CHIEF COMPLAINT: Failure to thrive

PRESENT ILLNESS: 78 yo F w/ hx of depression, with worsening sx. not eating, not
walking. in bed most of day xweeks.  She reports that this bout
of depression began 3-4 years ago. Could not specify a specific
trigger. "Its hard not to be depressed." + deconditioning.
Passive SI, no active HI. In the ED her VS on presentation were:
98.4, 84, 198/83, 98% on RA.  Her blood pressure then rose to
224/63 in the ED. She received lopressor 5 mg IV x2, 10 mg IV x
1, 1 mg ativan, 10 mg hydralazine IV and 400 mg IV cipro. FS =
141 on presentation. She was also given 1L NS

MEDICAL HISTORY: Chronic depression- Long hx of depression, with her first
hospitalization when she was around 25 yo. The patient has had
[**1-1**] hospitalizations after that (unsure exactly how many). She
denied any suicide attempts in the past. She currently has a
psychiatrist Dr. [**Last Name (STitle) 48416**] ([**Telephone/Fax (1) 48417**]. No therapist.The
patient has had ECT treatments for her depression in the past
that had been successfull
DM
HTN
Likely CAD
Vitamin B12 def-dx this admission
Anemia

MEDICATION ON ADMISSION: Risperdal 1 mg qhs
Atorvastatin 10 mg qd
Calcium + D 1250/200
[**Month/Year (2) **] 81 mg
Lisinopril 5 mg qd
Vitamin D 400 IU qd
Glipizide 10 mg qd
Metformin 500 mg qd
Toprol 200 mg qd
Effexor 150 mg qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: on discharge
Vitals: 98.5 132/60  84  18  99%RA
Access: PIV
Gen: nad, thin female lying in bed
HEENT: mm dry, missing teeth
CV: RRR, no m
Resp: CTAB, no crackles or wheezing
Chest: ecchymosis over right anterior chest and breast, mild
tenderness over swelling of soft tissue
Abd; soft, nontender, +BS
Ext; no edema
psych: flat affect

FAMILY HISTORY: Father with depression.

SOCIAL HISTORY: Pt born and raised in [**State 350**]. She describes childhood as
good. She attended school until the 10th grade and worked as a
[**Last Name (un) 19441**] after that. She never married and has no children. She
is currently living in a house with her sister (who is also
demented per Dr. [**Last Name (STitle) 48416**] and her nephew. She collects SSI.
ADLS:  Independent of ADLS when not depressed.
Rhabdomyolysis,Acute myocardial infarction of unspecified site, initial episode of care,Urinary tract infection, site not specified,Major depressive affective disorder, recurrent episode, severe, without mention of psychotic behavior,Acute posthemorrhagic anemia,Malignant hypertensive heart disease without heart failure,Other agents affecting blood constituents causing adverse effects in therapeutic use,Salicylates causing adverse effects in therapeutic use,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Other B-complex deficiencies
Rhabdomyolysis,AMI NOS, initial,Urin tract infection NOS,Recur depr psych-severe,Ac posthemorrhag anemia,Mal hyp ht dis w/o hf,Adv eff blood agent NEC,Adv eff salicylates,DMII wo cmp nt st uncntr,Crnry athrscl natve vssl,B-complex defic NEC
Admission Date:  [**2130-9-3**]              Discharge Date:   [**2130-9-11**]

Date of Birth:  [**2051-12-24**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 9853**]
Chief Complaint:
Failure to thrive

Major Surgical or Invasive Procedure:
None

History of Present Illness:
78 yo F w/ hx of depression, with worsening sx. not eating, not
walking. in bed most of day xweeks.  She reports that this bout
of depression began 3-4 years ago. Could not specify a specific
trigger. "Its hard not to be depressed." + deconditioning.
Passive SI, no active HI. In the ED her VS on presentation were:
98.4, 84, 198/83, 98% on RA.  Her blood pressure then rose to
224/63 in the ED. She received lopressor 5 mg IV x2, 10 mg IV x
1, 1 mg ativan, 10 mg hydralazine IV and 400 mg IV cipro. FS =
141 on presentation. She was also given 1L NS


