CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 41 year-old man
previously admitted on [**2151-10-22**] for alcoholic
pancreatitis leading to adult respiratory distress syndrome
and tracheostomy complicated by Pseudomonas pneumonia,
pancreatic necrosis, C-diff colitis, line sepsis, left upper
extremity deep venous thrombosis, Haldol induced
thrombocytopenia and decubitus ulcer.  He was discharged to a
rehabilitation center in [**State 108**].  He was readmitted [**2154-2-22**] for subacute renal failure with creatinine increase to
11.8 and was dialyzed and discharged with an improving
creatinine.

MEDICAL HISTORY: 1.  Type 2 diabetes.  2.  History of
acute pancreatitis [**2151-10-22**].  3.  History of acute renal
failure in [**2152-2-22**].  4.  History of adult
respiratory distress syndrome in [**2151-10-22**].  5.
Obstructive sleep apnea on home BiPAP.  6.  Hypertension.  7.
Diabetic foot ulcers.  8.  Obesity.  9.  History of
alcoholism.  10.  Peripheral neuropathy.

MEDICATION ON ADMISSION: 

ALLERGIES: Haldol causes thrombocytopenia.

PHYSICAL EXAM: 

FAMILY HISTORY: Positive for diabetes.

SOCIAL HISTORY: The patient is married with a history of
alcohol abuse in the past and currently has two to three
drinks per week.  He is a half a pack per day smoker.  No
history of elicit drug use.  He is currently unemployed.  He
previously worked in real estate.
Septicemia due to escherichia coli [E. coli],Other shock without mention of trauma,Acute kidney failure, unspecified,Diabetes with ketoacidosis, type II or unspecified type, uncontrolled,Hydronephrosis,Ulcer of heel and midfoot,Mixed acid-base balance disorder,Thrombocytopenia, unspecified,Calculus of ureter
E coli septicemia,Shock w/o trauma NEC,Acute kidney failure NOS,DMII ketoacd uncontrold,Hydronephrosis,Ulcer of heel & midfoot,Mixed acid-base bal dis,Thrombocytopenia NOS,Calculus of ureter
Admission Date:  [**2154-9-9**]     Discharge Date:  [**2154-9-18**]

Date of Birth:   [**2112-9-15**]     Sex:  M

Service:  [**Company 191**]

HISTORY OF PRESENT ILLNESS:  The patient is a 41 year-old man
previously admitted on [**2151-10-22**] for alcoholic
pancreatitis leading to adult respiratory distress syndrome
and tracheostomy complicated by Pseudomonas pneumonia,
pancreatic necrosis, C-diff colitis, line sepsis, left upper
extremity deep venous thrombosis, Haldol induced
thrombocytopenia and decubitus ulcer.  He was discharged to a
rehabilitation center in [**State 108**].  He was readmitted [**2154-2-22**] for subacute renal failure with creatinine increase to
11.8 and was dialyzed and discharged with an improving
creatinine.

The patient's current symptoms consist of left upper quadrant
abdominal pain, nausea, vomiting and weakness.  The course of
events began two days prior to presentation when he had
approximately six fried clams while on [**Location (un) **].  Within
approximately one hour he began having nausea and vomiting of
nonbloody material.  Diarrhea began within about five hours,
which was copious, watery and nonbloody.  He also had left
sided abdominal pain without radiation.  One day prior to
presentation he developed fever and chills with increasing
weakness and was advised by his primary care physician to
come to the Emergency Department.

In the Emergency Department he was noted to have a blood
glucose of 659 and he reported not taking insulin over the
last two days.  He was also noted to have an elevated
creatinine to 4.2.  While in the Emergency Department he
became progressively weaker and blood pressure dropped to the
70s systolic.  He was given a fluid challenge, which failed
to increase blood pressure or urine output so he was started
on Dopamine with maintenance systolic blood pressure in the
100s.  He was empirically given Levaquin and Flagyl for an
unknown infectious etiology.  CT scan of the abdomen was
performed while in the Emergency Department, which showed
multiple abnormalities of the pancrease with calcifications
in head, hypodense lesion within the body consistent with
pseudocyst versus neoplasm.  He was also noted to have left
renal stone in pelvis with right renal stone and proximal
ureter causing hydronephrosis and perinephric stranding.

He was transferred to the Intensive Care Unit for hemodynamic
monitoring, diabetic ketoacidosis, possible urosepsis
secondary to nephrolithiasis.

PAST MEDICAL HISTORY:  1.  Type 2 diabetes.  2.  History of
acute pancreatitis [**2151-10-22**].  3.  History of acute renal
failure in [**2152-2-22**].  4.  History of adult
respiratory distress syndrome in [**2151-10-22**].  5.
Obstructive sleep apnea on home BiPAP.  6.  Hypertension.  7.
Diabetic foot ulcers.  8.  Obesity.  9.  History of
alcoholism.  10.  Peripheral neuropathy.

