CHIEF COMPLAINT: Clotted AV Graft
Hyperkalemia

PRESENT ILLNESS: 74M well known to the transplant surgery service presents
with clotted AVG of the left upper extremity and hyperkalemia to
6.8.  According to patient he is unaware when graft lost it's
pulse and thrill, but today at HD it was noted to be
nonfunctioning.  He was unable to be dialyzed and referred to
[**Hospital1 18**] for thrombectomy.  However, in the preop holding area
patient preoperative labs were notable for K of 6.8.  HE was
given insulin 10 units iv and d50.  Attempts at placing an HD
line were unsuccessful he is currently awaiting IR placement of
temporary HD line.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Dyslipidemia, Hypertension
.
2. CARDIAC HISTORY:
-PERCUTANEOUS CORONARY INTERVENTIONS
(1) CAD s/p NSTEMI and stenting of the distal RCA, OM2 in [**2-/2147**]
complicated by GIB and paroxysmal atrial fibrillation
(2) s/p NSTEMI and unstable angina in [**2148-10-2**], cath showed
compelte occlusion of all three stents placed in [**2-/2147**], stent
placed in LCx
(3) s/p unstable angina, [**Year (4 digits) **] to LCx since LCx placed in [**9-/2148**]
had instent stenosis
.
3. OTHER PAST MEDICAL HISTORY:
-Three vessel CAD: see above for details
-Perioperative (bowel resection) vasospasm requiring cardiac
cath with NTG
-Mild-moderate MR
[**Name13 (STitle) 37625**] EF: 45% with focal inferior-posterior wall motion
abnormalities
-ESRD on HD, Cr [**2-18**] at baseline
-Ischemic Colitis: s/p SMA thrombectomy, with [**Doctor Last Name 3379**] pouch
and end ileostomy. Also complicated by recent diversion colitis
in 2/[**2146**].
-Peripheral [**Year (4 digits) 1106**] disease s/p aortobifemoral bypass [**2131**]
-Raynauds
-Dementia
-Atrial fibrillation
-H/o perioperative CVA: no deficits
-Hyperlipidemia
-HTN
-H/o Achalasia s/p esophageal dilation
-H/o VRE infection
-Anemia
-[**2149-3-26**] IR LUE AVF thrombectomy c/b Radial
art occlusion with thrombus extraction .

MEDICATION ON ADMISSION: aspirin 325 mg Tablet, Plavix 75 mg, amiodarone 200 mg',
carvedilol 12.5 mg", lisinopril 7.5 mg', loperamide 2 mg ",
pantoprazole 40 mg', lovastatin 10 mg', sevelamer HCl 800 mg"',
1337 mg "', isosorbide mononitrate 30 mg', Nephrocaps 1 mg'.

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS: 56 139/58 18 O2 sat=98% RA
NAD, Answers all questions, easily arousable but sleepy
bradycardic
crackles L> R
Soft abdomen with ileostomy with gas and + Output, Nontender
Ext: WWP, no edema.  LUE with radial avf scar well healed with
LUE AVG without pulse or thrill. 1+ radial bilaterally

FAMILY HISTORY: Comes from a family of 20 kids. Only 2 are still alive.
Significant history of cardiac disease in the family.

SOCIAL HISTORY: Patient lives with his wife. [**Name (NI) **] outside help needed. Active at
baseline.
-Tobacco history: 40 pack years, quit 11 years ago
-ETOH: None
-Illicit drugs: None
Other complications due to renal dialysis device, implant, and graft,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Embolism and thrombosis of other specified artery,Hyperpotassemia,Renal dialysis status,Atrial fibrillation,Raynaud's syndrome,Other and unspecified hyperlipidemia,Atherosclerosis of native arteries of the extremities, unspecified,Personal history of tobacco use
Comp-ren dialys dev/grft,End stage renal disease,Hyp kid NOS w cr kid V,Arterial embolism NEC,Hyperpotassemia,Renal dialysis status,Atrial fibrillation,Raynaud's syndrome,Hyperlipidemia NEC/NOS,Athscl extrm ntv art NOS,History of tobacco use
Admission Date:  [**2149-3-25**]              Discharge Date:   [**2149-4-1**]

Date of Birth:  [**2074-4-26**]             Sex:   M

Service: SURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 5569**]
Chief Complaint:
Clotted AV Graft
Hyperkalemia

Major Surgical or Invasive Procedure:
[**2149-3-25**]: Right femoral temporary dialysis line placement
[**2149-3-26**]: IR LUE AVF thrombectomy c/b Radial
art occlusion s/p extraction of thrombus.


