CHIEF COMPLAINT: The patient was admitted originally for
airway monitoring status post endoscopic retrograde
cholangiopancreatography with adverse reaction to Fentanyl
and tongue injury.

PRESENT ILLNESS: The patient is a 59 year-old
female status post endoscopic retrograde
cholangiopancreatography on the day of admission, which had
been done to evaluate for possible bile leak after
cholecystectomy was performed four days ago.  The patient was
in her usual state of health until four days prior to
admission when she had a cholecystectomy.  Her postop course
was uneventful until one day prior to admission when she
developed abdominal pain.  She went to an outside hospital
Emergency Room and was reassured and sent home.  On the day
of admission she returned to the outside hospital Emergency
Room where an abdominal CT was performed, which showed
"thickened stomach and free air."  She was sent to [**Hospital1 1444**] for an endoscopic retrograde
cholangiopancreatography and possible stent placement.  She
had a successful endoscopic retrograde
cholangiopancreatography, which showed a bile leak at the
duct of Luschka.  A stent was placed successfully.  After her
endoscopic retrograde cholangiopancreatography the patient
developed "jaw clenching, biting tongue, rigidity and
cold/chills."  The patient received ampicillin, Gentamycin
and Flagyl empirically as well as Narcan to reverse fentanyl.
Because of the tongue injury and tachycardia as well as
possible infection given her fevers or chills the GI Service
transferred the patient to the MICU for close observation.

MEDICAL HISTORY: 1.  Hiatal hernia.  2.  Status post
cholecystectomy four days prior to admission.  3.  Urinary
frequency secondary to interstitial cystitis.  4.  Mitral
valve prolapse.  5.  Tubal ligation many years ago.

MEDICATION ON ADMISSION: 1.  Prempro.  2.  Eye drops.

ALLERGIES: No known drug allergies at the time of admission,
however, it is assumed that her rigidity and jaw clenching
was secondary to Fentanyl.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is married.  She works as a
teacher's aid in [**Location (un) 8072**].  She denies tobacco or alcohol
use.
Other specified diseases of the jaws,Other opiates and related narcotics causing adverse effects in therapeutic use,Acute pancreatitis,Other pulmonary insufficiency, not elsewhere classified,Other specified cardiac dysrhythmias,Mitral valve disorders,Acidosis
Jaw disease NEC,Adv eff opiates,Acute pancreatitis,Other pulmonary insuff,Cardiac dysrhythmias NEC,Mitral valve disorder,Acidosis
Admission Date:  [**2118-4-12**]     Discharge Date:  [**2118-4-16**]

Date of Birth:   [**2058-6-24**]     Sex:  F

Service:  [**Company 191**]

CHIEF COMPLAINT:  The patient was admitted originally for
airway monitoring status post endoscopic retrograde
cholangiopancreatography with adverse reaction to Fentanyl
and tongue injury.

HISTORY OF PRESENT ILLNESS:  The patient is a 59 year-old
female status post endoscopic retrograde
cholangiopancreatography on the day of admission, which had
been done to evaluate for possible bile leak after
cholecystectomy was performed four days ago.  The patient was
in her usual state of health until four days prior to
admission when she had a cholecystectomy.  Her postop course
was uneventful until one day prior to admission when she
developed abdominal pain.  She went to an outside hospital
Emergency Room and was reassured and sent home.  On the day
of admission she returned to the outside hospital Emergency
Room where an abdominal CT was performed, which showed
"thickened stomach and free air."  She was sent to [**Hospital1 1444**] for an endoscopic retrograde
cholangiopancreatography and possible stent placement.  She
had a successful endoscopic retrograde
cholangiopancreatography, which showed a bile leak at the
duct of Luschka.  A stent was placed successfully.  After her
endoscopic retrograde cholangiopancreatography the patient
developed "jaw clenching, biting tongue, rigidity and
cold/chills."  The patient received ampicillin, Gentamycin
and Flagyl empirically as well as Narcan to reverse fentanyl.
Because of the tongue injury and tachycardia as well as
possible infection given her fevers or chills the GI Service
transferred the patient to the MICU for close observation.

PAST MEDICAL HISTORY:  1.  Hiatal hernia.  2.  Status post
cholecystectomy four days prior to admission.  3.  Urinary
frequency secondary to interstitial cystitis.  4.  Mitral
valve prolapse.  5.  Tubal ligation many years ago.

