CHIEF COMPLAINT: Dehydration.

PRESENT ILLNESS: 54 yo woman with metastatic pancreatic cancer to lungs admitted
for dehydration after chemotherapy.  She was given cycle #1
FOLFIRINOX [**2112-11-23**] and subsequently developed nausea, diarrhea,
and weakness.  Yesterday, she also had a nose bleed.  She notes
dizziness upon standing, severe fatigue and weakness, and
dyspnea/orthopnea.  She has difficulty speaking and her family
notes recent confusion and somnolence.  In the clinic, she was
given 1000mL Normal Saline and directly admitted to the floor
(11R) prior to her labs returning.  During transport, a sodium
of 113 and K 5.9 returned and ICU transfer was initiated prior
to the patient arriving on the floor.  Also she has recently
taken ibuprofen for pain.

MEDICAL HISTORY: - Pancreatic cancer, s/p Whipple, chemotherapy, CyberKnife.
- Portal vein thrombosis
- Psoriasis
- Severe osteoporosis
- Hip fracture after a fall in [**2109-3-10**].
- Breast surgery (removal of mass, negative cytology) [**2103**]
- Tubal Ligation [**2091**]
- ERCP
- EUS Lap staging procedure [**9-16**]
- GERD

MEDICATION ON ADMISSION: Lidocaine patch 5% 12hr on prn
Lorazepam 1-1.5mg PO q4-6hr prn
Nadolol 10mg PO daily
Ondansetron 8mg q8hr prn
Oxycodone 5-10mg PO q4-6hr prn
Prochlorperazine 10mg q6hr prn

ALLERGIES: Penicillins / Vancomycin / Dilaudid (PF)

PHYSICAL EXAM: ADMISSION EXAM:
VS: T - afebrile.
GEN: A&O, difficulty speaking, ill appearing, cachetic.
HEENT: Scleral icterus, EOM intact, dry MM.
Neck: Supple, no thyromegaly.
Lymph nodes: No cervical, supraclavicular or axillary LAD.
CV: S1S2, reg rate and rhythm, no murmurs, rubs or gallops.
RESP: Good air movement bilaterally, no rhonchi or wheezing.
ABD: Soft, moderately tender, distended, no inguinal LAD.
EXTR: No edema or calf tenderness.  No clubbing.
DERM: No rash.
Neuro: Difficulty speaking, very weak (generalized), no other
focal deficits.
PSYCH: Appropriate and calm.

FAMILY HISTORY: Her mother had rheumatoid arthritis and died last year of
vascular dementia at the age of 82.  Her father is 86 years old
and has colon cancer with liver metastases and has suffered from
cardiovascular disease.  She has a sister who is 64 years old
and has rheumatoid arthritis.

SOCIAL HISTORY: She lives in [**Location **], [**State 350**] with her husband.  She has
1 son who lives in [**Name (NI) 8449**] and 1 daughter who lives in [**Name (NI) 8117**],
[**Name (NI) 3844**].  She continues to work as a paralegal for a
medical device company.  She has approximately [**12-12**] alcoholic
beverages per week, does not smoke, and denies illicit drug use.
Unspecified septicemia,Acute respiratory failure,Acute kidney failure, unspecified,Acidosis,Secondary malignant neoplasm of lung,Jaundice, unspecified, not of newborn,Neutropenia, unspecified,Hypercalcemia,Severe sepsis,Personal history of malignant neoplasm of other gastrointestinal tract,Esophageal reflux,Osteoporosis, unspecified,Personal history of venous thrombosis and embolism,Other sequelae of chronic liver disease,Do not resuscitate status
Septicemia NOS,Acute respiratry failure,Acute kidney failure NOS,Acidosis,Secondary malig neo lung,Jaundice NOS,Neutropenia NOS,Hypercalcemia,Severe sepsis,Hx of GI malignancy NEC,Esophageal reflux,Osteoporosis NOS,Hx-ven thrombosis/embols,Oth sequela, chr liv dis,Do not resusctate status
Admission Date:  [**2112-11-29**]              Discharge Date:   [**2112-11-30**]

Date of Birth:  [**2058-2-28**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins / Vancomycin / Dilaudid (PF)

Attending:[**First Name3 (LF) 3984**]
Chief Complaint:
Dehydration.

