CHIEF COMPLAINT: Syncope x 3 in 2 days prior to admission

PRESENT ILLNESS: 58 yo M h/o ESRD on HD on tx list, s/p L partial nephrectomy for
RCC in [**2164**], diastolic CHF, HTN with recent addition of
Carvedilol, Hep C, DM2, Gout, past pericardial tamponade of
viral etiology who presents after 3 episodes of syncope over the
past 2 days.
.
The pt has HD on T,Th,Sat. His dry wt is thought to be 86kg. On
Tues he went for HD and had a full run. He returned on Wed for
more HD as he was felt to be fluid overloaded. At the end of the
extra run of HD he stood to leave, felt LH, tunnel vision, sat
down, and lost consciousness. Some of his fluid was returned.
The pt then returned for Thursday HD and was run even (wt 86.3
prior and 86.1 post). He went home and that night he stood from
bed at ~1am and had a syncopal episode. This happened again
later in the evening. He is unsure if he hit his head, but he
did fall from a stand. He notes increasing DOE (always present,
but now present when climbing 4 stairs), L jaw pain and chest
tightness reminiscent of his pericardial effusion.
.
In the ED he was noted to have a BP of 70's systolic, no
significant pulsus. He was seen by renal and received 3.5L NS, a
full aspirin, had CE's with a trop 0.02 and CK 269. Bedside US
revealed no signif pericardial effusion.
.
In addition, the pt notes that he has had increasing DOE, 3
pillow orthopnea, no PND, no [**Location (un) **], no fever, but + NS and chills.
Prior to the last week he had been eating more than normal.
Since passing out on Wednesday, he has been eating very little,
has vomitted x 2. He has chronic diarrhea up to 6x per day at
baseline and this has not changed. He has been very thirsty over
the past three days. He usually makes small amounts of urine,
but has made none since wednesday.
.

MEDICAL HISTORY: 1. ESRD on hemodialysis, awaiting placement on transplant list
(HD T,Th, Sat)
2. Renal cell carcinoma of left kidney (s/p partial nephrectomy

MEDICATION ON ADMISSION: 1. Allopurinol 100 mg qod
2. Prilosec 40mg [**Hospital1 **]
3. Calcium Carbonate 500 mg tid
4. Diltiazem HCl 180 mg daily (Ext Release)
5. Valsartan 320 mg daily
6. Amlodipine 5 mg daily
7. Sertraline 50mg daily
8. Insulin Glargine 10 daily plus SSI
9. Carvedilol 6.25 [**Hospital1 **]

ALLERGIES: Iron Dextran Complex

PHYSICAL EXAM: VS: T 98 BP 124/70 HR 80 RR 14 O2sat 100% RA
BG 99
GEN: NAD, conversant, oriented
HEENT: Anicteric sclera, OP clear, MM mod dry with dry/cracked
lips
NECK: supple, no LAD, no JVD
CARD: RRR, normal S1, S2. 2/6 systolic murmur at L USB
LUNG: Good air movement, clear lung fields laterally and
posterior
ABD: Protuberant, soft, ND, no tenderness. No HSM
EXT: WWP, dry, scaly skin on lower legs and feet bilaterally. DP

FAMILY HISTORY: Sister- DM
[**Name (NI) **] reported CAD.
Positive for alcoholism.
Mother died of "liver problems"; father died of stroke at 51. He

SOCIAL HISTORY: Lives with sister, previously worked in a hotel, quit after [**Month (only) **]
Hypotension of hemodialysis,Chronic diastolic heart failure,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Unspecified viral hepatitis C without hepatic coma,Acidosis,Awaiting organ transplant status,Gout, unspecified,Personal history of malignant neoplasm of kidney,Anemia in chronic kidney disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Hemododialysis hypotensn,Chr diastolic hrt fail,End stage renal disease,Hyp kid NOS w cr kid V,Hpt C w/o hepat coma NOS,Acidosis,Await organ transplnt st,Gout NOS,Hx of kidney malignancy,Anemia in chr kidney dis,DMII wo cmp nt st uncntr
Admission Date:  [**2166-4-25**]              Discharge Date:   [**2166-4-27**]

Date of Birth:  [**2108-4-9**]             Sex:   M

Service: MEDICINE

Allergies:
Iron Dextran Complex

Attending:[**First Name3 (LF) 30198**]
Chief Complaint:
Syncope x 3 in 2 days prior to admission

