CHIEF COMPLAINT: Bloody pleural effusion in OSH, SOB

PRESENT ILLNESS: This pt is a 60 y/o F with history of CKD, HTN, without
treatment for either, who presents with 6 months of
unintentional wt loss, increasing SOB on exertion, and
increasing LE edema. She presented to a new PCP, [**Name10 (NameIs) 1023**] sent her to
[**Location (un) **] ED  where a large loculated left pleural effusion was
found and 1L bloody effusion was removed ([**7-19**]). B/l LE dopplers
negative. CT scan from OSH showed no masses in abdomen or
pelvis, only effusion in left lower lung.
.
Since [**Month (only) **], the patient has had 85 pounds of unintentional
wt loss. She had shortness of breath on exertion after walking
about 40 feet. denies orthopnea. Denies PND. patient had
dependent edema at baseline, which she says has been worsenign
over the past 2-3 months. She also c/o fatigue, decreased
appetite.
.
Patient went to the doctor several years ago, and was noted to
have elevated creatinine, likely chronic renal failure from htn.
Pt says she has occassional elevated blood pressure, and does
not take medication for it. She did not follow up the chronic
kidney disease.
.
Patient has never had colonoscopy or mammogram. Does not see
doctor regularly.
.
In our ED, VS 95 174/80 95% RA. CXR w large left sided effusion.
K 5.4. No EKG changes. Kayexelate given. Hct 27, OB negative.
Creatinine 6.1.
.
On ROS: denies dysuria, hematuria, or noted sediment/discharge.
Denies any flank pain. No HA, vision changes, no LAD, no CP
palpitations, no abd pain, no const/diarrhea. no fevers, chills,
diaphorses.

MEDICAL HISTORY: nephrolithiasis 4yrs ago
HTN - Noted several times, but sometimes also normotensive, thus
never took meds for this.
CKD - noticed several years ago, never treated, never followed
up.
Osteoarthritis

MEDICATION ON ADMISSION: tylenol daily for OA

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 98, 166/92 HR 96 18 97% 2L
Gen: pleasant, appears older than stated age.

FAMILY HISTORY: Colon ca in [**Last Name (un) **] 52, GM 60
Lung ca in GF 65
Afib mom
TIA mom
DM sister and 2 [**Name2 (NI) **]
Celiac, sogrens sister

SOCIAL HISTORY: lives with mother. [**Name (NI) **] [**Name2 (NI) **]. Prior [**11-28**] ppd x 15yrs. No IVDU.
Social etoh. Many supportive family members. [**Name (NI) **]: case manager
at NH currently.
Unspecified pleural effusion,Empyema without mention of fistula,Acute kidney failure, unspecified,Cardiac complications, not elsewhere classified,Cardiac arrest,Subendocardial infarction, initial episode of care,Acute diastolic heart failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Pneumonia, organism unspecified,Anemia in chronic kidney disease,Loss of weight
Pleural effusion NOS,Empyema w/o fistula,Acute kidney failure NOS,Surg compl-heart,Cardiac arrest,Subendo infarct, initial,Ac diastolic hrt failure,Hyp kid NOS w cr kid V,End stage renal disease,Pneumonia, organism NOS,Anemia in chr kidney dis,Abnormal loss of weight
Admission Date:  [**2131-7-20**]              Discharge Date:   [**2131-8-10**]

Date of Birth:  [**2071-2-26**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2160**]
Chief Complaint:
Bloody pleural effusion in OSH, SOB

Major Surgical or Invasive Procedure:
VATS (Video assisted thorascopic surgery) and lung biopsy
Insertion of hemodialysis catheter
Cardiac arrest requiring CPR and electric cardioversion.


