CHIEF COMPLAINT: dizziness

PRESENT ILLNESS: 78 yo Cantonese speaking male started noticing dizziness about 5
days ago. He felt a room spinning sensation with both standing
up and change in head position. He did not have any tinnitus,
hearing loss, ear pain or drainage, headache, visual changes,
focal neurological changes. He denies fevers, chills,
congestion, cough. He took a chinese herbal tea called "small
box tea" day before yesterday and then went to see his PCP
[**Name Initial (PRE) 1262**]. His PCP drew some labs and he was found to have
neutropenia and anemia and pt was asked to see PCP again today.
Over the last 2 days, his dizziness had been improving and
currently he does not have any dizziness anymore.
      Other than the herbal tea, he denies ingesting any other
over the counter or herbal medications. He does not get
medications from anyone other that his PCP and has been on the
same medications for years
    Other than recent dizziness he has not fallen ill in the
last few months, he does not have any sick contacts and has not
had any foreign travel. He denies easy bruising or bleeding
    He denies chest pain, shortness of breath, cough,
nausea/vomiting/diarrhea, deneis urinary symptoms

MEDICAL HISTORY: 1. Diabetes Mellitus

MEDICATION ON ADMISSION: 1. Doxazosin 2mg QHS
2. Aspirin 325mg QD
3. Metformin 1000mg [**Hospital1 **]
4. Glipizide 10mg [**Hospital1 **]
5. Lisinopril 10mg QD

ALLERGIES: Cytarabine

PHYSICAL EXAM: Physical Exam:
Appearance: NAD
Vitals: T:98.4 BP:103/64 HR:93 RR: 16 O2:99  %  RA
Eyes: EOMI, PERRL, conjunctiva clear, anicteric,
ENT: Moist
Neck: No JVD, no LAD
Cardiovascular: RRR, nl S1/S2, no m/r/g
Respiratory: CTA bilaterally, comfortable, no wheezing, no
ronchi, no rales
Gastrointestinal: soft, non-tender, non-distended, normal bowel
sounds
Musculoskeletal/Extremities: no clubbing, no cyanosis, no joint
swelling, no edema in the bilateral extremities
Neurological: Alert and oriented x3, fluent speech, no pronator
drift, no asterixis, sensation WNL, CNII-XII intact
Integument: warm, no rash, no ulcer
Psychiatric: appropriate, pleasant
Hematological/Lymphatic: No cervical, supraclavicular, axillary,
or inguinal lymphadenopathy
GU: no CVAT

FAMILY HISTORY: No one in family has hx of cancer/blood disorders

SOCIAL HISTORY: Lives with wife. Married for 30+ years. Denies smoking, alcohol
or drug use history ever. Denies hx of blood transfusion. Does
not have intercourse with anyone other than wife.
Encounter for antineoplastic chemotherapy,Acute myeloid leukemia, without mention of having achieved remission,Other anaphylactic reaction,Urinary tract infection, site not specified,Viral hepatitis B without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta,Other and unspecified mycoses,Drug induced neutropenia,Unspecified essential hypertension,Hematoma complicating a procedure,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Accidents occurring in residential institution,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Other B-complex deficiencies,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Anemia in neoplastic disease,Diarrhea,Hypovolemia,Thrombocytopenia, unspecified,Other iatrogenic hypotension,Constipation, unspecified,Background diabetic retinopathy,Other specified disorders of biliary tract
Antineoplastic chemo enc,Ac myl leuk wo achv rmsn,Other anaphylactic react,Urin tract infection NOS,Hpt B acte wo cm wo dlta,Mycoses NEC & NOS,Drug induced neutropenia,Hypertension NOS,Hematoma complic proc,Adv eff antineoplastic,Accid in resident instit,Abn react-procedure NEC,Enterococcus group d,B-complex defic NEC,DMII oth nt st uncntrld,Anemia in neoplastic dis,Diarrhea,Hypovolemia,Thrombocytopenia NOS,Iatrogenc hypotnsion NEC,Constipation NOS,Diabetic retinopathy NOS,Dis of biliary tract NEC
Admission Date:  [**2194-2-26**]              Discharge Date:   [**2194-4-8**]

