CHIEF COMPLAINT: hyponatremia

PRESENT ILLNESS: 72 y/o with h/o HTN, L MCA CVa in [**6-12**] with resudual language
impairment and seizures presents to [**Hospital1 18**] ED with a Na of 114.
Because of her seizures, she was recently started on Trileptal
[**2141-10-13**], and seen by Neuro [**2141-10-20**]. On [**2141-10-23**], her Na was noted
to fall from 139 on [**2141-10-13**] to 126 on [**2141-10-21**]. Her trileptal was
tapered and she received her last dose on [**2141-10-23**] and she was
started keppra. For hypertension, she was started HCTz 5 days
ago by her PCP. [**Name10 (NameIs) **], she presents with being very fatigued. No
fevers, chills, no nausea or vomiting no chest pain or shortness
of breath. Denied any headaches, blurred vision. She has been
drinking [**2-7**] glasses of water per day and has not eaten very
much per the patient. per her son in law, she been urinating
very much.

MEDICAL HISTORY: Ischemic stroke L MCA superior division [**6-12**]- mild Broca's
aphasia but no weakness on discharge, in follow up with Dr.
[**Last Name (STitle) **] in [**Month (only) **] he describes that she had "hesitant, broken,
frustrated speech. On the other hand, she can string together at
least six words, and she is coherent. She can follow multiple
different two-step commands. She can salute. She can repeat
various different phrases except she did have difficulties
saying [**State 350**] Institute of Technology." Work up showed
evidence of rheumatic disease on mitral valve, no carotid
stenosis, no arrhythmias on telemetry
-CAD s/p MI 5 yrs ago s/p stent
-High cholesterol
-Hypertension
-s/p basal cell ca resection [**5-13**]
-GERD

MEDICATION ON ADMISSION: keppra
HCTZ 25mg daily
Atenolol 50 mg [**Hospital1 **]
Zetia 10 mg qd
Nexium 40 mg qd
Aspirin 325mg qd

ALLERGIES: Trileptal / Hydrochlorothiazide

PHYSICAL EXAM: On admission:
T- 96.3 BP- 149/66 HR- 56 RR- 13 O2Sat- 97% on RA
Gen: Lying in bed, NAD. SLowed speech, but appropriately
answering questions.
HEENT: NC/AT, dry mucosa
Neck: No tenderness to palpation, normal ROM, supple
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally. No RRW
aBd: +BS soft, nontender, nondistended
ext: no edema
skin: dry

FAMILY HISTORY: Family History:
No known early strokes in family.

SOCIAL HISTORY: Social History:
Lives with husband, very physically active, takes care of 4
horses; no tob, etoh, drugs.  Has one son [**Doctor First Name **], one daughter.
Other disorders of neurohypophysis,Hypovolemia,Saluretics causing adverse effects in therapeutic use,Other late effects of cerebrovascular disease,Epilepsy, unspecified, without mention of intractable epilepsy,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Esophageal reflux
Neurohypophysis dis NEC,Hypovolemia,Adv eff saluretics,Late effect CV dis NEC,Epilep NOS w/o intr epil,Hypertension NOS,Crnry athrscl natve vssl,Status-post ptca,Esophageal reflux
Admission Date:  [**2141-10-24**]              Discharge Date:   [**2141-10-26**]

Date of Birth:  [**2070-7-11**]             Sex:   F

Service: MEDICINE

Allergies:
Trileptal / Hydrochlorothiazide

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
hyponatremia

Major Surgical or Invasive Procedure:
None


History of Present Illness:
72 y/o with h/o HTN, L MCA CVa in [**6-12**] with resudual language
impairment and seizures presents to [**Hospital1 18**] ED with a Na of 114.
Because of her seizures, she was recently started on Trileptal
[**2141-10-13**], and seen by Neuro [**2141-10-20**]. On [**2141-10-23**], her Na was noted
to fall from 139 on [**2141-10-13**] to 126 on [**2141-10-21**]. Her trileptal was
tapered and she received her last dose on [**2141-10-23**] and she was
started keppra. For hypertension, she was started HCTz 5 days
ago by her PCP. [**Name10 (NameIs) **], she presents with being very fatigued. No
fevers, chills, no nausea or vomiting no chest pain or shortness
of breath. Denied any headaches, blurred vision. She has been
drinking [**2-7**] glasses of water per day and has not eaten very
much per the patient. per her son in law, she been urinating
very much.


