CHIEF COMPLAINT: Hypertensive urgency

PRESENT ILLNESS: This is a 42 year old M with past medical history significant
for ESRD s/p LRRT in [**2134**] c/b rejection now on HD with malignant
hypertension and likely PRES who presents with hypertensive
urgency. The patient reports that he had been feeling well since
his discharge from [**Hospital1 18**] in [**Month (only) 205**] of this year, though he notes
that his blood pressure has been persistently elevated to around
150s-160s/90s-100s. He presented to see his transplant
nephrologist this morning and developed acute onset of posterior
headache with visual changes which consisted of floaters in his
peripheral vision and the visualization of streaks of color. He
also notes that he felt tremulous at the time and as if he might
pass out, but this quickly passed. He therefore presented to the
ED for further evaluation.
.
The patient has a history of malignant hypertension and was
admitted in [**Month (only) 116**] of this year with a hypertensive emergency at
which time he had a seizure and a small SAH. He was then
admitted again in [**Month (only) 205**] with headaches and vision changes and a
SBP up to 200s. At that time, his antihypertensive regiemen was
increased and he has tolerated this regimen.
.
In the ED, initial VS: T 98.8 HR 69 BP 167/106 16 99% on RA. He
received 1L NS, morphine 4mg IV x1 and tylenol 650 mg PO x1 with
modest improvement in symptoms.
.
At this time, patient feels much improved. Denies any visual
changes, states headache is less than a [**1-20**] and does not want
further medication at this time. Otherwise, ROS negative for
fevers, chills, nightsweats, chest pain, shortness of breath,
cough, abdominal pain, nausea, vomiting, diarrhea, melena,
hematochezia, hematemesis, dysuria. No paresthesias or weakness.
Pertinent positives as above.

MEDICAL HISTORY: - ESRD secondary to chronic ureterovesical junction obstruction
leading to bilateral hydronephrosis, on hemodialysis
- S/p living-related renal transplant [**2134**] ([**Name (NI) 106515**] brother),
failed, now on hemodialysis since [**12-18**]
- Malignant hypertension
- PRES
- s/p SAH
- Gout
- Peptic Ulcer disease
- Bladder neck stricture
- Atypical chest pain

MEDICATION ON ADMISSION: Lisinopril 40 [**Hospital1 **]
Valsartan 160 [**Hospital1 **]
Bactrim 80-400 mg qday
Cellcept 1 gram [**Hospital1 **]
Sevelamer 800 mg tid
Clonidine patch 0.3 mg/24 hours - 1 patch q week
Carvedilol 50 mg [**Hospital1 **]
Protonix 20 mg q day
Hydralazine 50 mg q 6 hours
Nifedipine 30 mg q day
Nephrocaps 1 mg q day

ALLERGIES: Ciprofloxacin / Hydralazine

PHYSICAL EXAM: VS: T 98.5 BP 158/98 P 77 RR 22 98% RA
GEN: Well-appearing, comfortable in bed, talkative and in NAD
HEENT: NCAT, EOMI, PERRL, oropharynx clear and without erythema
or exudate
NECK: Supple, no appreciable JVD
CV: RRR, normal S1S2, no murmurs, rubs or gallops
PULM: CTAB, no w/r/r, good air movement bilaterally
ABD: Soft, NTND, normoactive bowel sounds, no organomegaly,
multiple well-healed incisions
EXT: Warm and well perfused, full and symmetric distal pulses,
no pedal edema, two hyperpigmented papules on plantar surface of
left foot
NEURO: AAOx3, responds appropriately to questions, CN 2-12
grossly intact, full strength in bilateral upper extremity
extensors, wrists, fingers, and lower extremities, downgoing
toes bilaterally

FAMILY HISTORY: Father had MI mid 50s. No DM. Brother had cancer of jaw which
was resected.

SOCIAL HISTORY: 40py, quit 2 yrs ago. No EtOH or other drugs. Lives in apartment
Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease,Complications of transplanted kidney,End stage renal disease,Hyperpotassemia,Other encephalopathy,Other ureteric obstruction,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Gout, unspecified
Mal hyp kid w cr kid V,Compl kidney transplant,End stage renal disease,Hyperpotassemia,Encephalopathy NEC,Ureteric obstruction NEC,Abn react-org transplant,Gout NOS
Admission Date:  [**2143-7-18**]              Discharge Date:   [**2143-7-26**]

Date of Birth:  [**2098-12-27**]             Sex:   M

Service: SURGERY

Allergies:
Ciprofloxacin / Hydralazine

Attending:[**First Name3 (LF) 668**]
Chief Complaint:
Hypertensive urgency

Major Surgical or Invasive Procedure:
[**2143-7-21**]: renal transplant nephrectomy


