CHIEF COMPLAINT: transfer from OSH for management of ESRD

PRESENT ILLNESS: Pt is a 73 yo male with h/o HTN, ESRD with PD catheter placed 3
wks ago, AS but non surgical candidate, who taken by ambulance
to OSH last evening c/o porgressive SOB over 12 hrs. Was put on
O2 and BIPAP and given 160mg IV lasix during ED visit. Initially
no UOP but "filled his Foley bag" when placed. Weaned off BIPAP
and sating well with NC.  Per pts daughter, he has had recurrent
episodes of SOB, which have been attributed to AS and worsening
renal function. Pt had PD catheter placed 3 weeks ago. s/p PD
dialysis last th/friday but found that PD cath leaking when pt
sitting up. Pt developed diarrhea on wed ([**1-18**]) and had his
"belly drained" at clinic.

MEDICAL HISTORY: 1. ESRD, PD catheter placed 3 wks ago
2. HTN
3. Severe aortic stenosis - non operable as had chest opened for
surgery but deemed to calcified to operate
4. s/p CVA with residual weakness on L

MEDICATION ON ADMISSION: unknown

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T: 97.4 P: 62 BP: 100/54 RR: 16 O2: 94% 2L
wt: 70.4
GEN: Pt somnolent, but arousable, answering questions
appropriately, min inc WOB, NAD
HEENT: EOMI, sclerae mildly injected bilat, OP-pink/clear, neck:
supple, FROM
CARDIAC: reg rate/rhythm, harsh SEM heard best at RUSB but
throughout precordium
LUNGS: cta at apices; bibasilar crackles and [**Month (only) **] BS at R base
Abd: soft, nt/nd, peritoneal site - c/d/i with tube clamped. no
exudate at site. +BS
EXT: warm/dry; no c/c/e, spont movt of all ext
NEURO: A&OX3, somnolent but arousable; CN 2-12 grossly intact -
no focal deficits; noted min L sided weakness ( 4+ to 5-/5 on
left upper/lower ext vs [**3-22**] on R)

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Pt is married and lives with wife; h/o smoking; no etOH
Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Acute posthemorrhagic anemia,Aortic valve disorders,Unspecified septicemia,Severe sepsis,Septic shock,Acidosis,Mechanical complication due to peritoneal dialysis catheter,Blood in stool,Stricture of artery,Other late effects of cerebrovascular disease,Other musculoskeletal symptoms referable to limbs,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in residential institution,Atherosclerosis of renal artery
Hyp kid NOS w cr kid V,Acute kidney failure NOS,CHF NOS,Ac posthemorrhag anemia,Aortic valve disorder,Septicemia NOS,Severe sepsis,Septic shock,Acidosis,Comp-periton dialys cath,Blood in stool,Stricture of artery,Late effect CV dis NEC,Muscskel sympt limb NEC,Abn react-renal dialysis,Accid in resident instit,Renal artery atheroscler
Admission Date:  [**2164-1-20**]              Discharge Date:   [**2164-1-23**]

Date of Birth:  [**2090-1-19**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 668**]
Chief Complaint:
transfer from OSH for management of ESRD

Major Surgical or Invasive Procedure:
angiogram and embolization
intubation
central line placement

History of Present Illness:
Pt is a 73 yo male with h/o HTN, ESRD with PD catheter placed 3
wks ago, AS but non surgical candidate, who taken by ambulance
to OSH last evening c/o porgressive SOB over 12 hrs. Was put on
O2 and BIPAP and given 160mg IV lasix during ED visit. Initially
no UOP but "filled his Foley bag" when placed. Weaned off BIPAP
and sating well with NC.  Per pts daughter, he has had recurrent
episodes of SOB, which have been attributed to AS and worsening
renal function. Pt had PD catheter placed 3 weeks ago. s/p PD
dialysis last th/friday but found that PD cath leaking when pt
sitting up. Pt developed diarrhea on wed ([**1-18**]) and had his
"belly drained" at clinic.

