CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an
89-year-old female with a past medical history significant
for COPD, recently discharged on [**2148-11-21**] with CHF
exacerbation with COPD and hypercarbia.  Most of the
patient's admission history was obtained from the daughter.
According to her, the patient was unable to rise from the
chair on the morning of admission.  She also reported having
symptoms of imbalance; however, there were no symptoms of
incontinence, loss of consciousness, chest discomfort,
shortness of breath, nausea, vomiting, dizziness,
lightheadedness, fever.  No history of bloody stools.  No
numbness, tingling, or weakness that was reported by the
patient.  She was admitted for mental status changes and for
some respiratory distress.

MEDICAL HISTORY: 1.  COPD on 2 liters at home.
2.  History of DVT.
3.  History of congestive heart failure and known EF of 65%.
4.  Diastolic dysfunction.
5.  History of hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives with her daughter who is
very involved in his care.  No history of smoking, alcohol
use, or illicit drug use.
Acute and chronic respiratory failure,Chronic diastolic heart failure,Chronic airway obstruction, not elsewhere classified,Acidosis,Acute kidney failure, unspecified,Retention of urine, unspecified,Unspecified acquired hypothyroidism
Acute & chronc resp fail,Chr diastolic hrt fail,Chr airway obstruct NEC,Acidosis,Acute kidney failure NOS,Retention urine NOS,Hypothyroidism NOS
Admission Date:  [**2148-12-13**]       Discharge Date:  [**2148-12-21**]


Service:  MEDICINE

HISTORY OF THE PRESENT ILLNESS:  The patient is an
89-year-old female with a past medical history significant
for COPD, recently discharged on [**2148-11-21**] with CHF
exacerbation with COPD and hypercarbia.  Most of the
patient's admission history was obtained from the daughter.
According to her, the patient was unable to rise from the
chair on the morning of admission.  She also reported having
symptoms of imbalance; however, there were no symptoms of
incontinence, loss of consciousness, chest discomfort,
shortness of breath, nausea, vomiting, dizziness,
lightheadedness, fever.  No history of bloody stools.  No
numbness, tingling, or weakness that was reported by the
patient.  She was admitted for mental status changes and for
some respiratory distress.

PAST MEDICAL HISTORY:
1.  COPD on 2 liters at home.
2.  History of DVT.
3.  History of congestive heart failure and known EF of 65%.
4.  Diastolic dysfunction.
5.  History of hypertension.

ADMISSION MEDICATIONS:
1.  Aspirin 81 mg p.o. q.d.
2.  Thiamine 100 mg p.o. q.d.
3.  Lopressor 25 mg p.o. b.i.d.
4.  Lisinopril 10 mg p.o. q.d.
5.  Combivent one puff q. six hours.
6.  Lasix 20 mg p.o. q.d.
7.  Senna.

ALLERGIES:  The patient has no known drug allergies.

SOCIAL HISTORY:  The patient lives with her daughter who is
very involved in his care.  No history of smoking, alcohol
use, or illicit drug use.

PHYSICAL EXAMINATION ON ADMISSION:  Vital signs:  She was
afebrile.  The temperature was 98.5, blood pressure 122/60,
pulse 70, respiratory rate of 18, saturating 95% on 2 liters.
General:  She was in no apparent distress.  HEENT:  Her
oropharynx was dry.  She had no lesions.  Chest:  She had
decreased breath sounds at both bases.  No wheezes or
crackles.  Cardiac:  Regular rate and rhythm.  Abdomen:
Nontender, nondistended.  Extremities:  No edema.
Neurologic:  Nonfocal.

LABORATORY/RADIOLOGIC DATA:  On admission, sodium 139,
potassium 5.1, chloride 85, bicarbonate 56 with a range
between the mid 30s to mid 40s, BUN 44, creatinine 1.4,
glucose 72.  She had a white blood cell count of 6.9,
hematocrit 38.3, platelets 229,000.  Her U/A was clean.

Chest x-ray showed small bilateral pleural effusion, no
pulmonary consolidation.

HOSPITAL COURSE:  1.  HYPOXIA:  The patient was found on
hospital day number two to have some changes in mental
status.  ABG done at that time showed a PAC02 of 114.  A CTA
was performed which was negative for a pulmonary embolism.  A
Pulmonary consult was obtained.  Their impression was that
this could be a central process and recommended checking a
TSH and a free T4 and to pursue a diagnosis of possible
myasthenia [**Last Name (un) 2902**].

In the interim, the patient was transferred to the Medical
Intensive Care Unit for BIPAP to reverse her hypercarbia.
The patient did not tolerate BIPAP, however, it resolved her
hypercarbia.  With the use of nebulizer therapy, the
patient's mentation improved with PAC02s on ABG in the 70s
down from 114.

