CHIEF COMPLAINT: fevers, back pain, confusion

PRESENT ILLNESS: 64yo man with a history of large lipsosarcoma s/p multiple
resections with large residual tumor despite trials of
chemotherapy who recently had PTC catheter placed at [**Hospital1 112**],
internal and external drainage, for obstructing jaundice
secondary to tumor.  ERCP was attempted and not able to access
biliary tree.  He was dischared 6 days ago with bilirubin down
to 2, afebrile, with PTC capped.  On the day prior to
presentation he devoloped low grade fevers and the catheter was
flushed easily.  On the day of presentation he continued to have
low grade fevers, and the PTC was placed to bag drainage without
output.  He then developed confusion and severe back pain, and
he was brought from home by family to [**Hospital **] Hospital where his
temp was 102, he was tachycardic to the 150s and hypotensive,
with elevated bilirubin.  Treated for sepsis with Vancomycin and
started on Levophed.  Attempts were made to transfer him to [**Hospital1 112**],
because his prior care had been there, however no ICU beds were
available and therefore he was transferred to [**Hospital1 18**].  On arrival
he was tachycardic with blood pressures in low 100s on levophed,
alert and oriented, with fevers to 103.  Treated with Zosyn.
Currently denies abdominal pain, no nausea or vomiting.
Tolerating less and less POs, mostly liquids.  Decreased
appetite.  Regular BMs, no blood, no diarrhea.  No dysuria.  No
chest pain or shortness or breath, no cough.

MEDICAL HISTORY: - liposarcoma s/p 50lb tumor excision [**2155**] with several more
smaller exvisions, residual tumor s/p chemo (last [**11-20**])
followed at [**Hospital3 328**]
- obstructive jaundice with PTC placed [**2159-1-4**] at [**Hospital1 112**]
- hypothyroid

MEDICATION ON ADMISSION: Dilaudid 4mg q4hrs
Fentynyl patch 25 mcg q 72hrs
Remeron 15mg qHS
Synthroid 25 mcg qAM
MVI
1000 Tums daily
Laxative/stool softener

ALLERGIES: Percocet / Ranitidine

PHYSICAL EXAM: 0.4 mcg/kg/min Levophed
98.9  110  100/73  16  96% 4L NC
Gen: pleasant man in NAD, A+Ox 3
HEENT: +scleral icterus, MMdry
CV: tachycardic
Lungs: decreased bases
Abd: soft, obese NT/ND, palpable mass right abdomen
ext: no c/c/e

FAMILY HISTORY: NC

SOCIAL HISTORY: no ETOH, no smoking
Cholangitis,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Unspecified acquired hypothyroidism,Other postprocedural status,Personal history of malignant neoplasm of other sites
Cholangitis,Oth gram negatv bacteria,Hypothyroidism NOS,Post-proc states NEC,Hx of malignancy NEC
Admission Date:  [**2159-1-11**]              Discharge Date:   [**2159-1-12**]

Date of Birth:  [**2094-11-5**]             Sex:   M

Service: SURGERY

Allergies:
Percocet / Ranitidine

Attending:[**First Name3 (LF) 598**]
Chief Complaint:
fevers, back pain, confusion

Major Surgical or Invasive Procedure:
IR upsizing of PTC catheter [**1-11**]

History of Present Illness:
64yo man with a history of large lipsosarcoma s/p multiple
resections with large residual tumor despite trials of
chemotherapy who recently had PTC catheter placed at [**Hospital1 112**],
internal and external drainage, for obstructing jaundice
secondary to tumor.  ERCP was attempted and not able to access
biliary tree.  He was dischared 6 days ago with bilirubin down
to 2, afebrile, with PTC capped.  On the day prior to
presentation he devoloped low grade fevers and the catheter was
flushed easily.  On the day of presentation he continued to have
low grade fevers, and the PTC was placed to bag drainage without
output.  He then developed confusion and severe back pain, and
he was brought from home by family to [**Hospital **] Hospital where his
temp was 102, he was tachycardic to the 150s and hypotensive,
with elevated bilirubin.  Treated for sepsis with Vancomycin and
started on Levophed.  Attempts were made to transfer him to [**Hospital1 112**],
because his prior care had been there, however no ICU beds were
available and therefore he was transferred to [**Hospital1 18**].  On arrival
he was tachycardic with blood pressures in low 100s on levophed,
alert and oriented, with fevers to 103.  Treated with Zosyn.
Currently denies abdominal pain, no nausea or vomiting.
Tolerating less and less POs, mostly liquids.  Decreased
appetite.  Regular BMs, no blood, no diarrhea.  No dysuria.  No
chest pain or shortness or breath, no cough.

