Extended criteria (experimental). This is the broader ten-condition engine, kept as a secondary area. It shows ICD-10-CM codes and illustrative grouping effects for CDI staff. The primary surface is Before you sign (kidney, measurement only). All extended pages.

ENC-00061: Mara Pemberton

47F · MRN24952443 · Hospital Medicine · admitted Sun Nov 08, 2026 09:24 AM · in hospital · attending Dr. Rosalind Quillan · resident Dr. Elena Nakashima · 163 cm, 58.0 kg

Documented diagnoses (current)

Principal: “sepsis” · A41.9 Sepsis, unspecified organism
“community-acquired pneumonia” · J18.9 Pneumonia, unspecified organism
“acute on chronic systolic heart failure” · I50.23 Acute on chronic systolic (congestive) heart failure
“hyponatremia” · E87.1 Hypo-osmolality and hyponatremia

Illustrative grouping now: MS-DRG 871 Septicemia or severe sepsis without MV >96 hours with MCC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG ?.

Queries and events

No queries yet.

All rules applied

Rule Criteria Finding Outcome

Acute kidney injury

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule aki v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: meets_definition	`creat_ratio >= t.ratio_s1 or creat_rise_48h >= t.rise_abs or coalesce(uo_hours_lt_0_5 >= t.uo_s1_h, false)`	creat_ratio=1.048, t.ratio_s1=1.5, creat_rise_48h=0.04, t.rise_abs=0.3, uo_hours_lt_0_5=unknown, t.uo_s1_h=6	false
derived: stage3	`meets_definition and (creat_ratio >= t.ratio_s3 or creat_peak >= t.scr_s3 or rrt_started or coalesce(uo_hours_lt_0_3 >= t.uo_s3_h, false) or coalesce(anuria_hours >= t.anuria_h, false))`	meets_definition=False, creat_ratio=1.048, t.ratio_s3=3.0, creat_peak=0.87, t.scr_s3=4.0, rrt_started=False, uo_hours_lt_0_3=unknown, t.uo_s3_h=24, anuria_hours=unknown, t.anuria_h=12	false
derived: stage2	`creat_ratio >= t.ratio_s2 or coalesce(uo_hours_lt_0_5 >= t.uo_s2_h, false)`	creat_ratio=1.048, t.ratio_s2=2.0, uo_hours_lt_0_5=unknown, t.uo_s2_h=12	false
derived: stage	`case(stage3, 3, stage2, 2, meets_definition, 1, 0)`	stage3=False, stage2=False, meets_definition=False	0
derived: baseline_independent	`creat_baseline_known or creat_rise_48h >= t.rise_abs or rrt_started`	creat_baseline_known=True, creat_rise_48h=0.04, t.rise_abs=0.3, rrt_started=False	true
outcome: aki_staged	`stage >= 1 and baseline_independent`	stage=0, baseline_independent=True	false
outcome: aki_presumed_baseline	`stage >= 1`	stage=0	false
outcome: not_met	`stage == 0`	stage=0	true

Acute blood loss anaemia

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule blood_loss_anemia v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: anaemic	`case(sex == 'M', hgb_nadir < t.hb_m, sex == 'F', hgb_nadir < t.hb_f, null)`	sex=F, hgb_nadir=12.44, t.hb_m=13, t.hb_f=12	false
derived: acute_fall	`hgb_drop >= t.drop_major or prbc_units >= t.prbc_major`	hgb_drop=0.0, t.drop_major=2.0, prbc_units=0, t.prbc_major=2	false
outcome: met	`bleeding_documented and anaemic and acute_fall`	bleeding_documented=False, anaemic=False, acute_fall=False	false
outcome: anaemia_only	`anaemic and hgb_drop < t.drop_min and prbc_units == 0`	anaemic=False, hgb_drop=0.0, t.drop_min=1.0, prbc_units=0	false
outcome: not_anaemic	`present(hgb_nadir) and not anaemic`	hgb_nadir=12.44, anaemic=False	true

Chronic kidney disease

Clinical judgement required

No gap

Not documented; egfr 60 or above; ckd g1-g2 requires markers of kidney damage, which are not assessed here.

