CHIEF COMPLAINT: nausea and vomiting

PRESENT ILLNESS: A 53-year-old male Ethiopian
with history of intracerebral hemorrhage most likely from
hypertension in the cerebellar region near the fourth
ventricle one month ago, [**2103-6-19**], that presents with
decreased energy and emesis times one week at rehab.  The
patient currently in rehab and was here in the Emergency
Department one day prior to admission and diagnosed with a
urinary tract infection and treated with Levaquin.  CT of the
abdomen showed gallstone but no other pathology.  The patient
states he vomits up everything he eats including medications.
It is green and he occasionally has blood.  He complains of
dizziness that feels like the room is spinning.  The patient
worsens after food intake.  No fever or upper respiratory
infection.  No diarrhea.

MEDICAL HISTORY: Back pain status post fall with back
and neck injuries [**2103-5-10**]; status post cerebellar
hemorrhage [**2103-6-19**]; status post ventricular drain;
hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: Two brothers had cholecystic disease.

SOCIAL HISTORY: Worked as [**Doctor Last Name **] at the airport but has been
in rehab for a month.  No alcohol, no tobacco personally.
Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Obstructive hydrocephalus,Nausea with vomiting,Personal history of other diseases of circulatory system,Unspecified essential hypertension,Anemia, unspecified,Unspecified accident,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction
Traumatic brain hem NEC,Obstructiv hydrocephalus,Nausea with vomiting,Hx-circulatory dis NEC,Hypertension NOS,Anemia NOS,Accident NOS,Cholelithiasis NOS
Admission Date: [**2103-7-18**]        Discharge Date: [**2103-8-3**]

Date of Birth:  [**2048-8-9**]        Sex:  M

Service:  MED

HISTORY OF PRESENT ILLNESS:  A 53-year-old male Ethiopian
with history of intracerebral hemorrhage most likely from
hypertension in the cerebellar region near the fourth
ventricle one month ago, [**2103-6-19**], that presents with
decreased energy and emesis times one week at rehab.  The
patient currently in rehab and was here in the Emergency
Department one day prior to admission and diagnosed with a
urinary tract infection and treated with Levaquin.  CT of the
abdomen showed gallstone but no other pathology.  The patient
states he vomits up everything he eats including medications.
It is green and he occasionally has blood.  He complains of
dizziness that feels like the room is spinning.  The patient
worsens after food intake.  No fever or upper respiratory
infection.  No diarrhea.

PAST MEDICAL HISTORY:  Back pain status post fall with back
and neck injuries [**2103-5-10**]; status post cerebellar
hemorrhage [**2103-6-19**]; status post ventricular drain;
hypertension.

MEDICATIONS:  Reglan 25 b.i.d., Levaquin 500 q. day,
citalopram 20 q. day, Megace 40 b.i.d., milk of magnesia,
bisacodyl, captopril 75 t.i.d., nicardipine 20 q. 8h.,
metoprolol 75 b.i.d., heparin 5000 subcutaneous b.i.d., Tylenol
q. 6h., Percocet q. 6h. as needed.

SOCIAL HISTORY:  Worked as [**Doctor Last Name **] at the airport but has been
in rehab for a month.  No alcohol, no tobacco personally.

FAMILY HISTORY:  Two brothers had cholecystic disease.

PHYSICAL EXAMINATION:  98.8, 164/110, 84, 18, 98 percent on
room air.  No apparent distress.  Alert and oriented times
three.  Cachectic appearing.  Moist mucus membranes.
Oropharynx moist.  Regular rate without murmur.  Clear to
auscultation bilaterally.  Soft, diffusely tender, no
guarding, no rigidity, faint bowel sounds.  No clubbing,
cyanosis or edema.  Warm.  Dorsalis pedis's 2 plus.

RADIOLOGY:  CT of the abdomen and kidneys showed gallstone,
mild ascending colon dilation.

LABORATORY:  Urinalysis was completely normal.  No signs of
infection.  White count 4.6, hematocrit 37.3, platelet count
374,000.  Electrolytes were unremarkable.  Liver function
tests were within normal limits except for an alk phos of
134.

HOSPITAL COURSE:  Nausea and emesis:  Neurology and
Neurosurgery were consulted.  It was felt that the nausea and
emesis were due to irritation of the edema and blood that
stills surrounds the fourth ventricle which is near the
chemotactic area.  The patient had a repeat MRI and CT scan
which showed no further hydrocephalus.  The patient was
transferred for one day to the Neurosurgery Intensive Care
Unit for a ventricular drainage which showed an opening
pressure of 13-14 cm which was within normal limits.  They
also drained some fluid with only modest improvement in
nausea and dizziness.  The patient slowly recovered.  He was
treated with ondansetron and Ativan to try to alleviate the
nausea.  He has been slowly improving his oral intake and is
taking nectar, thick liquids and soft solids.  Each day the
patient seems to have modest improvements.  Neurology also
wanted the patient to be on glycerine one ounce four times a
day to try to decrease the swelling surrounding that fourth
ventricle which is near the chemotactic area.

Hypertension:  The patient has very difficult hypertension to
manage.  He is currently taking atenolol and captopril.  He
may need increases in these doses with goal systolic blood
pressures around 140.

