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-00098: Celeste Hartwell

80M · MRN52546438 · Hospital Medicine · admitted Sat Nov 07, 2026 10:30 PM · in hospital · attending Dr. Kenji Stavros · 166 cm, 51.8 kg

Documented diagnoses (current)

Principal: “urinary tract infection” · N39.0 Urinary tract infection, site not specified
“severe protein-calorie malnutrition” · E43 Unspecified severe protein-calorie malnutrition
“acute respiratory failure with hypoxia” · J96.01 Acute respiratory failure with hypoxia
“hyponatremia” · E87.1 Hypo-osmolality and hyponatremia
“acute blood loss anemia” · D62 Acute posthemorrhagic anemia
“hypertension” · I10 Essential (primary) hypertension
“hyperlipidemia” · E78.5 Hyperlipidemia, unspecified

Illustrative grouping now: MS-DRG 689 Kidney and urinary tract infections with MCC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 690.

Queries and events

No queries yet.

All rules applied

Rule Criteria Finding Outcome

Acute kidney injury

Criteria met

Specificity gap

Criteria support Acute kidney injury (KDIGO stage 2) (N17.9); no corresponding diagnosis is documented.

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=2.574, t.ratio_s1=1.5, creat_rise_48h=0.53, t.rise_abs=0.3, uo_hours_lt_0_5=unknown, t.uo_s1_h=6	true
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=True, creat_ratio=2.574, t.ratio_s3=3.0, creat_peak=2.42, 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=2.574, t.ratio_s2=2.0, uo_hours_lt_0_5=unknown, t.uo_s2_h=12	true
derived: stage	`case(stage3, 3, stage2, 2, meets_definition, 1, 0)`	stage3=False, stage2=True, meets_definition=True	2
derived: baseline_independent	`creat_baseline_known or creat_rise_48h >= t.rise_abs or rrt_started`	creat_baseline_known=True, creat_rise_48h=0.53, t.rise_abs=0.3, rrt_started=False	true
outcome: aki_staged	`stage >= 1 and baseline_independent`	stage=2, baseline_independent=True	true

Acute blood loss anaemia

Criteria met

No gap

Supported as documented (D62).

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=M, hgb_nadir=9.58, t.hb_m=13, t.hb_f=12	true
derived: acute_fall	`hgb_drop >= t.drop_major or prbc_units >= t.prbc_major`	hgb_drop=3.2, t.drop_major=2.0, prbc_units=2, t.prbc_major=2	true
outcome: met	`bleeding_documented and anaemic and acute_fall`	bleeding_documented=True, anaemic=True, acute_fall=True	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=311, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=85.2, egfr_late=81.9	85.2
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=85.2, t.g2=60, egfr_late=81.9	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=85.2, 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=85.2, egfr_late=81.9, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=85.2, t.g2=60	true

Heart failure

Insufficient data

No gap

Insufficient data: the criteria could not be applied.

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=unknown, t.bnp=100, ntprobnp_max=unknown, t.ntprobnp=300	false
derived: acute_count	`count(iv_loop_diuretic, np_elevated, new_o2)`	iv_loop_diuretic=False, np_elevated=False, new_o2=False	0
derived: hf_type	`case(lvef <= t.ref, 'systolic', lvef >= t.pres, 'diastolic', 'midrange')`	lvef=unknown, t.ref=40, t.pres=50	unknown
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=unknown, 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=0, hf_history=False	unknown
outcome: improved_ef	`improved`	improved=False	false
outcome: midrange	`hf_type == 'midrange'`	hf_type=unknown	unknown
outcome: sys_aoc	`hf_type == 'systolic' and acuity == 'acute on chronic'`	hf_type=unknown, acuity=unknown	unknown
outcome: sys_acute	`hf_type == 'systolic' and acuity == 'acute'`	hf_type=unknown, acuity=unknown	unknown
outcome: sys_chronic	`hf_type == 'systolic' and acuity == 'chronic'`	hf_type=unknown, acuity=unknown	unknown
outcome: dia_aoc	`hf_type == 'diastolic' and acuity == 'acute on chronic'`	hf_type=unknown, acuity=unknown	unknown
outcome: dia_acute	`hf_type == 'diastolic' and acuity == 'acute'`	hf_type=unknown, acuity=unknown	unknown
outcome: dia_chronic	`hf_type == 'diastolic' and acuity == 'chronic'`	hf_type=unknown, acuity=unknown	unknown
outcome: one_indicator	`acute_count == 1`	acute_count=0	false

Hyponatraemia

Criteria not met

Clinical validation gap

Documented “hyponatremia” (E87.1) but the criteria are not met: All sodium values 135 or above (lowest 136).

