CHIEF COMPLAINT: 

PRESENT ILLNESS: This is an 85-year-old,
Caucasian, female patient with history of early Alzheimer's
dementia and diabetes mellitus type II, a remote history of
breast cancer, but previously otherwise independent who was
recently admitted to the Neurosurgical Service on [**2155-2-1**]
status post a head trauma with right frontotemporal
subarachnoid hemorrhage and cerebral edema.  She was
discharged on [**2155-2-5**] and returned with fevers.

MEDICAL HISTORY: Her past medical history is
significant for diabetes mellitus type II, Alzheimer's
dementia, breast cancer status post mastectomy, atrial
fibrillation.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Pneumonitis due to inhalation of food or vomitus,Atrial fibrillation,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage
Food/vomit pneumonitis,Atrial fibrillation,Alzheimer's disease,Dementia w/o behav dist,Hypothyroidism NOS,Hypertension NOS,DMII wo cmp nt st uncntr,Gstr/ddnts NOS w/o hmrhg
Admission Date:  [**2155-2-5**]       Discharge Date:  [**2155-2-12**]


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

HISTORY OF PRESENT ILLNESS:  This is an 85-year-old,
Caucasian, female patient with history of early Alzheimer's
dementia and diabetes mellitus type II, a remote history of
breast cancer, but previously otherwise independent who was
recently admitted to the Neurosurgical Service on [**2155-2-1**]
status post a head trauma with right frontotemporal
subarachnoid hemorrhage and cerebral edema.  She was
discharged on [**2155-2-5**] and returned with fevers.

The patient was followed by the Neurosurgical Service and was
loaded initially with Dilantin for concern of seizures as
well as Decadron for cerebral edema demonstrated on a head
CT.  The patient's neurologic status remained relatively
stable since her accident, and she was discharged to [**Hospital1 **]
for rehabilitation on the day of admission.  Prior to
discharge, today, the patient was noted to have a low-grade
fever of 100 degrees for which she was started on
levofloxacin for possible pneumonia as she failed a recent
speech and swallow evaluation in-house and self-discontinued
her nasogastric tube with possible aspiration.

Once she arrived at [**Hospital1 **], the patient was noted to have a
fever of 102 or 103 and was sent to back to the Emergency
Department at [**Hospital1 69**] for
reevaluation.  In the Emergency Department, the patient was
unable to provide an adequate history but received 1 gram of
ceftazidime, 500 mg of Flagyl, and two liters of normal
saline.

PAST MEDICAL HISTORY:  Her past medical history is
significant for diabetes mellitus type II, Alzheimer's
dementia, breast cancer status post mastectomy, atrial
fibrillation.

MEDICATIONS:  (On discharge) Aricept 5 mg p.o. q.h.s., Zantac
150 mg p.o. b.i.d., metoprolol 25 mg p.o. b.i.d., Levoxyl 112
mcg p.o. q.day, levofloxacin 500 mg p.o. q.day, Glyburide 10
mg p.o. b.i.d., lisinopril 10 mg p.o. q.day, subcutaneous
heparin, Lentis 20 units q.h.s., regular insulin sliding
scale, Colace 150 mg p.o. b.i.d.

ALLERGIES:  The patient has no known drug allergies.

PHYSICAL EXAMINATION:  Vital signs were temperature 97.8,
blood pressure 121/59, heart rate 92, respirations 20,
saturation 97 percent on two liters.  In general, the patient
is an elderly woman, awake but appearing slightly agitated,
not following commands.  HEENT:  Pupils are equal, round, and
reactive to light and accommodation bilaterally.  Extraocular
movements intact.  The oropharynx is clear.  She has dry
mucous membranes.  Lung exam reveals shallow breaths
bilaterally with crackles in the right upper lobe and right
lower lobe.  Decreased breath sounds were noted in the left
lower lobe.

Her heart had an irregularly irregular rhythm and was
tachycardiac.  Her abdomen was soft, nontender and
nondistended.  Extremities revealed no evidence of edema.
Neurologic: Awake, able to state several words, not following
commands, moving all extremities briskly and spontaneously.
Tight grasps bilaterally.  She had upgoing toes bilaterally.