Trace

Rule trace (rule ckd v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: chronic	`egfr_n >= 2 and egfr_span_days >= t.chronic_days`	egfr_n=2, egfr_span_days=197, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=85.0, egfr_late=87.4	87.4
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=85.0, t.g2=60, egfr_late=87.4	false
derived: category	`case(staging_egfr >= t.g2, 'G1-G2', staging_egfr >= t.g3a, 'G3a', staging_egfr >= t.g3b, 'G3b', staging_egfr >= t.g4, 'G4', 'G5')`	staging_egfr=87.4, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15	G1-G2
outcome: duration_not_shown	`not chronic`	chronic=True	false
outcome: straddles_60	`not both_below_60 and min(egfr_early, egfr_late) < t.g2`	both_below_60=False, egfr_early=85.0, egfr_late=87.4, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=87.4, t.g2=60	true

Heart failure

Criteria met

No gap

Supported as documented (I50.23).

Trace

Rule trace (rule heart_failure v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: np_elevated	`coalesce(bnp_max >= t.bnp, false) or coalesce(ntprobnp_max >= t.ntprobnp, false)`	bnp_max=2266.0, t.bnp=100, ntprobnp_max=unknown, t.ntprobnp=300	true
derived: acute_count	`count(iv_loop_diuretic, np_elevated, new_o2)`	iv_loop_diuretic=True, np_elevated=True, new_o2=False	2
derived: hf_type	`case(lvef <= t.ref, 'systolic', lvef >= t.pres, 'diastolic', 'midrange')`	lvef=24.0, t.ref=40, t.pres=50	systolic
derived: improved	`coalesce(lvef_prior_min <= t.ref and lvef > t.ref and lvef - lvef_prior_min >= t.improved_rise, false)`	lvef_prior_min=unknown, t.ref=40, lvef=24.0, t.improved_rise=10	false
derived: acuity	`case(acute_count >= 2 and hf_history, 'acute on chronic', acute_count >= 2, 'acute', acute_count == 0 and hf_history, 'chronic', null)`	acute_count=2, hf_history=True	acute on chronic
outcome: improved_ef	`improved`	improved=False	false
outcome: midrange	`hf_type == 'midrange'`	hf_type=systolic	false
outcome: sys_aoc	`hf_type == 'systolic' and acuity == 'acute on chronic'`	hf_type=systolic, acuity=acute on chronic	true

Hyponatraemia

Clinical judgement required

Clinical judgement required: Low sodium without documented treatment or repeat values; clinical significance is a clinician judgement.

Trace

Rule trace (rule hyponatremia v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: severity	`case(na_min < t.profound, 'profound', na_min < t.moderate, 'moderate', na_min < t.low, 'mild', 'none')`	na_min=133.0, t.profound=125, t.moderate=130, t.low=135	mild
outcome: met	`na_min < t.low and na_low_count >= t.repeat and na_treated`	na_min=133.0, t.low=135, na_low_count=1, t.repeat=2, na_treated=False	false
outcome: untreated	`na_min < t.low`	na_min=133.0, t.low=135	true

Malnutrition

Criteria met

Specificity gap

Criteria support Moderate (non-severe) protein-calorie malnutrition (acute illness context) (E44.0); no corresponding diagnosis is documented.

