CHIEF COMPLAINT: tongue, lip swelling

PRESENT ILLNESS: Ms. [**Known lastname 5239**] is an 80 y/o W w/ h/o asthma and HTN who p/w severe
swelling of tongue, lips, and throat. This began on the morning
of admission; she first noticed that she could not speak. Her
swelling progressed rapidly, so she went to her sister-in-law's
house and had her drive her to [**Hospital1 **] [**Location (un) 620**]. She denies that she
had trouble breathing during this episode. Of note, she has had
a similar experience twice before, once 4 years ago and once 5
years ago. Neither episode was as severe. She has not been able
to identify any trigger (no new foods, no insect or plant
exposure, etc) other than lisinopril, which she has been taking
for 5-6 years.
.
At [**Location (un) 620**], the patient was treated with epinephrine, Benadryl
50 IV, SoluMedrol 125 mg IV, pepcid 20 mg IV, racemic epi, and a
500 cc NS bolus. ENT evaluated her for a possible surgical
airway; laryngoscopy was consistent with angioedema. ENT
recommended observation, d/c'ing lisinopril permanently, and
decadron 12 mg Q8H. Patient was transferred to [**Hospital1 18**] for further
observation.
.
In the ED, she received 2 albuterol nebs and was admitted to
MICU for close observation. There, she was treated overnight
with Decadron 12 q8h, Benadryl 25 once, and Nebs q6h. She had
improved markedly from admission; she now says she is almost
back to normal, though with a little residual swelling. She is
called out to the floor for further management.
.
ROS: She is otherwise in good health. She denies dyspnea
currently, chest pain, palpitations, lightheadedness, dysphagia,
nausea, vomiting, diarrhea, and dysuria. She does report
"coughing twice today."

MEDICAL HISTORY: 1. Asthma
2. HTN

MEDICATION ON ADMISSION: Lisinopril
Albuterol
Atrovent
Nifedipine
Beclamethasone
lipitor
.
Allergies: shrimp, scallops, salmon (does not know what her
reaction is)

ALLERGIES: Lisinopril

PHYSICAL EXAM: VS: T97.1  HR99  BP136/57  RR18  O2 96% 3L NC
Gen: Obese woman appearing younger than stated age in NAD.
HEENT: No visible lip or tongue swelling, questionable neck
swelling; OP clear, PERRL, EOMI, neck supple w/o LAD.
CV: RRR, no m/r/g
Resp: End expiratory wheezes. No rales or rhonchi. No stridor.
Abd: soft, NT, ND, +BS
Ext: warm, well-perfused, + 2 DP pulses
NEURO: alert, oriented

FAMILY HISTORY: NC

SOCIAL HISTORY: No alcohol, tobacco (quit 40 years ago), drugs. Lives alone but
is completely independent in ADLs, IADLs.
Angioneurotic edema, not elsewhere classified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Acute kidney failure, unspecified,Chronic obstructive asthma, unspecified,Leukocytosis, unspecified,Anemia, unspecified,Other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use,Accidents occurring in other specified places,Pure hypercholesterolemia
Angioneurotic edema,Hyp kid NOS w cr kid V,End stage renal disease,Acute kidney failure NOS,Chronic obst asthma NOS,Leukocytosis NOS,Anemia NOS,Adv eff cardiovasc NEC,Accident in place NEC,Pure hypercholesterolem
Admission Date:  [**2174-3-13**]              Discharge Date:   [**2174-3-16**]

Date of Birth:  [**2093-8-12**]             Sex:   F

Service: MEDICINE

Allergies:
Lisinopril

Attending:[**First Name3 (LF) 905**]
Chief Complaint:
tongue, lip swelling


Major Surgical or Invasive Procedure:
None


History of Present Illness:
Ms. [**Known lastname 5239**] is an 80 y/o W w/ h/o asthma and HTN who p/w severe
swelling of tongue, lips, and throat. This began on the morning
of admission; she first noticed that she could not speak. Her
swelling progressed rapidly, so she went to her sister-in-law's
house and had her drive her to [**Hospital1 **] [**Location (un) 620**]. She denies that she
had trouble breathing during this episode. Of note, she has had
a similar experience twice before, once 4 years ago and once 5
years ago. Neither episode was as severe. She has not been able
to identify any trigger (no new foods, no insect or plant
exposure, etc) other than lisinopril, which she has been taking
for 5-6 years.
.
At [**Location (un) 620**], the patient was treated with epinephrine, Benadryl
50 IV, SoluMedrol 125 mg IV, pepcid 20 mg IV, racemic epi, and a
500 cc NS bolus. ENT evaluated her for a possible surgical
airway; laryngoscopy was consistent with angioedema. ENT
recommended observation, d/c'ing lisinopril permanently, and
decadron 12 mg Q8H. Patient was transferred to [**Hospital1 18**] for further
observation.
.
In the ED, she received 2 albuterol nebs and was admitted to
MICU for close observation. There, she was treated overnight
with Decadron 12 q8h, Benadryl 25 once, and Nebs q6h. She had
improved markedly from admission; she now says she is almost
back to normal, though with a little residual swelling. She is
called out to the floor for further management.
.
ROS: She is otherwise in good health. She denies dyspnea
currently, chest pain, palpitations, lightheadedness, dysphagia,
nausea, vomiting, diarrhea, and dysuria. She does report
"coughing twice today."


