CHIEF COMPLAINT: Nausea/Vomiting x3 days w/ 1 week of diarrhea.

PRESENT ILLNESS: HPI: Briefly, 63 yo F w/ CAD, h/o stroke with subsequent
hemiparesis, HTN, hyperlipidemia, DJD, DM type 2, CKD (baseline
Cr 1.2-1.4) and cortical blindness who came to ED w/ 3 days of
N/V. She had troponin leak. The N/V was thought ot be angina
equivalent. Cards were consulted and she was started on heparin
drip. However subsequently Cards recommended medical mgmt. She
also had AG of 15 with BG of 370. She was thought to be in DKA
and was started on insulin drip. The BG came back to normal and
the gap closed. The insulin drip was stopped and pt was started
on RISS. The pt conitnues to be nauseous and is not tolerating
POs. Nausea not so well controlled with meds.
.
At this time, pt c/o nausea. says she vomitted thrice today. not
taking in any solids. unable to keep liquids down. denies CP,
SOB, dizziness, palpitations. denies pain in abd. last BM 2 days
back and was loose.

MEDICAL HISTORY: HTN
DMII
Hyperlipidemia
h/o CVA w/ residual L sided hemiparesis
CAD- w/ stent '[**86**] and '[**89**]
Asthma
Rheumatic fever
Femoral Bypass - [**1-15**] complication of most recent cath
Asthma - last hospitalization mult years ago, uses rescue
albuterol inhaler 1-2 times per week
migraine headaches - tx with vicodin or tylenol
Breast Cancer - node negative (surgery only, no chemo, no rad)
Degenerative Disk Disease
Osteoarthritis
Osteoporosis
GERD

MEDICATION ON ADMISSION: ALBUTEROL prn
ROSIGLITAZONE 4 mg daily
BECLOMETHASONE (NASAL) 2 sprays daily
COLACE 100 mg [**Hospital1 **] prn
CARVEDILOL 6.25 mg [**Hospital1 **]
FUROSEMIDE 40 mg daily (recently up to 80 mg daily)
TERAZOSIN 5 mg qhs
METFORMIN 500 mg qhs
METFORMIN 850 mg qam
GABAPENTIN 300 mg daily
NIFEDIPINE 30 mg daily
NITROGLYCERIN prn
OMEPRAZOLE 20 mg [**Hospital1 **]
PLAVIX 75MG daily
TRIAMCINOLONE 2 puffs qid
COLESEVELAM 1300 mg [**Hospital1 **]
EZETEMIBE 10 mg daily

ALLERGIES: Aspirin / Premarin / Morphine / Crestor / Atorvastatin / Codeine

PHYSICAL EXAM: PE on discharge
97.1 94/62 71 20 100/RA
Gen: comfortable.
HEENT: anicteric, mmm, NCAT
chest: CTABL
heart: RRR,
abd: soft, NT, no HSM, BS+
extr: trace edema L>R
neuro: L-sided weakness, with reduced sensation in stocking and
glove distribution L>R.  Blind.  Alert and interactive.

FAMILY HISTORY: NC

SOCIAL HISTORY: Social history: Lives alone at home [**Location (un) 6409**]; wheelchair
bound s/p CVA; no h/o ETOH or tobacco use.  Has had at home
health aide and visiting nurse services.
Subendocardial infarction, initial episode of care,Systolic heart failure, unspecified,Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled,Dehydration,Chronic kidney disease, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Hematemesis,Nausea with vomiting,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Profound impairment, both eyes, impairment level not further specified,Other specified forms of chronic ischemic heart disease
Subendo infarct, initial,Systolic hrt failure NOS,DMI keto nt st uncntrld,Dehydration,Chronic kidney dis NOS,Chr blood loss anemia,Hematemesis,Nausea with vomiting,Late ef-hemplga side NOS,Both eyes blind-who def,Chr ischemic hrt dis NEC
Admission Date:  [**2196-6-21**]              Discharge Date:   [**2196-6-24**]

Date of Birth:  [**2132-11-18**]             Sex:   F

Service: MEDICINE

Allergies:
Aspirin / Premarin / Morphine / Crestor / Atorvastatin / Codeine

Attending:[**First Name3 (LF) 30**]
Chief Complaint:
Nausea/Vomiting x3 days w/ 1 week of diarrhea.

Major Surgical or Invasive Procedure:
None.

