CHIEF COMPLAINT: 

PRESENT ILLNESS: Ms. [**Known lastname 43251**] is a 41-year-old
woman with a history of depression and asthma.  She was well
until [**Month (only) **] of this year when she was found unresponsive in
her kitchen.

MEDICAL HISTORY: 1.  Recent admission to [**Hospital6 1708**] from
[**5-13**] until [**5-15**] of this year with respiratory arrest of
unknown etiology.  Reports obtained from the [**Hospital6 8866**] indicated that they suspected the
respiratory arrest was secondary to a drug overdose.  Of
note, her toxicology screen at that institution was negative.
At the time of this dictation, the gamma hydroxybutyrate and
Rohypnol levels obtained that institution were still pending.
2.  Recent urinary tract infection approximately one month
ago which was treated and resolved.
3.  A long history of depression, panic attacks, and
attempted suicide.
4.  Hypertension.
5.  Type 1 diabetes.
6.  A history of a low thyroid-stimulating hormone at the
[**Hospital6 1708**].
7.  Asthma.
8.  Polysubstance abuse.

MEDICATION ON ADMISSION: Medications taken prior to
admission included trazodone 150 mg p.o. q.h.s.,
Effexor-SR 75 mg p.o. q.h.s., Remeron 45 mg p.o. q.h.s.,
Neurontin 800 mg p.o. b.i.d., Klonopin (dose unknown),
albuterol inhalers on an as needed basis, Tylenol as needed,
Atrovent inhaler as needed.

ALLERGIES: PENICILLIN which results in a rash.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Ms. [**Known lastname 43251**] [**Last Name (Titles) 42866**] approximately one pack of
cigarettes per week.  She denies alcohol use at this time.
Of note, she also denies active substance abuse.
Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Other, mixed, or unspecified drug abuse, unspecified,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Anxiety state, unspecified,Anemia, unspecified
Acute respiratry failure,Food/vomit pneumonitis,DMI wo cmp nt st uncntrl,Drug abuse NEC-unspec,Hypertension NOS,Depressive disorder NEC,Anxiety state NOS,Anemia NOS
Admission Date:  [**2131-5-21**]     Discharge Date:  [**2131-5-24**]

Date of Birth:   [**2090-9-26**]     Sex:  F

Service:  Medicine

ADMISSION DIAGNOSIS:  Respiratory failure.

HISTORY OF PRESENT ILLNESS:  Ms. [**Known lastname 43251**] is a 41-year-old
woman with a history of depression and asthma.  She was well
until [**Month (only) **] of this year when she was found unresponsive in
her kitchen.

She was transported to the [**Hospital6 1708**],
apparently in respiratory distress.  She remained in that
institution for approximately seven days.  The workup there
did not explain her respiratory arrest.

A few days after her discharge from [**Hospital6 15291**], Ms. [**Known lastname 43251**] was visiting her daughter at [**Hospital3 18242**].  She was undergoing a heated discussion with her
family when she developed the sudden onset of chest pain and
diaphoresis.  The pain radiated to her left arm as well as to
her jaw.  After a short time, Ms. [**Known lastname 43251**] [**Last Name (Titles) 43252**] and was
apparently in respiratory arrest.  She was intubated at
[**Hospital3 1810**].  There were poor records around the code
that was run at [**Hospital3 1810**].  After intubation,
Ms. [**Known lastname 43251**] was transported to the Emergency Department at
[**Hospital1 69**].

PAST MEDICAL HISTORY:
1.  Recent admission to [**Hospital6 1708**] from
[**5-13**] until [**5-15**] of this year with respiratory arrest of
unknown etiology.  Reports obtained from the [**Hospital6 8866**] indicated that they suspected the
respiratory arrest was secondary to a drug overdose.  Of
note, her toxicology screen at that institution was negative.
At the time of this dictation, the gamma hydroxybutyrate and
Rohypnol levels obtained that institution were still pending.
2.  Recent urinary tract infection approximately one month
ago which was treated and resolved.
3.  A long history of depression, panic attacks, and
attempted suicide.
4.  Hypertension.
5.  Type 1 diabetes.
6.  A history of a low thyroid-stimulating hormone at the
[**Hospital6 1708**].
7.  Asthma.
8.  Polysubstance abuse.

