CHIEF COMPLAINT: 

PRESENT ILLNESS: This patient was transferred to
our service from the  medical Intensive Care Unit.  Briefly,
63-year-old female with end stage renal disease, status post
cadaveric kidney transplant who was recently discharged from
arrived at rehabilitation facility and was found
unresponsive.  She was not reacting to deep sternal rub, and
appeared to be in respiratory arrest.  Upon arrival in the
MICU, the patient remained unresponsive.  She had mild
reaction and to Narcan.  There was also no evidence to suggest
that she receive any narcotics.  As previously said, patient
remained unresponsive for the first 8-12 hours in the MICU
regained consciousness and became conversant.  Her arterial blood
gases in the MICU revealed hypercapnia and acidosis. In addition
pt with worsening renal failure. Pt put on bipap for OSA and
obesity hypoventilation syndrome c/b hypercarbia. Pt remianed
lethargic but improved over presentation. Her ABGs remained
abnormal with PH which was 7.13 and 7.18 and PCO2 between 50 and
80.  Her other medical systems were stable and she was
transferred to our floor.

MEDICAL HISTORY: 1) End stage renal disease. Had a
cadaveric transplant in [**2115**] 2) Sleep apnea.  The patient has
refused to go for sleep apnea
study but has presumptive diagnosis of obstructive sleep
apnea.  3) Obesity, hypoventilation syndrome.
4). HTN 5). DM 6) recurrent respiratory failure requiring
intubation X3 over past month presumed due to OSA/Obesity
hypoventilation. 7) SVC syndrome due to clots from repeated IV
access lines and possible uinderlying hypercoaguable state. 8)
recent hematoma in right groin due to femoral line requiring
transfusion. SOCIAL HISTORY: The patient lives alone in [**Hospital1 1474**],
has 6
children who are all very close to her and see her fairly
frequently.  The baseline patient was able to ambulate and
ride an exercise bike in [**Month (only) 547**] although reportedly had increasing
daytime somnolence for several months prior to admit.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: The patient lives alone in [**Hospital1 1474**],
has 6
children who are all very close to her and see her fairly
frequently.  The baseline patient was able to ambulate and
ride an exercise bike in [**Month (only) 547**] although reportedly had increasing
daytime somnolence for several months prior to admit.
Acute kidney failure, unspecified,Acute respiratory failure,Acidosis,Kidney replaced by transplant,Other alteration of consciousness,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Unspecified essential hypertension
Acute kidney failure NOS,Acute respiratry failure,Acidosis,Kidney transplant status,Other alter consciousnes,DMII renl nt st uncntrld,Nephritis NOS in oth dis,Hypertension NOS
Admission Date:  [**2125-6-7**]     Discharge Date:  [**2125-6-13**]

Date of Birth:   [**2063-1-15**]     Sex:  F


HISTORY OF PRESENT ILLNESS:  This patient was transferred to
our service from the  medical Intensive Care Unit.  Briefly,
63-year-old female with end stage renal disease, status post
cadaveric kidney transplant who was recently discharged from
arrived at rehabilitation facility and was found
unresponsive.  She was not reacting to deep sternal rub, and
appeared to be in respiratory arrest.  Upon arrival in the
MICU, the patient remained unresponsive.  She had mild
reaction and to Narcan.  There was also no evidence to suggest
that she receive any narcotics.  As previously said, patient
remained unresponsive for the first 8-12 hours in the MICU
regained consciousness and became conversant.  Her arterial blood
gases in the MICU revealed hypercapnia and acidosis. In addition
pt with worsening renal failure. Pt put on bipap for OSA and
obesity hypoventilation syndrome c/b hypercarbia. Pt remianed
lethargic but improved over presentation. Her ABGs remained
abnormal with PH which was 7.13 and 7.18 and PCO2 between 50 and
80.  Her other medical systems were stable and she was
transferred to our floor.

PAST MEDICAL HISTORY:  1) End stage renal disease. Had a
cadaveric transplant in [**2115**] 2) Sleep apnea.  The patient has
refused to go for sleep apnea
study but has presumptive diagnosis of obstructive sleep
apnea.  3) Obesity, hypoventilation syndrome.
4). HTN 5). DM 6) recurrent respiratory failure requiring
intubation X3 over past month presumed due to OSA/Obesity
hypoventilation. 7) SVC syndrome due to clots from repeated IV
access lines and possible uinderlying hypercoaguable state. 8)
recent hematoma in right groin due to femoral line requiring
transfusion. SOCIAL HISTORY: The patient lives alone in [**Hospital1 1474**],
has 6
children who are all very close to her and see her fairly
frequently.  The baseline patient was able to ambulate and
ride an exercise bike in [**Month (only) 547**] although reportedly had increasing
daytime somnolence for several months prior to admit.

FAMILY HISTORY:  Noncontributory.

MEDICATIONS:  Upon transfer from the MICU included RenaGel
1,600 po tid, insulin sliding scale, Prednisone 10 mg po q d,
Epogen 4,000 units subcu three times a week, Calcitriol 0.25
mcg po q d, Colace 100 mg po bid, Dulcolax 10 mg po prn,
Tylenol prn, Protonix 40 mg q d, Lopressor 25 mg po bid and
Imuran 100 mg po q d.

