CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 67-year-old
female with a history of CAD, HIV, end-stage renal disease on
hemodialysis, diabetes, being admitted for hypoxia and
respiratory distress, intubated in the field and transferred
to the MICU.  So, the patient was recently admitted to [**Hospital1 18**]
from [**2114-4-4**] to [**2114-4-21**] for a pneumonia that was
unresponsive to ceftriaxone.  A bronchoscopy was consistent
with eosinophilic pneumonia, and the patient was started on
prednisone with good response.  She was discharged to home on
[**2114-4-21**] and was doing well without complaints until the
evening of admission on [**2114-4-29**], where she began to
experience increasing shortness of [**Date Range 1440**] without relief from
her inhalers.  She also reports some chest pain and proceeded
to activate her lifeline.  On arrival, the EMS saw that the
patient was only talking in [**1-19**] words and not completing her
sentences.  She was very dyspneic.  She was 92 percent on 100
percent nonrebreather.  She had no response with albuterol or
Atrovent treatments; and she was intubated in the field and
transferred to the [**Hospital1 18**] ER for further management.

MEDICAL HISTORY: The patient has a history of CAD
status post MI.
End-stage renal disease.
HIV on HAART.
Diabetes, type 2.
Pericarditis.
History of recent pneumonia.

MEDICATION ON ADMISSION: 

ALLERGIES: TO NSAIDs.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Congenital factor VIII disorder,Acute idiopathic pericarditis,Asymptomatic human immunodeficiency virus [HIV] infection status,Coronary atherosclerosis of native coronary artery,Old myocardial infarction
Acute respiratry failure,Obs chr bronc w(ac) exac,Hyp kid NOS w cr kid V,Cong factor viii diord,Ac idiopath pericarditis,Asymp hiv infectn status,Crnry athrscl natve vssl,Old myocardial infarct
Admission Date: [**2114-4-29**]        Discharge Date: [**2114-5-2**]

Date of Birth:  [**2046-6-27**]        Sex:  F

Service:  MED


HISTORY OF PRESENT ILLNESS:  The patient is a 67-year-old
female with a history of CAD, HIV, end-stage renal disease on
hemodialysis, diabetes, being admitted for hypoxia and
respiratory distress, intubated in the field and transferred
to the MICU.  So, the patient was recently admitted to [**Hospital1 18**]
from [**2114-4-4**] to [**2114-4-21**] for a pneumonia that was
unresponsive to ceftriaxone.  A bronchoscopy was consistent
with eosinophilic pneumonia, and the patient was started on
prednisone with good response.  She was discharged to home on
[**2114-4-21**] and was doing well without complaints until the
evening of admission on [**2114-4-29**], where she began to
experience increasing shortness of [**Date Range 1440**] without relief from
her inhalers.  She also reports some chest pain and proceeded
to activate her lifeline.  On arrival, the EMS saw that the
patient was only talking in [**1-19**] words and not completing her
sentences.  She was very dyspneic.  She was 92 percent on 100
percent nonrebreather.  She had no response with albuterol or
Atrovent treatments; and she was intubated in the field and
transferred to the [**Hospital1 18**] ER for further management.

On arrival, she was afebrile.  Her heart rate was 138.  Her
pressure was 214/121.  Her respirations were 30.  She was 98
percent intubated.  In the ED, she was given insulin for a
fingerstick of 362, Zofran for some emesis, and Solu-Medrol
125 mg IV x1.  The patient was subsequently transferred to
the MICU for further management from the ER.

PAST MEDICAL HISTORY:  The patient has a history of CAD
status post MI.
End-stage renal disease.
HIV on HAART.
Diabetes, type 2.
Pericarditis.
History of recent pneumonia.

ALLERGIES:  TO NSAIDs.


MEDICATIONS:
1. Zidovudine.
2. Nevirapine.
3. Lamivudine.
4. Nephrocaps.
5. Advair.
6. Albuterol.
7. Atrovent.
8. Isordil.
9. Aspirin.
10.      Prilosec.
11.      Epogen.
12.      PhosLo.
13.      Reglan.
14.      Tums.
15.      Prednisone.
16.      Lipitor.


PHYSICAL EXAMINATION:  Her physical exam on admission to the
MICU showed a temperature of 97.0 degrees, heart rate of 100,
blood pressure of 132/53, respirations of 14.  She was
saturating 99 percent on SIMV with pressure support, tidal
volume of 600, PEEP of 8, and FiO2 of 60 percent.  She was
intubated, sedated, grimacing to pain.  Her pupils were
equal, round, and reactive to light.  She had no JVP.  Her
lungs were clear to auscultation anteriorly with no wheezes,
rales, or rhonchi.  Cardiovascular, she was tachycardiac.
She had a regular rhythm.  She had a [**2-23**] holosystolic murmur
heard best at the left sternal border.  Abdomen was soft and
nontender.  Bowel sounds were present.  Extremities were warm
without edema.  Neuro examination, she was intubated.

LABORATORY DATA:  Her laboratory values showed a white count
of 15.2 with 56 percent neutrophils, 37 percent lymphocytes,
3 percent monocytes, and 2 percent eosinophils.  Her
hematocrit was 35.0.  Her platelets were 232.  Her INR was
1.2.  Her PTT was 46.2.  Her Chem-7 showed a sodium of 140,
potassium of 4.1, chloride of 93, bicarbonate of 36, BUN of
69, creatinine of 5.2, glucose of 318.  Her CK was 65.  Her
troponin was 0.09.