History of Present Illness:
HPI: Briefly, 63 yo F w/ CAD, h/o stroke with subsequent
hemiparesis, HTN, hyperlipidemia, DJD, DM type 2, CKD (baseline
Cr 1.2-1.4) and cortical blindness who came to ED w/ 3 days of
N/V. She had troponin leak. The N/V was thought ot be angina
equivalent. Cards were consulted and she was started on heparin
drip. However subsequently Cards recommended medical mgmt. She
also had AG of 15 with BG of 370. She was thought to be in DKA
and was started on insulin drip. The BG came back to normal and
the gap closed. The insulin drip was stopped and pt was started
on RISS. The pt conitnues to be nauseous and is not tolerating
POs. Nausea not so well controlled with meds.
.
At this time, pt c/o nausea. says she vomitted thrice today. not
taking in any solids. unable to keep liquids down. denies CP,
SOB, dizziness, palpitations. denies pain in abd. last BM 2 days
back and was loose.

Past Medical History:
HTN
DMII
Hyperlipidemia
h/o CVA w/ residual L sided hemiparesis
CAD- w/ stent '[**86**] and '[**89**]
Asthma
Rheumatic fever
Femoral Bypass - [**1-15**] complication of most recent cath
Asthma - last hospitalization mult years ago, uses rescue
albuterol inhaler 1-2 times per week
migraine headaches - tx with vicodin or tylenol
Breast Cancer - node negative (surgery only, no chemo, no rad)
Degenerative Disk Disease
Osteoarthritis
Osteoporosis
GERD

Social History:
 Social history: Lives alone at home [**Location (un) 6409**]; wheelchair
bound s/p CVA; no h/o ETOH or tobacco use.  Has had at home
health aide and visiting nurse services.

Family History:
NC

Physical Exam:
PE on discharge
97.1 94/62 71 20 100/RA
Gen: comfortable.
HEENT: anicteric, mmm, NCAT
chest: CTABL
heart: RRR,
abd: soft, NT, no HSM, BS+
extr: trace edema L>R
neuro: L-sided weakness, with reduced sensation in stocking and
glove distribution L>R.  Blind.  Alert and interactive.

Pertinent Results:
[**2196-6-21**] 06:18PM   WBC-11.9* RBC-2.63* HGB-8.0* HCT-22.2* MCV-84
MCH-30.4 MCHC-36.0* RDW-15.0
[**2196-6-21**] 06:18PM   CALCIUM-8.9 PHOSPHATE-2.5* MAGNESIUM-2.8*
[**2196-6-21**] 06:18PM   CK-MB-5 cTropnT-0.27*
[**2196-6-21**] 06:18PM   CK(CPK)-166*
[**2196-6-21**] 06:18PM   GLUCOSE-232* UREA N-48* CREAT-1.3* SODIUM-143
POTASSIUM-3.7 CHLORIDE-107 TOTAL CO2-28 ANION GAP-12
[**2196-6-21**] 11:40AM URINE  RBC-[**2-15**]* WBC-0-2 BACTERIA-OCC YEAST-NONE
EPI-0-2
[**2196-6-21**] 11:40AM URINE  BLOOD-LG NITRITE-NEG PROTEIN-500
GLUCOSE-1000 KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2196-6-21**] 11:40AM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.020
[**2196-6-21**] 11:40AM URINE  bnzodzpn-NEG barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-NEG

CXR: IMPRESSION:

Cardiomegaly, interstitial pulmonary edema, small bilateral
pleural effusions.

CT: Abd/Pelvis: IMPRESSION:
1.  No acute pathology is identified to explain the patient's
symptom.  No
evidence of bowel ischemia or arterial dissection is identified.


2.  Anasarca is present and there is a small amount of free
fluid within the
pelvis.
3.  Cholelithiasis with no evidence of cholecystitis.

Echo:
Conclusions:
The left atrium is mildly dilated. No atrial septal defect is
seen by 2D or color Doppler. There is mild symmetric left
ventricular hypertrophy. The left ventricular cavity size is
normal. There is mild regional left ventricular systolic
dysfunction with inferior hypokinesis. There is turbulent color
flow around the left main coronary artery coursing anteriorly.
This may reflect hyperemic coronary flow, but a coronary artery
A-V fistula cannot be excluded.  Right ventricular chamber size
and free wall motion are normal. The aortic  valve leaflets (3)
are mildly thickened but aortic stenosis is not present. No
aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened.  There is no mitral valve prolapse. Mild (1+)
mitral regurgitation is seen. The  tricuspid valve leaflets are
mildly thickened. There is moderate pulmonary artery systolic
hypertension. There is a trivial/physiologic pericardial
effusion.


