CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 74 year-old female
with a history of ovarian cancer and aspiration pneumonia who
was recently discharged from the [**Hospital1 190**] on [**5-20**] after an episode of Klebsiella
urosepsis and hypotension, which required Dopamine and also
was accompanied by mental status changes.  The patient was
discharged to [**Hospital3 **] where she recently finished a
fourteen day course of Levaquin.  She was in her usual state
of health and alert and oriented times three as recent as the
day prior to admission at which point the patient began to
spike temperatures of 105.  She also had emesis times one.
Crackles were noted on examination and the patient was sent
to the [**Hospital1 69**] Emergency
Department.  In the Emergency Department the temperature was
105.  Blood pressure 106/40.  Pulse 129.  Respirations 27.
O2 saturation 96% on an unknown amount of oxygen, which
became 100% on 100% nonrebreather.  Chest x-ray revealed a
new left lower lobe infiltrate.  The patient was given
Ceftriaxone, Vanco and Tylenol and intravenous fluids times 4
liters of normal saline.  Blood pressure remained 94/23 and
given concern for hypotension the patient was admitted to the
Medical Intensive Care Unit.

MEDICAL HISTORY: Notable for C section,
cholecystectomy, ovarian cancer in [**2131-9-29**], status
post TAH/BSO, omentectomy, ileocolectomy complicated by a
perforation of the anastomosis in [**2131-12-29**], which led
to peritonitis and resection and a perihepatic abscess and a
new ileostomy.  Diabetes mellitus.  History of aspiration.
Paranoid schizophrenia, depression, recurrent herpes zoster,
history of acute renal failure.  Hyperlipidemia.  Status post
PEG removal on the last admission.  Urinary tract infection
with Klebsiella.

MEDICATION ON ADMISSION: Risperdal 0.5 mg po q.a.m. and 1.5
mg po q.p.m.  Magnesium oxide 400 mg po q.i.d., Epogen 40,000
units q week, aspirin 81 mg po q.d., heparin subQ, Protonix
40 mg po q.d., Allopurinol 100 mg po q.d., [**Doctor First Name **] 60 mg po
b.i.d., B-12 1000 mg IM q month, Levaquin 500 mg po q.d.
times two days, Bactroban, MVI, Lopressor 12.5 po b.i.d.,
Neurontin 600 mg po t.i.d. and Acyclovir 450 q 8 hours times
seven days.

ALLERGIES: Penicillin causes rash.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Tobacco abuse until [**2110**].  The patient is
widowed.  She has a daughter and presently living at
[**Hospital3 **].
Pneumonitis due to inhalation of food or vomitus,Bacteremia,Mitral valve disorders,Thrombocytopenia, unspecified,Paroxysmal ventricular tachycardia,Paranoid type schizophrenia, unspecified,Personal history of malignant neoplasm of ovary
Food/vomit pneumonitis,Bacteremia,Mitral valve disorder,Thrombocytopenia NOS,Parox ventric tachycard,Paranoid schizo-unspec,Hx of ovarian malignancy
Admission Date:  [**2132-6-2**]       Discharge Date:  [**2132-6-9**]

Date of Birth:   [**2057-5-9**]       Sex:  F

Service:  MEDICAL ICU/ACOVE

HISTORY OF PRESENT ILLNESS:  This is a 74 year-old female
with a history of ovarian cancer and aspiration pneumonia who
was recently discharged from the [**Hospital1 190**] on [**5-20**] after an episode of Klebsiella
urosepsis and hypotension, which required Dopamine and also
was accompanied by mental status changes.  The patient was
discharged to [**Hospital3 **] where she recently finished a
fourteen day course of Levaquin.  She was in her usual state
of health and alert and oriented times three as recent as the
day prior to admission at which point the patient began to
spike temperatures of 105.  She also had emesis times one.
Crackles were noted on examination and the patient was sent
to the [**Hospital1 69**] Emergency
Department.  In the Emergency Department the temperature was
105.  Blood pressure 106/40.  Pulse 129.  Respirations 27.
O2 saturation 96% on an unknown amount of oxygen, which
became 100% on 100% nonrebreather.  Chest x-ray revealed a
new left lower lobe infiltrate.  The patient was given
Ceftriaxone, Vanco and Tylenol and intravenous fluids times 4
liters of normal saline.  Blood pressure remained 94/23 and
given concern for hypotension the patient was admitted to the
Medical Intensive Care Unit.

