CHIEF COMPLAINT: OSH transfer for GIB

PRESENT ILLNESS: 84 year old male with a PMH of colon CA s/p hemicolectomy [**2151**],
chronic anemia (baseline HCT 30s), and CKD (Cr 1.8-2.2) who was
transferred from an OSH having presented there on [**2-21**] with
symptoms of anemia and two episodes of melena. One week ago, Mr.
[**Known lastname **] passed [**Last Name (un) **] "black diarrhea." Subsequently, he began
feeling light headed, fatigued, and dizzy. He was also not
eating very much, but states he was able ot keep up with his
fluid intake. His bowel habits returned to [**Location 213**] until 3 days
ago when he had a further episode of black stool. Since then,
his fatigue and dizziness have worsened. He felt short of breath
with minimal exertion. He had no further black bowel movements,
but when his wife began to experience similar symptoms, they
presented to [**Hospital3 **]. There, he was found to be guaiac
positive with a HCT of 13. He received 1 unit PRBCs. He was
transferred to [**Hospital1 18**] for further care.
.
In the [**Hospital1 18**] ED, vitals were 98.7, 110, 98/62, 22, 98%2L NC. A
CXR showed a LLL opacity c/w evolving pneumonia. Blood cultures
were sent and he received a dose of vancomycin and ceftriaxone.
EKG showed lateral ST depressions c/w a strain pattern. Initial
labs were notable for pancyopenia with WBC of 1.5 (ANC 1090, 74%
PMNs with 2% bands), a HCT of 16.9, and platelets of 35.
Potassium was 6.6 and lactate was 4.6. INR was 1.5. Troponin was
elevated at 0.25 (was 0.15 at OSH with normal CKs). He was given
protonix, ceftriaxone, azithromycin, vancomycin, and he was
typed and cross-matched.
.
Currently he denies any epigastric pain, nausea or vomiting.
He took an ibuprofen dose 2 days ago for his dizziness, but
denies any other NSAID use.

MEDICAL HISTORY: # Colon CA - stage B, s/p resection in [**2151**], no evidence of
disease recurrence, last CT abdomen was done in [**10-17**]
# HTN
# Macrocytic Anemia, on oral B12, HCT 33.6 in [**10-18**]
# CKD (baseline Cr 1.8-2.2)
# Increased IgM kappa monoclonal protein with polyclonal
increase in IgA. He has declined bone marrow aspiration and
biopsy.
# Chronic elevation of alkaline phosphatase, no hepatic
pathology
# gout

MEDICATION ON ADMISSION: Lopressor 50 mg PO BID
Allopurinol 300 mg PO daily
Folic Acid 1 mg PO daily
Vit B12 250 mcg PO daily
Aleve 220 mg PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T: 96.5 BP: 135/63 P: 103 RR: 22 O2 sat: 98% 2L
Gen: elderly, pleasant, NAD
HEENT: NCAT, PERRL, EOMI
Neck: JVP flat
CV: RRR no MRG, nl S1, S2
Resp: CTAB
Abd: NABS, soft, NTND, no guarding/rigidity/rebound
Back: no CVA tenderness
Rectal: Guaiac: positive per ED exam
Ext: no CCE, 2+/4 symmetric pedal pulses
Neuro: grossly non-focal

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: He drinks a 7 oz beer each day.
Lifelong smoker until yesterday, [**1-12**] ppd x 70 years
Lives with wife, is independent in function and ADLs.
Blood in stool,Subendocardial infarction, initial episode of care,Pneumonia, organism unspecified,Other and unspecified coagulation defects,Acute kidney failure, unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Hypoxemia,Hyperpotassemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Personal history of malignant neoplasm of large intestine
Blood in stool,Subendo infarct, initial,Pneumonia, organism NOS,Coagulat defect NEC/NOS,Acute kidney failure NOS,Obs chr bronc w(ac) exac,CHF NOS,Hypoxemia,Hyperpotassemia,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Hx of colonic malignancy
Admission Date:  [**2163-2-21**]              Discharge Date:   [**2163-2-23**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3556**]
Chief Complaint:
OSH transfer for GIB

