CHIEF COMPLAINT: The patient is an outside hospital transfer for mixed
respiratory failure, neurology work-up. He was initially
admitted to OSH for lethargy.

PRESENT ILLNESS: Mr. [**Known lastname 81970**] is a 77yoM with recent h/o hypercarbic respiratory
failure [**2-27**] asp PNA who presented on [**2141-1-27**] to [**Hospital1 5109**] for lethargy ([**Hospital1 2436**] ICU [**Telephone/Fax (1) 81971**]).  He was
transferred for further management and work-up of his
respiratory status.

MEDICAL HISTORY: #) Recent hypercarbic resp failure since [**2140-12-20**]
-- admitted in [**12-3**] with aspiration PNA; c/b parapneumonic
effusion
-- was discharged to rehab after hospitalization on BiPAP at
night with 2LNC during the day
#) Parksinson's Disease
-- diagnosed 3-4 months ago based on rigidity and withdrawal
from ADL's, as well as 30 lb weight loss
-- did not tolerate Sinemet (started in late [**Month (only) 359**] or early
[**Month (only) **]; had hallucinations) or Requip (somnolence); was
recently started on Mirapex.
-- Neurologist is Dr. [**Last Name (STitle) 81972**]
#) H/O papillary cell transitional cell bladder CA, [**2134**]
#) s/p TURP, ? BPH
#) HTN
#) Hyperlipidemia
#) IgA gammopathy-- per OSH H&P, first "noticed" in [**9-/2140**]
#) Pancytopenia-- per OSH H&P, first "noticed" in [**9-/2140**]
#) ? h/o chronic dysphagia-- supposedly prior to PD dx
-- had S&S eval prior to d/c on [**2140-12-30**]; no evidence of
aspiration on the study
#) ? iron overload
#) Erosive gastritis [**9-/2140**]
#) ? Asbestiosis-- calcifications c/w per recent chest CT's

MEDICATION ON ADMISSION: MEDICATIONS on transfer:
Combivent inhalers
Omeprazole
Pramipexole-- on list, though reportedly held due to delta MS
[**First Name (Titles) 61368**] [**Last Name (Titles) **]
Terazosin 10 mg QHS
Lisinopril 20 mg QD
Amlodipine 5 mg QD
Enoxaparin 40 mg SQD
Acetaminophen 650 mg PO Q4 hours PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS on arrival to the ICU: T 99.0; 121/46 (cuff), 141/46 (left
alin), HR 57;
vent settings AC, 450/14, 100/PEEP 8
General: intubated, sedated; elderly; had OG tube
HEENT: OP clear but dry
Lungs: decreased BS on left base; crackles half-way up
throughout; no wheezes
Cardio: RRR, no m.r.g. appreciated
Abd: +BS, soft, ND
Extremities: no edema, WWP
Skin: no rashes, no petechiae
Neuro: sedated; 2+ reflexes throughout

FAMILY HISTORY: Unknown.

SOCIAL HISTORY: -- girlfriend [**Name (NI) 81973**] has been with him for 25+ years
-- originally from [**Country 4754**], moved here in the [**2082**]'s
-- used to play professional soccer for [**Country 4754**]
-- an ex-smoker; unclear how much and when he quit
-- denied EtOH
Pneumonitis due to inhalation of food or vomitus,Ventilator associated pneumonia,Amyotrophic lateral sclerosis,Acute kidney failure, unspecified,Alkalosis,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Unspecified essential hypertension,Acute respiratory failure
Food/vomit pneumonitis,Ventltr assoc pneumonia,Amyotrophic sclerosis,Acute kidney failure NOS,Alkalosis,Pseudomonas infect NOS,Hypertension NOS,Acute respiratry failure
Admission Date:  [**2141-1-28**]              Discharge Date:   [**2141-2-17**]

Date of Birth:  [**2063-8-12**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 99**]
Chief Complaint:
The patient is an outside hospital transfer for mixed
respiratory failure, neurology work-up. He was initially
admitted to OSH for lethargy.

Major Surgical or Invasive Procedure:
Intubation
Tracheostomy
Percutaneous Gastrostomy tube


History of Present Illness:
Mr. [**Known lastname 81970**] is a 77yoM with recent h/o hypercarbic respiratory
failure [**2-27**] asp PNA who presented on [**2141-1-27**] to [**Hospital1 5109**] for lethargy ([**Hospital1 2436**] ICU [**Telephone/Fax (1) 81971**]).  He was
transferred for further management and work-up of his
respiratory status.

