CHIEF COMPLAINT: weakness and fall

PRESENT ILLNESS: 83F with PMH myositis, urinary retention (self caths [**Hospital1 **]), HTN,
hyponatremia who presents with weakness and fall. Pt states that
this morning while was walking with her cane and fell backwards
because she felt weak. She denies prodromal syx with no chest
pain, palpitations, lightheadedness, and had no LOC. She did
fall and struck her head. She says she has had problems with
myositis in the past and her legs are very weak. She had a MVA
10 days ago, and was seen here this MOnday with rib fractures.
She saw her PCP yesterday who recommended she see a specialist
for her myositis. This morning, she was also concerned because
she had no urine when she self-cath'd. She decided to drink a
lot of fluids and drank 12, 6oz, of water. She denies any fever,
chills, chest pain, SOB or cough. No myalgias or arthralgias.
.
In the ED inital vitals were, 98.6 61 163/103 20 99%. Labs were
notable for a Na of 116, which on stat repeat 3 hours later came
back at 120 in the context of having been given 500cc normal
saline. Her urine Na was 27, and a prelim head CT showed No
acute intracranial process. A prelim CXR showed no acute
infiltrate or effusion.
.
In the [**Hospital Unit Name 153**] she denies pain anywhere, chest pain, SOB,
palpitation, lightheadedness. She reports her weakness is not
new and that she was in rehab facilities in the past for this.
She stated that her physician at [**Name Initial (PRE) **]&W told her she has inlusion
body myositis. Denies nausea or vomiting or blurred vision.
Reports chronic constipation for which she takes medications.

MEDICAL HISTORY: Urinary incontinence
HYPOGAMMAGLOBULIMEMIA, UNSPEC
FRACTURE - THORACIC COMPRESSION
MYOPATHY, OTHER
HYPERCHOLESTEROLEMIA
OSTEOARTHRITIS, R CMC joint - HAND
SPINAL STENOSIS - LUMBAR L2-3
HISTORY BASAL CELL CARCINOMA-nose and ant chest
GLAUCOMA SUSPECT, UNSPEC
HISTORY TOBACCO USE
HYPERTENSION - ESSENTIAL
OSTEOPOROSIS, UNSPEC

MEDICATION ON ADMISSION: - naproxen sodium (ALEVE) 220 mg Oral Capsule 1 tablet po bid as
needed
- Citalopram 10 mg Oral Tablet Take 1 tablet daily (started 2
days ago)
- Gabapentin 100 mg Oral Capsule take 1 cap at HS
- Cephalexin 250 mg Oral Capsule 1 tab by mouth at bedtime each
night
- Estradiol (ESTRACE) 0.01 % (0.1 mg/g) Vaginal Cream insert per
vagina one gram weekly
- Atenolol 25 mg Oral Tablet Take 1 tablet daily
- Alendronate (FOSAMAX) 70 mg Oral Tablet 1 tablet one day a
week in am,30min before food.Do not lie down for at least 30min

ALLERGIES: Sulfa (Sulfonamide Antibiotics) / adhesive tape

PHYSICAL EXAM: Admission physical exam:
Vitals: T: 97.4 BP:155/70 P:66 R: 14 O2: 96% RA
General: Alert, orientedx3, no acute distress
HEENT: Sclera anicteric, MM relatively dry, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no rales, no wheezes
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft with large echymosis, non-tender, non-distended,
bowel sounds present, no rebound tenderness or guarding, no
organomegaly
GU: foley
Lower Ext: warm, well perfused, 1+ pulses, no clubbing or
cyanosis. trace ankle edema with venous stasis changes
Neuro: Aox3, CN 2-12 grossly intact. power UE [**5-9**] bilaterally.
power 3+ LE bilaterally.

