CHIEF COMPLAINT: lower extremity weakness, hypoxia

PRESENT ILLNESS: Mr. [**Known lastname 8789**] is an 87-yo man with history of colon cancer
(refusing treatment), PAF, CHF with chronic pleural effusions
who presented with lower extremity weakness and was found to be
hypoxic with O2 sat in the 80s requiring NRB and MICU admission.
.
The patient was mostly recently admitted on [**2188-6-20**] for
hypotension likely from dehydration. He was given IVF and was
discharged on [**2188-6-21**] with amox-clav for UTI. A day later, on
the day of this admission, he felt as if his legs were "rubbery"
and that he had difficulty ambulating even with his walker. He
denies dyspnea, chest pain, lightheadedness, or worsening of his
leg edema. He denies fevers, chills, coughs, abdominal pain,
diarrhea, constipatin, dysuria.
.
On arrival to the ED, T 101.2, BP 117/50, HR 76, RR 22, 89%RA.
His CEs were negative x 1. CXR revealed worsening R pleural
effusion. He received 1 liter NS, ceftriaxone 2 grams,
levofloxacin 750 mg. Due to his hypoxia, he required NRB and was
admitted to the MICU for further management.

MEDICAL HISTORY: Colonoscopy [**2184-3-25**]:
>Polyp in the transverse colon (polypectomy) - adenoma
>Polyps in the sigmoid colon (polypectomy)- Colonic mucosa with
focal hyperplastic features
>Polypoid, ulcerated mass in the hepatic flexure (biopsy) -
Superficial fragments of colonic mucosa with ulceration, marked
acute inflammation, and highly atypical glands, suspicious for
carcinoma.

MEDICATION ON ADMISSION: . Amiodarone 200 mg Tablet PO DAILY
2. Finasteride 5 mg PO DAILY
3. Omeprazole 20 mg Capsule PO DAILY
4. Toprol XL 25 mg [**Last Name (un) **]
5. Ferrous Sulfate 325 mg daily
6. Aspirin 81 mg Tablet once a day.
7. Terazosin 5 mg PO once a day.
8. Lasix 20 mg once a day
9. Multiple Vitamins once a day.
10. Augmentin 500-125 mg [**Hospital1 **] (Day 1=[**6-21**])

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 98.6, 105/58, HR 74, RR 13, SpO2 99% on 100% NRB
Gen: Very pleasant older gentleman, talking clearly and in full
sentences, lying flat in bed.
HEENT: Sclera anicteric, conjunctiva pale, OP clear, no exudates
or erythema. Skin coloring good. MMM. No JVD. No carotid bruits.

FAMILY HISTORY: brother had [**Name2 (NI) 500**] marrow stem cell transplant at age 82
Sister died from heart attack. Also had an unknown cancer.
Mother died from an unknown cancer.
Neice has unknown cancer.

SOCIAL HISTORY: living at lone at home with VNA, Former smoker with 35-pk-yrs,
quit 50-55 yrs ago. Social ETOH.
Congestive heart failure, unspecified,Acute kidney failure, unspecified,Unspecified pleural effusion,Urinary tract infection, site not specified,Malignant neoplasm of hepatic flexure,Hydronephrosis,Hemorrhage of gastrointestinal tract, unspecified,Other specified cystic kidney disease,Atrial fibrillation,Iron deficiency anemia secondary to blood loss (chronic),Osteoporosis, unspecified,Unspecified acquired hypothyroidism
CHF NOS,Acute kidney failure NOS,Pleural effusion NOS,Urin tract infection NOS,Mal neo hepatic flexure,Hydronephrosis,Gastrointest hemorr NOS,Cystic kidney diseas NEC,Atrial fibrillation,Chr blood loss anemia,Osteoporosis NOS,Hypothyroidism NOS
Admission Date:  [**2188-6-22**]              Discharge Date:   [**2188-6-27**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 8790**]
Chief Complaint:
lower extremity weakness, hypoxia

