CHIEF COMPLAINT: Chief complaint: acute renal failure, hyperkalemia
Reason for ICU admission: Hypotension not responsive to 4L NS
.

PRESENT ILLNESS: Mr. [**Known lastname 1356**] is a 53 year old male with CAD s/p MI, HTN, type 2 DM,
PVD, who [**Known lastname 1834**] right groin exploration and femoral patch
redo last week who presented to clinic today with fatigue for
one week. He denies fevers, chills, nausea, vomiting, shortness
of breath, diarrhea, constipation, abdominal pain. He does
report significant surgical incision pain at right groin without
significant drainage. In addition, he reported one hour of chest
pressure several days ago while at rest which resolved and has
not recurred.
.
In the ED, vitals were T 98.1, 74/47, 69, 18, 100% on RA. He was
given 4LNS with only transient improvements of his blood
pressure. In the ED, his blood pressure 70s-90s/ 50s-60s. A fast
exam was performed in the ED and was negative. His bedside echo
was unremarkable. He was not given antibiotics.
.
Upon arrival to the MICU, patient denied chest pain,
lightheadedness, thirst, fevers, chills, dysuria, cough,
shortness of breath, diarrhea, or any other concerning symptoms.

MEDICAL HISTORY: CAD s/p MI
HTN
DM, Type 2
Hyperlipidemia
Peripheral Vascular Disease s/p L SFA stent/angioplasty [**8-26**]
Arthritis
Spinal spenosis
Chronic back pain
Bilateral knee surgery
S/p liver orthotopic liver [**Month/Year (2) **] for ETOH cirrhosis

MEDICATION ON ADMISSION: Fosamax 70 mg weekly
Atenolol 50 mg daily
Lipitor 40 mg daily
Cilostazol 50 mb [**Hospital1 **]
Cipro 500 q 12 hours
Nexium 40 mg daily
Tricor 145 mg daily
Lasix 20 mg every other daily
Hydromorphone 2-4 mg q 4-6 hours
NPH 48 q am, 28 qpm with HISS
Lisinopril 5 mg daily
Cellcept [**Pager number **] mg [**Hospital1 **]
Nifedipine 30 mg daily
Viagra prn
Tacrolimus 4 mg [**Hospital1 **]
Detrol LA 4 mg [**Hospital1 **]
Trazodone 100 mg prn insomnia
Bactrim [**Hospital1 **]
Aspirin 325 daily
Calcium Carbonate 1500 [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: HR 68, BP 118/60, RR 19, 96% on RA
Gen: NAD, well appearing
HEENT: EOMI, moist mucous membranes
CV: RRR, no m/r/g, distant heart sounds
Pulm: CTA b/l, no crackles, wheezes
Abd: obese, soft, NT, ND
Ext: severe right groin tenderness along the upper aspect of the
surgical incision, +warm, but no visible drainage, right sided
2+pitting edema
Neuro: AxOx3, moving all extremities

FAMILY HISTORY: Father died 42 years old from MI.

SOCIAL HISTORY: Patient is a retired cook. He smoked 2 PPD for 40 years, but has
since quit. He is a former alcoholic, but has been sober for 6
years
Other specified hypotension,Acute kidney failure, unspecified,Liver replaced by transplant,Hematoma complicating a procedure,Hypovolemia,Atherosclerosis of native arteries of the extremities, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Hypotension NEC,Acute kidney failure NOS,Liver transplant status,Hematoma complic proc,Hypovolemia,Athscl extrm ntv art NOS,Hypertension NOS,Hyperlipidemia NEC/NOS,DMII wo cmp nt st uncntr,Crnry athrscl natve vssl,Old myocardial infarct,Abn react-anastom/graft
Admission Date:  [**2155-7-23**]              Discharge Date:   [**2155-7-24**]

Date of Birth:  [**2101-10-26**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
Chief complaint: acute renal failure, hyperkalemia
Reason for ICU admission: Hypotension not responsive to 4L NS
.


