CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 58 year-old
African American female with a past medical history
significant for chronic obstructive pulmonary disease, atrial
fibrillation, chronic renal failure and morbid obesity who
was admitted to the MICU at the [**Hospital1 188**] [**Hospital Ward Name 516**] from home with a one day history of fever
and mental status changes.  She had been home for only one
day after a five and a half month rehab stay at Towers [**Doctor Last Name **]
[**Hospital **] hospital.  She presented to the Emergency
Department with what was a one day course of fever and mental
status changes.  She was difficult to arouse and was
lethargic.  The patient presented with a temperature of 102.7
degrees Fahrenheit, respiratory rate 34 and an O2 saturation
of 71%.  She was given oxygen nonrebreather and her O2 sats
responded to 95%.  She had a chest x-ray done, which was poor
quality, but showed an enlarged heat with evidence of a left
lung base infiltrate versus atelectasis.  She had a CAT scan
of the head, which showed prominence to the right side of the
midline gyrus.  She was treated with nebulizers and was given
one dose of Ceftriaxone 2 grams intravenous.  On hospital day
one the patient's mental status improved and she was began on
Levofloxacin 250 mg intravenous q 48.  Upon further
questioning she denies dysuria prior to admission, but did
report increased urinary frequency.  The patient also had a
vague history of hemoptysis over the last two weeks and she
reported one episode of hemoptysis while in the Emergency
Room.  She also reported a history of blood per rectum for
which she was given a colonoscopy in the past, which
demonstrated no lesions or etiology of bleeding source.  This
colonoscopy was done in [**2189-5-12**].

MEDICAL HISTORY: 1.  Morbid obesity.
2.  Congestive heart failure with an ejection fraction of
approximately 20 to 30%.
3.  Chronic obstructive pulmonary disease.  She ahs O2 at
home and her home O2 requirement is 3 liters.  She is also on
BiPAP for obstructive sleep apnea.  Her settings are 15 and
8.
4.  Gastroesophageal reflux disease.
5.  Coronary artery disease status post stenting of the right
coronary artery.
6.  Diabetes mellitus.
7.  Atrial fibrillation for which she is on Coumadin 3 mg po
q.d. and Amiodarone 200 mg po q.d.
8.  Status post V fibrillation arrest on previous admission
and she is not a candidate for ICD placement secondary to her
body habitus.
9.  Pulmonary hypertension.
10.  Anemia of chronic disease.
11.  Chronic renal failure with a baseline creatinine of
approximately 2.2.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: Her mom passed away of multiple myeloma and
her dad past away and had a history of diabetes.

SOCIAL HISTORY: Significant for a 40 pack year history.  She
quit in [**Month (only) 958**] of last year.  She lives at home with her
boyfriend.
Acute kidney failure, unspecified,Urinary tract infection, site not specified,Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Esophageal reflux
Acute kidney failure NOS,Urin tract infection NOS,Obs chr bronc w(ac) exac,CHF NOS,Atrial fibrillation,DMII wo cmp nt st uncntr,Anemia NOS,Esophageal reflux
Admission Date:  [**2189-8-6**]       Discharge Date:  [**2189-8-12**]

Date of Birth:   [**2131-5-18**]       Sex:  F

Service:

HISTORY OF PRESENT ILLNESS:  The patient is a 58 year-old
African American female with a past medical history
significant for chronic obstructive pulmonary disease, atrial
fibrillation, chronic renal failure and morbid obesity who
was admitted to the MICU at the [**Hospital1 188**] [**Hospital Ward Name 516**] from home with a one day history of fever
and mental status changes.  She had been home for only one
day after a five and a half month rehab stay at Towers [**Doctor Last Name **]
[**Hospital **] hospital.  She presented to the Emergency
Department with what was a one day course of fever and mental
status changes.  She was difficult to arouse and was
lethargic.  The patient presented with a temperature of 102.7
degrees Fahrenheit, respiratory rate 34 and an O2 saturation
of 71%.  She was given oxygen nonrebreather and her O2 sats
responded to 95%.  She had a chest x-ray done, which was poor
quality, but showed an enlarged heat with evidence of a left
lung base infiltrate versus atelectasis.  She had a CAT scan
of the head, which showed prominence to the right side of the
midline gyrus.  She was treated with nebulizers and was given
one dose of Ceftriaxone 2 grams intravenous.  On hospital day
one the patient's mental status improved and she was began on
Levofloxacin 250 mg intravenous q 48.  Upon further
questioning she denies dysuria prior to admission, but did
report increased urinary frequency.  The patient also had a
vague history of hemoptysis over the last two weeks and she
reported one episode of hemoptysis while in the Emergency
Room.  She also reported a history of blood per rectum for
which she was given a colonoscopy in the past, which
demonstrated no lesions or etiology of bleeding source.  This
colonoscopy was done in [**2189-5-12**].

