CHIEF COMPLAINT: Fevers.

PRESENT ILLNESS: This is a 58-year-old white male
with a complicated past medical history including diabetes
type 1 with retinopathy, nephropathy, and neuropathy,
end-stage renal disease status post living related kidney
transplant in [**2130**] now with evidence of chronic rejection now
on hemodialysis status post peritoneal dialysis catheter
placed in [**2141-12-9**].  Patient has had multiple
hospitalizations in [**2142-1-8**] for choledocholithiasis
and cholecystitis status post ERCP and cholecystectomy.

MEDICAL HISTORY: As above.

MEDICATION ON ADMISSION: 

ALLERGIES: Compazine and dicloxacillin.

PHYSICAL EXAM: Exam was unremarkable.  Lungs with mild
crackles.

FAMILY HISTORY: 

SOCIAL HISTORY: 
Infection and inflammatory reaction due to peritoneal dialysis catheter,Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as uncontrolled,Congestive heart failure, unspecified,Acute respiratory failure,Cellulitis and abscess of trunk,Ulcer of other part of foot,Acute osteomyelitis, ankle and foot
React-periton dialy cath,DMI ophth nt st uncntrld,CHF NOS,Acute respiratry failure,Cellulitis of trunk,Ulcer other part of foot,Ac osteomyelitis-ankle
Admission Date:  [**2142-3-26**]       Discharge Date:  [**2142-4-10**]

Date of Birth:   [**2083-10-25**]       Sex:  M

Service:

CHIEF COMPLAINT:  Fevers.

HISTORY OF PRESENT ILLNESS:  This is a 58-year-old white male
with a complicated past medical history including diabetes
type 1 with retinopathy, nephropathy, and neuropathy,
end-stage renal disease status post living related kidney
transplant in [**2130**] now with evidence of chronic rejection now
on hemodialysis status post peritoneal dialysis catheter
placed in [**2141-12-9**].  Patient has had multiple
hospitalizations in [**2142-1-8**] for choledocholithiasis
and cholecystitis status post ERCP and cholecystectomy.

Patient presented on [**2142-3-26**] with complaints of
fevers.  Patient underwent abdominal CT scan to look for
source of fevers, however, subsequent days patient developed
worsening respiratory distress on [**3-28**].  Patient was
found to be hypoxic respiratory failure and transferred to
the MICU for acute respiratory distress.  Patient was
urgently dialyzed in the MICU and respiratory status
improved.

Upon return to the floor, patient felt well and was breathing
comfortably.  Denied any headache, abdominal pain, shortness
of breath, was tolerating p.o.  Patient was continued on his
regular hemodialysis schedule.

PAST MEDICAL HISTORY:  As above.

ALLERGIES:  Compazine and dicloxacillin.

MEDICATIONS ON ARRIVAL:
1. Prednisone 5.
2. Subq Heparin.
3. Aspirin.
4. Atenolol.
5. Pravastatin.
6. Gabapentin.
7. Imdur.
8. Calcium carbonate.
9. Proton-pump inhibitor.
10. Calcitriol.
11. Insulin-sliding scale.
12. Nifedipine.
13. Nephrocaps.
14. Synthroid.
15. Midodrine.

VITAL SIGNS ON ADMISSION:  97.2, 129/51, heart rate 17, and
breathing 97% on 3 liters.

PHYSICAL EXAM:  Exam was unremarkable.  Lungs with mild
crackles.

LABORATORIES:  Notable for a white blood cell count of 7.5,
hematocrit of 29.5, platelets of 127.  Chemistries with BUN
and creatinine of 26 and 4.2.  Glucose of 118.

HOSPITAL COURSE BY SYSTEM:
1. End-stage renal disease:  Patient was continued on his
usual schedule of hemodialysis.  Patient's peritoneal
dialysis catheter was thought to be possible source of
infection, and it was therefore removed on the 20th of
........  Patient was continued Nephrocaps, calcitriol,
PhosLo, and calcium carbonate, as well as low dosed
prednisone.  Patient will be setup for outpatient dialysis
upon discharge.

2. Fevers of unknown origin:  Patient had multiple workups in
the past for high fevers and multiple ID consults in the
past, however, no workup has been fruitful.  Early in this
hospital course the patient spiked a fever to 104.7.  A
gallium scan was obtained per prior ID recommendations,
however, the gallium scan was negative.  ID was reconsulted
and recommended following blood cultures and urine cultures
for fevers greater than 101.5.

After peritoneal dialysis catheter, there was evidence of
erythema and mild induration on patient's abdomen.  Patient
was treated with a course of Vancomycin and treated the MRSA
growing from his wound.  There is also evidence proteus
growing in the wound, however, further additional antibiotic
therapy was not indicated.

Patient's ESR and C-reactive protein were also checked.  ESR
was 55 indicating no significant acute inflammatory process
and C-reactive protein level was 7.8, which the lowest level
the patient has had in the past 2-3 years.

At the time of discharge, patient had been afebrile for
approximately five days.  Abdominal wound is healing well,
and no evidence of pain or infection in his right foot.

