CHIEF COMPLAINT: nausea/vomiting

PRESENT ILLNESS: 63 year olf female with history of DMII, CAD, CVA s/p recent
hospitalization for GIB, UTI presents within one day of
returning home from rehab with nausea, vomiting. In ED, her
emesis and stool were black, her hct was 32 (baseline 30) and
she was hemodynamically stable (hypertensive). Of note she was
scoped 1 week ago, colonoscopy showed 2 polyps that were removed
and EGD showed gastritis with no active bleeding. She complains
of vomiting x 1 day and nausea for past several days. She does
not know the color of her stool/emesis as she is blind. SHe
denies abdominal pain, chest pain, SOB, palps, dysuria.
In the ED, hypertensive to 180s/100s. Hct 32. She had an AG of
16. ABG was 7.46/42/185. Groin line place b/c unable to get
peripherals. Got 2L IVF, Cipro and Flagyl. On arrival to [**Hospital Unit Name 153**]
she was given insulin 10 units IV and started on insulin drip
for her diabetic ketosis. Her ECG showed TWI in lateral leads,
CKs were flat, trop 0.04. She was given metoprolol 5 IV and her
BP improved.

MEDICAL HISTORY: HTN
DMII
Hyperlipidemia
h/o CVA w/ residual L sided hemiparesis
CAD- w/ stent '[**86**] and '[**89**]
Asthma
Rheumatic fever
Femoral Bypass - [**1-15**] complication of most recent cath
Asthma - last hospitalization mult years ago, uses rescue
albuterol inhaler 1-2 times per week
migraine headaches - tx with vicodin or tylenol
Breast Cancer - node negative (surgery only, no chemo, no rad)
Degenerative Disk Disease
Osteoarthritis
Osteoporosis
GERD

MEDICATION ON ADMISSION: coumadin 5mg qHS
- Coreg 6.25mg [**Hospital1 **]
- plavix 75mg qD
- zyrtec 10mg qHS
- senna 2 tab [**Hospital1 **] PRN
- ocean nasal spray 2 spray TID
- glucophage 850mg qAM, 500 qPM
- lisinopril 40mg qD
- prilosec 20mg [**Hospital1 **]
- lasix 40mg qD
- neurontin 300mg qD
- welchol 625mg [**Hospital1 **]
- compazine 25mg PR q12h PRN

ALLERGIES: Aspirin / Nifedipine / Premarin / Morphine / Crestor /
Atorvastatin / Codeine

PHYSICAL EXAM: Physical Exam on Admission:
VS: 98 182/108 80 [**11-28**] 100% 5LNC
HEENT: dry MM, no elevated JVP
Cor: RRR no MRG
LUNGS: clear
ABD: soft/NT/ND/+BS
NEURO: Appropriate, oriented, speaking in full sentences, pupils
not reactive (hard to tell)
EXT: 1+ pedeal pulses on R, 2+ on L

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: lives alone at home [**Location (un) 6409**]; wheelchair bound s/p CVA; no
h/o ETOH or tobacco use
Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Acute kidney failure, unspecified,Thrombocytopenia, unspecified,Infection and inflammatory reaction due to indwelling urinary catheter,Urinary tract infection, site not specified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure
Hemorrhage complic proc,Ac posthemorrhag anemia,Acute kidney failure NOS,Thrombocytopenia NOS,React-indwell urin cath,Urin tract infection NOS,Hypertension NOS,DMII wo cmp nt st uncntr,Pure hypercholesterolem,Abn react-urinary cath
Admission Date:  [**2195-12-3**]              Discharge Date:   [**2195-12-10**]

Date of Birth:  [**2132-11-18**]             Sex:   F

Service: MEDICINE

Allergies:
Aspirin / Nifedipine / Premarin / Morphine / Crestor /
Atorvastatin / Codeine

Attending:[**First Name3 (LF) 2932**]
Chief Complaint:
nausea/vomiting

Major Surgical or Invasive Procedure:
colonoscopy


History of Present Illness:
63 year olf female with history of DMII, CAD, CVA s/p recent
hospitalization for GIB, UTI presents within one day of
returning home from rehab with nausea, vomiting. In ED, her
emesis and stool were black, her hct was 32 (baseline 30) and
she was hemodynamically stable (hypertensive). Of note she was
scoped 1 week ago, colonoscopy showed 2 polyps that were removed
and EGD showed gastritis with no active bleeding. She complains
of vomiting x 1 day and nausea for past several days. She does
not know the color of her stool/emesis as she is blind. SHe
denies abdominal pain, chest pain, SOB, palps, dysuria.
In the ED, hypertensive to 180s/100s. Hct 32. She had an AG of
16. ABG was 7.46/42/185. Groin line place b/c unable to get
peripherals. Got 2L IVF, Cipro and Flagyl. On arrival to [**Hospital Unit Name 153**]
she was given insulin 10 units IV and started on insulin drip
for her diabetic ketosis. Her ECG showed TWI in lateral leads,
CKs were flat, trop 0.04. She was given metoprolol 5 IV and her
BP improved.