Major Surgical or Invasive Procedure:
none


History of Present Illness:
Mr. [**Known lastname 1356**] is a 53 year old male with CAD s/p MI, HTN, type 2 DM,
PVD, who [**Known lastname 1834**] right groin exploration and femoral patch
redo last week who presented to clinic today with fatigue for
one week. He denies fevers, chills, nausea, vomiting, shortness
of breath, diarrhea, constipation, abdominal pain. He does
report significant surgical incision pain at right groin without
significant drainage. In addition, he reported one hour of chest
pressure several days ago while at rest which resolved and has
not recurred.
.
In the ED, vitals were T 98.1, 74/47, 69, 18, 100% on RA. He was
given 4LNS with only transient improvements of his blood
pressure. In the ED, his blood pressure 70s-90s/ 50s-60s. A fast
exam was performed in the ED and was negative. His bedside echo
was unremarkable. He was not given antibiotics.
.
Upon arrival to the MICU, patient denied chest pain,
lightheadedness, thirst, fevers, chills, dysuria, cough,
shortness of breath, diarrhea, or any other concerning symptoms.



Past Medical History:
CAD s/p MI
HTN
DM, Type 2
Hyperlipidemia
Peripheral Vascular Disease s/p L SFA stent/angioplasty [**8-26**]
Arthritis
Spinal spenosis
Chronic back pain
Bilateral knee surgery
S/p liver orthotopic liver [**Month/Year (2) **] for ETOH cirrhosis


Social History:
Patient is a retired cook. He smoked 2 PPD for 40 years, but has
since quit. He is a former alcoholic, but has been sober for 6
years

Family History:
Father died 42 years old from MI.

Physical Exam:
VS: HR 68, BP 118/60, RR 19, 96% on RA
Gen: NAD, well appearing
HEENT: EOMI, moist mucous membranes
CV: RRR, no m/r/g, distant heart sounds
Pulm: CTA b/l, no crackles, wheezes
Abd: obese, soft, NT, ND
Ext: severe right groin tenderness along the upper aspect of the
surgical incision, +warm, but no visible drainage, right sided
2+pitting edema
Neuro: AxOx3, moving all extremities


Pertinent Results:
[**2155-7-24**] 05:00AM BLOOD WBC-5.1 RBC-2.80* Hgb-8.3* Hct-25.6*
MCV-91 MCH-29.6 MCHC-32.5 RDW-14.8 Plt Ct-217
[**2155-7-23**] 02:35PM BLOOD WBC-5.8 RBC-2.97* Hgb-8.9* Hct-26.7*
MCV-90 MCH-29.8 MCHC-33.1 RDW-15.4 Plt Ct-266
[**2155-7-23**] 09:45AM BLOOD WBC-8.1 RBC-2.69* Hgb-8.3* Hct-24.6*
MCV-92 MCH-30.7 MCHC-33.5 RDW-15.1 Plt Ct-265
[**2155-7-24**] 05:00AM BLOOD Neuts-66.2 Lymphs-26.2 Monos-5.3 Eos-1.8
Baso-0.5
[**2155-7-23**] 02:35PM BLOOD Neuts-69.0 Lymphs-24.2 Monos-4.9 Eos-1.6
Baso-0.4
[**2155-7-24**] 05:00AM BLOOD Plt Ct-217
[**2155-7-24**] 05:00AM BLOOD PT-12.8 PTT-29.1 INR(PT)-1.1
[**2155-7-23**] 02:35PM BLOOD Plt Ct-266
[**2155-7-23**] 02:35PM BLOOD Plt Ct-266
[**2155-7-23**] 02:35PM BLOOD PT-13.0 PTT-28.4 INR(PT)-1.1
[**2155-7-23**] 09:45AM BLOOD Plt Ct-265
[**2155-7-24**] 03:46PM BLOOD UreaN-28* Creat-2.1* Na-137 K-5.3*
Cl-109* HCO3-21* AnGap-12
[**2155-7-24**] 05:00AM BLOOD Glucose-56* UreaN-30* Creat-2.1* Na-138
K-5.3* Cl-107 HCO3-21* AnGap-15
[**2155-7-23**] 10:44PM BLOOD Glucose-199* UreaN-34* Creat-2.2* Na-136
K-5.3* Cl-108 HCO3-20* AnGap-13
[**2155-7-23**] 07:31PM BLOOD Glucose-181* UreaN-36* Creat-2.2* Na-136
K-5.9* Cl-109* HCO3-20* AnGap-13
[**2155-7-23**] 02:35PM BLOOD Glucose-147* UreaN-43* Creat-2.8* Na-135
K-5.5* Cl-103 HCO3-24 AnGap-14
[**2155-7-23**] 09:45AM BLOOD UreaN-40* Creat-2.7* Na-132* K-6.2* Cl-99
HCO3-24 AnGap-15
[**2155-7-24**] 05:00AM BLOOD ALT-17 AST-17 LD(LDH)-195 CK(CPK)-41
AlkPhos-36* TotBili-0.2
[**2155-7-23**] 02:35PM BLOOD ALT-19 AST-17 AlkPhos-45 TotBili-0.2
[**2155-7-23**] 09:45AM BLOOD ALT-20 AST-19 AlkPhos-43 TotBili-0.2
[**2155-7-23**] 02:35PM BLOOD Lipase-11
[**2155-7-24**] 05:00AM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2155-7-24**] 05:00AM BLOOD Albumin-3.4 Calcium-8.6 Phos-3.2 Mg-2.2
[**2155-7-23**] 10:44PM BLOOD Calcium-8.2* Phos-2.7 Mg-1.6
[**2155-7-23**] 07:31PM BLOOD Calcium-7.5* Phos-2.9 Mg-1.6
[**2155-7-23**] 02:35PM BLOOD Albumin-3.8
[**2155-7-23**] 09:45AM BLOOD Albumin-4.1 Calcium-9.4 Phos-4.1 Mg-1.8
[**2155-7-23**] 09:45AM BLOOD tacroFK-5.4
[**2155-7-23**] 02:35PM BLOOD LtGrnHD-HOLD
[**2155-7-23**] 10:48PM BLOOD Type-[**Last Name (un) **] Comment-GREEN TOP
[**2155-7-23**] 02:36PM BLOOD Comment-GREEN TOP
[**2155-7-23**] 10:48PM BLOOD Lactate-1.2
[**2155-7-23**] 02:36PM BLOOD K-5.2
.
CXR-IMPRESSION: Normal chest radiograph
.
u/s groin-IMPRESSION: Hematoma without evidence for
pseudoaneurysm.

