CHIEF COMPLAINT: CC: "weakness"
Reason for MICU transfer: drop in Hct, guiac positive

PRESENT ILLNESS: This is a 79 yo F with h/o hypertension, CVA in
[**2131**] with residual left-sided weakness, epilepsy and Afib on
Couamdin, now brought in today by daughter because of worsened
generalized weakness and lethargy for the last one week. At
baseline, pt is verbal, conversant, oriented, gets around in a
wheelchair. Pt with decreased PO intake as well.
.
In the ED, initial VS were T 97.5 HR 70 BP 143/62 RR 20 O2 sat
100%. CT head was neg. Patient intermittently tender on abd exam
so a CT abd was performed which showed no acute process. Labs
revealed a Hct of 22.5 (down from 35.7 2 months ago). Pt was
guiac positive with green stool. EKG showed NSR 63, LVH and a
prolonged QTc. UA was neg for infection. GI evaluated pt and
recommended 2U pRBCs, PPI gtt and checking iron studies and
hemolysis labs. Pt was also ordered for 2 bags of FFP given INR
of 3.4. Pt has 2 PIVs. On transfer, VS were HR 54 BP 132/48 RR
17 O2 94% on RA.
.
Upon arrival to the ICU, pt is somnelent, not arousable to
voice, midly responsive to sternal rub. Daughter at bedside who
provided history. Denies bloody stools, dark stools, dysuria,
URI symptoms, constipation. Does endorse 3 bowel movements for
the last 2 days, but only one today. Denies seizure activity
(last seizure was 1 1/2 months ago).
.
ROS: as per HPI, denies CP, SOB, HAs, acute visual changes,
nausea/vomiting, dysuria. Endorses weight loss last few weeks
but not able to estimate how much. endorses mild diarrhea as
above.

MEDICAL HISTORY: - PVD s/p multiple stents of the superficial femoral artery
and balloon angioplasty of the tibial peroneal trunk; then found

MEDICATION ON ADMISSION: 1. amlodipine 10 mg DAILY
2. clopidogrel 75 mg DAILY
3. famotidine 40 mg Q24H
4. fluticasone 50 mcg/Actuation Spray One Spray [**Hospital1 **]
5. furosemide 80 mg DAILY
6. gabapentin 400 mg [**Hospital1 **]
7. insulin regular 8 Units twice a day
8. NPH 16 Units SC qam
9. NPH 12 Units SC at bedtime
10. hydralazine 150 mg [**Hospital1 **]
11. lorazepam 0.5 mg at bedtime as needed for anxiety
12. phenytoin sodium extended 100 mg 4 times a day
13. rosuvastatin 40 mg DAILY
14. sertraline 100 mg DAILY
15. sotalol 80 mg 2 times a day
16. valsartan 320 mg DAILY
17. ferrous sulfate 300 mg (60 mg Iron) DAILY
18. multivitamin DAILY
19. spiranolactone 25mg daily
20. warfarin 4mg daily except 3mg on Tues

ALLERGIES: Amoxicillin / Nitroimidazole Derivatives / Lisinopril /
Chlorophyllin (Chlorophyll) Analogues / Chlorhexidine Gluconate
/ Dextrose 0.5%-Water / IV Dye, Iodine Containing / Clonidine

PHYSICAL EXAM: VS: Temp: 97.6 BP: 144/70 HR: 64 RR: 15 O2sat 97% on RA
GEN: sleepy, nonrousable but later awake, uncooperative with
exam
HEENT: left pupil oval shaped but reactive to light, blind in
right eye, anicteric, dry MM, OP without lesions
Neck: no LAD, no JVD, no masses
RESP: bibasilar crackles, no wheezes
CV: irregular rhtyhm, regular rate, S1 and S2 wnl, no m/r/g
ABD: soft, nondistended, nontender
EXT: no edema
SKIN: +hyperpigmentation in bilat lower ext, no rashes
NEURO: AAOx2 (name, "hospital"). CNII-XII intact. 2/5 strength
in LUE, LLE. 5/5 strength in RUE, RLE. sensation intact.

FAMILY HISTORY: Mother died of a stroke in 80??????s. No FH PE, DVT, early CAD.

