CHIEF COMPLAINT: chills/sweats x 2 days

PRESENT ILLNESS: This is a 47 y/o female with ESRD [**1-14**] IDDM, s/p living donor
renal transplant [**2164**], significant vascular disease, s/p recent
right 5th toe debridement [**1-14**] osteomyelitis, presenting with
chills and sweats for the last two days. Per patient, onset was
two days ago with her chills and sweats occuring intermittently
3-4 times a day, now only 1-2 times today. No fevers at home.
This morning she developed nausea and vomited 3 times - no
hematemesis or bilious emesis. No abdominal pain, change in
bowel habits, BRBPR/melena/hematochezia. Reports a dry,
non-productive cough for the last two days with slight
associated SOB with exertion yesterday. No chest pain or
pleurisy. No recent sick contacts or travels. On Augmentin for
last one month s/p right toe debridement.
Pt reports having mild myalgias and generalized fatigue. Had flu
vaccine in [**8-17**]. Her sugars at home have been within normal
limits. Took her BP meds only PTA.
.
ROS - In addition to above, denies any H/A, vision changes,
photophobia, neck stiffness, dizziness/lightheadedness, URI
symptoms, dysuria, hematuria, extremity swelling,
weakness/numbness/loss of sensation.
.
In the ED, was given 2 L of NS, one dose of Vancomycin and
Zosyn, 10 units of regular insulin, and her BP medications.

MEDICAL HISTORY: 1. s/p living donor renal transplant [**2164**] [**1-14**] ESRD (kidney from
sister) - ESRD [**1-14**] IDDM, on cellcept and rapamune since [**2164**];
baseline Cr 2.5-3.4
2. IDDM since age 11 - retinopathy, nephropathy, neuropathy
3. PVD with b/l fem-[**Doctor Last Name **] [**2165**]
4. HTN
5. Hypercholesterolemia
6. Anemia - on procrit, Fe supplements
7. CVA x 2 [**2165**] - presentation of aphasia, no residual deficits

MEDICATION ON ADMISSION: 1. Rapamune 4mg qd
2. Cellcept [**Pager number **] mg [**Hospital1 **]
3. Nifedipine 60 mg [**Hospital1 **]
4. Lopressor 150 mg qAM, 100 mg qPM
5. Diovan 80 mg qd
6. Lipitor 10 mg qd
7. Insulin - Humulin N 30 units qAM, HSS
8. Catapres #3 patch qweek
9. Lasix 20 mg qd
10. Tricor 54 mg qd
11. Nirefex 150 mg qd
12. EC [**Hospital1 **] 325 mg qd
13. Epo 1,000 units qweek

ALLERGIES: Darvon

PHYSICAL EXAM: VS: T 98.4, BP 142/90, HR 85, RR 18, sats 100%/RA
General: Pleasant, middle-aged woman in NAD, appears slightly
pale. AO x 3.
HEENT: NC/AT, PERRL, EOMI. No conjuctival injection, no scleral
icterus. MMM, OP clear.
Neck: no LAD or JVD noted
Chest: Decreased BS over right base, + slight egophany over
right base; no dullness to percussion or decreased tactile
fremitus noted. Otherwise clear.
CV: RRR, s1 s2 normal. II/VII systolic murmur over LSB with
radiation to carotids. No rubs or gallops.
Abd: soft, NT/ND, NABS, no masses or organomegaly
Ext: trace edema b/l, weak distal pulses, right 5th toe w/o any
erythema, warmth, drainage or swelling; right calf > left calf
without any tenderness
Skin: white, scaly skin over lower legs b/l
Neuro: AO x 3, CN II-XII intact, MS [**4-16**] throughout, sensation
grossly intact

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives at home with her boyfriend. [**Name (NI) **] two children in the area.
Does not work. Former 30 pack-year smoker, quit in [**2165**]. No EtOH
use or illicit drug use.
Subendocardial infarction, initial episode of care,Pneumonia, organism unspecified,Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Hypoxemia,Complications of transplanted kidney,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Mitral valve disorders,Polyneuropathy in diabetes,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Background diabetic retinopathy,Coronary atherosclerosis of native coronary artery,Other bone involvement in diseases classified elsewhere,Unspecified osteomyelitis, ankle and foot,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in other specified places,Atherosclerosis of native arteries of the extremities with rest pain,Iron deficiency anemia, unspecified
Subendo infarct, initial,Pneumonia, organism NOS,DMI neuro nt st uncntrld,Hypoxemia,Compl kidney transplant,Acute kidney failure NOS,Hyp kid NOS w cr kid V,End stage renal disease,Mitral valve disorder,Neuropathy in diabetes,Nephritis NOS in oth dis,Diabetic retinopathy NOS,Crnry athrscl natve vssl,Bone involv in oth dis,Osteomyelitis NOS-ankle,Abn react-org transplant,Accident in place NEC,Ath ext ntv at w rst pn,Iron defic anemia NOS
Admission Date:  [**2173-1-7**]              Discharge Date:   [**2173-1-18**]