History of Present Illness:
This is a 42 year old M with past medical history significant
for ESRD s/p LRRT in [**2134**] c/b rejection now on HD with malignant
hypertension and likely PRES who presents with hypertensive
urgency. The patient reports that he had been feeling well since
his discharge from [**Hospital1 18**] in [**Month (only) 205**] of this year, though he notes
that his blood pressure has been persistently elevated to around
150s-160s/90s-100s. He presented to see his transplant
nephrologist this morning and developed acute onset of posterior
headache with visual changes which consisted of floaters in his
peripheral vision and the visualization of streaks of color. He
also notes that he felt tremulous at the time and as if he might
pass out, but this quickly passed. He therefore presented to the
ED for further evaluation.
.
The patient has a history of malignant hypertension and was
admitted in [**Month (only) 116**] of this year with a hypertensive emergency at
which time he had a seizure and a small SAH. He was then
admitted again in [**Month (only) 205**] with headaches and vision changes and a
SBP up to 200s. At that time, his antihypertensive regiemen was
increased and he has tolerated this regimen.
.
In the ED, initial VS: T 98.8 HR 69 BP 167/106 16 99% on RA. He
received 1L NS, morphine 4mg IV x1 and tylenol 650 mg PO x1 with
modest improvement in symptoms.
.
At this time, patient feels much improved. Denies any visual
changes, states headache is less than a [**1-20**] and does not want
further medication at this time. Otherwise, ROS negative for
fevers, chills, nightsweats, chest pain, shortness of breath,
cough, abdominal pain, nausea, vomiting, diarrhea, melena,
hematochezia, hematemesis, dysuria. No paresthesias or weakness.
Pertinent positives as above.


Past Medical History:
- ESRD secondary to chronic ureterovesical junction obstruction
leading to bilateral hydronephrosis, on hemodialysis
- S/p living-related renal transplant [**2134**] ([**Name (NI) 106515**] brother),
failed, now on hemodialysis since [**12-18**]
- Malignant hypertension
- PRES
- s/p SAH
- Gout
- Peptic Ulcer disease
- Bladder neck stricture
- Atypical chest pain


Social History:
40py, quit 2 yrs ago. No EtOH or other drugs. Lives in apartment

building with his wheelchair-bound wife where he works as
superintendent.


Family History:
Father had MI mid 50s. No DM. Brother had cancer of jaw which
was resected.

Physical Exam:
VS: T 98.5 BP 158/98 P 77 RR 22 98% RA
GEN: Well-appearing, comfortable in bed, talkative and in NAD
HEENT: NCAT, EOMI, PERRL, oropharynx clear and without erythema
or exudate
NECK: Supple, no appreciable JVD
CV: RRR, normal S1S2, no murmurs, rubs or gallops
PULM: CTAB, no w/r/r, good air movement bilaterally
ABD: Soft, NTND, normoactive bowel sounds, no organomegaly,
multiple well-healed incisions
EXT: Warm and well perfused, full and symmetric distal pulses,
no pedal edema, two hyperpigmented papules on plantar surface of
left foot
NEURO: AAOx3, responds appropriately to questions, CN 2-12
grossly intact, full strength in bilateral upper extremity
extensors, wrists, fingers, and lower extremities, downgoing
toes bilaterally


Pertinent Results:
On Admission: .
IMAGING:
.
CT HEAD W/O CONTRAST
Interval resolution of subarachnoid hemorrhage seen within the
parieto-occipital lobes in [**2143-5-5**]. No acute intracranial
hemorrhage.
Aerosolized secretions within the sphenoid sinus.
.
CXR [**2143-7-20**] -
 PA and lateral views of the chest are obtained. A right IJ
dialysis catheter is noted with its tip at the cavoatrial
junction. Lungs are clear bilaterally without evidence of
pneumonia or CHF. Cardiomediastinal silhouette is normal. There
is no pleural effusion or pneumothorax. Osseous structures
appear intact.
.
On Admission: [**2143-7-18**]
WBC-5.0 RBC-4.52* Hgb-13.3* Hct-42.1 MCV-93 MCH-29.3 MCHC-31.5
RDW-14.3 Plt Ct-153
PT-13.7* PTT-41.3* INR(PT)-1.2*
Glucose-83 UreaN-37* Creat-6.9*# Na-140 K-5.6* Cl-101 HCO3-26
AnGap-19
ALT-6 AST-18 CK(CPK)-217* AlkPhos-53 TotBili-0.4
Calcium-9.2 Phos-6.9* Mg-2.3
.
On Discharge [**2143-7-26**]
WBC-5.0 RBC-3.55* Hgb-10.4* Hct-32.1* MCV-90 MCH-29.3 MCHC-32.4
RDW-14.5 Plt Ct-224
Glucose-91 UreaN-26* Creat-10.3* Na-141 K-4.0 Cl-101 HCO3-26
AnGap-18
Calcium-9.8 Phos-5.7*# Mg-2.1
[**2143-7-23**] TSH-0.79
[**2143-7-23**] T4-8.0
[**2143-7-26**] 05:20AM BLOOD