LABORATORY DATA:  White blood cells 15.9, hematocrit 35.9,
platelets 382, PT 12.0, PTT 23.8, INR 1.0.  Sodium 129,
potassium 7.8 (hemolyzed), repeat 4.7, chloride 95,
bicarbonate 25, BUN 33, creatinine 1.0, glucose 258, calcium
9.1, phosphate 2.5, magnesium 2.2.  Urinalysis revealed pH
1.021, moderate blood, negative nitrites, negative leukocyte
esterase, 250 glucose.  TSH 13, free T4 0.9, hemoglobin A1C
7.4, phenytoin 4.4.

Head CT revealed right frontotemporal swelling consistent
with contusion, no evidence of blood, no new change compared
with a previous CT done on [**2155-1-30**].

Electrocardiogram revealed atrial fibrillation with a rate of
112.  No changes from her baseline.

HOSPITAL COURSE:  PROBLEM #1:  Fever:  The etiology of the
patient's fever was considered likely aspiration pneumonia
given her history of self-discontinuing her nasogastric tube
during her previous hospital stay.  The patient was continued
on levofloxacin and Flagyl throughout her brief hospital
stay.  She was noted to be afebrile with good oxygen
saturations in room air with no subjective complaints of
shortness of breath or cough.  Her lung exam cleared
throughout her brief hospital stay.  Her blood cultures and
urine cultures were negative throughout her admission.  The
patient will receive a 14-day course of both levofloxacin and
Flagyl for presumed aspiration pneumonia.

PROBLEM #2:  Neurologic:  The patient was admitted with a
questionable history of altered mental status.  The etiology
of the patient's mental status changes is likely
multifactorial including her cerebral edema and intracranial
hemorrhage, infection, hyponatremia on admission, as well as
her underlying dementia.  The patient's infection was treated
as above.  Her hyponatremia resolved with intravenous
hydration.  Donepezil was considered for Alzheimer's
dementia.  The patient's mental status was considered to be
stable throughout her brief hospital stay.

The patient was noted to be possibly more dysphagic and
dysarthric during this hospital stay and was reevaluated by
Neurosurgery who felt that these symptoms were unchanged from
her previous hospitalization.  A repeat head CT was performed
on [**2155-2-11**] which showed no change in her intracerebral
hemorrhage.  A neurologist, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], was
contact[**Name (NI) **] prior to the patient's discharge, and his comments
on the case are pending at the time of dictation.  Given that
there were no changes noted on the repeat CT, no further
workup is being initiated at this time.

PROBLEM #3:  Cardiovascular:  The patient was admitted with a
history of atrial fibrillation and diffuse ST elevations
noted on [**2155-2-6**].  A decision was made not to
anticoagulate the patient given her recent subarachnoid
hemorrhage.  The patient had stable tachycardia and was rate
controlled with a beta blocker.  Her rate improved once she
received a percutaneous endoscopic gastrostomy tube, and her
beta blocker could be administered.  The patient had an
echocardiogram performed on [**2155-2-7**] which was significant
for an ejection fraction over 55 percent, borderline
pulmonary artery hypertension, and no evidence of pericardial
effusion.  She was noted to be normotensive and
hemodynamically stable on her outpatient doses of an ACE
inhibitor and beta blocker.

Given the concern for myocardial infarction, with her ST
elevations on electrocardiogram, the patient was ruled out
for myocardial infarction with bicardiac enzymes.

PROBLEM #4:  Fluids, electrolytes and nutrition:  The patient
was noted to have significant dysphagia.  On admission, she
was evaluated by Speech and Swallow.  Their study was
significant for overt signs and symptoms of aspiration with
all consistencies assessed.  The patient's cognitive deficits
were considered likely contributors to her decreased bolus
manipulation and swallow initiation.  It was therefore
recommended that the patient receive a percutaneous
endoscopic gastrostomy tube, which she did on [**2155-2-11**].
She was restarted on tube feeds which were eventually
titrated up to goal.  The patient tolerated these tube feeds.
It is anticipated that this percutaneous endoscopic
gastrostomy tube will not significantly improve the patient's
risk of aspiration, but will allow her to receive adequate
nutrition.  The patient was also admitted with hyponatremia
which resolved with intravenous fluids.

PROBLEM #5:  Hypothyroidism:  The patient was noted to have a
TSH of 13 on admission.  Her levothyroxine dose was increased
to 125 mcg q.day.  She will need to have a repeat TSH and
free T4 checked approximately one month after this medication
change.