Date of Birth:  [**2125-1-14**]             Sex:   F

Service: MEDICINE

Allergies:
Darvon

Attending:[**First Name3 (LF) 465**]
Chief Complaint:
chills/sweats x 2 days

Major Surgical or Invasive Procedure:
cardiac catheterization w/ DES to the LAD

History of Present Illness:
 This is a 47 y/o female with ESRD [**1-14**] IDDM, s/p living donor
renal transplant [**2164**], significant vascular disease, s/p recent
right 5th toe debridement [**1-14**] osteomyelitis, presenting with
chills and sweats for the last two days. Per patient, onset was
two days ago with her chills and sweats occuring intermittently
3-4 times a day, now only 1-2 times today. No fevers at home.
This morning she developed nausea and vomited 3 times - no
hematemesis or bilious emesis. No abdominal pain, change in
bowel habits, BRBPR/melena/hematochezia. Reports a dry,
non-productive cough for the last two days with slight
associated SOB with exertion yesterday. No chest pain or
pleurisy. No recent sick contacts or travels. On Augmentin for
last one month s/p right toe debridement.
Pt reports having mild myalgias and generalized fatigue. Had flu
vaccine in [**8-17**]. Her sugars at home have been within normal
limits. Took her BP meds only PTA.
.
ROS - In addition to above, denies any H/A, vision changes,
photophobia, neck stiffness, dizziness/lightheadedness, URI
symptoms, dysuria, hematuria, extremity swelling,
weakness/numbness/loss of sensation.
.
In the ED, was given 2 L of NS, one dose of Vancomycin and
Zosyn, 10 units of regular insulin, and her BP medications.


Past Medical History:
1. s/p living donor renal transplant [**2164**] [**1-14**] ESRD (kidney from
sister) - ESRD [**1-14**] IDDM, on cellcept and rapamune since [**2164**];
baseline Cr 2.5-3.4
2. IDDM since age 11 - retinopathy, nephropathy, neuropathy
3. PVD with b/l fem-[**Doctor Last Name **] [**2165**]
4. HTN
5. Hypercholesterolemia
6. Anemia - on procrit, Fe supplements
7. CVA x 2 [**2165**] - presentation of aphasia, no residual deficits

8. TAH [**2170**] [**1-14**] menometorrhagia
9. Laser eye surgery
[**76**]. s/p Bartholin cyst/abscess drainage [**2167**]
11. Right 5th toe debridement [**1-14**] osteomyelitis - 1 month ago


Social History:
Lives at home with her boyfriend. [**Name (NI) **] two children in the area.
Does not work. Former 30 pack-year smoker, quit in [**2165**]. No EtOH
use or illicit drug use.

Family History:
non-contributory

Physical Exam:
VS: T 98.4, BP 142/90, HR 85, RR 18, sats 100%/RA
General: Pleasant, middle-aged woman in NAD, appears slightly
pale. AO x 3.
HEENT: NC/AT, PERRL, EOMI. No conjuctival injection, no scleral
icterus. MMM, OP clear.
Neck: no LAD or JVD noted
Chest: Decreased BS over right base, + slight egophany over
right base; no dullness to percussion or decreased tactile
fremitus noted. Otherwise clear.
CV: RRR, s1 s2 normal. II/VII systolic murmur over LSB with
radiation to carotids. No rubs or gallops.
Abd: soft, NT/ND, NABS, no masses or organomegaly
Ext: trace edema b/l, weak distal pulses, right 5th toe w/o any
erythema, warmth, drainage or swelling; right calf > left calf
without any tenderness
Skin: white, scaly skin over lower legs b/l
Neuro: AO x 3, CN II-XII intact, MS [**4-16**] throughout, sensation
grossly intact


