CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 63 year-old female
with a history of Prednisone dependent sarcoid, cirrhosis,
ascites with SBP who presented with one day of nausea,
vomiting, diarrhea and change in mental status.  She was
discharged to nursing home on [**2145-6-28**] after admission
for back pain.  She has had multiple admissions including
three day admissions for compression fracture of the spine,
which was complicated by pneumonia and ascites with a 7 liter
tap.  She also had azotemia and hypophosphatemia as well as
urinary tract infection, right tibia fibula fracture and that
admission date was from [**5-22**] until [**6-11**].  The patient
was doing well at nursing home, eating well and comfortable
one night prior to admission when this morning had nausea,
vomiting and diarrhea, initially presented to [**Hospital3 1442**] and was transferred to [**Hospital1 188**].  She received enema twice yesterday and had diarrhea
since then.  In the Emergency Department her vital status was
heart rate 120, blood pressure 100/68, respirations 18, and
then she became hypotensive.  Her blood pressure dropped down
to the 80s.  Her regular blood pressure ranging between 90s
to 110.  She was given Phenergan and her abdominal x-ray was
concerning for obstruction.  We recommended to have an
abdominal CT, but the patient did not tolerate NG tube
placement.  Her blood culture was sent and we also gave her 1
liter of normal saline.  She was seen by surgery who
recommended broad spectrum antibiotics.  CT scan was later
done without any contrast.

MEDICAL HISTORY: Cirrhosis, sarcoid, osteoporosis,
hyperlipidemia, hypertension, portal hypertension,
thrombocytopenia, esophageal varices and aortic stenosis.

MEDICATION ON ADMISSION: 

ALLERGIES: She has multiple allergies including Penicillin,
Oxacillin, Percocet, Keflex, intravenous iodine, Oxycontin,
Flagyl, and Codeine.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is divorced with many children.
She currently lives with children prior to being at
rehabilitation.  She denies tobacco and alcohol.
Acute vascular insufficiency of intestine,Infection and inflammatory reaction due to indwelling urinary catheter,Urinary tract infection, site not specified,Other shock without mention of trauma,Cirrhosis of liver without mention of alcohol,Sarcoidosis,Aortic valve disorders
Ac vasc insuff intestine,React-indwell urin cath,Urin tract infection NOS,Shock w/o trauma NEC,Cirrhosis of liver NOS,Sarcoidosis,Aortic valve disorder
Admission Date:  [**2145-7-1**]     Discharge Date:  [**2145-7-7**]

Date of Birth:   [**2082-1-26**]     Sex:  F

Service:  MICU/GREEN

HISTORY OF PRESENT ILLNESS:  This is a 63 year-old female
with a history of Prednisone dependent sarcoid, cirrhosis,
ascites with SBP who presented with one day of nausea,
vomiting, diarrhea and change in mental status.  She was
discharged to nursing home on [**2145-6-28**] after admission
for back pain.  She has had multiple admissions including
three day admissions for compression fracture of the spine,
which was complicated by pneumonia and ascites with a 7 liter
tap.  She also had azotemia and hypophosphatemia as well as
urinary tract infection, right tibia fibula fracture and that
admission date was from [**5-22**] until [**6-11**].  The patient
was doing well at nursing home, eating well and comfortable
one night prior to admission when this morning had nausea,
vomiting and diarrhea, initially presented to [**Hospital3 1442**] and was transferred to [**Hospital1 188**].  She received enema twice yesterday and had diarrhea
since then.  In the Emergency Department her vital status was
heart rate 120, blood pressure 100/68, respirations 18, and
then she became hypotensive.  Her blood pressure dropped down
to the 80s.  Her regular blood pressure ranging between 90s
to 110.  She was given Phenergan and her abdominal x-ray was
concerning for obstruction.  We recommended to have an
abdominal CT, but the patient did not tolerate NG tube
placement.  Her blood culture was sent and we also gave her 1
liter of normal saline.  She was seen by surgery who
recommended broad spectrum antibiotics.  CT scan was later
done without any contrast.

PAST MEDICAL HISTORY:  Cirrhosis, sarcoid, osteoporosis,
hyperlipidemia, hypertension, portal hypertension,
thrombocytopenia, esophageal varices and aortic stenosis.

PAST SURGICAL HISTORY:  Total abdominal hysterectomy, total
right hip placement.

ALLERGIES:  She has multiple allergies including Penicillin,
Oxacillin, Percocet, Keflex, intravenous iodine, Oxycontin,
Flagyl, and Codeine.

SOCIAL HISTORY:  The patient is divorced with many children.
She currently lives with children prior to being at
rehabilitation.  She denies tobacco and alcohol.

LABORATORY:  Ascites fluid white blood cell is [**Pager number 14569**], red
blood cell equal to 7700, poly 95%, band 1%.  Urinalysis
large amount of blood, positive nitrites, moderate
leukocytes, few bacteria.  CT of the abdomen with intravenous
contrast, there is extensive ascites with severely shrunken
nodular cirrhotic liver.  The pancrease is atrophic.  There
is a diffused wall thickening of the colon as well as several
loops of small bowel.  This is not evident on the previous
examination.  Extensive vascular calcifications are again
noted, however, in the interval there has been development of
extensive clot within the SMV.  No free air or pneumoptosis
is identified.