Most recently on [**2141-1-27**], he became lethargic at home with sats
in the 80's on home dose 3L NC.  He reportedly had difficulty
answering questions, but denied F/C/cough.  Per the notes, he
was not wearing his home BiPAP or NC as he was supposed to after
d/c from rehab.  CXR at the OSH showed ? new right effusion and
PNA, but he was not started on antibiotics.  ABG at the time was
7.18/104/106/41 on 2LNC; he was started on BiPAP but later
intubated for poor MS [**First Name (Titles) **] [**Last Name (Titles) **] developed hypoxemia.  Per
notes, secretions were minimal.  Chest CTA was negative for PE.
Head CT was negative; Mirapex was held due to the lethargy.  BP
meds were held on [**2141-1-28**]. He recieved D5W-1/2NS at 75 cc/hr.

Prior to transfer on [**2141-1-28**], he was noted to have O2 sats ~92%
with PaO2's around 50 on FI02 of 80% with a PEEP of 7.5; tidal
volume was set to 450 with a RR 16.

Past Medical History:
#) Recent hypercarbic resp failure since [**2140-12-20**]
-- admitted in [**12-3**] with aspiration PNA; c/b parapneumonic
effusion
-- was discharged to rehab after hospitalization on BiPAP at
night with 2LNC during the day
#) Parksinson's Disease
-- diagnosed 3-4 months ago based on rigidity and withdrawal
from ADL's, as well as 30 lb weight loss
-- did not tolerate Sinemet (started in late [**Month (only) 359**] or early
[**Month (only) **]; had hallucinations) or Requip (somnolence); was
recently started on Mirapex.
-- Neurologist is Dr. [**Last Name (STitle) 81972**]
#) H/O papillary cell transitional cell bladder CA, [**2134**]
#) s/p TURP, ? BPH
#) HTN
#) Hyperlipidemia
#) IgA gammopathy-- per OSH H&P, first "noticed" in [**9-/2140**]
#) Pancytopenia-- per OSH H&P, first "noticed" in [**9-/2140**]
#) ? h/o chronic dysphagia-- supposedly prior to PD dx
-- had S&S eval prior to d/c on [**2140-12-30**]; no evidence of
aspiration on the study
#) ? iron overload
#) Erosive gastritis [**9-/2140**]
#) ? Asbestiosis-- calcifications c/w per recent chest CT's

Social History:
-- girlfriend [**Name (NI) 81973**] has been with him for 25+ years
-- originally from [**Country 4754**], moved here in the [**2082**]'s
-- used to play professional soccer for [**Country 4754**]
-- an ex-smoker; unclear how much and when he quit
-- denied EtOH


Family History:
Unknown.


Physical Exam:
VS on arrival to the ICU: T 99.0; 121/46 (cuff), 141/46 (left
alin), HR 57;
vent settings AC, 450/14, 100/PEEP 8
General: intubated, sedated; elderly; had OG tube
HEENT: OP clear but dry
Lungs: decreased BS on left base; crackles half-way up
throughout; no wheezes
Cardio: RRR, no m.r.g. appreciated
Abd: +BS, soft, ND
Extremities: no edema, WWP
Skin: no rashes, no petechiae
Neuro: sedated; 2+ reflexes throughout

On discharge:
VS: T 97.0, BP 102/40, HR 97, RR 22, 94% on [**Last Name (un) **] air.
    Tm 97.6, 102-138/40-58, 97-117, 18-22
General: NAD
HEENT: OP clear
Lungs: decreased BS on bilateral bases; no wheezes, poor air
movement in bilateral upper fields, but improved from yesterday.
Cardio: regular, S1/S2, no murmurs, rubs or gallops appreciated.
Abd: +BS, soft, ND
Extremities: no edema, WWP
Skin: no rashes, no petechiae
Neuro: A&Ox3, normal strength, no tremor. +ve for right foot
drop.

