CHIEF COMPLAINT: shortness of breath, ascites, fluid overload.

PRESENT ILLNESS: 78 yo male with frequent admssion for heart failure and anemia
returns again from rehab for dyspnea, anemia, and subjective
cough and chest pain. DC'd from hospital 1 week ago on PO
regiment of diuretics, now returns with swollen scrotum,
ascites, fluid overload.

MEDICAL HISTORY: -HTN
-CAD: CABG [**2140**], cath [**2151**] with patent lima-lad, occluded
svg-om, near occluded svg-rca
-CHF: TTE [**7-5**] with EF 35%, mild LVH and LV-HK, 2+MR, 4+TR
-Afib
-Cardiac cirrhosis: Requiring repeat sx paracenteses
-Chronic GIB [**3-2**] AVMs
-Colon polyps
-HBV
-CRI: cr 1.5-1.8
-Hypothyroidism
-OA

MEDICATION ON ADMISSION: Levothyroxine 150 mcg po daily
Spironolactone 50mg po daily
Furosemide 120mg po bid
Digoxin 125 mcg po q Mo/We/Fr
Albuterol/atrovent nebs
Senna 8.6 mg po bid
Docusate 100mg po bid
acetaminophen 325mg po q4-6 prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE:
Vitals -t 97.3; BP 94-105/47-53, 90-93% ra
General - frail, elderly male, no respiratory distress, sleeping
comfortably
HEENT: NC/AT, PERRL, EOMI without nystagmus, no scleral icterus

FAMILY HISTORY: Mother- HTN, ?died of MI; Father-83 yo and died of "old age"; no
FH of cancer

SOCIAL HISTORY: Originally from [**Country 3397**]. Previously living with wife in [**Name (NI) 3146**],
but has been at rehab since recent hospitalization. Quit smoking
15 years ago. Smoked 1 ppd x 40 years. No EtOH. Retired, but
used to work as a machinist. Unable to walk. Needs
wheelchair/walker to get around his house.
Cirrhosis of liver without mention of alcohol,Acute kidney failure, unspecified,Hyposmolality and/or hyponatremia,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Congestive heart failure, unspecified,Chronic kidney disease, unspecified,Atrial fibrillation,Anemia in chronic kidney disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Coronary atherosclerosis of native coronary artery,Unspecified acquired hypothyroidism,Aortocoronary bypass status
Cirrhosis of liver NOS,Acute kidney failure NOS,Hyposmolality,Hpt B chrn wo cm wo dlta,CHF NOS,Chronic kidney dis NOS,Atrial fibrillation,Anemia in chr kidney dis,Hy kid NOS w cr kid I-IV,Crnry athrscl natve vssl,Hypothyroidism NOS,Aortocoronary bypass
Admission Date:  [**2153-7-27**]              Discharge Date:   [**2153-7-30**]

Date of Birth:  [**2075-5-19**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 898**]
Chief Complaint:
shortness of breath, ascites, fluid overload.

Major Surgical or Invasive Procedure:
paracentesis x 2

History of Present Illness:
78 yo male with frequent admssion for heart failure and anemia
returns again from rehab for dyspnea, anemia, and subjective
cough and chest pain. DC'd from hospital 1 week ago on PO
regiment of diuretics, now returns with swollen scrotum,
ascites, fluid overload.

Past Medical History:
-HTN
-CAD: CABG [**2140**], cath [**2151**] with patent lima-lad, occluded
svg-om, near occluded svg-rca
-CHF: TTE [**7-5**] with EF 35%, mild LVH and LV-HK, 2+MR, 4+TR
-Afib
-Cardiac cirrhosis: Requiring repeat sx paracenteses
-Chronic GIB [**3-2**] AVMs
-Colon polyps
-HBV
-CRI: cr 1.5-1.8
-Hypothyroidism
-OA

Social History:
Originally from [**Country 3397**]. Previously living with wife in [**Name (NI) 3146**],
but has been at rehab since recent hospitalization. Quit smoking
15 years ago. Smoked 1 ppd x 40 years. No EtOH. Retired, but
used to work as a machinist. Unable to walk. Needs
wheelchair/walker to get around his house.


