CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 64-year-old
female with a history of hypertension, type 2 diabetes,
subarachnoid hemorrhage status post left middle cerebral
artery clipping, left craniectomy, and VP shunt, who presents
from [**Hospital 582**] nursing home with decreased responsiveness per
her daughter for the past few days.  The patient was
diagnosed with proteus urinary tract infection on [**2196-4-18**].
She was started on amoxicillin 500 mg p.o. t.i.d. x7 days,
but the sensitivity also showed proteus resistant to
ampicillin.  The fingerstick blood sugar prior to [**Location (un) 582**] had
been 538 for which she was given 12 units of insulin on the
date of presentation.  She was also found to have a
temperature of 100.3 at [**Location (un) 582**].

MEDICAL HISTORY: 1. Hypertension.
2. Type 2 diabetes.
3. Subarachnoid hemorrhage in [**2195-11-14**] status post a
left middle cerebral artery aneurysm clipping status post a
left craniectomy due to mass effect.
4. Status post a PEG and tracheostomy in [**12-16**].
5. Status post a VP shunt in [**12-16**].
6. GPC meningitis in [**2196**], which has coag-negative Staph x3.
VP shunt was then removed and replaced.
7. Congestive heart failure.
8. Tracheal stenosis/severe tracheomalacia.
9. Anemia.
10. Colonization with MRSA and VRE.
11. Hypernatremia.
12. Nonverbal baseline.

MEDICATION ON ADMISSION: 1. Prevacid 30 mg p.o. q.d.
2. Glucophage 1000 mg p.o. b.i.d.
3. Glyburide 5 mg p.o. b.i.d.
4. Dilantin 200 mg p.o. t.i.d.
5. Captopril 25 mg p.o. t.i.d.
6. Hydralazine 50 mg p.o. t.i.d.
7. Lopressor 50 mg p.o. t.i.d.
8. Free water flushes 300 cc via PEG tube t.i.d.
9. Tube feeds 70 cc an hour.
10. Zantac 150 mg p.o. q.d.
11. Sliding scale insulin.
12. Senna 2 mg p.o. q.d.
13. Vicodin 1-2 tablets q.4h. prn.
14. Amoxicillin 500 mg p.o. t.i.d.  She was on day #4 for her
UTI.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Lives at [**Hospital 582**] nursing home.
Infection and inflammatory reaction due to indwelling urinary catheter,Unspecified septicemia,Hyperosmolality and/or hypernatremia,Congestive heart failure, unspecified,Thrombocytopenia, unspecified,Urinary tract infection, site not specified
React-indwell urin cath,Septicemia NOS,Hyperosmolality,CHF NOS,Thrombocytopenia NOS,Urin tract infection NOS
Admission Date:  [**2196-4-21**]       Discharge Date:  [**2196-4-27**]

Date of Birth:   [**2131-6-28**]       Sex:  F

Service:  [**Hospital1 139**]

HISTORY OF PRESENT ILLNESS:  The patient is a 64-year-old
female with a history of hypertension, type 2 diabetes,
subarachnoid hemorrhage status post left middle cerebral
artery clipping, left craniectomy, and VP shunt, who presents
from [**Hospital 582**] nursing home with decreased responsiveness per
her daughter for the past few days.  The patient was
diagnosed with proteus urinary tract infection on [**2196-4-18**].
She was started on amoxicillin 500 mg p.o. t.i.d. x7 days,
but the sensitivity also showed proteus resistant to
ampicillin.  The fingerstick blood sugar prior to [**Location (un) 582**] had
been 538 for which she was given 12 units of insulin on the
date of presentation.  She was also found to have a
temperature of 100.3 at [**Location (un) 582**].

On arrival to the Emergency Room, she was thought to have
urosepsis, and was given one dose of vancomycin IV given her
history of MRSA, but no additional antibiotics.  She was also
found to have a sodium of 164, which when corrected was 170
and a glucose of 463.  She was treated with 2 liters of
normal saline.

