CHIEF COMPLAINT: Back pain

PRESENT ILLNESS: HPI: This is an 86 yo F with a past medical history of dementia,
CHF, depression, anxiety, multiple lumbar compression fractures,
who has been recently treated for a UTI with cipro and then
started on flagyl for c diff, referred to [**Hospital1 18**] ED from nursing
home after she was found to have a BUN/Cr 140/11.7 with no prior
history of renal failure.
.
In the ED, she was found to be alert and confused, seemingly at
baseline with intermittent agitation, and with stable vitals.
She was found to have low urine output, and hyperkalemia. She
was given calcium gluconate, insulin and kayexalate and renal
was consulted, who felt that her renal failure was likely
secondary to dehydration from cdiff and recommended IVF
hydration. She had a renal ultrasound that was negative for
nephrolithiasis, hydronephrosis or free fluid. She was also
incidentally found to have a left sided pleural effusion.
.
She was transferred to the [**Hospital Unit Name 153**] for further management of her
acute renal failure for increased level of nursing care
secondary to agitation.

MEDICAL HISTORY: CHF
Dementia
depression
anxiety
osteoporosis
multiple lumbar compression fractures

MEDICATION ON ADMISSION: Aricept
citalopram
alendronate
lasix
lorazepam
tramadol
MVI
Ca and vit D
KCl

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 97.6 76 98/45 21 96%ra
general: asleep, comfortable, nad
heent: perrl, OP clear, edentulous. MM dry.
neck: no JVD, supple
chest: RRR no m/r/g
lungs: ctab, no w/r/r
abd: obese, ND, NT +BS. ? dullness to percussion in llq
ext: trace pitting edema at the ankles, 1+ DP pulses, cool
hands/toes but no cyanosis/clubbing
neuro: moving ext x 4, no evidence of focal deficits. Babinski
downgoing bilaterally
skin: cool and dry

FAMILY HISTORY: Non contributory to current illness

SOCIAL HISTORY: SOCHx: Italian speaking, lives at [**Hospital3 **] home. Has 2
sons.
Acute kidney failure with lesion of tubular necrosis,Congestive heart failure, unspecified,Intestinal infection due to Clostridium difficile,Pathologic fracture of vertebrae,Dehydration,Other persistent mental disorders due to conditions classified elsewhere,Dysthymic disorder,Anorexia
Ac kidny fail, tubr necr,CHF NOS,Int inf clstrdium dfcile,Path fx vertebrae,Dehydration,Mental disor NEC oth dis,Dysthymic disorder,Anorexia
Admission Date:  [**2111-8-4**]              Discharge Date:   [**2111-8-14**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1990**]
Chief Complaint:
Back pain

Major Surgical or Invasive Procedure:
Hemodialysis - one treatment only.


History of Present Illness:
HPI: This is an 86 yo F with a past medical history of dementia,
CHF, depression, anxiety, multiple lumbar compression fractures,
who has been recently treated for a UTI with cipro and then
started on flagyl for c diff, referred to [**Hospital1 18**] ED from nursing
home after she was found to have a BUN/Cr 140/11.7 with no prior
history of renal failure.
.
In the ED, she was found to be alert and confused, seemingly at
baseline with intermittent agitation, and with stable vitals.
She was found to have low urine output, and hyperkalemia. She
was given calcium gluconate, insulin and kayexalate and renal
was consulted, who felt that her renal failure was likely
secondary to dehydration from cdiff and recommended IVF
hydration. She had a renal ultrasound that was negative for
nephrolithiasis, hydronephrosis or free fluid. She was also
incidentally found to have a left sided pleural effusion.
.
She was transferred to the [**Hospital Unit Name 153**] for further management of her
acute renal failure for increased level of nursing care
secondary to agitation.

Past Medical History:
CHF
Dementia
depression
anxiety
osteoporosis
multiple lumbar compression fractures



Social History:
SOCHx: Italian speaking, lives at [**Hospital3 **] home. Has 2
sons.