Pertinent Results:
[**2173-1-7**] 11:00PM   CK(CPK)-183*
[**2173-1-7**] 11:00PM   CK-MB-7 cTropnT-0.32*
[**2173-1-7**] 11:00PM   PT-13.7* PTT-150* INR(PT)-1.2*
[**2173-1-7**] 07:45PM   CK(CPK)-176*
[**2173-1-7**] 07:45PM   CK-MB-8 cTropnT-0.26*
[**2173-1-7**] 04:30PM   GLUCOSE-388* UREA N-47* CREAT-2.8* SODIUM-138
POTASSIUM-4.6 CHLORIDE-106 TOTAL CO2-18* ANION GAP-19
[**2173-1-7**] 04:30PM   CALCIUM-8.6 PHOSPHATE-3.2 MAGNESIUM-1.7
[**2173-1-7**] 06:45AM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.024
[**2173-1-7**] 06:45AM URINE  BLOOD-LG NITRITE-NEG PROTEIN-500
GLUCOSE-1000 KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2173-1-7**] 06:45AM URINE  RBC-21-50* WBC-21-50* BACTERIA-OCC
YEAST-NONE EPI-[**2-14**]
[**2173-1-7**] 05:46AM   GLUCOSE-492* LACTATE-1.3 K+-4.8
[**2173-1-7**] 05:30AM   GLUCOSE-471* UREA N-48* CREAT-2.9* SODIUM-140
POTASSIUM-4.7 CHLORIDE-106 TOTAL CO2-18* ANION GAP-21*
[**2173-1-7**] 05:30AM   CK(CPK)-132
[**2173-1-7**] 05:30AM   CALCIUM-8.9 PHOSPHATE-3.7 MAGNESIUM-1.7
[**2173-1-7**] 05:30AM   WBC-12.2*# RBC-3.59* HGB-9.7* HCT-29.1*
MCV-81* MCH-27.0 MCHC-33.2 RDW-15.8*
[**2173-1-7**] 05:30AM   NEUTS-86.8* LYMPHS-9.0* MONOS-2.8 EOS-0.6
BASOS-0.9
[**2173-1-7**] 05:30AM   HYPOCHROM-1+ POIKILOCY-1+ MICROCYT-1+
[**2173-1-7**] 05:30AM   PLT COUNT-401
.
CT ABDOMEN: Again noted are moderate bilateral pleural effusions
and bibasilar atelectasis. Within the limits of this noncontrast
study, the liver is normal. Cholelithiasis is again identified.
The pancreas, spleen, adrenal glands and atrophic kidneys are
stable in appearance. Stomach and bowel loops are unremarkable.
There is no free air or free fluid. No mesenteric or
retroperitoneal lymphadenopathy is identified.
.
CT PELVIS: The bladder, sigmoid colon, rectum, right pelvic
transplant kidney are again seen. A femoral-femoral bypass graft
is again identified. There is no evidence of groin or
retroperitoneal hematoma. There is no free fluid and no pelvic
or inguinal lymphadenopathy.
.
CARDIAC CATHETERIZATION: The angiogram showed a mid 70% lesion
in the LAD. We planned to direct stent this. Heparin and reopro
were used
prophylactically. Reopro was preferred due to her renal failure.
A 6F [**Doctor Last Name **]
0.75 guide provided adequate support. We then derectly deployed
a 2.5 X
18mm Cypher stent at 14 at. The final angiogram showed TIMI III
flow
with no residual stenosis, no dissection and no embolisation.
The
patient left the lab in a stable condtion.


