CHIEF COMPLAINT: Fever, hematuria, hypotension

PRESENT ILLNESS: 87 y/o male w/ multiple medical problems including untreated
colon cancer (found on colonoscopy [**2184**], declined surgery at the
time), BPH, afib, diastolic heart failure and chronic right
sided pleural effusion who presents with fevers/chills and
urinary retention from [**Hospital 100**] Rehab. Patient was without
specific symptoms except for continued complications with
urinary catheter that again stopped draining on [**5-9**] but
improved with manipulation. Also with worsening dysuria over the
past couple of days, but has had dysuria/suprapubic discomfort
over the last 2 months ever since a traumatic foley placement.
Had fever to 101 day prior to presentation with chills, as well
as more fatigue than usual. Also relates black stools for the
last 10-11 days, multiple times per day, no BRBPR, no LH or
dizziness. Also was started on iron recently.
Social ETOH, no NSAID, no nausea/emesis/hematemesis or abdominal
pain. No URI sxs, cough, shortness of breath, chest pain, rashes
or new skin lesions. Per patient reason for transfer was SBP
around 89 in the setting of fever.

MEDICAL HISTORY: Colonoscopy [**2184-3-25**]:
>Polyp in the transverse colon (polypectomy) - adenoma
>Polyps in the sigmoid colon (polypectomy)- Colonic mucosa with
focal hyperplastic features
>Polypoid, ulcerated mass in the hepatic flexure (biopsy) -
Superficial fragments of colonic mucosa with ulceration, marked
acute inflammation, and highly atypical glands, suspicious for
carcinoma.

MEDICATION ON ADMISSION: Amiodarone 200 mg daily
Aspirin 81 mg daily
Toprol-XL 25 mg daily
Terazosin (hytrin) 10 mg daily
Lasix 40 mg daily
Keflex 500 Q12H
Proscar 5 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Tmax: 36.3 ??????C (97.3 ??????F)
Tcurrent: 36.3 ??????C (97.3 ??????F)
HR: 70 (70 - 72) bpm
BP: 89/53(62) {89/53(62) - 100/57(68)} mmHg
RR: 15 (13 - 15) insp/min
SpO2: 93%
Heart rhythm: SR (Sinus Rhythm)
Height: 72 Inch

FAMILY HISTORY: brother had [**Name2 (NI) 500**] marrow stem cell transplant at age 82
Sister died from heart attack. Also had an unknown cancer.
Mother died from an unknown cancer.
Neice has unknown cancer.

SOCIAL HISTORY: Was living alone, now at [**Hospital1 100**] Rebab. Former smoker with
35-pk-yrs, quit 50-55 yrs ago. Social ETOH.
Infection and inflammatory reaction due to indwelling urinary catheter,Unspecified septicemia,Sepsis,Hemorrhage of gastrointestinal tract, unspecified,Chronic diastolic heart failure,Unspecified pleural effusion,Unspecified intestinal obstruction,Malignant neoplasm of hepatic flexure,Intestinal infection due to Clostridium difficile,Acute posthemorrhagic anemia,Urinary tract infection, site not specified,Retention of urine, unspecified,Atrial fibrillation,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Benign neoplasm of colon,Chronic kidney disease, unspecified,Osteoporosis, unspecified,Unspecified acquired hypothyroidism
React-indwell urin cath,Septicemia NOS,Sepsis,Gastrointest hemorr NOS,Chr diastolic hrt fail,Pleural effusion NOS,Intestinal obstruct NOS,Mal neo hepatic flexure,Int inf clstrdium dfcile,Ac posthemorrhag anemia,Urin tract infection NOS,Retention urine NOS,Atrial fibrillation,BPH w/o urinary obs/LUTS,Benign neoplasm lg bowel,Chronic kidney dis NOS,Osteoporosis NOS,Hypothyroidism NOS
Admission Date:  [**2188-5-10**]              Discharge Date:   [**2188-5-16**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Known firstname 2745**]
Chief Complaint:
Fever, hematuria, hypotension

