CHIEF COMPLAINT: Acute renal failure, unable to obtain
vascular access.

PRESENT ILLNESS: This is a 63-year-old female
hospitalized at an outside hospital on [**5-1**] with several
sputum production.  On presentation, her creatinine was
somewhat above baseline.  She was intubated at that time for
a questionable congestive heart failure or hypercarbia.  Over
the course of the hospitalization, she was extubated and
reintubated times two for fatigue, hypercarbia plus or minus
hypoxia.  In mid [**Month (only) **], she developed hypotension and
creatinine started to rise rapidly.  At that point, she
not be done because she had severe central stenosis of all
vessels and no access was attempted at that point due to fear
of more thrombosis as patient had a transplanted kidney,
which was the only accessible vein.  She was transferred to
[**Hospital6 256**] for decisions about
access and treatment of her renal failure.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: She was on Imuran, cyclosporin,
Solu-Medrol, cephaeline, Lasix, Renagel, iron, Lopressor,
heparin and versed.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Myocardial infarction, renal failure.
Mother had diabetes.

SOCIAL HISTORY: No alcohol, no tobacco.
Acute kidney failure, unspecified,Acute respiratory failure,Hematoma complicating a procedure,Kidney replaced by transplant,Morbid obesity,Unspecified essential hypertension,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure
Acute kidney failure NOS,Acute respiratry failure,Hematoma complic proc,Kidney transplant status,Morbid obesity,Hypertension NOS,Abn react-procedure NEC
Admission Date:  [**2125-5-19**]     Discharge Date: [**2125-6-1**]

Date of Birth:   [**2063-1-15**]     Sex:  F

Service:  MICU
CHIEF COMPLAINT:  Acute renal failure, unable to obtain
vascular access.

HISTORY OF PRESENT ILLNESS:  This is a 63-year-old female
hospitalized at an outside hospital on [**5-1**] with several
sputum production.  On presentation, her creatinine was
somewhat above baseline.  She was intubated at that time for
a questionable congestive heart failure or hypercarbia.  Over
the course of the hospitalization, she was extubated and
reintubated times two for fatigue, hypercarbia plus or minus
hypoxia.  In mid [**Month (only) **], she developed hypotension and
creatinine started to rise rapidly.  At that point, she
not be done because she had severe central stenosis of all
vessels and no access was attempted at that point due to fear
of more thrombosis as patient had a transplanted kidney,
which was the only accessible vein.  She was transferred to
[**Hospital6 256**] for decisions about
access and treatment of her renal failure.

MEDICATIONS ON ADMISSION: She was on Imuran, cyclosporin,
Solu-Medrol, cephaeline, Lasix, Renagel, iron, Lopressor,
heparin and versed.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  No alcohol, no tobacco.

FAMILY HISTORY:  Myocardial infarction, renal failure.
Mother had diabetes.

BRIEF PHYSICAL EXAMINATION:  Patient intubated and sedated.
Vital signs:  Afebrile.  Pulse 66.  Blood pressure 144/65.
02 saturation 100%.  Vent settings, pressure support of 5,
total volume 700, rate 12, PEEP of 5, FIO2 30%.  Heart:
Regular rate and rhythm, normal S1, S2, no murmurs, rubs or
gallops.  Lungs clear to auscultation.  Abdomen:  Obese,
positive bowel sounds, soft, nontender.  Extremities:
Decreased skin turgor plus edema.

LABORATORIES ON ADMISSION:  Sodium 143, potassium 3.8,
chloride 103, bicarbonate 20, BUN 126, creatinine 7.5,
glucose 83, calcium 10.6, magnesium 1.9, phosphorus 2.4, PT
14, INR 1.3, PTT 94.  White blood cell count 7.  Hematocrit
28.6 and platelets 146,000.  Troponin is negative.
Urinalysis greater than 300 protein, [**5-14**] white blood cells
and specific gravity of 1.015.  In addition, outside venogram
demonstrated central stenosis of all upper extremity vessels
and the left femoral was not accessible.  The right femoral
was open.  She also has demonstrated left axillary deep vein
thrombosis by ultrasound.

BRIEF HOSPITAL COURSE:  On [**5-19**], Mrs. [**Known lastname 17597**] was transferred
to [**Hospital6 256**] for access issues.
She has continued to have poor intravenous access at
hospital.  Many stenosed veins, barring placement of
catheter. A Quinton catheter into her right femoral
to serve as intravenous access, drawing line, and possibly
for hemodialysis if needed.  After the placement of the Quinton,
she started to experience a drop in hematocrit and was
currently being heparinized at the time for multiple deep
vein thromboses in the past.  Abdominal CT at the time showed
no retroperitoneal bleed, but there was a large hematoma
surrounding the Quinton.  The Quinton catheter was determined
to be functional at that time, even though she had a
hematoma. She was transfused with five units of packed red
blood cells to raise her hematocrit and subsequently given
two more units of packed red blood cells that went into the
hematoma.  Patient's hematoma then stabilized on the [**5-28**] with a tense hematoma at the site of the Quinton
catheter, approximately 10 cm in diameter and the total
hematoma was 25 x 25 cm.

Over the course of her stay, she was extubated, but required
BiPAP at night for sleeping due to questionable sleep apnea
and/or hypoxic episodes due to her obesity.  She is morbidly
obese.  Over the course of the stay, the decision was made to
leave the Quinton in because that was her only access.  On
[**5-29**], the Quinton was replaced over a wire with a new
Quinton to try and stabilize the bleed.  At that point, the
hematoma stopped expanding and her hematocrit stabilized.
The right femoral Quinton remains her only access line.