SOCIAL HISTORY: Patient lives with her 88 yo spouse in a [**Location (un) **] handicap
accessible apartment. She has a daughter in the area who is her
HCP. She has home PCA. Pt denies ETOH, smoking (quit 30
years ago) or drug use
Iron deficiency anemia secondary to blood loss (chronic),Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Hemorrhage of gastrointestinal tract, unspecified,Acute kidney failure, unspecified,Chronic diastolic heart failure,Hyperosmolality and/or hypernatremia,Wheelchair dependence,Other late effects of cerebrovascular disease,Other malaise and fatigue,Abnormal coagulation profile,Epilepsy, unspecified, without mention of intractable epilepsy,Atrial fibrillation,Long-term (current) use of anticoagulants,Other musculoskeletal symptoms referable to limbs,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Internal hemorrhoids without mention of complication,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Do not resuscitate status,Intestinal infection due to other organism, not elsewhere classified
Chr blood loss anemia,Acute respiratry failure,Food/vomit pneumonitis,Gastrointest hemorr NOS,Acute kidney failure NOS,Chr diastolic hrt fail,Hyperosmolality,Wheelchair dependence,Late effect CV dis NEC,Malaise and fatigue NEC,Abnrml coagultion prfile,Epilep NOS w/o intr epil,Atrial fibrillation,Long-term use anticoagul,Muscskel sympt limb NEC,Hy kid NOS w cr kid I-IV,Chr kidney dis stage III,Int hemorrhoid w/o compl,DMII oth nt st uncntrld,Do not resusctate status,Viral enteritis NOS
Admission Date:  [**2144-2-14**]              Discharge Date:   [**2144-2-17**]

Date of Birth:  [**2065-1-18**]             Sex:   F

Service: MEDICINE

Allergies:
Amoxicillin / Nitroimidazole Derivatives / Lisinopril /
Chlorophyllin (Chlorophyll) Analogues / Chlorhexidine Gluconate
/ Dextrose 0.5%-Water / IV Dye, Iodine Containing / Clonidine

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
CC: "weakness"
Reason for MICU transfer: drop in Hct, guiac positive


Major Surgical or Invasive Procedure:
None

History of Present Illness:
This is a 79 yo F with h/o hypertension, CVA in
[**2131**] with residual left-sided weakness, epilepsy and Afib on
Couamdin, now brought in today by daughter because of worsened
generalized weakness and lethargy for the last one week. At
baseline, pt is verbal, conversant, oriented, gets around in a
wheelchair. Pt with decreased PO intake as well.
.
In the ED, initial VS were T 97.5 HR 70 BP 143/62 RR 20 O2 sat
100%. CT head was neg. Patient intermittently tender on abd exam
so a CT abd was performed which showed no acute process. Labs
revealed a Hct of 22.5 (down from 35.7 2 months ago). Pt was
guiac positive with green stool. EKG showed NSR 63, LVH and a
prolonged QTc. UA was neg for infection. GI evaluated pt and
recommended 2U pRBCs, PPI gtt and checking iron studies and
hemolysis labs. Pt was also ordered for 2 bags of FFP given INR
of 3.4. Pt has 2 PIVs. On transfer, VS were HR 54 BP 132/48 RR
17 O2 94% on RA.
.
Upon arrival to the ICU, pt is somnelent, not arousable to
voice, midly responsive to sternal rub. Daughter at bedside who
provided history. Denies bloody stools, dark stools, dysuria,
URI symptoms, constipation. Does endorse 3 bowel movements for
the last 2 days, but only one today. Denies seizure activity
(last seizure was 1 1/2 months ago).
.
ROS: as per HPI, denies CP, SOB, HAs, acute visual changes,
nausea/vomiting, dysuria. Endorses weight loss last few weeks
but not able to estimate how much. endorses mild diarrhea as
above.