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=136.0, t.profound=125, t.moderate=130, t.low=135	none
outcome: met	`na_min < t.low and na_low_count >= t.repeat and na_treated`	na_min=136.0, t.low=135, na_low_count=0, t.repeat=2, na_treated=False	false
outcome: untreated	`na_min < t.low`	na_min=136.0, t.low=135	false
outcome: not_met	`na_min >= t.low`	na_min=136.0, t.low=135	true

Malnutrition

Criteria met

Clinical validation gap

Documented “severe protein-calorie malnutrition” (E43) conflicts with what the criteria support (Moderate (non-severe) protein-calorie malnutrition (acute illness context), E44.0).

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=60.0, 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=60.0, 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=3.0	false
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=3.0	false
derived: c_sev_intake	`intake_pct <= t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=60.0, 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=60.0, 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=3.0	false
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=3.0	false
derived: n_assessed	`known(intake_pct, wt_loss_pct, fat_loss, muscle_loss, fluid, grip_reduced)`	intake_pct=60.0, wt_loss_pct=3.0, 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=False, fat_loss=1, muscle_loss=1, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_sev_wt=False	0
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=False, a_mod_wt=False, fat_loss=1, muscle_loss=1, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_mod_intake=False, c_sev_wt=False, c_mod_wt=False	3
outcome: severe	`n_severe >= 2`	n_severe=0	false
outcome: moderate	`n_moderate >= 2`	n_moderate=3	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=80, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=18.8, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=18.8, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=18.8, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=18.8, 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

Clinical validation gap

Documented “acute respiratory failure with hypoxia” (J96.01) but the criteria are not met: No hypoxaemia on room air (lowest SpO2 93%), oxygen no more than 0 L/min, no advanced support.

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=93.0, 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=93.0, 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=21.0, 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

No gap

Criteria support Sepsis (Sepsis-3); not documented (this rule does not prompt for an undocumented diagnosis).

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=37.6, t.t_hi=38, temp_min_48h=36.6, t.t_lo=36	false
derived: sirs_hr	`coalesce(hr_max_48h > t.hr, false)`	hr_max_48h=89.0, t.hr=90	false
derived: sirs_rr	`coalesce(rr_max_48h > t.rr, false) or coalesce(paco2_min_48h < t.paco2, false)`	rr_max_48h=21.0, t.rr=20, paco2_min_48h=unknown, t.paco2=32	true
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=10.19, t.wbc_hi=12, wbc_min_48h=6.6, t.wbc_lo=4, bands_max_48h=unknown, t.bands=10	false
derived: sirs_count	`count(sirs_temp, sirs_hr, sirs_rr, sirs_wbc)`	sirs_temp=False, sirs_hr=False, sirs_rr=True, sirs_wbc=False	1
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=192.0	0
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=0.65	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=0.0, map_min_48h=76.0	0
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=2.42	2
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=0.94	0
derived: sofa_delta	`sofa_resp + sofa_coag + sofa_liver + sofa_cardio + sofa_cns + sofa_renal - sofa_renal_baseline`	sofa_resp=0, sofa_coag=0, sofa_liver=0, sofa_cardio=0, sofa_cns=0, sofa_renal=2, sofa_renal_baseline=0	2
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=True, sofa_delta=2, t.sofa_delta=2	true
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=True, sirs_count=1, t.sirs_min=2	false
derived: shock	`sepsis3 and norepi_max_48h > 0 and coalesce(lactate_max_48h > t.lactate, false)`	sepsis3=True, norepi_max_48h=0.0, lactate_max_48h=unknown, t.lactate=2	false
outcome: no_infection	`not infection_documented`	infection_documented=True	false
outcome: septic_shock	`shock`	shock=False	false
outcome: both	`sepsis3 and sepsis2`	sepsis3=True, sepsis2=False	false
outcome: sepsis3_only	`sepsis3`	sepsis3=True	true

