CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 68 year old Spanish
speaking male with a 20 year history of hypertension who
presents with headache and chest pain to the Emergency Room.
He was found to have electrocardiogram changes, lateral ST
depressions and a [**Location (un) **] pressure of 260/120.  In the
Emergency Department the patient was put on Labetalol and the
[**Location (un) **] pressure dropped to 200/90.  Vital signs in the
Emergency Department were 214/103, pulse 97; respiratory 100%
on room air.  He received Labetalol 20 mg intravenously times
two, 40 mg times one, hydralazine and nitropaste.  The
patient stated that his headache had been going on for over a
month and that he called his primary care physician's office
and was told to come in to the Emergency Room secondary to
pressing chest pain, nonradiating.  No diaphoresis, no nausea
or vomiting.  This past Wednesday, his [**Location (un) **] pressure was
240/123.  He had an increased dose of his Labetalol from 20
to 40 mg and per his daughter, his [**Name2 (NI) **] pressures at home
have been high and with wide fluctuations over the past two
months.  Recently, he has stopped taking Atenolol and
Hydrochlorothiazide secondary to decreased platelets.

MEDICAL HISTORY: 1.  No prior hospitalization.
2.  Hypertension for 20 years.
3.  Congenital absence of one kidney.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Hypertension; no coronary artery disease.

SOCIAL HISTORY: He lives with his daughter.  [**Name (NI) **] does not
smoke, no alcohol.  He is retired and has a poor diet.
Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease,Acute kidney failure, unspecified,Thrombocytopenia, unspecified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Iron deficiency anemia, unspecified
Mal hyp kid w cr kid V,Acute kidney failure NOS,Thrombocytopenia NOS,BPH w/o urinary obs/LUTS,Iron defic anemia NOS
Admission Date:  [**2175-10-13**]     Discharge Date:  [**2175-10-18**]

Date of Birth:   [**2107-3-5**]     Sex:  M

Service:  [**Location (un) 259**]

HISTORY OF PRESENT ILLNESS:  This is a 68 year old Spanish
speaking male with a 20 year history of hypertension who
presents with headache and chest pain to the Emergency Room.
He was found to have electrocardiogram changes, lateral ST
depressions and a [**Location (un) **] pressure of 260/120.  In the
Emergency Department the patient was put on Labetalol and the
[**Location (un) **] pressure dropped to 200/90.  Vital signs in the
Emergency Department were 214/103, pulse 97; respiratory 100%
on room air.  He received Labetalol 20 mg intravenously times
two, 40 mg times one, hydralazine and nitropaste.  The
patient stated that his headache had been going on for over a
month and that he called his primary care physician's office
and was told to come in to the Emergency Room secondary to
pressing chest pain, nonradiating.  No diaphoresis, no nausea
or vomiting.  This past Wednesday, his [**Location (un) **] pressure was
240/123.  He had an increased dose of his Labetalol from 20
to 40 mg and per his daughter, his [**Name2 (NI) **] pressures at home
have been high and with wide fluctuations over the past two
months.  Recently, he has stopped taking Atenolol and
Hydrochlorothiazide secondary to decreased platelets.

PAST MEDICAL HISTORY:
1.  No prior hospitalization.
2.  Hypertension for 20 years.
3.  Congenital absence of one kidney.

REVIEW OF SYSTEMS:  Positive for dyspnea on exertion, but
there is no paroxysmal nocturnal dyspnea, no orthopnea.
Positive headache, worse with increased [**Name2 (NI) **] pressure.  No
visual changes, no loss of consciousness.

FAMILY HISTORY:  Hypertension; no coronary artery disease.

SOCIAL HISTORY:  He lives with his daughter.  [**Name (NI) **] does not
smoke, no alcohol.  He is retired and has a poor diet.

ALLERGIES:    No known drug allergies.

MEDICATIONS ON ARRIVAL:
1.  Cardura 2 mg.
2.  Benicar 20 mg q. h.s. with aspirin.

