leukocytosis of 25.96 x 1000/mm3, elevated creatinine of 2.17 mg/dL, hyperglycemia of 836 mg/dL, hyponatremia of 128 mEq/L, hyperkalemia of 5.2 mEq/L, and bicarbonate of 5 mEq/L. The anion gap was 25 and a venous blood gas showed a pH of 6.91. Urinalysis was positive for 2+ ketones and 1+ protein.
The patient was admitted to the intensive care unit with a new diagnosis of diabetes mellitus complicated with DKA. Intravenous normal saline, bicarbonate, and insulin drip were initiated. The chest X-ray on admission suggested findings compatible with pneumomediastinum (Figure ). Chest computed tomography (CT) was obtained and reaffirmed the findings (Figures -). Pneumomediastinum in the setting of intractable vomiting was worrisome for esophageal rupture and since our facility was not staffed to manage this clinical entity, the patient was emergently transferred to another facility. The patient was treated conservatively with analgesia and respiratory support and was discharged several days later without any complications.",What are the number of SIRS critiera met by the patient? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Temperature': [36.8, 'degrees celsius'], 'Heart Rate or Pulse': [92.0, 'beats per minute'], 'respiratory rate': [19.0, 'breaths per minute'], 'White blood cell count': [25960.0, 'mm^3']}",2,2,2,"The rules for SIRS Criteria are listed below:
    
1. Temperature >38°C (100.4°F) or <36°C (96.8°F): No = 0 points, Yes = +1 point
2. Heart rate >90: No = 0 points, Yes = +1 point
3. Respiratory rate >20 or PaCO₂ <32 mm Hg: No = 0 points, Yes = +1 point
4. White blood cell count (WBC) >12,000/mm³, <4,000/mm³, or >10% bands: No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the score for each criteria.
    
The current count of SIRS criteria met is 0.
The patient's temperature is 36.8 degrees celsius. Because the temperature is between 36 and 38 degrees celsius, this does not meet SIRS criteria for temperature, and so the current total remains at 0.
The patient's heart rate is 92.0 beats per minute. Because the heart rate is greater than 90 beats per minute, this meets SIRS criteria and so we increment the criteria count by 1 making the current total 0 + 1 = 1.
The patient's concentration of white blood cell is 25960.0 count/mm^3. Because the white blood cell count is greater than 12000 count per mm^3, we increment the criteria count by 1 making the current total 1 + 1 = 2.
The final SIRS criteria is whether the patient has a respiratory rate of more than 20 breaths per minute or if the patient's PaCO₂ partial pressure is less than 32 mm Hg. The patient's respiratory rate is 19.0 breaths per minute, which is less or equal to than 20 breaths per min. The patient's PaCO₂ partial pressure is not provided and so we assume that the patient's partial pressure is greater than or equal to 32 mm Hg. Neither criteria met and so keep the current total at 2.
Hence, the the number of SIRS criteria met by the patient is 2."
595,51,SIRS Criteria,diagnosis,integer,pmc-5406774-1,Extracted,"Twenty-year-old male presented with an influenza-like illness (LI) with fever, cough, wheezing, shortness of breath, and myalgias. His symptoms began 3 days prior to hospitalization, and he visited an Urgent Care Center and was started on amoxicillin. On admission, his temperature was 38 °C (101.8 °F), pulse was 125/min, and respiratory rate was 22/min. Physical exam was unremarkable except for wheezing and conjunctival suffusion. His white blood cell (WBC) count was 5.7 K/mm3 (81% PMNs, 8% lymphocytes, 11% monocytes) and platelet count was 158 K/µL (n > 160 K/mm3). Serum transaminases and alkaline phosphatase were normal. His C-reactive protein (CRP) was 110 mg/L (n < 3 mg/L) and procalcitonin (PCT) was 0.12 mg/mL (n < 0.5 mg/mL). CXR showed a right middle lobe infiltrate thought to represent a bacterial CAP, and the patient was empirically started on ceftriaxone. Respiratory viral PCR (Film Array) was positive for adenovirus. Moxifloxacin was started on hospital day (HD) #3. He was transferred to the medical intensive care unit (ICU), and his temperature was 102.6 °F, pulse was 116/min, respiratory rate was 30/min, and oxygen saturation was 92% on oxygen at 4 L/min. Repeat CXR showed worsening pneumonia, involving right middle and lower lobes. Multiple sputum and blood cultures—obtained prior to antibiotic therapy—were negative. Empiric antibiotics were changed to meropenem, vancomycin, and levofloxacin for presumed bacterial co-infection.
On HD #4, fevers continued, and he was intubated. WBC count remained normal at 6.2 K/mm3. His erythrocyte sedimentation rate (ESR) was 35 mm/h, CRP was 92 mg/L, and his PCT was 0.08 mg/mL (n < 0.5 mg/mL). Cold agglutinin titer was negative. Legionella sp. antibody and urine antigen were negative. Sputum and nasopharyngeal viral cultures were both positive for adenovirus. Repeat respiratory PCR remained positive for adenovirus, and his adenovirus titer was elevated at 1:128 (n ≤ 1:8). A dose of cidofovir was given. Since the fevers were clearly due to adenoviral pneumonia, multiple empiric antibiotics had no effect on his fevers. Accordingly, the infectious disease consultant repeatedly recommended discontinuing antibiotics for “presumed bacterial coinfection”. However, meropenem, levofloxacin, and vancomycin were continued for “possible bacterial co-infection” because the patient remained febrile ().
He was extubated on HD #8, but his 102 °F fevers continued. Repeat PCT was again unremarkable at 0.17 mg/mL (<0.5 mg/mL). CXR showed much improved right lung infiltrates, and by HD #12 he became afebrile and his CXR infiltrates had resolved. The eventual resolution of his severe adenoviral CAP should not be ascribed to a single dose of cidofovir.",What are the number of SIRS critiera met by the patient? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Temperature': [38.0, 'degrees celsius'], 'Heart Rate or Pulse': [125.0, 'beats per minute'], 'respiratory rate': [22.0, 'breaths per minute'], 'White blood cell count': [5700.0, 'mm^3']}",2,2,2,"The rules for SIRS Criteria are listed below:
    
1. Temperature >38°C (100.4°F) or <36°C (96.8°F): No = 0 points, Yes = +1 point
2. Heart rate >90: No = 0 points, Yes = +1 point
3. Respiratory rate >20 or PaCO₂ <32 mm Hg: No = 0 points, Yes = +1 point
4. White blood cell count (WBC) >12,000/mm³, <4,000/mm³, or >10% bands: No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the score for each criteria.
    
The current count of SIRS criteria met is 0.
The patient's temperature is 38.0 degrees celsius. Because the temperature is between 36 and 38 degrees celsius, this does not meet SIRS criteria for temperature, and so the current total remains at 0.
The patient's heart rate is 125.0 beats per minute. Because the heart rate is greater than 90 beats per minute, this meets SIRS criteria and so we increment the criteria count by 1 making the current total 0 + 1 = 1.
The patient's concentration of white blood cell is 5700.0 count/mm^3. Because the white blood cell count is between 4000 and 12000 count per mm^3, this does not meet SIRS criteria for white blood cell count, and so the current total remains at 1.
The final SIRS criteria is whether the patient has a respiratory rate of more than 20 breaths per minute or if the patient's PaCO₂ partial pressure is less than 32 mm Hg. The patient's respiratory rate is 22.0 breaths per minute, which is greater than 20 breaths per minute. The patient's PaCO₂ partial pressure is not provided and so we assume that the patient's partial pressure is greater than or equal to 32 mm Hg. At least one of the criteria is met, and so we increment the criteria count by 1 giving us a total of 1 + 1 = 2 criteria met.
Hence, the the number of SIRS criteria met by the patient is 2."
596,51,SIRS Criteria,diagnosis,integer,pmc-7189307-1,Extracted,"A 52-year-old male presented to the emergency department with four days of sore throat, odynophagia, and productive cough with clear-white, blood-tinged sputum. He also noted unintentional weight loss of approximately 10 pounds over the past three months but denied dyspnea, night sweats, fever, chills, or prior pulmonary complaints. Additional complaints included nausea, vomiting, polydipsia, and polyuria for the past few days after he stopped taking his long-acting insulin to adjust for decreased oral intake. He was sent to the emergency department by his primary care physician for abnormalities on chest X-ray taken the previous day, at which time he had been prescribed cephalexin empirically for suspected community acquired pneumonia.
His past medical history was significant for type 2 diabetes mellitus controlled with metformin and long-acting insulin without previous hospitalizations. He immigrated to the United States approximately 40 years ago from Central America and had never left the United States since. He works as short-distance truck driver and previously smoked heavily for a decade before quitting 20 years ago.
Upon arrival to the emergency department, his vital signs included blood pressure 123/90 mmHg, heart rate 134 beats per minute, respiratory rate 40 breaths per minute, temperature 97.8°F, and oxygen saturation 98% on room air. His physical exam revealed a cachectic man in mild distress with tachypnea, without nasal flaring or retractions, with dry mucous membranes, and hoarse voice. Lung auscultation revealed diffuse bilateral crackles. Cardiac exam revealed tachycardia with regular rhythm. Abdominal exam did not demonstrate hepatosplenomegaly or tenderness. There were no other significant physical findings on examination.
His chest X-ray revealed diffuse bilateral reticulonodular opacities and airspace disease with a possible lingular cavitary lesion (). A thoracic CT without contrast was obtained which revealed numerous, bilateral tiny nodular densities, most prominently in the upper lobes, and confirmed the lingular cavitary lesion (). A few scattered mediastinal lymph nodes were also noted. Serum chemistry was remarkable for an anion gap of 35, beta-hydroxybutyrate of 8.09 mmol/L, and blood glucose of 532 mg/dL. Hematology showed a white blood cell count of 13 000/μL with 0% eosinophils. Arterial blood gas analysis revealed a pH of 7.13, pCO2 of 32, and lactic acid of 5.46 mmol/L. Urinalysis was positive for 4+ glucose and 3+ acetone. Later, HIV antigen testing for types 1 and 2 was negative and CD4 count was 343 cells/μL. Vancomycin 1 g and piperacillin/tazobactam 3.375 g were given intravenously in the emergency department. Intravenous insulin was started with dose adjustment according to an in-house nursing algorithm alongside vigorous hydration.
He was admitted to the ICU on airborne isolation with differential diagnoses including coccidioidomycosis, tuberculosis, and lymphangitic carcinomatosis, complicated by diabetic ketoacidosis. In the ICU, empiric antifungal therapy with fluconazole 800 mg/day was started intravenously for suspected pulmonary Coccidioides infection. Although serum anion gap and bicarbonate normalized on day two, he remained tachycardic and tachypneic and required supplemental oxygen. He also continued to have odynophagia that necessitated enteral tube feeding until hospital day five, when he was finally able to tolerate an oral diet. At this point, he developed a mild elevation of transaminases and fluconazole was changed to itraconazole 200 mg twice daily due to concern for hepatotoxicity, and abdominal ultrasound and computed tomography (CT) were obtained to rule out hepatic involvement from the suspected fungal infection. Both of these studies were negative for ascites, focal hypoattenuation within the liver, or hepatic or splenic enlargement. The CT additionally did not demonstrate abdominal adenopathy. Aminotransferases trended from their peak on hospital day three to normal on day eight.
A week after admission, he remained tachypneic, hypoxic, and hoarse. Three sputum samples were negative for acid-fast bacilli but Coccidioides antibody titer and complement fixation had not yet resulted; thus, bronchoscopy was performed, revealing irregular-appearing borders of false and true vocal cords with erythema and edema, two vocal cord polyps, inflamed upper trachea in the subglottic space, and several flesh-colored endobronchial lesions bilaterally. Forceps biopsies and brushings were performed on the endobronchial lesions, true and false cords, and posterior trachea just below the larynx. Bronchoalveolar lavage (BAL) was performed in the right middle lobe and lingula. BAL fluid cell count and differential showed a neutrophilic predominance with spherules and endospores, consistent with Coccidioides immitis or Rhinosporidium seeberi. The biopsy specimens demonstrated the same pathogen in the laryngeal tissue. The culture of the BAL fluid eventually grew Coccidioides immitis on the day prior to discharge (day 14), but the laryngeal tissue was not cultured.
Otolaryngology consultant recommended outpatient follow-up with consideration for laryngoscopy after resolution of his acute illness. Two days after bronchoscopy, Coccidioides antibody titer returned positive at 1 : 16. The infectious disease consultant recommended continuing itraconazole for a minimum of 12 months with serial monitoring of Coccidioides titer, transaminases, and itraconazole level every three months. He continually improved on antifungal therapy until successfully weaning from supplemental oxygen and discharge after two weeks of hospitalization.
Coccidioides complement fixation returned strongly positive at 1 : 1024 nine days after discharge. Histoplasma urine antigen was positive but below the limit of quantification. At his follow-up appointments two and twelve weeks after discharge, his productive cough was present but improved and his hoarseness, dyspnea, and odynophagia had resolved. His liver enzymes remain within normal limits. At time of writing, the patient had not yet returned to have his Coccidioides titer or itraconazole level measured.",What are the number of SIRS critiera met by the patient? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Temperature': [97.8, 'degrees fahrenheit'], 'Heart Rate or Pulse': [134.0, 'beats per minute'], 'PaCO2': [32.0, 'mm hg'], 'respiratory rate': [40.0, 'breaths per minute'], 'White blood cell count': [13000.0, 'µL']}",3,3,3,"The rules for SIRS Criteria are listed below:
    
1. Temperature >38°C (100.4°F) or <36°C (96.8°F): No = 0 points, Yes = +1 point
2. Heart rate >90: No = 0 points, Yes = +1 point
3. Respiratory rate >20 or PaCO₂ <32 mm Hg: No = 0 points, Yes = +1 point
4. White blood cell count (WBC) >12,000/mm³, <4,000/mm³, or >10% bands: No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the score for each criteria.
    
The current count of SIRS criteria met is 0.
The patient's temperature is 97.8 degrees fahrenheit. To convert to degrees celsius, apply the formula 5/9 * [temperature (degrees fahrenheit) - 32]. This means that the patient's temperature is 5/9 * 65.8 = 36.55556 degrees celsius. Because the temperature is between 36 and 38 degrees celsius, this does not meet SIRS criteria for temperature, and so the current total remains at 0.
The patient's heart rate is 134.0 beats per minute. Because the heart rate is greater than 90 beats per minute, this meets SIRS criteria and so we increment the criteria count by 1 making the current total 0 + 1 = 1.
The patient's concentration of white blood cell is 13000.0 count/µL. To convert 13000.0 count/µL of white blood cell to mm^3, multiply by the conversion factor 1.0 µL/mm^3 which will give 13000.0 white blood cell count/µL * 1.0 µL/mm^3 = 13000.0 white blood cell count/mm^3. Because the white blood cell count is greater than 12000 count per mm^3, we increment the criteria count by 1 making the current total 1 + 1 = 2.
The final SIRS criteria is whether the patient has a respiratory rate of more than 20 breaths per minute or if the patient's PaCO₂ partial pressure is less than 32 mm Hg. The patient's respiratory rate is 40.0 breaths per minute, which is greater than 20 breaths per minute. The patient's PaCO₂ partial pressure is 32.0 mm Hg, At least one of the criteria is met, and so we increment the criteria count by 1 giving us a total of 2 + 1 = 3 criteria met.
Hence, the the number of SIRS criteria met by the patient is 3."
597,51,SIRS Criteria,diagnosis,integer,pmc-4499596-1,Extracted,"A 67-year-old man was admitted to our hospital with febrile sensation and cough for 3 days. He had no other underlying chronic disease. He was an ex-smoker (20 pack-years) and did not have a history of alcohol abuse. His vital signs were as follows: blood pressure, 140/82 mm Hg; heart rate, 68 beats per minute; respiratory rate, 20 per minute; and body temperature, 38.5℃. Auscultation revealed coarse crackles in both lower lung fields.
Chest radiography showed multiple pulmonary infiltrations in the right lung fields (). White blood cell count was 8,000/mm3 with 76.0% segmented neutrophils, 13.7% lymphocytes, and 1% eosinophils. C-reactive protein and procalcitonin were 23.34 mg/dL and 0.579 mg/dL, respectively. Other routine blood chemistry tests were all normal. Arterial blood gas analysis revealed pH 7.439, PCO2 36.3 mm Hg, PO2 52.4 mm Hg, and HCO3- 24.9 mmol/L.
A computed tomography (CT) scan of the chest was performed, and revealed multiple pulmonary consolidations, ground-glass opacities, and interstitial septal thickenings in both lower lung fields (). Based on these observations, we made a diagnosis of CAP and initiated antimicrobial therapy of intravenous ceftriaxone 2 g plus azithromycin 500 mg. After treatment of CAP, the clinical findings of the patient stabilized, and the patient was discharged on hospital day 4.
After three months, we performed a routine check-up of the patient. The patient had no definitive symptoms. Follow-up chest radiography showed resolution of multiple pulmonary consolidations throughout most of the lung fields, but a mass-like lesion without the loss of right cardiac borders at the right lower lobe field was observed (). Follow-up CT scans of the chest revealed interval improvements in pneumonic consolidations in both lower lung fields, but an increased mass in the right posterior mediastinum at T6-7 level that we had considered to be pneumonic consolidations on the previous CT scans was visible (). This oval and elongated mass with mild enhancement of soft tissue density without any bone destruction was observed (). Positron emission tomography using 2-[fluorine-18] fluoro-2-deoxy-D-glucose (FDG) imaging and CT scans of the whole body except the brain revealed mild FDG uptake of maximum standardized uptake value 3.4 at the posterior mediastinal mass.
Percutaneous needle biopsy using ultrasound was performed. Lung ultrasound revealed an ill-defined, hypoechoic subpleural lesion measuring about 5.0 cm×2.7 cm at right paraspinal area of T6-7 level. And microscopic examination showed diffuse infiltrates of polymorphous and asynchronous plasma cells with large and eccentric nuclei, prominent nucleoli, and abundant cytoplasm (). Immunohistochemistry revealed the biopsy was positive for CD138, the cytoplasm was diffusely reactive for monoclonal kappa-light chain (). Based on these findings, the posterior mediastinal mass was diagnosed as a IgG kappa type plasmacytoma.
We subsequently investigated the possibility of multiple myeloma. Laboratory tests showed an inverse albumin/globulin ratio (total protein, 10.7 g/dL; albumin, 3.0 g/dL; A/G ratio, 0.38). Serum hemoglobin, creatinine, and total calcium were 11.8 g/dL, 1.4 mg/dL, and 8.5 mg/dL, respectively. Immunofixation of serum showed monoclonal gammopathy of IgG-kappa type. In serum protein electrophoresis, the M spike level was 4.58 g/dL. Serum Ig determination revealed a markedly increased IgG level (6,993.1 mg/dL), and the level of β2-microglobulin was 3,674.2 ng/mL. On bone marrow aspiration and biopsy, plasma cells were increased up to 7.8% of all marrow nucleated cells. Those findings were consistent with monoclonal gammopathy of undetermined significance (MGUS) and insufficient for diagnostic criteria of symptomatic multiple myeloma. The patient was finally diagnosed as a posterior mediastinal plasmacytoma (IgG-kappa type). The patient was referred to the hematology department for proper treatment. This report was approved by the Ethical Review Committee.",What are the number of SIRS critiera met by the patient? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Temperature': [38.5, 'degrees celsius'], 'Heart Rate or Pulse': [68.0, 'beats per minute'], 'PaCO2': [36.3, 'mm hg'], 'respiratory rate': [20.0, 'breaths per minute'], 'White blood cell count': [8000.0, 'mm^3']}",1,1,1,"The rules for SIRS Criteria are listed below:
    
1. Temperature >38°C (100.4°F) or <36°C (96.8°F): No = 0 points, Yes = +1 point
2. Heart rate >90: No = 0 points, Yes = +1 point
3. Respiratory rate >20 or PaCO₂ <32 mm Hg: No = 0 points, Yes = +1 point
4. White blood cell count (WBC) >12,000/mm³, <4,000/mm³, or >10% bands: No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the score for each criteria.
    
The current count of SIRS criteria met is 0.
The patient's temperature is 38.5 degrees celsius. Because the temperature is greater than 38 degrees celsius, we increment the criteria count by 1 making the current total 0 + 1 = 1.
The patient's heart rate is 68.0 beats per minute. Because the heart rate is less than 90 beats per minute, this does not meet SIRS criteria for heart rate, and so the current total remains at 1.
The patient's concentration of white blood cell is 8000.0 count/mm^3. Because the white blood cell count is between 4000 and 12000 count per mm^3, this does not meet SIRS criteria for white blood cell count, and so the current total remains at 1.
The final SIRS criteria is whether the patient has a respiratory rate of more than 20 breaths per minute or if the patient's PaCO₂ partial pressure is less than 32 mm Hg. The patient's respiratory rate is 20.0 breaths per minute, which is less or equal to than 20 breaths per min. The patient's PaCO₂ partial pressure is 36.3 mm Hg, which is greater or equal to than 32 mm Hg. Neither criteria met and so keep the current total at 1.
Hence, the the number of SIRS criteria met by the patient is 1."
598,51,SIRS Criteria,diagnosis,integer,pmc-3048475-1,Extracted,"A 22-year-old South Indian man with a previous history of Fontan surgery at the age of 13 for double outlet right ventricle with severe pulmonary stenosis and straddling tricuspid valve presented with a spiking high-grade fever of 25-day duration. He had no history of cough, ear discharge, respiratory infection, dysuria, diarrhea, gastrointestinal distress or vomiting.
His past history included surgery for a brain abscess at the age of 13, Fontan surgery at the age of 13, ocular surgery for retinal detachment at the age of 16, and multiple small skin abscesses chiefly on his left foot, which recurred after treatment and led to an excision of an abscess on his foot. At the age of 20, he was diagnosed with protein-losing enteropathy.
The last echocardiography performed before his hospitalization showed a right to left flow in the Fontan circuit, signifying a flow of de-oxygenated blood from the intended pulmonic to the systemic circulation.
On physical examination, he was found to be febrile with a temperature of 39°C on admission, a heart rate of 88 per minute, a respiratory rate of 26 per minute, blood pressure of 98/60 mmHg, and oxygen saturation of 89 percent in room air. A head to toe examination identified clubbing of his nails, a median sternotomy scar, mild abdominal distension and pedal edema. His teeth and oral cavity were found to be normal. He was 174 cm tall and weighed 51 kg.
His laboratory data on admission showed the following: white blood cells (WBCs) 14,000/mm3, neutrophils 84.5 percent, lymphocytes 8.3 percent, eosinophils 0.2 percent, erythrocyte sedimentation rate 45 mm/hour, hemoglobin 10.1 g/dL, urea 19 mg/dL, serum creatinine 0.6 mg/dL, sodium 122 mmol/L, potassium 3.7 mmol/L, total protein 3.7 g/dL, serum albumin 1.3 g/dL and serum globulin 2.4 g/dL. He tested negative for hepatitis B surface antigen, hepatitis C virus and human immunodeficiency virus. A further work-up for immune deficiency could not be performed for logistical reasons. A urine analysis showed 20-25 red blood cells and 10-12 WBCs per high-power field.
A 2 D echocardiography revealed no vegetations. An ultrasound scan revealed a mass in his left kidney measuring 7.2 × 4 cm. A computed tomography (CT) scan showed a hypodense area in the lower pole of his left kidney measuring 5.28 × 6.22 cm, consistent with a renal abscess, which was percutaneously aspirated and grew highly sensitive Staphylococcus aureus. Special staining for acid-fast bacilli was negative. Figure shows the CT images. His blood cultures were repeatedly negative. One of the urine cultures grew Escherichia coli and Enterococcus species. The E. coli was sensitive to amikacin, cefoperazone and/or sulbactam, gentamicin, imipenem, meropenem, natamycin, nitrofurantoin, and piperacillin and/or tazobactam. The Enterococcus species was sensitive to amoxicillin and clavulanic acid, gentamicin, imipenem, linezolid, meropenem and nitrofurantoin.
On the basis of the sensitivity of the S. aureus isolated from the abscess, he was treated with intravenous gentamicin, 80 mg at eight-hourly intervals, and with intravenous teicoplanin, 400 mg once per day.
He continued experiencing spikes of high-grade fever, and a repeat ultrasound after 12 days of appropriate therapy showed only minimal resolution of the lesion. Surgery was anticipated. A technetium-99 m renogram was performed to see the split function of the kidney with the abscess and to determine whether or not a partial nephrectomy could be performed. The renogram revealed a total glomerular filtration rate of 94 mL/min, with the left kidney contributing 36 mL/min and the right kidney 58 mL/min, and no evidence of obstruction. Figure shows the results of the technetium-99 m renogram.
In view of the persistence of the abscess, he underwent a surgical exploration of the renal bed. An attempt was made to carry out a partial nephrectomy of the affected region. However, this failed and so a left nephrectomy was performed. Figure shows the nephrectomy specimen. Figures and show the histopathological picture.
Post-operatively, his fever subsided and the antibiotic coverage was continued for one week with teicoplanin and gentamicin. At the time of his discharge, his serum creatinine level was 1.1 mg/dL.
A histopathological examination of the diseased kidney revealed infiltrates of lymphocytes, plasma cells and histiocytes. The replacement of renal parenchymal tissue by sheets of foamy histiocytes admixed with neutrophils was observed and this was consistent with xanthogranulomatous pyelonephritis. A special stain for acid-fast bacilli was negative. Clinical, radiological and histopathological examinations failed to provide any evidence of an obstructive lesion in his urinary tract or of renal calculi.
Two weeks after his discharge from hospital, he complained of fever. A CT scan of his abdomen was performed and a residual renal bed abscess was found. A pigtail catheter was inserted and daily aspiration and antibiotic instillation were performed. A week later he was discharged again, with oral antibiotics.
About seven months after the surgery, he remained in a perfect state of health without reports of further infection. This also signified the absence of inherent immune deficiency.",What are the number of SIRS critiera met by the patient? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Temperature': [39.0, 'degrees celsius'], 'Heart Rate or Pulse': [88.0, 'beats per minute'], 'respiratory rate': [26.0, 'breaths per minute'], 'White blood cell count': [14000.0, 'mm^3']}",3,3,3,"The rules for SIRS Criteria are listed below:
    
1. Temperature >38°C (100.4°F) or <36°C (96.8°F): No = 0 points, Yes = +1 point
2. Heart rate >90: No = 0 points, Yes = +1 point
3. Respiratory rate >20 or PaCO₂ <32 mm Hg: No = 0 points, Yes = +1 point
4. White blood cell count (WBC) >12,000/mm³, <4,000/mm³, or >10% bands: No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the score for each criteria.
    
The current count of SIRS criteria met is 0.
The patient's temperature is 39.0 degrees celsius. Because the temperature is greater than 38 degrees celsius, we increment the criteria count by 1 making the current total 0 + 1 = 1.
The patient's heart rate is 88.0 beats per minute. Because the heart rate is less than 90 beats per minute, this does not meet SIRS criteria for heart rate, and so the current total remains at 1.
The patient's concentration of white blood cell is 14000.0 count/mm^3. Because the white blood cell count is greater than 12000 count per mm^3, we increment the criteria count by 1 making the current total 1 + 1 = 2.
The final SIRS criteria is whether the patient has a respiratory rate of more than 20 breaths per minute or if the patient's PaCO₂ partial pressure is less than 32 mm Hg. The patient's respiratory rate is 26.0 breaths per minute, which is greater than 20 breaths per minute. The patient's PaCO₂ partial pressure is not provided and so we assume that the patient's partial pressure is greater than or equal to 32 mm Hg. At least one of the criteria is met, and so we increment the criteria count by 1 giving us a total of 2 + 1 = 3 criteria met.
Hence, the the number of SIRS criteria met by the patient is 3."
599,51,SIRS Criteria,diagnosis,integer,pmc-5500273-1,Extracted,"A 58-year-old woman was admitted to the emergency department owing to generalized weakness, chilling sensation and myalgia since the previous 10 days. She had a medical history of uncontrolled diabetes mellitus and hypertension. She took a prescription for diabetes mellitus, but did not take well. She had no history of trauma or surgery. Her vital signs were as follows: blood pressure, 90/40 mmHg; pulse rate, 100/min; respiratory rate, 20/min; and body temperature, 36.5°C. Laboratory data showed that a white blood cell count 24,290/mm3 with 93% neutrophils, hemoglobin 11.7 g/dL, platelet count 57,000/mm3 and C-reactive protein 33.2 mg/dL. Liver function enzymes showed aspartate aminotransferase 22 U/L, alanine aminotransferase 17 U/L, alkaline phosphatase 1,303 U/L, gamma glutamyl transferase 135 U/L, and total bilirubin 1.11 mg/dL. The HbA1c level was 11.9%, and serum glucose level was 665 mg/dL. Urinalysis showed many bacteria. Blood and urine cultures were obtained prior to initiation of empirical antibiotics. The chest radiograph showed a prominent heart size but no apparent lung parenchymal lesion. The chest and abdominal computed tomography (CT) scan revealed intraosseous gas in the sternum and left clavicle and intra-muscular gas in the left pectoralis major muscle as well as soft tissue emphysema involving the left shoulder and both chest walls (). Additionaly, intraosseous gases were noted in the right iliac bone and sacroiliac joint (). Right pyelonephritis with abscess at the right lower kidney was observed as well ().
Empirical antibiotic therapy with intravenous meropenem (1 g q8h, iv) and teicoplanin (800 mg q24h for 3 days and then 400 mg q24h, iv) was initiated and urgent surgical drainage was performed. At the time of surgical decompression, the pus from sternum, left clavicle and pelvic bone had a foul odor. The pus revealed extended-spectrum ß-lactamase non-producing E. coli, and both blood and urine culture grew E. coli with same antimicrobial susceptibility. Antibiotics were changed to piperacillin/tazobactam (4.0/0.5 g q8h, iv).
A follow-up CT conducted 4 weeks after admission showed marked regression of intraosseous gas in the sternum, left clavicle and adjacent extensive soft tissue emphysema in the left side of neck, left axilla, and both anterior chest walls. However, slightly increased size of abscess pocket involving the right iliacus muscle and osteomyelitis involving the right iliac bone were still noted. Therefore, catheter drainage of right iliac area was maintained for 8 weeks, and pus drainage at the right iliacus muscle was performed again and antibiotic therapy was continued. Follow-up CT scan after 8 weeks revealed emphysematous osteomyelitis of the sternum, left clavicle and right iliac bone with adjacent cellulitis almost resolved ().
After 13 weeks of intravenous antibiotic therapy, the patient showed clinical improvement and was discharged.",What are the number of SIRS critiera met by the patient? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Temperature': [36.5, 'degrees celsius'], 'Heart Rate or Pulse': [100.0, 'beats per minute'], 'respiratory rate': [20.0, 'breaths per minute'], 'White blood cell count': [24290.0, 'mm^3']}",2,2,2,"The rules for SIRS Criteria are listed below:
    
1. Temperature >38°C (100.4°F) or <36°C (96.8°F): No = 0 points, Yes = +1 point
2. Heart rate >90: No = 0 points, Yes = +1 point
3. Respiratory rate >20 or PaCO₂ <32 mm Hg: No = 0 points, Yes = +1 point
4. White blood cell count (WBC) >12,000/mm³, <4,000/mm³, or >10% bands: No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the score for each criteria.
    
The current count of SIRS criteria met is 0.
The patient's temperature is 36.5 degrees celsius. Because the temperature is between 36 and 38 degrees celsius, this does not meet SIRS criteria for temperature, and so the current total remains at 0.
The patient's heart rate is 100.0 beats per minute. Because the heart rate is greater than 90 beats per minute, this meets SIRS criteria and so we increment the criteria count by 1 making the current total 0 + 1 = 1.
The patient's concentration of white blood cell is 24290.0 count/mm^3. Because the white blood cell count is greater than 12000 count per mm^3, we increment the criteria count by 1 making the current total 1 + 1 = 2.
The final SIRS criteria is whether the patient has a respiratory rate of more than 20 breaths per minute or if the patient's PaCO₂ partial pressure is less than 32 mm Hg. The patient's respiratory rate is 20.0 breaths per minute, which is less or equal to than 20 breaths per min. The patient's PaCO₂ partial pressure is not provided and so we assume that the patient's partial pressure is greater than or equal to 32 mm Hg. Neither criteria met and so keep the current total at 2.
Hence, the the number of SIRS criteria met by the patient is 2."
600,51,SIRS Criteria,diagnosis,integer,trec-cds-2016-23,Extracted,"85M dementia, colon cancer and recent colectomy with primary reanastomosis  p/w melena. HCT 30 to 23 but hemodynamically stable. NGL negative.  Exam notable for Tm 99 BP 128/50 HR 70 RR 16 with sat 100 on RA. WD man, NAD. Chest clear, JVP 8cm. RR s1s2. Soft abdomen, well healed surgical scar. No edema or cord. Labs notable for WBC 7K, HCT 24, K+ 4.0, Cr 0.7.",What are the number of SIRS critiera met by the patient? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Temperature': [99.0, 'degrees fahrenheit'], 'Heart Rate or Pulse': [70.0, 'beats per minute'], 'respiratory rate': [16.0, 'breaths per minute'], 'White blood cell count': [7000.0, 'µL']}",0,0,0,"The rules for SIRS Criteria are listed below:
    
1. Temperature >38°C (100.4°F) or <36°C (96.8°F): No = 0 points, Yes = +1 point
2. Heart rate >90: No = 0 points, Yes = +1 point
3. Respiratory rate >20 or PaCO₂ <32 mm Hg: No = 0 points, Yes = +1 point
4. White blood cell count (WBC) >12,000/mm³, <4,000/mm³, or >10% bands: No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the score for each criteria.
    
The current count of SIRS criteria met is 0.
The patient's temperature is 99.0 degrees fahrenheit. To convert to degrees celsius, apply the formula 5/9 * [temperature (degrees fahrenheit) - 32]. This means that the patient's temperature is 5/9 * 67.0 = 37.22222 degrees celsius. Because the temperature is between 36 and 38 degrees celsius, this does not meet SIRS criteria for temperature, and so the current total remains at 0.
The patient's heart rate is 70.0 beats per minute. Because the heart rate is less than 90 beats per minute, this does not meet SIRS criteria for heart rate, and so the current total remains at 0.
The patient's concentration of white blood cell is 7000.0 count/µL. To convert 7000.0 count/µL of white blood cell to mm^3, multiply by the conversion factor 1.0 µL/mm^3 which will give 7000.0 white blood cell count/µL * 1.0 µL/mm^3 = 7000.0 white blood cell count/mm^3. Because the white blood cell count is between 4000 and 12000 count per mm^3, this does not meet SIRS criteria for white blood cell count, and so the current total remains at 0.
The final SIRS criteria is whether the patient has a respiratory rate of more than 20 breaths per minute or if the patient's PaCO₂ partial pressure is less than 32 mm Hg. The patient's respiratory rate is 16.0 breaths per minute, which is less or equal to than 20 breaths per min. The patient's PaCO₂ partial pressure is not provided and so we assume that the patient's partial pressure is greater than or equal to 32 mm Hg. Neither criteria met and so keep the current total at 0.
Hence, the the number of SIRS criteria met by the patient is 0."
601,51,SIRS Criteria,diagnosis,integer,pmc-5997433-1,Extracted,"A 78-year-old African-American female presented to the hospital with complaints of worsening right elbow pain and swelling for six months. She described the pain as a dull ache that worsened with movement and, over time, was unable to fully move the arm. She denied any history of trauma or any other joint involvement. She had a past medical history of stage IIIC ovarian Mullerian tumor with peritoneal carcinomatosis, requiring abdominal hysterectomy with bilateral salpingo-oophorectomy and neoadjuvant chemotherapy with paclitaxel and carboplatin, which was completed two years ago. She was born in the United States and was a retired accountant. She denied any travel outside the country or exposure to TB cases in the United States. Her medications included meloxicam and alendronate.
On initial presentation, her vitals were significant for a temperature of 102.6 F, a respiratory rate of 22 breaths/minute, a pulse rate of 87/minute, and blood pressure of 124/66 mm Hg. The physical examination was remarkable for right elbow erythema, swelling, effusion, and tenderness to palpation. Her range of motion was restricted to only five degrees of flexion and extension at the right elbow joint. The laboratory evaluation revealed leukocytosis of 12.3 x 103/µL, a uric acid level of 7.1 mg/dL, a C-reactive protein of 115 mg/L, and an erythrocyte sedimentation rate of 104 mm/h. An X-ray and computed tomography (CT) of the elbow joint demonstrated bony erosive changes, joint space narrowing, and large effusion in the elbow joint. Magnetic resonance imaging (MRI) of the elbow joint revealed large joint effusion, synovitis, and osteomyelitis of the surrounding bones (Figure ). Blood cultures were drawn and the patient was started on intravenous vancomycin and piperacillin-tazobactam for presumptive pyogenic septic arthritis. She underwent incision and drainage of the right elbow after an unsuccessful attempt at arthrocentesis. Preliminary blood and surgical cultures were negative for bacterial growth. She was discharged home with empiric intravenous antibiotic therapy for six weeks, home wound care, and occupational therapy.
The patient’s symptoms initially improved but about three weeks later, she returned to the hospital with worsening right elbow pain and swelling. Acid-fast bacillus (AFB) cultures sent at the time of initial incision and drainage became positive for acid-fast bacilli (Figure ), and her antibiotics were switched to azithromycin, meropenem, and doxycycline to cover for atypical mycobacteria. A deoxyribonucleic acid (DNA) probe of the acid-fast bacilli was positive for Mycobacterium tuberculosis (MTB), and the patient was started on four-drug anti-tuberculosis therapy, including rifampin, ethambutol, isoniazid, and pyrazinamide with pyridoxine. Final culture results confirmed the presence of the Mycobacterium tuberculosis complex and susceptibilities revealed a non-resistant MTB strain. She was then evaluated for disseminated disease with a CT chest, abdomen, and pelvis. Her CT chest results were remarkable for multiple left, upper lobe nodules and left lower lobe air-space consolidation (Figure ). The patient denied ever having any symptoms of cough, shortness of breath, hemoptysis, and weight loss. She did report having night sweats and chronic fatigue. Bronchoscopy was performed and bronchoalveolar lavage fluid cultures were positive for MTB. She was diagnosed with active TB of the lungs and the elbow joint, possibly as a reactivation of latent TB. The HIV test was negative. The patient was discharged home on the four-drug anti-tuberculous regimen for 12 months under the supervision of the health department. At a four-month follow-up visit, the patient showed significant improvement in her symptoms.",What are the number of SIRS critiera met by the patient? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Temperature': [102.6, 'degrees fahrenheit'], 'Heart Rate or Pulse': [87.0, 'beats per minute'], 'respiratory rate': [22.0, 'breaths per minute'], 'White blood cell count': [12300.0, 'µL']}",3,3,3,"The rules for SIRS Criteria are listed below:
    
1. Temperature >38°C (100.4°F) or <36°C (96.8°F): No = 0 points, Yes = +1 point
2. Heart rate >90: No = 0 points, Yes = +1 point
3. Respiratory rate >20 or PaCO₂ <32 mm Hg: No = 0 points, Yes = +1 point
4. White blood cell count (WBC) >12,000/mm³, <4,000/mm³, or >10% bands: No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the score for each criteria.
    
The current count of SIRS criteria met is 0.
The patient's temperature is 102.6 degrees fahrenheit. To convert to degrees celsius, apply the formula 5/9 * [temperature (degrees fahrenheit) - 32]. This means that the patient's temperature is 5/9 * 70.6 = 39.22222 degrees celsius. Because the temperature is greater than 38 degrees celsius, we increment the criteria count by 1 making the current total 0 + 1 = 1.
The patient's heart rate is 87.0 beats per minute. Because the heart rate is less than 90 beats per minute, this does not meet SIRS criteria for heart rate, and so the current total remains at 1.
The patient's concentration of white blood cell is 12300.0 count/µL. To convert 12300.0 count/µL of white blood cell to mm^3, multiply by the conversion factor 1.0 µL/mm^3 which will give 12300.0 white blood cell count/µL * 1.0 µL/mm^3 = 12300.0 white blood cell count/mm^3. Because the white blood cell count is greater than 12000 count per mm^3, we increment the criteria count by 1 making the current total 1 + 1 = 2.
The final SIRS criteria is whether the patient has a respiratory rate of more than 20 breaths per minute or if the patient's PaCO₂ partial pressure is less than 32 mm Hg. The patient's respiratory rate is 22.0 breaths per minute, which is greater than 20 breaths per minute. The patient's PaCO₂ partial pressure is not provided and so we assume that the patient's partial pressure is greater than or equal to 32 mm Hg. At least one of the criteria is met, and so we increment the criteria count by 1 giving us a total of 2 + 1 = 3 criteria met.
Hence, the the number of SIRS criteria met by the patient is 3."
602,51,SIRS Criteria,diagnosis,integer,pmc-1780062-1,Extracted,"The patient was a 40-year-old male admitted for chronic cough and a 2-month history of intermittent afternoon fever. He denied both a history of traveling and contact with animals over the previous 3 months. Associated symptoms included general malaise, anorexia, and the loss of 6 kg body weight within the previous 2 months. On admission, the vital signs were shown as blood pressure: 124/68 mmHg; pulse rate: 80/min; respiratory rate: 22/min; body temperature: 38.5°C. Physical examination revealed a pansystolic murmur over the apex and left lower sternal border. An abscess in a molar cavity that required debridement was found, although the patient had not complained of dental pain. Laboratory tests revealed a WBC count of 9250/μL with elevated neutrophils (82.7%); normocytic anemia with a hemoglobin level of 10.4 g/dL; an elevated ESR level (123 mm/1 hr); and abnormal liver function with AST/ALT of 49/79 IU/L. A chest x-ray film revealed increased infiltration over the right upper and lower lobes, and abdominal sonography showed mild splenomegaly. Diagnosis of pulmonary tuberculosis was excluded by negative results from serial acid-fast stain and culture of Mycobacterium tuberculosis. Transthoracic echocardiography revealed a vegetation with size of 0.9 cm over the anterior leaflet of mitral valve, and moderate mitral regurgitation. However, the cardiac systolic and diastolic functions were normal with the ejection fraction of 78.9%, fraction shortening of 47.8%. Ultimately, definite subacute endocarditis was diagnosed according to the Duke criteria, including two blood culture results of B. vesicularis; the presence of vegetation on the mitral valve revealed by an echocardiogram (Fig. ); and such clinical and laboratory features as fever, splenomegaly, heart murmur, anemia, Osler's node (Fig. ),,and Roth's spot (Fig. ).
The pathogen was identified as B. vesicularis on the basis of the biochemical characteristics tested by the API ID 32 GN automatic identification system (bioMérieux, Marcy I' Étoile, France). These included the characteristics of positive activity of D-maltose/D-glucose oxidation; negative activity of inositol/D-sorbitol/L-arabinose oxidation; negative activity of L-alanine/capric acid/potassium 5-ketogluconate/trisodium citrate decarboxylation; negative activity of nitrate reduction and indole production. The organism was susceptible to amikacin, gentamicin, piperacillin, aztreonam, cefepime, meropenem, netilmicin, ampicillin, amoxicillin, ciprofloxacin, cefazolin, cefmetazole, ceftazidime, cefotaxime, ceftriaxone, and ticarcillin, according to the susceptibility test performed by the disc diffusion method with interpretation criteria for Pseudomonas []. The patient was treated with a combination of cefazolin (2 gm/8 hr) and gentamicin (80 mg/8 hr) as empiric antibiotics during the first 3 days and fever subsided gradually.
Ampicillin/sulbactam (3 gm/6 hr) was used alternatively for covering the infection of oral anaerobes while the patient underwent removal of the abscessed tooth. Treatment with amipicillin/sulbactam failed, however; the patient developed a flare-up of fever, the appearance of a new Osler's node on the fourth digit of the left hand (Fig. ), and pain in the right femur with right inguinal lymphadenopathy. Treatment with a combination of ceftriaxone (2 gm/12 hr) and gentamicin (80 mg/8 hr) was administered subsequently. The femoral-inguinal symptoms and fever improved gradually with the antimicrobial therapy and therefore were ascribed to embolism. Although the clinical symptoms and signs improved after use of these antibiotics, ciprofloxacin (400 mg/12 hr) was administered as an alternative due to the eruption of a skin rash from an allergic reaction after 7 days' treatment with ceftriaxone. Ultimately, the patient received the treatment regimen for one month and was discharged. There were no sequelae at 6-month follow-up and the mitral vegetation disappeared in the follow-up echocardiogram performed one month after discharge.",What are the number of SIRS critiera met by the patient? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Temperature': [38.5, 'degrees celsius'], 'Heart Rate or Pulse': [80.0, 'beats per minute'], 'respiratory rate': [22.0, 'breaths per minute'], 'White blood cell count': [9250.0, 'µL']}",2,2,2,"The rules for SIRS Criteria are listed below:
    
1. Temperature >38°C (100.4°F) or <36°C (96.8°F): No = 0 points, Yes = +1 point
2. Heart rate >90: No = 0 points, Yes = +1 point
3. Respiratory rate >20 or PaCO₂ <32 mm Hg: No = 0 points, Yes = +1 point
4. White blood cell count (WBC) >12,000/mm³, <4,000/mm³, or >10% bands: No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the score for each criteria.
    
The current count of SIRS criteria met is 0.
The patient's temperature is 38.5 degrees celsius. Because the temperature is greater than 38 degrees celsius, we increment the criteria count by 1 making the current total 0 + 1 = 1.
The patient's heart rate is 80.0 beats per minute. Because the heart rate is less than 90 beats per minute, this does not meet SIRS criteria for heart rate, and so the current total remains at 1.
The patient's concentration of white blood cell is 9250.0 count/µL. To convert 9250.0 count/µL of white blood cell to mm^3, multiply by the conversion factor 1.0 µL/mm^3 which will give 9250.0 white blood cell count/µL * 1.0 µL/mm^3 = 9250.0 white blood cell count/mm^3. Because the white blood cell count is between 4000 and 12000 count per mm^3, this does not meet SIRS criteria for white blood cell count, and so the current total remains at 1.
The final SIRS criteria is whether the patient has a respiratory rate of more than 20 breaths per minute or if the patient's PaCO₂ partial pressure is less than 32 mm Hg. The patient's respiratory rate is 22.0 breaths per minute, which is greater than 20 breaths per minute. The patient's PaCO₂ partial pressure is not provided and so we assume that the patient's partial pressure is greater than or equal to 32 mm Hg. At least one of the criteria is met, and so we increment the criteria count by 1 giving us a total of 1 + 1 = 2 criteria met.
Hence, the the number of SIRS criteria met by the patient is 2."
603,51,SIRS Criteria,diagnosis,integer,pmc-8404025-2,Extracted,"A 59-year-old Hispanic male patient with a medical history of hypertension, obesity, and poorly controlled diabetes mellitus (last HbA1c was 13%) presented to the emergency department for fever of 20 days duration and worsening cough with expectoration, as well as progressive respiratory distress. On admission, his vital signs were a blood pressure of 144/83 mmHg, heart rate of 74 beats per minute, respiratory rate of 50 breaths per minute, O2 saturation of 40% (room air), and temperature of 38 °C. On physical examination, he was found to be febrile, somnolent, and polypneic, with marked respiratory effort. Emergency orotracheal intubation and transfer to the intensive care unit were necessary.
Initial screening showed thrombocytopenia (platelet count 138 × 103 cells/µl), leukocytosis (WBC 15,760 cells/ml, 90% neutrophils) with lymphopenia (6.20% lymphocytes), elevated transaminases (ALT 1507.4 IU and AST 3049.7 IU), elevated d-dimer (44,066 µg/ml), and negative RT-PCR SARS CoV-2 test. Chest X-ray showed extensive interstitial infiltrates in both lung fields (Fig. b). Considering the progressive decrease in total platelet count as well as gradual lymphopenia (Fig. ), a dengue IgM/IgG test was conducted and was positive, while the dengue PCR-RT test was negative. According to radiographic findings and respiratory involvement, the RT-PCR test for SARS CoV-2 was repeated on two more occasions, with negative results. Therefore, IgG antibodies for SARS CoV-2 were assayed and were positive.
Positive serology for both SARS CoV-2 and dengue virus confirmed coinfection, so it was considered that he had probably entered a late stage of the disease. Steroid management was indicated according to COVID-19 management guidelines, in addition to pronation cycles, to which he presented poor response and persistent hypoxemia. During his stay in intensive care, he presented multiple complications, such as acute pulmonary embolism, with signs of secondary thromboembolic pulmonary hypertension, bacterial superinfection in his lungs by Klebsiella pneumoniae, and Akin III acute renal failure. Computerized tomography angiography of the chest was performed, which confirmed acute pulmonary thromboembolism of multiple bilateral lobar and segmental bilateral branches with signs of secondary pulmonary hypertension and pulmonary changes suggestive of organizing pneumonia secondary to viral infection (Fig. ). Details of the clinical description of the coinfection are presented in Table . The patient remained in the ICU for COVID-19, bacterial superinfection, and dengue with alarm signs for 63 days. His progression was slow, showing progressive clinical deterioration. He required prolonged mechanical ventilation and vasopressor management until he finally died.",What are the number of SIRS critiera met by the patient? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Temperature': [38.0, 'degrees celsius'], 'Heart Rate or Pulse': [74.0, 'beats per minute'], 'respiratory rate': [50.0, 'breaths per minute'], 'White blood cell count': [15760.0, 'mL']}",2,2,2,"The rules for SIRS Criteria are listed below:
    
1. Temperature >38°C (100.4°F) or <36°C (96.8°F): No = 0 points, Yes = +1 point
2. Heart rate >90: No = 0 points, Yes = +1 point
3. Respiratory rate >20 or PaCO₂ <32 mm Hg: No = 0 points, Yes = +1 point
4. White blood cell count (WBC) >12,000/mm³, <4,000/mm³, or >10% bands: No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the score for each criteria.
    
The current count of SIRS criteria met is 0.
The patient's temperature is 38.0 degrees celsius. Because the temperature is between 36 and 38 degrees celsius, this does not meet SIRS criteria for temperature, and so the current total remains at 0.
The patient's heart rate is 74.0 beats per minute. Because the heart rate is less than 90 beats per minute, this does not meet SIRS criteria for heart rate, and so the current total remains at 0.
The patient's concentration of white blood cell is 15760.0 count/mL. To convert 15760.0 count/mL of white blood cell to mm^3, multiply by the conversion factor 0.001 mL/mm^3 which will give 15760.0 white blood cell count/mL * 0.001 mL/mm^3 = 15.76 white blood cell count/mm^3. Because the white blood cell count is less than 4000 count per mm^3, we increment the criteria count by 1 making the current total 0 + 1 = 1.
The final SIRS criteria is whether the patient has a respiratory rate of more than 20 breaths per minute or if the patient's PaCO₂ partial pressure is less than 32 mm Hg. The patient's respiratory rate is 50.0 breaths per minute, which is greater than 20 breaths per minute. The patient's PaCO₂ partial pressure is not provided and so we assume that the patient's partial pressure is greater than or equal to 32 mm Hg. At least one of the criteria is met, and so we increment the criteria count by 1 giving us a total of 1 + 1 = 2 criteria met.
Hence, the the number of SIRS criteria met by the patient is 2."
604,51,SIRS Criteria,diagnosis,integer,pmc-4378701-1,Extracted,"A 62-year-old female patient underwent a laparoscopic anterior resection procedure for sigmoid colon cancer. The patient who was discharged on postoperative day four uneventfully presented with complaints of abdominal pain, distended abdomen, nausea, and fever lasting for 24 hours on 4th day after discharge. Her past medical and surgical history was unremarkable except for a previous diagnosis of systemic lupus erythematosus for which she received prednisolone 16 mg/day as treatment.
On physical examination, she had fever at 38.7 C, blood pressure was 110/60 mm/Hg, heart rate was 100/min, and the respiratory rate was 18/min. She was in mild/acute distress and she was alert and oriented. Abdominal examination was notable for distention, hypoactive bowel sounds, and tenderness in all quadrants. There was guarding and rebound in the lower quadrants of the abdomen.
Laboratory evaluation was remarkable for leukocytosis 18,000/mm3 (4500–10,000/mm3), and highly elevated C-reactive protein (CRP) levels of 372 mg/dL (normal range < 5 mg/dL). All other laboratory parameters including electrolytes and renal and liver function tests were within the normal range. A computed tomography (CT) of the abdomen revealed extravasation of luminal contrast from the anastomosis level into the pelvic region (). In addition, a collection of fluid measuring 8 × 5 cm was noticed in the pelvis. There was associated free air in the peritoneum.
A diagnosis of peritonitis due to anastomosis leakage was made and urgent surgical intervention was recommended. The laparoscopic approach was planned. The abdomen was entered laparoscopically via the previous trocar sites. On laparoscopic exploration, the anastomosis site was characterized with small bowel adhesions covered with layers of fibrin clots and purulent fluid accumulation in the pelvic region. Aspiration of the purulent fluid was performed followed by separation of the small bowel adhesions. A 1 cm colon peritoneal fistula covered with fibrin layers was identified at the anastomosis site, which localized intraperitoneally. There was no fecal contamination. The abdomen was irrigated with isotonic saline solution and a complete decontamination of the pelvic contents was performed. After adequate drainage of pelvic collection, a drain was placed through the port site at the left lower quadrant across the anastomosis site into the pelvic region and the procedure was ended. The need for an ostomy was precluded as an endoscopic stent was planned for the closure of the anastomosis site. However, because our endoscopy unit had not been work at night time as emergency services, the patient was sent to the endoscopy unit on 5th hour after the operation.
At sigmoidoscopy, the anastomosis site with 1 cm fistula was identified at 17 cm above the anal verge (). To close the fistula, a 12 cm long partially coated SEMS (Hanarostent Duodenum/Pylorus Lasso, NCN, MI Tech Co., Seoul, South Korea) was placed across the site of leak successfully (). The patient was placed on prophylactic treatment with a third generation cephalosporin and intravenous metronidazole. A dramatic decrease in the patients fever and leukocytosis was observed 24 hours after the procedure. Abdominal pain gradually resolved and oral feeding was started. Abdominal drainage which started at a rate of 150–200 cc/day ceased after 5 days. Follow-up CT demonstrated complete resolution of the anastomosis leak and abscess. The drain was removed and stent removal was planned at four weeks after the procedures. On the seventh postoperative day, the patient was discharged uneventfully. Twenty-four days after the procedure, the patient presented again. She reported an incident of the stent falling out and passing in bowel motion. Sigmoidoscopy was performed and it was consistent with a complete healing of the anastomosis site, while the absence of the stent in the previously inserted location was confirmed (). During follow-up, the patients remained well with no complaints with defecation.",What are the number of SIRS critiera met by the patient? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Temperature': [38.7, 'degrees celsius'], 'Heart Rate or Pulse': [100.0, 'beats per minute'], 'respiratory rate': [18.0, 'breaths per minute'], 'White blood cell count': [18000.0, 'mm^3']}",3,3,3,"The rules for SIRS Criteria are listed below:
    
1. Temperature >38°C (100.4°F) or <36°C (96.8°F): No = 0 points, Yes = +1 point
2. Heart rate >90: No = 0 points, Yes = +1 point
3. Respiratory rate >20 or PaCO₂ <32 mm Hg: No = 0 points, Yes = +1 point
4. White blood cell count (WBC) >12,000/mm³, <4,000/mm³, or >10% bands: No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the score for each criteria.
    
The current count of SIRS criteria met is 0.
The patient's temperature is 38.7 degrees celsius. Because the temperature is greater than 38 degrees celsius, we increment the criteria count by 1 making the current total 0 + 1 = 1.
The patient's heart rate is 100.0 beats per minute. Because the heart rate is greater than 90 beats per minute, this meets SIRS criteria and so we increment the criteria count by 1 making the current total 1 + 1 = 2.
The patient's concentration of white blood cell is 18000.0 count/mm^3. Because the white blood cell count is greater than 12000 count per mm^3, we increment the criteria count by 1 making the current total 2 + 1 = 3.
The final SIRS criteria is whether the patient has a respiratory rate of more than 20 breaths per minute or if the patient's PaCO₂ partial pressure is less than 32 mm Hg. The patient's respiratory rate is 18.0 breaths per minute, which is less or equal to than 20 breaths per min. The patient's PaCO₂ partial pressure is not provided and so we assume that the patient's partial pressure is greater than or equal to 32 mm Hg. Neither criteria met and so keep the current total at 3.
Hence, the the number of SIRS criteria met by the patient is 3."
605,51,SIRS Criteria,diagnosis,integer,pmc-6423866-1,Extracted,"A previously healthy 62-year-old woman living in a rural area developed fever, headache, and fatigue starting on July 27, 2018. She also had gastrointestinal symptoms, such as anorexia, nausea, and diarrhea later, and visited a local clinic on July 30. She was prescribed antipyretic analgesics and returned home. The following day, she developed a mild consciousness disorder and visited a local clinic again accompanied by her family. She underwent a magnetic resonance imaging examination, but no abnormality was noted. However, laboratory data showed leukocytopenia, thrombocytopenia, and increased aspartate aminotransferase (AST) and creatine kinase (CK) levels. She was transported to Kagoshima University Hospital.
On admission, she had a slight disturbance of consciousness [Glasgow Coma Scale of 14: E3, V5, M6], a body temperature of 37.4 °C, a respiratory rate of 22/min, blood pressure of 109/73 mmHg, heart rate of 97/min, SpO2 of 99% (room air), normal heart and respiratory sound, no swelling of the superficial lymph nodes, crusty bite wounds in the left inguinal region, although there was no tick. Laboratory testing showed leukocytopenia (total white blood cell count of 9100 cells/mm3); thrombocytopenia (platelet count of 63,000 cells/mm3); mildly elevated AST (68 U/L), lactate dehydrogenase (364 IU/L), and CK (317 U/L) levels; elevated ferritin level (1947 ng/mL); and normal CK-MB fraction (CK-MB) (4 U/L) and C-reactive protein (CRP) level (< 0.02 mg/dL). A urinary general examination showed protein (4+) and occult blood (3+). Electrocardiography (ECG) and chest radiography findings were normal on the day of admission (day 1).
Because of these clinical findings, she was suspected of having SFTS and transferred to the intensive care unit. Several hours after admission, SFTSV RNA was detected in her serum samples by RT-PCR, so she was definitively diagnosed as having SFTS.
Her clinical course is shown in Fig. . Her blood pressure gradually started to decrease from day 2 evening. Fluid resuscitation (100 ml/h for 10 h; crystalloids 500 ml, colloids 500 ml) was performed until day 3 morning because hand-held ultrasound on day 2 midnight showed collapsed IVC (inferior vena cava). Then, repeat hand-held ultrasound showed recover from collapsed IVC; nevertheless, her blood pressure had not recovered and administration of low doses of dopamine and norepinephrine was started. To exclude cardiogenic shock, trans-thoracic echocardiography was performed and showed diffuse left ventricular (LV) wall motion depression (with an EF: ejection fraction of 34.4%), diffuse LV wall thickening, and small amount of pericardial effusion. Further, ECG showed ST elevation in the II, III, aVf, and V2–6 leads and a low-voltage complex in all leads (Fig. ), and the level of troponin I was elevated (120.9 ng/mL), but that of CK-MB was not. She did not have any chest symptoms. She met several diagnostic criteria for clinically suspected myocarditis [], which include unexplained cardiogenic shock, elevated level of troponin I, abnormal ECG and echocardiographic findings. In addition, she also met criteria for fulminant myocarditis [], which include acute illness (history of < 2–4 weeks since the onset of symptoms), hemodynamic instability due to cardiogenic shock, and need for hemodynamic support (inotrope). Therefore, she was suspected of having fulminant myocarditis caused by SFTSV. However, we did not perform coronary angiography (CAG) or endomyocardial biopsy because thrombocytopenia and leukocytopenia greatly increased the risk of an invasive procedure. We screened for other viruses, including enterovirus, adenovirus, and influenza viruses that may cause myocarditis, but none of them were detected in nasal swab samples.
On day 5 of hospitalization, repeat echocardiography showed further LV dysfunction (with an EF of 27.9%), diffuse LV wall thickening (septum/posterior wall: 14.7 mm/13.5 mm), and narrowing of the left ventricular cavity (Fig. ). On the basis of these results, administration of low doses of dobutamine and milrinone was added. On day 6 of hospitalization, repeat echocardiography showed cardiac tamponade findings of the dilated IVC without respiratory variations and right ventricular diastolic collapse (Fig. ). However, no surgical pericardial puncture was performed, because there was no safe puncture space and a circulation agonist was able to maintain blood pressure. After that, echocardiography showed steady improvement of LV function (EF) and wall thickness, the urine output also continued to increase and the water balance gradually leaned toward negative as a result (Fig. ). Additionally, the pericardial effusion gradually decreased and the cardiac tamponade findings naturally disappeared. On day 11 of hospitalization, her mild disturbance of consciousness from admission had improved, and she no longer needed a circulatory agonist. On day 13 of hospitalization, ECG showed improvement of ST elevation in the II, III, aVf, and V2–6 leads. She was eventually transferred to a general ward on the same day. On day 17 of hospitalization, repeat echocardiography showed normal LV function (with an EF of 70.3%) and wall thickness (septum/posterior wall: 8.9 mm/9.4 mm) (Fig. ).
On day 20 of hospitalization, laboratory testing and ECG showed no abnormal findings. After exercise rehabilitation, she was discharged home on day 28 of hospitalization.
She had no history of cardiac diseases, allergy, or use of drugs that may cause myocarditis. During 28 days of hospitalization, CRP and bacterial culture were always negative, and there was no evidence of eosinophil elevation. Viruses, other than SFTSV, were not detected by virus isolation test. Based on these results, she was clinically diagnosed as having fulminant myocarditis caused by SFTSV.",What are the number of SIRS critiera met by the patient? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Temperature': [37.4, 'degrees celsius'], 'Heart Rate or Pulse': [97.0, 'beats per minute'], 'respiratory rate': [22.0, 'breaths per minute'], 'White blood cell count': [9100.0, 'mm^3']}",2,2,2,"The rules for SIRS Criteria are listed below:
    
1. Temperature >38°C (100.4°F) or <36°C (96.8°F): No = 0 points, Yes = +1 point
2. Heart rate >90: No = 0 points, Yes = +1 point
3. Respiratory rate >20 or PaCO₂ <32 mm Hg: No = 0 points, Yes = +1 point
4. White blood cell count (WBC) >12,000/mm³, <4,000/mm³, or >10% bands: No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the score for each criteria.
    
The current count of SIRS criteria met is 0.
The patient's temperature is 37.4 degrees celsius. Because the temperature is between 36 and 38 degrees celsius, this does not meet SIRS criteria for temperature, and so the current total remains at 0.
The patient's heart rate is 97.0 beats per minute. Because the heart rate is greater than 90 beats per minute, this meets SIRS criteria and so we increment the criteria count by 1 making the current total 0 + 1 = 1.
The patient's concentration of white blood cell is 9100.0 count/mm^3. Because the white blood cell count is between 4000 and 12000 count per mm^3, this does not meet SIRS criteria for white blood cell count, and so the current total remains at 1.
The final SIRS criteria is whether the patient has a respiratory rate of more than 20 breaths per minute or if the patient's PaCO₂ partial pressure is less than 32 mm Hg. The patient's respiratory rate is 22.0 breaths per minute, which is greater than 20 breaths per minute. The patient's PaCO₂ partial pressure is not provided and so we assume that the patient's partial pressure is greater than or equal to 32 mm Hg. At least one of the criteria is met, and so we increment the criteria count by 1 giving us a total of 1 + 1 = 2 criteria met.
Hence, the the number of SIRS criteria met by the patient is 2."
606,51,SIRS Criteria,diagnosis,integer,pmc-7370682-1,Extracted,"A 32-year-old female with a past medical history of obesity (body mass index of 42) and gastroesophageal reflux disease, not on home medications, presented to the emergency department complaining of worsening shortness of breath for two days. The patient was in her usual state of health until seven days before presentation, when she developed a dry cough, fever, chills, and malaise. She worked as a certified nursing assistant at a nursing home facility where a few cases of COVID-19 had been detected recently.
In the emergency department, her initial vital signs were as follows: temperature 99°F, pulse 106 beats per minute, blood pressure 107/70 mmHg, respiratory rate 34 breaths per minute, and oxygen saturation 70% on room air. Physical examination revealed an alert and oriented patient (Glasgow Coma Scale 15), with bilateral wheezing but otherwise unremarkable physical findings. She was promptly placed on nasal cannula and subsequently on nonrebreather 100% FiO2, with an improvement of her oxygen saturation to 95%.
Her initial laboratory results showed a white blood cell count of 10.9 K/µL (normal range [NR] 3.8-10.8 K/µL), absolute lymphocyte count of 0.64 K/µL (NR 0.85-3.9 K/µL), hemoglobin 14.1 g/dL (NR 13.2-17.1 g/dL), platelets 214 K/µL (NR 140-400 K/µL), C-reactive protein 30.94 mg/dL (NR < 0.80 mg/dL), ferritin 998 µg/L, lactic acid 3.3 mmol/L (NR 0.5-2.2 mmol/L), lactate dehydrogenase 556 U/L (NR 125-220 U/L), troponin was negative (NR < 0.30 ng/mL), creatinine 1.0 mg/dL (NR 0.7-1.3 mg/dL), Na 138 mmol/L (NR 135-145 mmol/L), K 3.4 mmol/L (NR 3.5-5.1 mmol/L), and high-sensitivity D-dimer 806 ng/mL (NR < 231 ng/mL).
The chest radiograph obtained in the emergency department demonstrated multiple rounded and peripheral ground-glass opacities throughout the lung fields (Figure ).
A nasopharyngeal swab was performed and tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA. Due to severe hypoxia, the patient was admitted to the intensive care unit (ICU). On hospital day 2, she underwent intubation and mechanical ventilation for worsening tachypnea and respiratory distress. The patient was started on intravenous steroids (methylprednisolone 40 mg every eight hours), received a dose of tocilizumab 400 mg, and completed a five-day course of hydroxychloroquine (800 mg/day for one day, then 400 mg/day for four days) and azithromycin (500 mg/day for one day, then 250 mg/day for four days).
On hospital day 3, her renal function worsened, and her creatinine peaked at 2.4 mg/dL, likely secondary to acute tubular necrosis. However, she remained with good urine output and no significant metabolic acidosis. Her creatinine gradually improved on the subsequent days, returning to the baseline renal function. The patient remained stable hemodynamically and sedated with hydromorphone and ketamine, but despite the optimized medical management she continued to spike fevers at 102°F, and repeated chest imaging with CT on day 5 showed significant worsening bilateral ground-glass airspace opacities (Figure ).
On hospital day 7, she received convalescent plasma transfusion and started on vancomycin after respiratory cultures demonstrated the presence of Staphylococcus aureus infection. On hospital day 8, the patient had an episode of oxygen desaturation to 75% with a PaO2/FiO2 ratio of 79, despite being on mechanical ventilation with FiO2 100% and positive end-expiratory pressure (PEEP) 12 cm H2O. She was bagged by the respiratory therapist for over one hour and given the failure of mechanical ventilation to provide adequate oxygenation, the decision was to start VV-ECMO.
The patient’s left femoral vein was cannulated with a 28-Fr heparin-coated cannula for blood return and the left internal jugular vein was cannulated with a 21-Fr cannula for blood access. The patient was placed on VV-ECMO (CentriMag [Thoratec, Pleasanton, CA, USA] short-term external circulatory device) with initial settings of flow 4.5 liters per minute, speed 3,300 revolutions per minute, and ECMO FiO2 100%, sweep three liters per minute. She was started on heparin drip, received infusion of neuromuscular blocking agent cisatracurium for a short period, and then remained sedated with hydromorphone and lorazepam. She continued to have episodes of fevers up to 101°F, and repeated sputum cultures demonstrated the presence of Acinetobacter species and Proteus mirabilis, while blood cultures were negative. She was placed on cefepime for ventilator-associated pneumonia and the episodes of fevers gradually improved.
On the following two weeks, the patient was gradually able to wean down VV-ECMO settings, decreasing ECMO FiO2 to 40%, and flow to 3.6 liters per minute. On hospital day 20, she had a transvenous pacemaker placed due to several episodes of bradycardia with pauses lasting up to 19 seconds during oral care, likely vagally mediated. On hospital day 21, a bronchoscopy was performed and showed minimal secretions and no mucus plug. Given her prolonged time intubated, she underwent tracheostomy placement on hospital day 22. On hospital day 26, the patient was finally able to have VV-ECMO explanted, after 18 days of extracorporeal therapy. As she continued to improve clinically, the mechanical ventilation was successfully weaned off on hospital day 38. The patient was noted to have no neurological deficits, and was able to be downgraded from ICU to the medical ward on the following day.",What are the number of SIRS critiera met by the patient? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Temperature': [99.0, 'degrees fahrenheit'], 'Heart Rate or Pulse': [106.0, 'beats per minute'], 'respiratory rate': [34.0, 'breaths per minute'], 'White blood cell count': [10900.0, 'µL']}",2,2,2,"The rules for SIRS Criteria are listed below:
    
1. Temperature >38°C (100.4°F) or <36°C (96.8°F): No = 0 points, Yes = +1 point
2. Heart rate >90: No = 0 points, Yes = +1 point
3. Respiratory rate >20 or PaCO₂ <32 mm Hg: No = 0 points, Yes = +1 point
4. White blood cell count (WBC) >12,000/mm³, <4,000/mm³, or >10% bands: No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the score for each criteria.
    
The current count of SIRS criteria met is 0.
The patient's temperature is 99.0 degrees fahrenheit. To convert to degrees celsius, apply the formula 5/9 * [temperature (degrees fahrenheit) - 32]. This means that the patient's temperature is 5/9 * 67.0 = 37.22222 degrees celsius. Because the temperature is between 36 and 38 degrees celsius, this does not meet SIRS criteria for temperature, and so the current total remains at 0.
The patient's heart rate is 106.0 beats per minute. Because the heart rate is greater than 90 beats per minute, this meets SIRS criteria and so we increment the criteria count by 1 making the current total 0 + 1 = 1.
The patient's concentration of white blood cell is 10900.0 count/µL. To convert 10900.0 count/µL of white blood cell to mm^3, multiply by the conversion factor 1.0 µL/mm^3 which will give 10900.0 white blood cell count/µL * 1.0 µL/mm^3 = 10900.0 white blood cell count/mm^3. Because the white blood cell count is between 4000 and 12000 count per mm^3, this does not meet SIRS criteria for white blood cell count, and so the current total remains at 1.
The final SIRS criteria is whether the patient has a respiratory rate of more than 20 breaths per minute or if the patient's PaCO₂ partial pressure is less than 32 mm Hg. The patient's respiratory rate is 34.0 breaths per minute, which is greater than 20 breaths per minute. The patient's PaCO₂ partial pressure is not provided and so we assume that the patient's partial pressure is greater than or equal to 32 mm Hg. At least one of the criteria is met, and so we increment the criteria count by 1 giving us a total of 1 + 1 = 2 criteria met.
Hence, the the number of SIRS criteria met by the patient is 2."
607,51,SIRS Criteria,diagnosis,integer,pmc-7652029-1,Extracted,"A 57-year-old lady was brought to the ED by family with complaints of severe generalized body weakness, confusion, difficulty walking, achiness in legs, numbness in extremities, dizziness, nausea, vomiting, abdominal pain, constipation and occasional palpitations. Patient had total parathyroidectomy and partial thyroidectomy three weeks ago for primary hyperparathyroidism caused by parathyroid adenomas. Serum calcium level at the referring facility was 21 mg/dL. EKG showed prolonged QTc of 476 ms and nonspecific ST-T wave changes, she denied chest pain and troponin levels were <0.015. At the time of admission in our facility, her vital signs were temperature 97.9 F, heart rate 87 bpm, respiratory rate 16/min and blood pressure 163/67 mmHg. She was alert and oriented, had normal reflexes through symmetrically decreased muscle strength in all four extremities with mild generalized abdominal tenderness. Rest of the physical exam was unremarkable. Patient’s initial laboratory values showed white blood cell (WBC) count of 15.5 k/mm3, hemoglobin (Hb) of 15.6 gm/dL, platelet count of 370 k/mm3, creatinine of 1.9 mg/dL (baseline was 0.8), BUN of 45 mg/dL, eGFR of 27 mL/min (baseline eGFR >60 mL/min), bicarbonate of 33 mEq/L, chloride of 94 mEq/L, potassium of 2.5 mEq/L, sodium of 135 mEq/L, total calcium of 23 mg/dL with ionized calcium of 12.03 mg/dL, phosphate of 1.3 mg/dL and PTH of 0. Her 25 hydroxyvitamin D level was 61 ng/mL (normal 30-100 ng/mL) and 1-25 hydroxyvitamin D3 level was 31 pg/ml (normal 18-72 pg/mL) (Table ).
When asked about medication history, patient reported 3 g calcium carbonate intake daily, calcitriol 0.5 mcg twice daily, cholecalciferol (vitamin D3) 10,000 units once daily, chlorthalidone 25 mg once daily and irbesartan 300 mg once daily. Her diet included a glass of milk after each meal. As explained earlier, a diagnosis of CATS was made, and treatment was started. It was obvious from history that hypercalcemia was due to excessive calcium intake so calcium, vitamin D supplements and chlorthalidone were stopped. Irbesartan contributing to AKI was also stopped. Aggressive hydration was instituted with intravenous (IV) normal saline 150-200 mL/hour with 4L given in the first 24 hours. Furosemide 40 mg twice daily was also started. Patient didn’t require calcitonin. Due to the anticipated serious risk of late hypocalcemia owing to parathyroidectomy, bisphosphonates were not considered. Patient improved clinically and her symptoms resolved, she was discharged on hospital day 5, with total calcium level reduced to 10.3 mg/dL and ionized calcium to 5.77 mg/dL. Her creatinine levels were close to baseline at 1.4 mg/dL on the day of discharge.",What are the number of SIRS critiera met by the patient? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Temperature': [97.9, 'degrees fahrenheit'], 'Heart Rate or Pulse': [87.0, 'bpm'], 'respiratory rate': [16.0, 'breaths per minute'], 'White blood cell count': [15500.0, 'mm^3']}",1,1,1,"The rules for SIRS Criteria are listed below:
    
1. Temperature >38°C (100.4°F) or <36°C (96.8°F): No = 0 points, Yes = +1 point
2. Heart rate >90: No = 0 points, Yes = +1 point
3. Respiratory rate >20 or PaCO₂ <32 mm Hg: No = 0 points, Yes = +1 point
4. White blood cell count (WBC) >12,000/mm³, <4,000/mm³, or >10% bands: No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the score for each criteria.
    
The current count of SIRS criteria met is 0.
The patient's temperature is 97.9 degrees fahrenheit. To convert to degrees celsius, apply the formula 5/9 * [temperature (degrees fahrenheit) - 32]. This means that the patient's temperature is 5/9 * 65.9 = 36.61111 degrees celsius. Because the temperature is between 36 and 38 degrees celsius, this does not meet SIRS criteria for temperature, and so the current total remains at 0.
The patient's heart rate is 87.0 beats per minute. Because the heart rate is less than 90 beats per minute, this does not meet SIRS criteria for heart rate, and so the current total remains at 0.
The patient's concentration of white blood cell is 15500.0 count/mm^3. Because the white blood cell count is greater than 12000 count per mm^3, we increment the criteria count by 1 making the current total 0 + 1 = 1.
The final SIRS criteria is whether the patient has a respiratory rate of more than 20 breaths per minute or if the patient's PaCO₂ partial pressure is less than 32 mm Hg. The patient's respiratory rate is 16.0 breaths per minute, which is less or equal to than 20 breaths per min. The patient's PaCO₂ partial pressure is not provided and so we assume that the patient's partial pressure is greater than or equal to 32 mm Hg. Neither criteria met and so keep the current total at 1.
Hence, the the number of SIRS criteria met by the patient is 1."
608,51,SIRS Criteria,diagnosis,integer,usmle-1182,Extracted,"A previously healthy 38-year-old woman is brought to the emergency department by her husband because of left-sided weakness. As she was getting dressed this morning, she was suddenly unable to button up her shirt. When she showed her husband, he noticed that she seemed confused. She has a 3-year history of diabetes mellitus, for which she takes metformin. She had a knee operation 2 days ago. Her temperature is 38.9°C (102°F), pulse is 98/min, respirations are 17/min, and blood pressure is 138/85 mm Hg. She is confused and oriented only to person. Neurologic examination shows diminished muscle strength on the left side. There are scattered petechiae over the chest, arms, and legs. Laboratory studies show:
Hemoglobin 7.5 g/dL
Leukocyte count 10,500/mm3
Platelet count 40,000/mm3
Prothrombin time 15 seconds
Partial thromboplastin time 36 seconds
Serum
Bilirubin
Total 3.5 mg/dL
Direct 0.3 mg/dL
Urea nitrogen 35 mg/dL
Creatinine 2.5 mg/dL
Lactate dehydrogenase 1074 U/L
A peripheral smear shows numerous schistocytes.",What are the number of SIRS critiera met by the patient? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Temperature': [38.9, 'degrees celsius'], 'Heart Rate or Pulse': [98.0, 'beats per minute'], 'respiratory rate': [17.0, 'breaths per minute'], 'White blood cell count': [10500.0, 'mm^3']}",2,2,2,"The rules for SIRS Criteria are listed below:
    
1. Temperature >38°C (100.4°F) or <36°C (96.8°F): No = 0 points, Yes = +1 point
2. Heart rate >90: No = 0 points, Yes = +1 point
3. Respiratory rate >20 or PaCO₂ <32 mm Hg: No = 0 points, Yes = +1 point
4. White blood cell count (WBC) >12,000/mm³, <4,000/mm³, or >10% bands: No = 0 points, Yes = +1 point

The total number of criteria met is taken by summing the score for each criteria.
    
The current count of SIRS criteria met is 0.
The patient's temperature is 38.9 degrees celsius. Because the temperature is greater than 38 degrees celsius, we increment the criteria count by 1 making the current total 0 + 1 = 1.
The patient's heart rate is 98.0 beats per minute. Because the heart rate is greater than 90 beats per minute, this meets SIRS criteria and so we increment the criteria count by 1 making the current total 1 + 1 = 2.
The patient's concentration of white blood cell is 10500.0 count/mm^3. Because the white blood cell count is between 4000 and 12000 count per mm^3, this does not meet SIRS criteria for white blood cell count, and so the current total remains at 2.
The final SIRS criteria is whether the patient has a respiratory rate of more than 20 breaths per minute or if the patient's PaCO₂ partial pressure is less than 32 mm Hg. The patient's respiratory rate is 17.0 breaths per minute, which is less or equal to than 20 breaths per min. The patient's PaCO₂ partial pressure is not provided and so we assume that the patient's partial pressure is greater than or equal to 32 mm Hg. Neither criteria met and so keep the current total at 2.
Hence, the the number of SIRS criteria met by the patient is 2."
609,56,QTc Fridericia Calculator,physical,decimal,1,Template,A patient has a heart rate of 171 bpm and a QT interval of 340 msec.,"Using the Fridericia Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [171, 'beats per minute'], 'QT Interval': [340, 'msec']}",482.05069,457.94816,506.15322,"The corrected QT interval using the Fredericia formula is computed as  QTc = QT interval / (RR interval)**(1/3), where ** denotes an exponent, QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 171 beats per minute.
The QT interval is 340 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/171 = 0.35088.
Hence, plugging in these values, we will get 340/√(0.35088) = 482.05069.The patient's corrected QT interval (QTc) is 482.05069 msec."
610,56,QTc Fridericia Calculator,physical,decimal,2,Template,A patient has a heart rate of 153 bpm and a QT interval of 206 msec.,"Using the Fridericia Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [153, 'beats per minute'], 'QT Interval': [206, 'msec']}",281.43587,267.36408,295.50766,"The corrected QT interval using the Fredericia formula is computed as  QTc = QT interval / (RR interval)**(1/3), where ** denotes an exponent, QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 153 beats per minute.
The QT interval is 206 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/153 = 0.39216.
Hence, plugging in these values, we will get 206/√(0.39216) = 281.43587.The patient's corrected QT interval (QTc) is 281.43587 msec."
611,56,QTc Fridericia Calculator,physical,decimal,3,Template,A patient has a heart rate of 55 bpm and a QT interval of 469 msec.,"Using the Fridericia Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [55, 'beats per minute'], 'QT Interval': [469, 'msec']}",455.59247,432.81285,478.37209,"The corrected QT interval using the Fredericia formula is computed as  QTc = QT interval / (RR interval)**(1/3), where ** denotes an exponent, QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 55 beats per minute.
The QT interval is 469 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/55 = 1.09091.
Hence, plugging in these values, we will get 469/√(1.09091) = 455.59247.The patient's corrected QT interval (QTc) is 455.59247 msec."
612,56,QTc Fridericia Calculator,physical,decimal,4,Template,A patient has a heart rate of 91 bpm and a QT interval of 317 msec.,"Using the Fridericia Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [91, 'beats per minute'], 'QT Interval': [317, 'msec']}",364.21357,346.00289,382.42425,"The corrected QT interval using the Fredericia formula is computed as  QTc = QT interval / (RR interval)**(1/3), where ** denotes an exponent, QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 91 beats per minute.
The QT interval is 317 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/91 = 0.65934.
Hence, plugging in these values, we will get 317/√(0.65934) = 364.21357.The patient's corrected QT interval (QTc) is 364.21357 msec."
613,56,QTc Fridericia Calculator,physical,decimal,5,Template,A patient has a heart rate of 53 bpm and a QT interval of 408 msec.,"Using the Fridericia Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [53, 'beats per minute'], 'QT Interval': [408, 'msec']}",391.47238,371.89876,411.046,"The corrected QT interval using the Fredericia formula is computed as  QTc = QT interval / (RR interval)**(1/3), where ** denotes an exponent, QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 53 beats per minute.
The QT interval is 408 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/53 = 1.13208.
Hence, plugging in these values, we will get 408/√(1.13208) = 391.47238.The patient's corrected QT interval (QTc) is 391.47238 msec."
614,56,QTc Fridericia Calculator,physical,decimal,6,Template,A patient has a heart rate of 99 bpm and a QT interval of 489 msec.,"Using the Fridericia Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [99, 'beats per minute'], 'QT Interval': [489, 'msec']}",577.83474,548.943,606.72648,"The corrected QT interval using the Fredericia formula is computed as  QTc = QT interval / (RR interval)**(1/3), where ** denotes an exponent, QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 99 beats per minute.
The QT interval is 489 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/99 = 0.60606.
Hence, plugging in these values, we will get 489/√(0.60606) = 577.83474.The patient's corrected QT interval (QTc) is 577.83474 msec."
615,56,QTc Fridericia Calculator,physical,decimal,7,Template,A patient has a heart rate of 113 bpm and a QT interval of 423 msec.,"Using the Fridericia Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [113, 'beats per minute'], 'QT Interval': [423, 'msec']}",522.37659,496.25776,548.49542,"The corrected QT interval using the Fredericia formula is computed as  QTc = QT interval / (RR interval)**(1/3), where ** denotes an exponent, QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 113 beats per minute.
The QT interval is 423 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/113 = 0.53097.
Hence, plugging in these values, we will get 423/√(0.53097) = 522.37659.The patient's corrected QT interval (QTc) is 522.37659 msec."
616,56,QTc Fridericia Calculator,physical,decimal,8,Template,A patient has a heart rate of 92 bpm and a QT interval of 248 msec.,"Using the Fridericia Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [92, 'beats per minute'], 'QT Interval': [248, 'msec']}",285.9772,271.67834,300.27606,"The corrected QT interval using the Fredericia formula is computed as  QTc = QT interval / (RR interval)**(1/3), where ** denotes an exponent, QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 92 beats per minute.
The QT interval is 248 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/92 = 0.65217.
Hence, plugging in these values, we will get 248/√(0.65217) = 285.9772.The patient's corrected QT interval (QTc) is 285.9772 msec."
617,56,QTc Fridericia Calculator,physical,decimal,9,Template,A patient has a heart rate of 131 bpm and a QT interval of 305 msec.,"Using the Fridericia Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [131, 'beats per minute'], 'QT Interval': [305, 'msec']}",395.67477,375.89103,415.45851,"The corrected QT interval using the Fredericia formula is computed as  QTc = QT interval / (RR interval)**(1/3), where ** denotes an exponent, QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 131 beats per minute.
The QT interval is 305 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/131 = 0.45802.
Hence, plugging in these values, we will get 305/√(0.45802) = 395.67477.The patient's corrected QT interval (QTc) is 395.67477 msec."
618,56,QTc Fridericia Calculator,physical,decimal,10,Template,A patient has a heart rate of 178 bpm and a QT interval of 348 msec.,"Using the Fridericia Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [178, 'beats per minute'], 'QT Interval': [348, 'msec']}",500.03636,475.03454,525.03818,"The corrected QT interval using the Fredericia formula is computed as  QTc = QT interval / (RR interval)**(1/3), where ** denotes an exponent, QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 178 beats per minute.
The QT interval is 348 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/178 = 0.33708.
Hence, plugging in these values, we will get 348/√(0.33708) = 500.03636.The patient's corrected QT interval (QTc) is 500.03636 msec."
619,56,QTc Fridericia Calculator,physical,decimal,11,Template,A patient has a heart rate of 118 bpm and a QT interval of 452 msec.,"Using the Fridericia Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [118, 'beats per minute'], 'QT Interval': [452, 'msec']}",566.30447,537.98925,594.61969,"The corrected QT interval using the Fredericia formula is computed as  QTc = QT interval / (RR interval)**(1/3), where ** denotes an exponent, QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 118 beats per minute.
The QT interval is 452 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/118 = 0.50847.
Hence, plugging in these values, we will get 452/√(0.50847) = 566.30447.The patient's corrected QT interval (QTc) is 566.30447 msec."
620,56,QTc Fridericia Calculator,physical,decimal,12,Template,A patient has a heart rate of 152 bpm and a QT interval of 229 msec.,"Using the Fridericia Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [152, 'beats per minute'], 'QT Interval': [229, 'msec']}",312.17523,296.56647,327.78399,"The corrected QT interval using the Fredericia formula is computed as  QTc = QT interval / (RR interval)**(1/3), where ** denotes an exponent, QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 152 beats per minute.
The QT interval is 229 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/152 = 0.39474.
Hence, plugging in these values, we will get 229/√(0.39474) = 312.17523.The patient's corrected QT interval (QTc) is 312.17523 msec."
621,56,QTc Fridericia Calculator,physical,decimal,13,Template,A patient has a heart rate of 179 bpm and a QT interval of 421 msec.,"Using the Fridericia Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [179, 'beats per minute'], 'QT Interval': [421, 'msec']}",606.05787,575.75498,636.36076,"The corrected QT interval using the Fredericia formula is computed as  QTc = QT interval / (RR interval)**(1/3), where ** denotes an exponent, QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 179 beats per minute.
The QT interval is 421 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/179 = 0.3352.
Hence, plugging in these values, we will get 421/√(0.3352) = 606.05787.The patient's corrected QT interval (QTc) is 606.05787 msec."
622,56,QTc Fridericia Calculator,physical,decimal,14,Template,A patient has a heart rate of 96 bpm and a QT interval of 261 msec.,"Using the Fridericia Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [96, 'beats per minute'], 'QT Interval': [261, 'msec']}",305.26745,290.00408,320.53082,"The corrected QT interval using the Fredericia formula is computed as  QTc = QT interval / (RR interval)**(1/3), where ** denotes an exponent, QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 96 beats per minute.
The QT interval is 261 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/96 = 0.625.
Hence, plugging in these values, we will get 261/√(0.625) = 305.26745.The patient's corrected QT interval (QTc) is 305.26745 msec."
623,56,QTc Fridericia Calculator,physical,decimal,15,Template,A patient has a heart rate of 123 bpm and a QT interval of 490 msec.,"Using the Fridericia Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [123, 'beats per minute'], 'QT Interval': [490, 'msec']}",622.46578,591.34249,653.58907,"The corrected QT interval using the Fredericia formula is computed as  QTc = QT interval / (RR interval)**(1/3), where ** denotes an exponent, QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 123 beats per minute.
The QT interval is 490 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/123 = 0.4878.
Hence, plugging in these values, we will get 490/√(0.4878) = 622.46578.The patient's corrected QT interval (QTc) is 622.46578 msec."
624,56,QTc Fridericia Calculator,physical,decimal,16,Template,A patient has a heart rate of 171 bpm and a QT interval of 408 msec.,"Using the Fridericia Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [171, 'beats per minute'], 'QT Interval': [408, 'msec']}",578.46083,549.53779,607.38387,"The corrected QT interval using the Fredericia formula is computed as  QTc = QT interval / (RR interval)**(1/3), where ** denotes an exponent, QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 171 beats per minute.
The QT interval is 408 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/171 = 0.35088.
Hence, plugging in these values, we will get 408/√(0.35088) = 578.46083.The patient's corrected QT interval (QTc) is 578.46083 msec."
625,56,QTc Fridericia Calculator,physical,decimal,17,Template,A patient has a heart rate of 161 bpm and a QT interval of 475 msec.,"Using the Fridericia Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [161, 'beats per minute'], 'QT Interval': [475, 'msec']}",660.06312,627.05996,693.06628,"The corrected QT interval using the Fredericia formula is computed as  QTc = QT interval / (RR interval)**(1/3), where ** denotes an exponent, QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 161 beats per minute.
The QT interval is 475 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/161 = 0.37267.
Hence, plugging in these values, we will get 475/√(0.37267) = 660.06312.The patient's corrected QT interval (QTc) is 660.06312 msec."
626,56,QTc Fridericia Calculator,physical,decimal,18,Template,A patient has a heart rate of 149 bpm and a QT interval of 267 msec.,"Using the Fridericia Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [149, 'beats per minute'], 'QT Interval': [267, 'msec']}",361.56904,343.49059,379.64749,"The corrected QT interval using the Fredericia formula is computed as  QTc = QT interval / (RR interval)**(1/3), where ** denotes an exponent, QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 149 beats per minute.
The QT interval is 267 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/149 = 0.40268.
Hence, plugging in these values, we will get 267/√(0.40268) = 361.56904.The patient's corrected QT interval (QTc) is 361.56904 msec."
627,56,QTc Fridericia Calculator,physical,decimal,19,Template,A patient has a heart rate of 149 bpm and a QT interval of 438 msec.,"Using the Fridericia Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [149, 'beats per minute'], 'QT Interval': [438, 'msec']}",593.13574,563.47895,622.79253,"The corrected QT interval using the Fredericia formula is computed as  QTc = QT interval / (RR interval)**(1/3), where ** denotes an exponent, QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 149 beats per minute.
The QT interval is 438 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/149 = 0.40268.
Hence, plugging in these values, we will get 438/√(0.40268) = 593.13574.The patient's corrected QT interval (QTc) is 593.13574 msec."
628,56,QTc Fridericia Calculator,physical,decimal,20,Template,A patient has a heart rate of 75 bpm and a QT interval of 326 msec.,"Using the Fridericia Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [75, 'beats per minute'], 'QT Interval': [326, 'msec']}",351.17285,333.61421,368.73149,"The corrected QT interval using the Fredericia formula is computed as  QTc = QT interval / (RR interval)**(1/3), where ** denotes an exponent, QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 75 beats per minute.
The QT interval is 326 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/75 = 0.8.
Hence, plugging in these values, we will get 326/√(0.8) = 351.17285.The patient's corrected QT interval (QTc) is 351.17285 msec."
629,57,QTc Framingham Calculator,physical,decimal,1,Template,A patient has a heart rate of 110 bpm and a QT interval of 490 msec.,"Using the Framingham Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [110, 'beats per minute'], 'QT Interval': [490, 'msec']}",560.0007,532.00067,588.00074,"The corrected QT interval using the Framingham formula is computed as  QTc = QT Interval + (154 * (1 - rr_interval_sec)), where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 110 beats per minute.
The QT interval is 490 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/110 = 0.54545.
Hence, plugging in these values, we will get 490/(154 * ( 1- 0.54545 )) = 560.0007.
The patient's corrected QT interval (QTc) is 560.0007 msec."
630,57,QTc Framingham Calculator,physical,decimal,2,Template,A patient has a heart rate of 102 bpm and a QT interval of 290 msec.,"Using the Framingham Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [102, 'beats per minute'], 'QT Interval': [290, 'msec']}",353.41104,335.74049,371.08159,"The corrected QT interval using the Framingham formula is computed as  QTc = QT Interval + (154 * (1 - rr_interval_sec)), where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 102 beats per minute.
The QT interval is 290 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/102 = 0.58824.
Hence, plugging in these values, we will get 290/(154 * ( 1- 0.58824 )) = 353.41104.
The patient's corrected QT interval (QTc) is 353.41104 msec."
631,57,QTc Framingham Calculator,physical,decimal,3,Template,A patient has a heart rate of 77 bpm and a QT interval of 273 msec.,"Using the Framingham Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [77, 'beats per minute'], 'QT Interval': [273, 'msec']}",307.00012,291.65011,322.35013,"The corrected QT interval using the Framingham formula is computed as  QTc = QT Interval + (154 * (1 - rr_interval_sec)), where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 77 beats per minute.
The QT interval is 273 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/77 = 0.77922.
Hence, plugging in these values, we will get 273/(154 * ( 1- 0.77922 )) = 307.00012.
The patient's corrected QT interval (QTc) is 307.00012 msec."
632,57,QTc Framingham Calculator,physical,decimal,4,Template,A patient has a heart rate of 56 bpm and a QT interval of 453 msec.,"Using the Framingham Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [56, 'beats per minute'], 'QT Interval': [453, 'msec']}",441.99978,419.89979,464.09977,"The corrected QT interval using the Framingham formula is computed as  QTc = QT Interval + (154 * (1 - rr_interval_sec)), where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 56 beats per minute.
The QT interval is 453 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/56 = 1.07143.
Hence, plugging in these values, we will get 453/(154 * ( 1- 1.07143 )) = 441.99978.
The patient's corrected QT interval (QTc) is 441.99978 msec."
633,57,QTc Framingham Calculator,physical,decimal,5,Template,A patient has a heart rate of 45 bpm and a QT interval of 314 msec.,"Using the Framingham Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [45, 'beats per minute'], 'QT Interval': [314, 'msec']}",262.66718,249.53382,275.80054,"The corrected QT interval using the Framingham formula is computed as  QTc = QT Interval + (154 * (1 - rr_interval_sec)), where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 45 beats per minute.
The QT interval is 314 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/45 = 1.33333.
Hence, plugging in these values, we will get 314/(154 * ( 1- 1.33333 )) = 262.66718.
The patient's corrected QT interval (QTc) is 262.66718 msec."
634,57,QTc Framingham Calculator,physical,decimal,6,Template,A patient has a heart rate of 55 bpm and a QT interval of 285 msec.,"Using the Framingham Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [55, 'beats per minute'], 'QT Interval': [285, 'msec']}",270.99986,257.44987,284.54985,"The corrected QT interval using the Framingham formula is computed as  QTc = QT Interval + (154 * (1 - rr_interval_sec)), where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 55 beats per minute.
The QT interval is 285 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/55 = 1.09091.
Hence, plugging in these values, we will get 285/(154 * ( 1- 1.09091 )) = 270.99986.
The patient's corrected QT interval (QTc) is 270.99986 msec."
635,57,QTc Framingham Calculator,physical,decimal,7,Template,A patient has a heart rate of 176 bpm and a QT interval of 379 msec.,"Using the Framingham Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [176, 'beats per minute'], 'QT Interval': [379, 'msec']}",480.49986,456.47487,504.52485,"The corrected QT interval using the Framingham formula is computed as  QTc = QT Interval + (154 * (1 - rr_interval_sec)), where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 176 beats per minute.
The QT interval is 379 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/176 = 0.34091.
Hence, plugging in these values, we will get 379/(154 * ( 1- 0.34091 )) = 480.49986.
The patient's corrected QT interval (QTc) is 480.49986 msec."
636,57,QTc Framingham Calculator,physical,decimal,8,Template,A patient has a heart rate of 132 bpm and a QT interval of 442 msec.,"Using the Framingham Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [132, 'beats per minute'], 'QT Interval': [442, 'msec']}",525.9993,499.69933,552.29926,"The corrected QT interval using the Framingham formula is computed as  QTc = QT Interval + (154 * (1 - rr_interval_sec)), where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 132 beats per minute.
The QT interval is 442 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/132 = 0.45455.
Hence, plugging in these values, we will get 442/(154 * ( 1- 0.45455 )) = 525.9993.
The patient's corrected QT interval (QTc) is 525.9993 msec."
637,57,QTc Framingham Calculator,physical,decimal,9,Template,A patient has a heart rate of 72 bpm and a QT interval of 432 msec.,"Using the Framingham Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [72, 'beats per minute'], 'QT Interval': [432, 'msec']}",457.66718,434.78382,480.55054,"The corrected QT interval using the Framingham formula is computed as  QTc = QT Interval + (154 * (1 - rr_interval_sec)), where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 72 beats per minute.
The QT interval is 432 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/72 = 0.83333.
Hence, plugging in these values, we will get 432/(154 * ( 1- 0.83333 )) = 457.66718.
The patient's corrected QT interval (QTc) is 457.66718 msec."
638,57,QTc Framingham Calculator,physical,decimal,10,Template,A patient has a heart rate of 84 bpm and a QT interval of 496 msec.,"Using the Framingham Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [84, 'beats per minute'], 'QT Interval': [496, 'msec']}",539.99934,512.99937,566.99931,"The corrected QT interval using the Framingham formula is computed as  QTc = QT Interval + (154 * (1 - rr_interval_sec)), where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 84 beats per minute.
The QT interval is 496 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/84 = 0.71429.
Hence, plugging in these values, we will get 496/(154 * ( 1- 0.71429 )) = 539.99934.
The patient's corrected QT interval (QTc) is 539.99934 msec."
639,57,QTc Framingham Calculator,physical,decimal,11,Template,A patient has a heart rate of 129 bpm and a QT interval of 461 msec.,"Using the Framingham Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [129, 'beats per minute'], 'QT Interval': [461, 'msec']}",543.37152,516.20294,570.5401,"The corrected QT interval using the Framingham formula is computed as  QTc = QT Interval + (154 * (1 - rr_interval_sec)), where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 129 beats per minute.
The QT interval is 461 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/129 = 0.46512.
Hence, plugging in these values, we will get 461/(154 * ( 1- 0.46512 )) = 543.37152.
The patient's corrected QT interval (QTc) is 543.37152 msec."
640,57,QTc Framingham Calculator,physical,decimal,12,Template,A patient has a heart rate of 135 bpm and a QT interval of 253 msec.,"Using the Framingham Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [135, 'beats per minute'], 'QT Interval': [253, 'msec']}",338.55624,321.62843,355.48405,"The corrected QT interval using the Framingham formula is computed as  QTc = QT Interval + (154 * (1 - rr_interval_sec)), where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 135 beats per minute.
The QT interval is 253 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/135 = 0.44444.
Hence, plugging in these values, we will get 253/(154 * ( 1- 0.44444 )) = 338.55624.
The patient's corrected QT interval (QTc) is 338.55624 msec."
641,57,QTc Framingham Calculator,physical,decimal,13,Template,A patient has a heart rate of 70 bpm and a QT interval of 310 msec.,"Using the Framingham Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [70, 'beats per minute'], 'QT Interval': [310, 'msec']}",332.00044,315.40042,348.60046,"The corrected QT interval using the Framingham formula is computed as  QTc = QT Interval + (154 * (1 - rr_interval_sec)), where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 70 beats per minute.
The QT interval is 310 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/70 = 0.85714.
Hence, plugging in these values, we will get 310/(154 * ( 1- 0.85714 )) = 332.00044.
The patient's corrected QT interval (QTc) is 332.00044 msec."
642,57,QTc Framingham Calculator,physical,decimal,14,Template,A patient has a heart rate of 96 bpm and a QT interval of 339 msec.,"Using the Framingham Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [96, 'beats per minute'], 'QT Interval': [339, 'msec']}",396.75,376.9125,416.5875,"The corrected QT interval using the Framingham formula is computed as  QTc = QT Interval + (154 * (1 - rr_interval_sec)), where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 96 beats per minute.
The QT interval is 339 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/96 = 0.625.
Hence, plugging in these values, we will get 339/(154 * ( 1- 0.625 )) = 396.75.
The patient's corrected QT interval (QTc) is 396.75 msec."
643,57,QTc Framingham Calculator,physical,decimal,15,Template,A patient has a heart rate of 124 bpm and a QT interval of 218 msec.,"Using the Framingham Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [124, 'beats per minute'], 'QT Interval': [218, 'msec']}",297.48402,282.60982,312.35822,"The corrected QT interval using the Framingham formula is computed as  QTc = QT Interval + (154 * (1 - rr_interval_sec)), where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 124 beats per minute.
The QT interval is 218 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/124 = 0.48387.
Hence, plugging in these values, we will get 218/(154 * ( 1- 0.48387 )) = 297.48402.
The patient's corrected QT interval (QTc) is 297.48402 msec."
644,57,QTc Framingham Calculator,physical,decimal,16,Template,A patient has a heart rate of 110 bpm and a QT interval of 312 msec.,"Using the Framingham Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [110, 'beats per minute'], 'QT Interval': [312, 'msec']}",382.0007,362.90067,401.10073,"The corrected QT interval using the Framingham formula is computed as  QTc = QT Interval + (154 * (1 - rr_interval_sec)), where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 110 beats per minute.
The QT interval is 312 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/110 = 0.54545.
Hence, plugging in these values, we will get 312/(154 * ( 1- 0.54545 )) = 382.0007.
The patient's corrected QT interval (QTc) is 382.0007 msec."
645,57,QTc Framingham Calculator,physical,decimal,17,Template,A patient has a heart rate of 92 bpm and a QT interval of 208 msec.,"Using the Framingham Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [92, 'beats per minute'], 'QT Interval': [208, 'msec']}",261.56582,248.48753,274.64411,"The corrected QT interval using the Framingham formula is computed as  QTc = QT Interval + (154 * (1 - rr_interval_sec)), where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 92 beats per minute.
The QT interval is 208 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/92 = 0.65217.
Hence, plugging in these values, we will get 208/(154 * ( 1- 0.65217 )) = 261.56582.
The patient's corrected QT interval (QTc) is 261.56582 msec."
646,57,QTc Framingham Calculator,physical,decimal,18,Template,A patient has a heart rate of 148 bpm and a QT interval of 378 msec.,"Using the Framingham Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [148, 'beats per minute'], 'QT Interval': [378, 'msec']}",469.56686,446.08852,493.0452,"The corrected QT interval using the Framingham formula is computed as  QTc = QT Interval + (154 * (1 - rr_interval_sec)), where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 148 beats per minute.
The QT interval is 378 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/148 = 0.40541.
Hence, plugging in these values, we will get 378/(154 * ( 1- 0.40541 )) = 469.56686.
The patient's corrected QT interval (QTc) is 469.56686 msec."
647,57,QTc Framingham Calculator,physical,decimal,19,Template,A patient has a heart rate of 176 bpm and a QT interval of 348 msec.,"Using the Framingham Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [176, 'beats per minute'], 'QT Interval': [348, 'msec']}",449.49986,427.02487,471.97485,"The corrected QT interval using the Framingham formula is computed as  QTc = QT Interval + (154 * (1 - rr_interval_sec)), where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 176 beats per minute.
The QT interval is 348 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/176 = 0.34091.
Hence, plugging in these values, we will get 348/(154 * ( 1- 0.34091 )) = 449.49986.
The patient's corrected QT interval (QTc) is 449.49986 msec."
648,57,QTc Framingham Calculator,physical,decimal,20,Template,A patient has a heart rate of 100 bpm and a QT interval of 241 msec.,"Using the Framingham Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [100, 'beats per minute'], 'QT Interval': [241, 'msec']}",302.6,287.47,317.73,"The corrected QT interval using the Framingham formula is computed as  QTc = QT Interval + (154 * (1 - rr_interval_sec)), where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 100 beats per minute.
The QT interval is 241 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/100 = 0.6.
Hence, plugging in these values, we will get 241/(154 * ( 1- 0.6 )) = 302.6.
The patient's corrected QT interval (QTc) is 302.6 msec."
649,58,QTc Hodges Calculator,physical,decimal,1,Template,A patient has a heart rate of 79 bpm and a QT interval of 380 msec.,"Using the Hodges Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [79, 'beats per minute'], 'QT Interval': [380, 'msec']}",413.25067,392.58814,433.9132,"The corrected QT interval using the Hodges formula is computed as  QTc = QT interval + 1.75 * [(60 /rr_interval_sec) - 60], where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 79 beats per minute.
The QT interval is 380 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/79 = 0.75949.
Hence, plugging in these values, we will get 380 + 1.75 * [(60/0.75949) - 60] = 413.25067.
The patient's corrected QT interval (QTc) is 413.25067 msec."
650,58,QTc Hodges Calculator,physical,decimal,2,Template,A patient has a heart rate of 59 bpm and a QT interval of 462 msec.,"Using the Hodges Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [59, 'beats per minute'], 'QT Interval': [462, 'msec']}",460.24991,437.23741,483.26241,"The corrected QT interval using the Hodges formula is computed as  QTc = QT interval + 1.75 * [(60 /rr_interval_sec) - 60], where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 59 beats per minute.
The QT interval is 462 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/59 = 1.01695.
Hence, plugging in these values, we will get 462 + 1.75 * [(60/1.01695) - 60] = 460.24991.
The patient's corrected QT interval (QTc) is 460.24991 msec."
651,58,QTc Hodges Calculator,physical,decimal,3,Template,A patient has a heart rate of 109 bpm and a QT interval of 477 msec.,"Using the Hodges Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [109, 'beats per minute'], 'QT Interval': [477, 'msec']}",562.74955,534.61207,590.88703,"The corrected QT interval using the Hodges formula is computed as  QTc = QT interval + 1.75 * [(60 /rr_interval_sec) - 60], where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 109 beats per minute.
The QT interval is 477 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/109 = 0.55046.
Hence, plugging in these values, we will get 477 + 1.75 * [(60/0.55046) - 60] = 562.74955.
The patient's corrected QT interval (QTc) is 562.74955 msec."
652,58,QTc Hodges Calculator,physical,decimal,4,Template,A patient has a heart rate of 78 bpm and a QT interval of 413 msec.,"Using the Hodges Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [78, 'beats per minute'], 'QT Interval': [413, 'msec']}",444.50014,422.27513,466.72515,"The corrected QT interval using the Hodges formula is computed as  QTc = QT interval + 1.75 * [(60 /rr_interval_sec) - 60], where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 78 beats per minute.
The QT interval is 413 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/78 = 0.76923.
Hence, plugging in these values, we will get 413 + 1.75 * [(60/0.76923) - 60] = 444.50014.
The patient's corrected QT interval (QTc) is 444.50014 msec."
653,58,QTc Hodges Calculator,physical,decimal,5,Template,A patient has a heart rate of 167 bpm and a QT interval of 327 msec.,"Using the Hodges Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [167, 'beats per minute'], 'QT Interval': [327, 'msec']}",514.25117,488.53861,539.96373,"The corrected QT interval using the Hodges formula is computed as  QTc = QT interval + 1.75 * [(60 /rr_interval_sec) - 60], where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 167 beats per minute.
The QT interval is 327 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/167 = 0.35928.
Hence, plugging in these values, we will get 327 + 1.75 * [(60/0.35928) - 60] = 514.25117.
The patient's corrected QT interval (QTc) is 514.25117 msec."
654,58,QTc Hodges Calculator,physical,decimal,6,Template,A patient has a heart rate of 143 bpm and a QT interval of 288 msec.,"Using the Hodges Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [143, 'beats per minute'], 'QT Interval': [288, 'msec']}",433.25025,411.58774,454.91276,"The corrected QT interval using the Hodges formula is computed as  QTc = QT interval + 1.75 * [(60 /rr_interval_sec) - 60], where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 143 beats per minute.
The QT interval is 288 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/143 = 0.41958.
Hence, plugging in these values, we will get 288 + 1.75 * [(60/0.41958) - 60] = 433.25025.
The patient's corrected QT interval (QTc) is 433.25025 msec."
655,58,QTc Hodges Calculator,physical,decimal,7,Template,A patient has a heart rate of 126 bpm and a QT interval of 211 msec.,"Using the Hodges Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [126, 'beats per minute'], 'QT Interval': [211, 'msec']}",326.50022,310.17521,342.82523,"The corrected QT interval using the Hodges formula is computed as  QTc = QT interval + 1.75 * [(60 /rr_interval_sec) - 60], where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 126 beats per minute.
The QT interval is 211 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/126 = 0.47619.
Hence, plugging in these values, we will get 211 + 1.75 * [(60/0.47619) - 60] = 326.50022.
The patient's corrected QT interval (QTc) is 326.50022 msec."
656,58,QTc Hodges Calculator,physical,decimal,8,Template,A patient has a heart rate of 110 bpm and a QT interval of 430 msec.,"Using the Hodges Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [110, 'beats per minute'], 'QT Interval': [430, 'msec']}",517.5016,491.62652,543.37668,"The corrected QT interval using the Hodges formula is computed as  QTc = QT interval + 1.75 * [(60 /rr_interval_sec) - 60], where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 110 beats per minute.
The QT interval is 430 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/110 = 0.54545.
Hence, plugging in these values, we will get 430 + 1.75 * [(60/0.54545) - 60] = 517.5016.
The patient's corrected QT interval (QTc) is 517.5016 msec."
657,58,QTc Hodges Calculator,physical,decimal,9,Template,A patient has a heart rate of 161 bpm and a QT interval of 443 msec.,"Using the Hodges Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [161, 'beats per minute'], 'QT Interval': [443, 'msec']}",619.75061,588.76308,650.73814,"The corrected QT interval using the Hodges formula is computed as  QTc = QT interval + 1.75 * [(60 /rr_interval_sec) - 60], where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 161 beats per minute.
The QT interval is 443 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/161 = 0.37267.
Hence, plugging in these values, we will get 443 + 1.75 * [(60/0.37267) - 60] = 619.75061.
The patient's corrected QT interval (QTc) is 619.75061 msec."
658,58,QTc Hodges Calculator,physical,decimal,10,Template,A patient has a heart rate of 48 bpm and a QT interval of 364 msec.,"Using the Hodges Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [48, 'beats per minute'], 'QT Interval': [364, 'msec']}",343,325.85,360.15,"The corrected QT interval using the Hodges formula is computed as  QTc = QT interval + 1.75 * [(60 /rr_interval_sec) - 60], where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 48 beats per minute.
The QT interval is 364 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/48 = 1.25.
Hence, plugging in these values, we will get 364 + 1.75 * [(60/1.25) - 60] = 343.0.
The patient's corrected QT interval (QTc) is 343.0 msec."
659,58,QTc Hodges Calculator,physical,decimal,11,Template,A patient has a heart rate of 160 bpm and a QT interval of 316 msec.,"Using the Hodges Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [160, 'beats per minute'], 'QT Interval': [316, 'msec']}",491,466.45,515.55,"The corrected QT interval using the Hodges formula is computed as  QTc = QT interval + 1.75 * [(60 /rr_interval_sec) - 60], where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 160 beats per minute.
The QT interval is 316 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/160 = 0.375.
Hence, plugging in these values, we will get 316 + 1.75 * [(60/0.375) - 60] = 491.0.
The patient's corrected QT interval (QTc) is 491.0 msec."
660,58,QTc Hodges Calculator,physical,decimal,12,Template,A patient has a heart rate of 174 bpm and a QT interval of 229 msec.,"Using the Hodges Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [174, 'beats per minute'], 'QT Interval': [229, 'msec']}",428.49787,407.07298,449.92276,"The corrected QT interval using the Hodges formula is computed as  QTc = QT interval + 1.75 * [(60 /rr_interval_sec) - 60], where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 174 beats per minute.
The QT interval is 229 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/174 = 0.34483.
Hence, plugging in these values, we will get 229 + 1.75 * [(60/0.34483) - 60] = 428.49787.
The patient's corrected QT interval (QTc) is 428.49787 msec."
661,58,QTc Hodges Calculator,physical,decimal,13,Template,A patient has a heart rate of 113 bpm and a QT interval of 406 msec.,"Using the Hodges Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [113, 'beats per minute'], 'QT Interval': [406, 'msec']}",498.75129,473.81373,523.68885,"The corrected QT interval using the Hodges formula is computed as  QTc = QT interval + 1.75 * [(60 /rr_interval_sec) - 60], where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 113 beats per minute.
The QT interval is 406 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/113 = 0.53097.
Hence, plugging in these values, we will get 406 + 1.75 * [(60/0.53097) - 60] = 498.75129.
The patient's corrected QT interval (QTc) is 498.75129 msec."
662,58,QTc Hodges Calculator,physical,decimal,14,Template,A patient has a heart rate of 173 bpm and a QT interval of 330 msec.,"Using the Hodges Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [173, 'beats per minute'], 'QT Interval': [330, 'msec']}",527.75071,501.36317,554.13825,"The corrected QT interval using the Hodges formula is computed as  QTc = QT interval + 1.75 * [(60 /rr_interval_sec) - 60], where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 173 beats per minute.
The QT interval is 330 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/173 = 0.34682.
Hence, plugging in these values, we will get 330 + 1.75 * [(60/0.34682) - 60] = 527.75071.
The patient's corrected QT interval (QTc) is 527.75071 msec."
663,58,QTc Hodges Calculator,physical,decimal,15,Template,A patient has a heart rate of 61 bpm and a QT interval of 492 msec.,"Using the Hodges Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [61, 'beats per minute'], 'QT Interval': [492, 'msec']}",493.74963,469.06215,518.43711,"The corrected QT interval using the Hodges formula is computed as  QTc = QT interval + 1.75 * [(60 /rr_interval_sec) - 60], where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 61 beats per minute.
The QT interval is 492 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/61 = 0.98361.
Hence, plugging in these values, we will get 492 + 1.75 * [(60/0.98361) - 60] = 493.74963.
The patient's corrected QT interval (QTc) is 493.74963 msec."
664,58,QTc Hodges Calculator,physical,decimal,16,Template,A patient has a heart rate of 103 bpm and a QT interval of 254 msec.,"Using the Hodges Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [103, 'beats per minute'], 'QT Interval': [254, 'msec']}",329.25132,312.78875,345.71389,"The corrected QT interval using the Hodges formula is computed as  QTc = QT interval + 1.75 * [(60 /rr_interval_sec) - 60], where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 103 beats per minute.
The QT interval is 254 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/103 = 0.58252.
Hence, plugging in these values, we will get 254 + 1.75 * [(60/0.58252) - 60] = 329.25132.
The patient's corrected QT interval (QTc) is 329.25132 msec."
665,58,QTc Hodges Calculator,physical,decimal,17,Template,A patient has a heart rate of 117 bpm and a QT interval of 343 msec.,"Using the Hodges Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [117, 'beats per minute'], 'QT Interval': [343, 'msec']}",442.7502,420.61269,464.88771,"The corrected QT interval using the Hodges formula is computed as  QTc = QT interval + 1.75 * [(60 /rr_interval_sec) - 60], where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 117 beats per minute.
The QT interval is 343 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/117 = 0.51282.
Hence, plugging in these values, we will get 343 + 1.75 * [(60/0.51282) - 60] = 442.7502.
The patient's corrected QT interval (QTc) is 442.7502 msec."
666,58,QTc Hodges Calculator,physical,decimal,18,Template,A patient has a heart rate of 175 bpm and a QT interval of 400 msec.,"Using the Hodges Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [175, 'beats per minute'], 'QT Interval': [400, 'msec']}",601.24745,571.18508,631.30982,"The corrected QT interval using the Hodges formula is computed as  QTc = QT interval + 1.75 * [(60 /rr_interval_sec) - 60], where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 175 beats per minute.
The QT interval is 400 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/175 = 0.34286.
Hence, plugging in these values, we will get 400 + 1.75 * [(60/0.34286) - 60] = 601.24745.
The patient's corrected QT interval (QTc) is 601.24745 msec."
667,58,QTc Hodges Calculator,physical,decimal,19,Template,A patient has a heart rate of 57 bpm and a QT interval of 414 msec.,"Using the Hodges Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [57, 'beats per minute'], 'QT Interval': [414, 'msec']}",408.75015,388.31264,429.18766,"The corrected QT interval using the Hodges formula is computed as  QTc = QT interval + 1.75 * [(60 /rr_interval_sec) - 60], where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 57 beats per minute.
The QT interval is 414 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/57 = 1.05263.
Hence, plugging in these values, we will get 414 + 1.75 * [(60/1.05263) - 60] = 408.75015.
The patient's corrected QT interval (QTc) is 408.75015 msec."
668,58,QTc Hodges Calculator,physical,decimal,20,Template,A patient has a heart rate of 136 bpm and a QT interval of 280 msec.,"Using the Hodges Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [136, 'beats per minute'], 'QT Interval': [280, 'msec']}",412.9981,392.34819,433.64801,"The corrected QT interval using the Hodges formula is computed as  QTc = QT interval + 1.75 * [(60 /rr_interval_sec) - 60], where QT interval is in msec, and RR interval is given as 60/(heart rate).
The patient's heart rate is 136 beats per minute.
The QT interval is 280 msec.
The RR interval is computed as 60/(heart rate), and so the RR interval is 60/136 = 0.44118.
Hence, plugging in these values, we will get 280 + 1.75 * [(60/0.44118) - 60] = 412.9981.
The patient's corrected QT interval (QTc) is 412.9981 msec."
669,59,QTc Rautaharju Calculator,physical,decimal,1,Template,A patient has a heart rate of 159 bpm and a QT interval of 325 msec.,"Using the Rautaharju Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [159, 'beats per minute'], 'QT Interval': [325, 'msec']}",503.75,478.5625,528.9375,"The corrected QT interval using the Rautaharju formula is computed as QTc = QT interval x (120 + HR) / 180, where QT interval is in msec, and HR is the heart rate in beats per minute.
The QT interval is 325 msec.
The patient's heart rate is 159 beats per minute.
Hence, plugging in these values, we will get 325 x (120 + 159) / 180 = 503.75.
The patient's corrected QT interval (QTc) is 503.75 msec."
670,59,QTc Rautaharju Calculator,physical,decimal,2,Template,A patient has a heart rate of 81 bpm and a QT interval of 303 msec.,"Using the Rautaharju Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [81, 'beats per minute'], 'QT Interval': [303, 'msec']}",338.35,321.4325,355.2675,"The corrected QT interval using the Rautaharju formula is computed as QTc = QT interval x (120 + HR) / 180, where QT interval is in msec, and HR is the heart rate in beats per minute.
The QT interval is 303 msec.
The patient's heart rate is 81 beats per minute.
Hence, plugging in these values, we will get 303 x (120 + 81) / 180 = 338.35.
The patient's corrected QT interval (QTc) is 338.35 msec."
671,59,QTc Rautaharju Calculator,physical,decimal,3,Template,A patient has a heart rate of 127 bpm and a QT interval of 465 msec.,"Using the Rautaharju Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [127, 'beats per minute'], 'QT Interval': [465, 'msec']}",638.08333,606.17916,669.9875,"The corrected QT interval using the Rautaharju formula is computed as QTc = QT interval x (120 + HR) / 180, where QT interval is in msec, and HR is the heart rate in beats per minute.
The QT interval is 465 msec.
The patient's heart rate is 127 beats per minute.
Hence, plugging in these values, we will get 465 x (120 + 127) / 180 = 638.08333.
The patient's corrected QT interval (QTc) is 638.08333 msec."
672,59,QTc Rautaharju Calculator,physical,decimal,4,Template,A patient has a heart rate of 56 bpm and a QT interval of 297 msec.,"Using the Rautaharju Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [56, 'beats per minute'], 'QT Interval': [297, 'msec']}",290.4,275.88,304.92,"The corrected QT interval using the Rautaharju formula is computed as QTc = QT interval x (120 + HR) / 180, where QT interval is in msec, and HR is the heart rate in beats per minute.
The QT interval is 297 msec.
The patient's heart rate is 56 beats per minute.
Hence, plugging in these values, we will get 297 x (120 + 56) / 180 = 290.4.
The patient's corrected QT interval (QTc) is 290.4 msec."
673,59,QTc Rautaharju Calculator,physical,decimal,5,Template,A patient has a heart rate of 169 bpm and a QT interval of 460 msec.,"Using the Rautaharju Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [169, 'beats per minute'], 'QT Interval': [460, 'msec']}",738.55556,701.62778,775.48334,"The corrected QT interval using the Rautaharju formula is computed as QTc = QT interval x (120 + HR) / 180, where QT interval is in msec, and HR is the heart rate in beats per minute.
The QT interval is 460 msec.
The patient's heart rate is 169 beats per minute.
Hence, plugging in these values, we will get 460 x (120 + 169) / 180 = 738.55556.
The patient's corrected QT interval (QTc) is 738.55556 msec."
674,59,QTc Rautaharju Calculator,physical,decimal,6,Template,A patient has a heart rate of 170 bpm and a QT interval of 220 msec.,"Using the Rautaharju Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [170, 'beats per minute'], 'QT Interval': [220, 'msec']}",354.44444,336.72222,372.16666,"The corrected QT interval using the Rautaharju formula is computed as QTc = QT interval x (120 + HR) / 180, where QT interval is in msec, and HR is the heart rate in beats per minute.
The QT interval is 220 msec.
The patient's heart rate is 170 beats per minute.
Hence, plugging in these values, we will get 220 x (120 + 170) / 180 = 354.44444.
The patient's corrected QT interval (QTc) is 354.44444 msec."
675,59,QTc Rautaharju Calculator,physical,decimal,7,Template,A patient has a heart rate of 129 bpm and a QT interval of 255 msec.,"Using the Rautaharju Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [129, 'beats per minute'], 'QT Interval': [255, 'msec']}",352.75,335.1125,370.3875,"The corrected QT interval using the Rautaharju formula is computed as QTc = QT interval x (120 + HR) / 180, where QT interval is in msec, and HR is the heart rate in beats per minute.
The QT interval is 255 msec.
The patient's heart rate is 129 beats per minute.
Hence, plugging in these values, we will get 255 x (120 + 129) / 180 = 352.75.
The patient's corrected QT interval (QTc) is 352.75 msec."
676,59,QTc Rautaharju Calculator,physical,decimal,8,Template,A patient has a heart rate of 139 bpm and a QT interval of 468 msec.,"Using the Rautaharju Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [139, 'beats per minute'], 'QT Interval': [468, 'msec']}",673.4,639.73,707.07,"The corrected QT interval using the Rautaharju formula is computed as QTc = QT interval x (120 + HR) / 180, where QT interval is in msec, and HR is the heart rate in beats per minute.
The QT interval is 468 msec.
The patient's heart rate is 139 beats per minute.
Hence, plugging in these values, we will get 468 x (120 + 139) / 180 = 673.4.
The patient's corrected QT interval (QTc) is 673.4 msec."
677,59,QTc Rautaharju Calculator,physical,decimal,9,Template,A patient has a heart rate of 52 bpm and a QT interval of 239 msec.,"Using the Rautaharju Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [52, 'beats per minute'], 'QT Interval': [239, 'msec']}",228.37778,216.95889,239.79667,"The corrected QT interval using the Rautaharju formula is computed as QTc = QT interval x (120 + HR) / 180, where QT interval is in msec, and HR is the heart rate in beats per minute.
The QT interval is 239 msec.
The patient's heart rate is 52 beats per minute.
Hence, plugging in these values, we will get 239 x (120 + 52) / 180 = 228.37778.
The patient's corrected QT interval (QTc) is 228.37778 msec."
678,59,QTc Rautaharju Calculator,physical,decimal,10,Template,A patient has a heart rate of 146 bpm and a QT interval of 273 msec.,"Using the Rautaharju Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [146, 'beats per minute'], 'QT Interval': [273, 'msec']}",403.43333,383.26166,423.605,"The corrected QT interval using the Rautaharju formula is computed as QTc = QT interval x (120 + HR) / 180, where QT interval is in msec, and HR is the heart rate in beats per minute.
The QT interval is 273 msec.
The patient's heart rate is 146 beats per minute.
Hence, plugging in these values, we will get 273 x (120 + 146) / 180 = 403.43333.
The patient's corrected QT interval (QTc) is 403.43333 msec."
679,59,QTc Rautaharju Calculator,physical,decimal,11,Template,A patient has a heart rate of 61 bpm and a QT interval of 313 msec.,"Using the Rautaharju Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [61, 'beats per minute'], 'QT Interval': [313, 'msec']}",314.73889,299.00195,330.47583,"The corrected QT interval using the Rautaharju formula is computed as QTc = QT interval x (120 + HR) / 180, where QT interval is in msec, and HR is the heart rate in beats per minute.
The QT interval is 313 msec.
The patient's heart rate is 61 beats per minute.
Hence, plugging in these values, we will get 313 x (120 + 61) / 180 = 314.73889.
The patient's corrected QT interval (QTc) is 314.73889 msec."
680,59,QTc Rautaharju Calculator,physical,decimal,12,Template,A patient has a heart rate of 75 bpm and a QT interval of 229 msec.,"Using the Rautaharju Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [75, 'beats per minute'], 'QT Interval': [229, 'msec']}",248.08333,235.67916,260.4875,"The corrected QT interval using the Rautaharju formula is computed as QTc = QT interval x (120 + HR) / 180, where QT interval is in msec, and HR is the heart rate in beats per minute.
The QT interval is 229 msec.
The patient's heart rate is 75 beats per minute.
Hence, plugging in these values, we will get 229 x (120 + 75) / 180 = 248.08333.
The patient's corrected QT interval (QTc) is 248.08333 msec."
681,59,QTc Rautaharju Calculator,physical,decimal,13,Template,A patient has a heart rate of 157 bpm and a QT interval of 396 msec.,"Using the Rautaharju Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [157, 'beats per minute'], 'QT Interval': [396, 'msec']}",609.4,578.93,639.87,"The corrected QT interval using the Rautaharju formula is computed as QTc = QT interval x (120 + HR) / 180, where QT interval is in msec, and HR is the heart rate in beats per minute.
The QT interval is 396 msec.
The patient's heart rate is 157 beats per minute.
Hence, plugging in these values, we will get 396 x (120 + 157) / 180 = 609.4.
The patient's corrected QT interval (QTc) is 609.4 msec."
682,59,QTc Rautaharju Calculator,physical,decimal,14,Template,A patient has a heart rate of 103 bpm and a QT interval of 336 msec.,"Using the Rautaharju Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [103, 'beats per minute'], 'QT Interval': [336, 'msec']}",416.26667,395.45334,437.08,"The corrected QT interval using the Rautaharju formula is computed as QTc = QT interval x (120 + HR) / 180, where QT interval is in msec, and HR is the heart rate in beats per minute.
The QT interval is 336 msec.
The patient's heart rate is 103 beats per minute.
Hence, plugging in these values, we will get 336 x (120 + 103) / 180 = 416.26667.
The patient's corrected QT interval (QTc) is 416.26667 msec."
683,59,QTc Rautaharju Calculator,physical,decimal,15,Template,A patient has a heart rate of 177 bpm and a QT interval of 488 msec.,"Using the Rautaharju Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [177, 'beats per minute'], 'QT Interval': [488, 'msec']}",805.2,764.94,845.46,"The corrected QT interval using the Rautaharju formula is computed as QTc = QT interval x (120 + HR) / 180, where QT interval is in msec, and HR is the heart rate in beats per minute.
The QT interval is 488 msec.
The patient's heart rate is 177 beats per minute.
Hence, plugging in these values, we will get 488 x (120 + 177) / 180 = 805.2.
The patient's corrected QT interval (QTc) is 805.2 msec."
684,59,QTc Rautaharju Calculator,physical,decimal,16,Template,A patient has a heart rate of 92 bpm and a QT interval of 390 msec.,"Using the Rautaharju Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [92, 'beats per minute'], 'QT Interval': [390, 'msec']}",459.33333,436.36666,482.3,"The corrected QT interval using the Rautaharju formula is computed as QTc = QT interval x (120 + HR) / 180, where QT interval is in msec, and HR is the heart rate in beats per minute.
The QT interval is 390 msec.
The patient's heart rate is 92 beats per minute.
Hence, plugging in these values, we will get 390 x (120 + 92) / 180 = 459.33333.
The patient's corrected QT interval (QTc) is 459.33333 msec."
685,59,QTc Rautaharju Calculator,physical,decimal,17,Template,A patient has a heart rate of 78 bpm and a QT interval of 383 msec.,"Using the Rautaharju Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [78, 'beats per minute'], 'QT Interval': [383, 'msec']}",421.3,400.235,442.365,"The corrected QT interval using the Rautaharju formula is computed as QTc = QT interval x (120 + HR) / 180, where QT interval is in msec, and HR is the heart rate in beats per minute.
The QT interval is 383 msec.
The patient's heart rate is 78 beats per minute.
Hence, plugging in these values, we will get 383 x (120 + 78) / 180 = 421.3.
The patient's corrected QT interval (QTc) is 421.3 msec."
686,59,QTc Rautaharju Calculator,physical,decimal,18,Template,A patient has a heart rate of 129 bpm and a QT interval of 221 msec.,"Using the Rautaharju Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [129, 'beats per minute'], 'QT Interval': [221, 'msec']}",305.71667,290.43084,321.0025,"The corrected QT interval using the Rautaharju formula is computed as QTc = QT interval x (120 + HR) / 180, where QT interval is in msec, and HR is the heart rate in beats per minute.
The QT interval is 221 msec.
The patient's heart rate is 129 beats per minute.
Hence, plugging in these values, we will get 221 x (120 + 129) / 180 = 305.71667.
The patient's corrected QT interval (QTc) is 305.71667 msec."
687,59,QTc Rautaharju Calculator,physical,decimal,19,Template,A patient has a heart rate of 92 bpm and a QT interval of 255 msec.,"Using the Rautaharju Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [92, 'beats per minute'], 'QT Interval': [255, 'msec']}",300.33333,285.31666,315.35,"The corrected QT interval using the Rautaharju formula is computed as QTc = QT interval x (120 + HR) / 180, where QT interval is in msec, and HR is the heart rate in beats per minute.
The QT interval is 255 msec.
The patient's heart rate is 92 beats per minute.
Hence, plugging in these values, we will get 255 x (120 + 92) / 180 = 300.33333.
The patient's corrected QT interval (QTc) is 300.33333 msec."
688,59,QTc Rautaharju Calculator,physical,decimal,20,Template,A patient has a heart rate of 155 bpm and a QT interval of 208 msec.,"Using the Rautaharju Formula for corrected QT interval, what is the patient's corrected QT interval in terms of msec?","{'Heart Rate or Pulse': [155, 'beats per minute'], 'QT Interval': [208, 'msec']}",317.77778,301.88889,333.66667,"The corrected QT interval using the Rautaharju formula is computed as QTc = QT interval x (120 + HR) / 180, where QT interval is in msec, and HR is the heart rate in beats per minute.
The QT interval is 208 msec.
The patient's heart rate is 155 beats per minute.
Hence, plugging in these values, we will get 208 x (120 + 155) / 180 = 317.77778.
The patient's corrected QT interval (QTc) is 317.77778 msec."
689,60,Body Surface Area Calculator,physical,decimal,pmc-7195762-1,Extracted,"A 39-year-old man presented with abdominal pain and jaundice and was diagnosed with cholecystolithiasis. He had a 16-year history of organic psychiatric disorder induced by a large hematoma and contusion of the brain following injury in a traffic accident. Because of delusions of persecution and severe irritability, the patient was treated with several antipsychotics and mood stabilizers, including zotepine (400 mg/day for 6 years), risperidone (12 mg/day for 8 years), paliperidone (12 mg/day for 3 years), olanzapine (20 mg/day for 8 years), and lithium (1200 mg/day for 6 years). His serum lithium concentration ranged from 0.75 to 1.35 mEq/mL.
The patient’s clinical course is shown in Fig. . At admission, the patient’s height was 176.1 cm and his body weight was 77.1 kg. His blood pressure was 136/102 mmHg and his pulse rate was 111 beats per minute. His body temperature was 37.6 °C on admission (Day 1). Laboratory examinations on Day 2 revealed a white blood cell count of 11,480/mL (range 3500–8500), C-reactive protein of 2.89 mg/dL (range 0.00–0.30), aspartate transaminase of 130 U/L (range 13–33), alanine transaminase of 245 U/L (range 8–42), alkaline phosphatase of 692 U/L (range 115–359), lactate dehydrogenase of 230 U/L (range 119–229), total bilirubin of 6.3 mg/dL (range 0.3–1.2), γ-glutamyltransferase of 348 U/L (range 10–47), amylase of 128 U/L (range 37–125), serum creatinine of 0.92 mg/dL (range 0.6–1.1), urea nitrogen of 5 mg/dL (range 8–22), serum sodium of 156 mmol/L (range 138–146), serum potassium of 3.7 mmol/L (range 3.6–4.9), and serum chloride of 114 mmol/L (range 99–109).
Because the patient’s polyuria was > 4000 mL/day, he received 3200 mL/day of 5% glucose perioperatively (Days 6–12). However, his serum sodium levels remained between 150 and 160 mmol/L. Plasma and urine osmolality were 318 mOsm/L and 141 mOsm/L, respectively, while the serum arginine vasopressin level was 6.4 pg/mL (range 0.0–3.8). Desmopressin was ineffective, resulting in a diagnosis of NDI. Nine days after admission (Day 9), laparoscopic cholecystectomy was performed. We gradually withdrew lithium starting on Day 15 because it was the suspected cause of NDI. Lithium was completely discontinued on Day 19. Urine volume increased further to a maximum of 10,000 mL/day. Because the patient had free water excretion resulting from NDI and we wanted to avoid excessive glucose to prevent diabetes mellitus, rehydration therapy with xylitol infusion was initiated. A maximum of 10,000 mL/day of 5% xylitol was administered for 8 days (Days 13–20).
The patient’s serum lithium concentration was 0.89 mEq/mL on Day 15. He developed lethargy on Day 19, although laboratory examinations showed no remarkable change (serum creatinine = 1.05 mg/dL, urea nitrogen = 8 mg/dL, serum sodium = 152 mmol/L). His consciousness level declined and his Glasgow Coma Scale (GCS) score was 6 points (E4V1M1) with metabolic acidosis on Day 20. The patient did not show meningeal signs, involuntary movements, or generalized tonic–clonic seizures. He had decreased muscle tension/tonus and deep tendon reflexes but showed jaw jerk reflex and snout reflex; a brainstem lesion was suspected. The patient maintained spontaneous breathing.
Arterial blood gas testing without oxygen therapy on Day 20 showed the following: fraction of inspired oxygen 0.21 (room air), pH 7.28 (range 7.36–7.44), carbon dioxide partial pressure = 14.7 (range 35.0–45.0), partial pressure of oxygen in arterial blood = 117.0 (range 75.0–95.0), hydrogen carbonate ion = 6.7 (range 22.0–28.0), and base excess = − 18.7 (range 23.0–27.0). Laboratory examinations revealed the following: serum creatinine = 1.58 mg/dL, urea nitrogen = 9 mg/dL, serum sodium = 155 mmol/L, serum potassium = 3.5 mmol/L, and serum chloride = 125 mmol/L. Computed tomographic and magnetic resonance imaging on Day 20 revealed brain edema but no cerebral herniation or findings of osmotic demyelination syndrome. Continuous hemodiafiltration (CHDF) was temporarily performed from Days 20 to 23, which corrected the patient’s metabolic acidosis. His consciousness level improved and his GCS rose to 12 points (E4V3M5) by Day 23. At that time, the patient showed normal brain stem reactions and deep tendon reflexes. He responded to a handshake. His serum lithium concentration was 0.05 mEq/mL on Day 22. However, his urine volume remained at approximately 3000 mL/day, serum sodium remained in the 150 mmol/L range, and serum creatinine increased to 4.74 mg/dL on Day 26. Urinalysis showed no remarkable findings throughout the examination period.
The patient’s serum sodium was in the high 140 mmol/L range and his creatinine level was near 1.5 mg/dL on Day 50. However, polyuria and polydipsia of approximately 4000 mL/day persisted. Renal biopsy on Day 60 showed deposition of double-refractive crystals in the cortical renal tubules. Tubular atrophy, macrophage and lymphocyte infiltration, and interstitial fibrosis were observed in parts of the tubulointerstitium. Decreased expression of water channel aquaporin-2 (AQP2) was observed in the cortical and medullary renal tubules (Fig. ); no urinary AQP2 was detected on ELISA (Human Aquaporin 2 ELISA Kit, Otsuka Pharmaceutical Co., Ltd., Tokyo, Japan). The diagnosis was lithium-induced NDI and cerebrorenal oxalosis induced by excess xylitol infusion.
Laboratory examinations on Day 80 revealed the following: serum creatinine = 1.25 mg/dL, urea nitrogen = 7 mg/dL, serum sodium = 147 mmol/L, plasma osmolality = 297 mOsm/L, and urine osmolality = 106 mOsm/L. The patient was discharged 82 days after admission; his thirst gradually decreased to 1500 to 2000 mL of water per day by 2 months after discharge. Urinary AQP2 levels increased to 1.14 ng/mg/g of creatinine and serum creatinine decreased to a low of 0.90 mg/dL. However, plasma and urine osmolality were 292 mOsm/L and 62 mOsm/L, respectively, 4 months after discontinuing lithium. The patient has had serum creatinine levels of approximately 1.2 mg/dL since that time.",What is the patient's body surface area? Please output your answer in terms of m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [77.1, 'kg'], 'height': [176.1, 'cm']}",1.94203,1.84493,2.03913,"For the body surface area computation, the formula is sqrt((weight (in kgs) * height (in cm))/3600, where the units of weight is in kg and the units of height is in cm.
The patient's height is 176.1 cm. 
The patient's weight is 77.1 kg. 
Therefore, the patient's bsa is sqrt((77.1 (in kgs) * 176.1 (in cm))/3600) = 1.94203 m^2."
690,60,Body Surface Area Calculator,physical,decimal,pmc-4255049-1,Extracted,"A 44-year-old woman was referred to our hospital on May 2009 due to an abnormal chest X-ray finding. She had a chest X-ray before a gastrofibroscopy at a local hospital. There were multiple rib fractures (). For further evaluation, she had a chest computed tomography (CT) scan done before visiting our hospital. The chest CT revealed multiple sclerotic masses with bone destruction in both hemithoraxes (right 2nd, 4th, 5th, 6th, 7th, and 10th ribs, left 2nd, 4th, 7th, 8th, and 9th ribs) of variable size (). Initially she was admitted to the pulmonology department to rule out bony metastases from a cancer of unknown origin. She had taken the bone densitometry of the L1-L4 lumbar spine by dual energy X-ray absorptiometry (DXA), at the local department of gynecology 1.5 years ago. The result of bone mineral density (BMD) was 0.726 g/cm2 and the average T-score of the L1-L4 lumbar spine was -2.6. The average Z-score of the L1-L4 lumbar spine was -2.0. Therefore, she was taking calcium, vitamin D supplements and hormone replacement therapy for osteoporosis. She also had a conization in 2002 due to squamous cell carcinoma in situ at the uterine cervix and thereafter received a total hysterectomy in 2005 due to uterine leiomyoma. She had no alcohol drinking or smoking history. There were no abnormal findings in her family history. Also, she had no trauma history. She did not have moon face, buffalo hump, or abdominal straie. She didn't have any pain on her ribs. On the physical examination, there wasn't tenderness around fracture sites. Her height and weight were 153 cm and 53 kg, respectively, with a body mass index (BMI) of 22 kg/m2. Her waist measurement was 83 cm, and she had experienced no recent weight changes. Her blood pressure was 140/80 mmHg with a pulse of 96 beats/min, a respiratory rate of 20 breaths/min, and a body temperature of 36.8℃. On the blood test, the leukocyte, hemoglobin, and platelet counts were 8,900/mm3 (neutrophils 85.9%, lymphocyte 8.4%, monocyte 5.7%), 14.9 g/dL, and 184,000/µL, respectively. Fasting glucose, albumin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and creatinine were 93 mg/dL, 4.0 g/dL, 45 IU/L, 81 IU/L, 49 IU/L, and 0.56 mg/dL, respectively. Total calcium and phosphate were 10.5 mg/dL and 3.5 mg/dL, respectively. In addition, serum intact parathyroid hormone (PTH) was 35.6 pg/mL (normal range, 13-54 pg/mL).
To evaluate the patient for metastatic cancer, a bone biopsy was performed at the right 6th rib posterior arc in the pulmonology department. Also a bone scan and the bone densitometry of the L1-L4 lumbar spine and an abdominal CT were performed. Fragmented bony particles with small amounts of marrow tissue were observed in the biopsy tissue.
There were no cancer cells nor cytokeratin (CK)-positive epithelial cells on immunohistochemical staining. There was no cancerous lesion in abdomen CT, except a left adrenal incidentaloma, a well-marginated soft tissue mass 25 mm in diameter, was found (). On the bone scan, multi-focal increased uptake was observed in both ribs, suggesting non-traumatic micro-fractures caused by osteoporosis (). The average BMD, T-score and Z-score of the L1-L4 lumbar spine was 0.761 g/cm2, -2.1 and -1.7, respectively. Therefore, an endocrine cause of osteoporotic fracture was suspected, and a hormonal study for adrenal incidentaloma was performed. Free cortisol in the urine and 17-hydroxycorticosteroid were 580.4 µg/day (normal range, 20-90 µg/day) and 12.93 mg/day (normal range, 3-15 mg/day), respectively. A low-dose dexamethasone suppression test showed that the serum adrenocorticotrophic hormone level was 1.4 pg/mL (normal <130 pg/mL), the basal cortisol was 26.3 µg/dL and the cortisol on the 3rd day was 35.4 µg/dL (normal, 3-6 µg/dL). Cortisol was not suppressed. Finally, she was diagnosed with Cushing's syndrome due to the left adrenocortical adenoma. A laparoscopic left adrenalectomy was performed in June 2009. A month after the laparoscopic left adrenalectomy, 24-hr urine free cortisol was checked, and was below 1.8 µg/day. A bone scan taken 1 year after the operation showed decreased multifocal uptake in the bilateral ribs () and the patient's BMD improved gradually, reaching 0.822 g/cm2 in 2012 (). Also, the average T-score and Z-score of the L1-L4 lumbar spine improved, reaching -1.6 and -1.0, respectively. Currently, she is being regularly followed-up and taking calcium and vitamin D for osteopenia.",What is the patient's body surface area? Please output your answer in terms of m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [53.0, 'kg'], 'height': [153.0, 'cm']}",1.50083,1.42579,1.57587,"For the body surface area computation, the formula is sqrt((weight (in kgs) * height (in cm))/3600, where the units of weight is in kg and the units of height is in cm.
The patient's height is 153.0 cm. 
The patient's weight is 53.0 kg. 
Therefore, the patient's bsa is sqrt((53.0 (in kgs) * 153.0 (in cm))/3600) = 1.50083 m^2."
691,60,Body Surface Area Calculator,physical,decimal,pmc-7418236-1,Extracted,"Case 1. The first patient was a 55-year-old woman with a height of 146 cm and weight of 42 kg. She was diagnosed with a right renal mass of about 63 × 58 × 62 mm in the lower pole of the right kidney. Laparoscopic right nephrectomy under general anesthesia was planned. Her preoperative electrocardiogram, chest X-ray, and laboratory parameters were within the normal range.
In the operating room, the patient’s blood pressure was 170/100 mmHg, heart rate was 80 beats/minute, and pulse oxygen saturation (SpO2) was 98%. The left internal jugular vein and left radial artery were accessed for monitoring. Standard induction was performed. The ventilation mode was volume-controlled ventilation with a tidal volume of 8 mL/kg, respiratory rate of 12 breaths/minute, and inspired oxygen fraction of 50% with no positive end-expiratory pressure. The patient was then placed in the left lateral recumbent position. Her PETCO2 before the introduction of CO2 pneumoperitoneum was 37 mmHg, and her SpO2 was 100%.
TEE (Vivid E95; GE Healthcare, Chicago, IL, USA) examination revealed no abnormality. Trocars were placed in the abdominal cavity at three sites (the navel, the subcostal margin at the midline of the clavicle, and the intersection of the anterior axillary line and level of the navel). The CO2 pneumoperitoneum was established at a pressure of 15 mmHg. Ten minutes after the introduction of CO2 pneumoperitoneum, while the surgeons were dissecting the perirenal fat without significant bleeding, TEE showed a sudden increase in small gas bubbles in the RA and small bubbles in the RV. The patient was immediately placed in the Trendelenburg position. About 8 minutes later, TEE showed a large amount of gas bubbles in the left atrium, left ventricle, ascending aorta, and pulmonary artery (). At the same time, the PETCO2 began to fall to 20 mmHg from 37 mmHg, and this decrease lasted for 20 minutes. There were no changes in the patient’s pulse, blood pressure, SpO2, or electrocardiogram parameters.
We quickly increased the fraction of inspired oxygen to 100%. Arterial blood gas analysis revealed a pH of 7.27, arterial oxygen pressure of 161 mmHg, arterial CO2 pressure of 65 mmHg, and lactic acid concentration of 2.4 mmol/L. After communication with the surgeon, the pneumoperitoneum pressure was reduced to 10 mmHg. Meanwhile, gas bubbles could still be seen in the whole heart, the hepatic vein, and the IVC (). There was no regional wall motion abnormality, and the RV was normal. Color ultrasonography showed no defect in the atrial septum or ventricular septum and no patent foramen ovale (PFO).
Nine hours after the operation, the patient exhibited slurred speech and developed an epileptiform seizure in the ward. After the seizure, the muscle strength of both limbs was weakened. The blood myoglobin and lactic acid concentrations were increased. However, a computed tomography scan showed no obvious infarction or hemorrhage. Postoperative transthoracic echocardiography was performed by an independent ultrasound physician, who confirmed that there was no defect in the atrial septum or ventricular septum and no PFO.",What is the patient's body surface area? Please output your answer in terms of m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [42.0, 'kg'], 'height': [146.0, 'cm']}",1.30512,1.23986,1.37038,"For the body surface area computation, the formula is sqrt((weight (in kgs) * height (in cm))/3600, where the units of weight is in kg and the units of height is in cm.
The patient's height is 146.0 cm. 
The patient's weight is 42.0 kg. 
Therefore, the patient's bsa is sqrt((42.0 (in kgs) * 146.0 (in cm))/3600) = 1.30512 m^2."
692,60,Body Surface Area Calculator,physical,decimal,pmc-8453642-1,Extracted,"A 51-year-old female with long-standing Hashimoto’s disease, chronic urticaria, mast cell activation disorder, hypertension, and diabetes mellitus type 2 (well controlled, with glycosylated hemoglobin A1C ranging from 5.1% to 6.0%), treated with metformin 1000 mg orally, twice daily, and liraglutide (Victoza®) 1.8 mg daily, presented to the clinic complaining of recurrent hives, skin dryness, fatigue, weight gain, intermittent constipation and diarrhea, cold intolerance, brain fog, difficulty with word finding, swelling in her lower extremities, and daytime somnolence. The patient was also suffering from multiple chemical sensitivities, including 76 food allergies, medication sensitivities, and reactions to food dyes and additives. She was very careful with her food and medication choices due to multiple symptoms. Written informed consent for publication of this case report was obtained from the patient. No institutional approval was required to publish this case report.
Physical examination demonstrated an otherwise healthy woman with a temperature of 36.6°C, pulse 92 beats per minute, blood pressure 136/88 mmHg, respiratory rate 18 respirations per minute, O2 saturation 98%, height 1.57 m, weight 92 kg, body mass index 37.3 kg/m2. She was in no acute distress, with no palpable thyroid nodules on physical examination and no visible urticaria. She had hypoactive bowel sounds on physical examination and minimal tenderness to palpation in the left lower quadrant. She had a family history of papillary thyroid cancer in a sister. Multiple bilateral nodules had previously been biopsied and found to be benign. She had previously tried and failed generic L-T4 and transitioned to L-T4 sodium tablets (Synthroid®) at 125 µg daily. Because of the variability in her gastrointestinal (GI) function, she had discontinued metformin for several weeks without resolution of the GI symptoms.
presents her thyroid-stimulating hormone (TSH), free T3, and free T4 values at presentation. She was aiming for TSH optimization and resolution of symptoms. For six months, she was put on increasing doses of L-T4 ranging from 112 µg to 137 µg daily. Because of multiple drug sensitivities and intolerances to additives, she was transitioned to a compounded T4/T3 prescription without additives (sustained-release L-T4/T3 at doses ranging from 125 to 200 µg L-T4 and 7.5–20 µg T3). However, her dose was escalated three times over the course of three months with only mild improvement in thyroid function. At 24 weeks, she experienced worsening GI symptoms, including projectile vomiting with undigested food and pill capsules, weight loss, and 10–20 bowel movements daily. Metformin and liraglutide were discontinued.
Upper endoscopy revealed gastritis and a hiatal hernia. Gastric emptying examination demonstrated 20% gastric retention at 4 hours; she was diagnosed with gastroparesis. She was placed on high-dose probiotics and dicyclomine hydrochloride (Bentyl®) and initiated on a gastroparesis diet.
A timeline of treatments administered is shown in .
Because of continued bloating and abdominal pain, she was treated with one cycle of rifaximin (Xifaxan®) after she was also diagnosed with SIBO, confirmed by a GI examination including clinical history, physical examination, and the gold standard SIBO breath test. At 24 weeks, due to further worsening symptoms and thyroid levels, she was switched to L-T4 oral solution at 150 µg ().
The medication was well tolerated, led to a resolution of the thyroid symptoms, and was successfully down-titrated to 112 µg daily dose based on her body weight. She did not experience any side effects or reaction to the medication despite her multiple chemical sensitivities. TSH control was successfully sustained as shown at the latest monitoring six weeks following down-titration of L-T4 oral solution ().",What is the patient's body surface area? Please output your answer in terms of m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [92.0, 'kg'], 'height': [1.57, 'm']}",2.00305,1.9029,2.1032,"For the body surface area computation, the formula is sqrt((weight (in kgs) * height (in cm))/3600, where the units of weight is in kg and the units of height is in cm.
The patient's height is 1.57 m, which is 1.57 m * 100 cm/m = 157.0 cm. 
The patient's weight is 92.0 kg. 
Therefore, the patient's bsa is sqrt((92.0 (in kgs) * 157.0 (in cm))/3600) = 2.00305 m^2."
693,60,Body Surface Area Calculator,physical,decimal,pmc-5608682-1,Extracted,"A 73-year-old male (height, 158 cm; weight, 62 kg) was referred by the cardiology department to the rehabilitation department because of a 3-week history of left foot drop. He also complained of numbness and a tingling sensation on the left lateral side of the lower leg and dorsum of the foot. At the time of referral, the left leg and foot were soft and non-tender. Only the right dorsalis pedis was pulsatile, but not on the left side. Pain in the left lateral lower leg and dorsum of foot was scored 3/10 on the Numeric Pain Rating Scale. The Medical Research Council scale for weakness showed the following grades (right/left): hip extension 5/5, knee flexion 5/5, ankle dorsiflexion 5/1, and hallucis extension 5/1. He had no lower back pain and the straight leg raise reached 80° on both sides. A positive Tinel's sign behind the fibular neck on the left side was noted. In a nerve conduction study, there was no compound motor action potential in the left deep peroneal nerve on the left extensor digitorum brevis or tibialis anterior muscle recordings, and no evoked sensory nerve action potential in the left superficial peroneal nerve (). Needle electromyography showed abnormal spontaneous activity at rest and no motor unit action potential activity in the left tibialis anterior, peroneus longus, and peroneus brevis muscles (). Computed tomography (CT) angiogram showed proximal occlusion of the left anterior tibial artery (ATA) () without any abnormal findings of the soft tissue. This led to a diagnosis of left common peroneal neuropathy due to occlusion of the left ATA. The patient was treated with oral warfarin.
The patient's medical history was reviewed. He did not have diabetes mellitus. He received a mitral valve replacement 5 years ago due to mitral stenosis, and echocardiography showed a moderate degree of aortic stenosis and regurgitation. In addition, he had complete atrioventricular block and valvular atrial fibrillation; and had a pacemaker inserted three years prior to referral. However, he had been prescribed only an antiplatelet agent because of a history of cerebellar intracranial hemorrhage 2 years previously.
Approximately 4 weeks prior to referral, he visited another hospital suffering from chest pain, and received percutaneous coronary angiography which took about 30 minutes. After percutaneous coronary angiography, he received conservative care in a general ward, without any physical restrain or requirement for absolute bed rest. He could ambulate the ward with only minimal assistance. Some days later, he complained of left leg weakness and a brain CT was performed to rule out an acute brain lesion. Magnetic resonance imaging (MRI) was contraindicated because of the cardiac pacemaker. The brain CT showed a subacute ischemic lesion in the right posterior temporal region but it did not clinically correlate with the weakness. Although he complained of foot drop and paresthesia, there were no symptoms of anterior compartment syndrome such as tenderness, redness or swelling of low leg. No deep vein thrombosis or abnormal findings of soft tissues were found upon ultrasonography of the left leg. After improvement of the chest pain, he was discharged home. Two weeks later he was admitted to the cardiology department in the present hospital due to chest pain, and was referred to the rehabilitation department. After diagnosis of the left common peroneal neuropathy and improvement of the chest discomfort with conservative therapy, he was transferred and received rehabilitation.",What is the patient's body surface area? Please output your answer in terms of m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [62.0, 'kg'], 'height': [158.0, 'cm']}",1.64958,1.5671,1.73206,"For the body surface area computation, the formula is sqrt((weight (in kgs) * height (in cm))/3600, where the units of weight is in kg and the units of height is in cm.
The patient's height is 158.0 cm. 
The patient's weight is 62.0 kg. 
Therefore, the patient's bsa is sqrt((62.0 (in kgs) * 158.0 (in cm))/3600) = 1.64958 m^2."
694,60,Body Surface Area Calculator,physical,decimal,pmc-4227985-1,Extracted,"A 54-year-old man, with a history of type 2 diabetes mellitus, poorly controlled chronic hypertension, and chronic kidney disease on hemodialysis, was evaluated for a one-month history of a painful, non-mobile, subcutaneous nodule within the inferior and medial aspect of his right breast. The patient also complained of general pruritus but no malaise, joint pain or muscle pain. Body temperature, respiration, and pulse were normal. His blood pressure was elevated at 182/94 mm Hg. His body height, body weight, and body mass index were 165 cm, 52 kg, and 19.1, respectively.
On physical examination, a firm, superficial, erythematous nodule measuring approximately 1 × 2 cm was noted within the lower, inner quadrant of the right breast. There was no nipple discharge, history of trauma, or cancer history. Given the possibility of breast carcinoma, the patient was admitted for further evaluation. Upon admission, initial laboratory results revealed: BUN, 40 mg/dl; creatinine, 28.63 mg/dl, C-reactive protein, 7.04 mg/L; hemoglobin, 6.3 g/dl; and a white blood count, 6700 /ml, with a left shift.
Chest X-ray upon admission showed increased patchy infiltrates bilaterally and a non-contrast chest CT was performed for further evaluation. The chest CT revealed diffuse patchy airspace consolidation and patchy pulmonary alveolar infiltrates with fine interstitial thickening over both lung fields, most severe within the left upper lobe and right lower lobe (Figure ). The primary diagnosis was atypical pneumonia. Differential diagnosis included asymmetric pulmonary edema and multifocal bronchoalveolar carcinoma.
Sputum culture, sputum cytology, serum mycoplasma antibody, and legionella antibody were performed. Azithromycin and augmentin were begun for possible atypical pneumonia. Sputum cytology was negative for malignant cells. Sputum culture, however, revealed Klebsiella pneumoniae and Klebsiella oxytoca (without tubercle bacillus). Appropriate antibiotic therapy was continued and repeat serial chest X-rays, performed during his hospital stay, showed resolution of the alveolar infiltrates, bilaterally.
Incidentally noted on chest CT was a small oval nodular lesion measuring approximately 1.0 cm × 0.6 cm over the inferior and medial aspect of the right breast with infiltration within the subcutaneous adipose tissue (Figure ). As the nature of the breast nodule was unclear, a breast ultrasound (GE Healthcare, Milwaukee, WI) was recommended for further evaluation. Breast sonography revealed an oval, heterogeneous, predominantly hypoechoic nodule within the right breast measuring 1.35 cm × 0.39 cm in size between 3 and 4 o’clock, 2 cm from the nipple, with a faint echogenic interface, partially indistinct margin, and increased blood flow signals on color Doppler (Figure ). Skin thickening and additional hypoechoic satellite nodules were noted in the surrounding area (Figure ). As this presentation was felt to be unusual in a male breast, breast malignancy was suspected. As the patient refused mammography or MRI, a sono-guided biopsy of the lesion was performed using an 18-gauge core biopsy needle (Figure ). Pathology from four strips tissue revealed fibroadipose tissue and hemorrhage with inflammatory cell infiltration. As the pathology was considered indeterminant, an excisional biopsy of the mass was performed. Pathology from the excisional biopsy confirmed breast panniculitis, consisting of fibroadipose tissue with prominent inflammation and fibrotic change in a vague perivascular pattern (Figure ). Hemorrhage and hemosiderin deposition were also present. Histologic section further revealed a vasculitis involving medium size arteries and small vessels without giant cells or granuloma formation (Figure ).
Mycoplasma antibody titer, legionella antibody titer, anti-neutrophil cytoplasmic antibody (ANCA), autoimmune markers, carcinoembryonic antigen, cancer antigen 15–3, prostatic specific antigen, immunoglobulin G, immunoglobulin A, human immunodeficiency virus antibody titer, hepatitis C antibody titer, and hepatitis B surface antigen titer were all negative. A non-contrast head CT was also negative, performed as part of a headache work-up. Renal sonogram revealed increased cortical echogenicity of both kidneys compatible with chronic renal parenchymal disease. No definite renal infarctions were identified.
The lesion within the right breast resolved after excisional biopsy without further treatment. As the diagnosis was compatible with an isolated breast panniculitis with vasculitis (BPWV), the patient did not receive systemic corticosteroids or anti-inflammatory therapy during admission or after discharge and his breast symptoms did not recur during the subsequent 5 years of clinical follow-up.",What is the patient's body surface area? Please output your answer in terms of m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [52.0, 'kg'], 'height': [165.0, 'cm']}",1.5438,1.46661,1.62099,"For the body surface area computation, the formula is sqrt((weight (in kgs) * height (in cm))/3600, where the units of weight is in kg and the units of height is in cm.
The patient's height is 165.0 cm. 
The patient's weight is 52.0 kg. 
Therefore, the patient's bsa is sqrt((52.0 (in kgs) * 165.0 (in cm))/3600) = 1.5438 m^2."
695,60,Body Surface Area Calculator,physical,decimal,pmc-6166568-1,Extracted,"A fifteen-year-old girl, born at term of normal delivery second of three siblings, initially presented in the Orthopaedics OPD in 2010 with a history of progressive knee deforming of 1month and was referred to an endocrinologist for evaluation of metabolic bone disease. Dietary history was suggestive of adequate calcium and vitamin D intake and adequate sun exposure. No history of malabsorption or renal disorder. On examination, height 150 cm (5–10 percentile), weight 32 kg <5th percentile, US: LS = 0.96, percentile target height: 161.5 cm, genu valgum deformity noted, intermalleolar distance: 10.9 cm, bilateral wrist widening noted.
Biochemical evaluation revealed serum calcium: 14.2 mg/dl, phosphorus: 3.4 mg/dl, 25(OH) vitamin D: 25.10 nmol/L, iPTH: 1967 pg/ml, alkaline phosphatase: 1400 U/L, 24 hours urinary calcium: 282 mg/24 hours. Imaging: X-ray hand showed features of rickets [Figures -]. CT neck: Features s/o left superior parathyroid adenoma. Lesion in lower pole of left lobe of thyroid Sestamibi scan: S/o functioning parathyroid adenoma on left side. She underwent left inferior parathyroidectomy in May 2010: however, on follow up after 1 year she was found to have elevated parathyroid hormone (PTH) and calcium and was then referred to SGPGI with a diagnosis of persistent hyperparathyroidism (HPT).
At evaluation in SGPGI there were no records of previous surgery; repeat methoxy iso butyl isonitrile (MIBI) revealed a superior parathyroid adenoma on left side and was concordant with the ultrasonography (USG) finding of a left superior parathyroid adenoma. Bilateral neck exploration was performed with intraoperative parathyroid hormone (IOPTH) monitoring. At operation, both right parathyroid glands were found to be grossly normal; a left superior parathyroid adenoma was found which was excised (2.2 × 1.6 × 1.6 mm, weight 2.2 gm). However, left inferior parathyroid gland could not be found. IOPTH according to Miami criteria was curative, as there was >50% drop from the pre-excision value of 2130 to 231 at 10 minutes. Histophalogical examination was suggestive of parathyroid adenoma. At the last follow up, in 2016, her biochemical parameters including calcium and iPTH were within normal limits and she was free of bone pains, though her genu valgum persisted.",What is the patient's body surface area? Please output your answer in terms of m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [32.0, 'kg'], 'height': [150.0, 'cm']}",1.1547,1.09696,1.21244,"For the body surface area computation, the formula is sqrt((weight (in kgs) * height (in cm))/3600, where the units of weight is in kg and the units of height is in cm.
The patient's height is 150.0 cm. 
The patient's weight is 32.0 kg. 
Therefore, the patient's bsa is sqrt((32.0 (in kgs) * 150.0 (in cm))/3600) = 1.1547 m^2."
696,60,Body Surface Area Calculator,physical,decimal,pmc-6280227-1,Extracted,"A 14-year-old adolescent boy was referred to our Endocrinology Department for evaluation of short stature. As no medical records were available, previous growth velocity could not be evaluated. The patient reported that he had always been short for his age throughout his childhood.
His recent medical history was negative for headaches, vomiting, or vision changes. There were no reports of fatigue, cold intolerance, constipation, and skin or hair changes. Appetite was normal with no recent weight loss. There were no academic concerns. He regularly played football, with no history of traumatic or nontraumatic fractures. He took no medications. For several months, he had reported minor bilateral symmetrical crookedness on his second fingers, without any pain or local symptoms.
He had been born at 36 gestational weeks, weighing 2450 g with no history of abnormal gestation, breech presentation, ischemic insult at birth, or other neonatal events.
Parental heights were normal, with a target height of 177.5 cm. Parental pubertal timing was also within normal limits. Family history was negative for short stature, endocrine, or autoimmune conditions.
Clinical examination revealed a dysmorphic, proportionate, and relatively short adolescent with normal vital signs. His anthropometric parameters were −2 SDs (standard deviations) for weight (37 kg) and between −2 SDs and −2.5 SDs for height (148 cm) (Belgian charts). His height was below his midparental genetic interval. His upper:lower segment ratio and arm span were normal. His hands and feet appeared short, with middle, painless tumefaction of soft tissue around the index proximal interphalangeal joints. No spinal abnormalities were noted, but a mild pectus excavatum was present. There was no thyromegaly. Testicular and pubic hair development was in Tanner stage II (testicular volume 6 ml). The most prominent dysmorphic features were a pear-shaped nose, a thin upper lip with small lower jaw, prominent ears, and markedly thin and sparse blonde hair with rarefaction of the lateral eyebrows (). The teeth examination was difficult because he wore dental braces to correct dental irregularities.
An extensive biological workup was performed. Complete blood count and serum levels of inflammatory markers, electrolytes, glucose, renal function, liver enzyme, and tissue transglutaminase antibody levels were normal. The laboratory findings showed normal thyroid and adrenal function and normal growth hormone secretion (normal levels of insulin-like growth factor and insulin-like growth factor binding protein). Additional pituitary and gonad testing revealed a normal prolactin level and pubertal testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) levels (). The bone age was evaluated at 12 years 6 months.
A renal and cardiac ultrasound looking for other possible somatic malformations [] wasperformed and showed normal morphological kidneys, ureters, and urinary bladder and no cardiac abnormalities.
After this first clinical, biological, and radiological evaluation, the working diagnosis was constitutional growth delay with late normal puberty, but skeletal dysplasia (dysmorphic features in the context of short stature) was considered for differential diagnosis.
During the follow-up 6 months later, the initial apparent soft tissue tumefaction of his indexes had progressed to localized noninflammatory and painless deformity, causing limited difficulty in writing and typing on a keyboard. This sign was isolated, and the patient did not complain of pain or history of local trauma or infection. At this time, his clinical appearance was normal, except for the aforementioned dysmorphic traits. His growth velocity (5 cm/6 months) was normal in the context of spontaneous pubertal progress (Tanner stage III, testicular volume 8–10 ml).
Clinical examination of his hands revealed isolated ulnar deviation of the second fingers and symmetrical deformity of proximal interphalangeal joints of both hands (). He had no other painful or deformed joints.
His feet look normal, but the toes are short ().
Theoretically, a differential diagnosis with inflammatory arthritis was considered, but the clinical findings (dysmorphic features, short stature, and relatively asymptomatic finger abnormalities) were more suggestive of a skeletal dysplasia. Radiographs of hands, feet, and pelvis were performed and allowed the definitive diagnosis.
The plain radiograph of his wrists showed cone-shaped epiphyses of the middle phalanges of the second digit of both hands with moderate deviation of the phalangeal axis (Figures and ).
Similar cone-shaped epiphyses were found in the proximal phalanx of the great toe and up to the fourth one of both feet with shortness of all toes ().
No other radiological joint impairments (juxtaarticular osteopenia or erosions) were found. Radiographs of the pelvis and whole-body magnetic resonance imaging (looking for fine abnormalities, particularly long bone cysts not visible on plain radiographs) [] were normal. The bone age was retarded at 12 years 6 months (the chronological age was 14 years 6 months).
Taking together the clinical and particularly the radiological findings, the correct diagnosis of trichorhinophalangeal syndrome (TRPS) was achieved. This was a delayed diagnosis, and our explanations for this include the underrecognition of the dysmorphic features (in our first examination), the underinterpretation of fingers tumefaction in the clinical context, and consecutively no hand radiological exam being conducted.
Other entities associating ectodermal and skeletal phenotypes were reviewed, particularly Albright osteodystrophy, acrodysostosis, and other brachydactyly syndromes, but several features of the presentation were inconsistent with these diagnoses.
Cytogenetic analysis was not performed. The family history appeared to be negative, his parents and his sister do not manifest the syndrome phenotype, and in such conditions, a sporadic case of TRPS type I was considered highly possible.",What is the patient's body surface area? Please output your answer in terms of m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [37.0, 'kg'], 'height': [148.0, 'cm']}",1.23333,1.17166,1.295,"For the body surface area computation, the formula is sqrt((weight (in kgs) * height (in cm))/3600, where the units of weight is in kg and the units of height is in cm.
The patient's height is 148.0 cm. 
The patient's weight is 37.0 kg. 
Therefore, the patient's bsa is sqrt((37.0 (in kgs) * 148.0 (in cm))/3600) = 1.23333 m^2."
697,60,Body Surface Area Calculator,physical,decimal,pmc-8138415-1,Extracted,"Upon assurance of patient's consent to participate in the study by signing the written consent form, from 8 months before the investigation, a 34-year-old married female patient (a medical staff) with a history of BN and weight and height of 52 kg and 164 cm, respectively, had been initially treated with slow-release bupropion at an initial dose of 75 mg due to sadness and impatience (mostly in the mornings) as well as hypersomnia and overeating. The mentioned dose reached 300 mg within 2 weeks. The patient was simultaneously taking 300 mg of bupropion with 20 mg of propranolol and 10 mg of chlordiazepoxide 10 at noon. The patient stated that her appetite would be decreased only in case of taking the three pills simultaneously. During the 8 months, the patient lost 6 kg of weight. Accordingly, after a while, she gradually increased the dose of slow-release bupropion to 450 mg/day due to the persistence of weight. Following such an increase in bupropion dose from 300 mg to 450 mg, after 3 days, she was suffering from painful muscular contractions in the legs, thighs, respiration, and swallowing and also abdominal pain, drooling, and suffocation feeling. She then referred the emergency department and received 10 g of diazepam intramuscularly. However, no change in symptoms made her suspected to be with acute dystonia. To this end, she was treated with 2 mg of biperiden intravenously, and then symptoms were resolved shortly. After 3 days, with the beginning use of 450 mg of bupropion again, the symptoms of acute dystonia begin to recur, which is ameliorated by the injection of biperiden. Two days later, the patient took 300 mg of bupropion again, which also led to acute dystonia symptoms.
The patient stated a history of BN disorder since the age of 15, during which she had used different calorie diets, fluoxetine tablets, ritalin tablets, diethylpropion hydrochloride tablets, laxatives, and bisacodyl suppositories as well as the intragastric balloon method. Besides, the patient stated no history of head trauma, convulsions, fever, and drug use. There was also no history of psychiatric disorders and physical diseases in her family.
Normal complete blood cell counts, calcium and magnesium levels, vitamin B12 levels, folic acid levels, and ferritin levels were reported. The patient's brain magnetic resonance imaging (MRI) also reported normal conditions. Accordingly, following diagnosis of bupropion-induced acute dystonia, the patient was advised to discontinue bupropion intake. In the follow-ups done 2 weeks later, 3 months later, and 6 months later, no signs of acute dystonia was observed.",What is the patient's body surface area? Please output your answer in terms of m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [52.0, 'kg'], 'height': [164.0, 'cm']}",1.53912,1.46216,1.61608,"For the body surface area computation, the formula is sqrt((weight (in kgs) * height (in cm))/3600, where the units of weight is in kg and the units of height is in cm.
The patient's height is 164.0 cm. 
The patient's weight is 52.0 kg. 
Therefore, the patient's bsa is sqrt((52.0 (in kgs) * 164.0 (in cm))/3600) = 1.53912 m^2."
698,60,Body Surface Area Calculator,physical,decimal,pmc-8593422-1,Extracted,"A 14-year-old girl was admitted to the pediatric emergency room with complaints of vomiting and dizziness. The patient stated that she had ingested 40 tablets verapamil (contains 120 mg verapamil hydrochloride in each tablet) 10 h before the emergency service admission. The patient underwent continuous cardiac monitoring. Her serial electrocardiography (ECGs) were obtained. On her physical examination, her body weight was 60 kg and her height was 157 cm. She was lethargic, her arterial blood pressure (BP), heart rate, respiration rate, and body temperature were measured as 57/32 mmHg, 50/min, 14/min, and 36.2°C, respectively. In the emergency department, gastric lavage and active charcoal treatment were not performed because she received the drug 10 h before the admission. 20 ml/kg 0.9% saline infusion has been given to the patient two times in the emergency department. The patient was taken to the PICU because her bradycardia and hypotension were resistant despite treatment. A central venous catheter was inserted quickly and 2500 ml/m2 hydration was started. In the laboratory analyses, complete blood count, renal function tests, serum electrolytes, and arterial blood gas analyses were taken, and all the results were within normal limits apart from elevated lactate levels (5.2 mml/L). Hyperglycemia was not found in the patient's blood glucose monitoring. In our follow-up, her general condition was poor and lethargic; bradycardia and ventricular extrasystoles were seen in the ECG []. She was in cardiogenic shock and dopamine infusion, at a rate of 10 mcg/kg/min was started, and calcium gluconate was given for CCB toxicity but her vital parameters did not change. Then, norepinephrine infusion therapy (0.1 mcg/kg/min) was started because she had peripheral vasodilatation symptoms and flushing. At the 2nd h of the patient's PICU hospitalization, we considered it appropriate to start ILE treatment, as the patient's hypotension and bradycardia continued, despite increased doses of inotropic drugs and calcium support. Intravenous lipid infusion (20% Intralipid) therapy was started at a rate of 1.5 ml/kg for 2 h. Half an hour after starting the ILE treatment, the patient's rhythm returned to the sinus rhythm, the ventricular extrasystoles disappeared on the patient's ECG and her arterial BP began to improve. The patient's BP was 79/52 mmHg when we started treatment. BPs were measured at 30 min, 1 h, and 2 h after the treatment had started, and the BPs were 84/56, 90/61, and 92/67 mmHg, respectively. Vital signs of the patient before and after ILE treatment are given in . After treatment, her inotropic drugs were gradually reduced within 8 h, and her consciousness began to recover very quickly. On the 2nd day of the intensive care stay, the patient was transferred to the cardiology service with complete neurological recovery and no organ failure. She was discharged from the hospital on the 4th day of admission. Detailed informed consent was obtained from the patient's parents in this case report.",What is the patient's body surface area? Please output your answer in terms of m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [60.0, 'kg'], 'height': [157.0, 'cm']}",1.61761,1.53673,1.69849,"For the body surface area computation, the formula is sqrt((weight (in kgs) * height (in cm))/3600, where the units of weight is in kg and the units of height is in cm.
The patient's height is 157.0 cm. 
The patient's weight is 60.0 kg. 
Therefore, the patient's bsa is sqrt((60.0 (in kgs) * 157.0 (in cm))/3600) = 1.61761 m^2."
699,60,Body Surface Area Calculator,physical,decimal,pmc-4208265-1,Extracted,"A 16-year-old Korean male presented with two episodes of lower leg paralysis in the morning for two weeks. The first episode was a sudden onset of complete paralysis below distal thigh, and he had no other symptoms except leg paralysis. At a local clinic, physical examination revealed symmetric hyporeflexia in both lower extremities. Laboratory analysis revealed mild hypokalemia as below: Na+, 146 mmol/L; K+, 2.7 mmol/L; Cl-, 110 mmol/L; tCO2, 25 mmol/L without abnormality of blood gas analysis. Electrocardiogram showed only sinus tachycardia without atrioventricular block or prominent U wave. However, further evaluation for hypokalemia was not taken, even though there was a suggestion of hypokalemic paralysis, and the patient was just advised to eat an adequate dietary supplement of potassium rich food without any medication by the local clinic. After two weeks, a second episode of leg weakness occurred after morning meal. The muscle weakness was initially subtle but progressed in paralysis below knee and lasted for 6 hours. Thus, he was referred to our hospital. However, the patient visited our clinic the next day, when the paralysis had already subsided.
There was no past history or family history of neuromuscular disease and endocrinologic disease, except for his aunt's hypothyroidism. His appearance was reasonably healthy. His height was 168 cm, his weight was 60 kg, and his body mass index was 21.2 kg/m2. His blood pressure was 110/80 mmHg, his respiratory rate was 18 breaths/min, and his body temperature was 36.8℃. He had mild tachycardia with a heart rate of 100-110 beats/min,, but he had no palpitations. Neurological examination findings, including deep tendon reflex and cerebellar function test, were normal. The laboratory findings showed normal complete blood cell counts, normal electrolytes as below: Na+, 140 mmol/L; K+, 4.4 mmol/L; Cl-, 104 mmol/L; tCO2, 24 mmol/L. The laboratory findings also showed his normal liver, kidney and cardiac functions. His urine K+ excretion rate was normally low as 0.96 of urine K+/Cr ratio (range, 0-2). There were no abnormal laboratory findings to suggest adrenal hormone excess or primary hyperaldosteronism: adrenocorticotropic hormone, 40.11 pg/mL (range, 3.5-13.2 pg/mL); cortisol, 8.7 µg/dL (range, 5.0-23.0 µg/dL); 17 hydroxyprogesterone, 2.68 ng/mL (range, 0.6-3.42 ng/mL); aldosterone, 180.29 pg/mL (range, 38.9-306.8 pg/mL); renin, 6.13 ng/mL/hr (range, 1.31-3.95 ng/mL/hr); epinephrine, 0.030 ng/mL (range, 0-0.30 ng/mL); norepinephrine, 0.087 ng/mL (range, 0-0.80 ng/mL). Thyroid function test (TFT) revealed a hyperthyroidism: serum free thyroxine (fT4), 2.10 ng/dL (range, 0.70-1.48 ng/dL); triiodothyronine (T3), 2.95 ng/mL (range, 0.58-1.59 ng/mL); thyroid-stimulating hormone (TSH), <0.025 mU/L (range, 0.35-4.94 mU/L). Thus, he was diagnosed as having hypokalemic paralysis due to hyperthyroidim. Serum TSH receptor antibodies were high at 6.05 IU/L (range, 0-1.75 IU/L), thyroid stimulating antibody was positive, and thyroid ultrasonography revealed diffuse enlarged thyroid and increased vascularity. These findings were consistent with Graves' disease as etiology of his hyperthyroidism. He was initially treated with lower dose of an antithyroid drug (methimazole 5 mg once daily) than usual, since his thyrotoxic symptoms and signs were absent, and his level of serum fT4 was not prominent. In addition, a β-adrenergic blocker (propranolol) was simultaneously used for preventing the paralysis. After two weeks, a follow-up TFT revealed aggravated hyperthyroidism, and he was treated with increased dose of antithyroid drugs. After two months, since his heart rate and blood pressure were stable and he had no symptoms of palpitations, β-blockers were discontinued successfully. No paralysis has occurred for one year, as hyperthyroidism can be well controlled with antithyroid drugs ().",What is the patient's body surface area? Please output your answer in terms of m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [60.0, 'kg'], 'height': [168.0, 'cm']}",1.67332,1.58965,1.75699,"For the body surface area computation, the formula is sqrt((weight (in kgs) * height (in cm))/3600, where the units of weight is in kg and the units of height is in cm.
The patient's height is 168.0 cm. 
The patient's weight is 60.0 kg. 
Therefore, the patient's bsa is sqrt((60.0 (in kgs) * 168.0 (in cm))/3600) = 1.67332 m^2."
700,60,Body Surface Area Calculator,physical,decimal,pmc-8203434-1,Extracted,"A 27-year-old male was referred to the Endocrine Unit of the University-Hospital of Padova, Padova, Italy, in 2017 after developing truncal obesity, facial rounding, and plethora in the previous four to six months. There were no medical events or endocrine diseases in his own or familial medical history. Informed consent was obtained from the patient for publication of this case.
Physical examination revealed a plethoric moon-shaped face and central obesity, without purple striae or a buffalo hump. The blood pressure was 150/90 mm Hg, and the patient’s height, body weight, and waist circumference were 187 cm, 90 kg, and 104 cm, respectively (body mass index 25.74 kg/m2).
The results of routine laboratory tests including liver and kidney function tests were normal. The fasting plasma glucose level of 6.5 mmol/L [reference interval (RI): 3.7–5.6 mmol/L] and glycosylated hemoglobin level of 44 mmol/mol (RI: 20–42 mmol/mol) were consistent with new-onset impaired fasting glucose. A sodium level of 146 mmol/L (RI: 136–145 mmol/L) and potassium level of 3.5 mmol/L (RI: 3.4–4.5 mmol/L) suggested increased mineralocorticoid activity.
After exclusion of exogenous steroids, first-line screening tests for suspected endogenous hypercortisolism were performed. The 24 hours urinary free cortisol excretion level was elevated (6.465–5.375 nmol/24 hours; RI: 16–168 nmol/24 hours), the salivary cortisol rhythm was impaired (late-night salivary cortisol level of 55–46 nmol/L; RI: 0.5–2.6 nmol/L), and serum cortisol level was not suppressed after administration of 1 mg dexamethasone (cortisol 444 nmol/L). These results confirmed a diagnosis of endogenous CS. ACTH levels were increased (14.1 pmol/L; RI: 2.2–11 pmol/L), indicating ACTH-dependent CS.
Over the next few weeks, hypokalemia was observed along with increased blood pressure levels. Therefore, we initiated medical therapy with potassium canrenoate and metyrapone, which achieved rapid control of blood pressure and potassium levels.
To identify the source of ACTH secretion, the patient underwent all second-line dynamic tests for ACTH-dependent hypercortisolism.
After the human CRH test (100 μg), there was a significant increase in both ACTH level (15.2 to 50.6 pmol/L, +233.3%) and cortisol level (763 to 1.631 nmol/L, +113.8%). There was also a significant increase in both ACTH level (16.8 to 27.7 pg/mL, +64.7%) and cortisol level (778 to 1,032 nmol/L, +32%) during the DDAVP test. These results suggested pituitary ACTH secretion (). However, no cortisol suppression was found after the HDDST (8 mg overnight, cortisol level 778 to 690 nmol/L, −11.3%).
Pituitary MRI revealed a 4-mm pituitary microadenoma; however, the clinical features, in particular the rapid onset of severe hypertension and hypokalemia, combined with reduced cortisol suppression after the HDDST, suggested EAS. Therefore, the patient underwent chest CT and abdominal enhanced MRI, which showed multiple pancreatic nodules; their neuroendocrine origin was suggested by the uptake of 68-Ga-DOTATOC PET/CT, confirming the presence of somatostatin receptors.
Considering the discordant responses to second-line dynamic tests and evidence of both pituitary and pancreatic lesions, we decided to perform BIPSS to facilitate the differential diagnosis between CD and EAS. The central IPS to peripheral (P) ACTH ratio (IPS:P =25) after CRH administration confirmed the pituitary origin of ACTH secretion.
Based on the clinical presentation (pituitary adenoma and pancreatic nodules in a young patient), we performed Sanger sequencing for multiple endocrine neoplasia type 1 (MEN1), which confirmed a pathogenic variant in the menin gene (base pair insertions c.188_189TT cDNA692_693_inTT Q64Sfs56, loss of frameshift).
The patient underwent pituitary surgery, and histological examination confirmed a pituitary adenoma with positive ACTH staining. After surgery, low levels of morning serum cortisol confirmed the remission of CD, requiring replacement therapy. On physical examination, we observed reduction in body weight and facial plethora; moreover, the patient’s blood pressure normalized without antihypertensive treatment.
A few months after the pituitary surgery, the patient underwent abdominal surgery (duodeno-cephalo-pancreatectomy and distal pancreatectomy). The histology report revealed well-differentiated neuroendocrine tumors and focal nesidioblastosis; immunohistochemistry showed positive staining for chromogranin, synaptophysin, and glucagon, and negative staining for ACTH, serotonin, somatostatin, gastrin, insulin, and pancreatic polypeptide.
At the last follow-up visit (38 months since diagnosis), clinical and biochemical parameters confirmed remission of CD, and abdominal imaging markers of neuroendocrine neoplasia were also negative.",What is the patient's body surface area? Please output your answer in terms of m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [90.0, 'kg'], 'height': [187.0, 'cm']}",2.16217,2.05406,2.27028,"For the body surface area computation, the formula is sqrt((weight (in kgs) * height (in cm))/3600, where the units of weight is in kg and the units of height is in cm.
The patient's height is 187.0 cm. 
The patient's weight is 90.0 kg. 
Therefore, the patient's bsa is sqrt((90.0 (in kgs) * 187.0 (in cm))/3600) = 2.16217 m^2."
701,60,Body Surface Area Calculator,physical,decimal,pmc-4377251-1,Extracted,"A 16-year-old boy complained fever and persistent cough unresponsive to antibiotics. Chest X-ray was normal. After 2 weeks skin petechiae and ecchymoses appeared and the boy was admitted to an Infectious Disease Division. Peripheral blood count showed: hemoglobin 11.9 g/dL, platelet 1 × 103/μL, white blood cells 8.5 × 103/μL, neutrophils 87%, lymphocytes 5%. ITP was suspected and intermediate dose methylprednisolone (0.5 mg/kg/day) was administered for 2 days. CT scan showed multiple masses both in the chest and abdomen, enlarged liver, and hypodense areas in the spleen. On admission to our center, clinical examination revealed obesity (weight 125 kg and height 171 cm), diffuse petechiae all over the skin and ecchymoses on upper and lower limbs. No enlarged peripheral lymph nodes were found. Liver and spleen margins were 2 and 2.5 cm under the lower costal limit, respectively. Laboratory investigation confirmed thrombocytopenia (platelet count 10 × 103/μL) with hemoglobin 12.2 g/dL and white blood cells 13.6 × 103/μL. Erythrocyte sedimentation rate measured 104 mm/h, reactive C protein 17.4 mg/dL (n.v. <0.8), lactate dehydrogenase level 1051 IU/L. Liver function tests including albumin, bilirubin, alkaline phosphatase, gamma glutamyltransferase, coagulation parameters, and transaminases as well as serum immunoglobulin (Ig) levels were within the normal range. Viral serology for EBV, hepatitis A, B, and C viruses and HIV as well as autoimmune markers were negative, thus excluding secondary thrombocytopenia. FDG-PET documented high metabolic activity in all the sites evidenced as pathologic by CT scan. Leukemia/lymphoma diagnosis was suspected. Bone marrow aspirate and trephine biopsy revealed normal cellularity with no evidence of neoplastic infiltration and increased megakaryocytes, a picture compatible with ITP. A tru-cut biopsy of one of the abdominal masses was excluded due to adiposity and, consequently, it was decided to perform a laparoscopic procedure. In order to achieve a safe platelet value, a dose of 30 g of IVIG for two consecutive days was administered before surgery. Platelet rose to 30 × 103/μL and two units of platelets were transfused immediately before and during surgery.
Laparoscopy was complicated by copious bleeding and converted to open surgery. Bleeding was soon controlled with no further complications. Due to the need of respiratory and hemostasis surveillance, the patient was transferred to Intensive Care Unit for 5 days. The platelet count fell to 22 × 103/μL and intravenous methylprednisolone (1 g daily for 3 days) was administered with a prompt rise of platelet count (204 × 103/μL at day 3). Histological report revealed Hodgkin lymphoma, nodular sclerosis type (immunophenotypic profile: CD 30+, CD15+/–, CD20–, CD3–, CD43–, LCA–, EMA–, ALK–). Chemotherapy was started according to AIEOP LH 2004 protocol, which includes 6 COPP/ABV cycles (cyclophosphamide, vincristine, procarbazine, prednisone/adriamycin, bleomycin, vinblastine) followed by involved field radiotherapy. Platelet count showed an asymptomatic second fall to 75 × 103/μL during the first course and rose up to normal values without the need of additional treatments. The boy is now in complete remission, with a normal platelet count, 13 months after the end of treatment (Fig.).",What is the patient's body surface area? Please output your answer in terms of m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [125.0, 'kg'], 'height': [171.0, 'cm']}",2.4367,2.31487,2.55854,"For the body surface area computation, the formula is sqrt((weight (in kgs) * height (in cm))/3600, where the units of weight is in kg and the units of height is in cm.
The patient's height is 171.0 cm. 
The patient's weight is 125.0 kg. 
Therefore, the patient's bsa is sqrt((125.0 (in kgs) * 171.0 (in cm))/3600) = 2.4367 m^2."
702,60,Body Surface Area Calculator,physical,decimal,pmc-8524955-1,Extracted,"A 172-cm tall, 18-year-old man, weight 100 kg, was admitted to our department in January 2020 due to left medial deep ankle pain after stamping the clutch about 10 days ago, who had an extreme liking of seafood, beer and carbonated drinks. During the physical examination, medial ankle tenderness and mild swelling were present, with a VAS score of 6 or 7, but the range of ankle motion was normal. Ankle X-rays, computerized tomography (CT) and magnetic resonance imaging (MRI) scans were conducted and a medial talus osteochondral lesion with subchondral cyst formation was detected (Fig. ). Various laboratory tests detected high levels of uric acid (568 µmol/L), anti-streptolysin O (130.10 IU/mL), procalcitonin (0.28 ng/mL) and a high level of serum C-reactive protein (39.50 mg/L). The patient’s erythrocyte sedimentation rate, blood cell counts, and other biochemical indexes were all within the normal range. He was primarily diagnosed with a Hepple stage V type talus osteochondral lesion, but the etiology was not clear. An ankle arthroscopy was conducted, and we found a few gouty tophus deposits in the talus articular cartilage and synovial tissue. The medial, central talus articular cartilage was soft, uneven and partially defective, with gouty tophus deposits. A 1.5-mm K-wire was drilled into this site to confirm the talus lesion site under C-arm fluoroscopy. A medial curved incision was made on the medial malleolus and the talus osteochondral lesion was exposed after inverted V-shaped medial malleolus osteotomy and removed with trephine; the removed lesions were found to be gouty tophus (Fig. ), which was further confirmed by the finding of monosodium urate monohydrate (MSU) crystals in postoperative histological sections (Fig. ). After complete debridement of these lesions, the lesion site was not a regular shape, and a very small amount of normal osteochondral tissue was cut with a small osteotome to form a square lesion site. Then an osteochondral block of the same size was harvested from the autologous talus neck and grafted onto the site and fixed with two 2.0 mm bioabsorbable screws. The donor site was filled and tamped with the cancellous bone on the osteotomy surface of the medial malleolus. Then the medial malleolus was fixed with three cannulated screws after reduction. Aceclofenac dispersible tablets and allopurinol were taken by the patient immediately after the operation and he was advised to use his left ankle passively, with no weight-bearing for 5 weeks. At this time his serum uric acid concentration was in the normal range and a good medial malleolus union was revealed by X-ray imaging. Partial weight-bearing was encouraged 2 months postoperatively when the cyst talus osteochondral lesion had disappeared and was replaced with normal bone tissue 6 months postoperatively. The patient could walk with slight pain at this time with a VAS score of 1 and was very satisfied with the outcome. Regular monitoring of serum uric acid concentrations and his modified diet continued, and he has been followed up for 12 months.",What is the patient's body surface area? Please output your answer in terms of m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'height': [172.0, 'cm'], 'weight': [100.0, 'kg']}",2.18581,2.07652,2.2951,"For the body surface area computation, the formula is sqrt((weight (in kgs) * height (in cm))/3600, where the units of weight is in kg and the units of height is in cm.
The patient's height is 172.0 cm. 
The patient's weight is 100.0 kg. 
Therefore, the patient's bsa is sqrt((100.0 (in kgs) * 172.0 (in cm))/3600) = 2.18581 m^2."
703,60,Body Surface Area Calculator,physical,decimal,pmc-6585518-1,Extracted,"The patient analyzed is a 14-year-old boy affected by severe AIS. He was recruited for the study in a tertiary outpatient clinical center specializing in conservative treatment of spinal disorders. The patient presented two primary curves, a right thoracic curve (60° Cobb angle) and left lumbar curve (63° Cobb angle) (). He was 170 cm and 70 kg (Body Mass Index (BMI): 24.22; Tri-Ponderal Mass Index (TMI) []: 14.25). Aesthetic impairment was observed as he obtained a score of 51.1 at the TRACE test in the recently developed Rasch version [] (). Radiological parameters of the curves, both in brace and out brace, are described in . In-brace spine x-ray is shown in .
The patient had come to our attention with a prescription of a rigid brace (Lyonese) 23 hours per day; nevertheless, self-reported compliance was just 8 to 10 hours per day. Because of the severity of the curves that well exceeded threshold for surgery consideration (63°), surgical treatment was advised; however, the patient refused surgery. For this reason, a very rigid brace (Sforzesco) was prescribed 23 hours per day. A thermic sensor was applied (Thermobrace) in order to objectively verify compliance [].
: The present case report adheres to the CARE (CAse REporting) structure and reporting Guidelines []. The present study is a case study with a prospective observational design. Additional and non-invasive procedures have been used, i.e. actigraphy. The subject’s rest-activity data were recorded for one consecutive week, at home, through an accelerometer, in the last week of July 2018; that period of the season was the holiday period for the subject, with no school commitments. The period coincided with the first days of Sforzesco brace wear 23 hours per day. The study protocol was conducted in accordance with the current national and international laws and regulations governing the use of human subjects (Declaration of Helsinki II). The subject, before the beginning of the study, signed an informed consent that explained the study protocol highlighting its benefits and possible risks.
: Actigraphy is widely used to study insomnia, sleep and rest-activity circadian rhythms disorders [,]; it represents a valid and practical tool that is extremely less invasive than the traditional polysomnography (PSG). An actigraph recording can be performed at home without hospitalization, lasting for many consecutive weeks []. It was also shown that the circadian period of the actigraph-defined sleep/wake rhythm accurately predicted the period of the PSG-defined activity-rest cycle [].
RAR was recorded using an the Actiwatch 2 actigraph (Philips Respironics, OR, USA). The device is composed by a piezoelectric triaxial accelerometer able to convert axial movements over time in electrical signals. The subject’s activity counts (AC) were recorded 24 hours/day for one week, i.e. seven consecutive days, from Monday to Sunday. The ACs data were transferred from actigraph to a PC with the use of the Philips Actiware 6 Software (Philips Respironics, OR, USA) and then exported and analyzed, epoch per epoch (1 epoch = 60 seconds), in an Excel working sheet (Microsoft Corporation, WA, USA) before performing the rhythmometric analysis (see statistical analysis for details).
: To determine the existence of RAR for each single day and for the week of monitoring, the ACs were analyzed using the single and the population mean cosinor method respectively [,]. Both methods studies the cosine mathematical function that best fits the data as a function of time and they describe three specific rhythmometric parameters: MESOR, the Midline Estimating Statistic of Rhythm; A, the amplitude; and Φ, the acrophase. The MESOR is a rhythm-adjusted mean for a 24-h period, A is the measure of one half the extent of the rhythmic variation in a cycle, and Φ indicates the time interval within which the highest values are observed. The three parameters are reported with the relevant 95% confidence intervals (CI) (). The statistical rhythmometric analyses were carried out using the Time Series Analysis Serial Cosinor 6.3 (Expert Soft Technology, Richelieu, France). Significance was set at p < 0.05.
: In parallel with RAR monitoring, sleep parameters were also objectively monitored for seven consecutive nights with the same actigraph (Philips Respironics, OR, USA). The Actiwatch 2 is a widely used actigraph worn on the non-dominant wrist that has the capability to determine both RARs but also sleep parameters [] and it has been validated against PSG in healthy children and adults []. It is however important to underline that sleep parameters can be derived from Actiwatch 2 recordings using three different threshold settings (low, medium, or high) for detection of movements. The threshold settings use different magnitudes of activity for discriminating sleep and wake states, and thus affect the sleep parameters derived from the actigraph. Therefore, in the present case study, a low actigraphic sensitivity threshold (80 counts per epoch) was selected since this cut-off value seems to provide the best combination of sensitivity and specificity in young subjects [,].
Ten sleep parameters were measured:
I) Sleep Start (SS): the start of sleep was derived automatically using the Actiwatch 2 algorithm; it is expressed in hours and minutes (hh:mm);
II) Sleep End (SEnd): the end of sleep was derived automatically using the Sleepwatch algorithm; it is expressed in hours and minutes (hh:mm);
III) Time in Bed (TB): the difference between SS and Send, expressed in minutes;
IV) Sleep Latency (SL): the period of time, in minutes, between bedtime and sleep onset time;
V) Sleep Efficiency (SE): the percentage of time in bed actually spent sleeping;
VI) Wake After Sleep Onset (WASO), the amount of time spent awake after sleep has been initiated; WASO is typically expressed in minutes;
VII) Total Sleep Time (TST), the amount of sleep, expressed both in minutes and percentage, obtained during a sleep period;
VIII) Immobility Time (IT), the total time, expressed both in percentage and minutes, spent without recording any movement during time in bed;
IX) Mobility Time (MT), the total time, expressed both in percentage and minutes, spent recording significant movement during time in bed;
X) Fragmentation Index (FI), the sum of the percentages of mobility and immobility accesses in one minute, divided by the number of immobility accesses. FI is expressed in percentage.
The data are reported as mean±SD. Together with the actigraph, the study subject received a sleep diary to record bed time, wake up time, the number of nocturnal awakenings, or the time spent without wearing the device.
: The sensor applied showed a very good compliance to treatment in the period analyzed with an objectively reported compliance of 22.8 hours per day.
: The single cosinor method revealed the presence of a statistically significant RAR for each single day (p < 0.001). Similarly, the population mean cosinor applied to total data of the seven days of monitoring, revealed the presence of a significant RAR (p < 0.001); specifically: the percentage of rhythm was 23.4%, the mean MESOR was 84.6 ACs, the amplitude registered a mean value of 74.4 ACs and the acrophase occurred at 17:56 h. reports the rhythmometric parameters of RAR and shows graphically the rhythm.
: and report both the raw data and the mean±SD of all sleep parameters. The subject showed a large variability in all ten parameters with a large gap between minimum and maximum values. For instance: SL ranged from 0 to 89 minutes with a mean value of 25.9 ± 35.9 minutes and, similarly, FI ranged from 11.3% to 43.2% with a mean value of 27.3 ± 12.8%. In general, the subject reached a good sleep quantity: 507.9 ± 30.2 minutes of TB with a mean TST of 450.7 ± 20.1 minutes, corresponding to the 88.9 ± 4.3% of time spent sleeping; on the contrary, as expected, sleep quality, although not bad, was not excellent: SE was equal to 83.3 ± 7.2%, mean WASO value was 57.1 ± 24.6 minute, and IT registered a mean value of 86.3 ± 4.4%. It is also important to note that sleep timing, i.e. SS and SEnd, showed an expected marked delay: on average, the subject started to sleep at 01:36 ± 01:02 h and woke up at 09:55 ± 00:40 h.",What is the patient's body surface area? Please output your answer in terms of m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [70.0, 'kg'], 'height': [170.0, 'cm']}",1.81812,1.72721,1.90903,"For the body surface area computation, the formula is sqrt((weight (in kgs) * height (in cm))/3600, where the units of weight is in kg and the units of height is in cm.
The patient's height is 170.0 cm. 
The patient's weight is 70.0 kg. 
Therefore, the patient's bsa is sqrt((70.0 (in kgs) * 170.0 (in cm))/3600) = 1.81812 m^2."
704,60,Body Surface Area Calculator,physical,decimal,pmc-4166389-2,Extracted,"A 50-year-old man (height, 167 cm; weight, 65 kg) was diagnosed with esophageal achalasia due to swallowing difficulty for several years. He was scheduled for peroral endoscopic myotomy (POEM), which is a technique that was developed in the context of transesophageal NOTES as an endoscopic alternative to laparoscopic esophageal myotomy. The patient had no relevant medical history, and preoperative examination did not reveal any specific conditions. He was premedicated using 1 mg of butorphanol and 0.2 mg of glycopyrrolate intramuscularly before surgery.
In the operating room, routine monitoring was conducted using ECG (lead II), pulse oximetry, ETCO2 measurements and noninvasive BP monitoring. The patient's vital signs were as follows: BP, 110/69 mmHg; heart rate (HR), 65 beats/min; and peripheral oxygen saturation (SpO2), 100%. General anesthesia was induced using 120 mg of propofol, 50 mg of rocuronium, and 100 µg of fentanyl, and nasotracheal intubation was performed using a nasal RAETM tracheal tube with a 7.5 mm ID. For the same reason as in case 1, tracheal intubation was performed through the nose. Anesthesia was maintained using O2 at 2 L/min, N2O at 2 L/min, and 1.5-2.5 vol% of sevoflurane. Volume controlled ventilation was performed using a tidal volume of 600 ml and at a rate of 10 breaths/min.
The patient was placed in the left lateral decubitus position, and the endoscopic operator stood on the left side of the patient. CO2 gas was provided for insufflation during the procedure, using a CO2 insufflator and a standard insufflating tube. Endoscopic CO2 insufflation was controlled with a gas feed of 1.2 L/min. The operation comprised the following steps: (1) creation of the mucosal entry and submucosal tunnel, (2) endoscopic myotomy, and (3) closure of the mucosal entry. First, the endoscopic operator administrated a submucosal injection (0.9% normal saline with indigo carmine dye) at the level of the midesophagus in order to ensure a safe mucosal incision. The mucosal incision was then made on the mucosal surface using an electric knife, and the endoscope was inserted into the submucosal space. The submucosal tunnel was then extended 2 cm below the gastroesophageal junction via the endoscopic submucosal dissection technique. Next, the endoscope was withdrawn to the mucosal incision and a circular muscle myotomy was performed. After completion of the myotomy, the mucosal entry site was closed using several hemostatic clips.
For this patient in particular, the surgical duration was relatively long as the achalasia lesion was large.
During surgery, ETCO2 was maintained at 30-34 mmHg and PIP at 13-15 mmHg. The patient's abdomen was not covered using surgical drapes to ensure visibility so that severe pneumoperitoneum could be recognized immediately (). The patient was hemodynamically stable throughout the entire surgery. The time required for the operation and anesthesia were 120 min and 160 min, respectively. The patient was transferred to the general ward after surgery, and a postoperative chest radiograph showed no pneumomediastinum.",What is the patient's body surface area? Please output your answer in terms of m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [65.0, 'kg'], 'height': [167.0, 'cm']}",1.73646,1.64964,1.82328,"For the body surface area computation, the formula is sqrt((weight (in kgs) * height (in cm))/3600, where the units of weight is in kg and the units of height is in cm.
The patient's height is 167.0 cm. 
The patient's weight is 65.0 kg. 
Therefore, the patient's bsa is sqrt((65.0 (in kgs) * 167.0 (in cm))/3600) = 1.73646 m^2."
705,60,Body Surface Area Calculator,physical,decimal,pmc-8072816-1,Extracted,"The patient was born with C/S at 38 weeks of gestation with a birth weight of 3820 g; was the 3 rd alive child of a 35-year-old mother in her 4th pregnancy. His mother’s second pregnancy was a male with agenesis of corpus callosum (ACC), congenital heart disease and absence of nasal bone which were detected on ultrasound at 24th week. The pregnancy had been terminated without genetic tests or autopsy. The patient’s antenatal ultrasonographic investigation showed an IACC at 18 weeks of gestation but fetal MRI was not performed and amniocentesis revealed 46, XY karyotype. He had not defecated for the first three days of life; he defecated a large amount of stool after rectal stimulation. The patient underwent laparotomy for intestinal biopsies and diagnosed with HSCR and ileostomy was opened.
He presented to our clinic when he was one year old with fever for two days. His weight was 8.4 kg (3 rd percentile); height 74 cm (3 rd percentile); and head circumference 46 cm (25th percentile). Hypertelorism, uplifted earlobes with a central depression, frontal bossing, telecanthus, deeply set eyes, infraorbital fold, long lashes, broad eyebrows with a medial flare, a wide nasal bridge with prominent and rounded nasal tip, low-hanging columella, open-mouth expression, thin “M” shaped upper lip, prominent chin, short neck, wide-spaced nipples, overlapping toes, and pes planus were noted (
–). Abdominal examination showed no guarding or rebound tenderness; he had orange-colored liquid stool in an ileostomy bag. He had eye contact, social smile, and stereotypic hand movements, speaking indistinguishable three words. Traction response was poor, and he was hypotonic on vertical suspension. He could not sit unassisted. Deep tendon reflexes were normal; bilaterally plantar reflexes were extensor; sustained Achilles clonus was noted. At admission, urinalysis showed pyuria. Acute pyelonephritis was diagnosed. Urinary ultrasound and voiding cystourethrogram showed grade 3 hydronephrosis affecting the right ureter. Cranial magnetic resonance imaging (MRI) demonstrated enlargement of the third and lateral ventricles, the occipital and temporal horns. There was a bilateral incomplete hippocampal inversion, enlargement of thalamus, nucleus caudate, and ACC (
–). A heterozygous “class 2” c.646dupT (p. Cys216LeufsTer23) mutation on exon 6 of ZEB2 (zinc finger E-box binding homeobox 2) gene was detected by a mutation surveyor program, and the diagnosis of MWS was made. At 16 months, he presented with fever due to pneumonia and generalized seizure for 5 minutes. His EEG showed no epileptic discharge but an immature parietooccipital rhythm for his age. Valproic acid was initiated. The patient is still on follow- up for developmental delay, renal, and gastrointestinal problems.",What is the patient's body surface area? Please output your answer in terms of m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [8.4, 'kg'], 'height': [74.0, 'cm']}",0.41553,0.39475,0.43631,"For the body surface area computation, the formula is sqrt((weight (in kgs) * height (in cm))/3600, where the units of weight is in kg and the units of height is in cm.
The patient's height is 74.0 cm. 
The patient's weight is 8.4 kg. 
Therefore, the patient's bsa is sqrt((8.4 (in kgs) * 74.0 (in cm))/3600) = 0.41553 m^2."
706,60,Body Surface Area Calculator,physical,decimal,usmle-8635,Extracted,"A 38-year-old woman is brought to the emergency department because of 3 1-hour episodes of severe, sharp, penetrating abdominal pain in the right upper quadrant. During these episodes, she had nausea and vomiting. She has no diarrhea, dysuria, or hematuria and is asymptomatic between episodes. She has hypertension and hyperlipidemia. Seven years ago, she underwent resection of the terminal ileum because of severe Crohn's disease. She is 155 cm (5 ft 2 in) tall and weighs 79 kg (175 lb). Her BMI is 32 kg/m2. Her temperature is 36.9°C (98.5°F), pulse is 80/min, and blood pressure is 130/95 mm Hg. There is mild scleral icterus. Cardiopulmonary examination shows no abnormalities. The abdomen is soft, and there is tenderness to palpation of the right upper quadrant without guarding or rebound. Bowel sounds are normal. The stool is brown, and a test for occult blood is negative. Laboratory studies show:
Laboratory test
Blood  
Hemoglobin 12.5 g/dL
Leukocyte count 9,500 mm3
Platelet count 170,000 mm3
Serum  
Total bilirubin 4.1 mg/dL
Alkaline phosphatase 348 U/L
AST 187 U/L
ALT 260 U/L
Abdominal ultrasonography shows a normal liver, a common bile duct caliber of 10 mm (normal < 6 mm), and gallbladder with multiple gallstones and no wall thickening or pericholecystic fluid.",What is the patient's body surface area? Please output your answer in terms of m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [79.0, 'kg'], 'height': [155.0, 'cm']}",1.84429,1.75208,1.9365,"For the body surface area computation, the formula is sqrt((weight (in kgs) * height (in cm))/3600, where the units of weight is in kg and the units of height is in cm.
The patient's height is 155.0 cm. 
The patient's weight is 79.0 kg. 
Therefore, the patient's bsa is sqrt((79.0 (in kgs) * 155.0 (in cm))/3600) = 1.84429 m^2."
707,60,Body Surface Area Calculator,physical,decimal,pmc-5177711-1,Extracted,"A 15-month-old Korean boy was referred to evaluate the cause of recurrent sinusitis and otitis media. He was born 2,700 g at 40 weeks of gestational age with normal-vaginal delivery, was well up to 6 months of age. After then, he had suffered from recurrent sinusitis and otitis media which failure to treat even though high-dose, oral amoxicillin therapy, consequently. The parent and older brother were healthy, but 2 maternal uncles were previously diagnosed as XLA at the adulthood ().
Physical examination showed normal growth and development, body weight was 10.6 kg (25th–50th percentile) and height was 77.2 cm (10th–25th percentile). There were no abnormal morphologic findings except absence of tonsil, purulent postnasal drip and palpable lymph-node. The fluid collection and cloudiness of the ear drum were observed.
Laboratory tests revealed as follows: white blood cells, 9,700/µL (neutrophils, 25.0%; lymphocyte, 63.8%); serum IgG, IgA, IgM and IgE levels were 151, 0, 11 mg/dL, and 54.7 KU/L; significantly decreased levels of CD19+ B cells in the peripheral blood (1.1%, 59/µL); the CD4/CD8 T-cell ratio was 2.7:1, respectively.
Radiologic examination showed normal finding in chest X-ray, however there was mucosal thickening in both maxillary sinuses and no adenoid shadow in paranasal sinuses views. Based on the family history of XLA, agammaglobulinemia and absent circulating-CD19+ B cells, and absence of adenoid and tonsil with recurrent sinusitis and otitis media, he was diagnosed as XLA. Mutational analysis for BTK gene of the proband and family members was performed to identify the underlying genetic defect. Informed consent was obtained before the start of the study. DNA was extracted from peripheral blood leukocytes. All coding exons with flanking intronic regions of the BTK gene were amplified using the polymerase chain reaction. Sequence chromatograms were compared with the reference sequence of BTK, NM_000061.2. As a result, the proband (III:2) was found to be hemizygous for a 1-bp deletion (c.82delC), which was predicted to result in frameshift at the 28th codon (Arg) and premature termination at the 5th downstream amino acid of the BTK protein (p. Arg28Alafs*5) (). A family study revealed that two maternal uncles (II:1 and II:2) were hemizygous patients and maternal grandmother (I:2), mother (II:4), and cousin (III:4) were heterozygous carriers for the same mutation.
After diagnosis of XLA, a scheduled Intravenous Immunoglobulin (IVIG) therapy (400 mg/kg, monthly) was started. The serum level of IgG was reached to target level (or therapeutic level) after 3rd dose of IVIG. The recurrent sinusitis and otitis media were not recurred during 8 months after diagnosis and treatment",What is the patient's body surface area? Please output your answer in terms of m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [10.6, 'kg'], 'height': [77.2, 'cm']}",0.47677,0.45293,0.50061,"For the body surface area computation, the formula is sqrt((weight (in kgs) * height (in cm))/3600, where the units of weight is in kg and the units of height is in cm.
The patient's height is 77.2 cm. 
The patient's weight is 10.6 kg. 
Therefore, the patient's bsa is sqrt((10.6 (in kgs) * 77.2 (in cm))/3600) = 0.47677 m^2."
708,60,Body Surface Area Calculator,physical,decimal,pmc-6967019-2,Extracted,"A 68-year-old man (170 cm, 70 kg) was planned for his first elective PDD TURBT under spinal anesthesia. The patient was medicated with losartan (25 mg/day) for hypertension and tamsulosin (0.2 mg/day) for dysuria. Preoperative examinations were within the normal ranges. On the day of the operation, the BP and PR were 126/81 mmHg and 71 bpm in the early morning, respectively. Daily medications were orally administered. Subsequently, crystalloid infusion was started. About 3 h before the PDD TURBT, the patient took a 5-ALA (1.5 g) solution. Thirty minutes before entering the operation room, the BP and PR were 96/57 mmHg and 80 bpm, respectively. When the patient stood up and headed to the operation room, he felt sick. The S-BP was 42 mmHg at that time. After 20 min, the vital signs were 76/44 mmHg and 68 bpm, respectively. He complained of dizziness with cold sweat and no rash. Fluid resuscitation with the Trendelenburg position was initiated. The operation was canceled due to sustained hypotension, and continuous dopamine infusion (0.3% solution; 3 mL/hr) was started. About 16 h after the 5-ALA pretreatment, the vital signs were 67/32 mmHg and 78 bpm, respectively. Continuous dopamine infusion was necessary until the next day. No reason was found for the hypotension except the 5-ALA pretreatment.",What is the patient's body surface area? Please output your answer in terms of m². You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'weight': [70.0, 'kg'], 'height': [170.0, 'cm']}",1.81812,1.72721,1.90903,"For the body surface area computation, the formula is sqrt((weight (in kgs) * height (in cm))/3600, where the units of weight is in kg and the units of height is in cm.
The patient's height is 170.0 cm. 
The patient's weight is 70.0 kg. 
Therefore, the patient's bsa is sqrt((70.0 (in kgs) * 170.0 (in cm))/3600) = 1.81812 m^2."
709,62,Adjusted Body Weight,physical,decimal,pmc-8342838-1,Extracted,"A 48-year-old South Asian woman (Patient A) from Bangladesh (height 168 cm, weight 80 kg) was admitted to the medical ward for three days after which she was transferred to the ICU; she had cough and increasing dyspnea for three days before hospital admission. Comorbidities included hypertension, hypercholesterinemia, coronary artery disease, previous stroke (fully recovered), and type 2 diabetes. On admission, her laboratory results were as follows: hemoglobin (Hb): 143 g/L, white blood cells (WBC): 9.0 × 109/L, lymphocytes: 1.4 × 109/L, platelets: 261 × 109/L, international normalized ratio (INR): 1.1, D-dimer: 510 μg/L, fibrinogen plasma concentration: 8.4 g/L, and C-reactive protein (CRP): 52 mg/L. Her chest radiograph showed cardiomegaly and extensive bilateral peripherally predominant ground-glass opacities. Polymerase chain reaction (PCR) result was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and negative for influence/respiratory syncytial virus (RSV). Blood cultures were negative. The patient was treated with nasal oxygen therapy and antibiotics (ceftriaxone and doxycycline, according the hospital’s COVID-19 protocol). Antiviral therapy and dexamethasone were not administered. Later, CRP increased to 137 mg/L on the second day of hospitalization. The patient was transferred to the ICU on the third day because of increased respiratory rate and oxygen requirement. ROTEM performed 2 hours after ICU admission () revealed that Patient A was hypercoagulable with the EXTEM assay showing an increased clot firmness with an amplitude of clot firmness 5 minutes after coagulation time (CT) (A5) of 65 mm and a maximum clot firmness (MCF) of 78 mm, indicating hypercoagulability with a high risk of thrombosis []. FIBTEM also showed increased clot firmness (A5 41 mm and MCF 50 mm), indicating increased fibrinogen concentration and fibrin polymerization. Furthermore, the EXTEM lysis index 60 minutes after CT (LI60) was 97%, i.e., in the physiologic range (82–97.9%), whereas FIBTEM LI60 was 100% []. Treatment consisted of continuation of antibiotics, enoxaparin 40 mg twice a day in view of ROTEM results, and high flow nasal oxygen and intermittent face mask continuous positive airway pressure (CPAP) therapies. The patient did not need intermittent positive pressure ventilation (IPPV) or any vasoactive support. Laboratory results on the second day in the ICU were as follows: Hb: 131 g/L, WBC: 10.8 × 109/L, platelet count: 307 × 109/L, INR: 1.1, activated partial thromboplastin time (APTT) ratio: 1.3, D-dimer: 510 μg/L, and CRP: 196 mg/L. The patient recovered well and was transferred from the ICU to the medical ward after two days in the ICU with a CRP of 73 mg/L and was discharged three days later with a prescription of her usual medication plus enoxaparin 40 mg once daily for 2 weeks. The patient did not show any clinical signs of thrombosis during her hospital stay.","Using the adjusted body weight formula, what is the patient's adjusted body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'weight': [80.0, 'kg'], 'height': [168.0, 'cm']}",67.77564,64.38686,71.16442,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Female.
The patient's height is 168.0 cm, which is 168.0 cm * 0.393701 in/cm = 66.14177 in. 
Plugging in the values for the IBW formula for females gives us 45.5 kg + 2.3 kg * (66.14177 (in inches) - 60) = 59.62607 kg.
Hence, the patient's IBW is 59.62607 kg.The patient's weight is 80.0 kg. To compute the ABW value, apply the following formula: ABW = IBW + 0.4 * (weight (in kg) - IBW (in kg)). ABW = 59.62607 kg + 0.4 * (80.0 kg  - 59.62607 kg) = 67.77564 kg. The patient's adjusted body weight is 67.77564 kg."
710,62,Adjusted Body Weight,physical,decimal,pmc-5943133-1,Extracted,"A 36-year-old man was admitted to West China Hospital because of low libido, decreased morning erections, and loss of axillary and pubic hair that lasted 8 years. He had a history of binocular diplopia, increased stool frequency 7 years prior to admission, and weight loss of 10 kg. He also had thyroid nodules, and thyroid functional tests showed normal FT3 (7.41, normal 3.6–7.5 pmol/L), FT4 (21.56, normal 12–22 pmol/L), and increased TSH (24.79, normal 0.27–4.2 μIU/mL). He ignored the test result, because of the normal concentration of FT3 and FT4. Four years ago the patient got married and was referred to our hospital because of sterility. At this time, the hormonal examination implied central hypogonadism with serum levels of 1.6 mIU/mL FSH (RR, 1.5–12.4), LH 1.0 mIU/mL (RR, 1.7–8.6), E2 <5 pg/mL (RR, 7.63–42.8), and T <0.03 ng/mL (RR 2.49–8.3). Magnetic resonance imaging (MRI) of the sella region was therefore performed, revealing a pituitary tumor measuring 4.3 × 4.1 × 3.0 cm in the sella, involving cavernous sinuses and extending inferior to the sphenoid sinus and third ventricle (Fig. ). He was referred to our multidisciplinary team of pituitary disease and transferred to department of neurosurgery. On physical examination at admission, the patient was 168.0 cm tall and weighed 59.0 kg with a body mass index (BMI) of 20.9 kg/m2. The patient's char-acteristics were as follows: temperature, 36.2 °C; pulse, 56 beat/min; blood pressure, 94/64 mmHg; respiratory rate, 20 breath/min. The patient presented with blurred vision. The TgAb and TPOAb were positive. The thyroid gland was diffusely enlarged and ultrasonography of the thyroid revealed a multinodular gland with a moderate parenchymal heterogeneity suggesting Hashimoto thyroiditis. The laboratory hormone examination showed hypopituitarism (Table ). The computer perimetry suggested a defective visual field. Based on these data, we diagnosed the patient with TSH-producing pituitary macroadenoma, hypopituitary, and Hashimoto thyroiditis. Two weeks after diagnosis, total resection of the pituitary macroadenoma was performed through trans-sphenoidal neurosurgery in September 2014. Upon immunohistochemical examination, the resected pituitary adenoma cells exhibited positive staining with the TSH and PRL antibody, and the percentage of positive Ki-67 was <2%, suggesting that the tumor was benign (Fig. ). After the operation, TSH and thyroid hormone rapidly decreased to a normal range. However, the concentration of ACTH, cortisol, LH, FSH, and testosterone were still extremely low. One year after the operation, this patient was attended to by our pituitary disease MDT team for reproductive reconstruction. We treated him with human chorionic gonadotropin (HCG) 2000 IU, qod and human menopausal gonadotropin (HMG) 75 IU, qod. Over the next 2 months, his sperm concentration increased, and finally his wife became pregnant naturally. The patient was administered hydrocortisone 20 mg/d, testosterone 80 mg/d, and followed up by our pituitary MDT team.","Using the adjusted body weight formula, what is the patient's adjusted body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'weight': [59.0, 'kg'], 'height': [168.0, 'cm']}",62.07564,58.97186,65.17942,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Male.
The patient's height is 168.0 cm, which is 168.0 cm * 0.393701 in/cm = 66.14177 in. 
Plugging in the values for the IBW formula for males gives us 50 kg + 2.3 kg * (66.14177 (in inches) - 60) = 64.12607 kg.
Hence, the patient's IBW is 64.12607 kg.The patient's weight is 59.0 kg. To compute the ABW value, apply the following formula: ABW = IBW + 0.4 * (weight (in kg) - IBW (in kg)). ABW = 64.12607 kg + 0.4 * (59.0 kg  - 64.12607 kg) = 62.07564 kg. The patient's adjusted body weight is 62.07564 kg."
711,62,Adjusted Body Weight,physical,decimal,pmc-4684581-1,Extracted,"A 54-year-old woman with failed back surgery syndrome following a lumbar microdiscectomy had a spinal cord stimulator inserted in October 2009. A Specify 5-6-5 electrode (Medtronic, Minneapolis, MN, USA) was implanted with the connectors tunnelled subcutaneously and connected to the IPG in the right iliac fossa. There were no intraoperative or postoperative complications. The patient experienced good relief of lower limb pain with stimulation.
At the point of insertion, she weighed 78.8 kg, with a height of 157 cm (body mass index [BMI], 31.9). Her pre-PMP assessment revealed moderate levels of depression and high levels of pain-related disability. Her Beck Depression Inventory score was 18 (mild). She had a Pain Anxiety Symptoms Scale of 60 (mean, 94; SD, 39; range 0–200, where 0 = no pain anxiety and 200 = severe pain anxiety).
In October 2011, she underwent reprogramming with failure to achieve satisfactory stimulation. Her imaging revealed twisting of the connecting wires adjacent to the pulse generator (Fig. ). As it was still partially functioning, she chose to defer revision surgery. Eventually the device failed completely. In May 2012, her IPG was repositioned with new connector leads. The connector wires were found knotted and twisted intraoperatively. The new wires were tunnelled to the right lumbar region above the belt line. No further problems have been reported on follow-up.","Using the adjusted body weight formula, what is the patient's adjusted body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'weight': [78.8, 'kg'], 'height': [157.0, 'cm']}",61.31926,58.2533,64.38522,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Female.
The patient's height is 157.0 cm, which is 157.0 cm * 0.393701 in/cm = 61.81106 in. 
Plugging in the values for the IBW formula for females gives us 45.5 kg + 2.3 kg * (61.81106 (in inches) - 60) = 49.66544 kg.
Hence, the patient's IBW is 49.66544 kg.The patient's weight is 78.8 kg. To compute the ABW value, apply the following formula: ABW = IBW + 0.4 * (weight (in kg) - IBW (in kg)). ABW = 49.66544 kg + 0.4 * (78.8 kg  - 49.66544 kg) = 61.31926 kg. The patient's adjusted body weight is 61.31926 kg."
712,62,Adjusted Body Weight,physical,decimal,pmc-7049766-1,Extracted,"A 31-year-old female patient was referred by her orthodontist to Asan Medical Center in Seoul, Korea for treatment of facial asymmetry and prognathism. The patient had never been diagnosed with a medical problem and had no previous history of fracture. Clinical examination revealed that the patient was slightly short in height (153.4 cm) and moderately overweight (62.4 kg, body mass index [BMI] 26.52 kg/m2). Examination of her facial features revealed a long lower face with vertical maxillary excess and mandibular asymmetry with occlusal canting of the maxilla. In addition, she had upper lip protrusion and lip incompetence.(, ) The intraoral findings included Class III malocclusion with an open bite. She had normal tooth structure and received proper dental care. Therefore, her periodontal health and oral hygiene were good.
After the initial interview, the patient was referred to an orthodontist for leveling and alignment of the teeth, and treatment continued for approximately one year. After the presurgical orthodontic treatment, a clinical evaluation was repeated, and cephalometric radiographs and face bow recordings were obtained for final surgical planning 4 weeks prior to the surgery.
In addition, a work-up for general anesthesia and surgery was performed, and the preoperative hematologic examination, electrocardiogram and chest radiograph were unremarkable.
The surgery included bimaxillary procedures. Le Fort I osteotomy with midline correction, canting correction, posterior impaction, and setback movement of the maxilla were performed via rigid skeletal fixation. Bilateral sagittal split ramus osteotomies were performed with a setback movement via the hybrid fixation technique (with one miniplate and one additional bicortical screw). On the left side, a greenstick fracture occurred in the proximal segment. However, we could appropriately position the proximal and distal segments as planned, and so two additional bicortical screws were used to fix the fractured proximal segment. Two closed suction drains were inserted into the mandibular surgical site. The operation was completed without major bleeding, and the estimated blood loss during the surgery was 200 mL.
Abnormal edema and ecchymosis were observed from the second postoperative day.() At first, an improperly functioning closed suction drain was suspected, but the ecchymosis and edema appeared to be bilateral, decreasing the likelihood of drain malfunction. On the second postoperative day, drain removal and maxilla-mandibular fixation (MMF) with elastic ring were routinely performed. Normally, an orthognathic surgical patient is hospitalized for 2 nights and 3 days after surgery, but in this case, the discharge was delayed due to the appearance of abnormal ecchymosis and edema. On the fifth postoperative day, nasal bleeding and transient blood pressure lowering were noted, but the problems resolved after nasal packing and administration of intravenous fluids. At 6 days postoperatively, the patient was stable, and she was discharged from the hospital.
MMF was routinely stopped 2 weeks after surgery, and training elastics were applied. No other complications were observed. However, the ecchymosis persisted for 6 weeks, and although it dissipated slowly and spontaneously, no specific treatment was needed for its resolution. The follow-up examination at postoperative 3 months showed uneventful healing.
During the search for the cause of unexpected postoperative bleeding, she recounted multiple fractures of the lower limbs during childhood, and blue sclera was noticed. Furthermore, her familial history included multiple bone fractures in her mother, grandmother, and cousin. Therefore, OI type I was suspected, and it was inferred that the patient's complications were ultimately caused by bleeding due to vessel fragility from OI.
The postsurgical orthodontic treatment began one month after surgery. The molar and canine relation became Class I, and the open bite was greatly improved. After approximately eight months, debonding was done. The long lower face with vertical maxillary excess and mandibular asymmetry with occlusal canting of the maxilla were greatly improved. The upper lip protrusion and lip incompetence were also improved.(, )","Using the adjusted body weight formula, what is the patient's adjusted body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'weight': [62.4, 'kg'], 'height': [153.4, 'cm']}",52.80335,50.16318,55.44352,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Female.
The patient's height is 153.4 cm, which is 153.4 cm * 0.393701 in/cm = 60.39373 in. 
Plugging in the values for the IBW formula for females gives us 45.5 kg + 2.3 kg * (60.39373 (in inches) - 60) = 46.40558 kg.
Hence, the patient's IBW is 46.40558 kg.The patient's weight is 62.4 kg. To compute the ABW value, apply the following formula: ABW = IBW + 0.4 * (weight (in kg) - IBW (in kg)). ABW = 46.40558 kg + 0.4 * (62.4 kg  - 46.40558 kg) = 52.80335 kg. The patient's adjusted body weight is 52.80335 kg."
713,62,Adjusted Body Weight,physical,decimal,pmc-7509996-1,Extracted,"A 55-year-old man who suffered from hematochezia for 3 mo consulted our hospital in July 2016 (Figure ).
The pathological diagnosis following biopsy showed “moderately differentiated adenocarcinoma of the sigmoid colon” (Figure ). Abdominal enhanced computed tomography (CT) showed mesenteric lymph node metastasis and multiple low-density lesions in the liver. The capecitabine plus oxaliplatin (XELOX) scheme was recommended for the neoadjuvant therapy regimen for three cycles. However, even with therapy, the evaluation was progressive disease (PD) given that lymph node and liver lesions continued to grow; thus, surgery was excluded.
From February 2 to October 14, 2017, folinic acid, fluorouracil, and irinotecan (FOLFIRI) plus bevacizumab was implemented for 12 cycles, and the classification was stable disease (SD); bevacizumab plus S-1 was offered as the maintenance treatment. On March 30, 2018, CT indicted disease progression. Due to intestinal obstruction, the patient underwent laparoscopic intestinal adhesion lysis and transverse colostomy on May 30, 2018.
The patient had no medical history of past illness.
The patient neither smoke tobacco nor consume alcohol. There was no notable family medical history, such as cancer.
The height and weight of the patient were 160 cm and 56.8 kg, respectively. On July 15, 2018, the performance status (PS) was 1 for this patient, with a body temperature of 36.3 °C, pulse rate of 86 beats/min, and blood pressure of 152/96 mmHg.
In July 2016, immunohistochemistry (IHC) and polymerase chain reaction (PCR) were performed to guide therapy at diagnosis. Kirsten rat sarcoma 2 viral oncogene homolog (KRAS), neuroblastoma RAS Viral Oncogene Homolog (NRAS), and v-raf murine sarcoma viral oncogene homolog B1 (BRAF) were wild-type, and mismatch repair proteins were proficient. On May 29, 2018, a peripheral blood sample was assessed for circulating tumor DNA (ctDNA) using next-generation sequencing (NGS) with an array of 189 genes to determine whether ras-rat sarcoma viral oncogene homolog/v-raf-murine sarcoma viral oncogene homolog (RAS/RAF) status changed during the past 2 years and EGFR monoclonal antibody could be used as the third-line therapy. The test results showed that KRAS, NRAS, and BRAF were still wild-type. Interestingly, high-level amplification of HER2 (absolute copy number: 63.67) (Figure ) was identified at the same time, which was reported as the resistance mechanism of anti-EGFR therapy previously[-]. Also, adenomatous polyposis coli (APC) and tumor protein 53 (TP53) alterations were detected, with a mutant allele frequency (MAF) of 7.3% and 9.3%, respectively. IHC for HER2 showed a score of 3+ based on the tumor tissue biopsy obtained on July 22, 2016 (Figure ), while fluorescence in situ hybridization (FISH) showed high-level amplification of HER2 (Figure ); thus, the two tests confirmed the results of ctDNA.
On March 30, 2018, CT showed that most of the liver lesions were increased compared to January 17, 2018, while new, multiple lesions were detected in the lung. Thus, the classification was PD, and the patient failed to respond to two lines of therapy.","Using the adjusted body weight formula, what is the patient's adjusted body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'weight': [56.8, 'kg'], 'height': [160.0, 'cm']}",56.84918,54.00672,59.69164,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Male.
The patient's height is 160.0 cm, which is 160.0 cm * 0.393701 in/cm = 62.99216 in. 
Plugging in the values for the IBW formula for males gives us 50 kg + 2.3 kg * (62.99216 (in inches) - 60) = 56.88197 kg.
Hence, the patient's IBW is 56.88197 kg.The patient's weight is 56.8 kg. To compute the ABW value, apply the following formula: ABW = IBW + 0.4 * (weight (in kg) - IBW (in kg)). ABW = 56.88197 kg + 0.4 * (56.8 kg  - 56.88197 kg) = 56.84918 kg. The patient's adjusted body weight is 56.84918 kg."
714,62,Adjusted Body Weight,physical,decimal,pmc-4891545-1,Extracted,"A 22-year-old, stuporous, but previously healthy man, 182 cm in height and 70 kg in weight, was admitted to the emergency room with an accidental injury from a fall. An emergent brain CT demonstrated acute traumatic subdural hematoma, thus an emergent decompressive craniectomy and hematoma removal was performed under general anesthesia without any remarkable incidences. After the first operation, the patient had not made favorable progresses, therefore several further operations such as brain abscess drainage, external ventricular drainage catheter insertion, cerebral lobectomy, ventriculoperitoneal shunt were performed during a 4 month period. Finally, the patient had cranioplasty.
The vital signs of the patient scheduled for cranioplasty were a systolic/diastolic blood pressure of 110/70 mmHg, heart rate 104 bpm, respiratory rate via tracheostomy 20 /min and the patient was still in a stuporous state. Preoperative laboratory data were within the normal range, and the chest X-ray revealed improvement of focal pneumonia and an arterial blood gas analysis in the tolerable range (ABGA; pH 7.418/PaCO2 39.5 mmHg/PaO2 104 mmHg with 2 L/min oxygen inhalation). An electrocardiogram (ECG) performed before the surgery showed sinus tachycardia, and transthoracic echocardiography revealed a preserved global left ventricular systolic function (ejection fraction; 69%). The preoperative brain CT sacn showed a marked shrinkage of the left cerebral hemisphere and an increase in ventricular size (). The general anesthesia was induced with 125 mg thiopental sodium and 50 mg rocuronium, without any premedication. The vital signs were monitored using noninvasive blood pressure (NIBP), ECG and a pulse oximeter. The tracheostomy tube was changed for a 7.5 mm cuffed tracheostomy tube. Following the induction of anesthesia, the right dorsalis pedis artery was cannulated with a 22 gauge catheter, and the right femoral vein was cannulated with an 18 gauge catheter. General anesthesia was maintained with balanced anesthesia using oxygen-air-sevoflurane (0.5–1.5%) and supplementary remifentanil (4–6 µg/kg/h) infusion. Cranioplasty was carried out under controlled ventilation, keeping within 10% fluctuation of the vital signs and ETCO2 with intermittent injections of ephedrine, phenylephrine and esmolol. The ABGA was checked immediately after skin incision, and the results were a pH of 7.436, PaCO2 35.1 mmHg, PaO2 219.1 mmHg, and base excess –0.5. Intravenous fluid replacement consisted of 500 ml plasma solution and 50 ml lactated Ringer solution, and the estimated blood loss was 200 ml. After 2 hours of operation, the dura was closed, and the bony fragment was wired into place. Subsequently, drainage catheters were introduced into both the subgaleal and epidural spaces. By the time the scalp sutures were completed, a closed negative suction through the catheters had been applied. Approximately 30 seconds after suction drainage, sudden asystole of ECG, the disappearance of ETCO2 wave and a flat line arterial wave form were noticed. Instantly, the suction drainage was stopped, and we started external cardiac massage for approximately 20 seconds. Two times injections of 500 µg epinephrine were administered under the diagnosis of cardiac arrest. The cardiac rhythm was resumed to 120 bpm, and systolic blood pressure was regained to 150 mmHg immediately. The ABGA was checked after resuscitation, and the results were in the normal range (pH 7.418, PaCO2 39.5 mmHg, PaO2 103.3 mmHg and base excess 0.2). The patient was transferred to the NICU with a controlled AMBU bagging.
He went into a coma and showed partial spastic movement of extremities, suggesting a sudden increase in intracranial pressure (ICP). Emergent brain CT () revealed extensive diffuse brain swelling. Due to the fact that there were no specific causes of brain edema during the operation or general anesthesia, the negative vacuum suction drainage was presumed to be the main cause, resulting in the patient being diagnosed with PHBS. The patient received agents to reduce ICP, in addition to general supportive care with controlled ventilation. He improved gradually in the NICU, and reached a stuporous state with self-respiration 3 months postoperatively.","Using the adjusted body weight formula, what is the patient's adjusted body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'weight': [70.0, 'kg'], 'height': [182.0, 'cm']}",74.08194,70.37784,77.78604,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Male.
The patient's height is 182.0 cm, which is 182.0 cm * 0.393701 in/cm = 71.65358 in. 
Plugging in the values for the IBW formula for males gives us 50 kg + 2.3 kg * (71.65358 (in inches) - 60) = 76.80323 kg.
Hence, the patient's IBW is 76.80323 kg.The patient's weight is 70.0 kg. To compute the ABW value, apply the following formula: ABW = IBW + 0.4 * (weight (in kg) - IBW (in kg)). ABW = 76.80323 kg + 0.4 * (70.0 kg  - 76.80323 kg) = 74.08194 kg. The patient's adjusted body weight is 74.08194 kg."
715,62,Adjusted Body Weight,physical,decimal,pmc-4784187-1,Extracted,"A 62-year-old, 180 cm, 90 kg male with a history of unstable angina, old inferior wall myocardial infarction and irreducible, obstructed paraumbilical hernia presented for resection of gangrenous loop of small bowel with anatomical repair of hernia. He also had long-standing diabetes, hypertension and was on multiple medications such as regular insulin, aspirin 75 mg, clopidogrel 75 mg, metoprolol 25 mg, atorvastatin 20 mg daily and nitrocontin 2.6 mg twice daily.
On examination, he was obese with poor effort tolerance. There was no pallor or edema feet and no signs of heart failure. His resting heart rate (HR) was 70/min and blood pressure measured 130/80 mmHg.
Most of his preoperative blood investigations including coagulation profile were within normal limits except random blood sugar which was 164 mg/dl. Electrocardiography (ECG) showed Q waves in leads II, III and aVF and ST segment depression in leads V1 -V6. The preoperative chest X-ray was normal. Two-dimensional echo done on admission revealed akinetic inferior and mid-posterior wall; hypokinetic basal, posterior wall, mid and distal interventricular septum; mildly dilated LV and left ventricular ejection fraction (LVEF) <25%.
Two months ago, a detailed cardiac work up of the patient had been done wherein a coronary angiogram revealed anomalous origin of the LAD from RCA and absent left main coronary artery (). Thallium scan also showed LVEF of 25% at rest tomography angiography showed a common ostium for RCA and LAD ().
Chronic total occlusion of RCA (after giving off LAD) as well as a short, narrowed out left circumflex (LCx) artery resulted in complete loss of viable myocardium in their corresponding territories. Thus, the myocardium had its blood supply from LAD and partly from LCx artery.
The patient was on medical management as coronary revascularization could not be considered owing to the semi-emergent nature of surgery and that most of the myocardium was already compromised. The patient's relatives were initially reluctant to give their consent for the procedure, thereby causing delay in surgical intervention. Until then, the patient was managed conservatively on continuous Ryle's tube aspiration, intravenous fluids and antibiotics.
All the prescribed medications were continued preoperatively except aspirin and clopidogrel, which were stopped at admission. Low molecular weight heparin (enoxaparin 60 mg subcutaneously twice daily) was started. It was discontinued 24 hours prior to surgery. The patient was hemodynamically stable and co-operative. Therefore, sequential epidural combined with local infiltration of the surgical site with 0.25% bupivacaine was selected as the anesthetic technique. Central venous pressure (CVP), arterial blood pressure (ABP), blood gas analysis and continuous cardiac output (CO) monitoring (Edwards Life sciences FloTrac monitor) were used along with routine monitors. The baseline ABP, HR, CVP, CO were 122/72 mmHg, 90/min, 7 mmHg and 7 L/min respectively. An epidural catheter was inserted in T10 -T11 interspace with the patient in sitting position. This provided sufficient analgesia and motor blockade for surgery. The surgical site was also infiltrated with 10 ml of 2% lignocaine. The patient was on spontaneous ventilation with tittrated mild sedation with fentanyl and midazolam. Total fluid administered was 1.5 L (1 L of normal saline; 500 ml of colloid). It was guided by CVP, stroke volume (SV), stroke volume variation (SVV) and CO on the Edwards Sciences FloTrac Vigileo monitor. The patient remained hemodynamically stable until about 50 min of the start of surgery when ABP was 86/54 (65mmHg) and CO was 3 L/min probably due to last epidural bolus of bupivacaine. This was not accompanied by any ECG changes. CVP remained normal. Blood loss was minimal. Ionotropic support (nor-adrenaline 0.07 μg/kg/min) was then started. Thereafter, ABP stabilized and serial ABG's done during surgery were normal. The surgical procedure included resection of gangrenous segment of bowel, anastomosis and anatomical repair of hernia, which lasted approximately 2 h.
Postoperatively, 12 lead ECG was done, which showed no fresh changes. Trop-T done after 12 h of surgery was also negative. Intensive monitoring (ABP, CVP, ECG, and CO) was continued for 48 h postoperatively. The ionotropic support was tapered and discontinued after 36 h of surgery to maintain a mean ABP of 75-80 mm Hg. Analgesia was maintained with epidural infusion of 0.125% bupivacaine with100 mcg fentanyl in 50 ml of normal saline titrated to effect and hemodynamics, intravenous analgesics (diclofenac 75 mg 8 hourly and tramadol whenever required). All preoperative medications including enoxaparin (60 mg sc twice daily for 2 days) and Aspirin were restarted on the 1st postoperative day (POD) and review done by a cardiologist and an endocrinologist. Epidural catheter was removed on the 2nd POD after which clopidogrel was resumed. The course of stay in the surgical intensive care unit (48 h) and later in the ward was uneventful. The patient was discharged on the 5th POD.","Using the adjusted body weight formula, what is the patient's adjusted body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'weight': [90.0, 'kg'], 'height': [180.0, 'cm']}",80.99533,76.94556,85.0451,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Male.
The patient's height is 180.0 cm, which is 180.0 cm * 0.393701 in/cm = 70.86618 in. 
Plugging in the values for the IBW formula for males gives us 50 kg + 2.3 kg * (70.86618 (in inches) - 60) = 74.99221 kg.
Hence, the patient's IBW is 74.99221 kg.The patient's weight is 90.0 kg. To compute the ABW value, apply the following formula: ABW = IBW + 0.4 * (weight (in kg) - IBW (in kg)). ABW = 74.99221 kg + 0.4 * (90.0 kg  - 74.99221 kg) = 80.99533 kg. The patient's adjusted body weight is 80.99533 kg."
716,62,Adjusted Body Weight,physical,decimal,pmc-2933634-1,Extracted,"A 28-year-old healthy Turkish woman (height 166 cm, weight 75 kg), without any medical history was admitted to a peripheral hospital at 37 weeks gestation for an elective caesarean delivery. During the course of the delivery, intravenous short-term infusion of 0.2 mg methylergometrine and 30IE oxytocin was administered for easy release of the placenta and prevention of bleeding during the post-partum phase. There were no complications during delivery. Approximately 30 minutes after delivery, the patient developed severe distress and chest pain. On physical examination, rales were detected in both lungs (Killip class II). The patient was transferred to our hospital for further investigation.
On electrocardiogram, a sinus tachycardia (100/min) without ST-segment changes was seen. The patient's blood pressure was 100/60 mmHg and her pO2 was 52 mmHg without oxygen supplementation. Chest x-ray revealed severe fluid consolidation (N-terminal prohormone brain natriuretic peptide-brain natriuretic peptide value 3900 pg/ml). Oxygen and loop diuretics rapidly improved the patient's respiratory status. The initial two-dimensional echocardiography showed moderately reduced systolic left ventricular function with a midventricular hypokinesia. Left ventricular end diastolic diameter was normal. The ejection fraction as measured by the Simpson's method was 38%. Laboratory investigations found raised levels of troponin T (0.19 ng/ml,; normal < 0.03 ng/mL) and creatine kinase (356 U/L; normal < 145 U/L). The patient was started on diuretics and angiotensin-converting enzyme inhibitors, after which she recovered quickly and showed no respiratory distress or other signs of heart failure.
In the absence of any cardiovascular risk factors and the age of the patient, we decided against using coronary angiography for initial anatomic. We conducted contrast-enhanced cardiac magnetic resonance (CMR) imaging, which showed a circular midventricular hypokinesia and no delayed enhancement after gadolinium application. Neither myocardial necrosis nor ischemia were seen, therefore coronary angiography was not performed
The patient's cardiac enzymes normalized within three days after admission. Two-dimensional echocardiography showed that systolic left ventricular function had completely recovered without any wall motion abnormalities within those three days.
Based on the patient's history with absence of cardiovascular risk factors, mild cardiac enzyme elevation and CMR findings of midventricular hypokinesia without necrosis and ischemia, she was diagnosed with tako-tsubo CMP. Seven days after admission, the patient and her healthy newborn child were discharged.","Using the adjusted body weight formula, what is the patient's adjusted body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'weight': [75.0, 'kg'], 'height': [166.0, 'cm']}",64.68903,61.45458,67.92348,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Female.
The patient's height is 166.0 cm, which is 166.0 cm * 0.393701 in/cm = 65.35437 in. 
Plugging in the values for the IBW formula for females gives us 45.5 kg + 2.3 kg * (65.35437 (in inches) - 60) = 57.81505 kg.
Hence, the patient's IBW is 57.81505 kg.The patient's weight is 75.0 kg. To compute the ABW value, apply the following formula: ABW = IBW + 0.4 * (weight (in kg) - IBW (in kg)). ABW = 57.81505 kg + 0.4 * (75.0 kg  - 57.81505 kg) = 64.68903 kg. The patient's adjusted body weight is 64.68903 kg."
717,62,Adjusted Body Weight,physical,decimal,pmc-4204687-1,Extracted,"A 31-year-old man with CD was admitted to the hospital because of severe abdominal pain and diarrhea. He had been diagnosed with CD 10 years previously, but he was lost to follow-up, during which he experienced repeated exacerbations and remissions. The patient had taken mesalazine 3,000 mg/day and azathioprine 50 mg/day and had started infliximab one year prior to admission. With infliximab, the patient experienced immediate relief of diarrhea and abdominal pain, but obstructive symptoms had gradually worsened. He complained of abdominal pain, increased borborygmus, decreased oral intake, and a decrease in body weight. Abdominal CT scan and small bowel series revealed an ileocolic fistula, multiple ulcers, and severe stricture of the small bowel (). Vital signs (blood pressure, 120/80 mmHg; pulse rate, 80 beats/min; respiratory rate, 20 beats/min; body temperature, 36.9℃) were normal. He has a height of 171 cm, a weight of 53 kg, and a BMI of 18.1 kg/m2. The patient had a chronically ill appearance with pale conjunctiva, mild tenderness in the lower abdomen, and accentuated bowel sounds. Liver and spleen were not palpable. Pitting edema could be seen on both lower limbs. Laboratory testing revealed anemia with a hemoglobin level of 8.7 g/dL, leukocyte count of 3,970/mm3, and platelet count of 265,000/mm3. Serum chemistry tests were consistent with severe malnutrition: AST/ALT 53/29 IU/L, BUN/creatinine 15/0.64 mg/dL, total protein/albumin 4.3/2.2 g/dL, and total cholesterol 88 mg/dL. ESR and CRP level were 35 mm/h and 2.1 mg/dL, respectively. Both anti-Saccharomyces cerevisiae-antibodies IgA and IgG were negative, and the patient's CDAI was about 261 points. He had been experiencing approximately 25 liquid stools per week, severe abdominal pain, and a very poor sense of well-being. To improve the patient's condition, wide resection of involved bowel and colostomy would be needed; however, because of a psychological reaction to personal disfigurement and the need to relearn bowel habits, he strongly refused colostomy. Therefore, we decided to perform a small and large bowel segmental resection and primary repair.
Gross findings during surgery included an abscess connected to the terminal ileum, bladder adhesion, a jejuno-sigmoid fistula, and huge inflammatory masses. An ileocecectomy, jejunal resection, and sigmoid colon resection were performed, followed by primary repair of the jejunum, rectum, and sigmoid colon (). Fortunately, 220 cm of the small bowel remained after surgery. However, one week postoperatively, the patient developed a high fever and abdominal pain. Abdominal CT scan revealed a fistula connected to an intraperitoneal abscess (). The patient was started on intravenous antibiotics, and the abscess was drained percutaneously. A total of four percutaneous drainages were performed. The drainage fluid was dark yellow and highly viscous but gradually cleared after continuous use of antibiotics. However, despite no further evidence of infection (white blood cell count 4,270/mm3 and CRP 0.3 mg/dL), approximately 30-50 cc of fluid issued from every drain daily, even one month after the operation.
The patient was started on 5 mg/kg of infliximab to treat the postoperative fistula and prevent a recurrence. After infliximab therapy was initiated, drainage decreased dramatically to less than 10 cc a day. In follow-up abdominal CT scans, the abscess in the abdominal cavity and the postoperative fistula disappeared (). The percutaneous drainages were consecutively removed, the patient began receiving oral nutrition, and the intravenous antibiotics were stopped. The patient quit smoking, and infliximab was injected to prevent disease recurrence. Three months after surgery, the patient looked healthy and reported passing stools once or twice a day. His body weight increased by 8 kg, BMI increased to 20.9 kg/m2, and his CDAI decreased to 60. In follow-up laboratory exams, the patient's hemoglobin level was 12.7 g/dL, total protein and albumin were 6.9/3.9 g/dL, and total cholesterol was 130 mg/dL.","Using the adjusted body weight formula, what is the patient's adjusted body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'weight': [53.0, 'kg'], 'height': [171.0, 'cm']}",61.30556,58.24028,64.37084,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Male.
The patient's height is 171.0 cm, which is 171.0 cm * 0.393701 in/cm = 67.32287 in. 
Plugging in the values for the IBW formula for males gives us 50 kg + 2.3 kg * (67.32287 (in inches) - 60) = 66.8426 kg.
Hence, the patient's IBW is 66.8426 kg.The patient's weight is 53.0 kg. To compute the ABW value, apply the following formula: ABW = IBW + 0.4 * (weight (in kg) - IBW (in kg)). ABW = 66.8426 kg + 0.4 * (53.0 kg  - 66.8426 kg) = 61.30556 kg. The patient's adjusted body weight is 61.30556 kg."
718,62,Adjusted Body Weight,physical,decimal,pmc-8641749-1,Extracted,"An 11-year-old boy presented with nail changes in his finger and toenails for 3-month duration. There was no preceding history of drug intake and systemic illness and there was absence of personal and family history of atopy. Yellow discoloration, thickening, and pitting were seen in almost all nails. Uplifting of nail plates because of subungual hyperkeratosis was seen in few nails []. Acral dusky erythematous with minimal scaly plaques was present. Mucosa and other cutaneous sites were not involved. A provision clinical diagnosis of nail psoriasis was made. Potassium hydroxide and periodic acid–Schiff staining of the nail were negative for fungal elements. Nail biopsy was denied. Routine hematological and biochemical investigations were normal. Initially, topical tazarotene 0.1% cream at night and a combination of calcipotriol–clobetasol propionate ointment twice a day was advised and continued for 8–10 weeks. Later on, acitretin was planned and started at a dose of 0.3 mg/kg daily along with topical calcipotriol. It was increased to 0.6 mg/kg daily and continued for 4–5 months. Gradual tapering of the dose was done and stopped completely. The patient was maintained with topical tazarotene gel thrice in a week and emollient daily. All biochemical tests were within normal limits during the course of treatment. There was remarkable improvement in discoloration, pitting, and disappearance of subungual hyperkeratosis in almost all his nails []. The patient was in regular follow-up. While in the course of follow-up, he noticed painless enlargement of both breasts []. On examination, bilateral nontender breast lumps without any palpable glandular tissue and discharge were present. He was being referred to the endocrine department for further evaluation for bilateral gynecomastia. His weight was 47 kg, height was 154 cm, and basal metabolic rate (body mass index) was 19.8 kg/m2 which were within normal limits for his age. His genitalia were tanner Stage II.
Hormonal evaluation showed a normal thyroid function test, the total testosterone level was 3.9 nmol/L (4.56–28.2 nmol/L). Prolactin level was 6.4 ng/ml (3–18.6). Lutenizing hormone level was 2.2 mIU/ml (1.8–7.8); follicle-stimulating hormone level was 5.6 (1.55–9.74 mIU/ml). His estradiol level was 116.6 pmol/L (97.5–592 pmol/l). Ultrasound (USG) of the breasts did not show any fibroglandular proliferation in both breasts; however, deposition of adipose tissue in the subcutaneous plane was noted, suggestive of pseudogynecomastia. Based on his USG report and low value of total testosterone, a working diagnosis of pseudogynecomastia was made. Tablet tamoxifen was started, in consultation with the department of endocrinology. It was continued for 3–4 months and later stopped, as no significant improvement was observed.","Using the adjusted body weight formula, what is the patient's adjusted body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'weight': [47.0, 'kg'], 'height': [154.0, 'cm']}",49.66933,47.18586,52.1528,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Male.
The patient's height is 154.0 cm, which is 154.0 cm * 0.393701 in/cm = 60.62995 in. 
Plugging in the values for the IBW formula for males gives us 50 kg + 2.3 kg * (60.62995 (in inches) - 60) = 51.44889 kg.
Hence, the patient's IBW is 51.44889 kg.The patient's weight is 47.0 kg. To compute the ABW value, apply the following formula: ABW = IBW + 0.4 * (weight (in kg) - IBW (in kg)). ABW = 51.44889 kg + 0.4 * (47.0 kg  - 51.44889 kg) = 49.66933 kg. The patient's adjusted body weight is 49.66933 kg."
719,62,Adjusted Body Weight,physical,decimal,usmle-1483,Extracted,"A 30-year-old woman comes to the physician because of headaches and nausea for the past 3 weeks. The headaches are holocranial and last up to several hours. During this period, she has also had a swishing sound in both ears, which decreases when she turns her head to either side. She has had multiple episodes of blurring of vision and double vision for the past 2 weeks. She has vomited twice in the past week. She has nodular cystic acne and polycystic ovarian disease. Current medications include an oral contraceptive, metformin, and isotretinoin. She is 163 cm (5 ft 4 in) tall and weighs 89 kg (196 lb); BMI is 33.5 kg/m2. Her temperature is 37.3°C (99.1°F), pulse is 70/min, and blood pressure is 128/82 mm Hg. She is oriented to time, place, and person. Examination shows acne over her cheeks and back. Hirsutism is present. Visual acuity is 20/20 in both eyes. There is esotropia of the left eye.","Using the adjusted body weight formula, what is the patient's adjusted body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'weight': [89.0, 'kg'], 'height': [163.0, 'cm']}",68.6591,65.22614,72.09206,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Female.
The patient's height is 163.0 cm, which is 163.0 cm * 0.393701 in/cm = 64.17326 in. 
Plugging in the values for the IBW formula for females gives us 45.5 kg + 2.3 kg * (64.17326 (in inches) - 60) = 55.0985 kg.
Hence, the patient's IBW is 55.0985 kg.The patient's weight is 89.0 kg. To compute the ABW value, apply the following formula: ABW = IBW + 0.4 * (weight (in kg) - IBW (in kg)). ABW = 55.0985 kg + 0.4 * (89.0 kg  - 55.0985 kg) = 68.6591 kg. The patient's adjusted body weight is 68.6591 kg."
720,62,Adjusted Body Weight,physical,decimal,pmc-7593758-1,Extracted,"We present the case of a 48-year-old man, complaining of a bilateral knee injury and functional disability. The patient fell about two meters down an embankment one hour before the presentation and was unable to stand up due to pain, so he was brought to our hospital by ambulance.
Clinical examination revealed a marked bilateral swelling of both knees, severe pain at the passive mobilization of the knee joints, pain-limiting active flexion to less than 30°, and an inability to actively extend the knee joints or to perform an active straight leg raise bilaterally. Additionally, weight-bearing had hardly been possible. There was a loss of fullness and a palpable deficit at the inferior poles of his patellae. Testing of the ligamentous knee joint stabilizers was significantly limited by guarding due to the severe sharp pain. The patient's medical history revealed that a couple of years earlier, he had a right knee sprain resulting in an acute rupture of the anterior cruciate ligament (ACL), which was treated conservatively. The patient does not take any drugs regularly, and we note that he is allergic to levofloxacin. The weight and height of the patient were recorded at the physical examination as 107 kilograms and 180 cm, with a body mass index (BMI) of 33.
Plain radiographs of his knees showed bilateral knee effusions with patella alta (high-riding patellae) on both anteroposterior and lateral views. Insall-Salvati ratios measured 1.6 and 1.47 for right and left knee, respectively () (normal values range from 0.8 to 1.2; patella alta > 1.2 and patella baja < 0.8). Moreover, the irregularity and incongruity of the patellar tendons on the lateral radiographs were additional signs suggestive of the extensor mechanism's rupture and consistent with the tendons' rupture from the lower pole of the patellae bilaterally.
Our patient was operated under general anesthesia 48 hours after the accident. He was placed in the supine position. The clinical examination under anesthesia of both knees demonstrated a full instability of the MCL with a valgus stress test at both 0 and 30° of knee flexion. No laxity was demonstrated in the remaining ligaments of the knee joint. The lower extremities were prepared and draped together in the usual sterile fashion. The intervention was performed without the use of a tourniquet.
Our ligamentous reconstruction was approached by an anterior longitudinal midline incision. Dissection was carried down through the skin and subcutaneous tissues to the level of the patellar and quadriceps paratenon, which were carefully preserved. The patellar tendon rupture was identified near the proximal osteotendinous junction bilaterally (). The hemarthrosis was evacuated, and the joint was copiously irrigated. A chronic tear of the right ACL was identified, with the proximal portion of the ligament missing and only scar tissue remaining with the ACL stump adhering to an intact Posterior Cruciate Ligament (PCL). A complete proximal (femoral) MCL tear was identified bilaterally, confirming our clinical suspicion. The medial and lateral retinacula, which were involved as well, were identified for later repair.
At first, with the same incision, the MCL tear was approached. Proximal reinsertion at the level of the medial femoral condyle using a DePuy Mitek super QuickAnchor™ Plus DS® was done to ensure the stability of the medial motion plane. Then, after debridement of the tendinous tissue and visualization of the inferior pole of the patella, three DePuy Mitek super QuickAnchor™ Plus DS® were screwed into the medial, middle, and lateral thirds of the patella in the proper coronal plane. The purchase of the anchors was tested as we were able to deliver the patella to the distal extent of the incision by pulling on the anchor sutures. Then, a circumferential 1.2 mm thick stainless steel wire was passed through the center of the thickness of the patella superiorly and the tibial tuberosity inferiorly. Gradual tension was applied on the metallic wire to obtain the optimal patellar height, confirmed by an intraoperative lateral X-ray. One suture in each anchor was used to create a running Krackow stitch distally through the tendon, ensuring that full-thickness bites were obtained.
The second limb of each suture was passed in a locked fashion through the proximal free tendon and tied within the substance of the tendon. The additional suture within each anchor was incorporated into the repair for reinforcement in a simple continuous fashion. The reconstruction was further protected by a strip of quadriceps tendon measuring 10 × 1 cm, long enough to cover the patellar tendon, which was harvested and turned down. The edges of the turned down quadriceps tendon were fixed to the underlying patellar tendon using slowly absorbable interrupted sutures (Vicryl 2.0). Next, the medial and lateral retinacula tears were repaired using interrupted No. 2 PDS sutures (Ethicon; Somerville, New Jersey, USA). The strength of the repair was tested bilaterally through a gentle range of motion; a flexion up to 130° was possible.
Postoperatively, the legs were placed in knee immobilizer braces, with the knees locked in full extension. The postoperative course was uneventful, and radiographic control was satisfactory (). On the second postoperative day, the patient began ambulation with a walker while keeping the extension knee braces. Full weight-bearing was permitted as tolerated, along with isometric quadriceps-strengthening exercises. The rest of the protocol is as follows: knee flexion exercises limited to 45° were started at the second postoperative week. He had no pain and reached 45° of active bilateral knee flexion. He had an active flexion of 80° at the sixth week, and the knee braces were discontinued. In the eighth postoperative week, the patient achieved a bilateral active complete knee extension and could walk without crutches. As part of his daily physiotherapy program, he was allowed full knee flexion along with a focus on muscle strengthening exercises. Twelve weeks after surgery, the patient presented 100° maximum bilateral knee flexion and returned to work.
Upon examination seven months after surgery, the patient showed an adequate range of motion of both knees (135° flexion, 0° extension) (). Quadriceps muscle, the primary contributor to knee joint stability, had a good strength with no clinical signs of muscular atrophy or extensor lag. The patient denied any sense of instability, and, consequently, he returned to his recreational sports activities. In addition, he reported feeling that his knees were as strong as they were before the accident. At the final follow-up 12 months after the injury, the patient was symptom-free and extremely satisfied as he recovered completely.","Using the adjusted body weight formula, what is the patient's adjusted body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'weight': [107.0, 'kg'], 'sex': 'Male', 'height': [180.0, 'cm']}",87.79533,83.40556,92.1851,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Male.
The patient's height is 180.0 cm, which is 180.0 cm * 0.393701 in/cm = 70.86618 in. 
Plugging in the values for the IBW formula for males gives us 50 kg + 2.3 kg * (70.86618 (in inches) - 60) = 74.99221 kg.
Hence, the patient's IBW is 74.99221 kg.The patient's weight is 107.0 kg. To compute the ABW value, apply the following formula: ABW = IBW + 0.4 * (weight (in kg) - IBW (in kg)). ABW = 74.99221 kg + 0.4 * (107.0 kg  - 74.99221 kg) = 87.79533 kg. The patient's adjusted body weight is 87.79533 kg."
721,62,Adjusted Body Weight,physical,decimal,pmc-7891243-1,Extracted,"A 79-year-old woman was referred to our hospital for recurrent paroxysmal AF with palpitation. She had a history of transient ischaemic attack and hypertension. She was on candesartan (8 mg once daily), amlodipine (2.5 mg once daily), and apixaban (2.5 mg twice daily). Her body weight was 39 kg, and height was 159 cm. All laboratory findings were within normal range. Electrocardiogram showed normal sinus rhythm and no evidence of ischaemic changes or ST elevation. Chest X-ray was unremarkable. She showed a dilated left atrium (LA diameter: 31 mm, LA volume index: 35 mL/m2) and normal left ventricular systolic function (left ventricular ejection fraction: 76%). Pre-procedural cardiac computed tomography (CT) showed four pulmonary veins, and slight dilated ascending aorta (maximum diameter: 40 mm, ) with mild calcific plaques. We decided to perform CA for AF, and recommended TOE before the CA to assess the presence or absence of left atrial appendage thrombus (LAAT) because she had a CHADS2 score of 4.
On the day before the CA, TOE was performed with an iE33 (Philips Medical System, Andover, MA, USA) with a 4-MHz OmniPlane probe. After local pharyngeal anaesthesia with lidocaine spray, the patient was placed in the left lateral position and midazolam (3 mg) was administered for mild sedation. Her physical examination showed a regular pulse rate (PR) of 62 b.p.m., a blood pressure (BP) of 117/84 mmHg, and a normal temperature. Her physical examinations at the time of TOE procedure were unremarkable. At 3 min after probe insertion, she had a BP of 117/84 mmHg, PR of 62 b.p.m., and there was no abnormal finding of the ascending aorta at that time (). We then administered additional midazolam (2 mg) due to body movement. At 5 min after the insertion, we confirmed that the absence of LAAT (BP: 95/40 mmHg, PR: 76 b.p.m.). However, TOE showed ascending aortic dissection without pericardial effusion (). The probe was removed at the end of anaesthesia after flumazenil (0.2 mg) infusion. After waking, she had severe back pain, and underwent a contrast-enhanced cardiac CT. Cardiac CT demonstrated Stanford type A aortic dissection extending from the aortic root to the bifurcation of common iliac arteries, and tight stenosis in the right coronary artery (maximum diameter; 49 mm, ). An electrocardiogram showed a normal sinus rhythm and no ST-segment abnormalities. The patient underwent a replacement of the ascending aorta, and a coronary artery bypass graft surgery for the right coronary artery. After surgery, the patient gradually stabilized, and she was transferred to a rehabilitation hospital on the 60th postoperative day. After 9 months of follow-up, the patient is doing well.","Using the adjusted body weight formula, what is the patient's adjusted body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'weight': [39.0, 'kg'], 'height': [159.0, 'cm']}",46.48588,44.16159,48.81017,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Female.
The patient's height is 159.0 cm, which is 159.0 cm * 0.393701 in/cm = 62.59846 in. 
Plugging in the values for the IBW formula for females gives us 45.5 kg + 2.3 kg * (62.59846 (in inches) - 60) = 51.47646 kg.
Hence, the patient's IBW is 51.47646 kg.The patient's weight is 39.0 kg. To compute the ABW value, apply the following formula: ABW = IBW + 0.4 * (weight (in kg) - IBW (in kg)). ABW = 51.47646 kg + 0.4 * (39.0 kg  - 51.47646 kg) = 46.48588 kg. The patient's adjusted body weight is 46.48588 kg."
722,62,Adjusted Body Weight,physical,decimal,pmc-3249576-1,Extracted,"An 80-year-old woman, 155 cm in height and 70 kg in weight, was admitted to our institution via the emergency room due to a right femur fracture. The patient had a 5-year history of hypertension, which was relatively well controlled with the medication regimen of an antihypertensive agent and aspirin. She did not exercise much due to obesity and depression. She showed delirium symptoms after admission and underwent brain computerized tomography (CT) to exclude organic brain diseases. A brain CT showed severe stenosis of the middle cerebral artery (MCA), an old localized infarction of the basal ganglia, and diffuse atrophy of the brain. She exhibited cardiomegaly on the preoperative chest X-ray, 1 degree A-V block on EKG, an ejection fraction of 65% on echocardiography and other blood studies, and her vital signs are within the normal limits. The preoperative PT/PTT was 12.7/24.4 seconds, INR was 1.15, and arterial blood gas analysis (ABGA) revealed the following: pH 7.376, PaO2 78.6 mmHg, PaCO2 27.5 mmHg.
On the 4th hospital day, she was scheduled to undergo total hip replacement surgery and aspirin was maintained until the 3rd hospital days. Upon arrival at the operating theater, standard monitoring devices were applied and the left radial artery was cannulated for continuous blood pressure monitoring. The patient's blood pressure (BP), heart rate (HR) and O2 saturation was 140/70 mmHg, 80 beats/min, and 98%, respectively, through a simple facial mask with 4 L/min of oxygen. Spinal anesthesia was administered with the patient in the right lateral position using a 26-gauge Quincke spinal needle at the L3-4 interspace with 0.5% hyperbaric bupivacaine 8 mg under standard aseptic conditions. The patient was then placed in the supine position. During the pin-prick test, the patient became unresponsive with BP 70/40 mmHg and HR 40-45 beats/min. Repeated ephedrine administration intravenously (IV) followed by epinephrine 10 µg and full dripping of the crystalloid did not increase the BP. Endotracheal intubation was performed after 7-8 minutes of manual ventilation and norepinephrine 0.1 µg/kg/min, dopamine 2 µg/kg/min were administered continuously. The patient's BP and HR was still 60/40 mmHg and 110 beats/min, respectively, and IV epinephrine 0.02 µg/kg/min was started. The ABGA at that time revealed the following: PaO2 = 488.9 mmHg, PaCO2 = 30.8 mmHg at FiO2 1.0, and EtCO2 = 28 mmHg and O2 saturation = 99%. The cause was suspected to be high spinal anesthesia rather than a pulmonary embolism because of the ABGA findings. Central venous catheterization via the right internal jugular vein was performed to administer the drugs and for hemodynamic monitoring. The central venous pressure was 30 mmHg and emergent TEE was performed immediately. TEE revealed an enlargement of the right atrium (RA) and right ventricle (RV), straightening of the interventricular septum and hypokinesia, which were consistent with PE. IV heparine 5,000 IU was administered and maintained at 1,000 IU/hr. 50 µg/kg of milrinone IV was loaded for 10 minutes and maintained at 0.5 µg/kg/min to manage RV failure. The ABGA results exhibited pH 7.224, PaO2 55.2 mmHg and PaCO2 52.8 mmHg, which were also consistent with PE.
The operation was postponed and the patient was transported to the intensive care unit (ICU). Twenty minutes later, her heart beat decreased to 30 beats/min and cardiopulmonary resuscitation was performed. Chest 3 dimensional PTCA and non-contrast brain CT were performed when the patient's hemodynamic parameter became temporarily stable.
A low density ovoid thromboembolism from the lobar pulmonary artery of the left lower lobe to the entire segmental pulmonary artery of the left lower lobe and enlargement of the right atrium and ventricle, which suggested a poor prognosis, was observed on the enhanced PCTA (). In addition, a low density large acute infarct at the right MCA territory with gyral swelling of the right insula and temporal lobe were noted on the non-enhanced brain CT scan (). After 17 hours admission to the ICU, her heart rate decreased to 30 beats/min, resuscitation was ineffective and she died.","Using the adjusted body weight formula, what is the patient's adjusted body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'weight': [70.0, 'kg'], 'height': [155.0, 'cm']}",56.71265,53.87702,59.54828,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Female.
The patient's height is 155.0 cm, which is 155.0 cm * 0.393701 in/cm = 61.02366 in. 
Plugging in the values for the IBW formula for females gives us 45.5 kg + 2.3 kg * (61.02366 (in inches) - 60) = 47.85442 kg.
Hence, the patient's IBW is 47.85442 kg.The patient's weight is 70.0 kg. To compute the ABW value, apply the following formula: ABW = IBW + 0.4 * (weight (in kg) - IBW (in kg)). ABW = 47.85442 kg + 0.4 * (70.0 kg  - 47.85442 kg) = 56.71265 kg. The patient's adjusted body weight is 56.71265 kg."
723,62,Adjusted Body Weight,physical,decimal,usmle-7046,Extracted,"A 52-year-old man presents to the office complaining of a 2-week history of fatigue, progressively worsening shortness of breath, and swelling of his lower legs and feet. His past medical history is only significant for slightly elevated blood pressure. The patient denies tobacco use although he does admit to drinking 8-10 beers, daily, for the past 10 years. He takes a low dose of aspirin daily, ever since he had an anterior myocardial infarction 2 years ago. The patient works as a financial consultant and frequently travels for work. The current temperature is 36.8°C (98.3°F), the pulse rate is 68/min, the blood pressure is 152/84 mm Hg, and the respiratory rate is 16/min. His weight is 102 kg (224 lb) and height 180 cm (5 ft 9 in). Echocardiography demonstrates an ejection fraction of 35% and a thin left ventricular wall.","Using the adjusted body weight formula, what is the patient's adjusted body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'weight': [102.0, 'kg'], 'height': [180.0, 'cm']}",85.79533,81.50556,90.0851,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Male.
The patient's height is 180.0 cm, which is 180.0 cm * 0.393701 in/cm = 70.86618 in. 
Plugging in the values for the IBW formula for males gives us 50 kg + 2.3 kg * (70.86618 (in inches) - 60) = 74.99221 kg.
Hence, the patient's IBW is 74.99221 kg.The patient's weight is 102.0 kg. To compute the ABW value, apply the following formula: ABW = IBW + 0.4 * (weight (in kg) - IBW (in kg)). ABW = 74.99221 kg + 0.4 * (102.0 kg  - 74.99221 kg) = 85.79533 kg. The patient's adjusted body weight is 85.79533 kg."
724,62,Adjusted Body Weight,physical,decimal,pmc-4331399-2,Extracted,"Case 2: A 47-year-old female diagnosed with type 2 diabetes 2 years before, and treatment started immediately thereafter. However, after a year, she stopped taking medications on her own decision. She presented to emergency department of our hospital with a fever of 38°C and bilateral lower leg pain for three days. She was hospitalized with a diagnosis of lower right leg cellulitis, and we began cefazolin administration at 3 g/day. On admission, her diabetic control was poor (HbA1c, 11.5%, postprandial blood glucose, 268 mg/dL); in addition, her body temperature was 39.2°C, pulse rate 106 beats/min, blood pressure 137/71 mmHg, height 166 cm, and body weight 61 kg. Routine laboratory testing showed an elevated leukocyte count of 13.8 × 103 cells/μL and a C-reactive protein level of 4.49 mg/dL. Serological tests for syphilis and HIV were negative. Soon after starting antibiotic treatment, her fever subsided. Five days later, redness and swelling disappeared; therefore, we changed treatment to cefdinir at 900 mg/day. She was discharged on day 8. The following day, we confirmed H. cinaedi from the blood culture taken on day 1; nevertheless, we decided to adopt a wait-and-see approach because no exacerbation of disease was observed since her initial admission.","Using the adjusted body weight formula, what is the patient's adjusted body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'weight': [61.0, 'kg'], 'height': [166.0, 'cm']}",59.08903,56.13458,62.04348,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Female.
The patient's height is 166.0 cm, which is 166.0 cm * 0.393701 in/cm = 65.35437 in. 
Plugging in the values for the IBW formula for females gives us 45.5 kg + 2.3 kg * (65.35437 (in inches) - 60) = 57.81505 kg.
Hence, the patient's IBW is 57.81505 kg.The patient's weight is 61.0 kg. To compute the ABW value, apply the following formula: ABW = IBW + 0.4 * (weight (in kg) - IBW (in kg)). ABW = 57.81505 kg + 0.4 * (61.0 kg  - 57.81505 kg) = 59.08903 kg. The patient's adjusted body weight is 59.08903 kg."
725,62,Adjusted Body Weight,physical,decimal,pmc-3816165-1,Extracted,"A 20-year-old woman presented with progressively worsening dyspnea for 6 months. She had no history of evaluation or treatment for her symptoms, although the symptoms started at the age of high school. Her symptoms became worse with time, and she presented with NYHA class III exertional dyspnea and orthopnea. Her height, weight, and body surface area were 156 cm, 49 kg, and 1.45 m2 respectively. Her vital signs were blood pressure 104/68 mmHg, heart rate 104/min, and respiratory rate 22/min. A regular heart beat was detected with wide fixed splitting of S2 at the pulmonary valve area, and no clubbing of the fingers or nails was observed. A simple chest X-ray showed cardiomegaly and a dilated pulmonary trunk with cephalization of pulmonary vascular marking. Electrocardiography revealed normal sinus rhythm with compatible findings of RV hypertrophy. A transthoracic echocardiogram revealed a large tissue defect of 29 mm with a bi-directional shunt through the interatrial septum (). The RV was prominently dilated and revealed significantly decreased contractility with a D-shaped left ventricle (LV) showing normal contractility (). There was no significant RV hypertrophy. The systolic pulmonary arterial pressure measured by maximal tricuspid regurgitation velocity (TR Vmax) was estimated at 95 mmHg (TR Vmax = 4.6 m/sec), which was roughly equal to systemic systolic blood pressure (). Her walking distance was 362 m on the 6-minute walking test with slightly decreased oxygen saturation from 98% to 92%. Further evaluations to identify the etiology of the pulmonary hypertension included a pulmonary function test, chest computed tomography angiogram and autoimmune panel, but all were negative.
Cardiac catheterization confirmed severe pulmonary hypertension with a mean pulmonary arterial pressure of 48 mmHg (76/36 mmHg absolute) and pulmonary vascular resistance (Rp) of 9.6 Wood units (WU) on room air. The mean systemic arterial pressure was 84 mmHg (97/73 mmHg absolute). After administering oxygen (10 L/min for 10 minutes via a nasal prong) and inhaling iloprost, her mean pulmonary arterial pressure was 50 and 46 mmHg respectively, and had not changed significantly. We failed to identify the pulmonary arterial responsibility after pulmonary vasodilator administration. Based on these findings, closure of the ASD was not performed. Instead, medical treatment including oral bosentan was started to improve patient's symptom.
Her symptoms and exercise tolerance improved from NYHA class III to NYHA class I to II after 1 year of using bosentan. She was able to walk 426 m during the 6-min walk test without desaturation. A follow-up echocardiogram showed no significant interval change except slight improvement in RV contractility compared to the initial echocardiogram, even though her symptoms were much improved. TR Vmax was 4.3 m/sec by continuous wave Doppler test, but there was no significant improvement in comparison with the initial test. Although the follow-up echocardiogram result was very disappointing, we decided to perform a cardiac catheterization and balloon occlusion test to confirm the change in Rp and possibly correct the ASD. We expected some favorable changes in pulmonary vascular physiology, because her exercise tolerance had much improved.
A follow-up cardiac catheterization revealed severe pulmonary hypertension with mean pulmonary arterial pressure of 45 mmHg (75/29 mmHg absolute). The mean aortic pressure was 74 mmHg (95/60 mmHg absolute). Although the patient still had severe pulmonary hypertension, Rp had decreased markedly from 9.6 to 4.2 WU and calculated pulmonary to systemic flow ratio (Qp/Qs) increased from 1.9 to 2.6 in comparison with the initial data. We performed the transient balloon occlusion test using a 34 mm sizing balloon for 10 minutes. As a result, mean pulmonary arterial pressure decreased to 36 mmHg (48/25 mmHg absolute), and mean aortic pressure increased to 85 mmHg (118/70 mmHg absolute). We decided to close the ASD with a transcatheter occluder device considering her young age and the high perioperative risk. We performed percutaneous closure of the defect with a 34 mm Amplatzer® septal occluder (AGA Medical Corp., Minneapolis, MN, USA).
No residual leak was observed on the follow-up transthoracic echocardiography. The patient was given antiplatelet therapy and was maintained on 62.5 mg bosentan bid with diuretics and an angiotensin receptor blocker for 1 year. Finally, her physical activity and symptoms were much improved as she could walk 554 m on the walk test 1 year after the device was deployed. A chest X-ray showed remarkably decreased pulmonary vascularity, but cardiomegaly remained. Follow-up transthoracic echocardiography showed increased left atrial size from 37 to 42 mm and LV chamber size of end-diastole/end-systole from 40/23 to 46/28 mm. RV size had decreased significantly, and RV contractility was much improved in comparison with the initial study, but a compressed LV still remained on the parasternal short axis view (). TR Vmax also decreased markedly from 4.6 m/sec to 3.0 m/sec ().","Using the adjusted body weight formula, what is the patient's adjusted body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'weight': [49.0, 'kg'], 'height': [156.0, 'cm']}",48.85596,46.41316,51.29876,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Female.
The patient's height is 156.0 cm, which is 156.0 cm * 0.393701 in/cm = 61.41736 in. 
Plugging in the values for the IBW formula for females gives us 45.5 kg + 2.3 kg * (61.41736 (in inches) - 60) = 48.75993 kg.
Hence, the patient's IBW is 48.75993 kg.The patient's weight is 49.0 kg. To compute the ABW value, apply the following formula: ABW = IBW + 0.4 * (weight (in kg) - IBW (in kg)). ABW = 48.75993 kg + 0.4 * (49.0 kg  - 48.75993 kg) = 48.85596 kg. The patient's adjusted body weight is 48.85596 kg."
726,62,Adjusted Body Weight,physical,decimal,pmc-6937415-1,Extracted,"We report a 15-year-old girl who presented with recurrent headaches, arterial hypertension, and a systolic murmur.
Echocardiographic examination in a medical practice had revealed a potential coarctation of the aorta.
The patient had no history of serious illness.
There were no medically relevant aspects from the patient’s personal history. Other than arterial hypertension and coronary artery disease in the patient’s grandfather, there was no known cardiac disease within the family.
The patient presented in good general condition. Body weight was 61 kg and height were 172 cm. Her blood pressure in the right arm with 144/86 [MAP (mean arterial pressure) 110 mmHg] was significantly higher than that in the left arm [118/82 (MAP 96) mmHg] and of the right leg [118/72 (MAP 91) mmHg]. We consistently felt an unequal pulse between the right and left radial arteries (right stronger than left). A 2/6 systolic murmur was identified ventrally in the second and third left intercostal space, and, less prominently, dorsally between the shoulder blades. All other aspects of the physical examination were normal.
No laboratory examinations were done in the diagnostic work-up.
Echocardiography and cardiac MRI revealed a hypoplastic native aortic arch with a bi-carotid trunk and a segment just proximal of the left subclavian artery which was stenosed by 75% ().","Using the adjusted body weight formula, what is the patient's adjusted body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Female', 'weight': [61.0, 'kg'], 'height': [172.0, 'cm']}",62.34887,59.23143,65.46631,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Female.
The patient's height is 172.0 cm, which is 172.0 cm * 0.393701 in/cm = 67.71657 in. 
Plugging in the values for the IBW formula for females gives us 45.5 kg + 2.3 kg * (67.71657 (in inches) - 60) = 63.24811 kg.
Hence, the patient's IBW is 63.24811 kg.The patient's weight is 61.0 kg. To compute the ABW value, apply the following formula: ABW = IBW + 0.4 * (weight (in kg) - IBW (in kg)). ABW = 63.24811 kg + 0.4 * (61.0 kg  - 63.24811 kg) = 62.34887 kg. The patient's adjusted body weight is 62.34887 kg."
727,62,Adjusted Body Weight,physical,decimal,pmc-3030064-1,Extracted,"A 63-year-old, 164 cm, 79 kg male was admitted after sustaining left hip and tibia fracture due to a road traffic accident. The patient underwent a transsphenoidal approach operation due to a pituitary adenoma 5 years previously and had been followed up for panhypopituitarism and diabetes mellitus at our institution.
The patient complained of mild dyspnea 10 hours after the traffic accident. Arterial blood gas analysis (ABGA) revealed pH 7.423, PaCO2 37.3 mmHg, PaO2 50.1 mmHg, SaO2 86.5% (FiO2 0.2). The alveolar-arterial oxygen gradient was increased to 53 but his chest x-ray was normal. On the 3rd hospital day, dyspnea and hypoxemia worsened and chest computed tomography (CT) was performed due to suspected PE. Chest CT scan showed thromboembolism in the right interlobar pulmonary artery, right lower lobe segmental artery and subsegmental pulmonary artery (). Heparin treatment was initiated immediately and dyspnea and hypoxemia improved. Transthoracic echocardiography was performed on the 4th hospital day without showing any abnormality or thrombus. On the 7th hospital day, left lower limb venography was taken but there was no venous thrombus and an inferior vena cava filter was not inserted. The patient was scheduled for an operation 11 days after the accident.
During heparin administration activated partial thromboplastin time (aPTT) was maintained between 60 and 67 sec and heparin was stopped at midnight on the day before the operation. Prothrombin time and aPTT were within normal range on the day of operation. Laboratory tests were within normal range except BUN/Cr which was increased to 23.7/1.5 mg/dl.
The patient was not premedicated. On arrival in the operating room, standard monitoring devices were applied. After Allen's test, the left radial artery was cannulated for continuous blood pressure monitoring and the initial blood pressure (BP) was 120/70 mmHg. 5 L of 100% O2 was applied to the patient via oxygen mask and initial ABGA showed pH 7.43, PaCO2 38.1 mmHg, PaO2 102.9 mmHg, and SaO2 98%. Spinal anesthesia was administered with the patient in the right lateral position using a 25-gauge Quincke spinal needle at the level of the L3-4 interspace under standard aseptic conditions. A total of 12 mg of 0.5% tetracaine, mixed with saline, the patient's CSF, and epinephrine 1 : 200,000 was administered slowly to the patient. The patient was then positioned supine and a sensory block to T10 was confirmed by pin-prick test 5 min later. During spinal anesthesia, 700 ml of Hartmann's solution was administered to the patient and there were no significant changes in BP or heart rate (HR). Forty min after spinal anesthesia, a pneumatic tourniquet was inflated on the left thigh. It was inflated to 350 mmHg, without prior use of an Esmarch bandage. Immediately after the skin incision was made, the patient became unresponsive with BP 50/30 mmHg and HR 40 bpm. Ephedrine hydrochloride 8 mg was administered intravenously followed by another 12 mg but BP did not increase. Phenylephrine 300 µg was administered and endotracheal intubation was performed immediately and the patient was ventilated with 100% oxygen. BP increased to 80/70 mmHg but cardiac arrest then followed, and external cardiac massage was initiated. The patient received epinephrine 1 mg and atropine 0.5 mg repeatedly for 4 times without any response and infusion of epinephrine 0.1 µg/kg/min and norepinephrine 0.1 µg/kg/min was started. Fifteen min after cardiopulmonary resuscitation was instituted, HR increased to 140 bpm and BP increased to 140/90 mmHg. ABGA at that time showed pH 7.127, PaCO2 37.2 mmHg, PaO2 144.4 mmHg, HCO3 12.0 mmol/L, BE -15.9 mmol/L, and SaO2 98.1%. Sodium bicarbonate 200 mEq was intravenously administered because of metabolic acidosis. BP was maintained by continuously infusing epinephrine and norepinephrine. Emergent TEE revealed multiple emboli in the right atrium and the interatrial septum to be bulging into the left atrium (). After the TEE diagnosis of PE, vital signs improved (BP 120/70 mmHg, HR 110 bpm) and the operation resumed. The patient was transferred to the intensive care unit (ICU) with 100% oxygen applied through an endotracheal tube (anesthesia and operation time were 135 min and 50 min in length, respectively). On admission to the ICU, mechanical ventilation was continued with FiO2 1.0. ABGA showed pH 7.165, PaCO2 66.6 mmHg, PaO2 66.6 mmHg, and SaO2 87.1%.
Heparin treatment was initiated immediately on arrival to ICU and D-dimer was 9467 ng/ml. D-dimer increased to 52,796 ng/ml on postoperative day (POD) 2. PaO2 continuously improved and ABGA on POD 7 was pH 7.485, PaCO2 32.4 mmHg, PaO2 142.2 mmHg, and SaO2 99.0% (FiO2 0.4). The patient was extubated on POD 9. The patient was on heparin treatment for 20 days. D-dimer started to decrease and chest CT and echocardiography did not show any pulmonary or intracardiac emboli. The patient's vital signs came to within normal range and the patient was transferred to the general ward on POD 30.","Using the adjusted body weight formula, what is the patient's adjusted body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'height': [164.0, 'cm'], 'sex': 'Male', 'weight': [79.0, 'kg']}",67.90241,64.50729,71.29753,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Male.
The patient's height is 164.0 cm, which is 164.0 cm * 0.393701 in/cm = 64.56696 in. 
Plugging in the values for the IBW formula for males gives us 50 kg + 2.3 kg * (64.56696 (in inches) - 60) = 60.50401 kg.
Hence, the patient's IBW is 60.50401 kg.The patient's weight is 79.0 kg. To compute the ABW value, apply the following formula: ABW = IBW + 0.4 * (weight (in kg) - IBW (in kg)). ABW = 60.50401 kg + 0.4 * (79.0 kg  - 60.50401 kg) = 67.90241 kg. The patient's adjusted body weight is 67.90241 kg."
728,62,Adjusted Body Weight,physical,decimal,pmc-5564119-1,Extracted,"The patient was a 50-year-old man (height 159 cm, weight 69 kg) scheduled for extraction of impacted wisdom teeth (#18, 28, 38, and 48) and saucerization owing to chronic osteomyelitis in the right mandibular molar area. The patient had a history of heavy snoring, but was otherwise in good health. However, he had an extreme phobia of tooth extraction. The oral surgeon also determined that the procedure would be highly invasive; as a result, intravenous sedation was requested from the department of dental anesthesiology. We planned conscious sedation using dexmedetomidine to help secure the patient's airway during the extraction procedure. The authors also planned PCS for adequate titration of sedation levels. The patient received an explanation about the dental procedure under sedation, after which he provided written consents for the procedure and the case report.
The results of the pre-anesthesia examination performed the day before the surgery after the patient was admitted showed no specific findings, except eosinophil levels elevated to 13% in the blood test. He was given instruction for NPO for eight hours before the procedure and was sent to the operating room after securing an 18-gauge intravenous line in his left arm.
The PCS pump used was a Perfusor® Space PCA Infusion Pump System (B. Braun Medical Inc., Germany). Dexmedetomidine (Precedex 200 µg/2 ml) was diluted in normal saline to prepare a 50 ml solution at 4 µg/ml. Without setting a basal infusion dose in the PCS pump, the bolus dose, lock-out time, and injection speed were set to 0.1 µg/kg, 1 min, and 1,500 ml/h, respectively.
Electrocardiogram, noninvasive blood pressure, oxygen saturation, and bispectral index (BIS) monitors were attached to the patient. The patient held the PCS demand button in one hand and the patient was instructed to push the button if he felt any anxiety or pain. Oxygen was supplied through a nasal canula, while capnography measurements were obtained simultaneously ().
The sedation procedure took a total of 100 min, and the procedure included saucerization of the region around #37 and extraction of impacted wisdom teeth (#18, 28, 38, and 48). The single dose administered when the patient pushed the button was 1.73 ml, equivalent to 6.93 µg. The patient pushed the button a total of 13 times, but was pushed four times within the lock-out time; therefore, the drug was actually administered nine times, totaling 15.6 ml (62.4 µg).
The patient maintained his state of consciousness and was able to respond to commands. His respiratory rate and vital signs also remained within a normal range (). During the operation, the button was pushed several times during painful procedures. Afterwards, the BIS value dropped to around 60 once, but was maintained around 90 throughout. The serum dexmedetomidine concentrations calculated from the patient and the number of times the button was pushed are shown in . The patient was discharged the next day without any complications.","Using the adjusted body weight formula, what is the patient's adjusted body weight in terms of kg? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.","{'sex': 'Male', 'weight': [69.0, 'kg'], 'height': [159.0, 'cm']}",61.18588,58.12659,64.24517,"For males, the ideal body weight (IBW) is calculated as follows: IBW = 50 kg + 2.3 kg * (height (in inches) - 60)
For females, the ideal body weight (IBW) is calculated as follows: 45.5 kg + 2.3 kg * (height (in inches) - 60)
The patient's gender is Male.
The patient's height is 159.0 cm, which is 159.0 cm * 0.393701 in/cm = 62.59846 in. 
Plugging in the values for the IBW formula for males gives us 50 kg + 2.3 kg * (62.59846 (in inches) - 60) = 55.97646 kg.
Hence, the patient's IBW is 55.97646 kg.The patient's weight is 69.0 kg. To compute the ABW value, apply the following formula: ABW = IBW + 0.4 * (weight (in kg) - IBW (in kg)). ABW = 55.97646 kg + 0.4 * (69.0 kg  - 55.97646 kg) = 61.18588 kg. The patient's adjusted body weight is 61.18588 kg."
729,63,Delta Gap,lab test,decimal,pmc-4614622-1,Extracted,"A 22-year-old man presented to the emergency department (ED) with a history of tonic-clonic generalized seizures, loss of consciousness, and head trauma following consumption of 800 mg Tramadol. On admission the patient's vital signs were as follows: systolic blood pressure = 160 mm Hg, diastolic blood pressure = 80 mm Hg, O2 saturation = 85%, pulse rate = 106/min, respiratory rate = 24/min and axillary temperature = 37.4°C. Initial examination revealed agitation and bilateral pupil mydriasis with positive pupillary response to light. Arterial blood gas (ABG) analysis showed a high anion gap metabolic acidosis: pH = 6.80, PaCO2 = 30.4 mm Hg, HCO3 = 4.6 mEq/L, Na = 139 mEq/L, Cl = 108 mEq/L. The metabolic acidosis in this patient could not be explained solely by lactic acidosis following seizure activity so other potential causes were explored. A thorough history of the patient’s family revealed that the patient drank homemade alcohol three days prior to presentation. Methanol poisoning was diagnosed on the basis of the previously mentioned history and initial evaluation and the decision was made to begin hemodialysis. Due to the history of head trauma, a computed tomography scan (CT scan) of the brain was performed prior to sending the patient to the dialysis unit (). Protective measures including ethanol gavage, folic acid, and sodium bicarbonate were administered to the patient while waiting to begin hemodialysis. Hemodialysis was then performed for four hours. Following hemodialysis, the patient’s acidosis was reduced, and the clinical features were improved. Approximately one hour later, the patient’s level of consciousness decreased and unilateral mydriasis with negative pupillary light response (anisocoria) developed in the right eye. The patient was immediately intubated and brain CT scan was repeated (). A large epidural hematoma was seen in the right fronto-parietal lobe with evidence of mass effect. The patient was taken to the operating room for hematoma evacuation.",What is the patient's delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [108.0, 'mEq/L'], 'Bicarbonate': [4.6, 'mEq/L'], 'Sodium': [139.0, 'mEq/L']}",14.4,13.68,15.12,"To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 139.0 mEq/L. 
The concentration of chloride is 108.0 mEq/L. 
The concentration of bicarbonate is 4.6 mEq/L. 
Plugging in these values into the anion gap formula gives us 139.0 mEq/L - (108.0 mEq/L + 4.6 mEq/L) = 26.4 mEq/L. Hence, The patient's anion gap is 26.4 mEq/L.Plugging in 26.4 mEq/L for the delta gap formula, we get 26.4 - 12 = 14.4 mEq/L. Hence, the patient's delta gap is 14.4 mEq/L."
730,63,Delta Gap,lab test,decimal,usmle-5483,Extracted,"A 69-year-old man presents to the emergency department with shortness of breath that has been worsening over the past month. The patient states that he has had worsening shortness of breath that has progressed to shortness of breath with simple activities and minor exertion. When he was unable to climb the stairs to his house today, he decided to come to the emergency department. The patient has a past medical history of poorly managed diabetes mellitus, hypertension, end stage renal disease, and obesity. His current medications include insulin, metformin, lisinopril, hydrochlorothiazide, and ibuprofen. The patient is notably non-compliant with his medications. An EKG and chest radiograph are normal. The patient had dialysis two days ago and attends most of his appointments. Laboratory values are ordered and are seen below:

