CHIEF COMPLAINT: Increasing creatinine value on labs, increasing confusion,
nausea and diarrhea since d/c from hospital on [**7-11**]

PRESENT ILLNESS: 60 y/o male s/p OLT on [**2110-5-13**] with several hospitalizations
since transplant for incisional wound issues, nausea, poor
appetite and confusion who now presents 11 days post last
admission with increasing creat on labs, increasing confusion
and still having nausea and diarrhea in spite of switching from
Cellcept to Myfortic. On last admission, confusion slowly
resolved. A neuro consult had been obtained at that time and he
was ruled out for cerebral bleed. IV Vitamins, hydration,
decreased Prograf dosing and starting thyroid replacement for
TSH of 12 were also done and improvement in MS was seen. Since
the discharge, he has continued with nausea, poor PO intake
(Feeding tube was self d/c'd by patient)and has seen an increase
in creatinine to 2.7. Liver enzymes have been stable, UC
negative. No fever or chills.

MEDICAL HISTORY: ETOH cirrhosis, s/p OLT [**2110-5-13**] (with mesh closure)
DM II
HTN
h/o C diff
s/p esophageal dilatation
Basal cell CA
Lumbar DJD
Failure to Thrive

MEDICATION ON ADMISSION: [**Last Name (un) **], mmf750'', protonix 40', valcyte 450', bactrim ss', fluc
400', colace 100", zoloft 100', levaquin 500 x 4 more days, ISS

ALLERGIES: Flagyl

PHYSICAL EXAM: On Admission:
VS: 96.9, 105, 135/65, 20, 96% RA
Gen: Appears confused
Oriented x1
CV: RRR, 2+ radial pulses
Pulm: CTA bilaterally
Abd: Diffusely tender with guarding

FAMILY HISTORY: Non Contrib

SOCIAL HISTORY: Lives in [**Location **] with wife in single family home
H/O ETOH abuse
Unspecified septicemia,Severe sepsis,Acute kidney failure with lesion of tubular necrosis,Septic shock,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Liver replaced by transplant,Acidosis,Unspecified protein-calorie malnutrition,Congestive heart failure, unspecified,Thrombocytopenia, unspecified,Metabolic encephalopathy,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Adult failure to thrive,Hypercalcemia,Anemia, unspecified
Septicemia NOS,Severe sepsis,Ac kidny fail, tubr necr,Septic shock,Acute respiratry failure,Food/vomit pneumonitis,Liver transplant status,Acidosis,Protein-cal malnutr NOS,CHF NOS,Thrombocytopenia NOS,Metabolic encephalopathy,DMII wo cmp nt st uncntr,Hypertension NOS,Failure to thrive-adult,Hypercalcemia,Anemia NOS
Name:  [**Known lastname 10594**],[**Known firstname **]                Unit No:   [**Numeric Identifier 10595**]

Admission Date:  [**2110-7-22**]              Discharge Date:   [**2110-8-13**]

Date of Birth:  [**2049-10-10**]             Sex:   M

Service: SURGERY

Allergies:
Flagyl

Attending:[**First Name3 (LF) 2800**]
Addendum:
Please note that patient was given stress dose steroids while in
the ICU for a cosyntropin stim test that showed a flat response,
with baseline cortisol 3.1, 1/2 hour 4.1 and 1 hour 4.3. Patient
was switched to prednisone taper and was sent out on 7.5 mg
prednisone daily. Will need final taper recommendations in
clinic.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 14**] & Rehab Center - [**Hospital1 15**]

                             [**First Name11 (Name Pattern1) 399**] [**Last Name (NamePattern4) 2801**] MD [**MD Number(1) 401**]

Completed by:[**2110-8-13**]

Admission Date:  [**2110-7-22**]              Discharge Date:   [**2110-8-13**]

Date of Birth:  [**2049-10-10**]             Sex:   M

Service: SURGERY

Allergies:
Flagyl

Attending:[**First Name3 (LF) 668**]
Chief Complaint:
Increasing creatinine value on labs, increasing confusion,
nausea and diarrhea since d/c from hospital on [**7-11**]

Major Surgical or Invasive Procedure:
Open J tube on [**2110-8-12**] placed after several attempts at
[**Last Name (un) 1372**]-duodenal tubes pulled or clogged

History of Present Illness:
60 y/o male s/p OLT on [**2110-5-13**] with several hospitalizations
since transplant for incisional wound issues, nausea, poor
appetite and confusion who now presents 11 days post last
admission with increasing creat on labs, increasing confusion
and still having nausea and diarrhea in spite of switching from
Cellcept to Myfortic. On last admission, confusion slowly
resolved. A neuro consult had been obtained at that time and he
was ruled out for cerebral bleed. IV Vitamins, hydration,
decreased Prograf dosing and starting thyroid replacement for
TSH of 12 were also done and improvement in MS was seen. Since
the discharge, he has continued with nausea, poor PO intake
(Feeding tube was self d/c'd by patient)and has seen an increase
in creatinine to 2.7. Liver enzymes have been stable, UC
negative. No fever or chills.