Structured data

Labs (38)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-003319	Tue Nov 11, 2025 09:15 AM	creatinine	0.91 mg/dL
LAB-003320	Sat Sep 19, 2026 10:05 AM	creatinine	0.94 mg/dL
LAB-003321	Sat Nov 07, 2026 11:30 PM	creatinine	1.89 mg/dL
LAB-003328	Sat Nov 07, 2026 11:30 PM	sodium	136.0 mmol/L
LAB-003335	Sat Nov 07, 2026 11:30 PM	hemoglobin	12.75 g/dL
LAB-003342	Sat Nov 07, 2026 11:30 PM	wbc	9.17 x10^3/uL
LAB-003343	Sat Nov 07, 2026 11:30 PM	platelets	192.0 x10^3/uL
LAB-003356	Sat Nov 07, 2026 11:30 PM	bilirubin	0.65 mg/dL
LAB-003322	Sun Nov 08, 2026 05:00 AM	creatinine	2.42 mg/dL
LAB-003329	Sun Nov 08, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-003336	Sun Nov 08, 2026 05:00 AM	hemoglobin	10.85 g/dL
LAB-003344	Sun Nov 08, 2026 05:00 AM	wbc	6.6 x10^3/uL
LAB-003345	Sun Nov 08, 2026 05:00 AM	platelets	241.0 x10^3/uL
LAB-003323	Mon Nov 09, 2026 05:00 AM	creatinine	2.18 mg/dL
LAB-003330	Mon Nov 09, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-003337	Mon Nov 09, 2026 05:00 AM	hemoglobin	9.58 g/dL
LAB-003346	Mon Nov 09, 2026 05:00 AM	wbc	10.19 x10^3/uL
LAB-003347	Mon Nov 09, 2026 05:00 AM	platelets	254.0 x10^3/uL
LAB-003324	Tue Nov 10, 2026 05:00 AM	creatinine	1.81 mg/dL
LAB-003331	Tue Nov 10, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-003338	Tue Nov 10, 2026 05:00 AM	hemoglobin	10.38 g/dL
LAB-003348	Tue Nov 10, 2026 05:00 AM	wbc	9.49 x10^3/uL
LAB-003349	Tue Nov 10, 2026 05:00 AM	platelets	224.0 x10^3/uL
LAB-003325	Wed Nov 11, 2026 05:00 AM	creatinine	1.5 mg/dL
LAB-003332	Wed Nov 11, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-003339	Wed Nov 11, 2026 05:00 AM	hemoglobin	10.68 g/dL
LAB-003350	Wed Nov 11, 2026 05:00 AM	wbc	8.69 x10^3/uL
LAB-003351	Wed Nov 11, 2026 05:00 AM	platelets	286.0 x10^3/uL
LAB-003326	Thu Nov 12, 2026 05:00 AM	creatinine	1.33 mg/dL
LAB-003333	Thu Nov 12, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-003340	Thu Nov 12, 2026 05:00 AM	hemoglobin	10.78 g/dL
LAB-003352	Thu Nov 12, 2026 05:00 AM	wbc	7.81 x10^3/uL
LAB-003353	Thu Nov 12, 2026 05:00 AM	platelets	175.0 x10^3/uL
LAB-003327	Fri Nov 13, 2026 05:00 AM	creatinine	1.21 mg/dL
LAB-003334	Fri Nov 13, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-003341	Fri Nov 13, 2026 05:00 AM	hemoglobin	10.78 g/dL
LAB-003354	Fri Nov 13, 2026 05:00 AM	wbc	6.96 x10^3/uL
LAB-003355	Fri Nov 13, 2026 05:00 AM	platelets	212.0 x10^3/uL

Vitals (108)

