CHIEF COMPLAINT: Cellulitis and hypotension.

PRESENT ILLNESS: This is a 42 year old male with
a history of diabetes mellitus, hypertension, morbid obesity,
who presented to an outside hospital feeling malaise with
chills and noted his legs were"burning".  Visiting nurse took
his temperature at the time which was 102.0.  He was brought
to the Emergency Department at [**Hospital3 4527**] Hospital
where his temperature was 104.0.  He had leg blisters that
were now surrounded with redness.  He became somewhat
dyspneic and had an episode of brief chest pain when feeling
shortness of breath.  He denies any cough.  He denies any
headache, stiff neck, back pain, abdominal pain, nausea,
vomiting, diarrhea or dysuria.  At [**Hospital3 4527**], his
blood pressure was 220/105 which subsequently dropped to a
systolic pressure of 80s.  Arterial blood gas at the time was
pH 7.40, 43 and 298 on 100% nonrebreathing mask which was
subsequently weaned to nasal cannula.  He was started on
Levofloxacin and Flagyl for his cellulitis and was
pancultured and his blood pressure remained in the 80s to
90s.  Because of his past history of cellulitis, requiring
intubation and tracheostomy, he was transferred to [**Hospital1 1444**] for further management if he
requires more aggressive airway management.

MEDICAL HISTORY: 1.  Diabetes mellitus.
2.  Morbid obesity.
3.  Asthma.
4.  Chronic obstructive pulmonary disease.
5.  Obstructive sleep apnea with CPAP at night.
6.  Coronary artery disease with a last ejection fraction of
55% on echocardiogram in [**2129-9-3**].
7.  Hypertension.
8.  Osteoarthritis.
9.  Chronic pain.
10. Quadriceps tendon repair.
11. Bilateral carpal tunnel release.
12. Hydrocele repair.
13. Sepsis from cellulitis, status post intubation and
tracheostomy.
14. History of Methicillin resistant Staphylococcus aureus.
15. History of Clostridium difficile.

MEDICATION ON ADMISSION: 1.  Combivent two puffs inhaled four times a day.
2.  Flonase two puffs inhaled twice a day.
3.  Lopressor 100 mg p.o. three times a day.
4.  Zestril 40 mg p.o. once daily.
5.  Protonix 40 mg p.o. once daily.
6.  Ativan 2 mg p.o. q.h.s.
7.  Xanax 0.5 mg three times a day p.o. p.r.n.
8.  Advair one puff twice a day.
9.  Mexiletine 400 mg p.o. twice a day.
10. Procardia 30 mg p.o. once daily.
11. Aspirin 81 mg p.o. once daily.
12. Celexa 60 mg p.o. twice a day.
13. Neurontin 600 mg p.o. three times a day.
14. Oxycontin 40 mg p.o. three times a day.
15. Lasix 80 mg p.o. once daily.
16. Humalog.

ALLERGIES: Fentanyl which causes shortness of breath and has
questionable allergies to Cephalosporins and Morphine.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives alone in a disabled home.
He has occasional tobacco use, denies any alcohol or
intravenous drug use.
Streptococcal septicemia,Cellulitis and abscess of leg, except foot,Ulcer of other part of foot,Chronic obstructive asthma, unspecified,Candidiasis of mouth,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Unspecified sleep apnea,Coronary atherosclerosis of native coronary artery,Morbid obesity
Streptococcal septicemia,Cellulitis of leg,Ulcer other part of foot,Chronic obst asthma NOS,Thrush,DMII oth nt st uncntrld,Sleep apnea NOS,Crnry athrscl natve vssl,Morbid obesity
Name:  [**Known lastname 5192**], [**Known firstname **]                        Unit No:  [**Numeric Identifier 5193**]

Admission Date:  [**2130-10-30**]     Discharge Date:  [**2130-11-7**]

Date of Birth:   [**2087-11-5**]     Sex:  M

Service:  [**Company 112**]

HOSPITAL COURSE CONTINUED:
1. Cardiovascular:  Based on the patient's body habitus, it
was difficult to ascertain his cardiac status.  Based on his
bacteremia, Cardiology was consulted for possible
transesophageal echocardiogram to rule out vegetations.
However, based on this patient's increased risk for
complications, Cardiology has deferred a transesophageal
echocardiogram at this time.

2. Cellulitis/bacteremia:  Patient was evaluated for possible
deep venous thrombosis.  On hospital day #2, bilateral lower
extremity ultrasounds were performed which revealed normal
flow, color, and augmentation of his femoral and popliteal
veins, and no evidence of deep venous thrombosis was
elicited.