Serum:
Na+: 135 mEq/L
K+: 4.5 mEq/L
Cl-: 100 mEq/L
HCO3-: 19 mEq/L
Urea nitrogen: 29 mg/dL
Glucose: 75 mg/dL
Creatinine: 2.5 mg/dL
Ca2+: 9.2 mg/dL
Mg2+: 1.7 mEq/L
AST: 11 U/L
ALT: 11 U/L

Leukocyte count and differential:
Leukocyte count: 4,500/mm^3
Platelet count: 150,000/mm^3
Neutrophil: 54%
Lymphocyte: 25%
Monocyte: 3%
Eosinophil: 1%
Basophil: 1%

Hemoglobin: 8.2 g/dL
Hematocrit: 22%
Mean corpuscular volume: 82 µm^3

The patient appears comfortable at rest but demonstrates notable shortness of breath when exerting himself. His temperature is 99.5°F (37.5°C), pulse is 89/min, blood pressure is 144/85 mmHg, respirations are 10/min, and oxygen saturation is 97% on room air. Pulmonary and cardiac exam are within normal limits.",What is the patient's delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [100.0, 'mEq/L'], 'Bicarbonate': [19.0, 'mEq/L'], 'Sodium': [135.0, 'mEq/L']}",4,3.8,4.2,"To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 135.0 mEq/L. 
The concentration of chloride is 100.0 mEq/L. 
The concentration of bicarbonate is 19.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 135.0 mEq/L - (100.0 mEq/L + 19.0 mEq/L) = 16.0 mEq/L. Hence, The patient's anion gap is 16.0 mEq/L.Plugging in 16.0 mEq/L for the delta gap formula, we get 16.0 - 12 = 4.0 mEq/L. Hence, the patient's delta gap is 4.0 mEq/L."
731,63,Delta Gap,lab test,decimal,pmc-5661137-1,Extracted,"A 63-year-old woman with biopsy-confirmed SCLC metastatic to the liver developed rash and lesions to the face, chest, back, and oral mucosa that coincided with initiating topotecan therapy ( and B). A physical examination revealed erythematous edematous plaques with central tense bullae and crusting on the forehead, posterior auricular region, and chest. Multiple bullae drained serosanguinous fluid, Nikolsky’s sign was absent, and multiple ulcers were found within the oral mucosa.
A skin biopsy revealed dermatitis that was initially suspected to be due to a drug reaction. However, her symptoms worsened despite oral prednisone therapy and discontinuation of topetecan. One week after rash onset, she developed angioedema, generalized weakness, and myalgia most prominent in her proximal extremities. The patient also reported difficulty transferring from her bed or lifting her upper extremities. Laboratory findings revealed abnormal levels of: creatine phosphokinase (CPK) 25,865 IU/L (normal range 26-174), aldolase 40.3 U/L, sodium 125 mmol/L (normal range 135-146), chloride 71 mmol/L (normal range 96-107), bicarbonate 17 mmol/L (normal range 21-31), lactic acid 7.1 mmol/L (normal range 0.5-22), aspartate transaminase (AST) 878 IU/L (normal range 0-32), alanine transaminase (ALT) 312 IU/L (normal range 10-35), white blood cells 15.45 K/uL (normal 4.8-10.8). Urine analysis found large blood on dipstick and <1 red blood cell per high-powered field.
Bedside sonogram showed trace pericardial effusion and grossly preserved cardiac contractility. Magnetic resonance imaging of her neck revealed soft tissue thickening and diffuse heterogeneous enhancement of muscles. Histopathologic examination of her left bicep muscle showed strongly-positive HLA Class I immunohistochemistry without myofiber necrosis and mild-to-moderate type 2 myofiber atrophy ( and B). Antinuclear antibody titer was positive at a 1:640 dilution with a speckled pattern. Antip155/ 140 antibody was positive. The remainder of the myositis antibody comprehensive panel, extractable nuclear antigen screening (anti-ENA), and paraneoplastic autoantibody panel were negative (anti-Jo- 1, anti-SSA 52, anti-SSA 60, anti-Mi-2, anti-PL-7, anti-PL-12, anti-EJ, anti-Ku, anti-U2 sn RNP, anti-SRP, anti-OJ, anti PM/Scl complex, anti-neuronal nuclear antibody types 1, 2, and 3; anti-glial nuclear antibody, anti-PCA-1, anti-PCA2, anti- PCA-Tr, anti-Amphiphysin, anti-CRMP-5, anti-striational, anti-P/Q-type calcium channel, anti-N-type calcium channel, anti- Ach receptor binding antibody, anti-ACHr Ganglionic neuronal antibody).
The patient was initially treated with intravenous fluids and oral prednisone. She was then advanced to intravenous methylprednisolone and intravenous immunoglobulin therapy, resulting in a gradual decline of the CPK level to less than 1300 IU/L and improvement of her rash and erythematous plaques. During this time, she had progressive dysphagia, odynophagia, and oral thrush concerning for esophageal candidiasis. Despite treatment with oral nystatin rinses, which resolved her oral thrush, the patient continued to have worsening symptoms of dysphagia. Videoscopy revealed acutely-worsening dysphagia and CT-imaging demonstrated laryngeal edema. She was intubated to protect her airway, started on plasmapheresis, and fed through a nasogastric tube. Although the CPK level declined to less than 1000 IU/L, her edema and weakness persisted. Thereafter, the patient was transferred to hospice care and comfort measures were implemented.",What is the patient's delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [71.0, 'mmol/L'], 'Bicarbonate': [17.0, 'mmol/L'], 'Sodium': [125.0, 'mmol/L']}",25,23.75,26.25,"To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 125.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 125.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 125.0 mmol * 1 mEq/mmol = 125.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 125.0 mmol sodium/L converts to 125.0 mEq sodium/L. 
The concentration of chloride is 71.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 71.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 71.0 mmol * 1 mEq/mmol = 71.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 71.0 mmol chloride/L converts to 71.0 mEq chloride/L. 
The concentration of bicarbonate is 17.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 17.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 17.0 mmol * 1 mEq/mmol = 17.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 17.0 mmol bicarbonate/L converts to 17.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 125.0 mEq/L - (71.0 mEq/L + 17.0 mEq/L) = 37.0 mEq/L. Hence, The patient's anion gap is 37.0 mEq/L.Plugging in 37.0 mEq/L for the delta gap formula, we get 37.0 - 12 = 25.0 mEq/L. Hence, the patient's delta gap is 25.0 mEq/L."
732,63,Delta Gap,lab test,decimal,pmc-7748582-1,Extracted,"The patient discussed in this case report is a 53-year-old male with a past medical history of hypertension, hyperlipidemia, and diabetes mellitus type 2, managed on metformin and canagliflozin. After undergoing a routine laparoscopic appendectomy, his postoperative course remained uneventful. He started tolerating oral feeds, having bowel movements and remained hemodynamically stable. Therefore, he was discharged two days after the surgery. However, a few hours later, on the day of discharge, he presented to the emergency department with sudden onset generalized abdominal pain, non-exertional shortness of breath, and fever.
On presentation, he was febrile (temperature: 100.7°F), tachycardia (heart rate: 114 bpm), tachypneic (respiratory rate: 30/min), and hypoxic with an oxygen saturation of 87% on room air. His physical examination was benign; lungs were clear to auscultation bilaterally and soft, non-tender abdomen. The surgical site looked clean, without any discharge, and was non-tender to touch.
The patient’s initial laboratory measurements were all within normal limits: blood glucose 126 mg/dL, sodium 134 mmol/L, potassium 4.5 mmol/L, chloride 105 mmol/L, bicarbonate 17 mEq/L, blood urea nitrogen (BUN) 11 mg/dL, and creatinine 0.9 mg/dL. The exception was his pH of 7.21. The patient was started on four liters nasal cannula, switched to non-rebreather as he remained hypoxic, and was subsequently admitted to the hospital for further management. A septic workup was initiated, and the patient was placed on empiric antibiotics.
Further laboratory results revealed positive serum ketones (beta-hydroxybutyrate 2.69 mmol/L), whereas the urinalysis revealed glucosuria (urine glucose > 1500 mg/dL) and ketonuria and no proteins. A urine culture was negative for any infectious growth. Serum lactate was 13 mg/dL. A computerized axial tomography (CAT) scan of the patient’s chest showed bilateral lower lobe consolidations suggestive of probable pneumonia. A CAT scan of his abdomen showed probable postoperative ileus with no obstruction or abscess. On further questioning, the patient reported having resumed canagliflozin and his regular diet as instructed upon being discharged.
Due to a high anion gap and positive ketones in the blood with normal blood glucose levels, the patient was diagnosed with euglycemic diabetic ketoacidosis secondary to his SGLT2-inhibitor use. Thus, canagliflozin was stopped, and the patient was started on an insulin drip with 10% dextrose. Subsequently, he was transferred to the intensive care unit (ICU) for closer monitoring. The patient’s condition started improving after the treatment with insulin and dextrose. On day two, following admission, his symptoms improved. On day three following admission, he was switched from an insulin drip to subcutaneous insulin and sliding scale as his laboratory results approached normal, with an anion gap of 13.2 mEq/L and beta-hydroxybutyrate of 0.81 mmol/L. With symptom resolution, the patient was then returned to the floor. However, his urine glucose remained high (>1500 mg/dL).
Discharged the next day and advised to continue subcutaneous insulin for a week, the patient was asked to consult his endocrinologist for further management. He was also recommended against resuming canagliflozin.",What is the patient's delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [105.0, 'mmol/L'], 'Bicarbonate': [17.0, 'mEq/L'], 'Sodium': [134.0, 'mmol/L']}",0,0,0,"To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 134.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 134.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 134.0 mmol * 1 mEq/mmol = 134.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 134.0 mmol sodium/L converts to 134.0 mEq sodium/L. 
The concentration of chloride is 105.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 105.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 105.0 mmol * 1 mEq/mmol = 105.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 105.0 mmol chloride/L converts to 105.0 mEq chloride/L. 
The concentration of bicarbonate is 17.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 134.0 mEq/L - (105.0 mEq/L + 17.0 mEq/L) = 12.0 mEq/L. Hence, The patient's anion gap is 12.0 mEq/L.Plugging in 12.0 mEq/L for the delta gap formula, we get 12.0 - 12 = 0 mEq/L. Hence, the patient's delta gap is 0 mEq/L."
733,63,Delta Gap,lab test,decimal,pmc-2852807-1,Extracted,"A 39-year-old man visited an emergency room because of dyspnea for 1 week. Seventeen years prior to admission, he was diagnosed with acute lymphoid leukemia in another hospital. One year ago, he was admitted to this hospital with general weakness, and a bone marrow biopsy showed leukemia recurrence. The bone marrow biopsy revealed acute pre-B cell acute lymphoblastic leukemia (ALL), group II with aberrant expression of CD33. Upon fluorescence in situ hybridization, p16 (CEP9) deletion on chromosome 9p21 was detected. After reinduction chemotherapy with vincristine, prednisolone, daunorubicin, and L-asparaginase (VPDL), he achieved a hematological but not a cytogenetic response. Upon admission, no specific sign was present except tachypnea, (respiratory rate 36 breaths/min). Blood pressure was 120/70 mmHg, pulse rate was 100 bpm, and body temperature was 36.9℃. No hepatomegaly was noted.
Laboratory data showed pH 7.206, PaCO2 11.7 mmHg, PaO2 131.3 mmHg, bicarbonate 4.5 mmol/L, and base excess -21.1. Serum sodium was 133 mEq/L, potassium 4.1 mEq/L, chloride 102 mEq/L. The complete blood cell count showed a white blood cell of 3,200/µL, hemoglobin 9.6 g/dL, and platelet count of 83,000/µL. The differential count showed 61% neutrophils, 27% lymphocytes, 11% immature cells, 1% band neutrophils, and no basophils, eosinophils or monocytes. The coagulation profile was within the normal range. Blood chemistry showed 17 mg/dL blood urea nitrogen, 0.8 mg/dL creatinine, 4.5 g/dL albumin, 8 IU/L aspartate aminotransferase, 5 IU/L alanine aminotransferase, 0.67 mg/dL total bilirubin, and 302 IU/L lactate dehydrogenase. C-reactive protein was 1.34 mg/dL. The random plasma glucose level in the emergency room was 179 mg/dL. Peripheral blood morphology examination showed 20% blasts with some spherocytes and tear drop cells. Serum thiamine level was 18.60 ng/mL (normal range, 21.3-81.9 ng/mL). A chest radiography showed no active infiltrative lesions.
Continuous bicarbonate replacement therapy was performed to maintain cardiovascular stability. Arterial blood gas analysis improved to pH 7.346, PaCO2 20.1 mmHg, PaO2 135.2 mmHg, H CO3- 10.7 mmol/L, and base excess of -12.3 mmol/L. The blood lactate level was not checked in the emergency room. On day 3 of admission, a bone marrow biopsy was performed, and the result showed that ALL was sustained. Re-induction chemotherapy with vincristine and prednisone (VP) regimen was started immediately. Lactate was 11.6 mmol/L on day 2 of chemotherapy. After 3 weeks, lactate level decreased to 4.6 mmol/L.
After finishing the chemotherapeutic schedule, leukemic blasts still showed on the follow-up bone marrow examination, and the number and percentage of blast cells in the peripheral blood started to increase. As the number of immature cells in peripheral blood increased, the lactic acid began to increase again. The serum lactic acid level fluctuated from 12 to 20 mmol/L, regardless of bicarbonate replacement. However, the patient was asymptomatic and blood pH remained neutral without bicarbonate replacement therapy. On day 147 of admission, the patient expired as a result of disease progression combined with uncontrolled infection.",What is the patient's delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [102.0, 'mEq/L'], 'Bicarbonate': [4.5, 'mmol/L'], 'Sodium': [133.0, 'mEq/L']}",14.5,13.775,15.225,"To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 133.0 mEq/L. 
The concentration of chloride is 102.0 mEq/L. 
The concentration of bicarbonate is 4.5 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 4.5 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 4.5 mmol * 1 mEq/mmol = 4.5 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 4.5 mmol bicarbonate/L converts to 4.5 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 133.0 mEq/L - (102.0 mEq/L + 4.5 mEq/L) = 26.5 mEq/L. Hence, The patient's anion gap is 26.5 mEq/L.Plugging in 26.5 mEq/L for the delta gap formula, we get 26.5 - 12 = 14.5 mEq/L. Hence, the patient's delta gap is 14.5 mEq/L."
734,63,Delta Gap,lab test,decimal,pmc-5295522-1,Extracted,"A 27-year-old African American female presented to the hospital after a sudden onset of severe retrosternal chest pain. Past medical history was insignificant for hypertension or diabetes mellitus. Patient has a history of smoking cigarettes, beginning at age 9, and frequent marijuana use. The patient was treated with morphine and Percocet for pain. Lab data and urine toxicology screen were negative for troponins and significant for marijuana, respectively. Urine drug screen was negative for cocaine and amphetamines. Drug screen was positive for opiates, but this result is most likely an artifact of morphine and Percocet treatment for chest pain. Initial laboratory findings included hemoglobin 12 g/dL, hematocrit 12.6%, platelets 223 × 103/μL, glucose 156 mg/dL, BUN 9 mg/dL, creatinine 0.8 mg/dL, sodium 135 mEq/L, potassium 4 mEq/L, chloride 101 mEq/L, and bicarbonate 18 mEq/L. In the emergency room, vital signs demonstrated a pulse rate of 98 beats/min, respiratory rate 22 breaths/min, blood pressure 132/89 mm Hg, temperature 98.1 °F, and oxygen saturation 100% on room air. The remainder of the physical examination was unremarkable. Initial electrocardiogram (ECG) demonstrated normal sinus rhythm, and the patient was admitted to telemetry for observation. The subsequent morning, the patient actively experienced chest pain and ECG changes. ECG demonstrated ST segment elevations in leads II and III, and T-wave inversions in V1-V3. Stat troponin level was found to be elevated at 11.07 ng/mL (< 0.30 ng/mL). The patient immediately underwent cardiac catheterization which demonstrated a 99% blockage of the left anterior descending artery and revascularization was performed (, ). Two-dimensional echocardiogram demonstrated a left ventricular ejection fraction of 40% with anterior wall akinesis. Transesophageal echocardiogram ruled out an apical mural thrombus, but confirmed the ejection fraction and wall akinesis from the previous echocardiogram. The patient was also found to have hyperlipidemia after the conduction of a lipid panel. Hypercoaguable state and vasculitis workup was negative.",What is the patient's delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Sodium': [135.0, 'mEq/L'], 'Bicarbonate': [18.0, 'mEq/L'], 'Chloride': [101.0, 'mEq/L']}",4,3.8,4.2,"To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 135.0 mEq/L. 
The concentration of chloride is 101.0 mEq/L. 
The concentration of bicarbonate is 18.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 135.0 mEq/L - (101.0 mEq/L + 18.0 mEq/L) = 16.0 mEq/L. Hence, The patient's anion gap is 16.0 mEq/L.Plugging in 16.0 mEq/L for the delta gap formula, we get 16.0 - 12 = 4.0 mEq/L. Hence, the patient's delta gap is 4.0 mEq/L."
735,63,Delta Gap,lab test,decimal,pmc-4488998-1,Extracted,"A 41-year-old female, with a past medical history of DM1 treated with insulin glargine and insulin aspart, presented with a 1-day history of diffuse abdominal pain and weakness. Her symptoms were associated with chills, nausea, and just one episode of emesis. Over the preceding 4 days, the patient had developed a Bartholin's gland cyst infection with abscess formation. She admitted to abstaining from any solid food intake in the previous 2 days; however, she maintained her liquid intake and continued taking her insulin glargine without insulin aspart. She denied any alcohol intake or drug abuse. Her vital signs were within normal limits. Physical examination was significant for diffuse abdominal tenderness without rigidity or guarding and a ruptured Bartholin's gland abscess with drainage to the skin. Blood work showed a white blood cell (WBC) count of 13,000 cells/mcL (normal range: 4,500-10,000/mcL), hemoglobin level 11.2 mg/dL (normal range: 12.3-15.3 g/dL), platelet count 448,000/mcL (normal range: 150,000-450,000/mcL), sodium 135 mmol/L (normal range: 136-145 mmol/L), potassium 3.6 mmol/L (normal range: 3.5-5.1 mmol/L), chloride 105 mmol/L (normal range: 98-107 mmol/L), bicarbonate 6 mmol/L (normal range: 21-32 mmol/L),  urea nitrogen 4 mg/dL (normal range: 7-18 mg/dL), creatinine 0.58 mg/dL (normal range: 0.6-1.3 mg/dL), glucose 191 mg/dL (normal range: 70-100 mg/dL), beta hydroxybutyrate >4.5 mg/dL (normal range: <0.4 mg/dL), magnesium 1.3 mg/dL (normal range: 1.6-2.3 mg/dL), phosphorus 1.3 mg/dL (normal range: 2.5-4.9 mg/dL), lactate 0.8 mmol/L (normal range: 0.4-2 mmol/L), and HBA1C 12.5% (normal range: 4-5.6%). Urinalysis was significant for +3 ketones and sugar. Arterial blood gas showed pH 7.07, pCO2 12. A urine drug screen was negative, and serum ethanol level was undetectable.
The patient was diagnosed with euglycemic DKA precipitated by an underlying infection. Intravenous fluid (IVF) resuscitation with normal saline was initially started at a rate of 1.0 L/h for a total of 2 L. The patient's hydration status, serum electrolytes, blood urea nitrogen (BUN), creatinine, glucose, and urine output were monitored closely. After 2 h, repeat blood work showed a serum sodium 141 mmol/L, carbon dioxide 8 mmol/L, potassium 3.5 mmol/L, and glucose 153 mg/dL. Subsequently, IVFs were switched to 5% dextrose and 0.45% NaCl at a rate of 250 cc/h, and an insulin drip at a rate of 5 units/h was started. Then, 30 mEq potassium was added to each liter of the IVF, excluding the first liter, targeting a serum potassium level of 4-5 mEq/L. After 11 h, blood work revealed a serum bicarbonate level of 16 mmol/L with a normal anion gap; hence, subcutaneous insulin and oral intake were initiated. Intravenous insulin was continued for another hour to ensure adequate plasma insulin levels. The Bartholin's gland abscess was treated, and the patient was discharged on the following day.",What is the patient's delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Sodium': [135.0, 'mmol/L'], 'Chloride': [105.0, 'mmol/L'], 'Bicarbonate': [6.0, 'mmol/L']}",12,11.4,12.6,"To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 135.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 135.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 135.0 mmol * 1 mEq/mmol = 135.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 135.0 mmol sodium/L converts to 135.0 mEq sodium/L. 
The concentration of chloride is 105.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 105.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 105.0 mmol * 1 mEq/mmol = 105.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 105.0 mmol chloride/L converts to 105.0 mEq chloride/L. 
The concentration of bicarbonate is 6.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 6.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 6.0 mmol * 1 mEq/mmol = 6.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 6.0 mmol bicarbonate/L converts to 6.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 135.0 mEq/L - (105.0 mEq/L + 6.0 mEq/L) = 24.0 mEq/L. Hence, The patient's anion gap is 24.0 mEq/L.Plugging in 24.0 mEq/L for the delta gap formula, we get 24.0 - 12 = 12.0 mEq/L. Hence, the patient's delta gap is 12.0 mEq/L."
736,63,Delta Gap,lab test,decimal,usmle-5168,Extracted,"A 5-year-old boy presents to the emergency department with sudden onset nausea and vomiting that started 2 hours ago. The patient's parents can not recall any inciting event and state that he very suddenly started acting irritable, started vomiting, and experienced 1 episode of diarrhea. His temperature is 98.7°F (37.1°C), blood pressure is 90/50 mmHg, pulse is 160/min, respirations are 29/min, and oxygen saturation is 99% on room air. The patient experiences 1 episode of bloody emesis while in the emergency department. Laboratory values are ordered as seen below.

Serum:
Na+: 140 mEq/L
Cl-: 100 mEq/L
K+: 4.3 mEq/L
HCO3-: 19 mEq/L
Glucose: 99 mg/dL
Creatinine: 1.1 mg/dL
Ca2+: 10.2 mg/dL

Radiography is performed and is notable for radiopaque objects in the gastrointestinal tract.",What is the patient's delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Sodium': [140.0, 'mEq/L'], 'Bicarbonate': [19.0, 'mEq/L'], 'Chloride': [100.0, 'mEq/L']}",9,8.55,9.45,"To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 140.0 mEq/L. 
The concentration of chloride is 100.0 mEq/L. 
The concentration of bicarbonate is 19.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 140.0 mEq/L - (100.0 mEq/L + 19.0 mEq/L) = 21.0 mEq/L. Hence, The patient's anion gap is 21.0 mEq/L.Plugging in 21.0 mEq/L for the delta gap formula, we get 21.0 - 12 = 9.0 mEq/L. Hence, the patient's delta gap is 9.0 mEq/L."
737,63,Delta Gap,lab test,decimal,pmc-3849624-1,Extracted,"The patient, a 52-year-old healthy woman without a significant past medical history, presented to a community care center complaining of 5 days of productive cough, diffuse myalgia, and subjective fever with chills. She was prescribed a course of azithromycin for presumed bronchitis. The following day, she presented to her local emergency department with acute onset of severe shortness of breath and associated chest pain. She was found to be hypotensive (90/60 mmHg), tachycardic (115 beats/min), and was admitted to the intensive care unit (ICU) with a presumptive diagnosis of septic shock. Norepinephrine and empiric IV vancomycin and piperacillin/tazobactam were started. Initial labs revealed: white blood cell count (WBC) 12.7/μL with 77.9% neutrophils, hemoglobin 12.7 g/dl, hematocrit 39.8%, platelets 141, lactate 8.2 mmol/L, sodium (Na) 149 mmol/L, potassium (K) 4.3 mmol/L, bicarbonate 16 mmol/L, chloride (Cl) 115, blood urea nitrogen (BUN) 28, creatinine (Cr) 1.3 mg/dl, blood glucose 214 mg/dl, aspartate aminotransferase (AST) 128 IU/L, alanine aminotransferase (ALT) 200, alkaline phosphatase (AP) 104 IU/L, serum troponin I 12.6 ng/ml, and creatine phosphokinase (CPK) 339 U/L. Her electrocardiogram revealed an accelerated junctional rhythm with a rate of 115 beats/min, poor R wave progression and low voltage. An emergent transthoracic echocardiogram (TTE) showed severely impaired left ventricular (LV) function with an estimated ejection fraction (EF) of 10%. Within 24 hours of presentation her condition deteriorated and she required intubation and mechanical ventilation. The patient then was transferred to our center for further management.
Upon arrival the patient was intubated, sedated, and afebrile. Her blood pressure was 70/40 mmHg and she had a heart rate of 110 beats/min. Examination revealed bilateral crepitations in the lungs, normal heart sounds and a benign abdomen. Her skin was mottled; and her extremities were cold and clammy. There was no pedal edema. Chest radiograph revealed diffuse bilateral patchy infiltrates and pulmonary vascular congestion. A repeat TTE demonstrated a left ventricular ejection fraction of 10%, normal LV and RV dimensions, moderate mitral regurgitation, left ventricle wall thickness of 12 mm, and global hypokinesis of LV with minor regional variation. There was no evidence of a pericardial effusion. Notable labs were a WBC 14.8/μL with 82% neutrophils, hematocrit 36.5%, platelets 113, CPK 365 U/L, troponin 7.6 ng/ml and Cr 0.76 mg/dl. The patient remained hypotensive despite maximum doses of norepinephrine, dobutamine and vasopressin. She was continued on empiric antibiotics and empiric oseltamivir (75 mg twice daily) was added. Immediate left and right heart catheterization demonstrated normal coronary anatomy, with a cardiac index of 1.16 L/min/m2. Emergent venoarterial ECMO (flow = 4 L/min) was placed via left common femoral vein and artery.
On day 3 of hospitalization, pulmonary congestion significantly improved but another repeat TTE showed persistent severe LV systolic dysfunction with an EF of 15%. Endotracheal aspiration at admission returned positive for influenza B by polymerase chain reaction (PCR). Right ventricular endomyocardial biopsy was performed on hospital day 3 (total 4 specimens). Histopathology was negative for inflammation. Immunohistochemical stain for parvovirus B19, HHV6, HSV and PCR for enteroviruses, EBV and CMV were all negative. Bronchoscopy revealed mild mucosal erythema with clear secretions. The bronchoalveolar lavage (BAL) fluid was negative for enteroviruses, adenoviruse, CMV, EBV and HSV by PCR. Blood, BAL and urine cultures were negative for bacterial growth and empiric antimicrobials were stopped on day 5 and oseltamivir was continued for a total of 7 days.
The patient’s clinical status gradually improved, inotropic support was stopped and a repeat TTE on day 7 showed significant recovery of left ventricular function with an estimated EF of 50%, and ECMO support was able to be withdrawn.
The patient was extubated on hospital day 8; low doses of a β -blocker and an angiotensin converting enzyme inhibitor were started. The patient’s course was complicated by a pseudoaneurysm of the left common femoral artery secondary to the ECMO therapy, which was repaired successfully. She was discharged on hospital day 15. Transthoracic echocardiography one month after discharge demonstrated normal LV systolic function with an EF of 60%, normal LV wall thickness, trace mitral regurgitation and no ventricular dilation.
During the 1918–1919 influenza pandemic an association between myocarditis and influenza viruses was noted during an autopsy study []. While there have been reports of fulminant myocarditis or cardiomyopathy associated with influenza B in children, it has very rarely been reported in adults [,-]. In 1958, a group of four patients with pericarditis, subacute myocarditis, and fatal chronic myocarditis associated with influenza B were documented []. Ray CG et al. described a 34-year-old healthy woman who presented with acute onset of dilated cardiomyopathy and cardiogenic shock following a few days of flu like syndrome. She had a very complicated course and died 6 weeks after the onset of symptoms. Influenza B virus was isolated from the nasopharynx and the diagnosis of acute myocarditis was confirmed by cardiac autopsy [].
McCarthy et al. described fulminant myocarditis as a distinct clinical presentation of abrupt onset of severe heart failure and cardiogenic shock preceded by a viral syndrome similar to our patient []. The typical echocardiographic findings in fulminant myocarditis are described as near normal ventricular dimensions, severely depressed LV systolic function, and increased left ventricle wall thickness []. Histological diagnosis of fulminant myocarditis can be difficult especially in the early phase of disease. The limited sensitivity of cardiac biopsy for detection of myocarditis is well recognized and negative cardiac biopsies results cannot exclude the diagnosis of myocarditis []. Myocarditis usually presents as a focal or patchy infiltration predominantly in the lateral free wall of the left ventricle and often not involving the right ventricle, therefore, biopsies taken from the right ventricle could be falsely negative [].
This patient’s clinical presentation of refractory cardiogenic shock 6 days after the onset of influenza and severely impaired left ventricular systolic function, and subsequent normalization of ventricular function after recovery of her viral illness; taken together with her typical echocardiogram findings in the setting of normal coronaries supports the clinical diagnosis of viral fulminant myocarditis; regardless of non diagnostic right ventricle biopsies. During influenza infection, severe myocardial dysfunction can be caused not only by direct injury to cardiac myocytes but also by overexpression of cytokines and severe inflammatory response to viral infection resulting cytokine and humoral mediated forms of myocarditis with no cellular infiltrate.
The reason for the unexpected severity of influenza B infection in our patient was not clear. Clinical data about risk factors and complications of influenza B are limited. Her only past medical history was remote myasthenia gravis and thymectomy over 20 years prior. The predominant circulating B strain was B/Wisconsin/1/2010- LIKE when the patient presented to the hospital, which was matched with the B component of the 2012–2013 vaccine []. We do not know if the patient had received an influenza vaccine this season. The possible lack of immunologic memory for this infection might have contributed to the severity of influenza B virus infection in our patient. Increasing awareness among patients and physicians about the importance of vaccination as the most important strategy for minimizing the severe complications of influenza infection could help to prevent similar cases in the future.
The treatment of influenza associated fulminant myocarditis still remains supportive. Studies have shown the early use of mechanical circulatory support for patients with fulminant myocarditis and cardiogenic shock who fail aggressive pharmacologic treatment would increase survival rate [,]. Our patient received oseltamivir, standard heart failure treatment but more important early initiation of ECMO support before irreversible organ failure developed.",What is the patient's delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Sodium': [149.0, 'mmol/L'], 'Chloride': [115.0, 'mEq/L'], 'Bicarbonate': [16.0, 'mmol/L']}",6,5.7,6.3,"To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 149.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 149.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 149.0 mmol * 1 mEq/mmol = 149.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 149.0 mmol sodium/L converts to 149.0 mEq sodium/L. 
The concentration of chloride is 115.0 mEq/L. 
The concentration of bicarbonate is 16.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 16.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 16.0 mmol * 1 mEq/mmol = 16.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 16.0 mmol bicarbonate/L converts to 16.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 149.0 mEq/L - (115.0 mEq/L + 16.0 mEq/L) = 18.0 mEq/L. Hence, The patient's anion gap is 18.0 mEq/L.Plugging in 18.0 mEq/L for the delta gap formula, we get 18.0 - 12 = 6.0 mEq/L. Hence, the patient's delta gap is 6.0 mEq/L."
738,63,Delta Gap,lab test,decimal,usmle-9759,Extracted,"A 71-year-old African American man is brought to the emergency department with a worsening productive cough and dyspnea for 2 days. He has had generalized bone pain for 2 months. He was admitted for pyelonephritis last month. He also received outpatient treatment for pneumonia almost 2 months ago. Over the past 2 months, he has been taking over-the-counter ibuprofen for pain as needed. He appears anxious. The vital signs include: temperature 38.8°C (101.8°F), pulse 95/min, respiratory rate 20/min, and blood pressure 155/90 mm Hg. The conjunctivae are pale. Crackles are heard in the right lower lobe. The cardiac examination shows no abnormalities. The laboratory studies show the following:
Hemoglobin 9 g/dL
Mean corpuscular volume 95 μm3
Leukocyte count 13,500/mm3
Segmented neutrophils 75%
Lymphocytes 25%
Platelet count 240,000/mm3
ESR 85 mm/hr
Serum
Na+ 135 mEq/L
K+ 4.2 mEq/L
Cl− 113 mEq/L
HCO3− 20 mEq/L
Ca+ 12.4 mg/dL
Albumin 4 g/dL
Urea nitrogen 38 mg/dL
Creatinine 2.2 mg/dL
A chest X-ray shows a right lower lobe opacity and blurring of the ipsilateral diaphragmatic dome. Skull and pelvic X-rays are performed (see image).",What is the patient's delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [113.0, 'mEq/L'], 'Bicarbonate': [20.0, 'mEq/L'], 'Sodium': [135.0, 'mEq/L']}",-10,-9.5,-10.5,"To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 135.0 mEq/L. 
The concentration of chloride is 113.0 mEq/L. 
The concentration of bicarbonate is 20.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 135.0 mEq/L - (113.0 mEq/L + 20.0 mEq/L) = 2.0 mEq/L. Hence, The patient's anion gap is 2.0 mEq/L.Plugging in 2.0 mEq/L for the delta gap formula, we get 2.0 - 12 = -10.0 mEq/L. Hence, the patient's delta gap is -10.0 mEq/L."
739,63,Delta Gap,lab test,decimal,usmle-4395,Extracted,"A 72-year-old man presents to the emergency department for a change in his behavior. The patient's wife called 911 and he was brought in by emergency medical services. She noticed that he seemed somnolent and not very responsive. The patient has a past medical history of type II diabetes, obesity, osteoarthritis, and migraine headaches. His current medications include naproxen, insulin, atorvastatin, metformin, ibuprofen, omeprazole, and fish oil. His temperature is 99.5°F (37.5°C), blood pressure is 170/115 mmHg, pulse is 80/min, respirations are 19/min, and oxygen saturation is 98% on room air. On physical exam, the patient is somnolent and has a Glasgow Coma Scale of 11. Cardiac and pulmonary exams are notable for bibasilar crackles and a systolic murmur that radiates to the carotids. Neurological exam is deferred due to the patient's condition. Laboratory values are shown below.

Hemoglobin: 12 g/dL
Hematocrit: 36%
Leukocyte count: 9,500 cells/mm^3 with normal differential
Platelet count: 199,000/mm^3

Serum:
Na+: 144 mEq/L
Cl-: 98 mEq/L
K+: 4.0 mEq/L
HCO3-: 16 mEq/L
BUN: 44 mg/dL
Glucose: 202 mg/dL
Creatinine: 2.7 mg/dL
Ca2+: 9.2 mg/dL
AST: 12 U/L
ALT: 22 U/L

The patient is started on IV fluids.",What is the patient's delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [98.0, 'mEq/L'], 'Bicarbonate': [16.0, 'mEq/L'], 'Sodium': [144.0, 'mEq/L']}",18,17.1,18.9,"To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 144.0 mEq/L. 
The concentration of chloride is 98.0 mEq/L. 
The concentration of bicarbonate is 16.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 144.0 mEq/L - (98.0 mEq/L + 16.0 mEq/L) = 30.0 mEq/L. Hence, The patient's anion gap is 30.0 mEq/L.Plugging in 30.0 mEq/L for the delta gap formula, we get 30.0 - 12 = 18.0 mEq/L. Hence, the patient's delta gap is 18.0 mEq/L."
740,63,Delta Gap,lab test,decimal,pmc-8182158-1,Extracted,"A 12-year-old boy who experienced a cardiac arrest was referred to our emergency department from a local hospital in January 2020. His medical history revealed a cardiac fibroma that was detected prenatally. After birth, the fibroma was partially resected twice at another hospital, as the size and extent of the tumor prohibited single-stage resection. Heart transplantation was considered at the time. At the age of 2 years, he experienced cardiac arrest and was admitted to the same hospital. At that time, ventricular tachycardia was repeatedly detected. He developed central nervous system complications, including hypoxic-ischemic encephalopathy and quadriplegia, after which he had received oral amiodarone. Later, hydrocephalus was detected on brain magnetic resonance imaging, and he was treated with a ventriculo-peritoneal shunt.
The patient’s medication was discretionally discontinued at 10 years of age. At 12 years of age, he experienced a cyanotic spell at home and was unable to breathe. He received cardiopulmonary resuscitation from his father. When the rescue squad arrived, they determined that he was in ventricular fibrillation. Defibrillation was performed, and sinus rhythm was restored. The boy was transported to a local hospital where he received endotracheal intubation. Thereafter, he was referred to our hospital, where he was admitted to the pediatric intensive care unit.
On admission, the patient’s blood pressure and heart rate were 115/70 mm Hg and 151 beats per minute, respectively. He was intubated and was in a stuporous state. Cardiac murmurs were not heard on chest auscultation. Venous blood gas analysis revealed pH, 7.22; pCO2, 58 mm Hg; pO2, 28 mm Hg; HCO3, 18.9 mmol/L; and SvO2, 39%. Serum biochemical analysis showed a lactate level of 9.25 mmol/L. The levels of serum electrolytes were as follows: sodium, 142 mEq/L; potassium, 3.6 mEq/L; chloride, 109 mEq/L; total calcium, 8.4 mEq/L; ionized calcium, 2.3 mEq/L; inorganic phosphorous, 4.0 mg/dL; and magnesium, 1.7 mg/dL. Serum cardiac enzyme levels were as follows: creatine kinase, 155 IU/L; creatine kinase-MB, 3.37 ng/mL; troponin-T, 0.137 ng/mL; and pro-brain natriuretic peptide, 85.9 pg/ml. Cardiomegaly was observed on chest radiography (). Electrocardiogram showed sinus tachycardia with intermittent monomorphic ventricular premature contractions (VPCs). On the 1st day of hospitalization, the patient was supported by mechanical ventilation, without an intravenous inotropic agent. On the 2nd day, VPCs preceded abrupt ventricular fibrillation. He was resuscitated with sinus rhythm restoration following cardiopulmonary resuscitation and defibrillation (2 J/kg). Transthoracic echocardiography () and cardiac computed tomography () demonstrated a known fibroma (about 9.5 cm × 5.5 cm) in the anteroseptal wall of the left ventricle without blood flow obstruction. Soon after, he developed ventricular tachycardia (), and direct current cardioversion was performed along with intravenous amiodarone administration. Additionally, intravenous dopamine was administered for hypotension management. From the third to 9th days of hospitalization, he experience recurrent ventricular tachycardia refractory to multiple (45 times) direct current cardioversions (2 to 4 J/kg) and aggressive administration of antiarrhythmic agents (intravenous amiodarone and lidocaine). Although we suspected that the fibroma induced the arrhythmia, we believed additional partial resection of the tumor would not prevent it. Further, the patient’s poor neurocognitive and psychomotor states posed additional considerations for management. On the 10th day of hospitalization, he underwent an electrophysiology study, and a single-chamber implantable cardioverter defibrillator (ICD) generator (Visia AF MRI XT VR SureScan; Medtronic, Minneapolis, MN, USA) with a lead (model 6935M-62cm, Medtronic) attached to the right ventricle was inserted (). On the 11th day, weaning from mechanical ventilation was initiated. Additionally, the intravenous antiarrhythmic agents were discontinued, and oral amiodarone (10 mg/kg/day) and propranolol (0.75 mg/kg/day) were prescribed. On the 18th day, in the absence of an episode of ventricular arrhythmia from ICD memory for five days, he was discharged in stable condition with the ICD generator and followed up in the outpatient clinic.",What is the patient's delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [109.0, 'mEq/L'], 'Bicarbonate': [18.9, 'mmol/L'], 'Sodium': [142.0, 'mEq/L']}",2.1,1.995,2.205,"To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 142.0 mEq/L. 
The concentration of chloride is 109.0 mEq/L. 
The concentration of bicarbonate is 18.9 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 18.9 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 18.9 mmol * 1 mEq/mmol = 18.9 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 18.9 mmol bicarbonate/L converts to 18.9 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 142.0 mEq/L - (109.0 mEq/L + 18.9 mEq/L) = 14.1 mEq/L. Hence, The patient's anion gap is 14.1 mEq/L.Plugging in 14.1 mEq/L for the delta gap formula, we get 14.1 - 12 = 2.1 mEq/L. Hence, the patient's delta gap is 2.1 mEq/L."
741,63,Delta Gap,lab test,decimal,pmc-6644245-1,Extracted,"A healthy nondiabetic 24-year-old 18 weeks postpartum woman presented to the emergency department with severe nausea, vomiting, and several episodes of diarrhea of 9-hour duration. While in the emergency department, she developed abdominal pain, low back cramps, and malaise. The patient reported adhering to a strict ketogenic diet as a health-conscious life style modification since the recent birth of her 18-week-old son. She had continued to provide her son an exclusively breastfed diet since birth. She reported an intentional 25-pound weight loss in the 18-week postpartum period. She had an unremarkable prenatal care and delivered a healthy baby boy at 40 weeks of gestation by spontaneous vaginal delivery. Her puerperium was otherwise uneventful. She denied smoking and use of alcohol. Dietary review revealed a typical breakfast consisting of egg and bacon; lunch usually consisted of some variation of vegetable salad with cheese, and a dinner consisted of vegetables and meat. Typical food items include vegetables such as peppers, spinach, broccoli, cheese, and carrot soups. For protein, she consumed mostly chicken, salmon, and other white fish. She avoided nuts or shellfish but would have 1-2 tablespoons of peanut butter per day. She eliminated all other forms of carbohydrate including wheat, pasta, bread, or any grain products. She denied any restriction in her daily caloric intake, stating that she consistently tracked her macronutrients at an average of 2200 Kcals per day.
On presentation to the emergency department, her blood pressure was 117/82 mmHg, heart rate of 103 beats/min, respiratory rate of 18 cycles/min, a temperature of 98.1°C, and oxygen saturation 98% on room air. Physical examination was remarkable for dry mucous membranes, comfortable resting tachypnea though she was breathing more deeply, mild epigastric/right upper quadrant tenderness, but was otherwise unremarkable.
Laboratory studies revealed a chemistry panel with sodium of 138 meq/L; potassium, 4.3 meq/L; chloride, 109 meq/L; urea, 10 mg/dl; creatinine, 0.84 mg/dl; bicarbonate, 6 meq/L; glucose 68mg/dl; calculated anion gap of 27.3 meq/L; phosphorus of 2.3meq/L; calcium of 9.7mg/dl; and venous lactate of 1.3 mmol/L. Hematologic indices were grossly unremarkable with hemoglobin of 14.4 g/dl; white blood cells at 9.4; and neutrophils, 7.8. Her beta-hydroxybutyric acid level was initially markedly elevated at 109.5mg/dl (). Urinalysis revealed trace protein, ketones 4+, and hemoglobin A1c, 4.8%. Osmolar gap was normal. An arterial blood gas evaluation showed a compensated AG metabolic acidosis acidaemia with pH- 7.11; partial pressure of carbon dioxide, 17 mmHg; bicarbonate (HCO3), 5.3 mmol/L; base excess, -22.2 mmol/L. Electrocardiogram revealed normal sinus rhythm with a rate of 87 and prolonged QTc interval of 506. Ultrasound of the abdomen was unremarkable. Toxicology screen was negative except for cannabinoids.
She was initially managed with a combination of IV fluids including NS, Isotonic Bicarbonate, and D5W. A repeat arterial blood gas in six hours showed improved pH- 7.28; partial pressure of carbon dioxide, 15.8 mmHg; bicarbonate (HCO3), 7.8 mmol/L; base excess, -16.9 mmol/L. She was immediately restarted on oral carbohydrate diet. She was allowed to continue to breastfeed her infant as she preferred. She received insulin with glucose supplementation as part of the treatment of nondiabetic ketoacidosis. Insulin levels measured at different times during hospitalization showed appropriate response to blood glucose levels ruling out euglycemic diabetic ketoacidosis. During her treatment, she developed significant metabolic derangements including worsening hypophosphatemia down to 1.0, hypokalemia to a nadir of 2.6, and hypocalcemia down to 7.3. These were closely monitored and were repleted accordingly. She experienced associated symptoms of digital tingling, perioral anesthesia, and trousseau syndrome which gradually improved with therapy. Interestingly, she did not develop respiratory failure associated with severe hypophosphatemia.
With the initiation of carbohydrates and dextrose her blood B-hydroxybutyric acid normalized and her anion gap closed in less than 24 hours of hospitalization. She was successfully discharged on day 4 of hospitalization () with close nephrology and primary care follow-up and symptom resolution. Follow-up labs after discharge remained normal ().",What is the patient's delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [109.0, 'mEq/L'], 'Bicarbonate': [6.0, 'mEq/L'], 'Sodium': [138.0, 'mEq/L']}",11,10.45,11.55,"To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 138.0 mEq/L. 
The concentration of chloride is 109.0 mEq/L. 
The concentration of bicarbonate is 6.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 138.0 mEq/L - (109.0 mEq/L + 6.0 mEq/L) = 23.0 mEq/L. Hence, The patient's anion gap is 23.0 mEq/L.Plugging in 23.0 mEq/L for the delta gap formula, we get 23.0 - 12 = 11.0 mEq/L. Hence, the patient's delta gap is 11.0 mEq/L."
742,63,Delta Gap,lab test,decimal,pmc-2791737-1,Extracted,"Near midday an 87-year-old woman activated 911 complaining of shortness of breath. The patient’s past history was significant for myocardial infarction. A recent echocardiogram showed left ventricular hypokinesis consistent with an ischemic cardiomyopathy with an ejection fraction of 20 to 25%. Previous magnetic resonance imaging showed a 9x11x16 mm meningioma, without metastasis, edema or hydrocephalus. Her medications included verapamil, timolol, and diazepam.
The initial assessment by paramedics at 1320 described an alert and appropriate patient with pupils equal, round and reactive; the breathing was not labored, lungs were clear, and finger stick glucose was 139. The rhythm was ventricular tachycardia. Paramedics gave 50mg lidocaine intravenous (IV) push, with resolution of the tachycardia to a narrow complex sinus rhythm at a rate of 80 beats per minute. The rhythm was stable for one to two minutes, then recurred. They administered a second dose of lidocaine 50mg IV push, resulting in resolution of the tachycardia to a sinus rate of 78 beats per minute. The patient reported a decrease in shortness of breath and some mild dizziness. Paramedic personnel initiated a lidocaine drip at 2mg/minute for transport to the emergency department (ED).
In the primary ED, 28 minutes later, the patient had a ventricular rate of 152 beats per minute. She received a third 50mg dose of lidocaine IV. Her electrocardiogram (EKG) revealed normal sinus rhythm with left ventricular hypertrophy and an anteroseptal infarct of indeterminate age. At 1413 the physician increased the lidocaine drip to 4mg/minute, and administered aspirin 325mg by mouth. Shortly thereafter, the patient received a loading dose of amiodarone 150mg IV, followed by an amiodarone drip at 1mg/minute. She then came via EMS to our hospital.
En route emergency medical service personnel noted the patient to be in normal sinus rhythm with ventricular ectopy. The lidocaine drip remained at 4mg/minute and the amiodarone drip at 1mg/minute. The IV pump delivering amiodarone failed 20 minutes into the transfer and the medication discontinued. During transfer the report notes that the patient complained of “being sleepy” but was alert and appropriate. Six minutes prior to arrival the patient’s mental status changed abruptly. She became non-verbal, her eyes remained open with a fixed gaze, but she was able to flex her hands on command.
Upon arrival to our ED the patient’s vitals signs were: heart rate 76 beats/min, respiratory rate 22 per minute, blood pressure 135/65, tympanic temperature 96.4°F, and oxygen saturation 92% on 15-liter flow nonrebreather mask. Her weight was 49 kilograms. Her airway was patent. The EKG monitor showed normal sinus rhythm. The patient was unresponsive to painful stimuli with pupils 4mm and nonreactive with intact gag reflex. Plantar reflexes were neutral. Given the patient’s abrupt change in mental status, brainstem stroke was considered and we consulted neurology. We ordered an expedited computerized tomographic scan (CT) of the head 19 minutes after arrival. Two minutes later she received 0.4mg naloxone intraveniously and the lidocaine drip was discontinued. The patient’s National Institute of Health (NIH) stroke score was 24, indicating severe neurologic impairment.
Initial imaging studies included a chest x-ray with the only abnormality being an enlarged cardiac silhouette. CT scan of the head revealed mild microvascular ischemic changes. An 11 mm partially calcified right falcine mass was consistent with a stable meningioma. CT angiography examination in the ED 51 minutes after arrival demonstrated no evidence of vaso-occlusive change affecting the cervical or intracranial arterial vessels. Laboratory values drawn 19 minutes after arrival at our facility were as follows: Sodium 135 mmol/L, potassium 3.7 mmol/L, chloride 103 mmol/L, bicarbonate 19 mmol/L, creatinine 0.7 mg/dL, blood urea nitrogen 19 mg/dL, glucose 164 mg/dL, Mg 1.6 mg/dL, phosphorus 4.8 mg/dL, ionized calcium 1.10 mmol/L (reference 1.17–1.33 mmol/L). Cardiac enzymes, creatinine kinase (CK), CKMB and Troponin-T were normal. The initial arterial blood gas obtained on room air showed a pH of 7.28; the pCO2 was 44 mmHg, pO2 63 mmHg, and oxygen saturation 87%. The serum lidocaine level drawn 51 minutes after arrival, 30 minutes after the lidocaine drip was discontinued, resulted 7.9 mg/L with a reference range in our laboratory of 1.5–6.0 mg/L.
Following termination of the lidocaine drip the patient’s mental status gradually and steadily improved. By 60 minutes after termination of the drip her NIH stroke scale score was three, indicative of minimal impairment. During the ensuing hospitalization no more abnormalities of mental status or other neurologic complaints were encountered.",What is the patient's delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [103.0, 'mEq/L'], 'Bicarbonate': [19.0, 'mEq/L'], 'Sodium': [135.0, 'mEq/L']}",1,0.95,1.05,"To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 135.0 mEq/L. 
The concentration of chloride is 103.0 mEq/L. 
The concentration of bicarbonate is 19.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 135.0 mEq/L - (103.0 mEq/L + 19.0 mEq/L) = 13.0 mEq/L. Hence, The patient's anion gap is 13.0 mEq/L.Plugging in 13.0 mEq/L for the delta gap formula, we get 13.0 - 12 = 1.0 mEq/L. Hence, the patient's delta gap is 1.0 mEq/L."
743,63,Delta Gap,lab test,decimal,pmc-7357312-1,Extracted,"A 27-year-old Hispanic male with a past medical history of obesity (BMI: 28.59 kg/m²), long-standing uncontrolled HTN, stage 3 CKD, and obstructive sleep apnea presented to the hospital with complaints of fatigue, generalized weakness, and bleeding from the upper lip. Approximately a week ago, he got a cut on his lip while drinking from an open can and since then was suffering from slow oozing of blood from the wound site. He also reported 25-30 pounds unintentional weight loss over the past two months. He denied dysuria, hematuria, urgency, cloudy urine, abdominal pain, diaphoresis, fever, chills, syncopal attacks, palpitations, headache, blurry vision, dyspnea, or lower extremity swelling.
The patient was diagnosed with HTN at the age of 13. Three years ago, he was evaluated for exertional chest pain and uncontrolled HTN, which led to the diagnosis of CKD stage III/IV with a baseline creatinine of 2.9 mg/dL. Cortisol level was normal, aldosterone level was less than 1 ng/dL, and renin activity level was elevated at 24.40 ng/mL/hour, but the patient was on lisinopril and repeat testing after discontinuing lisinopril was normal at 1.4 ng/mL/hour. Vasculitis work-up including antinuclear antibody (ANA), anti-neutrophilic cytoplasmic antibody (ANCA) screen, anti-double stranded DNA antibody, and C3 and C4 complement levels were all within the normal range. Renal artery duplex had shown no signs of renal artery stenosis, and CT of the chest had shown a 3.7 cm (borderline) ascending thoracic aorta but no signs of coarctation. Transthoracic echocardiography findings were within the normal range. Exercise cardiac stress test showed no evidence of myocardial ischemia. No secondary cause of HTN could be elicited, and the patient was diagnosed with primary essential HTN. He was placed on three anti-hypertensive drugs: amlodipine 10 mg daily, carvedilol 25 mg two times a day, and hydralazine three times a day. He had stopped taking his blood pressure (BP) medication about one year ago due to insurance issues.
He reported consumption of two beers a week but denied smoking and recreational drug abuse. The patient was adopted at the age of 6 when he immigrated from Mexico to the United States; hence, substantial medical history of his biological family could not be obtained.
On arrival, the patient was afebrile with temperature of 98.7°F, respiratory rate of 14 breaths per minute, heart rate of 98 beats per minute, elevated BP of 175/99 mm Hg, 100% oxygen saturation at room air, and BMI of 27.12 kg/m². Systolic BP in his previous outpatient visits ranged from 140 to 180 mm Hg, indicative of poorly controlled BP. On physical examination, the patient appeared well built but he was pale and lethargic. He had a scab on his upper lip and on removal of the scab, slow oozing of blood was noted. Rest of his examination including cardiovascular, respiratory, abdominal, and neurological showed no abnormalities. Blood chemistry revealed serum sodium of 137 mmol/L, potassium of 5.0 mmol/L, chloride of 98 mmol/L, bicarbonate of 9 mmol/L, serum phosphorus of 11.7 mg/dL, corrected calcium of 7 mg/dL, blood urea nitrogen (BUN) of 228 mg/dL, and serum creatinine of >37 mg/dL (Architect Analyzer, Abbott Laboratories, Abbott Park, IL, USA, alkaline picrate kinetic [AP-K] method) []. The glomerular filtration rate (GFR) was unmeasurable and therefore not reported. The calculated GFR using the Modification of Diet in Renal Disease (MDRD) equation was less than 1.5 mL/minute/1.73 m². His baseline creatinine was around 2.9 mg/dL. Complete blood count showed hemoglobin of 4.7 g/dL, hematocrit of 15.8%, mean corpuscular volume of 87.3 fL, and platelet count of 127 x 103/mcL. Peripheral smear showed poikilocytosis, ovalocytes, and elliptocytes. Parathyroid hormone levels were elevated at 1,008 pg/mL. Uric acid levels and creatine phosphokinase levels were elevated at 16.5 mg/dL and 353 U/L, respectively. Protime was mildly elevated to 15.2 seconds, with an unremarkable international normalized ratio (INR) of 1.2. On gross inspection, the urine sample was pale yellow and cloudy in appearance. The urinalysis showed a specific gravity of 1.012, with pH of 5.0, two plus proteinuria, two plus blood, three plus white blood cell esterase, and positive for leukocytes and red blood cells. Urine culture grew Escherichia coli (100,000 CFU/mL). Serological work-up including human immunodeficiency virus (HIV) antigen/antibodies and hepatitis B core IgM antibody, and urine drug screen were all negative.
Chest X-ray did not show any signs of fluid overload such as pulmonary edema or pleural effusion (Figure ). Electrocardiogram showed prolonged QT (QTc 493 ms) (Figure ) and transthoracic echocardiogram revealed mild left ventricular hypertrophy (Figure ). Renal ultrasound reported bilaterally increased parenchymal echogenicity and cortical thinning consistent with chronic renal insufficiency (Figure ).
The patient emergently underwent transfusion with two units of packed red blood cells. HTN was controlled with amlodipine and intravenous hydralazine. His metabolic acidosis was slowly corrected with intravenous bicarbonate infusion. An internal jugular venous hemodialysis catheter was placed, and the patient underwent emergent hemodialysis. With initiation of hemodialysis, bleeding and electrolyte imbalances resolved. During his hospital course, he was also treated with a five-day course of ceftriaxone for urinary tract infection. At discharge, his creatinine level had come down to 15.1 mg/dL, BUN was down to 56 mg/dL, potassium was down to 3.9 mmol/L and hemoglobin was 7.5 g/dL. Eventually, the patient was transitioned to peritoneal dialysis. Unfortunately, due to the patient's non-compliance with dialysis, he has been admitted multiple times over the past year with similar presentations.",What is the patient's delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [98.0, 'mmol/L'], 'Bicarbonate': [9.0, 'mmol/L'], 'Sodium': [137.0, 'mmol/L']}",18,17.1,18.9,"To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 137.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 137.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 137.0 mmol * 1 mEq/mmol = 137.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 137.0 mmol sodium/L converts to 137.0 mEq sodium/L. 
The concentration of chloride is 98.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 98.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 98.0 mmol * 1 mEq/mmol = 98.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 98.0 mmol chloride/L converts to 98.0 mEq chloride/L. 
The concentration of bicarbonate is 9.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 9.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 9.0 mmol * 1 mEq/mmol = 9.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 9.0 mmol bicarbonate/L converts to 9.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 137.0 mEq/L - (98.0 mEq/L + 9.0 mEq/L) = 30.0 mEq/L. Hence, The patient's anion gap is 30.0 mEq/L.Plugging in 30.0 mEq/L for the delta gap formula, we get 30.0 - 12 = 18.0 mEq/L. Hence, the patient's delta gap is 18.0 mEq/L."
744,63,Delta Gap,lab test,decimal,pmc-4543587-1,Extracted,"A 55-year-old female with past medical history of seizure disorder, bipolar disorder, and chronic pain was admitted to ICU due to severe agitation. The patient complained of dizziness along with nausea shortly before hospitalization which was first reported to home physical therapist. There was no neurological deficit besides becoming agitated progressively over time for which she was given several doses of benzodiazepines. Her initial vital signs were blood pressure 119/75 mmHg, pulse rate 58/min, tympanic temperature 98.5, and body weight 99 kg. The second set of laboratory data after ICU admission revealed following: sodium 148 mEq/L, potassium 5.6 mEq/L, chloride 108 mEq/L, bicarbonate 6 mEq/L, urea nitrogen 24 mg/dL, creatinine 1.85 mg/dL, calcium 8.7 mg/dL, and albumin 4.0 mg/dL. Serum osmolality was not obtained. The patient was intubated for airway protection using lorazepam and rocuronium. Arterial blood gas revealed pH 7.22 and PCO2 17 mmHg. Her baseline creatinine before admission was noted as 1.1 mg/dL. Blood concentrations of commonly abused alcohols were sought given anion gap metabolic acidosis and additional history of psychosocial issues from family. Urinalysis was negative for crystals. Ethylene glycol level became available 169 mg/dL (26.45 mmol/L) 19 hours after admission and other alcohols were negative. Glycolic acid or glyoxylic acid blood concentration was not obtained. Quantification of consumed ethylene glycol was not possible due to the lack of reliable consumption history. Plotting of blood concentrations of ethylene glycol and urea and their corresponding natural logarithm with trend lines using linear regression function is shown in . Fomepizole therapy was initiated and, within 2 hours, hemodialysis followed. The patient was treated using Polyflux Revaclear MAX dialyzer (Gambro, 1.8 m2 membrane surface area) via right internal jugular vascular catheter. Blood flow and dialysate flow were set 300–400 mL/min and 1.5 times blood flow, respectively. Total volume treated was 138.6 L for 8 hours with average blood flow 290 mL/min. The patient was maintained on continuous IV drip of lorazepam for sedation along with several doses of IV phenytoin for subtherapeutic drug level noted upon admission.",What is the patient's delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Sodium': [148.0, 'mEq/L'], 'Chloride': [108.0, 'mEq/L'], 'Bicarbonate': [6.0, 'mEq/L']}",22,20.9,23.1,"To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 148.0 mEq/L. 
The concentration of chloride is 108.0 mEq/L. 
The concentration of bicarbonate is 6.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 148.0 mEq/L - (108.0 mEq/L + 6.0 mEq/L) = 34.0 mEq/L. Hence, The patient's anion gap is 34.0 mEq/L.Plugging in 34.0 mEq/L for the delta gap formula, we get 34.0 - 12 = 22.0 mEq/L. Hence, the patient's delta gap is 22.0 mEq/L."
745,63,Delta Gap,lab test,decimal,pmc-4582075-1,Extracted,"A 72-year-old man suffered from a fever, diarrhea, pneumaturia, and fecaluria beginning in April 2013 and referred to our hospital in May 2013. He was hospitalized due to the symptom of abdominal distension. The abdominal X-ray showed dilated small intestine indicating mechanical bowel obstruction (Fig. ). The night of first hospital day, he developed a loss of consciousness, and the next morning, he developed whole body cramping. The patient had no previous history of hepatic disease and no episodes of confusion or neurological disorders. He was no taking any medications for any diseases.
The laboratory data indicated an inflammatory reaction with the elevation of the white blood cells count of 23,600/μl and a C-reactive protein concentration of 7.33 mg/dl and hyperchloremic acidosis, with Na 144 mEq/l, K 3.1 mEq/l, Cl 116 mEq/l, pH 7.116, PO2 145 mmHg, PCO2 34 mmHg, BE −16.8 μmol/l, and HCO3− 11.3 mmol/l. Furthermore the serum ammonia (NH3) level was highly elevated to 703 μg/dl.
The level of tumor markers, CEA and CA19-9, were elevated at 7.9 ng/ml and 43.6U/ml, respectively. The liver and renal functions were normal. The culture of urine indicated the existence of enterococcus faecalis and pseudomonas aeruginosa.
Contrast computed tomography (CT) indicated the huge tumor occupying minor pelvic space which was suspected to invade the ureter and urinary bladder (Fig. a). Two liver metastases with the sizes of 1.1 and 1.2 cm were also observed (Fig. b and c).
A water-soluble contrast enema showed rectovesical fistulae as well as ileal fistulae (Fig. a, b). Colonoscopy indicated the presence of a rectal carcinoma occupying total space at 15 cm far from the anal verge (Fig. ). The biopsy of the tumor indicated well differentiated adenocarcinoma.
We administered a solution of branched chain amino acids (BCAA) and antibiotics. Furthermore, we repeatedly irrigated the bladder through the urethral catheter. The patient’s symptoms recovered, and serum ammonia levels on second and third hospital day were decreased to 210 and 135 μg/dl, respectively. However, the symptoms of infection and confusion were suspected to repeat; we elected to perform a surgical treatment.
On the operative findings, ascites and disseminated tumors were not observed. However, the tumor could not be resected due to the invasive growth in the minor pelvic space. The surgical procedure we adopted was as follows. We disconnected both oral and anal sides of ileum which was involved in the tumor and made an ileocecal bypass. Furthermore, we performed sigmoidostomy to prevent feces pouring into the urinary bladder.
We continued irrigation of urinary bladder through the bladder catheter after the operation. The postoperative clinical course was no eventful. Serum ammonia values had been kept under 120 μg/dl.
He was treated with XELOX (oxaliplatin/capecitabine) for 11 cycles. However, massive ascites had been developed 1 year after the operation, and the patient died from peritoneal metastases.
The vesicular catheter had been kept during the whole period after operation, and hyperammonemia had never occurred.
It has been noted that a urinary diversion may sometimes be the cause of non-hepatic hyperammonemic encephalopathy []. However, the frequency of this complication is not known and considered to be extremely rare. Some cases have been reported in patients who underwent a urinary diversion due to bladder or prostate cancer []. To the best of our knowledge, only one case with rectal cancer was previously reported in the Japanese literature, in which the patient suffered from a rectovesical fistula and liver dysfunction due to multiple liver metastases [].
Approximately 10 % (17/178) of the patients who underwent surgical treatment to create an ileal conduit developed hyperchloremic acidosis according to the report by Schmitt et al. []. However, hyperammonemic encephalopathy was not observed in several reviews on the complications of urinary diversion [–]. Urea-splitting urinary tract infection has been noted to be crucial for the development of hyperammonemic encephalopathy [].
An elevation of the blood ammonia levels may result from the diversion of the urinary stream to the intact intestine, which provides an additional amount of ammonia that must be absorbed, especially when there is urine stasis in the bowel. Urea in the bowel is converted by urea-splitting bacteria to form ammonia. Ammonia chloride is generally reabsorbed and broken down to liberate free ammonia and hydrochloric acid. In the absence of liver dysfunction, the additional ammonia can be managed by the liver; however, in a damaged liver, the extra ammonia cannot be managed, resulting in hyperammonemia. Even with a normal liver function, urease-producing bacteria may form large amounts of ammonia, thereby, leading to hyperammonemia.
The sudden onset of hyperammonemic encephalopathy in the present case was caused by two mechanisms: urinary stasis and infection, which were induced by bowel obstruction.
Regarding the treatment of hyperammonemic encephalopathy, a bladder catheter was required to prevent urinal stasis and irrigation of bladder and antibiotics and hyperammonemia-reducing drugs were administered. However, surgical treatment is ultimately required to prevent the occurrence of repeated infection and hyperammonemia.
Concerning the surgical procedures, we could not divide the cystic bladder from rectum because of the invasive growth of the tumor. We performed surgical management only for bowel obstruction, ileal disconnection with ileocecal bypass, and sigmoidostomy. Therefore, the serum ammonia value was kept slightly high around 80~120 μg/dl after surgery, and bladder catheter was needed during the post operative period. Consequently, these comprehensive treatments were considered to be effective to prevent the repeated hyperammonemic encephalopathy.",What is the patient's delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [116.0, 'mEq/L'], 'Bicarbonate': [11.3, 'mmol/L'], 'Sodium': [144.0, 'mEq/L']}",4.7,4.465,4.935,"To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 144.0 mEq/L. 
The concentration of chloride is 116.0 mEq/L. 
The concentration of bicarbonate is 11.3 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 11.3 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 11.3 mmol * 1 mEq/mmol = 11.3 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 11.3 mmol bicarbonate/L converts to 11.3 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 144.0 mEq/L - (116.0 mEq/L + 11.3 mEq/L) = 16.7 mEq/L. Hence, The patient's anion gap is 16.7 mEq/L.Plugging in 16.7 mEq/L for the delta gap formula, we get 16.7 - 12 = 4.7 mEq/L. Hence, the patient's delta gap is 4.7 mEq/L."
746,63,Delta Gap,lab test,decimal,pmc-6016161-1,Extracted,"A 55-year-old woman with a history of type 2 diabetes mellitus, hyperlipidemia, obesity, and depression was referred to an endocrinologist with complaints of weight loss, palpitations, and diarrhea. The patient also had hypertension and was taking α-adrenergic receptor antagonists and a calcium channel blocker. She was found to have a thyroid-stimulating hormone (TSH) level of <0.10 (normal: 0.34 to 4.82) µlU/ml and a free T4 concentration of 4.28 (normal: 0.6 to 1.6) ng/dL. I123 thyroid scan revealed elevated, diffuse uptake bilaterally, without nodules, consistent with the diagnosis of Graves' disease. The patient was treated with 11.9 mCi of radioactive iodine. Ten days after the ablation treatment, the patient presented to a local hospital by ambulance after experiencing lightheadedness, diffuse abdominal pain, and one episode of bilious emesis.
Upon arrival, she was hypotensive (77/44 mm Hg), pale, bradycardic, and febrile (39.4°C). An electrocardiogram (ECG) revealed accelerated junctional rhythm at a rate of 53 beats/min. The patient was given atropine 0.5 mg intravenously without effect, followed by initiation of external cardiac pacing. Continuous intravenous infusions of dopamine and norepinephrine were started along with fluid resuscitation of 4 L of normal saline over a 2-hour period. She received one ampule of calcium gluconate with no change in her blood pressure, heart rate, or rhythm. Computed tomography of the abdomen was unrevealing. The patient was endotracheally intubated and transferred via helicopter to our facility.
Upon arrival to our facility, she was receiving intravenous infusions of dopamine at 20 µg/kg/min and norepinephrine at 10 µg/kg/min and remained hypotensive (92/55 mm Hg) and bradycardic (59 beats/min). ECG showed an accelerated junctional rhythm. Laboratory findings included serum sodium of 139 mEq/L, potassium of 5.3 mEq/L, chloride of 108 mEq/L, and a bicarbonate of 15 mmol/L, serum glucose of 208 mg/dL, urea nitrogen of 38 mg/dL, creatinine of 1.5 mg/dL, ionized calcium of 1.15 mmol/L, total bilirubin of 0.4 mg/dL, serum alkaline phosphatase of 141 U/L, aspartate aminotransferase of 2196 U/L, and alanine aminotransferase of 2010 U/L. Plasma troponin I was repeatedly undetectable. The peripheral leukocyte count was 15.9 x 109 cells/L with no immature forms. Blood cultures revealed no microbial growth. Thyroid function testing showed an undetectable TSH (<0.10 µlU/ml), a free T4 of 12.8 (normal: 0.6 to 1.6) ng/dL, total T4 of 21.9 (normal: 5.6 to 13.7) µg/dL, and a total T3 of 0.94 (normal: 0.8 to 1.8) ng/mL. The patient was treated for thyroid storm with 1000 mg of propylthiouracil by orogastric tube as a loading dose followed by 300 mg every 6 hours, 5 drops saturated solution of potassium iodide (SSKI) every 8 hours by orogastric tube, and 100 mg intravenously of hydrocortisone every 8 hours. The hypotension resolved, vasopressors were stopped, and the patient was extubated 25 hours after her initial presentation. During her stay in the intensive care unit, the patient exhibited fever (39.6°C maximum), tachycardia, and tremulousness. These manifestations resolved over a period of 22 hours. The patient was discharged in satisfactory condition on the fourth day of hospitalization on 100 mg of propylthiouracil orally every 8 hours. Outpatient testing days later demonstrated normalization of her thyroid function tests.",What is the patient's delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [108, 'mEq/L'], 'Bicarbonate': [15, 'mmol/L'], 'Sodium': [139, 'mEq/L']}",4,3.8,4.2,"To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 139 mEq/L. 
The concentration of chloride is 108 mEq/L. 
The concentration of bicarbonate is 15 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 15 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 15 mmol * 1 mEq/mmol = 15 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 15 mmol bicarbonate/L converts to 15.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 139 mEq/L - (108 mEq/L + 15.0 mEq/L) = 16.0 mEq/L. Hence, The patient's anion gap is 16.0 mEq/L.Plugging in 16.0 mEq/L for the delta gap formula, we get 16.0 - 12 = 4.0 mEq/L. Hence, the patient's delta gap is 4.0 mEq/L."
747,63,Delta Gap,lab test,decimal,pmc-7971718-1,Extracted,"A 59-year-old female with a history of neuromyelitis optica with baseline paraplegia and neurogenic bladder on chronic foley presented to the emergency department with altered mental status.
She was recently admitted to the hospital with septic shock requiring pressors for one day secondary to resistant Escherichia coli urinary tract infection and acute kidney injury (AKI) with elevated creatinine of 1.4 mg/dL (baseline of 0.6-0.7 mg/dL approximately five months ago) and decreased creatinine clearance (CrCl) of 36 mL/min. Her renal function quickly improved on day two of admission to a creatinine of 0.7 mg/dL and CrCl of 56.5 mL/min. She was initially started on intravenous (IV) ceftriaxone and later changed to IV cefepime due to her urine culture, sensitivity pattern, and renal recovery (Figure ). A PICC line was placed and the patient was discharged with IV cefepime. She had completed a 10-day course of cefepime just one day prior to the current admission.
During this admission, initial vitals were temperature 35.8ºC, heart rate 68 beats per minute, respiratory rate 19 breaths per minute, and blood pressure 81/54 mmHg. Her systolic blood pressures were in 80s for the last two to three months prior to admission and was maintained on home midodrine. This was attributed to autonomic dysfunction secondary to neuromyelitis optica after extensive workup. Examination was notable for expressive aphasia and altered mental status. She was also found to have AKI with elevated creatinine of 2.19 mg/dL (baseline 0.6 mg/dL), blood urea nitrogen of 68 mg/dL (baseline 7 mg/dL), and estimated glomerular filtration rate (eGFR) of 23 mL/min/1.73 m2 (baseline >60 mL/min/1.73 m2). Electrolyte levels were serum sodium 145 mmol/L (baseline 141 mmol/L), serum potassium 4.4 mmol/L (baseline 4.3 mmol/L), serum chloride 108 mmol/L (baseline 104 mmol/L), and serum bicarbonate 18 mmol/L (baseline 26 mmol/L). Her urine output was decreased to 600 mL in 24 hours. Brain computed tomography did not show any acute intracranial findings. Magnetic resonance imaging of the brain showed an interval increase in the size of the right centrum semi-ovale and a hyperintense demyelinating lesion without enhancement which ruled out an acute demyelinating process (Figure ).
She continued to become more lethargic over the next few hours and developed jerking of the left upper extremity and face. Medical management to treat the seizures was partially successful. Serum cefepime levels were measured and found to be elevated at 295 mg/L. After three hours of hemodialysis, cefepime levels improved from 295 mg/L to 70 mg/L. She was then started on continuous renal replacement therapy (CRRT) for ongoing clearance of cefepime. Serum cefepime level the next day was 17 mg/L. Her mental status continued to improve and CRRT was stopped 48 hours after initiation. Figure shows the trend of the patient’s renal function during her first admission.
Figure shows the timeline of renal function in relation to her current admission. She did not require additional dialysis while hospitalized.",What is the patient's delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [108.0, 'mmol/L'], 'Bicarbonate': [18.0, 'mmol/L'], 'Sodium': [145.0, 'mmol/L']}",7,6.65,7.35,"To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 145.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 145.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 145.0 mmol * 1 mEq/mmol = 145.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 145.0 mmol sodium/L converts to 145.0 mEq sodium/L. 
The concentration of chloride is 108.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 108.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 108.0 mmol * 1 mEq/mmol = 108.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 108.0 mmol chloride/L converts to 108.0 mEq chloride/L. 
The concentration of bicarbonate is 18.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 18.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 18.0 mmol * 1 mEq/mmol = 18.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 18.0 mmol bicarbonate/L converts to 18.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 145.0 mEq/L - (108.0 mEq/L + 18.0 mEq/L) = 19.0 mEq/L. Hence, The patient's anion gap is 19.0 mEq/L.Plugging in 19.0 mEq/L for the delta gap formula, we get 19.0 - 12 = 7.0 mEq/L. Hence, the patient's delta gap is 7.0 mEq/L."
748,63,Delta Gap,lab test,decimal,usmle-4289,Extracted,"A 19-year-old man with unknown medical history is found down on a subway platform and is brought to the hospital by ambulance. He experiences two episodes of emesis en route. In the emergency department, he appears confused and is complaining of abdominal pain. His temperature is 37.0° C (98.6° F), pulse is 94/min, blood pressure is 110/80 mmHg, respirations are 24/min, oxygen saturation is 99% on room air. His mucus membranes are dry and he is taking rapid, deep breathes. Laboratory work is presented below:

Serum:
Na+: 130 mEq/L
K+: 4.3 mEq/L
Cl-: 102 mEq/L
HCO3-: 12 mEq/L
BUN: 15 mg/dL
Glucose: 362 mg/dL
Creatinine: 1.2 mg/dL
Urine ketones: Positive


The patient is given a bolus of isotonic saline and started on intravenous insulin drip.",What is the patient's delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [102.0, 'mEq/L'], 'Bicarbonate': [12.0, 'mEq/L'], 'Sodium': [130.0, 'mEq/L']}",4,3.8,4.2,"To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 130.0 mEq/L. 
The concentration of chloride is 102.0 mEq/L. 
The concentration of bicarbonate is 12.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 130.0 mEq/L - (102.0 mEq/L + 12.0 mEq/L) = 16.0 mEq/L. Hence, The patient's anion gap is 16.0 mEq/L.Plugging in 16.0 mEq/L for the delta gap formula, we get 16.0 - 12 = 4.0 mEq/L. Hence, the patient's delta gap is 4.0 mEq/L."
749,64,Delta Ratio,lab test,decimal,pmc-5458028-1,Extracted,"A 58-year-old male with dyslipidemia, an eight-year history of T2DM, a family history, his mother, of T2DM, with no known micro- or macrovascular complications, was admitted to the emergency department for malaise, epigastric pain, polyuria, and progressive dyspnea which had begun 10 h ago. He had experienced a 2-kg weight loss over the last few days. His usual medications included aspirin 100 mg q24 h, atorvastatin 40 mg q24 h, and metformin 850 mg q8 h, which had been switched to dapagliflozin 20 days before, due to poor glycemic control, with HbA1c 12% (108 mmol/mol). His vital signs included a heart rate of 122 bpm, respiratory rate 33 rpm, blood pressure 142/70 mmHg, temperature 36.1°C, and body mass index 22.5 kg/m2. On physical examination, somnolence, dry skin and mucous membranes, a Kussmaul breathing pattern, and a capillary refill of 3 sec were observed. Blood tests revealed hemoglobin 17.1 g/dL (13.5–18), leukocytes 19.5 × 103 (4–10 × 103), platelets 296 × 103 (150–450 × 103), glucose 248 mg/dL (60–100), creatinine 0.97 mg/dL (0.67–1.17), sodium 136 mmol/L (135–145), potassium 4.7 mmol/L (3.5–5.5), chloride 101 mmol/L (95–112), phosphate 4.9 mg/dL (2.5–4.5), amylase 70 U/L (10–115), lipase 28 U/L (1–67), pH 6.95 (7.35–7.45), pCO2 23 mmHg (35–45), HCO3 5 mmol/L (22–26), lactate 1.8 mmol/L (0–1.5), urine ketone bodies >150 mg/dL (0–0), CK 112 U/L (1–190), CK-MB 7.3 ng/mL (0.1–5), and troponin I 0.07 ng/mL (0.001–0.05). The electrocardiogram (EKG) showed sinus rhythm with right bundle branch block, and nonspecific repolarization abnormalities. Because of the right bundle branch block was not previously known, a new troponin test was performed six hours later with a peak value of 4.28 ng/mL. Treatment with crystalloids, continuous infusion of intravenous insulin, and administration of potassium and sodium bicarbonate were begun in the emergency room (ER). Due to a poor response over the first two hours, with the persistence of lactic acidosis, the patient was transferred to the intensive care unit (ICU), where more aggressive rehydration with crystalloids was started, without further modifications of the original therapeutic plan.
Two days later, the patient was discharged from the ICU to the endocrinology ward. Because of his coronary risk factors and the elevated troponin on admission, a coronary angiography was performed, showing triple-vessel disease. Successful bypass surgery without extracorporeal circulation was performed a few days later, with internal mammary artery grafts to the anterior descendent and marginal obtuse arteries and a saphenous vein graft to the right coronary artery. He was discharged 3 days later on Lantus™ Sanofi-aventis S.p.a Valcanello,03012 Anagni (FR), Italia (insulin glargine) 20 IU and Insulina Novorapid™: Novo Nordisk A/S. Hallas Allé, DK-4400. Kalundborg, Dinamarca (insulin aspart) 6-4-4-0 IU subcutaneous insulin, aspirin, clopidogrel, enalapril, bisoprolol, atorvastatin, and furosemide. The oral antidiabetic treatment with dapagliflozin was not restarted. During follow-up by endocrinology, C-peptide, anti-GAD, and IA-2 antibodies were required due to normal BMI and lack of family history suggested T1DM or a latent autoimmune diabetes of adults (LADA) rather than T2DM as etiology of his diabetes. C-peptide was 1 mg/dL (0.9–7.1) with glycemia 214 mg/dL (60–100), anti-GAD <5 U/mL (0–12.5), and anti-IA-2 <7.5 U/mL (0–7.5).",What is the patient's delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [101.0, 'mmol/L'], 'Bicarbonate': [5.0, 'mmol/L'], 'Sodium': [136.0, 'mmol/L']}",0.94737,0.9,0.99474,"The formula for computing the delta ratio is delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 136.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 136.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 136.0 mmol * 1 mEq/mmol = 136.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 136.0 mmol sodium/L converts to 136.0 mEq sodium/L. 
The concentration of chloride is 101.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 101.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 101.0 mmol * 1 mEq/mmol = 101.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 101.0 mmol chloride/L converts to 101.0 mEq chloride/L. 
The concentration of bicarbonate is 5.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 5.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 5.0 mmol * 1 mEq/mmol = 5.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 5.0 mmol bicarbonate/L converts to 5.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 136.0 mEq/L - (101.0 mEq/L + 5.0 mEq/L) = 30.0 mEq/L. Hence, The patient's anion gap is 30.0 mEq/L.Plugging in 30.0 mEq/L for the delta gap formula, we get 30.0 - 12 = 18.0 mEq/L. Hence, the patient's delta gap is 18.0 mEq/L.Plugging in the delta gap and the bicarbonate concentration for the delta ratio formula, we get 18.0 mEq/L / 19.0 mEq/L = 0.94737. The patient's delta ratio is 0.94737."
750,64,Delta Ratio,lab test,decimal,pmc-4897681-1,Extracted,"A 34-year-old white male with a history of depression and seizure disorder was found down by police with fifteen empty cans of Dust-Off nearby. He was arousable on scene and was transported by the Emergency Medical Services to a local Emergency Department, where he remained awake and alert. He admitted to huffing the Dust-Off, as well as a history of recurrent and heavy hydrocarbon huffing. An electrocardiogram (ECG) was obtained and revealed sinus tachycardia with a prolonged QTc of 472 milliseconds (). The patient was transferred to a regional burn unit for frostbite on his hand due to refrigerant exposure.
While in the burn unit, the patient had a generalized seizure and went into cardiac arrest. Advanced Cardiac Life Support protocol was initiated. The patient was found to be in a torsades de pointes rhythm () and was given magnesium. He was intubated, resuscitated, and sent to the Cardiac Intensive Care Unit where he was placed on fentanyl and midazolam drips and continuously monitored. Episodes of hypotension and tachycardia were noted, as well as right bundle branch block on repeat ECG. He was started on multiple vasopressors and given amiodarone for dysrhythmias. Hypocalcemia (5.6 mg/dL) was treated with calcium gluconate boluses and resolved.
Pertinent medical history included multiple psychiatric admissions and tobacco and prior alcohol abuse. The patient was homeless and unemployed. Possible outpatient medications included multiple antidepressants and sedatives, but compliance was unknown.
At the time of toxicology consultation approximately 24 hours after presentation, physical exam revealed a young white male, intubated, arousable but easily agitated. Vital signs included a heart rate of 106, blood pressure of 110/67, respiratory rate of 14 per minute, and 100% oxygen saturation on the ventilator. Maximum temperature was noted to be 103.5 degrees Fahrenheit, with a temperature of 99.3 degrees Fahrenheit at consultation. His pupils were 3 mm and reactive to light. He was tachycardic with a regular rhythm. The remainder of the exam was benign with no appreciable neurological deficits, rigidity, or clonus.
Initial chemistry panel revealed creatinine of 1.55 mg/dL, sodium of 138 mmol/L, chloride of 103 mmol/L, bicarbonate of 16 mmol/L, potassium of 3.5 mmol/L, magnesium of 3.0 mg/dL. AST was mildly elevated at 64 U/L with an ALT of 48 U/L. Arterial blood gas analysis revealed pH of 7.38, pCO2 of 37 mmHg, pO2 of 80 mmHg, HCO3 of 22 mEq/L, and oxygen saturation at 94% prior to intubation. Over the next 24 hours, the patient was noted to have elevated lactate of 4.7 mmol/L and evidence of rhabdomyolysis (maximum CK 5058 U/L, day 2), shock liver (maximum AST 17432 U/L, day 3), acute kidney injury (maximum creatinine 1.86 mg/dL, day 2), troponin elevation (maximum 20.20 ng/mL, day 2), and coagulopathy (maximum INR 3.0, day 2).
Echocardiogram revealed left and right ventricular dysfunction with an ejection fraction of 25% and global hypokinesis. Multiple chest X-rays were negative for an acute cardiopulmonary process. Labs drawn prior to discharge revealed resolving transaminitis and rhabdomyolysis, as well as normalized renal function and INR.
The patient was discharged eight days after admission with a repeat echocardiogram showing normal left ventricle size and function, normal wall motion, and an ejection fraction of 55%. He confirmed that he had only used Dust-Off on the day of presentation.",What is the patient's delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [103.0, 'mmol/L'], 'Bicarbonate': [16.0, 'mmol/L'], 'Sodium': [138.0, 'mmol/L']}",0.875,0.83125,0.91875,"The formula for computing the delta ratio is delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 138.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 138.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 138.0 mmol * 1 mEq/mmol = 138.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 138.0 mmol sodium/L converts to 138.0 mEq sodium/L. 
The concentration of chloride is 103.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 103.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 103.0 mmol * 1 mEq/mmol = 103.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 103.0 mmol chloride/L converts to 103.0 mEq chloride/L. 
The concentration of bicarbonate is 16.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 16.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 16.0 mmol * 1 mEq/mmol = 16.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 16.0 mmol bicarbonate/L converts to 16.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 138.0 mEq/L - (103.0 mEq/L + 16.0 mEq/L) = 19.0 mEq/L. Hence, The patient's anion gap is 19.0 mEq/L.Plugging in 19.0 mEq/L for the delta gap formula, we get 19.0 - 12 = 7.0 mEq/L. Hence, the patient's delta gap is 7.0 mEq/L.Plugging in the delta gap and the bicarbonate concentration for the delta ratio formula, we get 7.0 mEq/L / 8.0 mEq/L = 0.875. The patient's delta ratio is 0.875."
751,64,Delta Ratio,lab test,decimal,usmle-5215,Extracted,"A 27-year-old man presents to the emergency department. He was brought in by staff from the homeless shelter when they found him unresponsive. The patient is a known IV drug abuser but otherwise has an unknown past medical history. He currently attends a methadone clinic. His temperature is 99.5°F (37.5°C), blood pressure is 97/48 mmHg, pulse is 140/min, respirations are 29/min, and oxygen saturation is 98% on room air. Initial laboratory values are shown below.

