CHIEF COMPLAINT: cough/fever

PRESENT ILLNESS: [**Age over 90 **] y.o. man with h/o seizure, orthostatic hypotension on
hydrocort, prostate ca, and chronic cough, p/w worsening cough
productive of sputum x 3 days. He has difficult getting the
sputum out of his lungs. He also c/o right pleuritic chest pain
only with coughing or movement, as well as fever at home. Also
c/o increased weakness and difficulty using his walker. Denies
sub-sternal CP, abd pain.
.
Upon arrival to ED, he had a rectal temp of 103.4, was
tachycardic to 100 and tachypneic so code sepsis was called. His
initial BP was 146/57 but dropped to 88/30. A right IJ was
placed and he was given 3L NS. CXR revealed left retrocardiac
and LUL pneumonia. He was given CTX and Azithromycin. His is
requiring 4L NC. Per his PCP (Dr. [**First Name8 (NamePattern2) 1312**] [**Last Name (NamePattern1) 1313**]) his baseline
SBP is in the 90s, last office visit, 98/60.
.
MICU Course: Patient was initially hypotensive and placed on
neosynephrine for 12 hours for blood pressure support. After
adequate hydration this was weaned successfully. He was started
on stres dose steroids given he is on hydrocort 10mg [**Hospital1 **] at
baseline for orthostatic hypotension. This was reduced back to
his home dose within 24 hours. His O2 was weaned from 4L at the
time of admission to RA by the time he was transferred to the
medicine floor. Creatinine trended down from 1.4 to his baseline
of 1.0.

MEDICAL HISTORY: 1. Complex partial seizures
2. Prostate cancer, diagnosed 5 years ago. Being followed
expectantly and treated with Proscar.
3. Sleep apnea with daytime sleepiness and sleep disordered
breathing noted in past. Trialed on Modafanil but this caused
oral buccal dyskinesias. Did not tolerate BiPap. Daytime
sleepiness improved after discontinuation of Depakote.
4. History of orthostatic hypotension in remote past, on Cortef

MEDICATION ON ADMISSION: MULTIVITAMIN TAB one po qd
COLACE CAP 100MG one po tid
RESTASIS 0.05% Oph OU [**Hospital1 **]
AZOPT 0.1% Oph OU [**Hospital1 **]
ASPIRIN TAB 81MG EC daily
PROSCAR TAB 5MG one po qhs
KEPPRA 750 MG TAB 1 [**Hospital1 **]
CORTEF 10 MG TAB (HYDROCORTISONE) One po bid- NO SUBSTITUTION
[**Doctor First Name **] CAP 60MG one po bid
MUCINEX 600 po bid

ALLERGIES: Depakote Er

PHYSICAL EXAM: VS T 102 (rectal) BP 105/38, HR 97, RR 23, 92% 4L NC
Gen: ill appearing, conversant
HEENT: moist discharge from b/l eyes. PERRL, OP dry. No JVD
Lungs: poor air mvmt. scattered crackle on left
Heart: RRR nl S1S2, no M/R/G
Abd: +BS, soft, ND/NT
Ext: 2+ pitting edema of ankles b/l
Neuro: AAO x 3

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: The pt is widowed since [**2151**]. Retired at age 70. Was on the
Board of Directors at [**Hospital1 18**]. Former smoker of 10 pack years but
quit 50+ years ago. Drinks one shot or cocktail nightly. Has 24
hour housekeeping and homecare assistance, driver. Walks with
cane for past one year.
Unspecified septicemia,Pneumonia, organism unspecified,Acute kidney failure, unspecified,Delirium due to conditions classified elsewhere,Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, without mention of intractable epilepsy,Sepsis,Orthostatic hypotension,Malignant neoplasm of prostate,Obstructive sleep apnea (adult)(pediatric),Unspecified hereditary and idiopathic peripheral neuropathy,Cardiac pacemaker in situ
Septicemia NOS,Pneumonia, organism NOS,Acute kidney failure NOS,Delirium d/t other cond,Psymotr epil w/o int epi,Sepsis,Orthostatic hypotension,Malign neopl prostate,Obstructive sleep apnea,Idio periph neurpthy NOS,Status cardiac pacemaker
Admission Date:  [**2156-12-1**]              Discharge Date:   [**2156-12-7**]


