CHIEF COMPLAINT: The patient was referred from outside
hospital for further management of hypoglycemia, acute on
chronic renal failure, and fever of unknown origin.

PRESENT ILLNESS: The patient is a 57-year-old man
who presents to the [**Hospital **] Hospital on [**2141-5-18**] after
being found unresponsive by his wife.  By report, the patient
awoke feeling poorly and had one episode of emesis on the
date of admission.  His temperature at that time was 102
degrees (of note the patient has had a long history of fever
of unknown origin with an extensive workup including
fluoroscopic lung [**Year (4 digits) **]).

MEDICAL HISTORY: 1. Type 1 diabetes complicated by triopathy.
2. End-stage renal disease status post transplant from a
living related donor in [**2130**] complicated by rejection and
transient dialysis for two months.  He is now currently off
dialysis.  His baseline creatinine is approximately 5.0.
3. Coronary artery disease status post myocardial infarction.
He has a stent in the left anterior descending artery placed
in [**2139-10-10**].
4. Congestive heart failure with a diastolic dysfunction and
an ejection fraction of 45%.
5. History of empyema status post VATS.
6. Recurrent pneumonias.
7. History of Clostridium difficile colitis.
8. Multiple myeloma.
9. Blindness OD.
10. History of FEO with extensive workup.
11. Obstructive-sleep apnea, wears CPAP at night.
12. History of deep venous thrombosis of the left thigh
currently on warfarin.
13. History of Barrett's esophagus.
14. History of bacteremia and septic emboli with
Staphylococcus aureus.

MEDICATION ON ADMISSION: 

ALLERGIES: Dicloxacillin causes nausea and vomiting.
Compazine causes hallucinations.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Chronic diastolic heart failure,Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Pneumonitis due to inhalation of food or vomitus,Complications of transplanted kidney,Acute respiratory failure,Acute kidney failure, unspecified
Chr diastolic hrt fail,DMI renl nt st uncntrld,Food/vomit pneumonitis,Compl kidney transplant,Acute respiratry failure,Acute kidney failure NOS
Admission Date:  [**2141-5-19**]       Discharge Date:  [**2141-5-25**]

Date of Birth:   [**2083-10-25**]       Sex:  M

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

CHIEF COMPLAINT:  The patient was referred from outside
hospital for further management of hypoglycemia, acute on
chronic renal failure, and fever of unknown origin.

HISTORY OF PRESENT ILLNESS:  The patient is a 57-year-old man
who presents to the [**Hospital **] Hospital on [**2141-5-18**] after
being found unresponsive by his wife.  By report, the patient
awoke feeling poorly and had one episode of emesis on the
date of admission.  His temperature at that time was 102
degrees (of note the patient has had a long history of fever
of unknown origin with an extensive workup including
fluoroscopic lung [**Year (4 digits) **]).

The patient was found by his wife unresponsive after she left
the house to run errands and returned approximately 90
minutes later, he was diaphoretic as well.

When the EMS arrived in his home, he had one further episode
of emesis, was cyanotic, and had good pulses.  His
fingerstick blood glucose was 17.  He received one ampule of
dextrose 50.

The patient was intubated upon arrival to [**Hospital **] Hospital,
and was still unresponsive despite fingerstick blood glucose
of 170.  Computed tomography of the head was unrevealing at
that time.  He was admitted to the Intensive Care Unit and
was extubated.  He was restless, complained of abdominal pain
(but had a benign examination), and had a desaturation of a
pulse oxygen to 88% on 100% nonrebreather face mask, and he
was reintubated.  The patient received stress dose of
steroids as he is on chronic prednisone for his transplant.
His BNP was found to be markedly elevated, and he was given a
dose of intravenous furosemide.

He was started on Unasyn for aspiration pneumonia and had
blood and urine cultures attained as well.  He was started on
Heparin intravenously for a deep venous thrombosis of his leg
as his INR was found to be subtherapeutic.

PAST MEDICAL HISTORY:
1. Type 1 diabetes complicated by triopathy.
2. End-stage renal disease status post transplant from a
living related donor in [**2130**] complicated by rejection and
transient dialysis for two months.  He is now currently off
dialysis.  His baseline creatinine is approximately 5.0.
3. Coronary artery disease status post myocardial infarction.
He has a stent in the left anterior descending artery placed
in [**2139-10-10**].
4. Congestive heart failure with a diastolic dysfunction and
an ejection fraction of 45%.
5. History of empyema status post VATS.
6. Recurrent pneumonias.
7. History of Clostridium difficile colitis.
8. Multiple myeloma.
9. Blindness OD.
10. History of FEO with extensive workup.
11. Obstructive-sleep apnea, wears CPAP at night.
12. History of deep venous thrombosis of the left thigh
currently on warfarin.
13. History of Barrett's esophagus.
14. History of bacteremia and septic emboli with
Staphylococcus aureus.

