CHIEF COMPLAINT: 

PRESENT ILLNESS: Ms. [**Known lastname 102099**] is a 66-year-old
woman with past medical history significant for symptoms
consistent with neuromuscular disorder.  Her symptoms began
approximately six months prior to admission and were
significant for lower extremity weakness which progressed to
the point where she was unable to ambulate.

MEDICAL HISTORY: 1. Coronary artery disease status post non-Q-wave myocardial
infarction in [**2173-3-23**].
2. Congestive heart failure with ejection fraction of 25%.
3. History of atrial fibrillation status post cardioversion
in [**2173-3-23**].
4. Hyponatremia, question secondary to SIADH.
5. Depression.
6. History of deep venous thrombosis.
7. Obesity.
8. Hepatitis C.
9. History of osteomyelitis of the skull status post
craniotomy which is complicated by a grand mal seizure.
10. Chronic low back pain.
11. History of compression fractures.
12. Type 2 diabetes mellitus, diet controlled.
13. Hypothyroid.

MEDICATION ON ADMISSION: 1. Lasix 80 mg q day.
2. Potassium chloride 30 mEq po q day.
3. Lopressor 50 mg [**Hospital1 **].
4. Aspirin 81 mg po q day.
5. Flovent two puffs [**Hospital1 **].
6. Lipitor 40 mg q day.
7. Phenobarbital 30 mg tid.
8. Prilosec 20 mg q day.
9. Imodium.
10. Multivitamin.
11. Ambien 5 mg q hs.
12. Darvocet prn.
13. Coumadin 3 mg q day.
14. Colace.
15. Zinc sulfate.
16. Sodium chloride.
17. Vitamin C.
18. Rhinocort.
19. Neurontin 100 tid.
20. Levoxyl 50 q day.
21. Zoloft 75 q day.
22. [**Doctor First Name **] 60 q day.
23. Water restriction to 1 liter q day.

ALLERGIES: Morphine which causes a rash.  She is allergic to
codeine which causes a rash.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She is married and denies alcohol or tobacco
use.  She formally worked as a nurse.  She currently lives in
a rehabilitation facility.
Acute respiratory failure,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Other malignant neoplasm without specification of site,Myasthenic syndromes in diseases classified elsewhere,Atrial fibrillation,Hyposmolality and/or hyponatremia
Acute respiratry failure,CHF NOS,Acute kidney failure NOS,Malignant neoplasm NOS,Myasthenia in oth dis,Atrial fibrillation,Hyposmolality
Admission Date:  [**2173-8-9**]     Discharge Date:  [**2173-8-26**]

Date of Birth:   [**2107-5-2**]     Sex:  F

Service:

HISTORY OF PRESENT ILLNESS:  Ms. [**Known lastname 102099**] is a 66-year-old
woman with past medical history significant for symptoms
consistent with neuromuscular disorder.  Her symptoms began
approximately six months prior to admission and were
significant for lower extremity weakness which progressed to
the point where she was unable to ambulate.

Three weeks prior to admission, she developed upper extremity
weakness and dysphagia.  She is admitted to outside hospital
where workup included equivocal EMG studies, positive P/Q
voltage-gated calcium channel antibody, and negative
acetylcholine receptor antibody.  She was subsequently
transferred to [**Hospital1 69**] for
further evaluation and management.

PAST MEDICAL HISTORY:
1. Coronary artery disease status post non-Q-wave myocardial
infarction in [**2173-3-23**].
2. Congestive heart failure with ejection fraction of 25%.
3. History of atrial fibrillation status post cardioversion
in [**2173-3-23**].
4. Hyponatremia, question secondary to SIADH.
5. Depression.
6. History of deep venous thrombosis.
7. Obesity.
8. Hepatitis C.
9. History of osteomyelitis of the skull status post
craniotomy which is complicated by a grand mal seizure.
10. Chronic low back pain.
11. History of compression fractures.
12. Type 2 diabetes mellitus, diet controlled.
13. Hypothyroid.

MEDICATIONS ON ADMISSION:
1. Lasix 80 mg q day.
2. Potassium chloride 30 mEq po q day.
3. Lopressor 50 mg [**Hospital1 **].
4. Aspirin 81 mg po q day.
5. Flovent two puffs [**Hospital1 **].
6. Lipitor 40 mg q day.
7. Phenobarbital 30 mg tid.
8. Prilosec 20 mg q day.
9. Imodium.
10. Multivitamin.
11. Ambien 5 mg q hs.
12. Darvocet prn.
13. Coumadin 3 mg q day.
14. Colace.
15. Zinc sulfate.
16. Sodium chloride.
17. Vitamin C.
18. Rhinocort.
19. Neurontin 100 tid.
20. Levoxyl 50 q day.
21. Zoloft 75 q day.
22. [**Doctor First Name **] 60 q day.
23. Water restriction to 1 liter q day.

