CHIEF COMPLAINT: 

PRESENT ILLNESS: On presentation, [**3-4**], the
following history was obtained by the Intensive Care Unit
resident.  Patient is a 69-year-old female with a history of
congestive heart failure, chronic obstructive pulmonary
disease, status post recent admission to [**Hospital3 417**]
Hospital for pneumonia complicated by chronic obstructive
pulmonary disease exacerbation on a prednisone taper.  She
was discharged back to the nursing home four days prior to
admission where she was recovering well until the night prior
to admission.  She was witnessed to have three generalized
tonic-clonic seizures lasting approximately 20 minutes.  EMS
was called and patient was intubated in the field for status.
Arrived at [**Hospital3 417**] Hospital with continued seizures,
treated with Ativan 4 mg, Valium 5 mg and loaded with 5
phenytoin.  Head CT revealed diffuse white matter disease
with evidence of edema, but no bleed.  Lumbar puncture was
slightly bloody, although decreased white count from tubes
one through four.  She was transferred to [**Hospital6 1760**] for further management.  She
was given Ceftriaxone 2 grams at [**Hospital3 417**] Hospital.
Patient had been treated for a urinary tract infection with
Bactrim and was noted to have a zoster rash on her back,
which was noted at [**Hospital3 417**] Hospital.  She was started
on acyclovir at the time.  According to the patient's family,
she was more lethargic during the day, [**3-3**], although,
the family was told that her vitals were okay.

MEDICAL HISTORY: 1.  Possible multifocal atrial tachycardia.
2.  Chronic obstructive pulmonary disease.
3.  Cardiomegaly.
4.  Congestive heart failure.
5.  Hypertension.
6.  Obesity.

MEDICATION ON ADMISSION: Digoxin .25 mg po q.d., Lasix 40
mg po q.d., potassium chloride 10 mg po q.d., diazepam 2 mg
po t.i.d., Azmacort 2 mg po q.i.d., famotidine 20 mg po
q.h.s., multivitamin 1 tablet po q.d., Vitamin C 500 mg po
b.i.d., Bactrim Double Strength b.i.d., theophylline 200 mg
po b.i.d., fluticasone salmeterol 1 puff po b.i.d., acyclovir
800 mg po q.i.d., Tylenol prn.

ALLERGIES: Patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She lives at a nursing home, former tobacco
user with 60+ pack year history of smoking, quit six years
prior to admission.  Patient was full code on admission.
Unspecified infectious and parasitic diseases,Other convulsions,Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Acidosis,Urinary tract infection, site not specified,Congestive heart failure, unspecified
Infect/parasite dis NOS,Convulsions NEC,Acute respiratry failure,Obs chr bronc w(ac) exac,Acidosis,Urin tract infection NOS,CHF NOS
Admission Date:  [**2168-3-4**]     Discharge Date:  [**2168-4-4**]

Date of Birth:   [**2098-8-23**]     Sex:  F

Service:

HISTORY OF PRESENT ILLNESS:  On presentation, [**3-4**], the
following history was obtained by the Intensive Care Unit
resident.  Patient is a 69-year-old female with a history of
congestive heart failure, chronic obstructive pulmonary
disease, status post recent admission to [**Hospital3 417**]
Hospital for pneumonia complicated by chronic obstructive
pulmonary disease exacerbation on a prednisone taper.  She
was discharged back to the nursing home four days prior to
admission where she was recovering well until the night prior
to admission.  She was witnessed to have three generalized
tonic-clonic seizures lasting approximately 20 minutes.  EMS
was called and patient was intubated in the field for status.
Arrived at [**Hospital3 417**] Hospital with continued seizures,
treated with Ativan 4 mg, Valium 5 mg and loaded with 5
phenytoin.  Head CT revealed diffuse white matter disease
with evidence of edema, but no bleed.  Lumbar puncture was
slightly bloody, although decreased white count from tubes
one through four.  She was transferred to [**Hospital6 1760**] for further management.  She
was given Ceftriaxone 2 grams at [**Hospital3 417**] Hospital.
Patient had been treated for a urinary tract infection with
Bactrim and was noted to have a zoster rash on her back,
which was noted at [**Hospital3 417**] Hospital.  She was started
on acyclovir at the time.  According to the patient's family,
she was more lethargic during the day, [**3-3**], although,
the family was told that her vitals were okay.

