CHIEF COMPLAINT: Hyponatremia

PRESENT ILLNESS: Mr. [**Known lastname 68759**] is a [**Age over 90 **] year old male with a history of chronic
hyponatremia attributed to SIADH, chronic bronchitis, moderate
aortic stenosis, htn who presents to the ED with complaints of
increased SOB.

MEDICAL HISTORY: # hyponatremia attributed to SIADH, (BL Na 125-131)
# chronic bronchitis
# Aortic stenosis (area 1.0-1.2cm2)
# Hypertension
# chronic diastolic CHF
# ? CAD
# anemia, ? MDS
# Zoster and postherpetic neuralgia
# History of peptic ulcer disease, H. pylori +
- unsure if he has been treated in past
- reports being following by Dr. [**First Name (STitle) 452**] in [**Hospital **] clinic
# s/p TURP
# Chronic bilateral rotator cuff tears
# skin cancer on L chin
# nasal polyposis

MEDICATION ON ADMISSION: Valsartan 100 mg PO DAILY
Foradil Aerolizer 12 mcg twice a day.
Docusate Sodium 100 mg [**Hospital1 **]
Ranitidine HCl 150 mg [**Hospital1 **]
Metoprolol Tartrate 50 mg [**Hospital1 **]
Albuterol Q6H as needed
Ipratropium Bromide Q6H
Clopidogrel 75 mg PO DAILY
Ocuvite 100-15-2-100 mg-unit-mg-mg Capsule once a day
Omeprazole 40 mg [**Hospital1 **]
Rosuvastatin 10 mg DAILY
Fluticasone Two Puffs [**Hospital1 **]
Acetaminophen 325 mg Q6H as needed.
Senna 8.6 mg [**Hospital1 **] as needed.
Lidocaine 5 %(700 mg/patch) Adhesive Patch, Topical DAILY
Isosorbide Mononitrate 60 mg PO DAILY
Bisacodyl 5 mg PO DAILY as needed
Alum-Mag Hydroxide-Simeth 200-200-20 mg/5 mL Q12H prn

ALLERGIES: Penicillins

PHYSICAL EXAM: T: 96 BP: 145/72 HR: 78 RR: O2 97% RA
elderly
circular erythematous macules over B UEs
JVP ~ 8 cm H20.
RRR. II/VI mid peaking <> murmur
CTAB
NABS. S/NT/ND.
WWP. No edema.
A+Ox3. CNs [**1-28**] intact. Moving all extremities.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Moved from [**Country 532**] 12 years ago to live in [**State 531**] City. Moved
to [**Location (un) 86**] 2 yrs ago because son lives here. Widowed, lives
alone. Very close to his son. [**Name (NI) **] walks with a cane. He smoked
during World War II but not since then. Denies alcohol use.
Other disorders of neurohypophysis,Chronic diastolic heart failure,Herpes zoster with other nervous system complications,Unspecified chronic bronchitis,Disorders of bursae and tendons in shoulder region, unspecified,Aortic valve disorders,Unspecified essential hypertension,Asthma, unspecified type, unspecified,Esophageal reflux,Anemia, unspecified,Coronary atherosclerosis of native coronary artery,Keratoderma, acquired,Personal history of peptic ulcer disease,Personal history of other malignant neoplasm of skin
Neurohypophysis dis NEC,Chr diastolic hrt fail,H zoster nerv syst NEC,Chronic bronchitis NOS,Rotator cuff synd NOS,Aortic valve disorder,Hypertension NOS,Asthma NOS,Esophageal reflux,Anemia NOS,Crnry athrscl natve vssl,Keratoderma, acquired,Prsnl hst peptic ulcr ds,Hx-skin malignancy NEC
Admission Date:  [**2200-12-12**]              Discharge Date:   [**2200-12-16**]


Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 898**]
Chief Complaint:
Hyponatremia

Major Surgical or Invasive Procedure:
None


History of Present Illness:
Mr. [**Known lastname 68759**] is a [**Age over 90 **] year old male with a history of chronic
hyponatremia attributed to SIADH, chronic bronchitis, moderate
aortic stenosis, htn who presents to the ED with complaints of
increased SOB.

