CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 75-year-old
Chinese male with a history of left MCA cerebrovascular
accident with resulting right hemiparesis on [**2103-8-14**], who was
transferred to [**Hospital1 69**] from
rehabilitation facility for treatment of recurrent aspiration
pneumonia and possible tracheostomy placement for pulmonary
toilet.  The patient had been discharged from [**Hospital1 346**] to [**Hospital1 2670**] skilled nursing
facility and then transferred to [**Hospital3 **]
facility.  The patient continued to have aspiration and
slight fevers despite the fact that he was treated with
ceftazidime and vancomycin at [**Hospital1 **].  The patient was
unable to clear his secretions on his own, and suctioning
seemed to exacerbate his regurgitation and aspiration per
transfer notes.

MEDICAL HISTORY: Significant for stroke as per history
of present illness, chronic obstructive pulmonary disease,
gout, hypothyroidism, asthma, hyperlipidemia.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Pneumonitis due to inhalation of food or vomitus,Unspecified pleural effusion,Chronic airway obstruction, not elsewhere classified,Other disorders of neurohypophysis,Loss of weight,Gout, unspecified,Other and unspecified hyperlipidemia,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side
Food/vomit pneumonitis,Pleural effusion NOS,Chr airway obstruct NEC,Neurohypophysis dis NEC,Abnormal loss of weight,Gout NOS,Hyperlipidemia NEC/NOS,Late ef-hemplga side NOS
Admission Date:  [**2103-10-12**]       Discharge Date:  [**2103-10-21**]

Date of Birth:   [**2028-4-2**]       Sex:  M

Service:  [**Doctor Last Name 1181**]

HISTORY OF PRESENT ILLNESS:  The patient is a 75-year-old
Chinese male with a history of left MCA cerebrovascular
accident with resulting right hemiparesis on [**2103-8-14**], who was
transferred to [**Hospital1 69**] from
rehabilitation facility for treatment of recurrent aspiration
pneumonia and possible tracheostomy placement for pulmonary
toilet.  The patient had been discharged from [**Hospital1 346**] to [**Hospital1 2670**] skilled nursing
facility and then transferred to [**Hospital3 **]
facility.  The patient continued to have aspiration and
slight fevers despite the fact that he was treated with
ceftazidime and vancomycin at [**Hospital1 **].  The patient was
unable to clear his secretions on his own, and suctioning
seemed to exacerbate his regurgitation and aspiration per
transfer notes.

The patient also reports a significant weight loss over the
past several months.  The patient had been guaiac positive
last [**Hospital1 69**] admission but,
given the acuity of his stroke, did not undergo further
workup for that at this time.  Family was interested in
colonoscopy and further workup of the patient's weight loss.

PAST MEDICAL HISTORY:  Significant for stroke as per history
of present illness, chronic obstructive pulmonary disease,
gout, hypothyroidism, asthma, hyperlipidemia.

MEDICATIONS ON TRANSFER:  Ceftazidime 1 gram every eight
hours started [**2103-10-3**], vancomycin 1 gram every 12 hours
started [**2103-10-3**], Protonix 40 mg by mouth twice a day, Ritalin
100 mg by mouth twice a day, Reglan 5 mg by mouth every six
hours, and heparin 5000 units subcutaneously every 12 hours.

ALLERGIES:  No known drug allergies.

PHYSICAL EXAMINATION:  On presentation, the patient was
febrile, with a temperature of 101.2, pulse 100, blood
pressure 106/68, breathing 22 times a minute, oxygen
saturation 93% on room air, 95% on 3 liters.  Generally, he
is a cachectic male, nonverbal.  Head, eyes, ears, nose and
throat:  Remarkable for dry oral mucosa.  Neck:  The patient
has flat neck veins and marked supraclavicular wasting.
Cardiovascular examination reveals a regular rate, normal S1
and S2, no murmurs appreciated.  The patient had shallow
respirations with coarse rales bilaterally at the bases.
Abdominal examination revealed a clean percutaneous
endoscopic gastrostomy site with soft bowel sounds.
Extremities:  There was no edema.  Feet were in waffle boots
bilaterally.  Neurologic examination was remarkable for a
left fixed pupil, patient unable to follow commands secondary
to language barrier, marked right hemiparesis with
contracture and cogwheeling of the patient's left upper
extremity.

LABORATORY DATA:  On admission, white count was 26.8,
hematocrit 36.3 which is stable, platelets 507.  Coags were
all within normal limits.  Electrolytes:  Sodium 131,
potassium 4.3, chloride 93, bicarbonate 28, BUN 11,
creatinine 0.4, glucose 93.  Chest x-ray revealed right
middle lobe and left lower lobe opacities, consistent with
pneumonia, and small bilateral pleural effusions.

