CHIEF COMPLAINT: hyperkalemia

PRESENT ILLNESS: This is a 62 year old woman with pmh significant for ESRD
secondary to IgA nephropathy, on HD, awoke this morning feeling
shortness of breath, palpitations, nausea, and reported feeling
crackles in her chest. She reports these symptoms are consistent
with her being hyperkalemic, as she has experienced these in the
past. She called EMS, on arrival her HR was in the 20's. EKG had
peaked T waves. She was given 1 amp of calcium chloride by EMS.

MEDICAL HISTORY: 1. Atrial fibrillation/flutter: first diagnosed in [**Month (only) **]
[**2195**]. She has not been on Coumadin until very recently due to
history of upper GI bleeding. On [**Month (only) 404**] of this year, she was
admitted to [**Hospital1 18**] with chest pain and shortness of breath in the

MEDICATION ON ADMISSION: CALCIUM ACETATE - 667 mg Capsule - 3 Capsule(s) by mouth three
times a day
CAPTOPRIL - 12.5 mg Tablet - 1 Tablet(s) by mouth at bedtime
CINACALCET [SENSIPAR] - 60 mg Tablet - 2 Tablet(s) by mouth
DAILY
(Daily)
CITALOPRAM - (Prescribed by Other Provider) - 40 mg Tablet - 1
Tablet(s) by mouth qam
LISINOPRIL - 40 mg Tablet - 1 Tablet(s) by mouth DAILY (Daily)
pt
holds on dialysis days
METOPROLOL SUCCINATE - 50 mg Tablet Sustained Release 24 hr - 1

ALLERGIES: Dilantin

PHYSICAL EXAM: General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2,SEM [**2-26**] in LUSB with
radiation to carotids, also continuous murmer in apex
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CN II-XII grossly intact, 5/5 strength in all 4 ext

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or

SOCIAL HISTORY: She is single, lives by herself in [**Location (un) 686**], and has no
children. She quit smoking 25 years ago (10-pack-years). She
rarely drinks alcohol, and denies illicit drug use. She used to
Hyperpotassemia,End stage renal disease,Complications of transplanted kidney,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Chronic diastolic heart failure,Atrial flutter,Other specified hypoglycemia,Nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney,Depressive disorder, not elsewhere classified,Esophageal reflux,Renal dialysis status,Personal history of tobacco use,Long-term (current) use of anticoagulants,Insulins and antidiabetic agents causing adverse effects in therapeutic use,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Hyperpotassemia,End stage renal disease,Compl kidney transplant,Hyp kid NOS w cr kid V,Chr diastolic hrt fail,Atrial flutter,Oth spcf hypoglycemia,Nephritis NOS,Depressive disorder NEC,Esophageal reflux,Renal dialysis status,History of tobacco use,Long-term use anticoagul,Adv eff insulin/antidiab,Abn react-org transplant
Admission Date:  [**2196-10-4**]              Discharge Date:   [**2196-10-5**]

Date of Birth:  [**2134-9-9**]             Sex:   F

Service: MEDICINE

Allergies:
Dilantin

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
 hyperkalemia

Major Surgical or Invasive Procedure:
hemodialysis

History of Present Illness:
This is a 62 year old woman with pmh significant for ESRD
secondary to IgA nephropathy, on HD, awoke this morning feeling
shortness of breath, palpitations, nausea, and reported feeling
crackles in her chest. She reports these symptoms are consistent
with her being hyperkalemic, as she has experienced these in the
past. She called EMS, on arrival her HR was in the 20's. EKG had
peaked T waves. She was given 1 amp of calcium chloride by EMS.

On arrival to [**Hospital1 18**] ED her HR was 36. Initial potassium was 9.9
on a hemolyzed sample. She was given an amp of sodium
bicarbonate, dextrose, albuterol, and insulin. Her HR increased
to 80's. Renal saw the patient and wanted admission to the ICU
for urgent HD.
.

In the ICU, she reports feeling rather diaphoretic and not well.
Notably, on FSBG check her BS is 60. She reports last HD session
was [**10-1**]. She did have some non-bloody emesis this am which is
new and has had some URI symptoms recently, though no myalgias,
fevers, chills or sweats. She denies any consumption of foods
high in potassium other than potatoes over the weekend. She has
been taking all medications as directed.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache. Denied cough, shortness of breath. Denied
chest pain or tightness, palpitations. Denied diarrhea,
constipation or abdominal pain. No recent change in bowel or
bladder habits. No dysuria. Denied arthralgias or myalgias.