Service: MEDICINE

Allergies:
Depakote Er

Attending:[**First Name3 (LF) 898**]
Chief Complaint:
cough/fever

Major Surgical or Invasive Procedure:
1. Central Line Placement


History of Present Illness:
[**Age over 90 **] y.o. man with h/o seizure, orthostatic hypotension on
hydrocort, prostate ca, and chronic cough, p/w worsening cough
productive of sputum x 3 days. He has difficult getting the
sputum out of his lungs. He also c/o right pleuritic chest pain
only with coughing or movement, as well as fever at home. Also
c/o increased weakness and difficulty using his walker. Denies
sub-sternal CP, abd pain.
.
Upon arrival to ED, he had a rectal temp of 103.4, was
tachycardic to 100 and tachypneic so code sepsis was called. His
initial BP was 146/57 but dropped to 88/30. A right IJ was
placed and he was given 3L NS. CXR revealed left retrocardiac
and LUL pneumonia. He was given CTX and Azithromycin. His is
requiring 4L NC. Per his PCP (Dr. [**First Name8 (NamePattern2) 1312**] [**Last Name (NamePattern1) 1313**]) his baseline
SBP is in the 90s, last office visit, 98/60.
.
MICU Course: Patient was initially hypotensive and placed on
neosynephrine for 12 hours for blood pressure support. After
adequate hydration this was weaned successfully. He was started
on stres dose steroids given he is on hydrocort 10mg [**Hospital1 **] at
baseline for orthostatic hypotension. This was reduced back to
his home dose within 24 hours. His O2 was weaned from 4L at the
time of admission to RA by the time he was transferred to the
medicine floor. Creatinine trended down from 1.4 to his baseline
of 1.0.


Past Medical History:
1. Complex partial seizures
2. Prostate cancer, diagnosed 5 years ago. Being followed
expectantly and treated with Proscar.
3. Sleep apnea with daytime sleepiness and sleep disordered
breathing noted in past. Trialed on Modafanil but this caused
oral buccal dyskinesias. Did not tolerate BiPap. Daytime
sleepiness improved after discontinuation of Depakote.
4. History of orthostatic hypotension in remote past, on Cortef

5. Left eye cataract status post surgery
6. Ptosis on right as a result of surgery for detached retina
7. Peripheral neuropathy
8. ? Esophageal diverticulum
9. Pacemaker

Social History:
The pt is widowed since [**2151**]. Retired at age 70. Was on the
Board of Directors at [**Hospital1 18**]. Former smoker of 10 pack years but
quit 50+ years ago. Drinks one shot or cocktail nightly. Has 24
hour housekeeping and homecare assistance, driver. Walks with
cane for past one year.



Family History:
Noncontributory.

Physical Exam:
VS T 102 (rectal) BP 105/38, HR 97, RR 23, 92% 4L NC
Gen: ill appearing, conversant
HEENT: moist discharge from b/l eyes. PERRL, OP dry. No JVD
Lungs: poor air mvmt. scattered crackle on left
Heart: RRR nl S1S2, no M/R/G
Abd: +BS, soft, ND/NT
Ext: 2+ pitting edema of ankles b/l
Neuro: AAO x 3


Pertinent Results:
[**2156-12-1**] 09:00PM   GLUCOSE-125* UREA N-31* CREAT-1.4* SODIUM-136
POTASSIUM-4.4 CHLORIDE-102 TOTAL CO2-23 ANION GAP-15
[**2156-12-1**] 09:00PM   ALT(SGPT)-21 AST(SGOT)-26 LD(LDH)-249
CK(CPK)-118 ALK PHOS-72 TOT BILI-0.9
[**2156-12-1**] 09:00PM   WBC-10.7# RBC-3.72* HGB-12.6* HCT-35.9*
MCV-97 MCH-33.8* MCHC-35.0 RDW-13.8
[**2156-12-1**] 09:00PM   NEUTS-68 BANDS-15* LYMPHS-7* MONOS-3 EOS-0
BASOS-0 ATYPS-0 METAS-7* MYELOS-0
[**2156-12-1**] CXR - 1. New extensive consolidation of the left upper
lobe and lingula, likely pneumonic, with small left pleural
effusion.
2. No CHF.
[**2156-12-2**] ECG
Sinus rhythm with first degree atrio-ventricular conduction
delay. Compared to previous tracing of [**2156-9-11**] no definite
change.


Brief Hospital Course:
Mr. [**Known lastname 452**] is a [**Age over 90 **] y.o. man with seizure d/o and chronic cough p/w
worsening productive cough, pleuritic chest pain, and fever up
to 103.4 rectally. He was originally admitted to the MICU for a
transiet pressor requirement.  He was started on ceftriaxone and
azithromycin antibiotic therapy for a likely left-sided
pneumonia.  His oxygenation status was stable throughout his
hospital course.  He was changed to cefpodoxime and azithromycin
PO for a total 2-week course. Cardiac etiology for his pleuritic
chest pain was continued but the EKG remaied unchanged and his
cardiac enzymes were negative.  I slightly elevated troponin was
attributed to acute renal failure.
.
During the hospitalization he had frequent evening episodes of
delirium thought to be secondary to his hospitalization and
recent infection.  Repeat blood and urine cultures remained
negative.  He was redirectable.  Concern for seizure was raised
but per his family and health care aid, his seizures present
with tonic clonic movements or episodes of staring.  He remained
on his home dose of Keppra. His family requested to not use any
antipsychotics.  He had a 1:1 sitter and was alert and oriented
at discharge.
.
The patient presented with an elevated creatinine to 1.4 with a
baseline Cr of 1.0 to 1.2.  This was believed to be

