CHIEF COMPLAINT: Fevers and chills, called out from Surgical
Intensive Care Unit on [**4-23**].

PRESENT ILLNESS: This is a 58 year-old male with
a history of end stage renal disease on hemodialysis, history
of chronic right foot infections, status post left below knee
amputation and a history of thrombosed right upper extremity
AV fistula, status post left IJ tunnel PermaCath with a
history of GI bleed and ischemic colitis,  History of IVDU
who was initially admitted from the hemodialysis center as an
outpatient where developed fevers, hypotension and altered
mental status.  He was subsequently admitted to the Intensive
Care Unit where he received intravenous fluids and Dopamine
drip for less than 12 hours.  The patient was pancultured at
the time for suspected sepsis and blood cultures on [**4-21**]
grew out 2 out of 4 bottles showing gram positive cocci in
pairs and clusters and a foot culture with gram stain showing
3+ positive cocci and 2+ gram negative rods.  In addition,
his right foot was noted to be malodorous with pus and he is
treated
empirically with Vancomycin and meropenem and one dose of
ceftazidime.  Podiatry was consulted and recommended right
foot amputation, but patient adamantly refused and so
was subsequently transferred to the floor medicine team, with
further evaluation from podiatry and possible surgical foot
debridement.
Patient also had chronic left shoulder pain.
Shoulder and neck films in the unit showed that the patient
had no acute pathology that explained the shoulder pain.  On
the morning of transfer the patient was being dialyzed.  He wa
s
awake, alert and had no complaints of
shortness of breath, chest pain, light headedness or
dizziness.  Patient notes chronic left shoulder pain with no
radiation.  Denies night sweats, fevers or chills.  Denies
nausea, vomiting or diarrhea.

MEDICAL HISTORY: 1) End stage renal disease on
hemodialysis.  2) History of thrombosed right upper extremity
AV fistula.  3) Status post left IJ PermaCath tunneled.   4)
Diabetes mellitus type 2.  5) Hepatitis B.  6) Hypertension.
7) Ischemic colitis with GI bleed.  8) Tuberculosis in the
past.  9) Status post left below knee amputation.  10)
Multiple right foot infections.  11) History of drug use.
12) Congestive heart failure with an ejection fraction of 55
percent and normal wall motion.  13) History of VR and MRSA.

MEDICATION ON ADMISSION: Norvasc 10 mg p.o. q day,
multivitamin, folate 1 mg p.o. q day, Renagel 800 mg p.o.
t.i.d., NPH 40 units q P.M., 60 units q A.M., insulin sliding
scale, Epogen 30,000 units subcutaneous three times weekly,
Vicodin p.r.n., aspirin 81 mg p.o. q day, Coumadin 1 mg p.o.
q day, Protonix 40 mg p.o. q day, Neurontin 100 mg p.o.
b.i.d. and methadone 100 mg p.o. q day.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Staphylococcal septicemia, unspecified,Cellulitis and abscess of other specified sites,Ulcer of other part of foot,Acute osteomyelitis, ankle and foot,Chronic hepatitis C without mention of hepatic coma,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Sepsis
Staphylcocc septicem NOS,Cellulitis, site NEC,Ulcer other part of foot,Ac osteomyelitis-ankle,Chrnc hpt C wo hpat coma,CHF NOS,Hyp kid NOS w cr kid V,Sepsis
Admission Date:  [**2184-4-21**]       Discharge Date:[**2184-4-27**]

Date of Birth:   [**2125-5-16**]       Sex:  M

Service:  [**Location (un) 259**] MEDICINE

CHIEF COMPLAINT:  Fevers and chills, called out from Surgical
Intensive Care Unit on [**4-23**].