History of Present Illness:
74M well known to the transplant surgery service presents
with clotted AVG of the left upper extremity and hyperkalemia to
6.8.  According to patient he is unaware when graft lost it's
pulse and thrill, but today at HD it was noted to be
nonfunctioning.  He was unable to be dialyzed and referred to
[**Hospital1 18**] for thrombectomy.  However, in the preop holding area
patient preoperative labs were notable for K of 6.8.  HE was
given insulin 10 units iv and d50.  Attempts at placing an HD
line were unsuccessful he is currently awaiting IR placement of
temporary HD line.


Past Medical History:
1. CARDIAC RISK FACTORS: Dyslipidemia, Hypertension
.
2. CARDIAC HISTORY:
-PERCUTANEOUS CORONARY INTERVENTIONS
(1) CAD s/p NSTEMI and stenting of the distal RCA, OM2 in [**2-/2147**]
complicated by GIB and paroxysmal atrial fibrillation
(2) s/p NSTEMI and unstable angina in [**2148-10-2**], cath showed
compelte occlusion of all three stents placed in [**2-/2147**], stent
placed in LCx
(3) s/p unstable angina, [**Year (4 digits) **] to LCx since LCx placed in [**9-/2148**]
had instent stenosis
.
3. OTHER PAST MEDICAL HISTORY:
-Three vessel CAD: see above for details
-Perioperative (bowel resection) vasospasm requiring cardiac
cath with NTG
-Mild-moderate MR
[**Name13 (STitle) 37625**] EF: 45% with focal inferior-posterior wall motion
abnormalities
-ESRD on HD, Cr [**2-18**] at baseline
-Ischemic Colitis: s/p SMA thrombectomy, with [**Doctor Last Name 3379**] pouch
and end ileostomy. Also complicated by recent diversion colitis
in 2/[**2146**].
-Peripheral [**Year (4 digits) 1106**] disease s/p aortobifemoral bypass [**2131**]
-Raynauds
-Dementia
-Atrial fibrillation
-H/o perioperative CVA: no deficits
-Hyperlipidemia
-HTN
-H/o Achalasia s/p esophageal dilation
-H/o VRE infection
-Anemia
-[**2149-3-26**] IR LUE AVF thrombectomy c/b Radial
art occlusion with thrombus extraction .


Social History:
Patient lives with his wife. [**Name (NI) **] outside help needed. Active at
baseline.
-Tobacco history: 40 pack years, quit 11 years ago
-ETOH: None
-Illicit drugs: None


Family History:
Comes from a family of 20 kids. Only 2 are still alive.
Significant history of cardiac disease in the family.

Physical Exam:
VS: 56 139/58 18 O2 sat=98% RA
NAD, Answers all questions, easily arousable but sleepy
bradycardic
crackles L> R
Soft abdomen with ileostomy with gas and + Output, Nontender
Ext: WWP, no edema.  LUE with radial avf scar well healed with
LUE AVG without pulse or thrill. 1+ radial bilaterally

Pertinent Results:
[**2149-3-30**] 04:19AM BLOOD WBC-6.2 RBC-3.33* Hgb-10.3* Hct-30.4*
MCV-91 MCH-30.9 MCHC-33.9 RDW-16.8* Plt Ct-140*
[**2149-3-31**] 05:15AM BLOOD PT-17.2* PTT-74.6* INR(PT)-1.5*
[**2149-3-30**] 04:19AM BLOOD PT-14.8* PTT-57.3* INR(PT)-1.3*
[**2149-3-29**] 04:16AM BLOOD PT-13.8* PTT-49.0* INR(PT)-1.2*
[**2149-3-30**] 04:19AM BLOOD Glucose-95 UreaN-24* Creat-5.5*# Na-139
K-3.6 Cl-96 HCO3-33* AnGap-14
[**2149-3-30**] 04:19AM BLOOD Calcium-9.0 Phos-4.7* Mg-2.0

