CHIEF COMPLAINT: Hypotension and hypothermia.

PRESENT ILLNESS: The patient is an 89-year-old
woman with a history of metastatic transitional cell
carcinoma, and bilateral hydronephrosis, chronic renal
insufficiency, and right infiltrating ductal carcinoma who
presented to the Emergency Department after being found down
by family members.  At that time, the patient was noted to be
both hypotensive and hypothermic.

MEDICAL HISTORY: 1.  Transitional cell carcinoma with metastatic disease to
the liver and pelvis, bilateral hydronephrosis.
 2.  Right infiltrating ductal carcinoma of the breast
diagnosed in [**2186-5-30**], status post lumpectomy and
radiation therapy.  Chemotherapy was discontinued at the
patient's request.
 3.  Hypertension.
 4.  Hypercholesterolemia.
 5.  Hypothyroidism after ablation.
 6.  Chronic renal insufficiency.
 7.  Macular degeneration.
 8.  Status post left total hip replacement in [**2180**].
 9.  Bilateral hydronephrosis (as previously described).
10.  Anemia.
11.  Nephrolithiasis.

MEDICATION ON ADMISSION: (At home)
1.  Nadolol 40 mg p.o. b.i.d.
2.  Diovan.
3.  Ferrous sulfate.
4.  Lipitor.
5.  Epogen.

ALLERGIES: Allergy to ASPIRIN and CODEINE.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives alone at home.  She has a
heavy tobacco use history, but quit more than 20 years ago.
She denies ethanol use.
Unspecified septicemia,Acute kidney failure, unspecified,Anemia, unspecified,Malignant neoplasm of liver, secondary,Secondary malignant neoplasm of kidney,Hydronephrosis,Unspecified essential hypertension,Pure hypercholesterolemia,Personal history of malignant neoplasm of breast
Septicemia NOS,Acute kidney failure NOS,Anemia NOS,Second malig neo liver,Second malig neo kidney,Hydronephrosis,Hypertension NOS,Pure hypercholesterolem,Hx of breast malignancy
Admission Date:  [**2187-4-13**]     Discharge Date:  [**2187-4-18**]


Service:

CHIEF COMPLAINT:  Hypotension and hypothermia.

HISTORY OF PRESENT ILLNESS:  The patient is an 89-year-old
woman with a history of metastatic transitional cell
carcinoma, and bilateral hydronephrosis, chronic renal
insufficiency, and right infiltrating ductal carcinoma who
presented to the Emergency Department after being found down
by family members.  At that time, the patient was noted to be
both hypotensive and hypothermic.

Per Emergency Department report, she apparently had fallen 24
hours to 36 hours before being found and was unable to rise
secondary to weakness.  She denied any loss of consciousness
or focal pain.

On initial presentation, the patient was alert, weak,
conversant, but hypothermic with a rectal temperature
of 92.9.  She was bradycardic into the 40s with a blood
pressure of 118/42.

PAST MEDICAL HISTORY:
 1.  Transitional cell carcinoma with metastatic disease to
the liver and pelvis, bilateral hydronephrosis.
 2.  Right infiltrating ductal carcinoma of the breast
diagnosed in [**2186-5-30**], status post lumpectomy and
radiation therapy.  Chemotherapy was discontinued at the
patient's request.
 3.  Hypertension.
 4.  Hypercholesterolemia.
 5.  Hypothyroidism after ablation.
 6.  Chronic renal insufficiency.
 7.  Macular degeneration.
 8.  Status post left total hip replacement in [**2180**].
 9.  Bilateral hydronephrosis (as previously described).
10.  Anemia.
11.  Nephrolithiasis.

MEDICATIONS ON ADMISSION:  (At home)
1.  Nadolol 40 mg p.o. b.i.d.
2.  Diovan.
3.  Ferrous sulfate.
4.  Lipitor.
5.  Epogen.

ALLERGIES:  Allergy to ASPIRIN and CODEINE.

SOCIAL HISTORY:  The patient lives alone at home.  She has a
heavy tobacco use history, but quit more than 20 years ago.
She denies ethanol use.