History of Present Illness:
This pt is a 60 y/o F with history of CKD, HTN, without
treatment for either, who presents with 6 months of
unintentional wt loss, increasing SOB on exertion, and
increasing LE edema. She presented to a new PCP, [**Name10 (NameIs) 1023**] sent her to
[**Location (un) **] ED  where a large loculated left pleural effusion was
found and 1L bloody effusion was removed ([**7-19**]). B/l LE dopplers
negative. CT scan from OSH showed no masses in abdomen or
pelvis, only effusion in left lower lung.
.
Since [**Month (only) **], the patient has had 85 pounds of unintentional
wt loss. She had shortness of breath on exertion after walking
about 40 feet. denies orthopnea. Denies PND. patient had
dependent edema at baseline, which she says has been worsenign
over the past 2-3 months. She also c/o fatigue, decreased
appetite.
.
Patient went to the doctor several years ago, and was noted to
have elevated creatinine, likely chronic renal failure from htn.
Pt says she has occassional elevated blood pressure, and does
not take medication for it. She did not follow up the chronic
kidney disease.
.
Patient has never had colonoscopy or mammogram. Does not see
doctor regularly.
.
In our ED, VS 95 174/80 95% RA. CXR w large left sided effusion.
K 5.4. No EKG changes. Kayexelate given. Hct 27, OB negative.
Creatinine 6.1.
.
On ROS: denies dysuria, hematuria, or noted sediment/discharge.
Denies any flank pain. No HA, vision changes, no LAD, no CP
palpitations, no abd pain, no const/diarrhea. no fevers, chills,
diaphorses.


Past Medical History:
nephrolithiasis 4yrs ago
HTN - Noted several times, but sometimes also normotensive, thus
never took meds for this.
CKD - noticed several years ago, never treated, never followed
up.
Osteoarthritis

Social History:
lives with mother. [**Name (NI) **] [**Name2 (NI) **]. Prior [**11-28**] ppd x 15yrs. No IVDU.
Social etoh. Many supportive family members. [**Name (NI) **]: case manager
at NH currently.

Family History:
Colon ca in [**Last Name (un) **] 52, GM 60
Lung ca in GF 65
Afib mom
TIA mom
DM sister and 2 [**Name2 (NI) **]
Celiac, sogrens sister

Physical Exam:
98, 166/92 HR 96 18 97% 2L
Gen: pleasant, appears older than stated age.

HEENT: anicteric, MMM, OP clear. no oral lesions.
Neck: no LAD, supple, postive JVD
breast; large 3x5 cm right breast mass reportedly unchanged for
over 20 years
CV: II/VI SEM LUSB, nl S1S2 Reg, tachy
Chest: decreased BS left base, +e->a egophany LLL, decreased
fremetus LLL. otherwise clear
Abd: no CVA tenderness. BS+ NT ND. no HSM. no rebound. no masses

Ext: mild edema. bilat very tender legs
Lymphs: full cervical, inguinal, and axillary neg
OB neg
NEURO: AAO x3