Date of Birth:  [**2115-9-30**]             Sex:   M

Service: MEDICINE

Allergies:
Cytarabine

Attending:[**First Name3 (LF) 7591**]
Chief Complaint:
dizziness

Major Surgical or Invasive Procedure:
none

History of Present Illness:
78 yo Cantonese speaking male started noticing dizziness about 5
days ago. He felt a room spinning sensation with both standing
up and change in head position. He did not have any tinnitus,
hearing loss, ear pain or drainage, headache, visual changes,
focal neurological changes. He denies fevers, chills,
congestion, cough. He took a chinese herbal tea called "small
box tea" day before yesterday and then went to see his PCP
[**Name Initial (PRE) 1262**]. His PCP drew some labs and he was found to have
neutropenia and anemia and pt was asked to see PCP again today.
Over the last 2 days, his dizziness had been improving and
currently he does not have any dizziness anymore.
      Other than the herbal tea, he denies ingesting any other
over the counter or herbal medications. He does not get
medications from anyone other that his PCP and has been on the
same medications for years
    Other than recent dizziness he has not fallen ill in the
last few months, he does not have any sick contacts and has not
had any foreign travel. He denies easy bruising or bleeding
    He denies chest pain, shortness of breath, cough,
nausea/vomiting/diarrhea, deneis urinary symptoms

ROS:
-Constitutional: [x]WNL []Weight loss []Fatigue/Malaise []Fever
[]Chills/Rigors []Nightweats []Anorexia
-Eyes: [x]WNL []Blurry Vision []Diplopia []Loss of Vision
[]Photophobia
-ENT: [x]WNL []Dry Mouth []Oral ulcers []Bleeding gums/nose
[]Tinnitus []Sinus pain []Sore throat
-Cardiac: [x]WNL []Chest pain []Palpitations []LE edema
[]Orthopnea/PND []DOE
-Respiratory: [x]WNL []SOB []Pleuritic pain []Hemoptysis []Cough
-Gastrointestinal: [x]WNL []Nausea []Vomiting []Abdominal pain
[]Abdominal Swelling []Diarrhea []Constipation []Hematemesis
[]Hematochezia []Melena
-Heme/Lymph: [x]WNL []Bleeding []Bruising []Lymphadenopathy
-GU: [x]WNL []Incontinence/Retention []Dysuria []Hematuria
[]DIscharge []Menorrhagia
-Skin: [x]WNL []Rash []Pruritus
-Endocrine: [x]WNL []Change in skin/hair []Loss of energy
[]Heat/Cold intolerance
-Musculoskeletal: [x]WNL []Myalgias []Arthralgias []Back pain
-Neurological: [x] WNL []Numbness of extremities []Weakness of
extremities []Parasthesias []Dizziness/Lightheaded []Vertigo
[]Confusion []Headache
-Psychiatric: [x]WNL []Depression []Suicidal Ideation
-Allergy/Immunological: [x] WNL []Seasonal Allergies
.


Past Medical History:
1. Diabetes Mellitus

Social History:
Lives with wife. Married for 30+ years. Denies smoking, alcohol
or drug use history ever. Denies hx of blood transfusion. Does
not have intercourse with anyone other than wife.

Family History:
No one in family has hx of cancer/blood disorders

Physical Exam:
Physical Exam:
Appearance: NAD
Vitals: T:98.4 BP:103/64 HR:93 RR: 16 O2:99  %  RA
Eyes: EOMI, PERRL, conjunctiva clear, anicteric,
ENT: Moist
Neck: No JVD, no LAD
Cardiovascular: RRR, nl S1/S2, no m/r/g
Respiratory: CTA bilaterally, comfortable, no wheezing, no
ronchi, no rales
Gastrointestinal: soft, non-tender, non-distended, normal bowel
sounds
Musculoskeletal/Extremities: no clubbing, no cyanosis, no joint
swelling, no edema in the bilateral extremities
Neurological: Alert and oriented x3, fluent speech, no pronator
drift, no asterixis, sensation WNL, CNII-XII intact
Integument: warm, no rash, no ulcer
Psychiatric: appropriate, pleasant
Hematological/Lymphatic: No cervical, supraclavicular, axillary,
or inguinal lymphadenopathy
GU: no CVAT


Pertinent Results:
[**2194-2-26**] 10:50AM   WBC-0.9* RBC-2.78* HGB-9.6* HCT-27.1* MCV-97
MCH-34.7* MCHC-35.6* RDW-15.6*
[**2194-2-26**] 10:50AM   NEUTS-10* BANDS-0 LYMPHS-80* MONOS-10 EOS-0
BASOS-0 ATYPS-0 METAS-0 MYELOS-0
[**2194-2-26**] 10:50AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-1000 KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2194-2-25**] 09:33AM   UREA N-16 CREAT-0.7 SODIUM-133 POTASSIUM-4.3
CHLORIDE-97 TOTAL CO2-27 ANION GAP-13
[**2194-2-25**] 09:33AM   TSH-0.90

Brief Hospital Course:
AP: 78 yo Chinese male w PMHx of T2DM presents with 4-5 day hx
of dizziness which is now resolved and found to have neutropenia
and anemia and AML.

