CHIEF COMPLAINT: Hypertension, headache

PRESENT ILLNESS: Mr. [**Known lastname 784**] is a 44 y/o man with h/o malignant hypertension and
ESRD on HD (s/p recent removal of failed transplanted kidney in
[**7-19**]) who presents with headache X 5 days and hypertension. The
patient noted occipital headache for past 5 days. Similar in
character & location to prior headaches associated with high
blood pressure. No visual symptoms. No numbness/tingling of
either arm or leg. No fevers or neck stiffness. Did not take any
meds for the pain. Took blood pressure which was 190s/110s at
home; tells me that last week, when he was feeling well, he saw
blood pressures in the range of 115-120 systolic. Contact[**Name (NI) **] PCP
office today and seen at [**Company 191**] where his BP was 180/120 on the L
and 190/110 on the right. He was directed to the emergency room
at that time for further workup and treatment.

MEDICAL HISTORY: - ESRD secondary to chronic ureterovesical junction obstruction
leading to bilateral hydronephrosis, on hemodialysis
- S/p living-related renal transplant [**2134**] ([**Name (NI) 106515**] brother),
failed, now on hemodialysis since [**12-18**]
- Malignant hypertension
- PRES
- s/p SAH
- Gout
- Peptic Ulcer disease
- Bladder neck stricture
- Atypical chest pain

MEDICATION ON ADMISSION: Renagel 1600 mg TID
Omeprazole 20 mg daily
Renal caps (renal MVI) daily
Lisinopril 40 mg [**Hospital1 **]
Nifedipine ER 120 mg daily
carvedilol 50 mg [**Hospital1 **]
diovan 160 mg [**Hospital1 **]
hydralazine 50 mg PO q6h
labetalol 400 mg TID
clonidine patch 0.3 weekly

ALLERGIES: Ciprofloxacin / Hydralazine

PHYSICAL EXAM: VS - Temp  96.6 F, BP 185/113, HR 53, R 12, O2-sat 99% 2L NC
GENERAL - alert male, pleasant, appropriately interactive, in no
acute distress
HEENT - PERRL bilaterally, EOMI, no scleral icterus, MMM, tongue
midline
NECK - supple, no thyromegaly or lymphadenopathy, JVD at 7 cm
LUNGS - clear bilaterally without crackles or rhonchi, good
inspiratory effort
HEART - RRR, normal S1 & S2, loud crescendo-decrescendo murmur
heard best at LUSB radiating to carotids
ABDOMEN - normoactive bowel sounds, nondistended, soft, no
appreciable tenderness to palpation, no masses or HSM, no
rebound/guarding
EXTREMITIES - WWP, no peripheral edema, 2+ DP & radial pulses
bilaterally
NEURO - A&O X 3. CN II-XII intact. Strength 5/5 bilateral
biceps, triceps, hand grip, hip flexors, ankle dorsiflexion &
plantarflexion. DTRs 2+ bilaterally at biceps. Sensation to
light touch intact bilateral upper & lower extremities. No
pronator drift. Finger to nose testing intact.

FAMILY HISTORY: Father had MI mid 50s. No DM. Brother had cancer of jaw which
was resected.

SOCIAL HISTORY: 40py, quit 2 yrs ago. No EtOH or other drugs. Lives in apartment
Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Other ureteric obstruction,Gout, unspecified,Anemia in chronic kidney disease,Disorders of phosphorus metabolism,Kidney replaced by transplant,Insomnia, unspecified,Other forms of migraine, without mention of intractable migraine without mention of status migrainosus
Mal hyp kid w cr kid V,End stage renal disease,Ureteric obstruction NEC,Gout NOS,Anemia in chr kidney dis,Dis phosphorus metabol,Kidney transplant status,Insomnia NOS,Othr migrne wo ntrc mgrn
Admission Date:  [**2143-8-15**]              Discharge Date:   [**2143-8-24**]

Date of Birth:  [**2098-12-27**]             Sex:   M

Service: MEDICINE

Allergies:
Ciprofloxacin / Hydralazine

Attending:[**First Name3 (LF) 613**]
Chief Complaint:
Hypertension, headache

Major Surgical or Invasive Procedure:
Arterial line placement-right radial.


