CHIEF COMPLAINT: 

PRESENT ILLNESS: This is an 89-year-old female
with history of hypertension, who is admitted postfall on her
knees secondary to questionable dizzy spell with no loss of
consciousness.  She was admitted for dehydration and elevated
CKs to rule out myocardial infarction, but now also being
worked up with findings consistent with rabdo picture and
treated with IV fluids.

MEDICAL HISTORY: 1. Hypertension.
2. Eye implants in [**2134**].
3. History of DVT, which she was treated for six months with
Coumadin in [**2142**].

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: She was lying down in no acute distress,
appeared to be comfortable.  HEENT:  Slightly dry membrane
mucosa.  Eyes:  Her pupils were sluggishly reactive to light
and her extraocular movements were not intact and with
questionable visual changes, decreased vision in both eyes.
Neck:  No LAD, no JVD noted, no carotid bruits.  Thyroid was
not palpable.  Respiratory:  She had these high-pitched
expiratory wheezes bilaterally, no rales or rhonchi.
Cardiovascular:  Regular, rate, and rhythm, normal S1, S2, no
S3, S4.  Abdomen:  Nondistended, nontender, soft, plus bowel
sounds in all quadrants, no hepatosplenomegaly.  Extremities:
2+ pitting edema in the lower extremities, no clubbing or
cyanosis.  Pulses were palpable 1+.  Neurologically, she was
alert and oriented times three.  Cranial nerves III, IV, and
VI slow for extraocular motors, not fully intact.  Other
cranial nerves were intact.  Her deep tendon reflexes were
intact.  Her motor strength was [**3-23**] throughout.  Sensation to
touch was intact.  Speech was normal.

FAMILY HISTORY: 

SOCIAL HISTORY: No tobacco, no ethanol, and no drugs.  Lives
alone in [**Location (un) **] Senior Center.  No stairs, housebound.
Son and daughter live in [**Name (NI) 1411**] and [**Name (NI) 745**] respectively.  He
was born in [**Country 4754**].
Acute kidney failure, unspecified,Acute diastolic heart failure,Acute respiratory failure,Mitral valve disorders,Other disorders of muscle, ligament, and fascia,Other fall
Acute kidney failure NOS,Ac diastolic hrt failure,Acute respiratry failure,Mitral valve disorder,Muscle/ligament dis NEC,Fall NEC
Admission Date:  [**2148-8-14**]       Discharge Date:  [**2148-8-21**]


Service:  [**Hospital1 **] MEDICINE

HISTORY OF PRESENT ILLNESS:  This is an 89-year-old female
with history of hypertension, who is admitted postfall on her
knees secondary to questionable dizzy spell with no loss of
consciousness.  She was admitted for dehydration and elevated
CKs to rule out myocardial infarction, but now also being
worked up with findings consistent with rabdo picture and
treated with IV fluids.

In ED her vitals were temperature of 97.0, blood pressure of
182/99, heart rate of 96, respiratory rate of 34, and O2
saturation of 92% on room air.  Patient in the ED was given
Aldomet 250 mg, aspirin, Lopressor, and 1.5 liters of normal
saline.  She also got a CT without contrast, which was
negative.  A chest x-ray and plain films and bilateral hips
were negative.

HOME MEDICATIONS:
1. Aldomet 1.5 tablet t.i.d.
2. Vasotec 5 mg q.d.
3. Maxzide half a tablet q.d.

ALLERGIES:  No known drug allergies.

PAST MEDICAL HISTORY:
1. Hypertension.
2. Eye implants in [**2134**].
3. History of DVT, which she was treated for six months with
Coumadin in [**2142**].

SOCIAL HISTORY:  No tobacco, no ethanol, and no drugs.  Lives
alone in [**Location (un) **] Senior Center.  No stairs, housebound.
Son and daughter live in [**Name (NI) 1411**] and [**Name (NI) 745**] respectively.  He
was born in [**Country 4754**].

On admission, her T max was 98, T current was also 98, BP was
133-145/75-77, heart rate was 76-80, respiratory rate was 16,
O2 saturation was 96% on 2 liters.

PHYSICAL EXAM:  She was lying down in no acute distress,
appeared to be comfortable.  HEENT:  Slightly dry membrane
mucosa.  Eyes:  Her pupils were sluggishly reactive to light
and her extraocular movements were not intact and with
questionable visual changes, decreased vision in both eyes.
Neck:  No LAD, no JVD noted, no carotid bruits.  Thyroid was
not palpable.  Respiratory:  She had these high-pitched
expiratory wheezes bilaterally, no rales or rhonchi.
Cardiovascular:  Regular, rate, and rhythm, normal S1, S2, no
S3, S4.  Abdomen:  Nondistended, nontender, soft, plus bowel
sounds in all quadrants, no hepatosplenomegaly.  Extremities:
2+ pitting edema in the lower extremities, no clubbing or
cyanosis.  Pulses were palpable 1+.  Neurologically, she was
alert and oriented times three.  Cranial nerves III, IV, and
VI slow for extraocular motors, not fully intact.  Other
cranial nerves were intact.  Her deep tendon reflexes were
intact.  Her motor strength was [**3-23**] throughout.  Sensation to
touch was intact.  Speech was normal.

