CHIEF COMPLAINT: Nausea, vomiting, abdominal pain

PRESENT ILLNESS: Presented to emergency room with 1 day history of nausea and
vomiting and possible aspiration pneumonia

MEDICAL HISTORY: -Parkinson disease s/p deep brain stimulator placement
-HTN
-Diabetes mellitus
-hyperlipidemia
-Shy-[**Last Name (un) **] syndrome
-diaphragmatic hernia
-ventral hernia
-GERD
-CKD
- h/o subtotal colectomy with Hartmann's pouch
- h/o end ileostomy and G-tube for sigmoid volvulus ([**2198**] -
[**Doctor Last Name **])
- ORIF R humerus fracture ([**2193**])
.

MEDICATION ON ADMISSION: 1. Glipizide 5 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day).

ALLERGIES: Serax

PHYSICAL EXAM: On admission:
Temp:98.0 HR:85 BP:103/59 Resp:24 O(2)Sat:88% low
Constitutional: Comfortable
HEENT: Normocephalic, atraumatic, Extraocular muscles
intact
Oropharynx within normal limits
Chest: coarse breath sounds
Cardiovascular: Regular Rate and Rhythm, Normal first and
second heart sounds
Abdominal: Soft, Nondistended, diffusely tender
GU/Flank: No costovertebral angle tenderness
Extr/Back: No cyanosis, clubbing or edema
Skin: No rash, Warm and dry
Neuro: + increased muscle tone
Heme/[**Last Name (un) **]/[**Last Name (un) **]: No petechiae

FAMILY HISTORY: Father: died of skin cancer
Brother #1: prostate cancer
Brother #2: CVA

SOCIAL HISTORY: Patient lives in [**Location **] with his wife, who has been disabled
for many decades now; and has aides to care for her and him 24
hours a day. His family owns a real estate company in [**Location (un) **].
He is retired from developing a construction company, and has 5
children. A daughter in an internist in [**Name (NI) 531**].
Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Unspecified intestinal obstruction,Other degenerative diseases of the basal ganglia,Delirium due to conditions classified elsewhere,Pulmonary collapse,Paralysis agitans,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Other and unspecified special symptoms or syndromes, not elsewhere classified,Tachypnea,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Other and unspecified hyperlipidemia,Diarrhea,Rash and other nonspecific skin eruption,Ileostomy status
Food/vomit pneumonitis,Acute kidney failure NOS,Intestinal obstruct NOS,Degen basal ganglia NEC,Delirium d/t other cond,Pulmonary collapse,Paralysis agitans,Hy kid NOS w cr kid I-IV,Chr kidney dis stage III,Special symptom NEC/NOS,Tachypnea,DMII wo cmp nt st uncntr,Esophageal reflux,Hyperlipidemia NEC/NOS,Diarrhea,Nonspecif skin erupt NEC,Ileostomy status
Admission Date:  [**2202-8-10**]              Discharge Date:   [**2202-8-23**]

Date of Birth:  [**2123-1-29**]             Sex:   M

Service: MEDICINE

Allergies:
Serax

Attending:[**Doctor First Name 3290**]
Chief Complaint:
Nausea, vomiting, abdominal pain

Major Surgical or Invasive Procedure:
None


History of Present Illness:
Presented to emergency room with 1 day history of nausea and
vomiting and possible aspiration pneumonia

Past Medical History:
-Parkinson disease s/p deep brain stimulator placement
-HTN
-Diabetes mellitus
-hyperlipidemia
-Shy-[**Last Name (un) **] syndrome
-diaphragmatic hernia
-ventral hernia
-GERD
-CKD
- h/o subtotal colectomy with Hartmann's pouch
- h/o end ileostomy and G-tube for sigmoid volvulus ([**2198**] -
[**Doctor Last Name **])
- ORIF R humerus fracture ([**2193**])
.


Social History:
Patient lives in [**Location **] with his wife, who has been disabled
for many decades now; and has aides to care for her and him 24
hours a day. His family owns a real estate company in [**Location (un) **].
He is retired from developing a construction company, and has 5
children. A daughter in an internist in [**Name (NI) 531**].


