CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 58 year old
Caucasian male with a history of diabetes mellitus type 1,
chronic renal insufficiency, status post transplant in [**2130**],
recurrent pneumoniae and coronary artery disease who has been
admitted to the Medical Intensive Care Unit (MICU) on
[**2141-12-13**] with hypoxic respiratory failure and
subsequently transferred to the floor.

MEDICAL HISTORY: 1.  Type 1 diabetes mellitus diagnosed at age 28, complicated
by retinopathy leading to blindness, neuropathy leading to
both autonomic and sensory motor disease with orthostatic
hypotension, gastroparesis and loose stools as well as
nephropathy.
2.  Status post living related donor kidney transplant in
[**2130**] with chronic renal insufficiency; [**Year (4 digits) **] done in [**2140**]
showed chronic inflammatory changes without acute rejection.
3.  Recurrent pneumoniae and multiple pulmonary nodules with
multiple broncho-alveolar lavages that have been negative on
culture and a recent transbronchial [**Year (4 digits) **] that showed patchy
interstitial fibrosis; patient also had a VAS with a right
lower lobe wedge [**Year (4 digits) **] showing patchy acute and organizing
pneumonia.
4.  MGUS with S-PEP significant for monoclonal IgG spike;
bone marrow [**Year (4 digits) **] in [**2140-2-9**] and [**2140-9-8**]
significant for increased plasma cells with eosinophilic
material/nucleoli.
5.  Obstructive sleep apnea.
6.  Anemia.
7.  Deep vein thrombosis of left thigh.
8.  Coronary artery disease, status post non-ST elevation
myocardial infarction in [**2139-3-12**], status post
percutaneous transluminal coronary angioplasty with stent of
the left anterior descending artery in [**2139-7-10**].
9.  Left ventricular systolic/diastolic dysfunction with an
echocardiogram in [**2141-8-8**] significant for a left
ventricular ejection fraction of 45%, mild left ventricular
hypertrophy, moderate left axis deviation, akinesis of the
distal septum.
10. Right pontine lacunar infarction.
11. Gastroesophageal reflux disease with Barrett's
esophagitis.
12. Diverticulosis.
13. Clostridium difficile.
14. Methicillin resistant Staphylococcus aureus bacteremia
complicated by septic pulmonary emboli and empyema.
15. Hypoglycemic coma in [**2141-5-9**].

MEDICATION ON ADMISSION: Midodrine 5 mg p.o.t.i.d.,
prednisone 5 mg p.o.q.d., Neurontin 300 mg p.o.b.i.d.,
atenolol 200 mg p.o.q.d., Pravachol 40 mg p.o.q.d.,
isosorbide 90 mg p.o.q.d., nitroglycerin p.r.n., Lantus
insulin 34 units q.p.m., LysPro insulin sliding scale,
Procrit 20,000 units twice weekly, Levoxyl 25 mcg p.o.q.d.,
Protonix 40 mg p.o.q.d., Procardia XL 60 mg p.o.q.d., Lasix
60 mg p.o.q.a.m. and 40 mg p.o.q.h.s., calcitriol, vitamin D
0.25 mcg p.o.b.i.d., Niferex 150 mg p.o.b.i.d.

ALLERGIES: Dicloxacillin and Compazine.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives with his wife and
daughter.  [**Name (NI) **] quit tobacco 18 years ago with a 20 pack year
history.  He has a distant history of [**Doctor Last Name 360**] [**Location (un) 2452**] exposure.
Pneumonia, organism unspecified,Acute respiratory failure,Diabetes with other coma, type I [juvenile type], not stated as uncontrolled,Complications of transplanted kidney,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Thrombocytopenia, unspecified
Pneumonia, organism NOS,Acute respiratry failure,DMI o cm nt st uncntrld,Compl kidney transplant,Acute kidney failure NOS,Hyp kid NOS w cr kid V,Thrombocytopenia NOS
Admission Date:  [**2141-12-13**]       Discharge Date:  [**2141-12-23**]

Date of Birth:   [**2083-10-25**]       Sex:  M

Service:  Medicine

HISTORY OF PRESENT ILLNESS:  The patient is a 58 year old
Caucasian male with a history of diabetes mellitus type 1,
chronic renal insufficiency, status post transplant in [**2130**],
recurrent pneumoniae and coronary artery disease who has been
admitted to the Medical Intensive Care Unit (MICU) on
[**2141-12-13**] with hypoxic respiratory failure and
subsequently transferred to the floor.

