CHIEF COMPLAINT: Worsened anemia

PRESENT ILLNESS: This is an 84 year old male with history dementia and end stage
kidney disease secondary to IgA nephropathy who presented to the
ED with chief complaint of worsened anemia.  The patient had
arrived at his dialysis center from his [**Hospital1 1501**].  There, he was
noted to have a ten point Hct drop and was also hypotensive
during dialysis.  On questioning he endorsed abdominal pain and
feeling generally tired/weak.  He was sent to the ED for further
work-up.

MEDICAL HISTORY: -End Stage Kidney Disease secondary to IgA nephropathy and HTN
-Anemia
-Gout
-COPD
-Recent left brachial vein thrombosis
-HTN
-prostate cancer
-Peripheral vascular disease
-GERD
-chronic pancreatitis secondary to alcoholism
-S/P bilateral THR
-S/P corneal implants

MEDICATION ON ADMISSION: 1. Bupropion HCl 100 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO QAM (once a day (in the morning)).
2. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
3. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Ace Inhibitors

PHYSICAL EXAM: On Presentation to ICU:
Vital Signs: Patient intubated, afebrile, thready pulse palpable
at left carotid
Gen: Cachectic African American elderly man intubated with
mottled skin
HEENT: intubated and sedated
Pulm: Clear lung sounds bilaterally
Abdomen: Soft, pt unable to report if tender, no guarding, no
masses
Extrem: Cool, mottled, no edema, femoral CVL
Skin: Cyanotic at lips, cool
Neuro: intubated, no spontaneous movements

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Denies EtOH/tobacco.
Lives at [**Hospital 671**] [**Hospital 4094**] Hospital in [**Location (un) 86**]. Family in [**State 4260**].
Has long term friend [**Name (NI) 1692**] [**Name (NI) 68466**] [**Telephone/Fax (1) 103350**] (who identifies
himselt as pts health care proxy)who takes care of things and
updates family in [**State 4260**].
lost apartment since long term stay at Radius. H/o staying at
[**First Name4 (NamePattern1) 3504**] [**Last Name (NamePattern1) **] in past.
Hypotension, unspecified,Chronic airway obstruction, not elsewhere classified,Other specified disorders of intestine,Coronary atherosclerosis of native coronary artery,Nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney,Renal dialysis status,Gout, unspecified,Abdominal pain, unspecified site,Other thalassemia,Esophageal reflux,Peripheral vascular disease, unspecified,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Other persistent mental disorders due to conditions classified elsewhere,Personal history of malignant neoplasm of prostate,Hemorrhage of gastrointestinal tract, unspecified,End stage renal disease,Other acute and subacute forms of ischemic heart disease, other,Cardiac arrest
Hypotension NOS,Chr airway obstruct NEC,Intestinal disorders NEC,Crnry athrscl natve vssl,Nephritis NOS,Renal dialysis status,Gout NOS,Abdmnal pain unspcf site,Thalassemia NEC,Esophageal reflux,Periph vascular dis NOS,Osteoarthros NOS-unspec,Mental disor NEC oth dis,Hx-prostatic malignancy,Gastrointest hemorr NOS,End stage renal disease,Ac ischemic hrt dis NEC,Cardiac arrest
Admission Date:  [**2117-8-24**]              Discharge Date:   [**2117-8-25**]

Date of Birth:  [**2035-3-29**]             Sex:   M

Service: MEDICINE

Allergies:
Ace Inhibitors

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

Major Surgical or Invasive Procedure:
Placement of femoral central venous line

History of Present Illness:
This is an 84 year old male with history dementia and end stage
kidney disease secondary to IgA nephropathy who presented to the
ED with chief complaint of worsened anemia.  The patient had
arrived at his dialysis center from his [**Hospital1 1501**].  There, he was
noted to have a ten point Hct drop and was also hypotensive
during dialysis.  On questioning he endorsed abdominal pain and
feeling generally tired/weak.  He was sent to the ED for further
work-up.