.
Acute renal failure: baseline cr 0.8-1.0. Admission creatinine
peaked at 1.4 thought to be likely pre-renal in setting of
sepsis. Creatinine trended down with hydration and was 0.7 on
discharge.
.
He was discharged home with VNA services and physical therapy
and has 24-hour caregivers at home.
.
# Contact: HCP, son Dr. [**First Name8 (NamePattern2) 449**] [**Known lastname 452**] ([**Telephone/Fax (1) 97313**], home. pager
in system. Also [**First Name8 (NamePattern2) 11705**] [**Last Name (NamePattern1) 97314**] ([**Telephone/Fax (1) 97315**]
# FULL CODE

Medications on Admission:
MULTIVITAMIN TAB one po qd
COLACE CAP 100MG one po tid
RESTASIS 0.05% Oph OU [**Hospital1 **]
AZOPT 0.1% Oph OU [**Hospital1 **]
ASPIRIN TAB 81MG EC daily
PROSCAR TAB 5MG one po qhs
KEPPRA 750 MG TAB 1 [**Hospital1 **]
CORTEF 10 MG TAB (HYDROCORTISONE) One po bid- NO SUBSTITUTION
[**Doctor First Name **] CAP 60MG one po bid
MUCINEX 600 po bid

Discharge Medications:
1. Docusate Sodium 50 mg/5 mL Liquid Sig: One Hundred (100) mg
PO three times a day.
2. Levetiracetam 750 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
3. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Azithromycin 250 mg Capsule Sig: One (1) Capsule PO Q24H
(every 24 hours) for 8 days: Your last dose will be on [**2156-12-14**].
Disp:*8 Capsule(s)* Refills:*0*
5. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
6. Brinzolamide 1 % Drops, Suspension Sig: One (1)  Ophthalmic
[**Hospital1 **] ().
7. Cyclosporine 0.05 % Dropperette Sig: One (1) Dropperette
Ophthalmic [**Hospital1 **] ().
8. Hydrocortisone 5 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
9. Cefpodoxime 100 mg Tablet Sig: Two (2) Tablet PO Q12H (every
12 hours) for 8 days.
Disp:*32 Tablet(s)* Refills:*0*
10. Multivitamin     Tablet Sig: One (1) Tablet PO once a day.
11. [**Doctor First Name **] 60 mg Tablet Sig: One (1) Tablet PO twice a day.
12. Mucinex 600 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO twice a day.


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 **] Family & Children Services

Discharge Diagnosis:
PRIMARY DIAGNOSIS:
1. Pneumonia
2. Hypotension
3. Delirium

SECONDARY DIAGNOSIS:
- Complex partial seizures
- Prostate cancer, diagnosed [**2144**]
- chronic LE edema
- Sleep apnea with daytime sleepiness
- h/o chronic PEs, not on anticoagulation
- Chronic bronchitis
- History of orthostatic hypotension in remote past, on
Hydrocort
- Left eye cataract status post surgery
- Right eye retinal detachment
- Ptosis on right as a result of surgery for detached retina
- Peripheral neuropathy
- ? Esophageal diverticulum
- Pacemaker [**3-/2156**] for sinus pauses w/syncope
- h/o pericarditis


Discharge Condition:
Stable. Patient was tolerating room air and working with
physical therapy for help with ambulation.


Discharge Instructions:
You were admitted to the hospital for treatment of pneumonia. We
started you on antibiotics for your pneumonia, and you will
complete a total 14 day course of the antibiotic cefpodoxime and
azithromycin at home. These should be completed on [**2156-12-14**]. You
also developed low blood pressures with this infection, and this
improved rapidly with medications and with intravenous fluids.
You were also slightly confused for a short time in the
hospital, and this also improved as we treated your infection.
.
Please continue to take your medications as prescribed.
.
If you have fevers, shaking chills, night sweats, shortness of
breath, increased cough, lower extremity swelling, chest pain,
diarrhea, light-headedness, or dizziness, please seek immediate
medical attention.
.
It will be important for you to continue to take all your
medications as prescribed. The only medications that we have
added are the following:
- cefpodoxime and azithromycin to treat your infection