ALLERGIES:  Haldol causes thrombocytopenia.

MEDICATIONS:  Insulin 70/30 typically 40 to 50 units split
between a.m. and p.m. (usually 30 in the a.m. and 20 in the
p.m.).

FAMILY HISTORY:  Positive for diabetes.

SOCIAL HISTORY:  The patient is married with a history of
alcohol abuse in the past and currently has two to three
drinks per week.  He is a half a pack per day smoker.  No
history of elicit drug use.  He is currently unemployed.  He
previously worked in real estate.

PHYSICAL EXAMINATION:  Vital signs on presentation to the
Intensive Care Unit, temperature 97.8, heart rate 92, blood
pressure 101/60, respiratory rate 20, oxygen saturation 96%
on room air.  In general, the patient is a mildly obese man
in no acute distress.  On HEENT examination pupils are equal,
round and reactive to light.  Extraocular movements intact.
He had no scleral icterus.  Neck was supple without any
lymphadenopathy.  Chest lungs were clear to auscultation
bilaterally.  Cardiovascular examination regular rate.
Normal S1 and S2.  No murmurs, rubs or gallops were
appreciated.  Abdominal examination his abdomen was soft,
nontender, nondistended, normoactive bowel sounds.  He had no
costovertebral angle tenderness.  He had no appreciable
bladder distention.  Rectal examination he had hemorrhoids
with enlarged firm prostate guaiac positive stools.  A
perianal sinus tract was noted with small furuncles.  On
extremity examination he had 2+ dorsalis pedis pulses and
posterior tibial pulses bilaterally.  Bilateral plantar skin
break down was noted.  There was no edema.

INITIAL LABORATORY VALUES:  White blood cell count 22.5,
hemoglobin 10.4, hematocrit 30.9, platelets 104, MCV 103.
Differential on the white count 56 neutrophils, 37 bands, 7%
lymphocytes, PT 13.5, PTT 37.4, INR 1.3.  Chemistry sodium
128, potassium 4.6, chloride 100, bicarb 14, BUN 38,
creatinine 4.2, glucose 659.  Alkaline phosphatase 120, ALT
13, AST 14, total bilirubin 0.3, amylase 28, lipase 5, CK 74,
calcium 7.7, phosphorus 2.2, magnesium 1.7, blood ketones
were negative.  TSH 2.5.

IMPRESSION:  The patient is a 41 year-old man with a history
of type 1 diabetes, history of acute pancreatitis and chronic
renal insufficiency presenting with fever, bandemia,
hydronephrosis and hypotension.

HOSPITAL COURSE:  The patient was admitted to the Intensive
Care Unit directly from the Emergency Department and was
continued on Dopamine for blood pressure support.  Blood
pressure support only transiently.  He was noted to have a
creatinine of 4.2 above baseline level of 2.5.  He was noted
to have a urinalysis consistent with infection and was found
to have three or four blood cultures bottles positive for
E-coli.  He was treated for pyelonephritis and urosepsis with
Rocephin.  DIC panel was performed, which showed elevated
coags, FDP and D-dimer, but elevated fibrinogen and
unremarkable hemolysis studies.  It was thought that the DIC
picture was likely secondary to bacteremia.  He was
hemodynamically stabilized and transferred to the floor on
hospital day number three.

An MRI was performed, which showed pancreatic pseudocyst and
obstructed right collecting system with hydronephrosis.  A
right sided percutaneous nephrostomy tube was placed on
[**2154-9-12**] and during placement large amounts of purulent
material was obtained while accessing the renal pelvis.  Gram
positive coxae were noted by gram stain and the patient was
started on Vancomycin.

As the patient was anuric since transfer to the floor
creatinine gradually rose to 5.2.  His bicarb progressively
worsened to reach a nadir of 8.  Nephrology was consulted and
felt that the acidemia was multifactorial with diarrhea,
renal failure and sepsis playing a predominant role.  He was
felt to be prerenal and was aggressively fluid rehydrated.
Despite receiving 8 amps of bicarb and fluid resuscitation
his blood pressure fell and he was transferred back to the
unit on hospital day number five.

The patient's second Intensive Care Unit course was fairly
unremarkable with urine output increasing to 50 to 100 cc an
hour with aggressive fluid repletion.  Blood pressures
stabilized and bicarb normalized with additional repletion.
He was transferred back to the floor on hospital day number
seven.  A renal ultrasound was performed, which showed no
evidence of hydronephrosis at that point.  Repeat blood
cultures were negative.  Once acute issues stabilized general
surgery was contact[**Name (NI) **] for evaluation of pancreatic
pseudocyst.  Surgery felt appropriate evaluation would
include outpatient endoscopic ultrasound to be performed by
Dr. [**Last Name (STitle) 8871**].

