CHIEF COMPLAINT: Hyperkalemia

PRESENT ILLNESS: 64 y/o F w/ ESRD [**2-21**] IgA nephropathy s/[**Name Initial (MD) **] failed CRT [**2173**] on HD
(MWF) through LUE AVF since [**2193**] and recent MVR surgery in [**Month (only) **]
[**2198**] presents to ED from rehab with diarrhea, nausea, and chills
x2 days. Patient states she has been feeling unwell for 2 days.
She has had approximately 14 episodes of diarrhea per day and
these have become less frequent today. Also had nausea but no
vomiting. Pt states she has been feeling more fatigued since
these symptoms started and has had a nonproductive cough for 2
days. Also endorses chills and decreased appetite. She missed HD
yesterday because she felt unwell. Denies lightheadednes, bloody
stool, abdominal pain, chest pain, shortness of breath,
palpitations, vomiting.  She has been in rehab since her MVR
surgery.
.
In the ED, initial VS were:  T 98.6 P 73 BP 131/63 RR18 SaO2 91%
2L NC. Pt was initially satting in the 80s but improved with O2.
 K was 7.4 and EKG showed QRS 180 (prior 104). CXR was
consistent with volume overload and suggestive of RML pna.
Patient was given albuterol, 2g CaGluc, 10 U Insulin, 1 amp D50.
 After treatment, QRS decreased to 172. She was also given
levoloxacin 750mg IV for pneumonia. Renal was consulted and
recommended emergent HD for hyperkalemia with associated EKG
changes.
 .
On arrival to the MICU, patient states she felt better and her
last BM was more formed. She was started on HD upon arrival to
the unit.
.
On the floor, the patient has a slight headache, but otherwise
is asymptomatic. Her nausea has resolved and her diarrhea is
improved.

MEDICAL HISTORY: 1. Atrial fibrillation/flutter: first diagnosed in [**Month (only) **]
[**2195**]. On coumadin
2. End-stage renal disease on hemodialysis secondary to IgA
nephropathy s/p cadaveric kidney transplant in [**2173**] which has
eventually failed, and started on hemodialysis in [**2193**].
3. History of upper GI bleeding on [**2195-2-20**] with evidence
of esophagitis, gastric ulcer, and bleeding duodenal vessel s/p
clipping, cauterization and PPI.
4. Diastolic heart failure supported by an echocardiography from
[**2195-12-21**]. Clinically asx.
5. History of malignant hypertension, which was complicated by
seizure on [**2193-5-20**]. Not on antiepileptic meds. Denies h/o CVA.

MEDICATION ON ADMISSION: 1. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Citalopram 20 mg Tablet Sig: One (1) Tablet PO once a day.
3.ASA 81 mg QD
4. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day.
5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
6. Bisacodyl 5mg QD
7. Norvasc 10 mg Tablet Sig: One (1) Tablet PO once a day.
8. Sensipar 30mg Tablet Sig: One (1) Tablet PO once a day.
9. Coumadin dose unknown
10. Nephrocaps
11. Pravastatin 80 mg QD
12. Trazadone 50mg PO

ALLERGIES: Dilantin Kapseal

PHYSICAL EXAM: VS: 97.7, HR 80 BP 113/66 RR 25 SaO2 93% on RA.
GEN: alert and oriented x3, NAD
CV: RRR, II/VI soft diastolic murmur in 2nd L-IC space, w/
radiation to carotids
LUNGS: bilbasilar crackles, R>L
ABD: soft, non-tender, non-distended, bowel sounds present, no
rebound tenderness or guarding, no organomegaly
EXT: thin, warm, well perfused, 2+ pulses, no clubbing, cyanosis
or edema
NEURO: moving all 4 extremeties, no focal deficits

FAMILY HISTORY: Her father died at the age of 80. Her mother died at the age of
64 from lung CA. She has a sister with breast CA. MI in uncle in
his 60s.

