CHIEF COMPLAINT: Right hip pain
Hyperglycemia

PRESENT ILLNESS: Mr. [**Known lastname **] is a 54 yo M with DM2, PE on coumadin, congenital
hip dysplasia s/p THR & multiple hip revisions, cardiomyopathy
and multiple other medical problems presents with 5 day duration
of sharp R hip pains. R hip pain started suddenly ~5days prior
to admission and he was unable to ambulate; pain was poorly
controlled at home however did not feel sick. Pain gradually
worsened to involve thigh muscles as well as popliteal area, now
reported malaise, chills, poor appetite and nausea; this was
when he presented to the ED. Denies vomiting or abdominal pains.

MEDICAL HISTORY: DM2: A1c 7.0 [**10/2111**]; proteinuria.
PE x2 on lifelong coumadin.
Congenital hip dysplasia s/p reconstruction at age 10, multiple
hip replacement over the years; most recently [**1-/2111**] (R hip
revision)
Hypertension
Hepatitis C (fibrosis on biopsy; followed by Dr.[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2643**])
Chronic Pain syndrome
Cardiomyopathy (normal cath [**2-/2111**]): EF 50-60%
s/p Laminectomy

MEDICATION ON ADMISSION: Aspirin 325 mg qd
Folic acid 2 mg qd
Humulin 70/30 30u qam & 32u qpm
HCTZ 12.5 mg po qd
lipitor 80mg po qd
lisinopril 40mg po qd
MS contin 30 mg po BID
Neurontin 400mg TID
Nortriptyline 75mg po QHS
Toprol XL 100mg po qd
Warfarin 5mg po qd
.
ALLERGIES: NSAIDS 'pruiritis' no resp.distress

ALLERGIES: Anti-Inflam/Antiarth Agents Misc. Classf

PHYSICAL EXAM: VS: T 101.9 F BP 110/60 P 79 RR 20 94% RA
GEN: Well developed male, lying in bed, winces with movement in
bed
HEENT: OP clear without lesions
Heart: RRR, no murmurs noted
Lungs: CTA b/l, no wheezing or rhonchi
Abd: obese, +bs, nontender to palpation
Ext: R>L warmth, R hip - large scar s/p hip replacements, tender
to palpation, hardened & enlarged per pt not new, no erythema
noted. Barely moves RLE due to pain.
Neuro: AAO x 3
.

FAMILY HISTORY: There is a family history of diabetes.  His mother and maternal
grandmother both had heart disease.

SOCIAL HISTORY: Pt currently unemployed, lives alone and uses a cane. Denies
current tobacco use, quit years ago. No recent EtoH use, quit
~10yrs ago. Denies IVDU.
Infection and inflammatory reaction due to internal joint prosthesis,Acute kidney failure, unspecified,Pyogenic arthritis, pelvic region and thigh,Chronic diastolic heart failure,Hyposmolality and/or hyponatremia,Other primary cardiomyopathies,Hip joint replacement,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Other congenital deformity of hip (joint),Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Chronic hepatitis C without mention of hepatic coma,Other chronic pain,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism,Anemia, unspecified,Unspecified hypertensive heart disease with heart failure
React-inter joint prost,Acute kidney failure NOS,Pyogen arthritis-pelvis,Chr diastolic hrt fail,Hyposmolality,Prim cardiomyopathy NEC,Joint replaced hip,Oth gram negatv bacteria,Cong hip deformity NEC,DMII wo cmp uncntrld,Chrnc hpt C wo hpat coma,Chronic pain NEC,Long-term use anticoagul,Hx-ven thrombosis/embols,Anemia NOS,Hyp ht dis NOS w ht fail
Admission Date:  [**2111-12-9**]              Discharge Date:   [**2111-12-19**]

Date of Birth:  [**2056-10-3**]             Sex:   M

Service: ORTHOPAEDICS

Allergies:
Anti-Inflam/Antiarth Agents Misc. Classf

Attending:[**First Name3 (LF) 11261**]
Chief Complaint:
Right hip pain
Hyperglycemia

Major Surgical or Invasive Procedure:
[**2111-12-9**]:  Right hip aspiration
[**2111-12-11**]:  Right hip I&D
[**2111-12-13**]:  PICC line placement


History of Present Illness:
Mr. [**Known lastname **] is a 54 yo M with DM2, PE on coumadin, congenital
hip dysplasia s/p THR & multiple hip revisions, cardiomyopathy
and multiple other medical problems presents with 5 day duration
of sharp R hip pains. R hip pain started suddenly ~5days prior
to admission and he was unable to ambulate; pain was poorly
controlled at home however did not feel sick. Pain gradually
worsened to involve thigh muscles as well as popliteal area, now
reported malaise, chills, poor appetite and nausea; this was
when he presented to the ED. Denies vomiting or abdominal pains.

