CHIEF COMPLAINT: Hypertensive emergency.

PRESENT ILLNESS: Mrs. [**Known lastname 22473**] is a 72 yo woman with a h/o poorly controlled HTN,
CRI (recent baseline 3.5-4.2), and DM2 who presented with
hypertension and chest pain. She was recently admitted to the
medicine service from [**11-2**] - [**11-5**] for peripheral extremity
tingling and shortness of breath. During this admission, she was
ruled out for an MI, transfused 2 units PRBC for anemia, and
spironolactone was stopped secondary to hyperkalemia. Over the
past few days at home, she c/o a sore throat, cough and
congestion. She states that her husband has similar sxs. Her
cough is productive of whitish sputum. She has not had any
fevers or sweats, but c/o chills. She c/o several months of DOE
with climbing 10 steps at her home, worse when she is carrying
her laundry. At these times, she also c/o left sided CP which is
dull in nature, nonradiating, and lasts for up to one minute.
Her last episode was last night. She does not c/o PND/orthopnea.
She had increased bilateral LE edema over the past few days and
came into the ED for evaluation.
She states her appetite has been poor recently and she has lost
[**10-15**] lbs over the past few months. She c/o nausea but no
emesis. No bleeding from her stools. She c/o dysuria, no
hematuria, no decreased frequency or quantity of urine. She also
has constipation and complains of gas. She has a right inguinal
hernia which has been more bothersome lately. She does not c/o
HA, abdominal pain, or focal neurologic sxs.
In the ED, her BP was initially 210/120. She was given Lopressor
5 mg IV x 3, 25 mg po x 1, ASA 325 mg po x 1, Clonidine 0.2 mg
po x 1 and then started on a Labetolol gtt at 2 mg/min which was
subsequently increased to 4 mg/min. She was then given
Lisinopril 20 mg po x1, and Lantus 30 units. Her SBP improved to
180/80. She did not have any CP. Her WBC was found to be 15 and
she was given a dose of Levofloxacin 500 mg po x 1.

MEDICAL HISTORY: 1) Chronic renal insufficiency: followed by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 10083**]
at [**Last Name (un) **]. (Baseline over the past 3 months 3.5-4.2).
2) HTN: Prior MRA showed three left renal arteries with superior

MEDICATION ON ADMISSION: 1. Labetalol 800 mg PO TID
2. Atorvastatin 10 mg PO DAILY
3. Pantoprazole 40 mg PO once a day.
4. Ferrous Sulfate 325 PO DAILY
5. Lisinopril 20 mg PO BID
6. Valsartan 100 mg PO HS
7. Hydralazine 100 mg PO TID
8. Clonazepam 1 mg PO daily
9. Clonidine 0.9 mg let PO BID
10. Isosorbide Mononitrate 90 mg Sustained Release PO DAILY
11. Folic acid 1 mg daily
12. Procrit 10,000 unit/mL 10,000 units Injection once a week.
13. Insulin Lantus 30 units QAM
14. Lasix 30 mg PO twice a day
15. MVI 1 tablet daily
16. B12 50 mcg po daily
17. Tylenol prn arthritis
18. Sevelemer 800 mg three times daily
19. ASA 81 mg daily
20. Amlodipine 10 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE: 96.0 180/80 55 19 100%RA
GEN: A+O x 3, NAD, laying in bed, thin AA female
HEENT: PERRL, EOMI, OP clear without exudates, no LAD or
thyromegaly
CV: RRR, no m/r/g, JVD 6 cm
LUNGS: CTAB
ABD: soft, distended, NTND +BS, +left inguinal hernia that was
nontender
EXT: 1+ pitting edema bilaterally, decreased peripheral pulses
Neuro: 5/5 strength in all extremities, decreased sensation at
feet bilaterally, CN II-XII intact