Pertinent Results:
ADMISSION LABS:
[**2141-1-29**] 12:08AM BLOOD WBC-8.0 RBC-3.19* Hgb-10.7* Hct-29.0*
MCV-91 MCH-33.6* MCHC-36.9* RDW-16.5* Plt Ct-160
[**2141-1-29**] 12:08AM BLOOD Neuts-73.8* Lymphs-16.1* Monos-9.4
Eos-0.3 Baso-0.4
[**2141-1-29**] 12:08AM BLOOD PT-13.7* PTT-35.2* INR(PT)-1.2*
[**2141-1-29**] 12:08AM BLOOD Glucose-92 UreaN-28* Creat-1.3* Na-129*
K-4.3 Cl-89* HCO3-38* AnGap-6*
[**2141-1-29**] 12:08AM BLOOD Calcium-9.3 Phos-3.3 Mg-1.7

MICROBIOLOGY:
[**2141-1-29**] Urine culture: negative
[**2141-1-29**] Blood culture, two sets: NGTD
[**2141-1-29**] Sputum culture:
GRAM STAIN:
      >25 PMNs and <10 epithelial cells/100X field.
      2+   (1-5 per 1000X FIELD):   GRAM POSITIVE COCCI.
                                    IN PAIRS AND CLUSTERS.
RESPIRATORY CULTURE:
                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             PSEUDOMONAS AERUGINOSA
                             |          ENTEROBACTER CLOACAE
                             |          |
CEFEPIME--------------     8 S      <=1 S
CEFTAZIDIME-----------     4 S       16 I
CEFTRIAXONE-----------               16 I
CIPROFLOXACIN---------   =>4 R      =>4 R
GENTAMICIN------------     4 S      <=1 S
MEROPENEM-------------     8 I   <=0.25 S
PIPERACILLIN----------     8 S       64 I
PIPERACILLIN/TAZO-----     8 S
TOBRAMYCIN------------   <=1 S      <=1 S
TRIMETHOPRIM/SULFA----              <=1 S

RADIOLOGY:
OSH Radiology Reports:
[**2141-1-28**] Admission CXR: ? loculated effusions b/l L > R, decreased
lung volumes on left
[**2141-1-27**] CXR report from OSH: interval decrease in LLL
consolidation compared to [**Date range (1) 81974**]; reportedly new right
pleural effusion
[**2141-1-27**] Head CT: negative for IC bleed and mass effect

[**2141-1-28**] [**Hospital1 18**] AMDISSION CXR:
Flattening of both diaphragms is present consistent with COPD.
Blunting of the right costophrenic angle is present. In the
absence of prior films, it is not known whether this is chronic
or acute. If acute the degree of failure should be suspected.
Old rib fractures are noted.
IMPRESSION: COPD, right effusion.

[**2141-1-31**] FOLLOW-UP CXR:
In comparison with the study of [**1-30**], there is more sharp
appearance of the left hemidiaphragm, though there is still
residual left basilar atelectasis. No evidence of shift of the
mediastinum to the left at this time. The degree of right
effusion has apparently decreased, though some of this could
relate to the more upright position of the patient on this
image.  No evidence of acute focal pneumonia.

Video swallow [**2141-2-1**]:
Trace penetration was noted to occur during the swallow nectar
thick liquids and cleared independently. The penetration was
noted to occur consistently during the swallow on thin liquids
and did not clear, increasing the risk of trace aspiration after
the swallow. One episode of overt aspiration was noted to occur
during the swallow on thin liquids. Cough was ineffective in
clearing aspirated material.

[**2141-2-7**]: Torso CT: IMPRESSION:
1. Trace pleural effusions, right lung atelectasis and left
lower lobe
collapse. Although no mass is identified, given the calcified
pleural plaques (implying asbestos exposure), differential
consideration for the etiology of collapse must include a
bronchogenic carcinoma. Further evaluation with bronchoscopy is
recommended.
2. Scattered, sub-5-mm pulmonary nodules as detailed above,
recommend follow- up in 6-12months with cross-sectional imaging.

3. Subcentimeter hypoattenuating pancreatic tail lesion,
differential
includes side- branch IPMN and recommend attention to this area
on subsequent imaging.

[**2141-2-7**]: MRI Head: IMPRESSION: Normal brain MRI.

[**2141-2-8**]: TTE:
IMPRESSION: Bicuspid aortic valve with minimal aortic stenosis.
Normal regional and globa biventricular systolic function.
Dilated aortic root. Biatrial enlargement.

[**2-8**]: Carotid U/S: IMPRESSION: There is less than 40% stenosis
within the right internal carotid artery.
There is 60 to 69% stenosis within the left internal carotid
artery.

