CHIEF COMPLAINT: ESRD

PRESENT ILLNESS: 59 year-old male with h/o ESRD secondary to DM.  Started
dialysis in [**2165-5-15**] via LUE AV graft.  Last dialysis was done
[**2167-4-21**].  He has dialysis Tuesday, Thursday, and Saturday.
Typically urinates 4-5 times a day.  He is admitted today,
[**2167-4-21**] for a kidney transplant.

MEDICAL HISTORY: 1. ESRD on hemodialysis, awaiting placement on transplant list
(HD T,Th, Sat)
2. Renal cell carcinoma of left kidney (s/p partial nephrectomy

MEDICATION ON ADMISSION: Allopurinal 100', ASA 81', diltiazem 360', diovan 320',
gabapentin 100"', glyburide 2.5', insulin, lantus 10u qHS,
nephrocaps 1', norvasc 10', prilosec 20", toprol 100', zoloft
100'

ALLERGIES: Iron Dextran Complex

PHYSICAL EXAM: ADMISSION EXAM:
100.0  88  147/95  20  96% room air
NAD
A&O x 3
RRR
CTA bilaterally
soft, obese, NT, NABS
no cyanosis, cords, edema

FAMILY HISTORY: Sister- DM
[**Name (NI) **] reported CAD.
Positive for alcoholism.
Mother died of "liver problems"; father died of stroke at 51. He
is unsure of any other medical problems in his family.

SOCIAL HISTORY: Lives with sister, previously worked in a hotel, quit after [**Month (only) **]
Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Surgical or other procedure not carried out because of contraindication,Congestive heart failure, unspecified,Anemia in chronic kidney disease,Personal history of malignant neoplasm of kidney,Acquired absence of kidney,Family history of diabetes mellitus,Gout, unspecified,Personal history of other infectious and parasitic diseases,Personal history of tobacco use,Old myocardial infarction
DMII renl nt st uncntrld,Hyp kid NOS w cr kid V,No proc/contraindication,CHF NOS,Anemia in chr kidney dis,Hx of kidney malignancy,Acquired absence kidney,Fam hx-diabetes mellitus,Gout NOS,Prsnl hst oth nfct parst,History of tobacco use,Old myocardial infarct
Admission Date:  [**2167-4-21**]              Discharge Date:   [**2167-4-27**]

Date of Birth:  [**2108-4-9**]             Sex:   M

Service: SURGERY

Allergies:
Iron Dextran Complex

Attending:[**First Name3 (LF) 668**]
Chief Complaint:
ESRD

Major Surgical or Invasive Procedure:
Attempted renal transplant/aborted [**2167-4-21**]


History of Present Illness:
59 year-old male with h/o ESRD secondary to DM.  Started
dialysis in [**2165-5-15**] via LUE AV graft.  Last dialysis was done
[**2167-4-21**].  He has dialysis Tuesday, Thursday, and Saturday.
Typically urinates 4-5 times a day.  He is admitted today,
[**2167-4-21**] for a kidney transplant.

Past Medical History:
1. ESRD on hemodialysis, awaiting placement on transplant list
(HD T,Th, Sat)
2. Renal cell carcinoma of left kidney (s/p partial nephrectomy

[**5-17**]) T1, N0, M0. Surveillance MR [**First Name8 (NamePattern2) **] [**2165-5-15**] was negative
for recurrence.
2. CHF (stage II) - diastolic - followed by Dr. [**First Name (STitle) 437**]. Recently
started on carvedilol (end of [**Month (only) 547**])
3. Hypertension
4. DM2, HbA1C 9
5. Hepatitis C
6. HOH
7. Gout
8. Anemia
9. [**Doctor Last Name 15532**]??????s Esophagus
10. Prostate nodule, PSA 2.8 fall [**2164**]
11. Viral Pericardial effusion - [**1-20**]. [**Month (only) 958**] seen by echo to
have resolved. Not thought to be uremic effusion.


Social History:
Lives with sister, previously worked in a hotel, quit after [**Month (only) **]

admission to hospital.
Previous 80 pack year smoking history, quit in [**2165-5-15**].
Previous ETOH history of 1 pint per week, quit in [**2165-5-15**]
Previous crack cocaine use (1-2 times per month), quite in [**Month (only) **]
[**2164**]
Previous heroin use, quite 5-6 years ago


Family History:
Sister- DM
[**Name (NI) **] reported CAD.
Positive for alcoholism.
Mother died of "liver problems"; father died of stroke at 51. He
is unsure of any other medical problems in his family.