HISTORY OF PRESENT ILLNESS:  This is a 58 year-old male with
a history of end stage renal disease on hemodialysis, history
of chronic right foot infections, status post left below knee
amputation and a history of thrombosed right upper extremity
AV fistula, status post left IJ tunnel PermaCath with a
history of GI bleed and ischemic colitis,  History of IVDU
who was initially admitted from the hemodialysis center as an
outpatient where developed fevers, hypotension and altered
mental status.  He was subsequently admitted to the Intensive
Care Unit where he received intravenous fluids and Dopamine
drip for less than 12 hours.  The patient was pancultured at
the time for suspected sepsis and blood cultures on [**4-21**]
grew out 2 out of 4 bottles showing gram positive cocci in
pairs and clusters and a foot culture with gram stain showing
3+ positive cocci and 2+ gram negative rods.  In addition,
his right foot was noted to be malodorous with pus and he is
treated
empirically with Vancomycin and meropenem and one dose of
ceftazidime.  Podiatry was consulted and recommended right
foot amputation, but patient adamantly refused and so
was subsequently transferred to the floor medicine team, with
further evaluation from podiatry and possible surgical foot
debridement.
Patient also had chronic left shoulder pain.
Shoulder and neck films in the unit showed that the patient
had no acute pathology that explained the shoulder pain.  On
the morning of transfer the patient was being dialyzed.  He wa
s
awake, alert and had no complaints of
shortness of breath, chest pain, light headedness or
dizziness.  Patient notes chronic left shoulder pain with no
radiation.  Denies night sweats, fevers or chills.  Denies
nausea, vomiting or diarrhea.

PAST MEDICAL HISTORY:  1) End stage renal disease on
hemodialysis.  2) History of thrombosed right upper extremity
AV fistula.  3) Status post left IJ PermaCath tunneled.   4)
Diabetes mellitus type 2.  5) Hepatitis B.  6) Hypertension.
7) Ischemic colitis with GI bleed.  8) Tuberculosis in the
past.  9) Status post left below knee amputation.  10)
Multiple right foot infections.  11) History of drug use.
12) Congestive heart failure with an ejection fraction of 55
percent and normal wall motion.  13) History of VR and MRSA.

MEDICATIONS ON ADMISSION:  Norvasc 10 mg p.o. q day,
multivitamin, folate 1 mg p.o. q day, Renagel 800 mg p.o.
t.i.d., NPH 40 units q P.M., 60 units q A.M., insulin sliding
scale, Epogen 30,000 units subcutaneous three times weekly,
Vicodin p.r.n., aspirin 81 mg p.o. q day, Coumadin 1 mg p.o.
q day, Protonix 40 mg p.o. q day, Neurontin 100 mg p.o.
b.i.d. and methadone 100 mg p.o. q day.

PHYSICAL EXAMINATION:  Temperature 97.9, blood pressure
128/78, heart rate of 90, respiratory rate of 16, satting 98
percent on room air.  In general, this was a gentleman who
was awake, alert on hemodialysis, chronically ill appearing
in no apparent distress.  Oropharynx is clear.  No jugular
venous distention, no masses in the neck.  Chest:  Tunneled
right catheter with dressing clean, dry and intact.
Decreased breath sounds bilaterally.  Coronary regular rate
and rhythm.  Abdomen soft, nontender, nondistended, positive
bowel sounds.  Extremities: Status post left below knee
amputation.  Right foot with 3+ edema with dressing clean,
dry and intact.  Neurologic alert and oriented times three,
moved all extremities spontaneously.

HOSPITAL COURSE:
1.  Sepsis:  Patient was transferred to the Intensive Care
Unit after three days for hypotension.  Patient was
resuscitated with intravenous fluids as well as Dopamine for
less than 12 hours as above.  Culture data showed bacteremia
that was persistent.  The patient was maintained on
Vancomycin dose by levels and meropenem.  Patient underwent a
foot debridement on [**4-23**] by podiatry for further
evaluation and debridement of his wound.  Podiatry had
recommended a right foot amputation for optimal control.
However, the patient adamantly refused and did not want his
other foot amputated as well.  Patient up to the date of this
discharge summary had no growth to date on his surveillance
cultures from [**4-23**] and [**4-25**].

2.  Right foot infection:  Podiatry was managing this patient
in terms of his foot infection.  The patient underwent
operating room surgical debridement on [**4-23**] that was
uncomplicated.  Cultures are still pending.  The patient was
maintained on Vancomycin and Meropenem.

