CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 49 year old
gentleman with a seizure disorder since a left middle
cerebral artery stroke in [**2167**].  He was admitted on [**2173-2-13**] with grand mal tonic-clonic seizure times six after
missed doses of Dilantin.  The patient had missed his doses
of Dilantin due to a late mail order of his medications.  His
serum level was 1.9 at admission.  The patient's status
epilepticus broke after Dilantin load on Ativan in the
Emergency Room.  However, he was intubated in the Emergency
Room for airway protection.

MEDICAL HISTORY: 1.  Seizure disorder.
2.  Left middle cerebral artery stroke in [**2167**] with residual
right hemiparesis.
3.  Expressive aphasia.
4.  Hypertension.
5.  Depression.

MEDICATION ON ADMISSION: 

ALLERGIES: Reportedly to Penicillin and Sulfa with a rash.

PHYSICAL EXAM: 

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: The patient is married.  He is originally
from [**Country 16573**].  He has four children.  He quit tobacco in
[**2163**].  No alcohol use.  Worked as a journalist before the
stroke.
Other late effects of cerebrovascular disease,Other convulsions,Acute kidney failure, unspecified,Pneumonitis due to inhalation of food or vomitus,Acidosis,Acute respiratory failure,Depressive disorder, not elsewhere classified,Other disorders of muscle, ligament, and fascia
Late effect CV dis NEC,Convulsions NEC,Acute kidney failure NOS,Food/vomit pneumonitis,Acidosis,Acute respiratry failure,Depressive disorder NEC,Muscle/ligament dis NEC
Admission Date:  [**2173-2-13**]     Discharge Date:  [**2173-2-19**]

Date of Birth:   [**2123-8-30**]     Sex:  M

Service:  ACOVE

HISTORY OF PRESENT ILLNESS:  The patient is a 49 year old
gentleman with a seizure disorder since a left middle
cerebral artery stroke in [**2167**].  He was admitted on [**2173-2-13**] with grand mal tonic-clonic seizure times six after
missed doses of Dilantin.  The patient had missed his doses
of Dilantin due to a late mail order of his medications.  His
serum level was 1.9 at admission.  The patient's status
epilepticus broke after Dilantin load on Ativan in the
Emergency Room.  However, he was intubated in the Emergency
Room for airway protection.

Patient was also initially hypertensive in the Emergency Room
to 220/100 and then hypotensive upon arrival to the Intensive
Care Unit with a blood pressure of 84/50 which responded to
intravenous fluids.  The patient was extubated the day after
admission without complication and transferred to the
Medicine floor on [**2173-2-15**].

Patient also had acute renal insufficiency which had resolved
by the time of transfer to the Medicine floor, but also with
rhabdomyolysis with peak creatinine kinase of 31,000 on
[**2173-2-16**].  This was also trending down at the time of
transfer. At the time of transfer, the patient denied any
symptoms or complaints and review of systems was negative.

PAST MEDICAL HISTORY:
1.  Seizure disorder.
2.  Left middle cerebral artery stroke in [**2167**] with residual
right hemiparesis.
3.  Expressive aphasia.
4.  Hypertension.
5.  Depression.

MEDICATIONS AT HOME:
1.  Vasotec 10 twice a day.
2.  Norvasc 5.
3.  Atenolol 50.
4.  Celexa 20.
5.  Dilantin 100 twice a day.
6.  Aspirin 81.
7.  Lipitor.

ALLERGIES:  Reportedly to Penicillin and Sulfa with a rash.

SOCIAL HISTORY:  The patient is married.  He is originally
from [**Country 16573**].  He has four children.  He quit tobacco in
[**2163**].  No alcohol use.  Worked as a journalist before the
stroke.

FAMILY HISTORY:  Non-contributory.

PHYSICAL EXAMINATION ON ADMISSION:  Pleasant African American
gentleman in no apparent distress, lying in bed.  Physical
examination with a normal examination except notable for
expressive aphasia with slurred verbalizations.  The patient
also has 1 out of 5 strength in the right upper and lower
extremities, but otherwise neurologically intact.  Physical
examination also notable for a large 1 inch laceration in the
left lateral aspect of the patient's tongue.

LABS ON ADMISSION TO INTENSIVE CARE UNIT:  BUN and creatinine
15/1.3; hematocrit 35; white blood count 23; Dilantin level
1.9; urinalysis with large blood, otherwise normal.

HOSPITAL COURSE:  This is a 49 year old gentleman with
seizure disorder status post stroke in [**2167**], admitted with
grand mal tonic-clonic seizure and status epilepticus which
broke after the Dilantin load and Ativan.  The patient was
intubated and then managed in the Intensive Care Unit for one
night.  He was then extubated without event.  Patient was
also noted to have rhabdomyolysis.  The patient was stable on
transfer to the floor on [**2173-2-15**].

1.  Rhabdomyolysis:  The patient's creatinine kinase peaked
at 31,000 [**2173-2-16**] and continued to trend down.  The
patient's rhabdomyolysis was likely due to his status
epilepticus on admission with resulting convulsions.
Patient's liver function tests were also slightly elevated,
but likely related to the rhabdo and muscle breakdown.
Patient was continued with aggressive intravenous fluids and
his electrolytes were monitored very carefully.  The patient
was started on bicarbonate in his intravenous fluids for two
days to alkalinize his urine.  The patient's creatinine
kinase continued to trend down at the time of discharge.