PAST MEDICAL HISTORY:
1. Hypertension.
2. Type 2 diabetes.
3. Subarachnoid hemorrhage in [**2195-11-14**] status post a
left middle cerebral artery aneurysm clipping status post a
left craniectomy due to mass effect.
4. Status post a PEG and tracheostomy in [**12-16**].
5. Status post a VP shunt in [**12-16**].
6. GPC meningitis in [**2196**], which has coag-negative Staph x3.
VP shunt was then removed and replaced.
7. Congestive heart failure.
8. Tracheal stenosis/severe tracheomalacia.
9. Anemia.
10. Colonization with MRSA and VRE.
11. Hypernatremia.
12. Nonverbal baseline.

MEDICATIONS ON ADMISSION:
1. Prevacid 30 mg p.o. q.d.
2. Glucophage 1000 mg p.o. b.i.d.
3. Glyburide 5 mg p.o. b.i.d.
4. Dilantin 200 mg p.o. t.i.d.
5. Captopril 25 mg p.o. t.i.d.
6. Hydralazine 50 mg p.o. t.i.d.
7. Lopressor 50 mg p.o. t.i.d.
8. Free water flushes 300 cc via PEG tube t.i.d.
9. Tube feeds 70 cc an hour.
10. Zantac 150 mg p.o. q.d.
11. Sliding scale insulin.
12. Senna 2 mg p.o. q.d.
13. Vicodin 1-2 tablets q.4h. prn.
14. Amoxicillin 500 mg p.o. t.i.d.  She was on day #4 for her
UTI.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  Lives at [**Hospital 582**] nursing home.

FAMILY HISTORY:  Noncontributory.

PHYSICAL EXAM ON ADMISSION:  Temperature 100.3, heart rate
113, blood pressure 122/74, respiratory rate 26, and oxygen
saturation 100% on 4 liters of oxygen.  In general:  The
patient is an African-American female with her mouth open,
awake, alert, nonverbal at baseline, in no acute distress
with her head at 45 degrees.  HEENT:  Pupils are equal,
round, and reactive to light, sclerae are anicteric.
Extraocular muscles are grossly intact.  Mucous membranes
dry.  Neck:  Supple, healed tracheostomy site.  Heart:
Tachycardic, regular rhythm, rapid, positive S1 and S2, grade
[**2-19**] crescendo systolic ejection murmur at the right upper
sternal border.  Grade [**3-19**] holosystolic murmur at the apex.
Chest:  Lungs were grossly clear to auscultation bilaterally,
poor inspiratory effort.  Abdomen:  Soft, nontender, and
nondistended, no masses or hepatosplenomegaly, positive PEG
tube site in place, positive bowel sounds.  Extremities:  No
edema, warm, 2+ distal pulses, no rash.  Neurologic:  Awake,
alert, eyes open, nonverbal.  Does not follow simple
commands.  Extremities with normal tone and bulk.  Reflexes:
1+ in the biceps bilaterally, 0 in the patella bilaterally.
Babinski's equivocal.  Winces to pain.

LABORATORY VALUES ON ADMISSION:  White blood cell count 7.8,
hematocrit 33.4, platelets 140.  Sodium 164, potassium 3.9,
chloride 123, bicarb 32, BUN 54, creatinine 0.9, glucose 463,
lactate 3.0.  PT 12.7, PTT 22.5, INR 1.1.  Urinalysis
revealing moderate leukocyte esterase, large blood, 30
protein, 100 glucose, trace ketones, and no nitrites, greater
than 50 epithelial cells.

Chest x-ray revealed no evidence of congestive heart failure
or pneumonia.

An EKG showed sinus tachycardia at 117 beats per minute,
normal axis, T-wave inversions in lead III, no ST segment
changes.

An ABG was obtained on 4 liters of oxygen by nasal cannula:
pH 7.37, CO2 55, oxygen 169.

IMPRESSION:  The patient is a 64-year-old female with a
history of multiple medical problems, who presents with
urosepsis.

