CHIEF COMPLAINT: tongue swelling, neck swelling

PRESENT ILLNESS: This is a [**Age over 90 **] year old woman with PMH significant for gallstones,
previous stroke, a fib who presents following ERCP for tongue
angioedema. She was admitted today for ERCP for recurrent stones
in her biliary tree. During the procedure, she received
gentamycin at 1430, glucagon, and anesthesia with versed and
fentanyl. Ampicillin was deferred given previous allergy. Six
stones were extracted with a balloon catheter and biopsy was
performed of an incidental polyp and she was put in the PACU. In
the PACU, she received 1 g of vancomycin at 1430 and then
complained of nausea, so she got 6.25 mg IV phenergan at 1445.
At 1645, she started complaining of neck and tongue swelling.
She was found to have some stridor and received 50 mg IV
benadryl and 100 mg hydrocortisone. She was admitted to the ICU
for close monitoring.
.
ROS: Vit her son, a [**Name2 (NI) **] interpreter, she is complaining of
moderate throat pain. She has slight shortness of breath, not
different from her baseline. She denies chest pain, abdominal
pain. She has some chronic leg swelling. She does not have a
rash.

MEDICAL HISTORY: 1. s/p R occipital CVA [**2-/2157**] complicated by seizures
2. Microvascular disease
3. extensive basal ganglia disease with ? Parkinsonian disorder

MEDICATION ON ADMISSION: lasix 160 mg po qd
coumadin 9.5 mg po MWF, 7.5 mg po other days (stopped 5 days
prior to procedure)
digoxin 0.25 mcg po qd
zoloft 50 mg po qd
dilantin 400 mg po Q sunday, 300 mg po rest of week
ursodiol 300 mg po bid
meclizine 12.5 mg po tid prn
metoprolol 25 mg po qd
captopril 25 mg po qd
lipitor 20 mg po qd

ALLERGIES: Iodine; Iodine Containing / Ampicillin / Phenergan

PHYSICAL EXAM: V: T98.6 P63 BP139/67 R18 96% 2LNC
Gen: voice muffled, neck swollen, no respiratory distress
HEENT: PERRLA, tongue enlarged, swollen and filling most of her
airway. Somewhat improved on repeat exam.
Neck: submandibular soft tissue full to palpation, 3-4 cm thick.
No woody appearance as noted previously
Resp: crackles bilateral bases, end expiratory wheezes
CV: RRR nl s1s2 III/VI SEM at apex
Abd: Soft, nontender, normal bowel sounds
Ext: no edema, pneumoboots in place
Neuro: CN 2-12 intact with slightly decreased sensation to light
touch on right cheek. strength 5/5 except [**5-2**] hip flexion in
bed.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives alone at home, daughter is primary caretaker. [**Name (NI) **] h/o
Tobacco or ETOH.
Angioneurotic edema, not elsewhere classified,Calculus of bile duct without mention of cholecystitis, without mention of obstruction,Atrial fibrillation,Congestive heart failure, unspecified,Other sedatives and hypnotics causing adverse effects in therapeutic use,Unspecified essential hypertension,Epilepsy, unspecified, without mention of intractable epilepsy
Angioneurotic edema,Choledocholithiasis NOS,Atrial fibrillation,CHF NOS,Adv eff sedat/hypnot NEC,Hypertension NOS,Epilep NOS w/o intr epil
Admission Date:  [**2165-5-14**]              Discharge Date:   [**2165-5-17**]


Service: MEDICINE

Allergies:
Iodine; Iodine Containing / Ampicillin / Phenergan

Attending:[**First Name3 (LF) 1148**]
Chief Complaint:
tongue swelling, neck swelling