FAMILY HISTORY: Father died of old age, mother had DM, HTN

SOCIAL HISTORY: Patient from Barbados, lives with husband, never used tobacco,
no EtOH.
Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Hyperpotassemia,End stage renal disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Dysthymic disorder,Esophageal reflux,Diaphragmatic hernia without mention of obstruction or gangrene,Osteoporosis, unspecified,Sickle-cell trait
Hyp kid NOS w cr kid V,Hyperpotassemia,End stage renal disease,DMII wo cmp nt st uncntr,Anemia NOS,Dysthymic disorder,Esophageal reflux,Diaphragmatic hernia,Osteoporosis NOS,Sickle-cell trait
Admission Date:  [**2157-11-18**]              Discharge Date:   [**2157-11-23**]

Date of Birth:  [**2085-6-27**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 19193**]
Chief Complaint:
Hypertensive emergency.

Major Surgical or Invasive Procedure:
None.

History of Present Illness:
Mrs. [**Known lastname 22473**] is a 72 yo woman with a h/o poorly controlled HTN,
CRI (recent baseline 3.5-4.2), and DM2 who presented with
hypertension and chest pain. She was recently admitted to the
medicine service from [**11-2**] - [**11-5**] for peripheral extremity
tingling and shortness of breath. During this admission, she was
ruled out for an MI, transfused 2 units PRBC for anemia, and
spironolactone was stopped secondary to hyperkalemia. Over the
past few days at home, she c/o a sore throat, cough and
congestion. She states that her husband has similar sxs. Her
cough is productive of whitish sputum. She has not had any
fevers or sweats, but c/o chills. She c/o several months of DOE
with climbing 10 steps at her home, worse when she is carrying
her laundry. At these times, she also c/o left sided CP which is
dull in nature, nonradiating, and lasts for up to one minute.
Her last episode was last night. She does not c/o PND/orthopnea.
She had increased bilateral LE edema over the past few days and
came into the ED for evaluation.
She states her appetite has been poor recently and she has lost
[**10-15**] lbs over the past few months. She c/o nausea but no
emesis. No bleeding from her stools. She c/o dysuria, no
hematuria, no decreased frequency or quantity of urine. She also
has constipation and complains of gas. She has a right inguinal
hernia which has been more bothersome lately. She does not c/o
HA, abdominal pain, or focal neurologic sxs.
In the ED, her BP was initially 210/120. She was given Lopressor
5 mg IV x 3, 25 mg po x 1, ASA 325 mg po x 1, Clonidine 0.2 mg
po x 1 and then started on a Labetolol gtt at 2 mg/min which was
subsequently increased to 4 mg/min. She was then given
Lisinopril 20 mg po x1, and Lantus 30 units. Her SBP improved to
180/80. She did not have any CP. Her WBC was found to be 15 and
she was given a dose of Levofloxacin 500 mg po x 1.


Past Medical History:
1) Chronic renal insufficiency: followed by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 10083**]
at [**Last Name (un) **]. (Baseline over the past 3 months 3.5-4.2).
2) HTN: Prior MRA showed three left renal arteries with superior

artery significant for renal artery stenosis. Several recent
admissions with HTN urgency in MICU/CCU.
3) Small hiatal hernia with severe GERD sx.
4) DM2: started insulin [**2157-8-1**].
5) Osteoporosis.
6) Vertebral fractures.
7) History of depression.
8) Anxiety.
9) Hypercholesterolemia
10) Chronic constipation.
11) Sickle cell trait.
12) Osteoarthritis.
13) Status post left knee replacement.
14) History of mechanical falls.
15) Total hysterectomy - about 20 years ago.

Social History:
Patient from Barbados, lives with husband, never used tobacco,
no EtOH.