SOCIAL HISTORY: Originally from [**Country 65588**], single, used to live by herself in
[**Location (un) 686**], and has no children. Has been in the rehab facility
since late [**Month (only) **]. Ambulates w/walker at rehab facility.
-Tobacco history: 10pyear hx, quit 25yrs ago
-ETOH:  rarely
-Illicit drugs: denies
Hyperpotassemia,End stage renal disease,Pneumonia, organism unspecified,Complications of transplanted kidney,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Chronic diastolic heart failure,Acute kidney failure, unspecified,Intestinal infection due to other organism, not elsewhere classified,Atrial fibrillation,Hypoxemia,Thrombocytopenia, unspecified,Leukocytopenia, unspecified,Abnormal coagulation profile,Anemia in chronic kidney disease,Other and unspecified hyperlipidemia,Depressive disorder, not elsewhere classified,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Renal dialysis status,Personal history of tobacco use,Long-term (current) use of anticoagulants,Heart valve replaced by other means
Hyperpotassemia,End stage renal disease,Pneumonia, organism NOS,Compl kidney transplant,Hyp kid NOS w cr kid V,Chr diastolic hrt fail,Acute kidney failure NOS,Viral enteritis NOS,Atrial fibrillation,Hypoxemia,Thrombocytopenia NOS,Leukocytopenia NOS,Abnrml coagultion prfile,Anemia in chr kidney dis,Hyperlipidemia NEC/NOS,Depressive disorder NEC,Abn react-org transplant,Renal dialysis status,History of tobacco use,Long-term use anticoagul,Heart valve replac NEC
Admission Date:  [**2199-3-6**]              Discharge Date:   [**2199-3-9**]

Date of Birth:  [**2134-9-9**]             Sex:   F

Service: MEDICINE

Allergies:
Dilantin Kapseal

Attending:[**First Name3 (LF) 9160**]
Chief Complaint:
Hyperkalemia

Major Surgical or Invasive Procedure:
Hemodialysis

History of Present Illness:
64 y/o F w/ ESRD [**2-21**] IgA nephropathy s/[**Name Initial (MD) **] failed CRT [**2173**] on HD
(MWF) through LUE AVF since [**2193**] and recent MVR surgery in [**Month (only) **]
[**2198**] presents to ED from rehab with diarrhea, nausea, and chills
x2 days. Patient states she has been feeling unwell for 2 days.
She has had approximately 14 episodes of diarrhea per day and
these have become less frequent today. Also had nausea but no
vomiting. Pt states she has been feeling more fatigued since
these symptoms started and has had a nonproductive cough for 2
days. Also endorses chills and decreased appetite. She missed HD
yesterday because she felt unwell. Denies lightheadednes, bloody
stool, abdominal pain, chest pain, shortness of breath,
palpitations, vomiting.  She has been in rehab since her MVR
surgery.
.
In the ED, initial VS were:  T 98.6 P 73 BP 131/63 RR18 SaO2 91%
2L NC. Pt was initially satting in the 80s but improved with O2.
 K was 7.4 and EKG showed QRS 180 (prior 104). CXR was
consistent with volume overload and suggestive of RML pna.
Patient was given albuterol, 2g CaGluc, 10 U Insulin, 1 amp D50.
 After treatment, QRS decreased to 172. She was also given
levoloxacin 750mg IV for pneumonia. Renal was consulted and
recommended emergent HD for hyperkalemia with associated EKG
changes.
 .
On arrival to the MICU, patient states she felt better and her
last BM was more formed. She was started on HD upon arrival to
the unit.
.
On the floor, the patient has a slight headache, but otherwise
is asymptomatic. Her nausea has resolved and her diarrhea is
improved.


Past Medical History:
1. Atrial fibrillation/flutter: first diagnosed in [**Month (only) **]
[**2195**]. On coumadin
2. End-stage renal disease on hemodialysis secondary to IgA
nephropathy s/p cadaveric kidney transplant in [**2173**] which has
eventually failed, and started on hemodialysis in [**2193**].
3. History of upper GI bleeding on [**2195-2-20**] with evidence
of esophagitis, gastric ulcer, and bleeding duodenal vessel s/p
clipping, cauterization and PPI.
4. Diastolic heart failure supported by an echocardiography from
[**2195-12-21**]. Clinically asx.
5. History of malignant hypertension, which was complicated by
seizure on [**2193-5-20**]. Not on antiepileptic meds. Denies h/o CVA.

