CHIEF COMPLAINT: Reason for MICU transfer:  Hypotension post-nephrectomy

PRESENT ILLNESS: 80yoM with diverticulitis, HTN, Dyslipidemia, PVD who was found
to have a left renal mass and who initially presented for left
partial nephrectomy being transferred to the [**Hospital1 18**] MICU for
hypoxia and acute renal failure.

MEDICAL HISTORY: - ?Diverticulitis
- HTN
- Dyslipidemia
- PVD
- BPH
- GERD
- DJD
- ?COPD
- Nasal polyposis
- s/p tonsillectomy
- s/p cholecystectomy
- s/p polyectomy
- s/p R varicose vein stripping

MEDICATION ON ADMISSION: Medications at home:
- Lasix 40mg daily
- Simvastatin 20mg daily
- Finasteride 5mg daily
- Atenolol 50mg daily
- Losartan 50mg daily
- Albuterol inhaler 2 puffs prn
- Preservision daily
- Vitamin D 1000 IU daily
- Vitamin B complex
- Centrum silver
- Exlax 1 pill at night
.
Meds on transfer:
- Norepinephrine gtt
- Phenylephrine gtt
- Ceftriaxone 1gm IV once
- Ertapenem 0.5gm IV daily
- Vancomycin 1gm IV once with HD
- Hydrocortisone 50mg/1ml IV q6h
- Albuterol 90mcg HFA 2 puffs q6h prn
- Albuterol-Ipratropium 103-18mcg aerosol 4 puffs q6h
- Artificial tears
- Bisacodyl 5mg po qhs
- Diphenhydramine 25mg IV q6h prn itching
- Fentanyl 25mcg/0.5ml IV q1h prn
- Fentanyl 50mcg/1ml IV q1h prn
- Fentanyl 100mcg/2ml IV q1h prn
- Lorazepam 1mg/0.5ml IV q30 mins
- Pantoprazole 40mg IV daily
- Simvastatin 20mg qhs
- Finasteride 5mg po qhs
- Metoclopramide 10mg/2ml IV q6h prn n/v

ALLERGIES: No Allergies/ADRs on File

PHYSICAL EXAM: VS: 99.9   108   156/76   TV 500/FIO2 100%/PEEP 5/R 14
GEN: Intubated, interactive and following commands, NAD
HEENT: PERRL, EOMI, sclera anicteric, MMM
CV: RRR, S1 and S2 wnl, no m/r/g
RESP: Coarse rhonchi and rales at RML without wheezes, equal air
movement b/l
ABD: Soft, moderate RLQ tenderness without rebound or guarding,
significant left sided tenderness near surgical site, surgical
dressing clean, dry, intact with minimal blood on the bandage.
No masses, +BS, no appreciable hepatosplenomegaly.
EXT: No c/c/e with compression stockings in place b/l.  2+ DP
pulses b/l.
SKIN: No rashes/no jaundice/no splinters
NEURO: Moving all extremities, following commands.

FAMILY HISTORY: CAD

SOCIAL HISTORY: - Tobacco:  (+) x15 year smoking history, quit 35 years ago
- EtOH:  Unknown
- Illicit Drugs:  Unknown
Lives with wife.
Unspecified septicemia,Septic shock,Acute kidney failure with lesion of tubular necrosis,Acidosis,Malignant neoplasm of kidney, except pelvis,Severe sepsis,Hypoxemia,Do not resuscitate status,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Peripheral vascular disease, unspecified
Septicemia NOS,Septic shock,Ac kidny fail, tubr necr,Acidosis,Malig neopl kidney,Severe sepsis,Hypoxemia,Do not resusctate status,Hypertension NOS,Hyperlipidemia NEC/NOS,Periph vascular dis NOS
Admission Date:  [**2111-7-19**]              Discharge Date:   [**2111-7-19**]

Date of Birth:  [**2030-8-28**]             Sex:   M

Service: MEDICINE

Allergies:
No Allergies/ADRs on File

Attending:[**First Name3 (LF) 3984**]
Chief Complaint:
Reason for MICU transfer:  Hypotension post-nephrectomy


Major Surgical or Invasive Procedure:
CRRT

History of Present Illness:
80yoM with diverticulitis, HTN, Dyslipidemia, PVD who was found
to have a left renal mass and who initially presented for left
partial nephrectomy being transferred to the [**Hospital1 18**] MICU for
hypoxia and acute renal failure.

