CHIEF COMPLAINT: Mental status change.

PRESENT ILLNESS: The patient is a 74-year-old
woman with the past medical history of ovarian cancer, status
post total abdominal hysterectomy, bilateral
salpingo-oophorectomy, omentectomy, and ileocecectomy in
[**2131-9-29**], complicated by perforation of the
anastomosis with peritonitis and abscess requiring
exploratory laparotomy and resection of the anastomosis with
ileostomy, perihepatic abscess MRSA, history of aspiration,
diabetes mellitus, paranoid schizophrenia, depression, recent
herpes zoster.  The patient presented with several days of
worsening mental status.  Over the past few months, the
patient has had multiple admissions related to ovarian cancer
and complications, thereof.  On [**5-13**], the patient was
discharged from her rehabilitation placement.  Over the
ensuing days, the patient had increased lethargy and
decreased responsiveness.  The patient presented to the
emergency department on [**2132-5-17**].  The patient was found to
be in acute renal failure, hypokalemia, hyponatremia,
leukocytosis of 12.3, purulent urine and a positive
urinalysis.  The patient was treated with Levofloxacin and
Vancomycin.  She became hypotensive despite hydration.  She
was transferred to the Intensive Care setting, where she
received IV dopamine through a central venous line.  Head CT
was performed and negative.  Abdominal CT was unremarkable.
The patient's ICU course was significant for a 10 point
hematocrit drop, which was thought to be dilutional.  LP and
chest x-ray were both negative.  The patient was gradually
weaned off dopamine.  Mental status rapidly returned to
baseline upon arrival to the ICU.

MEDICAL HISTORY: 1.  Ovarian cancer, diagnosed [**2131-9-29**], status post
total abdominal hysterectomy, bilateral
salpingo-oophorectomy, omentectomy, and ileocecectomy in
[**2131-9-29**].  [**2131-12-29**], the patient was found to
have perforation of her anastomosis with peritonitis and
intraabdominal abscess.  She under exploratory laparotomy and
resection with ileostomy.  Course was complicated by
intubation, acute renal failure.
2.  MRSA, perihepatic abscess.
3.  History of aspiration.
4.  Diabetes mellitus.
5.  EF 45% to 50% with 2+ MR
6.  Hyperlipidemia.
7.  Paranoid schizophrenia.
8.  Depression.
9.  Recent herpes zoster virus infection.
10. Status post PEG placement.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient is allergic to PENICILLIN, WHICH
CAUSES A RASH.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: The patient is widowed.
Unspecified septicemia,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Paranoid type schizophrenia, unspecified,Hyposmolality and/or hyponatremia,Mitral valve disorders,Herpes zoster with other nervous system complications,Personal history of malignant neoplasm of ovary,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Septicemia NOS,Acute kidney failure NOS,Urin tract infection NOS,Paranoid schizo-unspec,Hyposmolality,Mitral valve disorder,H zoster nerv syst NEC,Hx of ovarian malignancy,DMII wo cmp nt st uncntr
Admission Date:  [**2132-5-17**]       Discharge Date:  [**2132-5-20**]

Date of Birth:   [**2057-5-9**]       Sex:  F

Service:  ACOVE
CHIEF COMPLAINT:  Mental status change.

HISTORY OF THE PRESENT ILLNESS:  The patient is a 74-year-old
woman with the past medical history of ovarian cancer, status
post total abdominal hysterectomy, bilateral
salpingo-oophorectomy, omentectomy, and ileocecectomy in
[**2131-9-29**], complicated by perforation of the
anastomosis with peritonitis and abscess requiring
exploratory laparotomy and resection of the anastomosis with
ileostomy, perihepatic abscess MRSA, history of aspiration,
diabetes mellitus, paranoid schizophrenia, depression, recent
herpes zoster.  The patient presented with several days of
worsening mental status.  Over the past few months, the
patient has had multiple admissions related to ovarian cancer
and complications, thereof.  On [**5-13**], the patient was
discharged from her rehabilitation placement.  Over the
ensuing days, the patient had increased lethargy and
decreased responsiveness.  The patient presented to the
emergency department on [**2132-5-17**].  The patient was found to
be in acute renal failure, hypokalemia, hyponatremia,
leukocytosis of 12.3, purulent urine and a positive
urinalysis.  The patient was treated with Levofloxacin and
Vancomycin.  She became hypotensive despite hydration.  She
was transferred to the Intensive Care setting, where she
received IV dopamine through a central venous line.  Head CT
was performed and negative.  Abdominal CT was unremarkable.
The patient's ICU course was significant for a 10 point
hematocrit drop, which was thought to be dilutional.  LP and
chest x-ray were both negative.  The patient was gradually
weaned off dopamine.  Mental status rapidly returned to
baseline upon arrival to the ICU.