Pertinent Results:
[**2131-7-20**] 06:45PM   WBC-10.7 RBC-2.97* HGB-8.5* HCT-27.0* MCV-91
MCH-28.6 MCHC-31.5 RDW-18.8*
[**2131-7-20**] 06:45PM   NEUTS-71.6* LYMPHS-21.1 MONOS-4.1 EOS-2.7
BASOS-0.5
[**2131-7-20**] 06:45PM   PLT COUNT-452*
[**2131-7-20**] 06:45PM   PT-13.1 PTT-27.3 INR(PT)-1.1
[**2131-7-20**] 06:45PM   GLUCOSE-80 UREA N-74* CREAT-6.1* SODIUM-136
POTASSIUM-5.4* CHLORIDE-110* TOTAL CO2-12* ANION GAP-19
.
[**2131-7-21**] Renal U/S
RENAL ULTRASOUND:  The right kidney measures 8.6 cm.  The left
kidney measures 7.2 cm.  There is increased echogenicity of the
renal sinuses and thinning of the cortex bilaterally.  There are
no stones or hydronephrosis.  A 1.4 x 1.1 cm cyst is seen within
the lower pole of the right kidney.  A partially full bladder is
unremarkable.
IMPRESSION:
Atrophic kidneys bilaterally consistent with chronic
medical-renal disease. No stones or hydronephrosis.
.
[**2131-7-21**] CT Abdomen/Pelvis with contrast
CT CHEST FINDINGS:  Some subcentimeter mediastinal lymph nodes
are noted that are not pathological by size criteria.  The main
pulmonary artery is prominent at 3.2 cm with a maximum diameter
of the right pulmonary artery measuring 2.8 cm.  There is some
vascular calcification noted.  There is volume loss in the left
hemithorax.  There is a left pleural effusion which extends
circumferentially around the lateral side of the chest wall.
There is a slightly thickened rim of parietal pleura just
adjacent to the chest wall in relation to this pleural effusion.
 There is associated atelectasis; superimposed consolidation
cannot be excluded. There are calcified pleural plaques noted
suggesting a history of asbestos exposure.
CT ABDOMEN FINDINGS:  Given that this is a non-contrast CT, the
liver and
spleen are normal.  The gallbladder is normal.  There is
calcification of the splenic vasculature.  The adrenals are
normal.  The kidneys are reduced in size.  Some areas of low
attenuation are seen in the right kidney which may be consistent
with cysts.  Some tiny scattered punctate areas of high
attenuation are seen in relation to the kidneys bilaterally
which represent calculi that are nonobstructing.
The pancreas is normal.  No significant retroperitoneal
lymphadenopathy.  The bowel where visualized is normal.
CT PELVIS FINDINGS:  Note is made of diverticulosis without
evidence of
diverticulitis especially in the sigmoid colon.  The bladder is
normal.  The uterus is unremarkable.
Bony windows reveal some degenerative changes at the L5-S1
level.
Multiplanar reconstructions were essential in depicting the
anatomy and
identifying the pathology.
IMPRESSION:
1.  Volume loss in left hemithorax with moderate-sized left
pleural effusion and associated collapse and atelectasis but no
definite mass identified. No evidence of high attenuation in
pleural fluid to suggest recent hemorrhage.
2.  Calcified pleural plaques suggesting asbestos exposure.
Thickening of the parietal pleura surrounding the left pleural
effusion.
3.  Diverticulosis without evidence of diverticulitis.
4.  Prominent pulmonary artery which may suggest pulmonary
hypertension.
5.  Renal cysts and nonobstructing calculi.
.
[**2131-7-23**] Echocardiogram
Conclusions:
The left atrium is normal in size. There is moderate symmetric
left
ventricular hypertrophy. The left ventricular cavity size is
normal. Regional  left ventricular wall motion is normal.
Overall left ventricular systolic  function is normal
(LVEF>55%). Tissue Doppler imaging suggests an increased  left
ventricular filling pressure (PCWP>18mmHg). Right ventricular
chamber  size and free wall motion are normal. The aortic valve
leaflets (3) are mildly  thickened but aortic stenosis is not
present. No aortic regurgitation is seen.  The mitral valve
leaflets are structurally normal. There is no mitral valve
prolapse. Mild (1+) mitral regurgitation is seen. The estimated
pulmonary  artery systolic pressure is normal. There is no
pericardial effusion.
IMPRESSION: Moderate symmetric left ventricular hypertrophy with
normal cavity  size and regional/global systolic function. Mild
mitral regurgitatio.
.
[**7-24**] Venous duplex
IMPRESSION:  Right cephalic and basilic veins are patent.  The
left basilic vein is patent and the left cephalic vein is
clotted at the level of the forearm.
.
[**2131-7-31**]  Chest CT
IMPRESSION:
1.  Persistent left loculated pneumothorax with air leaking
along the chest wall into the subcutaneous tissue.
Bronchopleural fistula cannot be excluded. Overall slight
decrease in the amount of the right pleural effusion.
2.  Right pleural effusion, slightly increase in size,
accompanied by left
lower lobe atelectasis.
3.  New multiple bilateral, right more than left consolidations,
which may
represent aspiration and/or pneumonia.
4.  Improvement of aeration of the left upper lobe compared to
the most recent chest radiograph.
.
[**2131-8-9**] CXR
REASON FOR EXAMINATION:  Followup of a patient with known
loculated
hydropneumothorax on the left.
PA and lateral upright chest radiograph compared to [**8-8**], [**2130**].
The loculated left hydropneumothorax is unchanged.  The
cardiomediastinal
silhouette is stable.  The right pleural effusion is
small-to-moderate,
unchanged.  The right lung is unremarkable as well as the left
upper lung.
Subcutaneous emphysema within the left chest wall is stable.
IMPRESSION:  No evidence of interval change.







