CHIEF COMPLAINT: 

PRESENT ILLNESS: This is an 85-year-old female
with a history of hypertension who was living at home by
herself and had been lethargic, fatigued and dehydrated the
past week because of a heat wave, fell down two days prior to
admission and had been down for approximately 36 hours when
she was then found by her son.  She was taken to [**Hospital3 42966**] where her sodium was 115, potassium 2.5 and a head
CT revealed an subacute subdural hematoma.  She was then
transferred to [**Hospital6 256**] on
[**2112-7-10**] for further care.  Upon arrival, she had dried blood
on her scalp and appeared slightly confused at times, but was
occasionally oriented x3.

MEDICAL HISTORY: 1.  Hypertension x10 years
2.  Heart murmur, the character and type of which was not
known.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: VITAL SIGNS:  Stable.
GENERAL:  The patient was alert and oriented in no acute
distress.
HEAD, EARS, EYES, NOSE AND THROAT:  Her right pupil was
reactive, the left surgical.  Extraocular muscles intact.
Oropharynx was clear.
NECK:  Supple, no lymphadenopathy, no jugular venous
distention.
LUNGS:  Minimal bibasilar crackles at the base, otherwise are
clear to auscultation.  She continues to have an irregularly
irregular heart rate with a 2/6 systolic ejection murmur that
radiates to the carotids.
ABDOMEN:  Soft and nontender.
EXTREMITIES:  No edema and distal pulses are palpable 2+.
NEUROLOGIC:  The patient has equal upper extremity and lower
extremity strength, as well as 2+ reflexes bilaterally.

FAMILY HISTORY: Significant for a sister with [**Name2 (NI) 499**] cancer.

SOCIAL HISTORY: No alcohol or tobacco history.  The patient
lives by herself, but in close proximity to both of her
children who check on her everyday.
Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Atrial fibrillation,Mitral valve stenosis and aortic valve stenosis,Diseases of tricuspid valve,Urinary tract infection, site not specified,Other disorders of neurohypophysis,Unspecified essential hypertension,Fall from other slipping, tripping, or stumbling
Subdural hem w/o coma,Atrial fibrillation,Mitral/aortic stenosis,Tricuspid valve disease,Urin tract infection NOS,Neurohypophysis dis NEC,Hypertension NOS,Fall from slipping NEC
Admission Date:  [**2112-7-10**]       Discharge Date:  [**2112-7-16**]


Service:  MEDICINE [**Hospital1 **] FIRM

HISTORY OF PRESENT ILLNESS:  This is an 85-year-old female
with a history of hypertension who was living at home by
herself and had been lethargic, fatigued and dehydrated the
past week because of a heat wave, fell down two days prior to
admission and had been down for approximately 36 hours when
she was then found by her son.  She was taken to [**Hospital3 42966**] where her sodium was 115, potassium 2.5 and a head
CT revealed an subacute subdural hematoma.  She was then
transferred to [**Hospital6 256**] on
[**2112-7-10**] for further care.  Upon arrival, she had dried blood
on her scalp and appeared slightly confused at times, but was
occasionally oriented x3.

PAST MEDICAL HISTORY:
1.  Hypertension x10 years
2.  Heart murmur, the character and type of which was not
known.

MEDICATIONS:
1.  Hydrochlorothiazide 25 mg once a day
2.  Tiazac 180 mg once a day
3.  Levobunolol eyedrops GGTS

ALLERGIES:  No known drug allergies.

FAMILY HISTORY:  Significant for a sister with [**Name2 (NI) 499**] cancer.

SOCIAL HISTORY:  No alcohol or tobacco history.  The patient
lives by herself, but in close proximity to both of her
children who check on her everyday.

PHYSICAL EXAMINATION DURING ADMISSION:
GENERAL:  The patient was a well nourished, well dressed,
elderly woman in no acute distress, but slightly confused,
however.  Oriented x3.
HEAD AND NECK:  The left eye has a surgical pupil, but the
right is reactive.  Her cranial nerves II through XII were
intact.
NECK:  Supple.  She had no appreciable jugular venous
distention.
CHEST:  Clear to auscultation.
CARDIAC:  She had an irregular heart rhythm with a 2/6
systolic ejection murmur that radiated to the carotids.
ABDOMEN:  Soft and nonfocal.
EXTREMITIES were 5/5 strength with 2 reflexes bilaterally.

LABS ON PRESENTATION:  She had a white blood cell count of
17.1, hematocrit of 30.4, platelet count of 265.  Sodium of
115, potassium 2.9, chloride 78, bicarbonate 23, BUN 24,
creatinine 1.0 and glucose 133.  The patient's cardiac panel
showed a troponin of less than 0.3, CPK of 666 and a CK/MB of
15.5.  A urinalysis was done which was yellow and cloudy with
protein greater than 300, large blood, trace ketones, small
bilirubin, pH of 5, specific gravity of greater than 1.030,
large leukocytes, negative nitrite and greater than 50 white
blood cells and red blood cells.  The patient's
electrocardiogram showed atrial fibrillation with decreased
ST segments in V5 and V6.  The patient also had reports from
[**Hospital3 3765**] of a head CT of 1.2 cm x 6.5 cm of right
post frontal subdural without midline shift.  Chest x-ray
also by report from [**Hospital3 3765**] showed an obscured right
heart border and a cervical spine by report from [**Hospital3 42966**] showed no fracture or dislocation.

