CHIEF COMPLAINT: dyspnea

PRESENT ILLNESS: 68 yo female with h/o ESRD secondary to ? IgA nephropathy not
currently on HD (has refused in the past) presents with 1 day
h/o dyspnea and SOB at rest, which has gotten worse throughout
the day prior to admission. Pt had prior admission to [**Hospital1 336**] on
[**2-2**] for CHF in setting of ARF but left AMA. Denies CP, fevers,
palpitations, fevers, chills, nausea, N/V, weight gain,
increased salt intake. Pt was seen in clinic yesterday, with
lower weight and clear lungs. Normally makes urine. Last
admission to [**Hospital1 **] two weeks ago where pt was admitted for
hematuria.

MEDICAL HISTORY: -hypertension
-chronic renal insufficiency secondary to nephrosclerosis and
possibly IgA nephropathy creat acutely rising since [**11-3**]
-h/o alcohol abuse
-s/p R rotator cuff surgery
-h/o squamous cell carcinoma
-h/o DVT related to pregnancy, s/p venous stripping
-hypothyroidism
-chronic low back pain
-chronic LE edema
-h/o pulmonary nodules
-PTSD/anxiety
-MGUS
-s/p TAH
-?CHF admitted [**2-2**] to [**Hospital1 336**] for CHF (EF >55% with 1-2+MR in
[**12-5**])

MEDICATION ON ADMISSION: docusate
senna
hydralazine
atenolol
amlodipine
lasix
epo
sevelamer
asa
levothyroxine
atorvostatin
folic acid
MVI
thiamine
pantoprazole
diazapam

ALLERGIES: Codeine

PHYSICAL EXAM: 98.4   111   175/81   18  91%RA/99% 5L
[**Name2 (NI) 4459**]: NCAT, EOMI, perrla, trachea midline, dry mm
Lungs: rhonchi bilaterally with crackles in lower bases
CVS: S1S2RRR
Abd: soft, nt, nd, good bs
LE: no edema, +1 pedal pulses bilat
Gross neurological exam normal and symmetric

FAMILY HISTORY: The pt. has a daughter with SLE. Father died in his 60's of
liver problems, no [**Name2 (NI) **] Hx of kidney disease

SOCIAL HISTORY: The pt. lives alone in senior housing and is retired. She smoked
1ppd for 15 yrs and said that her last alcoholic beverage
was >1month ago. No illicit substance use. She has 5 children
and wants her daughter [**Name (NI) 4051**] [**Last Name (NamePattern1) 1968**] to be her HCP although has
never established this in the past.
Acute on chronic diastolic heart failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Mitral valve disorders,Acidosis,Acute kidney failure, unspecified,Other emphysema,Acute respiratory failure,Unspecified acquired hypothyroidism,Anemia in chronic kidney disease
Ac on chr diast hrt fail,Hyp kid NOS w cr kid V,Mitral valve disorder,Acidosis,Acute kidney failure NOS,Emphysema NEC,Acute respiratry failure,Hypothyroidism NOS,Anemia in chr kidney dis
Admission Date:  [**2165-4-3**]              Discharge Date:   [**2165-4-10**]

Date of Birth:  [**2097-1-4**]             Sex:   F

Service: MEDICINE

Allergies:
Codeine

Attending:[**First Name3 (LF) 1881**]
Chief Complaint:
dyspnea

Major Surgical or Invasive Procedure:
Hemodialysis tunnelled catheter placement
Hemodialysis
Cardiac stress test


History of Present Illness:
68 yo female with h/o ESRD secondary to ? IgA nephropathy not
currently on HD (has refused in the past) presents with 1 day
h/o dyspnea and SOB at rest, which has gotten worse throughout
the day prior to admission. Pt had prior admission to [**Hospital1 336**] on
[**2-2**] for CHF in setting of ARF but left AMA. Denies CP, fevers,
palpitations, fevers, chills, nausea, N/V, weight gain,
increased salt intake. Pt was seen in clinic yesterday, with
lower weight and clear lungs. Normally makes urine. Last
admission to [**Hospital1 **] two weeks ago where pt was admitted for
hematuria.

Past Medical History:
-hypertension
-chronic renal insufficiency secondary to nephrosclerosis and
possibly IgA nephropathy creat acutely rising since [**11-3**]
-h/o alcohol abuse
-s/p R rotator cuff surgery
-h/o squamous cell carcinoma
-h/o DVT related to pregnancy, s/p venous stripping
-hypothyroidism
-chronic low back pain
-chronic LE edema
-h/o pulmonary nodules
-PTSD/anxiety
-MGUS
-s/p TAH
-?CHF admitted [**2-2**] to [**Hospital1 336**] for CHF (EF >55% with 1-2+MR in
[**12-5**])


Social History:
The pt. lives alone in senior housing and is retired. She smoked
1ppd for 15 yrs and said that her last alcoholic beverage
was >1month ago. No illicit substance use. She has 5 children
and wants her daughter [**Name (NI) 4051**] [**Last Name (NamePattern1) 1968**] to be her HCP although has
never established this in the past.