Family History:
Non contributory to current illness

Physical Exam:
97.6 76 98/45 21 96%ra
general: asleep, comfortable, nad
heent: perrl, OP clear, edentulous. MM dry.
neck: no JVD, supple
chest: RRR no m/r/g
lungs: ctab, no w/r/r
abd: obese, ND, NT +BS. ? dullness to percussion in llq
ext: trace pitting edema at the ankles, 1+ DP pulses, cool
hands/toes but no cyanosis/clubbing
neuro: moving ext x 4, no evidence of focal deficits. Babinski
downgoing bilaterally
skin: cool and dry


Pertinent Results:
[**2111-8-4**] 03:30PM   PLT SMR-NORMAL PLT COUNT-258#
[**2111-8-4**] 03:30PM   HYPOCHROM-NORMAL ANISOCYT-NORMAL
POIKILOCY-NORMAL MACROCYT-NORMAL MICROCYT-NORMAL
POLYCHROM-NORMAL
[**2111-8-4**] 03:30PM   NEUTS-94.8* BANDS-0 LYMPHS-3.2* MONOS-1.6*
EOS-0.3 BASOS-0
[**2111-8-4**] 03:30PM   WBC-32.5*# RBC-4.59 HGB-13.8 HCT-39.6 MCV-86
MCH-30.1 MCHC-34.9 RDW-14.5
[**2111-8-4**] 03:30PM   ALBUMIN-2.8* CALCIUM-9.7 PHOSPHATE-5.7*
MAGNESIUM-3.1*
[**2111-8-4**] 03:30PM   CK-MB-NotDone cTropnT-0.05*
[**2111-8-4**] 03:30PM   LIPASE-70*
[**2111-8-4**] 03:30PM   ALT(SGPT)-16 AST(SGOT)-22 CK(CPK)-11* ALK
PHOS-148* AMYLASE-778* TOT BILI-0.5
[**2111-8-4**] 03:30PM   estGFR-Using this
[**2111-8-4**] 03:30PM   GLUCOSE-114* UREA N-133* CREAT-12.0*#
SODIUM-134 POTASSIUM-6.1* CHLORIDE-99 TOTAL CO2-17* ANION
GAP-24*
[**2111-8-4**] 03:44PM   LACTATE-1.6
[**2111-8-4**] 03:44PM   COMMENTS-GREEN TOP
[**2111-8-4**] 04:45PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2111-8-4**] 04:45PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.009
[**2111-8-4**] 08:45PM   GLUCOSE-79 UREA N-125* CREAT-11.0* SODIUM-138
POTASSIUM-5.2* CHLORIDE-106 TOTAL CO2-17* ANION GAP-20
[**2111-8-4**] 08:49PM   K+-5.1
[**2111-8-4**] 08:49PM   COMMENTS-GREEN TOP

Brief Hospital Course:
ARF:
tunnelled line placed in Rt. Subclavian Vein by IR.
HD completed only once, for uremia
Renal function has slowly improved, steadily, thoroughout the
hospitalization
HD cath removed [**8-12**]
O/P renal follow up arranged at [**Hospital1 18**]
Recommend matching I's And O's with D51/2NS as needed if still
having post atn diuresis that is not matched by intake
Avoid nephrotoxins, renally dose all meds.
continue to hold lasix for now

C.diff enterocolitis:
- cx positive, and OB pos stools continue (not unexpected in
colitis); Hct and VS stable.  Monitor Hct, and monitor for overt
blood per rectum at rehab.  Has only had occult GIB during
hospitalization.

Vancomycin and flagyl orally for total 14 days (last day will be
[**8-15**]).

Osteoporosis with compression fractures:
- lidocaine patch
- tylenol scheduled

Nutrition;

Pt. not eating enough calories during hospitaliztion.  Likely
due to a combination of uremia (anorexic) and colitis.  As these
resolve, PO intake should improve.  Nutrition consult obtained
and TF started.  Slowly taking more PO at time of discharge.