6. Depression.
7. Rheumatic fever in childhood
8. MVR in [**12/2198**]


Social History:
Originally from [**Country 65588**], single, used to live by herself in
[**Location (un) 686**], and has no children. Has been in the rehab facility
since late [**Month (only) **]. Ambulates w/walker at rehab facility.
-Tobacco history: 10pyear hx, quit 25yrs ago
-ETOH:  rarely
-Illicit drugs: denies


Family History:
Her father died at the age of 80. Her mother died at the age of
64 from lung CA. She has a sister with breast CA. MI in uncle in
his 60s.

Physical Exam:
VS: 97.7, HR 80 BP 113/66 RR 25 SaO2 93% on RA.
GEN: alert and oriented x3, NAD
CV: RRR, II/VI soft diastolic murmur in 2nd L-IC space, w/
radiation to carotids
LUNGS: bilbasilar crackles, R>L
ABD: soft, non-tender, non-distended, bowel sounds present, no
rebound tenderness or guarding, no organomegaly
EXT: thin, warm, well perfused, 2+ pulses, no clubbing, cyanosis
or edema
NEURO: moving all 4 extremeties, no focal deficits

Discharge vitals 98.4 bp126/70 p95 rr20 98% on Room air
GEN: alert and oriented x3, NAD
CV: RRR, II/VI soft diastolic murmur in 2nd L-IC space, w/
radiation to carotids
LUNGS: bilbasilar crackles, R>L
ABD: soft, non-tender, non-distended, bowel sounds present, no
rebound tenderness or guarding, no organomegaly
EXT: thin, warm, well perfused, 2+ pulses, no clubbing, cyanosis
or edema
NEURO: moving all 4 extremeties, no focal deficits


Pertinent Results:
[**2199-3-6**] 12:50PM BLOOD WBC-6.9 RBC-3.86*# Hgb-11.3*# Hct-35.5*
MCV-92 MCH-29.3 MCHC-31.9 RDW-16.7* Plt Ct-255
[**2199-3-8**] 05:40AM BLOOD WBC-2.5*# RBC-3.66* Hgb-10.2* Hct-34.3*
MCV-94 MCH-28.0 MCHC-29.9* RDW-17.3* Plt Ct-141*
[**2199-3-8**] 05:40AM BLOOD Neuts-69.8 Lymphs-21.6 Monos-7.7 Eos-0.4
Baso-0.4
[**2199-3-6**] 03:33PM BLOOD PT-18.7* PTT-34.6 INR(PT)-1.8*
[**2199-3-7**] 09:04AM BLOOD PT-36.2* PTT-150* INR(PT)-3.5*
[**2199-3-8**] 05:40AM BLOOD PT-16.5* PTT-33.7 INR(PT)-1.6*
[**2199-3-6**] 03:32PM BLOOD Glucose-95 UreaN-101* Creat-10.3*#
Na-132* K-6.2* Cl-95* HCO3-18* AnGap-25*
[**2199-3-8**] 05:40AM BLOOD Glucose-85 UreaN-21* Creat-3.7*# Na-136
K-3.7 Cl-94* HCO3-30 AnGap-16
[**2199-3-6**] 01:03PM BLOOD Lactate-1.8 Na-132* K-7.4* Cl-97
calHCO3-20*

[**2199-3-6**] 3:34 pm MRSA SCREEN      Source: Nasal swab.

                            **FINAL REPORT [**2199-3-8**]**

   MRSA SCREEN (Final [**2199-3-8**]):
      POSITIVE FOR METHICILLIN RESISTANT STAPH AUREUS.

[**2199-3-8**] Chest X-ray

INDICATION: Volume overload, pneumonia, assessment for interval
change.

COMPARISON: [**2199-3-6**].

