CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 21 year old
female with end-stage renal disease of unclear etiology who
had a cadaveric renal transplant on the [**2181-6-4**].
The patient was initially discharged from that operation on
the [**5-16**].  The patient is readmitted on the 6th with
persistent nausea and vomiting and with hypertension.  The
patient was seen by way of the Emergency Department by
Transplantation Surgery and the patient was seen to have a
blood pressure as high as 230/120.  The patient did not have
nausea on the day prior to admission and had a bowel movement
on the date of admission.  The patient denied any abdominal
pain, no nausea or vomiting, or bloody stools prior to that,
however, on the date of admission the patient noted the onset
of severe nausea and vomiting.  The patient missed her
medications since Sunday, including her blood pressure
medications.

MEDICAL HISTORY: 1.  Hypertension.
2.  End-stage renal disease.

MEDICATION ON ADMISSION: 1.  Immunosuppressant medications of Prednisone 20 q. day.
2.  CellCept [**Pager number **] four times a day.
3.  Tacrolimus 8 mg p.o. twice a day.
4.  Valcyte 450 mg p.o. q.o.d.
5.  Bactrim Single strength one q. day.
6.  Nystatin swish and swallow 5 cc four times a day.
7.  Protonix 4 mg p.o. q. day.
8.  Reglan 5 mg p.o. four times a day.
9.  Colace 100 mg p.o. twice a day.
10. Lamivudine 100 mg q. day.
11. Norvasc 10 mg q. day.
12. Labetalol 800 mg twice a day.
13. Hydralazine 75 mg four times a day.
14. Lasix 80 mg twice a day.
15. Clonidine 0.2 mg twice a day.
16. Percocet p.r.n.
17. Tums three times a day.
18. PhosLo three times a day.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Nausea with vomiting,Kidney replaced by transplant,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Home accidents,Unspecified essential hypertension,Other specified disorders of pancreatic internal secretion,Adrenal cortical steroids causing adverse effects in therapeutic use,Anemia, unspecified
Nausea with vomiting,Kidney transplant status,Adv eff antineoplastic,Accident in home,Hypertension NOS,Pancreatic disorder NEC,Adv eff corticosteroids,Anemia NOS
Admission Date:  [**2181-6-17**]     Discharge Date:  [**2181-6-25**]

Date of Birth:   [**2159-7-25**]     Sex:  F

Service:  TRANS [**Doctor First Name 147**]

HISTORY OF PRESENT ILLNESS:   The patient is a 21 year old
female with end-stage renal disease of unclear etiology who
had a cadaveric renal transplant on the [**2181-6-4**].
The patient was initially discharged from that operation on
the [**5-16**].  The patient is readmitted on the 6th with
persistent nausea and vomiting and with hypertension.  The
patient was seen by way of the Emergency Department by
Transplantation Surgery and the patient was seen to have a
blood pressure as high as 230/120.  The patient did not have
nausea on the day prior to admission and had a bowel movement
on the date of admission.  The patient denied any abdominal
pain, no nausea or vomiting, or bloody stools prior to that,
however, on the date of admission the patient noted the onset
of severe nausea and vomiting.  The patient missed her
medications since Sunday, including her blood pressure
medications.

PAST MEDICAL HISTORY:
1.  Hypertension.
2.  End-stage renal disease.

MEDICATIONS ON ADMISSION:
1.  Immunosuppressant medications of Prednisone 20 q. day.
2.  CellCept [**Pager number **] four times a day.
3.  Tacrolimus 8 mg p.o. twice a day.
4.  Valcyte 450 mg p.o. q.o.d.
5.  Bactrim Single strength one q. day.
6.  Nystatin swish and swallow 5 cc four times a day.
7.  Protonix 4 mg p.o. q. day.
8.  Reglan 5 mg p.o. four times a day.
9.  Colace 100 mg p.o. twice a day.
10. Lamivudine 100 mg q. day.
11. Norvasc 10 mg q. day.
12. Labetalol 800 mg twice a day.
13. Hydralazine 75 mg four times a day.
14. Lasix 80 mg twice a day.
15. Clonidine 0.2 mg twice a day.
16. Percocet p.r.n.
17. Tums three times a day.
18. PhosLo three times a day.

PHYSICAL EXAMINATION:   The patient had vital signs of 96.9
F. Temperature; heart rate 75; blood pressure 230/100 up to
161/97.  The patient was actively vomiting.  The patient's
HEENT was clear.  Chest had regular rate and rhythm with
clear breath sounds bilaterally; no murmurs.  The abdomen was
soft, there was no guarding or rebound tenderness and no
distention.

