CHIEF COMPLAINT: CC:[**CC Contact Info 104586**]
Major Surgical or Invasive Procedure:
endotracheal intubation
Nasogastric tube

PRESENT ILLNESS: HPI:  52 y/o lady with hyptension presented to the Emergency
Department with swollen tongue and funny feeling in her tongue.
Patient is sedated at this time and history was obtained from
the medical records.  Patient denied any difficulty breathing,
palpitations, nausea, vomitting or diarrhea.  No new food
exposure.  Vitals in ED were T 98.3  BP 161/117  HR 94  RR 12
100% RA.  Her swelling was worsening in ED and was she was
intubated for airway protection.  She recieved solumedrol 125 mg
IV, benadryl 30 mg IV, pepcid 20 mg IV, fentanyl 100 mcg IV x2
and versed 2 mg IV x 2.

MEDICAL HISTORY: PMHx:
Hypertension
Asthma
Menorrhagia secondary to fibroid uterus
Seasonal Allergies

MEDICATION ON ADMISSION: Home Medications:
Lisinopril 10 mg daily
Albuterol 2 puffs prn
Flovent [**12-24**] inh [**Hospital1 **]
Nasonex 50 mcg 2 sprays daily
Norethindrone-Ethin (Necon 1/35) once a day
.
Allergies:
Erythromycin causes rash and itching.  Penicillin causes throat
swelling and anaphylaxis type reaction.  Allergy to codeine,
which causes anaphylaxis.  Bactrim causes rash.  Egg causes
hives.

ALLERGIES: Erythromycin Base / Penicillins / Codeine / Bactrim Ds / Egg /
Shellfish Derived / Lisinopril / Ace Inhibitors / Valsartan

PHYSICAL EXAM: Vitals:  T 96.3  HR 79  BP 153/98  RR 14  100% FiO2.  CMV/AC
FiO2 100% TV 550 PEEP 5.
Gen:  Medically sedated.  Not responding to verbal stimuli.
HEENT:  Swollen lips.  asymetric swelling of the cheeks right
greater than left.  Unable to properly assess oropharynx given
swollen lips and OT tube.
Heart:  S1S2 RRR, no MRG
Lungs:  CTAB in ant lung fields, no wheezes or crackles
Abdomen:  Obese, BS present, soft NTND, no appreciable
mass/organomegaly
Ext:  WWP, DP 2+, no edema
Neuro: Limited due to sedation.  Pinpoint pupils.

FAMILY HISTORY: Unable to obtain any significant history.
.

SOCIAL HISTORY: Social History: (obtained from OMR notes)
She is single, currently not in a relationship.  She has two
grown sons.   in their 20s, a boy and girl.  She use to work at
[**Hospital1 18**].
Angioneurotic edema, not elsewhere classified,Other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use,Unspecified essential hypertension,Extrinsic asthma, unspecified,Leiomyoma of uterus, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Excessive or frequent menstruation,Enlargement of lymph nodes
Angioneurotic edema,Adv eff cardiovasc NEC,Hypertension NOS,Extrinsic asthma NOS,Uterine leiomyoma NOS,Chr blood loss anemia,Excessive menstruation,Enlargement lymph nodes
Admission Date:  [**2128-12-3**]              Discharge Date:   [**2128-12-6**]

Date of Birth:  [**2076-8-14**]             Sex:   F

Service: MEDICINE

Allergies:
Erythromycin Base / Penicillins / Codeine / Bactrim Ds / Egg /
Shellfish Derived / Lisinopril / Ace Inhibitors / Valsartan

Attending:[**First Name3 (LF) 2167**]
Chief Complaint:
CC:[**CC Contact Info 104586**]
Major Surgical or Invasive Procedure:
endotracheal intubation
Nasogastric tube

History of Present Illness:
HPI:  52 y/o lady with hyptension presented to the Emergency
Department with swollen tongue and funny feeling in her tongue.
Patient is sedated at this time and history was obtained from
the medical records.  Patient denied any difficulty breathing,
palpitations, nausea, vomitting or diarrhea.  No new food
exposure.  Vitals in ED were T 98.3  BP 161/117  HR 94  RR 12
100% RA.  Her swelling was worsening in ED and was she was
intubated for airway protection.  She recieved solumedrol 125 mg
IV, benadryl 30 mg IV, pepcid 20 mg IV, fentanyl 100 mcg IV x2
and versed 2 mg IV x 2.

On arrival to the floor her vitals were T 96.3  HR 79  BP 153/98
 RR 14  100% FiO2.  CMV/AC FiO2 100% TV 550 PEEP 5.  Patient is
heavily sedated and unable to give any history.


Past Medical History:
PMHx:
Hypertension
Asthma
Menorrhagia secondary to fibroid uterus
Seasonal Allergies

Social History:
Social History: (obtained from OMR notes)
She is single, currently not in a relationship.  She has two
grown sons.   in their 20s, a boy and girl.  She use to work at
[**Hospital1 18**].


