CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 55-year-old male who
was admitted to the Medical Intensive Care Unit on [**2139-7-5**], for shortness of breath and with a room air oxygen
saturation of 72%.  He had been admitted in [**Month (only) 956**] from
[**3-16**] to [**3-26**] with hypoxia and bilateral
pulmonary infiltrates.  Work-up at that time involved
bronchoscopy which was negative for PCP.  [**Name10 (NameIs) 14174**] of tissue
eventually grew out alpha Streptococcus.  He improved
clinically with diuresis, and an echocardiogram showed an
ejection fraction of 40%, anterior septal akinesis, apical
akinesis, anterior hypokinesis, and akinesis.

MEDICAL HISTORY: Significant for end-stage renal
disease status post a living-related donor kidney transplant
in [**2131-1-9**], diabetes mellitus with significant
neuropathy with orthostatic hypotension, nephropathy
requiring renal transplant, retinopathy with a history of
retinal hemorrhages.  The patient has a nephrostomy tube.  He
has obstructive sleep apnea and has been on BIPAP since
[**Month (only) 1096**].  His left ankle is significant for Charcot joint,
and he has a history of recurrent cellulitis.  His ejection
fraction in [**2139-3-12**] was as stated prior.  He has had
multiple skin cancers.  Coronary artery disease by stress
test.
MEDICATIONS ON ADMISSION:  Cyclosporin 200 b.i.d., Prednisone
5 mg q.d., Procardia XL 120 q.d., Pravachol 40 q.d.,
Neurontin 300 b.i.d., Lasix 40 q.d., Lopressor 50 b.i.d.,
ProAmatine 10 t.i.d., Niferex 150 q.d., NPH 32 U in the
morning, 9 U in the evening, regular Insulin sliding scale.

MEDICATION ON ADMISSION: Cyclosporin 200 b.i.d., Prednisone
5 mg q.d., Procardia XL 120 q.d., Pravachol 40 q.d.,
Neurontin 300 b.i.d., Lasix 40 q.d., Lopressor 50 b.i.d.,
ProAmatine 10 t.i.d., Niferex 150 q.d., NPH 32 U in the
morning, 9 U in the evening, regular Insulin sliding scale.

ALLERGIES: DICLOXACILLIN AND COMPAZINE.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He quit smoking in [**2110**].  He drinks two
beers a week.  He lives at home with his wife.  [**Name (NI) **] has
children.
Congestive heart failure, unspecified,Pneumonia, organism unspecified,Kidney replaced by transplant,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Background diabetic retinopathy
CHF NOS,Pneumonia, organism NOS,Kidney transplant status,Hyp kid NOS w cr kid V,DMI neuro nt st uncntrld,Nephritis NOS in oth dis,Diabetic retinopathy NOS
Admission Date:  [**2139-7-5**]       Discharge Date:  [**2139-7-9**]

Date of Birth:   [**2083-10-25**]       Sex:  M

Service:

HISTORY OF PRESENT ILLNESS:  This is a 55-year-old male who
was admitted to the Medical Intensive Care Unit on [**2139-7-5**], for shortness of breath and with a room air oxygen
saturation of 72%.  He had been admitted in [**Month (only) 956**] from
[**3-16**] to [**3-26**] with hypoxia and bilateral
pulmonary infiltrates.  Work-up at that time involved
bronchoscopy which was negative for PCP.  [**Name10 (NameIs) 14174**] of tissue
eventually grew out alpha Streptococcus.  He improved
clinically with diuresis, and an echocardiogram showed an
ejection fraction of 40%, anterior septal akinesis, apical
akinesis, anterior hypokinesis, and akinesis.

Clinically, although he improved with diuresis during that
admission, he was treated with Levaquin.  Since that
discharge, he has been started on Lasix and Lopressor with
cardiologist Dr. [**Last Name (STitle) 20612**] on [**4-15**] and [**5-3**]; however, he
continued to have increasing lower leg edema.

