CHIEF COMPLAINT: Weakness

PRESENT ILLNESS: Briefly, the patient is a 82 yo M with PMH CAD, CKD (bl 1.7),
HTN, HD, and PVD admitted to the MICU on [**2199-11-8**] with secondary
to pneumonia.  He had come to the ED because he felt weak and
had an episode of diarrhea and pleuritic chest pain. He does
have a smoker's cough present for at least 15 years (since he
quit smoking), but this cough has not been noticeably worse. He
has not had any subjective
fevers/chills/nausea/vomiting/shortness of breath/weight loss.
He has not had any hemoptysis.
.
In the ED, initial VS: 98 80/palp 80 15 88% on RA 96% on 4L nc.
He received 3L of IVF. A RIJ was placed and levophed was
started. A CXR showed RUL PNA. He received a dose of levofloxcin
and nebs.
.
In the MICU, the patient was kept on low dose levophed overnight
and hydrated with IVF. His levophed was weaned. He was continued
on ceftriaxone and levofloxacin. His leukocytosis, which was
marked on presentation, began to improve. He was transferred to
the floor.
.
Upon arrival to the floor, the patient was afebrile with stable
vital signs (see below). His foley was discontinued.

MEDICAL HISTORY: Lead Poisoning
H/o Tobacco use
Prostate CA S/p radical prostatectomy
HLD
AAA
Sick sinus syndrome s/p PPM
CKD
HTN
S/p L TKR

MEDICATION ON ADMISSION: Amlodipine 5 mg qd
Clopidogrel 75 mg
Ergocalciferol 50,000 unit qweek until [**2199-10-30**]
Hydrochlorothiazide 25 mg qd
Ipratropium 2 puffs qid
Lisinopril 20 mg qd
Rosuvastatin 40 mg qd
Tramadol 50 mg q6-8 hours as needed for pain
Ferrous sulfate
Glucosamine-chondroitin
Multivitamin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 97.5, BP 127/66, HR 66, RR 18, Sat 96RA
GEN: pleasant, comfortable, NAD
HEENT: PERRL, EOMI, anicteric, dry MMM
RESP: Moving air through all fields. Right upper posterior field
with crackles and wheezing. No dullness to percussion.
CV: regular rate, soft SEM at RUSB
ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly
EXT: no c/c/e
SKIN: no rashes/no jaundice
NEURO: AAOx3

FAMILY HISTORY: There is a positive family history of premature coronary artery
disease, with his father dying at age 54 of MI. Notably, he has
an identical twin brother with type 2 diabetes but no known CAD.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use; however, he had smoked for 60 years before quitting 12
years ago. There is no history of alcohol abuse.
Unspecified septicemia,Septic shock,Pneumonia, organism unspecified,Acute kidney failure, unspecified,Severe sepsis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Personal history of malignant neoplasm of prostate,Personal history of tobacco use,Abdominal aneurysm without mention of rupture,Cardiac pacemaker in situ
Septicemia NOS,Septic shock,Pneumonia, organism NOS,Acute kidney failure NOS,Severe sepsis,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Hx TIA/stroke w/o resid,Hyperlipidemia NEC/NOS,Crnry athrscl natve vssl,Hx-prostatic malignancy,History of tobacco use,Abdom aortic aneurysm,Status cardiac pacemaker
Admission Date:  [**2199-11-8**]              Discharge Date:   [**2199-11-11**]

Date of Birth:  [**2117-5-16**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3151**]
Chief Complaint:
Weakness

Major Surgical or Invasive Procedure:
Internal Jugular Central venous catheter placement

History of Present Illness:
Briefly, the patient is a 82 yo M with PMH CAD, CKD (bl 1.7),
HTN, HD, and PVD admitted to the MICU on [**2199-11-8**] with secondary
to pneumonia.  He had come to the ED because he felt weak and
had an episode of diarrhea and pleuritic chest pain. He does
have a smoker's cough present for at least 15 years (since he
quit smoking), but this cough has not been noticeably worse. He
has not had any subjective
fevers/chills/nausea/vomiting/shortness of breath/weight loss.
He has not had any hemoptysis.
.
In the ED, initial VS: 98 80/palp 80 15 88% on RA 96% on 4L nc.
He received 3L of IVF. A RIJ was placed and levophed was
started. A CXR showed RUL PNA. He received a dose of levofloxcin
and nebs.
.
In the MICU, the patient was kept on low dose levophed overnight
and hydrated with IVF. His levophed was weaned. He was continued
on ceftriaxone and levofloxacin. His leukocytosis, which was
marked on presentation, began to improve. He was transferred to
the floor.
.
Upon arrival to the floor, the patient was afebrile with stable
vital signs (see below). His foley was discontinued.


Past Medical History:
Lead Poisoning
H/o Tobacco use
Prostate CA S/p radical prostatectomy
HLD
AAA
Sick sinus syndrome s/p PPM
CKD
HTN
S/p L TKR

Social History:
Social history is significant for the absence of current tobacco
use; however, he had smoked for 60 years before quitting 12
years ago. There is no history of alcohol abuse.