ALLERGIES:  Dicloxacillin causes nausea and vomiting.
Compazine causes hallucinations.

MEDICATIONS ON TRANSFER:
1. Unasyn 1.5 grams every 24 hours.
2. Protonix 40 mg IV every 24 hours.
3. Erythropoietin 20,000 units twice weekly.
4. Niferex 150 mg [**Hospital1 **].
5. Aspirin 325 mg daily.
6. Heparin intravenously.
7. Versed and Fentanyl sedation.
8. Decadron 2 mg IV every eight hours.
9. Metoprolol 25 mg every six hours.
10. Insulin glargine and regular insulin-sliding scale.

EXAMINATION:  Temperature 96.0, heart rate 72, blood pressure
136/50, respiratory rate 16, and oxygen saturation of 96%.
Fingerstick glucose 233.  Generally, opening eyes following
commands with encouragement.  Neck:  No jugular venous
distention.  Heart:  Normal S1, S2, 1/6 systolic murmur, no
S3, S4.  Lungs are clear to auscultation bilaterally.
Abdomen:  Normal bowel sounds, soft, nontender, nondistended,
slightly obese.  Extremities:  No rash, no clubbing,
cyanosis, or edema, +2 dorsalis pedis pulses.  Neurologic:
Essentially unresponsive, he opens his eyes briefly and moves
all extremities on command.

LABORATORY VALUES ON PRESENTATION:  White blood cell count
7.1, hematocrit 29, platelets 149.  Chemistry panel is
significant for increase in BUN to 113 and creatinine to 6.5.
INR was 1.5.

LABORATORY EVALUATION AT THE OUTSIDE HOSPITAL:  He had a
computed tomograph of the head which was not revealing in
terms of acute hemorrhage and a chest x-ray on [**5-18**] showing
fluffy alveolar and interstitial markings consistent with
congestive heart failure.  He had an abdominal computer
tomograph on [**5-18**] as well, which showed multiple nonspecific
pretracheal and mediastinal lymph nodes, extensive
consolidation throughout both lung fields.  Nodular lesions
were also seen in the right upper lobe, cardiomegaly, large
dilated gallbladder, and a density in the right transplanted
kidney, hematoma versus cyst was on the differential.

HOSPITAL COURSE:  The patient was admitted to the Intensive
Care Unit.  We were following 1.5 days.  The patient self
extubated (i.e., the patient pulled the orotracheal tube
himself.  He complained of some throat pain on several days
following extubation.  His palate elevated symmetrically.
Computed tomography of the neck did not reveal a hematoma or
airway narrowing).

He underwent minor changes to his insulin scale specifically
increasing his glargine dose in the evenings as his
fingerstick blood glucose in the hospital ran as high as 300.
There was no evidence of ketoacidosis.

Pneumonia was treated initially with levofloxacin and
metronidazole.  However, a sputum culture revealed
methicillin-resistant Staphylococcus aureus.  Levofloxacin
was discontinued, Vancomycin intravenously was administered
(dose was 750 mg intravenously every 48 hours).

The patient's oxygen requirement decreased such that he was
able to breathe and maintain oxygen saturation on room air.
He was evaluated by the Physical Therapy service and deemed
safe to go home.

Patient's renal function stabilized with a creatinine ranging
between 5.2 and 5.6.  Placement of the peritoneal dialysis
catheter was deferred until later date, given that the
patient was not oliguric at this point.  A midline catheter
was placed in his arm for completion of his Vancomycin
course.