On this admission in the Emergency Department, he arrived
with an oxygen saturation of 72%, 92-96% on non-rebreather.
An ABG done at that time showed a pH of 7.39, 30, 94 on
non-rebreather.  He had transient orthostatic hypotension
because he missed his morning dose of Midodrine.  At the time
of admission in the Emergency Department, he was noted to be
febrile to 101.5??????, otherwise with normal vitals signs.  In
the Emergency Department, he was treated with Levaquin,
Prednisone, and intravenous Bactrim.  He was then transferred
to the Medical Intensive Care Unit where he was diuresed with
intravenous Lasix, and urine output to that was over a liter.
He became stable at 95% on 4 L with room air oxygen
saturations of 88-92%, and the patient himself said that he
felt much less short of breath.

PAST MEDICAL HISTORY:  Significant for end-stage renal
disease status post a living-related donor kidney transplant
in [**2131-1-9**], diabetes mellitus with significant
neuropathy with orthostatic hypotension, nephropathy
requiring renal transplant, retinopathy with a history of
retinal hemorrhages.  The patient has a nephrostomy tube.  He
has obstructive sleep apnea and has been on BIPAP since
[**Month (only) 1096**].  His left ankle is significant for Charcot joint,
and he has a history of recurrent cellulitis.  His ejection
fraction in [**2139-3-12**] was as stated prior.  He has had
multiple skin cancers.  Coronary artery disease by stress
test.
MEDICATIONS ON ADMISSION:  Cyclosporin 200 b.i.d., Prednisone
5 mg q.d., Procardia XL 120 q.d., Pravachol 40 q.d.,
Neurontin 300 b.i.d., Lasix 40 q.d., Lopressor 50 b.i.d.,
ProAmatine 10 t.i.d., Niferex 150 q.d., NPH 32 U in the
morning, 9 U in the evening, regular Insulin sliding scale.

SOCIAL HISTORY:  He quit smoking in [**2110**].  He drinks two
beers a week.  He lives at home with his wife.  [**Name (NI) **] has
children.

ALLERGIES:  DICLOXACILLIN AND COMPAZINE.

PHYSICAL EXAMINATION:  General:  Upon transfer to the
Medicine Team on [**7-6**] the patient was in general feeling
very comfortable.  Vital signs:  Temperature 97.5??????, pulse
73-93, blood pressure 112-157/61-78, 97% on 4 L, oxygen
saturation 88-92% on room air. I&Os:  Until midnight negative
500, to 11 a.m. were negative 500 that day.  HEENT:  Right
eye closed.  Left eye with full extraocular movements,
reactive.  Mucous membranes without lesions.  Neck:  Obese.
Left skin, question of cancer.  Heart:  Regular without
gallops.  Normal PMI.  Distant heart sounds.  No obvious
murmur.  Pulmonary:  Breath sounds on the left side with
crackles, on the right side with crackles, otherwise clear.
Abdomen:  Obese.  Positive bowel sounds.  Soft, nontender,
nondistended.  Right lower quadrant kidney allograft,
nontender.  Extremities:  Left Charcot joint reportedly
stable.  He had lateral abrasions.  There was an ulcer of the
right foot with irritated skin.  Both ankles were significant
for edema to the knees.

LABORATORY DATA:  The patient came in with a white count of
9.2, which subsequently fell to 5.2, hematocrit was 26.7 on
admission, platelet count 164,000; INR 1.3, PTT 30;
electrolytes were remarkable for a sodium of 136, potassium
4.7, chloride 109, bicarb 15, BUN 58, creatinine 3.1, glucose
207, baseline creatinine 2.3-3.3.

The patient had a chest x-ray which showed small bilateral
effusions, left greater than right, left lower lobe
consolidation versus atelectasis.  Electrocardiogram was
normal sinus rhythm at a rate of 75, normal axis, ST
elevations 1.0-1.5 mm in V1-V3 which were old, T-wave
inversions I, AVL, V5 and V6 which is new, Q in V1 and V2,
consistent with electrocardiogram from [**2139-3-23**].

