CHIEF COMPLAINT: Weakness

PRESENT ILLNESS: 69 year-old woman who presented with a week-long history of
malaise.  The pt is Mandarin speaking woman who was in her USOH
until last week when developed a low-grade fever, cough,
lethargy and was started on a medication amoxicillin, the a
course of azithromycin by her PCP without any improvement and
received IVFs by PCP without [**Name9 (PRE) 65**] improvement.

MEDICAL HISTORY: HTN
Hyperlipidemia

MEDICATION ON ADMISSION: cardizem 180mg
dyazide 2tabs day
xalatan 0.005% 1 drop qhs
saline eye drops
lipitor 10mg qd
ASA 81 mg qd

ALLERGIES: Thiazides

PHYSICAL EXAM: Gen- Appears stated age, pleasant, in NAD
Vs- 96.1 129/74 69  17 98RA
HEENT- NC/AT PERRL EOMI,
Neck- supple, JVP flat, no thyromegaly or LAD
CV- rrr, normal s1,s2, no m/r/g
Pulm- good air movement, no w/r/r
Back- no spinal or CVAT
Abd- Soft, NT, ND, +BS
Extr- no C/C/E. DP and PT pulses strong b/l
Neuro-global hyporeflexia, motor strength 5/5 b/l upper and
lower

FAMILY HISTORY: NC

SOCIAL HISTORY: The pt lives with her husband in [**Name (NI) 778**].  She is fully
independent in all of her ADLs.  There is no history of tobacco,
alcohol or illicit drug use. Immigrated to USA in '[**97**], has not
worked eversince.
Hyposmolality and/or hyponatremia,Retention of urine, unspecified,Saluretics causing adverse effects in therapeutic use,Hydronephrosis,Acute kidney failure, unspecified,Neurogenic bladder NOS,Acute upper respiratory infections of unspecified site,Unspecified essential hypertension,Pure hypercholesterolemia,Delirium due to conditions classified elsewhere,Other specified disease of white blood cells,Anemia, unspecified
Hyposmolality,Retention urine NOS,Adv eff saluretics,Hydronephrosis,Acute kidney failure NOS,Neurogenic bladder NOS,Acute uri NOS,Hypertension NOS,Pure hypercholesterolem,Delirium d/t other cond,Wbc disease NEC,Anemia NOS
Admission Date:  [**2112-2-16**]              Discharge Date:   [**2112-2-23**]

Date of Birth:  [**2042-4-10**]             Sex:   F

Service: MEDICINE

Allergies:
Thiazides

Attending:[**First Name3 (LF) 2186**]
Chief Complaint:
Weakness


Major Surgical or Invasive Procedure:
None

History of Present Illness:
69 year-old woman who presented with a week-long history of
malaise.  The pt is Mandarin speaking woman who was in her USOH
until last week when developed a low-grade fever, cough,
lethargy and was started on a medication amoxicillin, the a
course of azithromycin by her PCP without any improvement and
received IVFs by PCP without [**Name9 (PRE) 65**] improvement.

She continued to experience malaise and lethargy, requiring
assistance in ambulating for generalized weakness (baseline is
self ambulating) She denied focal weakness, numbness or
parasthesiae.  There is no history of back pain. Pt was seen
again by PCP on day of presentation to the ED and was told that
she had a distended abdomen and was sent to the ED for further
work up.

In the ED, a foley was placed and 1700cc of urine was cleared.
The patient had no urge to urinate and last urinated the AM of
admission. She stated that she feels that she was able to
appreciate a full bladder and has had no recent difficulties
urinating.  In addition, she denied any bowel retention or
incontinence and has had regular bowel movements as is usual.

She denied any headache,loss of vision, blurred vision,
diplopia.  Denied dysarthria, dysphagia.  Denied lightheadedness
or vertigo.  Denied any difficulties with her speech. Also + low
grade fever with her URI, no chills or nightsweats, no CP or
SOB, no palpitation,n,v,diarrhea, dysuria or abdominal pain,
myalgia, arthralgia or rash.