PAST MEDICAL HISTORY:
1.  Morbid obesity.
2.  Congestive heart failure with an ejection fraction of
approximately 20 to 30%.
3.  Chronic obstructive pulmonary disease.  She ahs O2 at
home and her home O2 requirement is 3 liters.  She is also on
BiPAP for obstructive sleep apnea.  Her settings are 15 and
8.
4.  Gastroesophageal reflux disease.
5.  Coronary artery disease status post stenting of the right
coronary artery.
6.  Diabetes mellitus.
7.  Atrial fibrillation for which she is on Coumadin 3 mg po
q.d. and Amiodarone 200 mg po q.d.
8.  Status post V fibrillation arrest on previous admission
and she is not a candidate for ICD placement secondary to her
body habitus.
9.  Pulmonary hypertension.
10.  Anemia of chronic disease.
11.  Chronic renal failure with a baseline creatinine of
approximately 2.2.

SOCIAL HISTORY:  Significant for a 40 pack year history.  She
quit in [**Month (only) 958**] of last year.  She lives at home with her
boyfriend.

FAMILY HISTORY:  Her mom passed away of multiple myeloma and
her dad past away and had a history of diabetes.

LABORATORIES ON ADMISSION:  White blood cell count of 7.2,
hematocrit 31.3, platelet count of 274.  She had an mean
corpuscular volume of 88 and she had a slight left shift with
81 polymorphonuclearocytes.  Chemistries, sodium 138,
potassium 5.5, chloride 97, bicarb of 27, BUN 59, creatinine
of 3.1 and a platelet count of 111.  She had an INR of 2.1
and a PTT of 33.2.  She had an ALT of 12, AST 27, alkaline
phosphatase 148, total bili of 1.4, lipase 15, amylase 24.
She had a CK of 40 and a troponin of .5.  She had a blood gas
done, which showed a pH 7.4.  In terms of imaging studies she
had a chest x-ray, which showed an enlarged heart, poor
quality and they could not rule out a basilar infiltrate as
mentioned previously.  Head CT demonstrated no hemorrhage, no
shifts and a prominence of the mid right side frontal gyrus
and the electrocardiogram demonstrated normal sinus rhythm
with left axis deviation.  Right bundle branch block.  She
did have an echocardiogram in [**2188-3-14**], which showed
an ejection fraction between 20 and 30%, mild left
ventricular hypertrophy, moderate left ventricular dilation
and severe global hypokinesis and mild mitral regurgitation.

HOSPITAL COURSE:  1.  Urinary tract infection:  The patient
was admitted with a urinary tract infection.  She was given
one dose of Ceftriaxone 2 grams in the Emergency Room and
then she was started on Levofloxacin renal dosing, which is
250 mg q 48 intravenous for ten days.  With the improvement
of the patient's mental status she was switched over to a po
dosing and with further discussion with the attending her
duration of antibiotics therapy was increased from 10 days to
14 days.  On the day of discharge it is day 6 of 14 of
antibiotics coverage and she is taking antibiotics every
other day for that 14 day period.  The cultures grew out two
isolates of estrichia coli, which was sensitive to
Levofloxacin.