FAMILY HISTORY: NC

SOCIAL HISTORY: - Tobacco:  Former Smoker
- Alcohol:  1.0 oz alcohol/week
- works at a book store and drives to her work
Other disorders of neurohypophysis,Inclusion body myositis,Retention of urine, unspecified,Unspecified essential hypertension,Constipation, unspecified,Other malaise and fatigue,Pure hypercholesterolemia,Osteoporosis, unspecified,Anxiety state, unspecified,Osteoarthrosis, localized, not specified whether primary or secondary, hand,History of fall,Personal history of other malignant neoplasm of skin,Aftercare for healing traumatic fracture of other bone
Neurohypophysis dis NEC,Inclusion body myositis,Retention urine NOS,Hypertension NOS,Constipation NOS,Malaise and fatigue NEC,Pure hypercholesterolem,Osteoporosis NOS,Anxiety state NOS,Loc osteoarth NOS-hand,Personal history of fall,Hx-skin malignancy NEC,Aftrce traum fx bone NEC
Name:  [**Known lastname 13077**],[**Known firstname 11693**] E               Unit No:   [**Numeric Identifier 15355**]

Admission Date:  [**2143-10-5**]              Discharge Date:   [**2143-10-9**]

Date of Birth:  [**2060-5-23**]             Sex:   F

Service: MEDICINE

Allergies:
Sulfa (Sulfonamide Antibiotics) / adhesive tape

Attending:[**First Name3 (LF) 11732**]
Addendum:
1. Patient had a low bicarb during hospitalization but quickly
resolved so the normal anion gap acidosis could not be
confirmed.
2. Cephlexin is for UTI prophylaxis
3.Hypogammaglobulinemia was not an active issue during this
hospitalization and her levels were not checked.

Discharge Disposition:
Extended Care

Facility:
[**First Name4 (NamePattern1) 3008**] [**Last Name (NamePattern1) **] - [**Location (un) 164**]

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 11733**] MD [**MD Number(2) 11734**]

Completed by:[**2143-11-7**]

Admission Date:  [**2143-10-5**]              Discharge Date:   [**2143-10-9**]

Date of Birth:  [**2060-5-23**]             Sex:   F

Service: MEDICINE

Allergies:
Sulfa (Sulfonamide Antibiotics) / adhesive tape

Attending:[**First Name3 (LF) 983**]
Chief Complaint:
weakness and fall

Major Surgical or Invasive Procedure:
None

History of Present Illness:
83F with PMH myositis, urinary retention (self caths [**Hospital1 **]), HTN,
hyponatremia who presents with weakness and fall. Pt states that
this morning while was walking with her cane and fell backwards
because she felt weak. She denies prodromal syx with no chest
pain, palpitations, lightheadedness, and had no LOC. She did
fall and struck her head. She says she has had problems with
myositis in the past and her legs are very weak. She had a MVA
10 days ago, and was seen here this MOnday with rib fractures.
She saw her PCP yesterday who recommended she see a specialist
for her myositis. This morning, she was also concerned because
she had no urine when she self-cath'd. She decided to drink a
lot of fluids and drank 12, 6oz, of water. She denies any fever,
chills, chest pain, SOB or cough. No myalgias or arthralgias.
.
In the ED inital vitals were, 98.6 61 163/103 20 99%. Labs were
notable for a Na of 116, which on stat repeat 3 hours later came
back at 120 in the context of having been given 500cc normal
saline. Her urine Na was 27, and a prelim head CT showed No
acute intracranial process. A prelim CXR showed no acute
infiltrate or effusion.
.
In the [**Hospital Unit Name 153**] she denies pain anywhere, chest pain, SOB,
palpitation, lightheadedness. She reports her weakness is not
new and that she was in rehab facilities in the past for this.
She stated that her physician at [**Name Initial (PRE) **]&W told her she has inlusion
body myositis. Denies nausea or vomiting or blurred vision.
Reports chronic constipation for which she takes medications.


Past Medical History:
Urinary incontinence
HYPOGAMMAGLOBULIMEMIA, UNSPEC
FRACTURE - THORACIC COMPRESSION
MYOPATHY, OTHER
HYPERCHOLESTEROLEMIA
OSTEOARTHRITIS, R CMC joint - HAND
SPINAL STENOSIS - LUMBAR L2-3
HISTORY BASAL CELL CARCINOMA-nose and ant chest
GLAUCOMA SUSPECT, UNSPEC
HISTORY TOBACCO USE
HYPERTENSION - ESSENTIAL
OSTEOPOROSIS, UNSPEC


Social History:
- Tobacco:  Former Smoker
- Alcohol:  1.0 oz alcohol/week
- works at a book store and drives to her work


Family History:
NC

Physical Exam:
Admission physical exam:
Vitals: T: 97.4 BP:155/70 P:66 R: 14 O2: 96% RA
General: Alert, orientedx3, no acute distress
HEENT: Sclera anicteric, MM relatively dry, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no rales, no wheezes
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft with large echymosis, non-tender, non-distended,
bowel sounds present, no rebound tenderness or guarding, no
organomegaly
GU: foley
Lower Ext: warm, well perfused, 1+ pulses, no clubbing or
cyanosis. trace ankle edema with venous stasis changes
Neuro: Aox3, CN 2-12 grossly intact. power UE [**5-9**] bilaterally.
power 3+ LE bilaterally.