Major Surgical or Invasive Procedure:
None

History of Present Illness:
58 yo M h/o ESRD on HD on tx list, s/p L partial nephrectomy for
RCC in [**2164**], diastolic CHF, HTN with recent addition of
Carvedilol, Hep C, DM2, Gout, past pericardial tamponade of
viral etiology who presents after 3 episodes of syncope over the
past 2 days.
.
The pt has HD on T,Th,Sat. His dry wt is thought to be 86kg. On
Tues he went for HD and had a full run. He returned on Wed for
more HD as he was felt to be fluid overloaded. At the end of the
extra run of HD he stood to leave, felt LH, tunnel vision, sat
down, and lost consciousness. Some of his fluid was returned.
The pt then returned for Thursday HD and was run even (wt 86.3
prior and 86.1 post). He went home and that night he stood from
bed at ~1am and had a syncopal episode. This happened again
later in the evening. He is unsure if he hit his head, but he
did fall from a stand. He notes increasing DOE (always present,
but now present when climbing 4 stairs), L jaw pain and chest
tightness reminiscent of his pericardial effusion.
.
In the ED he was noted to have a BP of 70's systolic, no
significant pulsus. He was seen by renal and received 3.5L NS, a
full aspirin, had CE's with a trop 0.02 and CK 269. Bedside US
revealed no signif pericardial effusion.
.
In addition, the pt notes that he has had increasing DOE, 3
pillow orthopnea, no PND, no [**Location (un) **], no fever, but + NS and chills.
Prior to the last week he had been eating more than normal.
Since passing out on Wednesday, he has been eating very little,
has vomitted x 2. He has chronic diarrhea up to 6x per day at
baseline and this has not changed. He has been very thirsty over
the past three days. He usually makes small amounts of urine,
but has made none since wednesday.
.


Past Medical History:
1. ESRD on hemodialysis, awaiting placement on transplant list
(HD T,Th, Sat)
2. Renal cell carcinoma of left kidney (s/p partial nephrectomy

[**5-17**]) T1, N0, M0. Surveillance MR [**First Name8 (NamePattern2) **] [**2165-5-15**] was negative
for recurrence.
2. CHF (stage II) - diastolic - followed by Dr. [**First Name (STitle) 437**]. Recently
started on carvedilol (end of [**Month (only) 547**])
3. Hypertension
4. DM2, HbA1C 9
5. Hepatitis C
6. HOH
7. Gout
8. Anemia
9. [**Doctor Last Name 15532**]??????s Esophagus
10.Prostate nodule, PSA 2.8 [**2165**]
11. Viral Pericardial effusion - [**1-20**]. [**Month (only) 958**] seen by echo to
have resolved. Not thought to be uremic effusion.


Social History:
Lives with sister, previously worked in a hotel, quit after [**Month (only) **]

admission to hospital.
Previous 80 pack year smoking history, quit in [**2165-5-15**].
Previous ETOH history of 1 pint per week, quit in [**2165-5-15**]
Previous crack cocaine use (1-2 times per month), quite in [**Month (only) **]
[**2164**]
Previous heroin use, quite 5-6 years ago


Family History:
Sister- DM
[**Name (NI) **] reported CAD.
Positive for alcoholism.
Mother died of "liver problems"; father died of stroke at 51. He

is unsure of any other medical problems in his family.

Physical Exam:
VS: T 98 BP 124/70 HR 80 RR 14 O2sat 100% RA
BG 99
GEN: NAD, conversant, oriented
HEENT: Anicteric sclera, OP clear, MM mod dry with dry/cracked
lips
NECK: supple, no LAD, no JVD
CARD: RRR, normal S1, S2. 2/6 systolic murmur at L USB
LUNG: Good air movement, clear lung fields laterally and
posterior
ABD: Protuberant, soft, ND, no tenderness. No HSM
EXT: WWP, dry, scaly skin on lower legs and feet bilaterally. DP

