CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 55 year old male with
a history of diabetes mellitus, end stage renal disease,
status post living related renal transplant in [**2130**],
congestive heart failure, coronary artery disease, status
post silent myocardial infarction and stent to the left
circumflex, who presents with poor appetite times two weeks,
decreased urine output over the course of three days, as well
as episodic band-like epigastric burning pain in the past
couple of days.  He describes the epigastric pain as eight
out of ten, nonexertional, band-like burning in the
epigastrium radiating around to his back.  This pain is also
associated with shortness of breath and mild nausea.  It
tends to last twenty minutes, although some episodes have
lasted up to three hours.  It also appears to be positional
in nature and somewhat relieved by antacids.

MEDICAL HISTORY: 1.  End stage renal disease, status post living related renal
transplant in [**2130**], currently on Prednisone and Cyclosporin
for immunosuppression.  Baseline creatinine is 3.0 to 3.5.
2.  Diabetes mellitus with triopathy.
3.  Coronary artery disease, status post myocardial
infarction and left anterior descending stent.
4.  Congestive heart failure with recent ejection fraction of
45 to 55%.
5.  Obstructive sleep apnea.  He uses BIPAP at home.
6.  Squamous and basal cell skin cancers.
7.  Legal blindness with retinal hemorrhages.

MEDICATION ON ADMISSION: 1.  Cyclosporin 200 mg p.o. b.i.d.
2.  Prednisone 5 mg p.o. q.d.
3.  Neurontin 300 mg p.o. b.i.d.
4.  Pravachol 40 mg p.o. q.d.
5.  Procardia 120 mg p.o. q.d.
6   Lasix 80 mg p.o. q.d.
7.  Lopressor 50 mg b.i.d.
8.  Epogen 3000 units b.i.week.
9.  Midodrine 10 mg p.o. t.i.d.
10. Aspirin 325 mg p.o. q.d.

ALLERGIES: 1.  Dicloxacillin.
2.  Compazine.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is retired.  He denies use of
tobacco or alcohol.
Complications of transplanted kidney,Acute kidney failure, unspecified,Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Background diabetic retinopathy,Polyneuropathy in diabetes,Congestive heart failure, unspecified
Compl kidney transplant,Acute kidney failure NOS,DMI renl nt st uncntrld,Nephritis NOS in oth dis,Diabetic retinopathy NOS,Neuropathy in diabetes,CHF NOS
Admission Date:  [**2139-9-9**]     Discharge Date:  [**2139-9-24**]

Date of Birth:   [**2083-10-25**]     Sex:  M

Service:  NEDICINE

HISTORY OF PRESENT ILLNESS:  This is a 55 year old male with
a history of diabetes mellitus, end stage renal disease,
status post living related renal transplant in [**2130**],
congestive heart failure, coronary artery disease, status
post silent myocardial infarction and stent to the left
circumflex, who presents with poor appetite times two weeks,
decreased urine output over the course of three days, as well
as episodic band-like epigastric burning pain in the past
couple of days.  He describes the epigastric pain as eight
out of ten, nonexertional, band-like burning in the
epigastrium radiating around to his back.  This pain is also
associated with shortness of breath and mild nausea.  It
tends to last twenty minutes, although some episodes have
lasted up to three hours.  It also appears to be positional
in nature and somewhat relieved by antacids.

The patient reports no urine output over the past eighteen
hours.  He denies any tenderness over the site of his renal
transplant.  He also denies fever, chills and dysuria.  He
does report that he recently finished a course of Biaxin
which he was taking for mouth infection.  He says that on the
day prior to admission he put out only approximately 150 cc
of urine.  His creatinine at baseline is 3.0 to 3.5.

The patient reports that he has had recurrent episodes of
progressive shortness of breath related to his congestive
heart failure.  He was admitted to the [**Hospital1 190**] in [**3-12**], with hypoxia and bilateral
infiltrates.  Bronchoscopy at that time was negative for PCP
but positive for alpha Streptococcus.  There was question of
mediastinal adenopathy and ground glass opacities on CT at
that time.  He returned to the [**Hospital1 188**] in [**6-9**], with similar symptoms which responded well
to antibiotics and diuresis.

Echocardiography in [**8-9**], revealed an ejection fraction of
45 to 55%.  Currently he does report shortness of breath,
dyspnea on exertion, however, denies paroxysmal nocturnal
dyspnea and orthopnea.  He also reports increased lower
extremity edema.