Major Surgical or Invasive Procedure:
none

History of Present Illness:
84 year old male with a PMH of colon CA s/p hemicolectomy [**2151**],
chronic anemia (baseline HCT 30s), and CKD (Cr 1.8-2.2) who was
transferred from an OSH having presented there on [**2-21**] with
symptoms of anemia and two episodes of melena. One week ago, Mr.
[**Known lastname **] passed [**Last Name (un) **] "black diarrhea." Subsequently, he began
feeling light headed, fatigued, and dizzy. He was also not
eating very much, but states he was able ot keep up with his
fluid intake. His bowel habits returned to [**Location 213**] until 3 days
ago when he had a further episode of black stool. Since then,
his fatigue and dizziness have worsened. He felt short of breath
with minimal exertion. He had no further black bowel movements,
but when his wife began to experience similar symptoms, they
presented to [**Hospital3 **]. There, he was found to be guaiac
positive with a HCT of 13. He received 1 unit PRBCs. He was
transferred to [**Hospital1 18**] for further care.
.
In the [**Hospital1 18**] ED, vitals were 98.7, 110, 98/62, 22, 98%2L NC. A
CXR showed a LLL opacity c/w evolving pneumonia. Blood cultures
were sent and he received a dose of vancomycin and ceftriaxone.
EKG showed lateral ST depressions c/w a strain pattern. Initial
labs were notable for pancyopenia with WBC of 1.5 (ANC 1090, 74%
PMNs with 2% bands), a HCT of 16.9, and platelets of 35.
Potassium was 6.6 and lactate was 4.6. INR was 1.5. Troponin was
elevated at 0.25 (was 0.15 at OSH with normal CKs). He was given
protonix, ceftriaxone, azithromycin, vancomycin, and he was
typed and cross-matched.
.
Currently he denies any epigastric pain, nausea or vomiting.
He took an ibuprofen dose 2 days ago for his dizziness, but
denies any other NSAID use.


Past Medical History:
# Colon CA - stage B, s/p resection in [**2151**], no evidence of
disease recurrence, last CT abdomen was done in [**10-17**]
# HTN
# Macrocytic Anemia, on oral B12, HCT 33.6 in [**10-18**]
# CKD (baseline Cr 1.8-2.2)
# Increased IgM kappa monoclonal protein with polyclonal
increase in IgA. He has declined bone marrow aspiration and
biopsy.
# Chronic elevation of alkaline phosphatase, no hepatic
pathology
# gout


Social History:
He drinks a 7 oz beer each day.
Lifelong smoker until yesterday, [**1-12**] ppd x 70 years
Lives with wife, is independent in function and ADLs.


Family History:
non-contributory

Physical Exam:
T: 96.5 BP: 135/63 P: 103 RR: 22 O2 sat: 98% 2L
Gen: elderly, pleasant, NAD
HEENT: NCAT, PERRL, EOMI
Neck: JVP flat
CV: RRR no MRG, nl S1, S2
Resp: CTAB
Abd: NABS, soft, NTND, no guarding/rigidity/rebound
Back: no CVA tenderness
Rectal: Guaiac: positive per ED exam
Ext: no CCE, 2+/4 symmetric pedal pulses
Neuro: grossly non-focal


Pertinent Results:
[**2163-2-21**] 02:50PM BLOOD WBC-1.5* RBC-1.49* Hgb-5.6* Hct-16.9*
MCV-114* MCH-37.5* MCHC-33.1 RDW-20.6* Plt Ct-35*
[**2163-2-21**] 02:50PM BLOOD Neuts-74* Bands-2 Lymphs-18 Monos-4 Eos-0
Baso-0 Atyps-2* Metas-0 Myelos-0
[**2163-2-21**] 02:50PM BLOOD PT-16.5* PTT-26.7 INR(PT)-1.5*
[**2163-2-21**] 02:50PM BLOOD Glucose-150* UreaN-87* Creat-3.1* Na-140
K-6.6* Cl-108 HCO3-15* AnGap-24*
[**2163-2-21**] 02:50PM BLOOD ALT-27 AST-37 LD(LDH)-342* AlkPhos-123*
TotBili-0.7
[**2163-2-21**] 02:50PM BLOOD cTropnT-0.25*
[**2163-2-21**] 06:45PM BLOOD CK-MB-5 cTropnT-0.20*
[**2163-2-22**] 03:46AM BLOOD CK-MB-6 cTropnT-0.22*
[**2163-2-22**] 03:46AM BLOOD VitB12-1235* Folate-GREATER TH Hapto-340*
[**2163-2-21**] 03:12PM BLOOD Lactate-4.6*
.
MICRO:
[**2163-2-22**] 1:47 am Influenza A/B by DFA
      Source: Nasopharyngeal aspirate.