Trace

Rule trace (rule malnutrition v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: a_sev_intake	`intake_pct <= t.a_sev_intake_pct and intake_days >= t.a_sev_intake_days`	intake_pct=70.0, t.a_sev_intake_pct=50, intake_days=9.0, t.a_sev_intake_days=5	false
derived: a_mod_intake	`intake_pct < t.a_mod_intake_pct and intake_days > t.a_mod_intake_days`	intake_pct=70.0, t.a_mod_intake_pct=75, intake_days=9.0, t.a_mod_intake_days=7	true
derived: a_sev_wt	`(wt_loss_days <= 7 and wt_loss_pct > 2) or (wt_loss_days <= 31 and wt_loss_pct > 5) or (wt_loss_days <= 92 and wt_loss_pct > 7.5)`	wt_loss_days=30.0, wt_loss_pct=5.1	true
derived: a_mod_wt	`(wt_loss_days <= 7 and wt_loss_pct >= 1) or (wt_loss_days <= 31 and wt_loss_pct >= 5) or (wt_loss_days <= 92 and wt_loss_pct >= 7.5)`	wt_loss_days=30.0, wt_loss_pct=5.1	true
derived: c_sev_intake	`intake_pct <= t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=70.0, t.c_intake_pct=75, intake_days=9.0, t.c_intake_days=30	false
derived: c_mod_intake	`intake_pct < t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=70.0, t.c_intake_pct=75, intake_days=9.0, t.c_intake_days=30	false
derived: c_sev_wt	`(wt_loss_days <= 31 and wt_loss_pct > 5) or (wt_loss_days <= 92 and wt_loss_pct > 7.5) or (wt_loss_days <= 183 and wt_loss_pct > 10) or (wt_loss_days <= 366 and wt_loss_pct > 20)`	wt_loss_days=30.0, wt_loss_pct=5.1	true
derived: c_mod_wt	`(wt_loss_days <= 31 and wt_loss_pct >= 5) or (wt_loss_days <= 92 and wt_loss_pct >= 7.5) or (wt_loss_days <= 183 and wt_loss_pct >= 10) or (wt_loss_days <= 366 and wt_loss_pct >= 20)`	wt_loss_days=30.0, wt_loss_pct=5.1	true
derived: n_assessed	`known(intake_pct, wt_loss_pct, fat_loss, muscle_loss, fluid, grip_reduced)`	intake_pct=70.0, wt_loss_pct=5.1, fat_loss=1, muscle_loss=1, fluid=0, grip_reduced=unknown	5
derived: n_severe	`case(nutr_context == 'acute', count(a_sev_intake, a_sev_wt, fat_loss >= 2, muscle_loss >= 2, fluid >= 2, grip_reduced), nutr_context == 'chronic', count(c_sev_intake, c_sev_wt, fat_loss >= 3, muscle_loss >= 3, fluid >= 3, grip_reduced), null)`	nutr_context=acute, a_sev_intake=False, a_sev_wt=True, fat_loss=1, muscle_loss=1, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_sev_wt=True	1
derived: n_moderate	`case(nutr_context == 'acute', count(a_sev_intake or a_mod_intake, a_sev_wt or a_mod_wt, fat_loss >= 1, muscle_loss >= 1, fluid >= 1, grip_reduced), nutr_context == 'chronic', count(c_sev_intake or c_mod_intake, c_sev_wt or c_mod_wt, fat_loss >= 1, muscle_loss >= 1, fluid >= 1, grip_reduced), null)`	nutr_context=acute, a_sev_intake=False, a_mod_intake=True, a_sev_wt=True, a_mod_wt=True, fat_loss=1, muscle_loss=1, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_mod_intake=False, c_sev_wt=True, c_mod_wt=True	4
outcome: severe	`n_severe >= 2`	n_severe=1	false
outcome: moderate	`n_moderate >= 2`	n_moderate=4	true

Obesity

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule obesity v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
outcome: not_adult	`age < t.adult`	age=47, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=21.8, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=21.8, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=21.8, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=21.8, t.c1=30	true

Pressure injury

Insufficient data

No gap

Insufficient data: the criteria could not be applied.

Trace

Rule trace (rule pressure_injury v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: sacral	`wound_site == 'sacral'`	wound_site=unknown	unknown
outcome: no_wound_note	`not present(wound_stage)`	wound_stage=unknown	true

Acute respiratory failure

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule respiratory_failure v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: measured	`present(spo2_min_ra) or present(pao2_min_ra) or present(pf_min)`	spo2_min_ra=94.0, pao2_min_ra=unknown, pf_min=unknown	true
derived: hypoxemia	`coalesce(spo2_min_ra < t.spo2_ra, false) or coalesce(pao2_min_ra < t.pao2, false) or coalesce(pf_min < t.pf, false)`	spo2_min_ra=94.0, t.spo2_ra=88, pao2_min_ra=unknown, t.pao2=60, pf_min=unknown, t.pf=300	false
derived: distress	`coalesce(rr_max >= t.rr_distress, false) or coalesce(wob_increased, false) or adv_resp_support`	rr_max=19.0, t.rr_distress=28, wob_increased=unknown, adv_resp_support=False	false
outcome: chronic_baseline	`home_o2 and hypoxemia`	home_o2=False, hypoxemia=False	false
outcome: met	`hypoxemia and distress`	hypoxemia=False, distress=False	false
outcome: hypoxemia_only	`hypoxemia`	hypoxemia=False	false
outcome: not_met	`measured and not hypoxemia and o2_max_lpm <= t.o2_low and not adv_resp_support`	measured=True, hypoxemia=False, o2_max_lpm=0.0, t.o2_low=2, adv_resp_support=False	true

Sepsis

Criteria met

Specificity gap

Documented “sepsis” (A41.9); criteria support the more specific Sepsis with septic shock (R65.21).

