CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: 49M ESRD/HD, HTN, DM2, morbid obesity, h/o noncompliance w/
dialysis, USOH until today at dialysis, when patient began to
complain of acute shortness of breath. Dialysis catheter was
noted to be slightly withdrawn during dialysis, and one hour
into dialysis, patient began to complain of acute shortness of
breath, diaphoresis.
.
In ED, SBP initially 140s, and pt was briefly started on ntg gtt
for thought of flash pulm edema. EKG revealed widened QRS, K
noted to be 6.0, given bicarb, insulin, d50, calcium. Initial
ABG 7.26/33/487/15 -> 7.37/34/476/20, following initiating bipap
and receiving bicarb. AG 29.
.
CXR in ED notable for pulmonary vascular congestion, but no
overt failure or infiltrate.
.
Noted in ED to have WBC of 25.8 63PMN, 1 band, 2 atyps, 1 metas,
2 myelos. Prior to transfer to MICU, patient noted to have SBP
of 100s-110s.

MEDICAL HISTORY: 1. ESRD on HD, frequent line infections
2. hypertension
3. venous insufficiency
4. DM type 2
5. former heroin user
6. morbid obesity

MEDICATION ON ADMISSION: 1. CALCIUM CARBONA...  500MG PO        [#90 R1]
 [**2119-7-10**]
     Take one by mouth three times a day with meals
  [[**Doctor Last Name **]]
2. FLUOXETINE HCL  20MG PO             [#30 R1]
 [**2120-2-5**]
     Take one by mouth every day, needs to see md [**First Name (Titles) **] [**Last Name (Titles) **] for
anymore refills.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 95 53 104/30 97% BIPAP 12/8
General: Obese, dyspneic, diaphoretic
HEENT: PERRL, EOMI, anicteric, OMMM
Neck: Obese, JVP not visible, supple, no LAD
CV: S1, S2, reg, brady, no mrg, but difficult exam
Lungs: Poor air mvmt, but no crackles appreciated
Abd: Obese, NT, ND, no rebound or guarding
Ext: Warm, no CCE
Neuro: A/OX3, rest of exam deferred given distress

FAMILY HISTORY: No ESRD or diabetes; mother and brother with hypertension

SOCIAL HISTORY: Pt denies current tobacco use - quit about 20 years ago, smoked
< [**12-31**] ppd.  Distant alcohol use.  Past heroin use, last use a
couple of months ago.  Has been on methadone x2 years, now at
90mg daily.
Infection and inflammatory reaction due to other vascular device, implant, and graft,Unspecified septicemia,Severe sepsis,Acute respiratory failure,Congestive heart failure, unspecified,Hyperpotassemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute and subacute necrosis of liver,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
React-oth vasc dev/graft,Septicemia NOS,Severe sepsis,Acute respiratry failure,CHF NOS,Hyperpotassemia,Hyp kid NOS w cr kid V,Acute necrosis of liver,DMII wo cmp nt st uncntr
Admission Date:  [**2120-9-5**]              Discharge Date:   [**2120-9-6**]

Date of Birth:  [**2071-5-9**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 297**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
Central line placement
Intubation

History of Present Illness:
49M ESRD/HD, HTN, DM2, morbid obesity, h/o noncompliance w/
dialysis, USOH until today at dialysis, when patient began to
complain of acute shortness of breath. Dialysis catheter was
noted to be slightly withdrawn during dialysis, and one hour
into dialysis, patient began to complain of acute shortness of
breath, diaphoresis.
.
In ED, SBP initially 140s, and pt was briefly started on ntg gtt
for thought of flash pulm edema. EKG revealed widened QRS, K
noted to be 6.0, given bicarb, insulin, d50, calcium. Initial
ABG 7.26/33/487/15 -> 7.37/34/476/20, following initiating bipap
and receiving bicarb. AG 29.
.
CXR in ED notable for pulmonary vascular congestion, but no
overt failure or infiltrate.
.
Noted in ED to have WBC of 25.8 63PMN, 1 band, 2 atyps, 1 metas,
2 myelos. Prior to transfer to MICU, patient noted to have SBP
of 100s-110s.