Past Medical History:
- PVD s/p multiple stents of the superficial femoral artery
and balloon angioplasty of the tibial peroneal trunk; then found

to have restenosis of SFA s/p angioplasty with stent placement
[**2140-9-23**]
- s/p CVA [**2131**] with residual left sided weakness
- Seizure disorder with partial seizures. Usually left arm
symptoms only.
- Stage III CKDz
- Hypertension
- Hyperlipidemia
- Type 2 diabetes
- CHF with preserved LVEF
- Atrial fibrillation on anticoagulation
- s/p hysterectomy
- s/p CCY
- h/o adenomatous polyp on colonoscopy [**2136**]
- h/o Grade 2 internal hemorrhoids on colonoscopy [**2136**]


Social History:
Patient lives with her 88 yo spouse in a [**Location (un) **] handicap
accessible apartment. She has a daughter in the area who is her
HCP. She has home PCA. Pt denies ETOH, smoking (quit 30
years ago) or drug use


Family History:
Mother died of a stroke in 80??????s. No FH PE, DVT, early CAD.

Physical Exam:
VS: Temp: 97.6 BP: 144/70 HR: 64 RR: 15 O2sat 97% on RA
GEN: sleepy, nonrousable but later awake, uncooperative with
exam
HEENT: left pupil oval shaped but reactive to light, blind in
right eye, anicteric, dry MM, OP without lesions
Neck: no LAD, no JVD, no masses
RESP: bibasilar crackles, no wheezes
CV: irregular rhtyhm, regular rate, S1 and S2 wnl, no m/r/g
ABD: soft, nondistended, nontender
EXT: no edema
SKIN: +hyperpigmentation in bilat lower ext, no rashes
NEURO: AAOx2 (name, "hospital"). CNII-XII intact. 2/5 strength
in LUE, LLE. 5/5 strength in RUE, RLE. sensation intact.


Pertinent Results:
[**2144-2-14**] 01:35PM BLOOD WBC-7.8 RBC-2.37*# Hgb-7.6*# Hct-22.5*#
MCV-95 MCH-31.8 MCHC-33.5 RDW-14.8 Plt Ct-198
[**2144-2-15**] 04:28AM BLOOD WBC-7.6 RBC-3.29* Hgb-10.4* Hct-29.9*
MCV-91 MCH-31.6 MCHC-34.8 RDW-16.5* Plt Ct-176
[**2144-2-16**] 06:25PM BLOOD WBC-13.5* RBC-3.21* Hgb-10.5* Hct-30.8*
MCV-96 MCH-32.7* MCHC-34.0 RDW-16.1* Plt Ct-195
[**2144-2-14**] 01:35PM BLOOD PT-33.9* PTT-34.9 INR(PT)-3.4*
[**2144-2-16**] 04:12AM BLOOD PT-33.3* PTT-32.4 INR(PT)-3.4*
[**2144-2-14**] 01:35PM BLOOD Ret Aut-4.1*
[**2144-2-14**] 01:35PM BLOOD Glucose-160* UreaN-44* Creat-1.8* Na-148*
K-3.7 Cl-111* HCO3-25 AnGap-16
[**2144-2-16**] 08:14PM BLOOD Glucose-176* UreaN-49* Creat-1.9* Na-151*
K-5.3* Cl-113* HCO3-23 AnGap-20
[**2144-2-16**] 04:12AM BLOOD proBNP-5168*
[**2144-2-14**] 01:35PM BLOOD Phenyto-19.8
[**2144-2-15**] 09:15AM BLOOD Phenyto-20.5* Phenyfr-2.0 %Phenyf-10
[**2144-2-15**] 04:28AM BLOOD ASA-NEG Acetmnp-NEG Bnzodzp-NEG
Barbitr-NEG Tricycl-NEG
[**2144-2-14**] 01:35PM BLOOD calTIBC-260 VitB12-622 Folate-GREATER TH
Hapto-177 Ferritn-64 TRF-200
[**2144-2-16**] 06:21PM BLOOD Type-ART pO2-62* pCO2-67* pH-7.24*
calTCO2-30 Base XS-0
[**2144-2-16**] 10:53PM BLOOD Type-ART pO2-65* pCO2-71* pH-7.20*
calTCO2-29 Base XS--1