Major Surgical or Invasive Procedure:
None.

History of Present Illness:
54 yo woman with metastatic pancreatic cancer to lungs admitted
for dehydration after chemotherapy.  She was given cycle #1
FOLFIRINOX [**2112-11-23**] and subsequently developed nausea, diarrhea,
and weakness.  Yesterday, she also had a nose bleed.  She notes
dizziness upon standing, severe fatigue and weakness, and
dyspnea/orthopnea.  She has difficulty speaking and her family
notes recent confusion and somnolence.  In the clinic, she was
given 1000mL Normal Saline and directly admitted to the floor
(11R) prior to her labs returning.  During transport, a sodium
of 113 and K 5.9 returned and ICU transfer was initiated prior
to the patient arriving on the floor.  Also she has recently
taken ibuprofen for pain.

ROS: She notes abdominal discomfort.  The diarrhea resolved
three days ago, but she has not been eating.  She denies F/C/S,
headache, visual/hearing changes, chest pain, cough, back pain,
constipation, hematochezia, hematuria, other urinary symptoms,
parasthesias, focal weakness, or rash.  All other ROS were
negative.

ONCOLOGIC HISTORY:
pancreatic head mass after p/w obstructive jaundice 08/[**2109**].
Although the overall picture was c/w a pancreatic
adenocarcinoma, multiple biopsies were (-).  On [**2110-11-27**], Dr.
[**Last Name (STitle) 468**] performed an open pancreatic biopsy w/
Roux-en-Y hepaticojejunostomy, open cholecystectomy, &
gastrojejunostomy. Pathology confirmed the presence of
well-differentiated pancreatic adenocarcinoma.  Gemcitabine was
started [**2110-12-31**].  She underwent CyberKnife stereotactic
radiation therapy [**105-10-10**]. She continued gemcitabine
after XRT w/ treatment course c/b by thrombocytopenia requiring
doses to be
held and dose reduction. She completed 6 cycles of gemcitabine
[**2111-6-10**], although C6 D15 was held for thrombocytopenia.  She
had been observed since completion of chemotherapy. Pt was
admitted to [**Hospital1 18**] [**Date range (1) 79826**] due to
melena/light-headedness, she underwent EGD w/ variceal banding
as well as PRBC transfusion.  She stopped coumadin which she was
taking for portal vein
thrombosis.  She had CT torso [**2112-7-27**] notable for mild
progression of multiple pulmonary nodules present since [**12/2111**],
concerning for metastatic disease, along with 2 liver lesions
also concerning for metastatic disease. She then underwent Liver
MRI [**2112-8-8**], and the lesions corresponded to areas of fatty
infiltration. Her CA19-9 has been slowly rising during this
time. She was seen in follow-up [**2112-8-29**] and discussion about
possible need to re-initiate chemotherapy was discussed. She had
repeat CT torso [**2112-10-28**] and this showed pulmonary nodules had
increased slightly in size. She was seen in follow-up [**2112-10-31**]
and was noted to have ongoing hyponatremia despite having
stopped her furosemide three days prior.  She was instructed to
stop her spironolactone as well.  Cycle #1 FOLFIRINOX was
administered [**2112-11-23**].

Past Medical History:
- Pancreatic cancer, s/p Whipple, chemotherapy, CyberKnife.
- Portal vein thrombosis
- Psoriasis
- Severe osteoporosis
- Hip fracture after a fall in [**2109-3-10**].
- Breast surgery (removal of mass, negative cytology) [**2103**]
- Tubal Ligation [**2091**]
- ERCP
- EUS Lap staging procedure [**9-16**]
- GERD

Social History:
She lives in [**Location **], [**State 350**] with her husband.  She has
1 son who lives in [**Name (NI) 8449**] and 1 daughter who lives in [**Name (NI) 8117**],
[**Name (NI) 3844**].  She continues to work as a paralegal for a
medical device company.  She has approximately [**12-12**] alcoholic
beverages per week, does not smoke, and denies illicit drug use.

