CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient was transferred from
the MICU to the medicine team.  He is a 24 year-old
previously healthy male who was well until after returning
from the Caribbean at the end of [**Month (only) 116**] when he developed right
upper quadrant pain, nausea, vomiting and anorexia.  He
have increased liver function tests, right pleural effusion,
pericardial effusion and ascites.  The right pleural effusion
was found to be transudative.  He became short of breath and
hypotensive during that hospital stay.  CT angiogram showed a
pulmonary embolus and he was started on heparin and
transferred to [**Hospital3 **].  He was in the MICU for hypoxic
respiratory failure, pulmonary embolus, pleural and
increased liver function tests.  His AST was as high as 855,
ALT as high as 827, alkaline phosphatase 57, T bili 1.2 and
albumin 2.7.  His echocardiogram on [**6-15**] showed a normal
left ventricular ejection fraction and a large pericardial
effusion with right ventricle diastolic collapse consistent
with tamponade physiology.  Right upper quadrant ultrasound
revealed a patent hepatic and portal veins and he underwent a
pericardiocentesis and drain on [**6-15**].  His MICU was
significant for temperature spikes to 102.8 and he was
treated with intravenous Vancomycin for three days.

MEDICAL HISTORY: Negative.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Positive for diabetes, father passed away of
lung cancer, however, no liver or clotting diseases were
noted.

SOCIAL HISTORY: The patient is from [**Location (un) **].  He recently
traveled to the Caribbean as he is a sailor.  He does have an
alcohol habit, however, no tobacco or intravenous drug use.
Other pulmonary embolism and infarction,Acute respiratory failure,Acute idiopathic pericarditis,Hepatitis, unspecified,Unspecified pleural effusion
Pulm embol/infarct NEC,Acute respiratry failure,Ac idiopath pericarditis,Hepatitis NOS,Pleural effusion NOS
Admission Date:  [**2118-6-14**]     Discharge Date:  [**2118-7-4**]

Date of Birth:   [**2094-5-3**]     Sex:  M

Service:Medicine
HISTORY OF PRESENT ILLNESS:  The patient was transferred from
the MICU to the medicine team.  He is a 24 year-old
previously healthy male who was well until after returning
from the Caribbean at the end of [**Month (only) 116**] when he developed right
upper quadrant pain, nausea, vomiting and anorexia.  He
have increased liver function tests, right pleural effusion,
pericardial effusion and ascites.  The right pleural effusion
was found to be transudative.  He became short of breath and
hypotensive during that hospital stay.  CT angiogram showed a
pulmonary embolus and he was started on heparin and
transferred to [**Hospital3 **].  He was in the MICU for hypoxic
respiratory failure, pulmonary embolus, pleural and
increased liver function tests.  His AST was as high as 855,
ALT as high as 827, alkaline phosphatase 57, T bili 1.2 and
albumin 2.7.  His echocardiogram on [**6-15**] showed a normal
left ventricular ejection fraction and a large pericardial
effusion with right ventricle diastolic collapse consistent
with tamponade physiology.  Right upper quadrant ultrasound
revealed a patent hepatic and portal veins and he underwent a
pericardiocentesis and drain on [**6-15**].  His MICU was
significant for temperature spikes to 102.8 and he was
treated with intravenous Vancomycin for three days.

PAST MEDICAL HISTORY:  Negative.

ALLERGIES:  No known drug allergies.

FAMILY HISTORY:  Positive for diabetes, father passed away of
lung cancer, however, no liver or clotting diseases were
noted.

SOCIAL HISTORY:  The patient is from [**Location (un) **].  He recently
traveled to the Caribbean as he is a sailor.  He does have an
alcohol habit, however, no tobacco or intravenous drug use.

MEDICATIONS AT HOME:  Prilosec.

MEDICATIONS ON TRANSFER TO THE MEDICINE TEAM:  Heparin at
1400 units an hour, Zantac 150 mg b.i.d., Colace 100 mg
b.i.d., Serax 15 mg q.h.s. and Tylenol.

PHYSICAL EXAMINATION ON TRANSFER TO THE MEDICINE TEAM:
Temperature 100.6, respiratory rate 20, heart rate 88, blood
pressure 132/80 and 95% on room air.  In general, he is an
alert, well appearing male sitting in the chair in no
apparent distress.  HEENT oropharynx clear.  Mucous membranes
are moist.  Pupils are equal, round and reactive to light.
Extraocular muscles are intact.  Neck, no JVP, no
lymphadenopathy.  Neck supple.  Chest with decreased breath
sounds at the bases bilaterally.  Positive for egophony and
dullness to percussion.  Heart regular rate and rhythm.  Loud
S1 and S2 and no murmurs, rubs or gallops.  Abdomen soft,
nontender, nondistended.  Normoactive bowel sounds.
Extremities trace to 1+ lower extremity edema more so on the
left then the right.  Doppler dorsalis pedis pulses +2
bilaterally.