#. Leukemia: Patient presented with neutropenia and anemia.
Found to have AML.  Started on 7+3.  Course complicated by
stridor and ICU stay (see below).  Patient recovered and
continued his chemo course without complication.  His counts
dropped as expected and he developed severe abdominal pain and
fevers (discussed below).  Eventually his counts recovered and
he did well.  He was noted to have some atypical cells in his
peripheral smear.  He never had a day 14 BM biopsy because of
his clinical deterioration during that time.  He will follow up
with Dr. [**Last Name (STitle) 410**] and they can discuss future treatments.
.
#. T2DM: Holding outpatient oral regemin and treating with
lantus at night and sliding scale.  Patient had increased
inslulin requirements while on steroids.  Then he had pretty
well controlled diabetes until the week prior to discharge when
he started having pretty severe hyperglycemia.  [**Last Name (un) **] was
consulted and his lantus and sldiding scale were changed.  He
was not on insulin prior to admission, and so he needed insulin
teaching and was hooked into the [**Hospital **] clinic as an outpatient.
 He and his wife and children were doing well with insulin
teaching.
.
# Febrile neutropenia / Fungemia - while patient was having
fevers during his nadir, he had a positive blood cutlure growing
[**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 563**].  ID was consulted and the patient had an echo
and eye exam, both of which were normal.  He was started on
micafungin and stopped having fevers.  Eventually when he had
elevated LFTs, we switched his micafungin to anidlofungin per ID
recs.  During this time, he was having severe abdominal pain, so
with worries for hepatosleno candidemia, we did an MRI that did
not show any involvement.  His abdominal pain improved, but he
contined to have elevated LFTs despite switching antifungals.
He also was hyperglycemic and tachycardic which would lead more
to continued infection.  We thought he should have an extended
course of the anidlofungin and was discharged home on it with ID
follow up prior to the end of his course.
.
# Elevated LFTs - after having fungemia, he had elevated LFTs
which were thought to likely be due to med effect v.
hepatospleno candidemia.  His MRI was negative, but he continued
to have clinical signs of infection (although never spiked
another fever once on antifungals).  Liver was consulted, and
his LFTs started trending down so it was decided that a biopsy
was not needed.  By time of discharge, they continued to be
trending downward.  Will follow up as outpatient.
.
# Abdominal pain - while patient was in his nadir of his counts,
he developed severe abdominal pain, which caused him to stop
eating.  He was placed on TPN because of his poor PO intake.  He
had two CT scans that did not show any bowel infection or
typhlitis.  It did show severe constipation.  He was treated for
his constipation and his symptoms improved.  When his counts
recovered, he no longer had abdominal pain and was eating very
very well by the time of discharge.
.
# Enterococcus UTI: Diagnosed from urine culture in the ED and
treated with cefepime.  Patient was spiking fevers after that
which were attributed to Leukemia but as he was neutropenic he
was continued on a course of Vancomycin and cefepime for
neutropenic fevers until his count recovers.  He had second
fevers while on vanco/cefepime and found to have fungemia (as
discussed above).
.
# Stridor/respiratory distress: The patient was started on
chemotherapy on [**3-6**].  He was given cytarabine and idarubicin.
After his first dose, he developed acute respiratory distress,
with tachypnea and audible stridor. He was presumed to have an
anaphylactic reaction to his chemotherapy, and was given
solumedrol 125mg IV X1, Benadryl 25mg IV X1, inhaled racemic
epinephrine, and epinephrine .3mg IM X1. His respiratory
distress did not subside, and he was transferred to the [**Hospital Unit Name 153**]
emergently for intubation. Anesthesia intubated the patient
without complications, and did not observe swollen or edemetous
trachea or vocal cords. His vitals at this time were Temp 103.0,
BP 180/100, HR 160.  He was transported to the ICU and intubated
for airway protection.  It could not be determined if he
actually had a reaction to the chemo or a transfusion reaction.
He was restarted on the chemo while getting IV steroids.  He was
premedicated for all blood products.  His blood was sent for a
transfusion reaction but none could be identified.  He had no
other respiratory symptoms except one day of wheezing which was
likely due to fluid overload and disappeared after being
diuresed.