History of Present Illness:
Mr. [**Known lastname 784**] is a 44 y/o man with h/o malignant hypertension and
ESRD on HD (s/p recent removal of failed transplanted kidney in
[**7-19**]) who presents with headache X 5 days and hypertension. The
patient noted occipital headache for past 5 days. Similar in
character & location to prior headaches associated with high
blood pressure. No visual symptoms. No numbness/tingling of
either arm or leg. No fevers or neck stiffness. Did not take any
meds for the pain. Took blood pressure which was 190s/110s at
home; tells me that last week, when he was feeling well, he saw
blood pressures in the range of 115-120 systolic. Contact[**Name (NI) **] PCP
office today and seen at [**Company 191**] where his BP was 180/120 on the L
and 190/110 on the right. He was directed to the emergency room
at that time for further workup and treatment.

In the ED, the patient's initial BP was 241/130 with HR 62. He
was treated with 40 mg IV labetalol and a nitroglycerin drip. He
complained of headache and was treated with IV dilaudid after
which time he was nauseous and vomited several times. He
received zofran for his nausea and was given 2 L NS. His blood
pressure improved to 170s-180s/90s and he was transferred to the
MICU.

On arrival to the MICU, the patient is complaining of [**4-20**]
posterior headache. No visual symptoms. Slight shortness of
breath (for past several days). No chest pain. No abdominal
pain, dysuria, fevers, constipation/diarrhea, or blood in his
stool. No particular precipitating event per his report. He has
been compliant with all medications by his report. He denies any
increased salt intake or alcohol intake. He also denies illicit
drug use. He is dialyzed on MWF so is due on [**8-16**].


Past Medical History:
- ESRD secondary to chronic ureterovesical junction obstruction
leading to bilateral hydronephrosis, on hemodialysis
- S/p living-related renal transplant [**2134**] ([**Name (NI) 106515**] brother),
failed, now on hemodialysis since [**12-18**]
- Malignant hypertension
- PRES
- s/p SAH
- Gout
- Peptic Ulcer disease
- Bladder neck stricture
- Atypical chest pain


Social History:
40py, quit 2 yrs ago. No EtOH or other drugs. Lives in apartment

building with his wheelchair-bound wife where he works as
superintendent.


Family History:
Father had MI mid 50s. No DM. Brother had cancer of jaw which
was resected.

Physical Exam:
VS - Temp  96.6 F, BP 185/113, HR 53, R 12, O2-sat 99% 2L NC
GENERAL - alert male, pleasant, appropriately interactive, in no
acute distress
HEENT - PERRL bilaterally, EOMI, no scleral icterus, MMM, tongue
midline
NECK - supple, no thyromegaly or lymphadenopathy, JVD at 7 cm
LUNGS - clear bilaterally without crackles or rhonchi, good
inspiratory effort
HEART - RRR, normal S1 & S2, loud crescendo-decrescendo murmur
heard best at LUSB radiating to carotids
ABDOMEN - normoactive bowel sounds, nondistended, soft, no
appreciable tenderness to palpation, no masses or HSM, no
rebound/guarding
EXTREMITIES - WWP, no peripheral edema, 2+ DP & radial pulses
bilaterally
NEURO - A&O X 3. CN II-XII intact. Strength 5/5 bilateral
biceps, triceps, hand grip, hip flexors, ankle dorsiflexion &
plantarflexion. DTRs 2+ bilaterally at biceps. Sensation to
light touch intact bilateral upper & lower extremities. No
pronator drift. Finger to nose testing intact.


