CHIEF COMPLAINT: [**First Name3 (LF) **]

PRESENT ILLNESS: 81M Cantonese speaking PMH of ESRD, DM2, Afib on coumadin, CAD,
and gout presenting today with fevers. He was in his USOH until
yesterday afternoon after his HD session when he developed a
[**First Name3 (LF) **] to 102.5 while awaiting his ride home. He took tylenol and
contact[**Name (NI) **] his physician who recommended [**Name9 (PRE) **] evaluation but he
deferred until today. He was recently discharged from [**Hospital1 18**] on
[**2184-3-4**] after an admission for placement of a tunnelled HD
catheter and had been doing well. He notes fatigue but denied
any other symptoms including chest pain, shortness of breath,
cough, abdominal pain, nausea, vomiting, diarrhea, headache,
weakness, athraglias or arthritis. He has had no sick contacts
outside of his [**Date Range 13241**] sessions. He has been afebrile since
his [**Date Range **] yesterday but did take tylenol at home. Of note, the
patient was admitted [**Date range (1) 108495**] with [**Date range (1) **] of unknown
origin.

MEDICAL HISTORY: 1. Left arm hematoma.
2. End stage renal disease (on [**Date range (1) 13241**]).
3. Status post left brachiocephalic AV fistula placement
    ([**2182-10-16**]).
4. Status post revision of AV fistula x2.
5. Atrial fibrillation.
6. Diabetes mellitus type 2.
7. Hypertension.
8. Coronary artery disease.
9. History of enterococcal urosepsis.
10.History of [**Year (4 digits) **] or unknown origin.
11.History of gastric ulcer.
12.History of upper gastrointestinal (GI) bleed.
13.Obstructive sleep apnea.
14.Gout.
15.Carpal tunnel.
16.Status post left circumflex coronary artery stent in [**2180**].
17.Status post carpal tunnel release.

MEDICATION ON ADMISSION: 1. Allopurinol 300 mg daily
2. Atorvastatin 10 mg daily
3. Calcitriol 0.25 mcg daily
4. Felodipine 10 mg daily
5. Folic Acid 1 mg daily
6. Isosorbide Mononitrate 30 mg daily
7. Levothyroxine 75 mcg daily
8. Methylprednisolone 8 mg daily
9. Metoprolol Tartrate 50 mg tid
10. Acetaminophen 325 mg prn
11. Coumadin 2.5 mg daily
12. Aspirin 81 mg daily
13. Levemir 16 units daily
14. Lactulose prn

ALLERGIES: Lovastatin

PHYSICAL EXAM: Vitals: T: 100.3 BP: 165/85 P: 87 RR: 20 SpO2: 100%RA
General: Awake, alert, NAD
HEENT: NC/AT, PERRL, EOMI, sclera anicteric. MMM, OP without
lesions
Neck: Supple, no JVD or carotid bruits appreciated
Pulm: CTAB without crackles, rhonchi, or wheezes
Cardiac: RRR, nl S1/S2, no M/R/G appreciated
Abdomen: Soft, NT/ND, + BS, no masses or hepatomegaly noted.
Ext: No edema b/t, 1+ DP and PT pulses b/l, left arm well-healed
fistula site without thrill/bruit
Lymphatics: No cervical, supraclavicular, axillary, or inguinal
LAD
Skin: Right tunnelled catheter site without erythema or exudate,
multiple ecchymoses, no rashes
Neurologic: Able to relate history without difficulty per
interpretor, CN II-XII intact, MAEW

FAMILY HISTORY: Both parents deceased. Father had diabetes. He has 2 children
who are well and no siblings.

SOCIAL HISTORY: Mr. [**Known lastname **] is Cantonese speaking. He lives at home with his wife.
[**Name (NI) **] has a remote 20-year history of tobacco smoking. He quit 20
years ago. No alcohol or illicit drug use
Acute on chronic systolic heart failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Cardiac arrest,Diabetes with renal manifestations, type II or unspecified type, uncontrolled,Alkalosis,Coronary atherosclerosis of native coronary artery,Obstructive sleep apnea (adult)(pediatric),Unspecified acquired hypothyroidism,Gout, unspecified,Other chronic pulmonary heart diseases,Dermatophytosis of nail,Secondary hyperparathyroidism (of renal origin),Other and unspecified coagulation defects
Ac on chr syst hrt fail,Hyp kid NOS w cr kid V,End stage renal disease,Cardiac arrest,DMII renal uncntrld,Alkalosis,Crnry athrscl natve vssl,Obstructive sleep apnea,Hypothyroidism NOS,Gout NOS,Chr pulmon heart dis NEC,Dermatophytosis of nail,Sec hyperparathyrd-renal,Coagulat defect NEC/NOS
Admission Date:  [**2184-3-17**]              Discharge Date:   [**2184-4-1**]