HOSPITAL COURSE:  This is a 75-year-old male with a right
hemiparesis secondary to left MCA infarct and recurrent
aspiration pneumonia secondary to aspiration of food from
gastrostomy tube.  The patient is evaluated for further
treatment of aspiration pneumonia and question of
tracheostomy for pulmonary protection.

1.  Pulmonary:  The patient had adequate oxygen saturation on
room air upon transfer, but still with marked secretions that
were difficult to suction and evidence of pneumonia on chest
x-ray.  The patient was treated with ceftazidime and
clindamycin.  Vancomycin was stopped.  The patient had some
improvement over the next couple of days, however, on the
morning of [**10-14**], the patient was found to be breathing
at 40 to 45 times a minute.  Arterial blood gas at that time
was most consistent with respiratory alkalosis.  The
patient's chest x-ray revealed increased pleural effusions,
particularly on the left side, and the patient was sent for a
pulmonary embolus protocol scan to rule out pulmonary
embolus, which was negative.  However, the scan did reveal an
increased size of the patient's left pleural effusion with
question of loculation. This effusion was tapped, and about
500 cc of turbid fluid was removed. This effusion proved to
be consistent with a parapneumonic effusion, simple,
uncomplicated.  No further treatment was needed, and cytology
was negative for malignant cells.  Cultures of this fluid
remained negative.

The patient's acute shortness of breath was treated with 20
mg of intravenous lasix, to which the patient had 1400 cc of
urine output over four hours, with marked improvement in
respiratory rate, down to the low 30s to high 20s.  Diuresis
combined with tap of the parapneumonic effusion resulted in a
much improved pulmonary status, and the patient was breathing
comfortably in the 20s for the rest of his hospital stay, and
had oxygen saturations of 95% on 3 to 4 liters nasal cannula.

While in-house, the patient also was evaluated by
Interventional Pulmonary for placement of a tracheostomy tube
for more aggressive pulmonary toilet.  The patient underwent
this procedure on [**2103-10-18**], tolerated the procedure well, and
was able to be better suctioned once his tracheostomy tube
was placed.

2.  Infectious Disease:  The patient had a white count of
26.8 on admission.  The patient was switched from ceftazidime
and vancomycin to ceftazidime and clindamycin.  The patient
was low-grade febrile for the first couple of days that he
was in-house, however, after his left pleural effusion was
tapped, the patient was afebrile for the rest of his stay.
The patient's white count continued to decrease and was 9.6
on the day prior to discharge.

The patient's ceftazidime was stopped on [**2103-10-20**].  The
patient should continue to receive clindamycin for two more
days to complete a ten day course.  The patient's cultures
remained negative throughout the course of his stay.

3.  Weight loss:  The patient came with a history of profound
weight loss over the last several months.  The patient had
chest and abdominal CT to assess for occult malignancy.
These fortunately revealed no masses.  Thus the patient's
weight loss is still somewhat of a mystery.

4.  Gastrointestinal:  The patient came with a history of
recurrent aspiration pneumonia secondary to vomiting tube
feeds.  The patient underwent gastrostomy tube advancement
into his jejunum while in-house.  The procedure was done by
Interventional Radiology, tolerated well by the patient.  The
patient was restarted on his tube feeds on [**2103-10-20**], and was
tolerating them well and almost at goal at this time of this
dictation.

5.  Hematology:  The patient came with a history of being
guaiac positive previously.  The patient's hematocrit
remained stable while he was in-house.  Given the patient's
fluctuating respiratory status, we elected not to consult
Gastroenterology and have the patient undergo colonoscopy at
this time, however, in the future the patient should probably
have a colonoscopy.

6.  Endocrine:  The patient had a history of being
hypothyroid and was not on levothyroxine when he came in.
His TSH was checked and found to be 4.2, within normal
limits.  Thus he was not started on any thyroid hormone
replacement at this time.

The patient was discharged to [**Hospital6 23127**] on [**2103-10-21**] in stable condition.