Serum:
Na+: 139 mEq/L
Cl-: 100 mEq/L
K+: 6.3 mEq/L
HCO3-: 17 mEq/L
Glucose: 589 mg/dL

The patient is given treatment. After treatment, his temperature is 99.5°F (37.5°C), blood pressure is 117/78 mmHg, pulse is 100/min, respirations are 23/min, and oxygen saturation is 98% on room air.",What is the patient's delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [100.0, 'mEq/L'], 'Bicarbonate': [17.0, 'mEq/L'], 'Sodium': [139.0, 'mEq/L']}",1.42857,1.35714,1.5,"The formula for computing the delta ratio is delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 139.0 mEq/L. 
The concentration of chloride is 100.0 mEq/L. 
The concentration of bicarbonate is 17.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 139.0 mEq/L - (100.0 mEq/L + 17.0 mEq/L) = 22.0 mEq/L. Hence, The patient's anion gap is 22.0 mEq/L.Plugging in 22.0 mEq/L for the delta gap formula, we get 22.0 - 12 = 10.0 mEq/L. Hence, the patient's delta gap is 10.0 mEq/L.Plugging in the delta gap and the bicarbonate concentration for the delta ratio formula, we get 10.0 mEq/L / 7.0 mEq/L = 1.42857. The patient's delta ratio is 1.42857."
752,64,Delta Ratio,lab test,decimal,pmc-6462314-1,Extracted,"A 48-year-old male presented to the emergency department with complaints of malaise and nausea. The past medical record was relevant for type 2 diabetes mellitus that was treated at the time with neutral protamine Hagedorn insulin. On initial examination, he had signs of severe dehydration and was polypneic; blood pressure was 80/60 mmHg, and heart rate was 125 bpm, with an oxygen saturation of 95% at room air. The capillary glucose level was 620 mg/dL; venous blood gases showed a metabolic acidosis with pH < 6.94 and HCO3− of 4.1 mEq/L. A severe DKA was diagnosed, and treatment was started with aggressive hydration and IV insulin. Initial electrolytes were Na+ 119.6 mEq/L, Cl− 95 mEq/L, and K+ 5.7 mEq/L, and serum creatinine was 2.6 mg/dL. A 12-lead electrocardiogram (ECG) was performed and showed an ST-segment elevation of 4 millimeters in V1 and V2 leads and 1 millimeter elevation in aVR lead; also, there was a QRS complex widening and tall T-waves in V3-V5 (). Concerns were raised of possible myocardial infarction as the precipitant factor for the DKA. A cardiology consult was required, and a point-of-care cardiac ultrasound was performed, which showed a normal left ventricular ejection fraction and no regional wall motion abnormalities, cardiac troponins where ordered and reported within the normal range. The patient continued on management. After 1 hour and 30 minutes of treatment for DKA, a subsequent ECG was performed, and it showed a complete resolution of the ST-segment elevation (). DKA was resolved, and the patient was admitted for monitoring, with a favorable evolution.",What is the patient's delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Sodium': [119.6, 'mEq/L'], 'Bicarbonate': [4.1, 'mEq/L'], 'Chloride': [95.0, 'mEq/L']}",0.42714,0.40578,0.4485,"The formula for computing the delta ratio is delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 119.6 mEq/L. 
The concentration of chloride is 95.0 mEq/L. 
The concentration of bicarbonate is 4.1 mEq/L. 
Plugging in these values into the anion gap formula gives us 119.6 mEq/L - (95.0 mEq/L + 4.1 mEq/L) = 20.5 mEq/L. Hence, The patient's anion gap is 20.5 mEq/L.Plugging in 20.5 mEq/L for the delta gap formula, we get 20.5 - 12 = 8.5 mEq/L. Hence, the patient's delta gap is 8.5 mEq/L.Plugging in the delta gap and the bicarbonate concentration for the delta ratio formula, we get 8.5 mEq/L / 19.9 mEq/L = 0.42714. The patient's delta ratio is 0.42714."
753,64,Delta Ratio,lab test,decimal,pmc-4620268-2,Extracted,"This patient is a 44-year-old male with a past medical history of spontaneous pneumothorax and urethral stricture who was found unconscious in a metal chrome plating shop for an undetermined duration of time near another unconscious male (Case #1). A bystander discovered the patient and emergency medical services were called. The patient was intubated on the field due to inability to protect airway and decreased mentation. On initial arrival at the emergency department, the patient remained unconscious. Due to the working environment, hydroxocobalamin 5 grams was administered 4 minutes after arrival.
The vital signs were the following: temperature 97.0°F, respiratory rate 17 breaths/minute, pulse 111 beats/minute, blood pressure 134/80 mmHg, and pulse oxygenation 99% on mechanical ventilation. On initial physical exam in transfer to the intensive care unit (approximately 4 hours after presenting), the patient was awake and responsive to commands. Pupils were equally round and reactive to light and accommodation with extraocular movements intact. Pulmonary exam had coarse breath sounds on ventilator. There was 5/5 strength on upper and lower extremities. Laboratory tests showed the following: sodium 137 mEq/L, potassium 3.5 mEq/L, chloride 99 mEq/L, bicarbonate 9 mEq/L, blood urea nitrogen 12 mg/dL, creatinine 1.85 mg/dL. White blood cell count was 16.2 mg/dL, hemoglobin 17.7 mg/dL, and platelet count 283/mm3. Arterial blood gas included pH 7.09, carbon dioxide 32 mmHg, oxygen partial pressure 342 mmHg, and bicarbonate 9.0 mEq/L. Hepatic function panel had total bilirubin 0.9 mg/dL, AST 41 u/L, ALT 19 u/L, alkaline phosphatase 91 u/L, creatine kinase 94 u/L, and ammonia 89 u/L. A lactate level of 16.3 mmol/L was drawn on initial presentation. Urine drug screen was positive for cocaine metabolites. Chest X-ray had mild vascular fullness. Head computed tomography was performed with no acute intracranial abnormality and abnormality of the cervical spine ().
The patient was given aggressive intravenous fluids. Within 24 hours, the patient was weaned off ventilator settings and extubated. The severe lactic acidosis and metabolic derangements rapidly improved. On the third day, the patient on exam was completely asymptomatic with no residual neurological findings. The laboratory electrolytes were within normal limits. The patient was discharged home.",What is the patient's delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [99.0, 'mEq/L'], 'Bicarbonate': [9.0, 'mEq/L'], 'Sodium': [137.0, 'mEq/L']}",1.13333,1.07666,1.19,"The formula for computing the delta ratio is delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 137.0 mEq/L. 
The concentration of chloride is 99.0 mEq/L. 
The concentration of bicarbonate is 9.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 137.0 mEq/L - (99.0 mEq/L + 9.0 mEq/L) = 29.0 mEq/L. Hence, The patient's anion gap is 29.0 mEq/L.Plugging in 29.0 mEq/L for the delta gap formula, we get 29.0 - 12 = 17.0 mEq/L. Hence, the patient's delta gap is 17.0 mEq/L.Plugging in the delta gap and the bicarbonate concentration for the delta ratio formula, we get 17.0 mEq/L / 15.0 mEq/L = 1.13333. The patient's delta ratio is 1.13333."
754,64,Delta Ratio,lab test,decimal,pmc-3544066-1,Extracted,"A 60-year-old lady, a known case of type 2 diabetes mellitus for 15 years and hypertension for 3 years, presented to the clinic with fever, chills, and bilateral loin pain of 4 days duration. No other co-morbidities like chronic kidney disease or coronary artery disease were known in her in the past and she was apparently in normal state of health prior to the presenting illness.
She developed high-grade fever with chills and rigors. Fever was accompanied by dysuria and bilateral loin pain which was constant and aching in nature. Two days following the onset of fever and loin pain, she developed hematuria and subsequently her urine output started declining and she was anuric at the time of admission to the hospital. She also experienced severe generalized muscle ache. There was no arthralgia, skin rash or hemoptysis. Her medications included glipizide and multivitamin.
At the time of admission, she was conscious, irritable, febrile, and tachypneic. Her conjunctivae appeared suffused. There was no icterus, purpura, or lymphadenopathy. Muscle tenderness in limbs was noted. Her pulse was 104/min, BP–110/70 mm Hg, respiratory rate 23/min, temperature 101°F, oxygen saturation 95% at room air. Rales were appreciated in the basal regions of the chest. Examination of abdomen revealed no organomegaly, but both renal angles were tender on palpation.
Investigations revealed hemoglobin of 10.8 g/dL; leukocyte count of 28400 cells/μL; differential count revealed polymorphs 91%, lymphocytes 8%; platelet count 60000/μL. The blood film revealed normocytic normochromic RBCs, neutrophilic leucocytosis with toxic granulations. No hemoparasites were detectable. Urine analysis revealed 1+ protein, 40-50 WBCs/high power field, 20-25 RBCs/high power field, bile salts and pigments - negative, ketone-negative. Blood sugar on admission was 208 mg/dL; blood urea nitrogen 74 mg/ dL; serum creatinine 5.4 mg/dL; serum sodium 138 mmol/L; potassium 4.8 mmol/L; bicarbonate 7.0 mmol/L; chloride 104 mmol/L; pO290 mm Hg., pCO226 mm Hg. Serum total bilirubin measured 2.1 mg/dl; SGOT – 44 U/L; SGPT – 34 U/L; alkaline phosphatase – 242 U/L; serum total protein 6.5 g/L; and serum albumin measured 2.4 g/ dL. Urine culture revealed significant growth of E. Coli., (>105 colony forming units/ ml) sensitive to ciprofloxacin, amikacin, and ceftriaxone. However, blood culture grew no organism. Ultrasonogram of the abdomen revealed bilaterally enlarged kidneys with hydroureteronephrosis. No radioopaque lesion could be made out in the ultrasonogram or X-ray KUB region. An MR urogram performed to further evaluate the obstruction [] revealed bilateral renal papillary necrosis (RPN) with bilateral midureteric obstruction.
Thrombocytopenia and severe myalgia prompted a search for leptospirosis, a common cause of AKI in this part of the country. The organism could not be isolated from the urine or blood. However, the MAT (Microscopic Agglutination Test) done in the second week of the illness detected Leptospira icterohemorrhagica; serovar hardjo. Serologic investigations for dengue were negative.
She was subjected to a USG-guided renal biopsy which revealed acute tubular necrosis, interstitial inflammation, and mild mesangial proliferation [Figure –].
The patient was treated with hemodialysis and her antibiotics included benzyl penicillin and ceftriaxone. Gradually, the fever settled, her general condition stabilized, and renal function started to improve. By the 20th day of the illness, serum creatinine was 1.7 mg/ dL and platelet count was 190,000/μL and patient was discharged. Follow-up at 3 months revealed a serum creatinine of 1.4 mg/dL.",What is the patient's delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [104.0, 'mmol/L'], 'Bicarbonate': [7.0, 'mmol/L'], 'Sodium': [138.0, 'mmol/L']}",0.88235,0.83823,0.92647,"The formula for computing the delta ratio is delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 138.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 138.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 138.0 mmol * 1 mEq/mmol = 138.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 138.0 mmol sodium/L converts to 138.0 mEq sodium/L. 
The concentration of chloride is 104.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 104.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 104.0 mmol * 1 mEq/mmol = 104.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 104.0 mmol chloride/L converts to 104.0 mEq chloride/L. 
The concentration of bicarbonate is 7.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 7.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 7.0 mmol * 1 mEq/mmol = 7.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 7.0 mmol bicarbonate/L converts to 7.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 138.0 mEq/L - (104.0 mEq/L + 7.0 mEq/L) = 27.0 mEq/L. Hence, The patient's anion gap is 27.0 mEq/L.Plugging in 27.0 mEq/L for the delta gap formula, we get 27.0 - 12 = 15.0 mEq/L. Hence, the patient's delta gap is 15.0 mEq/L.Plugging in the delta gap and the bicarbonate concentration for the delta ratio formula, we get 15.0 mEq/L / 17.0 mEq/L = 0.88235. The patient's delta ratio is 0.88235."
755,64,Delta Ratio,lab test,decimal,pmc-4971291-1,Extracted,"The patient was a 57-year-old man with a history of chronic myelogenous leukemia, hypertension, dyslipidemia, colon polyp (tubular adenoma, low-grade malignancy), and bilateral lower leg amputations due to a burn. He was also a heavy drinker and presented with chronic mild watery diarrhea. He had started experiencing bilateral upper extremity weakness and numbness, which gradually deteriorated. Two weeks later, he could not move by himself, and he was admitted to the hospital. His daily medications included imatinib 400 mg/day, valsartan 80 mg/day, atenolol 50 mg/day, eperisone 150 mg/day, ranitidine 300 mg/day, and irsogladine 1.5 g/day, but he had not taken them for several days before admission.
On admission, his blood pressure was 154/100 mmHg, pulse rate was 106 beats/minute in the supine position, and arterial oxygen saturation was 100% on room air. On physical examination, he showed dry mouth, hypoactive bowel sounds, weakening of tendon reflexes, 3/3 on a manual muscle test, a right-handed squeeze of 6 kg, a left-handed squeeze of 3 kg, and pain with pressure at the femurs; he did not show jugular vein distension, edema, or ascites. Electrocardiography revealed ST depletion, a tall U wave, and QTc prolongation. Laboratory data revealed serum concentrations of sodium of 140 mmol/L, chloride of 92 mmol/L, potassium of 2.0 mmol/L, corrected calcium of 2.2 mmol/L, phosphorus of 0.36 mmol/L, and magnesium of 1.2 mmol/L. Serum urea nitrogen and creatinine concentrations were 4.6 mmol/L and 61.0 μmol/L, respectively. Other serum biochemistry values were as follows: aspartate aminotransferase level, 622 IU/L; alanine aminotransferase level, 116 IU/L; lactate dehydrogenase level, 994 IU/L; creatine kinase level, 20,340 IU/L (CK-MM, 94%); and urine occult blood reaction, strongly positive; urinary erythrocytes were not identified. Arterial blood gas analysis showed a pH level of 7.586, carbon dioxide tension of 44.1 mmHg, and bicarbonate level of 37.8 mmol/L, compatible with metabolic alkalosis. Urine electrolyte levels of sodium, potassium, and chloride were 50 mmol/L, 6.4 mmol/L, and 66 mmol/L, respectively, with a urine anion gap of −9.6 and pH level of 6.0. Levels of thyroid-stimulating hormone, free T4, adrenocorticotropic hormone, and serum cortisol were 1.51 mIU/L (normal, 0.35–4.94 mIU/L), 0.15 pmol/L (normal, 0.09–0.19 pmol/L), 4.33 pmol/L (normal, 1.58–13.93 pmol/L), and 14.6 μg/dL (normal, 4.0–18.3 μg/dL), respectively, in the early morning. Plasma renin activity and plasma aldosterone concentration (PAC) were 11 μg/L/h (normal, 0.3–2.9 μg/L/h) and 0.72 nmol/L (normal, 0.83–4.40 nmol/L), respectively, in the supine position. The transtubular potassium gradient was 2.9 in pOsm 288 mOsm/kgH2O and uOsm 319 mOsm/kgH2O, with fractional excretion of potassium of 2.1%, sodium of 0.24%, and urea nitrogen of 15.6%.
A diagnosis of severe hypokalemia and volume depletion due to chronic watery diarrhea and concomitant chronic poor oral ingestion, complicated by rhabdomyolysis, was made. The patient received standard doses of potassium chloride (40–80 mmol/day) with normal saline intravenously in order to improve his serum potassium concentration and volume depletion. The clinical course is shown in . His muscle weakness gradually improved over the clinical course. The mild watery diarrhea also gradually improved, and he was able to intake orally. After discharge on hospital day 23, the patient's serum potassium concentration was maintained within its normal range.",What is the patient's delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [92.0, 'mmol/L'], 'Bicarbonate': [37.8, 'mmol/L'], 'Sodium': [140.0, 'mmol/L']}",0.13043,0.12391,0.13695,"The formula for computing the delta ratio is delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 140.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 140.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 140.0 mmol * 1 mEq/mmol = 140.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 140.0 mmol sodium/L converts to 140.0 mEq sodium/L. 
The concentration of chloride is 92.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 92.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 92.0 mmol * 1 mEq/mmol = 92.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 92.0 mmol chloride/L converts to 92.0 mEq chloride/L. 
The concentration of bicarbonate is 37.8 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 37.8 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 37.8 mmol * 1 mEq/mmol = 37.8 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 37.8 mmol bicarbonate/L converts to 37.8 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 140.0 mEq/L - (92.0 mEq/L + 37.8 mEq/L) = 10.2 mEq/L. Hence, The patient's anion gap is 10.2 mEq/L.Plugging in 10.2 mEq/L for the delta gap formula, we get 10.2 - 12 = -1.8 mEq/L. Hence, the patient's delta gap is -1.8 mEq/L.Plugging in the delta gap and the bicarbonate concentration for the delta ratio formula, we get -1.8 mEq/L / -13.799999999999997 mEq/L = 0.13043. The patient's delta ratio is 0.13043."
756,64,Delta Ratio,lab test,decimal,pmc-6374870-1,Extracted,"A 70-year-old female was brought to the emergency department of our tertiary care referral hospital with an alleged history of accidental “car coolant” consumption followed by unsteadiness of gait about 3 hours later. On examination, the patient was drowsy but following verbal commands. There was no odour of alcohol in the breath. The GCS score was 15/15 (E4V5M6). Her blood pressure was 140/80 mm of Hg and pulse rate 68 per minute. Oxygen saturation was maintained at room air. ECG was normal, and no focal neurological deficit was detected. Gastric lavage was performed as the first line of treatment. Laboratory investigations revealed Na+ 142 mEq/L, K+ 2.4 mEq/L, Cl− 101.1 mEq/L, HCO3− 15.8 mEq/L, Ca+ 5 mg/dl, urea 35 mg/dl, creatinine 0.7 mg/dl, BUN 16.35 mg/dl, random glucose 141 mg/dl, and serum osmolality 323 mOsm/kg. Arterial blood gas analysis showed pH 7.322, pCO2 30.7 mmHg, pO2 93.8 mmHg, cBase(B)c −9.1. Urine examination revealed crystals of calcium oxalate. Anion gap was 25.1 mEq/L, and osmolar gap was 17 mOsm/kg·H2O. Blood and urine levels of ethylene glycol could not be obtained for lack of such analytical facilities in the region.
Crystalluria observed in the case is considered as a major indicator of ethylene glycol consumption []. Anion gap metabolic acidosis and high osmolar gap gave further confirmation to our diagnosis. Oral ethanol therapy was started at 2.5 ml/kg of 40% ethanol [] through the nasogastric tube. In view of high anion gap metabolic acidosis, the patient was given hemodialysis (HD) over four hours with high potassium dialysate. Intravenous calcium gluconate was given over 10 minutes for management of hypocalcaemia. In addition, pyridoxine and thiamine were administered. She was given 100 ml of ethanol before dialysis.
Repeat arterial blood gas analysis was performed after 12 hours, which showed marked improvement in patient's condition. The patient improved clinically, and the investigations were in normal limits with pH 7.416, pCO2 34.7 mmHg, pO2 94.1 mmHg, and cBase(B)c −1.7. Calcium infusion was stopped. Repeat electrolytes were within normal limits with Na+ 141 mEq/L, K+ 5.2 mEq/L, Cl− 101.3 mEq/L, HCO3− 24.9 mEq/L, and Ca+ 9.4 mg/dl. Over the next 24 hours, she received 400 ml of ethanol through the nasogastric tube at timed intervals (approximately 35 ml second hourly).
Urine routine after 48 hours showed no crystalluria. The patient was clinically stable after 72 hours with laboratory parameters within normal range. No residual organ damages were detected upon follow-up.",What is the patient's delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [101.1, 'mEq/L'], 'Bicarbonate': [15.8, 'mEq/L'], 'Sodium': [142.0, 'mEq/L']}",1.59756,1.51768,1.67744,"The formula for computing the delta ratio is delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 142.0 mEq/L. 
The concentration of chloride is 101.1 mEq/L. 
The concentration of bicarbonate is 15.8 mEq/L. 
Plugging in these values into the anion gap formula gives us 142.0 mEq/L - (101.1 mEq/L + 15.8 mEq/L) = 25.1 mEq/L. Hence, The patient's anion gap is 25.1 mEq/L.Plugging in 25.1 mEq/L for the delta gap formula, we get 25.1 - 12 = 13.1 mEq/L. Hence, the patient's delta gap is 13.1 mEq/L.Plugging in the delta gap and the bicarbonate concentration for the delta ratio formula, we get 13.1 mEq/L / 8.2 mEq/L = 1.59756. The patient's delta ratio is 1.59756."
757,64,Delta Ratio,lab test,decimal,pmc-2783075-1,Extracted,"A 42-year-old African-American man with HIV/AIDS, not taking any medications including HAART and pneumocystis jiroveci prophylaxis since January 2007, presented in August 2007 with complaints of progressing shortness of breath, right-sided pleuritic chest pain, non-productive cough, and low-grade fever for last several weeks. He was diagnosed with HIV initially in 1999, during hospitalization for community-acquired pneumonia. The patient also had a history of facial herpes simplex virus type 2 (HSV-2) which has been recurrent and a history of pneumocystis pneumonia in June 2005. Previous laboratory studies from November 2006 revealed a CD4+ lymphocyte count of 20 and viral load HIV RNA of 65,833 copies/ml. He was a social drinker and had never used illicit drugs or tobacco products. HIV was presumed to be acquired sexually.
On initial assessment in the emergency department, he was cachectic but was in no acute distress. He had a fever of 38°C, blood pressure of 92/60 mmHg and regular pulse of 85 beats per minute. He was breathing at 20 breaths per minute. Oxygen saturation was 95% on room air, which decreased to 90% during ambulation. There were no oral lesions. His neck was supple. Examination of the lungs revealed bilateral expiratory wheezes and rare rhonchi. Cardiac examination demonstrated normal first sound, second sound with a regular rhythm and no murmurs. His abdomen was soft, nontender, nondistended with normoactive bowel sounds. His extremities were warm and his skin was dry with multiple small herpetic ulcers on the left ear and the left side of the face.
Laboratory tests revealed the following concentrations: sodium 138 mmol/L, potassium 4.5 mmol/L, chloride 103 mmol/L, bicarbonate 26 mmol/L, BUN 2.9 mmol/L, creatinine 61 μmol/L, glucose 4.78 mmol/L, white blood cell 3.4 × 109/L, neutrophils 86%, hemoglobin 7.1 mmol/L, hematocrit 33%, platelets 322 × 109/L, LDH 497 U/L, CD4+ lymphocyte count of 2. Chest X-ray was negative for infiltrate (Figure ), but high resolution CT of the chest revealed subtle right middle lobe and right upper lobe ground-glass opacity (Figure ).
The patient was admitted to the medical ward with a working diagnosis of pneumocystis pneumonia. A sputum sample was collected spontaneously for a culture work-up (Bartlett score: +3). No sputum sample was collected for mycobacterial stains. Empiric treatment with trimethoprim-sulfamethoxazole (1 tablet double-strength × 3 per day) and prednisone (40 mg × 2 per day) was started. The patient was also placed on treatment for HSV with acyclovir (400 mg × 3 per day). The prednisone doses were reduced as part of initial therapy for pneumocystis pneumonia. On the third day, direct fluorescent antibody test for Pneumocystis jiroveci was negative, but the culture was positive for Bordetella bronchiseptica. The patient was placed on droplet precautions; treatment was switched to levofloxacin (400 mg per day). Trimethoprim-sulfamethoxazole dose was modified to (1 tablet single-strength per day) for pneumocystis prophylaxis and azithromycin (1200 mg once per week) for Mycobacterium avium complex prophylaxis began. The patient subsequently improved on levofloxacin and on the seventh day was discharged home on levofloxacin, trimethoprim-sulfamethoxazole, azithromycin, and acyclovir. After eleven days, the patient visited our office. The patient had no complaints, no fever and no cough and his shortness of breath was fully resolved. On retrospect, the patient reported that he had been visited by his brother and his brother's dog at his home about a week prior to the illness.",What is the patient's delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [103.0, 'mmol/L'], 'Bicarbonate': [26.0, 'mmol/L'], 'Sodium': [138.0, 'mmol/L']}",1.5,1.425,1.575,"The formula for computing the delta ratio is delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 138.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 138.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 138.0 mmol * 1 mEq/mmol = 138.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 138.0 mmol sodium/L converts to 138.0 mEq sodium/L. 
The concentration of chloride is 103.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 103.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 103.0 mmol * 1 mEq/mmol = 103.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 103.0 mmol chloride/L converts to 103.0 mEq chloride/L. 
The concentration of bicarbonate is 26.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 26.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 26.0 mmol * 1 mEq/mmol = 26.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 26.0 mmol bicarbonate/L converts to 26.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 138.0 mEq/L - (103.0 mEq/L + 26.0 mEq/L) = 9.0 mEq/L. Hence, The patient's anion gap is 9.0 mEq/L.Plugging in 9.0 mEq/L for the delta gap formula, we get 9.0 - 12 = -3.0 mEq/L. Hence, the patient's delta gap is -3.0 mEq/L.Plugging in the delta gap and the bicarbonate concentration for the delta ratio formula, we get -3.0 mEq/L / -2.0 mEq/L = 1.5. The patient's delta ratio is 1.5."
758,64,Delta Ratio,lab test,decimal,pmc-4942506-1,Extracted,"A 36-year-old female smoker presented to the emergency department with epigastric abdominal pain, radiating to her back, of 1 week duration. Her past medical history was significant for type 2 diabetes for which she was on oral hypoglycemic agents and insulin; presumed secondary HTG for which she was on atorvastatin and gemfibrozil; furthermore, she used medroxyprogesterone acetate for contraception. She had stopped all these medications except the contraceptive 12 months prior to her presentation. The patient has no history of alcohol abuse, thyroid dysfunction, or family history of HTG. On admission, all vital signs were within normal limits. Physical examination was normal except for epigastric tenderness and a BMI of 31.4 kg/m2.
The initial relevant laboratory testing revealed sodium of 129 meq/l, potassium 3.7 meq/l, chloride 97 meq/l, BUN 10 mg/dl, creatinine 0.77 mg/dl (at baseline), bicarbonate 13.7 meq/l, glucose of 324 mg/dl, amylase 31 IU/l, lipase 206 IU/l, and TG 2,329 mg/dl with a previous baseline of around 2,000 mg/dl, serum calcium 9.0 mg/dl, TSH 1.182 µIU/ml, serum lactate 1.8 meq/l, negative urine ketones with serum beta-hydroxybutyrate 0.16 mmol/l, and negative urine pregnancy test. The abdominal computerized tomography scan showed no definite evidence of pancreatitis or any other pathology.
Despite unremarkable imaging, normal amylase, mild elevation of lipase, and a TG level that was mildly elevated from previous baseline, she was treated for possible HTGP with IV insulin based on the overall clinical picture. The differential diagnosis includes diabetic ketoacidosis (DKA); however, the patient lacked serum or urinary ketones. Regardless, IV insulin would treat both conditions of HTGP and DKA. The clinical impression of HTGP was further supported when her lipase increased to 370 IU/L and the TG levels on the initial sample was re-assayed resulting in a corrected reading of >10,000 mg/dl. The TG levels decreased to 6,069 mg/dl with IV insulin on day 5. However, given the worsening abdominal pain, plan for plasmapheresis to rapidly reduce the TG levels was taken. The TG levels decreased to 2,055 mg/dl after the first exchange and to 642 mg/dl after the second session, and her symptoms improved significantly.",What is the patient's delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Sodium': [129.0, 'mEq/L'], 'Bicarbonate': [13.7, 'mEq/L'], 'Chloride': [97.0, 'mEq/L']}",0.61165,0.58107,0.64223,"The formula for computing the delta ratio is delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 129.0 mEq/L. 
The concentration of chloride is 97.0 mEq/L. 
The concentration of bicarbonate is 13.7 mEq/L. 
Plugging in these values into the anion gap formula gives us 129.0 mEq/L - (97.0 mEq/L + 13.7 mEq/L) = 18.3 mEq/L. Hence, The patient's anion gap is 18.3 mEq/L.Plugging in 18.3 mEq/L for the delta gap formula, we get 18.3 - 12 = 6.3 mEq/L. Hence, the patient's delta gap is 6.3 mEq/L.Plugging in the delta gap and the bicarbonate concentration for the delta ratio formula, we get 6.3 mEq/L / 10.3 mEq/L = 0.61165. The patient's delta ratio is 0.61165."
759,64,Delta Ratio,lab test,decimal,pmc-7606204-1,Extracted,"A 38-year-old male with a past medical history of prediabetes was hospitalized and treated for acute hypoxemic respiratory failure secondary to COVID-19 pneumonia. During that admission, blood sugar level remained below 150 mg/dL even while the patient was being administered glucocorticoids. Glucocorticoids were discontinued after five days of hospitalization. Six weeks later, he was admitted for a severe hyperglycemic state of glucose level over 500 mg/dL. Symptoms reported included polyuria and polydipsia for one week. Physical examination and vital signs were unremarkable except for a body mass index of 29.52 kg/m2. Initial labs revealed sodium of 124 mmol/L (normal range: 136-145 mmol/L), chloride of 86 mmol/L (normal range: 98-108 mmol/L), blood sugar of 532 mg/dL (normal range: 74-110 mg/dL), bicarbonate of 14 mmol/L (normal range: 22-29 mmol/L), pH of 7.27 (normal range: 7.32-7.42), and lactate 3.1 of mmol/L (normal range: 0.5-2.2 mmol/L). Serum and urine ketones were positive. COVID-19 polymerase chain reaction (PCR) test was negative, whereas COVID-19 immunoglobulin G (IgG) antibodies titer was positive. Urine and blood cultures were negative, and chest X-ray was negative for any pneumonia, as shown in Figure . Hemoglobin A1c was found to be 10.8% (normal range: 4-5.6%), whereas during the last admission with COVID-19 pneumonia hemoglobin A1c was found to be 6.1%. Labs further showed triglyceride level of 1,269 mg/dL (normal range: 10-149 mg/dL), fasting C-peptide level of 1.8 ng/mL (normal range: 1.1-4.4 ng/mL), and weakly positive glutamic acid decarboxylase antibodies. Islet cell antibodies, insulin antibodies, and zinc transporter 8 antibodies were negative. The patient was treated for diabetic ketoacidosis with insulin detemir as a basal insulin and insulin lispro as a bolus. The anion gap closed and blood sugar level showed improvement. The patient was later discharged on metformin and pioglitazone in addition to the basal-bolus insulin. The patient was followed for three weeks after the second discharge and reported fasting blood sugars in the range of 120 to 130 mg/dL with dietary modification, lifestyle changes, oral antidiabetics, and insulin (Figure ).",What is the patient's delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Sodium': [124.0, 'mmol/L'], 'Chloride': [86.0, 'mmol/L'], 'Bicarbonate': [14.0, 'mmol/L']}",1.2,1.14,1.26,"The formula for computing the delta ratio is delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 124.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 124.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 124.0 mmol * 1 mEq/mmol = 124.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 124.0 mmol sodium/L converts to 124.0 mEq sodium/L. 
The concentration of chloride is 86.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 86.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 86.0 mmol * 1 mEq/mmol = 86.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 86.0 mmol chloride/L converts to 86.0 mEq chloride/L. 
The concentration of bicarbonate is 14.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 14.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 14.0 mmol * 1 mEq/mmol = 14.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 14.0 mmol bicarbonate/L converts to 14.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 124.0 mEq/L - (86.0 mEq/L + 14.0 mEq/L) = 24.0 mEq/L. Hence, The patient's anion gap is 24.0 mEq/L.Plugging in 24.0 mEq/L for the delta gap formula, we get 24.0 - 12 = 12.0 mEq/L. Hence, the patient's delta gap is 12.0 mEq/L.Plugging in the delta gap and the bicarbonate concentration for the delta ratio formula, we get 12.0 mEq/L / 10.0 mEq/L = 1.2. The patient's delta ratio is 1.2."
760,64,Delta Ratio,lab test,decimal,pmc-4992786-1,Extracted,"A fifty-seven-year-old female presented to emergency room with altered mental status, nausea, vomiting, and abdominal pain. The patient was in usual state of health 2 days before presentation, when she developed intermittent dull epigastric pain. The patient was able to tolerate the pain initially, but on day of presentation the pain became severe and persistent and she started having nonbilious vomiting. She also became somnolent and tachypneic and therefore the decision was made to bring her to the emergency room. Her past medical history was significant for diabetes mellitus and she was on insulin monotherapy. The family reported that for the last few weeks the patient was noncompliant with using insulin. On initial evaluation her vital signs were remarkable for temperature of 37 degree Celsius, pulse of 120/minutes, blood pressure (BP) of 134/78 mmHg, respiratory rate of 24 breath/minute, and oxygen saturation of 95% on 2-liter nasal cannula. Pertinent examination findings included obtunded patient who did not wake up to deep sternal rub, dry oral mucosa, and a weak gag reflex. Her pulmonary and cardiovascular examination was unremarkable. Admission labs indicated severe uncompensated metabolic acidosis with arterial blood gas showing pH of 7.02, PaCO2 of 14, PaO2 of 134, calculated bicarbonate of 4, and oxygen saturation of 97%. Serum chemistries indicated sodium 137 mEq/L (136–145 mEq/L), potassium 4.4 mEq/L (3.5–5.1 mEq/L), chloride 82 mEq/L (97–109 mEq/L), bicarbonate 10 mEq/L (23–32 mEq/L), blood urea nitrogen (BUN) 32 mg/dL (7–17 mg/dL), serum creatinine 2.84 mg/dL (0.7–1.1 mg/dL), serum glucose 172 mg/dL (66–111 mg/dL), and measured serum osmolality 324 mOsm/kg (280–300 mOsm/kg). Her urine analysis was positive for ketones. Urine and serum drug screen was positive for cocaine. Other labs including complete blood count, lactic acid, serum Tylenol levels, and liver function tests were within normal limits. Admission chest roentgenogram was unremarkable ().
Given concern for severe uncompensated metabolic acidosis and decreased sensorium, the patient was intubated for airway protection. Initial differential diagnosis included toxic alcohol ingestion, euglycemic diabetic ketoacidosis, alcoholic ketoacidosis, and starvation ketoacidosis. The serum ethanol, methanol, ethylene glycol, and propylene glycol were undetectable on admission labs and serum beta-hydroxybutyrate (BHB) levels were significantly elevated 15.95 mmol/L (0.02–0.27 mmol/L) confirming the diagnosis of euglycemic diabetic ketoacidosis. As the patient's blood glucose was 172 mg/dL on admission, we initially administered 1 liter bolus of intravenous (IV) 5% Dextrose and 0.45% normal saline (D5-1/2 NS), followed by a maintenance rate of 250 cc/hour, supplemented with 20 mEq of potassium chloride IV per liter of D5-1/2 NS. Insulin drip was initiated at a rate of 0.1 units/kg/hour. Finger stick blood glucose was checked hourly to maintain blood glucose between 150 and 200 mg/dL. Basic metabolic panel and BHB levels were checked at four-hour interval. After initial 4 liters of volume resuscitation, the patient's anion gap started to close and in 18 hours period her gap closed completely as shown in .
The patient was subsequently transitioned to subcutaneous insulin. Her mentation improved and she was extubated. After extubation patient confirmed that she was on a cocaine binge for 2 days and missed her insulin doses during that time. The patient was transferred out of medical intensive care unit and was discharged from hospital subsequently.",What is the patient's delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [82.0, 'mEq/L'], 'Bicarbonate': [10.0, 'mEq/L'], 'Sodium': [137.0, 'mEq/L']}",2.35714,2.23928,2.475,"The formula for computing the delta ratio is delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 137.0 mEq/L. 
The concentration of chloride is 82.0 mEq/L. 
The concentration of bicarbonate is 10.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 137.0 mEq/L - (82.0 mEq/L + 10.0 mEq/L) = 45.0 mEq/L. Hence, The patient's anion gap is 45.0 mEq/L.Plugging in 45.0 mEq/L for the delta gap formula, we get 45.0 - 12 = 33.0 mEq/L. Hence, the patient's delta gap is 33.0 mEq/L.Plugging in the delta gap and the bicarbonate concentration for the delta ratio formula, we get 33.0 mEq/L / 14.0 mEq/L = 2.35714. The patient's delta ratio is 2.35714."
761,64,Delta Ratio,lab test,decimal,pmc-4751718-1,Extracted,"A 65 year old previously healthy male presented to hospital with profound weakness. Five days before admission, he had received the Fluad seasonal influenza vaccine, comprised of one influenza A H1/N1 virus, one influenza A H3/N2 virus, one influenza B virus, and the MF59 adjuvant. Two days later, he developed bilateral crampy leg pain, muscle tenderness, and progressive weakness. He became unable to weight-bear and was brought to the emergency department by his wife. He denied experiencing headaches, paresthesias, arthralgias, skin lesions or constitutional symptoms. An infectious review of systems was unremarkable. He was not taking any medications or herbal preparations prior to admission, nor did he use recreational drugs.
On physical exam his vital signs were: pulse 92/minute, blood pressure 124/84, respiratory rate 20/minute, oral temperature 36.7 °C, and his oxygen saturation was 100 % on room air. His neurological exam was significant for 4/5 strength in bilateral hip flexors, hip extensors, hip abductors and hip adductors. He could not stand from the sitting position without the aid of his arms. The large muscle groups of his arms and legs were tender. Cardiac examination revealed a jugular venous pressure (JVP) two cm above the sternal angle, a normal apical beat, a normal S1 and S2 without any extra heart sounds, murmurs or rubs. His respiratory exam revealed mild crackles in the left lower lobe. The remainder of the examination was unremarkable.
His blood counts were WBC 11 × 99/L, hemoglobin 123 g/L (MCV 83 fL) and platelets 134 × 109/L. Electrolytes included sodium 126 mmol/L, potassium 3.2 mmol/L, chloride 101 mmol/L, bicarbonate 17 mmol/L, phosphate 0.75 mmol/L and magnesium 0.97 mmol/L. Other laboratory parameters included urea 11.6 mM/L, creatinine 157 mM/L, creatine kinase (CK) 7736 U/L (normal < 150 U/L) and troponin-I 9.44 mcg/L (normal < 0.2 mcg/L). A blood ethanol level was negative. His EKG revealed normal sinus rhythm and a right bundle branch block, without ischemic features. A chest radiograph and contrast enhanced computed tomography scan of the chest revealed a hiatus hernia, left lower lobe opacification, without evidence of pulmonary embolism.
Acute rhabdomyolysis was diagnosed and the patient received four liters of fluid over the ensuing 24 h. During volume resuscitation, he developed pulmonary crackles, his JVP increased to 5 cm above the sternal angle, and his oxygen saturation decreased to 90 % on room air. Supplemental oxygen and a single dose of furosemide 40 mg IV were provided, to which he responded well. He also initially received piperacillin–tazobactam for possible left lower lobe pneumonia. No steroids were prescribed. His creatinine, CK and troponin levels trended downwards after 12 h of therapy, and almost normalized within 5 days (see Fig. ).
A basic immunological workup was within normal limits, with an antinuclear antibody test (ANA) of 1:160, homogeneous pattern (non-specific), and negative anti-dsDNA, ENA panel, C3, C4, rheumatoid factor, and ANCA tests. Serum protein electrophoresis (SPEP) was consistent with an acute phase reaction and urine protein electrophoresis (UPEP) was negative. Dipstick urinalysis revealed 1+ protein and 1+ blood and his urine was positive for myoglobin. Microscopy revealed granular casts, urate crystals and no evidence of red blood cells. HIV, hepatitis B and C serological tests were negative. Blood and urine cultures yielded no growth. Computed tomography scans of the head and lumbar spine were negative; no other cause was found to explain the patient’s weakness. An echocardiogram performed on day three of admission revealed normal biventricular systolic function without regional wall motion abnormalities. Cardiac MRI on day four confirmed the diagnosis of myocarditis. A muscle biopsy was not performed as the patient recovered promptly; he was discharged home on day six.",What is the patient's delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [101.0, 'mmol/L'], 'Bicarbonate': [17.0, 'mmol/L'], 'Sodium': [126.0, 'mmol/L']}",-0.57143,-0.54286,-0.6,"The formula for computing the delta ratio is delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 126.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 126.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 126.0 mmol * 1 mEq/mmol = 126.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 126.0 mmol sodium/L converts to 126.0 mEq sodium/L. 
The concentration of chloride is 101.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 101.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 101.0 mmol * 1 mEq/mmol = 101.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 101.0 mmol chloride/L converts to 101.0 mEq chloride/L. 
The concentration of bicarbonate is 17.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 17.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 17.0 mmol * 1 mEq/mmol = 17.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 17.0 mmol bicarbonate/L converts to 17.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 126.0 mEq/L - (101.0 mEq/L + 17.0 mEq/L) = 8.0 mEq/L. Hence, The patient's anion gap is 8.0 mEq/L.Plugging in 8.0 mEq/L for the delta gap formula, we get 8.0 - 12 = -4.0 mEq/L. Hence, the patient's delta gap is -4.0 mEq/L.Plugging in the delta gap and the bicarbonate concentration for the delta ratio formula, we get -4.0 mEq/L / 7.0 mEq/L = -0.57143. The patient's delta ratio is -0.57143."
762,64,Delta Ratio,lab test,decimal,pmc-5051109-1,Extracted,"A 53-year-old male presented with 1 day duration of acute severe right lower quadrant abdominal pain, sharp, non-radiating associated with fever, chills and nausea but no vomiting or weight loss. On physical exam, his vital signs were blood pressure 126/68 mm Hg, pulse 90/min, respiratory rate 14/min, and temperature 99.4 °F. Abdominal exam revealed distension tenderness to Mcburney’s point, with guarding and rigidity but bowel sounds were normal. Laboratory data showed hemoglobin 13.4 g/dL, hematocrit 40.1%, white count 8.1 × 103/µL, platelets 172 × 103/µL, sodium 133 mmol/L, potassium 4.6 mmol/L, chloride 99 mmol/L, bicarbonate 20 mmol/L, BUN 24 mg/dL, creatinine 2.1 mg/dL and glucose 181 mg/dL. Computed tomography (CT) scan of abdomen showed the perforated appendicitis with two appendicoliths seen in the right lower quadrant (). Laparoscopic appendectomy with drainage of periappendiceal abscess was performed. Surgical pathology of appendix showed moderately differentiated adenocarcinoma with signet-ring cell (< 50% signet ring component) and carcinoid features involving muscular wall (). Tumor was penetrating and perforating the visceral serosa and diffusely infiltrating > 4/5 wall of the proximal portion of appendix with lymphovascular invasion. Special studies showed that the tumor is immunoreactive to CK20 (), focal to CD56, chromogranin (), synaptophysin; negative to CK7 (), TTF-1, PSA and CDx2. Mucin stain is positive (). The immunostains support the diagnosis. Patient was started on chemotherapy and after 3 months, patient complained of abdominal pain for which CT abdomen was performed which showed findings suspicious for spreading cancer. Patient failed chemotherapy and underwent hemicolectomy and peritonectomy as there were seedings on the peritoneum.",What is the patient's delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Bicarbonate': [20.0, 'mmol/L'], 'Chloride': [99.0, 'mmol/L'], 'Sodium': [133.0, 'mmol/L']}",0.5,0.475,0.525,"The formula for computing the delta ratio is delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 133.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 133.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 133.0 mmol * 1 mEq/mmol = 133.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 133.0 mmol sodium/L converts to 133.0 mEq sodium/L. 
The concentration of chloride is 99.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 99.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 99.0 mmol * 1 mEq/mmol = 99.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 99.0 mmol chloride/L converts to 99.0 mEq chloride/L. 
The concentration of bicarbonate is 20.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 20.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 20.0 mmol * 1 mEq/mmol = 20.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 20.0 mmol bicarbonate/L converts to 20.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 133.0 mEq/L - (99.0 mEq/L + 20.0 mEq/L) = 14.0 mEq/L. Hence, The patient's anion gap is 14.0 mEq/L.Plugging in 14.0 mEq/L for the delta gap formula, we get 14.0 - 12 = 2.0 mEq/L. Hence, the patient's delta gap is 2.0 mEq/L.Plugging in the delta gap and the bicarbonate concentration for the delta ratio formula, we get 2.0 mEq/L / 4.0 mEq/L = 0.5. The patient's delta ratio is 0.5."
763,64,Delta Ratio,lab test,decimal,pmc-3914193-1,Extracted,"A fifty-five-year-old Afghanistan gentleman with a history of hyperthyroidism (5 years) and ischemic cardiomyopathy (2 years) presented to Aga Khan University Hospital in July 2012. He was found to have kidney failure 2 months previously and was initiated on hemodialysis due to uremic encephalopathy. He was admitted to our institution for further work-up investigations for his kidney failure. His laboratory investigations were as follows:hemoglobin: 9 g/dL, white cell counts: 4,700 u/L, platelet count: 171,000/mm3. Urine DR showed yellow color with clear appearance, pH of 5, specific gravity of 1.010, 4 red blood cells per high-power field, 1 WBCs per high-power field, urine protein of 1.0 g/L, and 2 RBCs cast andurine protein to creatinine ratio: 3.9, BUN: 109 mg/dL, creatinine: 4.8 mg/dL, electrolytes: serum sodium 141 mmol/L, potassium 5.0 mmol/L, chloride 116 mmol/L, and bicarbonate 14.5 mmol/L, ANA: negative, C-ANCA: negative, P-ANCA: negative, hepatitis B surface antigen: nonreactive, hepatitis C antibody: nonreactive, PT/APTT/INR: 10.5/30.2/1. Because of symptomatic uremia, a right internal jugular nontunneled catheter was inserted on 28 of July 2012 for hemodialysis. In view of his normal size kidneys, a biopsy was done on 1 August 2012 to look for reversible causes. The biopsy showed 20 glomeruli in which 14 were globally sclerosed or severely collapsed and condensed. Several of them were associated with fibrocellular crescents with disruption of bowman's capsule and 4 had cellular crescents. Immunofluorescence showed IgA positivity in the mesangium and along the capillary walls. He was pulsed with methyl prednisolone 500 mg once a day for 3 days followed by oral prednisolone 25 mg twice a day. Cyclophosphamide or mycophenolate mofetil was not added in view of 14/20 sclerosed glomeruli and fibrocellular crescents. As there was no sign of renal recovery, the patient was discharged on three times a week dialysis through right internal jugular catheter with followup in nephrology outpatients clinic.",What is the patient's delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [116.0, 'mmol/L'], 'Bicarbonate': [14.5, 'mmol/L'], 'Sodium': [141.0, 'mmol/L']}",-0.15789,-0.15,-0.16578,"The formula for computing the delta ratio is delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 141.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 141.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 141.0 mmol * 1 mEq/mmol = 141.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 141.0 mmol sodium/L converts to 141.0 mEq sodium/L. 
The concentration of chloride is 116.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 116.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 116.0 mmol * 1 mEq/mmol = 116.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 116.0 mmol chloride/L converts to 116.0 mEq chloride/L. 
The concentration of bicarbonate is 14.5 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 14.5 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 14.5 mmol * 1 mEq/mmol = 14.5 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 14.5 mmol bicarbonate/L converts to 14.5 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 141.0 mEq/L - (116.0 mEq/L + 14.5 mEq/L) = 10.5 mEq/L. Hence, The patient's anion gap is 10.5 mEq/L.Plugging in 10.5 mEq/L for the delta gap formula, we get 10.5 - 12 = -1.5 mEq/L. Hence, the patient's delta gap is -1.5 mEq/L.Plugging in the delta gap and the bicarbonate concentration for the delta ratio formula, we get -1.5 mEq/L / 9.5 mEq/L = -0.15789. The patient's delta ratio is -0.15789."
764,64,Delta Ratio,lab test,decimal,pmc-7045622-1,Extracted,"A 33-year-old African-American female with no significant past medical history was evaluated as an outpatient for the complaints of 3-month duration of tiredness, diarrhea, and weight loss. Clinical examination suggested pallor, bilateral cervical lymphadenopathy, and splenomegaly. Further laboratory and imaging studies were ordered, but the patient did not follow-up for the next 2 months. Later, she reported to the emergency room for worsening symptoms. On examination, she was found to be apprehensive with vital signs of temperature of 98.9°F, a pulse rate of 140 beats/min, blood pressure of 90/60 mmHg, and a respiratory rate of 18 breaths/min. Laboratory examination showed a sodium level of 127 mmol/L, a potassium level of 3.9 mmol/L, a chloride level of 98 meq/L, a bicarbonate level of 19 meq/L, a blood urea nitrogen level of 21 mg/dL, a creatinine level of 1.11 mg/dL, a hemoglobin level of 4 gm/dL, a platelet count of 21,000 cells/mm3, and a total leukocyte count of 6100 cell/mm3 (DLC-P56, L11, M13, band cells 14, E3, and B3). Peripheral blood smear showed many hypochromic red blood cells (RBCs), many polychromatophilic RBCs, moderate teardrops, few target cells, and spherocytes.
In view of hypotension, breathlessness, severe anemia, and thrombocytopenia, she received urgent packed RBC transfusions (4 units) and single-donor apheresis platelets (SDAPs) (2 units). Computed tomography (CT) suggested massive splenomegaly and retroperitoneal, mediastinal, and cervical lymphadenopathy [Figure –]. Her rapid HIV test came positive with a CD4 count of 9 cells/mm3 and HIV viral load of 147,830 copies/ml. She was started on PCP prophylaxis problem (trimethoprim/sulfamethoxazole) and MAC prophylaxis (tablet azithromycin 1200 mg once a week).
In view of immunosuppression and ongoing suspected infection, laboratory works for opportunistic diseases were carried out including blood, urine cultures and lymph node and bone marrow (BM) biopsies. Both BM and lymph node aspirates were positive for acid-fast bacillus (AFB) stain [] based on which she was started on preemptive treatment for disseminated MAC (tablet azithromycin 500 mg once daily, tablet ethambutol 15 mg/kg/day, and tablet rifabutin 300 mg once daily). Later, blood and BM cultures confirmed M. avium
intracellulare. During her hospital stay, she gradually started feeling better with improving laboratory parameters []. Two weeks later, she was started on ART (efavirenz, emtricitabine, and tenofovir) and was discharged. At follow up, she expired a month later probably related to nonadherence to medications and superadded infections.",What is the patient's delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [98.0, 'mEq/L'], 'Bicarbonate': [19.0, 'mEq/L'], 'Sodium': [127.0, 'mmol/L']}",-0.4,-0.38,-0.42,"The formula for computing the delta ratio is delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 127.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 127.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 127.0 mmol * 1 mEq/mmol = 127.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 127.0 mmol sodium/L converts to 127.0 mEq sodium/L. 
The concentration of chloride is 98.0 mEq/L. 
The concentration of bicarbonate is 19.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 127.0 mEq/L - (98.0 mEq/L + 19.0 mEq/L) = 10.0 mEq/L. Hence, The patient's anion gap is 10.0 mEq/L.Plugging in 10.0 mEq/L for the delta gap formula, we get 10.0 - 12 = -2.0 mEq/L. Hence, the patient's delta gap is -2.0 mEq/L.Plugging in the delta gap and the bicarbonate concentration for the delta ratio formula, we get -2.0 mEq/L / 5.0 mEq/L = -0.4. The patient's delta ratio is -0.4."
765,64,Delta Ratio,lab test,decimal,pmc-5965110-1,Extracted,"We report the case of a 50-year-old male who presented to the emergency department (ED) complaining of dyspnea. The patient had a known history of asthma and felt that his symptoms were typical of his exacerbations. He noted a cough with yellow sputum but denied fevers or any pain. He also reported a history of tension headaches and hyperlipidemia; his medical history was negative for diabetes, seizures, or strokes. He had no prior surgeries. He reported taking amitriptyline 10mg as needed for headaches and was also on atorvastatin 40mg daily. He had no allergies to medications. He denied any and all alcohol intake and he was not clinically intoxicated.
The triage vital signs were as follow: blood pressure 139/105 mmHg, temperature 35.7ºC (96.3ºF), heart rate 104 beats per minute, oxygen saturation 94% on room air, and respiratory rate 20 breaths per minute. A chest radiograph did not reveal any acute abnormalities. The patient received a single dose of 15mg of albuterol, 1500mcg of ipratropium, and 60mg of prednisone shortly after his ED arrival. He remained somewhat dyspneic after this initial treatment and was given an additional 10mg of albuterol two hours later. Given that the patient required one additional treatment, the decision was made to transfer him to the observation unit for further monitoring.
As part of the admission process to the observation unit, a basic metabolic panel was ordered, which showed a sodium of 139 mmol/L, potassium of 3.2 mmol/L, chloride of 100 mmol/L, bicarbonate of 18 mmol/L. The creatinine was 0.91 mg/dL. The aspartate aminotransferase was 16 units/liter and the alanine transaminase was 22 units/liter. The white blood cell count was 7.19 x 109/L. The admitting team then ordered a lactate to address the anion gap, which resulted at 9.6 mmol/L with a corresponding pH from the venous blood gas of 7.31 and a partial pressure of carbon dioxide of 34 mmHg. The lactate was repeated one hour later and resulted at 10.3 mmol/L. A standard urine drug screen, examining for amphetamines, benzodiazapines, cannabinoids, cocaine metabolites, opiates, and phencyclidine, was negative. The patient’s symptoms had improved and he remained otherwise asymptomatic.
The conundrum we faced was to determine not only whether this was a Type A or Type B lactic acidosis but also its precipitant. Given the lack of toxic appearance, hypotension, and altered mental status it was strongly felt that Type A lactic acidosis was not the culprit. The patient was admitted to our medicine service and observed. Additional albuterol treatments were withheld and the serum lactate value cleared to 1.1 mmol/L approximately 24 hours later. The patient was discharged from the hospital without incident.",What is the patient's delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [100.0, 'mmol/L'], 'Bicarbonate': [18.0, 'mmol/L'], 'Sodium': [139.0, 'mmol/L']}",1.5,1.425,1.575,"The formula for computing the delta ratio is delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 139.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 139.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 139.0 mmol * 1 mEq/mmol = 139.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 139.0 mmol sodium/L converts to 139.0 mEq sodium/L. 
The concentration of chloride is 100.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 100.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 100.0 mmol * 1 mEq/mmol = 100.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 100.0 mmol chloride/L converts to 100.0 mEq chloride/L. 
The concentration of bicarbonate is 18.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 18.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 18.0 mmol * 1 mEq/mmol = 18.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 18.0 mmol bicarbonate/L converts to 18.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 139.0 mEq/L - (100.0 mEq/L + 18.0 mEq/L) = 21.0 mEq/L. Hence, The patient's anion gap is 21.0 mEq/L.Plugging in 21.0 mEq/L for the delta gap formula, we get 21.0 - 12 = 9.0 mEq/L. Hence, the patient's delta gap is 9.0 mEq/L.Plugging in the delta gap and the bicarbonate concentration for the delta ratio formula, we get 9.0 mEq/L / 6.0 mEq/L = 1.5. The patient's delta ratio is 1.5."
766,64,Delta Ratio,lab test,decimal,pmc-5984920-1,Extracted,"A 45-year-old Caucasian woman presented with abdominal pain, nausea, and vomiting for 17 h. At 22 h prior to admission, she went out to dinner and drank one glass of wine. A few hours after the meal, she developed epigastric and left upper quadrant abdominal pain that was moderate, persistent, cramping, and aching; the pain radiated to her left middle back and arm without exacerbating or alleviating factors. The pain was associated with nausea, vomiting, and she could not tolerate any oral intake. She felt thirsty and had polyuria and positional lightheadedness. She reported no fever, chills, chest pain, cough, sputum production, dysuria, hematuria, diarrhea, hematochezia, and melena.
On further questioning, the patient shared that she had a history of gestational glucose intolerance 6 years ago, and has had occasional impaired fasting glucose of 81–107 mg/dL for the past 6 years. She began following an American Diabetes Association (ADA) diet 2 years ago and lost 25 lb. Additionally, she had a past medical history of supraventricular tachycardia, irritable bowel syndrome, social alcohol use, cholecystectomy, and thyroid papillary adenocarcinoma status post partial thyroidectomy complicated by postsurgical hypothyroidism. Home medications included metoprolol tartrate, levothyroxine, and meloxicam. The patient reported no family history of diabetes.
Temperature 97.7 °F, pulse 130 bpm, respiratory rate 28 bpm, BP 134/71 mmHg, weight 87 kg, height 1.68 m, BMI 31 kg/m2, SpO2 99% on room air.
The patient was in moderate distress. There was no acanthosis nigricans. Cardiovascular system revealed tachycardia. A pulmonary exam revealed tachypnea, accessory muscle usage with moderate respiratory distress. Abdominal exam revealed central obesity, normoactive bowel sounds, left upper quadrant and epigastric tenderness to palpation, no rigidity or guarding. No costovertebral angle tenderness.
CBC: WBC 25.9 × 109/L, hemoglobin 14.7 g/dL, hematocrit 45.8%, platelet 386 × 109/L, MCV 100.2 µm3. BMP: sodium 135 mmol/L, potassium 7.4 mmol/L, chloride 89 mmol/L, bicarbonate 5 mmol/L, BUN 37 mg/dL, creatinine 1.27 mg/dL, glucose 931 mg/dL, eGFR 46 mL/min.
Liver chemistry: Total bilirubin 0.2 mg/dL, AST 23 U/L, ALT 54 U/L, ALP 138 U/L, total protein 7.5 g/dL, albumin 4.5 g/dL. Calcium 8.7 mg/dL, phosphate 1.4 mg/dL, magnesium 2.1 mg/dL. VBG: pH 6.92. Repeated ABG 2 h later: pH 7.21, pCO2 16 mmHg, pO2 129 mmHg, HCO3− 6.4 mmol/L, SaO2 98% on 2 L/min oxygen by nasal cannula. Beta-hydroxybutyrate 28 mmol/L, lactic acid 4.0 mmol/L. Urinalysis showed urine ketones 80 mg/dL, leukocyte esterase negative, urine culture no growth. HbA1c 6.4%. Lipid profile: triglycerides 89 mg/dL, total cholesterol 144 mg/dL, LDL 91 mg/dL, HDL 35 mg/dL. TSH 3.12 mIU/mL, free T4 1.26 ng/dL. Troponin I < 0.01 ng/mL.
Ultrasonography of the abdomen revealed mild hepatic steatosis, incidental mild to moderate right-sided hydronephrosis, status post cholecystectomy. ECG on admission: sinus rhythm, HR 126 bpm, peaked T waves at lead V2–V6 consistent with hyperkalemia, no ischemic changes.
All procedures performed in this study were in compliance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from the individual participant for being included in the study.",What is the patient's delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [89.0, 'mmol/L'], 'Bicarbonate': [5.0, 'mmol/L'], 'Sodium': [135.0, 'mmol/L']}",1.52632,1.45,1.60264,"The formula for computing the delta ratio is delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 135.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 135.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 135.0 mmol * 1 mEq/mmol = 135.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 135.0 mmol sodium/L converts to 135.0 mEq sodium/L. 
The concentration of chloride is 89.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 89.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 89.0 mmol * 1 mEq/mmol = 89.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 89.0 mmol chloride/L converts to 89.0 mEq chloride/L. 
The concentration of bicarbonate is 5.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 5.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 5.0 mmol * 1 mEq/mmol = 5.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 5.0 mmol bicarbonate/L converts to 5.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 135.0 mEq/L - (89.0 mEq/L + 5.0 mEq/L) = 41.0 mEq/L. Hence, The patient's anion gap is 41.0 mEq/L.Plugging in 41.0 mEq/L for the delta gap formula, we get 41.0 - 12 = 29.0 mEq/L. Hence, the patient's delta gap is 29.0 mEq/L.Plugging in the delta gap and the bicarbonate concentration for the delta ratio formula, we get 29.0 mEq/L / 19.0 mEq/L = 1.52632. The patient's delta ratio is 1.52632."
767,64,Delta Ratio,lab test,decimal,pmc-4421247-1,Extracted,"A 36-year-old 5-week postpartum woman presented to the emergency room with complaints of nausea and vomiting for 48 h. She also reported a 2-day history of general malaise and worsening dyspnoea. She denied chest pain, palpitations, diarrhoea or headaches. She reported eating; however, she limited herself to several small high-protein carbohydrate-free meals in an attempt to quickly return to her prepartum weight. Since her delivery, she had achieved an intentional weight loss of 30 lbs. Initial vital signs were: temperature 37 °C, blood pressure 140/63 mmHg, heart rate 84, respiratory rate 20 and a weight of 59.8 kg. She appeared unkempt and lethargic. Head and neck examinations were benign. Chest auscultation was clear with no adventitious sounds; heart examination was unremarkable. The abdomen was benign with a well-healed surgical C-section scar; there was no costovertebral angle tenderness. The extremities were without tenderness or oedema. She had no neurologic defects other than her blunted mentation.
Her past medical history was significant for a cesarean section, complicated by bladder damage, now resolved. Her only medication was percocet to manage post-surgical visceral pain. She denied alcohol or illicit substance use.
Initial laboratory data include sodium of 144 mEq/L, potassium 4.8 mEq/L, chloride 104 mEq/L and bicarbonate 5 mEq/L that is the lowest available determination possible at our institution. Her BUN was 3 mg/dL, creatinine was 1.1 mg/dL and glucose was 133 mg/dL. Serum lactate was 2.1 mmol/L, phosphate 1.0 mg/dL and magnesium 1.6 mg/dL. Arterial blood gas drawn on room air showed a pH of 6.9, PCO2 of 19 mmHg, PaO2 of 137 mmHg and SaO2 of 100%. White blood cell count was 17 600/mm3 with 88.2% segmented neutrophils, Hg 13.7 g/dL, haematocrit 43.1% and platelets of 340 000/mm3. Urinalysis had a pH of 5.5 with <80 mg/dL ketones. The serum osmolar gap was 7. A comprehensive drug screen was negative including salicylates and acetaminophen. Chest radiograph was normal. Blood and urine cultures were negative.
The patient was volume-depleted with a metabolic acidosis and a serum anion gap of 35. Fluid resuscitation with three ampules of sodium bicarbonate per litre of D5W at 100 cc/h was initiated for 24 h. Improvement in laboratory values occurred within 12 h with serum bicarbonate improving to 12 mEq/L. The serum bicarbonate improved to 20 mEq/L with normalization of the anion gap at 24 h. Symptomatic improvement occurred likewise. The patient was started on an 1800 kcal diet during her hospitalization, supplemented with a regular diet of home food provided by the husband. Breast feeding was stopped on advice from a lactation consultant and the acidosis did not reoccur. The patient's baby was reported to be in the 90th percentile for weight and height.",What is the patient's delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [104.0, 'mEq/L'], 'Bicarbonate': [5.0, 'mEq/L'], 'Sodium': [144.0, 'mEq/L']}",1.21053,1.15,1.27106,"The formula for computing the delta ratio is delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 144.0 mEq/L. 
The concentration of chloride is 104.0 mEq/L. 
The concentration of bicarbonate is 5.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 144.0 mEq/L - (104.0 mEq/L + 5.0 mEq/L) = 35.0 mEq/L. Hence, The patient's anion gap is 35.0 mEq/L.Plugging in 35.0 mEq/L for the delta gap formula, we get 35.0 - 12 = 23.0 mEq/L. Hence, the patient's delta gap is 23.0 mEq/L.Plugging in the delta gap and the bicarbonate concentration for the delta ratio formula, we get 23.0 mEq/L / 19.0 mEq/L = 1.21053. The patient's delta ratio is 1.21053."
768,64,Delta Ratio,lab test,decimal,pmc-2726561-1,Extracted,"A 49-year-old man with a history of intravenous drug abuse, mainly heroin, presented to the emergency department in Henry Ford Hospital where he complained of chills and diarrhea. The diarrhea was watery and continuous of 1-day duration accompanied by chills. He denied shortness of breath or chest pain.
Our patient was hospitalized in another facility 14 days before presenting to the emergency department of our hospital, and was found to have Candida parapsilosis and Pseudomonas aeruginosa endocarditis. A 2D echocardiogram was done there and showed vegetation of the prosthetic mitral valve, with normal aortic prosthesis. He was discharged with a peripherally inserted catheter (PIC) line and on intravenous antibiotics namely, tobramycin, cefepime and fluconazole. No valve replacement was performed at that time due to ongoing injection drug use. He was only out for 1 day before presenting to our emergency department.
His past medical history was significant for aortic and mitral valve replacement 1 year before this hospitalization for endocarditis. He also had stage 3 chronic kidney disease.
At initial presentation, he was found to be febrile at 100.3°F and hypotensive at a blood pressure of 85/50. His physical examination revealed a 3/6 systolic murmur in the aortic area with radiation to the precordium, and a 2/6 diastolic murmur over the mitral area without radiation.
His initial laboratory investigations showed white blood cell count of 19.2 k/μL with 93% neutrophils, hemoglobin of 9.6 g/dL, blood urea nitrogen (BUN) 26 mg/dL, creatinine 2.2 mg/dL, serum bicarbonate 16 mmol/L, chloride 112 mmol/L, sodium 136 mmol/L, magnesium 1.2 mmol/L. Prothrombin time was 15 seconds, and international normalized ratio (INR) was 1.17. Urine toxicology screen was positive for benzodiazepines. Troponin level was 2.2 ng/mL (normal<0.4). Initial blood cultures were drawn in the emergency department and later grew P. aeruginosa susceptible to amikacin, aztreonam, cefepime, ciprofloxacin, imipenem, piperacillin/tazobactam and tobramycin. Serology was positive for Hepatitis C infection and negative for HIV infection.
On presentation, he was admitted to the intensive care unit with the diagnosis of septic shock. He was started on intravenous vancomycin, tobramycin, micafungin and cefepime.
Three sets of blood cultures grew C. parapsilosis susceptible to fluconazole, itraconazole and 5 flucytosine, and P. aeruginosa susceptible to amikacin, aztreonam, cefepime, ciprofloxacin, imipenem, piperacillin/tazobactam and tobramycin.
A 2D echocardiogram showed a bioprosthetic aortic valve with a medium, 10 mm, pedunculated, highly mobile vegetation of the aortic valve attached to the posterior aortic annulus. There was no significant aortic valvular regurgitation. There was mild mitral valvular regurgitation.
At day 2 of hospitalization, a transesophageal echocardiogram was done. It showed no aortic abscess but small, 5 mm, mobile vegetation of the aortic valve attached to the non-coronary cusp without significant regurgitation. It also showed large, 10 mm, mobile mitral valve vegetation attached to the anterior leaflet without significant regurgitation.
The hospital course was complicated by acute renal failure and acute heart failure for which the patient was aggressively resuscitated. He was electively intubated and medically stabilized to undergo valve replacement 5 days later. Ethical and logistic considerations were the focus of an extensive discussion among the different treating medical and surgical teams given the active injecting drug use while being treated for a relapse of infective endocarditis. The decision was finally made to proceed with the valve replacement surgery. The patient was kept in hospital for the duration of intravenous antibiotics to ensure adherence to therapy and to prevent use of the intravenous access for illicit drug use.
At day 7 of hospitalization, he underwent aortic and mitral valve replacement. Cultures from the valves also grew P. aeruginosa and C. parapsilosis. All blood cultures drawn after day 1 were negative.
Tobramycin and cefepime were given for 6 weeks postoperatively. Tobramycin trough levels were measured frequently to ensure therapeutic levels. Micafungin was given for 5 days postoperatively, and replaced by anidulafungin that was given for 26 days. Fluconazole was given for 30 days postoperatively while in hospital and prescribed for 3 months after discharge from the hospital.
Throughout hospitalization, he remained afebrile and euvolemic without symptoms of heart failure. Two weeks after discharge from the hospital, he returned to the infectious disease clinic, being in good health, without history of fever, excess sweating, chest pain or shortness of breath. Follow-up blood cultures were drawn and were negative.",What is the patient's delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [112.0, 'mmol/L'], 'Bicarbonate': [16.0, 'mmol/L'], 'Sodium': [136.0, 'mmol/L']}",-0.5,-0.475,-0.525,"The formula for computing the delta ratio is delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of the delta gap, the formula is anion gap (in mEq/L) - 12. The first step is to compute the patient's anion gap.
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 136.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 136.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 136.0 mmol * 1 mEq/mmol = 136.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 136.0 mmol sodium/L converts to 136.0 mEq sodium/L. 
The concentration of chloride is 112.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 112.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 112.0 mmol * 1 mEq/mmol = 112.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 112.0 mmol chloride/L converts to 112.0 mEq chloride/L. 
The concentration of bicarbonate is 16.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 16.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 16.0 mmol * 1 mEq/mmol = 16.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 16.0 mmol bicarbonate/L converts to 16.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 136.0 mEq/L - (112.0 mEq/L + 16.0 mEq/L) = 8.0 mEq/L. Hence, The patient's anion gap is 8.0 mEq/L.Plugging in 8.0 mEq/L for the delta gap formula, we get 8.0 - 12 = -4.0 mEq/L. Hence, the patient's delta gap is -4.0 mEq/L.Plugging in the delta gap and the bicarbonate concentration for the delta ratio formula, we get -4.0 mEq/L / 8.0 mEq/L = -0.5. The patient's delta ratio is -0.5."
769,65,Albumin Corrected Anion Gap,lab test,decimal,pmc-3950226-1,Extracted,"The patient was a 20-year-old previously healthy woman. She was a university student. Her height and body weight were 168.1 cm and 52.2 kg, respectively. She ingested bamboo salt (about 150 grams ) in a day for the purpose of digestion and weight reduction. After that, she had more than ten episodes of vomiting and diarrhea for 2-3 hours. On arrival at our emergency department, vital signs were blood pressure of 128/81mmHg, heart rate of 75 beat/min, respiration rate of 20/min, and body temperature of 37.3℃. Her consciousness was clear but she complained of generalized weakness. The complete blood counts showed hemoglobin 11.3 g/dL, WBC 10,000 cells/µL, and platelet 196,000/µL. The results of her blood chemistry were as follows: Aspartate transaminase 11 IU/L, Alanine transaminase 9 IU/L, total protein 6.4 g/dL, albumin 4.5 g/dL, blood urea nitrogen 5.2mg/dL, bicarbonate 18.5mEq/L, and creatinine 0.57mg/dL. Serum osmolarity was 348mosm/kg. Serum sodium, potassium and chloride were 174mEql/L, 3.6mEq/L and 135mEq/L respectively. Urine sodium, potassium, chloride and osmolarity were 440mEq/L, 125.7 mEq/L, 314mEq/L and 841mosm/kg, respectively. On arterial blood gas analysis, pH was 7.32, PaCO2 36mmHg, PaO2 93mmHg and O2 saturation 97%. On the 1st day, total input and urine output was 3,700ml and 2,100ml, respectively. Her symptoms such as nausea, vomiting and diarrhea improved rapidly with 0.45% saline infusion and supportive care. On the 2nd day, her serum sodium concentration dropped to 152 mEq/L and urine output was 2,200ml/day. On the 3rd day, serum sodium concentration returned to normal range (). She recovered completely without any sequelae in 3 days.",What is the patient's albumin corrected anion gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [135.0, 'mEq/L'], 'Albumin': [4.5, 'g/dL'], 'Bicarbonate': [18.5, 'mEq/L'], 'Sodium': [174.0, 'mEq/L']}",19.25,18.2875,20.2125,"The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 174.0 mEq/L. 
The concentration of chloride is 135.0 mEq/L. 
The concentration of bicarbonate is 18.5 mEq/L. 
Plugging in these values into the anion gap formula gives us 174.0 mEq/L - (135.0 mEq/L + 18.5 mEq/L) = 20.5 mEq/L. Hence, The patient's anion gap is 20.5 mEq/L.The concentration of albumin is 4.5 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 20.5 (mEq/L) + 2.5 * (4 - 4.5 (in g/dL)) = 19.25 mEq/L. Hence, the patient's albumin corrected anion gap is 19.25 mEq/L."
770,65,Albumin Corrected Anion Gap,lab test,decimal,pmc-4525392-1,Extracted,"A 32-year-old female presented to the emergency room with a chief complaint of marked edema of 5 days' duration. Past medical history included: Bipolar disorder, panic disorder, hypothyroidism, and hidradenitis suppurativa. Her daily home medications included lithium carbonate 900 mg, synthroid 75 μg, cymbalata 60 mg, nortryptiline 30 mg, cipralex 30 mg, gabapentin 600-900 mg, and ibuprofen 200 mg. The patient had been on a stable dose of lithium for approximately 5 years experiencing no side effects. She presented to the hospital with a 5-day history of severe fatigue, migraine-like headaches, lethargy, and significant anasarca. Associated with these symptoms were upper extremity tremors as well as polyuria and polydipsia. She denied chest pain, shortness of breath, constitutional symptoms, and any urinary symptoms. Social history included 10-pack year history of tobacco.
On admission, the patient's vital signs were: Blood pressure 115/61, heart rate 61 beats/min, respiratory rate 20 breaths/min, and oxygen saturation 96% on room air. The patient was afebrile. There was generalized + 2 edema of lower extremities, upper extremities, and periorbital regions. Minimal bibasilar crackles were appreciated. The remainder of the cardiovascular and abdominal examination was unremarkable.
Blood work showed a plasma creatinine level of 119 μmol/L (baseline 69 μmol/L) and a blood urea of 10.4 mmol/L. Urine dipstick showed a specific gravity of 1.016, pH 7.5, and 4 + protein; and was negative for glucose, ketones, and nitrites. Microscopy revealed oval fat bodies and free fat droplets. The urine albumin to creatinine ratio was 973.4 mg/mmol and 24-h urine protein was 15.69 g. On admission, serum lithium level was 2.66 mmol/L (therapeutic 0.50-1.50 mmol/L). Serum sodium was 130 mmol/L, potassium 4.5 mmol/L, chloride 105 mmol/L, and bicarbonate 27 mmol/L. A complete blood count demonstrated hemoglobin 106 g/L, white blood cell count 9.46 × 109 /L, and platelet count 234 × 109 /L. Serum albumin was low at 20 g/L; but all liver enzymes, total bilirubin, and coagulation studies were within normal limits. Thyroid-stimulating hormone was 18.90 mU/L and free T4 8.2 pmol/L. Serology for hepatitis B and C, anti-double stranded deoxyribonucleic acid, antineutrophilic cytoplasmic antibodies, ribonucleoprotein, Sjogren's syndrome, scleroderma, inflammatory myositis, and Smith antibody were all negative. Antinuclear antibody was slightly positive on admission. Chest radiographs revealed nonspecific bibasilar infiltrates. Abdominal ultrasound demonstrated normal kidneys with no renal calculi or hydronephrosis.
Lithium treatment was discontinued immediately and the patient was treated conservatively with fluids. Initially the patient refused renal biopsy. Once stabilized, she was discharged from the hospital and lithium remained discontinued. At 2 months follow-up, the patient experienced worsening anasarca, significant acute kidney injury (AKI; serum creatinine 209 μmol/L), and persistent proteinuria. She was readmitted to the hospital and subsequently underwent a renal biopsy, when at the time her creatinine peaked at 348 μmol/l. On light microscopy, there was no global sclerosis, crescent formation, or necrotic lesions capillary wall thickness was normal. There was evidence of moderate focal interstitial fibrosis []. Immunofluorescence did not demonstrate any immune deposits. Electron microscopy revealed widespread fusion of podocyte foot processes affecting more than 75% of the surface of glomerular capillary loops []. No electron dense deposits were evident. A diagnosis of MCD secondary to lithium use was established and the patient was started on high dose corticosteroids, initially intravenously, but changed to oral prednisone 80 mg daily on discharge. Over the next 2 months of follow-up, the patient's creatinine, proteinuria, and edema all decreased significantly and she was tapered to oral prednisone 40 mg. At her 4 months follow-up, her albumin/creatinine ratio had decreased to 220 mg/mmol and she remained on oral prednisone 40 mg daily. Her edema as well as AKI had resolved. The progression of renal and glomerular failure is illustrated in .",What is the patient's albumin corrected anion gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [105.0, 'mEq/L'], 'Albumin': [20.0, 'g/L'], 'Bicarbonate': [27.0, 'mEq/L'], 'Sodium': [130.0, 'mEq/L']}",3,2.85,3.15,"The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 130.0 mEq/L. 
The concentration of chloride is 105.0 mEq/L. 
The concentration of bicarbonate is 27.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 130.0 mEq/L - (105.0 mEq/L + 27.0 mEq/L) = -2.0 mEq/L. Hence, The patient's anion gap is -2.0 mEq/L.The concentration of albumin is 20.0 g/L. We need to convert the concentration to g/dL. The mass units of the source and target are the same so no conversion is needed. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of g/dL. This will result to 20.0 g albumin/10.0 dL = 2.0 g albumin/dL. The concentration value of 20.0 g albumin/L converts to 2.0 g albumin/dL. Plugging in these values into the albumin corrected anion gap formula, we get -2.0 (mEq/L) + 2.5 * (4 - 2.0 (in g/dL)) = 3.0 mEq/L. Hence, the patient's albumin corrected anion gap is 3.0 mEq/L."
771,65,Albumin Corrected Anion Gap,lab test,decimal,pmc-5458001-1,Extracted,"A 43-year-old woman, with postliver transplant (2008) secondary to primary sclerosing cholangitis-related cirrhosis, maintained on tacrolimus, presented to our hospital with 4-day history of sore throat and fever and 2-day history of skin rash. On examination, patient was found to be febrile with temperature of 38.2 celsius, B. P 100/80 mmHg, respiratory rate (R. R) 24/min, and heart rate (H. R.) 130/min. Oxygen saturation on room air was 85%. Systemic examination revealed congested eyes, pharyngeal erythema, maculopapular skin rash involving face, upper limbs, and trunk. Chest examination revealed decreased breath sounds on the right basal area and crackles on the left side posteriorly till the mid-zone. Basic laboratory work-up was as follows: WBC: 9.8 × 103/μL, neutrophil: 7.7 × 103/UL, lymphocyte: 0.9 × 103/UL, BUN:2.80 mmol/L, creatinine: 88 μmol/L, Na: 129 mmol/L, K: 4 mmol/L, Cl: 99 mmol/L, HCO3: 18 mmol/L, bilirubin T: 7.6 μmol/L, albumin: 28 gm/L, ALT: 50 U/L, AST: 84 U/L, ALP: 268 U/L, INR: O.9, CRP: 53, ESR: 29 and tacrolimus level: 3.4. Hepatic transaminases showed progressive increase over 2 days. Ultrasound of abdomen and liver was normal. A CT pulmonary angiogram was ordered due to the presence of tachypnoea, tachycardia and drop in oxygen saturation. It did not show any evidence of PE but showed bilateral basal lung infiltrates more on the right side with associated two large size basal lung cysts (Fig. ) .
Patient was admitted as a case of viral exanthemata fever and bronchopneumonia with airborne precautions and was treated with intravenous antibiotics and fluids. The respiratory viral panel came negative. Viral serology results were positive for CMV Ab IgG, EBV nuclear antigen IgG, EBV capsid antigen IgG, rubella IgG Ab, measles IgG Ab, and measles IgM Ab. Autoimmune serologies and tuberculosis work-up were negative. On day 2 of admission, patient's skin rash started to fade from the face and patient showed clinical improvement with regard to fever and constitutional symptoms. Bronchoscopy with bronchoalveolar lavage to evaluate lung infiltrates and cystic lung disease showed negative work-up for acid-fast bacilli, Pneumocystis jiroveci pneumonia, and fungi. Measles virus PCR in serum was reported positive. She was managed with fluids and supportive measures. The patient improved clinically with the fading of skin rash gradually and normalization of liver enzymes over the next 5 days and was discharged home.",What is the patient's albumin corrected anion gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [99.0, 'mmol/L'], 'Albumin': [28.0, 'g/L'], 'Bicarbonate': [18.0, 'mmol/L'], 'Sodium': [129.0, 'mmol/L']}",15,14.25,15.75,"The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 129.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 129.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 129.0 mmol * 1 mEq/mmol = 129.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 129.0 mmol sodium/L converts to 129.0 mEq sodium/L. 
The concentration of chloride is 99.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 99.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 99.0 mmol * 1 mEq/mmol = 99.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 99.0 mmol chloride/L converts to 99.0 mEq chloride/L. 
The concentration of bicarbonate is 18.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 18.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 18.0 mmol * 1 mEq/mmol = 18.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 18.0 mmol bicarbonate/L converts to 18.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 129.0 mEq/L - (99.0 mEq/L + 18.0 mEq/L) = 12.0 mEq/L. Hence, The patient's anion gap is 12.0 mEq/L.The concentration of albumin is 28.0 g/L. We need to convert the concentration to g/dL. The mass units of the source and target are the same so no conversion is needed. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of g/dL. This will result to 28.0 g albumin/10.0 dL = 2.8 g albumin/dL. The concentration value of 28.0 g albumin/L converts to 2.8 g albumin/dL. Plugging in these values into the albumin corrected anion gap formula, we get 12.0 (mEq/L) + 2.5 * (4 - 2.8 (in g/dL)) = 15.0 mEq/L. Hence, the patient's albumin corrected anion gap is 15.0 mEq/L."
772,65,Albumin Corrected Anion Gap,lab test,decimal,pmc-6957036-1,Extracted,"A 28-year-old Caucasian woman presented to the emergency department (ED) with complaints of nausea, vomiting, abdominal pain and headache after ingesting a “hand full” (approximately 50) of 500 mg acetaminophen tablets as a suicide attempt gesture four days ago after having an altercation with her mother. Past medical history was significant for depression, anxiety, previous suicide attempts (with pill ingestions and wrist slitting), sexual abuse (rape), benzodiazepine addiction (underwent rehabilitation) and migraines. Her home prescription medications included buspirone and paroxetine. She had used amitriptyline in the past as well. She denied any history of drinking alcohol, smoking cigarettes or using illicit drugs. There was no family history of psychiatric disorders or liver-related diseases.
Vital signs showed a blood pressure of 111/59 mm Hg, temperature of 98.8 degrees Fahrenheit, heart rate 139 beats/min, respiratory rate 18 breaths/min, and oxygen saturation 97% on room air. Physical examination showed an alert yet anxious patient who had no signs of jaundice, bruising, hepatic encephalopathy or asterixis. Neurological exam on initial presentation revealed normal reflexes. On abdominal exam, there was tenderness to palpation in the right upper quadrant with normal active bowel sounds.
Investigations
Serum hematology tests showed white blood cell count 15,500 cells/micro liter (normal: 4,200-10,200), hemoglobin 10.8 (normal: 11.5-14.8), platelets 99,000 cells/micro liter (normal: 150,000-400,000), International Normalized Ratio (INR) 5.3 (normal: 0.8-1.0), prothrombin time (PT) 47.9 sec (normal: 11.7-14.5). Serum chemistry tests showed sodium 138 mEq/L (normal: 136-145), potassium 5.2 mEq/L (normal: 3.5-5.1), chloride 102 mEq/L (normal: 98-107), bicarbonate 15 mEq/L (normal: 22-32), blood urea nitrogen 37 mg/dL (normal: 7-18), creatinine 3.31 mg/dL (normal: 0.52-1.21), estimated glomerular filtration rate (eGFR) 16.6 mL/min/1.73 m2 (normal: > 60), albumin 2.6 g/dl (normal: 3.4-5.0), total bilirubin 3.4 mg/dl (normal: 0.2-1.0), alkaline phosphatase 142 U/L (normal: 45-117), AST 9368 U/L (normal: 15-37), ALT 7982 U/L (normal: 13-56), lactic acid 11.1 mEq/L (normal: 0.4-2.0), acetaminophen level 8.8 mcg/mL. Urine drug screen for illicit substances was negative. Ultrasound of the abdomen done in the ED showed hepatic steatosis (see Figure ) but no biliary dilatation.
The patient was diagnosed with high anion gap metabolic acidosis/lactic acidosis, acute kidney injury, elevated INR due to acetaminophen toxicity and was started on an intravenous N-acetylcysteine drip after initial volume resuscitation. She received intravenous vitamin K which helped correct her INR to 2.8. Given elevated transaminases, all her home prescription medications (including bupropion and paroxetine) were held on admission. In order to address her persistent nausea and vomiting, she was also started on scheduled intravenous metoclopramide 10 mg every six hours the following day by the hospital medicine team. With resuscitation and conservative management, her condition continued to improve during five days of her hospital stay with improvement in transaminases (AST 98 and ALT 851 U/L), acidosis/lactic acid (1.3 mmol/L), INR (1.5) and creatinine (1.4 mg/dl) by the time of discharge. Intravenous N-acetylcysteine was discontinued on hospital day 5. However, as a result of scheduled every six-hour intravenous metoclopramide use, on hospital day 4, she was found to have a blood pressure of 146/109 mmHg, heart rate 120 beats/min, clonus, tremors and hyperreflexia (see Video ). A diagnosis of metoclopramide-induced serotonin syndrome was made. Metoclopramide was promptly discontinued. Given her history of benzodiazepine addiction, patient and family members were reluctant to try intravenous lorazepam for symptom mitigation. Serotonin syndrome promptly resolved over the next 36 hours and she was discharged to a mental health facility under the care of a psychiatrist. The patient was seen in outpatient clinic two weeks later when her liver enzymes, creatinine, INR had normalized and the patient was back to her usual state of health.",What is the patient's albumin corrected anion gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [102.0, 'mEq/L'], 'Albumin': [2.6, 'g/dL'], 'Bicarbonate': [15.0, 'mEq/L'], 'Sodium': [138.0, 'mEq/L']}",24.5,23.275,25.725,"The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 138.0 mEq/L. 
The concentration of chloride is 102.0 mEq/L. 
The concentration of bicarbonate is 15.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 138.0 mEq/L - (102.0 mEq/L + 15.0 mEq/L) = 21.0 mEq/L. Hence, The patient's anion gap is 21.0 mEq/L.The concentration of albumin is 2.6 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 21.0 (mEq/L) + 2.5 * (4 - 2.6 (in g/dL)) = 24.5 mEq/L. Hence, the patient's albumin corrected anion gap is 24.5 mEq/L."
773,65,Albumin Corrected Anion Gap,lab test,decimal,pmc-5586928-1,Extracted,"A 70-year-old male with a medical history of alcohol abuse, withdrawal seizure and hypertension presented to the emergency department after being found unresponsive by his landlord. It was not clear how long the patient had been unconscious, although the landlord noted the patient was covered with bugs at the time of discovery. The history provided by the patient himself was very limited due to an altered mental status. In the emergency department, his vitals were significant for a temperature of 94.5°F, a heart rate of 94 beats per minute, a respiratory rate of 20 breaths per minute, blood pressure of 103/69 mm Hg and oxygen saturation 95% on room air. The physical examination was significant for cachexia, confusion and hepatomegaly upon abdominal exam.
Laboratory findings were notable for the following values: sodium 152 mmol/l, potassium 5.0 mmol/l, chloride 114 mmol/l, bicarbonate 14 mmol/l,  blood urea nitrogen 111 mg/dl, creatinine 3.4 mg/dl, glucose 118 mg/dl, corrected calcium 11.0 mg/dl, lactic acid 3.7 U/l, magnesium 3.2 mg/dl, aspartate aminotransferase 279 U/l, alanine aminotransferase 17 U/l, alkaline phosphatase 258 U/l, lactate dehydrogenase (LDH) 473 U/l, creatine phosphokinase 69 U/l, albumin 3.0 g/dl, thyroid-stimulating hormone 6.60 IU/ml and free thyroxine 0.88 ng/dl. Serologies for HIV and hepatitis A, B and C were all negative.
A computed tomography (CT) scan of the head showed chronic small-vessel ischemic changes and volume loss. Chest X-ray showed bilateral hazy perihilar opacities. Abdominal ultrasound revealed markedly abnormal hepatic echotexture, gallbladder sludge, a small amount of ascites and a 3.6 × 3 × 3 cm mass in the portahepatis region.
The patient was admitted to the intensive care unit and was started on intravenous fluids and antibiotics and was closely monitored. Once he had been stabilized, a chest CT was performed which showed extensive hilaradenopathy, large bilateral pleural effusions and a nodule in the left upper lobe. Abdominal CT without contrast revealed marked hepatomegaly, multiple areas of diminished density in the liver with a conglomerate lesion 14 × 14 cm and multiple, enlarged lymph nodes in the portahepatis and the mediastinum (fig. , ).
The test for alpha fetoprotein came back significantly high (>60,500 ng/ml). Based on this and the CT findings, the patient was presumed to have high-grade, metastatic HCC. Subsequent laboratory results revealed increasing levels of potassium (maximum 6.0 mmol/l), phosphorus (maximum 6.9 mg/dl), uric acid (maximum 22.9 mg/dl) and LDH (maximum 703 U/l). Corrected calcium decreased slightly from 11.0 mg/dl upon admission to 9.6 mg/dl after fluid resuscitation. An oncologist and a nephrologist were consulted and a consensus was reached that the patient had developed STLS from metastatic HCC. A biopsy of the liver mass was not obtained because his condition was critical. Despite aggressive fluid resuscitation, he continued to be oliguric and his renal function continued to deteriorate with the creatinine level increasing from 3.4 mg/dl upon admission to 4.6 mg/dl over 6 days. He initially received sodium bicarbonate for TLS and metabolic acidosis, but this was discontinued due to the minimal response. The prognosis was thought to be poor and he was discharged to hospice for palliative care.",What is the patient's albumin corrected anion gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [114.0, 'mmol/L'], 'Albumin': [3.0, 'g/dL'], 'Bicarbonate': [14.0, 'mmol/L'], 'Sodium': [152.0, 'mmol/L']}",26.5,25.175,27.825,"The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 152.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 152.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 152.0 mmol * 1 mEq/mmol = 152.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 152.0 mmol sodium/L converts to 152.0 mEq sodium/L. 
The concentration of chloride is 114.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 114.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 114.0 mmol * 1 mEq/mmol = 114.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 114.0 mmol chloride/L converts to 114.0 mEq chloride/L. 
The concentration of bicarbonate is 14.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 14.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 14.0 mmol * 1 mEq/mmol = 14.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 14.0 mmol bicarbonate/L converts to 14.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 152.0 mEq/L - (114.0 mEq/L + 14.0 mEq/L) = 24.0 mEq/L. Hence, The patient's anion gap is 24.0 mEq/L.The concentration of albumin is 3.0 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 24.0 (mEq/L) + 2.5 * (4 - 3.0 (in g/dL)) = 26.5 mEq/L. Hence, the patient's albumin corrected anion gap is 26.5 mEq/L."
774,65,Albumin Corrected Anion Gap,lab test,decimal,pmc-6197016-1,Extracted,"A 47-year-old Caucasian female presented to the emergency department because of a 2-day history of nausea, vomiting and moderate to severe progressive epigastric pain. She reported subjective fever with rigors and chills, loose, watery stools and abdominal fullness. Her past medical history was significant for chronic alcoholism; she drank 6–8 beers each day. She had no reported history of cirrhosis.
On arrival, her vitals included blood pressure: 120/88 mmHg, pulse:80/minute, respiratory rate:18/minute, temperature:98.6 ºF and oxygen saturation: 97% on ambient air. She appeared in mild distress; sclera was slightly jaundiced. Cardiovascular examination was unremarkable. The abdomen was mildly tender in the epigastric area without guarding and rigidity. Hepatomegaly was also noted. Central nervous system examination was non-focal. Skin showed no erythematous lesions. Laboratory data included haemoglobin 14.2 (12.0–15.7 g/dl), leucocyte count 9 (4.5–11 × 103/uL), platelets count 143 (4.5–11.0 × 103/uL), glucose 83(70–105 mg/dL), blood urea nitrogen 48(7–22 mg/dL), creatinine 2.52(0.50–1.50 mg/dL), sodium 129(134–145 mM/L), potassium 2.9(3.5–5.1 mM/L), chloride 94(98–112 mM/L), bicarbonate 18(24–30 mM/L), albumin 2.5(3.5–5.0 g/dL), total bilirubin 6.3(0.2–1.3 mg/dL), AST 71(8–40 U/L), ALP 66(39–117 U/L), ALT 128 (7–56 U/L), activated PTT 38.1 (23.0–31.0 sec) and PT 12.9 (9.5–12.0 sec) and lactic acid 2.8 (0.5–2.0 mM/L). Contrast-enhanced CT of the abdomen and pelvis showed severe, circumferential thickening of the gastric wall with the involvement of distal esophagus and the first portion of the duodenum in addition to perigastric stranding; findings were reported to be consistent with severe gastritis (). There was also mild mucosal thickening of the transverse and descending colon. The liver was enlarged with fatty infiltration. A small amount of ascites with small left-sided pleural effusion was seen throughout the peritoneum. No obstruction, perforation or intrabdominal abscess was seen. Based on her subtle presentation, physical exam and hemodynamic stability, primary peritonitis was deemed less likely upon initial assessment. Therefore, she was admitted to a medical floor with the provisional diagnoses of alcohol-related gastritis, alcoholic hepatitis, and acute kidney injury. She received a 2-litre bolus of intravenous (IV) normal saline and was started on maintenance fluid, IV antiemetics, and IV pantoprazole.
Within 8-hours of admission, the patient became hemodynamically unstable with subsequent intubation and fluid resuscitation. She was transferred to the intensive care unit. Because of bright red blood on nasogastric decompression, she was started on IV octreotide given her history of chronic alcoholism and possible variceal bleed. Because of hypotension and SIRS with peritoneal ascites, blood cultures were drawn, and the patient was started on broad-spectrum empiric antibiotics (vancomycin, piperacillin-tazobactam, and levofloxacin). A diagnostic paracentesis was performed obtaining 1.2 liters of thick serosanguinous peritoneal fluid. Ascitic fluid analysis was suggestive of monomicrobial primary peritonitis, showing abundant Gram-positive cocci and 51,500 leucocytes/mm3 with 67% neutrophils. Ascitic fluid was exudative in nature with total protein 3.8 g/dl, albumin 1.6 g/dl, lactate dehydrogenase 5189/UL and glucose 56 mg/dl. Serum-albumin ascitic-albumin gradient was 0.9 g/dl.
No surgical intervention was considered as the possibility of secondary peritonitis was less likely based on her CT and ascitic fluid findings. Blood cultures and ascitic fluid cultures were positive for GAS, and therefore, the patient was started on IV ampicillin and clindamycin for primary GAS peritonitis.
Because of hematemesis, the patient underwent EGD that showed diffuse gastric ulcerations, but no esophageal varices or active bleeding. Given diffuse ulceration of stomach with circumferential wall thickening, gastritis was thought to be caused by an underlying ischemic or infiltrative process.
Although the patient’s hemoglobin was stable, and she had required no blood transfusions, her hemodynamic status started to deteriorate requiring multiple pressor support and IV high-dose hydrocortisone. Given the context of isolation of GAS from blood and ascitic fluid, septic shock and multiorgan failure (renal failure and liver failure), a diagnosis of STSS was made. Her lactic acid level worsened from 2.8 at baseline to 42 mM/L. The patient was deemed a non-surgical candidate by the surgical team. However, an ultrasound-guided intraperitoneal drain was placed for therapeutic reasons. The patient received few doses of antibiotics; however, she continued to deteriorate and succumbed to death within 48-hours of admission due to cardiopulmonary arrest and multiorgan failure.",What is the patient's albumin corrected anion gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [94.0, 'mmol/L'], 'Albumin': [2.5, 'g/dL'], 'Bicarbonate': [18.0, 'mmol/L'], 'Sodium': [129.0, 'mmol/L']}",20.75,19.7125,21.7875,"The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 129.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 129.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 129.0 mmol * 1 mEq/mmol = 129.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 129.0 mmol sodium/L converts to 129.0 mEq sodium/L. 
The concentration of chloride is 94.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 94.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 94.0 mmol * 1 mEq/mmol = 94.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 94.0 mmol chloride/L converts to 94.0 mEq chloride/L. 
The concentration of bicarbonate is 18.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 18.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 18.0 mmol * 1 mEq/mmol = 18.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 18.0 mmol bicarbonate/L converts to 18.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 129.0 mEq/L - (94.0 mEq/L + 18.0 mEq/L) = 17.0 mEq/L. Hence, The patient's anion gap is 17.0 mEq/L.The concentration of albumin is 2.5 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 17.0 (mEq/L) + 2.5 * (4 - 2.5 (in g/dL)) = 20.75 mEq/L. Hence, the patient's albumin corrected anion gap is 20.75 mEq/L."
775,65,Albumin Corrected Anion Gap,lab test,decimal,pmc-4591497-1,Extracted,"A 71 year-old Caucasian male ex-smoker without any significant past medical history presented to the emergency department complaining of worsening redness and swelling in his left lower leg. He presented five days earlier and was given antibiotic treatment which did not resolve the problem. On physical exam BP 119/68 mHg, Pulse 61/min, Resp 17/min, Temp: 96.6°F, O2 saturation 96% on Room air. Laboratory testing showed hemoglobin 12.2 g/dL, WBC 7.3 K/uL, Platelet count 26 K/uL, Neutrophils 29, Lymphocytes 20%, MCV 73.2 fL, glucose 120 mg/dL, BUN 14 mg/dL, Creatinine 0.8 mg/dL, Calcium 8.7 mg/dL, albumin 4.3 g/dL, Sodium 137 mmol/L, Potassium 4 mmol/L, Chloride 100 mmol/L, and CO2 25 mmol/L. Liver enzymes were within normal limits. X-ray ruled out osseous contribution to his problem and venous Doppler was negative for DVT. Subsequently a diagnosis of cellulitis was made. CBC demonstrated multiple cytopenias, including thrombocytopenia ( and ). A review of hospital records noted previous findings of thrombocytopenia as far as four years earlier. Considering pancytopenia an oncology consult was called who reviewed the peripheral smear which showed slight anisocytosis, monocytosis with marked thrombocytopenia with some giant platelets, No pseudo-Pelger-Huet cells or circulating blasts were noted (). Given the laboratory findings, leukemia was considered as a differential and therefore a bone marrow biopsy was performed which showed the differential () granulopoiesis, hypercellular marrow with increased myelomonocytic cells and megakaryocytogenesis (Figure 1B,C). Immunohistochemistry showed CD117: about 5-10% positive cells, consistent with immature cells/blasts, CD34: No increase in CD34 positive cells, CD163: Highlights predominantly monocytic component, CD123: Negative. Reticulin staining showed mild diffuse reticulin fibrosis. Immunophenotyping by flow cytometry analysis FLG13-859 shows mild myelomonocytic abnormalities. PCR study for JAK2 is negative. FISH was performed for BCR/ABL1 to detect the (9:22) translocation associated with CML and less commonly ALL or AML were normal. Cytogenic testing demonstrated an abnormal karyotype 46, XY, del(20)(q11.2q13.3)(20) (). Other 15 metaphase spreads examined showed a normal male karyotype, 46, XY. Patient was diagnosed with myelodysplastic syndrome, Unclassified (MDS-U) with refractory thrombocytopenia.",What is the patient's albumin corrected anion gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [100.0, 'mmol/L'], 'Albumin': [4.3, 'g/dL'], 'Bicarbonate': [25.0, 'mmol/L'], 'Sodium': [137.0, 'mmol/L']}",11.25,10.6875,11.8125,"The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 137.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 137.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 137.0 mmol * 1 mEq/mmol = 137.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 137.0 mmol sodium/L converts to 137.0 mEq sodium/L. 
The concentration of chloride is 100.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 100.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 100.0 mmol * 1 mEq/mmol = 100.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 100.0 mmol chloride/L converts to 100.0 mEq chloride/L. 
The concentration of bicarbonate is 25.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 25.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 25.0 mmol * 1 mEq/mmol = 25.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 25.0 mmol bicarbonate/L converts to 25.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 137.0 mEq/L - (100.0 mEq/L + 25.0 mEq/L) = 12.0 mEq/L. Hence, The patient's anion gap is 12.0 mEq/L.The concentration of albumin is 4.3 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 12.0 (mEq/L) + 2.5 * (4 - 4.3 (in g/dL)) = 11.25 mEq/L. Hence, the patient's albumin corrected anion gap is 11.25 mEq/L."
776,65,Albumin Corrected Anion Gap,lab test,decimal,pmc-6385391-1,Extracted,"A 4-year-old boy, who had no systemic or inherited disease, presented with a 3-week history of intermittent vomiting without diarrhea or abdominal pain. In the past year, he experienced polydipsia and polyuria. Physical examination revealed body weight 17.5 kg (50th percentile), body height 100 cm (15~50th percentile), blood pressure 230/120 mmHg, heart rate 138 /min, and decreased skin turgor. There was no focal neurological deficit, blood pressure discrepancy between upper and lower extremities, palpable mass, nor any appreciation of an abdominal thrill. Laboratory studies revealed serum Na+ 124 mmol/L, K+ 2.4 mmol/L, Cl− 87 mmol/L, Ca2+ 8.5 mg/dL, HCO3− 34.5 mEq/L, creatinine 0.41 mg/dL, albumin 3.4 g/dL, IgG 247 mg/dL, and osmolality 290 mOsm/KgH2O. Urine analysis was significant for creatinine 11.2 mg/dL, Na+ 24 mEq/L, K+ 18 mEq/L, Cl− 24 mEq/L, osmolality 232 mOsm/KgH2O, RBC 168/μL, FENa 6%, and nephrotic-range proteinuria (55 mg/m2/hour). Survey for possible glomerulonephritis demonstrated the absence of anti-streptolysin O, p-ANCA, c-ANCA, ANA, and normal immunoglobulin A, C3, and C4 levels. In addition, work-up for secondary hypertension included: free T4 1.51 (normal range 0.8–2.0 ng/dL), TSH 5.7 (normal range 0.25–5.00 μIU/mL), cortisol 40.18 (normal range 4.3–25 μg/dL), ACTH 9.32 (normal range < 46 pg/mL), renin 1745 (normal range 2–15 ng/L), aldosterone 92.6 (normal range 4–25 ng/dL), and urine vanillylmandelic acid 3.8 (normal range 1.9–9.9 g/day). Renal ultrasonography revealed hyperechoic right kidney (7.6 cm in length) and small left kidney (5.3 cm in length). Due to the presence of hyperreninemic hypertension, natriuretic-hyponatremia, hypokalemia, and nephrotic range proteinuria, HHS was highly suspected. Computed tomography angiography confirmed high-grade renal artery stenosis with hypoplasia of the left kidney (Fig. ).
In terms of management for this case, we began with volume repletion by normal saline administration. Subsequently, his blood pressure declined from 210/120 mmHg to 180/90 mmHg. Intravenous calcium channel blocker was used to treat his hypertensive emergency, while oral captopril was prescribed for RAA axis blockage after diagnosis of unilateral renal artery stenosis. The systolic blood pressure gradually declined to 150~160 mmHg on the 3rd day. Potassium supplement was infused for his profound hypokalemia and generalized muscle weakness. Due to the severity of left renal artery stenosis, he was not a candidate for angiographic intervention, and decision was made to proceed with left nephrectomy. Overall, electrolyte abnormalities such as hyponatremia and hypokalemia were corrected within 1 week after admission, and resolution of polyuria, polydipsia, proteinuria, and hypertension were achieved 2 weeks after nephrectomy (Additional file : Table S1).",What is the patient's albumin corrected anion gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [87.0, 'mmol/L'], 'Albumin': [3.4, 'g/dL'], 'Bicarbonate': [34.5, 'mEq/L'], 'Sodium': [124.0, 'mmol/L']}",4,3.8,4.2,"The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 124.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 124.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 124.0 mmol * 1 mEq/mmol = 124.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 124.0 mmol sodium/L converts to 124.0 mEq sodium/L. 
The concentration of chloride is 87.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 87.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 87.0 mmol * 1 mEq/mmol = 87.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 87.0 mmol chloride/L converts to 87.0 mEq chloride/L. 
The concentration of bicarbonate is 34.5 mEq/L. 
Plugging in these values into the anion gap formula gives us 124.0 mEq/L - (87.0 mEq/L + 34.5 mEq/L) = 2.5 mEq/L. Hence, The patient's anion gap is 2.5 mEq/L.The concentration of albumin is 3.4 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 2.5 (mEq/L) + 2.5 * (4 - 3.4 (in g/dL)) = 4.0 mEq/L. Hence, the patient's albumin corrected anion gap is 4.0 mEq/L."
777,65,Albumin Corrected Anion Gap,lab test,decimal,pmc-3236148-1,Extracted,"A 64-year-old man with a history of hypertension, chronic kidney disease, and liver failure secondary to hepatitis C, with status post liver transplant 13 years priorly, was brought in by ambulance to the emergency department for acutely altered mental status. The patient had been in his usual state of health, until he told his family 3 hours before that he “felt sick.” The family incidentally found him on the floor, confused and lethargic, and immediately called the ambulance.
Upon arrival, the patient had a temperature of 96.4°F; pulse, 117 beats per minute; blood pressure, 151/93 mmHg; respiratory rate, 22 breaths per minute; and oxygen saturation of 100% on nonrebreather. The patient was known to have a history of recurrent episodes of hepatic encephalopathy, and his last episode of hepatic encephalopathy was in the prior 3 months, which was treated and controlled with lactulose. The patient's family stated that the patient had run out of lactulose 4 days before presentation. Other than lactulose, the patient was compliant with all of his home medications, including amlodipine, buproprion, cyclosporine, hydrocodone, lasix, methocarbamol, and ramipril. The patient had no known history of seizure, recent illness, brain trauma, or recent surgical procedures.
Physical examination showed a male in no acute distress with a Glasgow Coma Scale of 12 (eyes, 4; verbal, 3; motor, 5). There were no signs of trauma found on his body. His pupils were equally round and reactive to light, and his neck was supple and soft with a cervical collar in place. Cardiopulmonary examination was unremarkable except for tachycardia. Abdominal examination was unremarkable. Because he was not following commands, the neurologic examination was limited. However, the patient was able to move all extremities equally and pulses were distally equal to all extremities. There was no posturing or clonus noted, and Babinski was downgoing in both feet.
Fingerstick glucose level was 210 mg/dL and bedside hemoglobin level was 13.1 g/dL. Noncontrast head and cervical spine computed tomography revealed no acute pathologic lesion. Chest radiography also showed no acute pathologic lesion. Laboratory tests showed white blood cell counts of 5.5 K/mm3 with 60% neutrophils, hematocrit of 36.5%, and platelets of 115 K/mm3. Electrolyte and liver function results were as follows: sodium, 141 mmol/L; potassium, 3.5 mmol/L; chloride, 104 mmol/L; bicarbonate, 22 mmol/L; calcium, 9.3 mg/dL; blood urea nitrogen, 71 mmol/L; creatinine, 1.9 mg/dL; total bilirubin, 2.1 mg/dL; aspartate aminotransferase, 128 U/L; alanine aminotransferase, 124 U/L; alkaline phosphatase, 231 U/L; albumin, 4.0 g/dL; lipase, 30 U/L; prothrombin time, 14.5 seconds; INR, 1.09; and ammonia, 501 μmol/L (reference range, 15–55 μmol/L). Toxicology serum screen results were negative for acetaminophen, salicylate, and ethanol. Urine toxicology screen results were positive only for opiates. Venous blood gas was pH 7.44.
Owing to the patient's obtunded condition and inability to protect his airway, the patient was electively intubated and given midazolam drip for sedation. The patient was admitted to the intensive care unit (ICU) for monitoring with a presumed diagnosis of hepatic encephalopathy. While administration of empiric antibiotics was started in the emergency department, it was discontinued after an infectious etiology was deemed unlikely and culture results were negative. Results of a magnetic resonance imaging brain scan were also negative, including no evidence of infarct.
During the ICU stay, the patient was readministered lactulose, and ammonia levels decreased to117 μmol/L by hospital day 2 and to 78 μmol/L by hospital day 4. Despite discontinuation of sedation, the patient remained unresponsive. A neurologist was consulted and a bedside electroencephalogram (EEG) revealed findings consistent with status epilepticus. However, the patient had no clinical manifestations of status epilepticus, leading to a diagnosis of nonconvulsive status epilepticus. A phenytoin load was immediately administered, while a midazolam infusion was restarted, ultimately leading to EEG resolution of the status epilepticus. The patient did not immediately improve neurologically during the hospitalization stay and was ultimately transferred to another facility for continued treatment and rehabilitation.",What is the patient's albumin corrected anion gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [104.0, 'mmol/L'], 'Albumin': [4.0, 'g/dL'], 'Bicarbonate': [22.0, 'mmol/L'], 'Sodium': [141.0, 'mmol/L']}",15,14.25,15.75,"The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 141.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 141.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 141.0 mmol * 1 mEq/mmol = 141.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 141.0 mmol sodium/L converts to 141.0 mEq sodium/L. 
The concentration of chloride is 104.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 104.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 104.0 mmol * 1 mEq/mmol = 104.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 104.0 mmol chloride/L converts to 104.0 mEq chloride/L. 
The concentration of bicarbonate is 22.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 22.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 22.0 mmol * 1 mEq/mmol = 22.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 22.0 mmol bicarbonate/L converts to 22.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 141.0 mEq/L - (104.0 mEq/L + 22.0 mEq/L) = 15.0 mEq/L. Hence, The patient's anion gap is 15.0 mEq/L.The concentration of albumin is 4.0 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 15.0 (mEq/L) + 2.5 * (4 - 4.0 (in g/dL)) = 15.0 mEq/L. Hence, the patient's albumin corrected anion gap is 15.0 mEq/L."
778,65,Albumin Corrected Anion Gap,lab test,decimal,pmc-8340372-1,Extracted,"A 58-year-old Caucasian female presented to her local emergency department with fever and diarrhea. The patient developed nonbloody, large-volume diarrhea after eating take-out 11 days ago, with four to five bowel movements per day. During this time, she also experienced fevers, chills, nausea, vomiting, general malaise, and weakness. In addition, she observed leaking and drainage around her G-tube site with associated erythema and intense abdominal pain. The patient denied sick contacts or recent travel.
Her past medical history includes obesity, orthostatic hypotension, hyperlipidemia, chronic kidney disease, nephrolithiasis, gastrojejunal ulcer, Kawasaki’s disease, subdural hemorrhage, epilepsy, chronic pain syndrome, and anxiety. The patient’s past surgical history includes burr-hole craniotomy, lithotripsy, cholecystectomy, Roux-en-Y gastric bypass complicated by chronic refractory marginal ulceration and small bowel obstruction requiring two resections, ventral hernia repair, and gastrostomy tube insertion.
The patient was pregnant six times and had six miscarriages (G6P0060). She lives with her husband and adopted son with good social support. She is currently unemployed. The patient denies ever smoking and does not drink alcohol. Familial history consists of diabetes, heart disease, and nephrolithiasis in the patient’s mother. Her father had glaucoma, nephrolithiasis, and prostate cancer.
Medications before admission included pantoprazole 40 mg twice a day, sucralfate 1 g twice a day, ondansetron 4 mg twice a day as needed for nausea, midodrine 10 mg three times a day, fludrocortisone 0.1 mg twice a day, atorvastatin 40 mg daily, levetiracetam 1500 twice a day, methadone 10 mg every 8 hours, and lorazepam 0.5 mg daily as needed for anxiety. She was also on daily vitamin A, D3, and B-complex supplements and a monthly cyanocobalamin 1000 μg intramuscular injection, in addition to a nutritional supplement Isosource 1.5 Cal that is administered through the G-tube once every night.
Due to her complex past surgical history, the patient was sent from her local emergency department to our hospital. At presentation, the patient was febrile to 101 ℉. Blood pressure was 110/72 mmHg, and heart rate was 84 beats per minute. Further examination revealed diffuse abdominal tenderness with erythema and purulent drainage around the G-tube site on the left upper quadrant. The general examination showed a thin patient who is alert and oriented. Mucous membranes were moist. Lungs were clear to auscultation as she was breathing comfortably on room air. Heart sounds were regular without murmurs. Extremities were warm with intact pulses bilaterally and no edema. However, she had moderate muscle loss for her age. Skin was intact except for the previously mentioned erythema around the G-tube. Neurological examination revealed normal speech with comprehension, intact cranial nerves II–VII, XI, and XII, and 5/5 motor strength in all four extremities. Sensation was intact to light touch and pinprick throughout. Romberg test was negative. Gait was slowed owing to weakness but showed normal balance.
Serum chemistry showed sodium of 136 mmol/L, potassium of 2.9 mmol/L, chloride of 111 mmol/L, bicarbonate of 20 mmol/L, magnesium 1.2 mg/dL, calcium 6.1 mg/dL, and serum creatinine 1.0 mg/dL. Liver function tests showed low albumin of 2.5 g/dL, total bilirubin of 0.3 mg/dL, alkaline phosphatase of 86 U/L, alanine aminotransferase (ALT) of 13 U/L and aspartate aminotransferase (AST) of 21 U/L. Complete blood count showed a white blood cell count of 3.97 × 109 /L, hemoglobin of 12.6 g/dL, hematocrit of 39.6%, and platelet count of 239 × 109 /L. Urinalysis showed normal appearance and color, specific gravity of 1.020, without detecting red blood cells (RBC), white blood cells (WBC), ketones, glucose, leukocytes esterase, or nitrites. A stool sample was sent for Clostridium difficile and a molecular enteric panel but was pending at that time. Two out of two blood cultures that were collected at her local emergency department were positive for Gram-negative rods. An abdominal radiograph confirmed G-tube location overlying the stomach and a computed tomography (CT) abdomen/pelvis with contrast showed nonspecific skin thickening and subcutaneous fat stranding along the G-tube insertion site (Fig. ). Due to a prior history of penicillin and sulfa anaphylactic reactions, the patient was empirically treated with intravenous ciprofloxacin 400 mg every 8 hours for bacteremia, and oral clindamycin 450 mg every 8 hours for the cellulitis surrounding her G-tube site, in addition to intravenous fluid resuscitation with normal saline at 75 mL/hour and electrolyte repletion with oral potassium chloride 20 mEq for four total doses, and intravenous magnesium sulfate 4 g once.
A fluoroscopy G-tube study revealed no contrast leak or evidence of obstruction. On day 1 of hospitalization, the molecular enteric stool panel was positive for the Salmonella species. On day 4, two out of two blood cultures grew Salmonella enteritidis with susceptibilities to ampicillin, ceftriaxone, and trimethoprim/sulfamethoxazole. The patient was then transitioned from intravenous ciprofloxacin to a 14-day course of intravenous ceftriaxone 2 g every 24 hours. We resumed tube feeds through the G-tube on day 5 after a successful clamping trial. On day 6, the patient was somnolent and difficult to arouse, with poor skin turgor and dry mucous membranes. Vital signs remained within normal limits; T max of 98.6 ℉, blood pressure of 98/65 mmHg, and heart rate of 95 beats per minute. Laboratory results were significant for a serum creatinine level of 5.25 mg/dL and non-anion gap metabolic acidosis with sodium of 131 mmol/L, chloride of 105 mmol/L, and serum bicarbonate of 18 mmol/L. These clinical and laboratory findings of dehydration suggested the development of prerenal acute kidney injury (AKI) in the setting of prolonged GI volume loss. The patient was resuscitated with half normal saline containing 75 mEq sodium bicarbonate additive at 125 mL/hour. On day 8, the patient’s mental status improved but her G-tube began to leak, prompting clamping of the G-tube. The patient was encouraged to increase oral intake. Intravenous fluids were discontinued on day 9, as she was able to tolerate oral foods and liquids well. No further leakage was seen around her G-tube site. On day 13, the patient was discharged home with a peripherally inserted central line to finish a 14-day course of intravenous ceftriaxone (2 g every 24 hours).
Following completion of a 14-day course of intravenous ceftriaxone, the patient made a full recovery with resolution of her diarrhea and abdominal pain. Tube feeds were resumed without further issues. At a 4-month follow-up visit with her bariatric surgeon, the patient reports that she is doing well and happy with her progress. Electrolytes and serum creatinine were all within normal limits. The patient was readmitted 6 months following her initial hospitalization for abdominal pain and hematemesis due to a large marginal ulcer. She improved with conservative measures including bowel rest (nothing per os) and maintenance intravenous fluids, and was discharged 2 days later. At the time of discharge, her hemoglobin remained stable at 11.2 g/dL, and she was able to tolerate an oral diet. She continues to follow up with her bariatric surgeon in clinic with no recurrence of fever or diarrhea.",What is the patient's albumin corrected anion gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [111.0, 'mmol/L'], 'Albumin': [2.5, 'g/dL'], 'Bicarbonate': [20.0, 'mmol/L'], 'Sodium': [136.0, 'mmol/L']}",8.75,8.3125,9.1875,"The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 136.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 136.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 136.0 mmol * 1 mEq/mmol = 136.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 136.0 mmol sodium/L converts to 136.0 mEq sodium/L. 
The concentration of chloride is 111.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 111.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 111.0 mmol * 1 mEq/mmol = 111.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 111.0 mmol chloride/L converts to 111.0 mEq chloride/L. 
The concentration of bicarbonate is 20.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 20.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 20.0 mmol * 1 mEq/mmol = 20.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 20.0 mmol bicarbonate/L converts to 20.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 136.0 mEq/L - (111.0 mEq/L + 20.0 mEq/L) = 5.0 mEq/L. Hence, The patient's anion gap is 5.0 mEq/L.The concentration of albumin is 2.5 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 5.0 (mEq/L) + 2.5 * (4 - 2.5 (in g/dL)) = 8.75 mEq/L. Hence, the patient's albumin corrected anion gap is 8.75 mEq/L."
779,65,Albumin Corrected Anion Gap,lab test,decimal,pmc-6363666-1,Extracted,"A 13-years-old mentally impaired girl (since birth due to perinatal asphyxia) presented to the emergency department (ED) with a severe abdominal pain and signs of acute abdomen, fever, and hypovolemic shock. She was unconscious, febrile, with a blood pressure of 80/40 mmHg, pulse rate of 160/min, and a respiratory rate of 34/min. Physical examination revealed a diffuse tenderness and a muscular rigidity. The abdomen was distended and bowel sounds were absent. The abdominal X-ray obtained in a supine position showed a massive free air within the peritoneal cavity and undigested remains of food along the alimentary tract imitating the contrasting liquid (). At hospital admission, a medical audit accompanying the girl described a 4-days history of food rejection, frequent vomiting and progressive deterioration of her general condition. Her anamnesis was negative for traumatic events but was suggestive for PA due to a characteristic appearance of air swelling and abdominal distension that rapidly progressed during the day and caused the flatus during sleep.
Laboratory investigations revealed the following results: White blood cell count: 7.100/uL; mean platelet volume: 11.8 fL; platelet count: 220 × 103/uL; hemoglobin: 11.1 g/dL; hematocrit: 35.2%; serum proteins: 5.7 g/dL; serum albumin: 2.9 g/dL; serum globulin: 2.8 g/dL; aspartate aminotransferase: 107 IU/L; alanine aminotransferase: 30 IU/l; creatinine: 0.9 mg/dl; serum sodium: 135 mEq/L; serum potassium: 5.4 mEq/L; serum chloride: 101 mEq/L; C-reactive protein: 367.4 mg/L; serum lactate dehydrogenase: 401 IU/L; serum creatine kinase: 4,086 IU/L; serum glucose: 107 mg/dL; arterial blood pH: 7.07 nmol/L; PaCO2: 4.93 kPa; pO2: 5.59 kPa; HCO3: 10.5 mmol/L; base excess: 18.8 mEq/L.
Following an aggressive resuscitation with intravenous hydration, decompression of the stomach, a correction of metabolic abnormalities, and administration of empiric antibiotic therapy (amikacin, metronidazole, and meropenem), an emergency laparotomy was performed. It revealed a massively distended and partially necrotic stomach. Huge amounts of free peritoneal fluid (about four liters) with food particles due to perforation of the necrotic gastric wall were removed. The size of the perforation measured 7 × 3 cm affecting the greater curvature on the posterior wall of the stomach ().
A free peritoneal fluid with food particles was washed out from the abdominal cavity. The gastric perforation was treated by debridement of necrotic tissue and a primary closure with additional using an omental patch. The debrided necrotic gastric tissue was submitted to the pathologist for the examination. The pathology assessment of the gastric wall showed a multiple areas of massive, transmural necrosis ().
Post-operatively, the patient was transferred to the pediatric intensive care unit (PICU) on mechanical ventilation and treated with inotropes, cefotaxime, metronidazole, gentamicin, and fluconazole. A fourth day of admission, abdominal cultures taken at the laparotomy as well as a blood culture showed Enterococcus faecalis and Candida glabrata infections.
In the following days, despite an extensive medical support, her clinical condition rapidly deteriorated and she eventually died on day 26 after admission due to overwhelming infections and progressive multisystem failure.",What is the patient's albumin corrected anion gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [101.0, 'mEq/L'], 'Albumin': [2.9, 'g/dL'], 'Bicarbonate': [10.5, 'mmol/L'], 'Sodium': [135.0, 'mEq/L']}",26.25,24.9375,27.5625,"The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 135.0 mEq/L. 
The concentration of chloride is 101.0 mEq/L. 
The concentration of bicarbonate is 10.5 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 10.5 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 10.5 mmol * 1 mEq/mmol = 10.5 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 10.5 mmol bicarbonate/L converts to 10.5 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 135.0 mEq/L - (101.0 mEq/L + 10.5 mEq/L) = 23.5 mEq/L. Hence, The patient's anion gap is 23.5 mEq/L.The concentration of albumin is 2.9 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 23.5 (mEq/L) + 2.5 * (4 - 2.9 (in g/dL)) = 26.25 mEq/L. Hence, the patient's albumin corrected anion gap is 26.25 mEq/L."
780,65,Albumin Corrected Anion Gap,lab test,decimal,pmc-3544066-1,Extracted,"A 60-year-old lady, a known case of type 2 diabetes mellitus for 15 years and hypertension for 3 years, presented to the clinic with fever, chills, and bilateral loin pain of 4 days duration. No other co-morbidities like chronic kidney disease or coronary artery disease were known in her in the past and she was apparently in normal state of health prior to the presenting illness.
She developed high-grade fever with chills and rigors. Fever was accompanied by dysuria and bilateral loin pain which was constant and aching in nature. Two days following the onset of fever and loin pain, she developed hematuria and subsequently her urine output started declining and she was anuric at the time of admission to the hospital. She also experienced severe generalized muscle ache. There was no arthralgia, skin rash or hemoptysis. Her medications included glipizide and multivitamin.
At the time of admission, she was conscious, irritable, febrile, and tachypneic. Her conjunctivae appeared suffused. There was no icterus, purpura, or lymphadenopathy. Muscle tenderness in limbs was noted. Her pulse was 104/min, BP–110/70 mm Hg, respiratory rate 23/min, temperature 101°F, oxygen saturation 95% at room air. Rales were appreciated in the basal regions of the chest. Examination of abdomen revealed no organomegaly, but both renal angles were tender on palpation.
Investigations revealed hemoglobin of 10.8 g/dL; leukocyte count of 28400 cells/μL; differential count revealed polymorphs 91%, lymphocytes 8%; platelet count 60000/μL. The blood film revealed normocytic normochromic RBCs, neutrophilic leucocytosis with toxic granulations. No hemoparasites were detectable. Urine analysis revealed 1+ protein, 40-50 WBCs/high power field, 20-25 RBCs/high power field, bile salts and pigments - negative, ketone-negative. Blood sugar on admission was 208 mg/dL; blood urea nitrogen 74 mg/ dL; serum creatinine 5.4 mg/dL; serum sodium 138 mmol/L; potassium 4.8 mmol/L; bicarbonate 7.0 mmol/L; chloride 104 mmol/L; pO290 mm Hg., pCO226 mm Hg. Serum total bilirubin measured 2.1 mg/dl; SGOT – 44 U/L; SGPT – 34 U/L; alkaline phosphatase – 242 U/L; serum total protein 6.5 g/L; and serum albumin measured 2.4 g/ dL. Urine culture revealed significant growth of E. Coli., (>105 colony forming units/ ml) sensitive to ciprofloxacin, amikacin, and ceftriaxone. However, blood culture grew no organism. Ultrasonogram of the abdomen revealed bilaterally enlarged kidneys with hydroureteronephrosis. No radioopaque lesion could be made out in the ultrasonogram or X-ray KUB region. An MR urogram performed to further evaluate the obstruction [] revealed bilateral renal papillary necrosis (RPN) with bilateral midureteric obstruction.
Thrombocytopenia and severe myalgia prompted a search for leptospirosis, a common cause of AKI in this part of the country. The organism could not be isolated from the urine or blood. However, the MAT (Microscopic Agglutination Test) done in the second week of the illness detected Leptospira icterohemorrhagica; serovar hardjo. Serologic investigations for dengue were negative.
She was subjected to a USG-guided renal biopsy which revealed acute tubular necrosis, interstitial inflammation, and mild mesangial proliferation [Figure –].
The patient was treated with hemodialysis and her antibiotics included benzyl penicillin and ceftriaxone. Gradually, the fever settled, her general condition stabilized, and renal function started to improve. By the 20th day of the illness, serum creatinine was 1.7 mg/ dL and platelet count was 190,000/μL and patient was discharged. Follow-up at 3 months revealed a serum creatinine of 1.4 mg/dL.",What is the patient's albumin corrected anion gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [104.0, 'mmol/L'], 'Albumin': [2.4, 'g/dL'], 'Bicarbonate': [7.0, 'mmol/L'], 'Sodium': [138.0, 'mmol/L']}",31,29.45,32.55,"The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 138.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 138.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 138.0 mmol * 1 mEq/mmol = 138.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 138.0 mmol sodium/L converts to 138.0 mEq sodium/L. 
The concentration of chloride is 104.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 104.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 104.0 mmol * 1 mEq/mmol = 104.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 104.0 mmol chloride/L converts to 104.0 mEq chloride/L. 
The concentration of bicarbonate is 7.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 7.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 7.0 mmol * 1 mEq/mmol = 7.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 7.0 mmol bicarbonate/L converts to 7.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 138.0 mEq/L - (104.0 mEq/L + 7.0 mEq/L) = 27.0 mEq/L. Hence, The patient's anion gap is 27.0 mEq/L.The concentration of albumin is 2.4 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 27.0 (mEq/L) + 2.5 * (4 - 2.4 (in g/dL)) = 31.0 mEq/L. Hence, the patient's albumin corrected anion gap is 31.0 mEq/L."
781,65,Albumin Corrected Anion Gap,lab test,decimal,pmc-5885426-1,Extracted,"A 28-year-old female patient presented to the orthopedic department with pain in left lower limb after trivial trauma. Past history was significant for repeated episodes of muscle weakness. At that time, she was diagnosed to have hypokalemic periodic paralysis (HPP) and started on oral potassium supplementation. Her physical examination was normal except for subtrochanteric fractures of bilateral femora. There was no muscle weakness of both upper limbs. The power in the lower limbs could not be tested due to fractures of both femora. On investigation, serum creatinine was 1.4 mg/dl, BUN 26 mg/dl, S. Na+ - 133 mmol/L, S. K+ 2.7 mmol/L, S. Ca++ 9.7 mg/dl, Cl − - 122 mmol/L, S.phosphorus 2.1 mg/dl, uric acid 2 mg/dl, S.bilirubin 0.5 mg/dl, SGOT 42 U/L, SGPT 23 U/L, S.albumin 3.2 g/dl, bicarbonate 20.2 mmol/L, and alkaline phosphatase 837 mg/dl. Her Vitamin D3 was 10 ng/ml and S. PTH 38.5 pg/ml. Her thyroid function tests were normal. Analysis of arterial blood gases (ABGs) (on room air) revealed pH of 7.22, PaO2 of 61, PCO2 of 23, HCO3 of 11.3 with base deficit of - 17 mmol/L, Na+ - 139 meq/L, K+ 2.3 mmol/L, Ca++ 0.41 mmol/L. The urinary pH was 7.5. On radiological evaluation, there was an acute pathological subtrochanteric fracture of left femur, old subtrochanteric fracture of the right femur and left proximal fibula. On ultrasound abdomen, there was dystrophic parenchymal calcification in the left kidney and mild hydronephrosis and hydroureter on the right side. Tc-99m diethylene triamine penta acetic acid revealed nonfunctioning left kidney with the normally functioning right kidney. Electrocardiography (ECG) was normal except for frequent ventricular ectopics. Transthoracic echocardiography was normal. A bone scan showed avid uptake of tracer in right sixth rib, left seventh rib, bilateral proximal femora, left proximal fibula, shaft of the right humerus, and renal cortex [].
Based on the above findings, the patient was diagnosed to have RTA (distal or type 1, normal anion gap hyperchloremic acidosis) with hypokalemia, nephrocalcinosis, and metabolic bone disease. Surgery was deferred in order to optimize the condition of the patient. The goal of therapy was to maintain serum pH of >7.3 and S. K+ >3 mmol/L. She was started on potassium supplementation intravenously (IV), followed by oral potassium 21 meq tid, tablet alfacalcidol 0.25 mcg, oral sodium bicarbonate 1 g (11.9 mmol) thrice a day, and oral calcium 500 mg BD. After 4 days, ABG analysis showed pH 7.307, PaO296 mmHg, PCO225 mm Hg, HCO312.3 mmol/L with base deficit of - 12.6 mmol/L, K+ 3.1 mmol/L, and Ca++ 0.92 mmol/L. She was posted for interlocking nailing of fracture of left femur to be followed by right femur after 2 days.
On the day of surgery, she was premedicated with tablet alprazolam 0.25 mg and tablet pantoprazole 40 mg 2 h prior to shifting to the operation theatre (OT). In the OT, standard monitors were attached and wide bore IV access was secured. Radial arterial cannulation was done for continuous blood pressure monitoring and ABG analysis. Under strict aseptic precautions, epidural space was located in sitting position at L3-4 intervertebral space through a median approach by the loss of resistance to air with an 18G Tuohy needle. A subarachnoid block was established with the administration of 3 ml of 0.5% heavy bupivacaine with 25 μg of fentanyl via 27G spinal needle (needle through needle technique). A 22G epidural catheter was passed into the epidural space and fixed at 9 cm. The time taken for onset of the subarachnoid block was approximately 5-6 min and the highest level of the block (T8) was achieved within 13 min. During the procedure, which lasted for 120 min, 1.5 L of ringer lactate was infused and normal saline was avoided. IV sodium bicarbonate and potassium supplementation were given based on ABG findings so as to maintain pH of more than 7.3 and >3 -5 mEq/L. A total of 50 meq of 7.5% sodium bicarbonate and 10 meq of potassium chloride were infused. Intraoperative vitals were stable, blood loss was approximately 300 ml, and urine output was 20-40 ml/h. For postoperative analgesia, a bolus of 8 ml of 0.2% ropivacaine (after a test dose of 3 ml of 2% lignocaine without epinephrine) was given epidurally and an infusion of 0.2% ropivacaine was started at 6 ml/h. The operation on the contralateral femur was done under epidural anesthesia 2 days later. Postoperatively, ECG was continuously monitored and ABG analysis was done twice a day for 3 days. Oral bicarbonate and potassium supplements were continued and additional IV supplementation was given as required. She was discharged on the 10th postoperative day.",What is the patient's albumin corrected anion gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [122.0, 'mmol/L'], 'Albumin': [3.2, 'g/dL'], 'Bicarbonate': [20.2, 'mmol/L'], 'Sodium': [133.0, 'mmol/L']}",-7.2,-6.84,-7.56,"The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 133.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 133.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 133.0 mmol * 1 mEq/mmol = 133.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 133.0 mmol sodium/L converts to 133.0 mEq sodium/L. 
The concentration of chloride is 122.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 122.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 122.0 mmol * 1 mEq/mmol = 122.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 122.0 mmol chloride/L converts to 122.0 mEq chloride/L. 
The concentration of bicarbonate is 20.2 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 20.2 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 20.2 mmol * 1 mEq/mmol = 20.2 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 20.2 mmol bicarbonate/L converts to 20.2 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 133.0 mEq/L - (122.0 mEq/L + 20.2 mEq/L) = -9.2 mEq/L. Hence, The patient's anion gap is -9.2 mEq/L.The concentration of albumin is 3.2 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get -9.2 (mEq/L) + 2.5 * (4 - 3.2 (in g/dL)) = -7.2 mEq/L. Hence, the patient's albumin corrected anion gap is -7.2 mEq/L."
782,65,Albumin Corrected Anion Gap,lab test,decimal,pmc-3190515-1,Extracted,"A 48-year-old morbidly obese African-American male with a medical history of congestive heart failure, hypertension, obstructive sleep apnea on 2 l of home oxygen and non-complaint with continuous positive airway pressure at night presented to the emergency department (ED) with worsening shortness of breath and lower extremity oedema over one week. Vital signs in the ED were temperature, 98.7 degrees Fahrenheit; blood pressure, 116/66 mmHg; heart rate, 130 beats per minute; respiratory rate, 30; oxygen saturation, 85% on 2 l nasal cannula; weight, 162 kg and body mass index, 47. Physical examination revealed a morbidly obese male in acute respiratory distress with an irregularly irregular pulse and one plus lower extremity pitting oedema. Laboratory values in the ED include white blood cell count, 9 800/μl; haemoglobin, 14.2 g/dl; platelet count, 230 000/μl; sodium, 140 mEq/l; potassium, 4.5 mEq/l; chloride, 104 mEq/l; bicarbonate, 29 mEq/l; blood urea nitrogen (BUN), 38 mg/dl; creatinine, 1.4 mg/dl; glucose, 105 mg/dl; aspartate aminotransferase (AST), 51 U/l; alanine aminotransferase (ALT), 40 U/l; alkaline phosphatase, 68 U/l; total bilirubin, 1.5 mg/dl; albumin, 3.4 g/dl; total protein, 7.1 g/dl; international normalised ratio (INR), 1.2; myoglobin, 97 μg/l; troponin, 0.07 ng/ml and B-type natriuretic peptide, 934 pg/ml. Urine toxicology screen was positive for cocaine. Arterial blood gas showed a pH 7.33, paCO2 68.5 and paO2 88.6 on FiO2 of 40%. Electrocardiogram confirmed atrial fibrillation with a rapid ventricular response. Echocardiogram revealed a myopathic severely enlarged left ventricular chamber with moderate concentric left ventricular hypertrophy and severe global hypokinesis with an ejection fraction of 8 to 10%. The patient's work of breathing and oxygenation improved with Bipap. He was started on diltiazem and diuresis was initiated. The patient was admitted to the step-down unit with a new diagnosis of atrial fibrillation.
On hospital day number eight, the overnight nurse found the patient unresponsive. A code blue was called. His initial rhythm was ventricular fibrillation and he was shocked with 200 J twice before regaining pulses. When stabilised, he was transferred to the intensive care unit (ICU) where he regained consciousness and full neurologic function within one hour of the event. The following day, an automatic implantable cardioverter defibrillator (AICD) was placed. Intraoperatively, the patient had runs of ventricular tachycardia with hypotension to 80 mmHg systolic. Postoperatively, the patient was found to have a right fixed mid-dilated pupil, flaccid paralysis of the left arm and leg with hyperreflexia throughout the left side. Computed tomography (CT) of the head revealed a right midbrain and thalamic stroke thought to be secondary to transient arrhythmia-induced hypoperfusion, intraoperatively.
On postoperative day number three, after AICD placement and stroke, the patient acutely developed a rigid distended board-like abdomen with dullness to percussion. Vitals at that time were temperature, 98.4 degrees Fahrenheit; blood pressure, 112/67 mmHg; heart rate range, 55 beats per minute, and respiratory rate 26 on ventilator settings of assist control volume control with a rate of 26; tidal volume, 500 ml; FiO2, 40% and positive end-expiratory pressure of 5. His peak inspiratory pressure on the ventilator had risen from 26 to 72 mmHg; his plateau had risen from 15 to 48 mmHg with oxygen desaturation from 93 to 85%. The patient had received 1.5 l in and urinated 4.5 l over the 24 hours, leading up to this event. His laboratory values from that morning were unchanged from previous (white blood count, 10 400/μl; haemoglobin, 12.6 g/dl; platelets, 200 000/μl; sodium, 139 mEq/l; potassium, 4.7 mEq/l; chloride, 100 mEq/l; bicarbonate, 34 mEq/l; BUN, 36 mg/dl; creatinine, 1.41 mg/dl; glucose, 78 mg/dl; calcium, 8.3 mg/dl; magnesium, 2.0 mEq/l; phosphorus, 3.0 mg/dl; AST, 77 U/l; ALT, 94 U/l; alkaline phosphatase, 186 U/l; total bilirubin, 1.3 mg/dl). This constellation of findings prompted the team to measure an abdominal compartment pressure which was elevated to 53 cm H2O (40 mmHg) with an abdominal perfusion pressure (APP) of 42 mmHg. A CT scan of the abdomen and pelvis was performed which showed no dilated loops of bowel, no ileus, no evidence of free air, abscess or obstruction and minimal free fluid []. Pertinent labs from the event revealed a lactate of 1.0 mg/dl; lipase, 159 U/l; amylase, 76 U/l; creatinine, 1.53 mg/dl. Surgery was consulted and the FiO2 was increased to 100%, which improved his oxygen saturation to 96% despite his elevated peak inspiratory pressures.
Surgical recommendations were for an emergent bedside surgical abdominal decompression. The patient was administered 10 mg of intravenous cisatracurium besylate by anaesthesia in preparation for surgical management. Shortly following paralytic administration, his peak inspiratory pressure corrected from 72 to 23 mmHg, his plateau pressure from 48 to 16 mmHg and his oxygenation status tolerated a decrease in FiO2 down to 40% with his oxygen saturation returning to baseline. Measurement of his abdominal compartment pressure revealed a drop from 53 (40 mmHg) to 23 cm H2O (17 mmHg) and then normalised to 15 cm H20 (11 mmHg) over a three-hour period. During this entire event, the patient averaged 100 to 200 cc/hr of urine output and laboratory values from the following day showed a drop in creatinine from 1.53 to 1.29 mg/dl. Given this correction, surgical management was postponed and the patient was monitored. The patient remained hospitalised for an additional 73 days. He was ultimately transferred to a skilled nursing facility without return of symptoms.",What is the patient's albumin corrected anion gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [104.0, 'mEq/L'], 'Albumin': [3.4, 'g/dL'], 'Bicarbonate': [29.0, 'mEq/L'], 'Sodium': [140.0, 'mEq/L']}",8.5,8.075,8.925,"The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 140.0 mEq/L. 
The concentration of chloride is 104.0 mEq/L. 
The concentration of bicarbonate is 29.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 140.0 mEq/L - (104.0 mEq/L + 29.0 mEq/L) = 7.0 mEq/L. Hence, The patient's anion gap is 7.0 mEq/L.The concentration of albumin is 3.4 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 7.0 (mEq/L) + 2.5 * (4 - 3.4 (in g/dL)) = 8.5 mEq/L. Hence, the patient's albumin corrected anion gap is 8.5 mEq/L."
783,65,Albumin Corrected Anion Gap,lab test,decimal,pmc-4421656-1,Extracted,"A 50-year-old female was diagnosed with Gitelman syndrome at the age of 20 years. She was treated with spironolactone (100 mg/day), magnesium lactate (1.2 g/day), potassium chloride (5.4 g/day) and indometacin (25 mg/day).
The patient was recently admitted to our Nephrology Department with oliguria and progressive facial and lower limb oedema 15 days in duration. Her blood analyses showed urea 60 mg/dL, creatinine 0.93 mg/dL, Na 138 mmol/L, K 3.3 mmol/L, Cl 98 mmol/L, Mg 2.1 mg/dL, Ca 8.2 mg/dL (ionic 1.08), P 3.1 mg/dL, total proteins 4.5 g/dL, albumin 1.7 g/dL, bicarbonate 30.1 mmol/L, cholesterol 441 mg/dL, triglycerides 151 mg/dL, high-density lipoprotein 101 mg/dL, low-density lipoprotein 339 mg/dL. Anti-nuclear antibodies, antineutrophil cytoplasmic antibodies and serologic tests for hepatotropic virus, human immunodeficiency virus and treponema were negative, and her complement system, haemogram and thyroid function were normal. Urinalysis findings were proteinuria 11.7 g/day, Na 74 mmol/L, K 152.6 mmol/L, Ca 5.7 mg/dL (136.8 mg/day) and Mg 3.8 mg/dL. A renal biopsy showed: subendothelial and mesangial segmental C1q deposits, mainly located in the distal areas of the capillary loops (), with discrete mesangial proliferation, slight interstitial fibrosis and hyperplasia of the juxtaglomerular apparatus ().
Her definitive diagnosis was nephrotic syndrome secondary to C1q nephropathy, probably minimal change type. Treatment with steroids at a dose of 1 mg/kg/day was started. The nephrotic syndrome resolved after 6 weeks of treatment.",What is the patient's albumin corrected anion gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [98.0, 'mmol/L'], 'Albumin': [1.7, 'g/dL'], 'Bicarbonate': [30.1, 'mmol/L'], 'Sodium': [138.0, 'mmol/L']}",15.65,14.8675,16.4325,"The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 138.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 138.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 138.0 mmol * 1 mEq/mmol = 138.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 138.0 mmol sodium/L converts to 138.0 mEq sodium/L. 
The concentration of chloride is 98.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 98.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 98.0 mmol * 1 mEq/mmol = 98.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 98.0 mmol chloride/L converts to 98.0 mEq chloride/L. 
The concentration of bicarbonate is 30.1 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 30.1 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 30.1 mmol * 1 mEq/mmol = 30.1 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 30.1 mmol bicarbonate/L converts to 30.1 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 138.0 mEq/L - (98.0 mEq/L + 30.1 mEq/L) = 9.9 mEq/L. Hence, The patient's anion gap is 9.9 mEq/L.The concentration of albumin is 1.7 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 9.9 (mEq/L) + 2.5 * (4 - 1.7 (in g/dL)) = 15.65 mEq/L. Hence, the patient's albumin corrected anion gap is 15.65 mEq/L."
784,65,Albumin Corrected Anion Gap,lab test,decimal,pmc-8056694-1,Extracted,"A now four-year-old boy presented at the age of 3 years to our emergency department with a 2-week history of fever (39.5 °C), vomiting, and watery stools, which had already improved. He also had lower limb oedema and periorbital puffiness for one week. Apart from receiving paracetamol for the fever, there was no history of medication use. He is the offspring of parents in a consanguineous marriage with an unremarkable past medical history. He has one sister and three brothers. One of his brothers was diagnosed with steroid-resistant nephrotic syndrome due to membranous proliferative glomerulonephritis (MPGN) with C3 deposition diagnosed by kidney biopsy at 3 years of age. He reached chronic kidney disease stage 5 at the age of 4 years. Dialysis was considered, but he died in another hospital due to sepsis. No genetic testing was done on his brother.
On initial examination, the patient was stable but hypertensive with blood pressure reading of 136/83 mmHg, generalized oedema and a distended abdomen. No other abnormalities detected in systemic examinations. Laboratory investigations were performed and revealed the following: serum creatinine (45 µmol/L; normal 2.6–52.2 µmol/L), blood urea nitrogen (14.1 mmol/L; normal 1.8–6.4 mmol/L), potassium (5.5 mmol/L), sodium (135 mmol/L), chloride (110 mmol/L), bicarbonate (18 mmol/L), albumin (1.2 g/dL; normal 3.4-4.2 g/dL), haemoglobin (Hgb) (5.2 g/dL; normal 11.5–14.5 g/dL), white blood cell (WBC) count (9.13 × 109/L; normal 4–12 × 109/L), platelet count (23 × 109/L; normal 150–400 × 109/L), haptoglobin (< 0.058 g/L; normal 0.5–2.2 g/L), lactate dehydrogenase (LDH) (1425 U/L; normal 150–500 U/L), complement C3 (C3) (0.550 g/L; normal 0.80–1.60 g/L), and complement C4 (C4) (0.109/L; normal 0.16–0.48 g/L). The patient also had normal coagulation profile, normal level of ADAMTS13, negative coombs test and peripheral blood smears showed schistocytes. His urine dipstick showed urine protein excretion of > 400 mg/dL and 20–50 red blood cells/high power field. Stool cultures and analysis revealed no pathogens (Table ). Due to his uncontrolled hypertension and thrombocytopenia, the patient could not undergo a kidney biopsy.
The patient’s clinical picture fit the diagnosis of aHUS, and eculizumab was started within 24 h of the diagnosis. Following the recommendations of the Food and Drug Administration (FDA) and the manufacturer, he was given a 600 mg intravenous (IV) infusion as induction therapy and a 300 mg IV infusion every two weeks as maintenance therapy. After two doses of eculizumab, he started to show clinical and laboratory improvement. His Hgb improved to 9 g/dL; his platelet count increased to 169 × 109/L; and his C3, haptoglobin, and LDH levels were normalized (Table ). His blood pressure was controlled on amlodipine and lisinopril, and his oedema significantly improved. A genetic panel for aHUS was performed, and the patient showed a homozygous nonsense gene mutation in DGKE p.(Phe250Serfs*3). No mutation was detected in the gene coding regions of ADAMTS13, C3, CD46, CFB, CFH, CFHR1, CFHR2, CFHR3, CFHR5, CFI, MMACHC, PIGA, PLG, THBD, CD59, CR1, CR2, INF2, or MUT.
Six months after presentation, the patient was stable and in clinical remission on eculizumab 300 mg every other week. His laboratory parameters were within the normal ranges (Hgb 11.8 g/dL, platelet count 543 × 109/L, C3 0.9 g/L) apart from persistent moderate proteinuria, with urine dipstick 100 mg/dL and serum albumin 2.5 g/dL (Table ). Based on the genetic results and the patient’s general condition, we decided to start increasing the time between eculizumab doses, targeting discontinuation. A 300 mg IV infusion of eculizumab was administered every three weeks instead of every two weeks. Following the first dose after increasing the time between doses, the patient was noticed to be oedematous; his proteinuria in urine dipstick increased to 400 − 300 mg/dL with urine protein/creatinine ratio > 3 mg/mg, his albumin dropped to 1.9 g/dL, and other laboratory parameters, including Hgb and platelet count, were within the normal ranges (Hgb 12.2 g/dl and platelet count 494 × 109/L) (Table ). His oedema improved after the addition of oral furosemide at 1 mg/kg/dose twice daily. Nevertheless, after 4 months of eculizumab every 3 weeks, the patient’s proteinuria and albumin levels did not improve. The decision was made to try eculizumab every two weeks and observe his proteinuria. Interestingly, his proteinuria improved to 100 mg/dL after only two doses of the two-week regimen, his oedema subsided and serum albumin improved gradually from 1.9 g/L to 2.2 g/L (Table ). Four months later, patient is stable on eculizumab 300 mg IV infusion every two weeks with no oedema and stable proteinuria and Albumin (Table ). Throughout his first year after presentation, apart from proteinuria, his creatinine was within the normal range, and he had no signs of HUS activity after the first remission.",What is the patient's albumin corrected anion gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Sodium': [135.0, 'mEq/L'], 'Bicarbonate': [18.0, 'mEq/L'], 'Chloride': [110.0, 'mEq/L'], 'Albumin': [1.2, 'g/dL']}",14,13.3,14.7,"The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 135.0 mEq/L. 
The concentration of chloride is 110.0 mEq/L. 
The concentration of bicarbonate is 18.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 135.0 mEq/L - (110.0 mEq/L + 18.0 mEq/L) = 7.0 mEq/L. Hence, The patient's anion gap is 7.0 mEq/L.The concentration of albumin is 1.2 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 7.0 (mEq/L) + 2.5 * (4 - 1.2 (in g/dL)) = 14.0 mEq/L. Hence, the patient's albumin corrected anion gap is 14.0 mEq/L."
785,65,Albumin Corrected Anion Gap,lab test,decimal,pmc-8684889-1,Extracted,"A 60-year-old heterosexual man presented with 75 lb weight loss, dysphagia, jaw pain/swelling, hypotension and acute kidney injury. Medical history was significant for emphysema, hypertension, stroke, alcohol withdrawal seizure, alcohol abuse and cigarette smoking. He worked as a landscaper.
On presentation vitals were: 37.5°C, 68/48 mmHg, 95 beats/min, respiratory rate 22/min, oxygen saturation 99% on room air. Physical exam revealed halitosis, poor dentition, diffuse lower gum swelling and erythema. Soft palate showed exophytic growth (Figure ).
Abdominal exam was unremarkable. Serum chemistries showed sodium 139 mEq/L, chloride 102 mEq/L, bicarbonate 30 mEq/L, blood urea nitrogen 43 mg/dl, glucose 94 mg/dl, calcium 8.7 mg/dl, creatinine 2.3 (baseline 1.1 mg/dl), albumin 1.5 g/dl, alkaline phosphatase 574 U/L, lactic acid 2.9 mmol/L, Hb 10.8 g/dl with normal MCV, RDW, decreased RBC 3.87 x 106/ul (normal > 4.2), normal WBC 5000/ul, platelets 167,000/ul, normal bilirubin and ALT. CT neck (Figure ) showed soft palate asymmetry with thickening.
Piperacillin-tazobactam was started in addition to chlorhexidine empirically to provide coverage for any deep-seated bacterial infection of the oral mucosa while providing anaerobic coverage. ENT did soft palate biopsy which on GMS stain showed numerous round to oval yeast forms present intracellularly within the histiocytes and in the extracellular subepithelial tissue consistent with histoplasmosis (Figure ).
HIV-1/HIV-2 antigen/antibody screen was negative. Piperacillin-tazobactam was switched to amphotericin B. CD4 count was 36 cells/ul, CD8 count was normal, CD4:CD8 0.1 (normal: 1-3.6). Given a low CD4 count, he was started on azithromycin and sulfamethoxazole-trimethoprim for prophylaxis. Further testing revealed HIV RNA viral load (negative), HTLV-1/HTLV-2 DNA PCR (negative), hepatitis panel testing for hepatitis A, B and C (negative), vitamin B12 (normal), folate 3.7 ng/ml (low), reticulocyte count 2.2%, lactate dehydrogenase (normal), haptoglobin (normal), iron studies showed elevated ferritin, low iron, elevated transferrin saturation (anemia of chronic inflammation), copper (normal), zinc levels 37 mcg/dl (low), SPEP/UPEP (no monoclonal protein; diffuse hypergammaglobulinemia seen), IgA 467 mg/dl (high), IgG 2160 mg/dl (high), IgM 252 mg/dl (high), free light chain ratio (normal). Anti-nuclear antibody (ANA) 1:160, anti-CCP (cyclic citrullinated peptide) IgG 3.3 U/dl (high). Rapid plasma reagin (RPR) (negative), cytomegalovirus PCR (negative) and Epstein-Barr virus PCR were negative. Ultrasound abdomen showed no organomegaly. Bone marrow biopsy showed granulomas consistent with a diagnosis of histoplasmosis.
The patient subsequently developed upper gastrointestinal bleeding, so an EGD was performed which showed multiple 3-5 mm nodules in the second part of the duodenum (Figure ) which were biopsied.
Pathology showed duodenitis with fungal organisms on Gomorri-Methenamine Silver (GMS) stain compatible with histoplasmosis (Figure ).
CMV immunostain and AFB stain were negative. Colonoscopy showed diverticulosis, a 1 cm clean-based ulcer in the sigmoid colon (Figure ) which on biopsy showed the presence of histoplasma (Figure ).
The patient was then switched to oral itraconazole and discharged home on the same along with azithromycin, sulfamethoxazole-trimethoprim and folic acid.
Four months later, the patient had gained 10 lbs of weight, his dysphagia had resolved, and he was continuing his itraconazole therapy. His CD4 count now was 55/ul. Repeat low CD4+ T-cell count satisfied the criteria for the diagnosis of ICL.",What is the patient's albumin corrected anion gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [102.0, 'mEq/L'], 'Albumin': [1.5, 'g/dL'], 'Bicarbonate': [30.0, 'mEq/L'], 'Sodium': [139.0, 'mEq/L']}",13.25,12.5875,13.9125,"The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 139.0 mEq/L. 
The concentration of chloride is 102.0 mEq/L. 
The concentration of bicarbonate is 30.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 139.0 mEq/L - (102.0 mEq/L + 30.0 mEq/L) = 7.0 mEq/L. Hence, The patient's anion gap is 7.0 mEq/L.The concentration of albumin is 1.5 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 7.0 (mEq/L) + 2.5 * (4 - 1.5 (in g/dL)) = 13.25 mEq/L. Hence, the patient's albumin corrected anion gap is 13.25 mEq/L."
786,65,Albumin Corrected Anion Gap,lab test,decimal,pmc-4047698-1,Extracted,"This was a case report of a 35-year-old male patient who brought to our hospital with intentional ingestion of approximately 200 ml of glyphosate (herbicide) at around 10:15 AM at home. Later (after 15 m) when the family members recognized the consumption, he was taken immediately to a local hospital where gastric lavage was done and subsequently shifted to our multispecialty hospital. In the casualty the patient was conscious and obeying commands. On examination the patient was afebrile, pulse rate: 110/m, blood pressure (BP): 94/60 mm Hg, SpO2-97%, Glasgow coma scale 15/15, cardiovascular, respiratory and gastrointestinal systems were normal. The patient was initially stabilized with intravenous (IV) fluids in casualty and later shifted to the intensive care unit for further management.
Routine blood investigations were as follows: Hb%: 14.9 g/dl, total leucocyte count (TLC) 18,600 and platelet count: 2.9 lakh cells/cu mm. Serum creatinine: 2.1 mg/dl, blood urea: 44 mg/dl, serum sodium: 148 meq/l, potassium: 6.5 meq/l, chloride: 101 meq/l, bicarbondate: 18.4 mEq/L. Total bilirubin: 0.6 mg/dl, SGOT-11 U/l, SGPT-67 U/l, serum albumin: 5.3 g/dl. Arterial blood gas analysis: PH: 7.2, PCO2:31, PO2: 171. Sequential organ failure assessment score: 4 and acute physiology and chronic health evaluation score: 16.
He received calcium gluconate 1 g (10 ml) IV, dextrose-insulin infusion along with salbutamol nebulization for hyperkalemia. After 6 h of admission continuous veno-venous hemodiafiltration started in view of severe acidosis, hyperkalemia and raised creatinine levels.
After 10 h of ingestion patient had sudden respiratory distress along with hypotension and was hence intubated and ventilated. For hypotension after adequate fluid resuscitation with central venous pressure of 9-10 mm Hg (also using ultrasound guided-inferior venacaval collapsibility/distensibility), noradrenalin infusion started at 0.05 mcg/kg/min.
After 24 h, the patient was febrile, heart rate (HR): 160 beats/min, BP: 90/60 mm Hg (with high noradrenalin: 3 mcg/kg/min and vasopressin: 0.04 U/min) anuric, procalcitonin: >10 and serum lactate: 37.5 mg/dl (reference value 4-20 mg/dl), serum creatinine 6.1 mg/dl and TLC-13,000 cells/cumm. Patient was started on empirical antibiotic meropenem. IV lipid emulsion (20% intralipid 100 ml) once daily for three consecutive days (which started from 2nd day). On 4th day patient improved hemodynamically with HR: 90 beats/min, BP: 120/78 mm Hg with minimal inotropic support. TLC: 7800, serum potassium: 3.5 meq/l, serum creatinine: 3.5 mg/dl, PH: 7.42, PCO2:35.6 and PO2:145. The hemodynamic parameters from admission to first 5 days has been shown in .
Sustained low efficacy dialysis was done daily for first 4 days and later on alternate days for next four dialysis and stopped in view of adequate urine output from 14th day. Patient weaned from the ventilator on 4th day, later bi-level positive airway pressure support for few hours and oxygen mask for next 24 h. The inotrope and vasopressor tapered and stopped over next 24 h from day 4. Patient was successfully treated and discharged home on 18th day of admission.",What is the patient's albumin corrected anion gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [101.0, 'mEq/L'], 'Albumin': [5.3, 'g/dL'], 'Bicarbonate': [18.4, 'mEq/L'], 'Sodium': [148.0, 'mEq/L']}",25.35,24.0825,26.6175,"The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 148.0 mEq/L. 
The concentration of chloride is 101.0 mEq/L. 
The concentration of bicarbonate is 18.4 mEq/L. 
Plugging in these values into the anion gap formula gives us 148.0 mEq/L - (101.0 mEq/L + 18.4 mEq/L) = 28.6 mEq/L. Hence, The patient's anion gap is 28.6 mEq/L.The concentration of albumin is 5.3 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 28.6 (mEq/L) + 2.5 * (4 - 5.3 (in g/dL)) = 25.35 mEq/L. Hence, the patient's albumin corrected anion gap is 25.35 mEq/L."
787,65,Albumin Corrected Anion Gap,lab test,decimal,pmc-7216313-1,Extracted,"A 73-year-old woman with rheumatoid arthritis and Gilbert syndrome was admitted to the hospital with clinical evidence of encephalopathy. On presentation her temperature was 36.5° C, blood pressure 165/73 mmHg, pulse rate 76 bpm, and respiratory rate 16 breaths/minute. Her physical examination was otherwise notable for encephalopathy in which she was initially agitated and combative followed by lethargy and disorientation to time, place, and person. There were no focal neurological deficits nor stigmata suggestive of central nervous system infection, vasculitis or cirrhosis. Laboratory investigations included a leukocyte count of 4900 cell/mm3 (normal: 4.8-10.8 * 103cells/mm3), hemoglobin 12.2 g/dL (14.0-18.0 g/dl), platelet count 339,000/mm3 (140,000-440,000/mm3), prothrombin time (PT) 11.5 sec (9.4-11.7), international normalized ratio (INR) 1.03 (0.93-1.11), sodium 144 mmol/L (136-145 mmol/L), potassium 4.0 mmol/L (3.5-5.1 mmol/L), chloride 113 mmol/L (98-111 mmol/L), bicarbonate 25 mmol/L (21-31 mmol/L), blood urea nitrogen (BUN) 10 mg/dL (6-20 mg/dl), creatinine 0.5 mg/dL (0.6-1.2 mg/dl), calcium 9.6 mg/dL (8.6-10.0 mg/dl), albumin 3.8 g/dL (3.4- 4.8 g/dl), total protein 6.4 g/dL (6.4-8.3 g/dl), aspartate aminotransferase 20 U/L (8-20 U/L), alanine aminotransferase 15 U/L (10-40 U/L), alkaline phosphatase 68 U/L (25-100 U/L), total bilirubin 1.8 mg/dL (0.3-1.2 mg/dl), direct bilirubin 0.44 mg/dL (0.0-0.19 mg/dL) and ammonia level 165 mcmol/L (19-60 mcmol/L). Urinalysis and blood cultures were negative.
CT of the brain was unremarkable. Further laboratory testing revealed a negative human immunodeficiency virus (HIV) screen, hepatitis panel, and anti-smooth muscle antibodies. Abdominal ultrasonography revealed normal size and echotexture of the liver along with a dilated portal vein and dilated vascular channel within the right hepatic lobe. The liver appeared non-cirrhotic and a liver elastography showed a Metavir score of F1 indicating no evidence of cirrhosis.
Abdominal CT angiography revealed a dilated portal vein measuring up to 1.8 cm at the porta-hepatis along with dilated superior mesenteric and splenic veins. Multiple dilated vascular channels were seen within the right hepatic lobe. An intrahepatic portosystemic shunt between an enlarged middle hepatic vein and two separate branches of the right portal vein was visualized (Figures -).
A liver biopsy showed normal architecture with no sign of inflammation or fibrosis. She received conservative management with lactulose and rifaximin. Hyperammonemia and encephalopathy resolved after the second day of admission and she was discharged with close outpatient follow up by gastroenterology and interventional radiology.",What is the patient's albumin corrected anion gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [113.0, 'mmol/L'], 'Albumin': [3.8, 'g/dL'], 'Bicarbonate': [25.0, 'mmol/L'], 'Sodium': [144.0, 'mmol/L']}",6.5,6.175,6.825,"The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 144.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 144.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 144.0 mmol * 1 mEq/mmol = 144.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 144.0 mmol sodium/L converts to 144.0 mEq sodium/L. 
The concentration of chloride is 113.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 113.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 113.0 mmol * 1 mEq/mmol = 113.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 113.0 mmol chloride/L converts to 113.0 mEq chloride/L. 
The concentration of bicarbonate is 25.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 25.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 25.0 mmol * 1 mEq/mmol = 25.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 25.0 mmol bicarbonate/L converts to 25.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 144.0 mEq/L - (113.0 mEq/L + 25.0 mEq/L) = 6.0 mEq/L. Hence, The patient's anion gap is 6.0 mEq/L.The concentration of albumin is 3.8 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 6.0 (mEq/L) + 2.5 * (4 - 3.8 (in g/dL)) = 6.5 mEq/L. Hence, the patient's albumin corrected anion gap is 6.5 mEq/L."
788,65,Albumin Corrected Anion Gap,lab test,decimal,pmc-5937564-1,Extracted,"An 11-year-old Thai boy presented with progressive abdominal distension for one month prior to admission. He had a significant weight loss up to 8 kg within one month, but had no fever or jaundice. There is a history of eating habits: eating uncooked fish, meat, and beef. He also had polyuria upon admission. On physical examination, it was found that he was cachexic. His weight was in the 3rd percentile. Generalized lymphadenopathy and marked hepatosplenomegaly were detected. Neurological examination was within the normal limit.
His laboratory data revealed that the hemoglobin level was 13.3 g/dl, the hematocrit value was 41.5 volume %, the WBC count was 15,100 cells/mm3 (neutrophil 60%, lymphocyte 30%, monocyte 9%, and basophil 1%), and the platelets count was 304,000 cells/mm3. Peripheral blood smears were normochromic and normocytic red blood cells, without blasts cells. Bone marrow examination and biopsy were normal. The chromosome study reviewed 46 XY, normal male karyotype. The liver function test revealed that the level of albumin was 4.9 g/dl, total bilirubin 0.3 mg/dl, direct bilirubin 0.2 mg/dl, SGOT 73 U/L, SGPT 46 U/L, and alkaline phosphatase 339 U/L. Uric acid level was 6.1 mg/dl. The amount of lactate dehydrogenase (LDH) was 149 U/L. Serum electrolytes showed that the level of sodium was 134 mmol/l, potassium 3.82 mmol/l, chloride 98.5 mmol/l, and bicarbonate 26.3 mmol/l. Hypercalcemia and hypophosphatemia were detected; the serum calcium level had increased to 13.6 mg/dl and the phosphate level to 2.3 mg/dl. The blood urea nitrogen level was 11.7 mg/dl and creatinine 0.5 mg/dl. Serum amylase was 37 U/L, and serum lipase was higher than normal of 96 U/L. The amount of gamma-glutamyl transpeptidase (GGT) was 630 (normal range 15–85) U/L. Stool examination revealed blastocystis hominis. Chest X-ray showed generalized osteopenia (). The bone scan showed no evidence of active bone lesion.
CT chest and whole abdomen (Figures and ) revealed hepatomegaly and numerous heterogeneous low-attenuation centers varying in size, with peripheral rim-enhancing masses scattered in both hepatic lobes, and the largest one was 8 × 7.5 × 11.6 cm in size. No dilatation of intrahepatic duct and CBD was seen. The spleen was enlarged, and the hypodensity mass size was 1.4 × 1.9 cm. The pancreas was enlarged with an ill-defined irregular hypodensity mass at the pancreatic body, and the tail size was 2.2 × 4.7 × 2.8 cm. Enlarged portal and para-aortic nodes were observed.
Investigations for hypercalcemia were performed. The intact parathyroid hormone (iPTH) level was very low 6.33 (normal range 15–65) pg/ml, while the 25-OH vitamin D level was 27 (normal range 30–100) ng/ml. It was shown that secondary hypercalcemia developed due to malignancy that is most likely from the parathyroid hormone- (PTH-) related protein (PTHrP) producing tumor.
The level of serum tumor markers such as alpha fetoprotein was 78.52 ng/ml, CA 19-9 was 360.8 U/ml, and CA 125 was 267.10 U/ml while the CEA and β-hCG were normal.
Liver biopsy was performed for diagnosis. Histological examinations of fine-needle biopsy showed poorly differentiated tubular adenocarcinoma ().
In regard to immunohistochemistry, the tumor cells diffuse positive for cytokeratin 7 and 19 (), negative for cytokeratin 20 and synaptophysin, and lacked mCEA and pCEA ().
The patient was treated with vigorous hydration and diuretic; 20 mg of furosemide was given intravenously every 8 hours until the serum calcium level became lower than 12 mg/dl. He was placed on systemic chemotherapy; cisplatin (25 mg/m2) and gemcitabine (1,000 mg/m2) were administered intravenously on days 1 and 8 every 3 weeks for 8 cycles (24 weeks).
The patient was followed up with pediatric hemato-oncologists regularly. Physical examination and laboratory evaluation after the completion of the first cycle of chemotherapy revealed liver span, and the spleen decreased in size from 20 cm to 8 cm and 4 cm below left costal margin to just palpable. , respectively Also, the serum calcium level had decreased to 12.1 mg/dl, the phosphate level increased to 3.4 mg/dl, and the intact parathyroid hormone (iPTH) level had increased to 7.75 (normal range 15–65) pg/ml. However, he discontinued hydration therapy and diuretics.
Repeated CT chest and whole abdomen after the completion of the fourth cycle of chemotherapy for 12th and 24th weeks showed a decrease in size of the infiltrative mass in both hepatic lobes, the spleen, the pancreas, and intra-abdominal lymph nodes.",What is the patient's albumin corrected anion gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Albumin': [4.9, 'g/dL'], 'Sodium': [134.0, 'mmol/L'], 'Chloride': [98.5, 'mmol/L'], 'Bicarbonate': [26.3, 'mmol/L']}",6.95,6.6025,7.2975,"The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 134.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 134.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 134.0 mmol * 1 mEq/mmol = 134.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 134.0 mmol sodium/L converts to 134.0 mEq sodium/L. 
The concentration of chloride is 98.5 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 98.5 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 98.5 mmol * 1 mEq/mmol = 98.5 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 98.5 mmol chloride/L converts to 98.5 mEq chloride/L. 
The concentration of bicarbonate is 26.3 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 26.3 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 26.3 mmol * 1 mEq/mmol = 26.3 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 26.3 mmol bicarbonate/L converts to 26.3 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 134.0 mEq/L - (98.5 mEq/L + 26.3 mEq/L) = 9.2 mEq/L. Hence, The patient's anion gap is 9.2 mEq/L.The concentration of albumin is 4.9 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 9.2 (mEq/L) + 2.5 * (4 - 4.9 (in g/dL)) = 6.95 mEq/L. Hence, the patient's albumin corrected anion gap is 6.95 mEq/L."
789,66,Albumin Corrected Delta Gap,lab test,decimal,pmc-4170087-1,Extracted,"A 52-years-old female was visited to our hospital emergency department due to abrupt onset of headache, fever, and vomiting. On her past history she suffered from chronic sinusitis 10 years ago. Two years ago, she received right total maxillectomy for treatment of right maxillary sinus infection with necrosis. Since one year ago, she experienced orthopedic surgery of open reduction and internal fixation of both femur due to slip down injury (). She had no history of hypertension, diabetes, hepatitis, and tuberculosis. Family history of other family members could not obtained except her elder sister because she did not wanted disclose her disease further to her family members. Her elder sister diagnosed osteopetrosis 12 years ago during dental procedure and had past history of femur fracture since 22 years ago. On her social history, she took intermittent alcohol consumption without smoking.
On arrival at the emergency department, she had a systolic blood pressure of 110 mmHg, diastolic pressure of 70 mmHg, pulse rate of 133 per minute, breathing rate of 22 per minute, body temperature of 38.3℃. She had 153 cm of height, 40.1 kg of body weight, and 17.1 kg/m2 of body mass index (BMI). On physical and neurological examination, she showed right eye proptosis and lateral gaze palsy, left hearing disturbance, and left facial nerve area sensory deficit.
Laboratory examinations were performed at the time of visiting; leukocyte was 14,000/mm3 (reference range 4,000-10,000), hemoglobin was 10.6 g/dL (reference range 12.0-16.0), platelet count was 354,000/mm3 (reference range 140,000-400,000), erythrocyte sedimentation rate was 81 mm/hr (reference range 0-20), and C-reactive protein was 18.12 mg/dL (reference range 0-0.50). Blood chemistry showed serum albumin 3.7 g/dL (reference range 3.5-5.0), total calcium 7.8 mg/dL (reference range 7.8-10.0), phosphorus 1.6 mg/dL (reference range 2.9-4.3), ionized calcium 0.89 mM/L (reference range 0.96-1.40), sodium 125 mM/L (reference range 137-150), potassium 4.1 mM/L (reference range 3.5-5.3), chloride 87 mmol/L (reference range 99-110), bicarbonate 28 mmol/L (reference range 22-34).
Radiographs of chest and PNS showed diffuse sclerotic change in bony structures (). Brain magnetic resonance imaging (MRI) showed leptomeningitis with abscess formation along right Meckel's cave and right cavernous sinus wall ().
Empirical parenteral antibiotics were started with ceftriaxone, metronidazole, and vancomycin for cavernous sinus thrombophlebitis and meningitis. Antibiotics were changed to ceftriaxone alone after obtained blood culture results with streptococcus constellatus, milleri infection.
Ten days after admission, she showed symptoms of febrile sensation, vomiting, whirling type vertigo, and generalized tonic chronic seizure attack. Mental status changed from alert to deep drowsy. On brain MRI scan, epidural empyema along right frontotemporal convexity and aggravation of meningeal enhancement were seen (). She was moved to intensive care unit and antibiotics were changed to vancomycin and metronidazole because antibiotics therapy with ceftriaxone alone caused aggravation of patient's symptom. Intravenous (IV) steroid and mannitol were administered to control increased intracranial pressure. Prompt neurosurgical decompression was indicated, but neurosurgery was not done due to refusal of operation by family members, patient's poor nutritional status like extremely low BMI and sclerotic bone disease with possibility of nonunion after operation. On cerebrospinal fluid (CSF) examination, red blood cell 0/mm3, leukocyte 800/mm3 on fluid analysis, but micro-organism was not grown.
Thirteen days after admission, she was transferred to general ward because her mental status changed to alert again with no further seizure attack. Seventeen days after admission, fever was developed again, so metronidazole was changed to meropenem to cover broader spectrum of infection. Vancomycin was stopped for 2 weeks later because fever was developed during previous vancomycin usage, and maintained meropenem alone for further 10 weeks. On endoscopic examination, sphenoid sinus was suspected to focus of infection. Five weeks after admission, she got a right sphenoidotomy under local anesthesia. Complete resolution of infection was obtained after broad spectrum antibiotic therapy for 12 weeks.
For etiologic evaluation, we tested further examination for diffuse sclerosing bony structure. Laboratory data revealed elevated serum levels of tartrate resistant acid phosphatase (TRAP) without carbonic anhydrase II DNA mutation, the intact parathyroid hormone (PTH) was elevated by 144.04 pg/mL (reference range 15-65), the 1,25-dihydroxy-vitamin D (1,25-[OH]2D) was elevated by 91.0 pg/mL (reference range 20.0-60.0), and the 25-hydroxy-vitamin D3 (25-[OH]D3) was decreased by 11.43 ng/mL (reference range 20-30). Results of bone formation and resorption marker were various with the value of bone alkaline phosphatase isoenzyme 34.2 g/L (age and gender specific reference range below 22), osteocalcin 10.4 ng/mL (age and gender specific reference range 4.0-12.0), and deoxypyridinoline 9.5 nM deoxypyridinoline (DPD)/mM (reference range 3.0-7.4), respectively. A plain radiograph of the spine showed end-plate thickening and sclerosis producing the classic ""sandwich vertebra"" appearance (). Bone mineral densitometry showed increased lumbar spine vertebral bone density and bone mineral content values (bone mineral density 2.713 g/cm2 with T-score +14.84, bone mineral content of lumbar spine 173.28 g). For evaluation of chloride channel 7 (CLCN7) deficiency osteopetrosis, we performed a CLCN7 gene mutation analysis using genomic DNA which was extracted from peripheral blood using genomic DNA prep kit (Solgent Co. Ltd., Daejeon, Korea). But we could not found any mutations on 24 and 25 exon of CLCN7 gene. And her older sister's spine X-ray also showed sandwich vertebra appearance () and the CLCN7 gene mutation was not found, too.",What is the patient's albumin corrected delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Albumin': [3.7, 'g/dL'], 'Sodium': [125.0, 'mmol/L'], 'Chloride': [87.0, 'mmol/L'], 'Bicarbonate': [28.0, 'mmol/L']}",-1.25,-1.1875,-1.3125,"To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 125.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 125.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 125.0 mmol * 1 mEq/mmol = 125.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 125.0 mmol sodium/L converts to 125.0 mEq sodium/L. 
The concentration of chloride is 87.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 87.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 87.0 mmol * 1 mEq/mmol = 87.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 87.0 mmol chloride/L converts to 87.0 mEq chloride/L. 
The concentration of bicarbonate is 28.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 28.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 28.0 mmol * 1 mEq/mmol = 28.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 28.0 mmol bicarbonate/L converts to 28.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 125.0 mEq/L - (87.0 mEq/L + 28.0 mEq/L) = 10.0 mEq/L. Hence, The patient's anion gap is 10.0 mEq/L.The concentration of albumin is 3.7 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 10.0 (mEq/L) + 2.5 * (4 - 3.7 (in g/dL)) = 10.75 mEq/L. Hence, the patient's albumin corrected anion gap is 10.75 mEq/L.Plugging in 10.75 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 10.75 - 12 = -1.25 mEq/L. Hence, the patient's albumin corrected delta gap is -1.25 mEq/L."
790,66,Albumin Corrected Delta Gap,lab test,decimal,pmc-6197016-1,Extracted,"A 47-year-old Caucasian female presented to the emergency department because of a 2-day history of nausea, vomiting and moderate to severe progressive epigastric pain. She reported subjective fever with rigors and chills, loose, watery stools and abdominal fullness. Her past medical history was significant for chronic alcoholism; she drank 6–8 beers each day. She had no reported history of cirrhosis.
On arrival, her vitals included blood pressure: 120/88 mmHg, pulse:80/minute, respiratory rate:18/minute, temperature:98.6 ºF and oxygen saturation: 97% on ambient air. She appeared in mild distress; sclera was slightly jaundiced. Cardiovascular examination was unremarkable. The abdomen was mildly tender in the epigastric area without guarding and rigidity. Hepatomegaly was also noted. Central nervous system examination was non-focal. Skin showed no erythematous lesions. Laboratory data included haemoglobin 14.2 (12.0–15.7 g/dl), leucocyte count 9 (4.5–11 × 103/uL), platelets count 143 (4.5–11.0 × 103/uL), glucose 83(70–105 mg/dL), blood urea nitrogen 48(7–22 mg/dL), creatinine 2.52(0.50–1.50 mg/dL), sodium 129(134–145 mM/L), potassium 2.9(3.5–5.1 mM/L), chloride 94(98–112 mM/L), bicarbonate 18(24–30 mM/L), albumin 2.5(3.5–5.0 g/dL), total bilirubin 6.3(0.2–1.3 mg/dL), AST 71(8–40 U/L), ALP 66(39–117 U/L), ALT 128 (7–56 U/L), activated PTT 38.1 (23.0–31.0 sec) and PT 12.9 (9.5–12.0 sec) and lactic acid 2.8 (0.5–2.0 mM/L). Contrast-enhanced CT of the abdomen and pelvis showed severe, circumferential thickening of the gastric wall with the involvement of distal esophagus and the first portion of the duodenum in addition to perigastric stranding; findings were reported to be consistent with severe gastritis (). There was also mild mucosal thickening of the transverse and descending colon. The liver was enlarged with fatty infiltration. A small amount of ascites with small left-sided pleural effusion was seen throughout the peritoneum. No obstruction, perforation or intrabdominal abscess was seen. Based on her subtle presentation, physical exam and hemodynamic stability, primary peritonitis was deemed less likely upon initial assessment. Therefore, she was admitted to a medical floor with the provisional diagnoses of alcohol-related gastritis, alcoholic hepatitis, and acute kidney injury. She received a 2-litre bolus of intravenous (IV) normal saline and was started on maintenance fluid, IV antiemetics, and IV pantoprazole.
Within 8-hours of admission, the patient became hemodynamically unstable with subsequent intubation and fluid resuscitation. She was transferred to the intensive care unit. Because of bright red blood on nasogastric decompression, she was started on IV octreotide given her history of chronic alcoholism and possible variceal bleed. Because of hypotension and SIRS with peritoneal ascites, blood cultures were drawn, and the patient was started on broad-spectrum empiric antibiotics (vancomycin, piperacillin-tazobactam, and levofloxacin). A diagnostic paracentesis was performed obtaining 1.2 liters of thick serosanguinous peritoneal fluid. Ascitic fluid analysis was suggestive of monomicrobial primary peritonitis, showing abundant Gram-positive cocci and 51,500 leucocytes/mm3 with 67% neutrophils. Ascitic fluid was exudative in nature with total protein 3.8 g/dl, albumin 1.6 g/dl, lactate dehydrogenase 5189/UL and glucose 56 mg/dl. Serum-albumin ascitic-albumin gradient was 0.9 g/dl.
No surgical intervention was considered as the possibility of secondary peritonitis was less likely based on her CT and ascitic fluid findings. Blood cultures and ascitic fluid cultures were positive for GAS, and therefore, the patient was started on IV ampicillin and clindamycin for primary GAS peritonitis.
Because of hematemesis, the patient underwent EGD that showed diffuse gastric ulcerations, but no esophageal varices or active bleeding. Given diffuse ulceration of stomach with circumferential wall thickening, gastritis was thought to be caused by an underlying ischemic or infiltrative process.
Although the patient’s hemoglobin was stable, and she had required no blood transfusions, her hemodynamic status started to deteriorate requiring multiple pressor support and IV high-dose hydrocortisone. Given the context of isolation of GAS from blood and ascitic fluid, septic shock and multiorgan failure (renal failure and liver failure), a diagnosis of STSS was made. Her lactic acid level worsened from 2.8 at baseline to 42 mM/L. The patient was deemed a non-surgical candidate by the surgical team. However, an ultrasound-guided intraperitoneal drain was placed for therapeutic reasons. The patient received few doses of antibiotics; however, she continued to deteriorate and succumbed to death within 48-hours of admission due to cardiopulmonary arrest and multiorgan failure.",What is the patient's albumin corrected delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [94.0, 'mmol/L'], 'Albumin': [2.5, 'g/dL'], 'Bicarbonate': [18.0, 'mmol/L'], 'Sodium': [129.0, 'mmol/L']}",8.75,8.3125,9.1875,"To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 129.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 129.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 129.0 mmol * 1 mEq/mmol = 129.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 129.0 mmol sodium/L converts to 129.0 mEq sodium/L. 
The concentration of chloride is 94.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 94.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 94.0 mmol * 1 mEq/mmol = 94.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 94.0 mmol chloride/L converts to 94.0 mEq chloride/L. 
The concentration of bicarbonate is 18.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 18.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 18.0 mmol * 1 mEq/mmol = 18.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 18.0 mmol bicarbonate/L converts to 18.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 129.0 mEq/L - (94.0 mEq/L + 18.0 mEq/L) = 17.0 mEq/L. Hence, The patient's anion gap is 17.0 mEq/L.The concentration of albumin is 2.5 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 17.0 (mEq/L) + 2.5 * (4 - 2.5 (in g/dL)) = 20.75 mEq/L. Hence, the patient's albumin corrected anion gap is 20.75 mEq/L.Plugging in 20.75 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 20.75 - 12 = 8.75 mEq/L. Hence, the patient's albumin corrected delta gap is 8.75 mEq/L."
791,66,Albumin Corrected Delta Gap,lab test,decimal,pmc-6467431-1,Extracted,"A 45-year-old woman with a substantial past medical history of squamous cell cancer (SCC) was treated with laryngectomy and offered tracheostomy. She presented in the emergency department with complaints of shortness of breath (SOB). Her shortness of breath was getting progressively worse starting two days prior to admission. She denied any fevers, chills, sick contacts, nausea, abdominal pain, or diarrhea. She specified that she had actually been drinking a lot more water than regular prior to admission.
On admission, her vital signs revealed a blood pressure of 101/73 mmHg, a heart rate of 91 beats/min, a temperature of 37.4 degree Celsius, and a respiratory rate of 26 breaths/min. Her body mass index (BMI) was 18.6 kg/m2. Physical examination revealed a sick-appearing woman in severe respiratory distress using accessory muscles. She had a dry mucous membrane with poor skin turgor. The rest of the physical examination was unremarkable.
On laboratory assessment, the hemoglobin was 11.9 mg/dl, leukocyte count 3.6/mm3, serum creatinine 0.8 mg/dl, potassium 3.3 mmol/L, chloride 110 mmol/L, sodium 148 mmol/L, and bicarbonate 6 mmol/L. She had high anion gap metabolic acidosis (AGMA). Her serum albumin on admission was 4.2 g/dL, urine analysis revealed 80 mg/dl ketones, and serum lactate was 1.9 mmol/L. Furthermore, her liver enzymes revealed aspartate aminotransferase (AST) = 48 units/l, alanine aminotransferase (ALT) = 82 units/l, and alkaline phosphatase 199 units/l. Additionally, her blood glucose level was 133 mg/dl, salicylates = 6.8 mg/dl, and acetaminophen level was <2.0 ug/ml. Her blood alcohol level was normal and chest X-ray (CXR) on admission did not show any sign of acute cardiopulmonary problems.
Based on the initial evaluation, she received stoma suctioning and was placed on high O2 via a tracheostomy mask. Her history of laryngeal cancer, mild tachycardia and hypoxia raised the suspicion of pulmonary embolism, so a chest computed tomography angiography (CTA) was ordered. The chest CTA was negative for pulmonary embolism but showed mild emphysema.
In addition to that, an arterial blood gas (ABG) test was done, which revealed a high anion gap metabolic acidosis (HAGMA) as presented in Table . The patient continued to hyperventilate to compensate for the acidosis and was subsequently intubated.
Differential diagnoses including carbon monoxide poisoning, aminoglycoside toxicity, methanol, uremia, diabetic ketoacidosis (DKA), alcoholic ketosis, acetaminophen toxicity, iron ingestion, lactic acidosis, ethanol toxicity, salicylate toxicity, and aspirin ingestion were investigated. However, given the patient's normal acetaminophen, salicylate, lactic acid, and ethanol levels, these etiologies were ruled out. Furthermore, serum osmolality was normal and the osmolal gap was less than 10. Our differential diagnosis was further narrowed due to the presence of elevated ketones. Given the patient's malnourished state, the most likely cause of HAGMA in this patient was starvation ketosis. The patient was started on 5% dextrose water and sodium bicarbonate drip, and tube feeds. The ABG level swiftly improved within three days and she was extubated.
After four days of intensive care unit (ICU) course, she was downgraded and later on discharged after detailed counseling from a nutritionist regarding a balanced diet and avoiding fasting. She was followed up after three weeks of discharge with significant improvement on repeat basic metabolic panel with bicarbonate of 25 mmol/L, sodium 138 mmol/L, potassium 3.8 mmol/L, and chloride 102 mmol/L.",What is the patient's albumin corrected delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [110.0, 'mmol/L'], 'Albumin': [4.2, 'g/dL'], 'Bicarbonate': [6.0, 'mmol/L'], 'Sodium': [148.0, 'mmol/L']}",19.5,18.525,20.475,"To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 148.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 148.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 148.0 mmol * 1 mEq/mmol = 148.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 148.0 mmol sodium/L converts to 148.0 mEq sodium/L. 
The concentration of chloride is 110.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 110.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 110.0 mmol * 1 mEq/mmol = 110.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 110.0 mmol chloride/L converts to 110.0 mEq chloride/L. 
The concentration of bicarbonate is 6.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 6.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 6.0 mmol * 1 mEq/mmol = 6.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 6.0 mmol bicarbonate/L converts to 6.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 148.0 mEq/L - (110.0 mEq/L + 6.0 mEq/L) = 32.0 mEq/L. Hence, The patient's anion gap is 32.0 mEq/L.The concentration of albumin is 4.2 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 32.0 (mEq/L) + 2.5 * (4 - 4.2 (in g/dL)) = 31.5 mEq/L. Hence, the patient's albumin corrected anion gap is 31.5 mEq/L.Plugging in 31.5 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 31.5 - 12 = 19.5 mEq/L. Hence, the patient's albumin corrected delta gap is 19.5 mEq/L."
792,66,Albumin Corrected Delta Gap,lab test,decimal,pmc-4241635-1,Extracted,"A 61-year-old white woman presented in February 2013 with fatigue, decreased appetite and right upper quadrant abdominal pain for 2 weeks. She denied nausea, vomiting, weight loss and jaundice. Two weeks prior to presentation, the patient was found to have elevated liver enzymes by routine blood workup (AST 151 IU/l, ALT 199 IU/l), for which atorvastatin and ezetimibe were both discontinued (although she had been taking both for a long time). She was known to have MS (as she had clumsiness and optic neuritis with white matter hyperintensities by brain MRI, at that time not on any treatment, but treated with interferon in 2000 with resulting drug-induced hepatitis which resolved after discontinuation of interferon), hypothyroidism on levothyroxine (secondary to radioactive iodine ablation for Graves disease), hyperlipidemia and asthma.
On physical examination, blood pressure was 113/77 mm Hg, heart rate 64 beats/min and temperature 36.3°C. She was not jaundiced and her heart and respiratory sounds were normal. Her abdomen was soft, not tender, not distended, without hepatomegaly or splenomegaly and with normal bowel sounds. She was alert and oriented, the cranial nerves were grossly intact, muscle bulk, tone and power were normal, there was no sensory deficit, and coordination and gait were both unremarkable. Laboratory tests on admission revealed white blood cells 6.1 × 103/μl, hemoglobin 14 g/dl, platelets 433 × 103/μl, sodium 138 mEq/l, potassium 4.6 mEq/l, chloride 103 mEq/l, bicarbonate 29 mmol/l, BUN 11 mg/dl, creatinine 0.7 mg/dl and glucose 94 mg/dl. Liver function test showed AST 1,740 IU/l, ALT 1,497 IU/l, alkaline phosphatase (ALP) 140 IU/l, total bilirubin 2.4 mg/dl (direct bilirubin 1.3) – later on it went up to 5.1 mg/dl, gamma-glutamyl transferase (GGTP) 501 IU/l (normal 7–64 IU/l), total protein 8.3 g/dl and albumin 3.8 g/dl. Coagulation panel showed prothrombin time 13.6 s, international normalized ratio 1.44 and partial thromboplastin time 30.9 s. Urine drug screen was negative. The results of thyroid function testing were thyroid-stimulating hormone 10.3 mIU/ml and free thyroxine 0.8 ng/dl. She had normal alpha-fetoprotein and a negative ethanol level. Serum protein electrophoresis showed high gamma fraction of protein 2.1 g/dl. Viral hepatitis was ruled out by negative hepatitis panel including negative hepatitis C virus RNA PCR. Complete serological tests revealed positive anti-smooth muscle antibodies at 1:320 (normal titer <1:40), negative anti-mitochondrial antibodies, negative anti-nuclear antibodies, negative anti-neutrophil cytoplasmic antibodies, negative anti-myeloperoxidase antibodies, negative proteinase-3 antibodies and negative liver kidney microsomal antibodies. Ultrasound of the liver was performed and showed no significant abnormality in the liver, gallbladder or pancreas. There was no sign of gallstone or pericholecystic fluid formation. Abdominal computed tomography with contrast showed only mild fatty changes of the liver.