In the ED initial vital signs were BP 120/58, satting 98% on RA.
 He had a femoral line placed for access.  Hb was 7.2 and rectal
exam revealed guiac positive brown stool.  NG lavage was guiac
negative.  In the ED he dropped his blood pressure to 85/55 and
this improved with 500 cc of NS.  Nonspecific EKG changes led to
a cardiology consult and they recommended transfusion.  A CT
scan was ordered to evaluate the patient's abdominal pain that
showed changes consistent with ischemic bowel.  He received
ciprofloxacin and metronidazole.  After discussion with the
[**Hospital 228**] health care proxy goals of care were established as
the patient would not want surgery but he would want all other
resuscitation measures.  Please see hospital course for summary
of remainder of ED course and other hospital course.

Review of Systems: Positive as noted above per other
documentation.  Unobtainable at arrival to MICU.

Past Medical History:
-End Stage Kidney Disease secondary to IgA nephropathy and HTN
-Anemia
-Gout
-COPD
-Recent left brachial vein thrombosis
-HTN
-prostate cancer
-Peripheral vascular disease
-GERD
-chronic pancreatitis secondary to alcoholism
-S/P bilateral THR
-S/P corneal implants

Social History:
Denies EtOH/tobacco.
Lives at [**Hospital 671**] [**Hospital 4094**] Hospital in [**Location (un) 86**]. Family in [**State 4260**].
Has long term friend [**Name (NI) 1692**] [**Name (NI) 68466**] [**Telephone/Fax (1) 103350**] (who identifies
himselt as pts health care proxy)who takes care of things and
updates family in [**State 4260**].
lost apartment since long term stay at Radius. H/o staying at
[**First Name4 (NamePattern1) 3504**] [**Last Name (NamePattern1) **] in past.


Family History:
Non-contributory

Physical Exam:
On Presentation to ICU:
Vital Signs: Patient intubated, afebrile, thready pulse palpable
at left carotid
Gen: Cachectic African American elderly man intubated with
mottled skin
HEENT: intubated and sedated
Pulm: Clear lung sounds bilaterally
Abdomen: Soft, pt unable to report if tender, no guarding, no
masses
Extrem: Cool, mottled, no edema, femoral CVL
Skin: Cyanotic at lips, cool
Neuro: intubated, no spontaneous movements

Pertinent Results:
===================
LABORATORY RESULTS
===================
[**2117-8-24**] 07:00PM   GLUCOSE-127* UREA N-18 CREAT-2.2*# SODIUM-142
POTASSIUM-3.5 CHLORIDE-102 TOTAL CO2-29 ANION GAP-15
[**2117-8-24**] 07:13PM   LACTATE-3.2*
[**2117-8-24**] 07:00PM   ALT(SGPT)-19 AST(SGOT)-38 CK(CPK)-177* TOT
BILI-0.7
[**2117-8-24**] 07:00PM   LIPASE-6
[**2117-8-24**] 07:00PM   CK-MB-7 cTropnT-0.54*
[**2117-8-24**] 07:00PM   ALBUMIN-2.4*
[**2117-8-24**] 07:00PM   VoidSpec-UNLABELED
[**2117-8-24**] 07:00PM   NEUTS-87.9* LYMPHS-10.1* MONOS-1.6* EOS-0.3
BASOS-0.1
[**2117-8-24**] 07:00PM   PLT COUNT-165
[**2117-8-24**] 07:00PM   NEUTS-87.9* LYMPHS-10.1* MONOS-1.6* EOS-0.3
BASOS-0.1
[**2117-8-24**] 07:00PM   PT-18.8* PTT-121.5* INR(PT)-1.7*

===============
OTHER STUDIES
===============
ECG:
Normal sinus rhythm. Diffuse T wave flattening and mild ST
segment depression
in the lateral leads V4-V6. Compared to the previous tracing of
[**2117-3-24**] the
marked T wave flattening is new. Consider metabolic/electrolyte
abnormality.

