CHIEF COMPLAINT: 

PRESENT ILLNESS: 

MEDICAL HISTORY: 1.  Type 2 diabetes mellitus.  2. End-
stage renal disease, on hemodialysis.  3.  Peripheral vascular
disease, status post left below the knee amputation, status post
right transmetatarsal amputation.  4.  Deep vein
thrombosis/pulmonary embolus, status post [**Location (un) 260**] filter,
on Coumadin.  5.  Abdominal tuberculosis.  6.  Methicillin
resistant Staphylococcus aureus cellulitis.  7. Hypertension.  8.
Chronic obstructive pulmonary disease.  9. Gastroparesis.  10.
Blindness in left eye.  11.  Upper gastrointestinal bleed in the
past.  12.  Trigeminal neuralgia.

MEDICATION ON ADMISSION: Coumadin, Reglan, Tegretol,
calcium carbonate, Nephrocaps, desipramine, Oxycontin,
Percocet, Renagel, nifedipine and hydralazine.

ALLERGIES: Propulsid (nausea and vomiting) and gentamicin
(nausea, vomiting and vertigo).

PHYSICAL EXAM: 

FAMILY HISTORY: Not obtained.

SOCIAL HISTORY: The patient is married.  He admits to tobacco
use.
Other specified gastritis, with hemorrhage,Unspecified analgesic and antipyretic causing adverse effects in therapeutic use,Infection and inflammatory reaction due to other vascular device, implant, and graft,Staphylococcal septicemia, unspecified,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,Chronic airway obstruction, not elsewhere classified,Atherosclerosis of native arteries of the extremities, unspecified
Oth spf gastrt w hmrhg,Adv eff analgesic NOS,React-oth vasc dev/graft,Staphylcocc septicem NOS,DMII renl nt st uncntrld,Hyp kid NOS w cr kid V,Chr airway obstruct NEC,Athscl extrm ntv art NOS
Admission Date:  [**2136-12-11**]       Discharge Date:  [**2136-12-25**]

Date of Birth:   [**2076-9-11**]       Sex:  M

Service:  Medicine
with a history of type 2 diabetes mellitus, end-stage renal
disease, on hemodialysis, and history of guaiac positive stool
with a falling hematocrit.

mucosa in the stomach and normal duodenum.  The patient presents
episodes of hematemesis.  Of note, he is on Coumadin for a
history of recurrent deep vein thromboses and pulmonary emboli.

On the day of admission, the patient was at hemodialysis, felt a
chill and then threw up dark blood.  He had one prior episode of
hematemesis a few weeks prior to admission.  On the day of
admission, he vomited approximately three times, one to two
drowsiness and lightheadedness.  He also denied chest pain.

The patient does not take any aspirin and he has no history of
jaundice or liver disease.  However, he does take Advil and
ibuprofen frequently for pain, along with Percocet and Oxycontin.
His last episode of hematemesis was in the Emergency Room.
Attempts to pass a nasogastric tube for lavage were unsuccessful.

PAST MEDICAL HISTORY:  1.  Type 2 diabetes mellitus.  2. End-
stage renal disease, on hemodialysis.  3.  Peripheral vascular
disease, status post left below the knee amputation, status post
right transmetatarsal amputation.  4.  Deep vein
thrombosis/pulmonary embolus, status post [**Location (un) 260**] filter,
on Coumadin.  5.  Abdominal tuberculosis.  6.  Methicillin
resistant Staphylococcus aureus cellulitis.  7. Hypertension.  8.
Chronic obstructive pulmonary disease.  9. Gastroparesis.  10.
Blindness in left eye.  11.  Upper gastrointestinal bleed in the
past.  12.  Trigeminal neuralgia.

MEDICATIONS ON ADMISSION:  Coumadin, Reglan, Tegretol,
calcium carbonate, Nephrocaps, desipramine, Oxycontin,
Percocet, Renagel, nifedipine and hydralazine.

ALLERGIES:  Propulsid (nausea and vomiting) and gentamicin
(nausea, vomiting and vertigo).

FAMILY HISTORY:  Not obtained.