Major Surgical or Invasive Procedure:
None


History of Present Illness:
Mr. [**Known lastname 8789**] is an 87-yo man with history of colon cancer
(refusing treatment), PAF, CHF with chronic pleural effusions
who presented with lower extremity weakness and was found to be
hypoxic with O2 sat in the 80s requiring NRB and MICU admission.
.
The patient was mostly recently admitted on [**2188-6-20**] for
hypotension likely from dehydration. He was given IVF and was
discharged on [**2188-6-21**] with amox-clav for UTI. A day later, on
the day of this admission, he felt as if his legs were "rubbery"
and that he had difficulty ambulating even with his walker. He
denies dyspnea, chest pain, lightheadedness, or worsening of his
leg edema. He denies fevers, chills, coughs, abdominal pain,
diarrhea, constipatin, dysuria.
.
On arrival to the ED, T 101.2, BP 117/50, HR 76, RR 22, 89%RA.
His CEs were negative x 1. CXR revealed worsening R pleural
effusion. He received 1 liter NS, ceftriaxone 2 grams,
levofloxacin 750 mg. Due to his hypoxia, he required NRB and was
admitted to the MICU for further management.


Past Medical History:
Colonoscopy [**2184-3-25**]:
>Polyp in the transverse colon (polypectomy) - adenoma
>Polyps in the sigmoid colon (polypectomy)- Colonic mucosa with
focal hyperplastic features
>Polypoid, ulcerated mass in the hepatic flexure (biopsy) -
Superficial fragments of colonic mucosa with ulceration, marked
acute inflammation, and highly atypical glands, suspicious for
carcinoma.


Past history:
# Colon mass during colonoscopy for guaiac positive stools in
[**2184**]. Pathology was worrisome for carcinoma. Although the
patient was offered resection by Dr. [**Last Name (STitle) **], he declined
# hematuria/BPH - traumatic foley insertion and manipulation
[**3-16**] lead to urosepsis and subsequent urinary retention
# sick sinus syndrome and bifascicular block s/p pacemaker [**2184**]

# PAF - on amiodarone, not on coumadin d/t concern for
malignancy
# H/O SVT
# Atrial flutter status post ablation [**2-/2186**] - not on
anticoagulation d/t concern for malignancy
# Anemia - on arenesp and iron
# Echo [**2186**]: mild-to-moderate mitral regurgitation, RA and LA
# BPH s/p TURMP [**2187**]
# b/l edema with skin changes
# hard of hearing
# hx of guiaic positive stools/GI bleeding
# osteoarthritis
# osteoporosis
# subclinical hypothyroid state as per record
# [**Year (4 digits) **] insufficiency
# right pleural effusion - Found on CT on [**2188-2-25**] for increasing
DOE. [**3-6**] and [**3-18**] thoracentesis c/w transudative. Workup during
last admission revealed RV diastolic dysfunction. Concern was
for PE as etiology, but unable to get CTA d/w ARF and V/Q not
helpful. Not anticoagulated due to h/o GIB, pleurodesis not an
option d/t transudative.
# Tibial talar dislocation with comminuted distal tib fib
fracture status post surgery [**2181**]
# hx syncope in [**2181**], unclear etiology


Social History:
living at lone at home with VNA, Former smoker with 35-pk-yrs,
quit 50-55 yrs ago. Social ETOH.


Family History:
brother had [**Name2 (NI) 500**] marrow stem cell transplant at age 82
Sister died from heart attack. Also had an unknown cancer.
Mother died from an unknown cancer.
Neice has unknown cancer.


Physical Exam:
VS: T 98.6, 105/58, HR 74, RR 13, SpO2 99% on 100% NRB
Gen: Very pleasant older gentleman, talking clearly and in full
sentences, lying flat in bed.
HEENT: Sclera anicteric, conjunctiva pale, OP clear, no exudates
or erythema. Skin coloring good. MMM. No JVD. No carotid bruits.

