CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 50-year-old
female with multiple medical problems status post recent
admission to Medicine for hyponatremia and seizures who
presented with generalized weakness and inability to transfer
herself at home with a swollen knee.  In the ED, she was
noted to have focal seizures and left facial twitching.  She
denied generalization.  Treated with Ativan 2 mg IV.  A left
subclavian line was placed for IV access.  Swollen left knee
prompted a tap of the knee times three with no fluid
obtained.  Left lower extremity negative with no DVT.  The
patient was given vancomycin times one dose prophylactically
after knee tap.  U/A revealed positive UTI.  The patient was
given Levaquin in the ED.  Positive urinary incontinence
without dysuria, without back pain, but has knee pain.

MEDICAL HISTORY: 1.  Complex partial seizure with a right temporal occipital
lobectomy, VP shunt in [**2137**].
2.  OCD.
3.  Depression.
4.  Chronic left lower extremity edema.
5.  History of bilateral hip arthroplasty.
6.  History of MRSA infection in the left hip.
7.  Left hip osteoporosis.
8.  Anorexia.
9.  B12 deficiency.
10. Anemia.
11. Incontinence.
12. PVD.
13. SIADH secondary to Tegretol.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Urinary tract infection, site not specified,Other convulsions,Other disorders of neurohypophysis,Urinary incontinence, unspecified,Obsessive-compulsive disorders,Depressive disorder, not elsewhere classified,Osteoporosis, unspecified,Other B-complex deficiencies
Urin tract infection NOS,Convulsions NEC,Neurohypophysis dis NEC,Urinary incontinence NOS,Obsessive-compulsive dis,Depressive disorder NEC,Osteoporosis NOS,B-complex defic NEC
Admission Date:  [**2149-1-13**]       Discharge Date:  [**2149-1-21**]

Date of Birth:   [**2098-10-28**]       Sex:  F

Service:

ADDENDUM:  The patient's discharge was on [**2149-1-21**].
The patient waited over the weekend to have a peripherally
inserted central catheter line placed and a right double
lumen peripherally inserted central catheter placed on
Monday, [**2149-1-20**].

DISCHARGE DIAGNOSES:
1.  Urinary tract infection.
2.  Cellulitis.

CONDITION AT DISCHARGE:  The patient's condition on discharge
was stable.

MEDICATIONS ON DISCHARGE:  (The patient's discharge
medications were as follows)
 1.  Tiagabine 4 mg p.o. q.h.s.
 2.  Amoxapine 50 mg p.o. b.i.d.
 3.  Oxybutynin 10 mg p.o. b.i.d.
 4.  Protonix 40 mg p.o. q.d.
 5.  Risperidone one tablet p.o. b.i.d.
 6.  Raloxifene 60 mg p.o. q.d.
 7.  Baclofen 10 mg p.o. q.i.d.
 8.  Phenobarbital 30 mg p.o. t.i.d.
 9.  Hydroxyzine 25 mg p.o. as needed.
10.  Sodium chloride 4 g p.o. t.i.d.
11.  Colace 100 mg p.o. b.i.d.
12.  Calcium 500 mg p.o. t.i.d.
13.  Vitamin D 400 mg p.o. q.d.
14.  Senna one tablet p.o. b.i.d.
15.  Carbamazepine 200 mg to 300 mg at breakfast, lunch, and
dinner.
16.  Heparin 5000 units subcutaneously b.i.d. (until out of
bed consistently).
17.  Ciprofloxacin 500 mg p.o. b.i.d. (times one day).
18.  Vancomycin 750 mg p.o. q.12h. (times eight days).
19.  Lactulose 30 mg p.o. t.i.d.
20.  Percocet one to two tablets p.o. q.4-6h. as needed.
21.  Ibuprofen 600 mg p.o. q.i.d. as needed.






