CHIEF COMPLAINT: HA, seizure, hypertension

PRESENT ILLNESS: History was derived from the medical chart and the pt's wife.
.
Mr. [**Known lastname 784**] is a 44 yo man with ESRD [**1-12**] reflux nephropathy s/p
failed LRRT in [**2134**], HTN, PUD who awoke on the morning of
admission at ~4 a.m. with a severe headache. He had associated
nausea and vomiting. He was also mily disoriented, slurring his
words and even walked into a wall because he did not see it. The
pt's wife then called EMS. When EMS arrived, he reportedly ahd a
GTC seizure that lasted ~2 minutes that resolved without
intervention.
.
At the OSH, he underwent head CT, which did not demonstrate any
hemorrhage. His intial CBC was WBC 4.4, Hgb 10.2, Plt 105. His
BP was controlled with labetalol 20 mg IV x1 (down to 170/95).
.
He was transferred to [**Hospital1 18**] for further care.
.
In the ED at [**Hospital1 18**], his initial VSs were 99.9, 87, 233/125, 32,
99%. He underwent LP, which demonstrated no leukocytosis and 42
RBCs in Tubes 1 and 4. He received ceftriaxone 2g IV, ampicillin
2g IV, vancomycin 1g IV, acetaminophen, lorazepam 4mg IV total,
haloperidol 10mg IV total, hydralazine 20 mg IV, labetalol 20 mg
IV and was eventually started on a nitroprusside drip.
.
No further history was obtained from the pt [**1-12**] delirium.

MEDICAL HISTORY: - ESRD secondary to chronic ureterovesical junction obstruction

MEDICATION ON ADMISSION: Lisinopril 40 mg [**Hospital1 **]
Carvedilol 12.5 mg [**Hospital1 **]
Valsartan 80 mg daily
Nifedipine SR 30 mg [**Hospital1 **]
Clonidine 0.3 mg/24 hr Patch
Tacrolimus 2 mg [**Hospital1 **]
Mycophenolate Mofetil 1000 mg [**Hospital1 **]
Trimethoprim-Sulfamethoxazole 80-400 mg daily
Pantoprazole 40 mg daily
Sevelamer HCl 800 mg tid with meals
B Complex-Vitamin C-Folic Acid 1 mg daily

ALLERGIES: Ciprofloxacin

PHYSICAL EXAM: Vitals: T: 100.6 BP: 246/104 P: 85 R: 28 SaO2: 100%
General: Unarousable, jittery, does not follow commands
HEENT: NCAT, PERRL, no scleral icterus, MMM
Neck: supple, no significant JVD, no neck stiffness
Pulmonary: Lungs CTA bilaterally, no wheezes, ronchi or rales
Cardiac: RR, nl S1 S2, no murmurs, rubs or gallops appreciated
Abdomen: soft, ND, normoactive bowel sounds
Extremities: No edema, 2+ radial, DP pulses b/l
Skin: no rashes noted.
Neurologic: Unarousable, does not follow commands. PERRL. Normal
bulk. No abnormal movements noted. Moves all extremities. 2+
reflexes at the patella and biceps. Plantar response was flexor
bilaterally.

FAMILY HISTORY: Father had MI mid 50s. No DM. Brother had cancer of jaw which
was resected.

SOCIAL HISTORY: 40py, quit 2 yrs ago. No EtOH or other drugs. Lives in apartment
building with his wheelchair-bound wife where he works as
superintendent.
Other encephalopathy,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute respiratory failure,End stage renal disease,Complications of transplanted kidney,Generalized convulsive epilepsy, without mention of intractable epilepsy,Peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Gout, unspecified,Esophageal reflux,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Encephalopathy NEC,Acute kidney failure NOS,Hyp kid NOS w cr kid V,Acute respiratry failure,End stage renal disease,Compl kidney transplant,Gen cnv epil w/o intr ep,Peptic ulcer NOS,Gout NOS,Esophageal reflux,Abn react-org transplant
Admission Date:  [**2143-5-4**]              Discharge Date:   [**2143-5-11**]

Date of Birth:  [**2098-12-27**]             Sex:   M

Service: MEDICINE

Allergies:
Ciprofloxacin

Attending:[**First Name3 (LF) 9002**]
Chief Complaint:
HA, seizure, hypertension

Major Surgical or Invasive Procedure:
arterial line placement
lumbar puncture
endotracheal intubation


