CHIEF COMPLAINT: [**Female First Name (un) 564**] peritonitis.

PRESENT ILLNESS: This is a 50-year-old male with
type 2 diabetes for 30 years and end-stage renal disease (on
peritoneal dialysis) who was at the [**Hospital **] Rehabilitation
but presented to the Emergency Department on [**1-5**] with
increasing abdominal pain, subjective fevers for two weeks,
decreased oral intake and urine output, as well as lethargy.

MEDICAL HISTORY: 1.  Type 2 diabetes for 30 years; complicated by end-stage
renal disease, retinopathy, perineuropathy (now insulin
dependent).
 2.  End-stage renal disease (on peritoneal dialysis).
 3.  Hypertension.
 4.  Peripheral vascular disease; status post left below-knee
amputation.
 5.  Gastroesophageal reflux disease.
 6.  Depression; his psychiatrist is Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
(telephone number [**Telephone/Fax (1) 21864**]).
 7.  Hepatitis B.
 8.  Question of hepatitis C.
 9.  Charcot right foot.
10.  Chronic obstructive pulmonary disease.
11.  Status post pacemaker placement.
12.  Syncope.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He lives with [**Location (un) **] (his girlfriend).  She
is his health care proxy.  [**Name (NI) **] smoked one pack per day since
the age of 19.  He has a remote history alcohol, heroin, and
cocaine use.  The patient is adopted.
Other candidiasis of other specified sites,Peritonitis in infectious diseases classified elsewhere,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Chronic airway obstruction, not elsewhere classified,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Hypotension, unspecified,Depressive disorder, not elsewhere classified,Esophageal reflux
Candidiasis site NEC,Peritonitis in infec dis,Hyp kid NOS w cr kid V,Chr airway obstruct NEC,DMII renl nt st uncntrld,Hypotension NOS,Depressive disorder NEC,Esophageal reflux
Admission Date:  [**2176-1-5**]       Discharge Date:  [**2176-1-14**]

Date of Birth:   [**2125-7-31**]       Sex:  M

Service:  [**Doctor Last Name **]

CHIEF COMPLAINT:  [**Female First Name (un) 564**] peritonitis.

HISTORY OF PRESENT ILLNESS:  This is a 50-year-old male with
type 2 diabetes for 30 years and end-stage renal disease (on
peritoneal dialysis) who was at the [**Hospital **] Rehabilitation
but presented to the Emergency Department on [**1-5**] with
increasing abdominal pain, subjective fevers for two weeks,
decreased oral intake and urine output, as well as lethargy.

At [**Hospital1 **], he was found to be afebrile with a blood
pressure of 84/palp with a white blood cell count of 20.4
(with 85% polys and 7.9% lymphocytes), and a sodium of 128.
He also had a potassium of 3.8, a bicarbonate of 24, glucose
of 219, an albumin of 1.9, and a blood urea nitrogen of 35,
and a creatinine of 5.9.  A tap of the peritoneal fluid
revealed 360 white blood cells, 40 red blood cells (with 69%
polys, 23% monocytes, and 7% lymphocytes).

The patient was afebrile in the Emergency Department, but as
his systolic blood pressure remained in the 70s to 90s, he
was transferred to the Medical Intensive Care Unit.  He
received ceftazidime and Flagyl in the Emergency Department.

In the Medical Intensive Care Unit, he received aggressive
intravenous fluid repletion and was started on cefotaxime 2
mg intravenously q.d. while continuing his peritoneal
dialysis.  When peritoneal cultures came back growing
Candidiasis albicans, the antibiotics were discontinued on
[**1-7**], and it was changed to fluconazole 200 mg
intravenously q.24h. through the dialysate on [**1-7**] and
flucytosine 2 mg times one orally initially and then changed
to 1 mg p.o. q.d. was added on [**1-8**].

In the Medical Intensive Care Unit, systolic blood pressures
were 90 to 110 with low oxygen saturations of 90% (question
secondary to increased amount of intravenous fluids he
received), so he was transferred to the floor on [**1-7**].
His white blood cell count had decreased to 11.8.  He had
remained afebrile with stable blood pressures.

