CHIEF COMPLAINT: Fevers and decreased O2 sats

PRESENT ILLNESS: 62M w/ h/o OLT [**2158-5-22**] c/b wound infection for which a wound VAC
was placed was tranferred from his rehabilitation facility for
decreased oxygen saturation.  he was seen in clinic that day and
had his T-tube clamped.  Noted to have lower extremity edema
with lethargy.  Oxygen saturation was 60-70% on RA with fever to
101.0.  In ED was tachycardic to 130 with O2 sats of 91% on 4L
nasal canula.  Was alert and oriented, but reported upper
respiratory congestion and cough.  ABG showed hypoxia and
hypercarbia: 7.34/67/65, CXR showed LLL consolidation.  He
recieved levaquin and vancomycin and was admitted to the SICU.

MEDICAL HISTORY: OLT [**2158-5-22**] c/b wound infection
HCV
DM II
Esophageal varices
BPH
Bipolar d/o
Heart Failure

MEDICATION ON ADMISSION: Lopressor 75 [**Hospital1 **]
Bactrim 1 qd
fluconazole 200qd
valcyte 450 qd
cellcept 1gm [**Hospital1 **]
hydralazine 75 qid
protonix 40qd
lantus 58qam
riss
cardura 2qpm
rapamycin 7qd
risperidal 4qd
lasix 60 [**Hospital1 **]
colace 100 [**Hospital1 **]
prednisone 10 qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission:
T101.2 HR 117 BP128/61 RR22 SAT95/5L
GEN:Obese gentleman, NAD
HEENT: NCAT, PERRLA, EOMI
Neck: supple, no LAD
Lungs: diminished BS L base w/ rhonchi
CV: tachy, reg rythm
ABD: soft NT, distended, VAC in place
EXT: LE w/ 2+ edema, warmth, no erythema, cyanosis

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Quit ETOH 17yrs ago
Quit tobacco 8yrs ago
No illicit drug use
Divorced, lives alone
Pneumonia due to Klebsiella pneumoniae,Other pulmonary insufficiency, not elsewhere classified,Complications of transplanted liver,Congestive heart failure, unspecified,Alkalosis,Disruption of external operation (surgical) wound,Thrombocytopenia, unspecified,Chronic airway obstruction, not elsewhere classified
K. pneumoniae pneumonia,Other pulmonary insuff,Compl liver transplant,CHF NOS,Alkalosis,Disrup-external op wound,Thrombocytopenia NOS,Chr airway obstruct NEC
Admission Date:  [**2158-8-7**]              Discharge Date:   [**2158-8-30**]

Date of Birth:  [**2096-4-23**]             Sex:   M

Service: [**Doctor First Name 147**]

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3127**]
Chief Complaint:
Fevers and decreased O2 sats

Major Surgical or Invasive Procedure:
Bronchoscopy
Tracheostomy [**5-22**]


History of Present Illness:
62M w/ h/o OLT [**2158-5-22**] c/b wound infection for which a wound VAC
was placed was tranferred from his rehabilitation facility for
decreased oxygen saturation.  he was seen in clinic that day and
had his T-tube clamped.  Noted to have lower extremity edema
with lethargy.  Oxygen saturation was 60-70% on RA with fever to
101.0.  In ED was tachycardic to 130 with O2 sats of 91% on 4L
nasal canula.  Was alert and oriented, but reported upper
respiratory congestion and cough.  ABG showed hypoxia and
hypercarbia: 7.34/67/65, CXR showed LLL consolidation.  He
recieved levaquin and vancomycin and was admitted to the SICU.