History of Present Illness:
History was derived from the medical chart and the pt's wife.
.
Mr. [**Known lastname 784**] is a 44 yo man with ESRD [**1-12**] reflux nephropathy s/p
failed LRRT in [**2134**], HTN, PUD who awoke on the morning of
admission at ~4 a.m. with a severe headache. He had associated
nausea and vomiting. He was also mily disoriented, slurring his
words and even walked into a wall because he did not see it. The
pt's wife then called EMS. When EMS arrived, he reportedly ahd a
GTC seizure that lasted ~2 minutes that resolved without
intervention.
.
At the OSH, he underwent head CT, which did not demonstrate any
hemorrhage. His intial CBC was WBC 4.4, Hgb 10.2, Plt 105. His
BP was controlled with labetalol 20 mg IV x1 (down to 170/95).
.
He was transferred to [**Hospital1 18**] for further care.
.
In the ED at [**Hospital1 18**], his initial VSs were 99.9, 87, 233/125, 32,
99%. He underwent LP, which demonstrated no leukocytosis and 42
RBCs in Tubes 1 and 4. He received ceftriaxone 2g IV, ampicillin
2g IV, vancomycin 1g IV, acetaminophen, lorazepam 4mg IV total,
haloperidol 10mg IV total, hydralazine 20 mg IV, labetalol 20 mg
IV and was eventually started on a nitroprusside drip.
.
No further history was obtained from the pt [**1-12**] delirium.


Past Medical History:
- ESRD secondary to chronic ureterovesical junction obstruction

leading to bilateral hydronephrosis, on hemodialysis
- s/p renal transplant [**2134**] ([**Name (NI) 106515**] brother)
- Severe hypertension
- Gout
- Peptic Ulcer disease
- Bladder neck stricture
- Atypical chest pain


Social History:
40py, quit 2 yrs ago. No EtOH or other drugs. Lives in apartment
building with his wheelchair-bound wife where he works as
superintendent.

Family History:
Father had MI mid 50s. No DM. Brother had cancer of jaw which
was resected.

Physical Exam:
Vitals: T: 100.6 BP: 246/104 P: 85 R: 28 SaO2: 100%
General: Unarousable, jittery, does not follow commands
HEENT: NCAT, PERRL, no scleral icterus, MMM
Neck: supple, no significant JVD, no neck stiffness
Pulmonary: Lungs CTA bilaterally, no wheezes, ronchi or rales
Cardiac: RR, nl S1 S2, no murmurs, rubs or gallops appreciated
Abdomen: soft, ND, normoactive bowel sounds
Extremities: No edema, 2+ radial, DP pulses b/l
Skin: no rashes noted.
Neurologic: Unarousable, does not follow commands. PERRL. Normal
bulk. No abnormal movements noted. Moves all extremities. 2+
reflexes at the patella and biceps. Plantar response was flexor
bilaterally.


Pertinent Results:
Admission labs:
[**2143-5-4**] 11:50AM   WBC-5.3 RBC-3.52* HGB-10.0* HCT-31.4* MCV-89
MCH-28.5 MCHC-31.9 RDW-15.7*
[**2143-5-4**] 11:50AM   NEUTS-88.1* LYMPHS-9.2* MONOS-2.4 EOS-0.2
BASOS-0.2
[**2143-5-4**] 11:50AM   PLT COUNT-145*
[**2143-5-4**] 11:50AM   PT-13.4 PTT-32.4 INR(PT)-1.1
[**2143-5-4**] 11:50AM   GLUCOSE-103 UREA N-17 CREAT-6.4* SODIUM-140
POTASSIUM-6.5* CHLORIDE-103 TOTAL CO2-25 ANION GAP-19
[**2143-5-4**] 11:50AM   ALBUMIN-4.0 CALCIUM-9.2 PHOSPHATE-3.6
MAGNESIUM-2.4
[**2143-5-4**] 11:50AM   ALT(SGPT)-9 AST(SGOT)-67* LD(LDH)-885* ALK
PHOS-73 TOT BILI-0.7
[**2143-5-4**] 11:59AM   GLUCOSE-101 LACTATE-1.6 NA+-140 K+-4.1
CL--100 TCO2-30
[**2143-5-4**] 11:50AM   AMMONIA-LESS THAN
[**2143-5-4**] 11:50AM   TSH-1.0
[**2143-5-4**] 11:50AM   T4-7.8 FREE T4-1.1
[**2143-5-4**] 11:50AM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2143-5-4**] 12:30PM URINE  bnzodzpn-NEG barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2143-5-4**] 01:00PM CEREBROSPINAL FLUID (CSF)  PROTEIN-43
GLUCOSE-59
[**2143-5-4**] 01:00PM CEREBROSPINAL FLUID (CSF)  WBC-1 RBC-42*
POLYS-20 LYMPHS-60 MONOS-20
[**2143-5-4**] 01:00PM CEREBROSPINAL FLUID (CSF)  WBC-0 RBC-42*
POLYS-0 LYMPHS-0 MONOS-0

Brief Hospital Course:
44-year-old man with ESRD on HD and difficult-to-control
hypertension presented with seizures, found to be hypertensive
to 233/125.