Of note, he was recently admitted [**Date range (1) 68760**]/08 with epigastric
pain and atypical chest pain. He was ruled out for MI and
treated for GERD with PPI and Maalox and was scheduled for an
outpatient breath test for H pylori and close follow up with his
GI MD, Dr. [**First Name (STitle) 452**]. He was discharged to [**Hospital 100**] rehab. He was also
admitted in [**10/2200**] for hyponatremia in the setting of pna. At
that time he was treated with levofloxacin and 1500 cc fluid
restriction with improvement in Na back to his baseline.

Current history obtained with the aid of an interpreter and
through discussions with patient's son. On [**12-7**], patient fell
in the kitchen of his apartment. The fall seems to have been
mechanical without LOC seizure symptoms, CP, SOB, or dizziness.
At baseline he has B UE pain due to rotator cuff injuries.
However, after the fall, he had worse B UE pain. He was brought
to [**Hospital3 **] where he had X-rays which were negative for
fracture. He was then discharged to [**Hospital 100**] Rehab as son reported
significant decline in his level of independent function
including multiple falls over the last several months. It seems
he was discharged on a 1500 cc fluid restriction with
instructions to repeat Na in 1 week. Today, at rehab, patient
had routine labs drawn and were remarkable for Na 122. Per
report, patient was transferred to [**Hospital1 18**] for further evaluation
of hyponatremia.

In the ED, 96.0, 153/102, 64, 16, 98% RA. Patient interviewed
with aid of Russian interpreter. Mental status was felt to be at
most recent baseline. No seizures or other Neurologic changes
noted. Patient was without complaint with the exception of some
increased SOB and increased albuterol requirements. Labs
remarkable for Hct of 28 at most recent baseline, WBC of 10
without left shift, Na 116 (from BL of 125-131), BUN/Cr 17/0.8.
CXR was without significant abnormality.

On arrival to ICU, patient reports several days of icreased SOB.
He notes epigastric pain but denies any chest pressure. No
orthopnea or PND. No fevers or chills. 1 day of cough,
nonproductive. He notes significant B UE pain, including pain in
whole R arm, L arm from elbow to hand, and L thumb pain. He
denies any increased thirst or change in his regular po intake.


Past Medical History:
# hyponatremia attributed to SIADH, (BL Na 125-131)
# chronic bronchitis
# Aortic stenosis (area 1.0-1.2cm2)
# Hypertension
# chronic diastolic CHF
# ? CAD
# anemia, ? MDS
# Zoster and postherpetic neuralgia
# History of peptic ulcer disease, H. pylori +
- unsure if he has been treated in past
- reports being following by Dr. [**First Name (STitle) 452**] in [**Hospital **] clinic
# s/p TURP
# Chronic bilateral rotator cuff tears
# skin cancer on L chin
# nasal polyposis

Social History:
Moved from [**Country 532**] 12 years ago to live in [**State 531**] City. Moved
to [**Location (un) 86**] 2 yrs ago because son lives here. Widowed, lives
alone. Very close to his son. [**Name (NI) **] walks with a cane. He smoked
during World War II but not since then. Denies alcohol use.


Family History:
Noncontributory

Physical Exam:
T: 96 BP: 145/72 HR: 78 RR: O2 97% RA
elderly
circular erythematous macules over B UEs
JVP ~ 8 cm H20.
RRR. II/VI mid peaking <> murmur
CTAB
NABS. S/NT/ND.
WWP. No edema.
A+Ox3. CNs [**1-28**] intact. Moving all extremities.

Pertinent Results:
[**2200-12-12**] 03:45PM   GLUCOSE-100 UREA N-17 CREAT-0.8 SODIUM-116*
POTASSIUM-4.5 CHLORIDE-84* TOTAL CO2-25 ANION GAP-12
[**2200-12-12**] 03:45PM   CALCIUM-9.0 PHOSPHATE-4.3 MAGNESIUM-1.8
[**2200-12-12**] 03:45PM   OSMOLAL-247*
[**2200-12-12**] 03:45PM   WBC-10.2 RBC-3.50* HGB-10.7* HCT-28.5*
MCV-81* MCH-30.7 MCHC-37.7* RDW-13.8
[**2200-12-12**] 03:45PM   NEUTS-67.3 LYMPHS-26.8 MONOS-5.0 EOS-0.8
BASOS-0.1
[**2200-12-12**] 10:24PM   CORTISOL-6.6
[**2200-12-12**] 10:24PM   TSH-1.5
[**2200-12-12**] 10:24PM   CK-MB-NotDone cTropnT-<0.01
[**2200-12-12**] 10:24PM   CK(CPK)-59
[**2200-12-12**] 11:09PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0
LEUK-NEG
[**2200-12-12**] 11:09PM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.012

Studies:

ECG [**12-12**]: NSR @ 58. Nl axis and intervals. TWF in III. Compared
to prior, no sig change.

