CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname **] is an 83 year old man
with a past medical history significant for diabetes,
hypertension, hypercholesterolemia, coronary artery disease,
status post coronary artery bypass graft in [**2126**] who
originally presented to [**Hospital6 8283**] on [**2135-7-9**] with cough times one week productive of yellow sputum.
He had been started on Avelox as an outpatient on [**2135-7-7**].  However, he had progressive shortness of breath and
change in mental status.  He had confusion and garbled
speech, a very unsteady gait times one day prior to admission
to [**Hospital6 8283**].  At baseline the patient walks
with a cane, has no anginal symptoms, gets shortness of
breath after a few blocks.  His chest x-ray at [**Hospital3 **] showed possible mild congestive heart failure which
was unchanged from [**2135-7-10**].  His vital signs were
notable for an oxygen saturation at 90 percent on room air.
He was found to have a creatinine of 5.2 up from baseline of
1.5.  His creatinine kinase was normal but his troponin was
0.84.  His elevated troponin was thought to be secondary to
his acute renal failure.  For a question of congestive heart
failure, the patient received Bumex 2 mg intravenously and
Zaroxolyn 5 mg with minimal output.  A head computerized
tomography scan was performed which showed no acute process.
The patient was then transferred to [**Hospital6 649**] for further management.  Upon arrival, he was
94 percent on 4 liters, he denied chest pain or discomfort.
His arterial blood gas was 7.19/76/127.  His troponin T was
0.29, his creatinine kinases again were flat.  He was started
on a trial of BiPAP but his arterial blood gas worsened to
7.16/81/94, and the patient was intubated and placed on
assist control.  He was then admitted to the Medicine
Intensive Care Unit for further management.

MEDICAL HISTORY: Type 2 diabetes, hypertension,
hypercholesterolemia, coronary artery disease, status post
coronary artery bypass graft in [**2126**].

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Hypertension.

SOCIAL HISTORY: Significant history of alcohol use.  The
patient drinks Vodka every day.  He denies needing an eye
opener but admits that he is an alcoholic.  The patient also
has a significant tobacco history but quit 20 years ago.  He
lives at home with his wife in [**Hospital3 4298**].
Acute respiratory failure,Acute kidney failure, unspecified,Acute myocardial infarction of other specified sites, initial episode of care,Pneumonia, organism unspecified,Chronic airway obstruction, not elsewhere classified,Diastolic heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acidosis
Acute respiratry failure,Acute kidney failure NOS,AMI NEC, initial,Pneumonia, organism NOS,Chr airway obstruct NEC,Diastolc hrt failure NOS,Hyp kid NOS w cr kid V,Acidosis
Admission Date: [**2135-7-9**]        Discharge Date: [**2135-7-20**]


Service:  MED


HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname **] is an 83 year old man
with a past medical history significant for diabetes,
hypertension, hypercholesterolemia, coronary artery disease,
status post coronary artery bypass graft in [**2126**] who
originally presented to [**Hospital6 8283**] on [**2135-7-9**] with cough times one week productive of yellow sputum.
He had been started on Avelox as an outpatient on [**2135-7-7**].  However, he had progressive shortness of breath and
change in mental status.  He had confusion and garbled
speech, a very unsteady gait times one day prior to admission
to [**Hospital6 8283**].  At baseline the patient walks
with a cane, has no anginal symptoms, gets shortness of
breath after a few blocks.  His chest x-ray at [**Hospital3 **] showed possible mild congestive heart failure which
was unchanged from [**2135-7-10**].  His vital signs were
notable for an oxygen saturation at 90 percent on room air.
He was found to have a creatinine of 5.2 up from baseline of
1.5.  His creatinine kinase was normal but his troponin was
0.84.  His elevated troponin was thought to be secondary to
his acute renal failure.  For a question of congestive heart
failure, the patient received Bumex 2 mg intravenously and
Zaroxolyn 5 mg with minimal output.  A head computerized
tomography scan was performed which showed no acute process.
The patient was then transferred to [**Hospital6 649**] for further management.  Upon arrival, he was
94 percent on 4 liters, he denied chest pain or discomfort.
His arterial blood gas was 7.19/76/127.  His troponin T was
0.29, his creatinine kinases again were flat.  He was started
on a trial of BiPAP but his arterial blood gas worsened to
7.16/81/94, and the patient was intubated and placed on
assist control.  He was then admitted to the Medicine
Intensive Care Unit for further management.

PAST MEDICAL HISTORY:  Type 2 diabetes, hypertension,
hypercholesterolemia, coronary artery disease, status post
coronary artery bypass graft in [**2126**].

MEDICATIONS:  Nadolol 40 mg q.d., Bumex 0.5 to 1 mg q.d.,
Lisinopril/Hydrochlorothiazide 20/25 q.d., Lipitor 20 q.i.d.,
Vioxx 12.5 prn with meals, Aspirin 81 mg q.d., Avelox 400 mg
q.d., starting on [**2135-7-7**].

