CHIEF COMPLAINT: thrombosed lt. ue fistula with hyperkalemia and urgent need for
dialysis given this

PRESENT ILLNESS: 45 y/o man with DM, CAD, depression, who lives at the [**Hospital **]
Rehab, is blind, bedridden, and on HD for ESRD who was found to
have a clotted lt. UE fistula at [**Last Name (un) **], K of 7 (no ECG
changes), transferred to the [**Hospital1 **] for urgent HD.

MEDICAL HISTORY: 1. ESRD [**1-4**] ?diabetes; on HD for approx 1 year.
2. CAD s/p 4 MI's. further hx not available
3. ?Pericardial effusions vs pericarditis?
4. OSA/asthma. Has been on bipap at night; stopped [**1-4**] panic
attacks
5. "Liver disease;" pt does not know etiology. Has q2 week
paracenteses.
6. s/p CVA resulting in L-sided weakness. Resolved
7. s/p toe amputation
8. hypothyroidism
9. sacral decubiti
10. blindness
11. memory loss

MEDICATION ON ADMISSION: coreg 3.125 [**Hospital1 **]
phoslo 667; t caps w/ meals
nephrocaps QHS
iron 325
kayexalate 120cc daily
sorbitol on days off HD
synthroid 200 mcg daily
SSI (2U regular for each 50 over 200); no long-acting insulin
seen
combivent q4 hrs
zoloft 100 daily
wellbutrin SR 150 daily
risperidone 0.5mg po QHS
Ambien 5mg QHS
fentanyl patch 100mg q 72 hrs
biascodyl po and pr prn
senna
colace
MOM prn

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: 98.4  105/68  77  13 97 ra
GEN: chronically ill-appearing gentleman with anasarca; NAD
HEENT: EOMI, anicteric, MMM dry; corneal opacifications OU
NECK: no supraclavicular or cervical lymphadenopathy, no jvd, no
carotid bruits
RESP: CTA b/l with few [**Hospital1 **]-basilar cracles; BS decreased overall,
esp at bases
CV: RR, S1 and S2 wnl, +S4 gallop. No flow or bruit heard over
HD cath site. No JVD appreciable (stiff neck)
ABD: firm, distended with very tense/firm and inturated skin on
flanks. Otherwise abdomen non-tender. + BS.
EXT: tense edema,tender, + erythema B LE and questionable warmth
from tibial plateau to ankles; chronic venous stasis changes,
feet warm and well-perfused, very slight ulceration on rt shin -
no purulence or erythema.
SKIN: Legs as above; rt trunk with very tense and hard skin;
skin over back with papules and several areas of brownish
crusts. Large decubiti with + bleeding/stage I break-down.
Appears clean-based, no purulence.
NEURO: AAOx3. Cn II-XII intact. 4/5 strength throughout.

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives at the [**Hospital **] Rehab
Other complications due to renal dialysis device, implant, and graft,Hyperpotassemia,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Pressure ulcer, lower back,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Gastroparesis,Unspecified acquired hypothyroidism,Asthma, unspecified type, unspecified,Old myocardial infarction
Comp-ren dialys dev/grft,Hyperpotassemia,End stage renal disease,Hyp kid NOS w cr kid V,Pressure ulcer, low back,Abn react-anastom/graft,DMII renl nt st uncntrld,Gastroparesis,Hypothyroidism NOS,Asthma NOS,Old myocardial infarct
Admission Date:  [**2120-10-6**]              Discharge Date:   [**2120-10-9**]

Date of Birth:  [**2074-11-6**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 330**]
Chief Complaint:
thrombosed lt. ue fistula with hyperkalemia and urgent need for
dialysis given this

Major Surgical or Invasive Procedure:
TPA infusion to AV fistula for clearance


History of Present Illness:
45 y/o man with DM, CAD, depression, who lives at the [**Hospital **]
Rehab, is blind, bedridden, and on HD for ESRD who was found to
have a clotted lt. UE fistula at [**Last Name (un) **], K of 7 (no ECG
changes), transferred to the [**Hospital1 **] for urgent HD.

Past Medical History:
1. ESRD [**1-4**] ?diabetes; on HD for approx 1 year.
2. CAD s/p 4 MI's. further hx not available
3. ?Pericardial effusions vs pericarditis?
4. OSA/asthma. Has been on bipap at night; stopped [**1-4**] panic
attacks
5. "Liver disease;" pt does not know etiology. Has q2 week
paracenteses.
6. s/p CVA resulting in L-sided weakness. Resolved
7. s/p toe amputation
8. hypothyroidism
9. sacral decubiti
10. blindness
11. memory loss


Social History:
Lives at the [**Hospital **] Rehab

Social History: No smoking, occasional alcohol, no drug use.


