CHIEF COMPLAINT: A 58-year-old woman with a history of
severe asthma requiring many past hospitalizations.  No
Intensive Care Unit stays and has never been intubated who
presents with worsening shortness of breath over the past
several hours, not relieved by inhalers.

PRESENT ILLNESS: Ms. [**Known lastname 38086**] was in her usual
state of health until three days prior to admission when she
began to have fevers, nonproductive cough, worsening
shortness of breath, and dyspnea on exertion.

MEDICAL HISTORY: (Her past medical history includes)
1.  Asthma times five years.
2.  Hypertension.
3.  Hyperlipidemia.

MEDICATION ON ADMISSION: Medications at (preadmission)
included Pulmicort, Serevent, Flovent, albuterol, Combivent,
Zocor, Glucophage, glyburide, Avapro, Premarin, Accolate, and
cyclobenzaprine.

ALLERGIES: She has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history was positive for diabetes.
Mother recently died of chronic renal failure related to her
diabetes.

SOCIAL HISTORY: The patient lives with her husband.  [**Name (NI) 1403**]
as a manager of a house for the care of mentally disabled
people.  No recent travel.  No change of residence.  No pets.
No tobacco.  Husband smokes infrequently.  The patient
reports having had house renovated a couple of weeks ago.
Asthma, unspecified type, with (acute) exacerbation,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Acidosis,Constipation, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia
Asthma NOS w (ac) exac,DMII wo cmp uncntrld,Acidosis,Constipation NOS,Hypertension NOS,Pure hypercholesterolem
Admission Date:  [**2163-4-12**]     Discharge Date:  [**2163-4-21**]

Date of Birth:   [**2105-2-7**]     Sex:  F

Service:

CHIEF COMPLAINT:  A 58-year-old woman with a history of
severe asthma requiring many past hospitalizations.  No
Intensive Care Unit stays and has never been intubated who
presents with worsening shortness of breath over the past
several hours, not relieved by inhalers.

HISTORY OF PRESENT ILLNESS:  Ms. [**Known lastname 38086**] was in her usual
state of health until three days prior to admission when she
began to have fevers, nonproductive cough, worsening
shortness of breath, and dyspnea on exertion.

On the day of admission, these symptoms became worse, and
they were not relieved by her rescue albuterol inhaler.  She
then found that her peak flow was down to 90 from a baseline
of 200 to 250.  Therefore, she went to the [**Hospital1 346**] Emergency Department.

On presentation to the Emergency Department, her vital signs
were a temperature of 99.2, blood pressure of 153/73, heart
rate in the 130s, respiratory rate of 22, and an oxygen
saturation of 97% on room air.  Her peak flow was measured to
be in the 90s in the Emergency Department, with her baseline
at home noted to be 200.  A chest x-ray showed hyperinflated
lungs with no infiltrate.  She was requiring albuterol
nebulizers every hour and was not showing improvement while
in the Emergency Department.  Therefore, she was admitted to
the Intensive Care Unit.

While in the medical Intensive Care Unit an arterial blood
gas was obtained, from which she was found to have a pH of
7.28, a PCO2 of 29, and a PO2 of 76, with a lactate level
of 6.6.  Urinalysis showed a pH of 5, trace ketones, and a
glucose of greater than 1000.  At 5:30 p.m. arterial blood
gas showed a lactate level peaking at 10.2, with a pH
of 7.29, and a bicarbonate level of 11.  With this
presentation, bowel ischemia was considered.  An abdominal CT
was performed which was negative for ischemia or
abnormalities.  She then had an episode of chest pain which
occurred on the way to the CT scan which she regarded as
anxiety.  A 12-lead electrocardiogram at that time was
negative for ischemia.  She was subsequently ruled out by
enzymes with creatine kinases being negative times four, and
troponin I being negative times three q.6h.

She was started on intravenous Solu-Medrol at 60 mg t.i.d.,
and on admission to the floor was switched over to
prednisone 60 mg p.o. q.d.

PAST MEDICAL HISTORY:  (Her past medical history includes)
1.  Asthma times five years.
2.  Hypertension.
3.  Hyperlipidemia.

MEDICATIONS ON ADMISSION:  Medications at (preadmission)
included Pulmicort, Serevent, Flovent, albuterol, Combivent,
Zocor, Glucophage, glyburide, Avapro, Premarin, Accolate, and
cyclobenzaprine.

ALLERGIES:  She has no known drug allergies.