He was then transferred to our Service on the [**Hospital Ward Name **]
([**Doctor Last Name **] Medicine), as he went to the operating room today
for peritoneal dialysis catheter removal (surgeon was Dr. [**First Name (STitle) **]
[**Name (STitle) **]) as well as Hickman replacement in order to undergo
hemodialysis tomorrow.  Blood cultures from [**1-5**] and
[**1-9**] were no growth to date.  Also, he recently bumped
his left foot stump and had some mild bleeding at the site
with some purulent fluid.  This was swabbed, and the culture
was sent on [**1-9**].  So far there has been no growth to
date.  He also has had asterixis with occasional
disorientation at times (per the previous team).

Today when we first met him (on [**1-10**]), he was status
post right Hickman placement and peritoneal dialysis removal,
doing well.  He states he has decreased abdominal pain today
compared to yesterday ([**11-9**] has decreased to [**5-10**] in
intensity).

He currently denies shortness of breath, chest pain,
dizziness, nausea, vomiting, and diarrhea.  He has not had a
bowel movement since [**1-5**] but is refusing to take
lactulose.  He denies headache, numbness, tingling, and pain
at the Hickman site or his legs.  He urinated one times
yesterday (usually goes twice per day).  He has some appetite
and is less confused now.

PAST MEDICAL HISTORY:
 1.  Type 2 diabetes for 30 years; complicated by end-stage
renal disease, retinopathy, perineuropathy (now insulin
dependent).
 2.  End-stage renal disease (on peritoneal dialysis).
 3.  Hypertension.
 4.  Peripheral vascular disease; status post left below-knee
amputation.
 5.  Gastroesophageal reflux disease.
 6.  Depression; his psychiatrist is Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
(telephone number [**Telephone/Fax (1) 21864**]).
 7.  Hepatitis B.
 8.  Question of hepatitis C.
 9.  Charcot right foot.
10.  Chronic obstructive pulmonary disease.
11.  Status post pacemaker placement.
12.  Syncope.

ALLERGIES:  The patient has no known drug allergies.

MEDICATIONS ON TRANSFER:  (Transfer medications to the our
Service)
 1.  Reglan 10 mg p.o. q.i.d.
 2.  Seroquel 150 mg p.o. q.h.s.
 3.  Senna two tablets p.o. q.h.s.
 4.  Trazodone 100 mg p.o. q.h.s.
 5.  Compazine 10 mg p.o. q.4-6h. as needed.
 6.  Colace 100 mg p.o. b.i.d.
 7.  Protonix 40 mg p.o. q.d.
 8.  Regular insulin sliding-scale.
 9.  Tylenol as needed.
10.  Subcutaneous heparin.
11.  Calcium carbonate 500 mg p.o. t.i.d.
12.  Flucytosine 1 g q.d.
13.  Fluconazole 200 mg intravenously q.d. (via the
peritoneal dialysate).
14.  Lactulose 30 mg p.o. t.i.d. (the patient currently
refuses).
15.  Tylenol with codeine one to two tablets q.6h. as needed.
16.  Sevelamer 1600 mg p.o. t.i.d.
17.  Seroquel 500 mg p.o. q.4-6h. as needed.
18.  Bisacodyl 10 mg p.r. q.d.
19.  Epogen 8000 units on Monday and Friday.
20.  NPH 15 units in the morning and 7 units at night.
21.  Effexor-XR 225 mg p.o. q.d.
22.  Klonopin 1 mg p.o. q.h.s.

MEDICATIONS AT HOME:
 1.  Prevacid 30 mg p.o. q.d.
 2.  Reglan 10 mg p.o. q.i.d.
 3.  Effexor 150 mg p.o. q.d.
 4.  Seroquel 150 mg p.o. q.h.s.
 5.  Senna two tablet p.o. q.h.s.
 6.  Renagel 1200 mg p.o. b.i.d.
 7.  Trazodone 100 mg p.o. q.h.s.
 8.  Tylenol q.4.h. as needed for pain.
 9.  Tylenol 650 mg p.o. q.4h. as needed.
10.  Klonopin 1 mg p.o. q.h.s.
11.  Colace 100 mg p.o. b.i.d.
12.  Epogen 5000 units Tuesday and Friday.
13.  Humalog 40 units given at 7:30 in the morning and 15
units at 4:30 p.m.

PERTINENT LABORATORY DATA ON PRESENTATION:   Laboratories
from [**1-10**] revealed white blood cell count was 11.2,
hematocrit was 26.3, and platelets were 196.  Sodium was 130,
potassium was 3.4, chloride was 91, bicarbonate was 24, blood
urea nitrogen was 34, creatinine was 5.5, and blood glucose
was 299.  Calcium was 7.5, phosphorous was 5.7, magnesium was
2.1.  Free calcium was 0.99.  ALT was 16, AST was 28,
alkaline phosphatase was 128, LD was 251, total bilirubin was
0.9.