Vertigo:  The patient has sort of difficulty tracking things
with his eye movements.  The neurologist felt that this was
not vertigo, however, and that is all related to the
intracerebellar hemorrhage.

Urinary tract infection:  There were no signs of UTI in the
old UA or the new one so the Levaquin was discontinued.

DISPOSITION:  The rest of this discharge summary will be
dictated when the patient is discharged.




                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) **], MD [**MD Number(2) 27875**]

Dictated By:[**Last Name (NamePattern1) 14382**]
MEDQUIST36
D:  [**2103-7-31**] 11:30:19
T:  [**2103-7-31**] 11:53:48
Job#:  [**Job Number **]





Name:  [**Known lastname 18235**],[**Known firstname 18236**] G.             Unit No:   [**Numeric Identifier 18237**]

Admission Date:  [**2103-7-18**]              Discharge Date:   [**2103-8-3**]

Date of Birth:  [**2048-8-10**]             Sex:   M

Service: MED

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1775**]
Chief Complaint:
nausea and vomiting

Major Surgical or Invasive Procedure:
TBI/ICH one month ago ([**2103-6-19**]), s/p Ventricular Drainage


History of Present Illness:
HPI:  53 YO male ethiopian with Hx of TBI/ICH 1 month ago
([**2103-6-19**]) that presents with decreased energy and emesis x1
week.   CT of abdomen showed Gallstone but no other pathology.
Pt states vomits up everything he eats including meds.  Vomit is
"green" and occasionally has blood.  He c/o dizziness that feels
like room spinning.  Pt worsens after food intake.  No fever,
URI, no diarrhea.

Past Medical History:
PMH: Back pain
s/p fall with back and neck injury 4/32/04
s/p cerebellar hemorrhage [**2103-6-19**] s/p ventricular drain.
hypertension

Brief Hospital Course:
Due to the patients persistent nausea and green-tinged emesis,
an MRCP was performed to rule out biliary etiology. MRCP
demonstrated a large gallstone, but no other pathology. There
was no evidence of cholecystitis or biliary duct obstruction.
His nausea/emesis has slowly improved over the course of this
hospitalization. However, he still requires IV anti-emetic
therapy for control of his symptoms.

Discharge Medications:
1. Ondansetron 8 mg IV TID
2. Lorazepam 0.5 mg IV QID nausea
3. Glycerin 50 % Solution Sig: One (1) ounce PO QID (4 times a
day).
4. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO BID
(2 times a day).
5. Captopril 25 mg Tablet Sig: Three (3) Tablet PO TID (3 times
a day).
6. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).

7. Citalopram Hydrobromide 20 mg Tablet Sig: One (1) Tablet PO
QD (once a day).
8. Sucralfate 1 g Tablet Sig: One (1) Tablet PO QID (4 times a
day).
9. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
QD (once a day) as needed. Suppository(s)
10. Acetaminophen 500 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed for for pain.
11. Aluminum-Magnesium Hydroxide 225-200 mg/5 mL Suspension Sig:
15-30 MLs PO QID (4 times a day) as needed for GI upset


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 14**] & Rehab Center - [**Hospital1 15**]

Discharge Diagnosis:
Nausea with Emesis

Discharge Condition:
Nausea/emesis improved on IV anti-emetics, Blood pressure
stable. No pain concerns.

Discharge Instructions:
Please notify your physician if your nausea or vomiting worsens,
if you vomit up blood, if you have abdominal pains or headaches,
or if you develop a fever.

Followup Instructions:
F/U with PCP regarding Nausea control with oral agents, and
continued Blood pressure control.

The facility listed above is incorrect.  The patient was
discharged to [**Hospital3 **] in [**Location (un) 177**].


                             [**First Name11 (Name Pattern1) 1034**] [**Last Name (NamePattern1) 1778**] MD [**MD Number(2) 1779**]

Completed by:[**2103-8-2**]
{'Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Obstructive hydrocephalus,Nausea with vomiting,Personal history of other diseases of circulatory system,Unspecified essential hypertension,Anemia, unspecified,Unspecified accident,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction'}


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: nausea and vomiting

PRESENT ILLNESS: A 53-year-old male Ethiopian
with history of intracerebral hemorrhage most likely from
hypertension in the cerebellar region near the fourth
ventricle one month ago, [**2103-6-19**], that presents with
decreased energy and emesis times one week at rehab.  The
patient currently in rehab and was here in the Emergency
Department one day prior to admission and diagnosed with a
urinary tract infection and treated with Levaquin.  CT of the
abdomen showed gallstone but no other pathology.  The patient
states he vomits up everything he eats including medications.
It is green and he occasionally has blood.  He complains of
dizziness that feels like the room is spinning.  The patient
worsens after food intake.  No fever or upper respiratory
infection.  No diarrhea.

MEDICAL HISTORY: Back pain status post fall with back
and neck injuries [**2103-5-10**]; status post cerebellar
hemorrhage [**2103-6-19**]; status post ventricular drain;
hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: Two brothers had cholecystic disease.

SOCIAL HISTORY: Worked as [**Doctor Last Name **] at the airport but has been
in rehab for a month.  No alcohol, no tobacco personally. 

### Response:
{'Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Obstructive hydrocephalus,Nausea with vomiting,Personal history of other diseases of circulatory system,Unspecified essential hypertension,Anemia, unspecified,Unspecified accident,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction'}