Major Surgical or Invasive Procedure:
EGD

History of Present Illness:
87 y/o male w/ multiple medical problems including untreated
colon cancer (found on colonoscopy [**2184**], declined surgery at the
time), BPH, afib, diastolic heart failure and chronic right
sided pleural effusion who presents with fevers/chills and
urinary retention from [**Hospital 100**] Rehab. Patient was without
specific symptoms except for continued complications with
urinary catheter that again stopped draining on [**5-9**] but
improved with manipulation. Also with worsening dysuria over the
past couple of days, but has had dysuria/suprapubic discomfort
over the last 2 months ever since a traumatic foley placement.
Had fever to 101 day prior to presentation with chills, as well
as more fatigue than usual. Also relates black stools for the
last 10-11 days, multiple times per day, no BRBPR, no LH or
dizziness. Also was started on iron recently.
Social ETOH, no NSAID, no nausea/emesis/hematemesis or abdominal
pain. No URI sxs, cough, shortness of breath, chest pain, rashes
or new skin lesions. Per patient reason for transfer was SBP
around 89 in the setting of fever.

In ED vitals 100.1, 71, 90/50, 18, 90% RA, 93% on 4-5L. Foley
not draining well and when flushed had some blood clots. Coudet
#20 inserted and 375cc of dark red urine noted. Received 1L IVFs
and BP responded in high 90's. HCT 25 from baseline around 30
and given 1 unit PRBCs. Rectal exam guaiac positive. Total ins
1075, total outs 500. Tylenol 1gm PO, levoquin 750mg IV,
ceftriazone 2gm IV.


Past Medical History:
Colonoscopy [**2184-3-25**]:
>Polyp in the transverse colon (polypectomy) - adenoma
>Polyps in the sigmoid colon (polypectomy)- Colonic mucosa with
focal hyperplastic features
>Polypoid, ulcerated mass in the hepatic flexure (biopsy) -
Superficial fragments of colonic mucosa with ulceration, marked
acute inflammation, and highly atypical glands, suspicious for
carcinoma.


Past history:
# Colon mass during colonoscopy for guaiac positive stools in
[**2184**]. Pathology was worrisome for carcinoma. Although the
patient was offered resection by Dr. [**Last Name (STitle) **], he declined
# hematuria/BPH - traumatic foley insertion and manipulation
[**3-16**] lead to urosepsis and subsequent urinary retention
# sick sinus syndrome and bifascicular block s/p pacemaker [**2184**]

# PAF - on amiodarone, not on coumadin d/t concern for
malignancy
# H/O SVT
# Atrial flutter status post ablation [**2-/2186**] - not on
anticoagulation d/t concern for malignancy
# Anemia - on arenesp and iron
# Echo [**2186**]: mild-to-moderate mitral regurgitation, RA and LA
# BPH s/p TURMP [**2187**]
# b/l edema with skin changes
# hard of hearing
# hx of guiaic positive stools/GI bleeding
# osteoarthritis
# osteoporosis
# subclinical hypothyroid state as per record
# renal insufficiency
# right pleural effusion - Found on CT on [**2188-2-25**] for increasing
DOE. [**3-6**] and [**3-18**] thoracentesis c/w transudative. Workup during
last admission revealed RV diastolic dysfunction. Concern was
for PE as etiology, but unable to get CTA d/w ARF and V/Q not
helpful. Not anticoagulated due to h/o GIB, pleurodesis not an
option d/t transudative.
# Tibial talar dislocation with comminuted distal tib fib
fracture status post surgery [**2181**]
# hx syncope in [**2181**], unclear etiology


Social History:
Was living alone, now at [**Hospital1 100**] Rebab. Former smoker with
35-pk-yrs, quit 50-55 yrs ago. Social ETOH.

Family History:
brother had [**Name2 (NI) 500**] marrow stem cell transplant at age 82
Sister died from heart attack. Also had an unknown cancer.
Mother died from an unknown cancer.
Neice has unknown cancer.


