CHIEF COMPLAINT: Hyperkalemia

PRESENT ILLNESS: 78 y/o man w/Rght heart failure, left heart failure, severe TR,
cardiac cirrhosis, ascites requiring frequent paracentesis,
chronic GI bleed [**3-2**] AVMs, and afib admitted after became
hypotensive with labs drawn during routine paracentesis (5L
removed) showed acute renal failure (Cr. 2.2, baseline 1.6)
hyperkalemia (6.8), and Hct 21.

MEDICAL HISTORY: -HTN
-CAD: CABG [**2140**], cath [**2151**] with patent lima-lad, occluded
svg-om, near occluded svg-rca
-CHF: TTE [**7-5**] with EF 35%, mild LVH and LV-HK, 2+MR, 4+TR
-Afib
-Cardiac cirrhosis: Requiring repeat sx paracenteses
-Chronic GIB [**3-2**] AVMs
-Colon polyps
-HBV
-CRI: cr 1.5-1.8
-Hypothyroidism
-OA

MEDICATION ON ADMISSION: Levothyroxine 150 mcg po daily
Spironolactone 50mg po daily
Furosemide 120mg po bid
Digoxin 125 mcg po q Mo/We/Fr
Albuterol/atrovent nebs
Senna 8.6 mg po bid
Docusate 100mg po bid
acetaminophen 325mg po q4-6 prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAMINATION:
VS -  95.3  98/60  78  22  94% 2L   850/750   73.6kg
Gen: chronically ill appearing elderly man
HEENT: poor dentition. Sclera anicteric. PERRL, EOMI.
Conjunctiva were pink, no pallor or cyanosis of the oral mucosa.
 Dry mucosa. No xanthalesma.
Neck: Supple with JVP 10cm, distended external jugular veins,
systolic TR visible in jugular veins with systolic pulse.
CV: Irregularly irregular rhythym, S1, s2, no M/G/R.
Chest: Slightly tachypnic. Lungs with wheezing and rhonchi
bilaterally, crackles @ bases R>L. Decreased BS on left.
Abd: distended, tense.  large ubmilical hernia noted
Ext: 1+ pitting edema of LE bilaterally.
Skin: skin changes consistent with stasis dermatits noted
bilaterally.  multiple ecchymosis over body.
.
Pulses: Carotid 2+ Radial 2+ DP 2+ bilaterally.

FAMILY HISTORY: Mother- HTN, ?died of MI; Father-83 yo and died of "old age"; no
FH of cancer

SOCIAL HISTORY: Originally from [**Country 3397**]. Previously living with wife in [**Name (NI) 3146**],
but has been at rehab since recent hospitalization. Quit smoking
15 years ago. Smoked 1 ppd x 40 years. No EtOH. Retired, but
used to work as a machinist. Unable to walk. Needs
wheelchair/walker to get around his house.
Acute kidney failure, unspecified,Hyperpotassemia,Acute on chronic systolic heart failure,Diseases of tricuspid valve,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Cirrhosis of liver without mention of alcohol,Atrial fibrillation,Mitral valve disorders,Chronic kidney disease, unspecified,Unspecified acquired hypothyroidism,Aortocoronary bypass status,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified
Acute kidney failure NOS,Hyperpotassemia,Ac on chr syst hrt fail,Tricuspid valve disease,Hpt B chrn wo cm wo dlta,Cirrhosis of liver NOS,Atrial fibrillation,Mitral valve disorder,Chronic kidney dis NOS,Hypothyroidism NOS,Aortocoronary bypass,Hy kid NOS w cr kid I-IV
Admission Date:  [**2153-8-13**]              Discharge Date:   [**2153-8-18**]

Date of Birth:  [**2075-5-19**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 905**]
Chief Complaint:
Hyperkalemia

Major Surgical or Invasive Procedure:
Paracentesis X2


History of Present Illness:
78 y/o man w/Rght heart failure, left heart failure, severe TR,
cardiac cirrhosis, ascites requiring frequent paracentesis,
chronic GI bleed [**3-2**] AVMs, and afib admitted after became
hypotensive with labs drawn during routine paracentesis (5L
removed) showed acute renal failure (Cr. 2.2, baseline 1.6)
hyperkalemia (6.8), and Hct 21.

