CHIEF COMPLAINT: Chief Complaint: diarrhea

PRESENT ILLNESS: 67M w/ hx metastatic lung cancer, COPD, erosive gastritis p/w
hypotension and diarrhea, possible blood per rectum. States for
the past several days he felt faint, weak, and fatigued.
Yesterday his symtoms worsened and he also experienced several
episodes of ?bloody diarrhea.  No N/V, no CP or abdominal pain.
No fever, chills, dysuria. Complains of continued LLE pain c/w
chronic pain.  Also some ?SOB.  [**Name (NI) 1094**] sister states that pt was
on toilet and she caught him while he was trying to get up.
Called [**Hospital1 **], SOB on the phone.  Sister was with him
and stated he was too weak to walk or get down stairs.  She
called 911.

MEDICAL HISTORY: -Metastatic Lung Cancer (see below)
-Chronic Obstructive Pulmonary Disease
-Anemia (chemo and CKD)
-Erosive Gastritis (secondary to NSAID use)
-Psoriasis and Psoriatic Arthritis
-Hypertension
-Osteoarthritis
-Peripheral Vascular Disease (s/p LE bypass)
-Diverticulosis
-Hypercholesterolemia
-AAA repair in [**2171**]
-Left total knee replacement in [**2173**]
-Left L4/L5 spine surgery in [**2138**], reported as a discectomy;
and severe lumbar DJD
-Gallstone pancreatitis
-Rectal and colonic polyps
-ECHO [**4-/2179**]: L atrium mildly dilated; otherwise essentially NML
w/ EF 60%
-ECG [**4-/2179**]: normal sinus rhythm, Qwaves V1-V2

MEDICATION ON ADMISSION: - dexamethasone
- folic acid?
- lorazepam 1 mg as needed for insomnia or for nausea
- omeprazole 20 mg capsule, delayed release(DR/EC) [**Hospital1 **]
- ondansetron 8 mg tablet ODT every 8 hours as needed for nausea
- oxycodone 5 mg tablet every 4 hours as needed for pain
- prochlorperazine maleate 10 mg tablet every 6 hours as needed

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Physical Exam:
Vitals: T: 98.5, BP: 99/47, P: 93, R: 17, O2: 100% RA
General: Alert, oriented, no acute distress, rash on face, arms

FAMILY HISTORY: -Mother had some type of cancer. No family hx of pancreatitis.

SOCIAL HISTORY: -Divorced, two children
-Lives with sister, independent in ADLs
-Tobacco: quit 8 years ago
-ETOH: 1-2 drinks weekly at most, had 2 beers last night
-Illicits: None
Hemorrhage of gastrointestinal tract, unspecified,Acute respiratory failure,Other shock without mention of trauma,Secondary malignant neoplasm of lung,Secondary malignant neoplasm of bone and bone marrow,Malignant neoplasm of upper lobe, bronchus or lung,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Chronic airway obstruction, not elsewhere classified,Psoriatic arthropathy,Hypovolemia,Chronic kidney disease, Stage III (moderate),Cardiac arrest,Acute posthemorrhagic anemia,Pain in limb,Other chronic pain,Herpes zoster without mention of complication,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Peripheral vascular disease, unspecified,Pure hypercholesterolemia,Knee joint replacement,Personal history of tobacco use,Unspecified analgesic and antipyretic causing adverse effects in therapeutic use,Other specified gastritis, without mention of hemorrhage
Gastrointest hemorr NOS,Acute respiratry failure,Shock w/o trauma NEC,Secondary malig neo lung,Secondary malig neo bone,Mal neo upper lobe lung,Mal neo lymph-intrathor,Chr airway obstruct NEC,Psoriatic arthropathy,Hypovolemia,Chr kidney dis stage III,Cardiac arrest,Ac posthemorrhag anemia,Pain in limb,Chronic pain NEC,Herpes zoster NOS,Hy kid NOS w cr kid I-IV,Periph vascular dis NOS,Pure hypercholesterolem,Joint replaced knee,History of tobacco use,Adv eff analgesic NOS,Oth spf gstrt w/o hmrhg
Admission Date:  [**2180-8-21**]              Discharge Date:   [**2180-8-22**]