CXR [**12-12**]:
The lungs are well expanded. There is minimal atelectasis in the
retrocardiac left lung base; however, no consolidation or edema
is evident. There is minimal tortuosity of the thoracic aorta.
The cardiac silhouette size is borderline enlarged with a left
ventricular configuration. No effusion or pneumothorax is seen.
The visualized osseous structures are unremarkable.
IMPRESSION: Left base atelectasis, with no definite acute
pulmonary process.

Head CT [**12-12**]:
There is no acute intracranial hemorrhage. [**Doctor Last Name **]-white matter
differentiation is preserved. The ventricles and sulci are
slightly prominent, consistent with age-related involutional
changes. Punctate focus of mineralization is noted within the
left basal ganglia. The carotid siphons are heavily calcified.
Paranasal sinus disease has progressed from prior exam, with
moderate opacification of the ethmoidal air cells, sphenoid and
maxillary sinuses and fluid within the left mastoid air cells.
There is no calvarial fracture or soft tissue abnormality.
IMPRESSION:
1. No acute intracranial hemorrhage or calvarial fracture.
2. Progressed sinus disease, now moderate in extent.


Brief Hospital Course:
Mr. [**Known lastname 68759**] is a [**Age over 90 **] year old male with a history of chronic
hyponatremia attributed to SIADH, chronic bronchitis, moderate
aortic stenosis, htn admitted for hyponatremia.

# Hyponatremia: The patient has a history of chronic
hyponatremia secondary to SIADH. His baseline ranges from
125-130. On admission his Na was 116.  He did not appear to be
symptomatic.  He was placed on a 1.5 L water restriction and
started on salt tabs and his Na rose slowly.  By discharge his
Na had increased to 129. TSH and cortisol WNL. His CT head and
chest X-ray were unrevealing. He appeared euvolemic.  He had a
fall within the last month so pain may have triggered his
hyponatremia by increasing his ADH.  His pain was controlled
with standing tylenol and tramadol prn as below.  He was
discharged with a continued fluid restriction of 1500 cc/day,
salt tabs 2 gm po TID.

# SOB: The patient has a history of chronic bronchitis and had
subjective SOB on admission to the ICU. During his hospital
admission he was sating well on room air.  He remained afebrile
and his CXR was clear.  He was continued on fluticasone inhal
[**Hospital1 **] and given albuterol and atrovent nebs prn.

# Bilateral UE pain: The patient had a recent fall and was
admitted from rehab. He has known rotator cuff injuries. No
fractures by report from survey performed at [**Hospital3 **] after fall the fall.  His pain was controlled with
Tylenol 1 gm TID standing, ultram prn, and lidocaine patches.

# HTN: The patient was initally continued on his outpatient
regimen of metoprolol, isosorbide mononitrate, and valsartan.
His SBP were noted to be persistent elevated so his valsartan
was increased from 100 mg daily to 160 mg daily.

# Chronic diastolic CHF: The patient remained euvolemic during
his hospitalization.  He was continued on valsartan and
metoprolol.

# ? CAD: The paatient carries a history of CAD for unclear
reasons as he has never had a positive stress test nor cardiac
catheterization, has no WMA on ECHO and has no QWs on ECG.  He
was continued on his outpatient medications including plavix, a
statin, beta-blocker, and imdur.

# PUD:  The patient has a history of H pylori. Unclear if he was
treated.  He is scheduled for a breath test as an outpatient.
He was continued on his PPI [**Hospital1 **], ranitidine, and maalox prn.

# Anemia: The patient was anemia, but remained within his
basline Hct of 28-33 during his hospitalization.  On discharge
his Hct was stable at 28.6. He had no clinical evidence of
bleeding. Iron studies, B12, folate were normal when last
checked in 4/[**2199**].

# Rash/Itching: Per the son's report, the patient has a
significant eczema history and uses moisturizing cream [**Hospital1 **].
While here he complained of itching. A recent derm note
recommended hydroxyzine prn so he was started on this and was
continued on his home creams and moisturizers.

# Mouth pain: The patient reports that he has stomatitis and
mouth pain.  He was started on Gelclair 15 mL tid with some
relief.

