CHIEF COMPLAINT: fever, dehydration

PRESENT ILLNESS: 59 yo endstage multiple myeloma s/p auto BMT ('[**71**]), failed VAD
chemothx x 4, thalidomide, velcaide (most recently in [**3-26**]),
recently hospitalized (d/c [**7-13**]) for pneumonia now presenting
with fever and dehydration.

MEDICAL HISTORY: 1.	multiple myeloma.  Not yet ready for hospice but has
preferred supportive management.
2.	fracture of spine in [**2168**], did not receive fixation.
3.	s/p knee arthroscopy.
4.	skin lesions (ak vs. sq. cell). Bx??????d postponed by derm b/c
neutropenia

MEDICATION ON ADMISSION: MEDICATIONS CONTINUED ON DISCHARGE FROM HOME
1.	Decadron 40mg biw
2.	procrit q thurs
3.	zometa q thurs
4.	fentanyl patch 75mcg to be changed tonight.
5.	nystatin s&s
6.	vit b12 x 2 qd
7.	tums 1 [**Hospital1 **]
8.	compazine prn nausea
9.	Tylenol prn fever
10.     Levofloxacin 500 mg Tablet
11.     Metronidazole 500 mg Tablet

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS 102.2 118 24-28 94% on NC+partial mask
Pupils constricted but reactive b/l.  No LAD.  No oral lesions.
Chest with loud rhonchi and wheezing throughout all lung fields.
 Heart regular with
pansystolic murmur radiating to axilla.  No peripheral edema.
Abdomen soft nt nd with splenomegaly.  No CVA, paraspinal,
spinal tenderness. Extremities warm and well perfused.

FAMILY HISTORY: non contributory

SOCIAL HISTORY: Lives with wife in [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 669**]. Former mechanic for [**Location (un) **].
Son is police offier in [**Location (un) **].  No EtOH. No IVDU.
Multiple myeloma, without mention of having achieved remission,Pneumonia, organism unspecified,Other pulmonary embolism and infarction,Complications of transplanted bone marrow,Acute respiratory failure,Tachycardia, unspecified,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Mult mye w/o achv rmson,Pneumonia, organism NOS,Pulm embol/infarct NEC,Compl marrow transplant,Acute respiratry failure,Tachycardia NOS,Abn react-org transplant
Admission Date:  [**2175-7-15**]              Discharge Date:   [**2175-7-19**]

Date of Birth:  [**2116-6-23**]             Sex:   M

Service: OMED

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 8810**]
Chief Complaint:
fever, dehydration

Major Surgical or Invasive Procedure:
none

History of Present Illness:
59 yo endstage multiple myeloma s/p auto BMT ('[**71**]), failed VAD
chemothx x 4, thalidomide, velcaide (most recently in [**3-26**]),
recently hospitalized (d/c [**7-13**]) for pneumonia now presenting
with fever and dehydration.



Past Medical History:
1.	multiple myeloma.  Not yet ready for hospice but has
preferred supportive management.
2.	fracture of spine in [**2168**], did not receive fixation.
3.	s/p knee arthroscopy.
4.	skin lesions (ak vs. sq. cell). Bx??????d postponed by derm b/c
neutropenia


Social History:
Lives with wife in [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 669**]. Former mechanic for [**Location (un) **].
Son is police offier in [**Location (un) **].  No EtOH. No IVDU.


Family History:
non contributory

Physical Exam:
VS 102.2 118 24-28 94% on NC+partial mask
Pupils constricted but reactive b/l.  No LAD.  No oral lesions.
Chest with loud rhonchi and wheezing throughout all lung fields.
 Heart regular with
pansystolic murmur radiating to axilla.  No peripheral edema.
Abdomen soft nt nd with splenomegaly.  No CVA, paraspinal,
spinal tenderness. Extremities warm and well perfused.