Trace

Rule trace (rule sepsis v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: sirs_temp	`coalesce(temp_max_48h > t.t_hi, false) or coalesce(temp_min_48h < t.t_lo, false)`	temp_max_48h=39.1, t.t_hi=38, temp_min_48h=38.6, t.t_lo=36	true
derived: sirs_hr	`coalesce(hr_max_48h > t.hr, false)`	hr_max_48h=122.0, t.hr=90	true
derived: sirs_rr	`coalesce(rr_max_48h > t.rr, false) or coalesce(paco2_min_48h < t.paco2, false)`	rr_max_48h=19.0, t.rr=20, paco2_min_48h=unknown, t.paco2=32	false
derived: sirs_wbc	`coalesce(wbc_max_48h > t.wbc_hi, false) or coalesce(wbc_min_48h < t.wbc_lo, false) or coalesce(bands_max_48h > t.bands, false)`	wbc_max_48h=17.81, t.wbc_hi=12, wbc_min_48h=14.6, t.wbc_lo=4, bands_max_48h=unknown, t.bands=10	true
derived: sirs_count	`count(sirs_temp, sirs_hr, sirs_rr, sirs_wbc)`	sirs_temp=True, sirs_hr=True, sirs_rr=False, sirs_wbc=True	3
derived: sofa_resp	`coalesce(case(pf_min_48h < 100 and adv_resp_support, 4, pf_min_48h < 200 and adv_resp_support, 3, pf_min_48h < 300, 2, pf_min_48h < 400, 1, 0), 0)`	pf_min_48h=unknown, adv_resp_support=False	0
derived: sofa_coag	`coalesce(case(platelets_min_48h < 20, 4, platelets_min_48h < 50, 3, platelets_min_48h < 100, 2, platelets_min_48h < 150, 1, 0), 0)`	platelets_min_48h=88.0	2
derived: sofa_liver	`coalesce(case(bili_max_48h >= 12, 4, bili_max_48h >= 6, 3, bili_max_48h >= 2, 2, bili_max_48h >= 1.2, 1, 0), 0)`	bili_max_48h=0.43	0
derived: sofa_cardio	`coalesce(case(norepi_max_48h > 0.1, 4, norepi_max_48h > 0, 3, map_min_48h < 70, 1, 0), 0)`	norepi_max_48h=0.07, map_min_48h=60.0	3
derived: sofa_cns	`coalesce(case(gcs_min_48h < 6, 4, gcs_min_48h < 10, 3, gcs_min_48h < 13, 2, gcs_min_48h < 15, 1, 0), 0)`	gcs_min_48h=15.0	0
derived: sofa_renal	`coalesce(case(creat_max_48h >= 5, 4, creat_max_48h >= 3.5, 3, creat_max_48h >= 2, 2, creat_max_48h >= 1.2, 1, 0), 0)`	creat_max_48h=0.87	0
derived: sofa_renal_baseline	`coalesce(case(creat_baseline >= 5, 4, creat_baseline >= 3.5, 3, creat_baseline >= 2, 2, creat_baseline >= 1.2, 1, 0), 0)`	creat_baseline=0.83	0
derived: sofa_delta	`sofa_resp + sofa_coag + sofa_liver + sofa_cardio + sofa_cns + sofa_renal - sofa_renal_baseline`	sofa_resp=0, sofa_coag=2, sofa_liver=0, sofa_cardio=3, sofa_cns=0, sofa_renal=0, sofa_renal_baseline=0	5
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=True, sofa_delta=5, t.sofa_delta=2	true
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=True, sirs_count=3, t.sirs_min=2	true
derived: shock	`sepsis3 and norepi_max_48h > 0 and coalesce(lactate_max_48h > t.lactate, false)`	sepsis3=True, norepi_max_48h=0.07, lactate_max_48h=3.78, t.lactate=2	true
outcome: no_infection	`not infection_documented`	infection_documented=True	false
outcome: septic_shock	`shock`	shock=True	true