Past Medical History:
1. ESRD on HD, frequent line infections
2. hypertension
3. venous insufficiency
4. DM type 2
5. former heroin user
6. morbid obesity


Social History:
Pt denies current tobacco use - quit about 20 years ago, smoked
< [**12-31**] ppd.  Distant alcohol use.  Past heroin use, last use a
couple of months ago.  Has been on methadone x2 years, now at
90mg daily.


Family History:
No ESRD or diabetes; mother and brother with hypertension

Physical Exam:
95 53 104/30 97% BIPAP 12/8
General: Obese, dyspneic, diaphoretic
HEENT: PERRL, EOMI, anicteric, OMMM
Neck: Obese, JVP not visible, supple, no LAD
CV: S1, S2, reg, brady, no mrg, but difficult exam
Lungs: Poor air mvmt, but no crackles appreciated
Abd: Obese, NT, ND, no rebound or guarding
Ext: Warm, no CCE
Neuro: A/OX3, rest of exam deferred given distress


Pertinent Results:
[**2120-9-5**] 01:52PM BLOOD WBC-25.8*# RBC-3.64* Hgb-10.7* Hct-35.5*
MCV-97 MCH-29.3 MCHC-30.1* RDW-15.1
[**2120-9-6**] 08:13AM BLOOD WBC-28.6* RBC-3.44* Hgb-9.9* Hct-34.7*
MCV-101* MCH-28.7 MCHC-28.4* RDW-15.2 Plt Ct-57*
[**2120-9-5**] 01:52PM BLOOD Glucose-174* UreaN-49* Creat-11.9*#
Na-130* K-5.4* Cl-86* HCO3-15* AnGap-34*
[**2120-9-6**] 10:20AM BLOOD Glucose-137* UreaN-33* Creat-7.8* Na-143
K-6.0* Cl-102 HCO3-6* AnGap-41*
[**2120-9-5**] 01:52PM BLOOD Type-ART pO2-487* pCO2-33* pH-7.26*
calHCO3-15* Base XS--11
[**2120-9-6**] 03:22AM BLOOD Type-ART pO2-334* pCO2-24* pH-7.31*
calHCO3-13* Base XS--12
[**2120-9-6**] 04:43AM BLOOD Type-ART Temp-38.5 Tidal V-700 FiO2-100
pO2-309* pCO2-30* pH-7.16* calHCO3-11* Base XS--16 AADO2-393 REQ
O2-67 -ASSIST/CON Intubat-INTUBATED
[**2120-9-6**] 08:15AM BLOOD Type-ART Temp-38.8 pO2-212* pCO2-28*
pH-7.21* calHCO3-12* Base XS--15
[**2120-9-6**] 10:54AM BLOOD Type-ART Temp-37.8 pO2-193* pCO2-28*
pH-6.98* calHCO3-7* Base XS--24

Brief Hospital Course:
Mr [**Known lastname 20756**] was admitted for acute shortness of breath.  After
and initial evaluation, he was felt to be septic, possibly from
his hemodialysis line, and was started on vancomycin,
ceftriaxone, and metronidazole were initiated, the patient had a
central line placed, and was given IV fluid boluses to maintain
his blood pressure.  He was intubated for respiratory failure.
When IV fluids proved insufficient to support a MAP greater than
65, pressors were started, first norepinephrine and subsequently
vasopressin and phenylephrine.  The patient also developed a
number of rhythm abnormalities, including second degree heart
block and ventricular tachycardia, and frequently alternated
between these.
He was coded multiple times during the night of his admission,
with episodes marked by bradycardia and sudden, severe drops in
blood pressure (into the 30's and 40's systolic).  He generally
responded to fluids and increased pressors, but the overall
trend was worsening hemodynamics despite increasingly aggresive
resuscitation.  He was eventually started on dopamine in
addition to the aforementioned pressor agents, yet he continued
to clinically decompensate with worsening bp.  His family, who'd
been involved and apprised of the situation throughout the
morning, was contact[**Name (NI) **] and decided to make him comfort measures
only.  Once the pressors and ventilatory support were withdrawn,
he quickly expired.

Medications on Admission:
1. CALCIUM CARBONA...  500MG PO        [#90 R1]
 [**2119-7-10**]
     Take one by mouth three times a day with meals
  [[**Doctor Last Name **]]
2. FLUOXETINE HCL  20MG PO             [#30 R1]
 [**2120-2-5**]
     Take one by mouth every day, needs to see md [**First Name (Titles) **] [**Last Name (Titles) **] for
anymore refills.

