CHIEF COMPLAINT: Fevers

PRESENT ILLNESS: 47F s/p LURT [**12-18**], admitted for urosepsis. Had recent cardiac
cath 2 vessel stent [**2107-9-14**]. Course c/b pyelo (ESBL kleb PNA UTI)
treated with meropenem, sent home on 14 days of imipenem. Was
off abx for 1 week, came back w/ dysuria, back pain, T 100 at
home. Borderline low bp sbp98, +orthostatic so admitted to ICU.
[**10-3**] repeat Ucx enterococci VRE. On linezolid/meropenem
empirically. Started on stress steroids, now tapered to
pre-admit dose. Immuran held. CT abd neg for acute process.
Txred to floor on [**10-10**].

MEDICAL HISTORY: IDDM
ESRD s/p living unrelated renal transplant [**12-18**]
Hyperlipidemia
Hypothyroidism
Retroperitoneal bleed
sinusitis
IBS
h/o hypertension but recently treated for orthostatic
hypotension with midodrine
CAD S/P stenting in [**2107-9-15**]

MEDICATION ON ADMISSION: 1. Aspirin 325 mg Tablet, Delayed Release PO DAILY
2. Clopidogrel 75 mg  PO DAILY
3. Lorazepam 1 mg PO Q4-6H as needed.
4. Acetaminophen 650 mg PO every [**5-19**]  hours as needed for fever,
pain.
5. Aluminum-Magnesium Hydroxide 225-200 mg/5 mL Thirty ML PO QID
 as needed for indigestion.
6. Tacrolimus 2 mg PO BID
7. Prednisone 5 mg PO DAILY
8. Azathioprine 75 mg PO DAILY
9. Levothyroxine 75 mcg PO DAILY
10. Citalopram 60 mg PO DAILY
11. Sodium Bicarbonate 650 mg PO BID
12. Pantoprazole 40 mg Tablet, Delayed Release PO Q24H
13. Conjugated Estrogens 0.625 mg Tablet PO DAILY
14. Buspirone 5 mg PO TID
15. Phenobarb-Belladonna Alkaloids 16.2 mg/5 mL Five mL PO Q 6
HRS as needed for indigestion.
16. Trimethoprim-Sulfamethoxazole 80-400 mg PO DAILY
17. Ezetimibe 10 mg  PO DAILY
18. Valganciclovir 900 mg  PO DAILY
19. Insulin Glargine Fourteen units Subcutaneous at bedtime.
20. Nystatin 100,000 unit/mL Five ML PO  QIDACHS
21. Midodrine 5 mg PO TID

ALLERGIES: Morphine

PHYSICAL EXAM: VS - 97.3 105/62 69 20 99% on RA
Gen - awake, alert, sitting in the [**Last Name (un) **] next to the bed. NAD
HEENT - NCAT, Has tag of skin on the left buccal surface (of
note the patient has seen an OMF surgeon regarding biopsy of
this lesion) MMM, PERRL, EOMI.
Neck - supple, no LAD
Cor - RRR nl S1,S2 no M/R/G
Chest - CTA B, no W/R/R
Abd - s/nt/nd +BS, incisional wound with one fistula draining
serous fluid in the midline, no pain with palpation of
transplanted kidney. On left flank there is a scar from where
the fluid drain was located. There is no pain, erythema, or
swelling.
Ext - no c/c/e left D/P is difficult to find, but palpable. The
right foot is in a cast. Per patient she has fractured toe.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Denies EtOH and tobacco
Complications of transplanted kidney,Urinary tract infection, site not specified,Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Persistent postoperative fistula,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in other specified places,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Other specified anemias,Peripheral autonomic neuropathy in disorders classified elsewhere,Vesicoureteral reflux unspecified or without reflux nephropathy,Unspecified acquired hypothyroidism,Irritable bowel syndrome
Compl kidney transplant,Urin tract infection NOS,DMI neuro nt st uncntrld,Persist postop fistula,Hyp kid NOS w cr kid V,End stage renal disease,Abn react-org transplant,Accident in place NEC,Klebsiella pneumoniae,Crnry athrscl natve vssl,Status-post ptca,Anemia NEC,Aut neuropthy in oth dis,Vescouretrl rflux unspcf,Hypothyroidism NOS,Irritable bowel syndrome
Admission Date:  [**2107-10-9**]              Discharge Date:   [**2107-10-13**]

Date of Birth:  [**2060-1-14**]             Sex:   F

Service: MEDICINE

Allergies:
Morphine

Attending:[**First Name3 (LF) 5037**]
Chief Complaint:
Fevers

Major Surgical or Invasive Procedure:
None


History of Present Illness:
47F s/p LURT [**12-18**], admitted for urosepsis. Had recent cardiac
cath 2 vessel stent [**2107-9-14**]. Course c/b pyelo (ESBL kleb PNA UTI)
treated with meropenem, sent home on 14 days of imipenem. Was
off abx for 1 week, came back w/ dysuria, back pain, T 100 at
home. Borderline low bp sbp98, +orthostatic so admitted to ICU.
[**10-3**] repeat Ucx enterococci VRE. On linezolid/meropenem
empirically. Started on stress steroids, now tapered to
pre-admit dose. Immuran held. CT abd neg for acute process.
Txred to floor on [**10-10**].

