CHIEF COMPLAINT: 

PRESENT ILLNESS: Patient is a [**Age over 90 **]-year-old
gentleman with a complicated medical history most recently
significant for cholecystitis in [**2166-4-27**] status post T
tube placement with recurrent cholecystitis and in [**2166-7-28**] with another T tube placement.  He was admitted to
the [**Hospital1 **] from [**2166-8-25**] to [**2166-9-9**], and
transferred to rehab.

MEDICAL HISTORY: 1. Paroxysmal atrial fibrillation.
2. COPD.
3. Obstructive-sleep apnea.
4. Chronic renal insufficiency.
5. Hypertension.
6. Pacer placement for bradycardia.
7. Benign prostatic hypertrophy.
8. GERD.
9. MRSA.
10. Cholecystitis.
11. Anemia.
12. VRE.
13. CAD.

MEDICATION ON ADMISSION: 1. Reglan.
2. Sodium bicarb.
3. Nystatin.
4. Levothyroxine.
5. Aldactone.
6. Lasix.
7. Trazodone.
8. Prevacid.
9. Atrovent.
10. Hydrocort.
11. Heparin subQ.
12. Vitamin D.
13. Vitamin C.
14. Amiodarone.
15. Albuterol.
16. Linezolid.
17. Fluconazole.
18. Flagyl.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Septicemia due to gram-negative organism, unspecified,Septic shock,Pneumonia due to Klebsiella pneumoniae,Acute kidney failure with lesion of tubular necrosis,Panhypopituitarism,Atrial fibrillation,Mechanical complication due to other implant and internal device, not elsewhere classified
Gram-neg septicemia NOS,Septic shock,K. pneumoniae pneumonia,Ac kidny fail, tubr necr,Panhypopituitarism,Atrial fibrillation,Malfunc oth device/graft
Admission Date:  [**2166-10-3**]     Discharge Date:  [**2166-10-8**]


Service:  Medical Intensive Care Unit

HISTORY OF PRESENT ILLNESS:  Patient is a [**Age over 90 **]-year-old
gentleman with a complicated medical history most recently
significant for cholecystitis in [**2166-4-27**] status post T
tube placement with recurrent cholecystitis and in [**2166-7-28**] with another T tube placement.  He was admitted to
the [**Hospital1 **] from [**2166-8-25**] to [**2166-9-9**], and
transferred to rehab.

On [**2166-9-14**], he taken to [**Hospital 8**] Hospital for hypotension
and change in mental status with fever and leukocytosis,
question of aspiration pneumonia at that time.  He was
treated with Vancomycin and gentamicin, and was in the ICU at
[**Hospital 8**] Hospital requiring pressors to manage his blood
pressure.  PEG tube was placed at that time.  He had a bile
culture, which grew out E. fecalis.  Blood cultures were
sterile.  He was treated with linezolid, Flagyl, and
fluconazole, and discharged to [**Hospital1 **] [**2166-9-20**].

On the morning of admission, he was found by the nursing
staff at [**Hospital1 **] to be hypothermic with a temperature of
94.6.  He had a pulse of 60 and blood pressure 110/42.  T
tube was noted to be out.  Patient was only oriented to
himself.  He was transferred to the [**Hospital1 18**] for replacement of
T tube.

PAST MEDICAL HISTORY:
1. Paroxysmal atrial fibrillation.
2. COPD.
3. Obstructive-sleep apnea.
4. Chronic renal insufficiency.
5. Hypertension.
6. Pacer placement for bradycardia.
7. Benign prostatic hypertrophy.
8. GERD.
9. MRSA.
10. Cholecystitis.
11. Anemia.
12. VRE.
13. CAD.

MEDICATIONS ON ADMISSION:
1. Reglan.
2. Sodium bicarb.
3. Nystatin.
4. Levothyroxine.
5. Aldactone.
6. Lasix.
7. Trazodone.
8. Prevacid.
9. Atrovent.
10. Hydrocort.
11. Heparin subQ.
12. Vitamin D.
13. Vitamin C.
14. Amiodarone.
15. Albuterol.
16. Linezolid.
17. Fluconazole.
18. Flagyl.