Physical Exam:
ADMISSION EXAM:
100.0  88  147/95  20  96% room air
NAD
A&O x 3
RRR
CTA bilaterally
soft, obese, NT, NABS
no cyanosis, cords, edema

DISCHARGE EXAM:
97.3  61  128/65  16  94% room air
NAD
A&O x 3
RRR
CTA bilaterally
soft, obese, NT, NABS
incision clean, dry, intact
no cyanosis, cords, edema

Pertinent Results:
ADMISSION LABS:
[**2167-4-21**] 06:57PM BLOOD WBC-11.2* RBC-4.55* Hgb-12.3* Hct-39.6*
MCV-87# MCH-27.1 MCHC-31.2 RDW-20.9* Plt Ct-416
[**2167-4-21**] 06:57PM BLOOD PT-12.3 PTT-27.4 INR(PT)-1.1
[**2167-4-21**] 06:57PM BLOOD UreaN-24* Creat-8.2*# Na-141 K-4.0 Cl-98
HCO3-26 AnGap-21*
[**2167-4-21**] 06:57PM BLOOD ALT-40 AST-51*
[**2167-4-21**] 06:57PM BLOOD Albumin-4.3 Calcium-9.9 Phos-4.3# Mg-1.9
.
DISCHARGE LABS:
[**2167-4-27**] 08:08AM BLOOD WBC-12.9* RBC-3.88* Hgb-10.6* Hct-33.6*
MCV-87 MCH-27.3 MCHC-31.6 RDW-20.7* Plt Ct-358
[**2167-4-23**] 03:53AM BLOOD PT-11.9 PTT-25.3 INR(PT)-1.0
[**2167-4-27**] 08:08AM BLOOD Glucose-132* UreaN-62* Creat-10.3*#
Na-136 K-4.2 Cl-92* HCO3-26 AnGap-22*
[**2167-4-23**] 03:53AM BLOOD ALT-25 AST-47* AlkPhos-137* Amylase-107*
TotBili-0.3
[**2167-4-23**] 03:53AM BLOOD Lipase-100*
[**2167-4-27**] 08:08AM BLOOD Calcium-8.5 Phos-7.0* Mg-2.2
.
RADIOLOGY  Final Report
-59 DISTINCT PROCEDURAL SERVICE  [**2167-4-21**] 10:53 PM
CHEST PORT. LINE PLACEMENT; -59 DISTINCT PROCEDURAL SERVIC
Reason: ptx
[**Hospital 93**] MEDICAL CONDITION:
59 year old man with r IJ
REASON FOR THIS EXAMINATION:
ptx
INDICATIONS: 59-year-old man with right internal jugular
catheter.
COMPARISONS: Earlier in the same day.
CHEST, AP PORTABLE: There is a new endotracheal tube, beyond the
thoracic inlet, terminating 4 cm above the carina. A right
internal jugular central venous catheter terminates in the
distal superior vena cava. A new nasogastric tube terminates in
the stomach but there is a sidehole latter immediately at or
above the gastroesophageal junction.
Cardiac and mediastinal contours are unchanged. There is new
focal opacity in the left upper lobe, consistent with aspiration
or pneumonia.
IMPRESSION:
1. Nasogastric tube with side hole latter above the
gastroesophageal junction. 2. New focal opacity in the left
upper lobe with rapid onset, with the differential diagnosis
including aspiration or pneumonia.
Findings discussed with resident covering the patient.
.
RADIOLOGY  Final Report
CHEST (PA & LAT)  [**2167-4-21**] 6:59 PM
CHEST (PA & LAT)
Reason: pre op kidney [**Hospital 23678**]
[**Hospital 93**] MEDICAL CONDITION:
59 year old man with for kidney tx
REASON FOR THIS EXAMINATION:
pre op kidney tx
INDICATION: 59-year-old man with kidney transplant. Preop
study..
PA AND LATERAL CHEST RADIOGRAPHS: The heart size is at the upper
limits of normal. Mediastinal and hilar contours are stable and
unremarkable. The ill- defined pulmonary vasculature as well as
basilar interstitial opacities are most consistent with stable
vascular congestion. Overall there has been little interval
change compared to prior study.
IMPRESSION: No evidence of pneumonia. Mild vascular congestion.
.
RADIOLOGY  Final Report
CHEST (PORTABLE AP)  [**2167-4-22**] 11:58 AM
CHEST (PORTABLE AP)
Reason: infiltrates
[**Hospital 93**] MEDICAL CONDITION:
59 year old man with r IJ
REASON FOR THIS EXAMINATION:
infiltrates
PORTABLE UPRIGHT CHEST, 12:08 P.M.
INDICATION: Followup infiltrate.
FINDINGS: Compared with 5/8 at 11:38 p.m., no significant change
in tube and line positions. The right lung is grossly clear. No
overt CHF.
There has been partial interval clearing of the streaky
atelectasis/infiltrate in the retrocardiac region. There has
also been partial clearing of what appears to be atelectasis in
the left peri/suprahilar region.
.
Cardiology Report ECHO Study Date of [**2167-4-22**]
Conclusions:
The left atrium is mildly dilated. The right atrium is
moderately dilated.
Left ventricular wall thickness, cavity size, and systolic
function are normal
(LVEF>55%). Due to suboptimal technical quality, a focal wall
motion
abnormality cannot be fully excluded. There is no ventricular
septal defect.
Right ventricular chamber size and free wall motion are normal.
The aortic
valve leaflets (3) appear structurally normal with good leaflet
excursion and
no aortic regurgitation. The mitral valve appears structurally
normal with
trivial mitral regurgitation. The pulmonary artery systolic
pressure could not
be determined. There is no pericardial effusion.
Compared with the prior study (images reviewed) of [**2166-4-25**], no
change.
.
RADIOLOGY   Preliminary Report
CTA CHEST W&W/O C&RECONS, NON-CORONARY  [**2167-4-23**] 7:46 PM
CTA CHEST W&W/O C&RECONS, NON-
Reason: CTA CHEST ONLY; eval for PE infiltrates and pulmonary
fibros
Field of view: 36 Contrast: [**Hospital 13288**]
[**Hospital 93**] MEDICAL CONDITION:
59M s/p aborted kidney tx for hypoxia in OR
REASON FOR THIS EXAMINATION:
CTA CHEST ONLY; eval for PE infiltrates and pulmonary fibrosis
CONTRAINDICATIONS for IV CONTRAST: None.
STUDY: CTA OF THE CHEST WITHOUT AND WITH CONTRAST.
INDICATION: 59-year-old male status post aborted kidney
transplant, presenting with hypoxia. Assess for pulmonary
embolism.
COMPARISONS: None.
TECHNIQUE: Non-contrast MDCT axial images were acquired of the
chest. Following administration of intravenous contrast, MDCT
axial images were acquired from the thoracic inlet to the upper
abdomen. Coronal, sagittal, and oblique reformatted images were
then obtained.
CTA OF THE CHEST WITHOUT AND WITH IV CONTRAST: There are no
filling defects present within the main pulmonary arteries or
the segmental branches to the upper lobes bilaterally. However,
given technical difficulties of bolus administration, the lower
lobe arteries cannot be evaluated bilaterally. There is biatrial
enlargement. There is no aortic dissection. There is no evidence
of pulmonary fibrosis. There is a bilateral, dependent
atelectasis. There are mild, streaky opacities within the left
lobe. The lungs are otherwise unremarkable. A prominent
prevascular node measures 9 mm (3:18). There are few prominent
mediastinal nodes, particularly posterior to the esophagus. None
meet criteria for pathology. There are no pathologic hilar or
axillary lymph nodes.
Bone windows demonstrate no lytic or blastic lesions. There are
mild degenerative changes of the mid to lower thoracic spine.
Limited views of the upper abdomen are unremarkable.
IMPRESSION:
1. No evidence of pulmonary embolism within the main pulmonary
arteries and segmental branches to the upper lobes of the lungs.
The segmental arteries to the lower lobes of the lungs are
incompletely evaluated on this examination. A repeat evaluation
could be performed if clinically indicated.
2. No pulmonary fibrosis.
3. Mild, streaky opacities present at the left lung base largely
unchanged compared to the CT torso from [**2166-2-21**].
.
RADIOLOGY   Preliminary Report
US ABD LIMIT, SINGLE ORGAN  [**2167-4-26**] 12:04 PM
US ABD LIMIT, SINGLE ORGAN
Reason: seroma/hematoma
[**Hospital 93**] MEDICAL CONDITION:
59 year old man with aborted RLQ renal transplant now with cont
drainage from wound despite stitches
REASON FOR THIS EXAMINATION:
seroma/hematoma
LIMITED ABDOMINAL ULTRASOUND
INDICATION: 59-year-old man with aborted right lower quadrant
renal transplant, presenting with drainage from the wound. Rule
out seroma, hematoma.
COMPARISON: Not available.
FINDINGS: Limited [**Doctor Last Name 352**]-scale images of the right lower quadrant
area were obtained. No abnormal fluid collection was identified.
IMPRESSION: No evidence of fluid collection.

