CHIEF COMPLAINT: Acute renal failure

PRESENT ILLNESS: 67 y/o female with h/o uterine cancer s/p chemo and XRT 4 with
mets to small bowel s/p small bowel resection, who presented
from [**Hospital3 **] with ARF. She initially presented to
[**Hospital3 7571**]with generalized weakness, fatigue, increased
SOB, and general sense of malaise. There, vitals were T 97.3, HR
97, BP 132/69, RR 18, sat 100% RA and was noted to be slightly
disheveled and confused, but oriented, and slow to respond. ABG
7.11/11/113; WBC 20, Hct 22, BUN 101, creatinine 14.8 (baseline
[**5-5**] 1.1, [**4-6**] 2.5; [**8-6**] 2.8; [**12-7**] 3.3). Per report, Pt made no
urine even after foley placement. Given 500 cc NS bolus. Given
Vanc 1gm IV/Levo 500 IV/Flagyl 500 IV, transfused 2UPRBCs, 1amp
bicarb. Patient refused CTA, CT head and admission at [**Location (un) **]
and was then transferred to [**Hospital1 18**] for further care and urgent
dialysis.
.
In the [**Hospital1 18**] ED, T 97.0; BP 97/50; HR 87; RR 20; 98%RA. Pt seen
by renal, recommmended 2gm calcium gluconate X2, 2 amps bicarb
in D5W at 125cc/hr. Femoral line placed. Head CT negative.

MEDICAL HISTORY: # Uterine cancer: diagnosed 7-8 years ago s/p total
hysterectomy. Then subsequently found to have mets to small
bowel s/p resection then chemo, XRT. Since then, she has had
multiple surgeries for bowel adhesions.

MEDICATION ON ADMISSION: Advil- per daughter, patient has been taking at least 2 advil
QHS for past few months, stopped a week ago
Benedryl PRN
Clams Forte
Twin Lab B12
Ensure
Prilosec OTC (just started)
Rilazapam half pill [**Hospital1 **]

ALLERGIES: Penicillins

PHYSICAL EXAM: Well appearing thin white female.
T 98.8 BP 117/66 HR 75 RR 20 Sat 97% RA
SKIN: thin, papery
HEENT: PEERL, EOMI, mucous membranes moist, sclera anicteric.
NECK: No LAD or bruits.
CHEST: Lungs clear.
HEART: Regular rhythm. Pericardial rub.
ABD: NABS. Soft, NT, ND. No ingunal LAD.
EXT: No edema. Good pulses.
NEURO: Alert and oriented to person place and time. CN II-XII
intact. Full 5/5 strength throughout.

FAMILY HISTORY: No fam hx of kidney disease. Sisiter had cysts on kidneys.
Father died of lung cancer. Mother died of ?colon/stomach
cancer. Her brother and sister are both obese and have HTN.

SOCIAL HISTORY: No tobacco, rare alcohol, no Illicits.
End stage renal disease,Mitral valve disorders,Acidosis,Pulmonary collapse,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Acute kidney failure, unspecified,Unspecified disease of pericardium,Anemia, unspecified,Leukocytosis, unspecified,Edema,Diarrhea
End stage renal disease,Mitral valve disorder,Acidosis,Pulmonary collapse,Hy kid NOS w cr kid I-IV,Acute kidney failure NOS,Pericardial disease NOS,Anemia NOS,Leukocytosis NOS,Edema,Diarrhea
Admission Date:  [**2173-3-25**]              Discharge Date:   [**2173-4-3**]

Date of Birth:  [**2106-2-26**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 465**]
Chief Complaint:
Acute renal failure

Major Surgical or Invasive Procedure:
Tunnelled catheter placement


History of Present Illness:
67 y/o female with h/o uterine cancer s/p chemo and XRT 4 with
mets to small bowel s/p small bowel resection, who presented
from [**Hospital3 **] with ARF. She initially presented to
[**Hospital3 7571**]with generalized weakness, fatigue, increased
SOB, and general sense of malaise. There, vitals were T 97.3, HR
97, BP 132/69, RR 18, sat 100% RA and was noted to be slightly
disheveled and confused, but oriented, and slow to respond. ABG
7.11/11/113; WBC 20, Hct 22, BUN 101, creatinine 14.8 (baseline
[**5-5**] 1.1, [**4-6**] 2.5; [**8-6**] 2.8; [**12-7**] 3.3). Per report, Pt made no
urine even after foley placement. Given 500 cc NS bolus. Given
Vanc 1gm IV/Levo 500 IV/Flagyl 500 IV, transfused 2UPRBCs, 1amp
bicarb. Patient refused CTA, CT head and admission at [**Location (un) **]
and was then transferred to [**Hospital1 18**] for further care and urgent
dialysis.
.
In the [**Hospital1 18**] ED, T 97.0; BP 97/50; HR 87; RR 20; 98%RA. Pt seen
by renal, recommmended 2gm calcium gluconate X2, 2 amps bicarb
in D5W at 125cc/hr. Femoral line placed. Head CT negative.


