CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 55-year-old
white male with a history of severe diabetes mellitus, status
post living-related renal transplant plus immunosuppression
who presented on [**2139-3-16**], with a 2-day history of
fever, nausea, vomiting, diarrhea, and decreased p.o. intake
in the setting of a nonproductive cough.  On admission the
patient was noted to be hemodynamically stable, satting at
97% on room air.  A chest CT performed on admission revealed
bilateral pulmonary infiltrates.  On [**3-19**], the patient
underwent bronchoscopy which yielded an aspirate that was
negative for PCP, [**Name10 (NameIs) **] [**Name Initial (NameIs) **] biopsy that has remained negative to
date.  The patient was started on azithromycin at that time
for presumed atypical pneumonia.  Over the course of the
following three days, serial chest x-rays revealed a
progression of the infiltrative process, and the patient's
antibiotic coverage was changed to Levaquin.  In addition, on
[**3-21**], his respiratory status continued to deteriorate
with a decline in oxygen saturation of 89% on 3 liters to 91%
on 4 liters.  On [**3-22**], he was satting 87% on 3 liters
and 90% to 92% on a nonrebreather.  A chest x-ray at that
time revealed a worsening interstitial process (congestive
heart failure versus acute respiratory distress syndrome),
and the patient was given Lasix 40 mg IV and transferred to
the medical intensive care unit for closer monitoring.  He
was also started on ceftriaxone for gram-negative coverage.
Over the past 36 hours there has been notable in the
patient's clinical picture; that is, with regard to his
respiratory function, and he has been able to ambulate;
although, he still has persistent low-grade fevers.

MEDICAL HISTORY: The patient's past medical history is
notable for a 27-year history of insulin-dependent diabetes
mellitus combined with severe triopathy.  His past medical
history is also notable for hypertension, retinopathy with
bilateral blindness, gastroparesis, neuropathy with no
sensation below the knees, autonomic neuropathy with
orthostatic hypotension.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Pneumonia, organism unspecified,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Kidney replaced by transplant,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere
Pneumonia, organism NOS,CHF NOS,Acute kidney failure NOS,Hyp kid NOS w cr kid V,Kidney transplant status,DMII renl nt st uncntrld,Nephritis NOS in oth dis
Admission Date:  [**2139-3-16**]     Discharge Date:  [**2139-3-26**]

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

Service:  Medicine, [**Hospital1 **] Firm

Dictating for:  [**First Name8 (NamePattern2) **] [**Name8 (MD) **], M.D.

HISTORY OF PRESENT ILLNESS:   The patient is a 55-year-old
white male with a history of severe diabetes mellitus, status
post living-related renal transplant plus immunosuppression
who presented on [**2139-3-16**], with a 2-day history of
fever, nausea, vomiting, diarrhea, and decreased p.o. intake
in the setting of a nonproductive cough.  On admission the
patient was noted to be hemodynamically stable, satting at
97% on room air.  A chest CT performed on admission revealed
bilateral pulmonary infiltrates.  On [**3-19**], the patient
underwent bronchoscopy which yielded an aspirate that was
negative for PCP, [**Name10 (NameIs) **] [**Name Initial (NameIs) **] biopsy that has remained negative to
date.  The patient was started on azithromycin at that time
for presumed atypical pneumonia.  Over the course of the
following three days, serial chest x-rays revealed a
progression of the infiltrative process, and the patient's
antibiotic coverage was changed to Levaquin.  In addition, on
[**3-21**], his respiratory status continued to deteriorate
with a decline in oxygen saturation of 89% on 3 liters to 91%
on 4 liters.  On [**3-22**], he was satting 87% on 3 liters
and 90% to 92% on a nonrebreather.  A chest x-ray at that
time revealed a worsening interstitial process (congestive
heart failure versus acute respiratory distress syndrome),
and the patient was given Lasix 40 mg IV and transferred to
the medical intensive care unit for closer monitoring.  He
was also started on ceftriaxone for gram-negative coverage.
Over the past 36 hours there has been notable in the
patient's clinical picture; that is, with regard to his
respiratory function, and he has been able to ambulate;
although, he still has persistent low-grade fevers.