Medications on Admission:
Aricept
citalopram
alendronate
lasix
lorazepam
tramadol
MVI
Ca and vit D
KCl


Discharge Medications:
1. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) mL
Injection TID (3 times a day).
2. Vancomycin 250 mg Capsule Sig: One (1) Capsule PO Q6H (every
6 hours) for 2 days: last day [**8-15**].
Disp:*16 Capsule(s)* Refills:*0*
3. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Donepezil 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).

5. Alendronate 70 mg Tablet Sig: One (1) Tablet PO QSAT (every
Saturday).
6. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 2 days: last day [**8-15**]. Tablet(s)
7. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical QDAILY ().
8. Olanzapine 5 mg Tablet, Rapid Dissolve Sig: 0.5 Tablet, Rapid
Dissolve PO QDAILYPRN ().
9. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours).
10. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
11. Morphine 2 mg/mL Syringe Sig: 1-2 mg Injection Q6H (every 6
hours) as needed: for breakthrough pain.

Tramodol d/c's due to possible serotonin syndrome if taken
regularly with SSRI
Furosemide d/c'd due to pre renal etiology of disease


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 85**] TCU - [**Location (un) 86**]

Discharge Diagnosis:
Acute Renal Failure


Discharge Condition:
Stable


Discharge Instructions:
Take all medications as prescribed

Followup Instructions:
Provider: [**Last Name (NamePattern4) **]. [**First Name (STitle) **] [**Name (STitle) **] Phone:[**Telephone/Fax (1) 435**] Date/Time:[**2111-8-27**]
1:00;
Renal division (KIDNEY DOCTOR)
{'Acute kidney failure with lesion of tubular necrosis,Congestive heart failure, unspecified,Intestinal infection due to Clostridium difficile,Pathologic fracture of vertebrae,Dehydration,Other persistent mental disorders due to conditions classified elsewhere,Dysthymic disorder,Anorexia'}


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: Back pain

PRESENT ILLNESS: HPI: This is an 86 yo F with a past medical history of dementia,
CHF, depression, anxiety, multiple lumbar compression fractures,
who has been recently treated for a UTI with cipro and then
started on flagyl for c diff, referred to [**Hospital1 18**] ED from nursing
home after she was found to have a BUN/Cr 140/11.7 with no prior
history of renal failure.
.
In the ED, she was found to be alert and confused, seemingly at
baseline with intermittent agitation, and with stable vitals.
She was found to have low urine output, and hyperkalemia. She
was given calcium gluconate, insulin and kayexalate and renal
was consulted, who felt that her renal failure was likely
secondary to dehydration from cdiff and recommended IVF
hydration. She had a renal ultrasound that was negative for
nephrolithiasis, hydronephrosis or free fluid. She was also
incidentally found to have a left sided pleural effusion.
.
She was transferred to the [**Hospital Unit Name 153**] for further management of her
acute renal failure for increased level of nursing care
secondary to agitation.

MEDICAL HISTORY: CHF
Dementia
depression
anxiety
osteoporosis
multiple lumbar compression fractures

MEDICATION ON ADMISSION: Aricept
citalopram
alendronate
lasix
lorazepam
tramadol
MVI
Ca and vit D
KCl

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 97.6 76 98/45 21 96%ra
general: asleep, comfortable, nad
heent: perrl, OP clear, edentulous. MM dry.
neck: no JVD, supple
chest: RRR no m/r/g
lungs: ctab, no w/r/r
abd: obese, ND, NT +BS. ? dullness to percussion in llq
ext: trace pitting edema at the ankles, 1+ DP pulses, cool
hands/toes but no cyanosis/clubbing
neuro: moving ext x 4, no evidence of focal deficits. Babinski
downgoing bilaterally
skin: cool and dry

FAMILY HISTORY: Non contributory to current illness

SOCIAL HISTORY: SOCHx: Italian speaking, lives at [**Hospital3 **] home. Has 2
sons. 

### Response:
{'Acute kidney failure with lesion of tubular necrosis,Congestive heart failure, unspecified,Intestinal infection due to Clostridium difficile,Pathologic fracture of vertebrae,Dehydration,Other persistent mental disorders due to conditions classified elsewhere,Dysthymic disorder,Anorexia'}