Past Medical History:
- liposarcoma s/p 50lb tumor excision [**2155**] with several more
smaller exvisions, residual tumor s/p chemo (last [**11-20**])
followed at [**Hospital3 328**]
- obstructive jaundice with PTC placed [**2159-1-4**] at [**Hospital1 112**]
- hypothyroid


Social History:
no ETOH, no smoking

Family History:
NC

Physical Exam:
0.4 mcg/kg/min Levophed
98.9  110  100/73  16  96% 4L NC
Gen: pleasant man in NAD, A+Ox 3
HEENT: +scleral icterus, MMdry
CV: tachycardic
Lungs: decreased bases
Abd: soft, obese NT/ND, palpable mass right abdomen
ext: no c/c/e


Pertinent Results:
[**2159-1-10**] 11:20PM   WBC-8.6 RBC-3.73* HGB-11.4* HCT-35.3* MCV-95
MCH-30.5 MCHC-32.3 RDW-14.7
[**2159-1-10**] 11:20PM   NEUTS-92* BANDS-3 LYMPHS-1* MONOS-3 EOS-0
BASOS-0 ATYPS-0 METAS-1* MYELOS-0
[**2159-1-10**] 11:20PM   PLT COUNT-302
[**2159-1-10**] 11:20PM   PT-16.3* PTT-33.2 INR(PT)-1.4*
[**2159-1-10**] 11:20PM   GLUCOSE-133* UREA N-14 CREAT-1.6* SODIUM-134
POTASSIUM-3.9 CHLORIDE-102 TOTAL CO2-21* ANION GAP-15
[**2159-1-10**] 11:20PM   ALT(SGPT)-94* AST(SGOT)-124* ALK PHOS-578*
TOT BILI-4.0* DIR BILI-3.4* INDIR BIL-0.6
[**2159-1-10**] 11:20PM   LIPASE-29
[**2159-1-10**] 11:20PM   CALCIUM-7.3* PHOSPHATE-1.9* MAGNESIUM-1.4*
[**2159-1-10**] 11:28PM   LACTATE-3.2*
[**2159-1-11**] 05:02AM   WBC-21.8*# RBC-3.45* HGB-11.1* HCT-33.0*
MCV-96 MCH-32.2* MCHC-33.6 RDW-14.8
[**2159-1-11**] 05:02AM   PLT COUNT-330
[**2159-1-11**] 05:02AM   PT-16.1* PTT-48.2* INR(PT)-1.4*
[**2159-1-11**] 05:02AM   GLUCOSE-116* UREA N-17 CREAT-1.6* SODIUM-132*
POTASSIUM-4.3 CHLORIDE-103 TOTAL CO2-19* ANION GAP-14
[**2159-1-11**] 05:02AM   ALT(SGPT)-118* AST(SGOT)-161* ALK PHOS-555*
AMYLASE-25 TOT BILI-5.2*
[**2159-1-11**] 05:02AM   CALCIUM-7.2* PHOSPHATE-3.3 MAGNESIUM-1.4*
[**2159-1-11**] 05:02AM   LIPASE-22
[**2159-1-11**] 05:02AM   CRP-117.8*
[**2159-1-11**] 05:16AM   LACTATE-2.5*
[**2159-1-11**] 01:13PM   HCT-32.5*

Brief Hospital Course:
Pt was admitted to surgical ICU under Red/West3 service, placed
on broad-spectrum Abx (Vanco Zosyn), and provided IVF
resuscitation for presumptive dx of cholangitis and biliary
obstruction, possibly from obstructed PTC drain.  He remained
stable and underwent upsizing of the PTC cathether on [**1-11**] by
interventional radiology from 8Fr to 10Fr, a pullback
cholangiogram demonstrated severe common ductal
narrowing/occlusion, and moderate amount of blood coming from
drain as well as puncture site (most likely source is
intraductal tumor infiltration at the level of the common duct).
 Subsequent Hct was stable at 32.5.  Blood cultures obtained at
time of admission were [**4-15**] positive for GNR, and Zosyn was
changed to Meropenem.  After completing the procedure an ICU bed
became available at [**Hospital1 112**] and he accordingly was transferred there
to resume his prior care.


