CHIEF COMPLAINT: Failure to thrive

PRESENT ILLNESS: [**Age over 90 **] yo female with recent diagnosis of metastatic cancer with
unkown primary, who presented to the ED with abdominal discomfor
and nausea and poor PO intake for three days. She denies chest
pain, shortness of breath, N/V, fever, chills, dysuria. She is a
poor historian and notes that she "feels uncomfortable". SHe has
2 pillow orthopnea, no PND, no increased swelling. At home, she
is functional, cooks for herself, cares for herself. SHe has 2
nieces that check in on her.

MEDICAL HISTORY: Metastatic cancer - primary unknown
Arthritis

MEDICATION ON ADMISSION: Darvocet
ASA
K-dur

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 96.5, 120/54, 50-100, 20, 97%on 2L
Genl: cachectic female in NAD
HEENT: JVP sligtly elevated
LUNGS: CTA anteriorly
CV: RRR, nl S1,S2, no murmur
ABD: soft, nontender
EXT: ulnar deviation, 1+ pedal pulses, no edema
NEURO: A&O,

FAMILY HISTORY: Mother - hypertension

SOCIAL HISTORY: Lives alone at home. She denies tobacco, alcohol use.
Acute respiratory failure,Pneumonia, organism unspecified,Acute myocardial infarction of other anterior wall, initial episode of care,Congestive heart failure, unspecified,Cardiogenic shock,Cerebral artery occlusion, unspecified with cerebral infarction,Acidosis,Unspecified protein-calorie malnutrition,Malignant neoplasm of other parts of bronchus or lung,Secondary malignant neoplasm of bone and bone marrow,Anemia, unspecified,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Esophageal reflux
Acute respiratry failure,Pneumonia, organism NOS,AMI anterior wall, init,CHF NOS,Cardiogenic shock,Crbl art ocl NOS w infrc,Acidosis,Protein-cal malnutr NOS,Mal neo bronch/lung NEC,Secondary malig neo bone,Anemia NOS,Ocl crtd art wo infrct,Esophageal reflux
Admission Date:  [**2134-8-21**]              Discharge Date:   [**2134-8-27**]


Service: MED

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Last Name (NamePattern1) 14062**]
Chief Complaint:
Failure to thrive

Major Surgical or Invasive Procedure:
none

History of Present Illness:
[**Age over 90 **] yo female with recent diagnosis of metastatic cancer with
unkown primary, who presented to the ED with abdominal discomfor
and nausea and poor PO intake for three days. She denies chest
pain, shortness of breath, N/V, fever, chills, dysuria. She is a
poor historian and notes that she "feels uncomfortable". SHe has
2 pillow orthopnea, no PND, no increased swelling. At home, she
is functional, cooks for herself, cares for herself. SHe has 2
nieces that check in on her.

Past Medical History:
Metastatic cancer - primary unknown
Arthritis


Social History:
Lives alone at home. She denies tobacco, alcohol use.

Family History:
Mother - hypertension

Physical Exam:
VS: 96.5, 120/54, 50-100, 20, 97%on 2L
Genl: cachectic female in NAD
HEENT: JVP sligtly elevated
LUNGS: CTA anteriorly
CV: RRR, nl S1,S2, no murmur
ABD: soft, nontender
EXT: ulnar deviation, 1+ pedal pulses, no edema
NEURO: A&O,


