CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 76-year-old
female with a history of non-small cell lung cancer of the
left lower lobe diagnosed in [**2131-1-26**] status post
chemotherapy and radiation therapy for locally advanced
disease, and status post radiation treatment for brain
metastases, who is admitted for pneumonia and failure to
thrive with decreased oral intake and weakness which has
worsened over the prior two to three weeks.  Also, she had a
rash and urinary frequency.  She was admitted and treated for
a urinary tract infection, pneumonia, and volume depletion.

MEDICAL HISTORY: Past medical history as described
above.

MEDICATION ON ADMISSION: 

ALLERGIES: Allergy to SALICYLATES to which she gets hives.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history was noncontributory.

SOCIAL HISTORY: The patient smoked one and a half packs per
day of tobacco for 55 years and occasional alcohol use.
Secondary malignant neoplasm of other specified sites,Atrial fibrillation,Acute kidney failure, unspecified,Pneumonia, organism unspecified,Malignant neoplasm of lower lobe, bronchus or lung,Urinary tract infection, site not specified,Unspecified pleural effusion
Secondary malig neo NEC,Atrial fibrillation,Acute kidney failure NOS,Pneumonia, organism NOS,Mal neo lower lobe lung,Urin tract infection NOS,Pleural effusion NOS
Admission Date:  [**2131-8-21**]       Discharge Date:  [**2131-8-31**]

Date of Birth:   [**2055-3-30**]       Sex:  F

Service:  CCU

Dictating for:  [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.

HISTORY OF PRESENT ILLNESS:  The patient is a 76-year-old
female with a history of non-small cell lung cancer of the
left lower lobe diagnosed in [**2131-1-26**] status post
chemotherapy and radiation therapy for locally advanced
disease, and status post radiation treatment for brain
metastases, who is admitted for pneumonia and failure to
thrive with decreased oral intake and weakness which has
worsened over the prior two to three weeks.  Also, she had a
rash and urinary frequency.  She was admitted and treated for
a urinary tract infection, pneumonia, and volume depletion.

On admission, she was found to have worsening hypertension
with shortness of breath that was not improved with a saline
bolus and with Lasix.  An echocardiogram report showed a
pericardial effusion with tamponade and pulsus paradoxus
of 16.  The patient had a pericardiocentesis with a drain
placement that removed 500 cc of fluid and an additional
200 cc to 300 cc of fluid at the bedside.  The tamponade
resolved, and the patient was in stable condition.

PAST MEDICAL HISTORY:  Past medical history as described
above.

ALLERGIES:  Allergy to SALICYLATES to which she gets hives.

FAMILY HISTORY:   Family history was noncontributory.

SOCIAL HISTORY:  The patient smoked one and a half packs per
day of tobacco for 55 years and occasional alcohol use.

PHYSICAL EXAMINATION ON PRESENTATION:  Physical examination
on admission revealed vital signs with a temperature of 94.7
degrees Fahrenheit, heart rate was 95 to 100, blood pressure
was 91 to 110/35 to 58, respiratory was 18, oxygen saturation
was 95% on 4 liters, and a pulse of 6 mmHg.  In general, she
was awake and alert in no apparent distress.  Her head, eyes,
ears, nose, and throat examination was significant for pupils
were equal, round, and reactive to light.  She had dry oral
mucosa.  She had jugular venous pressure at 1 cm above the
clavicle at 30 degrees.  Cardiovascular examination was
significant for a regular rate and rhythm and without
murmurs, gallops or rubs.  Lung examination was significant
for rales one-third of the way up bilaterally.  Abdominal
examination revealed positive bowel sounds, nontender, and
nondistended.  No hepatosplenomegaly.  Extremities were
significant for an erythematous macular rash on the upper and
lower extremities bilaterally as well as the chest.
Pretibial edema of 1+.  Neurologic examination was nonfocal.

PERTINENT LABORATORY DATA ON PRESENTATION:  Laboratory
examination was significant for a white blood cell count
of 13, hematocrit was 27.9, hemoglobin was 9.5, platelets
were 187.  Differential showed 89 neutrophils with 3 bands
and 4 lymphocytes.  Chemistry-7 showed sodium was 131,
potassium was 5.6, chloride was 101, bicarbonate was 12,
blood urea nitrogen was 48, creatinine was 2.2, and blood
glucose was 153, with an anion gap of 18.  Calcium was 7.9,
phosphate was 7.2, magnesium was 1.7.  PTT was 37.6 and INR
was 3.  Pericardial fluid showed 2+ polymorphonuclear
leukocytes, white count of 550.

RADIOLOGY/IMAGING:   A chest x-ray showed a left lower lobe
pneumonia with atelectasis and consolidation.

Electrocardiogram showed low voltage with sinus rhythm at
106, diffuse minimal ST elevations, and question of
electrical alternans.

Echocardiogram showed a left ventricular ejection fraction of
greater than 55%, with moderate-to-large pericardial
effusion, and right ventricular diastolic collapse;
consistent with impaired filling and tamponade.

The echocardiogram after pericardial drainage showed the
effusion was resolved.  No residual fluid or residual
tamponade, and a thickened pericardial rim.