2.  History of hemoptysis:  The patient reported an
approximate two week history of hemoptysis prior to admission
and one episode in the Emergency Room.  While in the MICU and
on the medicine floor she had no further episodes of
hemoptysis.  Sputum gram stain demonstrated white cells and
epithelial cells, but no red cells and sputum culture was
contaminated.  I spoke to the nursing staff at Towers [**Doctor Last Name **]
Rehab Hospital where she stayed and they denied noticing any
episodes of hemoptysis there.  The patient had a chest CT
done at this hospital, which revealed no masses, no
infiltrates and no focal etiologies for hemoptysis.

3.  Chronic obstructive pulmonary disease/obstructive sleep
apnea:  Initially the patient was having difficulty with
breathing.  Over the course of her hospital stay she has been
maintained on her standing Albuterol ipratropium inhales and
she has been getting Albuterol ipatropium nebulizers prn,
which she has been responding to.  Her lung examination have
improved from having diffuse expiratory wheezing.  Today the
day of discharge her lungs were clear bilaterally.  She has
been maintained on her BiPAP machine with settings at 15 and
8 for which she has had no difficulties.

4.  Acute on chronic renal failure:  She has had creatinines
in the high 2s approximately 2.7, 2.8, 2.6 over the last
several days.  We believe her baseline creatinine to be 2.2.
In working up the acute on chronic renal failure we obtained
a FENA, which was less then 1% leading us to believe that the
cause of her renal failure was a prerenal source in a setting
with a patient with baseline congestive heart failure with a
low ejection fraction in the setting of dehydration and
presepsis with already baseline poor renal function.  It is
possible that this patient might have had an episode of
hypotension prior to the admission and it is possible that
the creatinine in the high 2s may be a new baseline secondary
to some ischemic injury or acute tubular necrosis that might
have occurred secondary to poor perfusion.  The patient has
been taking good po over the last five days and the
creatinines have remained stable.

5.  Diabetes mellitus:  The patient initially had elevated
finger sticks early on in the course of her hospital stay
with finger sticks in the high 190s to low 200s.  Upon
reviewing on line medical records we determined that the
patient's home diabetes regimen included insulin 70 NPH 30
regular 40 units in the morning and 30 units in the evening.
The patient was started on half this dose 20 units in the
morning, 15 in the evening.  She responded appropriately.
Her finger sticks had been maintained between the 80s and
100s over the last three days.  We obtained a hemoglobin A1C,
which was normal at 5.6.

6.  Bilateral foot pain:  Two days prior to discharge the
patient complained of bilateral pain over the dorsal surfaces
and lateral aspects of her feet.  She described this pain as
achy with occasional shooting pains up toward her hips.  The
patient was admitted in [**2189-1-11**] with a similar
complaint.  At that time it was not believed that this pain
was neuropathic in nature and instead was attributed to
trauma.  The patient on this hospital admission had x-rays of
her feet done, which demonstrated no acute fractures, diffuse
osteopenia and osteophyte formations.  On the previous
hospital admission the patient was started on Neurontin and
Nortriptyline, but this treatment was discontinued after a
short period of time.  The patient was given only one dose of
Neurontin 300 mg, but the etiology of the pain is not certain
that it is neuropathic in the setting of a hemoglobin A1C of
5.6, which demonstrates relatively good control of her blood
glucoses levels over the past several months.  This foot pain
might be related to chronic stasis of her lower extremities
secondary to her morbid obesity, congestive heart failure and
her diabetes.  The patient's pain was well controlled on
Acetaminophen 500 mg po q 4 hours standing with Oxycodone 5
mg po q 4 hours prn pain.

7.  Congestive heart failure:  The patient has denied any
symptoms of orthopnea or paroxysmal nocturnal dyspnea during
this hospital stay.  She has not reported any increased work
of breathing or shortness of breath above and beyond her
baseline chronic obstructive pulmonary disease and
obstructive sleep apnea.  Due to her acute on chronic renal
failure the patient's Lasix, Aldactone and Prinivil were held
and she was discharged with these medications still being
held and we recommended follow up with her primary care
physician as to restarting these medications.  Although the
patient did deny symptoms of orthopnea and paroxysmal
nocturnal dyspnea, she did have lower extremities pitting
edema 2+ bilaterally up to the mid thighs.