                          [**Doctor First Name **] C- [**Name8 (MD) **], M.D.  [**MD Number(1) 1689**]

Dictated By:[**Name8 (MD) 1554**]

MEDQUIST36

D:  [**2130-11-29**]  15:09
T:  [**2130-12-4**]  15:55
JOB#:  [**Job Number 5194**]


Admission Date:  [**2130-10-29**]     Discharge Date:  [**2130-11-7**]

Date of Birth:   [**2087-11-5**]     Sex:  M

Service:  [**Company 191**]

CHIEF COMPLAINT:  Cellulitis and hypotension.

HISTORY OF PRESENT ILLNESS:  This is a 42 year old male with
a history of diabetes mellitus, hypertension, morbid obesity,
who presented to an outside hospital feeling malaise with
chills and noted his legs were"burning".  Visiting nurse took
his temperature at the time which was 102.0.  He was brought
to the Emergency Department at [**Hospital3 4527**] Hospital
where his temperature was 104.0.  He had leg blisters that
were now surrounded with redness.  He became somewhat
dyspneic and had an episode of brief chest pain when feeling
shortness of breath.  He denies any cough.  He denies any
headache, stiff neck, back pain, abdominal pain, nausea,
vomiting, diarrhea or dysuria.  At [**Hospital3 4527**], his
blood pressure was 220/105 which subsequently dropped to a
systolic pressure of 80s.  Arterial blood gas at the time was
pH 7.40, 43 and 298 on 100% nonrebreathing mask which was
subsequently weaned to nasal cannula.  He was started on
Levofloxacin and Flagyl for his cellulitis and was
pancultured and his blood pressure remained in the 80s to
90s.  Because of his past history of cellulitis, requiring
intubation and tracheostomy, he was transferred to [**Hospital1 1444**] for further management if he
requires more aggressive airway management.

PAST MEDICAL HISTORY:
1.  Diabetes mellitus.
2.  Morbid obesity.
3.  Asthma.
4.  Chronic obstructive pulmonary disease.
5.  Obstructive sleep apnea with CPAP at night.
6.  Coronary artery disease with a last ejection fraction of
55% on echocardiogram in [**2129-9-3**].
7.  Hypertension.
8.  Osteoarthritis.
9.  Chronic pain.
10. Quadriceps tendon repair.
11. Bilateral carpal tunnel release.
12. Hydrocele repair.
13. Sepsis from cellulitis, status post intubation and
tracheostomy.
14. History of Methicillin resistant Staphylococcus aureus.
15. History of Clostridium difficile.

MEDICATIONS ON ADMISSION:
1.  Combivent two puffs inhaled four times a day.
2.  Flonase two puffs inhaled twice a day.
3.  Lopressor 100 mg p.o. three times a day.
4.  Zestril 40 mg p.o. once daily.
5.  Protonix 40 mg p.o. once daily.
6.  Ativan 2 mg p.o. q.h.s.
7.  Xanax 0.5 mg three times a day p.o. p.r.n.
8.  Advair one puff twice a day.
9.  Mexiletine 400 mg p.o. twice a day.
10. Procardia 30 mg p.o. once daily.
11. Aspirin 81 mg p.o. once daily.
12. Celexa 60 mg p.o. twice a day.
13. Neurontin 600 mg p.o. three times a day.
14. Oxycontin 40 mg p.o. three times a day.
15. Lasix 80 mg p.o. once daily.
16. Humalog.

ALLERGIES:  Fentanyl which causes shortness of breath and has
questionable allergies to Cephalosporins and Morphine.

SOCIAL HISTORY:  The patient lives alone in a disabled home.
He has occasional tobacco use, denies any alcohol or
intravenous drug use.

PHYSICAL EXAMINATION:  On admission, temperature is 99.9,
blood pressure 118/48, heart rate 99, oxygen saturation 100%
on four liters nasal cannula.  In general, the patient
appears obese in no acute distress.  Anicteric sclera.  The
oropharynx is clear.  The neck examination is supple and no
lymphadenopathy.  Cardiovascular examination - The heart
sounds are distant, regular rate and rhythm.  The lung
examination has decreased breath sounds at the bases
bilaterally.  Abdominal examination - bowel sounds present,
soft, nontender, nondistended.  Extremities revealed right
lower extremity with a 2.0 centimeter ulcer surrounding by
10.0 by 8.0 centimeters of erythema.  Left lower extremity
with an ulcer and extensive erythema and bilateral trace
edema.  Neurologically, the patient is alert and oriented
times three.  Cranial nerves II through XII are intact.
Motor is grossly intact.

LABORATORY DATA:  White blood cell count 16.0, 87%
neutrophils, 4% bands, hematocrit 36.6, platelets 312,000.
Sodium 135, potassium 5.4, chloride 95, CO2 31, blood urea
nitrogen 30, creatinine 1.4, glucose 175, calcium 9.3.
Partial thromboplastin time 31.0, INR 1.2.  Albumin 4.2,
protein 8.6, total bilirubin 0.5, alkaline phosphatase 79,
ALT 63, AST 24.

