CHIEF COMPLAINT: Lower extremity swelling

PRESENT ILLNESS: The patient is a 51 year old male with a history of DMI, left
Charcot foot and recent left tibia fracture in [**5-12**] who
presented originally to an outside hospital on [**2103-12-7**] with the
chief complaint of left foot pain and leg swelling x 2 days. The
patient is well known to the ortho service and Dr. [**Last Name (STitle) 1005**] at
[**Hospital1 18**]. He recently had his left lower extremity cast removed on
[**2103-11-20**] and had a removable boot since that time. On [**11-26**], the
patient was seen in ortho clinic at which time the patient
states that his boot was readjusted but was abrasive to the
dorsal aspect of his left foot.
.
For the past 2 days, the patient states that he has noticed
increased left lower extremity edema as well skin breakdown on
the dorsum of his left foot.  The patient presented to [**Hospital1 **] and received a CT-A that was negative for PE and LLE
U/S that was negative for DVT. Incidentally, it was found that
the patient had a significant LLL PMA on CXR although the
patient is asymptomatic. He denied any subjective fevers but was
febrile in our ED to 101.6. He denied any chills/cough or
shortness of breath but was found to be hypoxic to 89% on RA.
.
At [**Hospital1 3597**], the patient had received a heparin bolus for ?PE that
was discontinued. He also received levofloxacin 500 mg IV x 1.
He was transferred to [**Hospital1 18**] as he receives his ortho care here
and is unable to ambulate on his left lower extremity. At [**Hospital1 18**],
the patient was given flagyl 500 mg PO x 1 and oxycodone 10 mg
and dilaudid 2 mg IV x 1.
.
Of note, the patient had an xray of his LLE on [**11-26**] which
showed worsening of the varus angulation of the tibial fracture
and of the lateral side plate fracture since the previous study.

MEDICAL HISTORY: PMH:
DMI since the age of 18 c/b neuropathy
No CAD - negative cath in '[**97**]
EF 65% in [**2097**] by cath

MEDICATION ON ADMISSION: Lantus 25 units QHS
Humalog 8 units premeals and RIS 7 units premeals
Zetia
Augmentin x 2 months for RLE ulcer

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE:
Tc=101.6 P=106  BP=165/68  RR=16  89% on RA, 95% on 3 liters O2

FAMILY HISTORY: NC

SOCIAL HISTORY: Social History:
Bimalleolar fracture, closed,Fracture, cause unspecified,Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Acute and chronic respiratory failure,Disorders of diaphragm,Full-thickness skin loss [third degree NOS] of foot,Burn [any degree] involving less than 10 percent of body surface with third degree burn, less than 10 percent or unspecified,Accident caused by other hot substance or object,Arthropathy associated with neurological disorders,Peripheral autonomic neuropathy in disorders classified elsewhere,Polyneuropathy in diabetes,Gastroparesis,Other mechanical complication of other internal orthopedic device, implant, and graft,Hyposmolality and/or hyponatremia,Pressure ulcer, heel,Anemia of other chronic disease,Background diabetic retinopathy,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Unspecified essential hypertension
Fx bimalleolar-closed,Fracture, cause NOS,DMI neuro nt st uncntrld,Acute & chronc resp fail,Disorders of diaphragm,3rd deg burn foot,Bdy brn < 10%/3d deg NOS,Hot substance accid NEC,Arthropathy w nerve dis,Aut neuropthy in oth dis,Neuropathy in diabetes,Gastroparesis,Mech com orth dev NEC,Hyposmolality,Pressure ulcer, heel,Anemia-other chronic dis,Diabetic retinopathy NOS,Nephritis NOS in oth dis,Hypertension NOS
Admission Date:  [**2103-12-8**]              Discharge Date:   [**2103-12-11**]

Date of Birth:  [**2051-12-12**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5973**]
Chief Complaint:
Lower extremity swelling