HOSPITALIZATION COURSE BY SYSTEM:
1. Fluids, electrolytes, and nutrition:  The patient was
found to be severely hypernatremic with an initial sodium of
164, which when corrected for the hyperglycemia, it was 170.
She was given normal saline boluses.  She was started on
maintenance fluid of D5 [**1-15**] normal saline with 20 mEq of
potassium for 2 liters, and then this was run continuously.
Ultimately, her sodium corrected to within normal limits and
is 138 at the time of this dictation.  Patient was also
started on free water boluses via her PEG tube, which
initially were 500 cc q.4h. and decreased to 250 cc q.4h. by
the time of discharge.

Her tube feeds were started and she was given ProMod tube
feeds with fiber and reached her goal of 55 cc an hour by the
time of discharge.

2. Endocrine:  The patient has a history of type 2 diabetes.
She was initially placed on an insulin drip, which was
discontinued on [**2196-4-24**].  Her admitting blood glucose was
greater than 400 and had decreased to the 200 range by the
time of discharge.  Her metformin was restarted and gradually
increased her home dose of 1000 mg p.o. b.i.d.

3. Genitourinary:  The patient was admitted with a urinary
tract infection.  The urine culture was found to be sensitive
to ceftriaxone, and therefore the patient was started on
[**2196-4-24**] 1 gram of ceftriaxone IV q.d.  It is suggested
that she continues for a full two-week course given that this
is a complicated urinary tract infection obtained while the
patient had a Foley in place.  Her repeat urine culture was
negative.

The patient had a renal ultrasound performed to rule out
obstruction, which was questionable for emphysematous
pyelonephritis.  Therefore, CAT scan of the abdomen and
pelvis was obtained, which revealed no pleural effusions,
minor bibasilar atelectasis, no hepatic or splenic lesions,
correct position of the G tube, all other organs within
normal limits, but multiple bilateral renal stones with
largest and left upper pole of the kidney measuring 5 mm, no
air in the left kidney, no hydronephrosis, and no
obstruction, and positive hardening artifact.

4. Cardiovascular:  The patient had an echocardiogram
performed due to her murmurs found on exam.  She was found to
have a normal left atrium, and mild symmetric left
ventricular hypertrophy and an ejection fraction of 70%, 2+
tricuspid regurgitation, trivial mitral regurgitation, mild
pulmonary artery systolic hypertension.  She was restarted on
her hydralazine, which was increased to 50 mg p.o. t.i.d.
She is also restarted on her captopril 25 mg p.o. t.i.d.  She
was evaluated repeatedly for tachycardia, and her baseline
was ultimately felt to be in the low 100s.  This responded
well to intravenous fluids, as well as pain medication (Her
Vicodin was restarted).

5. Neurology:  The patient returned to her baseline mental
status at the time of discharge as per her daughter.  A CAT
scan was performed of the head, which was negative for any
acute changes.

DISCHARGE CONDITION:  Good.

DISCHARGE STATUS:  Extended care facility.

DISCHARGE DIAGNOSES:
1. Urosepsis.
2. Hypernatremia.
3. Hyperglycemia.
4. Tachycardia.

MEDICATIONS ON DISCHARGE:
1. Captopril 25 mg p.o. t.i.d.
2. Ceftriaxone 1 gram IV q.24h. to be completed on [**5-8**].
3. Colace 100 mg p.o. b.i.d.
4. Hydralazine 50 mg p.o. t.i.d.
5. Vicodin 1-2 tablets p.o. q.4-6h. prn agitation.
6. Insulin-sliding scale.
7. Lansoprazole 30 mg p.o. q.d.
8. Metoprolol 50 mg p.o. t.i.d.
9. Metformin 1000 mg p.o. b.i.d.
10. Senna one tablet p.o. b.i.d. prn.

FOLLOWUP:  The patient is to followup with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4844**]
at [**Telephone/Fax (1) 250**], her primary care physician [**Last Name (NamePattern4) **] [**1-15**] weeks for
follow-up appointment.



