CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: 49M h/o CRT [**7-27**] now w/ several day h/o increased shortness
of breath, worse lying flat, abdominal distension and peripheral
edema. He also complains of 1 week h/o hallucinations. Denies
f/c/n/v/d or any other signs/symptoms. Urine output at baseline,
no hematuria or dysuria.

MEDICAL HISTORY: -End-stage renal disease on HD T/T/S secondary to diabetic
nephropathy-started on dialysis [**2163-7-19**]
-diabetes for at least 20 years with retinopathy and neuropathy
with
footdrop
-coronary artery disease with history of ST elevation MI [**7-24**]
c/b pericardial tamponade requiring pericardiocentesis
-three-vessel disease with stents in the RCA and left circumflex

MEDICATION ON ADMISSION: 

ALLERGIES: Motrin / Lisinopril / Rapamune

PHYSICAL EXAM: GEN: NAD, A&O
PULM: CTAB
RESP: RRR
ABD: Soft, NTND. Incision well healed
EXT: 1+ edema bilat.

FAMILY HISTORY: Significant for myocardial infarction in his father at the age
of 49. Multiple family members with diabetes.

SOCIAL HISTORY: The patient does not smoke and he does not drink alcohol. He
lives with his wife, [**Name (NI) **].  From [**Male First Name (un) 1056**] originally. Has
multiple family members in the area including 4 children, one of
which works in BMT on the [**Hospital Ward Name 516**].
Persistent postoperative fistula,End stage renal disease,Acute kidney failure, unspecified,Complications of transplanted kidney,Unspecified pleural effusion,Other ascites,Acidosis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Old myocardial infarction,Other acquired deformities of ankle and foot,Gross hematuria,Long-term (current) use of insulin
Persist postop fistula,End stage renal disease,Acute kidney failure NOS,Compl kidney transplant,Pleural effusion NOS,Ascites NEC,Acidosis,Hyp kid NOS w cr kid V,DMI renl nt st uncntrld,Abn react-org transplant,Nephritis NOS in oth dis,Old myocardial infarct,Acq ankle-foot def NEC,Gross hematuria,Long-term use of insulin
Admission Date:  [**2166-10-19**]              Discharge Date:   [**2166-10-28**]

Date of Birth:  [**2117-4-21**]             Sex:   M

Service: SURGERY

Allergies:
Motrin / Lisinopril / Rapamune

Attending:[**First Name3 (LF) 668**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
AV fistula repair x 2.


History of Present Illness:
49M h/o CRT [**7-27**] now w/ several day h/o increased shortness
of breath, worse lying flat, abdominal distension and peripheral
edema. He also complains of 1 week h/o hallucinations. Denies
f/c/n/v/d or any other signs/symptoms. Urine output at baseline,
no hematuria or dysuria.


Past Medical History:
-End-stage renal disease on HD T/T/S secondary to diabetic
nephropathy-started on dialysis [**2163-7-19**]
-diabetes for at least 20 years with retinopathy and neuropathy
with
footdrop
-coronary artery disease with history of ST elevation MI [**7-24**]
c/b pericardial tamponade requiring pericardiocentesis
-three-vessel disease with stents in the RCA and left circumflex

-hypertension
-depression
-hyperlipidemia

PSH:
[**2166-8-1**] ECD renal transplant with delayed graft function

Social History:
The patient does not smoke and he does not drink alcohol. He
lives with his wife, [**Name (NI) **].  From [**Male First Name (un) 1056**] originally. Has
multiple family members in the area including 4 children, one of
which works in BMT on the [**Hospital Ward Name 516**].


Family History:
Significant for myocardial infarction in his father at the age
of 49. Multiple family members with diabetes.


Physical Exam:
GEN: NAD, A&O
PULM: CTAB
RESP: RRR
ABD: Soft, NTND. Incision well healed
EXT: 1+ edema bilat.

Brief Hospital Course:
The patient was seen and evaluated in the ED for shortness of
breath and admitted to the ICU for further management. Previous
biopsy had shown no evidence of rejection. The patient was
started on hemodialysis and a renal ultrasound obtained.
Ultrasound indicated an AV-Fistula & Repeat biopsy showed no
evidence of infection. Angiography was used to confirm the
patients AV-fistula, and this was coiled, the patient  recovered
without complication, but after several days no improvement in
his renal function was noted. The patient was observed to have a
persistent av-fistula on ultrasound and was taken for repeat
angiography and coiling. This successfully resolved the
patient's fistula. He did continue to have elevated serum
creatinines and was planned to follow up for continued
hemodialysis.