[**2141-2-9**]: EMG:
IMPRESSION:
Abnormal study. The electrophysiologic findings are highly
suggestive of
a disorder of motor neurons or their axons; however, multilevel
radicular
abnormalities or meningeal infiltrative/inflammatory process
might produce a similar electrophysiologic picture. Clinical
correlation is required.

Spine MRI [**2-11**]: CONCLUSION: Degenerative disc disease as
discussed above. No evidence of spinal cord or cauda equina
compression.

CXR [**2-16**] Tracheostomy tube is in standard position. Improving
bibasilar
atelectasis and persistent pleural effusions. Otherwise, no
change from
recent study.

Discharge Labs:
COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct
[**2141-2-17**] 03:26AM    7.0 2.64* 8.7* 24.8* 94 32.8* 35.0 17.3*
166

RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap
[**2141-2-17**] 03:26AM    145* 17 0.9 138 3.8 99 37* 6*
Calcium Phos Mg
8.8 2.6* 1.8


Brief Hospital Course:
MIXED RESPIRATORY FAILURE:
Mr. [**Known lastname 81970**] was admitted with respiratory failure, worse
ventillatory than hypoxic, thought to be due to an
aspiration/hospital-acquired pneumonia.  His hypoxia rapidly
corrected with significant improvement in lung volumes
(recruitment) on CXR.  His ventillatory failure was gradually
improved with bronchodilators and antibiotics, and he was
extubated without complication on [**2141-1-31**].  He was initially
started on vancomycin and zosyn on admission on [**2141-1-28**];
vancomycin was discontinued on [**2141-1-31**] when sputum cultures
returned pseudomonas. Speciation return Enterococcus and
Pseudomonas on [**2141-2-1**] and the patient was started on Cefepime to
finish on [**2141-2-7**].

There was concern that neuromuscular weakness may be
contributing to his poor respiratory status, though it was
unclear whether this was a primary problem or secondary to
deconditioning from being on the ventillatory (he was also on a
vent for two weeks earlier in [**1-2**] at [**Hospital3 2783**] with
aspiration PNA; he had difficulty weaning at the time).  At
[**Hospital1 18**], negative inspiratory forces were recorded at -11, -20 and
-23 on [**11-22**] prior to extubation.

Of note, the patient has a history of pancytopenia and was noted
to have a relative leukocytosis of 8.0 on admission.  WBC had
decreased to 2.8 upon discharge.

After discussion with the family, the patient underwent a
trach/PEG placement without complications.  On the second day
post operatively, the patient developed repeated desaturations
while on the vent to the mid 80s, but was asymptomatic.  A
bronchoscopy revealed multiple mucus plugs which were extracted.
However, overnight the patient spiked a fever to 101.  The
patient's cultures became positive for pseudomonas, which was
sensitive to ceftazidime which was started on [**2-16**] to be
continued until [**2141-3-2**].  (Of note, the patient's previous
pneumonia was pseudomonas treated with cefepime).  Please call
[**Telephone/Fax (1) 2756**] to follow up microbiology sensitivites on the
sputum cultures.

HYPERTENSION:
Mr. [**Name14 (STitle) 81975**] has baseline hypertension on home doses of
amlodipine and lisinopril.  Blood pressures were initially in
the 140's systolic on admission, but climbed after he was
extubated.  Prior to speech and swallow evaluation, he was
maintained on IV metoprolol and hydralazine.  He was later
changed to his prior medciation amlodipine when he was cleared
to take PO's. His Linisopril was not resumed as his blood
pressure was well controlled on Amlodipine.

LETHARGY:
Mr. [**Known lastname 81970**] initially presented to [**Hospital3 **] for
lethargy.  His pramipexole for Parkinson's Disease had been held
by the OSH for concern that medication side effects could be
contributing; head CT and EtOH level were negative.  It is
likely his ventillatory resp failure upon admission to the OSH
was also contributing to his somnolence.  While at [**Hospital1 18**], he did
not have problems with somnolence once off sedation for the
ventillator.  Pramipexole remained held.

WEAKNESS:
Mr. [**Known lastname 81970**] was recently diagnosed 3-4 months ago with
Parkinson's Disease. Neurology evaluation here showed dementia
and right foot drop. He was felt to likely have what have
arteriosclerotic disease which is chronic small vessel changes
in the brain with white matter abnormalities and lacunes.  While
the patient was on the floor, he had acute respiratory distress
and hypercapnia in the CT scanner while evaluating for possible
stroke.  The patient was intubated and transferred to the ICU,
and doing well when he was weaned from the vent.  He tolerated
approximately 6 hours extubated before needing to be reintubated
for work of breathing.  Of note, the patient's NIFs were ranging
from -8 to -13 on minimal vent settings.  Patient was further
evaluated by the Neuromuscular service where an EMG was
performed, indicating the patient has the diagnosis of ALS.   A
spinal MRI was obtained revealing no evidence of cord
compression or cauda equina that could be causing his weakness.