Past Medical History:
1. ESRD, PD catheter placed 3 wks ago
2. HTN
3. Severe aortic stenosis - non operable as had chest opened for
surgery but deemed to calcified to operate
4. s/p CVA with residual weakness on L

Social History:
Pt is married and lives with wife; h/o smoking; no etOH

Family History:
noncontributory

Physical Exam:
T: 97.4 P: 62 BP: 100/54 RR: 16 O2: 94% 2L
wt: 70.4
GEN: Pt somnolent, but arousable, answering questions
appropriately, min inc WOB, NAD
HEENT: EOMI, sclerae mildly injected bilat, OP-pink/clear, neck:
supple, FROM
CARDIAC: reg rate/rhythm, harsh SEM heard best at RUSB but
throughout precordium
LUNGS: cta at apices; bibasilar crackles and [**Month (only) **] BS at R base
Abd: soft, nt/nd, peritoneal site - c/d/i with tube clamped. no
exudate at site. +BS
EXT: warm/dry; no c/c/e, spont movt of all ext
NEURO: A&OX3, somnolent but arousable; CN 2-12 grossly intact -
no focal deficits; noted min L sided weakness ( 4+ to 5-/5 on
left upper/lower ext vs [**3-22**] on R)


Pertinent Results:
[**2164-1-20**] 07:29PM   GLUCOSE-68* UREA N-153* CREAT-9.4*
SODIUM-132* POTASSIUM-4.3 CHLORIDE-97 TOTAL CO2-14* ANION
GAP-25*
[**2164-1-20**] 07:29PM   CALCIUM-5.6* PHOSPHATE-11.0* MAGNESIUM-2.0
[**2164-1-20**] 07:29PM   WBC-5.4 RBC-3.60* HGB-9.9* HCT-30.6* MCV-85
MCH-27.5 MCHC-32.3 RDW-18.0*
[**2164-1-20**] 07:29PM   PT-14.2* PTT-34.2 INR(PT)-1.3
[**2164-1-20**] 07:29PM   PLT COUNT-139*
*
ECHO: The left atrium is normal in size. Left ventricular wall
thicknesses and cavity size are normal. There is moderate global
left ventricular hypokinesis.  No masses or thrombi are seen in
the left ventricle. Right ventricular chamber size is normal
with mild global free wall hypokinesis. The aortic valve
leaflets are moderately thickened. There is severe aortic valve
stenosis.  Trace aortic regurgitation is seen. The mitral valve
appears structurally [**Doctor First Name **]. Mild (1+) mitral regurgitation is
seen. There is mild pulmonary artery systolic hypertension.
There is no pericardial effusion.
*
CT Abdomen:
1) No evidence of retroperitoneal or intraabdominal hemorrhage.
2) Bilateral pleural effusions, right greater than left, with
changes of both atelectasis and consolidation in peribronchial
pattern, which may suggest aspiration.
3) Small right kidney, consistent with chronic renal disease.
4) Diverticulosis.
5) Wall thickening of virtually the entire colon may be related
to infectious causes such as C. difficile colitis.
6) Calcification of the coronary and abdominal/pelvic arteries.
*
Angio:
1. Abdominal aortogram revealed a diffusely diseased and
tortuous abdominal aorta, along with significant angiographic
stenosis of the left common iliac artery and the left internal
iliac artery. The renal arteries were not visualized, nor was
the inferior mesenteric artery.
2. Selective superior mesenteric arteriography reveals
retrograde opacification of the gastroduodenal and hepatic
arteries, suggesting severe obstruction of the proximal celiac
trunk. Delayed imaging reveals patency of the superior
mesenteric and portal veins. In addition, a focus of
intermittent extravasation was identified from a branch of the
marginal artery at the hepatic flexure.
3. Injection of Methylene Blue at the site of extravasation
followed by prophylactic embolization using GelFoam slurry with
good angiographic results.


