CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 50 year old
woman with a very extensive past medical, psychiatric and
neurologic history who was transferred back to medicine
service after left hip repair.  Patient had been admitted on
[**2148-11-9**], for hyponatremia.  She had suffered a
hyponatremia was noted on routine blood work.  Patient has a
significant history of epilepsy which required two
lobectomies and titration of a variety of antiepileptic
drugs.  She has had multiple admissions for hyponatremia down
to the 120s before.  Previous workup revealed a SIADH
picture.  Because the SIADH was thought to be secondary to
her antiepileptic medications, patient was previously treated
has been following her and drew a sodium which revealed
sodium of 120 on [**11-8**].  After further questioning,
patient reports her usual seizure activity, partial complex
of left hand and arm twitching times one two days prior to
admission.  She had not had a prior seizure in over a year.
On admission she was noted to have a large protruding mass
over the left thigh, extremely tender and erythematous.  Pain
films revealed a new fracture of the left acetabulum.
Patient has a history of bilateral hip fractures, although
she only recalls a left hip fracture.  An abscess over the
site was drained.  Cultures grew gram positive cocci in pairs
and clusters.  She went to the operating room on [**2148-11-10**], where hardware from previous repair was removed.
Cultures were taken in the operating room.  She received four
units of packed red blood cells and Lasix.  When patient was
seen she complained of left knee pain, severe in intensity.
She reports having had similar knee pain in the past and was
admitted in [**2146-9-4**] due to similar complaints.  Denies
dyspnea, fever, chills, chest pain.  Denies headaches.  Has
not had a seizure during this admission.

MEDICAL HISTORY: Complex partial seizures.  Status post
right temporooccipital lobectomy with VP shunt and partial
left hemiparesis in [**2127**].  Depression.  Obsessive compulsive
disorder.  Chronic left lower extremity edema.  Right hip
fracture to the left and fracture of the lateral ischial ring
on the right side.  Left hip fracture dislocation status post
left hip replacement.  History of methicillin resistant
Staphylococcus aureus growth in the left joint status post
total hip replacement.  Anorexia, binging eating disorder.
Osteoporosis status post multiple fractures.  Severe left
knee pain likely referred from the left hip.  Premenopausal.
History of B-12 deficient anemia.  History of incontinence
status post urinary stent.  Constipation.  Peripheral
vascular disease left lower extremity.  History of cellulitis
in left lower extremity.  Osteoporotic compression fractures.
Syndrome of inappropriate diuretic hormone thought to be
secondary to psychiatric medications.

MEDICATION ON ADMISSION: Carbamazepine 200 mg p.o. t.i.d.
(this must be brand name Tegretol), docusate sodium 100 mg
p.o. t.i.d., oxycodone sustained release 20 mg p.o. q.eight,
Tylenol, senna one tab p.o. b.i.d., Dulcolax 10 mg p.o. p.r.
q.d., vancomycin 1 gm IV q.12, Protonix 40 p.o. q.24,
midodrine 10 mg p.o. t.i.d., Percocet one to two tabs p.o.
q.four to six hours p.r.n., calcium, fluocinolone cream,
risperidone 1 mg p.o. b.i.d., raloxifene 60 mg q.d.,
phenobarbital 30 p.o. t.i.d., multivitamin, lactic acid
lotion, ibuprofen 400 mg p.o. q.eight p.r.n., hydrocortisone
cream 1% t.p. b.i.d., tiagabine 4 mg p.o. b.i.d., alendronate
sodium 70 mg p.o. q.Monday, oxybutynin 10 mg p.o. b.i.d.,
baclofen 10 mg p.o. q.i.d., hydroxyzine 25 p.o. q.four to six
hours p.r.n., amoxapine 25 p.o. t.i.d., Coumadin 5 mg p.o.
q.d.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She lives in [**Location (un) 55**].  She denies
ethanol use.  Denies tobacco use.  She graduated from high
school as well as from [**Hospital1 102955**]with a
bachelor's in religion.  She attended [**Hospital1 102956**] School.
She was forced to leave her studies after the second year
secondary to her seizure disorder.  She has never been
married.  She has no children.  She currently lives alone in
an apartment in [**Location (un) 55**].  She has a personal care
attendant who works with her five days a week.
Infection and inflammatory reaction due to internal joint prosthesis,Acute osteomyelitis, pelvic region and thigh,Closed fracture of acetabulum,Other disorders of neurohypophysis,Epilepsy, unspecified, without mention of intractable epilepsy,Peripheral vascular disease, unspecified,Osteoporosis, unspecified
React-inter joint prost,Ac osteomyelitis-pelvis,Fracture acetabulum-clos,Neurohypophysis dis NEC,Epilep NOS w/o intr epil,Periph vascular dis NOS,Osteoporosis NOS
Admission Date:  [**2148-11-9**]       Discharge Date:  [**2148-11-15**]