Past Medical History:
HTN
Hyperlipidemia


Social History:
The pt lives with her husband in [**Name (NI) 778**].  She is fully
independent in all of her ADLs.  There is no history of tobacco,
alcohol or illicit drug use. Immigrated to USA in '[**97**], has not
worked eversince.

Family History:
NC

Physical Exam:
Gen- Appears stated age, pleasant, in NAD
Vs- 96.1 129/74 69  17 98RA
HEENT- NC/AT PERRL EOMI,
Neck- supple, JVP flat, no thyromegaly or LAD
CV- rrr, normal s1,s2, no m/r/g
Pulm- good air movement, no w/r/r
Back- no spinal or CVAT
Abd- Soft, NT, ND, +BS
Extr- no C/C/E. DP and PT pulses strong b/l
Neuro-global hyporeflexia, motor strength 5/5 b/l upper and
lower

Pertinent Results:
RENAL U.S.  [**2112-2-16**] 11:24 PM: The right kidney measures 10.2 cm
and contains mild hydronephrosis. No stones or masses are
visualized. The left kidney measures 11 cm, and has minimal
fullness of the collecting system. There are no renal masses or
stones. The bladder is collapsed with a Foley catheter within
it.

IMPRESSION: Mild hydronephrosis, right greater than left.

[**2112-2-23**] 07:15AM BLOOD WBC-7.4 RBC-3.83* Hgb-11.2* Hct-33.8*
MCV-89 MCH-29.2 MCHC-33.0 RDW-13.8 Plt Ct-652*
[**2112-2-17**] 06:00AM BLOOD PT-11.9 PTT-27.9 INR(PT)-1.0
[**2112-2-16**] 06:40PM BLOOD Glucose-173* UreaN-25* Creat-1.8* Na-104*
K-3.3 Cl-67* HCO3-18* AnGap-22*
[**2112-2-16**] 08:40PM BLOOD Glucose-167* UreaN-24* Creat-1.5* Na-107*
K-2.9* Cl-70* HCO3-23 AnGap-17
[**2112-2-17**] 02:25AM BLOOD Glucose-116* UreaN-20 Creat-1.2* Na-116*
K-3.5 Cl-84* HCO3-23 AnGap-13
[**2112-2-17**] 06:00AM BLOOD Glucose-104 UreaN-19 Creat-1.0 Na-121*
K-3.1* Cl-87* HCO3-22 AnGap-15
[**2112-2-17**] 12:05PM BLOOD Glucose-121* UreaN-19 Creat-1.0 Na-121*
K-3.0* Cl-90* HCO3-22 AnGap-12
[**2112-2-18**] 05:32AM BLOOD Glucose-88 UreaN-19 Creat-0.9 Na-127*
K-3.6 Cl-95* HCO3-22 AnGap-14
[**2112-2-19**] 05:45AM BLOOD Glucose-91 UreaN-16 Creat-0.8 Na-128*
K-3.6 Cl-94* HCO3-24 AnGap-14
[**2112-2-22**] 07:30AM BLOOD Glucose-146* UreaN-16 Creat-0.9 Na-138
K-4.1 Cl-103 HCO3-25 AnGap-14
[**2112-2-23**] 07:15AM BLOOD Glucose-164* UreaN-17 Creat-0.9 Na-131*
K-4.1 Cl-96 HCO3-25 AnGap-14
[**2112-2-17**] 06:00AM BLOOD Cortsol-19.7
[**2112-2-16**] 08:40PM BLOOD T4-8.4
[**2112-2-16**] 08:40PM BLOOD TSH-0.68
[**2112-2-16**] 08:40PM BLOOD Osmolal-234*
[**2112-2-16**] 10:15PM URINE Osmolal-102
[**2112-2-16**] 10:15PM URINE Hours-RANDOM Creat-8 Na-28 K-4 Cl-24
HCO3-LESS THAN
.
MICROBIOLOGY
Urine cx (-) x3.  Blood cx x2 negative at time of d/c.

