CHIEF COMPLAINT: Respiratory failure with mesenteric
thrombosis.

PRESENT ILLNESS: The patient is a 37-year-old
gentleman with Down syndrome and tetralogy of Fallot who
presented to [**Hospital 1562**] Hospital from his group care facility
on [**2176-9-22**], with complaints of diarrhea, nausea, vomiting
and acute abdominal pain x 48 hours.  He was initially
admitted to the medical floor but acutely desaturated and
went into respiratory failure.  He required intubation and
was transferred to the ICU.  He had bilateral pulmonary
infiltrates.  He was started empirically on intravenous
antibiotics and began spiking temperatures and his abdominal
pain worsened.  He started passing bright red blood per
rectum and a CT scan was performed, which demonstrated
mesenteric venous thrombosis.  He had a hematocrit drop from
43 to 29 and he was transfused for supportive therapy.  His
respiratory status deteriorated and he was transferred to the
[**Hospital1 69**] for further tertiary
care on [**2176-9-25**].

MEDICAL HISTORY: 1. Down syndrome.
2. Congenital heart disease.
3. Tetralogy of Fallot.
4. Paget disease.
5. Chronic conjunctivitis.
6. Seizure disorder.
7. Mental retardation.
8. Depression.
9. Peripheral vascular disease.

MEDICATION ON ADMISSION: 1. Dilantin.
2. Ativan.
3. Colace.
4. Aspirin.
5. Valium.
6. Multivitamin.
7. Bacitracin.
8. Lasix.
9. Digoxin.
10.Claritin.
11.Tinactin.
12.Penicillin.
13.Zoloft.
14.Protonix.
15.Vancomycin.

ALLERGIES: GENTAMICIN EYE DROPS causing rash.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He lives in a group home and he is
profoundly retarded and nonambulatory, nonverbal and
frequently combative.  He does not drink or smoke.
Acute vascular insufficiency of intestine,Portal vein thrombosis,Other pulmonary insufficiency, not elsewhere classified,Tetralogy of fallot,Hyperosmolality and/or hypernatremia,Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified
Ac vasc insuff intestine,Portal vein thrombosis,Other pulmonary insuff,Tetralogy of fallot,Hyperosmolality,Food/vomit pneumonitis,CHF NOS
Admission Date: [**2176-9-25**]        Discharge Date: [**2176-10-4**]

Date of Birth:                    Sex:  M

Service:  General Surgery


DIAGNOSES:
1. Mesenteric venous thrombosis with bowel ischemia and
   infarction.
2. Congestive heart failure.
3. Respiratory failure.
4. Sepsis.
5. Tetralogy of Fallot.
6. Down syndrome.
7. Paget disease.
8. Chronic conjunctivitis.
9. Seizure disorder.
10.      Peripheral vascular disease.


CHIEF COMPLAINT:  Respiratory failure with mesenteric
thrombosis.

HISTORY OF PRESENT ILLNESS:  The patient is a 37-year-old
gentleman with Down syndrome and tetralogy of Fallot who
presented to [**Hospital 1562**] Hospital from his group care facility
on [**2176-9-22**], with complaints of diarrhea, nausea, vomiting
and acute abdominal pain x 48 hours.  He was initially
admitted to the medical floor but acutely desaturated and
went into respiratory failure.  He required intubation and
was transferred to the ICU.  He had bilateral pulmonary
infiltrates.  He was started empirically on intravenous
antibiotics and began spiking temperatures and his abdominal
pain worsened.  He started passing bright red blood per
rectum and a CT scan was performed, which demonstrated
mesenteric venous thrombosis.  He had a hematocrit drop from
43 to 29 and he was transfused for supportive therapy.  His
respiratory status deteriorated and he was transferred to the
[**Hospital1 69**] for further tertiary
care on [**2176-9-25**].

PAST MEDICAL HISTORY:
1. Down syndrome.
2. Congenital heart disease.
3. Tetralogy of Fallot.
4. Paget disease.
5. Chronic conjunctivitis.
6. Seizure disorder.
7. Mental retardation.
8. Depression.
9. Peripheral vascular disease.


PAST SURGICAL HISTORY:  None could be elicited, as the
patient was not responsive.

MEDICATIONS ON ADMISSION:
1. Dilantin.
2. Ativan.
3. Colace.
4. Aspirin.
5. Valium.
6. Multivitamin.
7. Bacitracin.
8. Lasix.
9. Digoxin.
10.Claritin.
11.Tinactin.
12.Penicillin.
13.Zoloft.
14.Protonix.
15.Vancomycin.


ALLERGIES:  GENTAMICIN EYE DROPS causing rash.

SOCIAL HISTORY:  He lives in a group home and he is
profoundly retarded and nonambulatory, nonverbal and
frequently combative.  He does not drink or smoke.