Date of Birth:   [**2098-10-28**]       Sex:  F

Service:  [**Location (un) 259**]
HISTORY OF PRESENT ILLNESS:  The patient is a 50 year old
woman with a very extensive past medical, psychiatric and
neurologic history who was transferred back to medicine
service after left hip repair.  Patient had been admitted on
[**2148-11-9**], for hyponatremia.  She had suffered a
hyponatremia was noted on routine blood work.  Patient has a
significant history of epilepsy which required two
lobectomies and titration of a variety of antiepileptic
drugs.  She has had multiple admissions for hyponatremia down
to the 120s before.  Previous workup revealed a SIADH
picture.  Because the SIADH was thought to be secondary to
her antiepileptic medications, patient was previously treated
has been following her and drew a sodium which revealed
sodium of 120 on [**11-8**].  After further questioning,
patient reports her usual seizure activity, partial complex
of left hand and arm twitching times one two days prior to
admission.  She had not had a prior seizure in over a year.
On admission she was noted to have a large protruding mass
over the left thigh, extremely tender and erythematous.  Pain
films revealed a new fracture of the left acetabulum.
Patient has a history of bilateral hip fractures, although
she only recalls a left hip fracture.  An abscess over the
site was drained.  Cultures grew gram positive cocci in pairs
and clusters.  She went to the operating room on [**2148-11-10**], where hardware from previous repair was removed.
Cultures were taken in the operating room.  She received four
units of packed red blood cells and Lasix.  When patient was
seen she complained of left knee pain, severe in intensity.
She reports having had similar knee pain in the past and was
admitted in [**2146-9-4**] due to similar complaints.  Denies
dyspnea, fever, chills, chest pain.  Denies headaches.  Has
not had a seizure during this admission.

PAST MEDICAL HISTORY:  Complex partial seizures.  Status post
right temporooccipital lobectomy with VP shunt and partial
left hemiparesis in [**2127**].  Depression.  Obsessive compulsive
disorder.  Chronic left lower extremity edema.  Right hip
fracture to the left and fracture of the lateral ischial ring
on the right side.  Left hip fracture dislocation status post
left hip replacement.  History of methicillin resistant
Staphylococcus aureus growth in the left joint status post
total hip replacement.  Anorexia, binging eating disorder.
Osteoporosis status post multiple fractures.  Severe left
knee pain likely referred from the left hip.  Premenopausal.
History of B-12 deficient anemia.  History of incontinence
status post urinary stent.  Constipation.  Peripheral
vascular disease left lower extremity.  History of cellulitis
in left lower extremity.  Osteoporotic compression fractures.
Syndrome of inappropriate diuretic hormone thought to be
secondary to psychiatric medications.

SOCIAL HISTORY:  She lives in [**Location (un) 55**].  She denies
ethanol use.  Denies tobacco use.  She graduated from high
school as well as from [**Hospital1 102955**]with a
bachelor's in religion.  She attended [**Hospital1 102956**] School.
She was forced to leave her studies after the second year
secondary to her seizure disorder.  She has never been
married.  She has no children.  She currently lives alone in
an apartment in [**Location (un) 55**].  She has a personal care
attendant who works with her five days a week.