While the patient was in the hospital, ultrasound-guided liver biopsy was done; she was started on oral prednisone 60 mg daily and discharged home on that dose awaiting the liver biopsy result. Later on this confirmed our diagnosis of AIH as it showed lobular lymphoplasmacytic infiltrate (fig. ), Councilman bodies and spotty necrosis. Bile duct damage and bridging periportal fibrosis were present (fig. ). In March 2013, the patient had improved clinically. Her liver enzymes were checked while she was still taking 60 mg prednisone daily with the following values: AST 360 IU/l, ALT 602 IU/l, ALP 92 IU/l, GGTP 398 IU/l and total bilirubin 2.9 mg/dl. After receiving the liver biopsy result, she was prescribed oral azathioprine 50 mg daily while tapering the prednisone dose. Her liver function was periodically checked with continuous improvement. In April 2013, she was taking both 20 mg prednisone and 50 mg azathioprine daily. In June 2013, the azathioprine was stopped and she was kept on oral prednisone 10 mg daily, which later on (in September 2013) was decreased to 5 mg daily. Her liver function has been always within the normal range since July 2013 with AST 40 IU/l, ALT 35 IU/l, ALP 37 IU/l, total bilirubin 0.9 mg/dl, GGTP 60 IU/l, total protein 6.8 g/dl and albumin 3.9 g/dl.",What is the patient's albumin corrected delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [103.0, 'mEq/L'], 'Albumin': [3.8, 'g/dL'], 'Bicarbonate': [29.0, 'mmol/L'], 'Sodium': [138.0, 'mEq/L']}",-5.5,-5.225,-5.775,"To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 138.0 mEq/L. 
The concentration of chloride is 103.0 mEq/L. 
The concentration of bicarbonate is 29.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 29.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 29.0 mmol * 1 mEq/mmol = 29.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 29.0 mmol bicarbonate/L converts to 29.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 138.0 mEq/L - (103.0 mEq/L + 29.0 mEq/L) = 6.0 mEq/L. Hence, The patient's anion gap is 6.0 mEq/L.The concentration of albumin is 3.8 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 6.0 (mEq/L) + 2.5 * (4 - 3.8 (in g/dL)) = 6.5 mEq/L. Hence, the patient's albumin corrected anion gap is 6.5 mEq/L.Plugging in 6.5 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 6.5 - 12 = -5.5 mEq/L. Hence, the patient's albumin corrected delta gap is -5.5 mEq/L."
793,66,Albumin Corrected Delta Gap,lab test,decimal,usmle-7444,Extracted,"A 66-year-old man presents to your office for a regular checkup. His only current complaint is periodic difficulty falling asleep at night. He takes captopril and hydrochlorothiazide for hypertension, atorvastatin for hyperlipidemia, and aspirin for cardiovascular disease prevention. His past medical history is significant for tympanoplasty performed 8 years ago for tympanic membrane rupture after an episode of purulent otitis media and intussusception that required surgical intervention 10 years ago. He also had a severe anaphylactic reaction after his 2nd Tdap administration 3 years ago. His blood pressure is 145/90 mm Hg, heart rate is 88/min, respiratory rate is 12/min, and temperature is 36.4°C (97.5°F). Physical examination only reveals a laterally displaced point of maximum impulse. Blood analysis shows the following findings:
Sodium
139 mEq/L (139 mmol/L)
Potassium
5.0 mEq/L (5.0 mmol/L)
Chloride
100 mEq/L (100 mmol/L)
Bicarbonate
22 mEq/L (22 mmol/L)
Albumin
3.8 g/dL (38 g/L)
Urea nitrogen
8 mg/dL (2.86 mmol/L)
Creatinine
2.1 mg/dL (0.185 mmol/l)
Uric acid
5.8 mg/ dL (0.34 mmol/L)
Calcium
8.9 mg/ dL (2.22 mmol/L)
Glucose
106 mg/ dL (5.89 mmol/L)
Total cholesterol
254 mg/dL (5.57 mmol/L)
Low-density lipoprotein
58 mg/dL (1.5 mmol/L)
High-density lipoprotein
77 mg/dL (2.0 mmol/L)
Triglycerides
159 mg/dL (1.8 mmol/L)
The patient is concerned about pneumococcal infection. He has never been vaccinated against pneumococcus, and he would like to get the appropriate vaccination. You advise him that he should not be vaccinated with PCV13 (pneumococcal conjugate vaccine) and should instead be administered PPSV23 (pneumococcal polysaccharide vaccine).",What is the patient's albumin corrected delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [100.0, 'mEq/L'], 'Albumin': [3.8, 'g/dL'], 'Bicarbonate': [22.0, 'mEq/L'], 'Sodium': [139.0, 'mEq/L']}",5.5,5.225,5.775,"To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 139.0 mEq/L. 
The concentration of chloride is 100.0 mEq/L. 
The concentration of bicarbonate is 22.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 139.0 mEq/L - (100.0 mEq/L + 22.0 mEq/L) = 17.0 mEq/L. Hence, The patient's anion gap is 17.0 mEq/L.The concentration of albumin is 3.8 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 17.0 (mEq/L) + 2.5 * (4 - 3.8 (in g/dL)) = 17.5 mEq/L. Hence, the patient's albumin corrected anion gap is 17.5 mEq/L.Plugging in 17.5 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 17.5 - 12 = 5.5 mEq/L. Hence, the patient's albumin corrected delta gap is 5.5 mEq/L."
794,66,Albumin Corrected Delta Gap,lab test,decimal,pmc-7402425-1,Extracted,"A 73-year-old man with a past medical history, including hypertension, diabetes mellitus type II, Global Initiative for Chronic Obstructive Lung Disease stage D chronic obstructive pulmonary disease, chronic respiratory failure on 2 L/minute of oxygen through a nasal cannula, and former tobacco user with >30 packs/year smoking history, presented with a one-week history of sharp, periumbilical/epigastric abdominal pain (8/10 on the visual analog pain scale) without radiation to the back. Associated symptoms included nausea without vomiting, anorexia, and fatigue; symptoms were exacerbated by movement and relieved with rest. The patient denied gallbladder disease, alcohol use, hyperlipidemia, trauma, history of pancreatitis, fever, recent illness, history of malignancy, occupational exposures, dietary changes, or recent travel. His family history was positive for small cell lung cancer in his mother as well as cancer in his sister and grandmother. This patient’s physical exam was notable for epigastric tenderness without hepatosplenomegaly, rebound tenderness, rigidity, jaundice, or right upper quadrant tenderness. His vital signs were within reference limits (heart rate 60 beats/minute, temperature 97.8°F, blood pressure of 117/50 mmHg, respiratory rate of 16 breaths/minute, and weight 102 kg). The patient’s laboratory results showed a white blood cell level of 13,300 cells/mcL, a hemoglobin level of 13.9 g/dL, hematocrit of 41%, a platelet count of 278,000 per mcL, a lactic acid level of 1.2 mg/dL, glucose of 169 mg/dL, blood urea nitrogen of 25 mg/dL, a creatinine level of 1.3 mg/dL, a sodium level of 134 mEq/L, a potassium level of 4.3 mEq/L, a chloride level of 103 mEq/L, a bicarbonate level of 20 mEq/L, a calcium level of 9.8 mg/dL, partial thromboplastin time of 32 seconds, an international normalized ratio of 1.0, a brain natriuretic peptide level of 25 pg/mL, a lipase level of 96 U/L, a triglyceride level of 150 mg/dL, a total bilirubin level of 0.4 mg/dL, an aspartate aminotransferase level of 14 U/L, an alanine aminotransferase level of 12 U/L, an alkaline phosphatase level of 45 IU/L, an albumin level of 4.1 g/dL, a troponin level of 0.01 ng/mL, and a procalcitonin level of 0.1 ng/mL. A CT of the abdomen/pelvis with contrast revealed fat stranding around the pancreatic head suspicious for acute pancreatitis; a gallbladder ultrasound showed no stones or sludge in the gallbladder but dilation of the pancreatic duct to 6 mm. A CT angiography (CTA) of the chest showed right paratracheal/hilar lymphadenopathy, as well as a 4.8 x 2.7 cm subcarinal mass (Figure ). Our patient presented with acute pancreatitis complicated by mediastinal lymphadenopathy and an abdominal mass.
Magnetic resonance cholangiopancreatography (MRCP) showed two 1-cm lesions in the pancreatic body (Figure ), lymphadenopathy, and inflammatory changes in the pancreatic head/uncinate process. The patient was discharged after abdominal pain and anorexia resolved, and he completed endoscopic ultrasound (EUS) with biopsy as an outpatient. The EUS confirmed mediastinal lymphadenopathy and showed that the two pancreatic lesions previously visualized on MRCP (8.1 x 7.6 mm and 6.1 x 4.3 mm) were communicating with the pancreatic duct. Fine needle aspiration (FNA) of the largest mediastinal lymph node (station 7) was sent for biopsy. The biopsy confirmed the diagnosis of metastatic small cell carcinoma.
The patient underwent an oncologic evaluation to determine the degree of metastasis of SCLC, and positron emission tomography (PET)-CT revealed an avid lymph node in the subcarinal portion of the mediastinum with moderate size lymph nodes throughout the mediastinum showing minimal PET activity (Figure ).
The patient was started on cisplatin and etoposide every three weeks for up to six cycles with the first two cycles concurrent with radiation by oncology, and he tolerated his first two cycles with no significant complications.",What is the patient's albumin corrected delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [103.0, 'mEq/L'], 'Albumin': [4.1, 'g/dL'], 'Bicarbonate': [20.0, 'mEq/L'], 'Sodium': [134.0, 'mEq/L']}",-1.25,-1.1875,-1.3125,"To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 134.0 mEq/L. 
The concentration of chloride is 103.0 mEq/L. 
The concentration of bicarbonate is 20.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 134.0 mEq/L - (103.0 mEq/L + 20.0 mEq/L) = 11.0 mEq/L. Hence, The patient's anion gap is 11.0 mEq/L.The concentration of albumin is 4.1 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 11.0 (mEq/L) + 2.5 * (4 - 4.1 (in g/dL)) = 10.75 mEq/L. Hence, the patient's albumin corrected anion gap is 10.75 mEq/L.Plugging in 10.75 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 10.75 - 12 = -1.25 mEq/L. Hence, the patient's albumin corrected delta gap is -1.25 mEq/L."
795,66,Albumin Corrected Delta Gap,lab test,decimal,pmc-2481241-1,Extracted,"A 52-year-old white male with O2-dependent COPD, hypertension, GERD, idiopathic gastroparesis, and chronic low back pain was noted to have persistent hypokalemia in the 2.7–3.3 meq/L range over more than 2 years. He complained also of chronic generalized weakness and fatigue. He denied nausea or vomiting, but did have occasional loose stools. The hypokalemia persisted despite discontinuation of diuretic treatment for hypertension and fludrocortisone that had been prescribed briefly for orthostatic hypotension. There was no improvement with aggressive oral potassium supplementation in amounts up to 120 meq per day. The patient's serum potassium level normalized on three occasions when he was hospitalized and given supplemental potassium (COPD exacerbations in 7/06 and 1/07, pseudoseizures in 7/07), but the hypokalemia promptly recurred after discharge from the hospital (Figure ). His medications were paroxetine, trazodone, pregabalin, sustained-release morphine, loratadine, isosorbide mononitrate, lisinopril, metoprolol, simvastatin, omeprazole, metoclopramide, potassium chloride, calcium/vitamin D tablets, alendronate, and mometasone, tiotropium, and albuterol inhalers. He smoked one-half pack of cigarettes per day and did not drink alcohol.
On physical examination, he was a chronically ill-appearing man wearing a nasal cannula. Height was 69 inches, weight 205 pounds. There were no cushingoid facies, buffalo hump, or abdominal striae. Vital signs were temperature 98.6 degrees, pulse 95, respiratory rate 14, blood pressure 128/73. There was no thyromegaly or lymphadenopathy. Lungs showed decreased breath sounds and mild expiratory wheezes bilaterally. Heart sounds were regular with no murmurs, rubs, or gallops. The abdomen was soft and non-tender, with no masses or organomegaly. Extremities showed no edema, clubbing or cyanosis. The neurologic examination revealed mild generalized muscular weakness (4+/5) and normal deep tendon reflexes.
Laboratory results include serum sodium 137 mmol/L, potassium 3.0 mg/dL, chloride 95 mmol/L, bicarbonate 30.0 mmol/L, blood urea nitrogen 5 mg/dL, creatinine 0.8 mg/dL, calcium 9.3 mg/dL, phosphorus 4.1 mg/dL, albumin 3.6 g/dL, ferritin 126 ng/mL, hemoglobin 12.7 g/dL, white blood cell count 10.6 K/cmm, and platelet count 160 K/cmm. Serum aldosterone was 4.8 ng/dL (normal 4–31 ng/dL) and the plasma renin activity was 0.33 ng/mL/hr (normal 1.31–3.96 ng/mL/hr upright, 0.15–2.33 ng/mL/hr supine). Spot urine potassium was 8.6 mEq/L, urine sodium was < 10 mEq/L, and urine chloride was 16 mmol/L.
In the absence of a clear explanation for this patient's chronic hypokalemia, he was asked to give the details of his diet. He admitted to drinking 4 liters of Pepsi-Cola per day for the past several years. It was his habit to sip cola slowly but almost continuously, throughout the day. When hospitalized, he had stopped drinking cola and his potassium levels had temporarily normalized. In early May 2008, he decreased his cola intake to 2 liters per day, with a resultant increase in the serum potassium from 3.0 to 3.5 mg/dL (Figure ).",What is the patient's albumin corrected delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [95.0, 'mmol/L'], 'Albumin': [3.6, 'g/dL'], 'Bicarbonate': [30.0, 'mmol/L'], 'Sodium': [137.0, 'mmol/L']}",1,0.95,1.05,"To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 137.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 137.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 137.0 mmol * 1 mEq/mmol = 137.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 137.0 mmol sodium/L converts to 137.0 mEq sodium/L. 
The concentration of chloride is 95.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 95.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 95.0 mmol * 1 mEq/mmol = 95.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 95.0 mmol chloride/L converts to 95.0 mEq chloride/L. 
The concentration of bicarbonate is 30.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 30.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 30.0 mmol * 1 mEq/mmol = 30.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 30.0 mmol bicarbonate/L converts to 30.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 137.0 mEq/L - (95.0 mEq/L + 30.0 mEq/L) = 12.0 mEq/L. Hence, The patient's anion gap is 12.0 mEq/L.The concentration of albumin is 3.6 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 12.0 (mEq/L) + 2.5 * (4 - 3.6 (in g/dL)) = 13.0 mEq/L. Hence, the patient's albumin corrected anion gap is 13.0 mEq/L.Plugging in 13.0 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 13.0 - 12 = 1.0 mEq/L. Hence, the patient's albumin corrected delta gap is 1.0 mEq/L."
796,66,Albumin Corrected Delta Gap,lab test,decimal,pmc-4528898-1,Extracted,"A 47-year-old African American man came to the emergency department with complaints of 4 days of severe, colicky back pain with some radiation to the flanks, associated with nausea and vomiting and a noticeable decrease in urination. He denied any history of trauma, stones, dysuria, frequency, hesitancy, rash, constipation, diarrhea, fever, or previous similar pain. He denied any unusual food or sick contact. He denied taking any medications for the past 18 months, including nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and antacids. He denied smoking, alcohol, and drugs although it had been noted in the chart that he had a positive urinary toxicology screen in the past for cocaine. Although he had a history of hypertension, diabetes, and hyperlipidemia diagnosed 3 years previously during a brief hospital stay, he was not taking any of the recommended prescription medications. Family history was positive for premature atherosclerosis, yet negative for autoimmune diseases and tuberculosis. On physical examination, his vital signs included blood pressure of 235/125 mm Hg, pulse 90 beats/min, respiratory rate 20/min, temperature 37°C, O2 saturation 96% on room air. He was awake and alert, had clear lungs, a regular heart rate with no murmurs, gallops, or rubs, a soft abdomen with normal bowels sounds, bilateral costophrenic tenderness to percussion, a normal prostate, and neurologic examination.
Creatinine was 10.48 mg/dL, up from his previous level of 1.15 mg/dL at his previous visit 3 years prior. Blood urea nitrogen 63 mg/dL, Na 134 mEq/L, K 4.4 mEq/L, Cl 100 mEq/L, HCO3- 22 mEq/L, glucose 151 mg/dL, Ca 9.4 mg/dL, PO4 6.1 mg/dL, Mg 2.1 mg/dL, hemoglobin 15 g/dL, hematocrit 45%, white blood cells (WBC) of 9100 with neutrophils 75%, lymphocytes 12.5%, and eosinophils 0.9%, platelets of 167 000. His troponin was 0.02 ng/mL, CK-MB 2.6 ng/mL, BNP 53 pg/mL, amylase 70 U/L, lipase 69 U/L, international normalized ratio 1.1, prothrombin time 13 seconds, partial thromboplastin time 31 seconds, HbA1c 6.6%, aspartate transaminotransferase (AST) 25 IU/L, alanine aminotransferase (ALT) 20 IU/L, albumin 3.8 g/dL, total protein 7.3 g/dL, bilirubin 1.4 mg/dL, alkaline phosphatase 39 IU/L, C-reactive protein 25 mg/L. Urine toxicology screen was positive for cocaine. Urinalysis showed 2+ blood, no red blood cells, no WBCs, including no eosinophils by special stain, no casts, no albumin, negative for nitrates, negative leukocyte esterase and negative for bacteria, trace ketone, pH 5.5, and specific gravity 1.015. No pigmented granular casts. His hepatitis panel: C-ANCA (cytoplasmic–antineutrophil cytoplasm antibodies) Ag, P-ANCA (perinuclear–antineutrophil cytoplasm antibodies), anti–glomerular basement membrane Ag, anti-myeloperoxidase, antinuclear antibody and Helicobacter pylori IgA were all negative. Creatine phosphokinase was 127 mg/dL and his serum electrophoresis was normal. C3 was 119 mg/dL and C4 was 88.5 mg/dL (both normal). Anti-proteinase 3 (PR-3) antibodies were positive.
His chest and abdominal radiographs were normal, and computed tomography of the abdomen and pelvis without contrast showed no urinary obstruction. Transthoracic echocardiogram showed normal wall motion and ejection fraction. Electrocardiography showed nonspecific T-wave abnormalities, which were unchanged since 2010.
The patient’s blood pressure was initially controlled with intravenous labetalol and hydralazine. Over the first 3 days of admission, his urinary output decreased from 700 cm3/d to less than 400 cm3/d and his creatinine rose to 13.6 mg/dL. Nephrology was consulted early and after ruling out acute toxic nephropathy, urinary obstruction, and acute rhabdomyolsis, it was suspected, based on his initial positive toxicology screen for cocaine that he may have cocaine-induced interstitial nephritis and a renal biopsy was performed (see below). Indeed, on further questioning, the patient admitted to smoking crack cocaine. It was confirmed with the patient and his spouse that the cocaine was not mixed or combined with any other substance. At that point (day 4) the patient was started on intravenous methylprednisolone at 125 mg every 6 hours as well as daily or every other day hemodialysis for a total of 6 sessions. The methylprednisolone was tapered to 80 mg every 6 hours after 3 days and then changed to oral prednisone, which was furthered tapered over the next 12 days. The steroid was used roughly day 4 of admission, and 7 days after symptoms had started, it is hard to tag a response to the steroid separately as the patient was started on both hemodialysis and steroid at the same time after biopsy of kidney confirmed the diagnosis; nevertheless, we were able to see stable improvement on creatinine on days 8 and 9, with improvement of urine output (roughly 1000-1500 cm3/d). The patient stabilized with his creatinine at 3.54 mg/dL before being discharged home and follow-up 8 weeks later showed a normal creatinine.
Renal biopsy () showed normocellular glomeruli, interstitial atrophy, and fibrosis with tubular loss of 10% to 20%. There were foci of interstitial inflammation composed of lymphocytes, plasma cells, eosinophils, and edema with areas of severe arterioarterosclerosis. No immune complexes were detected.",What is the patient's albumin corrected delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [100.0, 'mEq/L'], 'Albumin': [3.8, 'g/dL'], 'Bicarbonate': [22.0, 'mEq/L'], 'Sodium': [134.0, 'mEq/L']}",0.5,0.475,0.525,"To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 134.0 mEq/L. 
The concentration of chloride is 100.0 mEq/L. 
The concentration of bicarbonate is 22.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 134.0 mEq/L - (100.0 mEq/L + 22.0 mEq/L) = 12.0 mEq/L. Hence, The patient's anion gap is 12.0 mEq/L.The concentration of albumin is 3.8 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 12.0 (mEq/L) + 2.5 * (4 - 3.8 (in g/dL)) = 12.5 mEq/L. Hence, the patient's albumin corrected anion gap is 12.5 mEq/L.Plugging in 12.5 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 12.5 - 12 = 0.5 mEq/L. Hence, the patient's albumin corrected delta gap is 0.5 mEq/L."
797,66,Albumin Corrected Delta Gap,lab test,decimal,pmc-5984920-1,Extracted,"A 45-year-old Caucasian woman presented with abdominal pain, nausea, and vomiting for 17 h. At 22 h prior to admission, she went out to dinner and drank one glass of wine. A few hours after the meal, she developed epigastric and left upper quadrant abdominal pain that was moderate, persistent, cramping, and aching; the pain radiated to her left middle back and arm without exacerbating or alleviating factors. The pain was associated with nausea, vomiting, and she could not tolerate any oral intake. She felt thirsty and had polyuria and positional lightheadedness. She reported no fever, chills, chest pain, cough, sputum production, dysuria, hematuria, diarrhea, hematochezia, and melena.
On further questioning, the patient shared that she had a history of gestational glucose intolerance 6 years ago, and has had occasional impaired fasting glucose of 81–107 mg/dL for the past 6 years. She began following an American Diabetes Association (ADA) diet 2 years ago and lost 25 lb. Additionally, she had a past medical history of supraventricular tachycardia, irritable bowel syndrome, social alcohol use, cholecystectomy, and thyroid papillary adenocarcinoma status post partial thyroidectomy complicated by postsurgical hypothyroidism. Home medications included metoprolol tartrate, levothyroxine, and meloxicam. The patient reported no family history of diabetes.
Temperature 97.7 °F, pulse 130 bpm, respiratory rate 28 bpm, BP 134/71 mmHg, weight 87 kg, height 1.68 m, BMI 31 kg/m2, SpO2 99% on room air.
The patient was in moderate distress. There was no acanthosis nigricans. Cardiovascular system revealed tachycardia. A pulmonary exam revealed tachypnea, accessory muscle usage with moderate respiratory distress. Abdominal exam revealed central obesity, normoactive bowel sounds, left upper quadrant and epigastric tenderness to palpation, no rigidity or guarding. No costovertebral angle tenderness.
CBC: WBC 25.9 × 109/L, hemoglobin 14.7 g/dL, hematocrit 45.8%, platelet 386 × 109/L, MCV 100.2 µm3. BMP: sodium 135 mmol/L, potassium 7.4 mmol/L, chloride 89 mmol/L, bicarbonate 5 mmol/L, BUN 37 mg/dL, creatinine 1.27 mg/dL, glucose 931 mg/dL, eGFR 46 mL/min.
Liver chemistry: Total bilirubin 0.2 mg/dL, AST 23 U/L, ALT 54 U/L, ALP 138 U/L, total protein 7.5 g/dL, albumin 4.5 g/dL. Calcium 8.7 mg/dL, phosphate 1.4 mg/dL, magnesium 2.1 mg/dL. VBG: pH 6.92. Repeated ABG 2 h later: pH 7.21, pCO2 16 mmHg, pO2 129 mmHg, HCO3− 6.4 mmol/L, SaO2 98% on 2 L/min oxygen by nasal cannula. Beta-hydroxybutyrate 28 mmol/L, lactic acid 4.0 mmol/L. Urinalysis showed urine ketones 80 mg/dL, leukocyte esterase negative, urine culture no growth. HbA1c 6.4%. Lipid profile: triglycerides 89 mg/dL, total cholesterol 144 mg/dL, LDL 91 mg/dL, HDL 35 mg/dL. TSH 3.12 mIU/mL, free T4 1.26 ng/dL. Troponin I < 0.01 ng/mL.
Ultrasonography of the abdomen revealed mild hepatic steatosis, incidental mild to moderate right-sided hydronephrosis, status post cholecystectomy. ECG on admission: sinus rhythm, HR 126 bpm, peaked T waves at lead V2–V6 consistent with hyperkalemia, no ischemic changes.
All procedures performed in this study were in compliance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from the individual participant for being included in the study.",What is the patient's albumin corrected delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [89.0, 'mmol/L'], 'Albumin': [4.5, 'g/dL'], 'Bicarbonate': [5.0, 'mmol/L'], 'Sodium': [135.0, 'mmol/L']}",27.75,26.3625,29.1375,"To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 135.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 135.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 135.0 mmol * 1 mEq/mmol = 135.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 135.0 mmol sodium/L converts to 135.0 mEq sodium/L. 
The concentration of chloride is 89.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 89.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 89.0 mmol * 1 mEq/mmol = 89.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 89.0 mmol chloride/L converts to 89.0 mEq chloride/L. 
The concentration of bicarbonate is 5.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 5.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 5.0 mmol * 1 mEq/mmol = 5.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 5.0 mmol bicarbonate/L converts to 5.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 135.0 mEq/L - (89.0 mEq/L + 5.0 mEq/L) = 41.0 mEq/L. Hence, The patient's anion gap is 41.0 mEq/L.The concentration of albumin is 4.5 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 41.0 (mEq/L) + 2.5 * (4 - 4.5 (in g/dL)) = 39.75 mEq/L. Hence, the patient's albumin corrected anion gap is 39.75 mEq/L.Plugging in 39.75 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 39.75 - 12 = 27.75 mEq/L. Hence, the patient's albumin corrected delta gap is 27.75 mEq/L."
798,66,Albumin Corrected Delta Gap,lab test,decimal,pmc-5906769-1,Extracted,"A 73-year-old female presented initially to our emergency department complaining of cough for three weeks duration. She reported productive cough of white-colour sputum, right-sided pleuritic chest pain, exertional shortness of breath and acute limitation of functional capacity to less than two blocks. There was no history of haemoptysis, fever, night sweats, chills, recent infections or hospitalization. She had loss of appetite and unintentional weight loss of ten pounds over a period of 5 months. Past medical history was non-contributory. She was a lifetime nonsmoker with no history of alcohol or illicit drug abuse. She was afebrile, normotensive and maintaining optimal oxygen saturation on room air. The rest of the physical examination was unremarkable. Laboratory testing showed white blood cell count of 5.1 × 103/µL, haemoglobin 10.8 g/dl, haematocrit 32.4% and platelet count 276 × 103/µL. Comprehensive metabolic panel revealed serum sodium 141 mmol/L, potassium 4.4 mmol/L, chloride 103 mmol/L, bicarbonate 31 mmol/L, BUN 12 mg/dl, creatinine 0.6 mg/dl, calcium 9.3 mg/dl, bilirubin total 0.5 mg/dl, AST 15 mg/dl, ALT 6 mg/dl, ALP 78 mg/dl, total protein 7 g/dl of which albumin was 3.5 g/dl. Serum Β2-microglobulin was 3.3 mg/L. Thyroid function tests and iron studies were within normal limits. Chest x-ray () revealed right lower lobe consolidation and pleural effusion. In comparison, an old chest x-ray performed 3 years ago showed no active lung disease (). Computerized tomography of the chest without IV contrast () on second day of hospital stay revealed moderate right-sided pleural effusion and right lower lobe consolidation. Treatment with levofloxacin was started. She was clinically stable and was discharged with a plan to continue antibiotic for total duration of 7 days. She was scheduled for follow up with chest clinic in 2 weeks. The patient came back after 2 months for follow up at chest clinic. She reported unchanged cough and worsening shortness of breath. Since her symptoms were worsening, she was admitted to the hospital for further evaluation. On the second hospital admission vital signs were stable, chest CT scan () revealed no significant change in complete consolidation of right lower lobe as compared to previous chest CT scan there was a moderate right-sided pleural effusion and new right upper lobe infiltrate. Abdomen and pelvis CT scan revealed homogeneous attenuation of the liver. Size and contour were maintained with no focal lesions, the pancreas was intact without ductal dilatation, the spleen was normal in size, the adrenal glands were intact, no enlarged lymph nodes were found, no ascites was present and no worrisome osseous lesions were demonstrated. PET/CT scan revealed 2.5 cm infiltrate in right upper lobe and another larger lesion in right lower lobe, both with significant uptake. Moderate right pleural effusion. Bronchoscopy showed polypoid nodularities surrounded by black discoloured mucosa in the sub-segmental bronchi of the right lower lobe, transbronchial biopsy specimen revealed minute fragments of respiratory epithelium with atypical B cell-rich lymphocytes with no evidence of amyloid deposition. Polymerase chain reaction confirmed a clonal B cell gene rearrangement, findings suggestive of low-grade B cell lymphoma. Pleural fluid was sampled and analysis revealed straw-coloured fluid, pH 7.3, white blood cell count of 6400 cells, red cell count of 3750, fluid albumin of 2.2 g/dl (serum albumin 3.0 g/dl), fluid lactate dehydrogenase 52 IU/L (serum lactate dehydrogenase 199 IU/l). Pleural fluid cytology () with immunophenotypic flow cytometry revealed plasmacytoid lymphocytes. Serum immunofixation and free light-chain analysis unveiled large quantity of monoclonal paraproteins which was classified as IgM Kappa immunoglobulin. Concentration of IgM was 1491 mg/dl (range 26–217 mg/dl) while IgG and IgA levels were normal. Urine contained free kappa light chains. The clinical picture, serum IgM paraprotein, bronchoscopy specimen findings and pleural fluid analysis led to the diagnosis of Extramedullary Waldenström’s Macroglobulinemia. Patient was started on cyclophosphamide, prednisone and rituximab. Plan was to follow up with IgM level monthly and Chest CT scan after four months.",What is the patient's albumin corrected delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [103.0, 'mmol/L'], 'Albumin': [3.5, 'g/dL'], 'Bicarbonate': [31.0, 'mmol/L'], 'Sodium': [141.0, 'mmol/L']}",-3.75,-3.5625,-3.9375,"To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 141.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 141.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 141.0 mmol * 1 mEq/mmol = 141.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 141.0 mmol sodium/L converts to 141.0 mEq sodium/L. 
The concentration of chloride is 103.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 103.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 103.0 mmol * 1 mEq/mmol = 103.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 103.0 mmol chloride/L converts to 103.0 mEq chloride/L. 
The concentration of bicarbonate is 31.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 31.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 31.0 mmol * 1 mEq/mmol = 31.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 31.0 mmol bicarbonate/L converts to 31.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 141.0 mEq/L - (103.0 mEq/L + 31.0 mEq/L) = 7.0 mEq/L. Hence, The patient's anion gap is 7.0 mEq/L.The concentration of albumin is 3.5 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 7.0 (mEq/L) + 2.5 * (4 - 3.5 (in g/dL)) = 8.25 mEq/L. Hence, the patient's albumin corrected anion gap is 8.25 mEq/L.Plugging in 8.25 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 8.25 - 12 = -3.75 mEq/L. Hence, the patient's albumin corrected delta gap is -3.75 mEq/L."
799,66,Albumin Corrected Delta Gap,lab test,decimal,pmc-2827065-1,Extracted,"A 64 year old previously healthy white male construction worker presented with a four-week history of progressive shortness of breath, bilateral lower limb swelling, increased abdominal girth and a thirty pound weight gain. He was found to have new onset hypertension and an abnormal urinalysis.
On physical examination temperature was 98.6, pulse was 64 beat per minute and blood pressure was 208/104 mmHg. Fundoscopic exam was normal. Jugular veins were distended. Heart examination showed a displaced apical impulse. Breath sounds were decreased on the right side of the chest. The abdomen was remarkable for marked splenomegaly and shifting dullness. There was marked pretibial edema. No peripheral lymphadenopathy was detected.
Initial laboratory evaluation showed a white blood cell count of 7.2 ×109/L, hematocrit 34%, and platelet count 99 × 109/L. The serum creatinine was 2.9 mg/dl, and blood urea nitrogen was 37 mg/dl. Serum electrolytes were (in meq/l) sodium 143, potassium 4.3, chloride 112, and bicarbonate 22. Hepatic transaminases, alkaline phosphatase, and prothrombin time were normal. Total protein was 4.8 g/dl and albumin 2.6 g/dl. Urinalysis showed 3+ blood, 3+ protein with abundant granular casts and RBCS but no cellular casts. 24 hour urinary protein excretion was 28 g. Serum immunofixation electrophoresis, SPEP and UPEP were negative for monoclonal bands. Serum complement (C3) was 72.3 mg/dl (83-193) and C4 was 22.8 mg/dl (12-36). Rheumatoid factor was 299 IU (0-29). Tests for hepatitis B surface antigen, hepatitis C antibody, RPR, human immunodeficiency virus antibodies, streptozyme, and antinuclear antibodies were negative.
Chest radiographic study showed a right pleural effusion and a normal sized heart. Computerized tomography of the abdomen showed hepatosplenomegaly and periaortic lymphadenopathy. Doppler ultrasonography of the kidneys was normal.
A percutaneous renal biopsy was performed. Light microscopy showed increased cellularity in all glomeruli and accentuation of lobular architecture. Silver staining showed double contours within the capillary loops. Epithelial crescents were not present. Immunofluorescence studies showed granular staining in a lobular pattern for IgG, IgM, Kappa, and lambda. Electron microscopy showed subendothelial and mesangial fine electron dense deposits (Figure ). These histologic changes were consistent with MPGN, type 1. There was no evidence of lymphomatous infiltration and there was no histological evidence of cyroglobulin deposition or amyloidosis.
Bone marrow aspiration and biopsy showed a hypercellular bone marrow (80%) with extensive infiltration of small B cell lymphoctyes. The B cells were positive for the B cell marker CD20 and negative for T cell markers CD5 and CD3. The final diagnosis was low grade B cell NHL.
After initial treatment with six cycles of cyclophosphamide, vincristine, and prednisone. The patient improved symptomatically and his blood pressure normalized. Serum creatinine, which initially peaked at 7.1 mg/dl, decreased dramatically to a baseline level of 1.4 - 1.7 mg/dl. Urine protein excretion decreased to <300 mg/24hr. Microscopic hematuria resolved. Serum albumin increased to 3.5-4.0 g/dl with resolution of the proteinuria. The anemia and thrombocytopenia resolved. Repeated computed tomography of the abdomen at intervals of six and 12 months showed improvement in splenomegaly and periaortic lymphadenopathy. A repeat bone marrow biopsy showed no evidence for NHL. During long term follow up, the patient has had two relapses of NHL confirmed by bone marrow biopsies. The first relapse was treated with six cycles of fludarabine and mitoxantrone and the second with rituximab. Subsequent bone marrow biopsy showed no evidence for lymphoma, and computed tomography of the abdomen and pelvis showed resolution of lymphadenopathy with interval improvement in splenomegaly. In each relapse there was a transient increase in the serum creatinine concentration, up to 2 mg/dl, that was attributed to factors other than MPGN. Urinalysis remained normal. The patient continues to be in complete remission with respect to his MPGN and NHL, approximately 11 years following the initial diagnosis.",What is the patient's albumin corrected delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [112.0, 'mEq/L'], 'Albumin': [2.6, 'g/dL'], 'Bicarbonate': [22.0, 'mEq/L'], 'Sodium': [143.0, 'mEq/L']}",0.5,0.475,0.525,"To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 143.0 mEq/L. 
The concentration of chloride is 112.0 mEq/L. 
The concentration of bicarbonate is 22.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 143.0 mEq/L - (112.0 mEq/L + 22.0 mEq/L) = 9.0 mEq/L. Hence, The patient's anion gap is 9.0 mEq/L.The concentration of albumin is 2.6 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 9.0 (mEq/L) + 2.5 * (4 - 2.6 (in g/dL)) = 12.5 mEq/L. Hence, the patient's albumin corrected anion gap is 12.5 mEq/L.Plugging in 12.5 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 12.5 - 12 = 0.5 mEq/L. Hence, the patient's albumin corrected delta gap is 0.5 mEq/L."
800,66,Albumin Corrected Delta Gap,lab test,decimal,pmc-2687832-1,Extracted,"A 41-year-old man with a history of alcohol intake (90 g ethanol/day for three years) was admitted to Jeju Hospital in June 2004 due to a traffic accident in which he sustained a right distal radius fracture. During the hospital stay, he developed jaundice and was diagnosed with an aneurysm of the distal descending thoracic aorta. He was then transferred to Yonsei Medical Center, where he received further treatment.
The physical examination upon admission revealed the following vital signs: blood pressure 160/110 mmHg, pulse rate 85 beats/minute, respiration rate 18 breaths/minute, and body temperature 36.7℃. There was a slight hepatosplenomegaly without evidence of other abdominal masses. Laboratory tests revealed the following: hemoglobin 13.2 g/dL, hematocrit 38.7%, white blood cell count 5,720/µL with 59.4% polymorphonuclear cell, platelet count 97,000/µL, sodium 136.5 mEq/L, potassium 3.97 mEq/L, chloride 96.7 mEq/L, bicarbonate 23.9 mEq/L, blood urea nitrogen 6.5 mg/dL, creatinine 0.6 mg/dL, total protein 8.8 g/dL, albumin 3.7 g/dL, total bilirubin 2.6 mg/dL, direct bilirubin 1.9 mg/dL, alkaline phosphatase 159 IU/L, AST 82 IU/L, ALT 27 IU/L, gamma-glutamyltranspeptidase 605 IU/L, prothrombin time 70%, c-reactive protein 1.61 mg/dL, HBsAg negative, anti-HBs negative, anti-HBc negative, anti-HCV negative, alpha-fetoprotein (AFP) 7.52 ng/mL, and protein induced by vitamin K absence II 158 mAU/mL.
On the first day of hospitalization, a computerized tomography (CT) of the aorta and a dynamic CT of the liver were taken. The CT of the aorta showed a fusiform shaped aneurysm at the distal descending thoracic aorta measuring 4 cm at the maximal diameter, with circumferential calcification of the aneurysm wall. The CT also revealed surface nodularity of the liver, suggesting liver cirrhosis, and numerous small nodules throughout the entire liver. The dynamic liver CT showed multiple nodular lesions with arterial enhancement and delayed washout in both lobes of the liver (). On the fifth day, a US-guided liver gun biopsy was performed on a 2.5 cm-sized hyperechoic nodule with a peripheral halo in the right lobe of the liver (). The liver biopsy showed a hepatocellular nodule with slightly increased cellularity, fatty change, and Mallory bodies (). It also showed unpaired arteries and focal sinusoidal expression of CD34, indicating increased angiogenesis in the nodule; however, both the structural and cytological atypia were unremarkable and there was focal iron deposition. The background revealed alcoholic micronodular cirrhosis. From these observations, the lesion was tentatively diagnosed as a hypervascular hyperplastic nodule in alcoholic cirrhosis. On the twelfth day, a percutaneous transarterial angiography with stent insertion at the aortic aneurysm was performed. Two days later, an aortic CT demonstrated the complete exclusion of the aneurysm. Magnetic resonance imaging (MRI) of the liver was performed on the fifteenth day revealed underlying liver cirrhosis and numerous nodules that showed high signals on T1 weighted images, but there were some with a central low signal portion (). Among those, arterial phase enhancing nodules were present, suggesting overt HCCs. Other nodules also showed central enhancement patterns, suggesting dysplastic nodules with subfocus HCCs (). On the nineteenth day, a second liver gun biopsy was performed on the same lesion as the first biopsy and demonstrated the same pathological features. From these findings, the possibility of mistargeting the biopsy was ruled out and the diagnosis of hypervascular hyperplastic nodules in alcoholic cirrhosis was confirmed. Hepatic angiography performed on the twenty-fourth day showed faint multiple nodular staining of both liver lobes in the early arterial phase (). The patient was discharged three days after the hepatic angiography and scheduled for an outpatient follow-up.",What is the patient's albumin corrected delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [96.7, 'mEq/L'], 'Albumin': [3.7, 'g/dL'], 'Bicarbonate': [23.9, 'mEq/L'], 'Sodium': [136.5, 'mEq/L']}",4.65,4.4175,4.8825,"To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 136.5 mEq/L. 
The concentration of chloride is 96.7 mEq/L. 
The concentration of bicarbonate is 23.9 mEq/L. 
Plugging in these values into the anion gap formula gives us 136.5 mEq/L - (96.7 mEq/L + 23.9 mEq/L) = 15.9 mEq/L. Hence, The patient's anion gap is 15.9 mEq/L.The concentration of albumin is 3.7 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 15.9 (mEq/L) + 2.5 * (4 - 3.7 (in g/dL)) = 16.65 mEq/L. Hence, the patient's albumin corrected anion gap is 16.65 mEq/L.Plugging in 16.65 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 16.65 - 12 = 4.65 mEq/L. Hence, the patient's albumin corrected delta gap is 4.65 mEq/L."
801,66,Albumin Corrected Delta Gap,lab test,decimal,pmc-7571602-1,Extracted,"A 64-year-old male with a past medical history of Child B compensated liver cirrhosis complicated by non-bleeding esophageal varices, portal vein thrombosis, diverticulosis, and history of episodes of small bowel obstruction presented with chronic diffuse abdominal pain for three months. Review of systems was negative for nausea, vomiting, diarrhea, constipation, fever, or chills. The patient was passing flatus but denied any bowel movements for four days.
On physical examination, bowel sounds were decreased, and the patient’s abdomen was diffusely tender to palpation. Heart sounds were normal, and lungs were clear to auscultation.
Review of medication history revealed that the patient had been taking propranolol for primary prevention of variceal bleed for three years since being diagnosed with cirrhosis.
Pertinent laboratory values were as follows: sodium = 133 mEq/L (low [L]), potassium = 4.4 mEq/L (normal [nl]), chloride = 105 mEq/L (nl), BUN (blood urea nitrogen) = 16 mg/dL (nl), creatinine = 0.9 mg/dL (nl), white blood cell = 3.9 k/uL (L), hemoglobin = 9.0 g/dL (L), platelet = 204 k/uL (nl), lactate = 2.8 mmol/L (high [H]), AST (aspartate aminotransferase) = 53 U/L (H), ALT (alanine aminotransferase) = 16 U/L (H), GGT (gamma-glutamyl transpeptidase) = 223 U/L (H), direct bilirubin = 0.3 mg/dL (H), total bilirubin = 1.1 mg/dL (nl), alkaline phosphatase = 160 U/L (H), total protein = 6.0 g/dL (L), albumin = 3.2g/dL (L), and bicarbonate = 22 mEq/L (L).
Initial workup included an abdominal CT scan, which showed mobile loops of bowel with air-fluid levels concerning for ileus versus small bowel obstruction. However, given that the patient was passing gas, concern for complete bowel obstruction was low, and conservative medical management was recommended by the consulted surgical team.
Review of the previous medical records showed this patient to have a history of recurrent admissions for unremitting, diffuse abdominal pain. During a surgery to relieve his bowel obstruction approximately two years prior, a thick fibrous tissue encapsulating the ileum, jejunum, gallbladder, stomach, transverse colon, and omentum was noticed. Additionally, a separate fibrous capsule was found that encapsulated the aforementioned structures and fibrous sheath. The distal ileum was found to be completely decompressed, consistent with a diagnosis of small bowel obstruction. To relieve the obstruction, the thick fibrous tissue encasing the ileum and jejunum had to be excised. Some of the fibrous casing had to be left intact to preserve the integrity of bowel tissues.
CT images from two years prior are shown in Figures , .
During this admission, however, the patient’s bowel obstruction was managed conservatively. By day 5 of his hospital admission, imaging showed resolution of the obstruction.",What is the patient's albumin corrected delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [105.0, 'mEq/L'], 'Albumin': [3.2, 'g/dL'], 'Bicarbonate': [22.0, 'mEq/L'], 'Sodium': [133.0, 'mEq/L']}",-4,-3.8,-4.2,"To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 133.0 mEq/L. 
The concentration of chloride is 105.0 mEq/L. 
The concentration of bicarbonate is 22.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 133.0 mEq/L - (105.0 mEq/L + 22.0 mEq/L) = 6.0 mEq/L. Hence, The patient's anion gap is 6.0 mEq/L.The concentration of albumin is 3.2 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 6.0 (mEq/L) + 2.5 * (4 - 3.2 (in g/dL)) = 8.0 mEq/L. Hence, the patient's albumin corrected anion gap is 8.0 mEq/L.Plugging in 8.0 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 8.0 - 12 = -4.0 mEq/L. Hence, the patient's albumin corrected delta gap is -4.0 mEq/L."
802,66,Albumin Corrected Delta Gap,lab test,decimal,pmc-5930206-1,Extracted,"A 63-year-old Thai man, with a long-standing history of alcohol and tobacco use, was hospitalized with a two-month history of progressive jaundice, generalized pruritus, and significant involuntary weight loss. He reported no fever, abdominal pain, or vomiting. For the 4 weeks prior to his admission, he also suffered from progressive fatigue, poor oral intake, pale stools, and decreased urine output. His past medical history was significant for well-controlled type 2 diabetes mellitus, hypertension, and stage 3A chronic kidney disease (baseline serum creatinine of 1.5 mg/dL, estimated glomerular filtration rate of 48.8 mL/min/1.73 m2). His family history was negative for any kidney disease or malignancy. He had no history of herbal medicine use, intravenous drug abuse, tattoos, or blood transfusions. On physical examination, he was alert and oriented with severe jaundice, a distended abdomen with an enlarged liver, and a 1+ bilateral pitting edema of his lower extremities. He had no stigmata of chronic liver disease. The rest of the physical examination was unremarkable.
Laboratory data were as follows: hemoglobin = 9.6 g/dL, mean corpuscular volume (MCV) = 85 fL, white blood cells = 11,880/mm3 (neutrophil 81%, lymphocyte 4.9%, monocyte 12%), platelets = 384,000/mm3, international normalized ratio (INR) = 2.2, blood urea nitrogen = 73.8 mg/dL, serum creatinine = 7.78 mg/dL, sodium = 133 mEq/L, potassium = 3.8 mEq/L, bicarbonate = 16.8 mEq/L, chloride = 92 mEq/L, calcium = 8.7 mg/dL, phosphorus = 4.8 mg/dL, magnesium = 2.8 mg/dL, and glycated hemoglobin = 7.1%. Liver function tests revealed the following: total cholesterol = 177 mg/dL, total protein = 5.4 g/dL, albumin = 2.8 g/dL, globulin = 2.6 g/dL, total bilirubin = 36.1 mg/dL, direct bilirubin = 35 mg/dL, alanine transaminase (ALT) = 53 U/L, aspartate transaminase (AST) = 109 U/L, and alkaline phosphatase (ALP) = 408 U/L. Serum tests for human immunodeficiency virus, hepatitis B, and hepatitis C were negative. Serum carbohydrate antigen 19-9 (CA 19-9) levels were 850 U/mL (0–37). Urine appeared greenish with a specific gravity of 1.010, trace proteinuria, 5–10 red blood cells (RBCs)/high-power field, 1–2 white blood cells/high-power field along with numerous muddy brown granular casts (Fig. ), and bile casts (Fig. ). No RBC casts were found. The fractional excretion of sodium (FENa) was 2.7%, and FEurea was 44.8%. Abdominal computed tomography showed 4.3 × 4.2 cm and 3.1 × 3.5 cm inhomogeneous enhancing masses at liver segment 4A with moderately dilated intrahepatic ducts (Fig. ). Based on the symptoms of biliary obstruction, typical imaging findings, and elevated serum CA 19-9, the most likely diagnosis was cholangiocarcinoma (Bismuth–Corlette type IIIb). He was initially given intravenous fluids to combat his oliguric renal failure, but there was no improvement in serum creatinine and urine output. Over the next 5 days, hemodialysis was initiated due to diuretic-resistant oliguric acute renal failure. Percutaneous transhepatic biliary drainage (PTBD) was also performed to relieve his obstructive jaundice. However, he still experienced clinical deterioration. After approximately 2 weeks of hemodialysis, his total serum bilirubin continued to be in the 30 mg/dL range and he remained oliguric. On the 27th day of admission, the patient suffered from massive biliary hemorrhage requiring a blood transfusion. An emergency esophagogastroduodenoscopy (EGD) was performed and revealed active hemorrhage from the ampulla of Vater, a finding suggestive of tumor bleeding. After thorough discussion and consultation between the patient's family and the palliative care team, the healthcare providers proceed to initiate palliative treatment.",What is the patient's albumin corrected delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [92.0, 'mEq/L'], 'Albumin': [2.8, 'g/dL'], 'Bicarbonate': [16.8, 'mEq/L'], 'Sodium': [133.0, 'mEq/L']}",15.2,14.44,15.96,"To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 133.0 mEq/L. 
The concentration of chloride is 92.0 mEq/L. 
The concentration of bicarbonate is 16.8 mEq/L. 
Plugging in these values into the anion gap formula gives us 133.0 mEq/L - (92.0 mEq/L + 16.8 mEq/L) = 24.2 mEq/L. Hence, The patient's anion gap is 24.2 mEq/L.The concentration of albumin is 2.8 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 24.2 (mEq/L) + 2.5 * (4 - 2.8 (in g/dL)) = 27.2 mEq/L. Hence, the patient's albumin corrected anion gap is 27.2 mEq/L.Plugging in 27.2 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 27.2 - 12 = 15.2 mEq/L. Hence, the patient's albumin corrected delta gap is 15.2 mEq/L."
803,66,Albumin Corrected Delta Gap,lab test,decimal,pmc-2827053-1,Extracted,"A 36-year-old, previously healthy Hispanic female with no significant past medical history and no prior history of hypertension presented to the emergency room with sharp retrosternal chest pain radiating to the back. She was 165 centimeter tall and weighed 70 kilogram. She was a housewife and mother of two living children. She smoked one pack of cigarettes a day for more than ten years. For 3 months prior to presentation, she had been taking 18-20 tablets of caffeine-based weight loss pills daily, which was higher than the recommended daily dose. Each tablet contains 60-100 mg of caffeine and she was taking 1080 mg to 2000 mg of caffeine daily. She denied the use of other medications, stimulants, herbal, alcohol and illicit drugs. She said that she had lost approximately 20-25 kilograms in last 3 months. No family history of hypertension, diabetes or coronary artery disease. She denied palpitation, chest pain, insomnia, headache, abdominal pain or increase in urination.
On presentation, her blood pressure was found to be 220/110 mm Hg in right arm and 230/118 mm Hg in left arm. Her initial work-up included an electrocardiogram which showed T-wave inversion in leads III, aVF and V6. A complete blood count showed hemoglobin 12.9 g/dl (normal: 12.0-16.0 g/dl), white blood cell count 15.1 k/ul (normal: 4.0-11.0 k/ul) and platelet count 231 k/ul (normal: 150-450 k/ul). Serum basic metabolic panel showed sodium 132 mmol/L (normal: 135-145 mmol/L), potassium 3.3 mmol/L (normal: 3.5-5.3 mmol/L), chloride 103 mmol/L (normal: 95/105 mmol/L), bicarbonate 23 mmol/L (normal: 22-31 mmol/L), creatinine 1.3 mg/dl (normal: 0.6-1.3 mg/dl), calcium 8.3 mg/dl (normal: 8.6-10.3 mg/dl). Liver function test showed normal aspartate transaminase (15 U/L; normal: 0-55 U/L), alanine transaminase (23 U/L; normal: <45 U/L), alkaline phosphatase (55 U/L; normal: 34-104 U/L) and albumin (3.5 g/dl,normal:3.0-5.1 g/dl). Urinalysis showed only elevated specific gravity of 1.031(normal: 1.005-1.03). There were no crystals, protein and glucose in the urinalysis. Troponin I level was less than 0.030 ng/ml (normal: 0.0-0.049 ng/ml). Urine and serum toxicology screens were negative for cocaine, amphetamine, marijuana, benzodiazepines, barbiturates and phencyclidine. A chest X-ray did not show any infiltrate, consolidation, effusion or mediastinal widening. A computed tomography aortogram showed aortic dissection involving the posterior aspect of the arch extending into the common iliac arteries and right proximal external iliac artery. The dissection extended into the left subclavian and axillary arteries. There was narrowing of the origin of the right renal artery due to dissection (Stanford type B dissection) (Figure ,Figure , & Figure .)
She was started on intravenous esmolol and nitroprusside for blood pressure control and was admitted to the medical intensive care unit. During hospitalization, her blood pressure remained well controlled with amlodipine. All other investigations for a secondary cause of hypertension were negative. Patient was discharged home and upon follow-up 2 week later, her blood pressure remained well controlled with low dose amlodipine.",What is the patient's albumin corrected delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [103.0, 'mmol/L'], 'Albumin': [3.5, 'g/dL'], 'Bicarbonate': [23, 'mmol/L'], 'Sodium': [132.0, 'mmol/L']}",-4.75,-4.5125,-4.9875,"To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 132.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 132.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 132.0 mmol * 1 mEq/mmol = 132.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 132.0 mmol sodium/L converts to 132.0 mEq sodium/L. 
The concentration of chloride is 103.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 103.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 103.0 mmol * 1 mEq/mmol = 103.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 103.0 mmol chloride/L converts to 103.0 mEq chloride/L. 
The concentration of bicarbonate is 23 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 23 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 23 mmol * 1 mEq/mmol = 23 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 23 mmol bicarbonate/L converts to 23.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 132.0 mEq/L - (103.0 mEq/L + 23.0 mEq/L) = 6.0 mEq/L. Hence, The patient's anion gap is 6.0 mEq/L.The concentration of albumin is 3.5 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 6.0 (mEq/L) + 2.5 * (4 - 3.5 (in g/dL)) = 7.25 mEq/L. Hence, the patient's albumin corrected anion gap is 7.25 mEq/L.Plugging in 7.25 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 7.25 - 12 = -4.75 mEq/L. Hence, the patient's albumin corrected delta gap is -4.75 mEq/L."
804,66,Albumin Corrected Delta Gap,lab test,decimal,pmc-7392358-1,Extracted,"A 31-year-old Caucasian female with a past medical history significant for intravenous (IV) drug abuse, hypertension, and bipolar disorder was brought to the emergency department with complaints of shortness of breath, palpitations, and neck pain. The patient endorsed associated pleuritic chest pain, generalized weakness, fatigue, unintentional 10-pound weight loss, profuse sweating, diffuse abdominal pain, and nausea. She also endorsed recent flu-like symptoms, which resolved after a few days. She denied any heat or cold intolerance, tremors, and bowel habit changes. She endorsed dysuria but denied hematuria or urgency. She had a 15 pack-year smoking history, drank alcohol occasionally, and had been sober from IV drug abuse for four years. She denied any family history of thyroid disease or thyroid cancer.
Physical examination was remarkable for tachycardia (without murmurs), a tender diffuse goiter without any bruit or lymphadenopathy, dry mucosal membranes, and tachypnea without any abnormal respiratory sounds. Vital signs were remarkable for temperature (T) 99.2 F°, heart rate (HR) of 138, and respiratory rate (RR) of 22.
Labatory findings (Table ) revealed the following: white blood cells (WBCs) 9.26 cells/mcL, hemoglobin 13.8 g/dL, and platelets 155 cells/mcL. Basic metabolic profile (BMP) revealed sodium (Na) 126 mEq/L, potassium (K) 3.2 mEq/L, chloride (Cl) 102 mEq/L, bicarbonate (HCO3-) 28 mEq/L, blood urea nitrogen (BUN) 14 mg/dL, creatinine 0.8 mg/dL, and albumin 1.6 g/dL. The liver function panel was within normal limits. Troponins were <0.015 ng/mL, erythrocyte sedimentation rate (ESR) was 91 mm/h, and C-reactive protein (CRP) was 19 mg/L. Procalcitonin was 4.9 ng/mL.
Electrocardiogram (ECG) showed sinus tachycardia without ST-T wave changes. Chest X-ray (CXR) showed a right lower lobe infiltrate without pleural effusion or reactive lymphadenopathy (Figure ). Urinalysis revealed positive leukocyte esterase, nitrite, and white blood cells >10. Urine culture was negative. Blood cultures were positive for Escherichia coli (E. coli). Thyroid panel showed a thyroid-stimulating hormone (TSH) of 0.08 μU/mL (normal range 0.4-5 μU/mL), free thyroxine (T4) of 5.57 ng/dL (normal range: 0.8-2.8 ng/dL), total triiodothyronine (T3) of 201 ng/dL (normal range: 60 to 180 ng/dL), thyroid-stimulating immunoglobulin (TSI) <0.01 IU/L (normal range: 0-0.5 IU/L), and thyroid peroxidase antibodies (TPO) <6 IU/mL (normal range < 9 IU/mL). Thyroid ultrasonography (US) revealed heterogeneous diffuse goiter without any nodules, cysts, or abscess (Figure ). Doppler US revealed a hypovascular thyroid goiter (Figure ), thus confirming the diagnosis of subacute painful thyroiditis.
The patient was admitted to the progressive care unit for sepsis secondary to community-acquired pneumonia, E. coli bacteremia, and subacute painful thyroiditis. She was treated with IV fluids (initially 30 cc/kg bolus then 100 cc/hr maintenance), antibiotics, acetaminophen, and propranolol 20 mg every six hours. The second day, the patient triggered a rapid response due to altered mental status, high fever, profuse sweating, and palpitations. Vital signs showed a temperature of 104.5 F°, heart rate (HR) of 138, blood pressure (BP) 110/60, with 100% oxygen saturation on room air. Electrocardiogram (ECG) showed sinus tachycardia without ST-T wave changes (Figure ). Repeated troponin, lactic acid, and basic metabolic profile were unremarkable. Repeated free thyroxine (FT4) was >8, and thyroid-stimulating hormone (TSH) was undetectable. The patient was transferred to the intensive care unit (ICU) for further management of the thyroid storm. Endocrinology was consulted and recommended cold IV fluids, cooling blankets, acetaminophen 650 mg every six hours, titration of propranolol to 40 mg every six hours, with a target HR <100, hydrocortisone 100 mg once then 50 mg every six hours, and one cholestyramine packet every eight hours. On the third day, repeat FT4 was still >8, with slight clinical improvement of mental status. Endocrinology recommended starting a trial of propylthiouracil (PTU) of 150 mg every eight hours with FT4 daily. Over the next few days, the patient improved significantly and FT4 started to trend down (>8, >8, 6.46, 4.75, 3.48, 2.88,1.58, and 1.33). The patient was transferred out of the ICU, and propranolol, corticosteroids, cholestyramine, and PTU were tapered off over the next few days before she was discharged home. On her follow-up at the endocrinology clinic, her symptoms completely resolved. Repeat thyroid function tests were within normal limits.",What is the patient's albumin corrected delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [102.0, 'mEq/L'], 'Albumin': [1.6, 'g/dL'], 'Bicarbonate': [28.0, 'mEq/L'], 'Sodium': [126.0, 'mEq/L']}",-10,-9.5,-10.5,"To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 126.0 mEq/L. 
The concentration of chloride is 102.0 mEq/L. 
The concentration of bicarbonate is 28.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 126.0 mEq/L - (102.0 mEq/L + 28.0 mEq/L) = -4.0 mEq/L. Hence, The patient's anion gap is -4.0 mEq/L.The concentration of albumin is 1.6 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get -4.0 (mEq/L) + 2.5 * (4 - 1.6 (in g/dL)) = 2.0 mEq/L. Hence, the patient's albumin corrected anion gap is 2.0 mEq/L.Plugging in 2.0 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 2.0 - 12 = -10.0 mEq/L. Hence, the patient's albumin corrected delta gap is -10.0 mEq/L."
805,66,Albumin Corrected Delta Gap,lab test,decimal,pmc-2827053-1,Extracted,"A 36-year-old, previously healthy Hispanic female with no significant past medical history and no prior history of hypertension presented to the emergency room with sharp retrosternal chest pain radiating to the back. She was 165 centimeter tall and weighed 70 kilogram. She was a housewife and mother of two living children. She smoked one pack of cigarettes a day for more than ten years. For 3 months prior to presentation, she had been taking 18-20 tablets of caffeine-based weight loss pills daily, which was higher than the recommended daily dose. Each tablet contains 60-100 mg of caffeine and she was taking 1080 mg to 2000 mg of caffeine daily. She denied the use of other medications, stimulants, herbal, alcohol and illicit drugs. She said that she had lost approximately 20-25 kilograms in last 3 months. No family history of hypertension, diabetes or coronary artery disease. She denied palpitation, chest pain, insomnia, headache, abdominal pain or increase in urination.
On presentation, her blood pressure was found to be 220/110 mm Hg in right arm and 230/118 mm Hg in left arm. Her initial work-up included an electrocardiogram which showed T-wave inversion in leads III, aVF and V6. A complete blood count showed hemoglobin 12.9 g/dl (normal: 12.0-16.0 g/dl), white blood cell count 15.1 k/ul (normal: 4.0-11.0 k/ul) and platelet count 231 k/ul (normal: 150-450 k/ul). Serum basic metabolic panel showed sodium 132 mmol/L (normal: 135-145 mmol/L), potassium 3.3 mmol/L (normal: 3.5-5.3 mmol/L), chloride 103 mmol/L (normal: 95/105 mmol/L), bicarbonate 23 mmol/L (normal: 22-31 mmol/L), creatinine 1.3 mg/dl (normal: 0.6-1.3 mg/dl), and calcium 8.3 mg/dl (normal: 8.6-10.3 mg/dl). Liver function test showed normal aspartate transaminase (15 U/L; normal: 0-55 U/L), alanine transaminase (23 U/L; normal: <45 U/L), alkaline phosphatase (55 U/L; normal: 34-104 U/L) and albumin (3.5 g/dl,normal:3.0-5.1 g/dl). Urinalysis showed only elevated specific gravity of 1.031(normal: 1.005-1.03). There were no crystals, protein and glucose in the urinalysis. Troponin I level was less than 0.030 ng/ml (normal: 0.0-0.049 ng/ml). Urine and serum toxicology screens were negative for cocaine, amphetamine, marijuana, benzodiazepines, barbiturates and phencyclidine. A chest X-ray did not show any infiltrate, consolidation, effusion or mediastinal widening. A computed tomography aortogram showed aortic dissection involving the posterior aspect of the arch extending into the common iliac arteries and right proximal external iliac artery. The dissection extended into the left subclavian and axillary arteries. There was narrowing of the origin of the right renal artery due to dissection (Stanford type B dissection) (Figure ,Figure , & Figure .)
She was started on intravenous esmolol and nitroprusside for blood pressure control and was admitted to the medical intensive care unit. During hospitalization, her blood pressure remained well controlled with amlodipine. All other investigations for a secondary cause of hypertension were negative. Patient was discharged home and upon follow-up 2 week later, her blood pressure remained well controlled with low dose amlodipine.",What is the patient's albumin corrected delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [103.0, 'mmol/L'], 'Albumin': [3.5, 'g/dL'], 'Bicarbonate': [23.0, 'mmol/L'], 'Sodium': [132.0, 'mmol/L']}",-4.75,-4.5125,-4.9875,"To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 132.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 132.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 132.0 mmol * 1 mEq/mmol = 132.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 132.0 mmol sodium/L converts to 132.0 mEq sodium/L. 
The concentration of chloride is 103.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 103.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 103.0 mmol * 1 mEq/mmol = 103.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 103.0 mmol chloride/L converts to 103.0 mEq chloride/L. 
The concentration of bicarbonate is 23.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 23.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 23.0 mmol * 1 mEq/mmol = 23.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 23.0 mmol bicarbonate/L converts to 23.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 132.0 mEq/L - (103.0 mEq/L + 23.0 mEq/L) = 6.0 mEq/L. Hence, The patient's anion gap is 6.0 mEq/L.The concentration of albumin is 3.5 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 6.0 (mEq/L) + 2.5 * (4 - 3.5 (in g/dL)) = 7.25 mEq/L. Hence, the patient's albumin corrected anion gap is 7.25 mEq/L.Plugging in 7.25 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 7.25 - 12 = -4.75 mEq/L. Hence, the patient's albumin corrected delta gap is -4.75 mEq/L."
806,66,Albumin Corrected Delta Gap,lab test,decimal,pmc-4591497-1,Extracted,"A 71 year-old Caucasian male ex-smoker without any significant past medical history presented to the emergency department complaining of worsening redness and swelling in his left lower leg. He presented five days earlier and was given antibiotic treatment which did not resolve the problem. On physical exam BP 119/68 mHg, Pulse 61/min, Resp 17/min, Temp: 96.6°F, O2 saturation 96% on Room air. Laboratory testing showed hemoglobin 12.2 g/dL, WBC 7.3 K/uL, Platelet count 26 K/uL, Neutrophils 29, Lymphocytes 20%, MCV 73.2 fL, glucose 120 mg/dL, BUN 14 mg/dL, Creatinine 0.8 mg/dL, Calcium 8.7 mg/dL, albumin 4.3 g/dL, Sodium 137 mmol/L, Potassium 4 mmol/L, Chloride 100 mmol/L, and bicarboante 25 mmol/L. Liver enzymes were within normal limits. X-ray ruled out osseous contribution to his problem and venous Doppler was negative for DVT. Subsequently a diagnosis of cellulitis was made. CBC demonstrated multiple cytopenias, including thrombocytopenia ( and ). A review of hospital records noted previous findings of thrombocytopenia as far as four years earlier. Considering pancytopenia an oncology consult was called who reviewed the peripheral smear which showed slight anisocytosis, monocytosis with marked thrombocytopenia with some giant platelets, No pseudo-Pelger-Huet cells or circulating blasts were noted (). Given the laboratory findings, leukemia was considered as a differential and therefore a bone marrow biopsy was performed which showed the differential () granulopoiesis, hypercellular marrow with increased myelomonocytic cells and megakaryocytogenesis (Figure 1B,C). Immunohistochemistry showed CD117: about 5-10% positive cells, consistent with immature cells/blasts, CD34: No increase in CD34 positive cells, CD163: Highlights predominantly monocytic component, CD123: Negative. Reticulin staining showed mild diffuse reticulin fibrosis. Immunophenotyping by flow cytometry analysis FLG13-859 shows mild myelomonocytic abnormalities. PCR study for JAK2 is negative. FISH was performed for BCR/ABL1 to detect the (9:22) translocation associated with CML and less commonly ALL or AML were normal. Cytogenic testing demonstrated an abnormal karyotype 46, XY, del(20)(q11.2q13.3)(20) (). Other 15 metaphase spreads examined showed a normal male karyotype, 46, XY. Patient was diagnosed with myelodysplastic syndrome, Unclassified (MDS-U) with refractory thrombocytopenia.",What is the patient's albumin corrected delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [100.0, 'mmol/L'], 'Albumin': [4.3, 'g/dL'], 'Bicarbonate': [25.0, 'mmol/L'], 'Sodium': [137.0, 'mmol/L']}",-0.75,-0.7125,-0.7875,"To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 137.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 137.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 137.0 mmol * 1 mEq/mmol = 137.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 137.0 mmol sodium/L converts to 137.0 mEq sodium/L. 
The concentration of chloride is 100.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 100.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 100.0 mmol * 1 mEq/mmol = 100.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 100.0 mmol chloride/L converts to 100.0 mEq chloride/L. 
The concentration of bicarbonate is 25.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 25.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 25.0 mmol * 1 mEq/mmol = 25.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 25.0 mmol bicarbonate/L converts to 25.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 137.0 mEq/L - (100.0 mEq/L + 25.0 mEq/L) = 12.0 mEq/L. Hence, The patient's anion gap is 12.0 mEq/L.The concentration of albumin is 4.3 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 12.0 (mEq/L) + 2.5 * (4 - 4.3 (in g/dL)) = 11.25 mEq/L. Hence, the patient's albumin corrected anion gap is 11.25 mEq/L.Plugging in 11.25 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 11.25 - 12 = -0.75 mEq/L. Hence, the patient's albumin corrected delta gap is -0.75 mEq/L."
807,66,Albumin Corrected Delta Gap,lab test,decimal,pmc-6164201-1,Extracted,"A 14-year-old girl came to Thammasat University Hospital for renal replacement therapy. She presented with end-stage renal disease (oliguria, anemia, and failure to thrive). She was the first child of healthy nonconsanguineous Thai parents. She was born at term to a 23-year-old mother and a 25-year-old father. Her prenatal and perinatal periods were uncomplicated. Her development was unremarkable until six months of age. She clawed by using her knees and elbows, instead of hands, at the age of 8 months. She was unable to walk on her feet but moved on her knees during her childhood period. She came to our hospital at the age of 12 years. Her weight was 25.4 kilograms (below the 3rd percentile) and her sitting height was 70 cm (below the 3rd percentile). Her vitals were normal, except high blood pressure at 120/80 mmHg (above 99th percentile for her age, sex, and height). She had pallor. Her distinctive facial features were the cloudy cornea, exophthalmos, underdeveloped ala nasi, maxillary hypoplasia, and micrognathia (). Upper extremity deformities included shortening of arms and forearms, flexion contracture of elbows, distorted wrists, and shortening of all fingers. Deformities of lower extremities were short thighs, short-bowed legs, and flexion contracture of knee. Distorted and restricted in motion of ankles, and deformities of feet were observed. Her heart, lungs, abdomen, and neurological examination were unremarkable. Her cognitive was appropriated with age.
Her initial investigations demonstrated blood urea nitrogen 120 mg/dL, serum creatinine 8.3 mg/dL, Na 134, K 4.5, Cl 95, HCO3 11 mmol/L, phosphate 2.6, calcium 3.8 mg/dL, albumin 6.0 g/dL, alkaline phosphatase (ALP) 13.5 U/L, with parathyroid hormone (PTH) level at 94 pg/ml. Her radiography of the upper extremities showed absence of carpal bones, osteolytic lesions of metacarpal, and distal ends of ulna and radial bones (). The radiography of the lower extremities demonstrated absence of tarsal bones, osteolytic lesions of metatarsal bones, and distal end of fibula (). In addition, severe cortical thinning of all bones indicating osteopenia was observed (Figures and ).
Ultrasonography showed small size of both kidneys and echocardiography demonstrated left ventricular hypertrophy. The diagnosis of end-stage renal disease was made with estimated glomerular filtration rate (GFR) of 7 mL/min/1.73 m2. All clinical presentation and investigations were compatible with the clinical diagnosis of MCTO. She received hemodialysis followed by continuous ambulatory peritoneal dialysis and medications including erythropoietin, ferrous fumarate, 0.50 µg of calcitriol, and 1400 mg of elemental calcium. Six months later, she developed generalized tonic-clonic seizure from hypercalcemia (12.4 mg/dL). Her serum chemistry demonstrated normal serum phosphorus level (3.9 mg/dL) and low serum alkaline phosphatase (4 U/L), with normal serum PTH level at 103 pg/mL. These findings indicated a marked reduction in the bone uptake of calcium after a period of calcium supplement. Calcium and calcitriol were discontinued until serum calcium returned to normal level, then only 720 mg of elemental calcium was reintroduced. Two years later, she had a slightly high serum calcium level (10.8 mg/dL), normal serum phosphorus level (3.5 mg/dL), and normal PTH level (113 pg/ml). Interestingly, during the past 2 years, we observed persistently low serum ALP levels (2.6–4.9 U/L) [], indicating poor osteoblastic activity and limited bone formation. Thus, impaired bone mineralization from dysregulation of osteoblast and osteoclast was suspected and MAFB mutation might be responsible for MCTO disease in this patient.
We performed a genetic testing, MAFB sequencing on her and her parental blood. The genomic were isolated from peripheral lymphocytes using Puregene DNA extraction kit (Qiagen, Valencia, CA). A short region of the amino-terminal transcriptional activation domain of the MAFB gene, containing mutation hotspots, was amplified by polymerase chain reaction (PCR). We designed primers by using software (Primer3Plus). The forward and reverse primer sequences for PCR amplification were 5′-GCTCAAGT TCGACGTGAAGA-3′ and 5′-GTAGTTGCTCGCCATCCAGT-3′, respectively. PCR products were visualized on a 2% agarose gel and purified using DyeEx 2.0 spin kit (Qiagen, Valencia, CA). The products were then sequenced by capillary electrophoresis. This study was approved by the ethic committee of the Faculty of Medicine, Thammasat University, Thailand (MTU-EC-PE-1-005/59).
We identified a de novo heterozygous missense mutation at nucleotide 197 from C to G (NM_005461.4; c.197C > G; ), predicting the change of amino acid at codon 66 from serine to cysteine (p. Ser66Cys). There was negative in both mother and father's result. This missense mutation occurred within the transactivation domain of MafB protein. This serine at the codon 66 is evolutionarily conserved among species, and in silico prediction of pathogenicity programs classify this variant as deleterious (SIFT) and probably damaging (PolyPhen).",What is the patient's albumin corrected delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [95.0, 'mEq/L'], 'Albumin': [6.0, 'g/dL'], 'Bicarbonate': [11.0, 'mmol/L'], 'Sodium': [134.0, 'mEq/L']}",11,10.45,11.55,"To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 134.0 mEq/L. 
The concentration of chloride is 95.0 mEq/L. 
The concentration of bicarbonate is 11.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 11.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 11.0 mmol * 1 mEq/mmol = 11.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 11.0 mmol bicarbonate/L converts to 11.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 134.0 mEq/L - (95.0 mEq/L + 11.0 mEq/L) = 28.0 mEq/L. Hence, The patient's anion gap is 28.0 mEq/L.The concentration of albumin is 6.0 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 28.0 (mEq/L) + 2.5 * (4 - 6.0 (in g/dL)) = 23.0 mEq/L. Hence, the patient's albumin corrected anion gap is 23.0 mEq/L.Plugging in 23.0 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 23.0 - 12 = 11.0 mEq/L. Hence, the patient's albumin corrected delta gap is 11.0 mEq/L."
808,66,Albumin Corrected Delta Gap,lab test,decimal,pmc-8677960-1,Extracted,"An 8-year-old Chinese boy with no specific family or psychosocial history was admitted to our hospital with an emergency occurrence of purpura, severe hematemesis, large bloody stools, and sharp abdominal pain. His symptoms had begun 2 weeks prior to admission, with abdominal pain and an erythematous pinpoint rash on his arms. The rash developed from his upper limbs (opisthenar and arms) to his lower limbs. Laboratory examination in the outpatient clinic revealed no abnormalities in indicators such as white blood cell count, platelet count, and hemoglobin. After oral medication (specific unknown), his abdominal symptoms began to reduce, as did the purpura. Ten days prior, the rash progressed mostly on the legs, and he experienced deeper abdominal pain in the form of persistent pain with abdominal gassiness and emesis. He was admitted to another hospital with a diagnosis of HSP. Seven days prior, he had melena. After fasting and fluid replacement, there was no obvious improvement in the symptoms. Half a day prior, his face and lips appeared pale, and he had increased abdominal pain, accompanied by numerous bloody stools and hematemesis. He was immediately treated with methylprednisolone, posterior pituitary injection, somatostatin, and hemocoagulase, together with the infusion of large blood products (Table ). At this stage, the patient still produced large amounts of blood in the vomit and stool. His vital signs were extremely unstable, and he was transferred to the pediatric intensive care unit of our hospital. The patient had purpura with lower limb predominance and abdominal pain (consistent with one of the following 4 criteria: abdominal pain, histopathology, arthritis or arthralgia, and renal involvement), and was diagnosed with HSP.[
On admission, he had severe anemia, with a blood pressure of 76/44 mm Hg, pulse of 135 beats/min, and respiratory rate of 25 breaths/min. There was also a palpable purpura rash on both legs, tenderness in the abdomen, and absence of bowel sounds. Routine blood examination revealed a hemoglobin level of 70 g/L, white blood cell count of 11.48 × 109/L, and platelet count of 13 × 109/L. The liver function test showed albumin 10 g/L. The serum electrolytes showed sodium 140 mmol/L, potassium 2.92 mmol/L, chloride 112.1 mmol/L, and bicarbonate 15.9 mmol/L (Table ) with coagulopathy. Therefore, HSP complicated with an alimentary tract hemorrhage was diagnosed. He was immediately treated with intravenous methylprednisolone (2 mg/kg per day), infusion of blood products, and somatostatin but after 2 days after treatment (day 3), he still had massive gastrointestinal hemorrhage, poor circulation, a reduced level of consciousness, and unstable vital signs. Abdominal ultrasonography and plain abdominal radiography revealed no enterobrosis. The patient was also evaluated by pediatric surgeons, and the continuation of medical treatment was suggested. However, his condition deteriorated, and he needed to rely on a life-supporting blood transfusion. He developed signs of peritonitis with abdominal distension. Gastrointestinal tract perforation was suspected. A contrast-enhanced computed tomography (CT) scan of the whole abdomen revealed curved liquid samples and gas shadows on the left and front of the stomach, supporting the possibility of gastrointestinal tract perforation (Fig. ). On day 4, an emergency laparotomy was performed. The surgery revealed that the anterior wall of the descending duodenum was thinner with a 1 cm × 1 cm diameter perforation, and the posterior wall had a 3 cm × 1 cm ulcer, which had penetrated into the peritoneum of the pancreas and experienced active bleeding from the broken end of the vessel. The intraoperative hemorrhage volume was approximately 3000 mL, including intragastric bleeding and intestinal blood clots. Pathological examination indicated chronic inflammation of the intestinal wall mucosa in the descending part of the stomach and duodenum, with hemorrhage, ulceration, interstitial congestion, and edema. Immunofluorescence microscopy of paraffin sections showed granular and lumpy IgA focal deposition in the blood vessel walls (Fig. ). Postoperatively, he was administered nasal continuous positive airway pressure-assisted ventilation, anti-infection treatment, albumin transfusion, platelet transfusion, abdominal drainage, methylprednisolone, fluconazole antifungal treatment, and wound dressing. The general symptoms gradually improved, vital signs were stable, and abdominal pain was relieved. The drainage tube was assessed after discharge, the abdominal CT was repeated after 1 month and the duodenostomy tube was removed 50 days after surgery. There was no evidence of rebleeding during the 2-month follow-up assessment.",What is the patient's albumin corrected delta gap in mEq/L? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [112.1, 'mmol/L'], 'Albumin': [10.0, 'g/L'], 'Bicarbonate': [15.9, 'mmol/L'], 'Sodium': [140.0, 'mmol/L']}",7.5,7.125,7.875,"To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 140.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 140.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 140.0 mmol * 1 mEq/mmol = 140.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 140.0 mmol sodium/L converts to 140.0 mEq sodium/L. 
The concentration of chloride is 112.1 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 112.1 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 112.1 mmol * 1 mEq/mmol = 112.1 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 112.1 mmol chloride/L converts to 112.1 mEq chloride/L. 
The concentration of bicarbonate is 15.9 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 15.9 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 15.9 mmol * 1 mEq/mmol = 15.9 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 15.9 mmol bicarbonate/L converts to 15.9 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 140.0 mEq/L - (112.1 mEq/L + 15.9 mEq/L) = 12.0 mEq/L. Hence, The patient's anion gap is 12.0 mEq/L.The concentration of albumin is 10.0 g/L. We need to convert the concentration to g/dL. The mass units of the source and target are the same so no conversion is needed. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of g/dL. This will result to 10.0 g albumin/10.0 dL = 1.0 g albumin/dL. The concentration value of 10.0 g albumin/L converts to 1.0 g albumin/dL. Plugging in these values into the albumin corrected anion gap formula, we get 12.0 (mEq/L) + 2.5 * (4 - 1.0 (in g/dL)) = 19.5 mEq/L. Hence, the patient's albumin corrected anion gap is 19.5 mEq/L.Plugging in 19.5 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 19.5 - 12 = 7.5 mEq/L. Hence, the patient's albumin corrected delta gap is 7.5 mEq/L."
809,67,Albumin Corrected Delta Ratio,lab test,decimal,pmc-4417668-1,Extracted,"A 20-year-old female, unmarried, was admitted via the emergency department of our hospital on 11th December 2013 with complaints of generalized weakness since 2 weeks, difficulty in swallowing since 2 weeks, and loose stools since 5 days. The generalized weakness was gradual in onset and more marked in legs, so much so that she was unable to rise from the bed. She also felt difficulty in swallowing and in subsequent days, difficulty even voiding urine. She also complained of loose stools 4 to 5 times a day, semisolid in consistency. No mucous and no blood was noticed. However, these were associated with occasional abdominal cramps. In systemic inquiry, she did not complain of fever, sore throat, rashes, joint pain, swelling, cough, chest pain, dysuria, hematemesis or backache.
In the past history, she experienced similar episodes intermittently over the last five years. During these episodes, she used to develop generalized weakness, more of lower limbs, vomiting, and sometimes muscle cramps. With these complaints, she often visited doctors and also required admission in private hospitals, where she was given intravenous (IV) fluids with potassium and her weakness improved. Then she was discharged on potassium containing tablets which would relieve her symptoms. After recovery from the episodes, she used to discontinue oral potassium supplements. She used to remain well for 6 to 8 months before she developed another similar episode and treated similarly. In this way, she recalled 4 to 5 admissions. Record of some investigations seen showed that the predominant abnormality was low potassium level in the serum with normal renal functions.
Drug history was remarkable for tablet NeoK, capsule Esomeprazole, multivitamin syrup and tablet motilium. She is the only daughter with two brothers who enjoy good health. No family history of similar disease was elicited. Parents were non-consanguineous. She studied till ninth class and then left study due to the recurrent illness. She was not addicted to narcotics. She had adequate appetite and sleep.
On examination, she had short stature, lean built, and looked wasted and sick. Her pulse was 88 beats per minute, blood pressure (BP), 90/60 mm Hg, temperature, 98.6°F and respiratory rate, 20 breaths per minute. She was not pale looking, icteric or cyanosed. No koilonychia or clubbing was noted. Dehydration was positive, and muscles were wasted.
Her abdomen was soft, non tender, with palpable bladder but no other visceromegaly. The chest was clear. Both heart sounds were audible in all four areas. No added sounds were noted. In central nervous system (CNS) examination, Glasgow coma scale (GCS) was15/15; power was 3/5 in both lower limbs, 4/5 in upper limbs with intact sensation. Deep tendon reflexes were diminished in all 4 limbs.
A clinical differential of malabsorption, periodic hypokalemic paralysis, or salt-losing nephropathy was contemplated.
On laboratory investigations, serum urea was 73 mg/dl; creatinine, 1.72 mg/dl; sodium, 127 mEq/L; potassium, 1.4 mEq/L; chloride, 101 mEq/L; and bicarbonate, 09 mEq/L. Her hemogram showed hemoglobin (Hb) of 15.1 g/dl; total leucocyte count (TLC), 37.4×109/L; and platelets, 494×109/L. Urine analysis revealed pH of 7.00; albumin, 2+; pus cells, occasional; and red blood cells (RBCs), numerous. Further biochemical tests showed serum calcium, 6.4 mg/dl; phosphorus, 3.2 mg/dl; serum albumin, 1.8 g/dl; total bilirubin, 0.86 mg/dl; direct bilirubin, 0.08 mg/dl; alkaline phosphatase, 50 IU/L; serum glutamic oxaloacetic transaminase (SGOT), 14 IU/L; serum glutamic-pyruvic transaminase (SGPT), 6 IU/L; and gamma-glutamyl transferase (GGT), 7 IU/L.
Ultrasound abdomen showed both sided normal size kidneys with mild pelvicalyceal dilatation bilaterally. Bladder was distended with approximate volume of 430 ml. Chest X-ray was done, which was unremarkable (). Electrocardiography done showed flattening of T waves with occasional inversion in some leads, findings typically seen in hypokalemia ().
She was catheterized, rehydrated with isotonic saline with KCL, and IV antibiotics started on suspicion of urinary tract infection (UTI) as TLC was high. She maintained good urinary output (>1500 ml). By admission day 5, diarrhea had settled. Repeat laboratory tests at this time showed: serum urea of 47 mg/dl; creatinine, 1.6 mg/dl; potassium, 2.5 mEq/L and sodium, 127 mEq/L.
Further investigations showed serum magnesium of 1.02 mg/dl. IV magnesium sulphate was administered daily with modest elevation in serum levels during subsequent days. Potassium requirement remained high and was administered by oral and IV routes. On admission day 10, her serum creatinine was 0.85 mg/dl; potassium, 2.6 mEq/L; and magnesium, 0.95 mg/dl. The temporal changes in serum magnesium and potassium are shown in . The 24-h urinary metabolic study on day 10th of admission showed potassium, 44 mmol/24h; magnesium, 50 mg/ 24 h; calcium, 108 mg/24 h (normal range: 100 to 300 mg/24 h). Fractional excretion of magnesium was 27.3%. In the face of low serum magnesium, fractional magnesium excretion should be less than 2%.
Her gastrointestinal (GI) workup was also done including upper GI endoscopy and sigmoidoscopy. Upper GI endoscopy revealed normal mucosa, with mild antral erythema. Sigmoidoscopy showed normal mucosa. Tissue biopsies were also obtained. The duodenal biopsy showed mild stunting of villi with slightly increased intraepithelial lymphocytes; the antrum showed mild chronic nonspecific gastritis and the rectosigmoid, mild nonspecific colitis.
Anti-trangultaminase antibodies and anti-deamidated gliadin-derived peptide antibodies were negative. Final diagnosis was made of GS along with changes of tropical sprue on duodenal biopsy. Genetic testing could not be done due to non-availability of the test.
She was discharged on third January 2014 on tablet spironolactone 25 mg, once daily, increased subsequently to 50 mg; tablet Neok, 2 tablets, 8-hourly, capsule magnesium chloride 1 capsule, 8-hourly, tablet folic acid 5 mg, once daily, tablet Ciproxin 250 mg, 12-hourly. Laboratory tests on 2-week follow up showed serum urea of 15 mg/ dl; creatinine, 0.4 mg/dl; sodium, 142 mEq/L; potassium, 3.6 mEq/L; chloride, 102 mEq/L; bicarbonate, 30 mEq/L; calcium, 8.8 mg/dl; phosphorus, 3.8 mg/dl; albumin, 3.1 g/dl; and magnesium, 1.9 mg/dl. She is on regular follow-up and doing well at seven months of follow-up.",What is the patient's albumin corrected delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [101.0, 'mEq/L'], 'Albumin': [1.8, 'g/dL'], 'Bicarbonate': [9.0, 'mEq/L'], 'Sodium': [127.0, 'mEq/L']}",0.7,0.665,0.735,"The formula for computing the albumin corrected delta ratio is albumin corrected delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 127.0 mEq/L. 
The concentration of chloride is 101.0 mEq/L. 
The concentration of bicarbonate is 9.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 127.0 mEq/L - (101.0 mEq/L + 9.0 mEq/L) = 17.0 mEq/L. Hence, The patient's anion gap is 17.0 mEq/L.The concentration of albumin is 1.8 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 17.0 (mEq/L) + 2.5 * (4 - 1.8 (in g/dL)) = 22.5 mEq/L. Hence, the patient's albumin corrected anion gap is 22.5 mEq/L.Plugging in 22.5 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 22.5 - 12 = 10.5 mEq/L. Hence, the patient's albumin corrected delta gap is 10.5 mEq/L.Plugging in the albumin corrected delta gap and the bicarbonate concentration into the albumin corrected delta ratio formula, we get 10.5 mEq/L / 15.0 mEq/L = 0.7. The patient's albumin corrected delta ratio is 0.7."
810,67,Albumin Corrected Delta Ratio,lab test,decimal,usmle-9759,Extracted,"A 71-year-old African American man is brought to the emergency department with a worsening productive cough and dyspnea for 2 days. He has had generalized bone pain for 2 months. He was admitted for pyelonephritis last month. He also received outpatient treatment for pneumonia almost 2 months ago. Over the past 2 months, he has been taking over-the-counter ibuprofen for pain as needed. He appears anxious. The vital signs include: temperature 38.8°C (101.8°F), pulse 95/min, respiratory rate 20/min, and blood pressure 155/90 mm Hg. The conjunctivae are pale. Crackles are heard in the right lower lobe. The cardiac examination shows no abnormalities. The laboratory studies show the following:
Hemoglobin 9 g/dL
Mean corpuscular volume 95 μm3
Leukocyte count 13,500/mm3
Segmented neutrophils 75%
Lymphocytes 25%
Platelet count 240,000/mm3
ESR 85 mm/hr
Serum
Na+ 135 mEq/L
K+ 4.2 mEq/L
Cl− 113 mEq/L
HCO3− 20 mEq/L
Ca+ 12.4 mg/dL
Albumin 4 g/dL
Urea nitrogen 38 mg/dL
Creatinine 2.2 mg/dL
A chest X-ray shows a right lower lobe opacity and blurring of the ipsilateral diaphragmatic dome. Skull and pelvic X-rays are performed (see image).",What is the patient's albumin corrected delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [113.0, 'mEq/L'], 'Albumin': [4.0, 'g/dL'], 'Bicarbonate': [20.0, 'mEq/L'], 'Sodium': [135.0, 'mEq/L']}",-2.5,-2.375,-2.625,"The formula for computing the albumin corrected delta ratio is albumin corrected delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 135.0 mEq/L. 
The concentration of chloride is 113.0 mEq/L. 
The concentration of bicarbonate is 20.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 135.0 mEq/L - (113.0 mEq/L + 20.0 mEq/L) = 2.0 mEq/L. Hence, The patient's anion gap is 2.0 mEq/L.The concentration of albumin is 4.0 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 2.0 (mEq/L) + 2.5 * (4 - 4.0 (in g/dL)) = 2.0 mEq/L. Hence, the patient's albumin corrected anion gap is 2.0 mEq/L.Plugging in 2.0 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 2.0 - 12 = -10.0 mEq/L. Hence, the patient's albumin corrected delta gap is -10.0 mEq/L.Plugging in the albumin corrected delta gap and the bicarbonate concentration into the albumin corrected delta ratio formula, we get -10.0 mEq/L / 4.0 mEq/L = -2.5. The patient's albumin corrected delta ratio is -2.5."
811,67,Albumin Corrected Delta Ratio,lab test,decimal,pmc-6467431-1,Extracted,"A 45-year-old woman with a substantial past medical history of squamous cell cancer (SCC) was treated with laryngectomy and offered tracheostomy. She presented in the emergency department with complaints of shortness of breath (SOB). Her shortness of breath was getting progressively worse starting two days prior to admission. She denied any fevers, chills, sick contacts, nausea, abdominal pain, or diarrhea. She specified that she had actually been drinking a lot more water than regular prior to admission.
On admission, her vital signs revealed a blood pressure of 101/73 mmHg, a heart rate of 91 beats/min, a temperature of 37.4 degree Celsius, and a respiratory rate of 26 breaths/min. Her body mass index (BMI) was 18.6 kg/m2. Physical examination revealed a sick-appearing woman in severe respiratory distress using accessory muscles. She had a dry mucous membrane with poor skin turgor. The rest of the physical examination was unremarkable.
On laboratory assessment, the hemoglobin was 11.9 mg/dl, leukocyte count 3.6/mm3, serum creatinine 0.8 mg/dl, potassium 3.3 mmol/L, chloride 110 mmol/L, sodium 148 mmol/L, and bicarbonate 6 mmol/L. Her serum albumin on admission was 4.2 g/dL, urine analysis revealed 80 mg/dl ketones, and serum lactate was 1.9 mmol/L. Furthermore, her liver enzymes revealed aspartate aminotransferase (AST) = 48 units/l, alanine aminotransferase (ALT) = 82 units/l, and alkaline phosphatase 199 units/l. Additionally, her blood glucose level was 133 mg/dl, salicylates = 6.8 mg/dl, and acetaminophen level was <2.0 ug/ml. Her blood alcohol level was normal and chest X-ray (CXR) on admission did not show any sign of acute cardiopulmonary problems.
Based on the initial evaluation, she received stoma suctioning and was placed on high O2 via a tracheostomy mask. Her history of laryngeal cancer, mild tachycardia and hypoxia raised the suspicion of pulmonary embolism, so a chest computed tomography angiography (CTA) was ordered. The chest CTA was negative for pulmonary embolism but showed mild emphysema.
In addition to that, an arterial blood gas (ABG) test was done, which revealed a high anion gap metabolic acidosis (HAGMA) as presented in Table . The patient continued to hyperventilate to compensate for the acidosis and was subsequently intubated.
Differential diagnoses including carbon monoxide poisoning, aminoglycoside toxicity, methanol, uremia, diabetic ketoacidosis (DKA), alcoholic ketosis, acetaminophen toxicity, iron ingestion, lactic acidosis, ethanol toxicity, salicylate toxicity, and aspirin ingestion were investigated. However, given the patient's normal acetaminophen, salicylate, lactic acid, and ethanol levels, these etiologies were ruled out. Furthermore, serum osmolality was normal and the osmolal gap was less than 10. Our differential diagnosis was further narrowed due to the presence of elevated ketones. Given the patient's malnourished state, the most likely cause of HAGMA in this patient was starvation ketosis. The patient was started on 5% dextrose water and sodium bicarbonate drip, and tube feeds. The ABG level swiftly improved within three days and she was extubated.
After four days of intensive care unit (ICU) course, she was downgraded and later on discharged after detailed counseling from a nutritionist regarding a balanced diet and avoiding fasting. She was followed up after three weeks of discharge with significant improvement on repeat basic metabolic panel with bicarbonate of 25 mmol/L, sodium 138 mmol/L, potassium 3.8 mmol/L, and chloride 102 mmol/L.",What is the patient's albumin corrected delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [110.0, 'mmol/L'], 'Albumin': [4.2, 'g/dL'], 'Bicarbonate': [6.0, 'mmol/L'], 'Sodium': [148.0, 'mmol/L']}",1.08333,1.02916,1.1375,"The formula for computing the albumin corrected delta ratio is albumin corrected delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 148.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 148.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 148.0 mmol * 1 mEq/mmol = 148.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 148.0 mmol sodium/L converts to 148.0 mEq sodium/L. 
The concentration of chloride is 110.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 110.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 110.0 mmol * 1 mEq/mmol = 110.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 110.0 mmol chloride/L converts to 110.0 mEq chloride/L. 
The concentration of bicarbonate is 6.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 6.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 6.0 mmol * 1 mEq/mmol = 6.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 6.0 mmol bicarbonate/L converts to 6.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 148.0 mEq/L - (110.0 mEq/L + 6.0 mEq/L) = 32.0 mEq/L. Hence, The patient's anion gap is 32.0 mEq/L.The concentration of albumin is 4.2 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 32.0 (mEq/L) + 2.5 * (4 - 4.2 (in g/dL)) = 31.5 mEq/L. Hence, the patient's albumin corrected anion gap is 31.5 mEq/L.Plugging in 31.5 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 31.5 - 12 = 19.5 mEq/L. Hence, the patient's albumin corrected delta gap is 19.5 mEq/L.Plugging in the albumin corrected delta gap and the bicarbonate concentration into the albumin corrected delta ratio formula, we get 19.5 mEq/L / 18.0 mEq/L = 1.08333. The patient's albumin corrected delta ratio is 1.08333."
812,67,Albumin Corrected Delta Ratio,lab test,decimal,pmc-3544066-1,Extracted,"A 60-year-old lady, a known case of type 2 diabetes mellitus for 15 years and hypertension for 3 years, presented to the clinic with fever, chills, and bilateral loin pain of 4 days duration. No other co-morbidities like chronic kidney disease or coronary artery disease were known in her in the past and she was apparently in normal state of health prior to the presenting illness.
She developed high-grade fever with chills and rigors. Fever was accompanied by dysuria and bilateral loin pain which was constant and aching in nature. Two days following the onset of fever and loin pain, she developed hematuria and subsequently her urine output started declining and she was anuric at the time of admission to the hospital. She also experienced severe generalized muscle ache. There was no arthralgia, skin rash or hemoptysis. Her medications included glipizide and multivitamin.
At the time of admission, she was conscious, irritable, febrile, and tachypneic. Her conjunctivae appeared suffused. There was no icterus, purpura, or lymphadenopathy. Muscle tenderness in limbs was noted. Her pulse was 104/min, BP–110/70 mm Hg, respiratory rate 23/min, temperature 101°F, oxygen saturation 95% at room air. Rales were appreciated in the basal regions of the chest. Examination of abdomen revealed no organomegaly, but both renal angles were tender on palpation.
Investigations revealed hemoglobin of 10.8 g/dL; leukocyte count of 28400 cells/μL; differential count revealed polymorphs 91%, lymphocytes 8%; platelet count 60000/μL. The blood film revealed normocytic normochromic RBCs, neutrophilic leucocytosis with toxic granulations. No hemoparasites were detectable. Urine analysis revealed 1+ protein, 40-50 WBCs/high power field, 20-25 RBCs/high power field, bile salts and pigments - negative, ketone-negative. Blood sugar on admission was 208 mg/dL; blood urea nitrogen 74 mg/ dL; serum creatinine 5.4 mg/dL; serum sodium 138 mmol/L; potassium 4.8 mmol/L; bicarbonate 7.0 mmol/L; chloride 104 mmol/L; pO290 mm Hg., pCO226 mm Hg. Serum total bilirubin measured 2.1 mg/dl; SGOT – 44 U/L; SGPT – 34 U/L; alkaline phosphatase – 242 U/L; serum total protein 6.5 g/L; and serum albumin measured 2.4 g/ dL. Urine culture revealed significant growth of E. Coli., (>105 colony forming units/ ml) sensitive to ciprofloxacin, amikacin, and ceftriaxone. However, blood culture grew no organism. Ultrasonogram of the abdomen revealed bilaterally enlarged kidneys with hydroureteronephrosis. No radioopaque lesion could be made out in the ultrasonogram or X-ray KUB region. An MR urogram performed to further evaluate the obstruction [] revealed bilateral renal papillary necrosis (RPN) with bilateral midureteric obstruction.
Thrombocytopenia and severe myalgia prompted a search for leptospirosis, a common cause of AKI in this part of the country. The organism could not be isolated from the urine or blood. However, the MAT (Microscopic Agglutination Test) done in the second week of the illness detected Leptospira icterohemorrhagica; serovar hardjo. Serologic investigations for dengue were negative.
She was subjected to a USG-guided renal biopsy which revealed acute tubular necrosis, interstitial inflammation, and mild mesangial proliferation [Figure –].
The patient was treated with hemodialysis and her antibiotics included benzyl penicillin and ceftriaxone. Gradually, the fever settled, her general condition stabilized, and renal function started to improve. By the 20th day of the illness, serum creatinine was 1.7 mg/ dL and platelet count was 190,000/μL and patient was discharged. Follow-up at 3 months revealed a serum creatinine of 1.4 mg/dL.",What is the patient's albumin corrected delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [104.0, 'mmol/L'], 'Albumin': [2.4, 'g/dL'], 'Bicarbonate': [7.0, 'mmol/L'], 'Sodium': [138.0, 'mmol/L']}",1.11765,1.06177,1.17353,"The formula for computing the albumin corrected delta ratio is albumin corrected delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 138.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 138.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 138.0 mmol * 1 mEq/mmol = 138.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 138.0 mmol sodium/L converts to 138.0 mEq sodium/L. 
The concentration of chloride is 104.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 104.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 104.0 mmol * 1 mEq/mmol = 104.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 104.0 mmol chloride/L converts to 104.0 mEq chloride/L. 
The concentration of bicarbonate is 7.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 7.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 7.0 mmol * 1 mEq/mmol = 7.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 7.0 mmol bicarbonate/L converts to 7.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 138.0 mEq/L - (104.0 mEq/L + 7.0 mEq/L) = 27.0 mEq/L. Hence, The patient's anion gap is 27.0 mEq/L.The concentration of albumin is 2.4 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 27.0 (mEq/L) + 2.5 * (4 - 2.4 (in g/dL)) = 31.0 mEq/L. Hence, the patient's albumin corrected anion gap is 31.0 mEq/L.Plugging in 31.0 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 31.0 - 12 = 19.0 mEq/L. Hence, the patient's albumin corrected delta gap is 19.0 mEq/L.Plugging in the albumin corrected delta gap and the bicarbonate concentration into the albumin corrected delta ratio formula, we get 19.0 mEq/L / 17.0 mEq/L = 1.11765. The patient's albumin corrected delta ratio is 1.11765."
813,67,Albumin Corrected Delta Ratio,lab test,decimal,pmc-4241285-1,Extracted,"A 66-year-old male was admitted to the ICU with complaints of chronic weakness, fatigue, myalgia, weight loss, and left flank pain. Comorbidities included hypertension, active smoking, and diabetes mellitus. Patient denied nausea, vomiting, diarrhea, hematemesis, melena, hematochezia, chest pain, or any shortness of breath. He had a recent admission due to community acquired pneumonia and was treated with antibiotics. He denied using any illicit drugs or alcohol abuse. He was retired truck driver by profession.
On examination, he was an elderly man with clinical signs of dehydration. Blood pressure was 155/56 mm Hg, heart rate was 67/min, respiratory rate was 16/min, was afebrile, and his oxygen saturation was 99% on room air. He had mild epigastric tenderness without guarding or rigidity. He had bilateral lower extremities chronic skin changes with scaling. The rest of the physical examination was normal.
Significant laboratory data revealed serum sodium 124 mEq/L, potassium 5.1 mEq/L, chloride 89 mEq/L, bicarbonate 15 mEq/L, blood urea nitrogen 44 mg/dL, creatinine 1.5 mg/dL, glucose 85 mg/dL, calcium 10.3 mg/dL, total protein 7.3 g/dL, and albumin 2.9 g/dL. The rest of the liver function tests were within normal limit. Anemia was with hemoglobin 9.4 g/dL, hematocrit 27%, platelets 558 k/μL, and white blood cells 10.4 k/μL. Arterial blood gas analysis showed pH of 7.36, pCO2 of 25 mm Hg, pO2 of 90.3 mm Hg, and oxygen saturation of 97% on room air. Other data included a lactic acid of 4.8 mmoles/L, serum lipase of 1540 U/L, amylase 406 unit/L, gamma GT 25 unit/L, INR 1.3, and lactate dehydrogenase (LDH) 950 unit/L; cancer antigen CA 19-9 was 49.9 μ/mL, TSH was 2.25 mIU/L, serum acetone was negative, and alcohol level was less than 10 mg/dL. His serial cardiac enzymes were negative and he was ruled out for an acute coronary event.
Chest X-ray (CXR) revealed bilateral patchy airspace disease. CT of abdomen and pelvis without contrast showed diffuse enlargement of the pancreas with homogeneous attenuation and without significant peripancreatic inflammation () with extensive retroperitoneal and pelvic adenopathy (). A para-aortic lymph node measuring 2.1 cm and retrocaval lymph node measuring 1.6 cm were seen. A soft tissue density surrounding the right common iliac vessels likely representing confluent adenopathy was seen. His echocardiogram showed an ejection fraction of 67%; right ventricle systolic pressure was estimated to be 44 mm Hg. Pericardium was normal without any pericardial effusion. There was no significant valvular abnormality.
Initially, the patients EKG showed 2nd degree Mobitz type I block which later progressed to complete heart block. Patient was given atropine without improvement; hence, a temporary pacemaker was inserted. He was started on IV hydration and IV antibiotics and all his electrolyte abnormalities were corrected. His temporary pacemaker lead came out and it was removed. Subsequently he became unresponsive, was orally intubated, had four cardiac arrests, and was successfully resuscitated. Due to persistent pulmonary infiltrates he underwent fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsies which showed evidence of pneumocystis jiroveci pneumonia (PJP). He was started on Bactrim for the treatment of PJP. He tested positive for HIV and was found to have a CD 4 count of 12/uL.
A temporary pacemaker wire was again placed after ruling out the relevant reversible causes of third degree heart block. A repeat echocardiogram was unchanged from prior one. CT-guided biopsy of the para-aortic lymph nodes was consistent with diffuse large B-cell lymphoma with marked tumor necrosis (). Immunoprofile showed that CD 20 (), CD 79a, and CD 10 were positive. CD 43, CD 3, CD 7, and BcL were negative. Upper endoscopy for percutaneous endoscopic gastrostomy placement showed gastric polyps which revealed gastric lymphoma on biopsy.
Patient was not a candidate for chemotherapy or ART due to critical condition. Hospital course was complicated by acute respiratory distress syndrome, acute kidney injury, and eventual death a month into his hospital stay.",What is the patient's albumin corrected delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [89.0, 'mEq/L'], 'Albumin': [2.9, 'g/dL'], 'Bicarbonate': [15.0, 'mEq/L'], 'Sodium': [124.0, 'mEq/L']}",1.19444,1.13472,1.25416,"The formula for computing the albumin corrected delta ratio is albumin corrected delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 124.0 mEq/L. 
The concentration of chloride is 89.0 mEq/L. 
The concentration of bicarbonate is 15.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 124.0 mEq/L - (89.0 mEq/L + 15.0 mEq/L) = 20.0 mEq/L. Hence, The patient's anion gap is 20.0 mEq/L.The concentration of albumin is 2.9 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 20.0 (mEq/L) + 2.5 * (4 - 2.9 (in g/dL)) = 22.75 mEq/L. Hence, the patient's albumin corrected anion gap is 22.75 mEq/L.Plugging in 22.75 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 22.75 - 12 = 10.75 mEq/L. Hence, the patient's albumin corrected delta gap is 10.75 mEq/L.Plugging in the albumin corrected delta gap and the bicarbonate concentration into the albumin corrected delta ratio formula, we get 10.75 mEq/L / 9.0 mEq/L = 1.19444. The patient's albumin corrected delta ratio is 1.19444."
814,67,Albumin Corrected Delta Ratio,lab test,decimal,pmc-4989056-1,Extracted,"A 53-year-old obese male presented due to a wound in his right thigh. He stated that the wound started as an itch and that it progressed to its current state in just 5 days. The wound started to smell bad. The patient had a history of diabetes, which he reports to be diet controlled. He is a truck driver by trade and says he does his best to do a good job with his diet. His past medical history was notable for testicular cancer status after radiation 9 years earlier. He states that his left groin skin has always been a little sensitive after the radiation and in that he often will itch it. He says this wound started out as an itch as well. Intense itching led to an open wound, at which point he applied povidone iodine and put a dressing on it. He was remarkably stoic, considering the extent of the wound.
Review of systems is negative except as noted above. The patient specifically denied fever, chills, chest pain, shortness of breath, abdominal pain, nausea, vomiting, diarrhea, urinary symptoms, or headache. His prescribed medications included atorvastatin for hyperlipidemia, Diltiazem and Lisinopril for hypertension, Metformin for diabetes, and Gabapentin for diabetic neuropathy. The patient had no allergies and his tetanus status was up to date.
Patient's vital signs were as follows: blood pressure 145/85 mmHg; respiratory rate 20/min; pulse 91/min, SpO2 99%, temperature 36.7°C; and pain 8/10. On physical exam, he was alert and oriented to person, time, and place and in no acute distress. Pertinent positive findings included a 4 cm × 10 cm elliptical wound on the left thigh with necrotic flesh within, which was exquisitely foul smelling (). The left leg appeared somewhat mottled and cellulitic compared to right leg. Both legs had intact dorsalis pedis and popliteal pulses.
Laboratory analysis revealed an elevated white blood cell (WBC) count of 17.1 k/cm with the remainder of the CBC within normal limits. The metabolic panel revealed blood sugar of 398 and corresponding hyponatremia of 128 mmol/L. The chloride and bicarbonate were also low at 89 mmol/L and 21 mmol/L, respectively. The patient also has had hypoalbuminemia with a value of 2.5 g/dL. Lactate was elevated at 2.8 mmol/L. Coagulation studies were within normal limits. Blood cultures were sent. The urinalysis demonstrated clear glycosuria with >500 mg/dL of glucose, as well as pyuria with 17 WBC per high power field. There was no ketonuria, leukoesterase, or elevated nitrates.
AP and lateral radiographs of the left femur revealed mottled lucencies consistent with gas in the soft tissues of the medial thigh ().
A duplex Doppler exam with real time grey-scale imaging, spectral Doppler with wave form analysis, color Doppler, and physiologic maneuvers including compression were done to evaluate the venous system of the left leg from the groin down through the popliteal fossa. Subcutaneous edema was noted in left thigh, but there was no sonographic evidence of deep venous thrombosis.
The patient's presentation was most concerning for gas gangrene versus necrotizing fasciitis. Patient looked remarkably well, despite the differential diagnosis. He was resuscitated with 4 L of NSS, 10 U of intravenous regular insulin, 1 g of intravenous Vancomycin, and 3.375 g of intravenous Piperacillin-Tazobactam. He was given 2 oxycodone tablets for analgesia. Patient's mentation remained intact throughout. The patient was then transferred to the critical care unit where he underwent surgical debridement followed by hospitalization for intravenous antibiotics. He also received diabetes education, as he was not taking his Metformin, but rather under the impression that he was doing a good job controlling his diabetes with diet. His decompensated diabetes was likely a contributing cause to his necrotizing fasciitis. Following hospitalization, the patient was discharged with complete resolution of the infection and left with blood sugar well controlled.",What is the patient's albumin corrected delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [89.0, 'mmol/L'], 'Albumin': [2.5, 'g/dL'], 'Bicarbonate': [21.0, 'mmol/L'], 'Sodium': [128.0, 'mmol/L']}",3.25,3.0875,3.4125,"The formula for computing the albumin corrected delta ratio is albumin corrected delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 128.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 128.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 128.0 mmol * 1 mEq/mmol = 128.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 128.0 mmol sodium/L converts to 128.0 mEq sodium/L. 
The concentration of chloride is 89.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 89.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 89.0 mmol * 1 mEq/mmol = 89.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 89.0 mmol chloride/L converts to 89.0 mEq chloride/L. 
The concentration of bicarbonate is 21.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 21.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 21.0 mmol * 1 mEq/mmol = 21.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 21.0 mmol bicarbonate/L converts to 21.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 128.0 mEq/L - (89.0 mEq/L + 21.0 mEq/L) = 18.0 mEq/L. Hence, The patient's anion gap is 18.0 mEq/L.The concentration of albumin is 2.5 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 18.0 (mEq/L) + 2.5 * (4 - 2.5 (in g/dL)) = 21.75 mEq/L. Hence, the patient's albumin corrected anion gap is 21.75 mEq/L.Plugging in 21.75 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 21.75 - 12 = 9.75 mEq/L. Hence, the patient's albumin corrected delta gap is 9.75 mEq/L.Plugging in the albumin corrected delta gap and the bicarbonate concentration into the albumin corrected delta ratio formula, we get 9.75 mEq/L / 3.0 mEq/L = 3.25. The patient's albumin corrected delta ratio is 3.25."
815,67,Albumin Corrected Delta Ratio,lab test,decimal,pmc-2733967-2,Extracted,"A 26-day-old girl was referred for evaluation of renal failure. She was born at 38+5 weeks' gestational age with a birth weight of 3,200 g. She was well until two days before admission when she developed generalized tonic clonic seizure. At a local clinic, hypocalcemia, hyperkalemia and azotemia were detected and she was referred to us. On admission, generalized edema was noted. Her external genitalia were normal female. Laboratory findings showed: hemoglobin, 9.8 g/dL; cholesterol, 120 mg/dL; total serum protein, 3.7 g/dL; serum albumin, 1.5 g/dL; BUN, 75 mg/dL; serum creatinine, 4.1 mg/dL; total calcium, 5.9 mg/dL; phosphorus, 12.7 mg/dL; sodium, 136 mEq/L; potassium, 5.5 mEq/L; chloride, 113 mEq/L; bicarbonate 7.8 mEq/L. Albuminuria and hematuria were detected. An ultrasonogram revealed enlarged kidneys with increased parenchymal echogenicity and poor corticomedullary differentiation. A renal biopsy was performed at the age of 29 days and light microscopy showed small glomeruli with various degrees of mesangial sclerosis (). The tubules were dilated with regenerative activity. Her karyotype was 46 XX. Analysis of the sequence of WT1 exon 9 revealed the presence of a heterozygous G to T base substitution, converting 396Asp to 396Tyr, and a heterozygous 395 Ser (TCC) > Ser (TCA) polymorphism (). Both parents showed normal sequence at these sites. Peritoneal dialysis was commenced with a temporary shift to hemodiafiltration because of dialysate leakage at the exit site. Sustained hypertension (120/80 mmHg) responded to an angiotensin-converting enzyme inhibitor. She was maintained on total parenteral nutrition due to uncontrolled chylothorax that resulted from internal jugular vein catheterization, and the patient died at the age of six months due to multiple serious infections and failure to thrive. Autopsy was not performed.",What is the patient's albumin corrected delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [113.0, 'mEq/L'], 'Albumin': [1.5, 'g/dL'], 'Bicarbonate': [7.8, 'mEq/L'], 'Sodium': [136.0, 'mEq/L']}",0.58333,0.55416,0.6125,"The formula for computing the albumin corrected delta ratio is albumin corrected delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 136.0 mEq/L. 
The concentration of chloride is 113.0 mEq/L. 
The concentration of bicarbonate is 7.8 mEq/L. 
Plugging in these values into the anion gap formula gives us 136.0 mEq/L - (113.0 mEq/L + 7.8 mEq/L) = 15.2 mEq/L. Hence, The patient's anion gap is 15.2 mEq/L.The concentration of albumin is 1.5 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 15.2 (mEq/L) + 2.5 * (4 - 1.5 (in g/dL)) = 21.45 mEq/L. Hence, the patient's albumin corrected anion gap is 21.45 mEq/L.Plugging in 21.45 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 21.45 - 12 = 9.45 mEq/L. Hence, the patient's albumin corrected delta gap is 9.45 mEq/L.Plugging in the albumin corrected delta gap and the bicarbonate concentration into the albumin corrected delta ratio formula, we get 9.45 mEq/L / 16.2 mEq/L = 0.58333. The patient's albumin corrected delta ratio is 0.58333."
816,67,Albumin Corrected Delta Ratio,lab test,decimal,pmc-3950226-1,Extracted,"The patient was a 20-year-old previously healthy woman. She was a university student. Her height and body weight were 168.1 cm and 52.2 kg, respectively. She ingested bamboo salt (about 150 grams ) in a day for the purpose of digestion and weight reduction. After that, she had more than ten episodes of vomiting and diarrhea for 2-3 hours. On arrival at our emergency department, vital signs were blood pressure of 128/81mmHg, heart rate of 75 beat/min, respiration rate of 20/min, and body temperature of 37.3℃. Her consciousness was clear but she complained of generalized weakness. The complete blood counts showed hemoglobin 11.3 g/dL, WBC 10,000 cells/µL, and platelet 196,000/µL. The results of her blood chemistry were as follows: Aspartate transaminase 11 IU/L, Alanine transaminase 9 IU/L, total protein 6.4 g/dL, albumin 4.5 g/dL, blood urea nitrogen 5.2mg/dL, bicarbonate 18.5mEq/L, and creatinine 0.57mg/dL. Serum osmolarity was 348mosm/kg. Serum sodium, potassium and chloride were 174mEql/L, 3.6mEq/L and 135mEq/L respectively. Urine sodium, potassium, chloride and osmolarity were 440mEq/L, 125.7 mEq/L, 314mEq/L and 841mosm/kg, respectively. On arterial blood gas analysis, pH was 7.32, PaCO2 36mmHg, PaO2 93mmHg and O2 saturation 97%. On the 1st day, total input and urine output was 3,700ml and 2,100ml, respectively. Her symptoms such as nausea, vomiting and diarrhea improved rapidly with 0.45% saline infusion and supportive care. On the 2nd day, her serum sodium concentration dropped to 152 mEq/L and urine output was 2,200ml/day. On the 3rd day, serum sodium concentration returned to normal range (). She recovered completely without any sequelae in 3 days.",What is the patient's albumin corrected delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [135.0, 'mEq/L'], 'Albumin': [4.5, 'g/dL'], 'Bicarbonate': [18.5, 'mEq/L'], 'Sodium': [174.0, 'mEq/L']}",1.31818,1.25227,1.38409,"The formula for computing the albumin corrected delta ratio is albumin corrected delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 174.0 mEq/L. 
The concentration of chloride is 135.0 mEq/L. 
The concentration of bicarbonate is 18.5 mEq/L. 
Plugging in these values into the anion gap formula gives us 174.0 mEq/L - (135.0 mEq/L + 18.5 mEq/L) = 20.5 mEq/L. Hence, The patient's anion gap is 20.5 mEq/L.The concentration of albumin is 4.5 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 20.5 (mEq/L) + 2.5 * (4 - 4.5 (in g/dL)) = 19.25 mEq/L. Hence, the patient's albumin corrected anion gap is 19.25 mEq/L.Plugging in 19.25 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 19.25 - 12 = 7.25 mEq/L. Hence, the patient's albumin corrected delta gap is 7.25 mEq/L.Plugging in the albumin corrected delta gap and the bicarbonate concentration into the albumin corrected delta ratio formula, we get 7.25 mEq/L / 5.5 mEq/L = 1.31818. The patient's albumin corrected delta ratio is 1.31818."
817,67,Albumin Corrected Delta Ratio,lab test,decimal,pmc-4446924-1,Extracted,"A 38-year-old man presented with nausea, vomiting and loose stools of 2 days duration. Patient gave history of consumption of a tuber taken from the nearby forest with the intent of deliberate self-harm. Patient has consumed the tuber 6 days prior to the presentation. It was followed by nausea, vomiting, loose stools and haematochezia on 4th day. He also complained haematuria and bleeding from gums and rectum on 5th day. On 6th day he observed scalp hair fall, and easy pluckability of beard, moustache and body hair. He also complained oliguria on day 6. Patient's wife has brought the tuber. It was identified as G. superba. Patient revealed that he had consumed 250 g of the tuber along with water.
Patient had no history of any illness. He was apprehensive, with pulse rate of 120 bpm, blood pressure 70/40 mmHg, febrile, with congestion of conjunctivae. The pillow and bed were full of his hair. Patient himself demonstrated easy pluckability of hair. His investigations were, haemoglobin 6.0 g/dl, total leucocyte count 14,000/mm3, differential count: polymorphs: 60, lymphocytes 30, monocytes 5, eosinophils 5%, erythrocyte sedimentation rate 40 mm after first hour, platelet counts 0.24 lakhs/mm3, peripheral smear showed no abnormal cells and no features of haemolysis, there was thrombocytopenia, random blood glucose 120 mg/dl, serum creatinine 5.4 mg/dl, blood urea 188 mg/dl, serum sodium 127 mEq/L, serum potassium 3.9 mEq/L, serum chloride 88 mEq/L, serum bicarbonate 12.0 mmol/L, serum bilirubin 1.0 mg/dl, serum glutamic oxaloacetic transaminase 45 U/L, serum glutamic pyruvic transaminase: 65 U/L, serum alkaline phosphatase 125 U/L, serum proteins 6.9 g/dl, serum albumin 4.3 g/dl, serum creatinine kinase 65 IU/L (reference range: 40–200 IU/L), fractional excretion of sodium <1%, urine microscopy showed plenty of red blood cells and urine myoglobin was negative. Ultrasound abdomen revealed normal sized kidneys. Electrocardiogram showed T inversion in V4, V5, and V6. Chest radiograph was normal.
He was initiated on intravenous fluids, sodium bicarbonate supplementation and ionopressors. He was transfused with two units of whole blood. Blood pressure improved after 24 h. The bleeding manifestations subsided over next 72 h. Serum creatinine fell over next 6 days. Hair loss continued for next 10 days. He lost entire scalp hair. Patient regained scalp hair after 4 months.",What is the patient's albumin corrected delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [88.0, 'mEq/L'], 'Albumin': [4.3, 'g/dL'], 'Bicarbonate': [12.0, 'mmol/L'], 'Sodium': [127.0, 'mEq/L']}",1.1875,1.12813,1.24687,"The formula for computing the albumin corrected delta ratio is albumin corrected delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 127.0 mEq/L. 
The concentration of chloride is 88.0 mEq/L. 
The concentration of bicarbonate is 12.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 12.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 12.0 mmol * 1 mEq/mmol = 12.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 12.0 mmol bicarbonate/L converts to 12.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 127.0 mEq/L - (88.0 mEq/L + 12.0 mEq/L) = 27.0 mEq/L. Hence, The patient's anion gap is 27.0 mEq/L.The concentration of albumin is 4.3 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 27.0 (mEq/L) + 2.5 * (4 - 4.3 (in g/dL)) = 26.25 mEq/L. Hence, the patient's albumin corrected anion gap is 26.25 mEq/L.Plugging in 26.25 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 26.25 - 12 = 14.25 mEq/L. Hence, the patient's albumin corrected delta gap is 14.25 mEq/L.Plugging in the albumin corrected delta gap and the bicarbonate concentration into the albumin corrected delta ratio formula, we get 14.25 mEq/L / 12.0 mEq/L = 1.1875. The patient's albumin corrected delta ratio is 1.1875."
818,67,Albumin Corrected Delta Ratio,lab test,decimal,pmc-4543587-1,Extracted,"A 55-year-old female with past medical history of seizure disorder, bipolar disorder, and chronic pain was admitted to ICU due to severe agitation. The patient complained of dizziness along with nausea shortly before hospitalization which was first reported to home physical therapist. There was no neurological deficit besides becoming agitated progressively over time for which she was given several doses of benzodiazepines. Her initial vital signs were blood pressure 119/75 mmHg, pulse rate 58/min, tympanic temperature 98.5, and body weight 99 kg. Laboratory data revealed following: sodium 148 mEq/L, potassium 5.6 mEq/L, chloride 108 mEq/L, bicarbonate 6 mEq/L, urea nitrogen 24 mg/dL, creatinine 1.85 mg/dL, calcium 8.7 mg/dL, and albumin 4.0 g/dL. Serum osmolality was not obtained. The patient was intubated for airway protection using lorazepam and rocuronium. Arterial blood gas revealed pH 7.22 and PCO2 17 mmHg. Her baseline creatinine before admission was noted as 1.1 mg/dL. Blood concentrations of commonly abused alcohols were sought given anion gap metabolic acidosis and additional history of psychosocial issues from family. Urinalysis was negative for crystals. Ethylene glycol level became available 169 mg/dL (26.45 mmol/L) 19 hours after admission and other alcohols were negative. Glycolic acid or glyoxylic acid blood concentration was not obtained. Quantification of consumed ethylene glycol was not possible due to the lack of reliable consumption history. Plotting of blood concentrations of ethylene glycol and urea and their corresponding natural logarithm with trend lines using linear regression function is shown in . Fomepizole therapy was initiated and, within 2 hours, hemodialysis followed. The patient was treated using Polyflux Revaclear MAX dialyzer (Gambro, 1.8 m2 membrane surface area) via right internal jugular vascular catheter. Blood flow and dialysate flow were set 300–400 mL/min and 1.5 times blood flow, respectively. Total volume treated was 138.6 L for 8 hours with average blood flow 290 mL/min. The patient was maintained on continuous IV drip of lorazepam for sedation along with several doses of IV phenytoin for subtherapeutic drug level noted upon admission.",What is the patient's albumin corrected delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [108.0, 'mEq/L'], 'Albumin': [4.0, 'g/dL'], 'Bicarbonate': [6.0, 'mEq/L'], 'Sodium': [148.0, 'mEq/L']}",1.22222,1.16111,1.28333,"The formula for computing the albumin corrected delta ratio is albumin corrected delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 148.0 mEq/L. 
The concentration of chloride is 108.0 mEq/L. 
The concentration of bicarbonate is 6.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 148.0 mEq/L - (108.0 mEq/L + 6.0 mEq/L) = 34.0 mEq/L. Hence, The patient's anion gap is 34.0 mEq/L.The concentration of albumin is 4.0 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 34.0 (mEq/L) + 2.5 * (4 - 4.0 (in g/dL)) = 34.0 mEq/L. Hence, the patient's albumin corrected anion gap is 34.0 mEq/L.Plugging in 34.0 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 34.0 - 12 = 22.0 mEq/L. Hence, the patient's albumin corrected delta gap is 22.0 mEq/L.Plugging in the albumin corrected delta gap and the bicarbonate concentration into the albumin corrected delta ratio formula, we get 22.0 mEq/L / 18.0 mEq/L = 1.22222. The patient's albumin corrected delta ratio is 1.22222."
819,67,Albumin Corrected Delta Ratio,lab test,decimal,pmc-8022897-1,Extracted,"A 66-year-old morbidly obese woman presented to the ED with generalized weakness over the last seven days, oliguria, poor appetite, and thirst. Her past medical history included hypertension, hyperlipidemia, congestive heart failure, pulmonary hypertension, restrictive lung disease, morbid obesity, and type 2 diabetes mellitus. She had no history of cancer or multiple myeloma, or renal disease as evident from past admissions.
Upon presentation to the ED, she was found to have a serum creatinine of 5 mg/dL (her baseline was 0.5 mg/dL) and a serum calcium level of 23.1 mg/dL (normal reference range: 8-10.4 mg/dL) and ionized calcium of 3.23 mg/dL (normal reference range: 4.23-5.11 mg/dL). Her albumin was 3.9 g/dL, within normal range, indicating true hypercalcemia. CT of her abdomen and pelvis revealed an 18 mm cyst in upper pole of the right kidney with a parapelvic cyst measuring 18 mm x 18 mm (Figure ). Chest X-ray (CXR), CT of head also did not show any significant pathology. Her other labs included a white blood cell (WBC) 14.14, hemoglobin 11.8 g/dL, platelet 427,000 platelets per microliter, sodium 131 mEq/L, potassium 3.8 mEq/L, chloride 89 mEq/L, bicarbonate 36 mEq/L (normal reference 20-32 mEq/L), blood urea nitrogen (BUN) 62 mg/dL, magnesium 3 mEq/L, aspartate aminotransferase (AST) 71 IU/L, alanine aminotransferase (ALT) 46 IU/L, troponin 39 ng/mL, B-type natriuretic peptide (BNP) 435 pg/mL, international normalized ratio (INR) less than 0, and partial thromboplastin time (PTT) more than 212 s. Her electrocardiogram (EKG) showed intraventricular right bundle branch block (Figure ). Her vitals included a temperature of 97.8 degrees Fahrenheit, pulse of 72 beats/min, and blood pressure of 160 over 83 millimeters of mercury. A hypercalcemia work-up was done which included parathyroid hormone (PTH), PTH-related protein, and serum protein electrophoresis. PTH was found to be low at 13.9 pg/mL (normal range 15-75 pg/mL) and PTH-related protein (PTHrP) was less than 2 pmol/L, normal. Serum immunofixation showed no monoclonal band, and serum and urine protein electrophoresis were unremarkable. Viral hepatitis serologies were negative. Thyroid stimulating hormone (TSH) was 3.14 uIU/mL, normal. Vitamin D 25-hydroxy was normal, 50.3 ng/mL.
Treatment was initiated with fluid resuscitation (1 L normal saline bolus), the bisphosphonate Zometa (Sagent Pharmaceuticals, Schaumburg, IL), and Miacalcin (Mylan, Rockford, IL). A temporary dialysis catheter was placed and dialysis treatment was initiated 12 h later (day two), and again on day three due to a persistently elevated serum calcium level of 11.5 mg/dL. Dialysis was necessary as Zometa and Miacalcin were not working fast enough to ensure a positive outcome alone. In addition, there was concern for acute tubular necrosis due to Zometa in our patient with a creatinine clearance of less than 30 mL/min (Figures -, Table ). The patient’s serum creatinine and calcium levels improved by day six and patient was discharged home with outpatient follow-up.",What is the patient's albumin corrected delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [89.0, 'mEq/L'], 'Albumin': [3.9, 'g/dL'], 'Bicarbonate': [36.0, 'mEq/L'], 'Sodium': [131.0, 'mEq/L']}",0.47917,0.45521,0.50313,"The formula for computing the albumin corrected delta ratio is albumin corrected delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 131.0 mEq/L. 
The concentration of chloride is 89.0 mEq/L. 
The concentration of bicarbonate is 36.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 131.0 mEq/L - (89.0 mEq/L + 36.0 mEq/L) = 6.0 mEq/L. Hence, The patient's anion gap is 6.0 mEq/L.The concentration of albumin is 3.9 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 6.0 (mEq/L) + 2.5 * (4 - 3.9 (in g/dL)) = 6.25 mEq/L. Hence, the patient's albumin corrected anion gap is 6.25 mEq/L.Plugging in 6.25 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 6.25 - 12 = -5.75 mEq/L. Hence, the patient's albumin corrected delta gap is -5.75 mEq/L.Plugging in the albumin corrected delta gap and the bicarbonate concentration into the albumin corrected delta ratio formula, we get -5.75 mEq/L / -12.0 mEq/L = 0.47917. The patient's albumin corrected delta ratio is 0.47917."
820,67,Albumin Corrected Delta Ratio,lab test,decimal,pmc-6031073-1,Extracted,"A 57-year-old African American male with past medical history of coronary artery disease, systolic heart failure, alcohol abuse, and stage-IV sarcoidosis on long-term oral prednisone at 10 mg daily for over two years presented with massive hematemesis and melena that started the night before his arrival to the Emergency Department. Upon physical examination, the patient appeared pale and was noted to have tachycardia, hypotension, and hematochezia. He denied any recent alcohol intake, chest pain, abdominal pain, and abdominal or rectal trauma. Vital signs consisted of a blood pressure of 84/33 mmHg, heart rate of 118 bpm, room air saturation of 92%, and temperature of 98.8 degrees Fahrenheit (37.1 degrees Celsius). He was admitted to the medical ICU for hypovolemic shock secondary to massive bleeding that required immediate endotracheal intubation for airway protection. An initial blood work showed a hemoglobin count of 13.9 g/dL, white blood cell count of 18.7 K/UL, platelet count of 159 K/UL, sodium of 140 mmol/L, potassium of 3.8 mmol/L, chloride of 101 mmol/L, bicarbonate of 10 mmol/L, calcium of 2.2 mmol/L, albumin of 2.7 g/dL, CRP of 233 mg/L, ESR of 36 mm/hr, BUN of 17 mg/dL (6.07 mmol/L), creatinine of 1.5 mg/dL (132.6 Umol/L), lactic acid of 17.0 mmol/L, BNP of 1140.63 pg/ml, total bilirubin of 0.4 mg/dL, troponins of 0.020 ng/mL, and CK-MB of 408 ng/mL. Resuscitation was initiated with administration of isotonic solutions, blood transfusions, and initiation of vasoactive medications, and pantoprazole drip was provided. An initial urgent endoscopy revealed a bleeding Dieulafoy lesion, which was immediately clipped. Acute kidney injury was addressed with aggressive fluid resuscitation as evident by increase in BUN of 33 mg/dL (11.78 mmol/L) and creatinine of 2.9 mg/dL (256.33 Umol/L). CT scan of abdomen performed to rule out ischemic colitis in the setting of progressive abdominal distention showed a diffuse pericolonic inflammation most pronounced at the rectosigmoid colon. Repeat endoscopy showed multiple ulcerated lesions of the gastric mucosa () with a biopsy that revealed necrotic debris with acute leukocytic exudate and numerous variably sized, 90-degree angulated fungal hyphae favoring mucormycosis (). Intravenous liposomal amphotericin-B (5 mg/kg/day at 60 kg weight) was started at a dose of 300 mg daily. Due to deterioration of renal function on the second day, treatment was switched to oral suspension of posaconazole at a dose of 400 mg twice a day for a total of 6 days (of note, no levels of posaconazole were drawn during hospital course). Repeat CT scan of the abdomen showed mild-to-moderate hydroureter with hydronephrosis and bladder wall thickening Figures and . Cystoscopy showed distorted anatomy of bladder lumen with multiple mounds of tissues all throughout the bladder most notable in the trigone with failure to locate ureteral orifices. Random biopsies taken from the bladder tissue also showed necrotic debris with active inflammatory and numerous variably sized angulated fungal hyphae consistent with Mucorales species. Once bladder biopsy confirmed Mucor spp, treatment was switched from posaconazole to intravenous isavuconazonium sulfate at a dose of 372 mg every eight hours for 48 hours as loading dose and then to an oral dose of 372 mg daily. Unfortunately, no sensitivity of the isolate to the newer triazoles was available. Surgical approach was considered; however, given patient's frail state and multiple comorbidities, such approach was deferred. Hydronephrosis significantly improved after placement of bilateral nephrostomy tubes. In addition, continuous bladder irrigation with amphotericin-B was given for localized bladder infection for a total of 5 days. A three-way Foley catheter was inserted for continuous amphotericin-B bladder irrigation where 200 ml of medication was administered via catheter; then, the catheter was clamped for 90 minutes and drained to gravity every six hours. After three weeks of systemic treatment with antifungals, a third endoscopy showed only inflammatory changes with a pathologic report, in which mucormycosis was no longer appreciated. His kidney function improved and remained stable after clamping and removal of his nephrostomy tubes. The patient completed 6 months of therapy with 372 mg of oral isavuconazonium sulfate per day. He is currently at home with resolution of his symptoms and no clinical evidence of relapse after 12 months since completion of his treatment.",What is the patient's albumin corrected delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [101.0, 'mmol/L'], 'Albumin': [2.7, 'g/dL'], 'Bicarbonate': [10.0, 'mmol/L'], 'Sodium': [140.0, 'mmol/L']}",1.44643,1.37411,1.51875,"The formula for computing the albumin corrected delta ratio is albumin corrected delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 140.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 140.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 140.0 mmol * 1 mEq/mmol = 140.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 140.0 mmol sodium/L converts to 140.0 mEq sodium/L. 
The concentration of chloride is 101.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 101.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 101.0 mmol * 1 mEq/mmol = 101.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 101.0 mmol chloride/L converts to 101.0 mEq chloride/L. 
The concentration of bicarbonate is 10.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 10.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 10.0 mmol * 1 mEq/mmol = 10.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 10.0 mmol bicarbonate/L converts to 10.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 140.0 mEq/L - (101.0 mEq/L + 10.0 mEq/L) = 29.0 mEq/L. Hence, The patient's anion gap is 29.0 mEq/L.The concentration of albumin is 2.7 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 29.0 (mEq/L) + 2.5 * (4 - 2.7 (in g/dL)) = 32.25 mEq/L. Hence, the patient's albumin corrected anion gap is 32.25 mEq/L.Plugging in 32.25 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 32.25 - 12 = 20.25 mEq/L. Hence, the patient's albumin corrected delta gap is 20.25 mEq/L.Plugging in the albumin corrected delta gap and the bicarbonate concentration into the albumin corrected delta ratio formula, we get 20.25 mEq/L / 14.0 mEq/L = 1.44643. The patient's albumin corrected delta ratio is 1.44643."
821,67,Albumin Corrected Delta Ratio,lab test,decimal,pmc-6197016-1,Extracted,"A 47-year-old Caucasian female presented to the emergency department because of a 2-day history of nausea, vomiting and moderate to severe progressive epigastric pain. She reported subjective fever with rigors and chills, loose, watery stools and abdominal fullness. Her past medical history was significant for chronic alcoholism; she drank 6–8 beers each day. She had no reported history of cirrhosis.
On arrival, her vitals included blood pressure: 120/88 mmHg, pulse:80/minute, respiratory rate:18/minute, temperature:98.6 ºF and oxygen saturation: 97% on ambient air. She appeared in mild distress; sclera was slightly jaundiced. Cardiovascular examination was unremarkable. The abdomen was mildly tender in the epigastric area without guarding and rigidity. Hepatomegaly was also noted. Central nervous system examination was non-focal. Skin showed no erythematous lesions. Laboratory data included haemoglobin 14.2 (12.0–15.7 g/dl), leucocyte count 9 (4.5–11 × 103/uL), platelets count 143 (4.5–11.0 × 103/uL), glucose 83(70–105 mg/dL), blood urea nitrogen 48(7–22 mg/dL), creatinine 2.52(0.50–1.50 mg/dL), sodium 129(134–145 mM/L), potassium 2.9(3.5–5.1 mM/L), chloride 94(98–112 mM/L), bicarbonate 18(24–30 mM/L), albumin 2.5(3.5–5.0 g/dL), total bilirubin 6.3(0.2–1.3 mg/dL), AST 71(8–40 U/L), ALP 66(39–117 U/L), ALT 128 (7–56 U/L), activated PTT 38.1 (23.0–31.0 sec) and PT 12.9 (9.5–12.0 sec) and lactic acid 2.8 (0.5–2.0 mM/L). Contrast-enhanced CT of the abdomen and pelvis showed severe, circumferential thickening of the gastric wall with the involvement of distal esophagus and the first portion of the duodenum in addition to perigastric stranding; findings were reported to be consistent with severe gastritis (). There was also mild mucosal thickening of the transverse and descending colon. The liver was enlarged with fatty infiltration. A small amount of ascites with small left-sided pleural effusion was seen throughout the peritoneum. No obstruction, perforation or intrabdominal abscess was seen. Based on her subtle presentation, physical exam and hemodynamic stability, primary peritonitis was deemed less likely upon initial assessment. Therefore, she was admitted to a medical floor with the provisional diagnoses of alcohol-related gastritis, alcoholic hepatitis, and acute kidney injury. She received a 2-litre bolus of intravenous (IV) normal saline and was started on maintenance fluid, IV antiemetics, and IV pantoprazole.
Within 8-hours of admission, the patient became hemodynamically unstable with subsequent intubation and fluid resuscitation. She was transferred to the intensive care unit. Because of bright red blood on nasogastric decompression, she was started on IV octreotide given her history of chronic alcoholism and possible variceal bleed. Because of hypotension and SIRS with peritoneal ascites, blood cultures were drawn, and the patient was started on broad-spectrum empiric antibiotics (vancomycin, piperacillin-tazobactam, and levofloxacin). A diagnostic paracentesis was performed obtaining 1.2 liters of thick serosanguinous peritoneal fluid. Ascitic fluid analysis was suggestive of monomicrobial primary peritonitis, showing abundant Gram-positive cocci and 51,500 leucocytes/mm3 with 67% neutrophils. Ascitic fluid was exudative in nature with total protein 3.8 g/dl, albumin 1.6 g/dl, lactate dehydrogenase 5189/UL and glucose 56 mg/dl. Serum-albumin ascitic-albumin gradient was 0.9 g/dl.
No surgical intervention was considered as the possibility of secondary peritonitis was less likely based on her CT and ascitic fluid findings. Blood cultures and ascitic fluid cultures were positive for GAS, and therefore, the patient was started on IV ampicillin and clindamycin for primary GAS peritonitis.
Because of hematemesis, the patient underwent EGD that showed diffuse gastric ulcerations, but no esophageal varices or active bleeding. Given diffuse ulceration of stomach with circumferential wall thickening, gastritis was thought to be caused by an underlying ischemic or infiltrative process.
Although the patient’s hemoglobin was stable, and she had required no blood transfusions, her hemodynamic status started to deteriorate requiring multiple pressor support and IV high-dose hydrocortisone. Given the context of isolation of GAS from blood and ascitic fluid, septic shock and multiorgan failure (renal failure and liver failure), a diagnosis of STSS was made. Her lactic acid level worsened from 2.8 at baseline to 42 mM/L. The patient was deemed a non-surgical candidate by the surgical team. However, an ultrasound-guided intraperitoneal drain was placed for therapeutic reasons. The patient received few doses of antibiotics; however, she continued to deteriorate and succumbed to death within 48-hours of admission due to cardiopulmonary arrest and multiorgan failure.",What is the patient's albumin corrected delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [94.0, 'mmol/L'], 'Albumin': [2.5, 'g/dL'], 'Bicarbonate': [18.0, 'mmol/L'], 'Sodium': [129.0, 'mmol/L']}",1.45833,1.38541,1.53125,"The formula for computing the albumin corrected delta ratio is albumin corrected delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 129.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 129.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 129.0 mmol * 1 mEq/mmol = 129.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 129.0 mmol sodium/L converts to 129.0 mEq sodium/L. 
The concentration of chloride is 94.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 94.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 94.0 mmol * 1 mEq/mmol = 94.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 94.0 mmol chloride/L converts to 94.0 mEq chloride/L. 
The concentration of bicarbonate is 18.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 18.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 18.0 mmol * 1 mEq/mmol = 18.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 18.0 mmol bicarbonate/L converts to 18.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 129.0 mEq/L - (94.0 mEq/L + 18.0 mEq/L) = 17.0 mEq/L. Hence, The patient's anion gap is 17.0 mEq/L.The concentration of albumin is 2.5 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 17.0 (mEq/L) + 2.5 * (4 - 2.5 (in g/dL)) = 20.75 mEq/L. Hence, the patient's albumin corrected anion gap is 20.75 mEq/L.Plugging in 20.75 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 20.75 - 12 = 8.75 mEq/L. Hence, the patient's albumin corrected delta gap is 8.75 mEq/L.Plugging in the albumin corrected delta gap and the bicarbonate concentration into the albumin corrected delta ratio formula, we get 8.75 mEq/L / 6.0 mEq/L = 1.45833. The patient's albumin corrected delta ratio is 1.45833."
822,67,Albumin Corrected Delta Ratio,lab test,decimal,pmc-5930206-1,Extracted,"A 63-year-old Thai man, with a long-standing history of alcohol and tobacco use, was hospitalized with a two-month history of progressive jaundice, generalized pruritus, and significant involuntary weight loss. He reported no fever, abdominal pain, or vomiting. For the 4 weeks prior to his admission, he also suffered from progressive fatigue, poor oral intake, pale stools, and decreased urine output. His past medical history was significant for well-controlled type 2 diabetes mellitus, hypertension, and stage 3A chronic kidney disease (baseline serum creatinine of 1.5 mg/dL, estimated glomerular filtration rate of 48.8 mL/min/1.73 m2). His family history was negative for any kidney disease or malignancy. He had no history of herbal medicine use, intravenous drug abuse, tattoos, or blood transfusions. On physical examination, he was alert and oriented with severe jaundice, a distended abdomen with an enlarged liver, and a 1+ bilateral pitting edema of his lower extremities. He had no stigmata of chronic liver disease. The rest of the physical examination was unremarkable.
Laboratory data were as follows: hemoglobin = 9.6 g/dL, mean corpuscular volume (MCV) = 85 fL, white blood cells = 11,880/mm3 (neutrophil 81%, lymphocyte 4.9%, monocyte 12%), platelets = 384,000/mm3, international normalized ratio (INR) = 2.2, blood urea nitrogen = 73.8 mg/dL, serum creatinine = 7.78 mg/dL, sodium = 133 mEq/L, potassium = 3.8 mEq/L, bicarbonate = 16.8 mEq/L, chloride = 92 mEq/L, calcium = 8.7 mg/dL, phosphorus = 4.8 mg/dL, magnesium = 2.8 mg/dL, and glycated hemoglobin = 7.1%. Liver function tests revealed the following: total cholesterol = 177 mg/dL, total protein = 5.4 g/dL, albumin = 2.8 g/dL, globulin = 2.6 g/dL, total bilirubin = 36.1 mg/dL, direct bilirubin = 35 mg/dL, alanine transaminase (ALT) = 53 U/L, aspartate transaminase (AST) = 109 U/L, and alkaline phosphatase (ALP) = 408 U/L. Serum tests for human immunodeficiency virus, hepatitis B, and hepatitis C were negative. Serum carbohydrate antigen 19-9 (CA 19-9) levels were 850 U/mL (0–37). Urine appeared greenish with a specific gravity of 1.010, trace proteinuria, 5–10 red blood cells (RBCs)/high-power field, 1–2 white blood cells/high-power field along with numerous muddy brown granular casts (Fig. ), and bile casts (Fig. ). No RBC casts were found. The fractional excretion of sodium (FENa) was 2.7%, and FEurea was 44.8%. Abdominal computed tomography showed 4.3 × 4.2 cm and 3.1 × 3.5 cm inhomogeneous enhancing masses at liver segment 4A with moderately dilated intrahepatic ducts (Fig. ). Based on the symptoms of biliary obstruction, typical imaging findings, and elevated serum CA 19-9, the most likely diagnosis was cholangiocarcinoma (Bismuth–Corlette type IIIb). He was initially given intravenous fluids to combat his oliguric renal failure, but there was no improvement in serum creatinine and urine output. Over the next 5 days, hemodialysis was initiated due to diuretic-resistant oliguric acute renal failure. Percutaneous transhepatic biliary drainage (PTBD) was also performed to relieve his obstructive jaundice. However, he still experienced clinical deterioration. After approximately 2 weeks of hemodialysis, his total serum bilirubin continued to be in the 30 mg/dL range and he remained oliguric. On the 27th day of admission, the patient suffered from massive biliary hemorrhage requiring a blood transfusion. An emergency esophagogastroduodenoscopy (EGD) was performed and revealed active hemorrhage from the ampulla of Vater, a finding suggestive of tumor bleeding. After thorough discussion and consultation between the patient's family and the palliative care team, the healthcare providers proceed to initiate palliative treatment.",What is the patient's albumin corrected delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [92.0, 'mEq/L'], 'Albumin': [2.8, 'g/dL'], 'Bicarbonate': [16.8, 'mEq/L'], 'Sodium': [133.0, 'mEq/L']}",2.11111,2.00555,2.21667,"The formula for computing the albumin corrected delta ratio is albumin corrected delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 133.0 mEq/L. 
The concentration of chloride is 92.0 mEq/L. 
The concentration of bicarbonate is 16.8 mEq/L. 
Plugging in these values into the anion gap formula gives us 133.0 mEq/L - (92.0 mEq/L + 16.8 mEq/L) = 24.2 mEq/L. Hence, The patient's anion gap is 24.2 mEq/L.The concentration of albumin is 2.8 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 24.2 (mEq/L) + 2.5 * (4 - 2.8 (in g/dL)) = 27.2 mEq/L. Hence, the patient's albumin corrected anion gap is 27.2 mEq/L.Plugging in 27.2 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 27.2 - 12 = 15.2 mEq/L. Hence, the patient's albumin corrected delta gap is 15.2 mEq/L.Plugging in the albumin corrected delta gap and the bicarbonate concentration into the albumin corrected delta ratio formula, we get 15.2 mEq/L / 7.199999999999999 mEq/L = 2.11111. The patient's albumin corrected delta ratio is 2.11111."
823,67,Albumin Corrected Delta Ratio,lab test,decimal,pmc-8092952-1,Extracted,"A 40-year-old African American male patient, known to have homozygous sickle cell disease (SS genotype) and associated nephropathy, was admitted to our medical service in the summer of 2020 with a painful hemolytic crisis. He had presented with several weeks of progressive generalized weakness, generalized myalgias, and worsening dyspnea in the previous week. He had failed to take his prophylactic hydroxyurea for some time prior to presentation. Initial evaluation in the emergency department (ED) revealed lethargy and sedated level of consciousness with hypoxia and increased work of breathing. Following initial resuscitative measures in the ED, he improved. Pertinent admission laboratory data included sickle hemoglobin (HbS) 94.5%, hemoglobin A2 3.2%, mean corpuscular volume 103 fL, reticulocyte count 19.4% (baseline reticulocyte count of ~2.8%), white blood cell count 34.85×109/L with 85% neutrophils, platelet count 294×109/L, hemoglobin 4.6 g/dL, and hematocrit 13.1%. Peripheral smear revealed sickled red blood cells (RBCs). Chemistry revealed sodium 136 mmol/L, potassium 7.4 (3.5–5.0) mmol/L, glucose <20 mg/dL that quickly improved after 10% dextrose infusion, creatinine 7.20 mg/dL (baseline 1.5 mg/dL), bicarbonate 5 mmol/L, chloride 102 mmol/L, calcium 7.4 mg/dL, total bilirubin >40 mg/dL, phosphorus 11.6 mg/dL, conjugated bilirubin 38.7 mg/dL, unconjugated bilirubin 2.9 mg/dL, aspartate aminotransferase 374 IU/L, alanine aminotransferase 94 IU/L, alkaline phosphatase 418 IU/L, total protein 10.7 g/dL, albumin 3.6 g/dL, ferritin >6,000 ng/mL, creatine kinase 70 U/L, troponin I 0.042 (<0.034) ng/mL, ammonia 54 (<34) μmol/L, lactate dehydrogenase 3288 (313–618) U/L, N-terminal pro b-type natriuretic peptide 8940 (<125) pg/mL, partial thromboplastin time 31 s, prothrombin time 20.9 s, international normalized ratio 1.8, and lactic acid 11.6 mmol/L. The calculated MELD score was 40. Salicylate level was 1.7 mg/dL, and acetaminophen level was 14 μg/mL. Initial venous blood gas examination revealed pH 7.03, pCO2 38 mmHg, pO2 34 mmHg, TCO2 11 mmol/L, base deficit 19, and oxygen saturation was only 42%. Electrocardiogram (EKG) in the ED was abnormal and demonstrated sinus rhythm with prolonged QTc duration of 522 (<440) ms, together with inverted T waves in the lateral chest leads, V4–V6, consistent with true hyperkalemia (). He had promptly received emergency therapies for hyperkalemia including intravenous (IV) calcium gluconate infusion, IV sodium bicarbonate infusion, IV 10% dextrose infusion with insulin, and IV furosemide. In addition, he was started empirically on IV antibiotics, vancomycin, and meropenem.
He was transfused with two units of packed RBCs and was promptly transferred to the Medical ICU. He quickly underwent emergency RBC exchange with therapeutic apheresis via a right femoral vein cannula, utilizing 1,999 mL of packed RBCs with a net fluid balance of 270 mL. Sickle hemoglobin (HbS) quickly dropped to 26.3% post-apheresis exchange. Initial nephrology consultation on admission had recommended correction of metabolic acidosis and treatment of hyperkalemia with more isotonic sodium bicarbonate infusions, insulin/glucose infusions, and the initiation of oral sodium zirconium cyclosilicate (SZC). He received one hemodialysis treatment on day 3 following evidence of encephalopathy which was subsequently blamed on drug toxicity from IV ketamine that was used for pain management.
Despite observing significant improvement of the acute kidney injury on chronic kidney disease in the first two weeks of this admission with much improved serum creatinine 2–3 weeks into the admission, as well as normal urine output, and stabilization of serum bicarbonate level to 22–27 mmol/L, the patient had exhibited persistent hyperkalemia (5.2–6.7 mmol/L) even with continued administration of SZC at 10 mg 2 times daily. The simultaneous trajectories of serum creatinine, platelet count, and serum potassium concentrations during the admission are shown in . The patient had remained otherwise asymptomatic. Chlorthalidone, 25 mg daily, was added to manage the hyperkalemia without much success. Moreover, an EKG obtained in the 4th week of admission when the serum potassium that morning was 6.7 mmol/L was remarkably normal (). At this point, as demonstrated in , our patient had subsequently developed significantly progressive thrombocytosis, the result of previous treated sepsis. Admission leukocytosis of 34.85×109/L had decreased to 10.67×109/L in the 4th week of this admission. Nevertheless, usual therapies for hyperkalemia were again reinstituted in addition to the continued use of SZC and chlorthalidone.
From the foregoing observations and considerations, especially given the normal EKG shown in compared to the admission EKG in when he had true hyperkalemia with acute kidney injury and metabolic acidosis, for the very first time since this admission the possibility of pseudohyperkalemia was entertained. Consequently, later that same afternoon, following a conference call between the Nephrology and Internal Medicine Services, we repeated the simultaneous serum and plasma potassium measurements (after the emergency therapies for true hyperkalemia had been administered earlier that morning for a measured serum potassium level of 6.7 mmol/L). The measured simultaneous blood potassium levels were 5.8 mmol/L in serum versus 5.2 mmol/L in plasma. The reference range for blood potassium is 3.5–5.0 mmol/L. This confirmed the presence of pseudohyperkalemia secondary to the prevailing progressive thrombocytosis during this later part of the admission (). Pseudohyperkalemia is diagnosed when the serum potassium concentration exceeds that of plasma by at least 0.4 mmol/L. Subsequently, the new potassium binder SZC was discontinued.
Five weeks after discharge, the patient was re-admitted to the same medical service this time with symptomatic painful sickle cell anemia crisis, fevers, cough with green sputum production, leukocytosis of 31.98×109/L, bilirubin 8.4 mg/dL, and chest radiograph that demonstrated bilateral multifocal patchy infiltrates consistent with pneumonia. Both HIV 1 and 2 and repeated COVID-19 RT-PCR tests were negative. He was started empirically on IV ceftriaxone, IV azithromycin, and IV vancomycin. Blood cultures grew methicillin-resistant Staphylococcus aureus within 15 hours in two out of two bottles, and IV antibiotics were de-escalated to 6 weeks of IV vancomycin administration. Admission serum creatinine was only slightly increased at 1.48 mg/dL, potassium was 5.7 mmol/L, but bicarbonate was 23 mmol/L. The patient responded well to IV antibiotics with resolution of the fever, and WBC had quickly dropped to 14.99×109/L after 2 days. Despite this quick overall clinical improvement, persistent hyperkalemia was again recorded throughout this second admission despite a low-potassium diet, IV furosemide, and the addition of oral fludrocortisone, 0.2 mg daily. Admission platelet count of 546 ×109/L had decreased to 314–450×109/L following IV fluids and IV antibiotics. This time round, simultaneous serum and plasma potassium levels were checked multiple times, and serum and plasma potassium concentrations were similar, indicative of true hyperkalemia. Hyperkalemia in the past had been related to pseudohyperkalemia associated with thrombocytosis. Factors contributory to true hyperkalemia were suspected to include sepsis accompanying the sickle cell crisis and intravascular hemolysis, concurrent exposure to heparin (subcutaneous enoxaparin 40 mg daily for deep vein thrombosis prophylaxis), and underlying sickle cell nephropathy with chronic kidney disease. The patient was restarted on SZC 10 g b.i.d. for 48 hours, and continued at 10–15 g daily. Serum potassium was maintained in the 5.3–6.3 mmol/L range throughout the hospital stay. The administration of SZC was to be continued post-discharge for 6 weeks with monitoring of serum potassium levels. To our knowledge, the patient has remained stable since discharge from the hospital.",What is the patient's albumin corrected delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [102.0, 'mmol/L'], 'Albumin': [3.6, 'g/dL'], 'Bicarbonate': [5.0, 'mmol/L'], 'Sodium': [136.0, 'mmol/L']}",0.94737,0.9,0.99474,"The formula for computing the albumin corrected delta ratio is albumin corrected delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 136.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of sodium from mmol to mEq. The mass of sodium is 136.0 mmol. The compound, sodium, has a valence of 1, and so multiply the valence by the value of mmol to get, 136.0 mmol * 1 mEq/mmol = 136.0 mEq sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 136.0 mmol sodium/L converts to 136.0 mEq sodium/L. 
The concentration of chloride is 102.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of chloride from mmol to mEq. The mass of chloride is 102.0 mmol. The compound, chloride, has a valence of 1, and so multiply the valence by the value of mmol to get, 102.0 mmol * 1 mEq/mmol = 102.0 mEq chloride. The volume units is L so no volume conversion is needed. Hence, the concentration value of 102.0 mmol chloride/L converts to 102.0 mEq chloride/L. 
The concentration of bicarbonate is 5.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 5.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 5.0 mmol * 1 mEq/mmol = 5.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 5.0 mmol bicarbonate/L converts to 5.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 136.0 mEq/L - (102.0 mEq/L + 5.0 mEq/L) = 29.0 mEq/L. Hence, The patient's anion gap is 29.0 mEq/L.The concentration of albumin is 3.6 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 29.0 (mEq/L) + 2.5 * (4 - 3.6 (in g/dL)) = 30.0 mEq/L. Hence, the patient's albumin corrected anion gap is 30.0 mEq/L.Plugging in 30.0 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 30.0 - 12 = 18.0 mEq/L. Hence, the patient's albumin corrected delta gap is 18.0 mEq/L.Plugging in the albumin corrected delta gap and the bicarbonate concentration into the albumin corrected delta ratio formula, we get 18.0 mEq/L / 19.0 mEq/L = 0.94737. The patient's albumin corrected delta ratio is 0.94737."
824,67,Albumin Corrected Delta Ratio,lab test,decimal,pmc-8056694-1,Extracted,"A now four-year-old boy presented at the age of 3 years to our emergency department with a 2-week history of fever (39.5 °C), vomiting, and watery stools, which had already improved. He also had lower limb oedema and periorbital puffiness for one week. Apart from receiving paracetamol for the fever, there was no history of medication use. He is the offspring of parents in a consanguineous marriage with an unremarkable past medical history. He has one sister and three brothers. One of his brothers was diagnosed with steroid-resistant nephrotic syndrome due to membranous proliferative glomerulonephritis (MPGN) with C3 deposition diagnosed by kidney biopsy at 3 years of age. He reached chronic kidney disease stage 5 at the age of 4 years. Dialysis was considered, but he died in another hospital due to sepsis. No genetic testing was done on his brother.
On initial examination, the patient was stable but hypertensive with blood pressure reading of 136/83 mmHg, generalized oedema and a distended abdomen. No other abnormalities detected in systemic examinations. Laboratory investigations were performed and revealed the following: serum creatinine (45 µmol/L; normal 2.6–52.2 µmol/L), blood urea nitrogen (14.1 mmol/L; normal 1.8–6.4 mmol/L), potassium (5.5 mmol/L), sodium (135 mmol/L), chloride (110 mmol/L), bicarbonate (18 mmol/L), albumin (1.2 g/dL; normal 3.4-4.2 g/dL), haemoglobin (Hgb) (5.2 g/dL; normal 11.5–14.5 g/dL), white blood cell (WBC) count (9.13 × 109/L; normal 4–12 × 109/L), platelet count (23 × 109/L; normal 150–400 × 109/L), haptoglobin (< 0.058 g/L; normal 0.5–2.2 g/L), lactate dehydrogenase (LDH) (1425 U/L; normal 150–500 U/L), complement C3 (C3) (0.550 g/L; normal 0.80–1.60 g/L), and complement C4 (C4) (0.109/L; normal 0.16–0.48 g/L). The patient also had normal coagulation profile, normal level of ADAMTS13, negative coombs test and peripheral blood smears showed schistocytes. His urine dipstick showed urine protein excretion of > 400 mg/dL and 20–50 red blood cells/high power field. Stool cultures and analysis revealed no pathogens (Table ). Due to his uncontrolled hypertension and thrombocytopenia, the patient could not undergo a kidney biopsy.
The patient’s clinical picture fit the diagnosis of aHUS, and eculizumab was started within 24 h of the diagnosis. Following the recommendations of the Food and Drug Administration (FDA) and the manufacturer, he was given a 600 mg intravenous (IV) infusion as induction therapy and a 300 mg IV infusion every two weeks as maintenance therapy. After two doses of eculizumab, he started to show clinical and laboratory improvement. His Hgb improved to 9 g/dL; his platelet count increased to 169 × 109/L; and his C3, haptoglobin, and LDH levels were normalized (Table ). His blood pressure was controlled on amlodipine and lisinopril, and his oedema significantly improved. A genetic panel for aHUS was performed, and the patient showed a homozygous nonsense gene mutation in DGKE p.(Phe250Serfs*3). No mutation was detected in the gene coding regions of ADAMTS13, C3, CD46, CFB, CFH, CFHR1, CFHR2, CFHR3, CFHR5, CFI, MMACHC, PIGA, PLG, THBD, CD59, CR1, CR2, INF2, or MUT.
Six months after presentation, the patient was stable and in clinical remission on eculizumab 300 mg every other week. His laboratory parameters were within the normal ranges (Hgb 11.8 g/dL, platelet count 543 × 109/L, C3 0.9 g/L) apart from persistent moderate proteinuria, with urine dipstick 100 mg/dL and serum albumin 2.5 g/dL (Table ). Based on the genetic results and the patient’s general condition, we decided to start increasing the time between eculizumab doses, targeting discontinuation. A 300 mg IV infusion of eculizumab was administered every three weeks instead of every two weeks. Following the first dose after increasing the time between doses, the patient was noticed to be oedematous; his proteinuria in urine dipstick increased to 400 − 300 mg/dL with urine protein/creatinine ratio > 3 mg/mg, his albumin dropped to 1.9 g/dL, and other laboratory parameters, including Hgb and platelet count, were within the normal ranges (Hgb 12.2 g/dl and platelet count 494 × 109/L) (Table ). His oedema improved after the addition of oral furosemide at 1 mg/kg/dose twice daily. Nevertheless, after 4 months of eculizumab every 3 weeks, the patient’s proteinuria and albumin levels did not improve. The decision was made to try eculizumab every two weeks and observe his proteinuria. Interestingly, his proteinuria improved to 100 mg/dL after only two doses of the two-week regimen, his oedema subsided and serum albumin improved gradually from 1.9 g/L to 2.2 g/L (Table ). Four months later, patient is stable on eculizumab 300 mg IV infusion every two weeks with no oedema and stable proteinuria and Albumin (Table ). Throughout his first year after presentation, apart from proteinuria, his creatinine was within the normal range, and he had no signs of HUS activity after the first remission.",What is the patient's albumin corrected delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [110.0, 'mEq/L'], 'Albumin': [1.2, 'g/dL'], 'Bicarbonate': [18.0, 'mEq/L'], 'Sodium': [135.0, 'mEq/L']}",0.33333,0.31666,0.35,"The formula for computing the albumin corrected delta ratio is albumin corrected delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 135.0 mEq/L. 
The concentration of chloride is 110.0 mEq/L. 
The concentration of bicarbonate is 18.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 135.0 mEq/L - (110.0 mEq/L + 18.0 mEq/L) = 7.0 mEq/L. Hence, The patient's anion gap is 7.0 mEq/L.The concentration of albumin is 1.2 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 7.0 (mEq/L) + 2.5 * (4 - 1.2 (in g/dL)) = 14.0 mEq/L. Hence, the patient's albumin corrected anion gap is 14.0 mEq/L.Plugging in 14.0 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 14.0 - 12 = 2.0 mEq/L. Hence, the patient's albumin corrected delta gap is 2.0 mEq/L.Plugging in the albumin corrected delta gap and the bicarbonate concentration into the albumin corrected delta ratio formula, we get 2.0 mEq/L / 6.0 mEq/L = 0.33333. The patient's albumin corrected delta ratio is 0.33333."
825,67,Albumin Corrected Delta Ratio,lab test,decimal,usmle-8171,Extracted,"A 25-year-old man presents to his primary care physician with complaints of coughing up blood in his sputum and dark-colored urine for 1 week. There are streaks of blood intermixed with phlegm. He also expresses concerns about his urine being grossly dark brown. He denies any history of major bleeding from minor injuries. He is currently not taking any medications. His family history is negative for bleeding disorders. The vital signs include blood pressure 160/100 mm Hg, pulse 88/min, temperature 36.8°C (98.2°F), and respiratory rate 11/min. On physical examination, there are no significant clinical findings. The urinalysis results are as follows:
pH 6.7
Color dark brown
Red blood cell (RBC) count 12–14/HPF
White blood cell (WBC) count 3–4/HPF
Protein absent
Cast RBC and granular casts
Glucose absent
Crystal none
Ketone absent
Nitrite absent 
24 hours of urine protein excretion 1 g
His renal function test showed:
Sodium 136 mEq/L
Potassium 5.1 mEq/L
Chloride 101 mEq/L
Bicarbonate 22 mEq/L
Albumin 3.5 mg/ dL
Urea nitrogen 28 mg/dL
Creatinine 2.5 mg/dL
Uric Acid 6.8 mg/ dL
Calcium 8.7 mg/ dL
Glucose 111 mg/dL
HPF: high-power field
A kidney biopsy is obtained and the immunofluorescence shows linear immunoglobulin G (IgG) deposition in the glomeruli.",What is the patient's albumin corrected delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Sodium': [136.0, 'mEq/L'], 'Chloride': [101.0, 'mEq/L'], 'Bicarbonate': [22.0, 'mEq/L'], 'Albumin': [3.5, 'mg/dL']}",5.49563,5.22085,5.77041,"The formula for computing the albumin corrected delta ratio is albumin corrected delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 136.0 mEq/L. 
The concentration of chloride is 101.0 mEq/L. 
The concentration of bicarbonate is 22.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 136.0 mEq/L - (101.0 mEq/L + 22.0 mEq/L) = 13.0 mEq/L. Hence, The patient's anion gap is 13.0 mEq/L.The concentration of albumin is 3.5 mg/dL. We need to convert the concentration to g/dL. Let's first convert the mass of albumin from mg to g. The mass of albumin is 3.5 mg. To convert 3.5 mg of albumin to g, multiply by the conversion factor 0.001, giving us 3.5 mg albumin * 0.001 g/mg = 0.0035 g albumin. The volume units is dL so no volume conversion is needed. Hence, the concentration value of 3.5 mg albumin/dL converts to 0.0035 g albumin/dL. Plugging in these values into the albumin corrected anion gap formula, we get 13.0 (mEq/L) + 2.5 * (4 - 0.0035 (in g/dL)) = 22.99125 mEq/L. Hence, the patient's albumin corrected anion gap is 22.99125 mEq/L.Plugging in 22.99125 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 22.99125 - 12 = 10.99125 mEq/L. Hence, the patient's albumin corrected delta gap is 10.99125 mEq/L.Plugging in the albumin corrected delta gap and the bicarbonate concentration into the albumin corrected delta ratio formula, we get 10.99125 mEq/L / 2.0 mEq/L = 5.49563. The patient's albumin corrected delta ratio is 5.49563."
826,67,Albumin Corrected Delta Ratio,lab test,decimal,pmc-4528898-1,Extracted,"A 47-year-old African American man came to the emergency department with complaints of 4 days of severe, colicky back pain with some radiation to the flanks, associated with nausea and vomiting and a noticeable decrease in urination. He denied any history of trauma, stones, dysuria, frequency, hesitancy, rash, constipation, diarrhea, fever, or previous similar pain. He denied any unusual food or sick contact. He denied taking any medications for the past 18 months, including nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and antacids. He denied smoking, alcohol, and drugs although it had been noted in the chart that he had a positive urinary toxicology screen in the past for cocaine. Although he had a history of hypertension, diabetes, and hyperlipidemia diagnosed 3 years previously during a brief hospital stay, he was not taking any of the recommended prescription medications. Family history was positive for premature atherosclerosis, yet negative for autoimmune diseases and tuberculosis. On physical examination, his vital signs included blood pressure of 235/125 mm Hg, pulse 90 beats/min, respiratory rate 20/min, temperature 37°C, O2 saturation 96% on room air. He was awake and alert, had clear lungs, a regular heart rate with no murmurs, gallops, or rubs, a soft abdomen with normal bowels sounds, bilateral costophrenic tenderness to percussion, a normal prostate, and neurologic examination.
Creatinine was 10.48 mg/dL, up from his previous level of 1.15 mg/dL at his previous visit 3 years prior. Blood urea nitrogen 63 mg/dL, Na 134 mEq/L, K 4.4 mEq/L, Cl 100 mEq/L, bicarbonate 22 mEq/L, glucose 151 mg/dL, Ca 9.4 mg/dL, PO4 6.1 mg/dL, Mg 2.1 mg/dL, hemoglobin 15 g/dL, hematocrit 45%, white blood cells (WBC) of 9100 with neutrophils 75%, lymphocytes 12.5%, and eosinophils 0.9%, platelets of 167 000. His troponin was 0.02 ng/mL, CK-MB 2.6 ng/mL, BNP 53 pg/mL, amylase 70 U/L, lipase 69 U/L, international normalized ratio 1.1, prothrombin time 13 seconds, partial thromboplastin time 31 seconds, HbA1c 6.6%, aspartate transaminotransferase (AST) 25 IU/L, alanine aminotransferase (ALT) 20 IU/L, albumin 3.8 g/dL, total protein 7.3 g/dL, bilirubin 1.4 mg/dL, alkaline phosphatase 39 IU/L, C-reactive protein 25 mg/L. Urine toxicology screen was positive for cocaine. Urinalysis showed 2+ blood, no red blood cells, no WBCs, including no eosinophils by special stain, no casts, no albumin, negative for nitrates, negative leukocyte esterase and negative for bacteria, trace ketone, pH 5.5, and specific gravity 1.015. No pigmented granular casts. His hepatitis panel: C-ANCA (cytoplasmic–antineutrophil cytoplasm antibodies) Ag, P-ANCA (perinuclear–antineutrophil cytoplasm antibodies), anti–glomerular basement membrane Ag, anti-myeloperoxidase, antinuclear antibody and Helicobacter pylori IgA were all negative. Creatine phosphokinase was 127 mg/dL and his serum electrophoresis was normal. C3 was 119 mg/dL and C4 was 88.5 mg/dL (both normal). Anti-proteinase 3 (PR-3) antibodies were positive.
His chest and abdominal radiographs were normal, and computed tomography of the abdomen and pelvis without contrast showed no urinary obstruction. Transthoracic echocardiogram showed normal wall motion and ejection fraction. Electrocardiography showed nonspecific T-wave abnormalities, which were unchanged since 2010.
The patient’s blood pressure was initially controlled with intravenous labetalol and hydralazine. Over the first 3 days of admission, his urinary output decreased from 700 cm3/d to less than 400 cm3/d and his creatinine rose to 13.6 mg/dL. Nephrology was consulted early and after ruling out acute toxic nephropathy, urinary obstruction, and acute rhabdomyolsis, it was suspected, based on his initial positive toxicology screen for cocaine that he may have cocaine-induced interstitial nephritis and a renal biopsy was performed (see below). Indeed, on further questioning, the patient admitted to smoking crack cocaine. It was confirmed with the patient and his spouse that the cocaine was not mixed or combined with any other substance. At that point (day 4) the patient was started on intravenous methylprednisolone at 125 mg every 6 hours as well as daily or every other day hemodialysis for a total of 6 sessions. The methylprednisolone was tapered to 80 mg every 6 hours after 3 days and then changed to oral prednisone, which was furthered tapered over the next 12 days. The steroid was used roughly day 4 of admission, and 7 days after symptoms had started, it is hard to tag a response to the steroid separately as the patient was started on both hemodialysis and steroid at the same time after biopsy of kidney confirmed the diagnosis; nevertheless, we were able to see stable improvement on creatinine on days 8 and 9, with improvement of urine output (roughly 1000-1500 cm3/d). The patient stabilized with his creatinine at 3.54 mg/dL before being discharged home and follow-up 8 weeks later showed a normal creatinine.
Renal biopsy () showed normocellular glomeruli, interstitial atrophy, and fibrosis with tubular loss of 10% to 20%. There were foci of interstitial inflammation composed of lymphocytes, plasma cells, eosinophils, and edema with areas of severe arterioarterosclerosis. No immune complexes were detected.",What is the patient's albumin corrected delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [100.0, 'mEq/L'], 'Albumin': [3.8, 'g/dL'], 'Bicarbonate': [22.0, 'mEq/L'], 'Sodium': [134.0, 'mEq/L']}",0.25,0.2375,0.2625,"The formula for computing the albumin corrected delta ratio is albumin corrected delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 134.0 mEq/L. 
The concentration of chloride is 100.0 mEq/L. 
The concentration of bicarbonate is 22.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 134.0 mEq/L - (100.0 mEq/L + 22.0 mEq/L) = 12.0 mEq/L. Hence, The patient's anion gap is 12.0 mEq/L.The concentration of albumin is 3.8 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 12.0 (mEq/L) + 2.5 * (4 - 3.8 (in g/dL)) = 12.5 mEq/L. Hence, the patient's albumin corrected anion gap is 12.5 mEq/L.Plugging in 12.5 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 12.5 - 12 = 0.5 mEq/L. Hence, the patient's albumin corrected delta gap is 0.5 mEq/L.Plugging in the albumin corrected delta gap and the bicarbonate concentration into the albumin corrected delta ratio formula, we get 0.5 mEq/L / 2.0 mEq/L = 0.25. The patient's albumin corrected delta ratio is 0.25."
827,67,Albumin Corrected Delta Ratio,lab test,decimal,pmc-4530922-1,Extracted,"A 56-year-old male was brought to the emergency department by paramedics for a syncopal episode and inability to move his lower extremities. He complained of abdominal pain and inability to move his legs beginning five hours prior to arrival. He awakened from a nap that afternoon and experienced numbness in both legs, which progressed to paralysis. At baseline, he was ambulatory without any history of weakness and was last ambulatory hours prior. He endorsed occasional pain in his legs when walking at baseline.
He also complained of abdominal pain with nausea and vomiting for two days. He had a history of alcohol use and reported dark-colored emesis and last bowel movement three days prior. On review of symptoms the patient denied any history of headache, dizziness, chest pain, back pain, trauma, fevers, or extremity weakness. He walked longer than a mile the day prior. History from the patient’s wife revealed that he had an episode of altered level of consciousness while on the couch and that finding combined with his abdominal pain and paralysis prompted her to call 911. The patient’s past medical history was significant for hypertension, peripheral arterial disease, and myocardial infarction 10 years prior. His past surgical history included “abdominal stents” and a left carotid stent. His social history was significant for a 25-pack/year history of smoking and daily alcohol. His medications included atenolol and ranitidine.
Physical exam showed an oral temperature of 36.7°C, blood pressure 107/65mmHg, heart rate 99 beats/minute and a respiratory rate of 30 breaths/min, with oxygen saturation on 15L non-rebreather mask of 94%. His weight was 72.5kg and he appeared older than his stated age. He was alert, cooperative and in moderate distress, primarily complaining of pain and cramping in his lower extremities and repeatedly asking staff to straighten out his legs although they were already lying straight and motionless on the gurney. His head exam was unremarkable with the exception of a dry oropharynx. Cervical spine, cardiac, and lung exams were unremarkable. His abdomen was firm and diffusely tender to palpation with generalized rebound and guarding. An irreducible left inguinal hernia was present. He had vomiting, and placement of a nasogastric tube revealed 1.5 liters of coffee-ground emesis. Lower extremities were thin, cool, and without any palpable or Dopplerable pulses in bilateral femoral, popliteal or pedal distribution. There was trace non-reproducible sensation to the mottled lower extremities, and no sensation distal to the ankles. Motor exam was significant for lower extremity paralysis.
Laboratory data consisted of sodium 121mEq/L (135–145), potassium 6.8mEq/L (3.3–4.8), chloride 89mEq/L (101–111), bicarbonate 18mEq/L (25–34), BUN 31mg/dL (8–26), creatinine 1.5mg/dL (0.5–1.3), and blood glucose 367mg/dL (70–115). White blood cell 19.1thous/mcL (4.0–10.5), hemoglobin 12.8g/dL (13.5–16.9), lipase 107U/L (22–51), hematocrit 38.8% (39.5–50.0), and platelets 165thous/mcL (150–400). There was a left shift in the neutrophils 16.2thous/mcL (85%) (2.0–8.1). Alkaline phosphate 88IU/L (26–110), AST 84IU/L (8–40), ALT 38IU/L (0.0–60), total bilirubin 1mg/dL (0.0–1.4), total protein 5.4g/dL (6.1–8.2), albumin 2.6 g/dL (3.2–5.5). Lactate 7.2mmol/L (0.7–2.1). ABG showed pH of 7.25 (7.38–7.42), pCO2 31.6mmHg (36–42), pO2 123.6mmHg (80–104), bicarbonate 13.5mmol/L (21–27). PT was 17.3sec (9.5–12.3), PTT 45.9sec (24.1–35.1), and INR 1.62 (0.87–1.14). B-type natriuretic peptide 1,950pg/mL (<100). Troponin 2.75ng/mL (<0.03).
Chest radiograph was unremarkable. Electrocardiogram (ECG) showed sinus rhythm at 95 beats/minute with ST elevation inferiorly, anteriorly and laterally (). Bedside ultrasound to evaluate the abdominal aorta was limited. Vascular surgery was consulted prior to CT for concern of a vascular catastrophe. Cardiology was consulted for the patient’s ECG findings consistent with myocardial infarction. The patient went for a non-contrast head CT that was unremarkable and a CT angiogram of the chest, abdomen and pelvis, which was significant for the abdominal aorta with no contrast opacification 2.2cm superior to the bifurcation (), high-grade stenosis of the right common iliac artery, complete occlusion of the left common iliac artery, stents in the celiac artery and superior mesenteric artery (SMA), evidence of occlusion of the proximal SMA and inferior mesenteric artery (IMA), hepatic, splenic, bilateral renal infarctions, left inguinal hernia, bowel obstruction, pneumatosis intestinalis with evidence of ischemic bowel, and aspiration in the right lower lung. General surgery was consulted.
The cardiology service stated that the patient was not a candidate for cardiac catheterization and to start anticoagulation and low-dose aspirin if there was no contraindication or planned surgery. They also recommended thrombolytics for the diffuse thrombotic disease. The patient did have an echocardiography study that revealed an ejection fraction of 35% and multiple regional wall motion abnormalities. General surgery recommended comfort measures as he was not a surgical candidate. Vascular surgery commented that bypass would be futile and if patient survived, would be a candidate for extra-anatomical axillo-bifemoral bypass in the future. The patient was admitted to the medical intensive care unit for broad-spectrum antibiotics and a heparin drip and succumbed to his illness the following day.",What is the patient's albumin corrected delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [89.0, 'mEq/L'], 'Albumin': [2.6, 'g/dL'], 'Bicarbonate': [18.0, 'mmol/L'], 'Sodium': [121.0, 'mEq/L']}",0.91667,0.87084,0.9625,"The formula for computing the albumin corrected delta ratio is albumin corrected delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 121.0 mEq/L. 
The concentration of chloride is 89.0 mEq/L. 
The concentration of bicarbonate is 18.0 mmol/L. We need to convert the concentration to mEq/L. Let's first convert the mass of bicarbonate from mmol to mEq. The mass of bicarbonate is 18.0 mmol. The compound, bicarbonate, has a valence of 1, and so multiply the valence by the value of mmol to get, 18.0 mmol * 1 mEq/mmol = 18.0 mEq bicarbonate. The volume units is L so no volume conversion is needed. Hence, the concentration value of 18.0 mmol bicarbonate/L converts to 18.0 mEq bicarbonate/L. 
Plugging in these values into the anion gap formula gives us 121.0 mEq/L - (89.0 mEq/L + 18.0 mEq/L) = 14.0 mEq/L. Hence, The patient's anion gap is 14.0 mEq/L.The concentration of albumin is 2.6 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 14.0 (mEq/L) + 2.5 * (4 - 2.6 (in g/dL)) = 17.5 mEq/L. Hence, the patient's albumin corrected anion gap is 17.5 mEq/L.Plugging in 17.5 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 17.5 - 12 = 5.5 mEq/L. Hence, the patient's albumin corrected delta gap is 5.5 mEq/L.Plugging in the albumin corrected delta gap and the bicarbonate concentration into the albumin corrected delta ratio formula, we get 5.5 mEq/L / 6.0 mEq/L = 0.91667. The patient's albumin corrected delta ratio is 0.91667."
828,67,Albumin Corrected Delta Ratio,lab test,decimal,pmc-8310435-1,Extracted,"A 68-year-old woman with a past medical history of metastatic melanoma, hypertension, deep vein thrombosis, and pulmonary embolism with inferior vena cava filter placement presented with altered mental status, hypotension, and fever. She had received her second dose of immunotherapy with ipilimumab+nivolumab shortly before presentation.
Initial vitals were significant for blood pressure of 75/40 mm Hg, heart rate of 110 beats per minute, respiratory rate 24 breaths per minute, oxygen saturation 95% on room air, and temperature 98.4 F. Physical exam was remarkable for altered mental status, moderate respiratory distress, and bilateral lower extremity edema. Initial blood work before fluid resuscitation showed Hg 10.3 g/dL; WBC 13.9 K/mcL; Platelets 164 K/mcL; Na 133 mEq/L; K 3.1 mEq/L; Cl 110 mEq/L; HCO3− 10 mEq/L; BUN of 23 mg/dL; Cr 3.2 mg/dL; Plasma Glucose 103 mg/dL; Total Protein 5.0 g/dL; Albumin 2.6 g/dL; Aspartate Aminotransferase (AST) 737 U/L; Alanine Aminotransferase (ALA) 399 U/L; Alkaline Phosphatase (ALK) 99 U/L; Total Bilirubin 0.6 mg/dL; Direct Bilirubin 0.4 mg/dL; Calcium 7.3 mg/dL; Magnesium1.5 mg/dL; Inorganic Phosphorus 2.5 mg/dL; Procalcitonin 59.11 ng/mL; Lactic Acid 1.7 mmol/L; PT 17.7 SEC/INR 1.46; aPTT 49.2 SEC; COVID-19 PCR negative; SARS-CoV-2-IgG negative; Influenza Type A negative; Influenza Type B negative; Venous blood gas: pH 7.24, pCO2 of 24 mmHg ().
Additional diagnostic evaluations included the following:Electrocardiogram: normal sinus rhythm with premature ventricular contractions, heart rate of 94 beats per minute CXR: no focal consolidation or pleural effusion Computed tomography abdomen/pelvis w/o contrast: perinephric stranding and cholestasis Computed tomography head w/o contrast: no new acute intracranial abnormality or mass effect UA w/electrolytes: few white blood cells and red blood cells but no casts, urinary pH of 7.5, urine anion gap of 40, and fractional excretion of sodium of 0.6%
The patient underwent prophylactic right femur nailing with excision of a metastatic lesion and developed a fever of unknown origin, hypotension, acute blood loss, and acute tubular necrosis two weeks before presentation. At that time, she completed treatment with vancomycin, aztreonam, and metronidazole due to a penicillin allergy. However, the infectious workup remained negative throughout the admission. The patient remained afebrile, hemodynamically stable, and safely discharged to a subacute rehabilitation facility.
Four days after discharge, she presented to our emergency department for fever and hypotension. The team initiated the sepsis protocol, and the patient was adequately fluid resuscitated with an appropriate blood pressure response. Blood cultures were collected, and the patient received empiric antibiotic treatment and stress dose hydrocortisone with improvement in her mental status.
Throughout the hospital course, her functional status improved significantly. The patient again agreed to placement in a subacute rehab facility on day fourteen of hospitalization.
The clinical picture was suggestive of sepsis with multiorgan failure in the setting of a new RTA. The patient continued on antibiotics, maintenance fluids with lactated ringers, started on a sodium bicarbonate drip, and was admitted to the medical oncology service for further management. Working differential diagnoses included sepsis, adrenal insufficiency, antimicrobial toxicity, and immunotherapy adverse effects.
The patient completed a seven-day course of antibiotics. Infectious workup, including computed tomography abdominal and pelvis w/o contrast, urine culture, blood cultures, chest x-ray, and transthoracic echocardiogram (TTE), was unremarkable. While tapering the stress dose hydrocortisone, the patient developed transient hypotension, fever, and transaminitis episodes. Per discussion with the infectious disease team and primary oncologist, the thought was that the clinical presentation was likely related to immunotherapy.
Despite the acute renal failure resolution, the patient remained with a severe hyperchloremic non-anion gap metabolic acidosis, along with persistent hypokalemia (the nadir of 2.4 mEq/L) indicating a distal (type-I) RTA.
Although possible, antimicrobial-induced RTA was unlikely due to the resolution of the renal failure and that none of the agents are known culprits to manifest acid/base disturbances []. Giving rise to a suspected immunotherapy-induced RTA, the patient was started on prednisone one mg/kg and transitioned to sodium bicarbonate tablets. Repeat blood work revealed an appropriate response with downtrending liver enzymes and increased serum sodium bicarbonate, indicating a resolving RTA.
Further workup revealed a negative autoimmune panel (anti-Ro (SS-A), anti-La (SS-B), ANA). SPEP, UPEP, free light chains, hepatitis serology, and thyroid function tests were unremarkable. Alkaline urine, a positive urinary anion gap, a nonanion gap metabolic acidosis with low serum bicarbonate, and persistent hypokalemia suggested a distal-type-1 RTA.
The patient followed up with nephrology and oncology as an outpatient. She completed a prednisone taper over four weeks and denied symptoms at the follow-up encounter.",What is the patient's albumin corrected delta ratio? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Chloride': [110.0, 'mEq/L'], 'Albumin': [2.6, 'g/dL'], 'Bicarbonate': [10.0, 'mEq/L'], 'Sodium': [133.0, 'mEq/L']}",0.32143,0.30536,0.3375,"The formula for computing the albumin corrected delta ratio is albumin corrected delta gap (mEq/L)/(24 - bicarbonate mEq/L).
To compute the formula of albumin corrected delta gap, the formula is albumin corrected anion gap (in mEq/L) - 12.
The formula for computing a patient's albumin corrected anion gap is: anion_gap (in mEq/L) + 2.5 * (4 - albumin (in g/dL)).
The formula for computing a patient's anion gap is: sodium (mEq/L) - (chloride (mEq/L)+ bicarbonate (mEq/L)).
The concentration of sodium is 133.0 mEq/L. 
The concentration of chloride is 110.0 mEq/L. 
The concentration of bicarbonate is 10.0 mEq/L. 
Plugging in these values into the anion gap formula gives us 133.0 mEq/L - (110.0 mEq/L + 10.0 mEq/L) = 13.0 mEq/L. Hence, The patient's anion gap is 13.0 mEq/L.The concentration of albumin is 2.6 g/dL. Plugging in these values into the albumin corrected anion gap formula, we get 13.0 (mEq/L) + 2.5 * (4 - 2.6 (in g/dL)) = 16.5 mEq/L. Hence, the patient's albumin corrected anion gap is 16.5 mEq/L.Plugging in 16.5 mEq/L for the anion gap into the albumin corrected delta gap formula, we get 16.5 - 12 = 4.5 mEq/L. Hence, the patient's albumin corrected delta gap is 4.5 mEq/L.Plugging in the albumin corrected delta gap and the bicarbonate concentration into the albumin corrected delta ratio formula, we get 4.5 mEq/L / 14.0 mEq/L = 0.32143. The patient's albumin corrected delta ratio is 0.32143."
828,29,PSI Score: Pneumonia Severity Index for CAP,severity,integer,1,Handwritten,"A 25-year-old male patient presents at the clinic for a routine physical examination. The patient describes a recent episode of fever and altered mental state. He denies any past history of heart disease, renal disease, cerebrovascular disease, liver disease, or cancer. The patient is currently unemployed and lives alone. Upon physical examination, the patient has a measured body temperature of 34 degrees celsius, a heart rate of 101 beats per minute, and a respiratory rate of 32 breaths per minute. His blood pressure measures at 123/85 mm Hg. Laboratory findings show a hematocrit level of 35, a blood glucose level of 15 mmol/L, and a BUN of 33.21 mg/dL. His sodium level is moderately low at 123 mmol/L. Arterial blood gas results show a PaO2 of 67 mm Hg and a slightly acidotic pH of 7.17. The patient's chest X-ray shows no signs of pleural effusion.",What is the patient's Pneumonia Severity Index (PSI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Hematocrit': [35.0, '%'], 'Glucose': [15.0, 'mmol/L'], 'Partial pressure of oxygen': [67.0, 'mm Hg'], 'Congestive Heart Failure': False, 'Renal disease': False, 'Cerebrovascular disease history': False, 'Liver disease severity': False, 'Neoplastic disease': False, 'pH': 7.17, 'Blood Urea Nitrogen (BUN)': [33.21, 'mg/dL'], 'age': [25.0, 'years'], 'Altered mental status': True, 'Temperature': [34.0, 'degrees celsius'], 'Sodium': [123.0, 'mmol/L'], 'Heart Rate or Pulse': [101.0, 'beats per minute'], 'Pleural effusion on x-ray': False, 'sex': 'Male', 'Systolic Blood Pressure': [123.0, 'mm Hg'], 'respiratory rate': [32.0, 'breaths per minute'], 'Nursing home resident': False}",160,160,160,"The rules for computing the Pneumonia Severity Index (PSI) are shown below:

1. Age: Enter age in years (age score will be equal to age in years)
2. Sex: Female = -10 points, Male = 0 points
3. Nursing home resident: No = 0 points, Yes = +10 points
4. Neoplastic disease: No = 0 points, Yes = +30 points
5. Liver disease history: No = 0 points, Yes = +20 points
6. Congestive heart failure (CHF) history: No = 0 points, Yes = +10 points
7. Cerebrovascular disease history: No = 0 points, Yes = +10 points
8. Renal disease history: No = 0 points, Yes = +10 points
9. Altered mental status: No = 0 points, Yes = +20 points
10. Respiratory rate ≥30 breaths/min: No = 0 points, Yes = +20 points
11. Systolic blood pressure <90 mmHg: No = 0 points, Yes = +20 points
12. Temperature <35°C (95°F) or >39.9°C (103.8°F): No = 0 points, Yes = +15 points
13. Pulse ≥125 beats/min: No = 0 points, Yes = +10 points
14. pH <7.35: No = 0 points, Yes = +30 points
15. BUN ≥30 mg/dL or ≥11 mmol/L: No = 0 points, Yes = +20 points
16. Sodium <130 mmol/L: No = 0 points, Yes = +20 points
17. Glucose ≥250 mg/dL or ≥14 mmol/L: No = 0 points, Yes = +10 points
18. Hematocrit <30%: No = 0 points, Yes = +10 points
19. Partial pressure of oxygen <60 mmHg or <8 kPa: No = 0 points, Yes = +10 points
20. Pleural effusion on x-ray: No = 0 points, Yes = +10 points

The total score is calculated by summing the points for each criterion.

