CHIEF COMPLAINT: Aphasia

PRESENT ILLNESS: HPI: The patient is a 72 year old woman with a history of CAD
s/p
CABG x4, hypertension, DM2, hyperlipidemia, and CKD stage IV who
presents feeling shaky and diaphoretic at home, and in the ED
developed aphasia and then a 2 minute witnessed seizure
described
as right beating horizontal nystagmus then right gaze deviation,
clenched mouth, and clicking sounds with her mouth.

MEDICAL HISTORY: 1. CAD, CABGx4(LIMA->LAD< SVG->RCA, OM, Ramus) [**2106-7-6**]
2. HTN
3. G6PD carrier, does not have the disease.
4. DM2- Per pt, glucose well controlled with last Hgb A1c of 6.
something.
5. CRI (baseline 2.0)
6. Hyperlipidemia

MEDICATION ON ADMISSION: Amlodopine 10mg daily
Atorvastatin 60mg daily
Calcitriol 0.25mcg daily
Aranesp every other week
Furosemide 80mg dialy
Ezetimibe 10mg daily
Hydralazine 50m QID
Isosorbide Dinitrate 40mg [**Hospital1 **]
Latanoprost 1 gtt ou at bedtime
Metoprolol 75mg PO BID
Valsartan 320 mg PO daily
ASA 81mg PO daily
FeSO4 325mg PO daily
Humulin 70/30 20u twice daily
MVI
Procrit

ALLERGIES: Lisinopril

PHYSICAL EXAM: VS: temp 98.2, bp 222/119->152/120->187/108, HR 118, RR 20, SaO2
100% on RA
Genl: Sleepy, NAD, arouses to sternal rub
HEENT: Sclerae anicteric, no conjunctival injection, oropharynx
clear
Neck: No nuchal rigidity
CV: Tachycardic, Nl S1, S2, III/VI systolic murmur best at LUSB,
no rubs or gallops
Chest: CTA bilaterally anteriorly and laterally, no wheezes,
rhonchi, rales
Abd: +BS, soft, NTND abdomen

FAMILY HISTORY: Sister with CAD at age 60s. Mother died of MI
Son has G6PD deficiency

SOCIAL HISTORY: She does not smoke or drink alcohol. She is working in security
(desk job) for
[**Doctor Last Name 634**] Reuters.
Hypertensive encephalopathy,Acute kidney failure, unspecified,Cerebral artery occlusion, unspecified with cerebral infarction,Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage IV (severe),Aphasia,Urinary tract infection, site not specified,Other convulsions,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Obesity, unspecified,Anemia, unspecified,Hypoparathyroidism,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other specified bacteria
Hypertens encephalopathy,Acute kidney failure NOS,Crbl art ocl NOS w infrc,Mal hy kid w cr kid I-IV,Chr kidney dis stage IV,Aphasia,Urin tract infection NOS,Convulsions NEC,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Obesity NOS,Anemia NOS,Hypoparathyroidism,Oth specf bacteria
Admission Date:  [**2110-9-8**]              Discharge Date:   [**2110-9-12**]

Date of Birth:  [**2038-3-18**]             Sex:   F

Service: NEUROLOGY

Allergies:
Lisinopril

Attending:[**Last Name (NamePattern1) 1838**]
Chief Complaint:
Aphasia

Major Surgical or Invasive Procedure:
None

History of Present Illness:
HPI: The patient is a 72 year old woman with a history of CAD
s/p
CABG x4, hypertension, DM2, hyperlipidemia, and CKD stage IV who
presents feeling shaky and diaphoretic at home, and in the ED
developed aphasia and then a 2 minute witnessed seizure
described
as right beating horizontal nystagmus then right gaze deviation,
clenched mouth, and clicking sounds with her mouth.

Per the EMS report, they found her seated at home at 11:28 am
complaining of shakiness and diaphoresis since this morning. She
reported she was not feeling well, but denied chest pain, SOB,
nausea/vomiting, and cough. She was found to have bp 240/120, HR
124, RR 24, SaO2 100% on RA, FSBG 330. She was oriented x3, no
facial droop, normal speech and grip strength. She appeared
shaky. She was transferred to the [**Hospital1 18**] ED.