Brief Hospital Course:
44 year old M with history of ESRD s/p failed transplant on HD
who presents with headache and hypertension.
.
# Headache: Per the patient, it is similar to the headache he
had from his prior SAH in [**Month (only) 116**]. This, however, resolved much more
quickly and he currently has no other symptoms. Has been
improved with tylenol and one dose of morphine in the ED. No
other focal neurologic findings. Most likely due to
hypertension.  As no focal neurologic deficits, no clear
indication for MRI or further imaging as no evidence of bleed on
CT non-contrast.
# Malignant hypertension/h/o PRES: Has been admitted in the past
with hypertensive emergency and seizures. Concern for PRES
syndrome based on MRI done in [**Month (only) 116**] (was also on
tacrolimus/cyclosporine in the past). Also concern that patient
may have malignant hypertension as a result of failed renal
transplant.  Previous work up for renal transplant artery
stenosis which was negative. Renin/[**Male First Name (un) 2083**] levels drawn in [**Month (only) 205**]
showed low renin and aldosteron within normal range.

#Patient underwent transplant nephrectomy on [**7-21**] with Dr
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. The transplant kidney was satisfactorily removed
and he was extubated and transferred to the PACU in stable
condition.
.
# ESRD on HD s/p failed transplant: Patient underwent HD on
[**2143-7-19**], and then per M-W-F outpatient schedule.
In the post op period he progressed nicely. He was maintained on
many different classes of antihypertensives with reasonable
control. When he missed some doses due to HD on [**7-24**] he remained
with elevated BP requiring IV Lopressor.
He is being discharged on a new BP med regimen

.


Medications on Admission:
Lisinopril 40 [**Hospital1 **]
Valsartan 160 [**Hospital1 **]
Bactrim 80-400 mg qday
Cellcept 1 gram [**Hospital1 **]
Sevelamer 800 mg tid
Clonidine patch 0.3 mg/24 hours - 1 patch q week
Carvedilol 50 mg [**Hospital1 **]
Protonix 20 mg q day
Hydralazine 50 mg q 6 hours
Nifedipine 30 mg q day
Nephrocaps 1 mg q day


Discharge Medications:
1. Lisinopril 40 mg Tablet Sig: One (1) Tablet PO twice a day.
2. Protonix 20 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Polyvinyl Alcohol 1.4 % Drops Sig: 1-2 Drops Ophthalmic PRN
(as needed) as needed for pruritis, dryness, pain.
5. Clonidine 0.3 mg/24 hr Patch Weekly Sig: One (1) Patch Weekly
Transdermal QSUN (every Sunday).
6. Sevelamer HCl 800 mg Tablet Sig: Two (2) Tablet PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
7. Carvedilol 25 mg Tablet Sig: Two (2) Tablet PO twice a day.
8. Hydralazine 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours).
9. Valsartan 160 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
10. Nifedipine 60 mg Tablet Sustained Release Sig: Two (2)
Tablet Sustained Release PO DAILY (Daily).
Disp:*60 Tablet Sustained Release(s)* Refills:*2*
11. Labetalol 200 mg Tablet Sig: Two (2) Tablet PO TID (3 times
a day).
Disp:*180 Tablet(s)* Refills:*2*
12. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO every four
(4) hours as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
13. Nephrocaps 1 mg Capsule Sig: One (1) Capsule PO once a day.



Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnoses:
(1) Posterior reversible encephalopathy syndrome (PRES)
(2) End stage renal disease, on hemodialysis
(3) S/p renal transplant now s/p transplant nephrectomy

Secondary Diagnoses:
(1) Malignant hypertension


Discharge Condition:
Stable


Discharge Instructions:
You were admitted to the hospital with headache and vision
changes that were likely related to your prior diagnosis of PRES
syndrome.  Please continue to monitor your blood pressure at
home as you have been doing, keep a copy and bring to clinic
visits.
Call your doctor at [**Telephone/Fax (1) 673**] if BP routinely goes high
(above 180 for the systolic pressure), if you have dizziness or
headaches.
Please continue your normal dialysis schedule.
Continue food, fluid and medication recomendations per your
kidney doctors [**First Name (Titles) 7219**]
[**Last Name (Titles) **] heavy lifting, nothing more than a gallon of milk
Do not drive if taking narcotic pain medication
Monitor incision for redness, drainage or bleeding