On arrival to [**Hospital1 **], the patient was sedated
and intubated.  CT scan was reviewed with Radiology and felt
not to be consistent with subarachnoid hemorrhage.  Medical
Intensive Care Unit Team was called and admitted the patient.
She was not able to give any history of her own at that
time.

PAST MEDICAL HISTORY:
1.  Possible multifocal atrial tachycardia.
2.  Chronic obstructive pulmonary disease.
3.  Cardiomegaly.
4.  Congestive heart failure.
5.  Hypertension.
6.  Obesity.

MEDICATIONS ON ADMISSION:  Digoxin .25 mg po q.d., Lasix 40
mg po q.d., potassium chloride 10 mg po q.d., diazepam 2 mg
po t.i.d., Azmacort 2 mg po q.i.d., famotidine 20 mg po
q.h.s., multivitamin 1 tablet po q.d., Vitamin C 500 mg po
b.i.d., Bactrim Double Strength b.i.d., theophylline 200 mg
po b.i.d., fluticasone salmeterol 1 puff po b.i.d., acyclovir
800 mg po q.i.d., Tylenol prn.

ALLERGIES:  Patient has no known drug allergies.

SOCIAL HISTORY:  She lives at a nursing home, former tobacco
user with 60+ pack year history of smoking, quit six years
prior to admission.  Patient was full code on admission.

PHYSICAL EXAMINATION ON ADMISSION:  Temperature was 97.3.
Heart rate 86-96.  Blood pressure 105-117/55-63, breathing at
12-13, 02 saturation 98%.  Arterial blood gas was 7.43, 44,
86 on SIMV with pressures 700 x 12, FIO2 of .5, PEEP of 5,
pressure support was 5.  She has anicteric pupils, equal,
round and reactive to light.  No doll's eyes.  Oropharynx
showed ETT in place.  She had a supple neck.  Lungs were
clear to auscultation bilaterally.  Her heart was irregularly
irregular with no murmurs, rubs or gallops.  Her abdomen is
soft, nontender, nondistended, positive bowel sounds times
four.  She had 1+ edema.  Patient was sedated and
unresponsive to voice, withdrawing toes, spontaneously opens
eyes.

LABORATORIES FROM [**Hospital3 **] HOSPITAL:  White blood cell
count 15.3, hematocrit 56.2 with a differential of 90
neutrophils, 4 lymphocytes, 4 monocytes, platelets 136,000,
INR 1.4, PTT is 25, sodium 140, potassium 4.5, chloride 99,
bicarbonate 33, BUN 44, creatinine 1.3, glucose 125, albumin
3.7, calcium 9, magnesium 2.1, TSH was 5.3, T4 7, T3 uptake
41, theophylline was 6.4, which is subtherapeutic.
Therapeutic range is [**9-25**].  Digoxin 1.4.  Ammonia was 36.
ALT 31, AST 25, alkaline phosphatase 112, T bilirubin .8,
total protein 6.9.  Electrocardiogram shows sinus arrhythmia
with ST elevations in V1 and V2 and nonspecific ST-T wave
changes.  Cerebrospinal fluid tube one shows 2 white cells,
150 red cells, glucose of 75, protein 225.  Head CT
demonstrated white matter disease, left cerebral edema with
compression of the lateral ventricle, no gross shift,
question of air bubbles.