FINDINGS: As compared to the previous radiograph, there is a
minimal improvement of the reticular opacities. Otherwise, the
widespread bilateral parenchymal opacities are unchanged.
Unchanged small left pleural effusion, unchanged moderate
cardiomegaly.


Brief Hospital Course:
63 F w/ ESRD [**2-21**] IgA nephropathy s/p failed cadaveric transplant
in [**2173**] on HD (TRS) through LUE AVF since [**2193**] who presented
with nausea, vomiting, and diarrhea admitted to ICU for emergent
dialysis for volume overload and hyperkalemia. The patient had
resolution of her hyperkalemia and volume overload after HD and
was transferred to the floor.
.
# Hyperkalemia: Patient was found to have K 7.4 with prolonged
QRS and LBBB. Hyperkalemia felt most likely due to missing HD on
day prior to admission.  Underwent emergent dialysis with
normalization of her potassium level and QRS narrowing back to
baseline.  She was hemodialysed on [**1-16**], and [**3-9**]. Plan
for next HD session on [**2199-3-12**] to return to her normal T,Th,Sa
HD schedule.
.
# Volume overload: Likely related to missing HD due to acute
illness.  On admission, weight was ~ 3kg higher than dry weight
~ 39.7 Kg.  Patient underwent HD with 1.2 and 2.0 L in
ultrafiltrate removed during first 2 inpatient sessions.  Oxygen
requirement of 2L was no longer needed after removal of excess
fluid.  Due to patient's anuria, she is dependent on HD and
importance of maintening dry weight can not be emphasized more
clearly. At discharge, she was at her dry weight of 39KG.
.
# Hypoxia: Oxygen requirement of 2L on admission.  Due to chest
x-ray suggestive of questionable right middle lobe pneumonia,
was started on vancomycin, cefepime and levaquin in setting of
report of chills and cough for 2 days prior to admission.  RML
opacity improved with fluid removal during HD on review of
repeat films. Similar opacity on prior films has fluctuated with
volume status.  Given lack of leukocytosis and fever as well as
resolution of oxygen demand after HD, antibiotics were
discontinued upon transfer to the floor.  She remained afebrile
with minimal intermittant cough, felt to be non-infectious in
nature.
.
# Diarrhea: Symptoms improved over hospital course. Given
residence in rehab facility and transient course, likely viral
in nature. Lack of fever or leukocytosis, and benign abdominal
exam, made C. diff unlikely, so this was not checked.

# s/p mitral valve replacement: Pt is on coumadin with goal INR
3-3.5. INR was subtherapeutic at 1.8. She was started on a
heparin gtt to bridge and her coumadin was increased to 2mg with
increase to supratherapeutic levels and subsequently held.  She
is being discharged on heparin gtt until she reaches therapeutic
INR on Warfarin.
.
#Troponinemia: Likely related to renal failure in the setting of
HD. Patient denies chest pain. EKG changes likely related to
hyperkalemia. Baseline trop is 0.4. She was continued on her
home baby aspirin.
.
# HLD: Continued statin.
.
# Afib: Currently in sinus rhythm. Continued Amiodorone.
.
# Depression: Continued Celexa.

TRANSITIONAL ISSUES:
* INR - GOAL 3.0-3.5 for mechanical valve. On heparin gtt,
warfarin dosing titrated on daily basis as she is very sensitive
to slight changes in dose.
* ESRD - Resume Tuesday, Thursday, Saturday HD schedule.  On
renagel, sevelamer, and sensipar
* Cardiovascular - restarted low-dose carvedilol, should be
given after HD on HD days.
* Goal dry weight is 39kg, which was her weight on discharge.