Pertinent Results:
[**2134-8-21**] 10:33PM   GLUCOSE-157* UREA N-16 CREAT-1.2* SODIUM-139
POTASSIUM-6.4* CHLORIDE-99 TOTAL CO2-13* ANION GAP-33*
[**2134-8-21**] 10:33PM   ALT(SGPT)-12 AST(SGOT)-62* CK(CPK)-136 ALK
PHOS-1195* AMYLASE-130* TOT BILI-0.4
[**2134-8-21**] 10:33PM   LIPASE-30
[**2134-8-21**] 10:33PM   CK-MB-5 cTropnT-0.86*
[**2134-8-21**] 10:33PM   CALCIUM-10.7* PHOSPHATE-8.3*# MAGNESIUM-2.9*
[**2134-8-21**] 10:33PM   CORTISOL-72.0*
[**2134-8-21**] 10:33PM   WBC-19.1* RBC-4.22 HGB-11.7* HCT-39.2 MCV-93#
MCH-27.8 MCHC-30.0*# RDW-13.8
[**2134-8-21**] 10:33PM   NEUTS-66 BANDS-4 LYMPHS-23 MONOS-3 EOS-2
BASOS-0 ATYPS-0 METAS-2* MYELOS-0
[**2134-8-21**] 10:33PM   HYPOCHROM-1+ ANISOCYT-NORMAL POIKILOCY-2+
MACROCYT-NORMAL MICROCYT-NORMAL POLYCHROM-NORMAL OVALOCYT-1+
BURR-1+ TEARDROP-1+
[**2134-8-21**] 10:33PM   PLT COUNT-557*
[**2134-8-21**] 10:14PM   TYPE-ART TEMP-36.1 O2-70 PO2-115* PCO2-41
PH-7.10* TOTAL CO2-13* BASE XS--16 INTUBATED-NOT INTUBA
[**2134-8-21**] 10:14PM   LACTATE-12.1*
[**2134-8-21**] 07:02PM   CK(CPK)-60
[**2134-8-21**] 12:48PM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.013
[**2134-8-21**] 12:48PM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.013
[**2134-8-21**] 12:48PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-NEG
[**2134-8-21**] 12:25PM   GLUCOSE-115* UREA N-14 CREAT-0.7 SODIUM-136
POTASSIUM-4.8 CHLORIDE-101 TOTAL CO2-22 ANION GAP-18
[**2134-8-21**] 12:25PM   ALT(SGPT)-8 AST(SGOT)-41* CK(CPK)-70 ALK
PHOS-1162* AMYLASE-61 TOT BILI-0.4
[**2134-8-21**] 12:25PM   CK-MB-NotDone cTropnT-0.70*
[**2134-8-21**] 12:25PM   LIPASE-25
[**2134-8-21**] 12:25PM   ALBUMIN-3.5 CALCIUM-9.8 PHOSPHATE-3.1
MAGNESIUM-2.1 CHOLEST-208*
[**2134-8-21**] 12:25PM   TRIGLYCER-144 HDL CHOL-50 CHOL/HDL-4.2
LDL(CALC)-129
[**2134-8-21**] 12:25PM   WBC-13.3* RBC-4.47 HGB-12.5 HCT-37.1 MCV-83
MCH-28.0 MCHC-33.7 RDW-14.0
[**2134-8-21**] 12:25PM   NEUTS-79.1* LYMPHS-16.0* MONOS-3.8 EOS-0.7
BASOS-0.3
[**2134-8-21**] 12:25PM   PLT COUNT-513*

Studies:

[**8-23**] TTE: EF=40%, multiple wma
Head CT: large right MCA stroke

Brief Hospital Course:
[**Age over 90 **] yo female, with multiple medical problems, s/p MI and large R
CVA, who failed extubation, was made CMO due to poor prognosis,
and passed away comfortably.

1. Respiratory failure: known cancer metastatic, likely lung Ca
despite BAL neg with mass on cxr.  Now with likely pneumonia.
ABG on MICU admission with extremely acidemic [**12-28**] anion gap
metabolic acidosis with elevated lactate, likely respir distress
[**12-28**] inability to compensate with respirations from underlying
disease.  Also with RLL pna on cxr, on levaquin/flagyl, 7-day
course; Pt extubated, did well initially, then was reintubated
for increased work of breathing.  Need for reintubation thought
to be [**12-28**] pulmonary edema/chf (as pt s/p new MI).  Pt was made
CMO by family after prognosis was discussed. Pt passed away on
[**8-27**].

2. NonAnion Gap Metabolic Acidosis: AG 27 on MICU admission,
likely [**12-28**] Acute MI with spilled lactate.  Intubation allowing
for respiratory compensation.  Lactate and ABG improving.
[**Name (NI) 24995**] pt was initially extubated, was reintubated for
increased work of breathing, eventually made CMO before she
passed away.

3. Malaise/Neuro
- Antiemetics PRN for nausea
- Likely [**12-28**] myocardial ischemia- repeat EKG showed improved ST
changes lateral precordium. Pt to get MRI/MRA [**8-25**]; CT showed
large stroke of R-MCA/right posterior parietal and pt with left
hemineglect.  Will ck more thorough neuro exam when pt
completely alert.  What will be her prognosis for regaining
function?  Can she handle her secretions post-extubation.  After
pt was reintubated, neuro recommended Carotid duplex if
aggressive workup was pursued, but pt was made CMO, and expired.