LABORATORIES ON ADMISSION:  Cardiac enzymes:  She had a CK of
1759, CK MB of 52, index of 3.0, troponin-T of 0.21.  The
repeat CK was 1491, CK MB 44, index 3.0, troponin-T of 0.23
and the one after that, eight hours after was also negative.
UA showed small blood, trace protein, trace ketone,
occasional bacteria, 0-2 epi, 0-2 red blood cells, 0-2 white
blood cells.  Her PTT was 29.1.  INR 1.2.

Chest x-ray showed cardiomegaly, basilar bilateral linear
atelectasis with a calcified aorta, no effusion and no
pneumothorax.

Head CT further verification still showed no evidence of
intracranial hemorrhage and no acute brain infarct.

Patient was admitted for evaluation of dehydration, which
received normal saline since admission.  Also getting normal
saline secondary to presumed rhabdomyolysis with elevated CKs
which were trending down with normal saline IV fluid
hydration.  She was ruled out for myocardial infarction given
normal index of MB.

HOSPITAL COURSE:  Since she was admitted, her rabdo was
improving daily.  She was ruled out for myocardial
infarction, but on day two of hospital admission, she
developed shortness of breath, and she was slightly
refractory to O2 treatments.  An ABG was retained, which
showed a CO2 of 108 with good pO2.  She was then transferred
to the MICU for further evaluation secondary to CO2
retention.  She stayed in the MICU for three days.  Patient's
blood gas was repeated and over time, blood gas gradually
improved.  Although when readmitted to the floor, still the
bicarb for ........... were a mechanism was still elevated,
although decreasing each day.

For the past three days, the bicarb has been decreasing.  It
has gone from 50 to 48 to 44 and today's is pending.  Patient
is still on face mask today, but says that everything is
feeling better, and her extraocular motors are now back and
she notes that she is going back to her old self, although
still has some respiratory distress and is still currently on
BiPAP machine intermittently with nasal cannula.  Her lower
edema, she is wearing her stockings and since wearing the
stockings, had been feeling better.  Her rhabdomyolysis has
been improved and the last CK was dramatically improved from
the over 1,000 CK that was on admission, it was 300 and
today's CK pending.

CONDITION ON DISCHARGE:  Stable, some respiratory distress.
Continues to be on O2.

DISCHARGE STATUS:  Patient is planning on being discharged to
rehab center today.

DISCHARGE MEDICATIONS:
1. Ipratropium nebulizer IH q.6h.
2. Albuterol nebulizer one inhaled q.6h. prn.
3. Bisacodyl 10 mg p.r. prn.
4. Thiamine 100 mg p.o. q.d.
5. Bacitracin ointment TP b.i.d. apply to lumbar sore.
6. Heparin 5,000 units subQ q.12h.
7. Docusate sodium 100 mg p.o. b.i.d. prn.
8. Aspirin 81 mg p.o. q.d.

FOLLOWUP:  Patient is to followup with PCP early next week.



                            [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 4263**]

Dictated By:[**Last Name (STitle) 109878**]
MEDQUIST36

D:  [**2148-8-21**]  08:27
T:  [**2148-8-21**]  08:36
JOB#:  [**Job Number 109879**]

cc:[**CC Contact Info **]
{'Acute kidney failure, unspecified,Acute diastolic heart failure,Acute respiratory failure,Mitral valve disorders,Other disorders of muscle, ligament, and fascia,Other fall'}


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: This is an 89-year-old female
with history of hypertension, who is admitted postfall on her
knees secondary to questionable dizzy spell with no loss of
consciousness.  She was admitted for dehydration and elevated
CKs to rule out myocardial infarction, but now also being
worked up with findings consistent with rabdo picture and
treated with IV fluids.

MEDICAL HISTORY: 1. Hypertension.
2. Eye implants in [**2134**].
3. History of DVT, which she was treated for six months with
Coumadin in [**2142**].

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: She was lying down in no acute distress,
appeared to be comfortable.  HEENT:  Slightly dry membrane
mucosa.  Eyes:  Her pupils were sluggishly reactive to light
and her extraocular movements were not intact and with
questionable visual changes, decreased vision in both eyes.
Neck:  No LAD, no JVD noted, no carotid bruits.  Thyroid was
not palpable.  Respiratory:  She had these high-pitched
expiratory wheezes bilaterally, no rales or rhonchi.
Cardiovascular:  Regular, rate, and rhythm, normal S1, S2, no
S3, S4.  Abdomen:  Nondistended, nontender, soft, plus bowel
sounds in all quadrants, no hepatosplenomegaly.  Extremities:
2+ pitting edema in the lower extremities, no clubbing or
cyanosis.  Pulses were palpable 1+.  Neurologically, she was
alert and oriented times three.  Cranial nerves III, IV, and
VI slow for extraocular motors, not fully intact.  Other
cranial nerves were intact.  Her deep tendon reflexes were
intact.  Her motor strength was [**3-23**] throughout.  Sensation to
touch was intact.  Speech was normal.

FAMILY HISTORY: 

SOCIAL HISTORY: No tobacco, no ethanol, and no drugs.  Lives
alone in [**Location (un) **] Senior Center.  No stairs, housebound.
Son and daughter live in [**Name (NI) 1411**] and [**Name (NI) 745**] respectively.  He
was born in [**Country 4754**]. 

### Response:
{'Acute kidney failure, unspecified,Acute diastolic heart failure,Acute respiratory failure,Mitral valve disorders,Other disorders of muscle, ligament, and fascia,Other fall'}
