CHIEF COMPLAINT: Diarrhea
Dehydration

PRESENT ILLNESS: 56 yo M with h/o necrotizing pancreatitis & pancreatic
pseudocyst
s/p ex-lap, open cholecystectomy, pancreatic pseudocyst
jejeunostomy, modified roux-en-y and pancreatic necrosectomy by
Dr. [**Last Name (STitle) **] on [**2189-7-30**].  His post operative course has been c/b
bilateral chylothorax requiring pleurodesis and chylous ascites
requiring therapeutic paracentesis.

MEDICAL HISTORY: PMH: Necrotizing pancreatitis, DMII, dx [**10-28**], L5 herniated
disc, B/L pleural effusions, SMV thrombosis, Hx melanoma, w
subsequent follow-up with no recurrence, Hx SVT

MEDICATION ON ADMISSION: Ranitidine 150'', diltiazem 120 ER', metformin 1,000'',
glimepiride 1', hydromorphone 2 ([**11-22**] Q6H PRN)Colace 100'', senna
8.6 ''

ALLERGIES: Bactrim

PHYSICAL EXAM: On Discharge:
Vitals: 99.1, 83, 108/54, 20, 96% RAS
GEN: A&O, NAD
HEENT: No scleral icterus, dry mucus membranes
CV: RRR, No M/G/R
PULM: mildly decreased breath sounds at lung bases, mild
crackles
bilaterally
ABD: Soft, nondistended, nontender, no rebound or guarding,
normoactive bowel sounds, no palpable masses
Ext: No LE edema, LE warm and well perfused

FAMILY HISTORY: No biliary or pancreatic disease

SOCIAL HISTORY: He works with a software business company.  He lives at home
with his children.  He does not smoke, and drinks occasionally
five to six glasses of alcohol a week (prior dx. of
pancreatitis).  He denies any history of IV drug abuse.
Acute pancreatitis,Paroxysmal supraventricular tachycardia,Diarrhea,Dehydration,Palpitations,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of malignant melanoma of skin,Personal history of venous thrombosis and embolism
Acute pancreatitis,Parox atrial tachycardia,Diarrhea,Dehydration,Palpitations,DMII wo cmp nt st uncntr,Hx-malig skin melanoma,Hx-ven thrombosis/embols
Admission Date:  [**2190-3-31**]              Discharge Date:   [**2190-4-2**]

Date of Birth:  [**2133-6-4**]             Sex:   M

Service: SURGERY

Allergies:
Bactrim

Attending:[**First Name3 (LF) 148**]
Chief Complaint:
Diarrhea
Dehydration

Major Surgical or Invasive Procedure:
None


History of Present Illness:
56 yo M with h/o necrotizing pancreatitis & pancreatic
pseudocyst
s/p ex-lap, open cholecystectomy, pancreatic pseudocyst
jejeunostomy, modified roux-en-y and pancreatic necrosectomy by
Dr. [**Last Name (STitle) **] on [**2189-7-30**].  His post operative course has been c/b
bilateral chylothorax requiring pleurodesis and chylous ascites
requiring therapeutic paracentesis.

Mr. [**Known lastname 81329**] now presents with multiple episodes of diarrhea
since
yesterday (>12 episodes).  The diarrhea is clear and he feels he
is losing a large amount of water.  He presents in SVT to 170
and
hypotensive to sBP 80s which he reports he has a history of and
has had multiple similar presentations to the ED in the past.
Patient reports he is extremely lightheaded, nausea, but denies
vomiting, fever, chills, hematochezia and abdominal pain
currently.  He reports that he woke up this morning and was
short
of breath.

The patient was discharged home on [**2190-3-28**] and reports that at
that time he was having a few loose stools per day.  He was not
given any antibiotics on his last hospital visit. He denies sick
contacts. The stools then increased in frequency and became more
loose.  He had a low fat diet of cereal and pasta yesterday. He
currently supplements his nutrition with home TPN, which he does
at night.


