CHIEF COMPLAINT: back pain

PRESENT ILLNESS: 74 yo F with a history of hypertension, coronary artery disease,
carotid stenosis, hypercholesterolemia, afib, lacunar stroke,
who presented to the ED complaining of weakness.
She was found to have severe bradycardia, hypotension and acute
on chronic renal failure. She was initially treated with
kayexalate and atropine intially. However, upon arrival to the
MICU goals of care were further discussed. After multiple family
meetings, the decision was not to proceed with further workup
and have the goals directed at comfort measures only. She was
changed to morphine prn and zofran. Additionally she was given
NTG prn for back pain with relief.

MEDICAL HISTORY: Hypertension
Coronary artery disease non-intervenable 3 vessel disease
(severe disease of her left cx, mid and distal LAD) medically
managed
Hypercholesterolemia
Paroxysmal afib
Mini strokes
Right ICA 80-99%, left ICA 60-90% stenosis.
Renal insufficiency baseline Cr 1.2-1.4

MEDICATION ON ADMISSION: amiodarone 200 mg p.o. daily,
Zetia 10 mg po daily,
Inderal LA 160 mg p.o. daily,
lisinopril 20 mg twice a day,
Plavix 75 mg p.o. daily,
Nitro prn
Levoxyl 75 mcg p.o. daily,
Norvasc 10 mg p.o. daily,
aspirin 81 mg p.o. daily,
Triamterene/HCTZ 25 mg p.o. daily.
Imdur [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GENERAL: tired-appearing, NAD, speaks in very short phrases
(baseline)
NECK: JVP elevated
CV: regular, nl S1S2, nl M/R/G
PULM: crackles bilaterally, no wheezing
ABD: + BS, soft NT, ND, obese
Ext: no edema
NEURO: approprite; exam non-focal

FAMILY HISTORY: Her brother and mother have CAD.

SOCIAL HISTORY: A 35-40 pack year history, she quit in [**2103**]. No
alcohol use.
Acute kidney failure, unspecified,Congestive heart failure, unspecified,Dehydration,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Atrial fibrillation,Mitral valve disorders,End stage renal disease,Coronary atherosclerosis of native coronary artery,Unspecified acquired hypothyroidism,Anemia, unspecified
Acute kidney failure NOS,CHF NOS,Dehydration,Hyp kid NOS w cr kid V,Atrial fibrillation,Mitral valve disorder,End stage renal disease,Crnry athrscl natve vssl,Hypothyroidism NOS,Anemia NOS
Admission Date:  [**2116-7-24**]              Discharge Date:   [**2116-7-31**]

Date of Birth:  [**2041-9-27**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 898**]
Chief Complaint:
back pain

Major Surgical or Invasive Procedure:
PICC placement


History of Present Illness:
74 yo F with a history of hypertension, coronary artery disease,
carotid stenosis, hypercholesterolemia, afib, lacunar stroke,
who presented to the ED complaining of weakness.
She was found to have severe bradycardia, hypotension and acute
on chronic renal failure. She was initially treated with
kayexalate and atropine intially. However, upon arrival to the
MICU goals of care were further discussed. After multiple family
meetings, the decision was not to proceed with further workup
and have the goals directed at comfort measures only. She was
changed to morphine prn and zofran. Additionally she was given
NTG prn for back pain with relief.


Past Medical History:
Hypertension
Coronary artery disease non-intervenable 3 vessel disease
(severe disease of her left cx, mid and distal LAD) medically
managed
Hypercholesterolemia
Paroxysmal afib
Mini strokes
Right ICA 80-99%, left ICA 60-90% stenosis.
Renal insufficiency baseline Cr 1.2-1.4


Social History:
A 35-40 pack year history, she quit in [**2103**]. No
alcohol use.


Family History:
Her brother and mother have CAD.

