CHIEF COMPLAINT: Difficulty swallowing.

PRESENT ILLNESS: This is a 79 y/o male patient with multiple system atrophy
(aggresive form of Parkinsons), HTN, prostate ca s/p XRT who was
initially admitted to neurology service on [**7-14**] for dysphagia
secondary to rapid deterioration of MSA and PEG placement. PEG
placement successful but after patient had sudden Hct drop and
on CT scan was found to have right RP and thigh bleed hematoma,
unknown etiology, transferred to MICU. Vascular consulted and
felt surgery and angio no indicated at present time as patient
would require intubation. Patient was transfused a total of 9
units of blood while in the MICU. Patient last blood transfusion
was on [**2138-7-25**] in the am and Hct has been stable. For the past
few days patient neurologic function has become worse, where
patient very stiff. Neurology following patient for management
of MSA. Patient also noted to be hypernatremic in the MICU and
is being given free water bolus through PEG tube. During
hospital course patient had thrombocytopenia as well, HIT sent
which came back negative, plt count starting to improve. He
continue to spike low grade fevers, patient pan-cultured with no
source of infection found, CXR negative.

MEDICAL HISTORY: 1.)Multisystem atrophy
2.)HTN
3.)Prostate CA s/p XRT
4.)Cervical radiculopathy
5.)Hypercholesterolemia

MEDICATION ON ADMISSION: CELEXA 40MG--One by mouth every day
CIPRO 250 mg--one tablet(s) by mouth twice a day
DARVOCET-N 100 100-650MG--One by mouth q8 as needed for pain
DDAVP 0.2MG--One by mouth at bedtime
TERAZOSIN 10MG--2 by mouth every day
IBUPROFEN 800MG--One by mouth three times a day with food
NYSTATIN [**Numeric Identifier 4856**] U/G--Apply twice a day to affected area
PLAVIX 75MG--One every day
ROBINUL 1 mg--1 (one) tablet(s) by mouth three times a day
.
transfer-
1.)Terazosin 2mg daily
2.)Citalopram 40mg daily
3.)Mirapex 0.5mg daily
4.)Lansoprazole 30mg daily
5.)SC heparin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: t 98.4, bp 112/59, hr 104, rr 19, spo2 97%ra
gen- chronically ill appearing elderly male in nad
cv- tachy but reg, no m/r/g
pul- moves air well, minimal bibasilar rales
abd- peg in place, soft, nt, nd, nabs
back- no sacral edema, no bruising
extrm- 1+ edema over shins bilaterally
nails- no clubbing, no pitting/color changes/indentations
neuro- awake, non-verbal, resting tremor, moves extremeties

FAMILY HISTORY: No neuro disease

SOCIAL HISTORY: Pt lives with wife and is cared for by multiple aides.  He is
totally depedent for adl's.  Quit tobacco 30yrs ago.
Other degenerative diseases of the basal ganglia,Acute kidney failure, unspecified,Hematoma complicating a procedure,Hyperosmolality and/or hypernatremia,Thrombocytopenia, unspecified,Hydronephrosis,Acute posthemorrhagic anemia,Urinary tract infection, site not specified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Unspecified essential hypertension,Personal history of malignant neoplasm of prostate
Degen basal ganglia NEC,Acute kidney failure NOS,Hematoma complic proc,Hyperosmolality,Thrombocytopenia NOS,Hydronephrosis,Ac posthemorrhag anemia,Urin tract infection NOS,Abn react-surg proc NEC,Hypertension NOS,Hx-prostatic malignancy
Admission Date:  [**2138-7-14**]              Discharge Date:   [**2138-7-28**]

Date of Birth:  [**2059-4-21**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 6195**]
Chief Complaint:
Difficulty swallowing.

Major Surgical or Invasive Procedure:
PEG placement.


History of Present Illness:
This is a 79 y/o male patient with multiple system atrophy
(aggresive form of Parkinsons), HTN, prostate ca s/p XRT who was
initially admitted to neurology service on [**7-14**] for dysphagia
secondary to rapid deterioration of MSA and PEG placement. PEG
placement successful but after patient had sudden Hct drop and
on CT scan was found to have right RP and thigh bleed hematoma,
unknown etiology, transferred to MICU. Vascular consulted and
felt surgery and angio no indicated at present time as patient
would require intubation. Patient was transfused a total of 9
units of blood while in the MICU. Patient last blood transfusion
was on [**2138-7-25**] in the am and Hct has been stable. For the past
few days patient neurologic function has become worse, where
patient very stiff. Neurology following patient for management
of MSA. Patient also noted to be hypernatremic in the MICU and
is being given free water bolus through PEG tube. During
hospital course patient had thrombocytopenia as well, HIT sent
which came back negative, plt count starting to improve. He
continue to spike low grade fevers, patient pan-cultured with no
source of infection found, CXR negative.