The patient who was originally being evaluated for abdominal
pain underwent a CT abdomen for diverticulitis which showed a
possible lesion of the left lower pole of the anterior kidney.
An MRI confirmed enhancement of a 2cm mass, consistent with
renal cell carcinoma, and the patient underwent a laproscopic
left partial nephrectomy on [**7-16**].  Following the surgery, the
patient was hypoxic and hypotensive, and was found to have SBP
in the 60's-80's.  D-dimer was checked and he underwent a CTA to
rule out PE which was negative, and showed only bibasilar
atelectasis.  CE's were negative x1, EKG was unremarkable per
report.  The patient was started on Neosynephrine gtt for
hypotension and also received lasix 20mg IV for hyperkalemia.
Cardiology was consulted, and the patient was transferred to the
CCU for further monitoring and to r/o MI.  He complained of
abdominal pain and nausea, and had a leukocytosis of 18.5 and he
was given Reglan 10mg IV push.  SBP decreased to the 80's and
Neosynephrine gtt was increased.  He underwent a CT
abdomen/pelvis which showed left retroperitoneal hematoma from
the site of left nephrectomy extending superiorly into
perisplenic region and inferiorly into left pelvis.
Extravasation of excreted contrast from lower pole surgical bed
of the kidney.  Post-op pneumoperitoneum.  Hct was 33 from a
baseline of 42.6 pre-op on [**7-16**], UOP was 100cc over 3 hours and
SBP decreased to 65-69 with blood soaked dressings, and 90cc of
frank blood draining from the LP drain.  Neo gtt was increased
and the patient was given 2 units PRBC.  His Cr at this time was
1.36.  He received calcium gluconate, insulin/d50, kayexalate,
lasix 20mg IV x2 for further hyperkalemia of 6.4.  He also
received stress dose steroids.

On [**7-17**], the patient underwent IR for embolization (particle and
coil embolization of the left kidney and TLC) of the lower pole
left renal artery.  Hct was 37.4 from 33 following 2 units PRBC,
K+ 6.2, and BP 140/70 on Neo gtt.  He was given an additional
unit of PRBC for a total of 3 units PRBC and 6L IVF.  He was
subsequently edematous and complained of dyspnea and was
intubated [**7-18**].  A right a-line and right femoral cortis were
placed [**7-18**].  Cr 1.38.

On [**7-18**], the patient underwent hemodialysis.  Labs showed WBC
23.8, hct 31.3, Cr 3.82.  He was afebrile.  On transfer, the
vent settings were FIO2 75%, TV 550, R18, 5 PEEP.  During the
[**Location (un) **], the patient received Fentanyl 100mcg IV, Midazolam
2mg IV, Levophed 25mcg/min, phenyleprine 300mcg -> 200mcg.


Past Medical History:
- ?Diverticulitis
- HTN
- Dyslipidemia
- PVD
- BPH
- GERD
- DJD
- ?COPD
- Nasal polyposis
- s/p tonsillectomy
- s/p cholecystectomy
- s/p polyectomy
- s/p R varicose vein stripping


Social History:
- Tobacco:  (+) x15 year smoking history, quit 35 years ago
- EtOH:  Unknown
- Illicit Drugs:  Unknown
Lives with wife.


