CHIEF COMPLAINT: Hematuria
.

PRESENT ILLNESS: Mr. [**Known lastname 20899**] is a [**Age over 90 **] year old male with PMH significant for DM,
BPH s/p TURP, and remote low grade TCC s/p resection, who
presents with a chief complaint of gross hematuria. He had
previously been in his USOH until he began to have blood in his
urine last night. He denies dysuria, changes in frequency of
urination, difficulty voiding, pain with voiding, or abdominal
pain. He had a urinary tract infection several months ago which
presented with hematuria. He denies any fevers, chills,
abdominal pain.
.
In the ED, the patient had a urinalysis, which showed trace
leukocytes, large blood, and few bacteria. He was also found to
have a white count of 13.4. He received 1 gram ceftriaxone IV.
Urology was consulted.
.
Hospital course: Patient was seen and examined by the [**Doctor Last Name **]
medicine team. At approximately 1:00 AM, the team was called to
the room for a "code blue." The patient had been sitting on the
side of the bed to have a bowel movement and apparently
collapsed in the son's arms. The code team arrived, and found
the patient awake. Vital signs were immediately taken, pacer
pads were placed on the patient's chest, and a nasal cannula was
placed on the patient's nose. A BP was not able to be obtained
initially, but he had 2+ bilateral pedal pulses. The patient was
oriented to self, and responding appropriately. Fingerstick
glucose was measured to be 117. Repeat Hct had just returned at
35, which was a 3 point Hct drop from the ER. A fluid bolus of
500 cc NS was given. The decision was made with the MICU team to
get an EKG, which did not show new ST changes compared with an
old EKG. The attending was called, and the decision was made to
keep the patient on the floor on telemetry.
.

MEDICAL HISTORY: 1. CAD - s/p MI in [**2109**] tx with lytic therapy and rescue
angioplasty
2. CHF - EF 20-25%
3. DM2
4. History of PAF
5. S/P PPM
6. Hypertension
7. Hypercholesterolemia
8. L hip replacement [**2119**] c/b femur fx with "slipped prosthetic"

MEDICATION ON ADMISSION: ASA 81 mg qday
Glipizide 15 mg [**Hospital1 **]
Insulin sliding scale
Losartan 25 mg
Sotalol 80 mg po bid
Lorazepam 1 mg for insomnia
Carbamazipine 200 qday
nexium 40 qday
MVI
KCL
.

ALLERGIES: Erythromycin Base / Haloperidol / Percocet

PHYSICAL EXAM: Vitals: 98.2 F 55 148/70 16 95% RA
General: elderly, well-appearing male in NAD, appears stated age

FAMILY HISTORY: non-contributory
.

SOCIAL HISTORY: Lives with son. Baseline [**Name2 (NI) 3584**] and oriented x 1. Wife passed
away 4yrs ago. Retired plumber who worked here at [**Hospital1 18**].
.
Malignant neoplasm of other specified sites of bladder,Subendocardial infarction, initial episode of care,Chronic systolic heart failure,Acute kidney failure, unspecified,Acute posthemorrhagic anemia,Pneumonitis due to inhalation of food or vomitus,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Atrial fibrillation,Hypotension, unspecified,Cystitis, unspecified,Other persistent mental disorders due to conditions classified elsewhere,Diverticulosis of colon (without mention of hemorrhage),Hypoxemia,Cardiac pacemaker in situ,Personal history of tobacco use
Malig neo bladder NEC,Subendo infarct, initial,Chr systolic hrt failure,Acute kidney failure NOS,Ac posthemorrhag anemia,Food/vomit pneumonitis,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Hypertension NOS,Pure hypercholesterolem,Atrial fibrillation,Hypotension NOS,Cystitis NOS,Mental disor NEC oth dis,Dvrtclo colon w/o hmrhg,Hypoxemia,Status cardiac pacemaker,History of tobacco use
Admission Date:  [**2130-1-11**]              Discharge Date:   [**2130-1-22**]


Service: MEDICINE

Allergies:
Erythromycin Base / Haloperidol / Percocet

Attending:[**Doctor Last Name 10493**]
Chief Complaint:
Hematuria
.

