CHIEF COMPLAINT: Tranferred from rehab for replacement of J tube and elevated
creatinine

PRESENT ILLNESS: The patient is a 65 yo F with multiple medical problems
including HTN/DM/PVD, recent chylothorax, pancreatitis s/p
necrosectomy, s/p trach and PEG whose recent hospitalization was
from [**2125-7-13**] - [**2125-9-28**]. She was sent to rehab and is coming in
today with a rising creatinine and malpositioned J tube.
.
Briefly, the patient originally presented to [**Hospital1 18**] in [**2125-5-15**]
for a repair of an innominate aterial aneurysm. She was
discharged to rehab but returned on [**2125-6-14**] with respiratory
distress and sepsis. During this hospital course she had a PEA
arrest, inferior MI, and upper extremity DVT. She was ultimately
transferred to [**Hospital1 **] on [**2125-6-29**] on a 4 week course of
daptomycin for VRE/MRSA infection. She was readmitted to [**Hospital1 18**]
on [**2125-7-12**] after being found to have new neurological symptoms.
Eventually, she was diagnosed with severe brain injury. She had
a number of complications during this hospital course. She
developed a chylothroax and required multiple procedures
including a right VATS, thoracic duct [**Last Name (LF) 94710**], [**First Name3 (LF) **] duct
embolization, talc pleurodesis, and decortication. She was
trach'd and PEG'd on [**2125-8-8**]. She unfortunately the developed
near total pancraetic necrosis that required pancreatic
debridement and necrosectomy and abdominal drainage of numerous
absecesses. She was bacteremia on pressors at numerous points
during her hospital course. She was discharged to [**Hospital1 **] again
on [**2125-9-28**] with plans to complete a 14 day course of daptomycin
for VRE/MRSA and continue weaning from the vent if possible.
.
While at [**Hospital1 **], the patient continued to have full body
anasarca and was aggressively diuresed with a rise in her
creatine over time from 0.9 to 3.4. Prior to transfer to [**Hospital1 18**]
her lasix was being held. Also, her PEG jeujunostomy tube came
out and reposition was attempted. She was transferred to [**Hospital1 18**]
for replacement of her peg jeujunostomy tube.

MEDICAL HISTORY: -- DM2
-- chronic foot ulcers/PVD
-- HTN
-- Osteoarthritis
-- Obesity
-- Asthma
-- leg pain/neuropathy
-- Depression
-- Anemia
-- h/o MRSA bacteremia [**11-18**], also septic arthritis
-- Right thalamic hemorrhage resulting in a gait disorder and
incontinence of urine, followed by Dr. [**Last Name (STitle) **].
-- Hypercholesterolemia.
-- Right VATS and thoracic duct ligation [**2125-7-20**]
-- Thoracic duct embolization and talc pleurodesis [**2125-7-27**]
-- Tracheostomy and percutaneous endoscopic gastrostomy [**2125-8-8**]

MEDICATION ON ADMISSION: Mucomyst nebs [**Hospital1 **]
Vitamin C 500mg [**Hospital1 **]
Bacitracin to the PEG site
Colace 100mg [**Hospital1 **]
Advair HFA 1 puff [**Hospital1 **]
Heparin SQ TID
Regular ISS
Synthroid 50mcg via PEG daily
MVI daily
Accuzyme topically daily to the wounds
Beneprotein 1 scoop daily
Senna daily
Zinc sulfate 220mg via tube daily
Tylenol 650mg PRN
Atrovent and Albuterol q2 PRN
Aspirin 325mg daily
Dulcolax 10mL PR daily
Glycerine suppository PR PRN
Lactulose 20grams daily PRN
Reglan 10mg via tube q4 PRN
Nitroglycerin PRN
Seroquel 12.5mg q12 PRN - has not needed at [**Hospital1 **]