Family History:
CAD

Physical Exam:
VS: 99.9   108   156/76   TV 500/FIO2 100%/PEEP 5/R 14
GEN: Intubated, interactive and following commands, NAD
HEENT: PERRL, EOMI, sclera anicteric, MMM
CV: RRR, S1 and S2 wnl, no m/r/g
RESP: Coarse rhonchi and rales at RML without wheezes, equal air
movement b/l
ABD: Soft, moderate RLQ tenderness without rebound or guarding,
significant left sided tenderness near surgical site, surgical
dressing clean, dry, intact with minimal blood on the bandage.
No masses, +BS, no appreciable hepatosplenomegaly.
EXT: No c/c/e with compression stockings in place b/l.  2+ DP
pulses b/l.
SKIN: No rashes/no jaundice/no splinters
NEURO: Moving all extremities, following commands.


Pertinent Results:
[**2111-7-19**] 01:00PM   CK(CPK)-1051*
[**2111-7-19**] 01:00PM   CK-MB-18* MB INDX-1.7 cTropnT-0.32*
[**2111-7-19**] 11:41AM   LACTATE-13.4* K+-5

CT: prelim
The patient had approximately 95 cc of visipaque contrast
infiltration in his left hand.
1. Sub-optimal contrast for assessment of the segmental
pulmonary arteries. No large central PE.
Bibasal consolidations, likely atelectasis with small pleural
effusions.
2. S/P Partial nephrectomy with a 9.1 x 5.7 x 6.6 cm hematoma in
the
perinephric space, without significant compression of the left
renal vessels.
3. No bowel obstruction/ secondary signs of ischemic bowel.
4. Small amount of free intraperitoneal free air and
subcutaneous emphysema, relates to recent surgery. An
intraperitoneal drain is seen in the mid abdomen.
5. Ill-defined hypodense lesion in the left hepatic lobe, is not
well assessed in this study. [**Month (only) 116**] be helpful to compare with
prior imaging to further assess.


Brief Hospital Course:
80 yo M with diverticulitis, HTN, Dyslipidemia, PVD who was
found to have a left renal mass and who initially presented for
left partial nephrectomy being transferred to the [**Hospital1 18**] MICU for
hypoxia and acute renal failure. He continued to deteriorate
clinically including rising lactic acidosis to 13 and became
increasingly difficult to oxgenate.  Concern was for septic
shock though no clear source was located. He was covered with
broad spectrum antibiotics and required 3 pressors.  General
surgery saw and did not feel that there was an acute abdominal
process based on CT and exam that would benefit from surgical
intervention.  He was started on CRRT given his rising lactate.
Ultimately given his poor prognosis he was made DNR.  Shortly
thereafter, he became bradycardic and hypotensive to the 60's
and briefly lost his pulse.  He received mulitple amps of bicarb
and epi with return of spontaneous circulation.  Decision
ultimately made by family at bedside to change to comfort
measures only.  Pressors were stopped and he expired within 20
minutes.  Autopsy will be performed here at [**Hospital1 18**].


Medications on Admission:
Medications at home:
- Lasix 40mg daily
- Simvastatin 20mg daily
- Finasteride 5mg daily
- Atenolol 50mg daily
- Losartan 50mg daily
- Albuterol inhaler 2 puffs prn
- Preservision daily
- Vitamin D 1000 IU daily
- Vitamin B complex
- Centrum silver
- Exlax 1 pill at night
.
Meds on transfer:
- Norepinephrine gtt
- Phenylephrine gtt
- Ceftriaxone 1gm IV once
- Ertapenem 0.5gm IV daily
- Vancomycin 1gm IV once with HD
- Hydrocortisone 50mg/1ml IV q6h
- Albuterol 90mcg HFA 2 puffs q6h prn
- Albuterol-Ipratropium 103-18mcg aerosol 4 puffs q6h
- Artificial tears
- Bisacodyl 5mg po qhs
- Diphenhydramine 25mg IV q6h prn itching
- Fentanyl 25mcg/0.5ml IV q1h prn
- Fentanyl 50mcg/1ml IV q1h prn
- Fentanyl 100mcg/2ml IV q1h prn
- Lorazepam 1mg/0.5ml IV q30 mins
- Pantoprazole 40mg IV daily
- Simvastatin 20mg qhs
- Finasteride 5mg po qhs
- Metoclopramide 10mg/2ml IV q6h prn n/v