Major Surgical or Invasive Procedure:
none

History of Present Illness:
The patient is a 51 year old male with a history of DMI, left
Charcot foot and recent left tibia fracture in [**5-12**] who
presented originally to an outside hospital on [**2103-12-7**] with the
chief complaint of left foot pain and leg swelling x 2 days. The
patient is well known to the ortho service and Dr. [**Last Name (STitle) 1005**] at
[**Hospital1 18**]. He recently had his left lower extremity cast removed on
[**2103-11-20**] and had a removable boot since that time. On [**11-26**], the
patient was seen in ortho clinic at which time the patient
states that his boot was readjusted but was abrasive to the
dorsal aspect of his left foot.
.
For the past 2 days, the patient states that he has noticed
increased left lower extremity edema as well skin breakdown on
the dorsum of his left foot.  The patient presented to [**Hospital1 **] and received a CT-A that was negative for PE and LLE
U/S that was negative for DVT. Incidentally, it was found that
the patient had a significant LLL PMA on CXR although the
patient is asymptomatic. He denied any subjective fevers but was
febrile in our ED to 101.6. He denied any chills/cough or
shortness of breath but was found to be hypoxic to 89% on RA.
.
At [**Hospital1 3597**], the patient had received a heparin bolus for ?PE that
was discontinued. He also received levofloxacin 500 mg IV x 1.
He was transferred to [**Hospital1 18**] as he receives his ortho care here
and is unable to ambulate on his left lower extremity. At [**Hospital1 18**],
the patient was given flagyl 500 mg PO x 1 and oxycodone 10 mg
and dilaudid 2 mg IV x 1.
.
Of note, the patient had an xray of his LLE on [**11-26**] which
showed worsening of the varus angulation of the tibial fracture
and of the lateral side plate fracture since the previous study.

.

ROS:
.
Sleeps with 3 pillows. Has baseline bilateral lower extremity
edema. No chills/cough/shortness of breath. Otherwise negative.


Past Medical History:
PMH:
DMI since the age of 18 c/b neuropathy
No CAD - negative cath in '[**97**]
EF 65% in [**2097**] by cath

Past Surgical History:
.
LLE tibial fracture s/p repair


Social History:
Social History:

Lives in [**Hospital1 3597**] with wife and kids. Disabled.


Family History:
NC

Physical Exam:
PE:
Tc=101.6 P=106  BP=165/68  RR=16  89% on RA, 95% on 3 liters O2

Gen - NAD, AOx3
HEENT - pupils minimal, reactive to light, JVD 9 cm
Heart - Increased rate, RR, Grade II/VI holosystolic and
diastolic murmur
Lungs - CTAB, no E->A changes
Abdomen - Soft, NT, ND + BS
Ext - Bilateral +2 p. edema to knees, L>R, bandage over right
ankle [**1-10**] ulcer (healing) and LLE with skin erosion to
subcutaneous tissue with erythema, no pus over dorsum of foot
and over dorsum of digits.


Pertinent Results:
Labs:
.
Results/Images:
.
CXR [**2103-12-8**]: LLL PMA.
.
LLE U/S [**2103-12-8**]: No DVT.
.
EKG [**2103-12-7**]:
Sinus tachycardia, LAD. LVH. LBBB. No ST/TW ischemic changes.


Brief Hospital Course:
The patient is a 51 year old male with DMI, history of left
Charcot foot and recent LLE tibial fracture with known fractured
plate now with increased LLE edema, pain and LLL pneumonia.
.
Plan:
.
# LLL Pneumonia
- The patient is currently stable on 3 liters O2. Would give IV
levo/flagyl. Levofloxacin for a community acquired pneumonia and
flagyl for bilateral lower extremity ulcers.  After evaluation
his LLL infiltrate may not pneumonia, possibly a diaphragm
phrenic nerve neuropathy, to be further evaluated by
pulmonology. He was schedule to follow at outpatient clinic to
further evaluate the phrenic nerve neuropathy.
.
# LLE swelling
This was associated with a new bimalleolar fracture with
disruption of the left ankle mortise, orthopedics was consulted
and determined with the left foot ulceration, surgery was not
indicated that this time, and he was to follow up as an
outpatient for further management. Podiatry was consulted to
evaluate for duration of antibiotics and he was discharged on a
10 day course of levofloxacin and clindamycin.  He had chronic
pain requiring and was started on MSContin for basal pain
requirements with oxycodone for breakthrough with good relief.