ALLERGIES: Penicillins / Linezolid / Morphine / Oxycodone

PHYSICAL EXAM: Vitals - HR89 BP 144/32 RR16 O298% on Vent FIO2 100%
General - obese african american female, lying in bed
HEENT - PERRL, patient not following commands
Neck - trach in place
CV - regular rate, distant heart sounds
Lungs - clear to auscultation bilaterally
Abdomen - obese, G/J tube in place; large midline incision with
VAC (healing well, no signs of infection)
Ext - + edema

FAMILY HISTORY: Brother died of an MI in his 30's, she denies diabetes mellitus
in the family. Cancer in parents (mother died in 40s, father in
80s), at least two siblings, but unsure what kind.

SOCIAL HISTORY: Currently living at [**Hospital1 **] after a prolong hospital course.
Has seven children, many grandchildren.
Unspecified septicemia,Acute respiratory failure,Acute kidney failure, unspecified,Unspecified protein-calorie malnutrition,Urinary tract infection, site not specified,Anoxic brain damage,Hemorrhage of gastrointestinal tract, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Severe sepsis,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site,Thrombocytopenia, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Dehydration,Morbid obesity,Tracheostomy status
Septicemia NOS,Acute respiratry failure,Acute kidney failure NOS,Protein-cal malnutr NOS,Urin tract infection NOS,Anoxic brain damage,Gastrointest hemorr NOS,Hyp kid NOS w cr kid V,End stage renal disease,Severe sepsis,Proteus infection NOS,Thrombocytopenia NOS,Chr blood loss anemia,Dehydration,Morbid obesity,Tracheostomy status
Admission Date:  [**2125-10-23**]              Discharge Date:   [**2125-11-5**]

Date of Birth:  [**2060-7-29**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins / Linezolid / Morphine / Oxycodone

Attending:[**First Name3 (LF) 338**]
Chief Complaint:
Tranferred from rehab for replacement of J tube and elevated
creatinine

Major Surgical or Invasive Procedure:
[**10-26**] J tube placement
Arterial line
Midline PICC

History of Present Illness:
The patient is a 65 yo F with multiple medical problems
including HTN/DM/PVD, recent chylothorax, pancreatitis s/p
necrosectomy, s/p trach and PEG whose recent hospitalization was
from [**2125-7-13**] - [**2125-9-28**]. She was sent to rehab and is coming in
today with a rising creatinine and malpositioned J tube.
.
Briefly, the patient originally presented to [**Hospital1 18**] in [**2125-5-15**]
for a repair of an innominate aterial aneurysm. She was
discharged to rehab but returned on [**2125-6-14**] with respiratory
distress and sepsis. During this hospital course she had a PEA
arrest, inferior MI, and upper extremity DVT. She was ultimately
transferred to [**Hospital1 **] on [**2125-6-29**] on a 4 week course of
daptomycin for VRE/MRSA infection. She was readmitted to [**Hospital1 18**]
on [**2125-7-12**] after being found to have new neurological symptoms.
Eventually, she was diagnosed with severe brain injury. She had
a number of complications during this hospital course. She
developed a chylothroax and required multiple procedures
including a right VATS, thoracic duct [**Last Name (LF) 94710**], [**First Name3 (LF) **] duct
embolization, talc pleurodesis, and decortication. She was
trach'd and PEG'd on [**2125-8-8**]. She unfortunately the developed
near total pancraetic necrosis that required pancreatic
debridement and necrosectomy and abdominal drainage of numerous
absecesses. She was bacteremia on pressors at numerous points
during her hospital course. She was discharged to [**Hospital1 **] again
on [**2125-9-28**] with plans to complete a 14 day course of daptomycin
for VRE/MRSA and continue weaning from the vent if possible.
.
While at [**Hospital1 **], the patient continued to have full body
anasarca and was aggressively diuresed with a rise in her
creatine over time from 0.9 to 3.4. Prior to transfer to [**Hospital1 18**]
her lasix was being held. Also, her PEG jeujunostomy tube came
out and reposition was attempted. She was transferred to [**Hospital1 18**]
for replacement of her peg jeujunostomy tube.