Vitals
Row	When	Kind	Value	Detail
VIT-009541	Sat Nov 07, 2026 10:50 PM	spo2	95.0	room air
VIT-009542	Sat Nov 07, 2026 10:50 PM	rr	16.0
VIT-009577	Sat Nov 07, 2026 10:50 PM	temp_c	36.6
VIT-009578	Sat Nov 07, 2026 10:50 PM	hr	74.0
VIT-009579	Sat Nov 07, 2026 10:50 PM	map	76.0
VIT-009580	Sat Nov 07, 2026 10:50 PM	gcs	15.0
VIT-009543	Sun Nov 08, 2026 06:50 AM	spo2	94.0	room air
VIT-009544	Sun Nov 08, 2026 06:50 AM	rr	21.0
VIT-009581	Sun Nov 08, 2026 06:50 AM	temp_c	36.6
VIT-009582	Sun Nov 08, 2026 06:50 AM	hr	73.0
VIT-009583	Sun Nov 08, 2026 06:50 AM	map	86.0
VIT-009584	Sun Nov 08, 2026 06:50 AM	gcs	15.0
VIT-009545	Sun Nov 08, 2026 02:50 PM	spo2	96.0	room air
VIT-009546	Sun Nov 08, 2026 02:50 PM	rr	16.0
VIT-009585	Sun Nov 08, 2026 02:50 PM	temp_c	37.6
VIT-009586	Sun Nov 08, 2026 02:50 PM	hr	89.0
VIT-009587	Sun Nov 08, 2026 02:50 PM	map	79.0
VIT-009588	Sun Nov 08, 2026 02:50 PM	gcs	15.0
VIT-009547	Sun Nov 08, 2026 10:50 PM	spo2	97.0	room air
VIT-009548	Sun Nov 08, 2026 10:50 PM	rr	20.0
VIT-009589	Sun Nov 08, 2026 10:50 PM	temp_c	37.4
VIT-009590	Sun Nov 08, 2026 10:50 PM	hr	80.0
VIT-009591	Sun Nov 08, 2026 10:50 PM	map	80.0
VIT-009592	Sun Nov 08, 2026 10:50 PM	gcs	15.0
VIT-009549	Mon Nov 09, 2026 06:50 AM	spo2	97.0	room air
VIT-009550	Mon Nov 09, 2026 06:50 AM	rr	17.0
VIT-009593	Mon Nov 09, 2026 06:50 AM	temp_c	37.3
VIT-009594	Mon Nov 09, 2026 06:50 AM	hr	80.0
VIT-009595	Mon Nov 09, 2026 06:50 AM	map	87.0
VIT-009596	Mon Nov 09, 2026 06:50 AM	gcs	15.0
VIT-009551	Mon Nov 09, 2026 02:50 PM	spo2	96.0	room air
VIT-009552	Mon Nov 09, 2026 02:50 PM	rr	21.0
VIT-009597	Mon Nov 09, 2026 02:50 PM	temp_c	36.8
VIT-009598	Mon Nov 09, 2026 02:50 PM	hr	85.0
VIT-009599	Mon Nov 09, 2026 02:50 PM	map	92.0
VIT-009600	Mon Nov 09, 2026 02:50 PM	gcs	15.0
VIT-009553	Mon Nov 09, 2026 10:50 PM	spo2	93.0	room air
VIT-009554	Mon Nov 09, 2026 10:50 PM	rr	16.0
VIT-009601	Mon Nov 09, 2026 10:50 PM	temp_c	37.5
VIT-009602	Mon Nov 09, 2026 10:50 PM	hr	73.0
VIT-009603	Mon Nov 09, 2026 10:50 PM	map	81.0
VIT-009604	Mon Nov 09, 2026 10:50 PM	gcs	15.0
VIT-009555	Tue Nov 10, 2026 06:50 AM	spo2	93.0	room air
VIT-009556	Tue Nov 10, 2026 06:50 AM	rr	20.0
VIT-009605	Tue Nov 10, 2026 06:50 AM	temp_c	36.7
VIT-009606	Tue Nov 10, 2026 06:50 AM	hr	75.0
VIT-009607	Tue Nov 10, 2026 06:50 AM	map	81.0
VIT-009608	Tue Nov 10, 2026 06:50 AM	gcs	15.0
VIT-009557	Tue Nov 10, 2026 02:50 PM	spo2	93.0	room air
VIT-009558	Tue Nov 10, 2026 02:50 PM	rr	19.0
VIT-009609	Tue Nov 10, 2026 02:50 PM	temp_c	36.9
VIT-009610	Tue Nov 10, 2026 02:50 PM	hr	84.0
VIT-009611	Tue Nov 10, 2026 02:50 PM	map	76.0
VIT-009612	Tue Nov 10, 2026 02:50 PM	gcs	15.0