Past Medical History:
IDDM
ESRD s/p living unrelated renal transplant [**12-18**]
Hyperlipidemia
Hypothyroidism
Retroperitoneal bleed
sinusitis
IBS
h/o hypertension but recently treated for orthostatic
hypotension with midodrine
CAD S/P stenting in [**2107-9-15**]

Social History:
Denies EtOH and tobacco


Family History:
non-contributory

Physical Exam:
VS - 97.3 105/62 69 20 99% on RA
Gen - awake, alert, sitting in the [**Last Name (un) **] next to the bed. NAD
HEENT - NCAT, Has tag of skin on the left buccal surface (of
note the patient has seen an OMF surgeon regarding biopsy of
this lesion) MMM, PERRL, EOMI.
Neck - supple, no LAD
Cor - RRR nl S1,S2 no M/R/G
Chest - CTA B, no W/R/R
Abd - s/nt/nd +BS, incisional wound with one fistula draining
serous fluid in the midline, no pain with palpation of
transplanted kidney. On left flank there is a scar from where
the fluid drain was located. There is no pain, erythema, or
swelling.
Ext - no c/c/e left D/P is difficult to find, but palpable. The
right foot is in a cast. Per patient she has fractured toe.


Pertinent Results:
[**2107-10-9**] 2:49 pm URINE Site: CLEAN CATCH
URINE CULTURE:KLEBSIELLA PNEUMONIAE.    >100,000 ORGANISMS/ML..
_________________________________________________________
                             KLEBSIELLA PNEUMONIAE
                             |
AMPICILLIN/SULBACTAM--  =>32 R
CEFAZOLIN-------------  =>64 R
CEFEPIME--------------       R
CEFTAZIDIME-----------  =>64 R
CEFTRIAXONE-----------       R
CEFUROXIME------------  =>64 R
CIPROFLOXACIN---------   =>4 R
GENTAMICIN------------     8 I
IMIPENEM--------------   <=1 S
LEVOFLOXACIN----------   =>8 R
MEROPENEM-------------<=0.25 S
NITROFURANTOIN--------   128 R
PIPERACILLIN/TAZO-----     8 S
TETRACYCLINE----------       PND
TOBRAMYCIN------------     8 I
TRIMETHOPRIM/SULFA----  =>16 R

[**2107-10-9**] 02:49PM URINE Color-Yellow Appear-Hazy Sp [**Last Name (un) **]-1.008

[**2107-10-9**] 02:49PM URINE Blood-NEG Nitrite-POS Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-SM

[**2107-10-9**] 02:49PM URINE RBC-0-2 WBC-[**1-2**]* Bacteri-MANY
Yeast-NONE Epi-[**4-17**]

[**2107-10-9**] 12:35PM BLOOD WBC-2.7* RBC-4.00* Hgb-11.9* Hct-34.0*
MCV-85 MCH-
29.7 MCHC-35.0 RDW-17.6* Plt Ct-233
[**2107-10-13**] 06:00AM BLOOD WBC-2.0* RBC-3.35* Hgb-9.9* Hct-28.7*
MCV-86 MCH-29.7 MCHC-34.6 RDW-17.4* Plt Ct-230

Brief Hospital Course:
After transfer from MICU the patient declined fever, chills,
nausea, vomiting, dysuria, and hematuria until the time of
discharge.  Objectively, the patient's vital signs remained
stable.  On the day prior to discharge the patient complained of
diarrhea.  C.diff toxin was negative.

The patient's phyisical exam revealed a cutaneous fisutla in the
midline below the umbilicus at the end of the patient's
tranplant surgery scar.

Dr. [**First Name (STitle) **], from tranplant surgery saw the patient and offered
to close the fisutla in [**7-21**] weeks when the patient's cardiac
condition had quieted down - she had coronary artery stents
place on [**2107-9-15**].

ID was consulted regarding the optimal antibiotic regimen.  They
suggested 3 weeks total of Meropene.  They were concerned about
the patient white blood cell count and suggested that the
primary team consider bone marrow suppression as a possible
etiology.  To this end the patient was asked to have a CBC drawn
the day after discharge and to have the results sent to Dr.
[**Last Name (STitle) 17253**], the patient's tranplant nephrologist.  The patient
was also given the number of the [**Hospital **] clinic and asked to follow
up with them at her convenience.