PHYSICAL EXAMINATION:  Vital signs on admission were a
temperature of 98.5 F.; [**Name (NI) **] pressure 192/102; mean pulse of
92; respiratory rate 23, 100% O2 on room air.  In general, he
is awake, alert and oriented times three, with a daughter at
bed side.  HEENT:  His fundi were clear without AV nicking.
No hemorrhages.  Oropharynx was clear.  Neck was with no
bruits, full range of motion.  Jugular venous pressure about
5 cm.  Cardiac was regular rate with S1 and S2 pronounced.
Lungs were clear to auscultation bilaterally.  Abdomen with
no aortic or renal bruit.  No generalized bruit.  Two plus
dorsalis pedis and posterior tibial pulses, femoral,
popliteal, radial.  Abdomen with positive bowel sounds times
four.  Extremities were warm with no cyanosis, clubbing or
edema.  Neurologic examination is cranial nerves II through
XII were intact.  No visual changes.  No dyssymmetry.
Finger-to-nose was normal.  No asterixis.

LABORATORY:  On admission, white [**Name (NI) **] cell count 9.4,
hematocrit 40; platelets 123; 73% segmentals, 17%
lymphocytes, 4% monocytes.  Creatinine of 2.0 on admission.
CK 54, troponin less than 0.01.

Chest x-ray on admission was no pneumonia, mild pulmonary
edema.  EKG with 0.[**Street Address(2) 1755**] depressions in the lateral V5 and
V6.  Decreased inverted T waves in AVL.

HOSPITAL COURSE:
1.  HYPERTENSION:  The patient was admitted initially to the
Cardiac Care Unit and was maintained on a Labetalol
intravenous drip and a Nitroglycerin drip, with goal to
reduce his [**Street Address(2) **] pressure slowly.  Eventually, the patient
was titrated off of the intravenous drip and was restarted on
metoprolol 50 mg three times a day and was switched to oral
medicine.  The patient was continued with his aspirin.  His
[**Street Address(2) **] pressure stabilized on p.o. medicines and he was
transferred to the floor.

On the floor, the patient did well initially, however, on the
day prior to discharge, the patient's [**Street Address(2) **] pressure again
went up to 220/100 which responded to change from Metoprolol
to Atenolol 100 mg and also adding nitropaste and intravenous
hydralazine.  The following morning, the patient was started
on Nifedipine 60 mg once a day in addition to his atenolol
100 mg once a day.  The patient's [**Street Address(2) **] pressure stabilized
to 150s to 160s over 90 on the day of discharge.  Upon
talking to his primary care physician, [**Name10 (NameIs) **] [**Name10 (NameIs) **] pressure
diastolic had never been less than 100 under her care and has
been labile since she has seen him.

The patient's [**Name10 (NameIs) **] pressure improved on the regimen of
atenolol 100 mg once a day, nifedipine 60 mg once a day, and
the patient was set up with free care to help him afford his
medicines as compliance was likely a factor in his
hypertensive urgency and hypertensive lability.  The patient
also had work-up for secondary causes of hypertension which
included an MRA of his kidneys which revealed no right kidney
and a widely patent left renal artery with no stenosis.  He
had a left kidney incised at 7.8 cm with a moderate cortical
irregularities with multiple renal cysts.  He had no
hydronephrosis and other organs visualized were within normal
limits.

The patient also had a set of urine catecholamines sent out
and are pending at time of discharge.  The patient will have
this followed up with by his primary care physician.
[**Name10 (NameIs) **], the patient's [**Name10 (NameIs) **] pressure was under stable
control and remained asymptomatic in terms of chest pain,
however, his headache did continue and his headache increased
when his [**Name10 (NameIs) **] pressure was higher.  Otherwise, the patient's
headaches were well controlled with Tylenol p.r.n.

For the patient's chronic renal insufficiency, he did have an
acute renal insufficiency failure on top of his chronic renal
failure.  His creatinine elevated up to 2.6 which responded
to intravenous hydration and returned to 2.1 at time of
discharge.  The patient's diuretic and ARBs and ACE
inhibitors were held secondary to his creatinine although it
was determined that he was at his baseline creatinine renal
function.

For the patient's headache, the patient will continue on
Tylenol p.r.n. with goal to try to improve [**Name10 (NameIs) **] pressure
control.  The patient will return on Monday for an outpatient
MRI and MRA of his head to rule out any aneurysm or any other
causes of headaches not related to his hypertension.