Date of Birth:  [**2112-10-21**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 594**]
Chief Complaint:
Chief Complaint: diarrhea

Reason for MICU transfer: hypotension with GI bleed


Major Surgical or Invasive Procedure:
Arterial Line Placement
Central Venous Catheter Placement Attempt x 4
Intubation and Mechanical Ventilation
Blood transfusion
Intraosseous Line Placement

History of Present Illness:
67M w/ hx metastatic lung cancer, COPD, erosive gastritis p/w
hypotension and diarrhea, possible blood per rectum. States for
the past several days he felt faint, weak, and fatigued.
Yesterday his symtoms worsened and he also experienced several
episodes of ?bloody diarrhea.  No N/V, no CP or abdominal pain.
No fever, chills, dysuria. Complains of continued LLE pain c/w
chronic pain.  Also some ?SOB.  [**Name (NI) 1094**] sister states that pt was
on toilet and she caught him while he was trying to get up.
Called [**Hospital1 **], SOB on the phone.  Sister was with him
and stated he was too weak to walk or get down stairs.  She
called 911.

Patient presented to the [**Hospital1 18**] ED by ambulance.  On arrival at
[**Hospital1 18**] he was noted to be hypotensive and triggered.  ED vitals:
97.2, 102, 70/40-->repeat 95/47, 16, 100%.  He had heme postive,
brown stool w/ no gross blood.  Recent HCT 31.8 on [**2180-7-31**]
(Atrius), and patient was found to have HCT of 19, ordered 2
units PRBCs, but did not yet get.  Given 100mg hydrocortisone IV
as stress-dose steroids because pt is on steroids.  BPs have
been mostly in the 100s-110s.  Unclear if pt has had recent EGD
or colonoscopy, none in our system, did have recent EGD for
gallstone pancreatitis, but pt does reportedly have erosive
gastritis, diverticulitosis, and has had rectal and colonic
polyps.  Also recent history of peri-anal zoster, now on
Valtrex.  Patient was given 2L NS in ED, bedside U/S NML, and
had CT abdomen (oral, no IV contrast).  GI paged and aware, but
did not yet see patient.

Most recent set of ED vitals: 97.7, 95, 118/46, 19, 100%RA.

On arrival to the MICU, pt was mentating well, still c/o some
dizziness, no CP, no stool since arrived to ED.

Past Medical History:
-Metastatic Lung Cancer (see below)
-Chronic Obstructive Pulmonary Disease
-Anemia (chemo and CKD)
-Erosive Gastritis (secondary to NSAID use)
-Psoriasis and Psoriatic Arthritis
-Hypertension
-Osteoarthritis
-Peripheral Vascular Disease (s/p LE bypass)
-Diverticulosis
-Hypercholesterolemia
-AAA repair in [**2171**]
-Left total knee replacement in [**2173**]
-Left L4/L5 spine surgery in [**2138**], reported as a discectomy;
and severe lumbar DJD
-Gallstone pancreatitis
-Rectal and colonic polyps
-ECHO [**4-/2179**]: L atrium mildly dilated; otherwise essentially NML
w/ EF 60%
-ECG [**4-/2179**]: normal sinus rhythm, Qwaves V1-V2


Social History:
-Divorced, two children
-Lives with sister, independent in ADLs
-Tobacco: quit 8 years ago
-ETOH: 1-2 drinks weekly at most, had 2 beers last night
-Illicits: None


Family History:
-Mother had some type of cancer. No family hx of pancreatitis.