Medications on Admission:
1. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Citalopram 20 mg Tablet Sig: One (1) Tablet PO once a day.
3.ASA 81 mg QD
4. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day.
5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
6. Bisacodyl 5mg QD
7. Norvasc 10 mg Tablet Sig: One (1) Tablet PO once a day.
8. Sensipar 30mg Tablet Sig: One (1) Tablet PO once a day.
9. Coumadin dose unknown
10. Nephrocaps
11. Pravastatin 80 mg QD
12. Trazadone 50mg PO



Discharge Medications:
1. citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

2. cinacalcet 30 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
4. amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day.
5. sevelamer carbonate 800 mg Tablet Sig: One (1) Tablet PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
6. carvedilol 6.25 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day): hold for SBP<100 or HR<60.  Do not give prior to HD.
7. Dulcolax 5 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day as needed for
constipation.
8. Vitamin D 1,000 unit Tablet Sig: One (1) Tablet PO once a
day.
9. lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily):
hold for sbp<100.
10. amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. pravastatin 80 mg Tablet Sig: One (1) Tablet PO once a day.

12. trazodone 50 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime) as needed for sleep.
13. Senna Concentrate 8.6 mg Tablet Sig: 1-2 Tablets PO once a
day as needed for constipation.
14. B complex-vitamin C-folic acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
15. warfarin 1 mg Tablet Sig: 1-2 Tablets PO Once Daily at 4 PM:
Variable dosing based on INR.
16. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H
(every 6 hours) as needed for fever/pain.
17. omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
18. heparin (porcine) in D5W 25,000 unit/250 mL Parenteral
Solution Sig: Eight [**Age over 90 1230**]y (850) units/hour Intravenous
continuous infusion: HEPARIN PER INSTITUTIONAL POLICY.
Discontinue after INR 3.0-3.5.
19. epoetin alfa  Injection at dialysis


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 **]

Discharge Diagnosis:
Hyperkalemia
Subtherapeutic INR


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were admitted to the hospital due to electrolyte
abnormalities after you missed a dialysis session due to a
gastrointestinal illness. Here, you underwent urgent HD to
correct your high potassium and signs of fluid overload. You
tolerated the dialysis fine and will continue your Tuesday,
Thursday, Saturday schedule. Also, we saw that your coumadin
level was low while you were here. We gave you an extra dose of
coumadin and you will have to continue close monitoring of the
INR at rehab. We also added low dose Coreg back to your regimen.

Followup Instructions:
Once discharged from rehab facility, please schedule an
appointment to see your PCP.  [**Name10 (NameIs) 30236**] scheduled appointments
at [**Hospital1 18**]:

Department: CARDIAC SERVICES
When: FRIDAY [**2199-4-12**] at 3:00 PM
With: [**Name6 (MD) 251**] [**Last Name (NamePattern4) 677**], M.D. [**Telephone/Fax (1) 62**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 9162**]

Completed by:[**2199-3-9**]
{'Hyperpotassemia,End stage renal disease,Pneumonia, organism unspecified,Complications of transplanted kidney,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Chronic diastolic heart failure,Acute kidney failure, unspecified,Intestinal infection due to other organism, not elsewhere classified,Atrial fibrillation,Hypoxemia,Thrombocytopenia, unspecified,Leukocytopenia, unspecified,Abnormal coagulation profile,Anemia in chronic kidney disease,Other and unspecified hyperlipidemia,Depressive disorder, not elsewhere classified,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Renal dialysis status,Personal history of tobacco use,Long-term (current) use of anticoagulants,Heart valve replaced by other means'}