Structured data

Labs (35)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-002059	Fri Jan 09, 2026 09:15 AM	creatinine	0.85 mg/dL
LAB-002060	Sun Jul 26, 2026 10:05 AM	creatinine	0.83 mg/dL
LAB-002061	Sun Nov 08, 2026 10:24 AM	creatinine	0.87 mg/dL
LAB-002067	Sun Nov 08, 2026 10:24 AM	bnp	2266.0 pg/mL
LAB-002068	Sun Nov 08, 2026 10:24 AM	sodium	133.0 mmol/L
LAB-002074	Sun Nov 08, 2026 10:24 AM	hemoglobin	12.44 g/dL
LAB-002080	Sun Nov 08, 2026 10:24 AM	wbc	14.6 x10^3/uL
LAB-002081	Sun Nov 08, 2026 10:24 AM	platelets	89.0 x10^3/uL
LAB-002092	Sun Nov 08, 2026 10:24 AM	bilirubin	0.43 mg/dL
LAB-002093	Sun Nov 08, 2026 10:24 AM	lactate	3.78 mmol/L
LAB-002062	Mon Nov 09, 2026 05:00 AM	creatinine	0.85 mg/dL
LAB-002069	Mon Nov 09, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-002075	Mon Nov 09, 2026 05:00 AM	hemoglobin	12.59 g/dL
LAB-002082	Mon Nov 09, 2026 05:00 AM	wbc	14.71 x10^3/uL
LAB-002083	Mon Nov 09, 2026 05:00 AM	platelets	95.0 x10^3/uL
LAB-002063	Tue Nov 10, 2026 05:00 AM	creatinine	0.82 mg/dL
LAB-002070	Tue Nov 10, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-002076	Tue Nov 10, 2026 05:00 AM	hemoglobin	12.52 g/dL
LAB-002084	Tue Nov 10, 2026 05:00 AM	wbc	17.81 x10^3/uL
LAB-002085	Tue Nov 10, 2026 05:00 AM	platelets	88.0 x10^3/uL
LAB-002064	Wed Nov 11, 2026 05:00 AM	creatinine	0.86 mg/dL
LAB-002071	Wed Nov 11, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-002077	Wed Nov 11, 2026 05:00 AM	hemoglobin	12.9 g/dL
LAB-002086	Wed Nov 11, 2026 05:00 AM	wbc	9.24 x10^3/uL
LAB-002087	Wed Nov 11, 2026 05:00 AM	platelets	301.0 x10^3/uL
LAB-002065	Thu Nov 12, 2026 05:00 AM	creatinine	0.83 mg/dL
LAB-002072	Thu Nov 12, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-002078	Thu Nov 12, 2026 05:00 AM	hemoglobin	12.49 g/dL
LAB-002088	Thu Nov 12, 2026 05:00 AM	wbc	10.41 x10^3/uL
LAB-002089	Thu Nov 12, 2026 05:00 AM	platelets	245.0 x10^3/uL
LAB-002066	Fri Nov 13, 2026 05:00 AM	creatinine	0.84 mg/dL
LAB-002073	Fri Nov 13, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-002079	Fri Nov 13, 2026 05:00 AM	hemoglobin	12.56 g/dL
LAB-002090	Fri Nov 13, 2026 05:00 AM	wbc	10.94 x10^3/uL
LAB-002091	Fri Nov 13, 2026 05:00 AM	platelets	299.0 x10^3/uL

Vitals (96)