Per the patient's daughter she denied abdominal pain,
dysuria, shortness of breath, cough, melena, bright red blood
per rectum, but she did have decreased urine output.

PAST MEDICAL HISTORY:  Notable for C section,
cholecystectomy, ovarian cancer in [**2131-9-29**], status
post TAH/BSO, omentectomy, ileocolectomy complicated by a
perforation of the anastomosis in [**2131-12-29**], which led
to peritonitis and resection and a perihepatic abscess and a
new ileostomy.  Diabetes mellitus.  History of aspiration.
Paranoid schizophrenia, depression, recurrent herpes zoster,
history of acute renal failure.  Hyperlipidemia.  Status post
PEG removal on the last admission.  Urinary tract infection
with Klebsiella.

ALLERGIES:  Penicillin causes rash.

MEDICATIONS ON ADMISSION:  Risperdal 0.5 mg po q.a.m. and 1.5
mg po q.p.m.  Magnesium oxide 400 mg po q.i.d., Epogen 40,000
units q week, aspirin 81 mg po q.d., heparin subQ, Protonix
40 mg po q.d., Allopurinol 100 mg po q.d., [**Doctor First Name **] 60 mg po
b.i.d., B-12 1000 mg IM q month, Levaquin 500 mg po q.d.
times two days, Bactroban, MVI, Lopressor 12.5 po b.i.d.,
Neurontin 600 mg po t.i.d. and Acyclovir 450 q 8 hours times
seven days.

SOCIAL HISTORY:  Tobacco abuse until [**2110**].  The patient is
widowed.  She has a daughter and presently living at
[**Hospital3 **].

PHYSICAL EXAMINATION ON PRESENTATION TO THE MEDICAL INTENSIVE
CARE UNIT:  Vital signs temperature 100.9.  Heart rate 117.
Blood pressure 156/30.  Respiratory rate 16.  Oxygen
saturation 99% on 4 liters.  Generally, the patient was lying
in bed with cogwheel rigidity.  She was noncommunicative, but
followed simple commands.  HEENT examination normocephalic,
atraumatic.  Pupils are equal, round and reactive to light.
Oropharynx clear.  Mucous membranes are dry.  Neck no JVD or
bruits.  Lungs at the left base there were dry rales without
wheezes or rhonchi.  Cardiovascular tachy regular rate with a
1 to 2 out of 6 systolic ejection murmur at the left upper
sternal border.  No S3 or S4.  Abdomen was soft, nontender,
nondistended with normoactive bowel sounds.  Right colostomy,
which was pink and stooling in the left ileostomy was pink.
Extremities no clubbing, cyanosis or edema.  Cast present on
the right lower extremity.  Neurologically noncommunicative,
rigid with cogwheeling and tremor in all extremities.  The
patient would squeeze toes and hands to command.

ADMISSION LABORATORIES:  White blood cell count 11.6,
hematocrit 33.4, platelets 133, INR 1.1, sodium 131,
potassium 5.9, chloride 100, bicarb 20, BUN 18, creatinine
1.3, glucose 247.  Urinalysis was negative.  Urine culture
revealed no growth.  CT of the head was negative.  Chest
x-ray revealed new left base consolidation.
Electrocardiogram revealed sinus tachy in the 120s with left
axis deviation and normal intervals.  No ST or T wave
abnormalities.