8.  Atrial fibrillation:  She has been in and out of atrial
fibrillation throughout this hospital course.  She is
maintained on Coumadin 3 mg po q.d. and an INR was obtained
early on in the course of her hospital stay, which was 2.7.

9.  Gastroesophageal reflux disease:  She has not had any
complaints or symptoms of heartburn and she has been
maintained on Protonix 40 mg po q.d.

10.  Anemia of chronic disease:  This has been worked up in
the past and it has been stable and her hematocrit has been
stable through this admission.

11.  Depression:  She has been maintained on her Sertraline
50 mg po q.d. and has not complained of or demonstrated any
symptoms of depressed behavior during this hospital stay.

The patient will be discharged to an extended care facility.
The exact ECF has yet to be determined.  I will call back
with that information.






                            [**Doctor Last Name **] [**Name6 (MD) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 5712**]

Dictated By:[**Last Name (NamePattern1) 23310**]
MEDQUIST36

D:  [**2189-8-12**]  10:12
T:  [**2189-8-12**]  10:22
JOB#:  [**Job Number 23311**]


Name:  [**Known lastname 1012**], [**Known firstname **]                        Unit No:  [**Numeric Identifier 3955**]

Admission Date:  [**2189-8-6**]     Discharge Date:  [**2189-8-12**]

Date of Birth:   [**2131-5-18**]     Sex:  F

Service:

The patient is being discharged to [**Location (un) 3956**] Subacute Extended
Care Facility [**Location (un) 3957**], which is outside of [**Location (un) 42**],
[**State 1145**].  Patient was restarted on Prinivil 10 mg po q
day and it is Lasix 60 mg po bid and aldactone 25 mg po q
day, which are being held.  The Prinivil's usual home dose is
20 mg po q day, but we elected not to go to her full home
dose because of the resolving acute on chronic renal failure.
It will be important for her primary care physician to
[**Name9 (PRE) 587**] her congestive heart failure medications and to
re-evaluate starting her up again on her Lasix 60 mg po bid
and her aldactone 25 mg po q day.



                    DR.[**Last Name (STitle) **],[**First Name3 (LF) **] 12-735


Dictated By:[**Last Name (NamePattern1) 1566**]

MEDQUIST36

D:  [**2189-8-12**]  13:54
T:  [**2189-8-12**]  18:06
JOB#:  [**Job Number 3958**]


Name:  [**Known lastname 1012**], [**Known firstname **]                        Unit No:  [**Numeric Identifier 3955**]

Admission Date:  [**2189-8-6**]     Discharge Date:  [**2189-8-12**]

Date of Birth:   [**2131-5-18**]     Sex:  F

Service:

The previous discharge summary job number [**Numeric Identifier 3963**].

I left out some information which I would like to add on.

CONDITION ON DISCHARGE:  Good.

DISCHARGE STATUS:  To extended care facility.

PRIMARY DIAGNOSIS:  Urinary tract infection.

SECONDARY DIAGNOSES:
1. Diabetes type 2 controlled.
2. Chronic obstructive pulmonary disease.
3. Chronic renal failure.
4. Congestive heart failure.

DISCHARGE MEDICATIONS:
1. Amiodarone 200 mg po q day.
2. Sertraline 50 mg po q day.
3. Pantoprazole 40 mg po q day.
4. Fluticasone 110 mcg two puffs inhalation [**Hospital1 **].
5. Miconazole nitrate powder applied to skin-folds [**Hospital1 **].
6. Metoprolol 50 mg po bid.
7. Capsaicin 0.025% cream applied to arthritic joints tid.
8. Hydralazine 20 mg po q8h.
9. Isosorbide dinitrate 20 mg po tid.
10. Warfarin 3 mg po q day.
11. Albuterol/ipratropium inhalers 103 and 18 mcg two puffs
q6h.
12. Albuterol 0.83 mg/ml inhalation q6 prn.
13. Ipratropium 0.2 mg/ml two puffs q6 prn.
14. Montelukast 10 mg po q day.
15. Oxybutynin chloride 10 mg po q day.
16. Levofloxacin 250 mg po q48h for the next eight days for a
total course of 14 days.
17. Acetaminophen 500 mg po q4h.
18. Oxycodone 5 mg po q4-6h prn pain.
19. Insulin 70/30 20 units q am, 15 units q pm.

