CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 53-year-old
male with a past medical history significant for post acute
tubular necrosis with end-stage renal dialysis (who had been
on hemodialysis) with hypertension and type 2 diabetes who is
status post cadaveric renal transplant approximately nine
days prior to admission.

MEDICAL HISTORY: 1.  Hypertension.
2.  Type 2 diabetes.
3.  Post infectious acute tubular necrosis.
4.  End-stage renal disease; had been on hemodialysis for
approximately three years prior to transplant.

MEDICATION ON ADMISSION: (Medications on admission
included)
1.  FK506 6 mg p.o. twice per day.
2.  CellCept [**Pager number **] mg p.o. twice per day
3.  Prednisone 20 mg p.o. once per day.
4.  Protonix 40 mg p.o. once per day.
5.  Valcyte 450 mg p.o. every other day.
6.  Nystatin swish-and-swallow once per day four times per
day.
7.  Lopressor 25 mg p.o. twice per day.
8.  Norvasc 5 mg p.o. once per day.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Complications of transplanted kidney,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Atrial fibrillation,Secondary cardiomyopathy, unspecified,Subendocardial infarction, initial episode of care,Hyperpotassemia,Pyelonephritis, unspecified
Compl kidney transplant,Acute kidney failure NOS,CHF NOS,Atrial fibrillation,Second cardiomyopath NOS,Subendo infarct, initial,Hyperpotassemia,Pyelonephritis NOS
Admission Date:  [**2178-6-9**]     Discharge Date:  [**2178-6-29**]

Date of Birth:   [**2124-9-1**]     Sex:  M

Service:  Surgery/Transplant

HISTORY OF PRESENT ILLNESS:  The patient is a 53-year-old
male with a past medical history significant for post acute
tubular necrosis with end-stage renal dialysis (who had been
on hemodialysis) with hypertension and type 2 diabetes who is
status post cadaveric renal transplant approximately nine
days prior to admission.

He had been discharged to home two days earlier, but while at
home had been noted to have progressive difficulty voiding
and increasing pain in his abdomen.  He came to the Clinic
and was unable to give a urine sample.  He was admitted for
this.  He denied nausea, vomiting, fevers, chills, night
sweats, shortness of breath, or dyspnea.  He had not been
hemodialyzed during the postoperative period.

PAST MEDICAL HISTORY:
1.  Hypertension.
2.  Type 2 diabetes.
3.  Post infectious acute tubular necrosis.
4.  End-stage renal disease; had been on hemodialysis for
approximately three years prior to transplant.

PAST SURGICAL HISTORY:
1.  Left arteriovenous fistula.
2.  Status post cadaveric renal transplant.

MEDICATIONS ON ADMISSION:  (Medications on admission
included)
1.  FK506 6 mg p.o. twice per day.
2.  CellCept [**Pager number **] mg p.o. twice per day
3.  Prednisone 20 mg p.o. once per day.
4.  Protonix 40 mg p.o. once per day.
5.  Valcyte 450 mg p.o. every other day.
6.  Nystatin swish-and-swallow once per day four times per
day.
7.  Lopressor 25 mg p.o. twice per day.
8.  Norvasc 5 mg p.o. once per day.

ALLERGIES:  No known drug allergies.

PHYSICAL EXAMINATION ON PRESENTATION:  Physical examination
on admission revealed temperature was 97.9, heart rate was
62, respiratory rate was 18, blood pressure was 139/92, and
oxygen saturation was 97% on room air.  Blood glucose was
258.  Head and neck examination revealed equal pupils.
Extraocular movements were intact.  Lungs were clear to
auscultation bilaterally.  Heart was regular in rate and
rhythm.  Normal first heart sounds and second heart sounds.
His abdomen was soft and nontender over the graft.  There was
guarding or rebound.  His bowel sounds were slightly
decreased.  His extremities were without cyanosis, clubbing,
or edema.

PERTINENT LABORATORY VALUES ON PRESENTATION:  Laboratory
values on admission revealed white blood cell count was 10.3,
hematocrit was 30.7, and platelets were 274.  Sodium was 131,
potassium was 5.5, blood urea nitrogen was 90, creatinine was
4.5, and blood glucose was 119.  Calcium, magnesium, and
phosphate were 10.7, 5, and 2.5.

HOSPITAL COURSE:   The patient was admitted from the Clinic
to the service of Dr. [**First Name (STitle) **] on [**2178-6-9**].