Pertinent Results:
CT CHEST
Interval development of multiple predominantly upper lobe,
poorly defined
nodules, some of which demonstrate central lucency, possibly
reflecting
cavitation or a bronchogram given motion artifact. The
differential diagnosis
includes invasive Aspergillus, nocardia, and septic emboli.
Striking, diffuse, bilateral dependent areas of ground glass
opacity which
spare the anterior/nondependent portions of the lungs and are
associated with
bronchial dilation. The distribution is suggestive of ARDS,
which may
complicate infection. Diffuse atypical infection and drug
toxicity are also in
the differential diagnosis.


Brief Hospital Course:
Pt was treated in the ICU for difficulty maintaining adequate
oxygen saturation.  Pt's family chose to make patient DNR/DNI
but to continue antibiotic treatment of pneumonia and blood
product support.  He was transferred to BMT service where his
discomfort with breathing was treated with morphine for comfort,
antibiotics were continued and blood product support was
continued. Patient expired while on BMT service with family by
his side.

Medications on Admission:
MEDICATIONS CONTINUED ON DISCHARGE FROM HOME
1.	Decadron 40mg biw
2.	procrit q thurs
3.	zometa q thurs
4.	fentanyl patch 75mcg to be changed tonight.
5.	nystatin s&s
6.	vit b12 x 2 qd
7.	tums 1 [**Hospital1 **]
8.	compazine prn nausea
9.	Tylenol prn fever
10.     Levofloxacin 500 mg Tablet
11.     Metronidazole 500 mg Tablet


Discharge Medications:
n/a

Discharge Disposition:
Home

Discharge Diagnosis:
respiratory failure secondary to pneumonia secondary to multiple
myeloma

Discharge Condition:
n/a


Completed by:[**2175-7-23**]
{'Multiple myeloma, without mention of having achieved remission,Pneumonia, organism unspecified,Other pulmonary embolism and infarction,Complications of transplanted bone marrow,Acute respiratory failure,Tachycardia, unspecified,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: fever, dehydration

PRESENT ILLNESS: 59 yo endstage multiple myeloma s/p auto BMT ('[**71**]), failed VAD
chemothx x 4, thalidomide, velcaide (most recently in [**3-26**]),
recently hospitalized (d/c [**7-13**]) for pneumonia now presenting
with fever and dehydration.

MEDICAL HISTORY: 1.	multiple myeloma.  Not yet ready for hospice but has
preferred supportive management.
2.	fracture of spine in [**2168**], did not receive fixation.
3.	s/p knee arthroscopy.
4.	skin lesions (ak vs. sq. cell). Bx??????d postponed by derm b/c
neutropenia

MEDICATION ON ADMISSION: MEDICATIONS CONTINUED ON DISCHARGE FROM HOME
1.	Decadron 40mg biw
2.	procrit q thurs
3.	zometa q thurs
4.	fentanyl patch 75mcg to be changed tonight.
5.	nystatin s&s
6.	vit b12 x 2 qd
7.	tums 1 [**Hospital1 **]
8.	compazine prn nausea
9.	Tylenol prn fever
10.     Levofloxacin 500 mg Tablet
11.     Metronidazole 500 mg Tablet

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS 102.2 118 24-28 94% on NC+partial mask
Pupils constricted but reactive b/l.  No LAD.  No oral lesions.
Chest with loud rhonchi and wheezing throughout all lung fields.
 Heart regular with
pansystolic murmur radiating to axilla.  No peripheral edema.
Abdomen soft nt nd with splenomegaly.  No CVA, paraspinal,
spinal tenderness. Extremities warm and well perfused.

FAMILY HISTORY: non contributory

SOCIAL HISTORY: Lives with wife in [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 669**]. Former mechanic for [**Location (un) **].
Son is police offier in [**Location (un) **].  No EtOH. No IVDU. 

### Response:
{'Multiple myeloma, without mention of having achieved remission,Pneumonia, organism unspecified,Other pulmonary embolism and infarction,Complications of transplanted bone marrow,Acute respiratory failure,Tachycardia, unspecified,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