Family History:
The pt. has a daughter with SLE. Father died in his 60's of
liver problems, no [**Name2 (NI) **] Hx of kidney disease

Physical Exam:
98.4   111   175/81   18  91%RA/99% 5L
[**Name2 (NI) 4459**]: NCAT, EOMI, perrla, trachea midline, dry mm
Lungs: rhonchi bilaterally with crackles in lower bases
CVS: S1S2RRR
Abd: soft, nt, nd, good bs
LE: no edema, +1 pedal pulses bilat
Gross neurological exam normal and symmetric

Pertinent Results:
[**2165-4-3**] 09:30AM URINE  BLOOD-LG NITRITE-NEG PROTEIN-100
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2165-4-3**] 09:30AM URINE  RBC-21-50* WBC-0-2 BACTERIA-FEW
YEAST-NONE EPI-0-2
[**2165-4-3**] 09:05AM   GLUCOSE-103 UREA N-87* CREAT-5.6* SODIUM-142
POTASSIUM-5.0 CHLORIDE-106 TOTAL CO2-18* ANION GAP-23*
[**2165-4-3**] 09:05AM   CK(CPK)-106
[**2165-4-3**] 09:05AM   cTropnT-0.04*
[**2165-4-3**] 09:05AM   CK-MB-3
[**2165-4-3**] 09:05AM   WBC-11.1* RBC-3.22* HGB-10.5* HCT-31.3*
MCV-97 MCH-32.7* MCHC-33.6 RDW-14.4
[**2165-4-3**] 09:05AM   NEUTS-89.5* BANDS-0 LYMPHS-7.2* MONOS-2.4
EOS-0.5 BASOS-0.3
[**2165-4-3**] 09:05AM   PLT COUNT-280
[**2165-4-2**] 01:54PM   UREA N-92* CREAT-5.2* SODIUM-145
POTASSIUM-4.8 CHLORIDE-106 TOTAL CO2-20* ANION GAP-24*

CXR: lungs well inflated; heart slightly enlarged; interstitial
edema and kurly b lines in lower lobes c/w CHF; no infiltrate;
no comparisons; emphysema

Brief Hospital Course:
A/P
1. Dyspnea: Admitted to floors with ongoing diagnosis of
CHF/pulmonary edema secondary to renal failure. Pt given 80 mg
IV lasix in the ED. On the floor, the pt became acute dyspnic
and tachypnic, with diastolic pressures in the 110-120's and HR
in the 120's. CXR showed likely flash pulmonary edema, and pt
given lopressor and hydralazine at bedside with little effect.
During initial event, pt was satting 88% on NRB, but after being
given an additional lasix, came up into the mid 90's on 100%NRB.
Due to persistent diastolic hypertension and dyspnea, however,
pt was transferred to the MICU for 1 day for closer monitoring.
In the MICU, pt had hemodialysis, after which her respiratory
status markedly improved. Pt was moved back to floor where a
tunnelled catheter was placed successfully for Hemodialysis. Pt
very resistant to starting Hemodialysis, and was skeptical in
her ability to follow the regimen of HD 3 days a week. Social
work and neurobehavioral psych called to evaluate pt's ability
to cope with new diagnosis in addition to waxing/[**Doctor Last Name 688**] mental
status, mood changes. Seen by psych who did not think patient
had depression or strange affect, but stated the contrary, that
patient appeared to be competent. Changes in mood attributed to
mild post dialysis delirium. Mood improved HD #4 24 hours after
last dialysis.
2. Hyptothyroid: continued on synthroid, though TSH in-house 10.
Levothyroxine was increased to 125 mcg per day. Pt should be
followed up for further evaluation and workup as outpatient.
3. CHF: was ruled out for MI by enzymes. Had no complaints
during hospital visit.
5. Anemia: secondary to renal failure; remained on epoetin.
Should be re-evaluated and possibly started on Fe
supplementation as outpatient.
6. HTN: most likely [**1-2**] Renal failure, and improved with
hemodialysis.
7. CVS: P-MIBI done to evaluate possible etiology causing flash
pulmonary edema at the beginning of hospital course, which
showed fixed lateral defect and EF ~41%. No further cardiac
intervention done on this visit.
8. Hyponatremia: Unclear etiology. Some thoughts were low sodium
levels secondary to fluid overload from ESRD, increased body
water/Na ratio, serreptitious po intake. Levels improved to 128
upon discharge after HD. Pt discharged with instructions to
limit fluid intake to 4 glasses of water/equivalents per day. Na
level will be checked at next HD tomorrow AM.

