CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 56-year-old
male with history of type 1 diabetes, status post cadaveric
renal transplant 1?????? years prior to admission, who presented
to his primary care physician with fevers for the past week.
He had a low grade fever approximately one week prior to
admission and felt some chills.  These symptoms subsequently
improved but returned on the day of admission and his
temperature was 101.5 at home.  He was admitted directly to
medical service.

MEDICAL HISTORY: Type 1 diabetes diagnosed at 14 years
of age, neuropathy.  He uses leg braces and walker,
retinopathy.  He is status post laser surgery three years
ago.  Chronic end stage renal disease on dialysis from [**2194**]
to [**2192**].  History of peritonitis while on dialysis.  He is
status post cadaveric renal transplant [**2197-10-25**].  He has
a history of acute rejection in [**2197-12-26**] treated with
OKT3, history of hip fracture in [**2198-2-24**] status post hip
arthroplasty at that time, history of hypertension, history
of hypercholesterolemia, chronic hiccups, coronary artery
disease, GERD.

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillin causes nausea.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Calculus of gallbladder and bile duct with acute cholecystitis, without mention of obstruction,Cholangitis,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Kidney replaced by transplant,Acute kidney failure, unspecified,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use
Gall&bil cal w/ac w/o ob,Cholangitis,Hemorrhage complic proc,Ac posthemorrhag anemia,Kidney transplant status,Acute kidney failure NOS,Adv eff antineoplastic
Admission Date:  [**2199-6-13**]     Discharge Date:  [**2199-7-3**]

Date of Birth:   [**2142-6-14**]     Sex:  M

Service:  Transplant Surgery

HISTORY OF PRESENT ILLNESS:  The patient is a 56-year-old
male with history of type 1 diabetes, status post cadaveric
renal transplant 1?????? years prior to admission, who presented
to his primary care physician with fevers for the past week.
He had a low grade fever approximately one week prior to
admission and felt some chills.  These symptoms subsequently
improved but returned on the day of admission and his
temperature was 101.5 at home.  He was admitted directly to
medical service.

PAST MEDICAL HISTORY:  Type 1 diabetes diagnosed at 14 years
of age, neuropathy.  He uses leg braces and walker,
retinopathy.  He is status post laser surgery three years
ago.  Chronic end stage renal disease on dialysis from [**2194**]
to [**2192**].  History of peritonitis while on dialysis.  He is
status post cadaveric renal transplant [**2197-10-25**].  He has
a history of acute rejection in [**2197-12-26**] treated with
OKT3, history of hip fracture in [**2198-2-24**] status post hip
arthroplasty at that time, history of hypertension, history
of hypercholesterolemia, chronic hiccups, coronary artery
disease, GERD.

MEDICATIONS:  On admission, insulin NPH 25 units q a.m., 6
units q p.m., Regular insulin sliding scale, Rapamycin 2 mg
po q d, Prednisone 10 mg po q d, Lipitor 10 mg po q d, Lasix
20 mg po q d, Prograf 4 mg po bid, Reglan 10 mg po bid,
Prilosec 20 mg po bid, calcium 1500 mg po q d.

ALLERGIES:  Penicillin causes nausea.