# Skin cancer on L chin: The patient is scheduled for outpatient
follow up per son's report.

# CODE: FULL, confirmed with patient

Medications on Admission:
Valsartan 100 mg PO DAILY
Foradil Aerolizer 12 mcg twice a day.
Docusate Sodium 100 mg [**Hospital1 **]
Ranitidine HCl 150 mg [**Hospital1 **]
Metoprolol Tartrate 50 mg [**Hospital1 **]
Albuterol Q6H as needed
Ipratropium Bromide Q6H
Clopidogrel 75 mg PO DAILY
Ocuvite 100-15-2-100 mg-unit-mg-mg Capsule once a day
Omeprazole 40 mg [**Hospital1 **]
Rosuvastatin 10 mg DAILY
Fluticasone Two Puffs [**Hospital1 **]
Acetaminophen 325 mg Q6H as needed.
Senna 8.6 mg [**Hospital1 **] as needed.
Lidocaine 5 %(700 mg/patch) Adhesive Patch, Topical DAILY
Isosorbide Mononitrate 60 mg PO DAILY
Bisacodyl 5 mg PO DAILY as needed
Alum-Mag Hydroxide-Simeth 200-200-20 mg/5 mL Q12H prn

Discharge Medications:
1. Valsartan 160 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO TID (3
times a day).
3. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO TID (3
times a day).
4. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
[**12-19**] Adhesive Patch, Medicateds Topical QD (): Place where you
are experiencing pain.  Do no use more than 3 patches at one
time.  Use for 12 hours on and 12 hours off.
5. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q4H (every 4 hours) as needed.
6. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
7. Alum-Mag Hydroxide-Simeth 200-200-20 mg/5 mL Suspension Sig:
15-30 MLs PO QID (4 times a day) as needed.
8. Ocuvite  Oral
9. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
10. Omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO twice a day.
11. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
12. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
13. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
14. Rosuvastatin 10 mg Tablet Sig: One (1) Tablet PO once a day.

15. Fexofenadine 60 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
16. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical
[**Hospital1 **] (2 times a day) as needed.
17. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
18. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
19. Ipratropium Bromide 17 mcg/Actuation Aerosol Sig: Two (2)
Puff Inhalation every six (6) hours as needed.
20. Isosorbide Mononitrate 60 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO once a day.
21. Foradil Aerolizer 12 mcg Capsule, w/Inhalation Device Sig:
One (1) inh
inh Inhalation twice a day.
22. Hydroxyzine HCl 25 mg Tablet Sig: One (1) Tablet PO Q6H
(every 6 hours) as needed for itching.
Disp:*30 Tablet(s)* Refills:*0*
23. Sodium Chloride 1 gram Tablet Sig: Two (2) Tablet PO TID (3
times a day).
Disp:*180 Tablet(s)* Refills:*2*
24. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed.
Disp:*30 Tablet(s)* Refills:*0*
25. Oral Wound Care Products     Gel in Packet Sig: Fifteen (15)
ML Mucous membrane TID (3 times a day).
Disp:*1350 ML(s)* Refills:*2*


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - [**Location (un) 550**]

Discharge Diagnosis:
Primary -
Hyponatremia

Secondary -
Chronic bronchitis
Hypertension
Chronic diastolic CHF
Dry skin


Discharge Condition:
Stable


Discharge Instructions:
You were admitted to the hospital after a fall and found to have
hyponatremia (low sodium).  You were monitored in the ICU
initally.  You were placed on a fluid restriction of 1.5L per
day which you should continue to follow as an outpatient.  You
were also started on a salt tablet.

Changes to your medications:
1.  You should take 2 gm of salt three times daily.
2.  Your valsartan was increased to 160 mg daily for better
control of your blood pressure.
3.  You can take gelclair 15 ML three times daily as need for
mouth pain.
4.  You can take hydroxyzine 25 mg every 6 hours as needed for
itching.
5.  You should take tramadol 50 mg q4h prn for pain as needed.
You should also take 1000 mg of tylenol three times daily for
pain.
6.  You can take 15 mL of lactulose as needed for constipation.

Otherwise continue your outpatient medications as prescribed.

Go to the emergency room or call your primary doctor if you
experience fevers, chills, confusion, another fall, chest pain,
blood in your stool, or black stool.

