CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 62 year old
male who was admitted to the Intensive Care Unit for
urosepsis.  He has a complex past medical history.  He was
recently discharged from [**Hospital1 69**]
after decortication of bilateral fibrothoraxes and
subsequently required placement of a tracheostomy.  He was
being intermittently ventilated at rehabilitation and had
reportedly been doing well.

MEDICAL HISTORY: 1.  Bilateral fibrothoraxes status post right lung and
diaphragm decortication and tracheostomy placement in [**Month (only) 958**]
of this year.
2.  History of a Roux-en-Y reconstruction after a
laparoscopic cholecystectomy in [**2139-4-2**].
3.  History of knee replacement and chronic leg pain.
4.  Diabetes mellitus.
5.  Hypertension.
6.  Chronic anemia.
7.  Diabetic neuropathy.
8.  Cataracts.
9.  Benign prostatic hypertrophy with a history of
prostatitis.
10. History of appendectomy.

MEDICATION ON ADMISSION: 

ALLERGIES: Reportedly has hallucinations with Vicodin.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient recently admitted to [**Hospital **]
Rehabilitation.  He previously lived at home with his wife.
Unspecified septicemia,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Chronic respiratory failure,Subendocardial infarction, initial episode of care,Severe sepsis,Attention to tracheostomy,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled
Septicemia NOS,Acute kidney failure NOS,Urin tract infection NOS,Chronic respiratory fail,Subendo infarct, initial,Severe sepsis,Atten to tracheostomy,BPH w urinary obs/LUTS,DMII neuro nt st uncntrl
Admission Date:  [**2140-3-22**]       Discharge Date:  [**2140-3-25**]

Date of Birth:   [**2078-1-6**]       Sex:  M

Service:  [**Hospital Unit Name 153**]

HISTORY OF PRESENT ILLNESS:  The patient is a 62 year old
male who was admitted to the Intensive Care Unit for
urosepsis.  He has a complex past medical history.  He was
recently discharged from [**Hospital1 69**]
after decortication of bilateral fibrothoraxes and
subsequently required placement of a tracheostomy.  He was
being intermittently ventilated at rehabilitation and had
reportedly been doing well.

Approximately one to two days prior to admission, he
developed a fever to 104.0 F., tachycardia with heart rate to
the 150s and hypotension with systolic blood pressure to the
60s.  He was brought to the Emergency Department and was
placed on the MUST protocol as his white blood cell count was
43,000, he was febrile and hypotensive.  A right internal
jugular central line was placed in the Emergency Department
and he was given initially five liters of intravenous fluids
and was placed on Levophed to support his blood pressure into
the mid 90s.  He was given an initial one dose of Timentin
through a peripheral intravenous in his foot and was later
put on ceftriaxone, Levofloxacin and Vancomycin after a
central access was obtained.

On admission, he was found to have an elevated creatinine of
2.7 with a prior baseline as high as 1.6.  He was also found
to have a positive troponin of 0.26 with flat CKs.  Initial
infectious work-up was positive for urinalysis with over 50
white blood cells and he was admitted to the Intensive Care
Unit for suspected urosepsis.

PAST MEDICAL HISTORY:
1.  Bilateral fibrothoraxes status post right lung and
diaphragm decortication and tracheostomy placement in [**Month (only) 958**]
of this year.
2.  History of a Roux-en-Y reconstruction after a
laparoscopic cholecystectomy in [**2139-4-2**].
3.  History of knee replacement and chronic leg pain.
4.  Diabetes mellitus.
5.  Hypertension.
6.  Chronic anemia.
7.  Diabetic neuropathy.
8.  Cataracts.
9.  Benign prostatic hypertrophy with a history of
prostatitis.
10. History of appendectomy.

ALLERGIES:   Reportedly has hallucinations with Vicodin.

SOCIAL HISTORY:  The patient recently admitted to [**Hospital **]
Rehabilitation.  He previously lived at home with his wife.

MEDICATIONS ON TRANSFER:
1.  Colace 100 mg twice a day.
2.  Lopressor 75 mg twice a day.
3.  Insulin sliding scale.
4.  Lasix 40 mg twice a day.
5.  Percocet elixir p.r.n. q. four.
6.  Oxybiotin p.r.n.
7.  Ibuprofen 400 q. eight p.r.n.
8.  Levofloxacin 750 mg q. day.
9.  Pepcid 70 mg twice a day.
10. Ambien 4 mg p.r.n.
11. Nortriptyline 75 mg h.s.
12. Albuterol / ipratropium inhalers q. six hours.
13. Saline nasal p.r.n.
14. Neutra-Phos packets three times a day.
15. Tylenol p.r.n.
16. Subcutaneous heparin 5000 units three times a day.
17. Aspirin 325 mg q. day.