Major Surgical or Invasive Procedure:
None


History of Present Illness:
This is a [**Age over 90 **] year old woman with PMH significant for gallstones,
previous stroke, a fib who presents following ERCP for tongue
angioedema. She was admitted today for ERCP for recurrent stones
in her biliary tree. During the procedure, she received
gentamycin at 1430, glucagon, and anesthesia with versed and
fentanyl. Ampicillin was deferred given previous allergy. Six
stones were extracted with a balloon catheter and biopsy was
performed of an incidental polyp and she was put in the PACU. In
the PACU, she received 1 g of vancomycin at 1430 and then
complained of nausea, so she got 6.25 mg IV phenergan at 1445.
At 1645, she started complaining of neck and tongue swelling.
She was found to have some stridor and received 50 mg IV
benadryl and 100 mg hydrocortisone. She was admitted to the ICU
for close monitoring.
.
ROS: Vit her son, a [**Name2 (NI) **] interpreter, she is complaining of
moderate throat pain. She has slight shortness of breath, not
different from her baseline. She denies chest pain, abdominal
pain. She has some chronic leg swelling. She does not have a
rash.


Past Medical History:
1. s/p R occipital CVA [**2-/2157**] complicated by seizures
2. Microvascular disease
3. extensive basal ganglia disease with ? Parkinsonian disorder

4. gait disorder
5. A fib on coumadin
6. HTN
7. dyslipidemia
8. s/p cholecystectomy with recurrent CBD gallstones
9. advanced DJD
10. Meniere's disease
11. CHF
12. Basal cell cancer
13. Frequent falls


Social History:
Lives alone at home, daughter is primary caretaker. [**Name (NI) **] h/o
Tobacco or ETOH.

Family History:
non-contributory

Physical Exam:
V: T98.6 P63 BP139/67 R18 96% 2LNC
Gen: voice muffled, neck swollen, no respiratory distress
HEENT: PERRLA, tongue enlarged, swollen and filling most of her
airway. Somewhat improved on repeat exam.
Neck: submandibular soft tissue full to palpation, 3-4 cm thick.
No woody appearance as noted previously
Resp: crackles bilateral bases, end expiratory wheezes
CV: RRR nl s1s2 III/VI SEM at apex
Abd: Soft, nontender, normal bowel sounds
Ext: no edema, pneumoboots in place
Neuro: CN 2-12 intact with slightly decreased sensation to light
touch on right cheek. strength 5/5 except [**5-2**] hip flexion in
bed.


Pertinent Results:
[**2165-5-14**] 08:48PM   GLUCOSE-124* UREA N-21* CREAT-0.8 SODIUM-141
POTASSIUM-4.3 CHLORIDE-102 TOTAL CO2-29 ANION GAP-14
[**2165-5-14**] 08:48PM   CALCIUM-9.2 PHOSPHATE-3.4 MAGNESIUM-2.1
[**2165-5-14**] 08:48PM   DIGOXIN-1.8
[**2165-5-14**] 08:48PM   WBC-9.6 RBC-4.03* HGB-12.2 HCT-34.7* MCV-86
MCH-30.2 MCHC-35.1* RDW-16.4*
[**2165-5-14**] 08:48PM   NEUTS-87.0* LYMPHS-8.7* MONOS-3.6 EOS-0.3
BASOS-0.3
[**2165-5-14**] 08:48PM   MICROCYT-1+
[**2165-5-14**] 08:48PM   PLT COUNT-192
[**2165-5-14**] 08:48PM   PT-12.6 PTT-23.1 INR(PT)-1.1
[**2165-5-14**] 01:00PM   UREA N-24* CREAT-0.9 SODIUM-141 POTASSIUM-4.0
CHLORIDE-100 TOTAL CO2-31 ANION GAP-14
[**2165-5-14**] 01:00PM   ALT(SGPT)-34 AST(SGOT)-33 ALK PHOS-105
AMYLASE-72
[**2165-5-14**] 01:00PM   LIPASE-31
[**2165-5-14**] 01:00PM   ALBUMIN-4.2
[**2165-5-14**] 01:00PM   WBC-6.9 RBC-3.85* HGB-11.7* HCT-32.1* MCV-83
MCH-30.3 MCHC-36.3* RDW-15.8*
[**2165-5-14**] 01:00PM   PLT COUNT-215
[**2165-5-14**] 01:00PM   PT-13.1 INR(PT)-1.1
.
CXR: FINDINGS: The cardiomediastinal silhouette is relatively
unchanged, with tortuous aorta and mild cardiomegaly. There is a
hiatal hernia. Pulmonary vasculature is prominent, with upper
zone redistribution. Lung volumes are low. There is atelectasis
in the right lower lung. There is a retrocardiac density, that
may represent atelectasis, infiltrate, or combination of both.