LABORATORY:  Values on admission revealed a white blood cell
count of 7.8, a hematocrit of 25.6, platelets of 216.  Chem-7
with sodium of 134, potassium of 4.7, chloride of 99,
bicarbonate of 22, BUN of 82, and a creatinine of 9.0.

Calcium, magnesium and phosphorus were 10.4, 1.9 and 6.7.

Liver function tests were within normal limits. Amylase was
normal and bilirubin of 0.4, albumin of 3.9.

Urinalysis had blood but no white cells.

HOSPITAL COURSE SUMMARY:  This is a patient who had chronic
renal disease complicated by delayed graft function with
persistent nausea or vomiting question secondary to uremia,
and hypertension.  The patient was admitted to he Intensive
Care Unit for a Nipride drip.

For control of her hypertension, the patient is admitted to
the Intensive Care Unit, however, Nipride drip resulted in
patient developing a headache and the patient was switched to
Labetalol.  The patient was given an attempt at Lasix with
some response and urinary output.  Her Hydralazine was
increased to 20 q. six hours and the patient was given a
Clonidine patch.

With the nausea and vomiting the patient's CellCept was
discontinued and the patient was started on Rapamycin (which
changed to Solu-Medrol intravenously).  The patient continued
to improve in the Intensive Care Unit.  Creatinine decreased
to 7.8 by hospital day two.

We changed her Metoprolol to 50 twice a day and her
Hydralazine to 75 mg four times a day.  We continued her on
her Norvasc.  Her Clonidine was continued at 0.2, and she
also had a clonidine patch placed.

To assess her kidney's renal function, we obtained both an
MRA of her native kidneys and adrenals to rule out renal
artery stenosis or adrenal tumors, as well as an MRA of her
transplanted kidney.

The patient, for her increased phosphorus, she was continued
on Amphojel 30 cc q. eight hours.

The patient's MRI and MRA of her transplanted kidney
demonstrated good arterial flow with a slight slowing of the
venous anastomosis consistent with a small
non-hemodynamically significant stenosis.  The patient's
blood pressure was better controlled with blood pressures
running systolic of 140 to 190 and diastolic of 80 to 90 and
MAPs of 110 to 130s.

We changed her clonidine to 0.2 twice a day and to a #2
clonidine patch q. week.  Her labetalol was increased to 800
mg p.o. three times a day and hydralazine to 75 mg four times
a day.

Her graft function continued to improve.  The patient became
slightly prerenal and so her Lasix was discontinued.  The
patient was transferred from the Intensive Care Unit to the
Floor on the [**5-22**].  From the 10th until the [**5-26**], the patient improved.  She had an MRI done of her
native kidneys which demonstrated no renal artery stenosis
and no evidence of tumors in the adrenals or the kidneys.

The patient's creatinine continued to improve.  The patient's
nausea and vomiting became only a problem at night and then
resolved.  The patient was made therapeutic on Rapamycin
after a load.  On the 14th, the patient was doing well.  Her
creatinine had decreased to 5.3.  Her blood pressure was
better controlled from the 120s to 160s over 50s to 90s with
a heart rate in the 80s to 90s.  The patient was maintained
on Norvasc 10 mg q. day, Labetalol 800 mg three times a day;
Clonidine patch #2, Hydralazine 75 mg four times a day,
Clonidine 0.2 mg twice a day.

DISPOSITION:   The patient was discharged to home on those
medications as well as Rapamycin 4 mg q. day, tacrolimus 3 mg
twice a day; Prednisone 15 mg q. day; Bactrim Single strength
tablet one q. day; Valcyte 450 mg four times a day;
Chlortramizol troches; Lamivudine 100 mg q. day; Norvasc 10
mg q. day; Labetalol 800 mg three times a day; clonidine
patch #2; Hydralazine 75 mg four times a day; clonidine 0.2
mg twice a day; Protonix 40; Colace 100.



                          [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 1331**]

Dictated By:[**Last Name (NamePattern1) 14369**]

MEDQUIST36

D:  [**2181-12-10**]  10:58
T:  [**2181-12-12**]  22:49
JOB#:  [**Job Number 35071**]


Admission Date:  [**2181-6-17**]     Discharge Date:  [**2181-6-25**]

Date of Birth:   [**2159-7-25**]     Sex:  F

Service:

HISTORY OF PRESENT ILLNESS:  The patient is a 21-year-old
female with a history of end-stage renal disease with unclear
etiology.  The patient also has a history significant for
hypertension.