Major Surgical or Invasive Procedure:
Cystoscopy, transurethral resection and fulguration of bladder
tumor.
.
Continuous bladder irrigation.
.


History of Present Illness:
Mr. [**Known lastname 20899**] is a [**Age over 90 **] year old male with PMH significant for DM,
BPH s/p TURP, and remote low grade TCC s/p resection, who
presents with a chief complaint of gross hematuria. He had
previously been in his USOH until he began to have blood in his
urine last night. He denies dysuria, changes in frequency of
urination, difficulty voiding, pain with voiding, or abdominal
pain. He had a urinary tract infection several months ago which
presented with hematuria. He denies any fevers, chills,
abdominal pain.
.
In the ED, the patient had a urinalysis, which showed trace
leukocytes, large blood, and few bacteria. He was also found to
have a white count of 13.4. He received 1 gram ceftriaxone IV.
Urology was consulted.
.
Hospital course: Patient was seen and examined by the [**Doctor Last Name **]
medicine team. At approximately 1:00 AM, the team was called to
the room for a "code blue." The patient had been sitting on the
side of the bed to have a bowel movement and apparently
collapsed in the son's arms. The code team arrived, and found
the patient awake. Vital signs were immediately taken, pacer
pads were placed on the patient's chest, and a nasal cannula was
placed on the patient's nose. A BP was not able to be obtained
initially, but he had 2+ bilateral pedal pulses. The patient was
oriented to self, and responding appropriately. Fingerstick
glucose was measured to be 117. Repeat Hct had just returned at
35, which was a 3 point Hct drop from the ER. A fluid bolus of
500 cc NS was given. The decision was made with the MICU team to
get an EKG, which did not show new ST changes compared with an
old EKG. The attending was called, and the decision was made to
keep the patient on the floor on telemetry.
.

Past Medical History:
1. CAD - s/p MI in [**2109**] tx with lytic therapy and rescue
angioplasty
2. CHF - EF 20-25%
3. DM2
4. History of PAF
5. S/P PPM
6. Hypertension
7. Hypercholesterolemia
8. L hip replacement [**2119**] c/b femur fx with "slipped prosthetic"

[**2127**]
9. Past UTIs, most recently with proteus mirabalis (ctx
sensitive,
fluoroquinolone resistant)
10. S/p TURP
11. Dementia - baseline AAO x 1
.


Social History:
Lives with son. Baseline [**Name2 (NI) 3584**] and oriented x 1. Wife passed
away 4yrs ago. Retired plumber who worked here at [**Hospital1 18**].
.


Family History:
non-contributory
.

Physical Exam:
Vitals: 98.2 F 55 148/70 16 95% RA
General: elderly, well-appearing male in NAD, appears stated age

Lungs: clear anteriorally at bases
Cardiovascular: normal rate, regular rhythm
Abdomen: soft, non-tender, non-distended
GU: white patches on scrotum, foley in place, draining reddish
urine
Extremity: no edema
.


