CHIEF COMPLAINT: 

PRESENT ILLNESS: Briefly, the patient is a 43-
year-old male, previously diagnosed with metastatic renal
cell cancer, status post nephrectomy of his right kidney with
recent clinical course significant for T7 spinal cord
compression and large right loculated pleural effusion with
pigtail catheter drainage who presented from rehab with
shortness of breath, lethargy, pleuritic chest pain, and
decrease in hematocrit requiring transfusion.  Prior to
transfer, the patient was noted to have systolic blood
pressure of approximately 100, to be tachycardiac to 110, and
to have continued dyspnea with desaturations to 80 percent on
nasal cannula oxygen.

MEDICAL HISTORY: Metastatic renal cell cancer with
metastases to right pleura and spinal cord, status post right
nephrectomy in [**9-19**].

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Empyema without mention of fistula,Acute respiratory failure,Secondary malignant neoplasm of pleura,Septic shock,Secondary malignant neoplasm of bone and bone marrow,Paralytic ileus,Personal history of malignant neoplasm of kidney,Unspecified essential hypertension
Empyema w/o fistula,Acute respiratry failure,Second malig neo pleura,Septic shock,Secondary malig neo bone,Paralytic ileus,Hx of kidney malignancy,Hypertension NOS
Admission Date: [**2102-12-12**]        Discharge Date: [**2102-12-13**]

Date of Birth:  [**2059-10-4**]        Sex:  M

Service:  MICU


HISTORY OF PRESENT ILLNESS:  Briefly, the patient is a 43-
year-old male, previously diagnosed with metastatic renal
cell cancer, status post nephrectomy of his right kidney with
recent clinical course significant for T7 spinal cord
compression and large right loculated pleural effusion with
pigtail catheter drainage who presented from rehab with
shortness of breath, lethargy, pleuritic chest pain, and
decrease in hematocrit requiring transfusion.  Prior to
transfer, the patient was noted to have systolic blood
pressure of approximately 100, to be tachycardiac to 110, and
to have continued dyspnea with desaturations to 80 percent on
nasal cannula oxygen.

PAST MEDICAL HISTORY:  Metastatic renal cell cancer with
metastases to right pleura and spinal cord, status post right
nephrectomy in [**9-19**].

Hypertension.

Hyperlipidemia.

ALLERGIES:  No known drug allergies.

MEDICATIONS PRIOR TO ADMISSION:
1. Labetalol.
2. Colace.
3. Senna.
4. EPO.
5. Dilaudid.
6. Decadron.
7. Prevacid.
8. OxyContin.
9. Dulcolax.
10.      Lactulose.
11.      Home oxygen.


PHYSICAL EXAMINATION:  Temperature 98.8 degrees, heart rate
117, blood pressure 134/53, respiratory rate 20, and
saturating 98 percent on nasal cannula oxygen.  In general,
ill-appearing, diaphoretic, and dyspneic male.  HEENT:
Extraocular movements intact.  Neck:  No jugular venous
distention.  Lungs:  Decreased breath sounds at the right
base with dullness to percussion.  Cardiovascular:
Tachycardiac without a murmur.  Abdomen:  Obese, soft, and
nontender with normoactive bowel sounds.  Extremities:  No
edema.  Neurologic:  Alert, conversant, nonfocal.

DIAGNOSTIC STUDIES:  CBC, white count 4.5, hematocrit 25, and
platelets of 85.  Differential, 67 percent polymorphonuclear
leukocytes and 21 percent bands.  Chemistry significant for
phosphorus 5.0 and no anion gap.  Coags within normal limits.
Cardiac enzymes negative.  LFTs significant for isolated
alkaline phosphatase elevation of 168.

Chest x-ray, re-accumulation of previously seen right-sided
pleural effusion with a density at the right lung base
representing pneumonia.  CT of the chest, loculated pleural
fluid collections on the right with air-fluid levels
consistent with empyemas.  Multiple pulmonary and liver
metastases with lesions eroding into the left fifth and sixth
proximal ribs.  No evidence of pulmonary embolism.  Arterial
blood gas on 100 percent nonrebreather mask, 7.2/84/66/34/2.
Lactate 1.3.

HOSPITAL COURSE:  The patient was initially taken to
Radiology for a CAT scan of the chest to rule out pulmonary
embolus, at which time the patient became increasingly
lethargic with a decrease in respiratory rate and was
intubated for respiratory failure.  For his respiratory
failure, the patient was initially covered with vancomycin,
levofloxacin, and clindamycin for a presumed
pneumonia/empyema.  While at CT scan, the patient became
increasingly dyspneic, the patient was then admitted to the
Medical Intensive Care Unit and his hypotension was managed
with aggressive fluid resuscitation.

Additionally, the patient was given stress-dose steroids
given his chronic steroid dependency, and he was transfused
two units of packed red blood cells given his new-onset
anemia.  Upon admission to the Medical Intensive Care Unit,
the Oncology Consultation Service was asked to evaluate the
patient to assist in the management.  [**Hospital **] medical
resuscitation was continued until a discussion with the
family including the [**Hospital 228**] healthcare proxy revealed
wishes upon their part to provide comfort measures only to
the patient.  On hospital day two, the patient was made CMO
and the cross covering medical intern was asked to evaluate
the patient as he had become apneic and unresponsive.  Time
of death documented at 04:25 p.m. on [**2102-12-13**].  Family was
notified and refused autopsy.

CONDITION ON DISCHARGE:  Deceased.

DISCHARGE DIAGNOSES:  Renal cell carcinoma, metastatic.

Pneumonia.

Empyema.

Respiratory failure.

Septic shock.

Inflammatory response syndrome.



                        [**First Name8 (NamePattern2) **] [**Name8 (MD) **], MD [**MD Number(2) 48404**]

Dictated By:[**Doctor Last Name 21141**]
MEDQUIST36
D:  [**2103-6-20**] 13:44:53
T:  [**2103-6-20**] 15:15:28
Job#:  [**Job Number 50053**]
{'Empyema without mention of fistula,Acute respiratory failure,Secondary malignant neoplasm of pleura,Septic shock,Secondary malignant neoplasm of bone and bone marrow,Paralytic ileus,Personal history of malignant neoplasm of kidney,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: Briefly, the patient is a 43-
year-old male, previously diagnosed with metastatic renal
cell cancer, status post nephrectomy of his right kidney with
recent clinical course significant for T7 spinal cord
compression and large right loculated pleural effusion with
pigtail catheter drainage who presented from rehab with
shortness of breath, lethargy, pleuritic chest pain, and
decrease in hematocrit requiring transfusion.  Prior to
transfer, the patient was noted to have systolic blood
pressure of approximately 100, to be tachycardiac to 110, and
to have continued dyspnea with desaturations to 80 percent on
nasal cannula oxygen.

MEDICAL HISTORY: Metastatic renal cell cancer with
metastases to right pleura and spinal cord, status post right
nephrectomy in [**9-19**].

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Empyema without mention of fistula,Acute respiratory failure,Secondary malignant neoplasm of pleura,Septic shock,Secondary malignant neoplasm of bone and bone marrow,Paralytic ileus,Personal history of malignant neoplasm of kidney,Unspecified essential hypertension'}