Brief Hospital Course:
Mr. [**Known lastname 1356**] is a 53 yo male with PVD, HTN, HL, CAD s/p MI, s/p
liver [**Known lastname **] for alcoholic cirrhosis, admitted to the MICU
for hypotension.
.
Hypotension. Patient had significant hypotension in the ED that
required 4L of NS to normalize, and patient is now normotensive
in the MICU. Perhaps hypotension is related to overdiruesis with
home lasix dose, and med effect from several antihypertensives,
however there is concern for early sepsis in this patient who is
immunosuppressed with cellcept and prograf. Patient has
significant right groin pain, making the surgical site the most
likely source of infection. Normal lactate is reassuring.
Significant blood loss is less likely given Hct is stable over
the past week. Another possibility is cardiac etiology of
hypotension given transient chest pressure several days ago, but
this seems less likely in the setting of unchanged EKG. PT
covered with vanco/zosyn overnight. He was switched to
bactrim/cipro in am. U/S showing hematoma but no sign of
abscess. Pt given IVF and home diuretics and anti-hypertensives
held with good effect. Home BP meds except ACEI and diuretic
were resumed upon discharge.
.
Acute Renal failure. Patient has baseline creatinine between 1.8
and 2, now with rising Creatinine to 2.8. He likely has
pre-renal ARF as it responded to 4LNS bolus, though it remains
above baseline. Prograf may be causing the elevated Cr as well,
but dose was lowered today.  Cr returned to near baseline.
Prograf and cellcept continued.
.
Hyperkalemia. Likely secondary to renal failure and groin
hematoma resorption. No EKG changes. Pt got 2 doses of
kayexylate. He will have labs drawn in a few days and results
will be sent to his hepatologist. In addition, his baseline K is
around 5.
.
Right groin wound. Patient is s/p femoral graft removal and
replacement due to infection last week. Now with significant
wound tenderness. No clear evidence of drainage. U/S showing
small hematoma, no sign of abscess. Cilostazol 50mg [**Hospital1 **].
Per vascular, pt may stop the cipro and resume his normally
scheduled dosing of bactrim.
.
S/p Liver [**Hospital1 **]. Patient is s/p liver [**Hospital1 **] in [**2150**]
for alcoholic cirrhosis. Currently on prograf and cellcept.
Prograf dose reduced today from 5 mg [**Hospital1 **] to 4 mg [**Hospital1 **].
Immunosuppressants continued. Bactrim ppx continued.
.
CAD s/p MI. Patient has EKG without ischemic change. S/p chest
pressure 4 days ago.
- consider echo if not clear source of hypotension
.
HTN.
- hold home antihypertensives (Lisinopril, atenolol, nifedepine)

