CHIEF COMPLAINT: 

PRESENT ILLNESS: 52-year-old male with
insulin-dependent diabetes mellitus, coronary artery disease,
severe congestive heart failure, end stage renal disease on
peritoneal dialysis, who presents on the advice of VNA nurse
for "gangrene in the toe."  The patient is otherwise without
complaints, no shortness of breath, no chest pain, no
pre-syncope, no fevers or chills, no abdominal pain.
Positive cough with sputum production, no myalgias,
odynophagia or constitutional symptoms.  The patient received
one liter of normal saline bolus x 2 for SBP in 70s with
appropriate increase to 90s.  Normal peritoneal dialysis on
[**10-5**].  The patient is well known to the Medicine service,
with multiple admissions in the past, most recently for SBP
for which he was discharged from the hospital one week prior
with continued oral fluconazole and was to continue to be
followed up by Dr. [**First Name (STitle) 805**].  Now the patient comes for
evaluation of removal of the peritoneal dialysis catheter.

MEDICAL HISTORY: 1.  Insulin-dependent diabetes mellitus
2.  End stage renal disease on peritoneal dialysis
3.  Coronary artery disease status post myocardial infarction
in 5/00
4.  Congestive heart failure
5.  Hypertension
6.  Peripheral vascular disease status post right below the
knee amputation
7.  Polysubstance abuse
8.  Encephalopathy
9.  Right ocular prosthesis

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Infection and inflammatory reaction due to peritoneal dialysis catheter,Pneumonia, organism unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Staphylococcal septicemia, unspecified,Other shock without mention of trauma,Ulcer of other part of foot,Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as uncontrolled
React-periton dialy cath,Pneumonia, organism NOS,Hyp kid NOS w cr kid V,Staphylcocc septicem NOS,Shock w/o trauma NEC,Ulcer other part of foot,DMI ophth nt st uncntrld
Admission Date:  [**2123-10-5**]       Discharge Date:  [**2123-10-15**]

Date of Birth:   [**2071-4-18**]       Sex:  M

Service:  [**Location (un) 259**]

HISTORY OF PRESENT ILLNESS:   52-year-old male with
insulin-dependent diabetes mellitus, coronary artery disease,
severe congestive heart failure, end stage renal disease on
peritoneal dialysis, who presents on the advice of VNA nurse
for "gangrene in the toe."  The patient is otherwise without
complaints, no shortness of breath, no chest pain, no
pre-syncope, no fevers or chills, no abdominal pain.
Positive cough with sputum production, no myalgias,
odynophagia or constitutional symptoms.  The patient received
one liter of normal saline bolus x 2 for SBP in 70s with
appropriate increase to 90s.  Normal peritoneal dialysis on
[**10-5**].  The patient is well known to the Medicine service,
with multiple admissions in the past, most recently for SBP
for which he was discharged from the hospital one week prior
with continued oral fluconazole and was to continue to be
followed up by Dr. [**First Name (STitle) 805**].  Now the patient comes for
evaluation of removal of the peritoneal dialysis catheter.

PAST MEDICAL HISTORY:
1.  Insulin-dependent diabetes mellitus
2.  End stage renal disease on peritoneal dialysis
3.  Coronary artery disease status post myocardial infarction
in 5/00
4.  Congestive heart failure
5.  Hypertension
6.  Peripheral vascular disease status post right below the
knee amputation
7.  Polysubstance abuse
8.  Encephalopathy
9.  Right ocular prosthesis

MEDICATIONS:   Aspirin 81 mg by mouth once daily, Nephrocaps
one once daily, Zestril 30 mg by mouth once daily, atenolol
25 mg by mouth once daily, Reglan 10 mg by mouth four times a
day, Coumadin 2 mg by mouth daily at bedtime, Colace 100 mg
by mouth twice a day, insulin 70/30 7 units every morning and
3 units every evening, Fluconazole 400 mg by mouth once
daily.