Brief Hospital Course:
The patient was admitted to Dr.[**Name (NI) 670**] Transplant Service at
the [**Hospital1 69**] on [**2167-4-21**] for a DCD
renal transplant.  For details of the operation, please refer to
the operative report.  The operation was aborted
intra-operatively due to unknown cause of hypoxia.  The patient
was transferred to the SICU for further care immediately
post-operatively and continued to be intubated.  A chest xray a
new focal opacity in the left upper lobe with rapid onset.  On
POD 1, he remained intubated and sedated with continuing
improvement of his oxygenation status.  His sedation was weaned
in the afternoon and he was successfully extubated without
complications.  In the SICU, he underwent HD with 1.8
ultrafiltrate.  On POD 2, he was deemed stable for transfer to
the floor.  He remained afebrile and his oxygenation status
remained good on 3 liters nasal cannula.  His diet was advanced
to clear liquid, which he tolerated well.  He underwent HD with
an ultrafiltrate of 2.2 liters.  A CTA chest demonstrated no
PEs.  On POD 3, he continued to remain afebrile and was
tolerating a renal diet.  PFTs were performed.  On POD 4, he
continued to remain afebrile and toelrating a renal diet.  He
remained stable on room air and continued to have bowel
movements.  On POD 5, he remained afebrile and toelrating a
renal die.  His wound continued to have serous drainage and 3-0
nylon stiches were placed to better approximate the skin edges.
An abdominla ultrasound was performed which did not demonstrate
any fluid collection.  On POD 6, he was deemed stbale for
discharge home with VNA services.  He was tolerating a renal
diet, afebrile, ambulating well, and continued to have bowel
movements.  Further 3-0 nylon sutures were placed to better
approximate the skin edges to stop the serous drainage.  He will
follow-up with Dr. [**First Name (STitle) **].  He will resume his previous HD
schedule.