FOLLOW-UP PLANS:  An appointment with her primary care
physician, [**First Name8 (NamePattern2) 3964**] [**Name11 (NameIs) **], on [**8-25**] at 3 pm in the [**Doctor Last Name **]
Building, [**Location (un) 3965**] of the [**Hospital3 **] Hospital, and she is
also supposed to call [**Hospital 3966**] Clinic here at the [**Hospital3 **] Hospital for suggestions on weight loss.


                    DR.[**Last Name (STitle) **],[**First Name3 (LF) **] 12-735



Dictated By:[**Last Name (NamePattern1) 1566**]

MEDQUIST36

D:  [**2189-8-12**]  10:54
T:  [**2189-8-12**]  11:01
JOB#:  [**Job Number 3967**]
{'Acute kidney failure, unspecified,Urinary tract infection, site not specified,Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Esophageal reflux'}


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: The patient is a 58 year-old
African American female with a past medical history
significant for chronic obstructive pulmonary disease, atrial
fibrillation, chronic renal failure and morbid obesity who
was admitted to the MICU at the [**Hospital1 188**] [**Hospital Ward Name 516**] from home with a one day history of fever
and mental status changes.  She had been home for only one
day after a five and a half month rehab stay at Towers [**Doctor Last Name **]
[**Hospital **] hospital.  She presented to the Emergency
Department with what was a one day course of fever and mental
status changes.  She was difficult to arouse and was
lethargic.  The patient presented with a temperature of 102.7
degrees Fahrenheit, respiratory rate 34 and an O2 saturation
of 71%.  She was given oxygen nonrebreather and her O2 sats
responded to 95%.  She had a chest x-ray done, which was poor
quality, but showed an enlarged heat with evidence of a left
lung base infiltrate versus atelectasis.  She had a CAT scan
of the head, which showed prominence to the right side of the
midline gyrus.  She was treated with nebulizers and was given
one dose of Ceftriaxone 2 grams intravenous.  On hospital day
one the patient's mental status improved and she was began on
Levofloxacin 250 mg intravenous q 48.  Upon further
questioning she denies dysuria prior to admission, but did
report increased urinary frequency.  The patient also had a
vague history of hemoptysis over the last two weeks and she
reported one episode of hemoptysis while in the Emergency
Room.  She also reported a history of blood per rectum for
which she was given a colonoscopy in the past, which
demonstrated no lesions or etiology of bleeding source.  This
colonoscopy was done in [**2189-5-12**].

MEDICAL HISTORY: 1.  Morbid obesity.
2.  Congestive heart failure with an ejection fraction of
approximately 20 to 30%.
3.  Chronic obstructive pulmonary disease.  She ahs O2 at
home and her home O2 requirement is 3 liters.  She is also on
BiPAP for obstructive sleep apnea.  Her settings are 15 and
8.
4.  Gastroesophageal reflux disease.
5.  Coronary artery disease status post stenting of the right
coronary artery.
6.  Diabetes mellitus.
7.  Atrial fibrillation for which she is on Coumadin 3 mg po
q.d. and Amiodarone 200 mg po q.d.
8.  Status post V fibrillation arrest on previous admission
and she is not a candidate for ICD placement secondary to her
body habitus.
9.  Pulmonary hypertension.
10.  Anemia of chronic disease.
11.  Chronic renal failure with a baseline creatinine of
approximately 2.2.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: Her mom passed away of multiple myeloma and
her dad past away and had a history of diabetes.

SOCIAL HISTORY: Significant for a 40 pack year history.  She
quit in [**Month (only) 958**] of last year.  She lives at home with her
boyfriend. 

### Response:
{'Acute kidney failure, unspecified,Urinary tract infection, site not specified,Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Esophageal reflux'}