 [[**Location (un) **]]
3. FOLIC ACID  1MG PO                  [#30 R5]
 [**2120-4-12**]
     One by mouth every day
   [TUTKUS]
4. METOPROLOL TARTRA...  50MG PO       [#60 R5]
 [**2120-4-12**]
     Take one tablet twice a day
   [TUTKUS]
5. NEPHROCAPS  1MG PO                  [#30 R0]
 [**2118-5-11**]
     Take one by mouth every day
  [[**Doctor Last Name **]]
6. NORVASC  5MG PO                     [#30 R1]
 [**2119-11-13**]
     One by mouth every day
    [[**Doctor Last Name **]]
7. PROTONIX  40MG PO                   [#30 R1]
 [**2119-6-20**]
     One by mouth every day
  [[**Doctor Last Name **]]
8. ZESTRIL  20MG PO                    [#30 R5]
 [**2120-4-12**]
     One by mouth every day
   [TUTKUS]

Discharge Disposition:
Expired

Discharge Diagnosis:
Septic shock
Respiratory Failure
Ventricular tachycardia
Second degree heart block
Secondary:
1. ESRD on HD, frequent line infections
2. hypertension
3. venous insufficiency
4. DM type 2
5. former heroin user
6. morbid obesity

Discharge Condition:
Expired
{'Infection and inflammatory reaction due to other vascular device, implant, and graft,Unspecified septicemia,Severe sepsis,Acute respiratory failure,Congestive heart failure, unspecified,Hyperpotassemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute and subacute necrosis of liver,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: Shortness of breath

PRESENT ILLNESS: 49M ESRD/HD, HTN, DM2, morbid obesity, h/o noncompliance w/
dialysis, USOH until today at dialysis, when patient began to
complain of acute shortness of breath. Dialysis catheter was
noted to be slightly withdrawn during dialysis, and one hour
into dialysis, patient began to complain of acute shortness of
breath, diaphoresis.
.
In ED, SBP initially 140s, and pt was briefly started on ntg gtt
for thought of flash pulm edema. EKG revealed widened QRS, K
noted to be 6.0, given bicarb, insulin, d50, calcium. Initial
ABG 7.26/33/487/15 -> 7.37/34/476/20, following initiating bipap
and receiving bicarb. AG 29.
.
CXR in ED notable for pulmonary vascular congestion, but no
overt failure or infiltrate.
.
Noted in ED to have WBC of 25.8 63PMN, 1 band, 2 atyps, 1 metas,
2 myelos. Prior to transfer to MICU, patient noted to have SBP
of 100s-110s.

MEDICAL HISTORY: 1. ESRD on HD, frequent line infections
2. hypertension
3. venous insufficiency
4. DM type 2
5. former heroin user
6. morbid obesity

MEDICATION ON ADMISSION: 1. CALCIUM CARBONA...  500MG PO        [#90 R1]
 [**2119-7-10**]
     Take one by mouth three times a day with meals
  [[**Doctor Last Name **]]
2. FLUOXETINE HCL  20MG PO             [#30 R1]
 [**2120-2-5**]
     Take one by mouth every day, needs to see md [**First Name (Titles) **] [**Last Name (Titles) **] for
anymore refills.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 95 53 104/30 97% BIPAP 12/8
General: Obese, dyspneic, diaphoretic
HEENT: PERRL, EOMI, anicteric, OMMM
Neck: Obese, JVP not visible, supple, no LAD
CV: S1, S2, reg, brady, no mrg, but difficult exam
Lungs: Poor air mvmt, but no crackles appreciated
Abd: Obese, NT, ND, no rebound or guarding
Ext: Warm, no CCE
Neuro: A/OX3, rest of exam deferred given distress

FAMILY HISTORY: No ESRD or diabetes; mother and brother with hypertension

SOCIAL HISTORY: Pt denies current tobacco use - quit about 20 years ago, smoked
< [**12-31**] ppd.  Distant alcohol use.  Past heroin use, last use a
couple of months ago.  Has been on methadone x2 years, now at
90mg daily. 

### Response:
{'Infection and inflammatory reaction due to other vascular device, implant, and graft,Unspecified septicemia,Severe sepsis,Acute respiratory failure,Congestive heart failure, unspecified,Hyperpotassemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute and subacute necrosis of liver,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