HOSPITAL COURSE IN THE MEDICAL INTENSIVE CARE UNIT:  The
patient was admitted to the Medical Intensive Care Unit for
close observation and monitoring.  She was begun on
antibiotics with Ceftriaxone and Vancomycin and Flagyl given
her history of MRSA, pneumonia and aspiration.  On Intensive
Care Unit day number two one out of three bottles was growing
gram positive coxae and the patient continued to hve high
temperatures to 103 degrees.  On MICU day three two out of
three bottles were positive for staph aureus.  A PICC line
was placed for long term Vancomycin administration.  Oxygen
saturations improved slowly up to 98% on room air.
Additionally, cardiovascularly the patient had no signs of
ischemia, but remained hypotensive.  Her beta blocker was
held.  Intravenous fluids were given.  The patient had
ongoing sinus tachycardia attributed to fever.  Her
hypotension improved and her beta blocker was restarted.  On
approximately [**6-4**] to [**6-5**] the patient had an episode of
four beat run of nonsustained ventricular tachycardia,
however, this was in the setting of the patient being off of
beta blocker and it was noted that the patient's electrolytes
were not within normal limits.  These were corrected.  The
patient had no further episodes of nonsustained ventricular
tachycardia.

The patient was received on the Acove team on [**2132-6-5**].
The remainder of the patient's course is as follows:

1.  Infectious disease:  Up until the time the patient was
transferred to the floor team the patient had continued
temperature spikes and was being treated for pneumonia.  Her
white blood cell count fell to a slow as 4.1000.  She was
continued on Vancomycin, Flagyl and Ceftriaxone.  A CT of the
abdomen was obtained to look for other sources of possible
infection.  No abscess or intra-abdominal pathology was
found. The patient received a transthoracic [**Year (4 digits) 461**] to
look for possible endocarditis.  This found left atrial
dilatation, normal left ventricular wall thickness and cavity
size, global left ventricular hypokinesis with severe
hypokinesis of the basilar interior septum.  RV cavity was
dilated, but systolic function was normal for the Revealed
The aortic valve leaflets were thickened, but not stenotic.
There were no discreet vegetation.  There was trace aortic
regurgitation and no vegetation of the mitral valve leaflets.
There was 2+ mitral regurgitation and borderline pulmonary
artery systolic hypertension.  No effusions were seen.  Upon
transfer to the [**Hospital1 **] team the patient's fevers ceased.  She
was continued only on Vancomycin and Flagyl for pneumonia.
Ceftriaxone was discontinued.

2.  Pulmonary:  The patient's hypoxia had resolved by
transfer to the [**Hospital1 **] team.  Pneumonia treatment continued as
above.

3.  Cardiovascular:  For the patient's rhythm and episode of
nonsustained ventricular tachycardia, no further episodes of
nonsustained ventricular tachycardia occurred when the
patient was restarted on her beta blocker and magnesium and
potassium were repleted.  However, the patient did have
frequent ectopy and occasional couplets of premature
ventricular contractions.  Her blood pressure remained stable
on Lopressor and there were no signs of congestive heart
failure.

4.  Hematologic:  The patient's white blood cell count fell
to 4.1 on the day of transfer to the [**Hospital1 **] team.  The
significance of this was unknown, but the following day the
patient's white blood cell count began to arise again slowly.
Additionally the patient was found to have low platelets as
low as 86.  A DIC panel was checked and was within normal
limits.  It was thought that this could be secondary to
heparin induced thrombocytopenia and heparin flushes were
discontinued.  HIT antibody was sent and returned positive.
The patient should receive no further heparinized products.
The patient's hematocrit remained stable throughout the
course of her admission.

5.  Neuro/psych:  For the patient's tremor and Parkinsonism
symptoms that were found on MICU admission her Risperdal was
held initially and her symptoms resolved.  The patient
continued to appear depressed with flattened affect, but her
psychiatric medications were not restarted.  Further input
can be sought from her outpatient neurologist Dr. [**First Name4 (NamePattern1) 5627**] [**Last Name (NamePattern1) **]
[**Telephone/Fax (1) 34520**].  Zyprexa can be considered if it becomes
necessary.

6.  Orthopedic:  For the patient's right ankle fracture,
which was of unknown date of origin, the patient was seen in
consultation by the Orthopedic Service who recommended that
the cast be discontinued and this was done.  She was
recommended to weight bear as tolerated with full range of
motion.  She was seen by the Physical Therapy Service and
began ambulation.