Physical Exam:
GENERAL: tired-appearing, NAD, speaks in very short phrases
(baseline)
NECK: JVP elevated
CV: regular, nl S1S2, nl M/R/G
PULM: crackles bilaterally, no wheezing
ABD: + BS, soft NT, ND, obese
Ext: no edema
NEURO: approprite; exam non-focal


Pertinent Results:
Admission labs:
[**2116-7-23**] 08:15PM BLOOD WBC-11.6* RBC-4.04* Hgb-12.5 Hct-37.4
MCV-93# MCH-30.9 MCHC-33.4 RDW-14.7 Plt Ct-253
[**2116-7-23**] 08:15PM BLOOD PT-11.5 PTT-23.9 INR(PT)-1.0
[**2116-7-23**] 08:15PM BLOOD Glucose-185* UreaN-35* Creat-2.4*# Na-134
K-7.4* Cl-109* HCO3-16* AnGap-16
[**2116-7-24**] 03:42AM BLOOD Calcium-8.7 Phos-4.7* Mg-2.1
[**2116-7-24**] 03:42AM BLOOD Hapto-202*

Brief Hospital Course:
74 yo with CAD, afib, hypertension, bilateral carotid stenosis,
hypercholesterolemia, lacunar stroke, who presented to the ED
with hyperkalemia, acute on chronic renal failure and with
bradycardia.

Bradycardia. Found in the ED to be severely bradycardic and was
given atropine. On review of the ECG it appears to be slow
atrial fib or junctional escape rhythm.
Currently she is in normal sinus rhythm with a rate of 54 (only
slightly bradycardic). It is difficult to tell if the
bradycardia preceeded/caused renal failure.  She was evaluated
by PE and thought not to be a candidate for a pacer currently.
If she again goes into atrial fib or has persistent bradycardia,
may need to consider pacer at that time.

Acute on chronic renal failure: initally had rapidly worsening
renal function.  Potassium continued to increase and patient
refused dialysis.  She was treated with kayexelate but continued
to have poor renal function.  Was briefly CMO but had
improvement in renal function.
Cause thought to be secondary to prerenal causes.  Renal
function continued to improve without any clear cause.

CHF. EF 55% with 3+ MR [**First Name (Titles) **] [**Last Name (Titles) 1192**] TR. WAs volume overloaded
and had oxygen requirement. Held on diuresis until renal
function improved and then was given 1 dose of 20 mg lasix to
which she had large volume diuresis and at time of discharge did
not have an oxygen requirement.

CAD. Per history has non-intervenable 3 vessel disease that is
managed medically. Per previous records has refused
catherization. Will follow for now. [**Month (only) 116**] need stress test per
cardiology as outpatient.
- Continued on ASA, Plavix
- Held beta-blockers, lisinopril, imdur for now and will restart
with symptoms and increased BP.

Hypothyroidism. Continued Synthroid. TSH normal.

Anemia. Baseline Hct low 30's and stable but without signs of
iron deficiency (chronic disease).
.
PAF. No nodal agents. No amiodarone.

Code: DNR/I

Medications on Admission:
amiodarone 200 mg p.o. daily,
Zetia 10 mg po daily,
Inderal LA 160 mg p.o. daily,
lisinopril 20 mg twice a day,
Plavix 75 mg p.o. daily,
Nitro prn
Levoxyl 75 mcg p.o. daily,
Norvasc 10 mg p.o. daily,
aspirin 81 mg p.o. daily,
Triamterene/HCTZ 25 mg p.o. daily.
Imdur [**Hospital1 **]


Discharge Medications:
1. Nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) Tablet,
Sublingual Sublingual PRN (as needed) as needed for chest pain.

2. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
3. Simethicone 80 mg Tablet, Chewable Sig: [**2-11**] Tablet, Chewables
PO QID (4 times a day) as needed for indigestion.
4. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed.
5. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical Q 24H (Every 24 Hours)
as needed for back pain: 12 hours on, 12 hours off.
6. Levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
8. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. Acetaminophen 500 mg Tablet Sig: One (1) Tablet PO Q6H (every
6 hours) as needed for pain.
10. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours) as needed.
11. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
12. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
13. Calcitriol 0.25 mcg Capsule Sig: One (1) Capsule PO EVERY
OTHER DAY (Every Other Day).
14. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q12H
(every 12 hours) for 3 days.
15. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).