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: Hyperkalemia

PRESENT ILLNESS: 64 y/o F w/ ESRD [**2-21**] IgA nephropathy s/[**Name Initial (MD) **] failed CRT [**2173**] on HD
(MWF) through LUE AVF since [**2193**] and recent MVR surgery in [**Month (only) **]
[**2198**] presents to ED from rehab with diarrhea, nausea, and chills
x2 days. Patient states she has been feeling unwell for 2 days.
She has had approximately 14 episodes of diarrhea per day and
these have become less frequent today. Also had nausea but no
vomiting. Pt states she has been feeling more fatigued since
these symptoms started and has had a nonproductive cough for 2
days. Also endorses chills and decreased appetite. She missed HD
yesterday because she felt unwell. Denies lightheadednes, bloody
stool, abdominal pain, chest pain, shortness of breath,
palpitations, vomiting.  She has been in rehab since her MVR
surgery.
.
In the ED, initial VS were:  T 98.6 P 73 BP 131/63 RR18 SaO2 91%
2L NC. Pt was initially satting in the 80s but improved with O2.
 K was 7.4 and EKG showed QRS 180 (prior 104). CXR was
consistent with volume overload and suggestive of RML pna.
Patient was given albuterol, 2g CaGluc, 10 U Insulin, 1 amp D50.
 After treatment, QRS decreased to 172. She was also given
levoloxacin 750mg IV for pneumonia. Renal was consulted and
recommended emergent HD for hyperkalemia with associated EKG
changes.
 .
On arrival to the MICU, patient states she felt better and her
last BM was more formed. She was started on HD upon arrival to
the unit.
.
On the floor, the patient has a slight headache, but otherwise
is asymptomatic. Her nausea has resolved and her diarrhea is
improved.

MEDICAL HISTORY: 1. Atrial fibrillation/flutter: first diagnosed in [**Month (only) **]
[**2195**]. On coumadin
2. End-stage renal disease on hemodialysis secondary to IgA
nephropathy s/p cadaveric kidney transplant in [**2173**] which has
eventually failed, and started on hemodialysis in [**2193**].
3. History of upper GI bleeding on [**2195-2-20**] with evidence
of esophagitis, gastric ulcer, and bleeding duodenal vessel s/p
clipping, cauterization and PPI.
4. Diastolic heart failure supported by an echocardiography from
[**2195-12-21**]. Clinically asx.
5. History of malignant hypertension, which was complicated by
seizure on [**2193-5-20**]. Not on antiepileptic meds. Denies h/o CVA.

MEDICATION ON ADMISSION: 1. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Citalopram 20 mg Tablet Sig: One (1) Tablet PO once a day.
3.ASA 81 mg QD
4. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day.
5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
6. Bisacodyl 5mg QD
7. Norvasc 10 mg Tablet Sig: One (1) Tablet PO once a day.
8. Sensipar 30mg Tablet Sig: One (1) Tablet PO once a day.
9. Coumadin dose unknown
10. Nephrocaps
11. Pravastatin 80 mg QD
12. Trazadone 50mg PO

ALLERGIES: Dilantin Kapseal

PHYSICAL EXAM: VS: 97.7, HR 80 BP 113/66 RR 25 SaO2 93% on RA.
GEN: alert and oriented x3, NAD
CV: RRR, II/VI soft diastolic murmur in 2nd L-IC space, w/
radiation to carotids
LUNGS: bilbasilar crackles, R>L
ABD: soft, non-tender, non-distended, bowel sounds present, no
rebound tenderness or guarding, no organomegaly
EXT: thin, warm, well perfused, 2+ pulses, no clubbing, cyanosis
or edema
NEURO: moving all 4 extremeties, no focal deficits

FAMILY HISTORY: Her father died at the age of 80. Her mother died at the age of
64 from lung CA. She has a sister with breast CA. MI in uncle in
his 60s.

SOCIAL HISTORY: Originally from [**Country 65588**], single, used to live by herself in
[**Location (un) 686**], and has no children. Has been in the rehab facility
since late [**Month (only) **]. Ambulates w/walker at rehab facility.
-Tobacco history: 10pyear hx, quit 25yrs ago
-ETOH:  rarely
-Illicit drugs: denies 

### Response:
{'Hyperpotassemia,End stage renal disease,Pneumonia, organism unspecified,Complications of transplanted kidney,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Chronic diastolic heart failure,Acute kidney failure, unspecified,Intestinal infection due to other organism, not elsewhere classified,Atrial fibrillation,Hypoxemia,Thrombocytopenia, unspecified,Leukocytopenia, unspecified,Abnormal coagulation profile,Anemia in chronic kidney disease,Other and unspecified hyperlipidemia,Depressive disorder, not elsewhere classified,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Renal dialysis status,Personal history of tobacco use,Long-term (current) use of anticoagulants,Heart valve replaced by other means'}