PAST MEDICAL HISTORY:
1.  End stage renal disease, status post living related renal
transplant in [**2130**], currently on Prednisone and Cyclosporin
for immunosuppression.  Baseline creatinine is 3.0 to 3.5.
2.  Diabetes mellitus with triopathy.
3.  Coronary artery disease, status post myocardial
infarction and left anterior descending stent.
4.  Congestive heart failure with recent ejection fraction of
45 to 55%.
5.  Obstructive sleep apnea.  He uses BIPAP at home.
6.  Squamous and basal cell skin cancers.
7.  Legal blindness with retinal hemorrhages.

MEDICATIONS ON ADMISSION:
1.  Cyclosporin 200 mg p.o. b.i.d.
2.  Prednisone 5 mg p.o. q.d.
3.  Neurontin 300 mg p.o. b.i.d.
4.  Pravachol 40 mg p.o. q.d.
5.  Procardia 120 mg p.o. q.d.
6   Lasix 80 mg p.o. q.d.
7.  Lopressor 50 mg b.i.d.
8.  Epogen 3000 units b.i.week.
9.  Midodrine 10 mg p.o. t.i.d.
10. Aspirin 325 mg p.o. q.d.

ALLERGIES:
1.  Dicloxacillin.
2.  Compazine.

SOCIAL HISTORY:  The patient is retired.  He denies use of
tobacco or alcohol.

PHYSICAL EXAMINATION:  Vital signs reveal temperature 98.0,
blood pressure 140/90, heart rate 80, respiratory rate 20,
oxygen saturation 93% in room air.  Head, eyes, ears, nose
and throat - Right eyelid droop with fixed pupil.  The left
pupil is round and reactive to light.  The oropharynx is
clear.  The neck is supple with no lymphadenopathy or jugular
venous pressure equals 14 centimeters.  Lungs clear to
auscultation bilaterally.  Bibasilar crackles and no wheezes.
Cardiovascular regular rate and rhythm, S1 and S2 normal, no
S3 and no S4, no murmurs.  The abdomen is soft, nontender,
nondistended, positive bowel sounds, no hepatosplenomegaly,
no masses.  Extremities - warm, no cyanosis and no clubbing
and 1+ pitting edema bilaterally.  Neurologic -The patient is
alert and oriented times three.  Cranial nerves II through
XII are intact, nonfocal.

LABORATORY DATA:  On admission, white blood count 7.7,
hematocrit 26.7, platelets 205,000.  Sodium 134, potassium
4.6, chloride 102, bicarbonate 12, blood urea nitrogen 114,
creatinine 5.8, glucose 224.  Calcium 7.7, phosphate 8.0,
magnesium 2.2.  Urine sodium equals less than 10, urine
creatinine equals 134, urine osmolality equals 350.
Urinalysis showed 20 to 30 white blood cells, 30 to 50 red
blood cells, positive yeast, negative bacteria, negative
casts.

Chest x-ray showed interstitial pulmonary edema, small left
sided pleural effusion, right basilar atelectasis.

Electrocardiogram was unchanged from previous baseline.

HOSPITAL COURSE:
1.  Pulmonary - At the time of admission, the patient had
shortness of breath and worsening dyspnea on exertion, and
was found to have a possible right lower lobe pneumonia on
CT, for which he was started on Levaquin.  On hospital day
number four, the patient was transferred to the Medical
Intensive Care Unit for congestive heart failure, related
decline in respiratory function and decreased pH, for which
he was started on 100% nonrebreather face mask.  After
spiking fever to 102, the patient was started on Ceftaz and
Vancomycin for presumed pneumonia.

After a short time in the Medical Intensive Care Unit, his
respiratory status improved and he began saturating close to
100% in room air.  Antibiotics ere discontinued at that time
as his rapid response was thought to be more indicative of
congestive heart failure related symptoms rather than
pneumonia.  Following removal of significant amounts of fluid
at dialysis, as well as transfusion, the patient's
respiratory status improved dramatically as did his
appearance on chest x-ray.

At the time of discharge, the patient had been breathing room
air for approximately three days, oxygen saturation ranging
from 95 to 100% in room air.