ALLERGIES:  Morphine which causes a rash.  She is allergic to
codeine which causes a rash.

SOCIAL HISTORY:  She is married and denies alcohol or tobacco
use.  She formally worked as a nurse.  She currently lives in
a rehabilitation facility.

EXAMINATION:  Temperature 98.8, heart rate 70, blood pressure
120/70, respiratory rate 22, and oxygen saturation is 96% on
3 liters.  She is a morbidly obese woman lying motionless in
bed.  She is in no apparent distress.  Pupils are equal,
round, and reactive to light and accommodation.  Sclerae are
anicteric.  Moist mucous membranes.  Neck was supple with no
lymphadenopathy.  There were several palpable nodules in the
thyroid.  Lungs had bibasilar rales going 1.5 up the
posterior lung field.  Heart was regular with normal first
and second heart sounds.  No murmurs, rubs, or gallops.
Abdomen is obese, soft, nontender, nondistended.  There are
active bowel sounds and no abdominal bruits.  The extremities
showed 2+ pitting edema at the knees.  There were 2+ palpable
peripheral pulses.  Neurological examination was notable for
a disoriented woman with slurred speech.  She was also to
close her eyes, but she is not able to hold them closed
against resistance.  Her motor strength was [**1-25**] in the upper
extremities bilaterally.  Motor strength is 0/5 in the lower
extremities bilaterally.  There was no clonus or
vesiculations.  Her tone was flaccid in the lower
extremities.  Her upper extremities were mildly rigid.  Deep
tendon reflexes were absent in all four extremities.

DATA:  White count 15.6, hematocrit 35.4, platelets 271.  INR
2.2, PTT 32.2.  Sodium 142, potassium 4.0, chloride 103,
bicarb 24, BUN 38, creatinine 1.5, glucose 138.  Sed rate
172.  ALT 20, AST 40, alkaline phosphatase 211, total
bilirubin 0.6, albumin 2.4, total protein 6.3.

HOSPITAL COURSE:  Ms. [**Known lastname 102099**] was admitted to the hospital
for further management of her neuromuscular disease.  Due to
impending respiratory failure, she was transferred to the
Medical Intensive Care Unit soon after she arrived in the
hospital.

1. Pulmonary:  Ms. [**Known lastname 102099**] was subsequently intubated
secondary due to her respiratory muscle weakness.  At the
time of intubation, she had a decreased vital capacity and
decreased NIF.  Her pulmonary issues were complicated by
progressive fluid overload leading to cardiogenic pulmonary
edema.  She did not demonstrate any significant improvement
in her respiratory mechanics for the remainder of her
hospital stay.  She did have a diagnostic therapeutic
thoracentesis, which resulted with a removal of 1 liter of
fluid, however, this did not improve her respiratory
mechanics.

2. Cardiac:  She has a history of coronary artery disease,
congestive heart failure, and atrial fibrillation.  She was
in atrial fibrillation while she was in the MICU.  This was
complicated by worsening congestive heart failure and
decreased urine output.  She became more fluid overloaded
during the course of her hospital stay.  She required fluid
to maintain her blood pressure.  She was unable to diurese
with Lasix drip and dopamine drip.  She was cardioverted back
into normal sinus rhythm with improvement of her blood
pressure.  However, this did not effect her urine output at
all.

3. Renal:  She developed acute renal failure during her
hospital stay.  It was thought that part of her acute renal
failure were due to contrast induced ATN.  However, she did
not develop any improvement in her renal function, perhaps
due to inadequate tissue perfusion.  She was dialyzed several
times during her MICU course to remove fluid in an attempt to
improve her hemodynamic status.

4. Neurology:  Her differential diagnosis of her
neuromuscular disease included myasthenia [**Last Name (un) 2902**] and
[**Location (un) **]-[**Location (un) **] myasthenic syndrome.  Her serologic tests were
thought to be more consistent with [**Location (un) **]-[**Location (un) **].  She
underwent seven rounds of plasmapheresis with minimal
improvement in her clinical status.

