CHIEF COMPLAINT: dyspnea, volume overload

PRESENT ILLNESS: 59 M c hx of systolic CHF, DM2, HTN, Hep C, ESRD on
HD(tuthrsat), who p/w shortness of breath to ED on [**12-9**].
Patient was subsequently found to be severely hypertensive to
220s, started on nitroglycerin gtt, and transfered to MICU for
planned HD.

MEDICAL HISTORY: - ESRD: on HD (since '[**64**]) Tu/Th/Sat; failed kidney [**Year (2 digits) **]
attempted [**Year (2 digits) **] [**4-20**] from Hep C positive donor but aborted
[**1-16**] hypoxia
- Diabetes type 2: followed by [**Last Name (un) **]
- Hep C: genotype 1 c hepatitis C viral load of 18,400,000 I.U.
- Diastolic CHF: last ECHO [**4-20**]: [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 3841**] dilated, RA
moderately dilated; LVEF>55%
- GERD
- Former Substance Abuse: alcohol, cocaine, heroine; clean since
'[**64**], 1 relapse with cocaine in '[**65**]; attends [**Hospital1 **] and NA
- Renal cell carcinoma: s/p removal [**2162**] followed w/o recurrence

MEDICATION ON ADMISSION: Aspirin 81 mg
Citalopram 20 mg
Pantoprazole 40 mg
Cinacalcet 30 mg
Gabapentin 300 mg post HD
B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
Pramipexole 0.25 mg QHS
Allopurinol 100 mg Tablet Sig: 1.5 Tablets PO EVERY OTHER DAY
Metoclopramide 10 mg daily
Calcium Acetate 667 mg Capsule Sig: Two (2) Capsule PO TID
W/MEALS
Metoprolol 75 mg daily
Sevelamer 800 mg Tablet Sig: Two (2) Tablet PO TID W/MEALS
Glargine  30units at night

ALLERGIES: Iron Dextran Complex / Bupropion

PHYSICAL EXAM: Vitals: T 98.0 BP 156/96 HR 76 RR 12 O2sat 96% 3L
General: African American male, NAD, comfortable, speaking full
sentences, alert and oriented x 3
HEENT: unable to appreciate JVD, anicteric
Neck: RIJ in place
Chest: CTAB, crackles at bases, no wheezes
Cor: RRR, normal S1/S2, no m/r/g
Abdomen: obese, soft, moderately distended, non-tender, well
healed RLQ surgical scar
Ext: no pitting lower extremity edema, no calf tenderness
LUE: graft for dialysis, no warmth, no induration, no signs of
infection

FAMILY HISTORY: Father-died at age 52 from stroke
Mother-died in her 50s from cirrhosis
[**Name (NI) 12408**] DM
[**Name (NI) 30204**] addict
[**Name (NI) 30205**] at unknown age, due to problems with kidney and
pancreas

SOCIAL HISTORY: Mr. [**Known lastname 30197**] previously worked at Sheraton Hotel, retired in
[**2164**]. Currently lives with his sister
[**Name (NI) 1139**]: 80 pack-year history, quit [**2165-5-15**]
ETOH: history of 1 pint per week, quit [**2165-5-15**]
Illicits: Previous crack cocaine use, quit [**2165-5-15**].
Previous heroin use, quite 5-6 years ago. Member of NA, in
therapy for substance abuse.
Acute on chronic combined systolic and diastolic heart failure,End stage renal disease,Intestinal infection due to Clostridium difficile,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Obstructive sleep apnea (adult)(pediatric),Depressive disorder, not elsewhere classified,Gout, unspecified,Personal history of noncompliance with medical treatment, presenting hazards to health,Unspecified viral hepatitis C without hepatic coma,Chest pain, unspecified,Personal history of malignant neoplasm of kidney,Carpal tunnel syndrome,Barrett's esophagus,Other, mixed, or unspecified drug abuse, in remission,Hyperpotassemia,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled
Ac/chr syst/dia hrt fail,End stage renal disease,Int inf clstrdium dfcile,Hyp kid NOS w cr kid V,Obstructive sleep apnea,Depressive disorder NEC,Gout NOS,Hx of past noncompliance,Hpt C w/o hepat coma NOS,Chest pain NOS,Hx of kidney malignancy,Carpal tunnel syndrome,Barrett's esophagus,Drug abuse NEC-in remiss,Hyperpotassemia,DMII wo cmp uncntrld
Admission Date:  [**2167-12-10**]              Discharge Date:   [**2167-12-11**]