Brief Hospital Course:
74 y/o male admitted with non-functioning AV graft, found at HD.
On admission labs the potassium was 6.8. At this time an attempt
was made to place a temporary IJ line for emergent HD. Right IJ
was very small in caliber and left IJ was unable to be wired.
Procedure was stopped and the patient sent to IR to have femoral
line placed given past history of bilateral aorto-[**Hospital1 **] fems.
Hemodialysis was performed via that line with post HD potassium
of 4.3.

On [**2149-3-26**], he underwent IR LUE AVF thrombectomy c/b radial art
occlusion that requried consulting Dr. [**Last Name (STitle) **] who
performed  extraction of thrombus with export device. He was
treated w/ heparin, integrelin and TPA. Completion angiogram
demonstrated patent radial and ulnar arteries. However, the left
radial pulse was not palpable, but the ulnar was palpable.

On [**3-29**], hemodialysis was successfully performed via the left
arm AVG. On [**3-30**], the temporary right groin dialysis line was
removed. He did experience bleeding at this site requiring a
pressure dressing that was removed on [**3-31**]. No futher bleeding
occurred at groin site. He was dialyzed again on [**4-1**] without
incident via the left AVG.

He remained on a heparin drip until [**3-31**]. Coumadin (5mg) was
given on [**3-30**] and [**3-31**]. INR increased to 2.2 on [**4-1**].  After
furhter review, long term coumadin was stopped given h/o of GI
bleed 6months prior. He was to continue on aspirin and plavix
given h/o cardiac stents.

The left arm AVG had a thrill and was working well for dialysis
on [**4-1**]. Vital signs were notable for sbp in 160-190 range.
Amlodipine 5mg qd was started. He was tolerating food and ostomy
was functioning well. PT assessed him and declared him safe for
discharge to home. He will resume dialysis in [**Location (un) **].

Of note, PT recommended a rolling walker and home PT. This was
arranged prior to discharge.
.


Medications on Admission:
aspirin 325 mg Tablet, Plavix 75 mg, amiodarone 200 mg',
carvedilol 12.5 mg", lisinopril 7.5 mg', loperamide 2 mg ",
pantoprazole 40 mg', lovastatin 10 mg', sevelamer HCl 800 mg"',
1337 mg "', isosorbide mononitrate 30 mg', Nephrocaps 1 mg'.


Discharge Medications:
1. carvedilol 12.5 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
2. loperamide 2 mg Capsule Sig: One (1) Capsule PO Q 12H (Every
12 Hours).
3. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
4. sevelamer HCl 400 mg Tablet Sig: Two (2) Tablet PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
5. calcium acetate 667 mg Capsule Sig: Two (2) Capsule PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
6. B complex-vitamin C-folic acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
7. isosorbide mononitrate 30 mg Tablet Extended Release 24 hr
Sig: One (1) Tablet Extended Release 24 hr PO BID (2 times a
day).
8. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain or fever: no more than 4000mg per
day.
9. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
10. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
12. amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
13. lovastatin 10 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Home with Service

Facility:
[**Hospital6 459**] for the Aged - MACU

Discharge Diagnosis:
ESRD
thrombosed AVG
left radial artery occlusion


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.

Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
Please call Dr.[**Name (NI) 8584**] office [**Telephone/Fax (1) 673**] if you have any of
the following:
fever, chills, Left arm swelling, discoloration, numbness,
increased pain or bleeding or you experience any bleeding from
right groin old catheter site
You can resume dialysis at [**Location (un) **]. Dr. [**Last Name (STitle) **] will manage your
Coumadin dosing


Followup Instructions:
[**Name6 (MD) 5536**] [**Name8 (MD) **], MD ([**Hospital **] Care Center) Phone:[**Telephone/Fax (1) 5537**]
Date/Time:[**2149-4-21**] 1:00