Past Medical History:
PMH: Necrotizing pancreatitis, DMII, dx [**10-28**], L5 herniated
disc, B/L pleural effusions, SMV thrombosis, Hx melanoma, w
subsequent follow-up with no recurrence, Hx SVT

PSH:  [**2189-7-30**]: Exploratory laparotomy, open cholecystectomy,
pancreatic pseudocyst jejunostomy, roux-en-Y formation via an
omega loopa, and pancreatic necrosectomy. [**2189-10-29**]: bilateral
talc pleurodesis for chylothorax


Social History:
He works with a software business company.  He lives at home
with his children.  He does not smoke, and drinks occasionally
five to six glasses of alcohol a week (prior dx. of
pancreatitis).  He denies any history of IV drug abuse.


Family History:
No biliary or pancreatic disease


Physical Exam:
On Discharge:
Vitals: 99.1, 83, 108/54, 20, 96% RAS
GEN: A&O, NAD
HEENT: No scleral icterus, dry mucus membranes
CV: RRR, No M/G/R
PULM: mildly decreased breath sounds at lung bases, mild
crackles
bilaterally
ABD: Soft, nondistended, nontender, no rebound or guarding,
normoactive bowel sounds, no palpable masses
Ext: No LE edema, LE warm and well perfused


Pertinent Results:
[**2190-3-31**] 11:30AM BLOOD WBC-12.2*# RBC-4.61 Hgb-12.0* Hct-36.2*
MCV-79* MCH-26.0* MCHC-33.1 RDW-16.7* Plt Ct-491*#
[**2190-3-31**] 11:30AM BLOOD Glucose-227* UreaN-24* Creat-0.7 Na-137
K-4.7 Cl-105 HCO3-19* AnGap-18
[**2190-3-31**] 11:30AM BLOOD Albumin-3.3* Calcium-8.3* Phos-4.6*
Mg-2.0
[**2190-4-2**] 02:11AM BLOOD Calcium-8.5 Phos-4.3 Mg-2.0
[**2190-3-31**] 04:40PM BLOOD CK-MB-3 cTropnT-0.01
[**2190-4-1**] 12:02AM BLOOD CK-MB-3 cTropnT-0.03*
[**2190-4-1**] 05:07PM BLOOD CK-MB-3 cTropnT-<0.01
[**2190-3-31**] 04:40PM BLOOD CK(CPK)-27*
[**2190-4-1**] 12:02AM BLOOD CK(CPK)-31*
[**2190-4-1**] 05:07PM BLOOD CK(CPK)-31*
[**2190-4-2**] 02:11AM BLOOD WBC-6.2 RBC-3.96* Hgb-10.5* Hct-30.5*
MCV-77* MCH-26.5* MCHC-34.5 RDW-16.7* Plt Ct-310

[**2190-3-31**] 3:40 pm MRSA SCREEN      Source: Nasal swab.
                  **FINAL REPORT [**2190-4-2**]**
MRSA SCREEN (Final [**2190-4-2**]): POSITIVE FOR METHICILLIN RESISTANT
STAPH AUREUS.

[**2190-4-1**] 2:30 am BLOOD CULTURE      FROM RT PICC # 2.
Blood Culture, Routine (Preliminary): GRAM POSITIVE
COCCUS(COCCI).  IN PAIRS AND CLUSTERS.

[**2190-3-31**] EKG:
Narrow complex supraventricular tachycardia at a rate of 182
with diffuse
ST-T wave abnormalities. Compared to the previous tracing of
[**2189-12-16**] the
abnormalities and the tachycardia are new but they were present
on the
earlier tracing of [**2189-12-16**].

[**2190-4-1**] EKG:
Sinus rhythm. Minor inferior T wave flattening. Compared to
tracing #1
supraventricular tachycardia has resolved.

[**2190-3-31**] CHEST PA:
IMPRESSION:
1. Slightly retracted right PICC, now at cavoatrial junction.
2. Stable bilateral small effusions and bibasilar atelectasis.