Brief Hospital Course:
Pt is a 47 y/o female with IDDM c/b ESRD (s/p living donor renal
transplant [**2164**]), PVD (s/p recent right 5th toe debridement [**1-14**]
osteomyelitis), HTN, and CVA x2 who presented to [**Hospital1 18**] with
chills and sweats x2d. She was admitted to general medicine and
treated broadly for CAP (CXR w/ lingular and RLL opacities) w/
zosyn/vanco given her immunosuppressed state.  In the context of
this treatment course, the patient was noted to have
persistently elevated blood glucose values and was started on an
insulin gtt.  Also, CE drawn at her admission demonstrated a
troponin of 0.26 w/ TWI anteriorly and inferiorly.  She was
taken urgently to the cath lab where she received a DES to the
LAD and was sent to the CCU for further monitoring.  Following
her transfer out of the CCU, the following issues were
addressed:
.
# Hypoxia: Patient received R thoracentesis  for a transudative
effusion that was likely [**1-14**] her significantly fluid overloaded
state.  900cc was removed.  After the thoracentesis the patient
was quickly weaned from 6L O2 by NC back down to room air.  An
HD catheter was placed and the patient received a total of 3
runs of HD for ultrafiltration, with continued symptomatic
improvement.  There was no reaccumulation of per pleural
effusion on discharge.
.
# CAP: Patient presented with a LLL opacity on admission, which
was initiallytreated with Levaquin.  With her respiratory
decompensation preceding her thoracentesis, she was switched to
Zosyn for coverage amid concern for possible infectious cause.
She completed a course of Zosyn for this opacity, and was
discharged without any additional antibiotics.  She was
restarted on her Bactrim for prophylaxis on discharge, given her
immunosuppression.
.
# Blood Pressure Control:  Following her CCU admission with
coronary angioplasty, the patient was transferred back to the
medical [**Hospital1 **].  She received all of her antihypertensive
medications as well as some pain medication all in close
proximity to eachother, and then suffered a hypotensive episode
with SBP in the 70s.  The patient was transferred to the MICU
briefly for this hypotension.  She was very fluid responsive,
had a normal lactate, normal WBC count, and no fever.  Concern
for an RP bleed was briefly entertained given the recent cath,
but CT abd/pelvis was normal.  With slight modification of her
antihypertensive regimen, she suffered no additional hypotensive
episodes.  In fact, she returned to her baseline level of
hypertension.  She was discharged on high dose Toprol XL,
Nifedipine CR, and clonidine.  The clonidine can be changed to
catapres patch after discharge.  She was also taking lasix for
volume overload.  It is expected that her hypertension will
become easier to control with improved renal function as her
kidney recovers from the dye insult.
.
# Acute on Chronic renal failure:  Patient is s/p renal
transplant in [**2164**]. Baseline cr of 2.8 elevated to 4.9 in ICU,
which was presumed [**1-14**] contrast nephropathy.  The patient
developed progressive fluid overload, requiring thoracentesis as
above.  She had an HD catheter placed and recieved several runs
of HD during her hospitalization, which she tolerated well.  At
the time of discharge, her Cr was in the mid-3 range.  It is
hoped that her kidney will gradually improve after discharge
back to baseline level as it recovers from the contrast
nephropathy.  The HD catheter was discontinued prior to
discharge.  The patient was discharged on Cellcept, low dose
prednisone, and sirolimus.  She will have very close follow up
with Dr.[**Doctor Last Name 4849**].  She was continued on lasix at discharge as
well, to prevent worsening fluid overload at home.  She was
making good urine at the time of discharge.
.
# Ischemia/CAD: Patient is now s/p anterior NSTEMI with DES x1
to LAD.  She experienced no further CAD symptoms or chest pain
during her hospitalization.  The patient was discharged on
[**Last Name (LF) **], [**First Name3 (LF) **], Statin, B-blocker, and her CCB.  She was not
started on an ACE-I or [**Last Name (un) **] due to her elevated Cr.
.
#. Hyperlipidemia: Lipitor was continued during the remainder of
the hospitalization.  No changes were made to this medication on
discharge.
.
# DM: The patient experienced some blood sugar lability during
her stay, likely [**1-14**] to underlying infection (CAP) as well as
her cardiac ischemic event.  She was briefly on high dose
Prednisone after her Cr increase, which further exacerbated her
blood sugar issues.  However, on discharge she was only taking
low dose prednisone and her sugars were reasonably controlled.
She was followed by [**Last Name (un) **] during her stay, and will follow up
after discharge.
.
# Anemia: Patient had a brief drop in her Hct during her stay,
raising concern for RP bleed, which was ruled out as noted
above.  In retrospect, the decreased Hct was likely [**1-14**] volume
overload due to her contrast nephropathy.  The patient was
continued on Epo and iron repletion, managed at hemodialysis.