.
# DMI
He had hyperglycemia on admission he was continued lantus and
humalog and SSI. During his hospital course, Transfered to MICU
[**12-7**] for apparent hyperglycemic episode, found unresponsive, no
loss of pulse/respirations. 6pm the nurse found the patient
unresponsive and called a code. Vitals upon code teams arival
were T 9836 BP 115/70 P 100 R 20 O2 70's on RA. He had a pulse
and was breathing spontaneously. Patient was placed on NRB mask
and Sats went up to 99% Stayed O/N in MICU and tx'd out [**12-9**].  He
only required an overnight MICU stay, was stabilized back to the
floors, his insulin regiment was restarted as [**First Name8 (NamePattern2) **] [**Last Name (un) **] recs
with good control of sugars after titrating his sliding scale.

.
# HTN
The patients SBP was in the 160s and has known diabetes, and was
started on lisinopril with good control of his blood pressure.

# Hyponatremia
This was new onset on admission. His baseline sodium 134-140.
Check urine lytes.  His urine electrolytes were more suggestive
of hypovolemia, his sodium normalized with increased POs.
.
# Anemia: This was likely associated with chronic kidney disease
and remained at baseline.

# FEN - Diabetic, cardiac diet, monitor lytes - K, fluid
restrict to 2 liters.
.
# PPX - PPI, heparin SQ
.
# Code - FULL

.


Medications on Admission:
Lantus 25 units QHS
Humalog 8 units premeals and RIS 7 units premeals
Zetia
Augmentin x 2 months for RLE ulcer


Discharge Medications:
1. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
Disp:*30 Tablet(s)* Refills:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
3. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Enoxaparin 40 mg/0.4mL Syringe Sig: One (1)  Subcutaneous
DAILY (Daily).
Disp:*30 qs* Refills:*0*
5. Midodrine 5 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day) as needed for Hypotension.
Disp:*30 Tablet(s)* Refills:*0*
6. Oxycodone 20 mg Tablet Sustained Release 12HR Sig: One (1)
Tablet Sustained Release 12HR PO Q12H (every 12 hours).
Disp:*60 Tablet Sustained Release 12HR(s)* Refills:*0*
7. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO every four (4)
hours as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
8. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
9. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
10. Clindamycin HCl 300 mg Capsule Sig: Two (2) Capsule PO three
times a day for 6 days.
Disp:*18 Capsule(s)* Refills:*0*
11. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO once a day
for 6 days.
Disp:*6 Tablet(s)* Refills:*0*
12. Insulin Glargine 100 unit/mL Solution Sig: One (1)
Subcutaneous at bedtime: 25U qhs.
Disp:*1 qs* Refills:*2*
13. Humalog 100 unit/mL Cartridge Sig: One (1)  Subcutaneous
three times a day: 8U morning, lunch, dinner.
Disp:*1 qs* Refills:*2*
14. Insulin Regular Human 100 unit/mL Cartridge Sig: One (1)
Injection three times a day: 7U breakfast, lunch, dinner.
Disp:*1 qs* Refills:*2*
15. Silver Sulfadiazine 1 % Cream Sig: One (1) Appl Topical
ONCE (once) for 1 doses.
Disp:*1 qs* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Left tibular fracture
Left Foot Burn


Discharge Condition:
Stable


Discharge Instructions:
Please follow up with your appointments below.

If you experience increased fevers chills, shortness of breath,
pain, please contact your PCP.

Please

Please take your medications as instructed

Followup Instructions:
Orthopedics: Dr. [**Last Name (STitle) 1005**] [**2103-12-25**] 11:00am for follow up
appointment.  Dr.[**Name (NI) 4016**] office will call you to schedule
an earlier appointment.