While in the ED, FSBG 328. At 12:20 pm, the ED technician came
in
to evaluate the patient, and she was speaking jibberish. He was
asking her orientation questions, and she could appropriately
answer yes/no to her name and location, but when asked to
actually say her name or date "jibberish" came out. She was
evaluated then by the ED resident, who said she was diffusely
shaking in her bilateral arms which appeared like rigors. She
was
nonfocal but per the ED resident was speaking "word salad". A
Code Stroke was called. One minute later she had a witnessed
seizure characterized by right horizontal nystagmus then right
gaze deviation, mouth was clenched back, and making a clicking
sound with her mouth. She had a diffuse tremor or her arms, but
no generalized tonic clonic movements or bowel/bladder
incontinence. She was given Ativan 2 mg IV during the seizure
activity, and the seizure lasted a total of 2 minutes.
Afterwards
she was sleepy. The code stroke was cancelled, but emergent
neurology consult was then called.


Past Medical History:
1. CAD, CABGx4(LIMA->LAD< SVG->RCA, OM, Ramus) [**2106-7-6**]
2. HTN
3. G6PD carrier, does not have the disease.
4. DM2- Per pt, glucose well controlled with last Hgb A1c of 6.
something.
5. CRI (baseline 2.0)
6. Hyperlipidemia

Social History:
She does not smoke or drink alcohol. She is working in security
(desk job) for
[**Doctor Last Name 634**] Reuters.


Family History:
Sister with CAD at age 60s. Mother died of MI
Son has G6PD deficiency

Physical Exam:
VS: temp 98.2, bp 222/119->152/120->187/108, HR 118, RR 20, SaO2
100% on RA
Genl: Sleepy, NAD, arouses to sternal rub
HEENT: Sclerae anicteric, no conjunctival injection, oropharynx
clear
Neck: No nuchal rigidity
CV: Tachycardic, Nl S1, S2, III/VI systolic murmur best at LUSB,
no rubs or gallops
Chest: CTA bilaterally anteriorly and laterally, no wheezes,
rhonchi, rales
Abd: +BS, soft, NTND abdomen

Neurologic examination:
Mental status: Sleepy but arouses to sternal rub, this limits
her
exam. Initially does not follow commands to open eyes or squeeze
hands bilaterally. Initially does not answer orientation
questions, but upon repeat examination says her first name and
her date of birth.

Cranial Nerves: Pupils equally round and reactive to light, 3 to
2 mm bilaterally. Decreased blink to threat on the right. No
obvious facial asymmetry.

Motor/Sensation: Normal tone bilaterally. No observed myoclonus
or tremor. Withdraws bilateral upper and lower extremities to
noxious stimulus.

Reflexes: 2+ and symmetric in biceps, brachioradialis, triceps.
1+ and symmetric in knees, 0 and symmetric in ankles. Toes
downgoing bilaterally.

Gait: Deferred


Pertinent Results:
Labs on Admissions:
[**2110-9-8**] 12:30PM BLOOD WBC-17.1*# RBC-4.81# Hgb-14.1# Hct-44.1#
MCV-92 MCH-29.3 MCHC-31.9 RDW-15.3 Plt Ct-169
[**2110-9-8**] 12:30PM BLOOD Neuts-82.4* Lymphs-12.8* Monos-4.4
Eos-0.1 Baso-0.3
[**2110-9-8**] 12:30PM BLOOD PT-12.4 PTT-25.0 INR(PT)-1.0
[**2110-9-8**] 12:30PM BLOOD Glucose-322* UreaN-54* Creat-3.1* Na-147*
K-3.9 Cl-108 HCO3-22 AnGap-21*
[**2110-9-8**] 12:30PM BLOOD ALT-29 AST-39 LD(LDH)-682* CK(CPK)-483*
AlkPhos-83 TotBili-1.0
[**2110-9-8**] 12:30PM BLOOD CK-MB-7 cTropnT-0.02*
[**2110-9-8**] 10:25PM BLOOD CK-MB-6 cTropnT-0.02*
[**2110-9-8**] 12:30PM BLOOD Albumin-3.6 Calcium-9.1 Phos-3.0 Mg-2.2
[**2110-9-8**] 12:30PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2110-9-8**] 03:31PM BLOOD Lactate-2.5*
[**2110-9-8**] 01:35PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.019
[**2110-9-8**] 01:35PM URINE Blood-LG Nitrite-NEG Protein-500
Glucose-100 Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG
[**2110-9-8**] 01:35PM URINE RBC-[**11-14**]* WBC-[**2-27**] Bacteri-FEW Yeast-NONE
Epi-[**2-27**]
[**2110-9-8**] 04:13PM CEREBROSPINAL FLUID (CSF) WBC-2 RBC-375*
Polys-51 Lymphs-27 Monos-22
[**2110-9-8**] 04:13PM CEREBROSPINAL FLUID (CSF) WBC-0 RBC-47* Polys-5
Lymphs-70 Monos-25
[**2110-9-8**] 04:13PM CEREBROSPINAL FLUID (CSF) TotProt-77*
Glucose-175

