CHIEF COMPLAINT: fluid overload/edema/leg erythema/hypoglycemia

PRESENT ILLNESS: [**Age over 90 **] yo male well known to the csurg
service as he's status post Urgent coronary artery bypass graft
x6 on [**2136-9-7**]. Please refer to his discharge summary on
[**2136-9-13**]
for further details on his hospital course. He was released to
[**First Name4 (NamePattern1) 2299**] [**Last Name (NamePattern1) **] rehab where he had worsening edema and ?? UTI.  He
was transferred to the [**Hospital1 18**] ED for further evaluation. CXR
demonstrates worsening bilateral pleural effusions and
peripheral
edema.  His po intake has been poor. He denies dyspnea, cough or
fever.

MEDICAL HISTORY: coronary artery disease,remote non-STEMI s/p cabg x6
Chronic diastolic heart failure
chronic atrial fibrillation
noninsulin dependentg diabetes mellitus
hypertension
Hyperlipidemia
Gout
Glaucoma
-Hypothyroidism
s/p left total hip arthroplasty
s/p bilateral hernia repairs
s/p Cataract surgery

MEDICATION ON ADMISSION: Allopurinol 100mg daily
Amlodipine 2.5mg [**Hospital1 **]
Lipitor 80 mg daily
Lumigan 0.03% 1gtt OU HS
darbepoetin 40mcg Q6week
CoSopt 0.5% 1gttOS [**Hospital1 **]
Lasix 80mg PO daily
Cipro 500mg daily for 2days [**Doctor First Name **]

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse:75   Resp16:  O2 sat96% on RA:
B/P  Right:111/66    Left:112/66
Height: 5ft 9"    Weight: 64.1kg

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.
DM on mother's side.

SOCIAL HISTORY: Lives at home in [**Location (un) **] with companion, Ms. [**Last Name (Titles) 93013**]- his
significant other, who is also HCP.  Previous college art
professor. 10 pack year history of smoking, quit at age 38.
Denies any alcohol, IVDU.
Septicemia due to anaerobes,Acute on chronic diastolic heart failure,Acute kidney failure, unspecified,Other pulmonary insufficiency, not elsewhere classified, following trauma and surgery,Hyperosmolality and/or hypernatremia,Intestinal infection due to Clostridium difficile,Other ascites,Cachexia,Urinary tract infection, site not specified,Hemorrhage complicating a procedure,Atrial flutter,Severe sepsis,Retention of urine, unspecified,Edema of male genital organs,Aortocoronary bypass status,Old myocardial infarction,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Gout, unspecified,Hip joint replacement,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Unspecified acquired hypothyroidism
Anaerobic septicemia,Ac on chr diast hrt fail,Acute kidney failure NOS,Ot pul insuf fol trm/srg,Hyperosmolality,Int inf clstrdium dfcile,Ascites NEC,Cachexia,Urin tract infection NOS,Hemorrhage complic proc,Atrial flutter,Severe sepsis,Retention urine NOS,Edema, male genital orgn,Aortocoronary bypass,Old myocardial infarct,Hy kid NOS w cr kid I-IV,Gout NOS,Joint replaced hip,DMII wo cmp nt st uncntr,Pseudomonas infect NOS,Hypothyroidism NOS
Admission Date:  [**2136-9-24**]              Discharge Date:   [**2136-10-18**]


Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
fluid overload/edema/leg erythema/hypoglycemia

Major Surgical or Invasive Procedure:
[**2136-10-1**] ex. laparotomy/evac. hematoma and washout
[**2136-9-29**] total colectomy/rectal stump/end ileostomy


History of Present Illness:
[**Age over 90 **] yo male well known to the csurg
service as he's status post Urgent coronary artery bypass graft
x6 on [**2136-9-7**]. Please refer to his discharge summary on
[**2136-9-13**]
for further details on his hospital course. He was released to
[**First Name4 (NamePattern1) 2299**] [**Last Name (NamePattern1) **] rehab where he had worsening edema and ?? UTI.  He
was transferred to the [**Hospital1 18**] ED for further evaluation. CXR
demonstrates worsening bilateral pleural effusions and
peripheral
edema.  His po intake has been poor. He denies dyspnea, cough or
fever.


Past Medical History:
coronary artery disease,remote non-STEMI s/p cabg x6
Chronic diastolic heart failure
chronic atrial fibrillation
noninsulin dependentg diabetes mellitus
hypertension
Hyperlipidemia
Gout
Glaucoma
-Hypothyroidism
s/p left total hip arthroplasty
s/p bilateral hernia repairs
s/p Cataract surgery


Social History:
Lives at home in [**Location (un) **] with companion, Ms. [**Last Name (Titles) 93013**]- his
significant other, who is also HCP.  Previous college art
professor. 10 pack year history of smoking, quit at age 38.
Denies any alcohol, IVDU.


Family History:
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.
DM on mother's side.

