CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 63 year-old
woman with Zollinger [**Doctor Last Name 9480**] syndrome and chronic diarrhea
who initially presented with syncope.  In the two months
prior to admission the patient developed weakness with
difficulty breathing.  She was having severe dumping syndrome
with diarrhea and was seen by gastroenterology as an
outpatient.  On [**2114-7-8**] the patient experienced syncope.  She
denied tongue biting, incontinence, headaches, neck
stiffness.  In the Emergency Department she was somnolent and
found to have a fever of 100.4.  Review of systems was
otherwise negative.  An LP was performed and meningitis ruled
out.  The patient was initially covered with Ceftriaxone.
The patient was placed on CPAP after an arterial blood gas
showed a pH of 7.14, PCO2 of 123, PAO2 of 17.  The patient
was admitted to the MICU for workup.

MEDICAL HISTORY: 1.  Zollinger [**Doctor Last Name 9480**] syndrome.
2.  Status post antrectomy and vagotomy.
3.  History of gastrinoma on [**9-/2109**].
4.  Diabetes mellitus.
5.  Status post Whipple [**1-7**].
6.  Chronic diarrhea with 38 pound weight loss over last
year.
7.  Pericardial effusion, negative workup [**9-8**] found to be
sterile.
8.  Depression.
9.  Cholangitis [**9-8**].

MEDICATION ON ADMISSION: 1.  Viokase with meals.
2.  Prilosec.
3.  Reglan.
4.  Flonase.
5.  Multivitamins.

ALLERGIES: Sulfa causes a rash.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Acute and chronic respiratory failure,Glycogenosis,Thoracic or lumbosacral neuritis or radiculitis, unspecified,Intestinal bypass or anastomosis status,Depressive disorder, not elsewhere classified,Abnormality of secretion of gastrin,Myoneural disorders, unspecified,Postgastric surgery syndromes
Acute & chronc resp fail,Glycogenosis,Lumbosacral neuritis NOS,Intestinal bypass status,Depressive disorder NEC,Abnorm secretion gastrin,Myoneural disorders NOS,Postgastric surgery synd
Admission Date:  [**2114-7-8**]     Discharge Date:  [**2114-7-14**]

Date of Birth:   [**2052-6-26**]     Sex:  F

Service:

HISTORY OF PRESENT ILLNESS:  The patient is a 63 year-old
woman with Zollinger [**Doctor Last Name 9480**] syndrome and chronic diarrhea
who initially presented with syncope.  In the two months
prior to admission the patient developed weakness with
difficulty breathing.  She was having severe dumping syndrome
with diarrhea and was seen by gastroenterology as an
outpatient.  On [**2114-7-8**] the patient experienced syncope.  She
denied tongue biting, incontinence, headaches, neck
stiffness.  In the Emergency Department she was somnolent and
found to have a fever of 100.4.  Review of systems was
otherwise negative.  An LP was performed and meningitis ruled
out.  The patient was initially covered with Ceftriaxone.
The patient was placed on CPAP after an arterial blood gas
showed a pH of 7.14, PCO2 of 123, PAO2 of 17.  The patient
was admitted to the MICU for workup.

PAST MEDICAL HISTORY:
1.  Zollinger [**Doctor Last Name 9480**] syndrome.
2.  Status post antrectomy and vagotomy.
3.  History of gastrinoma on [**9-/2109**].
4.  Diabetes mellitus.
5.  Status post Whipple [**1-7**].
6.  Chronic diarrhea with 38 pound weight loss over last
year.
7.  Pericardial effusion, negative workup [**9-8**] found to be
sterile.
8.  Depression.
9.  Cholangitis [**9-8**].

ALLERGIES:  Sulfa causes a rash.

MEDICATIONS ON ADMISSION:
1.  Viokase with meals.
2.  Prilosec.
3.  Reglan.
4.  Flonase.
5.  Multivitamins.

PHYSICAL EXAMINATION ON ADMISSION:  Temperature 100.4.  Blood
pressure 109/56.  Heart rate 100 sating 95% on room air.
General, the patient was asleep, but easily arousable, alert
to date, place and time.  HEENT pupils are equal, round and
reactive to light.  Extraocular movements intact.  Mucous
membranes are moist.  No lymphadenopathy.  Cardiac regular
rhythm no murmurs.  Lungs clear to auscultation bilaterally.
Abdomen soft, nontender, nondistended.  Positive bowel
sounds.  Extremities no edema.  Neurological examination
cranial nerves II through XII intact.  Strength is 5 out of 5
throughout.  Positive asterixis.

SIGNIFICANT LABORATORIES ON ADMISSION:  White blood cell
count 11.7, 65 neutrophils, 28 bands, 2 lymphocytes, 3
monocytes, 1 eosinophils, 1 atypical.  Urinalysis negative.
Liver function tests within normal limits.  LP showed 6 white
blood cells, 4 red blood cells, protein of 18.