PAST MEDICAL HISTORY:  The patient's past medical history is
notable for a 27-year history of insulin-dependent diabetes
mellitus combined with severe triopathy.  His past medical
history is also notable for hypertension, retinopathy with
bilateral blindness, gastroparesis, neuropathy with no
sensation below the knees, autonomic neuropathy with
orthostatic hypotension.

PAST SURGICAL HISTORY:   His past surgical history is notable
for his living-related renal transplant in [**2131-1-9**].
He is also status post lymphocele drainage and ureteral

reimplantation in [**2131-5-10**], and he is also status post
nephrostomy tube placement in [**2131-5-10**].

PHYSICAL EXAMINATION:  On physical examination upon transfer,
his vitals were as follows.  He had temperature current
of 100.1, a heart rate of 104, a respiratory rate of 24, a
blood pressure of 180/90.  He was satting 91% on room air, 3
liters nasal cannula.  In general, he appeared nontoxic and
in no apparent distress.  His head, ears, nose, eyes and
throat examination was notable for ptosis of the left eye;
however, his pupils were equal, round and reactive to light.
His skin examination revealed multiple raised red papules
with dry serous discharge and hemorrhagic crust.  His oral
mucosa was moist and pink.  Cardiac examination was notable
for a normal S1 and S2.  No murmurs, gallops or rubs.
Pulmonary examination revealed positive bowel sounds, mild
crackles at the bases.  His abdomen was soft, nontender, and
nondistended.  His extremity examination was normal with no
cyanosis, clubbing or edema, and no calf tenderness.

LABORATORY:  His laboratory values were notable for a
hematocrit of 26.4, a chloride level of 15, and a BUN of 71,
and a creatinine of 2.5 with a glucose of 181.  All of these
abnormalities were in the process of improving at the time of
his evaluation, in comparison to the laboratory values noted
when he was in the medical intensive care unit.

To date, on admission, microbiology work revealed negative
blood cultures, negative urine, negative cryptococcal
antigen, and a negative toxoplasma serology.  He did have a
positive EBV, IgG; however, the IgM was negative.  Pathology
revealed no anaerobes, and the AFB smear was negative, and so
were fungal cultures.  His urine revealed no eosinophils.

He had an echocardiogram done on [**3-23**] which revealed
left atrial left atrial enlargement, 5, and mild-to-moderate
regional left ventricular systolic dysfunction with an
ejection fraction of 40%.  His echocardiogram also revealed
anteroseptal akinesis and apical akinesis as well.  Trivial
mitral regurgitation and a small pericardial effusion were
also noted on the echocardiogram performed on [**3-23**].

Chest x-ray revealed no changes in the infiltrative process
noted on his admission films.

HOSPITAL COURSE BY SYSTEM:

1.  PULMONARY:  At the time that the patient was transferred
he was in a state of clinical improvement, and no definitive
infectious etiology was noted.  The patient was continued on
a regimen of ceftriaxone and levofloxacin.  On post transfer
date two, the patient was satting 100% on room air and
breathing quite comfortably with continued improvement in his
pulmonary function.  The origin of the patient's acute
pulmonary disease was still of unknown etiology, but it was
believed to be either viral versus atypical pneumonia.  On
day three post transfer, no nebulizer treatments were
necessary.  The patient continued to improve clinically.  He
exhibited no shortness of breath and was breathing very
comfortably on room air.  It is important to note that the
patient is at increased risk for infection given his current
immunosuppressive regimen of prednisone and cyclosporin given
his LLRT (i.e. living-related renal transplant).

2.  CARDIAC:  The patient's blood pressure was managed
effectively with Procardia and Pravachol.  On admission,
given the abnormalities noted on the patient's
echocardiogram, he was scheduled to follow up with
Dr. [**First Name (STitle) 805**] for further cardiac management given the
findings consistent with mild congestive heart failure on
chest x-ray in addition to the abnormal findings on
echocardiogram.

3.  INFECTIOUS DISEASE:  With regard to infectious disease
issues, on post transfer day two, the patient was on day 7
out of 10 for Levaquin, and his ceftriaxone was discontinued
at that time.  Infectious disease consultation stated that
the patient should go home on a 10 to 14-day course of
levofloxacin.  Although [**Female First Name (un) **] was noted on a
bronchoalveolar lavage performed earlier in the [**Hospital 228**]
hospital course, it was infectious disease's belief that it
simply reflected a contaminant and was not a primary source
for the patient's condition; and thus, there was no treatment
necessary for this positive finding of [**Female First Name (un) **].

