CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname **] is a 45 year old male
with a history of morbid obesity, diabetes mellitus, chronic
obstructive pulmonary disease with home O2, congestive heart
failure who was admitted to the [**Hospital1 **] [**Hospital3 **] for chronic obstructive pulmonary disease
exacerbation and improved with steroids.  However, during
that hospitalization he developed severe abdominal pain and
evaluation with radiograph reveals free air under the
abdomen.  His hospital course was significant for Kayexalate
for mild hyperkalemia.  The patient was then transferred to
the [**Hospital1 69**] for further
management.

MEDICAL HISTORY: Is significant for diabetes mellitus
with nephropathy, retinopathy and neuropathy.  He has a
history of lower extremity ulcers.  History of hypertension,
chronic obstructive pulmonary disease, congestive heart
failure with a recent ejection fraction of 50 percent,
anemia, morbid obesity,  history of methicillin resistant
Staphylococcus aureus and pseudomonas pneumonia.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Perforation of intestine,Pneumonia due to Pseudomonas,Infection and inflammatory reaction due to other vascular device, implant, and graft,Acute cholecystitis,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Infection with microorganisms resistant to penicillins,Unspecified essential hypertension,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Polyneuropathy in diabetes,Morbid obesity,Long-term (current) use of insulin
Perforation of intestine,Pseudomonal pneumonia,React-oth vasc dev/graft,Acute cholecystitis,CHF NOS,Chr airway obstruct NEC,Inf mcrg rstn pncllins,Hypertension NOS,DMII renl nt st uncntrld,Nephritis NOS in oth dis,Neuropathy in diabetes,Morbid obesity,Long-term use of insulin
Admission Date: [**2132-12-17**]        Discharge Date: [**2133-1-23**]

Date of Birth:  [**2087-11-5**]        Sex:  M

Service:  [**Last Name (un) **]


HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname **] is a 45 year old male
with a history of morbid obesity, diabetes mellitus, chronic
obstructive pulmonary disease with home O2, congestive heart
failure who was admitted to the [**Hospital1 **] [**Hospital3 **] for chronic obstructive pulmonary disease
exacerbation and improved with steroids.  However, during
that hospitalization he developed severe abdominal pain and
evaluation with radiograph reveals free air under the
abdomen.  His hospital course was significant for Kayexalate
for mild hyperkalemia.  The patient was then transferred to
the [**Hospital1 69**] for further
management.

PAST MEDICAL HISTORY:  Is significant for diabetes mellitus
with nephropathy, retinopathy and neuropathy.  He has a
history of lower extremity ulcers.  History of hypertension,
chronic obstructive pulmonary disease, congestive heart
failure with a recent ejection fraction of 50 percent,
anemia, morbid obesity,  history of methicillin resistant
Staphylococcus aureus and pseudomonas pneumonia.

PAST SURGICAL HISTORY:  Is significant for left below knee
amputation

MEDICATIONS AT HOME:  Prior to admission were insulin sliding
scale, aspirin, OxyContin 80 q.i.d., Neurontin 600 t.i.d.,
Paxil 40 B.I.D., Klonopin 2 B.I.D., Lopressor 100 B.I.D.,
mexiletine 400 B.I.D., Singulair, lisinopril 10 daily,
Ambien, Flonase and Advair.

HOSPITAL COURSE:  The patient was taken emergently to the
operating room and exploration revealed a perforated
transverse colon.  The patient then underwent an exploratory
laparotomy, partial colectomy and transverse colostomy with
mucous fistula and a jejunostomy tube.  Patient tolerated the
procedure well and immediately postoperatively in the
recovery room the patient underwent a percutaneous
tracheostomy for anticipated respiratory failure with the
history of severe chronic obstructive pulmonary disease,
morbid obesity and emergent abdominal exploration.  The
patient's postoperative course was then significant for
respiratory failure, pneumonia due to pseudomonas and
methicillin resistant Staphylococcus aureus and
hyperglycemia.  Postoperatively the patient was treated
empirically with Vancomycin and Zosyn and was supported with
mechanical ventilation.  He was initially treated with tube
feeds and total parenteral nutrition for nutrition.  Total
parenteral nutrition was weaned off as the tube feeds were
advanced.  The patient then developed fever postoperatively
and the patient was continued on broad spectrum antibiotics.
Sputum cultures revealed pneumonia due to pseudomonas,
Citrobacter and methicillin resistant Staphylococcus aureus.
The patient had persistent fevers and central venous
catheters were removed and a pseudomonas line infection was
diagnosed and treated with antibiotics.  Due to persistent
fevers the patient then underwent a CT of the chest and
abdomen which showed on postoperative day 16 that the patient
had a distended gallbladder that was concerning for
acalculous cholecystitis and a cholecystostomy tube was
placed.  There were also moderate bilateral pleural effusions
and no evidence of intra-abdominal abscess.

The remainder of the [**Hospital 228**] hospital course was
significant for primarily respiratory failure as well as
hyperglycemia.  The patient was slowly weaning from the
ventilator and ultimately a course of steroids was initiated
as well as aggressive diuresis which ultimately enabled Mr.
[**Known lastname **] to wean from the ventilator and remain on tracheostomy
collar for a significant period of time.  The patient had
significant insulin resistance and hyperglycemia requiring an
insulin drip for a prolonged period of time which was
exacerbated with the steroids.  At the time of discharge the
patient's condition by system is as follows:

1. Neurologic:  Mr. [**Known lastname **] is comfortable and is being
   adequately treated for pain with methadone and is on
   gabapentin as well as Klonopin.