Past Medical History:
1.)Multisystem atrophy
2.)HTN
3.)Prostate CA s/p XRT
4.)Cervical radiculopathy
5.)Hypercholesterolemia


Social History:
Pt lives with wife and is cared for by multiple aides.  He is
totally depedent for adl's.  Quit tobacco 30yrs ago.


Family History:
No neuro disease

Physical Exam:
t 98.4, bp 112/59, hr 104, rr 19, spo2 97%ra
gen- chronically ill appearing elderly male in nad
cv- tachy but reg, no m/r/g
pul- moves air well, minimal bibasilar rales
abd- peg in place, soft, nt, nd, nabs
back- no sacral edema, no bruising
extrm- 1+ edema over shins bilaterally
nails- no clubbing, no pitting/color changes/indentations
neuro- awake, non-verbal, resting tremor, moves extremeties


Pertinent Results:
[**2138-7-24**] CT abd/pel: No change compared to the exam of two days
earlier. This includes the left-sided retroperitoneal bleed and
the more superior portion of the right lower extremity bleeding.
.
[**2138-7-23**] renal u/s: Ultrasound is compared with a CT scan
performed 1 day previously. Again, shown is bilateral
hydronephrosis with atrophic kidneys with marked cortical
atrophy. No perirenal fluid is identified. The retroperitoneal
hematoma surrounding the left kidney is not seen. Please note
that ultrasound is not a reliable imaging technique for
excluding the presence of retroperitoneal blood or for ongoing
active bleeding.
.
[**2138-7-22**] EKG:Baseline artifact
Rhythm uncertain - mostly regular/slight irregular tachycardia -
may be atrial tachycardia but baseline artifacttmad
Right bundle branch block
Nonspecific ST-T wave changes
Suggest repeat tracing
Since previous tracing of [**2138-7-16**], bradycardia replaced by
tachyarrhythmia
.
[**2138-7-22**] CT: 1. Large right thigh hematoma.
2. Large left posterior pararenal space hematoma, which appears
separate from the muscles associated with the left iliac [**Doctor First Name 362**] as
well as from the psoas muscle.
3. Pulmonary opacities in the right and left lower lobes,
suggestive of aspiration. Very small bilateral pleural
effusions.
4. Small pericardial effusion.
.