2.  Cardiovascular - On admission, serial enzymes were drawn
and the patient was ruled out for myocardial infarction.  No
new changes were noted on electrocardiogram.  Episodes of
epigastric pain were thought to be noncardiac in nature.  On
admission, the patient had shortness of breath, worsening
dyspnea on exertion and jugular venous pressure up to the jaw
on examination.  During his hospitalization, the patient's
congestive heart failure worsened and he was admitted to the
Medical Intensive Care Unit for respiratory failure.
Following removal of fluid at dialysis, the patient's
congestive heart failure related symptoms improved as
mentioned above.

3.  Renal - On admission, the patient had oliguria and acute
renal failure of unclear etiology.  His creatinine was 5.8
which was up from his baseline of approximately 3.0 to 3.5.
Renal ultrasound did not show hydronephrosis, making
postrenal obstruction an unlikely cause of his acute renal
failure.  Renal [**Year (4 digits) **] showed no evidence of acute rejection
or AIN and only showed signs of chronic diabetes mellitus and
chronic transplant changes.

During his first few days in the hospital, the patient showed
progressively worsening renal failure, and on hospital day
three, it was decided to start him on hemodialysis.  After
being transferred to the Medical Intensive Care Unit, the
patient continued dialysis three times a week, with
subsequent relief of his congestive heart failure symptoms.

On hospital day number two, the patient was switched from
Cyclosporin to Rapamune, however, before leaving the Medical
Intensive Care Unit, the Rapamune was also discontinued and
the patient was continued only on Prednisone.  Following
admission, arrangements had been made for the patient to
undergo hemodialysis at the Center in [**Location (un) **].

4.  Infectious disease - On admission, the patient was
started on Fluconazole for suspected fungal urinary tract
infection.  Cultures subsequently came back positive, and
were then followed up by negative cultures at which time the
Fluconazole was discontinued.

On hospital day number three, the patient was started on
Levaquin for suspected right lower lobe pneumonia seen on CT.
On hospital day number four, the patient developed profuse
watery diarrhea which was C. difficile positive.  He was
started on Flagyl at that time.  In the Medical Intensive
Care Unit, his diarrhea worsened, at which time he was
started on p.o. Vancomycin in addition to the Flagyl. His
symptoms persisted for several days and then declined at
which time he was transferred back to the floor.  Prior to
admission, subsequent C. difficile toxin screens came back
negative, although the patient continued to experience mild
diarrhea.  At the time of discharge, he was instructed to
continue fourteen day course of p.o. Vancomycin and p.o.
Flagyl.

After returning to the floor from the Medical Intensive Care
Unit, the patient was found to have erythema, discharge from
around his femora catheter site.  The site was cultured and
came back as Methicillin resistant Staphylococcus aureus
positive.  The patient was at that time started on
intravenous Vancomycin, and continued a seven day course of
this.

5.  Gastrointestinal - Following admission, the patient's
epigastric pain was thought to be consistent with
pancreatitis or gallbladder disease.  Liver function tests,
amylase, and lipase were found to be normal, however.  CT
examination revealed gallstones, which were thought to be
possibly contributing to his episodic positional postprandial
pain.  These symptoms gradually decreased in frequency and
severity throughout his hospitalization.  At the time of
discharge, he was asymptomatic.  By hospital day number
three, the patient developed profuse watery diarrhea and was
found to be C. difficile positive.  He was started on p.o.
Flagyl, however, his diarrhea persisted in the Medical
Intensive Care Unit and he was then started on p.o.
Vancomycin and intravenous Flagyl with subsequent improvement
in symptoms.  At the time of discharge, his symptoms were
much improved, however, he still had a small amount of
diarrhea.

6.  Hematology - The patient has had chronic anemia thought
to be secondary to his renal failure.  During his
hospitalization, his dose of Epogen was increased from 3000
to 6000 units three times a week, which he would receive at
the time of hemodialysis.  After being started on Rapamune,
the patient developed thrombocytopenia, which resolved
following discontinuation of the Rapamune.

7.  Endocrine - Initially the patient was started on his
outpatient dose of NPH with appropriate glucose control.
Following dialysis, however, the patient experienced
recurrent episodes of hypoglycemia, which was appropriately
treated with D50.  In the Medical Intensive Care Unit,
glucose control on NPH remained difficult and the NPH was
discontinued and the patient was started on an insulin
sliding scale.

After returning to the floor, the patient was gradually
increased to his prehospitalization doses of NPH.