Pertinent Results:
Admission Labs:
[**2143-8-15**] 08:50PM BLOOD WBC-4.0 RBC-4.26* Hgb-12.1* Hct-37.3*
MCV-88 MCH-28.4 MCHC-32.4 RDW-14.0 Plt Ct-191
[**2143-8-15**] 08:50PM BLOOD Neuts-65.7 Lymphs-25.8 Monos-5.7 Eos-2.3
Baso-0.4
[**2143-8-15**] 08:50PM BLOOD Plt Ct-191
[**2143-8-16**] 01:10AM BLOOD PT-15.7* PTT-40.4* INR(PT)-1.4*
[**2143-8-15**] 08:50PM BLOOD Glucose-95 UreaN-42* Creat-11.0* Na-141
K-4.8 Cl-99 HCO3-25 AnGap-22*
[**2143-8-15**] 08:50PM BLOOD ALT-2 AST-12 CK(CPK)-25* AlkPhos-71
TotBili-0.3
[**2143-8-15**] 08:50PM BLOOD cTropnT-0.02*
[**2143-8-16**] 06:44AM BLOOD CK-MB-NotDone cTropnT-0.03*
[**2143-8-15**] 08:50PM BLOOD Calcium-9.8 Phos-6.6* Mg-2.2
[**2143-8-16**] 06:44AM BLOOD Cortsol-27.3*
[**2143-8-16**] 11:47PM BLOOD Cortsol-21.4*
Metanephrines: <0.20

Discharge Labs:
[**2143-8-24**] 06:30AM BLOOD WBC-4.1 RBC-4.25* Hgb-12.4* Hct-37.9*
MCV-89 MCH-29.3 MCHC-32.8 RDW-13.4 Plt Ct-164
[**2143-8-24**] 06:30AM BLOOD Plt Ct-164
[**2143-8-24**] 06:30AM BLOOD Glucose-101 UreaN-37* Creat-8.7*# Na-140
K-4.6 Cl-98 HCO3-30 AnGap-17
[**2143-8-16**] 06:44AM BLOOD CK(CPK)-24*
[**2143-8-24**] 06:30AM BLOOD Calcium-10.0 Phos-6.4* Mg-2.2

Studies:
[**2143-8-15**] CT head: HEAD CT WITHOUT IV CONTRAST: There is no
fracture, hemorrhage, edema, mass effect, or shift of normally
midline structures. The visualized paranasal sinuses again
demonstrate a small amount of secretion in the right sphenoid
sinus, which demonstrates a slight decrease in degree of
aerosolization. The soft tissues are unremarkable.
IMPRESSION: No evidence of hemorrhage. Findings posted to the ED
dashboard
at time of scan completion.

[**2143-8-16**] Echo: The left atrium is mildly dilated. The right atrium
is moderately dilated. There is moderate symmetric left
ventricular hypertrophy. The left ventricular cavity size is
normal for the patient's body size. Regional left ventricular
wall motion is normal. Overall left ventricular systolic
function is normal (LVEF>55%). Right ventricular chamber size
and free wall motion are normal. The ascending aorta is mildly
dilated. The aortic arch is mildly dilated. The aortic valve
leaflets (3) appear structurally normal with good leaflet
excursion and no aortic regurgitation. The mitral valve appears
structurally normal with trivial mitral regurgitation. There is
no mitral valve prolapse. The estimated pulmonary artery
systolic pressure is normal. There is no pericardial effusion.

IMPRESSION: Moderate symmetric left ventricular hypertrophy with
preserved global and regional biventricular systolic function.
Dilated thoracic aorta.

[**2143-8-17**] CXR: FINDINGS: There is a right IJ line with tip in the
SVC/RA junction. The heart remains mildly enlarged. There is no
focal infiltrate or effusion.