Date of Birth:  [**2103-1-26**]             Sex:   M

Service: MEDICINE

Allergies:
Lovastatin

Attending:[**First Name3 (LF) 348**]
Chief Complaint:
[**First Name3 (LF) **]

Major Surgical or Invasive Procedure:
Tunneled dialysis catheter removal and replacement
[**First Name3 (LF) **]
Attempted transesophageal echocardiogram

History of Present Illness:
81M Cantonese speaking PMH of ESRD, DM2, Afib on coumadin, CAD,
and gout presenting today with fevers. He was in his USOH until
yesterday afternoon after his HD session when he developed a
[**First Name3 (LF) **] to 102.5 while awaiting his ride home. He took tylenol and
contact[**Name (NI) **] his physician who recommended [**Name9 (PRE) **] evaluation but he
deferred until today. He was recently discharged from [**Hospital1 18**] on
[**2184-3-4**] after an admission for placement of a tunnelled HD
catheter and had been doing well. He notes fatigue but denied
any other symptoms including chest pain, shortness of breath,
cough, abdominal pain, nausea, vomiting, diarrhea, headache,
weakness, athraglias or arthritis. He has had no sick contacts
outside of his [**Date Range 13241**] sessions. He has been afebrile since
his [**Date Range **] yesterday but did take tylenol at home. Of note, the
patient was admitted [**Date range (1) 108495**] with [**Date range (1) **] of unknown
origin.

In the ED, VS 97.5 64 154/43 16 100%RA. Laboratories revealed
only renal insufficiency without evidence of a leukocytosis,
bandemia, or left shift. CXR showed no abnormality and blood
cultures were drawn. He received vancomycin 1gm in concern for a
catheter associated infection. He was seen by transplant surgery
and nephrology who agree with vancomycin and admission for
further evaluation.

Past Medical History:
1. Left arm hematoma.
2. End stage renal disease (on [**Date range (1) 13241**]).
3. Status post left brachiocephalic AV fistula placement
    ([**2182-10-16**]).
4. Status post revision of AV fistula x2.
5. Atrial fibrillation.
6. Diabetes mellitus type 2.
7. Hypertension.
8. Coronary artery disease.
9. History of enterococcal urosepsis.
10.History of [**Year (4 digits) **] or unknown origin.
11.History of gastric ulcer.
12.History of upper gastrointestinal (GI) bleed.
13.Obstructive sleep apnea.
14.Gout.
15.Carpal tunnel.
16.Status post left circumflex coronary artery stent in [**2180**].
17.Status post carpal tunnel release.


Social History:
Mr. [**Known lastname **] is Cantonese speaking. He lives at home with his wife.
[**Name (NI) **] has a remote 20-year history of tobacco smoking. He quit 20
years ago. No alcohol or illicit drug use





Family History:
Both parents deceased. Father had diabetes. He has 2 children
who are well and no siblings.


Physical Exam:
Vitals: T: 100.3 BP: 165/85 P: 87 RR: 20 SpO2: 100%RA
General: Awake, alert, NAD
HEENT: NC/AT, PERRL, EOMI, sclera anicteric. MMM, OP without
lesions
Neck: Supple, no JVD or carotid bruits appreciated
Pulm: CTAB without crackles, rhonchi, or wheezes
Cardiac: RRR, nl S1/S2, no M/R/G appreciated
Abdomen: Soft, NT/ND, + BS, no masses or hepatomegaly noted.
Ext: No edema b/t, 1+ DP and PT pulses b/l, left arm well-healed
fistula site without thrill/bruit
Lymphatics: No cervical, supraclavicular, axillary, or inguinal
LAD
Skin: Right tunnelled catheter site without erythema or exudate,
multiple ecchymoses, no rashes
Neurologic: Able to relate history without difficulty per
interpretor, CN II-XII intact, MAEW