Chest x-ray revealed a limited examination but was grossly
normal and an obscured right hemidiaphragm.
Electrocardiogram revealed normal sinus rhythm at a rate of
99 beats per minute, normal intervals and axis, no
hypertrophy and no acute ST-T wave changes.  Blood cultures
drawn at [**Hospital3 4527**] Hospital revealed 2/4 bottles
positive in te anaerobic bottles for beta hemolytic group G
Streptococcus.

HOSPITAL COURSE:
1.  Cardiovascular - The patient's antihypertensive
medications were held and his blood pressure remained stable
at admission of his Intensive Care Unit stay.  He was
vigorously hydrated with intravenous fluids and was
transferred out of the Intensive Care Unit on hospital day
number two.  His blood pressure remained stable and the
patient was restarted on his hypertensive medications without
any complications.

2.  Bacteremia and cellulitis - The patient was continued on
his Flagyl, Levofloxacin and Vancomycin for empiric treatment
while his blood cultures were awaiting sensitivities.  The
wound care service was consulted for optimal treatment for
his open ulcers on his legs.  On hospital day number six,
sensitivities of his blood cultures returned revealing
Clindamycin, Erythromycin, Penicillin and Vancomycin
sensitive cultures, however, he was noted to have extensive
blistering on the lateral aspect of his left leg and
dermatology was consulted for further evaluation.  These
vesicles were consistent with venous stasis and changes from
edema.  His intravenous antibiotics were changed to Kefzol
two grams q8hours and his erythema slowly was resolving with
improvement at the time of discharge.  His intravenous
antibiotics were switched to Keflex 1000 mg p.o. q6hours on
hospital day number nine.  He will continue on this for a two
week course and will require close follow-up with his primary
care physician so that his cellulitis will be closely
monitored.

3.  Oral herpes sores - On hospital day number four, the
patient was complaining of mouth pain and was begun on
Valtrac 500 mg p.o. twice a day for oral herpes lesions.  His
mouth pain gradually improved over the ensuing days and he
was discharged to complete a total five day course of
Valtrac.

4.  Diarrhea and abdominal pain - The patient was noted to
have the onset of diarrhea on hospital day four.  Based on
his start of broad spectrum antibiotics, his stool was
collected to rule out infectious causes of his diarrhea.  His
Clostridium difficile toxin came back negative.  His stool
cultures were otherwise unremarkable.  A KUB was taken on
hospital day number seven revealing no evidence of
obstruction.  Gastroenterology consultation was obtained for
further recommendations for evaluation in this large man.  He
was unable to be imaged because of his size, however, his
diarrhea self resolved on its own as well as his abdominal
pain.  He had no further episodes of diarrhea or abdominal
pain at the time of discharge.

5.  Anemia - The patient was noted to have hematocrit ranging
in the high 20s to low 30s.  Iron studies were sent revealing
a mixed picture of iron deficiency with anemia of chronic
disease.  He did not require transfusion during this hospital
admission and his hematocrit remained stable.

6.  Diabetes mellitus - The patient was noted to have
extremely labile blood sugar ranging from 200s to 400s
despite an aggressive insulin sliding scale.  The patient was
consulted by the [**Last Name (un) **] Diabetes service which verified that
the patient was taking U-500 insulin (five times the
concentrated regular insulin) and suggested placing him on 26
units of U-500 three times a day with Humalog coverage of 10
to 20 units premeals.  He will be followed up with Dr.
[**First Name (STitle) **] in the [**Hospital **] Clinic in approximately one month for
further follow-up and control of his hyperglycemia.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:  To home with VNA services.

FOLLOW-UP:  He is to have follow-up with his primary care
physician in approximately two weeks as well as follow-up
with Dr. [**First Name (STitle) **] in [**Hospital **] Clinic in approximately one
month.

MEDICATIONS ON DISCHARGE:
1.  Combivent two puffs inhaled four times a day.
2.  Flonase two puffs inhaled twice a day.
3.  Lopressor 100 mg p.o. three times a day.
4.  Zestril 40 mg p.o. once daily.
5.  Protonix 40 mg p.o. once daily.
6.  Ativan 2 mg p.o. q.h.s.
7.  Xanax 0.5 mg three times a day p.o. p.r.n.
8.  Advair one puff inhaled twice a day.
9.  Mexiletine 400 mg p.o. twice a day.
10. Procardia 30 mg p.o. once daily.
11. Aspirin 81 mg p.o. once daily.
12. Celexa 60 mg p.o. twice a day.
13. Neurontin 600 mg p.o. three times a day.
14. Oxycontin 40 mg p.o. three times a day.
15. Lasix 80 mg p.o. once daily.
16. Humalog units premeals.
17. U-500 26 units subcutaneous three times a day.
18. Keflex 1000 mg p.o. q6hours times fourteen days.