4.  RENAL/FLUIDS/ELECTROLYTES/NUTRITION:   The patient's
electrolyte balance was managed with repletion as needed.
Although an elevated BUN and creatinine were noted earlier in
the [**Hospital 228**] hospital course, it continued to improve during
the latter part of his hospitalization; more specifically,
upon transfer to the medical floor.  His Foley was
discontinued on transfer day two, and the patient produced
good urine output.  He will be continued on cyclosporin and
prednisone as immunosuppression for his transplant.  Renal
consultation recommended Lasix for the patient's mild left
lower extremity edema, and the patient does note however that
he follows his edema closely and currently takes Lasix 20 mg
q.d. every two days as needed.  Thus, no further management
was necessary at this time.

CONDITION AT DISCHARGE:  The patient was discharged in stable
condition on [**2139-3-25**].  Per infectious disease
consultation, the patient was treated on an outpatient basis
with levofloxacin for 10 to 14 days.


MEDICATIONS ON DISCHARGE:
 1.  Cyclosporin 200 mg p.o. b.i.d.
 2.  Prednisone 5 mg p.o. q.d.
 3.  Midodrine 10 mg p.o. t.i.d.
 4.  Levofloxacin 250 mg p.o. q.d. times 10 to 14 days.
 5.  Pravachol 40 mg p.o. q.d.
 6.  Procardia-XL 60 mg p.o. q.d.
 7.  Neurontin 300 mg p.o. b.i.d.
 8.  Niferex 150 mg p.o. q.d.
 9.  Bicitra 30 cc p.o. t.i.d.
10.  NPH 32 units in the a.m., 13 units in the p.m.
11.  Regular insulin sliding-scale as needed.

DISCHARGE DIAGNOSIS:  Pneumonia.



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

Dictated By:[**Last Name (NamePattern1) 20610**]

MEDQUIST36

D:  [**2139-4-2**]  17:28
T:  [**2139-4-4**]  04:46
JOB#:  [**Job Number 20611**]
{'Pneumonia, organism unspecified,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Kidney replaced by transplant,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere'}


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 55-year-old
white male with a history of severe diabetes mellitus, status
post living-related renal transplant plus immunosuppression
who presented on [**2139-3-16**], with a 2-day history of
fever, nausea, vomiting, diarrhea, and decreased p.o. intake
in the setting of a nonproductive cough.  On admission the
patient was noted to be hemodynamically stable, satting at
97% on room air.  A chest CT performed on admission revealed
bilateral pulmonary infiltrates.  On [**3-19**], the patient
underwent bronchoscopy which yielded an aspirate that was
negative for PCP, [**Name10 (NameIs) **] [**Name Initial (NameIs) **] biopsy that has remained negative to
date.  The patient was started on azithromycin at that time
for presumed atypical pneumonia.  Over the course of the
following three days, serial chest x-rays revealed a
progression of the infiltrative process, and the patient's
antibiotic coverage was changed to Levaquin.  In addition, on
[**3-21**], his respiratory status continued to deteriorate
with a decline in oxygen saturation of 89% on 3 liters to 91%
on 4 liters.  On [**3-22**], he was satting 87% on 3 liters
and 90% to 92% on a nonrebreather.  A chest x-ray at that
time revealed a worsening interstitial process (congestive
heart failure versus acute respiratory distress syndrome),
and the patient was given Lasix 40 mg IV and transferred to
the medical intensive care unit for closer monitoring.  He
was also started on ceftriaxone for gram-negative coverage.
Over the past 36 hours there has been notable in the
patient's clinical picture; that is, with regard to his
respiratory function, and he has been able to ambulate;
although, he still has persistent low-grade fevers.

MEDICAL HISTORY: The patient's past medical history is
notable for a 27-year history of insulin-dependent diabetes
mellitus combined with severe triopathy.  His past medical
history is also notable for hypertension, retinopathy with
bilateral blindness, gastroparesis, neuropathy with no
sensation below the knees, autonomic neuropathy with
orthostatic hypotension.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Pneumonia, organism unspecified,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Kidney replaced by transplant,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere'}