Past Medical History:
HTN
DMII
Hyperlipidemia
h/o CVA w/ residual L sided hemiparesis
CAD- w/ stent '[**86**] and '[**89**]
Asthma
Rheumatic fever
Femoral Bypass - [**1-15**] complication of most recent cath
Asthma - last hospitalization mult years ago, uses rescue
albuterol inhaler 1-2 times per week
migraine headaches - tx with vicodin or tylenol
Breast Cancer - node negative (surgery only, no chemo, no rad)
Degenerative Disk Disease
Osteoarthritis
Osteoporosis
GERD

Social History:
lives alone at home [**Location (un) 6409**]; wheelchair bound s/p CVA; no
h/o ETOH or tobacco use


Family History:
non-contributory

Physical Exam:
Physical Exam on Admission:
VS: 98 182/108 80 [**11-28**] 100% 5LNC
HEENT: dry MM, no elevated JVP
Cor: RRR no MRG
LUNGS: clear
ABD: soft/NT/ND/+BS
NEURO: Appropriate, oriented, speaking in full sentences, pupils
not reactive (hard to tell)
EXT: 1+ pedeal pulses on R, 2+ on L

Pertinent Results:
Laboratory studies on admission:
[**2195-12-3**]
WBC-12.7 HGB-11.7 HCT-32.1 MCV-81 RDW-14.0 PLT COUNT-149
NEUTS-87.8 LYMPHS-10.0 MONOS-2.1 EOS-0.1 BASOS-0
CK-MB-NotDone cTropnT-0.04
GLUCOSE-446 UREA N-33 CREAT-1.3 SODIUM-145 POTASSIUM-3.6
CHLORIDE-99 TOTAL CO2-30
PT-11.9 PTT-24.6 INR(PT)-1.0

Laboratory studies on discharge:
[**2195-12-10**]
WBC-6.8 Hgb-10.4 Hct-29.2 MCV-82 RDW-13.9 Plt Ct-131
Neuts-62.3 Lymphs-27.4 Monos-7.6 Eos-2.6 Baso-0.2
PT-11.8 PTT-25.0 INR(PT)-1.0
Glucose-172 UreaN-12 Creat-1.0 Na-144 K-3.7 Cl-105 HCO3-33

[**12-3**] EKG: Sinus rhythm. No significant change from the tracing
of [**2195-9-26**]. The tracing continues to show left ventricular
hypertrophy by voltage in lead aVL and non-specific ST-T wave
abnormalities which may be due in part to the left ventricular
hypertrophy.

Radiology
[**12-3**] CXR: No evidence of cardiopulmonary process.

[**12-6**] bleeding scan: No GI bleeding focus identified.

Endoscopy:
[**12-8**] colonoscopy: Grade 2 internal hemorrhoids. Polyps in the
sigmoid colon and ascending colon

[**11-24**] colonoscopy: Polyp in the proximal ascending colon
(polypectomy, path c/w adenoma). Polyp in the descending
colon/40cm (polypectomy, path c/w hyperplastic). Diverticulosis
of the sigmoid colon and distal descending colon. Grade 1
internal hemorrhoids.

[**11-24**] upper endoscopy: Patchy discontinuous erythema of the
mucosa with no bleeding was noted in the stomach body and
antrum. These findings are compatible with Gastritis. Cold
forceps biopsies were performed for histology at the stomach
antrum (normal pathology)


Brief Hospital Course:
63 year old female with type II diabetes presents with
nausea/vomiting/melena. She was initially admitted to the
intensive care unit, where she became hypotensive and  her HCT
dropped to 23. She was transfused 2 units of PRBC and
transferred to the general medical floor on the evening of
[**2195-12-5**].

