CHIEF COMPLAINT: dizziness, acute renal failure

PRESENT ILLNESS: Mr. [**Known lastname 805**] is a 57 yo male with PMH of HCV cirrhosis, HCC
(followed by Dr. [**Last Name (STitle) 497**] DM, anemia, HTN who was admitted to MICU
on [**11-5**] for two episodes of 10 second pauses.  The patient was
admitted recently for anasarca.  He was sent home on increased
dose of spironolactone.  He had presyncopal episode with
standing on the day of admission.  He was taken to the ED where
he was noted to have K 5.6 and creatinine up to 3.1 (baseline
1.6-1.7).  ECG showed peaked T waves.  He was treated with
insulin, bicarb and kayexalate.  While in the ED he was noted to
have two episodes of ten second pauses.  During these episodes
the patient was noted to be lightheaded.  Cardiology was
consulted and felt that his pauses were related to electrolyte
disturbances.
.
While in the MICU the patient was monitored on telemetry.  He
was noted to be in a junctional rhythm overnight, converted to
NSR in the AM.  His calcium channel blockers were held and were
postulated to be the cause of the asystole.  His potassium was
corrected with bicarb, insulin, kayexalate, and calcium
gluconate and is currently 3.9.  Creatinine has also improved to
2.2 (almost baseline) with IVF.  He remained alert and oriented
in MICU.

MEDICAL HISTORY: #. Multiple gallbladder stones w/o cholecystitis
#. Hepatocellular Carcinoma
- two bx lesions c (+) path
- s/p RFA [**2103-8-29**]
#. Recent hospitalization x2 over last 2-3 months for severe
cellulitis of lower extremities
#. Hep C Genotype 1
- Pegylated interferon, ribavirin ([**2096**]): Viral relapse
- Liver bx ([**2099**]): Stage 3 fibrosis, grade 2 inflammation
- EGD ([**7-/2101**]): Esophagitis, no varices
- AFP 9.8
#. Hypertension
#. DMII: c/b neuropathy
#. Psoriasis
#. Anxiety
#. GERD
#. Chronic anemia
#. s/p laminectomy ([**11/2095**])
#. Chronic pain [**2-3**] laminectomy managed by methadone
#. s/p right ankle surgery ([**2089**])

MEDICATION ON ADMISSION: ASA 81mg PO daily
Diltiazem 300mg PO daily
Furosemide 50mg PO daily
Spironolactone 75mg PO daily - working up to a dose of 100mg PO
daily
Klonopin 0.5mg PO daily prn
Lantus 110u SQ qHS
Methadone 40mg PO qAM, 30mg PO qPM
Ezetimibe 10mg PO daily
Amlactin 12% apply to arms and legs daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T98.6  HR84  BP128/86  RR16  O2Sats 100% RA
Gen: Well appearing, well nourished. Alert, oriented and in NAD.

FAMILY HISTORY: Both parents alive and in good health. Overweight/obesity and
HTN in multiple family members.

SOCIAL HISTORY: Lives at home with girlfriend. Currently on disability
(formerly employed in communications/IT); no tobacco; no hx of
recreational drug use; very occasional EtOH (last beer was 1
week ago when son was visiting).
Acute kidney failure, unspecified,Malignant neoplasm of liver, primary,Hyperpotassemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Sinoatrial node dysfunction,Chronic hepatitis C without mention of hepatic coma,Cirrhosis of liver without mention of alcohol,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Unspecified essential hypertension,Anemia, unspecified
Acute kidney failure NOS,Mal neo liver, primary,Hyperpotassemia,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Sinoatrial node dysfunct,Chrnc hpt C wo hpat coma,Cirrhosis of liver NOS,DMII neuro nt st uncntrl,Neuropathy in diabetes,Hypertension NOS,Anemia NOS
Admission Date:  [**2103-11-5**]              Discharge Date:   [**2103-11-7**]

Date of Birth:  [**2046-10-17**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2745**]
Chief Complaint:
dizziness, acute renal failure