Past Medical History:
ETOH cirrhosis, s/p OLT [**2110-5-13**] (with mesh closure)
DM II
HTN
h/o C diff
s/p esophageal dilatation
Basal cell CA
Lumbar DJD
Failure to Thrive

Social History:
Lives in [**Location **] with wife in single family home
H/O ETOH abuse


Family History:
Non Contrib

Physical Exam:
On Admission:
VS: 96.9, 105, 135/65, 20, 96% RA
Gen: Appears confused
Oriented x1
CV: RRR, 2+ radial pulses
Pulm: CTA bilaterally
Abd: Diffusely tender with guarding

Pertinent Results:
[**2110-7-22**] 11:00PM   GLUCOSE-91 UREA N-10 CREAT-2.6*# SODIUM-138
POTASSIUM-4.2 CHLORIDE-107 TOTAL CO2-19* ANION GAP-16
[**2110-7-22**] 11:00PM   ALT(SGPT)-23 AST(SGOT)-51* ALK PHOS-107
AMYLASE-16 TOT BILI-0.3
[**2110-7-22**] 11:00PM   LIPASE-15
[**2110-7-22**] 11:00PM   WBC-3.4* RBC-3.40* HGB-9.9* HCT-28.8* MCV-85
MCH-29.1 MCHC-34.3 RDW-15.7*
[**2110-7-22**] 11:00PM   PLT COUNT-192
[**2110-7-22**] 11:00PM   PT-13.9* PTT-34.3 INR(PT)-1.2*

Brief Hospital Course:
Patient admitted with increasing confusion from baseline,
increasing creat, nausea and diarrhea. S/P OLT in [**4-29**] for ETOH
cirrhosis and coming from rehab center where he has been a
patient since discharge [**7-11**].
Initial therapy was given with IV fluids for likelydehydration,
Head CT done showing no acute intracranial hemorrhage or mass
effect.  Abd/Pelvis CT were done showing bilateral pleural
effusions, pericardial effusions, Status post OLT, reduced size
of anterior abdominal wall collection and reduction in size of
right adrenal hematoma.
Liver U/S showed patent vessels, normal blood flow.
It was noted that patient was having difficulty swallowing
pills, and in general was "orally defensive". Swallow eval not
done as patient confused and could not cooperate with testing.
Kept NPO.
EGD on [**7-24**] showed normal esophagus, normal stomach and normal
duodenum and an NJ tube was placed for feeding at this time.
On the evening of [**7-25**] patient found to be coughing and then
vomited mucous, coarse breath sounds noted. Increased resp rate
with low O@ sats and tachycardia noted with slight fever and
when not improved the patient was moved to ICU, intubated.
Bronchoscopy on [**7-26**] showed normal secretions and no gross mass.
Vanco and Meropenem started for coverage after pan-culture.
Sputum cultures, and bronchalveolar lavage did not grow
significant organisms. In light of illness at that time patient
continued with meropenem, vanco and addition of ambisome and
Cipro.
While in ICU patient received CVVH for worsening kidney
function/metabolic acidosis.
LP also performed which was negative.
By [**7-28**] patient off pressors, CVVHD stopped for one day and then
restarted on [**7-29**]  for fluid management. Creat maximum value 2.8
Patient noted to continue to have pulmonary edema with bilateral
pleural effusions.
Antibiotics changed to Vanco, meropenem,  and prophylactic
fluconazole, gancyclovir and bactrim. Patient continued on tube
feeds.
Initially failed weaning, and then was successfully extubated on
[**8-1**] and then transferred back to floor on [**8-3**].
Mental status slowly improving at this time. Creat slowly
falling.
Swallow eval done [**Last Name (un) 7162**] at this time  and this time diet advanced
to regular solids and thin liquids, calorie counts and
aspiration precautions.
PT evaluated and found to require PT training 2-3x/week and
recommended d/c to rehab as part of planning.
Due to patient pulling out several dobhoff feeding tubes, a J
tubes was surgically placed  on [**8-6**].
On [**8-7**], patient again transferred to ICU following episode of
vomiting with tachycardia and question of aspiration. Patient
also intermittently confused.
At this time patient on Vanco and Zosyn for questionable
aspiration PNA. Short stay in ICU and then transferred back to
regular floor.
TPN was started in addition to tube feed through J tube. Patient
is to continue on strict aspiration precautions.
Received 5 units Packed RBCs over the hospital course for
anemia. Continues on PO Iron and Erythropoietin
Zoloft, which had been d/c'd on admission due to confusion was
restarted.
Mental status continued to improve, patient assessed by social
work and may require further outpatient evaluation.
Will complete antibiotic course with 2 days of PO Augmentin, all
other antibiotics have been completed. TPN was weaned as of [**8-12**]
and he will continue on Tube feeds.
Liver enzymes remained normal during this hospitalization.
Immunosuppression regimen stable.


