CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname 51887**] was a previously
generally healthy 67 year old gentleman who underwent
screening colonoscopy in early [**2125-6-26**] and subsequently on
[**2125-6-30**] developed severe abdominal pain which was
accompanied by fever, nausea and vomiting for which he went
to the Emergency Room at an outside hospital.  There it was
discovered that he had what appeared to be a perforated
diverticulitis, based on radiologic imaging he was treated
conservatively at first with intravenous fluids, antibiotics,
nasogastric tube and bowel rest.  The patient's symptoms
worsened and he was taken to the Operating Room on [**2125-7-5**] for sigmoid resection with diverting colostomy.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Unspecified septicemia,Acute respiratory failure,Congestive heart failure, unspecified,Acute posthemorrhagic anemia,Acute kidney failure, unspecified,Unspecified pleural effusion,Diverticulitis of colon (without mention of hemorrhage),Atrial fibrillation
Septicemia NOS,Acute respiratry failure,CHF NOS,Ac posthemorrhag anemia,Acute kidney failure NOS,Pleural effusion NOS,Dvrtcli colon w/o hmrhg,Atrial fibrillation
Admission Date:  [**2125-7-16**]       Discharge Date:  [**2125-8-3**]

Date of Birth:   [**2057-12-10**]       Sex:  M

Service:

ADMISSION DIAGNOSIS:
1.  Sepsis
2.  Perforated diverticulitis
3.  Acute renal failure
4.  Atrial fibrillation

DISCHARGE DIAGNOSIS:
1.  Sepsis
2.  Acute respiratory failure
3.  Acute renal failure
4.  Perforated diverticulitis
5.  Intra-abdominal abscesses
6.  Atrial fibrillation
7.  Status post computerized tomography-guided drainage of
intra-abdominal abscesses
8.  Status post partial colectomy

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 51887**] was a previously
generally healthy 67 year old gentleman who underwent
screening colonoscopy in early [**2125-6-26**] and subsequently on
[**2125-6-30**] developed severe abdominal pain which was
accompanied by fever, nausea and vomiting for which he went
to the Emergency Room at an outside hospital.  There it was
discovered that he had what appeared to be a perforated
diverticulitis, based on radiologic imaging he was treated
conservatively at first with intravenous fluids, antibiotics,
nasogastric tube and bowel rest.  The patient's symptoms
worsened and he was taken to the Operating Room on [**2125-7-5**] for sigmoid resection with diverting colostomy.

He had intraoperative cultures taken at that time which grew
five different microorganisms and he was started on Zosyn,
Gentamicin and Flagyl.

On postoperative day #7 from this procedure, the patient went
into some sort of arrest, it is unclear but it was reported
as respiratory arrest in the Intensive Care Unit which
required him to be intubated and placed on pressor drugs and
started on broad spectrum antibiotics and Xigris.

While in the Intensive Care Unit his blood cultures grew out
multiple gram positive cocci and it is notable that his
hematocrit dropped to 31 from 37, thereby requiring the
patient be transfused 2 units of red blood cells.  It was at
this time that the patient's family requested he be
transferred to the [**Hospital6 256**] for
further management of his care.

He was initially admitted to the Medical Intensive Care Unit
where was continued on broad spectrum antibiotics which
included Imipenem and Flagyl and continued while he remained
intubated in acute renal failure which was presumed to be
acute tubular necrosis secondary to his hypertensive episodes
at the outside hospital.

The patient was again placed on broad spectrum antibiotics in
an attempt to optimize his therapy.  When the patient was
admitted his white count was 18.3 with a hematocrit of 30.6,
platelet count of 478.  Electrolytes showed BUN and
creatinine of 57 and 2.4 and creatinine of 2.4 was down from
previously reported value of 3.2.  His ALT was 23, AST 45,
alkaline phosphatase 67, total bilirubin 0.5, albumin 1.5,
calcium 7.3, magnesium 2.6, phosphorus 1.9.  His arterial
blood gases was 7.37, 56, 195, 34, and +5.

After the patient was admitted it is notable that all of his
lines were changed in order to rule them out as an etiology
for his continued infection.  He underwent CT scan on the day
after admission which included CT guided drainage of four
abdominal abscesses with placement of four pigtail drains.