The patient underwent a cadaveric renal transplant on [**6-4**].  The patient's postoperative course was prolonged and
complicated by delayed graft function, persistent nausea and
vomiting, and the arrangements for dialysis.  The patient was
discharged two days prior to admission and had been doing
well until the morning of admission when she awoke with
severe nausea and vomiting times one.  The patient again was
seen in the Emergency Department.  The patient denied any
abdominal pain.  She denied any fevers or chills.  The
patient also had normal bowel movements.

PAST MEDICAL HISTORY:  (Past medical history is significant
for)
1.  End-stage renal disease.
2.  Hypertension.

MEDICATIONS ON ADMISSION:  (Medications on admission
included)
 1.  Colace 100 mg by mouth twice per day.
 2.  Epivir 100 mg by mouth once per day.
 3.  Amlodipine 10 mg by mouth once per day.
 4.  Labetalol 100 mg by mouth twice per day.
 5.  Hydralazine 75 mg by mouth four times per day.
 6.  Tums.
 7.  Lasix 80 mg by mouth twice per day.
 8.  Phos-Lo.
 9.  Clonidine 0.2 mg by mouth twice per day.
10.  Prograf 8 mg by mouth twice per day.
11.  Prednisone 20 mg by mouth once per day.
12.  CellCept [**Pager number **] mg by mouth four times per day.
13.  Valcyte 450 mg by mouth every other day.
14.  Bactrim single strength one tablet by mouth every day.
15.  Nystatin 5 cc by mouth four times per day.
16.  Protonix 40 mg by mouth once per day.
17.  Reglan 5 mg by mouth four times per day.
18.  Percocet by mouth as needed.

ALLERGIES:  The patient has no known drug allergies.

PHYSICAL EXAMINATION ON PRESENTATION:  Physical examination
on admission revealed the patient's temperature was 96.9
degrees Fahrenheit, her heart rate was 76, her blood pressure
was 160/110 to 160/97, her respiratory rate was 16, and her
oxygen saturation was 100%.  The sclerae were anicteric.  The
patient's cardiovascular examination revealed a regular rate
and rhythm.  There were normal heart sounds.  Respiratory
examination revealed clear chest fields bilaterally.
Abdominal examination revealed the abdomen was soft without
tenderness.  There was no rebound or guarding.  The incision
was clean, dry, and intact with no discharge.  Extremity
examination revealed the extremities were warm with 2+ pulses
bilaterally.

PERTINENT LABORATORY VALUES ON PRESENTATION:  Laboratory
examination on admission revealed the patient's white blood
cell count was 7.8, her hematocrit was 25.6, and her
platelets were 216.  Electrolytes were within normal limits
with a blood urea nitrogen of 82 and creatinine of 9.  Her
glucose was 106.  Calcium, magnesium, and phosphate were
10.4, 1.9, and 6.7; respectively.  Her amylase was 60.  Her
bilirubin was 0.4.  Her albumin was 3.9.  Urinalysis revealed
blood without evidence of white blood cells.

CONCISE SUMMARY OF HOSPITAL COURSE:  The patient was
therefore re-admitted two days after discharge after a
cadaveric renal transplant which was complicated by delayed
graft function.  The patient had persistent nausea and
vomiting; after which she was unable to keep down her by
mouth medications including her antihypertensive medications.
The patient also presented with hypertension.

The patient was given some intravenous fluids and continued
on her immunosuppressive medications.  The patient was
admitted to the Intensive Care Unit for control of her blood
pressure.

The patient was admitted to the Intensive Care Unit and was
started on a Nipride drip.  Unfortunately, the patient
developed headaches, and because of her renal function the
Nipride drip was discontinued.  The patient was changed to
labetalol.  In the Intensive Care Unit, the patient's
creatinine decreased to 7.2.  The patient's nausea and
vomiting did improve, and her blood pressure was improved.

The patient was transferred to the floor on [**6-21**].  The
patient's CellCept (which was felt also to be contributing to
her nausea and vomiting) was discontinued.  The patient was
loaded with 10 mg once per day of rapamycin for three days
and then was started on a standing dose of 4 mg of rapamycin
once per day.  The patient's other antihypertensive
medications were adjusted to lower her blood pressure to the
120 level.

