CHIEF COMPLAINT: Right-sided pain, status post fall.

PRESENT ILLNESS: This is an 82-year-old female
with a history of diabetes, AS, history of recent atrial
fibrillation, who presents status post fall.  She states that
while she was going from her walker to the toilet, she
slipped and slid down to the bathroom floor.  There was no
head trauma or loss of consciousness.  Patient complains of
right hip pain.  She insists that she had no presyncopal
events.

MEDICAL HISTORY: 1.  Diabetes, insulin dependent.
2.  Hypertension.
3.  Hypercholesterolemia.
4.  Chronic renal failure.
5.  Question of CHF.
6.  AS.
7.  Atrial fibrillation.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Patient denies any tobacco or alcohol use.
She lives alone.  She has a son in the area and a daughter
living in [**Name (NI) 3844**].
Acute kidney failure, unspecified,Cardiac arrest,Congestive heart failure, unspecified,Aortic valve disorders,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Diverticulitis of colon (without mention of hemorrhage),Unspecified essential hypertension
Acute kidney failure NOS,Cardiac arrest,CHF NOS,Aortic valve disorder,DMII wo cmp nt st uncntr,Dvrtcli colon w/o hmrhg,Hypertension NOS
Admission Date:  [**2185-3-15**]     Discharge Date:  [**2185-3-16**]


Service:  MICU

CHIEF COMPLAINT:  Right-sided pain, status post fall.

HISTORY OF PRESENT ILLNESS:  This is an 82-year-old female
with a history of diabetes, AS, history of recent atrial
fibrillation, who presents status post fall.  She states that
while she was going from her walker to the toilet, she
slipped and slid down to the bathroom floor.  There was no
head trauma or loss of consciousness.  Patient complains of
right hip pain.  She insists that she had no presyncopal
events.

Of note, the patient presented to the Emergency Department
with atraumatic right hip pain on [**2185-3-12**].  MRI was performed
that showed no fracture, abscess or other pathology.  The
patient was discharged from the Emergency Department with a
walker and nonsteroidals.

Also of note, the patient was hospitalized with a syncopal
episode in [**11-13**], found to be in new onset atrial
fibrillation.  An echo was performed which showed severe AS
with a valve area of 0.70.  At that time, she was started on
Coumadin.

In the Emergency Department, the patient was found to have
anemia with an elevated white blood cell count.  Plain films
of the right hip were negative for fracture.  CT of the
abdomen showed diverticulitis.  The patient received
ampicillin, gentamicin, Flagyl, and three liters of normal
saline.  The patient's blood pressure rebounded from a
systolic in the 70's to the 110's.  She, however, was felt to
be going into CHF, although she was maintaining her
saturations on four-and-a-half liters of oxygen nasal
cannula.

PAST MEDICAL HISTORY:
1.  Diabetes, insulin dependent.
2.  Hypertension.
3.  Hypercholesterolemia.
4.  Chronic renal failure.
5.  Question of CHF.
6.  AS.
7.  Atrial fibrillation.

MEDICATIONS:
1.  Coumadin.
2.  Gemfibrozil, 600 mg PO b.i.d..
3.  Humulin.
4.  Lisinopril, 10 mg PO q d.
5.  Multivitamin.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  Patient denies any tobacco or alcohol use.
She lives alone.  She has a son in the area and a daughter
living in [**Name (NI) 3844**].

FAMILY HISTORY:  Noncontributory.

REVIEW OF SYSTEMS:  Currently, patient complains only of
right-sided flank pain.  She denies any chest pain, shortness
of breath, palpitations, headache, neck stiffness, nausea,
vomiting, fevers, chills, diaphoresis, cough, abdominal pain.
She reported some diarrhea after receiving Kayexalate,
chronic lower extremity edema, and orthopnea.  Patient denies
any dyspnea on exertion or PND.  She also has a positive
review of systems for polyuria and hesitancy.  No dysuria.