1) GI bleeding/acute blood loss anemia: The melena/coffee-ground
emesis on admission was most likely secondary to gastritis
versus possible [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] tear in the setting of vomiting
(possibly from gastroparesis versus gastroenteritis). As
indicated above, she received 2 units of PRBC in the intensive
care unit. GI was consulted, who did not recommend repeat EGD,
given recent EGD [**2195-11-24**] (see results section). She remained
stable until [**2195-12-6**], when she had bright red blood per rectum
and a hematocrit drop to 25. She was transfused 2 units of PRBC
along with 1 unit of platelets given thrombocytopenia (see
below) with stabilization of her hematocrit. She underwent a
bleeding scan, which was negative. On the evening of [**12-7**], she
had another episode of BRBPR; she was prepped for a colonoscopy,
which she underwent [**12-8**]. Although the preparation was poor, no
bleeding source was identified. The GI service felt that her
rectal bleeding was most likely from her [**11-24**] polypectomy
sites. At the time of discharge, her hematocrit was stable at
29, despite re-initiation of Plavix. She will follow-up with
gastroenterology as an outpatient and have a repeat hematocrit
checked within 1 week. She was continued on a PPI twice a day
for gastritis.

3) Type II diabetes poorly controlled with complications: The
patient had previously been on 22 units of lantus with a sliding
scale in [**9-/2195**], recently switched to metformin alone. As
mentioned above, she was briefly on an insulin drip while in the
ICU given concern for DKA. At time of discharge, her blood
sugars were well-controlled on metformin alone.

4) UTI: The patient's urine culture grew >100k E. coli resistant
to quinolones, sensitive to ceftriaxone. She will complete a 7
day course of cefpodoxime.

5) Thrombocytopenia: The patient's platelet count nadired at 84,
rising to 133 at time of discharge. The etiology is unclear, but
it may have been related to acute illness. Her fibrinogen/PT/PTT
were not consistent with DIC and HIT antibody was negative. Her
platelet count should be monitored as an outpatient; if
thrombocytopenia persists, an outpatient hematology consult may
be considered at the discretion of her PCP.

6) h/o CVA: No embolic source had been identified during her
prior admission, but she had been started on coumadin and
Plavix, although her INR was only 1 on admission. Her
neurological exam remained stable, and she was restarted on
Plavix as indicated above. She will have a repeat hematocrit
checked within 1 week; if she remains stable, her coumadin can
be restarted by her PCP for [**Name Initial (PRE) **] goal INR 2-2.5.

7) CAD: The patient's EKG showed lateral ST depressions on
admissions, however cardiac enzymes were not consistent with
active ischemia. She was continued on beta-blocker and, as
mentioned above, Plavix was restarted by the time of discharge.

8) HTN: The patient's blood pressure remained labile. At time of
discharge, she had been restarted on her home doses of Coreg,
Lasix, and lisinopril.

9) Full Code

Medications on Admission:
 coumadin 5mg qHS
- Coreg 6.25mg [**Hospital1 **]
- plavix 75mg qD
- zyrtec 10mg qHS
- senna 2 tab [**Hospital1 **] PRN
- ocean nasal spray 2 spray TID
- glucophage 850mg qAM, 500 qPM
- lisinopril 40mg qD
- prilosec 20mg [**Hospital1 **]
- lasix 40mg qD
- neurontin 300mg qD
- welchol 625mg [**Hospital1 **]
- compazine 25mg PR q12h PRN


Discharge Medications:
1. Carvedilol 6.25 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*0*
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
3. Metformin 850 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)).
Disp:*30 Tablet(s)* Refills:*0*
4. Metformin 500 mg Tablet Sig: One (1) Tablet PO QPM (once a
day (in the evening)).
Disp:*30 Tablet(s)* Refills:*0*
5. Lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
6. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO twice a day.
Disp:*60 Capsule, Delayed Release(E.C.)(s)* Refills:*0*
7. Cefpodoxime 100 mg Tablet Sig: Two (2) Tablet PO Q12H (every
12 hours) for 5 days.
Disp:*20 Tablet(s)* Refills:*0*
8. Colesevelam 625 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*0*
9. Neurontin 300 mg Capsule Sig: One (1) Capsule PO once a day.

10. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
11. Cetirizine 10 mg Tablet Sig: One (1) Tablet PO qHS ().
Disp:*30 Tablet(s)* Refills:*0*
12. Compazine 25 mg Suppository Sig: One (1) suppository Rectal
twice a day as needed for nausea.
Disp:*30 suppositories* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Primary: gastrointestinal bleeding
Secondary: acute blood loss anemia, hypertension, Type II
diabetes well-controlled with complications, thrombocytopenia,
hypercholesterolemia, urinary tract infection, history of stroke


Discharge Condition:
Good


Discharge Instructions:
1) Please follow-up as indicated below
2) Please take all medications as prescribed. You should not
restart coumadin until instructed to do so by your PCP. [**Name10 (NameIs) **] will
take 5 more days of cepodoxime to treat the urinary tract
infection.
3) Please come to the emergency room or see your PCP if you
develop rectal bleeding, nausea/vomiting, black stool, fevers,
chills, or other symptoms that concern you.

Followup Instructions:
1) Primary Care
Provider: [**Name10 (NameIs) **] [**Name10 (NameIs) **], RNC Date/Time:[**2195-12-18**] 10:00
- you should have a repeat hematocrit and platelet count checked
at that time to ensure stability
2) Gastroenterology
Provider: [**Name10 (NameIs) **],[**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] WEST OFFICE (SB)
Date/Time:[**2195-12-30**] 1:30


                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 2937**]

Completed by:[**2195-12-10**]
{'Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Acute kidney failure, unspecified,Thrombocytopenia, unspecified,Infection and inflammatory reaction due to indwelling urinary catheter,Urinary tract infection, site not specified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}


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: nausea/vomiting

PRESENT ILLNESS: 63 year olf female with history of DMII, CAD, CVA s/p recent
hospitalization for GIB, UTI presents within one day of
returning home from rehab with nausea, vomiting. In ED, her
emesis and stool were black, her hct was 32 (baseline 30) and
she was hemodynamically stable (hypertensive). Of note she was
scoped 1 week ago, colonoscopy showed 2 polyps that were removed
and EGD showed gastritis with no active bleeding. She complains
of vomiting x 1 day and nausea for past several days. She does
not know the color of her stool/emesis as she is blind. SHe
denies abdominal pain, chest pain, SOB, palps, dysuria.
In the ED, hypertensive to 180s/100s. Hct 32. She had an AG of
16. ABG was 7.46/42/185. Groin line place b/c unable to get
peripherals. Got 2L IVF, Cipro and Flagyl. On arrival to [**Hospital Unit Name 153**]
she was given insulin 10 units IV and started on insulin drip
for her diabetic ketosis. Her ECG showed TWI in lateral leads,
CKs were flat, trop 0.04. She was given metoprolol 5 IV and her
BP improved.

MEDICAL HISTORY: HTN
DMII
Hyperlipidemia
h/o CVA w/ residual L sided hemiparesis
CAD- w/ stent '[**86**] and '[**89**]
Asthma
Rheumatic fever
Femoral Bypass - [**1-15**] complication of most recent cath
Asthma - last hospitalization mult years ago, uses rescue
albuterol inhaler 1-2 times per week
migraine headaches - tx with vicodin or tylenol
Breast Cancer - node negative (surgery only, no chemo, no rad)
Degenerative Disk Disease
Osteoarthritis
Osteoporosis
GERD

MEDICATION ON ADMISSION: coumadin 5mg qHS
- Coreg 6.25mg [**Hospital1 **]
- plavix 75mg qD
- zyrtec 10mg qHS
- senna 2 tab [**Hospital1 **] PRN
- ocean nasal spray 2 spray TID
- glucophage 850mg qAM, 500 qPM
- lisinopril 40mg qD
- prilosec 20mg [**Hospital1 **]
- lasix 40mg qD
- neurontin 300mg qD
- welchol 625mg [**Hospital1 **]
- compazine 25mg PR q12h PRN

ALLERGIES: Aspirin / Nifedipine / Premarin / Morphine / Crestor /
Atorvastatin / Codeine

PHYSICAL EXAM: Physical Exam on Admission:
VS: 98 182/108 80 [**11-28**] 100% 5LNC
HEENT: dry MM, no elevated JVP
Cor: RRR no MRG
LUNGS: clear
ABD: soft/NT/ND/+BS
NEURO: Appropriate, oriented, speaking in full sentences, pupils
not reactive (hard to tell)
EXT: 1+ pedeal pulses on R, 2+ on L

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: lives alone at home [**Location (un) 6409**]; wheelchair bound s/p CVA; no
h/o ETOH or tobacco use 

### Response:
{'Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Acute kidney failure, unspecified,Thrombocytopenia, unspecified,Infection and inflammatory reaction due to indwelling urinary catheter,Urinary tract infection, site not specified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}