Brief Hospital Course:
The patient well known for pancreaticobiliary service was
admitted on [**2190-3-31**] with c/c of diarrhea, dehydration and
palpitations. In ED, the patient was found to have SVT, which
was converted to regular rhythm with adenosine. The patient was
given IV fluid resuscitation and transferred into ICU for
observation. On HD #2, repeat EKG revealed RRR, cardiac enzymes
were negative, the patient was transferred on the floor. Diet
was advanced to regular no fat, TPN was restarted. The patient
was hemodynamically stable. One set of blood cultures drawn in
the ED grew coag negative staph. Follow up blood/urine  cultures
were no growth to date. Given that only one set was positive
this was likely a contaminated set. The patient was discharged
home on HD # 3 in stable condition.
At the time of discharge, the patient was doing well, afebrile
with stable vital signs.  The patient was tolerating a regular
diet, ambulating, voiding without assistance, and pain was well
controlled.  The patient received discharge teaching and
follow-up instructions with understanding verbalized and
agreement with the discharge plan.


Medications on Admission:
Ranitidine 150'', diltiazem 120 ER', metformin 1,000'',
glimepiride 1', hydromorphone 2 ([**11-22**] Q6H PRN)Colace 100'', senna
8.6 ''


Discharge Medications:
1. diltiazem HCl 120 mg Capsule, Extended Release Sig: One (1)
Capsule, Extended Release PO DAILY (Daily).
2. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO twice a
day.
3. metformin 1,000 mg Tablet Sig: One (1) Tablet PO twice a day.

4. glimepiride 1 mg Tablet Sig: One (1) Tablet PO once a day.
5. Dilaudid 2 mg Tablet Sig: 1-2 Tablets PO every six (6) hours
as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
6. insulin regular human 100 unit/mL Solution Sig: 2-14 units
Injection ASDIR (AS DIRECTED): Please follow the sliding scale.

7. vitamin A 10,000 unit Capsule Sig: One (1) Capsule PO once a
day for 2 weeks.
8. vitamin E 400 unit Capsule Sig: One (1) Capsule PO once a
day.
Disp:*30 Capsule(s)* Refills:*2*
9. ergocalciferol (vitamin D2) 50,000 unit Capsule Sig: One (1)
Capsule PO once a day for 2 months.


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 511**] Home Therapy

Discharge Diagnosis:
1. Necrotizing pancreatitis
2. Pancreatic pseudocyst
3. Supraventricular tachycardia
4. Diarrhea and dehydration


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Please resume all regular home medications , unless specifically
advised not to take a particular medication.  Also, please take
any new medications as prescribed.
Please get plenty of rest, continue to ambulate several times
per day, and drink adequate amounts of fluids.  Avoid lifting
weights greater than [**3-30**] lbs until you follow-up with your
surgeon, who will instruct you further regarding activity
restrictions.
Avoid driving or operating heavy machinery while taking pain
medications.
Please follow-up with your surgeon and Primary Care Provider
(PCP) as advised.
Please call your doctor or nurse practitioner if you experience
the following:
*You experience new chest pain, pressure, squeezing or
tightness.
*New or worsening cough, shortness of breath, or wheeze.
*If you are vomiting and cannot keep down fluids or your
medications.
*You are getting dehydrated due to continued vomiting, diarrhea,
or other reasons. Signs of dehydration include dry mouth, rapid
heartbeat, or feeling dizzy or faint when standing.
*You see blood or dark/black material when you vomit or have a
bowel movement.
*You experience burning when you urinate, have blood in your
urine, or experience a discharge.
*Your pain is not improving within 8-12 hours or is not gone
within 24 hours. Call or return immediately if your pain is
getting worse or changes location or moving to your chest or
back.
*You have shaking chills, or fever greater than 101.5 degrees
Fahrenheit or 38 degrees Celsius.
*Any change in your symptoms, or any new symptoms that concern
you.
PICC Line:
*Please monitor the site regularly, and [**Name6 (MD) 138**] your MD, nurse
practitioner, or [**Name6 (MD) 269**] Nurse if you notice redness, swelling,
tenderness or pain, drainage or bleeding at the insertion site.
* [**Name6 (MD) **] your MD [**First Name (Titles) **] [**Last Name (Titles) 10836**] to the Emergency Room immediately if
the PICC Line tubing becomes damaged or punctured, or if the
line is pulled out partially or completely.  DO NOT USE THE PICC
LINE IN THESE CIRCUMSTANCES.Please keep the dressing clean and
dry. Contact your [**Name2 (NI) 269**] Nurse if the dressing comes undone or is
significantly soiled for further instructions.


Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 2832**], MD Phone:[**Telephone/Fax (1) 1231**]
Date/Time:[**2190-5-7**] 10:30 [**Hospital Ward Name 23**] 3, [**Hospital Ward Name **]
.
Provider: [**Name Initial (NameIs) **] 2 (ST-4) GI ROOMS Date/Time:[**2190-7-1**] 11:00
Provider: [**Name10 (NameIs) 1948**] [**Last Name (NamePattern4) 1949**], MD Phone:[**Telephone/Fax (1) 463**]
Date/Time:[**2190-7-1**] 11:00
.
Please follow up with [**Name6 (MD) 251**] [**Last Name (NamePattern4) 677**], MD (ELECTROPHYSIOLOGY)
in [**1-22**] weeks to discuss treatment options for your SVT. Call
[**Telephone/Fax (1) 7332**] to schedule an appointment.



Completed by:[**2190-4-2**]
{'Acute pancreatitis,Paroxysmal supraventricular tachycardia,Diarrhea,Dehydration,Palpitations,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of malignant melanoma of skin,Personal history of venous thrombosis and embolism'}


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: Diarrhea
Dehydration

PRESENT ILLNESS: 56 yo M with h/o necrotizing pancreatitis & pancreatic
pseudocyst
s/p ex-lap, open cholecystectomy, pancreatic pseudocyst
jejeunostomy, modified roux-en-y and pancreatic necrosectomy by
Dr. [**Last Name (STitle) **] on [**2189-7-30**].  His post operative course has been c/b
bilateral chylothorax requiring pleurodesis and chylous ascites
requiring therapeutic paracentesis.

MEDICAL HISTORY: PMH: Necrotizing pancreatitis, DMII, dx [**10-28**], L5 herniated
disc, B/L pleural effusions, SMV thrombosis, Hx melanoma, w
subsequent follow-up with no recurrence, Hx SVT

MEDICATION ON ADMISSION: Ranitidine 150'', diltiazem 120 ER', metformin 1,000'',
glimepiride 1', hydromorphone 2 ([**11-22**] Q6H PRN)Colace 100'', senna
8.6 ''

ALLERGIES: Bactrim

PHYSICAL EXAM: On Discharge:
Vitals: 99.1, 83, 108/54, 20, 96% RAS
GEN: A&O, NAD
HEENT: No scleral icterus, dry mucus membranes
CV: RRR, No M/G/R
PULM: mildly decreased breath sounds at lung bases, mild
crackles
bilaterally
ABD: Soft, nondistended, nontender, no rebound or guarding,
normoactive bowel sounds, no palpable masses
Ext: No LE edema, LE warm and well perfused

FAMILY HISTORY: No biliary or pancreatic disease

SOCIAL HISTORY: He works with a software business company.  He lives at home
with his children.  He does not smoke, and drinks occasionally
five to six glasses of alcohol a week (prior dx. of
pancreatitis).  He denies any history of IV drug abuse. 

### Response:
{'Acute pancreatitis,Paroxysmal supraventricular tachycardia,Diarrhea,Dehydration,Palpitations,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of malignant melanoma of skin,Personal history of venous thrombosis and embolism'}