CV: RR, NL S1, S2. No murmurs, rubs or gallops.
Lungs: Crackles at L base, decreased BS at R base. Otherwise
clear, no wheezes or rhonchi.
ABD: Soft, NT, ND. Hyperactive BS. No masses, no HSM.
EXT: 1+ edema to mid-shins bilaterally. 2+ DP pulses BL.
SKIN: No rash but chronic venous stasis changes to LE
bilaterally.
NEURO: AAOx3, appropriate. CN II-XII grossly intact.
.
VS: T 97.6, 98/58, HR 74, RR 13, SpO2 94% on RA NRB
Gen: Very pleasant older gentleman, talking clearly and in full
sentences, lying flat in bed.
HEENT: Sclera anicteric, conjunctiva pale, OP clear, no exudates
or erythema. Skin coloring good. MMM. No JVD. No carotid bruits.

CV: RR, NL S1, S2. No murmurs, rubs or gallops.
Lungs: CTAb, no labored breathing
ABD: Soft, NT, ND. Hyperactive BS. No masses, no HSM.
EXT: trace edema to mid-shins bilaterally. 2+ DP pulses BL.
SKIN: No rash but chronic venous stasis changes to LE
bilaterally.
NEURO: AAOx3, appropriate. CN II-XII grossly intact.


Pertinent Results:
[**2188-6-21**] 07:35AM BLOOD WBC-5.4 RBC-3.35* Hgb-8.9* Hct-30.5*
MCV-91 MCH-26.5* MCHC-29.1* RDW-16.0* Plt Ct-235
[**2188-6-23**] 05:10AM BLOOD WBC-10.3 RBC-3.02* Hgb-8.3* Hct-26.1*
MCV-87 MCH-27.3 MCHC-31.6 RDW-16.6* Plt Ct-240
[**2188-6-23**] 04:25PM BLOOD Hct-28.1*
[**2188-6-24**] 05:45AM BLOOD WBC-9.3 RBC-3.19* Hgb-8.7* Hct-27.7*
MCV-87 MCH-27.2 MCHC-31.3 RDW-16.2* Plt Ct-230
[**2188-6-24**] 01:20PM BLOOD Hct-27.3*
[**2188-6-25**] 05:45AM BLOOD WBC-8.4 RBC-3.63* Hgb-10.3* Hct-31.3*
MCV-86 MCH-28.3 MCHC-32.9 RDW-16.0* Plt Ct-231
[**2188-6-26**] 05:00AM BLOOD WBC-9.0 RBC-3.92* Hgb-11.0* Hct-34.3*
MCV-87 MCH-28.0 MCHC-32.0 RDW-16.3* Plt Ct-222
[**2188-6-27**] 06:40AM BLOOD WBC-8.6 RBC-3.73* Hgb-10.2* Hct-32.3*
MCV-87 MCH-27.4 MCHC-31.6 RDW-16.1* Plt Ct-213
.
Chem 7
[**2188-6-23**] 05:10AM BLOOD Glucose-88 UreaN-22* Creat-1.3* Na-140
K-3.6 Cl-107 HCO3-25 AnGap-12
[**2188-6-24**] 05:45AM BLOOD Glucose-87 UreaN-20 Creat-1.2 Na-139
K-3.5 Cl-105 HCO3-27 AnGap-11
[**2188-6-25**] 05:45AM BLOOD Glucose-88 UreaN-18 Creat-1.1 Na-139
K-3.5 Cl-105 HCO3-27 AnGap-11
[**2188-6-25**] 05:10PM BLOOD Glucose-94 UreaN-18 Creat-1.2 Na-138
K-3.6 Cl-104 HCO3-25 AnGap-13
[**2188-6-26**] 05:00AM BLOOD Glucose-93 UreaN-17 Creat-1.2 Na-139
K-3.5 Cl-104 HCO3-27 AnGap-12
[**2188-6-27**] 06:40AM BLOOD Glucose-87 UreaN-17 Creat-1.1 Na-137
K-4.0 Cl-103 HCO3-27 AnGap-11
[**2188-6-25**] 05:45AM BLOOD Calcium-8.2* Phos-3.0 Mg-1.9
[**2188-6-25**] 05:10PM BLOOD Calcium-8.1* Phos-2.8 Mg-1.9
[**2188-6-26**] 05:00AM BLOOD Calcium-8.3* Phos-2.7 Mg-2.0
[**2188-6-27**] 06:40AM BLOOD Calcium-7.7* Phos-2.4* Mg-1.9
.
Misc
[**2188-6-23**] 05:10AM BLOOD TSH-1.7