The patient was in his usual state of health until the
morning of [**2141-12-13**], when he had an acute episode of
hypoglycemia with a blood sugar of 27.  The patient reports
taking his normal dose of insulin the night before and eating
his bedtime snack and, in the middle of the morning, was
shaking and unresponsive.  His wife called emergency medical
services, who came and treated the patient with juice and
possibly an ampule of D50 and the patient subsequently
aroused.  He had some dyspnea and some abdominal discomfort
and he and his wife came to the Emergency Room.

In the Emergency Room, the patient was noted to have a
temperature of 102 and decreased oxygen saturation to 80%.  A
chest x-ray done was consistent with right middle lobe and
right lower lobe pneumonia and the patient was intubated for
hypoxic respiratory failure and transferred to the MICU.

PAST MEDICAL HISTORY:
1.  Type 1 diabetes mellitus diagnosed at age 28, complicated
by retinopathy leading to blindness, neuropathy leading to
both autonomic and sensory motor disease with orthostatic
hypotension, gastroparesis and loose stools as well as
nephropathy.
2.  Status post living related donor kidney transplant in
[**2130**] with chronic renal insufficiency; [**Year (4 digits) **] done in [**2140**]
showed chronic inflammatory changes without acute rejection.
3.  Recurrent pneumoniae and multiple pulmonary nodules with
multiple broncho-alveolar lavages that have been negative on
culture and a recent transbronchial [**Year (4 digits) **] that showed patchy
interstitial fibrosis; patient also had a VAS with a right
lower lobe wedge [**Year (4 digits) **] showing patchy acute and organizing
pneumonia.
4.  MGUS with S-PEP significant for monoclonal IgG spike;
bone marrow [**Year (4 digits) **] in [**2140-2-9**] and [**2140-9-8**]
significant for increased plasma cells with eosinophilic
material/nucleoli.
5.  Obstructive sleep apnea.
6.  Anemia.
7.  Deep vein thrombosis of left thigh.
8.  Coronary artery disease, status post non-ST elevation
myocardial infarction in [**2139-3-12**], status post
percutaneous transluminal coronary angioplasty with stent of
the left anterior descending artery in [**2139-7-10**].
9.  Left ventricular systolic/diastolic dysfunction with an
echocardiogram in [**2141-8-8**] significant for a left
ventricular ejection fraction of 45%, mild left ventricular
hypertrophy, moderate left axis deviation, akinesis of the
distal septum.
10. Right pontine lacunar infarction.
11. Gastroesophageal reflux disease with Barrett's
esophagitis.
12. Diverticulosis.
13. Clostridium difficile.
14. Methicillin resistant Staphylococcus aureus bacteremia
complicated by septic pulmonary emboli and empyema.
15. Hypoglycemic coma in [**2141-5-9**].

MEDICATIONS ON ADMISSION:  Midodrine 5 mg p.o.t.i.d.,
prednisone 5 mg p.o.q.d., Neurontin 300 mg p.o.b.i.d.,
atenolol 200 mg p.o.q.d., Pravachol 40 mg p.o.q.d.,
isosorbide 90 mg p.o.q.d., nitroglycerin p.r.n., Lantus
insulin 34 units q.p.m., LysPro insulin sliding scale,
Procrit 20,000 units twice weekly, Levoxyl 25 mcg p.o.q.d.,
Protonix 40 mg p.o.q.d., Procardia XL 60 mg p.o.q.d., Lasix
60 mg p.o.q.a.m. and 40 mg p.o.q.h.s., calcitriol, vitamin D
0.25 mcg p.o.b.i.d., Niferex 150 mg p.o.b.i.d.

ALLERGIES:  Dicloxacillin and Compazine.

SOCIAL HISTORY:  The patient lives with his wife and
daughter.  [**Name (NI) **] quit tobacco 18 years ago with a 20 pack year
history.  He has a distant history of [**Doctor Last Name 360**] [**Location (un) 2452**] exposure.