Family History:
NC

Physical Exam:
VS: 98.4  105/68  77  13 97 ra
GEN: chronically ill-appearing gentleman with anasarca; NAD
HEENT: EOMI, anicteric, MMM dry; corneal opacifications OU
NECK: no supraclavicular or cervical lymphadenopathy, no jvd, no
carotid bruits
RESP: CTA b/l with few [**Hospital1 **]-basilar cracles; BS decreased overall,
esp at bases
CV: RR, S1 and S2 wnl, +S4 gallop. No flow or bruit heard over
HD cath site. No JVD appreciable (stiff neck)
ABD: firm, distended with very tense/firm and inturated skin on
flanks. Otherwise abdomen non-tender. + BS.
EXT: tense edema,tender, + erythema B LE and questionable warmth
from tibial plateau to ankles; chronic venous stasis changes,
feet warm and well-perfused, very slight ulceration on rt shin -
no purulence or erythema.
SKIN: Legs as above; rt trunk with very tense and hard skin;
skin over back with papules and several areas of brownish
crusts. Large decubiti with + bleeding/stage I break-down.
Appears clean-based, no purulence.
NEURO: AAOx3. Cn II-XII intact. 4/5 strength throughout.


Pertinent Results:
[**2120-10-6**] 02:10AM   PT-15.3* PTT-27.6 INR(PT)-1.4*
[**2120-10-6**] 02:10AM   PLT COUNT-213
[**2120-10-6**] 02:10AM   HYPOCHROM-3+ ANISOCYT-1+ MACROCYT-3+
[**2120-10-6**] 02:10AM   NEUTS-80.5* LYMPHS-10.6* MONOS-6.1 EOS-2.4
BASOS-0.4
[**2120-10-6**] 02:10AM   WBC-7.6 RBC-2.95* HGB-9.3* HCT-30.4* MCV-103*
MCH-31.7 MCHC-30.7* RDW-16.4*
[**2120-10-6**] 02:10AM   CALCIUM-8.9 PHOSPHATE-4.7* MAGNESIUM-2.8*
[**2120-10-6**] 02:10AM   GLUCOSE-114* UREA N-54* CREAT-4.8*
SODIUM-131* POTASSIUM-6.7* CHLORIDE-96 TOTAL CO2-25 ANION GAP-17
[**2120-10-6**] 06:30AM   ALBUMIN-3.2*
[**2120-10-6**] 06:30AM   ALT(SGPT)-19 AST(SGOT)-26 ALK PHOS-288* TOT
BILI-0.3
[**2120-10-6**] 06:30AM   POTASSIUM-6.4*
[**2120-10-6**] 06:38AM   K+-6.3*
[**2120-10-6**] 01:00PM   CALCIUM-8.9 PHOSPHATE-5.4* MAGNESIUM-2.7*
[**2120-10-6**] 01:00PM   GLUCOSE-87 UREA N-60* CREAT-5.2* SODIUM-132*
POTASSIUM-6.3* CHLORIDE-95* TOTAL CO2-26 ANION GAP-17
[**2120-10-6**] 08:49PM   GLUCOSE-96 UREA N-37* CREAT-3.8*# SODIUM-142
POTASSIUM-4.8 CHLORIDE-101 TOTAL CO2-29 ANION GAP-17

Brief Hospital Course:
Pt. was admitted to [**Hospital Ward Name 121**] 10 Hepatorenal service and went to IR
for placement of a temporary HD catheter ("Quinten" catheter
placed to the Rt. Subclavian vein).

He then underwent HD without complication.  He was subsequently
evaluated by IR through fistulography which confirmed a
thrombosis.  Catheters were introduced to the fistula, and a TPA
infusion was begun, necessitating ICU admission for monitoring.

He received the TPA thougout the night of [**10-7**]-7, and repeat
fistulography was performed the next day - the fistula was clear
of thrombosis.  He suffered no complication of the TPA infusion.

Otherwise, he was maintained on his usual outpatient medications
without complication or incident.

He was discharged back to [**Last Name (un) **] on [**10-9**].