Family History:
Her mother had rheumatoid arthritis and died last year of
vascular dementia at the age of 82.  Her father is 86 years old
and has colon cancer with liver metastases and has suffered from
cardiovascular disease.  She has a sister who is 64 years old
and has rheumatoid arthritis.

Physical Exam:
ADMISSION EXAM:
VS: T - afebrile.
GEN: A&O, difficulty speaking, ill appearing, cachetic.
HEENT: Scleral icterus, EOM intact, dry MM.
Neck: Supple, no thyromegaly.
Lymph nodes: No cervical, supraclavicular or axillary LAD.
CV: S1S2, reg rate and rhythm, no murmurs, rubs or gallops.
RESP: Good air movement bilaterally, no rhonchi or wheezing.
ABD: Soft, moderately tender, distended, no inguinal LAD.
EXTR: No edema or calf tenderness.  No clubbing.
DERM: No rash.
Neuro: Difficulty speaking, very weak (generalized), no other
focal deficits.
PSYCH: Appropriate and calm.

Pertinent Results:
ADMISSION LABS:
[**2112-11-29**] 03:40PM BLOOD WBC-PND RBC-4.12*# Hgb-11.5* Hct-34.9*
MCV-85 MCH-27.9 MCHC-33.0 RDW-14.7 Plt Ct-PND
[**2112-11-29**] 03:40PM BLOOD UreaN-67* Creat-1.8*# Na-113* K-5.9*
Cl-84* HCO3-21* AnGap-14
[**2112-11-29**] 03:40PM BLOOD Albumin-PND Calcium-10.8* Phos-5.1*#
Mg-2.2
[**2112-11-29**] 03:40PM BLOOD ALT-34 AST-21 LD(LDH)-PND AlkPhos-127*
TotBili-6.1*


Brief Hospital Course:
Assessment/Plan: A 54 yo woman with metastatic pancreatic cancer
admitted for dehydration after FOLFIRINOX cycle #1 chemotherapy.

Ms. [**Known lastname 79825**] was severely dehydrated as evidenced by the severe
hyponatremia, severe hyperkalemia, and acute renal failure. She
received intravenous fluid boluses and started on continuous
infusion of normal saline for low blood pressure and low urine
output. Despite this, her blood pressure continued to fall and
she required increasing doses of Levophed to maintain perfusion.
When her blood pressure continued to fall, vasopressin was
added. An echocardiogram was done that showed global systolic
dysfunction consistent with toxic/metabolic insult. The patient
was treated broadly from the time of admission for infection
with intravenous vancomycin, cefepime, ciprofloxacin, and
metronidazole. Blood cultures from admission came back positive
for gram positive cocci in pairs and chains on the first
hospital day.

When the patient's blood pressure and oxygen saturations
continued to decline, despite aggressive volume resuscitation,
antibiotics, and non-invasive positive-pressure ventilation, a
discussion was held with family members. The decision was made
not to escalate care, as patient had clearly expressed prior to
this admission that she did not want to be intubated or
resuscitated.

She passed away on the first hospital day from multiorgan system
failure complicating severe septic shock.

Medications on Admission:
Lidocaine patch 5% 12hr on prn
Lorazepam 1-1.5mg PO q4-6hr prn
Nadolol 10mg PO daily
Ondansetron 8mg q8hr prn
Oxycodone 5-10mg PO q4-6hr prn
Prochlorperazine 10mg q6hr prn

Discharge Medications:
PATIENT EXPIRED

Discharge Disposition:
Expired

Discharge Diagnosis:
PATIENT EXPRIED

PRIMARY DIAGNOSIS:
Multiorgan failure from overwhelming sepsis.

SECONDARY DIAGNOSIS:
Pancreatic Cancer.