Vitals
Row	When	Kind	Value	Detail
VIT-005921	Sun Nov 08, 2026 09:44 AM	spo2	95.0	room air
VIT-005922	Sun Nov 08, 2026 09:44 AM	rr	18.0
VIT-005953	Sun Nov 08, 2026 09:44 AM	temp_c	38.6
VIT-005954	Sun Nov 08, 2026 09:44 AM	hr	118.0
VIT-005955	Sun Nov 08, 2026 09:44 AM	map	64.0
VIT-005956	Sun Nov 08, 2026 09:44 AM	gcs	15.0
VIT-005923	Sun Nov 08, 2026 05:44 PM	spo2	98.0	room air
VIT-005924	Sun Nov 08, 2026 05:44 PM	rr	19.0
VIT-005957	Sun Nov 08, 2026 05:44 PM	temp_c	38.9
VIT-005958	Sun Nov 08, 2026 05:44 PM	hr	105.0
VIT-005959	Sun Nov 08, 2026 05:44 PM	map	60.0
VIT-005960	Sun Nov 08, 2026 05:44 PM	gcs	15.0
VIT-005925	Mon Nov 09, 2026 01:44 AM	spo2	98.0	room air
VIT-005926	Mon Nov 09, 2026 01:44 AM	rr	19.0
VIT-005961	Mon Nov 09, 2026 01:44 AM	temp_c	39.1
VIT-005962	Mon Nov 09, 2026 01:44 AM	hr	103.0
VIT-005963	Mon Nov 09, 2026 01:44 AM	map	63.0
VIT-005964	Mon Nov 09, 2026 01:44 AM	gcs	15.0
VIT-005927	Mon Nov 09, 2026 09:44 AM	spo2	99.0	room air
VIT-005928	Mon Nov 09, 2026 09:44 AM	rr	17.0
VIT-005965	Mon Nov 09, 2026 09:44 AM	temp_c	38.8
VIT-005966	Mon Nov 09, 2026 09:44 AM	hr	103.0
VIT-005967	Mon Nov 09, 2026 09:44 AM	map	63.0
VIT-005968	Mon Nov 09, 2026 09:44 AM	gcs	15.0
VIT-005929	Mon Nov 09, 2026 05:44 PM	spo2	97.0	room air
VIT-005930	Mon Nov 09, 2026 05:44 PM	rr	16.0
VIT-005969	Mon Nov 09, 2026 05:44 PM	temp_c	39.0
VIT-005970	Mon Nov 09, 2026 05:44 PM	hr	122.0
VIT-005971	Mon Nov 09, 2026 05:44 PM	map	62.0
VIT-005972	Mon Nov 09, 2026 05:44 PM	gcs	15.0
VIT-005931	Tue Nov 10, 2026 01:44 AM	spo2	95.0	room air
VIT-005932	Tue Nov 10, 2026 01:44 AM	rr	15.0
VIT-005973	Tue Nov 10, 2026 01:44 AM	temp_c	38.7
VIT-005974	Tue Nov 10, 2026 01:44 AM	hr	108.0
VIT-005975	Tue Nov 10, 2026 01:44 AM	map	61.0
VIT-005976	Tue Nov 10, 2026 01:44 AM	gcs	15.0
VIT-005933	Tue Nov 10, 2026 09:44 AM	spo2	96.0	room air
VIT-005934	Tue Nov 10, 2026 09:44 AM	rr	15.0
VIT-005977	Tue Nov 10, 2026 09:44 AM	temp_c	36.6
VIT-005978	Tue Nov 10, 2026 09:44 AM	hr	84.0
VIT-005979	Tue Nov 10, 2026 09:44 AM	map	90.0
VIT-005980	Tue Nov 10, 2026 09:44 AM	gcs	15.0
VIT-005935	Tue Nov 10, 2026 05:44 PM	spo2	95.0	room air
VIT-005936	Tue Nov 10, 2026 05:44 PM	rr	16.0
VIT-005981	Tue Nov 10, 2026 05:44 PM	temp_c	37.2
VIT-005982	Tue Nov 10, 2026 05:44 PM	hr	76.0
VIT-005983	Tue Nov 10, 2026 05:44 PM	map	88.0
VIT-005984	Tue Nov 10, 2026 05:44 PM	gcs	15.0
