CHIEF COMPLAINT: Failure to Thrive

PRESENT ILLNESS: 62 year old woman with history of DM II, CAD s/p stent and MI,
HTN, hypercholesterolemia, prior R MCA infarct with residual
blindness, who was recently admitted to [**Hospital1 18**] from [**9-2**] to [**9-10**]
after she presented to the ED with fall and coffee ground
emesis. She was found to be in DKA felt to be possibly due to
UTI with pansensitive E. Coli, for which she was to complete 7d
course of cipro. She also developed UGIB and was found to have
candidal esophagitis on EGD and was started on fluconazole
treatment. She also had ST elevations in inferior leads on that
admission but ruled out for MI with enzymes. She was discharged
home on [**9-10**] (lives alone). Two days later, on [**9-12**] VNA found
her disheveled in bed, not having eaten for 2 days, concern that
apartment may have been broken into. Per notes, she normally is
able to pivot from bed to wheelchair, which was next to her bed,
but this time felt too weak and fatigued to do so, and also
couldn't see where her chair or phone was. In ER, FSBG 242, U/A
w/ 1000 glu, tr ketones, no acidosis/AG by chem 7. She was
re-admitted to the medicine service for further workup of
failure to thrive, safety at home.

MEDICAL HISTORY: HTN
DMII
Hyperlipidemia
h/o CVA w/ residual L sided hemiparesis
CAD- w/ stent '[**86**] and '[**89**]
Asthma
Rheumatic fever
Femoral Bypass - [**1-15**] complication of most recent cath
Asthma - last hospitalization mult years ago, uses rescue
albuterol inhaler 1-2 times per week
migraine headaches - tx with vicodin or tylenol
Breast Cancer - node negative (surgery only, no chemo, no rad)
Degenerative Disk Disease
Osteoarthritis
Osteoporosis
GERD

MEDICATION ON ADMISSION: 

ALLERGIES: Aspirin / Nifedipine / Premarin / Morphine / Crestor /
Atorvastatin / Codeine

PHYSICAL EXAM: 98.7, 150/100, 98, 22, 99% RA
Blind, decreased L zygoma swelling, - fluctuance
MMM
RRR, S1/S2
Soft, NT/ND, +BS
bibasilar crackles (less than prior)
warm, - CCE
alert

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: lives alone at home [**Location (un) 6409**]; wheelchair bound s/p CVA; no
h/o ETOH or tobacco use
Cerebral artery occlusion, unspecified with cerebral infarction,Acute respiratory failure,Combined systolic and diastolic heart failure, unspecified,Candidal esophagitis,Acute posthemorrhagic anemia,Dehydration,Cortical blindness,Other late effects of cerebrovascular disease,Homonymous bilateral field defects,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Long-term (current) use of insulin,Unspecified essential hypertension,Adult failure to thrive,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Asthma, unspecified type, unspecified,Headache
Crbl art ocl NOS w infrc,Acute respiratry failure,Syst/diast hrt fail NOS,Candidal esophagitis,Ac posthemorrhag anemia,Dehydration,Cortical blindness,Late effect CV dis NEC,Homonymous hemianopsia,DMII neuro nt st uncntrl,Neuropathy in diabetes,Long-term use of insulin,Hypertension NOS,Failure to thrive-adult,Crnry athrscl natve vssl,Status-post ptca,Asthma NOS,Headache
Admission Date:  [**2195-9-12**]              Discharge Date:   [**2195-9-26**]

Date of Birth:  [**2132-11-18**]             Sex:   F

Service: MEDICINE

Allergies:
Aspirin / Nifedipine / Premarin / Morphine / Crestor /
Atorvastatin / Codeine

Attending:[**First Name3 (LF) 1973**]
Chief Complaint:
Failure to Thrive

Major Surgical or Invasive Procedure:
Echocardiogram (TEE, TTE)
MRI/MRA Head
CT Chest
CT Head, Sinus, Orbits
PICC
Carotid Evaluation

History of Present Illness:
62 year old woman with history of DM II, CAD s/p stent and MI,
HTN, hypercholesterolemia, prior R MCA infarct with residual
blindness, who was recently admitted to [**Hospital1 18**] from [**9-2**] to [**9-10**]
after she presented to the ED with fall and coffee ground
emesis. She was found to be in DKA felt to be possibly due to
UTI with pansensitive E. Coli, for which she was to complete 7d
course of cipro. She also developed UGIB and was found to have
candidal esophagitis on EGD and was started on fluconazole
treatment. She also had ST elevations in inferior leads on that
admission but ruled out for MI with enzymes. She was discharged
home on [**9-10**] (lives alone). Two days later, on [**9-12**] VNA found
her disheveled in bed, not having eaten for 2 days, concern that
apartment may have been broken into. Per notes, she normally is
able to pivot from bed to wheelchair, which was next to her bed,
but this time felt too weak and fatigued to do so, and also
couldn't see where her chair or phone was. In ER, FSBG 242, U/A
w/ 1000 glu, tr ketones, no acidosis/AG by chem 7. She was
re-admitted to the medicine service for further workup of
failure to thrive, safety at home.