HOSPITAL COURSE:  [**Hospital **] hospital course can best be
summarized day to day as her main problems were her
neurologic problems and pulmonary problems and these were
overlapping issues.  The patient's work-up at [**Hospital1 **] included an MRI of her head which showed diffuse
cerebral edema.  MRA and MRV were normal and
electroencephalogram showed frontal spike on the left with a
diffusely slow background.  Treatment included reloading the
patient with phenytoin steroids and acyclovir for presumed
HSV encephalitis.  Follow-up MRIs did not demonstrate
progression and in fact showed resolution of her cerebral
edema.  The culture results from [**Hospital3 417**] Hospital
revealed HSV2 positive PCRs.  It is felt to be positive for
her aseptic meningitis or asymptomatic shedding from a sacral
nerve root.  The Infectious Disease Service was not convinced
that her clinical picture was consistent with HSV2, they felt
it was more likely to be consistent with HHV6.  The patient
completed her acyclovir however, and this is not a further
issue.  The patient was noted to be more responsive and was
finally extubated in the Intensive Care Unit on [**2168-3-13**].

She was transferred to the Medical Service for further
management.  Her neurologic exam at that time showed that her
eyes were open at baseline.  She was able to follow examiner
with her eyes.  Her speech was slow, dysarthric with simple
sentence production and soft voice.  She was moving all four
extremities, left greater than right, was capable of
following one and two step commands with variable
re-productability, cannot print by correct date or location
but knew her name.  Cranial nerves respond to visual threat.
Full elevation and depression of eyes, right lateral gaze was
intact, capable of moving eyes to the left, but incomplete
motion.  Eyes were in mid position at baseline.

Facial sensation was difficult to assess, motion was noted to
be decreased in her lower face on the right side.  Her
hearing was grossly intact.  Palate was up bilaterally.  Head
turning and shoulder shrug were difficult to assess.  The
patient had full tongue motion.  Her strength and normal bulk
increased tone on right side, left side was stronger than
right, but capable of moving all four extremities.  Patient
was hyperreflexic in the right upper extremity, diffusely
decreased lower extremity reflexes, toes are downgoing
bilaterally.  Sensory examination showed that the patient was
capable of localizing painful stimuli.  She had no tremors.
Cerebellar signs were difficult to elicit.

Patient's course on the Medical Floor:  On [**3-16**], the
patient was noted to be more responsive.  Repeat MRI showed
some regression of the T2 hyperintensity white matter
changes, especially in the centrum semiovale and a possible
increase in cerebral blood flow.  The patient continued to
feel better. On [**3-17**], she was suctioned aggressively for
several episodes of desaturation.  On [**3-18**], the patient
had no significant shortness of breath.  A rash was noted for
the first time.  It is felt to be consistent with Dilantin
Infatabs rash.  The Infatabs were changed back to the regular
formulation and the rash slowly, but incompletely resolved.

On [**3-19**], the patient was noted to have several
desaturations which responded to aggressive suctioning.  On
[**3-20**], the patient was once again suctioned with
improvement in her respiratory status.  On [**3-21**], the
patient was examined during morning pre rounds and found to
have an arterial blood gas of pH 7.25, PCO2 of 95, PO2 of 56.
She was intubated and taken back to the Medical Intensive
Care Unit.  The patient self extubated on [**3-22**] and
returned to the regular medical floor on [**3-23**].

The patient was started on CPAP while on the regular medical
floor.  She tolerated this treatment the first night.  The
patient on the morning of [**3-25**] was noted to have
decreased oxygen saturations.  She was found to have an 02
saturation of 57%.  An arterial blood gas was done at that
time pH 7.38, PO2 was 32, PCO2 was 69.  Her BiPAP was
adjusted and she was administered a nebulizer.  Follow-up
arterial blood gas was pH 7.39, pCO2 72, PO was 79.  Patient
was maintaining at her previous baseline.  She was left in no
apparent distress at that time on oxygen by shovel mask.  The
patient developed decreased oxygen saturations at 5:30 a.m.
on [**3-26**].  She was reintubated and taken back to the
Intensive Care Unit.  After a long and protracted course in
the Intensive Care Unit, the decision was made by the
patient's family to make the patient "Do Not Resuscitate, Do
Not Intubate."  She was extubated as she was tolerating
spontaneous breathing trials.  The patient's respiratory
status did not improve.  The decision was made to make her
comfort measures only.  The patient was called out to the
regular medical floor on [**2168-4-3**].  On the morning of
[**2168-4-4**], she was found on pre rounds.  Her pupils were
unreactive.  She had no heart sounds, no breath sounds, no
spontaneous movements, no response to pain, no radial or
femoral pulses.  The patient was pronounced dead on [**4-4**]
at 8 a.m.