Past Medical History:
1. Asthma
2. HTN


Social History:
No alcohol, tobacco (quit 40 years ago), drugs. Lives alone but
is completely independent in ADLs, IADLs.


Family History:
NC


Physical Exam:
VS: T97.1  HR99  BP136/57  RR18  O2 96% 3L NC
Gen: Obese woman appearing younger than stated age in NAD.
HEENT: No visible lip or tongue swelling, questionable neck
swelling; OP clear, PERRL, EOMI, neck supple w/o LAD.
CV: RRR, no m/r/g
Resp: End expiratory wheezes. No rales or rhonchi. No stridor.
Abd: soft, NT, ND, +BS
Ext: warm, well-perfused, + 2 DP pulses
NEURO: alert, oriented


Pertinent Results:
OSH: crea: 1.3, BUN: 27, Trop T 0.014 (normal = <0.01)
[**Hospital1 18**] [**3-14**]:
Chem 7:
140  105  30  200
5.0  24  1.3
CK: 93  MB: Notdone  Trop-T: <0.01
WBC: 9.2; Hct: 35.5; Plt: 313


Brief Hospital Course:
Ms. [**Known lastname 5239**] is a pleasant 80 year old woman with a history of
hypertension, treated in part with lisinopril, and asthma who
presented with signs and symptoms of angioedema. Her brief
hospital course by problem is as follows:
.
1. Angioedema.
This was attributed to her lisinopril. She was initially
admitted to the MICU for observation, but she never required
airway support and after a day of high-dose steroids she had
improved dramatically. Her care was continued on the floor,
where a taper of her steroids was begun. She was also treated
with famotidine and diphenhydramine. On discharge, she was given
a prescription for a 7-day steroid taper and was instructed to
follow up with an allergist, whose name and number were
provided, as well as her PCP. *** Her PCP may wish to have her
obtain a MedicAlert bracelet. ***
.
2. Asthma.
She had a flare of her asthma on the planned day of discharge,
which necessitated an additional night in the hospital. This
improved with standing albuterol and ipratropium nebulizers q6h
as she uses at home and an inhaled steroid similar to her
outpatient budesonide. At the time of discharge, she was
breathing comfortably and reported that she was at her baseline.

.
3. Hypertension.
She was started on Nifedipine to control her blood pressure,
which had good effect. She was given a prescription for
Nifedipine XL and was instructed not to use ACE inhibitors in
the future.
.
4. Leukocytosis.
She had a brief increase in her WBC count of one day's duration.
She had no signs of infection, and it was believed that this was
due to steroids. It resolved as the steroids were tapered.
.
5. Anemia.
She was at her baseline hematocrit, although the etiology of
this is as yet unknown. She had no evidence of iron, B12, or
folate deficiency, and her stool was negative for occult blood.
.
6. Chronic renal failure.
She has had an elevated creatinine over the last several months,
with a baseline of 1.2 to 1.4. She remained in this range
throughout her hospitalization, although actually improved to
0.9 on discharge. Further evaluation was deferred.
.
7. Prophylaxis: She was given a bowel regimen PRN, pneumoboots
to prevent DVTs, and an insulin sliding scale while she was on
high-dose steroids.
.
8. Code Status: FULL
.
9. Dispo: She was discharged to home.

Medications on Admission:
Lisinopril
Albuterol
Atrovent
Nifedipine
Beclamethasone
lipitor
.
Allergies: shrimp, scallops, salmon (does not know what her
reaction is)


Discharge Medications:
1. Nifedipine 30 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO once a day.
Disp:*30 Tablet Sustained Release(s)* Refills:*2*
2. Ipratropium Bromide 0.02 % Solution Sig: One (1) INH
Inhalation Q6H (every 6 hours).
3. Albuterol Sulfate 0.083 % Solution Sig: One (1) INH
Inhalation Q6H (every 6 hours).
4. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 2 weeks.
Disp:*28 Tablet(s)* Refills:*0*
5. Diphenhydramine HCl 25 mg Capsule Sig: One (1) Capsule PO Q6H
(every 6 hours) as needed for lip, tongue, or face swelling for
2 weeks.
Disp:*30 Capsule(s)* Refills:*0*
6. Pulmicort 0.5 mg/2 mL Solution for Nebulization Sig: One (1)
INH Inhalation twice a day.
7. Prednisone 10 mg Tablet Sig: AS DIR Tablet PO once a day for
7 days: Take 4 tablets on Day 1; then take 3 tablets on Days 2 &
3; then take 2 tablets on Days 4 & 5; then take 1 tablet on Days
6 & 7; then stop.
Disp:*16 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
1. Angioedema
2. Asthma
3. Acute renal failure
.
Secondary:
1. Hypertension


Discharge Condition:
Good condition, breathing comfortably, ambulating independently,
vital signs stable.