# Hypertensive emergency: Patient continued on valstartan,
carvediol, clonidine, hydralazine, lisinopril, and nifedepine.
In the MICU his BP was controlled with labetolol and nitro gtts.
Nicardipine gtt was eventually used. He was converted from
nicardipine to nifedipine on [**2143-5-9**]. Blood pressure were in the
150's with the drips and were slightly higher on the nifedipine
but with maintained diastolics in the 80-90's. He was
transitioned back to PO home meds while in the MICU and then
transferred to the floor. He was electively intubated for airway
protection. He self-extubated and was reintubated, and was
eventually extubated without incident. His BP on the floor
remained in the 150-160/80-90 range. Further workup of the
etiology of his refractory chronic HTN was deferred for his
outpatient care providers given that laboratory test results
would have taken a week to return and he did not require
inpatient level of care.

# Neurology: Patient's mental status improved gradually. He was
initially treated with acyclovir pending CSF HSV PCR, but it was
discontinued when CSF was found to be HSV negative. Neurology
signed off and indicated no need for further neurologic f/u.

# Respiratory failure: Patient extubated without any respiratory
difficulty.

# ID: Patient afebrile off of all antibiotics. An infectious
etiology for his presentation was felt to be unlikely.

# ESRD s/p failed transplant: He had HD every Mon, Wed, Fri.
Tacrolimus was discontinued due to concern for PRES.
Mycophenolate was increased to 1000 [**Hospital1 **]. He was continued on PCP
prophylaxis with TMP/SMX. His medications were renally dosed.

# GERD/PUD:  continued on outpatient pantoprazole.

# Code status: FULL CODE

Medications on Admission:
Lisinopril 40 mg [**Hospital1 **]
Carvedilol 12.5 mg [**Hospital1 **]
Valsartan 80 mg daily
Nifedipine SR 30 mg [**Hospital1 **]
Clonidine 0.3 mg/24 hr Patch
Tacrolimus 2 mg [**Hospital1 **]
Mycophenolate Mofetil 1000 mg [**Hospital1 **]
Trimethoprim-Sulfamethoxazole 80-400 mg daily
Pantoprazole 40 mg daily
Sevelamer HCl 800 mg tid with meals
B Complex-Vitamin C-Folic Acid 1 mg daily


Discharge Medications:
1. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily).
2. Clonidine 0.3 mg/24 hr Patch Weekly Sig: One (1) Patch Weekly
Transdermal QMON (every Monday).
Disp:*4 Patch Weekly(s)* Refills:*2*
3. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
6. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for fever.
7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
8. Mycophenolate Mofetil 250 mg Capsule Sig: Four (4) Capsule PO
BID (2 times a day).
9. Simethicone 80 mg Tablet, Chewable Sig: One (1) Tablet,
Chewable PO QID (4 times a day) as needed.
10. Hydralazine 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours).
Disp:*120 Tablet(s)* Refills:*2*
11. Valsartan 160 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*2*
12. Carvedilol 25 mg Tablet Sig: Two (2) Tablet PO twice a day.
Disp:*120 Tablet(s)* Refills:*2*
13. Lisinopril 40 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*2*
14. Renagel 800 mg Tablet Sig: One (1) Tablet PO three times a
day.
15. Nifedipine 30 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO once a day.
Disp:*30 Tablet Sustained Release(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Major: Hypertensive emergency
PRES
seizure
.
Minor:
acute renal failure


Discharge Condition:
stable


Discharge Instructions:
You were admitted for severely elevated blood pressure. You were
found to have a neurologic condition called PRES which was
thought to be related to your high blood pressure. PRES results
in your thinking being confused and is life threatening. It is
very important to keep your blood pressure under control. Your
blood pressure is under better control. It is important that you
take all of your medications as prescribed. You were also
evaluated by neurology.

If you develop fevers, chills, confusion, weakness,
numbness/tingling in your extremities, or find blood pressures
>160 at home you should call your doctor.

Please take all of your medications as prescribed and follow up
with the appointments below.