PHYSICAL EXAMINATION:  Vital signs:  Temperature 101.9, pulse
83, blood pressure 159/60, oxygen saturation 100% on 100%
FiO2 AC 600/14, PEEP 10.  General:  Intubated, sedated.
Head, eyes, ears, nose and throat:  Anicteric sclerae,
oropharynx clear, ptosis of right eye, surgical left pupil,
right sided cataract, moist mucous membranes.  Pulmonary:
Crackles at right base.  Cardiovascular:  Regular rate and
rhythm, normal S1 and S2, no murmur, rub or gallop.  Abdomen:
Soft, nontender, nondistended, positive bowel sounds.
Extremities:  No edema, no rashes.  Neurologic:  Withdraws to
pain.

LABORATORY DATA:  White blood cell count 8.6 with 79%
polycytes, 1% bands, 9% lymphocytes, 10% monocytes and 1%
eosinophils, hematocrit 44.4, platelet count 118,000, sodium
137, potassium 5.1, chloride 104, bicarbonate 20, BUN 108,
creatinine 8.3, glucose 278, anion gap 13, prothrombin time
12.9, partial thromboplastin time 26.2, INR 1.1, ALT 14, AST
16, alkaline phosphatase 106, amylase 56, total bilirubin
0.8, lipase 15, albumin 3.7.  Urinalysis:  Straw, clear,
1.017, small blood, negative nitrites, 500 protein, 1,000
glucose, negative ketones, negative leukocyte esterase.

Chest x-ray:  Right lower lobe and right middle lobe
pneumonia.  CT of abdomen:  Right middle lobe, right lower
lobe, left lower lobe consolidation, small pleural effusions
bilaterally, no free air/fluid in abdomen, bowel loops
normal, evidence of diverticulosis.  Electrocardiogram:
Sinus rhythm with first degree A-V block, borderline left
axis, ST elevations V1 through V3, ST elevations which are
old, lateral T wave inversions and ST depressions which are
also old.

HOSPITAL COURSE:  1.  Pulmonary:  The patient was admitted to
the MICU intubation for hypoxic respiratory failure.  He was
started on levofloxacin for a [**Hospital1 **]-lobar pneumonia noted on
chest x-ray.  The patient remained intubated for two days in
the MICU and was eventually weaned and extubated without
problems.  Throughout the remainder of his hospital course on
the floor, the patient was completely stable from a
respiratory standpoint.  His oxygen was eventually weaned and
a repeat chest x-ray prior to discharge showed dramatic
improvement in his [**Hospital1 **]-lobar pneumonia.  He will complete a
full 14 day course of levofloxacin.  Flagyl was added several
days after levofloxacin for a concern of aspiration during
his hypoglycemic coma and during resuscitation by the
emergency medical technicians with juice.

2.  Endocrine:  The patient was admitted to the MICU after a
hypoglycemic coma and was started on fluids with Dextrose.
He subsequently had high fingerstick glucoses and was started
on an insulin drip in the unit.  On transfer to the floor, he
was switched back over to subcutaneous insulin, with poorly
controlled blood sugars in the 400s.  His total daily dose of
insulin was calculated, his sensitivity ratio was calculated
and his insulin to carbohydrate ratio was calculated, and the
patient was started on a new regimen with glargine 20 units
in the evening and a new insulin sliding scale, with
subsequent excellent control of his blood sugars.  Once the
patient was on nothing by mouth for various catheter
placements, his blood sugars were again poorly controlled and
the endocrinology/diabetes consult service was contact[**Name (NI) **].
They changed his regimen and his blood sugars were noted to
be under improved control.  The patient was kept on his
operating table dose of Levoxyl for hypothyroidism.

3.  Renal:  The patient was admitted with a history of
chronic renal insufficiency, status post a kidney transplant
in [**2130**], and was thought to have chronic rejection, though
previous biopsies show no evidence of rejection.  The renal
team followed the patient throughout his entire
hospitalization.  Once the patient was transferred to the
floor, he received a hemodialysis catheter and received
hemodialysis three days.  He was maintained on sodium
bicarbonate and calcium acetate as well as Nephrocaps
throughout his hospital course.  The patient was supposed to
get a peritoneal dialysis catheter placed on the day prior to
discharge but, due to a hypertensive crisis, this will be
done as an outpatient and the patient will receive
hemodialysis as a bridge to peritoneal dialysis.