Physical Exam:
Tmax: 36.3 ??????C (97.3 ??????F)
Tcurrent: 36.3 ??????C (97.3 ??????F)
HR: 70 (70 - 72) bpm
BP: 89/53(62) {89/53(62) - 100/57(68)} mmHg
RR: 15 (13 - 15) insp/min
SpO2: 93%
Heart rhythm: SR (Sinus Rhythm)
Height: 72 Inch

Awake, alert and oriented
HEENT: no jaundice
Lungs: CTA
CVS: regular
Abd: soft, NT, BS+, no HSM
Ext: trace edema


Brief Hospital Course:
The patient is an 87 y.o.m. with multiple medical problems
including untreated colon cancer, BPH, chronic foley, afib,
diastolic heart failure and chronic right sided pleural effusion
who presents with fevers/chills, hypotension, and urinary
retention from [**Hospital 100**] Rehab.

# Hypotension - Believed by ICU team to be secondary to
preseptic physiology secondary to UTI and melena.  Resolved
after volume resuscitation and treatment of UTI.

# GIB -Patient with melena on presentation. EGD [**5-12**] revealed a
single non-bleeding erosion in the antrum of the stomach.

# Urinary retention - Etiology from traumatic foley placement
during admission in [**2-29**], followed by urology and Dr. [**Last Name (STitle) 3748**] as
an outpatient.  Foley currently draining well without clots
after manipulation overnight. Continue BPH meds.  Outpatient
urology f/u.

#UTI) [**5-10**] urine culture no growth but patient with symptoms of
UTI and equivocal u/a in setting of hypotension with indwelling
foley and thus was presumptively started on abx by ED and ICU.
Will complete 7 day course of abx.

C. Difficile Colitis)  Patient developed during his
hospitalization.  Flagyl po for 14 days total.

# CKD - Currently at baseline.  Cr 1.1

#Colon CA)  Patient underwent colonoscopy on [**5-15**] that revealed
pseudomembranous colitis, two polyps and his earlier colonic
mass at the hepatic flexure.  Per GI, there is concern for
future risk of obstruction from mass.  Patient now appears more
interested in discussing surgical options.  Patient to f/u in
Dr.[**Name (NI) 8788**] clinic.  Oncology service noted no role for
solitary chemo given size of mass.


Medications on Admission:
Amiodarone 200 mg daily
Aspirin 81 mg daily
Toprol-XL 25 mg daily
Terazosin (hytrin) 10 mg daily
Lasix 40 mg daily
Keflex 500 Q12H
Proscar 5 mg daily


Discharge Medications:
1. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Furosemide 10 mg/mL Solution Sig: Two (2) mL Injection DAILY
(Daily).
3. Toprol XL 25 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO once a day.
4. Terazosin 10 mg Capsule Sig: One (1) Capsule PO once a day.
5. Proscar 5 mg Tablet Sig: One (1) Tablet PO once a day.
6. Cefpodoxime 100 mg po bid for 2 more days (d/c on am of [**5-19**])
7. Flagyl 500 mg po tid for 12 more days.
8. medication change
Note:  Given recent melena, holding patient's prior asa 81 mg EC
po qd.


Discharge Disposition:
Extended Care

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

Discharge Diagnosis:
UTI
Clostridium Difficile Diarrhea and Colitis
Heart Failure, Diastolic

Discharge Condition:
Vital Signs Stable

Discharge Instructions:
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
Adhere to 2 gm sodium diet
Fluid Restriction: 2000cc/day
Return to ED if having bleeding from rectum, fevers, difficulty
breathing.