MEDICATIONS ON ADMISSION:  1.  Prempro.  2.  Eye drops.

ALLERGIES:  No known drug allergies at the time of admission,
however, it is assumed that her rigidity and jaw clenching
was secondary to Fentanyl.

SOCIAL HISTORY:  The patient is married.  She works as a
teacher's aid in [**Location (un) 8072**].  She denies tobacco or alcohol
use.

PHYSICAL EXAMINATION ON ADMISSION TO THE MICU:  Vital signs
temperature 100.6.  Heart rate 105.  Blood pressure 162/76.
Respiratory rate 18.  Sating 98% on 3 liters.  In general,
the patient was groggy status post anesthesia, shivering, but
awake.  HEENT showed tongue with laceration on the right
edge.  Mucous membranes are moist.  Pupils are equal, round
and reactive to light.   Extraocular movements intact.  Lungs
were clear to auscultation bilaterally.  Heart regular rate
and rhythm.  No murmurs, rubs or gallops.  Abdomen was soft,
nontender, nondistended.  There were normoactive bowel
sounds.  There was no rebound or guarding.  There were post
laparoscopic incisions without erythema with Steri-Strips in
place.  The extremities were without edema.  Dorsalis pedis
pulses were intact bilaterally.  There were no rashes.

LABORATORIES ON ADMISSION:  White blood cell count 9.0,
hematocrit 39.3, platelets 296, neutrophil count 82,
lymphocytes 14, 4 monocytes, troponin was less then 0.3.
Sodium 139, potassium 3.8, chloride 101, bicarb 26, BUN 9,
creatinine 0.7, glucose 141, albumin 4.1, calcium 8.9, LDH
665, AST 44, ALT of 57, amylase 41, CK 32.

Electrocardiogram showed normal sinus rhythm at 73 beats per
minute.  There was normal axis.  Normal intervals.  There
were no ST or T wave changes.  Abdominal CT showed
inflammation in the right upper quadrant, small fluid in the
circumferential thickening of the distal stomach.  There was
a question of a small ulcer.  There was a tiny amount of free
air.  This was per report of [**Hospital3 3583**].

HOSPITAL COURSE:  In summary the patient is a 59 year-old
female who was admitted to [**Hospital1 188**] for an endoscopic retrograde cholangiopancreatography
for possible stent placement for a bile leak secondary to
cholecystectomy performed four days prior to admission.  She
then suffered rigidity with jaw clenching and tongue biting
secondary to Fentanyl administration and was transferred to
the MICU for close observation.  She did well overnight in
the MICU.  She was started on Ampicillin, Gentamycin and
Flagyl.  Her liver function tests and amylase and lipase were
followed closely.

On the second hospital day the patient was doing much better
and was stable from an airway perspective, so she was
transferred to the General Medical Floor.

1.  Gastrointestinal:  As stated the patient was status post
endoscopic retrograde cholangiopancreatography with stent
placement for a bile leak from the duct of Luschka.  The
patient was continued on Ampicillin, Gentamycin and Flagyl,
which had been started at the time of transfer to the MICU.
She had waxing and [**Doctor Last Name 688**] fevers.  However, her white blood
cell count was never really elevated and she did not have a
bandemia.  On the day of transfer to the General Medical
Floor the patient had received clear liquids.  She did not
tolerate this very well.  Her amylase and lipase on the day
following the endoscopic retrograde cholangiopancreatography
were elevated.  Amylase was 2304 with lipase being 7116.
Therefore she was made NPO and given aggressive intravenous
hydration.  On the second hospital day on the General Medical
Floor the patient had marked rebound to palpation of her
abdomen.  She was followed closely with serial abdominal
examinations.  Her amylase and lipase were trending down,
however.  An abdominal CT was obtained, which showed only
mild pancreatitis.  There were no intra-abdominal fluid
collections, which required any drainage.

On the third hospital day the patient's pain was improving
and the rebound was decreasing.  Her enzymes continued to
trend down.  She received clear liquids in the evening and
tolerated these well.  On the day of discharge the patient
was tolerating a BRAT diet without significant abdominal
pain.  She had no further rebound.  She had no temperature
spikes in greater then 24 hours at the time of discharge.

2.  Hematology:  The patient's hematocrit was 34.8 at the
time of admission.  It decreased to 30 in the setting of
aggressive hydration.  It remained stable at the time of
discharge and it was 29.5 on the day of discharge.