PHYSICAL EXAMINATION:   Vital signs:  Pulse 68, blood
pressure 95/60, respiratory rate 16, 96% on 2 liters nasal
cannula.  General:  Elderly male, in mild distress.  Head,
eyes, ears, nose and throat:  Right orbit empty, left eye
sclera clear, not injected, no lymph nodes, oropharynx dry,
no jugular venous distention.  Pulmonary:  Decreased breath
sounds bilaterally, left greater than right, no wheezes,
rhonchi or rales, question possible dullness to percussion
one-third of the way up the left side.  Cardiovascular:
Respiratory rate, without any murmurs, gallops or rubs,
normal S1 and S2.  Abdomen:  Soft, nontender, nondistended,
normal active bowel sounds, no rebound or guarding noted.
Extremities:  Chronic venous stasis changes noted to the left
lower extremity, no open ulcers or lesions, no tenderness.
Left third toe black, small necrotic-appearing ulcer, no
scars or symptoms noted, no inflammation.  Positive distal
pulse by Doppler.  Right below the knee amputation noted.

LABORATORY DATA:   White blood cells 8.2, 72% neutrophils, no
bands, 19% lymphocytes.  Hematocrit 31.0, platelets 389.
Coagulation:  INR 3.5.  Sodium 134, potassium 3.5, chloride
93, CO2 28, BUN 37, creatinine 7.2, glucose 325.  Chest
x-ray:  Atelectasis vs. scarring at the right base, new area
of infiltrate with air bronchogram to the left base.
Electrocardiogram showed normal sinus rhythm at 66, axis was
normal.  There were no acute ST/T wave changes, T waves in V1
and V4 consistent with prior electrocardiogram of [**2123-1-26**].

HOSPITAL COURSE:  Mr. [**Known lastname 20464**] was admitted to [**Hospital1 346**], [**Location (un) **] firm, for ongoing
treatment and workup of fungal peritonitis and left third toe
gangrenous ulcer.

1.  Infectious Disease:  The patient was felt to have
continued fungal peritonitis, as during his previous hospital
stay.  He was continued on oral fluconazole 400 mg by mouth
once daily in the first three hospital days.  In discussion
with the Infectious Disease team, it was felt he would
benefit from change in the anti-fungal regimen, so he was
switched to amphotericin intravenously.  After a test dose,
he was given amphotericin B 33 mg intravenously once daily
with premedication with Demerol and hydrocortisone for seven
days.  This was continued after his peritoneal dialysis
catheter was removed.  He tolerated the amphotericin B well.
He continued afebrile throughout the entire hospital course,
however, on hospital day four, he was noted to have an
elevated white count without a local source of infection.
His white count was followed and dropped over the course of
subsequent days to 13.5 at the time of this dictation.

2.  Access:  The patient continued to have an infected
peritoneal dialysis catheter at the time of hospital
admission.  On hospital day three, this peritoneal dialysis
catheter was removed without complications.  He remained
without dialysis access for several days.  Finally, on
hospital day six, the patient had a right femoral tunneled
catheter placed after multiple attempts in surgery and
interventional radiology to place the tunneled hemodialysis
catheter in his subclavian/axillary/internal jugular veins.
It was felt that these sites were all very poor access sites,
and the only alternative at that time was felt to be a
tunneled femoral hemodialysis catheter, although this is not
felt to be ideal and is only a temporary bridge until we can
replace the peritoneal dialysis catheter.

3.  Vascular:  Mr. [**Known lastname 20464**] was evaluated by the Vascular team
on hospital day two for left second toe gangrenous ulcer.  He
was noted to have arterial insufficiency of the left leg
evidenced by skin changes, nonpalpable pulses, however, his
third toe was not felt to be gangrenous and no vascular
intervention is indicated at this point.  During the rest of
his hospital stay, he was without complaint of his left
second toe, and no further progression of his mild ulcer.  If
desired, Mr. [**Known lastname 20464**] can follow up with Dr. [**Last Name (STitle) 20466**] of the
vascular team as an outpatient for possible treatment
options.

4.  Psychiatric:  Mr. [**Known lastname 20464**] was followed by the inpatient
psychiatric team for issues of competence and agitation on
the hospital floor.  Numerous times during the hospital
course, Mr. [**Known lastname 20464**] was seen by the psychiatric team and was
felt to be competent, fully aware of his decisions and
repercussions.  On hospital day eight, during hemodialysis,
Mr. [**Known lastname 20464**] became acute agitated and was sedated during
hemodialysis, which caused the hemodialysis session to be
terminated early.  He was given Ativan with good response, an
calmed down appropriately.  He will be pre-mediated for
future hemodialysis sessions with Ativan.