Of note, pt reports that he has chronically been on
ciprofloxacin 500mg po BID since [**1-/2111**] s/p R hip revision c/b
infection; he reports that he has accidentally only been taking
cipro once daily. This regimen was under the control of
Dr.[**Last Name (STitle) 8362**](ID) at [**Hospital3 **] hosp.
.
ROS: Reports recent improving cough, no rhinorrhea or
sorethroat. Denies chestpain or sob. Denies myalgias or
arthralgias to other sites however does report chronic backpain.
Reports poor compliance with his insulin over the last few days
as had poor oral intake. Reports polyuria but no dysuria. Denies
diarrhea, constipation, melena or hematochezia.
.
ED COURSE: T 99.2F BP 104/77 P 121 RR 16 O2sats 95%RA. Ortho c/s
in ED, plan for CT guided arthrocentesis of R hip joint.
Received Vancomycin 1000mg IV x 1, Levofloxacin 500mg po x 1,
regular insulin for blood glucose of 300's and NS x1L. Pt
admitted to medicine for further managment.


Past Medical History:
DM2: A1c 7.0 [**10/2111**]; proteinuria.
PE x2 on lifelong coumadin.
Congenital hip dysplasia s/p reconstruction at age 10, multiple
hip replacement over the years; most recently [**1-/2111**] (R hip
revision)
Hypertension
Hepatitis C (fibrosis on biopsy; followed by Dr.[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2643**])
Chronic Pain syndrome
Cardiomyopathy (normal cath [**2-/2111**]): EF 50-60%
s/p Laminectomy


Social History:
Pt currently unemployed, lives alone and uses a cane. Denies
current tobacco use, quit years ago. No recent EtoH use, quit
~10yrs ago. Denies IVDU.

Family History:
There is a family history of diabetes.  His mother and maternal
grandmother both had heart disease.

Physical Exam:
VS: T 101.9 F BP 110/60 P 79 RR 20 94% RA
GEN: Well developed male, lying in bed, winces with movement in
bed
HEENT: OP clear without lesions
Heart: RRR, no murmurs noted
Lungs: CTA b/l, no wheezing or rhonchi
Abd: obese, +bs, nontender to palpation
Ext: R>L warmth, R hip - large scar s/p hip replacements, tender
to palpation, hardened & enlarged per pt not new, no erythema
noted. Barely moves RLE due to pain.
Neuro: AAO x 3
.


Pertinent Results:
COMPLETE BLOOD COUNT   WBC  RBC Hgb Hct MCV MCH MCHC RDW Plt Ct
[**2111-12-10**] 08:30AM    10.3 4.15* 12.2* 36.4* 88 29.3 33.4 12.9
322
[**2111-12-9**] 03:00PM    9.5  4.36* 13.0* 36.7* 84 29.9 35.5* 13.6
337
.
RENAL & GLUCOSE       Glucose UreaN Creat Na   K  Cl HCO3
[**2111-12-10**] 08:30AM    [**Telephone/Fax (2) 104246**] 3.7 89  26
.
IMMUNOLOGY               CRP
[**2111-12-9**] 03:00PM    229.3
.
CT guided arthrocentesis [**2111-12-10**]
Aspiration of purulent material from right hip joint. Highly
suspicious for infection and material is sent for microbiology
as well as cell count and differential.
.
Synovial fluid analysis [**2111-12-10**]
WBC 299,000
PMN's 98%