Medications on Admission:
[**Last Name (un) **], mmf750'', protonix 40', valcyte 450', bactrim ss', fluc
400', colace 100", zoloft 100', levaquin 500 x 4 more days, ISS


Discharge Medications:
1. Epoetin Alfa 3,000 unit/mL Solution Sig: One (1)  Injection
QMOWEFR (Monday -Wednesday-Friday).
2. Albuterol 90 mcg/Actuation Aerosol Sig: 2-4 Puffs Inhalation
QID (4 times a day) as needed.
3. Ferrous Sulfate 300 mg/5 mL Liquid Sig: One (1)  PO DAILY
(Daily).
4. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection [**Hospital1 **] (2 times a day).
5. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
Injection ASDIR (AS DIRECTED): See sliding scale.
6. Sirolimus 1 mg Tablet Sig: Four (4) Tablet PO DAILY (Daily).

7. Levothyroxine 25 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Mycophenolate Sodium 180 mg Tablet, Delayed Release (E.C.)
Sig: Two (2) Tablet, Delayed Release (E.C.) PO BID (2 times a
day).
9. Trimethoprim-Sulfamethoxazole 40-200 mg/5 mL Suspension Sig:
Ten (10) ML PO DAILY (Daily).
10. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
11. Metoclopramide 10 mg Tablet Sig: One (1) Tablet PO QIDACHS
(4 times a day (before meals and at bedtime)).
12. Prednisone 2.5 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
13. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
14. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
15. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4-6H (every 4 to 6 hours) as needed.
16. Sertraline 50 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
17. Amoxicillin-Pot Clavulanate 250-62.5 mg/5 mL Suspension for
Reconstitution Sig: One (1)  PO Q8H (every 8 hours) for 2 doses.

18. Potassium Chloride 10 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO once a day:
Please check Potassium level q Monday and Thursday with
transplant labs.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7**] & Rehab Center - [**Hospital1 8**]

Discharge Diagnosis:
s/p OLT [**4-29**]
aspiration pneumonia
sepsis
failure to thrive
ATN (resolving)

Discharge Condition:
Stable


Discharge Instructions:
Call [**Telephone/Fax (1) 673**] if you experience any of the following
symptoms: fever,chills, nausea, vomiting, diarrhea, pain over
the liver or at the feeding tube site, jaundice, an increase in
abdominal girth or any other symptoms concerning to you.
Have labs drawn every Monday and Thursday and have them faxed to
[**Telephone/Fax (1) 697**]. CBC, Chem 10, AST,ALT, Alk Phos, Albumin, T Bili
and trough Rapamune Level

Continue Tube Feeds per order



Completed by:[**2110-8-13**]
{'Unspecified septicemia,Severe sepsis,Acute kidney failure with lesion of tubular necrosis,Septic shock,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Liver replaced by transplant,Acidosis,Unspecified protein-calorie malnutrition,Congestive heart failure, unspecified,Thrombocytopenia, unspecified,Metabolic encephalopathy,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Adult failure to thrive,Hypercalcemia,Anemia, unspecified'}


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: Increasing creatinine value on labs, increasing confusion,
nausea and diarrhea since d/c from hospital on [**7-11**]

PRESENT ILLNESS: 60 y/o male s/p OLT on [**2110-5-13**] with several hospitalizations
since transplant for incisional wound issues, nausea, poor
appetite and confusion who now presents 11 days post last
admission with increasing creat on labs, increasing confusion
and still having nausea and diarrhea in spite of switching from
Cellcept to Myfortic. On last admission, confusion slowly
resolved. A neuro consult had been obtained at that time and he
was ruled out for cerebral bleed. IV Vitamins, hydration,
decreased Prograf dosing and starting thyroid replacement for
TSH of 12 were also done and improvement in MS was seen. Since
the discharge, he has continued with nausea, poor PO intake
(Feeding tube was self d/c'd by patient)and has seen an increase
in creatinine to 2.7. Liver enzymes have been stable, UC
negative. No fever or chills.

MEDICAL HISTORY: ETOH cirrhosis, s/p OLT [**2110-5-13**] (with mesh closure)
DM II
HTN
h/o C diff
s/p esophageal dilatation
Basal cell CA
Lumbar DJD
Failure to Thrive

MEDICATION ON ADMISSION: [**Last Name (un) **], mmf750'', protonix 40', valcyte 450', bactrim ss', fluc
400', colace 100", zoloft 100', levaquin 500 x 4 more days, ISS

ALLERGIES: Flagyl

PHYSICAL EXAM: On Admission:
VS: 96.9, 105, 135/65, 20, 96% RA
Gen: Appears confused
Oriented x1
CV: RRR, 2+ radial pulses
Pulm: CTA bilaterally
Abd: Diffusely tender with guarding

FAMILY HISTORY: Non Contrib

SOCIAL HISTORY: Lives in [**Location **] with wife in single family home
H/O ETOH abuse 

### Response:
{'Unspecified septicemia,Severe sepsis,Acute kidney failure with lesion of tubular necrosis,Septic shock,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Liver replaced by transplant,Acidosis,Unspecified protein-calorie malnutrition,Congestive heart failure, unspecified,Thrombocytopenia, unspecified,Metabolic encephalopathy,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Adult failure to thrive,Hypercalcemia,Anemia, unspecified'}