Discharge Instructions:
You have been evaluated for tongue and lip swelling, a condition
known as angioedema. This was most likely due to your ACE
inhibitor, lisinopril. You should avoid taking all ACE
Inhibitors in the future. You have been given a prescription for
a steroid taper; you should complete the entire course of
prednisone even if you feel better. Please take all medications
as directed and please keep all follow-up appointments.
.
If you should develop recurrent swelling, shortness of breath
above your baseline, chest pain, fever/chills, or any other
symptom that is concerning to you, please call your PCP or go to
the nearest hospital emergency department.

Followup Instructions:
An appointment will be made for you with an allergist, Dr.
[**Last Name (STitle) 2603**], to confirm the cause of your symptoms. His office will
contact you to schedule the appointment, but if you have not
heard from them by Friday afternoon ([**3-18**]), please call
[**Telephone/Fax (1) 1723**].
.
Please also call your PCP, [**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) 3075**] [**Last Name (NamePattern1) **], at [**Telephone/Fax (1) 19980**] to
schedule an appointment. You should see him in [**12-14**] weeks.


                             [**Name6 (MD) 251**] [**Name8 (MD) **] MD [**MD Number(1) 910**]

Completed by:[**2174-3-16**]
{'Angioneurotic edema, not elsewhere classified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Acute kidney failure, unspecified,Chronic obstructive asthma, unspecified,Leukocytosis, unspecified,Anemia, unspecified,Other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use,Accidents occurring in other specified places,Pure hypercholesterolemia'}


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: tongue, lip swelling

PRESENT ILLNESS: Ms. [**Known lastname 5239**] is an 80 y/o W w/ h/o asthma and HTN who p/w severe
swelling of tongue, lips, and throat. This began on the morning
of admission; she first noticed that she could not speak. Her
swelling progressed rapidly, so she went to her sister-in-law's
house and had her drive her to [**Hospital1 **] [**Location (un) 620**]. She denies that she
had trouble breathing during this episode. Of note, she has had
a similar experience twice before, once 4 years ago and once 5
years ago. Neither episode was as severe. She has not been able
to identify any trigger (no new foods, no insect or plant
exposure, etc) other than lisinopril, which she has been taking
for 5-6 years.
.
At [**Location (un) 620**], the patient was treated with epinephrine, Benadryl
50 IV, SoluMedrol 125 mg IV, pepcid 20 mg IV, racemic epi, and a
500 cc NS bolus. ENT evaluated her for a possible surgical
airway; laryngoscopy was consistent with angioedema. ENT
recommended observation, d/c'ing lisinopril permanently, and
decadron 12 mg Q8H. Patient was transferred to [**Hospital1 18**] for further
observation.
.
In the ED, she received 2 albuterol nebs and was admitted to
MICU for close observation. There, she was treated overnight
with Decadron 12 q8h, Benadryl 25 once, and Nebs q6h. She had
improved markedly from admission; she now says she is almost
back to normal, though with a little residual swelling. She is
called out to the floor for further management.
.
ROS: She is otherwise in good health. She denies dyspnea
currently, chest pain, palpitations, lightheadedness, dysphagia,
nausea, vomiting, diarrhea, and dysuria. She does report
"coughing twice today."

MEDICAL HISTORY: 1. Asthma
2. HTN

MEDICATION ON ADMISSION: Lisinopril
Albuterol
Atrovent
Nifedipine
Beclamethasone
lipitor
.
Allergies: shrimp, scallops, salmon (does not know what her
reaction is)

ALLERGIES: Lisinopril

PHYSICAL EXAM: VS: T97.1  HR99  BP136/57  RR18  O2 96% 3L NC
Gen: Obese woman appearing younger than stated age in NAD.
HEENT: No visible lip or tongue swelling, questionable neck
swelling; OP clear, PERRL, EOMI, neck supple w/o LAD.
CV: RRR, no m/r/g
Resp: End expiratory wheezes. No rales or rhonchi. No stridor.
Abd: soft, NT, ND, +BS
Ext: warm, well-perfused, + 2 DP pulses
NEURO: alert, oriented

FAMILY HISTORY: NC

SOCIAL HISTORY: No alcohol, tobacco (quit 40 years ago), drugs. Lives alone but
is completely independent in ADLs, IADLs. 

### Response:
{'Angioneurotic edema, not elsewhere classified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Acute kidney failure, unspecified,Chronic obstructive asthma, unspecified,Leukocytosis, unspecified,Anemia, unspecified,Other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use,Accidents occurring in other specified places,Pure hypercholesterolemia'}