Pertinent Results:
Admission Labs:
[**2130-1-11**] GLUCOSE-216* UREA N-37* CREAT-1.5* SODIUM-136
POTASSIUM-4.6 CHLORIDE-96 TOTAL CO2-29
[**2130-1-11**] WBC-13.4 HGB-12.8* HCT-38.6* PLT COUNT-283
N-67.1 L-23.8 M-5.7 E-2.9 B-0.6
.
[**2130-1-11**] Urinalysis:  COLOR-Red APPEAR-Cloudy SP [**Last Name (un) 155**]-1.009
BLOOD-LG NITRITE-NEG PROTEIN-30 GLUCOSE-NEG KETONE-NEG
BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 LEUK-TR RBC->50 WBC-21-50*
BACTERIA-FEW YEAST-NONE EPI-0-2
.
Micro:
[**1-11**] Urine culture: no growth
[**1-11**] Blood culture: no growth
12/2 Blood culture: no growth
.
Studies:
.
[**1-12**] CXR (AP): No evidence of acute cardiopulmonary process.
.
[**1-15**] CXR (AP): No appreciable change. Mild blunting of bilateral
costophrenic angles.
.
[**1-17**] CT abdomen/pelvis:
1. Filling defect within the bladder may represent clot or
recurrence of transitional cell carcinoma. Direct visualization
is recommended.
2. Mild aspiration pneumonia.
3. Extensive sigmoid diverticulosis without evidence of
diverticulitis.
4. Cholelithiasis without evidence of cholecystitis.
5. Extensive degenerative changes of the thoracolumbar spine.
.
[**1-18**] Video Oropharyngeal swallow:
Fluoroscopic assistance was provided for the speech and
swallowing division. There is poor epiglottic deflection and no
laryngeal elevation. Penetration was seen both before and during
administration of nectar thick liquids. There was premature
spillover during the oral phase due to loss of bolus control and
swallowing delay. Microaspiration was seen with all
consistencies.
IMPRESSION: Multiple episodes of penetration with several
episodes of microaspiration with all consistencies of barium.
.
[**1-20**] Bladder biopsy pathology:
1.  Low grade papillary urothelial carcinoma, no lamina propria
invasion seen.
2.  Muscularis propria present.
.


Brief Hospital Course:
Brief hospital course by problem:
.
## Hemorrhagic cystitis: The patient was admitted with hematuria
and continued to have significant hematuria during most of the
admission. He was evaluated by urology and maintained on
continuous bladder irrigation. She was manually bladder
irrigated by urology and approximately 2 units of clot were
removed. He required a total of 6 units RBC transfusion. In the
past, he has had admissions for UTI, usually presenting with
hematuria. Given this history, he was treated with a 7 day
course of ceftriaxone for empiric UTI coverage, though his urine
culture was negative. CT urogram was concerning for possible
recurrence of TCC (showed filling defect in the bladder). He
underwent cystoscopy on [**1-20**], which revealed recurrent TCC. The
tumor was resected and fulgurated under spinal block anesthesia.
After the procedure, his urine cleared. CBI and his foley were
discontinued. He received a 3 day course of ciprofloxacin, per
usual post-cystoscopy regimen. On discharge, his urine was clear
and without clots. He will follow-up with Dr. [**Last Name (STitle) **] [**Last Name (STitle) **] urology as
an outpatient.
.
# Troponinemia/CAD: He had a troponin leak in the ICU with peak
of 0.21. Troponin increased again on the floor with peak of
0.61. This likely represented demand ischemia in the setting of
vasovagal syncope (during BM), UTI, and anemia secondary to
acute blood loss from hematuria. He had no new EKG changes. He
did have one episode of chest pain prior to the initial troponin
leak, however this was felt unlikely to be ACS given transient
nature and no EKG changes. He was evaluated by the cardiology
service who recomended optimal medical management as he was not
a candidate for intervention. He was treated with aspirin,
statin, beta blocker, [**Last Name (un) **], and intermittent lasix. His
outpatient cardiologist, Dr. [**First Name (STitle) **] was made aware of these
events.
.
## Hypotension: He had several episodes of transient hypotension
during this admission. The first resulted in a code blue (as
above) when he became hypotensive to the 60s and unresponsive
while on the commode; likely a vasovagal episode. His SBP came
back up to normal range without intervention. Later, he again
became hypotensive to the 60s 1-2 hours after manual bladder
irrigation. Given the hypotension and his leukocytosis there was
concern for developing urosepsis and he was transferred to the
MICU. He was given IVF and his BP came back to the normal range.
He was transferred back to the medical floor the next day. He
had one further episode of hypotension, again with SBP
transiently to the 60s 2 hours after manual bladder irrigation.
He was given a 250cc bolus of NS and his BP responded
appropriately. These episodes were most likely related to blood
loss from his bladder vs vasovagal response to the fluid shifts
with bladder irrigation. On discharge he was hemodynamically
stable. Urine and blood cultures were all negative making
urosepsis less likely.
.
## Cough/Wheeze/Hypoxia: The patient became wheezy at times with
productive cough and intermittent transient hypoxia. This was
most likely related to mucous plugging vs mild CHF. He would
occasionally desaturate intermittently to low 90s but improve
with suctioning of mucous plug. There was also concern for a
possible aspiration event. He did have a leukocytosis with WBC
up to 15-16, however he remained afebrile. He was treated with
ceftriaxone for empiric UTI coverage (as above) and this was
felt sufficient to cover for possible aspiration pneumonia. He
was also treated with nebulizers, chest physiotherapy, and lasix
as needed. On discharge, he was restarted on his home lasix
dose.
.
## Altered Mental Status: Per his sons, the patient has a
history of delirium and agitation when hospitalized. He did have
several episodes of delirium and agitation, requiring restraints
at time. He also responded to zyprexa. His sons are very
involved in his care and were at the bedside as much as
possible, helping to control his agitation.
.
## Acute renal failure: On admission, his creatinine was
elevated to 1.5. This was likely pre-renal renal failure. His
creatinine improved to baseline after IVF repletion.
.
## Acute on chronic systolic CHF (EF 20-25%). He was
intermittently diuresed with lasix for volume overload. He was
continued on aspirin, statin, beta blocker, and [**Last Name (un) **]. Beta
blocker and [**Last Name (un) **] were held while in the MICU and re-started on
the floor when his blood pressure was stable.
.
## DM2: He was covered with glargine and an insulin sliding
scale. His oral hypoglycemics were held during his hospital stay
and re-started on discharge.
.
The patient was full code for this admission, confirmed with his
sons.

