CHIEF COMPLAINT: Fever, headache, hypercarbia

PRESENT ILLNESS: 47M who persents from psychiatric rehab with six days of
"migraine headache" and fever.
.
In the ED, his initial VS were:  99.1 89 112/83 22 91% 4L Nasal
Cannula. He stated that "he does not have a fever, but instead
has a "feverish attitude." He endorses taking all of his
medications. A CXR was concerning for PNA vs CHF.  He was given
vanco and cefepime and 20 iv lasix. ECG was without ischemia. A
ddimer was 714 and he went for CTA which was negative for PE.
.
On arrival to the MICU, he feels better. He states his headache
has improved. He states that he felt warm in his room but didnt
want to open the window. He has a dry non-productive cough. He
has not had chest pain, wosened shortness of breath, orpthopnea,
PND, increase LE edema, abdominal pain, n/v/diarrhea. He wears
his bipap every night and 3L NC. He states his oxygen sat is
usually around 90.
.
Review of systems:
(+) Per HPI

MEDICAL HISTORY: 1. Complex sleep disorder on bipap at night with severe
nocturnal and daytime hypoxia related to hypoventiliation
2. Schizophrenia
3. Bipolar disorder
4. CHF with diastolic dysfxn
5. Asthma
6. HTN
7. DM type 2, diet controlled
8. Erythrocythosis, thought secondary to hypoxia

MEDICATION ON ADMISSION: albuterol nebs prn
combinebs prn
asa 325
carbamazepine 200 qid
doxepin 10 qhs
furosemide 100mg [**Hospital1 **]
lisinopril 2.5 daily
metolazone 2.5 daily
metoprolol 12..5 [**Hospital1 **]
omeprazole 20 daily
kcl 60meq daily
risperidone 4mg [**Hospital1 **]
acetaminophen 650 q4 prn
benztropine 0.5mg daily prn dystonia
atrovent nebs q 6 hours prn

ALLERGIES: Penicillins

PHYSICAL EXAM: General Appearance: Overweight / Obese
Cardiovascular: (S1: Normal), (S2: Normal)
Peripheral Vascular: (Right radial pulse: Present), (Left radial
pulse: Present), (Right DP pulse: Present), (Left DP pulse:
Present)
Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds:
No(t) Crackles : , No(t) Wheezes : , Diminished: )
Abdominal: Soft, Non-tender, Distended, Obese
Extremities: Right lower extremity edema: Trace, Left lower
extremity edema: Trace, No(t) Cyanosis, No(t) Clubbing
Skin:  Warm
Neurologic: Attentive, Follows simple commands, Responds to: Not
assessed, Movement: Not assessed, Tone: Not assessed

FAMILY HISTORY: Mother with asthma, Several sibling all in good health. No
family history of cardiac dz or DM.

SOCIAL HISTORY: Has been living at [**Location 1268**] [**Hospital1 1501**] (RossCommons) since [**Month (only) 958**]
[**2134**] for his sleep apnea and BIPAP use. Sister is HCP
- [**Name (NI) 1139**]: none
- Alcohol: none
- Illicits: none
Obesity hypoventilation syndrome,Acidosis,Chronic diastolic heart failure,Chronic respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Schizoaffective disorder, chronic,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus
Obesity hypovent synd,Acidosis,Chr diastolic hrt fail,Chronic respiratory fail,Obs chr bronc w(ac) exac,Schizoaffective dis-chr,Obstructive sleep apnea,Hypertension NOS,DMII wo cmp nt st uncntr,Migrne unsp wo ntrc mgrn
Admission Date:  [**2135-2-5**]              [**Year/Month/Day **] Date:   [**2135-2-6**]

Date of Birth:  [**2087-8-23**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins

Attending:[**Last Name (NamePattern4) 290**]
Chief Complaint:
Fever, headache, hypercarbia