Pertinent Results:
Admission labs:
[**2184-3-17**] 04:00PM   WBC-4.4 RBC-3.63* HGB-11.0* HCT-34.3* MCV-94
MCH-30.2 MCHC-32.0 RDW-16.3*
[**2184-3-17**] 04:00PM   NEUTS-76.4* LYMPHS-16.9* MONOS-6.4 EOS-0.1
BASOS-0.3
[**2184-3-17**] 04:00PM   PLT COUNT-212
[**2184-3-17**] 04:00PM   GLUCOSE-134* UREA N-36* CREAT-3.7*#
SODIUM-139 POTASSIUM-4.0 CHLORIDE-100 TOTAL CO2-28 ANION GAP-15
[**2184-3-17**] 10:04PM   PT-25.6* INR(PT)-2.5*
.
Studies:
CHEST (PA & LAT)  [**2184-3-17**]
FINDINGS: A right subclavian tunneled line is in standard
position. There is no evidence of infiltrate. The heart is
enlarged, but there is no evidence of volume overload or
pneumothorax. The aorta is tortuous and calcified.
IMPRESSION: No acute cardiopulmonary process.
.
TIB/FIB (AP & LAT) LEFT  [**2184-3-19**]
FINDINGS: No evidence of acute fracture or other bone
abnormality. There is extensive calcification of vascular
structures throughout the leg, ankle, and foot, suggesting
underlying diabetes. Small inferior calcaneal spur.
.
MR ANKLE W/O CONTRAST LEFT  [**2184-3-24**]
IMPRESSION:
1. Edema in the fat surrounding the Achilles with some mild
tendinosis of the Achilles tendon itself.
2. Mild degenerative change in the tibiotalar joint and mid
foot.
.
TTE (Complete) Done [**2184-3-23**]
 The left atrium is elongated. The estimated right atrial
pressure is 10-20mmHg. There is mild symmetric left ventricular
hypertrophy with normal cavity size. There is moderate regional
left ventricular systolic dysfunction with focal akinesis of the
inferior wall and moderate global hypokinesis of the remaining
segments (LVEF = 30-35 %). Right ventricular chamber size and
free wall motion are normal. The aortic valve leaflets (3) are
mildly thickened (especially the non-coronary cusp) but aortic
stenosis is not present. No masses or vegetations are seen on
the aortic valve, but cannot be fully excluded due to suboptimal
image quality. Trace aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. No mass or vegetation is
seen on the mitral valve. Mild to moderate ([**12-17**]+) mitral
regurgitation is seen. There is severe pulmonary artery systolic
hypertension. There is no pericardial effusion.
IMPRESSION: No valvular vegetations identified. Mild symmetric
left ventricular hypertrophy with regional left ventricular
systolic dysfunction c/w CAD. Mild/moderate mitral
regurgitation. Severe pulmonary hypertension.
.
TEE (Complete) Done [**2184-3-31**]
The TEE probe could not be passed into the esophagus due to the
patients inability to comply with swallowing instructions and
strong gag reflex. Anesthesia support is suggested for the
future.
.
CT TORSO W/CONTRAST  [**2184-3-26**]
IMPRESSION:
1. No evidence of infectious source.
2. Increased bilateral pleural effusions are identified.
3. Sub-cm right thyroid nodule.
.
IN-111 WHITE BLOOD CELL STUDY  [**2184-3-29**]
IMPRESSION: No scintigraphic evidence for a focal site of
infection.
.
CT HEAD W/O CONTRAST  [**2184-3-31**]
IMPRESSION: No acute intracranial process.