Family History:
Mother- HTN, ?died of MI; Father-83 yo and died of "old age"; no
FH of cancer

Physical Exam:
PE:
Vitals -t 97.3; BP 94-105/47-53, 90-93% ra
General - frail, elderly male, no respiratory distress, sleeping
comfortably
HEENT: NC/AT, PERRL, EOMI without nystagmus, no scleral icterus

noted, MMM, no lesions noted in OP, poor dentition
Neck: supple, + JVD
Pulmonary: crackles bilaterally at bases, very wheezy
Cardiac: RRR, nl. S1S2, holosystolic murmur RUSB
Abdomen: soft, NT, slightly distended, normoactive bowel sounds,

no masses or organomegaly noted. large umbilical hernia, scrotal
edema.
Extremities: 1+ edema to hips. + scrotal edema. Erythema on
shins b/l.


Pertinent Results:
[**2153-7-26**]
WBC-8.6 RBC-2.48* Hgb-7.2* Hct-23.1* MCV-93 MCH-29.2 MCHC-31.2
RDW-18.7* Plt Ct-379
Neuts-88.5* Bands-0 Lymphs-4.6* Monos-4.4 Eos-2.0 Baso-0.5
PT-11.9 PTT-29.1 INR(PT)-1.0
Glucose-131* UreaN-92* Creat-2.0* Na-131* K-5.5* Cl-97 HCO3-24
AnGap-16
CK(CPK)-119
CK-MB-13* MB Indx-10.9* cTropnT-0.20*
Calcium-7.5* Phos-4.7* Mg-3.1*
Digoxin-1.0
.
[**2153-7-27**]
WBC-8.3 RBC-2.88* Hgb-8.7* Hct-25.3* MCV-88 MCH-30.3 MCHC-34.6
RDW-18.6* Plt Ct-292
CK(CPK)-108
CK(CPK)-118
TropnT-0.20*
TropnT-0.20*
.
[**2153-7-28**] WBC-7.6 RBC-2.97* Hgb-8.8* Hct-27.0* MCV-91 MCH-29.5
MCHC-32.4 RDW-18.5* Plt Ct-346
.
[**2153-7-30**] WBC-10.5 RBC-3.01* Hgb-9.0* Hct-27.9* MCV-93 MCH-29.9
MCHC-32.3 RDW-18.3* Plt Ct-435
Glucose-124* UreaN-69* Creat-1.5* Na-132* K-5.0 Cl-100 HCO3-23
AnGap-14
.
[**2153-7-26**] ECG:Atrial fibrillation with a moderate ventricular
response. Right bundle-branch block. Loss of R waves in the
anteroseptal leads suggests old anteroseptal myocardial
infarction. Generalized low QRS voltage. Compared to the
previous tracing of [**2153-7-17**] no significant diagnostic change.
.
[**2153-7-26**] PORTABLE AP CHEST: Comparison is made to [**2153-7-17**].
Lung volumes remain low with worsening retrocardiac opacity. A
small left pleural effusion may be present. There is no evidence
of pneumothorax.
Patient is status post median sternotomy and CABG with an
unchanged enlarged cardiac silhouette. Pulmonary vascularity
appears stable and there is no evidence of overt edema. A
Port-A- Cath is in stable course and position.
.
IMPRESSION: Worsening retrocardiac opacity may represent
atelectasis however focal infectious consolidation cannot be
excluded. When clinically feasible, PA and lateral views would
help further evaluate.
.
[**2153-7-27**] 6:26 pm PERITONEAL FLUID      PERITONEAL FLUID .

   GRAM STAIN (Final [**2153-7-27**]):
      1+    (<1 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      NO MICROORGANISMS SEEN.
      This is a concentrated smear made by cytospin method,
please refer to
      hematology for a quantitative white blood cell count..

   FLUID CULTURE (Final [**2153-7-30**]):    NO GROWTH.

   ANAEROBIC CULTURE (Preliminary):    NO GROWTH.