Past Medical History:
-HTN
-CAD: CABG [**2140**], cath [**2151**] with patent lima-lad, occluded
svg-om, near occluded svg-rca
-CHF: TTE [**7-5**] with EF 35%, mild LVH and LV-HK, 2+MR, 4+TR
-Afib
-Cardiac cirrhosis: Requiring repeat sx paracenteses
-Chronic GIB [**3-2**] AVMs
-Colon polyps
-HBV
-CRI: cr 1.5-1.8
-Hypothyroidism
-OA

Social History:
Originally from [**Country 3397**]. Previously living with wife in [**Name (NI) 3146**],
but has been at rehab since recent hospitalization. Quit smoking
15 years ago. Smoked 1 ppd x 40 years. No EtOH. Retired, but
used to work as a machinist. Unable to walk. Needs
wheelchair/walker to get around his house.


Family History:
Mother- HTN, ?died of MI; Father-83 yo and died of "old age"; no
FH of cancer

Physical Exam:
PHYSICAL EXAMINATION:
VS -  95.3  98/60  78  22  94% 2L   850/750   73.6kg
Gen: chronically ill appearing elderly man
HEENT: poor dentition. Sclera anicteric. PERRL, EOMI.
Conjunctiva were pink, no pallor or cyanosis of the oral mucosa.
 Dry mucosa. No xanthalesma.
Neck: Supple with JVP 10cm, distended external jugular veins,
systolic TR visible in jugular veins with systolic pulse.
CV: Irregularly irregular rhythym, S1, s2, no M/G/R.
Chest: Slightly tachypnic. Lungs with wheezing and rhonchi
bilaterally, crackles @ bases R>L. Decreased BS on left.
Abd: distended, tense.  large ubmilical hernia noted
Ext: 1+ pitting edema of LE bilaterally.
Skin: skin changes consistent with stasis dermatits noted
bilaterally.  multiple ecchymosis over body.
.
Pulses: Carotid 2+ Radial 2+ DP 2+ bilaterally.


Pertinent Results:
[**2153-8-13**] 08:55AM BLOOD WBC-9.1 RBC-2.38* Hgb-6.5* Hct-21.3*
MCV-89 MCH-27.1 MCHC-30.3* RDW-17.7* Plt Ct-396
[**2153-8-17**] 06:46AM BLOOD WBC-10.0 RBC-3.28* Hgb-8.9* Hct-27.7*
MCV-84 MCH-27.1 MCHC-32.1 RDW-17.7* Plt Ct-302
[**2153-8-13**] 11:15AM BLOOD Hypochr-1+ Anisocy-3+ Poiklo-NORMAL
Macrocy-2+ Microcy-2+ Polychr-2+ Target-1+
[**2153-8-14**] 04:49AM BLOOD PT-13.2* INR(PT)-1.2*
[**2153-8-13**] 08:55AM BLOOD Glucose-95 UreaN-96* Creat-2.1* Na-127*
K-6.8* Cl-96 HCO3-23 AnGap-15
[**2153-8-17**] 06:46AM BLOOD Glucose-101 UreaN-93* Creat-1.9* Na-130*
K-3.3 Cl-93* HCO3-25 AnGap-15
[**2153-8-13**] 11:15AM BLOOD Calcium-7.4* Phos-6.8*# Mg-3.1*
[**2153-8-17**] 06:46AM BLOOD Calcium-6.6* Phos-4.9* Mg-2.7*
[**2153-8-16**] 05:22AM BLOOD TSH-31*
[**2153-8-16**] 05:22AM BLOOD T4-3.3*
[**2153-8-13**] 11:15AM BLOOD Digoxin-0.9

[**2153-8-16**] Echo The left atrium is moderately dilated. The
estimated right atrial pressure is 0-5mmHg. The estimated right
atrial pressure is >20 mmHg. Left ventricular wall thicknesses
are normal. The left ventricular cavity is mildly dilated. There
is probably mild to moderate global left ventricular hypokinesis
(LVEF = ?40 %; views are technically suboptimal for assessment
of wall motion).[Intrinsic left ventricular systolic function is
likely more depressed given the severity of valvular
regurgitation.] The right ventricular cavity is markedly
dilated. There is mild global right ventricular free wall
hypokinesis. [Intrinsic right ventricular systolic function is
likely more depressed given the severity of tricuspid
regurgitation.] There is abnormal septal motion/position
consistent with right ventricular pressure/volume overload. The
aortic root is moderately dilated at the sinus level. The
ascending aorta is mildly dilated. The aortic valve leaflets are
mildly  thickened. There is no aortic valve stenosis. No aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. Mild to moderate ([**1-30**]+) mitral regurgitation is seen.
The tricuspid valve leaflets are mildly thickened and do not
coapt. Moderate to severe [3+] tricuspid regurgitation is seen.
There is no pericardial effusion. There is at least moderate
pulmonary artery systolic hypertension (given elevated high
IVC/RA pressure and measured TR jet velocity).