Urology was consulted to help identify the reason for the
patient's recurrent UTIs.  They suggested a Voiding
Cystourethrogram (VCUG), which demonstrated reflux.  Urology did
not feel that an acute intervention was indicated and asked for
follow up of the patienet in their clinic.  An apointment was
arranged.

Regarding the patient's diabetes, she was encouraged to follow
up at the [**Last Name (un) **] Diabetes center.

The patient was also notified of her appointment to follow up
with her cardiologist Dr. [**Last Name (STitle) 171**].

Medications on Admission:
1. Aspirin 325 mg Tablet, Delayed Release PO DAILY
2. Clopidogrel 75 mg  PO DAILY
3. Lorazepam 1 mg PO Q4-6H as needed.
4. Acetaminophen 650 mg PO every [**5-19**]  hours as needed for fever,
pain.
5. Aluminum-Magnesium Hydroxide 225-200 mg/5 mL Thirty ML PO QID
 as needed for indigestion.
6. Tacrolimus 2 mg PO BID
7. Prednisone 5 mg PO DAILY
8. Azathioprine 75 mg PO DAILY
9. Levothyroxine 75 mcg PO DAILY
10. Citalopram 60 mg PO DAILY
11. Sodium Bicarbonate 650 mg PO BID
12. Pantoprazole 40 mg Tablet, Delayed Release PO Q24H
13. Conjugated Estrogens 0.625 mg Tablet PO DAILY
14. Buspirone 5 mg PO TID
15. Phenobarb-Belladonna Alkaloids 16.2 mg/5 mL Five mL PO Q 6
HRS as needed for indigestion.
16. Trimethoprim-Sulfamethoxazole 80-400 mg PO DAILY
17. Ezetimibe 10 mg  PO DAILY
18. Valganciclovir 900 mg  PO DAILY
19. Insulin Glargine Fourteen units Subcutaneous at bedtime.
20. Nystatin 100,000 unit/mL Five ML PO  QIDACHS
21. Midodrine 5 mg PO TID

Discharge Medications:
1. PICC
PICC care per routine protocol
2. Meropenem 500 mg Recon Soln Sig: One (1) gram Intravenous
every eight (8) hours for 17 days.
Disp:*51 grams* Refills:*0*
3. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
4. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Citalopram 20 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
7. Sodium Bicarbonate 650 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
9. Conjugated Estrogens 0.625 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
10. Buspirone 5 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day).
11. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily).
12. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

13. Valganciclovir 450 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
14. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO
QIDACHS (4 times a day (before meals and at bedtime)).
15. Outpatient Lab Work
Complete blood count.  Please call results to Dr. [**First Name (STitle) **]
[**Name (STitle) **] ([**Telephone/Fax (1) 673**])
16. Insulin Glargine 100 unit/mL Solution Sig: Fourteen (14)
units Subcutaneous at bedtime.
17. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day) as needed.
18. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4
to 6 hours) as needed.
19. Phenobarb-Belladonna Alkaloids 16.2 mg/5 mL Elixir Sig: Five
(5) ml PO QID (4 times a day) as needed for IBS.
Disp:*6000 ml* Refills:*0*
20. Tacrolimus 1 mg Capsule Sig: Two (2) Capsule PO BID (2 times
a day).
21. Prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

22. Metoprolol Succinate 25 mg Tablet Sustained Release 24HR
Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily).


Discharge Disposition:
Home With Service

Facility:
[**Last Name (LF) 486**], [**First Name3 (LF) 487**]

Discharge Diagnosis:
- Endstage renal disease status post transplant
- Urosepsis
- Ureteral reflux
- Autonomic neuropathy with hypotension
- Insulin dependent diabetes
- Anemia of inflammation as well as probable bone marrow
suppression
- Antibiotic associated diarrhea


Discharge Condition:
Good, afebrile.


Followup Instructions:
Please follow up with your appointments listed below in
Cardiology, Urology and Transplant [**Hospital 10701**] Clinic.
Please follow up at Infectious disease clinic at ([**Telephone/Fax (1) 4170**]
Please follow up with Dr. [**First Name (STitle) **] and with the [**Last Name (un) **] Diabetes
Center as discussed (you had mentioned having the numbers for
these clinics).
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 1989**] Date/Time:[**2108-1-2**]
10:20
Provider: [**First Name8 (NamePattern2) 161**] [**Name11 (NameIs) 162**] [**Name8 (MD) 163**], MD Phone:[**Telephone/Fax (1) 921**]
Date/Time:[**2107-11-11**] 8:30
Provider: [**Name10 (NameIs) 161**] [**Name8 (MD) 6476**], MD Phone:[**Telephone/Fax (1) 921**]
Date/Time:[**2107-10-21**] 8:30
Provider: [**Name10 (NameIs) 2105**] [**Name11 (NameIs) 2106**], MD Phone:[**Telephone/Fax (1) 673**]
Date/Time:[**2107-10-21**] 9:30
Provider: [**Name10 (NameIs) 2105**] [**Name11 (NameIs) 2106**], MD Phone:[**Telephone/Fax (1) 673**]
Date/Time:[**2107-10-25**] 1:00
Infectious disease clinic.