Discharge exam:
Vitals: Temp.: 97.2 BP 145/67 HR 56 O2 98 RA
GEN:  Patient sitting up in bed nad a+ox3
HEENT:  MMM oropharynx clear
NECK:  supple no thyromegaly
CV:  rrr no m/r/g
RESP: ctab no w/r/r
ABD:  soft nt nd bs+
EXTR: no le edema good pedal pulses bilaterally
DERM:  no rashes, ulcers or petechiae
neuro:  cn 2-12 grossly intact non-focal
PSYCH: normal affect and mood



Pertinent Results:
CBC:
[**2143-10-5**] 06:00PM BLOOD WBC-7.1 RBC-4.53 Hgb-14.6 Hct-38.6 MCV-85
MCH-32.2* MCHC-37.8* RDW-15.1 Plt Ct-230
[**2143-10-6**] 04:46AM BLOOD WBC-6.7 RBC-3.96* Hgb-12.6 Hct-34.5*
MCV-87 MCH-31.7 MCHC-36.4* RDW-14.5 Plt Ct-223
.
Blood chemistry:
[**2143-10-5**] 06:00PM BLOOD Glucose-99 UreaN-11 Creat-0.4 Na-116*
K-4.2 Cl-85* HCO3-19* AnGap-16
[**2143-10-6**] 01:58AM BLOOD Na-120*
[**2143-10-6**] 11:30AM BLOOD Na-124* K-3.7 Cl-94*
[**2143-10-6**] 04:46AM BLOOD Calcium-8.2* Phos-2.4* Mg-1.7
[**2143-10-6**] 04:46AM BLOOD ALT-20 AST-26 LD(LDH)-272* AlkPhos-77
TotBili-0.9
.
Blood Osm:
[**2143-10-5**] 06:00PM BLOOD Osmolal-243*
[**2143-10-6**] 04:46AM BLOOD Osmolal-247*
.
Urine:
[**2143-10-5**] 07:35PM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-10 Bilirub-NEG Urobiln-NEG pH-6.5 Leuks-NEG
[**2143-10-6**] 04:46AM URINE Hours-RANDOM UreaN-234 Creat-27 Na-32
K-20 Cl-25
[**2143-10-5**] 07:35PM URINE UCG-NEGATIVE Osmolal-227
[**2143-10-6**] 04:46AM URINE Osmolal-201

Hormones:
[**2143-10-6**] 04:46AM BLOOD TSH-3.3
[**2143-10-6**] 04:46AM BLOOD Cortsol-23.5*
.
IMAGING:
CT head without contrast [**2143-10-5**]:
IMPRESSION:
1. No acute intracranial process.
2. Chronic left sphenoid sinusitis.
.
CXR PA and LAT [**2143-10-5**]:
FINDINGS: There is mild hyperinflation of the lungs. The heart
size is top
normal. There is no pulmonary edema, or pneumothorax. Small
bilateral
pleural effusions. Multiple mid-thoracic vertebral body
compression
fractures, stable.
IMPRESSION: No pneumonia. Small effusions.

Discharge labs

[**2143-10-7**] 06:40AM BLOOD WBC-6.1 RBC-4.02* Hgb-12.8 Hct-36.6
MCV-91 MCH-31.9 MCHC-35.1* RDW-15.0 Plt Ct-218
[**2143-10-9**] 07:05AM BLOOD Creat-0.4 Na-133 K-4.4 Cl-102
[**2143-10-8**] 06:50AM BLOOD Glucose-81 UreaN-13 Creat-0.5 Na-134
K-4.5 Cl-102 HCO3-27 AnGap-10