Date of Birth:  [**2108-4-9**]             Sex:   M

Service: MEDICINE

Allergies:
Iron Dextran Complex / Bupropion

Attending:[**First Name3 (LF) 2485**]
Chief Complaint:
dyspnea, volume overload

Major Surgical or Invasive Procedure:
hemodialysis

History of Present Illness:
59 M c hx of systolic CHF, DM2, HTN, Hep C, ESRD on
HD(tuthrsat), who p/w shortness of breath to ED on [**12-9**].
Patient was subsequently found to be severely hypertensive to
220s, started on nitroglycerin gtt, and transfered to MICU for
planned HD.

He had HD on [**12-7**], instead of [**12-8**] this week due to the
holiday.  Subsuquently he became more progressively dyspneic
starting on noon.  Patient reports his symptoms worsening at
dinner and especially become very orthopnic when he laid down.
He also reported chest tightness and wheezing.  His chest
tightness was diffuse, brought on with exertion at home, lasting
few minutes.  It was non radiating, he denies any arm
involvement, no lightheadedness, no nausea.  He did report
significant gasping for air with chest tightness.  The last time
it occured was in ED when he was moving around and the symptoms
were relieved with SLNTG.  It has not recurred since. Patient
also reported an episode of chills with T of 100.2 @ noon on
[**12-9**], that has not since recurred.  NO cough, no abdominal
pain, diarrhea x 3 days, once a day.  Minimal urine.  Also
reports increased LE swelling. Patient reports this is similar
to his prior volume overload episodes.

In ED, his VS were O2 Sats 91% RA, unable to talk in full
sentences. Given lasix 80 IV (no UO, due to HD) , nebs. K= 6.1,
given kayexalate. He also had brief episode of CP in ED,
resolved with SL nitro. Given ASA 325. No EKG changes. CXR with
overload. He was started on nitro paste with nitro gtt that
brought his BP to 160s.  He also had a RIJ placed in ED [**1-16**] to
difficult access.  Patient was hypertensive to 220s in AM still
on nitroglycerin gtt, and due to need for HD while on
nitroglycerin gtt was transfered to ICU.


Past Medical History:
- ESRD: on HD (since '[**64**]) Tu/Th/Sat; failed kidney [**Year (2 digits) **]
attempted [**Year (2 digits) **] [**4-20**] from Hep C positive donor but aborted
[**1-16**] hypoxia
- Diabetes type 2: followed by [**Last Name (un) **]
- Hep C: genotype 1 c hepatitis C viral load of 18,400,000 I.U.
- Diastolic CHF: last ECHO [**4-20**]: [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 3841**] dilated, RA
moderately dilated; LVEF>55%
- GERD
- Former Substance Abuse: alcohol, cocaine, heroine; clean since
'[**64**], 1 relapse with cocaine in '[**65**]; attends [**Hospital1 **] and NA
- Renal cell carcinoma: s/p removal [**2162**] followed w/o recurrence

- Pericardial effusion [**2165**], presumed viral; s/p
pericardiocentesis for tamponade physiology
- Depression: no suicide attempts, +passive thoughts about
suicide with no plan
- Barrett's Esophagus
- Carpal Tunnel Syndrome: used wrist slints
- Sleep Apnea: on CPAP


Social History:
Mr. [**Known lastname 30197**] previously worked at Sheraton Hotel, retired in
[**2164**]. Currently lives with his sister
[**Name (NI) 1139**]: 80 pack-year history, quit [**2165-5-15**]
ETOH: history of 1 pint per week, quit [**2165-5-15**]
Illicits: Previous crack cocaine use, quit [**2165-5-15**].
Previous heroin use, quite 5-6 years ago. Member of NA, in
therapy for substance abuse.