CT Abdomen and Pelvis W and W/O Contrast:
IMPRESSION:
1. Portal venous gas, pneumatosis and small bowel dilatation,
compatible with ischemic bowel. A nonenhancing loop of bowel in
the left abdomen is likely infarcted.
2. Focal high attenuation area in the right lung base concerning
for
aspiration of oral contrast. Oral contrast distending the distal
esophagus
places the patient at risk for recurrent aspiration.
3. Bilateral pleural effusions, right greater than left.
4. Cholelithiasis.
5. The aorta and mesenteric vessels are patent without
significant stenosis.  The mesenteric veins are not optimally
assessed due to timing of the IV contrast bolus.
6. Expansion of the left psoas muscle with central low density,
which appears to be a fluid collection. Infection cannot be
excluded.
7. Atrophic native kidneys, with suggestion of striated
nephrograms that
could represent infection or infarction.
8. Coronary artery calcifications.
9. Findings of chronic pancreatitis.

Brief Hospital Course:
This is an 82 year old male with dementia, end stage renal
disease, and chronic anemia who presented with worsening anemia,
guiac positive stool, and likely ischemic bowel.

In the ED after CT scan the patient had a PEA arrest.  He
received multiple rounds of atropine and epinephrine with
eventual return of spontaneous circulation.  He was intubated
during this initial code blue event.  As attempts were made to
wheel the patient out of ED and up to MICU he had a second PEA
arrest and once again received multiple rounds of medications
and a brief period of pacing.  Shortly after this second arrest
the patient was wheeled upstairs with an ED physician
accompanying him.  He received another milligram of epinephrine
in the elevator after losing his pulse.

On arrival to MICU the patient had no spontaneous movements and
appeared cachectic and cool with mottled skin.  Per records he
had received at least 6 mg of epinephrine and three doses of
atropine.  Only palpable pulse was thready carotid pulse on
left.  Within less than five minutes of arrival to MICU patient
once again became pulse less with PEA rhythm.  He received an
additional two cycles of CPR and another milligram of
epinephrine.  Given likely etiology of arrest was thought to be
sepsis and persistent hypotension from infarcting bowel and that
no other reversible cause seemed reasonable, as well as the fact
the patient had received >20 minutes of total CPR between his
multiple events, resuscitation efforts were stopped.

Medications on Admission:
1. Bupropion HCl 100 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO QAM (once a day (in the morning)).
2. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
3. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Calcitriol 0.25 mcg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
5. Calcium Acetate 667 mg Capsule Sig: Two (2) Capsule PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
6. Clonidine 0.3 mg/24 hr Patch Weekly Sig: One (1) Patch Weekly

Transdermal QFRI (every Friday).
7. Hydralazine 10 mg Tablet Sig: Two (2) Tablet PO Q8H (every 8
hours): hold for sbp <100.
8. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
9. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
const.
10. Dulcolax 10 mg Suppository Sig: One (1)  Rectal prn: qd.
11. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
12. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO once a day as
needed for constipation.
13. Morphine 1 mg/mL Syringe Sig: One (1) mg Injection Q4H
(every 4 hours) as needed for pain: subcutaneous for arm or leg
incision pain.
14. Diovan 160 mg Tablet Sig: One (1) Tablet PO twice a day.
15. Labetalol 200 mg Tablet Sig: One (1) Tablet PO every eight
(8) hours.
16. Wellbutrin SR 100 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO once a day.
17. Nitroglycerin 2 % Ointment Sig: One (1) inch Transdermal
prn: q 6 hours for chest pain.
18. Aranesp (Polysorbate) 40 mcg/0.4 mL Syringe Sig: One (1)
Injection once a week: Wednesday.
19. Aspirin and Heparin SQ
hold until right thigh incision stops oozing
20. Ferrlecit 12.5 mg/mL Solution Sig: One [**Age over 90 **]y Five
(125) mg Intravenous once a week: Tuesday.
21. EMLA 2.5-2.5 % Cream Sig: One (1) applic Topical 3x/week at
hemodialysis.
22. Lac-Hydrin 12 % Lotion Sig: One (1) application Topical
twice a day: to dry areas.