4. + cardiac markers and tachypnea: Large lateral V5 and V6 ST
depressions on primary EKG. Tachypnea noted on exam though pt
denied SOB, O2 sats high 90s on minimal O2 (2L). Pt thought to
have had a large MI by cardiac markers, EKG changes.  EF showed
decreased systolic function (EF=40%).  When pt was extubated,
she had increased pulmonary edema/chf (likely [**12-28**] to the
pressure effects of extubation on preload and afterload).
Re-extubation was thought to be an unlikely possibility given
her cardiac status.  Family did not want to pursue aggressive
measures (cardiac cath/CABG), she was made CMO, and passed away.


5. Hypotension: likely cardiogenic shock, on levophed.  Goal CVP
15 (given it may be falsely elevated given pulm htn); will give
fluids (and blood products as necessary).  Pt now with A-line.
Goal SBP>120 given recent stroke.  BP stable now off pressors.
Pt failed extubation as above.

6. Sinus tach: unclear etiology, afebrile, denies pain, no
pulsus. Is anxious. [**Month (only) 116**] have PE given ca hx, but given CXR and
phys exam will diurese first, if no improvement, consider CTA
(again question if we would heparinize).  Now stable.

7. Cancer: No treatment now, pt has declined treatment in the
past.

8. Leukocytosis: 79% neutrophils. [**Last Name (LF) **], [**First Name3 (LF) **] follow for now. RLL
pna on cxr. On levaquin and flagyl; WBC is coming down and pt
afebrile; will monitor.  7-day empiric course levo/flagyl

9.  Anemia: Pt with low hct; guaiac negative; are cking
hemolysis labs as well as B12/folate; c/w ACD; will transfuse
for goal>30

10. GERD: PPI

11. FEN: Nutrition c/s. Tube feeds.
12. Proph: PPI, SQH; Constipation: bowel meds
13. Code: Pt was initially full code as per her wishes.  After
she failed extubation, prognosis was discussed with her family,
and she was made CMO.  Pt was extubated, put on a morphine drip,
and she passed away comfortably on [**8-27**].


Medications on Admission:
Darvocet
ASA
K-dur

Discharge Medications:
none

Discharge Disposition:
Extended Care

Facility:
Pt expired on [**8-27**]

Discharge Diagnosis:
Respiratory failure
Myocardial infarction with resultant Congestive heart failure
and pulmonary edema
Stroke

Discharge Condition:
deceased

Discharge Instructions:
none

Followup Instructions:
none

                             [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) 5004**] [**Last Name (NamePattern1) **] MD, [**MD Number(3) 14063**]
{'Acute respiratory failure,Pneumonia, organism unspecified,Acute myocardial infarction of other anterior wall, initial episode of care,Congestive heart failure, unspecified,Cardiogenic shock,Cerebral artery occlusion, unspecified with cerebral infarction,Acidosis,Unspecified protein-calorie malnutrition,Malignant neoplasm of other parts of bronchus or lung,Secondary malignant neoplasm of bone and bone marrow,Anemia, unspecified,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Esophageal reflux'}


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: [**Age over 90 **] yo female with recent diagnosis of metastatic cancer with
unkown primary, who presented to the ED with abdominal discomfor
and nausea and poor PO intake for three days. She denies chest
pain, shortness of breath, N/V, fever, chills, dysuria. She is a
poor historian and notes that she "feels uncomfortable". SHe has
2 pillow orthopnea, no PND, no increased swelling. At home, she
is functional, cooks for herself, cares for herself. SHe has 2
nieces that check in on her.

MEDICAL HISTORY: Metastatic cancer - primary unknown
Arthritis

MEDICATION ON ADMISSION: Darvocet
ASA
K-dur

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 96.5, 120/54, 50-100, 20, 97%on 2L
Genl: cachectic female in NAD
HEENT: JVP sligtly elevated
LUNGS: CTA anteriorly
CV: RRR, nl S1,S2, no murmur
ABD: soft, nontender
EXT: ulnar deviation, 1+ pedal pulses, no edema
NEURO: A&O,

FAMILY HISTORY: Mother - hypertension

SOCIAL HISTORY: Lives alone at home. She denies tobacco, alcohol use. 

### Response:
{'Acute respiratory failure,Pneumonia, organism unspecified,Acute myocardial infarction of other anterior wall, initial episode of care,Congestive heart failure, unspecified,Cardiogenic shock,Cerebral artery occlusion, unspecified with cerebral infarction,Acidosis,Unspecified protein-calorie malnutrition,Malignant neoplasm of other parts of bronchus or lung,Secondary malignant neoplasm of bone and bone marrow,Anemia, unspecified,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Esophageal reflux'}