PHYSICAL EXAMINATION:  On exam, he had a temperature of 33.5
C, pulse of 60, blood pressure 113/30, satting 96% on 2
liters nasal cannula.  He is able to follow only simple
commands.  Chest has few basilar crackles, distant cardiac
sounds.  Slightly distended, diffusely tender abdomen.
Quiet, quiet bowel sounds.  Four plus anasarca with necrotic
ulcers on his right leg.

LABORATORIES:  He had a white count of 7.5, hematocrit of
35.4, platelets of 105.  Chem-7 of 151, potassium 4.2,
chloride 127, bicarb 13, BUN 90, creatinine 3.3, platelets of
124.  He had an ABG done which was pH 7.16, pCO2 of 31, pO2
of 78.

HOSPITAL COURSE:  Patient was admitted to the Medical
Intensive Care Unit.  He had a DNR/DNI status, so was not
intubated.  Family was [**Name (NI) 653**], and they wanted to continue
all other aggressive measures including pressors and IV
antibiotics.

During the course of his MICU stay, the patient did not
improve on broad-spectrum antibiotics.  Patient was on
ceftriaxone, linezolid, and Zosyn.  He did have 3/4 bottles
that were positive for gram-negative rods.

Patient did not improve on broad-spectrum antibiotics.  On
[**10-7**] discussion with the family specifically the son
and daughter occurred where they wanted a trial off of CPAP
understanding that his acid-base status might worsen and they
also agreed to increasing pain medications for comfort.
Patient passed away on [**2166-10-8**].  Time of death was
5:05 p.m.  Family was present when he passed away.  They
declined postmortem.  The attending was notified.



                          [**First Name8 (NamePattern2) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 7585**]

Dictated By:[**Last Name (NamePattern1) 11207**]

MEDQUIST36

D:  [**2166-12-17**]  13:58
T:  [**2166-12-18**]  06:21
JOB#:  [**Job Number 94518**]
{'Septicemia due to gram-negative organism, unspecified,Septic shock,Pneumonia due to Klebsiella pneumoniae,Acute kidney failure with lesion of tubular necrosis,Panhypopituitarism,Atrial fibrillation,Mechanical complication due to other implant and internal device, not elsewhere classified'}


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: Patient is a [**Age over 90 **]-year-old
gentleman with a complicated medical history most recently
significant for cholecystitis in [**2166-4-27**] status post T
tube placement with recurrent cholecystitis and in [**2166-7-28**] with another T tube placement.  He was admitted to
the [**Hospital1 **] from [**2166-8-25**] to [**2166-9-9**], and
transferred to rehab.

MEDICAL HISTORY: 1. Paroxysmal atrial fibrillation.
2. COPD.
3. Obstructive-sleep apnea.
4. Chronic renal insufficiency.
5. Hypertension.
6. Pacer placement for bradycardia.
7. Benign prostatic hypertrophy.
8. GERD.
9. MRSA.
10. Cholecystitis.
11. Anemia.
12. VRE.
13. CAD.

MEDICATION ON ADMISSION: 1. Reglan.
2. Sodium bicarb.
3. Nystatin.
4. Levothyroxine.
5. Aldactone.
6. Lasix.
7. Trazodone.
8. Prevacid.
9. Atrovent.
10. Hydrocort.
11. Heparin subQ.
12. Vitamin D.
13. Vitamin C.
14. Amiodarone.
15. Albuterol.
16. Linezolid.
17. Fluconazole.
18. Flagyl.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Septicemia due to gram-negative organism, unspecified,Septic shock,Pneumonia due to Klebsiella pneumoniae,Acute kidney failure with lesion of tubular necrosis,Panhypopituitarism,Atrial fibrillation,Mechanical complication due to other implant and internal device, not elsewhere classified'}