WEIGHT LOSS:
He has had a 30 pound weight loss in the last 3-4 months.  It is
unclear whether this has been secondary to behavioral/PD-related
problems or malignancy, a more likely possibility is ALS as
discussed above.

HISTORY OF BPH:
He had as foley on admission and was continued on his home
tamsulosin dose once he was taking PO's, restarted on discharge

PENDING ISSUES FOR FOLLOW-UP:
Follow up Pseudomonas cultures/sensitivities


Medications on Admission:
MEDICATIONS on transfer:
Combivent inhalers
Omeprazole
Pramipexole-- on list, though reportedly held due to delta MS
[**First Name (Titles) 61368**] [**Last Name (Titles) **]
Terazosin 10 mg QHS
Lisinopril 20 mg QD
Amlodipine 5 mg QD
Enoxaparin 40 mg SQD
Acetaminophen 650 mg PO Q4 hours PRN

MEDICATIONS at home (doses not listed):
Flomax
Lisiopril
Amlodipine
Omeprazole
Mirapex


Discharge Medications:
1. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
2. Heparin Flush (10 units/ml) 2 mL IV PRN line flush
PICC, heparin dependent: Flush with 10mL Normal Saline followed
by Heparin as above daily and PRN per lumen.
3. Saline Flush 0.9 % Syringe Sig: One (1)  Injection Q8H:PRN:
Peripheral line: Flush with 3 mL Normal Saline every 8 hours and
PRN.  .
4. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
5. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
6. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
7. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
Six (6) Puff Inhalation Q4H (every 4 hours) as needed for
wheezing.
8. Ipratropium Bromide 17 mcg/Actuation Aerosol Sig: Six (6)
Puff Inhalation QID (4 times a day).
9. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

10. Ceftazidime 2 gram Recon Soln Sig: One (1) Recon Soln
Injection Q8H (every 8 hours) for 14 days: Until [**2141-3-2**].
11. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
12. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
13. Heparin Flush (10 units/ml) 2 mL IV PRN line flush
PICC, heparin dependent: Flush with 10mL Normal Saline followed
by Heparin as above daily and PRN per lumen.
14. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q4H (every 4 hours) as
needed.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 105**] - [**Location (un) 1121**] - [**Location (un) 1456**]

Discharge Diagnosis:
Primary Diagnoses:
- Amylotrophic Lateral Sclerosis
- Ventilator Associated Pneumonia-pseudomonas

Secondary:
-Hypertension


Discharge Condition:
Stable, afebrile, A&Ox3 (baseline). Patient with known right
foot drop and dementia NOS (at baseline), tracheostomy &
percutaneous gastric tube in place.


Discharge Instructions:
You were admitted to [**Hospital1 18**] for evaluation of shortness of
breath.  You were found to have an infection in your airways
which required IV antibiotics.  A breathing tube was placed
because you were unable to breath on your own.  Because you were
having such difficulty coming off the breathing tube, a
Neurological evaluation was completed.  The Neurologists
determined that you most likely have Amylotrophic Lateral
Sclerosis, or ALS.  It was necessary to undergo a procedure to
place a permanent breathing tube in your neck, a tracheostomy,
to help you breath.  You also had a feeding tube placed to
undergo tube feeds.  You have been given a PICC line (central IV
line) for continuation of IV antibiotics.

While you were here, you were seen by Neurology who felt that
you did not display signs of Parkinson's and more likely carry
the diagnosis of ALS.  This diagnosis was made by MRI's of your
spine and head, and an EMG of the muscles of your chest.  Thus,
your Parkinson's medication Mirapex was discontinued. You were
started on the medication Aggrenox which can help to prevent
strokes.  You will follow up with the Neuromuscular specialist,
Dr. [**Last Name (STitle) **], in approximately one month.  Her office will contact
you to set up the appointment.  If you do not hear from them,
the phone number is ([**Telephone/Fax (1) 81976**].