                            [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] [**Name8 (MD) **], M.D.

Dictated By:[**Last Name (NamePattern1) 13262**]
MEDQUIST36

D:  [**2125-8-3**]  14:59
T:  [**2125-8-3**]  15:07
JOB#:  [**Job Number 51890**]


Admission Date:  [**2125-7-16**]       Discharge Date:  [**2125-8-3**]

Date of Birth:   [**2057-12-10**]       Sex:  M

Service:

ADMISSION DIAGNOSIS:
1.  Sepsis.
2.  Acute respiratory failure.
3.  Acute renal failure.
4.  Perforated diverticulitis.
5.  Atrial fibrillation.

DISCHARGE DIAGNOSIS:
1.  Sepsis.
2.  Acute respiratory failure.
3.  Acute renal failure.
4.  Perforated diverticulitis.
......








Dictated By:[**Last Name (NamePattern1) 13262**]
MEDQUIST36

D:  [**2125-8-3**]  15:02
T:  [**2125-8-3**]  15:16
JOB#:  [**Job Number 51963**]


Admission Date:  [**2125-7-16**]       Discharge Date:  [**2125-8-3**]

Date of Birth:   [**2057-12-10**]       Sex:  M

Service:

ADMISSION DIAGNOSIS:
1.  Sepsis
2.  Acute respiratory failure
3.  Acute renal failure
4.  Perforated diverticulitis
5.  Atrial fibrillation

DISCHARGE DIAGNOSIS:
1.  Sepsis
2.  Acute respiratory failure
3.  Acute renal failure
4.  Blood loss anemia
5.  Perforated diverticulitis
6.  Atrial fibrillation
7.  Status post computerized tomography-guided drainage of
intra-abdominal abscesses

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 51887**] was a previously
generally healthy 67 year old male who underwent colonoscopy
on [**2125-6-26**] which occurred without complication on [**2125-6-30**].  He began to experience some severe abdominal pain
accompanied with nausea, vomiting, diarrhea and a fever which
was noted to be above 103 or 104 degrees.  He went to the
Emergency Department at an outside hospital and was treated
conservatively initially with intravenous fluids,
antibiotics, nasogastric tube and bowel rest but was
subsequently taken to the Operating Room on [**2125-7-5**] for
sigmoid resection with diverting colostomy first diagnosed
with perforated diverticulitis, intraoperatively cultures
grew out five different microorganisms and he was placed on
Zosyn, Gentamicin and Flagyl.  He was in the Intensive Care
Unit postoperatively until [**7-12**] when the patient did
poorly and went into a more severe respiratory distress and
went into a hypotensive state.  He was placed on pressors and
remained intubated.  He was placed on ....................
and started on broad spectrum antibiotics such as Imipenem,
Flagyl, and Fluconazole.  His heart was intermittently in
atrial fibrillation throughout this period.  Cultures at that
time grew gram positive cocci.  On [**2125-7-15**], while in
the Intensive Care Unit at the outside hospital his
hematocrit dropped 6 points from 37 to 31.  He was transfused
2 units and his family requested that he be transferred to
[**Hospital6 256**].

ADMISSION PHYSICAL EXAMINATION:  At the time of arrival he
was 101.1 degrees, pulse 87, blood pressure 108/57, his PA
pressure was 40/20 with a pulmonary capillary wedge pressure
of 16.  His central venous pressure was 11, his SVR was 742,
he was on assisted control of 550 times 14 on 60% with a
positive end-expiratory pressure of 8.  He appeared to be
obese and edematous while intubated and sedated.  His pupils
were equal, round and reactive to light.  His oropharynx
revealed a beefy large tongue with abrasions from his teeth.
Carotids were 2+ bilaterally.  His heart was regular in rate
and rhythm with no murmur, rub or gallop noted.  Bilaterally
he had rhonchi on auscultation of the lungs with decreased
breathsounds at the bases bilaterally.  His abdomen was tense
and erythematous with sutures in place.  He had [**Initials (NamePattern4) **]
[**Last Name (NamePattern4) 1661**]-[**Location (un) 1662**] and Penrose drain in place with ostomy draining
stool.  No bowel sounds were noted.  He has 2 to 3+ pitting
edema in the lower extremities which were both warm and he
did have a positive gag reflex but did not respond to voices.
He was sedated and intubated.