MEDICATIONS ON ADMISSION:  Medications taken prior to
admission included trazodone 150 mg p.o. q.h.s.,
Effexor-SR 75 mg p.o. q.h.s., Remeron 45 mg p.o. q.h.s.,
Neurontin 800 mg p.o. b.i.d., Klonopin (dose unknown),
albuterol inhalers on an as needed basis, Tylenol as needed,
Atrovent inhaler as needed.

ALLERGIES:  PENICILLIN which results in a rash.

SOCIAL HISTORY:  Ms. [**Known lastname 43251**] [**Last Name (Titles) 42866**] approximately one pack of
cigarettes per week.  She denies alcohol use at this time.
Of note, she also denies active substance abuse.

PHYSICAL EXAMINATION ON PRESENTATION:  In the Emergency
Department, Ms. [**Known lastname 43253**] physical examination was
unremarkable.  Her vital signs were within normal limits.
There was nothing focal on neurologic examination.
Cardiovascular examination was unremarkable.  The abdomen was
soft and nontender.  Chest examination revealed good air
entry bilaterally.

PERTINENT LABORATORY DATA ON PRESENTATION:  Laboratory
results on admission revealed the white blood cell count
was 16.2, hematocrit was 35.9, platelets were 418.  INR
was 0.9, PTT was 24.6.  Glucose was 317, blood urea nitrogen
was 14, creatinine was 0.6, sodium was 134, potassium
was 5.2, chloride was 97, bicarbonate was 25.  Her creatine
kinase was elevated at 285, CK/MB was 3, and troponin was
less than 0.3.  Her toxicology screen in the Emergency
Department was negative for aspirin, alcohol,
benzodiazepines, barbiturates, tricyclics, and Tylenol.  An
arterial blood gas obtained in the Emergency Department
showed an oxygen of 334, carbon dioxide of 56, pH of 7.31,
bicarbonate of 30.  A urinalysis was negative for nitrites
and ketones.  A large amount of blood was present in the
urine.  Leukocyte esterase was negative.

RADIOLOGY/IMAGING:  Electrocardiogram on admission was
unremarkable.  There were no signs of ischemia.

An electroencephalogram was obtained which was negative for
seizure activity.

An echocardiogram was obtained which showed a trivial mitral
regurgitation and a mildly dilated left atrium.

A CT of the head was negative.

A chest x-ray showed no evidence of pneumonia of congestive
heart failure.

Subsequently, a CT of the chest was obtained.  This was
negative for a pulmonary embolism.  Of note, it did not an
aspiration pneumonia.  It was felt that this was secondary to
a difficult intubation.  There were reports that Ms. [**Known lastname 43251**]
[**Last Name (Titles) 43254**] during intubation at [**Hospital3 1810**].

HOSPITAL COURSE:  Ms. [**Known lastname 43251**] was transferred to the Medical
Intensive Care Unit on [**5-21**].  She was easily weaned from
the ventilator.  She ruled out for a myocardial infarction by
enzymes.  Her telemetry remained unremarkable.  She remained
asymptomatic in the Medical Intensive Care Unit.

On [**5-22**], she was transferred to the Medical [**Hospital1 **].  She
remained asymptomatic on the Medicine floor.

There was some discussion as to whether her episodes of
respiratory arrest could be attributed to seizure activity.
A Neurology consultation was obtained.  After reviewing her
electroencephalogram and her relevant history, the Neurology
team did not feel that her symptoms could be attributable to
seizures.

The Electrophysiology Service was also consulted.  Given her
unremarkable telemetry during her three day stay in the
hospital, the Electrophysiology team did not feel that
Ms. [**Known lastname 43251**] required an electrophysiology study at this
point.  At this time it is unclear what the etiology of her
episodes of respiratory arrest are.

Ms. [**Known lastname 43251**] was started on levofloxacin to treat her
aspiration pneumonia.  She remained afebrile throughout her
stay in the hospital.  She never developed a white blood
count.  As such, it was felt that the findings on the CT of
the chest were likely related to aspiration pneumonitis.  Her
levofloxacin was stopped on [**5-24**].

Ms. [**Known lastname 43251**] has type 1 diabetes and is maintained on insulin
at home.  On presentation, her blood sugar was noted to be in
the 300s.  She was started on an insulin sliding-scale while
in the hospital.  The benefits of maintaining a blood sugar
in the target range were discussed with her.