# Gluteal Hematoma: Patient had a traumatic bone marrow biopsy
complicated by a gluteal hematoma.  This eventually extended
down his thigh and was likely the cause of a hematocrit drop.
There was no evidence of compartment syndrome and he was
transfused.  He improved with supportive care.  By time of
discharge, the bruising and discoloration was gone and he had no
pain.


Medications on Admission:
1. Doxazosin 2mg QHS
2. Aspirin 325mg QD
3. Metformin 1000mg [**Hospital1 **]
4. Glipizide 10mg [**Hospital1 **]
5. Lisinopril 10mg QD

Discharge Medications:
1. Doxazosin 4 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime).
Disp:*15 Tablet(s)* Refills:*2*
2. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed: take
for constipation.
3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
4. Anidulafungin 100 mg Recon Soln Sig: One (1) Recon Soln
Intravenous daily () for 11 days.
Disp:*11 Recon Soln(s)* Refills:*0*
5. Saline Flush 0.9 % Syringe Sig: One (1) flush Injection twice
a day for 30 days.
Disp:*60 syringes* Refills:*0*
6. Lamivudine 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Lantus 100 unit/mL Solution Sig: 16 u in AM, 30 u in PM units
Subcutaneous qAM and qPM.
Disp:*10 ml* Refills:*2*
8. Insulin Syringes (Disposable) 1 mL   Syringe Sig: One (1)
syringe Miscellaneous twice a day.
Disp:*120 syringes* Refills:*2*
9. Ultra Thin Lancets     Misc Sig: One (1) lancet Miscellaneous
four times a day.
Disp:*120 lancets* Refills:*2*
10. Blood Glucose Test     Strip Sig: One (1) strip In [**Last Name (un) 5153**]
four times a day.
Disp:*120 strips* Refills:*2*
11. Insulin Regular Human 100 unit/mL Solution Sig: as directed
by sliding scale unit Injection four times a day.
Disp:*10 ml* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
Critical Care Systems

Discharge Diagnosis:
Final Diagnosis:
1. Neutropenia/Anemia
2. AML
3. Diabetes
4. Fungemia
5. Hepatospleno candidasis


Discharge Condition:
stable, walking around with walker, feeling well


Discharge Instructions:
You were admited because your primary care doctor found some of
your blood levels to be low.  You were worked up and found to
have leukemia.  You started chemotherapy.  Right when you
started you had a bad reaction to either some blood or the
chemo.  It required you to go to the intensive care unit and be
intubated.  You were extubated and restarted your chemotherapy
without any issues.  You were given medications to prevent
another reaction with blood.
.
While your white count was low, you got an infection with
[**Female First Name (un) **] (a type of yeast/fungus).  You were very sick and had a
lot of abdominal pain during this time, too.  We treated you
with antibiotics.  You will need to continue receiving the
anti-fungal at home through your PICC line, with the help of a
home nurse.
.
We also did several CT and MRI scans to look at your abdomen.
We think your pain was mostly from constipation.  You should
continue to make sure you are having bowel movements at home and
call or take stool softeners if you have not had one in over 2
days.  You also likely had the fungus infection in your liver.
We followed your liver function tests in your blood and they
have started going towards normal.  You will need to continue
getting IV antibiotics for the next two weeks.
.
Please return to the hospital for any fevers, chills, redness or
pain around your PICC line, chest pain, shortness of breath,
abdominal pain, worsening diarrhea, constipation or any other
concerns.  Please follow up as listed below.

Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) 410**] on Thursday [**4-10**] at 11:00 am in
[**Hospital Ward Name 23**] 7 to discuss the future AML treatment.

Please follow up with Dr. [**Last Name (STitle) 724**] in infectious disease next Tues
[**4-15**] at 2pm in [**Hospital Ward Name 23**] 7 (where you see Dr. [**Last Name (STitle) 410**] to determine
whether or not you will need to continue your antibiotics.

Please follow up at [**Last Name (un) **] in the Asian [**Hospital 982**] Clinic with
[**First Name8 (NamePattern2) 8463**] [**Last Name (NamePattern1) 13260**] on [**5-13**] at 1:30 pm.  [**Last Name (un) **] will be contacting you
if there is a cancellation for you to see them earlier.