To continue the workup for myasthenia [**Last Name (un) 2902**], the patient had
an EMG study which did not show any evidence of disease at
the neuromuscular junction.  The patient's TSH was normal
with a low T4 suggestive of subclinical hypothyroidism,
ruling out a central process for her hypercarbia and ruling
out myasthenia [**Last Name (un) 2902**] as another etiology.  It was decided
that this was just progression of her known restrictive lung
disease.  This is known from PFTs performed in [**2148-7-19**] which showed an FVC of 25% predicted, FEV1 of 32%
predicted, and an FEV1/FVC ratio of 129% predicted.

It was believed that this was progression towards end-stage
of her disease.  Dr. [**Last Name (STitle) 1266**] is in active discussions with
the patient and the family towards transitioning to hospice
care; however, at the time of discharge, the patient and the
patient's family were willing for rehabilitation placement
but not hospice care as of yet.

2.  CONGESTIVE HEART FAILURE AND DIASTOLIC DYSFUNCTION:  The
patient's medication regimen was adjusted.  She was placed on
Toprol XL 100 mg p.o. q.d. and Lisinopril 30 mg p.o. q.d.
She was also continued on her Lasix 20 mg p.o. q.d.

3.  SUBCLINICAL HYPOTHYROIDISM:  The patient was started on
levothyroxine 25 micrograms p.o. q.d.

The patient is officially DNR/DNI.

CONDITION ON DISCHARGE:  Fair.

DISCHARGE STATUS:  [**Hospital **] [**Hospital **] Hospital.

DISCHARGE DIAGNOSIS:
1.  Hypercarbia secondary to progressive restrictive lung
disease.
2.  Congestive heart failure.
3.  Subclinical hypothyroidism.

DISCHARGE MEDICATIONS:
1.  Aspirin 81 mg p.o. q.d.
2.  Thiamine 100 mg p.o. q.d.
3.  Senna one tablet p.o. b.i.d.
4.  Tylenol 325 mg one to two tablets p.o. q. four to six
hours p.r.n.
5.  Colace 100 mg p.o. b.i.d.
6.  Dulcolax delayed release 10 mg p.o. q.d. p.r.n.
7.  Albuterol nebulizer one ampule q. four hours inhalation
p.r.n.
8.  Atrovent nebulizer one ampule q. six hours inhalation
p.r.n.
9.  Combivent one to two puffs q. six hours p.r.n.
10. Nystatin ointment topical p.r.n.
11. Lisinopril 30 mg p.o. q.d.
12. Toprol XL 100 mg p.o. q.d.
13. Levothyroxine 25 micrograms p.o. q.d.

FOLLOW-UP:  The patient will follow-up with Dr. [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) 1266**] within two to three days after discharge from
[**Hospital3 7**].



                            [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 4263**]

Dictated By:[**Last Name (NamePattern1) 11207**]
MEDQUIST36

D:  [**2148-12-20**]  05:31
T:  [**2148-12-20**]  19:16
JOB#:  [**Job Number 109882**]

cc:[**Hospital3 **]
{'Acute and chronic respiratory failure,Chronic diastolic heart failure,Chronic airway obstruction, not elsewhere classified,Acidosis,Acute kidney failure, unspecified,Retention of urine, unspecified,Unspecified acquired hypothyroidism'}


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 an
89-year-old female with a past medical history significant
for COPD, recently discharged on [**2148-11-21**] with CHF
exacerbation with COPD and hypercarbia.  Most of the
patient's admission history was obtained from the daughter.
According to her, the patient was unable to rise from the
chair on the morning of admission.  She also reported having
symptoms of imbalance; however, there were no symptoms of
incontinence, loss of consciousness, chest discomfort,
shortness of breath, nausea, vomiting, dizziness,
lightheadedness, fever.  No history of bloody stools.  No
numbness, tingling, or weakness that was reported by the
patient.  She was admitted for mental status changes and for
some respiratory distress.

MEDICAL HISTORY: 1.  COPD on 2 liters at home.
2.  History of DVT.
3.  History of congestive heart failure and known EF of 65%.
4.  Diastolic dysfunction.
5.  History of hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives with her daughter who is
very involved in his care.  No history of smoking, alcohol
use, or illicit drug use. 

### Response:
{'Acute and chronic respiratory failure,Chronic diastolic heart failure,Chronic airway obstruction, not elsewhere classified,Acidosis,Acute kidney failure, unspecified,Retention of urine, unspecified,Unspecified acquired hypothyroidism'}