Followup Instructions:
[**First Name11 (Name Pattern1) 819**] [**Last Name (NamePattern4) 820**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2143-8-1**] 8:00
[**Name6 (MD) 2105**] [**Name8 (MD) 2106**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2143-8-6**] 2:40



Completed by:[**2143-7-26**]
{'Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease,Complications of transplanted kidney,End stage renal disease,Hyperpotassemia,Other encephalopathy,Other ureteric obstruction,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Gout, unspecified'}


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: Hypertensive urgency

PRESENT ILLNESS: This is a 42 year old M with past medical history significant
for ESRD s/p LRRT in [**2134**] c/b rejection now on HD with malignant
hypertension and likely PRES who presents with hypertensive
urgency. The patient reports that he had been feeling well since
his discharge from [**Hospital1 18**] in [**Month (only) 205**] of this year, though he notes
that his blood pressure has been persistently elevated to around
150s-160s/90s-100s. He presented to see his transplant
nephrologist this morning and developed acute onset of posterior
headache with visual changes which consisted of floaters in his
peripheral vision and the visualization of streaks of color. He
also notes that he felt tremulous at the time and as if he might
pass out, but this quickly passed. He therefore presented to the
ED for further evaluation.
.
The patient has a history of malignant hypertension and was
admitted in [**Month (only) 116**] of this year with a hypertensive emergency at
which time he had a seizure and a small SAH. He was then
admitted again in [**Month (only) 205**] with headaches and vision changes and a
SBP up to 200s. At that time, his antihypertensive regiemen was
increased and he has tolerated this regimen.
.
In the ED, initial VS: T 98.8 HR 69 BP 167/106 16 99% on RA. He
received 1L NS, morphine 4mg IV x1 and tylenol 650 mg PO x1 with
modest improvement in symptoms.
.
At this time, patient feels much improved. Denies any visual
changes, states headache is less than a [**1-20**] and does not want
further medication at this time. Otherwise, ROS negative for
fevers, chills, nightsweats, chest pain, shortness of breath,
cough, abdominal pain, nausea, vomiting, diarrhea, melena,
hematochezia, hematemesis, dysuria. No paresthesias or weakness.
Pertinent positives as above.

MEDICAL HISTORY: - ESRD secondary to chronic ureterovesical junction obstruction
leading to bilateral hydronephrosis, on hemodialysis
- S/p living-related renal transplant [**2134**] ([**Name (NI) 106515**] brother),
failed, now on hemodialysis since [**12-18**]
- Malignant hypertension
- PRES
- s/p SAH
- Gout
- Peptic Ulcer disease
- Bladder neck stricture
- Atypical chest pain

MEDICATION ON ADMISSION: Lisinopril 40 [**Hospital1 **]
Valsartan 160 [**Hospital1 **]
Bactrim 80-400 mg qday
Cellcept 1 gram [**Hospital1 **]
Sevelamer 800 mg tid
Clonidine patch 0.3 mg/24 hours - 1 patch q week
Carvedilol 50 mg [**Hospital1 **]
Protonix 20 mg q day
Hydralazine 50 mg q 6 hours
Nifedipine 30 mg q day
Nephrocaps 1 mg q day

ALLERGIES: Ciprofloxacin / Hydralazine

PHYSICAL EXAM: VS: T 98.5 BP 158/98 P 77 RR 22 98% RA
GEN: Well-appearing, comfortable in bed, talkative and in NAD
HEENT: NCAT, EOMI, PERRL, oropharynx clear and without erythema
or exudate
NECK: Supple, no appreciable JVD
CV: RRR, normal S1S2, no murmurs, rubs or gallops
PULM: CTAB, no w/r/r, good air movement bilaterally
ABD: Soft, NTND, normoactive bowel sounds, no organomegaly,
multiple well-healed incisions
EXT: Warm and well perfused, full and symmetric distal pulses,
no pedal edema, two hyperpigmented papules on plantar surface of
left foot
NEURO: AAOx3, responds appropriately to questions, CN 2-12
grossly intact, full strength in bilateral upper extremity
extensors, wrists, fingers, and lower extremities, downgoing
toes bilaterally

FAMILY HISTORY: Father had MI mid 50s. No DM. Brother had cancer of jaw which
was resected.

SOCIAL HISTORY: 40py, quit 2 yrs ago. No EtOH or other drugs. Lives in apartment 

### Response:
{'Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease,Complications of transplanted kidney,End stage renal disease,Hyperpotassemia,Other encephalopathy,Other ureteric obstruction,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Gout, unspecified'}