PROBLEM #6:  Diabetes:  The patient was previously evaluated
by the [**Hospital **] Clinic.  Her insulin regimen was continued per
their recommendation, and she was noted to have well
controlled sugars throughout this admission.

PROBLEM #7:  Gastrointestinal:  As noted above, the patient
received a percutaneous endoscopic gastrostomy by the
Gastroenterology Consultation Service on [**2155-2-11**].  During
the esophagogastroduodenoscopy, she was noted to have mild
gastritis and erosions, and her H2 blocker was switched to a
proton pump inhibitor.

CONDITION ON DISCHARGE:  Good.

DISCHARGE STATUS:  The patient is discharged to a
rehabilitation facility where she will continue all
medications as prescribed.

DISCHARGE DIAGNOSIS:
1.  Pneumonia, unspecified.
2.  Hypertension.
3.  Atrial fibrillation.
4.  Subarachnoid hemorrhage.
5.  Hypothyroidism.
6.  Diabetes mellitus type II.

DISCHARGE MEDICATIONS:
1.  Levothyroxine 125 mcg p.o. q.day.
2.  Lisinopril 10 mg p.o. q.day.
3.  Metoprolol 25 mg p.o. b.i.d.
4.  Pantoprazole 40 mg p.o. q.day.
5.  Colace 150 mg p.o. b.i.d.
6.  Senna 8.6 mg one tablet p.o. b.i.d. p.r.n.
7.  Donepezil 5 mg p.o. q.h.s.
8.  Insulin fixed dose and sliding scale, 10 units of
Glargine subcutaneously q.p.m.
9.  Heparin subcutaneously.
10. Albuterol one inhalation q.6 hours p.r.n.
11. Levofloxacin 250 mg p.o. q.day times three days.
12. Flagyl 500 mg p.o. t.i.d. times three days.

FOLLOW-UP:  The patient will be followed by the physicians at
the rehabilitation facility.  Her primary care physician, [**Last Name (NamePattern4) **].
[**Last Name (STitle) 20040**], should be contact[**Name (NI) **] for any questions or concerns.
The patient should have a follow-up appointment with Dr.
[**Last Name (STitle) 20040**] once she leaves the rehabilitation facility.





                            [**Name6 (MD) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 4446**]

Dictated By:[**Last Name (NamePattern1) 4950**]
MEDQUIST36

D:  [**2155-2-12**]  11:01
T:  [**2155-2-12**]  11:16
JOB#:


Admission Date:  [**2155-2-5**]       Discharge Date:  [**2155-2-12**]


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

HISTORY OF PRESENT ILLNESS:  This is an 85-year-old, Caucasian,
female patient with history of early Alzheimer's dementia and
diabetes mellitus type II, a remote history of breast cancer, but
previously otherwise independent who was recently admitted to the
Neurosurgical Service on [**2155-2-1**] status post a head trauma
with right frontotemporal subarachnoid hemorrhage and cerebral
edema.  She was discharged on [**2155-2-5**] and returned with
fevers.

The patient was followed by the Neurosurgical Service and was
loaded initially with Dilantin for concern of seizures as
well as Decadron for cerebral edema demonstrated on a head
CT.  The patient's neurologic status remained relatively
stable since her accident, and she was discharged to [**Hospital1 **]
for rehabilitation on the day of admission.  Prior to
discharge, today, the patient was noted to have a low-grade
fever of 100 degrees for which she was started on
levofloxacin for possible pneumonia as she failed a recent
speech and swallow evaluation in-house and self-discontinued
her nasogastric tube with possible aspiration.

Once she arrived at [**Hospital1 **], the patient was noted to have a
fever of 102 or 103 and was sent to back to the Emergency
Department at [**Hospital1 69**] for
reevaluation.  In the Emergency Department, the patient was
unable to provide an adequate history but received 1 gram of
ceftazidime, 500 mg of Flagyl, and two liters of normal saline.

PAST MEDICAL HISTORY:  Her past medical history is significant
for diabetes mellitus type II, Alzheimer's dementia, breast
cancer status post mastectomy, atrial fibrillation.

MEDICATIONS:  Aricept 5 mg p.o. q.h.s., Zantac 150 mg p.o.
b.i.d., metoprolol 25 mg p.o. b.i.d., Levoxyl 112 mcg p.o. q.day,
levofloxacin 500 mg p.o. q.day, Glyburide 10 mg p.o. b.i.d.,
lisinopril 10 mg p.o. q.day, subcutaneous heparin, Lentis 20
units q.h.s., regular insulin sliding scale, Colace 150 mg p.o.
b.i.d.