Major Surgical or Invasive Procedure:
None


History of Present Illness:
Mr. [**Known lastname 805**] is a 57 yo male with PMH of HCV cirrhosis, HCC
(followed by Dr. [**Last Name (STitle) 497**] DM, anemia, HTN who was admitted to MICU
on [**11-5**] for two episodes of 10 second pauses.  The patient was
admitted recently for anasarca.  He was sent home on increased
dose of spironolactone.  He had presyncopal episode with
standing on the day of admission.  He was taken to the ED where
he was noted to have K 5.6 and creatinine up to 3.1 (baseline
1.6-1.7).  ECG showed peaked T waves.  He was treated with
insulin, bicarb and kayexalate.  While in the ED he was noted to
have two episodes of ten second pauses.  During these episodes
the patient was noted to be lightheaded.  Cardiology was
consulted and felt that his pauses were related to electrolyte
disturbances.
.
While in the MICU the patient was monitored on telemetry.  He
was noted to be in a junctional rhythm overnight, converted to
NSR in the AM.  His calcium channel blockers were held and were
postulated to be the cause of the asystole.  His potassium was
corrected with bicarb, insulin, kayexalate, and calcium
gluconate and is currently 3.9.  Creatinine has also improved to
2.2 (almost baseline) with IVF.  He remained alert and oriented
in MICU.


Past Medical History:
#. Multiple gallbladder stones w/o cholecystitis
#. Hepatocellular Carcinoma
- two bx lesions c (+) path
- s/p RFA [**2103-8-29**]
#. Recent hospitalization x2 over last 2-3 months for severe
cellulitis of lower extremities
#. Hep C Genotype 1
- Pegylated interferon, ribavirin ([**2096**]): Viral relapse
- Liver bx ([**2099**]): Stage 3 fibrosis, grade 2 inflammation
- EGD ([**7-/2101**]): Esophagitis, no varices
- AFP 9.8
#. Hypertension
#. DMII: c/b neuropathy
#. Psoriasis
#. Anxiety
#. GERD
#. Chronic anemia
#. s/p laminectomy ([**11/2095**])
#. Chronic pain [**2-3**] laminectomy managed by methadone
#. s/p right ankle surgery ([**2089**])


Social History:
 Lives at home with girlfriend. Currently on disability
(formerly employed in communications/IT); no tobacco; no hx of
recreational drug use; very occasional EtOH (last beer was 1
week ago when son was visiting).


Family History:
Both parents alive and in good health. Overweight/obesity and
HTN in multiple family members.

Physical Exam:
Vitals: T98.6  HR84  BP128/86  RR16  O2Sats 100% RA
Gen: Well appearing, well nourished. Alert, oriented and in NAD.

Heent: NC/AT, PERRL, EOMI
Neck: no JVD, Trachea is midline, no thyromegaly
Pulm: CTA-B except for the occasional crackle at his lung bases

CV: RRR, nl S1 and S2, no MRG
Abd: ND, NA BS, S/NT
Extr: MAEE, darkened skin over LE bilaterally concsistent with
areas of skin breakdown during previous admission for anasarca,
now well healed.  Stigmata of chronic venous stasis
Neuro: Sensation is grossly normal with 5/5 strength throughout;
CNIII-XII intact.


Pertinent Results:
[**2103-11-5**] 08:28PM   K+-5.7*
[**2103-11-5**] 07:05PM   CK-MB-9 cTropnT-0.04*
[**2103-11-5**] 07:05PM   CK(CPK)-395*
[**2103-11-5**] 07:05PM   WBC-9.9 RBC-3.56* HGB-11.1* HCT-34.2* MCV-96
MCH-31.2 MCHC-32.6 RDW-15.1
[**2103-11-5**] 07:05PM   NEUTS-70.9* LYMPHS-19.9 MONOS-7.1 EOS-1.2
BASOS-0.9
[**2103-11-5**] 07:05PM   GLUCOSE-346* UREA N-37* CREAT-3.1*
SODIUM-127* POTASSIUM-5.6* CHLORIDE-93* TOTAL CO2-20* ANION
GAP-20

Brief Hospital Course:
57 year old male with history of HCV cirrhosis, HCC, DM, anemia,
HTN who was admitted to MICU on [**11-5**] after two episodes of ten
second pauses and had an uneventful, brief hospital course.