Past Medical History:
-- DM2
-- chronic foot ulcers/PVD
-- HTN
-- Osteoarthritis
-- Obesity
-- Asthma
-- leg pain/neuropathy
-- Depression
-- Anemia
-- h/o MRSA bacteremia [**11-18**], also septic arthritis
-- Right thalamic hemorrhage resulting in a gait disorder and
incontinence of urine, followed by Dr. [**Last Name (STitle) **].
-- Hypercholesterolemia.
-- Right VATS and thoracic duct ligation [**2125-7-20**]
-- Thoracic duct embolization and talc pleurodesis [**2125-7-27**]
-- Tracheostomy and percutaneous endoscopic gastrostomy [**2125-8-8**]

-- Exploratory laparotomy, pancreatic necrosectomy, gastrostomy
tube [**2125-8-22**]
-- Exploratory laparotomy, abdominal wash out [**2125-8-23**]
-- Exploratory lap, takedown gastrostomy, debride necrotic
pancreas and multiple retroperitoneal abscesses [**2125-8-25**]
-- Abdominal closure and vac dressing application [**2125-8-26**]
-- Left thoracotomy and decortication, flexible bronchoscopy
[**2125-9-19**]
-- Aorto innominate and left carotid bypass [**2125-5-22**]
-- Left carotid to left subclavian bypass using 8 mm PTFE and
thoracic aortic stent graft placement [**2125-5-23**]


Social History:
Currently living at [**Hospital1 **] after a prolong hospital course.
Has seven children, many grandchildren.

Family History:
Brother died of an MI in his 30's, she denies diabetes mellitus
in the family. Cancer in parents (mother died in 40s, father in
80s), at least two siblings, but unsure what kind.


Physical Exam:
Vitals - HR89 BP 144/32 RR16 O298% on Vent FIO2 100%
General - obese african american female, lying in bed
HEENT - PERRL, patient not following commands
Neck - trach in place
CV - regular rate, distant heart sounds
Lungs - clear to auscultation bilaterally
Abdomen - obese, G/J tube in place; large midline incision with
VAC (healing well, no signs of infection)
Ext - + edema


Pertinent Results:
Admission labs:
[**2125-10-23**] 06:17PM BLOOD WBC-13.1* RBC-3.19*# Hgb-9.7* Hct-28.1*
MCV-88 MCH-30.5 MCHC-34.6 RDW-16.0* Plt Ct-67*
[**2125-10-23**] 06:17PM BLOOD Neuts-95* Bands-5 Lymphs-0 Monos-0 Eos-0
Baso-0 Atyps-0 Metas-0 Myelos-0
[**2125-10-23**] 06:17PM BLOOD PT-13.7* PTT-30.5 INR(PT)-1.2*
[**2125-10-23**] 06:17PM BLOOD Glucose-144* UreaN-160* Creat-3.6*#
Na-138 K-4.2 Cl-99 HCO3-20* AnGap-23*
[**2125-10-25**] 07:10PM BLOOD ALT-63* AST-47* LD(LDH)-297* CK(CPK)-16*
AlkPhos-484* TotBili-0.3
[**2125-10-25**] 07:10PM BLOOD CK-MB-NotDone cTropnT-0.41*
[**2125-10-26**] 04:20AM BLOOD CK-MB-NotDone cTropnT-0.37*
[**2125-10-26**] 04:20AM BLOOD CK(CPK)-17*
[**2125-10-23**] 06:17PM BLOOD Calcium-9.8 Phos-5.0* Mg-2.8*
[**2125-10-24**] 10:19AM BLOOD Type-ART pO2-146* pCO2-31* pH-7.39
calTCO2-19* Base XS--4
[**2125-10-26**] 04:24AM BLOOD Lactate-1.0
[**2125-10-26**] 04:24AM BLOOD freeCa-1.16