1. Pulmonary:  Mr. [**Known lastname **] is now tolerated a tracheostomy
   collar without ventilatory support within the last 24 to
   48 hours.  He is on a steroid taper as well as
   bronchodilators.

1. Cardiac:  The patient with a normal rate and rhythm on
   Lopressor with adequate control of his hypertension with
   Clonidine as well.

1. Gastrointestinal:  Patient was tolerating his tube fees
   and his cholecystostomy is being drained every six hours
   and this bile is being replaced through the jejunostomy
   tube.

1. Renal:  He is aggressively diuresed to a BUN of 60.
   However, this has plateaued and diuresis has been stopped
   and his BUN is expected to come back down.  His creatinine
   has remained normal.  His urine output has been adequate.

1. Heme:  He is on Lovenox for deep venous thrombosis
   prophylaxis.  His hematocrits have been adequate.

1. Infectious Disease:  He has been off antibiotics.  He has
   had no fever and a normal white count.  He appears to be
   colonized with pseudomonas and methicillin resistant
   Staphylococcus aureus which is not causing an acute
   infectious problem.

1. Endocrine:  Mr. [**Known lastname **] is being weaned on a steroid taper.
   He was started on steroids as Solu-Medrol 60 intravenous q
   6 and is currently being weaned on half the dose every two
   days.  Mr. [**Known lastname **] is now off insulin drip and he is on
   Lantus as well as insulin sliding scale and is maintaining
   sugars under 130.


DISCHARGE DIAGNOSES:
1. Colon perforation.
2. Diabetes mellitus.
3. Nephropathy, retinopathy and neuropathy.
4. Hypertension.
5. Chronic obstructive pulmonary disease.
6. Home O2.
7. Home CPAP.
8. Congestive heart failure near 50 percent.
9. Anemia.
10.      Morbid obesity.
11.      Depression.



PROCEDURES:
1. Status post partial resection of transverse colon, end
   transverse colostomy, mucus fistula, jejunostomy tube and
   percutaneous tracheostomy on [**2132-12-16**].
2. Status post percutaneous cholecystostomy tube [**2134-1-1**].


MEDICATIONS ON DISCHARGE:  Tylenol 650 mg P.O. q 4 to 6 PRN,
albuterol inhaler q 6 PRN, Combivent inhaler 1 to 2 puffs q
4, Atrovent inhaler q 6 PRN, Prevacid 30 mg P.O., daily,
Lantus 200 units subcutaneous at bedtime, Ativan 0.5 mg
intravenous PRN, Clonazepam 2 mg P.O. q 12, Clonidine 0.4 mg
P.O. q 8, enoxaparin 60 mg subcutaneous B.I.D., gabapentin
600 mg P.O. q 8, hydrochlorothiazide 12.5 mg P.O. daily,
hydralazine 20 mg intravenous q 6, insulin sliding scale,
Lopressor 100 mg P.O. B.I.D., Lopressor 5 mg intravenous q 4
PRN, methadone 30 mg P.O. jejunostomy tube t.i.d., Percocet
elixir 5 to 10 cc P.O. q 4 to 6 PRN, [**Location (un) 2452**] oil 1 vial q 6
PRN, paroxetine 40 mg P.O. q day, valsartan 80 mg P.O. q day
and prednisone 25 mg P.O. t.i.d. started on [**2133-1-22**] to be
tapered by [**1-4**] every two to three days as indicated.

DISCHARGE STATUS:  Condition is fair.

FOLLOW UP:  With Dr. [**Last Name (STitle) **] in two weeks.

DISPOSITION:  Transfer to rehabilitation.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 11987**]

Dictated By:[**Name8 (MD) 26127**]
MEDQUIST36
D:  [**2133-1-22**] 17:13:12
T:  [**2133-1-22**] 18:01:29
Job#:  [**Job Number 28629**]

cc:[**Hospital6 28630**]
{'Perforation of intestine,Pneumonia due to Pseudomonas,Infection and inflammatory reaction due to other vascular device, implant, and graft,Acute cholecystitis,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Infection with microorganisms resistant to penicillins,Unspecified essential hypertension,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Polyneuropathy in diabetes,Morbid obesity,Long-term (current) use of insulin'}


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: Mr. [**Known lastname **] is a 45 year old male
with a history of morbid obesity, diabetes mellitus, chronic
obstructive pulmonary disease with home O2, congestive heart
failure who was admitted to the [**Hospital1 **] [**Hospital3 **] for chronic obstructive pulmonary disease
exacerbation and improved with steroids.  However, during
that hospitalization he developed severe abdominal pain and
evaluation with radiograph reveals free air under the
abdomen.  His hospital course was significant for Kayexalate
for mild hyperkalemia.  The patient was then transferred to
the [**Hospital1 69**] for further
management.

MEDICAL HISTORY: Is significant for diabetes mellitus
with nephropathy, retinopathy and neuropathy.  He has a
history of lower extremity ulcers.  History of hypertension,
chronic obstructive pulmonary disease, congestive heart
failure with a recent ejection fraction of 50 percent,
anemia, morbid obesity,  history of methicillin resistant
Staphylococcus aureus and pseudomonas pneumonia.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Perforation of intestine,Pneumonia due to Pseudomonas,Infection and inflammatory reaction due to other vascular device, implant, and graft,Acute cholecystitis,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Infection with microorganisms resistant to penicillins,Unspecified essential hypertension,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Polyneuropathy in diabetes,Morbid obesity,Long-term (current) use of insulin'}