Family History:
Father: died of skin cancer
Brother #1: prostate cancer
Brother #2: CVA

Physical Exam:
On admission:
Temp:98.0 HR:85 BP:103/59 Resp:24 O(2)Sat:88% low
Constitutional: Comfortable
HEENT: Normocephalic, atraumatic, Extraocular muscles
intact
Oropharynx within normal limits
Chest: coarse breath sounds
Cardiovascular: Regular Rate and Rhythm, Normal first and
second heart sounds
Abdominal: Soft, Nondistended, diffusely tender
GU/Flank: No costovertebral angle tenderness
Extr/Back: No cyanosis, clubbing or edema
Skin: No rash, Warm and dry
Neuro: + increased muscle tone
Heme/[**Last Name (un) **]/[**Last Name (un) **]: No petechiae



Pertinent Results:
On admission:
[**2202-8-10**] 03:40PM BLOOD WBC-7.2 RBC-4.14* Hgb-13.3* Hct-40.1
MCV-97 MCH-32.2* MCHC-33.1 RDW-13.7 Plt Ct-311
[**2202-8-10**] 03:40PM BLOOD Neuts-89.0* Lymphs-5.9* Monos-3.3 Eos-0.1
Baso-1.7
[**2202-8-10**] 03:40PM BLOOD PT-13.8* PTT-24.7 INR(PT)-1.2*
[**2202-8-10**] 03:40PM BLOOD Glucose-211* UreaN-28* Creat-2.1* Na-138
K-4.7 Cl-99 HCO3-24 AnGap-20
[**2202-8-10**] 03:40PM BLOOD ALT-14 AST-23 AlkPhos-128 TotBili-0.6
[**2202-8-10**] 03:40PM BLOOD Lipase-57
[**2202-8-10**] 03:40PM BLOOD Calcium-9.4 Phos-4.5 Mg-1.8
[**2202-8-10**] 03:42PM BLOOD Lactate-4.2*
.
On discharge:
.
[**2202-8-22**] 06:45AM BLOOD WBC-8.9 RBC-3.18* Hgb-9.6* Hct-30.6*
MCV-96 MCH-30.3 MCHC-31.6 RDW-13.7 Plt Ct-635*
[**2202-8-22**] 06:45AM BLOOD Glucose-97 UreaN-12 Creat-1.0 Na-139
K-4.0 Cl-105 HCO3-30 AnGap-8
[**2202-8-22**] 06:45AM BLOOD Calcium-8.3* Phos-3.6 Mg-1.8
.
Studies:
.
[**8-16**] CXR: FINDINGS: In comparison with the study of [**8-14**], there
are continued low lung
volumes. Extensive left basilar consolidation is again seen with
continued
less prominent opacifications in much of the right lung. The
findings are
consistent with widespread pneumonia, possibly complicated by
increased
pulmonary venous pressure in a patient with prominence of the
cardiomediastinal silhouette.
Deep brain stimulators are again seen.
.
[**8-22**] CXR:
There are low lung volumes. Cardiac size is top normal. Large
left lung
consolidation consistent with pneumonia is minimally improved
from prior
study. Hazy opacities in the right lung are unchanged, also
consistent with
pneumonia. There are no new lung abnormalities. There is no
pneumothorax.
If any there is a small left pleural effusion. Brain stimulators
are again
seen.
.
[**8-10**] CT abd/pelvis: 1. High-grade small-bowel obstruction at the
level of small bowel containing supraumbilical ventral abdominal
wall hernia with distal decompression. No perforation or other
complication.
2. Cholelithiasis without cholecystitis.
3. Consolidation at the left lung base posteriorly may represent
aspiration.
4. Markedly distended stomach containing fluid and gastric
contents as a
result of the small bowel obstruction.
.
[**8-16**] Video swallow study:
FINDINGS: Barium passes freely through the oropharynx without
evidence of
obstruction. There was no gross aspiration or penetration. For
details,
please refer to the speech and swallow division note in OMR.

IMPRESSION:
No penetration or aspiration.