Medications on Admission:
1. Rapamune 4mg qd
2. Cellcept [**Pager number **] mg [**Hospital1 **]
3. Nifedipine 60 mg [**Hospital1 **]
4. Lopressor 150 mg qAM, 100 mg qPM
5. Diovan 80 mg qd
6. Lipitor 10 mg qd
7. Insulin - Humulin N 30 units qAM, HSS
8. Catapres #3 patch qweek
9. Lasix 20 mg qd
10. Tricor 54 mg qd
11. Nirefex 150 mg qd
12. EC [**Hospital1 **] 325 mg qd
13. Epo 1,000 units qweek


Discharge Medications:
1. Mycophenolate Mofetil 500 mg Tablet Sig: Two (2) Tablet PO
BID (2 times a day).
Disp:*120 Tablet(s)* Refills:*0*
2. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
3. Polysaccharide Iron Complex 150 mg Capsule Sig: One (1)
Capsule PO DAILY (Daily).
Disp:*30 Capsule(s)* Refills:*2*
4. Epoetin Alfa 4,000 unit/mL Solution Sig: 4000. units
Injection QMOWEFR (Monday -Wednesday-Friday).
Disp:*qs units* Refills:*0*
5. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
7. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1)
Tablet PO 3X/WEEK (MO,WE,FR).
Disp:*90 Tablet(s)* Refills:*0*
8. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for anxiety.
Disp:*20 Tablet(s)* Refills:*0*
9. Nifedipine 60 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO BID (2 times a day).
Disp:*60 Tablet Sustained Release(s)* Refills:*2*
10. Sirolimus 1 mg Tablet Sig: Four (4) Tablet PO DAILY (Daily).
Disp:*120 Tablet(s)* Refills:*0*
11. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
Disp:*30 Tablet(s)* Refills:*2*
12. Clonidine 0.1 mg Tablet Sig: Two (2) Tablet PO TID (3 times
a day).
Disp:*180 Tablet(s)* Refills:*2*
13. Lasix 40 mg Tablet Sig: Three (3) Tablet PO twice a day.
Disp:*180 Tablet(s)* Refills:*0*
14. Prednisone 1 mg Tablet Sig: Four (4) Tablet PO once a day.
Disp:*120 Tablet(s)* Refills:*0*
15. Toprol XL 200 mg Tablet Sustained Release 24HR Sig: One (1)
Tablet Sustained Release 24HR PO once a day.
Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*2*
16. Humulin N 100 unit/mL Suspension Sig: Thirty (30) units
Subcutaneous qAM.
Disp:*qs qs* Refills:*2*
17. Humulin N 100 unit/mL Suspension Sig: Twelve (12) units
Subcutaneous at bedtime.
Disp:*qs qs* Refills:*2*
18. Humalog 100 unit/mL Solution Sig: Per sliding scale units
Subcutaneous four times a day.
Disp:*qs qs* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Acute Renal Failure
Non-ST Elevation Myocardial Infarction
Hypotension
Hypoxia
Pleural Effusion
Diabetes Mellitus I
Orthotopic Renal Transplant


Discharge Condition:
Stable, tolerating adequate PO and ambulating without
assistance.


Discharge Instructions:
If you experience fevers, chills, nausea, vomiting, chest pain,
shortness of breath, or any other concerning symptoms, contact
your physician or return to the emergency room.
.
Please weigh yourself every day, and if you gain more than 10
pounds call Dr.[**Name (NI) 19918**] office.

Followup Instructions:
Please call Dr.[**Name (NI) 19918**] office in the morning at ([**Telephone/Fax (1) 4923**]
to organize your appointment.  We have called ahead for you and
your appointment should be approved.  It is essential that you
see Dr.[**Name (NI) 4849**] on [**1-21**] or [**1-22**].
.
Please call [**Last Name (un) **] Diabetes Center at ([**Telephone/Fax (1) 17484**] for an
appointment in the next 2-4 weeks.
.
If you would like to establish care with a new Primary Care
Physician at [**Hospital1 18**], call [**Telephone/Fax (1) 250**] for an appointment.
Ideally you should be seen by a primary care doctor within the
next month.