Past Medical History:
# Uterine cancer: diagnosed 7-8 years ago s/p total
hysterectomy. Then subsequently found to have mets to small
bowel s/p resection then chemo, XRT. Since then, she has had
multiple surgeries for bowel adhesions.

Social History:
No tobacco, rare alcohol, no Illicits.

Family History:
No fam hx of kidney disease. Sisiter had cysts on kidneys.
Father died of lung cancer. Mother died of ?colon/stomach
cancer. Her brother and sister are both obese and have HTN.

Physical Exam:
Well appearing thin white female.
T 98.8 BP 117/66 HR 75 RR 20 Sat 97% RA
SKIN: thin, papery
HEENT: PEERL, EOMI, mucous membranes moist, sclera anicteric.
NECK: No LAD or bruits.
CHEST: Lungs clear.
HEART: Regular rhythm. Pericardial rub.
ABD: NABS. Soft, NT, ND. No ingunal LAD.
EXT: No edema. Good pulses.
NEURO: Alert and oriented to person place and time. CN II-XII
intact. Full 5/5 strength throughout.


Pertinent Results:
[**2173-3-25**] 09:05PM BLOOD WBC-17.9* RBC-2.20* Hgb-6.4* Hct-20.2*
MCV-92 MCH-29.3 MCHC-31.9 RDW-15.4 Plt Ct-216
[**2173-3-26**] 01:16AM BLOOD WBC-14.7* RBC-1.91* Hgb-5.7* Hct-17.2*
MCV-90 MCH-29.8 MCHC-33.0 RDW-15.2 Plt Ct-198
[**2173-3-26**] 11:44AM BLOOD Hct-20.4*
[**2173-3-26**] 05:45PM BLOOD Hct-23.5*
[**2173-3-26**] 10:10PM BLOOD WBC-10.0 RBC-2.63*# Hgb-8.1*# Hct-22.5*
MCV-86 MCH-31.0 MCHC-36.2* RDW-14.6 Plt Ct-141*
[**2173-3-27**] 04:29AM BLOOD WBC-7.8 RBC-2.93* Hgb-8.9* Hct-25.3*
MCV-86 MCH-30.6 MCHC-35.4* RDW-14.7 Plt Ct-149*
[**2173-3-28**] 06:10AM BLOOD WBC-7.2 RBC-3.11* Hgb-9.2* Hct-27.3*
MCV-88 MCH-29.6 MCHC-33.8 RDW-14.9 Plt Ct-161
[**2173-3-29**] 04:50AM BLOOD WBC-8.8 RBC-3.21* Hgb-9.7* Hct-28.6*
MCV-89 MCH-30.2 MCHC-33.8 RDW-15.0 Plt Ct-199
[**2173-3-30**] 04:50AM BLOOD WBC-8.8 RBC-3.13* Hgb-9.3* Hct-28.3*
MCV-90 MCH-29.7 MCHC-32.9 RDW-15.2 Plt Ct-215
[**2173-3-31**] 04:45AM BLOOD WBC-7.6 RBC-3.09* Hgb-9.3* Hct-28.0*
MCV-91 MCH-30.1 MCHC-33.3 RDW-15.5 Plt Ct-191
[**2173-4-1**] 04:35AM BLOOD WBC-8.9 RBC-3.27* Hgb-9.9* Hct-29.7*
MCV-91 MCH-30.2 MCHC-33.3 RDW-15.3 Plt Ct-210
[**2173-4-2**] 04:40AM BLOOD WBC-8.3 RBC-3.18* Hgb-9.4* Hct-28.7*
MCV-90 MCH-29.4 MCHC-32.6 RDW-15.2 Plt Ct-158
[**2173-3-25**] 09:05PM BLOOD Glucose-92 UreaN-100* Creat-15.7* Na-141
K-3.8 Cl-112* HCO3-LESS THAN
[**2173-3-26**] 01:16AM BLOOD Glucose-109* UreaN-101* Creat-15.8*
Na-145 K-3.0* Cl-111* HCO3-8* AnGap-29*
[**2173-3-26**] 10:10PM BLOOD Glucose-95 UreaN-57* Creat-9.7*# Na-144
K-2.6* Cl-106 HCO3-19* AnGap-22*
[**2173-3-27**] 04:29AM BLOOD Glucose-91 UreaN-60* Creat-10.2* Na-144
K-3.1* Cl-108 HCO3-19* AnGap-20
[**2173-3-28**] 06:10AM BLOOD Glucose-93 UreaN-43* Creat-7.9*# Na-143
K-3.5 Cl-107 HCO3-23 AnGap-17
[**2173-3-29**] 04:50AM BLOOD Glucose-94 UreaN-49* Creat-9.1*# Na-142
K-3.9 Cl-104 HCO3-23 AnGap-19
[**2173-3-30**] 04:50AM BLOOD Glucose-93 UreaN-54* Creat-9.6* Na-141
K-3.8 Cl-104 HCO3-23 AnGap-18
[**2173-3-31**] 04:45AM BLOOD Glucose-88 UreaN-31* Creat-6.6*# Na-144
K-3.8 Cl-104 HCO3-27 AnGap-17
[**2173-4-1**] 04:35AM BLOOD Glucose-86 UreaN-39* Creat-8.4*# Na-144
K-3.6 Cl-104 HCO3-27 AnGap-17
[**2173-4-2**] 04:40AM BLOOD Glucose-95 UreaN-26* Creat-6.3*# Na-143
K-3.5 Cl-104 HCO3-29 AnGap-14
[**2173-4-3**] 06:00AM BLOOD Glucose-85 UreaN-34* Creat-8.0*# Na-140
K-3.8 Cl-101 HCO3-26 AnGap-17
[**2173-3-26**] 01:16AM BLOOD ALT-13 AST-18 LD(LDH)-194 CK(CPK)-273*
AlkPhos-61 Amylase-278* TotBili-0.2
[**2173-3-26**] 01:16AM BLOOD CK-MB-20* MB Indx-7.3 cTropnT-0.08*
proBNP-[**Numeric Identifier 27934**]*
[**2173-3-30**] 04:50AM BLOOD HBsAg-NEGATIVE HBsAb-NEGATIVE
HBcAb-NEGATIVE
[**2173-3-30**] 04:50AM BLOOD HCV Ab-NEGATIVE