                            [**Name6 (MD) 2415**] [**Last Name (NamePattern4) 3474**], M.D.  [**MD Number(1) 3475**]

Dictated By:[**Name8 (MD) 23023**]
MEDQUIST36

D:  [**2149-1-21**]  10:19
T:  [**2149-1-21**]  10:21
JOB#:  [**Job Number 44972**]


Admission Date:  [**2149-1-13**]       Discharge Date:  [**2149-1-21**]

Date of Birth:   [**2098-10-28**]       Sex:  F

Service:  ACOVE MEDICINE

HISTORY OF THE PRESENT ILLNESS:  The patient is a 50-year-old
female with multiple medical problems status post recent
admission to Medicine for hyponatremia and seizures who
presented with generalized weakness and inability to transfer
herself at home with a swollen knee.  In the ED, she was
noted to have focal seizures and left facial twitching.  She
denied generalization.  Treated with Ativan 2 mg IV.  A left
subclavian line was placed for IV access.  Swollen left knee
prompted a tap of the knee times three with no fluid
obtained.  Left lower extremity negative with no DVT.  The
patient was given vancomycin times one dose prophylactically
after knee tap.  U/A revealed positive UTI.  The patient was
given Levaquin in the ED.  Positive urinary incontinence
without dysuria, without back pain, but has knee pain.

PAST MEDICAL HISTORY:
1.  Complex partial seizure with a right temporal occipital
lobectomy, VP shunt in [**2137**].
2.  OCD.
3.  Depression.
4.  Chronic left lower extremity edema.
5.  History of bilateral hip arthroplasty.
6.  History of MRSA infection in the left hip.
7.  Left hip osteoporosis.
8.  Anorexia.
9.  B12 deficiency.
10. Anemia.
11. Incontinence.
12. PVD.
13. SIADH secondary to Tegretol.

ADMISSION MEDICATIONS:
1.  Tiagabine 4 mg q.h.s.
2.  Amoxapine 50 mg twice a day.
3.  Oxybutynin 10 twice a day.
4.  Protonix 40 once a day.
5.  Risperidone 1 twice a day.
6.  Loxapine 60 once a day.
7.  Phenobarbital 30 three times a day.
8.  Baclofen 10 four times a day.
9.  Hydrazine 25 p.m.
10. Sodium chloride 4 grams three times a day.
11. Lactulose 30 three times a day p.r.n.
12. Colace 100 twice a day.
13. Calcium.
14. Vitamin D.
15. Senna one twice a day.
16. Tegretol XL 200 a.m., 200 afternoon, 300 p.m.
17. Hydrocortisone cream p.r.n.
18. Ibuprofen 600 p.r.n.
19. Oxycodone sustained release 10 twice a day.

PHYSICAL EXAMINATION ON ADMISSION:  Vital signs:  Blood
pressure 110/70, pulse 100, respiratory rate 20, temperature
99.3, saturating 100% on 2 liters.  General:  The patient was
frail and ill appearing. HEENT:  The extraocular movements
were intact.  The oropharynx was clear.  Neck:  Supple.
Chest:  Clear to auscultation bilaterally.  Cardiovascular:
Regular rate and rhythm, normal S1, S2, negative murmur,
rubs, or gallops.  Abdomen:  Soft, nontender, nondistended.
Back:  She has a stage I sacral decubitus.  Extremities:
Left foot erythematous, 4+ edema to the knee.  Pain over the
left knee without appreciable effusions, without warmth.
Upper extremity revealed bilateral hand erythema, [**12-5**]+ edema.
Neurological:  The patient was alert and oriented times
three.

LABORATORY DATA UPON ADMISSION:  White count 6.0, hematocrit
28.9, platelets 440,000.  Sodium 134, potassium 4.4, chloride
84, bicarbonate 27, BUN 11, creatinine 0.2, glucose 86.  The
U/A revealed greater than 50 white cells, moderate
leukocytes, positive nitrates.  The urine culture is pending.

LENI negative for DVT.

Knee film revealed osteopenia.

HOSPITAL COURSE:  The patient is a 50-year-old female well
known to the team who presented with a potential seizure,
SIADH, although not with obvious hyponatremia and UTI.

1.  INFECTIOUS DISEASE:  The patient's UTI was treated with
Cipro.  The patient also had likely cellulitis of the hands.
The patient was started on a 14 day course of vancomycin.
The patient had a PICC line placed for vancomycin prior to
discharge.

2.  NEUROLOGIC:  The patient was continued on medications
without seizures.  The patient has very small seizures.  The
patient was also found to be unresponsive one morning.

The patient was transferred to the SICU which is likely
urosepsis.  The patient responded with fluids and
antibiotics.  The patient was discharged back to the floor
the next day without incident.