VIT-009559	Tue Nov 10, 2026 10:50 PM	spo2	96.0	room air
VIT-009560	Tue Nov 10, 2026 10:50 PM	rr	18.0
VIT-009613	Tue Nov 10, 2026 10:50 PM	temp_c	37.2
VIT-009614	Tue Nov 10, 2026 10:50 PM	hr	86.0
VIT-009615	Tue Nov 10, 2026 10:50 PM	map	89.0
VIT-009616	Tue Nov 10, 2026 10:50 PM	gcs	15.0
VIT-009561	Wed Nov 11, 2026 06:50 AM	spo2	95.0	room air
VIT-009562	Wed Nov 11, 2026 06:50 AM	rr	19.0
VIT-009617	Wed Nov 11, 2026 06:50 AM	temp_c	37.0
VIT-009618	Wed Nov 11, 2026 06:50 AM	hr	92.0
VIT-009619	Wed Nov 11, 2026 06:50 AM	map	80.0
VIT-009620	Wed Nov 11, 2026 06:50 AM	gcs	15.0
VIT-009563	Wed Nov 11, 2026 02:50 PM	spo2	95.0	room air
VIT-009564	Wed Nov 11, 2026 02:50 PM	rr	16.0
VIT-009621	Wed Nov 11, 2026 02:50 PM	temp_c	37.2
VIT-009622	Wed Nov 11, 2026 02:50 PM	hr	92.0
VIT-009623	Wed Nov 11, 2026 02:50 PM	map	75.0
VIT-009624	Wed Nov 11, 2026 02:50 PM	gcs	15.0
VIT-009565	Wed Nov 11, 2026 10:50 PM	spo2	96.0	room air
VIT-009566	Wed Nov 11, 2026 10:50 PM	rr	20.0
VIT-009625	Wed Nov 11, 2026 10:50 PM	temp_c	36.5
VIT-009626	Wed Nov 11, 2026 10:50 PM	hr	85.0
VIT-009627	Wed Nov 11, 2026 10:50 PM	map	86.0
VIT-009628	Wed Nov 11, 2026 10:50 PM	gcs	15.0
VIT-009567	Thu Nov 12, 2026 06:50 AM	spo2	97.0	room air
VIT-009568	Thu Nov 12, 2026 06:50 AM	rr	18.0
VIT-009629	Thu Nov 12, 2026 06:50 AM	temp_c	36.5
VIT-009630	Thu Nov 12, 2026 06:50 AM	hr	72.0
VIT-009631	Thu Nov 12, 2026 06:50 AM	map	87.0
VIT-009632	Thu Nov 12, 2026 06:50 AM	gcs	15.0
VIT-009569	Thu Nov 12, 2026 02:50 PM	spo2	96.0	room air
VIT-009570	Thu Nov 12, 2026 02:50 PM	rr	19.0
VIT-009633	Thu Nov 12, 2026 02:50 PM	temp_c	37.3
VIT-009634	Thu Nov 12, 2026 02:50 PM	hr	86.0
VIT-009635	Thu Nov 12, 2026 02:50 PM	map	82.0
VIT-009636	Thu Nov 12, 2026 02:50 PM	gcs	15.0
VIT-009571	Thu Nov 12, 2026 10:50 PM	spo2	97.0	room air
VIT-009572	Thu Nov 12, 2026 10:50 PM	rr	18.0
VIT-009637	Thu Nov 12, 2026 10:50 PM	temp_c	37.1
VIT-009638	Thu Nov 12, 2026 10:50 PM	hr	85.0
VIT-009639	Thu Nov 12, 2026 10:50 PM	map	82.0
VIT-009640	Thu Nov 12, 2026 10:50 PM	gcs	15.0
VIT-009573	Fri Nov 13, 2026 06:50 AM	spo2	97.0	room air
VIT-009574	Fri Nov 13, 2026 06:50 AM	rr	18.0
VIT-009641	Fri Nov 13, 2026 06:50 AM	temp_c	36.6
VIT-009642	Fri Nov 13, 2026 06:50 AM	hr	90.0
VIT-009643	Fri Nov 13, 2026 06:50 AM	map	89.0
VIT-009644	Fri Nov 13, 2026 06:50 AM	gcs	15.0
VIT-009575	Fri Nov 13, 2026 02:50 PM	spo2	97.0	room air
VIT-009576	Fri Nov 13, 2026 02:50 PM	rr	21.0
VIT-009645	Fri Nov 13, 2026 02:50 PM	temp_c	36.9
VIT-009646	Fri Nov 13, 2026 02:50 PM	hr	78.0
VIT-009647	Fri Nov 13, 2026 02:50 PM	map	86.0
VIT-009648	Fri Nov 13, 2026 02:50 PM	gcs	15.0