Brief Hospital Course:
Mr. [**Known lastname **] presented to the [**Hospital1 18**] on [**2111-12-9**] with right hip
pain.  He was evaluated by the orthopaedic and medical service.
He underwent a CT guided aspiration of his right hip and was
started on Vancomycin and ciprofloxacin.  The CT drainage grew
299K WBC with 98% PMN's.  He was also noted to have elevated
blood glucose levels and the [**Last Name (un) **] team was consulted in help
with blood glucose control.  He was also noted to have
hyponatremia which was corrected with IV fluid.  On [**2111-12-11**] he
was transferred to the ICU for better blood glucose control as
finger sticks remained elevated over 400.  He also have
temperature greater than 102, and HR 120's.  Later on [**2111-12-11**] he
was taken to the operating room and underwent and I&D of his
right hip.  He tolerated the procedure well and was transferred
back to the ICU post operatively.  He continued on Vancomycin,
Ceftaz, and Clindamycin.  On [**2111-12-13**] a PICC line was placed for
long term antibiotics.  He was also transfused with 2 units of
packed red blood cells due to acute post operative anemia.  On
[**2111-12-14**] the vancomycin and clindamycin was stopped and he
remained on ceftaz.  He was also transferred to the floor on
[**2111-12-14**]. Infectious disease was consulted for antibiotic
coverage and length of treatment.  On [**2111-12-16**] the ceftaz was
discontinued and he was started on Ceftazidime for a 6 week
course.
.
With his history of two pulmonary embolism he is on lifelong
coumadin.  Goal INR is [**12-20**].  The rest of his hospital stay was
uneventful with his lab data and vital signs within normal
limits and his pain controlled.  He is being discharged today in
stable condition.

Medications on Admission:
Aspirin 325 mg qd
Folic acid 2 mg qd
Humulin 70/30 30u qam & 32u qpm
HCTZ 12.5 mg po qd
lipitor 80mg po qd
lisinopril 40mg po qd
MS contin 30 mg po BID
Neurontin 400mg TID
Nortriptyline 75mg po QHS
Toprol XL 100mg po qd
Warfarin 5mg po qd
.
ALLERGIES: NSAIDS 'pruiritis' no resp.distress


Discharge Medications:
1. PICC Care
Normal Saline flush 5-10cc SASH/prn
Heparin Flush 100unit/cc 3-5cc SASH/prn
2. Outpatient Lab Work
Please draw weekly CBC with fidd, Chem 7, LFT's, ESR, and CRP
Please fax results to attention Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 432**]
3. Atorvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
4. Gabapentin 400 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
5. Nortriptyline 25 mg Capsule Sig: Three (3) Capsule PO HS (at
bedtime).
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
7. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours
as needed for 1 months.
Disp:*90 Tablet(s)* Refills:*0*
8. Ceftazidime-Dextrose (Iso-osm) 1 gram/50 mL Piggyback Sig:
One (1) g IV Intravenous Q8H (every 8 hours).
Disp:*3 week supply* Refills:*2*
9. Lovenox 80 mg/0.8 mL Syringe Sig: One (1) syringe
Subcutaneous twice a day for 1 months.
Disp:*60 syringes* Refills:*0*
10. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

11. Morphine 15 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO Q12H (every 12 hours).
Disp:*60 Tablet Sustained Release(s)* Refills:*2*
12. Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO
DAILY (Daily).
13. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
14: INSULIN
Insulin SC Fixed Dose Orders
Bedtime: Glargine (Lantus) 55  Units
Insulin SC Sliding Scale
Glucose Insulin Dose Insulin Dose Insulin Dose Insulin Dose
071-099  10 Units    10 Units     13 Units     0 Units
100-149  13 Units    13 Units     16 Units     0 Units
150-199  16 Units    16 Units     19 Units     0 Units
200-249  19 Units    19 Units     22 Units     5 Units
250-299  22 Units    22 Units     25 Units     8 Units
300-349  25 Units    25 Units     28 Units     10 Units
350-400  28 Units    28 Units     28 Units     12 Units


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Right hip infection
Acute post operative anemia


Discharge Condition:
Stable, to home


Discharge Instructions:
Continue to be weight bearing as tolerated on you right hip
.
Continue your IV antibiotics as instructed
.
If you notice any increased redness drainage or swelling, or if
you have a temperature greater than 101.5 please call the office
or come to the emergency department.
Physical Therapy:
Activity as tolerated
Right Lower extermity:  Weight bearing as tolerated
Treatments Frequency:
Staples/sutures out 14 days after surgery or at follow up
appointment.

Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) 7111**] in 2 weeks, please call
[**Telephone/Fax (1) 11262**] to schedule that appointment.
.
Please follow up with Dr. [**Last Name (STitle) **] in infectious disease clinic in 4
weeks, please call [**Telephone/Fax (1) 457**] to schedule that appointment.

Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 435**]
Date/Time:[**2111-12-23**] 4:00
Provider: [**Name10 (NameIs) **] LAB Phone:[**Telephone/Fax (1) 1237**] Date/Time:[**2112-1-1**]
2:30
Provider: [**Name10 (NameIs) **] LAB Phone:[**Telephone/Fax (1) 1237**] Date/Time:[**2112-1-6**]
1:00
{'Infection and inflammatory reaction due to internal joint prosthesis,Acute kidney failure, unspecified,Pyogenic arthritis, pelvic region and thigh,Chronic diastolic heart failure,Hyposmolality and/or hyponatremia,Other primary cardiomyopathies,Hip joint replacement,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Other congenital deformity of hip (joint),Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Chronic hepatitis C without mention of hepatic coma,Other chronic pain,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism,Anemia, unspecified,Unspecified hypertensive heart disease with heart failure'}


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 hip pain
Hyperglycemia

PRESENT ILLNESS: Mr. [**Known lastname **] is a 54 yo M with DM2, PE on coumadin, congenital
hip dysplasia s/p THR & multiple hip revisions, cardiomyopathy
and multiple other medical problems presents with 5 day duration
of sharp R hip pains. R hip pain started suddenly ~5days prior
to admission and he was unable to ambulate; pain was poorly
controlled at home however did not feel sick. Pain gradually
worsened to involve thigh muscles as well as popliteal area, now
reported malaise, chills, poor appetite and nausea; this was
when he presented to the ED. Denies vomiting or abdominal pains.

MEDICAL HISTORY: DM2: A1c 7.0 [**10/2111**]; proteinuria.
PE x2 on lifelong coumadin.
Congenital hip dysplasia s/p reconstruction at age 10, multiple
hip replacement over the years; most recently [**1-/2111**] (R hip
revision)
Hypertension
Hepatitis C (fibrosis on biopsy; followed by Dr.[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2643**])
Chronic Pain syndrome
Cardiomyopathy (normal cath [**2-/2111**]): EF 50-60%
s/p Laminectomy

MEDICATION ON ADMISSION: Aspirin 325 mg qd
Folic acid 2 mg qd
Humulin 70/30 30u qam & 32u qpm
HCTZ 12.5 mg po qd
lipitor 80mg po qd
lisinopril 40mg po qd
MS contin 30 mg po BID
Neurontin 400mg TID
Nortriptyline 75mg po QHS
Toprol XL 100mg po qd
Warfarin 5mg po qd
.
ALLERGIES: NSAIDS 'pruiritis' no resp.distress

ALLERGIES: Anti-Inflam/Antiarth Agents Misc. Classf

PHYSICAL EXAM: VS: T 101.9 F BP 110/60 P 79 RR 20 94% RA
GEN: Well developed male, lying in bed, winces with movement in
bed
HEENT: OP clear without lesions
Heart: RRR, no murmurs noted
Lungs: CTA b/l, no wheezing or rhonchi
Abd: obese, +bs, nontender to palpation
Ext: R>L warmth, R hip - large scar s/p hip replacements, tender
to palpation, hardened & enlarged per pt not new, no erythema
noted. Barely moves RLE due to pain.
Neuro: AAO x 3
.

FAMILY HISTORY: There is a family history of diabetes.  His mother and maternal
grandmother both had heart disease.

SOCIAL HISTORY: Pt currently unemployed, lives alone and uses a cane. Denies
current tobacco use, quit years ago. No recent EtoH use, quit
~10yrs ago. Denies IVDU. 

### Response:
{'Infection and inflammatory reaction due to internal joint prosthesis,Acute kidney failure, unspecified,Pyogenic arthritis, pelvic region and thigh,Chronic diastolic heart failure,Hyposmolality and/or hyponatremia,Other primary cardiomyopathies,Hip joint replacement,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Other congenital deformity of hip (joint),Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Chronic hepatitis C without mention of hepatic coma,Other chronic pain,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism,Anemia, unspecified,Unspecified hypertensive heart disease with heart failure'}
