CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 58 year old woman with
end-stage renal disease secondary to membranous glomerular
nephritis.  She has been on hemodialysis for the past four
years previous to admission.  She presented to [**Hospital1 346**] on [**2116-3-30**], for a kidney
transplant when a donor organ became available.  She has no
history of peritoneal dialysis.  She denies any recent chest
pain, shortness of breath, change in bowel habits, evidence
of melena or bright red blood per rectum.

MEDICAL HISTORY: 1.  Hypothyroidism.
2.  Hepatitis C.
3.  End-stage renal disease on hemodialysis as described in
the History of Present Illness.
4.  Hypertension.
5.  Status post hysterectomy in [**2110**].

MEDICATION ON ADMISSION: 1.  Norvasc.
2.  Zestril.
3.  Renagel.
4.  Quinine.
5.  Nephrocaps.
6.  Levoxyl.
7.  B12.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Hyperpotassemia,Urinary tract infection, site not specified,Acute hepatitis C without mention of hepatic coma,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Anemia, unspecified,Unspecified acquired hypothyroidism
Hyperpotassemia,Urin tract infection NOS,Hpt C acute wo hpat coma,Oth gram negatv bacteria,Anemia NOS,Hypothyroidism NOS
Name:  [**Known lastname 16846**], [**Known firstname **] W                     Unit No:  [**Numeric Identifier 16847**]

Admission Date:  [**2116-3-30**]     Discharge Date:  [**2116-4-10**]

Date of Birth:   [**2057-8-25**]     Sex:  F

Service:  Transplant Surgery

ADDENDUM:  On the day prior to anticipated day of discharge,
Ms. [**Known lastname **] began complaining of epigastric pain.  The pain
became very severe and was accompanied by emesis times one.
A subsequent endoscopy on hospital day eight revealed a very
large ulceration at the gastroesophageal junction.  This was
biopsied.  At the time of discharge this pathology was not
finalized.  However, initial report supported changes
consistent with acute esophagitis.  There was no evidence of
viral change.

For this, she was treated with Protonix, and she was started
on Valcyte 450 mg p.o. q.d. to cover both cytomegalovirus and
herpes simplex virus.

By postoperative 11, Ms. [**Known lastname **] was stable to tolerate
adequate oral intake and was ready to be discharged to home.

Additionally, during this interval, sensitivities from urine
cultures previously sent revealed she had in fact grown out
Enterobacter cloacae from her urine.  This was sensitive to
levofloxacin and ciprofloxacin.  She was to be discharged
home on 10 additional days of levofloxacin 250 mg p.o. q.d.

All previously dictated medications, discharge diagnoses, and
instructions remained the same except for the aforementioned
changes.




                          [**First Name4 (NamePattern1) 168**] [**Last Name (NamePattern1) 1030**], MD  [**MD Number(1) 1031**]

Dictated By:[**Last Name (NamePattern1) 2383**]

MEDQUIST36

D:  [**2116-4-9**]  19:26
T:  [**2116-4-11**]  07:47
JOB#:  [**Job Number **]


Admission Date:  [**2116-3-30**]     Discharge Date:  [**2116-4-7**]

Date of Birth:   [**2057-8-25**]     Sex:  F

Service:  TRANS [**Doctor First Name 147**]

HISTORY OF PRESENT ILLNESS:  This is a 58 year old woman with
end-stage renal disease secondary to membranous glomerular
nephritis.  She has been on hemodialysis for the past four
years previous to admission.  She presented to [**Hospital1 346**] on [**2116-3-30**], for a kidney
transplant when a donor organ became available.  She has no
history of peritoneal dialysis.  She denies any recent chest
pain, shortness of breath, change in bowel habits, evidence
of melena or bright red blood per rectum.

PAST MEDICAL HISTORY:
1.  Hypothyroidism.
2.  Hepatitis C.
3.  End-stage renal disease on hemodialysis as described in
the History of Present Illness.
4.  Hypertension.
5.  Status post hysterectomy in [**2110**].

MEDICATIONS ON ADMISSION:
1.  Norvasc.
2.  Zestril.
3.  Renagel.
4.  Quinine.
5.  Nephrocaps.
6.  Levoxyl.
7.  B12.

PHYSICAL EXAMINATION:  On admission, Ms. [**Known lastname **] is a well
appearing woman appearing her stated age.  Temperature is
97.2 F.; pulse is 98; blood pressure is 198/80; respiratory
rate is 18.  Pupils were equal, round and reactive to light.
Extraocular muscles are intact.  Sclerae are anicteric.  She
has no jugular venous distention and no cervical
lymphadenopathy.  Her lungs are clear to auscultation
bilaterally.  Her heart is regular rate and rhythm without
evidence of murmur.  Her abdomen is soft, slightly distended
without any evidence of organomegaly or ascites.  Rectal
examination is no masses and guaiac negative.  Extremities
are warm with palpable dorsalis pedis pulse bilaterally.