SOCIAL HISTORY:  The patient is married.  He admits to tobacco
use.

PHYSICAL EXAMINATION:  Physical examination on admission was
notable for a temperature of 99.7, maximum temperature 100.6,
heart rate 119 and blood pressure 108/77.  General;  Alert,
sitting in bed, in no acute distress.  Head, eyes, ears, nose
and throat:  Pupils equal, round, and reactive to light and
accommodation, extraocular movements intact, moist mucous
membranes, trace dried blood around lips, no carotid bruits.
Chest:  End expiratory wheezes anteriorly on right, decreased
breath sounds posteriorly.  Cardiovascular:  Tachycardiac, no
jugular venous distention, S1 and S2 normal, regular rhythm.
Abdomen:  Soft, nontender, nondistended, positive bowel
sounds, normal liver span, no stigmata of liver disease.
Extremities:  Left below the knee amputation, right
transmetatarsal amputation.  Neurologic examination:  Alert,
speech regular, pupils equal and reactive, tongue midline,
moving all four extremities.

LABORATORY DATA:  Admission potassium was 5.3, BUN 62,
creatinine 5.7, white blood cell count 11.7, hematocrit 38,
prothrombin time 22.2, INR 3.4 and partial thromboplastin
time 60.1.

HOSPITAL COURSE:  The patient was admitted with a low grade
temperature and tachycardia but in no acute distress.  His
coagulopathy was corrected with vitamin K 5 mg and fresh frozen
plasma.  He received an esophagogastroduodenoscopy on [**2136-12-12**], which revealed evidence of gastritis and duodenitis.

The patient was started on intravenous Protonix and his
hematocrit remained relatively stable in the low 30s.  Two out of
two blood cultures were positive for gram negative rods and he
was given one dose of ciprofloxacin and one dose of ceftazidime.

At that point, he was called out to the general medical service.
He was switched from intravenous to oral Protonix. There were no
beds on the floor that day, therefore, two days later, he was
called out again to the floor.

At this point, the patient had also grown out coagulase negative
Staphylococcus in his blood cultures.  Because of this, he was
given vancomycin in addition to ceftazidime and ciprofloxacin.
His antibiotics were dosed at hemodialysis and he severe access
problems throughout his hospital course.

The patient's left external jugular line and his right Perm-A-
Cath appeared to be infected and his left external jugular line
was removed upon arrival to the floor per infectious disease
recommendations.  He was also being followed by the renal team
and interventional radiology for possible placement of a Perm-A-
Cath.

The patient's right Perm-A-Cath was then removed just after
hemodialysis and he continued to receive antibiotics with
dialysis.  Two days later, when his blood cultures had been
negative for greater than 48 hours, with no lines in place,
interventional radiology placed a new Perm-A-Cath in his left
subclavian.  His last positive blood culture was from [**2136-12-17**], which grew out Stenotrophomonas maltophilia in one out
of two blood culture bottles from the right Port-A-Cath just
before it was removed.

Based on the sensitivities, the patient was switched to Bactrim
in addition to the vancomycin and, since that date, he has been
treated with vancomycin and Bactrim, dosed with hemodialysis.

The patient's course was also complicated by mental status
changes which appeared to be secondary to a combination of his
narcotics and Neurontin, which had been given for his trigeminal
neuralgia and chronic pain.  The Neurontin was stopped and he
received hemodialysis on consecutive days.  His narcotics and
Tegretol were also stopped as they were thought to possibly be
contributing to his mental status change.

The patient had a negative head CT scan and a negative magnetic
resonance imaging scan.  A lumbar puncture was not done because
he was not febrile and there were no meningeal signs, as well as
the fact that his mental status improved with the withdrawal of
those medications and hemodialysis removed the Neurontin.

The patient was evaluated by physical therapy and deemed not
ready to go home.  The plan was to transfer to a short term
rehabilitation facility for continued antibiotics and physical
therapy for eventual transfer to home.