PAST MEDICAL HISTORY:
1.  Ovarian cancer, diagnosed [**2131-9-29**], status post
total abdominal hysterectomy, bilateral
salpingo-oophorectomy, omentectomy, and ileocecectomy in
[**2131-9-29**].  [**2131-12-29**], the patient was found to
have perforation of her anastomosis with peritonitis and
intraabdominal abscess.  She under exploratory laparotomy and
resection with ileostomy.  Course was complicated by
intubation, acute renal failure.
2.  MRSA, perihepatic abscess.
3.  History of aspiration.
4.  Diabetes mellitus.
5.  EF 45% to 50% with 2+ MR
6.  Hyperlipidemia.
7.  Paranoid schizophrenia.
8.  Depression.
9.  Recent herpes zoster virus infection.
10. Status post PEG placement.

ALLERGIES:  The patient is allergic to PENICILLIN, WHICH
CAUSES A RASH.

MEDICATIONS:
1.  Celexa 60 mg p.o.q.d.
2.  Protonix 40 mg q.d.
3.  Risperdal 0.5 mg p.o.q.a.m. and 1.5 mg p.o.q.p.m.
4.  Neurontin 300 mg p.o.t.i.d.
5.  Ativan 0.5 mg b.i.d.
6.  Magnesium oxide 400 mg q.i.d.
7.  Erythropoietin 40,000 units q. week.
8.  Allopurinol 100 mg q.d.
9.  Aspirin 81 mg p.o.q.d.
10. Metoprolol 50 mg p.o.b.i.d.

SOCIAL HISTORY:  The patient is widowed.

FAMILY HISTORY:  Noncontributory.

PHYSICAL EXAMINATION:  Examination revealed the following:
The patient's temperature was 98.3, pulse 68, respiratory
rate 20, blood pressure 118/60 with oxygen saturation 97% on
room air.  GENERAL:  The patient was a fairly well-appearing
female in no apparent distress.  HEENT:  EOMI, PERRLA.  NECK:
Slightly dry mucous membranes.  Neck examination revealed no
lymphadenopathy and no elevation of her central venous
pressure.  CARDIAC:  Regular rate and rhythm, normal S1 and
S2, no murmurs, rubs, or gallops.  PULMONARY:  Examination
revealed lungs clear to auscultation bilaterally.  ABDOMEN:
Exam revealed the belly, which was soft, nontender,
nondistended with normal bowel sounds.  Of note:  The patient
had a PEG tube in the left upper quadrant with foul-smelling
exudate around the insertion site.  The patient also has an
ileostomy.  EXTREMITIES:  Examination revealed no edema and a
right cast for ankle fracture the patient sustained prior to
this admission.  Vascular examination revealed good
peripheral pulses.

LABORATORY DATA:  Pertinent laboratory findings revealed the
following:  The patient had a white blood cell count of 12.3
with hematocrit of 38.9, platelet count 215,000.  The patient
had a sodium of 123, potassium 6.7, chloride 86, bicarbonate
21, BUN 83, creatinine 4.0, sodium 148.  The patient had a
urinalysis, which revealed moderate leukocyte esterase, small
blood, trace protein, greater than 50 white blood cells, many
bacteria, and no epithelial cells.  FENa was calculated at
0.6 percent.

HOSPITAL COURSE:  The patient is a 74-year-old female with a
history of ovarian cancer, status post resection with
multiple complications, who presented with urosepsis.

#1.  INFECTIOUS DISEASE:  The patient has mental status
change and hypotension requiring pressors in the setting of a
positive urinalysis and urine culture, which eventually grew
greater than 100,000 colonies of Klebsiella, which was
pansensitive.  This picture was consistent with urosepsis.
The patient was initially treated with Levofloxacin, dosed
for renal function, as well as Vancomycin.  The patient's
blood cultures were no growth at the time of this dictation.
The patient had a negative C. difficile toxin.  CSF culture
revealed no growth at the time of this dictation.  The
patient was seen by the Department of Interventional
Radiology for evaluation of her PEG tube, which had
foul-smelling exudate draining from the insertion site.
Decision was made to have the PEG tube removed, as the
patient was taking PO, meeting 50% to 75% of her needs.
There did not appear to be significant erythema around the
insertion site.  The plan was simply to discontinue the PEG
tube.  The PEG tube was removed in the Department of
Interventional Radiology.

#2.  HEMATOLOGIC:  The patient presented with the hematocrit
of 38 and then experienced a ten-point hematocrit drop, which
was thought to be secondary to hemodilution from vigorous
fluid resuscitation.  Multiple serial hematocrit revealed
stable hematocrit in the 30s to 33s.  There were no overt
signs of bleeding.

#3.  ACUTE RENAL FAILURE:  This was thought to be secondary
to prerenal physiology given the FENa of less than 1%.  The
patient improved rapidly with hydration.  Hematocrit returned
to baseline of 0.8.

#4.  POSTHERPETIC NEURALGIA:  The patient presented with
recent history of herpes zoster virus infection with
postherpetic neuralgia.  She was continued on Neurontin,
Lidoderm, and morphine sulfate.  Pain control was excellent.

#5.  CARDIOVASCULAR:  The patient presented hypotensive;
eventually weaned off pressors.  It was suspected that the
patient had vasodilatory physiology related to urosepsis.
She ruled out for myocardial infarction.  She was continued
on Lopressor and aspirin.

#6.  PSYCHIATRIC:  The patient has a history of
schizophrenia, maintained on her output neuroleptic regimen,
including Risperdal.