4.  Cardiovascular:  On admission to the MICU the patient was
transiently hypotensive and required fluid resuscitation and
a brief course of Levophed.  On transfer to the floor, he was
normotensive and restarted on his outpatient antihypertensive
regimen.  The patient was hemodynamically stable throughout
his stay on the floor until the day prior to discharge, when
the patient's blood pressure went up to 236/110.  The
etiology of this is not clear at this point, though it is
considered possible that this was a reaction to intravenous
Epogen, as the patient had a similar reaction 13 years ago
with intravenous Epogen.  Once the patient was dialyzed and
brought back to the floor, he was given 10 mg of intravenous
hydralazine with good response.  He was restarted on his oral
antihypertensives, which were stopped for his upcoming
procedure, and the patient was again normotensive.

5.  Hematology:  The patient is noted to be anemic and
thrombocytopenia at baseline.  His counts were monitored
throughout his hospital course and noted to be stable.  He
was maintained on his outpatient dose of Epogen, but this was
stopped the day prior to discharge secondary to his
hypertensive crisis and the thought that it could be related
to intravenous Epogen.

6.  Infectious disease:  The patient was noted to have a
[**Hospital1 **]-lobar pneumonia on admission to the MICU and was started
on levofloxacin, of which he is to receive a full 14 day
course.  Given a concern for aspiration pneumonia, the
patient was started on Flagyl for anaerobic coverage and will
take this with levofloxacin for a full course.  The patient
was febrile on admission but his fever curve gradually
decreased over his hospital stay and he was afebrile for four
to five days prior to discharge.  The patient's white blood
cell count was noted to be normal throughout his hospital
stay.  Multiple cultures were sent and were noted to be
negative.  A nasopharyngeal swab was sent and was noted to be
positive for coagulase positive Staphylococcus, thought to be
the patient's Methicillin resistant Staphylococcus aureus
(MRSA) and the patient was kept on MRSA precautions
throughout his hospital stay.

CONDITION ON DISCHARGE:  Good.

DISCHARGE STATUS:  The patient is to be discharged home and
will be followed closely by Dr. [**First Name (STitle) 805**] with hemodialysis on
Mondays, Wednesdays and Fridays.

DISCHARGE DIAGNOSES:
1.  Pneumonia.
2.  Diabetes mellitus.
3.  Chronic renal insufficiency, status post kidney
transplant.
4.  MGUS.
5.  Hypertension.

DISCHARGE MEDICATIONS:
1.  Prednisone 5 mg p.o.q.d.
2.  Levothyroxine 25 mcg p.o.q.d.
3.  Nephrocaps one p.o.q.d.
4.  Calcium carbonate 1,000 mg p.o.q.i.d.
5.  Calcitriol 0.25 mcg p.o.q.d.
6.  Pantoprazole 40 mg p.o.q.d.
7.  Nifedipine SR 60 mg p.o.q.d.
8.  Calcium acetate 1,334 mg p.o.t.i.d. with meals.
9.  Isosorbide mononitrate SR 60 mg p.o.q.d.
10. Colace 100 mg p.o.b.i.d.
11, Neurontin 300 mg p.o.b.i.d.
12. Pravastatin 40 mg p.o.q.d.
13. Midodrine 5 mg p.o.t.i.d.
14. Atenolol 200 mg p.o.q.d.
15. Levofloxacin 250 mg p.o.q.o.d. times four days.
16. Flagyl 500 mg p.o.t.i.d. times four days.
17. Insulin glargine 18 units s.c.q.p.m.
18. Insulin sliding scale with Humalog insulin.

FOLLOW-UP:  The patient will have hemodialysis on Mondays,
Wednesdays and Fridays at [**Location (un) 4265**] [**Location (un) **] with Dr. [**First Name (STitle) 805**],
with whom he will follow up.  The patient has a scheduled
visit with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], endocrinologist at the [**Hospital **]
Clinic on [**2142-1-19**] at 9:00 a.m.  He also has a
scheduled visit with the diabetic dietitian at the [**Hospital **]
Clinic on [**2141-12-27**] at 9:00 a.m.  The patient also
has a follow-up appointment with his cardiologist, Dr.
[**Last Name (STitle) **], on [**2142-1-23**] at 11:40 a.m.