Past Medical History:
Ischemic stroke L MCA superior division [**6-12**]- mild Broca's
aphasia but no weakness on discharge, in follow up with Dr.
[**Last Name (STitle) **] in [**Month (only) **] he describes that she had "hesitant, broken,
frustrated speech. On the other hand, she can string together at
least six words, and she is coherent. She can follow multiple
different two-step commands. She can salute. She can repeat
various different phrases except she did have difficulties
saying [**State 350**] Institute of Technology." Work up showed
evidence of rheumatic disease on mitral valve, no carotid
stenosis, no arrhythmias on telemetry
-CAD s/p MI 5 yrs ago s/p stent
-High cholesterol
-Hypertension
-s/p basal cell ca resection [**5-13**]
-GERD


Social History:
Social History:
Lives with husband, very physically active, takes care of 4
horses; no tob, etoh, drugs.  Has one son [**Doctor First Name **], one daughter.


Family History:
Family History:
No known early strokes in family.


Physical Exam:
On admission:
T- 96.3 BP- 149/66 HR- 56 RR- 13 O2Sat- 97% on RA
Gen: Lying in bed, NAD. SLowed speech, but appropriately
answering questions.
HEENT: NC/AT, dry mucosa
Neck: No tenderness to palpation, normal ROM, supple
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally. No RRW
aBd: +BS soft, nontender, nondistended
ext: no edema
skin: dry


Pertinent Results:
Labs on Admission:

[**2141-10-24**] 05:30PM BLOOD WBC-5.1 RBC-4.48 Hgb-14.2 Hct-38.6 MCV-86
MCH-31.6 MCHC-36.7* RDW-12.2 Plt Ct-258
[**2141-10-24**] 05:30PM BLOOD Neuts-73.9* Lymphs-17.2* Monos-7.6
Eos-0.8 Baso-0.5
[**2141-10-24**] 05:30PM BLOOD Plt Ct-258
[**2141-10-25**] 03:40AM BLOOD PT-11.3 PTT-26.7 INR(PT)-1.0
[**2141-10-24**] 03:59PM BLOOD ESR-14
[**2141-10-24**] 05:30PM BLOOD Glucose-116* UreaN-15 Creat-1.0 Na-114*
K-4.5 Cl-78* HCO3-26 AnGap-15
[**2141-10-24**] 05:30PM BLOOD CK(CPK)-93
[**2141-10-24**] 05:30PM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2141-10-24**] 05:30PM BLOOD Calcium-9.8 Phos-3.5 Mg-2.0
[**2141-10-24**] 09:40PM BLOOD Osmolal-245*
[**2141-10-24**] 05:30PM BLOOD TSH-1.3

Brief Hospital Course:
72 y/o with h/o HTN, L MCA CVa in [**6-12**] with resudual language
impairment and seizures presents to [**Hospital1 18**] ED with slowed speech
and fatigue. Because of her seizures, she was recently started
on Trileptal [**2141-10-13**]. On [**2141-10-21**], her Na was noted to fall from
139 on [**2141-10-13**] to 126 on [**2141-10-21**]. Her trileptal was tapered and
she received her last dose on [**2141-10-23**] and she was started
keppra. For hypertension, she was started HCTz 5 days ago.
Today, she presents with being very fatigued with slowed speech.
She denied fevers, chills, nausea, vomiting, chest pain or
shortness of breath. Denied any headaches, blurred vision. She
has been drinking [**2-7**] glasses of water per day and has not eaten
very much - per the patient. Per her son in law, she been
experiencing increased urination over the past week.
.
In the ED:
- 80cc/hr of NS for a total of 500 cc - and her Na increased to
116.
.
Her Urine Sodium was 48, her serum Osm was 248 and her Urine Osm
was in the 432 consistent with SIADH. We also felt that she was
slightly hypovolemic. Hence she was treated with hypertonic
saline with a goal of increasing her Na ~ 8MeQ/24 hours. She
also received NS for volume repletion. Her trileptal was tapered
off by the  Neurology sevice and transitioned over to keppra for
antiseizure prophylaxis. Also, her HCTZ was discontinued and her
BP remained in the 120s-130s in the ICU. Her Na gradually
improved to 134 by the morning of [**2141-10-26**].  The pt. remained
stable while in the ICU, showing no evidence of seizure
activity, and her mental status gradually improving.  Per
request of the Neurology service she underwent an [**Date Range **] that on
prelim read showed slowing in the region of your old stroke -
however, the final read is pending at the time of your
discharge.  On HD 3 the pt. Na had reached a normal level, she
was tolerating PO intake, was urinating without difficulty, was
ambulating without difficulty, and was ready for discharge.
Moreover, the pt. mental status was at baseline at the time of
discharge - A&O x3 and speaking in full sentences.

Medications on Admission:
keppra
HCTZ 25mg daily
Atenolol 50 mg [**Hospital1 **]
Zetia 10 mg qd
Nexium 40 mg qd
Aspirin 325mg qd


Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
3. Zetia 10 mg Tablet Sig: One (1) Tablet PO once a day.
4. Nexium 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.