1) Pauses: Attributed to calcium channel blocker overload in the
setting of renal failure, perhaps with contribution of
electrolyte abnormalities also due to renal failure.  Negative
cardiac enzymes. ECG with prolonged Q-T interval as was
previously recorded. Monitored on telemetry throughout. Held
Calcium channel blocker until the day of discharge, at which
point it was restarted at a lower dose (Dilt Extended Release,
120mg QD). BP was generally between 100 and 120 systolic with HR
52-72 (generally above 60 later in the hospital course).  There
were no further pauses on telemetry.

2) Hyperkalemia: In the setting of recent increases in his
diuretic dosages for treatment of his ascities, poor PO intake
and decreased UOP, we felt that the patient sufferred from acute
on chronic renal failure from over-diuresis, which subsequently
lead to his electrolyte abnormalities.  K normalized with
treatment. Spironolactone was discontinued. The patient was
discharged on Lasix, with strict instructions and prescriptions
mandating repeat blood work within one week with results to be
followed-up at his scheduled outpatient appointment.

3) Acute on chronic renal failure (with a baseline of 1.7-1.9)
in the setting of aggressive diuresis post admission for
anasarca.  Returned to baseline. Stopped Spironolactone as
above. Pt will require continued close follow-up while on Lasix
20mg QD as above.

4) DMII: Patient was maintained on Lantus, SS with good control
throughout the hospitalizaiton.

5) HTN: As above, patient's K-sparing diuretic was stopped
secondary to hyperkalemia. Pressures remained essentially at
baseline throughout his course despite this change. Lasix was
decreased to 20mg QD.


6) Chronic Pain: Unchanged from baseline throughout course.
Continued Methadone 40 QAM and 30 QHS as patient's home regimen.

7) Chronic Anxiety: Stable throughout course. Continued Klonopin
0.5 QHS.

8) HCV cirrhosis/HCC: per report, patient being evaluated for
liver transplant. Previous MELD of 16. Transplantation options
were not further persued during this brief hospitalization.

9) PPx: Patient was maintained on H2 blocker, pneumoboots and/or
Heparin SC throughout course.



Medications on Admission:
ASA 81mg PO daily
Diltiazem 300mg PO daily
Furosemide 50mg PO daily
Spironolactone 75mg PO daily - working up to a dose of 100mg PO
daily
Klonopin 0.5mg PO daily prn
Lantus 110u SQ qHS
Methadone 40mg PO qAM, 30mg PO qPM
Ezetimibe 10mg PO daily
Amlactin 12% apply to arms and legs daily

Discharge Medications:
1. Clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO QHS PRN at
bedtime for anxiety. (Only if needed).
Disp:*30 Tablet(s)* Refills:*0*
2. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
Disp:*30 Tablet, Chewable(s)* Refills:*0*
3. Diltiazem HCl 120 mg Capsule, Sustained Release Sig: One (1)
Capsule, Sustained Release PO DAILY (Daily).
Disp:*30 Capsule, Sustained Release(s)* Refills:*0*
4. Methadone 10 mg Tablet Sig: Three (3) Tablet PO QHS (once a
day (at bedtime)) as needed.
Disp:*90 Tablet(s)* Refills:*0*
5. Methadone 40 mg Tablet, Soluble Sig: One (1) Tablet, Soluble
PO QAM (once a day (in the morning)) as needed.
Disp:*30 Tablet, Soluble(s)* Refills:*0*
6. Lantus 100 unit/mL Cartridge Sig: One Hundred-Ten (110) units
Subcutaneous at bedtime.
Disp:*60 * Refills:*0*
7. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
Caregroup

Discharge Diagnosis:
Hyperkalemia
Acute Renal Failure
Asystolic Pauses


Discharge Condition:
Good


Discharge Instructions:
You were admitted for hyperkalemia and pauses in your heart beat
as well as compromised renal function.
.
Please call your PCP or return to the hospital for chest pain,
shortness of breath, changes in vision, dizziness, vertigo,
syncope, palpitations, new headache, intractable nausea and
vomiting, palptiations, or any other concerning symptom.
.
We DISCONTINUED the following medications:
-Spironolactone
-Lasix
.
We did not add any medications.
We changed your dose of Diltiazam ER from 300mg PO QD to 120mg
QD