DISCHARGE DIAGNOSIS:
1.  Aspiration pneumonia
2.  Left parapneumonic effusion
3.  Chronic obstructive pulmonary disease
4.  History of gout
5.  History of hypothyroidism
6.  Status post left MCA cerebrovascular accident
7.  History of asthma

DISCHARGE MEDICATIONS:
1.  Lansoprazole oral solution 30 mg per gastrostomy tube
once daily
2.  Clindamycin 600 mg intravenously every eight hours for
two more days
3.  Heparin 5000 units subcutaneously every 12 hours
4.  Methylphenidate hydrochloride 10 mg by mouth twice a day
5.  Reglan 5 mg by mouth every six hours while the patient is
taking tube feeds
6.  Albuterol nebulizers every six hours as needed
7.  Morphine sulfate .5 to 1 mg every four to six hours as
needed for air hunger
8.  Tylenol 325 to 650 mg by mouth every four to six hours as
needed for pain or fever

The patient should follow up with Dr. [**Last Name (STitle) 17399**], his primary
care physician, [**Name10 (NameIs) **] also with Dr. [**Last Name (STitle) 10030**] in Neurology.




                            [**First Name11 (Name Pattern1) 734**] [**Last Name (NamePattern1) 735**], M.D.  [**MD Number(1) 736**]

Dictated By:[**Doctor First Name 102593**]
MEDQUIST36

D:  [**2103-10-21**]  01:22
T:  [**2103-10-21**]  01:58
JOB#:  [**Job Number 37930**]


Name:  [**Known lastname **], [**Known firstname 16563**] KIT                      Unit No:  [**Numeric Identifier 16564**]

Admission Date:  [**2103-10-12**]     Discharge Date:  [**2103-10-23**]

Date of Birth:   [**2028-4-2**]     Sex:  M

Service:  [**Hospital 2433**] Medical Service

ADDENDUM:  Events between the time the discharge summary was
dictated on [**2103-10-20**] and the patient's actual
discharge on [**2103-10-23**].

HOSPITAL COURSE:  The patient completed three more days of
treatment with Clindamycin to complete a ten day total course
of Clindamycin for aspiration pneumonia.  The patient was at
goal on tube feeds and receiving free water flushes.  The
patient's sodium dropped from 130s down to a low of 125.  The
patient's urine electrolytes and urine osmolality were
consistent with syndrome of inappropriate antidiuretic
hormone.  This was likely due to accessory water the patient
received in the form of three water flushes with his tube
feeds and we would recommend the patient be free water
restricted but not fluid restricted until such time as his
syndrome of inappropriate antidiuretic hormone is resolved.
Syndrome of inappropriate antidiuretic hormone in this case
is thought to be likely due to pulmonary process secondary to
the patient's pneumonia.  The patient was otherwise stable at
the time of discharge.

DISCHARGE MEDICATIONS:  As indicated on the previous
discharge summary with the exception of Clindamycin, the
patient has completed his course of Clindamycin and will no
longer need to take Clindamycin.

FOLLOW UP:  Also note, the patient should follow up with Dr.
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] of [**Hospital3 7005**] Group for his primary care,
address [**Hospital3 7005**] Group, 545A [**Street Address(1) **], [**Location (un) 16565**] [**Numeric Identifier 16566**].




                          [**First Name11 (Name Pattern1) 27**] [**Last Name (NamePattern1) 28**], M.D.  [**MD Number(1) 29**]

Dictated By:[**Name8 (MD) 648**]

MEDQUIST36

D:  [**2103-10-24**]  15:21
T:  [**2103-10-24**]  17:18
JOB#:  [**Job Number 16567**]
{'Pneumonitis due to inhalation of food or vomitus,Unspecified pleural effusion,Chronic airway obstruction, not elsewhere classified,Other disorders of neurohypophysis,Loss of weight,Gout, unspecified,Other and unspecified hyperlipidemia,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side'}


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 is a 75-year-old
Chinese male with a history of left MCA cerebrovascular
accident with resulting right hemiparesis on [**2103-8-14**], who was
transferred to [**Hospital1 69**] from
rehabilitation facility for treatment of recurrent aspiration
pneumonia and possible tracheostomy placement for pulmonary
toilet.  The patient had been discharged from [**Hospital1 346**] to [**Hospital1 2670**] skilled nursing
facility and then transferred to [**Hospital3 **]
facility.  The patient continued to have aspiration and
slight fevers despite the fact that he was treated with
ceftazidime and vancomycin at [**Hospital1 **].  The patient was
unable to clear his secretions on his own, and suctioning
seemed to exacerbate his regurgitation and aspiration per
transfer notes.

MEDICAL HISTORY: Significant for stroke as per history
of present illness, chronic obstructive pulmonary disease,
gout, hypothyroidism, asthma, hyperlipidemia.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Unspecified pleural effusion,Chronic airway obstruction, not elsewhere classified,Other disorders of neurohypophysis,Loss of weight,Gout, unspecified,Other and unspecified hyperlipidemia,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side'}