The current PSI score is 0.
The patient is 25.0 years old. We add the the number of years of age of the patient to the psi score, making the current total 0 + 25.0 = 25.0.
Because the patient is male, no adjustments are made to the score, keeping the current total at 25.0.
The patient is not a nursing home resident and so we do not add any points to the current total keeping it at 25.0.
Neoplastic disease is determined to be false for the patient and so we do not add any points to the current total keeping it at 25.0.
Liver disease history is determined to be false for the patient and so we do not add any points to the current total keeping it at 25.0.
CHF History is determined to be false for the patient and so we do not add any points to the current total keeping it at 25.0.
Cerebrovascular disease history is determined to be false for the patient and so we do not add any points to the current total keeping it at 25.0.
Renal Disease History is determined to be false for the patient and so we do not add any points to the current total keeping it at 25.0.
Altered Mental Status is determined to be present for the patient and so we add 20 points to the score, making the current total 25.0 + 20 = 45.0.
Pleural effusion on x-ray is determined to be false for the patient and so we do not add any points to the current total keeping it at 45.0.
The patient's pulse is 101.0 beats per minute. The pulse is less than 125 beats per minute and so we do not add any points to the score, keeping it at 45.0.
The patient's temperature is 34.0 degrees celsius. The patient's temperature is less than 35 degrees celsius, and so we add 15 points to the score, making the current total 45.0 + 15 = 60.0.
The patient's pH is 7.17. The patient's pH is less than 7.35, and so we add 30 points to the score, making the current total 60.0 + 30 = 90.0.
The patient's respiratory rate is 32.0 breaths per minute. The patient's respiratory rate is greater than or equal to 30 breaths per minute and so we add 20 points to the score, making current total 90.0 + 20 = 110.0.
The patient's systolic blood pressure is 123.0 mm Hg. The patient's systolic blood pressure is greater than or equal to 90 mm Hg and so we do not add any points to the score, keeping the total at 110.0.
The concentration of BUN is 33.21 mg/dL. The patient's BUN is greater than or equal to 30 mg/dL, and so we add 20 points to the score, making current total 110.0 + 20 = 130.0.
The concentration of sodium is 123.0 mmol/L. The patient's sodium is less than 130 mmol/L, and so we add 20 points to the score, making the current total 130.0 + 20 = 150.0.
The concentration of glucose is 15.0 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of glucose from mmol to mg. The mass of glucose is 15.0 mmol. To convert 15.0 mmol of glucose to mol, multiply by the conversion factor 0.001, giving us 15.0 mmol glucose * 0.001 mol/mmol = 0.015 mol glucose. To convert from mol glucose to grams, multiply by the molar mass 180.16 g/mol, which will give 0.015 mol glucose * 180.16 g/mol = 2.702 g glucose. To convert 2.702 g of glucose to mg, multiply by the conversion factor 1000.0, giving us 2.702 g glucose * 1000.0 mg/g = 2702.0 mg glucose. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 2702.0 mg glucose/10.0 dL = 270.2 mg glucose/dL. The concentration value of 15.0 mmol glucose/L converts to 270.2 mg glucose/dL. The patient's glucose concentration is greater than 250 mg/dL, and so we add 10 points to the score, making the current total 150.0 + 10 = 160.0.
The patient's hematocrit is 35.0 %. The patient's hematocrit is greater than or equal to 30%, and so we not add any points to the current total, keeping it at 160.0.
The patient's partial pressure of oxygen is 67.0 mm Hg. The patient's partial pressure of oxygen is greater than or equal to 60 mm Hg, and so we not add any points to the current total, keeping it at 160.0.
The patient's PSI score is 160.0."
829,29,PSI Score: Pneumonia Severity Index for CAP,severity,integer,2,Handwritten,"A 64-year-old male patient presents to the emergency department with complaints of fever, disorientation, and rapid breathing. His history includes renal disease and liver disease, but has no documented history of heart failure or cerebrovascular disease. The patient is not currently residing in a nursing home and has no history of neoplastic disease. On examination, his vital signs are as follows: Heart rate of 94 beats per minute, respiratory rate of 34 breaths per minute, blood pressure 94/70 mm Hg, and a temperature of 38 degrees celsius. The patient's altered mental status is consistent with potential encephalopathy. Laboratory workup shows a hematocrit of 37 and a glucose level of 251.12 mg/dL, indicative of hyperglycemia. The blood urea nitrogen levels are relatively high at 26.75 mg/dL, with a sodium level of 128.43 mmol/L. Arterial blood gas results indicate a PaO2 level of 75 mm Hg and an alkalotic pH level of 7.60. A chest X-ray reveals the presence of a pleural effusion.",What is the patient's Pneumonia Severity Index (PSI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Hematocrit': [37.0, '%'], 'Glucose': [251.12, 'mg/dL'], 'Partial pressure of oxygen': [75.0, 'mm Hg'], 'Congestive Heart Failure': False, 'Renal disease': True, 'Cerebrovascular disease history': False, 'Liver disease severity': True, 'Neoplastic disease': False, 'pH': 7.6, 'Blood Urea Nitrogen (BUN)': [26.75, 'mg/dL'], 'age': [64.0, 'years'], 'Altered mental status': True, 'Temperature': [38.0, 'degrees celsius'], 'Sodium': [128.43, 'mmol/L'], 'Heart Rate or Pulse': [94.0, 'beats per minute'], 'Pleural effusion on x-ray': True, 'sex': 'Male', 'Systolic Blood Pressure': [94.0, 'mm Hg'], 'respiratory rate': [34.0, 'breaths per minute'], 'Nursing home resident': False}",174,174,174,"The rules for computing the Pneumonia Severity Index (PSI) are shown below:

1. Age: Enter age in years (age score will be equal to age in years)
2. Sex: Female = -10 points, Male = 0 points
3. Nursing home resident: No = 0 points, Yes = +10 points
4. Neoplastic disease: No = 0 points, Yes = +30 points
5. Liver disease history: No = 0 points, Yes = +20 points
6. Congestive heart failure (CHF) history: No = 0 points, Yes = +10 points
7. Cerebrovascular disease history: No = 0 points, Yes = +10 points
8. Renal disease history: No = 0 points, Yes = +10 points
9. Altered mental status: No = 0 points, Yes = +20 points
10. Respiratory rate ≥30 breaths/min: No = 0 points, Yes = +20 points
11. Systolic blood pressure <90 mmHg: No = 0 points, Yes = +20 points
12. Temperature <35°C (95°F) or >39.9°C (103.8°F): No = 0 points, Yes = +15 points
13. Pulse ≥125 beats/min: No = 0 points, Yes = +10 points
14. pH <7.35: No = 0 points, Yes = +30 points
15. BUN ≥30 mg/dL or ≥11 mmol/L: No = 0 points, Yes = +20 points
16. Sodium <130 mmol/L: No = 0 points, Yes = +20 points
17. Glucose ≥250 mg/dL or ≥14 mmol/L: No = 0 points, Yes = +10 points
18. Hematocrit <30%: No = 0 points, Yes = +10 points
19. Partial pressure of oxygen <60 mmHg or <8 kPa: No = 0 points, Yes = +10 points
20. Pleural effusion on x-ray: No = 0 points, Yes = +10 points

The total score is calculated by summing the points for each criterion.

The current PSI score is 0.
The patient is 64.0 years old. We add the the number of years of age of the patient to the psi score, making the current total 0 + 64.0 = 64.0.
Because the patient is male, no adjustments are made to the score, keeping the current total at 64.0.
The patient is not a nursing home resident and so we do not add any points to the current total keeping it at 64.0.
Neoplastic disease is determined to be false for the patient and so we do not add any points to the current total keeping it at 64.0.
Liver disease history is determined to be present for the patient and so we add 20 points to the score, making the current total 64.0 + 20 = 84.0.
CHF History is determined to be false for the patient and so we do not add any points to the current total keeping it at 84.0.
Cerebrovascular disease history is determined to be false for the patient and so we do not add any points to the current total keeping it at 84.0.
Renal Disease History is determined to be present for the patient and so we add 10 points to the score, making the current total 84.0 + 10 = 94.0.
Altered Mental Status is determined to be present for the patient and so we add 20 points to the score, making the current total 94.0 + 20 = 114.0.
Pleural effusion on x-ray is determined to be present for the patient and so we add 10 points to the score, making the current total 114.0 + 10 = 124.0.
The patient's pulse is 94.0 beats per minute. The pulse is less than 125 beats per minute and so we do not add any points to the score, keeping it at 124.0.
The patient's temperature is 38.0 degrees celsius. The patient's temperature is greater than 35 degrees celsius and the temperature is less than 39.9 degrees celsius, and so we do not add any points to the score, keeping the total at 124.0.
The patient's pH is 7.6. The patient's pH is greater than or equal to 7.35, and so we do not add any points to the score, keeping the current total at 124.0.
The patient's respiratory rate is 34.0 breaths per minute. The patient's respiratory rate is greater than or equal to 30 breaths per minute and so we add 20 points to the score, making current total 124.0 + 20 = 144.0.
The patient's systolic blood pressure is 94.0 mm Hg. The patient's systolic blood pressure is greater than or equal to 90 mm Hg and so we do not add any points to the score, keeping the total at 144.0.
The concentration of BUN is 26.75 mg/dL. The patient's BUN is less than 30 mg/dL, and so we do not add any points to the score, keeping the total at 144.0.
The concentration of sodium is 128.43 mmol/L. The patient's sodium is less than 130 mmol/L, and so we add 20 points to the score, making the current total 144.0 + 20 = 164.0.
The concentration of glucose is 251.12 mg/dL. The patient's glucose concentration is greater than 250 mg/dL, and so we add 10 points to the score, making the current total 164.0 + 10 = 174.0.
The patient's hematocrit is 37.0 %. The patient's hematocrit is greater than or equal to 30%, and so we not add any points to the current total, keeping it at 174.0.
The patient's partial pressure of oxygen is 75.0 mm Hg. The patient's partial pressure of oxygen is greater than or equal to 60 mm Hg, and so we not add any points to the current total, keeping it at 174.0.
The patient's PSI score is 174.0."
830,29,PSI Score: Pneumonia Severity Index for CAP,severity,integer,3,Handwritten,"A 77-year-old female patient with a past medical history significant for chronic kidney disease and previous cerebrovascular accident, with otherwise no history of liver disease, neoplastic disease, or congestive heart failure visits the outpatient clinic today for increased fatigue and confusion over the past week. She is not a nursing home resident and has no change in her mental status at present. Physical exam notes a temperature of 42 degrees celsius, a heart rate of 130 beats per minute, a respiratory rate of 34 breaths per minute, and a blood pressure reading of 87/70 mm Hg. Lab studies reveal a hematocrit of 37, a sodium level of 117 mmol/L and an elevated random blood glucose of 250.21 mg/dL. Her blood urea nitrogen (BUN) level is significantly high at 36.75 mg/dL. An arterial blood gas analysis shows a PaO2 of 87 mm Hg and a normal pH at 7.39. A chest X-ray shows no signs of any pleural effusion.",What is the patient's Pneumonia Severity Index (PSI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Hematocrit': [37.0, '%'], 'Glucose': [250.21, 'mg/dL'], 'Partial pressure of oxygen': [87.0, 'mm Hg'], 'Congestive Heart Failure': False, 'Renal disease': True, 'Cerebrovascular disease history': True, 'Liver disease severity': False, 'Neoplastic disease': False, 'pH': 7.39, 'Blood Urea Nitrogen (BUN)': [36.75, 'mg/dL'], 'age': [77.0, 'years'], 'Altered mental status': False, 'Temperature': [42.0, 'degrees celsius'], 'Sodium': [117.0, 'mmol/L'], 'Heart Rate or Pulse': [130.0, 'beats per minute'], 'Pleural effusion on x-ray': False, 'sex': 'Female', 'Systolic Blood Pressure': [87.0, 'mm Hg'], 'respiratory rate': [34.0, 'breaths per minute'], 'Nursing home resident': False}",202,202,202,"The rules for computing the Pneumonia Severity Index (PSI) are shown below:

1. Age: Enter age in years (age score will be equal to age in years)
2. Sex: Female = -10 points, Male = 0 points
3. Nursing home resident: No = 0 points, Yes = +10 points
4. Neoplastic disease: No = 0 points, Yes = +30 points
5. Liver disease history: No = 0 points, Yes = +20 points
6. Congestive heart failure (CHF) history: No = 0 points, Yes = +10 points
7. Cerebrovascular disease history: No = 0 points, Yes = +10 points
8. Renal disease history: No = 0 points, Yes = +10 points
9. Altered mental status: No = 0 points, Yes = +20 points
10. Respiratory rate ≥30 breaths/min: No = 0 points, Yes = +20 points
11. Systolic blood pressure <90 mmHg: No = 0 points, Yes = +20 points
12. Temperature <35°C (95°F) or >39.9°C (103.8°F): No = 0 points, Yes = +15 points
13. Pulse ≥125 beats/min: No = 0 points, Yes = +10 points
14. pH <7.35: No = 0 points, Yes = +30 points
15. BUN ≥30 mg/dL or ≥11 mmol/L: No = 0 points, Yes = +20 points
16. Sodium <130 mmol/L: No = 0 points, Yes = +20 points
17. Glucose ≥250 mg/dL or ≥14 mmol/L: No = 0 points, Yes = +10 points
18. Hematocrit <30%: No = 0 points, Yes = +10 points
19. Partial pressure of oxygen <60 mmHg or <8 kPa: No = 0 points, Yes = +10 points
20. Pleural effusion on x-ray: No = 0 points, Yes = +10 points

The total score is calculated by summing the points for each criterion.

The current PSI score is 0.
The patient is 77.0 years old. We add the the number of years of age of the patient to the psi score, making the current total 0 + 77.0 = 77.0.
Because the patient is female, we subtract 10 points from the current total, making the current total 77.0 - 10 = 67.0.
The patient is not a nursing home resident and so we do not add any points to the current total keeping it at 67.0.
Neoplastic disease is determined to be false for the patient and so we do not add any points to the current total keeping it at 67.0.
Liver disease history is determined to be false for the patient and so we do not add any points to the current total keeping it at 67.0.
CHF History is determined to be false for the patient and so we do not add any points to the current total keeping it at 67.0.
Cerebrovascular disease history is determined to be present for the patient and so we add 10 points to the score, making the current total 67.0 + 10 = 77.0.
Renal Disease History is determined to be present for the patient and so we add 10 points to the score, making the current total 77.0 + 10 = 87.0.
Altered Mental Status is determined to be false for the patient and so we do not add any points to the current total keeping it at 87.0.
Pleural effusion on x-ray is determined to be false for the patient and so we do not add any points to the current total keeping it at 87.0.
The patient's pulse is 130.0 beats per minute. The pulse is greater or equal to than 125 beats per minute, and so we add 10 points to the score, making the current total 87.0 + 10 = 97.0.
The patient's temperature is 42.0 degrees celsius. The patient's temperature is greater than 39.9 degrees celsius and so we add 15 points to the score, making the current total 97.0 + 15 = 112.0.
The patient's pH is 7.39. The patient's pH is greater than or equal to 7.35, and so we do not add any points to the score, keeping the current total at 112.0.
The patient's respiratory rate is 34.0 breaths per minute. The patient's respiratory rate is greater than or equal to 30 breaths per minute and so we add 20 points to the score, making current total 112.0 + 20 = 132.0.
The patient's systolic blood pressure is 87.0 mm Hg. The patient's systolic blood pressure is less than 90 mm Hg and so we add 20 points to the score, making current total 132.0 + 20 = 152.0.
The concentration of BUN is 36.75 mg/dL. The patient's BUN is greater than or equal to 30 mg/dL, and so we add 20 points to the score, making current total 152.0 + 20 = 172.0.
The concentration of sodium is 117.0 mmol/L. The patient's sodium is less than 130 mmol/L, and so we add 20 points to the score, making the current total 172.0 + 20 = 192.0.
The concentration of glucose is 250.21 mg/dL. The patient's glucose concentration is greater than 250 mg/dL, and so we add 10 points to the score, making the current total 192.0 + 10 = 202.0.
The patient's hematocrit is 37.0 %. The patient's hematocrit is greater than or equal to 30%, and so we not add any points to the current total, keeping it at 202.0.
The patient's partial pressure of oxygen is 87.0 mm Hg. The patient's partial pressure of oxygen is greater than or equal to 60 mm Hg, and so we not add any points to the current total, keeping it at 202.0.
The patient's PSI score is 202.0."
831,29,PSI Score: Pneumonia Severity Index for CAP,severity,integer,4,Handwritten,"A 73-year-old female patient coming from her house arrives at the emergency department. She had an altered mental status onset around an hour prior to arrival. She denies any past medical history of congestive heart failure, renal disease, cerebrovascular disease, liver disease, or neoplastic disease. Her vital signs on presentation include a body temperature of 36 degrees celsius, heart rate of 130 beats per minute, respiratory rate of 31 breaths per minute, and a blood pressure of 140/90 mm Hg. Laboratory findings demonstrated a hematocrit of 28, an elevated glucose level of 17 mmol/L, and a blood urea nitrogen level of 28.43 mg/dL. Sodium was slightly low at 127 mmol/L, and Arterial blood gas results showed a PaO2 of 59 mm Hg and an alkalotic pH of 7.81. The patient's chest X-ray was positive for pleural effusion.",What is the patient's Pneumonia Severity Index (PSI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Hematocrit': [28.0, '%'], 'Glucose': [17.0, 'mmol/L'], 'Partial pressure of oxygen': [59.0, 'mm Hg'], 'Congestive Heart Failure': False, 'Renal disease': False, 'Cerebrovascular disease history': False, 'Liver disease severity': False, 'Neoplastic disease': False, 'pH': 7.81, 'Blood Urea Nitrogen (BUN)': [28.43, 'mg/dL'], 'age': [73.0, 'years'], 'Altered mental status': True, 'Temperature': [36.0, 'degrees celsius'], 'Sodium': [127.0, 'mmol/L'], 'Heart Rate or Pulse': [130.0, 'beats per minute'], 'Pleural effusion on x-ray': True, 'sex': 'Female', 'Systolic Blood Pressure': [140.0, 'mm Hg'], 'respiratory rate': [31.0, 'breaths per minute'], 'Nursing home resident': False}",173,173,173,"The rules for computing the Pneumonia Severity Index (PSI) are shown below:

1. Age: Enter age in years (age score will be equal to age in years)
2. Sex: Female = -10 points, Male = 0 points
3. Nursing home resident: No = 0 points, Yes = +10 points
4. Neoplastic disease: No = 0 points, Yes = +30 points
5. Liver disease history: No = 0 points, Yes = +20 points
6. Congestive heart failure (CHF) history: No = 0 points, Yes = +10 points
7. Cerebrovascular disease history: No = 0 points, Yes = +10 points
8. Renal disease history: No = 0 points, Yes = +10 points
9. Altered mental status: No = 0 points, Yes = +20 points
10. Respiratory rate ≥30 breaths/min: No = 0 points, Yes = +20 points
11. Systolic blood pressure <90 mmHg: No = 0 points, Yes = +20 points
12. Temperature <35°C (95°F) or >39.9°C (103.8°F): No = 0 points, Yes = +15 points
13. Pulse ≥125 beats/min: No = 0 points, Yes = +10 points
14. pH <7.35: No = 0 points, Yes = +30 points
15. BUN ≥30 mg/dL or ≥11 mmol/L: No = 0 points, Yes = +20 points
16. Sodium <130 mmol/L: No = 0 points, Yes = +20 points
17. Glucose ≥250 mg/dL or ≥14 mmol/L: No = 0 points, Yes = +10 points
18. Hematocrit <30%: No = 0 points, Yes = +10 points
19. Partial pressure of oxygen <60 mmHg or <8 kPa: No = 0 points, Yes = +10 points
20. Pleural effusion on x-ray: No = 0 points, Yes = +10 points

The total score is calculated by summing the points for each criterion.

The current PSI score is 0.
The patient is 73.0 years old. We add the the number of years of age of the patient to the psi score, making the current total 0 + 73.0 = 73.0.
Because the patient is female, we subtract 10 points from the current total, making the current total 73.0 - 10 = 63.0.
The patient is not a nursing home resident and so we do not add any points to the current total keeping it at 63.0.
Neoplastic disease is determined to be false for the patient and so we do not add any points to the current total keeping it at 63.0.
Liver disease history is determined to be false for the patient and so we do not add any points to the current total keeping it at 63.0.
CHF History is determined to be false for the patient and so we do not add any points to the current total keeping it at 63.0.
Cerebrovascular disease history is determined to be false for the patient and so we do not add any points to the current total keeping it at 63.0.
Renal Disease History is determined to be false for the patient and so we do not add any points to the current total keeping it at 63.0.
Altered Mental Status is determined to be present for the patient and so we add 20 points to the score, making the current total 63.0 + 20 = 83.0.
Pleural effusion on x-ray is determined to be present for the patient and so we add 10 points to the score, making the current total 83.0 + 10 = 93.0.
The patient's pulse is 130.0 beats per minute. The pulse is greater or equal to than 125 beats per minute, and so we add 10 points to the score, making the current total 93.0 + 10 = 103.0.
The patient's temperature is 36.0 degrees celsius. The patient's temperature is greater than 35 degrees celsius and the temperature is less than 39.9 degrees celsius, and so we do not add any points to the score, keeping the total at 103.0.
The patient's pH is 7.81. The patient's pH is greater than or equal to 7.35, and so we do not add any points to the score, keeping the current total at 103.0.
The patient's respiratory rate is 31.0 breaths per minute. The patient's respiratory rate is greater than or equal to 30 breaths per minute and so we add 20 points to the score, making current total 103.0 + 20 = 123.0.
The patient's systolic blood pressure is 140.0 mm Hg. The patient's systolic blood pressure is greater than or equal to 90 mm Hg and so we do not add any points to the score, keeping the total at 123.0.
The concentration of BUN is 28.43 mg/dL. The patient's BUN is less than 30 mg/dL, and so we do not add any points to the score, keeping the total at 123.0.
The concentration of sodium is 127.0 mmol/L. The patient's sodium is less than 130 mmol/L, and so we add 20 points to the score, making the current total 123.0 + 20 = 143.0.
The concentration of glucose is 17.0 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of glucose from mmol to mg. The mass of glucose is 17.0 mmol. To convert 17.0 mmol of glucose to mol, multiply by the conversion factor 0.001, giving us 17.0 mmol glucose * 0.001 mol/mmol = 0.017 mol glucose. To convert from mol glucose to grams, multiply by the molar mass 180.16 g/mol, which will give 0.017 mol glucose * 180.16 g/mol = 3.063 g glucose. To convert 3.063 g of glucose to mg, multiply by the conversion factor 1000.0, giving us 3.063 g glucose * 1000.0 mg/g = 3063.0 mg glucose. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 3063.0 mg glucose/10.0 dL = 306.3 mg glucose/dL. The concentration value of 17.0 mmol glucose/L converts to 306.3 mg glucose/dL. The patient's glucose concentration is greater than 250 mg/dL, and so we add 10 points to the score, making the current total 143.0 + 10 = 153.0.
The patient's hematocrit is 28.0 %. The patient's hematocrit is less than 30%, and so we add 10 points to the score, making the current total 153.0 + 10 = 163.0.
The patient's partial pressure of oxygen is 59.0 mm Hg. The patient's partial pressure of oxygen is less than 60 mm Hg, and so we add 163.0 points to the score, making the current total 163.0 + 10 = 173.0.
The patient's PSI score is 173.0."
832,29,PSI Score: Pneumonia Severity Index for CAP,severity,integer,5,Handwritten,"A 72-year-old female patient with a past medical history of stroke and congestive heart failure, is brought to the emergency department unclear of any kidney or liver diseases previously. She is alert and responsive, with an afebrile body temperature of 37.6 degrees celsius. Her vital signs include a heart rate of 85 beats per minute, a respiratory rate of 20 breaths per minute, and a blood pressure of 125/85 mm Hg. Laboratory studies report a hematocrit level of 39 % an average glucose level of 122 mg/dL, and a blood urea nitrogen (BUN) level of 22 mg/dL. Her sodium level is normal at 138 mEq/L. Analysis of arterial blood gas showed pH to be 7.2 indicating mild acidemia and the partial pressure of oxygen (PaO₂) is 75 mm Hg. The patient's chest X-ray could not be reviewed during the examination.",What is the patient's Pneumonia Severity Index (PSI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [85.0, 'beats per minute'], 'pH': 7.2, 'Altered mental status': False, 'Systolic Blood Pressure': [125.0, 'mm Hg'], 'Blood Urea Nitrogen (BUN)': [22.0, 'mg/dL'], 'Renal disease': False, 'Cerebrovascular disease history': True, 'Sodium': [138.0, 'mEq/L'], 'Liver disease severity': False, 'Congestive Heart Failure': True, 'Partial pressure of oxygen': [75.0, 'mm Hg'], 'age': [72.0, 'years'], 'respiratory rate': [20.0, 'breaths per minute'], 'sex': 'Female', 'Hematocrit': [39.0, '%'], 'Glucose': [122.0, 'mg/dL'], 'Temperature': [37.6, 'degrees celsius']}",112,112,112,"The rules for computing the Pneumonia Severity Index (PSI) are shown below:

1. Age: Enter age in years (age score will be equal to age in years)
2. Sex: Female = -10 points, Male = 0 points
3. Nursing home resident: No = 0 points, Yes = +10 points
4. Neoplastic disease: No = 0 points, Yes = +30 points
5. Liver disease history: No = 0 points, Yes = +20 points
6. Congestive heart failure (CHF) history: No = 0 points, Yes = +10 points
7. Cerebrovascular disease history: No = 0 points, Yes = +10 points
8. Renal disease history: No = 0 points, Yes = +10 points
9. Altered mental status: No = 0 points, Yes = +20 points
10. Respiratory rate ≥30 breaths/min: No = 0 points, Yes = +20 points
11. Systolic blood pressure <90 mmHg: No = 0 points, Yes = +20 points
12. Temperature <35°C (95°F) or >39.9°C (103.8°F): No = 0 points, Yes = +15 points
13. Pulse ≥125 beats/min: No = 0 points, Yes = +10 points
14. pH <7.35: No = 0 points, Yes = +30 points
15. BUN ≥30 mg/dL or ≥11 mmol/L: No = 0 points, Yes = +20 points
16. Sodium <130 mmol/L: No = 0 points, Yes = +20 points
17. Glucose ≥250 mg/dL or ≥14 mmol/L: No = 0 points, Yes = +10 points
18. Hematocrit <30%: No = 0 points, Yes = +10 points
19. Partial pressure of oxygen <60 mmHg or <8 kPa: No = 0 points, Yes = +10 points
20. Pleural effusion on x-ray: No = 0 points, Yes = +10 points

The total score is calculated by summing the points for each criterion.

The current PSI score is 0.
The patient is 72.0 years old. We add the the number of years of age of the patient to the psi score, making the current total 0 + 72.0 = 72.0.
Because the patient is female, we subtract 10 points from the current total, making the current total 72.0 - 10 = 62.0.
Whether patient is a nursing home resident is not reported. Hence, we assume this to be false and so not add any points to the current total keeping it at 62.0.
Neoplastic disease is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 62.0.
Liver disease history is determined to be false for the patient and so we do not add any points to the current total keeping it at 62.0.
CHF History is determined to be present for the patient and so we add 10 points to the score, making the current total 62.0 + 10 = 72.0.
Cerebrovascular disease history is determined to be present for the patient and so we add 10 points to the score, making the current total 72.0 + 10 = 82.0.
Renal Disease History is determined to be false for the patient and so we do not add any points to the current total keeping it at 82.0.
Altered Mental Status is determined to be false for the patient and so we do not add any points to the current total keeping it at 82.0.
Pleural effusion on x-ray is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 82.0.
The patient's pulse is 85.0 beats per minute. The pulse is less than 125 beats per minute and so we do not add any points to the score, keeping it at 82.0.
The patient's temperature is 37.6 degrees celsius. The patient's temperature is greater than 35 degrees celsius and the temperature is less than 39.9 degrees celsius, and so we do not add any points to the score, keeping the total at 82.0.
The patient's pH is 7.2. The patient's pH is less than 7.35, and so we add 30 points to the score, making the current total 82.0 + 30 = 112.0.
The patient's respiratory rate is 20.0 breaths per minute. The patient's respiratory rate is less than 30 breaths per minute and so we do not add any points to the score, keeping the total score at 112.0.
The patient's systolic blood pressure is 125.0 mm Hg. The patient's systolic blood pressure is greater than or equal to 90 mm Hg and so we do not add any points to the score, keeping the total at 112.0.
The concentration of BUN is 22.0 mg/dL. The patient's BUN is less than 30 mg/dL, and so we do not add any points to the score, keeping the total at 112.0.
The concentration of sodium is 138.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 138.0 mEq. To convert from 138.0 mEq to mmol, convert from mEq to mmol. The compound 138.0 has a valence of 1, and so divide the valence by the value of mEq to get, 138.0 mEq/(1 mEq/mmol) = 138.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 138.0 mEq sodium/L converts to 138.0 mmol sodium/L. The patient's sodium is greater than or equal to 130 mmol/L, and so we do not add any points to the score, keeping the total at 112.0.
The concentration of glucose is 122.0 mg/dL. The patient's glucose concentration is less than or equal to than 250 mg/dL, and so we not add any points to the current total, keeping it at 112.0.
The patient's hematocrit is 39.0 %. The patient's hematocrit is greater than or equal to 30%, and so we not add any points to the current total, keeping it at 112.0.
The patient's partial pressure of oxygen is 75.0 mm Hg. The patient's partial pressure of oxygen is greater than or equal to 60 mm Hg, and so we not add any points to the current total, keeping it at 112.0.
The patient's PSI score is 112.0."
833,29,PSI Score: Pneumonia Severity Index for CAP,severity,integer,6,Handwritten,"A 78-year-old male who lives independently, presents to the emergency department with an altered mental status. His past medical history includes renal disease and he is currently under treatment for neoplasia. He doesn’t have a history of any liver disease. On examination, the patient is found with a temperature of 99.5 degrees Fahrenheit, heart rate of 85 beats per minute, respiratory rate of 24 breaths per minute, and blood pressure of 115/75 mm Hg. Laboratory tests report a hematocrit of 33%, a glucose level of 7.2 mmol/L, and a blood urea nitrogen level of 30 mg/dl. His sodium level is within the normal range at 140 mEq/L. Arterial Blood Gas shows a pH of 7.35 and PaO2 of 70 mm Hg. The chest X-ray does not denote any pleural effusion. His cardiovascular history could not be ascertained during medical inquiries.",What is the patient's Pneumonia Severity Index (PSI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [85.0, 'beats per minute'], 'pH': 7.35, 'Altered mental status': True, 'Systolic Blood Pressure': [115, 'mm Hg'], 'Blood Urea Nitrogen (BUN)': [30, 'mg/dL'], 'Renal disease': True, 'Sodium': [140.0, 'mEq/L'], 'Liver disease severity': False, 'Partial pressure of oxygen': [70.0, 'mm Hg'], 'age': [78, 'years'], 'respiratory rate': [24, 'breaths per minute'], 'sex': 'Male', 'Hematocrit': [33, '%'], 'Glucose': [7.2, 'mmol/L'], 'Temperature': [99.5, 'degrees fahrenheit'], 'Pleural effusion on x-ray': False, 'Neoplastic disease': True}",158,158,158,"The rules for computing the Pneumonia Severity Index (PSI) are shown below:

1. Age: Enter age in years (age score will be equal to age in years)
2. Sex: Female = -10 points, Male = 0 points
3. Nursing home resident: No = 0 points, Yes = +10 points
4. Neoplastic disease: No = 0 points, Yes = +30 points
5. Liver disease history: No = 0 points, Yes = +20 points
6. Congestive heart failure (CHF) history: No = 0 points, Yes = +10 points
7. Cerebrovascular disease history: No = 0 points, Yes = +10 points
8. Renal disease history: No = 0 points, Yes = +10 points
9. Altered mental status: No = 0 points, Yes = +20 points
10. Respiratory rate ≥30 breaths/min: No = 0 points, Yes = +20 points
11. Systolic blood pressure <90 mmHg: No = 0 points, Yes = +20 points
12. Temperature <35°C (95°F) or >39.9°C (103.8°F): No = 0 points, Yes = +15 points
13. Pulse ≥125 beats/min: No = 0 points, Yes = +10 points
14. pH <7.35: No = 0 points, Yes = +30 points
15. BUN ≥30 mg/dL or ≥11 mmol/L: No = 0 points, Yes = +20 points
16. Sodium <130 mmol/L: No = 0 points, Yes = +20 points
17. Glucose ≥250 mg/dL or ≥14 mmol/L: No = 0 points, Yes = +10 points
18. Hematocrit <30%: No = 0 points, Yes = +10 points
19. Partial pressure of oxygen <60 mmHg or <8 kPa: No = 0 points, Yes = +10 points
20. Pleural effusion on x-ray: No = 0 points, Yes = +10 points

The total score is calculated by summing the points for each criterion.

The current PSI score is 0.
The patient is 78 years old. We add the the number of years of age of the patient to the psi score, making the current total 0 + 78 = 78.
Because the patient is male, no adjustments are made to the score, keeping the current total at 78.
Whether patient is a nursing home resident is not reported. Hence, we assume this to be false and so not add any points to the current total keeping it at 78.
Neoplastic disease is determined to be present for the patient and so we add 30 points to the score, making the current total 78 + 30 = 108.
Liver disease history is determined to be false for the patient and so we do not add any points to the current total keeping it at 108.
CHF History is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 108.
Cerebrovascular disease history is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 108.
Renal Disease History is determined to be present for the patient and so we add 10 points to the score, making the current total 108 + 10 = 118.
Altered Mental Status is determined to be present for the patient and so we add 20 points to the score, making the current total 118 + 20 = 138.
Pleural effusion on x-ray is determined to be false for the patient and so we do not add any points to the current total keeping it at 138.
The patient's pulse is 85.0 beats per minute. The pulse is less than 125 beats per minute and so we do not add any points to the score, keeping it at 138.
The patient's temperature is 99.5 degrees fahrenheit. To convert to degrees celsius, apply the formula 5/9 * [temperature (degrees fahrenheit) - 32]. This means that the patient's temperature is 5/9 * 67.5 = 37.5 degrees celsius. The patient's temperature is greater than 35 degrees celsius and the temperature is less than 39.9 degrees celsius, and so we do not add any points to the score, keeping the total at 138.
The patient's pH is 7.35. The patient's pH is greater than or equal to 7.35, and so we do not add any points to the score, keeping the current total at 138.
The patient's respiratory rate is 24 breaths per minute. The patient's respiratory rate is less than 30 breaths per minute and so we do not add any points to the score, keeping the total score at 138.
The patient's systolic blood pressure is 115 mm Hg. The patient's systolic blood pressure is greater than or equal to 90 mm Hg and so we do not add any points to the score, keeping the total at 138.
The concentration of BUN is 30 mg/dL. The patient's BUN is greater than or equal to 30 mg/dL, and so we add 20 points to the score, making current total 138 + 20 = 158.
The concentration of sodium is 140.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 140.0 mEq. To convert from 140.0 mEq to mmol, convert from mEq to mmol. The compound 140.0 has a valence of 1, and so divide the valence by the value of mEq to get, 140.0 mEq/(1 mEq/mmol) = 140.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 140.0 mEq sodium/L converts to 140.0 mmol sodium/L. The patient's sodium is greater than or equal to 130 mmol/L, and so we do not add any points to the score, keeping the total at 158.
The concentration of glucose is 7.2 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of glucose from mmol to mg. The mass of glucose is 7.2 mmol. To convert 7.2 mmol of glucose to mol, multiply by the conversion factor 0.001, giving us 7.2 mmol glucose * 0.001 mol/mmol = 0.007 mol glucose. To convert from mol glucose to grams, multiply by the molar mass 180.16 g/mol, which will give 0.007 mol glucose * 180.16 g/mol = 1.261 g glucose. To convert 1.261 g of glucose to mg, multiply by the conversion factor 1000.0, giving us 1.261 g glucose * 1000.0 mg/g = 1261.0 mg glucose. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 1261.0 mg glucose/10.0 dL = 126.1 mg glucose/dL. The concentration value of 7.2 mmol glucose/L converts to 126.1 mg glucose/dL. The patient's glucose concentration is less than or equal to than 250 mg/dL, and so we not add any points to the current total, keeping it at 158.
The patient's hematocrit is 33 %. The patient's hematocrit is greater than or equal to 30%, and so we not add any points to the current total, keeping it at 158.
The patient's partial pressure of oxygen is 70.0 mm Hg. The patient's partial pressure of oxygen is greater than or equal to 60 mm Hg, and so we not add any points to the current total, keeping it at 158.
The patient's PSI score is 158."
834,29,PSI Score: Pneumonia Severity Index for CAP,severity,integer,7,Handwritten,"A 68-year-old female who resides in a nursing home is admitted with intermittent fever and known liver disease. Her past medical history is not significant for cerebrovascular disease or congestive heart failure. On admission, her vitals are recorded: body temperature is 38.2 degrees celsius, heart rate is 110 beats per minute, respiratory rate is 16 breaths per minute, and blood pressure is 135/90 mm Hg. She shows no signs of altered mental status. Laboratory investigations reveal a hematocrit of 41 % and slightly elevated glucose level at 165 mg/dL. Her Blood Urea Nitrogen (BUN) is within normal range at 15 mg/dL and sodium at slightly low at 132 mEq/L. An arterial blood gas drawn from her shows a pH of 7.48 and a PaO2 of 92 mm Hg. Her chest X-ray reveals the presence of pleural effusion. The patient does not have any history of renal conditions or neoplastic diseases.",What is the patient's Pneumonia Severity Index (PSI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [110.0, 'beats per minute'], 'pH': 7.48, 'Altered mental status': False, 'Systolic Blood Pressure': [135.0, 'mm Hg'], 'Blood Urea Nitrogen (BUN)': [15.0, 'mg/dL'], 'Pleural effusion on x-ray': True, 'Cerebrovascular disease history': False, 'Sodium': [132.0, 'mEq/L'], 'Liver disease severity': True, 'Congestive Heart Failure': False, 'Nursing home resident': True, 'Partial pressure of oxygen': [92.0, 'mm Hg'], 'age': [68.0, 'years'], 'respiratory rate': [16.0, 'breaths per minute'], 'sex': 'Female', 'Hematocrit': [41.0, '%'], 'Glucose': [165.0, 'mg/dL'], 'Temperature': [38.2, 'degrees celsius']}",98,98,98,"The rules for computing the Pneumonia Severity Index (PSI) are shown below:

1. Age: Enter age in years (age score will be equal to age in years)
2. Sex: Female = -10 points, Male = 0 points
3. Nursing home resident: No = 0 points, Yes = +10 points
4. Neoplastic disease: No = 0 points, Yes = +30 points
5. Liver disease history: No = 0 points, Yes = +20 points
6. Congestive heart failure (CHF) history: No = 0 points, Yes = +10 points
7. Cerebrovascular disease history: No = 0 points, Yes = +10 points
8. Renal disease history: No = 0 points, Yes = +10 points
9. Altered mental status: No = 0 points, Yes = +20 points
10. Respiratory rate ≥30 breaths/min: No = 0 points, Yes = +20 points
11. Systolic blood pressure <90 mmHg: No = 0 points, Yes = +20 points
12. Temperature <35°C (95°F) or >39.9°C (103.8°F): No = 0 points, Yes = +15 points
13. Pulse ≥125 beats/min: No = 0 points, Yes = +10 points
14. pH <7.35: No = 0 points, Yes = +30 points
15. BUN ≥30 mg/dL or ≥11 mmol/L: No = 0 points, Yes = +20 points
16. Sodium <130 mmol/L: No = 0 points, Yes = +20 points
17. Glucose ≥250 mg/dL or ≥14 mmol/L: No = 0 points, Yes = +10 points
18. Hematocrit <30%: No = 0 points, Yes = +10 points
19. Partial pressure of oxygen <60 mmHg or <8 kPa: No = 0 points, Yes = +10 points
20. Pleural effusion on x-ray: No = 0 points, Yes = +10 points

The total score is calculated by summing the points for each criterion.

The current PSI score is 0.
The patient is 68.0 years old. We add the the number of years of age of the patient to the psi score, making the current total 0 + 68.0 = 68.0.
Because the patient is female, we subtract 10 points from the current total, making the current total 68.0 - 10 = 58.0.
The patient is reported to be a nursing home resident and so we add 10 points to the score, making the current total 58.0 + 10 = 68.0.
Neoplastic disease is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 68.0.
Liver disease history is determined to be present for the patient and so we add 20 points to the score, making the current total 68.0 + 20 = 88.0.
CHF History is determined to be false for the patient and so we do not add any points to the current total keeping it at 88.0.
Cerebrovascular disease history is determined to be false for the patient and so we do not add any points to the current total keeping it at 88.0.
Renal Disease History is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 88.0.
Altered Mental Status is determined to be false for the patient and so we do not add any points to the current total keeping it at 88.0.
Pleural effusion on x-ray is determined to be present for the patient and so we add 10 points to the score, making the current total 88.0 + 10 = 98.0.
The patient's pulse is 110.0 beats per minute. The pulse is less than 125 beats per minute and so we do not add any points to the score, keeping it at 98.0.
The patient's temperature is 38.2 degrees celsius. The patient's temperature is greater than 35 degrees celsius and the temperature is less than 39.9 degrees celsius, and so we do not add any points to the score, keeping the total at 98.0.
The patient's pH is 7.48. The patient's pH is greater than or equal to 7.35, and so we do not add any points to the score, keeping the current total at 98.0.
The patient's respiratory rate is 16.0 breaths per minute. The patient's respiratory rate is less than 30 breaths per minute and so we do not add any points to the score, keeping the total score at 98.0.
The patient's systolic blood pressure is 135.0 mm Hg. The patient's systolic blood pressure is greater than or equal to 90 mm Hg and so we do not add any points to the score, keeping the total at 98.0.
The concentration of BUN is 15.0 mg/dL. The patient's BUN is less than 30 mg/dL, and so we do not add any points to the score, keeping the total at 98.0.
The concentration of sodium is 132.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 132.0 mEq. To convert from 132.0 mEq to mmol, convert from mEq to mmol. The compound 132.0 has a valence of 1, and so divide the valence by the value of mEq to get, 132.0 mEq/(1 mEq/mmol) = 132.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 132.0 mEq sodium/L converts to 132.0 mmol sodium/L. The patient's sodium is greater than or equal to 130 mmol/L, and so we do not add any points to the score, keeping the total at 98.0.
The concentration of glucose is 165.0 mg/dL. The patient's glucose concentration is less than or equal to than 250 mg/dL, and so we not add any points to the current total, keeping it at 98.0.
The patient's hematocrit is 41.0 %. The patient's hematocrit is greater than or equal to 30%, and so we not add any points to the current total, keeping it at 98.0.
The patient's partial pressure of oxygen is 92.0 mm Hg. The patient's partial pressure of oxygen is greater than or equal to 60 mm Hg, and so we not add any points to the current total, keeping it at 98.0.
The patient's PSI score is 98.0."
835,29,PSI Score: Pneumonia Severity Index for CAP,severity,integer,8,Handwritten,"An 80-year-old male patient, not a nursing home resident, presents to the emergency department with fever and an altered mental status. He has a documented history of congestive heart failure and is currently under treatment for neoplastic disease. His past medical conditions do not list renal disease. His present vital signs include a body temperature of 100.2 degrees Fahrenheit, heart rate of 90 beats per minute, respiratory rate of 18 breaths per minute, and blood pressure of 140/85 mm Hg. Results from his initial laboratory evaluations include a hematocrit of 38 % and a glucose level of 6.0 mmol/L. His blood urea nitrogen level is found to be 18 mg/dL while his sodium level is within normal limits at 135 mEq/L. His arterial blood gas reveals a PaO2 of 60 mm Hg and pH of 7.28. His history pertaining to liver disease or cerebrovascular disease could not be obtained at the time of presentation.",What is the patient's Pneumonia Severity Index (PSI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [90.0, 'beats per minute'], 'pH': 7.28, 'Altered mental status': True, 'Systolic Blood Pressure': [140.0, 'mm Hg'], 'Blood Urea Nitrogen (BUN)': [18.0, 'mg/dL'], 'Renal disease': False, 'Neoplastic disease': True, 'Sodium': [135.0, 'mEq/L'], 'Congestive Heart Failure': True, 'Nursing home resident': False, 'Partial pressure of oxygen': [60.0, 'mm Hg'], 'age': [80.0, 'years'], 'respiratory rate': [18.0, 'breaths per minute'], 'sex': 'Male', 'Hematocrit': [38.0, '%'], 'Glucose': [6.0, 'mmol/L'], 'Temperature': [100.2, 'degrees fahrenheit']}",170,170,170,"The rules for computing the Pneumonia Severity Index (PSI) are shown below:

1. Age: Enter age in years (age score will be equal to age in years)
2. Sex: Female = -10 points, Male = 0 points
3. Nursing home resident: No = 0 points, Yes = +10 points
4. Neoplastic disease: No = 0 points, Yes = +30 points
5. Liver disease history: No = 0 points, Yes = +20 points
6. Congestive heart failure (CHF) history: No = 0 points, Yes = +10 points
7. Cerebrovascular disease history: No = 0 points, Yes = +10 points
8. Renal disease history: No = 0 points, Yes = +10 points
9. Altered mental status: No = 0 points, Yes = +20 points
10. Respiratory rate ≥30 breaths/min: No = 0 points, Yes = +20 points
11. Systolic blood pressure <90 mmHg: No = 0 points, Yes = +20 points
12. Temperature <35°C (95°F) or >39.9°C (103.8°F): No = 0 points, Yes = +15 points
13. Pulse ≥125 beats/min: No = 0 points, Yes = +10 points
14. pH <7.35: No = 0 points, Yes = +30 points
15. BUN ≥30 mg/dL or ≥11 mmol/L: No = 0 points, Yes = +20 points
16. Sodium <130 mmol/L: No = 0 points, Yes = +20 points
17. Glucose ≥250 mg/dL or ≥14 mmol/L: No = 0 points, Yes = +10 points
18. Hematocrit <30%: No = 0 points, Yes = +10 points
19. Partial pressure of oxygen <60 mmHg or <8 kPa: No = 0 points, Yes = +10 points
20. Pleural effusion on x-ray: No = 0 points, Yes = +10 points

The total score is calculated by summing the points for each criterion.

The current PSI score is 0.
The patient is 80.0 years old. We add the the number of years of age of the patient to the psi score, making the current total 0 + 80.0 = 80.0.
Because the patient is male, no adjustments are made to the score, keeping the current total at 80.0.
The patient is not a nursing home resident and so we do not add any points to the current total keeping it at 80.0.
Neoplastic disease is determined to be present for the patient and so we add 30 points to the score, making the current total 80.0 + 30 = 110.0.
Liver disease history is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 110.0.
CHF History is determined to be present for the patient and so we add 10 points to the score, making the current total 110.0 + 10 = 120.0.
Cerebrovascular disease history is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 120.0.
Renal Disease History is determined to be false for the patient and so we do not add any points to the current total keeping it at 120.0.
Altered Mental Status is determined to be present for the patient and so we add 20 points to the score, making the current total 120.0 + 20 = 140.0.
Pleural effusion on x-ray is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 140.0.
The patient's pulse is 90.0 beats per minute. The pulse is less than 125 beats per minute and so we do not add any points to the score, keeping it at 140.0.
The patient's temperature is 100.2 degrees fahrenheit. To convert to degrees celsius, apply the formula 5/9 * [temperature (degrees fahrenheit) - 32]. This means that the patient's temperature is 5/9 * 68.2 = 37.889 degrees celsius. The patient's temperature is greater than 35 degrees celsius and the temperature is less than 39.9 degrees celsius, and so we do not add any points to the score, keeping the total at 140.0.
The patient's pH is 7.28. The patient's pH is less than 7.35, and so we add 30 points to the score, making the current total 140.0 + 30 = 170.0.
The patient's respiratory rate is 18.0 breaths per minute. The patient's respiratory rate is less than 30 breaths per minute and so we do not add any points to the score, keeping the total score at 170.0.
The patient's systolic blood pressure is 140.0 mm Hg. The patient's systolic blood pressure is greater than or equal to 90 mm Hg and so we do not add any points to the score, keeping the total at 170.0.
The concentration of BUN is 18.0 mg/dL. The patient's BUN is less than 30 mg/dL, and so we do not add any points to the score, keeping the total at 170.0.
The concentration of sodium is 135.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 135.0 mEq. To convert from 135.0 mEq to mmol, convert from mEq to mmol. The compound 135.0 has a valence of 1, and so divide the valence by the value of mEq to get, 135.0 mEq/(1 mEq/mmol) = 135.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 135.0 mEq sodium/L converts to 135.0 mmol sodium/L. The patient's sodium is greater than or equal to 130 mmol/L, and so we do not add any points to the score, keeping the total at 170.0.
The concentration of glucose is 6.0 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of glucose from mmol to mg. The mass of glucose is 6.0 mmol. To convert 6.0 mmol of glucose to mol, multiply by the conversion factor 0.001, giving us 6.0 mmol glucose * 0.001 mol/mmol = 0.006 mol glucose. To convert from mol glucose to grams, multiply by the molar mass 180.16 g/mol, which will give 0.006 mol glucose * 180.16 g/mol = 1.081 g glucose. To convert 1.081 g of glucose to mg, multiply by the conversion factor 1000.0, giving us 1.081 g glucose * 1000.0 mg/g = 1081.0 mg glucose. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 1081.0 mg glucose/10.0 dL = 108.1 mg glucose/dL. The concentration value of 6.0 mmol glucose/L converts to 108.1 mg glucose/dL. The patient's glucose concentration is less than or equal to than 250 mg/dL, and so we not add any points to the current total, keeping it at 170.0.
The patient's hematocrit is 38.0 %. The patient's hematocrit is greater than or equal to 30%, and so we not add any points to the current total, keeping it at 170.0.
The patient's partial pressure of oxygen is 60.0 mm Hg. The patient's partial pressure of oxygen is greater than or equal to 60 mm Hg, and so we not add any points to the current total, keeping it at 170.0.
The patient's PSI score is 170.0."
836,29,PSI Score: Pneumonia Severity Index for CAP,severity,integer,9,Handwritten,"A 75-year-old woman presents to the clinic for a routine checkup. She has a history of a prior stroke. The patient reports no known incidents of congestive heart failure and no existing kidney ailments. A physical examination reveals a standard body temperature of 36.6 degrees celsius, a heart rate of 105 beats per minute, a respiratory rate of 22 breaths per minute, and a blood pressure reading of 120/85 mm Hg. Laboratory investigations identify a hematocrit of 42 %, a sodium level of 137 mEq/L, a glucose level of 95 mg/dL, and a Blood Urea Nitrogen (BUN) of 24 mg/dL. Arterial Blood Gas results show a pH of 7.40 and a PaO2 of 80 mm Hg. A chest X-ray shows the presence of pleural effusion.",What is the patient's Pneumonia Severity Index (PSI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [105.0, 'beats per minute'], 'pH': 7.4, 'Systolic Blood Pressure': [120.0, 'mm Hg'], 'Blood Urea Nitrogen (BUN)': [24.0, 'mg/dL'], 'Renal disease': False, 'Pleural effusion on x-ray': True, 'Cerebrovascular disease history': True, 'Neoplastic disease': False, 'Sodium': [137.0, 'mEq/L'], 'Congestive Heart Failure': False, 'Partial pressure of oxygen': [80.0, 'mm Hg'], 'age': [75.0, 'years'], 'respiratory rate': [22.0, 'breaths per minute'], 'sex': 'Female', 'Hematocrit': [42.0, '%'], 'Glucose': [95.0, 'mg/dL'], 'Temperature': [36.6, 'degrees celsius']}",85,85,85,"The rules for computing the Pneumonia Severity Index (PSI) are shown below:

1. Age: Enter age in years (age score will be equal to age in years)
2. Sex: Female = -10 points, Male = 0 points
3. Nursing home resident: No = 0 points, Yes = +10 points
4. Neoplastic disease: No = 0 points, Yes = +30 points
5. Liver disease history: No = 0 points, Yes = +20 points
6. Congestive heart failure (CHF) history: No = 0 points, Yes = +10 points
7. Cerebrovascular disease history: No = 0 points, Yes = +10 points
8. Renal disease history: No = 0 points, Yes = +10 points
9. Altered mental status: No = 0 points, Yes = +20 points
10. Respiratory rate ≥30 breaths/min: No = 0 points, Yes = +20 points
11. Systolic blood pressure <90 mmHg: No = 0 points, Yes = +20 points
12. Temperature <35°C (95°F) or >39.9°C (103.8°F): No = 0 points, Yes = +15 points
13. Pulse ≥125 beats/min: No = 0 points, Yes = +10 points
14. pH <7.35: No = 0 points, Yes = +30 points
15. BUN ≥30 mg/dL or ≥11 mmol/L: No = 0 points, Yes = +20 points
16. Sodium <130 mmol/L: No = 0 points, Yes = +20 points
17. Glucose ≥250 mg/dL or ≥14 mmol/L: No = 0 points, Yes = +10 points
18. Hematocrit <30%: No = 0 points, Yes = +10 points
19. Partial pressure of oxygen <60 mmHg or <8 kPa: No = 0 points, Yes = +10 points
20. Pleural effusion on x-ray: No = 0 points, Yes = +10 points

The total score is calculated by summing the points for each criterion.

The current PSI score is 0.
The patient is 75.0 years old. We add the the number of years of age of the patient to the psi score, making the current total 0 + 75.0 = 75.0.
Because the patient is female, we subtract 10 points from the current total, making the current total 75.0 - 10 = 65.0.
Whether patient is a nursing home resident is not reported. Hence, we assume this to be false and so not add any points to the current total keeping it at 65.0.
Neoplastic disease is determined to be false for the patient and so we do not add any points to the current total keeping it at 65.0.
Liver disease history is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 65.0.
CHF History is determined to be false for the patient and so we do not add any points to the current total keeping it at 65.0.
Cerebrovascular disease history is determined to be present for the patient and so we add 10 points to the score, making the current total 65.0 + 10 = 75.0.
Renal Disease History is determined to be false for the patient and so we do not add any points to the current total keeping it at 75.0.
Altered Mental Status is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 75.0.
Pleural effusion on x-ray is determined to be present for the patient and so we add 10 points to the score, making the current total 75.0 + 10 = 85.0.
The patient's pulse is 105.0 beats per minute. The pulse is less than 125 beats per minute and so we do not add any points to the score, keeping it at 85.0.
The patient's temperature is 36.6 degrees celsius. The patient's temperature is greater than 35 degrees celsius and the temperature is less than 39.9 degrees celsius, and so we do not add any points to the score, keeping the total at 85.0.
The patient's pH is 7.4. The patient's pH is greater than or equal to 7.35, and so we do not add any points to the score, keeping the current total at 85.0.
The patient's respiratory rate is 22.0 breaths per minute. The patient's respiratory rate is less than 30 breaths per minute and so we do not add any points to the score, keeping the total score at 85.0.
The patient's systolic blood pressure is 120.0 mm Hg. The patient's systolic blood pressure is greater than or equal to 90 mm Hg and so we do not add any points to the score, keeping the total at 85.0.
The concentration of BUN is 24.0 mg/dL. The patient's BUN is less than 30 mg/dL, and so we do not add any points to the score, keeping the total at 85.0.
The concentration of sodium is 137.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 137.0 mEq. To convert from 137.0 mEq to mmol, convert from mEq to mmol. The compound 137.0 has a valence of 1, and so divide the valence by the value of mEq to get, 137.0 mEq/(1 mEq/mmol) = 137.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 137.0 mEq sodium/L converts to 137.0 mmol sodium/L. The patient's sodium is greater than or equal to 130 mmol/L, and so we do not add any points to the score, keeping the total at 85.0.
The concentration of glucose is 95.0 mg/dL. The patient's glucose concentration is less than or equal to than 250 mg/dL, and so we not add any points to the current total, keeping it at 85.0.
The patient's hematocrit is 42.0 %. The patient's hematocrit is greater than or equal to 30%, and so we not add any points to the current total, keeping it at 85.0.
The patient's partial pressure of oxygen is 80.0 mm Hg. The patient's partial pressure of oxygen is greater than or equal to 60 mm Hg, and so we not add any points to the current total, keeping it at 85.0.
The patient's PSI score is 85.0."
837,29,PSI Score: Pneumonia Severity Index for CAP,severity,integer,10,Handwritten,"A 67-year-old male residing in a nursing home is brought to the ER due to recent episodes of confusion. His past medical history is significant for chronic renal disease and liver illness. The patient doesn't have any known history of congestive heart failure. His vitals on admission show a blood pressure of 130/90 mm Hg, a heart rate of 100 beats per minute, respiratory rate at a steady 24 breaths per minute, and a body temperature holding at a normal 98.6 degrees Fahrenheit. Laboratory findings indicate a hematocrit level of 37 %, sodium concentration at 134 mEq/L, blood urea nitrogen level elevated at 28 mg/dL, and a glucose level at 150 mg/dL. An arterial blood gas shows a slightly decreased pH of 7.32 and a PaO2 of 88 mm Hg. Chest X-ray findings are notable for the absence of pleural effusion.",What is the patient's Pneumonia Severity Index (PSI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [100.0, 'beats per minute'], 'pH': 7.32, 'Altered mental status': True, 'Systolic Blood Pressure': [130.0, 'mm Hg'], 'Blood Urea Nitrogen (BUN)': [28.0, 'mg/dL'], 'Renal disease': True, 'Pleural effusion on x-ray': False, 'Sodium': [134.0, 'mEq/L'], 'Liver disease severity': True, 'Congestive Heart Failure': False, 'Nursing home resident': True, 'Partial pressure of oxygen': [88.0, 'mm Hg'], 'age': [67.0, 'years'], 'respiratory rate': [24.0, 'breaths per minute'], 'sex': 'Male', 'Hematocrit': [37.0, '%'], 'Glucose': [150.0, 'mg/dL'], 'Temperature': [98.6, 'degrees fahrenheit']}",157,157,157,"The rules for computing the Pneumonia Severity Index (PSI) are shown below:

1. Age: Enter age in years (age score will be equal to age in years)
2. Sex: Female = -10 points, Male = 0 points
3. Nursing home resident: No = 0 points, Yes = +10 points
4. Neoplastic disease: No = 0 points, Yes = +30 points
5. Liver disease history: No = 0 points, Yes = +20 points
6. Congestive heart failure (CHF) history: No = 0 points, Yes = +10 points
7. Cerebrovascular disease history: No = 0 points, Yes = +10 points
8. Renal disease history: No = 0 points, Yes = +10 points
9. Altered mental status: No = 0 points, Yes = +20 points
10. Respiratory rate ≥30 breaths/min: No = 0 points, Yes = +20 points
11. Systolic blood pressure <90 mmHg: No = 0 points, Yes = +20 points
12. Temperature <35°C (95°F) or >39.9°C (103.8°F): No = 0 points, Yes = +15 points
13. Pulse ≥125 beats/min: No = 0 points, Yes = +10 points
14. pH <7.35: No = 0 points, Yes = +30 points
15. BUN ≥30 mg/dL or ≥11 mmol/L: No = 0 points, Yes = +20 points
16. Sodium <130 mmol/L: No = 0 points, Yes = +20 points
17. Glucose ≥250 mg/dL or ≥14 mmol/L: No = 0 points, Yes = +10 points
18. Hematocrit <30%: No = 0 points, Yes = +10 points
19. Partial pressure of oxygen <60 mmHg or <8 kPa: No = 0 points, Yes = +10 points
20. Pleural effusion on x-ray: No = 0 points, Yes = +10 points

The total score is calculated by summing the points for each criterion.

The current PSI score is 0.
The patient is 67.0 years old. We add the the number of years of age of the patient to the psi score, making the current total 0 + 67.0 = 67.0.
Because the patient is male, no adjustments are made to the score, keeping the current total at 67.0.
The patient is reported to be a nursing home resident and so we add 10 points to the score, making the current total 67.0 + 10 = 77.0.
Neoplastic disease is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 77.0.
Liver disease history is determined to be present for the patient and so we add 20 points to the score, making the current total 77.0 + 20 = 97.0.
CHF History is determined to be false for the patient and so we do not add any points to the current total keeping it at 97.0.
Cerebrovascular disease history is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 97.0.
Renal Disease History is determined to be present for the patient and so we add 10 points to the score, making the current total 97.0 + 10 = 107.0.
Altered Mental Status is determined to be present for the patient and so we add 20 points to the score, making the current total 107.0 + 20 = 127.0.
Pleural effusion on x-ray is determined to be false for the patient and so we do not add any points to the current total keeping it at 127.0.
The patient's pulse is 100.0 beats per minute. The pulse is less than 125 beats per minute and so we do not add any points to the score, keeping it at 127.0.
The patient's temperature is 98.6 degrees fahrenheit. To convert to degrees celsius, apply the formula 5/9 * [temperature (degrees fahrenheit) - 32]. This means that the patient's temperature is 5/9 * 66.6 = 37.0 degrees celsius. The patient's temperature is greater than 35 degrees celsius and the temperature is less than 39.9 degrees celsius, and so we do not add any points to the score, keeping the total at 127.0.
The patient's pH is 7.32. The patient's pH is less than 7.35, and so we add 30 points to the score, making the current total 127.0 + 30 = 157.0.
The patient's respiratory rate is 24.0 breaths per minute. The patient's respiratory rate is less than 30 breaths per minute and so we do not add any points to the score, keeping the total score at 157.0.
The patient's systolic blood pressure is 130.0 mm Hg. The patient's systolic blood pressure is greater than or equal to 90 mm Hg and so we do not add any points to the score, keeping the total at 157.0.
The concentration of BUN is 28.0 mg/dL. The patient's BUN is less than 30 mg/dL, and so we do not add any points to the score, keeping the total at 157.0.
The concentration of sodium is 134.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 134.0 mEq. To convert from 134.0 mEq to mmol, convert from mEq to mmol. The compound 134.0 has a valence of 1, and so divide the valence by the value of mEq to get, 134.0 mEq/(1 mEq/mmol) = 134.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 134.0 mEq sodium/L converts to 134.0 mmol sodium/L. The patient's sodium is greater than or equal to 130 mmol/L, and so we do not add any points to the score, keeping the total at 157.0.
The concentration of glucose is 150.0 mg/dL. The patient's glucose concentration is less than or equal to than 250 mg/dL, and so we not add any points to the current total, keeping it at 157.0.
The patient's hematocrit is 37.0 %. The patient's hematocrit is greater than or equal to 30%, and so we not add any points to the current total, keeping it at 157.0.
The patient's partial pressure of oxygen is 88.0 mm Hg. The patient's partial pressure of oxygen is greater than or equal to 60 mm Hg, and so we not add any points to the current total, keeping it at 157.0.
The patient's PSI score is 157.0."
838,29,PSI Score: Pneumonia Severity Index for CAP,severity,integer,11,Handwritten,"A 70-year-old female presents to the outpatient department for a follow-up consultation after her recent discharge from the hospital due to congestion heart failure. The patient's medical history shed light on a previous cerebrovascular accident, but no evidence of neoplastic disease or liver disease. Her vital signs are stable, indicating a body temperature of 36.8 degrees celsius, heart rhythm showing 80 beats per minute, breathing rate counted at 19 breaths per minute, and a blood pressure reading of 140/85 mm Hg. Laboratory results illustrate a hematocrit of 44 %, a glucose level of 4.8 mmol/L, and blood urea nitrogen of 26 mg/dL. Sodium levels are normal at 135 mEq/L. An arterial blood gas analysis shows pH at 7.36 and a PaO2 of 77 mm Hg. Chest X-ray indicates the presence of a pleural effusion.",What is the patient's Pneumonia Severity Index (PSI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [80.0, 'beats per minute'], 'pH': 7.36, 'Systolic Blood Pressure': [140.0, 'mm Hg'], 'Blood Urea Nitrogen (BUN)': [26.0, 'mg/dL'], 'Pleural effusion on x-ray': True, 'Cerebrovascular disease history': True, 'Neoplastic disease': False, 'Sodium': [135.0, 'mEq/L'], 'Liver disease severity': False, 'Congestive Heart Failure': True, 'Partial pressure of oxygen': [77.0, 'mm Hg'], 'age': [70.0, 'years'], 'respiratory rate': [19.0, 'breaths per minute'], 'sex': 'Female', 'Hematocrit': [44.0, '%'], 'Glucose': [4.8, 'mmol/L'], 'Temperature': [36.8, 'degrees celsius']}",90,90,90,"The rules for computing the Pneumonia Severity Index (PSI) are shown below:

1. Age: Enter age in years (age score will be equal to age in years)
2. Sex: Female = -10 points, Male = 0 points
3. Nursing home resident: No = 0 points, Yes = +10 points
4. Neoplastic disease: No = 0 points, Yes = +30 points
5. Liver disease history: No = 0 points, Yes = +20 points
6. Congestive heart failure (CHF) history: No = 0 points, Yes = +10 points
7. Cerebrovascular disease history: No = 0 points, Yes = +10 points
8. Renal disease history: No = 0 points, Yes = +10 points
9. Altered mental status: No = 0 points, Yes = +20 points
10. Respiratory rate ≥30 breaths/min: No = 0 points, Yes = +20 points
11. Systolic blood pressure <90 mmHg: No = 0 points, Yes = +20 points
12. Temperature <35°C (95°F) or >39.9°C (103.8°F): No = 0 points, Yes = +15 points
13. Pulse ≥125 beats/min: No = 0 points, Yes = +10 points
14. pH <7.35: No = 0 points, Yes = +30 points
15. BUN ≥30 mg/dL or ≥11 mmol/L: No = 0 points, Yes = +20 points
16. Sodium <130 mmol/L: No = 0 points, Yes = +20 points
17. Glucose ≥250 mg/dL or ≥14 mmol/L: No = 0 points, Yes = +10 points
18. Hematocrit <30%: No = 0 points, Yes = +10 points
19. Partial pressure of oxygen <60 mmHg or <8 kPa: No = 0 points, Yes = +10 points
20. Pleural effusion on x-ray: No = 0 points, Yes = +10 points

The total score is calculated by summing the points for each criterion.

The current PSI score is 0.
The patient is 70.0 years old. We add the the number of years of age of the patient to the psi score, making the current total 0 + 70.0 = 70.0.
Because the patient is female, we subtract 10 points from the current total, making the current total 70.0 - 10 = 60.0.
Whether patient is a nursing home resident is not reported. Hence, we assume this to be false and so not add any points to the current total keeping it at 60.0.
Neoplastic disease is determined to be false for the patient and so we do not add any points to the current total keeping it at 60.0.
Liver disease history is determined to be false for the patient and so we do not add any points to the current total keeping it at 60.0.
CHF History is determined to be present for the patient and so we add 10 points to the score, making the current total 60.0 + 10 = 70.0.
Cerebrovascular disease history is determined to be present for the patient and so we add 10 points to the score, making the current total 70.0 + 10 = 80.0.
Renal Disease History is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 80.0.
Altered Mental Status is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 80.0.
Pleural effusion on x-ray is determined to be present for the patient and so we add 10 points to the score, making the current total 80.0 + 10 = 90.0.
The patient's pulse is 80.0 beats per minute. The pulse is less than 125 beats per minute and so we do not add any points to the score, keeping it at 90.0.
The patient's temperature is 36.8 degrees celsius. The patient's temperature is greater than 35 degrees celsius and the temperature is less than 39.9 degrees celsius, and so we do not add any points to the score, keeping the total at 90.0.
The patient's pH is 7.36. The patient's pH is greater than or equal to 7.35, and so we do not add any points to the score, keeping the current total at 90.0.
The patient's respiratory rate is 19.0 breaths per minute. The patient's respiratory rate is less than 30 breaths per minute and so we do not add any points to the score, keeping the total score at 90.0.
The patient's systolic blood pressure is 140.0 mm Hg. The patient's systolic blood pressure is greater than or equal to 90 mm Hg and so we do not add any points to the score, keeping the total at 90.0.
The concentration of BUN is 26.0 mg/dL. The patient's BUN is less than 30 mg/dL, and so we do not add any points to the score, keeping the total at 90.0.
The concentration of sodium is 135.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 135.0 mEq. To convert from 135.0 mEq to mmol, convert from mEq to mmol. The compound 135.0 has a valence of 1, and so divide the valence by the value of mEq to get, 135.0 mEq/(1 mEq/mmol) = 135.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 135.0 mEq sodium/L converts to 135.0 mmol sodium/L. The patient's sodium is greater than or equal to 130 mmol/L, and so we do not add any points to the score, keeping the total at 90.0.
The concentration of glucose is 4.8 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of glucose from mmol to mg. The mass of glucose is 4.8 mmol. To convert 4.8 mmol of glucose to mol, multiply by the conversion factor 0.001, giving us 4.8 mmol glucose * 0.001 mol/mmol = 0.005 mol glucose. To convert from mol glucose to grams, multiply by the molar mass 180.16 g/mol, which will give 0.005 mol glucose * 180.16 g/mol = 0.901 g glucose. To convert 0.901 g of glucose to mg, multiply by the conversion factor 1000.0, giving us 0.901 g glucose * 1000.0 mg/g = 901.0 mg glucose. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 901.0 mg glucose/10.0 dL = 90.1 mg glucose/dL. The concentration value of 4.8 mmol glucose/L converts to 90.1 mg glucose/dL. The patient's glucose concentration is less than or equal to than 250 mg/dL, and so we not add any points to the current total, keeping it at 90.0.
The patient's hematocrit is 44.0 %. The patient's hematocrit is greater than or equal to 30%, and so we not add any points to the current total, keeping it at 90.0.
The patient's partial pressure of oxygen is 77.0 mm Hg. The patient's partial pressure of oxygen is greater than or equal to 60 mm Hg, and so we not add any points to the current total, keeping it at 90.0.
The patient's PSI score is 90.0."
839,29,PSI Score: Pneumonia Severity Index for CAP,severity,integer,12,Handwritten,"A 76-year-old male resident of a nursing home is noted to have increased fatigue and change of appetite. He has a history of renal disease, is undergoing treatment for neoplastic disease, but exhibits no signs of cognitive impairment. His medical record doesn't highlight any history of heart disease or stroke. Temperature readings show a stable 98.4 degrees Fahrenheit. His heart rate is at 92 beats per minute, respiratory rate is 21 breaths per minute, and his blood pressure is found to be 150/90 mm Hg. Laboratory tests reveal a hematocrit level of 36 %, a glucose level of 120 mg/dL, and a blood urea nitrogen level of 23 mg/dL. Sodium readings are robust coming in at 143 mEq/L. Arterial blood gas analysis presents with a pH value of 7.44, and a PaO2 of 68 mm Hg.",What is the patient's Pneumonia Severity Index (PSI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [92.0, 'beats per minute'], 'pH': 7.44, 'Altered mental status': False, 'Systolic Blood Pressure': [150.0, 'mm Hg'], 'Blood Urea Nitrogen (BUN)': [23.0, 'mg/dL'], 'Renal disease': True, 'Cerebrovascular disease history': False, 'Neoplastic disease': True, 'Sodium': [143.0, 'mEq/L'], 'Congestive Heart Failure': False, 'Nursing home resident': True, 'Partial pressure of oxygen': [68.0, 'mm Hg'], 'age': [76.0, 'years'], 'respiratory rate': [21.0, 'breaths per minute'], 'sex': 'Male', 'Hematocrit': [36.0, '%'], 'Glucose': [120.0, 'mg/dL'], 'Temperature': [98.4, 'degrees fahrenheit']}",126,126,126,"The rules for computing the Pneumonia Severity Index (PSI) are shown below:

1. Age: Enter age in years (age score will be equal to age in years)
2. Sex: Female = -10 points, Male = 0 points
3. Nursing home resident: No = 0 points, Yes = +10 points
4. Neoplastic disease: No = 0 points, Yes = +30 points
5. Liver disease history: No = 0 points, Yes = +20 points
6. Congestive heart failure (CHF) history: No = 0 points, Yes = +10 points
7. Cerebrovascular disease history: No = 0 points, Yes = +10 points
8. Renal disease history: No = 0 points, Yes = +10 points
9. Altered mental status: No = 0 points, Yes = +20 points
10. Respiratory rate ≥30 breaths/min: No = 0 points, Yes = +20 points
11. Systolic blood pressure <90 mmHg: No = 0 points, Yes = +20 points
12. Temperature <35°C (95°F) or >39.9°C (103.8°F): No = 0 points, Yes = +15 points
13. Pulse ≥125 beats/min: No = 0 points, Yes = +10 points
14. pH <7.35: No = 0 points, Yes = +30 points
15. BUN ≥30 mg/dL or ≥11 mmol/L: No = 0 points, Yes = +20 points
16. Sodium <130 mmol/L: No = 0 points, Yes = +20 points
17. Glucose ≥250 mg/dL or ≥14 mmol/L: No = 0 points, Yes = +10 points
18. Hematocrit <30%: No = 0 points, Yes = +10 points
19. Partial pressure of oxygen <60 mmHg or <8 kPa: No = 0 points, Yes = +10 points
20. Pleural effusion on x-ray: No = 0 points, Yes = +10 points

The total score is calculated by summing the points for each criterion.

The current PSI score is 0.
The patient is 76.0 years old. We add the the number of years of age of the patient to the psi score, making the current total 0 + 76.0 = 76.0.
Because the patient is male, no adjustments are made to the score, keeping the current total at 76.0.
The patient is reported to be a nursing home resident and so we add 10 points to the score, making the current total 76.0 + 10 = 86.0.
Neoplastic disease is determined to be present for the patient and so we add 30 points to the score, making the current total 86.0 + 30 = 116.0.
Liver disease history is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 116.0.
CHF History is determined to be false for the patient and so we do not add any points to the current total keeping it at 116.0.
Cerebrovascular disease history is determined to be false for the patient and so we do not add any points to the current total keeping it at 116.0.
Renal Disease History is determined to be present for the patient and so we add 10 points to the score, making the current total 116.0 + 10 = 126.0.
Altered Mental Status is determined to be false for the patient and so we do not add any points to the current total keeping it at 126.0.
Pleural effusion on x-ray is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 126.0.
The patient's pulse is 92.0 beats per minute. The pulse is less than 125 beats per minute and so we do not add any points to the score, keeping it at 126.0.
The patient's temperature is 98.4 degrees fahrenheit. To convert to degrees celsius, apply the formula 5/9 * [temperature (degrees fahrenheit) - 32]. This means that the patient's temperature is 5/9 * 66.4 = 36.889 degrees celsius. The patient's temperature is greater than 35 degrees celsius and the temperature is less than 39.9 degrees celsius, and so we do not add any points to the score, keeping the total at 126.0.
The patient's pH is 7.44. The patient's pH is greater than or equal to 7.35, and so we do not add any points to the score, keeping the current total at 126.0.
The patient's respiratory rate is 21.0 breaths per minute. The patient's respiratory rate is less than 30 breaths per minute and so we do not add any points to the score, keeping the total score at 126.0.
The patient's systolic blood pressure is 150.0 mm Hg. The patient's systolic blood pressure is greater than or equal to 90 mm Hg and so we do not add any points to the score, keeping the total at 126.0.
The concentration of BUN is 23.0 mg/dL. The patient's BUN is less than 30 mg/dL, and so we do not add any points to the score, keeping the total at 126.0.
The concentration of sodium is 143.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 143.0 mEq. To convert from 143.0 mEq to mmol, convert from mEq to mmol. The compound 143.0 has a valence of 1, and so divide the valence by the value of mEq to get, 143.0 mEq/(1 mEq/mmol) = 143.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 143.0 mEq sodium/L converts to 143.0 mmol sodium/L. The patient's sodium is greater than or equal to 130 mmol/L, and so we do not add any points to the score, keeping the total at 126.0.
The concentration of glucose is 120.0 mg/dL. The patient's glucose concentration is less than or equal to than 250 mg/dL, and so we not add any points to the current total, keeping it at 126.0.
The patient's hematocrit is 36.0 %. The patient's hematocrit is greater than or equal to 30%, and so we not add any points to the current total, keeping it at 126.0.
The patient's partial pressure of oxygen is 68.0 mm Hg. The patient's partial pressure of oxygen is greater than or equal to 60 mm Hg, and so we not add any points to the current total, keeping it at 126.0.
The patient's PSI score is 126.0."
840,29,PSI Score: Pneumonia Severity Index for CAP,severity,integer,13,Handwritten,"A 68-year-old female resident of a nearby nursing home has been brought to the emergency department due to alterations in her mental status. She has no previous record of renal disease, congestive heart failure, or cancer. On physical examination, she is found to have a heart rate of 88 beats per minute, a respiratory pace of 22 breaths per minute, a blood pressure of 130/80 mm Hg, and temperature of 37.4 degrees celsius. Lab results showed her hematocrit is at 40 %, glucose reading stands at 7.1 mmol/L, with a blood urea nitrogen (BUN) reaching 25 mg/dL. Her sodium level measures within the normal range at 142 mEq/L. The arterial blood gas detected a pH of 7.38 with a partial pressure of oxygen at 82 mm Hg. A chest X-ray revealed the presence of pleural effusion.",What is the patient's Pneumonia Severity Index (PSI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [88.0, 'beats per minute'], 'pH': 7.38, 'Altered mental status': True, 'Systolic Blood Pressure': [130.0, 'mm Hg'], 'Blood Urea Nitrogen (BUN)': [25.0, 'mg/dL'], 'Renal disease': False, 'Pleural effusion on x-ray': True, 'Neoplastic disease': False, 'Sodium': [142.0, 'mEq/L'], 'Congestive Heart Failure': False, 'Nursing home resident': True, 'Partial pressure of oxygen': [82.0, 'mm Hg'], 'age': [68.0, 'years'], 'respiratory rate': [22.0, 'breaths per minute'], 'sex': 'Female', 'Hematocrit': [40.0, '%'], 'Glucose': [7.1, 'mmol/L'], 'Temperature': [37.4, 'degrees celsius']}",98,98,98,"The rules for computing the Pneumonia Severity Index (PSI) are shown below:

1. Age: Enter age in years (age score will be equal to age in years)
2. Sex: Female = -10 points, Male = 0 points
3. Nursing home resident: No = 0 points, Yes = +10 points
4. Neoplastic disease: No = 0 points, Yes = +30 points
5. Liver disease history: No = 0 points, Yes = +20 points
6. Congestive heart failure (CHF) history: No = 0 points, Yes = +10 points
7. Cerebrovascular disease history: No = 0 points, Yes = +10 points
8. Renal disease history: No = 0 points, Yes = +10 points
9. Altered mental status: No = 0 points, Yes = +20 points
10. Respiratory rate ≥30 breaths/min: No = 0 points, Yes = +20 points
11. Systolic blood pressure <90 mmHg: No = 0 points, Yes = +20 points
12. Temperature <35°C (95°F) or >39.9°C (103.8°F): No = 0 points, Yes = +15 points
13. Pulse ≥125 beats/min: No = 0 points, Yes = +10 points
14. pH <7.35: No = 0 points, Yes = +30 points
15. BUN ≥30 mg/dL or ≥11 mmol/L: No = 0 points, Yes = +20 points
16. Sodium <130 mmol/L: No = 0 points, Yes = +20 points
17. Glucose ≥250 mg/dL or ≥14 mmol/L: No = 0 points, Yes = +10 points
18. Hematocrit <30%: No = 0 points, Yes = +10 points
19. Partial pressure of oxygen <60 mmHg or <8 kPa: No = 0 points, Yes = +10 points
20. Pleural effusion on x-ray: No = 0 points, Yes = +10 points

The total score is calculated by summing the points for each criterion.

The current PSI score is 0.
The patient is 68.0 years old. We add the the number of years of age of the patient to the psi score, making the current total 0 + 68.0 = 68.0.
Because the patient is female, we subtract 10 points from the current total, making the current total 68.0 - 10 = 58.0.
The patient is reported to be a nursing home resident and so we add 10 points to the score, making the current total 58.0 + 10 = 68.0.
Neoplastic disease is determined to be false for the patient and so we do not add any points to the current total keeping it at 68.0.
Liver disease history is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 68.0.
CHF History is determined to be false for the patient and so we do not add any points to the current total keeping it at 68.0.
Cerebrovascular disease history is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 68.0.
Renal Disease History is determined to be false for the patient and so we do not add any points to the current total keeping it at 68.0.
Altered Mental Status is determined to be present for the patient and so we add 20 points to the score, making the current total 68.0 + 20 = 88.0.
Pleural effusion on x-ray is determined to be present for the patient and so we add 10 points to the score, making the current total 88.0 + 10 = 98.0.
The patient's pulse is 88.0 beats per minute. The pulse is less than 125 beats per minute and so we do not add any points to the score, keeping it at 98.0.
The patient's temperature is 37.4 degrees celsius. The patient's temperature is greater than 35 degrees celsius and the temperature is less than 39.9 degrees celsius, and so we do not add any points to the score, keeping the total at 98.0.
The patient's pH is 7.38. The patient's pH is greater than or equal to 7.35, and so we do not add any points to the score, keeping the current total at 98.0.
The patient's respiratory rate is 22.0 breaths per minute. The patient's respiratory rate is less than 30 breaths per minute and so we do not add any points to the score, keeping the total score at 98.0.
The patient's systolic blood pressure is 130.0 mm Hg. The patient's systolic blood pressure is greater than or equal to 90 mm Hg and so we do not add any points to the score, keeping the total at 98.0.
The concentration of BUN is 25.0 mg/dL. The patient's BUN is less than 30 mg/dL, and so we do not add any points to the score, keeping the total at 98.0.
The concentration of sodium is 142.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 142.0 mEq. To convert from 142.0 mEq to mmol, convert from mEq to mmol. The compound 142.0 has a valence of 1, and so divide the valence by the value of mEq to get, 142.0 mEq/(1 mEq/mmol) = 142.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 142.0 mEq sodium/L converts to 142.0 mmol sodium/L. The patient's sodium is greater than or equal to 130 mmol/L, and so we do not add any points to the score, keeping the total at 98.0.
The concentration of glucose is 7.1 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of glucose from mmol to mg. The mass of glucose is 7.1 mmol. To convert 7.1 mmol of glucose to mol, multiply by the conversion factor 0.001, giving us 7.1 mmol glucose * 0.001 mol/mmol = 0.007 mol glucose. To convert from mol glucose to grams, multiply by the molar mass 180.16 g/mol, which will give 0.007 mol glucose * 180.16 g/mol = 1.261 g glucose. To convert 1.261 g of glucose to mg, multiply by the conversion factor 1000.0, giving us 1.261 g glucose * 1000.0 mg/g = 1261.0 mg glucose. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 1261.0 mg glucose/10.0 dL = 126.1 mg glucose/dL. The concentration value of 7.1 mmol glucose/L converts to 126.1 mg glucose/dL. The patient's glucose concentration is less than or equal to than 250 mg/dL, and so we not add any points to the current total, keeping it at 98.0.
The patient's hematocrit is 40.0 %. The patient's hematocrit is greater than or equal to 30%, and so we not add any points to the current total, keeping it at 98.0.
The patient's partial pressure of oxygen is 82.0 mm Hg. The patient's partial pressure of oxygen is greater than or equal to 60 mm Hg, and so we not add any points to the current total, keeping it at 98.0.
The patient's PSI score is 98.0."
841,29,PSI Score: Pneumonia Severity Index for CAP,severity,integer,14,Handwritten,"An 80-year-old male presents to the clinic for his regular health check-up. His past history is significant for chronic kidney disease and a previous cerebrovascular accident. The patient also has a history of congestive heart failure but no known neoplastic conditions or liver illness. On examination, he is stable with a heart rate of 110 beats per minute, respiratory rate of 20 breaths per minute, a blood pressure of 120/80 mm Hg, and a temperature of 38.2 degrees celsius. Lab studies show a hematocrit level of 41 %, Blood Urea Nitrogen value at 30 mg/dL, a glucose of 105 mg/dL, and sodium level at 139 mEq/L. An arterial blood gas analysis delivers a result of a pH at 7.46 and a PaO2 of 90 mm Hg. He currently lives at home with his son.",What is the patient's Pneumonia Severity Index (PSI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [110.0, 'beats per minute'], 'pH': 7.46, 'Systolic Blood Pressure': [120.0, 'mm Hg'], 'Blood Urea Nitrogen (BUN)': [30.0, 'mg/dL'], 'Renal disease': True, 'Cerebrovascular disease history': True, 'Neoplastic disease': False, 'Sodium': [139.0, 'mEq/L'], 'Liver disease severity': False, 'Congestive Heart Failure': True, 'Nursing home resident': False, 'Partial pressure of oxygen': [90.0, 'mm Hg'], 'age': [80.0, 'years'], 'respiratory rate': [20.0, 'breaths per minute'], 'sex': 'Male', 'Hematocrit': [41.0, '%'], 'Glucose': [105.0, 'mg/dL'], 'Temperature': [38.2, 'degrees celsius']}",130,130,130,"The rules for computing the Pneumonia Severity Index (PSI) are shown below:

1. Age: Enter age in years (age score will be equal to age in years)
2. Sex: Female = -10 points, Male = 0 points
3. Nursing home resident: No = 0 points, Yes = +10 points
4. Neoplastic disease: No = 0 points, Yes = +30 points
5. Liver disease history: No = 0 points, Yes = +20 points
6. Congestive heart failure (CHF) history: No = 0 points, Yes = +10 points
7. Cerebrovascular disease history: No = 0 points, Yes = +10 points
8. Renal disease history: No = 0 points, Yes = +10 points
9. Altered mental status: No = 0 points, Yes = +20 points
10. Respiratory rate ≥30 breaths/min: No = 0 points, Yes = +20 points
11. Systolic blood pressure <90 mmHg: No = 0 points, Yes = +20 points
12. Temperature <35°C (95°F) or >39.9°C (103.8°F): No = 0 points, Yes = +15 points
13. Pulse ≥125 beats/min: No = 0 points, Yes = +10 points
14. pH <7.35: No = 0 points, Yes = +30 points
15. BUN ≥30 mg/dL or ≥11 mmol/L: No = 0 points, Yes = +20 points
16. Sodium <130 mmol/L: No = 0 points, Yes = +20 points
17. Glucose ≥250 mg/dL or ≥14 mmol/L: No = 0 points, Yes = +10 points
18. Hematocrit <30%: No = 0 points, Yes = +10 points
19. Partial pressure of oxygen <60 mmHg or <8 kPa: No = 0 points, Yes = +10 points
20. Pleural effusion on x-ray: No = 0 points, Yes = +10 points

The total score is calculated by summing the points for each criterion.

The current PSI score is 0.
The patient is 80.0 years old. We add the the number of years of age of the patient to the psi score, making the current total 0 + 80.0 = 80.0.
Because the patient is male, no adjustments are made to the score, keeping the current total at 80.0.
The patient is not a nursing home resident and so we do not add any points to the current total keeping it at 80.0.
Neoplastic disease is determined to be false for the patient and so we do not add any points to the current total keeping it at 80.0.
Liver disease history is determined to be false for the patient and so we do not add any points to the current total keeping it at 80.0.
CHF History is determined to be present for the patient and so we add 10 points to the score, making the current total 80.0 + 10 = 90.0.
Cerebrovascular disease history is determined to be present for the patient and so we add 10 points to the score, making the current total 90.0 + 10 = 100.0.
Renal Disease History is determined to be present for the patient and so we add 10 points to the score, making the current total 100.0 + 10 = 110.0.
Altered Mental Status is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 110.0.
Pleural effusion on x-ray is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 110.0.
The patient's pulse is 110.0 beats per minute. The pulse is less than 125 beats per minute and so we do not add any points to the score, keeping it at 110.0.
The patient's temperature is 38.2 degrees celsius. The patient's temperature is greater than 35 degrees celsius and the temperature is less than 39.9 degrees celsius, and so we do not add any points to the score, keeping the total at 110.0.
The patient's pH is 7.46. The patient's pH is greater than or equal to 7.35, and so we do not add any points to the score, keeping the current total at 110.0.
The patient's respiratory rate is 20.0 breaths per minute. The patient's respiratory rate is less than 30 breaths per minute and so we do not add any points to the score, keeping the total score at 110.0.
The patient's systolic blood pressure is 120.0 mm Hg. The patient's systolic blood pressure is greater than or equal to 90 mm Hg and so we do not add any points to the score, keeping the total at 110.0.
The concentration of BUN is 30.0 mg/dL. The patient's BUN is greater than or equal to 30 mg/dL, and so we add 20 points to the score, making current total 110.0 + 20 = 130.0.
The concentration of sodium is 139.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 139.0 mEq. To convert from 139.0 mEq to mmol, convert from mEq to mmol. The compound 139.0 has a valence of 1, and so divide the valence by the value of mEq to get, 139.0 mEq/(1 mEq/mmol) = 139.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 139.0 mEq sodium/L converts to 139.0 mmol sodium/L. The patient's sodium is greater than or equal to 130 mmol/L, and so we do not add any points to the score, keeping the total at 130.0.
The concentration of glucose is 105.0 mg/dL. The patient's glucose concentration is less than or equal to than 250 mg/dL, and so we not add any points to the current total, keeping it at 130.0.
The patient's hematocrit is 41.0 %. The patient's hematocrit is greater than or equal to 30%, and so we not add any points to the current total, keeping it at 130.0.
The patient's partial pressure of oxygen is 90.0 mm Hg. The patient's partial pressure of oxygen is greater than or equal to 60 mm Hg, and so we not add any points to the current total, keeping it at 130.0.
The patient's PSI score is 130.0."
842,29,PSI Score: Pneumonia Severity Index for CAP,severity,integer,15,Handwritten,"A 74-year-old woman living independently visits the clinic reporting malaise and weakness. She has a known history of liver disease. She denies any past heart failure or prior strokes. At present, her mental status appears undisturbed. Today's exam measures her body temperature at 99.5 degrees Fahrenheit, and vitals recorded an elevated heart rate at 115 beats per minute, a respiratory rate of 18 breaths per minute, and slightly lower blood pressure at 110/75 mm Hg. Laboratory studies reveal a hematocrit of 37 %, blood urea nitrogen at 28 mg/dL, glucose at 6.4 mmol/L, and sodium at the upper normal limit at 136 mEq/L. Results from arterial blood gas reports a pH of 7.42 and a PaO2 at 84 mm Hg, suggesting good oxygen levels. A recent chest X-ray demonstrates presence of pleural effusion.",What is the patient's Pneumonia Severity Index (PSI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [115.0, 'beats per minute'], 'pH': 7.42, 'Altered mental status': False, 'Systolic Blood Pressure': [110.0, 'mm Hg'], 'Blood Urea Nitrogen (BUN)': [28.0, 'mg/dL'], 'Pleural effusion on x-ray': True, 'Cerebrovascular disease history': False, 'Sodium': [136.0, 'mEq/L'], 'Liver disease severity': True, 'Congestive Heart Failure': False, 'Nursing home resident': False, 'Partial pressure of oxygen': [84.0, 'mm Hg'], 'age': [74.0, 'years'], 'respiratory rate': [18.0, 'breaths per minute'], 'sex': 'Female', 'Hematocrit': [37.0, '%'], 'Glucose': [6.4, 'mmol/L'], 'Temperature': [99.5, 'degrees fahrenheit']}",94,94,94,"The rules for computing the Pneumonia Severity Index (PSI) are shown below:

1. Age: Enter age in years (age score will be equal to age in years)
2. Sex: Female = -10 points, Male = 0 points
3. Nursing home resident: No = 0 points, Yes = +10 points
4. Neoplastic disease: No = 0 points, Yes = +30 points
5. Liver disease history: No = 0 points, Yes = +20 points
6. Congestive heart failure (CHF) history: No = 0 points, Yes = +10 points
7. Cerebrovascular disease history: No = 0 points, Yes = +10 points
8. Renal disease history: No = 0 points, Yes = +10 points
9. Altered mental status: No = 0 points, Yes = +20 points
10. Respiratory rate ≥30 breaths/min: No = 0 points, Yes = +20 points
11. Systolic blood pressure <90 mmHg: No = 0 points, Yes = +20 points
12. Temperature <35°C (95°F) or >39.9°C (103.8°F): No = 0 points, Yes = +15 points
13. Pulse ≥125 beats/min: No = 0 points, Yes = +10 points
14. pH <7.35: No = 0 points, Yes = +30 points
15. BUN ≥30 mg/dL or ≥11 mmol/L: No = 0 points, Yes = +20 points
16. Sodium <130 mmol/L: No = 0 points, Yes = +20 points
17. Glucose ≥250 mg/dL or ≥14 mmol/L: No = 0 points, Yes = +10 points
18. Hematocrit <30%: No = 0 points, Yes = +10 points
19. Partial pressure of oxygen <60 mmHg or <8 kPa: No = 0 points, Yes = +10 points
20. Pleural effusion on x-ray: No = 0 points, Yes = +10 points

The total score is calculated by summing the points for each criterion.

The current PSI score is 0.
The patient is 74.0 years old. We add the the number of years of age of the patient to the psi score, making the current total 0 + 74.0 = 74.0.
Because the patient is female, we subtract 10 points from the current total, making the current total 74.0 - 10 = 64.0.
The patient is not a nursing home resident and so we do not add any points to the current total keeping it at 64.0.
Neoplastic disease is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 64.0.
Liver disease history is determined to be present for the patient and so we add 20 points to the score, making the current total 64.0 + 20 = 84.0.
CHF History is determined to be false for the patient and so we do not add any points to the current total keeping it at 84.0.
Cerebrovascular disease history is determined to be false for the patient and so we do not add any points to the current total keeping it at 84.0.
Renal Disease History is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 84.0.
Altered Mental Status is determined to be false for the patient and so we do not add any points to the current total keeping it at 84.0.
Pleural effusion on x-ray is determined to be present for the patient and so we add 10 points to the score, making the current total 84.0 + 10 = 94.0.
The patient's pulse is 115.0 beats per minute. The pulse is less than 125 beats per minute and so we do not add any points to the score, keeping it at 94.0.
The patient's temperature is 99.5 degrees fahrenheit. To convert to degrees celsius, apply the formula 5/9 * [temperature (degrees fahrenheit) - 32]. This means that the patient's temperature is 5/9 * 67.5 = 37.5 degrees celsius. The patient's temperature is greater than 35 degrees celsius and the temperature is less than 39.9 degrees celsius, and so we do not add any points to the score, keeping the total at 94.0.
The patient's pH is 7.42. The patient's pH is greater than or equal to 7.35, and so we do not add any points to the score, keeping the current total at 94.0.
The patient's respiratory rate is 18.0 breaths per minute. The patient's respiratory rate is less than 30 breaths per minute and so we do not add any points to the score, keeping the total score at 94.0.
The patient's systolic blood pressure is 110.0 mm Hg. The patient's systolic blood pressure is greater than or equal to 90 mm Hg and so we do not add any points to the score, keeping the total at 94.0.
The concentration of BUN is 28.0 mg/dL. The patient's BUN is less than 30 mg/dL, and so we do not add any points to the score, keeping the total at 94.0.
The concentration of sodium is 136.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 136.0 mEq. To convert from 136.0 mEq to mmol, convert from mEq to mmol. The compound 136.0 has a valence of 1, and so divide the valence by the value of mEq to get, 136.0 mEq/(1 mEq/mmol) = 136.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 136.0 mEq sodium/L converts to 136.0 mmol sodium/L. The patient's sodium is greater than or equal to 130 mmol/L, and so we do not add any points to the score, keeping the total at 94.0.
The concentration of glucose is 6.4 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of glucose from mmol to mg. The mass of glucose is 6.4 mmol. To convert 6.4 mmol of glucose to mol, multiply by the conversion factor 0.001, giving us 6.4 mmol glucose * 0.001 mol/mmol = 0.006 mol glucose. To convert from mol glucose to grams, multiply by the molar mass 180.16 g/mol, which will give 0.006 mol glucose * 180.16 g/mol = 1.081 g glucose. To convert 1.081 g of glucose to mg, multiply by the conversion factor 1000.0, giving us 1.081 g glucose * 1000.0 mg/g = 1081.0 mg glucose. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 1081.0 mg glucose/10.0 dL = 108.1 mg glucose/dL. The concentration value of 6.4 mmol glucose/L converts to 108.1 mg glucose/dL. The patient's glucose concentration is less than or equal to than 250 mg/dL, and so we not add any points to the current total, keeping it at 94.0.
The patient's hematocrit is 37.0 %. The patient's hematocrit is greater than or equal to 30%, and so we not add any points to the current total, keeping it at 94.0.
The patient's partial pressure of oxygen is 84.0 mm Hg. The patient's partial pressure of oxygen is greater than or equal to 60 mm Hg, and so we not add any points to the current total, keeping it at 94.0.
The patient's PSI score is 94.0."
843,29,PSI Score: Pneumonia Severity Index for CAP,severity,integer,16,Handwritten,"A 79-year-old male who lives independently at home comes to the clinic accompanied by his daughter, who noticed her dad showing signs of confusion in recent days. His medical history includes renal disease and an active neoplastic condition, but no records of cerebrovascular disease, congestive heart failure or liver disease. On physical examination, he is A&Ox2 (but not to year or situation), his body temperature registers at 37.0 degrees celsius, his heart rate is measured at 95 beats per minute, the respiratory rate is regular at 24 breaths per minute, and his blood pressure is noted to be 115/70 mm Hg. Laboratory findings indicate a hematocrit level of 36 %, a slightly elevated blood urea nitrogen concentration of 35 mg/dL, and a glucose level of 8.0 mmol/L. Sodium level in his blood is found to be 141 mEq/L. Arterial blood gas results show a pH of 7.34 and a PaO2 of 75 mm Hg, which are within normal limits.",What is the patient's Pneumonia Severity Index (PSI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [95.0, 'beats per minute'], 'pH': 7.34, 'Altered mental status': True, 'Systolic Blood Pressure': [115.0, 'mm Hg'], 'Blood Urea Nitrogen (BUN)': [35.0, 'mg/dL'], 'Renal disease': True, 'Cerebrovascular disease history': False, 'Neoplastic disease': True, 'Sodium': [141.0, 'mEq/L'], 'Nursing home resident': False, 'Partial pressure of oxygen': [75.0, 'mm Hg'], 'age': [79.0, 'years'], 'respiratory rate': [24.0, 'breaths per minute'], 'sex': 'Male', 'Hematocrit': [36.0, '%'], 'Glucose': [8.0, 'mmol/L'], 'Temperature': [37.0, 'degrees celsius']}",189,189,189,"The rules for computing the Pneumonia Severity Index (PSI) are shown below:

1. Age: Enter age in years (age score will be equal to age in years)
2. Sex: Female = -10 points, Male = 0 points
3. Nursing home resident: No = 0 points, Yes = +10 points
4. Neoplastic disease: No = 0 points, Yes = +30 points
5. Liver disease history: No = 0 points, Yes = +20 points
6. Congestive heart failure (CHF) history: No = 0 points, Yes = +10 points
7. Cerebrovascular disease history: No = 0 points, Yes = +10 points
8. Renal disease history: No = 0 points, Yes = +10 points
9. Altered mental status: No = 0 points, Yes = +20 points
10. Respiratory rate ≥30 breaths/min: No = 0 points, Yes = +20 points
11. Systolic blood pressure <90 mmHg: No = 0 points, Yes = +20 points
12. Temperature <35°C (95°F) or >39.9°C (103.8°F): No = 0 points, Yes = +15 points
13. Pulse ≥125 beats/min: No = 0 points, Yes = +10 points
14. pH <7.35: No = 0 points, Yes = +30 points
15. BUN ≥30 mg/dL or ≥11 mmol/L: No = 0 points, Yes = +20 points
16. Sodium <130 mmol/L: No = 0 points, Yes = +20 points
17. Glucose ≥250 mg/dL or ≥14 mmol/L: No = 0 points, Yes = +10 points
18. Hematocrit <30%: No = 0 points, Yes = +10 points
19. Partial pressure of oxygen <60 mmHg or <8 kPa: No = 0 points, Yes = +10 points
20. Pleural effusion on x-ray: No = 0 points, Yes = +10 points

The total score is calculated by summing the points for each criterion.

The current PSI score is 0.
The patient is 79.0 years old. We add the the number of years of age of the patient to the psi score, making the current total 0 + 79.0 = 79.0.
Because the patient is male, no adjustments are made to the score, keeping the current total at 79.0.
The patient is not a nursing home resident and so we do not add any points to the current total keeping it at 79.0.
Neoplastic disease is determined to be present for the patient and so we add 30 points to the score, making the current total 79.0 + 30 = 109.0.
Liver disease history is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 109.0.
CHF History is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 109.0.
Cerebrovascular disease history is determined to be false for the patient and so we do not add any points to the current total keeping it at 109.0.
Renal Disease History is determined to be present for the patient and so we add 10 points to the score, making the current total 109.0 + 10 = 119.0.
Altered Mental Status is determined to be present for the patient and so we add 20 points to the score, making the current total 119.0 + 20 = 139.0.
Pleural effusion on x-ray is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 139.0.
The patient's pulse is 95.0 beats per minute. The pulse is less than 125 beats per minute and so we do not add any points to the score, keeping it at 139.0.
The patient's temperature is 37.0 degrees celsius. The patient's temperature is greater than 35 degrees celsius and the temperature is less than 39.9 degrees celsius, and so we do not add any points to the score, keeping the total at 139.0.
The patient's pH is 7.34. The patient's pH is less than 7.35, and so we add 30 points to the score, making the current total 139.0 + 30 = 169.0.
The patient's respiratory rate is 24.0 breaths per minute. The patient's respiratory rate is less than 30 breaths per minute and so we do not add any points to the score, keeping the total score at 169.0.
The patient's systolic blood pressure is 115.0 mm Hg. The patient's systolic blood pressure is greater than or equal to 90 mm Hg and so we do not add any points to the score, keeping the total at 169.0.
The concentration of BUN is 35.0 mg/dL. The patient's BUN is greater than or equal to 30 mg/dL, and so we add 20 points to the score, making current total 169.0 + 20 = 189.0.
The concentration of sodium is 141.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 141.0 mEq. To convert from 141.0 mEq to mmol, convert from mEq to mmol. The compound 141.0 has a valence of 1, and so divide the valence by the value of mEq to get, 141.0 mEq/(1 mEq/mmol) = 141.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 141.0 mEq sodium/L converts to 141.0 mmol sodium/L. The patient's sodium is greater than or equal to 130 mmol/L, and so we do not add any points to the score, keeping the total at 189.0.
The concentration of glucose is 8.0 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of glucose from mmol to mg. The mass of glucose is 8.0 mmol. To convert 8.0 mmol of glucose to mol, multiply by the conversion factor 0.001, giving us 8.0 mmol glucose * 0.001 mol/mmol = 0.008 mol glucose. To convert from mol glucose to grams, multiply by the molar mass 180.16 g/mol, which will give 0.008 mol glucose * 180.16 g/mol = 1.441 g glucose. To convert 1.441 g of glucose to mg, multiply by the conversion factor 1000.0, giving us 1.441 g glucose * 1000.0 mg/g = 1441.0 mg glucose. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 1441.0 mg glucose/10.0 dL = 144.1 mg glucose/dL. The concentration value of 8.0 mmol glucose/L converts to 144.1 mg glucose/dL. The patient's glucose concentration is less than or equal to than 250 mg/dL, and so we not add any points to the current total, keeping it at 189.0.
The patient's hematocrit is 36.0 %. The patient's hematocrit is greater than or equal to 30%, and so we not add any points to the current total, keeping it at 189.0.
The patient's partial pressure of oxygen is 75.0 mm Hg. The patient's partial pressure of oxygen is greater than or equal to 60 mm Hg, and so we not add any points to the current total, keeping it at 189.0.
The patient's PSI score is 189.0."
844,29,PSI Score: Pneumonia Severity Index for CAP,severity,integer,17,Handwritten,"A 75-year-old female residing in a nursing home is brought to the outpatient department by her nurse for a regular health check. Her medical records indicate a past history of congestive heart failure but no known liver disease or neoplastic conditions. Today's examination finds her mentally alert with a body temperature reading of 36.5 degrees celsius, a pulse rate of 82 beats per minute, a respiratory rate of 22 breaths per minute, and blood pressure measuring at 128/80 mm Hg. Laboratory results are collected; hematocrit at 39 %, glucose elevated to 180 mg/dL, blood urea nitrogen (BUN) slightly high at 27 mg/dL, and sodium within normal limits at 139 mEq/L. An arterial blood gas analysis reports a pH of 7.40 and PaO2 at 80 mm Hg. Chest X-rays show indications of pleural effusion.",What is the patient's Pneumonia Severity Index (PSI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [82.0, 'beats per minute'], 'pH': 7.4, 'Altered mental status': False, 'Systolic Blood Pressure': [128.0, 'mm Hg'], 'Blood Urea Nitrogen (BUN)': [27.0, 'mg/dL'], 'Pleural effusion on x-ray': True, 'Neoplastic disease': False, 'Sodium': [139.0, 'mEq/L'], 'Liver disease severity': False, 'Congestive Heart Failure': True, 'Nursing home resident': True, 'Partial pressure of oxygen': [80.0, 'mm Hg'], 'age': [75.0, 'years'], 'respiratory rate': [22.0, 'breaths per minute'], 'sex': 'Female', 'Hematocrit': [39.0, '%'], 'Glucose': [180.0, 'mg/dL'], 'Temperature': [36.5, 'degrees celsius']}",95,95,95,"The rules for computing the Pneumonia Severity Index (PSI) are shown below:

1. Age: Enter age in years (age score will be equal to age in years)
2. Sex: Female = -10 points, Male = 0 points
3. Nursing home resident: No = 0 points, Yes = +10 points
4. Neoplastic disease: No = 0 points, Yes = +30 points
5. Liver disease history: No = 0 points, Yes = +20 points
6. Congestive heart failure (CHF) history: No = 0 points, Yes = +10 points
7. Cerebrovascular disease history: No = 0 points, Yes = +10 points
8. Renal disease history: No = 0 points, Yes = +10 points
9. Altered mental status: No = 0 points, Yes = +20 points
10. Respiratory rate ≥30 breaths/min: No = 0 points, Yes = +20 points
11. Systolic blood pressure <90 mmHg: No = 0 points, Yes = +20 points
12. Temperature <35°C (95°F) or >39.9°C (103.8°F): No = 0 points, Yes = +15 points
13. Pulse ≥125 beats/min: No = 0 points, Yes = +10 points
14. pH <7.35: No = 0 points, Yes = +30 points
15. BUN ≥30 mg/dL or ≥11 mmol/L: No = 0 points, Yes = +20 points
16. Sodium <130 mmol/L: No = 0 points, Yes = +20 points
17. Glucose ≥250 mg/dL or ≥14 mmol/L: No = 0 points, Yes = +10 points
18. Hematocrit <30%: No = 0 points, Yes = +10 points
19. Partial pressure of oxygen <60 mmHg or <8 kPa: No = 0 points, Yes = +10 points
20. Pleural effusion on x-ray: No = 0 points, Yes = +10 points

The total score is calculated by summing the points for each criterion.

The current PSI score is 0.
The patient is 75.0 years old. We add the the number of years of age of the patient to the psi score, making the current total 0 + 75.0 = 75.0.
Because the patient is female, we subtract 10 points from the current total, making the current total 75.0 - 10 = 65.0.
The patient is reported to be a nursing home resident and so we add 10 points to the score, making the current total 65.0 + 10 = 75.0.
Neoplastic disease is determined to be false for the patient and so we do not add any points to the current total keeping it at 75.0.
Liver disease history is determined to be false for the patient and so we do not add any points to the current total keeping it at 75.0.
CHF History is determined to be present for the patient and so we add 10 points to the score, making the current total 75.0 + 10 = 85.0.
Cerebrovascular disease history is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 85.0.
Renal Disease History is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 85.0.
Altered Mental Status is determined to be false for the patient and so we do not add any points to the current total keeping it at 85.0.
Pleural effusion on x-ray is determined to be present for the patient and so we add 10 points to the score, making the current total 85.0 + 10 = 95.0.
The patient's pulse is 82.0 beats per minute. The pulse is less than 125 beats per minute and so we do not add any points to the score, keeping it at 95.0.
The patient's temperature is 36.5 degrees celsius. The patient's temperature is greater than 35 degrees celsius and the temperature is less than 39.9 degrees celsius, and so we do not add any points to the score, keeping the total at 95.0.
The patient's pH is 7.4. The patient's pH is greater than or equal to 7.35, and so we do not add any points to the score, keeping the current total at 95.0.
The patient's respiratory rate is 22.0 breaths per minute. The patient's respiratory rate is less than 30 breaths per minute and so we do not add any points to the score, keeping the total score at 95.0.
The patient's systolic blood pressure is 128.0 mm Hg. The patient's systolic blood pressure is greater than or equal to 90 mm Hg and so we do not add any points to the score, keeping the total at 95.0.
The concentration of BUN is 27.0 mg/dL. The patient's BUN is less than 30 mg/dL, and so we do not add any points to the score, keeping the total at 95.0.
The concentration of sodium is 139.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 139.0 mEq. To convert from 139.0 mEq to mmol, convert from mEq to mmol. The compound 139.0 has a valence of 1, and so divide the valence by the value of mEq to get, 139.0 mEq/(1 mEq/mmol) = 139.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 139.0 mEq sodium/L converts to 139.0 mmol sodium/L. The patient's sodium is greater than or equal to 130 mmol/L, and so we do not add any points to the score, keeping the total at 95.0.
The concentration of glucose is 180.0 mg/dL. The patient's glucose concentration is less than or equal to than 250 mg/dL, and so we not add any points to the current total, keeping it at 95.0.
The patient's hematocrit is 39.0 %. The patient's hematocrit is greater than or equal to 30%, and so we not add any points to the current total, keeping it at 95.0.
The patient's partial pressure of oxygen is 80.0 mm Hg. The patient's partial pressure of oxygen is greater than or equal to 60 mm Hg, and so we not add any points to the current total, keeping it at 95.0.
The patient's PSI score is 95.0."
845,29,PSI Score: Pneumonia Severity Index for CAP,severity,integer,18,Handwritten,"A 71-year-old male visited the clinic today for a routine follow-up. His medical records indicate a history of chronic kidney disease, a prior stroke in 2018, and an active diagnosis of congestive heart failure. His living situation is not recorded, and he exhibits no sign of altered mental status today. His vital signs are within normal limits with a body temperature of 37.8 degrees celsius, heart rate of 105 beats per minute, a steady respiratory rate of 19 breaths per minute, and blood pressure reading at 140/80 mm Hg, efficient for a patient his age. From his recent diagnostics, lab results reveal a hematocrit level of 45 %, a glucose level of 7.2 mmol/L, and a blood urea nitrogen concentration of 22 mg/dL. Sodium level is slightly low at 133 mEq/L. An arterial blood gas analysis was conducted revealing a pH of 7.37 and PaO2 of 75 mm Hg. His chest x-ray from the previous consultation was without any abnormalities. He has no past history of liver disease or neoplastic diseases.",What is the patient's Pneumonia Severity Index (PSI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [105.0, 'beats per minute'], 'pH': 7.37, 'Altered mental status': False, 'Systolic Blood Pressure': [140.0, 'mm Hg'], 'Blood Urea Nitrogen (BUN)': [22.0, 'mg/dL'], 'Renal disease': True, 'Pleural effusion on x-ray': False, 'Cerebrovascular disease history': True, 'Neoplastic disease': False, 'Sodium': [133.0, 'mEq/L'], 'Liver disease severity': False, 'Congestive Heart Failure': True, 'Partial pressure of oxygen': [75.0, 'mm Hg'], 'age': [71.0, 'years'], 'respiratory rate': [19.0, 'breaths per minute'], 'sex': 'Male', 'Hematocrit': [45.0, '%'], 'Glucose': [7.2, 'mmol/L'], 'Temperature': [37.8, 'degrees celsius']}",101,101,101,"The rules for computing the Pneumonia Severity Index (PSI) are shown below:

1. Age: Enter age in years (age score will be equal to age in years)
2. Sex: Female = -10 points, Male = 0 points
3. Nursing home resident: No = 0 points, Yes = +10 points
4. Neoplastic disease: No = 0 points, Yes = +30 points
5. Liver disease history: No = 0 points, Yes = +20 points
6. Congestive heart failure (CHF) history: No = 0 points, Yes = +10 points
7. Cerebrovascular disease history: No = 0 points, Yes = +10 points
8. Renal disease history: No = 0 points, Yes = +10 points
9. Altered mental status: No = 0 points, Yes = +20 points
10. Respiratory rate ≥30 breaths/min: No = 0 points, Yes = +20 points
11. Systolic blood pressure <90 mmHg: No = 0 points, Yes = +20 points
12. Temperature <35°C (95°F) or >39.9°C (103.8°F): No = 0 points, Yes = +15 points
13. Pulse ≥125 beats/min: No = 0 points, Yes = +10 points
14. pH <7.35: No = 0 points, Yes = +30 points
15. BUN ≥30 mg/dL or ≥11 mmol/L: No = 0 points, Yes = +20 points
16. Sodium <130 mmol/L: No = 0 points, Yes = +20 points
17. Glucose ≥250 mg/dL or ≥14 mmol/L: No = 0 points, Yes = +10 points
18. Hematocrit <30%: No = 0 points, Yes = +10 points
19. Partial pressure of oxygen <60 mmHg or <8 kPa: No = 0 points, Yes = +10 points
20. Pleural effusion on x-ray: No = 0 points, Yes = +10 points

The total score is calculated by summing the points for each criterion.

The current PSI score is 0.
The patient is 71.0 years old. We add the the number of years of age of the patient to the psi score, making the current total 0 + 71.0 = 71.0.
Because the patient is male, no adjustments are made to the score, keeping the current total at 71.0.
Whether patient is a nursing home resident is not reported. Hence, we assume this to be false and so not add any points to the current total keeping it at 71.0.
Neoplastic disease is determined to be false for the patient and so we do not add any points to the current total keeping it at 71.0.
Liver disease history is determined to be false for the patient and so we do not add any points to the current total keeping it at 71.0.
CHF History is determined to be present for the patient and so we add 10 points to the score, making the current total 71.0 + 10 = 81.0.
Cerebrovascular disease history is determined to be present for the patient and so we add 10 points to the score, making the current total 81.0 + 10 = 91.0.
Renal Disease History is determined to be present for the patient and so we add 10 points to the score, making the current total 91.0 + 10 = 101.0.
Altered Mental Status is determined to be false for the patient and so we do not add any points to the current total keeping it at 101.0.
Pleural effusion on x-ray is determined to be false for the patient and so we do not add any points to the current total keeping it at 101.0.
The patient's pulse is 105.0 beats per minute. The pulse is less than 125 beats per minute and so we do not add any points to the score, keeping it at 101.0.
The patient's temperature is 37.8 degrees celsius. The patient's temperature is greater than 35 degrees celsius and the temperature is less than 39.9 degrees celsius, and so we do not add any points to the score, keeping the total at 101.0.
The patient's pH is 7.37. The patient's pH is greater than or equal to 7.35, and so we do not add any points to the score, keeping the current total at 101.0.
The patient's respiratory rate is 19.0 breaths per minute. The patient's respiratory rate is less than 30 breaths per minute and so we do not add any points to the score, keeping the total score at 101.0.
The patient's systolic blood pressure is 140.0 mm Hg. The patient's systolic blood pressure is greater than or equal to 90 mm Hg and so we do not add any points to the score, keeping the total at 101.0.
The concentration of BUN is 22.0 mg/dL. The patient's BUN is less than 30 mg/dL, and so we do not add any points to the score, keeping the total at 101.0.
The concentration of sodium is 133.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 133.0 mEq. To convert from 133.0 mEq to mmol, convert from mEq to mmol. The compound 133.0 has a valence of 1, and so divide the valence by the value of mEq to get, 133.0 mEq/(1 mEq/mmol) = 133.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 133.0 mEq sodium/L converts to 133.0 mmol sodium/L. The patient's sodium is greater than or equal to 130 mmol/L, and so we do not add any points to the score, keeping the total at 101.0.
The concentration of glucose is 7.2 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of glucose from mmol to mg. The mass of glucose is 7.2 mmol. To convert 7.2 mmol of glucose to mol, multiply by the conversion factor 0.001, giving us 7.2 mmol glucose * 0.001 mol/mmol = 0.007 mol glucose. To convert from mol glucose to grams, multiply by the molar mass 180.16 g/mol, which will give 0.007 mol glucose * 180.16 g/mol = 1.261 g glucose. To convert 1.261 g of glucose to mg, multiply by the conversion factor 1000.0, giving us 1.261 g glucose * 1000.0 mg/g = 1261.0 mg glucose. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 1261.0 mg glucose/10.0 dL = 126.1 mg glucose/dL. The concentration value of 7.2 mmol glucose/L converts to 126.1 mg glucose/dL. The patient's glucose concentration is less than or equal to than 250 mg/dL, and so we not add any points to the current total, keeping it at 101.0.
The patient's hematocrit is 45.0 %. The patient's hematocrit is greater than or equal to 30%, and so we not add any points to the current total, keeping it at 101.0.
The patient's partial pressure of oxygen is 75.0 mm Hg. The patient's partial pressure of oxygen is greater than or equal to 60 mm Hg, and so we not add any points to the current total, keeping it at 101.0.
The patient's PSI score is 101.0."
846,29,PSI Score: Pneumonia Severity Index for CAP,severity,integer,19,Handwritten,"A 77-year-old female patient, living in her own home, visits the primary care clinic for her regular check-up. Today, she appears alert and well-oriented. Her medical history is significant for prior breast cancer, but there is no record of liver, renal or cerebrovascular diseases, or congestive heart failure. Today's vital signs find her with a temperature at 98.6 degrees Fahrenheit, heart rate counted at 78 beats per minute, a breathing rate of 18 breaths per minute, and a blood pressure level of 135/85 mm Hg. The hematocrit is at 42 % and a blood glucose level of 6.9 mmol/L from lab results. Her blood urea nitrogen (BUN) value is 20 mg/dL and sodium is within the normal range at 140 mEq/L. An arterial blood gas analysis returns normal with a pH of 7.45 and a PaO2 of 78 mm Hg. The patient's most recent chest X-ray does not seem to be available at this visit.",What is the patient's Pneumonia Severity Index (PSI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [78.0, 'beats per minute'], 'pH': 7.45, 'Altered mental status': False, 'Systolic Blood Pressure': [135.0, 'mm Hg'], 'Blood Urea Nitrogen (BUN)': [20.0, 'mg/dL'], 'Renal disease': False, 'Cerebrovascular disease history': False, 'Neoplastic disease': True, 'Sodium': [140.0, 'mEq/L'], 'Liver disease severity': False, 'Congestive Heart Failure': False, 'Nursing home resident': False, 'Partial pressure of oxygen': [78.0, 'mm Hg'], 'age': [77.0, 'years'], 'respiratory rate': [18.0, 'breaths per minute'], 'sex': 'Female', 'Hematocrit': [42.0, '%'], 'Glucose': [6.9, 'mmol/L'], 'Temperature': [98.6, 'degrees fahrenheit']}",97,97,97,"The rules for computing the Pneumonia Severity Index (PSI) are shown below:

1. Age: Enter age in years (age score will be equal to age in years)
2. Sex: Female = -10 points, Male = 0 points
3. Nursing home resident: No = 0 points, Yes = +10 points
4. Neoplastic disease: No = 0 points, Yes = +30 points
5. Liver disease history: No = 0 points, Yes = +20 points
6. Congestive heart failure (CHF) history: No = 0 points, Yes = +10 points
7. Cerebrovascular disease history: No = 0 points, Yes = +10 points
8. Renal disease history: No = 0 points, Yes = +10 points
9. Altered mental status: No = 0 points, Yes = +20 points
10. Respiratory rate ≥30 breaths/min: No = 0 points, Yes = +20 points
11. Systolic blood pressure <90 mmHg: No = 0 points, Yes = +20 points
12. Temperature <35°C (95°F) or >39.9°C (103.8°F): No = 0 points, Yes = +15 points
13. Pulse ≥125 beats/min: No = 0 points, Yes = +10 points
14. pH <7.35: No = 0 points, Yes = +30 points
15. BUN ≥30 mg/dL or ≥11 mmol/L: No = 0 points, Yes = +20 points
16. Sodium <130 mmol/L: No = 0 points, Yes = +20 points
17. Glucose ≥250 mg/dL or ≥14 mmol/L: No = 0 points, Yes = +10 points
18. Hematocrit <30%: No = 0 points, Yes = +10 points
19. Partial pressure of oxygen <60 mmHg or <8 kPa: No = 0 points, Yes = +10 points
20. Pleural effusion on x-ray: No = 0 points, Yes = +10 points

The total score is calculated by summing the points for each criterion.

The current PSI score is 0.
The patient is 77.0 years old. We add the the number of years of age of the patient to the psi score, making the current total 0 + 77.0 = 77.0.
Because the patient is female, we subtract 10 points from the current total, making the current total 77.0 - 10 = 67.0.
The patient is not a nursing home resident and so we do not add any points to the current total keeping it at 67.0.
Neoplastic disease is determined to be present for the patient and so we add 30 points to the score, making the current total 67.0 + 30 = 97.0.
Liver disease history is determined to be false for the patient and so we do not add any points to the current total keeping it at 97.0.
CHF History is determined to be false for the patient and so we do not add any points to the current total keeping it at 97.0.
Cerebrovascular disease history is determined to be false for the patient and so we do not add any points to the current total keeping it at 97.0.
Renal Disease History is determined to be false for the patient and so we do not add any points to the current total keeping it at 97.0.
Altered Mental Status is determined to be false for the patient and so we do not add any points to the current total keeping it at 97.0.
Pleural effusion on x-ray is not reported for the patient and so we assume it to be false. Hence, we do not add any points to the current total keeping it at 97.0.
The patient's pulse is 78.0 beats per minute. The pulse is less than 125 beats per minute and so we do not add any points to the score, keeping it at 97.0.
The patient's temperature is 98.6 degrees fahrenheit. To convert to degrees celsius, apply the formula 5/9 * [temperature (degrees fahrenheit) - 32]. This means that the patient's temperature is 5/9 * 66.6 = 37.0 degrees celsius. The patient's temperature is greater than 35 degrees celsius and the temperature is less than 39.9 degrees celsius, and so we do not add any points to the score, keeping the total at 97.0.
The patient's pH is 7.45. The patient's pH is greater than or equal to 7.35, and so we do not add any points to the score, keeping the current total at 97.0.
The patient's respiratory rate is 18.0 breaths per minute. The patient's respiratory rate is less than 30 breaths per minute and so we do not add any points to the score, keeping the total score at 97.0.
The patient's systolic blood pressure is 135.0 mm Hg. The patient's systolic blood pressure is greater than or equal to 90 mm Hg and so we do not add any points to the score, keeping the total at 97.0.
The concentration of BUN is 20.0 mg/dL. The patient's BUN is less than 30 mg/dL, and so we do not add any points to the score, keeping the total at 97.0.
The concentration of sodium is 140.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 140.0 mEq. To convert from 140.0 mEq to mmol, convert from mEq to mmol. The compound 140.0 has a valence of 1, and so divide the valence by the value of mEq to get, 140.0 mEq/(1 mEq/mmol) = 140.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 140.0 mEq sodium/L converts to 140.0 mmol sodium/L. The patient's sodium is greater than or equal to 130 mmol/L, and so we do not add any points to the score, keeping the total at 97.0.
The concentration of glucose is 6.9 mmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of glucose from mmol to mg. The mass of glucose is 6.9 mmol. To convert 6.9 mmol of glucose to mol, multiply by the conversion factor 0.001, giving us 6.9 mmol glucose * 0.001 mol/mmol = 0.007 mol glucose. To convert from mol glucose to grams, multiply by the molar mass 180.16 g/mol, which will give 0.007 mol glucose * 180.16 g/mol = 1.261 g glucose. To convert 1.261 g of glucose to mg, multiply by the conversion factor 1000.0, giving us 1.261 g glucose * 1000.0 mg/g = 1261.0 mg glucose. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 1261.0 mg glucose/10.0 dL = 126.1 mg glucose/dL. The concentration value of 6.9 mmol glucose/L converts to 126.1 mg glucose/dL. The patient's glucose concentration is less than or equal to than 250 mg/dL, and so we not add any points to the current total, keeping it at 97.0.
The patient's hematocrit is 42.0 %. The patient's hematocrit is greater than or equal to 30%, and so we not add any points to the current total, keeping it at 97.0.
The patient's partial pressure of oxygen is 78.0 mm Hg. The patient's partial pressure of oxygen is greater than or equal to 60 mm Hg, and so we not add any points to the current total, keeping it at 97.0.
The patient's PSI score is 97.0."
847,29,PSI Score: Pneumonia Severity Index for CAP,severity,integer,20,Handwritten,"A 73-year-old male patient presents to the clinic with family reporting recent episodes of confusion. The patient's medical history is indicative of both a prior stroke and MASH, however, there's no mention of renal or neoplastic disease, and the patient has no reported heart failure. Today, he appears stable with a body temperature of 36.3 degrees celsius, a heart rate of 90 beats per minute, a respiratory rate of 20 breaths per minute, and a blood pressure of 120/80 mm Hg. Mental status on physical exam reveals only A&Ox2. His laboratory results included a hematocrit level of 39 %, blood urea nitrogen level of 24 mg/dL, a glucose value of 115 mg/dL, and the patient's sodium level is at 137 mEq/L. The arterial blood gas analysis presents a pH of 7.48 and a PaO2 of 72 mm Hg. His recent chest X-ray was marked by the presence of pleural effusion. His residency status is not clearly mentioned in the patient's current records.",What is the patient's Pneumonia Severity Index (PSI)? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [90.0, 'beats per minute'], 'pH': 7.48, 'Altered mental status': True, 'Systolic Blood Pressure': [120.0, 'mm Hg'], 'Blood Urea Nitrogen (BUN)': [24.0, 'mg/dL'], 'Renal disease': False, 'Pleural effusion on x-ray': True, 'Cerebrovascular disease history': True, 'Neoplastic disease': False, 'Sodium': [137.0, 'mEq/L'], 'Liver disease severity': False, 'Congestive Heart Failure': False, 'Partial pressure of oxygen': [72.0, 'mm Hg'], 'age': [73.0, 'years'], 'respiratory rate': [20.0, 'breaths per minute'], 'sex': 'Male', 'Hematocrit': [39.0, '%'], 'Glucose': [115.0, 'mg/dL'], 'Temperature': [36.3, 'degrees celsius']}",113,113,113,"The rules for computing the Pneumonia Severity Index (PSI) are shown below:

1. Age: Enter age in years (age score will be equal to age in years)
2. Sex: Female = -10 points, Male = 0 points
3. Nursing home resident: No = 0 points, Yes = +10 points
4. Neoplastic disease: No = 0 points, Yes = +30 points
5. Liver disease history: No = 0 points, Yes = +20 points
6. Congestive heart failure (CHF) history: No = 0 points, Yes = +10 points
7. Cerebrovascular disease history: No = 0 points, Yes = +10 points
8. Renal disease history: No = 0 points, Yes = +10 points
9. Altered mental status: No = 0 points, Yes = +20 points
10. Respiratory rate ≥30 breaths/min: No = 0 points, Yes = +20 points
11. Systolic blood pressure <90 mmHg: No = 0 points, Yes = +20 points
12. Temperature <35°C (95°F) or >39.9°C (103.8°F): No = 0 points, Yes = +15 points
13. Pulse ≥125 beats/min: No = 0 points, Yes = +10 points
14. pH <7.35: No = 0 points, Yes = +30 points
15. BUN ≥30 mg/dL or ≥11 mmol/L: No = 0 points, Yes = +20 points
16. Sodium <130 mmol/L: No = 0 points, Yes = +20 points
17. Glucose ≥250 mg/dL or ≥14 mmol/L: No = 0 points, Yes = +10 points
18. Hematocrit <30%: No = 0 points, Yes = +10 points
19. Partial pressure of oxygen <60 mmHg or <8 kPa: No = 0 points, Yes = +10 points
20. Pleural effusion on x-ray: No = 0 points, Yes = +10 points

The total score is calculated by summing the points for each criterion.

The current PSI score is 0.
The patient is 73.0 years old. We add the the number of years of age of the patient to the psi score, making the current total 0 + 73.0 = 73.0.
Because the patient is male, no adjustments are made to the score, keeping the current total at 73.0.
Whether patient is a nursing home resident is not reported. Hence, we assume this to be false and so not add any points to the current total keeping it at 73.0.
Neoplastic disease is determined to be false for the patient and so we do not add any points to the current total keeping it at 73.0.
Liver disease history is determined to be false for the patient and so we do not add any points to the current total keeping it at 73.0.
CHF History is determined to be false for the patient and so we do not add any points to the current total keeping it at 73.0.
Cerebrovascular disease history is determined to be present for the patient and so we add 10 points to the score, making the current total 73.0 + 10 = 83.0.
Renal Disease History is determined to be false for the patient and so we do not add any points to the current total keeping it at 83.0.
Altered Mental Status is determined to be present for the patient and so we add 20 points to the score, making the current total 83.0 + 20 = 103.0.
Pleural effusion on x-ray is determined to be present for the patient and so we add 10 points to the score, making the current total 103.0 + 10 = 113.0.
The patient's pulse is 90.0 beats per minute. The pulse is less than 125 beats per minute and so we do not add any points to the score, keeping it at 113.0.
The patient's temperature is 36.3 degrees celsius. The patient's temperature is greater than 35 degrees celsius and the temperature is less than 39.9 degrees celsius, and so we do not add any points to the score, keeping the total at 113.0.
The patient's pH is 7.48. The patient's pH is greater than or equal to 7.35, and so we do not add any points to the score, keeping the current total at 113.0.
The patient's respiratory rate is 20.0 breaths per minute. The patient's respiratory rate is less than 30 breaths per minute and so we do not add any points to the score, keeping the total score at 113.0.
The patient's systolic blood pressure is 120.0 mm Hg. The patient's systolic blood pressure is greater than or equal to 90 mm Hg and so we do not add any points to the score, keeping the total at 113.0.
The concentration of BUN is 24.0 mg/dL. The patient's BUN is less than 30 mg/dL, and so we do not add any points to the score, keeping the total at 113.0.
The concentration of sodium is 137.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 137.0 mEq. To convert from 137.0 mEq to mmol, convert from mEq to mmol. The compound 137.0 has a valence of 1, and so divide the valence by the value of mEq to get, 137.0 mEq/(1 mEq/mmol) = 137.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 137.0 mEq sodium/L converts to 137.0 mmol sodium/L. The patient's sodium is greater than or equal to 130 mmol/L, and so we do not add any points to the score, keeping the total at 113.0.
The concentration of glucose is 115.0 mg/dL. The patient's glucose concentration is less than or equal to than 250 mg/dL, and so we not add any points to the current total, keeping it at 113.0.
The patient's hematocrit is 39.0 %. The patient's hematocrit is greater than or equal to 30%, and so we not add any points to the current total, keeping it at 113.0.
The patient's partial pressure of oxygen is 72.0 mm Hg. The patient's partial pressure of oxygen is greater than or equal to 60 mm Hg, and so we not add any points to the current total, keeping it at 113.0.
The patient's PSI score is 113.0."
848,21,Glasgow Coma Score (GCS),severity,integer,1,Handwritten,"A 32-year-old female is found unconscious at home by her roommate and is brought to the emergency department. Her roommate reports that the patient has been feeling increasingly depressed over the past few weeks and had recently stopped taking her antidepressant medication. She has a history of depression and occasional migraines but no other significant medical history. Upon arrival, the patient's vital signs are stable: blood pressure is 120/75 mmHg, heart rate is 90 beats per minute, respiratory rate is 14 breaths per minute, and oxygen saturation is 98 % on room air. On a physical exam, she is seen unconscious on the stretcher with her eyes closed. She is not able to be aroused verbally but does momentarily open her eyes to sternal rub. She also adjusted her position to move her chest away from the examiner's hand. When asked if she knows where she is, she responds, 'I am in the Lego aisle of Target.' There are no signs of trauma or focal neurological deficits. Blood tests, including a toxicology screen, are pending. Her pupils are equal and reactive to light, and there are no signs of nystagmus.",What is the patient's Glasgow Coma Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Best eye response': 'eye opening to pain', 'Best verbal response': 'inappropriate words', 'Best motor response': 'withdrawal from pain'}",9,9,9,"The Glasgow Coma Scale (GCS) for assessing a patient's level of consciousness is shown below:
    
1. Best Eye Response: Spontaneously = +4 points, To verbal command = +3 points, To pain = +2 points, No eye opening = +1 point
2. Best Verbal Response: Oriented = +5 points, Confused = +4 points, Inappropriate words = +3 points, Incomprehensible sounds = +2 points, No verbal response = +1 point
3. Best Motor Response: Obeys commands = +6 points, Localizes pain = +5 points, Withdrawal from pain = +4 points, Flexion to pain = +3 points, Extension to pain = +2 points, No motor response = +1 point

For each criteria, if a patient's value is not mentioned/not testable in the note, we assume that it gets the full score for that attribute.  The total GCS score is calculated by summing the points for each of the three components.
    
The current glasgow coma score is 0.
Based on the patient note, the best eye response for the patient is 'eye opening to pain', and so we add 2 points making the current total 0 + 2 = 2.
Based on the patient note, the best verbal response for the patient is 'inappropriate words', and so we add 3 points making the current total 2 + 3 = 5.
Based on the patient note, the best motor response for the patient is 'withdrawal from pain', and so we add 4 points making the current total 5 + 4 = 9.
Hence, the patient's glasgow coma score is 9."
849,21,Glasgow Coma Score (GCS),severity,integer,2,Handwritten,"A 58 year old female is brought to the emergency department following a high speed head-on motor vehicle collision. Upon extrication from the vehicle, he was found conscious but confused by emergency responders. Vital signs are notable for  heart rate 100 bpm, blood pressure 150/90 mmHg, respiratory rate 22 breaths per minute, temperature 37.2°C (99.0°F), and O2 sat 95 % on room air. The patient appears anxious and disoriented. He intermittently opens his eyes in response to verbal commands but is unable to provide accurate information about the injury. He localizes painful stimuli. Cranial nerves are intact. Secondary assessment reveals tenderness and swelling over the right forearm and abdominal tenderness to palpation. Further evaluation with head CT, X-rays of the right forearm, and abdominal imaging are ordered.",What is the patient's Glasgow Coma Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Best eye response': 'eye opening to verbal command', 'Best verbal response': 'confused', 'Best motor response': 'localizes pain'}",12,12,12,"The Glasgow Coma Scale (GCS) for assessing a patient's level of consciousness is shown below:
    
1. Best Eye Response: Spontaneously = +4 points, To verbal command = +3 points, To pain = +2 points, No eye opening = +1 point
2. Best Verbal Response: Oriented = +5 points, Confused = +4 points, Inappropriate words = +3 points, Incomprehensible sounds = +2 points, No verbal response = +1 point
3. Best Motor Response: Obeys commands = +6 points, Localizes pain = +5 points, Withdrawal from pain = +4 points, Flexion to pain = +3 points, Extension to pain = +2 points, No motor response = +1 point

For each criteria, if a patient's value is not mentioned/not testable in the note, we assume that it gets the full score for that attribute.  The total GCS score is calculated by summing the points for each of the three components.
    
The current glasgow coma score is 0.
Based on the patient note, the best eye response for the patient is 'eye opening to verbal command', and so we add 3 points making the current total 0 + 3 = 3.
Based on the patient note, the best verbal response for the patient is 'confused', and so we add 4 points making the current total 3 + 4 = 7.
Based on the patient note, the best motor response for the patient is 'localizes pain', and so we add 5 points making the current total 7 + 5 = 12.
Hence, the patient's glasgow coma score is 12."
850,21,Glasgow Coma Score (GCS),severity,integer,3,Handwritten,"A 32 year old female is brought to the emergency department by ambulance after falling down a flight of stairs. She was found unconscious at the scene by her husband. On arrival, heart rate is 110 bpm, blood pressure is 140/90 mmHg, respiratory rate is 20, and O2 saturation is 90 % on room air. On evaluation in the trauma bay, the patient is lying on a stretcher with eyes closed. She is unresponsive to verbal stimuli but groans without intelligible speech. She opens her eyes and withdraws in response to painful stimuli in all extremities. No obvious deformities or signs of injury are noted on external evaluation. The patient is intubated and IV access is obtained. Head CT reveals subdural hematoma with midline shift. The patient is admitted to the intensive care unit and neurosurgery is consulted.",What is the patient's Glasgow Coma Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Best eye response': 'eye opening to pain', 'Best verbal response': 'incomprehensible sounds', 'Best motor response': 'withdrawal from pain'}",8,8,8,"The Glasgow Coma Scale (GCS) for assessing a patient's level of consciousness is shown below:
    
1. Best Eye Response: Spontaneously = +4 points, To verbal command = +3 points, To pain = +2 points, No eye opening = +1 point
2. Best Verbal Response: Oriented = +5 points, Confused = +4 points, Inappropriate words = +3 points, Incomprehensible sounds = +2 points, No verbal response = +1 point
3. Best Motor Response: Obeys commands = +6 points, Localizes pain = +5 points, Withdrawal from pain = +4 points, Flexion to pain = +3 points, Extension to pain = +2 points, No motor response = +1 point

For each criteria, if a patient's value is not mentioned/not testable in the note, we assume that it gets the full score for that attribute.  The total GCS score is calculated by summing the points for each of the three components.
    
The current glasgow coma score is 0.
Based on the patient note, the best eye response for the patient is 'eye opening to pain', and so we add 2 points making the current total 0 + 2 = 2.
Based on the patient note, the best verbal response for the patient is 'incomprehensible sounds', and so we add 2 points making the current total 2 + 2 = 4.
Based on the patient note, the best motor response for the patient is 'withdrawal from pain', and so we add 4 points making the current total 4 + 4 = 8.
Hence, the patient's glasgow coma score is 8."
851,21,Glasgow Coma Score (GCS),severity,integer,4,Handwritten,"A 50 year old man presents to the emergency department after a fall from a ladder with positive headstrike. He was found conscious but disoriented by bystanders. Vital signs are stable on arrival. On evaluation, he is awake, alert, and following simple commands. He is confused and tangential, but able to answer questions coherently. Cervical spine precautions were initiated upon arrival. Thorough neurological examination reveals intact cranial nerves and no focal deficits. A head CT shows no evidence of acute intracranial hemorrhage or traumatic brain injury.",What is the patient's Glasgow Coma Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Best eye response': 'eyes open spontaneously', 'Best verbal response': 'confused', 'Best motor response': 'obeys commands'}",14,14,14,"The Glasgow Coma Scale (GCS) for assessing a patient's level of consciousness is shown below:
    
1. Best Eye Response: Spontaneously = +4 points, To verbal command = +3 points, To pain = +2 points, No eye opening = +1 point
2. Best Verbal Response: Oriented = +5 points, Confused = +4 points, Inappropriate words = +3 points, Incomprehensible sounds = +2 points, No verbal response = +1 point
3. Best Motor Response: Obeys commands = +6 points, Localizes pain = +5 points, Withdrawal from pain = +4 points, Flexion to pain = +3 points, Extension to pain = +2 points, No motor response = +1 point

For each criteria, if a patient's value is not mentioned/not testable in the note, we assume that it gets the full score for that attribute.  The total GCS score is calculated by summing the points for each of the three components.
    
The current glasgow coma score is 0.
Based on the patient note, the best eye response for the patient is 'eyes open spontaneously', and so we add 4 points making the current total 0 + 4 = 4.
Based on the patient note, the best verbal response for the patient is 'confused', and so we add 4 points making the current total 4 + 4 = 8.
Based on the patient note, the best motor response for the patient is 'obeys commands', and so we add 6 points making the current total 8 + 6 = 14.
Hence, the patient's glasgow coma score is 14."
852,21,Glasgow Coma Score (GCS),severity,integer,5,Handwritten,"A 45-year-old female was brought to the emergency department by paramedics after a high-speed motor vehicle collision. On scene, she was found unrestrained in the vehicle, with the air bag deployed. Upon arrival in the trauma bay, she had heart rate of 72 bpm and blood pressure of 123/78 mmHg. Her eyes open upon painful stimulus. On examination, a pinch to the nail bed induces a withdrawal response in her extremities. Her speech is incomprehensible. She grunts and moans on occasion, but no discernible words are appreciated. Her pupils are equal, round, and unreactive to light. Blood work, including full blood count, urea and electrolytes, liver function tests, coagulation studies, and a toxicology screen, is initiated together with a CT scan of her head and neck. The trauma team commences resuscitative measures with an emphasis on preserving neurological function.",What is the patient's Glasgow Coma Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Best motor response': 'withdrawal from pain', 'Best eye response': 'eye opening to pain', 'Best verbal response': 'incomprehensible sounds'}",8,8,8,"The Glasgow Coma Scale (GCS) for assessing a patient's level of consciousness is shown below:
    
1. Best Eye Response: Spontaneously = +4 points, To verbal command = +3 points, To pain = +2 points, No eye opening = +1 point
2. Best Verbal Response: Oriented = +5 points, Confused = +4 points, Inappropriate words = +3 points, Incomprehensible sounds = +2 points, No verbal response = +1 point
3. Best Motor Response: Obeys commands = +6 points, Localizes pain = +5 points, Withdrawal from pain = +4 points, Flexion to pain = +3 points, Extension to pain = +2 points, No motor response = +1 point

For each criteria, if a patient's value is not mentioned/not testable in the note, we assume that it gets the full score for that attribute.  The total GCS score is calculated by summing the points for each of the three components.
    
The current glasgow coma score is 0.
Based on the patient note, the best eye response for the patient is 'eye opening to pain', and so we add 2 points making the current total 0 + 2 = 2.
Based on the patient note, the best verbal response for the patient is 'incomprehensible sounds', and so we add 2 points making the current total 2 + 2 = 4.
Based on the patient note, the best motor response for the patient is 'withdrawal from pain', and so we add 4 points making the current total 4 + 4 = 8.
Hence, the patient's glasgow coma score is 8."
853,21,Glasgow Coma Score (GCS),severity,integer,6,Handwritten,"A 70-year-old male presented with dizziness to the emergency department. His wife reports that he has been very compliant with his antihypertensive medication but over the last few days, he has been feeling progressively weak and off balance. It is revealed that he had a recent change in his medication regimen. On entering the room, he is sitting on the bed, alert, with eyes open and actively looking around. He immediately makes eye contact when acknowledged and is oriented to situation. He was able to recognize his treating physician and the emergency ward, spontaneously stating that he is in the hospital for dizziness. During neurological examination, he follows two step commands. His blood pressure is 90/60 mmHg with a heart rate of 58 bpm. Blood samples are taken for laboratory analysis, including a full blood count, renal function, electrolytes, and thyroid function tests. An EKG is ordered to rule out arrhythmias as the cause of his symptoms.",What is the patient's Glasgow Coma Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Best motor response': 'obeys commands', 'Best eye response': 'eyes open spontaneously', 'Best verbal response': 'oriented'}",15,15,15,"The Glasgow Coma Scale (GCS) for assessing a patient's level of consciousness is shown below:
    
1. Best Eye Response: Spontaneously = +4 points, To verbal command = +3 points, To pain = +2 points, No eye opening = +1 point
2. Best Verbal Response: Oriented = +5 points, Confused = +4 points, Inappropriate words = +3 points, Incomprehensible sounds = +2 points, No verbal response = +1 point
3. Best Motor Response: Obeys commands = +6 points, Localizes pain = +5 points, Withdrawal from pain = +4 points, Flexion to pain = +3 points, Extension to pain = +2 points, No motor response = +1 point

For each criteria, if a patient's value is not mentioned/not testable in the note, we assume that it gets the full score for that attribute.  The total GCS score is calculated by summing the points for each of the three components.
    
The current glasgow coma score is 0.
Based on the patient note, the best eye response for the patient is 'eyes open spontaneously', and so we add 4 points making the current total 0 + 4 = 4.
Based on the patient note, the best verbal response for the patient is 'oriented', and so we add 5 points making the current total 4 + 5 = 9.
Based on the patient note, the best motor response for the patient is 'obeys commands', and so we add 6 points making the current total 9 + 6 = 15.
Hence, the patient's glasgow coma score is 15."
854,21,Glasgow Coma Score (GCS),severity,integer,7,Handwritten,"A 56-year-old male construction worker was admitted to the emergency department after a minor fall from scaffolding. He was awake but appeared somewhat disoriented. Initial vital signs included a blood pressure of 128/85 mmHg, heart rate of 80 bpm, respirations at 18 breaths per minute, and oxygen saturation of 96 % on room air. He opens his eyes upon verbal request. His speech was disjointed and he appeared confused when asked about the day of the week, though he correctly identified his location as a hospital. Upon sternal rub, he was able to specifically locate the sensation and attempted to push the hand away. His wife denies any known allergies and states that he only takes occasional over-the-counter ibuprofen for joint pain. A STAT CT scan was ordered to assess for any potential traumatic brain injury. The remainder of his physical examination was unremarkable, and he was moved to observation for further evaluation.",What is the patient's Glasgow Coma Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Best motor response': 'localizes pain', 'Best eye response': 'eye opening to verbal command', 'Best verbal response': 'confused'}",12,12,12,"The Glasgow Coma Scale (GCS) for assessing a patient's level of consciousness is shown below:
    
1. Best Eye Response: Spontaneously = +4 points, To verbal command = +3 points, To pain = +2 points, No eye opening = +1 point
2. Best Verbal Response: Oriented = +5 points, Confused = +4 points, Inappropriate words = +3 points, Incomprehensible sounds = +2 points, No verbal response = +1 point
3. Best Motor Response: Obeys commands = +6 points, Localizes pain = +5 points, Withdrawal from pain = +4 points, Flexion to pain = +3 points, Extension to pain = +2 points, No motor response = +1 point

For each criteria, if a patient's value is not mentioned/not testable in the note, we assume that it gets the full score for that attribute.  The total GCS score is calculated by summing the points for each of the three components.
    
The current glasgow coma score is 0.
Based on the patient note, the best eye response for the patient is 'eye opening to verbal command', and so we add 3 points making the current total 0 + 3 = 3.
Based on the patient note, the best verbal response for the patient is 'confused', and so we add 4 points making the current total 3 + 4 = 7.
Based on the patient note, the best motor response for the patient is 'localizes pain', and so we add 5 points making the current total 7 + 5 = 12.
Hence, the patient's glasgow coma score is 12."
855,21,Glasgow Coma Score (GCS),severity,integer,8,Handwritten,"A 60-year-old male was found unconscious at home by his neighbor and brought to the emergency department by Emergency Medical Services. Vital signs on arrival were heart rate 65 bpm, blood pressure 100/70 mmHg, respiratory rate 14 per minute, and oxygen saturation 98 % on room air. Upon being assessed by the medical staff, there were no immediate signs of trauma or medical alert bracelets. When subjected to a sternal rub, his eyes slightly opened and his limbs were noted to hesitatingly reflex into an extension movement. However, despite repeated attempts, the patient remained nonverbal and not responsive to questions or requests. The initial clinical impression was a possible stroke or major neurological event. Blood tests were run, including coagulation profile, cardiac troponins, glucose, and complete blood count. An urgent CT scan was ordered and he was transferred to the Stroke Unit for further care.",What is the patient's Glasgow Coma Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Best motor response': 'extension to pain', 'Best eye response': 'eye opening to pain', 'Best verbal response': 'no verbal response'}",5,5,5,"The Glasgow Coma Scale (GCS) for assessing a patient's level of consciousness is shown below:
    
1. Best Eye Response: Spontaneously = +4 points, To verbal command = +3 points, To pain = +2 points, No eye opening = +1 point
2. Best Verbal Response: Oriented = +5 points, Confused = +4 points, Inappropriate words = +3 points, Incomprehensible sounds = +2 points, No verbal response = +1 point
3. Best Motor Response: Obeys commands = +6 points, Localizes pain = +5 points, Withdrawal from pain = +4 points, Flexion to pain = +3 points, Extension to pain = +2 points, No motor response = +1 point

For each criteria, if a patient's value is not mentioned/not testable in the note, we assume that it gets the full score for that attribute.  The total GCS score is calculated by summing the points for each of the three components.
    
The current glasgow coma score is 0.
Based on the patient note, the best eye response for the patient is 'eye opening to pain', and so we add 2 points making the current total 0 + 2 = 2.
Based on the patient note, the best verbal response for the patient is 'no verbal response', and so we add 1 point making the current total 2 + 1 = 3.
Based on the patient note, the best motor response for the patient is 'extension to pain', and so we add 2 points making the current total 3 + 2 = 5.
Hence, the patient's glasgow coma score is 5."
856,21,Glasgow Coma Score (GCS),severity,integer,9,Handwritten,"A 55-year-old man was brought in by ambulance after collapsing at his work. His colleagues report a sudden onset of headache followed by loss of consciousness. Upon arrival, the patient was found to be in full cardiac arrest, CPR was initiated immediately, and he was intubated on site by paramedics. In the emergency department, vital signs were: heart rate of 60 bpm under active CPR, non-measurable blood pressure, and respiratory rate controlled by the ventilatory assistance. Despite attempts to rouse him, there was no eye opening, no purposeful movement of his limbs in response to tactile or painful stimulation, and he made no sounds or attempts to speak. His intubation prevented further assessment of verbal responsiveness. An urgent CT scan revealed a massive intracranial hemorrhage. The patient was promptly evaluated by the neurosurgery team.",What is the patient's Glasgow Coma Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Best motor response': 'no motor response', 'Best eye response': 'no eye opening', 'Best verbal response': 'no verbal response'}",3,3,3,"The Glasgow Coma Scale (GCS) for assessing a patient's level of consciousness is shown below:
    
1. Best Eye Response: Spontaneously = +4 points, To verbal command = +3 points, To pain = +2 points, No eye opening = +1 point
2. Best Verbal Response: Oriented = +5 points, Confused = +4 points, Inappropriate words = +3 points, Incomprehensible sounds = +2 points, No verbal response = +1 point
3. Best Motor Response: Obeys commands = +6 points, Localizes pain = +5 points, Withdrawal from pain = +4 points, Flexion to pain = +3 points, Extension to pain = +2 points, No motor response = +1 point

For each criteria, if a patient's value is not mentioned/not testable in the note, we assume that it gets the full score for that attribute.  The total GCS score is calculated by summing the points for each of the three components.
    
The current glasgow coma score is 0.
Based on the patient note, the best eye response for the patient is 'no eye opening', and so we add 1 point making the current total 0 + 1 = 1.
Based on the patient note, the best verbal response for the patient is 'no verbal response', and so we add 1 point making the current total 1 + 1 = 2.
Based on the patient note, the best motor response for the patient is 'no motor response', and so we add 1 point making the current total 2 + 1 = 3.
Hence, the patient's glasgow coma score is 3."
857,21,Glasgow Coma Score (GCS),severity,integer,10,Handwritten,"A 32-year-old man was found lying on the ground in a local club by the staff, who promptly called for emergency medical services. In the emergency department, his initial vital signs included a heart rate of 130 bpm, blood pressure of 142/90 mmHg, and a respiratory rate of 22 breaths per minute. Due to a sustained, generalized tonic-clonic seizure that has been refractory to first-line antiseizure medications, his eyes only opened briefly with intense external stimulation before closing again. His verbal output consisted of random, inappropriate words that had no relevance to the questions or the situation. Application of a painful stimulus led to abnormal flexion of his upper limbs. A STAT computed tomography (CT) scan of the head was ordered and neurology was immediately consulted for further management of his case. The seizure disorder was new per the information provided by an accompanying friend. Blood workup including complete blood count, liver and renal profile, serum electrolytes, and toxicology screening is initiated.",What is the patient's Glasgow Coma Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Best motor response': 'flexion to pain', 'Best eye response': 'eye opening to pain', 'Best verbal response': 'inappropriate words'}",8,8,8,"The Glasgow Coma Scale (GCS) for assessing a patient's level of consciousness is shown below:
    
1. Best Eye Response: Spontaneously = +4 points, To verbal command = +3 points, To pain = +2 points, No eye opening = +1 point
2. Best Verbal Response: Oriented = +5 points, Confused = +4 points, Inappropriate words = +3 points, Incomprehensible sounds = +2 points, No verbal response = +1 point
3. Best Motor Response: Obeys commands = +6 points, Localizes pain = +5 points, Withdrawal from pain = +4 points, Flexion to pain = +3 points, Extension to pain = +2 points, No motor response = +1 point

For each criteria, if a patient's value is not mentioned/not testable in the note, we assume that it gets the full score for that attribute.  The total GCS score is calculated by summing the points for each of the three components.
    
The current glasgow coma score is 0.
Based on the patient note, the best eye response for the patient is 'eye opening to pain', and so we add 2 points making the current total 0 + 2 = 2.
Based on the patient note, the best verbal response for the patient is 'inappropriate words', and so we add 3 points making the current total 2 + 3 = 5.
Based on the patient note, the best motor response for the patient is 'flexion to pain', and so we add 3 points making the current total 5 + 3 = 8.
Hence, the patient's glasgow coma score is 8."
858,21,Glasgow Coma Score (GCS),severity,integer,11,Handwritten,"A 68-year-old woman, with past medical history of hypertension and diabetes, arrived at the emergency department in a state of confusion. She complained of a sharp pain in her lower back, which started abruptly while she was gardening. Upon hearing the nurse ask her to open her eyes, she complied. However, her speech was disoriented and she was unable to provide coherent responses to questions related to time and place. She was able to follow simple commands. Her vital signs were stable with a blood pressure of 130/80 mmHg and a heart rate of 86 bpm. Measures were taken to manage her pain with analgesics and her back pain was investigated by the orthopedic team. Further neurological evaluation was also warranted considering her state of confusion and delirium.",What is the patient's Glasgow Coma Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Best motor response': 'obeys commands', 'Best eye response': 'eye opening to verbal command', 'Best verbal response': 'confused'}",13,13,13,"The Glasgow Coma Scale (GCS) for assessing a patient's level of consciousness is shown below:
    
1. Best Eye Response: Spontaneously = +4 points, To verbal command = +3 points, To pain = +2 points, No eye opening = +1 point
2. Best Verbal Response: Oriented = +5 points, Confused = +4 points, Inappropriate words = +3 points, Incomprehensible sounds = +2 points, No verbal response = +1 point
3. Best Motor Response: Obeys commands = +6 points, Localizes pain = +5 points, Withdrawal from pain = +4 points, Flexion to pain = +3 points, Extension to pain = +2 points, No motor response = +1 point

For each criteria, if a patient's value is not mentioned/not testable in the note, we assume that it gets the full score for that attribute.  The total GCS score is calculated by summing the points for each of the three components.
    
The current glasgow coma score is 0.
Based on the patient note, the best eye response for the patient is 'eye opening to verbal command', and so we add 3 points making the current total 0 + 3 = 3.
Based on the patient note, the best verbal response for the patient is 'confused', and so we add 4 points making the current total 3 + 4 = 7.
Based on the patient note, the best motor response for the patient is 'obeys commands', and so we add 6 points making the current total 7 + 6 = 13.
Hence, the patient's glasgow coma score is 13."
859,21,Glasgow Coma Score (GCS),severity,integer,12,Handwritten,"A 70-year old female was found unconscious by her caregiver. Upon EMS arrival, the patient had regained consciousness, but was unable to communicate clearly or coherently. She was immediately transported to the emergency department where she was found to be opening her eyes spontaneously. She did not produce intelligible responses but kept continuously groaning. When the medical team applied a painful stimulus, she localized her hand to the site of the pain. Her vital signs, upon arrival, were: heart rate 94 bpm, blood pressure 135/85 mmHg, respiratory rate 22 breaths per minute, temperature 37.6 degrees celsius, and oxygen saturation of 96 % on room air. An immediate neurology consult was ordered given her presentation. A stat head CT and labs including CBC, BMP, coagulation studies, lactate level, troponin, and ABG were also ordered.",What is the patient's Glasgow Coma Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Best motor response': 'localizes pain', 'Best eye response': 'eyes open spontaneously', 'Best verbal response': 'incomprehensible sounds'}",11,11,11,"The Glasgow Coma Scale (GCS) for assessing a patient's level of consciousness is shown below:
    
1. Best Eye Response: Spontaneously = +4 points, To verbal command = +3 points, To pain = +2 points, No eye opening = +1 point
2. Best Verbal Response: Oriented = +5 points, Confused = +4 points, Inappropriate words = +3 points, Incomprehensible sounds = +2 points, No verbal response = +1 point
3. Best Motor Response: Obeys commands = +6 points, Localizes pain = +5 points, Withdrawal from pain = +4 points, Flexion to pain = +3 points, Extension to pain = +2 points, No motor response = +1 point

For each criteria, if a patient's value is not mentioned/not testable in the note, we assume that it gets the full score for that attribute.  The total GCS score is calculated by summing the points for each of the three components.
    
The current glasgow coma score is 0.
Based on the patient note, the best eye response for the patient is 'eyes open spontaneously', and so we add 4 points making the current total 0 + 4 = 4.
Based on the patient note, the best verbal response for the patient is 'incomprehensible sounds', and so we add 2 points making the current total 4 + 2 = 6.
Based on the patient note, the best motor response for the patient is 'localizes pain', and so we add 5 points making the current total 6 + 5 = 11.
Hence, the patient's glasgow coma score is 11."
860,21,Glasgow Coma Score (GCS),severity,integer,13,Handwritten,"A 60-year-old male with a history of thyroid surgery was rushed to the emergency department after collapsing at home. The patient's wife reported he complained of difficulty breathing. Emergency airway was required and a tracheostomy was performed by EMS on site. On physical examination, his hemisphere functions such as sensation, power, tone, and deep tendon reflexes are intact on both sides and he is able to obey commands to grip and release his hand. He opens his eyes when pinched but does not attempt to verbalize due to the tracheostomy. Initial vital signs are; a heart rate of 100 bpm, blood pressure 140/85 mmHg, respiratory rate 19 breaths per minute, and O2 saturation 93 % on room air. Blood work including complete blood count, coagulation panel, comprehensive metabolic panel, and arterial blood gas is collected. ENT is consulted for a tracheostomy review and the patient is admitted to ICU for further care.",What is the patient's Glasgow Coma Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Best motor response': 'obeys commands', 'Best eye response': 'eye opening to pain', 'Best verbal response': 'no verbal response'}",9,9,9,"The Glasgow Coma Scale (GCS) for assessing a patient's level of consciousness is shown below:
    
1. Best Eye Response: Spontaneously = +4 points, To verbal command = +3 points, To pain = +2 points, No eye opening = +1 point
2. Best Verbal Response: Oriented = +5 points, Confused = +4 points, Inappropriate words = +3 points, Incomprehensible sounds = +2 points, No verbal response = +1 point
3. Best Motor Response: Obeys commands = +6 points, Localizes pain = +5 points, Withdrawal from pain = +4 points, Flexion to pain = +3 points, Extension to pain = +2 points, No motor response = +1 point

For each criteria, if a patient's value is not mentioned/not testable in the note, we assume that it gets the full score for that attribute.  The total GCS score is calculated by summing the points for each of the three components.
    
The current glasgow coma score is 0.
Based on the patient note, the best eye response for the patient is 'eye opening to pain', and so we add 2 points making the current total 0 + 2 = 2.
Based on the patient note, the best verbal response for the patient is 'no verbal response', and so we add 1 point making the current total 2 + 1 = 3.
Based on the patient note, the best motor response for the patient is 'obeys commands', and so we add 6 points making the current total 3 + 6 = 9.
Hence, the patient's glasgow coma score is 9."
861,21,Glasgow Coma Score (GCS),severity,integer,14,Handwritten,"A 50-year-old male patient was brought into the emergency department following a cycling accident. EMS report described a possible concussion and arm fracture, and stated the patient was disoriented. His initial vitals showed a heart rate of 85 bpm, blood pressure of 120/80 mmHg, and O2 stats of 97 %. When the nurses called out his name, he was able to open his eyes. However his speech was disjointed and included inappropriate words. After attempting to assess any motor responses, it was observed that he showed an abnormal extension in response to painful stimuli. This observation was made while the trauma team was performing a splinting procedure on his right arm, which seemed to cause the patient significant pain. Subsequent imaging results confirmed the existence of the fracture, and the patient was scheduled for orthopedic surgery. In addition, a neurology consultation was ordered due to his abnormal response patterns to assess any possibilities of serious brain injuries.",What is the patient's Glasgow Coma Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Best motor response': 'extension to pain', 'Best eye response': 'eye opening to verbal command', 'Best verbal response': 'inappropriate words'}",8,8,8,"The Glasgow Coma Scale (GCS) for assessing a patient's level of consciousness is shown below:
    
1. Best Eye Response: Spontaneously = +4 points, To verbal command = +3 points, To pain = +2 points, No eye opening = +1 point
2. Best Verbal Response: Oriented = +5 points, Confused = +4 points, Inappropriate words = +3 points, Incomprehensible sounds = +2 points, No verbal response = +1 point
3. Best Motor Response: Obeys commands = +6 points, Localizes pain = +5 points, Withdrawal from pain = +4 points, Flexion to pain = +3 points, Extension to pain = +2 points, No motor response = +1 point

For each criteria, if a patient's value is not mentioned/not testable in the note, we assume that it gets the full score for that attribute.  The total GCS score is calculated by summing the points for each of the three components.
    
The current glasgow coma score is 0.
Based on the patient note, the best eye response for the patient is 'eye opening to verbal command', and so we add 3 points making the current total 0 + 3 = 3.
Based on the patient note, the best verbal response for the patient is 'inappropriate words', and so we add 3 points making the current total 3 + 3 = 6.
Based on the patient note, the best motor response for the patient is 'extension to pain', and so we add 2 points making the current total 6 + 2 = 8.
Hence, the patient's glasgow coma score is 8."
862,21,Glasgow Coma Score (GCS),severity,integer,15,Handwritten,"An elderly gentleman, aged 78, was brought to the emergency department after a minor fall at home. His family reported that he was initially unresponsive but became alert shortly after. Upon arrival, his initial vital signs included a blood pressure of 145/85 mmHg, pulse of 78 bpm, and respiratory rate of 18 breaths per minute. His eyes were open on arrival, and he appeared fully aware of his surroundings, accurately identifying the date, his location, and explaining what had happened. During a pain assessment, he instinctively pulled his arm away when pressure was applied to his nail bed. A full workup was initiated, including a CT scan to rule out any head injury given his recent fall. Blood tests, including a complete blood count, metabolic panel, and coagulation profile, were also ordered.",What is the patient's Glasgow Coma Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Best motor response': 'withdrawal from pain', 'Best eye response': 'eyes open spontaneously', 'Best verbal response': 'oriented'}",13,13,13,"The Glasgow Coma Scale (GCS) for assessing a patient's level of consciousness is shown below:
    
1. Best Eye Response: Spontaneously = +4 points, To verbal command = +3 points, To pain = +2 points, No eye opening = +1 point
2. Best Verbal Response: Oriented = +5 points, Confused = +4 points, Inappropriate words = +3 points, Incomprehensible sounds = +2 points, No verbal response = +1 point
3. Best Motor Response: Obeys commands = +6 points, Localizes pain = +5 points, Withdrawal from pain = +4 points, Flexion to pain = +3 points, Extension to pain = +2 points, No motor response = +1 point

For each criteria, if a patient's value is not mentioned/not testable in the note, we assume that it gets the full score for that attribute.  The total GCS score is calculated by summing the points for each of the three components.
    
The current glasgow coma score is 0.
Based on the patient note, the best eye response for the patient is 'eyes open spontaneously', and so we add 4 points making the current total 0 + 4 = 4.
Based on the patient note, the best verbal response for the patient is 'oriented', and so we add 5 points making the current total 4 + 5 = 9.
Based on the patient note, the best motor response for the patient is 'withdrawal from pain', and so we add 4 points making the current total 9 + 4 = 13.
Hence, the patient's glasgow coma score is 13."
863,21,Glasgow Coma Score (GCS),severity,integer,16,Handwritten,"A 72-year-old male with a history of chronic obstructive pulmonary disease was brought in after choking during dinner. On arrival, the patient had an O2 saturation of 80%. His other vital signs included a heart rate of 110 bpm and blood pressure of 130/80 mmHg. He was noted to open his eyes without prompting during evaluation and was scanning the room, occasionally responding to questions with somewhat accurate answers but often seeming disoriented and unable to keep track of the conversation. Painful stimuli applied revealed a decorticate posture with abnormal flexion. Due to his desaturation, he was rapidly intubated, with O2 saturation improving to 95%. A chest X-ray was conducted to verify the placement of the endotracheal tube, and further bloodwork and radiographs were ordered to ascertain the cause of the choking incident. The patient was moved to the ICU for further observation and management.",What is the patient's Glasgow Coma Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Best motor response': 'flexion to pain', 'Best eye response': 'eyes open spontaneously', 'Best verbal response': 'confused'}",11,11,11,"The Glasgow Coma Scale (GCS) for assessing a patient's level of consciousness is shown below:
    
1. Best Eye Response: Spontaneously = +4 points, To verbal command = +3 points, To pain = +2 points, No eye opening = +1 point
2. Best Verbal Response: Oriented = +5 points, Confused = +4 points, Inappropriate words = +3 points, Incomprehensible sounds = +2 points, No verbal response = +1 point
3. Best Motor Response: Obeys commands = +6 points, Localizes pain = +5 points, Withdrawal from pain = +4 points, Flexion to pain = +3 points, Extension to pain = +2 points, No motor response = +1 point

For each criteria, if a patient's value is not mentioned/not testable in the note, we assume that it gets the full score for that attribute.  The total GCS score is calculated by summing the points for each of the three components.
    
The current glasgow coma score is 0.
Based on the patient note, the best eye response for the patient is 'eyes open spontaneously', and so we add 4 points making the current total 0 + 4 = 4.
Based on the patient note, the best verbal response for the patient is 'confused', and so we add 4 points making the current total 4 + 4 = 8.
Based on the patient note, the best motor response for the patient is 'flexion to pain', and so we add 3 points making the current total 8 + 3 = 11.
Hence, the patient's glasgow coma score is 11."
864,21,Glasgow Coma Score (GCS),severity,integer,17,Handwritten,"A 65-year-old woman was brought to the emergency department by her son due to issues with her speech and lack of movement of her limbs. He reports that she was behaving unusually during their phone conversation, speaking in a confused and delirious manner, which caused him to rush to her house to check on her. Upon arrival at the ED, the patient had no voluntary movements in her limbs, including to painful stimuli. Despite her severe motor response deficiency, she showed a response to verbal commands by opening her eyes when she was told to. Her speech was rambling with significant tangents in her chain of thought. Her vital signs were within normal limits: temperature 98.6°F, pulse 72 beats per minute, respiratory rate 20 breaths per minute, blood pressure 120/80 mmHg, and oxygen saturation 98 % on room air. A complete neurologic exam was ordered, and a battery of lab tests were performed along with a state CT scan to further assess her condition. The stroke team was promptly notified due to suspicions of a neurological event.",What is the patient's Glasgow Coma Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Best motor response': 'no motor response', 'Best eye response': 'eye opening to verbal command', 'Best verbal response': 'confused'}",8,8,8,"The Glasgow Coma Scale (GCS) for assessing a patient's level of consciousness is shown below:
    
1. Best Eye Response: Spontaneously = +4 points, To verbal command = +3 points, To pain = +2 points, No eye opening = +1 point
2. Best Verbal Response: Oriented = +5 points, Confused = +4 points, Inappropriate words = +3 points, Incomprehensible sounds = +2 points, No verbal response = +1 point
3. Best Motor Response: Obeys commands = +6 points, Localizes pain = +5 points, Withdrawal from pain = +4 points, Flexion to pain = +3 points, Extension to pain = +2 points, No motor response = +1 point

For each criteria, if a patient's value is not mentioned/not testable in the note, we assume that it gets the full score for that attribute.  The total GCS score is calculated by summing the points for each of the three components.
    