Brief Hospital Course:
A/P: [**Age over 90 **]F with h/o CHF, A fib, h/o stroke and recurrent
gallstones s/p ERCP with angioedema.
.
#) angioedema - unclear which inciting medication was most
likely. Meds she received in the hours before the event include
vancomycin, phenergan, gentamycin, glucagon, fentanyl and
versed. She is also on captopril which is associated with
angioedema. Responded to benadryl, famotidine, solumedrol IV,
racemic epi.  Transferred out of the MICU and monitored without
need for further meds or recurrent event.  Seen by allergy who
is interested to do skin testing once patient more than 4 days
without H1 blockers.  Patient encouraged to arrange follow up
appointment.  Possible that this was in relationship to contrast
she received as well.  At time of discharge some mild R neck
pain but no further tongue swelling.
.
#) s/p ERCP for gallstones - procedure went well, pt without
abdominal pain post op.  Will follow up with Dr. [**Last Name (STitle) **] as
outpatient.
.
#) h/o seizures
- continued dilantin
.
#) h/o A fib - in NSR for now.  Held coumadin post op but will
begin again now on discharge and get INR followed up in next few
days.  Restarted dig and other cardiac meds once taking good po.

.
#) h/o CHF - JVD low and breathing well on room air, so
initially held lasix but restarted dose prior to discharge.
.
3) Right antecub - Patient developed erythema and tenderness
around area of IV site.  IV removed and hot compresses placed.
Told to see doctor if pain worsens or redness worsens.

Medications on Admission:
lasix 160 mg po qd
coumadin 9.5 mg po MWF, 7.5 mg po other days (stopped 5 days
prior to procedure)
digoxin 0.25 mcg po qd
zoloft 50 mg po qd
dilantin 400 mg po Q sunday, 300 mg po rest of week
ursodiol 300 mg po bid
meclizine 12.5 mg po tid prn
metoprolol 25 mg po qd
captopril 25 mg po qd
lipitor 20 mg po qd


Discharge Medications:
1. Furosemide 40 mg Tablet Sig: Four (4) Tablet PO DAILY
(Daily).
2. Digoxin 250 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Sertraline 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Phenytoin Sodium Extended 100 mg Capsule Sig: Four (4)
Capsule PO QSUN (every Sunday).
5. Phenytoin Sodium Extended 100 mg Capsule Sig: Three (3)
Capsule PO DAILY (Daily).
6. Ursodiol 300 mg Capsule Sig: One (1) Capsule PO BID (2 times
a day).
7. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Captopril 12.5 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
9. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. Coumadin 2.5 mg Tablet Sig: as directed Tablet PO as
directed: Please restart as directed previously.
11. Outpatient Lab Work
Please check INR on [**5-22**] and send results to [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 143**],
MD Phone:[**Telephone/Fax (1) 142**]


Discharge Disposition:
Home With Service

Facility:
[**Hospital6 1952**], [**Location (un) 86**]

Discharge Diagnosis:
Angioedema
Allergic reaction


Discharge Condition:
Good


Discharge Instructions:
You had swelling of your tongue after receiving medicines for an
ERCP.  It is unclear which medication you reacted to so it is
important to get further testing in allergy clinic.  Please
return if you develop swelling of your tongue again, difficulty
breathing, worsening throat swelling/pain.
.
You should now restart your coumadin as previous and get your
INR checked next week.
.
The swelling in your right arm is likely from the IV site.  If
it becomes more red or painful or you develop a fever please
call your primary care doctor [**First Name (Titles) **] [**Last Name (Titles) 2742**].