ALLERGIES:  The patient has no known drug allergies.

PHYSICAL EXAMINATION:  Vital signs were temperature 97.8,
blood pressure 121/59, heart rate 92, respirations 20,
saturation 97 percent on two liters.  In general, the patient
is an elderly woman, awake but appearing slightly agitated,
not following commands.  HEENT:  Pupils are equal, round, and
reactive to light and accommodation bilaterally.  Extraocular
movements intact.  The oropharynx is clear.  She has dry
mucous membranes.  Lung exam reveals shallow breaths
bilaterally with crackles in the right upper lobe and right
lower lobe.  Decreased breath sounds were noted in the left
lower lobe.

Her heart had an irregularly irregular rhythm and was
tachycardiac.  Her abdomen was soft, nontender and nondistended.
Extremities revealed no evidence of edema. Neurologic: Awake,
able to state several words, not following commands, moving all
extremities briskly and spontaneously. Tight grasps bilaterally.
She had upgoing toes bilaterally.

LABORATORY DATA:  White blood cells 15.9, hematocrit 35.9,
platelets 382, PT 12.0, PTT 23.8, INR 1.0.  Sodium 129,
potassium 7.8 (hemolyzed), repeat 4.7, chloride 95,
bicarbonate 25, BUN 33, creatinine 1.0, glucose 258, calcium
9.1, phosphate 2.5, magnesium 2.2.  Urinalysis revealed pH
1.021, moderate blood, negative nitrites, negative leukocyte
esterase, 250 glucose.  TSH 13, free T4 0.9, hemoglobin A1C
7.4, phenytoin 4.4.

Head CT revealed right frontotemporal swelling consistent with
contusion, no evidence of blood, no new change compared with a
previous CT done on [**2155-1-30**].

Electrocardiogram revealed atrial fibrillation with a rate of
112.  No changes from her baseline.

HOSPITAL COURSE: Fever:  The etiology of the patient's fever was
considered likely aspiration pneumonia given her history of self-
discontinuing her nasogastric tube during her previous hospital
stay.  The patient was continued on levofloxacin and Flagyl
throughout her brief hospital stay.  She was noted to be afebrile
with good oxygen saturations in room air with no subjective
complaints of shortness of breath or cough. Her lung exam cleared
throughout her brief hospital stay.  Her blood cultures and urine
cultures were negative throughout her admission.  The patient
will receive a 14-day course of both levofloxacin and Flagyl for
presumed aspiration pneumonia.

Neurologic:  The patient was admitted with a questionable history
of altered mental status.  The etiology of the patient's mental
status changes is likely multifactorial including her cerebral
edema and intracranial hemorrhage, infection, hyponatremia on
admission, as well as her underlying dementia.  The patient's
infection was treated as above.  Her hyponatremia resolved with
intravenous hydration.  Donepezil was considered for Alzheimer's
dementia.  The patient's mental status was considered to be
stable throughout her brief hospital stay.

The patient was noted to be possibly more dysphagic and
dysarthric during this hospital stay and was reevaluated by
Neurosurgery who felt that these symptoms were unchanged from
her previous hospitalization.  A repeat head CT was performed
on [**2155-2-11**] which showed no change in her intracerebral
hemorrhage.  A neurologist, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], was
contact[**Name (NI) **] prior to the patient's discharge, and his comments
on the case are pending at the time of dictation.  Given that
there were no changes noted on the repeat CT, no further
workup is being initiated at this time.

Cardiovascular:  The patient was admitted with a history of
atrial fibrillation and diffuse ST elevations noted on
[**2155-2-6**].  A decision was made not to anticoagulate the patient
given her recent subarachnoid hemorrhage.  The patient had stable
tachycardia and was rate controlled with a beta blocker.  Her
rate improved once she received a percutaneous endoscopic
gastrostomy tube, and her beta blocker could be administered. The
patient had an echocardiogram performed on [**2155-2-7**] which was
significant for an ejection fraction over 55 percent, borderline
pulmonary artery hypertension, and no evidence of pericardial
effusion.  She was noted to be normotensive and hemodynamically
stable on her outpatient doses of an ACE inhibitor and beta
blocker.