Brief Hospital Course:
# Hyponatermia/SIADH: Unknown baseline. Na was 126 on [**9-30**] and
125 on [**10-4**]. Her Na dropped from 125 to 120 on her prior
admission after IV NS. Her serum osm is suggestive of SIADH in
the context of urine osm > 100. No polydypsia per history.
Hypothyroidism and adrenal insuffiency might be possible
etiologies for hyponatermia as well.  At PCP [**10-4**] serum osm 265
urine osm 447, more keeping with SIADH. Celexa has been held as
it can contribute to SIADH. TSH and AM corisol were normal. Her
free water intake was restricted to 1.25 L with improvement in
her Na level. Renal was following who recommended not to salt
restrict diet and to start salt tabs 1 tab TID. Her Na continued
to improve and salt tabs were d/ced and fluid intake was
liberalized.  On day of discharge her Na had normalized to 133.
PLEASE CHECK BIWEEKLY SODIUM AND URINE OSM AT REHAB FACILITY.
RESTRICT TO 2L FREE WATER AND ADJUST PER SODIUM LEVELS.
.
# fall: most likely mechanical related to her underlying
myositis and weakness. She was told at B&W per patient that she
has inclusion body myositis. Her weakness is not new, but she
feels she is weaker recently. She was previously in rehab
facilities which according to her helped her weakness.  Though
she remembers hitting her head, her CT scan final report didn't
show ICH. Her weakness improved with physical therapy and
correction of hyponatremia.  She will be discharged to a rehab
facility to continue working with physical therapy(patient is
very concerned about her lower extremity strength and hopes this
will be emphasized at rehab).
.
# Hypertension: continue home meds
- Atenolol 25 mg once daily
- clonidine 0.1 mg once daily - bed time
.
# urine incontinence: she self cath's herself twice daily for
passing urine. Takes keflex 250 mg once daily at bed time.
PLEASE CONTINUE STRAIGHT CATH [**Hospital1 **] AND CEPHALEXIN .


Medications on Admission:
- naproxen sodium (ALEVE) 220 mg Oral Capsule 1 tablet po bid as
needed
- Citalopram 10 mg Oral Tablet Take 1 tablet daily (started 2
days ago)
- Gabapentin 100 mg Oral Capsule take 1 cap at HS
- Cephalexin 250 mg Oral Capsule 1 tab by mouth at bedtime each
night
- Estradiol (ESTRACE) 0.01 % (0.1 mg/g) Vaginal Cream insert per
vagina one gram weekly
- Atenolol 25 mg Oral Tablet Take 1 tablet daily
- Alendronate (FOSAMAX) 70 mg Oral Tablet 1 tablet one day a
week in am,30min before food.Do not lie down for at least 30min

- Clonidine 0.1 mg Oral Tablet 1 tab QHS

Discharge Medications:
1. cephalexin 250 mg Capsule Sig: One (1) Capsule PO HS (at
bedtime).
2. atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
3. clonidine 0.1 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
4. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
5. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
6. heparin (porcine) 5,000 unit/mL Solution Sig: One (1)
Injection twice a day.
7. gabapentin 100 mg Capsule Sig: One (1) Capsule PO HS (at
bedtime).
8. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1)  PO
DAILY (Daily) as needed for constipation.
9. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO every six
(6) hours as needed for fever or pain.
10. Outpatient Lab Work
Please check sodium, potassium and creatinine and urine/serum
osmolality twice weekly starting friday [**10-11**] at rehab facility


Discharge Disposition:
Extended Care

Facility:
[**First Name4 (NamePattern1) 1188**] [**Last Name (NamePattern1) **] - [**Location (un) 538**]

Discharge Diagnosis:
hyponatremia secondary to SIADH
weakness


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
You were admitted with weakness and found to have low sodium in
your blood thought to be from a condition called SIADH.  With
salt tabs and restricting your fluid intake it corrected.  On
discharge you did not need salt tabs and you were able to drink
up to 2L of fluid daily.  Physical therapy also evaluated your
weakness and felt that you would benefit from a stay at a rehab
facility.

Followup Instructions:
You will be going to a rehab facility to help increase your
strength.  After you are discharged from rehab, please call your
primary care physician and make [**Name Initial (PRE) **] follow up appointment(about
1-2 weeks after leaving the rehab facility)
{'Other disorders of neurohypophysis,Inclusion body myositis,Retention of urine, unspecified,Unspecified essential hypertension,Constipation, unspecified,Other malaise and fatigue,Pure hypercholesterolemia,Osteoporosis, unspecified,Anxiety state, unspecified,Osteoarthrosis, localized, not specified whether primary or secondary, hand,History of fall,Personal history of other malignant neoplasm of skin,Aftercare for healing traumatic fracture of other bone'}