3.  End stage renal disease on hemodialysis:  Renal was
consulted in management of this patient.  Patient was
dialyzed Monday, Wednesday and Friday, was continued on phos
lowering agents.  Patient was also maintained on 1 mg of
Coumadin at night for prophylactic use for his tunnel
catheter.

4.  Diabetes mellitus:  The patient was maintained on his
NPH.  [**Last Name (un) **] was consulted in management of the patient.
They recommended alternating his NPH for optimal control.
The patient was maintained on a regular sliding scale with
q.i.d. blood glucose fingers.

5.  Cardiology:  The patient had an ejection of 55%,
question diastolic dysfunction.  Given the fact that he is
hypotensive his antihypertensive medications were held during
this hospital stay until his blood pressure normalized.

6.  Chronic pain:  The patient had a history of chronic pain
as well as history of intravenous drug use and possible
heroin use.  Patient was maintained on his outpatient doses
of methadone and p.r.n. Vicodin postoperatively.  Also for
chronic right shoulder pain.

7.  Anemia:  The patient with anemia of chronic disease and
end stage renal disease.  Patient was transfused for
hematocrit of less than 28 percent.  Patient got one unit of
packed red cells at dialysis on [**4-23**] and was maintained
on his Epogen shots three times weekly at hemodialysis.

8.  Constipation:  Patient was maintained on Colace, Senna
and Dulcolax.

9.  Prophylaxis:  Patient was maintained on proton pump
inhibitor and Pneumoboots.

10.  Code:  Patient was maintained on full code.

The remainder of the hospital course will be dictated by the
next intern who will be covering for this patient.






                            [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 9755**]

Dictated By:[**Last Name (NamePattern1) 5227**]
MEDQUIST36

D:  [**2184-4-25**]  22:03
T:  [**2184-4-25**]  22:31
JOB#:  [**Job Number 101057**]


Name:  [**Known lastname 16230**], [**Known firstname 77**]                     Unit No:  [**Numeric Identifier 16231**]

Admission Date:  [**2184-4-21**]     Discharge Date:  [**2184-4-28**]

Date of Birth:   [**2125-5-16**]     Sex:  M

Service:

The addendum covers the period of hospitalization between [**4-26**] and [**2184-4-28**].

HOSPITAL COURSE:
1.  Sepsis:  During this period of time the patient remained
afebrile without any complaints.  His blood culture from
[**4-21**] grew staph coag positive, and gram stain from his
right foot ulcer showed staph guaiac positive and proteus and
Mirabilis.  The patient was maintained on Vancomycin and
Ceftazidime.  Both medications were administered at the time
of hemodialysis.

2.  Diabetes mellitus:  The patient was continued on insulin
therapy with NPH and regular insulin sliding scale as
recommended by [**Last Name (un) 616**] consult.

3.  Access:  A femoral line had been placed on the patient.
The line was removed on [**2184-4-26**].  Apparently the patient
has no intravenous access.  His only intravenous medications
are Ceftazidime and Vancomycin, both of which were
administered during hemodialysis.

DISCHARGE INSTRUCTIONS:  The patient should follow up with
his primary care physician within [**Name Initial (PRE) **] week.  Also he should
follow up with the Podiatry Service on Monday [**2184-5-3**] at
which point further management will be decided.

DISCHARGE STATUS:  To extended care facility.

DISCHARGE CONDITION:  Stable.

DISCHARGE DIAGNOSES:
1.  Sepsis.
2.  End stage renal disease on hemodialysis.
3.  Ulcers/infection.
4.  Diabetes mellitus, insulin dependent.

DISCHARGE MEDICATIONS:
1.  Protonix 40 mg po q.d.
2.  Gabapentin 100 mg po b.i.d.
3.  Multivitamins one cap po q.d.
4.  Folic acid 1 mg po q.d.
5.  Methadone 100 mg po q.d.
6.  Nephrocaps one capsule po q.d.
7.  Tylenol 325 to 650 mg po q 4 to 6 hours prn.
8.  Sevelamer 3200 mg po t.i.d.
9.  Warfarin 1 mg po q.h.s.
10.  Colace 100 mg po b.i.d.
11.  Senna one tablet po b.i.d.
12.  Bisacodyl 10 mg po/pr q.d. prn for constipation.
13.  Hydrocodone/Acetaminophen one to two tabs po q 4 to 6
hours prn for pain.
14.  Insulin sliding scale with 60 units of NPH at breakfast
and regular insulin sliding scale with q.i.d. finger sticks.
15.  Ceftazidime 1 gram q hemodialysis (with each
hemodialysis session).
16.  Vancomycin with each hemodialysis session dosed by
levels drawn prior to hemodialysis.