DISCHARGE DIAGNOSES:
1. Aspiration pneumonia.
2. Type 1 diabetes mellitus complicated by hypoglycemic coma.
Type 1 diabetes complicated by triopathy.
3. End-stage renal disease status post transplant from a
living related donor in [**2130**] complicated by rejection and
transient dialysis for two months.  He is now currently off
dialysis.  His baseline creatinine is approximately 5.0.
4. Coronary artery disease status post myocardial infarction.
He has a stent in the left anterior descending artery placed
in [**2139-10-10**].
5. Congestive heart failure with a diastolic dysfunction and
an ejection fraction of 45%.
6. History of empyema status post VATS.
7. Recurrent pneumonias.
8. History of Clostridium difficile colitis.
9. Multiple myeloma.
10. Blindness OD.
11. History of FEO with extensive workup.
12. Obstructive-sleep apnea, wears CPAP at night.
13. History of deep venous thrombosis of the left thigh
currently on warfarin.
14. History of Barrett's esophagus.
15. History of bacteremia and septic emboli with
Staphylococcus aureus.

DISCHARGE MEDICATIONS:
1. Metronidazole 500 mg po tid x10 days.
2. Levofloxacin 250 mg po q4-8h x10 days starting on
[**2141-5-25**].
3. Vancomycin 750 mg IV q4-8 for seven days starting on
[**2141-5-25**].
4. Niferex 150 mg po bid.
5. Warfarin 2.5 mg po q day.
6. Calcium carbonate 500 mg po tid.
7. Furosemide 40 mg po q am and 60 mg po q pm.
8. Prednisone 5 mg daily.
9. Atenolol 175 mg daily.
10. Midodrine 5 mg po tid.
11. Pravastatin 40 mg po q day.
12. Sodium bicarbonate 1.3 grams po tid.
13. Nitroglycerin 0.3 mg po q5 minutes if needed.
14. Multivitamin one capsule po daily.
15. Isosorbide mononitrate sustained release 30 mg po q24h.
16. Gabapentin 300 mg po tid.
17. Amlodipine 5 mg po q24h.
18. Aspirin 325 mg po daily.
19. Pantoprazole 40 mg po q24h.
20. Erythropoietin 20,000 units q Monday and Thursday.

DISPOSITION:  The patient was discharged home to complete a
seven day course of Vancomycin, specifically received doses
on [**5-27**] and [**2141-5-29**].  He should have his INR checked
weekly as well as his BUN and creatinine.  Heparin flushes
should be administered in his midline.



                            [**Name6 (MD) 251**] [**Last Name (NamePattern4) 11865**], M.D.  [**MD Number(1) 11866**]

Dictated By:[**Name8 (MD) 7102**]
MEDQUIST36

D:  [**2141-5-25**]  17:05
T:  [**2141-5-26**]  07:19
JOB#:  [**Job Number 20631**]
{'Chronic diastolic heart failure,Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Pneumonitis due to inhalation of food or vomitus,Complications of transplanted kidney,Acute respiratory failure,Acute kidney failure, unspecified'}


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: The patient was referred from outside
hospital for further management of hypoglycemia, acute on
chronic renal failure, and fever of unknown origin.

PRESENT ILLNESS: The patient is a 57-year-old man
who presents to the [**Hospital **] Hospital on [**2141-5-18**] after
being found unresponsive by his wife.  By report, the patient
awoke feeling poorly and had one episode of emesis on the
date of admission.  His temperature at that time was 102
degrees (of note the patient has had a long history of fever
of unknown origin with an extensive workup including
fluoroscopic lung [**Year (4 digits) **]).

MEDICAL HISTORY: 1. Type 1 diabetes complicated by triopathy.
2. End-stage renal disease status post transplant from a
living related donor in [**2130**] complicated by rejection and
transient dialysis for two months.  He is now currently off
dialysis.  His baseline creatinine is approximately 5.0.
3. Coronary artery disease status post myocardial infarction.
He has a stent in the left anterior descending artery placed
in [**2139-10-10**].
4. Congestive heart failure with a diastolic dysfunction and
an ejection fraction of 45%.
5. History of empyema status post VATS.
6. Recurrent pneumonias.
7. History of Clostridium difficile colitis.
8. Multiple myeloma.
9. Blindness OD.
10. History of FEO with extensive workup.
11. Obstructive-sleep apnea, wears CPAP at night.
12. History of deep venous thrombosis of the left thigh
currently on warfarin.
13. History of Barrett's esophagus.
14. History of bacteremia and septic emboli with
Staphylococcus aureus.

MEDICATION ON ADMISSION: 

ALLERGIES: Dicloxacillin causes nausea and vomiting.
Compazine causes hallucinations.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Chronic diastolic heart failure,Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Pneumonitis due to inhalation of food or vomitus,Complications of transplanted kidney,Acute respiratory failure,Acute kidney failure, unspecified'}