Family History:
Father died of old age, mother had DM, HTN

Physical Exam:
PE: 96.0 180/80 55 19 100%RA
GEN: A+O x 3, NAD, laying in bed, thin AA female
HEENT: PERRL, EOMI, OP clear without exudates, no LAD or
thyromegaly
CV: RRR, no m/r/g, JVD 6 cm
LUNGS: CTAB
ABD: soft, distended, NTND +BS, +left inguinal hernia that was
nontender
EXT: 1+ pitting edema bilaterally, decreased peripheral pulses
Neuro: 5/5 strength in all extremities, decreased sensation at
feet bilaterally, CN II-XII intact


Pertinent Results:
LABS:
Discharge CBC:
wbc 5.5, hct 32.4, plt 156

Discharge electrolytes:
Na 134, K 4.6, Cl 102, HCO3 19, BUN 129, Cr 4.8, glucose 72, Ca
8.2, Mg 2.1, Ph 7.3

Troponin trend: 0.2 -> 0.18 -> 0.18 -> 0.19 -> 0.19 -> 0.17

U/A: WNL

MICROBIOLOGY:
[**11-18**] Blood culture: negative.
[**11-18**] Urine culture: negative.

IMAGING:
CHEST (PORTABLE AP)  [**2157-11-18**]
There is prominence of the pulmonary vasculature indicating mild
congestive heart failure with cardiomegaly and small bilateral
pleural effusion. No pneumothorax is seen.
IMPRESSION: Mild congestive heart failure with cardiomegaly.

ECHO [**2157-11-21**]
Conclusions:
The left atrium is moderately dilated. The right atrium is
markedly dilated.  There is moderate symmetric left ventricular
hypertrophy. The left ventricular cavity size is normal. Overall
left ventricular systolic function is normal (LVEF>55%). Tissue
velocity imaging E/e' is elevated (>15) suggesting increased
left ventricular filling pressure (PCWP>18mmHg). Right
ventricular chamber size and free wall motion are normal. The
aortic valve leaflets (3) are mildly thickened. There is no
aortic valve stenosis. Trace aortic regurgitation is seen. The
mitral valve leaflets are mildly thickened. Mild to moderate
([**1-2**]+) mitral regurgitation is seen. There is moderate pulmonary
artery systolic hypertension. There is a small pericardial
effusion.
Compared with the prior study (tape reviewed) of [**2157-5-18**],
systolic function appears slightly more vigorous today and
systemic blood pressure at the time of the study is lower today.






Brief Hospital Course:
Mrs. [**Known lastname 22473**] is a 72 year old woman with a history of diabetes,
chronic kidney disease that has recently been deteriorating
(over last few months baseline creatinine has increased from 2
to 4), and poorly controlled hypertension on multiple
antihypertensive agents. She was admitted to MICU on [**11-18**] with
hypertensive emergency characterized by SBP in 220's, anginal
chest pain, shortness of breath and edema in lower extremities.
In MICU, a labetalol drip was required to control blood
pressure, but she is now back on her home regimen of
antihypertensives with the only change being a slight increase
in her dose of isosorbide mononitrate. At this point she was
transferred to the medical floor.

1. Hypertension:
Her blood pressure stayed stable on her regimen of multiple
anti-hypertensives (Labetolol, Valsartan, Lisinopril,
Amlodipine, Hydralazine, Imdur, Clonidine, Lasix).  Her
difficult to control blood pressure is almost certainly due to
her extensive renal disease and ultimately her treatment for her
blood pressure will require hemodialysis.  This was emphasized
to her and she is at this point reluctant to start HD.  Since
there was no acute need for HD during this hospitalization, she
was discharged to home and she will let her PCP (Dr. [**Last Name (STitle) 16258**] and
her renal physician (Dr. [**First Name (STitle) 10083**] know about her plans for
hemodialysis in the future.

2. Chest pain:
Her chest pain and initial EKG changes (deep T wave inversions)
were thought to be due to her initial hypertension in the ED.
The cardiology service was notified and involved in her care and
thought she had demand ischemia in the setting of hypertension.
Her EKG changes resolved with correction of her blood pressure
and her cardiac enzymes remained flat (their slight elevation
was likely due to her chronic renal failure).  An echocardiogram
was done which revealed normal systolic function and no wall
motion abnormalities.  She was continued on her
anti-hypertensives as well as aspirin.  She will likely have a
p-MIBI as an outpatient at the discretion of her PCP.