Brief Hospital Course:
The patient was admitted with hypoxia and was intially sent to
the ICU. He was diuresed, but also started on Vanc, Flagyl and
Levofloxacin empirically. After diuresis, his oxygenation
improved and he was transfered to the floor. He was continued on
abx empirically but they were discontinued after 48hours of
negative cultures. He was then switched back to Augmentin to
complete a course for UTI started on last admssion.  It is
likely that he experienced a CHF exacerbation [**2-23**] to the IVF
given on last admission and [**2-23**] to decreased lasix on discharge.
His "weakness" was consistent with deconditioning and poor
cardiopulmonary status on admission rather than focal leg
weakness. On exam, strength was [**5-26**] in LE and his walked very
well with PT. His ambulation improved with diuresis. TSH was
normal. Diuresis was continued. His hypoxia continued to improve
with 90-94% RA and on ambulation. He continued to refuse
thoracentesis. He did have rare desturations at night to 87% and
may benefit from O2 at night in the future. He also received 2
units pRBC's for HCT below baseline. He was discharged without
shortness of breath or hypoxia on his orginal home dose of lasix
40mg daily.

Medications on Admission:
. Amiodarone 200 mg Tablet PO DAILY
2. Finasteride 5 mg PO DAILY
3. Omeprazole 20 mg Capsule PO DAILY
4. Toprol XL 25 mg [**Last Name (un) **]
5. Ferrous Sulfate 325 mg daily
6. Aspirin 81 mg Tablet once a day.
7. Terazosin 5 mg PO once a day.
8. Lasix 20 mg once a day
9. Multiple Vitamins once a day.
10. Augmentin 500-125 mg [**Hospital1 **] (Day 1=[**6-21**])


Discharge Medications:
1. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*3*
5. Terazosin 5 mg Capsule Sig: One (1) Capsule PO once a day.
6. Aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day.
7. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
8. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
9. Amoxicillin-Pot Clavulanate 500-125 mg Tablet Sig: One (1)
Tablet PO BID (2 times a day) for 1.5 days.
Disp:*3 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
All Care VNA of Greater [**Location (un) **]

Discharge Diagnosis:
CHF exacerbation
UTI


Discharge Condition:
improved


Discharge Instructions:
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
Adhere to 2 gm sodium diet
.
If you have difficulty breathing, light-headeness, chest pain or
fever, you should return to the emergency room.


Followup Instructions:
Provider: [**Last Name (NamePattern4) **]. [**Last Name (STitle) 311**] [**Telephone/Fax (1) 1713**] [**2188-7-21**] 2:00pm
Provider: [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **], [**First Name3 (LF) 3947**]. Phone:[**Telephone/Fax (1) 62**]
Date/Time:[**2188-7-14**] 11:20
Provider: [**Name10 (NameIs) 2793**] Ultrasound [**Telephone/Fax (1) 327**] [**2188-8-25**] 1:15pm
[**Hospital Ward Name 452**] 3
Provider: [**Last Name (NamePattern4) **]. [**Last Name (STitle) 3748**] ([**Telephone/Fax (1) 8791**] [**2188-8-28**] 11:00am
.
.
If you are interterested in finding a primary care physician in
[**Name9 (PRE) **], we would recommend Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] ([**Telephone/Fax (1) 1579**]).
He comes highly recommended from physicians here, works at [**Hospital1 18**]
[**Location (un) **] and has agreed to see Mr. [**Known lastname 8789**].
{'Congestive heart failure, unspecified,Acute kidney failure, unspecified,Unspecified pleural effusion,Urinary tract infection, site not specified,Malignant neoplasm of hepatic flexure,Hydronephrosis,Hemorrhage of gastrointestinal tract, unspecified,Other specified cystic kidney disease,Atrial fibrillation,Iron deficiency anemia secondary to blood loss (chronic),Osteoporosis, unspecified,Unspecified acquired hypothyroidism'}