On [**2178-6-9**], additionally, the patient had an ultrasound
which demonstrated a peritransplant fluid collection.  No
hydronephrosis in the transplanted kidney.  The patient was
started on Levaquin and Flagyl for a 7-day course when he was
admitted.  A Foley was placed and drained approximately 145
cc and continued to have good urine output post the Foley
being placed.  Additionally, the patient was started on
Kayexalate for his high potassium value.

He had a percutaneous drain placed on [**6-10**] which drained
approximately 900 cc of old blood and fluid; it was thought
not to be an abscess.  He was moved back to a regular diet on
hospital day two.

On [**2178-6-12**], on hospital day three, the patient was found
to be in atrial fibrillation.  The patient was changed from
his usual dose of carvedilol to metoprolol and titrated for
control of his atrial fibrillation.  The Cardiology Service
was consulted.  They recommended rate control with Lopressor,
and an echocardiogram, as well as to start Coumadin.  The
patient was started on Coumadin on [**6-24**] for a goal INR of 2
to 2.5.

Throughout his hospitalization, after the initial drain was
placed under ultrasound-guidance the patient continued to
have a moderate amount of drain output.  Successful
ultrasound on [**6-16**] and [**6-19**] demonstrated residual
transplant fluid collections which increased in size until
[**6-16**].

On [**6-19**], the patient was taken to the operating room with
Dr. [**First Name (STitle) **] for creation of a peritoneal window and a kidney
biopsy.  He tolerated this procedure well with approximately
100 cc of crystalloid and minimal blood loss.  A follow-up
ultrasound after this demonstrated a very small residual
fluid collection.

Additionally, on [**6-19**], the patient underwent a stress MIBI
which demonstrated marked ventricular enlargement with
hypokinesis and an ejection fraction of 44%; consistent with
a cardiomyopathy.

On [**2178-6-16**] the Podiatry Service was consulted for toe
pain and Raynaud's phenomenon.  They recommended no treatment
for this and to follow up with their Clinic.

The patient continued to do postoperatively on [**2178-6-17**]
to [**2178-6-29**].  He was started back on his usual home
medications.  Additionally, he was slowly coumadinized to his
goal INR.  Per the Cardiology Service, additionally, the
patient was begun on a regimen of amiodarone for control of
his atrial fibrillation.

On [**2178-6-19**], on postoperative day two, the patient's
pigtail drain was discontinued.

The remainder of the hospitalization from [**2178-6-19**] to
[**2178-6-29**] was marked by slowly deteriorating renal
function with creatinine climbing from a value of 3.8 into
the low 5s.  These were felt to be stable at this value.

On [**2178-6-21**], the Vascular Surgery Service was consulted
for cyanotic-appearing feet.  The Vascular Surgery Service
felt the changes in his feet were likely secondary to his
Raynaud's and were chronic changes.

On [**2178-6-29**], with the patient's renal function stable,
and his ability to tolerate a regular diet, and able to
ambulate, and have his pain well controlled, and his
abdominal examination benign and unchanged for several days,
it was decided to discharge the patient to home.  A followup
on his pathology demonstrated no events of acute or chronic
rejection.  His immunosuppressive regimen was changed to
include only Rapamune, CellCept, and prednisone.  From a
cardiovascular standpoint, his atrial fibrillation was
stabilized on a regimen of amiodarone and Lopressor.  From a
renal standpoint, again, the biopsy showed no evidence of
acute or chronic rejection.  His creatinine remained elevated
but stable at a value of approximately 5.2 to 5.3.  Followup
was to be as per the transplant coordinator.

MEDICATIONS ON DISCHARGE:
 1.  Valcyte 450 mg p.o. every other day.
 2.  Protonix 40 mg p.o. once per day.
 3.  Bactrim one tablet p.o. once per day
 4.  Nystatin oral suspension 5 mL p.o. four times per day.
 5.  Insulin sliding-scale.
 6.  Colace 100 mg p.o. twice per day.
 7.  Venlafaxine 75 mg p.o. twice per day.
 8.  Dilaudid 4 mg p.o. q.3-4h. as needed (for pain).
 9.  Bisacodyl 10 mg p.o./p.r. once per day as needed (no
stool).
10.  Sarna lotion one application topically three times per
day as needed.
11.  Benadryl 25 mg p.o. q.h.s.
12.  Aspirin 81 mg p.o. once per day.
13.  Rosiglitazone maleate 4 mg p.o. twice per day.
14.  Amiodarone 400 mg p.o. once per day.
15.  Lopressor 12.5 mg p.o. twice per day.
16.  Mycophenolate mofetil 1000 mg p.o. twice per day.
17.  Prednisone 50 mg p.o. once per day.
18.  Hydralazine 25 mg p.o. q.6h.
19.  Isordil 30 mg p.o. once per day.
20.  Tylenol.
21.  Coumadin 3 mg p.o. once per day.