Major Surgical or Invasive Procedure:
None

History of Present Illness:
47M who persents from psychiatric rehab with six days of
"migraine headache" and fever.
.
In the ED, his initial VS were:  99.1 89 112/83 22 91% 4L Nasal
Cannula. He stated that "he does not have a fever, but instead
has a "feverish attitude." He endorses taking all of his
medications. A CXR was concerning for PNA vs CHF.  He was given
vanco and cefepime and 20 iv lasix. ECG was without ischemia. A
ddimer was 714 and he went for CTA which was negative for PE.
.
On arrival to the MICU, he feels better. He states his headache
has improved. He states that he felt warm in his room but didnt
want to open the window. He has a dry non-productive cough. He
has not had chest pain, wosened shortness of breath, orpthopnea,
PND, increase LE edema, abdominal pain, n/v/diarrhea. He wears
his bipap every night and 3L NC. He states his oxygen sat is
usually around 90.
.
Review of systems:
(+) Per HPI


Past Medical History:
1. Complex sleep disorder on bipap at night with severe
nocturnal and daytime hypoxia related to hypoventiliation
2. Schizophrenia
3. Bipolar disorder
4. CHF with diastolic dysfxn
5. Asthma
6. HTN
7. DM type 2, diet controlled
8. Erythrocythosis, thought secondary to hypoxia


Social History:
Has been living at [**Location 1268**] [**Hospital1 1501**] (RossCommons) since [**Month (only) 958**]
[**2134**] for his sleep apnea and BIPAP use. Sister is HCP
- [**Name (NI) 1139**]: none
- Alcohol: none
- Illicits: none


Family History:
Mother with asthma, Several sibling all in good health. No
family history of cardiac dz or DM.


Physical Exam:
General Appearance: Overweight / Obese
Cardiovascular: (S1: Normal), (S2: Normal)
Peripheral Vascular: (Right radial pulse: Present), (Left radial
pulse: Present), (Right DP pulse: Present), (Left DP pulse:
Present)
Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds:
No(t) Crackles : , No(t) Wheezes : , Diminished: )
Abdominal: Soft, Non-tender, Distended, Obese
Extremities: Right lower extremity edema: Trace, Left lower
extremity edema: Trace, No(t) Cyanosis, No(t) Clubbing
Skin:  Warm
Neurologic: Attentive, Follows simple commands, Responds to: Not
assessed, Movement: Not assessed, Tone: Not assessed


Pertinent Results:
ADMISSION LABS

[**2135-2-5**] 03:40PM BLOOD WBC-10.4# RBC-6.19 Hgb-16.7 Hct-54.7*
MCV-88 MCH-27.0 MCHC-30.6* RDW-19.2* Plt Ct-208
[**2135-2-5**] 03:40PM BLOOD Neuts-70.9* Lymphs-19.2 Monos-6.7 Eos-2.6
Baso-0.7
[**2135-2-5**] 03:40PM BLOOD Glucose-107* UreaN-28* Creat-1.3* Na-137
K-4.6 Cl-87* HCO3-37* AnGap-18
[**2135-2-5**] 03:40PM BLOOD proBNP-184*
[**2135-2-6**] 04:47AM BLOOD Calcium-8.0* Phos-6.3*# Mg-1.8
[**2135-2-5**] 03:40PM BLOOD D-Dimer-714*
[**2135-2-5**] 03:40PM BLOOD Carbamz-5.2
[**2135-2-5**] 06:34PM BLOOD Type-ART O2 Flow-2 pO2-53* pCO2-84*
pH-7.32* calTCO2-45* Base XS-12 Comment-NASAL [**Last Name (un) 154**]
[**2135-2-5**] 03:44PM BLOOD Lactate-2.5*

[**Year/Month/Day 894**] LABS

[**2135-2-6**] 04:47AM BLOOD WBC-8.5 RBC-5.80 Hgb-15.8 Hct-51.3 MCV-89
MCH-27.2 MCHC-30.8* RDW-19.2* Plt Ct-197
[**2135-2-6**] 04:47AM BLOOD Neuts-69.3 Lymphs-19.7 Monos-7.4 Eos-2.8
Baso-0.9
[**2135-2-6**] 05:38PM BLOOD Glucose-173* UreaN-33* Creat-1.2 Na-138
K-4.0 Cl-85* HCO3-42* AnGap-15
[**2135-2-6**] 05:08AM BLOOD Type-[**Last Name (un) **] pO2-60* pCO2-91* pH-7.30*
calTCO2-47* Base XS-14

CXR: IMPRESSION: Low lung volumes with bibasilar atelectasis

CTA: IMPRESSION:
1. No pulmonary embolism or acute aortic pathology.
2. Mild bilateral lower lobe atelectasis.
3. Hepatic steatosis.