Brief Hospital Course:
81M Cantonese speaking PMH of ESRD, DM2, Afib on coumadin, and
CAD presenting after an episode of [**Month/Day/Year **] to 102.5 following
[**Month/Day/Year 13241**].
.
# [**Month/Day/Year **] of unknown origin:  Infection was a concern as pt is
chronically on steroids for gout.  Pt initially spiked fevers
with dialysis, and a line or line pocket infection was suspected
and he was started on vancomycin.  However, bcxs prior to
initiation of antibiotics as well as subsequent blood cxs and HD
catheter tip culture were all negative. HD line was removed [**3-20**]
but pt continued to spike fevers.  Vancomycin was discontinued
for suspected drug [**Month/Day (1) **]; however, fevers continued.  The Renal
team also tried multiple dialysis membranes for concern of
dialysis membrane reaction; however, pt continued to spike.  He
initially complained of L leg pain, and MRI of L ankle was
benign. Ultrasound of fistula did not show an abscess. ID was
consulted. The following studies were also sent and negative:
HBV VL, CMV VL, monospot, HIV, and strongyloides. CT torso did
not show obvious source of infection.  He had an TTE that did
not show evidence of endocarditis, and TEE was attempted but the
probe could not be passed through the oropharynx.  Tagged WBC
scan was neg.  His methylprednisolone was even tapered to reveal
a possible infectious source.  Oncologic causes were also
considered.  He had slightly elevated LDH but had pan-scan did
not show any pathologic adenopathy to suggest lymphoma. SPEP was
without monoclonal spike.  Pt's family deferred a bone marrow
biospy as they would not have pursued treatment.
Rheumatological causes were also considered.  He has a history
of gout; however, his Rheumatologist had visited him and did not
find any affected joints at this time.  [**Doctor First Name **], RF were WNL.  The
cause of the [**Doctor First Name **] remains unknown.
.
# Atrial fibrillation with RVR:  Pt was rate-controlled except
in the setting of fevers.  He was continued on metoprolol, which
was titrated up as tolerated by his blood pressure.  He was
continued on anticoagulation after placement of his new HD line.
.
# Hypertension:  His blood pressure was labile.  He was
continued on home metoprolol, imdur.  A switch from metoprolol
to carvediolol was attempted but his blood pressure had fallen
with carvediolol, requiring IVF boluses.  He was switched back
to metoprolol.
.
# Acute on chronic systolic congestive heart failure:  On [**3-31**],
pt was noted to be acutely hypoxic and in pulmonary edema.  This
was likely due to IVFs the pt had received during his episode of
hypotension as described above.  He was transferred to the MICU
for emergent HD overnight.  Unfortunately, his BP only tolerated
removal of 1L IVFs.
.
# Acute mental status changes:  Pt was consistently less
responsive in the setting of his fevers.  He was watched in the
MICU overnight for acute mental status changes.  CT head was
negative.  His narcotics were scaled back.
.
# ESRD on HD: Pt had long-standing renal impairment likely due
to diabetes. He continued HD on T/Th/Sa schedule, received epo
at HD, and continued on nephrocaps.
.
# CAD: Pt had a couple episodes of chest pain on [**3-27**] that were
relieved with NTG. EKG showed new T wave inversions. Troponin
was mildly elevated above baseline but CKs were flat. Cardiology
was consulted.  Pt was placed on heparin gtt overnight to [**3-28**]
and was discontinued when his CEs trended down.  This was likely
[**1-17**] demand ischemia.  He was continued on ASA, BB, nitrate,
statin, plavix.
.
# Diabetes type 2: He was continue on home insulin regimen with
sliding scale insulin.
.
# Hypothyroidism: TSH was WNL and he was continued on his home
levothyroxine dose.
.
# Gout: This was not active. He was continued on
methylprednisolone and allopurinol.
.
# On [**3-31**], pt became acutely hypoxic and was found to be in
pulmonary edema as described above.  He was started on a nitro
gtt and transferred to MICU for emergent HD.  Unfortunately, his
BP only tolerated removal of 1L IVFs.  At this time, the family
changed their goals of care to comfort.  Pt was started on a
morphine gtt and transferred to the floor.  He passed away on
[**2184-4-1**].  Pt's family declined an autopsy.

Medications on Admission:
1. Allopurinol 300 mg daily
2. Atorvastatin 10 mg daily
3. Calcitriol 0.25 mcg daily
4. Felodipine 10 mg daily
5. Folic Acid 1 mg daily
6. Isosorbide Mononitrate 30 mg daily
7. Levothyroxine 75 mcg daily
8. Methylprednisolone 8 mg daily
9. Metoprolol Tartrate 50 mg tid
10. Acetaminophen 325 mg prn
11. Coumadin 2.5 mg daily
12. Aspirin 81 mg daily
13. Levemir 16 units daily
14. Lactulose prn

Discharge Medications:
N/A

Discharge Disposition:
Expired

Discharge Diagnosis:
[**Date Range **] of Unknown Origin
Atrial fibrillation
Acute on chronic systolic congestive heart failure
Chronic kidney disease, stage V

Discharge Condition:
N/A

Discharge Instructions:
N/A

Followup Instructions:
N/A
{'Acute on chronic systolic heart failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Cardiac arrest,Diabetes with renal manifestations, type II or unspecified type, uncontrolled,Alkalosis,Coronary atherosclerosis of native coronary artery,Obstructive sleep apnea (adult)(pediatric),Unspecified acquired hypothyroidism,Gout, unspecified,Other chronic pulmonary heart diseases,Dermatophytosis of nail,Secondary hyperparathyroidism (of renal origin),Other and unspecified coagulation defects'}