Brief Hospital Course:
78M with CHF and longstanding cardiac cirrhosis presented with
repeated exacerbation of cardiac cirrhosis. Admitted to MICU for
paracentesis and hemodynamic monitoring, subsequently
transferred to floor for follow-up care. Pt presented on [**7-26**]
with exacerbated ascites severe enough to cause shortness of
breath and dyspnea. On [**7-27**] he underwent paracentesis with
removal of 4.3 liters of fluid (negative for SBP). His symptoms
drastically improved. On admission his diuretics were briefly
held for concern of renal failure, but were restarted on
transfer to the floor [**7-28**]. However, given his renal failure and
relative hyponatremia, his lasix dose was decreased and should
be titrated upwards with care. Urine output was acceptable
throughout. On [**7-30**] patient underwent regularly scheduled
paracentesis and was discharged back to his rehab facility.
.
With regards to his CHF, his digoxin level was 1.0 on admission.
Dig was held initially but restarted on the floor.
.
With regards to his DYSPNEA, his oxygen saturations have
remained normal off of supplemental oxygen. He denies SOB and
now speaks in complete sentences without breathlessness. His
crackles at lungh bases may represent transudative effusions
passing via diaphragm.
.
With regards to his ACUTE ON CHRONIC RENAL FAILURE, his baseline
is variable and fluctuates between 1 and 2. On admission, his
creatinine was 2.0, and on discharge it was 1.5. As mentioned,
he was never oliguric. His lasix and aldactone were restarted,
but lasix was continued at a lower dose than on admission.
.
With regards to his ANASARCA/EDEMA, he underwent 2 paracenteses,
on [**7-27**] and [**7-30**]. His perionteal fluid showed no evidence of SBP.
.
With regards to his ANEMIA, he received 2 units PRBCs in the
MICU with appropriate bump in Hct. His baseline Hct 24-28, and
on discharge it was stable at 27.9.
.
With regards to his HYPOTHYROIDISM, we continued his
levothyroxine 150 mcg po qd thoughout his stay.
.
With regards to his A-FIB, his rate was well controlled
throughout his stay. As with previous admissions, the decision
was made not to anticoagulate him based on his history of GI
bleeding from colonic AVMs.
.
With regards to his DELIRIUM, he briefly exhibited confused and
aggressive behavior in the MICU, and was placed on Abilify qd.
However, on transfer to the floor, no such behavior was noted,
and the medication will be d/c'ed on discharge.
.
He ate a regular diet, and minimal IVF was given for fear of
developing more ascites.
.
Prophylactically, he complained of constipation despite being on
Senna/Colace. We added bisacodyl 10mg po/pr qd and milk of
magnesia, with good effect. We continued his PPI. He was not
anticoagulated as mentioned above.
.
He continues to be DNR/DNI code status.

Medications on Admission:
Levothyroxine 150 mcg po daily
Spironolactone 50mg po daily
Furosemide 120mg po bid
Digoxin 125 mcg po q Mo/We/Fr
Albuterol/atrovent nebs
Senna 8.6 mg po bid
Docusate 100mg po bid
acetaminophen 325mg po q4-6 prn


Discharge Medications:
1. Levothyroxine 150 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Dextromethorphan-Guaifenesin 10-100 mg/5 mL Syrup Sig: [**6-7**]
MLs PO Q6H (every 6 hours) as needed for cough.
3. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
4. Zinc Sulfate 220 (50) mg Capsule Sig: One (1) Capsule PO
DAILY (Daily).
5. Maalox/Diphenhydramine/Lidocaine   Sig: Five (5) mL  three
times a day as needed for cough.
6. Ipratropium Bromide 0.02 % Solution Sig: One (1) Nebulizer
Inhalation Q6H (every 6 hours) as needed for shortness of breath
or wheezing.
7. Albuterol Sulfate 0.083 % (0.83 mg/mL) Solution Sig: One (1)
Nebulizer Inhalation Q6H (every 6 hours) as needed for shortness
of breath or wheezing.
8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
9. Spironolactone 25 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
10. Furosemide 20 mg Tablet Sig: Three (3) Tablet PO BID (2
times a day).
11. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO 3X/WEEK
(MO,WE,FR).
12. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
13. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
14. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
15. Trazodone 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime) as
needed for insomnia.
16. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed for constipation.