LABORATORY DATA:  At the time of admission his white count
was 18.3 with a hematocrit of 30.6 and a platelet count of
478.  His electrolytes showed sodium 141, potassium 5.1,
chloride 103, carbon dioxide 30, BUN and creatinine of 37 and
2.4 with a glucose of 131.  His albumin was 1.5.  His
coagulase tests were PT 14.4, PTT 29.7, INR 1.4.  Chest x-ray
showed bilateral pleural effusions, right greater than left,
increased vascular markings but his lines were in place.  His
electrocardiogram shows normal sinus rhythm with good
evidence of atrial enlargement with T wave inversion in I and
II but no ST changes.

HOSPITAL COURSE:  The patient was initially admitted to the
Medical Service and continued on Imipenem and Flagyl and
pancultured.  Pending sensitivities, he remained on a
ventilator secondary to hypoxia from pleural effusions and
pulmonary edema.  They tried to minimize him on his fluids
secondary to his volume overload.  The patient's condition
remained unchanged on hospital day #2.  He remained
intubated.  He underwent computerized tomography-guided
drainage of intra-abdominal abscesses which were found times
four with subsequent placement of drains.  By hospital day #3
he was noted to be clinically improving but still remained
severely continued on his Imipenem and Flagyl as attempts
were made to wean him off of his ventilator.  As the
patient's edema moved into the intravascular space and his
kidney perfusion improve his creatinine began to come down
and by hospital day #4 his creatinine was down to 1.1.  His
creatinine returned to more of baseline at 1.1.  His
peritoneal fluids although did not show any microorganisms
but grew 2 to 4+ polymorphonuclear leukocytes, his cultures
remained pending as the patient remained intubated.  Culture
reports were available by hospital day #4 from the outside
hospital which showed Klebsiella Escherichia coli,
Clostridium but from his abscess drainage, the cultures
remained negative.  The patient continued to remain febrile
with temperatures above 100.1 degrees.  As noted previously
the patient has been going in and out of atrial fibrillation
but had no episodes which were thought to be ischemic, so he
was treated with intravenous Lopressor prn for this.  By
hospital day #5 the patient was awakened from sedation.  On
hospital day #6 it was notable that his cultures grew back
yeast, but the patient's antibiotic regimen did cover this.
Throughout the [**Hospital 228**] hospital course he was given
nutrition through total parenteral nutrition and over time he
was switched over to tube feeds.  The patient again spiked a
fever to 102.9 degrees on hospital day #6 and was again
pancultured.  His white blood cell count increased to 17.2 at
bedtime and a chest x-ray showed a slightly worsening pleural
effusions.  This raised the question of persistent undrained
abdominal collections.  Therefore, the patient underwent
another computerized tomography scan and drainage of fluid
collections again.  The patient's total parenteral nutrition
was discontinued on hospital day #9 and he was switched
completely to tube feeds.  He was extubated on hospital day
#9 also.  Over the course of the weaning from his ventilator
on hospital day #11 the patient again had some difficulties
with respiration which required biPAP and subsequent to this
he had done well.  Notably he did have cultures returning
from his abscess which showed a growth of [**Female First Name (un) 564**] which was
covered by the Fluconazole that the patient was on.  By
hospital day #12 the patient's course had fairly stabilized
and he was no longer spiking temperatures although he was
continued on broad spectrum antibiotic coverage.  He has done
well off of the respirator and his main issues were nutrition
which were taken care with tube feeds.  He did have swallow
evaluations which taught him technique such as chin-tuck in
order to drink liquids and he was going to be placed on a
liquid diet.  His Imipenem and Fluconazole was continued
throughout his course in order to share in adequate coverage
for the growth organisms from his abscesses.  The patient's
creatinine had been stable, below 1 throughout the latter
portion of his course.  He was making good urine and his
hematocrit had stabilized around 30.  He was no longer
spiking temperatures.  The patient's video swallow study
prior to discharge stated that he should initiate a p.o.
diet, consisting of thin liquids, ground solids, and crushed
medications and purees.  He is supposed to maintained strict
aspiration precautions and bolt upright for all meals and
chin-tuck maneuver for liquids.  By hospital day #17 the
patient was weaned back to some of his home medications for
blood pressures which included Captopril, and he was switched
to p.o. antibiotics including antifungals as close to the
intravenous medications that he had been getting previously.
He was transferred to the floor on hospital day #18 where he
did well and had no respiratory issues or temperatures.  By
the next day, hospital day #19 the patient was deemed as
stable for transfer from the acute care setting in the
hospital to rehabilitation as he had been afebrile, no
infectious focus was noted.  His respiratory status was
markedly improved, although he continued to have some
bilateral pleural effusions.  He was not having any
difficulty oxygenating without oxygen via nasal cannula and
his cardiac issues had stabilized as he had been in sinus
rhythm.  It was felt though the patient would have aggressive
rehabilitation in order to overcome the deconditioning that
he had undergone.  At the time of discharge, the patient's
white count was 9.6, hematocrit 31.9, his platelet count was
268.  PT 13.9, PTT 29.0, INR 1.3.  His potassium was 4.1 with
a sodium of 142, chloride 104, HCL 334, BUN and creatinine 18
and 0.5, glucose 113.  His calcium, magnesium and phosphorus
were 8.4, 4.0 and 1.8.  His chest x-ray continued to show
some bilateral effusions at the bases but these had markedly
improved.  His Methicillin-resistant Staphylococcus aureus
screen was negative.  His catheter tip cultures had not shown
any growth.  His blood cultures again had been negative for
over one week.  Therefore, the patient was discharged to
rehabilitation in fair condition with only two remaining
drains in place.  The other two drains had been removed on
hospital day #18.