Brief Hospital Course:
This is a 79 yo F with h/o hypertension, CVA in [**2131**] with
residual left-sided weakness, epilepsy and Afib on Couamdin, who
now presents with weakness and found to have Hct drop who
subsequently developed hypoxic respiratory failure.
.
# Anemia: Unclear if anemia was acute or subacute. It is
presumably related to GI blood loss since she was guaiac
positive, however, could also be Fe def [**2-12**] poor nutrition.
Hemolysis labs negative. She was satrted on PPI drip then
transitioned to PPI IV BID. GI was consulted and planned to
scope her once INR trended down. She received 2 units PRBCs.
.
# Lethargy/generalized weakness: Unclear etiology but most
likely secondary to hypovolemia and anemia. Throughtou her
hosptial course, however, she never became interactive or alert
as she develoepd profound hypoxemia. Hypernatremia likely also
contributed to lethargy.
.
#. Hypoxic hypercarbic respiratory failure: Pt wasinitially 97%
on RA on arrival to MICU but became progressively more hypoxic.
She had witnessed aspiration event on [**2-15**] and CXR was consistent
with bilateral airspace opacities and likely pulmonary edema. We
attempted to diurese her but she did not respond to lasix up to
80mg IV and was not awake enough to tolerate BiPap. She became
more lethargic and unresponsive and was not effectively
ventilating. ABG was 7.20/67/62 on 100% NRB. Given her
progressive decline and her wishes to be DNR/DNI, her family was
contact[**Name (NI) **] and she was made [**Name (NI) 3225**]. They were at her bedside when
she expired at 2:05am on [**2144-2-17**]. Progressive hypoxic respiratory
failure was attributed to development of pulmonary edema or
TRALI related to blood transfusions or ARDS/[**Doctor Last Name **] related to
aspiration event.
.
# Diarrhea: likely viral etiology but has h/o c diff
- check c diff, stool studies
.
# Afib: Warfarin held and she was given FFP given
supratherapeutic INR.
.
# Seizure d/o:  Phenytoin level monitored
.




Medications on Admission:
1. amlodipine 10 mg DAILY
2. clopidogrel 75 mg DAILY
3. famotidine 40 mg Q24H
4. fluticasone 50 mcg/Actuation Spray One Spray [**Hospital1 **]
5. furosemide 80 mg DAILY
6. gabapentin 400 mg [**Hospital1 **]
7. insulin regular 8 Units twice a day
8. NPH 16 Units SC qam
9. NPH 12 Units SC at bedtime
10. hydralazine 150 mg [**Hospital1 **]
11. lorazepam 0.5 mg at bedtime as needed for anxiety
12. phenytoin sodium extended 100 mg 4 times a day
13. rosuvastatin 40 mg DAILY
14. sertraline 100 mg DAILY
15. sotalol 80 mg 2 times a day
16. valsartan 320 mg DAILY
17. ferrous sulfate 300 mg (60 mg Iron) DAILY
18. multivitamin DAILY
19. spiranolactone 25mg daily
20. warfarin 4mg daily except 3mg on Tues


Discharge Medications:
None

Discharge Disposition:
Expired

Discharge Diagnosis:
Expired

Discharge Condition:
Expired

Discharge Instructions:
N/A

Followup Instructions:
None
{'Iron deficiency anemia secondary to blood loss (chronic),Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Hemorrhage of gastrointestinal tract, unspecified,Acute kidney failure, unspecified,Chronic diastolic heart failure,Hyperosmolality and/or hypernatremia,Wheelchair dependence,Other late effects of cerebrovascular disease,Other malaise and fatigue,Abnormal coagulation profile,Epilepsy, unspecified, without mention of intractable epilepsy,Atrial fibrillation,Long-term (current) use of anticoagulants,Other musculoskeletal symptoms referable to limbs,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Internal hemorrhoids without mention of complication,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Do not resuscitate status,Intestinal infection due to other organism, not elsewhere classified'}


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: CC: "weakness"
Reason for MICU transfer: drop in Hct, guiac positive