[**2138-7-27**] 03:31AM BLOOD WBC-28.6*# RBC-4.31* Hgb-13.3* Hct-39.3*
MCV-91 MCH-30.8 MCHC-33.8 RDW-15.4 Plt Ct-122*
[**2138-7-26**] 04:30AM BLOOD WBC-17.3* RBC-3.80* Hgb-11.6* Hct-34.3*
MCV-90 MCH-30.5 MCHC-33.8 RDW-15.6* Plt Ct-99*
[**2138-7-25**] 03:37AM BLOOD WBC-15.8* RBC-3.27* Hgb-10.0* Hct-29.5*
MCV-90 MCH-30.4 MCHC-33.7 RDW-15.5 Plt Ct-69*
[**2138-7-24**] 04:23AM BLOOD WBC-24.4* RBC-2.88* Hgb-8.7* Hct-25.3*
MCV-88 MCH-30.1 MCHC-34.2 RDW-15.8* Plt Ct-87*
[**2138-7-23**] 11:09AM BLOOD WBC-24.5* RBC-2.80* Hgb-8.3* Hct-24.7*
MCV-89 MCH-29.5 MCHC-33.3 RDW-15.2 Plt Ct-80*
[**2138-7-17**] 12:55PM BLOOD WBC-9.5 RBC-3.71* Hgb-11.1* Hct-32.7*
MCV-88 MCH-30.0 MCHC-34.1 RDW-13.6 Plt Ct-142*
[**2138-7-14**] 04:46PM BLOOD WBC-12.4*# RBC-4.26* Hgb-12.3* Hct-37.4*
MCV-88 MCH-28.9 MCHC-32.9 RDW-13.7 Plt Ct-189#
[**2138-7-23**] 11:09AM BLOOD Neuts-78* Bands-2 Lymphs-9* Monos-10
Eos-0 Baso-0 Atyps-0 Metas-0 Myelos-1*
[**2138-7-14**] 04:46PM BLOOD Neuts-82.2* Lymphs-11.4* Monos-5.8
Eos-0.4 Baso-0.3
[**2138-7-27**] 03:31AM BLOOD Plt Ct-122*
[**2138-7-27**] 03:31AM BLOOD PT-13.0 PTT-23.9 INR(PT)-1.1
[**2138-7-27**] 03:31AM BLOOD Fibrino-490*
[**2138-7-24**] 08:56AM BLOOD FDP-0-10
[**2138-7-27**] 03:31AM BLOOD Glucose-133* UreaN-31* Creat-1.0 Na-146*
K-3.2* Cl-104 HCO3-28 AnGap-17
[**2138-7-23**] 05:00AM BLOOD Glucose-129* UreaN-31* Creat-1.2 Na-145
K-4.5 Cl-114* HCO3-23 AnGap-13
[**2138-7-17**] 12:55PM BLOOD Glucose-76 UreaN-24* Creat-1.0 Na-145
K-3.3 Cl-106 HCO3-22 AnGap-20
[**2138-7-14**] 04:46PM BLOOD Glucose-104 UreaN-35* Creat-1.3* Na-145
K-4.3 Cl-108 HCO3-24 AnGap-17
[**2138-7-27**] 03:31AM BLOOD CK(CPK)-932*
[**2138-7-23**] 05:00AM BLOOD CK(CPK)-1354*
[**2138-7-22**] 03:00PM BLOOD LD(LDH)-208 TotBili-0.4
[**2138-7-14**] 04:46PM BLOOD ALT-32 AST-29 TotBili-0.6
[**2138-7-27**] 03:31AM BLOOD CK-MB-12* MB Indx-1.3 cTropnT-0.17*
[**2138-7-27**] 03:31AM BLOOD Calcium-8.0*
[**2138-7-26**] 04:30AM BLOOD Calcium-8.0* Phos-3.2 Mg-2.0
[**2138-7-25**] 03:37AM BLOOD Albumin-2.6* Calcium-8.0* Phos-3.9 Mg-1.9
[**2138-7-15**] 05:30AM BLOOD Calcium-9.2 Phos-3.3 Mg-2.2
[**2138-7-22**] 03:00PM BLOOD Hapto-159
[**2138-7-15**] 05:30AM BLOOD TSH-1.1
[**2138-7-27**] 02:31AM BLOOD Type-ART pO2-111* pCO2-48* pH-7.41
calHCO3-31* Base XS-5 Intubat-NOT INTUBA
[**2138-7-27**] 12:52AM BLOOD Type-ART Temp-38.8 pO2-92 pCO2-64*
pH-7.30* calHCO3-33* Base XS-2 Intubat-NOT INTUBA
[**2138-7-22**] 06:18PM BLOOD Type-ART pO2-175* pCO2-34* pH-7.42
calHCO3-23 Base XS--1
[**2138-7-27**] 02:17AM BLOOD Lactate-2.6*
[**2138-7-27**] 12:52AM BLOOD Lactate-1.5
[**2138-7-22**] 06:18PM BLOOD Lactate-4.3*
[**2138-7-27**] 02:17AM BLOOD Hgb-13.1* calcHCT-39 O2 Sat-84

Brief Hospital Course:
On [**2138-7-27**], the pt was seen by a Catholic priest and
administered last rights. A family meeting outlined the pt's
wishes, including that he not be intubated, resuscitated, fed
via tube (though the family did undergo an initial attempt with
the PEG tube), or CPR. The pt was transferred from the MICU to
the floor with the status of Comfort Measures Only. The family
remained with the patient. A family member awoke and the pt had
died. The night float resident was summoned to the room, and the
patient was pronounced dead at 0410 on [**2138-7-28**]. The primary
cause of death was respiratory arrest secondary to multisystem
atrophy. An autopsy was declined by the family. The death
certificate was filled out by [**First Name8 (NamePattern2) **] [**Name8 (MD) 4154**], MD, the night float
covering intern.
.
The [**Hospital **] medical issues are as below:
1.)Acute blood loss anemia:
Top source appears to be into right thigh, given physical exam.
Other possibilities include RP or intra-abdominal bleed from
peg.  Pt has been guaiac positive, but only trace positive brown
stool, making GI bleed seem less likely.  Pt has been discussed
with vascular.
The pt was evaluated with CT and transfused multiple unit of
blood. The pt was made CMO before this issue was resolved.
.
2.)MSA:
The pt was treated with mirapex and had a PEG in place, though
the tube feedings were stopped after the family meeting, in
concordance with the pt's wishes.
.
3.)HTN:
vital sign monitoring was stopped after pt made CMO.Prior to
that, the BP meds were held due to blood loss anemia.
.
4.)Leukocytosis:
Pt without fever, feel this is most likely a stress response.
No clinically obvious infection.
.
5.)Thrombocytopenia:
Pt appears to be chronically low but is now lower than usual.
No documentation as to etiology.  Will transfuse to keep over
50.
.
6.)FEN:
Pt initially tube fed via PEG, then discontinued per family
meeting.