Followup Instructions:
1) Please see Dr. [**Last Name (STitle) **], phone ([**Telephone/Fax (1) 17612**] [**12-3**] at
7:15PM.
.
2) Provider: [**Name10 (NameIs) 1570**],INTERPRET W/LAB NO CHECK-IN [**Name10 (NameIs) 1570**] INTEPRETATION
BILLING Date/Time:[**2103-11-13**] 2:00
.
3) Provider: [**Name10 (NameIs) 1571**] FUNCTION LAB Phone:[**Telephone/Fax (1) 609**]
Date/Time:[**2103-11-13**] 2:00
.
4) Provider: [**Name10 (NameIs) **] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 673**]
Date/Time:[**2103-11-26**] 8:00



Completed by:[**2103-11-13**]
{'Acute kidney failure, unspecified,Malignant neoplasm of liver, primary,Hyperpotassemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Sinoatrial node dysfunction,Chronic hepatitis C without mention of hepatic coma,Cirrhosis of liver without mention of alcohol,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Unspecified essential hypertension,Anemia, unspecified'}


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: dizziness, acute renal failure

PRESENT ILLNESS: Mr. [**Known lastname 805**] is a 57 yo male with PMH of HCV cirrhosis, HCC
(followed by Dr. [**Last Name (STitle) 497**] DM, anemia, HTN who was admitted to MICU
on [**11-5**] for two episodes of 10 second pauses.  The patient was
admitted recently for anasarca.  He was sent home on increased
dose of spironolactone.  He had presyncopal episode with
standing on the day of admission.  He was taken to the ED where
he was noted to have K 5.6 and creatinine up to 3.1 (baseline
1.6-1.7).  ECG showed peaked T waves.  He was treated with
insulin, bicarb and kayexalate.  While in the ED he was noted to
have two episodes of ten second pauses.  During these episodes
the patient was noted to be lightheaded.  Cardiology was
consulted and felt that his pauses were related to electrolyte
disturbances.
.
While in the MICU the patient was monitored on telemetry.  He
was noted to be in a junctional rhythm overnight, converted to
NSR in the AM.  His calcium channel blockers were held and were
postulated to be the cause of the asystole.  His potassium was
corrected with bicarb, insulin, kayexalate, and calcium
gluconate and is currently 3.9.  Creatinine has also improved to
2.2 (almost baseline) with IVF.  He remained alert and oriented
in MICU.

MEDICAL HISTORY: #. Multiple gallbladder stones w/o cholecystitis
#. Hepatocellular Carcinoma
- two bx lesions c (+) path
- s/p RFA [**2103-8-29**]
#. Recent hospitalization x2 over last 2-3 months for severe
cellulitis of lower extremities
#. Hep C Genotype 1
- Pegylated interferon, ribavirin ([**2096**]): Viral relapse
- Liver bx ([**2099**]): Stage 3 fibrosis, grade 2 inflammation
- EGD ([**7-/2101**]): Esophagitis, no varices
- AFP 9.8
#. Hypertension
#. DMII: c/b neuropathy
#. Psoriasis
#. Anxiety
#. GERD
#. Chronic anemia
#. s/p laminectomy ([**11/2095**])
#. Chronic pain [**2-3**] laminectomy managed by methadone
#. s/p right ankle surgery ([**2089**])

MEDICATION ON ADMISSION: ASA 81mg PO daily
Diltiazem 300mg PO daily
Furosemide 50mg PO daily
Spironolactone 75mg PO daily - working up to a dose of 100mg PO
daily
Klonopin 0.5mg PO daily prn
Lantus 110u SQ qHS
Methadone 40mg PO qAM, 30mg PO qPM
Ezetimibe 10mg PO daily
Amlactin 12% apply to arms and legs daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T98.6  HR84  BP128/86  RR16  O2Sats 100% RA
Gen: Well appearing, well nourished. Alert, oriented and in NAD.

FAMILY HISTORY: Both parents alive and in good health. Overweight/obesity and
HTN in multiple family members.

SOCIAL HISTORY: Lives at home with girlfriend. Currently on disability
(formerly employed in communications/IT); no tobacco; no hx of
recreational drug use; very occasional EtOH (last beer was 1
week ago when son was visiting). 

### Response:
{'Acute kidney failure, unspecified,Malignant neoplasm of liver, primary,Hyperpotassemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Sinoatrial node dysfunction,Chronic hepatitis C without mention of hepatic coma,Cirrhosis of liver without mention of alcohol,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Unspecified essential hypertension,Anemia, unspecified'}