Medications on Admission:
docusate
senna
hydralazine
atenolol
amlodipine
lasix
epo
sevelamer
asa
levothyroxine
atorvostatin
folic acid
MVI
thiamine
pantoprazole
diazapam


Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
2. Atorvastatin Calcium 20 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
3. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
6. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
7. Hydralazine HCl 10 mg Tablet Sig: Two (2) Tablet PO Q6H
(every 6 hours).
8. Amlodipine Besylate 5 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
9. Epoetin Alfa 10,000 unit/mL Solution Sig: One (1)  Injection
ASDIR (AS DIRECTED).
10. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
every six (6) hours.
Disp:*1 inhaler* Refills:*0*
11. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*0*
12. Diazepam 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
13. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
Disp:*30 Cap(s)* Refills:*0*
14. Sevelamer HCl 800 mg Tablet Sig: Two (2) Tablet PO TID (3
times a day).
Disp:*180 Tablet(s)* Refills:*0*
15. Levothyroxine Sodium 125 mcg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Renal failure
CHF
Hypothyroidism
Anemia
hypertension
Hyponatremia


Discharge Condition:
stable

Discharge Instructions:
1. Take all your medications as prescribed
2. DO NOT DRINK MORE THAN 4 8 ounce glasses fluid per day!
3. Please go to hemodialysis as instructed on Tuesday, Thursday
and Saturdays at noon at [**Location (un) 86**] Dialysis Center at [**Hospital1 336**].
4. If you find that you are having problems getting to
hemodialysis, please call Dr. [**Last Name (STitle) **] at [**Telephone/Fax (1) 250**] to
discuss the difficulties you may be having. He will also help
you follow up with the renal clinic

Followup Instructions:
Please go to hemodialysis as instructed on Tuesday, Thursday and
Saturdays at noon at [**Location (un) 86**] Dialysis Center at [**Hospital1 336**].

You have a follow up appointment with Dr. [**Last Name (STitle) 13964**] next week.
See below for information:

[**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1882**], MD Where: [**Hospital6 29**]
Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2165-4-18**] 11:40


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1882**] MD, [**MD Number(3) 1883**]
{'Acute on chronic diastolic heart failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Mitral valve disorders,Acidosis,Acute kidney failure, unspecified,Other emphysema,Acute respiratory failure,Unspecified acquired hypothyroidism,Anemia in chronic kidney disease'}


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

PRESENT ILLNESS: 68 yo female with h/o ESRD secondary to ? IgA nephropathy not
currently on HD (has refused in the past) presents with 1 day
h/o dyspnea and SOB at rest, which has gotten worse throughout
the day prior to admission. Pt had prior admission to [**Hospital1 336**] on
[**2-2**] for CHF in setting of ARF but left AMA. Denies CP, fevers,
palpitations, fevers, chills, nausea, N/V, weight gain,
increased salt intake. Pt was seen in clinic yesterday, with
lower weight and clear lungs. Normally makes urine. Last
admission to [**Hospital1 **] two weeks ago where pt was admitted for
hematuria.

MEDICAL HISTORY: -hypertension
-chronic renal insufficiency secondary to nephrosclerosis and
possibly IgA nephropathy creat acutely rising since [**11-3**]
-h/o alcohol abuse
-s/p R rotator cuff surgery
-h/o squamous cell carcinoma
-h/o DVT related to pregnancy, s/p venous stripping
-hypothyroidism
-chronic low back pain
-chronic LE edema
-h/o pulmonary nodules
-PTSD/anxiety
-MGUS
-s/p TAH
-?CHF admitted [**2-2**] to [**Hospital1 336**] for CHF (EF >55% with 1-2+MR in
[**12-5**])

MEDICATION ON ADMISSION: docusate
senna
hydralazine
atenolol
amlodipine
lasix
epo
sevelamer
asa
levothyroxine
atorvostatin
folic acid
MVI
thiamine
pantoprazole
diazapam

ALLERGIES: Codeine

PHYSICAL EXAM: 98.4   111   175/81   18  91%RA/99% 5L
[**Name2 (NI) 4459**]: NCAT, EOMI, perrla, trachea midline, dry mm
Lungs: rhonchi bilaterally with crackles in lower bases
CVS: S1S2RRR
Abd: soft, nt, nd, good bs
LE: no edema, +1 pedal pulses bilat
Gross neurological exam normal and symmetric

FAMILY HISTORY: The pt. has a daughter with SLE. Father died in his 60's of
liver problems, no [**Name2 (NI) **] Hx of kidney disease

SOCIAL HISTORY: The pt. lives alone in senior housing and is retired. She smoked
1ppd for 15 yrs and said that her last alcoholic beverage
was >1month ago. No illicit substance use. She has 5 children
and wants her daughter [**Name (NI) 4051**] [**Last Name (NamePattern1) 1968**] to be her HCP although has
never established this in the past. 

### Response:
{'Acute on chronic diastolic heart failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Mitral valve disorders,Acidosis,Acute kidney failure, unspecified,Other emphysema,Acute respiratory failure,Unspecified acquired hypothyroidism,Anemia in chronic kidney disease'}