Labs Prior to Discharge

[**2110-9-12**] 05:10AM BLOOD WBC-10.6 RBC-3.69* Hgb-10.7* Hct-33.0*
MCV-89 MCH-28.9 MCHC-32.4 RDW-16.2* Plt Ct-210
[**2110-9-12**] 05:10AM BLOOD Neuts-70.0 Lymphs-18.3 Monos-5.1 Eos-5.9*
Baso-0.6
[**2110-9-12**] 05:10AM BLOOD Glucose-172* UreaN-54* Creat-3.1* Na-138
K-3.9 Cl-106 HCO3-21* AnGap-15
[**2110-9-12**] 05:10AM BLOOD ALT-84* AST-47* LD(LDH)-415* AlkPhos-87
TotBili-0.4
[**2110-9-12**] 05:10AM BLOOD Albumin-3.1* Calcium-8.1* Phos-3.7 Mg-2.0
[**2110-9-9**] 05:30AM BLOOD Triglyc-156* HDL-40 CHOL/HD-5.5
LDLcalc-148*
[**2110-9-9**] 05:30AM BLOOD %HbA1c-7.5*

Imaging:
FINDINGS: There are extensive confluent T2 hyperintensities
throughout the
bihemispheric white matter, as well as extending into the deep
brain nuclei,
predominantly involving the thalami and to a lesser extent
lentiform nuclei.
Similar signal abnormality is present within the brainstem,
particularly the
dorsal pons and midbrain. Subtle scattered FLAIR hyperintense
foci are also
noted in the cerebellar hemispheres. There is a punctate region
of restricted
diffusion within the left centrum semiovale (series 702, im 22).
The remainder
of the elsions do not demonstrate restricted diffusion. There
are no findings
of intracranial hemorrhage. The ventricles and cerebral sulci
are
unremarkable. There is small amount of fluid/mucosal thickening
in the left
mastoid air cells.

IMPRESSION:
1. Extensive confluent signal abnormality within bihemispheric
white matter,
as well as the deep brain nuclei and brainstem. While the
changes could
relate to severe microvascular disease, some of the lesions are
atypical- in
the right frontal and temporal lobes and bilateral thalami.
Addiitonal
superimposed causes related to inflammatory, infective etiology,
drug-
induced/immunosuppression related conditions are also in the
differential
diagnosis with less likely possibility of neoplastic etiology
for some
lesions. Assessment is limited due to lack of IV contrast, which
could not be
given due to renal failure.
Correlation with labs, LP and a close follow up study if
possible with GAdo
can be considered to assess interval change.

2. Single punctate focus of restricted diffusion within the left
centrum
semiovale compatible with acute infarct which could be either
embolic or
watershed in etiology.

Radiology Report CAROTID SERIES COMPLETE Study Date of [**2110-9-9**]
8:24 AM
Findings: Duplex evaluation was performed of bilateral carotid
arteries. On
the right there is mild heterogeneous plaque in the ICA. On the
left there is
mild heterogeneous plaque in the ICA. Tortuous left ICA.