Given the concern for myocardial infarction, with her ST
elevations on electrocardiogram, the patient was ruled out for
myocardial infarction with bicardiac enzymes.

Fluids, electrolytes and nutrition:  The patient was noted to
have significant dysphagia.  On admission, she was evaluated by
Speech and Swallow.  Their study was significant for overt signs
and symptoms of aspiration with all consistencies assessed.  The
patient's cognitive deficits were considered likely contributors
to her decreased bolus manipulation and swallow initiation.  It
was therefore recommended that the patient receive a percutaneous
endoscopic gastrostomy tube, which she did on [**2155-2-11**].
She was restarted on tube feeds which were eventually titrated up
to goal.  The patient tolerated these tube feeds. It is
anticipated that this percutaneous endoscopic gastrostomy tube
will not significantly improve the patient's risk of aspiration,
but will allow her to receive adequate nutrition.  The patient
was also admitted with hyponatremia which resolved with
intravenous fluids.

Hypothyroidism:  The patient was noted to have a TSH of 13 on
admission.  Her levothyroxine dose was increased to 125 mcg
q.day.  She will need to have a repeat TSH and free T4 checked
approximately one month after this medication change.

Diabetes:  The patient was previously evaluated by the [**Hospital **]
Clinic.  Her insulin regimen was continued per their
recommendation, and she was noted to have well controlled sugars
throughout this admission.

PROBLEM #7:  Gastrointestinal:  As noted above, the patient
received a percutaneous endoscopic gastrostomy by the
Gastroenterology Consultation Service on [**2155-2-11**].  During
the esophagogastroduodenoscopy, she was noted to have mild
gastritis and erosions, and her H2 blocker was switched to a
proton pump inhibitor.

CONDITION ON DISCHARGE:  Good.

DISCHARGE STATUS:  The patient is discharged to a rehabilitation
facility where she will continue all medications as prescribed.

DISCHARGE DIAGNOSIS:
1.  Pneumonia, unspecified.
2.  Hypertension.
3.  Atrial fibrillation.
4.  Subarachnoid hemorrhage.
5.  Hypothyroidism.
6.  Diabetes mellitus type II.

DISCHARGE MEDICATIONS:
1.  Levothyroxine 125 mcg p.o. q.day.
2.  Lisinopril 10 mg p.o. q.day.
3.  Metoprolol 25 mg p.o. b.i.d.
4.  Pantoprazole 40 mg p.o. q.day.
5.  Colace 150 mg p.o. b.i.d.
6.  Senna 8.6 mg one tablet p.o. b.i.d. p.r.n.
7.  Donepezil 5 mg p.o. q.h.s.
8.  Insulin fixed dose and sliding scale, 10 units of
Glargine subcutaneously q.p.m.
9.  Heparin subcutaneously.
10. Albuterol one inhalation q.6 hours p.r.n.
11. Levofloxacin 250 mg p.o. q.day times three days.
12. Flagyl 500 mg p.o. t.i.d. times three days.

FOLLOW-UP:  The patient will be followed by the physicians at the
rehabilitation facility.  Her primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 20040**],
should be contact[**Name (NI) **] for any questions or concerns. The patient
should have a follow-up appointment with Dr. [**Last Name (STitle) 20040**] once she
leaves the rehabilitation facility.





                            [**Name6 (MD) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 4446**]

Dictated By:[**Last Name (NamePattern1) 4950**]
MEDQUIST36

D:  [**2155-2-12**]  11:01
T:  [**2155-2-12**]  11:16
JOB#:[**Job Number 52842**]
{"Pneumonitis due to inhalation of food or vomitus,Atrial fibrillation,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage"}


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: This is an 85-year-old,
Caucasian, female patient with history of early Alzheimer's
dementia and diabetes mellitus type II, a remote history of
breast cancer, but previously otherwise independent who was
recently admitted to the Neurosurgical Service on [**2155-2-1**]
status post a head trauma with right frontotemporal
subarachnoid hemorrhage and cerebral edema.  She was
discharged on [**2155-2-5**] and returned with fevers.

MEDICAL HISTORY: Her past medical history is
significant for diabetes mellitus type II, Alzheimer's
dementia, breast cancer status post mastectomy, atrial
fibrillation.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{"Pneumonitis due to inhalation of food or vomitus,Atrial fibrillation,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage"}