Your Mirapex was discontinued. Your Lisinopril was discontinued.
You were started on Aggrenox (1 capsule twice a day). You are
also being given Ceftazidime IV (2g every 8hours) for an
additional 14 days.

Please return to the hospital or call your doctor if you have
temperature greater than 101, shortness of breath, worsening
difficulty with swallowing, chest pain, abdominal pain,
diarrhea, or any other symptoms that you are concerned about.

Followup Instructions:
Please see your PCP, [**First Name8 (NamePattern2) 1399**] [**Last Name (NamePattern1) 1313**], as needed.

Please follow up with Dr. [**Last Name (STitle) **] in the next month.  You will be
contact[**Name (NI) **] for the appointment date.

Please follow up in neuromuscular clinic in 1 month by calling
[**Telephone/Fax (1) 81977**] to schedule an appointment
{'Pneumonitis due to inhalation of food or vomitus,Ventilator associated pneumonia,Amyotrophic lateral sclerosis,Acute kidney failure, unspecified,Alkalosis,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Unspecified essential hypertension,Acute respiratory 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: The patient is an outside hospital transfer for mixed
respiratory failure, neurology work-up. He was initially
admitted to OSH for lethargy.

PRESENT ILLNESS: Mr. [**Known lastname 81970**] is a 77yoM with recent h/o hypercarbic respiratory
failure [**2-27**] asp PNA who presented on [**2141-1-27**] to [**Hospital1 5109**] for lethargy ([**Hospital1 2436**] ICU [**Telephone/Fax (1) 81971**]).  He was
transferred for further management and work-up of his
respiratory status.

MEDICAL HISTORY: #) Recent hypercarbic resp failure since [**2140-12-20**]
-- admitted in [**12-3**] with aspiration PNA; c/b parapneumonic
effusion
-- was discharged to rehab after hospitalization on BiPAP at
night with 2LNC during the day
#) Parksinson's Disease
-- diagnosed 3-4 months ago based on rigidity and withdrawal
from ADL's, as well as 30 lb weight loss
-- did not tolerate Sinemet (started in late [**Month (only) 359**] or early
[**Month (only) **]; had hallucinations) or Requip (somnolence); was
recently started on Mirapex.
-- Neurologist is Dr. [**Last Name (STitle) 81972**]
#) H/O papillary cell transitional cell bladder CA, [**2134**]
#) s/p TURP, ? BPH
#) HTN
#) Hyperlipidemia
#) IgA gammopathy-- per OSH H&P, first "noticed" in [**9-/2140**]
#) Pancytopenia-- per OSH H&P, first "noticed" in [**9-/2140**]
#) ? h/o chronic dysphagia-- supposedly prior to PD dx
-- had S&S eval prior to d/c on [**2140-12-30**]; no evidence of
aspiration on the study
#) ? iron overload
#) Erosive gastritis [**9-/2140**]
#) ? Asbestiosis-- calcifications c/w per recent chest CT's

MEDICATION ON ADMISSION: MEDICATIONS on transfer:
Combivent inhalers
Omeprazole
Pramipexole-- on list, though reportedly held due to delta MS
[**First Name (Titles) 61368**] [**Last Name (Titles) **]
Terazosin 10 mg QHS
Lisinopril 20 mg QD
Amlodipine 5 mg QD
Enoxaparin 40 mg SQD
Acetaminophen 650 mg PO Q4 hours PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS on arrival to the ICU: T 99.0; 121/46 (cuff), 141/46 (left
alin), HR 57;
vent settings AC, 450/14, 100/PEEP 8
General: intubated, sedated; elderly; had OG tube
HEENT: OP clear but dry
Lungs: decreased BS on left base; crackles half-way up
throughout; no wheezes
Cardio: RRR, no m.r.g. appreciated
Abd: +BS, soft, ND
Extremities: no edema, WWP
Skin: no rashes, no petechiae
Neuro: sedated; 2+ reflexes throughout

FAMILY HISTORY: Unknown.

SOCIAL HISTORY: -- girlfriend [**Name (NI) 81973**] has been with him for 25+ years
-- originally from [**Country 4754**], moved here in the [**2082**]'s
-- used to play professional soccer for [**Country 4754**]
-- an ex-smoker; unclear how much and when he quit
-- denied EtOH 

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Ventilator associated pneumonia,Amyotrophic lateral sclerosis,Acute kidney failure, unspecified,Alkalosis,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Unspecified essential hypertension,Acute respiratory failure'}