Brief Hospital Course:
44 y/o M with h/o malignant hypertension & ESRD on HD (s/p
recent removal of transplanted kidney) admitted with
hypertensive urgency with headache.
.
#. Hypertensive urgency: Patient's blood pressure at [**Company 191**] in the
180s-190s systolic but up to 240s/130s in the ED.  He received
labetalol with good effect but HR down to 50s.  Because he was
bradycardic, nitroglycerin gtt was started.  Arterial line
placed on arrival to the MICU registering blood pressures 50
points higher systolic than noninvasive monitoring.  The morning
following admission, his oral antihypertensives were restarted
and renal was consulted for urgent dialysis.  During this time
he was still requiring nitro gtt for BP control.  In the course
of restarting all home meds he had a drop in BP and thus, his
meds were staggered.  Also per renal recs, minoxidil was
initiated for further control.  Following the minoxidil, he had
one episode of orthostasis.  Unclear if minoxidil was the cause.
 On the day of transfer to the floor, he was 190s/100s in the
am, but once he received his meds he dropped 100-110s/60s.
.
On the floor, the patient BP remained initially labile with
peaks in the 200s and lows systolic 100s-110s.  He was
asymptomatic with high blood pressures at this time, but did
complain of some lightheadedness with ambulation when he blood
pressure was systolic 110s.  The patient had two episodes of
dizziness in the setting of SBP in the 100-110s which were
attributed to the combination of 120mg nifedepine and 600mg
labetalol given at night.  At the time of discharge his regimen
consisted of:
AM: lisinopril 40mg, Nifedipine CR 30mg, Labetalol 400mg,
metoprolol XL200mg, minoxidil 5mg and valsartan 160mg.
Noon: Labetalol 400mg, minoxidil 5mg.
PM: Nifedipine CR 90mg, Labetalol 600mg, lisinopril 40mg.
He wears a Clonidine patch 0.3 put on every Sunday and was being
treated with oral Clonidine 0.1mg for elevated blood pressures.
He will continue with his outpatient dialysis schedule and will
go to his HD center on a regular basis for BP checks.  He was
also scheduled to see Dr. [**Last Name (STitle) **] in follow up on [**8-27**].

#. Headache, resolved: Likely related to his hypertension.  Had
a negative head CT upon admission.  In the MICU, the patient was
treated for pain with morphine as well as with compazine for
nausea.  The headache resolved by time of transfer with improved
BP control.
.
#. ESRD on HD: HD on MWF. The patient received sevelamer & renal
vitamin. Electrolytes were managed per Renal during dialysis.
Plan for follow up with Dr. [**Last Name (STitle) **] to discuss future options.


Medications on Admission:
Renagel 1600 mg TID
Omeprazole 20 mg daily
Renal caps (renal MVI) daily
Lisinopril 40 mg [**Hospital1 **]
Nifedipine ER 120 mg daily
carvedilol 50 mg [**Hospital1 **]
diovan 160 mg [**Hospital1 **]
hydralazine 50 mg PO q6h
labetalol 400 mg TID
clonidine patch 0.3 weekly


Discharge Medications:
1. Valsartan 160 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
2. Clonidine 0.3 mg/24 hr Patch Weekly Sig: One (1) Patch Weekly
Transdermal QSUN (every Sunday).
3. Acetaminophen 500 mg Tablet Sig: One (1) Tablet PO Q6H (every
6 hours) as needed for headache.
4. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime)
as needed for PRN insomnia.
5. Sevelamer HCl 800 mg Tablet Sig: Two (2) Tablet PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
6. Labetalol 200 mg Tablet Sig: 2-3 Tablets PO three times a
day: 400 mg at 6 AM and 2 PM, and 600 mg at 10 PM.
Disp:*210 Tablet(s)* Refills:*0*
7. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr
Sig: Two (2) Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*60 Tablet Sustained Release 24 hr(s)* Refills:*0*
8. Minoxidil 2.5 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
Disp:*120 Tablet(s)* Refills:*0*
9. Nifedipine 30 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO DAILY (Daily): take at 8am.
Disp:*30 Tablet Sustained Release(s)* Refills:*0*
10. Nifedipine 90 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO HS (at bedtime): Please take at 8pm.
Disp:*30 Tablet Sustained Release(s)* Refills:*0*
11. Clonidine 0.1 mg Tablet Sig: One (1) Tablet PO ONCE (Once)
as needed for headache associated with high blood pressure.
Disp:*30 Tablet(s)* Refills:*0*
12. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
13. Lisinopril 40 mg Tablet Sig: One (1) Tablet PO twice a day.



Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Primary:
- Hypertensive urgency.
- End stage renal failure.


Discharge Condition:
Stable.


Discharge Instructions:
You were admitted for elevated blood pressure and headaches.
Your high blood pressure was treated with a combination of
antihypertensive medications as well as hemodialysis. Your
headaches were felt to be due to elevated blood pressure.

In the future, please come to the dialysis center to have your
blood pressure recorded everyday.  This has been arranged for
you by your dialysis doctors.