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  Significant history of alcohol use.  The
patient drinks Vodka every day.  He denies needing an eye
opener but admits that he is an alcoholic.  The patient also
has a significant tobacco history but quit 20 years ago.  He
lives at home with his wife in [**Hospital3 4298**].

FAMILY HISTORY:  Hypertension.

PHYSICAL EXAMINATION:  Temperature 98.6, heart rate 55, blood
pressure 138/68, oxygen saturations 100 percent intubated.
General, intubated man, sedated.  Head, eyes, ears, nose and
throat, pupils equal, round and reactive to light,
extraocular movements intact.  Neck, thick, no obvious
jugular venous distension.  Lungs clear to auscultation with
sparse expiratory wheezes bilaterally.  Cardiovascular,
distant heart sounds, no murmurs, rubs or gallops.  Abdomen,
obese but nontender, nondistended, normoactive bowel sounds.
Extremities, no cyanosis, clubbing or edema.  Dorsalis pedis
and posterior tibial pulses were not palpable but were
audible by Doppler.  Neurologic, the patient was sedated but
could move all four extremities.

HOSPITAL COURSE:  Renal - The patient was in acute renal
failure at the time of presentation to [**Hospital6 649**].  This was thought to be secondary to
continued diuresis with Bumex at home and the continued use
of Lisinopril and Hydrochlorothiazide.  A renal consult was
obtained.  The Renal Team felt that the patient's cause of
renal failure was prerenal, acute renal failure worsened by
clinical use of ACE inhibitor, diuretics and non-steroidal
anti-inflammatory drugs at the outside hospital.  They
recommended hydration with intravenous fluids.  On
intravenous fluids, the patient's renal failure quickly
improved and his creatinine returned to below his baseline
with a value of 1.4.

Coronary artery disease - The patient presented with elevated
troponins but normal creatinine kinase.  This was believed to
be secondary to renal failure.  A cardiology consult was
obtained.  They recommended no cardiac catheterization at
this time.  In the setting of aggressive fluid hydration, the
patient became 4 liters positive while ventilated.  Chest x-
ray showed very mild congestive heart failure.  Once the
patient's renal function returned to [**Location 213**], he was
effectively diuresed with low doses of Lasix.  He returned to
his dry weight.

Pulmonary - The patient's pulmonary failure was thought to be
multifactorial.  1.  He had positive sick contacts with his
wife, having just been treated for pneumonia.  The patient
was thus started on a 10 day course of Levofloxacin and
completed this course prior to discharge.  2.  It was felt
that the patient had underlying chronic obstructive pulmonary
disease.  3.  The patient's blood tested positive for opioid
use.  4.  The patient had a known history of excessive
alcohol use and could have had an aspiration event.  The
patient arrived to the floor vented.  He failed multiple
spontaneous breathing trials.  This was felt to be due to
volume overload in the setting of aggressive fluid hydration.
He was successfully diuresed to his dry weight.  However, the
patient's RSBI although improved still remained greater than
120.  After discussion was had with the patient's family he
was extubated with a RSBI of 120.  The patient initially did
well with status post extubation but did require BiPAP on two
occasions due to rising pCO2.  At the time the patient left
the Medicine Intensive Care Unit he was on nasal cannula
only.

Alcohol/change in mental status - As the patient was weaned
off of sedation in an attempt to extubate him he became
agitated on multiple occasions.  He was started on round-the-
clock Ativan as this was thought to be secondary to alcohol
withdrawal.  He received 2 mg t.i.d.  Following this, the
patient was titrated off standing Ativan prn.  The patient
was successfully extubated and status post extubation was
written for Seroquel 25 mg b.i.d. and Ativan prn.  However,
the patient had multiple episodes of confusion while
receiving Seroquel and Ativan so both of these were
discontinued.

Access - The right internal jugular and arterial line were
placed during the patient's Medicine Intensive Care Unit
course.  Both of these were discontinued prior to discharging
the patient to the floor.



                        [**Name6 (MD) **] [**Name8 (MD) **], [**MD Number(1) 2019**]

Dictated By:[**Doctor Last Name 2020**]
MEDQUIST36
D:  [**2135-7-20**] 06:44:02
T:  [**2135-7-20**] 08:18:07
Job#:  [**Job Number 39559**]


Name:  [**Known lastname **], [**Known firstname 7138**]             Unit No:  [**Numeric Identifier 7139**]

Admission Date:                   Discharge Date: [**2135-7-21**]

Date of Birth:                    Sex:

Service:

ADDENDUM OF [**2135-7-20**]:  The patient transferred to general
medical floor where he continued to improve on a pulmonary
standpoint.  He was able to ambulate approximately 5 feet
with the aid of  physical therapist and a 3 liter nasal
cannula oxygen requirement.  The patient met with physical
therapy and occupational therapy, and it was felt that he
would benefit from rehabilitation.  He was discharged to
rehab in [**Location (un) **] to complete pulmonary, physical and
occupational rehab.