Brief Hospital Course:
A/P: 69 yo Cantonse speaking female who presented with letargy,
gait abnormality and a serum sodium of 104. In ED she was found
to have obstructive uropathy resolving with foley placement. Of
note she has been of HCTZ/Triamtrene for number of years as
treatment of her HTN.

1. Hyponatremia: Pt with profound hyponatremia thought likely
secondary to her diuretic use. In the ED she appeared dry on
exam.  The patient had an initial FeNa of 4.91 and a urine Na of
26 which was consistent with renal losses and inconsistent with
SIADH.  In the ED she received one liter of normal saline and
her sodium increased from the nadir of 104 to 121 by the time of
arrival to the ICU.  She was not given any more saline at that
time, and her sodium was monitored while tolerating a regular
diet. It slowly increased to 127, she was noted to have global
hyporeflexia but no other neurological deficits at time of
transfer to the floors.   Pt was monitored and all IVFs were
held, as her sodium level slowly increased to normal on HD#5.
It was thought that her neurogenic bladder caused a decrease in
GFR, and a build of thiazide diuretic which led to her severe
hyponatremia.  Once a Foley was placed in the [**Name (NI) **], pt was able to
urinate and auto-correct, and her sodium drifted to normal with
minimal intervention.  No neurologic sequelae was seen due to
the correction of her sodium during this admission.  Pt was
instructed at discharge to never restart her thiazide diuretic
as this alone may have precipitated her severe hyponatremia.
.
2. Urine outflow obstruction:
It remained unclear what caused her initial neurogenic bladder
and bladder residual of 1700cc at time of admission.  It was
thought that perhaps a medication effect, whether OTC medication
or anticholinergic benadryl in cough syrup, that perhaps
contributed to her neurogenic bladder.  Pt was attempted
multiple voiding trials on HD#5 and HD#7 but each time patient
had PVR of >700cc, and the Foley was reinserted.  Urology was
consulted who recommended leaving the Foley in place for 1 week
after discharge, and to f/u with urology in 1 week for voiding
trial at that time.  A spinal MRI perfomed at this admission did
not show mass or any cord compression that would lead to urinary
retention.
.
3. Cough: She developed a productive cough with mild hemoptysis
at time of transfer to the floors, this was associated with a
fever of 101 the night prior. She was therefore contained on
precautions and ruled out for TB, although with no history of TB
and no evidence of opacities on chest xray
.
4. Renal Failure:
ARF on admission with Cr 1.8 due to obstructive uropathy,
resolved with Foley placement, returning to 0.9 on discharge.
Renal u/s with R>L hydro appears to be resolving.
.
5. HTN: normotensive on presentation to the ED. Pt's previous
cardizem and dyazide were stopped, and patient was started on
Metoprolol for BP control.  Pt was instructed to never restart
her dyazide diuretic.
.
DISPO:
Spoke to PCP, [**Last Name (NamePattern4) **]. [**First Name (STitle) **] on day of discharge regarding f/u sodium
recheck in 3 days after discharge, and f/u appointment with Dr.
[**Last Name (STitle) 27479**] from urology on [**2112-3-1**].

Communications: Daughter [**Name (NI) 27480**] [**Known lastname 22924**] [**Telephone/Fax (1) 27481**]
(mandarin/cantonese speaking)
[**Name (NI) 27482**] [**Name (NI) **] Granddaughter [**Telephone/Fax (1) 27483**]
[**Name (NI) 27484**] [**Name (NI) 22924**] Granddaughter [**Telephone/Fax (1) 27485**]
PCP [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] [**Hospital1 27486**] Basement, [**Location (un) 745**] Ctr, MA
[**Telephone/Fax (1) 27487**]

Medications on Admission:
cardizem 180mg
dyazide 2tabs day
xalatan 0.005% 1 drop qhs
saline eye drops
lipitor 10mg qd
ASA 81 mg qd


Discharge Medications:
1. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Toprol XL 100 mg Tablet Sustained Release 24HR Sig: One (1)
Tablet Sustained Release 24HR PO once a day.
Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*2*
3. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic  HS
(at bedtime).
4. Outpatient Lab Work
Please have a sodium (Na) level drawn, Friday, [**2-26**], and fax
results to Dr.[**Name (NI) 27488**] office.