Hospital course labs:
[**2125-11-4**] 04:50AM BLOOD WBC-8.5 RBC-3.42* Hgb-10.3* Hct-29.9*
MCV-88 MCH-30.0 MCHC-34.3 RDW-16.0* Plt Ct-45*
[**2125-11-4**] 04:50AM BLOOD Plt Ct-45*
[**2125-11-1**] 04:26AM BLOOD PT-13.7* PTT-30.1 INR(PT)-1.2*
[**2125-11-4**] 04:50AM BLOOD Glucose-124* UreaN-169* Creat-5.4*
Na-146* K-4.3 Cl-114* HCO3-14* AnGap-22*
[**2125-10-30**] 04:12AM BLOOD ALT-29 AST-13 LD(LDH)-227 AlkPhos-275*
Amylase-41 TotBili-0.3
[**2125-10-30**] 04:12AM BLOOD Lipase-68*
[**2125-11-4**] 04:50AM BLOOD Calcium-8.6 Phos-4.0 Mg-2.4
[**2125-10-30**] 04:12AM BLOOD Albumin-2.0* Calcium-8.7 Phos-4.0 Mg-2.2
[**2125-10-31**] 06:08PM BLOOD TSH-31*
[**2125-10-31**] 06:08PM BLOOD Free T4-0.53*
[**2125-10-29**] 05:43PM BLOOD Cortsol-43.8*
[**2125-10-29**] 04:54PM BLOOD Cortsol-41.4*
[**2125-10-29**] 04:31PM BLOOD Cortsol-25.2*
[**2125-10-27**] 01:53PM BLOOD Type-ART Temp-36.2 Rates-/28 FiO2-50
pO2-90 pCO2-34* pH-7.20* calTCO2-14* Base XS--13
Intubat-INTUBATED
[**2125-11-2**] 10:07AM BLOOD Type-ART pO2-138* pCO2-31* pH-7.30*
calTCO2-16* Base XS--9
[**2125-10-28**] 04:55AM BLOOD Lactate-3.2*
[**2125-11-2**] 10:07AM BLOOD Lactate-1.2

Brief Hospital Course:
65yo F c complex medical history, who is s/p a prolonged
hospital course complicated by sepsis, pancreatic necrosis
requiring pancreatic necrosectomy, and cylothorax requiring
numerous surgical procedures, presented from rehab with
malpositioned J tube and an elevated creatinine. She was
admitted to the MICU because she was chronically
ventilated/trached. Her J tube was replaced by IR on [**10-26**]
without compications. She had limited to no cognative response
during her MICU course. During her complicated MICU course, she
developed worsening renal failure and a GI bleed along with a
rising WBC count and hypotension. After many family discussions
including with her HCP daughter, it was decided to not escalate
care on [**11-2**].  On [**11-5**] the family decided to make her DNR/DNI
and begin comfort care. Her vent was turned to room air settings
with minimal pressure support. She was started on a morphine
drip and the patient passed away.  Family requested autopsy.

Her course was complicated by the following:

# Respiratory Failure - s/p trach in [**7-21**]. She had difficulty
weaning off the vent at rehab and was continued to be 24 hour
vent dependent at the time of transfer to [**Hospital1 18**].

# ID - s/p course of Synercid, Meropenem, and Caspofungin
(finished on [**2125-10-5**]) prior to hospitalization. Patient likely
colonized with multiple resistant organisms. WBC recently
declined on Meropenem for Proteus UTI and was started on bactrim
on [**2125-10-31**] for Stenotrophomonas infection. She developed
proteus UTI and pneumonia along with MRSA pneumonia. She had a
pleural vac inplace on admission which had fluid draining which
was growing VRE and MRSA. She was on vanco and meropenem. She
still had an abdominal vac inplace s/p pancreatic surgery.