3. Diabetes:  Patient was continued on his home dose of
glargine as well as insulin-sliding scale and diabetic diet.
Blood sugars were elevated during this admission as high as
400 to 600, but were controlled appropriately with insulin.

4. Cardiovascular status stable during this admission.  All
home medications were continued.

5. Code status:  Full code.

CONDITION ON DISCHARGE:  Stable, afebrile.

DISCHARGE STATUS:  Discharged to home with services.

MEDICATIONS ON DISCHARGE:
1. Synthroid 25 mcg p.o. q.d.
2. Aspirin 325 mg p.o. q.d.
3. Isosorbide mononitrate 90 mg p.o. q.d.
4. Atenolol 100 mg two tablets p.o. q.d.
5. Nifedipine 60 mg p.o. q.d.
6. Calcium acetate 667 mg tablet two tablets t.i.d. with
meals.
7. Pravastatin 40 mg p.o. q.d.
8. Gabapentin 300 mg p.o. b.i.d.
9. Multivitamin one tablet p.o. q.d.
10. Prednisone 5 mg p.o. q.d.
11. Calcium carbonate 500 mg p.o. b.i.d.
12. Calcitriol 0.25 mcg p.o. q.d.
13. Protonix 40 mg p.o. q.d.
14. Midodrine 5 mg p.o. t.i.d.
15. Glargine 14 units q.h.s.
16. Nephrocaps one tablet p.o. q.d.

FOLLOW-UP INSTRUCTIONS:  Patient is to followup with Dr. [**First Name8 (NamePattern2) **]
[**Name (STitle) 805**] within 7-10 days.  Patient is also to keep his
outpatient hemodialysis schedule.



                            [**Name6 (MD) 1344**] [**Name8 (MD) 1345**], M.D.  [**MD Number(1) 1346**]

Dictated By:[**Last Name (NamePattern1) 20637**]
MEDQUIST36

D:  [**2142-4-10**]  08:23
T:  [**2142-4-10**]  08:27
JOB#:  [**Job Number 20638**]


Name:  [**Known lastname 3425**], [**Known firstname 499**]                      Unit No:  [**Numeric Identifier 3426**]

Admission Date:  [**2142-3-26**]       Discharge Date:  [**2142-4-13**]

Date of Birth:   [**2083-10-25**]       Sex:  M

Service:

ADDENDUM TO PREVIOUS DISCHARGE SUMMARY.

Patient was discharged on [**2142-4-13**] instead of on [**4-10**]
as initially dictated.

Patient was seen by Podiatry for a foot film of his right
ulcer that showed some erosion of the cortex of the tip of
the great toe, distal to phalanx, which appeared slightly
greater than on the prior study.  Podiatry decided to take
the patient to the Operating Room for a debridement and
partial phalangectomy of the right hallux.  Patient was taken
to the Operating Room on [**2142-4-12**] and the procedure was
successfully.  Cultures were taken in the Operating Room and
are pending at the time of this dictation, however, the Gram
stain was negative.  Patient will be discharged on vancomycin
for treatment of his Methicillin resistant Staphylococcus
aureus wound infection.  He will be dosed at Dialysis by
levels.  Her has follow-up to begin Dialysis at [**Location (un) 1144**] on
Monday, [**4-17**].  He will follow-up with Podiatry in seven to
ten days as scheduled, and any new culture data will be
followed up at the time.  Patient was discharged on the
medications dictated on the last discharge summary.  There
were no changes in his medications except for the additional
of vancomycin.  Patient will follow-up with up with Dr.
[**First Name (STitle) **] at Dialysis.






                            [**Name6 (MD) 116**] [**Last Name (NamePattern4) 1531**], M.D.  [**MD Number(1) 1532**]

Dictated By:[**Last Name (NamePattern1) 1791**]
MEDQUIST36

D:  [**2142-4-13**]  04:25
T:  [**2142-4-13**]  20:35
JOB#:  [**Job Number 3500**]
{'Infection and inflammatory reaction due to peritoneal dialysis catheter,Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as uncontrolled,Congestive heart failure, unspecified,Acute respiratory failure,Cellulitis and abscess of trunk,Ulcer of other part of foot,Acute osteomyelitis, ankle and foot'}


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: Fevers.

PRESENT ILLNESS: This is a 58-year-old white male
with a complicated past medical history including diabetes
type 1 with retinopathy, nephropathy, and neuropathy,
end-stage renal disease status post living related kidney
transplant in [**2130**] now with evidence of chronic rejection now
on hemodialysis status post peritoneal dialysis catheter
placed in [**2141-12-9**].  Patient has had multiple
hospitalizations in [**2142-1-8**] for choledocholithiasis
and cholecystitis status post ERCP and cholecystectomy.

MEDICAL HISTORY: As above.

MEDICATION ON ADMISSION: 

ALLERGIES: Compazine and dicloxacillin.

PHYSICAL EXAM: Exam was unremarkable.  Lungs with mild
crackles.

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Infection and inflammatory reaction due to peritoneal dialysis catheter,Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as uncontrolled,Congestive heart failure, unspecified,Acute respiratory failure,Cellulitis and abscess of trunk,Ulcer of other part of foot,Acute osteomyelitis, ankle and foot'}