                             [**Name6 (MD) 2105**] [**Name8 (MD) 2106**] MD [**MD Number(2) 5038**]

Completed by:[**2107-10-14**]
{"Complications of transplanted kidney,Urinary tract infection, site not specified,Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Persistent postoperative fistula,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in other specified places,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Other specified anemias,Peripheral autonomic neuropathy in disorders classified elsewhere,Vesicoureteral reflux unspecified or without reflux nephropathy,Unspecified acquired hypothyroidism,Irritable bowel syndrome"}


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: Fevers

PRESENT ILLNESS: 47F s/p LURT [**12-18**], admitted for urosepsis. Had recent cardiac
cath 2 vessel stent [**2107-9-14**]. Course c/b pyelo (ESBL kleb PNA UTI)
treated with meropenem, sent home on 14 days of imipenem. Was
off abx for 1 week, came back w/ dysuria, back pain, T 100 at
home. Borderline low bp sbp98, +orthostatic so admitted to ICU.
[**10-3**] repeat Ucx enterococci VRE. On linezolid/meropenem
empirically. Started on stress steroids, now tapered to
pre-admit dose. Immuran held. CT abd neg for acute process.
Txred to floor on [**10-10**].

MEDICAL HISTORY: IDDM
ESRD s/p living unrelated renal transplant [**12-18**]
Hyperlipidemia
Hypothyroidism
Retroperitoneal bleed
sinusitis
IBS
h/o hypertension but recently treated for orthostatic
hypotension with midodrine
CAD S/P stenting in [**2107-9-15**]

MEDICATION ON ADMISSION: 1. Aspirin 325 mg Tablet, Delayed Release PO DAILY
2. Clopidogrel 75 mg  PO DAILY
3. Lorazepam 1 mg PO Q4-6H as needed.
4. Acetaminophen 650 mg PO every [**5-19**]  hours as needed for fever,
pain.
5. Aluminum-Magnesium Hydroxide 225-200 mg/5 mL Thirty ML PO QID
 as needed for indigestion.
6. Tacrolimus 2 mg PO BID
7. Prednisone 5 mg PO DAILY
8. Azathioprine 75 mg PO DAILY
9. Levothyroxine 75 mcg PO DAILY
10. Citalopram 60 mg PO DAILY
11. Sodium Bicarbonate 650 mg PO BID
12. Pantoprazole 40 mg Tablet, Delayed Release PO Q24H
13. Conjugated Estrogens 0.625 mg Tablet PO DAILY
14. Buspirone 5 mg PO TID
15. Phenobarb-Belladonna Alkaloids 16.2 mg/5 mL Five mL PO Q 6
HRS as needed for indigestion.
16. Trimethoprim-Sulfamethoxazole 80-400 mg PO DAILY
17. Ezetimibe 10 mg  PO DAILY
18. Valganciclovir 900 mg  PO DAILY
19. Insulin Glargine Fourteen units Subcutaneous at bedtime.
20. Nystatin 100,000 unit/mL Five ML PO  QIDACHS
21. Midodrine 5 mg PO TID

ALLERGIES: Morphine

PHYSICAL EXAM: VS - 97.3 105/62 69 20 99% on RA
Gen - awake, alert, sitting in the [**Last Name (un) **] next to the bed. NAD
HEENT - NCAT, Has tag of skin on the left buccal surface (of
note the patient has seen an OMF surgeon regarding biopsy of
this lesion) MMM, PERRL, EOMI.
Neck - supple, no LAD
Cor - RRR nl S1,S2 no M/R/G
Chest - CTA B, no W/R/R
Abd - s/nt/nd +BS, incisional wound with one fistula draining
serous fluid in the midline, no pain with palpation of
transplanted kidney. On left flank there is a scar from where
the fluid drain was located. There is no pain, erythema, or
swelling.
Ext - no c/c/e left D/P is difficult to find, but palpable. The
right foot is in a cast. Per patient she has fractured toe.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Denies EtOH and tobacco 

### Response:
{"Complications of transplanted kidney,Urinary tract infection, site not specified,Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Persistent postoperative fistula,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in other specified places,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Other specified anemias,Peripheral autonomic neuropathy in disorders classified elsewhere,Vesicoureteral reflux unspecified or without reflux nephropathy,Unspecified acquired hypothyroidism,Irritable bowel syndrome"}