                            **FINAL REPORT [**2163-2-22**]**

   DIRECT INFLUENZA A ANTIGEN TEST (Final [**2163-2-22**]):
      Negative for Influenza A viral antigen.

   DIRECT INFLUENZA B ANTIGEN TEST (Final [**2163-2-22**]):
      POSITIVE FOR INFLUENZA B VIRAL ANTIGEN.
      REPORTED BY PHONE TO DR. [**Last Name (STitle) 16800**] [**2163-2-22**] 3:15PM.

.
[**2-21**] CXR
IMPRESSION:
1. Left lower lobe opacity likely representing atelectasis,
however, early pneumonia cannot be excluded. Right pleural
effusion noted.
2. If clinically feasible, dedicated PA and lateral views could
be helpful for further evalution.
.
[**2-22**] CXR
IMPRESSION: Marked interval progression with now massive
bilateral pulmonary edema and moderate bilateral pleural
effusions. Previously noted left lower lobe focal consolidation
is discernable; however, difficult to characterize in the
presence of diffuse background parenchymal changes.

[**2-22**] ECHO
The left atrium is normal in size. The estimated right atrial
pressure is 10-20mmHg. The left ventricular cavity size is
normal. There is moderate to severe global left ventricular
hypokinesis with more severe mid to distal
septal/anterior/inferior and apical hypokinesis/akinesis (LVEF =
30 %). [Intrinsic left ventricular systolic function is likely
more depressed given the severity of valvular regurgitation.]
Right ventricular chamber size is borderline dilated with
depressed free wall contractility. [Intrinsic right ventricular
systolic function is likely more depressed given the severity of
tricuspid regurgitation.] The aortic valve leaflets (3) are
mildly thickened. No aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. Moderate (2+) mitral
regurgitation is seen. The tricuspid valve leaflets are mildly
thickened. Moderate [2+] tricuspid regurgitation is seen. There
is moderate pulmonary artery systolic hypertension. There is no
pericardial effusion.

Brief Hospital Course:
84M with distant h/o colon CA now p/w GI bleed, found to have
PNA and influenza. Pt presented to OSH with HCT of 13, bumped to
16 after 1 unit PRBCs. At [**Hospital1 18**] ICU, placed on IV PPI and
transfused 2 units pRBCs. Also received 2 units of FFP to
reverse mild coagulopathy and 1 unit of platelts for
thrombocytopenia. Pt confirmed DNR/DNI status on admission. GI
consulted and deferred endocscopy given pt's relative
hemodynamic [**Name2 (NI) 77558**] and noted troponin leak with EKG changes
c/w demand strain. Was also given CTX and azithro for CAP. A DFA
was positive for influenza B.

Shortly after transfusion of 2nd units of RBCs, pt noted to be
hypoxic and in worsening respiratory distress and exam was c/w
pulmonary edema. IV lasix and morphine were administered with
mild improvement. Pt did not tolerate CPAP so was given
supplemental O2 via face tent. Nebulized bronchodilators and IV
solumedrol were given for possible COPD exacerbation given pt's
smoking history. An echocardiogram showed moderate to severely
depressed LVEF of 30%. Repeat CXR showed massive pulmonary
edema. A large IV Lasix challenge was given with 200mg IV, and
pt did put out urine to this, but continued to have worsening
pulmonary edema. Pt's family was present throughout and
requested only that the pt be kept as comfortable as possible.
Liberal IV morphine was used to this effect with good results.
On the morning of [**2163-2-23**], pt expired peacefully with family at
bedside. Family declined autopsy.