VIT-005937	Wed Nov 11, 2026 01:44 AM	spo2	97.0	room air
VIT-005938	Wed Nov 11, 2026 01:44 AM	rr	14.0
VIT-005985	Wed Nov 11, 2026 01:44 AM	temp_c	37.5
VIT-005986	Wed Nov 11, 2026 01:44 AM	hr	69.0
VIT-005987	Wed Nov 11, 2026 01:44 AM	map	88.0
VIT-005988	Wed Nov 11, 2026 01:44 AM	gcs	15.0
VIT-005939	Wed Nov 11, 2026 09:44 AM	spo2	94.0	room air
VIT-005940	Wed Nov 11, 2026 09:44 AM	rr	16.0
VIT-005989	Wed Nov 11, 2026 09:44 AM	temp_c	37.4
VIT-005990	Wed Nov 11, 2026 09:44 AM	hr	71.0
VIT-005991	Wed Nov 11, 2026 09:44 AM	map	86.0
VIT-005992	Wed Nov 11, 2026 09:44 AM	gcs	15.0
VIT-005941	Wed Nov 11, 2026 05:44 PM	spo2	95.0	room air
VIT-005942	Wed Nov 11, 2026 05:44 PM	rr	16.0
VIT-005993	Wed Nov 11, 2026 05:44 PM	temp_c	36.8
VIT-005994	Wed Nov 11, 2026 05:44 PM	hr	91.0
VIT-005995	Wed Nov 11, 2026 05:44 PM	map	80.0
VIT-005996	Wed Nov 11, 2026 05:44 PM	gcs	15.0
VIT-005943	Thu Nov 12, 2026 01:44 AM	spo2	96.0	room air
VIT-005944	Thu Nov 12, 2026 01:44 AM	rr	15.0
VIT-005997	Thu Nov 12, 2026 01:44 AM	temp_c	36.8
VIT-005998	Thu Nov 12, 2026 01:44 AM	hr	91.0
VIT-005999	Thu Nov 12, 2026 01:44 AM	map	82.0
VIT-006000	Thu Nov 12, 2026 01:44 AM	gcs	15.0
VIT-005945	Thu Nov 12, 2026 09:44 AM	spo2	95.0	room air
VIT-005946	Thu Nov 12, 2026 09:44 AM	rr	15.0
VIT-006001	Thu Nov 12, 2026 09:44 AM	temp_c	36.5
VIT-006002	Thu Nov 12, 2026 09:44 AM	hr	79.0
VIT-006003	Thu Nov 12, 2026 09:44 AM	map	87.0
VIT-006004	Thu Nov 12, 2026 09:44 AM	gcs	15.0
VIT-005947	Thu Nov 12, 2026 05:44 PM	spo2	98.0	room air
VIT-005948	Thu Nov 12, 2026 05:44 PM	rr	14.0
VIT-006005	Thu Nov 12, 2026 05:44 PM	temp_c	36.7
VIT-006006	Thu Nov 12, 2026 05:44 PM	hr	90.0
VIT-006007	Thu Nov 12, 2026 05:44 PM	map	80.0
VIT-006008	Thu Nov 12, 2026 05:44 PM	gcs	15.0
VIT-005949	Fri Nov 13, 2026 01:44 AM	spo2	98.0	room air
VIT-005950	Fri Nov 13, 2026 01:44 AM	rr	16.0
VIT-006009	Fri Nov 13, 2026 01:44 AM	temp_c	37.0
VIT-006010	Fri Nov 13, 2026 01:44 AM	hr	82.0
VIT-006011	Fri Nov 13, 2026 01:44 AM	map	75.0
VIT-006012	Fri Nov 13, 2026 01:44 AM	gcs	15.0
VIT-005951	Fri Nov 13, 2026 09:44 AM	spo2	99.0	room air
VIT-005952	Fri Nov 13, 2026 09:44 AM	rr	15.0
VIT-006013	Fri Nov 13, 2026 09:44 AM	temp_c	37.1
VIT-006014	Fri Nov 13, 2026 09:44 AM	hr	69.0
VIT-006015	Fri Nov 13, 2026 09:44 AM	map	89.0
VIT-006016	Fri Nov 13, 2026 09:44 AM	gcs	15.0