On the right systolic/end diastolic velocities of the ICA
proximal, mid and
distal respectively are 67/16, 70/18, 80/22 cm/sec. CCA peak
systolic
velocity is 64 cm/sec. ECA peak systolic velocity is 119 cm/sec.
The ICA/CCA
ratio is 1.3. These findings are consistent with <40% stenosis.

On the left systolic/end diastolic velocities of the ICA
proximal, mid and
distal respectively are 69/14, 92/18, 81/17 cm/sec. CCA peak
systolic
velocity is 69 cm/sec. ECA peak systolic velocity is 54 cm/sec.
The ICA/CCA
ratio is 1.2. These findings are consistent with <40% stenosis.

There is antegrade right vertebral artery flow.
There is antegrade left vertebral artery flow.

Impression: Right ICA stenosis <40%.
Left ICA stenosis <40%.

TTE ([**9-10**])
Conclusions
The left atrium is mildly dilated. The interatrial septum is
aneurysmal. No atrial septal defect or patent foramen ovale is
seen by 2D, color Doppler or saline contrast with maneuvers.
There is mild symmetric left ventricular hypertrophy with normal
cavity size. Tissue Doppler imaging suggests an increased left
ventricular filling pressure (PCWP>18mmHg). Right ventricular
chamber size and free wall motion are normal. The aortic valve
leaflets (3) are mildly thickened. There is a minimally
increased gradient consistent with minimal aortic valve
stenosis. No aortic regurgitation is seen. The mitral valve
leaflets are mildly thickened. There is no mitral valve
prolapse. Trivial mitral regurgitation is seen. The left
ventricular inflow pattern suggests impaired relaxation. The
tricuspid valve leaflets are mildly thickened. The pulmonary
artery systolic pressure could not be determined. There is no
pericardial effusion.

IMPRESSION: No cardiac source of embolism identified. Mild
symmetric left ventricular hypertrophy with preserved global and
regional biventricular systolic function. Diastolic dysfunction.
Minimal aortic stenosis.

Compared with the report of the prior study (images unavailable
for review) of [**2106-6-30**], the aortic valve is now minimally
stenotic. The other findings are similar.

Radiology Report MRV HEAD W/O CONTRAST Study Date of [**2110-9-9**]
10:01 PM
FINDINGS:
There is narrowing of the left transverse sinus and sigmoid
sinus, reflecting
hypoplasia rather than thrombosis. There is apparent attenuation
of the
superior sagital sinus on the vertical posterior portion
reflecting artifact.
The remainder of the dural venous sinuses are normal. The deep
cerebral veins
are also normal.

IMPRESSION:

No evidence for cerebral venous thrombosis.


Brief Hospital Course:
Ms. [**Known lastname 3175**] is a 72 year old woman with a history of CAD s/p CABG
x4, hypertension, DM2, hyperlipidemia, and CKD stage IV who
presented on [**9-8**] with headache, visual disturbance and a
witnessed seizure in the setting of hypertension.

# Neuro:  The patient's initial exam was limited by sleepiness
felt to be post-ictal in nature.  Head CT showed a hypodensity
in her left temporal lobe, which was felt to be a chronic
infarct.  An MRI/MRA was obtained and showed diffuse white
matter changes as well as bilateral thalamic hyperintensities on
T2 flare.  She was admitted to the stroke service.  Her blood
pressures were intially in the 160's (systolic) but began to
rise, with minimal response to oral anti-hypertensives. Given
the increasing blood blood pressure with MRI findings, a
decision was made to transfer Ms. [**Known lastname 3175**] to the ICU given the
concern for possible hypertensive encephalopathy. At the ICU,
Ms. [**Known lastname 3175**] was started on IV drip of Nicardipine and blood
pressures stabilized. MRV was done to rule out sinus venous
thrombosis with results showing, no evidence of cerebral venous
thrombosis. Clinically, Ms. [**Known lastname 3175**] started to improve with
improvement of speech with no word finding difficulty.  It was
suspected that her episode was due to hypertensive
encephalopathy, in the context of not being able to tolerate her
blood pressure medication during her episode of gastroenteritis
prior to admission.  She was restarted on her home blood
pressure regimen, and her mental status improved, with no
deficits on discharge.  She did have a very small stroke on MRI,
for which she was switched from ASA to Plavix.  She should
continue on her simvastatin, however LFTs were very mildly
elevated on discharge, and should be rechecked in [**12-27**] weeks.
She will need a repeat MRI in 3 weeks to evaluate progression,
and will follow-up with Neurology in 4 weeks.