On [**5-31**], Mrs. [**Known lastname 17597**], was discharged to the floor in care of
another team with the Quinton line in place.

MEDICATIONS ON TRANSFER:
1.  Renagel 1600.
2.  Insulin sliding scale.
3.  Prednisone 10 po.
4.  Oxycodone.
5.  Lactulose.
6.  Cyclosporin.
7.  Epogen.
8.  Calcitrel.
9.  Colace.
10. Dulcolax.
11. Tylenol.
12. Versed.
13. Ativan.
14. Protonix.
15. Iron.
16. Lopressor.
17. Azathioprine.

DISCHARGE DIAGNOSES FROM THE FLOOR:  End stage renal disease
with multiple access problems.




                          DR.[**Last Name (STitle) **],[**First Name3 (LF) **] 12-948

Dictated By:[**Name8 (MD) 23023**]

MEDQUIST36

D:  [**2125-6-1**]  22:56
T:  [**2125-6-1**]  22:56
JOB#:  [**Job Number **]


Name:  [**Known lastname **], [**Known firstname 3441**]                       Unit No:  [**Numeric Identifier 17272**]

Admission Date:  [**2125-5-19**]     Discharge Date:  [**2125-6-6**]

Date of Birth:   [**2063-1-15**]     Sex:  F

Service:  MEDICINE

ADDENDUM:

BRIEF HOSPITAL COURSE SINCE TRANSFER FROM THE MEDICAL
INTENSIVE CARE UNIT:

The patient was transferred to a Regular Medical Floor on
[**5-31**].  Her condition upon transfer was very stable.  Her
main issue remained access.  The only available access that
we had was a tunnelled hemodialysis catheter in her right
groin.  Since she was medically improving, it was felt that
it would be in her best interest if the line was removed as
there was a significant risk of infection.  There was no need
to follow labs on her and therefore lack of intravenous
access was not a pressing issue.

During her stay, she was on night Bi-PAP for presumed sleep
apnea.  The patient had never had a formal study of sleep
apnea and we would appreciate your cooperation in arranging
such a study.

Her cardiovascular function remained stable.  The only
outstanding issue was hypertension with systolic pressure
between 140 and 160 and diastolic between 80 and 100, which
required an increase in her Lopressor to 25 p.o. twice a day.

From a Hematology standpoint, the patient's hematocrit upon
transfer was 24.  She received two units of packed red blood
cells and her hematocrit stabilized at 30.  In addition, her
Epogen dose was increased to 800 three times a week. It was
decided that anti-coagulation would not be in her best
interest:  All her previous clots had been in the upper
extremities and she had a history of gastrointestinal bleed
on Coumadin.

Her renal function remained stable, although it did not
return to her pre-hospital levels.  She never required
hemodialysis and it is likely that she will require some in
the near future.  She was continued on her immunosuppression.

It is recommended that the patient drinks about 400 cc. of
water every four hours when awake.  She should be on a renal
diet.

On the day before discharge, her access line was removed and
with no complications associated with this procedure.

CONDITION ON DISCHARGE:   Stable.

DISPOSITION:   Discharged to an acute care rehabilitation
facility.

DISCHARGE MEDICATIONS:
1.  Lopressor 25 mg twice a day.
2.  Epogen 8000 units three times a week.
3.  Senna one tablet p.o. twice a day.
4.  Dulcolax 10 mg p.o. q. day.
5.  Protonix 40 mg q. day.
6.  Remegel 1600 mg p.o. three times a day.
7.  Prednisone 10 mg q. day.
8.  Cyclosporin 100 mg p.o. q. day.
9.  Ferrous sulfate 325 mg p.o. q. day.
10. Imuran 100 mg p.o. q. day.
11. Tylenol 325 to 650 mg p.o. q. four to six hours p.r.n.
for pain.
12. Maalox 15 to 30 ml p.o. four times a day p.r.n.


                         DR.[**Last Name (STitle) 639**],[**First Name3 (LF) 77**] 12-948

Dictated By:[**Name8 (MD) 2940**]

MEDQUIST36

D:  [**2125-6-8**]  14:00
T:  [**2125-6-14**]  22:25
JOB#:  [**Job Number **]
{'Acute kidney failure, unspecified,Acute respiratory failure,Hematoma complicating a procedure,Kidney replaced by transplant,Morbid obesity,Unspecified essential hypertension,Other specified procedures 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: Acute renal failure, unable to obtain
vascular access.

PRESENT ILLNESS: This is a 63-year-old female
hospitalized at an outside hospital on [**5-1**] with several
sputum production.  On presentation, her creatinine was
somewhat above baseline.  She was intubated at that time for
a questionable congestive heart failure or hypercarbia.  Over
the course of the hospitalization, she was extubated and
reintubated times two for fatigue, hypercarbia plus or minus
hypoxia.  In mid [**Month (only) **], she developed hypotension and
creatinine started to rise rapidly.  At that point, she
not be done because she had severe central stenosis of all
vessels and no access was attempted at that point due to fear
of more thrombosis as patient had a transplanted kidney,
which was the only accessible vein.  She was transferred to
[**Hospital6 256**] for decisions about
access and treatment of her renal failure.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: She was on Imuran, cyclosporin,
Solu-Medrol, cephaeline, Lasix, Renagel, iron, Lopressor,
heparin and versed.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Myocardial infarction, renal failure.
Mother had diabetes.

SOCIAL HISTORY: No alcohol, no tobacco. 

### Response:
{'Acute kidney failure, unspecified,Acute respiratory failure,Hematoma complicating a procedure,Kidney replaced by transplant,Morbid obesity,Unspecified essential hypertension,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}