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: weakness and fall

PRESENT ILLNESS: 83F with PMH myositis, urinary retention (self caths [**Hospital1 **]), HTN,
hyponatremia who presents with weakness and fall. Pt states that
this morning while was walking with her cane and fell backwards
because she felt weak. She denies prodromal syx with no chest
pain, palpitations, lightheadedness, and had no LOC. She did
fall and struck her head. She says she has had problems with
myositis in the past and her legs are very weak. She had a MVA
10 days ago, and was seen here this MOnday with rib fractures.
She saw her PCP yesterday who recommended she see a specialist
for her myositis. This morning, she was also concerned because
she had no urine when she self-cath'd. She decided to drink a
lot of fluids and drank 12, 6oz, of water. She denies any fever,
chills, chest pain, SOB or cough. No myalgias or arthralgias.
.
In the ED inital vitals were, 98.6 61 163/103 20 99%. Labs were
notable for a Na of 116, which on stat repeat 3 hours later came
back at 120 in the context of having been given 500cc normal
saline. Her urine Na was 27, and a prelim head CT showed No
acute intracranial process. A prelim CXR showed no acute
infiltrate or effusion.
.
In the [**Hospital Unit Name 153**] she denies pain anywhere, chest pain, SOB,
palpitation, lightheadedness. She reports her weakness is not
new and that she was in rehab facilities in the past for this.
She stated that her physician at [**Name Initial (PRE) **]&W told her she has inlusion
body myositis. Denies nausea or vomiting or blurred vision.
Reports chronic constipation for which she takes medications.

MEDICAL HISTORY: Urinary incontinence
HYPOGAMMAGLOBULIMEMIA, UNSPEC
FRACTURE - THORACIC COMPRESSION
MYOPATHY, OTHER
HYPERCHOLESTEROLEMIA
OSTEOARTHRITIS, R CMC joint - HAND
SPINAL STENOSIS - LUMBAR L2-3
HISTORY BASAL CELL CARCINOMA-nose and ant chest
GLAUCOMA SUSPECT, UNSPEC
HISTORY TOBACCO USE
HYPERTENSION - ESSENTIAL
OSTEOPOROSIS, UNSPEC

MEDICATION ON ADMISSION: - naproxen sodium (ALEVE) 220 mg Oral Capsule 1 tablet po bid as
needed
- Citalopram 10 mg Oral Tablet Take 1 tablet daily (started 2
days ago)
- Gabapentin 100 mg Oral Capsule take 1 cap at HS
- Cephalexin 250 mg Oral Capsule 1 tab by mouth at bedtime each
night
- Estradiol (ESTRACE) 0.01 % (0.1 mg/g) Vaginal Cream insert per
vagina one gram weekly
- Atenolol 25 mg Oral Tablet Take 1 tablet daily
- Alendronate (FOSAMAX) 70 mg Oral Tablet 1 tablet one day a
week in am,30min before food.Do not lie down for at least 30min

ALLERGIES: Sulfa (Sulfonamide Antibiotics) / adhesive tape

PHYSICAL EXAM: Admission physical exam:
Vitals: T: 97.4 BP:155/70 P:66 R: 14 O2: 96% RA
General: Alert, orientedx3, no acute distress
HEENT: Sclera anicteric, MM relatively dry, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no rales, no wheezes
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft with large echymosis, non-tender, non-distended,
bowel sounds present, no rebound tenderness or guarding, no
organomegaly
GU: foley
Lower Ext: warm, well perfused, 1+ pulses, no clubbing or
cyanosis. trace ankle edema with venous stasis changes
Neuro: Aox3, CN 2-12 grossly intact. power UE [**5-9**] bilaterally.
power 3+ LE bilaterally.

FAMILY HISTORY: NC

SOCIAL HISTORY: - Tobacco:  Former Smoker
- Alcohol:  1.0 oz alcohol/week
- works at a book store and drives to her work 

### Response:
{'Other disorders of neurohypophysis,Inclusion body myositis,Retention of urine, unspecified,Unspecified essential hypertension,Constipation, unspecified,Other malaise and fatigue,Pure hypercholesterolemia,Osteoporosis, unspecified,Anxiety state, unspecified,Osteoarthrosis, localized, not specified whether primary or secondary, hand,History of fall,Personal history of other malignant neoplasm of skin,Aftercare for healing traumatic fracture of other bone'}
