CHIEF COMPLAINT: Transferred from outside hospital for
respiratory distress.

PRESENT ILLNESS: Mr. [**Known lastname 29390**] is a 46-year-old male
with multiple medical problems status post living related
renal transplant at [**Hospital1 69**] in
[**2098**] who presented to an outside hospital with increased
respiratory distress.  The patient was intubated there and
bronched at the outside hospital.  He was initially admitted
on [**5-7**] with shortness of breath and possible pneumonia.
The patient had increasing respiratory distress necessitating
intubation, and was then transferred to [**Hospital1 190**] for further treatment on [**2106-5-10**].

MEDICAL HISTORY: 1. Insulin dependent-diabetes mellitus.
2. Neuropathy.
3. Nephropathy.
4. Lower extremity ulcers.
5. Status post multiple right sided amputations.
6. Coronary artery disease.
7. Gastroparesis.
8. Hepatitis C positive.
9. Depression.
10. Peripheral vascular disease.
11. History of pneumonia.
12. Status post fall with fractures in [**2106-4-22**].
13. DVT of left arm.
14. PICC line infection MRSA.
15. Status post renal transplant in [**2098**] at [**Hospital1 346**].
16. Status post right multiple amputations of toes.
17. Status post left below the knee amputation.

MEDICATION ON ADMISSION: 

ALLERGIES: Erythromycin.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Candidiasis of lung,Acidosis,Kidney replaced by transplant,Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Acute respiratory failure,Chronic airway obstruction, not elsewhere classified,Chronic hepatitis C without mention of hepatic coma,Polyneuropathy in diabetes
Candidiasis of lung,Acidosis,Kidney transplant status,DMI neuro nt st uncntrld,Acute respiratry failure,Chr airway obstruct NEC,Chrnc hpt C wo hpat coma,Neuropathy in diabetes
Admission Date:  [**2106-5-10**]       Discharge Date:  [**2106-5-22**]

Date of Birth:   [**2060-4-24**]       Sex:  M

Service:  Transplant Surgery

CHIEF COMPLAINT:  Transferred from outside hospital for
respiratory distress.

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 29390**] is a 46-year-old male
with multiple medical problems status post living related
renal transplant at [**Hospital1 69**] in
[**2098**] who presented to an outside hospital with increased
respiratory distress.  The patient was intubated there and
bronched at the outside hospital.  He was initially admitted
on [**5-7**] with shortness of breath and possible pneumonia.
The patient had increasing respiratory distress necessitating
intubation, and was then transferred to [**Hospital1 190**] for further treatment on [**2106-5-10**].

PAST MEDICAL HISTORY:
1. Insulin dependent-diabetes mellitus.
2. Neuropathy.
3. Nephropathy.
4. Lower extremity ulcers.
5. Status post multiple right sided amputations.
6. Coronary artery disease.
7. Gastroparesis.
8. Hepatitis C positive.
9. Depression.
10. Peripheral vascular disease.
11. History of pneumonia.
12. Status post fall with fractures in [**2106-4-22**].
13. DVT of left arm.
14. PICC line infection MRSA.
15. Status post renal transplant in [**2098**] at [**Hospital1 346**].
16. Status post right multiple amputations of toes.
17. Status post left below the knee amputation.

MEDICATIONS ON ADMISSION FROM OUTSIDE HOSPITAL:
1. Zosyn 2.25 mg IV tid.
2. Diflucan 100 mg IV q day.
3. Solu-Medrol 80 mg IV q8.
4. Coreg 3.125 mg po bid.
5. Flomax 0.4 mg po q day.
6. Folic acid 4 mg po bid.
7. Albuterol nebulizers.
8. Lipitor 40 mg po q day.
9. Reglan 5 mg po qid.
10. Nepro tube feeds.
11. Neurontin 600 mg po bid.
12. Norvasc 10 mg q am and 5 mg q pm.
13. Zoloft 300 mg po q day.
14. Protonix 40 mg po q day.
15. Tequin 1200 mg IV q day.
16. Bactrim ......... mg IV q day.
17. Sandimmune 50 mg po bid.
18. Prednisone 15 mg po q day.
19. Regular insulin-sliding scale.

ALLERGIES:  Erythromycin.