Followup Instructions:
- Please schedule an appointment with your Primary Care
Physician [**Telephone/Fax (1) **] Dr. [**First Name (STitle) 1313**] within 1 week after your
discharge
- Please follow-up with your urologist [**First Name11 (Name Pattern1) 275**] [**Last Name (NamePattern4) 276**], M.D.
at your previously scheduled appointment on [**2156-12-29**] 11:00. If
you need to reschedule, please call his office at [**Telephone/Fax (1) 277**].
- Please also follow-up with your neurologist [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 16747**],
M.D. at your previously scheduled appointment on [**2156-12-31**] 2:00.
If you need to reschedule, please call his office at
[**Telephone/Fax (1) 16748**].
- Please also follow-up in DEVICE CLINIC at your previously
scheduled appointment on [**2157-2-21**] 11:30. If you need to
reschedule, please call his office at [**Telephone/Fax (1) 59**].
{'Unspecified septicemia,Pneumonia, organism unspecified,Acute kidney failure, unspecified,Delirium due to conditions classified elsewhere,Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, without mention of intractable epilepsy,Sepsis,Orthostatic hypotension,Malignant neoplasm of prostate,Obstructive sleep apnea (adult)(pediatric),Unspecified hereditary and idiopathic peripheral neuropathy,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: cough/fever

PRESENT ILLNESS: [**Age over 90 **] y.o. man with h/o seizure, orthostatic hypotension on
hydrocort, prostate ca, and chronic cough, p/w worsening cough
productive of sputum x 3 days. He has difficult getting the
sputum out of his lungs. He also c/o right pleuritic chest pain
only with coughing or movement, as well as fever at home. Also
c/o increased weakness and difficulty using his walker. Denies
sub-sternal CP, abd pain.
.
Upon arrival to ED, he had a rectal temp of 103.4, was
tachycardic to 100 and tachypneic so code sepsis was called. His
initial BP was 146/57 but dropped to 88/30. A right IJ was
placed and he was given 3L NS. CXR revealed left retrocardiac
and LUL pneumonia. He was given CTX and Azithromycin. His is
requiring 4L NC. Per his PCP (Dr. [**First Name8 (NamePattern2) 1312**] [**Last Name (NamePattern1) 1313**]) his baseline
SBP is in the 90s, last office visit, 98/60.
.
MICU Course: Patient was initially hypotensive and placed on
neosynephrine for 12 hours for blood pressure support. After
adequate hydration this was weaned successfully. He was started
on stres dose steroids given he is on hydrocort 10mg [**Hospital1 **] at
baseline for orthostatic hypotension. This was reduced back to
his home dose within 24 hours. His O2 was weaned from 4L at the
time of admission to RA by the time he was transferred to the
medicine floor. Creatinine trended down from 1.4 to his baseline
of 1.0.

MEDICAL HISTORY: 1. Complex partial seizures
2. Prostate cancer, diagnosed 5 years ago. Being followed
expectantly and treated with Proscar.
3. Sleep apnea with daytime sleepiness and sleep disordered
breathing noted in past. Trialed on Modafanil but this caused
oral buccal dyskinesias. Did not tolerate BiPap. Daytime
sleepiness improved after discontinuation of Depakote.
4. History of orthostatic hypotension in remote past, on Cortef

MEDICATION ON ADMISSION: MULTIVITAMIN TAB one po qd
COLACE CAP 100MG one po tid
RESTASIS 0.05% Oph OU [**Hospital1 **]
AZOPT 0.1% Oph OU [**Hospital1 **]
ASPIRIN TAB 81MG EC daily
PROSCAR TAB 5MG one po qhs
KEPPRA 750 MG TAB 1 [**Hospital1 **]
CORTEF 10 MG TAB (HYDROCORTISONE) One po bid- NO SUBSTITUTION
[**Doctor First Name **] CAP 60MG one po bid
MUCINEX 600 po bid

ALLERGIES: Depakote Er

PHYSICAL EXAM: VS T 102 (rectal) BP 105/38, HR 97, RR 23, 92% 4L NC
Gen: ill appearing, conversant
HEENT: moist discharge from b/l eyes. PERRL, OP dry. No JVD
Lungs: poor air mvmt. scattered crackle on left
Heart: RRR nl S1S2, no M/R/G
Abd: +BS, soft, ND/NT
Ext: 2+ pitting edema of ankles b/l
Neuro: AAO x 3

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: The pt is widowed since [**2151**]. Retired at age 70. Was on the
Board of Directors at [**Hospital1 18**]. Former smoker of 10 pack years but
quit 50+ years ago. Drinks one shot or cocktail nightly. Has 24
hour housekeeping and homecare assistance, driver. Walks with
cane for past one year. 

### Response:
{'Unspecified septicemia,Pneumonia, organism unspecified,Acute kidney failure, unspecified,Delirium due to conditions classified elsewhere,Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, without mention of intractable epilepsy,Sepsis,Orthostatic hypotension,Malignant neoplasm of prostate,Obstructive sleep apnea (adult)(pediatric),Unspecified hereditary and idiopathic peripheral neuropathy,Cardiac pacemaker in situ'}