Family History:
Father-died at age 52 from stroke
Mother-died in her 50s from cirrhosis
[**Name (NI) 12408**] DM
[**Name (NI) 30204**] addict
[**Name (NI) 30205**] at unknown age, due to problems with kidney and
pancreas

Physical Exam:
Vitals: T 98.0 BP 156/96 HR 76 RR 12 O2sat 96% 3L
General: African American male, NAD, comfortable, speaking full
sentences, alert and oriented x 3
HEENT: unable to appreciate JVD, anicteric
Neck: RIJ in place
Chest: CTAB, crackles at bases, no wheezes
Cor: RRR, normal S1/S2, no m/r/g
Abdomen: obese, soft, moderately distended, non-tender, well
healed RLQ surgical scar
Ext: no pitting lower extremity edema, no calf tenderness
LUE: graft for dialysis, no warmth, no induration, no signs of
infection


Pertinent Results:
[**2167-12-10**] 01:59AM   WBC-13.7* RBC-3.42* HGB-9.7* HCT-31.7* MCV-93
MCH-28.4 MCHC-30.6* RDW-21.9*
[**2167-12-10**] 01:59AM   PLT COUNT-421
[**2167-12-10**] 01:59AM   PT-14.2* PTT-30.2 INR(PT)-1.2*
[**2167-12-10**] 01:59AM   GLUCOSE-86 UREA N-43* CREAT-11.2*# SODIUM-138
POTASSIUM-6.1* CHLORIDE-100 TOTAL CO2-24 ANION GAP-20
[**2167-12-10**] 01:59AM   CK(CPK)-96
[**2167-12-10**] 01:59AM   cTropnT-0.04*

[**2167-12-9**]: EKG - Sinus rhythm. Consider left ventricular
hypertrophy by voltage.  Prolonged QTc interval is non-specific

[**2167-12-10**]: chest xray - Pulmonary vascular engorgement and
perihilar haziness as well as fluffy opacities throughout the
lung fields are consistent with moderate CHF. Cardiomediastinal
silhouette is normal. There is no effusion or pneumothorax.

[**2167-12-10**]: TTE - The left atrium is normal in size. There is mild
symmetric left ventricular hypertrophy. The left ventricular
cavity size is normal. Overall left ventricular systolic
function is normal (LVEF>55%). Right ventricular chamber size
and free wall motion are normal. The aortic valve leaflets (3)
are mildly thickened. There is no aortic valve stenosis. No
aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened. No mitral regurgitation is seen. The pulmonary
artery systolic pressure could not be determined. There is no
pericardial effusion.


Brief Hospital Course:
In brief, the patient is a 59 year old man with hx of diastolic
CHF, DM2, HTN, Hep C, ESRD on HD, p/w shortness of breath likely
due to volume overload due to extra day without HD.

Acute on chronic diastolic CHF exacerbation: This was felt
likely due to extra day without HD due to holidays worsened by
hypertension. Patient denies any medication indescretion, likely
diet nonadherence. There was no evidence of cardiac ischemia.
There was no evidence of infection. His TTE was notable for
normal systolic function without significant valvular pathology.
He was dialysed without incident and was able to wean down on
his supplemental oxygen.  At the time of discharge he was
breathing comfortably on room air.

Chest pain: The patient had transient chest pain on admission
that resolved with control of his blood pressure and fluid
removal via ultrafiltration. As above, there was no sign of
acute cardiac ischemia. He continued on his home dose
metoprolol.

End-stage renal disease:  On HD T-Th-Sa hemodialysis via a left
arm AV graft.  He was dialyzed as above.  His phos-binder
regimen was increased.  His initial hyperkalemia was corrected
with kayexalate and dialysis. He will resume his regular
dialysis schedule upon discharge.

Diabetes mellitus: He continued on his home insulin regimen.

Diarrhea secondary to c. dif colitis: The patient had been
having loose stools ever since his last hospitalization.  A c
dif toxin was positive and he will complete a 10 day course of
metronidazole.