INITIAL PHYSICAL EXAMINATION:  Temperature 99.4, blood
pressure 89/50, heart rate 63, respirations 18, and 97% on
room air.  Patient is intubated and sedated.  He had regular,
rate, and rhythm, coarse sounds bilaterally.  Increased
coarseness on the left upper lobe.  His abdomen is distended.
He has a nasogastric tube in place which is not connected
currently.  No tenderness.  Extremities:  No edema or
swelling.

INITIAL IMAGING:  Chest x-ray shows diffuse patchy opacity
throughout most likely ARDS.

[**Hospital 1749**] HOSPITAL COURSE:  On [**2106-5-10**], the patient was
accepted on transfer from the outside hospital, and
transferred to the Intensive Care Unit.  The patient was
intubated and sedated.  A nasogastric tube was placed for
decompression and Foley for following urine output.  The
patient was found to be coagulopathic on initial laboratories
with an INR of 4.4.

The patient was also found to be in metabolic acidosis, as
well as hyponatremic.  The patient was started on
levofloxacin, fluconazole, and Bactrim, and ID consult was
obtained.

The ID consult team followed the patient throughout his
hospital stay.  They monitored his antibiotics, and he was
started initially on ceftriaxone and azithromycin, and this
was soon changed to levofloxacin and azithromycin which the
patient was on for the remainder of his stay.

A Pulmonary Medicine consult was obtained, and a
bronchoalveolar lavage was performed on hospital day one.
The patient tolerated this procedure well, and this would
soon grow out [**Female First Name (un) 564**] glabrata, showing that the patient had
fungal pneumonia causing acute respiratory distress syndrome.

The patient remained in the unit and intubated for the next
few days.  His antibiotics were tailored to the
bronchoalveolar lavage results.  His coagulopathy was
corrected as was his hyponatremia.  His blood pressure and
respiratory status were managed closely in the Intensive Care
Unit.

Over the next few days, the patient slowly improved.  His
antibiotics changed from Vancomycin to AmBisome to finally
levofloxacin with azithromycin.  The patient ..........
pressors for some time within the Intensive Care Unit,
however, he slowly improved over the next few days.  The
patient's severe respiratory distress, ARDS, improved while
the patient was in the Intensive Care Unit.

The patient improved to the point of extubation on [**5-12**].
After which the patient quickly improved and was able to be
transferred to the floor by [**5-18**].  On the floor, the
patient did well.  He was ambulating in his wheelchair on his
own.  He was tolerating regular diet, and was placed back on
all of his home medications.  He was switched to po
antibiotics, which he would complete his course of three
weeks, and was targeted for a course to [**2106-5-31**].  The
patient was ready for discharge to an extended rehab facility
secondary to the patient's decondition from his prolonged
Intensive Care Unit stay, as well as severe
pneumonia/respiratory distress.

Also of note, the patient's cyclosporin level was closely
monitored by the Transplant team throughout his stay.  He was
kept on his regular dose of Sandimmune cyclosporin 50 mg po
bid, and his prednisone level was decreased to 10 mg po q
day.

CONDITION ON DISCHARGE:  Patient is stable, mobile in his
wheelchair, tolerating a regular diet, as well as po
antibiotics.  Stabilized on his immunosuppression
medications.

DISCHARGE STATUS:  To extended rehab facility.

DISCHARGE DIAGNOSES:
1. Fungal, [**Female First Name (un) 564**] pneumonia.
2. Respiratory failure/ARDS.
3. Metabolic acidosis.
4. Status post bronchoalveolar lavage.
5. Insulin dependent-diabetes mellitus.
6. Peripheral vascular disease.
7. History of kidney transplant.
8. Coronary artery disease.
9. Depression.
10. Deep venous thrombosis of left arm.

DISCHARGE MEDICATIONS:
1. Prednisone 10 mg po q day.
2. Sandimmune 50 mg po bid.
3. Levofloxacin 500 mg po q day until [**5-31**].
4. Azithromycin 250 mg po q day until [**5-31**].
5. Fluconazole 400 mg po q day.
6. Bactrim single strength one tablet po q day.
7. Carvedilol 3.125 mg po bid.
8. Prevacid 30 mg po q day.
9. Dorzolamide drops two to each eye for glaucoma.
10. Reglan 5 mg po qid.
11. Sertraline 300 mg po q day.
12. Norvasc 10 mg po q am, 5 mg po q pm.
13. Flomax 0.4 mg po q day.
14. Lipitor 40 mg po q day.
15. Folic acid 2 mg po bid.
16. Neurontin 600 mg po bid.
17. Provigil 200 mg po q day.
18. Miconazole powder topical prn.
19. NPH insulin 20 units q am, 20 units q pm with regular
insulin-sliding scale.