Discharge Disposition:
Extended Care

Facility:
[**Hospital 3145**] Nursing Home - [**Location (un) 3146**]

Discharge Diagnosis:
Cardiac Cirrhosis with chronic ascites
.
Other diagnoses:
-Coronary Artery Disease: 3 vessel bypass [**2140**], cath [**2151**] with
patent lima-lad, occluded
svg-om, near occluded svg-rca
-Congestive heart failure: echo [**7-5**] with ejection fraction 35%,
mild left vent hypertrophy, 2+ mitral regurg, 4+ tricuspid
regurg
-hypertension
-Atrial fibrillation - not on anticoag [**3-2**] prior gastrointesinal
bleeding
-Cardiac cirrhosis: Requiring repeat sx paracenteses
-Chronic Gastrointestinal bleeding [**3-2**] colonic angiodysplasias
-Colon polyps
-Lipids
-HBV positive
-Chronic Renal Insufficiency: creatinine 1.5-1.8
-Hypothyroidism - on T4
-osteoarthritis


Discharge Condition:
Improved, Stable


Discharge Instructions:
You were admitted to the hospital with swelling, fluid overload,
and shortness of breath. After your discharge, please continue
to take all your medicines as prescribed. If you experience any
difficulty breathing, abdominal pain, fevers, or other symptoms
that concern you, please call your doctor or go to the nearest
emergency room.
.
Weigh yourself every morning, call doctor if weight > 3 lbs.
Adhere to 2 gm sodium diet

Followup Instructions:
Please follow-up with your doctor in [**1-30**] weeks.
{'Cirrhosis of liver without mention of alcohol,Acute kidney failure, unspecified,Hyposmolality and/or hyponatremia,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Congestive heart failure, unspecified,Chronic kidney disease, unspecified,Atrial fibrillation,Anemia in chronic kidney disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Coronary atherosclerosis of native coronary artery,Unspecified acquired hypothyroidism,Aortocoronary bypass status'}


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: shortness of breath, ascites, fluid overload.

PRESENT ILLNESS: 78 yo male with frequent admssion for heart failure and anemia
returns again from rehab for dyspnea, anemia, and subjective
cough and chest pain. DC'd from hospital 1 week ago on PO
regiment of diuretics, now returns with swollen scrotum,
ascites, fluid overload.

MEDICAL HISTORY: -HTN
-CAD: CABG [**2140**], cath [**2151**] with patent lima-lad, occluded
svg-om, near occluded svg-rca
-CHF: TTE [**7-5**] with EF 35%, mild LVH and LV-HK, 2+MR, 4+TR
-Afib
-Cardiac cirrhosis: Requiring repeat sx paracenteses
-Chronic GIB [**3-2**] AVMs
-Colon polyps
-HBV
-CRI: cr 1.5-1.8
-Hypothyroidism
-OA

MEDICATION ON ADMISSION: Levothyroxine 150 mcg po daily
Spironolactone 50mg po daily
Furosemide 120mg po bid
Digoxin 125 mcg po q Mo/We/Fr
Albuterol/atrovent nebs
Senna 8.6 mg po bid
Docusate 100mg po bid
acetaminophen 325mg po q4-6 prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE:
Vitals -t 97.3; BP 94-105/47-53, 90-93% ra
General - frail, elderly male, no respiratory distress, sleeping
comfortably
HEENT: NC/AT, PERRL, EOMI without nystagmus, no scleral icterus

FAMILY HISTORY: Mother- HTN, ?died of MI; Father-83 yo and died of "old age"; no
FH of cancer

SOCIAL HISTORY: Originally from [**Country 3397**]. Previously living with wife in [**Name (NI) 3146**],
but has been at rehab since recent hospitalization. Quit smoking
15 years ago. Smoked 1 ppd x 40 years. No EtOH. Retired, but
used to work as a machinist. Unable to walk. Needs
wheelchair/walker to get around his house. 

### Response:
{'Cirrhosis of liver without mention of alcohol,Acute kidney failure, unspecified,Hyposmolality and/or hyponatremia,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Congestive heart failure, unspecified,Chronic kidney disease, unspecified,Atrial fibrillation,Anemia in chronic kidney disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Coronary atherosclerosis of native coronary artery,Unspecified acquired hypothyroidism,Aortocoronary bypass status'}