3.  FLUIDS, ELECTROLYTES, AND NUTRITION:  The patient had a
sodium of 134, retested the patient's sodium was 120, 134 was
likely an error in the laboratory.  The patient's sodium came
up appropriately with fluid restriction and salt tabs.

4.  KNEE PAIN:  No workup was really done.  This patient is
well known to Dr. [**Last Name (STitle) 7111**] and is to have outpatient workup of
pain.

5.  PSYCHIATRY:  The patient's medicines were continued.

6.  GASTROINTESTINAL:  The patient was put on a bowel
regimen.  Protonix was continued.

7.  ENDOCRINE:  The patient was continued on calcium, vitamin
E.

8.  PAIN:  MS04 and Oxycodone were held as the patient was
found to be unresponsive.  The patient was changed to
Percocet.

9.  FLUIDS, ELECTROLYTES, AND NUTRITION:  The patient was
given a regular diet with Boost.

10. LINES:  The patient's left subclavian was changed to a
PICC.

DISCHARGE CONDITION:  Fair.

DISCHARGE DIAGNOSIS:  Unable to care for self.

DISCHARGE MEDICATIONS:
1.  Tiagabine 4 q.h.s.
2.  Amoxapine 50 b.i.d.
3.  Oxybutynin 10 b.i.d.
4.  Pantoprazole 40 once a day.
5.  Risperidone one twice a day.
6.  Loxapine 60 once a day.
7.  Phenobarbital 30 three times a day.
8.  Baclofen 10 four times a day.
9.  Hydroxyzine 25 p.r.n.
10. Sodium chloride 4 grams t.i.d.
11. Colace 100 twice a day.
12. Calcium 500 three times a day.
13. Vitamin D 400 once a day.
14. Senna one twice a day.
15. Carbamazepine 200 in the a.m., 200 in the p.m., 300 in
the evening.
16. Ibuprofen for pain.
17. Acetaminophen for pain.
18. Ciprofloxacin 500 b.i.d.
19. Vancomycin 750 b.i.d.
20. Lactulose 30 three times a day.



                            [**Name6 (MD) 2415**] [**Last Name (NamePattern4) 3474**], M.D.  [**MD Number(1) 3475**]

Dictated By:[**Name8 (MD) 23023**]
MEDQUIST36

D:  [**2149-1-17**]  04:35
T:  [**2149-1-17**]  23:13
JOB#:  [**Job Number **]
{'Urinary tract infection, site not specified,Other convulsions,Other disorders of neurohypophysis,Urinary incontinence, unspecified,Obsessive-compulsive disorders,Depressive disorder, not elsewhere classified,Osteoporosis, unspecified,Other B-complex deficiencies'}


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 50-year-old
female with multiple medical problems status post recent
admission to Medicine for hyponatremia and seizures who
presented with generalized weakness and inability to transfer
herself at home with a swollen knee.  In the ED, she was
noted to have focal seizures and left facial twitching.  She
denied generalization.  Treated with Ativan 2 mg IV.  A left
subclavian line was placed for IV access.  Swollen left knee
prompted a tap of the knee times three with no fluid
obtained.  Left lower extremity negative with no DVT.  The
patient was given vancomycin times one dose prophylactically
after knee tap.  U/A revealed positive UTI.  The patient was
given Levaquin in the ED.  Positive urinary incontinence
without dysuria, without back pain, but has knee pain.

MEDICAL HISTORY: 1.  Complex partial seizure with a right temporal occipital
lobectomy, VP shunt in [**2137**].
2.  OCD.
3.  Depression.
4.  Chronic left lower extremity edema.
5.  History of bilateral hip arthroplasty.
6.  History of MRSA infection in the left hip.
7.  Left hip osteoporosis.
8.  Anorexia.
9.  B12 deficiency.
10. Anemia.
11. Incontinence.
12. PVD.
13. SIADH secondary to Tegretol.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Urinary tract infection, site not specified,Other convulsions,Other disorders of neurohypophysis,Urinary incontinence, unspecified,Obsessive-compulsive disorders,Depressive disorder, not elsewhere classified,Osteoporosis, unspecified,Other B-complex deficiencies'}