ALLERGIES:  No known drug allergies.

LABORATORY DATA:  White count 5.9, hematocrit 29.6, platelet
count 288,000, PT 13.2 with INR 1.2, PTT 29, sodium 149,
potassium 6.6, hemolyzed, chloride 117, CO2 23, BUN 120,
creatinine 6 .5.  Repeat potassium was 4.6.  She also had
calcium of 9.7, phosphorus 3.8 and magnesium 2.3.  ALT was 8,
AST 8, alkaline phosphatase 90 and total bilirubin .7.
Latest arterial blood gas showed PH 7.17, PCO2 62, PO2 142.

HOSPITAL COURSE:  Upon transfer to our service, it was deemed
that patient would require dialysis fairly soon.  We
therefore obtained an ultrasound of her lower extremities to
evaluate the possibility of any patent vessels which might be
used for AV graft.  Unfortunately, ultrasound revealed no
patent vessels.  It was therefore felt that patient was a
very poor candidate for hemodialysis given lack of access.
Meanwhile her mental status continued to deteriorate with
lethargy/confusion. She was difficult to arouse. There was ?new
left facial droop so Head CT was performed and this was negative
for actue bleed/cva. Repeat labs showed persistent acidosis with
Ph 7.11 and worsening renal failure. her acidosis appeared to be
combined metabolic and respiratory.
Her respiratory status continued to worsen.  Consultation
with pulmonary was obtained and it was felt that her
respiratory compromise was a combination of sleep apnea and
obesity hyperventilation syndrome.  It was now felt that the
patient's respiratory and renal function were steadily
worsening and there was no clear solution to her worsening
status.  Her prognosis was extremely poor given a lack of IV
access for dialysis and ongoing hypoventilation and refusal to
use BIPAP. A family meeting was therefore held. The family
felt that the best option was to make the patient comfort
measures only as there was no apparent way to improve her
renal or respiratory compromise (short of tracheostomy with
cpap/mechanical ventiation as needed). The patient was made
comfort measures only on [**6-12**].  She was started on sublingual
Morphine which she did not tolerate very well.  She was
therefore switched to IV Morphine 2 mg q 4-6 hours prn.  The
patient expired on [**2125-6-12**] at 8:20 a.m.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3022**], M.D.  [**MD Number(1) 3023**]

Dictated By:[**Doctor Last Name 22847**]

MEDQUIST36

D:  [**2125-6-14**]  18:43
T:  [**2125-6-17**]  20:00
JOB#:  [**Job Number **]
{'Acute kidney failure, unspecified,Acute respiratory failure,Acidosis,Kidney replaced by transplant,Other alteration of consciousness,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Unspecified essential hypertension'}


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 patient was transferred to
our service from the  medical Intensive Care Unit.  Briefly,
63-year-old female with end stage renal disease, status post
cadaveric kidney transplant who was recently discharged from
arrived at rehabilitation facility and was found
unresponsive.  She was not reacting to deep sternal rub, and
appeared to be in respiratory arrest.  Upon arrival in the
MICU, the patient remained unresponsive.  She had mild
reaction and to Narcan.  There was also no evidence to suggest
that she receive any narcotics.  As previously said, patient
remained unresponsive for the first 8-12 hours in the MICU
regained consciousness and became conversant.  Her arterial blood
gases in the MICU revealed hypercapnia and acidosis. In addition
pt with worsening renal failure. Pt put on bipap for OSA and
obesity hypoventilation syndrome c/b hypercarbia. Pt remianed
lethargic but improved over presentation. Her ABGs remained
abnormal with PH which was 7.13 and 7.18 and PCO2 between 50 and
80.  Her other medical systems were stable and she was
transferred to our floor.

MEDICAL HISTORY: 1) End stage renal disease. Had a
cadaveric transplant in [**2115**] 2) Sleep apnea.  The patient has
refused to go for sleep apnea
study but has presumptive diagnosis of obstructive sleep
apnea.  3) Obesity, hypoventilation syndrome.
4). HTN 5). DM 6) recurrent respiratory failure requiring
intubation X3 over past month presumed due to OSA/Obesity
hypoventilation. 7) SVC syndrome due to clots from repeated IV
access lines and possible uinderlying hypercoaguable state. 8)
recent hematoma in right groin due to femoral line requiring
transfusion. SOCIAL HISTORY: The patient lives alone in [**Hospital1 1474**],
has 6
children who are all very close to her and see her fairly
frequently.  The baseline patient was able to ambulate and
ride an exercise bike in [**Month (only) 547**] although reportedly had increasing
daytime somnolence for several months prior to admit.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: The patient lives alone in [**Hospital1 1474**],
has 6
children who are all very close to her and see her fairly
frequently.  The baseline patient was able to ambulate and
ride an exercise bike in [**Month (only) 547**] although reportedly had increasing
daytime somnolence for several months prior to admit. 

### Response:
{'Acute kidney failure, unspecified,Acute respiratory failure,Acidosis,Kidney replaced by transplant,Other alteration of consciousness,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Unspecified essential hypertension'}