Discharge Disposition:
Home With Service

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

Discharge Diagnosis:
Primary Diagnoses:
1) hyponatremia, suspected thiazide induced
2) URI
3) urinary retention


Discharge Condition:
Good, hyponatremia resolved, foley in place to be re-evaluated
by urology in one week.


Discharge Instructions:
1) Please take your medications as directed.  Your aspirin has
been held because you coughed up blood in the ICU.  Please
discuss with your primary care physician whether to restart this
medication or not.  You should NEVER take any THIAZIDE
medication.  You have been prescribed a new blood pressure
lowering medication, Toprol.
.
2) Please attend your follow-up appointments.
.
3) Please have your sodium level rechecked on Friday, [**2-26**].
Please fax results to Dr.[**Name (NI) 27488**] office.
.
4) You were not given the pneumococcal vaccine in-house.  Please
discuss this with your primary care physician.

Followup Instructions:
1) You are scheduled to see Dr. [**Last Name (STitle) 4229**](Urology) on [**3-1**] at
4pm to have your Foley removed.  Call [**Telephone/Fax (1) **] to reschedule
that appointment.
.
2) Please call the office of your primary care physician, [**Last Name (NamePattern4) **].
[**First Name (STitle) **]



Completed by:[**2112-2-24**]
{'Hyposmolality and/or hyponatremia,Retention of urine, unspecified,Saluretics causing adverse effects in therapeutic use,Hydronephrosis,Acute kidney failure, unspecified,Neurogenic bladder NOS,Acute upper respiratory infections of unspecified site,Unspecified essential hypertension,Pure hypercholesterolemia,Delirium due to conditions classified elsewhere,Other specified disease of white blood cells,Anemia, 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: Weakness

PRESENT ILLNESS: 69 year-old woman who presented with a week-long history of
malaise.  The pt is Mandarin speaking woman who was in her USOH
until last week when developed a low-grade fever, cough,
lethargy and was started on a medication amoxicillin, the a
course of azithromycin by her PCP without any improvement and
received IVFs by PCP without [**Name9 (PRE) 65**] improvement.

MEDICAL HISTORY: HTN
Hyperlipidemia

MEDICATION ON ADMISSION: cardizem 180mg
dyazide 2tabs day
xalatan 0.005% 1 drop qhs
saline eye drops
lipitor 10mg qd
ASA 81 mg qd

ALLERGIES: Thiazides

PHYSICAL EXAM: Gen- Appears stated age, pleasant, in NAD
Vs- 96.1 129/74 69  17 98RA
HEENT- NC/AT PERRL EOMI,
Neck- supple, JVP flat, no thyromegaly or LAD
CV- rrr, normal s1,s2, no m/r/g
Pulm- good air movement, no w/r/r
Back- no spinal or CVAT
Abd- Soft, NT, ND, +BS
Extr- no C/C/E. DP and PT pulses strong b/l
Neuro-global hyporeflexia, motor strength 5/5 b/l upper and
lower

FAMILY HISTORY: NC

SOCIAL HISTORY: The pt lives with her husband in [**Name (NI) 778**].  She is fully
independent in all of her ADLs.  There is no history of tobacco,
alcohol or illicit drug use. Immigrated to USA in '[**97**], has not
worked eversince. 

### Response:
{'Hyposmolality and/or hyponatremia,Retention of urine, unspecified,Saluretics causing adverse effects in therapeutic use,Hydronephrosis,Acute kidney failure, unspecified,Neurogenic bladder NOS,Acute upper respiratory infections of unspecified site,Unspecified essential hypertension,Pure hypercholesterolemia,Delirium due to conditions classified elsewhere,Other specified disease of white blood cells,Anemia, unspecified'}