2.  Seizure disorder:  The patient was without any further
seizure disorder since the Emergency Room.  Patient's status
epilepticus was likely related to patient's missing multiple
doses of his home Dilantin due to the mail order medication
being late.  I spoke with the patient's primary care taker
who is his wife, and they have an adequate supply and were
counseled on the importance of compliance.  Patient stayed on
Dilantin throughout his hospital stay.   The albumin adjusted
serum level was monitored.  Planned outpatient follow-up on
Dilantin levels and titration.

3.  Blood pressure:  The patient was initially hypotensive in
the Intensive Care Unit, but responded to intravenous fluids
after the Dilantin intravenous was stopped.  The patient then
became hypertensive which he has been known to be for many
years.  Patient's beta-blocker was titrated up as needed.

4.  Infectious disease:  The patient was febrile in the
Intensive Care Unit which may have been a stress response,
but also possibly related to him being intubated.  His
differential includes pneumonia pneumonitis, although there
is no evidence of aspiration or process on chest x-ray.  The
patient's white blood count was initially elevated at
admission, but trended down to within normal limits.  The
patient was continued on Levofloxacin and Flagyl which had
been started in the Intensive Care Unit for coverage and was
continued on this for a seven day course.  Patient's blood
cultures from admission had no growth to date.

5.  Red urine:  The patient's red urine was likely due to
myoglobinuria, hematuria from Foley trauma given the greater
than 1,000 red blood cells in the urinalysis.  Patient's
urine cleared and was yellow by the time of discharge.

6.  Tongue laceration:  This is from the seizure at
admission.  The patient's tongue was evaluated by Ear, Nose,
and Throat consult who recommended conservative treatment.
The patient had good granulation tissue there.  Patient was
continued on Peridex swish and spit which he was discharged
on for use at home.

7.  Anemia:  The patient's iron study was most consistent
with iron deficiency.  He should consider starting iron
supplements as an outpatient after rhabdomyolysis has
resolved.  Patient's hematocrit was stable throughout his
hospital stay.

8.  History of stroke:  The patient was continued on aspirin
and blood pressure control as above.

9.  Mental status:  The patient was minimally responsive at
admission due to his status epilepticus, but his mental
status was at baseline throughout the remainder of his
hospital stay.

10. Fluids, Electrolytes and Nutrition:  The patient was
evaluated by Speech and Swallow after his Intensive Care Unit
stay with intubation and was cleared for p.o. with pureed and
thin liquids.  The patient's electrolytes should be monitored
closely given his rhabdomyolysis.

11.  Communication:  With patient and wife daily.  Patient's
code status is full.

DISCHARGE CONDITION:  Stable.

DISCHARGE STATUS:  To home with services.

DISCHARGE DIAGNOSIS:
1.  Seizure disorder.
2.  Status epilepticus.
3.  Renal failure.
4.  Rhabdomyolysis.

MEDICATIONS ON DISCHARGE:
1.  Peridex by mouth swish and spit times 10 days.
2.  Colace liquid as needed.
3.  Atenolol 100 once daily.
4.  Aspirin 325 once daily.
5.  Ranitidine 150 twice a day.
6.  Celexa 20 once daily.
7.  Levofloxacin 500 once daily, total of 7 day course.
8.  Flagyl 500 three times a day, total of 7 day course.
9.  Phenytoin 100 mg q12 hours.

FOLLOW-UP PLANS:  Patient is to follow-up with Dr. [**Last Name (STitle) 1699**] as
scheduled.  Patient is also to follow-up with Dr. [**Last Name (STitle) **]
of the [**Hospital **] Clinic as scheduled.



                          [**First Name11 (Name Pattern1) 312**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 313**], M.D.  [**MD Number(1) 314**]

Dictated By:[**Name8 (MD) 6906**]

MEDQUIST36

D:  [**2173-5-14**]  01:24
T:  [**2173-5-14**]  18:53
JOB#:  [**Job Number 44248**]
{'Other late effects of cerebrovascular disease,Other convulsions,Acute kidney failure, unspecified,Pneumonitis due to inhalation of food or vomitus,Acidosis,Acute respiratory failure,Depressive disorder, not elsewhere classified,Other disorders of muscle, ligament, and fascia'}


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: 

PRESENT ILLNESS: The patient is a 49 year old
gentleman with a seizure disorder since a left middle
cerebral artery stroke in [**2167**].  He was admitted on [**2173-2-13**] with grand mal tonic-clonic seizure times six after
missed doses of Dilantin.  The patient had missed his doses
of Dilantin due to a late mail order of his medications.  His
serum level was 1.9 at admission.  The patient's status
epilepticus broke after Dilantin load on Ativan in the
Emergency Room.  However, he was intubated in the Emergency
Room for airway protection.

MEDICAL HISTORY: 1.  Seizure disorder.
2.  Left middle cerebral artery stroke in [**2167**] with residual
right hemiparesis.
3.  Expressive aphasia.
4.  Hypertension.
5.  Depression.

MEDICATION ON ADMISSION: 

ALLERGIES: Reportedly to Penicillin and Sulfa with a rash.

PHYSICAL EXAM: 

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: The patient is married.  He is originally
from [**Country 16573**].  He has four children.  He quit tobacco in
[**2163**].  No alcohol use.  Worked as a journalist before the
stroke. 

### Response:
{'Other late effects of cerebrovascular disease,Other convulsions,Acute kidney failure, unspecified,Pneumonitis due to inhalation of food or vomitus,Acidosis,Acute respiratory failure,Depressive disorder, not elsewhere classified,Other disorders of muscle, ligament, and fascia'}