#7.  CODE:  The patient was full code throughout the
admission.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:  The patient was discharged to acute
rehabilitation.  She was discharged to followup in her
primary care physician's office, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in one to
two weeks.  The patient was discharged on the following
medications:

DISCHARGE MEDICATIONS:
1.  Regular insulin sliding scale.
2.  Lopressor 25 mg p.o.b.i.d.
3.  Levofloxacin 500 mg p.o.q.d. for fourteen days.
4.  Risperdal 0.5 mg p.o. q.a.m. and 1.5 mg p.o.q.p.m.
5.  Magnesium oxide 400 mg p.o.q.i.d.
6.  Epogen 40,000 units subcutaneously q.week
7.  Aspirin 81 mg p.o.q.d.
8.  Heparin 5000 units subcutaneously b.i.d. until
ambulatory.
9.  Protonix 40 mg p.o.q.d.
10. Neurontin 400 mg p.o.t.i.d.
11. Lidoderm patch one to two patches to affected areas q.24
p.r.n.
12. Tylenol 650 mg p.o.q.4h. to 6h.p.r.n.

DIET:  The patient was discharged on [**First Name8 (NamePattern2) **] [**Doctor First Name **] diet.

The patient is to undergo physical therapy with full
weightbearing.  She will followup with the Department of
Orthopedics as scheduled for her ankle fracture.

DISCHARGE DIAGNOSES:
1.  Klebsiella pneumoniae urosepsis.
2.  Acute renal insufficiency.
3.  Anemia.
4.  Postherpetic neuralgia.
5.  Ovarian cancer.
6.  History of MRSA abscess.
7.  History of aspiration in the past.
8.  Diabetes mellitus.
9.  Paranoid schizophrenia.
10. Depression.
11. Status post PEG removal.

                            [**Name6 (MD) 251**] [**Name8 (MD) **], M.D.  [**MD Number(1) 1197**]

Dictated By:  [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.
MEDQUIST36
D:  [**2132-5-20**]  10:25
T:  [**2132-5-20**]  10:32
JOB#:  [**Job Number 35756**]
cc: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1143**], M.D.
{'Unspecified septicemia,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Paranoid type schizophrenia, unspecified,Hyposmolality and/or hyponatremia,Mitral valve disorders,Herpes zoster with other nervous system complications,Personal history of malignant neoplasm of ovary,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: Mental status change.

PRESENT ILLNESS: The patient is a 74-year-old
woman with the past medical history of ovarian cancer, status
post total abdominal hysterectomy, bilateral
salpingo-oophorectomy, omentectomy, and ileocecectomy in
[**2131-9-29**], complicated by perforation of the
anastomosis with peritonitis and abscess requiring
exploratory laparotomy and resection of the anastomosis with
ileostomy, perihepatic abscess MRSA, history of aspiration,
diabetes mellitus, paranoid schizophrenia, depression, recent
herpes zoster.  The patient presented with several days of
worsening mental status.  Over the past few months, the
patient has had multiple admissions related to ovarian cancer
and complications, thereof.  On [**5-13**], the patient was
discharged from her rehabilitation placement.  Over the
ensuing days, the patient had increased lethargy and
decreased responsiveness.  The patient presented to the
emergency department on [**2132-5-17**].  The patient was found to
be in acute renal failure, hypokalemia, hyponatremia,
leukocytosis of 12.3, purulent urine and a positive
urinalysis.  The patient was treated with Levofloxacin and
Vancomycin.  She became hypotensive despite hydration.  She
was transferred to the Intensive Care setting, where she
received IV dopamine through a central venous line.  Head CT
was performed and negative.  Abdominal CT was unremarkable.
The patient's ICU course was significant for a 10 point
hematocrit drop, which was thought to be dilutional.  LP and
chest x-ray were both negative.  The patient was gradually
weaned off dopamine.  Mental status rapidly returned to
baseline upon arrival to the ICU.

MEDICAL HISTORY: 1.  Ovarian cancer, diagnosed [**2131-9-29**], status post
total abdominal hysterectomy, bilateral
salpingo-oophorectomy, omentectomy, and ileocecectomy in
[**2131-9-29**].  [**2131-12-29**], the patient was found to
have perforation of her anastomosis with peritonitis and
intraabdominal abscess.  She under exploratory laparotomy and
resection with ileostomy.  Course was complicated by
intubation, acute renal failure.
2.  MRSA, perihepatic abscess.
3.  History of aspiration.
4.  Diabetes mellitus.
5.  EF 45% to 50% with 2+ MR
6.  Hyperlipidemia.
7.  Paranoid schizophrenia.
8.  Depression.
9.  Recent herpes zoster virus infection.
10. Status post PEG placement.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient is allergic to PENICILLIN, WHICH
CAUSES A RASH.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: The patient is widowed. 

### Response:
{'Unspecified septicemia,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Paranoid type schizophrenia, unspecified,Hyposmolality and/or hyponatremia,Mitral valve disorders,Herpes zoster with other nervous system complications,Personal history of malignant neoplasm of ovary,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