.
DM, Type 2.
- NPH and ISS
- follow fingersticks
.
Hyperlipidemia.
- continue lipitor
.
Peripheral Vascular Disease s/p L SFA stent/angioplasty [**8-26**]
Cilostazol 50 mb [**Hospital1 **]
- vascular following
.


Medications on Admission:
Fosamax 70 mg weekly
Atenolol 50 mg daily
Lipitor 40 mg daily
Cilostazol 50 mb [**Hospital1 **]
Cipro 500 q 12 hours
Nexium 40 mg daily
Tricor 145 mg daily
Lasix 20 mg every other daily
Hydromorphone 2-4 mg q 4-6 hours
NPH 48 q am, 28 qpm with HISS
Lisinopril 5 mg daily
Cellcept [**Pager number **] mg [**Hospital1 **]
Nifedipine 30 mg daily
Viagra prn
Tacrolimus 4 mg [**Hospital1 **]
Detrol LA 4 mg [**Hospital1 **]
Trazodone 100 mg prn insomnia
Bactrim [**Hospital1 **]
Aspirin 325 daily
Calcium Carbonate 1500 [**Hospital1 **]


Discharge Medications:
1. Alendronate 70 mg Tablet Sig: One (1) Tablet PO QMON (every
Monday).
2. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
3. Cilostazol 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for PVD.
4. Fenofibrate Micronized 145 mg Tablet Sig: One (1) Tablet PO
daily ().
5. Mycophenolate Mofetil 500 mg Tablet Sig: One (1) Tablet PO
BID (2 times a day).
6. Tolterodine 2 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
7. Trazodone 50 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime)
as needed for insomnia.
8. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
9. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1)
Tablet PO QMOWEFR (Monday -Wednesday-Friday).
10. Tacrolimus 1 mg Capsule Sig: Four (4) Capsule PO BID (2
times a day).
11. Atenolol 50 mg Tablet Sig: One (1) Tablet PO once a day.
12. Nexium 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
13. Dilaudid 2 mg Tablet Sig: 1-2 Tablets PO every four (4)
hours.
14. Nifedipine 30 mg Tablet Extended Rel 24 hr (2) Sig: One (1)
Tablet Extended Rel 24 hr (2) PO once a day.
15. Calcium Carbonate 600 mg (1,500 mg) Tablet Sig: One (1)
Tablet PO twice a day.
16. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: see
below  Subcutaneous twice a day: 48 units qam
28 units qpm.
17. Insulin Lispro 100 unit/mL Solution Sig: as directed
Subcutaneous as directed.
18. Outpatient Lab Work
chemistry panel, including potassium. to be done [**7-26**].
Fax results to Patient Phone:  ([**Telephone/Fax (1) 1582**] Patient Fax:
([**Telephone/Fax (1) 12173**]


Discharge Disposition:
Home

Discharge Diagnosis:
Major:
hypotension due to hypovolemia
acute renal failure
hyperkalemia
.
s/p R.femoral vascular surgery
s/p liver [**Telephone/Fax (1) **]


Discharge Condition:
stable


Discharge Instructions:
You were admitted for low blood pressure and fatigue. For the
low blood pressure you were given IVF and your home diuretics
were stopped. Your low blood pressure resolved. You also were
evaluated by the vascular surgery team and [**Telephone/Fax (1) 1834**] a groin
ultrasound that showed a small hematoma but no evidence of
infection or aneurysm. In addition, you had mild renal failure
that resolved with the above treatments.
.
You should not take your lasix or lisinopril until you see your
liver doctor. However your other blood pressure medications,
atenolol and nifedipine should be resumed upon discharge.
.
You should see your liver doctor within 1 week of discharge.
.
Please continue to take you medications as prescribed and follow
up with the appointments below.
.
You also had elevated blood potassium. For this you were given a
dose of kayexylate. You should be sure to have this blood level
checked either at your PCP or liver doctor's office within 2
days.
.