The current glasgow coma score is 0.
Based on the patient note, the best eye response for the patient is 'eye opening to verbal command', and so we add 3 points making the current total 0 + 3 = 3.
Based on the patient note, the best verbal response for the patient is 'confused', and so we add 4 points making the current total 3 + 4 = 7.
Based on the patient note, the best motor response for the patient is 'no motor response', and so we add 1 point making the current total 7 + 1 = 8.
Hence, the patient's glasgow coma score is 8."
865,21,Glasgow Coma Score (GCS),severity,integer,18,Handwritten,"A 59-year-old man was found unconscious in his apartment by a neighbor and was immediately rushed by ambulance to the emergency department. Upon admission, his vital signs were: blood pressure 94/58 mmHg, heart rate 110 bpm, temperature 38.1°C, and O2 saturation at 95 %. The man was clearly in distress. On examination, he was able to react to painful stimuli by grimacing and moving his hands towards the site of the pinch. He opened his eyes only in response to sternal rub. As for verbal responses, the patient kept mumbling nonsensical words. Blood was drawn for labs, which included a CBC, CMP, blood cultures, and a lumbar puncture was quickly organized considering the possibility of meningitis. Meanwhile, the infectious disease team was alerted and the patient was placed under respiratory isolation due to recent reports of meningococcal outbreaks in the area.",What is the patient's Glasgow Coma Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Best motor response': 'localizes pain', 'Best eye response': 'eye opening to pain', 'Best verbal response': 'inappropriate words'}",10,10,10,"The Glasgow Coma Scale (GCS) for assessing a patient's level of consciousness is shown below:
    
1. Best Eye Response: Spontaneously = +4 points, To verbal command = +3 points, To pain = +2 points, No eye opening = +1 point
2. Best Verbal Response: Oriented = +5 points, Confused = +4 points, Inappropriate words = +3 points, Incomprehensible sounds = +2 points, No verbal response = +1 point
3. Best Motor Response: Obeys commands = +6 points, Localizes pain = +5 points, Withdrawal from pain = +4 points, Flexion to pain = +3 points, Extension to pain = +2 points, No motor response = +1 point

For each criteria, if a patient's value is not mentioned/not testable in the note, we assume that it gets the full score for that attribute.  The total GCS score is calculated by summing the points for each of the three components.
    
The current glasgow coma score is 0.
Based on the patient note, the best eye response for the patient is 'eye opening to pain', and so we add 2 points making the current total 0 + 2 = 2.
Based on the patient note, the best verbal response for the patient is 'inappropriate words', and so we add 3 points making the current total 2 + 3 = 5.
Based on the patient note, the best motor response for the patient is 'localizes pain', and so we add 5 points making the current total 5 + 5 = 10.
Hence, the patient's glasgow coma score is 10."
866,21,Glasgow Coma Score (GCS),severity,integer,19,Handwritten,"An 87-year-old widowed woman with a history of hypertension and diabetes was admitted to the emergency room by her home care worker who found her lying on the bathroom floor. On arrival, her vitals were pulse 88 bpm, BP 140/80 mmHg, Temp 36.6°C, RR 22/min, and SpO2 96 %. Despite repeated prompting and a firm sternal rub, she steadfastly kept her eyes shut and did not attempt to open them. However, upon receiving commands, she was able to respond appropriately by lifting an arm or moving her fingers. When asked questions, she responded with incomprehensible, garbled sounds. The neurology team was paged, and based on their recommendations, a CT head scan was ordered along with some blood investigations. The patient was given a provisional diagnosis of an acute stroke pending further investigations. Her daughter was contacted soon after her admission considering the potentially serious implications of her condition.",What is the patient's Glasgow Coma Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Best motor response': 'obeys commands', 'Best eye response': 'no eye opening', 'Best verbal response': 'incomprehensible sounds'}",9,9,9,"The Glasgow Coma Scale (GCS) for assessing a patient's level of consciousness is shown below:
    
1. Best Eye Response: Spontaneously = +4 points, To verbal command = +3 points, To pain = +2 points, No eye opening = +1 point
2. Best Verbal Response: Oriented = +5 points, Confused = +4 points, Inappropriate words = +3 points, Incomprehensible sounds = +2 points, No verbal response = +1 point
3. Best Motor Response: Obeys commands = +6 points, Localizes pain = +5 points, Withdrawal from pain = +4 points, Flexion to pain = +3 points, Extension to pain = +2 points, No motor response = +1 point

For each criteria, if a patient's value is not mentioned/not testable in the note, we assume that it gets the full score for that attribute.  The total GCS score is calculated by summing the points for each of the three components.
    
The current glasgow coma score is 0.
Based on the patient note, the best eye response for the patient is 'no eye opening', and so we add 1 point making the current total 0 + 1 = 1.
Based on the patient note, the best verbal response for the patient is 'incomprehensible sounds', and so we add 2 points making the current total 1 + 2 = 3.
Based on the patient note, the best motor response for the patient is 'obeys commands', and so we add 6 points making the current total 3 + 6 = 9.
Hence, the patient's glasgow coma score is 9."
867,21,Glasgow Coma Score (GCS),severity,integer,20,Handwritten,"A 40-year-old male was brought to the emergency department by EMS after he was found unconscious in a park. Per EMS report, he was found with a half-empty bottle of pills nearby. His vital signs were stable on arrival: BP 110/70 mmHg, HR 60 bpm, and O2sat at 98 %. On hearing his name called out, the patient managed to open his eyes and look towards the source intermittently, but he did not appear to follow the speaker or make sustained eye contact. When painful stimuli were applied, such as a sternal rub or fingernail pressure, the patient responded by grimacing and attempts to evade the source of the discomfort. He did not respond verbally to any inquiry or command. His medical bracelet indicates he is diabetic but does not mention any allergies or additional conditions. A toxicology screen, liver profile, renal profile, and blood glucose level were ordered to gather more information on his condition. The mental health team was also alerted due to the suspicion of a possible suicide attempt.",What is the patient's Glasgow Coma Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Best motor response': 'withdrawal from pain', 'Best eye response': 'eye opening to verbal command', 'Best verbal response': 'no verbal response'}",8,8,8,"The Glasgow Coma Scale (GCS) for assessing a patient's level of consciousness is shown below:
    
1. Best Eye Response: Spontaneously = +4 points, To verbal command = +3 points, To pain = +2 points, No eye opening = +1 point
2. Best Verbal Response: Oriented = +5 points, Confused = +4 points, Inappropriate words = +3 points, Incomprehensible sounds = +2 points, No verbal response = +1 point
3. Best Motor Response: Obeys commands = +6 points, Localizes pain = +5 points, Withdrawal from pain = +4 points, Flexion to pain = +3 points, Extension to pain = +2 points, No motor response = +1 point

For each criteria, if a patient's value is not mentioned/not testable in the note, we assume that it gets the full score for that attribute.  The total GCS score is calculated by summing the points for each of the three components.
    
The current glasgow coma score is 0.
Based on the patient note, the best eye response for the patient is 'eye opening to verbal command', and so we add 3 points making the current total 0 + 3 = 3.
Based on the patient note, the best verbal response for the patient is 'no verbal response', and so we add 1 point making the current total 3 + 1 = 4.
Based on the patient note, the best motor response for the patient is 'withdrawal from pain', and so we add 4 points making the current total 4 + 4 = 8.
Hence, the patient's glasgow coma score is 8."
868,28,APACHE II Score,risk,integer,1,Handwritten,"A 43-year-old male with a history of Type 2 Diabetes Mellitus (DM2) and diabetic retinopathy presents with tachycardia to 120 beats per minute and hypothermia (34.9°C). On examination, he appears pale with conjunctival pallor and decreased capillary refill. Blood pressure is 122/81 mmHg, and respiratory rate is 17 breaths per minute. Laboratory results reveal a sodium level of 137.49 mmol/L, potassium level of 5.43 mmol/L, creatinine level of 1.85 mg/dL, and white blood cell count of 9,103/µL. Hematocrit is 35%, and reticulocytes are decreased. Arterial blood gas analysis shows a pH of 7.53 on a FiO₂ of 57%, with an A-a gradient of 375. On physical exam he has eye movements to verbal command (3), is confused (4) and responds to localized pain (5). Decreased sensation is noted bilaterally in the feet extending to the mid-shin. Urine output over the past six hours was 104 mL, suggesting oliguria. ",What is the patient's APACHE II score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [120.0, 'beats per minute'], 'Sodium': [137.49, 'mmol/L'], 'creatinine': [1.85, 'mg/dL'], 'Systolic Blood Pressure': [122.0, 'mm Hg'], 'age': [43.0, 'years'], 'Acute renal failure': True, 'Hematocrit': [35.0, '%'], 'Glasgow Coma Score': 12.0, 'pH': 7.53, 'White blood cell count': [9103.0, 'µL'], 'Potassium': [5.43, 'mmol/L'], 'Temperature': [34.9, 'degrees celsius'], 'respiratory rate': [17.0, 'breaths per minute'], 'History of severe organ failure or immunocompromise': False, 'A-a gradient': 375.0, 'Chronic renal failure': False, 'Diastolic Blood Pressure': [81.0, 'mm Hg'], 'FiO2': [57.0, '%']}",14,14,14,"The criteria for the APACHE II Score are listed below:

1. Age, years: ≤44 = 0 points, 45-54 = +2 points, 55-64 = +3 points, 65-74 = +5 points, ≥75 = +6 points
2. History of severe organ insufficiency or immunocompromised: Yes, nonoperative or emergency postoperative patient = +5 points, Yes, elective postoperative patient = +2 points, No = 0 points
3. Rectal temperature, °C: ≥41 = +4 points, 39 to <41 = +3 points, 38.5 to <39 = +1 point, 36 to <38.5 = 0 points, 34 to <36 = +1 point, 32 to <34 = +2 points, 30 to <32 = +3 points, <30 = +4 points
4. Mean arterial pressure, mmHg: ≥160 = +4 points, 130-159 = +3 points, 110-129 = +2 points, 70-109 = 0 points, 50-69 = +2 points, 40-49 = +3 points, <40 = +4 points
5. Heart rate, beats per minute: ≥180 = +4 points, 140 to <180 = +3 points, 110 to <140 = +2 points, 70 to <110 = 0 points, 55 to <70 = +2 points, 40 to <55 = +3 points, <40 = +4 points
6. Respiratory rate, breaths per minute: ≥50 = +4 points, 35 to <50 = +3 points, 25 to <35 = +1 point, 12 to <25 = 0 points, 10 to <12 = +1 point, 6 to <10 = +2 points, <6 = +4 points
7. Oxygenation (use PaO2 if FiO2 <50%, otherwise use Aa gradient): Aa gradient >349 = +4 points, Aa gradient 350-349 = +3 points, Aa gradient 200-349 = +2 points, Aa gradient <200 (if FiO2 over 45%) or PaO2 <70 (if FiO2 less than 50%) = +1 point, PaO2 61-70 = +1 point, PaO2 55-60 = +3 points, PaO2 <55 = +4 points
8. Arterial pH: ≥7.7 = +4 points, 7.60 to <7.70 = +3 points, 7.50 to <7.60 = +1 point, 7.33 to <7.50 = 0 points, 7.25 to <7.33 = +2 points, 7.15 to <7.25 = +3 points, <7.15 = +4 points
9. Serum sodium, mmol/L: ≥180 = +4 points, 160 to <180 = +3 points, 155 to <160 = +2 points, 150 to <155 = +1 point, 130 to <150 = 0 points, 120 to <130 = +2 points, 111 to <120 = +3 points, <111 = +4 points
10. Serum potassium, mmol/L: ≥7.0 = +4 points, 6.0 to <7.0 = +3 points, 5.5 to <6.0 = +1 point, 3.5 to <5.5 = 0 points, 3.0 to <3.5 = +1 point, 2.5 to <3.0 = +2 points, <2.5 = +4 points
11. Serum creatinine, mg/100 mL: ≥3.5 and ACUTE renal failure = +8 points, 2.0 to <3.5 and ACUTE renal failure = +6 points, ≥3.5 and CHRONIC renal failure = +4 points, 1.5 to <2.0 and ACUTE renal failure = +4 points, 2.0 to <3.5 and CHRONIC renal failure = +3 points, 1.5 to <2.0 and CHRONIC renal failure = +2 points, 0.6 to <1.5 = 0 points, <0.6 = +2 points
12. Hematocrit, %: ≥60 = +4 points, 50 to <60 = +2 points, 46 to <50 = +1 point, 30 to <46 = 0 points, 20 to <30 = +2 points, <20 = +4 points
13. White blood count, total/cubic mm in 10^3: ≥40 = +4 points, 20 to <40 = +2 points, 15 to <20 = +1 point, 3 to <15 = 0 points, 1 to <3 = +2 points, <1 = +4 points
14. Glasgow Coma Scale (GCS): 1-15 points (use 15 - [GCS Score])

The total APACHE II score is calculated by summing the points for each criterion.
    
The patient's current APACHE II score is 0 points.
The patient is 43.0 years old. Because the patient's age is less than 45, no points are added to the score, keeping it at 0.The patient note does not report any history on immunocompromise and so we assume this to be false. Hence, 0 points are added to the total, keeping the total at 0 points.
The patient's FiO2 percentage is 57.0%.
Because the patent's FiO2 percentrage is greater than 50%, we need to examine the A-a-gradient to compute the APACHE II score. The patient's A-a-gradient is 375.0. Because the patient's A-a gradient is between 350 and 500, we add 3 points to the total, making the current total 0 + 3 = 3.
The patient's temperature is 34.9 degrees celsius. 
Because the patient's temperature is between 34 and 36 degrees celsius, 1 point is added to the score, making the current total, 3 + 1 = 4.
The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 122.0 mm Hg + 2/3 * 81.0 mm Hg = 94.667 mm Hg.
Hence, the patient's mean arterial pressure is 94.667 mm Hg.Because the patient's mean arterial pressure is between 70 and 109 mmHg, 0 points are added to the patient's score, keeping the total at 4.
The patient's heart rate is 120.0 beats per minute.
Because the patient's heart rate is between 110 and 139 beats per minute, 2 points are added to the score, making the current total, 4 + 2 = 6.
The patient's respiratory rate is 17.0 breaths per minute.
Because the patient's respiratory rate is between 12 and 24 breaths per minute, 0 points are added to the patient's score, keeping the total at 6.
The patient's pH is 7.53.
Because the patient's pH is between 7.50 and 7.59, 1 point is added to the score, making the current total 6 + 1 = 7.
The concentration of sodium is 137.49 mmol/L. Because the patient's sodium level is between 130 and 149 mmol/L, 0 points are added to the patient's score, keeping the total at 7.
The concentration of potassium is 5.43 mmol/L. Because the patient's potassium level is between 3.5 and 5.4 mmol/L, 0 points are added to the patient's score, keeping the total at 7.
The concentration of creatinine is 1.85 mg/dL. The patient is determined to have an acute renal failure.
The patient is determined to not have a chronic renal failure.
Because the patient has acute renal failure and a creatinine level between 1.5 and 2.0, 4 points are added to the score, making the current total 7 + 4 = 11.
The patient has a hematocrit of 35.0%.
Because the patient's hematocrit is between 30% and 45%, 0 points are added to the patient's score, keeping the total at 11.
The patient's concentration of white blood cell count is 9103.0 count/µL. To convert 9103.0 count/µL of white blood cell count to L, multiply by the conversion factor 1000000.0 µL/L which will give 9103.0 white blood cell count count/µL * 1000000.0 µL/L = 9103000000.0 white blood cell count count/L. Because the patient's white blood cell count is at least 3x10^9/L, but less than 15 x10^9/L, 0 points are added to the patient's score, keeping the total at 11.
The patient's Glasgow Coma Score is 12. For this criterion, we subtract 15 from the 12 points and add that to the total score. 15 - 12 = 3. Hence, we add 3 to the total making the current total 3 + 11 = 14.
Hence, the patient's APACHE II score is 14."
869,28,APACHE II Score,risk,integer,2,Handwritten,"A 61-year-old male with a history of chronic kidney disease not requiring dialysis, diabetes, and HLD presents with decreased urine output, mild abdominal tenderness, and suprapubic fullness. His HR is 143, the patient's blood pressure is  125/83 mmHg, RR of 21, and T of 38.3C. Laboratory results reveal a sodium level of 133.28 mmol/L, potassium level of 6.43 mmol/L, creatinine level of 2.57 mg/dL, and white blood cell count of 27,463 count/µL, suggestive of a possible infection or inflammatory process. Hematocrit of 54 % with increased reticulocytes. ABG shows pH of 7.47 a 68 % FiO₂, and an A-a-gradient of 240. On physical examination, the patient is alert and oriented to person, place, time, and situation (AxOx4).",What is the patient's APACHE II score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [143.0, 'beats per minute'], 'Sodium': [133.28, 'mmol/L'], 'creatinine': [2.57, 'mg/dL'], 'Systolic Blood Pressure': [125.0, 'mm Hg'], 'age': [61.0, 'years'], 'Acute renal failure': True, 'Hematocrit': [54.0, '%'], 'Glasgow Coma Score': 15.0, 'pH': 7.47, 'White blood cell count': [27463.0, 'µL'], 'Potassium': [6.43, 'mEq/L'], 'Temperature': [38.3, 'degrees celsius'], 'respiratory rate': [21.0, 'breaths per minute'], 'History of severe organ failure or immunocompromise': False, 'A-a gradient': 240.0, 'Chronic renal failure': True, 'Diastolic Blood Pressure': [83.0, 'mm Hg'], 'FiO2': [68.0, '%']}",21,21,21,"The criteria for the APACHE II Score are listed below:

1. Age, years: ≤44 = 0 points, 45-54 = +2 points, 55-64 = +3 points, 65-74 = +5 points, ≥75 = +6 points
2. History of severe organ insufficiency or immunocompromised: Yes, nonoperative or emergency postoperative patient = +5 points, Yes, elective postoperative patient = +2 points, No = 0 points
3. Rectal temperature, °C: ≥41 = +4 points, 39 to <41 = +3 points, 38.5 to <39 = +1 point, 36 to <38.5 = 0 points, 34 to <36 = +1 point, 32 to <34 = +2 points, 30 to <32 = +3 points, <30 = +4 points
4. Mean arterial pressure, mmHg: ≥160 = +4 points, 130-159 = +3 points, 110-129 = +2 points, 70-109 = 0 points, 50-69 = +2 points, 40-49 = +3 points, <40 = +4 points
5. Heart rate, beats per minute: ≥180 = +4 points, 140 to <180 = +3 points, 110 to <140 = +2 points, 70 to <110 = 0 points, 55 to <70 = +2 points, 40 to <55 = +3 points, <40 = +4 points
6. Respiratory rate, breaths per minute: ≥50 = +4 points, 35 to <50 = +3 points, 25 to <35 = +1 point, 12 to <25 = 0 points, 10 to <12 = +1 point, 6 to <10 = +2 points, <6 = +4 points
7. Oxygenation (use PaO2 if FiO2 <50%, otherwise use Aa gradient): Aa gradient >349 = +4 points, Aa gradient 350-349 = +3 points, Aa gradient 200-349 = +2 points, Aa gradient <200 (if FiO2 over 45%) or PaO2 <70 (if FiO2 less than 50%) = +1 point, PaO2 61-70 = +1 point, PaO2 55-60 = +3 points, PaO2 <55 = +4 points
8. Arterial pH: ≥7.7 = +4 points, 7.60 to <7.70 = +3 points, 7.50 to <7.60 = +1 point, 7.33 to <7.50 = 0 points, 7.25 to <7.33 = +2 points, 7.15 to <7.25 = +3 points, <7.15 = +4 points
9. Serum sodium, mmol/L: ≥180 = +4 points, 160 to <180 = +3 points, 155 to <160 = +2 points, 150 to <155 = +1 point, 130 to <150 = 0 points, 120 to <130 = +2 points, 111 to <120 = +3 points, <111 = +4 points
10. Serum potassium, mmol/L: ≥7.0 = +4 points, 6.0 to <7.0 = +3 points, 5.5 to <6.0 = +1 point, 3.5 to <5.5 = 0 points, 3.0 to <3.5 = +1 point, 2.5 to <3.0 = +2 points, <2.5 = +4 points
11. Serum creatinine, mg/100 mL: ≥3.5 and ACUTE renal failure = +8 points, 2.0 to <3.5 and ACUTE renal failure = +6 points, ≥3.5 and CHRONIC renal failure = +4 points, 1.5 to <2.0 and ACUTE renal failure = +4 points, 2.0 to <3.5 and CHRONIC renal failure = +3 points, 1.5 to <2.0 and CHRONIC renal failure = +2 points, 0.6 to <1.5 = 0 points, <0.6 = +2 points
12. Hematocrit, %: ≥60 = +4 points, 50 to <60 = +2 points, 46 to <50 = +1 point, 30 to <46 = 0 points, 20 to <30 = +2 points, <20 = +4 points
13. White blood count, total/cubic mm in 10^3: ≥40 = +4 points, 20 to <40 = +2 points, 15 to <20 = +1 point, 3 to <15 = 0 points, 1 to <3 = +2 points, <1 = +4 points
14. Glasgow Coma Scale (GCS): 1-15 points (use 15 - [GCS Score])

The total APACHE II score is calculated by summing the points for each criterion.
    
The patient's current APACHE II score is 0 points.
The patient is 61.0 years old. Because the patient's age is between 55 and 64, 3 points are added to the total, making the current total, 0 + 3 = 3.
The patient note does not report any history on immunocompromise and so we assume this to be false. Hence, 0 points are added to the total, keeping the total at 3 points.
The patient's FiO2 percentage is 68.0%.
Because the patent's FiO2 percentrage is greater than 50%, we need to examine the A-a-gradient to compute the APACHE II score. The patient's A-a-gradient is 240.0. Because the patient's A-a gradient is between 200 and 349, we add 2 points to the total, making the current total 3 + 2 = 5.
The patient's temperature is 38.3 degrees celsius. 
Because the patient's temperature is between 36 and 38.5 degrees celsius, no points are added to the score, keeping the current total at 5.
The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 125.0 mm Hg + 2/3 * 83.0 mm Hg = 97.0 mm Hg.
Hence, the patient's mean arterial pressure is 97.0 mm Hg.Because the patient's mean arterial pressure is between 70 and 109 mmHg, 0 points are added to the patient's score, keeping the total at 5.
The patient's heart rate is 143.0 beats per minute.
Because the patient's heart rate is between 140 and 179 beats per minute, 3 points are added to the score, making the current total, 5 + 3 = 8.
The patient's respiratory rate is 21.0 breaths per minute.
Because the patient's respiratory rate is between 12 and 24 breaths per minute, 0 points are added to the patient's score, keeping the total at 8.
The patient's pH is 7.47.
Because the patient's pH is between 7.33 and 7.49, 0 points are added to the patient's score, keeping the total at 8.
The concentration of sodium is 133.28 mmol/L. Because the patient's sodium level is between 130 and 149 mmol/L, 0 points are added to the patient's score, keeping the total at 8.
The concentration of potassium is 6.43 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of potassium from mEq to mmol. The mass of potassium is 6.43 mEq. To convert from 6.43 mEq to mmol, convert from mEq to mmol. The compound 6.43 has a valence of 1, and so divide the valence by the value of mEq to get, 6.43 mEq/(1 mEq/mmol) = 6.43 mmol potassium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 6.43 mEq potassium/L converts to 6.43 mmol potassium/L. Because the patient's potassium level is between 6.0 and 6.9 mmol/L, 3 points are added to the score, making the current total 8 + 3 = 11.
The concentration of creatinine is 2.57 mg/dL. The patient is determined to have an acute renal failure.
The patient is determined to have a chronic renal failure.
Because the patient has acute renal failure and a creatinine level between 2.0 and 3.5, 6 points are added to the score, making the current total 11 + 6 = 17.
The patient has a hematocrit of 54.0%.
Because the patient's hematocrit is between 50% and 59%, 2 points are added to the score, making the current total 17 + 2 = 19.
The patient's concentration of white blood cell count is 27463.0 count/µL. To convert 27463.0 count/µL of white blood cell count to L, multiply by the conversion factor 1000000.0 µL/L which will give 27463.0 white blood cell count count/µL * 1000000.0 µL/L = 27463000000.0 white blood cell count count/L. Because the patient's white blood cell count is at least 20x10^9/L, but less than 40 x10^9/L, 2 points are added to the score, making the current total 19 + 2 = 21.
The patient's Glasgow Coma Score is 15. For this criterion, we subtract 15 from the 15 points and add that to the total score. 15 - 15 = 0. Hence, we add 0 to the total making the current total 0 + 21 = 21.
Hence, the patient's APACHE II score is 21."
870,28,APACHE II Score,risk,integer,3,Handwritten,"A 73-year-old male is admitted to the emergency department following an acute abdominal pain that started suddenly 8 hours ago. He has a known history of hypertension, type 2 diabetes, for which he takes insulin daily, and liver cirrhosis. The patient denies any history of cerebrovascular events or ischemic heart disease. On physical examination, his blood pressure is 138/92 mmHg, heart rate is 107 beats per minute, respiratory rate is 35 breaths per minute, and he is afebrile with a temperature of 37.2°C. Auscultation of the chest reveals no rales, S3 gallop, or signs of congestive heart failure. His Glasgow Coma Scale score is 15, indicating full consciousness. Laboratory results show a creatinine level of 4.58 mg/dL, indicating impaired renal function, and a sodium level of 143.21 mmol/L and a potassium level of 3.68 mmol/L. His fraction of inspired oxygen is 63%. Arterial blood gas analysis reveals a pH of 7.29, a PaO₂ of 78 mm Hg, and an A-a gradient of 331 mm Hg, consistent with significant hypoxemia. Hematocrit is at 41%, and white blood cell count is 15,105 cells/µL. Given his acute presentation, history of diabetes managed with insulin, and laboratory findings, a thorough evaluation including imaging and further laboratory tests is warranted to assess the severity and underlying cause of his symptoms. At present, his management approach does not involve surgical intervention, with close monitoring and reassessment planned.",What is the patient's APACHE II score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [107.0, 'beats per minute'], 'Sodium': [143.21, 'mmol/L'], 'creatinine': [4.58, 'mg/dL'], 'Systolic Blood Pressure': [138.0, 'mm Hg'], 'age': [73.0, 'years'], 'Acute renal failure': True, 'Hematocrit': [41.0, '%'], 'Glasgow Coma Score': 15.0, 'pH': 7.29, 'White blood cell count': [15105.0, 'µL'], 'Potassium': [3.68, 'mmol/L'], 'Temperature': [37.2, 'degrees celsius'], 'respiratory rate': [35.0, 'breaths per minute'], 'History of severe organ failure or immunocompromise': True, 'A-a gradient': 331.0, 'Chronic renal failure': False, 'Diastolic Blood Pressure': [92.0, 'mm Hg'], 'Surgery Type': 'Nonoperative', 'FiO2': [63.0, '%']}",21,21,21,"The criteria for the APACHE II Score are listed below:

1. Age, years: ≤44 = 0 points, 45-54 = +2 points, 55-64 = +3 points, 65-74 = +5 points, ≥75 = +6 points
2. History of severe organ insufficiency or immunocompromised: Yes, nonoperative or emergency postoperative patient = +5 points, Yes, elective postoperative patient = +2 points, No = 0 points
3. Rectal temperature, °C: ≥41 = +4 points, 39 to <41 = +3 points, 38.5 to <39 = +1 point, 36 to <38.5 = 0 points, 34 to <36 = +1 point, 32 to <34 = +2 points, 30 to <32 = +3 points, <30 = +4 points
4. Mean arterial pressure, mmHg: ≥160 = +4 points, 130-159 = +3 points, 110-129 = +2 points, 70-109 = 0 points, 50-69 = +2 points, 40-49 = +3 points, <40 = +4 points
5. Heart rate, beats per minute: ≥180 = +4 points, 140 to <180 = +3 points, 110 to <140 = +2 points, 70 to <110 = 0 points, 55 to <70 = +2 points, 40 to <55 = +3 points, <40 = +4 points
6. Respiratory rate, breaths per minute: ≥50 = +4 points, 35 to <50 = +3 points, 25 to <35 = +1 point, 12 to <25 = 0 points, 10 to <12 = +1 point, 6 to <10 = +2 points, <6 = +4 points
7. Oxygenation (use PaO2 if FiO2 <50%, otherwise use Aa gradient): Aa gradient >349 = +4 points, Aa gradient 350-349 = +3 points, Aa gradient 200-349 = +2 points, Aa gradient <200 (if FiO2 over 45%) or PaO2 <70 (if FiO2 less than 50%) = +1 point, PaO2 61-70 = +1 point, PaO2 55-60 = +3 points, PaO2 <55 = +4 points
8. Arterial pH: ≥7.7 = +4 points, 7.60 to <7.70 = +3 points, 7.50 to <7.60 = +1 point, 7.33 to <7.50 = 0 points, 7.25 to <7.33 = +2 points, 7.15 to <7.25 = +3 points, <7.15 = +4 points
9. Serum sodium, mmol/L: ≥180 = +4 points, 160 to <180 = +3 points, 155 to <160 = +2 points, 150 to <155 = +1 point, 130 to <150 = 0 points, 120 to <130 = +2 points, 111 to <120 = +3 points, <111 = +4 points
10. Serum potassium, mmol/L: ≥7.0 = +4 points, 6.0 to <7.0 = +3 points, 5.5 to <6.0 = +1 point, 3.5 to <5.5 = 0 points, 3.0 to <3.5 = +1 point, 2.5 to <3.0 = +2 points, <2.5 = +4 points
11. Serum creatinine, mg/100 mL: ≥3.5 and ACUTE renal failure = +8 points, 2.0 to <3.5 and ACUTE renal failure = +6 points, ≥3.5 and CHRONIC renal failure = +4 points, 1.5 to <2.0 and ACUTE renal failure = +4 points, 2.0 to <3.5 and CHRONIC renal failure = +3 points, 1.5 to <2.0 and CHRONIC renal failure = +2 points, 0.6 to <1.5 = 0 points, <0.6 = +2 points
12. Hematocrit, %: ≥60 = +4 points, 50 to <60 = +2 points, 46 to <50 = +1 point, 30 to <46 = 0 points, 20 to <30 = +2 points, <20 = +4 points
13. White blood count, total/cubic mm in 10^3: ≥40 = +4 points, 20 to <40 = +2 points, 15 to <20 = +1 point, 3 to <15 = 0 points, 1 to <3 = +2 points, <1 = +4 points
14. Glasgow Coma Scale (GCS): 1-15 points (use 15 - [GCS Score])

The total APACHE II score is calculated by summing the points for each criterion.
    
The patient's current APACHE II score is 0 points.
The patient is 73.0 years old. Because the patient's age is between 65 and 74, 5 points are added to the total, making the current total, 0 + 5 = 5.
The patient note does not report any history on immunocompromise and so we assume this to be false. Hence, 0 points are added to the total, keeping the total at 5 points.
The patient's FiO2 percentage is 63.0%.
Because the patent's FiO2 percentrage is greater than 50%, we need to examine the A-a-gradient to compute the APACHE II score. The patient's A-a-gradient is 331.0. Because the patient's A-a gradient is between 200 and 349, we add 2 points to the total, making the current total 5 + 2 = 7.
The patient's temperature is 37.2 degrees celsius. 
Because the patient's temperature is between 36 and 38.5 degrees celsius, no points are added to the score, keeping the current total at 7.
The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 138.0 mm Hg + 2/3 * 92.0 mm Hg = 107.333 mm Hg.
Hence, the patient's mean arterial pressure is 107.333 mm Hg.Because the patient's mean arterial pressure is between 70 and 109 mmHg, 0 points are added to the patient's score, keeping the total at 7.
The patient's heart rate is 107.0 beats per minute.
Because the patient's heart rate is between 70 and 109 beats per minute, 0 points are added to the patient's score, keeping the total at 7.
The patient's respiratory rate is 35.0 breaths per minute.
Because the patient's respiratory rate is between 35 and 49 breaths per minute, 3 points are added to the score, making the current total, 7 + 3 = 10.
The patient's pH is 7.29.
Because the patient's pH is between 7.25 and 7.32, 2 points are added to the score, making the current total 10 + 2 = 12.
The concentration of sodium is 143.21 mmol/L. Because the patient's sodium level is between 130 and 149 mmol/L, 0 points are added to the patient's score, keeping the total at 12.
The concentration of potassium is 3.68 mmol/L. Because the patient's potassium level is between 3.5 and 5.4 mmol/L, 0 points are added to the patient's score, keeping the total at 12.
The concentration of creatinine is 4.58 mg/dL. The patient is determined to have an acute renal failure.
The patient is determined to not have a chronic renal failure.
Because the patient has acute renal failure and a creatinine level above 3.5, 8 points are added to the score, making the current total 12 + 8 = 20.
The patient has a hematocrit of 41.0%.
Because the patient's hematocrit is between 30% and 45%, 0 points are added to the patient's score, keeping the total at 20.
The patient's concentration of white blood cell count is 15105.0 count/µL. To convert 15105.0 count/µL of white blood cell count to L, multiply by the conversion factor 1000000.0 µL/L which will give 15105.0 white blood cell count count/µL * 1000000.0 µL/L = 15105000000.0 white blood cell count count/L. Because the patient's white blood cell count is at least 15x10^9/L, but less than 20 x10^9/L, 1 points is added to the score, making the current total 20 + 1 = 21.
The patient's Glasgow Coma Score is 15. For this criterion, we subtract 15 from the 15 points and add that to the total score. 15 - 15 = 0. Hence, we add 0 to the total making the current total 0 + 21 = 21.
Hence, the patient's APACHE II score is 21."
871,28,APACHE II Score,risk,integer,4,Handwritten,"A 57-year-old male presents to the emergency department with generalized weakness and difficulty breathing that started two days ago. He has a history of chronic renal failure, managed conservatively, and had a scheduled kidney transplant in the past. He reports feeling more fatigued and short of breath than usual, particularly with mild exertion. His medical history is significant for diabetes mellitus, managed with oral hypoglycemic agents, but no history of cerebrovascular or ischemic heart disease. On examination, his pulse is 73 beats per minute, and he appears slightly dyspneic with a respiratory rate of 27 breaths per minute. Blood pressure is elevated at 132/103 mm Hg. He is afebrile with a temperature of 37.2°C. Laboratory tests reveal a sodium level of 132.39 mmol/L, creatinine of 3.67 mg/dL, potassium of 4.31 mmol/L, and a hematocrit of 32 %. His white blood cell count is 12,476 cells/µL. Arterial blood gas analysis shows a pH of 7.40 and a PaO2 of 57 mm Hg while breathing 32 % oxygen. His Glasgow Coma Scale score is 15, indicating he is fully alert. The patient has no signs of acute renal failure, though his chronic renal condition and current symptoms suggest a need for careful preoperative management. His history of diabetes and chronic renal failure, combined with current vital signs and laboratory findings, place him at an increased risk for postoperative complications. ",What is the patient's APACHE II score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [73.0, 'beats per minute'], 'Sodium': [132.39, 'mmol/L'], 'creatinine': [3.67, 'mg/dL'], 'Systolic Blood Pressure': [132.0, 'mm Hg'], 'age': [57.0, 'years'], 'Acute renal failure': False, 'Hematocrit': [32.0, '%'], 'Glasgow Coma Score': 15.0, 'pH': 7.4, 'White blood cell count': [12476.0, 'µL'], 'Potassium': [4.31, 'mmol/L'], 'Temperature': [37.2, 'degrees celsius'], 'respiratory rate': [27.0, 'breaths per minute'], 'History of severe organ failure or immunocompromise': True, 'Chronic renal failure': True, 'Diastolic Blood Pressure': [103.0, 'mm Hg'], 'Surgery Type': 'Elective', 'PaO2': [57.0, 'mm Hg'], 'FiO2': [32.0, '%']}",13,13,13,"The criteria for the APACHE II Score are listed below:

1. Age, years: ≤44 = 0 points, 45-54 = +2 points, 55-64 = +3 points, 65-74 = +5 points, ≥75 = +6 points
2. History of severe organ insufficiency or immunocompromised: Yes, nonoperative or emergency postoperative patient = +5 points, Yes, elective postoperative patient = +2 points, No = 0 points
3. Rectal temperature, °C: ≥41 = +4 points, 39 to <41 = +3 points, 38.5 to <39 = +1 point, 36 to <38.5 = 0 points, 34 to <36 = +1 point, 32 to <34 = +2 points, 30 to <32 = +3 points, <30 = +4 points
4. Mean arterial pressure, mmHg: ≥160 = +4 points, 130-159 = +3 points, 110-129 = +2 points, 70-109 = 0 points, 50-69 = +2 points, 40-49 = +3 points, <40 = +4 points
5. Heart rate, beats per minute: ≥180 = +4 points, 140 to <180 = +3 points, 110 to <140 = +2 points, 70 to <110 = 0 points, 55 to <70 = +2 points, 40 to <55 = +3 points, <40 = +4 points
6. Respiratory rate, breaths per minute: ≥50 = +4 points, 35 to <50 = +3 points, 25 to <35 = +1 point, 12 to <25 = 0 points, 10 to <12 = +1 point, 6 to <10 = +2 points, <6 = +4 points
7. Oxygenation (use PaO2 if FiO2 <50%, otherwise use Aa gradient): Aa gradient >349 = +4 points, Aa gradient 350-349 = +3 points, Aa gradient 200-349 = +2 points, Aa gradient <200 (if FiO2 over 45%) or PaO2 <70 (if FiO2 less than 50%) = +1 point, PaO2 61-70 = +1 point, PaO2 55-60 = +3 points, PaO2 <55 = +4 points
8. Arterial pH: ≥7.7 = +4 points, 7.60 to <7.70 = +3 points, 7.50 to <7.60 = +1 point, 7.33 to <7.50 = 0 points, 7.25 to <7.33 = +2 points, 7.15 to <7.25 = +3 points, <7.15 = +4 points
9. Serum sodium, mmol/L: ≥180 = +4 points, 160 to <180 = +3 points, 155 to <160 = +2 points, 150 to <155 = +1 point, 130 to <150 = 0 points, 120 to <130 = +2 points, 111 to <120 = +3 points, <111 = +4 points
10. Serum potassium, mmol/L: ≥7.0 = +4 points, 6.0 to <7.0 = +3 points, 5.5 to <6.0 = +1 point, 3.5 to <5.5 = 0 points, 3.0 to <3.5 = +1 point, 2.5 to <3.0 = +2 points, <2.5 = +4 points
11. Serum creatinine, mg/100 mL: ≥3.5 and ACUTE renal failure = +8 points, 2.0 to <3.5 and ACUTE renal failure = +6 points, ≥3.5 and CHRONIC renal failure = +4 points, 1.5 to <2.0 and ACUTE renal failure = +4 points, 2.0 to <3.5 and CHRONIC renal failure = +3 points, 1.5 to <2.0 and CHRONIC renal failure = +2 points, 0.6 to <1.5 = 0 points, <0.6 = +2 points
12. Hematocrit, %: ≥60 = +4 points, 50 to <60 = +2 points, 46 to <50 = +1 point, 30 to <46 = 0 points, 20 to <30 = +2 points, <20 = +4 points
13. White blood count, total/cubic mm in 10^3: ≥40 = +4 points, 20 to <40 = +2 points, 15 to <20 = +1 point, 3 to <15 = 0 points, 1 to <3 = +2 points, <1 = +4 points
14. Glasgow Coma Scale (GCS): 1-15 points (use 15 - [GCS Score])

The total APACHE II score is calculated by summing the points for each criterion.
    
The patient's current APACHE II score is 0 points.
The patient is 57.0 years old. Because the patient's age is between 55 and 64, 3 points are added to the total, making the current total, 0 + 3 = 3.
The patient note does not report any history on immunocompromise and so we assume this to be false. Hence, 0 points are added to the total, keeping the total at 3 points.
The patient's FiO2 percentage is 32.0%.
Because the patent's FiO2 percentrage is less than 50%, we need to examine the patient's A-a-gradient to compute the APACHE II score. The patient's partial pressure of oxygen is 57.0 mm Hg. Because the patient's partial pressure of oxygen is between 55 and 60 mm Hg, we add three points to the total, making the current total 3 + 3 = 6.
The patient's temperature is 37.2 degrees celsius. 
Because the patient's temperature is between 36 and 38.5 degrees celsius, no points are added to the score, keeping the current total at 6.
The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 132.0 mm Hg + 2/3 * 103.0 mm Hg = 112.667 mm Hg.
Hence, the patient's mean arterial pressure is 112.667 mm Hg.Because the patient's mean arterial pressure is between 110 and 129 mmHg, 2 points are added to the score, making the current total, 6 + 2 = 8.
The patient's heart rate is 73.0 beats per minute.
Because the patient's heart rate is between 70 and 109 beats per minute, 0 points are added to the patient's score, keeping the total at 8.
The patient's respiratory rate is 27.0 breaths per minute.
Because the patient's respiratory rate is between 25 and 34 breaths per minute, 1 point is added to the score, making the current total, 8 + 1 = 9.
The patient's pH is 7.4.
Because the patient's pH is between 7.33 and 7.49, 0 points are added to the patient's score, keeping the total at 9.
The concentration of sodium is 132.39 mmol/L. Because the patient's sodium level is between 130 and 149 mmol/L, 0 points are added to the patient's score, keeping the total at 9.
The concentration of potassium is 4.31 mmol/L. Because the patient's potassium level is between 3.5 and 5.4 mmol/L, 0 points are added to the patient's score, keeping the total at 9.
The concentration of creatinine is 3.67 mg/dL. The patient is determined to not have an acute renal failure.
The patient is determined to have a chronic renal failure.
Because the patient has chronic renal failure and a creatinine level above 3.5, 4 points are added to the score, making the current total 9 + 4 = 13.
The patient has a hematocrit of 32.0%.
Because the patient's hematocrit is between 30% and 45%, 0 points are added to the patient's score, keeping the total at 13.
The patient's concentration of white blood cell count is 12476.0 count/µL. To convert 12476.0 count/µL of white blood cell count to L, multiply by the conversion factor 1000000.0 µL/L which will give 12476.0 white blood cell count count/µL * 1000000.0 µL/L = 12476000000.0 white blood cell count count/L. Because the patient's white blood cell count is at least 3x10^9/L, but less than 15 x10^9/L, 0 points are added to the patient's score, keeping the total at 13.
The patient's Glasgow Coma Score is 15. For this criterion, we subtract 15 from the 15 points and add that to the total score. 15 - 15 = 0. Hence, we add 0 to the total making the current total 0 + 13 = 13.
Hence, the patient's APACHE II score is 13."
872,28,APACHE II Score,risk,integer,5,Handwritten,"A 52-year-old patient with a known medical history characterized by several organ failures managed with medications presented to the hospital with general malaise and signs of confusion. On examination, the patient had a pulse rate of 90 beats per minute and the blood pressure measurement displayed 120/70 mm Hg. The respiratory rate was 16 breaths per minute, with oxygen saturation stably maintained on 60 % FiO₂. Basal temperature was found to be normal, at 37°C. Initial neurological evaluation revealed a slightly lowered level of consciousness, with a Glasgow Coma Score of 12. Laboratory workup showed a normal creatinine level of 1.2 mg/dL, indicating no recent onset of renal impairment. Complete blood count displayed a white blood cell count of 7000 per microliter, within the reference ranges. Routine electrolyte panel demonstrated sodium and potassium concentrations at 137 and 4.8 mEq/L, respectively. Arterial blood gas analysis revealed a pH of 7.35 with a A-a-gradient of 375. Hematocrit level was observed at a standard 45 %. Owing to the patient's historical pattern of severe organ failure and present immunocompromised state, continued vigilance and monitoring are of paramount importance for any signs of potential complications.",What is the patient's APACHE II score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [90.0, 'beats per minute'], 'Diastolic Blood Pressure': [70.0, 'mm Hg'], 'pH': 7.35, 'Systolic Blood Pressure': [120.0, 'mm Hg'], 'Acute renal failure': False, 'History of severe organ failure or immunocompromise': True, 'creatinine': [1.2, 'mg/dL'], 'White blood cell count': [7000.0, 'µL'], 'Sodium': [137.0, 'mEq/L'], 'Potassium': [4.8, 'mEq/L'], 'A-a gradient': 375, 'age': [52.0, 'years'], 'respiratory rate': [16.0, 'breaths per minute'], 'Glasgow Coma Score': 12.0, 'Hematocrit': [45.0, '%'], 'Temperature': [37.0, 'degrees celsius'], 'Surgery Type': 'Nonoperative', 'FiO2': [60.0, '%']}",8,8,8,"The criteria for the APACHE II Score are listed below:

1. Age, years: ≤44 = 0 points, 45-54 = +2 points, 55-64 = +3 points, 65-74 = +5 points, ≥75 = +6 points
2. History of severe organ insufficiency or immunocompromised: Yes, nonoperative or emergency postoperative patient = +5 points, Yes, elective postoperative patient = +2 points, No = 0 points
3. Rectal temperature, °C: ≥41 = +4 points, 39 to <41 = +3 points, 38.5 to <39 = +1 point, 36 to <38.5 = 0 points, 34 to <36 = +1 point, 32 to <34 = +2 points, 30 to <32 = +3 points, <30 = +4 points
4. Mean arterial pressure, mmHg: ≥160 = +4 points, 130-159 = +3 points, 110-129 = +2 points, 70-109 = 0 points, 50-69 = +2 points, 40-49 = +3 points, <40 = +4 points
5. Heart rate, beats per minute: ≥180 = +4 points, 140 to <180 = +3 points, 110 to <140 = +2 points, 70 to <110 = 0 points, 55 to <70 = +2 points, 40 to <55 = +3 points, <40 = +4 points
6. Respiratory rate, breaths per minute: ≥50 = +4 points, 35 to <50 = +3 points, 25 to <35 = +1 point, 12 to <25 = 0 points, 10 to <12 = +1 point, 6 to <10 = +2 points, <6 = +4 points
7. Oxygenation (use PaO2 if FiO2 <50%, otherwise use Aa gradient): Aa gradient >349 = +4 points, Aa gradient 350-349 = +3 points, Aa gradient 200-349 = +2 points, Aa gradient <200 (if FiO2 over 45%) or PaO2 <70 (if FiO2 less than 50%) = +1 point, PaO2 61-70 = +1 point, PaO2 55-60 = +3 points, PaO2 <55 = +4 points
8. Arterial pH: ≥7.7 = +4 points, 7.60 to <7.70 = +3 points, 7.50 to <7.60 = +1 point, 7.33 to <7.50 = 0 points, 7.25 to <7.33 = +2 points, 7.15 to <7.25 = +3 points, <7.15 = +4 points
9. Serum sodium, mmol/L: ≥180 = +4 points, 160 to <180 = +3 points, 155 to <160 = +2 points, 150 to <155 = +1 point, 130 to <150 = 0 points, 120 to <130 = +2 points, 111 to <120 = +3 points, <111 = +4 points
10. Serum potassium, mmol/L: ≥7.0 = +4 points, 6.0 to <7.0 = +3 points, 5.5 to <6.0 = +1 point, 3.5 to <5.5 = 0 points, 3.0 to <3.5 = +1 point, 2.5 to <3.0 = +2 points, <2.5 = +4 points
11. Serum creatinine, mg/100 mL: ≥3.5 and ACUTE renal failure = +8 points, 2.0 to <3.5 and ACUTE renal failure = +6 points, ≥3.5 and CHRONIC renal failure = +4 points, 1.5 to <2.0 and ACUTE renal failure = +4 points, 2.0 to <3.5 and CHRONIC renal failure = +3 points, 1.5 to <2.0 and CHRONIC renal failure = +2 points, 0.6 to <1.5 = 0 points, <0.6 = +2 points
12. Hematocrit, %: ≥60 = +4 points, 50 to <60 = +2 points, 46 to <50 = +1 point, 30 to <46 = 0 points, 20 to <30 = +2 points, <20 = +4 points
13. White blood count, total/cubic mm in 10^3: ≥40 = +4 points, 20 to <40 = +2 points, 15 to <20 = +1 point, 3 to <15 = 0 points, 1 to <3 = +2 points, <1 = +4 points
14. Glasgow Coma Scale (GCS): 1-15 points (use 15 - [GCS Score])

The total APACHE II score is calculated by summing the points for each criterion.
    
The patient's current APACHE II score is 0 points.
The patient is 52.0 years old. Because the patient's age is between 45 and 54, 2 points are added to the total, making the current total, 0 + 2 = 2.
The patient note does not report any history on immunocompromise and so we assume this to be false. Hence, 0 points are added to the total, keeping the total at 2 points.
The patient's FiO2 percentage is 60.0%.
Because the patent's FiO2 percentrage is greater than 50%, we need to examine the A-a-gradient to compute the APACHE II score. The patient's A-a-gradient is 375. Because the patient's A-a gradient is between 350 and 500, we add 3 points to the total, making the current total 2 + 3 = 5.
The patient's temperature is 37.0 degrees celsius. 
Because the patient's temperature is between 36 and 38.5 degrees celsius, no points are added to the score, keeping the current total at 5.
The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 120.0 mm Hg + 2/3 * 70.0 mm Hg = 86.667 mm Hg.
Hence, the patient's mean arterial pressure is 86.667 mm Hg.Because the patient's mean arterial pressure is between 70 and 109 mmHg, 0 points are added to the patient's score, keeping the total at 5.
The patient's heart rate is 90.0 beats per minute.
Because the patient's heart rate is between 70 and 109 beats per minute, 0 points are added to the patient's score, keeping the total at 5.
The patient's respiratory rate is 16.0 breaths per minute.
Because the patient's respiratory rate is between 12 and 24 breaths per minute, 0 points are added to the patient's score, keeping the total at 5.
The patient's pH is 7.35.
Because the patient's pH is between 7.33 and 7.49, 0 points are added to the patient's score, keeping the total at 5.
The concentration of sodium is 137.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 137.0 mEq. To convert from 137.0 mEq to mmol, convert from mEq to mmol. The compound 137.0 has a valence of 1, and so divide the valence by the value of mEq to get, 137.0 mEq/(1 mEq/mmol) = 137.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 137.0 mEq sodium/L converts to 137.0 mmol sodium/L. Because the patient's sodium level is between 130 and 149 mmol/L, 0 points are added to the patient's score, keeping the total at 5.
The concentration of potassium is 4.8 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of potassium from mEq to mmol. The mass of potassium is 4.8 mEq. To convert from 4.8 mEq to mmol, convert from mEq to mmol. The compound 4.8 has a valence of 1, and so divide the valence by the value of mEq to get, 4.8 mEq/(1 mEq/mmol) = 4.8 mmol potassium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 4.8 mEq potassium/L converts to 4.8 mmol potassium/L. Because the patient's potassium level is between 3.5 and 5.4 mmol/L, 0 points are added to the patient's score, keeping the total at 5.
The concentration of creatinine is 1.2 mg/dL. The patient is determined to not have an acute renal failure.
The patient is determined to not have a chronic renal failure.
Because the patient's creatinine level is between 0.6 and 1.4, no points are added to the score, keeping the current total at 5.
The patient has a hematocrit of 45.0%.
Because the patient's hematocrit is between 30% and 45%, 0 points are added to the patient's score, keeping the total at 5.
The patient's concentration of white blood cell count is 7000.0 count/µL. To convert 7000.0 count/µL of white blood cell count to L, multiply by the conversion factor 1000000.0 µL/L which will give 7000.0 white blood cell count count/µL * 1000000.0 µL/L = 7000000000.0 white blood cell count count/L. Because the patient's white blood cell count is at least 3x10^9/L, but less than 15 x10^9/L, 0 points are added to the patient's score, keeping the total at 5.
The patient's Glasgow Coma Score is 12. For this criterion, we subtract 15 from the 12 points and add that to the total score. 15 - 12 = 3. Hence, we add 3 to the total making the current total 3 + 5 = 8.
Hence, the patient's APACHE II score is 8."
873,28,APACHE II Score,risk,integer,6,Handwritten,"A gentleman of 65 years of age, with a long-standing diagnosis of chronic kidney disease, has attended the hospital complaining of severe back pain and fatigue. Initial evaluation revealed an elevated body temperature of 38.5°C, a heart rate of 110 beats per minute, respiratory rate of 20 breaths per minute, and blood pressure recorded at 140/80 mm Hg. He appears somewhat lethargic and responds to verbal commands occasionally, with a Glasgow Coma Score of 14 recorded. Laboratory parameters returned borderline high creatinine levels of 2.0 mg/dL, a clear indication of an acute kidney injury. Additionally, the patient's complete blood count disclosed leukocytosis, with 15000 white blood cells per µL. Electrolyte analysis asserted normal sodium concentration of 140 mEq/L and a slightly elevated potassium level of 5.2 mEq/L. Arterial blood gas showed a slightly reduced pH of 7.30 and a partial pressure of oxygen at 65 mm Hg while on 45% FiO₂. Her hematocrit was somewhat depressed at 39% - a red flag for possible anemia. Given the acute onset of renal dysfunction, aggressive management in a monitored setting is warranted.",What is the patient's APACHE II score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [110.0, 'beats per minute'], 'Diastolic Blood Pressure': [80.0, 'mm Hg'], 'pH': 7.3, 'FiO2': [45.0, '%'], 'Systolic Blood Pressure': [140.0, 'mm Hg'], 'Acute renal failure': True, 'creatinine': [2.0, 'mg/dL'], 'White blood cell count': [15000.0, 'µL'], 'Sodium': [140.0, 'mEq/L'], 'Potassium': [5.2, 'mEq/L'], 'PaO2': [65.0, 'mm Hg'], 'age': [65.0, 'years'], 'respiratory rate': [20.0, 'breaths per minute'], 'Glasgow Coma Score': 14.0, 'Hematocrit': [39.0, '%'], 'Temperature': [38.5, 'degrees celsius'], 'Chronic renal failure': True, 'History of severe organ failure or immunocompromise': False}",19,19,19,"The criteria for the APACHE II Score are listed below:

1. Age, years: ≤44 = 0 points, 45-54 = +2 points, 55-64 = +3 points, 65-74 = +5 points, ≥75 = +6 points
2. History of severe organ insufficiency or immunocompromised: Yes, nonoperative or emergency postoperative patient = +5 points, Yes, elective postoperative patient = +2 points, No = 0 points
3. Rectal temperature, °C: ≥41 = +4 points, 39 to <41 = +3 points, 38.5 to <39 = +1 point, 36 to <38.5 = 0 points, 34 to <36 = +1 point, 32 to <34 = +2 points, 30 to <32 = +3 points, <30 = +4 points
4. Mean arterial pressure, mmHg: ≥160 = +4 points, 130-159 = +3 points, 110-129 = +2 points, 70-109 = 0 points, 50-69 = +2 points, 40-49 = +3 points, <40 = +4 points
5. Heart rate, beats per minute: ≥180 = +4 points, 140 to <180 = +3 points, 110 to <140 = +2 points, 70 to <110 = 0 points, 55 to <70 = +2 points, 40 to <55 = +3 points, <40 = +4 points
6. Respiratory rate, breaths per minute: ≥50 = +4 points, 35 to <50 = +3 points, 25 to <35 = +1 point, 12 to <25 = 0 points, 10 to <12 = +1 point, 6 to <10 = +2 points, <6 = +4 points
7. Oxygenation (use PaO2 if FiO2 <50%, otherwise use Aa gradient): Aa gradient >349 = +4 points, Aa gradient 350-349 = +3 points, Aa gradient 200-349 = +2 points, Aa gradient <200 (if FiO2 over 45%) or PaO2 <70 (if FiO2 less than 50%) = +1 point, PaO2 61-70 = +1 point, PaO2 55-60 = +3 points, PaO2 <55 = +4 points
8. Arterial pH: ≥7.7 = +4 points, 7.60 to <7.70 = +3 points, 7.50 to <7.60 = +1 point, 7.33 to <7.50 = 0 points, 7.25 to <7.33 = +2 points, 7.15 to <7.25 = +3 points, <7.15 = +4 points
9. Serum sodium, mmol/L: ≥180 = +4 points, 160 to <180 = +3 points, 155 to <160 = +2 points, 150 to <155 = +1 point, 130 to <150 = 0 points, 120 to <130 = +2 points, 111 to <120 = +3 points, <111 = +4 points
10. Serum potassium, mmol/L: ≥7.0 = +4 points, 6.0 to <7.0 = +3 points, 5.5 to <6.0 = +1 point, 3.5 to <5.5 = 0 points, 3.0 to <3.5 = +1 point, 2.5 to <3.0 = +2 points, <2.5 = +4 points
11. Serum creatinine, mg/100 mL: ≥3.5 and ACUTE renal failure = +8 points, 2.0 to <3.5 and ACUTE renal failure = +6 points, ≥3.5 and CHRONIC renal failure = +4 points, 1.5 to <2.0 and ACUTE renal failure = +4 points, 2.0 to <3.5 and CHRONIC renal failure = +3 points, 1.5 to <2.0 and CHRONIC renal failure = +2 points, 0.6 to <1.5 = 0 points, <0.6 = +2 points
12. Hematocrit, %: ≥60 = +4 points, 50 to <60 = +2 points, 46 to <50 = +1 point, 30 to <46 = 0 points, 20 to <30 = +2 points, <20 = +4 points
13. White blood count, total/cubic mm in 10^3: ≥40 = +4 points, 20 to <40 = +2 points, 15 to <20 = +1 point, 3 to <15 = 0 points, 1 to <3 = +2 points, <1 = +4 points
14. Glasgow Coma Scale (GCS): 1-15 points (use 15 - [GCS Score])

The total APACHE II score is calculated by summing the points for each criterion.
    
The patient's current APACHE II score is 0 points.
The patient is 65.0 years old. Because the patient's age is between 65 and 74, 5 points are added to the total, making the current total, 0 + 5 = 5.
The patient note does not report any history on immunocompromise and so we assume this to be false. Hence, 0 points are added to the total, keeping the total at 5 points.
The patient's FiO2 percentage is 45.0%.
Because the patent's FiO2 percentrage is less than 50%, we need to examine the patient's A-a-gradient to compute the APACHE II score. The patient's partial pressure of oxygen is 65.0 mm Hg. Because the patient's partial pressure of oxygen is between 61 and 70 mm Hg, we do add one point to the total, making the current total 5 + 1 = 6.
The patient's temperature is 38.5 degrees celsius. 
Because the patient's temperature is between 38.5 and 39 degrees celsius, 1 point is added to the score, making the current total, 6 + 1 = 7.
The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 140.0 mm Hg + 2/3 * 80.0 mm Hg = 100.0 mm Hg.
Hence, the patient's mean arterial pressure is 100.0 mm Hg.Because the patient's mean arterial pressure is between 70 and 109 mmHg, 0 points are added to the patient's score, keeping the total at 7.
The patient's heart rate is 110.0 beats per minute.
Because the patient's heart rate is between 110 and 139 beats per minute, 2 points are added to the score, making the current total, 7 + 2 = 9.
The patient's respiratory rate is 20.0 breaths per minute.
Because the patient's respiratory rate is between 12 and 24 breaths per minute, 0 points are added to the patient's score, keeping the total at 9.
The patient's pH is 7.3.
Because the patient's pH is between 7.25 and 7.32, 2 points are added to the score, making the current total 9 + 2 = 11.
The concentration of sodium is 140.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 140.0 mEq. To convert from 140.0 mEq to mmol, convert from mEq to mmol. The compound 140.0 has a valence of 1, and so divide the valence by the value of mEq to get, 140.0 mEq/(1 mEq/mmol) = 140.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 140.0 mEq sodium/L converts to 140.0 mmol sodium/L. Because the patient's sodium level is between 130 and 149 mmol/L, 0 points are added to the patient's score, keeping the total at 11.
The concentration of potassium is 5.2 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of potassium from mEq to mmol. The mass of potassium is 5.2 mEq. To convert from 5.2 mEq to mmol, convert from mEq to mmol. The compound 5.2 has a valence of 1, and so divide the valence by the value of mEq to get, 5.2 mEq/(1 mEq/mmol) = 5.2 mmol potassium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 5.2 mEq potassium/L converts to 5.2 mmol potassium/L. Because the patient's potassium level is between 3.5 and 5.4 mmol/L, 0 points are added to the patient's score, keeping the total at 11.
The concentration of creatinine is 2.0 mg/dL. The patient is determined to have an acute renal failure.
The patient is determined to have a chronic renal failure.
Because the patient has acute renal failure and a creatinine level between 2.0 and 3.5, 6 points are added to the score, making the current total 11 + 6 = 17.
The patient has a hematocrit of 39.0%.
Because the patient's hematocrit is between 30% and 45%, 0 points are added to the patient's score, keeping the total at 17.
The patient's concentration of white blood cell count is 15000.0 count/µL. To convert 15000.0 count/µL of white blood cell count to L, multiply by the conversion factor 1000000.0 µL/L which will give 15000.0 white blood cell count count/µL * 1000000.0 µL/L = 15000000000.0 white blood cell count count/L. Because the patient's white blood cell count is at least 15x10^9/L, but less than 20 x10^9/L, 1 points is added to the score, making the current total 17 + 1 = 18.
The patient's Glasgow Coma Score is 14. For this criterion, we subtract 15 from the 14 points and add that to the total score. 15 - 14 = 1. Hence, we add 1 to the total making the current total 1 + 18 = 19.
Hence, the patient's APACHE II score is 19."
874,28,APACHE II Score,risk,integer,7,Handwritten,"A 58-year-old male with no significant past medical history presents to the emergency department with an episode of mild disorientation and general fatigue. On clinical examination, the patient's temperature is 36.5°C, heart rate is 85 beats per minute, respiratory rate is 18 breaths per minute, and blood pressure is 130/78 mmHg. Neurological assessment reveals mild confusion, resulting in a Glasgow Coma Score of 13. Labs show a creatinine of 1.3 mg/dL, sodium 139 mEq/L, potassium 5.0 mEq/L, and white blood cell count of 8000 count/µL. Hematocrit was measured at 42 %. His arterial blood gas showed a pH of 7.37; the patient was maintaining an A_A_gradient of 425 on 54 % FiO2.",What is the patient's APACHE II score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [85.0, 'beats per minute'], 'Diastolic Blood Pressure': [78.0, 'mm Hg'], 'pH': 7.37, 'Systolic Blood Pressure': [130.0, 'mm Hg'], 'History of severe organ failure or immunocompromise': False, 'creatinine': [1.3, 'mg/dL'], 'White blood cell count': [8000.0, 'µL'], 'Sodium': [139.0, 'mEq/L'], 'Potassium': [5.0, 'mEq/L'], 'A-a gradient': 425, 'age': [58.0, 'years'], 'respiratory rate': [18.0, 'breaths per minute'], 'Chronic renal failure': False, 'Glasgow Coma Score': 13.0, 'Hematocrit': [42.0, '%'], 'Temperature': [36.5, 'degrees celsius'], 'FiO2': [54.0, '%']}",8,8,8,"The criteria for the APACHE II Score are listed below:

1. Age, years: ≤44 = 0 points, 45-54 = +2 points, 55-64 = +3 points, 65-74 = +5 points, ≥75 = +6 points
2. History of severe organ insufficiency or immunocompromised: Yes, nonoperative or emergency postoperative patient = +5 points, Yes, elective postoperative patient = +2 points, No = 0 points
3. Rectal temperature, °C: ≥41 = +4 points, 39 to <41 = +3 points, 38.5 to <39 = +1 point, 36 to <38.5 = 0 points, 34 to <36 = +1 point, 32 to <34 = +2 points, 30 to <32 = +3 points, <30 = +4 points
4. Mean arterial pressure, mmHg: ≥160 = +4 points, 130-159 = +3 points, 110-129 = +2 points, 70-109 = 0 points, 50-69 = +2 points, 40-49 = +3 points, <40 = +4 points
5. Heart rate, beats per minute: ≥180 = +4 points, 140 to <180 = +3 points, 110 to <140 = +2 points, 70 to <110 = 0 points, 55 to <70 = +2 points, 40 to <55 = +3 points, <40 = +4 points
6. Respiratory rate, breaths per minute: ≥50 = +4 points, 35 to <50 = +3 points, 25 to <35 = +1 point, 12 to <25 = 0 points, 10 to <12 = +1 point, 6 to <10 = +2 points, <6 = +4 points
7. Oxygenation (use PaO2 if FiO2 <50%, otherwise use Aa gradient): Aa gradient >349 = +4 points, Aa gradient 350-349 = +3 points, Aa gradient 200-349 = +2 points, Aa gradient <200 (if FiO2 over 45%) or PaO2 <70 (if FiO2 less than 50%) = +1 point, PaO2 61-70 = +1 point, PaO2 55-60 = +3 points, PaO2 <55 = +4 points
8. Arterial pH: ≥7.7 = +4 points, 7.60 to <7.70 = +3 points, 7.50 to <7.60 = +1 point, 7.33 to <7.50 = 0 points, 7.25 to <7.33 = +2 points, 7.15 to <7.25 = +3 points, <7.15 = +4 points
9. Serum sodium, mmol/L: ≥180 = +4 points, 160 to <180 = +3 points, 155 to <160 = +2 points, 150 to <155 = +1 point, 130 to <150 = 0 points, 120 to <130 = +2 points, 111 to <120 = +3 points, <111 = +4 points
10. Serum potassium, mmol/L: ≥7.0 = +4 points, 6.0 to <7.0 = +3 points, 5.5 to <6.0 = +1 point, 3.5 to <5.5 = 0 points, 3.0 to <3.5 = +1 point, 2.5 to <3.0 = +2 points, <2.5 = +4 points
11. Serum creatinine, mg/100 mL: ≥3.5 and ACUTE renal failure = +8 points, 2.0 to <3.5 and ACUTE renal failure = +6 points, ≥3.5 and CHRONIC renal failure = +4 points, 1.5 to <2.0 and ACUTE renal failure = +4 points, 2.0 to <3.5 and CHRONIC renal failure = +3 points, 1.5 to <2.0 and CHRONIC renal failure = +2 points, 0.6 to <1.5 = 0 points, <0.6 = +2 points
12. Hematocrit, %: ≥60 = +4 points, 50 to <60 = +2 points, 46 to <50 = +1 point, 30 to <46 = 0 points, 20 to <30 = +2 points, <20 = +4 points
13. White blood count, total/cubic mm in 10^3: ≥40 = +4 points, 20 to <40 = +2 points, 15 to <20 = +1 point, 3 to <15 = 0 points, 1 to <3 = +2 points, <1 = +4 points
14. Glasgow Coma Scale (GCS): 1-15 points (use 15 - [GCS Score])

The total APACHE II score is calculated by summing the points for each criterion.
    
The patient's current APACHE II score is 0 points.
The patient is 58.0 years old. Because the patient's age is between 55 and 64, 3 points are added to the total, making the current total, 0 + 3 = 3.
The patient note does not report any history on immunocompromise and so we assume this to be false. Hence, 0 points are added to the total, keeping the total at 3 points.
The patient's FiO2 percentage is 54.0%.
Because the patent's FiO2 percentrage is greater than 50%, we need to examine the A-a-gradient to compute the APACHE II score. The patient's A-a-gradient is 425. Because the patient's A-a gradient is between 350 and 500, we add 3 points to the total, making the current total 3 + 3 = 6.
The patient's temperature is 36.5 degrees celsius. 
Because the patient's temperature is between 36 and 38.5 degrees celsius, no points are added to the score, keeping the current total at 6.
The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 130.0 mm Hg + 2/3 * 78.0 mm Hg = 95.333 mm Hg.
Hence, the patient's mean arterial pressure is 95.333 mm Hg.Because the patient's mean arterial pressure is between 70 and 109 mmHg, 0 points are added to the patient's score, keeping the total at 6.
The patient's heart rate is 85.0 beats per minute.
Because the patient's heart rate is between 70 and 109 beats per minute, 0 points are added to the patient's score, keeping the total at 6.
The patient's respiratory rate is 18.0 breaths per minute.
Because the patient's respiratory rate is between 12 and 24 breaths per minute, 0 points are added to the patient's score, keeping the total at 6.
The patient's pH is 7.37.
Because the patient's pH is between 7.33 and 7.49, 0 points are added to the patient's score, keeping the total at 6.
The concentration of sodium is 139.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 139.0 mEq. To convert from 139.0 mEq to mmol, convert from mEq to mmol. The compound 139.0 has a valence of 1, and so divide the valence by the value of mEq to get, 139.0 mEq/(1 mEq/mmol) = 139.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 139.0 mEq sodium/L converts to 139.0 mmol sodium/L. Because the patient's sodium level is between 130 and 149 mmol/L, 0 points are added to the patient's score, keeping the total at 6.
The concentration of potassium is 5.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of potassium from mEq to mmol. The mass of potassium is 5.0 mEq. To convert from 5.0 mEq to mmol, convert from mEq to mmol. The compound 5.0 has a valence of 1, and so divide the valence by the value of mEq to get, 5.0 mEq/(1 mEq/mmol) = 5.0 mmol potassium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 5.0 mEq potassium/L converts to 5.0 mmol potassium/L. Because the patient's potassium level is between 3.5 and 5.4 mmol/L, 0 points are added to the patient's score, keeping the total at 6.
The concentration of creatinine is 1.3 mg/dL. The patient is determined to not have an acute renal failure.
The patient is determined to not have a chronic renal failure.
Because the patient's creatinine level is between 0.6 and 1.4, no points are added to the score, keeping the current total at 6.
The patient has a hematocrit of 42.0%.
Because the patient's hematocrit is between 30% and 45%, 0 points are added to the patient's score, keeping the total at 6.
The patient's concentration of white blood cell count is 8000.0 count/µL. To convert 8000.0 count/µL of white blood cell count to L, multiply by the conversion factor 1000000.0 µL/L which will give 8000.0 white blood cell count count/µL * 1000000.0 µL/L = 8000000000.0 white blood cell count count/L. Because the patient's white blood cell count is at least 3x10^9/L, but less than 15 x10^9/L, 0 points are added to the patient's score, keeping the total at 6.
The patient's Glasgow Coma Score is 13. For this criterion, we subtract 15 from the 13 points and add that to the total score. 15 - 13 = 2. Hence, we add 2 to the total making the current total 2 + 6 = 8.
Hence, the patient's APACHE II score is 8."
875,28,APACHE II Score,risk,integer,8,Handwritten,"A 60-year-old male with a history of acute aortic disection which was treated with an emergency surgery in the past, presents to the emergency department with acute symptoms of lethargy and decreased appetite. Physical examination reveals tachycardia to 95 beats per minute, respiratory rate of 19 breaths per minute, blood pressure registering at 135/75 mm Hg and a baseline temperature of 37.2°C. Neurological assessment demonstrates mild confusion, corresponding to a Glasgow Coma Score of 14. Blood tests reveal elevated creatinine levels at 3.8 mg/dL. Metabolic panel showed sodium at 138 and potassium at 4.5 mEq/L. The white blood cell count was 12,000 per µL, triggering concern for a possible infection. Hematocrit was just within normal range at 43%. The patient had an arterial blood gas pH of 7.32 and a A-a-gradient of 364, with a supplementary FiO₂ of 55 %. This patient's acute renal failure symptomatology, alongside the history of severe organ failure and immunocompromised, mandate rigorous monitoring and urgent medical intervention.",What is the patient's APACHE II score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [95.0, 'beats per minute'], 'Diastolic Blood Pressure': [75.0, 'mm Hg'], 'pH': 7.32, 'Systolic Blood Pressure': [135.0, 'mm Hg'], 'Acute renal failure': True, 'History of severe organ failure or immunocompromise': True, 'creatinine': [3.8, 'mg/dL'], 'White blood cell count': [12000.0, 'µL'], 'Sodium': [138.0, 'mEq/L'], 'Potassium': [4.5, 'mEq/L'], 'A-a gradient': 364, 'age': [60.0, 'years'], 'respiratory rate': [19.0, 'breaths per minute'], 'Glasgow Coma Score': 14.0, 'Hematocrit': [43.0, '%'], 'Temperature': [37.2, 'degrees celsius'], 'Surgery Type': 'Emergency', 'FiO2': [55.0, '%']}",17,17,17,"The criteria for the APACHE II Score are listed below:

1. Age, years: ≤44 = 0 points, 45-54 = +2 points, 55-64 = +3 points, 65-74 = +5 points, ≥75 = +6 points
2. History of severe organ insufficiency or immunocompromised: Yes, nonoperative or emergency postoperative patient = +5 points, Yes, elective postoperative patient = +2 points, No = 0 points
3. Rectal temperature, °C: ≥41 = +4 points, 39 to <41 = +3 points, 38.5 to <39 = +1 point, 36 to <38.5 = 0 points, 34 to <36 = +1 point, 32 to <34 = +2 points, 30 to <32 = +3 points, <30 = +4 points
4. Mean arterial pressure, mmHg: ≥160 = +4 points, 130-159 = +3 points, 110-129 = +2 points, 70-109 = 0 points, 50-69 = +2 points, 40-49 = +3 points, <40 = +4 points
5. Heart rate, beats per minute: ≥180 = +4 points, 140 to <180 = +3 points, 110 to <140 = +2 points, 70 to <110 = 0 points, 55 to <70 = +2 points, 40 to <55 = +3 points, <40 = +4 points
6. Respiratory rate, breaths per minute: ≥50 = +4 points, 35 to <50 = +3 points, 25 to <35 = +1 point, 12 to <25 = 0 points, 10 to <12 = +1 point, 6 to <10 = +2 points, <6 = +4 points
7. Oxygenation (use PaO2 if FiO2 <50%, otherwise use Aa gradient): Aa gradient >349 = +4 points, Aa gradient 350-349 = +3 points, Aa gradient 200-349 = +2 points, Aa gradient <200 (if FiO2 over 45%) or PaO2 <70 (if FiO2 less than 50%) = +1 point, PaO2 61-70 = +1 point, PaO2 55-60 = +3 points, PaO2 <55 = +4 points
8. Arterial pH: ≥7.7 = +4 points, 7.60 to <7.70 = +3 points, 7.50 to <7.60 = +1 point, 7.33 to <7.50 = 0 points, 7.25 to <7.33 = +2 points, 7.15 to <7.25 = +3 points, <7.15 = +4 points
9. Serum sodium, mmol/L: ≥180 = +4 points, 160 to <180 = +3 points, 155 to <160 = +2 points, 150 to <155 = +1 point, 130 to <150 = 0 points, 120 to <130 = +2 points, 111 to <120 = +3 points, <111 = +4 points
10. Serum potassium, mmol/L: ≥7.0 = +4 points, 6.0 to <7.0 = +3 points, 5.5 to <6.0 = +1 point, 3.5 to <5.5 = 0 points, 3.0 to <3.5 = +1 point, 2.5 to <3.0 = +2 points, <2.5 = +4 points
11. Serum creatinine, mg/100 mL: ≥3.5 and ACUTE renal failure = +8 points, 2.0 to <3.5 and ACUTE renal failure = +6 points, ≥3.5 and CHRONIC renal failure = +4 points, 1.5 to <2.0 and ACUTE renal failure = +4 points, 2.0 to <3.5 and CHRONIC renal failure = +3 points, 1.5 to <2.0 and CHRONIC renal failure = +2 points, 0.6 to <1.5 = 0 points, <0.6 = +2 points
12. Hematocrit, %: ≥60 = +4 points, 50 to <60 = +2 points, 46 to <50 = +1 point, 30 to <46 = 0 points, 20 to <30 = +2 points, <20 = +4 points
13. White blood count, total/cubic mm in 10^3: ≥40 = +4 points, 20 to <40 = +2 points, 15 to <20 = +1 point, 3 to <15 = 0 points, 1 to <3 = +2 points, <1 = +4 points
14. Glasgow Coma Scale (GCS): 1-15 points (use 15 - [GCS Score])

The total APACHE II score is calculated by summing the points for each criterion.
    
The patient's current APACHE II score is 0 points.
The patient is 60.0 years old. Because the patient's age is between 55 and 64, 3 points are added to the total, making the current total, 0 + 3 = 3.
The patient note does not report any history on immunocompromise and so we assume this to be false. Hence, 0 points are added to the total, keeping the total at 3 points.
The patient's FiO2 percentage is 55.0%.
Because the patent's FiO2 percentrage is greater than 50%, we need to examine the A-a-gradient to compute the APACHE II score. The patient's A-a-gradient is 364. Because the patient's A-a gradient is between 350 and 500, we add 3 points to the total, making the current total 3 + 3 = 6.
The patient's temperature is 37.2 degrees celsius. 
Because the patient's temperature is between 36 and 38.5 degrees celsius, no points are added to the score, keeping the current total at 6.
The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 135.0 mm Hg + 2/3 * 75.0 mm Hg = 95.0 mm Hg.
Hence, the patient's mean arterial pressure is 95.0 mm Hg.Because the patient's mean arterial pressure is between 70 and 109 mmHg, 0 points are added to the patient's score, keeping the total at 6.
The patient's heart rate is 95.0 beats per minute.
Because the patient's heart rate is between 70 and 109 beats per minute, 0 points are added to the patient's score, keeping the total at 6.
The patient's respiratory rate is 19.0 breaths per minute.
Because the patient's respiratory rate is between 12 and 24 breaths per minute, 0 points are added to the patient's score, keeping the total at 6.
The patient's pH is 7.32.
Because the patient's pH is between 7.25 and 7.32, 2 points are added to the score, making the current total 6 + 2 = 8.
The concentration of sodium is 138.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 138.0 mEq. To convert from 138.0 mEq to mmol, convert from mEq to mmol. The compound 138.0 has a valence of 1, and so divide the valence by the value of mEq to get, 138.0 mEq/(1 mEq/mmol) = 138.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 138.0 mEq sodium/L converts to 138.0 mmol sodium/L. Because the patient's sodium level is between 130 and 149 mmol/L, 0 points are added to the patient's score, keeping the total at 8.
The concentration of potassium is 4.5 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of potassium from mEq to mmol. The mass of potassium is 4.5 mEq. To convert from 4.5 mEq to mmol, convert from mEq to mmol. The compound 4.5 has a valence of 1, and so divide the valence by the value of mEq to get, 4.5 mEq/(1 mEq/mmol) = 4.5 mmol potassium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 4.5 mEq potassium/L converts to 4.5 mmol potassium/L. Because the patient's potassium level is between 3.5 and 5.4 mmol/L, 0 points are added to the patient's score, keeping the total at 8.
The concentration of creatinine is 3.8 mg/dL. The patient is determined to have an acute renal failure.
The patient is determined to not have a chronic renal failure.
Because the patient has acute renal failure and a creatinine level above 3.5, 8 points are added to the score, making the current total 8 + 8 = 16.
The patient has a hematocrit of 43.0%.
Because the patient's hematocrit is between 30% and 45%, 0 points are added to the patient's score, keeping the total at 16.
The patient's concentration of white blood cell count is 12000.0 count/µL. To convert 12000.0 count/µL of white blood cell count to L, multiply by the conversion factor 1000000.0 µL/L which will give 12000.0 white blood cell count count/µL * 1000000.0 µL/L = 12000000000.0 white blood cell count count/L. Because the patient's white blood cell count is at least 3x10^9/L, but less than 15 x10^9/L, 0 points are added to the patient's score, keeping the total at 16.
The patient's Glasgow Coma Score is 14. For this criterion, we subtract 15 from the 14 points and add that to the total score. 15 - 14 = 1. Hence, we add 1 to the total making the current total 1 + 16 = 17.
Hence, the patient's APACHE II score is 17."
876,28,APACHE II Score,risk,integer,9,Handwritten,"A 67-year-old patient is admitted to the hospital with fever, shortness of breath, and rapid heart rate. Initial examination uncovers a temperature of 38.7 degrees celsius, heart rate of 105 beats per minute, breathing rate at 22 breaths per minute, and a blood pressure of 138/82 mm Hg. The patient's Glasgow Coma Score is assessed at 13. Comprehensive lab testing creatinine at 2.5 mg/dL. The white blood cell count is noted at 10,000 per µL, further raising suspicion for systemic infection. The patient's sodium and potassium levels remain within normal ranges at 142 mEq/L and 4.7 mEq/L, respectively. Arterial blood gas analysis indicates a pH of 7.33 along with an A-a-gradient of 473, while receiving a FiO2 of 50 %. Hematocrit measures 41 %. Given the current symptoms of infection and the possible occurrence of acute renal failure, the patient will likely require prompt antibiotic therapy and renal supportive care.",What is the patient's APACHE II score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [105.0, 'beats per minute'], 'Diastolic Blood Pressure': [82.0, 'mm Hg'], 'pH': 7.33, 'Systolic Blood Pressure': [138.0, 'mm Hg'], 'Acute renal failure': True, 'creatinine': [2.5, 'mg/dL'], 'White blood cell count': [10000.0, 'µL'], 'Sodium': [142.0, 'mEq/L'], 'Potassium': [4.7, 'mEq/L'], 'A-a gradient': 473, 'age': [67.0, 'years'], 'respiratory rate': [22.0, 'breaths per minute'], 'Glasgow Coma Score': 13.0, 'Hematocrit': [41.0, '%'], 'Temperature': [38.7, 'degrees celsius'], 'FiO2': [50.0, '%']}",17,17,17,"The criteria for the APACHE II Score are listed below:

1. Age, years: ≤44 = 0 points, 45-54 = +2 points, 55-64 = +3 points, 65-74 = +5 points, ≥75 = +6 points
2. History of severe organ insufficiency or immunocompromised: Yes, nonoperative or emergency postoperative patient = +5 points, Yes, elective postoperative patient = +2 points, No = 0 points
3. Rectal temperature, °C: ≥41 = +4 points, 39 to <41 = +3 points, 38.5 to <39 = +1 point, 36 to <38.5 = 0 points, 34 to <36 = +1 point, 32 to <34 = +2 points, 30 to <32 = +3 points, <30 = +4 points
4. Mean arterial pressure, mmHg: ≥160 = +4 points, 130-159 = +3 points, 110-129 = +2 points, 70-109 = 0 points, 50-69 = +2 points, 40-49 = +3 points, <40 = +4 points
5. Heart rate, beats per minute: ≥180 = +4 points, 140 to <180 = +3 points, 110 to <140 = +2 points, 70 to <110 = 0 points, 55 to <70 = +2 points, 40 to <55 = +3 points, <40 = +4 points
6. Respiratory rate, breaths per minute: ≥50 = +4 points, 35 to <50 = +3 points, 25 to <35 = +1 point, 12 to <25 = 0 points, 10 to <12 = +1 point, 6 to <10 = +2 points, <6 = +4 points
7. Oxygenation (use PaO2 if FiO2 <50%, otherwise use Aa gradient): Aa gradient >349 = +4 points, Aa gradient 350-349 = +3 points, Aa gradient 200-349 = +2 points, Aa gradient <200 (if FiO2 over 45%) or PaO2 <70 (if FiO2 less than 50%) = +1 point, PaO2 61-70 = +1 point, PaO2 55-60 = +3 points, PaO2 <55 = +4 points
8. Arterial pH: ≥7.7 = +4 points, 7.60 to <7.70 = +3 points, 7.50 to <7.60 = +1 point, 7.33 to <7.50 = 0 points, 7.25 to <7.33 = +2 points, 7.15 to <7.25 = +3 points, <7.15 = +4 points
9. Serum sodium, mmol/L: ≥180 = +4 points, 160 to <180 = +3 points, 155 to <160 = +2 points, 150 to <155 = +1 point, 130 to <150 = 0 points, 120 to <130 = +2 points, 111 to <120 = +3 points, <111 = +4 points
10. Serum potassium, mmol/L: ≥7.0 = +4 points, 6.0 to <7.0 = +3 points, 5.5 to <6.0 = +1 point, 3.5 to <5.5 = 0 points, 3.0 to <3.5 = +1 point, 2.5 to <3.0 = +2 points, <2.5 = +4 points
11. Serum creatinine, mg/100 mL: ≥3.5 and ACUTE renal failure = +8 points, 2.0 to <3.5 and ACUTE renal failure = +6 points, ≥3.5 and CHRONIC renal failure = +4 points, 1.5 to <2.0 and ACUTE renal failure = +4 points, 2.0 to <3.5 and CHRONIC renal failure = +3 points, 1.5 to <2.0 and CHRONIC renal failure = +2 points, 0.6 to <1.5 = 0 points, <0.6 = +2 points
12. Hematocrit, %: ≥60 = +4 points, 50 to <60 = +2 points, 46 to <50 = +1 point, 30 to <46 = 0 points, 20 to <30 = +2 points, <20 = +4 points
13. White blood count, total/cubic mm in 10^3: ≥40 = +4 points, 20 to <40 = +2 points, 15 to <20 = +1 point, 3 to <15 = 0 points, 1 to <3 = +2 points, <1 = +4 points
14. Glasgow Coma Scale (GCS): 1-15 points (use 15 - [GCS Score])

The total APACHE II score is calculated by summing the points for each criterion.
    
The patient's current APACHE II score is 0 points.
The patient is 67.0 years old. Because the patient's age is between 65 and 74, 5 points are added to the total, making the current total, 0 + 5 = 5.
The patient note does not report any history on immunocompromise and so we assume this to be false. Hence, 0 points are added to the total, keeping the total at 5 points.
The patient's FiO2 percentage is 50.0%.
Because the patent's FiO2 percentrage is greater than 50%, we need to examine the A-a-gradient to compute the APACHE II score. The patient's A-a-gradient is 473. Because the patient's A-a gradient is between 350 and 500, we add 3 points to the total, making the current total 5 + 3 = 8.
The patient's temperature is 38.7 degrees celsius. 
Because the patient's temperature is between 38.5 and 39 degrees celsius, 1 point is added to the score, making the current total, 8 + 1 = 9.
The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 138.0 mm Hg + 2/3 * 82.0 mm Hg = 100.667 mm Hg.
Hence, the patient's mean arterial pressure is 100.667 mm Hg.Because the patient's mean arterial pressure is between 70 and 109 mmHg, 0 points are added to the patient's score, keeping the total at 9.
The patient's heart rate is 105.0 beats per minute.
Because the patient's heart rate is between 70 and 109 beats per minute, 0 points are added to the patient's score, keeping the total at 9.
The patient's respiratory rate is 22.0 breaths per minute.
Because the patient's respiratory rate is between 12 and 24 breaths per minute, 0 points are added to the patient's score, keeping the total at 9.
The patient's pH is 7.33.
Because the patient's pH is between 7.33 and 7.49, 0 points are added to the patient's score, keeping the total at 9.
The concentration of sodium is 142.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 142.0 mEq. To convert from 142.0 mEq to mmol, convert from mEq to mmol. The compound 142.0 has a valence of 1, and so divide the valence by the value of mEq to get, 142.0 mEq/(1 mEq/mmol) = 142.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 142.0 mEq sodium/L converts to 142.0 mmol sodium/L. Because the patient's sodium level is between 130 and 149 mmol/L, 0 points are added to the patient's score, keeping the total at 9.
The concentration of potassium is 4.7 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of potassium from mEq to mmol. The mass of potassium is 4.7 mEq. To convert from 4.7 mEq to mmol, convert from mEq to mmol. The compound 4.7 has a valence of 1, and so divide the valence by the value of mEq to get, 4.7 mEq/(1 mEq/mmol) = 4.7 mmol potassium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 4.7 mEq potassium/L converts to 4.7 mmol potassium/L. Because the patient's potassium level is between 3.5 and 5.4 mmol/L, 0 points are added to the patient's score, keeping the total at 9.
The concentration of creatinine is 2.5 mg/dL. The patient is determined to have an acute renal failure.
The patient is determined to not have a chronic renal failure.
Because the patient has acute renal failure and a creatinine level between 2.0 and 3.5, 6 points are added to the score, making the current total 9 + 6 = 15.
The patient has a hematocrit of 41.0%.
Because the patient's hematocrit is between 30% and 45%, 0 points are added to the patient's score, keeping the total at 15.
The patient's concentration of white blood cell count is 10000.0 count/µL. To convert 10000.0 count/µL of white blood cell count to L, multiply by the conversion factor 1000000.0 µL/L which will give 10000.0 white blood cell count count/µL * 1000000.0 µL/L = 10000000000.0 white blood cell count count/L. Because the patient's white blood cell count is at least 3x10^9/L, but less than 15 x10^9/L, 0 points are added to the patient's score, keeping the total at 15.
The patient's Glasgow Coma Score is 13. For this criterion, we subtract 15 from the 13 points and add that to the total score. 15 - 13 = 2. Hence, we add 2 to the total making the current total 2 + 15 = 17.
Hence, the patient's APACHE II score is 17."
877,28,APACHE II Score,risk,integer,10,Handwritten,"A 55-year-old female with no significant past medical history presented to the clinic for a routine check-up. Physical examination findings included a body temperature of 36.8 degrees Celsius, a heart rate of 98 beats per minute, a respiratory rate of 20 breaths per minute, and a blood pressure of 128/76 mm Hg. The patient is alert and responds appropriately to environmental stimuli, with a Glasgow Coma Score measured at 15. Laboratory results revealed an elevated creatinine level of 1.6 mg/dL, consistent with acute renal failure not requiring dialysis. The patient’s pH was within normal limits at 7.41, and their white blood cell count was 9,000 per µL. Electrolyte levels are stable, with sodium at 141 mEq/L and potassium at 4.6 mEq/L. Regarding pulmonary function, the patient is managing an A-a gradient of 430 while on 52% FiO₂, which reflects significant impairment in oxygen exchange. Hematocrit stands at a normal 40%. Given the observed acute renal failure, close monitoring of kidney function and evaluation for underlying causes are recommended. The elevated A-a gradient also warrants further investigation to assess for potential pulmonary or cardiopulmonary issues.",What is the patient's APACHE II score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [98.0, 'beats per minute'], 'Diastolic Blood Pressure': [76.0, 'mm Hg'], 'Systolic Blood Pressure': [128.0, 'mm Hg'], 'History of severe organ failure or immunocompromise': False, 'creatinine': [1.6, 'mg/dL'], 'White blood cell count': [9000.0, 'µL'], 'Sodium': [141.0, 'mEq/L'], 'Potassium': [4.6, 'mEq/L'], 'A-a gradient': 430, 'age': [55.0, 'years'], 'respiratory rate': [20.0, 'breaths per minute'], 'Acute renal failure': True, 'Glasgow Coma Score': 15.0, 'Hematocrit': [40.0, '%'], 'Temperature': [36.8, 'degrees celsius'], 'pH': 7.41, 'FiO2': [52.0, '%']}",10,10,10,"The criteria for the APACHE II Score are listed below:

1. Age, years: ≤44 = 0 points, 45-54 = +2 points, 55-64 = +3 points, 65-74 = +5 points, ≥75 = +6 points
2. History of severe organ insufficiency or immunocompromised: Yes, nonoperative or emergency postoperative patient = +5 points, Yes, elective postoperative patient = +2 points, No = 0 points
3. Rectal temperature, °C: ≥41 = +4 points, 39 to <41 = +3 points, 38.5 to <39 = +1 point, 36 to <38.5 = 0 points, 34 to <36 = +1 point, 32 to <34 = +2 points, 30 to <32 = +3 points, <30 = +4 points
4. Mean arterial pressure, mmHg: ≥160 = +4 points, 130-159 = +3 points, 110-129 = +2 points, 70-109 = 0 points, 50-69 = +2 points, 40-49 = +3 points, <40 = +4 points
5. Heart rate, beats per minute: ≥180 = +4 points, 140 to <180 = +3 points, 110 to <140 = +2 points, 70 to <110 = 0 points, 55 to <70 = +2 points, 40 to <55 = +3 points, <40 = +4 points
6. Respiratory rate, breaths per minute: ≥50 = +4 points, 35 to <50 = +3 points, 25 to <35 = +1 point, 12 to <25 = 0 points, 10 to <12 = +1 point, 6 to <10 = +2 points, <6 = +4 points
7. Oxygenation (use PaO2 if FiO2 <50%, otherwise use Aa gradient): Aa gradient >349 = +4 points, Aa gradient 350-349 = +3 points, Aa gradient 200-349 = +2 points, Aa gradient <200 (if FiO2 over 45%) or PaO2 <70 (if FiO2 less than 50%) = +1 point, PaO2 61-70 = +1 point, PaO2 55-60 = +3 points, PaO2 <55 = +4 points
8. Arterial pH: ≥7.7 = +4 points, 7.60 to <7.70 = +3 points, 7.50 to <7.60 = +1 point, 7.33 to <7.50 = 0 points, 7.25 to <7.33 = +2 points, 7.15 to <7.25 = +3 points, <7.15 = +4 points
9. Serum sodium, mmol/L: ≥180 = +4 points, 160 to <180 = +3 points, 155 to <160 = +2 points, 150 to <155 = +1 point, 130 to <150 = 0 points, 120 to <130 = +2 points, 111 to <120 = +3 points, <111 = +4 points
10. Serum potassium, mmol/L: ≥7.0 = +4 points, 6.0 to <7.0 = +3 points, 5.5 to <6.0 = +1 point, 3.5 to <5.5 = 0 points, 3.0 to <3.5 = +1 point, 2.5 to <3.0 = +2 points, <2.5 = +4 points
11. Serum creatinine, mg/100 mL: ≥3.5 and ACUTE renal failure = +8 points, 2.0 to <3.5 and ACUTE renal failure = +6 points, ≥3.5 and CHRONIC renal failure = +4 points, 1.5 to <2.0 and ACUTE renal failure = +4 points, 2.0 to <3.5 and CHRONIC renal failure = +3 points, 1.5 to <2.0 and CHRONIC renal failure = +2 points, 0.6 to <1.5 = 0 points, <0.6 = +2 points
12. Hematocrit, %: ≥60 = +4 points, 50 to <60 = +2 points, 46 to <50 = +1 point, 30 to <46 = 0 points, 20 to <30 = +2 points, <20 = +4 points
13. White blood count, total/cubic mm in 10^3: ≥40 = +4 points, 20 to <40 = +2 points, 15 to <20 = +1 point, 3 to <15 = 0 points, 1 to <3 = +2 points, <1 = +4 points
14. Glasgow Coma Scale (GCS): 1-15 points (use 15 - [GCS Score])

The total APACHE II score is calculated by summing the points for each criterion.
    
The patient's current APACHE II score is 0 points.
The patient is 55.0 years old. Because the patient's age is between 55 and 64, 3 points are added to the total, making the current total, 0 + 3 = 3.
The patient note does not report any history on immunocompromise and so we assume this to be false. Hence, 0 points are added to the total, keeping the total at 3 points.
The patient's FiO2 percentage is 52.0%.
Because the patent's FiO2 percentrage is greater than 50%, we need to examine the A-a-gradient to compute the APACHE II score. The patient's A-a-gradient is 430. Because the patient's A-a gradient is between 350 and 500, we add 3 points to the total, making the current total 3 + 3 = 6.
The patient's temperature is 36.8 degrees celsius. 
Because the patient's temperature is between 36 and 38.5 degrees celsius, no points are added to the score, keeping the current total at 6.
The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 128.0 mm Hg + 2/3 * 76.0 mm Hg = 93.333 mm Hg.
Hence, the patient's mean arterial pressure is 93.333 mm Hg.Because the patient's mean arterial pressure is between 70 and 109 mmHg, 0 points are added to the patient's score, keeping the total at 6.
The patient's heart rate is 98.0 beats per minute.
Because the patient's heart rate is between 70 and 109 beats per minute, 0 points are added to the patient's score, keeping the total at 6.
The patient's respiratory rate is 20.0 breaths per minute.
Because the patient's respiratory rate is between 12 and 24 breaths per minute, 0 points are added to the patient's score, keeping the total at 6.
The patient's pH is 7.41.
Because the patient's pH is between 7.33 and 7.49, 0 points are added to the patient's score, keeping the total at 6.
The concentration of sodium is 141.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 141.0 mEq. To convert from 141.0 mEq to mmol, convert from mEq to mmol. The compound 141.0 has a valence of 1, and so divide the valence by the value of mEq to get, 141.0 mEq/(1 mEq/mmol) = 141.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 141.0 mEq sodium/L converts to 141.0 mmol sodium/L. Because the patient's sodium level is between 130 and 149 mmol/L, 0 points are added to the patient's score, keeping the total at 6.
The concentration of potassium is 4.6 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of potassium from mEq to mmol. The mass of potassium is 4.6 mEq. To convert from 4.6 mEq to mmol, convert from mEq to mmol. The compound 4.6 has a valence of 1, and so divide the valence by the value of mEq to get, 4.6 mEq/(1 mEq/mmol) = 4.6 mmol potassium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 4.6 mEq potassium/L converts to 4.6 mmol potassium/L. Because the patient's potassium level is between 3.5 and 5.4 mmol/L, 0 points are added to the patient's score, keeping the total at 6.
The concentration of creatinine is 1.6 mg/dL. The patient is determined to have an acute renal failure.
The patient is determined to not have a chronic renal failure.
Because the patient has acute renal failure and a creatinine level between 1.5 and 2.0, 4 points are added to the score, making the current total 6 + 4 = 10.
The patient has a hematocrit of 40.0%.
Because the patient's hematocrit is between 30% and 45%, 0 points are added to the patient's score, keeping the total at 10.
The patient's concentration of white blood cell count is 9000.0 count/µL. To convert 9000.0 count/µL of white blood cell count to L, multiply by the conversion factor 1000000.0 µL/L which will give 9000.0 white blood cell count count/µL * 1000000.0 µL/L = 9000000000.0 white blood cell count count/L. Because the patient's white blood cell count is at least 3x10^9/L, but less than 15 x10^9/L, 0 points are added to the patient's score, keeping the total at 10.
The patient's Glasgow Coma Score is 15. For this criterion, we subtract 15 from the 15 points and add that to the total score. 15 - 15 = 0. Hence, we add 0 to the total making the current total 0 + 10 = 10.
Hence, the patient's APACHE II score is 10."
878,28,APACHE II Score,risk,integer,11,Handwritten,"A 70-year-old male with chronic kidney disease stage II attended the clinic accompanied by family members, citing sporadic moments of agitation and disorientation. The initial evaluation established a high heart rate at 115 beats per minute, a blood pressure of 125/90 mm Hg, and a respiration rate of 18 breaths per minute. His body temperature is registered at 37.4 degrees celsius. Regarding neurological status, the Glasgow Coma Score was tallied at 14, with 1 point for minor confusion. Laboratory studies showed a sodium concentration of 145 mEq/L, potassium at 4.2 mEq/L, and a creatinine level of 2.0 mg/dL. The reported white blood cell count was 11,000 per µL, while the hematocrit was slightly low at 37 %. Arterial blood gas values demonstrated a decreased pH of 7.28, however, the patient was maintaining a PaO2 of 80 mmHg on 40 % FiO2. Due to both the patient's age and the observed clinical abnormalities, comprehensive investigations are warranted to rule out any possible underlying conditions.",What is the patient's APACHE II score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [115.0, 'beats per minute'], 'Diastolic Blood Pressure': [90.0, 'mm Hg'], 'pH': 7.28, 'Systolic Blood Pressure': [125.0, 'mm Hg'], 'creatinine': [2.0, 'mg/dL'], 'White blood cell count': [11000.0, 'µL'], 'Sodium': [145.0, 'mEq/L'], 'Potassium': [4.2, 'mEq/L'], 'age': [70.0, 'years'], 'respiratory rate': [18.0, 'breaths per minute'], 'Chronic renal failure': True, 'Glasgow Coma Score': 14.0, 'Hematocrit': [37.0, '%'], 'Temperature': [37.4, 'degrees celsius'], 'PaO2': [80.0, 'mm Hg'], 'FiO2': [40.0, '%']}",13,13,13,"The criteria for the APACHE II Score are listed below:

1. Age, years: ≤44 = 0 points, 45-54 = +2 points, 55-64 = +3 points, 65-74 = +5 points, ≥75 = +6 points
2. History of severe organ insufficiency or immunocompromised: Yes, nonoperative or emergency postoperative patient = +5 points, Yes, elective postoperative patient = +2 points, No = 0 points
3. Rectal temperature, °C: ≥41 = +4 points, 39 to <41 = +3 points, 38.5 to <39 = +1 point, 36 to <38.5 = 0 points, 34 to <36 = +1 point, 32 to <34 = +2 points, 30 to <32 = +3 points, <30 = +4 points
4. Mean arterial pressure, mmHg: ≥160 = +4 points, 130-159 = +3 points, 110-129 = +2 points, 70-109 = 0 points, 50-69 = +2 points, 40-49 = +3 points, <40 = +4 points
5. Heart rate, beats per minute: ≥180 = +4 points, 140 to <180 = +3 points, 110 to <140 = +2 points, 70 to <110 = 0 points, 55 to <70 = +2 points, 40 to <55 = +3 points, <40 = +4 points
6. Respiratory rate, breaths per minute: ≥50 = +4 points, 35 to <50 = +3 points, 25 to <35 = +1 point, 12 to <25 = 0 points, 10 to <12 = +1 point, 6 to <10 = +2 points, <6 = +4 points
7. Oxygenation (use PaO2 if FiO2 <50%, otherwise use Aa gradient): Aa gradient >349 = +4 points, Aa gradient 350-349 = +3 points, Aa gradient 200-349 = +2 points, Aa gradient <200 (if FiO2 over 45%) or PaO2 <70 (if FiO2 less than 50%) = +1 point, PaO2 61-70 = +1 point, PaO2 55-60 = +3 points, PaO2 <55 = +4 points
8. Arterial pH: ≥7.7 = +4 points, 7.60 to <7.70 = +3 points, 7.50 to <7.60 = +1 point, 7.33 to <7.50 = 0 points, 7.25 to <7.33 = +2 points, 7.15 to <7.25 = +3 points, <7.15 = +4 points
9. Serum sodium, mmol/L: ≥180 = +4 points, 160 to <180 = +3 points, 155 to <160 = +2 points, 150 to <155 = +1 point, 130 to <150 = 0 points, 120 to <130 = +2 points, 111 to <120 = +3 points, <111 = +4 points
10. Serum potassium, mmol/L: ≥7.0 = +4 points, 6.0 to <7.0 = +3 points, 5.5 to <6.0 = +1 point, 3.5 to <5.5 = 0 points, 3.0 to <3.5 = +1 point, 2.5 to <3.0 = +2 points, <2.5 = +4 points
11. Serum creatinine, mg/100 mL: ≥3.5 and ACUTE renal failure = +8 points, 2.0 to <3.5 and ACUTE renal failure = +6 points, ≥3.5 and CHRONIC renal failure = +4 points, 1.5 to <2.0 and ACUTE renal failure = +4 points, 2.0 to <3.5 and CHRONIC renal failure = +3 points, 1.5 to <2.0 and CHRONIC renal failure = +2 points, 0.6 to <1.5 = 0 points, <0.6 = +2 points
12. Hematocrit, %: ≥60 = +4 points, 50 to <60 = +2 points, 46 to <50 = +1 point, 30 to <46 = 0 points, 20 to <30 = +2 points, <20 = +4 points
13. White blood count, total/cubic mm in 10^3: ≥40 = +4 points, 20 to <40 = +2 points, 15 to <20 = +1 point, 3 to <15 = 0 points, 1 to <3 = +2 points, <1 = +4 points
14. Glasgow Coma Scale (GCS): 1-15 points (use 15 - [GCS Score])

The total APACHE II score is calculated by summing the points for each criterion.
    
The patient's current APACHE II score is 0 points.
The patient is 70.0 years old. Because the patient's age is between 65 and 74, 5 points are added to the total, making the current total, 0 + 5 = 5.
The patient note does not report any history on immunocompromise and so we assume this to be false. Hence, 0 points are added to the total, keeping the total at 5 points.
The patient's FiO2 percentage is 40.0%.
Because the patent's FiO2 percentrage is less than 50%, we need to examine the patient's A-a-gradient to compute the APACHE II score. The patient's partial pressure of oxygen is 80.0 mm Hg. Because the patient's partial pressure of oxygen is more than 70 mm Hg, we do not add any points to the total, keeing the current total at 5.
The patient's temperature is 37.4 degrees celsius. 
Because the patient's temperature is between 36 and 38.5 degrees celsius, no points are added to the score, keeping the current total at 5.
The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 125.0 mm Hg + 2/3 * 90.0 mm Hg = 101.667 mm Hg.
Hence, the patient's mean arterial pressure is 101.667 mm Hg.Because the patient's mean arterial pressure is between 70 and 109 mmHg, 0 points are added to the patient's score, keeping the total at 5.
The patient's heart rate is 115.0 beats per minute.
Because the patient's heart rate is between 110 and 139 beats per minute, 2 points are added to the score, making the current total, 5 + 2 = 7.
The patient's respiratory rate is 18.0 breaths per minute.
Because the patient's respiratory rate is between 12 and 24 breaths per minute, 0 points are added to the patient's score, keeping the total at 7.
The patient's pH is 7.28.
Because the patient's pH is between 7.25 and 7.32, 2 points are added to the score, making the current total 7 + 2 = 9.
The concentration of sodium is 145.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 145.0 mEq. To convert from 145.0 mEq to mmol, convert from mEq to mmol. The compound 145.0 has a valence of 1, and so divide the valence by the value of mEq to get, 145.0 mEq/(1 mEq/mmol) = 145.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 145.0 mEq sodium/L converts to 145.0 mmol sodium/L. Because the patient's sodium level is between 130 and 149 mmol/L, 0 points are added to the patient's score, keeping the total at 9.
The concentration of potassium is 4.2 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of potassium from mEq to mmol. The mass of potassium is 4.2 mEq. To convert from 4.2 mEq to mmol, convert from mEq to mmol. The compound 4.2 has a valence of 1, and so divide the valence by the value of mEq to get, 4.2 mEq/(1 mEq/mmol) = 4.2 mmol potassium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 4.2 mEq potassium/L converts to 4.2 mmol potassium/L. Because the patient's potassium level is between 3.5 and 5.4 mmol/L, 0 points are added to the patient's score, keeping the total at 9.
The concentration of creatinine is 2.0 mg/dL. The patient is determined to not have an acute renal failure.
The patient is determined to have a chronic renal failure.
Because the patient has chronic renal failure and a creatinine level between 2.0 and 3.5, 3 points are added to the score, making the current total 9 + 3 = 12.
The patient has a hematocrit of 37.0%.
Because the patient's hematocrit is between 30% and 45%, 0 points are added to the patient's score, keeping the total at 12.
The patient's concentration of white blood cell count is 11000.0 count/µL. To convert 11000.0 count/µL of white blood cell count to L, multiply by the conversion factor 1000000.0 µL/L which will give 11000.0 white blood cell count count/µL * 1000000.0 µL/L = 11000000000.0 white blood cell count count/L. Because the patient's white blood cell count is at least 3x10^9/L, but less than 15 x10^9/L, 0 points are added to the patient's score, keeping the total at 12.
The patient's Glasgow Coma Score is 14. For this criterion, we subtract 15 from the 14 points and add that to the total score. 15 - 14 = 1. Hence, we add 1 to the total making the current total 1 + 12 = 13.
Hence, the patient's APACHE II score is 13."
879,28,APACHE II Score,risk,integer,12,Handwritten,"A 63-year-old female presents to herself to the emergency department, due to a high blood pressure, pulse rate, and breathing rate. Upon physical examination, the patient was found to have a normal temperature of 36.6 degrees celsius, a pulse that reads 129 beats per minute, a breathing rate of 32 respirations per minute, and a blood pressure of 150/95 mmHg. The patient’s mental status was determined to be fully alert with a Glasgow Coma Score of 15. Lab studies show a creatinine level at 1.1 mg/dL. The patient's white blood cell count was also documented as within the normal range, at 6500 cells per µL. Sodium is measured at 140 and potassium at 4.4 mEq/L. The patient's FiO2 was reported as 46%. Arterial blood gas analysis demonstrates a pH of 7.36 and the patient has a recorded PaO2 of 74 mmHg. The patient’s hematocrit value is at 38%. ",What is the patient's APACHE II score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [129.0, 'beats per minute'], 'Diastolic Blood Pressure': [95.0, 'mm Hg'], 'pH': 7.36, 'Systolic Blood Pressure': [150.0, 'mm Hg'], 'creatinine': [1.1, 'mg/dL'], 'White blood cell count': [6500.0, 'µL'], 'Sodium': [140.0, 'mEq/L'], 'Potassium': [4.4, 'mEq/L'], 'PaO2': [74.0, 'mm Hg'], 'age': [63.0, 'years'], 'respiratory rate': [32.0, 'breaths per minute'], 'Glasgow Coma Score': 15.0, 'Hematocrit': [38.0, '%'], 'Temperature': [36.6, 'degrees celsius'], 'FiO2': [46, '%']}",8,8,8,"The criteria for the APACHE II Score are listed below:

1. Age, years: ≤44 = 0 points, 45-54 = +2 points, 55-64 = +3 points, 65-74 = +5 points, ≥75 = +6 points
2. History of severe organ insufficiency or immunocompromised: Yes, nonoperative or emergency postoperative patient = +5 points, Yes, elective postoperative patient = +2 points, No = 0 points
3. Rectal temperature, °C: ≥41 = +4 points, 39 to <41 = +3 points, 38.5 to <39 = +1 point, 36 to <38.5 = 0 points, 34 to <36 = +1 point, 32 to <34 = +2 points, 30 to <32 = +3 points, <30 = +4 points
4. Mean arterial pressure, mmHg: ≥160 = +4 points, 130-159 = +3 points, 110-129 = +2 points, 70-109 = 0 points, 50-69 = +2 points, 40-49 = +3 points, <40 = +4 points
5. Heart rate, beats per minute: ≥180 = +4 points, 140 to <180 = +3 points, 110 to <140 = +2 points, 70 to <110 = 0 points, 55 to <70 = +2 points, 40 to <55 = +3 points, <40 = +4 points
6. Respiratory rate, breaths per minute: ≥50 = +4 points, 35 to <50 = +3 points, 25 to <35 = +1 point, 12 to <25 = 0 points, 10 to <12 = +1 point, 6 to <10 = +2 points, <6 = +4 points
7. Oxygenation (use PaO2 if FiO2 <50%, otherwise use Aa gradient): Aa gradient >349 = +4 points, Aa gradient 350-349 = +3 points, Aa gradient 200-349 = +2 points, Aa gradient <200 (if FiO2 over 45%) or PaO2 <70 (if FiO2 less than 50%) = +1 point, PaO2 61-70 = +1 point, PaO2 55-60 = +3 points, PaO2 <55 = +4 points
8. Arterial pH: ≥7.7 = +4 points, 7.60 to <7.70 = +3 points, 7.50 to <7.60 = +1 point, 7.33 to <7.50 = 0 points, 7.25 to <7.33 = +2 points, 7.15 to <7.25 = +3 points, <7.15 = +4 points
9. Serum sodium, mmol/L: ≥180 = +4 points, 160 to <180 = +3 points, 155 to <160 = +2 points, 150 to <155 = +1 point, 130 to <150 = 0 points, 120 to <130 = +2 points, 111 to <120 = +3 points, <111 = +4 points
10. Serum potassium, mmol/L: ≥7.0 = +4 points, 6.0 to <7.0 = +3 points, 5.5 to <6.0 = +1 point, 3.5 to <5.5 = 0 points, 3.0 to <3.5 = +1 point, 2.5 to <3.0 = +2 points, <2.5 = +4 points
11. Serum creatinine, mg/100 mL: ≥3.5 and ACUTE renal failure = +8 points, 2.0 to <3.5 and ACUTE renal failure = +6 points, ≥3.5 and CHRONIC renal failure = +4 points, 1.5 to <2.0 and ACUTE renal failure = +4 points, 2.0 to <3.5 and CHRONIC renal failure = +3 points, 1.5 to <2.0 and CHRONIC renal failure = +2 points, 0.6 to <1.5 = 0 points, <0.6 = +2 points
12. Hematocrit, %: ≥60 = +4 points, 50 to <60 = +2 points, 46 to <50 = +1 point, 30 to <46 = 0 points, 20 to <30 = +2 points, <20 = +4 points
13. White blood count, total/cubic mm in 10^3: ≥40 = +4 points, 20 to <40 = +2 points, 15 to <20 = +1 point, 3 to <15 = 0 points, 1 to <3 = +2 points, <1 = +4 points
14. Glasgow Coma Scale (GCS): 1-15 points (use 15 - [GCS Score])

The total APACHE II score is calculated by summing the points for each criterion.
    
The patient's current APACHE II score is 0 points.
The patient is 63.0 years old. Because the patient's age is between 55 and 64, 3 points are added to the total, making the current total, 0 + 3 = 3.
The patient note does not report any history on immunocompromise and so we assume this to be false. Hence, 0 points are added to the total, keeping the total at 3 points.
The patient's FiO2 percentage is 46%.
Because the patent's FiO2 percentrage is less than 50%, we need to examine the patient's A-a-gradient to compute the APACHE II score. The patient's partial pressure of oxygen is 74.0 mm Hg. Because the patient's partial pressure of oxygen is more than 70 mm Hg, we do not add any points to the total, keeing the current total at 3.
The patient's temperature is 36.6 degrees celsius. 
Because the patient's temperature is between 36 and 38.5 degrees celsius, no points are added to the score, keeping the current total at 3.
The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 150.0 mm Hg + 2/3 * 95.0 mm Hg = 113.333 mm Hg.
Hence, the patient's mean arterial pressure is 113.333 mm Hg.Because the patient's mean arterial pressure is between 110 and 129 mmHg, 2 points are added to the score, making the current total, 3 + 2 = 5.
The patient's heart rate is 129.0 beats per minute.
Because the patient's heart rate is between 110 and 139 beats per minute, 2 points are added to the score, making the current total, 5 + 2 = 7.
The patient's respiratory rate is 32.0 breaths per minute.
Because the patient's respiratory rate is between 25 and 34 breaths per minute, 1 point is added to the score, making the current total, 7 + 1 = 8.
The patient's pH is 7.36.
Because the patient's pH is between 7.33 and 7.49, 0 points are added to the patient's score, keeping the total at 8.
The concentration of sodium is 140.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 140.0 mEq. To convert from 140.0 mEq to mmol, convert from mEq to mmol. The compound 140.0 has a valence of 1, and so divide the valence by the value of mEq to get, 140.0 mEq/(1 mEq/mmol) = 140.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 140.0 mEq sodium/L converts to 140.0 mmol sodium/L. Because the patient's sodium level is between 130 and 149 mmol/L, 0 points are added to the patient's score, keeping the total at 8.
The concentration of potassium is 4.4 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of potassium from mEq to mmol. The mass of potassium is 4.4 mEq. To convert from 4.4 mEq to mmol, convert from mEq to mmol. The compound 4.4 has a valence of 1, and so divide the valence by the value of mEq to get, 4.4 mEq/(1 mEq/mmol) = 4.4 mmol potassium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 4.4 mEq potassium/L converts to 4.4 mmol potassium/L. Because the patient's potassium level is between 3.5 and 5.4 mmol/L, 0 points are added to the patient's score, keeping the total at 8.
The concentration of creatinine is 1.1 mg/dL. The patient is determined to not have an acute renal failure.
The patient is determined to not have a chronic renal failure.
Because the patient's creatinine level is between 0.6 and 1.4, no points are added to the score, keeping the current total at 8.
The patient has a hematocrit of 38.0%.
Because the patient's hematocrit is between 30% and 45%, 0 points are added to the patient's score, keeping the total at 8.
The patient's concentration of white blood cell count is 6500.0 count/µL. To convert 6500.0 count/µL of white blood cell count to L, multiply by the conversion factor 1000000.0 µL/L which will give 6500.0 white blood cell count count/µL * 1000000.0 µL/L = 6500000000.0 white blood cell count count/L. Because the patient's white blood cell count is at least 3x10^9/L, but less than 15 x10^9/L, 0 points are added to the patient's score, keeping the total at 8.
The patient's Glasgow Coma Score is 15. For this criterion, we subtract 15 from the 15 points and add that to the total score. 15 - 15 = 0. Hence, we add 0 to the total making the current total 0 + 8 = 8.
Hence, the patient's APACHE II score is 8."
880,28,APACHE II Score,risk,integer,13,Handwritten,"A 56-year-old male with chronic kidney disease stage II presents to the clinic for routine follow-up. On physical examination, temperature is documented at 37.1 degrees celsius, heart rate at 92 beats per minute, respiratory rate of 16 breaths per minute, and blood pressure at 122/74 mmHg. Mild confusion was present during assessment, resulting in a Glasgow Coma Score of 13. Laboratory findings include a creatinine level of 1.8 mg/dL and white blood cell count at 7500 cells per µL. Sodium is measured at 135 mEq/L and potassium at 4.6 mEq/L. ABG shows blood pH at 7.34 with an FiO2% of 49% and a partial pressure of PaO2 at 77 mm Hg. The hematocrit level is noted to be slightly reduced to 41 %. The presence of chronic renal failure, despite the patient's current stable state, emphasizes the importance of regular monitoring and management to prevent further health deterioration.",What is the patient's APACHE II score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [92.0, 'beats per minute'], 'Diastolic Blood Pressure': [74.0, 'mm Hg'], 'pH': 7.34, 'Systolic Blood Pressure': [122.0, 'mm Hg'], 'creatinine': [1.8, 'mg/dL'], 'White blood cell count': [7500.0, 'µL'], 'Sodium': [135.0, 'mEq/L'], 'Potassium': [4.6, 'mEq/L'], 'age': [56.0, 'years'], 'respiratory rate': [16.0, 'breaths per minute'], 'Chronic renal failure': True, 'Glasgow Coma Score': 13.0, 'Hematocrit': [41.0, '%'], 'Temperature': [37.1, 'degrees celsius'], 'PaO2': [77.0, 'mm Hg'], 'FiO2': [49, '%']}",7,7,7,"The criteria for the APACHE II Score are listed below:

1. Age, years: ≤44 = 0 points, 45-54 = +2 points, 55-64 = +3 points, 65-74 = +5 points, ≥75 = +6 points
2. History of severe organ insufficiency or immunocompromised: Yes, nonoperative or emergency postoperative patient = +5 points, Yes, elective postoperative patient = +2 points, No = 0 points
3. Rectal temperature, °C: ≥41 = +4 points, 39 to <41 = +3 points, 38.5 to <39 = +1 point, 36 to <38.5 = 0 points, 34 to <36 = +1 point, 32 to <34 = +2 points, 30 to <32 = +3 points, <30 = +4 points
4. Mean arterial pressure, mmHg: ≥160 = +4 points, 130-159 = +3 points, 110-129 = +2 points, 70-109 = 0 points, 50-69 = +2 points, 40-49 = +3 points, <40 = +4 points
5. Heart rate, beats per minute: ≥180 = +4 points, 140 to <180 = +3 points, 110 to <140 = +2 points, 70 to <110 = 0 points, 55 to <70 = +2 points, 40 to <55 = +3 points, <40 = +4 points
6. Respiratory rate, breaths per minute: ≥50 = +4 points, 35 to <50 = +3 points, 25 to <35 = +1 point, 12 to <25 = 0 points, 10 to <12 = +1 point, 6 to <10 = +2 points, <6 = +4 points
7. Oxygenation (use PaO2 if FiO2 <50%, otherwise use Aa gradient): Aa gradient >349 = +4 points, Aa gradient 350-349 = +3 points, Aa gradient 200-349 = +2 points, Aa gradient <200 (if FiO2 over 45%) or PaO2 <70 (if FiO2 less than 50%) = +1 point, PaO2 61-70 = +1 point, PaO2 55-60 = +3 points, PaO2 <55 = +4 points
8. Arterial pH: ≥7.7 = +4 points, 7.60 to <7.70 = +3 points, 7.50 to <7.60 = +1 point, 7.33 to <7.50 = 0 points, 7.25 to <7.33 = +2 points, 7.15 to <7.25 = +3 points, <7.15 = +4 points
9. Serum sodium, mmol/L: ≥180 = +4 points, 160 to <180 = +3 points, 155 to <160 = +2 points, 150 to <155 = +1 point, 130 to <150 = 0 points, 120 to <130 = +2 points, 111 to <120 = +3 points, <111 = +4 points
10. Serum potassium, mmol/L: ≥7.0 = +4 points, 6.0 to <7.0 = +3 points, 5.5 to <6.0 = +1 point, 3.5 to <5.5 = 0 points, 3.0 to <3.5 = +1 point, 2.5 to <3.0 = +2 points, <2.5 = +4 points
11. Serum creatinine, mg/100 mL: ≥3.5 and ACUTE renal failure = +8 points, 2.0 to <3.5 and ACUTE renal failure = +6 points, ≥3.5 and CHRONIC renal failure = +4 points, 1.5 to <2.0 and ACUTE renal failure = +4 points, 2.0 to <3.5 and CHRONIC renal failure = +3 points, 1.5 to <2.0 and CHRONIC renal failure = +2 points, 0.6 to <1.5 = 0 points, <0.6 = +2 points
12. Hematocrit, %: ≥60 = +4 points, 50 to <60 = +2 points, 46 to <50 = +1 point, 30 to <46 = 0 points, 20 to <30 = +2 points, <20 = +4 points
13. White blood count, total/cubic mm in 10^3: ≥40 = +4 points, 20 to <40 = +2 points, 15 to <20 = +1 point, 3 to <15 = 0 points, 1 to <3 = +2 points, <1 = +4 points
14. Glasgow Coma Scale (GCS): 1-15 points (use 15 - [GCS Score])

The total APACHE II score is calculated by summing the points for each criterion.
    
The patient's current APACHE II score is 0 points.
The patient is 56.0 years old. Because the patient's age is between 55 and 64, 3 points are added to the total, making the current total, 0 + 3 = 3.
The patient note does not report any history on immunocompromise and so we assume this to be false. Hence, 0 points are added to the total, keeping the total at 3 points.
The patient's FiO2 percentage is 49%.
Because the patent's FiO2 percentrage is less than 50%, we need to examine the patient's A-a-gradient to compute the APACHE II score. The patient's partial pressure of oxygen is 77.0 mm Hg. Because the patient's partial pressure of oxygen is more than 70 mm Hg, we do not add any points to the total, keeing the current total at 3.
The patient's temperature is 37.1 degrees celsius. 
Because the patient's temperature is between 36 and 38.5 degrees celsius, no points are added to the score, keeping the current total at 3.
The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 122.0 mm Hg + 2/3 * 74.0 mm Hg = 90.0 mm Hg.
Hence, the patient's mean arterial pressure is 90.0 mm Hg.Because the patient's mean arterial pressure is between 70 and 109 mmHg, 0 points are added to the patient's score, keeping the total at 3.
The patient's heart rate is 92.0 beats per minute.
Because the patient's heart rate is between 70 and 109 beats per minute, 0 points are added to the patient's score, keeping the total at 3.
The patient's respiratory rate is 16.0 breaths per minute.
Because the patient's respiratory rate is between 12 and 24 breaths per minute, 0 points are added to the patient's score, keeping the total at 3.
The patient's pH is 7.34.
Because the patient's pH is between 7.33 and 7.49, 0 points are added to the patient's score, keeping the total at 3.
The concentration of sodium is 135.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 135.0 mEq. To convert from 135.0 mEq to mmol, convert from mEq to mmol. The compound 135.0 has a valence of 1, and so divide the valence by the value of mEq to get, 135.0 mEq/(1 mEq/mmol) = 135.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 135.0 mEq sodium/L converts to 135.0 mmol sodium/L. Because the patient's sodium level is between 130 and 149 mmol/L, 0 points are added to the patient's score, keeping the total at 3.
The concentration of potassium is 4.6 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of potassium from mEq to mmol. The mass of potassium is 4.6 mEq. To convert from 4.6 mEq to mmol, convert from mEq to mmol. The compound 4.6 has a valence of 1, and so divide the valence by the value of mEq to get, 4.6 mEq/(1 mEq/mmol) = 4.6 mmol potassium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 4.6 mEq potassium/L converts to 4.6 mmol potassium/L. Because the patient's potassium level is between 3.5 and 5.4 mmol/L, 0 points are added to the patient's score, keeping the total at 3.
The concentration of creatinine is 1.8 mg/dL. The patient is determined to not have an acute renal failure.
The patient is determined to have a chronic renal failure.
Because the patient has chronic renal failure and a creatinine level between 1.5 and 2.0, 2 points are added to the score, making the current total 3 + 2 = 5.
The patient has a hematocrit of 41.0%.
Because the patient's hematocrit is between 30% and 45%, 0 points are added to the patient's score, keeping the total at 5.
The patient's concentration of white blood cell count is 7500.0 count/µL. To convert 7500.0 count/µL of white blood cell count to L, multiply by the conversion factor 1000000.0 µL/L which will give 7500.0 white blood cell count count/µL * 1000000.0 µL/L = 7500000000.0 white blood cell count count/L. Because the patient's white blood cell count is at least 3x10^9/L, but less than 15 x10^9/L, 0 points are added to the patient's score, keeping the total at 5.
The patient's Glasgow Coma Score is 13. For this criterion, we subtract 15 from the 13 points and add that to the total score. 15 - 13 = 2. Hence, we add 2 to the total making the current total 2 + 5 = 7.
Hence, the patient's APACHE II score is 7."
881,28,APACHE II Score,risk,integer,14,Handwritten,"A 50-year-old individual presents to the emergency department due to fatigue for the past several days. Upon physical examination, the patient's vitals showed a temperature of 37.5 degrees celsius, heart rate at 100 beats per minute, respiratory rate at 18 breaths per minute, and a blood pressure of 124/77 mmHg. Despite reporting feeling fatigued, the patient oriented well and had a full Glasgow Coma Score of 15. Laboratory testing showed a slightly increased creatinine level of 1.4 mg/dL and a white blood cell count within the reference range, at 8,000 per µL. Electrolyte levels showed sodium at 138 mEq/L and potassium at 4.9 mEq/L. Arterial blood gas demonstrated a somewhat lowered pH of 7.32 while maintaining a partial pressure of oxygen of 76 mmHg on a supplemental FiO₂ of 48 %. Hematocrit was in the normal range, measuring at 40 %. Despite no history of severe organ failure or immunocompromise, the current symptoms demand further observation and possible medical intervention to effectively manage the presented fatigue and prevent further complications.",What is the patient's APACHE II score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [100.0, 'beats per minute'], 'Diastolic Blood Pressure': [77.0, 'mm Hg'], 'pH': 7.32, 'Systolic Blood Pressure': [124.0, 'mm Hg'], 'History of severe organ failure or immunocompromise': False, 'creatinine': [1.4, 'mg/dL'], 'White blood cell count': [8000.0, 'µL'], 'Sodium': [138.0, 'mEq/L'], 'Potassium': [4.9, 'mEq/L'], 'age': [50.0, 'years'], 'respiratory rate': [18.0, 'breaths per minute'], 'Glasgow Coma Score': 15.0, 'Hematocrit': [40.0, '%'], 'Temperature': [37.5, 'degrees celsius'], 'PaO2': [76.0, 'mm Hg'], 'FiO2': [48.0, '%']}",4,4,4,"The criteria for the APACHE II Score are listed below:

1. Age, years: ≤44 = 0 points, 45-54 = +2 points, 55-64 = +3 points, 65-74 = +5 points, ≥75 = +6 points
2. History of severe organ insufficiency or immunocompromised: Yes, nonoperative or emergency postoperative patient = +5 points, Yes, elective postoperative patient = +2 points, No = 0 points
3. Rectal temperature, °C: ≥41 = +4 points, 39 to <41 = +3 points, 38.5 to <39 = +1 point, 36 to <38.5 = 0 points, 34 to <36 = +1 point, 32 to <34 = +2 points, 30 to <32 = +3 points, <30 = +4 points
4. Mean arterial pressure, mmHg: ≥160 = +4 points, 130-159 = +3 points, 110-129 = +2 points, 70-109 = 0 points, 50-69 = +2 points, 40-49 = +3 points, <40 = +4 points
5. Heart rate, beats per minute: ≥180 = +4 points, 140 to <180 = +3 points, 110 to <140 = +2 points, 70 to <110 = 0 points, 55 to <70 = +2 points, 40 to <55 = +3 points, <40 = +4 points
6. Respiratory rate, breaths per minute: ≥50 = +4 points, 35 to <50 = +3 points, 25 to <35 = +1 point, 12 to <25 = 0 points, 10 to <12 = +1 point, 6 to <10 = +2 points, <6 = +4 points
7. Oxygenation (use PaO2 if FiO2 <50%, otherwise use Aa gradient): Aa gradient >349 = +4 points, Aa gradient 350-349 = +3 points, Aa gradient 200-349 = +2 points, Aa gradient <200 (if FiO2 over 45%) or PaO2 <70 (if FiO2 less than 50%) = +1 point, PaO2 61-70 = +1 point, PaO2 55-60 = +3 points, PaO2 <55 = +4 points
8. Arterial pH: ≥7.7 = +4 points, 7.60 to <7.70 = +3 points, 7.50 to <7.60 = +1 point, 7.33 to <7.50 = 0 points, 7.25 to <7.33 = +2 points, 7.15 to <7.25 = +3 points, <7.15 = +4 points
9. Serum sodium, mmol/L: ≥180 = +4 points, 160 to <180 = +3 points, 155 to <160 = +2 points, 150 to <155 = +1 point, 130 to <150 = 0 points, 120 to <130 = +2 points, 111 to <120 = +3 points, <111 = +4 points
10. Serum potassium, mmol/L: ≥7.0 = +4 points, 6.0 to <7.0 = +3 points, 5.5 to <6.0 = +1 point, 3.5 to <5.5 = 0 points, 3.0 to <3.5 = +1 point, 2.5 to <3.0 = +2 points, <2.5 = +4 points
11. Serum creatinine, mg/100 mL: ≥3.5 and ACUTE renal failure = +8 points, 2.0 to <3.5 and ACUTE renal failure = +6 points, ≥3.5 and CHRONIC renal failure = +4 points, 1.5 to <2.0 and ACUTE renal failure = +4 points, 2.0 to <3.5 and CHRONIC renal failure = +3 points, 1.5 to <2.0 and CHRONIC renal failure = +2 points, 0.6 to <1.5 = 0 points, <0.6 = +2 points
12. Hematocrit, %: ≥60 = +4 points, 50 to <60 = +2 points, 46 to <50 = +1 point, 30 to <46 = 0 points, 20 to <30 = +2 points, <20 = +4 points
13. White blood count, total/cubic mm in 10^3: ≥40 = +4 points, 20 to <40 = +2 points, 15 to <20 = +1 point, 3 to <15 = 0 points, 1 to <3 = +2 points, <1 = +4 points
14. Glasgow Coma Scale (GCS): 1-15 points (use 15 - [GCS Score])

The total APACHE II score is calculated by summing the points for each criterion.
    
The patient's current APACHE II score is 0 points.
The patient is 50.0 years old. Because the patient's age is between 45 and 54, 2 points are added to the total, making the current total, 0 + 2 = 2.
The patient note does not report any history on immunocompromise and so we assume this to be false. Hence, 0 points are added to the total, keeping the total at 2 points.
The patient's FiO2 percentage is 48.0%.
Because the patent's FiO2 percentrage is less than 50%, we need to examine the patient's A-a-gradient to compute the APACHE II score. The patient's partial pressure of oxygen is 76.0 mm Hg. Because the patient's partial pressure of oxygen is more than 70 mm Hg, we do not add any points to the total, keeing the current total at 2.
The patient's temperature is 37.5 degrees celsius. 
Because the patient's temperature is between 36 and 38.5 degrees celsius, no points are added to the score, keeping the current total at 2.
The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 124.0 mm Hg + 2/3 * 77.0 mm Hg = 92.667 mm Hg.
Hence, the patient's mean arterial pressure is 92.667 mm Hg.Because the patient's mean arterial pressure is between 70 and 109 mmHg, 0 points are added to the patient's score, keeping the total at 2.
The patient's heart rate is 100.0 beats per minute.
Because the patient's heart rate is between 70 and 109 beats per minute, 0 points are added to the patient's score, keeping the total at 2.
The patient's respiratory rate is 18.0 breaths per minute.
Because the patient's respiratory rate is between 12 and 24 breaths per minute, 0 points are added to the patient's score, keeping the total at 2.
The patient's pH is 7.32.
Because the patient's pH is between 7.25 and 7.32, 2 points are added to the score, making the current total 2 + 2 = 4.
The concentration of sodium is 138.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 138.0 mEq. To convert from 138.0 mEq to mmol, convert from mEq to mmol. The compound 138.0 has a valence of 1, and so divide the valence by the value of mEq to get, 138.0 mEq/(1 mEq/mmol) = 138.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 138.0 mEq sodium/L converts to 138.0 mmol sodium/L. Because the patient's sodium level is between 130 and 149 mmol/L, 0 points are added to the patient's score, keeping the total at 4.
The concentration of potassium is 4.9 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of potassium from mEq to mmol. The mass of potassium is 4.9 mEq. To convert from 4.9 mEq to mmol, convert from mEq to mmol. The compound 4.9 has a valence of 1, and so divide the valence by the value of mEq to get, 4.9 mEq/(1 mEq/mmol) = 4.9 mmol potassium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 4.9 mEq potassium/L converts to 4.9 mmol potassium/L. Because the patient's potassium level is between 3.5 and 5.4 mmol/L, 0 points are added to the patient's score, keeping the total at 4.
The concentration of creatinine is 1.4 mg/dL. The patient is determined to not have an acute renal failure.
The patient is determined to not have a chronic renal failure.
Because the patient's creatinine level is between 0.6 and 1.4, no points are added to the score, keeping the current total at 4.
The patient has a hematocrit of 40.0%.
Because the patient's hematocrit is between 30% and 45%, 0 points are added to the patient's score, keeping the total at 4.
The patient's concentration of white blood cell count is 8000.0 count/µL. To convert 8000.0 count/µL of white blood cell count to L, multiply by the conversion factor 1000000.0 µL/L which will give 8000.0 white blood cell count count/µL * 1000000.0 µL/L = 8000000000.0 white blood cell count count/L. Because the patient's white blood cell count is at least 3x10^9/L, but less than 15 x10^9/L, 0 points are added to the patient's score, keeping the total at 4.
The patient's Glasgow Coma Score is 15. For this criterion, we subtract 15 from the 15 points and add that to the total score. 15 - 15 = 0. Hence, we add 0 to the total making the current total 0 + 4 = 4.
Hence, the patient's APACHE II score is 4."
882,28,APACHE II Score,risk,integer,15,Handwritten,"A 64-year-old individual with no known medical history was brought to the emergency department due to episodes of mild confusion. Vital signs on admission included a heart rate of 96 beats per minute, a respiratory rate of 18 breaths per minute, a blood pressure of 130/80 mm Hg, and a body temperature recorded as 37.0 degrees celsius. The patient's level of consciousness was also evaluated with a resultant Glasgow Coma Score of 14. Laboratory investigations noted a mild elevation in creatinine levels, recorded at 1.4 mg/dL. The patients white blood cell count appeared normal at 7000 per µL. Electrolytes were found to be within normal ranges, with sodium reported at 139 mEq/L and potassium reading 4.5 mEq/L. Analysis of arterial blood gases showed a slightly reduced pH of 7.33, with the patient having an A-a-gradient of 478 on a supplemented FiO₂ of 52 %. Hematocrit measured within the normal range, at 43 %. Given the new onset of confusion in an otherwise healthy patient, further diagnostic evaluations may be essential to determine the underlying cause.",What is the patient's APACHE II score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [96.0, 'beats per minute'], 'Diastolic Blood Pressure': [80.0, 'mm Hg'], 'pH': 7.33, 'FiO2': [52.0, '%'], 'Systolic Blood Pressure': [130.0, 'mm Hg'], 'creatinine': [1.4, 'mg/dL'], 'White blood cell count': [7000.0, 'µL'], 'Sodium': [139.0, 'mEq/L'], 'Potassium': [4.5, 'mEq/L'], 'A-a gradient': 478, 'age': [64.0, 'years'], 'respiratory rate': [18.0, 'breaths per minute'], 'Glasgow Coma Score': 14.0, 'Hematocrit': [43.0, '%'], 'Temperature': [37.0, 'degrees celsius']}",7,7,7,"The criteria for the APACHE II Score are listed below:

1. Age, years: ≤44 = 0 points, 45-54 = +2 points, 55-64 = +3 points, 65-74 = +5 points, ≥75 = +6 points
2. History of severe organ insufficiency or immunocompromised: Yes, nonoperative or emergency postoperative patient = +5 points, Yes, elective postoperative patient = +2 points, No = 0 points
3. Rectal temperature, °C: ≥41 = +4 points, 39 to <41 = +3 points, 38.5 to <39 = +1 point, 36 to <38.5 = 0 points, 34 to <36 = +1 point, 32 to <34 = +2 points, 30 to <32 = +3 points, <30 = +4 points
4. Mean arterial pressure, mmHg: ≥160 = +4 points, 130-159 = +3 points, 110-129 = +2 points, 70-109 = 0 points, 50-69 = +2 points, 40-49 = +3 points, <40 = +4 points
5. Heart rate, beats per minute: ≥180 = +4 points, 140 to <180 = +3 points, 110 to <140 = +2 points, 70 to <110 = 0 points, 55 to <70 = +2 points, 40 to <55 = +3 points, <40 = +4 points
6. Respiratory rate, breaths per minute: ≥50 = +4 points, 35 to <50 = +3 points, 25 to <35 = +1 point, 12 to <25 = 0 points, 10 to <12 = +1 point, 6 to <10 = +2 points, <6 = +4 points
7. Oxygenation (use PaO2 if FiO2 <50%, otherwise use Aa gradient): Aa gradient >349 = +4 points, Aa gradient 350-349 = +3 points, Aa gradient 200-349 = +2 points, Aa gradient <200 (if FiO2 over 45%) or PaO2 <70 (if FiO2 less than 50%) = +1 point, PaO2 61-70 = +1 point, PaO2 55-60 = +3 points, PaO2 <55 = +4 points
8. Arterial pH: ≥7.7 = +4 points, 7.60 to <7.70 = +3 points, 7.50 to <7.60 = +1 point, 7.33 to <7.50 = 0 points, 7.25 to <7.33 = +2 points, 7.15 to <7.25 = +3 points, <7.15 = +4 points
9. Serum sodium, mmol/L: ≥180 = +4 points, 160 to <180 = +3 points, 155 to <160 = +2 points, 150 to <155 = +1 point, 130 to <150 = 0 points, 120 to <130 = +2 points, 111 to <120 = +3 points, <111 = +4 points
10. Serum potassium, mmol/L: ≥7.0 = +4 points, 6.0 to <7.0 = +3 points, 5.5 to <6.0 = +1 point, 3.5 to <5.5 = 0 points, 3.0 to <3.5 = +1 point, 2.5 to <3.0 = +2 points, <2.5 = +4 points
11. Serum creatinine, mg/100 mL: ≥3.5 and ACUTE renal failure = +8 points, 2.0 to <3.5 and ACUTE renal failure = +6 points, ≥3.5 and CHRONIC renal failure = +4 points, 1.5 to <2.0 and ACUTE renal failure = +4 points, 2.0 to <3.5 and CHRONIC renal failure = +3 points, 1.5 to <2.0 and CHRONIC renal failure = +2 points, 0.6 to <1.5 = 0 points, <0.6 = +2 points
12. Hematocrit, %: ≥60 = +4 points, 50 to <60 = +2 points, 46 to <50 = +1 point, 30 to <46 = 0 points, 20 to <30 = +2 points, <20 = +4 points
13. White blood count, total/cubic mm in 10^3: ≥40 = +4 points, 20 to <40 = +2 points, 15 to <20 = +1 point, 3 to <15 = 0 points, 1 to <3 = +2 points, <1 = +4 points
14. Glasgow Coma Scale (GCS): 1-15 points (use 15 - [GCS Score])

The total APACHE II score is calculated by summing the points for each criterion.
    
The patient's current APACHE II score is 0 points.
The patient is 64.0 years old. Because the patient's age is between 55 and 64, 3 points are added to the total, making the current total, 0 + 3 = 3.
The patient note does not report any history on immunocompromise and so we assume this to be false. Hence, 0 points are added to the total, keeping the total at 3 points.
The patient's FiO2 percentage is 52.0%.
Because the patent's FiO2 percentrage is greater than 50%, we need to examine the A-a-gradient to compute the APACHE II score. The patient's A-a-gradient is 478. Because the patient's A-a gradient is between 350 and 500, we add 3 points to the total, making the current total 3 + 3 = 6.
The patient's temperature is 37.0 degrees celsius. 
Because the patient's temperature is between 36 and 38.5 degrees celsius, no points are added to the score, keeping the current total at 6.
The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 130.0 mm Hg + 2/3 * 80.0 mm Hg = 96.667 mm Hg.
Hence, the patient's mean arterial pressure is 96.667 mm Hg.Because the patient's mean arterial pressure is between 70 and 109 mmHg, 0 points are added to the patient's score, keeping the total at 6.
The patient's heart rate is 96.0 beats per minute.
Because the patient's heart rate is between 70 and 109 beats per minute, 0 points are added to the patient's score, keeping the total at 6.
The patient's respiratory rate is 18.0 breaths per minute.
Because the patient's respiratory rate is between 12 and 24 breaths per minute, 0 points are added to the patient's score, keeping the total at 6.
The patient's pH is 7.33.
Because the patient's pH is between 7.33 and 7.49, 0 points are added to the patient's score, keeping the total at 6.
The concentration of sodium is 139.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 139.0 mEq. To convert from 139.0 mEq to mmol, convert from mEq to mmol. The compound 139.0 has a valence of 1, and so divide the valence by the value of mEq to get, 139.0 mEq/(1 mEq/mmol) = 139.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 139.0 mEq sodium/L converts to 139.0 mmol sodium/L. Because the patient's sodium level is between 130 and 149 mmol/L, 0 points are added to the patient's score, keeping the total at 6.
The concentration of potassium is 4.5 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of potassium from mEq to mmol. The mass of potassium is 4.5 mEq. To convert from 4.5 mEq to mmol, convert from mEq to mmol. The compound 4.5 has a valence of 1, and so divide the valence by the value of mEq to get, 4.5 mEq/(1 mEq/mmol) = 4.5 mmol potassium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 4.5 mEq potassium/L converts to 4.5 mmol potassium/L. Because the patient's potassium level is between 3.5 and 5.4 mmol/L, 0 points are added to the patient's score, keeping the total at 6.
The concentration of creatinine is 1.4 mg/dL. The patient is determined to not have an acute renal failure.
The patient is determined to not have a chronic renal failure.
Because the patient's creatinine level is between 0.6 and 1.4, no points are added to the score, keeping the current total at 6.
The patient has a hematocrit of 43.0%.
Because the patient's hematocrit is between 30% and 45%, 0 points are added to the patient's score, keeping the total at 6.
The patient's concentration of white blood cell count is 7000.0 count/µL. To convert 7000.0 count/µL of white blood cell count to L, multiply by the conversion factor 1000000.0 µL/L which will give 7000.0 white blood cell count count/µL * 1000000.0 µL/L = 7000000000.0 white blood cell count count/L. Because the patient's white blood cell count is at least 3x10^9/L, but less than 15 x10^9/L, 0 points are added to the patient's score, keeping the total at 6.
The patient's Glasgow Coma Score is 14. For this criterion, we subtract 15 from the 14 points and add that to the total score. 15 - 14 = 1. Hence, we add 1 to the total making the current total 1 + 6 = 7.
Hence, the patient's APACHE II score is 7."
883,28,APACHE II Score,risk,integer,16,Handwritten,"The patient is a 57-year-old individual with a noted history of significant chronic liver failure requiring a scheduled transplant. The individual presented to the emergency unit with complaints of recent onset lethargy and general fatigue. Vital signs showed mild tachycardia with a pulse rate of 102 beats per minute, blood pressure of 120/75 mm Hg, a respiratory rate of 19 breaths per minute, and a body temperature of 36.7 degrees Celsius. The Glasgow Coma Score was calculated to be 13, indicating a mild decrease in overall alertness. Laboratory findings included a slightly elevated creatinine level of 1.3 mg/dL, a white blood cell count of 7800/µL, sodium levels at 142 mEq/L, and potassium concentration within the normal range at 4.7 mEq/L. Arterial blood gas illustrated a pH of 7.31, with the patient maintaining an A-a gradient of 400 on 54% FiO₂. Hematocrit readings were within normal parameters at 41%. Despite no evidence of acute renal failure, the patient's history and new symptomatology necessitate a cautious and well-monitored approach to their care, with further investigations planned to decipher the underlying cause.",What is the patient's APACHE II score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [102.0, 'beats per minute'], 'Diastolic Blood Pressure': [75.0, 'mm Hg'], 'pH': 7.31, 'Systolic Blood Pressure': [120.0, 'mm Hg'], 'Acute renal failure': False, 'History of severe organ failure or immunocompromise': True, 'creatinine': [1.3, 'mg/dL'], 'White blood cell count': [7800.0, 'µL'], 'Sodium': [142.0, 'mEq/L'], 'Potassium': [4.7, 'mEq/L'], 'A-a gradient': 400, 'age': [57.0, 'years'], 'respiratory rate': [19.0, 'breaths per minute'], 'Glasgow Coma Score': 13.0, 'Hematocrit': [41.0, '%'], 'Temperature': [36.7, 'degrees celsius'], 'Surgery Type': 'Elective', 'FiO2': [54.0, '%']}",10,10,10,"The criteria for the APACHE II Score are listed below:

1. Age, years: ≤44 = 0 points, 45-54 = +2 points, 55-64 = +3 points, 65-74 = +5 points, ≥75 = +6 points
2. History of severe organ insufficiency or immunocompromised: Yes, nonoperative or emergency postoperative patient = +5 points, Yes, elective postoperative patient = +2 points, No = 0 points
3. Rectal temperature, °C: ≥41 = +4 points, 39 to <41 = +3 points, 38.5 to <39 = +1 point, 36 to <38.5 = 0 points, 34 to <36 = +1 point, 32 to <34 = +2 points, 30 to <32 = +3 points, <30 = +4 points
4. Mean arterial pressure, mmHg: ≥160 = +4 points, 130-159 = +3 points, 110-129 = +2 points, 70-109 = 0 points, 50-69 = +2 points, 40-49 = +3 points, <40 = +4 points
5. Heart rate, beats per minute: ≥180 = +4 points, 140 to <180 = +3 points, 110 to <140 = +2 points, 70 to <110 = 0 points, 55 to <70 = +2 points, 40 to <55 = +3 points, <40 = +4 points
6. Respiratory rate, breaths per minute: ≥50 = +4 points, 35 to <50 = +3 points, 25 to <35 = +1 point, 12 to <25 = 0 points, 10 to <12 = +1 point, 6 to <10 = +2 points, <6 = +4 points
7. Oxygenation (use PaO2 if FiO2 <50%, otherwise use Aa gradient): Aa gradient >349 = +4 points, Aa gradient 350-349 = +3 points, Aa gradient 200-349 = +2 points, Aa gradient <200 (if FiO2 over 45%) or PaO2 <70 (if FiO2 less than 50%) = +1 point, PaO2 61-70 = +1 point, PaO2 55-60 = +3 points, PaO2 <55 = +4 points
8. Arterial pH: ≥7.7 = +4 points, 7.60 to <7.70 = +3 points, 7.50 to <7.60 = +1 point, 7.33 to <7.50 = 0 points, 7.25 to <7.33 = +2 points, 7.15 to <7.25 = +3 points, <7.15 = +4 points
9. Serum sodium, mmol/L: ≥180 = +4 points, 160 to <180 = +3 points, 155 to <160 = +2 points, 150 to <155 = +1 point, 130 to <150 = 0 points, 120 to <130 = +2 points, 111 to <120 = +3 points, <111 = +4 points
10. Serum potassium, mmol/L: ≥7.0 = +4 points, 6.0 to <7.0 = +3 points, 5.5 to <6.0 = +1 point, 3.5 to <5.5 = 0 points, 3.0 to <3.5 = +1 point, 2.5 to <3.0 = +2 points, <2.5 = +4 points
11. Serum creatinine, mg/100 mL: ≥3.5 and ACUTE renal failure = +8 points, 2.0 to <3.5 and ACUTE renal failure = +6 points, ≥3.5 and CHRONIC renal failure = +4 points, 1.5 to <2.0 and ACUTE renal failure = +4 points, 2.0 to <3.5 and CHRONIC renal failure = +3 points, 1.5 to <2.0 and CHRONIC renal failure = +2 points, 0.6 to <1.5 = 0 points, <0.6 = +2 points
12. Hematocrit, %: ≥60 = +4 points, 50 to <60 = +2 points, 46 to <50 = +1 point, 30 to <46 = 0 points, 20 to <30 = +2 points, <20 = +4 points
13. White blood count, total/cubic mm in 10^3: ≥40 = +4 points, 20 to <40 = +2 points, 15 to <20 = +1 point, 3 to <15 = 0 points, 1 to <3 = +2 points, <1 = +4 points
14. Glasgow Coma Scale (GCS): 1-15 points (use 15 - [GCS Score])

The total APACHE II score is calculated by summing the points for each criterion.
    
The patient's current APACHE II score is 0 points.
The patient is 57.0 years old. Because the patient's age is between 55 and 64, 3 points are added to the total, making the current total, 0 + 3 = 3.
The patient note does not report any history on immunocompromise and so we assume this to be false. Hence, 0 points are added to the total, keeping the total at 3 points.
The patient's FiO2 percentage is 54.0%.
Because the patent's FiO2 percentrage is greater than 50%, we need to examine the A-a-gradient to compute the APACHE II score. The patient's A-a-gradient is 400. Because the patient's A-a gradient is between 350 and 500, we add 3 points to the total, making the current total 3 + 3 = 6.
The patient's temperature is 36.7 degrees celsius. 
Because the patient's temperature is between 36 and 38.5 degrees celsius, no points are added to the score, keeping the current total at 6.
The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 120.0 mm Hg + 2/3 * 75.0 mm Hg = 90.0 mm Hg.
Hence, the patient's mean arterial pressure is 90.0 mm Hg.Because the patient's mean arterial pressure is between 70 and 109 mmHg, 0 points are added to the patient's score, keeping the total at 6.
The patient's heart rate is 102.0 beats per minute.
Because the patient's heart rate is between 70 and 109 beats per minute, 0 points are added to the patient's score, keeping the total at 6.
The patient's respiratory rate is 19.0 breaths per minute.
Because the patient's respiratory rate is between 12 and 24 breaths per minute, 0 points are added to the patient's score, keeping the total at 6.
The patient's pH is 7.31.
Because the patient's pH is between 7.25 and 7.32, 2 points are added to the score, making the current total 6 + 2 = 8.
The concentration of sodium is 142.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 142.0 mEq. To convert from 142.0 mEq to mmol, convert from mEq to mmol. The compound 142.0 has a valence of 1, and so divide the valence by the value of mEq to get, 142.0 mEq/(1 mEq/mmol) = 142.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 142.0 mEq sodium/L converts to 142.0 mmol sodium/L. Because the patient's sodium level is between 130 and 149 mmol/L, 0 points are added to the patient's score, keeping the total at 8.
The concentration of potassium is 4.7 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of potassium from mEq to mmol. The mass of potassium is 4.7 mEq. To convert from 4.7 mEq to mmol, convert from mEq to mmol. The compound 4.7 has a valence of 1, and so divide the valence by the value of mEq to get, 4.7 mEq/(1 mEq/mmol) = 4.7 mmol potassium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 4.7 mEq potassium/L converts to 4.7 mmol potassium/L. Because the patient's potassium level is between 3.5 and 5.4 mmol/L, 0 points are added to the patient's score, keeping the total at 8.
The concentration of creatinine is 1.3 mg/dL. The patient is determined to not have an acute renal failure.
The patient is determined to not have a chronic renal failure.
Because the patient's creatinine level is between 0.6 and 1.4, no points are added to the score, keeping the current total at 8.
The patient has a hematocrit of 41.0%.
Because the patient's hematocrit is between 30% and 45%, 0 points are added to the patient's score, keeping the total at 8.
The patient's concentration of white blood cell count is 7800.0 count/µL. To convert 7800.0 count/µL of white blood cell count to L, multiply by the conversion factor 1000000.0 µL/L which will give 7800.0 white blood cell count count/µL * 1000000.0 µL/L = 7800000000.0 white blood cell count count/L. Because the patient's white blood cell count is at least 3x10^9/L, but less than 15 x10^9/L, 0 points are added to the patient's score, keeping the total at 8.
The patient's Glasgow Coma Score is 13. For this criterion, we subtract 15 from the 13 points and add that to the total score. 15 - 13 = 2. Hence, we add 2 to the total making the current total 2 + 8 = 10.
Hence, the patient's APACHE II score is 10."
884,28,APACHE II Score,risk,integer,17,Handwritten,"A 59-year-old individual recently visited the office after feeling ""out of sorts"" and generally unwell over the past few days. During examination, the patient displayed a slightly increased heart rate of 104 beats per minute and blood pressure reading of 126/72 mm Hg. The patient's respiratory rate was noted to be 17 breaths per minute, and body temperature was within normal limit at 36.5 degrees celsius. While mildly confused, with a Glasgow Coma Score of 14, the patient was adequately oriented to person, place, and time. Key laboratory findings indicated a creatinine value of 0.7 mg/dL and a white blood cell count of 8800 cells per µL. Electrolyte levels remained within the normal range, with sodium measured at 138 mEq/L and potassium at 4.3 mEq/L. The arterial blood gas determined a pH of 7.33 and showed the patient was maintaining a partial pressure of oxygen (PaO₂) of 76 mm Hg on 43 % FiO₂. The hematocrit was measured at 41 %, falling within the average range. Despite the absence of a significant past medical history, the current symptoms, in combination with the slightly high creatinine values, warrant further evaluation.",What is the patient's APACHE II score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [104.0, 'beats per minute'], 'Diastolic Blood Pressure': [72.0, 'mm Hg'], 'pH': 7.33, 'Systolic Blood Pressure': [126.0, 'mm Hg'], 'creatinine': [0.7, 'mg/dL'], 'White blood cell count': [8800.0, 'µL'], 'Sodium': [138.0, 'mEq/L'], 'Potassium': [4.3, 'mEq/L'], 'age': [59.0, 'years'], 'respiratory rate': [17.0, 'breaths per minute'], 'Chronic renal failure': False, 'Glasgow Coma Score': 14.0, 'Hematocrit': [41.0, '%'], 'Temperature': [36.5, 'degrees celsius'], 'PaO2': [76.0, 'mm Hg'], 'FiO2': [43, '%']}",4,4,4,"The criteria for the APACHE II Score are listed below:

1. Age, years: ≤44 = 0 points, 45-54 = +2 points, 55-64 = +3 points, 65-74 = +5 points, ≥75 = +6 points
2. History of severe organ insufficiency or immunocompromised: Yes, nonoperative or emergency postoperative patient = +5 points, Yes, elective postoperative patient = +2 points, No = 0 points
3. Rectal temperature, °C: ≥41 = +4 points, 39 to <41 = +3 points, 38.5 to <39 = +1 point, 36 to <38.5 = 0 points, 34 to <36 = +1 point, 32 to <34 = +2 points, 30 to <32 = +3 points, <30 = +4 points
4. Mean arterial pressure, mmHg: ≥160 = +4 points, 130-159 = +3 points, 110-129 = +2 points, 70-109 = 0 points, 50-69 = +2 points, 40-49 = +3 points, <40 = +4 points
5. Heart rate, beats per minute: ≥180 = +4 points, 140 to <180 = +3 points, 110 to <140 = +2 points, 70 to <110 = 0 points, 55 to <70 = +2 points, 40 to <55 = +3 points, <40 = +4 points
6. Respiratory rate, breaths per minute: ≥50 = +4 points, 35 to <50 = +3 points, 25 to <35 = +1 point, 12 to <25 = 0 points, 10 to <12 = +1 point, 6 to <10 = +2 points, <6 = +4 points
7. Oxygenation (use PaO2 if FiO2 <50%, otherwise use Aa gradient): Aa gradient >349 = +4 points, Aa gradient 350-349 = +3 points, Aa gradient 200-349 = +2 points, Aa gradient <200 (if FiO2 over 45%) or PaO2 <70 (if FiO2 less than 50%) = +1 point, PaO2 61-70 = +1 point, PaO2 55-60 = +3 points, PaO2 <55 = +4 points
8. Arterial pH: ≥7.7 = +4 points, 7.60 to <7.70 = +3 points, 7.50 to <7.60 = +1 point, 7.33 to <7.50 = 0 points, 7.25 to <7.33 = +2 points, 7.15 to <7.25 = +3 points, <7.15 = +4 points
9. Serum sodium, mmol/L: ≥180 = +4 points, 160 to <180 = +3 points, 155 to <160 = +2 points, 150 to <155 = +1 point, 130 to <150 = 0 points, 120 to <130 = +2 points, 111 to <120 = +3 points, <111 = +4 points
10. Serum potassium, mmol/L: ≥7.0 = +4 points, 6.0 to <7.0 = +3 points, 5.5 to <6.0 = +1 point, 3.5 to <5.5 = 0 points, 3.0 to <3.5 = +1 point, 2.5 to <3.0 = +2 points, <2.5 = +4 points
11. Serum creatinine, mg/100 mL: ≥3.5 and ACUTE renal failure = +8 points, 2.0 to <3.5 and ACUTE renal failure = +6 points, ≥3.5 and CHRONIC renal failure = +4 points, 1.5 to <2.0 and ACUTE renal failure = +4 points, 2.0 to <3.5 and CHRONIC renal failure = +3 points, 1.5 to <2.0 and CHRONIC renal failure = +2 points, 0.6 to <1.5 = 0 points, <0.6 = +2 points
12. Hematocrit, %: ≥60 = +4 points, 50 to <60 = +2 points, 46 to <50 = +1 point, 30 to <46 = 0 points, 20 to <30 = +2 points, <20 = +4 points
13. White blood count, total/cubic mm in 10^3: ≥40 = +4 points, 20 to <40 = +2 points, 15 to <20 = +1 point, 3 to <15 = 0 points, 1 to <3 = +2 points, <1 = +4 points
14. Glasgow Coma Scale (GCS): 1-15 points (use 15 - [GCS Score])

The total APACHE II score is calculated by summing the points for each criterion.
    
The patient's current APACHE II score is 0 points.
The patient is 59.0 years old. Because the patient's age is between 55 and 64, 3 points are added to the total, making the current total, 0 + 3 = 3.
The patient note does not report any history on immunocompromise and so we assume this to be false. Hence, 0 points are added to the total, keeping the total at 3 points.
The patient's FiO2 percentage is 43%.
Because the patent's FiO2 percentrage is less than 50%, we need to examine the patient's A-a-gradient to compute the APACHE II score. The patient's partial pressure of oxygen is 76.0 mm Hg. Because the patient's partial pressure of oxygen is more than 70 mm Hg, we do not add any points to the total, keeing the current total at 3.
The patient's temperature is 36.5 degrees celsius. 
Because the patient's temperature is between 36 and 38.5 degrees celsius, no points are added to the score, keeping the current total at 3.
The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 126.0 mm Hg + 2/3 * 72.0 mm Hg = 90.0 mm Hg.
Hence, the patient's mean arterial pressure is 90.0 mm Hg.Because the patient's mean arterial pressure is between 70 and 109 mmHg, 0 points are added to the patient's score, keeping the total at 3.
The patient's heart rate is 104.0 beats per minute.
Because the patient's heart rate is between 70 and 109 beats per minute, 0 points are added to the patient's score, keeping the total at 3.
The patient's respiratory rate is 17.0 breaths per minute.
Because the patient's respiratory rate is between 12 and 24 breaths per minute, 0 points are added to the patient's score, keeping the total at 3.
The patient's pH is 7.33.
Because the patient's pH is between 7.33 and 7.49, 0 points are added to the patient's score, keeping the total at 3.
The concentration of sodium is 138.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 138.0 mEq. To convert from 138.0 mEq to mmol, convert from mEq to mmol. The compound 138.0 has a valence of 1, and so divide the valence by the value of mEq to get, 138.0 mEq/(1 mEq/mmol) = 138.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 138.0 mEq sodium/L converts to 138.0 mmol sodium/L. Because the patient's sodium level is between 130 and 149 mmol/L, 0 points are added to the patient's score, keeping the total at 3.
The concentration of potassium is 4.3 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of potassium from mEq to mmol. The mass of potassium is 4.3 mEq. To convert from 4.3 mEq to mmol, convert from mEq to mmol. The compound 4.3 has a valence of 1, and so divide the valence by the value of mEq to get, 4.3 mEq/(1 mEq/mmol) = 4.3 mmol potassium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 4.3 mEq potassium/L converts to 4.3 mmol potassium/L. Because the patient's potassium level is between 3.5 and 5.4 mmol/L, 0 points are added to the patient's score, keeping the total at 3.
The concentration of creatinine is 0.7 mg/dL. The patient is determined to not have an acute renal failure.
The patient is determined to not have a chronic renal failure.
Because the patient's creatinine level is between 0.6 and 1.4, no points are added to the score, keeping the current total at 3.
The patient has a hematocrit of 41.0%.
Because the patient's hematocrit is between 30% and 45%, 0 points are added to the patient's score, keeping the total at 3.
The patient's concentration of white blood cell count is 8800.0 count/µL. To convert 8800.0 count/µL of white blood cell count to L, multiply by the conversion factor 1000000.0 µL/L which will give 8800.0 white blood cell count count/µL * 1000000.0 µL/L = 8800000000.0 white blood cell count count/L. Because the patient's white blood cell count is at least 3x10^9/L, but less than 15 x10^9/L, 0 points are added to the patient's score, keeping the total at 3.
The patient's Glasgow Coma Score is 14. For this criterion, we subtract 15 from the 14 points and add that to the total score. 15 - 14 = 1. Hence, we add 1 to the total making the current total 1 + 3 = 4.
Hence, the patient's APACHE II score is 4."
885,28,APACHE II Score,risk,integer,18,Handwritten,"The individual under assessment is a 61-year-old patient known to have a longstanding diagnosis of chronic kidney disease. During this particular visit, the patient presented to the emergency department due to increased fatigue and shortness of breath. On initial assessment, certain vitals were noted: body temperature at 37 degrees celsius, heart rate was slightly high at 98 beats per minute, a respiratory rate of 18 breaths per minute, and blood pressure registering at 130/74 mm Hg. Neurological assessment yielded a Glasgow Coma Score of 14, suggesting a slight reduction in consciousness. Laboratory results revealed elevated creatinine at 1.8 mg/dL and a white blood cell count of 8000/µL, suggesting a possible underlying infection. Sodium levels were slightly above the normal range at 141 mEq/L, and potassium levels were near normal at 4.4 mEq/L. Analysis of the arterial blood gas indicated a pH of 7.33 and a A-a-gradient of 445  at a fraction of inspired oxygen (FiO₂) of 53 %. The hematocrit result was within normal limits at 42 %. Based on these findings, the patient's escalating symptoms of fatigue and shortness of breath call for prompt management given the underlying chronic renal condition.",What is the patient's APACHE II score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [98.0, 'beats per minute'], 'Diastolic Blood Pressure': [74.0, 'mm Hg'], 'pH': 7.33, 'Systolic Blood Pressure': [130.0, 'mm Hg'], 'Acute renal failure': False, 'History of severe organ failure or immunocompromise': False, 'creatinine': [1.8, 'mg/dL'], 'White blood cell count': [8000.0, 'µL'], 'Sodium': [141.0, 'mEq/L'], 'Potassium': [4.4, 'mEq/L'], 'age': [61.0, 'years'], 'respiratory rate': [18.0, 'breaths per minute'], 'Chronic renal failure': True, 'Glasgow Coma Score': 14.0, 'Hematocrit': [42.0, '%'], 'Temperature': [37.0, 'degrees celsius'], 'A-a gradient': 445, 'FiO2': [53.0, '%']}",9,9,9,"The criteria for the APACHE II Score are listed below:

1. Age, years: ≤44 = 0 points, 45-54 = +2 points, 55-64 = +3 points, 65-74 = +5 points, ≥75 = +6 points
2. History of severe organ insufficiency or immunocompromised: Yes, nonoperative or emergency postoperative patient = +5 points, Yes, elective postoperative patient = +2 points, No = 0 points
3. Rectal temperature, °C: ≥41 = +4 points, 39 to <41 = +3 points, 38.5 to <39 = +1 point, 36 to <38.5 = 0 points, 34 to <36 = +1 point, 32 to <34 = +2 points, 30 to <32 = +3 points, <30 = +4 points
4. Mean arterial pressure, mmHg: ≥160 = +4 points, 130-159 = +3 points, 110-129 = +2 points, 70-109 = 0 points, 50-69 = +2 points, 40-49 = +3 points, <40 = +4 points
5. Heart rate, beats per minute: ≥180 = +4 points, 140 to <180 = +3 points, 110 to <140 = +2 points, 70 to <110 = 0 points, 55 to <70 = +2 points, 40 to <55 = +3 points, <40 = +4 points
6. Respiratory rate, breaths per minute: ≥50 = +4 points, 35 to <50 = +3 points, 25 to <35 = +1 point, 12 to <25 = 0 points, 10 to <12 = +1 point, 6 to <10 = +2 points, <6 = +4 points
7. Oxygenation (use PaO2 if FiO2 <50%, otherwise use Aa gradient): Aa gradient >349 = +4 points, Aa gradient 350-349 = +3 points, Aa gradient 200-349 = +2 points, Aa gradient <200 (if FiO2 over 45%) or PaO2 <70 (if FiO2 less than 50%) = +1 point, PaO2 61-70 = +1 point, PaO2 55-60 = +3 points, PaO2 <55 = +4 points
8. Arterial pH: ≥7.7 = +4 points, 7.60 to <7.70 = +3 points, 7.50 to <7.60 = +1 point, 7.33 to <7.50 = 0 points, 7.25 to <7.33 = +2 points, 7.15 to <7.25 = +3 points, <7.15 = +4 points
9. Serum sodium, mmol/L: ≥180 = +4 points, 160 to <180 = +3 points, 155 to <160 = +2 points, 150 to <155 = +1 point, 130 to <150 = 0 points, 120 to <130 = +2 points, 111 to <120 = +3 points, <111 = +4 points
10. Serum potassium, mmol/L: ≥7.0 = +4 points, 6.0 to <7.0 = +3 points, 5.5 to <6.0 = +1 point, 3.5 to <5.5 = 0 points, 3.0 to <3.5 = +1 point, 2.5 to <3.0 = +2 points, <2.5 = +4 points
11. Serum creatinine, mg/100 mL: ≥3.5 and ACUTE renal failure = +8 points, 2.0 to <3.5 and ACUTE renal failure = +6 points, ≥3.5 and CHRONIC renal failure = +4 points, 1.5 to <2.0 and ACUTE renal failure = +4 points, 2.0 to <3.5 and CHRONIC renal failure = +3 points, 1.5 to <2.0 and CHRONIC renal failure = +2 points, 0.6 to <1.5 = 0 points, <0.6 = +2 points
12. Hematocrit, %: ≥60 = +4 points, 50 to <60 = +2 points, 46 to <50 = +1 point, 30 to <46 = 0 points, 20 to <30 = +2 points, <20 = +4 points
13. White blood count, total/cubic mm in 10^3: ≥40 = +4 points, 20 to <40 = +2 points, 15 to <20 = +1 point, 3 to <15 = 0 points, 1 to <3 = +2 points, <1 = +4 points
14. Glasgow Coma Scale (GCS): 1-15 points (use 15 - [GCS Score])

The total APACHE II score is calculated by summing the points for each criterion.
    
The patient's current APACHE II score is 0 points.
The patient is 61.0 years old. Because the patient's age is between 55 and 64, 3 points are added to the total, making the current total, 0 + 3 = 3.
The patient note does not report any history on immunocompromise and so we assume this to be false. Hence, 0 points are added to the total, keeping the total at 3 points.
The patient's FiO2 percentage is 53.0%.
Because the patent's FiO2 percentrage is greater than 50%, we need to examine the A-a-gradient to compute the APACHE II score. The patient's A-a-gradient is 445. Because the patient's A-a gradient is between 350 and 500, we add 3 points to the total, making the current total 3 + 3 = 6.
The patient's temperature is 37.0 degrees celsius. 
Because the patient's temperature is between 36 and 38.5 degrees celsius, no points are added to the score, keeping the current total at 6.
The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 130.0 mm Hg + 2/3 * 74.0 mm Hg = 92.667 mm Hg.
Hence, the patient's mean arterial pressure is 92.667 mm Hg.Because the patient's mean arterial pressure is between 70 and 109 mmHg, 0 points are added to the patient's score, keeping the total at 6.
The patient's heart rate is 98.0 beats per minute.
Because the patient's heart rate is between 70 and 109 beats per minute, 0 points are added to the patient's score, keeping the total at 6.
The patient's respiratory rate is 18.0 breaths per minute.
Because the patient's respiratory rate is between 12 and 24 breaths per minute, 0 points are added to the patient's score, keeping the total at 6.
The patient's pH is 7.33.
Because the patient's pH is between 7.33 and 7.49, 0 points are added to the patient's score, keeping the total at 6.
The concentration of sodium is 141.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 141.0 mEq. To convert from 141.0 mEq to mmol, convert from mEq to mmol. The compound 141.0 has a valence of 1, and so divide the valence by the value of mEq to get, 141.0 mEq/(1 mEq/mmol) = 141.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 141.0 mEq sodium/L converts to 141.0 mmol sodium/L. Because the patient's sodium level is between 130 and 149 mmol/L, 0 points are added to the patient's score, keeping the total at 6.
The concentration of potassium is 4.4 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of potassium from mEq to mmol. The mass of potassium is 4.4 mEq. To convert from 4.4 mEq to mmol, convert from mEq to mmol. The compound 4.4 has a valence of 1, and so divide the valence by the value of mEq to get, 4.4 mEq/(1 mEq/mmol) = 4.4 mmol potassium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 4.4 mEq potassium/L converts to 4.4 mmol potassium/L. Because the patient's potassium level is between 3.5 and 5.4 mmol/L, 0 points are added to the patient's score, keeping the total at 6.
The concentration of creatinine is 1.8 mg/dL. The patient is determined to not have an acute renal failure.
The patient is determined to have a chronic renal failure.
Because the patient has chronic renal failure and a creatinine level between 1.5 and 2.0, 2 points are added to the score, making the current total 6 + 2 = 8.
The patient has a hematocrit of 42.0%.
Because the patient's hematocrit is between 30% and 45%, 0 points are added to the patient's score, keeping the total at 8.
The patient's concentration of white blood cell count is 8000.0 count/µL. To convert 8000.0 count/µL of white blood cell count to L, multiply by the conversion factor 1000000.0 µL/L which will give 8000.0 white blood cell count count/µL * 1000000.0 µL/L = 8000000000.0 white blood cell count count/L. Because the patient's white blood cell count is at least 3x10^9/L, but less than 15 x10^9/L, 0 points are added to the patient's score, keeping the total at 8.
The patient's Glasgow Coma Score is 14. For this criterion, we subtract 15 from the 14 points and add that to the total score. 15 - 14 = 1. Hence, we add 1 to the total making the current total 1 + 8 = 9.
Hence, the patient's APACHE II score is 9."
886,28,APACHE II Score,risk,integer,19,Handwritten,"The patient in question is a 68-year-old individual, known to have previously experienced severe liver failure managed with medications. He also had chronic kidney disease stage I. Currently, the individual presented to the outpatient clinic, complaining of increased fatigue. On physical examination, the patient exhibited a body temperature of 37.6 degrees celsius with a heart rate of 89 beats per minute. Blood pressure was measured at 110/72 mm Hg and respiratory rate was recorded as 16 breaths per minute. Neurologic evaluation yielded a perfect Glasgow Coma Score of 15. The laboratory results specified creatinine at 1.3 mg/dL, combined with a white blood cell count of 7000/µL. The sodium level is towards the lower end of normal at 136 mEq/L with potassium within the normal range, documented at 4.2 mEq/L. The patient's arterial blood gas showed a typical pH of 7.4 with a partial pressure of oxygen (PaO₂) being 78 mm Hg on 45 % FiO₂. The hematocrit level was mildly reduced to 38%. Given the patient's history of severe organ failure, the current clinical context and the elevated creatinine levels necessitate further evaluation and careful monitoring.",What is the patient's APACHE II score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [89.0, 'beats per minute'], 'Diastolic Blood Pressure': [72.0, 'mm Hg'], 'pH': 7.4, 'Systolic Blood Pressure': [110.0, 'mm Hg'], 'History of severe organ failure or immunocompromise': True, 'creatinine': [1.3, 'mg/dL'], 'White blood cell count': [7000.0, 'µL'], 'Sodium': [136.0, 'mEq/L'], 'Potassium': [4.2, 'mEq/L'], 'age': [68.0, 'years'], 'respiratory rate': [16.0, 'breaths per minute'], 'Glasgow Coma Score': 15.0, 'Hematocrit': [38.0, '%'], 'Temperature': [37.6, 'degrees celsius'], 'Surgery Type': 'Nonoperative', 'PaO2': [78.0, 'mm Hg'], 'FiO2': [45.0, '%']}",5,5,5,"The criteria for the APACHE II Score are listed below:

1. Age, years: ≤44 = 0 points, 45-54 = +2 points, 55-64 = +3 points, 65-74 = +5 points, ≥75 = +6 points
2. History of severe organ insufficiency or immunocompromised: Yes, nonoperative or emergency postoperative patient = +5 points, Yes, elective postoperative patient = +2 points, No = 0 points
3. Rectal temperature, °C: ≥41 = +4 points, 39 to <41 = +3 points, 38.5 to <39 = +1 point, 36 to <38.5 = 0 points, 34 to <36 = +1 point, 32 to <34 = +2 points, 30 to <32 = +3 points, <30 = +4 points
4. Mean arterial pressure, mmHg: ≥160 = +4 points, 130-159 = +3 points, 110-129 = +2 points, 70-109 = 0 points, 50-69 = +2 points, 40-49 = +3 points, <40 = +4 points
5. Heart rate, beats per minute: ≥180 = +4 points, 140 to <180 = +3 points, 110 to <140 = +2 points, 70 to <110 = 0 points, 55 to <70 = +2 points, 40 to <55 = +3 points, <40 = +4 points
6. Respiratory rate, breaths per minute: ≥50 = +4 points, 35 to <50 = +3 points, 25 to <35 = +1 point, 12 to <25 = 0 points, 10 to <12 = +1 point, 6 to <10 = +2 points, <6 = +4 points
7. Oxygenation (use PaO2 if FiO2 <50%, otherwise use Aa gradient): Aa gradient >349 = +4 points, Aa gradient 350-349 = +3 points, Aa gradient 200-349 = +2 points, Aa gradient <200 (if FiO2 over 45%) or PaO2 <70 (if FiO2 less than 50%) = +1 point, PaO2 61-70 = +1 point, PaO2 55-60 = +3 points, PaO2 <55 = +4 points
8. Arterial pH: ≥7.7 = +4 points, 7.60 to <7.70 = +3 points, 7.50 to <7.60 = +1 point, 7.33 to <7.50 = 0 points, 7.25 to <7.33 = +2 points, 7.15 to <7.25 = +3 points, <7.15 = +4 points
9. Serum sodium, mmol/L: ≥180 = +4 points, 160 to <180 = +3 points, 155 to <160 = +2 points, 150 to <155 = +1 point, 130 to <150 = 0 points, 120 to <130 = +2 points, 111 to <120 = +3 points, <111 = +4 points
10. Serum potassium, mmol/L: ≥7.0 = +4 points, 6.0 to <7.0 = +3 points, 5.5 to <6.0 = +1 point, 3.5 to <5.5 = 0 points, 3.0 to <3.5 = +1 point, 2.5 to <3.0 = +2 points, <2.5 = +4 points
11. Serum creatinine, mg/100 mL: ≥3.5 and ACUTE renal failure = +8 points, 2.0 to <3.5 and ACUTE renal failure = +6 points, ≥3.5 and CHRONIC renal failure = +4 points, 1.5 to <2.0 and ACUTE renal failure = +4 points, 2.0 to <3.5 and CHRONIC renal failure = +3 points, 1.5 to <2.0 and CHRONIC renal failure = +2 points, 0.6 to <1.5 = 0 points, <0.6 = +2 points
12. Hematocrit, %: ≥60 = +4 points, 50 to <60 = +2 points, 46 to <50 = +1 point, 30 to <46 = 0 points, 20 to <30 = +2 points, <20 = +4 points
13. White blood count, total/cubic mm in 10^3: ≥40 = +4 points, 20 to <40 = +2 points, 15 to <20 = +1 point, 3 to <15 = 0 points, 1 to <3 = +2 points, <1 = +4 points
14. Glasgow Coma Scale (GCS): 1-15 points (use 15 - [GCS Score])

The total APACHE II score is calculated by summing the points for each criterion.
    
The patient's current APACHE II score is 0 points.
The patient is 68.0 years old. Because the patient's age is between 65 and 74, 5 points are added to the total, making the current total, 0 + 5 = 5.
The patient note does not report any history on immunocompromise and so we assume this to be false. Hence, 0 points are added to the total, keeping the total at 5 points.
The patient's FiO2 percentage is 45.0%.
Because the patent's FiO2 percentrage is less than 50%, we need to examine the patient's A-a-gradient to compute the APACHE II score. The patient's partial pressure of oxygen is 78.0 mm Hg. Because the patient's partial pressure of oxygen is more than 70 mm Hg, we do not add any points to the total, keeing the current total at 5.
The patient's temperature is 37.6 degrees celsius. 
Because the patient's temperature is between 36 and 38.5 degrees celsius, no points are added to the score, keeping the current total at 5.
The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 110.0 mm Hg + 2/3 * 72.0 mm Hg = 84.667 mm Hg.
Hence, the patient's mean arterial pressure is 84.667 mm Hg.Because the patient's mean arterial pressure is between 70 and 109 mmHg, 0 points are added to the patient's score, keeping the total at 5.
The patient's heart rate is 89.0 beats per minute.
Because the patient's heart rate is between 70 and 109 beats per minute, 0 points are added to the patient's score, keeping the total at 5.
The patient's respiratory rate is 16.0 breaths per minute.
Because the patient's respiratory rate is between 12 and 24 breaths per minute, 0 points are added to the patient's score, keeping the total at 5.
The patient's pH is 7.4.
Because the patient's pH is between 7.33 and 7.49, 0 points are added to the patient's score, keeping the total at 5.
The concentration of sodium is 136.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 136.0 mEq. To convert from 136.0 mEq to mmol, convert from mEq to mmol. The compound 136.0 has a valence of 1, and so divide the valence by the value of mEq to get, 136.0 mEq/(1 mEq/mmol) = 136.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 136.0 mEq sodium/L converts to 136.0 mmol sodium/L. Because the patient's sodium level is between 130 and 149 mmol/L, 0 points are added to the patient's score, keeping the total at 5.
The concentration of potassium is 4.2 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of potassium from mEq to mmol. The mass of potassium is 4.2 mEq. To convert from 4.2 mEq to mmol, convert from mEq to mmol. The compound 4.2 has a valence of 1, and so divide the valence by the value of mEq to get, 4.2 mEq/(1 mEq/mmol) = 4.2 mmol potassium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 4.2 mEq potassium/L converts to 4.2 mmol potassium/L. Because the patient's potassium level is between 3.5 and 5.4 mmol/L, 0 points are added to the patient's score, keeping the total at 5.
The concentration of creatinine is 1.3 mg/dL. The patient is determined to not have an acute renal failure.
The patient is determined to not have a chronic renal failure.
Because the patient's creatinine level is between 0.6 and 1.4, no points are added to the score, keeping the current total at 5.
The patient has a hematocrit of 38.0%.
Because the patient's hematocrit is between 30% and 45%, 0 points are added to the patient's score, keeping the total at 5.
The patient's concentration of white blood cell count is 7000.0 count/µL. To convert 7000.0 count/µL of white blood cell count to L, multiply by the conversion factor 1000000.0 µL/L which will give 7000.0 white blood cell count count/µL * 1000000.0 µL/L = 7000000000.0 white blood cell count count/L. Because the patient's white blood cell count is at least 3x10^9/L, but less than 15 x10^9/L, 0 points are added to the patient's score, keeping the total at 5.
The patient's Glasgow Coma Score is 15. For this criterion, we subtract 15 from the 15 points and add that to the total score. 15 - 15 = 0. Hence, we add 0 to the total making the current total 0 + 5 = 5.
Hence, the patient's APACHE II score is 5."
887,28,APACHE II Score,risk,integer,20,Handwritten,"A 64-year-old male presents to the ICU department with complaints of feeling lethargic and general malaise. The patient exhibited a body temperature of 37.1 degrees celsius, heart rate of 93 beats per minute, blood pressure measured to be 115/75 mm Hg, and a respiratory rate of 14 breaths per minute. Neurological examination conducted revealed the patient to have full consciousness with a Glasgow Coma Score at 15. Laboratory results indicated an elevation in creatinine level, documented at 1.4 mg/dL, suggestive of some level of renal impairment, and a white blood cell count of 7300 count/µL. Electrolyte analysis showed sodium level of 138 mEq/L and a potassium level of 4.6 mEq/L. The patient's arterial blood gas analysis showed a pH of 7.34 in conjunction with a patient maintaining a partial pressure of oxygen (PaO₂) of 77 mm Hg on a supplementary FiO₂ of 46%. The hematocrit was slightly below average at 38%. Considering the lab results along with the patient's general feeling of malaise, further diagnostic tests are in order to rule out additional potential underlying pathologies.",What is the patient's APACHE II score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Heart Rate or Pulse': [93.0, 'beats per minute'], 'Diastolic Blood Pressure': [75.0, 'mm Hg'], 'pH': 7.34, 'Systolic Blood Pressure': [115.0, 'mm Hg'], 'Acute renal failure': False, 'creatinine': [1.4, 'mg/dL'], 'White blood cell count': [7300.0, 'µL'], 'Sodium': [138.0, 'mEq/L'], 'Potassium': [4.6, 'mEq/L'], 'age': [64.0, 'years'], 'respiratory rate': [14.0, 'breaths per minute'], 'Chronic renal failure': False, 'Glasgow Coma Score': 15.0, 'Hematocrit': [38.0, '%'], 'Temperature': [37.1, 'degrees celsius'], 'PaO2': [77.0, 'mm Hg'], 'FiO2': [46.0, '%']}",3,3,3,"The criteria for the APACHE II Score are listed below:

1. Age, years: ≤44 = 0 points, 45-54 = +2 points, 55-64 = +3 points, 65-74 = +5 points, ≥75 = +6 points
2. History of severe organ insufficiency or immunocompromised: Yes, nonoperative or emergency postoperative patient = +5 points, Yes, elective postoperative patient = +2 points, No = 0 points
3. Rectal temperature, °C: ≥41 = +4 points, 39 to <41 = +3 points, 38.5 to <39 = +1 point, 36 to <38.5 = 0 points, 34 to <36 = +1 point, 32 to <34 = +2 points, 30 to <32 = +3 points, <30 = +4 points
4. Mean arterial pressure, mmHg: ≥160 = +4 points, 130-159 = +3 points, 110-129 = +2 points, 70-109 = 0 points, 50-69 = +2 points, 40-49 = +3 points, <40 = +4 points
5. Heart rate, beats per minute: ≥180 = +4 points, 140 to <180 = +3 points, 110 to <140 = +2 points, 70 to <110 = 0 points, 55 to <70 = +2 points, 40 to <55 = +3 points, <40 = +4 points
6. Respiratory rate, breaths per minute: ≥50 = +4 points, 35 to <50 = +3 points, 25 to <35 = +1 point, 12 to <25 = 0 points, 10 to <12 = +1 point, 6 to <10 = +2 points, <6 = +4 points
7. Oxygenation (use PaO2 if FiO2 <50%, otherwise use Aa gradient): Aa gradient >349 = +4 points, Aa gradient 350-349 = +3 points, Aa gradient 200-349 = +2 points, Aa gradient <200 (if FiO2 over 45%) or PaO2 <70 (if FiO2 less than 50%) = +1 point, PaO2 61-70 = +1 point, PaO2 55-60 = +3 points, PaO2 <55 = +4 points
8. Arterial pH: ≥7.7 = +4 points, 7.60 to <7.70 = +3 points, 7.50 to <7.60 = +1 point, 7.33 to <7.50 = 0 points, 7.25 to <7.33 = +2 points, 7.15 to <7.25 = +3 points, <7.15 = +4 points
9. Serum sodium, mmol/L: ≥180 = +4 points, 160 to <180 = +3 points, 155 to <160 = +2 points, 150 to <155 = +1 point, 130 to <150 = 0 points, 120 to <130 = +2 points, 111 to <120 = +3 points, <111 = +4 points
10. Serum potassium, mmol/L: ≥7.0 = +4 points, 6.0 to <7.0 = +3 points, 5.5 to <6.0 = +1 point, 3.5 to <5.5 = 0 points, 3.0 to <3.5 = +1 point, 2.5 to <3.0 = +2 points, <2.5 = +4 points
11. Serum creatinine, mg/100 mL: ≥3.5 and ACUTE renal failure = +8 points, 2.0 to <3.5 and ACUTE renal failure = +6 points, ≥3.5 and CHRONIC renal failure = +4 points, 1.5 to <2.0 and ACUTE renal failure = +4 points, 2.0 to <3.5 and CHRONIC renal failure = +3 points, 1.5 to <2.0 and CHRONIC renal failure = +2 points, 0.6 to <1.5 = 0 points, <0.6 = +2 points
12. Hematocrit, %: ≥60 = +4 points, 50 to <60 = +2 points, 46 to <50 = +1 point, 30 to <46 = 0 points, 20 to <30 = +2 points, <20 = +4 points
13. White blood count, total/cubic mm in 10^3: ≥40 = +4 points, 20 to <40 = +2 points, 15 to <20 = +1 point, 3 to <15 = 0 points, 1 to <3 = +2 points, <1 = +4 points
14. Glasgow Coma Scale (GCS): 1-15 points (use 15 - [GCS Score])

The total APACHE II score is calculated by summing the points for each criterion.
    