Past Medical History:
Chronic depression- Long hx of depression, with her first
hospitalization when she was around 25 yo. The patient has had
[**1-1**] hospitalizations after that (unsure exactly how many). She
denied any suicide attempts in the past. She currently has a
psychiatrist Dr. [**Last Name (STitle) 48416**] ([**Telephone/Fax (1) 48417**]. No therapist.The
patient has had ECT treatments for her depression in the past
that had been successfull
DM
HTN
Likely CAD
Vitamin B12 def-dx this admission
Anemia


Social History:
Pt born and raised in [**State 350**]. She describes childhood as
good. She attended school until the 10th grade and worked as a
[**Last Name (un) 19441**] after that. She never married and has no children. She
is currently living in a house with her sister (who is also
demented per Dr. [**Last Name (STitle) 48416**] and her nephew. She collects SSI.
ADLS:  Independent of ADLS when not depressed.


Family History:
Father with depression.

Physical Exam:
on discharge
Vitals: 98.5 132/60  84  18  99%RA
Access: PIV
Gen: nad, thin female lying in bed
HEENT: mm dry, missing teeth
CV: RRR, no m
Resp: CTAB, no crackles or wheezing
Chest: ecchymosis over right anterior chest and breast, mild
tenderness over swelling of soft tissue
Abd; soft, nontender, +BS
Ext; no edema
psych: flat affect


Pertinent Results:
chem panel unremarkable
Hgb 12--->10s
CK 1083-->400s
LFTs stable, albumin 3.3
Trop 2.71-2.91, finally drop to 2.26 [**9-8**], stop checking
TSH 0.76
Vit B12 146 (low), folate nl, ferritin 294

UA [**9-3**]: 21-50 wbc, mod LE, few bacteria
urine cx: contamination and >100K corneybacterium
blood cx [**9-3**] ntd X2

Imaging/results:
Xray L spine: osteopenia, no fracture

Echo normal EF >55%, mod TR and mod pulm HTN, otw normla

LE dopplers: no DVT b/l LE

CT head [**9-3**]: no acute intracranial process

CT chest [**9-8**]: Large right pectoral hematoma running along the
right breast into the anterior right axillary region, with a
large amount of subcutaneous soft tissue swelling. Mixed high
density is consistent with acute hemorrhage. No other hematoma
or fracture is seen.
A subpleural nodule in the left lower lobe measures 4 x 2 mm.
3-mm and 2-mm left upper lobe nodules are also noted.


Brief Hospital Course:
Pt was admitted from home on [**9-3**] per her nephew for essentially
failure to thrive and placement. Per the nephew, [**Name (NI) **], who is
her HCP, she has progressively been more depressed and less
attentive to her personal care. She has not been participating
in any activities, even ADLs. Around the time of admission, she
was so weak, he couldnt event get her off the toilet. He is also
caring for his ailing mother and it is very hard for him.

Upon admission, her CKs were mildly elevated to 1000s, thought
to be rhabdo [**12-31**] inmobility. She was hydrated and CKs
downtrended. However, her troponin was also checked on admission
given her BP was 242/60s and came back at 2.71. Repeat troponins
over the next 36hours oscillated between 2.71-2.93 as did CKMB.
Her EKG was unremarkable and she did not have any cardiac
complaints and was hemodyamically stable. Her Echo did not show
any WMA and EF was normal (only showed mod TR/pulm HTN) and LE
dopplers negative/good O2 sats. The etiology of her trop leak is
not very clear at this point, esp since it remains elevated when
her BP has improved (normal creat). Cardiology has also been
following and don't have a good explanation, ?tail end of
cardiac event a few weeks ago? vs hypertensive heart disease vs
less likely myocarditis. Given her RF for likely CAD, she was
started her on [**Last Name (LF) 4532**], [**First Name3 (LF) **] 325 and kept on the ACE/BB/statin.
Since there is no acute event and she is poor candidate for
cath/stent placement given ?compliance with [**First Name3 (LF) 4532**] if she needs
it, and pt not interested in pursuing cath, plan is to medically
manage and f/u with STRESS ECHO in on month (PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **]
was notified of this plan).