HOSPITAL COURSE:  Mrs. [**Known lastname **] was admitted to the Transplant
Service and on the day of admission was brought to the
Operating Room whereupon she received a cadaveric renal
transplant.  The procedure was performed by Dr. [**Last Name (STitle) **]
assisted by Dr. [**Last Name (STitle) 104233**].  The procedure was performed under
general anesthesia with an estimated 50 cc of blood loss.
During the procedure she received 2.6 liters of Crystalloid
and made 25 cc of urine.  Please see previously dictated
operative note for more details.

The patient tolerated the procedure well, was extubated in
the Operating Room and transferred to the Post-Anesthesia
Care Unit.

Mrs.[**Hospital 104234**] hospital course was relatively uncomplicated.
After the Operating Room she was admitted to the Surgical
Intensive Care Unit so that she could be monitored more
closely in her postoperative period.  On postoperative day
one, she was transferred from the Intensive Care Unit to the
Patient Care Floor without incident.

She was placed on the standard regimen of immunosuppression
therapy including CellCept starting at 1000 mg for the first
three days and then titrated down to 500 mg thereafter.  She
was on a sliding steroid taper such that she was tapered down
to 20 mg of Solu-Medrol and then Prednisone on postoperative
day number seven.  She will remain on the 20 mg a day.

She received three doses of 100 mg of anti-Thymoglobulin,
followed by two doses of 50 mg.  She was started on
Rapamune on postoperative day number five.

During the rest of this hospitalization, she was slow to make
urine and, in fact, required hemodialysis during her
postoperative period.  However, on postoperative day number
six, she made 300 cc of urine.

Mrs. [**Known lastname **] complained of epigastric discomfort for several
days and, in fact, vomited on postoperative day number six.
Because of this episode of nausea and vomiting, she was ruled
out for myocardial infarction by serial enzymes.  Also, an
EKG was obtained which was unchanged from baseline EKG.

She is on Protonix 40 mg p.o. q. day for her epigastric
discomfort.

On postoperative day number six, she complained of dysuria.
For this, she was placed on Ciprofloxacin and started on a
five day course.

CONDITION AT DISCHARGE:   Stable.

DISCHARGE DISPOSITION:   To home.

DISCHARGE DIAGNOSES:
1.  Status post cadaveric renal transplant.
2.  Urinary tract infection.

MEDICATIONS ON DISCHARGE:
1.  Levoxyl 125 micrograms p.o. q. day.
2.  Protonix 40 mg p.o. q. day.
3.  Percocet 1 to 2 tablets p.o. q. four to six hours p.r.n.
4.  Colace 100 mg p.o. twice a day.
5.  Ganciclovir 500 mg p.o. q.o.d.
6.  Bactrim Single Strength 1 tablet p.o. q. day.
7.  CellCept [**Pager number **] mg p.o. four times a day.
8.  Prednisone 20 mg p.o. q. day.
9.  Rapamune 5 mg p.o. q. day.
10. Amphojel 30 mg p.o. q. eight hours.
11. Nystatin Swish and Swallow.
12. Ciprofloxacin 500 mg p.o. q. day.
13. Ditropan 5 mg p.o. twice a day.

DISCHARGE INSTRUCTIONS:
1.  The patient will follow-up with Dr. [**Last Name (STitle) **] in the
Transplant Surgery Clinic.
2.  Follow-up for her Rapamune levels, blood work has been
arranged.


                          [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 3598**], MD  [**MD Number(1) 3599**]

Dictated By:[**Last Name (NamePattern1) 6355**]

MEDQUIST36

D:  [**2116-4-7**]  18:25
T:  [**2116-4-7**]  10:59
JOB#:  [**Job Number **]
{'Hyperpotassemia,Urinary tract infection, site not specified,Acute hepatitis C without mention of hepatic coma,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Anemia, unspecified,Unspecified acquired hypothyroidism'}


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 a 58 year old woman with
end-stage renal disease secondary to membranous glomerular
nephritis.  She has been on hemodialysis for the past four
years previous to admission.  She presented to [**Hospital1 346**] on [**2116-3-30**], for a kidney
transplant when a donor organ became available.  She has no
history of peritoneal dialysis.  She denies any recent chest
pain, shortness of breath, change in bowel habits, evidence
of melena or bright red blood per rectum.

MEDICAL HISTORY: 1.  Hypothyroidism.
2.  Hepatitis C.
3.  End-stage renal disease on hemodialysis as described in
the History of Present Illness.
4.  Hypertension.
5.  Status post hysterectomy in [**2110**].

MEDICATION ON ADMISSION: 1.  Norvasc.
2.  Zestril.
3.  Renagel.
4.  Quinine.
5.  Nephrocaps.
6.  Levoxyl.
7.  B12.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Hyperpotassemia,Urinary tract infection, site not specified,Acute hepatitis C without mention of hepatic coma,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Anemia, unspecified,Unspecified acquired hypothyroidism'}