Podiatry: Provider: [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 542**], DPM Phone:[**Telephone/Fax (1) 543**]
Date/Time:[**2103-12-12**] 3:30

Gastroenterology: Provider: [**First Name8 (NamePattern2) 870**] [**Last Name (NamePattern1) **], MD
Phone:[**Telephone/Fax (1) 1954**] Date/Time:[**2103-12-17**] 3:30

Sleep Study Followup Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 21189**], M.D.
Phone:[**Telephone/Fax (1) 612**] Date/Time:[**2103-12-18**] 11:00

Dr. [**Last Name (STitle) **], Dr. [**Last Name (STitle) **] [**2103-12-28**] 8:10am Pulmonology appointment
for concerns regarding left diaphragm
{'Bimalleolar fracture, closed,Fracture, cause unspecified,Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Acute and chronic respiratory failure,Disorders of diaphragm,Full-thickness skin loss [third degree NOS] of foot,Burn [any degree] involving less than 10 percent of body surface with third degree burn, less than 10 percent or unspecified,Accident caused by other hot substance or object,Arthropathy associated with neurological disorders,Peripheral autonomic neuropathy in disorders classified elsewhere,Polyneuropathy in diabetes,Gastroparesis,Other mechanical complication of other internal orthopedic device, implant, and graft,Hyposmolality and/or hyponatremia,Pressure ulcer, heel,Anemia of other chronic disease,Background diabetic retinopathy,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Unspecified essential hypertension'}


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 swelling

PRESENT ILLNESS: The patient is a 51 year old male with a history of DMI, left
Charcot foot and recent left tibia fracture in [**5-12**] who
presented originally to an outside hospital on [**2103-12-7**] with the
chief complaint of left foot pain and leg swelling x 2 days. The
patient is well known to the ortho service and Dr. [**Last Name (STitle) 1005**] at
[**Hospital1 18**]. He recently had his left lower extremity cast removed on
[**2103-11-20**] and had a removable boot since that time. On [**11-26**], the
patient was seen in ortho clinic at which time the patient
states that his boot was readjusted but was abrasive to the
dorsal aspect of his left foot.
.
For the past 2 days, the patient states that he has noticed
increased left lower extremity edema as well skin breakdown on
the dorsum of his left foot.  The patient presented to [**Hospital1 **] and received a CT-A that was negative for PE and LLE
U/S that was negative for DVT. Incidentally, it was found that
the patient had a significant LLL PMA on CXR although the
patient is asymptomatic. He denied any subjective fevers but was
febrile in our ED to 101.6. He denied any chills/cough or
shortness of breath but was found to be hypoxic to 89% on RA.
.
At [**Hospital1 3597**], the patient had received a heparin bolus for ?PE that
was discontinued. He also received levofloxacin 500 mg IV x 1.
He was transferred to [**Hospital1 18**] as he receives his ortho care here
and is unable to ambulate on his left lower extremity. At [**Hospital1 18**],
the patient was given flagyl 500 mg PO x 1 and oxycodone 10 mg
and dilaudid 2 mg IV x 1.
.
Of note, the patient had an xray of his LLE on [**11-26**] which
showed worsening of the varus angulation of the tibial fracture
and of the lateral side plate fracture since the previous study.

MEDICAL HISTORY: PMH:
DMI since the age of 18 c/b neuropathy
No CAD - negative cath in '[**97**]
EF 65% in [**2097**] by cath

MEDICATION ON ADMISSION: Lantus 25 units QHS
Humalog 8 units premeals and RIS 7 units premeals
Zetia
Augmentin x 2 months for RLE ulcer

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE:
Tc=101.6 P=106  BP=165/68  RR=16  89% on RA, 95% on 3 liters O2

FAMILY HISTORY: NC

SOCIAL HISTORY: Social History: 

### Response:
{'Bimalleolar fracture, closed,Fracture, cause unspecified,Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Acute and chronic respiratory failure,Disorders of diaphragm,Full-thickness skin loss [third degree NOS] of foot,Burn [any degree] involving less than 10 percent of body surface with third degree burn, less than 10 percent or unspecified,Accident caused by other hot substance or object,Arthropathy associated with neurological disorders,Peripheral autonomic neuropathy in disorders classified elsewhere,Polyneuropathy in diabetes,Gastroparesis,Other mechanical complication of other internal orthopedic device, implant, and graft,Hyposmolality and/or hyponatremia,Pressure ulcer, heel,Anemia of other chronic disease,Background diabetic retinopathy,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Unspecified essential hypertension'}