PHYSICAL EXAMINATION:  Upon arrival to the [**Hospital Unit Name 153**], his
temperature was 95.4 F.; blood pressure 130/62 on Levophed;
heart rate 72 to 79; on assist controlled 500 at a rate of 12
with 5 of PEEP, over breathing the vent 10 to 12.  On
examination, he was sedated, ventilated, minimally
responsive.  Head and Neck examination:  Nonicteric.  Mucous
membranes were moist.  Lungs were clear to auscultation
anterior and laterally.  Cardiac examination was regular rate
and rhythm.  Abdomen had positive bowel sounds, nontender,
nondistended, no rebound noted.  Extremities with trace lower
extremity edema bilaterally.  Neurologic examination:  The
patient was minimally responsive; otherwise a nonfocal
examination.  Skin with no obvious rashes.

LABORATORY:  Initially significant for a white blood cell
count of 43.4, hematocrit 31.2, platelets 369.  Initial
Chem-7 notable for a sodium of 140, potassium 3.0, chloride
89, bicarbonate 43, BUN and creatinine 70 and 2.7, glucose of
125.

Initial cardiac enzymes notable for a troponin of 0.26, but a
CK of 18; follow-up troponin trended down, 0.16.

Urinalysis was notable for cloudy urine, negative nitrite,
moderate leukocyte esterase, more than 50 red blood cells,
more than 50 white blood cells with moderate bacteria, zero
to two epithelials.

Initial arterial blood gas was 7.38, 76, 149.

Chest x-ray showing stable postoperative changes; small
bilateral pleural effusions and bibasilar atelectasis.

Previous cardiac catheterization in [**2139-6-2**] showing
clean coronaries except for mild coronary artery disease in
left circumflex of 30 to 40% lesion.

HOSPITAL COURSE:
1.  SEPSIS:  With initial positive urinalysis and negative
chest x-ray, the patient was thought to be in urosepsis.  He
was initially placed on pressors, given aggressive
intravenous fluid hydration.  After approximately an hour on
pressors, the pressors were weaned off and the patient had
stable blood pressure.  He was initially febrile in the
Emergency Department and subsequently became hypothermic.
His temperature after the first 24 hours was within normal
limits.

Initially he was given central access, serial lactates were
drawn; an arterial line was placed, and he was placed on
steroids for presumed relative adrenal insufficiency.  He was
placed on ceftriaxone, Vancomycin and Levofloxacin.

After the patient's blood pressure stabilized, he became
afebrile and his urine culture returned as infective
pseudomonas, he was taken off steroids and placed on Zosyn
for pseudomonas coverage.  The pseudomonas was resistant to
Ciprofloxacin, so fluoroquinolones were not used.  As he
became hemodynamically stable throughout the rest of his
hospital course, his central access was discontinued as well
as his arterial line.

2.  INFECTIOUS DISEASE:  He had a presumed urine infection
with pseudomonas that was resistant to fluoroquinolones.  He
was placed on Zosyn for complete three week course.  A PICC
line was placed for long term antibiotics.  Pseudomonas was
also cultured from his sputum and was thought to be a
colonization.

3.  BENIGN PROSTATIC HYPERTROPHY:  The patient has had a
Foley catheter in place for at least one to two months
because of a history of benign prostatic hypertrophy and
urinary retention.  A Foley catheter was continued during his
inpatient hospital stay but he will likely need an outpatient
urology evaluation and / or possible transurethral resection
of the prostate procedure as indwelling Foley catheter may
increase his risk for recurrent urinary tract infections and
/ or future episodes of urosepsis.

4.  PULMONARY:  The patient was continued on the ventilator
intermittently as he had done previously and he was not
thought to have a primary pulmonary process as the cause of
this admission.  Because of air leak around the cuff of his
tracheostomy, his tracheostomy was changed to a Portex #7.
He did well on intermittent pressure support and no vent
changes were made.  He will continue with a ventilatory wean
as he had done previously at rehabilitation.

5.  CARDIOVASCULAR:  The patient had initial elevated
troponin of 0.26 in the setting of hypotension and acute
renal failure.  His CKs were flat and he had a previous
cardiac catheterization showing fairly clean coronary
arteries.  Given the clinical circumstance, his elevated
troponin was thought to be due to demand ischemia.  He was
continued on aspirin and beta blocker.  Consideration was
made to starting an ACE inhibitor but was not started given
his renal failure.