# ARF - Etiology likely prerenal and progressed to ATN. She
continued to have rising creatinine and uremia. Renal consult
was called and many discussions were held regarding the utility
of hemodialysis for her.  Ultimately, it was decided on [**2125-11-2**]
with HCP daughter not to escalate care. In addition, it was felt
by the renal consult team and the primary team that HD was not
medically indiacated given poor prognosis and lack of bridge to
intermittent HD.

# Anemia - Patient required several units of PRBCs to keep HCT
above 21. During her hospitalization she began to pass clots per
her rectum. GI was consulted and it was decided that the risk of
endoscopy was greater than the benefits at that time.

# Hypothyroid - continued synthroid and increased dose and gave
it IV as her TSH was above 30 and it was thought that her GI
absorption was very poor.

# Diabetes - continued insulin

# skin - several areas of breakdown without signs of infection.

FEN - tube feeds
PPx - PPI, bowel regimen
Access - midline, a-line, EJ
Code - DNR, no pressors; family meeting again on [**2125-11-2**]-
family decided to not escalate care. Will continue current care.
If patient decompensates, will call family and change to
morphine and ativan to help keep her comfortable and will stop
all other care.
Contact - daughter/HCP, [**Name (NI) **] [**Name (NI) 1557**] Cell [**Telephone/Fax (1) 94711**]; home -
[**Telephone/Fax (1) 94712**]

.


Medications on Admission:
Mucomyst nebs [**Hospital1 **]
Vitamin C 500mg [**Hospital1 **]
Bacitracin to the PEG site
Colace 100mg [**Hospital1 **]
Advair HFA 1 puff [**Hospital1 **]
Heparin SQ TID
Regular ISS
Synthroid 50mcg via PEG daily
MVI daily
Accuzyme topically daily to the wounds
Beneprotein 1 scoop daily
Senna daily
Zinc sulfate 220mg via tube daily
Tylenol 650mg PRN
Atrovent and Albuterol q2 PRN
Aspirin 325mg daily
Dulcolax 10mL PR daily
Glycerine suppository PR PRN
Lactulose 20grams daily PRN
Reglan 10mg via tube q4 PRN
Nitroglycerin PRN
Seroquel 12.5mg q12 PRN - has not needed at [**Hospital1 **]


Discharge Medications:
none

Discharge Disposition:
Expired

Discharge Diagnosis:
expired

Discharge Condition:
expired

Discharge Instructions:
none

Followup Instructions:
none


Completed by:[**2125-12-13**]
{'Unspecified septicemia,Acute respiratory failure,Acute kidney failure, unspecified,Unspecified protein-calorie malnutrition,Urinary tract infection, site not specified,Anoxic brain damage,Hemorrhage of gastrointestinal tract, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Severe sepsis,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site,Thrombocytopenia, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Dehydration,Morbid obesity,Tracheostomy 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: Tranferred from rehab for replacement of J tube and elevated
creatinine