The patient's current APACHE II score is 0 points.
The patient is 64.0 years old. Because the patient's age is between 55 and 64, 3 points are added to the total, making the current total, 0 + 3 = 3.
The patient note does not report any history on immunocompromise and so we assume this to be false. Hence, 0 points are added to the total, keeping the total at 3 points.
The patient's FiO2 percentage is 46.0%.
Because the patent's FiO2 percentrage is less than 50%, we need to examine the patient's A-a-gradient to compute the APACHE II score. The patient's partial pressure of oxygen is 77.0 mm Hg. Because the patient's partial pressure of oxygen is more than 70 mm Hg, we do not add any points to the total, keeing the current total at 3.
The patient's temperature is 37.1 degrees celsius. 
Because the patient's temperature is between 36 and 38.5 degrees celsius, no points are added to the score, keeping the current total at 3.
The mean average pressure is computed by the formula 1/3 * (systolic blood pressure) + 2/3 * (diastolic blood pressure). Plugging in the values, we get 1/3 * 115.0 mm Hg + 2/3 * 75.0 mm Hg = 88.333 mm Hg.
Hence, the patient's mean arterial pressure is 88.333 mm Hg.Because the patient's mean arterial pressure is between 70 and 109 mmHg, 0 points are added to the patient's score, keeping the total at 3.
The patient's heart rate is 93.0 beats per minute.
Because the patient's heart rate is between 70 and 109 beats per minute, 0 points are added to the patient's score, keeping the total at 3.
The patient's respiratory rate is 14.0 breaths per minute.
Because the patient's respiratory rate is between 12 and 24 breaths per minute, 0 points are added to the patient's score, keeping the total at 3.
The patient's pH is 7.34.
Because the patient's pH is between 7.33 and 7.49, 0 points are added to the patient's score, keeping the total at 3.
The concentration of sodium is 138.0 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of sodium from mEq to mmol. The mass of sodium is 138.0 mEq. To convert from 138.0 mEq to mmol, convert from mEq to mmol. The compound 138.0 has a valence of 1, and so divide the valence by the value of mEq to get, 138.0 mEq/(1 mEq/mmol) = 138.0 mmol sodium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 138.0 mEq sodium/L converts to 138.0 mmol sodium/L. Because the patient's sodium level is between 130 and 149 mmol/L, 0 points are added to the patient's score, keeping the total at 3.
The concentration of potassium is 4.6 mEq/L. We need to convert the concentration to mmol/L. Let's first convert the mass of potassium from mEq to mmol. The mass of potassium is 4.6 mEq. To convert from 4.6 mEq to mmol, convert from mEq to mmol. The compound 4.6 has a valence of 1, and so divide the valence by the value of mEq to get, 4.6 mEq/(1 mEq/mmol) = 4.6 mmol potassium. The volume units is L so no volume conversion is needed. Hence, the concentration value of 4.6 mEq potassium/L converts to 4.6 mmol potassium/L. Because the patient's potassium level is between 3.5 and 5.4 mmol/L, 0 points are added to the patient's score, keeping the total at 3.
The concentration of creatinine is 1.4 mg/dL. The patient is determined to not have an acute renal failure.
The patient is determined to not have a chronic renal failure.
Because the patient's creatinine level is between 0.6 and 1.4, no points are added to the score, keeping the current total at 3.
The patient has a hematocrit of 38.0%.
Because the patient's hematocrit is between 30% and 45%, 0 points are added to the patient's score, keeping the total at 3.
The patient's concentration of white blood cell count is 7300.0 count/µL. To convert 7300.0 count/µL of white blood cell count to L, multiply by the conversion factor 1000000.0 µL/L which will give 7300.0 white blood cell count count/µL * 1000000.0 µL/L = 7300000000.0 white blood cell count count/L. Because the patient's white blood cell count is at least 3x10^9/L, but less than 15 x10^9/L, 0 points are added to the patient's score, keeping the total at 3.
The patient's Glasgow Coma Score is 15. For this criterion, we subtract 15 from the 15 points and add that to the total score. 15 - 15 = 0. Hence, we add 0 to the total making the current total 0 + 3 = 3.
Hence, the patient's APACHE II score is 3."
888,43,Sequential Organ Failure Assessment (SOFA) Score,risk,integer,1,Handwritten,"A 68-year-old male presents with a significant medical history, a BP of 63/41 and altered mental status (GCS: eye response to pain, inappropriate word use, withdrawls from pain). He is currently on mechanical ventilation with a fraction of inspired oxygen (FiO₂) set at 60 %, and is not on continuous positive airway pressure. His recent laboratory evaluations reveal a creatinine level of 121.32 µmol/L, indicating some degree of renal impairment. Additionally, his bilirubin level is elevated at 88.41 µmol/L, suggestive of possible liver dysfunction. His platelet count stands at 140,400 per microliter. The partial pressure of oxygen (PaO₂) measured at 76 mm Hg indicates compromised oxygenation. The patient has no urine output noted, raising concerns for renal or urinary complications. ",What is the patient's Sequential Organ Failure Assessment (SOFA) Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'On mechanical ventilation': True, 'Hypotension': True, 'Glasgow Coma Score': 9.0, 'creatinine': [121.32, 'µmol/L'], 'Bilirubin': [88.41, 'µmol/L'], 'Platelet count': [140400.0, 'µL'], 'Continuous positive airway pressure': False, 'Systolic Blood Pressure': [63, 'mm Hg'], 'Diastolic Blood Pressure': [41, 'mm Hg'], 'PaO2': [76.0, 'mm Hg'], 'FiO2': [60.0, '%']}",8,8,8,"The patient's systolic blood pressure is 63 mm Hg and the patient's diastolic blood pressure is 41 mm Hg, making the patient's mean arterial blood pressure 48.333 mm Hg. For one point to be given, the patient's mean arterial pressure must be less than 70 mm Hg, making the current total 3 + 1 = 4.
The patient's glasgow coma score is not reported so we take it to be 15. Because the patient's glasgow coma score is 15, we add 0 points to the score, keeping the score at 4.
 The concentration of bilirubin is 88.41 µmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of bilirubin from µmol to mg. The mass of bilirubin is 88.41 µmol. To convert 88.41 µmol of bilirubin to mol, multiply by the conversion factor 1e-06, giving us 88.41 µmol bilirubin * 1e-06 mol/µmol = 8.84e-05 mol bilirubin. To convert from mol bilirubin to grams, multiply by the molar mass 584.66 g/mol, which will give 8.84e-05 mol bilirubin * 584.66 g/mol = 0.052 g bilirubin. To convert 0.052 g of bilirubin to mg, multiply by the conversion factor 1000.0, giving us 0.052 g bilirubin * 1000.0 mg/g = 52.0 mg bilirubin. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 52.0 mg bilirubin/10.0 dL = 5.2 mg bilirubin/dL. The concentration value of 88.41 µmol bilirubin/L converts to 5.2 mg bilirubin/dL. Because the patient's bilirubin concentration is at least 2.0 mg/dL, but less than 6.0 mg/dL, we increment the score by two points, make the current score 4 + 2 = 6.
The patient's concentration of platelet is 140400.0 count/µL. Because the patient's platelet count is between 100*10³/µL but less than 150*10³/µL, we increment the score by one point, making the current score 6 + 1 = 7.
The concentration of creatinine is 121.32 µmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of creatinine from µmol to mg. The mass of creatinine is 121.32 µmol. To convert 121.32 µmol of creatinine to mol, multiply by the conversion factor 1e-06, giving us 121.32 µmol creatinine * 1e-06 mol/µmol = 0.000121 mol creatinine. To convert from mol creatinine to grams, multiply by the molar mass 113.12 g/mol, which will give 0.000121 mol creatinine * 113.12 g/mol = 0.014 g creatinine. To convert 0.014 g of creatinine to mg, multiply by the conversion factor 1000.0, giving us 0.014 g creatinine * 1000.0 mg/g = 14.0 mg creatinine. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 14.0 mg creatinine/10.0 dL = 1.4 mg creatinine/dL. The concentration value of 121.32 µmol creatinine/L converts to 1.4 mg creatinine/dL. Because the patient's creatinine concentration is at least 1.2 mg/dL, but less than 2.0 mg/dL, we increment the score by one point, making the current total 7 + 1 = 8.
Hence, the patient's SOFA score is 8 points."
889,43,Sequential Organ Failure Assessment (SOFA) Score,risk,integer,2,Handwritten,"A 65-year-old male with a history of hypertension and diabetes presents with altered mental status and jaundice. He reports feeling progressively weak over the past week with associated abdominal discomfort and swelling in his lower extremities. On examination, he is lethargic with a Glasgow Coma Scale score of 10, and scleral icterus is noted. His vital signs reveal a heart rate of 90 beats per minute. Laboratory investigations reveal a serum creatinine level of 92.12 µmol/L and a total bilirubin level of 1.57 mg/L, suggesting mild renal impairment and cholestasis, respectively. Additionally, his platelet count is decreased at 88400/µL. There are signs of overt hypotension, and so the patient is receiving norepi and epi infusions at 0.1 mcg/kg/min each, with a concurrent dopamine infusion at 6.32 mcg/kg/min. The patient is currently receiving 41 % FiO₂ with continuous positive airway pressure. His partial pressure of oxygen is recorded to be 90 mm Hg. Notably, there is no urine output recorded. Given the constellation of symptoms and laboratory findings, further investigation into the etiology of his hepatic and renal dysfunction is warranted.",What is the patient's Sequential Organ Failure Assessment (SOFA) Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'norEPINEPHrine': [0.1, 'mcg/kg/min'], 'On mechanical ventilation': False, 'EPINEPHrine': [0.1, 'mcg/kg/min'], 'DOPamine': [6.32, 'mcg/kg/min'], 'Hypotension': True, 'Glasgow Coma Score': 10.0, 'creatinine': [92.12, 'µmol/L'], 'Bilirubin': [1.57, 'mg/dL'], 'Platelet count': [88400.0, 'µL'], 'Continuous positive airway pressure': True, 'PaO2': [90.0, 'mm Hg'], 'FiO2': [41.0, '%']}",8,8,8,"The criteria for the SOFA Score are shown below:
    
1. PaO₂/FiO₂ ratio (mm Hg): ≥400 = 0 points, 300-399 = +1 point, 200-299 = +2 points, 100-199 (with respiratory support) = +3 points, <100 (with respiratory support) = +4 points
2. Platelets (x10³/µL): ≥150 = 0 points, 100-149 = +1 point, 50-99 = +2 points, 20-49 = +3 points, <20 = +4 points
3. Glasgow Coma Scale (GCS): 15 = 0 points, 13-14 = +1 point, 10-12 = +2 points, 6-9 = +3 points, <6 = +4 points
4. Bilirubin (mg/dL): <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-5.9 = +2 points, 6.0-11.9 = +3 points, ≥12.0 = +4 points
5. Mean arterial pressure (MAP) or administration of vasopressors (in mcg): No hypotension = 0 points, MAP <70 mmHg = +1 point, Dopamine ≤5 or Dobutamine (any dose) = +2 points, Dopamine >5 or Epinephrine ≤0.1 or norepinephrine ≤0.1 = +3 points, Dopamine >15 or Epinephrine >0.1 or norepinephrine >0.1 = +4 points
6. Creatinine (mg/dL) or urine output: <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-3.4 = +2 points, 3.5-4.9 or urine output <500 mL/day = +3 points, ≥5.0 or urine output <200 mL/day = +4 points

The total SOFA Score is calculated by summing the points for each criterion.
    
The patient's current SOFA score is 0.
The patient's partial pressure of oxygen is 90.0 mm Hg and FiO₂ percentage is 41.0 %. This means that the patient's partial pressure of oxygen to FiO₂ ratio is 219.512. The patient is reported to not be on mechanical ventillation. The patient is reported to be using continuous positive airway pressure. Because the patient's partial pressure of oxygen to FiO₂ ratio is between 200 and 300, we increase the score by two points, makeing the current total 0 + 2 = 2.
For three points to be given, the patient must be taking more than 5 micrograms/kg/min, less than or equal to 0.1 micrograms/kg/min of epinephrine, or less than or equal to 0.1 micrograms/kg/min of norepinephrine. Because at least one of these cases is true for the patient, we increment the score by three points, making the current total 2 + 3 = 5.
The patient's glasgow coma score is not reported so we take it to be 15. Because the patient's glasgow coma score is 15, we add 0 points to the score, keeping the score at 5.
 The concentration of bilirubin is 1.57 mg/dL. Because the patient's bilirubin concentration is at least 1.2 mg/dL, but less than 2.0 mg/dL, we increment the score by one point, make the current score 5 + 1 = 6.
The patient's concentration of platelet is 88400.0 count/µL. Because the patient's platelet count is between 50*10³/µL but less than 100*10³/µL, we increment the score by two points, making the current score 6 + 2 = 8.
The concentration of creatinine is 92.12 µmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of creatinine from µmol to mg. The mass of creatinine is 92.12 µmol. To convert 92.12 µmol of creatinine to mol, multiply by the conversion factor 1e-06, giving us 92.12 µmol creatinine * 1e-06 mol/µmol = 9.21e-05 mol creatinine. To convert from mol creatinine to grams, multiply by the molar mass 113.12 g/mol, which will give 9.21e-05 mol creatinine * 113.12 g/mol = 0.01 g creatinine. To convert 0.01 g of creatinine to mg, multiply by the conversion factor 1000.0, giving us 0.01 g creatinine * 1000.0 mg/g = 10.0 mg creatinine. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 10.0 mg creatinine/10.0 dL = 1.0 mg creatinine/dL. The concentration value of 92.12 µmol creatinine/L converts to 1.0 mg creatinine/dL. Because the patient's creatinine concentration is less than 1.2 mg/dL, we do not add any points to the score, keeping the current total at 8.
Hence, the patient's SOFA score is 8 points."
890,43,Sequential Organ Failure Assessment (SOFA) Score,risk,integer,3,Handwritten,"A 62-year-old male with a history of diabetes has been hospitalized for severe fatigue and weight loss. Despite manifesting a clear and oriented mental status, Glasgow Coma Score of 15, he displays other concerning symptoms. Neurological examination showed no abnormalities; however, lab workup revealed elevated bilirubin levels of 7.43 mg/dL. As well, impaired renal function was evident from a creatinine level of 2.56 mg/dL. Intravenous vasopressors, specifically EPINEPHrine of 0.33 mcg/kg/min and DOPamine of 9.1 mcg/kg/min, were administered to maintain a stable circulatory status, the patient currently is not presenting signs of hypotension, furthermore, the patient is not currently on mechanical ventilation or continuous positive airway pressure, with a fraction of inspired oxygen (FiO₂) at 53% and a measured partial pressure of oxygen (PaO₂) of 87 mm Hg. Thrombocytopenia was noted with a platelet count of 75,300/µL. ",What is the patient's Sequential Organ Failure Assessment (SOFA) Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'On mechanical ventilation': False, 'EPINEPHrine': [0.33, 'mcg/kg/min'], 'DOPamine': [9.1, 'mcg/kg/min'], 'Glasgow Coma Score': 15.0, 'creatinine': [2.56, 'mg/dL'], 'Bilirubin': [7.43, 'mg/dL'], 'Platelet count': [75300.0, 'µL'], 'Continuous positive airway pressure': False, 'PaO2': [87.0, 'mm Hg'], 'FiO2': [53.0, '%']}",13,13,13,"The criteria for the SOFA Score are shown below:
    
1. PaO₂/FiO₂ ratio (mm Hg): ≥400 = 0 points, 300-399 = +1 point, 200-299 = +2 points, 100-199 (with respiratory support) = +3 points, <100 (with respiratory support) = +4 points
2. Platelets (x10³/µL): ≥150 = 0 points, 100-149 = +1 point, 50-99 = +2 points, 20-49 = +3 points, <20 = +4 points
3. Glasgow Coma Scale (GCS): 15 = 0 points, 13-14 = +1 point, 10-12 = +2 points, 6-9 = +3 points, <6 = +4 points
4. Bilirubin (mg/dL): <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-5.9 = +2 points, 6.0-11.9 = +3 points, ≥12.0 = +4 points
5. Mean arterial pressure (MAP) or administration of vasopressors (in mcg): No hypotension = 0 points, MAP <70 mmHg = +1 point, Dopamine ≤5 or Dobutamine (any dose) = +2 points, Dopamine >5 or Epinephrine ≤0.1 or norepinephrine ≤0.1 = +3 points, Dopamine >15 or Epinephrine >0.1 or norepinephrine >0.1 = +4 points
6. Creatinine (mg/dL) or urine output: <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-3.4 = +2 points, 3.5-4.9 or urine output <500 mL/day = +3 points, ≥5.0 or urine output <200 mL/day = +4 points

The total SOFA Score is calculated by summing the points for each criterion.
    
The patient's current SOFA score is 0.
The patient's partial pressure of oxygen is 87.0 mm Hg and FiO₂ percentage is 53.0 %. This means that the patient's partial pressure of oxygen to FiO₂ ratio is 164.151. The patient is reported to not be on mechanical ventillation. The patient is reported to not be using continuous positive airway pressure. Because the patient's partial pressure of oxygen to FiO₂ ratio is less than 200, the patient is not on mechanical ventillation and is not using continious positive airway pressure, we increase the score by two points, making the current total 0 + 2 = 2.
For four points to be given, the patient must be taking more than 15 micrograms/kg/min, more than 0.1 micrograms/kg/min of epinephrine, or more than 0.1 micrograms/kg/min of norepinephrine. Because at least one of these cases is true for the patient, we increment the score by four points, making the current total 2 + 4 = 6.
The patient's glasgow coma score is not reported so we take it to be 15. Because the patient's glasgow coma score is 15, we add 0 points to the score, keeping the score at 6.
 The concentration of bilirubin is 7.43 mg/dL. Because the patient's bilirubin concentration is at least 6.0 mg/dL but less than 12.0 mg/dL, we increment the score by three points, make the current score 6 + 3 = 9.
The patient's concentration of platelet is 75300.0 count/µL. Because the patient's platelet count is between 50*10³/µL but less than 100*10³/µL, we increment the score by two points, making the current score 9 + 2 = 11.
The concentration of creatinine is 2.56 mg/dL. Because the patient's creatinine concentration is at least 2.0 mg/dL but less than 3.5 mg/dL, we increment the score by two points, making the current total 11 + 2 = 13.
Hence, the patient's SOFA score is 13 points."
891,43,Sequential Organ Failure Assessment (SOFA) Score,risk,integer,4,Handwritten,"A 74-year-old female was admitted with multiple organ dysfunction. Despite her being afebrile, the neurology consultants noted a serious decrease in her level of consciousness, and her Glasgow Coma Score was 8/15. She has been normotensive and has not required vasopressors. Her FiO₂ was recorded at 71%, with a PaO₂ of 87 mm Hg. She's been on continuous veno-venous hemodialysis during the previous week with limited urine output of only 132 mL/day. She had significant jaundice with an elevated bilirubin level of 3.32 mg/dL. Her platelet count is 87,000/μL.",What is the patient's Sequential Organ Failure Assessment (SOFA) Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'On mechanical ventilation': False, 'Urine Output': [132, 'mL/day'], 'Glasgow Coma Score': 8.0, 'Bilirubin': [3.32, 'mg/dL'], 'Platelet count': [87000.0, 'µL'], 'Continuous positive airway pressure': False, 'PaO2': [87.0, 'mm Hg'], 'FiO2': [71.0, '%']}",10,10,10,"The criteria for the SOFA Score are shown below:
    
1. PaO₂/FiO₂ ratio (mm Hg): ≥400 = 0 points, 300-399 = +1 point, 200-299 = +2 points, 100-199 (with respiratory support) = +3 points, <100 (with respiratory support) = +4 points
2. Platelets (x10³/µL): ≥150 = 0 points, 100-149 = +1 point, 50-99 = +2 points, 20-49 = +3 points, <20 = +4 points
3. Glasgow Coma Scale (GCS): 15 = 0 points, 13-14 = +1 point, 10-12 = +2 points, 6-9 = +3 points, <6 = +4 points
4. Bilirubin (mg/dL): <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-5.9 = +2 points, 6.0-11.9 = +3 points, ≥12.0 = +4 points
5. Mean arterial pressure (MAP) or administration of vasopressors (in mcg): No hypotension = 0 points, MAP <70 mmHg = +1 point, Dopamine ≤5 or Dobutamine (any dose) = +2 points, Dopamine >5 or Epinephrine ≤0.1 or norepinephrine ≤0.1 = +3 points, Dopamine >15 or Epinephrine >0.1 or norepinephrine >0.1 = +4 points
6. Creatinine (mg/dL) or urine output: <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-3.4 = +2 points, 3.5-4.9 or urine output <500 mL/day = +3 points, ≥5.0 or urine output <200 mL/day = +4 points

The total SOFA Score is calculated by summing the points for each criterion.
    
The patient's current SOFA score is 0.
The patient's partial pressure of oxygen is 87.0 mm Hg and FiO₂ percentage is 71.0 %. This means that the patient's partial pressure of oxygen to FiO₂ ratio is 122.535. The patient is reported to not be on mechanical ventillation. The patient is reported to not be using continuous positive airway pressure. Because the patient's partial pressure of oxygen to FiO₂ ratio is less than 200, the patient is not on mechanical ventillation and is not using continious positive airway pressure, we increase the score by two points, making the current total 0 + 2 = 2.
Whether the patient has hypotension is not reported, and so we do not add any points to the score, keeping the current total at 2.
The patient's glasgow coma score is not reported so we take it to be 15. Because the patient's glasgow coma score is 15, we add 0 points to the score, keeping the score at 2.
 The concentration of bilirubin is 3.32 mg/dL. Because the patient's bilirubin concentration is at least 2.0 mg/dL, but less than 6.0 mg/dL, we increment the score by two points, make the current score 2 + 2 = 4.
The patient's concentration of platelet is 87000.0 count/µL. Because the patient's platelet count is between 50*10³/µL but less than 100*10³/µL, we increment the score by two points, making the current score 4 + 2 = 6.
The patients urine output is 132 mL/day.

For four points to be given, either the patient's creatinine clearance must be greater than 5.0 mg/dL or the patient's urine output is less than 200 mL/day. Because at least one of these statemets is true, we increment the score by four points, making the current total 6 + 4 = 10.
Hence, the patient's SOFA score is 10 points."
892,43,Sequential Organ Failure Assessment (SOFA) Score,risk,integer,5,Handwritten,"A 56-year-old male with a longstanding pulmonary disorder is admitted to our ICU due to significant dyspnea and low oxygen saturation levels. He is placed on mechanical ventilation with a fraction of inspired oxygen (FiO₂) of 60%, resulting in a partial pressure of oxygen (PaO₂) of 68 mm Hg. His assessment indicates mild cognitive impairment, his Glasgow Coma Score being recorded as 13/15.  Laboratory investigations reveal a mildly elevated creatinine level of 1.5 mg/dL, along with bilirubin at 3 mg/dL. Thrombocytopenia is also present with a platelet count of 150000 µL. Although he is producing somewhat sufficient urine output, recorded at 600 mL/day, symptoms and lab results point to multiple organ dysfunction. Despite the challenging circumstances, the patient continues to show resilience and responsiveness to treatment.",What is the patient's Sequential Organ Failure Assessment (SOFA) Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Urine Output': [600, 'mL/day'], 'Platelet count': [150000.0, 'µL'], 'On mechanical ventilation': True, 'Continuous positive airway pressure': False, 'Glasgow Coma Score': 13.0, 'Bilirubin': [3.0, 'mg/dL'], 'creatinine': [1.5, 'mg/dL'], 'PaO2': [68.0, 'mm Hg'], 'FiO2': [60.0, '%']}",6,6,6,"The criteria for the SOFA Score are shown below:
    
1. PaO₂/FiO₂ ratio (mm Hg): ≥400 = 0 points, 300-399 = +1 point, 200-299 = +2 points, 100-199 (with respiratory support) = +3 points, <100 (with respiratory support) = +4 points
2. Platelets (x10³/µL): ≥150 = 0 points, 100-149 = +1 point, 50-99 = +2 points, 20-49 = +3 points, <20 = +4 points
3. Glasgow Coma Scale (GCS): 15 = 0 points, 13-14 = +1 point, 10-12 = +2 points, 6-9 = +3 points, <6 = +4 points
4. Bilirubin (mg/dL): <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-5.9 = +2 points, 6.0-11.9 = +3 points, ≥12.0 = +4 points
5. Mean arterial pressure (MAP) or administration of vasopressors (in mcg): No hypotension = 0 points, MAP <70 mmHg = +1 point, Dopamine ≤5 or Dobutamine (any dose) = +2 points, Dopamine >5 or Epinephrine ≤0.1 or norepinephrine ≤0.1 = +3 points, Dopamine >15 or Epinephrine >0.1 or norepinephrine >0.1 = +4 points
6. Creatinine (mg/dL) or urine output: <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-3.4 = +2 points, 3.5-4.9 or urine output <500 mL/day = +3 points, ≥5.0 or urine output <200 mL/day = +4 points

The total SOFA Score is calculated by summing the points for each criterion.
    
The patient's current SOFA score is 0.
The patient's partial pressure of oxygen is 68.0 mm Hg and FiO₂ percentage is 60.0 %. This means that the patient's partial pressure of oxygen to FiO₂ ratio is 113.333. The patient is reported to be on mechanical ventillation. The patient is reported to not be using continuous positive airway pressure. Because the patient's partial pressure of oxygen to FiO₂ ratio is between 100 to 199, and the patient is using at least one of (i) mechanical ventillation or (ii) continious positive airway pressure, we increase the score by three points, makeing the current total 0 + 3 = 3.
Whether the patient has hypotension is not reported, and so we do not add any points to the score, keeping the current total at 3.
The patient's glasgow coma score is not reported so we take it to be 15. Because the patient's glasgow coma score is 15, we add 0 points to the score, keeping the score at 3.
 The concentration of bilirubin is 3.0 mg/dL. Because the patient's bilirubin concentration is at least 2.0 mg/dL, but less than 6.0 mg/dL, we increment the score by two points, make the current score 3 + 2 = 5.
The patient's concentration of platelet is 150000.0 count/µL. Because the patient's platelet count is at least 150*10³/µL, we do not any points to the score, keeping the current score at 5.
The concentration of creatinine is 1.5 mg/dL. The patients urine output is 600 mL/day.

Because the patient's creatinine concentration is at least 1.2 mg/dL, but less than 2.0 mg/dL, we increment the score by one point, making the current total 5 + 1 = 6.
Hence, the patient's SOFA score is 6 points."
893,43,Sequential Organ Failure Assessment (SOFA) Score,risk,integer,6,Handwritten,"A 67-year-old female patient was admitted to the ICU due to rapidly decreasing levels of consciousness. Her current status is best reflected by a Glasgow Coma Score of nine, indicative of a severe impairment in her cognitive and physical response. Hemodynamic stability is maintained because of the patient's low blood pressure. Our patient is currently on continuous positive airway pressure, with a fraction of inspired oxygen (FiO₂) of 50%, and a measured partial pressure of oxygen (PaO₂) of 80 mm Hg. Vasopressor therapy has been initiated with DOPamine of 2 mcg/kg/min, norEPINEPHrine at a rate of 0.07 mcg/kg/min, DOBUTamine running at 5 mcg/kg/min, and EPINEPHrine at 0.08 mcg/kg/min to maintain an appropriate systemic circulatory state. Her urine output has been adequate at around 700 mL/day. Lab findings revealed mild renal impairment with a serum creatinine of 150 µmol/L and measure of bilirubin at 2.5 mg/dL, might suggest mild hepatic dysfunction. Her platelet counts measures 200,000/µL, which lies within normal range.",What is the patient's Sequential Organ Failure Assessment (SOFA) Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Urine Output': [700, 'mL/day'], 'DOPamine': [2.0, 'mcg/kg/min'], 'norEPINEPHrine': [0.07, 'mcg/kg/min'], 'Bilirubin': [2.5, 'mg/dL'], 'creatinine': [150.0, 'µmol/L'], 'DOBUTamine': [5.0, 'mcg/kg/min'], 'Platelet count': [200000.0, 'µL'], 'Hypotension': True, 'Glasgow Coma Score': 9, 'EPINEPHrine': [0.08, 'mcg/kg/min'], 'On mechanical ventilation': False, 'Continuous positive airway pressure': True, 'PaO2': [80, 'mm Hg'], 'FiO2': [50, '%']}",9,9,9,"The criteria for the SOFA Score are shown below:
    
1. PaO₂/FiO₂ ratio (mm Hg): ≥400 = 0 points, 300-399 = +1 point, 200-299 = +2 points, 100-199 (with respiratory support) = +3 points, <100 (with respiratory support) = +4 points
2. Platelets (x10³/µL): ≥150 = 0 points, 100-149 = +1 point, 50-99 = +2 points, 20-49 = +3 points, <20 = +4 points
3. Glasgow Coma Scale (GCS): 15 = 0 points, 13-14 = +1 point, 10-12 = +2 points, 6-9 = +3 points, <6 = +4 points
4. Bilirubin (mg/dL): <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-5.9 = +2 points, 6.0-11.9 = +3 points, ≥12.0 = +4 points
5. Mean arterial pressure (MAP) or administration of vasopressors (in mcg): No hypotension = 0 points, MAP <70 mmHg = +1 point, Dopamine ≤5 or Dobutamine (any dose) = +2 points, Dopamine >5 or Epinephrine ≤0.1 or norepinephrine ≤0.1 = +3 points, Dopamine >15 or Epinephrine >0.1 or norepinephrine >0.1 = +4 points
6. Creatinine (mg/dL) or urine output: <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-3.4 = +2 points, 3.5-4.9 or urine output <500 mL/day = +3 points, ≥5.0 or urine output <200 mL/day = +4 points

The total SOFA Score is calculated by summing the points for each criterion.
    
The patient's current SOFA score is 0.
The patient's partial pressure of oxygen is 80 mm Hg and FiO₂ percentage is 50 %. This means that the patient's partial pressure of oxygen to FiO₂ ratio is 160.0. The patient is reported to not be on mechanical ventillation. The patient is reported to be using continuous positive airway pressure. Because the patient's partial pressure of oxygen to FiO₂ ratio is between 100 to 199, and the patient is using at least one of (i) mechanical ventillation or (ii) continious positive airway pressure, we increase the score by three points, makeing the current total 0 + 3 = 3.
For three points to be given, the patient must be taking more than 5 micrograms/kg/min, less than or equal to 0.1 micrograms/kg/min of epinephrine, or less than or equal to 0.1 micrograms/kg/min of norepinephrine. Because at least one of these cases is true for the patient, we increment the score by three points, making the current total 3 + 3 = 6.
The patient's glasgow coma score is not reported so we take it to be 15. Because the patient's glasgow coma score is 15, we add 0 points to the score, keeping the score at 6.
 The concentration of bilirubin is 2.5 mg/dL. Because the patient's bilirubin concentration is at least 2.0 mg/dL, but less than 6.0 mg/dL, we increment the score by two points, make the current score 6 + 2 = 8.
The patient's concentration of platelet is 200000.0 count/µL. Because the patient's platelet count is at least 150*10³/µL, we do not any points to the score, keeping the current score at 8.
The concentration of creatinine is 150.0 µmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of creatinine from µmol to mg. The mass of creatinine is 150.0 µmol. To convert 150.0 µmol of creatinine to mol, multiply by the conversion factor 1e-06, giving us 150.0 µmol creatinine * 1e-06 mol/µmol = 0.00015 mol creatinine. To convert from mol creatinine to grams, multiply by the molar mass 113.12 g/mol, which will give 0.00015 mol creatinine * 113.12 g/mol = 0.017 g creatinine. To convert 0.017 g of creatinine to mg, multiply by the conversion factor 1000.0, giving us 0.017 g creatinine * 1000.0 mg/g = 17.0 mg creatinine. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 17.0 mg creatinine/10.0 dL = 1.7 mg creatinine/dL. The concentration value of 150.0 µmol creatinine/L converts to 1.7 mg creatinine/dL. The patients urine output is 700 mL/day.

Because the patient's creatinine concentration is at least 1.2 mg/dL, but less than 2.0 mg/dL, we increment the score by one point, making the current total 8 + 1 = 9.
Hence, the patient's SOFA score is 9 points."
894,43,Sequential Organ Failure Assessment (SOFA) Score,risk,integer,7,Handwritten,"Patient is a 79-year-old woman brought in due to episodes of fainting and general weakness; she has been admitted to the ICU. A rapid decline in her cognitive functioning has been observed with a Glasgow Coma Score measuring 11, indicative of a moderate degree of impairment. Hemodynamic instability noted with her blood pressure considerably lower than what is usual. To maintain an optimal circulatory volume, her therapy includes the following: norEPINEPHrine prescribed at 0.06 mcg/kg/min and a flow of EPINEPHrine at 0.07 mcg/kg/min as well. Clinically, she does not require mechanical ventilation, at present, the fraction of inspired oxygen (FiO₂) is maintained at 45 % with measured partial pressure of oxygen (PaO₂) at 75 mm Hg. Lab reports reveal a serum creatinine level of 120 µmol/L suggestive of possibly compromised renal function; bilirubin count also appears slightly elevated at 1.8 mg/dL indicative of mild hepatic stress. Platelet count lies within a normal range reading as 180,000/µL. Her urine output has been maintained at nearly 600 mL/day.",What is the patient's Sequential Organ Failure Assessment (SOFA) Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Urine Output': [600, 'mL/day'], 'norEPINEPHrine': [0.06, 'mcg/kg/min'], 'Bilirubin': [1.8, 'mg/dL'], 'creatinine': [120.0, 'µmol/L'], 'Platelet count': [180000.0, 'µL'], 'Hypotension': True, 'On mechanical ventilation': False, 'Glasgow Coma Score': 11.0, 'EPINEPHrine': [0.07, 'mcg/kg/min'], 'Continuous positive airway pressure': False, 'PaO2': [75.0, 'mm Hg'], 'FiO2': [45.0, '%']}",7,7,7,"The criteria for the SOFA Score are shown below:
    
1. PaO₂/FiO₂ ratio (mm Hg): ≥400 = 0 points, 300-399 = +1 point, 200-299 = +2 points, 100-199 (with respiratory support) = +3 points, <100 (with respiratory support) = +4 points
2. Platelets (x10³/µL): ≥150 = 0 points, 100-149 = +1 point, 50-99 = +2 points, 20-49 = +3 points, <20 = +4 points
3. Glasgow Coma Scale (GCS): 15 = 0 points, 13-14 = +1 point, 10-12 = +2 points, 6-9 = +3 points, <6 = +4 points
4. Bilirubin (mg/dL): <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-5.9 = +2 points, 6.0-11.9 = +3 points, ≥12.0 = +4 points
5. Mean arterial pressure (MAP) or administration of vasopressors (in mcg): No hypotension = 0 points, MAP <70 mmHg = +1 point, Dopamine ≤5 or Dobutamine (any dose) = +2 points, Dopamine >5 or Epinephrine ≤0.1 or norepinephrine ≤0.1 = +3 points, Dopamine >15 or Epinephrine >0.1 or norepinephrine >0.1 = +4 points
6. Creatinine (mg/dL) or urine output: <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-3.4 = +2 points, 3.5-4.9 or urine output <500 mL/day = +3 points, ≥5.0 or urine output <200 mL/day = +4 points

The total SOFA Score is calculated by summing the points for each criterion.
    
The patient's current SOFA score is 0.
The patient's partial pressure of oxygen is 75.0 mm Hg and FiO₂ percentage is 45.0 %. This means that the patient's partial pressure of oxygen to FiO₂ ratio is 166.667. The patient is reported to not be on mechanical ventillation. The patient is reported to not be using continuous positive airway pressure. Because the patient's partial pressure of oxygen to FiO₂ ratio is less than 200, the patient is not on mechanical ventillation and is not using continious positive airway pressure, we increase the score by two points, making the current total 0 + 2 = 2.
For three points to be given, the patient must be taking more than 5 micrograms/kg/min, less than or equal to 0.1 micrograms/kg/min of epinephrine, or less than or equal to 0.1 micrograms/kg/min of norepinephrine. Because at least one of these cases is true for the patient, we increment the score by three points, making the current total 2 + 3 = 5.
The patient's glasgow coma score is not reported so we take it to be 15. Because the patient's glasgow coma score is 15, we add 0 points to the score, keeping the score at 5.
 The concentration of bilirubin is 1.8 mg/dL. Because the patient's bilirubin concentration is at least 1.2 mg/dL, but less than 2.0 mg/dL, we increment the score by one point, make the current score 5 + 1 = 6.
The patient's concentration of platelet is 180000.0 count/µL. Because the patient's platelet count is at least 150*10³/µL, we do not any points to the score, keeping the current score at 6.
The concentration of creatinine is 120.0 µmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of creatinine from µmol to mg. The mass of creatinine is 120.0 µmol. To convert 120.0 µmol of creatinine to mol, multiply by the conversion factor 1e-06, giving us 120.0 µmol creatinine * 1e-06 mol/µmol = 0.00012 mol creatinine. To convert from mol creatinine to grams, multiply by the molar mass 113.12 g/mol, which will give 0.00012 mol creatinine * 113.12 g/mol = 0.014 g creatinine. To convert 0.014 g of creatinine to mg, multiply by the conversion factor 1000.0, giving us 0.014 g creatinine * 1000.0 mg/g = 14.0 mg creatinine. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 14.0 mg creatinine/10.0 dL = 1.4 mg creatinine/dL. The concentration value of 120.0 µmol creatinine/L converts to 1.4 mg creatinine/dL. The patients urine output is 600 mL/day.

Because the patient's creatinine concentration is at least 1.2 mg/dL, but less than 2.0 mg/dL, we increment the score by one point, making the current total 6 + 1 = 7.
Hence, the patient's SOFA score is 7 points."
895,43,Sequential Organ Failure Assessment (SOFA) Score,risk,integer,8,Handwritten,"A 71-year-old male presented to the emergency room with worsening shortness of breath and was admitted to the ICU. His medical history includes mild hepatic and renal impairments which are continuously monitored. Recent laboratory reports revealed a slight increase in creatinine levels of 1.2 mg/dL and bilirubin of 2.2 mg/dL. A Glasgow Coma Scale of 12 indicated slight cognitive impairment. His blood pressure was tightly controlled with readings around 130/85 mm Hg. With agitated breathing patterns, he was started on managed mechanical ventilation to better control his respiratory distress. After receiving oxygen therapy, his fraction of inspired oxygen (FiO₂) became stabilized at 55 %, this resulted in a partial pressure of oxygen (PaO₂) of 70 mm Hg. Two vasopressor therapies were initiated; DOPamine ran at 4 mcg/kg/min and norEPINEPHrine at the slightly higher rate of 0.08 mcg/kg/min. The platelet count in his blood sample was screened to be 170,000/µL. He had fairly normal urine output documented at 800 mL/day.",What is the patient's Sequential Organ Failure Assessment (SOFA) Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Urine Output': [800, 'mL/day'], 'DOPamine': [4.0, 'mcg/kg/min'], 'norEPINEPHrine': [0.08, 'mcg/kg/min'], 'Bilirubin': [2.2, 'mg/dL'], 'creatinine': [1.2, 'mg/dL'], 'Platelet count': [170000.0, 'µL'], 'On mechanical ventilation': True, 'Diastolic Blood Pressure': [85.0, 'mm Hg'], 'Glasgow Coma Score': 12.0, 'Systolic Blood Pressure': [130.0, 'mm Hg'], 'Continuous positive airway pressure': False, 'PaO2': [70.0, 'mm Hg'], 'FiO2': [55.0, '%']}",9,9,9,"The criteria for the SOFA Score are shown below:
    
1. PaO₂/FiO₂ ratio (mm Hg): ≥400 = 0 points, 300-399 = +1 point, 200-299 = +2 points, 100-199 (with respiratory support) = +3 points, <100 (with respiratory support) = +4 points
2. Platelets (x10³/µL): ≥150 = 0 points, 100-149 = +1 point, 50-99 = +2 points, 20-49 = +3 points, <20 = +4 points
3. Glasgow Coma Scale (GCS): 15 = 0 points, 13-14 = +1 point, 10-12 = +2 points, 6-9 = +3 points, <6 = +4 points
4. Bilirubin (mg/dL): <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-5.9 = +2 points, 6.0-11.9 = +3 points, ≥12.0 = +4 points
5. Mean arterial pressure (MAP) or administration of vasopressors (in mcg): No hypotension = 0 points, MAP <70 mmHg = +1 point, Dopamine ≤5 or Dobutamine (any dose) = +2 points, Dopamine >5 or Epinephrine ≤0.1 or norepinephrine ≤0.1 = +3 points, Dopamine >15 or Epinephrine >0.1 or norepinephrine >0.1 = +4 points
6. Creatinine (mg/dL) or urine output: <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-3.4 = +2 points, 3.5-4.9 or urine output <500 mL/day = +3 points, ≥5.0 or urine output <200 mL/day = +4 points

The total SOFA Score is calculated by summing the points for each criterion.
    
The patient's current SOFA score is 0.
The patient's partial pressure of oxygen is 70.0 mm Hg and FiO₂ percentage is 55.0 %. This means that the patient's partial pressure of oxygen to FiO₂ ratio is 127.273. The patient is reported to be on mechanical ventillation. The patient is reported to not be using continuous positive airway pressure. Because the patient's partial pressure of oxygen to FiO₂ ratio is between 100 to 199, and the patient is using at least one of (i) mechanical ventillation or (ii) continious positive airway pressure, we increase the score by three points, makeing the current total 0 + 3 = 3.
For three points to be given, the patient must be taking more than 5 micrograms/kg/min, less than or equal to 0.1 micrograms/kg/min of epinephrine, or less than or equal to 0.1 micrograms/kg/min of norepinephrine. Because at least one of these cases is true for the patient, we increment the score by three points, making the current total 3 + 3 = 6.
The patient's glasgow coma score is not reported so we take it to be 15. Because the patient's glasgow coma score is 15, we add 0 points to the score, keeping the score at 6.
 The concentration of bilirubin is 2.2 mg/dL. Because the patient's bilirubin concentration is at least 2.0 mg/dL, but less than 6.0 mg/dL, we increment the score by two points, make the current score 6 + 2 = 8.
The patient's concentration of platelet is 170000.0 count/µL. Because the patient's platelet count is at least 150*10³/µL, we do not any points to the score, keeping the current score at 8.
The concentration of creatinine is 1.2 mg/dL. The patients urine output is 800 mL/day.

Because the patient's creatinine concentration is at least 1.2 mg/dL, but less than 2.0 mg/dL, we increment the score by one point, making the current total 8 + 1 = 9.
Hence, the patient's SOFA score is 9 points."
896,43,Sequential Organ Failure Assessment (SOFA) Score,risk,integer,9,Handwritten,"A 78-year-old male was admitted due to diminished mental status over the past 24 hours. His Glasgow Coma Score was recorded to be 10. His blood pressure was stable with a systolic of 83 and diastolic of 60 mm Hg. Laboratory findings from the admission show creatinine of 2.1 mg/dL. His liver function test also showed a slightly elevated bilirubin of 2.8 mg/dL. His platelet count was 150,000/µL. The patient is receiving a continuous positive airway pressure (CPAP) therapy, with a FiO₂ set at 50%, maintaining a PaO₂ of 80 mm Hg. He has two vasopressors running concurrently, DOPamine and DOBUTamine at 6 mcg/kg/min and 2 mcg/kg/min. He had an adequate fluid balance with a urine output of 900 mL/day in the past 24 hours. Due to his significant organ dysfunction, he requires close monitoring in the ICU.",What is the patient's Sequential Organ Failure Assessment (SOFA) Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Urine Output': [900, 'mL/day'], 'Bilirubin': [2.8, 'mg/dL'], 'creatinine': [2.1, 'mg/dL'], 'Platelet count': [150000.0, 'µL'], 'Diastolic Blood Pressure': [60.0, 'mm Hg'], 'Glasgow Coma Score': 10.0, 'PaO2': [80.0, 'mm Hg'], 'FiO2': [50.0, '%'], 'Systolic Blood Pressure': [83.0, 'mm Hg'], 'On mechanical ventilation': False, 'DOBUTamine': [2, 'mcg/kg/min'], 'DOPamine': [6, 'mcg/kg/min']}",9,9,9,"The criteria for the SOFA Score are shown below:
    
1. PaO₂/FiO₂ ratio (mm Hg): ≥400 = 0 points, 300-399 = +1 point, 200-299 = +2 points, 100-199 (with respiratory support) = +3 points, <100 (with respiratory support) = +4 points
2. Platelets (x10³/µL): ≥150 = 0 points, 100-149 = +1 point, 50-99 = +2 points, 20-49 = +3 points, <20 = +4 points
3. Glasgow Coma Scale (GCS): 15 = 0 points, 13-14 = +1 point, 10-12 = +2 points, 6-9 = +3 points, <6 = +4 points
4. Bilirubin (mg/dL): <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-5.9 = +2 points, 6.0-11.9 = +3 points, ≥12.0 = +4 points
5. Mean arterial pressure (MAP) or administration of vasopressors (in mcg): No hypotension = 0 points, MAP <70 mmHg = +1 point, Dopamine ≤5 or Dobutamine (any dose) = +2 points, Dopamine >5 or Epinephrine ≤0.1 or norepinephrine ≤0.1 = +3 points, Dopamine >15 or Epinephrine >0.1 or norepinephrine >0.1 = +4 points
6. Creatinine (mg/dL) or urine output: <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-3.4 = +2 points, 3.5-4.9 or urine output <500 mL/day = +3 points, ≥5.0 or urine output <200 mL/day = +4 points

The total SOFA Score is calculated by summing the points for each criterion.
    
The patient's current SOFA score is 0.
The patient's partial pressure of oxygen is 80.0 mm Hg and FiO₂ percentage is 50.0 %. This means that the patient's partial pressure of oxygen to FiO₂ ratio is 160.0. The patient is reported to not be on mechanical ventillation. Whether the patient is on continuous positive airway pressure is not reported and so we assume this to be false. Because the patient's partial pressure of oxygen to FiO₂ ratio is less than 200, the patient is not on mechanical ventillation and is not using continious positive airway pressure, we increase the score by two points, making the current total 0 + 2 = 2.
For three points to be given, the patient must be taking more than 5 micrograms/kg/min, less than or equal to 0.1 micrograms/kg/min of epinephrine, or less than or equal to 0.1 micrograms/kg/min of norepinephrine. Because at least one of these cases is true for the patient, we increment the score by three points, making the current total 2 + 3 = 5.
The patient's glasgow coma score is not reported so we take it to be 15. Because the patient's glasgow coma score is 15, we add 0 points to the score, keeping the score at 5.
 The concentration of bilirubin is 2.8 mg/dL. Because the patient's bilirubin concentration is at least 2.0 mg/dL, but less than 6.0 mg/dL, we increment the score by two points, make the current score 5 + 2 = 7.
The patient's concentration of platelet is 150000.0 count/µL. Because the patient's platelet count is at least 150*10³/µL, we do not any points to the score, keeping the current score at 7.
The concentration of creatinine is 2.1 mg/dL. The patients urine output is 900 mL/day.

Because the patient's creatinine concentration is at least 2.0 mg/dL but less than 3.5 mg/dL, we increment the score by two points, making the current total 7 + 2 = 9.
Hence, the patient's SOFA score is 9 points."
897,43,Sequential Organ Failure Assessment (SOFA) Score,risk,integer,10,Handwritten,"A 58-year-old male was admitted to the ICU following the deterioration of his conscious state; currently, he is rated with a Glasgow Coma Scale score of 10. He is presently on mechanical ventilation, with FiO₂ at 54 %, and his arterial blood gas shows a PaO₂ of 76 mm Hg. Furthermore, there are ongoing infusions of the vasopressors of DOBUTamine at 1 mcg/kg/min to maintain his hemodynamic stability. His systolic and diastolic blood pressure recorded at 120 mm Hg and 75 mm Hg, respectively. Biochemical findings show creatinine measurement at 1.4 mg/dL, indicating a slight deviation in renal function, while the bilirubin level stood at 2.3 mg/dL. His platelet count is 175,000/µL. Over the past 24-hours, his urine output was 850 mL/day.",What is the patient's Sequential Organ Failure Assessment (SOFA) Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Urine Output': [850, 'mL/day'], 'Bilirubin': [2.3, 'mg/dL'], 'creatinine': [1.4, 'mg/dL'], 'DOBUTamine': [1.0, 'mcg/kg/min'], 'Platelet count': [175000.0, 'µL'], 'On mechanical ventilation': True, 'Diastolic Blood Pressure': [75.0, 'mm Hg'], 'Glasgow Coma Score': 10.0, 'Systolic Blood Pressure': [120.0, 'mm Hg'], 'Continuous positive airway pressure': False, 'PaO2': [76.0, 'mm Hg'], 'FiO2': [54.0, '%']}",6,6,6,"The criteria for the SOFA Score are shown below:
    
1. PaO₂/FiO₂ ratio (mm Hg): ≥400 = 0 points, 300-399 = +1 point, 200-299 = +2 points, 100-199 (with respiratory support) = +3 points, <100 (with respiratory support) = +4 points
2. Platelets (x10³/µL): ≥150 = 0 points, 100-149 = +1 point, 50-99 = +2 points, 20-49 = +3 points, <20 = +4 points
3. Glasgow Coma Scale (GCS): 15 = 0 points, 13-14 = +1 point, 10-12 = +2 points, 6-9 = +3 points, <6 = +4 points
4. Bilirubin (mg/dL): <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-5.9 = +2 points, 6.0-11.9 = +3 points, ≥12.0 = +4 points
5. Mean arterial pressure (MAP) or administration of vasopressors (in mcg): No hypotension = 0 points, MAP <70 mmHg = +1 point, Dopamine ≤5 or Dobutamine (any dose) = +2 points, Dopamine >5 or Epinephrine ≤0.1 or norepinephrine ≤0.1 = +3 points, Dopamine >15 or Epinephrine >0.1 or norepinephrine >0.1 = +4 points
6. Creatinine (mg/dL) or urine output: <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-3.4 = +2 points, 3.5-4.9 or urine output <500 mL/day = +3 points, ≥5.0 or urine output <200 mL/day = +4 points

The total SOFA Score is calculated by summing the points for each criterion.
    
The patient's current SOFA score is 0.
The patient's partial pressure of oxygen is 76.0 mm Hg and FiO₂ percentage is 54.0 %. This means that the patient's partial pressure of oxygen to FiO₂ ratio is 140.741. The patient is reported to be on mechanical ventillation. The patient is reported to not be using continuous positive airway pressure. Because the patient's partial pressure of oxygen to FiO₂ ratio is between 100 to 199, and the patient is using at least one of (i) mechanical ventillation or (ii) continious positive airway pressure, we increase the score by three points, makeing the current total 0 + 3 = 3.
Whether the patient has hypotension is not reported, and so we do not add any points to the score, keeping the current total at 3.
The patient's glasgow coma score is not reported so we take it to be 15. Because the patient's glasgow coma score is 15, we add 0 points to the score, keeping the score at 3.
 The concentration of bilirubin is 2.3 mg/dL. Because the patient's bilirubin concentration is at least 2.0 mg/dL, but less than 6.0 mg/dL, we increment the score by two points, make the current score 3 + 2 = 5.
The patient's concentration of platelet is 175000.0 count/µL. Because the patient's platelet count is at least 150*10³/µL, we do not any points to the score, keeping the current score at 5.
The concentration of creatinine is 1.4 mg/dL. The patients urine output is 850 mL/day.

Because the patient's creatinine concentration is at least 1.2 mg/dL, but less than 2.0 mg/dL, we increment the score by one point, making the current total 5 + 1 = 6.
Hence, the patient's SOFA score is 6 points."
898,43,Sequential Organ Failure Assessment (SOFA) Score,risk,integer,11,Handwritten,"A 70-year-old female was rushed into the ICU due to respiratory distress, following which she was promptly put on mechanical ventilation. Her delivered oxygen fell to 51 % FiO₂; meanwhile, her partial pressure of oxygen (PaO₂) registered at 74 mm Hg. She was conscious but visibly disoriented with a functional Glasgow Coma Score of 12. Her blood pressure was 91/70 mm Hg. Two vasopressors are being administered simultaneously including DOBUTamine at 3 mcg/kg/min, and EPINEPHrine at 0.03 mcg/kg/min. Laboratory evaluations revealed mild renal impairment with creatinine levels slightly elevated at 1.6 mg/dL and a bilirubin level of 1.9 mg/dL. Her platelet count was found to be 165,000/µL. Her daily urine output of 950 mL.",What is the patient's Sequential Organ Failure Assessment (SOFA) Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Urine Output': [950, 'mL/day'], 'Bilirubin': [1.9, 'mg/dL'], 'creatinine': [1.6, 'mg/dL'], 'DOBUTamine': [3.0, 'mcg/kg/min'], 'Platelet count': [165000.0, 'µL'], 'Hypotension': True, 'On mechanical ventilation': True, 'Diastolic Blood Pressure': [70.0, 'mm Hg'], 'Glasgow Coma Score': 12.0, 'EPINEPHrine': [0.03, 'mcg/kg/min'], 'Systolic Blood Pressure': [91.0, 'mm Hg'], 'Continuous positive airway pressure': False, 'PaO2': [74.0, 'mm Hg'], 'FiO2': [51.0, '%']}",8,8,8,"The criteria for the SOFA Score are shown below:
    
1. PaO₂/FiO₂ ratio (mm Hg): ≥400 = 0 points, 300-399 = +1 point, 200-299 = +2 points, 100-199 (with respiratory support) = +3 points, <100 (with respiratory support) = +4 points
2. Platelets (x10³/µL): ≥150 = 0 points, 100-149 = +1 point, 50-99 = +2 points, 20-49 = +3 points, <20 = +4 points
3. Glasgow Coma Scale (GCS): 15 = 0 points, 13-14 = +1 point, 10-12 = +2 points, 6-9 = +3 points, <6 = +4 points
4. Bilirubin (mg/dL): <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-5.9 = +2 points, 6.0-11.9 = +3 points, ≥12.0 = +4 points
5. Mean arterial pressure (MAP) or administration of vasopressors (in mcg): No hypotension = 0 points, MAP <70 mmHg = +1 point, Dopamine ≤5 or Dobutamine (any dose) = +2 points, Dopamine >5 or Epinephrine ≤0.1 or norepinephrine ≤0.1 = +3 points, Dopamine >15 or Epinephrine >0.1 or norepinephrine >0.1 = +4 points
6. Creatinine (mg/dL) or urine output: <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-3.4 = +2 points, 3.5-4.9 or urine output <500 mL/day = +3 points, ≥5.0 or urine output <200 mL/day = +4 points

The total SOFA Score is calculated by summing the points for each criterion.
    
The patient's current SOFA score is 0.
The patient's partial pressure of oxygen is 74.0 mm Hg and FiO₂ percentage is 51.0 %. This means that the patient's partial pressure of oxygen to FiO₂ ratio is 145.098. The patient is reported to be on mechanical ventillation. The patient is reported to not be using continuous positive airway pressure. Because the patient's partial pressure of oxygen to FiO₂ ratio is between 100 to 199, and the patient is using at least one of (i) mechanical ventillation or (ii) continious positive airway pressure, we increase the score by three points, makeing the current total 0 + 3 = 3.
For three points to be given, the patient must be taking more than 5 micrograms/kg/min, less than or equal to 0.1 micrograms/kg/min of epinephrine, or less than or equal to 0.1 micrograms/kg/min of norepinephrine. Because at least one of these cases is true for the patient, we increment the score by three points, making the current total 3 + 3 = 6.
The patient's glasgow coma score is not reported so we take it to be 15. Because the patient's glasgow coma score is 15, we add 0 points to the score, keeping the score at 6.
 The concentration of bilirubin is 1.9 mg/dL. Because the patient's bilirubin concentration is at least 1.2 mg/dL, but less than 2.0 mg/dL, we increment the score by one point, make the current score 6 + 1 = 7.
The patient's concentration of platelet is 165000.0 count/µL. Because the patient's platelet count is at least 150*10³/µL, we do not any points to the score, keeping the current score at 7.
The concentration of creatinine is 1.6 mg/dL. The patients urine output is 950 mL/day.

Because the patient's creatinine concentration is at least 1.2 mg/dL, but less than 2.0 mg/dL, we increment the score by one point, making the current total 7 + 1 = 8.
Hence, the patient's SOFA score is 8 points."
899,43,Sequential Organ Failure Assessment (SOFA) Score,risk,integer,12,Handwritten,"A 74-year-old gentleman was admitted to the ICU after slight confusion and diminished interaction levels were noted; the Glasgow Coma Scale score was 13, suggesting mild cognitive impairment. His blood pressure was 93/62 mm Hg. He was not on mechanical ventilation but FiO₂ was maintained at 55 % providing him an adequate partial pressure of oxygen (PaO₂) at 75 mm Hg. The doctors have placed him on multiple vasopressors -  DOBUTamine running at 5 mcg/kg/min, and norEPINEPHrine coupled with EPINEPHrine at 0.07 mcg/kg/min and 0.06 mcg/kg/min respectively. Lab reports displayed an elevated creatinine level of 2.4 mg/dL indicating impaired renal function. Also, at 2.3 mg/dL, his bilirubin level has spiked slightly beyond the usual range. His platelet counts were lower than average, recorded at 160,000/µL. He was having adequate fluid balance as his urine output was found to be 900 mL/day.",What is the patient's Sequential Organ Failure Assessment (SOFA) Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Urine Output': [900, 'mL/day'], 'norEPINEPHrine': [0.07, 'mcg/kg/min'], 'Bilirubin': [2.3, 'mg/dL'], 'creatinine': [2.4, 'mg/dL'], 'DOBUTamine': [5.0, 'mcg/kg/min'], 'Platelet count': [160000.0, 'µL'], 'Hypotension': True, 'On mechanical ventilation': False, 'Diastolic Blood Pressure': [62.0, 'mm Hg'], 'Glasgow Coma Score': 13.0, 'EPINEPHrine': [0.06, 'mcg/kg/min'], 'Systolic Blood Pressure': [93.0, 'mm Hg'], 'Continuous positive airway pressure': False, 'PaO2': [75.0, 'mm Hg'], 'FiO2': [55.0, '%']}",9,9,9,"The criteria for the SOFA Score are shown below:
    
1. PaO₂/FiO₂ ratio (mm Hg): ≥400 = 0 points, 300-399 = +1 point, 200-299 = +2 points, 100-199 (with respiratory support) = +3 points, <100 (with respiratory support) = +4 points
2. Platelets (x10³/µL): ≥150 = 0 points, 100-149 = +1 point, 50-99 = +2 points, 20-49 = +3 points, <20 = +4 points
3. Glasgow Coma Scale (GCS): 15 = 0 points, 13-14 = +1 point, 10-12 = +2 points, 6-9 = +3 points, <6 = +4 points
4. Bilirubin (mg/dL): <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-5.9 = +2 points, 6.0-11.9 = +3 points, ≥12.0 = +4 points
5. Mean arterial pressure (MAP) or administration of vasopressors (in mcg): No hypotension = 0 points, MAP <70 mmHg = +1 point, Dopamine ≤5 or Dobutamine (any dose) = +2 points, Dopamine >5 or Epinephrine ≤0.1 or norepinephrine ≤0.1 = +3 points, Dopamine >15 or Epinephrine >0.1 or norepinephrine >0.1 = +4 points
6. Creatinine (mg/dL) or urine output: <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-3.4 = +2 points, 3.5-4.9 or urine output <500 mL/day = +3 points, ≥5.0 or urine output <200 mL/day = +4 points

The total SOFA Score is calculated by summing the points for each criterion.
    
The patient's current SOFA score is 0.
The patient's partial pressure of oxygen is 75.0 mm Hg and FiO₂ percentage is 55.0 %. This means that the patient's partial pressure of oxygen to FiO₂ ratio is 136.364. The patient is reported to not be on mechanical ventillation. The patient is reported to not be using continuous positive airway pressure. Because the patient's partial pressure of oxygen to FiO₂ ratio is less than 200, the patient is not on mechanical ventillation and is not using continious positive airway pressure, we increase the score by two points, making the current total 0 + 2 = 2.
For three points to be given, the patient must be taking more than 5 micrograms/kg/min, less than or equal to 0.1 micrograms/kg/min of epinephrine, or less than or equal to 0.1 micrograms/kg/min of norepinephrine. Because at least one of these cases is true for the patient, we increment the score by three points, making the current total 2 + 3 = 5.
The patient's glasgow coma score is not reported so we take it to be 15. Because the patient's glasgow coma score is 15, we add 0 points to the score, keeping the score at 5.
 The concentration of bilirubin is 2.3 mg/dL. Because the patient's bilirubin concentration is at least 2.0 mg/dL, but less than 6.0 mg/dL, we increment the score by two points, make the current score 5 + 2 = 7.
The patient's concentration of platelet is 160000.0 count/µL. Because the patient's platelet count is at least 150*10³/µL, we do not any points to the score, keeping the current score at 7.
The concentration of creatinine is 2.4 mg/dL. The patients urine output is 900 mL/day.

Because the patient's creatinine concentration is at least 2.0 mg/dL but less than 3.5 mg/dL, we increment the score by two points, making the current total 7 + 2 = 9.
Hence, the patient's SOFA score is 9 points."
900,43,Sequential Organ Failure Assessment (SOFA) Score,risk,integer,13,Handwritten,"A 64-year-old male with a history of chronic renal disease has been admitted with a Glasgow Coma Score of 11, implying a moderate cognitive impairment. His blood pressure readings have recorded lower values than normal, with systolic and diastolic measures at 87 and 59 mm Hg, respectively. For maintaining an optimum circulation, he currently receives EPINEPHrine infusions at rates of 0.04 mcg/kg/min. It was reported that FiO₂ is maintained at 53 %, leading to a partial pressure of oxygen (PaO₂) of 72 mm Hg. He is not on mechanical ventilation. His creatinine is 1.1 mg/dL and bilirubin is 1.8 mg/dL. His platelet count is 170,000/µL. His fluid balance was reported as satisfactory with a urine output recorded 850 mL/day.",What is the patient's Sequential Organ Failure Assessment (SOFA) Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Urine Output': [850, 'mL/day'], 'Bilirubin': [1.8, 'mg/dL'], 'creatinine': [1.1, 'mg/dL'], 'Platelet count': [170000.0, 'µL'], 'Hypotension': True, 'Continuous positive airway pressure': False, 'Diastolic Blood Pressure': [59.0, 'mm Hg'], 'Glasgow Coma Score': 11.0, 'EPINEPHrine': [0.04, 'mcg/kg/min'], 'Systolic Blood Pressure': [87.0, 'mm Hg'], 'On mechanical ventilation': False, 'PaO2': [72.0, 'mm Hg'], 'FiO2': [53.0, '%']}",6,6,6,"The criteria for the SOFA Score are shown below:
    
1. PaO₂/FiO₂ ratio (mm Hg): ≥400 = 0 points, 300-399 = +1 point, 200-299 = +2 points, 100-199 (with respiratory support) = +3 points, <100 (with respiratory support) = +4 points
2. Platelets (x10³/µL): ≥150 = 0 points, 100-149 = +1 point, 50-99 = +2 points, 20-49 = +3 points, <20 = +4 points
3. Glasgow Coma Scale (GCS): 15 = 0 points, 13-14 = +1 point, 10-12 = +2 points, 6-9 = +3 points, <6 = +4 points
4. Bilirubin (mg/dL): <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-5.9 = +2 points, 6.0-11.9 = +3 points, ≥12.0 = +4 points
5. Mean arterial pressure (MAP) or administration of vasopressors (in mcg): No hypotension = 0 points, MAP <70 mmHg = +1 point, Dopamine ≤5 or Dobutamine (any dose) = +2 points, Dopamine >5 or Epinephrine ≤0.1 or norepinephrine ≤0.1 = +3 points, Dopamine >15 or Epinephrine >0.1 or norepinephrine >0.1 = +4 points
6. Creatinine (mg/dL) or urine output: <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-3.4 = +2 points, 3.5-4.9 or urine output <500 mL/day = +3 points, ≥5.0 or urine output <200 mL/day = +4 points

The total SOFA Score is calculated by summing the points for each criterion.
    
The patient's current SOFA score is 0.
The patient's partial pressure of oxygen is 72.0 mm Hg and FiO₂ percentage is 53.0 %. This means that the patient's partial pressure of oxygen to FiO₂ ratio is 135.849. The patient is reported to not be on mechanical ventillation. The patient is reported to not be using continuous positive airway pressure. Because the patient's partial pressure of oxygen to FiO₂ ratio is less than 200, the patient is not on mechanical ventillation and is not using continious positive airway pressure, we increase the score by two points, making the current total 0 + 2 = 2.
For three points to be given, the patient must be taking more than 5 micrograms/kg/min, less than or equal to 0.1 micrograms/kg/min of epinephrine, or less than or equal to 0.1 micrograms/kg/min of norepinephrine. Because at least one of these cases is true for the patient, we increment the score by three points, making the current total 2 + 3 = 5.
The patient's glasgow coma score is not reported so we take it to be 15. Because the patient's glasgow coma score is 15, we add 0 points to the score, keeping the score at 5.
 The concentration of bilirubin is 1.8 mg/dL. Because the patient's bilirubin concentration is at least 1.2 mg/dL, but less than 2.0 mg/dL, we increment the score by one point, make the current score 5 + 1 = 6.
The patient's concentration of platelet is 170000.0 count/µL. Because the patient's platelet count is at least 150*10³/µL, we do not any points to the score, keeping the current score at 6.
The concentration of creatinine is 1.1 mg/dL. The patients urine output is 850 mL/day.

Because the patient's creatinine concentration is less than 1.2 mg/dL, we do not add any points to the score, keeping the current total at 6.
Hence, the patient's SOFA score is 6 points."
901,43,Sequential Organ Failure Assessment (SOFA) Score,risk,integer,14,Handwritten,"A 72-year-old male patient with a known history of liver and kidney disease was transferred to our ICU due to respiratory distress. He was promptly placed on mechanical ventilation. The providing FiO₂ was recorded at 52%, with a corroborating PaO₂ of 76 mm Hg. In response to his low blood pressure readings, multiple vasopressor infusions were necessitated, which included DOBUTamine at 2 mcg/kg/min and EPINEPHrine at 0.04 mcg/kg/min. Glasgow Coma Score was 14. Lab findings showed a creatinine level of 1.7 mg/dL with bilirubin levels of 2.1 mg/dL. His platelet count was found to be 160,000/µL. His urine output was documented adequately at 950 mL/day.",What is the patient's Sequential Organ Failure Assessment (SOFA) Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Urine Output': [950, 'mL/day'], 'Bilirubin': [2.1, 'mg/dL'], 'creatinine': [1.7, 'mg/dL'], 'DOBUTamine': [2.0, 'mcg/kg/min'], 'Platelet count': [160000.0, 'µL'], 'Hypotension': True, 'On mechanical ventilation': True, 'Glasgow Coma Score': 14.0, 'EPINEPHrine': [0.04, 'mcg/kg/min'], 'Continuous positive airway pressure': False, 'PaO2': [76.0, 'mm Hg'], 'FiO2': [52.0, '%']}",9,9,9,"The criteria for the SOFA Score are shown below:
    
1. PaO₂/FiO₂ ratio (mm Hg): ≥400 = 0 points, 300-399 = +1 point, 200-299 = +2 points, 100-199 (with respiratory support) = +3 points, <100 (with respiratory support) = +4 points
2. Platelets (x10³/µL): ≥150 = 0 points, 100-149 = +1 point, 50-99 = +2 points, 20-49 = +3 points, <20 = +4 points
3. Glasgow Coma Scale (GCS): 15 = 0 points, 13-14 = +1 point, 10-12 = +2 points, 6-9 = +3 points, <6 = +4 points
4. Bilirubin (mg/dL): <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-5.9 = +2 points, 6.0-11.9 = +3 points, ≥12.0 = +4 points
5. Mean arterial pressure (MAP) or administration of vasopressors (in mcg): No hypotension = 0 points, MAP <70 mmHg = +1 point, Dopamine ≤5 or Dobutamine (any dose) = +2 points, Dopamine >5 or Epinephrine ≤0.1 or norepinephrine ≤0.1 = +3 points, Dopamine >15 or Epinephrine >0.1 or norepinephrine >0.1 = +4 points
6. Creatinine (mg/dL) or urine output: <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-3.4 = +2 points, 3.5-4.9 or urine output <500 mL/day = +3 points, ≥5.0 or urine output <200 mL/day = +4 points

The total SOFA Score is calculated by summing the points for each criterion.
    
The patient's current SOFA score is 0.
The patient's partial pressure of oxygen is 76.0 mm Hg and FiO₂ percentage is 52.0 %. This means that the patient's partial pressure of oxygen to FiO₂ ratio is 146.154. The patient is reported to be on mechanical ventillation. The patient is reported to not be using continuous positive airway pressure. Because the patient's partial pressure of oxygen to FiO₂ ratio is between 100 to 199, and the patient is using at least one of (i) mechanical ventillation or (ii) continious positive airway pressure, we increase the score by three points, makeing the current total 0 + 3 = 3.
For three points to be given, the patient must be taking more than 5 micrograms/kg/min, less than or equal to 0.1 micrograms/kg/min of epinephrine, or less than or equal to 0.1 micrograms/kg/min of norepinephrine. Because at least one of these cases is true for the patient, we increment the score by three points, making the current total 3 + 3 = 6.
The patient's glasgow coma score is not reported so we take it to be 15. Because the patient's glasgow coma score is 15, we add 0 points to the score, keeping the score at 6.
 The concentration of bilirubin is 2.1 mg/dL. Because the patient's bilirubin concentration is at least 2.0 mg/dL, but less than 6.0 mg/dL, we increment the score by two points, make the current score 6 + 2 = 8.
The patient's concentration of platelet is 160000.0 count/µL. Because the patient's platelet count is at least 150*10³/µL, we do not any points to the score, keeping the current score at 8.
The concentration of creatinine is 1.7 mg/dL. The patients urine output is 950 mL/day.

Because the patient's creatinine concentration is at least 1.2 mg/dL, but less than 2.0 mg/dL, we increment the score by one point, making the current total 8 + 1 = 9.
Hence, the patient's SOFA score is 9 points."
902,43,Sequential Organ Failure Assessment (SOFA) Score,risk,integer,15,Handwritten,"A 75-year-old female was admitted to our ICU with respiratory distress and increased confusion. This patient’s Glasgow Coma Score has been observed at 12, suggestive of a minor to moderate cognitive impairment. She did not require mechanical ventilation; instead, her oxygen requirement was manageable at 55% FiO₂ resulting in a measured partial pressure of oxygen (PaO₂) of 75 mm Hg. Hemodynamically, she has been stable throughout the day with a systolic and diastolic blood pressure documented as 115 and 62 mm Hg, respectively. She was given multiple vasopressor treatment regimens which included DOPamine running at 3.2 mcg/kg/min and norEPINEPHrine at 0.05 mcg/kg/min. Lab results revealed elevated bilirubin of 2.5 mg/dL and increased creatinine levels of 1.8 mg/dL, offering insights into potential liver and renal impairments. The platelet count was within a normal range as 175,000/µL. She was maintaining a good urine output, recorded at 920 mL/day. This case calls for a meticulous and steady monitoring of her vitals and organ function while in an ICU setup.",What is the patient's Sequential Organ Failure Assessment (SOFA) Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Urine Output': [920, 'mL/day'], 'DOPamine': [3.2, 'mcg/kg/min'], 'norEPINEPHrine': [0.05, 'mcg/kg/min'], 'Bilirubin': [2.5, 'mg/dL'], 'creatinine': [1.8, 'mg/dL'], 'Platelet count': [175000.0, 'µL'], 'On mechanical ventilation': False, 'Diastolic Blood Pressure': [62.0, 'mm Hg'], 'Glasgow Coma Score': 12.0, 'Systolic Blood Pressure': [115.0, 'mm Hg'], 'Continuous positive airway pressure': False, 'PaO2': [75.0, 'mm Hg'], 'FiO2': [55.0, '%']}",8,8,8,"The criteria for the SOFA Score are shown below:
    
1. PaO₂/FiO₂ ratio (mm Hg): ≥400 = 0 points, 300-399 = +1 point, 200-299 = +2 points, 100-199 (with respiratory support) = +3 points, <100 (with respiratory support) = +4 points
2. Platelets (x10³/µL): ≥150 = 0 points, 100-149 = +1 point, 50-99 = +2 points, 20-49 = +3 points, <20 = +4 points
3. Glasgow Coma Scale (GCS): 15 = 0 points, 13-14 = +1 point, 10-12 = +2 points, 6-9 = +3 points, <6 = +4 points
4. Bilirubin (mg/dL): <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-5.9 = +2 points, 6.0-11.9 = +3 points, ≥12.0 = +4 points
5. Mean arterial pressure (MAP) or administration of vasopressors (in mcg): No hypotension = 0 points, MAP <70 mmHg = +1 point, Dopamine ≤5 or Dobutamine (any dose) = +2 points, Dopamine >5 or Epinephrine ≤0.1 or norepinephrine ≤0.1 = +3 points, Dopamine >15 or Epinephrine >0.1 or norepinephrine >0.1 = +4 points
6. Creatinine (mg/dL) or urine output: <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-3.4 = +2 points, 3.5-4.9 or urine output <500 mL/day = +3 points, ≥5.0 or urine output <200 mL/day = +4 points

The total SOFA Score is calculated by summing the points for each criterion.
    
The patient's current SOFA score is 0.
The patient's partial pressure of oxygen is 75.0 mm Hg and FiO₂ percentage is 55.0 %. This means that the patient's partial pressure of oxygen to FiO₂ ratio is 136.364. The patient is reported to not be on mechanical ventillation. The patient is reported to not be using continuous positive airway pressure. Because the patient's partial pressure of oxygen to FiO₂ ratio is less than 200, the patient is not on mechanical ventillation and is not using continious positive airway pressure, we increase the score by two points, making the current total 0 + 2 = 2.
For three points to be given, the patient must be taking more than 5 micrograms/kg/min, less than or equal to 0.1 micrograms/kg/min of epinephrine, or less than or equal to 0.1 micrograms/kg/min of norepinephrine. Because at least one of these cases is true for the patient, we increment the score by three points, making the current total 2 + 3 = 5.
The patient's glasgow coma score is not reported so we take it to be 15. Because the patient's glasgow coma score is 15, we add 0 points to the score, keeping the score at 5.
 The concentration of bilirubin is 2.5 mg/dL. Because the patient's bilirubin concentration is at least 2.0 mg/dL, but less than 6.0 mg/dL, we increment the score by two points, make the current score 5 + 2 = 7.
The patient's concentration of platelet is 175000.0 count/µL. Because the patient's platelet count is at least 150*10³/µL, we do not any points to the score, keeping the current score at 7.
The concentration of creatinine is 1.8 mg/dL. The patients urine output is 920 mL/day.

Because the patient's creatinine concentration is at least 1.2 mg/dL, but less than 2.0 mg/dL, we increment the score by one point, making the current total 7 + 1 = 8.
Hence, the patient's SOFA score is 8 points."
903,43,Sequential Organ Failure Assessment (SOFA) Score,risk,integer,16,Handwritten,"An elderly 76-year-old male with existing renal issues was admitted to the ICU due to reduced responsiveness. Current GCS of 13. He necessitated mechanical ventilation to maintain oxygen saturation. FiO₂ was at 53 %, and PaO₂ values were noted at 75 mm Hg. Alongside, the hemodynamic status was sustained with systolic and diastolic blood pressure readings of 120 and 80 mm Hg, respectively. Therapeutic interventions currently include DOPamine at 3.6 mcg/kg/min. Despite the medications, the blood chemistry showed worrisome values, including a creatinine level of 160 µmol/L and bilirubin concentration at 2.4 mg/dL. Complete blood count highlighted the platelet count, which was within the standard range of 175,000/µL. His daily urine output was recorded as an acceptable 875 mL/day, considering his renal condition. His overall condition necessitates stringent medical monitoring, anticipating potential organ dysfunctions based on his declining pathophysiological responses.",What is the patient's Sequential Organ Failure Assessment (SOFA) Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Urine Output': [875, 'mL/day'], 'DOPamine': [3.6, 'mcg/kg/min'], 'Bilirubin': [2.4, 'mg/dL'], 'creatinine': [160.0, 'µmol/L'], 'Platelet count': [175000.0, 'µL'], 'On mechanical ventilation': True, 'Diastolic Blood Pressure': [80.0, 'mm Hg'], 'Glasgow Coma Score': 13.0, 'Systolic Blood Pressure': [120.0, 'mm Hg'], 'Continuous positive airway pressure': False, 'PaO2': [75.0, 'mm Hg'], 'FiO2': [53.0, '%']}",8,8,8,"The criteria for the SOFA Score are shown below:
    
1. PaO₂/FiO₂ ratio (mm Hg): ≥400 = 0 points, 300-399 = +1 point, 200-299 = +2 points, 100-199 (with respiratory support) = +3 points, <100 (with respiratory support) = +4 points
2. Platelets (x10³/µL): ≥150 = 0 points, 100-149 = +1 point, 50-99 = +2 points, 20-49 = +3 points, <20 = +4 points
3. Glasgow Coma Scale (GCS): 15 = 0 points, 13-14 = +1 point, 10-12 = +2 points, 6-9 = +3 points, <6 = +4 points
4. Bilirubin (mg/dL): <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-5.9 = +2 points, 6.0-11.9 = +3 points, ≥12.0 = +4 points
5. Mean arterial pressure (MAP) or administration of vasopressors (in mcg): No hypotension = 0 points, MAP <70 mmHg = +1 point, Dopamine ≤5 or Dobutamine (any dose) = +2 points, Dopamine >5 or Epinephrine ≤0.1 or norepinephrine ≤0.1 = +3 points, Dopamine >15 or Epinephrine >0.1 or norepinephrine >0.1 = +4 points
6. Creatinine (mg/dL) or urine output: <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-3.4 = +2 points, 3.5-4.9 or urine output <500 mL/day = +3 points, ≥5.0 or urine output <200 mL/day = +4 points

The total SOFA Score is calculated by summing the points for each criterion.
    
The patient's current SOFA score is 0.
The patient's partial pressure of oxygen is 75.0 mm Hg and FiO₂ percentage is 53.0 %. This means that the patient's partial pressure of oxygen to FiO₂ ratio is 141.509. The patient is reported to be on mechanical ventillation. The patient is reported to not be using continuous positive airway pressure. Because the patient's partial pressure of oxygen to FiO₂ ratio is between 100 to 199, and the patient is using at least one of (i) mechanical ventillation or (ii) continious positive airway pressure, we increase the score by three points, makeing the current total 0 + 3 = 3.
For two points to be given, the patient must be taking less than or equal to 5 micrograms/kg/min or any amount of dobutamine. Because at least one of these cases is true for the patient, we increment the score by two points, making the current total 3 + 2 = 5.
The patient's glasgow coma score is not reported so we take it to be 15. Because the patient's glasgow coma score is 15, we add 0 points to the score, keeping the score at 5.
 The concentration of bilirubin is 2.4 mg/dL. Because the patient's bilirubin concentration is at least 2.0 mg/dL, but less than 6.0 mg/dL, we increment the score by two points, make the current score 5 + 2 = 7.
The patient's concentration of platelet is 175000.0 count/µL. Because the patient's platelet count is at least 150*10³/µL, we do not any points to the score, keeping the current score at 7.
The concentration of creatinine is 160.0 µmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of creatinine from µmol to mg. The mass of creatinine is 160.0 µmol. To convert 160.0 µmol of creatinine to mol, multiply by the conversion factor 1e-06, giving us 160.0 µmol creatinine * 1e-06 mol/µmol = 0.00016 mol creatinine. To convert from mol creatinine to grams, multiply by the molar mass 113.12 g/mol, which will give 0.00016 mol creatinine * 113.12 g/mol = 0.018 g creatinine. To convert 0.018 g of creatinine to mg, multiply by the conversion factor 1000.0, giving us 0.018 g creatinine * 1000.0 mg/g = 18.0 mg creatinine. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 18.0 mg creatinine/10.0 dL = 1.8 mg creatinine/dL. The concentration value of 160.0 µmol creatinine/L converts to 1.8 mg creatinine/dL. The patients urine output is 875 mL/day.

Because the patient's creatinine concentration is at least 1.2 mg/dL, but less than 2.0 mg/dL, we increment the score by one point, making the current total 7 + 1 = 8.
Hence, the patient's SOFA score is 8 points."
904,43,Sequential Organ Failure Assessment (SOFA) Score,risk,integer,17,Handwritten,"A 68-year-old female was admitted to the ICU following an episode of respiratory distress. Her medical history is significant for chronic kidney disease. A reduction in her mental status is noted with a Glasgow Coma Score recently read as 13. She is currently on CPAP, with a fraction of inspired oxygen (FiO₂) set at 54%, resulting in a recorded partial pressure of oxygen (PaO₂) at 77 mm Hg. Despite her concerning condition, her blood pressure remained stable, at 120 and 80 mm Hg on multiple vasopressors: DOPamine and DOBUTamine at 4 mcg/kg/min and 3.5 mcg/kg/min, respectively. Serum chemistry reports show a slightly elevated creatinine of 1.9 mg/dL and bilirubin levels at 1.7 mg/dL, possible evidence of mild renal dysfunction and liver abnormalities respectively. Platelets were measured to total 180,000/µL, a typical value. Her urine output represented a somewhat regular fluid balance, documented at 925 mL/day. Continuous monitoring of her organ function and judicious intervention is warranted based on her specific health scenario.",What is the patient's Sequential Organ Failure Assessment (SOFA) Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Urine Output': [925, 'mL/day'], 'DOPamine': [4.0, 'mcg/kg/min'], 'Bilirubin': [1.7, 'mg/dL'], 'creatinine': [1.9, 'mg/dL'], 'DOBUTamine': [3.5, 'mcg/kg/min'], 'Platelet count': [180000.0, 'µL'], 'Continuous positive airway pressure': True, 'Diastolic Blood Pressure': [80.0, 'mm Hg'], 'Glasgow Coma Score': 13.0, 'PaO2': [77.0, 'mm Hg'], 'FiO2': [54.0, '%'], 'Systolic Blood Pressure': [120.0, 'mm Hg'], 'On mechanical ventilation': False}",7,7,7,"The criteria for the SOFA Score are shown below:
    
1. PaO₂/FiO₂ ratio (mm Hg): ≥400 = 0 points, 300-399 = +1 point, 200-299 = +2 points, 100-199 (with respiratory support) = +3 points, <100 (with respiratory support) = +4 points
2. Platelets (x10³/µL): ≥150 = 0 points, 100-149 = +1 point, 50-99 = +2 points, 20-49 = +3 points, <20 = +4 points
3. Glasgow Coma Scale (GCS): 15 = 0 points, 13-14 = +1 point, 10-12 = +2 points, 6-9 = +3 points, <6 = +4 points
4. Bilirubin (mg/dL): <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-5.9 = +2 points, 6.0-11.9 = +3 points, ≥12.0 = +4 points
5. Mean arterial pressure (MAP) or administration of vasopressors (in mcg): No hypotension = 0 points, MAP <70 mmHg = +1 point, Dopamine ≤5 or Dobutamine (any dose) = +2 points, Dopamine >5 or Epinephrine ≤0.1 or norepinephrine ≤0.1 = +3 points, Dopamine >15 or Epinephrine >0.1 or norepinephrine >0.1 = +4 points
6. Creatinine (mg/dL) or urine output: <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-3.4 = +2 points, 3.5-4.9 or urine output <500 mL/day = +3 points, ≥5.0 or urine output <200 mL/day = +4 points

The total SOFA Score is calculated by summing the points for each criterion.
    
The patient's current SOFA score is 0.
The patient's partial pressure of oxygen is 77.0 mm Hg and FiO₂ percentage is 54.0 %. This means that the patient's partial pressure of oxygen to FiO₂ ratio is 142.593. The patient is reported to not be on mechanical ventillation. The patient is reported to be using continuous positive airway pressure. Because the patient's partial pressure of oxygen to FiO₂ ratio is between 100 to 199, and the patient is using at least one of (i) mechanical ventillation or (ii) continious positive airway pressure, we increase the score by three points, makeing the current total 0 + 3 = 3.
For two points to be given, the patient must be taking less than or equal to 5 micrograms/kg/min or any amount of dobutamine. Because at least one of these cases is true for the patient, we increment the score by two points, making the current total 3 + 2 = 5.
The patient's glasgow coma score is not reported so we take it to be 15. Because the patient's glasgow coma score is 15, we add 0 points to the score, keeping the score at 5.
 The concentration of bilirubin is 1.7 mg/dL. Because the patient's bilirubin concentration is at least 1.2 mg/dL, but less than 2.0 mg/dL, we increment the score by one point, make the current score 5 + 1 = 6.
The patient's concentration of platelet is 180000.0 count/µL. Because the patient's platelet count is at least 150*10³/µL, we do not any points to the score, keeping the current score at 6.
The concentration of creatinine is 1.9 mg/dL. The patients urine output is 925 mL/day.

Because the patient's creatinine concentration is at least 1.2 mg/dL, but less than 2.0 mg/dL, we increment the score by one point, making the current total 6 + 1 = 7.
Hence, the patient's SOFA score is 7 points."
905,43,Sequential Organ Failure Assessment (SOFA) Score,risk,integer,18,Handwritten,"A 77-year-old male was admitted to the ICU due to an unexpected drop in cognition, with a Glasgow Coma Score currently reading as 11. While he’s not on mechanical ventilation, he doesn’t suffer from respiratory distress; his fraction of inspired oxygen (FiO₂) is 54%, producing a partial pressure of oxygen (PaO₂) of 76 mm Hg. He is on multiple vasopressors; currently, DOPamine is flowing at 3.4 mcg/kg/min, DOBUTamine at 3 mcg/kg/min, norEPINEPHrine at 0.04 mcg/kg/min and EPINEPHrine at 0.02 mcg/kg/min. Recorded BP was 75/45. Blood chemistry revealed a creatinine level of 130 µmol/L and bilirubin level of 1.6 mg/dL – both mildly above the normal range, suggesting a possible renal and liver function disruption. His complete blood counts reported a platelet count of 165,000/µL. His urine output is documented at 910 mL/day, depicting a reasonable fluid balance. This patient requires stringent addressing to the current health conditions and monitoring of organ function while he remains under critical care.",What is the patient's Sequential Organ Failure Assessment (SOFA) Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Urine Output': [910, 'mL/day'], 'DOPamine': [3.4, 'mcg/kg/min'], 'norEPINEPHrine': [0.04, 'mcg/kg/min'], 'Bilirubin': [1.6, 'mg/dL'], 'creatinine': [130.0, 'µmol/L'], 'DOBUTamine': [3.0, 'mcg/kg/min'], 'Platelet count': [165000.0, 'µL'], 'Hypotension': True, 'On mechanical ventilation': False, 'Diastolic Blood Pressure': [45.0, 'mm Hg'], 'Glasgow Coma Score': 11.0, 'EPINEPHrine': [0.02, 'mcg/kg/min'], 'Systolic Blood Pressure': [75.0, 'mm Hg'], 'Continuous positive airway pressure': False, 'PaO2': [76.0, 'mm Hg'], 'FiO2': [54.0, '%']}",7,7,7,"The criteria for the SOFA Score are shown below:
    
1. PaO₂/FiO₂ ratio (mm Hg): ≥400 = 0 points, 300-399 = +1 point, 200-299 = +2 points, 100-199 (with respiratory support) = +3 points, <100 (with respiratory support) = +4 points
2. Platelets (x10³/µL): ≥150 = 0 points, 100-149 = +1 point, 50-99 = +2 points, 20-49 = +3 points, <20 = +4 points
3. Glasgow Coma Scale (GCS): 15 = 0 points, 13-14 = +1 point, 10-12 = +2 points, 6-9 = +3 points, <6 = +4 points
4. Bilirubin (mg/dL): <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-5.9 = +2 points, 6.0-11.9 = +3 points, ≥12.0 = +4 points
5. Mean arterial pressure (MAP) or administration of vasopressors (in mcg): No hypotension = 0 points, MAP <70 mmHg = +1 point, Dopamine ≤5 or Dobutamine (any dose) = +2 points, Dopamine >5 or Epinephrine ≤0.1 or norepinephrine ≤0.1 = +3 points, Dopamine >15 or Epinephrine >0.1 or norepinephrine >0.1 = +4 points
6. Creatinine (mg/dL) or urine output: <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-3.4 = +2 points, 3.5-4.9 or urine output <500 mL/day = +3 points, ≥5.0 or urine output <200 mL/day = +4 points

The total SOFA Score is calculated by summing the points for each criterion.
    
The patient's current SOFA score is 0.
The patient's partial pressure of oxygen is 76.0 mm Hg and FiO₂ percentage is 54.0 %. This means that the patient's partial pressure of oxygen to FiO₂ ratio is 140.741. The patient is reported to not be on mechanical ventillation. The patient is reported to not be using continuous positive airway pressure. Because the patient's partial pressure of oxygen to FiO₂ ratio is less than 200, the patient is not on mechanical ventillation and is not using continious positive airway pressure, we increase the score by two points, making the current total 0 + 2 = 2.
For three points to be given, the patient must be taking more than 5 micrograms/kg/min, less than or equal to 0.1 micrograms/kg/min of epinephrine, or less than or equal to 0.1 micrograms/kg/min of norepinephrine. Because at least one of these cases is true for the patient, we increment the score by three points, making the current total 2 + 3 = 5.
The patient's glasgow coma score is not reported so we take it to be 15. Because the patient's glasgow coma score is 15, we add 0 points to the score, keeping the score at 5.
 The concentration of bilirubin is 1.6 mg/dL. Because the patient's bilirubin concentration is at least 1.2 mg/dL, but less than 2.0 mg/dL, we increment the score by one point, make the current score 5 + 1 = 6.
The patient's concentration of platelet is 165000.0 count/µL. Because the patient's platelet count is at least 150*10³/µL, we do not any points to the score, keeping the current score at 6.
The concentration of creatinine is 130.0 µmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of creatinine from µmol to mg. The mass of creatinine is 130.0 µmol. To convert 130.0 µmol of creatinine to mol, multiply by the conversion factor 1e-06, giving us 130.0 µmol creatinine * 1e-06 mol/µmol = 0.00013 mol creatinine. To convert from mol creatinine to grams, multiply by the molar mass 113.12 g/mol, which will give 0.00013 mol creatinine * 113.12 g/mol = 0.015 g creatinine. To convert 0.015 g of creatinine to mg, multiply by the conversion factor 1000.0, giving us 0.015 g creatinine * 1000.0 mg/g = 15.0 mg creatinine. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 15.0 mg creatinine/10.0 dL = 1.5 mg creatinine/dL. The concentration value of 130.0 µmol creatinine/L converts to 1.5 mg creatinine/dL. The patients urine output is 910 mL/day.

Because the patient's creatinine concentration is at least 1.2 mg/dL, but less than 2.0 mg/dL, we increment the score by one point, making the current total 6 + 1 = 7.
Hence, the patient's SOFA score is 7 points."
906,43,Sequential Organ Failure Assessment (SOFA) Score,risk,integer,19,Handwritten,"A 60-year-old lady was taken into the ICU following a sudden decrease in her level of consciousness. Her Glasgow Coma Score was calculated as 12. She has been granted continuous positive airway pressure, and the fraction of inspired oxygen (FiO₂) is maintained at 55%, maintaining her partial pressure of oxygen (PaO₂) at 78 mm Hg. She is currently being subject to several infusions; the vasopressors include DOPamine and DOBUTamine at 3.8 mcg/kg/min and 4.5 mcg/kg/min respectively. The lab analyses paint a picture of mild renal impairment, creatinine measure stands at 1.7 mg/dL, and a bilirubin reading of 2 mg/dL suggesting a possible liver dysfunction. Her complete blood count shows a platelet count of 170,000/µL. An output of 890 mL/day of urine records a reasonable fluid balance. A close monitoring of her conditions is being maintained based on the presented organ function profile.",What is the patient's Sequential Organ Failure Assessment (SOFA) Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Urine Output': [890, 'mL/day'], 'DOPamine': [3.8, 'mcg/kg/min'], 'Bilirubin': [2.0, 'mg/dL'], 'creatinine': [1.7, 'mg/dL'], 'DOBUTamine': [4.5, 'mcg/kg/min'], 'Platelet count': [170000.0, 'µL'], 'Continuous positive airway pressure': True, 'Glasgow Coma Score': 12.0, 'On mechanical ventilation': False, 'PaO2': [78.0, 'mm Hg'], 'FiO2': [55.0, '%']}",8,8,8,"The criteria for the SOFA Score are shown below:
    
1. PaO₂/FiO₂ ratio (mm Hg): ≥400 = 0 points, 300-399 = +1 point, 200-299 = +2 points, 100-199 (with respiratory support) = +3 points, <100 (with respiratory support) = +4 points
2. Platelets (x10³/µL): ≥150 = 0 points, 100-149 = +1 point, 50-99 = +2 points, 20-49 = +3 points, <20 = +4 points
3. Glasgow Coma Scale (GCS): 15 = 0 points, 13-14 = +1 point, 10-12 = +2 points, 6-9 = +3 points, <6 = +4 points
4. Bilirubin (mg/dL): <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-5.9 = +2 points, 6.0-11.9 = +3 points, ≥12.0 = +4 points
5. Mean arterial pressure (MAP) or administration of vasopressors (in mcg): No hypotension = 0 points, MAP <70 mmHg = +1 point, Dopamine ≤5 or Dobutamine (any dose) = +2 points, Dopamine >5 or Epinephrine ≤0.1 or norepinephrine ≤0.1 = +3 points, Dopamine >15 or Epinephrine >0.1 or norepinephrine >0.1 = +4 points
6. Creatinine (mg/dL) or urine output: <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-3.4 = +2 points, 3.5-4.9 or urine output <500 mL/day = +3 points, ≥5.0 or urine output <200 mL/day = +4 points

The total SOFA Score is calculated by summing the points for each criterion.
    
The patient's current SOFA score is 0.
The patient's partial pressure of oxygen is 78.0 mm Hg and FiO₂ percentage is 55.0 %. This means that the patient's partial pressure of oxygen to FiO₂ ratio is 141.818. The patient is reported to not be on mechanical ventillation. The patient is reported to be using continuous positive airway pressure. Because the patient's partial pressure of oxygen to FiO₂ ratio is between 100 to 199, and the patient is using at least one of (i) mechanical ventillation or (ii) continious positive airway pressure, we increase the score by three points, makeing the current total 0 + 3 = 3.
For two points to be given, the patient must be taking less than or equal to 5 micrograms/kg/min or any amount of dobutamine. Because at least one of these cases is true for the patient, we increment the score by two points, making the current total 3 + 2 = 5.
The patient's glasgow coma score is not reported so we take it to be 15. Because the patient's glasgow coma score is 15, we add 0 points to the score, keeping the score at 5.
 The concentration of bilirubin is 2.0 mg/dL. Because the patient's bilirubin concentration is at least 2.0 mg/dL, but less than 6.0 mg/dL, we increment the score by two points, make the current score 5 + 2 = 7.
The patient's concentration of platelet is 170000.0 count/µL. Because the patient's platelet count is at least 150*10³/µL, we do not any points to the score, keeping the current score at 7.
The concentration of creatinine is 1.7 mg/dL. The patients urine output is 890 mL/day.

Because the patient's creatinine concentration is at least 1.2 mg/dL, but less than 2.0 mg/dL, we increment the score by one point, making the current total 7 + 1 = 8.
Hence, the patient's SOFA score is 8 points."
907,43,Sequential Organ Failure Assessment (SOFA) Score,risk,integer,20,Handwritten,"A 63-year-old man was admitted to the ICU following a sudden drop in consciousness level. Currently, his Glasgow Coma Score is listed as 12. The patient is mechanically ventilated, and oxygen therapy reveals a FiO₂ of 52 % which allows him to maintain a partial pressure of oxygen (PaO₂) at 76 mm Hg. Multiple vasopressors are administered to support hemodynamic stability, these include norEPINEPHrine along with EPINEPHrine controlled at the rate of 0.03 mcg/kg/min and 0.02 mcg/kg/min respectively. Laboratory analysis rendered a serum creatinine level of 140 µmol/L and a total bilirubin level scaled at 2.2 mg/dL, specs that suggest mild renal impairment along with a probable hepatic dysfunction. The reported platelet count suggested normalcy at 165,000/µL of blood. A daily urine output is listed close to 880 mL/day, recording a satisfactory level of fluid balance. Careful monitoring and management are needed to uphold his potential recovery.",What is the patient's Sequential Organ Failure Assessment (SOFA) Score? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Urine Output': [880, 'mL/day'], 'norEPINEPHrine': [0.03, 'mcg/kg/min'], 'Bilirubin': [2.2, 'mg/dL'], 'creatinine': [140.0, 'µmol/L'], 'Platelet count': [165000.0, 'µL'], 'On mechanical ventilation': True, 'Glasgow Coma Score': 12.0, 'EPINEPHrine': [0.02, 'mcg/kg/min'], 'Continuous positive airway pressure': False, 'PaO2': [76.0, 'mm Hg'], 'FiO2': [52.0, '%']}",9,9,9,"The criteria for the SOFA Score are shown below:
    
1. PaO₂/FiO₂ ratio (mm Hg): ≥400 = 0 points, 300-399 = +1 point, 200-299 = +2 points, 100-199 (with respiratory support) = +3 points, <100 (with respiratory support) = +4 points
2. Platelets (x10³/µL): ≥150 = 0 points, 100-149 = +1 point, 50-99 = +2 points, 20-49 = +3 points, <20 = +4 points
3. Glasgow Coma Scale (GCS): 15 = 0 points, 13-14 = +1 point, 10-12 = +2 points, 6-9 = +3 points, <6 = +4 points
4. Bilirubin (mg/dL): <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-5.9 = +2 points, 6.0-11.9 = +3 points, ≥12.0 = +4 points
5. Mean arterial pressure (MAP) or administration of vasopressors (in mcg): No hypotension = 0 points, MAP <70 mmHg = +1 point, Dopamine ≤5 or Dobutamine (any dose) = +2 points, Dopamine >5 or Epinephrine ≤0.1 or norepinephrine ≤0.1 = +3 points, Dopamine >15 or Epinephrine >0.1 or norepinephrine >0.1 = +4 points
6. Creatinine (mg/dL) or urine output: <1.2 = 0 points, 1.2-1.9 = +1 point, 2.0-3.4 = +2 points, 3.5-4.9 or urine output <500 mL/day = +3 points, ≥5.0 or urine output <200 mL/day = +4 points

The total SOFA Score is calculated by summing the points for each criterion.
    
The patient's current SOFA score is 0.
The patient's partial pressure of oxygen is 76.0 mm Hg and FiO₂ percentage is 52.0 %. This means that the patient's partial pressure of oxygen to FiO₂ ratio is 146.154. The patient is reported to be on mechanical ventillation. The patient is reported to not be using continuous positive airway pressure. Because the patient's partial pressure of oxygen to FiO₂ ratio is between 100 to 199, and the patient is using at least one of (i) mechanical ventillation or (ii) continious positive airway pressure, we increase the score by three points, makeing the current total 0 + 3 = 3.
For three points to be given, the patient must be taking more than 5 micrograms/kg/min, less than or equal to 0.1 micrograms/kg/min of epinephrine, or less than or equal to 0.1 micrograms/kg/min of norepinephrine. Because at least one of these cases is true for the patient, we increment the score by three points, making the current total 3 + 3 = 6.
The patient's glasgow coma score is not reported so we take it to be 15. Because the patient's glasgow coma score is 15, we add 0 points to the score, keeping the score at 6.
 The concentration of bilirubin is 2.2 mg/dL. Because the patient's bilirubin concentration is at least 2.0 mg/dL, but less than 6.0 mg/dL, we increment the score by two points, make the current score 6 + 2 = 8.
The patient's concentration of platelet is 165000.0 count/µL. Because the patient's platelet count is at least 150*10³/µL, we do not any points to the score, keeping the current score at 8.
The concentration of creatinine is 140.0 µmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of creatinine from µmol to mg. The mass of creatinine is 140.0 µmol. To convert 140.0 µmol of creatinine to mol, multiply by the conversion factor 1e-06, giving us 140.0 µmol creatinine * 1e-06 mol/µmol = 0.00014 mol creatinine. To convert from mol creatinine to grams, multiply by the molar mass 113.12 g/mol, which will give 0.00014 mol creatinine * 113.12 g/mol = 0.016 g creatinine. To convert 0.016 g of creatinine to mg, multiply by the conversion factor 1000.0, giving us 0.016 g creatinine * 1000.0 mg/g = 16.0 mg creatinine. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 16.0 mg creatinine/10.0 dL = 1.6 mg creatinine/dL. The concentration value of 140.0 µmol creatinine/L converts to 1.6 mg creatinine/dL. The patients urine output is 880 mL/day.

Because the patient's creatinine concentration is at least 1.2 mg/dL, but less than 2.0 mg/dL, we increment the score by one point, making the current total 8 + 1 = 9.
Hence, the patient's SOFA score is 9 points."
908,36,Caprini Score for Venous Thromboembolism (2005),risk,integer,1,Handwritten,"A 63 year old female a history of prior DVT is being evaluated at a rehabilitation facility following multiple traumas sustained in a motor vehicle collision. She was transferred to the facility 1 day ago following discharge from the hospital with injuries including multiple rib fractures, a left femoral shaft fracture, and a traumatic brain injury. There was no spinal cord damage or paralysis bhe patient remains confined to bed due to her injuries. The patient denies history of heart failure, any recent infections or sepsis, stroke, pulmonary embolism, inflammatory bowel disease, coronary artery disease, chronic obstructive pulmonary disease, or malignancy. Prior coagulability workup in the patient revealed elevated serum homocysteine, and was otherwise negative for factor V Leiden, prothrombin 20210A, lupus anticoagulant, and anticardiolipin antibody. Heparin has been administered throughout the hospitalization with no complications and the patient has no other history of congenital or acquired thrombophilia. The patient's mother had a DVT/PE in her 50's. The patient's BMI is 27.1 kg/m^2. Physical exam of the lower extremities is notable for a well-healed surgical incision over the left femoral shaft with no signs of infection. There patient has varicose veins bilaterally. There is no lower extremity edema. Range of motion of the left hip and knee are limited due to pain and immobilization. The patient will continue rehabilitation with physical and occupational therapy at the facility to optimize functional recovery.",What is the patient's Caprini Score for Venous Thromboembolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [63.0, 'years'], 'sex': 'Female', 'Surgery Type': 'major', 'Major Surgery in the last month': False, 'Congestive Heart Failure in the last month': False, 'Sepsis in the last month': False, 'Pneumonia in the last month': False, 'Hip, pelvis, or leg fracture in the last month': True, 'Stroke in the last month': False, 'Multiple trauma in the last month': True, 'Acute spinal cord injury causing paralysis in the last month': False, 'Varicose veins': True, 'Current swollen legs': False, 'Previously documented Deep Vein Thrombosis': True, 'Previously Documented Pulmonary Embolism': False, 'Family history of thrombosis': True, 'Positive Factor V Leiden': False, 'Positive prothrombin 20210A': False, 'Elevated serum homocysteine': True, 'Positive lupus anticoagulant': False, 'Elevated anticardiolipin antibody': False, 'Heparin-induced thrombocytopenia': False, 'Other congenital or acquired thrombophilia': False, 'Mobility': 'on bed rest', 'History of inflammatory bowel disease': False, 'Body Mass Index (BMI)': [27.1, 'kg/m^2'], 'Acute Myocardial infarction': False, 'Chronic Obstructive Pulmonary Disease': False, 'Present or previous malignancy': False}",25,25,25,"The criteria for the Caprini Score are listed below:

1. Age, years: ≤40 = 0 points, 41-60 = +1 point, 61-74 = +2 points, ≥75 = +3 points
2. Sex: Male = 0 points, Female = +1 point
3. Type of surgery: None = 0 points, Minor = +1 point, Major >45 min (laparoscopic or arthroscopic) = +2 points, Elective major lower extremity arthroplasty = +5 points
4. Recent (≤1 month) event: Major surgery = +1 point, Congestive heart failure (CHF) = +1 point, Sepsis = +1 point, Pneumonia = +1 point, Immobilizing plaster cast = +1 point, Hip, pelvis, or leg fracture = +5 points, Stroke = +5 points, Multiple trauma = +5 points, Acute spinal cord injury causing paralysis = +5 points
5. Venous disease or clotting disorder: Varicose veins = +1 point, Current swollen legs = +1 point, Current central venous access = +2 points, History of deep vein thrombosis (DVT) or pulmonary embolism (PE) = +3 points, Family history of thrombosis = +3 points, Positive Factor V Leiden = +3 points, Positive prothrombin 20210A = +3 points, Elevated serum homocysteine = +3 points
6. Other congenital or acquired thrombophilia: Positive lupus anticoagulant = +3 points, Elevated anticardiolipin antibody = +3 points, Heparin-induced thrombocytopenia = +3 points
7. Mobility: Normal, out of bed = 0 points, Medical patient currently on bed rest = +1 point, Patient confined to bed >72 hours = +2 points
8. Other present and past history: History of inflammatory bowel disease = +1 point, BMI ≥25 = +1 point, Acute myocardial infarction = +1 point, Chronic obstructive pulmonary disease (COPD) = +1 point, Present or previous malignancy = +2 points

The total Caprini Score is calculated by summing the points for each criterion.
    
The patient's current caprini score is 0.
The patient's gender is Female.
The patient is 63.0 years old. Because the patient's age is between 61 and 74, we add two points to the current total, making the current total, 0 + 2 = 2.
The patient does not report anything about s and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about major surgery in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about congestive heart failure in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient's has does not have sepsis in the last month. Hence, 0 points are added to the score, keeping the total at 2.The patient's has does not have pneumonia in the last month. Hence, 0 points are added to the score, keeping the total at 2.The patient does not report anything about immobilizing plaster cast in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient's has hip, pelvis, or leg fracture in the last month. Hence, we add 5 to the total, making the current total 5 + 2 = 7.
 The patient does not report anything about stroke in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 7. The patient's has multiple trauma in the last month. Hence, we add 5 to the total, making the current total 5 + 7 = 12.
 The patient's has does not have acute spinal cord injury causing paralysis in the last month. Hence, 0 points are added to the score, keeping the total at 12.The patient's has varicose veins. Hence, we add 1 to the total, making the current total 1 + 12 = 13.
 The patient's has does not have current swollen legs. Hence, 0 points are added to the score, keeping the total at 13.The patient does not report anything about current central venuous access and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 13. The patient's has previous DVT documented. Hence, we add 3 to the total, making the current total 3 + 13 = 16.
 The patient's has does not have previous pulmonary embolism documented. Hence, 0 points are added to the score, keeping the total at 16.The patient's has family history of thrombosis. Hence, we add 3 to the total, making the current total 3 + 16 = 19.
 The patient's has does not have Positive Factor V Leiden. Hence, 0 points are added to the score, keeping the total at 19.The patient's has does not have Positive prothrombin 20210A. Hence, 0 points are added to the score, keeping the total at 19.The patient's has an elevated serum homocysteine. Hence, we add 3 to the total, making the current total 3 + 19 = 22.
 The patient's has does not have a positive lupus anticoagulant. Hence, 0 points are added to the score, keeping the total at 22.The patient's has does not have an elevated anticardiolipin antibody. Hence, 0 points are added to the score, keeping the total at 22.The patient's has does not have a heparin-induced thrombocytopenia. Hence, 0 points are added to the score, keeping the total at 22.The patient's has does not have other congenital or acquired thrombophilia. Hence, 0 points are added to the score, keeping the total at 22.The patient's mobility status is determined to be 'on bed rest'. Hence, we add 1 points to the total, making the current total 1 + 22 = 23.
 The patient's has does not have history of inflammatory bowel disease. Hence, 0 points are added to the score, keeping the total at 23.The patient's has does not have acute Myocardial infarction. Hence, 0 points are added to the score, keeping the total at 23.The patient's has does not have chronic Obstructive Pulmonary Disease. Hence, 0 points are added to the score, keeping the total at 23.The patient's has does not have malignancy. Hence, 0 points are added to the score, keeping the total at 23.The patient's BMI is 27.1 kg/m^2, which is greater than 25 kg/m^2, and so we add 2 points to the total, making the current total 23 + 2 = 25.
"
909,36,Caprini Score for Venous Thromboembolism (2005),risk,integer,2,Handwritten,"An 81-year-old male (BMI 21.4) with a PMH of prothrombin 20210A mutation, HTN, HIT, HLD, previous DVT, and recent admission in the past month for sepsis and stroke is admitted following a scheduled right total knee replacement. On physical exam of the right leg there are varicose veins and no swelling. The incision is cool dry and intact with no evidence of dehiscence. There is no recent history of congestive heart failure or pneumonia. Family history is significant for thrombosis, lung cancer, and HTN. The patient is able to mobalize normally but describes some pain in his right knee with flexion. Review of systems is negative for inflammatory bowel disease, acute myocardial infarction, chronic obstructive pulmonary disease, or malignancy. Further evaluation may be warranted to assess thrombotic risk and determine appropriate management strategies. Additional laboratory tests such as coagulation studies and imaging studies may provide further insight into the patient's condition.",What is the patient's Caprini Score for Venous Thromboembolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [81.0, 'years'], 'sex': 'Male', 'Surgery Type': 'elective major lower extremity arthroplasty', 'Major Surgery in the last month': False, 'Congestive Heart Failure in the last month': False, 'Sepsis in the last month': True, 'Pneumonia in the last month': False, 'Immobilizing plaster cast in the last month': False, 'Hip, pelvis, or leg fracture in the last month': False, 'Stroke in the last month': True, 'Multiple trauma in the last month': False, 'Acute spinal cord injury causing paralysis in the last month': False, 'Varicose veins': True, 'Current swollen legs': False, 'Current central venous access': False, 'Previously documented Deep Vein Thrombosis': True, 'Previously Documented Pulmonary Embolism': False, 'Family history of thrombosis': True, 'Positive Factor V Leiden': False, 'Positive prothrombin 20210A': True, 'Elevated serum homocysteine': False, 'Positive lupus anticoagulant': False, 'Elevated anticardiolipin antibody': False, 'Heparin-induced thrombocytopenia': True, 'Other congenital or acquired thrombophilia': False, 'Mobility': 'normal', 'History of inflammatory bowel disease': False, 'Body Mass Index (BMI)': [21.4, 'kg/m^2'], 'Acute Myocardial infarction': False, 'Chronic Obstructive Pulmonary Disease': False, 'Present or previous malignancy': False}",17,17,17,"The criteria for the Caprini Score are listed below:

1. Age, years: ≤40 = 0 points, 41-60 = +1 point, 61-74 = +2 points, ≥75 = +3 points
2. Sex: Male = 0 points, Female = +1 point
3. Type of surgery: None = 0 points, Minor = +1 point, Major >45 min (laparoscopic or arthroscopic) = +2 points, Elective major lower extremity arthroplasty = +5 points
4. Recent (≤1 month) event: Major surgery = +1 point, Congestive heart failure (CHF) = +1 point, Sepsis = +1 point, Pneumonia = +1 point, Immobilizing plaster cast = +1 point, Hip, pelvis, or leg fracture = +5 points, Stroke = +5 points, Multiple trauma = +5 points, Acute spinal cord injury causing paralysis = +5 points
5. Venous disease or clotting disorder: Varicose veins = +1 point, Current swollen legs = +1 point, Current central venous access = +2 points, History of deep vein thrombosis (DVT) or pulmonary embolism (PE) = +3 points, Family history of thrombosis = +3 points, Positive Factor V Leiden = +3 points, Positive prothrombin 20210A = +3 points, Elevated serum homocysteine = +3 points
6. Other congenital or acquired thrombophilia: Positive lupus anticoagulant = +3 points, Elevated anticardiolipin antibody = +3 points, Heparin-induced thrombocytopenia = +3 points
7. Mobility: Normal, out of bed = 0 points, Medical patient currently on bed rest = +1 point, Patient confined to bed >72 hours = +2 points
8. Other present and past history: History of inflammatory bowel disease = +1 point, BMI ≥25 = +1 point, Acute myocardial infarction = +1 point, Chronic obstructive pulmonary disease (COPD) = +1 point, Present or previous malignancy = +2 points

The total Caprini Score is calculated by summing the points for each criterion.
    
The patient's current caprini score is 0.
The patient's gender is Male.
The patient is 81.0 years old. Because the patient's age at least 75, we add three points to the current total, making the current total, 0 + 3 = 3.
The patient does not report anything about s and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 3. The patient does not report anything about major surgery in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 3. The patient does not report anything about congestive heart failure in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 3. The patient's has sepsis in the last month. Hence, we add 1 to the total, making the current total 1 + 3 = 4.
 The patient's has does not have pneumonia in the last month. Hence, 0 points are added to the score, keeping the total at 4.The patient does not report anything about immobilizing plaster cast in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 4. The patient's has does not have hip, pelvis, or leg fracture in the last month. Hence, 0 points are added to the score, keeping the total at 4.The patient does not report anything about stroke in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 4. The patient's has does not have multiple trauma in the last month. Hence, 0 points are added to the score, keeping the total at 4.The patient's has does not have acute spinal cord injury causing paralysis in the last month. Hence, 0 points are added to the score, keeping the total at 4.The patient's has varicose veins. Hence, we add 1 to the total, making the current total 1 + 4 = 5.
 The patient's has does not have current swollen legs. Hence, 0 points are added to the score, keeping the total at 5.The patient's has does not have current central venuous access. Hence, 0 points are added to the score, keeping the total at 5.The patient's has previous DVT documented. Hence, we add 3 to the total, making the current total 3 + 5 = 8.
 The patient's has does not have previous pulmonary embolism documented. Hence, 0 points are added to the score, keeping the total at 8.The patient's has family history of thrombosis. Hence, we add 3 to the total, making the current total 3 + 8 = 11.
 The patient's has does not have Positive Factor V Leiden. Hence, 0 points are added to the score, keeping the total at 11.The patient's has Positive prothrombin 20210A. Hence, we add 3 to the total, making the current total 3 + 11 = 14.
 The patient's has does not have an elevated serum homocysteine. Hence, 0 points are added to the score, keeping the total at 14.The patient's has does not have a positive lupus anticoagulant. Hence, 0 points are added to the score, keeping the total at 14.The patient's has does not have an elevated anticardiolipin antibody. Hence, 0 points are added to the score, keeping the total at 14.The patient's has a heparin-induced thrombocytopenia. Hence, we add 3 to the total, making the current total 3 + 14 = 17.
 The patient's has does not have other congenital or acquired thrombophilia. Hence, 0 points are added to the score, keeping the total at 17.The patient's mobility status is determined to be 'normal'. Hence, we add 0 points to the total, making the current total 0 + 17 = 17.
 The patient's has does not have history of inflammatory bowel disease. Hence, 0 points are added to the score, keeping the total at 17.The patient's has does not have acute Myocardial infarction. Hence, 0 points are added to the score, keeping the total at 17.The patient's has does not have chronic Obstructive Pulmonary Disease. Hence, 0 points are added to the score, keeping the total at 17.The patient's has does not have malignancy. Hence, 0 points are added to the score, keeping the total at 17.The patient's BMI is 21.4 kg/m^2, which is less than 25 kg/m^2, and so we add 0 points to the total, keeping the total at 17.
"
910,36,Caprini Score for Venous Thromboembolism (2005),risk,integer,3,Handwritten,"A 74-year-old female (BMI 23.1) with a PMH of MI (2014) HTN, and dementia presents following a recent motor vehicle accident (MVA) resulting in the immobilization of her left lower extremity with a plaster cast. Concurrent management of her congestive heart failure (CHF) was administered during this period. Additionally, she underwent minor surgery for cosmetic reconstruction of the limb and necessitates central venous access for antibiotic therapy administration for hospital acquired pneumonia. There is no recent history of major surgery, sepsis, or acute spinal cord injury. On physical exam there is no current evidence of swollen legs however there are numerous varicose veins. She has a family history of thrombosis, however she is negative for specific thrombophilic factors. She is currently bed bound due to the cast and central line. She does not have a history of IBD, COPD or malignancy. Further assessment and management are indicated, considering her recent medical history and current clinical status.",What is the patient's Caprini Score for Venous Thromboembolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [74.0, 'years'], 'sex': 'Female', 'Surgery Type': 'minor', 'Major Surgery in the last month': False, 'Congestive Heart Failure in the last month': True, 'Sepsis in the last month': False, 'Pneumonia in the last month': True, 'Immobilizing plaster cast in the last month': True, 'Hip, pelvis, or leg fracture in the last month': False, 'Stroke in the last month': False, 'Multiple trauma in the last month': True, 'Acute spinal cord injury causing paralysis in the last month': False, 'Varicose veins': True, 'Current swollen legs': False, 'Current central venous access': True, 'Previously documented Deep Vein Thrombosis': False, 'Previously Documented Pulmonary Embolism': False, 'Family history of thrombosis': True, 'Positive Factor V Leiden': False, 'Positive prothrombin 20210A': False, 'Elevated serum homocysteine': False, 'Positive lupus anticoagulant': False, 'Elevated anticardiolipin antibody': False, 'Heparin-induced thrombocytopenia': False, 'Other congenital or acquired thrombophilia': False, 'Mobility': 'on bed rest', 'History of inflammatory bowel disease': False, 'Body Mass Index (BMI)': [23.1, 'kg/m^2'], 'Acute Myocardial infarction': True, 'Chronic Obstructive Pulmonary Disease': False, 'Present or previous malignancy': False}",16,16,16,"The criteria for the Caprini Score are listed below:

1. Age, years: ≤40 = 0 points, 41-60 = +1 point, 61-74 = +2 points, ≥75 = +3 points
2. Sex: Male = 0 points, Female = +1 point
3. Type of surgery: None = 0 points, Minor = +1 point, Major >45 min (laparoscopic or arthroscopic) = +2 points, Elective major lower extremity arthroplasty = +5 points
4. Recent (≤1 month) event: Major surgery = +1 point, Congestive heart failure (CHF) = +1 point, Sepsis = +1 point, Pneumonia = +1 point, Immobilizing plaster cast = +1 point, Hip, pelvis, or leg fracture = +5 points, Stroke = +5 points, Multiple trauma = +5 points, Acute spinal cord injury causing paralysis = +5 points
5. Venous disease or clotting disorder: Varicose veins = +1 point, Current swollen legs = +1 point, Current central venous access = +2 points, History of deep vein thrombosis (DVT) or pulmonary embolism (PE) = +3 points, Family history of thrombosis = +3 points, Positive Factor V Leiden = +3 points, Positive prothrombin 20210A = +3 points, Elevated serum homocysteine = +3 points
6. Other congenital or acquired thrombophilia: Positive lupus anticoagulant = +3 points, Elevated anticardiolipin antibody = +3 points, Heparin-induced thrombocytopenia = +3 points
7. Mobility: Normal, out of bed = 0 points, Medical patient currently on bed rest = +1 point, Patient confined to bed >72 hours = +2 points
8. Other present and past history: History of inflammatory bowel disease = +1 point, BMI ≥25 = +1 point, Acute myocardial infarction = +1 point, Chronic obstructive pulmonary disease (COPD) = +1 point, Present or previous malignancy = +2 points

The total Caprini Score is calculated by summing the points for each criterion.
    
The patient's current caprini score is 0.
The patient's gender is Female.
The patient is 74.0 years old. Because the patient's age is between 61 and 74, we add two points to the current total, making the current total, 0 + 2 = 2.
The patient does not report anything about s and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about major surgery in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about congestive heart failure in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient's has does not have sepsis in the last month. Hence, 0 points are added to the score, keeping the total at 2.The patient's has pneumonia in the last month. Hence, we add 1 to the total, making the current total 1 + 2 = 3.
 The patient does not report anything about immobilizing plaster cast in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 3. The patient's has does not have hip, pelvis, or leg fracture in the last month. Hence, 0 points are added to the score, keeping the total at 3.The patient does not report anything about stroke in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 3. The patient's has multiple trauma in the last month. Hence, we add 5 to the total, making the current total 5 + 3 = 8.
 The patient's has does not have acute spinal cord injury causing paralysis in the last month. Hence, 0 points are added to the score, keeping the total at 8.The patient's has varicose veins. Hence, we add 1 to the total, making the current total 1 + 8 = 9.
 The patient's has does not have current swollen legs. Hence, 0 points are added to the score, keeping the total at 9.The patient's has current central venuous access. Hence, we add 2 to the total, making the current total 2 + 9 = 11.
 The patient's has does not have previous DVT documented. Hence, 0 points are added to the score, keeping the total at 11.The patient's has does not have previous pulmonary embolism documented. Hence, 0 points are added to the score, keeping the total at 11.The patient's has family history of thrombosis. Hence, we add 3 to the total, making the current total 3 + 11 = 14.
 The patient's has does not have Positive Factor V Leiden. Hence, 0 points are added to the score, keeping the total at 14.The patient's has does not have Positive prothrombin 20210A. Hence, 0 points are added to the score, keeping the total at 14.The patient's has does not have an elevated serum homocysteine. Hence, 0 points are added to the score, keeping the total at 14.The patient's has does not have a positive lupus anticoagulant. Hence, 0 points are added to the score, keeping the total at 14.The patient's has does not have an elevated anticardiolipin antibody. Hence, 0 points are added to the score, keeping the total at 14.The patient's has does not have a heparin-induced thrombocytopenia. Hence, 0 points are added to the score, keeping the total at 14.The patient's has does not have other congenital or acquired thrombophilia. Hence, 0 points are added to the score, keeping the total at 14.The patient's mobility status is determined to be 'on bed rest'. Hence, we add 1 points to the total, making the current total 1 + 14 = 15.
 The patient's has does not have history of inflammatory bowel disease. Hence, 0 points are added to the score, keeping the total at 15.The patient's has acute Myocardial infarction. Hence, we add 1 to the total, making the current total 1 + 15 = 16.
 The patient's has does not have chronic Obstructive Pulmonary Disease. Hence, 0 points are added to the score, keeping the total at 16.The patient's has does not have malignancy. Hence, 0 points are added to the score, keeping the total at 16.The patient's BMI is 23.1 kg/m^2, which is less than 25 kg/m^2, and so we add 0 points to the total, keeping the total at 16.
"
911,36,Caprini Score for Venous Thromboembolism (2005),risk,integer,4,Handwritten,"A 67-year-old female with a BMI of 28.3 kg/m^2 with a PMH of Factor V, positive lupus anticoagulant, and breast cancer, presents following a recent fall resulting in a spinal injury and nonoperative management of a lower leg fracture. She had a recent admission for pneumonia following a pulmonary embolism three weeks ago. On examination, she exhibits swollen legs but is able to ambulate normally. There is no current central venous access, and she denies any family history of thrombosis. She has no history of inflammatory bowel disease, chronic obstructive pulmonary disease, MI, sepsis or stroke. Further evaluation is warranted to address her recent medical history and current clinical presentation.",What is the patient's Caprini Score for Venous Thromboembolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [67.0, 'years'], 'sex': 'Female', 'Major Surgery in the last month': False, 'Congestive Heart Failure in the last month': False, 'Sepsis in the last month': False, 'Pneumonia in the last month': True, 'Immobilizing plaster cast in the last month': False, 'Hip, pelvis, or leg fracture in the last month': True, 'Stroke in the last month': False, 'Multiple trauma in the last month': False, 'Acute spinal cord injury causing paralysis in the last month': False, 'Varicose veins': False, 'Current swollen legs': True, 'Current central venous access': False, 'Previously documented Deep Vein Thrombosis': False, 'Previously Documented Pulmonary Embolism': True, 'Family history of thrombosis': False, 'Positive Factor V Leiden': True, 'Positive prothrombin 20210A': False, 'Elevated serum homocysteine': False, 'Positive lupus anticoagulant': True, 'Elevated anticardiolipin antibody': False, 'Heparin-induced thrombocytopenia': False, 'Other congenital or acquired thrombophilia': False, 'Mobility': 'normal', 'History of inflammatory bowel disease': False, 'Body Mass Index (BMI)': [28.3, 'kg/m^2'], 'Acute Myocardial infarction': False, 'Chronic Obstructive Pulmonary Disease': False, 'Present or previous malignancy': True, 'Surgery Type': 'none'}",22,22,22,"The criteria for the Caprini Score are listed below:

1. Age, years: ≤40 = 0 points, 41-60 = +1 point, 61-74 = +2 points, ≥75 = +3 points
2. Sex: Male = 0 points, Female = +1 point
3. Type of surgery: None = 0 points, Minor = +1 point, Major >45 min (laparoscopic or arthroscopic) = +2 points, Elective major lower extremity arthroplasty = +5 points
4. Recent (≤1 month) event: Major surgery = +1 point, Congestive heart failure (CHF) = +1 point, Sepsis = +1 point, Pneumonia = +1 point, Immobilizing plaster cast = +1 point, Hip, pelvis, or leg fracture = +5 points, Stroke = +5 points, Multiple trauma = +5 points, Acute spinal cord injury causing paralysis = +5 points
5. Venous disease or clotting disorder: Varicose veins = +1 point, Current swollen legs = +1 point, Current central venous access = +2 points, History of deep vein thrombosis (DVT) or pulmonary embolism (PE) = +3 points, Family history of thrombosis = +3 points, Positive Factor V Leiden = +3 points, Positive prothrombin 20210A = +3 points, Elevated serum homocysteine = +3 points
6. Other congenital or acquired thrombophilia: Positive lupus anticoagulant = +3 points, Elevated anticardiolipin antibody = +3 points, Heparin-induced thrombocytopenia = +3 points
7. Mobility: Normal, out of bed = 0 points, Medical patient currently on bed rest = +1 point, Patient confined to bed >72 hours = +2 points
8. Other present and past history: History of inflammatory bowel disease = +1 point, BMI ≥25 = +1 point, Acute myocardial infarction = +1 point, Chronic obstructive pulmonary disease (COPD) = +1 point, Present or previous malignancy = +2 points

The total Caprini Score is calculated by summing the points for each criterion.
    
The patient's current caprini score is 0.
The patient's gender is Female.
The patient is 67.0 years old. Because the patient's age is between 61 and 74, we add two points to the current total, making the current total, 0 + 2 = 2.
The patient does not report anything about s and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about major surgery in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about congestive heart failure in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient's has does not have sepsis in the last month. Hence, 0 points are added to the score, keeping the total at 2.The patient's has pneumonia in the last month. Hence, we add 1 to the total, making the current total 1 + 2 = 3.
 The patient does not report anything about immobilizing plaster cast in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 3. The patient's has hip, pelvis, or leg fracture in the last month. Hence, we add 5 to the total, making the current total 5 + 3 = 8.
 The patient does not report anything about stroke in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 8. The patient's has does not have multiple trauma in the last month. Hence, 0 points are added to the score, keeping the total at 8.The patient's has does not have acute spinal cord injury causing paralysis in the last month. Hence, 0 points are added to the score, keeping the total at 8.The patient's has does not have varicose veins. Hence, 0 points are added to the score, keeping the total at 8.The patient's has current swollen legs. Hence, we add 1 to the total, making the current total 1 + 8 = 9.
 The patient's has does not have current central venuous access. Hence, 0 points are added to the score, keeping the total at 9.The patient's has does not have previous DVT documented. Hence, 0 points are added to the score, keeping the total at 9.The patient's has previous pulmonary embolism documented. Hence, we add 3 to the total, making the current total 3 + 9 = 12.
 The patient's has does not have family history of thrombosis. Hence, 0 points are added to the score, keeping the total at 12.The patient's has Positive Factor V Leiden. Hence, we add 3 to the total, making the current total 3 + 12 = 15.
 The patient's has does not have Positive prothrombin 20210A. Hence, 0 points are added to the score, keeping the total at 15.The patient's has does not have an elevated serum homocysteine. Hence, 0 points are added to the score, keeping the total at 15.The patient's has a positive lupus anticoagulant. Hence, we add 3 to the total, making the current total 3 + 15 = 18.
 The patient's has does not have an elevated anticardiolipin antibody. Hence, 0 points are added to the score, keeping the total at 18.The patient's has does not have a heparin-induced thrombocytopenia. Hence, 0 points are added to the score, keeping the total at 18.The patient's has does not have other congenital or acquired thrombophilia. Hence, 0 points are added to the score, keeping the total at 18.The patient's mobility status is determined to be 'normal'. Hence, we add 0 points to the total, making the current total 0 + 18 = 18.
 The patient's has does not have history of inflammatory bowel disease. Hence, 0 points are added to the score, keeping the total at 18.The patient's has does not have acute Myocardial infarction. Hence, 0 points are added to the score, keeping the total at 18.The patient's has does not have chronic Obstructive Pulmonary Disease. Hence, 0 points are added to the score, keeping the total at 18.The patient's has malignancy. Hence, we add 2 to the total, making the current total 2 + 18 = 20.
 The patient's BMI is 28.3 kg/m^2, which is greater than 25 kg/m^2, and so we add 2 points to the total, making the current total 20 + 2 = 22.
"
912,36,Caprini Score for Venous Thromboembolism (2005),risk,integer,5,Handwritten,"A 76-year-old man with a past medical history significant for chronic obstructive pulmonary disease was admitted for elective major lower extremity arthroplasty. Over the past month, heart failure exacerbation and pneumonia had prolonged the patient's hospital stay, during which he remained mostly confined to his bed and needed central venous access for medication delivery. The patient denies any recent fractures nor immobilization with plaster cast. Recent cerebrovascular insult exacerbated his hospital course and he is still recovering. The patient's coagulation profile reveals presence of Factor V Leiden. Screening for prothrombin 20210A mutation and anticardiolipin antibody were negative. He has no history of heparin-induced thrombocytopenia and no other congenital or acquired thrombophilia. He has not had sepsis during the current admission. His BMI is 28 kg/m^2. On physical examination, the lower limbs appear bilaterally swollen. His past medical history is negative for inflammatory bowel disease, myocardial infarction, spinal cord injury, or malignancy, and no family history of thrombosis has been reported.",What is the patient's Caprini Score for Venous Thromboembolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'History of inflammatory bowel disease': False, 'Hip, pelvis, or leg fracture in the last month': False, 'Acute Myocardial infarction': False, 'Chronic Obstructive Pulmonary Disease': True, 'Elevated anticardiolipin antibody': False, 'Mobility': 'on bed rest', 'Current central venous access': True, 'Positive prothrombin 20210A': False, 'Acute spinal cord injury causing paralysis in the last month': False, 'Stroke in the last month': True, 'Present or previous malignancy': False, 'Body Mass Index (BMI)': [28.0, 'kg/m^2'], 'Immobilizing plaster cast in the last month': False, 'Other congenital or acquired thrombophilia': False, 'Pneumonia in the last month': True, 'age': [76.0, 'years'], 'Family history of thrombosis': False, 'Surgery Type': 'elective major lower extremity arthroplasty', 'Sepsis in the last month': False, 'Heparin-induced thrombocytopenia': False, 'Major Surgery in the last month': False, 'sex': 'Male', 'Positive Factor V Leiden': True, 'Current swollen legs': True}",14,14,14,"The criteria for the Caprini Score are listed below:

1. Age, years: ≤40 = 0 points, 41-60 = +1 point, 61-74 = +2 points, ≥75 = +3 points
2. Sex: Male = 0 points, Female = +1 point
3. Type of surgery: None = 0 points, Minor = +1 point, Major >45 min (laparoscopic or arthroscopic) = +2 points, Elective major lower extremity arthroplasty = +5 points
4. Recent (≤1 month) event: Major surgery = +1 point, Congestive heart failure (CHF) = +1 point, Sepsis = +1 point, Pneumonia = +1 point, Immobilizing plaster cast = +1 point, Hip, pelvis, or leg fracture = +5 points, Stroke = +5 points, Multiple trauma = +5 points, Acute spinal cord injury causing paralysis = +5 points
5. Venous disease or clotting disorder: Varicose veins = +1 point, Current swollen legs = +1 point, Current central venous access = +2 points, History of deep vein thrombosis (DVT) or pulmonary embolism (PE) = +3 points, Family history of thrombosis = +3 points, Positive Factor V Leiden = +3 points, Positive prothrombin 20210A = +3 points, Elevated serum homocysteine = +3 points
6. Other congenital or acquired thrombophilia: Positive lupus anticoagulant = +3 points, Elevated anticardiolipin antibody = +3 points, Heparin-induced thrombocytopenia = +3 points
7. Mobility: Normal, out of bed = 0 points, Medical patient currently on bed rest = +1 point, Patient confined to bed >72 hours = +2 points
8. Other present and past history: History of inflammatory bowel disease = +1 point, BMI ≥25 = +1 point, Acute myocardial infarction = +1 point, Chronic obstructive pulmonary disease (COPD) = +1 point, Present or previous malignancy = +2 points

The total Caprini Score is calculated by summing the points for each criterion.
    
The patient's current caprini score is 0.
The patient's gender is Male.
The patient is 76.0 years old. Because the patient's age at least 75, we add three points to the current total, making the current total, 0 + 3 = 3.
The patient does not report anything about s and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 3. The patient does not report anything about major surgery in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 3. The patient does not report anything about congestive heart failure in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 3. The patient's has does not have sepsis in the last month. Hence, 0 points are added to the score, keeping the total at 3.The patient's has pneumonia in the last month. Hence, we add 1 to the total, making the current total 1 + 3 = 4.
 The patient does not report anything about immobilizing plaster cast in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 4. The patient's has does not have hip, pelvis, or leg fracture in the last month. Hence, 0 points are added to the score, keeping the total at 4.The patient does not report anything about stroke in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 4. The patient does not report anything about multiple trauma in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 4. The patient's has does not have acute spinal cord injury causing paralysis in the last month. Hence, 0 points are added to the score, keeping the total at 4.The patient does not report anything about varicose veins and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 4. The patient's has current swollen legs. Hence, we add 1 to the total, making the current total 1 + 4 = 5.
 The patient's has current central venuous access. Hence, we add 2 to the total, making the current total 2 + 5 = 7.
 The patient does not report anything about previous DVT documented and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 7. The patient does not report anything about previous pulmonary embolism documented and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 7. The patient's has does not have family history of thrombosis. Hence, 0 points are added to the score, keeping the total at 7.The patient's has Positive Factor V Leiden. Hence, we add 3 to the total, making the current total 3 + 7 = 10.
 The patient's has does not have Positive prothrombin 20210A. Hence, 0 points are added to the score, keeping the total at 10.The patient does not report anything about an elevated serum homocysteine and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 10. The patient does not report anything about a positive lupus anticoagulant and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 10. The patient's has does not have an elevated anticardiolipin antibody. Hence, 0 points are added to the score, keeping the total at 10.The patient's has does not have a heparin-induced thrombocytopenia. Hence, 0 points are added to the score, keeping the total at 10.The patient's has does not have other congenital or acquired thrombophilia. Hence, 0 points are added to the score, keeping the total at 10.The patient's mobility status is determined to be 'on bed rest'. Hence, we add 1 points to the total, making the current total 1 + 10 = 11.
 The patient's has does not have history of inflammatory bowel disease. Hence, 0 points are added to the score, keeping the total at 11.The patient's has does not have acute Myocardial infarction. Hence, 0 points are added to the score, keeping the total at 11.The patient's has chronic Obstructive Pulmonary Disease. Hence, we add 1 to the total, making the current total 1 + 11 = 12.
 The patient's has does not have malignancy. Hence, 0 points are added to the score, keeping the total at 12.The patient's BMI is 28.0 kg/m^2, which is greater than 25 kg/m^2, and so we add 2 points to the total, making the current total 12 + 2 = 14.
"
913,36,Caprini Score for Venous Thromboembolism (2005),risk,integer,6,Handwritten,"A 56 year old male with a history significant for hypertension, hyperlipidemia, and diabetes mellitus was admitted to the hospital three weeks ago for ischemic stroke. He presented with sudden onset left-sided weakness and slurred speech. Upon admission, imaging confirmed a right middle cerebral artery stroke. TPA was administered and the patient was admitted to the stroke unit. During hospitalization, the patient developed fever, tachycardia, and hypotension. Blood cultures were obtained and empiric broad-spectrum antibiotic therapy started for presumed sepsis of unclear source. Due to the patient's acutely deteriorating clinical status, a central venous catheter was surgically inserted for hemodynamic monitoring and administration of antibiotics and vasopressor support. The patient is being closely followed by the stroke, infectious disease, and critical care teams. Neurological function has been gradually improving. Antibiotic therapy has been narrowed per culture results and the patient has been hemodynamically stabilized. He is able to ambulate around the room. The patient has no history of prior pneumonia, DVT or PE, heart failure, myocardial infarction, malignancy, chronic obstructive pulmonary disease, or inflammatory bowel disease. The patient recently underwent extensive workup for thrombophilic risk factors, which revealed elevated serum homocysteine and positive anticardiolipin antibody. Evaluation of Factor V Leiden, prothrombin 20210A, and lupus anticoagulant were negative. There is no family history of thrombosis. The patient has no recent history of trauma or fractures. BMI is 23.4 kg/m^2. On physical exam, heart and lung sounds are normal. Lower extremities are normal with no edema or varicose veins. The patient will remain hospitalized for ongoing management and monitoring.",What is the patient's Caprini Score for Venous Thromboembolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'age': [56.0, 'years'], 'sex': 'Male', 'Major Surgery in the last month': False, 'Congestive Heart Failure in the last month': False, 'Sepsis in the last month': True, 'Pneumonia in the last month': False, 'Hip, pelvis, or leg fracture in the last month': False, 'Stroke in the last month': True, 'Multiple trauma in the last month': False, 'Varicose veins': False, 'Current swollen legs': False, 'Current central venous access': True, 'Previously documented Deep Vein Thrombosis': False, 'Previously Documented Pulmonary Embolism': False, 'Family history of thrombosis': False, 'Positive Factor V Leiden': False, 'Positive prothrombin 20210A': False, 'Elevated serum homocysteine': True, 'Positive lupus anticoagulant': False, 'Elevated anticardiolipin antibody': True, 'Mobility': 'normal', 'History of inflammatory bowel disease': False, 'Body Mass Index (BMI)': [23.4, 'kg/m^2'], 'Acute Myocardial infarction': False, 'Chronic Obstructive Pulmonary Disease': False, 'Present or previous malignancy': False, 'Surgery Type': 'none'}",10,10,10,"The criteria for the Caprini Score are listed below:

1. Age, years: ≤40 = 0 points, 41-60 = +1 point, 61-74 = +2 points, ≥75 = +3 points
2. Sex: Male = 0 points, Female = +1 point
3. Type of surgery: None = 0 points, Minor = +1 point, Major >45 min (laparoscopic or arthroscopic) = +2 points, Elective major lower extremity arthroplasty = +5 points
4. Recent (≤1 month) event: Major surgery = +1 point, Congestive heart failure (CHF) = +1 point, Sepsis = +1 point, Pneumonia = +1 point, Immobilizing plaster cast = +1 point, Hip, pelvis, or leg fracture = +5 points, Stroke = +5 points, Multiple trauma = +5 points, Acute spinal cord injury causing paralysis = +5 points
5. Venous disease or clotting disorder: Varicose veins = +1 point, Current swollen legs = +1 point, Current central venous access = +2 points, History of deep vein thrombosis (DVT) or pulmonary embolism (PE) = +3 points, Family history of thrombosis = +3 points, Positive Factor V Leiden = +3 points, Positive prothrombin 20210A = +3 points, Elevated serum homocysteine = +3 points
6. Other congenital or acquired thrombophilia: Positive lupus anticoagulant = +3 points, Elevated anticardiolipin antibody = +3 points, Heparin-induced thrombocytopenia = +3 points
7. Mobility: Normal, out of bed = 0 points, Medical patient currently on bed rest = +1 point, Patient confined to bed >72 hours = +2 points
8. Other present and past history: History of inflammatory bowel disease = +1 point, BMI ≥25 = +1 point, Acute myocardial infarction = +1 point, Chronic obstructive pulmonary disease (COPD) = +1 point, Present or previous malignancy = +2 points

The total Caprini Score is calculated by summing the points for each criterion.
    
The patient's current caprini score is 0.
The patient's gender is Male.
The patient is 56.0 years old. Because the patient's age is between 61 and 74, we add one point to the current total, making the current total, 0 + 1 = 1.
The patient does not report anything about s and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about major surgery in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about congestive heart failure in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient's has sepsis in the last month. Hence, we add 1 to the total, making the current total 1 + 1 = 2.
 The patient's has does not have pneumonia in the last month. Hence, 0 points are added to the score, keeping the total at 2.The patient does not report anything about immobilizing plaster cast in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient's has does not have hip, pelvis, or leg fracture in the last month. Hence, 0 points are added to the score, keeping the total at 2.The patient does not report anything about stroke in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient's has does not have multiple trauma in the last month. Hence, 0 points are added to the score, keeping the total at 2.The patient does not report anything about acute spinal cord injury causing paralysis in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient's has does not have varicose veins. Hence, 0 points are added to the score, keeping the total at 2.The patient's has does not have current swollen legs. Hence, 0 points are added to the score, keeping the total at 2.The patient's has current central venuous access. Hence, we add 2 to the total, making the current total 2 + 2 = 4.
 The patient's has does not have previous DVT documented. Hence, 0 points are added to the score, keeping the total at 4.The patient's has does not have previous pulmonary embolism documented. Hence, 0 points are added to the score, keeping the total at 4.The patient's has does not have family history of thrombosis. Hence, 0 points are added to the score, keeping the total at 4.The patient's has does not have Positive Factor V Leiden. Hence, 0 points are added to the score, keeping the total at 4.The patient's has does not have Positive prothrombin 20210A. Hence, 0 points are added to the score, keeping the total at 4.The patient's has an elevated serum homocysteine. Hence, we add 3 to the total, making the current total 3 + 4 = 7.
 The patient's has does not have a positive lupus anticoagulant. Hence, 0 points are added to the score, keeping the total at 7.The patient's has an elevated anticardiolipin antibody. Hence, we add 3 to the total, making the current total 3 + 7 = 10.
 The patient does not report anything about a heparin-induced thrombocytopenia and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 10. The patient does not report anything about other congenital or acquired thrombophilia and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 10. The patient's mobility status is determined to be 'normal'. Hence, we add 0 points to the total, making the current total 0 + 10 = 10.
 The patient's has does not have history of inflammatory bowel disease. Hence, 0 points are added to the score, keeping the total at 10.The patient's has does not have acute Myocardial infarction. Hence, 0 points are added to the score, keeping the total at 10.The patient's has does not have chronic Obstructive Pulmonary Disease. Hence, 0 points are added to the score, keeping the total at 10.The patient's has does not have malignancy. Hence, 0 points are added to the score, keeping the total at 10.The patient's BMI is 23.4 kg/m^2, which is less than 25 kg/m^2, and so we add 0 points to the total, keeping the total at 10.
"
914,36,Caprini Score for Venous Thromboembolism (2005),risk,integer,7,Handwritten,"A 68-year-old female patient is currently being managed in the critical care unit following recent major laparoscopic surgery performed for ovarian cancer. Her medical history includes prior deep vein thrombosis and a pulmonary embolism. Her BMI is 30 kg/m^2. Over the post-operative period, due to her recovery and limited movement, she has spent over 72 hours confined to bed. Her current hospital stay has been complicated by acute myocardial infarction. Physical examination reveals swelling in the legs. Labs have indicated elevated serum homocysteine levels. Prothrombin 20210A, lupus anticoagulant, and factor V Leiden mutation are negative. She also has long-standing inflammatory bowel disease and a positive family history of thrombosis. She has no history of chronic obstructive pulmonary disease, trauma, or sepsis and no hip, pelvis, or leg fractures in the recent past. She has required no immobilizing plaster casts.",What is the patient's Caprini Score for Venous Thromboembolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'History of inflammatory bowel disease': True, 'Hip, pelvis, or leg fracture in the last month': False, 'Acute Myocardial infarction': True, 'Chronic Obstructive Pulmonary Disease': False, 'Mobility': 'confined to bed >72 hours', 'Positive prothrombin 20210A': False, 'Previously documented Deep Vein Thrombosis': True, 'Present or previous malignancy': True, 'Multiple trauma in the last month': False, 'Body Mass Index (BMI)': [30.0, 'kg/m^2'], 'Previously Documented Pulmonary Embolism': True, 'Immobilizing plaster cast in the last month': False, 'Positive lupus anticoagulant': False, 'age': [68.0, 'years'], 'Family history of thrombosis': True, 'Surgery Type': 'laparoscopic', 'Sepsis in the last month': False, 'Major Surgery in the last month': False, 'sex': 'Female', 'Elevated serum homocysteine': True, 'Positive Factor V Leiden': False, 'Current swollen legs': True}",23,23,23,"The criteria for the Caprini Score are listed below:

1. Age, years: ≤40 = 0 points, 41-60 = +1 point, 61-74 = +2 points, ≥75 = +3 points
2. Sex: Male = 0 points, Female = +1 point
3. Type of surgery: None = 0 points, Minor = +1 point, Major >45 min (laparoscopic or arthroscopic) = +2 points, Elective major lower extremity arthroplasty = +5 points
4. Recent (≤1 month) event: Major surgery = +1 point, Congestive heart failure (CHF) = +1 point, Sepsis = +1 point, Pneumonia = +1 point, Immobilizing plaster cast = +1 point, Hip, pelvis, or leg fracture = +5 points, Stroke = +5 points, Multiple trauma = +5 points, Acute spinal cord injury causing paralysis = +5 points
5. Venous disease or clotting disorder: Varicose veins = +1 point, Current swollen legs = +1 point, Current central venous access = +2 points, History of deep vein thrombosis (DVT) or pulmonary embolism (PE) = +3 points, Family history of thrombosis = +3 points, Positive Factor V Leiden = +3 points, Positive prothrombin 20210A = +3 points, Elevated serum homocysteine = +3 points
6. Other congenital or acquired thrombophilia: Positive lupus anticoagulant = +3 points, Elevated anticardiolipin antibody = +3 points, Heparin-induced thrombocytopenia = +3 points
7. Mobility: Normal, out of bed = 0 points, Medical patient currently on bed rest = +1 point, Patient confined to bed >72 hours = +2 points
8. Other present and past history: History of inflammatory bowel disease = +1 point, BMI ≥25 = +1 point, Acute myocardial infarction = +1 point, Chronic obstructive pulmonary disease (COPD) = +1 point, Present or previous malignancy = +2 points

The total Caprini Score is calculated by summing the points for each criterion.
    
The patient's current caprini score is 0.
The patient's gender is Female.
The patient is 68.0 years old. Because the patient's age is between 61 and 74, we add two points to the current total, making the current total, 0 + 2 = 2.
The patient does not report anything about s and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about major surgery in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about congestive heart failure in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient's has does not have sepsis in the last month. Hence, 0 points are added to the score, keeping the total at 2.The patient does not report anything about pneumonia in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about immobilizing plaster cast in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient's has does not have hip, pelvis, or leg fracture in the last month. Hence, 0 points are added to the score, keeping the total at 2.The patient does not report anything about stroke in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient's has does not have multiple trauma in the last month. Hence, 0 points are added to the score, keeping the total at 2.The patient does not report anything about acute spinal cord injury causing paralysis in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about varicose veins and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient's has current swollen legs. Hence, we add 1 to the total, making the current total 1 + 2 = 3.
 The patient does not report anything about current central venuous access and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 3. The patient's has previous DVT documented. Hence, we add 3 to the total, making the current total 3 + 3 = 6.
 The patient's has previous pulmonary embolism documented. Hence, we add 3 to the total, making the current total 3 + 6 = 9.
 The patient's has family history of thrombosis. Hence, we add 3 to the total, making the current total 3 + 9 = 12.
 The patient's has does not have Positive Factor V Leiden. Hence, 0 points are added to the score, keeping the total at 12.The patient's has does not have Positive prothrombin 20210A. Hence, 0 points are added to the score, keeping the total at 12.The patient's has an elevated serum homocysteine. Hence, we add 3 to the total, making the current total 3 + 12 = 15.
 The patient's has does not have a positive lupus anticoagulant. Hence, 0 points are added to the score, keeping the total at 15.The patient does not report anything about an elevated anticardiolipin antibody and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 15. The patient does not report anything about a heparin-induced thrombocytopenia and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 15. The patient does not report anything about other congenital or acquired thrombophilia and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 15. The patient's mobility status is determined to be 'confined to bed >72 hours'. Hence, we add 2 points to the total, making the current total 2 + 15 = 17.
 The patient's has history of inflammatory bowel disease. Hence, we add 1 to the total, making the current total 1 + 17 = 18.
 The patient's has acute Myocardial infarction. Hence, we add 1 to the total, making the current total 1 + 18 = 19.
 The patient's has does not have chronic Obstructive Pulmonary Disease. Hence, 0 points are added to the score, keeping the total at 19.The patient's has malignancy. Hence, we add 2 to the total, making the current total 2 + 19 = 21.
 The patient's BMI is 30.0 kg/m^2, which is greater than 25 kg/m^2, and so we add 2 points to the total, making the current total 21 + 2 = 23.
"
915,36,Caprini Score for Venous Thromboembolism (2005),risk,integer,8,Handwritten,"A 39-year-old man is confined to bed rest due to a recent minor surgery. His past medical history includes inflammatory bowel disease and recent decompensated congestive heart failure. The patient has suffered from a stroke in the last month, which has led to this hospitalization and current period of bed rest. A central venous catheter was inserted for medication delivery. There is no record of acute spinal cord injury and the patient denies any previous pulmonary embolism, malignant disease, or acute myocardial infarction. His body mass index is 32 kg/m^2 and recent lab tests have confirmed elevated serum homocysteine levels. His prothrombin 20210A mutation test and lupus anticoagulant were negative. The patient's paternal grandmother had an incident of thrombosis. Upon examination, varicose veins were observed, although no lower extremity swelling was noted. The patient's clinical picture is complicated by a positive history of heparin-induced thrombocytopenia. He has required no immobilizing plaster casts.",What is the patient's Caprini Score for Venous Thromboembolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'History of inflammatory bowel disease': True, 'Congestive Heart Failure in the last month': True, 'Acute Myocardial infarction': False, 'Mobility': 'on bed rest', 'Current central venous access': True, 'Positive prothrombin 20210A': False, 'Acute spinal cord injury causing paralysis in the last month': False, 'Stroke in the last month': True, 'Present or previous malignancy': False, 'Body Mass Index (BMI)': [32.0, 'kg/m^2'], 'Previously Documented Pulmonary Embolism': False, 'Immobilizing plaster cast in the last month': False, 'Positive lupus anticoagulant': False, 'age': [39.0, 'years'], 'Family history of thrombosis': True, 'Surgery Type': 'minor', 'Heparin-induced thrombocytopenia': True, 'sex': 'Male', 'Elevated serum homocysteine': True, 'Varicose veins': True, 'Current swollen legs': False}",16,16,16,"The criteria for the Caprini Score are listed below:

1. Age, years: ≤40 = 0 points, 41-60 = +1 point, 61-74 = +2 points, ≥75 = +3 points
2. Sex: Male = 0 points, Female = +1 point
3. Type of surgery: None = 0 points, Minor = +1 point, Major >45 min (laparoscopic or arthroscopic) = +2 points, Elective major lower extremity arthroplasty = +5 points
4. Recent (≤1 month) event: Major surgery = +1 point, Congestive heart failure (CHF) = +1 point, Sepsis = +1 point, Pneumonia = +1 point, Immobilizing plaster cast = +1 point, Hip, pelvis, or leg fracture = +5 points, Stroke = +5 points, Multiple trauma = +5 points, Acute spinal cord injury causing paralysis = +5 points
5. Venous disease or clotting disorder: Varicose veins = +1 point, Current swollen legs = +1 point, Current central venous access = +2 points, History of deep vein thrombosis (DVT) or pulmonary embolism (PE) = +3 points, Family history of thrombosis = +3 points, Positive Factor V Leiden = +3 points, Positive prothrombin 20210A = +3 points, Elevated serum homocysteine = +3 points
6. Other congenital or acquired thrombophilia: Positive lupus anticoagulant = +3 points, Elevated anticardiolipin antibody = +3 points, Heparin-induced thrombocytopenia = +3 points
7. Mobility: Normal, out of bed = 0 points, Medical patient currently on bed rest = +1 point, Patient confined to bed >72 hours = +2 points
8. Other present and past history: History of inflammatory bowel disease = +1 point, BMI ≥25 = +1 point, Acute myocardial infarction = +1 point, Chronic obstructive pulmonary disease (COPD) = +1 point, Present or previous malignancy = +2 points

The total Caprini Score is calculated by summing the points for each criterion.
    
The patient's current caprini score is 0.
The patient's gender is Male.
The patient is 39.0 years old. Because the patient's age is less or equal to 40, we do not add any points to the total, keeping the current total at 0.
The patient does not report anything about s and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 0. The patient does not report anything about major surgery in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 0. The patient does not report anything about congestive heart failure in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 0. The patient does not report anything about sepsis in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 0. The patient does not report anything about pneumonia in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 0. The patient does not report anything about immobilizing plaster cast in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 0. The patient does not report anything about hip, pelvis, or leg fracture in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 0. The patient does not report anything about stroke in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 0. The patient does not report anything about multiple trauma in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 0. The patient's has does not have acute spinal cord injury causing paralysis in the last month. Hence, 0 points are added to the score, keeping the total at 0.The patient's has varicose veins. Hence, we add 1 to the total, making the current total 1 + 0 = 1.
 The patient's has does not have current swollen legs. Hence, 0 points are added to the score, keeping the total at 1.The patient's has current central venuous access. Hence, we add 2 to the total, making the current total 2 + 1 = 3.
 The patient does not report anything about previous DVT documented and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 3. The patient's has does not have previous pulmonary embolism documented. Hence, 0 points are added to the score, keeping the total at 3.The patient's has family history of thrombosis. Hence, we add 3 to the total, making the current total 3 + 3 = 6.
 The patient does not report anything about Positive Factor V Leiden and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 6. The patient's has does not have Positive prothrombin 20210A. Hence, 0 points are added to the score, keeping the total at 6.The patient's has an elevated serum homocysteine. Hence, we add 3 to the total, making the current total 3 + 6 = 9.
 The patient's has does not have a positive lupus anticoagulant. Hence, 0 points are added to the score, keeping the total at 9.The patient does not report anything about an elevated anticardiolipin antibody and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 9. The patient's has a heparin-induced thrombocytopenia. Hence, we add 3 to the total, making the current total 3 + 9 = 12.
 The patient does not report anything about other congenital or acquired thrombophilia and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 12. The patient's mobility status is determined to be 'on bed rest'. Hence, we add 1 points to the total, making the current total 1 + 12 = 13.
 The patient's has history of inflammatory bowel disease. Hence, we add 1 to the total, making the current total 1 + 13 = 14.
 The patient's has does not have acute Myocardial infarction. Hence, 0 points are added to the score, keeping the total at 14.The patient does not report anything about chronic Obstructive Pulmonary Disease and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 14. The patient's has does not have malignancy. Hence, 0 points are added to the score, keeping the total at 14.The patient's BMI is 32.0 kg/m^2, which is greater than 25 kg/m^2, and so we add 2 points to the total, making the current total 14 + 2 = 16.
"
916,36,Caprini Score for Venous Thromboembolism (2005),risk,integer,9,Handwritten,"A 45-year-old woman presents for a follow-up visit after treatment for a pulmonary embolism. She leads an active lifestyle with normal mobility and has a body mass index of 22 kg/m^2. The patient has no history of inflammatory bowel disease, congestive heart failure, stroke, trauma, deep vein thrombosis, pneumonia, heparin-induced thrombocytopenia, or varicose veins, and no recent surgeries. Genetic testing has revealed the presence of prothrombin 20210A mutation. Factor V Leiden and anticardiolipin antibody testing were negative, and she has no other congenital or acquired thrombophilia. Recent blood tests have shown elevated serum homocysteine levels. She had breast cancer which was successfully treated, and she remains in remission on recent evaluations. Family history is negative for thrombosis. Further close follow-up is recommended for cardiovascular risk assessment and management.",What is the patient's Caprini Score for Venous Thromboembolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'History of inflammatory bowel disease': False, 'Congestive Heart Failure in the last month': False, 'Elevated anticardiolipin antibody': False, 'Mobility': 'normal', 'Positive prothrombin 20210A': True, 'Previously documented Deep Vein Thrombosis': False, 'Stroke in the last month': False, 'Present or previous malignancy': True, 'Multiple trauma in the last month': False, 'Body Mass Index (BMI)': [22.0, 'kg/m^2'], 'Previously Documented Pulmonary Embolism': True, 'Other congenital or acquired thrombophilia': False, 'Pneumonia in the last month': False, 'age': [45.0, 'years'], 'Family history of thrombosis': False, 'Heparin-induced thrombocytopenia': False, 'sex': 'Female', 'Elevated serum homocysteine': True, 'Positive Factor V Leiden': False, 'Varicose veins': False}",12,12,12,"The criteria for the Caprini Score are listed below:

1. Age, years: ≤40 = 0 points, 41-60 = +1 point, 61-74 = +2 points, ≥75 = +3 points
2. Sex: Male = 0 points, Female = +1 point
3. Type of surgery: None = 0 points, Minor = +1 point, Major >45 min (laparoscopic or arthroscopic) = +2 points, Elective major lower extremity arthroplasty = +5 points
4. Recent (≤1 month) event: Major surgery = +1 point, Congestive heart failure (CHF) = +1 point, Sepsis = +1 point, Pneumonia = +1 point, Immobilizing plaster cast = +1 point, Hip, pelvis, or leg fracture = +5 points, Stroke = +5 points, Multiple trauma = +5 points, Acute spinal cord injury causing paralysis = +5 points
5. Venous disease or clotting disorder: Varicose veins = +1 point, Current swollen legs = +1 point, Current central venous access = +2 points, History of deep vein thrombosis (DVT) or pulmonary embolism (PE) = +3 points, Family history of thrombosis = +3 points, Positive Factor V Leiden = +3 points, Positive prothrombin 20210A = +3 points, Elevated serum homocysteine = +3 points
6. Other congenital or acquired thrombophilia: Positive lupus anticoagulant = +3 points, Elevated anticardiolipin antibody = +3 points, Heparin-induced thrombocytopenia = +3 points
7. Mobility: Normal, out of bed = 0 points, Medical patient currently on bed rest = +1 point, Patient confined to bed >72 hours = +2 points
8. Other present and past history: History of inflammatory bowel disease = +1 point, BMI ≥25 = +1 point, Acute myocardial infarction = +1 point, Chronic obstructive pulmonary disease (COPD) = +1 point, Present or previous malignancy = +2 points

The total Caprini Score is calculated by summing the points for each criterion.
    
The patient's current caprini score is 0.
The patient's gender is Female.
The patient is 45.0 years old. Because the patient's age is between 61 and 74, we add one point to the current total, making the current total, 0 + 1 = 1.
The patient does not report anything about s and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about major surgery in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about congestive heart failure in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about sepsis in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient's has does not have pneumonia in the last month. Hence, 0 points are added to the score, keeping the total at 1.The patient does not report anything about immobilizing plaster cast in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about hip, pelvis, or leg fracture in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about stroke in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient's has does not have multiple trauma in the last month. Hence, 0 points are added to the score, keeping the total at 1.The patient does not report anything about acute spinal cord injury causing paralysis in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient's has does not have varicose veins. Hence, 0 points are added to the score, keeping the total at 1.The patient does not report anything about current swollen legs and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about current central venuous access and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient's has does not have previous DVT documented. Hence, 0 points are added to the score, keeping the total at 1.The patient's has previous pulmonary embolism documented. Hence, we add 3 to the total, making the current total 3 + 1 = 4.
 The patient's has does not have family history of thrombosis. Hence, 0 points are added to the score, keeping the total at 4.The patient's has does not have Positive Factor V Leiden. Hence, 0 points are added to the score, keeping the total at 4.The patient's has Positive prothrombin 20210A. Hence, we add 3 to the total, making the current total 3 + 4 = 7.
 The patient's has an elevated serum homocysteine. Hence, we add 3 to the total, making the current total 3 + 7 = 10.
 The patient does not report anything about a positive lupus anticoagulant and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 10. The patient's has does not have an elevated anticardiolipin antibody. Hence, 0 points are added to the score, keeping the total at 10.The patient's has does not have a heparin-induced thrombocytopenia. Hence, 0 points are added to the score, keeping the total at 10.The patient's has does not have other congenital or acquired thrombophilia. Hence, 0 points are added to the score, keeping the total at 10.The patient's mobility status is determined to be 'normal'. Hence, we add 0 points to the total, making the current total 0 + 10 = 10.
 The patient's has does not have history of inflammatory bowel disease. Hence, 0 points are added to the score, keeping the total at 10.The patient does not report anything about acute Myocardial infarction and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 10. The patient does not report anything about chronic Obstructive Pulmonary Disease and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 10. The patient's has malignancy. Hence, we add 2 to the total, making the current total 2 + 10 = 12.
 The patient's BMI is 22.0 kg/m^2, which is less than 25 kg/m^2, and so we add 0 points to the total, keeping the total at 12.
"
917,36,Caprini Score for Venous Thromboembolism (2005),risk,integer,10,Handwritten,"A 55-year-old gentleman with a history of chronic obstructive pulmonary disease and recent heart failure exacerbation was admitted for a laparoscopic surgery procedure. His hospital stay has been prolonged due to a recent episode of pneumonia. Due to these complications, he remains on bed rest. He has a past incident of deep vein thrombosis. Prior workup revealed positive Factor V Leiden. Prothrombin 20210A and anticardiolipin antibody tests are negative and homocysteine levels are within normal limits. The patient is obese with a body mass index of 31 kg/m^2. He has no history of malignant cancer, congenital or acquired thrombophilia, or recent fractures. Additional preventative measures tailored to increase physical activity and monitor his cardiovascular and respiratory status should be considered in the postoperative period.",What is the patient's Caprini Score for Venous Thromboembolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Congestive Heart Failure in the last month': True, 'Hip, pelvis, or leg fracture in the last month': False, 'Chronic Obstructive Pulmonary Disease': True, 'Elevated anticardiolipin antibody': False, 'Mobility': 'on bed rest', 'Positive prothrombin 20210A': False, 'Previously documented Deep Vein Thrombosis': True, 'Present or previous malignancy': False, 'Body Mass Index (BMI)': [31.0, 'kg/m^2'], 'Other congenital or acquired thrombophilia': False, 'Pneumonia in the last month': True, 'age': [55.0, 'years'], 'Surgery Type': 'laparoscopic', 'Major Surgery in the last month': False, 'sex': 'Male', 'Elevated serum homocysteine': False, 'Positive Factor V Leiden': True}",12,12,12,"The criteria for the Caprini Score are listed below:

1. Age, years: ≤40 = 0 points, 41-60 = +1 point, 61-74 = +2 points, ≥75 = +3 points
2. Sex: Male = 0 points, Female = +1 point
3. Type of surgery: None = 0 points, Minor = +1 point, Major >45 min (laparoscopic or arthroscopic) = +2 points, Elective major lower extremity arthroplasty = +5 points
4. Recent (≤1 month) event: Major surgery = +1 point, Congestive heart failure (CHF) = +1 point, Sepsis = +1 point, Pneumonia = +1 point, Immobilizing plaster cast = +1 point, Hip, pelvis, or leg fracture = +5 points, Stroke = +5 points, Multiple trauma = +5 points, Acute spinal cord injury causing paralysis = +5 points
5. Venous disease or clotting disorder: Varicose veins = +1 point, Current swollen legs = +1 point, Current central venous access = +2 points, History of deep vein thrombosis (DVT) or pulmonary embolism (PE) = +3 points, Family history of thrombosis = +3 points, Positive Factor V Leiden = +3 points, Positive prothrombin 20210A = +3 points, Elevated serum homocysteine = +3 points
6. Other congenital or acquired thrombophilia: Positive lupus anticoagulant = +3 points, Elevated anticardiolipin antibody = +3 points, Heparin-induced thrombocytopenia = +3 points
7. Mobility: Normal, out of bed = 0 points, Medical patient currently on bed rest = +1 point, Patient confined to bed >72 hours = +2 points
8. Other present and past history: History of inflammatory bowel disease = +1 point, BMI ≥25 = +1 point, Acute myocardial infarction = +1 point, Chronic obstructive pulmonary disease (COPD) = +1 point, Present or previous malignancy = +2 points

The total Caprini Score is calculated by summing the points for each criterion.
    
The patient's current caprini score is 0.
The patient's gender is Male.
The patient is 55.0 years old. Because the patient's age is between 61 and 74, we add one point to the current total, making the current total, 0 + 1 = 1.
The patient does not report anything about s and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about major surgery in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about congestive heart failure in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about sepsis in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient's has pneumonia in the last month. Hence, we add 1 to the total, making the current total 1 + 1 = 2.
 The patient does not report anything about immobilizing plaster cast in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient's has does not have hip, pelvis, or leg fracture in the last month. Hence, 0 points are added to the score, keeping the total at 2.The patient does not report anything about stroke in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about multiple trauma in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about acute spinal cord injury causing paralysis in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about varicose veins and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about current swollen legs and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about current central venuous access and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient's has previous DVT documented. Hence, we add 3 to the total, making the current total 3 + 2 = 5.
 The patient does not report anything about previous pulmonary embolism documented and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 5. The patient does not report anything about family history of thrombosis and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 5. The patient's has Positive Factor V Leiden. Hence, we add 3 to the total, making the current total 3 + 5 = 8.
 The patient's has does not have Positive prothrombin 20210A. Hence, 0 points are added to the score, keeping the total at 8.The patient's has does not have an elevated serum homocysteine. Hence, 0 points are added to the score, keeping the total at 8.The patient does not report anything about a positive lupus anticoagulant and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 8. The patient's has does not have an elevated anticardiolipin antibody. Hence, 0 points are added to the score, keeping the total at 8.The patient does not report anything about a heparin-induced thrombocytopenia and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 8. The patient's has does not have other congenital or acquired thrombophilia. Hence, 0 points are added to the score, keeping the total at 8.The patient's mobility status is determined to be 'on bed rest'. Hence, we add 1 points to the total, making the current total 1 + 8 = 9.
 The patient does not report anything about history of inflammatory bowel disease and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 9. The patient does not report anything about acute Myocardial infarction and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 9. The patient's has chronic Obstructive Pulmonary Disease. Hence, we add 1 to the total, making the current total 1 + 9 = 10.
 The patient's has does not have malignancy. Hence, 0 points are added to the score, keeping the total at 10.The patient's BMI is 31.0 kg/m^2, which is greater than 25 kg/m^2, and so we add 2 points to the total, making the current total 10 + 2 = 12.
"
918,36,Caprini Score for Venous Thromboembolism (2005),risk,integer,11,Handwritten,"A 70-year-old woman presented to the clinic for a follow-up visit after a leg fracture, which was her only injury from a skiing accident. She has no other trauma history. The patient's mobility is normal. The patient has a history of recent sepsis and stroke 1 month ago as well as a history of pulmonary embolism but no deep vein thrombosis. Laboratory workup for coagulability is notable for elevated anticardiolipin antibody and Factor V Leiden. She has no past medical history of inflammatory bowel disease, heparin-induced thrombocytopenia, nor chronic obstructive pulmonary disease. Her BMI today is 24 kg/m^2. Her current management includes central venous access and regular monitoring for potential complications of Protein C deficiency. Apart from varicose veins, her lower extremities exam is unremarkable with no significant swelling. Further clinical evaluation and supervision remain essential for her complete recovery and prevention of potential complications, given her medical history and anticoagulation profile.",What is the patient's Caprini Score for Venous Thromboembolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'History of inflammatory bowel disease': False, 'Hip, pelvis, or leg fracture in the last month': True, 'Chronic Obstructive Pulmonary Disease': False, 'Elevated anticardiolipin antibody': True, 'Mobility': 'normal', 'Current central venous access': True, 'Previously documented Deep Vein Thrombosis': False, 'Stroke in the last month': True, 'Multiple trauma in the last month': False, 'Body Mass Index (BMI)': [24.0, 'kg/m^2'], 'Previously Documented Pulmonary Embolism': True, 'Other congenital or acquired thrombophilia': True, 'Positive lupus anticoagulant': False, 'age': [70.0, 'years'], 'Sepsis in the last month': True, 'Heparin-induced thrombocytopenia': False, 'sex': 'Female', 'Positive Factor V Leiden': True, 'Varicose veins': True, 'Current swollen legs': False}",23,23,23,"The criteria for the Caprini Score are listed below:

1. Age, years: ≤40 = 0 points, 41-60 = +1 point, 61-74 = +2 points, ≥75 = +3 points
2. Sex: Male = 0 points, Female = +1 point
3. Type of surgery: None = 0 points, Minor = +1 point, Major >45 min (laparoscopic or arthroscopic) = +2 points, Elective major lower extremity arthroplasty = +5 points
4. Recent (≤1 month) event: Major surgery = +1 point, Congestive heart failure (CHF) = +1 point, Sepsis = +1 point, Pneumonia = +1 point, Immobilizing plaster cast = +1 point, Hip, pelvis, or leg fracture = +5 points, Stroke = +5 points, Multiple trauma = +5 points, Acute spinal cord injury causing paralysis = +5 points
5. Venous disease or clotting disorder: Varicose veins = +1 point, Current swollen legs = +1 point, Current central venous access = +2 points, History of deep vein thrombosis (DVT) or pulmonary embolism (PE) = +3 points, Family history of thrombosis = +3 points, Positive Factor V Leiden = +3 points, Positive prothrombin 20210A = +3 points, Elevated serum homocysteine = +3 points
6. Other congenital or acquired thrombophilia: Positive lupus anticoagulant = +3 points, Elevated anticardiolipin antibody = +3 points, Heparin-induced thrombocytopenia = +3 points
7. Mobility: Normal, out of bed = 0 points, Medical patient currently on bed rest = +1 point, Patient confined to bed >72 hours = +2 points
8. Other present and past history: History of inflammatory bowel disease = +1 point, BMI ≥25 = +1 point, Acute myocardial infarction = +1 point, Chronic obstructive pulmonary disease (COPD) = +1 point, Present or previous malignancy = +2 points

The total Caprini Score is calculated by summing the points for each criterion.
    
The patient's current caprini score is 0.
The patient's gender is Female.
The patient is 70.0 years old. Because the patient's age is between 61 and 74, we add two points to the current total, making the current total, 0 + 2 = 2.
The patient does not report anything about s and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about major surgery in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about congestive heart failure in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient's has sepsis in the last month. Hence, we add 1 to the total, making the current total 1 + 2 = 3.
 The patient does not report anything about pneumonia in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 3. The patient does not report anything about immobilizing plaster cast in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 3. The patient's has hip, pelvis, or leg fracture in the last month. Hence, we add 5 to the total, making the current total 5 + 3 = 8.
 The patient does not report anything about stroke in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 8. The patient's has does not have multiple trauma in the last month. Hence, 0 points are added to the score, keeping the total at 8.The patient does not report anything about acute spinal cord injury causing paralysis in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 8. The patient's has varicose veins. Hence, we add 1 to the total, making the current total 1 + 8 = 9.
 The patient's has does not have current swollen legs. Hence, 0 points are added to the score, keeping the total at 9.The patient's has current central venuous access. Hence, we add 2 to the total, making the current total 2 + 9 = 11.
 The patient's has does not have previous DVT documented. Hence, 0 points are added to the score, keeping the total at 11.The patient's has previous pulmonary embolism documented. Hence, we add 3 to the total, making the current total 3 + 11 = 14.
 The patient does not report anything about family history of thrombosis and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 14. The patient's has Positive Factor V Leiden. Hence, we add 3 to the total, making the current total 3 + 14 = 17.
 The patient does not report anything about Positive prothrombin 20210A and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 17. The patient does not report anything about an elevated serum homocysteine and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 17. The patient's has does not have a positive lupus anticoagulant. Hence, 0 points are added to the score, keeping the total at 17.The patient's has an elevated anticardiolipin antibody. Hence, we add 3 to the total, making the current total 3 + 17 = 20.
 The patient's has does not have a heparin-induced thrombocytopenia. Hence, 0 points are added to the score, keeping the total at 20.The patient's has other congenital or acquired thrombophilia. Hence, we add 3 to the total, making the current total 3 + 20 = 23.
 The patient's mobility status is determined to be 'normal'. Hence, we add 0 points to the total, making the current total 0 + 23 = 23.
 The patient's has does not have history of inflammatory bowel disease. Hence, 0 points are added to the score, keeping the total at 23.The patient does not report anything about acute Myocardial infarction and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 23. The patient's has does not have chronic Obstructive Pulmonary Disease. Hence, 0 points are added to the score, keeping the total at 23.The patient does not report anything about malignancy and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 23. The patient's BMI is 24.0 kg/m^2, which is less than 25 kg/m^2, and so we add 0 points to the total, keeping the total at 23.
"
919,36,Caprini Score for Venous Thromboembolism (2005),risk,integer,12,Handwritten,"A 52-year-old male with a medical history of chronic obstructive pulmonary disease is confined to bed rest for 4 days after a bowel resection (3 hours surgical time) for management of ascending colon carcinoma. He denies having any acute myocardial infarction, congestive heart failure, stroke, pneumonia, or sepsis. He has a previous history of deep vein thrombosis and pulmonary embolism. Lab workup revealed positive lupus anticoagulant. Prothrombin 20210A is normal and serum homocysteine within normal range. The patient has a family history of thrombosis in his mother. He has no central venous access, and no other congenital or acquired thrombophilia. On physical exam, there are no signs of current swollen legs. The patient's Body Mass Index (BMI) is 29 kg/m^2. To maintain his overall good health, continued supervision, and necessary interventions are recommended to avoid any thrombotic episodes.",What is the patient's Caprini Score for Venous Thromboembolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Congestive Heart Failure in the last month': False, 'Acute Myocardial infarction': False, 'Chronic Obstructive Pulmonary Disease': True, 'Mobility': 'confined to bed >72 hours', 'Positive prothrombin 20210A': False, 'Previously documented Deep Vein Thrombosis': True, 'Stroke in the last month': False, 'Present or previous malignancy': True, 'Body Mass Index (BMI)': [29.0, 'kg/m^2'], 'Previously Documented Pulmonary Embolism': True, 'Other congenital or acquired thrombophilia': False, 'Positive lupus anticoagulant': True, 'Pneumonia in the last month': False, 'age': [52.0, 'years'], 'Family history of thrombosis': True, 'Surgery Type': 'major', 'Sepsis in the last month': False, 'Major Surgery in the last month': False, 'sex': 'Male', 'Elevated serum homocysteine': False, 'Current swollen legs': False}",20,20,20,"The criteria for the Caprini Score are listed below:

1. Age, years: ≤40 = 0 points, 41-60 = +1 point, 61-74 = +2 points, ≥75 = +3 points
2. Sex: Male = 0 points, Female = +1 point
3. Type of surgery: None = 0 points, Minor = +1 point, Major >45 min (laparoscopic or arthroscopic) = +2 points, Elective major lower extremity arthroplasty = +5 points
4. Recent (≤1 month) event: Major surgery = +1 point, Congestive heart failure (CHF) = +1 point, Sepsis = +1 point, Pneumonia = +1 point, Immobilizing plaster cast = +1 point, Hip, pelvis, or leg fracture = +5 points, Stroke = +5 points, Multiple trauma = +5 points, Acute spinal cord injury causing paralysis = +5 points
5. Venous disease or clotting disorder: Varicose veins = +1 point, Current swollen legs = +1 point, Current central venous access = +2 points, History of deep vein thrombosis (DVT) or pulmonary embolism (PE) = +3 points, Family history of thrombosis = +3 points, Positive Factor V Leiden = +3 points, Positive prothrombin 20210A = +3 points, Elevated serum homocysteine = +3 points
6. Other congenital or acquired thrombophilia: Positive lupus anticoagulant = +3 points, Elevated anticardiolipin antibody = +3 points, Heparin-induced thrombocytopenia = +3 points
7. Mobility: Normal, out of bed = 0 points, Medical patient currently on bed rest = +1 point, Patient confined to bed >72 hours = +2 points
8. Other present and past history: History of inflammatory bowel disease = +1 point, BMI ≥25 = +1 point, Acute myocardial infarction = +1 point, Chronic obstructive pulmonary disease (COPD) = +1 point, Present or previous malignancy = +2 points

The total Caprini Score is calculated by summing the points for each criterion.
    
The patient's current caprini score is 0.
The patient's gender is Male.
The patient is 52.0 years old. Because the patient's age is between 61 and 74, we add one point to the current total, making the current total, 0 + 1 = 1.
The patient does not report anything about s and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about major surgery in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about congestive heart failure in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient's has does not have sepsis in the last month. Hence, 0 points are added to the score, keeping the total at 1.The patient's has does not have pneumonia in the last month. Hence, 0 points are added to the score, keeping the total at 1.The patient does not report anything about immobilizing plaster cast in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about hip, pelvis, or leg fracture in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about stroke in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about multiple trauma in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about acute spinal cord injury causing paralysis in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about varicose veins and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient's has does not have current swollen legs. Hence, 0 points are added to the score, keeping the total at 1.The patient does not report anything about current central venuous access and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient's has previous DVT documented. Hence, we add 3 to the total, making the current total 3 + 1 = 4.
 The patient's has previous pulmonary embolism documented. Hence, we add 3 to the total, making the current total 3 + 4 = 7.
 The patient's has family history of thrombosis. Hence, we add 3 to the total, making the current total 3 + 7 = 10.
 The patient does not report anything about Positive Factor V Leiden and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 10. The patient's has does not have Positive prothrombin 20210A. Hence, 0 points are added to the score, keeping the total at 10.The patient's has does not have an elevated serum homocysteine. Hence, 0 points are added to the score, keeping the total at 10.The patient's has a positive lupus anticoagulant. Hence, we add 3 to the total, making the current total 3 + 10 = 13.
 The patient does not report anything about an elevated anticardiolipin antibody and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 13. The patient does not report anything about a heparin-induced thrombocytopenia and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 13. The patient's has does not have other congenital or acquired thrombophilia. Hence, 0 points are added to the score, keeping the total at 13.The patient's mobility status is determined to be 'confined to bed >72 hours'. Hence, we add 2 points to the total, making the current total 2 + 13 = 15.
 The patient does not report anything about history of inflammatory bowel disease and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 15. The patient's has does not have acute Myocardial infarction. Hence, 0 points are added to the score, keeping the total at 15.The patient's has chronic Obstructive Pulmonary Disease. Hence, we add 1 to the total, making the current total 1 + 15 = 16.
 The patient's has malignancy. Hence, we add 2 to the total, making the current total 2 + 16 = 18.
 The patient's BMI is 29.0 kg/m^2, which is greater than 25 kg/m^2, and so we add 2 points to the total, making the current total 18 + 2 = 20.
"
920,36,Caprini Score for Venous Thromboembolism (2005),risk,integer,13,Handwritten,"A 60-year-old woman is admitted following a stroke and thromboembolism removal. She has remained confined to her bed for more than 72 hours. She currently has an immobilizing plaster cast due to a leg fracture.She is positive for lupus anticoagulant and has an elevated serum homocysteine levels, both factors contributing to her thrombophilic profile. However, anticardiolipin antibody test came back negative and Factor V Leiden mutation is not present, easing her thrombotic burden. She has a strong family history of thrombotic events with her mother and brother suffering MIs. Her BMI is reported as 27 kg/m^2 and upon physical examination, her legs were found to be swollen, a notable finding amidst her hospital stay. ROS is negative for CHF, COPD, malignancy, sepsis, pneumonia, MI, and deep vein thrombosis. Close monitoring of her vitals remains paramount given her recent stroke and thrombotic predisposition.",What is the patient's Caprini Score for Venous Thromboembolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Congestive Heart Failure in the last month': False, 'Hip, pelvis, or leg fracture in the last month': True, 'Acute Myocardial infarction': False, 'Elevated anticardiolipin antibody': False, 'Mobility': 'confined to bed >72 hours', 'Current central venous access': False, 'Previously documented Deep Vein Thrombosis': False, 'Stroke in the last month': True, 'Present or previous malignancy': False, 'Body Mass Index (BMI)': [27.0, 'kg/m^2'], 'Immobilizing plaster cast in the last month': True, 'Positive lupus anticoagulant': True, 'Pneumonia in the last month': False, 'age': [60.0, 'years'], 'Family history of thrombosis': True, 'Heparin-induced thrombocytopenia': False, 'Major Surgery in the last month': True, 'sex': 'Female', 'Elevated serum homocysteine': True, 'Positive Factor V Leiden': False, 'Current swollen legs': True}",20,20,20,"The criteria for the Caprini Score are listed below:

1. Age, years: ≤40 = 0 points, 41-60 = +1 point, 61-74 = +2 points, ≥75 = +3 points
2. Sex: Male = 0 points, Female = +1 point
3. Type of surgery: None = 0 points, Minor = +1 point, Major >45 min (laparoscopic or arthroscopic) = +2 points, Elective major lower extremity arthroplasty = +5 points
4. Recent (≤1 month) event: Major surgery = +1 point, Congestive heart failure (CHF) = +1 point, Sepsis = +1 point, Pneumonia = +1 point, Immobilizing plaster cast = +1 point, Hip, pelvis, or leg fracture = +5 points, Stroke = +5 points, Multiple trauma = +5 points, Acute spinal cord injury causing paralysis = +5 points
5. Venous disease or clotting disorder: Varicose veins = +1 point, Current swollen legs = +1 point, Current central venous access = +2 points, History of deep vein thrombosis (DVT) or pulmonary embolism (PE) = +3 points, Family history of thrombosis = +3 points, Positive Factor V Leiden = +3 points, Positive prothrombin 20210A = +3 points, Elevated serum homocysteine = +3 points
6. Other congenital or acquired thrombophilia: Positive lupus anticoagulant = +3 points, Elevated anticardiolipin antibody = +3 points, Heparin-induced thrombocytopenia = +3 points
7. Mobility: Normal, out of bed = 0 points, Medical patient currently on bed rest = +1 point, Patient confined to bed >72 hours = +2 points
8. Other present and past history: History of inflammatory bowel disease = +1 point, BMI ≥25 = +1 point, Acute myocardial infarction = +1 point, Chronic obstructive pulmonary disease (COPD) = +1 point, Present or previous malignancy = +2 points

The total Caprini Score is calculated by summing the points for each criterion.
    