Depression: He continued his home dose of celexa.

Gout: There were no signs of acute flare and he continued on his
home dose of allopurinol.

FEN: - Diabetic low salt diet
Access: HD access via AV graft. had RIJ placed w/o complication
on admission, removed before discharge
Ppx: - SC heparin, PPI, bowel regimen
CODE: - Full
DISPO: - to home with previously scheduled HD follow-up


Medications on Admission:
Aspirin 81 mg
Citalopram 20 mg
Pantoprazole 40 mg
Cinacalcet 30 mg
Gabapentin 300 mg post HD
B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
Pramipexole 0.25 mg QHS
Allopurinol 100 mg Tablet Sig: 1.5 Tablets PO EVERY OTHER DAY
Metoclopramide 10 mg daily
Calcium Acetate 667 mg Capsule Sig: Two (2) Capsule PO TID
W/MEALS
Metoprolol 75 mg daily
Sevelamer 800 mg Tablet Sig: Two (2) Tablet PO TID W/MEALS
Glargine  30units at night


Discharge Medications:
1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
2. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
4. Cinacalcet 30 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO QHD (each
hemodialysis).
6. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
7. Pramipexole 0.25 mg Tablet Sig: One (1) Tablet PO qHS ().
8. Allopurinol 300 mg Tablet Sig: 0.5 Tablet PO EVERY OTHER DAY
(Every Other Day).
9. Metoclopramide 10 mg Tablet Sig: One (1) Tablet PO once a day
as needed.
10. Calcium Acetate 667 mg Capsule Sig: Two (2) Capsule PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
11. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO
BID (2 times a day).
12. Sevelamer 800 mg Tablet Sig: Three (3) Tablet PO TID W/MEALS
(3 TIMES A DAY WITH MEALS).
Disp:*90 Tablet(s)* Refills:*2*
13. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO three
times a day.
Disp:*30 Tablet(s)* Refills:*0*
14. Insulin Glargine 100 unit/mL Solution Sig: Thirty (30) units
Subcutaneous at bedtime.


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
Acute on chronic diastolic congestive heart failure
End-stage renal disease
Clostridium deficile colitis

Secondary:
Diabetes type 2 with complication
Obstructive sleep apnea


Discharge Condition:
good. ambulating without assist. normal oxygenation on room air.


Discharge Instructions:
You have been evaluated and treated for shortness of breath and
fluid overload. This was most likely related to not having
enough dialysis to match you intake.  As you had dialysis you
improved your breathing significantly.

You were also found to have an infectious diarrhrea.  This can
be treated with oral antibiotics.  It is important not to drink
any alcohol as the combination of alcohol and this antibiotic
can make you very nauseated and feel uncomfortable.

Please resume your regular dialysis session on Saturday
([**2167-12-12**]).

If you have any concerning symptoms such as chest pain,
shortness of breath, palpitations, or severe abdominal pain;
please seek medical attention.

Followup Instructions:
Cardiology Clinic:
[**First Name8 (NamePattern2) 1903**] [**Last Name (NamePattern1) 1904**], [**MD Number(3) 1240**]:[**Telephone/Fax (1) 3512**] Date/Time:[**2167-12-30**] 9:00

Primary Care physician:
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2168-1-1**] 10:00

Pulmonary clinic:
DR. [**First Name8 (NamePattern2) **] [**Name (STitle) **] Phone:[**Telephone/Fax (1) 612**] Date/Time:[**2168-1-8**] 8:50

[**Hospital **] Clinic: [**Location (un) **] dialysis clinic on Saturday [**2167-12-12**]
{"Acute on chronic combined systolic and diastolic heart failure,End stage renal disease,Intestinal infection due to Clostridium difficile,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Obstructive sleep apnea (adult)(pediatric),Depressive disorder, not elsewhere classified,Gout, unspecified,Personal history of noncompliance with medical treatment, presenting hazards to health,Unspecified viral hepatitis C without hepatic coma,Chest pain, unspecified,Personal history of malignant neoplasm of kidney,Carpal tunnel syndrome,Barrett's esophagus,Other, mixed, or unspecified drug abuse, in remission,Hyperpotassemia,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled"}


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: dyspnea, volume overload

PRESENT ILLNESS: 59 M c hx of systolic CHF, DM2, HTN, Hep C, ESRD on
HD(tuthrsat), who p/w shortness of breath to ED on [**12-9**].
Patient was subsequently found to be severely hypertensive to
220s, started on nitroglycerin gtt, and transfered to MICU for
planned HD.