PHYSICAL EXAMINATION ON PRESENTATION:  Initial physical
examination was as follows; temperature of _____, pulse
of 55, blood pressure of 96/43, respiratory rate of 16,
oxygen saturation of 100% on 3 liters nasal cannula.  She was
an elderly-appearing, thin, chronically ill-appearing woman
in no acute distress.  Her head, eyes, ears, nose, and throat
examination was significant for bilateral irregular post
surgical pupils.  Her mucous membranes were dry.  Her neck
was supple.  No lymphadenopathy was noted.  Her lungs were
clear to auscultation bilaterally.  Her heart was regular but
bradycardic.  Normal first heart sound and second heart
sound.  No third heart sound or fourth heart sound were
noted; however, there was a 2/6 systolic murmur at the apex
and a 2/6 systolic murmur at the base.  Her abdomen was soft,
nontender, and nondistended, with inguinal lymphadenopathy.
Her extremities were without clubbing, cyanosis or edema.
She had chronic venous stasis changes in her shins
bilaterally.  On neurologic examination, she was awake and
oriented to person only.

PERTINENT LABORATORY DATA ON PRESENTATION:  Admission
laboratory studies were as follows; white blood cell count
of 26, hematocrit of 34.1, platelets of 339.  On her white
blood count, there was left shift with 92% polys, 3% bands,
3% lymphocytes, 2% monocytes.  Sodium of 143, potassium
of 4.6, chloride of 106, bicarbonate of 15, blood urea
nitrogen of 57, creatinine of 2 (up from a baseline of 1.4),
blood glucose of 75.

RADIOLOGY/IMAGING:  Electrocardiogram showed sinus
bradycardia with normal axis, first-degree anterior vesicular
block delay with an increased QTc of 515.

A chest x-ray was unrevealing.

A head CT without contrast did not show any acute
intracranial pathology.

HOSPITAL COURSE:  The patient was initially admitted to the
Medical Intensive Care Unit for pressor support, as the
patient had previous advanced directive of do not
resuscitate/do not intubate.

By hospital day four, the patient was weaned off pressors;
however, she subsequently developed left upper extremity
paralysis and a leftward gaze and was unresponsive.

At that time, the family decided to make the patient comfort
measures only with antibiotics and intravenous fluids to be
continued. Under the guidance of palliative care, a morphine
drip was started to make the patient more comfortable.  The
patient expired on [**2187-4-18**].

DISCHARGE DIAGNOSES:
1.  Transitional cell carcinoma.
2.  Cerebrovascular accident.
3.  Sepsis.



                          [**First Name11 (Name Pattern1) 312**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 313**], M.D.  [**MD Number(1) 314**]

Dictated By:[**Last Name (NamePattern1) 9348**]

MEDQUIST36

D:  [**2187-7-3**]  16:19
T:  [**2187-7-4**]  12:30
JOB#:  [**Job Number 104595**]
{'Unspecified septicemia,Acute kidney failure, unspecified,Anemia, unspecified,Malignant neoplasm of liver, secondary,Secondary malignant neoplasm of kidney,Hydronephrosis,Unspecified essential hypertension,Pure hypercholesterolemia,Personal history of malignant neoplasm of breast'}


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: Hypotension and hypothermia.

PRESENT ILLNESS: The patient is an 89-year-old
woman with a history of metastatic transitional cell
carcinoma, and bilateral hydronephrosis, chronic renal
insufficiency, and right infiltrating ductal carcinoma who
presented to the Emergency Department after being found down
by family members.  At that time, the patient was noted to be
both hypotensive and hypothermic.

MEDICAL HISTORY: 1.  Transitional cell carcinoma with metastatic disease to
the liver and pelvis, bilateral hydronephrosis.
 2.  Right infiltrating ductal carcinoma of the breast
diagnosed in [**2186-5-30**], status post lumpectomy and
radiation therapy.  Chemotherapy was discontinued at the
patient's request.
 3.  Hypertension.
 4.  Hypercholesterolemia.
 5.  Hypothyroidism after ablation.
 6.  Chronic renal insufficiency.
 7.  Macular degeneration.
 8.  Status post left total hip replacement in [**2180**].
 9.  Bilateral hydronephrosis (as previously described).
10.  Anemia.
11.  Nephrolithiasis.

MEDICATION ON ADMISSION: (At home)
1.  Nadolol 40 mg p.o. b.i.d.
2.  Diovan.
3.  Ferrous sulfate.
4.  Lipitor.
5.  Epogen.

ALLERGIES: Allergy to ASPIRIN and CODEINE.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives alone at home.  She has a
heavy tobacco use history, but quit more than 20 years ago.
She denies ethanol use. 

### Response:
{'Unspecified septicemia,Acute kidney failure, unspecified,Anemia, unspecified,Malignant neoplasm of liver, secondary,Secondary malignant neoplasm of kidney,Hydronephrosis,Unspecified essential hypertension,Pure hypercholesterolemia,Personal history of malignant neoplasm of breast'}