Head CT: No evidence of masses or hemorrhage

CXR: Left lower lobe opacity either representing atelectasis or
consolidation. Continued followup is suggested given clinical
history.

Echocardiogram: The left atrium is mildly dilated. The estimated
right atrial pressure is 0-5mmHg. Left ventricular wall
thickness, cavity size, and systolic function are normal
(LVEF>55%). Regional left ventricular wall motion is normal.
Tissue Doppler imaging suggests a normal left ventricular
filling pressure (PCWP<12mmHg). Transmitral Doppler and tissue
velocity imaging are consistent with normal LV diastolic
function. Right ventricular chamber size and free wall motion
are normal. The ascending aorta is mildly dilated. The aortic
valve leaflets (3) appear structurally normal with good leaflet
excursion. There is no aortic valve stenosis. Trace aortic
regurgitation is seen. The mitral valve leaflets are
structurally normal. There is no mitral valve prolapse. Mild
(1+) mitral regurgitation is seen. There is borderline pulmonary
artery systolic hypertension. There is a small pericardial
effusion (< 1.0 cm in diastole). The effusion appears
circumferential.

Renal U/S:
1.  No hydronephrosis.
2.  Echogenic kidneys suggesting medical renal disease.


Brief Hospital Course:
67 y/o female with hx metastatic uterine cancer presenting with
acute on chronic renal failure. Tunnelled catheter placed.
Initiated dialysis.

# Acute renal failure: Unclear etiology as to whether
obstructive (retroperitoneal fibrosis, ureteral obstruction from
adhesions) versus intrarenal (ATN vs AIN from NSAID use). No
evidence of hydro, so not c/w complete obstruction. Appears to
be chronic based on small kidney size by U/S and rising Cr over
last several years. Had pericardial friction rub during most of
stay that was gone at the time of discharge. No clinical or
echocardiographic evidence of tamponade, and no other evidence
of uremia. A tunnelled dialysis catheter was placed, and
dialysis was initiated.

# Metabolic Acidosis: Corrected with bicarb and dialysis. Likely
[**3-5**] uremia.

# Anemia: Unclear what is baseline. Likely [**3-5**] to decreased
erythropoietin production from renal failure. No overt signs of
blood loss, guaiac neg in ED. RDW nl. MCV nl. Received a total
of 3 units pRBCs and was initiated on erythropoietin replacement
with dialysis.