PHYSICAL EXAMINATION:  Vitals: Temperature 96.3, pulse 98,
blood pressure 112/64, respiratory rate 22.  Oxygen
saturation 100% on 4.5 liters.  General: The patient is in
some pain with movement, shortness of breath with speaking.
HEENT: Mucous membranes moist.  Pupils pinpoint, minimally
reactive.  Neck: Supple.  No lymphadenopathy.
Cardiovascular: A III/VI systolic ejection murmur radiating
to the carotids.  Regular rate and rhythm.  Lungs: Decreased
breath sounds bilaterally.  Inspiratory crackles, greater on
the right than the left.  Right hip is locally tender.
Abdomen: Soft, distended, guaiac positive, left lower
quadrant pain to deeper palpation, overall tympanitic,
normoactive bowel sounds.  Extremities: 2+ bilateral lower
extremity edema with chronic venous changes.  Neuro: Alert
and oriented times three, no focal signs.

LABORATORY/DIAGNOSTICS:  White count 21.3 with 88%
neutrophils, 7% lymphocytes, hematocrit 27.0, baseline is 32,
platelets 309.  PT 23.5, PTT 38.0, INR 3.7, ESR 120.  CK 159,
MB 7, troponin less than 0.3.  Sodium 138, potassium 5.3,
chloride 103, bicarbonate 26, BUN 53, creatinine 1.7.
Urinalysis shows [**3-16**] white blood cells, occasional bacteria,
less than 2 squamous epithelial cells.

CT of the head shows no hemorrhage or mass effect.

Right hip films show no fracture or dislocation.

Chest x-ray shows no acute cardiopulmonary process, there is
some left base linear atelectasis.

CT of the abdomen shows sigmoid diverticulitis, no abscess or
free air.

EKG shows normal sinus rhythm at 94 beats per minute, LVH,
normal intervals, Q waves in III and F, question of peaked T
waves, otherwise unchanged from [**11-13**].

Echocardiogram from [**11-13**] shows mild symmetric LVH, EF 60%,
severe AS, 1+ MR, valve area of 0.7 cm2 and a gradient of
4.1.

HOSPITAL COURSE:  In short, this is an 82-year-old female
with diabetes, AS, found status post fall complaining of
right-sided pain.  Found to be hypotensive with elevated
white blood cell count and diverticulitis by CT.  Patient's
hypotension was thought to be most likely secondary to
dehydration or sepsis.  Her right lower quadrant pain was
thought to be musculoskeletal in origin, although we could
not rule out metastases as the source of pain.  Patient's
blood pressure responded to a 250 cc bolus of normal saline.
Patient was started on Cipro and Flagyl for her
diverticulitis.

Overnight, the patient had a cardiac arrest. Multiple
resuscitation attempts were performed per ACLS protocol.  The
code was called at 3:30 a.m. on [**2185-3-16**].






                          [**Name6 (MD) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 968**]

Dictated By:[**Name8 (MD) 4990**]

MEDQUIST36

D:  [**2185-7-18**]  12:11
T:  [**2185-7-21**]  11:09
JOB#:  [**Job Number 107821**]
{'Acute kidney failure, unspecified,Cardiac arrest,Congestive heart failure, unspecified,Aortic valve disorders,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Diverticulitis of colon (without mention of hemorrhage),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: Right-sided pain, status post fall.

PRESENT ILLNESS: This is an 82-year-old female
with a history of diabetes, AS, history of recent atrial
fibrillation, who presents status post fall.  She states that
while she was going from her walker to the toilet, she
slipped and slid down to the bathroom floor.  There was no
head trauma or loss of consciousness.  Patient complains of
right hip pain.  She insists that she had no presyncopal
events.

MEDICAL HISTORY: 1.  Diabetes, insulin dependent.
2.  Hypertension.
3.  Hypercholesterolemia.
4.  Chronic renal failure.
5.  Question of CHF.
6.  AS.
7.  Atrial fibrillation.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Patient denies any tobacco or alcohol use.
She lives alone.  She has a son in the area and a daughter
living in [**Name (NI) 3844**]. 

### Response:
{'Acute kidney failure, unspecified,Cardiac arrest,Congestive heart failure, unspecified,Aortic valve disorders,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Diverticulitis of colon (without mention of hemorrhage),Unspecified essential hypertension'}