Discharge Medications:
Patient expired

Discharge Disposition:
Expired

Discharge Diagnosis:
Primary Diagnosis
Cardiovascular arrest presumed secondary to bowel
infarction/sepsis as well as anemia in the context of coronary
artery disease
GI bleed

Discharge Condition:
Pt expired

Discharge Instructions:
Pt expired

Followup Instructions:
Pt expired
{'Hypotension, unspecified,Chronic airway obstruction, not elsewhere classified,Other specified disorders of intestine,Coronary atherosclerosis of native coronary artery,Nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney,Renal dialysis status,Gout, unspecified,Abdominal pain, unspecified site,Other thalassemia,Esophageal reflux,Peripheral vascular disease, unspecified,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Other persistent mental disorders due to conditions classified elsewhere,Personal history of malignant neoplasm of prostate,Hemorrhage of gastrointestinal tract, unspecified,End stage renal disease,Other acute and subacute forms of ischemic heart disease, other,Cardiac arrest'}


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: Worsened anemia

PRESENT ILLNESS: This is an 84 year old male with history dementia and end stage
kidney disease secondary to IgA nephropathy who presented to the
ED with chief complaint of worsened anemia.  The patient had
arrived at his dialysis center from his [**Hospital1 1501**].  There, he was
noted to have a ten point Hct drop and was also hypotensive
during dialysis.  On questioning he endorsed abdominal pain and
feeling generally tired/weak.  He was sent to the ED for further
work-up.

MEDICAL HISTORY: -End Stage Kidney Disease secondary to IgA nephropathy and HTN
-Anemia
-Gout
-COPD
-Recent left brachial vein thrombosis
-HTN
-prostate cancer
-Peripheral vascular disease
-GERD
-chronic pancreatitis secondary to alcoholism
-S/P bilateral THR
-S/P corneal implants

MEDICATION ON ADMISSION: 1. Bupropion HCl 100 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO QAM (once a day (in the morning)).
2. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
3. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Ace Inhibitors

PHYSICAL EXAM: On Presentation to ICU:
Vital Signs: Patient intubated, afebrile, thready pulse palpable
at left carotid
Gen: Cachectic African American elderly man intubated with
mottled skin
HEENT: intubated and sedated
Pulm: Clear lung sounds bilaterally
Abdomen: Soft, pt unable to report if tender, no guarding, no
masses
Extrem: Cool, mottled, no edema, femoral CVL
Skin: Cyanotic at lips, cool
Neuro: intubated, no spontaneous movements

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Denies EtOH/tobacco.
Lives at [**Hospital 671**] [**Hospital 4094**] Hospital in [**Location (un) 86**]. Family in [**State 4260**].
Has long term friend [**Name (NI) 1692**] [**Name (NI) 68466**] [**Telephone/Fax (1) 103350**] (who identifies
himselt as pts health care proxy)who takes care of things and
updates family in [**State 4260**].
lost apartment since long term stay at Radius. H/o staying at
[**First Name4 (NamePattern1) 3504**] [**Last Name (NamePattern1) **] in past. 

### Response:
{'Hypotension, unspecified,Chronic airway obstruction, not elsewhere classified,Other specified disorders of intestine,Coronary atherosclerosis of native coronary artery,Nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney,Renal dialysis status,Gout, unspecified,Abdominal pain, unspecified site,Other thalassemia,Esophageal reflux,Peripheral vascular disease, unspecified,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Other persistent mental disorders due to conditions classified elsewhere,Personal history of malignant neoplasm of prostate,Hemorrhage of gastrointestinal tract, unspecified,End stage renal disease,Other acute and subacute forms of ischemic heart disease, other,Cardiac arrest'}