Physical Exam:
Pulse:75   Resp16:  O2 sat96% on RA:
B/P  Right:111/66    Left:112/66
Height: 5ft 9"    Weight: 64.1kg

General:
Skin: Dry [] intact [x]lower extremity vascular skin changes
venous stasis changes, someweeping L shin. mild erythema harvest
sites L
HEENT: PERRLA [] EOMI []irregular pupils bilaterally and
sluggish
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally []diminished at basesR>L
Heart: RRR [x]  Irregular []  Murmur [x] grade _3/6_____
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ []
Extremities: Warm [x], well-perfused []  Edema [x] lower ext
bilaterally 2+Varicosities: None [x]
Neuro: Grossly intact [x] lower ext weak to resistence,
otherwise
no focal findings
Pulses:
Femoral      Right: +2  Left:+2
DP           Right: trace  Left:Trace
PT           [**Name (NI) 167**]: Trace  Left:Trace
Radial       Right:+2   Left:+2

Carotid Bruit        Right: +   Left:+


Pertinent Results:
Conclusions
The left atrium is mildly dilated. There is mild symmetric left
ventricular hypertrophy with normal cavity size and
regional/global systolic function (LVEF>55%). The right
ventricular cavity is mildly dilated with mild global free wall
hypokinesis. The diameters of aorta at the sinus, ascending and
arch levels are normal. Significant aortic stenosis is present
(not quantified). The mitral valve leaflets are mildly
thickened. There is no mitral valve prolapse. Mild (1+) mitral
regurgitation is seen. The pulmonary artery systolic pressure
could not be determined. There is a very small pericardial
effusion.

IMPRESSION: Symmetric LVH with normal global and regional
biventricular systolic function. Mild mitral regurgitation.
Aortic stenosis (not quantified)

Compared with the prior study (images reviewed) of [**2136-9-25**],
the findings are similar.
  Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 171**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2136-9-28**] 11:39
Admission Labs:
[**2136-9-24**] 05:45PM   PT-12.5 PTT-31.5 INR(PT)-1.1
[**2136-9-24**] 05:45PM   PLT COUNT-346#
[**2136-9-24**] 05:45PM   NEUTS-92.7* LYMPHS-4.4* MONOS-2.5 EOS-0.3
BASOS-0.1
[**2136-9-24**] 05:45PM   WBC-9.5 RBC-2.88* HGB-9.4* HCT-28.7* MCV-100*
MCH-32.5* MCHC-32.6 RDW-17.7*
[**2136-9-24**] 05:45PM   ALBUMIN-2.9*
[**2136-9-24**] 05:45PM   cTropnT-0.17* proBNP-6420*
[**2136-9-24**] 05:45PM   estGFR-Using this
[**2136-9-24**] 05:45PM   GLUCOSE-34* UREA N-84* CREAT-3.0* SODIUM-139
POTASSIUM-4.1 CHLORIDE-105 TOTAL CO2-25 ANION GAP-13
[**2136-9-24**] 06:40PM URINE  BLOOD-MOD NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-TR

Radiology Report CHEST (PORTABLE AP) Study Date of [**2136-10-18**]
12:48 PM
Final Report: Moderate-to-large left pleural effusion has
apparently increased in size, although positional differences
may contribute to this apparent change.  Cardiac silhouette is
difficult to assess due to partial obscuration by the effusion.
Small-to-moderate layering right pleural effusion appears
similar to the prior study. Diffuse haziness within the imaged
portion of the upper abdomen suggests the possibility of
ascites, a finding that has been documented on prior abdominal
ultrasound of [**2136-10-8**].

Radiology Report VIDEO OROPHARYNGEAL SWALLOW Study Date of
[**2136-10-12**]
Final Report
VIDEO OROPHARYNGEAL SWALLOW: A video oropharyngeal swallow study
was
performed in conjunction with the speech and swallow team.
Multiple
consistencies of barium were administered. There were
moderate-to-severe
residuals with all consistencies of liquid. While clearing the
residuals with thin liquids, there was penetration from the
residuals in the piriform sinuses. Penetration cleared with
coughing. There is no obvious aspiration visualized. Of note,
the patient was very fatigued from just a few swallows.
IMPRESSION:
1. Penetration from the residuals in the piriform sinuses.
2. No evidence of aspiration.
3. For complete report, please see speech and swallow note in
OMR.

Radiology Report ABDOMEN U.S. (COMPLETE STUDY) PORT Study Date
of [**2136-10-8**] Final Report: The liver demonstrates no focal or
textural abnormality. There is no biliary dilatation. The common
duct measures 4 mm. The gallbladder does not contain stone.
There is no significant gallbladder wall thickening. A
moderate-sized abdominal ascites is present. The spleen measures
11 cm.  Normal hepatopetal flow is present within the portal
vein.
IMPRESSION: No evidence of biliary obstruction. Moderate
abdominal ascites.