Brief Hospital Course:
74 yo male presented to OSH with SOB - attributed to CHF
exacerbation, ESRD s/p placement of PD - now w/ leak, HTN,
admitted for further management of ESRD and initiation of HD--
course complicated by GI bleed on night of admission requiring
unit transfer.  On night of transfer taken for tagged red blood
cell scan with evidence of bleeding at hepatic flexure.  Then
taken to angiography that night with surgery following along.
Angio embolized the right colic artery and patient brought back
to the unit and supported with blood products and slowly the GI
bleeding resolved with stable hematocrits and decreased melena
and clots from rectum.  During the proceudre was noted to be in
increased respiratory distress and intubated on arrival back to
intensive care unit.  He required pressors to help maintain his
blood pressure even with supportive blood products and fluid
boluses.  He was started on CVVH for acidosis and renal failure.
 Then started showing signs of bilateral infiltrates and
remained difficult to oxygenate, requiring elevated PEEPs to
help support his oxygenation. As persistently hypotensive even
with stable anemia and bleeding had stopped concern for sepsis
with low grade temperatures and started on Vancomycin and zosyn.
 Also was showing signs of coagulopathy and pancytopenia
concerning for sepsis.  After discussion with wife and based on
patient's wished prior to intubation, he would not have wanted
to continue this level of care with concern of quality of life
after this event.  After waiting and seeing little improvemtn in
his prognosis, Ms [**Known lastname 60303**] wished to withdraw care and patient
was weaned off sedation, started on morphine drip and extubated.
 All other meds were discontinued and patient expired at 3/7 at
7:25pm.

Medications on Admission:
unknown

Discharge Medications:
none

Discharge Disposition:
Expired

Discharge Diagnosis:
acute respiratory distress
metabolic acidosis
septic shock
acute on chronic renal failure
blood loss anemia
pancytopenia

Discharge Condition:
expired

Discharge Instructions:
none

Followup Instructions:
none


Completed by:[**2164-1-23**]
{'Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Acute posthemorrhagic anemia,Aortic valve disorders,Unspecified septicemia,Severe sepsis,Septic shock,Acidosis,Mechanical complication due to peritoneal dialysis catheter,Blood in stool,Stricture of artery,Other late effects of cerebrovascular disease,Other musculoskeletal symptoms referable to limbs,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in residential institution,Atherosclerosis of renal artery'}


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: transfer from OSH for management of ESRD

PRESENT ILLNESS: Pt is a 73 yo male with h/o HTN, ESRD with PD catheter placed 3
wks ago, AS but non surgical candidate, who taken by ambulance
to OSH last evening c/o porgressive SOB over 12 hrs. Was put on
O2 and BIPAP and given 160mg IV lasix during ED visit. Initially
no UOP but "filled his Foley bag" when placed. Weaned off BIPAP
and sating well with NC.  Per pts daughter, he has had recurrent
episodes of SOB, which have been attributed to AS and worsening
renal function. Pt had PD catheter placed 3 weeks ago. s/p PD
dialysis last th/friday but found that PD cath leaking when pt
sitting up. Pt developed diarrhea on wed ([**1-18**]) and had his
"belly drained" at clinic.

MEDICAL HISTORY: 1. ESRD, PD catheter placed 3 wks ago
2. HTN
3. Severe aortic stenosis - non operable as had chest opened for
surgery but deemed to calcified to operate
4. s/p CVA with residual weakness on L

MEDICATION ON ADMISSION: unknown

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T: 97.4 P: 62 BP: 100/54 RR: 16 O2: 94% 2L
wt: 70.4
GEN: Pt somnolent, but arousable, answering questions
appropriately, min inc WOB, NAD
HEENT: EOMI, sclerae mildly injected bilat, OP-pink/clear, neck:
supple, FROM
CARDIAC: reg rate/rhythm, harsh SEM heard best at RUSB but
throughout precordium
LUNGS: cta at apices; bibasilar crackles and [**Month (only) **] BS at R base
Abd: soft, nt/nd, peritoneal site - c/d/i with tube clamped. no
exudate at site. +BS
EXT: warm/dry; no c/c/e, spont movt of all ext
NEURO: A&OX3, somnolent but arousable; CN 2-12 grossly intact -
no focal deficits; noted min L sided weakness ( 4+ to 5-/5 on
left upper/lower ext vs [**3-22**] on R)

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Pt is married and lives with wife; h/o smoking; no etOH 

### Response:
{'Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Acute posthemorrhagic anemia,Aortic valve disorders,Unspecified septicemia,Severe sepsis,Septic shock,Acidosis,Mechanical complication due to peritoneal dialysis catheter,Blood in stool,Stricture of artery,Other late effects of cerebrovascular disease,Other musculoskeletal symptoms referable to limbs,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in residential institution,Atherosclerosis of renal artery'}