Followup Instructions:
Please make a follow up appointment with allergy clinic in the
next month to get further skin testing.  Please call
[**Telephone/Fax (1) 1723**] to arrange an appointment.
.
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 143**], MD Phone:[**Telephone/Fax (1) 142**]
Date/Time:[**2165-6-10**] 2:00; please call to arrange this appointment
a week sooner.
.
Please call [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 2743**] office ([**Telephone/Fax (1) 2744**]) to arrange
follow up with him.
{'Angioneurotic edema, not elsewhere classified,Calculus of bile duct without mention of cholecystitis, without mention of obstruction,Atrial fibrillation,Congestive heart failure, unspecified,Other sedatives and hypnotics causing adverse effects in therapeutic use,Unspecified essential hypertension,Epilepsy, unspecified, without mention of intractable epilepsy'}


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 swelling, neck swelling

PRESENT ILLNESS: This is a [**Age over 90 **] year old woman with PMH significant for gallstones,
previous stroke, a fib who presents following ERCP for tongue
angioedema. She was admitted today for ERCP for recurrent stones
in her biliary tree. During the procedure, she received
gentamycin at 1430, glucagon, and anesthesia with versed and
fentanyl. Ampicillin was deferred given previous allergy. Six
stones were extracted with a balloon catheter and biopsy was
performed of an incidental polyp and she was put in the PACU. In
the PACU, she received 1 g of vancomycin at 1430 and then
complained of nausea, so she got 6.25 mg IV phenergan at 1445.
At 1645, she started complaining of neck and tongue swelling.
She was found to have some stridor and received 50 mg IV
benadryl and 100 mg hydrocortisone. She was admitted to the ICU
for close monitoring.
.
ROS: Vit her son, a [**Name2 (NI) **] interpreter, she is complaining of
moderate throat pain. She has slight shortness of breath, not
different from her baseline. She denies chest pain, abdominal
pain. She has some chronic leg swelling. She does not have a
rash.

MEDICAL HISTORY: 1. s/p R occipital CVA [**2-/2157**] complicated by seizures
2. Microvascular disease
3. extensive basal ganglia disease with ? Parkinsonian disorder

MEDICATION ON ADMISSION: lasix 160 mg po qd
coumadin 9.5 mg po MWF, 7.5 mg po other days (stopped 5 days
prior to procedure)
digoxin 0.25 mcg po qd
zoloft 50 mg po qd
dilantin 400 mg po Q sunday, 300 mg po rest of week
ursodiol 300 mg po bid
meclizine 12.5 mg po tid prn
metoprolol 25 mg po qd
captopril 25 mg po qd
lipitor 20 mg po qd

ALLERGIES: Iodine; Iodine Containing / Ampicillin / Phenergan

PHYSICAL EXAM: V: T98.6 P63 BP139/67 R18 96% 2LNC
Gen: voice muffled, neck swollen, no respiratory distress
HEENT: PERRLA, tongue enlarged, swollen and filling most of her
airway. Somewhat improved on repeat exam.
Neck: submandibular soft tissue full to palpation, 3-4 cm thick.
No woody appearance as noted previously
Resp: crackles bilateral bases, end expiratory wheezes
CV: RRR nl s1s2 III/VI SEM at apex
Abd: Soft, nontender, normal bowel sounds
Ext: no edema, pneumoboots in place
Neuro: CN 2-12 intact with slightly decreased sensation to light
touch on right cheek. strength 5/5 except [**5-2**] hip flexion in
bed.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives alone at home, daughter is primary caretaker. [**Name (NI) **] h/o
Tobacco or ETOH. 

### Response:
{'Angioneurotic edema, not elsewhere classified,Calculus of bile duct without mention of cholecystitis, without mention of obstruction,Atrial fibrillation,Congestive heart failure, unspecified,Other sedatives and hypnotics causing adverse effects in therapeutic use,Unspecified essential hypertension,Epilepsy, unspecified, without mention of intractable epilepsy'}