# Renal: While in the ICU, Ms. [**Known lastname 98113**] renal condition started
to decrease. On admission her creatinine was 3.1. While in the
ICU, the creatinine increased to 3.6.
Renal was consulted made the recomendation that since FeNa 0.4%
was uninterpretable in setting of active diuresis, and FeUrea
28% was consistent with perfusion-related kidney injury the
likely cause of the decreased renal function was likely
malignant nephrosclerosis, and acute worsening of renal function
may be a byproduct of successful lowering of BP to desired
range. The reccomendation was made to treat hypertension with
the same goals and avoid ACE inhibitors/ARBS.  On the day of
discharge her creatinine had begun to improve to 3.1.  She will
follow-up with her outpatient nephrologist.

#Heme: The patient also missed her regular EPO shot that she
regularly receives in the outpatient setting. Nephrology has
recommended that she hold EPO in the immediate time period given
the potential to increase blood pressures.  This will be
readdressed at her outpatient nephrology appointment.

#ID: Urine culture positive for gardnerella vaginalis, received
single dose of metronidazole. Patient was afebrile throughout
hospital course.


Medications on Admission:
Amlodopine 10mg daily
Atorvastatin 60mg daily
Calcitriol 0.25mcg daily
Aranesp every other week
Furosemide 80mg dialy
Ezetimibe 10mg daily
Hydralazine 50m QID
Isosorbide Dinitrate 40mg [**Hospital1 **]
Latanoprost 1 gtt ou at bedtime
Metoprolol 75mg PO BID
Valsartan 320 mg PO daily
ASA 81mg PO daily
FeSO4 325mg PO daily
Humulin 70/30 20u twice daily
MVI
Procrit


Discharge Medications:
1. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

2. Calcitriol 0.25 mcg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
3. Hydralazine 25 mg Tablet Sig: Two (2) Tablet PO QID (4 times
a day).
4. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Isosorbide Dinitrate 20 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
6. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at
bedtime).
7. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
8. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
10. Insulin NPH & Regular Human 100 unit/mL (70-30) Suspension
Sig: Twenty (20) units Subcutaneous twice a day.
11. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
12. Aranesp (Polysorbate) 100 mcg/0.5 mL Syringe Sig: One (1)
syringe Injection once a month.
13. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO TID
(3 times a day).
Disp:*180 Tablet(s)* Refills:*2*
14. Atorvastatin 60mg Daily


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
1. Posterior Reversible Leukoencephalopathy (PRES); hypertensive
encephalopathy
2. Acute Stroke, Ischemic, Left centrum semiovale
3. Acute renal failure (worsening of chronic)


Discharge Condition:
Stable condition. Neurologic exam shows intact attention,
language (naming, comprehension, and repetition); mild Right
pronator drift, 4+/5 strength at bilateral triceps, IP, and HS;
intact sensation; mild hyperreflexia at right patella; all else
normal.


Discharge Instructions:
You were admitted with difficulty speaking and a seizure, which
was found to be due to PRES, an encephalopathy due to
hypertension (high blood pressure). The treatment of this is
control of your blood pressure, which was done in the ICU. Due
to your high blood pressure, you also had worsening of your
kidney function. As a result, we made some changes in your
medications: your Lasix dose was cut in half; your Diovan was
(temporarily) stopped, and your metoprolol was increased. You
should discuss these changes with your PCP as your renal
function improves.
.
In addition, you have been started on Plavix. You may take this
in place of aspirin to prevent future strokes. Finally, you have
been scheduled to have a repeat MRI of the brain as an
outpatient to ensure resolution of the changes we saw. Please
take all medications as directed and keep all follow-up
appointments.
.
If you have any further difficulty speaking, difficulty with
vision, loss of consciousness, weakness, numbness, or facial
droop, please call 911. If you have any questions about your
neurologic care, you may call Dr. [**First Name (STitle) **] at [**Telephone/Fax (1) 2574**].