On this admission, she said that her vision was blurry but
apparently
had this complaint before. Then she developed of a headache,
thought to be migraine. She had a head CT on [**9-13**] that revealed
new hypodensity in the right parieto-occipital region. Neurology
was consulted and an MRI showed multiple bilateral occipital
infarct. The work up for embolic source was initiated (carotid
US pending, TEE was recommended).

She was doing well on the floor, satting high 90's on RA - 2L NC
until 1am [**2195-9-16**]. Vitals at MN revealed T 98.9; 140/70; 75;
18; 93% on 2L. Shortly thereafter, the patient complained of
medications and when she returned about 15 minutes later, she
found the patient in respiratory distress. O2 sat 62% on RA. The
patient was placed on 5L NC and given Albuterol nebulizer for
audible wheezing. Then placed on 100% NRB (satting 90% on NRB;
ABG 7.36/58/60; lactate 1.0 on a NRB). Received Lasix 40 mg IV
once with good response. EKG done and showed no ischemic
changes. CXR showed diffuse bilateral pulmonary edema (new from
[**2195-9-13**]).  In the [**Hospital Unit Name 153**], she was diuresed successfully. She had
a repeat MRI/MRA. Neuro continued to follow for her posterior
embolic strokes and recommend avoiding hypo/hypertension, good
glycemic control.  She was also ruled out for MI with CEs (neg
CKs, flat tnts). TEE ruled out vegetation/other abnormality or
embolic source.

Past Medical History:
HTN
DMII
Hyperlipidemia
h/o CVA w/ residual L sided hemiparesis
CAD- w/ stent '[**86**] and '[**89**]
Asthma
Rheumatic fever
Femoral Bypass - [**1-15**] complication of most recent cath
Asthma - last hospitalization mult years ago, uses rescue
albuterol inhaler 1-2 times per week
migraine headaches - tx with vicodin or tylenol
Breast Cancer - node negative (surgery only, no chemo, no rad)
Degenerative Disk Disease
Osteoarthritis
Osteoporosis
GERD

Social History:
lives alone at home [**Location (un) 6409**]; wheelchair bound s/p CVA; no
h/o ETOH or tobacco use


Family History:
non-contributory

Physical Exam:
98.7, 150/100, 98, 22, 99% RA
Blind, decreased L zygoma swelling, - fluctuance
MMM
RRR, S1/S2
Soft, NT/ND, +BS
bibasilar crackles (less than prior)
warm, - CCE
alert


Pertinent Results:
[**2195-9-26**] 05:48AM BLOOD WBC-5.9 RBC-3.73* Hgb-10.4* Hct-31.6*
MCV-85 MCH-27.9 MCHC-32.9 RDW-14.4 Plt Ct-314
[**2195-9-26**] 05:48AM BLOOD PT-26.7* INR(PT)-2.7*
[**2195-9-26**] 05:48AM BLOOD UreaN-20 Creat-1.0 Na-143 K-4.0
[**2195-9-25**] 04:17AM BLOOD Glucose-89 UreaN-19 Creat-0.9 Na-147*
K-3.7 Cl-110* HCO3-30 AnGap-11
[**2195-9-25**] 04:17AM BLOOD TotBili-0.2
[**2195-9-15**] 02:39PM BLOOD CK(CPK)-56
[**2195-9-15**] 03:24AM BLOOD ALT-22 AST-27 CK(CPK)-68
[**2195-9-15**] 02:39PM BLOOD CK-MB-1 cTropnT-0.03*
[**2195-9-26**] 05:48AM BLOOD Phos-3.9 Mg-2.3
[**2195-9-25**] 04:17AM BLOOD Hapto-194
[**2195-9-17**] 07:20AM BLOOD Folate-9.3
[**2195-9-14**] 12:40PM BLOOD calTIBC-259* VitB12-477 Ferritn-566*
TRF-199*

CT SINUS/ORBIT: IMPRESSION:

1. Normal-appearing orbits bilaterally, without periorbital
edema, soft tissue stranding, or collection.

2. Stable near complete opacification of the left maxillary
sinus, with hyperdense and minimally enhancing material. While
these could represent chronic inspissated secretions, fungal
sinusitis cannot be excluded, and clinical correlation is
requested.