MICROBIOLOGY:
1.  [**1-10**] blood cultures times one plus fungal, no
growth to date.
2.  [**1-9**] blood cultures times two plus fungal, no
growth to date.
3.  [**1-5**] blood cultures times two, no growth to date.
4.  [**1-9**] wound culture of the left stump revealed no
polys, no organisms, no growth to date.
5.  [**1-5**] peritoneal fluid was positive for [**Female First Name (un) 564**]
albicans.

RADIOLOGY/IMAGING:
1.  Chest x-ray from [**1-9**] showed no change from the
study from [**1-7**].  Increased density at the right base
medially; most likely poor inspiration and compressive
atelectasis.  No congestive heart failure.
2.  A computed tomography of the abdomen and pelvis on
[**1-5**] showed positive free fluid and free, consistent
with peritoneal dialysis.  No focal collections.  No bowel
abnormalities.  Positive cholelithiasis without
cholecystitis.

SOCIAL HISTORY:  He lives with [**Location (un) **] (his girlfriend).  She
is his health care proxy.  [**Name (NI) **] smoked one pack per day since
the age of 19.  He has a remote history alcohol, heroin, and
cocaine use.  The patient is adopted.

PHYSICAL EXAMINATION ON PRESENTATION:   Physical examination
revealed temperature was 98, heart rate was 96, blood
pressure was 100/58, respiratory rate was 20, oxygen
saturation was 90% on room air, and the patient was refusing
oxygen by nasal cannula, as he was asymptomatic.  In general,
awake, alert, and oriented times three.  In no acute
distress.  Head, eyes, ears, nose, and throat examination
revealed anicteric.  Normocephalic and atraumatic.  Pupils
were equal, round, and reactive to light.  Cardiovascular
examination revealed a regular rate and rhythm.   A 2/6
systolic ejection murmur.  Chest revealed right Hickman in
place.  Nontender and no erythema or discharge.  Respiratory
examination revealed clear to auscultation bilaterally.  Neck
revealed there was no jugular venous distention.  The abdomen
revealed increased bowel sounds.  Nontender and nondistended.
A dressing over the left lower quadrant was clean, dry, and
intact.  A soft belly.  Extremities revealed left below-knee
amputation with a scabbed over wound with some minimal
serosanguineous drainage and minimal erythema and 2+ lower
extremity edema over the right foot and ankle.  There was a
superficial ulcer on the right lower extremity.  Neurologic
examination revealed subtle asterixis.  Alert and oriented
times three.

ASSESSMENT:  This is a 50-year-old male with type 2 diabetes
(complicated by end-stage renal disease on chronic peritoneal
dialysis for the last nine months) and status post a left
below-knee amputation who presented to the Emergency
Department on [**1-5**] from rehabilitation with sepsis (?)
secondary to [**Female First Name (un) **] peritonitis.  On day of anti-fungal
treatment the peritoneal dialysis catheter was removed, and a
right Hickman was placed, and he was started on hemodialysis.

HOSPITAL COURSE:  Mr. [**Known lastname 21865**] was started on hemodialysis and
tolerated this well.  He was given calcium carbonate with
meals as a phosphate binder.  He was followed by Dr. [**First Name (STitle) 805**]
(his nephrologist).

1.  CARDIOVASCULAR:  His blood pressures remained low on the
floor; ranging from 70s to 122 at time after his dialysis.
However, they were asymptomatic and responded to a normal
saline bolus.  He had anywhere from 1.5 kg to 2 kg removed on
the hemodialysis that he went to on [**1-11**] and on
[**1-13**].  After this, his blood pressure was noted to be
asymptomatically low.

2.  INFECTIOUS DISEASE:  For [**Female First Name (un) **] peritonitis, his
fluconazole was changed from intraperitoneal to intravenous,
and the dose was changed to 200 mg every 48 hours secondary
to his renal insufficiency.  He was continued on the oral
flucytosine.

At the time of this dictation (on [**1-14**]) he had been
afebrile for the last three to four days, and his white blood
cell count had decreased to 8.2 by [**1-14**].  His
abdominal examination was much improved, and he was
complaining of minimal abdominal pain by [**1-14**].  Also,
please note that his Epogen was changed, and he will be
receiving it at dialysis from now on.