Medications on Admission:
ASA 81 mg qday
Glipizide 15 mg [**Hospital1 **]
Insulin sliding scale
Losartan 25 mg
Sotalol 80 mg po bid
Lorazepam 1 mg for insomnia
Carbamazipine 200 qday
nexium 40 qday
MVI
KCL
.


Discharge Medications:
1. Sotalol 80 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
2. Carbamazepine 200 mg Tablet Sustained Release 12 hr Sig: One
(1) Tablet Sustained Release 12 hr PO DAILY (Daily).
3. Nexium 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
4. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
5. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
6. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
Disp:*1 inhaler* Refills:*2*
7. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. Losartan 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
9. Glipizide 5 mg Tablet Sig: Three (3) Tablet PO twice a day.
10. Insulin sliding scale
please continue insulin sliding scale as previously prescribed
11. Olanzapine 5 mg Tablet, Rapid Dissolve Sig: One (1) Tablet,
Rapid Dissolve PO QHS (once a day (at bedtime)).
Disp:*30 Tablet, Rapid Dissolve(s)* Refills:*2*
12. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
13. Insulin Glargine 100 unit/mL Cartridge Sig: Twenty Four (24)
units Subcutaneous at bedtime.
14. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO once a day.
.

Discharge Disposition:
Home

Discharge Diagnosis:
Primary: Recurrent bladder transitional cell carcinoma
Secondary:
1) CHF
2) CAD
3) Acute renal failure
4) Diabetes mellitus, Type 2
.


Discharge Condition:
Vital signs stable, urine clear.
.


Discharge Instructions:
You were admitted to the hospital with blood in your urine and
low blood pressure. While in the hospital you had a mild
"silent" heart attack, which was felt to be due to strain on
your heart from the significant amount of blood loss in your
urine. You had a cystoscopy that revealed extensive bladder
cancer as the cause for your hematuria. This was resected and
cauterized in the OR. You were also treated with antibiotics for
possible urinary tract infection. Please note that you have been
started on a few new medications. These include atorvastatin for
your heart, fluticasone for wheezing, and olanzapine to help
with delirium at night.
.
If you develop significant blood in your urine, fever > 101,
chest pain, SOB, please return to the nearest ER. Please take
all medications as prescribed.
.

Followup Instructions:
Please call Dr.[**Name (NI) 19421**] office to arrange follow-up within the
next 2 weeks. Please also follow-up with Dr. [**First Name (STitle) **] (cardiology)
in the next 2 weeks.
.
Please call Dr. [**Last Name (STitle) **] (urology) to arrange follow-up in the next
2-4 weeks. The phone number is ([**Telephone/Fax (1) 4376**].
.