Family History:
Unable to obtain any significant history.
.


Physical Exam:
Vitals:  T 96.3  HR 79  BP 153/98  RR 14  100% FiO2.  CMV/AC
FiO2 100% TV 550 PEEP 5.
Gen:  Medically sedated.  Not responding to verbal stimuli.
HEENT:  Swollen lips.  asymetric swelling of the cheeks right
greater than left.  Unable to properly assess oropharynx given
swollen lips and OT tube.
Heart:  S1S2 RRR, no MRG
Lungs:  CTAB in ant lung fields, no wheezes or crackles
Abdomen:  Obese, BS present, soft NTND, no appreciable
mass/organomegaly
Ext:  WWP, DP 2+, no edema
Neuro: Limited due to sedation.  Pinpoint pupils.


Pertinent Results:
[**2128-12-3**] 09:40AM BLOOD WBC-5.0 RBC-4.22 Hgb-11.3* Hct-34.6*
MCV-82 MCH-26.9* MCHC-32.8 RDW-14.2 Plt Ct-199
[**2128-12-6**] 06:25AM BLOOD WBC-14.3* RBC-4.09* Hgb-10.7* Hct-33.3*
MCV-81* MCH-26.2* MCHC-32.1 RDW-13.6 Plt Ct-200
[**2128-12-3**] 09:40AM BLOOD Neuts-60.0 Lymphs-32.3 Monos-3.8 Eos-3.1
Baso-0.7
[**2128-12-4**] 06:00AM BLOOD Neuts-91.4* Lymphs-7.8* Monos-0.5*
Eos-0.2 Baso-0
[**2128-12-4**] 06:00AM BLOOD PT-13.5* PTT-26.2 INR(PT)-1.2*
[**2128-12-4**] 06:00AM BLOOD ESR-20
[**2128-12-3**] 09:40AM BLOOD Glucose-97 UreaN-12 Creat-0.6 Na-139
K-3.5 Cl-107 HCO3-24 AnGap-12
[**2128-12-6**] 06:25AM BLOOD Glucose-93 UreaN-13 Creat-0.6 Na-138
K-4.0 Cl-102 HCO3-29 AnGap-11
[**2128-12-5**] 06:33AM BLOOD Calcium-8.4 Phos-2.8 Mg-2.7*
[**2128-12-4**] 06:00AM BLOOD TSH-0.23*
[**2128-12-3**] 05:15PM BLOOD C1 ESTERASE INHIBITOR, FUNCTIONAL
ASSAY-PND
[**2128-12-4**] 06:00AM BLOOD C4-PND
.
CXR [**12-3**]: FINDINGS: The patient is status post endotracheal
tube placement with the tip lying 3.0 cm above the level of the
carina. There are right base atelectatic changes. There are low
lung volumes. The lungs are clear with no evidence of pneumonia
or congestive heart failure. There is no evidence of pleural
effusions or pneumothorax. The cardiac and mediastinal contours
are normal in appearance. The visualized osseous structures are
unremarkable. There are high-density ovoid structures projecting
over the right upper quadrant of the abdomen that could either
represent gallstones or may be extrinsic to the patient. Please
correlate clinically. IMPRESSION: 1. ET tube 3 cm above the
level of the carina. 2. Possible calcified gallstones.
.
CXR ([**2128-12-4**]): Tubes and lines in good position. Nasogastric
tube coils in the stomach. Atelectasis in the left lower lobe.

Brief Hospital Course:
The patient presented with lip and tongue swelling consistent
with angioedema in setting of ACEi use. She was intubated for
airway protection in the ED. Upon admission to the ICU, the
patient was started on pulse dose steroids, antihistamines and
H2 blockers around the clock. Her swelling rapidly improved and
she was successfully extubated within 48 hours. She was
evaluated by the allergy consult service who recommended C4 and
C1 esterase inhibitor levels which are pending at the time of
discharge. The patient was discharged on an oral prednisone
taper. She was transitioned off of her home ACEi in favor of
amlodipine for blood pressure control. She was also [**Month/Day/Year 1988**]
for outpatient allergy follow-up. The patient should avoid all
ACEi and [**Last Name (un) **] use in the future.

The patient was incidentally noted to have hilar lymphadenopathy
on CXR. Outpatient CT is recommended for further evaluation of
this finding.

She continues on albuertol for astham and oral contraceptives
for chronic uterine bleeding.

Medications on Admission:
Home Medications:
Lisinopril 10 mg daily
Albuterol 2 puffs prn
Flovent [**12-24**] inh [**Hospital1 **]
Nasonex 50 mcg 2 sprays daily
Norethindrone-Ethin (Necon 1/35) once a day
.
Allergies:
Erythromycin causes rash and itching.  Penicillin causes throat
swelling and anaphylaxis type reaction.  Allergy to codeine,
which causes anaphylaxis.  Bactrim causes rash.  Egg causes
hives.