7.  Fluid, electrolytes and nutrition:  The patient required
repletion of magnesium and potassium on several occasions as
well as phosphorus.  She was able to tolerate a soft diet.

DISPOSITION:  On [**2132-6-9**] the patient was deemed stable
for discharge to [**Hospital3 **].  She is being prepared for
transfer at this time.

DISCHARGE INSTRUCTIONS:  The patient should weight bear as
tolerated with full range of motion to complete
rehabilitation.  Routine PICC line care with no heparin
flushes.

FOLLOW UP INSTRUCTIONS:  The patient should follow up with
her primary neurologist listed above and with orthopedics Dr.
[**First Name8 (NamePattern2) **] [**Name (STitle) 9694**], [**Telephone/Fax (1) 4301**].  Orthopedics follow up should be
in two weeks.

DISCHARGE DIAGNOSES:
1.  Nonsustained ventricular tachycardia.
2.  Hypophosphatemia.
3.  Hypokalemia.
4.  Hypomagnesemia.
5.  Pneumonia.
6.  Ankle fracture.
7.  Heparin induced thrombocytopenia.
8.  Leukopenia.
9.  Extra parameatal symptoms of neuroleptic medication.
10.  Hypotension.
11.  Anemia.
12.  Depression.
13.  Bacteremia.

DISCHARGE MEDICATIONS:  Lopressor 12.5 mg po b.i.d.,
Vancomycin 1 gram intravenous q 18 hours, Flagyl 500 mg po
t.i.d., Protonix 40 mg po q.d., Neurontin 400 mg po t.i.d.,
aspirin 81 mg po q.d., Epogen 40,000 units subQ q week,
Neutrophos two packets po q.i.d., magnesium oxide 400 mg po
q.i.d., B-12 1000 mg IM q month, multivitamin one po q.d.





                            [**Name6 (MD) 251**] [**Name8 (MD) **], M.D.  [**MD Number(1) 1197**]

Dictated By:[**Name8 (MD) 2665**]
MEDQUIST36

D:  [**2132-6-9**]  08:23
T:  [**2132-6-9**]  08:44
JOB#:  [**Job Number 35757**]


Admission Date:  [**2132-6-2**]       Discharge Date:  [**2132-6-20**]

Date of Birth:   [**2057-5-9**]       Sex:  F

Service:  ACOVE

ADDENDUM:  Ms. [**Known lastname **] has been essentially stable since the
prior discharge summary. Her only significant issue being
that of mild dehydration with increased ostomy output.  The
patient in the last one to two days has been tried on Imodium
first at a low then at the maximum dose in an attempt to
decrease the patient's ostomy output without the
.................... effects. At this time we will being the
patient on tincture of opium 10% 0.6 ml po qid holding for
sedation or change in mental status to again attempt to
decrease the patient's ostomy output with the hopes of making
the patient increasingly more euvolemic as the patient's
dehydration was thought to be perhaps secondary to increased
ostomy output.

DISCHARGE MEDICATIONS: See page one for further information.
1.  Vitamin B12 1 gram IM q month.
2.  Magnesium Oxide 800 mg po qid.
3.  Lopressor 25 mg po bid hold for systolic blood pressure
of 110 or pulse less than 60.
4.  Protonix 40 mg po q day.
5.  Neurontin 400 mg po tid.
6.  Aspirin 81 mg po q day.
7.  Epogen 40,000 units subcutaneous q week.
8.  Neutra-Phos two packets po qid.
9.  Opium tincture 10% 0.6 ml po qid holding for sedation.
10. Vancomycin 1 gram IV q 48 hours for an additional 12 days
after discharge.
11. Risperdal 0.5 mg po bid.
12. Regular sliding scale insulin.