If you experience similar headaches please take 0.1mg Clonidine
by mouth. If the headaches are not alleviated by clonidine or if
you experience other symptoms such as blurry vision, please
return to the emergency room.

Followup Instructions:
Please keep your primary care doctor's appointment with Dr.
[**Last Name (STitle) **] on Tuesday, [**8-27**] at 4pm.  His phone number is
[**Telephone/Fax (1) 250**].


                             [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**]
{'Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Other ureteric obstruction,Gout, unspecified,Anemia in chronic kidney disease,Disorders of phosphorus metabolism,Kidney replaced by transplant,Insomnia, unspecified,Other forms of migraine, without mention of intractable migraine without mention of status migrainosus'}


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: Hypertension, headache

PRESENT ILLNESS: Mr. [**Known lastname 784**] is a 44 y/o man with h/o malignant hypertension and
ESRD on HD (s/p recent removal of failed transplanted kidney in
[**7-19**]) who presents with headache X 5 days and hypertension. The
patient noted occipital headache for past 5 days. Similar in
character & location to prior headaches associated with high
blood pressure. No visual symptoms. No numbness/tingling of
either arm or leg. No fevers or neck stiffness. Did not take any
meds for the pain. Took blood pressure which was 190s/110s at
home; tells me that last week, when he was feeling well, he saw
blood pressures in the range of 115-120 systolic. Contact[**Name (NI) **] PCP
office today and seen at [**Company 191**] where his BP was 180/120 on the L
and 190/110 on the right. He was directed to the emergency room
at that time for further workup and treatment.

MEDICAL HISTORY: - ESRD secondary to chronic ureterovesical junction obstruction
leading to bilateral hydronephrosis, on hemodialysis
- S/p living-related renal transplant [**2134**] ([**Name (NI) 106515**] brother),
failed, now on hemodialysis since [**12-18**]
- Malignant hypertension
- PRES
- s/p SAH
- Gout
- Peptic Ulcer disease
- Bladder neck stricture
- Atypical chest pain

MEDICATION ON ADMISSION: Renagel 1600 mg TID
Omeprazole 20 mg daily
Renal caps (renal MVI) daily
Lisinopril 40 mg [**Hospital1 **]
Nifedipine ER 120 mg daily
carvedilol 50 mg [**Hospital1 **]
diovan 160 mg [**Hospital1 **]
hydralazine 50 mg PO q6h
labetalol 400 mg TID
clonidine patch 0.3 weekly

ALLERGIES: Ciprofloxacin / Hydralazine

PHYSICAL EXAM: VS - Temp  96.6 F, BP 185/113, HR 53, R 12, O2-sat 99% 2L NC
GENERAL - alert male, pleasant, appropriately interactive, in no
acute distress
HEENT - PERRL bilaterally, EOMI, no scleral icterus, MMM, tongue
midline
NECK - supple, no thyromegaly or lymphadenopathy, JVD at 7 cm
LUNGS - clear bilaterally without crackles or rhonchi, good
inspiratory effort
HEART - RRR, normal S1 & S2, loud crescendo-decrescendo murmur
heard best at LUSB radiating to carotids
ABDOMEN - normoactive bowel sounds, nondistended, soft, no
appreciable tenderness to palpation, no masses or HSM, no
rebound/guarding
EXTREMITIES - WWP, no peripheral edema, 2+ DP & radial pulses
bilaterally
NEURO - A&O X 3. CN II-XII intact. Strength 5/5 bilateral
biceps, triceps, hand grip, hip flexors, ankle dorsiflexion &
plantarflexion. DTRs 2+ bilaterally at biceps. Sensation to
light touch intact bilateral upper & lower extremities. No
pronator drift. Finger to nose testing intact.

FAMILY HISTORY: Father had MI mid 50s. No DM. Brother had cancer of jaw which
was resected.

SOCIAL HISTORY: 40py, quit 2 yrs ago. No EtOH or other drugs. Lives in apartment 

### Response:
{'Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Other ureteric obstruction,Gout, unspecified,Anemia in chronic kidney disease,Disorders of phosphorus metabolism,Kidney replaced by transplant,Insomnia, unspecified,Other forms of migraine, without mention of intractable migraine without mention of status migrainosus'}