Ms. [**Known lastname 43251**] apparently had a low thyroid-stimulating hormone
during her stay at the [**Hospital6 1708**].  Repeat
studies here revealed a thyroid-stimulating hormone of 0.43
and a free T4 of 5.5; both of which were within normal
limits.

Of note, Ms. [**Known lastname 43251**] was noted to have an anemia during her
stay here.  After her initial blood draw in the Emergency
Department, her hematocrit ranged from 26.5 to 29.  The mean
cell volume was normal at 85 to 87.  Iron studies were sent
which were normal.  Of note, her ferritin was 251.  Her
vitamin B12 was 294, and her folate was 11.4.  The total
iron-binding capacity was 257.

At the time of this dictation, there was no clear etiology
for Ms. [**Known lastname 43253**] episode of respiratory arrest.  It was
noted that she has an extensive psychiatric history.  It was
also noted that she has been under a considerable amount of
stress over the past month.  Her eldest daughter is getting
married this week.  Apparently, there has been a great deal
of arguing amongst the family in relation to this event.  Her
younger daughter was also hospitalized at [**Hospital3 18242**].  It was possible that her episodes in the past week
were related to a psychiatric problem.

DISCHARGE DIAGNOSES:  Syncope/apnea of unclear etiology.

MEDICATIONS ON DISCHARGE:
1.  Tylenol one to two tablets p.o. q.4-6h. as needed.
2.  Trazodone 150 mg p.o. q.h.s.
3.  Effexor-SR 75 mg p.o. q.h.s.
4.  Klonopin 2 mg p.o. b.i.d. as needed.
5.  Albuterol inhaler.
6.  Atrovent inhaler.
7.  Regular insulin 10 units in the morning and 5 units at
5 p.m. and 10 units q.h.s.; and NPH insulin 10 units in the
morning and 10 units at 5 p.m. and 10 units q.h.s.

DISCHARGE FOLLOWUP:  Ms. [**Known lastname 43251**] was to see her primary care
physician on [**5-25**] if possible.  If not, she was to see her
primary care physician on [**5-28**].  She was also instructed
to follow up with her outpatient psychiatrist.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(2) 10451**]

Dictated By:[**Last Name (NamePattern1) 222**]

MEDQUIST36

D:  [**2131-5-25**]  13:41
T:  [**2131-5-28**]  08:23
JOB#:  [**Job Number 43255**]
{'Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Other, mixed, or unspecified drug abuse, unspecified,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Anxiety state, unspecified,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: 

PRESENT ILLNESS: Ms. [**Known lastname 43251**] is a 41-year-old
woman with a history of depression and asthma.  She was well
until [**Month (only) **] of this year when she was found unresponsive in
her kitchen.

MEDICAL HISTORY: 1.  Recent admission to [**Hospital6 1708**] from
[**5-13**] until [**5-15**] of this year with respiratory arrest of
unknown etiology.  Reports obtained from the [**Hospital6 8866**] indicated that they suspected the
respiratory arrest was secondary to a drug overdose.  Of
note, her toxicology screen at that institution was negative.
At the time of this dictation, the gamma hydroxybutyrate and
Rohypnol levels obtained that institution were still pending.
2.  Recent urinary tract infection approximately one month
ago which was treated and resolved.
3.  A long history of depression, panic attacks, and
attempted suicide.
4.  Hypertension.
5.  Type 1 diabetes.
6.  A history of a low thyroid-stimulating hormone at the
[**Hospital6 1708**].
7.  Asthma.
8.  Polysubstance abuse.

MEDICATION ON ADMISSION: Medications taken prior to
admission included trazodone 150 mg p.o. q.h.s.,
Effexor-SR 75 mg p.o. q.h.s., Remeron 45 mg p.o. q.h.s.,
Neurontin 800 mg p.o. b.i.d., Klonopin (dose unknown),
albuterol inhalers on an as needed basis, Tylenol as needed,
Atrovent inhaler as needed.

ALLERGIES: PENICILLIN which results in a rash.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Ms. [**Known lastname 43251**] [**Last Name (Titles) 42866**] approximately one pack of
cigarettes per week.  She denies alcohol use at this time.
Of note, she also denies active substance abuse. 

### Response:
{'Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Other, mixed, or unspecified drug abuse, unspecified,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Anxiety state, unspecified,Anemia, unspecified'}