MEDICAL HISTORY: - ESRD: on HD (since '[**64**]) Tu/Th/Sat; failed kidney [**Year (2 digits) **]
attempted [**Year (2 digits) **] [**4-20**] from Hep C positive donor but aborted
[**1-16**] hypoxia
- Diabetes type 2: followed by [**Last Name (un) **]
- Hep C: genotype 1 c hepatitis C viral load of 18,400,000 I.U.
- Diastolic CHF: last ECHO [**4-20**]: [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 3841**] dilated, RA
moderately dilated; LVEF>55%
- GERD
- Former Substance Abuse: alcohol, cocaine, heroine; clean since
'[**64**], 1 relapse with cocaine in '[**65**]; attends [**Hospital1 **] and NA
- Renal cell carcinoma: s/p removal [**2162**] followed w/o recurrence

MEDICATION ON ADMISSION: Aspirin 81 mg
Citalopram 20 mg
Pantoprazole 40 mg
Cinacalcet 30 mg
Gabapentin 300 mg post HD
B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
Pramipexole 0.25 mg QHS
Allopurinol 100 mg Tablet Sig: 1.5 Tablets PO EVERY OTHER DAY
Metoclopramide 10 mg daily
Calcium Acetate 667 mg Capsule Sig: Two (2) Capsule PO TID
W/MEALS
Metoprolol 75 mg daily
Sevelamer 800 mg Tablet Sig: Two (2) Tablet PO TID W/MEALS
Glargine  30units at night

ALLERGIES: Iron Dextran Complex / Bupropion

PHYSICAL EXAM: Vitals: T 98.0 BP 156/96 HR 76 RR 12 O2sat 96% 3L
General: African American male, NAD, comfortable, speaking full
sentences, alert and oriented x 3
HEENT: unable to appreciate JVD, anicteric
Neck: RIJ in place
Chest: CTAB, crackles at bases, no wheezes
Cor: RRR, normal S1/S2, no m/r/g
Abdomen: obese, soft, moderately distended, non-tender, well
healed RLQ surgical scar
Ext: no pitting lower extremity edema, no calf tenderness
LUE: graft for dialysis, no warmth, no induration, no signs of
infection

FAMILY HISTORY: Father-died at age 52 from stroke
Mother-died in her 50s from cirrhosis
[**Name (NI) 12408**] DM
[**Name (NI) 30204**] addict
[**Name (NI) 30205**] at unknown age, due to problems with kidney and
pancreas

SOCIAL HISTORY: Mr. [**Known lastname 30197**] previously worked at Sheraton Hotel, retired in
[**2164**]. Currently lives with his sister
[**Name (NI) 1139**]: 80 pack-year history, quit [**2165-5-15**]
ETOH: history of 1 pint per week, quit [**2165-5-15**]
Illicits: Previous crack cocaine use, quit [**2165-5-15**].
Previous heroin use, quite 5-6 years ago. Member of NA, in
therapy for substance abuse. 

### Response:
{"Acute on chronic combined systolic and diastolic heart failure,End stage renal disease,Intestinal infection due to Clostridium difficile,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Obstructive sleep apnea (adult)(pediatric),Depressive disorder, not elsewhere classified,Gout, unspecified,Personal history of noncompliance with medical treatment, presenting hazards to health,Unspecified viral hepatitis C without hepatic coma,Chest pain, unspecified,Personal history of malignant neoplasm of kidney,Carpal tunnel syndrome,Barrett's esophagus,Other, mixed, or unspecified drug abuse, in remission,Hyperpotassemia,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled"}
