CHIEF COMPLAINT: headache

PRESENT ILLNESS: 38-year-old African-American man with recently diagnosed
hypertension presented with 5 days of headache, found to have
SBP in 200-210, admitted to MICU on nitroprusside drip.
.
Mr. [**Known lastname 86556**] initially presented to his PCP [**Last Name (NamePattern4) **] [**2151-3-8**] with a
new, dull, constant headache, was found to have BP 200/120, Cr.
1.5, aldosterone 61, renin 1.9. Serum metaneprhine fraction was
normal; 24-hr urine metanephrine pending. He was started on
lisinopril 20 mg qday. Three days later, BP was still high, and
his lisinopril was increased to 40 mg qday and labetolol 100 [**Hospital1 **]
was added. Outpatient nephrologist suggested renal MRI for
further work-up of his elevated creatinine. He went back to the
PCP's office the day of admission when his BP was found to be
unchanged; labetolol was added. With persistent headache, he
presented to the ED. He denies any visual changes, chest pain,
shortness of breath, weakness.
.
In ED, initial BP was 200-210/110-120, HR in the 50s. Exam,
including optic disc exam, was unremarkable. Cr. was 1.8. He was
started on nitroprusside at 0.25 mcg/kg/min and his SBP dropped
quickly to 160. Nitroprusside was decreased to 0.15 mcg/kg/min.
By transfer to MICU, his BP was 180/100, HR 70s. He received one
Percocet for his headache.
.
ROS: Denies fever, chills, night sweats, vision changes,
rhinorrhea, congestion, sore throat, cough, shortness of breath,
chest pain, abdominal pain, nausea, vomiting, diarrhea,
constipation, BRBPR, melena, hematochezia, dysuria, hematuria.

MEDICAL HISTORY: hypertension

MEDICATION ON ADMISSION: lisinopril 40 mg qday
labetolol 100 mg [**Hospital1 **]

ALLERGIES: Latex

PHYSICAL EXAM: GENERAL: muscular young man in NAD
HEENT: EOMI, PERRL, OP moist without lesion
CARDIAC: RR, normal S1/S2, no m/r/g
LUNG: CTAB
ABDOMEN: soft, NT, ND, BS present
EXT: no c/c/e
NEURO: awake, alert, oriented x 3

FAMILY HISTORY: Mother and brother have hypertension

SOCIAL HISTORY: No smoking. Social drinker
Unspecified essential hypertension,Acute kidney failure with lesion of tubular necrosis,Other antihypertensive agents causing adverse effects in therapeutic use
Hypertension NOS,Ac kidny fail, tubr necr,Adv eff antihyperten agt
Admission Date:  [**2151-3-12**]              Discharge Date:   [**2151-3-16**]

Date of Birth:  [**2112-4-22**]             Sex:   M

Service: MEDICINE

Allergies:
Latex

Attending:[**First Name3 (LF) 30**]
Chief Complaint:
headache

Major Surgical or Invasive Procedure:
None

History of Present Illness:
38-year-old African-American man with recently diagnosed
hypertension presented with 5 days of headache, found to have
SBP in 200-210, admitted to MICU on nitroprusside drip.
.
Mr. [**Known lastname 86556**] initially presented to his PCP [**Last Name (NamePattern4) **] [**2151-3-8**] with a
new, dull, constant headache, was found to have BP 200/120, Cr.
1.5, aldosterone 61, renin 1.9. Serum metaneprhine fraction was
normal; 24-hr urine metanephrine pending. He was started on
lisinopril 20 mg qday. Three days later, BP was still high, and
his lisinopril was increased to 40 mg qday and labetolol 100 [**Hospital1 **]
was added. Outpatient nephrologist suggested renal MRI for
further work-up of his elevated creatinine. He went back to the
PCP's office the day of admission when his BP was found to be
unchanged; labetolol was added. With persistent headache, he
presented to the ED. He denies any visual changes, chest pain,
shortness of breath, weakness.
.
In ED, initial BP was 200-210/110-120, HR in the 50s. Exam,
including optic disc exam, was unremarkable. Cr. was 1.8. He was
started on nitroprusside at 0.25 mcg/kg/min and his SBP dropped
quickly to 160. Nitroprusside was decreased to 0.15 mcg/kg/min.
By transfer to MICU, his BP was 180/100, HR 70s. He received one
Percocet for his headache.
.
ROS: Denies fever, chills, night sweats, vision changes,
rhinorrhea, congestion, sore throat, cough, shortness of breath,
chest pain, abdominal pain, nausea, vomiting, diarrhea,
constipation, BRBPR, melena, hematochezia, dysuria, hematuria.