Medications on Admission:
Allopurinal 100', ASA 81', diltiazem 360', diovan 320',
gabapentin 100"', glyburide 2.5', insulin, lantus 10u qHS,
nephrocaps 1', norvasc 10', prilosec 20", toprol 100', zoloft
100'

Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed.
Disp:*30 Tablet(s)* Refills:*0*
2. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day:
take while taking pain medication.
Disp:*60 Capsule(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
esrd
hypoxia


Discharge Condition:
good


Discharge Instructions:
Please call Dr.[**Name (NI) 670**] office if fever, chills, nausea,
vomiting, incision red/bleeding/draining pus or any questions
No heavy lifting
[**Month (only) 116**] shower
resume Tuesday-Thursday-Sat hemodialysis schedule

Followup Instructions:
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2167-5-1**] 8:00
Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **] TRANSPLANT SOCIAL WORK
Date/Time:[**2167-5-4**] 10:30
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1330**], MD Phone:[**Telephone/Fax (1) 673**]
Date/Time:[**2167-5-4**] 2:40
{'Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Surgical or other procedure not carried out because of contraindication,Congestive heart failure, unspecified,Anemia in chronic kidney disease,Personal history of malignant neoplasm of kidney,Acquired absence of kidney,Family history of diabetes mellitus,Gout, unspecified,Personal history of other infectious and parasitic diseases,Personal history of tobacco use,Old myocardial infarction'}


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: ESRD

PRESENT ILLNESS: 59 year-old male with h/o ESRD secondary to DM.  Started
dialysis in [**2165-5-15**] via LUE AV graft.  Last dialysis was done
[**2167-4-21**].  He has dialysis Tuesday, Thursday, and Saturday.
Typically urinates 4-5 times a day.  He is admitted today,
[**2167-4-21**] for a kidney transplant.

MEDICAL HISTORY: 1. ESRD on hemodialysis, awaiting placement on transplant list
(HD T,Th, Sat)
2. Renal cell carcinoma of left kidney (s/p partial nephrectomy

MEDICATION ON ADMISSION: Allopurinal 100', ASA 81', diltiazem 360', diovan 320',
gabapentin 100"', glyburide 2.5', insulin, lantus 10u qHS,
nephrocaps 1', norvasc 10', prilosec 20", toprol 100', zoloft
100'

ALLERGIES: Iron Dextran Complex

PHYSICAL EXAM: ADMISSION EXAM:
100.0  88  147/95  20  96% room air
NAD
A&O x 3
RRR
CTA bilaterally
soft, obese, NT, NABS
no cyanosis, cords, edema

FAMILY HISTORY: Sister- DM
[**Name (NI) **] reported CAD.
Positive for alcoholism.
Mother died of "liver problems"; father died of stroke at 51. He
is unsure of any other medical problems in his family.

SOCIAL HISTORY: Lives with sister, previously worked in a hotel, quit after [**Month (only) **] 

### Response:
{'Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Surgical or other procedure not carried out because of contraindication,Congestive heart failure, unspecified,Anemia in chronic kidney disease,Personal history of malignant neoplasm of kidney,Acquired absence of kidney,Family history of diabetes mellitus,Gout, unspecified,Personal history of other infectious and parasitic diseases,Personal history of tobacco use,Old myocardial infarction'}