2+ bilaterally. No edema


Pertinent Results:
ADMISSION LABS:
[**2166-4-25**] 08:05AM BLOOD WBC-10.4 RBC-5.43# Hgb-15.0# Hct-46.5#
MCV-86 MCH-27.6 MCHC-32.2 RDW-18.6* Plt Ct-382
[**2166-4-25**] 08:05AM BLOOD Neuts-55.0 Lymphs-34.8 Monos-8.0 Eos-1.5
Baso-0.8
[**2166-4-25**] 08:05AM BLOOD Plt Ct-382
[**2166-4-25**] 08:15AM BLOOD PT-12.0 PTT-23.0 INR(PT)-1.0
[**2166-4-25**] 08:05AM BLOOD Glucose-170* UreaN-34* Creat-8.0*# Na-139
K-4.3 Cl-95* HCO3-23 AnGap-25*
[**2166-4-25**] 08:05AM BLOOD ALT-35 AST-45* CK(CPK)-269* AlkPhos-132*
Amylase-130* TotBili-0.5
[**2166-4-25**] 08:05AM BLOOD Lipase-108*
[**2166-4-25**] 08:05AM BLOOD CK-MB-1 cTropnT-0.02*
[**2166-4-25**] 07:53PM BLOOD CK-MB-1 cTropnT-0.02*
[**2166-4-25**] 07:53PM BLOOD CK(CPK)-201*
[**2166-4-25**] 08:05AM BLOOD Calcium-10.0 Phos-1.7* Mg-1.5*
[**2166-4-25**] 06:38PM BLOOD Type-ART pO2-65* pCO2-40 pH-7.42
calHCO3-27 Base XS-0
[**2166-4-25**] 08:17AM BLOOD Lactate-3.0* K-4.4
[**2166-4-25**] 06:38PM BLOOD Lactate-1.4 Na-143 K-4.3 Cl-101
.
IMAGING: CXR - clear

Brief Hospital Course:
# Hypotension: Pt had aggressive dialysis the week prior to
admission. He had an extra run and then felt lightheaded on
standing, and lost consciousness. He was thought to have a dry
wt of 86kg, however he has been eating more than normal over
recent wks, and believes he has been putting on weight. Dry
weight likely 88-89kg. After transfer to the floor, Mr.
[**Known lastname 30199**] BP remained stable overnight. He was restarted on
carvedilol 6.25mg PO bid without complication. He was slightly
orthostatic in the morning, and was given 1L NS over two hours.
He ambulated without difficulty or symptoms of dizziness. His AM
sodium came back as 126, but was thought to be dilutional, and
recheck was 138. He was d/c'ed on his home BP regimen with
instructions to continue hemodialysis as before. The
hemodialysis service will inform Mr. [**Known lastname 30199**] outside
nephrologist that his clothed dry weight should now be
considered 88-89kg.
.
# CHF: Followed by Dr. [**First Name (STitle) 437**]. At baseline has DOE on flat ground
and with stairs. EF intact, not volume overloaded in-house on
exam or radiographically. As above, d/c'ed on [**Last Name (un) **] and
carvedilol.
.
# HTN: At home on norvasc 5, carvedilol 6.25 [**Hospital1 **], valsartan 320,
dilt 180.  As above, restarted these meds while in-house, and
d/c'ed on home regimen.
.
#.Anemia:
Likely related to ESRD, has required transfusions in the past.
On Aranesp as an outpatient. Held in-house per renal.
.
#.Nausea and Diarrhea: Chronic issue. C. diff and stool cultures
sent in [**Hospital Unit Name 153**], pending at time of discharge.
.
#.Depression: Continued home dose of Zoloft.
.
#. Diabetes: Lantus 10U qHS and SSI at home. This was continued
while in-house.
.
#.Gout: Continued allopurinol 100mg QOD.
.
#.[**Doctor Last Name 15532**]??????s Esophagus: Continued PPI 40mg [**Hospital1 **]
.
#.Hepatitis C: Last viral load [**2166-1-30**]: 5,780,000 IU/mL. No
active cirrhosis, was not addressed during this admission.
.
#.Prophylaxis: Maintained with subcutaneous heparin, PPI



Medications on Admission:
1. Allopurinol 100 mg qod
2. Prilosec 40mg [**Hospital1 **]
3. Calcium Carbonate 500 mg tid
4. Diltiazem HCl 180 mg daily (Ext Release)
5. Valsartan 320 mg daily
6. Amlodipine 5 mg daily
7. Sertraline 50mg daily
8. Insulin Glargine 10 daily plus SSI
9. Carvedilol 6.25 [**Hospital1 **]

Discharge Medications:
1. Omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO twice a day.
2. Allopurinol 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TIDAC (3 times a day (before meals)).
4. Valsartan 160 mg Tablet Sig: Two (2) Tablet PO once a day.
5. Sertraline 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
7. DILT-XR 180 mg Capsule,Degradable Cnt Release Sig: One (1)
Capsule,Degradable Cnt Release PO once a day.
8. Carvedilol 3.125 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
9. Insulin
Lantus 10U SC qHS
10. Sliding Scale Insulin
Per home regimen
11. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1)
Capsule PO once a day.
12. Norvasc 5 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Home

Discharge Diagnosis:
Syncope


Discharge Condition:
Good


Discharge Instructions:
You were admitted after fainting, and were found to have had too
much fluid taken off during dialysis. You should take all of
your medicines as directed. You should call your physician or go
to the ED if you experience more lightheadedness or fainting,
fever, chills, or for any other problems that concern you. You
should continue to go to your dialysis sessions before, and
should tell your dialysis doctor that your dry weight should now
be considered 88-89kg while clothed.