Brief Hospital Course:
This is a 47 yo with obesity hypoventilation and severe OSA
presenting with subjective fevers, headache, and found to have
hypoxemia and hypercarbia (baseline) on admission.
.
1. Hypoxemia: The patient's PaO2 was 53 on admission. He had
some brief desaturations, but he was very easy to oxygenate on
nasal canula. The patient had a CXR that only showed bibasilar
atelectasis. Due to his A-a gradient and a positive D dimer, the
patient had a CTA that did not show a PE. The patient was weaned
to his home O2 requirement and he was not hypoxic. He remained
hypercarbic, secondary to his obesity and sleep apnea, but this
was not significantly different than his baseline and his
mentation remained stable. The patient had an elevated bicarb,
c/w his chronic resp acidosis. The patient was fitted with a
BiPap mask overnight, which he tolerated okay. He says that he
is more comfortable with his mask that he has at [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 42905**].
The patient was kept on his home dose lasix and metolazone and
had good urine output and normal electrolytes. He was placed on
a low salt diet. The patient was maintained on his inhalers.
.
2. Fever - tmax 99.2 at rehab. Afebrile here. All culture data
is negative and chest xray was not concerning for infection
.
3. Headache: Has chronic migraines. No signs or symptoms of
menigitis. The patient had a normal Tegretol level and his
headache did not recur. The patient is continued on
Carbamazepine.
.
4 Schozaffective disorder: Continued home meds of Doxepin,
Risperidone, Benxtropine.
.
5. HTN: The patient was continued on Metoprolol 12.5mg [**Hospital1 **] and
Lisinopril 2.5mg Qday. The patient is also on Lasix and
Metolazone.
.
6. Prophylaxis: The patient remains on Aspirin 325mg, colace.
.
The patient has chronic hypercarbia.  He was sent back to [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) 42905**] with the BiPap mast he used during this hospitalization.
 He will need to be extremely compliant with his CPAP. The
patient was also wondering about a portable O2 tank for when he
leaves the facility. All culture data will be reported if
positive.

Medications on Admission:
albuterol nebs prn
combinebs prn
asa 325
carbamazepine 200 qid
doxepin 10 qhs
furosemide 100mg [**Hospital1 **]
lisinopril 2.5 daily
metolazone 2.5 daily
metoprolol 12..5 [**Hospital1 **]
omeprazole 20 daily
kcl 60meq daily
risperidone 4mg [**Hospital1 **]
acetaminophen 650 q4 prn
benztropine 0.5mg daily prn dystonia
atrovent nebs q 6 hours prn


[**Hospital1 **] Medications:
1. aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. carbamazepine 200 mg Tablet Sig: One (1) Tablet PO QID (4
times a day).
3. doxepin 10 mg Capsule Sig: One (1) Capsule PO HS (at
bedtime).
4. metolazone 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
5. metoprolol tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
6. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
7. risperidone 2 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
8. ketoconazole 2 % Cream Sig: One (1) Appl Topical [**Hospital1 **] (2 times
a day).
9. furosemide 40 mg Tablet Sig: 2.5 Tablets PO BID (2 times a
day).
10. lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
11. benztropine 0.5 mg Tablet Sig: One (1) Tablet PO once a day.

12. potassium chloride 20 mEq Tablet, ER Particles/Crystals Sig:
Three (3) Tablet, ER Particles/Crystals PO once a day.
13. Atrovent HFA 17 mcg/Actuation HFA Aerosol Inhaler Sig: One
(1) spray Inhalation every six (6) hours as needed for shortness
of breath or wheezing.
14. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
1-2 puffs Inhalation every four (4) hours as needed for
shortness of breath or wheezing.


[**Hospital1 **] Disposition:
Extended Care

Facility:
[**Doctor Last Name **]

[**Doctor Last Name **] Diagnosis:
Hypercarbic respiratory failure
Hypoxemic respiratory distress


[**Doctor Last Name **] Condition:
Mental Status: Confused - sometimes.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


[**Doctor Last Name **] Instructions:
You were admitted for headache, fevers, and SOB. Your headache
resolved as did your fevers. We got a CTA that did not show a
pulmonary embolism or other cause of your shortness of breath.
You remained on your home oxygen and wore your CPAP at night and
your breathing improved. You will be discharged back to your
home.