RADIOGRAPHIC STUDIES:  Her chest x-ray showed focal mid and
lower lung zone opacities, some pleural thickening at the
right base.  No new infiltrates or effusions.  Her EKG showed
sinus tachycardia at 130 with normal axis, normal intervals,
and some degree of LVH.

HOSPITAL COURSE/IMPRESSION:  A 67-year-old woman with CAD,
diabetes, HIV, end-stage renal disease, and a recent
admission for eosinophilic pneumonia, now admitted in
respiratory distress.  In terms of her pulmonary status, the
patient was continued on the intubation through the night,
but with a goal to wean her to pressure support.  They were
going to check a sputum culture and monitor her oxygenation
levels.  On hospital day 2, the patient was safely extubated
without incidence.  The differential diagnoses for her
shortness of [**Month/Day (4) 1440**] included PE, COPD flare, superimposed
pneumonia.  The patient was continued on steroids IV.  Gram
stain of the sputum did not show any organisms.  A CT scan
was obtained of her lungs that showed stable multifocal
parenchymal opacities, a small interval increase in the right-
sided pleural effusion.  No new focal consolidation or ground-
glass opacity to suggest any acute process.  The patient's
respiratory status continued to remain stable.  She was
subsequently switched to p.o. prednisone and continued on the
medications and inhaler treatments.  In terms of her
cardiovascular status, the patient initially had some
elevated troponins, but did not appear to be having any acute
coronary events.  She was continued on her outpatient regimen
of Lopressor and aspirin.  She did not experience any
episodes of chest pain on this admission, and her
cardiovascular signs remained stable including her blood
pressure.  In terms of her renal status, she was continued on
her hemodialysis every Monday, Wednesday, and Friday without
incident.  In terms of her diabetes, her blood sugars were
somewhat difficult to control on the steroids.  We had her on
insulin sliding scale with pretty good effect.  In terms of
her HIV status, we continued her on her outpatient regimen.
The patient was discharged to home on hospital day 4 in
stable condition with visiting nurse services.

DISCHARGE DIAGNOSES:  Respiratory distress.
Diabetes.
End-stage renal disease, on hemodialysis.

DISCHARGE MEDICATIONS:
1. Zidovudine 200 mg b.i.d.
2. Nevirapine 200 mg b.i.d.
3. Lamivudine 50 mg q.d.
4. Metoprolol 25 mg b.i.d.
5. Fluticasone-salmeterol 1 puff b.i.d.
6. Isordil 10 mg b.i.d.
7. Aspirin 325 mg q.d.
8. Protonix 40 mg q.d.
9. Metoclopramide 10 mg p.o. q.h.s.
10.      Calcium acetate 1334 mg t.i.d. with meals.
11.      Calcium carbonate 500 mg b.i.d.
12.      Prednisone 40 mg p.o. q.d. with a taper to end over
   2 weeks.
13.      Bactrim 1 single strength tablet q.d.


DISCHARGE FOLLOW-UP INSTRUCTIONS:  The patient is to follow
up with her primary care physician [**Name Initial (PRE) 176**] 3 days.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 14364**]

Dictated By:[**Last Name (NamePattern1) 267**]
MEDQUIST36
D:  [**2114-7-5**] 09:09:14
T:  [**2114-7-5**] 15:36:00
Job#:  [**Job Number **]
{'Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Congenital factor VIII disorder,Acute idiopathic pericarditis,Asymptomatic human immunodeficiency virus [HIV] infection status,Coronary atherosclerosis of native coronary artery,Old myocardial infarction'}


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 67-year-old
female with a history of CAD, HIV, end-stage renal disease on
hemodialysis, diabetes, being admitted for hypoxia and
respiratory distress, intubated in the field and transferred
to the MICU.  So, the patient was recently admitted to [**Hospital1 18**]
from [**2114-4-4**] to [**2114-4-21**] for a pneumonia that was
unresponsive to ceftriaxone.  A bronchoscopy was consistent
with eosinophilic pneumonia, and the patient was started on
prednisone with good response.  She was discharged to home on
[**2114-4-21**] and was doing well without complaints until the
evening of admission on [**2114-4-29**], where she began to
experience increasing shortness of [**Date Range 1440**] without relief from
her inhalers.  She also reports some chest pain and proceeded
to activate her lifeline.  On arrival, the EMS saw that the
patient was only talking in [**1-19**] words and not completing her
sentences.  She was very dyspneic.  She was 92 percent on 100
percent nonrebreather.  She had no response with albuterol or
Atrovent treatments; and she was intubated in the field and
transferred to the [**Hospital1 18**] ER for further management.

MEDICAL HISTORY: The patient has a history of CAD
status post MI.
End-stage renal disease.
HIV on HAART.
Diabetes, type 2.
Pericarditis.
History of recent pneumonia.

MEDICATION ON ADMISSION: 

ALLERGIES: TO NSAIDs.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Congenital factor VIII disorder,Acute idiopathic pericarditis,Asymptomatic human immunodeficiency virus [HIV] infection status,Coronary atherosclerosis of native coronary artery,Old myocardial infarction'}