Medications, orders, echo, history (5)

MED-000385 11-07 23:30 cefepime per protocol IV
MED-000386 11-08 05:00 ceftriaxone per protocol IV
MED-000387 11-09 05:00 piperacillin-tazobactam per protocol IV
ORD-000086 11-07 23:00 blood_culture: blood cultures x2
ORD-000087 11-08 09:00 transfusion_prbc: transfuse PRBC

Notes

History and physical · DOC-000332 · Dr. Kenji Stavros (attending) · Sun Nov 08, 2026 01:30 AM

Cited facts from this note (2)

bleeding_source: bright red blood per rectum · cited p. 1, line 5 · confidence 0.85

Show source for bleeding_source

… 0-year-old man admitted with urinary tract infection. Urinalysis with pyuria; treated for urinary tract infection with cefepime. Hospital course complicated by bright red blood per rectum. Past medical history: hypertension, hyperlipidemia. Review of systems otherwise negative. Exam: Lungs: clear to auscultation bilaterally. Assessment and plan: …
infection_source: urinary tract infection · cited p. 1, line 5 · confidence 0.85

Show source for infection_source

… : MRN52546438 Admitted: 2026-11-07 22:30 Service: Hospital Medicine Attending: Dr. Kenji Stavros History of present illness: 80-year-old man admitted with urinary tract infection. Urinalysis with pyuria; treated for urinary tract infection with cefepime. Hospital course complicated by bright red blood per rectum. Past medical history: h …

Source document DOC-000332: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Celeste Hartwell   MRN: MRN52546438   Admitted: 2026-11-07 22:30
Service: Hospital Medicine   Attending: Dr. Kenji Stavros

History of present illness: 80-year-old man admitted with urinary tract infection. Urinalysis with pyuria; treated for urinary tract infection with cefepime. Hospital course complicated by bright red blood per rectum.
Past medical history: hypertension, hyperlipidemia.
Review of systems otherwise negative.
Exam: Lungs: clear to auscultation bilaterally.
Assessment and plan:
1. Urinary tract infection: antibiotics.

Nutrition assessment · DOC-000331 · Dario Larkspur, RD (dietitian) · Mon Nov 09, 2026 01:30 AM

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 60% of needs for 9 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip strength: not assessed. Assessment: meets criteria for non-severe (moderate) malnutrition.
fluid_accumulation: none · cited p. 1, line 7 · confidence 0.90

Show source for fluid_accumulation

… take 60% of needs for 9 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip strength: not assessed. Assessment: meets criteria for non-severe (moderate) malnutrition.
intake_days: 9 · cited p. 1, line 5 · confidence 0.95

Show source for intake_days

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Celeste Hartwell MRN: MRN52546438 Context: acute illness Intake: estimated energy intake 60% of needs for 9 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip …
intake_pct: 60 · cited p. 1, line 5 · confidence 0.95

Show source for intake_pct

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Celeste Hartwell MRN: MRN52546438 Context: acute illness Intake: estimated energy intake 60% of needs for 9 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip …
muscle_loss: mild · cited p. 1, line 7 · confidence 0.90

Show source for muscle_loss

… : estimated energy intake 60% of needs for 9 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip strength: not assessed. Assessment: meets criteria for non-severe (moderate) malnutrition.
nutrition_context: acute · cited p. 1, line 4 · confidence 0.95

Show source for nutrition_context

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Celeste Hartwell MRN: MRN52546438 Context: acute illness Intake: estimated energy intake 60% of needs for 9 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneou …
weight_loss_days: 30 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_days

… stered Dietitian) Patient: Celeste Hartwell MRN: MRN52546438 Context: acute illness Intake: estimated energy intake 60% of needs for 9 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip strength: not assessed. Assessment: meets cri …
weight_loss_pct: 3 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_pct

… stered Dietitian) Patient: Celeste Hartwell MRN: MRN52546438 Context: acute illness Intake: estimated energy intake 60% of needs for 9 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip strength: not assessed. Assessment: meets cri …

Source document DOC-000331: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Celeste Hartwell   MRN: MRN52546438

Context: acute illness
Intake: estimated energy intake 60% of needs for 9 days.
Weight history: 3% weight loss over 30 days.
Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation.
Grip strength: not assessed.
Assessment: meets criteria for non-severe (moderate) malnutrition.

Progress note · DOC-000333 · Dr. Kenji Stavros (attending) · Fri Nov 13, 2026 10:55 AM

Source document DOC-000333: Progress note (synthetic)

PROGRESS NOTE (Attending)
Patient: Celeste Hartwell   MRN: MRN52546438   Hospital day 6

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Urinary tract infection: continue current management.
2. Severe protein-calorie malnutrition: dietitian following, supplements.
3. Acute respiratory failure with hypoxia: supplemental oxygen, wean as tolerated.
4. Hyponatremia: trend sodium.
5. Acute blood loss anemia: trend hemoglobin, transfuse if needed.

Attending: Dr. Kenji Stavros