At time of discharge, given findings of chest x-ray and
progressive pulmonary assistance, he should have outpatient
pulmonary function tests in approximately 1 month.  In
addition, given his troponin leak likely representing stress-
induced myocardial ischemia, he should have an outpatient
cardiac stress test.

DISCHARGE MEDICATION:
1. Atorvastatin 20 mg p.o. q.d.
2. Aspirin 325 mg p.o. q.d.
3. Ipratropium nebulizer q.i.d.
4. Albuterol nebulizer 1 nebulizer q. 6 p.r.n.
5. Albuterol MDI actuator 1-2 puffs q. 6 p.r.n.
6. Multivitamin 1 capsule p.o. q.d.
7. Lisinopril 5 mg p.o. q.d.
8. Protonix 40 mg p.o. q.d.
9. Folic acid 1 mg p.o. q.d.
10.Thiamine 100 mg p.o. q.d.
11.Fluticasone 110 mcg MDI 2 puffs b.i.d.
12.Metoprolol 25 mg p.o. b.i.d.
13.Finishing course of dicloxacillin 500 mg p.o. q. 6 for a
duration of 5 days.
14.Clotrimazole cream 1 application b.i.d. to affected area.

RECOMMENDED FOLLOW-UP:  The patient to arrange follow-up with
PCP, [**Name10 (NameIs) **] arrange follow-up with pulmonologist as above, and
cardiac evaluation as above.  The patient discharged to rehab
in fair condition.



                        [**Name6 (MD) 73**] [**Name8 (MD) 72**], M.D.  [**MD Number(1) 352**]

Dictated By:[**Last Name (NamePattern1) 7164**]
MEDQUIST36
D:  [**2135-10-18**] 11:21:37
T:  [**2135-10-19**] 13:44:11
Job#:  [**Job Number **]
{'Acute respiratory failure,Acute kidney failure, unspecified,Acute myocardial infarction of other specified sites, initial episode of care,Pneumonia, organism unspecified,Chronic airway obstruction, not elsewhere classified,Diastolic heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acidosis'}


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: Mr. [**Known lastname **] is an 83 year old man
with a past medical history significant for diabetes,
hypertension, hypercholesterolemia, coronary artery disease,
status post coronary artery bypass graft in [**2126**] who
originally presented to [**Hospital6 8283**] on [**2135-7-9**] with cough times one week productive of yellow sputum.
He had been started on Avelox as an outpatient on [**2135-7-7**].  However, he had progressive shortness of breath and
change in mental status.  He had confusion and garbled
speech, a very unsteady gait times one day prior to admission
to [**Hospital6 8283**].  At baseline the patient walks
with a cane, has no anginal symptoms, gets shortness of
breath after a few blocks.  His chest x-ray at [**Hospital3 **] showed possible mild congestive heart failure which
was unchanged from [**2135-7-10**].  His vital signs were
notable for an oxygen saturation at 90 percent on room air.
He was found to have a creatinine of 5.2 up from baseline of
1.5.  His creatinine kinase was normal but his troponin was
0.84.  His elevated troponin was thought to be secondary to
his acute renal failure.  For a question of congestive heart
failure, the patient received Bumex 2 mg intravenously and
Zaroxolyn 5 mg with minimal output.  A head computerized
tomography scan was performed which showed no acute process.
The patient was then transferred to [**Hospital6 649**] for further management.  Upon arrival, he was
94 percent on 4 liters, he denied chest pain or discomfort.
His arterial blood gas was 7.19/76/127.  His troponin T was
0.29, his creatinine kinases again were flat.  He was started
on a trial of BiPAP but his arterial blood gas worsened to
7.16/81/94, and the patient was intubated and placed on
assist control.  He was then admitted to the Medicine
Intensive Care Unit for further management.

MEDICAL HISTORY: Type 2 diabetes, hypertension,
hypercholesterolemia, coronary artery disease, status post
coronary artery bypass graft in [**2126**].

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Hypertension.

SOCIAL HISTORY: Significant history of alcohol use.  The
patient drinks Vodka every day.  He denies needing an eye
opener but admits that he is an alcoholic.  The patient also
has a significant tobacco history but quit 20 years ago.  He
lives at home with his wife in [**Hospital3 4298**]. 

### Response:
{'Acute respiratory failure,Acute kidney failure, unspecified,Acute myocardial infarction of other specified sites, initial episode of care,Pneumonia, organism unspecified,Chronic airway obstruction, not elsewhere classified,Diastolic heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acidosis'}