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4450**], M.D. Phone:[**Telephone/Fax (1) 4451**]
Date/Time:[**2166-5-14**] 11:30
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2166-5-19**] 3:30
Provider: [**First Name4 (NamePattern1) 971**] [**Last Name (NamePattern1) 970**], MD Phone:[**Telephone/Fax (1) 673**]
Date/Time:[**2166-7-25**] 9:10


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 30200**] MD, MSC 12-AIE
{'Hypotension of hemodialysis,Chronic diastolic heart failure,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Unspecified viral hepatitis C without hepatic coma,Acidosis,Awaiting organ transplant status,Gout, unspecified,Personal history of malignant neoplasm of kidney,Anemia in chronic kidney disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: Syncope x 3 in 2 days prior to admission

PRESENT ILLNESS: 58 yo M h/o ESRD on HD on tx list, s/p L partial nephrectomy for
RCC in [**2164**], diastolic CHF, HTN with recent addition of
Carvedilol, Hep C, DM2, Gout, past pericardial tamponade of
viral etiology who presents after 3 episodes of syncope over the
past 2 days.
.
The pt has HD on T,Th,Sat. His dry wt is thought to be 86kg. On
Tues he went for HD and had a full run. He returned on Wed for
more HD as he was felt to be fluid overloaded. At the end of the
extra run of HD he stood to leave, felt LH, tunnel vision, sat
down, and lost consciousness. Some of his fluid was returned.
The pt then returned for Thursday HD and was run even (wt 86.3
prior and 86.1 post). He went home and that night he stood from
bed at ~1am and had a syncopal episode. This happened again
later in the evening. He is unsure if he hit his head, but he
did fall from a stand. He notes increasing DOE (always present,
but now present when climbing 4 stairs), L jaw pain and chest
tightness reminiscent of his pericardial effusion.
.
In the ED he was noted to have a BP of 70's systolic, no
significant pulsus. He was seen by renal and received 3.5L NS, a
full aspirin, had CE's with a trop 0.02 and CK 269. Bedside US
revealed no signif pericardial effusion.
.
In addition, the pt notes that he has had increasing DOE, 3
pillow orthopnea, no PND, no [**Location (un) **], no fever, but + NS and chills.
Prior to the last week he had been eating more than normal.
Since passing out on Wednesday, he has been eating very little,
has vomitted x 2. He has chronic diarrhea up to 6x per day at
baseline and this has not changed. He has been very thirsty over
the past three days. He usually makes small amounts of urine,
but has made none since wednesday.
.

MEDICAL HISTORY: 1. ESRD on hemodialysis, awaiting placement on transplant list
(HD T,Th, Sat)
2. Renal cell carcinoma of left kidney (s/p partial nephrectomy

MEDICATION ON ADMISSION: 1. Allopurinol 100 mg qod
2. Prilosec 40mg [**Hospital1 **]
3. Calcium Carbonate 500 mg tid
4. Diltiazem HCl 180 mg daily (Ext Release)
5. Valsartan 320 mg daily
6. Amlodipine 5 mg daily
7. Sertraline 50mg daily
8. Insulin Glargine 10 daily plus SSI
9. Carvedilol 6.25 [**Hospital1 **]

ALLERGIES: Iron Dextran Complex

PHYSICAL EXAM: VS: T 98 BP 124/70 HR 80 RR 14 O2sat 100% RA
BG 99
GEN: NAD, conversant, oriented
HEENT: Anicteric sclera, OP clear, MM mod dry with dry/cracked
lips
NECK: supple, no LAD, no JVD
CARD: RRR, normal S1, S2. 2/6 systolic murmur at L USB
LUNG: Good air movement, clear lung fields laterally and
posterior
ABD: Protuberant, soft, ND, no tenderness. No HSM
EXT: WWP, dry, scaly skin on lower legs and feet bilaterally. DP

FAMILY HISTORY: Sister- DM
[**Name (NI) **] reported CAD.
Positive for alcoholism.
Mother died of "liver problems"; father died of stroke at 51. He

SOCIAL HISTORY: Lives with sister, previously worked in a hotel, quit after [**Month (only) **] 

### Response:
{'Hypotension of hemodialysis,Chronic diastolic heart failure,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Unspecified viral hepatitis C without hepatic coma,Acidosis,Awaiting organ transplant status,Gout, unspecified,Personal history of malignant neoplasm of kidney,Anemia in chronic kidney disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