PRESENT ILLNESS: This is a 79 yo F with h/o hypertension, CVA in
[**2131**] with residual left-sided weakness, epilepsy and Afib on
Couamdin, now brought in today by daughter because of worsened
generalized weakness and lethargy for the last one week. At
baseline, pt is verbal, conversant, oriented, gets around in a
wheelchair. Pt with decreased PO intake as well.
.
In the ED, initial VS were T 97.5 HR 70 BP 143/62 RR 20 O2 sat
100%. CT head was neg. Patient intermittently tender on abd exam
so a CT abd was performed which showed no acute process. Labs
revealed a Hct of 22.5 (down from 35.7 2 months ago). Pt was
guiac positive with green stool. EKG showed NSR 63, LVH and a
prolonged QTc. UA was neg for infection. GI evaluated pt and
recommended 2U pRBCs, PPI gtt and checking iron studies and
hemolysis labs. Pt was also ordered for 2 bags of FFP given INR
of 3.4. Pt has 2 PIVs. On transfer, VS were HR 54 BP 132/48 RR
17 O2 94% on RA.
.
Upon arrival to the ICU, pt is somnelent, not arousable to
voice, midly responsive to sternal rub. Daughter at bedside who
provided history. Denies bloody stools, dark stools, dysuria,
URI symptoms, constipation. Does endorse 3 bowel movements for
the last 2 days, but only one today. Denies seizure activity
(last seizure was 1 1/2 months ago).
.
ROS: as per HPI, denies CP, SOB, HAs, acute visual changes,
nausea/vomiting, dysuria. Endorses weight loss last few weeks
but not able to estimate how much. endorses mild diarrhea as
above.

MEDICAL HISTORY: - PVD s/p multiple stents of the superficial femoral artery
and balloon angioplasty of the tibial peroneal trunk; then found

MEDICATION ON ADMISSION: 1. amlodipine 10 mg DAILY
2. clopidogrel 75 mg DAILY
3. famotidine 40 mg Q24H
4. fluticasone 50 mcg/Actuation Spray One Spray [**Hospital1 **]
5. furosemide 80 mg DAILY
6. gabapentin 400 mg [**Hospital1 **]
7. insulin regular 8 Units twice a day
8. NPH 16 Units SC qam
9. NPH 12 Units SC at bedtime
10. hydralazine 150 mg [**Hospital1 **]
11. lorazepam 0.5 mg at bedtime as needed for anxiety
12. phenytoin sodium extended 100 mg 4 times a day
13. rosuvastatin 40 mg DAILY
14. sertraline 100 mg DAILY
15. sotalol 80 mg 2 times a day
16. valsartan 320 mg DAILY
17. ferrous sulfate 300 mg (60 mg Iron) DAILY
18. multivitamin DAILY
19. spiranolactone 25mg daily
20. warfarin 4mg daily except 3mg on Tues

ALLERGIES: Amoxicillin / Nitroimidazole Derivatives / Lisinopril /
Chlorophyllin (Chlorophyll) Analogues / Chlorhexidine Gluconate
/ Dextrose 0.5%-Water / IV Dye, Iodine Containing / Clonidine

PHYSICAL EXAM: VS: Temp: 97.6 BP: 144/70 HR: 64 RR: 15 O2sat 97% on RA
GEN: sleepy, nonrousable but later awake, uncooperative with
exam
HEENT: left pupil oval shaped but reactive to light, blind in
right eye, anicteric, dry MM, OP without lesions
Neck: no LAD, no JVD, no masses
RESP: bibasilar crackles, no wheezes
CV: irregular rhtyhm, regular rate, S1 and S2 wnl, no m/r/g
ABD: soft, nondistended, nontender
EXT: no edema
SKIN: +hyperpigmentation in bilat lower ext, no rashes
NEURO: AAOx2 (name, "hospital"). CNII-XII intact. 2/5 strength
in LUE, LLE. 5/5 strength in RUE, RLE. sensation intact.

FAMILY HISTORY: Mother died of a stroke in 80??????s. No FH PE, DVT, early CAD.

SOCIAL HISTORY: Patient lives with her 88 yo spouse in a [**Location (un) **] handicap
accessible apartment. She has a daughter in the area who is her
HCP. She has home PCA. Pt denies ETOH, smoking (quit 30
years ago) or drug use 

### Response:
{'Iron deficiency anemia secondary to blood loss (chronic),Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Hemorrhage of gastrointestinal tract, unspecified,Acute kidney failure, unspecified,Chronic diastolic heart failure,Hyperosmolality and/or hypernatremia,Wheelchair dependence,Other late effects of cerebrovascular disease,Other malaise and fatigue,Abnormal coagulation profile,Epilepsy, unspecified, without mention of intractable epilepsy,Atrial fibrillation,Long-term (current) use of anticoagulants,Other musculoskeletal symptoms referable to limbs,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Internal hemorrhoids without mention of complication,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Do not resuscitate status,Intestinal infection due to other organism, not elsewhere classified'}