3. Bilateral occipital lobe hypodensities, unchanged.

4. Right thyroid nodule.

TEE: Conclusions:
1. No spontaneous echo contrast or thrombus is seen in the body
of the left
atrium/left atrial appendage or the body of the right
atrium/right atrial
appendage. No atrial septal defect or patent foramen ovale is
seen by 2D,
color Doppler or saline contrast with maneuvers.
2. The left ventricular cavity size is normal. Overall left
ventricular
systolic function is mildly depressed. Inferior hypokinesis is
present.
3. The mitral valve leaflets are structurally normal. Mild (1+)
mitral
regurgitation is seen.
4. There is a small pericardial effusion.
5. No cardiac source of embolism seen.
6. Compared to the previous study of [**2195-9-22**], there is no
significant
change.

CT HEAD: IMPRESSION:

1) No intracranial hemorrhage. Stable multiple low-density
lesions within both parieto-occipital lobes, are stable from the
prior examination but new from the examination of [**2195-9-6**]. Further evaluation with MRI should be performed.

2) Chronic sinusitis of the left maxillary sinus versus fungal
sinusitis.

ECHO (TTE) Conclusions:
The left atrium is mildly dilated. No atrial septal defect or
patent foramen
ovale is seen by 2D, color Doppler or saline contrast with
maneuvers. There is
mild symmetric left ventricular hypertrophy with normal cavity
size. There is
mild regional left ventricular systolic dysfunction with
hypokinesis of the
inferior wall. The remaining segments contract well. Right
ventricular chamber
size and free wall motion are normal. The ascending aorta is
mildly dilated.
The aortic valve leaflets appear structurally normal with good
leaflet
excursion. There is no aortic valve stenosis. Trace aortic
regurgitation is
seen. The mitral valve leaflets are structurally normal. There
is no mitral
valve prolapse. Mild to moderate ([**12-15**]+) mitral regurgitation is
seen. There is
mild pulmonary artery systolic hypertension. There is a small
pericardial
effusion. There are bilateral pleural effusions

MRA BRAIN: IMPRESSION:

Acute infarcts in bilateral PCA distribution.

Filling defects in bilateral PCA, left MCA, likely due to
embolic phenomena. These findings were discussed with [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) **] by Dr. [**Last Name (STitle) **] on [**2195-9-17**] at 5:41 p.m.

MRI BRAIN: IMPRESSION: Multiple T2 hyperintense areas of slow
diffusion involving both cerebral hemispheres, likely within the
PCA distribution, consistent with embolic infarcts. Further
evaluation with MRA of the head and neck is recommended.

CAROTID DUPLEX: FINDINGS: Duplex evaluation was performed of
both carotid arteries. Minimal plaques identified.

On the right, peak systolic velocities are 74, 63, 80 in the
ICA, CCA, and ECA respectively. This is consistent with no
stenosis.

On the left, peak systolic velocities are 87, 73, 76 in the ICA,
CCA, and ECA respectively. This is consistent with no stenosis.

There is antegrade flow in both vertebral arteries.

IMPRESSION: No evidence of stenosis in either carotid artery.


Brief Hospital Course:
Stroke workup, including TEE, TTE (Bubble), carotid, MRA were
all negative for source of embolus.

Anemia was treated with transfusions with good response.
Brief periorbital edema was concerning for mucor, but resolved
spontaneously with negative CT imaging.

Pt had multiple episodes of hypoxia due to fluid overload, which
were treated with lasix IV with good response. Diuresis post
transfusion and all fluid containing medications was performed
with good result.

Insulin regimen was titrated by the [**Last Name (un) **] DM team.

Social work is critical, as patient's apartment was robbed while
she was in it, and was not a safe environment.

BP Control achieved to manage hypertension, with goal in the
130-145 range as recent acute CVA, per neurology with
hydralazine and lisinopril.

Discharge Medications:
1. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Albuterol Sulfate 0.083 % Solution Sig: One (1) puff
Inhalation Q6H (every 6 hours) as needed for SOB, wheeze.
3. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO Q12H (every
12 hours).
4. Budesonide 0.25 mg/2 mL Solution for Nebulization Sig: Two
(2) ML Inhalation [**Hospital1 **] (2 times a day).
5. Ipratropium Bromide 0.02 % Solution Sig: One (1) puff
Inhalation Q6H (every 6 hours).
6. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
9. Colesevelam 625 mg Tablet Sig: Three (3) Tablet PO bid ().
10. Heparin (Porcine) 5,000 unit/mL Solution Sig: 5000 (5000)
units Injection TID (3 times a day).
11. Sodium Chloride 0.65 % Aerosol, Spray Sig: [**12-15**] Sprays Nasal
TID (3 times a day) as needed.
12. Hydralazine 25 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours).
13. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
14. Warfarin 2 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).