Brief Hospital Course:
Readmitted from ER [**9-24**] to CVICU for mgmt of CHF/fluid
overload. Pleural effusions noted. Fever and leukocytosis with
malodorous stools revealed C. diff. He was also noted to have a
pseudomonas UTI , rising creatinine. C. diff proved to be toxic
and he underwent total abdominal colectomy with Dr. [**Last Name (STitle) **] on
[**9-29**] and returned to OR  for ex. lap for mesenteric bleeding on
[**10-1**]. He was unstable and required multiple pressors to support
hemodynamica status. He slowly weaned from pressors. During his
post-op recovery he had bilateral chest tubes placed to drain
recurrent pleural effusions. After they were drained he slowly
weaned from the ventilator and was eventually extubated.  After
extubation he had a post pyloric feeding tube placed because he
failed a swallow examination. Also during this period he was
treated for acute on chronic renal failure and for
hypernatremia. On [**10-18**] he was noted to be desating he became
bradycardic, hypotensive and went into respiratory arrest. The
family deferred intubation  and he expired.


Medications on Admission:
Allopurinol 100mg daily
Amlodipine 2.5mg [**Hospital1 **]
Lipitor 80 mg daily
Lumigan 0.03% 1gtt OU HS
darbepoetin 40mcg Q6week
CoSopt 0.5% 1gttOS [**Hospital1 **]
Lasix 80mg PO daily
Cipro 500mg daily for 2days [**Doctor First Name **]


Discharge Medications:
expired

Discharge Disposition:
Expired

Discharge Diagnosis:
expired

Discharge Condition:
expired

Discharge Instructions:
expired

Followup Instructions:
expired

                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**]

Completed by:[**2136-10-30**]
{'Septicemia due to anaerobes,Acute on chronic diastolic heart failure,Acute kidney failure, unspecified,Other pulmonary insufficiency, not elsewhere classified, following trauma and surgery,Hyperosmolality and/or hypernatremia,Intestinal infection due to Clostridium difficile,Other ascites,Cachexia,Urinary tract infection, site not specified,Hemorrhage complicating a procedure,Atrial flutter,Severe sepsis,Retention of urine, unspecified,Edema of male genital organs,Aortocoronary bypass status,Old myocardial infarction,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Gout, unspecified,Hip joint replacement,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pseudomonas infection in conditions classified elsewhere and of unspecified site,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: fluid overload/edema/leg erythema/hypoglycemia

PRESENT ILLNESS: [**Age over 90 **] yo male well known to the csurg
service as he's status post Urgent coronary artery bypass graft
x6 on [**2136-9-7**]. Please refer to his discharge summary on
[**2136-9-13**]
for further details on his hospital course. He was released to
[**First Name4 (NamePattern1) 2299**] [**Last Name (NamePattern1) **] rehab where he had worsening edema and ?? UTI.  He
was transferred to the [**Hospital1 18**] ED for further evaluation. CXR
demonstrates worsening bilateral pleural effusions and
peripheral
edema.  His po intake has been poor. He denies dyspnea, cough or
fever.

MEDICAL HISTORY: coronary artery disease,remote non-STEMI s/p cabg x6
Chronic diastolic heart failure
chronic atrial fibrillation
noninsulin dependentg diabetes mellitus
hypertension
Hyperlipidemia
Gout
Glaucoma
-Hypothyroidism
s/p left total hip arthroplasty
s/p bilateral hernia repairs
s/p Cataract surgery

MEDICATION ON ADMISSION: Allopurinol 100mg daily
Amlodipine 2.5mg [**Hospital1 **]
Lipitor 80 mg daily
Lumigan 0.03% 1gtt OU HS
darbepoetin 40mcg Q6week
CoSopt 0.5% 1gttOS [**Hospital1 **]
Lasix 80mg PO daily
Cipro 500mg daily for 2days [**Doctor First Name **]

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse:75   Resp16:  O2 sat96% on RA:
B/P  Right:111/66    Left:112/66
Height: 5ft 9"    Weight: 64.1kg

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.
DM on mother's side.

SOCIAL HISTORY: Lives at home in [**Location (un) **] with companion, Ms. [**Last Name (Titles) 93013**]- his
significant other, who is also HCP.  Previous college art
professor. 10 pack year history of smoking, quit at age 38.
Denies any alcohol, IVDU. 

### Response:
{'Septicemia due to anaerobes,Acute on chronic diastolic heart failure,Acute kidney failure, unspecified,Other pulmonary insufficiency, not elsewhere classified, following trauma and surgery,Hyperosmolality and/or hypernatremia,Intestinal infection due to Clostridium difficile,Other ascites,Cachexia,Urinary tract infection, site not specified,Hemorrhage complicating a procedure,Atrial flutter,Severe sepsis,Retention of urine, unspecified,Edema of male genital organs,Aortocoronary bypass status,Old myocardial infarction,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Gout, unspecified,Hip joint replacement,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Unspecified acquired hypothyroidism'}