Followup Instructions:
Please make sure you follow up the liver service within 1 week
of discharge.
.
Please also be sure to follow up with your PCP.
.
Provider: [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) 2604**], MD Phone:[**Telephone/Fax (1) 1237**]
Date/Time:[**2155-7-31**] 4:00
.
Provider: [**Name10 (NameIs) **] [**Apartment Address(1) **] (ST-3) GI ROOMS Date/Time:[**2155-8-19**] 10:00
.
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 8507**], MD Phone:[**Telephone/Fax (1) 463**]
Date/Time:[**2155-8-19**] 10:00
{'Other specified hypotension,Acute kidney failure, unspecified,Liver replaced by transplant,Hematoma complicating a procedure,Hypovolemia,Atherosclerosis of native arteries of the extremities, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: Chief complaint: acute renal failure, hyperkalemia
Reason for ICU admission: Hypotension not responsive to 4L NS
.

PRESENT ILLNESS: Mr. [**Known lastname 1356**] is a 53 year old male with CAD s/p MI, HTN, type 2 DM,
PVD, who [**Known lastname 1834**] right groin exploration and femoral patch
redo last week who presented to clinic today with fatigue for
one week. He denies fevers, chills, nausea, vomiting, shortness
of breath, diarrhea, constipation, abdominal pain. He does
report significant surgical incision pain at right groin without
significant drainage. In addition, he reported one hour of chest
pressure several days ago while at rest which resolved and has
not recurred.
.
In the ED, vitals were T 98.1, 74/47, 69, 18, 100% on RA. He was
given 4LNS with only transient improvements of his blood
pressure. In the ED, his blood pressure 70s-90s/ 50s-60s. A fast
exam was performed in the ED and was negative. His bedside echo
was unremarkable. He was not given antibiotics.
.
Upon arrival to the MICU, patient denied chest pain,
lightheadedness, thirst, fevers, chills, dysuria, cough,
shortness of breath, diarrhea, or any other concerning symptoms.

MEDICAL HISTORY: CAD s/p MI
HTN
DM, Type 2
Hyperlipidemia
Peripheral Vascular Disease s/p L SFA stent/angioplasty [**8-26**]
Arthritis
Spinal spenosis
Chronic back pain
Bilateral knee surgery
S/p liver orthotopic liver [**Month/Year (2) **] for ETOH cirrhosis

MEDICATION ON ADMISSION: Fosamax 70 mg weekly
Atenolol 50 mg daily
Lipitor 40 mg daily
Cilostazol 50 mb [**Hospital1 **]
Cipro 500 q 12 hours
Nexium 40 mg daily
Tricor 145 mg daily
Lasix 20 mg every other daily
Hydromorphone 2-4 mg q 4-6 hours
NPH 48 q am, 28 qpm with HISS
Lisinopril 5 mg daily
Cellcept [**Pager number **] mg [**Hospital1 **]
Nifedipine 30 mg daily
Viagra prn
Tacrolimus 4 mg [**Hospital1 **]
Detrol LA 4 mg [**Hospital1 **]
Trazodone 100 mg prn insomnia
Bactrim [**Hospital1 **]
Aspirin 325 daily
Calcium Carbonate 1500 [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: HR 68, BP 118/60, RR 19, 96% on RA
Gen: NAD, well appearing
HEENT: EOMI, moist mucous membranes
CV: RRR, no m/r/g, distant heart sounds
Pulm: CTA b/l, no crackles, wheezes
Abd: obese, soft, NT, ND
Ext: severe right groin tenderness along the upper aspect of the
surgical incision, +warm, but no visible drainage, right sided
2+pitting edema
Neuro: AxOx3, moving all extremities

FAMILY HISTORY: Father died 42 years old from MI.

SOCIAL HISTORY: Patient is a retired cook. He smoked 2 PPD for 40 years, but has
since quit. He is a former alcoholic, but has been sober for 6
years 

### Response:
{'Other specified hypotension,Acute kidney failure, unspecified,Liver replaced by transplant,Hematoma complicating a procedure,Hypovolemia,Atherosclerosis of native arteries of the extremities, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