Please make sure to call your opthamologist and make a follow up
appointment at some point in the near future.  They will help
you set up this appointment when you see the diabetes doctor [**First Name8 (NamePattern2) **] [**Last Name (un) 4372**].

Please follow up with your primary care doctor Dr. [**First Name (STitle) **] [**Name (STitle) **] at
phone number [**Telephone/Fax (1) 8236**].  Call to make an appointment for
sometime in the next month.



Completed by:[**2194-4-17**]
{'Encounter for antineoplastic chemotherapy,Acute myeloid leukemia, without mention of having achieved remission,Other anaphylactic reaction,Urinary tract infection, site not specified,Viral hepatitis B without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta,Other and unspecified mycoses,Drug induced neutropenia,Unspecified essential hypertension,Hematoma complicating a procedure,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Accidents occurring in residential institution,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Other B-complex deficiencies,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Anemia in neoplastic disease,Diarrhea,Hypovolemia,Thrombocytopenia, unspecified,Other iatrogenic hypotension,Constipation, unspecified,Background diabetic retinopathy,Other specified disorders of biliary tract'}


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: dizziness

PRESENT ILLNESS: 78 yo Cantonese speaking male started noticing dizziness about 5
days ago. He felt a room spinning sensation with both standing
up and change in head position. He did not have any tinnitus,
hearing loss, ear pain or drainage, headache, visual changes,
focal neurological changes. He denies fevers, chills,
congestion, cough. He took a chinese herbal tea called "small
box tea" day before yesterday and then went to see his PCP
[**Name Initial (PRE) 1262**]. His PCP drew some labs and he was found to have
neutropenia and anemia and pt was asked to see PCP again today.
Over the last 2 days, his dizziness had been improving and
currently he does not have any dizziness anymore.
      Other than the herbal tea, he denies ingesting any other
over the counter or herbal medications. He does not get
medications from anyone other that his PCP and has been on the
same medications for years
    Other than recent dizziness he has not fallen ill in the
last few months, he does not have any sick contacts and has not
had any foreign travel. He denies easy bruising or bleeding
    He denies chest pain, shortness of breath, cough,
nausea/vomiting/diarrhea, deneis urinary symptoms

MEDICAL HISTORY: 1. Diabetes Mellitus

MEDICATION ON ADMISSION: 1. Doxazosin 2mg QHS
2. Aspirin 325mg QD
3. Metformin 1000mg [**Hospital1 **]
4. Glipizide 10mg [**Hospital1 **]
5. Lisinopril 10mg QD

ALLERGIES: Cytarabine

PHYSICAL EXAM: Physical Exam:
Appearance: NAD
Vitals: T:98.4 BP:103/64 HR:93 RR: 16 O2:99  %  RA
Eyes: EOMI, PERRL, conjunctiva clear, anicteric,
ENT: Moist
Neck: No JVD, no LAD
Cardiovascular: RRR, nl S1/S2, no m/r/g
Respiratory: CTA bilaterally, comfortable, no wheezing, no
ronchi, no rales
Gastrointestinal: soft, non-tender, non-distended, normal bowel
sounds
Musculoskeletal/Extremities: no clubbing, no cyanosis, no joint
swelling, no edema in the bilateral extremities
Neurological: Alert and oriented x3, fluent speech, no pronator
drift, no asterixis, sensation WNL, CNII-XII intact
Integument: warm, no rash, no ulcer
Psychiatric: appropriate, pleasant
Hematological/Lymphatic: No cervical, supraclavicular, axillary,
or inguinal lymphadenopathy
GU: no CVAT

FAMILY HISTORY: No one in family has hx of cancer/blood disorders

SOCIAL HISTORY: Lives with wife. Married for 30+ years. Denies smoking, alcohol
or drug use history ever. Denies hx of blood transfusion. Does
not have intercourse with anyone other than wife. 

### Response:
{'Encounter for antineoplastic chemotherapy,Acute myeloid leukemia, without mention of having achieved remission,Other anaphylactic reaction,Urinary tract infection, site not specified,Viral hepatitis B without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta,Other and unspecified mycoses,Drug induced neutropenia,Unspecified essential hypertension,Hematoma complicating a procedure,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Accidents occurring in residential institution,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Other B-complex deficiencies,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Anemia in neoplastic disease,Diarrhea,Hypovolemia,Thrombocytopenia, unspecified,Other iatrogenic hypotension,Constipation, unspecified,Background diabetic retinopathy,Other specified disorders of biliary tract'}