3.  FEN:  The patient was aggressively hydrated given that
she was NPO.  She required periodic repletion of her
potassium.  Her bicarb began to drop and she developed an
anion gap acidosis.  This was most likely secondary to
ketoacidosis as she had no dextrose in her intravenous
fluids.  This was added on the evening prior to discharge and
on the day of discharge her anion gap acidosis had resolved.

CONDITION ON DISCHARGE:  Stable.

MEDICATIONS ON DISCHARGE:  1.  Levaquin 500 mg one po q day
times seven days.  2.  Protonix 40 mg po q day.  3.  Percocet
one to two tablets po q 4 to 6 hours prn.  The patient was
given a prescription for ten pills.  4.  Prempro as the
patient was formerly taking.  5.  Trazodone at bedtime.

DISCHARGE FOLLOW UP:  The patient was to make an appointment
with Dr. [**Last Name (STitle) **] within one to two months after discharge for
removal of the stent.  In addition, she would follow up with
her primary care physician within one to two weeks following
discharge.  She was to continue on a BRAT diet over the
weekend and two days after discharge she could advance to a
low fat no dairy diet.  She could slowly advance back to a
normal diet over the next week.

DISCHARGE DIAGNOSES:
1.  Post endoscopic retrograde cholangiopancreatography
pancreatitis.
2.  Anemia.
3.  Hypokalemia.
4.  Anion gap acidosis.
5.  Bile leak.






                          [**Doctor Last Name **] [**Name6 (MD) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 5712**]

Dictated By:[**Last Name (NamePattern1) 6859**]

MEDQUIST36

D:  [**2118-4-16**]  13:49
T:  [**2118-4-18**]  08:16
JOB#:  [**Job Number 35463**]
{'Other specified diseases of the jaws,Other opiates and related narcotics causing adverse effects in therapeutic use,Acute pancreatitis,Other pulmonary insufficiency, not elsewhere classified,Other specified cardiac dysrhythmias,Mitral valve disorders,Acidosis'}


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: The patient was admitted originally for
airway monitoring status post endoscopic retrograde
cholangiopancreatography with adverse reaction to Fentanyl
and tongue injury.

PRESENT ILLNESS: The patient is a 59 year-old
female status post endoscopic retrograde
cholangiopancreatography on the day of admission, which had
been done to evaluate for possible bile leak after
cholecystectomy was performed four days ago.  The patient was
in her usual state of health until four days prior to
admission when she had a cholecystectomy.  Her postop course
was uneventful until one day prior to admission when she
developed abdominal pain.  She went to an outside hospital
Emergency Room and was reassured and sent home.  On the day
of admission she returned to the outside hospital Emergency
Room where an abdominal CT was performed, which showed
"thickened stomach and free air."  She was sent to [**Hospital1 1444**] for an endoscopic retrograde
cholangiopancreatography and possible stent placement.  She
had a successful endoscopic retrograde
cholangiopancreatography, which showed a bile leak at the
duct of Luschka.  A stent was placed successfully.  After her
endoscopic retrograde cholangiopancreatography the patient
developed "jaw clenching, biting tongue, rigidity and
cold/chills."  The patient received ampicillin, Gentamycin
and Flagyl empirically as well as Narcan to reverse fentanyl.
Because of the tongue injury and tachycardia as well as
possible infection given her fevers or chills the GI Service
transferred the patient to the MICU for close observation.

MEDICAL HISTORY: 1.  Hiatal hernia.  2.  Status post
cholecystectomy four days prior to admission.  3.  Urinary
frequency secondary to interstitial cystitis.  4.  Mitral
valve prolapse.  5.  Tubal ligation many years ago.

MEDICATION ON ADMISSION: 1.  Prempro.  2.  Eye drops.

ALLERGIES: No known drug allergies at the time of admission,
however, it is assumed that her rigidity and jaw clenching
was secondary to Fentanyl.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is married.  She works as a
teacher's aid in [**Location (un) 8072**].  She denies tobacco or alcohol
use. 

### Response:
{'Other specified diseases of the jaws,Other opiates and related narcotics causing adverse effects in therapeutic use,Acute pancreatitis,Other pulmonary insufficiency, not elsewhere classified,Other specified cardiac dysrhythmias,Mitral valve disorders,Acidosis'}