The patient's current caprini score is 0.
The patient's gender is Female.
The patient is 60.0 years old. Because the patient's age is between 61 and 74, we add one point to the current total, making the current total, 0 + 1 = 1.
The patient does not report anything about s and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about major surgery in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about congestive heart failure in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about sepsis in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient's has does not have pneumonia in the last month. Hence, 0 points are added to the score, keeping the total at 1.The patient does not report anything about immobilizing plaster cast in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient's has hip, pelvis, or leg fracture in the last month. Hence, we add 5 to the total, making the current total 5 + 1 = 6.
 The patient does not report anything about stroke in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 6. The patient does not report anything about multiple trauma in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 6. The patient does not report anything about acute spinal cord injury causing paralysis in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 6. The patient does not report anything about varicose veins and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 6. The patient's has current swollen legs. Hence, we add 1 to the total, making the current total 1 + 6 = 7.
 The patient's has does not have current central venuous access. Hence, 0 points are added to the score, keeping the total at 7.The patient's has does not have previous DVT documented. Hence, 0 points are added to the score, keeping the total at 7.The patient does not report anything about previous pulmonary embolism documented and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 7. The patient's has family history of thrombosis. Hence, we add 3 to the total, making the current total 3 + 7 = 10.
 The patient's has does not have Positive Factor V Leiden. Hence, 0 points are added to the score, keeping the total at 10.The patient does not report anything about Positive prothrombin 20210A and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 10. The patient's has an elevated serum homocysteine. Hence, we add 3 to the total, making the current total 3 + 10 = 13.
 The patient's has a positive lupus anticoagulant. Hence, we add 3 to the total, making the current total 3 + 13 = 16.
 The patient's has does not have an elevated anticardiolipin antibody. Hence, 0 points are added to the score, keeping the total at 16.The patient's has does not have a heparin-induced thrombocytopenia. Hence, 0 points are added to the score, keeping the total at 16.The patient does not report anything about other congenital or acquired thrombophilia and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 16. The patient's mobility status is determined to be 'confined to bed >72 hours'. Hence, we add 2 points to the total, making the current total 2 + 16 = 18.
 The patient does not report anything about history of inflammatory bowel disease and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 18. The patient's has does not have acute Myocardial infarction. Hence, 0 points are added to the score, keeping the total at 18.The patient does not report anything about chronic Obstructive Pulmonary Disease and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 18. The patient's has does not have malignancy. Hence, 0 points are added to the score, keeping the total at 18.The patient's BMI is 27.0 kg/m^2, which is greater than 25 kg/m^2, and so we add 2 points to the total, making the current total 18 + 2 = 20.
"
921,36,Caprini Score for Venous Thromboembolism (2005),risk,integer,14,Handwritten,"A 48-year-old man recently reported to the emergency department with chest pain and was subsequently diagnosed with acute myocardial infarction. On his past medical records, he was found to have a history of deep vein thrombosis and a prostate cancer that is currently in remission. He underwent minor surgery some months back for a trigger finger release. The patient is usually active, and is able to walk without pain. His body mass index is recorded as 28 kg/m^2. On examination, there were signs of varicose veins but no swelling in the legs. The patient has a current central venous access in place for antithombotics. He does not have positive lupus anticoagulant or elevated anticardiolipin antibody. Genetics tests confirmed an acquired thrombophilia. His chest scan reveals no signs of pneumonia and there was no family history of thrombosis. He denied any inflammatory bowel disease, chronic obstructive pulmonary disease, and did not fit the criteria for heparin-induced thrombocytopenia. Vigilance is warranted for his cardiovascular and potential thrombotic risk profile given the recent myocardial infarction.",What is the patient's Caprini Score for Venous Thromboembolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'History of inflammatory bowel disease': False, 'Acute Myocardial infarction': True, 'Chronic Obstructive Pulmonary Disease': False, 'Elevated anticardiolipin antibody': False, 'Mobility': 'normal', 'Current central venous access': True, 'Previously documented Deep Vein Thrombosis': True, 'Stroke in the last month': False, 'Present or previous malignancy': True, 'Body Mass Index (BMI)': [28.0, 'kg/m^2'], 'Previously Documented Pulmonary Embolism': False, 'Other congenital or acquired thrombophilia': True, 'Pneumonia in the last month': False, 'age': [48.0, 'years'], 'Surgery Type': 'minor', 'Heparin-induced thrombocytopenia': False, 'sex': 'Male', 'Elevated serum homocysteine': False, 'Varicose veins': True, 'Current swollen legs': False}",15,15,15,"The criteria for the Caprini Score are listed below:

1. Age, years: ≤40 = 0 points, 41-60 = +1 point, 61-74 = +2 points, ≥75 = +3 points
2. Sex: Male = 0 points, Female = +1 point
3. Type of surgery: None = 0 points, Minor = +1 point, Major >45 min (laparoscopic or arthroscopic) = +2 points, Elective major lower extremity arthroplasty = +5 points
4. Recent (≤1 month) event: Major surgery = +1 point, Congestive heart failure (CHF) = +1 point, Sepsis = +1 point, Pneumonia = +1 point, Immobilizing plaster cast = +1 point, Hip, pelvis, or leg fracture = +5 points, Stroke = +5 points, Multiple trauma = +5 points, Acute spinal cord injury causing paralysis = +5 points
5. Venous disease or clotting disorder: Varicose veins = +1 point, Current swollen legs = +1 point, Current central venous access = +2 points, History of deep vein thrombosis (DVT) or pulmonary embolism (PE) = +3 points, Family history of thrombosis = +3 points, Positive Factor V Leiden = +3 points, Positive prothrombin 20210A = +3 points, Elevated serum homocysteine = +3 points
6. Other congenital or acquired thrombophilia: Positive lupus anticoagulant = +3 points, Elevated anticardiolipin antibody = +3 points, Heparin-induced thrombocytopenia = +3 points
7. Mobility: Normal, out of bed = 0 points, Medical patient currently on bed rest = +1 point, Patient confined to bed >72 hours = +2 points
8. Other present and past history: History of inflammatory bowel disease = +1 point, BMI ≥25 = +1 point, Acute myocardial infarction = +1 point, Chronic obstructive pulmonary disease (COPD) = +1 point, Present or previous malignancy = +2 points

The total Caprini Score is calculated by summing the points for each criterion.
    
The patient's current caprini score is 0.
The patient's gender is Male.
The patient is 48.0 years old. Because the patient's age is between 61 and 74, we add one point to the current total, making the current total, 0 + 1 = 1.
The patient does not report anything about s and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about major surgery in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about congestive heart failure in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about sepsis in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient's has does not have pneumonia in the last month. Hence, 0 points are added to the score, keeping the total at 1.The patient does not report anything about immobilizing plaster cast in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about hip, pelvis, or leg fracture in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about stroke in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about multiple trauma in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about acute spinal cord injury causing paralysis in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient's has varicose veins. Hence, we add 1 to the total, making the current total 1 + 1 = 2.
 The patient's has does not have current swollen legs. Hence, 0 points are added to the score, keeping the total at 2.The patient's has current central venuous access. Hence, we add 2 to the total, making the current total 2 + 2 = 4.
 The patient's has previous DVT documented. Hence, we add 3 to the total, making the current total 3 + 4 = 7.
 The patient's has does not have previous pulmonary embolism documented. Hence, 0 points are added to the score, keeping the total at 7.The patient does not report anything about family history of thrombosis and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 7. The patient does not report anything about Positive Factor V Leiden and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 7. The patient does not report anything about Positive prothrombin 20210A and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 7. The patient's has does not have an elevated serum homocysteine. Hence, 0 points are added to the score, keeping the total at 7.The patient does not report anything about a positive lupus anticoagulant and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 7. The patient's has does not have an elevated anticardiolipin antibody. Hence, 0 points are added to the score, keeping the total at 7.The patient's has does not have a heparin-induced thrombocytopenia. Hence, 0 points are added to the score, keeping the total at 7.The patient's has other congenital or acquired thrombophilia. Hence, we add 3 to the total, making the current total 3 + 7 = 10.
 The patient's mobility status is determined to be 'normal'. Hence, we add 0 points to the total, making the current total 0 + 10 = 10.
 The patient's has does not have history of inflammatory bowel disease. Hence, 0 points are added to the score, keeping the total at 10.The patient's has acute Myocardial infarction. Hence, we add 1 to the total, making the current total 1 + 10 = 11.
 The patient's has does not have chronic Obstructive Pulmonary Disease. Hence, 0 points are added to the score, keeping the total at 11.The patient's has malignancy. Hence, we add 2 to the total, making the current total 2 + 11 = 13.
 The patient's BMI is 28.0 kg/m^2, which is greater than 25 kg/m^2, and so we add 2 points to the total, making the current total 13 + 2 = 15.
"
922,36,Caprini Score for Venous Thromboembolism (2005),risk,integer,15,Handwritten,"A 72-year-old female who recently survived an acute myocardial infarction is presented for a routine checkup. Despite the distressing circumstances, she seems to be in good spirits and her mobility is normal following PT. She has a history of a recent spinal cord injury without fracture which led to a brief period of paralysis. Furthermore, she was a victim of a multi-trauma incident a few weeks ago, but she denies any major surgery in the past month. Comparative review of her medical records indicates no previous episodes of deep vein thrombosis or pulmonary embolism. Her body mass index, visibly in the normal range, is calculated as 23 kg/m^2. She has positive Factor V Leiden status which stands as a crucial risk factor in her susceptibility to thrombotic events. Her lowered extremities show noticeable swelling on examination. She has no active central venous access and her sepsis screening reports were negative. She does have a positive history of heparin-induced thrombocytopenia; however, lupus anticoagulant is absent. The patient denies any history of malignancy. Continuing clinical investigation is of utmost importance adhering to her recent cardiac episode and other comorbid conditions.",What is the patient's Caprini Score for Venous Thromboembolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Hip, pelvis, or leg fracture in the last month': False, 'Acute Myocardial infarction': True, 'Mobility': 'normal', 'Current central venous access': False, 'Previously documented Deep Vein Thrombosis': False, 'Acute spinal cord injury causing paralysis in the last month': True, 'Present or previous malignancy': False, 'Multiple trauma in the last month': True, 'Body Mass Index (BMI)': [23.0, 'kg/m^2'], 'Previously Documented Pulmonary Embolism': False, 'Positive lupus anticoagulant': False, 'age': [72.0, 'years'], 'Sepsis in the last month': False, 'Heparin-induced thrombocytopenia': True, 'Major Surgery in the last month': False, 'sex': 'Female', 'Positive Factor V Leiden': True, 'Current swollen legs': True}",20,20,20,"The criteria for the Caprini Score are listed below:

1. Age, years: ≤40 = 0 points, 41-60 = +1 point, 61-74 = +2 points, ≥75 = +3 points
2. Sex: Male = 0 points, Female = +1 point
3. Type of surgery: None = 0 points, Minor = +1 point, Major >45 min (laparoscopic or arthroscopic) = +2 points, Elective major lower extremity arthroplasty = +5 points
4. Recent (≤1 month) event: Major surgery = +1 point, Congestive heart failure (CHF) = +1 point, Sepsis = +1 point, Pneumonia = +1 point, Immobilizing plaster cast = +1 point, Hip, pelvis, or leg fracture = +5 points, Stroke = +5 points, Multiple trauma = +5 points, Acute spinal cord injury causing paralysis = +5 points
5. Venous disease or clotting disorder: Varicose veins = +1 point, Current swollen legs = +1 point, Current central venous access = +2 points, History of deep vein thrombosis (DVT) or pulmonary embolism (PE) = +3 points, Family history of thrombosis = +3 points, Positive Factor V Leiden = +3 points, Positive prothrombin 20210A = +3 points, Elevated serum homocysteine = +3 points
6. Other congenital or acquired thrombophilia: Positive lupus anticoagulant = +3 points, Elevated anticardiolipin antibody = +3 points, Heparin-induced thrombocytopenia = +3 points
7. Mobility: Normal, out of bed = 0 points, Medical patient currently on bed rest = +1 point, Patient confined to bed >72 hours = +2 points
8. Other present and past history: History of inflammatory bowel disease = +1 point, BMI ≥25 = +1 point, Acute myocardial infarction = +1 point, Chronic obstructive pulmonary disease (COPD) = +1 point, Present or previous malignancy = +2 points

The total Caprini Score is calculated by summing the points for each criterion.
    
The patient's current caprini score is 0.
The patient's gender is Female.
The patient is 72.0 years old. Because the patient's age is between 61 and 74, we add two points to the current total, making the current total, 0 + 2 = 2.
The patient does not report anything about s and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about major surgery in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about congestive heart failure in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient's has does not have sepsis in the last month. Hence, 0 points are added to the score, keeping the total at 2.The patient does not report anything about pneumonia in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about immobilizing plaster cast in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient's has does not have hip, pelvis, or leg fracture in the last month. Hence, 0 points are added to the score, keeping the total at 2.The patient does not report anything about stroke in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient's has multiple trauma in the last month. Hence, we add 5 to the total, making the current total 5 + 2 = 7.
 The patient's has acute spinal cord injury causing paralysis in the last month. Hence, we add 5 to the total, making the current total 5 + 7 = 12.
 The patient does not report anything about varicose veins and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 12. The patient's has current swollen legs. Hence, we add 1 to the total, making the current total 1 + 12 = 13.
 The patient's has does not have current central venuous access. Hence, 0 points are added to the score, keeping the total at 13.The patient's has does not have previous DVT documented. Hence, 0 points are added to the score, keeping the total at 13.The patient's has does not have previous pulmonary embolism documented. Hence, 0 points are added to the score, keeping the total at 13.The patient does not report anything about family history of thrombosis and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 13. The patient's has Positive Factor V Leiden. Hence, we add 3 to the total, making the current total 3 + 13 = 16.
 The patient does not report anything about Positive prothrombin 20210A and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 16. The patient does not report anything about an elevated serum homocysteine and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 16. The patient's has does not have a positive lupus anticoagulant. Hence, 0 points are added to the score, keeping the total at 16.The patient does not report anything about an elevated anticardiolipin antibody and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 16. The patient's has a heparin-induced thrombocytopenia. Hence, we add 3 to the total, making the current total 3 + 16 = 19.
 The patient does not report anything about other congenital or acquired thrombophilia and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 19. The patient's mobility status is determined to be 'normal'. Hence, we add 0 points to the total, making the current total 0 + 19 = 19.
 The patient does not report anything about history of inflammatory bowel disease and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 19. The patient's has acute Myocardial infarction. Hence, we add 1 to the total, making the current total 1 + 19 = 20.
 The patient does not report anything about chronic Obstructive Pulmonary Disease and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 20. The patient's has does not have malignancy. Hence, 0 points are added to the score, keeping the total at 20.The patient's BMI is 23.0 kg/m^2, which is less than 25 kg/m^2, and so we add 0 points to the total, keeping the total at 20.
"
923,36,Caprini Score for Venous Thromboembolism (2005),risk,integer,16,Handwritten,"A 65-year-old woman recently underwent minor surgery for bunion correction currently immobilized with a plaster cast. She was active and ambulating normally before the procedure. Her past records note a previously confirmed deep vein thrombosis but no episodes of pulmonary embolism. Although she does not have a current central venous access, her genetic tests revealed a positive Factor V Leiden mutation. Her past medical history is significant for inflammatory bowel disease. With a BMI of 27 kg/m^2, she falls in the overweight category. Despite her inherent thrombotic risk profile, she reports neither a family history of thrombosis nor records of heparin-induced thrombocytopenia. The patient also tested negative for prothrombin 20210A mutation and elevated anticardiolipin antibody. Regular follow-ups and evaluation for potential postoperative complications are recommended in her case, considering her recent surgery and related medical history. Careful monitoring of her thrombotic risk factors remains implied due to her age and medical history.",What is the patient's Caprini Score for Venous Thromboembolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'History of inflammatory bowel disease': True, 'Hip, pelvis, or leg fracture in the last month': False, 'Elevated anticardiolipin antibody': False, 'Mobility': 'normal', 'Positive prothrombin 20210A': False, 'Previously documented Deep Vein Thrombosis': True, 'Stroke in the last month': False, 'Body Mass Index (BMI)': [27.0, 'kg/m^2'], 'Immobilizing plaster cast in the last month': True, 'Positive lupus anticoagulant': False, 'age': [65.0, 'years'], 'Family history of thrombosis': False, 'Surgery Type': 'minor', 'Heparin-induced thrombocytopenia': False, 'Major Surgery in the last month': False, 'sex': 'Female', 'Positive Factor V Leiden': True, 'Varicose veins': False, 'Current swollen legs': False}",11,11,11,"The criteria for the Caprini Score are listed below:

1. Age, years: ≤40 = 0 points, 41-60 = +1 point, 61-74 = +2 points, ≥75 = +3 points
2. Sex: Male = 0 points, Female = +1 point
3. Type of surgery: None = 0 points, Minor = +1 point, Major >45 min (laparoscopic or arthroscopic) = +2 points, Elective major lower extremity arthroplasty = +5 points
4. Recent (≤1 month) event: Major surgery = +1 point, Congestive heart failure (CHF) = +1 point, Sepsis = +1 point, Pneumonia = +1 point, Immobilizing plaster cast = +1 point, Hip, pelvis, or leg fracture = +5 points, Stroke = +5 points, Multiple trauma = +5 points, Acute spinal cord injury causing paralysis = +5 points
5. Venous disease or clotting disorder: Varicose veins = +1 point, Current swollen legs = +1 point, Current central venous access = +2 points, History of deep vein thrombosis (DVT) or pulmonary embolism (PE) = +3 points, Family history of thrombosis = +3 points, Positive Factor V Leiden = +3 points, Positive prothrombin 20210A = +3 points, Elevated serum homocysteine = +3 points
6. Other congenital or acquired thrombophilia: Positive lupus anticoagulant = +3 points, Elevated anticardiolipin antibody = +3 points, Heparin-induced thrombocytopenia = +3 points
7. Mobility: Normal, out of bed = 0 points, Medical patient currently on bed rest = +1 point, Patient confined to bed >72 hours = +2 points
8. Other present and past history: History of inflammatory bowel disease = +1 point, BMI ≥25 = +1 point, Acute myocardial infarction = +1 point, Chronic obstructive pulmonary disease (COPD) = +1 point, Present or previous malignancy = +2 points

The total Caprini Score is calculated by summing the points for each criterion.
    
The patient's current caprini score is 0.
The patient's gender is Female.
The patient is 65.0 years old. Because the patient's age is between 61 and 74, we add two points to the current total, making the current total, 0 + 2 = 2.
The patient does not report anything about s and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about major surgery in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about congestive heart failure in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about sepsis in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about pneumonia in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about immobilizing plaster cast in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient's has does not have hip, pelvis, or leg fracture in the last month. Hence, 0 points are added to the score, keeping the total at 2.The patient does not report anything about stroke in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about multiple trauma in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about acute spinal cord injury causing paralysis in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient's has does not have varicose veins. Hence, 0 points are added to the score, keeping the total at 2.The patient's has does not have current swollen legs. Hence, 0 points are added to the score, keeping the total at 2.The patient does not report anything about current central venuous access and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient's has previous DVT documented. Hence, we add 3 to the total, making the current total 3 + 2 = 5.
 The patient does not report anything about previous pulmonary embolism documented and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 5. The patient's has does not have family history of thrombosis. Hence, 0 points are added to the score, keeping the total at 5.The patient's has Positive Factor V Leiden. Hence, we add 3 to the total, making the current total 3 + 5 = 8.
 The patient's has does not have Positive prothrombin 20210A. Hence, 0 points are added to the score, keeping the total at 8.The patient does not report anything about an elevated serum homocysteine and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 8. The patient's has does not have a positive lupus anticoagulant. Hence, 0 points are added to the score, keeping the total at 8.The patient's has does not have an elevated anticardiolipin antibody. Hence, 0 points are added to the score, keeping the total at 8.The patient's has does not have a heparin-induced thrombocytopenia. Hence, 0 points are added to the score, keeping the total at 8.The patient does not report anything about other congenital or acquired thrombophilia and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 8. The patient's mobility status is determined to be 'normal'. Hence, we add 0 points to the total, making the current total 0 + 8 = 8.
 The patient's has history of inflammatory bowel disease. Hence, we add 1 to the total, making the current total 1 + 8 = 9.
 The patient does not report anything about acute Myocardial infarction and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 9. The patient does not report anything about chronic Obstructive Pulmonary Disease and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 9. The patient does not report anything about malignancy and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 9. The patient's BMI is 27.0 kg/m^2, which is greater than 25 kg/m^2, and so we add 2 points to the total, making the current total 9 + 2 = 11.
"
924,36,Caprini Score for Venous Thromboembolism (2005),risk,integer,17,Handwritten,"A 56-year-old man presents for follow up after recently recovering from pneumonia. The patient's recent medical encounters include a hip fracture requiring a major surgical intervention. He is ambulating well now and he denies any immobilization or placement of a plaster cast. His thrombotic risk is defined by the presence of elevated anticardiolipin antibodies and Factor V Leiden mutation. However, no past records of deep vein thrombosis or pulmonary embolism are found. No current central venous access is identified. This gentleman bears a BMI of 24 kg/m^2 and on physical examination, evident swelling of the lower extremities is noticed. He has no history of sepsis, acute myocardial infarction, stroke, or congestive heart failure. He further denies any history of inflammatory bowel disease or chronic obstructive pulmonary disease but has acquired thrombophilia. Upon consultation, he clarified having neither been diagnosed with a malignancy, nor having any significant family history of thrombosis. He is under regular prophylaxis and monitoring for his thrombotic risk factors given his age and medical history.",What is the patient's Caprini Score for Venous Thromboembolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'History of inflammatory bowel disease': False, 'Hip, pelvis, or leg fracture in the last month': True, 'Chronic Obstructive Pulmonary Disease': False, 'Elevated anticardiolipin antibody': True, 'Mobility': 'normal', 'Current central venous access': False, 'Previously documented Deep Vein Thrombosis': False, 'Stroke in the last month': False, 'Multiple trauma in the last month': False, 'Body Mass Index (BMI)': [24.0, 'kg/m^2'], 'Previously Documented Pulmonary Embolism': False, 'Other congenital or acquired thrombophilia': True, 'Positive lupus anticoagulant': False, 'Pneumonia in the last month': True, 'age': [56.0, 'years'], 'Sepsis in the last month': False, 'Major Surgery in the last month': True, 'sex': 'Male', 'Positive Factor V Leiden': True, 'Current swollen legs': True}",17,17,17,"The criteria for the Caprini Score are listed below:

1. Age, years: ≤40 = 0 points, 41-60 = +1 point, 61-74 = +2 points, ≥75 = +3 points
2. Sex: Male = 0 points, Female = +1 point
3. Type of surgery: None = 0 points, Minor = +1 point, Major >45 min (laparoscopic or arthroscopic) = +2 points, Elective major lower extremity arthroplasty = +5 points
4. Recent (≤1 month) event: Major surgery = +1 point, Congestive heart failure (CHF) = +1 point, Sepsis = +1 point, Pneumonia = +1 point, Immobilizing plaster cast = +1 point, Hip, pelvis, or leg fracture = +5 points, Stroke = +5 points, Multiple trauma = +5 points, Acute spinal cord injury causing paralysis = +5 points
5. Venous disease or clotting disorder: Varicose veins = +1 point, Current swollen legs = +1 point, Current central venous access = +2 points, History of deep vein thrombosis (DVT) or pulmonary embolism (PE) = +3 points, Family history of thrombosis = +3 points, Positive Factor V Leiden = +3 points, Positive prothrombin 20210A = +3 points, Elevated serum homocysteine = +3 points
6. Other congenital or acquired thrombophilia: Positive lupus anticoagulant = +3 points, Elevated anticardiolipin antibody = +3 points, Heparin-induced thrombocytopenia = +3 points
7. Mobility: Normal, out of bed = 0 points, Medical patient currently on bed rest = +1 point, Patient confined to bed >72 hours = +2 points
8. Other present and past history: History of inflammatory bowel disease = +1 point, BMI ≥25 = +1 point, Acute myocardial infarction = +1 point, Chronic obstructive pulmonary disease (COPD) = +1 point, Present or previous malignancy = +2 points

The total Caprini Score is calculated by summing the points for each criterion.
    
The patient's current caprini score is 0.
The patient's gender is Male.
The patient is 56.0 years old. Because the patient's age is between 61 and 74, we add one point to the current total, making the current total, 0 + 1 = 1.
The patient does not report anything about s and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about major surgery in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about congestive heart failure in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient's has does not have sepsis in the last month. Hence, 0 points are added to the score, keeping the total at 1.The patient's has pneumonia in the last month. Hence, we add 1 to the total, making the current total 1 + 1 = 2.
 The patient does not report anything about immobilizing plaster cast in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient's has hip, pelvis, or leg fracture in the last month. Hence, we add 5 to the total, making the current total 5 + 2 = 7.
 The patient does not report anything about stroke in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 7. The patient's has does not have multiple trauma in the last month. Hence, 0 points are added to the score, keeping the total at 7.The patient does not report anything about acute spinal cord injury causing paralysis in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 7. The patient does not report anything about varicose veins and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 7. The patient's has current swollen legs. Hence, we add 1 to the total, making the current total 1 + 7 = 8.
 The patient's has does not have current central venuous access. Hence, 0 points are added to the score, keeping the total at 8.The patient's has does not have previous DVT documented. Hence, 0 points are added to the score, keeping the total at 8.The patient's has does not have previous pulmonary embolism documented. Hence, 0 points are added to the score, keeping the total at 8.The patient does not report anything about family history of thrombosis and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 8. The patient's has Positive Factor V Leiden. Hence, we add 3 to the total, making the current total 3 + 8 = 11.
 The patient does not report anything about Positive prothrombin 20210A and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 11. The patient does not report anything about an elevated serum homocysteine and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 11. The patient's has does not have a positive lupus anticoagulant. Hence, 0 points are added to the score, keeping the total at 11.The patient's has an elevated anticardiolipin antibody. Hence, we add 3 to the total, making the current total 3 + 11 = 14.
 The patient does not report anything about a heparin-induced thrombocytopenia and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 14. The patient's has other congenital or acquired thrombophilia. Hence, we add 3 to the total, making the current total 3 + 14 = 17.
 The patient's mobility status is determined to be 'normal'. Hence, we add 0 points to the total, making the current total 0 + 17 = 17.
 The patient's has does not have history of inflammatory bowel disease. Hence, 0 points are added to the score, keeping the total at 17.The patient does not report anything about acute Myocardial infarction and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 17. The patient's has does not have chronic Obstructive Pulmonary Disease. Hence, 0 points are added to the score, keeping the total at 17.The patient does not report anything about malignancy and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 17. The patient's BMI is 24.0 kg/m^2, which is less than 25 kg/m^2, and so we add 0 points to the total, keeping the total at 17.
"
925,36,Caprini Score for Venous Thromboembolism (2005),risk,integer,18,Handwritten,"A 62-year-old man was on medical admission for elective major lower extremity arthroplasty. The patient has been slowly recovering, but due to his weakness, he is currently confined to bed rest. His past medical history is negative for inflammatory bowel disease, chronic obstructive pulmonary disease, previous deep vein thrombosis, and pulmonary embolism. The patient's labs showed a positive prothrombin 20210A mutation and elevated serum homocysteine levels. His Body Mass Index (BMI) was recorded at 30 kg/m^2, indicative of obesity. On physical examination, swelling was noted in the lower extremities, but no varicose veins were appreciated. His medical history and recent heart failure exacerbation placed him in a high-risk category for thromboembolic events necessitating a careful approach in terms of prophylaxis and monitoring. Collaboration between cardiology, neurology, and orthopedic team would be beneficial in his ongoing management.  ",What is the patient's Caprini Score for Venous Thromboembolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'History of inflammatory bowel disease': False, 'Elevated anticardiolipin antibody': False, 'Mobility': 'on bed rest', 'Positive prothrombin 20210A': True, 'Acute spinal cord injury causing paralysis in the last month': False, 'Present or previous malignancy': False, 'Body Mass Index (BMI)': [30.0, 'kg/m^2'], 'Previously Documented Pulmonary Embolism': False, 'Immobilizing plaster cast in the last month': False, 'Positive lupus anticoagulant': False, 'age': [62.0, 'years'], 'Surgery Type': 'elective major lower extremity arthroplasty', 'Major Surgery in the last month': False, 'sex': 'Male', 'Elevated serum homocysteine': True, 'Varicose veins': False, 'Current swollen legs': True}",12,12,12,"The criteria for the Caprini Score are listed below:

1. Age, years: ≤40 = 0 points, 41-60 = +1 point, 61-74 = +2 points, ≥75 = +3 points
2. Sex: Male = 0 points, Female = +1 point
3. Type of surgery: None = 0 points, Minor = +1 point, Major >45 min (laparoscopic or arthroscopic) = +2 points, Elective major lower extremity arthroplasty = +5 points
4. Recent (≤1 month) event: Major surgery = +1 point, Congestive heart failure (CHF) = +1 point, Sepsis = +1 point, Pneumonia = +1 point, Immobilizing plaster cast = +1 point, Hip, pelvis, or leg fracture = +5 points, Stroke = +5 points, Multiple trauma = +5 points, Acute spinal cord injury causing paralysis = +5 points
5. Venous disease or clotting disorder: Varicose veins = +1 point, Current swollen legs = +1 point, Current central venous access = +2 points, History of deep vein thrombosis (DVT) or pulmonary embolism (PE) = +3 points, Family history of thrombosis = +3 points, Positive Factor V Leiden = +3 points, Positive prothrombin 20210A = +3 points, Elevated serum homocysteine = +3 points
6. Other congenital or acquired thrombophilia: Positive lupus anticoagulant = +3 points, Elevated anticardiolipin antibody = +3 points, Heparin-induced thrombocytopenia = +3 points
7. Mobility: Normal, out of bed = 0 points, Medical patient currently on bed rest = +1 point, Patient confined to bed >72 hours = +2 points
8. Other present and past history: History of inflammatory bowel disease = +1 point, BMI ≥25 = +1 point, Acute myocardial infarction = +1 point, Chronic obstructive pulmonary disease (COPD) = +1 point, Present or previous malignancy = +2 points

The total Caprini Score is calculated by summing the points for each criterion.
    
The patient's current caprini score is 0.
The patient's gender is Male.
The patient is 62.0 years old. Because the patient's age is between 61 and 74, we add two points to the current total, making the current total, 0 + 2 = 2.
The patient does not report anything about s and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about major surgery in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about congestive heart failure in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about sepsis in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about pneumonia in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about immobilizing plaster cast in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about hip, pelvis, or leg fracture in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about stroke in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about multiple trauma in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient's has does not have acute spinal cord injury causing paralysis in the last month. Hence, 0 points are added to the score, keeping the total at 2.The patient's has does not have varicose veins. Hence, 0 points are added to the score, keeping the total at 2.The patient's has current swollen legs. Hence, we add 1 to the total, making the current total 1 + 2 = 3.
 The patient does not report anything about current central venuous access and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 3. The patient does not report anything about previous DVT documented and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 3. The patient's has does not have previous pulmonary embolism documented. Hence, 0 points are added to the score, keeping the total at 3.The patient does not report anything about family history of thrombosis and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 3. The patient does not report anything about Positive Factor V Leiden and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 3. The patient's has Positive prothrombin 20210A. Hence, we add 3 to the total, making the current total 3 + 3 = 6.
 The patient's has an elevated serum homocysteine. Hence, we add 3 to the total, making the current total 3 + 6 = 9.
 The patient's has does not have a positive lupus anticoagulant. Hence, 0 points are added to the score, keeping the total at 9.The patient's has does not have an elevated anticardiolipin antibody. Hence, 0 points are added to the score, keeping the total at 9.The patient does not report anything about a heparin-induced thrombocytopenia and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 9. The patient does not report anything about other congenital or acquired thrombophilia and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 9. The patient's mobility status is determined to be 'on bed rest'. Hence, we add 1 points to the total, making the current total 1 + 9 = 10.
 The patient's has does not have history of inflammatory bowel disease. Hence, 0 points are added to the score, keeping the total at 10.The patient does not report anything about acute Myocardial infarction and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 10. The patient does not report anything about chronic Obstructive Pulmonary Disease and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 10. The patient's has does not have malignancy. Hence, 0 points are added to the score, keeping the total at 10.The patient's BMI is 30.0 kg/m^2, which is greater than 25 kg/m^2, and so we add 2 points to the total, making the current total 10 + 2 = 12.
"
926,36,Caprini Score for Venous Thromboembolism (2005),risk,integer,19,Handwritten,"A 58-year-old woman came to the hospital after a fall, resulting in a fracture to her hip. Her hospitalization was prolonged due to an episode of pneumonia. Despite her hip fracture, she was able to ambulate without significant aid post minor surgery and was often seen navigating her room. However, she does require a plaster cast for proper healing of her hip. Further medical history revealed varicose veins but she did not complain of swelling in her legs. Biochemical analysis showed the presence of elevated serum homocysteine and anticardiolipin antibody. However, the lupus anticoagulant test was negative. The absence of a history of congestive heart failure, chronic obstructive pulmonary disease, stroke, sepsis, deep vein thrombosis, pulmonary embolism, or heparin-induced thrombocytopenia was noted in her medical records. Her body mass index is within the normal range, calculated at 25 kg/m^2. Routine post-operative monitoring and prophylactic measures are strongly advised in her case to ensure a smooth and uneventful recovery process. ",What is the patient's Caprini Score for Venous Thromboembolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'Hip, pelvis, or leg fracture in the last month': True, 'Chronic Obstructive Pulmonary Disease': False, 'Elevated anticardiolipin antibody': True, 'Mobility': 'normal', 'Current central venous access': False, 'Previously documented Deep Vein Thrombosis': False, 'Stroke in the last month': False, 'Multiple trauma in the last month': False, 'Body Mass Index (BMI)': [25.0, 'kg/m^2'], 'Previously Documented Pulmonary Embolism': False, 'Immobilizing plaster cast in the last month': True, 'Positive lupus anticoagulant': False, 'Pneumonia in the last month': True, 'age': [58.0, 'years'], 'Surgery Type': 'minor', 'Heparin-induced thrombocytopenia': False, 'Major Surgery in the last month': False, 'sex': 'Female', 'Elevated serum homocysteine': True, 'Varicose veins': True, 'Current swollen legs': False}",14,14,14,"The criteria for the Caprini Score are listed below:

1. Age, years: ≤40 = 0 points, 41-60 = +1 point, 61-74 = +2 points, ≥75 = +3 points
2. Sex: Male = 0 points, Female = +1 point
3. Type of surgery: None = 0 points, Minor = +1 point, Major >45 min (laparoscopic or arthroscopic) = +2 points, Elective major lower extremity arthroplasty = +5 points
4. Recent (≤1 month) event: Major surgery = +1 point, Congestive heart failure (CHF) = +1 point, Sepsis = +1 point, Pneumonia = +1 point, Immobilizing plaster cast = +1 point, Hip, pelvis, or leg fracture = +5 points, Stroke = +5 points, Multiple trauma = +5 points, Acute spinal cord injury causing paralysis = +5 points
5. Venous disease or clotting disorder: Varicose veins = +1 point, Current swollen legs = +1 point, Current central venous access = +2 points, History of deep vein thrombosis (DVT) or pulmonary embolism (PE) = +3 points, Family history of thrombosis = +3 points, Positive Factor V Leiden = +3 points, Positive prothrombin 20210A = +3 points, Elevated serum homocysteine = +3 points
6. Other congenital or acquired thrombophilia: Positive lupus anticoagulant = +3 points, Elevated anticardiolipin antibody = +3 points, Heparin-induced thrombocytopenia = +3 points
7. Mobility: Normal, out of bed = 0 points, Medical patient currently on bed rest = +1 point, Patient confined to bed >72 hours = +2 points
8. Other present and past history: History of inflammatory bowel disease = +1 point, BMI ≥25 = +1 point, Acute myocardial infarction = +1 point, Chronic obstructive pulmonary disease (COPD) = +1 point, Present or previous malignancy = +2 points

The total Caprini Score is calculated by summing the points for each criterion.
    
The patient's current caprini score is 0.
The patient's gender is Female.
The patient is 58.0 years old. Because the patient's age is between 61 and 74, we add one point to the current total, making the current total, 0 + 1 = 1.
The patient does not report anything about s and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about major surgery in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about congestive heart failure in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about sepsis in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient's has pneumonia in the last month. Hence, we add 1 to the total, making the current total 1 + 1 = 2.
 The patient does not report anything about immobilizing plaster cast in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient's has hip, pelvis, or leg fracture in the last month. Hence, we add 5 to the total, making the current total 5 + 2 = 7.
 The patient does not report anything about stroke in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 7. The patient's has does not have multiple trauma in the last month. Hence, 0 points are added to the score, keeping the total at 7.The patient does not report anything about acute spinal cord injury causing paralysis in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 7. The patient's has varicose veins. Hence, we add 1 to the total, making the current total 1 + 7 = 8.
 The patient's has does not have current swollen legs. Hence, 0 points are added to the score, keeping the total at 8.The patient's has does not have current central venuous access. Hence, 0 points are added to the score, keeping the total at 8.The patient's has does not have previous DVT documented. Hence, 0 points are added to the score, keeping the total at 8.The patient's has does not have previous pulmonary embolism documented. Hence, 0 points are added to the score, keeping the total at 8.The patient does not report anything about family history of thrombosis and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 8. The patient does not report anything about Positive Factor V Leiden and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 8. The patient does not report anything about Positive prothrombin 20210A and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 8. The patient's has an elevated serum homocysteine. Hence, we add 3 to the total, making the current total 3 + 8 = 11.
 The patient's has does not have a positive lupus anticoagulant. Hence, 0 points are added to the score, keeping the total at 11.The patient's has an elevated anticardiolipin antibody. Hence, we add 3 to the total, making the current total 3 + 11 = 14.
 The patient's has does not have a heparin-induced thrombocytopenia. Hence, 0 points are added to the score, keeping the total at 14.The patient does not report anything about other congenital or acquired thrombophilia and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 14. The patient's mobility status is determined to be 'normal'. Hence, we add 0 points to the total, making the current total 0 + 14 = 14.
 The patient does not report anything about history of inflammatory bowel disease and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 14. The patient does not report anything about acute Myocardial infarction and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 14. The patient's has does not have chronic Obstructive Pulmonary Disease. Hence, 0 points are added to the score, keeping the total at 14.The patient does not report anything about malignancy and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 14. The patient's BMI is 25.0 kg/m^2, which is less than 25 kg/m^2, and so we add 0 points to the total, keeping the total at 14.
"
927,36,Caprini Score for Venous Thromboembolism (2005),risk,integer,20,Handwritten,"A 50-year-old female patient has recently been confined to bed rest due to a congestive heart failure exacerbation. Despite the improvement in her heart function, her hospital stay has been prolonged due to her difficult recovery and being stricken with sepsis. Interestingly, she has a past medical history noted with a previous deep vein thrombosis and a pulmonary embolism. Currently, she has a central venous line in place for antibiotic administration and monitoring. To rule out potential risks, a hypercoagulable workup was conducted revealing elevated serum homocysteine levels and further confirming the presence of another thrombophilia. Her body mass index is recorded at 30 kg/m^2, classified as obese. Physical examination reveals lower extremity edema but absent varicose veins. She does not have a history of inflammatory bowel disease, trauma, myocardial infarction, pneumonia, stroke, or major surgery in the past month. She denies having a congenital disease like Factor V Leiden mutation or a family history of thrombosis. As she is at high risk for thromboembolic events, a multidisciplinary approach including infectious disease, cardiology, hematology, and primary care is needed for management.",What is the patient's Caprini Score for Venous Thromboembolism? You should use the patient's medical values and health status when they were first admitted to the hospital prior to any treatment.,"{'History of inflammatory bowel disease': False, 'Congestive Heart Failure in the last month': True, 'Acute Myocardial infarction': False, 'Mobility': 'on bed rest', 'Current central venous access': True, 'Previously documented Deep Vein Thrombosis': True, 'Multiple trauma in the last month': False, 'Body Mass Index (BMI)': [30.0, 'kg/m^2'], 'Previously Documented Pulmonary Embolism': True, 'Other congenital or acquired thrombophilia': True, 'Pneumonia in the last month': False, 'age': [50.0, 'years'], 'Family history of thrombosis': False, 'Sepsis in the last month': True, 'Heparin-induced thrombocytopenia': False, 'sex': 'Female', 'Elevated serum homocysteine': True, 'Positive Factor V Leiden': False, 'Current swollen legs': True}",20,20,20,"The criteria for the Caprini Score are listed below:

1. Age, years: ≤40 = 0 points, 41-60 = +1 point, 61-74 = +2 points, ≥75 = +3 points
2. Sex: Male = 0 points, Female = +1 point
3. Type of surgery: None = 0 points, Minor = +1 point, Major >45 min (laparoscopic or arthroscopic) = +2 points, Elective major lower extremity arthroplasty = +5 points
4. Recent (≤1 month) event: Major surgery = +1 point, Congestive heart failure (CHF) = +1 point, Sepsis = +1 point, Pneumonia = +1 point, Immobilizing plaster cast = +1 point, Hip, pelvis, or leg fracture = +5 points, Stroke = +5 points, Multiple trauma = +5 points, Acute spinal cord injury causing paralysis = +5 points
5. Venous disease or clotting disorder: Varicose veins = +1 point, Current swollen legs = +1 point, Current central venous access = +2 points, History of deep vein thrombosis (DVT) or pulmonary embolism (PE) = +3 points, Family history of thrombosis = +3 points, Positive Factor V Leiden = +3 points, Positive prothrombin 20210A = +3 points, Elevated serum homocysteine = +3 points
6. Other congenital or acquired thrombophilia: Positive lupus anticoagulant = +3 points, Elevated anticardiolipin antibody = +3 points, Heparin-induced thrombocytopenia = +3 points
7. Mobility: Normal, out of bed = 0 points, Medical patient currently on bed rest = +1 point, Patient confined to bed >72 hours = +2 points
8. Other present and past history: History of inflammatory bowel disease = +1 point, BMI ≥25 = +1 point, Acute myocardial infarction = +1 point, Chronic obstructive pulmonary disease (COPD) = +1 point, Present or previous malignancy = +2 points

The total Caprini Score is calculated by summing the points for each criterion.
    
The patient's current caprini score is 0.
The patient's gender is Female.
The patient is 50.0 years old. Because the patient's age is between 61 and 74, we add one point to the current total, making the current total, 0 + 1 = 1.
The patient does not report anything about s and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about major surgery in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient does not report anything about congestive heart failure in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 1. The patient's has sepsis in the last month. Hence, we add 1 to the total, making the current total 1 + 1 = 2.
 The patient's has does not have pneumonia in the last month. Hence, 0 points are added to the score, keeping the total at 2.The patient does not report anything about immobilizing plaster cast in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about hip, pelvis, or leg fracture in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about stroke in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient's has does not have multiple trauma in the last month. Hence, 0 points are added to the score, keeping the total at 2.The patient does not report anything about acute spinal cord injury causing paralysis in the last month and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient does not report anything about varicose veins and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 2. The patient's has current swollen legs. Hence, we add 1 to the total, making the current total 1 + 2 = 3.
 The patient's has current central venuous access. Hence, we add 2 to the total, making the current total 2 + 3 = 5.
 The patient's has previous DVT documented. Hence, we add 3 to the total, making the current total 3 + 5 = 8.
 The patient's has previous pulmonary embolism documented. Hence, we add 3 to the total, making the current total 3 + 8 = 11.
 The patient's has does not have family history of thrombosis. Hence, 0 points are added to the score, keeping the total at 11.The patient's has does not have Positive Factor V Leiden. Hence, 0 points are added to the score, keeping the total at 11.The patient does not report anything about Positive prothrombin 20210A and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 11. The patient's has an elevated serum homocysteine. Hence, we add 3 to the total, making the current total 3 + 11 = 14.
 The patient does not report anything about a positive lupus anticoagulant and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 14. The patient does not report anything about an elevated anticardiolipin antibody and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 14. The patient's has does not have a heparin-induced thrombocytopenia. Hence, 0 points are added to the score, keeping the total at 14.The patient's has other congenital or acquired thrombophilia. Hence, we add 3 to the total, making the current total 3 + 14 = 17.
 The patient's mobility status is determined to be 'on bed rest'. Hence, we add 1 points to the total, making the current total 1 + 17 = 18.
 The patient's has does not have history of inflammatory bowel disease. Hence, 0 points are added to the score, keeping the total at 18.The patient's has does not have acute Myocardial infarction. Hence, 0 points are added to the score, keeping the total at 18.The patient does not report anything about chronic Obstructive Pulmonary Disease and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 18. The patient does not report anything about malignancy and so we assume this to be false. Hence, 0 points are added to the score, keeping the total at 18. The patient's BMI is 30.0 kg/m^2, which is greater than 25 kg/m^2, and so we add 2 points to the total, making the current total 18 + 2 = 20.
"
929,13,Estimated Due Date,date,date,1,Template,The patient's last menstrual period was on 12/11/2013. Her cycle length is 22 days.,"Using Naegele's Rule for estimated due date based on the last menstrual period and cycle length, what is the the patient's estimated due date? Your response should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and no other text.","{'cycle length': 22, 'Last menstrual date': '12/11/2013'}",09/23/2014,09/23/2014,09/23/2014,"The patient's estimated due date based on their last period is computed by using Naegele's Rule. Using Naegele's Rule, we add 40 weeks to the patient's last menstrual period date. We then add or subtract days from the patient's estimated due date depending on how many more or less days a patient's cycle length is from the standard 28 days. 
The patient's last menstrual period was 12/11/2013. 
The date after adding 40 weeks to the patient's last menstrual period date is 09/17/2014. 
Because the patient's cycle length is 22 days, this means that we must subtract -6 days from the patient's estimate due date. Hence, the patient's estimated due date is 09/23/2014."
930,13,Estimated Due Date,date,date,2,Template,The patient's last menstrual period was on 03/31/2006. Her cycle length is 24 days.,"Using Naegele's Rule for estimated due date based on the last menstrual period and cycle length, what is the the patient's estimated due date? Your response should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and no other text.","{'cycle length': 24, 'Last menstrual date': '03/31/2006'}",01/09/2007,01/09/2007,01/09/2007,"The patient's estimated due date based on their last period is computed by using Naegele's Rule. Using Naegele's Rule, we add 40 weeks to the patient's last menstrual period date. We then add or subtract days from the patient's estimated due date depending on how many more or less days a patient's cycle length is from the standard 28 days. 
The patient's last menstrual period was 03/31/2006. 
The date after adding 40 weeks to the patient's last menstrual period date is 01/05/2007. 
Because the patient's cycle length is 24 days, this means that we must subtract -4 days from the patient's estimate due date. Hence, the patient's estimated due date is 01/09/2007."
931,13,Estimated Due Date,date,date,3,Template,The patient's last menstrual period was on 02/13/2002. Her cycle length is 25 days.,"Using Naegele's Rule for estimated due date based on the last menstrual period and cycle length, what is the the patient's estimated due date? Your response should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and no other text.","{'cycle length': 25, 'Last menstrual date': '02/13/2002'}",11/23/2002,11/23/2002,11/23/2002,"The patient's estimated due date based on their last period is computed by using Naegele's Rule. Using Naegele's Rule, we add 40 weeks to the patient's last menstrual period date. We then add or subtract days from the patient's estimated due date depending on how many more or less days a patient's cycle length is from the standard 28 days. 
The patient's last menstrual period was 02/13/2002. 
The date after adding 40 weeks to the patient's last menstrual period date is 11/20/2002. 
Because the patient's cycle length is 25 days, this means that we must subtract -3 days from the patient's estimate due date. Hence, the patient's estimated due date is 11/23/2002."
932,13,Estimated Due Date,date,date,4,Template,The patient's last menstrual period was on 06/20/2011. Her cycle length is 21 days.,"Using Naegele's Rule for estimated due date based on the last menstrual period and cycle length, what is the the patient's estimated due date? Your response should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and no other text.","{'cycle length': 21, 'Last menstrual date': '06/20/2011'}",04/02/2012,04/02/2012,04/02/2012,"The patient's estimated due date based on their last period is computed by using Naegele's Rule. Using Naegele's Rule, we add 40 weeks to the patient's last menstrual period date. We then add or subtract days from the patient's estimated due date depending on how many more or less days a patient's cycle length is from the standard 28 days. 
The patient's last menstrual period was 06/20/2011. 
The date after adding 40 weeks to the patient's last menstrual period date is 03/26/2012. 
Because the patient's cycle length is 21 days, this means that we must subtract -7 days from the patient's estimate due date. Hence, the patient's estimated due date is 04/02/2012."
933,13,Estimated Due Date,date,date,5,Template,The patient's last menstrual period was on 01/15/2023. Her cycle length is 24 days.,"Using Naegele's Rule for estimated due date based on the last menstrual period and cycle length, what is the the patient's estimated due date? Your response should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and no other text.","{'cycle length': 24, 'Last menstrual date': '01/15/2023'}",10/26/2023,10/26/2023,10/26/2023,"The patient's estimated due date based on their last period is computed by using Naegele's Rule. Using Naegele's Rule, we add 40 weeks to the patient's last menstrual period date. We then add or subtract days from the patient's estimated due date depending on how many more or less days a patient's cycle length is from the standard 28 days. 
The patient's last menstrual period was 01/15/2023. 
The date after adding 40 weeks to the patient's last menstrual period date is 10/22/2023. 
Because the patient's cycle length is 24 days, this means that we must subtract -4 days from the patient's estimate due date. Hence, the patient's estimated due date is 10/26/2023."
934,13,Estimated Due Date,date,date,6,Template,The patient's last menstrual period was on 02/03/2012. Her cycle length is 28 days.,"Using Naegele's Rule for estimated due date based on the last menstrual period and cycle length, what is the the patient's estimated due date? Your response should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and no other text.","{'cycle length': 28, 'Last menstrual date': '02/03/2012'}",11/09/2012,11/09/2012,11/09/2012,"The patient's estimated due date based on their last period is computed by using Naegele's Rule. Using Naegele's Rule, we add 40 weeks to the patient's last menstrual period date. We then add or subtract days from the patient's estimated due date depending on how many more or less days a patient's cycle length is from the standard 28 days. 
The patient's last menstrual period was 02/03/2012. 
The date after adding 40 weeks to the patient's last menstrual period date is 11/09/2012. 
Because the patient's cycle length is 28 days, we do not make any changes to the date. Hence, the patient's estimated due date is 11/09/2012."
935,13,Estimated Due Date,date,date,7,Template,The patient's last menstrual period was on 05/20/2020. Her cycle length is 28 days.,"Using Naegele's Rule for estimated due date based on the last menstrual period and cycle length, what is the the patient's estimated due date? Your response should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and no other text.","{'cycle length': 28, 'Last menstrual date': '05/20/2020'}",02/24/2021,02/24/2021,02/24/2021,"The patient's estimated due date based on their last period is computed by using Naegele's Rule. Using Naegele's Rule, we add 40 weeks to the patient's last menstrual period date. We then add or subtract days from the patient's estimated due date depending on how many more or less days a patient's cycle length is from the standard 28 days. 
The patient's last menstrual period was 05/20/2020. 
The date after adding 40 weeks to the patient's last menstrual period date is 02/24/2021. 
Because the patient's cycle length is 28 days, we do not make any changes to the date. Hence, the patient's estimated due date is 02/24/2021."
936,13,Estimated Due Date,date,date,8,Template,The patient's last menstrual period was on 10/23/2006. Her cycle length is 25 days.,"Using Naegele's Rule for estimated due date based on the last menstrual period and cycle length, what is the the patient's estimated due date? Your response should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and no other text.","{'cycle length': 25, 'Last menstrual date': '10/23/2006'}",08/02/2007,08/02/2007,08/02/2007,"The patient's estimated due date based on their last period is computed by using Naegele's Rule. Using Naegele's Rule, we add 40 weeks to the patient's last menstrual period date. We then add or subtract days from the patient's estimated due date depending on how many more or less days a patient's cycle length is from the standard 28 days. 
The patient's last menstrual period was 10/23/2006. 
The date after adding 40 weeks to the patient's last menstrual period date is 07/30/2007. 
Because the patient's cycle length is 25 days, this means that we must subtract -3 days from the patient's estimate due date. Hence, the patient's estimated due date is 08/02/2007."
937,13,Estimated Due Date,date,date,9,Template,The patient's last menstrual period was on 01/08/2021. Her cycle length is 21 days.,"Using Naegele's Rule for estimated due date based on the last menstrual period and cycle length, what is the the patient's estimated due date? Your response should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and no other text.","{'cycle length': 21, 'Last menstrual date': '01/08/2021'}",10/22/2021,10/22/2021,10/22/2021,"The patient's estimated due date based on their last period is computed by using Naegele's Rule. Using Naegele's Rule, we add 40 weeks to the patient's last menstrual period date. We then add or subtract days from the patient's estimated due date depending on how many more or less days a patient's cycle length is from the standard 28 days. 
The patient's last menstrual period was 01/08/2021. 
The date after adding 40 weeks to the patient's last menstrual period date is 10/15/2021. 
Because the patient's cycle length is 21 days, this means that we must subtract -7 days from the patient's estimate due date. Hence, the patient's estimated due date is 10/22/2021."
938,13,Estimated Due Date,date,date,10,Template,The patient's last menstrual period was on 02/28/2007. Her cycle length is 24 days.,"Using Naegele's Rule for estimated due date based on the last menstrual period and cycle length, what is the the patient's estimated due date? Your response should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and no other text.","{'cycle length': 24, 'Last menstrual date': '02/28/2007'}",12/09/2007,12/09/2007,12/09/2007,"The patient's estimated due date based on their last period is computed by using Naegele's Rule. Using Naegele's Rule, we add 40 weeks to the patient's last menstrual period date. We then add or subtract days from the patient's estimated due date depending on how many more or less days a patient's cycle length is from the standard 28 days. 
The patient's last menstrual period was 02/28/2007. 
The date after adding 40 weeks to the patient's last menstrual period date is 12/05/2007. 
Because the patient's cycle length is 24 days, this means that we must subtract -4 days from the patient's estimate due date. Hence, the patient's estimated due date is 12/09/2007."
939,13,Estimated Due Date,date,date,11,Template,The patient's last menstrual period was on 07/15/2008. Her cycle length is 21 days.,"Using Naegele's Rule for estimated due date based on the last menstrual period and cycle length, what is the the patient's estimated due date? Your response should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and no other text.","{'cycle length': 21, 'Last menstrual date': '07/15/2008'}",04/28/2009,04/28/2009,04/28/2009,"The patient's estimated due date based on their last period is computed by using Naegele's Rule. Using Naegele's Rule, we add 40 weeks to the patient's last menstrual period date. We then add or subtract days from the patient's estimated due date depending on how many more or less days a patient's cycle length is from the standard 28 days. 
The patient's last menstrual period was 07/15/2008. 
The date after adding 40 weeks to the patient's last menstrual period date is 04/21/2009. 
Because the patient's cycle length is 21 days, this means that we must subtract -7 days from the patient's estimate due date. Hence, the patient's estimated due date is 04/28/2009."
940,13,Estimated Due Date,date,date,12,Template,The patient's last menstrual period was on 06/12/2005. Her cycle length is 30 days.,"Using Naegele's Rule for estimated due date based on the last menstrual period and cycle length, what is the the patient's estimated due date? Your response should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and no other text.","{'cycle length': 30, 'Last menstrual date': '06/12/2005'}",03/21/2006,03/21/2006,03/21/2006,"The patient's estimated due date based on their last period is computed by using Naegele's Rule. Using Naegele's Rule, we add 40 weeks to the patient's last menstrual period date. We then add or subtract days from the patient's estimated due date depending on how many more or less days a patient's cycle length is from the standard 28 days. 
The patient's last menstrual period was 06/12/2005. 
The date after adding 40 weeks to the patient's last menstrual period date is 03/19/2006. 
Because the patient's cycle length is 30 days, this means that we must add 2 days to the patient's estimate due date. Hence, the patient's estimated due date is 03/21/2006."
941,13,Estimated Due Date,date,date,13,Template,The patient's last menstrual period was on 04/09/2021. Her cycle length is 25 days.,"Using Naegele's Rule for estimated due date based on the last menstrual period and cycle length, what is the the patient's estimated due date? Your response should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and no other text.","{'cycle length': 25, 'Last menstrual date': '04/09/2021'}",01/17/2022,01/17/2022,01/17/2022,"The patient's estimated due date based on their last period is computed by using Naegele's Rule. Using Naegele's Rule, we add 40 weeks to the patient's last menstrual period date. We then add or subtract days from the patient's estimated due date depending on how many more or less days a patient's cycle length is from the standard 28 days. 
The patient's last menstrual period was 04/09/2021. 
The date after adding 40 weeks to the patient's last menstrual period date is 01/14/2022. 
Because the patient's cycle length is 25 days, this means that we must subtract -3 days from the patient's estimate due date. Hence, the patient's estimated due date is 01/17/2022."
942,13,Estimated Due Date,date,date,14,Template,The patient's last menstrual period was on 11/20/2002. Her cycle length is 30 days.,"Using Naegele's Rule for estimated due date based on the last menstrual period and cycle length, what is the the patient's estimated due date? Your response should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and no other text.","{'cycle length': 30, 'Last menstrual date': '11/20/2002'}",08/29/2003,08/29/2003,08/29/2003,"The patient's estimated due date based on their last period is computed by using Naegele's Rule. Using Naegele's Rule, we add 40 weeks to the patient's last menstrual period date. We then add or subtract days from the patient's estimated due date depending on how many more or less days a patient's cycle length is from the standard 28 days. 
The patient's last menstrual period was 11/20/2002. 
The date after adding 40 weeks to the patient's last menstrual period date is 08/27/2003. 
Because the patient's cycle length is 30 days, this means that we must add 2 days to the patient's estimate due date. Hence, the patient's estimated due date is 08/29/2003."
943,13,Estimated Due Date,date,date,15,Template,The patient's last menstrual period was on 03/24/2017. Her cycle length is 30 days.,"Using Naegele's Rule for estimated due date based on the last menstrual period and cycle length, what is the the patient's estimated due date? Your response should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and no other text.","{'cycle length': 30, 'Last menstrual date': '03/24/2017'}",12/31/2017,12/31/2017,12/31/2017,"The patient's estimated due date based on their last period is computed by using Naegele's Rule. Using Naegele's Rule, we add 40 weeks to the patient's last menstrual period date. We then add or subtract days from the patient's estimated due date depending on how many more or less days a patient's cycle length is from the standard 28 days. 
The patient's last menstrual period was 03/24/2017. 
The date after adding 40 weeks to the patient's last menstrual period date is 12/29/2017. 
Because the patient's cycle length is 30 days, this means that we must add 2 days to the patient's estimate due date. Hence, the patient's estimated due date is 12/31/2017."
944,13,Estimated Due Date,date,date,16,Template,The patient's last menstrual period was on 03/13/2014. Her cycle length is 23 days.,"Using Naegele's Rule for estimated due date based on the last menstrual period and cycle length, what is the the patient's estimated due date? Your response should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and no other text.","{'cycle length': 23, 'Last menstrual date': '03/13/2014'}",12/23/2014,12/23/2014,12/23/2014,"The patient's estimated due date based on their last period is computed by using Naegele's Rule. Using Naegele's Rule, we add 40 weeks to the patient's last menstrual period date. We then add or subtract days from the patient's estimated due date depending on how many more or less days a patient's cycle length is from the standard 28 days. 
The patient's last menstrual period was 03/13/2014. 
The date after adding 40 weeks to the patient's last menstrual period date is 12/18/2014. 
Because the patient's cycle length is 23 days, this means that we must subtract -5 days from the patient's estimate due date. Hence, the patient's estimated due date is 12/23/2014."
945,13,Estimated Due Date,date,date,17,Template,The patient's last menstrual period was on 11/18/2022. Her cycle length is 24 days.,"Using Naegele's Rule for estimated due date based on the last menstrual period and cycle length, what is the the patient's estimated due date? Your response should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and no other text.","{'cycle length': 24, 'Last menstrual date': '11/18/2022'}",08/29/2023,08/29/2023,08/29/2023,"The patient's estimated due date based on their last period is computed by using Naegele's Rule. Using Naegele's Rule, we add 40 weeks to the patient's last menstrual period date. We then add or subtract days from the patient's estimated due date depending on how many more or less days a patient's cycle length is from the standard 28 days. 
The patient's last menstrual period was 11/18/2022. 
The date after adding 40 weeks to the patient's last menstrual period date is 08/25/2023. 
Because the patient's cycle length is 24 days, this means that we must subtract -4 days from the patient's estimate due date. Hence, the patient's estimated due date is 08/29/2023."
946,13,Estimated Due Date,date,date,18,Template,The patient's last menstrual period was on 11/27/2010. Her cycle length is 23 days.,"Using Naegele's Rule for estimated due date based on the last menstrual period and cycle length, what is the the patient's estimated due date? Your response should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and no other text.","{'cycle length': 23, 'Last menstrual date': '11/27/2010'}",09/08/2011,09/08/2011,09/08/2011,"The patient's estimated due date based on their last period is computed by using Naegele's Rule. Using Naegele's Rule, we add 40 weeks to the patient's last menstrual period date. We then add or subtract days from the patient's estimated due date depending on how many more or less days a patient's cycle length is from the standard 28 days. 
The patient's last menstrual period was 11/27/2010. 
The date after adding 40 weeks to the patient's last menstrual period date is 09/03/2011. 
Because the patient's cycle length is 23 days, this means that we must subtract -5 days from the patient's estimate due date. Hence, the patient's estimated due date is 09/08/2011."
947,13,Estimated Due Date,date,date,19,Template,The patient's last menstrual period was on 04/26/2001. Her cycle length is 20 days.,"Using Naegele's Rule for estimated due date based on the last menstrual period and cycle length, what is the the patient's estimated due date? Your response should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and no other text.","{'cycle length': 20, 'Last menstrual date': '04/26/2001'}",02/08/2002,02/08/2002,02/08/2002,"The patient's estimated due date based on their last period is computed by using Naegele's Rule. Using Naegele's Rule, we add 40 weeks to the patient's last menstrual period date. We then add or subtract days from the patient's estimated due date depending on how many more or less days a patient's cycle length is from the standard 28 days. 
The patient's last menstrual period was 04/26/2001. 
The date after adding 40 weeks to the patient's last menstrual period date is 01/31/2002. 
Because the patient's cycle length is 20 days, this means that we must subtract -8 days from the patient's estimate due date. Hence, the patient's estimated due date is 02/08/2002."
948,13,Estimated Due Date,date,date,20,Template,The patient's last menstrual period was on 07/03/2008. Her cycle length is 25 days.,"Using Naegele's Rule for estimated due date based on the last menstrual period and cycle length, what is the the patient's estimated due date? Your response should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and no other text.","{'cycle length': 25, 'Last menstrual date': '07/03/2008'}",04/12/2009,04/12/2009,04/12/2009,"The patient's estimated due date based on their last period is computed by using Naegele's Rule. Using Naegele's Rule, we add 40 weeks to the patient's last menstrual period date. We then add or subtract days from the patient's estimated due date depending on how many more or less days a patient's cycle length is from the standard 28 days. 
The patient's last menstrual period was 07/03/2008. 
The date after adding 40 weeks to the patient's last menstrual period date is 04/09/2009. 
Because the patient's cycle length is 25 days, this means that we must subtract -3 days from the patient's estimate due date. Hence, the patient's estimated due date is 04/12/2009."
949,24,Steroid Conversion Calculator,dosage conversion,decimal,1,Template,Patient has taken 7.96 mg of Dexamethasone PO.,"Based on the patient's dose of Dexamethasone PO, what is the equivalent dosage in mg of PrednisoLONE PO?","{'input steroid': ['Dexamethasone PO', 7.96, 'mg'], 'target steroid': 'PrednisoLONE PO'}",53.0932,50.43854,55.74786,"The Steroid Conversions providing equivalent doses for various corticosteroids are listed below:
1. Betamethasone: Route = IV, Equivalent Dose = 0.75 mg
2. Cortisone: Route = PO, Equivalent Dose = 25 mg
3. Dexamethasone (Decadron): Route = IV or PO, Equivalent Dose = 0.75 mg
4. Hydrocortisone: Route = IV or PO, Equivalent Dose = 20 mg
5. MethylPrednisoLONE: Route = IV or PO, Equivalent Dose = 4 mg
6. PrednisoLONE: Route = PO, Equivalent Dose = 5 mg
7. PredniSONE: Route = PO, Equivalent Dose = 5 mg
8. Triamcinolone: Route = IV, Equivalent Dose = 4 mg 
The mass of Dexamethasone PO is 7.96 mg. 
To convert from the Dexamethasone PO to PrednisoLONE PO, multiply by the conversion factor, 6.67 mg PrednisoLONE PO/Dexamethasone PO, giving us 7.96 mg Dexamethasone PO * 6.67 mg PrednisoLONE PO/mg Dexamethasone PO = 53.0932 mg PrednisoLONE PO. 7.96 mg of Dexamethasone PO is equal to 53.0932 mg of PrednisoLONE PO."
950,24,Steroid Conversion Calculator,dosage conversion,decimal,2,Template,Patient has taken 162.935 mg of Hydrocortisone PO.,"Based on the patient's dose of Hydrocortisone PO, what is the equivalent dosage in mg of Dexamethasone PO?","{'input steroid': ['Hydrocortisone PO', 162.935, 'mg'], 'target steroid': 'Dexamethasone PO'}",6.11006,5.80456,6.41556,"The Steroid Conversions providing equivalent doses for various corticosteroids are listed below:
1. Betamethasone: Route = IV, Equivalent Dose = 0.75 mg
2. Cortisone: Route = PO, Equivalent Dose = 25 mg
3. Dexamethasone (Decadron): Route = IV or PO, Equivalent Dose = 0.75 mg
4. Hydrocortisone: Route = IV or PO, Equivalent Dose = 20 mg
5. MethylPrednisoLONE: Route = IV or PO, Equivalent Dose = 4 mg
6. PrednisoLONE: Route = PO, Equivalent Dose = 5 mg
7. PredniSONE: Route = PO, Equivalent Dose = 5 mg
8. Triamcinolone: Route = IV, Equivalent Dose = 4 mg 
The mass of Hydrocortisone PO is 162.935 mg. 
To convert from the Hydrocortisone PO to Dexamethasone PO, multiply by the conversion factor, 0.0375 mg Dexamethasone PO/Hydrocortisone PO, giving us 162.935 mg Hydrocortisone PO * 0.0375 mg Dexamethasone PO/mg Hydrocortisone PO = 6.11006 mg Dexamethasone PO. 162.935 mg of Hydrocortisone PO is equal to 6.11006 mg of Dexamethasone PO."
951,24,Steroid Conversion Calculator,dosage conversion,decimal,3,Template,Patient has taken 34.068 mg of PrednisoLONE PO.,"Based on the patient's dose of PrednisoLONE PO, what is the equivalent dosage in mg of Dexamethasone PO?","{'input steroid': ['PrednisoLONE PO', 34.068, 'mg'], 'target steroid': 'Dexamethasone PO'}",5.10782,4.85243,5.36321,"The Steroid Conversions providing equivalent doses for various corticosteroids are listed below:
1. Betamethasone: Route = IV, Equivalent Dose = 0.75 mg
2. Cortisone: Route = PO, Equivalent Dose = 25 mg
3. Dexamethasone (Decadron): Route = IV or PO, Equivalent Dose = 0.75 mg
4. Hydrocortisone: Route = IV or PO, Equivalent Dose = 20 mg
5. MethylPrednisoLONE: Route = IV or PO, Equivalent Dose = 4 mg
6. PrednisoLONE: Route = PO, Equivalent Dose = 5 mg
7. PredniSONE: Route = PO, Equivalent Dose = 5 mg
8. Triamcinolone: Route = IV, Equivalent Dose = 4 mg 
The mass of PrednisoLONE PO is 34.068 mg. 
To convert from the PrednisoLONE PO to Dexamethasone PO, multiply by the conversion factor, 0.14993 mg Dexamethasone PO/PrednisoLONE PO, giving us 34.068 mg PrednisoLONE PO * 0.14993 mg Dexamethasone PO/mg PrednisoLONE PO = 5.10782 mg Dexamethasone PO. 34.068 mg of PrednisoLONE PO is equal to 5.10782 mg of Dexamethasone PO."
952,24,Steroid Conversion Calculator,dosage conversion,decimal,4,Template,Patient has taken 222.331 mg of Cortisone PO.,"Based on the patient's dose of Cortisone PO, what is the equivalent dosage in mg of PrednisoLONE PO?","{'input steroid': ['Cortisone PO', 222.331, 'mg'], 'target steroid': 'PrednisoLONE PO'}",44.49288,42.26824,46.71752,"The Steroid Conversions providing equivalent doses for various corticosteroids are listed below:
1. Betamethasone: Route = IV, Equivalent Dose = 0.75 mg
2. Cortisone: Route = PO, Equivalent Dose = 25 mg
3. Dexamethasone (Decadron): Route = IV or PO, Equivalent Dose = 0.75 mg
4. Hydrocortisone: Route = IV or PO, Equivalent Dose = 20 mg
5. MethylPrednisoLONE: Route = IV or PO, Equivalent Dose = 4 mg
6. PrednisoLONE: Route = PO, Equivalent Dose = 5 mg
7. PredniSONE: Route = PO, Equivalent Dose = 5 mg
8. Triamcinolone: Route = IV, Equivalent Dose = 4 mg 
The mass of Cortisone PO is 222.331 mg. 
To convert from the Cortisone PO to PrednisoLONE PO, multiply by the conversion factor, 0.20012 mg PrednisoLONE PO/Cortisone PO, giving us 222.331 mg Cortisone PO * 0.20012 mg PrednisoLONE PO/mg Cortisone PO = 44.49288 mg PrednisoLONE PO. 222.331 mg of Cortisone PO is equal to 44.49288 mg of PrednisoLONE PO."
953,24,Steroid Conversion Calculator,dosage conversion,decimal,5,Template,Patient has taken 45.802 mg of PredniSONE PO.,"Based on the patient's dose of PredniSONE PO, what is the equivalent dosage in mg of Hydrocortisone IV?","{'input steroid': ['PredniSONE PO', 45.802, 'mg'], 'target steroid': 'Hydrocortisone IV'}",183.1393,173.98233,192.29627,"The Steroid Conversions providing equivalent doses for various corticosteroids are listed below:
1. Betamethasone: Route = IV, Equivalent Dose = 0.75 mg
2. Cortisone: Route = PO, Equivalent Dose = 25 mg
3. Dexamethasone (Decadron): Route = IV or PO, Equivalent Dose = 0.75 mg
4. Hydrocortisone: Route = IV or PO, Equivalent Dose = 20 mg
5. MethylPrednisoLONE: Route = IV or PO, Equivalent Dose = 4 mg
6. PrednisoLONE: Route = PO, Equivalent Dose = 5 mg
7. PredniSONE: Route = PO, Equivalent Dose = 5 mg
8. Triamcinolone: Route = IV, Equivalent Dose = 4 mg 
The mass of PredniSONE PO is 45.802 mg. 
To convert from the PredniSONE PO to Hydrocortisone IV, multiply by the conversion factor, 3.9985 mg Hydrocortisone IV/PredniSONE PO, giving us 45.802 mg PredniSONE PO * 3.9985 mg Hydrocortisone IV/mg PredniSONE PO = 183.1393 mg Hydrocortisone IV. 45.802 mg of PredniSONE PO is equal to 183.1393 mg of Hydrocortisone IV."
954,24,Steroid Conversion Calculator,dosage conversion,decimal,6,Template,Patient has taken 21.065 mg of MethylPrednisoLONE IV.,"Based on the patient's dose of MethylPrednisoLONE IV, what is the equivalent dosage in mg of PrednisoLONE PO?","{'input steroid': ['MethylPrednisoLONE IV', 21.065, 'mg'], 'target steroid': 'PrednisoLONE PO'}",26.36095,25.0429,27.679,"The Steroid Conversions providing equivalent doses for various corticosteroids are listed below:
1. Betamethasone: Route = IV, Equivalent Dose = 0.75 mg
2. Cortisone: Route = PO, Equivalent Dose = 25 mg
3. Dexamethasone (Decadron): Route = IV or PO, Equivalent Dose = 0.75 mg
4. Hydrocortisone: Route = IV or PO, Equivalent Dose = 20 mg
5. MethylPrednisoLONE: Route = IV or PO, Equivalent Dose = 4 mg
6. PrednisoLONE: Route = PO, Equivalent Dose = 5 mg
7. PredniSONE: Route = PO, Equivalent Dose = 5 mg
8. Triamcinolone: Route = IV, Equivalent Dose = 4 mg 
The mass of MethylPrednisoLONE IV is 21.065 mg. 
To convert from the MethylPrednisoLONE IV to PrednisoLONE PO, multiply by the conversion factor, 1.25141 mg PrednisoLONE PO/MethylPrednisoLONE IV, giving us 21.065 mg MethylPrednisoLONE IV * 1.25141 mg PrednisoLONE PO/mg MethylPrednisoLONE IV = 26.36095 mg PrednisoLONE PO. 21.065 mg of MethylPrednisoLONE IV is equal to 26.36095 mg of PrednisoLONE PO."
955,24,Steroid Conversion Calculator,dosage conversion,decimal,7,Template,Patient has taken 23.465 mg of Triamcinolone IV.,"Based on the patient's dose of Triamcinolone IV, what is the equivalent dosage in mg of Betamethasone IV?","{'input steroid': ['Triamcinolone IV', 23.465, 'mg'], 'target steroid': 'Betamethasone IV'}",4.4025,4.18237,4.62263,"The Steroid Conversions providing equivalent doses for various corticosteroids are listed below:
1. Betamethasone: Route = IV, Equivalent Dose = 0.75 mg
2. Cortisone: Route = PO, Equivalent Dose = 25 mg
3. Dexamethasone (Decadron): Route = IV or PO, Equivalent Dose = 0.75 mg
4. Hydrocortisone: Route = IV or PO, Equivalent Dose = 20 mg
5. MethylPrednisoLONE: Route = IV or PO, Equivalent Dose = 4 mg
6. PrednisoLONE: Route = PO, Equivalent Dose = 5 mg
7. PredniSONE: Route = PO, Equivalent Dose = 5 mg
8. Triamcinolone: Route = IV, Equivalent Dose = 4 mg 
The mass of Triamcinolone IV is 23.465 mg. 
To convert from the Triamcinolone IV to Betamethasone IV, multiply by the conversion factor, 0.18762 mg Betamethasone IV/Triamcinolone IV, giving us 23.465 mg Triamcinolone IV * 0.18762 mg Betamethasone IV/mg Triamcinolone IV = 4.4025 mg Betamethasone IV. 23.465 mg of Triamcinolone IV is equal to 4.4025 mg of Betamethasone IV."
956,24,Steroid Conversion Calculator,dosage conversion,decimal,8,Template,Patient has taken 260.997 mg of Cortisone PO.,"Based on the patient's dose of Cortisone PO, what is the equivalent dosage in mg of Betamethasone IV?","{'input steroid': ['Cortisone PO', 260.997, 'mg'], 'target steroid': 'Betamethasone IV'}",7.82991,7.43841,8.22141,"The Steroid Conversions providing equivalent doses for various corticosteroids are listed below:
1. Betamethasone: Route = IV, Equivalent Dose = 0.75 mg
2. Cortisone: Route = PO, Equivalent Dose = 25 mg
3. Dexamethasone (Decadron): Route = IV or PO, Equivalent Dose = 0.75 mg
4. Hydrocortisone: Route = IV or PO, Equivalent Dose = 20 mg
5. MethylPrednisoLONE: Route = IV or PO, Equivalent Dose = 4 mg
6. PrednisoLONE: Route = PO, Equivalent Dose = 5 mg
7. PredniSONE: Route = PO, Equivalent Dose = 5 mg
8. Triamcinolone: Route = IV, Equivalent Dose = 4 mg 
The mass of Cortisone PO is 260.997 mg. 
To convert from the Cortisone PO to Betamethasone IV, multiply by the conversion factor, 0.03 mg Betamethasone IV/Cortisone PO, giving us 260.997 mg Cortisone PO * 0.03 mg Betamethasone IV/mg Cortisone PO = 7.82991 mg Betamethasone IV. 260.997 mg of Cortisone PO is equal to 7.82991 mg of Betamethasone IV."
957,24,Steroid Conversion Calculator,dosage conversion,decimal,9,Template,Patient has taken 7.25 mg of Dexamethasone IV.,"Based on the patient's dose of Dexamethasone IV, what is the equivalent dosage in mg of Triamcinolone IV?","{'input steroid': ['Dexamethasone IV', 7.25, 'mg'], 'target steroid': 'Triamcinolone IV'}",38.6425,36.71037,40.57462,"The Steroid Conversions providing equivalent doses for various corticosteroids are listed below:
1. Betamethasone: Route = IV, Equivalent Dose = 0.75 mg
2. Cortisone: Route = PO, Equivalent Dose = 25 mg
3. Dexamethasone (Decadron): Route = IV or PO, Equivalent Dose = 0.75 mg
4. Hydrocortisone: Route = IV or PO, Equivalent Dose = 20 mg
5. MethylPrednisoLONE: Route = IV or PO, Equivalent Dose = 4 mg
6. PrednisoLONE: Route = PO, Equivalent Dose = 5 mg
7. PredniSONE: Route = PO, Equivalent Dose = 5 mg
8. Triamcinolone: Route = IV, Equivalent Dose = 4 mg 
The mass of Dexamethasone IV is 7.25 mg. 
To convert from the Dexamethasone IV to Triamcinolone IV, multiply by the conversion factor, 5.33 mg Triamcinolone IV/Dexamethasone IV, giving us 7.25 mg Dexamethasone IV * 5.33 mg Triamcinolone IV/mg Dexamethasone IV = 38.6425 mg Triamcinolone IV. 7.25 mg of Dexamethasone IV is equal to 38.6425 mg of Triamcinolone IV."
958,24,Steroid Conversion Calculator,dosage conversion,decimal,10,Template,Patient has taken 6.026 mg of MethylPrednisoLONE IV.,"Based on the patient's dose of MethylPrednisoLONE IV, what is the equivalent dosage in mg of PrednisoLONE PO?","{'input steroid': ['MethylPrednisoLONE IV', 6.026, 'mg'], 'target steroid': 'PrednisoLONE PO'}",7.541,7.16395,7.91805,"The Steroid Conversions providing equivalent doses for various corticosteroids are listed below:
1. Betamethasone: Route = IV, Equivalent Dose = 0.75 mg
2. Cortisone: Route = PO, Equivalent Dose = 25 mg
3. Dexamethasone (Decadron): Route = IV or PO, Equivalent Dose = 0.75 mg
4. Hydrocortisone: Route = IV or PO, Equivalent Dose = 20 mg
5. MethylPrednisoLONE: Route = IV or PO, Equivalent Dose = 4 mg
6. PrednisoLONE: Route = PO, Equivalent Dose = 5 mg
7. PredniSONE: Route = PO, Equivalent Dose = 5 mg
8. Triamcinolone: Route = IV, Equivalent Dose = 4 mg 
The mass of MethylPrednisoLONE IV is 6.026 mg. 
To convert from the MethylPrednisoLONE IV to PrednisoLONE PO, multiply by the conversion factor, 1.25141 mg PrednisoLONE PO/MethylPrednisoLONE IV, giving us 6.026 mg MethylPrednisoLONE IV * 1.25141 mg PrednisoLONE PO/mg MethylPrednisoLONE IV = 7.541 mg PrednisoLONE PO. 6.026 mg of MethylPrednisoLONE IV is equal to 7.541 mg of PrednisoLONE PO."
959,24,Steroid Conversion Calculator,dosage conversion,decimal,11,Template,Patient has taken 47.837 mg of MethylPrednisoLONE IV.,"Based on the patient's dose of MethylPrednisoLONE IV, what is the equivalent dosage in mg of PrednisoLONE PO?","{'input steroid': ['MethylPrednisoLONE IV', 47.837, 'mg'], 'target steroid': 'PrednisoLONE PO'}",59.8637,56.87051,62.85689,"The Steroid Conversions providing equivalent doses for various corticosteroids are listed below:
1. Betamethasone: Route = IV, Equivalent Dose = 0.75 mg
2. Cortisone: Route = PO, Equivalent Dose = 25 mg
3. Dexamethasone (Decadron): Route = IV or PO, Equivalent Dose = 0.75 mg
4. Hydrocortisone: Route = IV or PO, Equivalent Dose = 20 mg
5. MethylPrednisoLONE: Route = IV or PO, Equivalent Dose = 4 mg
6. PrednisoLONE: Route = PO, Equivalent Dose = 5 mg
7. PredniSONE: Route = PO, Equivalent Dose = 5 mg
8. Triamcinolone: Route = IV, Equivalent Dose = 4 mg 
The mass of MethylPrednisoLONE IV is 47.837 mg. 
To convert from the MethylPrednisoLONE IV to PrednisoLONE PO, multiply by the conversion factor, 1.25141 mg PrednisoLONE PO/MethylPrednisoLONE IV, giving us 47.837 mg MethylPrednisoLONE IV * 1.25141 mg PrednisoLONE PO/mg MethylPrednisoLONE IV = 59.8637 mg PrednisoLONE PO. 47.837 mg of MethylPrednisoLONE IV is equal to 59.8637 mg of PrednisoLONE PO."
960,24,Steroid Conversion Calculator,dosage conversion,decimal,12,Template,Patient has taken 58.403 mg of PredniSONE PO.,"Based on the patient's dose of PredniSONE PO, what is the equivalent dosage in mg of Hydrocortisone IV?","{'input steroid': ['PredniSONE PO', 58.403, 'mg'], 'target steroid': 'Hydrocortisone IV'}",233.5244,221.84818,245.20062,"The Steroid Conversions providing equivalent doses for various corticosteroids are listed below:
1. Betamethasone: Route = IV, Equivalent Dose = 0.75 mg
2. Cortisone: Route = PO, Equivalent Dose = 25 mg
3. Dexamethasone (Decadron): Route = IV or PO, Equivalent Dose = 0.75 mg
4. Hydrocortisone: Route = IV or PO, Equivalent Dose = 20 mg
5. MethylPrednisoLONE: Route = IV or PO, Equivalent Dose = 4 mg
6. PrednisoLONE: Route = PO, Equivalent Dose = 5 mg
7. PredniSONE: Route = PO, Equivalent Dose = 5 mg
8. Triamcinolone: Route = IV, Equivalent Dose = 4 mg 
The mass of PredniSONE PO is 58.403 mg. 
To convert from the PredniSONE PO to Hydrocortisone IV, multiply by the conversion factor, 3.9985 mg Hydrocortisone IV/PredniSONE PO, giving us 58.403 mg PredniSONE PO * 3.9985 mg Hydrocortisone IV/mg PredniSONE PO = 233.5244 mg Hydrocortisone IV. 58.403 mg of PredniSONE PO is equal to 233.5244 mg of Hydrocortisone IV."
961,24,Steroid Conversion Calculator,dosage conversion,decimal,13,Template,Patient has taken 6.33 mg of Betamethasone IV.,"Based on the patient's dose of Betamethasone IV, what is the equivalent dosage in mg of Cortisone PO?","{'input steroid': ['Betamethasone IV', 6.33, 'mg'], 'target steroid': 'Cortisone PO'}",210.9789,200.42996,221.52785,"The Steroid Conversions providing equivalent doses for various corticosteroids are listed below:
1. Betamethasone: Route = IV, Equivalent Dose = 0.75 mg
2. Cortisone: Route = PO, Equivalent Dose = 25 mg
3. Dexamethasone (Decadron): Route = IV or PO, Equivalent Dose = 0.75 mg
4. Hydrocortisone: Route = IV or PO, Equivalent Dose = 20 mg
5. MethylPrednisoLONE: Route = IV or PO, Equivalent Dose = 4 mg
6. PrednisoLONE: Route = PO, Equivalent Dose = 5 mg
7. PredniSONE: Route = PO, Equivalent Dose = 5 mg
8. Triamcinolone: Route = IV, Equivalent Dose = 4 mg 
The mass of Betamethasone IV is 6.33 mg. 
To convert from the Betamethasone IV to Cortisone PO, multiply by the conversion factor, 33.33 mg Cortisone PO/Betamethasone IV, giving us 6.33 mg Betamethasone IV * 33.33 mg Cortisone PO/mg Betamethasone IV = 210.9789 mg Cortisone PO. 6.33 mg of Betamethasone IV is equal to 210.9789 mg of Cortisone PO."
962,24,Steroid Conversion Calculator,dosage conversion,decimal,14,Template,Patient has taken 47.069 mg of PredniSONE PO.,"Based on the patient's dose of PredniSONE PO, what is the equivalent dosage in mg of Hydrocortisone IV?","{'input steroid': ['PredniSONE PO', 47.069, 'mg'], 'target steroid': 'Hydrocortisone IV'}",188.2054,178.79513,197.61567,"The Steroid Conversions providing equivalent doses for various corticosteroids are listed below:
1. Betamethasone: Route = IV, Equivalent Dose = 0.75 mg
2. Cortisone: Route = PO, Equivalent Dose = 25 mg
3. Dexamethasone (Decadron): Route = IV or PO, Equivalent Dose = 0.75 mg
4. Hydrocortisone: Route = IV or PO, Equivalent Dose = 20 mg
5. MethylPrednisoLONE: Route = IV or PO, Equivalent Dose = 4 mg
6. PrednisoLONE: Route = PO, Equivalent Dose = 5 mg
7. PredniSONE: Route = PO, Equivalent Dose = 5 mg
8. Triamcinolone: Route = IV, Equivalent Dose = 4 mg 
The mass of PredniSONE PO is 47.069 mg. 
To convert from the PredniSONE PO to Hydrocortisone IV, multiply by the conversion factor, 3.9985 mg Hydrocortisone IV/PredniSONE PO, giving us 47.069 mg PredniSONE PO * 3.9985 mg Hydrocortisone IV/mg PredniSONE PO = 188.2054 mg Hydrocortisone IV. 47.069 mg of PredniSONE PO is equal to 188.2054 mg of Hydrocortisone IV."
963,24,Steroid Conversion Calculator,dosage conversion,decimal,15,Template,Patient has taken 81.868 mg of Hydrocortisone PO.,"Based on the patient's dose of Hydrocortisone PO, what is the equivalent dosage in mg of Cortisone PO?","{'input steroid': ['Hydrocortisone PO', 81.868, 'mg'], 'target steroid': 'Cortisone PO'}",102.31208,97.19648,107.42768,"The Steroid Conversions providing equivalent doses for various corticosteroids are listed below:
1. Betamethasone: Route = IV, Equivalent Dose = 0.75 mg
2. Cortisone: Route = PO, Equivalent Dose = 25 mg
3. Dexamethasone (Decadron): Route = IV or PO, Equivalent Dose = 0.75 mg
4. Hydrocortisone: Route = IV or PO, Equivalent Dose = 20 mg
5. MethylPrednisoLONE: Route = IV or PO, Equivalent Dose = 4 mg
6. PrednisoLONE: Route = PO, Equivalent Dose = 5 mg
7. PredniSONE: Route = PO, Equivalent Dose = 5 mg
8. Triamcinolone: Route = IV, Equivalent Dose = 4 mg 
The mass of Hydrocortisone PO is 81.868 mg. 
To convert from the Hydrocortisone PO to Cortisone PO, multiply by the conversion factor, 1.24972 mg Cortisone PO/Hydrocortisone PO, giving us 81.868 mg Hydrocortisone PO * 1.24972 mg Cortisone PO/mg Hydrocortisone PO = 102.31208 mg Cortisone PO. 81.868 mg of Hydrocortisone PO is equal to 102.31208 mg of Cortisone PO."
964,24,Steroid Conversion Calculator,dosage conversion,decimal,16,Template,Patient has taken 0.63 mg of Dexamethasone IV.,"Based on the patient's dose of Dexamethasone IV, what is the equivalent dosage in mg of MethylPrednisoLONE PO?","{'input steroid': ['Dexamethasone IV', 0.63, 'mg'], 'target steroid': 'MethylPrednisoLONE PO'}",3.3579,3.19,3.5258,"The Steroid Conversions providing equivalent doses for various corticosteroids are listed below:
1. Betamethasone: Route = IV, Equivalent Dose = 0.75 mg
2. Cortisone: Route = PO, Equivalent Dose = 25 mg
3. Dexamethasone (Decadron): Route = IV or PO, Equivalent Dose = 0.75 mg
4. Hydrocortisone: Route = IV or PO, Equivalent Dose = 20 mg
5. MethylPrednisoLONE: Route = IV or PO, Equivalent Dose = 4 mg
6. PrednisoLONE: Route = PO, Equivalent Dose = 5 mg
7. PredniSONE: Route = PO, Equivalent Dose = 5 mg
8. Triamcinolone: Route = IV, Equivalent Dose = 4 mg 
The mass of Dexamethasone IV is 0.63 mg. 
To convert from the Dexamethasone IV to MethylPrednisoLONE PO, multiply by the conversion factor, 5.33 mg MethylPrednisoLONE PO/Dexamethasone IV, giving us 0.63 mg Dexamethasone IV * 5.33 mg MethylPrednisoLONE PO/mg Dexamethasone IV = 3.3579 mg MethylPrednisoLONE PO. 0.63 mg of Dexamethasone IV is equal to 3.3579 mg of MethylPrednisoLONE PO."
965,24,Steroid Conversion Calculator,dosage conversion,decimal,17,Template,Patient has taken 186.669 mg of Hydrocortisone IV.,"Based on the patient's dose of Hydrocortisone IV, what is the equivalent dosage in mg of PredniSONE PO?","{'input steroid': ['Hydrocortisone IV', 186.669, 'mg'], 'target steroid': 'PredniSONE PO'}",46.68405,44.34985,49.01825,"The Steroid Conversions providing equivalent doses for various corticosteroids are listed below:
1. Betamethasone: Route = IV, Equivalent Dose = 0.75 mg
2. Cortisone: Route = PO, Equivalent Dose = 25 mg
3. Dexamethasone (Decadron): Route = IV or PO, Equivalent Dose = 0.75 mg
4. Hydrocortisone: Route = IV or PO, Equivalent Dose = 20 mg
5. MethylPrednisoLONE: Route = IV or PO, Equivalent Dose = 4 mg
6. PrednisoLONE: Route = PO, Equivalent Dose = 5 mg
7. PredniSONE: Route = PO, Equivalent Dose = 5 mg
8. Triamcinolone: Route = IV, Equivalent Dose = 4 mg 
The mass of Hydrocortisone IV is 186.669 mg. 
To convert from the Hydrocortisone IV to PredniSONE PO, multiply by the conversion factor, 0.25009 mg PredniSONE PO/Hydrocortisone IV, giving us 186.669 mg Hydrocortisone IV * 0.25009 mg PredniSONE PO/mg Hydrocortisone IV = 46.68405 mg PredniSONE PO. 186.669 mg of Hydrocortisone IV is equal to 46.68405 mg of PredniSONE PO."
966,24,Steroid Conversion Calculator,dosage conversion,decimal,18,Template,Patient has taken 52.736 mg of PredniSONE PO.,"Based on the patient's dose of PredniSONE PO, what is the equivalent dosage in mg of Cortisone PO?","{'input steroid': ['PredniSONE PO', 52.736, 'mg'], 'target steroid': 'Cortisone PO'}",263.52179,250.3457,276.69788,"The Steroid Conversions providing equivalent doses for various corticosteroids are listed below:
1. Betamethasone: Route = IV, Equivalent Dose = 0.75 mg
2. Cortisone: Route = PO, Equivalent Dose = 25 mg
3. Dexamethasone (Decadron): Route = IV or PO, Equivalent Dose = 0.75 mg
4. Hydrocortisone: Route = IV or PO, Equivalent Dose = 20 mg
5. MethylPrednisoLONE: Route = IV or PO, Equivalent Dose = 4 mg
6. PrednisoLONE: Route = PO, Equivalent Dose = 5 mg
7. PredniSONE: Route = PO, Equivalent Dose = 5 mg
8. Triamcinolone: Route = IV, Equivalent Dose = 4 mg 
The mass of PredniSONE PO is 52.736 mg. 
To convert from the PredniSONE PO to Cortisone PO, multiply by the conversion factor, 4.997 mg Cortisone PO/PredniSONE PO, giving us 52.736 mg PredniSONE PO * 4.997 mg Cortisone PO/mg PredniSONE PO = 263.52179 mg Cortisone PO. 52.736 mg of PredniSONE PO is equal to 263.52179 mg of Cortisone PO."
967,24,Steroid Conversion Calculator,dosage conversion,decimal,19,Template,Patient has taken 152.535 mg of Hydrocortisone IV.,"Based on the patient's dose of Hydrocortisone IV, what is the equivalent dosage in mg of PredniSONE PO?","{'input steroid': ['Hydrocortisone IV', 152.535, 'mg'], 'target steroid': 'PredniSONE PO'}",38.14748,36.24011,40.05485,"The Steroid Conversions providing equivalent doses for various corticosteroids are listed below:
1. Betamethasone: Route = IV, Equivalent Dose = 0.75 mg
2. Cortisone: Route = PO, Equivalent Dose = 25 mg
3. Dexamethasone (Decadron): Route = IV or PO, Equivalent Dose = 0.75 mg
4. Hydrocortisone: Route = IV or PO, Equivalent Dose = 20 mg
5. MethylPrednisoLONE: Route = IV or PO, Equivalent Dose = 4 mg
6. PrednisoLONE: Route = PO, Equivalent Dose = 5 mg
7. PredniSONE: Route = PO, Equivalent Dose = 5 mg
8. Triamcinolone: Route = IV, Equivalent Dose = 4 mg 
The mass of Hydrocortisone IV is 152.535 mg. 
To convert from the Hydrocortisone IV to PredniSONE PO, multiply by the conversion factor, 0.25009 mg PredniSONE PO/Hydrocortisone IV, giving us 152.535 mg Hydrocortisone IV * 0.25009 mg PredniSONE PO/mg Hydrocortisone IV = 38.14748 mg PredniSONE PO. 152.535 mg of Hydrocortisone IV is equal to 38.14748 mg of PredniSONE PO."
968,24,Steroid Conversion Calculator,dosage conversion,decimal,20,Template,Patient has taken 7.01 mg of Dexamethasone IV.,"Based on the patient's dose of Dexamethasone IV, what is the equivalent dosage in mg of Hydrocortisone PO?","{'input steroid': ['Dexamethasone IV', 7.01, 'mg'], 'target steroid': 'Hydrocortisone PO'}",186.9567,177.60887,196.30454,"The Steroid Conversions providing equivalent doses for various corticosteroids are listed below:
1. Betamethasone: Route = IV, Equivalent Dose = 0.75 mg
2. Cortisone: Route = PO, Equivalent Dose = 25 mg
3. Dexamethasone (Decadron): Route = IV or PO, Equivalent Dose = 0.75 mg
4. Hydrocortisone: Route = IV or PO, Equivalent Dose = 20 mg
5. MethylPrednisoLONE: Route = IV or PO, Equivalent Dose = 4 mg
6. PrednisoLONE: Route = PO, Equivalent Dose = 5 mg
7. PredniSONE: Route = PO, Equivalent Dose = 5 mg
8. Triamcinolone: Route = IV, Equivalent Dose = 4 mg 
The mass of Dexamethasone IV is 7.01 mg. 
To convert from the Dexamethasone IV to Hydrocortisone PO, multiply by the conversion factor, 26.67 mg Hydrocortisone PO/Dexamethasone IV, giving us 7.01 mg Dexamethasone IV * 26.67 mg Hydrocortisone PO/mg Dexamethasone IV = 186.9567 mg Hydrocortisone PO. 7.01 mg of Dexamethasone IV is equal to 186.9567 mg of Hydrocortisone PO."
969,61,Target weight,physical,decimal,1,Template,Patient has a height of 196 cm and their target BMI is 19.2 kg/m^2.,"Based on the patient's height and target BMI, what is the patient's target weight in kg?","{'Body Mass Index (BMI)': [19.2, 'kg/m^2'], 'height': [196, 'cm']}",73.75872,70.07078,77.44666,"The formula for calculating the target weight is bmi * height^2, where bmi is in kg/m^2 and height is in meters. The patient's target bmi is 19.2 kg/m^2. The patient's height is 196 cm, which is 196 cm * 1 m / 100 cm = 1.96 m. From this, the patient's target weight is 19.2 kg/m^2 * 1.96 m * 1.96 m = 73.75872 kg. "
970,61,Target weight,physical,decimal,2,Template,Patient has a height of 169 cm and their target BMI is 24.1 kg/m^2.,"Based on the patient's height and target BMI, what is the patient's target weight in kg?","{'Body Mass Index (BMI)': [24.1, 'kg/m^2'], 'height': [169, 'cm']}",68.83201,65.39041,72.27361,"The formula for calculating the target weight is bmi * height^2, where bmi is in kg/m^2 and height is in meters. The patient's target bmi is 24.1 kg/m^2. The patient's height is 169 cm, which is 169 cm * 1 m / 100 cm = 1.69 m. From this, the patient's target weight is 24.1 kg/m^2 * 1.69 m * 1.69 m = 68.83201 kg. "
971,61,Target weight,physical,decimal,3,Template,Patient has a height of 194 cm and their target BMI is 20.7 kg/m^2.,"Based on the patient's height and target BMI, what is the patient's target weight in kg?","{'Body Mass Index (BMI)': [20.7, 'kg/m^2'], 'height': [194, 'cm']}",77.90652,74.01119,81.80185,"The formula for calculating the target weight is bmi * height^2, where bmi is in kg/m^2 and height is in meters. The patient's target bmi is 20.7 kg/m^2. The patient's height is 194 cm, which is 194 cm * 1 m / 100 cm = 1.94 m. From this, the patient's target weight is 20.7 kg/m^2 * 1.94 m * 1.94 m = 77.90652 kg. "
972,61,Target weight,physical,decimal,4,Template,Patient has a height of 1.99 m and their target BMI is 24.5 kg/m^2.,"Based on the patient's height and target BMI, what is the patient's target weight in kg?","{'Body Mass Index (BMI)': [24.5, 'kg/m^2'], 'height': [1.99, 'm']}",97.02245,92.17133,101.87357,"The formula for calculating the target weight is bmi * height^2, where bmi is in kg/m^2 and height is in meters. The patient's target bmi is 24.5 kg/m^2. The patient's height is 1.99 m. From this, the patient's target weight is 24.5 kg/m^2 * 1.99 m * 1.99 m = 97.02245 kg. "
973,61,Target weight,physical,decimal,5,Template,Patient has a height of 1.87 m and their target BMI is 21.0 kg/m^2.,"Based on the patient's height and target BMI, what is the patient's target weight in kg?","{'Body Mass Index (BMI)': [21.0, 'kg/m^2'], 'height': [1.87, 'm']}",73.4349,69.76315,77.10665,"The formula for calculating the target weight is bmi * height^2, where bmi is in kg/m^2 and height is in meters. The patient's target bmi is 21.0 kg/m^2. The patient's height is 1.87 m. From this, the patient's target weight is 21.0 kg/m^2 * 1.87 m * 1.87 m = 73.4349 kg. "
974,61,Target weight,physical,decimal,6,Template,Patient has a height of 78 in and their target BMI is 22.6 kg/m^2.,"Based on the patient's height and target BMI, what is the patient's target weight in kg?","{'Body Mass Index (BMI)': [22.6, 'kg/m^2'], 'height': [78, 'in']}",88.70847,84.27305,93.14389,"The formula for calculating the target weight is bmi * height^2, where bmi is in kg/m^2 and height is in meters. The patient's target bmi is 22.6 kg/m^2. The patient's height is 78 in, which is 78 in * 0.0254 m / in = 1.9812 m. From this, the patient's target weight is 22.6 kg/m^2 * 1.9812 m * 1.9812 m = 88.70847 kg. "
975,61,Target weight,physical,decimal,7,Template,Patient has a height of 169 cm and their target BMI is 20.1 kg/m^2.,"Based on the patient's height and target BMI, what is the patient's target weight in kg?","{'Body Mass Index (BMI)': [20.1, 'kg/m^2'], 'height': [169, 'cm']}",57.40761,54.53723,60.27799,"The formula for calculating the target weight is bmi * height^2, where bmi is in kg/m^2 and height is in meters. The patient's target bmi is 20.1 kg/m^2. The patient's height is 169 cm, which is 169 cm * 1 m / 100 cm = 1.69 m. From this, the patient's target weight is 20.1 kg/m^2 * 1.69 m * 1.69 m = 57.40761 kg. "
976,61,Target weight,physical,decimal,8,Template,Patient has a height of 78 in and their target BMI is 23.2 kg/m^2.,"Based on the patient's height and target BMI, what is the patient's target weight in kg?","{'Body Mass Index (BMI)': [23.2, 'kg/m^2'], 'height': [78, 'in']}",91.06356,86.51038,95.61674,"The formula for calculating the target weight is bmi * height^2, where bmi is in kg/m^2 and height is in meters. The patient's target bmi is 23.2 kg/m^2. The patient's height is 78 in, which is 78 in * 0.0254 m / in = 1.9812 m. From this, the patient's target weight is 23.2 kg/m^2 * 1.9812 m * 1.9812 m = 91.06356 kg. "
977,61,Target weight,physical,decimal,9,Template,Patient has a height of 1.44 m and their target BMI is 18.4 kg/m^2.,"Based on the patient's height and target BMI, what is the patient's target weight in kg?","{'Body Mass Index (BMI)': [18.4, 'kg/m^2'], 'height': [1.44, 'm']}",38.15424,36.24653,40.06195,"The formula for calculating the target weight is bmi * height^2, where bmi is in kg/m^2 and height is in meters. The patient's target bmi is 18.4 kg/m^2. The patient's height is 1.44 m. From this, the patient's target weight is 18.4 kg/m^2 * 1.44 m * 1.44 m = 38.15424 kg. "
978,61,Target weight,physical,decimal,10,Template,Patient has a height of 69 in and their target BMI is 24.4 kg/m^2.,"Based on the patient's height and target BMI, what is the patient's target weight in kg?","{'Body Mass Index (BMI)': [24.4, 'kg/m^2'], 'height': [69, 'in']}",74.9472,71.19984,78.69456,"The formula for calculating the target weight is bmi * height^2, where bmi is in kg/m^2 and height is in meters. The patient's target bmi is 24.4 kg/m^2. The patient's height is 69 in, which is 69 in * 0.0254 m / in = 1.7526 m. From this, the patient's target weight is 24.4 kg/m^2 * 1.7526 m * 1.7526 m = 74.9472 kg. "
979,61,Target weight,physical,decimal,11,Template,Patient has a height of 172 cm and their target BMI is 24.7 kg/m^2.,"Based on the patient's height and target BMI, what is the patient's target weight in kg?","{'Body Mass Index (BMI)': [24.7, 'kg/m^2'], 'height': [172, 'cm']}",73.07248,69.41886,76.7261,"The formula for calculating the target weight is bmi * height^2, where bmi is in kg/m^2 and height is in meters. The patient's target bmi is 24.7 kg/m^2. The patient's height is 172 cm, which is 172 cm * 1 m / 100 cm = 1.72 m. From this, the patient's target weight is 24.7 kg/m^2 * 1.72 m * 1.72 m = 73.07248 kg. "
980,61,Target weight,physical,decimal,12,Template,Patient has a height of 145 cm and their target BMI is 18.5 kg/m^2.,"Based on the patient's height and target BMI, what is the patient's target weight in kg?","{'Body Mass Index (BMI)': [18.5, 'kg/m^2'], 'height': [145, 'cm']}",38.89625,36.95144,40.84106,"The formula for calculating the target weight is bmi * height^2, where bmi is in kg/m^2 and height is in meters. The patient's target bmi is 18.5 kg/m^2. The patient's height is 145 cm, which is 145 cm * 1 m / 100 cm = 1.45 m. From this, the patient's target weight is 18.5 kg/m^2 * 1.45 m * 1.45 m = 38.89625 kg. "
981,61,Target weight,physical,decimal,13,Template,Patient has a height of 144 cm and their target BMI is 20.8 kg/m^2.,"Based on the patient's height and target BMI, what is the patient's target weight in kg?","{'Body Mass Index (BMI)': [20.8, 'kg/m^2'], 'height': [144, 'cm']}",43.13088,40.97434,45.28742,"The formula for calculating the target weight is bmi * height^2, where bmi is in kg/m^2 and height is in meters. The patient's target bmi is 20.8 kg/m^2. The patient's height is 144 cm, which is 144 cm * 1 m / 100 cm = 1.44 m. From this, the patient's target weight is 20.8 kg/m^2 * 1.44 m * 1.44 m = 43.13088 kg. "
982,61,Target weight,physical,decimal,14,Template,Patient has a height of 77 in and their target BMI is 19.7 kg/m^2.,"Based on the patient's height and target BMI, what is the patient's target weight in kg?","{'Body Mass Index (BMI)': [19.7, 'kg/m^2'], 'height': [77, 'in']}",75.35553,71.58775,79.12331,"The formula for calculating the target weight is bmi * height^2, where bmi is in kg/m^2 and height is in meters. The patient's target bmi is 19.7 kg/m^2. The patient's height is 77 in, which is 77 in * 0.0254 m / in = 1.9558 m. From this, the patient's target weight is 19.7 kg/m^2 * 1.9558 m * 1.9558 m = 75.35553 kg. "
983,61,Target weight,physical,decimal,15,Template,Patient has a height of 69 in and their target BMI is 18.6 kg/m^2.,"Based on the patient's height and target BMI, what is the patient's target weight in kg?","{'Body Mass Index (BMI)': [18.6, 'kg/m^2'], 'height': [69, 'in']}",57.13189,54.2753,59.98848,"The formula for calculating the target weight is bmi * height^2, where bmi is in kg/m^2 and height is in meters. The patient's target bmi is 18.6 kg/m^2. The patient's height is 69 in, which is 69 in * 0.0254 m / in = 1.7526 m. From this, the patient's target weight is 18.6 kg/m^2 * 1.7526 m * 1.7526 m = 57.13189 kg. "
984,61,Target weight,physical,decimal,16,Template,Patient has a height of 70 in and their target BMI is 21.7 kg/m^2.,"Based on the patient's height and target BMI, what is the patient's target weight in kg?","{'Body Mass Index (BMI)': [21.7, 'kg/m^2'], 'height': [70, 'in']}",68.59986,65.16987,72.02985,"The formula for calculating the target weight is bmi * height^2, where bmi is in kg/m^2 and height is in meters. The patient's target bmi is 21.7 kg/m^2. The patient's height is 70 in, which is 70 in * 0.0254 m / in = 1.778 m. From this, the patient's target weight is 21.7 kg/m^2 * 1.778 m * 1.778 m = 68.59986 kg. "
985,61,Target weight,physical,decimal,17,Template,Patient has a height of 196 cm and their target BMI is 22.7 kg/m^2.,"Based on the patient's height and target BMI, what is the patient's target weight in kg?","{'Body Mass Index (BMI)': [22.7, 'kg/m^2'], 'height': [196, 'cm']}",87.20432,82.8441,91.56454,"The formula for calculating the target weight is bmi * height^2, where bmi is in kg/m^2 and height is in meters. The patient's target bmi is 22.7 kg/m^2. The patient's height is 196 cm, which is 196 cm * 1 m / 100 cm = 1.96 m. From this, the patient's target weight is 22.7 kg/m^2 * 1.96 m * 1.96 m = 87.20432 kg. "
986,61,Target weight,physical,decimal,18,Template,Patient has a height of 1.59 m and their target BMI is 20.8 kg/m^2.,"Based on the patient's height and target BMI, what is the patient's target weight in kg?","{'Body Mass Index (BMI)': [20.8, 'kg/m^2'], 'height': [1.59, 'm']}",52.58448,49.95526,55.2137,"The formula for calculating the target weight is bmi * height^2, where bmi is in kg/m^2 and height is in meters. The patient's target bmi is 20.8 kg/m^2. The patient's height is 1.59 m. From this, the patient's target weight is 20.8 kg/m^2 * 1.59 m * 1.59 m = 52.58448 kg. "
987,61,Target weight,physical,decimal,19,Template,Patient has a height of 1.8 m and their target BMI is 21.2 kg/m^2.,"Based on the patient's height and target BMI, what is the patient's target weight in kg?","{'Body Mass Index (BMI)': [21.2, 'kg/m^2'], 'height': [1.8, 'm']}",68.688,65.2536,72.1224,"The formula for calculating the target weight is bmi * height^2, where bmi is in kg/m^2 and height is in meters. The patient's target bmi is 21.2 kg/m^2. The patient's height is 1.8 m. From this, the patient's target weight is 21.2 kg/m^2 * 1.8 m * 1.8 m = 68.688 kg. "
988,61,Target weight,physical,decimal,20,Template,Patient has a height of 196 cm and their target BMI is 18.1 kg/m^2.,"Based on the patient's height and target BMI, what is the patient's target weight in kg?","{'Body Mass Index (BMI)': [18.1, 'kg/m^2'], 'height': [196, 'cm']}",69.53296,66.05631,73.00961,"The formula for calculating the target weight is bmi * height^2, where bmi is in kg/m^2 and height is in meters. The patient's target bmi is 18.1 kg/m^2. The patient's height is 196 cm, which is 196 cm * 1 m / 100 cm = 1.96 m. From this, the patient's target weight is 18.1 kg/m^2 * 1.96 m * 1.96 m = 69.53296 kg. "
989,49,Morphine Milligram Equivalents (MME) Calculator,dosage conversion,decimal,1,Template,A patient takes 10 mg of Methadone 3 times a day and 20 mg of Tapentadol 1 time a day.,"Based on the number of doses per day and the quantity of different doses, what is the patient's daily Morphine Miligram Equivalents (MME)?","{'Methadone Dose': [10, 'mg'], 'Methadone Dose Per Day': [3, 'per day'], 'Tapentadol Dose': [20, 'mg'], 'Tapentadol Dose Per Day': [1, 'per day']}",149,141.55,156.45,"The Opioid Conversion Table with MME (Morphine Milligram Equivalent) conversion factors are listed below:
1. Codeine: MME conversion factor = 0.15
2. FentaNYL buccal: MME conversion factor = 0.13
3. HYDROcodone: MME conversion factor = 1
4. HYDROmorphone: MME conversion factor = 5
5. Methadone: MME conversion factor = 4.7
6. Morphine: MME conversion factor = 1
7. OxyCODONE: MME conversion factor = 1.5
8. OxyMORphone: MME conversion factor = 3
9. Tapentadol: MME conversion factor = 0.4
10. TraMADol: MME conversion factor = 0.2
11. Buprenorphine: MME conversion factor = 10

The curent Morphine Milligram Equivalents (MME) is 0 MME per day.
The patient's dose of Methadone is 10 mg. The patient takes 3 doses/day of Methadone. This means that the patient takes 10 mg/dose Methadone * 3 dose/day = 30 mg/day. To convert to mme/day of Methadone, multiply the 30 mg/day by the mme conversion factor, 4.7 mme/mg, giving us 141.0 mme/day. Adding the mme/day of Methadone to the total mme/day gives us 0 + 141.0 = 141.0 mme/day.
The patient's dose of Tapentadol is 20 mg. The patient takes 1 doses/day of Tapentadol. This means that the patient takes 20 mg/dose Tapentadol * 1 dose/day = 20 mg/day. To convert to mme/day of Tapentadol, multiply the 20 mg/day by the mme conversion factor, 0.4 mme/mg, giving us 8.0 mme/day. Adding the mme/day of Tapentadol to the total mme/day gives us 141.0 + 8.0 = 149.0 mme/day.
The patient's mme/day is 149.0 mme/day."
990,49,Morphine Milligram Equivalents (MME) Calculator,dosage conversion,decimal,2,Template,"A patient takes 20 mg of FentaNYL buccal 2 times a day, 20 mg of HYDROmorphone 3 times a day, and 10 mg of Morphine 3 times a day.","Based on the number of doses per day and the quantity of different doses, what is the patient's daily Morphine Miligram Equivalents (MME)?","{'FentaNYL buccal Dose': [20, 'µg'], 'FentaNYL buccal Dose Per Day': [2, 'per day'], 'HYDROmorphone Dose': [20, 'mg'], 'HYDROmorphone Dose Per Day': [3, 'per day'], 'Morphine Dose': [10, 'mg'], 'Morphine Dose Per Day': [3, 'per day']}",335.2,318.44,351.96,"The Opioid Conversion Table with MME (Morphine Milligram Equivalent) conversion factors are listed below:
1. Codeine: MME conversion factor = 0.15
2. FentaNYL buccal: MME conversion factor = 0.13
3. HYDROcodone: MME conversion factor = 1
4. HYDROmorphone: MME conversion factor = 5
5. Methadone: MME conversion factor = 4.7
6. Morphine: MME conversion factor = 1
7. OxyCODONE: MME conversion factor = 1.5
8. OxyMORphone: MME conversion factor = 3
9. Tapentadol: MME conversion factor = 0.4
10. TraMADol: MME conversion factor = 0.2
11. Buprenorphine: MME conversion factor = 10

The curent Morphine Milligram Equivalents (MME) is 0 MME per day.
The patient's dose of FentaNYL buccal is 20 µg.
The patient takes 2 doses/day of FentaNYL buccal. This means that the patient takes 20 µg/dose FentaNYL buccal * 2 dose/day = 40 µg/day. To convert to mme/day of FentaNYL buccal, multiply the 40 µg/day by the mme conversion factor, 0.13 mme/µg, giving us 5.2 mme/day. Adding the mme/day of FentaNYL buccal to the total mme/day gives us 0 + 5.2 = 5.2 mme/day.
The patient's dose of HYDROmorphone is 20 mg. The patient takes 3 doses/day of HYDROmorphone. This means that the patient takes 20 mg/dose HYDROmorphone * 3 dose/day = 60 mg/day. To convert to mme/day of HYDROmorphone, multiply the 60 mg/day by the mme conversion factor, 5 mme/mg, giving us 300 mme/day. Adding the mme/day of HYDROmorphone to the total mme/day gives us 5.2 + 300 = 305.2 mme/day.
The patient's dose of Morphine is 10 mg. The patient takes 3 doses/day of Morphine. This means that the patient takes 10 mg/dose Morphine * 3 dose/day = 30 mg/day. To convert to mme/day of Morphine, multiply the 30 mg/day by the mme conversion factor, 1 mme/mg, giving us 30 mme/day. Adding the mme/day of Morphine to the total mme/day gives us 305.2 + 30 = 335.2 mme/day.
The patient's mme/day is 335.2 mme/day."
991,49,Morphine Milligram Equivalents (MME) Calculator,dosage conversion,decimal,3,Template,"A patient takes 30 mg of Methadone 3 times a day, 30 mg of Tapentadol 1 time a day, and 20 mg of Codeine 3 times a day.","Based on the number of doses per day and the quantity of different doses, what is the patient's daily Morphine Miligram Equivalents (MME)?","{'Methadone Dose': [30, 'mg'], 'Methadone Dose Per Day': [3, 'per day'], 'Tapentadol Dose': [30, 'mg'], 'Tapentadol Dose Per Day': [1, 'per day'], 'Codeine Dose': [20, 'mg'], 'Codeine Dose Per Day': [3, 'per day']}",444,421.8,466.2,"The Opioid Conversion Table with MME (Morphine Milligram Equivalent) conversion factors are listed below:
1. Codeine: MME conversion factor = 0.15
2. FentaNYL buccal: MME conversion factor = 0.13
3. HYDROcodone: MME conversion factor = 1
4. HYDROmorphone: MME conversion factor = 5
5. Methadone: MME conversion factor = 4.7
6. Morphine: MME conversion factor = 1
7. OxyCODONE: MME conversion factor = 1.5
8. OxyMORphone: MME conversion factor = 3
9. Tapentadol: MME conversion factor = 0.4
10. TraMADol: MME conversion factor = 0.2
11. Buprenorphine: MME conversion factor = 10

The curent Morphine Milligram Equivalents (MME) is 0 MME per day.
The patient's dose of Methadone is 30 mg. The patient takes 3 doses/day of Methadone. This means that the patient takes 30 mg/dose Methadone * 3 dose/day = 90 mg/day. To convert to mme/day of Methadone, multiply the 90 mg/day by the mme conversion factor, 4.7 mme/mg, giving us 423.0 mme/day. Adding the mme/day of Methadone to the total mme/day gives us 0 + 423.0 = 423.0 mme/day.
The patient's dose of Tapentadol is 30 mg. The patient takes 1 doses/day of Tapentadol. This means that the patient takes 30 mg/dose Tapentadol * 1 dose/day = 30 mg/day. To convert to mme/day of Tapentadol, multiply the 30 mg/day by the mme conversion factor, 0.4 mme/mg, giving us 12.0 mme/day. Adding the mme/day of Tapentadol to the total mme/day gives us 423.0 + 12.0 = 435.0 mme/day.
The patient's dose of Codeine is 20 mg. The patient takes 3 doses/day of Codeine. This means that the patient takes 20 mg/dose Codeine * 3 dose/day = 60 mg/day. To convert to mme/day of Codeine, multiply the 60 mg/day by the mme conversion factor, 0.15 mme/mg, giving us 9.0 mme/day. Adding the mme/day of Codeine to the total mme/day gives us 435.0 + 9.0 = 444.0 mme/day.
The patient's mme/day is 444.0 mme/day."
992,49,Morphine Milligram Equivalents (MME) Calculator,dosage conversion,decimal,4,Template,A patient takes 30 mg of Methadone 2 times a day.,"Based on the number of doses per day and the quantity of different doses, what is the patient's daily Morphine Miligram Equivalents (MME)?","{'Methadone Dose': [30, 'mg'], 'Methadone Dose Per Day': [2, 'per day']}",282,267.9,296.1,"The Opioid Conversion Table with MME (Morphine Milligram Equivalent) conversion factors are listed below:
1. Codeine: MME conversion factor = 0.15
2. FentaNYL buccal: MME conversion factor = 0.13
3. HYDROcodone: MME conversion factor = 1
4. HYDROmorphone: MME conversion factor = 5
5. Methadone: MME conversion factor = 4.7
6. Morphine: MME conversion factor = 1
7. OxyCODONE: MME conversion factor = 1.5
8. OxyMORphone: MME conversion factor = 3
9. Tapentadol: MME conversion factor = 0.4
10. TraMADol: MME conversion factor = 0.2
11. Buprenorphine: MME conversion factor = 10

The curent Morphine Milligram Equivalents (MME) is 0 MME per day.
The patient's dose of Methadone is 30 mg. The patient takes 2 doses/day of Methadone. This means that the patient takes 30 mg/dose Methadone * 2 dose/day = 60 mg/day. To convert to mme/day of Methadone, multiply the 60 mg/day by the mme conversion factor, 4.7 mme/mg, giving us 282.0 mme/day. Adding the mme/day of Methadone to the total mme/day gives us 0 + 282.0 = 282.0 mme/day.
The patient's mme/day is 282.0 mme/day."
993,49,Morphine Milligram Equivalents (MME) Calculator,dosage conversion,decimal,5,Template,"A patient takes 20 mg of TraMADol 3 times a day, 20 mg of Methadone 2 times a day, and 20 mg of FentaNYL buccal 3 times a day.","Based on the number of doses per day and the quantity of different doses, what is the patient's daily Morphine Miligram Equivalents (MME)?","{'TraMADol Dose': [20, 'mg'], 'TraMADol Dose Per Day': [3, 'per day'], 'Methadone Dose': [20, 'mg'], 'Methadone Dose Per Day': [2, 'per day'], 'FentaNYL buccal Dose': [20, 'µg'], 'FentaNYL buccal Dose Per Day': [3, 'per day']}",207.8,197.41,218.19,"The Opioid Conversion Table with MME (Morphine Milligram Equivalent) conversion factors are listed below:
1. Codeine: MME conversion factor = 0.15
2. FentaNYL buccal: MME conversion factor = 0.13
3. HYDROcodone: MME conversion factor = 1
4. HYDROmorphone: MME conversion factor = 5
5. Methadone: MME conversion factor = 4.7
6. Morphine: MME conversion factor = 1
7. OxyCODONE: MME conversion factor = 1.5
8. OxyMORphone: MME conversion factor = 3
9. Tapentadol: MME conversion factor = 0.4
10. TraMADol: MME conversion factor = 0.2
11. Buprenorphine: MME conversion factor = 10

The curent Morphine Milligram Equivalents (MME) is 0 MME per day.
The patient's dose of TraMADol is 20 mg. The patient takes 3 doses/day of TraMADol. This means that the patient takes 20 mg/dose TraMADol * 3 dose/day = 60 mg/day. To convert to mme/day of TraMADol, multiply the 60 mg/day by the mme conversion factor, 0.2 mme/mg, giving us 12.0 mme/day. Adding the mme/day of TraMADol to the total mme/day gives us 0 + 12.0 = 12.0 mme/day.
The patient's dose of Methadone is 20 mg. The patient takes 2 doses/day of Methadone. This means that the patient takes 20 mg/dose Methadone * 2 dose/day = 40 mg/day. To convert to mme/day of Methadone, multiply the 40 mg/day by the mme conversion factor, 4.7 mme/mg, giving us 188.0 mme/day. Adding the mme/day of Methadone to the total mme/day gives us 12.0 + 188.0 = 200.0 mme/day.
The patient's dose of FentaNYL buccal is 20 µg.
The patient takes 3 doses/day of FentaNYL buccal. This means that the patient takes 20 µg/dose FentaNYL buccal * 3 dose/day = 60 µg/day. To convert to mme/day of FentaNYL buccal, multiply the 60 µg/day by the mme conversion factor, 0.13 mme/µg, giving us 7.8 mme/day. Adding the mme/day of FentaNYL buccal to the total mme/day gives us 200.0 + 7.8 = 207.8 mme/day.
The patient's mme/day is 207.8 mme/day."
994,49,Morphine Milligram Equivalents (MME) Calculator,dosage conversion,decimal,6,Template,A patient takes 10 mg of TraMADol 2 times a day.,"Based on the number of doses per day and the quantity of different doses, what is the patient's daily Morphine Miligram Equivalents (MME)?","{'TraMADol Dose': [10, 'mg'], 'TraMADol Dose Per Day': [2, 'per day']}",4,3.8,4.2,"The Opioid Conversion Table with MME (Morphine Milligram Equivalent) conversion factors are listed below:
1. Codeine: MME conversion factor = 0.15
2. FentaNYL buccal: MME conversion factor = 0.13
3. HYDROcodone: MME conversion factor = 1
4. HYDROmorphone: MME conversion factor = 5
5. Methadone: MME conversion factor = 4.7
6. Morphine: MME conversion factor = 1
7. OxyCODONE: MME conversion factor = 1.5
8. OxyMORphone: MME conversion factor = 3
9. Tapentadol: MME conversion factor = 0.4
10. TraMADol: MME conversion factor = 0.2
11. Buprenorphine: MME conversion factor = 10

The curent Morphine Milligram Equivalents (MME) is 0 MME per day.
The patient's dose of TraMADol is 10 mg. The patient takes 2 doses/day of TraMADol. This means that the patient takes 10 mg/dose TraMADol * 2 dose/day = 20 mg/day. To convert to mme/day of TraMADol, multiply the 20 mg/day by the mme conversion factor, 0.2 mme/mg, giving us 4.0 mme/day. Adding the mme/day of TraMADol to the total mme/day gives us 0 + 4.0 = 4.0 mme/day.
The patient's mme/day is 4.0 mme/day."
995,49,Morphine Milligram Equivalents (MME) Calculator,dosage conversion,decimal,7,Template,A patient takes 30 mg of Methadone 3 times a day and 10 mg of HYDROmorphone 1 time a day.,"Based on the number of doses per day and the quantity of different doses, what is the patient's daily Morphine Miligram Equivalents (MME)?","{'Methadone Dose': [30, 'mg'], 'Methadone Dose Per Day': [3, 'per day'], 'HYDROmorphone Dose': [10, 'mg'], 'HYDROmorphone Dose Per Day': [1, 'per day']}",473,449.35,496.65,"The Opioid Conversion Table with MME (Morphine Milligram Equivalent) conversion factors are listed below:
1. Codeine: MME conversion factor = 0.15
2. FentaNYL buccal: MME conversion factor = 0.13
3. HYDROcodone: MME conversion factor = 1
4. HYDROmorphone: MME conversion factor = 5
5. Methadone: MME conversion factor = 4.7
6. Morphine: MME conversion factor = 1
7. OxyCODONE: MME conversion factor = 1.5
8. OxyMORphone: MME conversion factor = 3
9. Tapentadol: MME conversion factor = 0.4
10. TraMADol: MME conversion factor = 0.2
11. Buprenorphine: MME conversion factor = 10

The curent Morphine Milligram Equivalents (MME) is 0 MME per day.
The patient's dose of Methadone is 30 mg. The patient takes 3 doses/day of Methadone. This means that the patient takes 30 mg/dose Methadone * 3 dose/day = 90 mg/day. To convert to mme/day of Methadone, multiply the 90 mg/day by the mme conversion factor, 4.7 mme/mg, giving us 423.0 mme/day. Adding the mme/day of Methadone to the total mme/day gives us 0 + 423.0 = 423.0 mme/day.
The patient's dose of HYDROmorphone is 10 mg. The patient takes 1 doses/day of HYDROmorphone. This means that the patient takes 10 mg/dose HYDROmorphone * 1 dose/day = 10 mg/day. To convert to mme/day of HYDROmorphone, multiply the 10 mg/day by the mme conversion factor, 5 mme/mg, giving us 50 mme/day. Adding the mme/day of HYDROmorphone to the total mme/day gives us 423.0 + 50 = 473.0 mme/day.
The patient's mme/day is 473.0 mme/day."
996,49,Morphine Milligram Equivalents (MME) Calculator,dosage conversion,decimal,8,Template,A patient takes 30 mg of OxyCODONE 1 time a day and 20 mg of Tapentadol 2 times a day.,"Based on the number of doses per day and the quantity of different doses, what is the patient's daily Morphine Miligram Equivalents (MME)?","{'OxyCODONE Dose': [30, 'mg'], 'OxyCODONE Dose Per Day': [1, 'per day'], 'Tapentadol Dose': [20, 'mg'], 'Tapentadol Dose Per Day': [2, 'per day']}",61,57.95,64.05,"The Opioid Conversion Table with MME (Morphine Milligram Equivalent) conversion factors are listed below:
1. Codeine: MME conversion factor = 0.15
2. FentaNYL buccal: MME conversion factor = 0.13
3. HYDROcodone: MME conversion factor = 1
4. HYDROmorphone: MME conversion factor = 5
5. Methadone: MME conversion factor = 4.7
6. Morphine: MME conversion factor = 1
7. OxyCODONE: MME conversion factor = 1.5
8. OxyMORphone: MME conversion factor = 3
9. Tapentadol: MME conversion factor = 0.4
10. TraMADol: MME conversion factor = 0.2
11. Buprenorphine: MME conversion factor = 10

The curent Morphine Milligram Equivalents (MME) is 0 MME per day.
The patient's dose of OxyCODONE is 30 mg. The patient takes 1 doses/day of OxyCODONE. This means that the patient takes 30 mg/dose OxyCODONE * 1 dose/day = 30 mg/day. To convert to mme/day of OxyCODONE, multiply the 30 mg/day by the mme conversion factor, 1.5 mme/mg, giving us 45.0 mme/day. Adding the mme/day of OxyCODONE to the total mme/day gives us 0 + 45.0 = 45.0 mme/day.
The patient's dose of Tapentadol is 20 mg. The patient takes 2 doses/day of Tapentadol. This means that the patient takes 20 mg/dose Tapentadol * 2 dose/day = 40 mg/day. To convert to mme/day of Tapentadol, multiply the 40 mg/day by the mme conversion factor, 0.4 mme/mg, giving us 16.0 mme/day. Adding the mme/day of Tapentadol to the total mme/day gives us 45.0 + 16.0 = 61.0 mme/day.
The patient's mme/day is 61.0 mme/day."
997,49,Morphine Milligram Equivalents (MME) Calculator,dosage conversion,decimal,9,Template,"A patient takes 10 mg of Methadone 3 times a day, 30 mg of TraMADol 2 times a day, and 30 mg of HYDROcodone 2 times a day.","Based on the number of doses per day and the quantity of different doses, what is the patient's daily Morphine Miligram Equivalents (MME)?","{'Methadone Dose': [10, 'mg'], 'Methadone Dose Per Day': [3, 'per day'], 'TraMADol Dose': [30, 'mg'], 'TraMADol Dose Per Day': [2, 'per day'], 'HYDROcodone Dose': [30, 'mg'], 'HYDROcodone Dose Per Day': [2, 'per day']}",213,202.35,223.65,"The Opioid Conversion Table with MME (Morphine Milligram Equivalent) conversion factors are listed below:
1. Codeine: MME conversion factor = 0.15
2. FentaNYL buccal: MME conversion factor = 0.13
3. HYDROcodone: MME conversion factor = 1
4. HYDROmorphone: MME conversion factor = 5
5. Methadone: MME conversion factor = 4.7
6. Morphine: MME conversion factor = 1
7. OxyCODONE: MME conversion factor = 1.5
8. OxyMORphone: MME conversion factor = 3
9. Tapentadol: MME conversion factor = 0.4
10. TraMADol: MME conversion factor = 0.2
11. Buprenorphine: MME conversion factor = 10

The curent Morphine Milligram Equivalents (MME) is 0 MME per day.
The patient's dose of Methadone is 10 mg. The patient takes 3 doses/day of Methadone. This means that the patient takes 10 mg/dose Methadone * 3 dose/day = 30 mg/day. To convert to mme/day of Methadone, multiply the 30 mg/day by the mme conversion factor, 4.7 mme/mg, giving us 141.0 mme/day. Adding the mme/day of Methadone to the total mme/day gives us 0 + 141.0 = 141.0 mme/day.
The patient's dose of TraMADol is 30 mg. The patient takes 2 doses/day of TraMADol. This means that the patient takes 30 mg/dose TraMADol * 2 dose/day = 60 mg/day. To convert to mme/day of TraMADol, multiply the 60 mg/day by the mme conversion factor, 0.2 mme/mg, giving us 12.0 mme/day. Adding the mme/day of TraMADol to the total mme/day gives us 141.0 + 12.0 = 153.0 mme/day.
The patient's dose of HYDROcodone is 30 mg. The patient takes 2 doses/day of HYDROcodone. This means that the patient takes 30 mg/dose HYDROcodone * 2 dose/day = 60 mg/day. To convert to mme/day of HYDROcodone, multiply the 60 mg/day by the mme conversion factor, 1 mme/mg, giving us 60 mme/day. Adding the mme/day of HYDROcodone to the total mme/day gives us 153.0 + 60 = 213.0 mme/day.
The patient's mme/day is 213.0 mme/day."
998,49,Morphine Milligram Equivalents (MME) Calculator,dosage conversion,decimal,10,Template,"A patient takes 20 mg of Methadone 1 time a day, 30 mg of OxyMORphone 3 times a day, and 20 mg of FentaNYL buccal 1 time a day.","Based on the number of doses per day and the quantity of different doses, what is the patient's daily Morphine Miligram Equivalents (MME)?","{'Methadone Dose': [20, 'mg'], 'Methadone Dose Per Day': [1, 'per day'], 'OxyMORphone Dose': [30, 'mg'], 'OxyMORphone Dose Per Day': [3, 'per day'], 'FentaNYL buccal Dose': [20, 'µg'], 'FentaNYL buccal Dose Per Day': [1, 'per day']}",366.6,348.27,384.93,"The Opioid Conversion Table with MME (Morphine Milligram Equivalent) conversion factors are listed below:
1. Codeine: MME conversion factor = 0.15
2. FentaNYL buccal: MME conversion factor = 0.13
3. HYDROcodone: MME conversion factor = 1
4. HYDROmorphone: MME conversion factor = 5
5. Methadone: MME conversion factor = 4.7
6. Morphine: MME conversion factor = 1
7. OxyCODONE: MME conversion factor = 1.5
8. OxyMORphone: MME conversion factor = 3
9. Tapentadol: MME conversion factor = 0.4
10. TraMADol: MME conversion factor = 0.2
11. Buprenorphine: MME conversion factor = 10

The curent Morphine Milligram Equivalents (MME) is 0 MME per day.
The patient's dose of Methadone is 20 mg. The patient takes 1 doses/day of Methadone. This means that the patient takes 20 mg/dose Methadone * 1 dose/day = 20 mg/day. To convert to mme/day of Methadone, multiply the 20 mg/day by the mme conversion factor, 4.7 mme/mg, giving us 94.0 mme/day. Adding the mme/day of Methadone to the total mme/day gives us 0 + 94.0 = 94.0 mme/day.
The patient's dose of OxyMORphone is 30 mg. The patient takes 3 doses/day of OxyMORphone. This means that the patient takes 30 mg/dose OxyMORphone * 3 dose/day = 90 mg/day. To convert to mme/day of OxyMORphone, multiply the 90 mg/day by the mme conversion factor, 3 mme/mg, giving us 270 mme/day. Adding the mme/day of OxyMORphone to the total mme/day gives us 94.0 + 270 = 364.0 mme/day.
The patient's dose of FentaNYL buccal is 20 µg.
The patient takes 1 doses/day of FentaNYL buccal. This means that the patient takes 20 µg/dose FentaNYL buccal * 1 dose/day = 20 µg/day. To convert to mme/day of FentaNYL buccal, multiply the 20 µg/day by the mme conversion factor, 0.13 mme/µg, giving us 2.6 mme/day. Adding the mme/day of FentaNYL buccal to the total mme/day gives us 364.0 + 2.6 = 366.6 mme/day.
The patient's mme/day is 366.6 mme/day."
999,49,Morphine Milligram Equivalents (MME) Calculator,dosage conversion,decimal,11,Template,A patient takes 20 mg of Methadone 1 time a day.,"Based on the number of doses per day and the quantity of different doses, what is the patient's daily Morphine Miligram Equivalents (MME)?","{'Methadone Dose': [20, 'mg'], 'Methadone Dose Per Day': [1, 'per day']}",94,89.3,98.7,"The Opioid Conversion Table with MME (Morphine Milligram Equivalent) conversion factors are listed below:
1. Codeine: MME conversion factor = 0.15
2. FentaNYL buccal: MME conversion factor = 0.13
3. HYDROcodone: MME conversion factor = 1
4. HYDROmorphone: MME conversion factor = 5
5. Methadone: MME conversion factor = 4.7
6. Morphine: MME conversion factor = 1
7. OxyCODONE: MME conversion factor = 1.5
8. OxyMORphone: MME conversion factor = 3
9. Tapentadol: MME conversion factor = 0.4
10. TraMADol: MME conversion factor = 0.2
11. Buprenorphine: MME conversion factor = 10

The curent Morphine Milligram Equivalents (MME) is 0 MME per day.
The patient's dose of Methadone is 20 mg. The patient takes 1 doses/day of Methadone. This means that the patient takes 20 mg/dose Methadone * 1 dose/day = 20 mg/day. To convert to mme/day of Methadone, multiply the 20 mg/day by the mme conversion factor, 4.7 mme/mg, giving us 94.0 mme/day. Adding the mme/day of Methadone to the total mme/day gives us 0 + 94.0 = 94.0 mme/day.
The patient's mme/day is 94.0 mme/day."
1000,49,Morphine Milligram Equivalents (MME) Calculator,dosage conversion,decimal,12,Template,A patient takes 20 mg of HYDROmorphone 2 times a day and 30 mg of Morphine 1 time a day.,"Based on the number of doses per day and the quantity of different doses, what is the patient's daily Morphine Miligram Equivalents (MME)?","{'HYDROmorphone Dose': [20, 'mg'], 'HYDROmorphone Dose Per Day': [2, 'per day'], 'Morphine Dose': [30, 'mg'], 'Morphine Dose Per Day': [1, 'per day']}",230,218.5,241.5,"The Opioid Conversion Table with MME (Morphine Milligram Equivalent) conversion factors are listed below:
1. Codeine: MME conversion factor = 0.15
2. FentaNYL buccal: MME conversion factor = 0.13
3. HYDROcodone: MME conversion factor = 1
4. HYDROmorphone: MME conversion factor = 5
5. Methadone: MME conversion factor = 4.7
6. Morphine: MME conversion factor = 1
7. OxyCODONE: MME conversion factor = 1.5
8. OxyMORphone: MME conversion factor = 3
9. Tapentadol: MME conversion factor = 0.4
10. TraMADol: MME conversion factor = 0.2
11. Buprenorphine: MME conversion factor = 10

The curent Morphine Milligram Equivalents (MME) is 0 MME per day.
The patient's dose of HYDROmorphone is 20 mg. The patient takes 2 doses/day of HYDROmorphone. This means that the patient takes 20 mg/dose HYDROmorphone * 2 dose/day = 40 mg/day. To convert to mme/day of HYDROmorphone, multiply the 40 mg/day by the mme conversion factor, 5 mme/mg, giving us 200 mme/day. Adding the mme/day of HYDROmorphone to the total mme/day gives us 0 + 200 = 200 mme/day.
The patient's dose of Morphine is 30 mg. The patient takes 1 doses/day of Morphine. This means that the patient takes 30 mg/dose Morphine * 1 dose/day = 30 mg/day. To convert to mme/day of Morphine, multiply the 30 mg/day by the mme conversion factor, 1 mme/mg, giving us 30 mme/day. Adding the mme/day of Morphine to the total mme/day gives us 200 + 30 = 230 mme/day.
The patient's mme/day is 230 mme/day."
1001,49,Morphine Milligram Equivalents (MME) Calculator,dosage conversion,decimal,13,Template,A patient takes 30 mg of FentaNYL buccal 2 times a day and 20 mg of Tapentadol 3 times a day.,"Based on the number of doses per day and the quantity of different doses, what is the patient's daily Morphine Miligram Equivalents (MME)?","{'FentaNYL buccal Dose': [30, 'µg'], 'FentaNYL buccal Dose Per Day': [2, 'per day'], 'Tapentadol Dose': [20, 'mg'], 'Tapentadol Dose Per Day': [3, 'per day']}",31.8,30.21,33.39,"The Opioid Conversion Table with MME (Morphine Milligram Equivalent) conversion factors are listed below:
1. Codeine: MME conversion factor = 0.15
2. FentaNYL buccal: MME conversion factor = 0.13
3. HYDROcodone: MME conversion factor = 1
4. HYDROmorphone: MME conversion factor = 5
5. Methadone: MME conversion factor = 4.7
6. Morphine: MME conversion factor = 1
7. OxyCODONE: MME conversion factor = 1.5
8. OxyMORphone: MME conversion factor = 3
9. Tapentadol: MME conversion factor = 0.4
10. TraMADol: MME conversion factor = 0.2
11. Buprenorphine: MME conversion factor = 10

The curent Morphine Milligram Equivalents (MME) is 0 MME per day.
The patient's dose of FentaNYL buccal is 30 µg.
The patient takes 2 doses/day of FentaNYL buccal. This means that the patient takes 30 µg/dose FentaNYL buccal * 2 dose/day = 60 µg/day. To convert to mme/day of FentaNYL buccal, multiply the 60 µg/day by the mme conversion factor, 0.13 mme/µg, giving us 7.8 mme/day. Adding the mme/day of FentaNYL buccal to the total mme/day gives us 0 + 7.8 = 7.8 mme/day.
The patient's dose of Tapentadol is 20 mg. The patient takes 3 doses/day of Tapentadol. This means that the patient takes 20 mg/dose Tapentadol * 3 dose/day = 60 mg/day. To convert to mme/day of Tapentadol, multiply the 60 mg/day by the mme conversion factor, 0.4 mme/mg, giving us 24.0 mme/day. Adding the mme/day of Tapentadol to the total mme/day gives us 7.8 + 24.0 = 31.8 mme/day.
The patient's mme/day is 31.8 mme/day."
1002,49,Morphine Milligram Equivalents (MME) Calculator,dosage conversion,decimal,14,Template,A patient takes 20 mg of Morphine 2 times a day.,"Based on the number of doses per day and the quantity of different doses, what is the patient's daily Morphine Miligram Equivalents (MME)?","{'Morphine Dose': [20, 'mg'], 'Morphine Dose Per Day': [2, 'per day']}",40,38,42,"The Opioid Conversion Table with MME (Morphine Milligram Equivalent) conversion factors are listed below:
1. Codeine: MME conversion factor = 0.15
2. FentaNYL buccal: MME conversion factor = 0.13
3. HYDROcodone: MME conversion factor = 1
4. HYDROmorphone: MME conversion factor = 5
5. Methadone: MME conversion factor = 4.7
6. Morphine: MME conversion factor = 1
7. OxyCODONE: MME conversion factor = 1.5
8. OxyMORphone: MME conversion factor = 3
9. Tapentadol: MME conversion factor = 0.4
10. TraMADol: MME conversion factor = 0.2
11. Buprenorphine: MME conversion factor = 10

The curent Morphine Milligram Equivalents (MME) is 0 MME per day.
The patient's dose of Morphine is 20 mg. The patient takes 2 doses/day of Morphine. This means that the patient takes 20 mg/dose Morphine * 2 dose/day = 40 mg/day. To convert to mme/day of Morphine, multiply the 40 mg/day by the mme conversion factor, 1 mme/mg, giving us 40 mme/day. Adding the mme/day of Morphine to the total mme/day gives us 0 + 40 = 40 mme/day.
The patient's mme/day is 40 mme/day."
1003,49,Morphine Milligram Equivalents (MME) Calculator,dosage conversion,decimal,15,Template,A patient takes 30 mg of TraMADol 2 times a day.,"Based on the number of doses per day and the quantity of different doses, what is the patient's daily Morphine Miligram Equivalents (MME)?","{'TraMADol Dose': [30, 'mg'], 'TraMADol Dose Per Day': [2, 'per day']}",12,11.4,12.6,"The Opioid Conversion Table with MME (Morphine Milligram Equivalent) conversion factors are listed below:
1. Codeine: MME conversion factor = 0.15
2. FentaNYL buccal: MME conversion factor = 0.13
3. HYDROcodone: MME conversion factor = 1
4. HYDROmorphone: MME conversion factor = 5
5. Methadone: MME conversion factor = 4.7
6. Morphine: MME conversion factor = 1
7. OxyCODONE: MME conversion factor = 1.5
8. OxyMORphone: MME conversion factor = 3
9. Tapentadol: MME conversion factor = 0.4
10. TraMADol: MME conversion factor = 0.2
11. Buprenorphine: MME conversion factor = 10

The curent Morphine Milligram Equivalents (MME) is 0 MME per day.
The patient's dose of TraMADol is 30 mg. The patient takes 2 doses/day of TraMADol. This means that the patient takes 30 mg/dose TraMADol * 2 dose/day = 60 mg/day. To convert to mme/day of TraMADol, multiply the 60 mg/day by the mme conversion factor, 0.2 mme/mg, giving us 12.0 mme/day. Adding the mme/day of TraMADol to the total mme/day gives us 0 + 12.0 = 12.0 mme/day.
The patient's mme/day is 12.0 mme/day."
1004,49,Morphine Milligram Equivalents (MME) Calculator,dosage conversion,decimal,16,Template,"A patient takes 10 mg of OxyCODONE 3 times a day, 10 mg of HYDROcodone 3 times a day, and 20 mg of HYDROmorphone 1 time a day.","Based on the number of doses per day and the quantity of different doses, what is the patient's daily Morphine Miligram Equivalents (MME)?","{'OxyCODONE Dose': [10, 'mg'], 'OxyCODONE Dose Per Day': [3, 'per day'], 'HYDROcodone Dose': [10, 'mg'], 'HYDROcodone Dose Per Day': [3, 'per day'], 'HYDROmorphone Dose': [20, 'mg'], 'HYDROmorphone Dose Per Day': [1, 'per day']}",175,166.25,183.75,"The Opioid Conversion Table with MME (Morphine Milligram Equivalent) conversion factors are listed below:
1. Codeine: MME conversion factor = 0.15
2. FentaNYL buccal: MME conversion factor = 0.13
3. HYDROcodone: MME conversion factor = 1
4. HYDROmorphone: MME conversion factor = 5
5. Methadone: MME conversion factor = 4.7
6. Morphine: MME conversion factor = 1
7. OxyCODONE: MME conversion factor = 1.5
8. OxyMORphone: MME conversion factor = 3
9. Tapentadol: MME conversion factor = 0.4
10. TraMADol: MME conversion factor = 0.2
11. Buprenorphine: MME conversion factor = 10

The curent Morphine Milligram Equivalents (MME) is 0 MME per day.
The patient's dose of OxyCODONE is 10 mg. The patient takes 3 doses/day of OxyCODONE. This means that the patient takes 10 mg/dose OxyCODONE * 3 dose/day = 30 mg/day. To convert to mme/day of OxyCODONE, multiply the 30 mg/day by the mme conversion factor, 1.5 mme/mg, giving us 45.0 mme/day. Adding the mme/day of OxyCODONE to the total mme/day gives us 0 + 45.0 = 45.0 mme/day.
The patient's dose of HYDROcodone is 10 mg. The patient takes 3 doses/day of HYDROcodone. This means that the patient takes 10 mg/dose HYDROcodone * 3 dose/day = 30 mg/day. To convert to mme/day of HYDROcodone, multiply the 30 mg/day by the mme conversion factor, 1 mme/mg, giving us 30 mme/day. Adding the mme/day of HYDROcodone to the total mme/day gives us 45.0 + 30 = 75.0 mme/day.
The patient's dose of HYDROmorphone is 20 mg. The patient takes 1 doses/day of HYDROmorphone. This means that the patient takes 20 mg/dose HYDROmorphone * 1 dose/day = 20 mg/day. To convert to mme/day of HYDROmorphone, multiply the 20 mg/day by the mme conversion factor, 5 mme/mg, giving us 100 mme/day. Adding the mme/day of HYDROmorphone to the total mme/day gives us 75.0 + 100 = 175.0 mme/day.
The patient's mme/day is 175.0 mme/day."
1005,49,Morphine Milligram Equivalents (MME) Calculator,dosage conversion,decimal,17,Template,A patient takes 30 mg of HYDROcodone 3 times a day and 10 mg of Tapentadol 1 time a day.,"Based on the number of doses per day and the quantity of different doses, what is the patient's daily Morphine Miligram Equivalents (MME)?","{'HYDROcodone Dose': [30, 'mg'], 'HYDROcodone Dose Per Day': [3, 'per day'], 'Tapentadol Dose': [10, 'mg'], 'Tapentadol Dose Per Day': [1, 'per day']}",94,89.3,98.7,"The Opioid Conversion Table with MME (Morphine Milligram Equivalent) conversion factors are listed below:
1. Codeine: MME conversion factor = 0.15
2. FentaNYL buccal: MME conversion factor = 0.13
3. HYDROcodone: MME conversion factor = 1
4. HYDROmorphone: MME conversion factor = 5
5. Methadone: MME conversion factor = 4.7
6. Morphine: MME conversion factor = 1
7. OxyCODONE: MME conversion factor = 1.5
8. OxyMORphone: MME conversion factor = 3
9. Tapentadol: MME conversion factor = 0.4
10. TraMADol: MME conversion factor = 0.2
11. Buprenorphine: MME conversion factor = 10

The curent Morphine Milligram Equivalents (MME) is 0 MME per day.
The patient's dose of HYDROcodone is 30 mg. The patient takes 3 doses/day of HYDROcodone. This means that the patient takes 30 mg/dose HYDROcodone * 3 dose/day = 90 mg/day. To convert to mme/day of HYDROcodone, multiply the 90 mg/day by the mme conversion factor, 1 mme/mg, giving us 90 mme/day. Adding the mme/day of HYDROcodone to the total mme/day gives us 0 + 90 = 90 mme/day.
The patient's dose of Tapentadol is 10 mg. The patient takes 1 doses/day of Tapentadol. This means that the patient takes 10 mg/dose Tapentadol * 1 dose/day = 10 mg/day. To convert to mme/day of Tapentadol, multiply the 10 mg/day by the mme conversion factor, 0.4 mme/mg, giving us 4.0 mme/day. Adding the mme/day of Tapentadol to the total mme/day gives us 90 + 4.0 = 94.0 mme/day.
The patient's mme/day is 94.0 mme/day."
1006,49,Morphine Milligram Equivalents (MME) Calculator,dosage conversion,decimal,18,Template,"A patient takes 30 mg of OxyMORphone 3 times a day, 10 mg of Morphine 3 times a day, and 30 mg of Tapentadol 2 times a day.","Based on the number of doses per day and the quantity of different doses, what is the patient's daily Morphine Miligram Equivalents (MME)?","{'OxyMORphone Dose': [30, 'mg'], 'OxyMORphone Dose Per Day': [3, 'per day'], 'Morphine Dose': [10, 'mg'], 'Morphine Dose Per Day': [3, 'per day'], 'Tapentadol Dose': [30, 'mg'], 'Tapentadol Dose Per Day': [2, 'per day']}",324,307.8,340.2,"The Opioid Conversion Table with MME (Morphine Milligram Equivalent) conversion factors are listed below:
1. Codeine: MME conversion factor = 0.15
2. FentaNYL buccal: MME conversion factor = 0.13
3. HYDROcodone: MME conversion factor = 1
4. HYDROmorphone: MME conversion factor = 5
5. Methadone: MME conversion factor = 4.7
6. Morphine: MME conversion factor = 1
7. OxyCODONE: MME conversion factor = 1.5
8. OxyMORphone: MME conversion factor = 3
9. Tapentadol: MME conversion factor = 0.4
10. TraMADol: MME conversion factor = 0.2
11. Buprenorphine: MME conversion factor = 10

The curent Morphine Milligram Equivalents (MME) is 0 MME per day.
The patient's dose of OxyMORphone is 30 mg. The patient takes 3 doses/day of OxyMORphone. This means that the patient takes 30 mg/dose OxyMORphone * 3 dose/day = 90 mg/day. To convert to mme/day of OxyMORphone, multiply the 90 mg/day by the mme conversion factor, 3 mme/mg, giving us 270 mme/day. Adding the mme/day of OxyMORphone to the total mme/day gives us 0 + 270 = 270 mme/day.
The patient's dose of Morphine is 10 mg. The patient takes 3 doses/day of Morphine. This means that the patient takes 10 mg/dose Morphine * 3 dose/day = 30 mg/day. To convert to mme/day of Morphine, multiply the 30 mg/day by the mme conversion factor, 1 mme/mg, giving us 30 mme/day. Adding the mme/day of Morphine to the total mme/day gives us 270 + 30 = 300 mme/day.
The patient's dose of Tapentadol is 30 mg. The patient takes 2 doses/day of Tapentadol. This means that the patient takes 30 mg/dose Tapentadol * 2 dose/day = 60 mg/day. To convert to mme/day of Tapentadol, multiply the 60 mg/day by the mme conversion factor, 0.4 mme/mg, giving us 24.0 mme/day. Adding the mme/day of Tapentadol to the total mme/day gives us 300 + 24.0 = 324.0 mme/day.
The patient's mme/day is 324.0 mme/day."
1007,49,Morphine Milligram Equivalents (MME) Calculator,dosage conversion,decimal,19,Template,A patient takes 20 mg of OxyCODONE 2 times a day and 30 mg of Morphine 3 times a day.,"Based on the number of doses per day and the quantity of different doses, what is the patient's daily Morphine Miligram Equivalents (MME)?","{'OxyCODONE Dose': [20, 'mg'], 'OxyCODONE Dose Per Day': [2, 'per day'], 'Morphine Dose': [30, 'mg'], 'Morphine Dose Per Day': [3, 'per day']}",150,142.5,157.5,"The Opioid Conversion Table with MME (Morphine Milligram Equivalent) conversion factors are listed below:
1. Codeine: MME conversion factor = 0.15
2. FentaNYL buccal: MME conversion factor = 0.13
3. HYDROcodone: MME conversion factor = 1
4. HYDROmorphone: MME conversion factor = 5
5. Methadone: MME conversion factor = 4.7
6. Morphine: MME conversion factor = 1
7. OxyCODONE: MME conversion factor = 1.5
8. OxyMORphone: MME conversion factor = 3
9. Tapentadol: MME conversion factor = 0.4
10. TraMADol: MME conversion factor = 0.2
11. Buprenorphine: MME conversion factor = 10

The curent Morphine Milligram Equivalents (MME) is 0 MME per day.
The patient's dose of OxyCODONE is 20 mg. The patient takes 2 doses/day of OxyCODONE. This means that the patient takes 20 mg/dose OxyCODONE * 2 dose/day = 40 mg/day. To convert to mme/day of OxyCODONE, multiply the 40 mg/day by the mme conversion factor, 1.5 mme/mg, giving us 60.0 mme/day. Adding the mme/day of OxyCODONE to the total mme/day gives us 0 + 60.0 = 60.0 mme/day.
The patient's dose of Morphine is 30 mg. The patient takes 3 doses/day of Morphine. This means that the patient takes 30 mg/dose Morphine * 3 dose/day = 90 mg/day. To convert to mme/day of Morphine, multiply the 90 mg/day by the mme conversion factor, 1 mme/mg, giving us 90 mme/day. Adding the mme/day of Morphine to the total mme/day gives us 60.0 + 90 = 150.0 mme/day.
The patient's mme/day is 150.0 mme/day."
1008,49,Morphine Milligram Equivalents (MME) Calculator,dosage conversion,decimal,20,Template,"A patient takes 30 mg of Methadone 1 time a day, 20 mg of Morphine 2 times a day, and 20 mg of FentaNYL buccal 2 times a day.","Based on the number of doses per day and the quantity of different doses, what is the patient's daily Morphine Miligram Equivalents (MME)?","{'Methadone Dose': [30, 'mg'], 'Methadone Dose Per Day': [1, 'per day'], 'Morphine Dose': [20, 'mg'], 'Morphine Dose Per Day': [2, 'per day'], 'FentaNYL buccal Dose': [20, 'µg'], 'FentaNYL buccal Dose Per Day': [2, 'per day']}",186.2,176.89,195.51,"The Opioid Conversion Table with MME (Morphine Milligram Equivalent) conversion factors are listed below:
1. Codeine: MME conversion factor = 0.15
2. FentaNYL buccal: MME conversion factor = 0.13
3. HYDROcodone: MME conversion factor = 1
4. HYDROmorphone: MME conversion factor = 5
5. Methadone: MME conversion factor = 4.7
6. Morphine: MME conversion factor = 1
7. OxyCODONE: MME conversion factor = 1.5
8. OxyMORphone: MME conversion factor = 3
9. Tapentadol: MME conversion factor = 0.4
10. TraMADol: MME conversion factor = 0.2
11. Buprenorphine: MME conversion factor = 10

The curent Morphine Milligram Equivalents (MME) is 0 MME per day.
The patient's dose of Methadone is 30 mg. The patient takes 1 doses/day of Methadone. This means that the patient takes 30 mg/dose Methadone * 1 dose/day = 30 mg/day. To convert to mme/day of Methadone, multiply the 30 mg/day by the mme conversion factor, 4.7 mme/mg, giving us 141.0 mme/day. Adding the mme/day of Methadone to the total mme/day gives us 0 + 141.0 = 141.0 mme/day.
The patient's dose of Morphine is 20 mg. The patient takes 2 doses/day of Morphine. This means that the patient takes 20 mg/dose Morphine * 2 dose/day = 40 mg/day. To convert to mme/day of Morphine, multiply the 40 mg/day by the mme conversion factor, 1 mme/mg, giving us 40 mme/day. Adding the mme/day of Morphine to the total mme/day gives us 141.0 + 40 = 181.0 mme/day.
The patient's dose of FentaNYL buccal is 20 µg.
The patient takes 2 doses/day of FentaNYL buccal. This means that the patient takes 20 µg/dose FentaNYL buccal * 2 dose/day = 40 µg/day. To convert to mme/day of FentaNYL buccal, multiply the 40 µg/day by the mme conversion factor, 0.13 mme/µg, giving us 5.2 mme/day. Adding the mme/day of FentaNYL buccal to the total mme/day gives us 181.0 + 5.2 = 186.2 mme/day.
The patient's mme/day is 186.2 mme/day."
1009,68,Estimated of Conception,date,date,1,Template,The patient's last menstrual period was on 01/12/2006.,"Based on the patient's last menstrual period, what is the the patient's estimated date of conception? Your answer should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and not other text.",{'Last menstrual date': '01/12/2006'},01/26/2006,01/26/2006,01/26/2006,"The patient's estimated date of conception based on their last period is computed by adding to 2 weeks to the patient's last menstrual period date. The patient's last menstrual period was 01/12/2006. 
Hence, the estimated date of conception after adding 2 weeks to the patient's last menstrual period date is 01/26/2006."
1010,68,Estimated of Conception,date,date,2,Template,The patient's last menstrual period was on 06/17/2011.,"Based on the patient's last menstrual period, what is the the patient's estimated date of conception? Your answer should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and not other text.",{'Last menstrual date': '06/17/2011'},07/01/2011,07/01/2011,07/01/2011,"The patient's estimated date of conception based on their last period is computed by adding to 2 weeks to the patient's last menstrual period date. The patient's last menstrual period was 06/17/2011. 
Hence, the estimated date of conception after adding 2 weeks to the patient's last menstrual period date is 07/01/2011."
1011,68,Estimated of Conception,date,date,3,Template,The patient's last menstrual period was on 04/11/2003.,"Based on the patient's last menstrual period, what is the the patient's estimated date of conception? Your answer should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and not other text.",{'Last menstrual date': '04/11/2003'},04/25/2003,04/25/2003,04/25/2003,"The patient's estimated date of conception based on their last period is computed by adding to 2 weeks to the patient's last menstrual period date. The patient's last menstrual period was 04/11/2003. 
Hence, the estimated date of conception after adding 2 weeks to the patient's last menstrual period date is 04/25/2003."
1012,68,Estimated of Conception,date,date,4,Template,The patient's last menstrual period was on 01/04/2017.,"Based on the patient's last menstrual period, what is the the patient's estimated date of conception? Your answer should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and not other text.",{'Last menstrual date': '01/04/2017'},01/18/2017,01/18/2017,01/18/2017,"The patient's estimated date of conception based on their last period is computed by adding to 2 weeks to the patient's last menstrual period date. The patient's last menstrual period was 01/04/2017. 
Hence, the estimated date of conception after adding 2 weeks to the patient's last menstrual period date is 01/18/2017."
1013,68,Estimated of Conception,date,date,5,Template,The patient's last menstrual period was on 08/21/2017.,"Based on the patient's last menstrual period, what is the the patient's estimated date of conception? Your answer should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and not other text.",{'Last menstrual date': '08/21/2017'},09/04/2017,09/04/2017,09/04/2017,"The patient's estimated date of conception based on their last period is computed by adding to 2 weeks to the patient's last menstrual period date. The patient's last menstrual period was 08/21/2017. 
Hence, the estimated date of conception after adding 2 weeks to the patient's last menstrual period date is 09/04/2017."
1014,68,Estimated of Conception,date,date,6,Template,The patient's last menstrual period was on 05/25/2007.,"Based on the patient's last menstrual period, what is the the patient's estimated date of conception? Your answer should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and not other text.",{'Last menstrual date': '05/25/2007'},06/08/2007,06/08/2007,06/08/2007,"The patient's estimated date of conception based on their last period is computed by adding to 2 weeks to the patient's last menstrual period date. The patient's last menstrual period was 05/25/2007. 
Hence, the estimated date of conception after adding 2 weeks to the patient's last menstrual period date is 06/08/2007."
1015,68,Estimated of Conception,date,date,7,Template,The patient's last menstrual period was on 06/17/2003.,"Based on the patient's last menstrual period, what is the the patient's estimated date of conception? Your answer should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and not other text.",{'Last menstrual date': '06/17/2003'},07/01/2003,07/01/2003,07/01/2003,"The patient's estimated date of conception based on their last period is computed by adding to 2 weeks to the patient's last menstrual period date. The patient's last menstrual period was 06/17/2003. 
Hence, the estimated date of conception after adding 2 weeks to the patient's last menstrual period date is 07/01/2003."
1016,68,Estimated of Conception,date,date,8,Template,The patient's last menstrual period was on 07/14/2017.,"Based on the patient's last menstrual period, what is the the patient's estimated date of conception? Your answer should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and not other text.",{'Last menstrual date': '07/14/2017'},07/28/2017,07/28/2017,07/28/2017,"The patient's estimated date of conception based on their last period is computed by adding to 2 weeks to the patient's last menstrual period date. The patient's last menstrual period was 07/14/2017. 
Hence, the estimated date of conception after adding 2 weeks to the patient's last menstrual period date is 07/28/2017."
1017,68,Estimated of Conception,date,date,9,Template,The patient's last menstrual period was on 11/18/2009.,"Based on the patient's last menstrual period, what is the the patient's estimated date of conception? Your answer should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and not other text.",{'Last menstrual date': '11/18/2009'},12/02/2009,12/02/2009,12/02/2009,"The patient's estimated date of conception based on their last period is computed by adding to 2 weeks to the patient's last menstrual period date. The patient's last menstrual period was 11/18/2009. 
Hence, the estimated date of conception after adding 2 weeks to the patient's last menstrual period date is 12/02/2009."
1018,68,Estimated of Conception,date,date,10,Template,The patient's last menstrual period was on 11/03/2006.,"Based on the patient's last menstrual period, what is the the patient's estimated date of conception? Your answer should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and not other text.",{'Last menstrual date': '11/03/2006'},11/17/2006,11/17/2006,11/17/2006,"The patient's estimated date of conception based on their last period is computed by adding to 2 weeks to the patient's last menstrual period date. The patient's last menstrual period was 11/03/2006. 
Hence, the estimated date of conception after adding 2 weeks to the patient's last menstrual period date is 11/17/2006."
1019,68,Estimated of Conception,date,date,11,Template,The patient's last menstrual period was on 09/15/2023.,"Based on the patient's last menstrual period, what is the the patient's estimated date of conception? Your answer should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and not other text.",{'Last menstrual date': '09/15/2023'},09/29/2023,09/29/2023,09/29/2023,"The patient's estimated date of conception based on their last period is computed by adding to 2 weeks to the patient's last menstrual period date. The patient's last menstrual period was 09/15/2023. 
Hence, the estimated date of conception after adding 2 weeks to the patient's last menstrual period date is 09/29/2023."
1020,68,Estimated of Conception,date,date,12,Template,The patient's last menstrual period was on 10/06/2015.,"Based on the patient's last menstrual period, what is the the patient's estimated date of conception? Your answer should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and not other text.",{'Last menstrual date': '10/06/2015'},10/20/2015,10/20/2015,10/20/2015,"The patient's estimated date of conception based on their last period is computed by adding to 2 weeks to the patient's last menstrual period date. The patient's last menstrual period was 10/06/2015. 
Hence, the estimated date of conception after adding 2 weeks to the patient's last menstrual period date is 10/20/2015."
1021,68,Estimated of Conception,date,date,13,Template,The patient's last menstrual period was on 06/13/2003.,"Based on the patient's last menstrual period, what is the the patient's estimated date of conception? Your answer should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and not other text.",{'Last menstrual date': '06/13/2003'},06/27/2003,06/27/2003,06/27/2003,"The patient's estimated date of conception based on their last period is computed by adding to 2 weeks to the patient's last menstrual period date. The patient's last menstrual period was 06/13/2003. 
Hence, the estimated date of conception after adding 2 weeks to the patient's last menstrual period date is 06/27/2003."
1022,68,Estimated of Conception,date,date,14,Template,The patient's last menstrual period was on 05/26/2010.,"Based on the patient's last menstrual period, what is the the patient's estimated date of conception? Your answer should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and not other text.",{'Last menstrual date': '05/26/2010'},06/09/2010,06/09/2010,06/09/2010,"The patient's estimated date of conception based on their last period is computed by adding to 2 weeks to the patient's last menstrual period date. The patient's last menstrual period was 05/26/2010. 
Hence, the estimated date of conception after adding 2 weeks to the patient's last menstrual period date is 06/09/2010."
1023,68,Estimated of Conception,date,date,15,Template,The patient's last menstrual period was on 08/03/2013.,"Based on the patient's last menstrual period, what is the the patient's estimated date of conception? Your answer should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and not other text.",{'Last menstrual date': '08/03/2013'},08/17/2013,08/17/2013,08/17/2013,"The patient's estimated date of conception based on their last period is computed by adding to 2 weeks to the patient's last menstrual period date. The patient's last menstrual period was 08/03/2013. 
Hence, the estimated date of conception after adding 2 weeks to the patient's last menstrual period date is 08/17/2013."
1024,68,Estimated of Conception,date,date,16,Template,The patient's last menstrual period was on 05/13/2007.,"Based on the patient's last menstrual period, what is the the patient's estimated date of conception? Your answer should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and not other text.",{'Last menstrual date': '05/13/2007'},05/27/2007,05/27/2007,05/27/2007,"The patient's estimated date of conception based on their last period is computed by adding to 2 weeks to the patient's last menstrual period date. The patient's last menstrual period was 05/13/2007. 
Hence, the estimated date of conception after adding 2 weeks to the patient's last menstrual period date is 05/27/2007."
1025,68,Estimated of Conception,date,date,17,Template,The patient's last menstrual period was on 09/05/2013.,"Based on the patient's last menstrual period, what is the the patient's estimated date of conception? Your answer should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and not other text.",{'Last menstrual date': '09/05/2013'},09/19/2013,09/19/2013,09/19/2013,"The patient's estimated date of conception based on their last period is computed by adding to 2 weeks to the patient's last menstrual period date. The patient's last menstrual period was 09/05/2013. 
Hence, the estimated date of conception after adding 2 weeks to the patient's last menstrual period date is 09/19/2013."
1026,68,Estimated of Conception,date,date,18,Template,The patient's last menstrual period was on 04/28/2020.,"Based on the patient's last menstrual period, what is the the patient's estimated date of conception? Your answer should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and not other text.",{'Last menstrual date': '04/28/2020'},05/12/2020,05/12/2020,05/12/2020,"The patient's estimated date of conception based on their last period is computed by adding to 2 weeks to the patient's last menstrual period date. The patient's last menstrual period was 04/28/2020. 
Hence, the estimated date of conception after adding 2 weeks to the patient's last menstrual period date is 05/12/2020."
1027,68,Estimated of Conception,date,date,19,Template,The patient's last menstrual period was on 10/07/2011.,"Based on the patient's last menstrual period, what is the the patient's estimated date of conception? Your answer should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and not other text.",{'Last menstrual date': '10/07/2011'},10/21/2011,10/21/2011,10/21/2011,"The patient's estimated date of conception based on their last period is computed by adding to 2 weeks to the patient's last menstrual period date. The patient's last menstrual period was 10/07/2011. 
Hence, the estimated date of conception after adding 2 weeks to the patient's last menstrual period date is 10/21/2011."
1028,68,Estimated of Conception,date,date,20,Template,The patient's last menstrual period was on 06/14/2017.,"Based on the patient's last menstrual period, what is the the patient's estimated date of conception? Your answer should be in the format of M/D/Y (ie 08/31/2023, 07/03/2000) with just the date and not other text.",{'Last menstrual date': '06/14/2017'},06/28/2017,06/28/2017,06/28/2017,"The patient's estimated date of conception based on their last period is computed by adding to 2 weeks to the patient's last menstrual period date. The patient's last menstrual period was 06/14/2017. 
Hence, the estimated date of conception after adding 2 weeks to the patient's last menstrual period date is 06/28/2017."
1029,69,Estimated Gestational Age,date,date,1,Template,The patient's last menstrual period was on 03/23/2020. Today's date is 03/29/2020.,"Based on the patient's last menstrual period, what is the patient's estimated gestational age? Your answer should be a tuple, specifying the number of weeks and days (i.e. (4 weeks, 3 days), (0 weeks, 5 days), (1 week, 5 days), (8 weeks, 0 days)).","{'Current Date': '03/29/2020', 'Last menstrual date': '03/23/2020'}","('0 weeks', '6 days')","('0 weeks', '6 days')","('0 weeks', '6 days')","To compute the estimated gestational age, we compute the number of weeks and days apart today's date is from the patient's last menstrual period date. The current date is 03/29/2020 and the patient's last menstrual period date was 03/23/2020. The gap between these two dates is 6 days. Hence, the estimated gestational age is 6 days. "
1030,69,Estimated Gestational Age,date,date,2,Template,The patient's last menstrual period was on 02/14/2024. Today's date is 05/23/2024.,"Based on the patient's last menstrual period, what is the patient's estimated gestational age? Your answer should be a tuple, specifying the number of weeks and days (i.e. (4 weeks, 3 days), (0 weeks, 5 days), (1 week, 5 days), (8 weeks, 0 days)).","{'Current Date': '05/23/2024', 'Last menstrual date': '02/14/2024'}","('14 weeks', '1 days')","('14 weeks', '1 days')","('14 weeks', '1 days')","To compute the estimated gestational age, we compute the number of weeks and days apart today's date is from the patient's last menstrual period date. The current date is 05/23/2024 and the patient's last menstrual period date was 02/14/2024. The gap between these two dates is 14 weeks and 1 days. Hence, the estimated gestational age is 14 weeks and 1 days. "
1031,69,Estimated Gestational Age,date,date,3,Template,The patient's last menstrual period was on 12/15/2016. Today's date is 01/09/2017.,"Based on the patient's last menstrual period, what is the patient's estimated gestational age? Your answer should be a tuple, specifying the number of weeks and days (i.e. (4 weeks, 3 days), (0 weeks, 5 days), (1 week, 5 days), (8 weeks, 0 days)).","{'Current Date': '01/09/2017', 'Last menstrual date': '12/15/2016'}","('3 weeks', '4 days')","('3 weeks', '4 days')","('3 weeks', '4 days')","To compute the estimated gestational age, we compute the number of weeks and days apart today's date is from the patient's last menstrual period date. The current date is 01/09/2017 and the patient's last menstrual period date was 12/15/2016. The gap between these two dates is 3 weeks and 4 days. Hence, the estimated gestational age is 3 weeks and 4 days. "
1032,69,Estimated Gestational Age,date,date,4,Template,The patient's last menstrual period was on 04/15/2003. Today's date is 06/16/2003.,"Based on the patient's last menstrual period, what is the patient's estimated gestational age? Your answer should be a tuple, specifying the number of weeks and days (i.e. (4 weeks, 3 days), (0 weeks, 5 days), (1 week, 5 days), (8 weeks, 0 days)).","{'Current Date': '06/16/2003', 'Last menstrual date': '04/15/2003'}","('8 weeks', '6 days')","('8 weeks', '6 days')","('8 weeks', '6 days')","To compute the estimated gestational age, we compute the number of weeks and days apart today's date is from the patient's last menstrual period date. The current date is 06/16/2003 and the patient's last menstrual period date was 04/15/2003. The gap between these two dates is 8 weeks and 6 days. Hence, the estimated gestational age is 8 weeks and 6 days. "
1033,69,Estimated Gestational Age,date,date,5,Template,The patient's last menstrual period was on 08/17/2021. Today's date is 04/23/2022.,"Based on the patient's last menstrual period, what is the patient's estimated gestational age? Your answer should be a tuple, specifying the number of weeks and days (i.e. (4 weeks, 3 days), (0 weeks, 5 days), (1 week, 5 days), (8 weeks, 0 days)).","{'Current Date': '04/23/2022', 'Last menstrual date': '08/17/2021'}","('35 weeks', '4 days')","('35 weeks', '4 days')","('35 weeks', '4 days')","To compute the estimated gestational age, we compute the number of weeks and days apart today's date is from the patient's last menstrual period date. The current date is 04/23/2022 and the patient's last menstrual period date was 08/17/2021. The gap between these two dates is 35 weeks and 4 days. Hence, the estimated gestational age is 35 weeks and 4 days. "
1034,69,Estimated Gestational Age,date,date,6,Template,The patient's last menstrual period was on 06/29/2024. Today's date is 01/15/2025.,"Based on the patient's last menstrual period, what is the patient's estimated gestational age? Your answer should be a tuple, specifying the number of weeks and days (i.e. (4 weeks, 3 days), (0 weeks, 5 days), (1 week, 5 days), (8 weeks, 0 days)).","{'Current Date': '01/15/2025', 'Last menstrual date': '06/29/2024'}","('28 weeks', '4 days')","('28 weeks', '4 days')","('28 weeks', '4 days')","To compute the estimated gestational age, we compute the number of weeks and days apart today's date is from the patient's last menstrual period date. The current date is 01/15/2025 and the patient's last menstrual period date was 06/29/2024. The gap between these two dates is 28 weeks and 4 days. Hence, the estimated gestational age is 28 weeks and 4 days. "
1035,69,Estimated Gestational Age,date,date,7,Template,The patient's last menstrual period was on 12/14/2016. Today's date is 08/19/2017.,"Based on the patient's last menstrual period, what is the patient's estimated gestational age? Your answer should be a tuple, specifying the number of weeks and days (i.e. (4 weeks, 3 days), (0 weeks, 5 days), (1 week, 5 days), (8 weeks, 0 days)).","{'Current Date': '08/19/2017', 'Last menstrual date': '12/14/2016'}","('35 weeks', '3 days')","('35 weeks', '3 days')","('35 weeks', '3 days')","To compute the estimated gestational age, we compute the number of weeks and days apart today's date is from the patient's last menstrual period date. The current date is 08/19/2017 and the patient's last menstrual period date was 12/14/2016. The gap between these two dates is 35 weeks and 3 days. Hence, the estimated gestational age is 35 weeks and 3 days. "
1036,69,Estimated Gestational Age,date,date,8,Template,The patient's last menstrual period was on 03/28/2023. Today's date is 10/27/2023.,"Based on the patient's last menstrual period, what is the patient's estimated gestational age? Your answer should be a tuple, specifying the number of weeks and days (i.e. (4 weeks, 3 days), (0 weeks, 5 days), (1 week, 5 days), (8 weeks, 0 days)).","{'Current Date': '10/27/2023', 'Last menstrual date': '03/28/2023'}","('30 weeks', '3 days')","('30 weeks', '3 days')","('30 weeks', '3 days')","To compute the estimated gestational age, we compute the number of weeks and days apart today's date is from the patient's last menstrual period date. The current date is 10/27/2023 and the patient's last menstrual period date was 03/28/2023. The gap between these two dates is 30 weeks and 3 days. Hence, the estimated gestational age is 30 weeks and 3 days. "
1037,69,Estimated Gestational Age,date,date,9,Template,The patient's last menstrual period was on 05/08/2024. Today's date is 09/10/2024.,"Based on the patient's last menstrual period, what is the patient's estimated gestational age? Your answer should be a tuple, specifying the number of weeks and days (i.e. (4 weeks, 3 days), (0 weeks, 5 days), (1 week, 5 days), (8 weeks, 0 days)).","{'Current Date': '09/10/2024', 'Last menstrual date': '05/08/2024'}","('17 weeks', '6 days')","('17 weeks', '6 days')","('17 weeks', '6 days')","To compute the estimated gestational age, we compute the number of weeks and days apart today's date is from the patient's last menstrual period date. The current date is 09/10/2024 and the patient's last menstrual period date was 05/08/2024. The gap between these two dates is 17 weeks and 6 days. Hence, the estimated gestational age is 17 weeks and 6 days. "
1038,69,Estimated Gestational Age,date,date,10,Template,The patient's last menstrual period was on 09/21/2015. Today's date is 01/06/2016.,"Based on the patient's last menstrual period, what is the patient's estimated gestational age? Your answer should be a tuple, specifying the number of weeks and days (i.e. (4 weeks, 3 days), (0 weeks, 5 days), (1 week, 5 days), (8 weeks, 0 days)).","{'Current Date': '01/06/2016', 'Last menstrual date': '09/21/2015'}","('15 weeks', '2 days')","('15 weeks', '2 days')","('15 weeks', '2 days')","To compute the estimated gestational age, we compute the number of weeks and days apart today's date is from the patient's last menstrual period date. The current date is 01/06/2016 and the patient's last menstrual period date was 09/21/2015. The gap between these two dates is 15 weeks and 2 days. Hence, the estimated gestational age is 15 weeks and 2 days. "
1039,69,Estimated Gestational Age,date,date,11,Template,The patient's last menstrual period was on 08/23/2002. Today's date is 12/28/2002.,"Based on the patient's last menstrual period, what is the patient's estimated gestational age? Your answer should be a tuple, specifying the number of weeks and days (i.e. (4 weeks, 3 days), (0 weeks, 5 days), (1 week, 5 days), (8 weeks, 0 days)).","{'Current Date': '12/28/2002', 'Last menstrual date': '08/23/2002'}","('18 weeks', '1 days')","('18 weeks', '1 days')","('18 weeks', '1 days')","To compute the estimated gestational age, we compute the number of weeks and days apart today's date is from the patient's last menstrual period date. The current date is 12/28/2002 and the patient's last menstrual period date was 08/23/2002. The gap between these two dates is 18 weeks and 1 days. Hence, the estimated gestational age is 18 weeks and 1 days. "
1040,69,Estimated Gestational Age,date,date,12,Template,The patient's last menstrual period was on 05/11/2010. Today's date is 01/04/2011.,"Based on the patient's last menstrual period, what is the patient's estimated gestational age? Your answer should be a tuple, specifying the number of weeks and days (i.e. (4 weeks, 3 days), (0 weeks, 5 days), (1 week, 5 days), (8 weeks, 0 days)).","{'Current Date': '01/04/2011', 'Last menstrual date': '05/11/2010'}","('34 weeks', '0 days')","('34 weeks', '0 days')","('34 weeks', '0 days')","To compute the estimated gestational age, we compute the number of weeks and days apart today's date is from the patient's last menstrual period date. The current date is 01/04/2011 and the patient's last menstrual period date was 05/11/2010. The gap between these two dates is 34 weeks. Hence, the estimated gestational age is 34 weeks. "
1041,69,Estimated Gestational Age,date,date,13,Template,The patient's last menstrual period was on 03/08/2004. Today's date is 08/28/2004.,"Based on the patient's last menstrual period, what is the patient's estimated gestational age? Your answer should be a tuple, specifying the number of weeks and days (i.e. (4 weeks, 3 days), (0 weeks, 5 days), (1 week, 5 days), (8 weeks, 0 days)).","{'Current Date': '08/28/2004', 'Last menstrual date': '03/08/2004'}","('24 weeks', '5 days')","('24 weeks', '5 days')","('24 weeks', '5 days')","To compute the estimated gestational age, we compute the number of weeks and days apart today's date is from the patient's last menstrual period date. The current date is 08/28/2004 and the patient's last menstrual period date was 03/08/2004. The gap between these two dates is 24 weeks and 5 days. Hence, the estimated gestational age is 24 weeks and 5 days. "
1042,69,Estimated Gestational Age,date,date,14,Template,The patient's last menstrual period was on 03/07/2022. Today's date is 04/07/2022.,"Based on the patient's last menstrual period, what is the patient's estimated gestational age? Your answer should be a tuple, specifying the number of weeks and days (i.e. (4 weeks, 3 days), (0 weeks, 5 days), (1 week, 5 days), (8 weeks, 0 days)).","{'Current Date': '04/07/2022', 'Last menstrual date': '03/07/2022'}","('4 weeks', '3 days')","('4 weeks', '3 days')","('4 weeks', '3 days')","To compute the estimated gestational age, we compute the number of weeks and days apart today's date is from the patient's last menstrual period date. The current date is 04/07/2022 and the patient's last menstrual period date was 03/07/2022. The gap between these two dates is 4 weeks and 3 days. Hence, the estimated gestational age is 4 weeks and 3 days. "
1043,69,Estimated Gestational Age,date,date,15,Template,The patient's last menstrual period was on 07/18/2010. Today's date is 02/09/2011.,"Based on the patient's last menstrual period, what is the patient's estimated gestational age? Your answer should be a tuple, specifying the number of weeks and days (i.e. (4 weeks, 3 days), (0 weeks, 5 days), (1 week, 5 days), (8 weeks, 0 days)).","{'Current Date': '02/09/2011', 'Last menstrual date': '07/18/2010'}","('29 weeks', '3 days')","('29 weeks', '3 days')","('29 weeks', '3 days')","To compute the estimated gestational age, we compute the number of weeks and days apart today's date is from the patient's last menstrual period date. The current date is 02/09/2011 and the patient's last menstrual period date was 07/18/2010. The gap between these two dates is 29 weeks and 3 days. Hence, the estimated gestational age is 29 weeks and 3 days. "
1044,69,Estimated Gestational Age,date,date,16,Template,The patient's last menstrual period was on 01/27/2006. Today's date is 07/31/2006.,"Based on the patient's last menstrual period, what is the patient's estimated gestational age? Your answer should be a tuple, specifying the number of weeks and days (i.e. (4 weeks, 3 days), (0 weeks, 5 days), (1 week, 5 days), (8 weeks, 0 days)).","{'Current Date': '07/31/2006', 'Last menstrual date': '01/27/2006'}","('26 weeks', '3 days')","('26 weeks', '3 days')","('26 weeks', '3 days')","To compute the estimated gestational age, we compute the number of weeks and days apart today's date is from the patient's last menstrual period date. The current date is 07/31/2006 and the patient's last menstrual period date was 01/27/2006. The gap between these two dates is 26 weeks and 3 days. Hence, the estimated gestational age is 26 weeks and 3 days. "
1045,69,Estimated Gestational Age,date,date,17,Template,The patient's last menstrual period was on 10/01/2022. Today's date is 06/13/2023.,"Based on the patient's last menstrual period, what is the patient's estimated gestational age? Your answer should be a tuple, specifying the number of weeks and days (i.e. (4 weeks, 3 days), (0 weeks, 5 days), (1 week, 5 days), (8 weeks, 0 days)).","{'Current Date': '06/13/2023', 'Last menstrual date': '10/01/2022'}","('36 weeks', '3 days')","('36 weeks', '3 days')","('36 weeks', '3 days')","To compute the estimated gestational age, we compute the number of weeks and days apart today's date is from the patient's last menstrual period date. The current date is 06/13/2023 and the patient's last menstrual period date was 10/01/2022. The gap between these two dates is 36 weeks and 3 days. Hence, the estimated gestational age is 36 weeks and 3 days. "
1046,69,Estimated Gestational Age,date,date,18,Template,The patient's last menstrual period was on 08/31/2000. Today's date is 02/03/2001.,"Based on the patient's last menstrual period, what is the patient's estimated gestational age? Your answer should be a tuple, specifying the number of weeks and days (i.e. (4 weeks, 3 days), (0 weeks, 5 days), (1 week, 5 days), (8 weeks, 0 days)).","{'Current Date': '02/03/2001', 'Last menstrual date': '08/31/2000'}","('22 weeks', '2 days')","('22 weeks', '2 days')","('22 weeks', '2 days')","To compute the estimated gestational age, we compute the number of weeks and days apart today's date is from the patient's last menstrual period date. The current date is 02/03/2001 and the patient's last menstrual period date was 08/31/2000. The gap between these two dates is 22 weeks and 2 days. Hence, the estimated gestational age is 22 weeks and 2 days. "
1047,69,Estimated Gestational Age,date,date,19,Template,The patient's last menstrual period was on 07/18/2013. Today's date is 03/19/2014.,"Based on the patient's last menstrual period, what is the patient's estimated gestational age? Your answer should be a tuple, specifying the number of weeks and days (i.e. (4 weeks, 3 days), (0 weeks, 5 days), (1 week, 5 days), (8 weeks, 0 days)).","{'Current Date': '03/19/2014', 'Last menstrual date': '07/18/2013'}","('34 weeks', '6 days')","('34 weeks', '6 days')","('34 weeks', '6 days')","To compute the estimated gestational age, we compute the number of weeks and days apart today's date is from the patient's last menstrual period date. The current date is 03/19/2014 and the patient's last menstrual period date was 07/18/2013. The gap between these two dates is 34 weeks and 6 days. Hence, the estimated gestational age is 34 weeks and 6 days. "
1048,69,Estimated Gestational Age,date,date,20,Template,The patient's last menstrual period was on 10/16/2007. Today's date is 01/24/2008.,"Based on the patient's last menstrual period, what is the patient's estimated gestational age? Your answer should be a tuple, specifying the number of weeks and days (i.e. (4 weeks, 3 days), (0 weeks, 5 days), (1 week, 5 days), (8 weeks, 0 days)).","{'Current Date': '01/24/2008', 'Last menstrual date': '10/16/2007'}","('14 weeks', '2 days')","('14 weeks', '2 days')","('14 weeks', '2 days')","To compute the estimated gestational age, we compute the number of weeks and days apart today's date is from the patient's last menstrual period date. The current date is 01/24/2008 and the patient's last menstrual period date was 10/16/2007. The gap between these two dates is 14 weeks and 2 days. Hence, the estimated gestational age is 14 weeks and 2 days. "