Past Medical History:
1. Atrial fibrillation/flutter: first diagnosed in [**Month (only) **]
[**2195**]. She has not been on Coumadin until very recently due to
history of upper GI bleeding. On [**Month (only) 404**] of this year, she was
admitted to [**Hospital1 18**] with chest pain and shortness of breath in the

setting of atrial flutter with rapid ventricular response and
hyperkalemia. She was treated for hyperkalemia and subsequently

her atrial flutter was converted to sinus rhythm. Myocardial
infarction was [**Hospital1 20003**] out based EKG and biomarkers. Thereafter,
she underwent right-sided isthmus ablation of clockwise atrial
flutter, and was started on quinidine and Coumadin.
2. End-stage renal disease on hemodialysis secondary to IgA
nephropathy. She underwent cadaveric kidney transplant in [**2173**]
which has eventually failed, and started on hemodialysis in
[**2193**].
3. History of upper GI bleeding on [**2195-2-20**] with evidence
of esophagitis, gastric ulcer, and bleeding duodenal vessel. She

was treated by clipping, cauterization and PPI. Repeated
endoscopy in [**2195-4-21**] revealed mild inflammation and healing
ulcer. She has not had any recurrent episodes of GI bleeding
since then.
4. Diastolic heart failure supported by an echocardiography from

[**2195-12-21**]. Clinically, she is stable and fairly asymptomatic

on her current medical regimen.
5. History of malignant hypertension, which was complicated by
seizure on [**2193-5-20**]. Not on antiepileptic meds. Denies h/o CVA.

6. Depression.
7. Rheumatic fever in childhood
.


Social History:
She is single, lives by herself in [**Location (un) 686**], and has no
children. She quit smoking 25 years ago (10-pack-years). She
rarely drinks alcohol, and denies illicit drug use. She used to

work part-time in a coffee shop, but currently does not work.


Family History:
No family history of early MI, arrhythmia, cardiomyopathies, or

sudden cardiac death; otherwise non-contributory. Her father
died at the age of 80. Her mother died at the age of 64 from
lung CA. She has a sister with breast CA. MI in uncle in his 60s



Physical Exam:
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2,SEM [**2-26**] in LUSB with
radiation to carotids, also continuous murmer in apex
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CN II-XII grossly intact, 5/5 strength in all 4 ext


Pertinent Results:
on admission:

133 | 93 | 96
--------------144
7.7 | 17 |11.7

ca12.8
mg 3.3
phos 4.7

11.4 > 40.5 < 244

trop 0.5 CK 85

Brief Hospital Course:
Assessment and Plan: This is a 62 yo female with history of ESRD
on HD who presents with hyperkalemia of unclear etiology with
ECG changes but otherwise hemodynamically stable admitted to
MICU for urgent HD.
.
# Hyperkalemia: Potassium of 7.7 on presentation to ED. Unclear
etiology given recent HD, no dietary indiscretions, normal acid
base status and no other metabolic abnormalities. Pt was
urgently dialyzed in the MICU. Recheck potassium 4 hours after
HD was 4.0. She was sent home with a prescription for
kayexelate.
.
# Hypoglycemia: Pt found to be hypoglycemic upon admission to
the ICU. This was felt to likely be related to insulin she
received in ED for her hyperkalemia, [**1-22**] amp D50 given c good
result.
.
# HTN: BP currently stable. Continued outpateint regimen of
lopressor (switched to tartrate while hospitalized) and
lisinopril. Captopril held overnight, however, pt was more
hypertensive overnight. Pt discharged on home dose of
amlodipine.
.
#Afib: continued on amniodarone
.
# GERD: continued pantoprazole
.
# Depression: continued citalopram
.
# FEN: No IVF, HD for electrolyte balance, Renal Diet
.
# Prophylaxis: Subcutaneous heparin, PPI
.
# Access: peripherals
.
# Code: DNR/DNI per discussion with patient

Medications on Admission:
CALCIUM ACETATE - 667 mg Capsule - 3 Capsule(s) by mouth three
times a day
CAPTOPRIL - 12.5 mg Tablet - 1 Tablet(s) by mouth at bedtime
CINACALCET [SENSIPAR] - 60 mg Tablet - 2 Tablet(s) by mouth
DAILY
(Daily)
CITALOPRAM - (Prescribed by Other Provider) - 40 mg Tablet - 1
Tablet(s) by mouth qam
LISINOPRIL - 40 mg Tablet - 1 Tablet(s) by mouth DAILY (Daily)
pt
holds on dialysis days
METOPROLOL SUCCINATE - 50 mg Tablet Sustained Release 24 hr - 1

