CHIEF COMPLAINT: 

PRESENT ILLNESS: This is an 80 year old Caucasian
male who was admitted to [**Hospital3 **] from [**Hospital1 1444**] on [**2186-6-10**], with the
following diagnoses of fatigue, dehydration, status post
resection of gastrointestinal stromal tumor in [**2185-12-26**].
The patient is an 80 year old male patient with a past
medical history of Crohn's and had just had tumor resected by
Dr. [**Last Name (STitle) 957**], noninsulin dependent diabetes mellitus,
metastases of the chest, status post Gleevec tumor therapy.
He was readmitted, after discharge from [**Hospital1 190**] on [**2186-6-9**], on [**2186-6-11**], when he
represented via the Emergency Department for fatigue,
decreased appetite, diarrhea and came in complaining of
dehydration, increased lethargy and hypotension.  The patient
was seen in the Emergency Department by the surgical service
and was assessed to have a distended, tender and tympanitic
abdomen.

MEDICAL HISTORY: Crohn's disease.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Perforation of intestine,Unspecified pleural effusion,Thrombocytopenia, unspecified,Unspecified septicemia,Acute posthemorrhagic anemia,Hyposmolality and/or hyponatremia,Other postoperative infection
Perforation of intestine,Pleural effusion NOS,Thrombocytopenia NOS,Septicemia NOS,Ac posthemorrhag anemia,Hyposmolality,Other postop infection
Unit No: [**Unit Number 41750**]
Admission Date: [**2186-6-11**]
Discharge Date: [**2186-7-20**]
Sex:  Male
Service:  General Surgery


HISTORY OF PRESENT ILLNESS:  This is an 80 year old Caucasian
male who was admitted to [**Hospital3 **] from [**Hospital1 1444**] on [**2186-6-10**], with the
following diagnoses of fatigue, dehydration, status post
resection of gastrointestinal stromal tumor in [**2185-12-26**].
The patient is an 80 year old male patient with a past
medical history of Crohn's and had just had tumor resected by
Dr. [**Last Name (STitle) 957**], noninsulin dependent diabetes mellitus,
metastases of the chest, status post Gleevec tumor therapy.
He was readmitted, after discharge from [**Hospital1 190**] on [**2186-6-9**], on [**2186-6-11**], when he
represented via the Emergency Department for fatigue,
decreased appetite, diarrhea and came in complaining of
dehydration, increased lethargy and hypotension.  The patient
was seen in the Emergency Department by the surgical service
and was assessed to have a distended, tender and tympanitic
abdomen.

PAST MEDICAL HISTORY:  Crohn's disease.

Melanoma.

Spinal stenosis.

Cataract.

Noninsulin dependent diabetes mellitus.

PAST SURGICAL HISTORY:  Small bowel resection.

HOSPITAL COURSE:  X-ray obtained in the Emergency Department
illustrated free air with evidence of an acute abdomen and
was taken to the operating room by Dr. [**First Name (STitle) 2819**] who was covering
for Dr. [**Last Name (STitle) 957**] as he was out of town.  The patient was found
to have a perforated viscus.  Please see operative note on
[**2186-6-11**], for further information.  He was seen to have a
perforation at the distal transverse colon on the proximal
sigmoid and he was having a transverse left end sigmoid
colectomy, colostomy, Hartmann's pouch with placement of a
gastrostomy tube, jejunostomy tube and take-down of the
splenic flexure.