DISCHARGE DIAGNOSES:
1.  Cellulitis, complicated by group G Streptococcus
bacteremia.
2.  Diabetes mellitus.
3.  Hypertension.
4.  Obesity.
5.  Asthma, chronic obstructive pulmonary disease.
6.  Obstructive sleep apnea.
7.  Coronary artery disease.
8.  Hypertension.
9.  Osteoarthritis.
10. Chronic pain.
11. Anemia of chronic disease.




                          [**Doctor First Name 306**] C- [**Name8 (MD) 308**], M.D.  [**MD Number(1) 11871**]

Dictated By:[**Name8 (MD) 5406**]

MEDQUIST36

D:  [**2130-11-29**]  15:01
T:  [**2130-12-4**]  19:38
JOB#:  [**Job Number **]
{'Streptococcal septicemia,Cellulitis and abscess of leg, except foot,Ulcer of other part of foot,Chronic obstructive asthma, unspecified,Candidiasis of mouth,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Unspecified sleep apnea,Coronary atherosclerosis of native coronary artery,Morbid obesity'}


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: Cellulitis and hypotension.

PRESENT ILLNESS: This is a 42 year old male with
a history of diabetes mellitus, hypertension, morbid obesity,
who presented to an outside hospital feeling malaise with
chills and noted his legs were"burning".  Visiting nurse took
his temperature at the time which was 102.0.  He was brought
to the Emergency Department at [**Hospital3 4527**] Hospital
where his temperature was 104.0.  He had leg blisters that
were now surrounded with redness.  He became somewhat
dyspneic and had an episode of brief chest pain when feeling
shortness of breath.  He denies any cough.  He denies any
headache, stiff neck, back pain, abdominal pain, nausea,
vomiting, diarrhea or dysuria.  At [**Hospital3 4527**], his
blood pressure was 220/105 which subsequently dropped to a
systolic pressure of 80s.  Arterial blood gas at the time was
pH 7.40, 43 and 298 on 100% nonrebreathing mask which was
subsequently weaned to nasal cannula.  He was started on
Levofloxacin and Flagyl for his cellulitis and was
pancultured and his blood pressure remained in the 80s to
90s.  Because of his past history of cellulitis, requiring
intubation and tracheostomy, he was transferred to [**Hospital1 1444**] for further management if he
requires more aggressive airway management.

MEDICAL HISTORY: 1.  Diabetes mellitus.
2.  Morbid obesity.
3.  Asthma.
4.  Chronic obstructive pulmonary disease.
5.  Obstructive sleep apnea with CPAP at night.
6.  Coronary artery disease with a last ejection fraction of
55% on echocardiogram in [**2129-9-3**].
7.  Hypertension.
8.  Osteoarthritis.
9.  Chronic pain.
10. Quadriceps tendon repair.
11. Bilateral carpal tunnel release.
12. Hydrocele repair.
13. Sepsis from cellulitis, status post intubation and
tracheostomy.
14. History of Methicillin resistant Staphylococcus aureus.
15. History of Clostridium difficile.

MEDICATION ON ADMISSION: 1.  Combivent two puffs inhaled four times a day.
2.  Flonase two puffs inhaled twice a day.
3.  Lopressor 100 mg p.o. three times a day.
4.  Zestril 40 mg p.o. once daily.
5.  Protonix 40 mg p.o. once daily.
6.  Ativan 2 mg p.o. q.h.s.
7.  Xanax 0.5 mg three times a day p.o. p.r.n.
8.  Advair one puff twice a day.
9.  Mexiletine 400 mg p.o. twice a day.
10. Procardia 30 mg p.o. once daily.
11. Aspirin 81 mg p.o. once daily.
12. Celexa 60 mg p.o. twice a day.
13. Neurontin 600 mg p.o. three times a day.
14. Oxycontin 40 mg p.o. three times a day.
15. Lasix 80 mg p.o. once daily.
16. Humalog.

ALLERGIES: Fentanyl which causes shortness of breath and has
questionable allergies to Cephalosporins and Morphine.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives alone in a disabled home.
He has occasional tobacco use, denies any alcohol or
intravenous drug use. 

### Response:
{'Streptococcal septicemia,Cellulitis and abscess of leg, except foot,Ulcer of other part of foot,Chronic obstructive asthma, unspecified,Candidiasis of mouth,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Unspecified sleep apnea,Coronary atherosclerosis of native coronary artery,Morbid obesity'}