[**8-14**]/o7 CXR AP PORTABLE UPRIGHT VIEW OF THE CHEST: The
Port-A-Cath device is in stable position. Moderate left pleural
effusion is not significantly changed compared to the study of
seven hours prior. Right lung is grossly clear. There is no
evidence of pneumothorax. The patient is status post CABG.

IMPRESSION: No significant interval change and moderate
left-sided pleural effusion.


Brief Hospital Course:
Patient had brief stay in MICU, was medically managed with
kayexalate, insulin and albuterol,  and hyperkalemia resolved.
Was on [**Location **] service with progressive increase in
abdominal girth and pleural effusions. Cardiology was consulted,
decided to hold spironolactone ACEI, BB, and to continue with
Lasix.  On night of [**8-15**] had 2 Units PRBCs with total 100mg IV
lasix but developed shortness of breath with slightly increased
oxygen requirment. Put out minimal urine to lasix with continued
dyspnea and oxygen requirment initiating transfer to [**Hospital1 1516**]
service for higher level managment (i.e. lasix drip). Had second
large volume paracentesis [**8-16**] with removal of 4 iters and
administration of 37.5gm [**Month/Year (2) 61990**] for prevention of hepatorenal
syndrome in setting of acute renal failure.  Lasix drip 10mg/hr
was begun on [**8-16**].  the following morning the patient was
negative 1.2L. His systolic blood pressure was stable as it
remained in the 100's. He continued on the lasix drip through
[**8-17**], with the goal of keeping him negative another 1-2L.  By
[**8-18**] the patient was negative 4.5L.  His Lasix was discontinued
and bumetonide 1mg IV BID was added because it has better
absorption from the GI tract. Endocrinology was consulted for
recommendations regarding the patient's hypothyroidism, and they
suggested remeasuring TSH and free T4 next week. Also on [**8-18**],
the patient was demanding to go home, he began to refuse vital
sign checks and medications and threatened to leave AMA.  His
placement was complicated by the fact that the [**Hospital1 1501**] he came from
did reserve his bed.  The earliest he could have been rescreened
was Monday, but he insisted on being home by Sunday for a family
engagement.  Sending him home with services was not an issue
because he has been blacklisted by VNA.  The medical team did
not feel it was safe to send him home, and eventually the
patient left against medical advice.

Medications on Admission:
Levothyroxine 150 mcg po daily
Spironolactone 50mg po daily
Furosemide 120mg po bid
Digoxin 125 mcg po q Mo/We/Fr
Albuterol/atrovent nebs
Senna 8.6 mg po bid
Docusate 100mg po bid
acetaminophen 325mg po q4-6 prn

Discharge Medications:
1. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
2. Senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day).

3. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Trazodone 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime).
6. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
7. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
8. Zinc Sulfate 220 (50) mg Capsule Sig: One (1) Capsule PO
DAILY (Daily).
9. Levothyroxine 75 mcg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
10. Dextromethorphan-Guaifenesin 10-100 mg/5 mL Syrup Sig: Ten
(10) ML PO Q6H (every 6 hours) as needed.
11. Albuterol Sulfate 0.083 % (0.83 mg/mL) Solution Sig: One (1)
 Inhalation Q4H (every 4 hours).
12. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO QMOWEFR
(Monday -Wednesday-Friday).
13. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours).
14. Metolazone 5 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
15. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID (3 times a day).
16. Trazodone 50 mg Tablet Sig: 0.25 Tablet PO HS (at bedtime)
as needed.
17. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H
(every 6 hours) as needed.