Tablet(s) by mouth DAILY (Daily)
PANTOPRAZOLE - 40 mg Tablet, Delayed Release (E.C.) - 1
Tablet(s)
by mouth once a day
SEVELAMER CARBONATE [RENVELA] - 800 mg Tablet - 3 Tablet(s) by
mouth three times a day
WARFARIN - (Prescribed by Other Provider: [**Name10 (NameIs) **] [**Name Initial (NameIs) **]/c from [**Hospital1 18**]) - 2

mg Tablet - 2 Tablet(s) by mouth once a day


Discharge Medications:
1. Calcium Acetate 667 mg Capsule Sig: Three (3) Capsule PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
2. Toprol XL 50 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO once a day.
3. Sevelamer Carbonate 800 mg Tablet Sig: Three (3) Tablet PO
TID W/MEALS (3 TIMES A DAY WITH MEALS).
4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
5. Citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

6. Warfarin 4 mg Tablet Sig: One (1) Tablet PO once a day.
7. Cinacalcet  Oral
8. Lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day.
9. Captopril 12.5 mg Tablet Sig: One (1) Tablet PO at bedtime.
10. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. Amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day.
12. Kayexalate     Powder Sig: Fifteen (15) grams PO once a day.
Disp:*30 qs* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
primary diagnosis: hyperkalemia
secondary diagnosis: chronic kidney disease, hypertension


Discharge Condition:
stable


Discharge Instructions:
You were admitted with a high potassium level. It is not clear
what resulted in this potassium elevation. High potassium can
cause arrythmias so you were admitted to the hospital for
emergency dialysis. After dialysis your potassium was just a
little bit above normal.

When you go home, please eat a low potassium diet. We are
providing you with some information about how to eat a low
potassium diet. This is very important.

Please continue with your regular hemodialysis. Please continue
all of your current medicines.


Followup Instructions:
Please call Dr [**Last Name (STitle) **] and make an appointment to see him
within the next week. Please tell him that you were recently
hospitalized for elevated potassium levels.
{'Hyperpotassemia,End stage renal disease,Complications of transplanted kidney,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Chronic diastolic heart failure,Atrial flutter,Other specified hypoglycemia,Nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney,Depressive disorder, not elsewhere classified,Esophageal reflux,Renal dialysis status,Personal history of tobacco use,Long-term (current) use of anticoagulants,Insulins and antidiabetic agents causing adverse effects in therapeutic use,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: hyperkalemia

PRESENT ILLNESS: This is a 62 year old woman with pmh significant for ESRD
secondary to IgA nephropathy, on HD, awoke this morning feeling
shortness of breath, palpitations, nausea, and reported feeling
crackles in her chest. She reports these symptoms are consistent
with her being hyperkalemic, as she has experienced these in the
past. She called EMS, on arrival her HR was in the 20's. EKG had
peaked T waves. She was given 1 amp of calcium chloride by EMS.

MEDICAL HISTORY: 1. Atrial fibrillation/flutter: first diagnosed in [**Month (only) **]
[**2195**]. She has not been on Coumadin until very recently due to
history of upper GI bleeding. On [**Month (only) 404**] of this year, she was
admitted to [**Hospital1 18**] with chest pain and shortness of breath in the

MEDICATION ON ADMISSION: CALCIUM ACETATE - 667 mg Capsule - 3 Capsule(s) by mouth three
times a day
CAPTOPRIL - 12.5 mg Tablet - 1 Tablet(s) by mouth at bedtime
CINACALCET [SENSIPAR] - 60 mg Tablet - 2 Tablet(s) by mouth
DAILY
(Daily)
CITALOPRAM - (Prescribed by Other Provider) - 40 mg Tablet - 1
Tablet(s) by mouth qam
LISINOPRIL - 40 mg Tablet - 1 Tablet(s) by mouth DAILY (Daily)
pt
holds on dialysis days
METOPROLOL SUCCINATE - 50 mg Tablet Sustained Release 24 hr - 1

ALLERGIES: Dilantin

PHYSICAL EXAM: General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2,SEM [**2-26**] in LUSB with
radiation to carotids, also continuous murmer in apex
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CN II-XII grossly intact, 5/5 strength in all 4 ext

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or

SOCIAL HISTORY: She is single, lives by herself in [**Location (un) 686**], and has no
children. She quit smoking 25 years ago (10-pack-years). She
rarely drinks alcohol, and denies illicit drug use. She used to 

### Response:
{'Hyperpotassemia,End stage renal disease,Complications of transplanted kidney,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Chronic diastolic heart failure,Atrial flutter,Other specified hypoglycemia,Nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney,Depressive disorder, not elsewhere classified,Esophageal reflux,Renal dialysis status,Personal history of tobacco use,Long-term (current) use of anticoagulants,Insulins and antidiabetic agents causing adverse effects in therapeutic use,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