                           [**First Name8 (NamePattern2) **] [**Doctor First Name **], M.D.  [**MD Number(1) 19814**]

Dictated By:[**Name8 (MD) 6206**]
MEDQUIST36

D:  [**2196-4-27**]  10:36
T:  [**2196-4-27**]  10:37
JOB#:  [**Job Number 100031**]

cc:[**Last Name (un) 100032**]

Name:  [**Known lastname 11160**], [**Known firstname 16051**] A                   Unit No:  [**Numeric Identifier 16052**]

Admission Date:  [**2196-4-21**]       Discharge Date:  [**2196-4-29**]

Date of Birth:   [**2131-6-28**]       Sex:  F

Service:  Medicine, [**Hospital1 **] Firm

ADDENDUM:  Please refer to the prior dictated Discharge
Summary for a more detailed account of the patient's
hospitalization course up until [**2196-4-26**].

SUMMARY OF HOSPITAL COURSE BY ISSUE/SYSTEM (CONTINUED):

1.  ENDOCRINE ISSUES:  The patient was noted on [**4-27**] to
have an elevated calcium level.  This seemed to be a chronic
problem for the patient.

This was worked up with the following laboratory values:
Vitamin D level, parathyroid hormone, and alkaline
phosphatase (all of which were pending at the time of this
dictation) to rule out malignancy.  Serum and urine protein
electrophoresis were pending at the time of this dictation.
A 24-hour urinary calcium was 6.7.  A 24-hour urinary
creatinine (in order to calculate the fractional secretion of
calcium was also pending at the time of this dictation.

The thinking was that if the fractional secretion of calcium
is less than 1%, this is most likely consistent with familial
hypocalcemic hypocalciuria (FHH).  If it is greater than 2%,
then this is most likely significant for primary
hyperparathyroidism.  The patient had a high INS calcium of
1.39.

Also as part of a malignancy workup, a breast examination was
performed which was within normal limits.  The patient will
require an Endocrine followup at her rehabilitation center.

From a diabetes standpoint, the patient had well controlled
blood sugars on her metformin 1000 mg by mouth twice per day.
Her glyburide was actually stopped on the day of discharge
due to low blood sugars in the 50s.

2.  CARDIOVASCULAR ISSUES:  The patient's hypertensive
regimen was changed slightly.  Her captopril was
discontinued, and she was changed to lisinopril 20 mg by
mouth once per day.  In addition, she was continued on her
metoprolol 50 mg by mouth three times per day.  Her
hydralazine was discontinued as well.  This resulted in
adequate control of her blood pressure and heart rate.

3.  HEMATOLOGIC ISSUES:  The patient was noted to be anemic
with a hematocrit of 26.5 on [**2196-4-28**].  Thus, she was
transfused one unit of packed red blood cells.  Her
hematocrit did increase, but not quite appropriately, to
27.5.  She was started on iron supplementation with ferrous
sulfate 325 mg by mouth once per day.

4.  GENITOURINARY ISSUES:  The patient was continued on
ceftriaxone 1 gram intravenously q.24h. for her admitting
diagnosis of urosepsis.  This was to be completed on [**2196-5-8**] for a total of a 2-week course.

5.  GASTROINTESTINAL/FLUIDS/ELECTROLYTES/NUTRITION ISSUES:
The patient reached her maximum tube feeds of ProMod with
fiber for a goal of 55 cc per hour.  She was continued with
free water flushes 250 mL through the tube q.4h.   She was
also administered Dulcolax for constipation.

Her hypernatremia was corrected, and her sodium was within
normal limits by the time of discharge.

6.  CODE STATUS ISSUES:  Do not resuscitate/do not intubate
status was determined for this patient upon consultation with
her daughter.

CONDITION AT DISCHARGE:  Good.

DISCHARGE STATUS:  To [**Hospital3 643**] facility.

DISCHARGE DIAGNOSES:
1.  Urosepsis.
2.  Hypernatremia.
3.  Hyperglycemia.
4.  Anemia.
5.  Hypertension.
6.  Type 2 diabetes.