Brief Hospital Course:
60 y/o F with history of HTN and CKD (untreated) who presented
with increasing SOB, bloody pleural effussion, and concern for
ARF.  VATS for decortication and biopsy was attempted however
had to be aborted as patient went into cardiac arrest PEA v.
asystole v. fine vfib arrest she was resuscitated and
transferred to MICU for continued care.  She had an elevation in
cardiac enzymes following this event felt most likely due to
cardiac defibrillation rather than ACS.  Renal function was
worsened following this event and patient had to be started on
hemodialysis for treatment on volume overload and uremia.  She
also had a chest tube in place to treat her persistent pleural
effusions.  The chest tube was removed prior to discharge which
she tolerated well.  Prior to discharge, outpatient hemodialysis
was arranged as well as contact for consideration of peritoneal
dialysis.
.
Brief Hospital Course by Problem:
.
#Persistent Bloody pleural effusion: On admission, VATS
attempted for biopsy and decortication however the procedure had
to be aborted due to cardiac arrest.  Tissue sample and pleural
fluid was obtained and was negative for AFB, fungus, bacteria,
malignancy.  She had a chest tube placed in the OR following
biopsy.  This was left in place with considerable drainage of
bloody fluid.  Chest tube was removed prior to discharge which
she tolerated without event.  She continued to have bilateral
persistent pleural effusions and she was discharge on oxygen as
she desaturated on ambulation. She will follow up with Dr.
[**Last Name (STitle) **].
.
#. hospital/ventillator acquired pneumonia - during MICU stay
she was noted to have infiltrate felt most likely to be due to
hopital/ventillator acquired pneumonia.  She was treated with 2
week course of cefepime and vancomycin with last dose on
[**2131-8-13**].  She was discharged on levofloxacin and vancomycin
dosed with dialysis to complete course of treatment.
.
#. Acute renal on end stage renal failure - on admission she had
end stage renal failure with likely hemodialysis in the near
future however her renal function was significantly worsened
following her cardiac arrest.  She did not recover any
significant renal function in the days following the event and
she was started on hemodialysis for treatment of uremia and
volume overload.  She tolerated dialysis well and was discharge
with outpatient hemodialysis and appointment to discuss option
of peritoneal dialysis.  She was treated with epogen and iron
with dialysis for anemia.  In addition she was started on
nephrocaps and renagel.
.
#s/p asystolic/VF arrest at time of lung bipsy with NSTEMI and
troponins up to 0.5- most likely [**12-29**] cardioversion with
resuscitation.  She was started on metoprolol, ASA and
lisinopril prior to discharge.  She opted not to have inpatient
stress test to further evaluate risk for cardiac ishemia however
agreed to have her primary care physician arrange this as an
outpatient.  Echocardiogram showed low normal EF at 50% without
focal wall motion abnormalities.
.
#Left cephalic vein clot on prior UE u/s - likely related to
prior PICC on that side.  She refused repeat ultrasound to asses
for extension or resolution of clot but agreed to have her
primary care doctor arrange as an outpatient.
.
#.Weight loss- significant unintentional weight loss prior to
admission. Pleural fluid without evidence of malignancy, no LAD
or fevers/sweats. No prior colonoscopy or mammogram. Concern for
lipoma vs. breast mass, per pt-breast mass on R side has not
grown, no bx done but U/S done in past. Pt with family h/o colon
CA.  She agreed to follow up with colonoscopy and mammogram as
an outpatient.
.
#. Anemia - ACD secondary to renal disease, stable hematocrit
throughout admission.  Treated with epogen and iron with
dialysis.  She will follow up with colonoscopy as outpatient.
.
#. CODE: DNR/DNI discussed