HOSPITAL COURSE:  The patient was admitted to medical
service.  His temperature on admission was 101.3, blood
pressure 140/70, heart rate 80 saturating 100% on room air.
His white count was 34, hematocrit 36.2, platelet count
291,000, sodium 137, potassium 5.1, chloride 101, CO2 20, BUN
43, creatinine 2 and blood sugar 346.  His ALT was 75, AST
96, alkaline phosphatase 180, bilirubin 0.5.  He underwent
chest x-ray which showed no signs of infiltrate.  His abdomen
was nontender and non distended with no signs of peritoneal
irritation.  The patient was placed on Zosyn empirically and
his white count started to come down.  He underwent
ultrasound which showed stones and sludge in the gallbladder
and common bile duct and signs of cholecystitis.  ERCP
consult was called and he underwent ERCP for diagnosis of
cholecystitis and cholangitis. Sphincterotomy was done during
ERCP and multiple stones and sludge were extracted
successfully.  There were no remaining stones in the common
bile duct at the end of procedure.  The patient was
maintained on Zosyn and he underwent interval cholecystectomy
on [**2199-6-19**].  An attempt to remove gallbladder
laparoscopically was made but the gallbladder was very
inflamed and the procedure had to be converted to open
cholecystectomy.  He tolerated the procedure well without
complications.  He did well initially postoperatively but
then he noticed to have an increased scleral icterus.  His
LFTs were checked and his alkaline phosphatase was 671 with
bilirubin going up to 6.4.  His amylase and lipase were
normal.  His creatinine was also rising up to 2.2.  He
underwent another ERCP which showed dilatation of CVD and
multiple blood clots in common bile duct along with one
yellow stone.  The sphincterotomy site was bicapped for
possibility of bleeding from the sphincterotomy site and
double pigtail stent was placed into common bile duct for
drainage.  After this ERCP bilirubin peaked at 7.4 with
alkaline phosphatase at 1100 and then started to slowly
decrease.  White count at the time was ranging between 12 and
17.  He was afebrile.  His blood sugars were under good
control.  He was tolerating regular diet.  On post ERCP day
#4, the patient was noticed to be passing several stools with
blood clots.  He became lightheaded and his hematocrit
dropped from 29 to 24 and urgent ERCP was done which showed
oozing from the sphincterotomy site with pulsating vessel on
the bottom and stent eroding injury in sphincterotomy.  Due
to close proximity of the sphincterotomy site to pancreatic
duct, BICAP could not be applied anymore but the vessel was
injected with Epinephrine several times and seemed to stop.
The patient was admitted to surgical ICU for close
observation and serial hematocrits.  He was transfused
several units of packed red blood cells around the ERCP but
then his hematocrits were stable.  He was eventually
transferred back from the surgical ICU to regular floor and
his diet was slowly advanced.  He tolerated this well.  He
was discharged home on postoperative day #14.  At the time of
discharge he was afebrile, stable, with heart rate of 73,
blood pressure 140/60, blood sugars were well controlled.  On
the day of discharge his white count was 16.7, hematocrit
26.3 which was stable, platelet count 308,000, sodium 141,
potassium 4.1, chloride 104, CO2 26, BUN 20 and creatinine
1.3, glucose in the morning was 94.  His FK levels were 16.3
on discharge.

DISCHARGE MEDICATIONS:  Included Prednisone 5 mg po q d,
Prograf 4 mg po bid, Rapamycin 5 mg po q d, Norvasc 5 mg po q
d, Lopressor 50 mg po bid, Flomax 0.4 mg po q d, Calcium 1500
mg po q d, Prilosec, Lipitor, NPH insulin 25 units subcu q
a.m. and 6 units subcu q p.m. and iron supplements.  He is
also taking Reglan and Colace.

FOLLOW-UP:  He will follow-up with Dr. [**Last Name (STitle) **] on Monday
following discharge and with Dr. [**Last Name (STitle) **] from ERCP in two
months for removal of his stent.




                          [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 3598**], MD  [**MD Number(1) 3599**]

Dictated By:[**Name8 (MD) 20287**]

MEDQUIST36

D:  [**2199-7-4**]  10:25
T:  [**2199-7-9**]  08:07
JOB#:  [**Job Number 20288**]
{'Calculus of gallbladder and bile duct with acute cholecystitis, without mention of obstruction,Cholangitis,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Kidney replaced by transplant,Acute kidney failure, unspecified,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic 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: 

PRESENT ILLNESS: The patient is a 56-year-old
male with history of type 1 diabetes, status post cadaveric
renal transplant 1?????? years prior to admission, who presented
to his primary care physician with fevers for the past week.
He had a low grade fever approximately one week prior to
admission and felt some chills.  These symptoms subsequently
improved but returned on the day of admission and his
temperature was 101.5 at home.  He was admitted directly to
medical service.

MEDICAL HISTORY: Type 1 diabetes diagnosed at 14 years
of age, neuropathy.  He uses leg braces and walker,
retinopathy.  He is status post laser surgery three years
ago.  Chronic end stage renal disease on dialysis from [**2194**]
to [**2192**].  History of peritonitis while on dialysis.  He is
status post cadaveric renal transplant [**2197-10-25**].  He has
a history of acute rejection in [**2197-12-26**] treated with
OKT3, history of hip fracture in [**2198-2-24**] status post hip
arthroplasty at that time, history of hypertension, history
of hypercholesterolemia, chronic hiccups, coronary artery
disease, GERD.

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillin causes nausea.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Calculus of gallbladder and bile duct with acute cholecystitis, without mention of obstruction,Cholangitis,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Kidney replaced by transplant,Acute kidney failure, unspecified,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use'}