6.  ACUTE RENAL FAILURE:  His creatinine was elevated up to
2.7 on admission thought to be due to his sepsis and
decreased intervascular volume.  After aggressive intravenous
fluid hydration, this currently dropped to 1.2 at the time of
discharge which is well within his baseline.

7.  FLUIDS, ELECTROLYTES AND NUTRITION:  The patient had a
swallowing study to evaluate his ability to take a p.o. diet
which he did poorly.  To maintain adequate nutrition,
Gastroenterology was consulted and a PEG was placed on [**3-24**].  The patient had minimal bleeding around the site of
the PEG placement so his aspirin dose was lowered from 325 mg
to 81 mg which is a prophylactic dose.  His PEG was safe for
tube feeds, so tube feeds were begun.

8.  DIABETES MELLITUS:  The patient had some elevated glucose
while on steroids.  He was continued on a Regular insulin
sliding scale.

DISPOSITION:   The patient's mental status improved
dramatically and it was felt by both the patient and his
family that he had improved from his baseline.  He was
afebrile with stable hemodynamics and doing well on a
ventilator.  He was felt to be safe for discharge to [**Hospital **]
Rehabilitation for continuation of his ventilatory wean and
for continued intravenous antibiotic therapy.

CONDITION AT DISCHARGE:   Stable.

DISCHARGE DIAGNOSES:
1.  Urosepsis with pseudomonas urinary tract infection.
2.  Non-ST elevation myocardial infarction.
3.  Acute renal failure, now resolved.
4.  Ventilator dependent with tracheostomy.
5.  Diabetes mellitus.
6.  Hypertension.
7.  Benign prostatic hypertrophy.

DISCHARGE MEDICATIONS:
1.  Regular insulin sliding scale.
2.  Lopressor 50 mg p.o. twice a day.
3.  Percocet Elixir, 5 to 10 ml q. four to six hours as
needed for leg pain.
4.  Eye drops; Artificial tears one to two drops p.r.n.
5.  Aspirin 81 mg p.o. q. day.
6.  Ranitidine 150 mg q. day.
7.  Zosyn 4.5 grams intravenously q. eight hours for another
18 days.

DISCHARGE INSTRUCTIONS:
1.  The patient was told to follow-up with his primary care
physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], within one to two weeks of
discharge.  Will likely need referral to outpatient Urology
to evaluate his benign prostatic hypertrophy.
2.  Will likely need follow-up care with Pulmonary within the
next two to three weeks.
3.  He was told to continue taking all medications as
prescribed.
4.  He was told that if he developed any recurrent fevers or
chills, episodes of nausea, lightheadedness, confusion or any
other concerning symptoms whatsoever, that he should seek
immediate medical attention.



                            [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3795**]

Dictated By:[**Last Name (NamePattern1) 6289**]
MEDQUIST36

D:  [**2140-3-25**]  13:51
T:  [**2140-3-25**]  14:05
JOB#:  [**Job Number 34872**]

cc:[**Location (un) 34873**]
{'Unspecified septicemia,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Chronic respiratory failure,Subendocardial infarction, initial episode of care,Severe sepsis,Attention to tracheostomy,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled'}


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 62 year old
male who was admitted to the Intensive Care Unit for
urosepsis.  He has a complex past medical history.  He was
recently discharged from [**Hospital1 69**]
after decortication of bilateral fibrothoraxes and
subsequently required placement of a tracheostomy.  He was
being intermittently ventilated at rehabilitation and had
reportedly been doing well.

MEDICAL HISTORY: 1.  Bilateral fibrothoraxes status post right lung and
diaphragm decortication and tracheostomy placement in [**Month (only) 958**]
of this year.
2.  History of a Roux-en-Y reconstruction after a
laparoscopic cholecystectomy in [**2139-4-2**].
3.  History of knee replacement and chronic leg pain.
4.  Diabetes mellitus.
5.  Hypertension.
6.  Chronic anemia.
7.  Diabetic neuropathy.
8.  Cataracts.
9.  Benign prostatic hypertrophy with a history of
prostatitis.
10. History of appendectomy.

MEDICATION ON ADMISSION: 

ALLERGIES: Reportedly has hallucinations with Vicodin.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient recently admitted to [**Hospital **]
Rehabilitation.  He previously lived at home with his wife. 

### Response:
{'Unspecified septicemia,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Chronic respiratory failure,Subendocardial infarction, initial episode of care,Severe sepsis,Attention to tracheostomy,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled'}