Past Medical History:
OLT [**2158-5-22**] c/b wound infection
HCV
DM II
Esophageal varices
BPH
Bipolar d/o
Heart Failure

Social History:
Quit ETOH 17yrs ago
Quit tobacco 8yrs ago
No illicit drug use
Divorced, lives alone

Family History:
Noncontributory

Physical Exam:
Admission:
T101.2 HR 117 BP128/61 RR22 SAT95/5L
GEN:Obese gentleman, NAD
HEENT: NCAT, PERRLA, EOMI
Neck: supple, no LAD
Lungs: diminished BS L base w/ rhonchi
CV: tachy, reg rythm
ABD: soft NT, distended, VAC in place
EXT: LE w/ 2+ edema, warmth, no erythema, cyanosis


Pertinent Results:
Admission Labs:
[**2158-8-7**] WBC-7.1 Hgb-9.6* Hct-29.5* Plt-191
[**2158-8-7**] Glucose-53* UreaN-23* Creat-1.2 Na-142 K-3.7 Cl-101
HCO3-31* AnGap-14
[**2158-8-7**] ALT-11 AST-18 AlkPhos-86 Amylase-50 TotBili-0.3
Albumin-2.9* Calcium-8.6 Phos-3.4 Mg-1.7

Discharge Labs:
[**2158-8-29**] WBC-9.9 RBC-3.45* Hgb-9.4* Hct-29.4* MCV-85 MCH-27.4
MCHC-32.1 RDW-16.4* Plt Ct-199
[**2158-8-29**] Glucose-115* UreaN-51* Creat-1.2 Na-145 K-5.0 Cl-105
HCO3-35* AnGap-10
[**2158-8-28**] ALT-9 AST-11 LD(LDH)-203 AlkPhos-93 Amylase-28
TotBili-0.5
[**2158-8-29**] 08:07AM Type-ART pO2-80* pCO2-72* pH-7.33* calHCO3-40*
Base XS-8

Cultures:
[**8-7**] BCX- neg
[**8-7**] UCX- neg
[**8-9**] sputum- klebsiella (multi-resistant, [**Last Name (un) 36**] to meropenem)
LEGIONELLA CULTURE (Final [**2158-8-19**]):    NO LEGIONELLA ISOLATED.
IMMUNOFLUORESCENT TEST FOR PNEUMOCYSTIS CARINII (Final
[**2158-8-10**]): PNEUMOCYSTIS CARINII NOT SEEN.
FUNGAL CULTURE (Final [**2158-8-22**]):    NO FUNGUS ISOLATED.
ACID FAST SMEAR (Final [**2158-8-11**]):
      NO ACID FAST BACILLI SEEN ON DIRECT SMEAR.
      This is only a PRELIMINARY result.  If ruling out
tuberculosis, you
      must wait for confirmation by concentrated smear.
      DUE TO  QUANTITY NOT SUFFICIENT CONCENTRATED SMEAR RESULT
NOT
      AVAILABLE.
[**2158-8-24**] L SCV CVL- No significant growth.


Brief Hospital Course:
Mr [**Known lastname 1182**] was admitted to the SICU and placed on BIPAP/mask
ventilation to manage his hypoxia/hypercarbia.  Zosyn was
started, and he was tranfused 1u pRBCs.  A CTA of the chest,
abdomen and pelvis was obtained that did not show a PE, but a
LLL pneumonia and a R posterior perihepatic fluid collection
were visualized.  He defervesced on HD#4.  By systems:

Neuro: He was admitted on his outpatient regimen of resperidal
for his bipolar disorder.  Psychiatry was consulted and had no
specific recommendations.  They did not think the resperidal was
diminishing his respiratory drive.  Neurology consult did not
think there was a central inhibition of his respiratory drive.

Cardiovascular:  Given the reported history of CHF, and findings
on his CXR an echo was obtained on [**2158-8-15**].  This showed that LV
and RV systolic function were normal(LVEF>55%). There were no
major valvular abnormalities and moderate pulmonary artery
systolic hypertension that had increased from the last study.
He was diuresed with lasix, for diastolic dysfunction.  PA
catheter was placed [**2158-8-19**] with PA 64/32 and PCWP 24-26 and
lasix drip was started.  His PA numbers improved and his swan
was subsequently removed.