Medications on Admission:
Lopressor 50 mg PO BID
Allopurinol 300 mg PO daily
Folic Acid 1 mg PO daily
Vit B12 250 mcg PO daily
Aleve 220 mg PRN


Discharge Medications:
n/a

Discharge Disposition:
Expired

Discharge Diagnosis:
expired

Discharge Condition:
expired

Discharge Instructions:
n/a

Followup Instructions:
n/a

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3559**] MD, [**MD Number(3) 3560**]
{'Blood in stool,Subendocardial infarction, initial episode of care,Pneumonia, organism unspecified,Other and unspecified coagulation defects,Acute kidney failure, unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Hypoxemia,Hyperpotassemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Personal history of malignant neoplasm of large intestine'}


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: OSH transfer for GIB

PRESENT ILLNESS: 84 year old male with a PMH of colon CA s/p hemicolectomy [**2151**],
chronic anemia (baseline HCT 30s), and CKD (Cr 1.8-2.2) who was
transferred from an OSH having presented there on [**2-21**] with
symptoms of anemia and two episodes of melena. One week ago, Mr.
[**Known lastname **] passed [**Last Name (un) **] "black diarrhea." Subsequently, he began
feeling light headed, fatigued, and dizzy. He was also not
eating very much, but states he was able ot keep up with his
fluid intake. His bowel habits returned to [**Location 213**] until 3 days
ago when he had a further episode of black stool. Since then,
his fatigue and dizziness have worsened. He felt short of breath
with minimal exertion. He had no further black bowel movements,
but when his wife began to experience similar symptoms, they
presented to [**Hospital3 **]. There, he was found to be guaiac
positive with a HCT of 13. He received 1 unit PRBCs. He was
transferred to [**Hospital1 18**] for further care.
.
In the [**Hospital1 18**] ED, vitals were 98.7, 110, 98/62, 22, 98%2L NC. A
CXR showed a LLL opacity c/w evolving pneumonia. Blood cultures
were sent and he received a dose of vancomycin and ceftriaxone.
EKG showed lateral ST depressions c/w a strain pattern. Initial
labs were notable for pancyopenia with WBC of 1.5 (ANC 1090, 74%
PMNs with 2% bands), a HCT of 16.9, and platelets of 35.
Potassium was 6.6 and lactate was 4.6. INR was 1.5. Troponin was
elevated at 0.25 (was 0.15 at OSH with normal CKs). He was given
protonix, ceftriaxone, azithromycin, vancomycin, and he was
typed and cross-matched.
.
Currently he denies any epigastric pain, nausea or vomiting.
He took an ibuprofen dose 2 days ago for his dizziness, but
denies any other NSAID use.

MEDICAL HISTORY: # Colon CA - stage B, s/p resection in [**2151**], no evidence of
disease recurrence, last CT abdomen was done in [**10-17**]
# HTN
# Macrocytic Anemia, on oral B12, HCT 33.6 in [**10-18**]
# CKD (baseline Cr 1.8-2.2)
# Increased IgM kappa monoclonal protein with polyclonal
increase in IgA. He has declined bone marrow aspiration and
biopsy.
# Chronic elevation of alkaline phosphatase, no hepatic
pathology
# gout

MEDICATION ON ADMISSION: Lopressor 50 mg PO BID
Allopurinol 300 mg PO daily
Folic Acid 1 mg PO daily
Vit B12 250 mcg PO daily
Aleve 220 mg PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T: 96.5 BP: 135/63 P: 103 RR: 22 O2 sat: 98% 2L
Gen: elderly, pleasant, NAD
HEENT: NCAT, PERRL, EOMI
Neck: JVP flat
CV: RRR no MRG, nl S1, S2
Resp: CTAB
Abd: NABS, soft, NTND, no guarding/rigidity/rebound
Back: no CVA tenderness
Rectal: Guaiac: positive per ED exam
Ext: no CCE, 2+/4 symmetric pedal pulses
Neuro: grossly non-focal

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: He drinks a 7 oz beer each day.
Lifelong smoker until yesterday, [**1-12**] ppd x 70 years
Lives with wife, is independent in function and ADLs. 

### Response:
{'Blood in stool,Subendocardial infarction, initial episode of care,Pneumonia, organism unspecified,Other and unspecified coagulation defects,Acute kidney failure, unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Hypoxemia,Hyperpotassemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Personal history of malignant neoplasm of large intestine'}