Medications on Admission:
Dilaudid 4mg q4hrs
Fentynyl patch 25 mcg q 72hrs
Remeron 15mg qHS
Synthroid 25 mcg qAM
MVI
1000 Tums daily
Laxative/stool softener

Discharge Medications:
Levothyroxine Sodium 25 mcg PO/NG DAILY
LR at 100 ml/hr
Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN wheezing
Dextrose 50% 12.5 gm IV PRN hypoglycemia protocol
Norepinephrine 0.03-0.25 mcg/kg/min IV DRIP TITRATE TO MAP>65
Famotidine 20 mg IV Q24H
Ondansetron 4 mg IV Q8H:PRN nausea
Glucagon 1 mg IM Q15MIN:PRN hypoglycemia protocol
Pantoprazole 40 mg IV Q24H
HYDROmorphone (Dilaudid) 0.5 mg IV Q2H PRN pain
Insulin SC  (per Insulin Flowsheet) Sliding Scale
Vancomycin 1000 mg IV Q 12H
Meropenem 1000 mg IV Q8H

Discharge Disposition:
Extended Care

Facility:
[**Hospital6 1708**]

Discharge Diagnosis:
cholangitis
liposarcoma
hypothyroid

Discharge Condition:
fair

Discharge Instructions:
pt transferring to [**Hospital1 112**] for further care

Followup Instructions:
Can follow-up with Dr. [**Last Name (STitle) **] as necessary, ([**Telephone/Fax (1) 2537**].
Otherwise remaining follow-up will be via his primary caretakers
at the [**Name (NI) 112**] and [**Name (NI) 2860**].

                             [**First Name8 (NamePattern2) **] [**Name8 (MD) **] MD [**MD Number(2) 601**]
{'Cholangitis,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Unspecified acquired hypothyroidism,Other postprocedural status,Personal history of malignant neoplasm of other sites'}


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: fevers, back pain, confusion

PRESENT ILLNESS: 64yo man with a history of large lipsosarcoma s/p multiple
resections with large residual tumor despite trials of
chemotherapy who recently had PTC catheter placed at [**Hospital1 112**],
internal and external drainage, for obstructing jaundice
secondary to tumor.  ERCP was attempted and not able to access
biliary tree.  He was dischared 6 days ago with bilirubin down
to 2, afebrile, with PTC capped.  On the day prior to
presentation he devoloped low grade fevers and the catheter was
flushed easily.  On the day of presentation he continued to have
low grade fevers, and the PTC was placed to bag drainage without
output.  He then developed confusion and severe back pain, and
he was brought from home by family to [**Hospital **] Hospital where his
temp was 102, he was tachycardic to the 150s and hypotensive,
with elevated bilirubin.  Treated for sepsis with Vancomycin and
started on Levophed.  Attempts were made to transfer him to [**Hospital1 112**],
because his prior care had been there, however no ICU beds were
available and therefore he was transferred to [**Hospital1 18**].  On arrival
he was tachycardic with blood pressures in low 100s on levophed,
alert and oriented, with fevers to 103.  Treated with Zosyn.
Currently denies abdominal pain, no nausea or vomiting.
Tolerating less and less POs, mostly liquids.  Decreased
appetite.  Regular BMs, no blood, no diarrhea.  No dysuria.  No
chest pain or shortness or breath, no cough.

MEDICAL HISTORY: - liposarcoma s/p 50lb tumor excision [**2155**] with several more
smaller exvisions, residual tumor s/p chemo (last [**11-20**])
followed at [**Hospital3 328**]
- obstructive jaundice with PTC placed [**2159-1-4**] at [**Hospital1 112**]
- hypothyroid

MEDICATION ON ADMISSION: Dilaudid 4mg q4hrs
Fentynyl patch 25 mcg q 72hrs
Remeron 15mg qHS
Synthroid 25 mcg qAM
MVI
1000 Tums daily
Laxative/stool softener

ALLERGIES: Percocet / Ranitidine

PHYSICAL EXAM: 0.4 mcg/kg/min Levophed
98.9  110  100/73  16  96% 4L NC
Gen: pleasant man in NAD, A+Ox 3
HEENT: +scleral icterus, MMdry
CV: tachycardic
Lungs: decreased bases
Abd: soft, obese NT/ND, palpable mass right abdomen
ext: no c/c/e

FAMILY HISTORY: NC

SOCIAL HISTORY: no ETOH, no smoking 

### Response:
{'Cholangitis,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Unspecified acquired hypothyroidism,Other postprocedural status,Personal history of malignant neoplasm of other sites'}