Family History:
There is a positive family history of premature coronary artery
disease, with his father dying at age 54 of MI. Notably, he has
an identical twin brother with type 2 diabetes but no known CAD.

Physical Exam:
VS: T 97.5, BP 127/66, HR 66, RR 18, Sat 96RA
GEN: pleasant, comfortable, NAD
HEENT: PERRL, EOMI, anicteric, dry MMM
RESP: Moving air through all fields. Right upper posterior field
with crackles and wheezing. No dullness to percussion.
CV: regular rate, soft SEM at RUSB
ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly
EXT: no c/c/e
SKIN: no rashes/no jaundice
NEURO: AAOx3

Pertinent Results:
[**2199-11-8**] 05:09PM   LACTATE-2.6*
[**2199-11-8**] 05:00PM   GLUCOSE-117* UREA N-48* CREAT-3.0* SODIUM-143
POTASSIUM-5.0 CHLORIDE-108 TOTAL CO2-24 ANION GAP-16
[**2199-11-8**] 05:00PM   estGFR-Using this
[**2199-11-8**] 05:00PM   cTropnT-0.02*
[**2199-11-8**] 05:00PM   WBC-25.3*# RBC-4.03* HGB-12.1* HCT-35.5*
MCV-88 MCH-30.1 MCHC-34.1 RDW-13.8
[**2199-11-8**] 05:00PM   NEUTS-89* BANDS-5 LYMPHS-1* MONOS-4 EOS-0
BASOS-0 ATYPS-0 METAS-1* MYELOS-0
[**2199-11-8**] 05:00PM   HYPOCHROM-NORMAL ANISOCYT-NORMAL
POIKILOCY-NORMAL MACROCYT-NORMAL MICROCYT-NORMAL
POLYCHROM-NORMAL
[**2199-11-8**] 05:00PM   PLT SMR-NORMAL PLT COUNT-202

Brief Hospital Course:
Brief Summary:
The patient was an active 82 year old male with several chronic
medical problems who presented to the emergency department with
hypotension. A central venous catheter and foley catheter were
placed. A chest xray showed a right upper lobe community
acquired pneumonia. The patient had a white count of 25.3 on
admission.  He was started on intravenous ceftriaxone and oral
levofloxacin for the treatment of community acquired pneumonia.
He was fluid resuscitated and spent one night in the medical
intensive care unit, where he required a low dose of a
norepinephrine drip. The patient was weaned off of this pressor
on the morning of hospital day two and was transferred to the
medicine floor at that time. His right internal jugular central
venous catheter and foley catheter were removed. His intravenous
ceftriaxone was discontinued. He was continued on oral
levofloxacin and remained stable on this regimen until hospital
day three, when he was discharged home. He was afebrile for 48
hours upon discharge. His discharge WBC was 10.5 and he felt
generally well. The patient recieved subcutaneous heparin for
deep venous thrombosis prophylaxis.

The patient's problem list on the medicine floor was as follows:
Right upper lobe Community Acquired pneumonia: The patient was
discharged to continue a total 10 day course of oral
levofloxacin.
.
# Acute on Chronic Renal Failure: Resolved with fluid
resicitation. Creatinine improved from 3.0 on admission to 1.9
on the day of discharge (the patient's baseline is around 1.9).
.
# Elevated Troponin: The patient had a slightly elevated
troponin at .02 on admission. His second troponin was negative.
His EKG showed no changes that would indicate acute cardiac
ischemia.

.
# History of transient ischemic attack: The patient was
continued on his home dose  of clopidogrel.
# HTN: The patient continued his home anti-hypertensive
medications on HD 3.
# HLD: The patient continued his home dose of statin.
# Communication:  wife [**Name (NI) **] [**Name (NI) **] is HCP [**Telephone/Fax (1) 110558**]
# Code: FULL


Medications on Admission:
Amlodipine 5 mg qd
Clopidogrel 75 mg
Ergocalciferol 50,000 unit qweek until [**2199-10-30**]
Hydrochlorothiazide 25 mg qd
Ipratropium 2 puffs qid
Lisinopril 20 mg qd
Rosuvastatin 40 mg qd
Tramadol 50 mg q6-8 hours as needed for pain
Ferrous sulfate
Glucosamine-chondroitin
Multivitamin

Discharge Medications:
1. levofloxacin 250 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily) for 6 days.
Disp:*6 Tablet(s)* Refills:*0*
2. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
3. rosuvastatin 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
4. hydrochlorothiazide 12.5 mg Capsule Sig: Two (2) Capsule PO
DAILY (Daily).
5. amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. ergocalciferol (vitamin D2) 50,000 unit Capsule Sig: One (1)
Capsule PO once a day.
8. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO once a day.
9. Atrovent HFA 17 mcg/Actuation HFA Aerosol Inhaler Sig: [**2-2**]
Inhalation every four (4) hours as needed for shortness of
breath or wheezing.
10. FerrouSul 325 mg (65 mg Iron) Tablet Sig: 1-2 Tablets PO
once a day.