                          [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4273**], M.D.  [**MD Number(1) 4274**]

Dictated By:[**Last Name (NamePattern1) 3221**]

MEDQUIST36

D:  [**2184-4-28**]  10:09
T:  [**2184-4-28**]  10:12
JOB#:  [**Job Number 16232**]
{'Staphylococcal septicemia, unspecified,Cellulitis and abscess of other specified sites,Ulcer of other part of foot,Acute osteomyelitis, ankle and foot,Chronic hepatitis C without mention of hepatic coma,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Sepsis'}


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: Fevers and chills, called out from Surgical
Intensive Care Unit on [**4-23**].

PRESENT ILLNESS: This is a 58 year-old male with
a history of end stage renal disease on hemodialysis, history
of chronic right foot infections, status post left below knee
amputation and a history of thrombosed right upper extremity
AV fistula, status post left IJ tunnel PermaCath with a
history of GI bleed and ischemic colitis,  History of IVDU
who was initially admitted from the hemodialysis center as an
outpatient where developed fevers, hypotension and altered
mental status.  He was subsequently admitted to the Intensive
Care Unit where he received intravenous fluids and Dopamine
drip for less than 12 hours.  The patient was pancultured at
the time for suspected sepsis and blood cultures on [**4-21**]
grew out 2 out of 4 bottles showing gram positive cocci in
pairs and clusters and a foot culture with gram stain showing
3+ positive cocci and 2+ gram negative rods.  In addition,
his right foot was noted to be malodorous with pus and he is
treated
empirically with Vancomycin and meropenem and one dose of
ceftazidime.  Podiatry was consulted and recommended right
foot amputation, but patient adamantly refused and so
was subsequently transferred to the floor medicine team, with
further evaluation from podiatry and possible surgical foot
debridement.
Patient also had chronic left shoulder pain.
Shoulder and neck films in the unit showed that the patient
had no acute pathology that explained the shoulder pain.  On
the morning of transfer the patient was being dialyzed.  He wa
s
awake, alert and had no complaints of
shortness of breath, chest pain, light headedness or
dizziness.  Patient notes chronic left shoulder pain with no
radiation.  Denies night sweats, fevers or chills.  Denies
nausea, vomiting or diarrhea.

MEDICAL HISTORY: 1) End stage renal disease on
hemodialysis.  2) History of thrombosed right upper extremity
AV fistula.  3) Status post left IJ PermaCath tunneled.   4)
Diabetes mellitus type 2.  5) Hepatitis B.  6) Hypertension.
7) Ischemic colitis with GI bleed.  8) Tuberculosis in the
past.  9) Status post left below knee amputation.  10)
Multiple right foot infections.  11) History of drug use.
12) Congestive heart failure with an ejection fraction of 55
percent and normal wall motion.  13) History of VR and MRSA.

MEDICATION ON ADMISSION: Norvasc 10 mg p.o. q day,
multivitamin, folate 1 mg p.o. q day, Renagel 800 mg p.o.
t.i.d., NPH 40 units q P.M., 60 units q A.M., insulin sliding
scale, Epogen 30,000 units subcutaneous three times weekly,
Vicodin p.r.n., aspirin 81 mg p.o. q day, Coumadin 1 mg p.o.
q day, Protonix 40 mg p.o. q day, Neurontin 100 mg p.o.
b.i.d. and methadone 100 mg p.o. q day.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Staphylococcal septicemia, unspecified,Cellulitis and abscess of other specified sites,Ulcer of other part of foot,Acute osteomyelitis, ankle and foot,Chronic hepatitis C without mention of hepatic coma,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Sepsis'}