HOSPITAL COURSE:  1.  SMV/thrombosis:  CT of the abdomen on
[**Month (only) 205**] the 4th, showed diffuse thickening of loops of large and
small bowel in the setting of extensive clots within SMV.
These findings are concerning for venous ischemia.  Also
showing clots within the protal venous confluents as previous
CT scan [**2145-3-30**].  Heparin was started.  Repeated abdominal
CT on [**2145-7-3**] shows no growth change in the clots within
the SMV and portal venous confluence.  Heparin therapy
continues.

2.  Respiratory:  The patient's respiratory deteriorated
since admission, became progressively labored and tachypneic.
Chest x-ray shows lung volumes are extremely low due to
massive ascites pushing up on diaphragm.  CT showed
atelectasis at the lung bases.  On [**7-3**] the patient's
respiratory status worsened with mental status change.
Arterial blood gas showed 7.09/68/78.  The patient's proxy
did not wish to intubate the patient.  Therapeutic
paracentesis was done to remove 6 liters of fluid.  The
patient received three bags of albumin, however, still
developed hypotensive episodes and became unresponsive
afterwards.

3.  Cirrhosis:  The patient had end stage renal disease with
cirrhosis and massive ascites.  The patient received albumin
75 grams on [**2145-7-2**] and another 50 grams on [**2145-7-4**].  (per liver consult suggestion to decrease motility in
people with ascites).

4.  Infectious disease:  Paracentesis on [**7-2**] showed white
blood cell of more then 5000 and gram negative rods, which
was later identified to be Pseudomonal and urinalysis was
consistent with urinary tract infection.  The patient was
initially put on Vancomycin and Cipro, but later changed to
Flagyl and Aztreonam per ID consult suggestion.

5.  Code:  The patient was initially on full code, however,
on [**7-5**] after taping the patient had a discussion with the
patient's proxy and family members and decision was made to
keep the patient on comfort measures only.  O line was
discontinued and medications stopped except for morphine
drips to keep the patient pain free.  The patient expired on
the evening of [**2145-7-7**] at 7:30 p.m.






                          [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 4561**]

Dictated By:[**Doctor Last Name 14570**]

MEDQUIST36

D:  [**2145-7-9**]  05:17
T:  [**2145-7-14**]  08:55
JOB#:  [**Job Number 14571**]
{'Acute vascular insufficiency of intestine,Infection and inflammatory reaction due to indwelling urinary catheter,Urinary tract infection, site not specified,Other shock without mention of trauma,Cirrhosis of liver without mention of alcohol,Sarcoidosis,Aortic valve disorders'}


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 63 year-old female
with a history of Prednisone dependent sarcoid, cirrhosis,
ascites with SBP who presented with one day of nausea,
vomiting, diarrhea and change in mental status.  She was
discharged to nursing home on [**2145-6-28**] after admission
for back pain.  She has had multiple admissions including
three day admissions for compression fracture of the spine,
which was complicated by pneumonia and ascites with a 7 liter
tap.  She also had azotemia and hypophosphatemia as well as
urinary tract infection, right tibia fibula fracture and that
admission date was from [**5-22**] until [**6-11**].  The patient
was doing well at nursing home, eating well and comfortable
one night prior to admission when this morning had nausea,
vomiting and diarrhea, initially presented to [**Hospital3 1442**] and was transferred to [**Hospital1 188**].  She received enema twice yesterday and had diarrhea
since then.  In the Emergency Department her vital status was
heart rate 120, blood pressure 100/68, respirations 18, and
then she became hypotensive.  Her blood pressure dropped down
to the 80s.  Her regular blood pressure ranging between 90s
to 110.  She was given Phenergan and her abdominal x-ray was
concerning for obstruction.  We recommended to have an
abdominal CT, but the patient did not tolerate NG tube
placement.  Her blood culture was sent and we also gave her 1
liter of normal saline.  She was seen by surgery who
recommended broad spectrum antibiotics.  CT scan was later
done without any contrast.

MEDICAL HISTORY: Cirrhosis, sarcoid, osteoporosis,
hyperlipidemia, hypertension, portal hypertension,
thrombocytopenia, esophageal varices and aortic stenosis.

MEDICATION ON ADMISSION: 

ALLERGIES: She has multiple allergies including Penicillin,
Oxacillin, Percocet, Keflex, intravenous iodine, Oxycontin,
Flagyl, and Codeine.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is divorced with many children.
She currently lives with children prior to being at
rehabilitation.  She denies tobacco and alcohol. 

### Response:
{'Acute vascular insufficiency of intestine,Infection and inflammatory reaction due to indwelling urinary catheter,Urinary tract infection, site not specified,Other shock without mention of trauma,Cirrhosis of liver without mention of alcohol,Sarcoidosis,Aortic valve disorders'}