Discharge Condition:
PATIENT EXPIRED

Discharge Instructions:
PATIENT EXPIRED

Followup Instructions:
PATIENT EXPIRED

                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2437**] MD [**MD Number(1) 2438**]

Completed by:[**2112-11-30**]
{'Unspecified septicemia,Acute respiratory failure,Acute kidney failure, unspecified,Acidosis,Secondary malignant neoplasm of lung,Jaundice, unspecified, not of newborn,Neutropenia, unspecified,Hypercalcemia,Severe sepsis,Personal history of malignant neoplasm of other gastrointestinal tract,Esophageal reflux,Osteoporosis, unspecified,Personal history of venous thrombosis and embolism,Other sequelae of chronic liver disease,Do not resuscitate status'}


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: Dehydration.

PRESENT ILLNESS: 54 yo woman with metastatic pancreatic cancer to lungs admitted
for dehydration after chemotherapy.  She was given cycle #1
FOLFIRINOX [**2112-11-23**] and subsequently developed nausea, diarrhea,
and weakness.  Yesterday, she also had a nose bleed.  She notes
dizziness upon standing, severe fatigue and weakness, and
dyspnea/orthopnea.  She has difficulty speaking and her family
notes recent confusion and somnolence.  In the clinic, she was
given 1000mL Normal Saline and directly admitted to the floor
(11R) prior to her labs returning.  During transport, a sodium
of 113 and K 5.9 returned and ICU transfer was initiated prior
to the patient arriving on the floor.  Also she has recently
taken ibuprofen for pain.

MEDICAL HISTORY: - Pancreatic cancer, s/p Whipple, chemotherapy, CyberKnife.
- Portal vein thrombosis
- Psoriasis
- Severe osteoporosis
- Hip fracture after a fall in [**2109-3-10**].
- Breast surgery (removal of mass, negative cytology) [**2103**]
- Tubal Ligation [**2091**]
- ERCP
- EUS Lap staging procedure [**9-16**]
- GERD

MEDICATION ON ADMISSION: Lidocaine patch 5% 12hr on prn
Lorazepam 1-1.5mg PO q4-6hr prn
Nadolol 10mg PO daily
Ondansetron 8mg q8hr prn
Oxycodone 5-10mg PO q4-6hr prn
Prochlorperazine 10mg q6hr prn

ALLERGIES: Penicillins / Vancomycin / Dilaudid (PF)

PHYSICAL EXAM: ADMISSION EXAM:
VS: T - afebrile.
GEN: A&O, difficulty speaking, ill appearing, cachetic.
HEENT: Scleral icterus, EOM intact, dry MM.
Neck: Supple, no thyromegaly.
Lymph nodes: No cervical, supraclavicular or axillary LAD.
CV: S1S2, reg rate and rhythm, no murmurs, rubs or gallops.
RESP: Good air movement bilaterally, no rhonchi or wheezing.
ABD: Soft, moderately tender, distended, no inguinal LAD.
EXTR: No edema or calf tenderness.  No clubbing.
DERM: No rash.
Neuro: Difficulty speaking, very weak (generalized), no other
focal deficits.
PSYCH: Appropriate and calm.

FAMILY HISTORY: Her mother had rheumatoid arthritis and died last year of
vascular dementia at the age of 82.  Her father is 86 years old
and has colon cancer with liver metastases and has suffered from
cardiovascular disease.  She has a sister who is 64 years old
and has rheumatoid arthritis.

SOCIAL HISTORY: She lives in [**Location **], [**State 350**] with her husband.  She has
1 son who lives in [**Name (NI) 8449**] and 1 daughter who lives in [**Name (NI) 8117**],
[**Name (NI) 3844**].  She continues to work as a paralegal for a
medical device company.  She has approximately [**12-12**] alcoholic
beverages per week, does not smoke, and denies illicit drug use. 

### Response:
{'Unspecified septicemia,Acute respiratory failure,Acute kidney failure, unspecified,Acidosis,Secondary malignant neoplasm of lung,Jaundice, unspecified, not of newborn,Neutropenia, unspecified,Hypercalcemia,Severe sepsis,Personal history of malignant neoplasm of other gastrointestinal tract,Esophageal reflux,Osteoporosis, unspecified,Personal history of venous thrombosis and embolism,Other sequelae of chronic liver disease,Do not resuscitate status'}