Discharge Medications:
1. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
Disp:*qs Tablet(s)* Refills:*2*
2. Gabapentin 100 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
Disp:*qs Capsule(s)* Refills:*2*
3. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
Disp:*qs Tablet(s)* Refills:*2*
4. Mycophenolate Mofetil 500 mg Tablet Sig: Two (2) Tablet PO
BID (2 times a day).
Disp:*qs Tablet(s)* Refills:*2*
5. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
Disp:*qs Capsule, Delayed Release(E.C.)(s)* Refills:*2*
6. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*qs Tablet(s)* Refills:*2*
7. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily).
Disp:*qs Tablet(s)* Refills:*2*
8. Epoetin Alfa 10,000 unit/mL Solution Sig: One (1) dose
Injection ASDIR (AS DIRECTED).
Disp:*qs dose* Refills:*2*
9. Lantus 100 unit/mL Cartridge Sig: Six (6) units Subcutaneous
qAM.
Disp:*qs * Refills:*2*
10. Ativan 2 mg Tablet Sig: One (1) Tablet PO at bedtime.
Disp:*qs Tablet(s)* Refills:*2*
11. Tacrolimus 0.5 mg Capsule Sig: Three (3) Capsule PO twice a
day: Total dose = 1.5 milligrams at 6 am and 6 pm daily.
Disp:*180 Capsule(s)* Refills:*0*
12. Diphenhydramine HCl 25 mg Tablet Sig: Two (2) Tablet PO at
bedtime: total dose 50 mg qhs.
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
AV Fistula


Discharge Condition:
Good


Discharge Instructions:
Please call the Transplant Office [**Telephone/Fax (1) 673**] if fever, chills,
nausea, vomiting, decreased urine output, shortness of breath,
or edema.
Continue to get labs drawn every Monday and Thursday as
previous.
No driving if taking pain medication
Drink enough fluids to keep urine light yellow in color

MEDS:
You will no longer need to take your Valcyte.
Please take tacrolimus at 1.5mg twice daily unless instructed to
change your dosing per the clinic.

Followup Instructions:
Please keep all previous appointments as planned. You will still
require Monday and Thursday blood draws as before.

[**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1523**], MD Interventional Cardiology
Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2167-1-19**] 1:20
[**Last Name (LF) **],[**First Name3 (LF) **] (Internal Medicine) [**Telephone/Fax (1) 1792**]  Call to
schedule appointment
[**Last Name (LF) **],[**First Name3 (LF) **] R.  (Transplant Surgery) [**Telephone/Fax (1) 673**]  Call to
schedule appointment
[**Last Name (LF) **], [**First Name3 (LF) **] (Vascular Surgery) [**Telephone/Fax (1) 2625**] Call to
schedule appointment
{'Persistent postoperative fistula,End stage renal disease,Acute kidney failure, unspecified,Complications of transplanted kidney,Unspecified pleural effusion,Other ascites,Acidosis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Old myocardial infarction,Other acquired deformities of ankle and foot,Gross hematuria,Long-term (current) use of insulin'}


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: Shortness of breath

PRESENT ILLNESS: 49M h/o CRT [**7-27**] now w/ several day h/o increased shortness
of breath, worse lying flat, abdominal distension and peripheral
edema. He also complains of 1 week h/o hallucinations. Denies
f/c/n/v/d or any other signs/symptoms. Urine output at baseline,
no hematuria or dysuria.

MEDICAL HISTORY: -End-stage renal disease on HD T/T/S secondary to diabetic
nephropathy-started on dialysis [**2163-7-19**]
-diabetes for at least 20 years with retinopathy and neuropathy
with
footdrop
-coronary artery disease with history of ST elevation MI [**7-24**]
c/b pericardial tamponade requiring pericardiocentesis
-three-vessel disease with stents in the RCA and left circumflex

MEDICATION ON ADMISSION: 

ALLERGIES: Motrin / Lisinopril / Rapamune

PHYSICAL EXAM: GEN: NAD, A&O
PULM: CTAB
RESP: RRR
ABD: Soft, NTND. Incision well healed
EXT: 1+ edema bilat.

FAMILY HISTORY: Significant for myocardial infarction in his father at the age
of 49. Multiple family members with diabetes.

SOCIAL HISTORY: The patient does not smoke and he does not drink alcohol. He
lives with his wife, [**Name (NI) **].  From [**Male First Name (un) 1056**] originally. Has
multiple family members in the area including 4 children, one of
which works in BMT on the [**Hospital Ward Name 516**]. 

### Response:
{'Persistent postoperative fistula,End stage renal disease,Acute kidney failure, unspecified,Complications of transplanted kidney,Unspecified pleural effusion,Other ascites,Acidosis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Old myocardial infarction,Other acquired deformities of ankle and foot,Gross hematuria,Long-term (current) use of insulin'}