Discharge Disposition:
Home

Discharge Diagnosis:
Community Acquired Pneumonia


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Dear Mr. [**Known lastname **]:
It was a pleasure taking care of you at [**Hospital1 18**]. You came to the
hospital because you felt weak and had an episode of diarrhea.
We found that you had pneumonia based on a chest X-ray. As a
result you developed low blood pressure, and we had to monitor
you in the medical intensive care unit for one night. You
received a medication to help support your blood pressure, in
addition to antibiotics. You were then transferred to the
medicine floor, where you have improved.

Please make the following changes to your home medication
regimen:
1. Please take levofloxacin (levaquin) 250mg by mouth daily for
six days.

Followup Instructions:
You will need a followup chest x-ray 6 weeks after discharge.
This can be scheduled through your primary care physician.

You have the following follow-up appointments at [**Hospital1 18**]:

In addition, please make an appointment to see your primary care
physician within one week of discharge:
Name: [**Last Name (LF) 665**], [**First Name3 (LF) **] D. MD
Location: [**Hospital3 249**]
[**Hospital1 **]/EAST
Address: [**Location (un) **], E/CC-6, [**Location (un) **],[**Numeric Identifier 718**]
Phone: [**Telephone/Fax (1) 250**]

Department: ORTHOPEDICS
When: FRIDAY [**2199-11-15**] at 2:00 PM
With: [**First Name11 (Name Pattern1) 177**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3260**], PA [**Telephone/Fax (1) 1228**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 551**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: [**Hospital3 249**]
When: TUESDAY [**2199-11-26**] at 11:20 AM
With: [**Name6 (MD) 251**] [**Last Name (NamePattern4) 1114**], M.D. [**Telephone/Fax (1) 250**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 895**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: [**Hospital3 1935**] CENTER
When: MONDAY [**2200-1-6**] at 2:30 PM
With: [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) 2334**], M.D. [**Telephone/Fax (1) 253**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage



Completed by:[**2199-11-13**]
{'Unspecified septicemia,Septic shock,Pneumonia, organism unspecified,Acute kidney failure, unspecified,Severe sepsis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Personal history of malignant neoplasm of prostate,Personal history of tobacco use,Abdominal aneurysm without mention of rupture,Cardiac pacemaker in situ'}


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

PRESENT ILLNESS: Briefly, the patient is a 82 yo M with PMH CAD, CKD (bl 1.7),
HTN, HD, and PVD admitted to the MICU on [**2199-11-8**] with secondary
to pneumonia.  He had come to the ED because he felt weak and
had an episode of diarrhea and pleuritic chest pain. He does
have a smoker's cough present for at least 15 years (since he
quit smoking), but this cough has not been noticeably worse. He
has not had any subjective
fevers/chills/nausea/vomiting/shortness of breath/weight loss.
He has not had any hemoptysis.
.
In the ED, initial VS: 98 80/palp 80 15 88% on RA 96% on 4L nc.
He received 3L of IVF. A RIJ was placed and levophed was
started. A CXR showed RUL PNA. He received a dose of levofloxcin
and nebs.
.
In the MICU, the patient was kept on low dose levophed overnight
and hydrated with IVF. His levophed was weaned. He was continued
on ceftriaxone and levofloxacin. His leukocytosis, which was
marked on presentation, began to improve. He was transferred to
the floor.
.
Upon arrival to the floor, the patient was afebrile with stable
vital signs (see below). His foley was discontinued.

MEDICAL HISTORY: Lead Poisoning
H/o Tobacco use
Prostate CA S/p radical prostatectomy
HLD
AAA
Sick sinus syndrome s/p PPM
CKD
HTN
S/p L TKR

MEDICATION ON ADMISSION: Amlodipine 5 mg qd
Clopidogrel 75 mg
Ergocalciferol 50,000 unit qweek until [**2199-10-30**]
Hydrochlorothiazide 25 mg qd
Ipratropium 2 puffs qid
Lisinopril 20 mg qd
Rosuvastatin 40 mg qd
Tramadol 50 mg q6-8 hours as needed for pain
Ferrous sulfate
Glucosamine-chondroitin
Multivitamin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 97.5, BP 127/66, HR 66, RR 18, Sat 96RA
GEN: pleasant, comfortable, NAD
HEENT: PERRL, EOMI, anicteric, dry MMM
RESP: Moving air through all fields. Right upper posterior field
with crackles and wheezing. No dullness to percussion.
CV: regular rate, soft SEM at RUSB
ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly
EXT: no c/c/e
SKIN: no rashes/no jaundice
NEURO: AAOx3

FAMILY HISTORY: There is a positive family history of premature coronary artery
disease, with his father dying at age 54 of MI. Notably, he has
an identical twin brother with type 2 diabetes but no known CAD.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use; however, he had smoked for 60 years before quitting 12
years ago. There is no history of alcohol abuse. 

### Response:
{'Unspecified septicemia,Septic shock,Pneumonia, organism unspecified,Acute kidney failure, unspecified,Severe sepsis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Personal history of malignant neoplasm of prostate,Personal history of tobacco use,Abdominal aneurysm without mention of rupture,Cardiac pacemaker in situ'}