Medications on Admission:
CELEXA 40MG--One by mouth every day
CIPRO 250 mg--one tablet(s) by mouth twice a day
DARVOCET-N 100 100-650MG--One by mouth q8 as needed for pain
DDAVP 0.2MG--One by mouth at bedtime
TERAZOSIN 10MG--2 by mouth every day
IBUPROFEN 800MG--One by mouth three times a day with food
NYSTATIN [**Numeric Identifier 4856**] U/G--Apply twice a day to affected area
PLAVIX 75MG--One every day
ROBINUL 1 mg--1 (one) tablet(s) by mouth three times a day
.
transfer-
1.)Terazosin 2mg daily
2.)Citalopram 40mg daily
3.)Mirapex 0.5mg daily
4.)Lansoprazole 30mg daily
5.)SC heparin

Discharge Medications:
Pt deceased.

Discharge Disposition:
Expired

Discharge Diagnosis:
Deceased.

Discharge Condition:
Deceased.

Discharge Instructions:
Not applicable.

Followup Instructions:
Not applicable.

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 6198**] MD, [**MD Number(3) 6199**]
{'Other degenerative diseases of the basal ganglia,Acute kidney failure, unspecified,Hematoma complicating a procedure,Hyperosmolality and/or hypernatremia,Thrombocytopenia, unspecified,Hydronephrosis,Acute posthemorrhagic anemia,Urinary tract infection, site not specified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Unspecified essential hypertension,Personal history of malignant neoplasm of prostate'}


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: Difficulty swallowing.

PRESENT ILLNESS: This is a 79 y/o male patient with multiple system atrophy
(aggresive form of Parkinsons), HTN, prostate ca s/p XRT who was
initially admitted to neurology service on [**7-14**] for dysphagia
secondary to rapid deterioration of MSA and PEG placement. PEG
placement successful but after patient had sudden Hct drop and
on CT scan was found to have right RP and thigh bleed hematoma,
unknown etiology, transferred to MICU. Vascular consulted and
felt surgery and angio no indicated at present time as patient
would require intubation. Patient was transfused a total of 9
units of blood while in the MICU. Patient last blood transfusion
was on [**2138-7-25**] in the am and Hct has been stable. For the past
few days patient neurologic function has become worse, where
patient very stiff. Neurology following patient for management
of MSA. Patient also noted to be hypernatremic in the MICU and
is being given free water bolus through PEG tube. During
hospital course patient had thrombocytopenia as well, HIT sent
which came back negative, plt count starting to improve. He
continue to spike low grade fevers, patient pan-cultured with no
source of infection found, CXR negative.

MEDICAL HISTORY: 1.)Multisystem atrophy
2.)HTN
3.)Prostate CA s/p XRT
4.)Cervical radiculopathy
5.)Hypercholesterolemia

MEDICATION ON ADMISSION: CELEXA 40MG--One by mouth every day
CIPRO 250 mg--one tablet(s) by mouth twice a day
DARVOCET-N 100 100-650MG--One by mouth q8 as needed for pain
DDAVP 0.2MG--One by mouth at bedtime
TERAZOSIN 10MG--2 by mouth every day
IBUPROFEN 800MG--One by mouth three times a day with food
NYSTATIN [**Numeric Identifier 4856**] U/G--Apply twice a day to affected area
PLAVIX 75MG--One every day
ROBINUL 1 mg--1 (one) tablet(s) by mouth three times a day
.
transfer-
1.)Terazosin 2mg daily
2.)Citalopram 40mg daily
3.)Mirapex 0.5mg daily
4.)Lansoprazole 30mg daily
5.)SC heparin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: t 98.4, bp 112/59, hr 104, rr 19, spo2 97%ra
gen- chronically ill appearing elderly male in nad
cv- tachy but reg, no m/r/g
pul- moves air well, minimal bibasilar rales
abd- peg in place, soft, nt, nd, nabs
back- no sacral edema, no bruising
extrm- 1+ edema over shins bilaterally
nails- no clubbing, no pitting/color changes/indentations
neuro- awake, non-verbal, resting tremor, moves extremeties

FAMILY HISTORY: No neuro disease

SOCIAL HISTORY: Pt lives with wife and is cared for by multiple aides.  He is
totally depedent for adl's.  Quit tobacco 30yrs ago. 

### Response:
{'Other degenerative diseases of the basal ganglia,Acute kidney failure, unspecified,Hematoma complicating a procedure,Hyperosmolality and/or hypernatremia,Thrombocytopenia, unspecified,Hydronephrosis,Acute posthemorrhagic anemia,Urinary tract infection, site not specified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Unspecified essential hypertension,Personal history of malignant neoplasm of prostate'}