HOSPITAL COURSE:   The patient's pericardial effusion was
initially resolved with a drain placement and reaccumulated.
It was decided to place another larger pericardial catheter
instead of a pericardial window for drainage of the
pericardial space.  In addition, a drain was placed in the
pleural space to drain bilateral pleural effusions.  Cytology
of the pericardial fluid showed malignant cells consistent
with non-small cell carcinoma.  Drainage of the pericardial
space slowly declined, and the pericardial drain was
eventually removed without problems.

Atrial fibrillation occurred intermittently.  Digoxin
0.125 mg was given for this as the patient's high liver
function tests prevented amiodarone, and the patient's
hypotension prevented the use of calcium channel blocker and
beta blockers.

The patient had pulmonary edema and bilateral pleural
effusions for which a pleural drain was placed.  The patient
had episodes of oxygen desaturations to the middle 80s on
room air and was maintained on 15 liters face mask at 96% and
eventually was able to be weaned down to was 2 liters nasal
cannula with oxygen saturations in the low 90s.

At the time of this Discharge Summary, the pleural drain
continued to be in place, but the plan was to remove upon
discharge.

The acute renal failure on admission was complicated by
hyperkalemia, and hyperphosphatemia, and an increased anion
gap.  All resolved with volume repletion, use of Kayexalate,
and phosphate binders.

The patient's pneumonia on admission was treated with
levofloxacin 250 mg q.d. which was increased to 500 mg q.d.
once the acute renal failure was resolved.

The hospital course was also complicated by increased liver
function tests with an AST of 5700 that eventually resolved
on its own.  An ultrasound of the liver to evaluate for
metastases was negative.

The patient was found to have low platelets and a positive
screen for heparin antibody.  After discontinuation of
heparin flushes, the thrombocytopenia resolved.  Vitamin K,
fresh frozen plasma, and platelets were given with success to
improve coagulation.

Neurologically, the patient worsened after the placement of
the second pericardial drain and remained intermittently
lucid and disoriented.

Nutritionally, the patient was admitted with a decreased oral
intake; and this, give and take, worsened throughout the
[**Hospital 228**] hospital stay.  After a discussion with the patient
and the family regarding placement of a nasogastric tube
and/or a gastrojejunostomy tube for nutritional
supplementation, it was decided that based on the patient's
poor prognosis that these options were not appropriate.

Finally, the [**Hospital 228**] hospital stay was complicated by
hypercalcemia which was treated with moderate success with
intravenous normal saline and intravenous Lasix.

MEDICATIONS ON DISCHARGE:
1.  Fentanyl patch 25 mcg per hour q.72h.
2.  Scopolamine patch 1.5 mg every three days as needed for
nausea.
3.  Lorazepam 0.5 mg to 2 mg p.o. q.4h. as needed for anxiety
and restlessness; given sublingually and dispensed with 2 cc
of 5 mg/cc elixir.
4.  Levsin 0.125 mg to 2.5 mg q.4-6h. as needed for
respiratory congestion; dispense sublingually 2 cc of
0.25mg/cc elixir.
5.  Morphine concentrate 5 mg to 20 mg q.1-2h. as needed for
pain or dyspnea; dispense 2 cc of 50 mg/cc elixir.
6.  Lasix 40 mg intravenously q.d.

DISCHARGE DIAGNOSES:   End-stage metastatic non-small cell
lung cancer.

CONDITION AT DISCHARGE: Condition on discharge was fair.

DISCHARGE DISPOSITION:  The patient was to be discharged to
the [**Hospital3 38643**].




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1013**], M.D.  [**MD Number(1) 1014**]

Dictated By:[**Last Name (NamePattern4) 38644**]
MEDQUIST36

D:  [**2131-8-30**]  15:27
T:  [**2131-8-30**]  15:42
JOB#:  [**Job Number 38645**]
{'Secondary malignant neoplasm of other specified sites,Atrial fibrillation,Acute kidney failure, unspecified,Pneumonia, organism unspecified,Malignant neoplasm of lower lobe, bronchus or lung,Urinary tract infection, site not specified,Unspecified pleural effusion'}


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: 

PRESENT ILLNESS: The patient is a 76-year-old
female with a history of non-small cell lung cancer of the
left lower lobe diagnosed in [**2131-1-26**] status post
chemotherapy and radiation therapy for locally advanced
disease, and status post radiation treatment for brain
metastases, who is admitted for pneumonia and failure to
thrive with decreased oral intake and weakness which has
worsened over the prior two to three weeks.  Also, she had a
rash and urinary frequency.  She was admitted and treated for
a urinary tract infection, pneumonia, and volume depletion.

MEDICAL HISTORY: Past medical history as described
above.

MEDICATION ON ADMISSION: 

ALLERGIES: Allergy to SALICYLATES to which she gets hives.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history was noncontributory.

SOCIAL HISTORY: The patient smoked one and a half packs per
day of tobacco for 55 years and occasional alcohol use. 

### Response:
{'Secondary malignant neoplasm of other specified sites,Atrial fibrillation,Acute kidney failure, unspecified,Pneumonia, organism unspecified,Malignant neoplasm of lower lobe, bronchus or lung,Urinary tract infection, site not specified,Unspecified pleural effusion'}