DISCHARGE DIAGNOSES:   Lymphocele, status post cadaveric
renal transplant.  Secondary diagnoses as in the Past Medical
History above.





                          [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 1331**]

Dictated By:[**Name8 (MD) 16207**]

MEDQUIST36

D:  [**2178-6-29**]  03:46
T:  [**2178-7-1**]  08:30
JOB#:  [**Job Number **]


Admission Date:  [**2178-6-9**]       Discharge Date:  [**2178-7-14**]

Date of Birth:   [**2124-9-1**]       Sex:  M

Service:

This is a death discharge dictation for Mr. [**Known lastname 6359**].

HISTORY OF PRESENT ILLNESS:  The patient is a 53 year old
male, with past medical history of end stage renal disease,
hypertension, type II diabetes, and congestive heart failure,
who is status post a cadaveric renal transplant, which was
performed on [**2178-5-31**].

The patient had been discharged home initially following his
renal transplant on the 11th but returned on the [**2178-6-9**].  He returned for increasing abdominal pain and
difficulty voiding.  At that time, he was found to have a
lymphocele around his transplanted kidney.  He underwent CT
guided drainage of this lymphocele initially and then went to
the operating room on [**2178-6-17**] for creation of a peritoneal
window and lymphocele drainage.  Following this, the patient
initially did well. He was evaluated by the cardiology
service on the [**6-12**]. He was found to be in atrial
fibrillation.  They continued to follow the patient
throughout his hospitalization.

The patient did well initially following creation of his
peritoneal window.  However, on the [**6-1**], the patient
began to complain of some chest pain and shortness of breath.
At that time, cardiac enzymes demonstrated a small treponin
leak.  This was partially attributed to his congestive heart
failure by the cardiology service. He was transferred to the
Intensive Care Unit on the [**2178-7-2**], where he stayed
until about the [**2178-7-14**].

While in the Intensive Care Unit, he was evaluated by the
renal service and underwent successful round of hemodialysis
given his worsening renal failure.

Initially, he was seen by the infectious disease service.
The [**2178-7-14**], he was transferred from the Intensive
Care Unit to the regular surgical floor. At approximately
3:30 a.m., the surgical team was contact[**Name (NI) **].  The patient had
been found in bed unresponsive.  ACLS protocols were
initiated.  Resuscitative effort lasted approximately 20
minutes without the ability to recapture heart activity.  12
lead electrocardiogram was performed which demonstrated
asystole.  The patient was pronounced dead at approximately
3:50 a.m. on [**2178-7-14**].

After resuscitative efforts, the patient was pronounced dead
at approximately 3:50 a.m. on [**2178-7-14**].







                            [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 1331**]

Dictated By:[**Doctor Last Name 106831**]
MEDQUIST36

D:  [**2178-7-14**]  04:36
T:  [**2178-7-14**]  04:11
JOB#:  [**Job Number 106832**]
{'Complications of transplanted kidney,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Atrial fibrillation,Secondary cardiomyopathy, unspecified,Subendocardial infarction, initial episode of care,Hyperpotassemia,Pyelonephritis, 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: The patient is a 53-year-old
male with a past medical history significant for post acute
tubular necrosis with end-stage renal dialysis (who had been
on hemodialysis) with hypertension and type 2 diabetes who is
status post cadaveric renal transplant approximately nine
days prior to admission.

MEDICAL HISTORY: 1.  Hypertension.
2.  Type 2 diabetes.
3.  Post infectious acute tubular necrosis.
4.  End-stage renal disease; had been on hemodialysis for
approximately three years prior to transplant.

MEDICATION ON ADMISSION: (Medications on admission
included)
1.  FK506 6 mg p.o. twice per day.
2.  CellCept [**Pager number **] mg p.o. twice per day
3.  Prednisone 20 mg p.o. once per day.
4.  Protonix 40 mg p.o. once per day.
5.  Valcyte 450 mg p.o. every other day.
6.  Nystatin swish-and-swallow once per day four times per
day.
7.  Lopressor 25 mg p.o. twice per day.
8.  Norvasc 5 mg p.o. once per day.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Complications of transplanted kidney,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Atrial fibrillation,Secondary cardiomyopathy, unspecified,Subendocardial infarction, initial episode of care,Hyperpotassemia,Pyelonephritis, unspecified'}