HOSPITAL COURSE:  The patient was admitted to the Medical
Intensive Care Unit under medicine service with consultation
from neurologic surgery.  During her Medical Intensive Care
Unit course, the patient's repeat head CT showed subdural
hematoma which was unchanged to slightly smaller.  The
patient ruled out for a myocardial infarction by enzymes,
despite the electrocardiogram changes persisting.  The
patient was felt to have hypovolemic hyponatremia and was
started on normal saline infusion with improvement of her
sodium from 115 to 120, as well as improvement of her mental
status.  The patient was never intubated.  She had an episode
of chest pain during her second Medical Intensive Care Unit
day, but the electrocardiogram was unchanged.  A second panel
of cardiac enzymes were sent which were again negative.

The patient was transferred from the Medical Intensive Care
Unit to the medicine floor on [**2112-7-11**].  The patient was
given intravenous Zantac as well as Protonix for likely
epigastric pain presenting as chest discomfort with no relief
of her chest pain.  The patient was then given 1 mg of
intravenous morphine which relieved her pain, but made her
very drowsy.  At this point, it was felt that the patient was
too drowsy in order to adequately monitor her neurologic
status and there was some question of whether or not there
was a depression in her neurologic status despite the
morphine.  She was then sent again for a repeat CT scan which
showed no change in her subdural hematoma and the patient
denied any further chest discomfort from then on.

The patient's neurologic status also remarkably improved by
[**2112-7-12**].  The patient was taken off of aspiration
precautions after a speech and swallow consultation.  The
patient was treated for her hyponatremia with fluid
restriction, thought likely to be SIADH given her subdural
hematoma.  Her sodium continued to increase through her
hospital course.  She was given some hypertonic sodium
chloride solution, 3% sodium chloride which also helped
increase her sodium level.  The patient was found to have
some congestive heart failure and was occasionally given
Lasix diuresis as needed.  The patient had an echocardiogram
which was completed on [**2112-7-11**] which shows severe
symmetric left ventricular hypertrophy, mild dilated left
atrium, hyperdynamic left ventricle with an ejection fraction
of greater than 75%, aortic valve leaflets severely thickened
and deformed, moderate aortic stenosis, mild mitral stenosis,
1+ to 2+ tricuspid regurgitation, moderate pulmonary artery
hypertension.

The patient continued to be in atrial fibrillation according
to telemetry and repeat electrocardiogram with slight
decrease in the level of ST depression from the baseline
electrocardiogram.  Cardiology was consulted in order to
determine how best to manage her atrial fibrillation, aortic
stenosis, but also given her contraindication to
anticoagulation given her intracranial bleed.  At that point,
cardiology's recommendations were to continue to rate control
her with Diltiazem 180 mg q day and not cardiovert her
secondary to the contraindications, as well as not give her
aspirin secondary to her bleed.

Neurosurgery continued to follow the patient until [**2112-7-13**].
Their recommendations were that the patient should follow up
in four week with a repeat head CT.  The patient was treated
for a urinary tract infection during the course of her stay
with Levaquin 250 mg every day with a total course of seven
days.  The repeat urine cultures showed no growth which
indicated that there was adequate coverage with the
antibiotic chosen.  The patient's electrolytes were monitored
on a daily basis and repleted as necessary, especially in
regards to her potassium phosphorus and magnesium.  The
patient was able to tolerate a full diet without any
difficulty and on [**2112-7-14**], her fluid restriction was
removed without any complications upon her sodium.

Physical therapy and occupational therapy were consulted
which recommended that the patient move on to an inpatient
rehabilitation facility in order to regain her strength.  The
patient was discharged on [**2112-7-16**] to an inpatient
rehabilitation facility.

DISCHARGE PHYSICAL EXAM:
VITAL SIGNS:  Stable.
GENERAL:  The patient was alert and oriented in no acute
distress.
HEAD, EARS, EYES, NOSE AND THROAT:  Her right pupil was
reactive, the left surgical.  Extraocular muscles intact.
Oropharynx was clear.
NECK:  Supple, no lymphadenopathy, no jugular venous
distention.
LUNGS:  Minimal bibasilar crackles at the base, otherwise are
clear to auscultation.  She continues to have an irregularly
irregular heart rate with a 2/6 systolic ejection murmur that
radiates to the carotids.
ABDOMEN:  Soft and nontender.
EXTREMITIES:  No edema and distal pulses are palpable 2+.
NEUROLOGIC:  The patient has equal upper extremity and lower
extremity strength, as well as 2+ reflexes bilaterally.

DISCHARGE LABS:  Her white blood cell count is 11.8.
Hemoglobin is 12.6.  Hematocrit is 35.8.  Platelet count is
266.  Her sodium is 132, potassium 4.3, chloride 94,
bicarbonate 27, BUN 17, creatinine 0.8, glucose 123.  Calcium
is 8.9, potassium 3.2, magnesium 1.9.