Medications on Admission:
tylenol daily for OA

Discharge Medications:
1. mammogram
bilateral mammogram. Pt has never had one. H/O R.breast "lipoma"
2. colonoscopy
Screening and diagnostic colonoscopy. Pt has never had one.
3. gynecology
Pt needs gyn appointment/referral for complete pelvic exam and
pap smear.
4. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
Disp:*30 Tablet, Chewable(s)* Refills:*2*
5. Vancomycin 500 mg Recon Soln Sig: per dialysis protocol based
on trough Recon Soln Intravenous ONCE (Once) for 1 doses: you
should get one additional dose of vancomycin with dialysis on
[**8-13**] based on your trough.  This will complete your course of
vancomycin.
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
7. Calcium Acetate 667 mg Capsule Sig: Three (3) Capsule PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
Disp:*270 Capsule(s)* Refills:*2*
8. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
9. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
Disp:*30 Cap(s)* Refills:*2*
10. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) puffs
Inhalation every four to six hours as needed as needed for
shortness of breath or wheezing.
Disp:*1 inhaler* Refills:*1*
11. Sevelamer 800 mg Tablet Sig: One (1) Tablet PO TID W/MEALS
(3 TIMES A DAY WITH MEALS).
Disp:*90 Tablet(s)* Refills:*2*
12. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
13. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q48H
(every 48 hours) for 1 days: take this pill on [**2131-8-12**], then you
are finished with your antibiotics.
Disp:*1 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) **] Nursing Services

Discharge Diagnosis:
CArdiac arrest
Pleural Effusion, hydropneumothorax s/p [**Hospital 74566**]
Hospital acquired pneumonia
Acute renal failure
CKD V on hemodialysis
HTN
minor: breast lipoma
Anemia from chronic kidney disease

Discharge Condition:
good


Discharge Instructions:
You were admitted because you were found to have a bloody
pleural effusion. In addition you had hypertension and chronic
kidney disease that were not treated.  A bloody pleural effusion
can be a sign of malignancy, however the diagnostic studies have
not shown any evidence of malignancy. However, you will need to
have a mammogram and breast ultrasound, a pelvic exam and pap
smear to continue to evaluate for any evidence of cancer. You
will also need a colonoscopy as you have not yet had these
exams. These are very important.  It is important that you take
your medications as prescribed and follow up with the
appointments below.
.
In addition, you had a cardiac arrest during the lung biopsy
procedure that you had.  It is unclear why this happended to you
but as we discussed, we feel that you should have further work
up to make sure that you do not have coronary artery disease.
We wanted to do a stress test for your heart in the hospital
however you opted not to have that.  Please ask your primary
care doctor to arrange for you to have that test as an
outpatient.

You are now on hemodialysis to treat your kidney failure.
Please follow up with dialysis as arranged.  In addition you
have an appointment with the kidney doctor as listed below.

You should also follow up with the lung doctors as listed below.

You have a blood clot in the cephalic vein of your left arm.
Please ask your doctor [**First Name (Titles) **] [**Last Name (Titles) **] an ultrasound to re-evaluate
this to make sure that it has not gotten any larger.

You have some new medications including lipitor and lisinopril.
Please have your doctor check your liver enzymes and a chemistry
panel at your appointment.

[**First Name8 (NamePattern2) 5969**] [**Last Name (NamePattern1) 15170**] will be contacting you to set up follow up to
discuss peritoneal dialysis.
Call your doctor or return to the hospital if you experience any
concerning symptoms including shortness of breath, chest pain,
fever, worsening cough, or any other concerning symptoms.

Followup Instructions:
You will be having dialysis treatments at Physicians Dialysis,
INC in [**Location (un) 1157**], MA.  [**Street Address(2) 74567**], PH#[**Telephone/Fax (1) 74568**] on
monday wednesday and friday.  You will be getting one more dose
of vancomycin at your dialysis appointment on monday based on
your trough level.

1. Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 435**]
Date/Time:[**2131-8-15**] 3:00

2.  You have an appointment with your PCP [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 27542**]
[**Telephone/Fax (1) 27541**] on [**2131-8-20**] at 1:30 for treatment of your high blood
pressure, kidney disease and to fascilitate mammography, breast
ultrasound, colonoscopy, and gyn exam.  In addition, please ask
him to set up an appointment for a stress test for your heart.
You also need a repeat ultrasound of your arm to follow up on
the blood clot that was seen in your left cephalic vein.

4. Provider: [**First Name11 (Name Pattern1) 2389**] [**Last Name (NamePattern1) 2390**], MD Phone:[**0-0-**]
Date/Time:[**2131-8-23**] 9:30.  This appointment is to follow up from
the chest tube.

5.  Dr. [**Last Name (STitle) **] (pulmonary)  [**2131-9-12**] at 4pm.  The phone number
to call and reschedule this appointment is [**Telephone/Fax (1) **].
{'Unspecified pleural effusion,Empyema without mention of fistula,Acute kidney failure, unspecified,Cardiac complications, not elsewhere classified,Cardiac arrest,Subendocardial infarction, initial episode of care,Acute diastolic heart failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Pneumonia, organism unspecified,Anemia in chronic kidney disease,Loss of weight'}


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: Bloody pleural effusion in OSH, SOB

PRESENT ILLNESS: This pt is a 60 y/o F with history of CKD, HTN, without
treatment for either, who presents with 6 months of
unintentional wt loss, increasing SOB on exertion, and
increasing LE edema. She presented to a new PCP, [**Name10 (NameIs) 1023**] sent her to
[**Location (un) **] ED  where a large loculated left pleural effusion was
found and 1L bloody effusion was removed ([**7-19**]). B/l LE dopplers
negative. CT scan from OSH showed no masses in abdomen or
pelvis, only effusion in left lower lung.
.
Since [**Month (only) **], the patient has had 85 pounds of unintentional
wt loss. She had shortness of breath on exertion after walking
about 40 feet. denies orthopnea. Denies PND. patient had
dependent edema at baseline, which she says has been worsenign
over the past 2-3 months. She also c/o fatigue, decreased
appetite.
.
Patient went to the doctor several years ago, and was noted to
have elevated creatinine, likely chronic renal failure from htn.
Pt says she has occassional elevated blood pressure, and does
not take medication for it. She did not follow up the chronic
kidney disease.
.
Patient has never had colonoscopy or mammogram. Does not see
doctor regularly.
.
In our ED, VS 95 174/80 95% RA. CXR w large left sided effusion.
K 5.4. No EKG changes. Kayexelate given. Hct 27, OB negative.
Creatinine 6.1.
.
On ROS: denies dysuria, hematuria, or noted sediment/discharge.
Denies any flank pain. No HA, vision changes, no LAD, no CP
palpitations, no abd pain, no const/diarrhea. no fevers, chills,
diaphorses.

MEDICAL HISTORY: nephrolithiasis 4yrs ago
HTN - Noted several times, but sometimes also normotensive, thus
never took meds for this.
CKD - noticed several years ago, never treated, never followed
up.
Osteoarthritis

MEDICATION ON ADMISSION: tylenol daily for OA

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 98, 166/92 HR 96 18 97% 2L
Gen: pleasant, appears older than stated age.

FAMILY HISTORY: Colon ca in [**Last Name (un) **] 52, GM 60
Lung ca in GF 65
Afib mom
TIA mom
DM sister and 2 [**Name2 (NI) **]
Celiac, sogrens sister

SOCIAL HISTORY: lives with mother. [**Name (NI) **] [**Name2 (NI) **]. Prior [**11-28**] ppd x 15yrs. No IVDU.
Social etoh. Many supportive family members. [**Name (NI) **]: case manager
at NH currently. 

### Response:
{'Unspecified pleural effusion,Empyema without mention of fistula,Acute kidney failure, unspecified,Cardiac complications, not elsewhere classified,Cardiac arrest,Subendocardial infarction, initial episode of care,Acute diastolic heart failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Pneumonia, organism unspecified,Anemia in chronic kidney disease,Loss of weight'}