HOSPITAL COURSE:  The patient's antibiotic regimen was
changed to Vancomycin and Levofloxacin and Flagyl.  The
patient's workup included a negative tox screen, negative
brain MR, normal ESR, [**Doctor First Name **] and RF.  Pulmonary function tests
were done consistent with restrictive disease.  The patient
was felt to hve a neuromuscular disorder.  Neurology was
consulted.  An echocardiogram was done in the MICU, which did
show normal diaphragmatic motion.  An EMG was performed and
was negative for a neuromuscular transition disorder.
Gastrointestinal was consulted regarding the patient's
diarrhea and recommended high dose PPI and Viokase enzymes
with meals.  The patient's diarrhea improved.  Also random
Cortisol was checked and found to be 9.3.  A core stim test
was performed and was within normal limits.  The patient's
glucose was found to be elevated. Hemoglobin A1C was 7.8.
The patient was started on oral hypoglycemics.  The patient's
neuromuscular dysfunction was felt to be consistent with
adult onset acid maltase deficiency versus multi level
radiculopathy either spinal or inflammatory causing
paraspinal denervation.  The patient will follow up with
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 6755**] neuromuscular EMG fellow for a tensilon test
versus CT of the neck/chest to look at sinus, plus minus
muscle biopsy and repeat single fiber EMG.

Regarding her diarrhea, the patient will continue
Pantoprazole and Viokase enzymes and follow up with Dr.
[**Last Name (STitle) 1940**] as an outpatient. Regarding her diabetes she will
continue Glipizide and a diabetic diet.

DISCHARGE DIAGNOSES:
1.  Hypercarbic respiratory distress.
2.  Restrictive pulmonary disease suggestive of neuromuscular
etiology.
3.  Zollinger [**Doctor Last Name 9480**] syndrome.
4.  Type 2 diabetes.

DISCHARGE MEDICATIONS:
1.  Viokase four tablets t.i.d. with meals.
2.  Pantoprazole 40 mg po t.i.d.
3.  Beclomethasone nasal spray.
4.  Reglan 10 cc po b.i.d.
5.  Multivitamin one tab po q.d.

FOLLOW UP APPOINTMENTS:
1.  Dr. [**Last Name (STitle) 1940**] [**Telephone/Fax (1) 1983**] in one to two weeks.
2.  Dr. [**Last Name (STitle) 6755**] neuromuscular clinic [**Telephone/Fax (1) 558**] in the
upcoming week.
3.  Follow up with neurosurgery for muscle biopsy
[**Telephone/Fax (1) 1669**].






                          [**Name6 (MD) 7853**] [**Last Name (NamePattern4) 7854**], M.D.  [**MD Number(1) 7855**]

Dictated By:[**Last Name (NamePattern1) 3411**]

MEDQUIST36

D:  [**2114-7-17**]  11:32
T:  [**2114-7-20**]  12:27
JOB#:  [**Job Number 48515**]
{'Acute and chronic respiratory failure,Glycogenosis,Thoracic or lumbosacral neuritis or radiculitis, unspecified,Intestinal bypass or anastomosis status,Depressive disorder, not elsewhere classified,Abnormality of secretion of gastrin,Myoneural disorders, unspecified,Postgastric surgery syndromes'}


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 63 year-old
woman with Zollinger [**Doctor Last Name 9480**] syndrome and chronic diarrhea
who initially presented with syncope.  In the two months
prior to admission the patient developed weakness with
difficulty breathing.  She was having severe dumping syndrome
with diarrhea and was seen by gastroenterology as an
outpatient.  On [**2114-7-8**] the patient experienced syncope.  She
denied tongue biting, incontinence, headaches, neck
stiffness.  In the Emergency Department she was somnolent and
found to have a fever of 100.4.  Review of systems was
otherwise negative.  An LP was performed and meningitis ruled
out.  The patient was initially covered with Ceftriaxone.
The patient was placed on CPAP after an arterial blood gas
showed a pH of 7.14, PCO2 of 123, PAO2 of 17.  The patient
was admitted to the MICU for workup.

MEDICAL HISTORY: 1.  Zollinger [**Doctor Last Name 9480**] syndrome.
2.  Status post antrectomy and vagotomy.
3.  History of gastrinoma on [**9-/2109**].
4.  Diabetes mellitus.
5.  Status post Whipple [**1-7**].
6.  Chronic diarrhea with 38 pound weight loss over last
year.
7.  Pericardial effusion, negative workup [**9-8**] found to be
sterile.
8.  Depression.
9.  Cholangitis [**9-8**].

MEDICATION ON ADMISSION: 1.  Viokase with meals.
2.  Prilosec.
3.  Reglan.
4.  Flonase.
5.  Multivitamins.

ALLERGIES: Sulfa causes a rash.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Acute and chronic respiratory failure,Glycogenosis,Thoracic or lumbosacral neuritis or radiculitis, unspecified,Intestinal bypass or anastomosis status,Depressive disorder, not elsewhere classified,Abnormality of secretion of gastrin,Myoneural disorders, unspecified,Postgastric surgery syndromes'}