Medications, orders, echo, history (16)

MED-000217 11-08 10:24 ceftriaxone per protocol IV
MED-000218 11-09 05:00 cefepime per protocol IV
MED-000219 11-10 05:00 cefepime per protocol IV
MED-000220 11-08 08:00 furosemide 40 mg IV
MED-000221 11-08 20:00 furosemide 40 mg IV
MED-000222 11-09 08:00 furosemide 40 mg IV
MED-000223 11-09 20:00 furosemide 40 mg IV
MED-000224 11-10 08:00 furosemide 40 mg IV
MED-000225 11-10 20:00 furosemide 40 mg IV
MED-000226 11-08 10:24 norepinephrine infusion IV 0.07 mcg/kg/min
MED-000227 11-08 14:24 norepinephrine infusion IV 0.07 mcg/kg/min
MED-000228 11-08 18:24 norepinephrine infusion IV 0.06 mcg/kg/min
MED-000229 11-08 23:24 norepinephrine infusion IV 0.07 mcg/kg/min
ORD-000049 11-08 09:54 blood_culture: blood cultures x2
ECH-000028 2026-11-09 echo LVEF 24.0%
HX-000021 history: heart failure with reduced ejection fraction

Notes

History and physical · DOC-000211 · Dr. Elena Nakashima (resident) · Sun Nov 08, 2026 12:24 PM

Cited facts from this note (1)

infection_source: multifocal pneumonia · cited p. 1, line 5 · confidence 0.85

Show source for infection_source

… 11-08 09:24 Service: Hospital Medicine Attending: Dr. Rosalind Quillan History of present illness: 47-year-old woman admitted with sepsis. Chest x-ray shows multifocal pneumonia; blood cultures drawn and ceftriaxone started. Hypotensive despite a 30 mL/kg crystalloid bolus; norepinephrine started. Past medical history: heart failure wi …

Source document DOC-000211: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Mara Pemberton   MRN: MRN24952443   Admitted: 2026-11-08 09:24
Service: Hospital Medicine   Attending: Dr. Rosalind Quillan

History of present illness: 47-year-old woman admitted with sepsis. Chest x-ray shows multifocal pneumonia; blood cultures drawn and ceftriaxone started. Hypotensive despite a 30 mL/kg crystalloid bolus; norepinephrine started.
Past medical history: heart failure with reduced ejection fraction.
Review of systems otherwise negative.
Exam: Lungs: clear to auscultation bilaterally.
Assessment and plan:
1. Sepsis: antibiotics, fluids.
2. Community-acquired pneumonia: antibiotics.

Nutrition assessment · DOC-000210 · Dario Larkspur, RD (dietitian) · Mon Nov 09, 2026 02:24 PM

Cited facts from this note (8)

fat_loss: mild · cited p. 1, line 7 · confidence 0.90

Show source for fat_loss

… Context: acute illness Intake: estimated energy intake 70% of needs for 9 days. Weight history: 5.1% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; calorie counts; weekly weights.
fluid_accumulation: none · cited p. 1, line 7 · confidence 0.90

Show source for fluid_accumulation

… ke 70% of needs for 9 days. Weight history: 5.1% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; calorie counts; weekly weights.
intake_days: 9 · cited p. 1, line 5 · confidence 0.95

Show source for intake_days

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Mara Pemberton MRN: MRN24952443 Context: acute illness Intake: estimated energy intake 70% of needs for 9 days. Weight history: 5.1% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Rec …
intake_pct: 70 · cited p. 1, line 5 · confidence 0.95

Show source for intake_pct

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Mara Pemberton MRN: MRN24952443 Context: acute illness Intake: estimated energy intake 70% of needs for 9 days. Weight history: 5.1% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Rec …
muscle_loss: mild · cited p. 1, line 7 · confidence 0.90

Show source for muscle_loss

… estimated energy intake 70% of needs for 9 days. Weight history: 5.1% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; calorie counts; weekly weights.
nutrition_context: acute · cited p. 1, line 4 · confidence 0.95

Show source for nutrition_context

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Mara Pemberton MRN: MRN24952443 Context: acute illness Intake: estimated energy intake 70% of needs for 9 days. Weight history: 5.1% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutane …
weight_loss_days: 30 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_days

… gistered Dietitian) Patient: Mara Pemberton MRN: MRN24952443 Context: acute illness Intake: estimated energy intake 70% of needs for 9 days. Weight history: 5.1% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; cal …
weight_loss_pct: 5.1 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_pct

… gistered Dietitian) Patient: Mara Pemberton MRN: MRN24952443 Context: acute illness Intake: estimated energy intake 70% of needs for 9 days. Weight history: 5.1% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; cal …

Source document DOC-000210: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Mara Pemberton   MRN: MRN24952443

Context: acute illness
Intake: estimated energy intake 70% of needs for 9 days.
Weight history: 5.1% weight loss over 30 days.
Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation.
Recommendations: high-protein oral supplement; calorie counts; weekly weights.

Progress note · DOC-000212 · Dr. Elena Nakashima (resident) · Fri Nov 13, 2026 10:55 AM · awaiting cosign

Source document DOC-000212: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Mara Pemberton   MRN: MRN24952443   Hospital day 6

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Sepsis: continue current management.
2. Acute on chronic systolic heart failure: diuresis and daily weights; monitor electrolytes.
3. Hyponatremia: trend sodium.

Resident: Dr. Elena Nakashima   Attending cosign: pending