For his new wound on his left leg stump, the cultures from it
were negative, and it was no longer draining purulent fluid,
and looked like it was going to heal.  He was not started on
antibiotics for this at this time.

3.  ANEMIA:  His hematocrit had been stable but low (ranging
from 25 to 29) which seems to be his baseline.  His Epogen
was increased during this admission to 8000 units two times
per week, and he will now be receiving this at hemodialysis.

4.  ENDOCRINE SYSTEM:  His blood sugars have been somewhat
poorly controlled, but by the end of his stay, his blood
pressures were ranging from the 100s to the low 200s on NPH
15 units at breakfast and 7 units at dinner with a regular
insulin sliding-scale.

5.  PULMONARY SYSTEM:  The patient had persistently low
oxygen saturations (in the 90s) when he first came to our
Service, but was asymptomatic.  He had a chest x-ray that did
not show any evidence of congestive heart failure on [**1-9**], and he had no clinical signs of fluid overload.  They
continued to take off 1 kg to 2 kg in dialysis as well.  By
the end of his admission, his oxygen saturations were ranging
from 94% to 98% on room air, and this transient decrease in
his oxygen saturations might have been secondary to his
aggressive intravenous fluid repletion in the Medical
Intensive Care Unit.

6.  PSYCHIATRY:  The patient was originally taken off his
psychiatric medications, and after the previous intern's
discussion with his psychiatrist (Dr. [**First Name (STitle) **] he was replaced
on his Seroquel, trazodone, and Klonopin q.h.s.  He has had
increasing depression over his illness and had several times
been quite irritable on occasion.  However, this improved
slightly when he was back on some of his psychiatric
medications and improved with redirecting him.

7.  GASTROINTESTINAL SYSTEM:  For his constipation, he was
refusing to take lactulose but agreed to Dulcolax p.r. which
did work for him.

8.  DISPOSITION:  The patient has been stable on our Service
for several days on hemodialysis.  He will likely need to go
back to a rehabilitation facility; perhaps [**Hospital1 **], which is
where he was previous to this admission.

At the time of this dictation (on [**1-14**]) we were
waiting to find out where he will go, and any updates on his
hospital course will be dictated by the next intern who will
be taking over my service on [**1-15**].





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

Dictated By:[**Name8 (MD) 210**]
MEDQUIST36

D:  [**2176-1-14**]  21:21
T:  [**2176-1-15**]  00:25
JOB#:  [**Job Number 21866**]
{'Other candidiasis of other specified sites,Peritonitis in infectious diseases classified elsewhere,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Chronic airway obstruction, not elsewhere classified,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Hypotension, unspecified,Depressive disorder, not elsewhere classified,Esophageal reflux'}


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: [**Female First Name (un) 564**] peritonitis.

PRESENT ILLNESS: This is a 50-year-old male with
type 2 diabetes for 30 years and end-stage renal disease (on
peritoneal dialysis) who was at the [**Hospital **] Rehabilitation
but presented to the Emergency Department on [**1-5**] with
increasing abdominal pain, subjective fevers for two weeks,
decreased oral intake and urine output, as well as lethargy.

MEDICAL HISTORY: 1.  Type 2 diabetes for 30 years; complicated by end-stage
renal disease, retinopathy, perineuropathy (now insulin
dependent).
 2.  End-stage renal disease (on peritoneal dialysis).
 3.  Hypertension.
 4.  Peripheral vascular disease; status post left below-knee
amputation.
 5.  Gastroesophageal reflux disease.
 6.  Depression; his psychiatrist is Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
(telephone number [**Telephone/Fax (1) 21864**]).
 7.  Hepatitis B.
 8.  Question of hepatitis C.
 9.  Charcot right foot.
10.  Chronic obstructive pulmonary disease.
11.  Status post pacemaker placement.
12.  Syncope.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He lives with [**Location (un) **] (his girlfriend).  She
is his health care proxy.  [**Name (NI) **] smoked one pack per day since
the age of 19.  He has a remote history alcohol, heroin, and
cocaine use.  The patient is adopted. 

### Response:
{'Other candidiasis of other specified sites,Peritonitis in infectious diseases classified elsewhere,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Chronic airway obstruction, not elsewhere classified,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Hypotension, unspecified,Depressive disorder, not elsewhere classified,Esophageal reflux'}