Brief Hospital Course:
Mr. [**Known lastname 16284**] is a 79 year old gentleman with PMH s/f advanced
Parkinson's disease/Shy-[**Last Name (un) 16294**] Syndrome, DM, HTN, ventral
hernia and distant sigmoid volvulus (s/p colectomy w/ostomy in
place), who was admitted with SBO which resolved w/ conservative
management, now with aspiration PNA, likely present at
admission.
.
#SBO: The patient was admitted to the surgical service. He has a
history of subtotal coletomy with Hartmann's pouch and end
ileostomy for sigmoid volvulus. An NG tube was placed and the
patient was managed conservatively with fluids and electrolyte
repletion. His SBO eventually resolved and he maintained good
ostomy output without nausea or vomiting during his admission to
the medical service.
.
#Aspiration pneumonia: The patient was admitted with a CXR
concerning for aspiration. He was started on broad-spectrum
antibiotics, which were tapered to Levaquin. The patient was
then transferred to the medicine service where he developed
increasing hypoxia. Antibiotics were then re-broadened and the
patient was closely followed with serial chest X rays; O2
support was intitially via Venturi mask, but the patient was
weaned to nasal cannula. He completed an 8-day course of
broad-spectrum antibiotics and was discharged with home oxygen.
O2 saturations on the day of discharge were 95-96% on 1L nasal
cannula. The patient passed a video swallow study and was kept
on soft foods and thin liquids during this admission.
.
#PARKINSONS/SHY-[**Last Name (un) **]: The patient was continued on his home
medications Sinemet and [**Last Name (un) 16285**]. He is s/p placement of deep
brain stimulators. Sertraline was continued for depression.
Physical therapy was consulted and helped work with the patient
and helped him advance his activity.
.
#ACUTE ON CHRONIC RENAL FAILURE. The patient's creatinine was
closely monitored. On admission, creatinine was 1.5. With close
monitoring of the patient's output and IV fluid hydration, the
patient's creatinine stabilized at 1.0.
.
#AGITATION: The patient was maintained on his home medications
quetiapine and trazodone at night. He occasionally required
extra doses of these medications and would intermittently become
very agitated at night - this frequently led to hypoxia and
increased O2 requirement.
.
#DM: The patient's home glipizide therapy was held. Fasting AM
glucose levels were checked and ranged from 100-160s. The
patient was received SSI and a diabetic diet.
.
#GERD: The patient was continued on his home omeprazole.
.
# GROIN RASH: The patient received antifungal cream and powder
for a candidal rash.
.
# HYPERLIPIDEMIA: The patient was continued on his home
medication simvastatin.
.
# SOFT STOOL:  Resolved. C. diff toxin negative x3.
.
#The patient received subQ heparin for DVT prophylaxis. He
remained full code during this admission. He was discharged with
close follow-up by his PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 141**].

Medications on Admission:
1. Glipizide 5 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day).

2. Quetiapine 50 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

3. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Trazodone 50 mg Tablet Sig: Three (3) Tablet PO HS (at
bedtime) as needed for sleep.
5. Sinemet-25/250 25-250 mg Tablet Sig: One (1) Tablet PO BID at
6:30 AM and 9AM.
6. Sinemet-25/250 25-250 mg Tablet Sig: 1.5 Tablets PO BID at
11:30AM and 4:30PM.
7. Sinemet-25/250 25-250 mg Tablet Sig: 1.75 Tablets PO qd at
2:00 PM.
8. Sinemet-25/250 25-250 mg Tablet Sig: Two (2) Tablet PO qd at
7:00PM.
9. Fludrocortisone 0.1 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. Sertraline 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. Vesicare 5 mg Tablet Sig: One (1) Tablet PO once a day.
12. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
13. Ropinirole 1 mg Tablet Sig: Two (2) Tablet PO TID (3 times a
day): 2 mg TID at 6:30AM, 9:00AM, and 2:00PM.
14. Ropinirole 2 mg Tablet Sig: 1.5 Tablets PO qd at 11:30AM.
15. Restasis 0.05 % Dropperette Sig: One (1) drop in both eyes
Ophthalmic twice a day.
16. Patanol 0.1 % Drops Sig: Two (2) drops per eye Ophthalmic
twice a day as needed for itching.
17. Miralax 17 gram/dose Powder Sig: One (1) 17 gram dose PO
once a day as needed for constipation.


Discharge Medications:
1. Glipizide 5 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day).

2. Quetiapine 50 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

3. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Trazodone 50 mg Tablet Sig: Three (3) Tablet PO HS (at
bedtime) as needed for sleep.
5. Sinemet-25/250 25-250 mg Tablet Sig: One (1) Tablet PO BID at
6:30 AM and 9AM.
6. Sinemet-25/250 25-250 mg Tablet Sig: 1.5 Tablets PO BID at
11:30AM and 4:30PM.
7. Sinemet-25/250 25-250 mg Tablet Sig: 1.75 Tablets PO qd at
2:00 PM.
8. Sinemet-25/250 25-250 mg Tablet Sig: Two (2) Tablet PO qd at
7:00PM.
9. Fludrocortisone 0.1 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. Sertraline 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. Vesicare 5 mg Tablet Sig: One (1) Tablet PO once a day.
12. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
13. Ropinirole 1 mg Tablet Sig: Two (2) Tablet PO TID (3 times a
day): 2 mg TID at 6:30AM, 9:00AM, and 2:00PM.
14. Ropinirole 2 mg Tablet Sig: 1.5 Tablets PO qd at 11:30AM.
15. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical [**Hospital1 **]
(2 times a day) as needed for groin rash.
16. Restasis 0.05 % Dropperette Sig: One (1) drop in both eyes
Ophthalmic twice a day.
17. Patanol 0.1 % Drops Sig: Two (2) drops per eye Ophthalmic
twice a day as needed for itching.
18. Miralax 17 gram/dose Powder Sig: One (1) 17 gram dose PO
once a day as needed for constipation.
19. Home Oxygen
Home oxygen at 1-4 LPM continuous, pulse-dose for portability