PRESENT ILLNESS: The patient is a 65 yo F with multiple medical problems
including HTN/DM/PVD, recent chylothorax, pancreatitis s/p
necrosectomy, s/p trach and PEG whose recent hospitalization was
from [**2125-7-13**] - [**2125-9-28**]. She was sent to rehab and is coming in
today with a rising creatinine and malpositioned J tube.
.
Briefly, the patient originally presented to [**Hospital1 18**] in [**2125-5-15**]
for a repair of an innominate aterial aneurysm. She was
discharged to rehab but returned on [**2125-6-14**] with respiratory
distress and sepsis. During this hospital course she had a PEA
arrest, inferior MI, and upper extremity DVT. She was ultimately
transferred to [**Hospital1 **] on [**2125-6-29**] on a 4 week course of
daptomycin for VRE/MRSA infection. She was readmitted to [**Hospital1 18**]
on [**2125-7-12**] after being found to have new neurological symptoms.
Eventually, she was diagnosed with severe brain injury. She had
a number of complications during this hospital course. She
developed a chylothroax and required multiple procedures
including a right VATS, thoracic duct [**Last Name (LF) 94710**], [**First Name3 (LF) **] duct
embolization, talc pleurodesis, and decortication. She was
trach'd and PEG'd on [**2125-8-8**]. She unfortunately the developed
near total pancraetic necrosis that required pancreatic
debridement and necrosectomy and abdominal drainage of numerous
absecesses. She was bacteremia on pressors at numerous points
during her hospital course. She was discharged to [**Hospital1 **] again
on [**2125-9-28**] with plans to complete a 14 day course of daptomycin
for VRE/MRSA and continue weaning from the vent if possible.
.
While at [**Hospital1 **], the patient continued to have full body
anasarca and was aggressively diuresed with a rise in her
creatine over time from 0.9 to 3.4. Prior to transfer to [**Hospital1 18**]
her lasix was being held. Also, her PEG jeujunostomy tube came
out and reposition was attempted. She was transferred to [**Hospital1 18**]
for replacement of her peg jeujunostomy tube.

MEDICAL HISTORY: -- DM2
-- chronic foot ulcers/PVD
-- HTN
-- Osteoarthritis
-- Obesity
-- Asthma
-- leg pain/neuropathy
-- Depression
-- Anemia
-- h/o MRSA bacteremia [**11-18**], also septic arthritis
-- Right thalamic hemorrhage resulting in a gait disorder and
incontinence of urine, followed by Dr. [**Last Name (STitle) **].
-- Hypercholesterolemia.
-- Right VATS and thoracic duct ligation [**2125-7-20**]
-- Thoracic duct embolization and talc pleurodesis [**2125-7-27**]
-- Tracheostomy and percutaneous endoscopic gastrostomy [**2125-8-8**]

MEDICATION ON ADMISSION: Mucomyst nebs [**Hospital1 **]
Vitamin C 500mg [**Hospital1 **]
Bacitracin to the PEG site
Colace 100mg [**Hospital1 **]
Advair HFA 1 puff [**Hospital1 **]
Heparin SQ TID
Regular ISS
Synthroid 50mcg via PEG daily
MVI daily
Accuzyme topically daily to the wounds
Beneprotein 1 scoop daily
Senna daily
Zinc sulfate 220mg via tube daily
Tylenol 650mg PRN
Atrovent and Albuterol q2 PRN
Aspirin 325mg daily
Dulcolax 10mL PR daily
Glycerine suppository PR PRN
Lactulose 20grams daily PRN
Reglan 10mg via tube q4 PRN
Nitroglycerin PRN
Seroquel 12.5mg q12 PRN - has not needed at [**Hospital1 **]

ALLERGIES: Penicillins / Linezolid / Morphine / Oxycodone

PHYSICAL EXAM: Vitals - HR89 BP 144/32 RR16 O298% on Vent FIO2 100%
General - obese african american female, lying in bed
HEENT - PERRL, patient not following commands
Neck - trach in place
CV - regular rate, distant heart sounds
Lungs - clear to auscultation bilaterally
Abdomen - obese, G/J tube in place; large midline incision with
VAC (healing well, no signs of infection)
Ext - + edema

FAMILY HISTORY: Brother died of an MI in his 30's, she denies diabetes mellitus
in the family. Cancer in parents (mother died in 40s, father in
80s), at least two siblings, but unsure what kind.

SOCIAL HISTORY: Currently living at [**Hospital1 **] after a prolong hospital course.
Has seven children, many grandchildren. 

### Response:
{'Unspecified septicemia,Acute respiratory failure,Acute kidney failure, unspecified,Unspecified protein-calorie malnutrition,Urinary tract infection, site not specified,Anoxic brain damage,Hemorrhage of gastrointestinal tract, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Severe sepsis,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site,Thrombocytopenia, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Dehydration,Morbid obesity,Tracheostomy status'}