8.  Fluids, electrolytes and nutrition - Following admission,
the patient was found to be acidemic, likely related to his
uremia.  At that time, the patient was started on intravenous
fluids with bicarbonate in order to correct his acidemia.  In
the Medical Intensive Care Unit, the patient again developed
acidemia which was thought to be secondary to both renal
failure and diarrhea.  He was repleted again with intravenous
fluids containing bicarbonate.

With his diarrhea, the patient became severely hypokalemic
and was appropriately repleted with potassium.  At the time
of discharge, the patient's electrolytes had remained stable
for several days.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE MEDICATIONS:
1.  Aspirin 325 mg p.o. q.d.
2.  Epogen 6000 units three times a week.
3.  Flagyl 500 mg p.o. t.i.d. times four days.
4.  Vancomycin 250 mg p.o. q.i.d. times four days.
5.  Lopressor 75 mg p.o. t.i.d.
6.  Prednisone 5 mg p.o. q.d.
7.  NPH 30 units a.m. and 10 units p.m..
8.  Pravachol 40 mg p.o. q.d.
9.  Procardia 120 mg p.o. q.d.
10. Neurontin 300 mg p.o. q.d.
11. Protonix 40 mg p.o. q.d.
12. Nephrocaps one tablet p.o. q.d.
13. Midodrine 5 mg p.o. t.i.d.
14. Vancomycin one gram intravenously times one.

DISCHARGE DIAGNOSES:
1.  Acute renal failure, etiology unclear, the patient
started on hemodialysis.
2.  Congestive heart failure.
3.  C. difficile diarrhea.
4.  Methicillin resistant Staphylococcus aureus positive line
infection.
5.  Cholelithiasis.

FOLLOW-UP:  Arrangements were made for the patient to undergo
hemodialysis at [**Location (un) **].  The patient was also instructed to
follow-up with his primary care physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Name (STitle) 805**].




                          [**Name6 (MD) 251**] [**Last Name (NamePattern4) 11865**], M.D.  [**MD Number(1) 11866**]

Dictated By:[**Last Name (NamePattern1) 20615**]

MEDQUIST36

D:  [**2139-9-24**]  14:18
T:  [**2139-9-28**]  19:34
JOB#:  [**Job Number 20616**]
{'Complications of transplanted kidney,Acute kidney failure, unspecified,Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Background diabetic retinopathy,Polyneuropathy in diabetes,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: This is a 55 year old male with
a history of diabetes mellitus, end stage renal disease,
status post living related renal transplant in [**2130**],
congestive heart failure, coronary artery disease, status
post silent myocardial infarction and stent to the left
circumflex, who presents with poor appetite times two weeks,
decreased urine output over the course of three days, as well
as episodic band-like epigastric burning pain in the past
couple of days.  He describes the epigastric pain as eight
out of ten, nonexertional, band-like burning in the
epigastrium radiating around to his back.  This pain is also
associated with shortness of breath and mild nausea.  It
tends to last twenty minutes, although some episodes have
lasted up to three hours.  It also appears to be positional
in nature and somewhat relieved by antacids.

MEDICAL HISTORY: 1.  End stage renal disease, status post living related renal
transplant in [**2130**], currently on Prednisone and Cyclosporin
for immunosuppression.  Baseline creatinine is 3.0 to 3.5.
2.  Diabetes mellitus with triopathy.
3.  Coronary artery disease, status post myocardial
infarction and left anterior descending stent.
4.  Congestive heart failure with recent ejection fraction of
45 to 55%.
5.  Obstructive sleep apnea.  He uses BIPAP at home.
6.  Squamous and basal cell skin cancers.
7.  Legal blindness with retinal hemorrhages.

MEDICATION ON ADMISSION: 1.  Cyclosporin 200 mg p.o. b.i.d.
2.  Prednisone 5 mg p.o. q.d.
3.  Neurontin 300 mg p.o. b.i.d.
4.  Pravachol 40 mg p.o. q.d.
5.  Procardia 120 mg p.o. q.d.
6   Lasix 80 mg p.o. q.d.
7.  Lopressor 50 mg b.i.d.
8.  Epogen 3000 units b.i.week.
9.  Midodrine 10 mg p.o. t.i.d.
10. Aspirin 325 mg p.o. q.d.

ALLERGIES: 1.  Dicloxacillin.
2.  Compazine.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is retired.  He denies use of
tobacco or alcohol. 

### Response:
{'Complications of transplanted kidney,Acute kidney failure, unspecified,Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Background diabetic retinopathy,Polyneuropathy in diabetes,Congestive heart failure, unspecified'}