Medications on Admission:
coreg 3.125 [**Hospital1 **]
phoslo 667; t caps w/ meals
nephrocaps QHS
iron 325
kayexalate 120cc daily
sorbitol on days off HD
synthroid 200 mcg daily
SSI (2U regular for each 50 over 200); no long-acting insulin
seen
combivent q4 hrs
zoloft 100 daily
wellbutrin SR 150 daily
risperidone 0.5mg po QHS
Ambien 5mg QHS
fentanyl patch 100mg q 72 hrs
biascodyl po and pr prn
senna
colace
MOM prn


Discharge Medications:
1. Carvedilol 3.125 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
2. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed.
4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
5. Calcium Acetate 667 mg Capsule Sig: Two (2) Capsule PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
6. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: [**12-4**]
Puffs Inhalation Q4H (every 4 hours) as needed.
7. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed.
8. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO Q8H (every
8 hours) as needed.
9. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
10. Insulin Regular Human 100 unit/mL Solution Sig: as per
sliding scale units, insulin Injection ASDIR (AS DIRECTED): as
per sliding scale (included).
11. Fentanyl 100 mcg/hr Patch 72HR Sig: One (1) Patch 72HR
Transdermal Q72H (every 72 hours).
12. Sertraline 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
13. Sertraline 50 mg Tablet Sig: One (1) Tablet PO once a day.
14. Bupropion 150 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO QAM (once a day (in the morning)).
15. Risperidone 0.5 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
16. Levothyroxine 100 mcg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
17. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
18. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
19. Simethicone 80 mg Tablet, Chewable Sig: One (1) Tablet,
Chewable PO QID (4 times a day) as needed.
20. Fexofenadine 60 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
21. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime)
as needed.


Discharge Disposition:
Extended Care

Facility:
[**Last Name (un) **] Center - [**Location (un) 701**]

Discharge Diagnosis:
Chronic renal failure with failure (thrombosis) of Lt. UE AV
fistula


Discharge Condition:
Stable


Discharge Instructions:
Take all your medications as prescribed

Followup Instructions:
With your usual dialysis providers at the [**Hospital **] Rehab.
{'Other complications due to renal dialysis device, implant, and graft,Hyperpotassemia,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Pressure ulcer, lower back,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Gastroparesis,Unspecified acquired hypothyroidism,Asthma, unspecified type, unspecified,Old myocardial infarction'}


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: thrombosed lt. ue fistula with hyperkalemia and urgent need for
dialysis given this

PRESENT ILLNESS: 45 y/o man with DM, CAD, depression, who lives at the [**Hospital **]
Rehab, is blind, bedridden, and on HD for ESRD who was found to
have a clotted lt. UE fistula at [**Last Name (un) **], K of 7 (no ECG
changes), transferred to the [**Hospital1 **] for urgent HD.

MEDICAL HISTORY: 1. ESRD [**1-4**] ?diabetes; on HD for approx 1 year.
2. CAD s/p 4 MI's. further hx not available
3. ?Pericardial effusions vs pericarditis?
4. OSA/asthma. Has been on bipap at night; stopped [**1-4**] panic
attacks
5. "Liver disease;" pt does not know etiology. Has q2 week
paracenteses.
6. s/p CVA resulting in L-sided weakness. Resolved
7. s/p toe amputation
8. hypothyroidism
9. sacral decubiti
10. blindness
11. memory loss

MEDICATION ON ADMISSION: coreg 3.125 [**Hospital1 **]
phoslo 667; t caps w/ meals
nephrocaps QHS
iron 325
kayexalate 120cc daily
sorbitol on days off HD
synthroid 200 mcg daily
SSI (2U regular for each 50 over 200); no long-acting insulin
seen
combivent q4 hrs
zoloft 100 daily
wellbutrin SR 150 daily
risperidone 0.5mg po QHS
Ambien 5mg QHS
fentanyl patch 100mg q 72 hrs
biascodyl po and pr prn
senna
colace
MOM prn

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: 98.4  105/68  77  13 97 ra
GEN: chronically ill-appearing gentleman with anasarca; NAD
HEENT: EOMI, anicteric, MMM dry; corneal opacifications OU
NECK: no supraclavicular or cervical lymphadenopathy, no jvd, no
carotid bruits
RESP: CTA b/l with few [**Hospital1 **]-basilar cracles; BS decreased overall,
esp at bases
CV: RR, S1 and S2 wnl, +S4 gallop. No flow or bruit heard over
HD cath site. No JVD appreciable (stiff neck)
ABD: firm, distended with very tense/firm and inturated skin on
flanks. Otherwise abdomen non-tender. + BS.
EXT: tense edema,tender, + erythema B LE and questionable warmth
from tibial plateau to ankles; chronic venous stasis changes,
feet warm and well-perfused, very slight ulceration on rt shin -
no purulence or erythema.
SKIN: Legs as above; rt trunk with very tense and hard skin;
skin over back with papules and several areas of brownish
crusts. Large decubiti with + bleeding/stage I break-down.
Appears clean-based, no purulence.
NEURO: AAOx3. Cn II-XII intact. 4/5 strength throughout.

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives at the [**Hospital **] Rehab 

### Response:
{'Other complications due to renal dialysis device, implant, and graft,Hyperpotassemia,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Pressure ulcer, lower back,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Gastroparesis,Unspecified acquired hypothyroidism,Asthma, unspecified type, unspecified,Old myocardial infarction'}