Past Medical History:
hypertension

Social History:
No smoking. Social drinker

Family History:
Mother and brother have hypertension

Physical Exam:
GENERAL: muscular young man in NAD
HEENT: EOMI, PERRL, OP moist without lesion
CARDIAC: RR, normal S1/S2, no m/r/g
LUNG: CTAB
ABDOMEN: soft, NT, ND, BS present
EXT: no c/c/e
NEURO: awake, alert, oriented x 3

Pertinent Results:
Admission labs:
[**2151-3-12**] 03:20PM   WBC-6.3 RBC-4.96 HGB-13.6* HCT-41.2 MCV-83
MCH-27.3 MCHC-32.9 RDW-12.6
[**2151-3-12**] 03:20PM   NEUTS-65.1 LYMPHS-24.4 MONOS-5.2 EOS-5.0*
BASOS-0.3
[**2151-3-12**] 03:20PM   PLT COUNT-253
[**2151-3-12**] 03:20PM   PT-11.9 PTT-25.5 INR(PT)-1.0
[**2151-3-12**] 03:20PM   GLUCOSE-134* UREA N-17 CREAT-1.8* SODIUM-140
POTASSIUM-3.9 CHLORIDE-103 TOTAL CO2-30 ANION GAP-11
[**2151-3-12**] 03:20PM   SED RATE-11
[**2151-3-12**] 06:40PM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.013
[**2151-3-12**] 06:40PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-30
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0
LEUK-NEG
[**2151-3-12**] 06:40PM URINE  RBC-0-2 WBC-0-2 BACTERIA-FEW YEAST-NONE
EPI-0

Discharge labs:
[**2151-3-16**] 06:20AM BLOOD WBC-7.3 RBC-5.20 Hgb-14.5 Hct-44.6 MCV-86
MCH-27.8 MCHC-32.4 RDW-12.6 Plt Ct-340
[**2151-3-16**] 06:20AM BLOOD Plt Ct-340
[**2151-3-16**] 06:20AM BLOOD Glucose-90 UreaN-16 Creat-2.3* Na-137
K-4.3 Cl-97 HCO3-32 AnGap-12
[**2151-3-16**] 06:20AM BLOOD Calcium-9.9 Phos-5.1* Mg-2.6
[**2151-3-16**] 06:20AM BLOOD TSH-1.6
[**2151-3-13**] 02:03PM BLOOD HIV Ab-NEGATIVE

Imaging:
Renal U/S w/ doppler: IMPRESSION:
1. No hydronephrosis, nephrolithiasis, or renal mass lesion.
Renal parenchyma is normal in appearance.
2. Doppler interrogation of the kidneys demonstrates normal
velocities in the main renal arteries. Resistive indices are
within normal limits in the
interlobar arteries, though there are characteristic
tarud/parvus waveforms, suggesting possible renal artery
stenosis or fibromuscular dyhsplasia. Further evaluation with
MRI should be considered.

N/C Head CT: IMPRESSION: No acute intracranial process.

Admission ECG: Sinus rhythm. Left axis deviation. Early
repolarization. No previous tracing available for comparison.

Brief Hospital Course:
38-year-old African-American man with recently diagnosed
hypertension presented with 5 days of headache, found to have
SBP in 200-210, admitted to MICU on nitroprusside drip.
.
# HTN: His SBP was in the 170s on arrival to the MICU. The
nitroprusside was discontinued after 2 hours, after the
initiation of labetolol 200 mg PO bid. His SBP remained in
140s-160s overnight then increased to 180s-190s. Labetolol was
uptitrated to 200 mg PO tid. His headache decreased but still
persisted. No visual changes, chest pain, shortness of breath.
Blood pressure rose back to 200.  Nitroglycerin drip was
started.  Labetalol was uptitrated; HCTZ was added.  Hydralazine
was given for short-acting effect.  The next morning the
nitroglycerin was titrated off and the patient did well.  He was
transferred to the floor on labetalol 600mg [**Hospital1 **], amlodipine 10mg
daily and HCTZ 25mg daily.  He did well with SBPs to in the 140
to 160 range.  His headaches improved.  He was discharged with
close follow-up to repeat BP checks.
.
# Acute kidney injury: Cr. 1.8, from 1.5 at PCP's office on
Monday. Recent increase might be due to initiation of ACE
inhibitor, so his lisinopril was held. Renal ultrasound should
normal appearing kidneys, but was concerning for possible RAS or
fibromuscular dysplasia. FENa was 1.1%. Nephrology was consulted
and saw rare muddy-brown casts concerning for ATN. Concerning
for FSGS as well.  HIV was negative.  His Cr initially
stabilized, then rose slightly to 2.3 on the day of discharge.
However, he was making good amounts of urine and had no
electrolyte disturbances.  He was discharged with instructions
to follow-up closely with his PCP with repeat lab tests.  He
will also see a nephrologist, Dr. [**Last Name (STitle) 86557**].  He should a kidney
MRA as an outpatient once his creatinine clearance has improved.