Physical Exam:
Admission Physical Exam:
Vitals: T: 98.5, BP: 99/47, P: 93, R: 17, O2: 100% RA
General: Alert, oriented, no acute distress, rash on face, arms

HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, holosystolic
murmur, no rubs, gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
Rectal: Melena, guaiac +
Ext: no edema
Neuro: CNII-XII intact

Discharge Exam: expired

Pertinent Results:
[**2180-8-21**] 12:55AM BLOOD WBC-10.9# RBC-2.23*# Hgb-5.8*# Hct-19.4*#
MCV-87 MCH-26.0* MCHC-29.8* RDW-17.2* Plt Ct-482*#
[**2180-8-21**] 12:55AM BLOOD Neuts-81.9* Lymphs-11.5* Monos-5.8
Eos-0.5 Baso-0.2
[**2180-8-21**] 12:55AM BLOOD Glucose-169* UreaN-47* Creat-1.9* Na-138
K-4.1 Cl-104 HCO3-24 AnGap-14
[**2180-8-21**] 12:55AM BLOOD Albumin-2.4* Calcium-7.7* Phos-2.5*
Mg-1.3*
[**2180-8-21**] 05:40PM BLOOD WBC-17.5*# RBC-3.29* Hgb-9.6*# Hct-28.5*
MCV-87 MCH-29.1 MCHC-33.7 RDW-15.0 Plt Ct-333
[**2180-8-21**] 05:40PM BLOOD Mg-2.5
[**2180-8-21**] 12:55AM BLOOD ALT-10 AST-16 AlkPhos-91 TotBili-0.1


Brief Hospital Course:
67M w/ hx metastatic lung cancer, COPD, erosive gastritis who
presented with diarrhea and GI bleed with admission Hct of 19.
He was initially admitted to the ICU for close monitoring,
during which time he was transfused 2 units of pRBCs. He
remained hemodynamically stable. GI was consulted who planned to
complete an EGD. However as the day progressed, patient became
increasingly hypotensive with sBPs in 60s. Vascular surgery
consulted for concern aortoenteric fistula. Patient became too
unstable to CT scan. Plan was made to pursue EGD more urgently
to rule out upper GI bleed. Patient was intubated in preparation
of EGD. Prior EGD, family meeting was held to explain the
patient's poor condition. After speaking to the HCP, he was kelp
full code until she could arrive to be at this bedside Just
prior to EGD, patient's BPs dropped and he ultimately went
pulseless. Resuscitative measures were initiated with chest
compressions. Patient received 1mg of epinephrine and ROSC was
established. Massive transfusion protocol was commensed. He then
remained on maximal BP support and was started on epinephrine
gtt. He remained profoundly hypotensive despite maximal
vasopressor support and massive transfusion. Family meeting was
held and focus was shifted to comfort oriented care. Patient
passed on [**2180-8-21**] at 2145. Family declined autopsy.

Medications on Admission:
- dexamethasone
- folic acid?
- lorazepam 1 mg as needed for insomnia or for nausea
- omeprazole 20 mg capsule, delayed release(DR/EC) [**Hospital1 **]
- ondansetron 8 mg tablet ODT every 8 hours as needed for nausea
- oxycodone 5 mg tablet every 4 hours as needed for pain
- prochlorperazine maleate 10 mg tablet every 6 hours as needed

- simvastatin 80 mg daily (pravastatin?)
- Alleve
- Zometa
- imatinib 100 mg daily
- Tarceva (erlotinib)
- Valtrex

Discharge Medications:
expired

Discharge Disposition:
Expired

Discharge Diagnosis:
expired

Discharge Condition:
expired

Discharge Instructions:
expired

Followup Instructions:
expired


Completed by:[**2180-8-22**]
{'Hemorrhage of gastrointestinal tract, unspecified,Acute respiratory failure,Other shock without mention of trauma,Secondary malignant neoplasm of lung,Secondary malignant neoplasm of bone and bone marrow,Malignant neoplasm of upper lobe, bronchus or lung,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Chronic airway obstruction, not elsewhere classified,Psoriatic arthropathy,Hypovolemia,Chronic kidney disease, Stage III (moderate),Cardiac arrest,Acute posthemorrhagic anemia,Pain in limb,Other chronic pain,Herpes zoster without mention of complication,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Peripheral vascular disease, unspecified,Pure hypercholesterolemia,Knee joint replacement,Personal history of tobacco use,Unspecified analgesic and antipyretic causing adverse effects in therapeutic use,Other specified gastritis, without mention of hemorrhage'}