5.  Hematology:  Mr. [**Known lastname 20464**] had a baseline hematocrit of
approximately 30 on admission.  This was consistent with his
previous hematocrits, and notable low secondary to his end
stage renal disease.  He received Epogen, however, this was
not continued during the first part of this hospitalization.
By hospital day six, he was noted to have a hematocrit of
approximately 26, and was given Epogen after hemodialysis,
and he was followed thereafter with appropriate increases in
hematocrit.

Further discharge diagnoses, status and discharge medications
will be addended at a later time, at the time of hospital
discharge.




                            [**Name6 (MD) 251**] [**Last Name (NamePattern4) 11865**], M.D.  [**MD Number(1) 11866**]

Dictated By:[**Last Name (NamePattern1) 14434**]
MEDQUIST36

D:  [**2123-10-15**]  02:58
T:  [**2123-10-15**]  03:58
JOB#:  [**Job Number 20467**]


Admission Date:  [**2123-10-5**]     Discharge Date:  [**2123-10-23**]

Date of Birth:   [**2071-4-18**]     Sex:  M

Service:  MICU

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 20464**] is a 52-year-old
gentleman with a past medical history significant for
insulin-dependent diabetes mellitus, end-stage renal disease
(on peritoneal dialysis), multiple episodes of peritonitis,
polysubstance abuse (alcohol and cocaine), coronary artery
disease, and congestive heart failure.  He is status post
recent discharge from this hospital for [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]
parapsilosis.  He was sent to the hospital for this admission
by [**Hospital6 407**] after being discovered to have
possible left toe gangrene at home.

HOSPITAL COURSE:  He was seen by the Vascular Surgery team
who thought that surgical intervention was not necessary at
this time.

During the course of his stay on the floor he was lethargic
with systolic blood pressures ranging in the 80s.  His normal
blood pressure runs in the low 100s.  After a sustained
period of lethargy with systolic pressures in the 80s, he was
transferred to the Medical Intensive Care Unit.  His blood
pressure continued to fall despite adding on broad spectrum
antibiotic coverage.  He was started on pressor therapy with
Levophed and then Neo-Synephrine.  Despite using
supratherapeutic doses of these blood pressure medications we
were unable to maintain his blood pressure at a level to
adequately perfuse his vital organs.

Given his poor response to intensive medical therapy, the
focus of his care was shifted to providing comfort measures.
He expired on [**10-23**].



                          [**Name6 (MD) 251**] [**Last Name (NamePattern4) 11865**], M.D.  [**MD Number(1) 11866**]

Dictated By:[**Last Name (NamePattern1) 7787**]

MEDQUIST36

D:  [**2124-1-3**]  10:34
T:  [**2124-1-4**]  15:55
JOB#:  [**Job Number 20524**]
{'Infection and inflammatory reaction due to peritoneal dialysis catheter,Pneumonia, organism unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Staphylococcal septicemia, unspecified,Other shock without mention of trauma,Ulcer of other part of foot,Diabetes with ophthalmic manifestations, type I [juvenile 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: 

PRESENT ILLNESS: 52-year-old male with
insulin-dependent diabetes mellitus, coronary artery disease,
severe congestive heart failure, end stage renal disease on
peritoneal dialysis, who presents on the advice of VNA nurse
for "gangrene in the toe."  The patient is otherwise without
complaints, no shortness of breath, no chest pain, no
pre-syncope, no fevers or chills, no abdominal pain.
Positive cough with sputum production, no myalgias,
odynophagia or constitutional symptoms.  The patient received
one liter of normal saline bolus x 2 for SBP in 70s with
appropriate increase to 90s.  Normal peritoneal dialysis on
[**10-5**].  The patient is well known to the Medicine service,
with multiple admissions in the past, most recently for SBP
for which he was discharged from the hospital one week prior
with continued oral fluconazole and was to continue to be
followed up by Dr. [**First Name (STitle) 805**].  Now the patient comes for
evaluation of removal of the peritoneal dialysis catheter.

MEDICAL HISTORY: 1.  Insulin-dependent diabetes mellitus
2.  End stage renal disease on peritoneal dialysis
3.  Coronary artery disease status post myocardial infarction
in 5/00
4.  Congestive heart failure
5.  Hypertension
6.  Peripheral vascular disease status post right below the
knee amputation
7.  Polysubstance abuse
8.  Encephalopathy
9.  Right ocular prosthesis

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Infection and inflammatory reaction due to peritoneal dialysis catheter,Pneumonia, organism unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Staphylococcal septicemia, unspecified,Other shock without mention of trauma,Ulcer of other part of foot,Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as uncontrolled'}