Diagnosis: Aspiration pneumonia


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
Primary:
Small bowel obstruction
Aspiration pneumonia
Secondary:
Parkinson disease s/p deep brain stimulator placement
HTN
Diabetes mellitus
Hyperlipidemia
GERD
h/o subtotal colectomy with Hartmann's pouch
h/o end ileostomy and G-tube for sigmoid volvulus ([**2198**] -
[**Doctor Last Name **])

Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).
Activity Status: Out of Bed with assistance to chair or
wheelchair.


Discharge Instructions:
Dear Mr. [**Known lastname 16284**],

It was a pleasure taking care of you at the [**Hospital1 771**]. You were admitted for a small bowel
obstruction that resolved with conservative management. Your
hospital course was complicated by pneumonia - likely,
aspiration pneumonia, for which you were treated with
broad-spectrum antibiotics and oxygen support.

We made no major changes to your medication regimen and you
should continue to take your medications as directed by Dr.
[**Last Name (STitle) 141**]. We did add miconazole powder for the rash in your
groin to be used as needed.

An appointment with Dr. [**Last Name (STitle) 141**] is scheduled for next Thursday,
[**9-2**] at 4 pm. You can call his office if this needs to be
re-scheduled.

You were discharged with oxygen to be used at home and the
visiting nurses will help to wean you from oxygen as your
strength improves and as your body continues to absorb the fluid
and infection from your lungs.


Followup Instructions:
The information for your follow-up appointment with Dr. [**Last Name (STitle) 141**]
is listed below:

Department: INTERNAL MEDICINE
When: THURSDAY [**2202-9-2**] at 4:00 PM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 143**], MD [**Telephone/Fax (1) 142**]
Building: LM [**Hospital Unit Name **] [**Location (un) **]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage
{'Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Unspecified intestinal obstruction,Other degenerative diseases of the basal ganglia,Delirium due to conditions classified elsewhere,Pulmonary collapse,Paralysis agitans,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Other and unspecified special symptoms or syndromes, not elsewhere classified,Tachypnea,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Other and unspecified hyperlipidemia,Diarrhea,Rash and other nonspecific skin eruption,Ileostomy status'}


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: Nausea, vomiting, abdominal pain

PRESENT ILLNESS: Presented to emergency room with 1 day history of nausea and
vomiting and possible aspiration pneumonia

MEDICAL HISTORY: -Parkinson disease s/p deep brain stimulator placement
-HTN
-Diabetes mellitus
-hyperlipidemia
-Shy-[**Last Name (un) **] syndrome
-diaphragmatic hernia
-ventral hernia
-GERD
-CKD
- h/o subtotal colectomy with Hartmann's pouch
- h/o end ileostomy and G-tube for sigmoid volvulus ([**2198**] -
[**Doctor Last Name **])
- ORIF R humerus fracture ([**2193**])
.

MEDICATION ON ADMISSION: 1. Glipizide 5 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day).

ALLERGIES: Serax

PHYSICAL EXAM: On admission:
Temp:98.0 HR:85 BP:103/59 Resp:24 O(2)Sat:88% low
Constitutional: Comfortable
HEENT: Normocephalic, atraumatic, Extraocular muscles
intact
Oropharynx within normal limits
Chest: coarse breath sounds
Cardiovascular: Regular Rate and Rhythm, Normal first and
second heart sounds
Abdominal: Soft, Nondistended, diffusely tender
GU/Flank: No costovertebral angle tenderness
Extr/Back: No cyanosis, clubbing or edema
Skin: No rash, Warm and dry
Neuro: + increased muscle tone
Heme/[**Last Name (un) **]/[**Last Name (un) **]: No petechiae

FAMILY HISTORY: Father: died of skin cancer
Brother #1: prostate cancer
Brother #2: CVA

SOCIAL HISTORY: Patient lives in [**Location **] with his wife, who has been disabled
for many decades now; and has aides to care for her and him 24
hours a day. His family owns a real estate company in [**Location (un) **].
He is retired from developing a construction company, and has 5
children. A daughter in an internist in [**Name (NI) 531**]. 

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Unspecified intestinal obstruction,Other degenerative diseases of the basal ganglia,Delirium due to conditions classified elsewhere,Pulmonary collapse,Paralysis agitans,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Other and unspecified special symptoms or syndromes, not elsewhere classified,Tachypnea,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Other and unspecified hyperlipidemia,Diarrhea,Rash and other nonspecific skin eruption,Ileostomy status'}