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: Chief Complaint: diarrhea

PRESENT ILLNESS: 67M w/ hx metastatic lung cancer, COPD, erosive gastritis p/w
hypotension and diarrhea, possible blood per rectum. States for
the past several days he felt faint, weak, and fatigued.
Yesterday his symtoms worsened and he also experienced several
episodes of ?bloody diarrhea.  No N/V, no CP or abdominal pain.
No fever, chills, dysuria. Complains of continued LLE pain c/w
chronic pain.  Also some ?SOB.  [**Name (NI) 1094**] sister states that pt was
on toilet and she caught him while he was trying to get up.
Called [**Hospital1 **], SOB on the phone.  Sister was with him
and stated he was too weak to walk or get down stairs.  She
called 911.

MEDICAL HISTORY: -Metastatic Lung Cancer (see below)
-Chronic Obstructive Pulmonary Disease
-Anemia (chemo and CKD)
-Erosive Gastritis (secondary to NSAID use)
-Psoriasis and Psoriatic Arthritis
-Hypertension
-Osteoarthritis
-Peripheral Vascular Disease (s/p LE bypass)
-Diverticulosis
-Hypercholesterolemia
-AAA repair in [**2171**]
-Left total knee replacement in [**2173**]
-Left L4/L5 spine surgery in [**2138**], reported as a discectomy;
and severe lumbar DJD
-Gallstone pancreatitis
-Rectal and colonic polyps
-ECHO [**4-/2179**]: L atrium mildly dilated; otherwise essentially NML
w/ EF 60%
-ECG [**4-/2179**]: normal sinus rhythm, Qwaves V1-V2

MEDICATION ON ADMISSION: - dexamethasone
- folic acid?
- lorazepam 1 mg as needed for insomnia or for nausea
- omeprazole 20 mg capsule, delayed release(DR/EC) [**Hospital1 **]
- ondansetron 8 mg tablet ODT every 8 hours as needed for nausea
- oxycodone 5 mg tablet every 4 hours as needed for pain
- prochlorperazine maleate 10 mg tablet every 6 hours as needed

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Physical Exam:
Vitals: T: 98.5, BP: 99/47, P: 93, R: 17, O2: 100% RA
General: Alert, oriented, no acute distress, rash on face, arms

FAMILY HISTORY: -Mother had some type of cancer. No family hx of pancreatitis.

SOCIAL HISTORY: -Divorced, two children
-Lives with sister, independent in ADLs
-Tobacco: quit 8 years ago
-ETOH: 1-2 drinks weekly at most, had 2 beers last night
-Illicits: None 

### Response:
{'Hemorrhage of gastrointestinal tract, unspecified,Acute respiratory failure,Other shock without mention of trauma,Secondary malignant neoplasm of lung,Secondary malignant neoplasm of bone and bone marrow,Malignant neoplasm of upper lobe, bronchus or lung,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Chronic airway obstruction, not elsewhere classified,Psoriatic arthropathy,Hypovolemia,Chronic kidney disease, Stage III (moderate),Cardiac arrest,Acute posthemorrhagic anemia,Pain in limb,Other chronic pain,Herpes zoster without mention of complication,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Peripheral vascular disease, unspecified,Pure hypercholesterolemia,Knee joint replacement,Personal history of tobacco use,Unspecified analgesic and antipyretic causing adverse effects in therapeutic use,Other specified gastritis, without mention of hemorrhage'}