ASSESSMENT AND PLAN:  This is a 55-year-old man with rapidly
resolving hypoxic respiratory event.  His chest x-ray is
consistent with left lower lobe process, but the rapid
development in resolution of his hypoxemia, as well as his
chest x-ray findings, are most consistent with acute
pulmonary edema.  Certainly PCP would not be consistent with
this clinical picture given that his [**Month (only) 547**] MIBI showed
significant partially reversible perfusion defect.  A
potential clinical picture would be infection such as
pneumonia causing increased myocardial demand resulting in
acute diastolic dysfunction and then resulting in congestive
heart failure.

HOSPITAL COURSE:  1.  Acute pulmonary edema:  The patient was
diuresed in the Medical Intensive Care Unit with resolution
of hypoxemia.  He was then transferred to the floor, given
one more dose of intravenous Lasix with subsequent diuresis.
The patient continued with Lopressor 25 t.i.d., and I&Os were
monitored, and a follow-up chest x-ray showed improvement in
bilateral effusion.

2.  Cardiology:  The patient was ruled out for myocardial
infarction, and it was noted that he had an [**Month (only) 547**] MIBI which
showed severe perfusion defect in the apex, moderate
perfusion defect in the inferior wall, moderate perfusion
defect in the septum, all partially reversible, with an
ejection fraction of 47%, and septal hypokinesis.  There were
no electrocardiogram changes and no angina.  Cardiac
catheterization was considered at that time but was deferred
because of worsening renal function.

On this admission, Cardiology was reconsulted, and given that
the patient had pulmonary edema, it was felt that it would be
prudent to proceed with cardiac catheterization at the
soonest possible time, as long as the patient's renal
function was stabilized.  In addition, the patient was
started on an Aspirin a day after discussion with his
ophthalmologist about a slight increased risk of retinal
hemorrhages.  It was decided that even in this patient with a
history of retinal hemorrhages, that in light of his
significant coronary artery disease, it would be unwise to
not give him Aspirin.  In addition, he was continued on his
Lopressor 25 b.i.d., and he was continued on his Procardia
120 XL q.d. for blood pressure control, as well as his
Pravachol 40 q.d.

After discussion with the patient and his attending, as well
as Cardiology, it was decided that the patient could come
back for an elective catheterization within the next two
weeks after discharge.  He will likely need admission prior
to catheterization for intravenous hydration, given his renal
function.

3.  Renal function:  The patient, on the hospital floor,
developed worsening creatinine to a peak creatinine of 4.0 on
the 29th; however, his urine output continued to be adequate,
and he continued to have actually high urine output even
after Lasix was discontinued.  The etiology of this renal
failure was unclear.  Cyclosporin toxicity was considered,
and the trough was checked which was normal at 163.  It was
felt that overdiuresis could be contributing to the acute
renal failure.  Lasix was held, and the creatinine actually
improved to a creatinine of 2.9 at the time of discharge.
Because of his high urine output, which was consistent with
an ATN-like picture, the patient was instructed to maintain
p.o. intake to greater than 2 L to avoid dehydration.

In addition, on arrival to the hospital floor, the patient's
bicarb was extremely low, and this was followed, and the
patient was started on Bicitra to maintain his bicarb level
as well.

4.  Infectious disease:  The patient had a temperature to
101.4?????? on admission.  Blood cultures, urine cultures were
negative.  Chest x-ray however showed a retrocardiac opacity
which remained even after diuresis; however, the patient was
afebrile on the floor.  He was treated however with Levaquin
which was renally dosed at 250 q.d., and the patient was
continued for a full 14-day course of Levaquin; however, he
had no elevation in white count and had no fevers on the
Medical floor at all.

5.  Hematology:  The patient had anemia with a hematocrit of
29 post-diuresis.  Since Cyclosporin can cause hemolytic
anemia, haptoglobin was checked which was 136, not decreased,
and thus this was deemed very unlikely.  He will need
follow-up as an outpatient for this anemia.