Discharge Medications:
1. Prednisone 20 mg Tablet Sig: Per schedule Tablet PO DAILY
(Daily): 2 pills for 2 days, 1 pill for 2 days and then 0.5
pills for 2 days.
Disp:*8 Tablet(s)* Refills:*0*
2. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation Q6H (every 6 hours).
3. Flovent HFA 110 mcg/Actuation Aerosol Sig: [**12-24**]  Inhalation
twice a day.
4. Nasonex 50 mcg/Actuation Spray, Non-Aerosol Sig: Two (2)
Nasal once a day.
5. Necon 1/35 (28) 1-35 mg-mcg Tablet Sig: One (1) Tablet PO
once a day.
6. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Angioedema

Hypertension


Discharge Condition:
Stable


Discharge Instructions:
You were admitted with swelling of the lips and tongue. This was
almost certainly due to an allergic reaction to the medication
lisinopril. Avoid this medication in the future and all other
medications of this class, called ACE inhibitors or angiotensin
converting enzyme inhibitors.Please complete a course of
prednisone as treatment for this problem. Follow-up in your
primary care doctors office as [**Name5 (PTitle) 1988**].  Also follow-up with
Dr. [**Last Name (STitle) 2603**] of allergy medicine as [**Last Name (STitle) 1988**].

Take all medications as prescribed. Take amlodipine for blood
pressure control.

Call your doctor or return to the ED for any new or worsening
swelling of the lips or tongue, shortness of breath, chest pain
or any other concerning symptoms.

Followup Instructions:
Primary care: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], RN, CS Phone:[**Telephone/Fax (1) 250**] [**2128-12-14**]
8:00

Allergy: Dr. [**Last Name (STitle) 2603**] ([**Telephone/Fax (1) **]) Tuesday [**2128-2-8**]
9:00AM
{'Angioneurotic edema, not elsewhere classified,Other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use,Unspecified essential hypertension,Extrinsic asthma, unspecified,Leiomyoma of uterus, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Excessive or frequent menstruation,Enlargement of lymph nodes'}


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: CC:[**CC Contact Info 104586**]
Major Surgical or Invasive Procedure:
endotracheal intubation
Nasogastric tube

PRESENT ILLNESS: HPI:  52 y/o lady with hyptension presented to the Emergency
Department with swollen tongue and funny feeling in her tongue.
Patient is sedated at this time and history was obtained from
the medical records.  Patient denied any difficulty breathing,
palpitations, nausea, vomitting or diarrhea.  No new food
exposure.  Vitals in ED were T 98.3  BP 161/117  HR 94  RR 12
100% RA.  Her swelling was worsening in ED and was she was
intubated for airway protection.  She recieved solumedrol 125 mg
IV, benadryl 30 mg IV, pepcid 20 mg IV, fentanyl 100 mcg IV x2
and versed 2 mg IV x 2.

MEDICAL HISTORY: PMHx:
Hypertension
Asthma
Menorrhagia secondary to fibroid uterus
Seasonal Allergies

MEDICATION ON ADMISSION: Home Medications:
Lisinopril 10 mg daily
Albuterol 2 puffs prn
Flovent [**12-24**] inh [**Hospital1 **]
Nasonex 50 mcg 2 sprays daily
Norethindrone-Ethin (Necon 1/35) once a day
.
Allergies:
Erythromycin causes rash and itching.  Penicillin causes throat
swelling and anaphylaxis type reaction.  Allergy to codeine,
which causes anaphylaxis.  Bactrim causes rash.  Egg causes
hives.

ALLERGIES: Erythromycin Base / Penicillins / Codeine / Bactrim Ds / Egg /
Shellfish Derived / Lisinopril / Ace Inhibitors / Valsartan

PHYSICAL EXAM: Vitals:  T 96.3  HR 79  BP 153/98  RR 14  100% FiO2.  CMV/AC
FiO2 100% TV 550 PEEP 5.
Gen:  Medically sedated.  Not responding to verbal stimuli.
HEENT:  Swollen lips.  asymetric swelling of the cheeks right
greater than left.  Unable to properly assess oropharynx given
swollen lips and OT tube.
Heart:  S1S2 RRR, no MRG
Lungs:  CTAB in ant lung fields, no wheezes or crackles
Abdomen:  Obese, BS present, soft NTND, no appreciable
mass/organomegaly
Ext:  WWP, DP 2+, no edema
Neuro: Limited due to sedation.  Pinpoint pupils.

FAMILY HISTORY: Unable to obtain any significant history.
.

SOCIAL HISTORY: Social History: (obtained from OMR notes)
She is single, currently not in a relationship.  She has two
grown sons.   in their 20s, a boy and girl.  She use to work at
[**Hospital1 18**]. 

### Response:
{'Angioneurotic edema, not elsewhere classified,Other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use,Unspecified essential hypertension,Extrinsic asthma, unspecified,Leiomyoma of uterus, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Excessive or frequent menstruation,Enlargement of lymph nodes'}