Followup Instructions:
Please keep your previously scheduled appointments:

Provider: [**Name10 (NameIs) 2975**] [**Name8 (MD) 2976**], MD Phone:[**Telephone/Fax (1) 2977**]
Date/Time:[**2200-12-23**] 3:30
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 7937**], MD Phone:[**Telephone/Fax (1) 463**]
Date/Time:[**2201-1-7**] 9:15
Provider: [**First Name11 (Name Pattern1) 1877**] [**Last Name (NamePattern1) 1878**], M.D. Phone:[**Telephone/Fax (1) 435**]
Date/Time:[**2201-1-15**] 1:00



Completed by:[**2200-12-16**]
{'Other disorders of neurohypophysis,Chronic diastolic heart failure,Herpes zoster with other nervous system complications,Unspecified chronic bronchitis,Disorders of bursae and tendons in shoulder region, unspecified,Aortic valve disorders,Unspecified essential hypertension,Asthma, unspecified type, unspecified,Esophageal reflux,Anemia, unspecified,Coronary atherosclerosis of native coronary artery,Keratoderma, acquired,Personal history of peptic ulcer disease,Personal history of other malignant neoplasm of skin'}


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: Hyponatremia

PRESENT ILLNESS: Mr. [**Known lastname 68759**] is a [**Age over 90 **] year old male with a history of chronic
hyponatremia attributed to SIADH, chronic bronchitis, moderate
aortic stenosis, htn who presents to the ED with complaints of
increased SOB.

MEDICAL HISTORY: # hyponatremia attributed to SIADH, (BL Na 125-131)
# chronic bronchitis
# Aortic stenosis (area 1.0-1.2cm2)
# Hypertension
# chronic diastolic CHF
# ? CAD
# anemia, ? MDS
# Zoster and postherpetic neuralgia
# History of peptic ulcer disease, H. pylori +
- unsure if he has been treated in past
- reports being following by Dr. [**First Name (STitle) 452**] in [**Hospital **] clinic
# s/p TURP
# Chronic bilateral rotator cuff tears
# skin cancer on L chin
# nasal polyposis

MEDICATION ON ADMISSION: Valsartan 100 mg PO DAILY
Foradil Aerolizer 12 mcg twice a day.
Docusate Sodium 100 mg [**Hospital1 **]
Ranitidine HCl 150 mg [**Hospital1 **]
Metoprolol Tartrate 50 mg [**Hospital1 **]
Albuterol Q6H as needed
Ipratropium Bromide Q6H
Clopidogrel 75 mg PO DAILY
Ocuvite 100-15-2-100 mg-unit-mg-mg Capsule once a day
Omeprazole 40 mg [**Hospital1 **]
Rosuvastatin 10 mg DAILY
Fluticasone Two Puffs [**Hospital1 **]
Acetaminophen 325 mg Q6H as needed.
Senna 8.6 mg [**Hospital1 **] as needed.
Lidocaine 5 %(700 mg/patch) Adhesive Patch, Topical DAILY
Isosorbide Mononitrate 60 mg PO DAILY
Bisacodyl 5 mg PO DAILY as needed
Alum-Mag Hydroxide-Simeth 200-200-20 mg/5 mL Q12H prn

ALLERGIES: Penicillins

PHYSICAL EXAM: T: 96 BP: 145/72 HR: 78 RR: O2 97% RA
elderly
circular erythematous macules over B UEs
JVP ~ 8 cm H20.
RRR. II/VI mid peaking <> murmur
CTAB
NABS. S/NT/ND.
WWP. No edema.
A+Ox3. CNs [**1-28**] intact. Moving all extremities.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Moved from [**Country 532**] 12 years ago to live in [**State 531**] City. Moved
to [**Location (un) 86**] 2 yrs ago because son lives here. Widowed, lives
alone. Very close to his son. [**Name (NI) **] walks with a cane. He smoked
during World War II but not since then. Denies alcohol use. 

### Response:
{'Other disorders of neurohypophysis,Chronic diastolic heart failure,Herpes zoster with other nervous system complications,Unspecified chronic bronchitis,Disorders of bursae and tendons in shoulder region, unspecified,Aortic valve disorders,Unspecified essential hypertension,Asthma, unspecified type, unspecified,Esophageal reflux,Anemia, unspecified,Coronary atherosclerosis of native coronary artery,Keratoderma, acquired,Personal history of peptic ulcer disease,Personal history of other malignant neoplasm of skin'}