2. CRI:
She was followed by her nephrologist, Dr. [**First Name (STitle) 10083**], while she was
hospitalized.  Her renal function and hypertension have reached
the level where she will soon likely need hemodialysis.  Again,
she was resistant to starting this during this hospitalization
and will discuss this with her family before contacting Dr.
[**First Name (STitle) 10083**] and Dr. [**Last Name (STitle) 16258**] regarding the timing of starting
hemodialysis.  Her renal medications included sevelamer 1600 tid
and epo 10,000 units weekly.

3. DM:
She was continued on lantus with a sliding scale and was in
adequate control during her hospitalization.  At discharge she
was instructed to take lantus 28 units daily and continue to use
a sliding scale.

4. Anemia:
Her anemia is thought to be a combination of her sickle cell
trait, chronic disease, and her renal disease.  At discharge her
hct was stable around 32 and she was restarted on epo.

5. GERD:
She was maintained on pantoprazole twice daily.


Medications on Admission:
1. Labetalol 800 mg PO TID
2. Atorvastatin 10 mg PO DAILY
3. Pantoprazole 40 mg PO once a day.
4. Ferrous Sulfate 325 PO DAILY
5. Lisinopril 20 mg PO BID
6. Valsartan 100 mg PO HS
7. Hydralazine 100 mg PO TID
8. Clonazepam 1 mg PO daily
9. Clonidine 0.9 mg let PO BID
10. Isosorbide Mononitrate 90 mg Sustained Release PO DAILY
11. Folic acid 1 mg daily
12. Procrit 10,000 unit/mL 10,000 units Injection once a week.
13. Insulin Lantus 30 units QAM
14. Lasix 30 mg PO twice a day
15. MVI 1 tablet daily
16. B12 50 mcg po daily
17. Tylenol prn arthritis
18. Sevelemer 800 mg three times daily
19. ASA 81 mg daily
20. Amlodipine 10 mg daily


Discharge Medications:
1. Labetalol 200 mg Tablet Sig: Four (4) Tablet PO TID (3 times
a day).
2. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
4. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
5. Losartan 50 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
6. Hydralazine 50 mg Tablet Sig: Two (2) Tablet PO Q8H (every 8
hours).
7. Clonidine 0.3 mg Tablet Sig: Three (3) Tablet PO BID (2 times
a day).
8. Isosorbide Mononitrate 60 mg Tablet Sustained Release 24HR
Sig: Two (2) Tablet Sustained Release 24HR PO DAILY (Daily).
Disp:*60 Tablet Sustained Release 24HR(s)* Refills:*2*
9. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

10. Multivitamin     Capsule Sig: One (1) Cap PO DAILY (Daily).

11. Cyanocobalamin 100 mcg Tablet Sig: 0.5 Tablet PO DAILY
(Daily).
12. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

13. Furosemide 20 mg Tablet Sig: 1.5 Tablets PO BID (2 times a
day).
14. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
15. Sevelamer 800 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
16. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

17. Epoetin Alfa 4,000 unit/mL Solution Sig: 10,000 U Injection
once a week.


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
1. Hypertensive emergency
2. Demand ischemia
3. ESRD


Discharge Condition:
Stable on her home BP regimen. TTE unchanged. Needs to have a
P-MIBI for a complete evaluation to rule out coronary disease as
did have demand ischemia in the setting of severe hypertension


Discharge Instructions:
Please take all your medications as directed.

Please take insulin (lantus): note new dose; 28U qhs.

Please come to the emergency room should you experience any
CP/dyspnea/fevers/chills or other concerning symptoms

Followup Instructions:
1. Please follow up with your PCP within next weeks.
2. Please follow up with your kidney doctors within next [**Name5 (PTitle) 15935**]
weeks
3. Your PCP should refer you for a stress test to make sure you
do not have coronary artery disease



Completed by:[**2157-11-24**]
{'Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Hyperpotassemia,End stage renal disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Dysthymic disorder,Esophageal reflux,Diaphragmatic hernia without mention of obstruction or gangrene,Osteoporosis, unspecified,Sickle-cell trait'}


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: Hypertensive emergency.