Creatinine trended up to reach a peak of 6.5, however,
normalized during remainder of hospitalization and was down
to 5.8 by the time of discharge.

Of note, the patient was thrombocytopenic during
hospitalization with platelets reaching a nadir of 29,000.
No etiology was identified and it was thought that low
platelets were most likely secondary to malnutrition.  They
rose back to baseline by the time of discharge.

DISCHARGE CONDITION:  Stable and improved.

DISCHARGE DIAGNOSES:
1.  Diabetic ketoacidosis.
2.  Urosepsis.
3.  Bilateral nephrolithiasis with right hydronephrosis.
4.  Status post right percutaneous nephrostomy.
5.  Acute on chronic renal failure.
6.  Diabetes type 2.
7.  Acute tubular necrosis.
8.  Pancreatic pseudocyst.
9.  Thrombocytopenia resolved.
10.  Right heel ulcer.
11.  Hypertension.
12.  Obesity.
13.  Obstructive sleep apnea.

DISCHARGE MEDICATIONS:  1.  Protonix 40 mg q.d.  2.  Regular
insulin sliding scale.  3.  Insulin 70/30 10 units q.a.m. and
10 units q.p.m.  4.  Multivitamin.  5.  Thiamine folate.  6.
Pancrease.  7.  Sodium bicarb 650 mg two tabs b.i.d.  8.
Tums 500 mg t.i.d. with meals.  9.  Percocet one to two tabs
q six hours prn.  10.  Albuterol two puffs prn.  11.
Levaquin 250 mg q.d. times seven days.

DISCHARGE INSTRUCTIONS:  1.  Follow up with nephrology in one
week, appointment to be scheduled by patient.  2. Follow up
urology Dr. [**Last Name (STitle) 8872**] in two weeks.  3.  Follow up in podiatry
in three weeks.  4.  Follow up hepatobiliary service Dr.
[**Last Name (STitle) 8871**] to be scheduled by the patient.  5.  Follow up with
primary care physician [**Last Name (NamePattern4) **]. [**Last Name (STitle) 1683**] in four weeks.





                          [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 8873**] [**Name8 (MD) **], M.D.  [**MD Number(1) 8874**]

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

MEDQUIST36

D:  [**2154-12-4**]  03:31
T:  [**2154-12-4**]  11:02
JOB#:  [**Job Number 8875**]
{'Septicemia due to escherichia coli [E. coli],Other shock without mention of trauma,Acute kidney failure, unspecified,Diabetes with ketoacidosis, type II or unspecified type, uncontrolled,Hydronephrosis,Ulcer of heel and midfoot,Mixed acid-base balance disorder,Thrombocytopenia, unspecified,Calculus of ureter'}


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 41 year-old man
previously admitted on [**2151-10-22**] for alcoholic
pancreatitis leading to adult respiratory distress syndrome
and tracheostomy complicated by Pseudomonas pneumonia,
pancreatic necrosis, C-diff colitis, line sepsis, left upper
extremity deep venous thrombosis, Haldol induced
thrombocytopenia and decubitus ulcer.  He was discharged to a
rehabilitation center in [**State 108**].  He was readmitted [**2154-2-22**] for subacute renal failure with creatinine increase to
11.8 and was dialyzed and discharged with an improving
creatinine.

MEDICAL HISTORY: 1.  Type 2 diabetes.  2.  History of
acute pancreatitis [**2151-10-22**].  3.  History of acute renal
failure in [**2152-2-22**].  4.  History of adult
respiratory distress syndrome in [**2151-10-22**].  5.
Obstructive sleep apnea on home BiPAP.  6.  Hypertension.  7.
Diabetic foot ulcers.  8.  Obesity.  9.  History of
alcoholism.  10.  Peripheral neuropathy.

MEDICATION ON ADMISSION: 

ALLERGIES: Haldol causes thrombocytopenia.

PHYSICAL EXAM: 

FAMILY HISTORY: Positive for diabetes.

SOCIAL HISTORY: The patient is married with a history of
alcohol abuse in the past and currently has two to three
drinks per week.  He is a half a pack per day smoker.  No
history of elicit drug use.  He is currently unemployed.  He
previously worked in real estate. 

### Response:
{'Septicemia due to escherichia coli [E. coli],Other shock without mention of trauma,Acute kidney failure, unspecified,Diabetes with ketoacidosis, type II or unspecified type, uncontrolled,Hydronephrosis,Ulcer of heel and midfoot,Mixed acid-base balance disorder,Thrombocytopenia, unspecified,Calculus of ureter'}