Medications on Admission:
Advil- per daughter, patient has been taking at least 2 advil
QHS for past few months, stopped a week ago
Benedryl PRN
Clams Forte
Twin Lab B12
Ensure
Prilosec OTC (just started)
Rilazapam half pill [**Hospital1 **]


Discharge Medications:
1. Nephrocaps 1 mg Capsule Sig: One (1) Capsule PO once a day.
Disp:*30 Capsule(s)* Refills:*2*
2. Calcium Acetate 667 mg Capsule Sig: One (1) Capsule PO three
times a day: with meals.
Disp:*90 Capsule(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
End-stage renal disease

Secondary:
Uterine cancer
s/p multiple lysis of adhesions


Discharge Condition:
Stable, ambulatory


Discharge Instructions:
You were admitted because of kidney failure and have started
dialysis. Please call your primary care doctor or return to the
hospital if you experience bleeding, chest pain, shortness of
breath or anything else concerning.

Please take all of your medications as prescribed.

Please attend dialysis in [**Location (un) 1514**], MA, Tuesdays, Thursdays and
Saturdays.

Please make a follow-up appointment with your primary care
doctor as soon as possible.

Followup Instructions:
Please make a follow-up appointment with your primary care
doctor as soon as possible.

Please make a follow-up appointment with your nephrologist.


                             [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 472**]
{'End stage renal disease,Mitral valve disorders,Acidosis,Pulmonary collapse,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Acute kidney failure, unspecified,Unspecified disease of pericardium,Anemia, unspecified,Leukocytosis, unspecified,Edema,Diarrhea'}


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: Acute renal failure

PRESENT ILLNESS: 67 y/o female with h/o uterine cancer s/p chemo and XRT 4 with
mets to small bowel s/p small bowel resection, who presented
from [**Hospital3 **] with ARF. She initially presented to
[**Hospital3 7571**]with generalized weakness, fatigue, increased
SOB, and general sense of malaise. There, vitals were T 97.3, HR
97, BP 132/69, RR 18, sat 100% RA and was noted to be slightly
disheveled and confused, but oriented, and slow to respond. ABG
7.11/11/113; WBC 20, Hct 22, BUN 101, creatinine 14.8 (baseline
[**5-5**] 1.1, [**4-6**] 2.5; [**8-6**] 2.8; [**12-7**] 3.3). Per report, Pt made no
urine even after foley placement. Given 500 cc NS bolus. Given
Vanc 1gm IV/Levo 500 IV/Flagyl 500 IV, transfused 2UPRBCs, 1amp
bicarb. Patient refused CTA, CT head and admission at [**Location (un) **]
and was then transferred to [**Hospital1 18**] for further care and urgent
dialysis.
.
In the [**Hospital1 18**] ED, T 97.0; BP 97/50; HR 87; RR 20; 98%RA. Pt seen
by renal, recommmended 2gm calcium gluconate X2, 2 amps bicarb
in D5W at 125cc/hr. Femoral line placed. Head CT negative.

MEDICAL HISTORY: # Uterine cancer: diagnosed 7-8 years ago s/p total
hysterectomy. Then subsequently found to have mets to small
bowel s/p resection then chemo, XRT. Since then, she has had
multiple surgeries for bowel adhesions.

MEDICATION ON ADMISSION: Advil- per daughter, patient has been taking at least 2 advil
QHS for past few months, stopped a week ago
Benedryl PRN
Clams Forte
Twin Lab B12
Ensure
Prilosec OTC (just started)
Rilazapam half pill [**Hospital1 **]

ALLERGIES: Penicillins

PHYSICAL EXAM: Well appearing thin white female.
T 98.8 BP 117/66 HR 75 RR 20 Sat 97% RA
SKIN: thin, papery
HEENT: PEERL, EOMI, mucous membranes moist, sclera anicteric.
NECK: No LAD or bruits.
CHEST: Lungs clear.
HEART: Regular rhythm. Pericardial rub.
ABD: NABS. Soft, NT, ND. No ingunal LAD.
EXT: No edema. Good pulses.
NEURO: Alert and oriented to person place and time. CN II-XII
intact. Full 5/5 strength throughout.

FAMILY HISTORY: No fam hx of kidney disease. Sisiter had cysts on kidneys.
Father died of lung cancer. Mother died of ?colon/stomach
cancer. Her brother and sister are both obese and have HTN.

SOCIAL HISTORY: No tobacco, rare alcohol, no Illicits. 

### Response:
{'End stage renal disease,Mitral valve disorders,Acidosis,Pulmonary collapse,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Acute kidney failure, unspecified,Unspecified disease of pericardium,Anemia, unspecified,Leukocytosis, unspecified,Edema,Diarrhea'}