PRESENT ILLNESS: Mrs. [**Known lastname 22473**] is a 72 yo woman with a h/o poorly controlled HTN,
CRI (recent baseline 3.5-4.2), and DM2 who presented with
hypertension and chest pain. She was recently admitted to the
medicine service from [**11-2**] - [**11-5**] for peripheral extremity
tingling and shortness of breath. During this admission, she was
ruled out for an MI, transfused 2 units PRBC for anemia, and
spironolactone was stopped secondary to hyperkalemia. Over the
past few days at home, she c/o a sore throat, cough and
congestion. She states that her husband has similar sxs. Her
cough is productive of whitish sputum. She has not had any
fevers or sweats, but c/o chills. She c/o several months of DOE
with climbing 10 steps at her home, worse when she is carrying
her laundry. At these times, she also c/o left sided CP which is
dull in nature, nonradiating, and lasts for up to one minute.
Her last episode was last night. She does not c/o PND/orthopnea.
She had increased bilateral LE edema over the past few days and
came into the ED for evaluation.
She states her appetite has been poor recently and she has lost
[**10-15**] lbs over the past few months. She c/o nausea but no
emesis. No bleeding from her stools. She c/o dysuria, no
hematuria, no decreased frequency or quantity of urine. She also
has constipation and complains of gas. She has a right inguinal
hernia which has been more bothersome lately. She does not c/o
HA, abdominal pain, or focal neurologic sxs.
In the ED, her BP was initially 210/120. She was given Lopressor
5 mg IV x 3, 25 mg po x 1, ASA 325 mg po x 1, Clonidine 0.2 mg
po x 1 and then started on a Labetolol gtt at 2 mg/min which was
subsequently increased to 4 mg/min. She was then given
Lisinopril 20 mg po x1, and Lantus 30 units. Her SBP improved to
180/80. She did not have any CP. Her WBC was found to be 15 and
she was given a dose of Levofloxacin 500 mg po x 1.

MEDICAL HISTORY: 1) Chronic renal insufficiency: followed by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 10083**]
at [**Last Name (un) **]. (Baseline over the past 3 months 3.5-4.2).
2) HTN: Prior MRA showed three left renal arteries with superior

MEDICATION ON ADMISSION: 1. Labetalol 800 mg PO TID
2. Atorvastatin 10 mg PO DAILY
3. Pantoprazole 40 mg PO once a day.
4. Ferrous Sulfate 325 PO DAILY
5. Lisinopril 20 mg PO BID
6. Valsartan 100 mg PO HS
7. Hydralazine 100 mg PO TID
8. Clonazepam 1 mg PO daily
9. Clonidine 0.9 mg let PO BID
10. Isosorbide Mononitrate 90 mg Sustained Release PO DAILY
11. Folic acid 1 mg daily
12. Procrit 10,000 unit/mL 10,000 units Injection once a week.
13. Insulin Lantus 30 units QAM
14. Lasix 30 mg PO twice a day
15. MVI 1 tablet daily
16. B12 50 mcg po daily
17. Tylenol prn arthritis
18. Sevelemer 800 mg three times daily
19. ASA 81 mg daily
20. Amlodipine 10 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE: 96.0 180/80 55 19 100%RA
GEN: A+O x 3, NAD, laying in bed, thin AA female
HEENT: PERRL, EOMI, OP clear without exudates, no LAD or
thyromegaly
CV: RRR, no m/r/g, JVD 6 cm
LUNGS: CTAB
ABD: soft, distended, NTND +BS, +left inguinal hernia that was
nontender
EXT: 1+ pitting edema bilaterally, decreased peripheral pulses
Neuro: 5/5 strength in all extremities, decreased sensation at
feet bilaterally, CN II-XII intact

FAMILY HISTORY: Father died of old age, mother had DM, HTN

SOCIAL HISTORY: Patient from Barbados, lives with husband, never used tobacco,
no EtOH. 

### Response:
{'Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Hyperpotassemia,End stage renal disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Dysthymic disorder,Esophageal reflux,Diaphragmatic hernia without mention of obstruction or gangrene,Osteoporosis, unspecified,Sickle-cell trait'}