FOLLOW-UP PLANS:
1. The patient was instructed to followup with Dr. [**Last Name (STitle) **] in
the Transplant Center, and to call the office for an
appointment.
2. The patient was to be discharged to an extended rehab
facility for continued rehabilitation.




                            [**Name6 (MD) 1344**] [**Name8 (MD) 1345**], M.D.  [**MD Number(1) 1346**]

Dictated By:[**Name8 (MD) 1750**]
MEDQUIST36

D:  [**2106-5-21**]  03:40
T:  [**2106-5-21**]  06:31
JOB#:  [**Job Number 29391**]


Admission Date:  [**2106-5-10**]       Discharge Date:  [**2106-5-21**]

Date of Birth:   [**2060-4-24**]       Sex:  M

Service:

ADDENDUM:  Of note, the patient will not be going out on
Fluconazole.  This was stopped on the day of discharge and
the patient had no evidence of fungal pneumonia and there was
no requirement for fungal prophylaxis as the patient was
years out from his prior transplant.  Additionally, the
patient will resume Coumadin at 10 mg p.o. q.d. with daily
INR values to be checked.  He should have daily cyclosporin
levels measured now that he is off fluconazole which is a
P450 interaction medication; therefore, his Sandimmune level
will likely fluctuate and this can be coordinated with the
Transplant Center at [**Telephone/Fax (1) 673**] by speaking one of the
transplant nephrology fellows or with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], or
with Dr. .................... of the Transplant Surgical
Service.

This information was conveyed directly to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 29444**]
at St. [**Hospital 11042**] Hospital in [**Location (un) 8117**], [**Location (un) 3844**] who will be
the receiving physician for this patient for the remainder of
his care.






Dictated By:[**Last Name (NamePattern4) 3204**]
MEDQUIST36

D:  [**2106-5-21**]  01:38
T:  [**2106-5-21**]  20:18
JOB#:  [**Job Number 29445**]
{'Candidiasis of lung,Acidosis,Kidney replaced by transplant,Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Acute respiratory failure,Chronic airway obstruction, not elsewhere classified,Chronic hepatitis C without mention of hepatic coma,Polyneuropathy in diabetes'}


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: Transferred from outside hospital for
respiratory distress.

PRESENT ILLNESS: Mr. [**Known lastname 29390**] is a 46-year-old male
with multiple medical problems status post living related
renal transplant at [**Hospital1 69**] in
[**2098**] who presented to an outside hospital with increased
respiratory distress.  The patient was intubated there and
bronched at the outside hospital.  He was initially admitted
on [**5-7**] with shortness of breath and possible pneumonia.
The patient had increasing respiratory distress necessitating
intubation, and was then transferred to [**Hospital1 190**] for further treatment on [**2106-5-10**].

MEDICAL HISTORY: 1. Insulin dependent-diabetes mellitus.
2. Neuropathy.
3. Nephropathy.
4. Lower extremity ulcers.
5. Status post multiple right sided amputations.
6. Coronary artery disease.
7. Gastroparesis.
8. Hepatitis C positive.
9. Depression.
10. Peripheral vascular disease.
11. History of pneumonia.
12. Status post fall with fractures in [**2106-4-22**].
13. DVT of left arm.
14. PICC line infection MRSA.
15. Status post renal transplant in [**2098**] at [**Hospital1 346**].
16. Status post right multiple amputations of toes.
17. Status post left below the knee amputation.

MEDICATION ON ADMISSION: 

ALLERGIES: Erythromycin.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Candidiasis of lung,Acidosis,Kidney replaced by transplant,Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Acute respiratory failure,Chronic airway obstruction, not elsewhere classified,Chronic hepatitis C without mention of hepatic coma,Polyneuropathy in diabetes'}