SOCIAL HISTORY:  The patient lives with her husband.  [**Name (NI) 1403**]
as a manager of a house for the care of mentally disabled
people.  No recent travel.  No change of residence.  No pets.
No tobacco.  Husband smokes infrequently.  The patient
reports having had house renovated a couple of weeks ago.

FAMILY HISTORY:  Family history was positive for diabetes.
Mother recently died of chronic renal failure related to her
diabetes.

PHYSICAL EXAMINATION ON PRESENTATION:  Vital signs revealed
temperature of 98.3, heart rate of 89, blood pressure
of 134/88, respiratory rate of 18, oxygen saturation of 95%
on room air and 100% on 4 liters.  In general, a mildly obese
African-American woman in mild respiratory discomfort.  Head,
eyes, ears, nose, and throat revealed extraocular movements
were intact.  Pupils were equal, round, and reactive to light
(3 mm to 2 mm).  The oropharynx was clear without erythema,
moist mucous membranes.  Neck was supple.  Carotids were 2+
bilaterally without bruits.  No thyromegaly.  No upper airway
wheezing.  Chest revealed bilateral symmetric excursions,
expiratory and inspiratory wheezes throughout.  No
costovertebral angle tenderness.  Heart had a regular rate
and rhythm.  No third heart sound or fourth heart sound.  No
murmurs.  The abdomen was soft, protuberant, nontender and
nondistended, normal bowel sounds.  Stool was guaiac-negative
in the Emergency Department.  Extremities revealed no ankle
edema, no calf tenderness or swelling, 2+ dorsalis pedis
pulses bilaterally.

PERTINENT LABORATORY DATA ON PRESENTATION:  Laboratories
revealed complete blood count with white blood cell count
of 12.8, hematocrit of 12.1, platelets of 381.  Chem-7
revealed sodium of 140, potassium of 4.1, chloride of 106,
bicarbonate of 24, blood urea nitrogen of 16, creatinine
of 0.7, glucose of 182.  Creatine kinases were 124, 146, and
150.  CK/MB was 22, troponin of less than 0.3.  Arterial
blood gas revealed pH of 7.34, PCO2 of 39, PO2 of 73, with a
lactate level of 1.7.

ASSESSMENT:  A 58-year-old woman with severe asthma, type 2
diabetes mellitus (on metformin) presenting with an asthma
exacerbation.  The patient seems to have had about one week
of worsening upper respiratory tract infection symptoms;
probably a viral upper respiratory infection preceding this
admission, which most likely led to the exacerbation.  A
transient episode of lactic acidosis of unknown etiology, now
resolving; possibly due to side effect of metformin.

HOSPITAL COURSE:

1.  ASTHMA:  On admission, peak flows were at less than 50%
of predicted value at 90.  The patient was started on
intravenous Solu-Medrol and then switched to oral
prednisone 60 mg p.o. q.d.   She is now completing third day
at 60 mg.  Subjectively better; peak flows now in the 180
range to 200 range.  The patient was continued on home
regimen of meter-dosed inhalers and q.4h. Albuterol
nebulizers, now spaced out to p.r.n. which she received one
to two times per day.

For her asthma, she will be sent to complete her prednisone
taper and was written for three days of prednisone p.o. q.d.
at 40 mg, then 20 mg p.o. q.d. for three days, then 10 mg
p.o. q.d. for three days.  She will continue on her Flovent
meter-dosed inhaler 220 mg 3 puffs b.i.d., Atrovent ,
albuterol, Serevent, and Accolate (which were unchanged).

2.  DIABETES:  The patient reported having high blood sugars
in the 400 range for about two weeks before admission.  Blood
sugars during her hospital stay continued to be elevated.
Control was difficult, especially with the patient on
corticosteroids.  Sliding-scale NPH was added while the
patient was in the hospital to help control blood sugar
levels.  The patient will be leaving on an adjusted control
regimen due to metformin being discontinued secondary to an
episode of lactic acidosis.  Glyburide was changed to
glipizide by recommendation of the [**Last Name (un) **] Diabetic Service
who were following her throughout her stay.  The patient was
to go home on glipizide 10 mg p.o. q.d., Actos 30 mg p.o.
q.d., and NPH sliding-scale for additional coverage while
finishing her prednisone taper.

3.  CONSTIPATION:  The patient reported that she had not had
a bowel movement since being admitted to the hospital.  A KUB
on the fifth day of admission showed no free air, no signs of
perforation, and no signs of obstruction with retained
contrast throughout the bowel.  She was put on a regimen for
her constipation including Colace, Dulcolax, and Fleet
enemas.