On [**9-8**], her hematocrit was noted to have dropped 10 points
throughout the day, and she had swelling and ecchymosis of the
right anterior chest. A CT scan showed a large right pectoralis
major hematoma. A code blue was called that evening because the
patient was noted to be unreponsive, not answering questions but
did respond to painful stimuli.  SBP was int he 80s and
increased to 108 with a 500cc NS bolus. By the time of transfer
to the ICU, her mental status had already improved dramatically.
She received 2U PRBC that had been ordered earlier, and since
then her hematocrit has been stable at 27-29. Surgery was
consulted but felt that given the nature of the hematoma surgery
could potentially make it worse and recommended compression
dressings and limiting movement of the right arm. Etiology was
unclear but could have been minor trauma such as boosting in bed
or steadying her under the arm while ambulating in the setting
of recently-started anticoagulation with [**Month/Year (2) **] and [**Month/Year (2) **]. [**Month/Year (2) **] and
[**Month/Year (2) **] were stopped, cardiology was notified and agreed.

Her other issues include her c/o some prox LE
weakness/discomfort with ambulation. L spine films negative, no
objective weakness, ESR 14, CK down to 500s, TSH wnl. She was
participating in PT and her history was inconsistent, so this
was not w/u further at this time.  She is also B12 def and she
was started on high dose oral supp (2000mcg qd) as well as other
vitamins per psych. Lung nodules were noted in the left lower
and upper lobes; as there was no CT available for comparison and
there is no history of smoking or malignancy, 1-year followup CT
is recommended


Medications on Admission:
Risperdal 1 mg qhs
Atorvastatin 10 mg qd
Calcium + D 1250/200
[**Month/Year (2) **] 81 mg
Lisinopril 5 mg qd
Vitamin D 400 IU qd
Glipizide 10 mg qd
Metformin 500 mg qd
Toprol 200 mg qd
Effexor 150 mg qd

Discharge Medications:
1. Risperidone 1 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
2. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID (3 times a day).
3. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2)
Tablet PO DAILY (Daily).
4. Venlafaxine 75 mg Capsule, Sust. Release 24 hr Sig: Two (2)
Capsule, Sust. Release 24 hr PO DAILY (Daily).
5. Magnesium Oxide 400 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
6. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr
Sig: Two (2) Tablet Sustained Release 24 hr PO DAILY (Daily).
7. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

10. Cyanocobalamin 500 mcg Tablet Sig: Four (4) Tablet PO DAILY
(Daily).
11. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
12. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
13. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed.
14. Glipizide 10 mg Tablet Sig: One (1) Tablet PO once a day.
15. Metformin 500 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 2561**] - [**Hospital1 8**]

Discharge Diagnosis:
Severe Depression
Elevated Troponin of unclear etiology (recent cardiac event vs
hypertensive heart disease and HTN urgency)
Rhabdomyolysis-mild
Vitamin B12 deficiency
Anemia
right pectoralis major hematoma


Discharge Condition:
Improved


Discharge Instructions:
You were admitted because you were having hard time taking care
of yourself and your nephew, [**Name (NI) **], was concerned for your
health.
You have severe depression that is not well controlled and you
will go to a facility to manage this.
While here you were found to have Vit B12 def and you were
started on Vitamin B12 supplemenation as well as other vitamins.
Also, your heart enzymes were elevated, the reasons for which
was not clear to us. Cardiology saw you while here and
recommended you get an outpatient Stress Echo.
You also had a bleed into the tissues of your right chest wall
after being placed on anticoagulation. Your [**Name (NI) **] and [**Name (NI) **] was
stopped and compression dressings applied per recommendation by
surgery, and after transfusion of 2 units of blood you remained
stable.