Otherwise, for the patient's benign prostatic hypertrophy,
the patient was continued on Cardura throughout the course of
his stay but was switched to Prazosin 2 mg q. h.s. at time of
discharge because of affordability issues.  Also, the patient
was started on Colace for a bowel prophylaxis while starting
the new calcium channel blockers to prevent constipation.

For the patient's anemia, the patient had stable hematocrits
during the course of his admission which ranged from 35 to
40, however, he did have a very microcytic MCV at 66.  The
patient had iron studies which were normal but in the low
range and had an erythropoietin level which was also in the
low normal range; but as his hematocrit was stable, no
further treatment was started at this time.

The patient can have his hematocrit and MCV followed as an
outpatient.

CONDITION AT DISCHARGE:   Good.  The patient was ambulating
without difficulty, improved [**Name10 (NameIs) **] pressure in the range of
systolic of 150s to 160s, diastolic less than 100.  He is not
on home oxygen or on oxygen during this admission.

DISCHARGE STATUS:   Discharged to home with his family with
free care medication plan.

DISCHARGE DIAGNOSES:
1.  Hypertensive urgency.
2.  Acute on chronic renal failure.
3.  Headache.
4.  Anemia.
5.  Benign prostatic hypertrophy.

DISCHARGE MEDICATIONS:
1.  Aspirin 325 mg p.o. once a day.
2.  Prazosin 2 mg p.o. q. h.s.
3.  Saline nasal spray, one to two sprays four times a day
p.r.n.
4.  Atenolol 100 mg p.o. q. day.
5.  Nifedipine 60 mg tablet, once a day.
6.  Colace 100 mg p.o. twice a day.

DISCHARGE INSTRUCTIONS:
1.  The patient is to follow-up with Dr. [**Last Name (STitle) 5263**] within seven
to ten days.
2.  The patient is to return on Monday, [**10-23**], to the
[**Hospital Unit Name 1825**], [**Location (un) 10043**], [**Hospital Ward Name 23**], at 05:45 a.m. for an MRI
/ MRA of his head.



                          [**Doctor Last Name **] [**Name6 (MD) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 5712**]

Dictated By:[**Name8 (MD) 264**]

MEDQUIST36

D:  [**2175-10-18**]  11:20
T:  [**2175-10-18**]  17:35
JOB#:  [**Job Number 50202**]
{'Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease,Acute kidney failure, unspecified,Thrombocytopenia, unspecified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Iron deficiency anemia, unspecified'}


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: 

PRESENT ILLNESS: This is a 68 year old Spanish
speaking male with a 20 year history of hypertension who
presents with headache and chest pain to the Emergency Room.
He was found to have electrocardiogram changes, lateral ST
depressions and a [**Location (un) **] pressure of 260/120.  In the
Emergency Department the patient was put on Labetalol and the
[**Location (un) **] pressure dropped to 200/90.  Vital signs in the
Emergency Department were 214/103, pulse 97; respiratory 100%
on room air.  He received Labetalol 20 mg intravenously times
two, 40 mg times one, hydralazine and nitropaste.  The
patient stated that his headache had been going on for over a
month and that he called his primary care physician's office
and was told to come in to the Emergency Room secondary to
pressing chest pain, nonradiating.  No diaphoresis, no nausea
or vomiting.  This past Wednesday, his [**Location (un) **] pressure was
240/123.  He had an increased dose of his Labetalol from 20
to 40 mg and per his daughter, his [**Name2 (NI) **] pressures at home
have been high and with wide fluctuations over the past two
months.  Recently, he has stopped taking Atenolol and
Hydrochlorothiazide secondary to decreased platelets.

MEDICAL HISTORY: 1.  No prior hospitalization.
2.  Hypertension for 20 years.
3.  Congenital absence of one kidney.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Hypertension; no coronary artery disease.

SOCIAL HISTORY: He lives with his daughter.  [**Name (NI) **] does not
smoke, no alcohol.  He is retired and has a poor diet. 

### Response:
{'Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease,Acute kidney failure, unspecified,Thrombocytopenia, unspecified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Iron deficiency anemia, unspecified'}