DISCHARGE MEDICATIONS:
1.  Lopressor 100 mg p.o. t.i.d.
2.  Captopril 25 mg p.o. or nasogastric tube t.i.d.
3.  Fluconazole 200 mg p.o. q.d.
4.  Amoxicillin clavulanic acid 500 mg p.o. t.i.d.
5.  Metronidazole 250 mg p.o. t.i.d.

These were supposed to be continued for another ten day
course.



                            [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 51888**]

Dictated By:[**Last Name (NamePattern1) 13262**]
MEDQUIST36

D:  [**2125-8-3**]  15:46
T:  [**2125-8-3**]  15:59
JOB#:  [**Job Number 51889**]


Admission Date:  [**2125-7-16**]       Discharge Date: [**2125-8-7**]

Date of Birth:   [**2057-12-10**]       Sex:  M

Service:

ADDENDUM:  Since the last dictation on [**2125-8-3**], the patient
has had an uneventful hospital course.  He remains
hospitalized pending placement in rehabilitation.  The only
notable events are that his remaining drains have been
removed.





                        DR.[**Last Name (STitle) **],[**First Name3 (LF) **] 02-205

Dictated By:[**Last Name (NamePattern4) 39415**]
MEDQUIST36

D:  [**2125-8-6**]  08:54
T:  [**2125-8-6**]  09:19
JOB#:  [**Job Number 51964**]
{'Unspecified septicemia,Acute respiratory failure,Congestive heart failure, unspecified,Acute posthemorrhagic anemia,Acute kidney failure, unspecified,Unspecified pleural effusion,Diverticulitis of colon (without mention of hemorrhage),Atrial fibrillation'}


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: Mr. [**Known lastname 51887**] was a previously
generally healthy 67 year old gentleman who underwent
screening colonoscopy in early [**2125-6-26**] and subsequently on
[**2125-6-30**] developed severe abdominal pain which was
accompanied by fever, nausea and vomiting for which he went
to the Emergency Room at an outside hospital.  There it was
discovered that he had what appeared to be a perforated
diverticulitis, based on radiologic imaging he was treated
conservatively at first with intravenous fluids, antibiotics,
nasogastric tube and bowel rest.  The patient's symptoms
worsened and he was taken to the Operating Room on [**2125-7-5**] for sigmoid resection with diverting colostomy.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Unspecified septicemia,Acute respiratory failure,Congestive heart failure, unspecified,Acute posthemorrhagic anemia,Acute kidney failure, unspecified,Unspecified pleural effusion,Diverticulitis of colon (without mention of hemorrhage),Atrial fibrillation'}