On the night prior to discharge, she had a large bowel
movement overnight with subsequent relief of her symptoms of
bloating.  The patient is much more comfortable now after
having a large bowel movement.  She was instructed to stay
actively ambulating, to stay well hydrated, and to add fiber
to her diet.  She was to continue on over-the-counter
anti-constipations medications p.r.n. at home.  Current
episode of constipation was probably due to a combination of
inactivity, poor p.o. fluid intake, and low fiber diet.

4.  DISPOSITION:  The patient was to continue on her
preadmission preventative medications including  aspirin
81 mg p.o. q.d. and Protonix 40 mg p.o. q.d.   She was to
follow up with her primary care doctor, Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 14323**]; who
was made aware of the details of her hospital stay and her
medication changes.  Dr. [**Last Name (STitle) 14323**] was in agreement with the
treatment plan, and she will follow Ms. [**Known lastname 38086**] over the
next couple of week; every two to three days by phone to
follow blood sugar levels and NPH dosing while Ms. [**Known lastname 38086**]
is being tapered from her prednisone for an asthma
exacerbation.

DISCHARGE DIAGNOSES:  Acute asthma exacerbation.

DISCHARGE STATUS:  Discharged to home.

CODE STATUS:  Full code.

DISCHARGE FOLLOWUP:  The patient was to follow up with her
primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 14323**], within the next two to
three weeks in person and every two to three days for NPH
adjustments.  The patient was interested in following with
diabetes care specialist.  The decision on this issue will be
left to her primary care physician.

MEDICATIONS ON DISCHARGE:
 1.  Prednisone taper 40 mg p.o. q.d. times three days; then
20 mg p.o. q.d. times three days; then 10 mg p.o. q.d. times
three days.
 2.  Flovent meter-dosed inhaler 220 mcg 3 puffs b.i.d.
 3.  Atrovent meter-dosed inhaler 2 puffs q.i.d.
 4.  Albuterol meter-dosed inhaler 2 puffs q.4-6h. p.r.n.
 5.  Serevent meter-dosed inhaler 2 puffs b.i.d.
 6.  Accolate 20 mg p.o. b.i.d.
 7.  Glipizide 10 mg p.o. q.d.
 8.  Actos 30 mg p.o. q.d.
 9.  NPH sliding-scale starting at 25 units q.a.m.
and 10 units q.p.m.
10.  Aspirin 81 mg p.o. q.d.
11.  Protonix 40 mg p.o. q.d.
12.  Zocor 40 mg p.o. q.d.
13.  Avapro 150 mg p.o. q.d.




                          [**Name6 (MD) 2415**] [**Last Name (NamePattern4) 3474**], M.D.  [**MD Number(1) 3475**]

Dictated By:[**Company 38087**]

MEDQUIST36

D:  [**2163-4-21**]  10:22
T:  [**2163-4-23**]  03:25
JOB#:  [**Job Number 38088**]
{'Asthma, unspecified type, with (acute) exacerbation,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Acidosis,Constipation, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia'}


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: A 58-year-old woman with a history of
severe asthma requiring many past hospitalizations.  No
Intensive Care Unit stays and has never been intubated who
presents with worsening shortness of breath over the past
several hours, not relieved by inhalers.

PRESENT ILLNESS: Ms. [**Known lastname 38086**] was in her usual
state of health until three days prior to admission when she
began to have fevers, nonproductive cough, worsening
shortness of breath, and dyspnea on exertion.

MEDICAL HISTORY: (Her past medical history includes)
1.  Asthma times five years.
2.  Hypertension.
3.  Hyperlipidemia.

MEDICATION ON ADMISSION: Medications at (preadmission)
included Pulmicort, Serevent, Flovent, albuterol, Combivent,
Zocor, Glucophage, glyburide, Avapro, Premarin, Accolate, and
cyclobenzaprine.

ALLERGIES: She has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history was positive for diabetes.
Mother recently died of chronic renal failure related to her
diabetes.

SOCIAL HISTORY: The patient lives with her husband.  [**Name (NI) 1403**]
as a manager of a house for the care of mentally disabled
people.  No recent travel.  No change of residence.  No pets.
No tobacco.  Husband smokes infrequently.  The patient
reports having had house renovated a couple of weeks ago. 

### Response:
{'Asthma, unspecified type, with (acute) exacerbation,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Acidosis,Constipation, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia'}