Followup Instructions:
Please call your PCP's office at [**Telephone/Fax (1) 3581**] on Monday to
schedule a follow-up appointment. You should ask to speak to Dr. [**Name (NI) 95215**] nurse, [**Doctor First Name **] M., so that she can schedule you to be
seen in the next week.
.
In addition, you have the following appointments scheduled:
1. RADIOLOGY: Outpatient Head MRI Phone:[**Telephone/Fax (1) 327**]
Date/Time:[**2110-10-7**] 3:00
2. Neurology: [**First Name8 (NamePattern2) **] [**Name8 (MD) 162**], MD Phone:[**Telephone/Fax (1) 2574**]
Date/Time:[**2110-10-13**] 1:30
3. Nephrology (Kidney): [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 721**]
Date/Time:[**2110-10-15**] 10:00
4. Cardiology: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1523**], MD Phone:[**Telephone/Fax (1) 62**]
Date/Time:[**2111-2-2**] 4:40
.
If you cannot keep any of these appointments, please call the
number listed to re-schedule.
{'Hypertensive encephalopathy,Acute kidney failure, unspecified,Cerebral artery occlusion, unspecified with cerebral infarction,Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage IV (severe),Aphasia,Urinary tract infection, site not specified,Other convulsions,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Obesity, unspecified,Anemia, unspecified,Hypoparathyroidism,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other specified bacteria'}


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: Aphasia

PRESENT ILLNESS: HPI: The patient is a 72 year old woman with a history of CAD
s/p
CABG x4, hypertension, DM2, hyperlipidemia, and CKD stage IV who
presents feeling shaky and diaphoretic at home, and in the ED
developed aphasia and then a 2 minute witnessed seizure
described
as right beating horizontal nystagmus then right gaze deviation,
clenched mouth, and clicking sounds with her mouth.

MEDICAL HISTORY: 1. CAD, CABGx4(LIMA->LAD< SVG->RCA, OM, Ramus) [**2106-7-6**]
2. HTN
3. G6PD carrier, does not have the disease.
4. DM2- Per pt, glucose well controlled with last Hgb A1c of 6.
something.
5. CRI (baseline 2.0)
6. Hyperlipidemia

MEDICATION ON ADMISSION: Amlodopine 10mg daily
Atorvastatin 60mg daily
Calcitriol 0.25mcg daily
Aranesp every other week
Furosemide 80mg dialy
Ezetimibe 10mg daily
Hydralazine 50m QID
Isosorbide Dinitrate 40mg [**Hospital1 **]
Latanoprost 1 gtt ou at bedtime
Metoprolol 75mg PO BID
Valsartan 320 mg PO daily
ASA 81mg PO daily
FeSO4 325mg PO daily
Humulin 70/30 20u twice daily
MVI
Procrit

ALLERGIES: Lisinopril

PHYSICAL EXAM: VS: temp 98.2, bp 222/119->152/120->187/108, HR 118, RR 20, SaO2
100% on RA
Genl: Sleepy, NAD, arouses to sternal rub
HEENT: Sclerae anicteric, no conjunctival injection, oropharynx
clear
Neck: No nuchal rigidity
CV: Tachycardic, Nl S1, S2, III/VI systolic murmur best at LUSB,
no rubs or gallops
Chest: CTA bilaterally anteriorly and laterally, no wheezes,
rhonchi, rales
Abd: +BS, soft, NTND abdomen

FAMILY HISTORY: Sister with CAD at age 60s. Mother died of MI
Son has G6PD deficiency

SOCIAL HISTORY: She does not smoke or drink alcohol. She is working in security
(desk job) for
[**Doctor Last Name 634**] Reuters. 

### Response:
{'Hypertensive encephalopathy,Acute kidney failure, unspecified,Cerebral artery occlusion, unspecified with cerebral infarction,Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage IV (severe),Aphasia,Urinary tract infection, site not specified,Other convulsions,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Obesity, unspecified,Anemia, unspecified,Hypoparathyroidism,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other specified bacteria'}