MEDICATIONS ON ADMISSION:  Carbamazepine 200 mg p.o. t.i.d.
(this must be brand name Tegretol), docusate sodium 100 mg
p.o. t.i.d., oxycodone sustained release 20 mg p.o. q.eight,
Tylenol, senna one tab p.o. b.i.d., Dulcolax 10 mg p.o. p.r.
q.d., vancomycin 1 gm IV q.12, Protonix 40 p.o. q.24,
midodrine 10 mg p.o. t.i.d., Percocet one to two tabs p.o.
q.four to six hours p.r.n., calcium, fluocinolone cream,
risperidone 1 mg p.o. b.i.d., raloxifene 60 mg q.d.,
phenobarbital 30 p.o. t.i.d., multivitamin, lactic acid
lotion, ibuprofen 400 mg p.o. q.eight p.r.n., hydrocortisone
cream 1% t.p. b.i.d., tiagabine 4 mg p.o. b.i.d., alendronate
sodium 70 mg p.o. q.Monday, oxybutynin 10 mg p.o. b.i.d.,
baclofen 10 mg p.o. q.i.d., hydroxyzine 25 p.o. q.four to six
hours p.r.n., amoxapine 25 p.o. t.i.d., Coumadin 5 mg p.o.
q.d.

ALLERGIES:  No known drug allergies.

PHYSICAL EXAMINATION:  Temperature 98.4, heart rate 70 to 80,
blood pressure 100/60, respirations 12 to 16, oxygen
saturation 99% on 2 liters nasal cannula.  In general, this
was an alert female with slow speech pattern, however, she
was talkative with sporadic intermittently tearful episodes.
HEENT: extraocular movements intact.  Pupils were equal,
round, and reactive to light and accommodation bilaterally.
Oropharynx had poor dentition, but otherwise clear.  Mucosal
membranes were moist.  Neck no LAD, supple, palpable VP shunt
on right side of neck.  Heart widely split S2 with loud P2,
regular rate, mild [**1-10**] HSM radiating to the axilla.  Lungs
had no wheezes or crackles limited anteriorly.  Abdomen
normal bowel sounds, distended, mildly tympanitic, nontender,
no rebound or guarding.  Extremities: left hip covered with
bandage, has drain collecting sanguineous fluid.  Left knee
appears more swollen than right.  No clear collection of
fluid.  Nontender to palpation.  Both lower extremities were
cool to touch.  Had dopplerable PT and DP pulses bilaterally.
Left lower extremity from knee to foot is erythematous, not
so in right lower extremity.  On neuro exam cranial nerves
II-XII intact.  Left arm [**3-8**], right side [**4-7**].  Has limited
ankle dorsiflexion and plantar flexion.  Left subclavian line
nontender.

LABORATORY DATA:  White cell count 12.9, hematocrit 43.7,
platelets 272.  INR 1.2.  Urinalysis showed 30 protein, 3
white cells.  Chest x-ray confirmed good central line
placement from subclavian.  Left hip film showed a large soft
tissue density projected over the left groin.  This appeared
to be a fractured left acetabulum with continued protrusion
of the acetabular component of the total hip prosthesis into
the pelvis.

HOSPITAL COURSE:  After the patient returned from surgery
where infected hardware was removed, her hyponatremia was
managed with fluid restriction and sodium tablets.  Sodium
remained stable at 130 over the two to three days prior to
discharge. The sodium supplementation helped her chronically low
blood pressure.  Her midodrine was therefore discontinued. She
was continued on vancomycin. Wound cultures returned with
cultures positive for MRSA.  ID consult was requested and
recommended very long term antibiotic use with vancomycin 1 gm IV
q.12 hours for a total of four to six months.  Followup with ID
was to be scheduled by rehab staff within three to four weeks
after discharge from the hospital.

The patient was started on Coumadin for anticoagulation with
a goal of 1.5 to 2.0.  She was discharged on Coumadin 5 mg
p.o. q.d.

Regarding epilepsy, patient remained seizure free during her
hospital stay.  Her seizure episode was thought to be caused
by hyponatremia.  Per ID recommendation an MRI of the left
thigh was performed.  This showed old left supracondylar
fracture with high suspicion for complications with
osteomyelitis with discrete interosseous abscess.  There was
also inflammatory change present within the joint and soft
tissue, particularly the posterior compartment.  However, no
discrete soft tissue abscess was appreciated.  Orthopaedic
surgeon, Dr. [**Last Name (STitle) 7111**], was consulted again and recommended
conservative management with long term vancomycin with no
surgical intervention at that time.  Infectious disease was
consulted as well and they agreed with the plan.