You will be followed by the doctors at your facility; if you
have lightheadedness, episodes of loss of consciousness,
evidence of active bleeding, fevers, chills, or any other
concerning symptoms, you may need to be transferred to another
facility for further medical care.

Followup Instructions:
Please follow up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in 1 month to set up
Stress echo. Call his office at [**Telephone/Fax (1) 1579**] to make an
appointment.

Please follow up with psychiatry as instructed by your
physicians after discharge from [**Hospital3 **].
{'Rhabdomyolysis,Acute myocardial infarction of unspecified site, initial episode of care,Urinary tract infection, site not specified,Major depressive affective disorder, recurrent episode, severe, without mention of psychotic behavior,Acute posthemorrhagic anemia,Malignant hypertensive heart disease without heart failure,Other agents affecting blood constituents causing adverse effects in therapeutic use,Salicylates causing adverse effects in therapeutic use,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Other B-complex deficiencies'}


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: Failure to thrive

PRESENT ILLNESS: 78 yo F w/ hx of depression, with worsening sx. not eating, not
walking. in bed most of day xweeks.  She reports that this bout
of depression began 3-4 years ago. Could not specify a specific
trigger. "Its hard not to be depressed." + deconditioning.
Passive SI, no active HI. In the ED her VS on presentation were:
98.4, 84, 198/83, 98% on RA.  Her blood pressure then rose to
224/63 in the ED. She received lopressor 5 mg IV x2, 10 mg IV x
1, 1 mg ativan, 10 mg hydralazine IV and 400 mg IV cipro. FS =
141 on presentation. She was also given 1L NS

MEDICAL HISTORY: Chronic depression- Long hx of depression, with her first
hospitalization when she was around 25 yo. The patient has had
[**1-1**] hospitalizations after that (unsure exactly how many). She
denied any suicide attempts in the past. She currently has a
psychiatrist Dr. [**Last Name (STitle) 48416**] ([**Telephone/Fax (1) 48417**]. No therapist.The
patient has had ECT treatments for her depression in the past
that had been successfull
DM
HTN
Likely CAD
Vitamin B12 def-dx this admission
Anemia

MEDICATION ON ADMISSION: Risperdal 1 mg qhs
Atorvastatin 10 mg qd
Calcium + D 1250/200
[**Month/Year (2) **] 81 mg
Lisinopril 5 mg qd
Vitamin D 400 IU qd
Glipizide 10 mg qd
Metformin 500 mg qd
Toprol 200 mg qd
Effexor 150 mg qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: on discharge
Vitals: 98.5 132/60  84  18  99%RA
Access: PIV
Gen: nad, thin female lying in bed
HEENT: mm dry, missing teeth
CV: RRR, no m
Resp: CTAB, no crackles or wheezing
Chest: ecchymosis over right anterior chest and breast, mild
tenderness over swelling of soft tissue
Abd; soft, nontender, +BS
Ext; no edema
psych: flat affect

FAMILY HISTORY: Father with depression.

SOCIAL HISTORY: Pt born and raised in [**State 350**]. She describes childhood as
good. She attended school until the 10th grade and worked as a
[**Last Name (un) 19441**] after that. She never married and has no children. She
is currently living in a house with her sister (who is also
demented per Dr. [**Last Name (STitle) 48416**] and her nephew. She collects SSI.
ADLS:  Independent of ADLS when not depressed. 

### Response:
{'Rhabdomyolysis,Acute myocardial infarction of unspecified site, initial episode of care,Urinary tract infection, site not specified,Major depressive affective disorder, recurrent episode, severe, without mention of psychotic behavior,Acute posthemorrhagic anemia,Malignant hypertensive heart disease without heart failure,Other agents affecting blood constituents causing adverse effects in therapeutic use,Salicylates causing adverse effects in therapeutic use,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Other B-complex deficiencies'}