                             [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 472**]

Completed by:[**2173-2-1**]
{'Subendocardial infarction, initial episode of care,Pneumonia, organism unspecified,Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Hypoxemia,Complications of transplanted kidney,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Mitral valve disorders,Polyneuropathy in diabetes,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Background diabetic retinopathy,Coronary atherosclerosis of native coronary artery,Other bone involvement in diseases classified elsewhere,Unspecified osteomyelitis, ankle and foot,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in other specified places,Atherosclerosis of native arteries of the extremities with rest pain,Iron deficiency 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: chills/sweats x 2 days

PRESENT ILLNESS: This is a 47 y/o female with ESRD [**1-14**] IDDM, s/p living donor
renal transplant [**2164**], significant vascular disease, s/p recent
right 5th toe debridement [**1-14**] osteomyelitis, presenting with
chills and sweats for the last two days. Per patient, onset was
two days ago with her chills and sweats occuring intermittently
3-4 times a day, now only 1-2 times today. No fevers at home.
This morning she developed nausea and vomited 3 times - no
hematemesis or bilious emesis. No abdominal pain, change in
bowel habits, BRBPR/melena/hematochezia. Reports a dry,
non-productive cough for the last two days with slight
associated SOB with exertion yesterday. No chest pain or
pleurisy. No recent sick contacts or travels. On Augmentin for
last one month s/p right toe debridement.
Pt reports having mild myalgias and generalized fatigue. Had flu
vaccine in [**8-17**]. Her sugars at home have been within normal
limits. Took her BP meds only PTA.
.
ROS - In addition to above, denies any H/A, vision changes,
photophobia, neck stiffness, dizziness/lightheadedness, URI
symptoms, dysuria, hematuria, extremity swelling,
weakness/numbness/loss of sensation.
.
In the ED, was given 2 L of NS, one dose of Vancomycin and
Zosyn, 10 units of regular insulin, and her BP medications.

MEDICAL HISTORY: 1. s/p living donor renal transplant [**2164**] [**1-14**] ESRD (kidney from
sister) - ESRD [**1-14**] IDDM, on cellcept and rapamune since [**2164**];
baseline Cr 2.5-3.4
2. IDDM since age 11 - retinopathy, nephropathy, neuropathy
3. PVD with b/l fem-[**Doctor Last Name **] [**2165**]
4. HTN
5. Hypercholesterolemia
6. Anemia - on procrit, Fe supplements
7. CVA x 2 [**2165**] - presentation of aphasia, no residual deficits

MEDICATION ON ADMISSION: 1. Rapamune 4mg qd
2. Cellcept [**Pager number **] mg [**Hospital1 **]
3. Nifedipine 60 mg [**Hospital1 **]
4. Lopressor 150 mg qAM, 100 mg qPM
5. Diovan 80 mg qd
6. Lipitor 10 mg qd
7. Insulin - Humulin N 30 units qAM, HSS
8. Catapres #3 patch qweek
9. Lasix 20 mg qd
10. Tricor 54 mg qd
11. Nirefex 150 mg qd
12. EC [**Hospital1 **] 325 mg qd
13. Epo 1,000 units qweek

ALLERGIES: Darvon

PHYSICAL EXAM: VS: T 98.4, BP 142/90, HR 85, RR 18, sats 100%/RA
General: Pleasant, middle-aged woman in NAD, appears slightly
pale. AO x 3.
HEENT: NC/AT, PERRL, EOMI. No conjuctival injection, no scleral
icterus. MMM, OP clear.
Neck: no LAD or JVD noted
Chest: Decreased BS over right base, + slight egophany over
right base; no dullness to percussion or decreased tactile
fremitus noted. Otherwise clear.
CV: RRR, s1 s2 normal. II/VII systolic murmur over LSB with
radiation to carotids. No rubs or gallops.
Abd: soft, NT/ND, NABS, no masses or organomegaly
Ext: trace edema b/l, weak distal pulses, right 5th toe w/o any
erythema, warmth, drainage or swelling; right calf > left calf
without any tenderness
Skin: white, scaly skin over lower legs b/l
Neuro: AO x 3, CN II-XII intact, MS [**4-16**] throughout, sensation
grossly intact

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives at home with her boyfriend. [**Name (NI) **] two children in the area.
Does not work. Former 30 pack-year smoker, quit in [**2165**]. No EtOH
use or illicit drug use. 

### Response:
{'Subendocardial infarction, initial episode of care,Pneumonia, organism unspecified,Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Hypoxemia,Complications of transplanted kidney,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Mitral valve disorders,Polyneuropathy in diabetes,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Background diabetic retinopathy,Coronary atherosclerosis of native coronary artery,Other bone involvement in diseases classified elsewhere,Unspecified osteomyelitis, ankle and foot,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in other specified places,Atherosclerosis of native arteries of the extremities with rest pain,Iron deficiency anemia, unspecified'}