DISCHARGE MEDICATIONS:
1.  Diltiazem Extended Release 180 mg q day
2.  Levobunolol hydrochlorothiazide 0.5% solution, 1 drop on
the left eye twice a day
3.  Levofloxacin 250 mg po x1 more day to complete a total of
a seven day course.

The patient is to contact her primary care physician, [**Last Name (NamePattern4) **].
[**Last Name (STitle) 42967**], for a follow up appointment upon her discharge from
the rehabilitation facility with Dr. [**Last Name (STitle) 42967**].  She will then
choose a cardiologist to follow up with on a regular basis,
as well as having a repeat head CT in four weeks and a follow
up appointment with neurosurgery, Dr. [**Last Name (STitle) **].




                             [**Last Name (LF) **],[**Name8 (MD) **] M.D.  12.ADF

Dictated By:[**Last Name (NamePattern1) 22577**]
MEDQUIST36

D:  [**2112-7-16**]  09:47
T:  [**2112-7-16**]  12:14
JOB#:  [**Job Number 42968**]


Admission Date:  [**2112-7-10**]       Discharge Date:  [**2112-7-16**]


Service:  .

ADDENDUM:

Please note that we have discontinued her Hydrochlorothiazide
as an outpatient and she will receive Lasix 40 mg p.o. p.r.n.
chest crackles or decreasing oxygen saturation while in her
rehabilitation facility.



                            [**Last Name (LF) **],[**Name8 (MD) **] M.D.  12.ADF

Dictated By:[**Last Name (NamePattern1) 43237**]
MEDQUIST36

D:  [**2112-7-16**]  11:08
T:  [**2112-7-16**]  15:13
JOB#:  [**Job Number 43238**]
1
1
1
DR



Admission Date:  [**2112-7-10**]       Discharge Date:


Service:

ADDENDUM:

Please note that the patient was made DNR/DNI during her
hospital stay on [**2112-7-11**].  The patient was discharged in
stable condition.

DISCHARGE DIAGNOSES:
1.  Hyponatremia.
2.  Subdural hematoma.
3.  Atrial fibrillation.
4.  Aortic stenosis.
5.  Urinary tract infection.

The patient will also be discharged on Hydrochlorothiazide 25
mg p.o. once daily.




                             [**Last Name (LF) **],[**Name8 (MD) **] M.D.  12.ADF

Dictated By:[**Last Name (NamePattern1) 9296**]
MEDQUIST36

D:  [**2112-7-16**]  09:50
T:  [**2112-7-16**]  12:37
JOB#:  [**Job Number 43236**] and [**Numeric Identifier **]
{'Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Atrial fibrillation,Mitral valve stenosis and aortic valve stenosis,Diseases of tricuspid valve,Urinary tract infection, site not specified,Other disorders of neurohypophysis,Unspecified essential hypertension,Fall from other slipping, tripping, or stumbling'}


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 an 85-year-old female
with a history of hypertension who was living at home by
herself and had been lethargic, fatigued and dehydrated the
past week because of a heat wave, fell down two days prior to
admission and had been down for approximately 36 hours when
she was then found by her son.  She was taken to [**Hospital3 42966**] where her sodium was 115, potassium 2.5 and a head
CT revealed an subacute subdural hematoma.  She was then
transferred to [**Hospital6 256**] on
[**2112-7-10**] for further care.  Upon arrival, she had dried blood
on her scalp and appeared slightly confused at times, but was
occasionally oriented x3.

MEDICAL HISTORY: 1.  Hypertension x10 years
2.  Heart murmur, the character and type of which was not
known.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: VITAL SIGNS:  Stable.
GENERAL:  The patient was alert and oriented in no acute
distress.
HEAD, EARS, EYES, NOSE AND THROAT:  Her right pupil was
reactive, the left surgical.  Extraocular muscles intact.
Oropharynx was clear.
NECK:  Supple, no lymphadenopathy, no jugular venous
distention.
LUNGS:  Minimal bibasilar crackles at the base, otherwise are
clear to auscultation.  She continues to have an irregularly
irregular heart rate with a 2/6 systolic ejection murmur that
radiates to the carotids.
ABDOMEN:  Soft and nontender.
EXTREMITIES:  No edema and distal pulses are palpable 2+.
NEUROLOGIC:  The patient has equal upper extremity and lower
extremity strength, as well as 2+ reflexes bilaterally.

FAMILY HISTORY: Significant for a sister with [**Name2 (NI) 499**] cancer.

SOCIAL HISTORY: No alcohol or tobacco history.  The patient
lives by herself, but in close proximity to both of her
children who check on her everyday. 

### Response:
{'Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Atrial fibrillation,Mitral valve stenosis and aortic valve stenosis,Diseases of tricuspid valve,Urinary tract infection, site not specified,Other disorders of neurohypophysis,Unspecified essential hypertension,Fall from other slipping, tripping, or stumbling'}