DISCHARGE CONDITION:  Dead.

DISCHARGE DIAGNOSES:  Identical to her admission diagnoses
with the addition of:
1.  Encephalitis.
2.  Cerebral edema.
3.  Seizure disorder.   Patient did not have any seizures
during this hospitalization.



                        DR.[**Last Name (STitle) **],[**First Name3 (LF) **]  12-761
Dictated By:[**Last Name (NamePattern1) 5476**]

MEDQUIST36

D:  [**2168-4-5**]  15:20
T:  [**2168-4-5**]  15:20
JOB#:  [**Job Number 41360**]
{'Unspecified infectious and parasitic diseases,Other convulsions,Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Acidosis,Urinary tract infection, site not specified,Congestive heart failure, 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: 

PRESENT ILLNESS: On presentation, [**3-4**], the
following history was obtained by the Intensive Care Unit
resident.  Patient is a 69-year-old female with a history of
congestive heart failure, chronic obstructive pulmonary
disease, status post recent admission to [**Hospital3 417**]
Hospital for pneumonia complicated by chronic obstructive
pulmonary disease exacerbation on a prednisone taper.  She
was discharged back to the nursing home four days prior to
admission where she was recovering well until the night prior
to admission.  She was witnessed to have three generalized
tonic-clonic seizures lasting approximately 20 minutes.  EMS
was called and patient was intubated in the field for status.
Arrived at [**Hospital3 417**] Hospital with continued seizures,
treated with Ativan 4 mg, Valium 5 mg and loaded with 5
phenytoin.  Head CT revealed diffuse white matter disease
with evidence of edema, but no bleed.  Lumbar puncture was
slightly bloody, although decreased white count from tubes
one through four.  She was transferred to [**Hospital6 1760**] for further management.  She
was given Ceftriaxone 2 grams at [**Hospital3 417**] Hospital.
Patient had been treated for a urinary tract infection with
Bactrim and was noted to have a zoster rash on her back,
which was noted at [**Hospital3 417**] Hospital.  She was started
on acyclovir at the time.  According to the patient's family,
she was more lethargic during the day, [**3-3**], although,
the family was told that her vitals were okay.

MEDICAL HISTORY: 1.  Possible multifocal atrial tachycardia.
2.  Chronic obstructive pulmonary disease.
3.  Cardiomegaly.
4.  Congestive heart failure.
5.  Hypertension.
6.  Obesity.

MEDICATION ON ADMISSION: Digoxin .25 mg po q.d., Lasix 40
mg po q.d., potassium chloride 10 mg po q.d., diazepam 2 mg
po t.i.d., Azmacort 2 mg po q.i.d., famotidine 20 mg po
q.h.s., multivitamin 1 tablet po q.d., Vitamin C 500 mg po
b.i.d., Bactrim Double Strength b.i.d., theophylline 200 mg
po b.i.d., fluticasone salmeterol 1 puff po b.i.d., acyclovir
800 mg po q.i.d., Tylenol prn.

ALLERGIES: Patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She lives at a nursing home, former tobacco
user with 60+ pack year history of smoking, quit six years
prior to admission.  Patient was full code on admission. 

### Response:
{'Unspecified infectious and parasitic diseases,Other convulsions,Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Acidosis,Urinary tract infection, site not specified,Congestive heart failure, unspecified'}