Followup Instructions:
Patient to f/u with Dr. [**Last Name (STitle) **], Colorectal surgery clinic,
[**Last Name (NamePattern1) **]., [**Hospital Unit Name **].  [**Telephone/Fax (1) 2981**]. Dr.[**Name (NI) 1482**]
office called, message left for his administative assistant.
Patient to schedule f/u with PCP [**Last Name (NamePattern4) **] 2 weeks.
{'Infection and inflammatory reaction due to indwelling urinary catheter,Unspecified septicemia,Sepsis,Hemorrhage of gastrointestinal tract, unspecified,Chronic diastolic heart failure,Unspecified pleural effusion,Unspecified intestinal obstruction,Malignant neoplasm of hepatic flexure,Intestinal infection due to Clostridium difficile,Acute posthemorrhagic anemia,Urinary tract infection, site not specified,Retention of urine, unspecified,Atrial fibrillation,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Benign neoplasm of colon,Chronic kidney disease, unspecified,Osteoporosis, unspecified,Unspecified acquired hypothyroidism'}


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: Fever, hematuria, hypotension

PRESENT ILLNESS: 87 y/o male w/ multiple medical problems including untreated
colon cancer (found on colonoscopy [**2184**], declined surgery at the
time), BPH, afib, diastolic heart failure and chronic right
sided pleural effusion who presents with fevers/chills and
urinary retention from [**Hospital 100**] Rehab. Patient was without
specific symptoms except for continued complications with
urinary catheter that again stopped draining on [**5-9**] but
improved with manipulation. Also with worsening dysuria over the
past couple of days, but has had dysuria/suprapubic discomfort
over the last 2 months ever since a traumatic foley placement.
Had fever to 101 day prior to presentation with chills, as well
as more fatigue than usual. Also relates black stools for the
last 10-11 days, multiple times per day, no BRBPR, no LH or
dizziness. Also was started on iron recently.
Social ETOH, no NSAID, no nausea/emesis/hematemesis or abdominal
pain. No URI sxs, cough, shortness of breath, chest pain, rashes
or new skin lesions. Per patient reason for transfer was SBP
around 89 in the setting of fever.

MEDICAL HISTORY: Colonoscopy [**2184-3-25**]:
>Polyp in the transverse colon (polypectomy) - adenoma
>Polyps in the sigmoid colon (polypectomy)- Colonic mucosa with
focal hyperplastic features
>Polypoid, ulcerated mass in the hepatic flexure (biopsy) -
Superficial fragments of colonic mucosa with ulceration, marked
acute inflammation, and highly atypical glands, suspicious for
carcinoma.

MEDICATION ON ADMISSION: Amiodarone 200 mg daily
Aspirin 81 mg daily
Toprol-XL 25 mg daily
Terazosin (hytrin) 10 mg daily
Lasix 40 mg daily
Keflex 500 Q12H
Proscar 5 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Tmax: 36.3 ??????C (97.3 ??????F)
Tcurrent: 36.3 ??????C (97.3 ??????F)
HR: 70 (70 - 72) bpm
BP: 89/53(62) {89/53(62) - 100/57(68)} mmHg
RR: 15 (13 - 15) insp/min
SpO2: 93%
Heart rhythm: SR (Sinus Rhythm)
Height: 72 Inch

FAMILY HISTORY: brother had [**Name2 (NI) 500**] marrow stem cell transplant at age 82
Sister died from heart attack. Also had an unknown cancer.
Mother died from an unknown cancer.
Neice has unknown cancer.

SOCIAL HISTORY: Was living alone, now at [**Hospital1 100**] Rebab. Former smoker with
35-pk-yrs, quit 50-55 yrs ago. Social ETOH. 

### Response:
{'Infection and inflammatory reaction due to indwelling urinary catheter,Unspecified septicemia,Sepsis,Hemorrhage of gastrointestinal tract, unspecified,Chronic diastolic heart failure,Unspecified pleural effusion,Unspecified intestinal obstruction,Malignant neoplasm of hepatic flexure,Intestinal infection due to Clostridium difficile,Acute posthemorrhagic anemia,Urinary tract infection, site not specified,Retention of urine, unspecified,Atrial fibrillation,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Benign neoplasm of colon,Chronic kidney disease, unspecified,Osteoporosis, unspecified,Unspecified acquired hypothyroidism'}