Discharge Disposition:
Home

Discharge Diagnosis:
Hyponatremia due to trileptal/HCTZ


Discharge Condition:
AAO x 3. Speaking fluently.


Discharge Instructions:
You were admitted to the hospital because your Sodium level was
low. This was most likely related to taking Trileptal and
Hydrochlorthiazide, both of which can lower your Sodium levels.
Please STOP taking these medications.
.
Please also limit your fluid intake to 64 ounces per day = 2
quarts. This will also help your sodium level to improve.
.
Please go to Dr.[**Name (NI) 49335**] office on Friday to have your sodium
level checked. In addition, you will follow up with him on
Monday for an office visit.

Followup Instructions:
**It is very important that you make the following appointments.
 Please call to confirm appointments**
.
You have an appointment at Dr.[**Last Name (STitle) **] office on Friday for a
blood draw for your Sodium level.
.
You have an appointment on Monday the 24th at Dr.[**Name (NI) 49335**]
office at 145pm for a follow up visit. Please bring a copy of
your discharge summary which we will provide for you for this.
.
Please call Dr.[**Name (NI) 17720**] office at [**Telephone/Fax (1) 2574**] for to arrange
for a follow up appointment.
.
You have an [**Telephone/Fax (1) **] test which is scheduled as below. This is to
follow up your stroke.
Provider: [**Name10 (NameIs) **] LAB Phone:[**Telephone/Fax (1) 19105**] Date/Time:[**2141-10-31**] 3:00
{'Other disorders of neurohypophysis,Hypovolemia,Saluretics causing adverse effects in therapeutic use,Other late effects of cerebrovascular disease,Epilepsy, unspecified, without mention of intractable epilepsy,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Esophageal reflux'}


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: hyponatremia

PRESENT ILLNESS: 72 y/o with h/o HTN, L MCA CVa in [**6-12**] with resudual language
impairment and seizures presents to [**Hospital1 18**] ED with a Na of 114.
Because of her seizures, she was recently started on Trileptal
[**2141-10-13**], and seen by Neuro [**2141-10-20**]. On [**2141-10-23**], her Na was noted
to fall from 139 on [**2141-10-13**] to 126 on [**2141-10-21**]. Her trileptal was
tapered and she received her last dose on [**2141-10-23**] and she was
started keppra. For hypertension, she was started HCTz 5 days
ago by her PCP. [**Name10 (NameIs) **], she presents with being very fatigued. No
fevers, chills, no nausea or vomiting no chest pain or shortness
of breath. Denied any headaches, blurred vision. She has been
drinking [**2-7**] glasses of water per day and has not eaten very
much per the patient. per her son in law, she been urinating
very much.

MEDICAL HISTORY: Ischemic stroke L MCA superior division [**6-12**]- mild Broca's
aphasia but no weakness on discharge, in follow up with Dr.
[**Last Name (STitle) **] in [**Month (only) **] he describes that she had "hesitant, broken,
frustrated speech. On the other hand, she can string together at
least six words, and she is coherent. She can follow multiple
different two-step commands. She can salute. She can repeat
various different phrases except she did have difficulties
saying [**State 350**] Institute of Technology." Work up showed
evidence of rheumatic disease on mitral valve, no carotid
stenosis, no arrhythmias on telemetry
-CAD s/p MI 5 yrs ago s/p stent
-High cholesterol
-Hypertension
-s/p basal cell ca resection [**5-13**]
-GERD

MEDICATION ON ADMISSION: keppra
HCTZ 25mg daily
Atenolol 50 mg [**Hospital1 **]
Zetia 10 mg qd
Nexium 40 mg qd
Aspirin 325mg qd

ALLERGIES: Trileptal / Hydrochlorothiazide

PHYSICAL EXAM: On admission:
T- 96.3 BP- 149/66 HR- 56 RR- 13 O2Sat- 97% on RA
Gen: Lying in bed, NAD. SLowed speech, but appropriately
answering questions.
HEENT: NC/AT, dry mucosa
Neck: No tenderness to palpation, normal ROM, supple
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally. No RRW
aBd: +BS soft, nontender, nondistended
ext: no edema
skin: dry

FAMILY HISTORY: Family History:
No known early strokes in family.

SOCIAL HISTORY: Social History:
Lives with husband, very physically active, takes care of 4
horses; no tob, etoh, drugs.  Has one son [**Doctor First Name **], one daughter. 

### Response:
{'Other disorders of neurohypophysis,Hypovolemia,Saluretics causing adverse effects in therapeutic use,Other late effects of cerebrovascular disease,Epilepsy, unspecified, without mention of intractable epilepsy,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Esophageal reflux'}