Followup Instructions:
Department: PULMONARY FUNCTION LAB
When: THURSDAY [**2135-3-31**] at 3:40 PM
With: PULMONARY FUNCTION LAB [**Telephone/Fax (1) 609**]
Building: [**Hospital6 29**] [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: MEDICAL SPECIALTIES
When: THURSDAY [**2135-3-31**] at 4:00 PM
With: DR. [**Last Name (STitle) **]/DR. [**Last Name (STitle) **] [**Telephone/Fax (1) 612**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: CARDIAC SERVICES
When: THURSDAY [**2135-4-7**] at 3:20 PM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1523**], MD [**Telephone/Fax (1) 62**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage


                             [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**]
{'Obesity hypoventilation syndrome,Acidosis,Chronic diastolic heart failure,Chronic respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Schizoaffective disorder, chronic,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus'}


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, headache, hypercarbia

PRESENT ILLNESS: 47M who persents from psychiatric rehab with six days of
"migraine headache" and fever.
.
In the ED, his initial VS were:  99.1 89 112/83 22 91% 4L Nasal
Cannula. He stated that "he does not have a fever, but instead
has a "feverish attitude." He endorses taking all of his
medications. A CXR was concerning for PNA vs CHF.  He was given
vanco and cefepime and 20 iv lasix. ECG was without ischemia. A
ddimer was 714 and he went for CTA which was negative for PE.
.
On arrival to the MICU, he feels better. He states his headache
has improved. He states that he felt warm in his room but didnt
want to open the window. He has a dry non-productive cough. He
has not had chest pain, wosened shortness of breath, orpthopnea,
PND, increase LE edema, abdominal pain, n/v/diarrhea. He wears
his bipap every night and 3L NC. He states his oxygen sat is
usually around 90.
.
Review of systems:
(+) Per HPI

MEDICAL HISTORY: 1. Complex sleep disorder on bipap at night with severe
nocturnal and daytime hypoxia related to hypoventiliation
2. Schizophrenia
3. Bipolar disorder
4. CHF with diastolic dysfxn
5. Asthma
6. HTN
7. DM type 2, diet controlled
8. Erythrocythosis, thought secondary to hypoxia

MEDICATION ON ADMISSION: albuterol nebs prn
combinebs prn
asa 325
carbamazepine 200 qid
doxepin 10 qhs
furosemide 100mg [**Hospital1 **]
lisinopril 2.5 daily
metolazone 2.5 daily
metoprolol 12..5 [**Hospital1 **]
omeprazole 20 daily
kcl 60meq daily
risperidone 4mg [**Hospital1 **]
acetaminophen 650 q4 prn
benztropine 0.5mg daily prn dystonia
atrovent nebs q 6 hours prn

ALLERGIES: Penicillins

PHYSICAL EXAM: General Appearance: Overweight / Obese
Cardiovascular: (S1: Normal), (S2: Normal)
Peripheral Vascular: (Right radial pulse: Present), (Left radial
pulse: Present), (Right DP pulse: Present), (Left DP pulse:
Present)
Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds:
No(t) Crackles : , No(t) Wheezes : , Diminished: )
Abdominal: Soft, Non-tender, Distended, Obese
Extremities: Right lower extremity edema: Trace, Left lower
extremity edema: Trace, No(t) Cyanosis, No(t) Clubbing
Skin:  Warm
Neurologic: Attentive, Follows simple commands, Responds to: Not
assessed, Movement: Not assessed, Tone: Not assessed

FAMILY HISTORY: Mother with asthma, Several sibling all in good health. No
family history of cardiac dz or DM.

SOCIAL HISTORY: Has been living at [**Location 1268**] [**Hospital1 1501**] (RossCommons) since [**Month (only) 958**]
[**2134**] for his sleep apnea and BIPAP use. Sister is HCP
- [**Name (NI) 1139**]: none
- Alcohol: none
- Illicits: none 

### Response:
{'Obesity hypoventilation syndrome,Acidosis,Chronic diastolic heart failure,Chronic respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Schizoaffective disorder, chronic,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus'}