4. I&D:  She developed a methicillin-resistant Staphylococcus
aureus pneumonia, and a methicillin-resistant Staphylococcus
aureus sacral decubitus ulcer.  Her sacral decubitus ulcer
also grew Pseudomonas.  She received Vancomycin for treatment
of her infections.  Her sacral decubitus ulcer was debrided
by Surgery.  Due to her hematologic issues, however, she had
problems clotting after the debridement, and she continued to
ooze from her decubitus ulcer for the remainder of her
hospital stay.

5. Hematology:  Her course is complicated by both anemia and
thrombocytopenia.  It is thought that the thrombocytopenia
might be due to Heparin, so the Heparin was discontinued, and
she was started on lepirudin.  She remained coagulopathic for
the rest of her hospital stay.

Despite aggressive measures in the Intensive Care Unit, Ms.
[**Known lastname 102099**] continued to get worse.  After further discussion
with her family, decision was made to shift the focus of our
care for comfort measures for Ms. [**Known lastname 102099**].  She expired on
[**2173-8-26**].

DISCHARGE STATUS:  Expired.

DISCHARGE DIAGNOSES:
1. [**Location (un) **]-[**Location (un) **] myasthenic syndrome versus myasthenia
[**Last Name (un) 2902**].
2. Hypercarbic respiratory failure requiring mechanical
intubation.
3. Methicillin-resistant Staphylococcus aureus pneumonia.
4. Atrial fibrillation status post DC cardioversion.
5. Congestive heart failure.
6. Acute renal failure requiring hemodialysis.
7. Sacral decubitus ulcer complicated by infection of
methicillin-resistant Staphylococcus aureus and Pseudomonas.
8. Anemia.
9. Thrombocytopenia, question Heparin-induced
thrombocytopenia.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 7512**]

Dictated By:[**Last Name (NamePattern1) 7787**]

MEDQUIST36

D:  [**2174-12-29**]  16:59
T:  [**2175-1-2**]  06:15
JOB#:  [**Job Number 102100**]
{'Acute respiratory failure,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Other malignant neoplasm without specification of site,Myasthenic syndromes in diseases classified elsewhere,Atrial fibrillation,Hyposmolality and/or hyponatremia'}


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: Ms. [**Known lastname 102099**] is a 66-year-old
woman with past medical history significant for symptoms
consistent with neuromuscular disorder.  Her symptoms began
approximately six months prior to admission and were
significant for lower extremity weakness which progressed to
the point where she was unable to ambulate.

MEDICAL HISTORY: 1. Coronary artery disease status post non-Q-wave myocardial
infarction in [**2173-3-23**].
2. Congestive heart failure with ejection fraction of 25%.
3. History of atrial fibrillation status post cardioversion
in [**2173-3-23**].
4. Hyponatremia, question secondary to SIADH.
5. Depression.
6. History of deep venous thrombosis.
7. Obesity.
8. Hepatitis C.
9. History of osteomyelitis of the skull status post
craniotomy which is complicated by a grand mal seizure.
10. Chronic low back pain.
11. History of compression fractures.
12. Type 2 diabetes mellitus, diet controlled.
13. Hypothyroid.

MEDICATION ON ADMISSION: 1. Lasix 80 mg q day.
2. Potassium chloride 30 mEq po q day.
3. Lopressor 50 mg [**Hospital1 **].
4. Aspirin 81 mg po q day.
5. Flovent two puffs [**Hospital1 **].
6. Lipitor 40 mg q day.
7. Phenobarbital 30 mg tid.
8. Prilosec 20 mg q day.
9. Imodium.
10. Multivitamin.
11. Ambien 5 mg q hs.
12. Darvocet prn.
13. Coumadin 3 mg q day.
14. Colace.
15. Zinc sulfate.
16. Sodium chloride.
17. Vitamin C.
18. Rhinocort.
19. Neurontin 100 tid.
20. Levoxyl 50 q day.
21. Zoloft 75 q day.
22. [**Doctor First Name **] 60 q day.
23. Water restriction to 1 liter q day.

ALLERGIES: Morphine which causes a rash.  She is allergic to
codeine which causes a rash.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She is married and denies alcohol or tobacco
use.  She formally worked as a nurse.  She currently lives in
a rehabilitation facility. 

### Response:
{'Acute respiratory failure,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Other malignant neoplasm without specification of site,Myasthenic syndromes in diseases classified elsewhere,Atrial fibrillation,Hyposmolality and/or hyponatremia'}