Discharge Disposition:
Extended Care

Facility:
Roscommon

Discharge Diagnosis:
Renal failure
Bradycardia
Congestive heart failure

Secondary: Hypertension, coronary artery disease,
hypercholesterolemia, history of atrial fibrillation, history of
strokes, carotid stenosis, renal insufficiency


Discharge Condition:
improved renal function


Discharge Instructions:
You were admitted with renal failure and low heart rate.   You
were treated with IV fluids and holding your heart rate
medications

Please return to the ED or call your doctor if you have any
shortness of breath, pain, passing out or any other concerning
sytmptoms.

Patient recently had renal failure leading to hyperkalemia.
Will need close monitoring of her renal function and
electrolytes.

Also patient with volume overload.  Will need monitoring of
fluid status.  Responds well to lasix.

She has been taken off all of her cardiac medicines including
imdur, norvasc, lisinopril, zetia, inderal, and amiodarone due
to bradycardia.  She has a history of atrial fibrillation and
hypertension.  If patient becomes tachycardic or hypertensive
will need to restart.

Followup Instructions:
Please follow up with your PCP [**Name9 (PRE) **],[**Name9 (PRE) **] [**Telephone/Fax (1) 250**] in
[**2-11**] weeks

Please follow up with cardiology.
{'Acute kidney failure, unspecified,Congestive heart failure, unspecified,Dehydration,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Atrial fibrillation,Mitral valve disorders,End stage renal disease,Coronary atherosclerosis of native coronary artery,Unspecified acquired hypothyroidism,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: back pain

PRESENT ILLNESS: 74 yo F with a history of hypertension, coronary artery disease,
carotid stenosis, hypercholesterolemia, afib, lacunar stroke,
who presented to the ED complaining of weakness.
She was found to have severe bradycardia, hypotension and acute
on chronic renal failure. She was initially treated with
kayexalate and atropine intially. However, upon arrival to the
MICU goals of care were further discussed. After multiple family
meetings, the decision was not to proceed with further workup
and have the goals directed at comfort measures only. She was
changed to morphine prn and zofran. Additionally she was given
NTG prn for back pain with relief.

MEDICAL HISTORY: Hypertension
Coronary artery disease non-intervenable 3 vessel disease
(severe disease of her left cx, mid and distal LAD) medically
managed
Hypercholesterolemia
Paroxysmal afib
Mini strokes
Right ICA 80-99%, left ICA 60-90% stenosis.
Renal insufficiency baseline Cr 1.2-1.4

MEDICATION ON ADMISSION: amiodarone 200 mg p.o. daily,
Zetia 10 mg po daily,
Inderal LA 160 mg p.o. daily,
lisinopril 20 mg twice a day,
Plavix 75 mg p.o. daily,
Nitro prn
Levoxyl 75 mcg p.o. daily,
Norvasc 10 mg p.o. daily,
aspirin 81 mg p.o. daily,
Triamterene/HCTZ 25 mg p.o. daily.
Imdur [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GENERAL: tired-appearing, NAD, speaks in very short phrases
(baseline)
NECK: JVP elevated
CV: regular, nl S1S2, nl M/R/G
PULM: crackles bilaterally, no wheezing
ABD: + BS, soft NT, ND, obese
Ext: no edema
NEURO: approprite; exam non-focal

FAMILY HISTORY: Her brother and mother have CAD.

SOCIAL HISTORY: A 35-40 pack year history, she quit in [**2103**]. No
alcohol use. 

### Response:
{'Acute kidney failure, unspecified,Congestive heart failure, unspecified,Dehydration,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Atrial fibrillation,Mitral valve disorders,End stage renal disease,Coronary atherosclerosis of native coronary artery,Unspecified acquired hypothyroidism,Anemia, unspecified'}
