CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 56-year-old male
with a past medical history significant for insulin-dependent
diabetes mellitus, hypertension, hypercholesterolemia, renal
insufficiency, and coronary artery disease with recent non ST
elevation MI on [**2142-11-11**].

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Coronary atherosclerosis of native coronary artery,Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,Acidosis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Crnry athrscl natve vssl,Subendo infarct, initial,Acute kidney failure NOS,Acidosis,Hyp kid NOS w cr kid V,Pure hypercholesterolem,DMII wo cmp nt st uncntr
Admission Date:  [**2142-11-19**]     Discharge Date:  [**2142-11-30**]

Date of Birth:   [**2086-9-23**]     Sex:  M

Service:  CARDIOTHORACIC SURGERY

HISTORY OF THE PRESENT ILLNESS:  This is a 56-year-old male
with a past medical history significant for insulin-dependent
diabetes mellitus, hypertension, hypercholesterolemia, renal
insufficiency, and coronary artery disease with recent non ST
elevation MI on [**2142-11-11**].

ALLERGIES:  The patient has no known drug allergies.

ADMISSION MEDICATIONS:
1.  Paxil 20 mg p.o. q.d.
2.  Lipitor 20 mg p.o. q.d.
3.  Insulin regular 8 units b.i.d. and NPH 30 units in the
morning, 20 units in the evening.
4.  Metformin 1,000 mg q.a.m. and 800 mg q.p.m.
5.  Diltiazem 360 mg q.d.
6.  Aspirin.
7.  Lisinopril 40 mg p.o. q.d.
8.  Hydrochlorothiazide.

This is a 56-year-old male who has had several week symptoms
including dyspnea on exertion, paroxysmal nocturnal dyspnea,
orthopnea, who was admitted to [**Hospital1 **] and transferred for
cardiac catheterization on [**2142-11-19**] to [**Doctor First Name **]-[**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) **].  Cardiac catheterization revealed 80% left main
disease and 100% right coronary artery disease.  The
patient's creatinine level prior to admission was 3.8 and
ranged to 4.2 precatheterization with his chronic renal
insufficiency due to his diabetes and hypertension.

HOSPITAL COURSE:  The patient was subsequently referred to
Cardiac Surgery for coronary artery bypass grafting.  The
patient underwent coronary artery bypass grafting on [**2142-11-20**].  Total cross-clamp time 37 minutes, total
cardiopulmonary bypass time 66 minutes.

The patient underwent coronary artery bypass grafting times
three with the left internal mammary artery to the left
anterior descending coronary artery, reversed saphenous vein
graft from the aorta to the distal right coronary artery and
reversed saphenous vein graft from the aorta to the obtuse
marginal coronary artery.

The patient was transferred in stable condition to the
Cardiac Surgery Recovery Unit on propofol and milrinone.  On
postoperative day number one, 24-hour events included blood
transfusion times one for a hematocrit of 27.
Post-transfusion hematocrit was 28.  The patient also had
decreased urine output and a blood pressure of 65 for which
he was administered 2 mg of Neo-Synephrine and administered
Lasix for the decreased urine output.  The patient was still
on Neo-Synephrine at 1 and milrinone.

On physical examination, the patient was arousable, moving
all four extremities.  Vital signs were stable, in sinus
rhythm with a heart rate of 92.  White count 10, platelet
count 286,000.

Renal came by to see the patient for the patient's decreased
urine output, at which time they recommended to increase the
intravascular volume and increase the patient's blood
pressure by transfusing [**11-29**] units of packed red blood cells
and starting Epogen 5,000 t.i.w. and 1 liter of D5W with 3
amps of bicarbonate over the day.  They did not feel that
there was any indication for dialysis that day but it may be
an issue in the next few days.  They also recommended to
continue the Neo-Synephrine drip with a goal blood pressure
of 130-140.  They recommended to hold off on diuretics for
now as the CVP and PADs are low.  They recommended to check
the urine electrolytes, sodium, creatinine, urea, and to
check the urine protein-creatinine ratio.  They also felt
that the patient's volume status appeared intravascularly
depleted with a low CVP and they recommended to give volume
and hold the diuretics.  They thought that the metabolic
acidosis was secondary to acute renal failure and, therefore,
to administer the bicarbonate as suggested earlier.  Dose the
patient's vancomycin by levels.