Brief Hospital Course:
HPI: Briefly, 63 yo F w/ CAD, h/o stroke with subsequent
hemiparesis, HTN, hyperlipidemia, DJD, DM type 2, CKD (baseline
Cr 1.2-1.4) and cortical blindness who came to ED w/ 3 days of
N/V. She had troponin leak. The N/V was thought ot be angina
equivalent. Cards were consulted and she was started on heparin
drip. However subsequently Cards recommended medical mgmt. She
also had AG of 15 with BG of 370. She was thought to be in DKA
and was started on insulin drip. The BG came back to normal and
the gap closed. The insulin drip was stopped and pt was started
on RISS. The pt conitnues to be nauseous and is not tolerating
POs. Nausea not so well controlled with meds.
.
On the floor, the patient was transitioned to lantus 10 units
qhs and restarted on metformin.  Her hematocrit remained at her
pre-admission baseline and near post-transfusion levels.  CT of
the abdomen revealed no evidence of any acute intra-abdominal
process.  USD of the lower extremity was negative for any DVT.
Patient was restarted on at home meds on discharge.  Her
hospital course was otherwise uncomplicated.

Medications on Admission:
ALBUTEROL prn
ROSIGLITAZONE 4 mg daily
BECLOMETHASONE (NASAL) 2 sprays daily
COLACE 100 mg [**Hospital1 **] prn
CARVEDILOL 6.25 mg [**Hospital1 **]
FUROSEMIDE 40 mg daily (recently up to 80 mg daily)
TERAZOSIN 5 mg qhs
METFORMIN 500 mg qhs
METFORMIN 850 mg qam
GABAPENTIN 300 mg daily
NIFEDIPINE 30 mg daily
NITROGLYCERIN prn
OMEPRAZOLE 20 mg [**Hospital1 **]
PLAVIX 75MG daily
TRIAMCINOLONE 2 puffs qid
COLESEVELAM 1300 mg [**Hospital1 **]
EZETEMIBE 10 mg daily

Discharge Medications:
1. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet,
Sublingual Sublingual PRN (as needed) as needed for chest pain.
Disp:*30 Tablet, Sublingual(s)* Refills:*0*
2. Metformin 850 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)).
Disp:*30 Tablet(s)* Refills:*2*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed.
Disp:*30 Capsule(s)* Refills:*0*
4. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Metoclopramide 10 mg Tablet Sig: One (1) Tablet PO QIDACHS (4
times a day (before meals and at bedtime)).
Disp:*30 Tablet(s)* Refills:*2*
7. Metformin 500 mg Tablet Sig: One (1) Tablet PO QHS (once a
day (at bedtime)).
Disp:*30 Tablet(s)* Refills:*2*
8. Carvedilol 6.25 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*2*
9. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
10. Insulin Glargine 100 unit/mL Cartridge Sig: Ten (10) units
Subcutaneous at bedtime.
Disp:*300 units* Refills:*2*


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 1186**] - [**Location (un) 538**]

Discharge Diagnosis:
Primary:
1.  Nausea and Vomiting NOS.
2.  Hyperglycemia
3.  Acute Renal Failure - Dehydration.
4.  Left Heart Failure.
5.  Non-ST Elevation Myocardial Infarction.

Secondary:
1.  Bilateral parietal-occipital CVA.
2.  Cortical Blindness - left hemiparesis
3.  2-Vessel CAD s/p IMI.
4.  PTCA-Stent RCA and Lcx
5.  Diabetes Mellitus Type II.
6.  Hyperlipidemia
7.  Asthma
8.  Rheumatic fever
9.  Post-Cath Mycotic Femoral Pseudoaneurysm s/p Bypass.
10. Migraine headaches
11. Breast Cancer - node negative (surgery only, no chemo, no
rad)
12. Degenerative Disk Disease
13. Osteoarthritis
14. Osteoporosis
15. Esophageal candidiasis.
16. Esophagitis/Gastritis
17. Chronic Kidney Disease Stage II/III


Discharge Condition:
Stable.


Discharge Instructions:
You have been admitted to the hospital for treatment of nausea,
vomiting, hyperglycemia (high blood sugar) and for blood loss
into your stomach from an unclear source.  Your blood sugar was
treated with insulin and oral medications.  Please take all
medications as directed when you return home.  Your insulin dose
has been adjusted to Lantus 10 units subcutaneously at bed time.
 You have been prescribed pre-filled syringes to use safely at
home - please use as directed.  For your bleeding, you were
given a blood transfusion.  Please follow-up with your Doctor [**First Name (Titles) 3**] [**Last Name (Titles) 97843**]d if you have any questions.  Please go the Emergency
room or call your physician if you have any of the following
symptoms: severe chest pain, sudden shortness of breath,
bleeding of any kind, or any other symptom concerning to you.

As part of on going care for your heart failure, please remember
to weigh yourself every morning, [**Name8 (MD) 138**] MD if weight changes by
more than 3lbs.  Adhere to 2 gm sodium (low salt diet) and
diabetic diet.