PHYSICAL EXAMINATION:  His temperature is 101.8, heart rate
88, blood pressure 104/54, he is saturating 96 percent on
assist  control with 100 percent FiO2.  Generally, he was
sedated, intubated and nonresponsive.  His head was
normocephalic.  His mucous membranes were dry and he had
nasogastric tube and an endotracheal tube.  Reflexes could
not be elicited.  His chest had coarse breath sounds
bilaterally with diminishment at the bases.  He was without
wheezes or crackles.  His heart was regular rate and rhythm
with a 4/6 systolic murmur.  His abdomen was distended and
soft.  He had no bowel sounds.  He had anasarca with pitting
edema in both extremities.  His white blood cell count was
11.2.  His hematocrit 32, his platelet count 159, 87
neutrophils, no bands, 9 lymphocytes.  Sodium was 150,
potassium was 3.8, chloride was 114, bicarbonate 27, BUN 23,
creatinine 0.9 and glucose 96.  His calcium was 8.1,
magnesium was 1.8, phosphorus was 2.2.  AST 44, ALT 20,
alkaline phosphatase 77, amylase 73, lipase 13, albumin 2.1,
and total bilirubin 0.4.  Blood cultures were taken and a
urine culture was taken.  His PT was 16.8 and INR 1.8.  His
ABG was pH 7.33, pO2 of 136 and pCO2 of 60.  Lactate of 1.

Chest x-ray showed bilateral fluffy infiltrates about
pneumoperitoneum.

CT scan was reviewed from the outside hospital and
demonstrated mesenteric venous thrombosis with bowel wall
thickening and ascites.

CONCISE SUMMARY OF HOSPITAL COURSE:  The patient was admitted
on [**2176-9-25**], started on intravenous heparin and broad-
spectrum antibiotics.  His condition initially improved and
then did plateau.  A central line was placed for access for
parenteral nutrition and he was started on parenteral
nutrition.  The patient continued to have heme-positive stool
and his hemodynamics secondary to his tetralogy of Fallot and
his ischemia did not improve.  Cardiology consult, Vascular
consult and Infectious Disease consult were all obtained.
The patient's condition stabilized but did not significantly
improve over the course of approximately 1 week.  After
detailed discussions with the patient's family, it was
decided that no surgery would be performed in the event that
the bowel declared itself as being infarcted rather than
merely ischemic.  The patient was transferred to the Medical
Service for supportive therapy.  The patient continued with
lack of improvement and the [**Location (un) 511**] Organ Bank was
contact[**Name (NI) **] and the patient was chosen for donation.  On
[**2176-10-4**], the patient was taken to the operating room.  He
was extubated and declared dead and his organs were
harvested.


DATE OF DEATH:  [**2176-10-4**].



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 18475**]

Dictated By:[**Last Name (NamePattern4) 9859**]
MEDQUIST36
D:  [**2176-12-17**] 14:47:01
T:  [**2176-12-17**] 23:06:56
Job#:  [**Job Number 50984**]
{'Acute vascular insufficiency of intestine,Portal vein thrombosis,Other pulmonary insufficiency, not elsewhere classified,Tetralogy of fallot,Hyperosmolality and/or hypernatremia,Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, 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: Respiratory failure with mesenteric
thrombosis.

PRESENT ILLNESS: The patient is a 37-year-old
gentleman with Down syndrome and tetralogy of Fallot who
presented to [**Hospital 1562**] Hospital from his group care facility
on [**2176-9-22**], with complaints of diarrhea, nausea, vomiting
and acute abdominal pain x 48 hours.  He was initially
admitted to the medical floor but acutely desaturated and
went into respiratory failure.  He required intubation and
was transferred to the ICU.  He had bilateral pulmonary
infiltrates.  He was started empirically on intravenous
antibiotics and began spiking temperatures and his abdominal
pain worsened.  He started passing bright red blood per
rectum and a CT scan was performed, which demonstrated
mesenteric venous thrombosis.  He had a hematocrit drop from
43 to 29 and he was transfused for supportive therapy.  His
respiratory status deteriorated and he was transferred to the
[**Hospital1 69**] for further tertiary
care on [**2176-9-25**].

MEDICAL HISTORY: 1. Down syndrome.
2. Congenital heart disease.
3. Tetralogy of Fallot.
4. Paget disease.
5. Chronic conjunctivitis.
6. Seizure disorder.
7. Mental retardation.
8. Depression.
9. Peripheral vascular disease.

MEDICATION ON ADMISSION: 1. Dilantin.
2. Ativan.
3. Colace.
4. Aspirin.
5. Valium.
6. Multivitamin.
7. Bacitracin.
8. Lasix.
9. Digoxin.
10.Claritin.
11.Tinactin.
12.Penicillin.
13.Zoloft.
14.Protonix.
15.Vancomycin.

ALLERGIES: GENTAMICIN EYE DROPS causing rash.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He lives in a group home and he is
profoundly retarded and nonambulatory, nonverbal and
frequently combative.  He does not drink or smoke. 

### Response:
{'Acute vascular insufficiency of intestine,Portal vein thrombosis,Other pulmonary insufficiency, not elsewhere classified,Tetralogy of fallot,Hyperosmolality and/or hypernatremia,Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified'}