DISCHARGE MEDICATIONS:  Cyclosporin 200 p.o. b.i.d.,
Prednisone 5 q.d., Procardia XL 120 q.d., Pravachol 40 q.d.,
Neurontin 300 b.i.d., Lasix 40 q.d. with the option of extra
dosing p.r.n. congestive heart failure symptoms, Lopressor 50
b.i.d., ProAmatine 10 t.i.d., Niferex 150 q.d., NPH 32 and 9
as previously, regular Insulin sliding scale, Levaquin 250
p.o. q.d. for a total of a 14-day course, Bicitra 1 tbsp p.o.
b.i.d.

DISCHARGE DIAGNOSIS:
1.  Congestive heart failure.
2.  Diabetes mellitus.
3.  End-stage renal failure with transplant and acute renal
failure on chronic renal failure.

CONDITION ON DISCHARGE:  Stable to go home with return for
cardiac catheterization within two weeks.





                            [**Name6 (MD) 251**] [**Last Name (NamePattern4) 11865**], M.D.  [**MD Number(1) 11866**]

Dictated By:[**Last Name (NamePattern1) 8853**]
MEDQUIST36

D:  [**2139-7-16**]  01:41
T:  [**2139-7-16**]  06:51
JOB#:  [**Job Number **]
{'Congestive heart failure, unspecified,Pneumonia, organism unspecified,Kidney replaced by transplant,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Background diabetic retinopathy'}


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: 

PRESENT ILLNESS: This is a 55-year-old male who
was admitted to the Medical Intensive Care Unit on [**2139-7-5**], for shortness of breath and with a room air oxygen
saturation of 72%.  He had been admitted in [**Month (only) 956**] from
[**3-16**] to [**3-26**] with hypoxia and bilateral
pulmonary infiltrates.  Work-up at that time involved
bronchoscopy which was negative for PCP.  [**Name10 (NameIs) 14174**] of tissue
eventually grew out alpha Streptococcus.  He improved
clinically with diuresis, and an echocardiogram showed an
ejection fraction of 40%, anterior septal akinesis, apical
akinesis, anterior hypokinesis, and akinesis.

MEDICAL HISTORY: Significant for end-stage renal
disease status post a living-related donor kidney transplant
in [**2131-1-9**], diabetes mellitus with significant
neuropathy with orthostatic hypotension, nephropathy
requiring renal transplant, retinopathy with a history of
retinal hemorrhages.  The patient has a nephrostomy tube.  He
has obstructive sleep apnea and has been on BIPAP since
[**Month (only) 1096**].  His left ankle is significant for Charcot joint,
and he has a history of recurrent cellulitis.  His ejection
fraction in [**2139-3-12**] was as stated prior.  He has had
multiple skin cancers.  Coronary artery disease by stress
test.
MEDICATIONS ON ADMISSION:  Cyclosporin 200 b.i.d., Prednisone
5 mg q.d., Procardia XL 120 q.d., Pravachol 40 q.d.,
Neurontin 300 b.i.d., Lasix 40 q.d., Lopressor 50 b.i.d.,
ProAmatine 10 t.i.d., Niferex 150 q.d., NPH 32 U in the
morning, 9 U in the evening, regular Insulin sliding scale.

MEDICATION ON ADMISSION: Cyclosporin 200 b.i.d., Prednisone
5 mg q.d., Procardia XL 120 q.d., Pravachol 40 q.d.,
Neurontin 300 b.i.d., Lasix 40 q.d., Lopressor 50 b.i.d.,
ProAmatine 10 t.i.d., Niferex 150 q.d., NPH 32 U in the
morning, 9 U in the evening, regular Insulin sliding scale.

ALLERGIES: DICLOXACILLIN AND COMPAZINE.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He quit smoking in [**2110**].  He drinks two
beers a week.  He lives at home with his wife.  [**Name (NI) **] has
children. 

### Response:
{'Congestive heart failure, unspecified,Pneumonia, organism unspecified,Kidney replaced by transplant,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Background diabetic retinopathy'}