Discharge Disposition:
Expired

Discharge Diagnosis:
NA

Discharge Condition:
deceased

Discharge Instructions:
NA

Followup Instructions:
NA

                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2437**] MD [**MD Number(1) 2438**]
{'Unspecified septicemia,Septic shock,Acute kidney failure with lesion of tubular necrosis,Acidosis,Malignant neoplasm of kidney, except pelvis,Severe sepsis,Hypoxemia,Do not resuscitate status,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Peripheral vascular disease, 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: Reason for MICU transfer:  Hypotension post-nephrectomy

PRESENT ILLNESS: 80yoM with diverticulitis, HTN, Dyslipidemia, PVD who was found
to have a left renal mass and who initially presented for left
partial nephrectomy being transferred to the [**Hospital1 18**] MICU for
hypoxia and acute renal failure.

MEDICAL HISTORY: - ?Diverticulitis
- HTN
- Dyslipidemia
- PVD
- BPH
- GERD
- DJD
- ?COPD
- Nasal polyposis
- s/p tonsillectomy
- s/p cholecystectomy
- s/p polyectomy
- s/p R varicose vein stripping

MEDICATION ON ADMISSION: Medications at home:
- Lasix 40mg daily
- Simvastatin 20mg daily
- Finasteride 5mg daily
- Atenolol 50mg daily
- Losartan 50mg daily
- Albuterol inhaler 2 puffs prn
- Preservision daily
- Vitamin D 1000 IU daily
- Vitamin B complex
- Centrum silver
- Exlax 1 pill at night
.
Meds on transfer:
- Norepinephrine gtt
- Phenylephrine gtt
- Ceftriaxone 1gm IV once
- Ertapenem 0.5gm IV daily
- Vancomycin 1gm IV once with HD
- Hydrocortisone 50mg/1ml IV q6h
- Albuterol 90mcg HFA 2 puffs q6h prn
- Albuterol-Ipratropium 103-18mcg aerosol 4 puffs q6h
- Artificial tears
- Bisacodyl 5mg po qhs
- Diphenhydramine 25mg IV q6h prn itching
- Fentanyl 25mcg/0.5ml IV q1h prn
- Fentanyl 50mcg/1ml IV q1h prn
- Fentanyl 100mcg/2ml IV q1h prn
- Lorazepam 1mg/0.5ml IV q30 mins
- Pantoprazole 40mg IV daily
- Simvastatin 20mg qhs
- Finasteride 5mg po qhs
- Metoclopramide 10mg/2ml IV q6h prn n/v

ALLERGIES: No Allergies/ADRs on File

PHYSICAL EXAM: VS: 99.9   108   156/76   TV 500/FIO2 100%/PEEP 5/R 14
GEN: Intubated, interactive and following commands, NAD
HEENT: PERRL, EOMI, sclera anicteric, MMM
CV: RRR, S1 and S2 wnl, no m/r/g
RESP: Coarse rhonchi and rales at RML without wheezes, equal air
movement b/l
ABD: Soft, moderate RLQ tenderness without rebound or guarding,
significant left sided tenderness near surgical site, surgical
dressing clean, dry, intact with minimal blood on the bandage.
No masses, +BS, no appreciable hepatosplenomegaly.
EXT: No c/c/e with compression stockings in place b/l.  2+ DP
pulses b/l.
SKIN: No rashes/no jaundice/no splinters
NEURO: Moving all extremities, following commands.

FAMILY HISTORY: CAD

SOCIAL HISTORY: - Tobacco:  (+) x15 year smoking history, quit 35 years ago
- EtOH:  Unknown
- Illicit Drugs:  Unknown
Lives with wife. 

### Response:
{'Unspecified septicemia,Septic shock,Acute kidney failure with lesion of tubular necrosis,Acidosis,Malignant neoplasm of kidney, except pelvis,Severe sepsis,Hypoxemia,Do not resuscitate status,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Peripheral vascular disease, unspecified'}