The patient had a magnetic resonance imaging of her native
kidney and magnetic resonance angiography as well, as a
magnetic resonance imaging of her adrenals revealed no
evidence of renal artery stenosis, no evidence of adrenal or
renal masses.  The patient had a magnetic resonance
angiography and magnetic resonance imaging of her
transplanted kidney which also demonstrated no evidence of
renal artery stenosis and not hemodynamically significant
stenosis of her renal vein.

The patient was advanced to a regular diet.  The patient was
tolerating a regular diet and ambulating.  The patient had
resolution of her nausea and vomiting.

DISCHARGE DISPOSITION:  By [**6-25**], the patient was doing
well and was discharged to home.

MEDICATIONS ON DISCHARGE:  (The patient's medications on
discharge included the following)
 1.  Rapamycin 4 mg by mouth once per day.
 2.  Prograf 3 mg by mouth twice per day.
 3.  Prednisone 15 mg by mouth once per day.
 4.  Bactrim single strength one tablet by mouth every day.
 5.  Valcyte 450 mg by mouth every other day.
 6.  Clotrimazole troches.
 7.  Lamivudine 100 mg by mouth once per day.
 8.  Norvasc 10 mg by mouth once per day.
 9.  Labetalol 800 mg by mouth three times per day.
10.  Clonidine patch.
11.  Hydralazine 75 mg by mouth four times per day.
12.  Clonidine tablets 0.2 mg by mouth twice per day.
13.  Protonix 40 mg by mouth once per day.
14.  Colace 100 mg by mouth twice per day.
15.  Reglan 5 mg by mouth four times per day.
16.  Percocet for pain.

DISCHARGE INSTRUCTIONS/FOLLOWUP:  The patient was instructed
to follow up with Dr. [**First Name (STitle) **] [**Name (STitle) **] as well as with Dr.
[**Last Name (STitle) **] in the [**Hospital 1326**] Clinic.




                          [**Name6 (MD) 1344**] [**Name8 (MD) 1345**], M.D.  [**MD Number(1) 1346**]

Dictated By:[**Last Name (NamePattern1) 14369**]

MEDQUIST36

D:  [**2181-12-10**]  11:07
T:  [**2181-12-13**]  09:13
JOB#:  [**Job Number 35072**]
{'Nausea with vomiting,Kidney replaced by transplant,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Home accidents,Unspecified essential hypertension,Other specified disorders of pancreatic internal secretion,Adrenal cortical steroids causing adverse effects in therapeutic use,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: 

PRESENT ILLNESS: The patient is a 21 year old
female with end-stage renal disease of unclear etiology who
had a cadaveric renal transplant on the [**2181-6-4**].
The patient was initially discharged from that operation on
the [**5-16**].  The patient is readmitted on the 6th with
persistent nausea and vomiting and with hypertension.  The
patient was seen by way of the Emergency Department by
Transplantation Surgery and the patient was seen to have a
blood pressure as high as 230/120.  The patient did not have
nausea on the day prior to admission and had a bowel movement
on the date of admission.  The patient denied any abdominal
pain, no nausea or vomiting, or bloody stools prior to that,
however, on the date of admission the patient noted the onset
of severe nausea and vomiting.  The patient missed her
medications since Sunday, including her blood pressure
medications.

MEDICAL HISTORY: 1.  Hypertension.
2.  End-stage renal disease.

MEDICATION ON ADMISSION: 1.  Immunosuppressant medications of Prednisone 20 q. day.
2.  CellCept [**Pager number **] four times a day.
3.  Tacrolimus 8 mg p.o. twice a day.
4.  Valcyte 450 mg p.o. q.o.d.
5.  Bactrim Single strength one q. day.
6.  Nystatin swish and swallow 5 cc four times a day.
7.  Protonix 4 mg p.o. q. day.
8.  Reglan 5 mg p.o. four times a day.
9.  Colace 100 mg p.o. twice a day.
10. Lamivudine 100 mg q. day.
11. Norvasc 10 mg q. day.
12. Labetalol 800 mg twice a day.
13. Hydralazine 75 mg four times a day.
14. Lasix 80 mg twice a day.
15. Clonidine 0.2 mg twice a day.
16. Percocet p.r.n.
17. Tums three times a day.
18. PhosLo three times a day.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Nausea with vomiting,Kidney replaced by transplant,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Home accidents,Unspecified essential hypertension,Other specified disorders of pancreatic internal secretion,Adrenal cortical steroids causing adverse effects in therapeutic use,Anemia, unspecified'}