Followup Instructions:
[**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) **] [**Doctor Last Name **], ([**Telephone/Fax (1) 1921**], [**7-12**] at 10:50AM.
Please call the office for an earlier appointment.

Provider: [**Name10 (NameIs) 6131**] [**Name11 (NameIs) **], MD Phone:[**Telephone/Fax (1) 253**] Date/Time:[**2196-6-28**]
9:30

Provider: [**Name10 (NameIs) **] FIELD SCREENING Phone:[**Telephone/Fax (1) 253**]
Date/Time:[**2196-6-28**] 10:00

Provider: [**Name10 (NameIs) 900**] [**Name8 (MD) 901**], M.D. Phone:[**Telephone/Fax (1) 902**]
Date/Time:[**2196-6-29**] 9:00
{'Subendocardial infarction, initial episode of care,Systolic heart failure, unspecified,Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled,Dehydration,Chronic kidney disease, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Hematemesis,Nausea with vomiting,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Profound impairment, both eyes, impairment level not further specified,Other specified forms of chronic ischemic heart disease'}


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: Nausea/Vomiting x3 days w/ 1 week of diarrhea.

PRESENT ILLNESS: HPI: Briefly, 63 yo F w/ CAD, h/o stroke with subsequent
hemiparesis, HTN, hyperlipidemia, DJD, DM type 2, CKD (baseline
Cr 1.2-1.4) and cortical blindness who came to ED w/ 3 days of
N/V. She had troponin leak. The N/V was thought ot be angina
equivalent. Cards were consulted and she was started on heparin
drip. However subsequently Cards recommended medical mgmt. She
also had AG of 15 with BG of 370. She was thought to be in DKA
and was started on insulin drip. The BG came back to normal and
the gap closed. The insulin drip was stopped and pt was started
on RISS. The pt conitnues to be nauseous and is not tolerating
POs. Nausea not so well controlled with meds.
.
At this time, pt c/o nausea. says she vomitted thrice today. not
taking in any solids. unable to keep liquids down. denies CP,
SOB, dizziness, palpitations. denies pain in abd. last BM 2 days
back and was loose.

MEDICAL HISTORY: HTN
DMII
Hyperlipidemia
h/o CVA w/ residual L sided hemiparesis
CAD- w/ stent '[**86**] and '[**89**]
Asthma
Rheumatic fever
Femoral Bypass - [**1-15**] complication of most recent cath
Asthma - last hospitalization mult years ago, uses rescue
albuterol inhaler 1-2 times per week
migraine headaches - tx with vicodin or tylenol
Breast Cancer - node negative (surgery only, no chemo, no rad)
Degenerative Disk Disease
Osteoarthritis
Osteoporosis
GERD

MEDICATION ON ADMISSION: ALBUTEROL prn
ROSIGLITAZONE 4 mg daily
BECLOMETHASONE (NASAL) 2 sprays daily
COLACE 100 mg [**Hospital1 **] prn
CARVEDILOL 6.25 mg [**Hospital1 **]
FUROSEMIDE 40 mg daily (recently up to 80 mg daily)
TERAZOSIN 5 mg qhs
METFORMIN 500 mg qhs
METFORMIN 850 mg qam
GABAPENTIN 300 mg daily
NIFEDIPINE 30 mg daily
NITROGLYCERIN prn
OMEPRAZOLE 20 mg [**Hospital1 **]
PLAVIX 75MG daily
TRIAMCINOLONE 2 puffs qid
COLESEVELAM 1300 mg [**Hospital1 **]
EZETEMIBE 10 mg daily

ALLERGIES: Aspirin / Premarin / Morphine / Crestor / Atorvastatin / Codeine

PHYSICAL EXAM: PE on discharge
97.1 94/62 71 20 100/RA
Gen: comfortable.
HEENT: anicteric, mmm, NCAT
chest: CTABL
heart: RRR,
abd: soft, NT, no HSM, BS+
extr: trace edema L>R
neuro: L-sided weakness, with reduced sensation in stocking and
glove distribution L>R.  Blind.  Alert and interactive.

FAMILY HISTORY: NC

SOCIAL HISTORY: Social history: Lives alone at home [**Location (un) 6409**]; wheelchair
bound s/p CVA; no h/o ETOH or tobacco use.  Has had at home
health aide and visiting nurse services. 

### Response:
{'Subendocardial infarction, initial episode of care,Systolic heart failure, unspecified,Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled,Dehydration,Chronic kidney disease, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Hematemesis,Nausea with vomiting,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Profound impairment, both eyes, impairment level not further specified,Other specified forms of chronic ischemic heart disease'}