The patient was discharged to rehab on [**2148-11-15**], on
the following medications.

DISCHARGE MEDICATIONS:
1.  Coumadin 5 mg p.o. q.d.
2.  Lactulose 30 mg p.o. q.eight p.r.n.
3.  Tiagabine 4 mg p.o. h.s.
4.  Oxycodone extended release 10 mg p.o. q.12.
5.  Amoxapine 50 mg p.o. b.i.d.
6.  Tegretol (this must be brand name Tegretol) 200 mg p.o.
t.i.d.
7.  Vitamin D 50,000 units p.o. twice a week on Wednesday and
Saturday for a total of six doses, then resume 800 IU q.d.
8.  Sodium tabs 4 gm p.o. t.i.d.
9.  Colace 100 mg p.o. b.i.d.
10. Senna one tab p.o. b.i.d.
11. Eucerin cream q.i.d. p.r.n.
12. Dulcolax 10 mg p.o. p.r. q.d.
13. Vancomycin 1 gm IV q.12.  Duration to be determined by
infectious disease.  At this time the anticipated duration is
four to six months.
14. Oxybutynin 10 mg p.o. b.i.d.
15. Protonix 40 mg p.o. q.d.
16. Risperidone 1 mg p.o. b.i.d.
17. Percocet one to two tabs p.o. q.four to six hours p.r.n.
18. Calcium carbonate 1250 p.o. b.i.d.
19. Fluocinolone cream b.i.d.
20. Raloxifene 60 mg p.o. q.d.
21. Phenobarbital 30 mg p.o. t.i.d.
22. Multivitamin one tab p.o. q.d.
23. Lactic acid lotion.
24. Ibuprofen 400 mg p.o. t.i.d.
25. Hydrocortisone cream 1% b.i.d.
26. Alendronate sodium 70 mg p.o. q.Monday.
27. Baclofen 10 mg p.o. q.i.d.
28. Hydroxyzine 25 mg p.o. q.four to six hours p.r.n.
29. Ditropan XL 10 mg p.o. b.i.d.

DISCHARGE INSTRUCTIONS:  CBC, chem-7, albumin, calcium will
need to be checked every week at minimum.  Calcium must be
followed given high dose of vitamin D.  Followup appointments
will need to be set up by rehab staff with infectious disease
specialist, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1774**] or Dr. [**Last Name (STitle) 1005**] at [**Telephone/Fax (1) **], in
three to four weeks after discharge and orthopaedic surgeon,
Dr. [**Last Name (STitle) 7111**], in four to five weeks after discharge.  Discharge
diet high protein, high salt with fluid restriction of 1
liter a day.

CONDITION ON DISCHARGE:  Fair.

DISCHARGE DIAGNOSES:
1.  Seizures.
2.  Acetabular fracture.
3.  Infected hardware status post removal.
4.  Hyponatremia.
5.  Osteomyelitis of left femoral bone.






                            [**First Name8 (NamePattern2) **] [**First Name4 (NamePattern1) 1775**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 1776**]

Dictated By:[**Doctor Last Name 16524**]
MEDQUIST36

D:  [**2148-11-15**]  16:29
T:  [**2148-11-15**]  17:35
JOB#:  [**Job Number 102957**]
{'Infection and inflammatory reaction due to internal joint prosthesis,Acute osteomyelitis, pelvic region and thigh,Closed fracture of acetabulum,Other disorders of neurohypophysis,Epilepsy, unspecified, without mention of intractable epilepsy,Peripheral vascular disease, unspecified,Osteoporosis, unspecified'}