The patient was admitted to the Intensive Care Unit and
continued to have a complicated course.  The patient received
blood transfusions, as well as aggressive Intensive Care Unit
care.  Various services were consulted for management of this
acutely ill patient including oncology service.  The patient
was eventually weaned off the vasopressin for support and was
started on TPN for nutritional support due to his prolonged
Intensive Care Unit admission.  The patient was managed by
the Intensive Care Unit team in the interim with consults
from the general surgery service.  The patient continued to
oscillate in terms of his respiratory status alternating
between vent settings and at times being able to support
decreasing PEEP and pressure support.  The patient in the
beginning of [**Month (only) **] continued to have hemodynamic instability
and despite noninvasive imaging immediate source was not
obtained.  The patient was given fluid and Levophed and
packed red blood cells in hopes to increase blood pressure
and hemodynamic stability and was thought origin might be due
to intra-abdominal sepsis and was reintubated for airway
protection.  CT scan of the chest illustrated bilateral
pleural effusions.  On [**2186-6-29**], thoracic surgery was
consulted and chest tube was placed and 750 cc of serous
fluid was obtained in the pleurovac.  With this increased
serous output, the patient required less Levophed and
appeared to clinically improve.  Over the next few days, the
patient continued to have massive drainage from the chest
tube and was eventually stabilized.  In the beginning of
[**Month (only) **], the patient continued to have a few intermittent
episodes of hypotension and intermittent fevers which were
appropriately treated.  An infectious disease consultation
was obtained for management of his intermittent fevers and
for further investigation of his intra-abdominal sepsis.
Infectious disease made numerous recommendations which were
taken into consideration.  General surgery consultation was
appreciated and continued to follow closely in conjunction
with Dr. [**Last Name (STitle) 957**].  The patient continued to have hemodynamic
instability despite numerous attempts to wean the patient
from ventilatory support secondary to hemodynamic
instability, hypovolemia and intra-abdominal sepsis.  The
patient was restarted on nutritional support via TPN and
stopped on tube feeds.  Chest tubes continued to drain
considerable amount of serosanguineous fluid with the
drainage from his gastrostomy tube continuing.  The patient
on [**2186-7-9**], went into atrial fibrillation with heart rates
in the 110 to 130 range with blood pressure dropping to the
80s.  Fluid boluses provided only transient effect.  Initial
Lopressor given provided no effect.  The patient was
cardioverted and remained in sinus rhythm and improved with
two additional fluid boluses.  The patient was monitored
closely for additional cardiac events.  The patient was tried
on continuous positive airway pressure and eventually was
weaned after an extended period of time and was extubated on
the morning of [**2186-7-11**], and he appeared to be clinically
improving for a few days, however, began to have some mental
confusion the day after extubation on [**2186-7-12**].  Neurology
was consulted for evaluation of a stroke.  The patient was
decided to become DNI on approximately [**2186-7-16**], after
requiring multiple fluid boluses and restarted on Levophed
overnight due to additional hemodynamic instability.  The
patient was thought to have a multifactorial cause of his
confusion but could not rule out an underlying neurological
cause such as stroke given his recent events.  CT scan was
obtained.  A family meeting on [**2186-7-18**], was held and it
was decided for the patient to be DNR/DNI.  The patient
continued to deteriorate hemodynamically and clinically.  The
patient expired on [**2186-7-20**], at approximately [**2202**].  He
became apneic and asystolic on the monitor.  As the patient
was DNR/DNI as per family, his status was confirmed with no
vital signs.  Dr. [**Last Name (STitle) 957**] was made aware and he would contact
the family personally.  Death report was in progress soon
after expiration.

CONDITION ON DISCHARGE:  Expiration.

DISCHARGE STATUS:  Not applicable.

DISCHARGE DIAGNOSES:  Hemodynamic instability requiring
multiple fluid boluses and pressors.

Crohn's disease.

Just had tumor resection.

Small bowel resection.

Noninsulin dependent diabetes mellitus.

Mental status changes.

Intermittent episode of atrial fibrillation.

MEDICATIONS ON DISCHARGE:  Not applicable.

FOLLOW UP PLANS:  Not applicable.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) **], [**MD Number(1) 26005**]

Dictated By:[**Doctor Last Name 31967**]
MEDQUIST36
D:  [**2186-11-17**] 08:46:48
T:  [**2186-11-17**] 10:06:30
Job#:  [**Job Number 41751**]
{'Perforation of intestine,Unspecified pleural effusion,Thrombocytopenia, unspecified,Unspecified septicemia,Acute posthemorrhagic anemia,Hyposmolality and/or hyponatremia,Other postoperative infection'}


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: 

PRESENT ILLNESS: This is an 80 year old Caucasian
male who was admitted to [**Hospital3 **] from [**Hospital1 1444**] on [**2186-6-10**], with the
following diagnoses of fatigue, dehydration, status post
resection of gastrointestinal stromal tumor in [**2185-12-26**].
The patient is an 80 year old male patient with a past
medical history of Crohn's and had just had tumor resected by
Dr. [**Last Name (STitle) 957**], noninsulin dependent diabetes mellitus,
metastases of the chest, status post Gleevec tumor therapy.
He was readmitted, after discharge from [**Hospital1 190**] on [**2186-6-9**], on [**2186-6-11**], when he
represented via the Emergency Department for fatigue,
decreased appetite, diarrhea and came in complaining of
dehydration, increased lethargy and hypotension.  The patient
was seen in the Emergency Department by the surgical service
and was assessed to have a distended, tender and tympanitic
abdomen.

MEDICAL HISTORY: Crohn's disease.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Perforation of intestine,Unspecified pleural effusion,Thrombocytopenia, unspecified,Unspecified septicemia,Acute posthemorrhagic anemia,Hyposmolality and/or hyponatremia,Other postoperative infection'}