Completed by:[**2149-4-1**]
{"Other complications due to renal dialysis device, implant, and graft,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Embolism and thrombosis of other specified artery,Hyperpotassemia,Renal dialysis status,Atrial fibrillation,Raynaud's syndrome,Other and unspecified hyperlipidemia,Atherosclerosis of native arteries of the extremities, unspecified,Personal history of tobacco use"}


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: Clotted AV Graft
Hyperkalemia

PRESENT ILLNESS: 74M well known to the transplant surgery service presents
with clotted AVG of the left upper extremity and hyperkalemia to
6.8.  According to patient he is unaware when graft lost it's
pulse and thrill, but today at HD it was noted to be
nonfunctioning.  He was unable to be dialyzed and referred to
[**Hospital1 18**] for thrombectomy.  However, in the preop holding area
patient preoperative labs were notable for K of 6.8.  HE was
given insulin 10 units iv and d50.  Attempts at placing an HD
line were unsuccessful he is currently awaiting IR placement of
temporary HD line.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Dyslipidemia, Hypertension
.
2. CARDIAC HISTORY:
-PERCUTANEOUS CORONARY INTERVENTIONS
(1) CAD s/p NSTEMI and stenting of the distal RCA, OM2 in [**2-/2147**]
complicated by GIB and paroxysmal atrial fibrillation
(2) s/p NSTEMI and unstable angina in [**2148-10-2**], cath showed
compelte occlusion of all three stents placed in [**2-/2147**], stent
placed in LCx
(3) s/p unstable angina, [**Year (4 digits) **] to LCx since LCx placed in [**9-/2148**]
had instent stenosis
.
3. OTHER PAST MEDICAL HISTORY:
-Three vessel CAD: see above for details
-Perioperative (bowel resection) vasospasm requiring cardiac
cath with NTG
-Mild-moderate MR
[**Name13 (STitle) 37625**] EF: 45% with focal inferior-posterior wall motion
abnormalities
-ESRD on HD, Cr [**2-18**] at baseline
-Ischemic Colitis: s/p SMA thrombectomy, with [**Doctor Last Name 3379**] pouch
and end ileostomy. Also complicated by recent diversion colitis
in 2/[**2146**].
-Peripheral [**Year (4 digits) 1106**] disease s/p aortobifemoral bypass [**2131**]
-Raynauds
-Dementia
-Atrial fibrillation
-H/o perioperative CVA: no deficits
-Hyperlipidemia
-HTN
-H/o Achalasia s/p esophageal dilation
-H/o VRE infection
-Anemia
-[**2149-3-26**] IR LUE AVF thrombectomy c/b Radial
art occlusion with thrombus extraction .

MEDICATION ON ADMISSION: aspirin 325 mg Tablet, Plavix 75 mg, amiodarone 200 mg',
carvedilol 12.5 mg", lisinopril 7.5 mg', loperamide 2 mg ",
pantoprazole 40 mg', lovastatin 10 mg', sevelamer HCl 800 mg"',
1337 mg "', isosorbide mononitrate 30 mg', Nephrocaps 1 mg'.

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS: 56 139/58 18 O2 sat=98% RA
NAD, Answers all questions, easily arousable but sleepy
bradycardic
crackles L> R
Soft abdomen with ileostomy with gas and + Output, Nontender
Ext: WWP, no edema.  LUE with radial avf scar well healed with
LUE AVG without pulse or thrill. 1+ radial bilaterally

FAMILY HISTORY: Comes from a family of 20 kids. Only 2 are still alive.
Significant history of cardiac disease in the family.

SOCIAL HISTORY: Patient lives with his wife. [**Name (NI) **] outside help needed. Active at
baseline.
-Tobacco history: 40 pack years, quit 11 years ago
-ETOH: None
-Illicit drugs: None 

### Response:
{"Other complications due to renal dialysis device, implant, and graft,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Embolism and thrombosis of other specified artery,Hyperpotassemia,Renal dialysis status,Atrial fibrillation,Raynaud's syndrome,Other and unspecified hyperlipidemia,Atherosclerosis of native arteries of the extremities, unspecified,Personal history of tobacco use"}