FINAL DIAGNOSES:
1.  Upper gastrointestinal bleed secondary to gastritis from
non-steroidal anti-inflammatory drug use, resolved.
2.  Mental status changes believed secondary to Neurontin and
narcotics, resolved.
3.  Coagulase negative Staphylococcus and Stenotrophomonas
bacteremia.

DISCHARGE MEDICATIONS:
Protonix 40 mg p.o.b.i.d.
Nephrocaps one p.o.q.d.
Renagel 800 mg two p.o.t.i.d. with meals.
Nicoderm patch 14 mg q.d.
Reglan 10 mg p.o.t.i.d.
Nifedipine XR 60 mg p.o.b.i.d.
Colace 100 mg p.o.b.i.d.
Desipramine 10 mg p.o.q.h.s.
Lovenox 90 mg s.c.b.i.d. until therapeutic INR.
Boost supplementation t.i.d.
Bactrim 600 mg i.v.q.h.d. given with hemodialysis until
[**2137-1-4**], to complete a 14 day course.
Vancomycin 1 gm i.v. when the vancomycin level is less than
15, given with hemodialysis until [**2136-12-31**], to
complete a 14 day course.
Albuterol meter dose inhaler two puffs q.4h.p.r.n.
Atrovent meter dose inhaler two puffs q.4h.p.r.n.
Dulcolax 10 mg p.o.q.d.p.r.n.
Coumadin 5 mg p.o.q.h.s., to be adjusted with INR.

DIET:  Cardiac [**Doctor First Name **].

DISCHARGE INSTRUCTIONS:  The patient should receive physical
therapy.

CONDITION ON DISCHARGE:  The patient is stable for discharge
to a short term rehabilitation facility.

Addendum:  The patient refused rehab stay, and left AMA on
[**2136-12-25**] to the care of his wife.  [**Name (NI) **] will continue to receive
antibiotics at dialysis, and will follow-up in clinic with Dr.
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in [**Company 191**].


                            [**Name6 (MD) **] [**Name8 (MD) **], M.D. [**MD Number(2) 4814**]

Dictated By:[**Name8 (MD) 6069**]
MEDQUIST36

D:  [**2136-12-25**]  11:43
T:  [**2136-12-25**]  11:59
JOB#:  [**Job Number 8223**]
{'Other specified gastritis, with hemorrhage,Unspecified analgesic and antipyretic causing adverse effects in therapeutic use,Infection and inflammatory reaction due to other vascular device, implant, and graft,Staphylococcal septicemia, unspecified,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,Chronic airway obstruction, not elsewhere classified,Atherosclerosis of native arteries of the extremities, unspecified'}


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: 

MEDICAL HISTORY: 1.  Type 2 diabetes mellitus.  2. End-
stage renal disease, on hemodialysis.  3.  Peripheral vascular
disease, status post left below the knee amputation, status post
right transmetatarsal amputation.  4.  Deep vein
thrombosis/pulmonary embolus, status post [**Location (un) 260**] filter,
on Coumadin.  5.  Abdominal tuberculosis.  6.  Methicillin
resistant Staphylococcus aureus cellulitis.  7. Hypertension.  8.
Chronic obstructive pulmonary disease.  9. Gastroparesis.  10.
Blindness in left eye.  11.  Upper gastrointestinal bleed in the
past.  12.  Trigeminal neuralgia.

MEDICATION ON ADMISSION: Coumadin, Reglan, Tegretol,
calcium carbonate, Nephrocaps, desipramine, Oxycontin,
Percocet, Renagel, nifedipine and hydralazine.

ALLERGIES: Propulsid (nausea and vomiting) and gentamicin
(nausea, vomiting and vertigo).

PHYSICAL EXAM: 

FAMILY HISTORY: Not obtained.

SOCIAL HISTORY: The patient is married.  He admits to tobacco
use. 

### Response:
{'Other specified gastritis, with hemorrhage,Unspecified analgesic and antipyretic causing adverse effects in therapeutic use,Infection and inflammatory reaction due to other vascular device, implant, and graft,Staphylococcal septicemia, unspecified,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,Chronic airway obstruction, not elsewhere classified,Atherosclerosis of native arteries of the extremities, unspecified'}