MEDICATIONS:
Your Carvedilol and Valsartan has been increased to better
control your blood pressure.
Your Nifedipine dose has been decreased to help control your
blood pressure.
Hydralazine has been STARTED to treat your high blood pressure.
Your TACROLIMUS has been STOPPED as you do not need this drug
any longer.

Followup Instructions:
Please call your PCP to set up a follow-up appointment within
the next two weeks. Dr.[**Name (NI) 29254**] telephone number is
[**Telephone/Fax (1) 250**].

Please continue to follow-up with your outpatient hemodialysis
program and your outpatient nephrologist per your usual
schedule.

You do not need a follow-up appointment with neurology. However,
if you would like to reach the neurology clinic, please call
[**Telephone/Fax (1) 8302**].
{'Other encephalopathy,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute respiratory failure,End stage renal disease,Complications of transplanted kidney,Generalized convulsive epilepsy, without mention of intractable epilepsy,Peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Gout, unspecified,Esophageal reflux,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: HA, seizure, hypertension

PRESENT ILLNESS: History was derived from the medical chart and the pt's wife.
.
Mr. [**Known lastname 784**] is a 44 yo man with ESRD [**1-12**] reflux nephropathy s/p
failed LRRT in [**2134**], HTN, PUD who awoke on the morning of
admission at ~4 a.m. with a severe headache. He had associated
nausea and vomiting. He was also mily disoriented, slurring his
words and even walked into a wall because he did not see it. The
pt's wife then called EMS. When EMS arrived, he reportedly ahd a
GTC seizure that lasted ~2 minutes that resolved without
intervention.
.
At the OSH, he underwent head CT, which did not demonstrate any
hemorrhage. His intial CBC was WBC 4.4, Hgb 10.2, Plt 105. His
BP was controlled with labetalol 20 mg IV x1 (down to 170/95).
.
He was transferred to [**Hospital1 18**] for further care.
.
In the ED at [**Hospital1 18**], his initial VSs were 99.9, 87, 233/125, 32,
99%. He underwent LP, which demonstrated no leukocytosis and 42
RBCs in Tubes 1 and 4. He received ceftriaxone 2g IV, ampicillin
2g IV, vancomycin 1g IV, acetaminophen, lorazepam 4mg IV total,
haloperidol 10mg IV total, hydralazine 20 mg IV, labetalol 20 mg
IV and was eventually started on a nitroprusside drip.
.
No further history was obtained from the pt [**1-12**] delirium.

MEDICAL HISTORY: - ESRD secondary to chronic ureterovesical junction obstruction

MEDICATION ON ADMISSION: Lisinopril 40 mg [**Hospital1 **]
Carvedilol 12.5 mg [**Hospital1 **]
Valsartan 80 mg daily
Nifedipine SR 30 mg [**Hospital1 **]
Clonidine 0.3 mg/24 hr Patch
Tacrolimus 2 mg [**Hospital1 **]
Mycophenolate Mofetil 1000 mg [**Hospital1 **]
Trimethoprim-Sulfamethoxazole 80-400 mg daily
Pantoprazole 40 mg daily
Sevelamer HCl 800 mg tid with meals
B Complex-Vitamin C-Folic Acid 1 mg daily

ALLERGIES: Ciprofloxacin

PHYSICAL EXAM: Vitals: T: 100.6 BP: 246/104 P: 85 R: 28 SaO2: 100%
General: Unarousable, jittery, does not follow commands
HEENT: NCAT, PERRL, no scleral icterus, MMM
Neck: supple, no significant JVD, no neck stiffness
Pulmonary: Lungs CTA bilaterally, no wheezes, ronchi or rales
Cardiac: RR, nl S1 S2, no murmurs, rubs or gallops appreciated
Abdomen: soft, ND, normoactive bowel sounds
Extremities: No edema, 2+ radial, DP pulses b/l
Skin: no rashes noted.
Neurologic: Unarousable, does not follow commands. PERRL. Normal
bulk. No abnormal movements noted. Moves all extremities. 2+
reflexes at the patella and biceps. Plantar response was flexor
bilaterally.

FAMILY HISTORY: Father had MI mid 50s. No DM. Brother had cancer of jaw which
was resected.

SOCIAL HISTORY: 40py, quit 2 yrs ago. No EtOH or other drugs. Lives in apartment
building with his wheelchair-bound wife where he works as
superintendent. 

### Response:
{'Other encephalopathy,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute respiratory failure,End stage renal disease,Complications of transplanted kidney,Generalized convulsive epilepsy, without mention of intractable epilepsy,Peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Gout, unspecified,Esophageal reflux,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