Pulmonary:  Treatment was started for LLL pneumonia with zosyn.
He was maintained on BIPAP, however he continued to be somnolent
and tachypneic with elevated pCO2.  He was electively intubated
[**2158-8-11**] and bronchoscopy was performed.  This showed mild LMSB
deviation c/w LLL collapse and minimal secretions.  BAL was
performed and subsequently grew multi-resistant klebsiella.  He
remained a difficult wean with hypercarbia thought to be driven
by lasix diuresis with metabolic alkalosis.  Pulmonary consult
was obtained: thought that pt had pickwickian syndrome with
hypoventilation with diastolic dysfunction/CHF and needed more
agressive diuresis.  His pleural effusions continued to worsen
so more lasix and diamox were admininstered.  His effusions
eventually improved and his oxygenation improved, but he
continued to have a poor respiratory drive, requiring high
pressure support.  Tracheostomy was performed [**2158-8-25**].  Trach
collar trials were unsuccessful due to hypercarbia w/ pCO2 in
the 70s.

GI:  He was started on liquids initially.  After intubation he
was started on tube-feeds.  A post-pyloric dobhoff was placed,
and TF were advanced to goal of 120cc/h of [**2-9**] strength 1cc/kg
formula (currently on impact w/ fibre).

Liver Transplant: LFT's and coags were normal on admission.  His
[**Last Name (un) **] was held because of persistently high levels.  He was
switched to cyclosporin (neoral) with good levels.  His current
regimen includes: MMF 1gram [**Hospital1 **], prednisone 10mg qd, and neoral
200mg [**Hospital1 **].  His valcyte and fluconazole were discontinued.  He
continues on bactrim.  He will need full labs, including
cyclosporin level twice weekly.  The t-tube remained clamped.

GU: Given his respiratory failure and CHF, he was diuresed with
lasix, with intermittent diamox to manage metabolic alkalosis.
His creatinine peaked at 1.8, and subsequently came down to 1.2
and stabilized.

HEME:  Required blood transfusions initially for a
borderline/low HCT of 28.  He otherwise stabilized with no major
issues.

ID:  He was started on zosyn emperically, however his BAL grew
multiresistant klebsiella, sensitive only to meropenem.  He
completed a 14 day course on [**2158-8-28**], and remained afebrile with
a normal WBC count.

END:  His insulin regimen was adjusted, and his glargine was
incresed to 80u at HS.

Wound:  His abdominal wound was managed with a VAC dressing,
changed every 3 days.  The wound was clean and granulating well.

Medications on Admission:
Lopressor 75 [**Hospital1 **]
Bactrim 1 qd
fluconazole 200qd
valcyte 450 qd
cellcept 1gm [**Hospital1 **]
hydralazine 75 qid
protonix 40qd
lantus 58qam
riss
cardura 2qpm
rapamycin 7qd
risperidal 4qd
lasix 60 [**Hospital1 **]
colace 100 [**Hospital1 **]
prednisone 10 qd

Discharge Medications:
1. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1)
Tablet PO QD (once a day).
2. Mycophenolate Mofetil 200 mg/mL Suspension for Reconstitution
Sig: 1000 (1000) mg PO BID (2 times a day).
3. Risperidone 1 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
4. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed.
5. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q4H (every 4 hours).
6. Doxazosin Mesylate 2 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
7. Docusate Sodium 150 mg/15 mL Liquid Sig: One Hundred (100) mg
PO BID (2 times a day).
8. Lansoprazole 30 mg Capsule, Delayed Release(E.C.) Sig: One
(1) Capsule, Delayed Release(E.C.) PO QD (once a day).
9. Metoprolol Tartrate 50 mg Tablet Sig: Three (3) Tablet PO BID
(2 times a day).
10. Hydralazine HCl 50 mg Tablet Sig: Two (2) Tablet PO Q6H
(every 6 hours).
11. Amlodipine Besylate 5 mg Tablet Sig: Two (2) Tablet PO QD
(once a day).
12. Heparin Sodium (Porcine) 5,000 unit/mL Solution Sig: One (1)
ml Injection [**Hospital1 **] (2 times a day): subcutaneous.
13. Cyclosporine Modified 100 mg/mL Solution Sig: Two Hundred
(200) mg PO 6PM AND 6AM (): [**Hospital1 **].  dose may change depending on
results of [**Hospital1 **]-weekly levels.  MUST CALL TRANSPLANT CENTER AFTER
LEVEL SENT.
14. Insulin Glargine 100 unit/mL Solution Sig: Eighty (80) units
Subcutaneous at bedtime.
15. Insulin Regular Human 300 unit/3 mL Syringe Sig: sliding
scale  Subcutaneous four times a day.
16. Prednisone 5 mg Tablet Sig: 1.5 Tablets PO once a day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7**] & Rehab Center - [**Hospital1 8**]