Discharge Disposition:
Home

Discharge Diagnosis:
CHF
Anemia
Acute renal failure
Hyperkalemia
Hypocalcemia
Hypothyroidism


Discharge Condition:
fair


Discharge Instructions:
You have decided to discharge yourself from the hospital against
medical advice (AMA). The risks of this, including death, were
explained to you, and you stated that you understood these risks
and still desired to leave the hospital. You signed a legal form
stating your desire to leave as above.
.
Please continue to take all your medicines as directed. If you
experience any symptoms that are disturbing to you, please call
your primary care doctor, or go to the nearest Emergency Room.
.
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
Adhere to 2 gm sodium diet
Fluid Restriction: 1.5L/day

Followup Instructions:
please follow-up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], your cardiologist, in
[**1-30**] weeks


                             [**Name6 (MD) 251**] [**Name8 (MD) **] MD [**MD Number(1) 910**]
{'Acute kidney failure, unspecified,Hyperpotassemia,Acute on chronic systolic heart failure,Diseases of tricuspid valve,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Cirrhosis of liver without mention of alcohol,Atrial fibrillation,Mitral valve disorders,Chronic kidney disease, unspecified,Unspecified acquired hypothyroidism,Aortocoronary bypass status,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}


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: Hyperkalemia

PRESENT ILLNESS: 78 y/o man w/Rght heart failure, left heart failure, severe TR,
cardiac cirrhosis, ascites requiring frequent paracentesis,
chronic GI bleed [**3-2**] AVMs, and afib admitted after became
hypotensive with labs drawn during routine paracentesis (5L
removed) showed acute renal failure (Cr. 2.2, baseline 1.6)
hyperkalemia (6.8), and Hct 21.

MEDICAL HISTORY: -HTN
-CAD: CABG [**2140**], cath [**2151**] with patent lima-lad, occluded
svg-om, near occluded svg-rca
-CHF: TTE [**7-5**] with EF 35%, mild LVH and LV-HK, 2+MR, 4+TR
-Afib
-Cardiac cirrhosis: Requiring repeat sx paracenteses
-Chronic GIB [**3-2**] AVMs
-Colon polyps
-HBV
-CRI: cr 1.5-1.8
-Hypothyroidism
-OA

MEDICATION ON ADMISSION: Levothyroxine 150 mcg po daily
Spironolactone 50mg po daily
Furosemide 120mg po bid
Digoxin 125 mcg po q Mo/We/Fr
Albuterol/atrovent nebs
Senna 8.6 mg po bid
Docusate 100mg po bid
acetaminophen 325mg po q4-6 prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAMINATION:
VS -  95.3  98/60  78  22  94% 2L   850/750   73.6kg
Gen: chronically ill appearing elderly man
HEENT: poor dentition. Sclera anicteric. PERRL, EOMI.
Conjunctiva were pink, no pallor or cyanosis of the oral mucosa.
 Dry mucosa. No xanthalesma.
Neck: Supple with JVP 10cm, distended external jugular veins,
systolic TR visible in jugular veins with systolic pulse.
CV: Irregularly irregular rhythym, S1, s2, no M/G/R.
Chest: Slightly tachypnic. Lungs with wheezing and rhonchi
bilaterally, crackles @ bases R>L. Decreased BS on left.
Abd: distended, tense.  large ubmilical hernia noted
Ext: 1+ pitting edema of LE bilaterally.
Skin: skin changes consistent with stasis dermatits noted
bilaterally.  multiple ecchymosis over body.
.
Pulses: Carotid 2+ Radial 2+ DP 2+ bilaterally.

FAMILY HISTORY: Mother- HTN, ?died of MI; Father-83 yo and died of "old age"; no
FH of cancer

SOCIAL HISTORY: Originally from [**Country 3397**]. Previously living with wife in [**Name (NI) 3146**],
but has been at rehab since recent hospitalization. Quit smoking
15 years ago. Smoked 1 ppd x 40 years. No EtOH. Retired, but
used to work as a machinist. Unable to walk. Needs
wheelchair/walker to get around his house. 

### Response:
{'Acute kidney failure, unspecified,Hyperpotassemia,Acute on chronic systolic heart failure,Diseases of tricuspid valve,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Cirrhosis of liver without mention of alcohol,Atrial fibrillation,Mitral valve disorders,Chronic kidney disease, unspecified,Unspecified acquired hypothyroidism,Aortocoronary bypass status,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}