Medications on Admission:
lisinopril 40 mg qday
labetolol 100 mg [**Hospital1 **]

Discharge Medications:
1. Labetalol 300 mg Tablet Sig: Two (2) Tablet PO twice a day.
Disp:*120 Tablet(s)* Refills:*2*
2. Amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
3. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once
a day.
Disp:*30 Tablet(s)* Refills:*2*
4. Blood pressure cuff
Please provide patient with home blood pressure cuff


Discharge Disposition:
Home

Discharge Diagnosis:
Diagnosis: hypertensive emergency


Discharge Condition:
Mental Status: Clear and coherent
Level of Consciousness: Alert and interactive
Activity Status: Ambulatory - Independent

Discharge Instructions:
You were admitted with very high blood pressure and headaches
and were found to have an elevated creatinine, a marker for
abnormal kidney function. Your blood pressure is now better
controlled, but you continue to have below-normal kidney
function.  You need to follow-up closely with your primary care
doctor to ensure that your kidney function improves and your
blood pressure is well-controlled.
.
You were started on three medications to control your blood
pressure:
- Labetalol, 300mg tablets, 2 tablets twice a day
- Amlodipine, 10mg tablets, 1 tablet once a day
- Hydrochlorothiazide (HCTZ), 25mg tablets, 1 tablet once a day
.
We are also giving you a prescription for a blood-pressure cuff.
 You can be blood pressure cuffs at most drug stores.  You can
use this to monitor you blood pressures at home.
.
Your headaches have improved with better blood pressure control.
 If you have recurrent headaches, check your blood pressure and
call your doctor.  If your headache is severe and you can't get
a hold of your doctor, you should go to an emergency department.
.
Your kidney function remains below normal.  Please have your
blood drawn Thursday at the [**Location (un) **] [**Hospital1 **] office so
that the results will be ready for your appointment Friday.  If
you go to the lab there, they will have the order for your lab
work to be done.

Followup Instructions:
Appointment #1
MD: [**First Name4 (NamePattern1) 41875**] [**First Name8 (NamePattern2) **] [**Location (un) **]
Specialty: Internal Medicine/ PCP
[**Name Initial (PRE) 2897**]/ Time: Friday, [**3-19**], 1:30pm
Location: [**Location (un) 2274**] [**Location (un) **].  [**Location (un) 2129**], [**Location (un) 86**].
Phone number: [**Telephone/Fax (1) 2261**]

Please follow-up with the nephrologist, Dr. [**Last Name (STitle) 86557**], [**3-31**]
at 3pm.


Completed by:[**2151-3-16**]
{'Unspecified essential hypertension,Acute kidney failure with lesion of tubular necrosis,Other antihypertensive agents causing adverse effects in therapeutic use'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: headache

PRESENT ILLNESS: 38-year-old African-American man with recently diagnosed
hypertension presented with 5 days of headache, found to have
SBP in 200-210, admitted to MICU on nitroprusside drip.
.
Mr. [**Known lastname 86556**] initially presented to his PCP [**Last Name (NamePattern4) **] [**2151-3-8**] with a
new, dull, constant headache, was found to have BP 200/120, Cr.
1.5, aldosterone 61, renin 1.9. Serum metaneprhine fraction was
normal; 24-hr urine metanephrine pending. He was started on
lisinopril 20 mg qday. Three days later, BP was still high, and
his lisinopril was increased to 40 mg qday and labetolol 100 [**Hospital1 **]
was added. Outpatient nephrologist suggested renal MRI for
further work-up of his elevated creatinine. He went back to the
PCP's office the day of admission when his BP was found to be
unchanged; labetolol was added. With persistent headache, he
presented to the ED. He denies any visual changes, chest pain,
shortness of breath, weakness.
.
In ED, initial BP was 200-210/110-120, HR in the 50s. Exam,
including optic disc exam, was unremarkable. Cr. was 1.8. He was
started on nitroprusside at 0.25 mcg/kg/min and his SBP dropped
quickly to 160. Nitroprusside was decreased to 0.15 mcg/kg/min.
By transfer to MICU, his BP was 180/100, HR 70s. He received one
Percocet for his headache.
.
ROS: Denies fever, chills, night sweats, vision changes,
rhinorrhea, congestion, sore throat, cough, shortness of breath,
chest pain, abdominal pain, nausea, vomiting, diarrhea,
constipation, BRBPR, melena, hematochezia, dysuria, hematuria.

MEDICAL HISTORY: hypertension

MEDICATION ON ADMISSION: lisinopril 40 mg qday
labetolol 100 mg [**Hospital1 **]

ALLERGIES: Latex

PHYSICAL EXAM: GENERAL: muscular young man in NAD
HEENT: EOMI, PERRL, OP moist without lesion
CARDIAC: RR, normal S1/S2, no m/r/g
LUNG: CTAB
ABDOMEN: soft, NT, ND, BS present
EXT: no c/c/e
NEURO: awake, alert, oriented x 3

FAMILY HISTORY: Mother and brother have hypertension

SOCIAL HISTORY: No smoking. Social drinker 

### Response:
{'Unspecified essential hypertension,Acute kidney failure with lesion of tubular necrosis,Other antihypertensive agents causing adverse effects in therapeutic use'}