Discharge Diagnosis:
End-stage liver disease
Orthotopic liver transplant [**5-22**]
Respiratory failure
Left lower lobe Pneumonia
Hepatitis C
Esophageal varices
history of encephalopathy
diabetes mellitus
heart failure
benign prostatic hypertrophy
Bipolar disorder


Discharge Condition:
Good

Discharge Instructions:
[**Hospital1 **]-weekly labs (Monday/Thursday): CBC, chem10, AST, ALT, alk
phos, albuimin, T. bili, cyclosporin level 2hours after am dose
on the given day.  [**Last Name (un) **] lab results to: [**Telephone/Fax (1) 697**]
Trach care/vent wean
Tubefeeding via dobhoff
VAC dressing to abdominal wound, change every 3 days.

Followup Instructions:
Transplant Center [**Last Name (NamePattern1) 439**], [**Location (un) 436**] [**Telephone/Fax (1) 673**]/ Dr
[**Last Name (STitle) **].  Follow-up in [**6-17**] days


Completed by:[**0-0-0**]
{'Pneumonia due to Klebsiella pneumoniae,Other pulmonary insufficiency, not elsewhere classified,Complications of transplanted liver,Congestive heart failure, unspecified,Alkalosis,Disruption of external operation (surgical) wound,Thrombocytopenia, unspecified,Chronic airway obstruction, not elsewhere classified'}


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 and decreased O2 sats

PRESENT ILLNESS: 62M w/ h/o OLT [**2158-5-22**] c/b wound infection for which a wound VAC
was placed was tranferred from his rehabilitation facility for
decreased oxygen saturation.  he was seen in clinic that day and
had his T-tube clamped.  Noted to have lower extremity edema
with lethargy.  Oxygen saturation was 60-70% on RA with fever to
101.0.  In ED was tachycardic to 130 with O2 sats of 91% on 4L
nasal canula.  Was alert and oriented, but reported upper
respiratory congestion and cough.  ABG showed hypoxia and
hypercarbia: 7.34/67/65, CXR showed LLL consolidation.  He
recieved levaquin and vancomycin and was admitted to the SICU.

MEDICAL HISTORY: OLT [**2158-5-22**] c/b wound infection
HCV
DM II
Esophageal varices
BPH
Bipolar d/o
Heart Failure

MEDICATION ON ADMISSION: Lopressor 75 [**Hospital1 **]
Bactrim 1 qd
fluconazole 200qd
valcyte 450 qd
cellcept 1gm [**Hospital1 **]
hydralazine 75 qid
protonix 40qd
lantus 58qam
riss
cardura 2qpm
rapamycin 7qd
risperidal 4qd
lasix 60 [**Hospital1 **]
colace 100 [**Hospital1 **]
prednisone 10 qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission:
T101.2 HR 117 BP128/61 RR22 SAT95/5L
GEN:Obese gentleman, NAD
HEENT: NCAT, PERRLA, EOMI
Neck: supple, no LAD
Lungs: diminished BS L base w/ rhonchi
CV: tachy, reg rythm
ABD: soft NT, distended, VAC in place
EXT: LE w/ 2+ edema, warmth, no erythema, cyanosis

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Quit ETOH 17yrs ago
Quit tobacco 8yrs ago
No illicit drug use
Divorced, lives alone 

### Response:
{'Pneumonia due to Klebsiella pneumoniae,Other pulmonary insufficiency, not elsewhere classified,Complications of transplanted liver,Congestive heart failure, unspecified,Alkalosis,Disruption of external operation (surgical) wound,Thrombocytopenia, unspecified,Chronic airway obstruction, not elsewhere classified'}