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 10491**] MD, [**MD Number(3) 10495**]
{'Malignant neoplasm of other specified sites of bladder,Subendocardial infarction, initial episode of care,Chronic systolic heart failure,Acute kidney failure, unspecified,Acute posthemorrhagic anemia,Pneumonitis due to inhalation of food or vomitus,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Atrial fibrillation,Hypotension, unspecified,Cystitis, unspecified,Other persistent mental disorders due to conditions classified elsewhere,Diverticulosis of colon (without mention of hemorrhage),Hypoxemia,Cardiac pacemaker in situ,Personal history of tobacco use'}


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: Hematuria
.

PRESENT ILLNESS: Mr. [**Known lastname 20899**] is a [**Age over 90 **] year old male with PMH significant for DM,
BPH s/p TURP, and remote low grade TCC s/p resection, who
presents with a chief complaint of gross hematuria. He had
previously been in his USOH until he began to have blood in his
urine last night. He denies dysuria, changes in frequency of
urination, difficulty voiding, pain with voiding, or abdominal
pain. He had a urinary tract infection several months ago which
presented with hematuria. He denies any fevers, chills,
abdominal pain.
.
In the ED, the patient had a urinalysis, which showed trace
leukocytes, large blood, and few bacteria. He was also found to
have a white count of 13.4. He received 1 gram ceftriaxone IV.
Urology was consulted.
.
Hospital course: Patient was seen and examined by the [**Doctor Last Name **]
medicine team. At approximately 1:00 AM, the team was called to
the room for a "code blue." The patient had been sitting on the
side of the bed to have a bowel movement and apparently
collapsed in the son's arms. The code team arrived, and found
the patient awake. Vital signs were immediately taken, pacer
pads were placed on the patient's chest, and a nasal cannula was
placed on the patient's nose. A BP was not able to be obtained
initially, but he had 2+ bilateral pedal pulses. The patient was
oriented to self, and responding appropriately. Fingerstick
glucose was measured to be 117. Repeat Hct had just returned at
35, which was a 3 point Hct drop from the ER. A fluid bolus of
500 cc NS was given. The decision was made with the MICU team to
get an EKG, which did not show new ST changes compared with an
old EKG. The attending was called, and the decision was made to
keep the patient on the floor on telemetry.
.

MEDICAL HISTORY: 1. CAD - s/p MI in [**2109**] tx with lytic therapy and rescue
angioplasty
2. CHF - EF 20-25%
3. DM2
4. History of PAF
5. S/P PPM
6. Hypertension
7. Hypercholesterolemia
8. L hip replacement [**2119**] c/b femur fx with "slipped prosthetic"

MEDICATION ON ADMISSION: ASA 81 mg qday
Glipizide 15 mg [**Hospital1 **]
Insulin sliding scale
Losartan 25 mg
Sotalol 80 mg po bid
Lorazepam 1 mg for insomnia
Carbamazipine 200 qday
nexium 40 qday
MVI
KCL
.

ALLERGIES: Erythromycin Base / Haloperidol / Percocet

PHYSICAL EXAM: Vitals: 98.2 F 55 148/70 16 95% RA
General: elderly, well-appearing male in NAD, appears stated age

FAMILY HISTORY: non-contributory
.

SOCIAL HISTORY: Lives with son. Baseline [**Name2 (NI) 3584**] and oriented x 1. Wife passed
away 4yrs ago. Retired plumber who worked here at [**Hospital1 18**].
. 

### Response:
{'Malignant neoplasm of other specified sites of bladder,Subendocardial infarction, initial episode of care,Chronic systolic heart failure,Acute kidney failure, unspecified,Acute posthemorrhagic anemia,Pneumonitis due to inhalation of food or vomitus,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Atrial fibrillation,Hypotension, unspecified,Cystitis, unspecified,Other persistent mental disorders due to conditions classified elsewhere,Diverticulosis of colon (without mention of hemorrhage),Hypoxemia,Cardiac pacemaker in situ,Personal history of tobacco use'}