DISCHARGE PLAN: The patient will follow up with Dr. [**Last Name (STitle) 9694**]
of Orthopedics approximately one week status post discharge
[**Telephone/Fax (1) 4301**]. she will additionally follow up with Dr. [**First Name4 (NamePattern1) 5627**]
[**Last Name (NamePattern1) **], Neurology [**Telephone/Fax (1) 34520**] as soon as possible status post
discharge. The patient should have PIC flushes of normal
saline. She should not have Heparin used as she has an
allergy to that medication. She should have her ins and outs
closely monitored with the hopes that the patient's ostomy
output decreases on tincture opium although this may need to
be re-assessed in the next 24 to 48 hours.  The patient can
bear weight as tolerated with full range of motion to
complete rehabilitation.

Please see prior discharge summary for full discharge
summary.

DISCHARGE CONDITION:  Stable.




                            [**Name6 (MD) 251**] [**Name8 (MD) **], M.D.  [**MD Number(1) 1197**]

Dictated By:[**Name8 (MD) 2058**]
MEDQUIST36

D:  [**2132-6-20**]  11:04
T:  [**2132-6-20**]  14:05
JOB#:  [**Job Number 35758**]
{'Pneumonitis due to inhalation of food or vomitus,Bacteremia,Mitral valve disorders,Thrombocytopenia, unspecified,Paroxysmal ventricular tachycardia,Paranoid type schizophrenia, unspecified,Personal history of malignant neoplasm of ovary'}


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: This is a 74 year-old female
with a history of ovarian cancer and aspiration pneumonia who
was recently discharged from the [**Hospital1 190**] on [**5-20**] after an episode of Klebsiella
urosepsis and hypotension, which required Dopamine and also
was accompanied by mental status changes.  The patient was
discharged to [**Hospital3 **] where she recently finished a
fourteen day course of Levaquin.  She was in her usual state
of health and alert and oriented times three as recent as the
day prior to admission at which point the patient began to
spike temperatures of 105.  She also had emesis times one.
Crackles were noted on examination and the patient was sent
to the [**Hospital1 69**] Emergency
Department.  In the Emergency Department the temperature was
105.  Blood pressure 106/40.  Pulse 129.  Respirations 27.
O2 saturation 96% on an unknown amount of oxygen, which
became 100% on 100% nonrebreather.  Chest x-ray revealed a
new left lower lobe infiltrate.  The patient was given
Ceftriaxone, Vanco and Tylenol and intravenous fluids times 4
liters of normal saline.  Blood pressure remained 94/23 and
given concern for hypotension the patient was admitted to the
Medical Intensive Care Unit.

MEDICAL HISTORY: Notable for C section,
cholecystectomy, ovarian cancer in [**2131-9-29**], status
post TAH/BSO, omentectomy, ileocolectomy complicated by a
perforation of the anastomosis in [**2131-12-29**], which led
to peritonitis and resection and a perihepatic abscess and a
new ileostomy.  Diabetes mellitus.  History of aspiration.
Paranoid schizophrenia, depression, recurrent herpes zoster,
history of acute renal failure.  Hyperlipidemia.  Status post
PEG removal on the last admission.  Urinary tract infection
with Klebsiella.

MEDICATION ON ADMISSION: Risperdal 0.5 mg po q.a.m. and 1.5
mg po q.p.m.  Magnesium oxide 400 mg po q.i.d., Epogen 40,000
units q week, aspirin 81 mg po q.d., heparin subQ, Protonix
40 mg po q.d., Allopurinol 100 mg po q.d., [**Doctor First Name **] 60 mg po
b.i.d., B-12 1000 mg IM q month, Levaquin 500 mg po q.d.
times two days, Bactroban, MVI, Lopressor 12.5 po b.i.d.,
Neurontin 600 mg po t.i.d. and Acyclovir 450 q 8 hours times
seven days.

ALLERGIES: Penicillin causes rash.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Tobacco abuse until [**2110**].  The patient is
widowed.  She has a daughter and presently living at
[**Hospital3 **]. 

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Bacteremia,Mitral valve disorders,Thrombocytopenia, unspecified,Paroxysmal ventricular tachycardia,Paranoid type schizophrenia, unspecified,Personal history of malignant neoplasm of ovary'}