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: lower extremity weakness, hypoxia

PRESENT ILLNESS: Mr. [**Known lastname 8789**] is an 87-yo man with history of colon cancer
(refusing treatment), PAF, CHF with chronic pleural effusions
who presented with lower extremity weakness and was found to be
hypoxic with O2 sat in the 80s requiring NRB and MICU admission.
.
The patient was mostly recently admitted on [**2188-6-20**] for
hypotension likely from dehydration. He was given IVF and was
discharged on [**2188-6-21**] with amox-clav for UTI. A day later, on
the day of this admission, he felt as if his legs were "rubbery"
and that he had difficulty ambulating even with his walker. He
denies dyspnea, chest pain, lightheadedness, or worsening of his
leg edema. He denies fevers, chills, coughs, abdominal pain,
diarrhea, constipatin, dysuria.
.
On arrival to the ED, T 101.2, BP 117/50, HR 76, RR 22, 89%RA.
His CEs were negative x 1. CXR revealed worsening R pleural
effusion. He received 1 liter NS, ceftriaxone 2 grams,
levofloxacin 750 mg. Due to his hypoxia, he required NRB and was
admitted to the MICU for further management.

MEDICAL HISTORY: Colonoscopy [**2184-3-25**]:
>Polyp in the transverse colon (polypectomy) - adenoma
>Polyps in the sigmoid colon (polypectomy)- Colonic mucosa with
focal hyperplastic features
>Polypoid, ulcerated mass in the hepatic flexure (biopsy) -
Superficial fragments of colonic mucosa with ulceration, marked
acute inflammation, and highly atypical glands, suspicious for
carcinoma.

MEDICATION ON ADMISSION: . Amiodarone 200 mg Tablet PO DAILY
2. Finasteride 5 mg PO DAILY
3. Omeprazole 20 mg Capsule PO DAILY
4. Toprol XL 25 mg [**Last Name (un) **]
5. Ferrous Sulfate 325 mg daily
6. Aspirin 81 mg Tablet once a day.
7. Terazosin 5 mg PO once a day.
8. Lasix 20 mg once a day
9. Multiple Vitamins once a day.
10. Augmentin 500-125 mg [**Hospital1 **] (Day 1=[**6-21**])

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 98.6, 105/58, HR 74, RR 13, SpO2 99% on 100% NRB
Gen: Very pleasant older gentleman, talking clearly and in full
sentences, lying flat in bed.
HEENT: Sclera anicteric, conjunctiva pale, OP clear, no exudates
or erythema. Skin coloring good. MMM. No JVD. No carotid bruits.

FAMILY HISTORY: brother had [**Name2 (NI) 500**] marrow stem cell transplant at age 82
Sister died from heart attack. Also had an unknown cancer.
Mother died from an unknown cancer.
Neice has unknown cancer.

SOCIAL HISTORY: living at lone at home with VNA, Former smoker with 35-pk-yrs,
quit 50-55 yrs ago. Social ETOH. 

### Response:
{'Congestive heart failure, unspecified,Acute kidney failure, unspecified,Unspecified pleural effusion,Urinary tract infection, site not specified,Malignant neoplasm of hepatic flexure,Hydronephrosis,Hemorrhage of gastrointestinal tract, unspecified,Other specified cystic kidney disease,Atrial fibrillation,Iron deficiency anemia secondary to blood loss (chronic),Osteoporosis, unspecified,Unspecified acquired hypothyroidism'}