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: The patient is a 50 year old
woman with a very extensive past medical, psychiatric and
neurologic history who was transferred back to medicine
service after left hip repair.  Patient had been admitted on
[**2148-11-9**], for hyponatremia.  She had suffered a
hyponatremia was noted on routine blood work.  Patient has a
significant history of epilepsy which required two
lobectomies and titration of a variety of antiepileptic
drugs.  She has had multiple admissions for hyponatremia down
to the 120s before.  Previous workup revealed a SIADH
picture.  Because the SIADH was thought to be secondary to
her antiepileptic medications, patient was previously treated
has been following her and drew a sodium which revealed
sodium of 120 on [**11-8**].  After further questioning,
patient reports her usual seizure activity, partial complex
of left hand and arm twitching times one two days prior to
admission.  She had not had a prior seizure in over a year.
On admission she was noted to have a large protruding mass
over the left thigh, extremely tender and erythematous.  Pain
films revealed a new fracture of the left acetabulum.
Patient has a history of bilateral hip fractures, although
she only recalls a left hip fracture.  An abscess over the
site was drained.  Cultures grew gram positive cocci in pairs
and clusters.  She went to the operating room on [**2148-11-10**], where hardware from previous repair was removed.
Cultures were taken in the operating room.  She received four
units of packed red blood cells and Lasix.  When patient was
seen she complained of left knee pain, severe in intensity.
She reports having had similar knee pain in the past and was
admitted in [**2146-9-4**] due to similar complaints.  Denies
dyspnea, fever, chills, chest pain.  Denies headaches.  Has
not had a seizure during this admission.

MEDICAL HISTORY: Complex partial seizures.  Status post
right temporooccipital lobectomy with VP shunt and partial
left hemiparesis in [**2127**].  Depression.  Obsessive compulsive
disorder.  Chronic left lower extremity edema.  Right hip
fracture to the left and fracture of the lateral ischial ring
on the right side.  Left hip fracture dislocation status post
left hip replacement.  History of methicillin resistant
Staphylococcus aureus growth in the left joint status post
total hip replacement.  Anorexia, binging eating disorder.
Osteoporosis status post multiple fractures.  Severe left
knee pain likely referred from the left hip.  Premenopausal.
History of B-12 deficient anemia.  History of incontinence
status post urinary stent.  Constipation.  Peripheral
vascular disease left lower extremity.  History of cellulitis
in left lower extremity.  Osteoporotic compression fractures.
Syndrome of inappropriate diuretic hormone thought to be
secondary to psychiatric medications.

MEDICATION ON ADMISSION: Carbamazepine 200 mg p.o. t.i.d.
(this must be brand name Tegretol), docusate sodium 100 mg
p.o. t.i.d., oxycodone sustained release 20 mg p.o. q.eight,
Tylenol, senna one tab p.o. b.i.d., Dulcolax 10 mg p.o. p.r.
q.d., vancomycin 1 gm IV q.12, Protonix 40 p.o. q.24,
midodrine 10 mg p.o. t.i.d., Percocet one to two tabs p.o.
q.four to six hours p.r.n., calcium, fluocinolone cream,
risperidone 1 mg p.o. b.i.d., raloxifene 60 mg q.d.,
phenobarbital 30 p.o. t.i.d., multivitamin, lactic acid
lotion, ibuprofen 400 mg p.o. q.eight p.r.n., hydrocortisone
cream 1% t.p. b.i.d., tiagabine 4 mg p.o. b.i.d., alendronate
sodium 70 mg p.o. q.Monday, oxybutynin 10 mg p.o. b.i.d.,
baclofen 10 mg p.o. q.i.d., hydroxyzine 25 p.o. q.four to six
hours p.r.n., amoxapine 25 p.o. t.i.d., Coumadin 5 mg p.o.
q.d.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She lives in [**Location (un) 55**].  She denies
ethanol use.  Denies tobacco use.  She graduated from high
school as well as from [**Hospital1 102955**]with a
bachelor's in religion.  She attended [**Hospital1 102956**] School.
She was forced to leave her studies after the second year
secondary to her seizure disorder.  She has never been
married.  She has no children.  She currently lives alone in
an apartment in [**Location (un) 55**].  She has a personal care
attendant who works with her five days a week. 

### Response:
{'Infection and inflammatory reaction due to internal joint prosthesis,Acute osteomyelitis, pelvic region and thigh,Closed fracture of acetabulum,Other disorders of neurohypophysis,Epilepsy, unspecified, without mention of intractable epilepsy,Peripheral vascular disease, unspecified,Osteoporosis, unspecified'}