LABORATORIES ON TRANSFER:  White count 6.1, hematocrit 32.1,
sodium 141, potassium 3.5, chloride 106, bicarb 21, BUN 5,
creatinine 0.7, glucose 93, PTT 62.9, albumin 2.4, calcium
7.9, phosphate 3.9, magnesium 1.6, ESR 18.  ALT 232, AST 44,
LDH 365, alkaline phosphatase 56, T bili 0.4.

HOSPITAL COURSE:  1.  Respiratory:  The patient had large
bilateral pleural effusions and was being treated for a
pulmonary embolus.  Throughout the course of his stay his
effusions were subsequently drained by interventional
radiology and ultrasound guided thoracentesis.  He continued
incentive spirometry and is O2 sats improved.  He was found
eventually found to be positive for factor V liden deficiency
and he was continued on heparin and is was discussed with the
patient that he will need life long anticoagulation therapy.

2.  Pericarditis:  It was considered likely post viral as his
autoimmune infectious workup were negative throughout the
course of his stay.  Repeat echocardiogram showed no
significant reaccumulation of fluids and no cardiothoracic
surgery was deemed necessary.

3.  Infectious disease:  He had temperature spikes to 102.8
in the MICU.  He was given Vancomycin for a three day course
and low grade temperatures after this antibiotics course was
considered secondary to atelectasis.  His infectious disease
workup was negative.

4.  Hematology:  He was anemic at times throughout his stay,
however, this resolved prior to discharge.

5.  Gastrointestinal:  His high liver function tests were
considered likely secondary to his hepatic shock and
congestion and they eventually returned to [**Location 213**] and he also
was given Colace for constipation.

6.  Fluids, electrolytes and nutrition:  The patient
autodiuresed and he was advanced to a regular diet and
tolerated po well.

7.  Prophylaxis:  He was maintained on Zantac and intravenous
heparin.

8.  Disposition:  The patient told us that he was going to be
staying in the [**Location (un) 86**] area with friends for at least a month
after discharge.  He was to follow up with pulmonary,
hematology and cardiovascular clinics and he received Lovenox
teaching prior to discharge.

DISCHARGE DIAGNOSES:
1.  Status post pericarditis, pulmonary embolus and
hypercoagulable state secondary to factor V liden deficiency.

MEDICATIONS ON DISCHARGE:  Coumadin, Lovenox and
non-steroidal anti-inflammatory drugs.

DISCHARGE INSTRUCTIONS:  Return for a fever greater then 101,
increased pain, chest pain, dizziness, palpitations or
shortness of breath.  Follow up with cardiology, pulmonary
and coumadin clinics next week.






                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3022**], M.D.  [**MD Number(1) 3023**]

Dictated By:[**Name8 (MD) 4385**]

MEDQUIST36

D:  [**2118-11-14**]  14:58
T:  [**2118-11-15**]  14:44
JOB#:  [**Job Number 35667**]
{'Other pulmonary embolism and infarction,Acute respiratory failure,Acute idiopathic pericarditis,Hepatitis, unspecified,Unspecified pleural effusion'}


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: 

PRESENT ILLNESS: The patient was transferred from
the MICU to the medicine team.  He is a 24 year-old
previously healthy male who was well until after returning
from the Caribbean at the end of [**Month (only) 116**] when he developed right
upper quadrant pain, nausea, vomiting and anorexia.  He
have increased liver function tests, right pleural effusion,
pericardial effusion and ascites.  The right pleural effusion
was found to be transudative.  He became short of breath and
hypotensive during that hospital stay.  CT angiogram showed a
pulmonary embolus and he was started on heparin and
transferred to [**Hospital3 **].  He was in the MICU for hypoxic
respiratory failure, pulmonary embolus, pleural and
increased liver function tests.  His AST was as high as 855,
ALT as high as 827, alkaline phosphatase 57, T bili 1.2 and
albumin 2.7.  His echocardiogram on [**6-15**] showed a normal
left ventricular ejection fraction and a large pericardial
effusion with right ventricle diastolic collapse consistent
with tamponade physiology.  Right upper quadrant ultrasound
revealed a patent hepatic and portal veins and he underwent a
pericardiocentesis and drain on [**6-15**].  His MICU was
significant for temperature spikes to 102.8 and he was
treated with intravenous Vancomycin for three days.

MEDICAL HISTORY: Negative.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Positive for diabetes, father passed away of
lung cancer, however, no liver or clotting diseases were
noted.

SOCIAL HISTORY: The patient is from [**Location (un) **].  He recently
traveled to the Caribbean as he is a sailor.  He does have an
alcohol habit, however, no tobacco or intravenous drug use. 

### Response:
{'Other pulmonary embolism and infarction,Acute respiratory failure,Acute idiopathic pericarditis,Hepatitis, unspecified,Unspecified pleural effusion'}