On postoperative day number two, 24-hour events included
administering 2 units of packed red blood cells as well as
administrating bicarbonate.  The patient was still with
variable urine output and acidosis.

On physical examination, the patient was arousable and alert,
moving all four extremities.  No longer on any drips.  The
vital signs were stable.  The patient was in sinus rhythm at
84 with a blood pressure of 156/61 and a cardiac index of
2.95 with a BUN of 80 and creatinine of 5.9 which is up from
4.7, white count 13.8, and hematocrit of 29.1.

Renal came by and saw the patient again, at which time they
stated that the patient had worsening renal function;
however, the patient is still putting out urine, is not
oliguric, although the picture could worsen.  They did not
feel that there was the need for hemodialysis at that time.
However, they stated that they would continue to monitor for
hemodialysis potential.  They also felt that since his blood
pressure was improved, Lasix could be administered 100 mg IV
in order to increase diuresis.  They also recommended to
avoid magnesium and potassium and to give Amphojel 30 cc
q.o.d. or Tums two p.o. t.i.d. with meals for phosphorus
binding.  They also recommended to give Lactulose to promote
bowel movements.

On postoperative day number three, the patient was
hemodynamically stable.  The physical examination remained
unchanged.  The white count came down to 8.9, hematocrit
stable at 27, BUN 92, creatinine 6.5, with adequate urine
output.

Renal came by to see the patient again, at which time they
recommended to transfusing to maintain a hematocrit of
greater than 30, continue Amphojel at 30 cc p.o. t.i.d. with
meals for increasing the phosphorus until the phosphorus
level was less than 5, decrease the Zantac from 150 mg p.o.
b.i.d. to q.d., continue the Epogen, and they stated that the
patient is close to possibly needing hemodialysis.  However,
they do not want to remove fluid too quickly whether by
diuresis or hemodialysis because this might induce more
hypotension and it would decrease the patient's chance for
renal recovery.

The Renal attending came by the same day and stated that once
a line is placed he felt that it would be necessary to
proceed with hemodialysis and ultrafiltration, at which time
they will give some IV Epogen.  The patient underwent
hemodialysis after a Quinton catheter was placed on [**2142-11-23**].

The patient underwent hemodialysis that day which he
tolerated with a blood pressure around 140-150.

On postoperative day number four, the patient remained
hemodynamically stable, afebrile, with a stable white count
and hematocrit, BUN 69, creatinine 5.1.

Renal came by and saw the patient again, at which time they
stated that there was no need for dialysis that day; however,
he may need it in the morning.  They recommended to give Tums
t.i.d. with meals and snacks for hyperphosphatemia and the
patient received Epogen yesterday for his mild anemia.

On postoperative day number five, the patient continued to
remain afebrile, hemodynamically stable with a stable white
count and hematocrit.

Renal came by and stated that as far as the patient's volume
status was concerned he was still 10 kilograms above his
preoperative weight.  They wanted the goal to remove 3
kilograms today during hemodialysis and to check the
phosphorus and if it is less than 5, they will be
discontinuing the Amphojel and during hemodialysis which was
planned to be performed that day they will be administering
5,000 of Epogen.  Hemodialysis was performed on [**2142-11-25**], at
which time 3 kilograms was removed.  The patient remained in
sinus rhythm throughout dialysis, however, with occasional to
frequent PVCs with a stable blood pressure.

The patient was subsequently transferred to the floor on
postoperative day number five in stable condition.  On
postoperative day number six, the patient remained
hemodynamically stable with a stable white count and
hematocrit, BUN 83, creatinine 5.4, with an unremarkable
physical examination.

Renal came by to see the patient, at which time they stated
that the patient did still remain oliguric; however, they
would continue to observe daily to determine the patient's
dialysis need.  They recommended to check the patient's
calcium and phosphorus and to avoid NSAIDs, to use Lactulose
for constipation and to avoid magnesium-containing compounds
due to his renal failure.