15. Heparin Lock Flush (Porcine) 100 unit/mL Syringe Sig: Ten
(10) ML Intravenous  DAILY (Daily) as needed.
16. Saline Flush 0.9 % Syringe Sig: Ten (10) ml Injection Q
SHIFT: PICC.
17. Coreg 3.125 mg Tablet Sig: One (1) Tablet PO twice a day.
18. Lantus 100 unit/mL Solution Sig: Twenty Two (22) Units
Subcutaneous at bedtime.
19. RISS
See Enclosed RISS Sheet


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 2558**] - [**Location (un) **]

Discharge Diagnosis:
CVA with residual blindness
CHF
Diabetes Mellitus
Hypertension
[**Female First Name (un) 564**] Esophagitis

Discharge Condition:
Good

Discharge Instructions:
Return to the hospital for hypoxia, dyspnea if failure after
lasix

Continue on low salt diet, avoid drinking large quantities of
water

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) 354**] [**Last Name (NamePattern4) 3013**], M.D. Date/Time:[**2195-11-18**] 1:00
Provider: [**Name10 (NameIs) **] PROCEDURE Phone:[**Telephone/Fax (1) 253**] Date/Time:[**2195-11-18**]
1:00
Provider: [**Name10 (NameIs) **],[**First Name8 (NamePattern2) 4283**] [**Last Name (NamePattern1) 10803**]  [**Telephone/Fax (1) 250**]  Call to schedule
appointment within 2 weeks
{'Cerebral artery occlusion, unspecified with cerebral infarction,Acute respiratory failure,Combined systolic and diastolic heart failure, unspecified,Candidal esophagitis,Acute posthemorrhagic anemia,Dehydration,Cortical blindness,Other late effects of cerebrovascular disease,Homonymous bilateral field defects,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Long-term (current) use of insulin,Unspecified essential hypertension,Adult failure to thrive,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Asthma, unspecified type, unspecified,Headache'}


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: Failure to Thrive

PRESENT ILLNESS: 62 year old woman with history of DM II, CAD s/p stent and MI,
HTN, hypercholesterolemia, prior R MCA infarct with residual
blindness, who was recently admitted to [**Hospital1 18**] from [**9-2**] to [**9-10**]
after she presented to the ED with fall and coffee ground
emesis. She was found to be in DKA felt to be possibly due to
UTI with pansensitive E. Coli, for which she was to complete 7d
course of cipro. She also developed UGIB and was found to have
candidal esophagitis on EGD and was started on fluconazole
treatment. She also had ST elevations in inferior leads on that
admission but ruled out for MI with enzymes. She was discharged
home on [**9-10**] (lives alone). Two days later, on [**9-12**] VNA found
her disheveled in bed, not having eaten for 2 days, concern that
apartment may have been broken into. Per notes, she normally is
able to pivot from bed to wheelchair, which was next to her bed,
but this time felt too weak and fatigued to do so, and also
couldn't see where her chair or phone was. In ER, FSBG 242, U/A
w/ 1000 glu, tr ketones, no acidosis/AG by chem 7. She was
re-admitted to the medicine service for further workup of
failure to thrive, safety at home.

MEDICAL HISTORY: HTN
DMII
Hyperlipidemia
h/o CVA w/ residual L sided hemiparesis
CAD- w/ stent '[**86**] and '[**89**]
Asthma
Rheumatic fever
Femoral Bypass - [**1-15**] complication of most recent cath
Asthma - last hospitalization mult years ago, uses rescue
albuterol inhaler 1-2 times per week
migraine headaches - tx with vicodin or tylenol
Breast Cancer - node negative (surgery only, no chemo, no rad)
Degenerative Disk Disease
Osteoarthritis
Osteoporosis
GERD

MEDICATION ON ADMISSION: 

ALLERGIES: Aspirin / Nifedipine / Premarin / Morphine / Crestor /
Atorvastatin / Codeine

PHYSICAL EXAM: 98.7, 150/100, 98, 22, 99% RA
Blind, decreased L zygoma swelling, - fluctuance
MMM
RRR, S1/S2
Soft, NT/ND, +BS
bibasilar crackles (less than prior)
warm, - CCE
alert

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: lives alone at home [**Location (un) 6409**]; wheelchair bound s/p CVA; no
h/o ETOH or tobacco use 

### Response:
{'Cerebral artery occlusion, unspecified with cerebral infarction,Acute respiratory failure,Combined systolic and diastolic heart failure, unspecified,Candidal esophagitis,Acute posthemorrhagic anemia,Dehydration,Cortical blindness,Other late effects of cerebrovascular disease,Homonymous bilateral field defects,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Long-term (current) use of insulin,Unspecified essential hypertension,Adult failure to thrive,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Asthma, unspecified type, unspecified,Headache'}