MEDICATIONS ON DISCHARGE:
 1.  Ceftriaxone 1 gram intravenously q.24h. (through [**5-8**]).
 2.  Colace 100 mg by mouth twice per day.
 3.  Vicodin one to two tablets by mouth q.4-6h. as needed
(for pain).
 4.  Insulin sliding-scale.
 5.  Lansoprazole 30 mg by mouth once per day.
 6.  Lisinopril 20 mg by mouth once per day.
 7.  Metoprolol 50 mg by mouth three times per day.
 8.  Metformin 1000 mg by mouth twice per day.
 9.  Nystatin oral suspension 5 mL by mouth four times per
day as needed (for thrush).
10.  Senna one tablet by mouth twice per day.
11.  Ferrous sulfate 325 mg by mouth once per day.

DISCHARGE INSTRUCTIONS/FOLLOWUP:
1.  The patient was instructed to follow up with her primary
care physician [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] (telephone number
[**Telephone/Fax (1) 23**]) within one to two weeks.
2.  The patient was also to have followup with an
endocrinologist at her rehabilitation facility for further
workup of hypercalcemia.





                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(2) 5452**]

Dictated By:[**Name8 (MD) 3684**]
MEDQUIST36

D:  [**2196-4-29**]  10:40
T:  [**2196-4-29**]  10:46
JOB#:  [**Job Number 16056**]

cc:[**Hospital3 16057**]
{'Infection and inflammatory reaction due to indwelling urinary catheter,Unspecified septicemia,Hyperosmolality and/or hypernatremia,Congestive heart failure, unspecified,Thrombocytopenia, unspecified,Urinary tract infection, site not specified'}


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 64-year-old
female with a history of hypertension, type 2 diabetes,
subarachnoid hemorrhage status post left middle cerebral
artery clipping, left craniectomy, and VP shunt, who presents
from [**Hospital 582**] nursing home with decreased responsiveness per
her daughter for the past few days.  The patient was
diagnosed with proteus urinary tract infection on [**2196-4-18**].
She was started on amoxicillin 500 mg p.o. t.i.d. x7 days,
but the sensitivity also showed proteus resistant to
ampicillin.  The fingerstick blood sugar prior to [**Location (un) 582**] had
been 538 for which she was given 12 units of insulin on the
date of presentation.  She was also found to have a
temperature of 100.3 at [**Location (un) 582**].

MEDICAL HISTORY: 1. Hypertension.
2. Type 2 diabetes.
3. Subarachnoid hemorrhage in [**2195-11-14**] status post a
left middle cerebral artery aneurysm clipping status post a
left craniectomy due to mass effect.
4. Status post a PEG and tracheostomy in [**12-16**].
5. Status post a VP shunt in [**12-16**].
6. GPC meningitis in [**2196**], which has coag-negative Staph x3.
VP shunt was then removed and replaced.
7. Congestive heart failure.
8. Tracheal stenosis/severe tracheomalacia.
9. Anemia.
10. Colonization with MRSA and VRE.
11. Hypernatremia.
12. Nonverbal baseline.

MEDICATION ON ADMISSION: 1. Prevacid 30 mg p.o. q.d.
2. Glucophage 1000 mg p.o. b.i.d.
3. Glyburide 5 mg p.o. b.i.d.
4. Dilantin 200 mg p.o. t.i.d.
5. Captopril 25 mg p.o. t.i.d.
6. Hydralazine 50 mg p.o. t.i.d.
7. Lopressor 50 mg p.o. t.i.d.
8. Free water flushes 300 cc via PEG tube t.i.d.
9. Tube feeds 70 cc an hour.
10. Zantac 150 mg p.o. q.d.
11. Sliding scale insulin.
12. Senna 2 mg p.o. q.d.
13. Vicodin 1-2 tablets q.4h. prn.
14. Amoxicillin 500 mg p.o. t.i.d.  She was on day #4 for her
UTI.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Lives at [**Hospital 582**] nursing home. 

### Response:
{'Infection and inflammatory reaction due to indwelling urinary catheter,Unspecified septicemia,Hyperosmolality and/or hypernatremia,Congestive heart failure, unspecified,Thrombocytopenia, unspecified,Urinary tract infection, site not specified'}