                            [**Name6 (MD) 251**] [**Last Name (NamePattern4) 11865**], M.D.  [**MD Number(1) 11866**]

Dictated By:[**Last Name (NamePattern1) 4950**]
MEDQUIST36

D:  [**2141-12-22**]  03:33
T:  [**2141-12-22**]  19:09
JOB#:  [**Job Number 20633**]
{'Pneumonia, organism unspecified,Acute respiratory failure,Diabetes with other coma, type I [juvenile type], not stated as uncontrolled,Complications of transplanted kidney,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Thrombocytopenia, 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: 

PRESENT ILLNESS: The patient is a 58 year old
Caucasian male with a history of diabetes mellitus type 1,
chronic renal insufficiency, status post transplant in [**2130**],
recurrent pneumoniae and coronary artery disease who has been
admitted to the Medical Intensive Care Unit (MICU) on
[**2141-12-13**] with hypoxic respiratory failure and
subsequently transferred to the floor.

MEDICAL HISTORY: 1.  Type 1 diabetes mellitus diagnosed at age 28, complicated
by retinopathy leading to blindness, neuropathy leading to
both autonomic and sensory motor disease with orthostatic
hypotension, gastroparesis and loose stools as well as
nephropathy.
2.  Status post living related donor kidney transplant in
[**2130**] with chronic renal insufficiency; [**Year (4 digits) **] done in [**2140**]
showed chronic inflammatory changes without acute rejection.
3.  Recurrent pneumoniae and multiple pulmonary nodules with
multiple broncho-alveolar lavages that have been negative on
culture and a recent transbronchial [**Year (4 digits) **] that showed patchy
interstitial fibrosis; patient also had a VAS with a right
lower lobe wedge [**Year (4 digits) **] showing patchy acute and organizing
pneumonia.
4.  MGUS with S-PEP significant for monoclonal IgG spike;
bone marrow [**Year (4 digits) **] in [**2140-2-9**] and [**2140-9-8**]
significant for increased plasma cells with eosinophilic
material/nucleoli.
5.  Obstructive sleep apnea.
6.  Anemia.
7.  Deep vein thrombosis of left thigh.
8.  Coronary artery disease, status post non-ST elevation
myocardial infarction in [**2139-3-12**], status post
percutaneous transluminal coronary angioplasty with stent of
the left anterior descending artery in [**2139-7-10**].
9.  Left ventricular systolic/diastolic dysfunction with an
echocardiogram in [**2141-8-8**] significant for a left
ventricular ejection fraction of 45%, mild left ventricular
hypertrophy, moderate left axis deviation, akinesis of the
distal septum.
10. Right pontine lacunar infarction.
11. Gastroesophageal reflux disease with Barrett's
esophagitis.
12. Diverticulosis.
13. Clostridium difficile.
14. Methicillin resistant Staphylococcus aureus bacteremia
complicated by septic pulmonary emboli and empyema.
15. Hypoglycemic coma in [**2141-5-9**].

MEDICATION ON ADMISSION: Midodrine 5 mg p.o.t.i.d.,
prednisone 5 mg p.o.q.d., Neurontin 300 mg p.o.b.i.d.,
atenolol 200 mg p.o.q.d., Pravachol 40 mg p.o.q.d.,
isosorbide 90 mg p.o.q.d., nitroglycerin p.r.n., Lantus
insulin 34 units q.p.m., LysPro insulin sliding scale,
Procrit 20,000 units twice weekly, Levoxyl 25 mcg p.o.q.d.,
Protonix 40 mg p.o.q.d., Procardia XL 60 mg p.o.q.d., Lasix
60 mg p.o.q.a.m. and 40 mg p.o.q.h.s., calcitriol, vitamin D
0.25 mcg p.o.b.i.d., Niferex 150 mg p.o.b.i.d.

ALLERGIES: Dicloxacillin and Compazine.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives with his wife and
daughter.  [**Name (NI) **] quit tobacco 18 years ago with a 20 pack year
history.  He has a distant history of [**Doctor Last Name 360**] [**Location (un) 2452**] exposure. 

### Response:
{'Pneumonia, organism unspecified,Acute respiratory failure,Diabetes with other coma, type I [juvenile type], not stated as uncontrolled,Complications of transplanted kidney,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Thrombocytopenia, unspecified'}