On postoperative day number seven, the patient continued to
remain hemodynamically stable, in sinus rhythm at 66.
Physical examination remained unchanged.  The plan was for
the patient to undergo hemodialysis that day.  The patient
did undergo hemodialysis with the plan to undergo
hemodialysis for three hours.

Again, Renal saw the patient.  At this time, they again
stated to avoid magnesium-containing compounds.

On postoperative day number eight, the patient continued to
remain hemodynamically stable with a BUN of 74 and creatinine
of 4.9.

On postoperative day number nine, regarding 24-hour events,
the patient was reportedly feeling well and anxious to leave
the hospital.  The last hemodialysis was on [**2142-11-27**].  The patient still remained hemodynamically stable,
putting out sufficient urine.  The physical examination
remained benign.  The BUN was 55, creatinine 4.3.  The plan
was to continue to follow the laboratories to determine
whether or not he will need further hemodialysis.

Renal came by and saw the patient on postoperative day number
nine, at which time they stated that the urine output was
somewhat better with a good blood pressure.  However, the
creatinine was still elevated over the last 24 hours.  They
recommended to repeat a stat potassium and if the potassium
was better to hold off on hemodialysis with the potassium
being 5.0 with slight hemolysis that day.  They also
recommended to elevate the legs as much as possible and to
continue aluminum hydroxide until the phosphorus is less than
5.

On postoperative day number ten, the patient was afebrile.
The vital signs were stable with a stable blood pressure of
110-160/70s-80s and the heart rate in sinus rhythm at 60.
The physical examination remained unchanged with lungs that
were clear and lower extremities with mild edema.  The white
count and hematocrit were stable with a BUN of 58 and
creatinine of 4.2 with the plan to discharge the patient that
day.

The patient was discharged to Care Group VNA on the following
medications.

DISCHARGE MEDICATIONS:
1.  Lopressor 12.5 mg p.o. b.i.d.
2.  Aspirin 325 mg p.o. q.d.
3.  Protonix 40 mg p.o. q.d.
4.  Insulin NPH 30 units q.a.m., 20 units q.p.m.
5.  Insulin regular 8 units q.a.m., 8 units q.p.m.
6.  Ferrous gluconate 300 mg p.o. q.d.
7.  Nephrocaps one p.o. q.d.
8.  Tums one tablet t.i.d. with meals.
9.  Epogen 4,000 units subcutaneously two times per week,
[**Year (4 digits) 766**] and Thursday.
10. Paxil 20 mg p.o. q.d.
11. Lipitor 20 mg p.o. q.d.
12. Percocet one to two tablets p.o. q. 4-6 hours p.r.n.
pain.

DISCHARGE INSTRUCTIONS:  The patient to have drawn a CBC,
Chem-7, calcium, magnesium, phosphorus, and albumin on
[**Last Name (LF) 766**], [**2142-12-3**], with the results to be sent to Dr.
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 47285**] at [**Hospital6 **] with the patient
checking daily weights and daily blood pressures.  The
laboratory results were to be faxed on [**Last Name (LF) 766**], [**2142-12-3**] to [**Telephone/Fax (1) 47286**], Attn:  [**Doctor Last Name 501**] and Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 47287**].

DISCHARGE DIAGNOSIS:
1.  Coronary artery disease, status post coronary artery
bypass grafting times three on [**2142-11-20**].
2.  Chronic renal failure.
3.  Insulin-dependent diabetes mellitus.
4.  Hypertension.
5.  Hyperlipidemia.

DISPOSITION:  The patient is in stable condition.  Discharge
instructions include the patient to make an appointment to
visit Dr. [**Last Name (STitle) 70**] in four to six weeks.




                          [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 75**]

Dictated By:[**Doctor Last Name 182**]

MEDQUIST36

D:  [**2142-11-30**]  14:02
T:  [**2142-12-2**]  09:12
JOB#:  [**Job Number 44014**]
{'Coronary atherosclerosis of native coronary artery,Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,Acidosis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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 56-year-old male
with a past medical history significant for insulin-dependent
diabetes mellitus, hypertension, hypercholesterolemia, renal
insufficiency, and coronary artery disease with recent non ST
elevation MI on [**2142-11-11**].

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Coronary atherosclerosis of native coronary artery,Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,Acidosis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