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: [**First Name3 (LF) **]

PRESENT ILLNESS: 81M Cantonese speaking PMH of ESRD, DM2, Afib on coumadin, CAD,
and gout presenting today with fevers. He was in his USOH until
yesterday afternoon after his HD session when he developed a
[**First Name3 (LF) **] to 102.5 while awaiting his ride home. He took tylenol and
contact[**Name (NI) **] his physician who recommended [**Name9 (PRE) **] evaluation but he
deferred until today. He was recently discharged from [**Hospital1 18**] on
[**2184-3-4**] after an admission for placement of a tunnelled HD
catheter and had been doing well. He notes fatigue but denied
any other symptoms including chest pain, shortness of breath,
cough, abdominal pain, nausea, vomiting, diarrhea, headache,
weakness, athraglias or arthritis. He has had no sick contacts
outside of his [**Date Range 13241**] sessions. He has been afebrile since
his [**Date Range **] yesterday but did take tylenol at home. Of note, the
patient was admitted [**Date range (1) 108495**] with [**Date range (1) **] of unknown
origin.

MEDICAL HISTORY: 1. Left arm hematoma.
2. End stage renal disease (on [**Date range (1) 13241**]).
3. Status post left brachiocephalic AV fistula placement
    ([**2182-10-16**]).
4. Status post revision of AV fistula x2.
5. Atrial fibrillation.
6. Diabetes mellitus type 2.
7. Hypertension.
8. Coronary artery disease.
9. History of enterococcal urosepsis.
10.History of [**Year (4 digits) **] or unknown origin.
11.History of gastric ulcer.
12.History of upper gastrointestinal (GI) bleed.
13.Obstructive sleep apnea.
14.Gout.
15.Carpal tunnel.
16.Status post left circumflex coronary artery stent in [**2180**].
17.Status post carpal tunnel release.

MEDICATION ON ADMISSION: 1. Allopurinol 300 mg daily
2. Atorvastatin 10 mg daily
3. Calcitriol 0.25 mcg daily
4. Felodipine 10 mg daily
5. Folic Acid 1 mg daily
6. Isosorbide Mononitrate 30 mg daily
7. Levothyroxine 75 mcg daily
8. Methylprednisolone 8 mg daily
9. Metoprolol Tartrate 50 mg tid
10. Acetaminophen 325 mg prn
11. Coumadin 2.5 mg daily
12. Aspirin 81 mg daily
13. Levemir 16 units daily
14. Lactulose prn

ALLERGIES: Lovastatin

PHYSICAL EXAM: Vitals: T: 100.3 BP: 165/85 P: 87 RR: 20 SpO2: 100%RA
General: Awake, alert, NAD
HEENT: NC/AT, PERRL, EOMI, sclera anicteric. MMM, OP without
lesions
Neck: Supple, no JVD or carotid bruits appreciated
Pulm: CTAB without crackles, rhonchi, or wheezes
Cardiac: RRR, nl S1/S2, no M/R/G appreciated
Abdomen: Soft, NT/ND, + BS, no masses or hepatomegaly noted.
Ext: No edema b/t, 1+ DP and PT pulses b/l, left arm well-healed
fistula site without thrill/bruit
Lymphatics: No cervical, supraclavicular, axillary, or inguinal
LAD
Skin: Right tunnelled catheter site without erythema or exudate,
multiple ecchymoses, no rashes
Neurologic: Able to relate history without difficulty per
interpretor, CN II-XII intact, MAEW

FAMILY HISTORY: Both parents deceased. Father had diabetes. He has 2 children
who are well and no siblings.

SOCIAL HISTORY: Mr. [**Known lastname **] is Cantonese speaking. He lives at home with his wife.
[**Name (NI) **] has a remote 20-year history of tobacco smoking. He quit 20
years ago. No alcohol or illicit drug use 

### Response:
{'Acute on chronic systolic heart failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Cardiac arrest,Diabetes with renal manifestations, type II or unspecified type, uncontrolled,Alkalosis,Coronary atherosclerosis of native coronary artery,Obstructive sleep apnea (adult)(pediatric),Unspecified acquired hypothyroidism,Gout, unspecified,Other chronic pulmonary heart diseases,Dermatophytosis of nail,Secondary hyperparathyroidism (of renal origin),Other and unspecified coagulation defects'}
