CHIEF COMPLAINT: Nausea, vomiting, shortness of breath.

PRESENT ILLNESS: This is a 48 year old woman with
a history of alcoholic cirrhosis, congestive heart failure,
asthma, diabetes, hypertension, pancreatitis, recently
admitted to [**Hospital1 69**] from [**1-28**]
to [**1-31**] for an asthma exacerbation, who now presents with
a one day history of fever, chills, nonproductive cough, sore
throat and increased wheezing.  She denies headache,
abdominal pain, dysuria or diarrhea.  She also complains of a
two week history of dyspnea on exertion with severe bilateral
lower extremity edema and increased abdominal girth.  She
denies chest pain, lightheadedness or palpitations.  She
reports low back pain secondary to abdominal girth and
tightness.  In the emergency room bedside ultrasound revealed
little ascitic fluid to tap.  In the emergency room she was
given 1 gm of Tylenol, 40 mg of IV Lasix, 500 mg of
levofloxacin p.o.

MEDICAL HISTORY: Alcoholic cirrhosis with no history of
varices.  Asthma with recent flare treated with prednisone.
Patient has just finished with her prednisone taper.
Diabetes mellitus on insulin.  Hypertension.
Anxiety/depression on Celexa.  Congestive heart failure with
an ejection fraction of 37%.  Post traumatic stress disorder.
Gastritis.  Alcoholic pancreatitis.  Status post cataract
surgery on [**2151-2-3**].

MEDICATION ON ADMISSION: Diltiazem 60 mg p.o. q.i.d.,
Klonopin 1 mg p.o. b.i.d., Celexa 30 mg p.o. q.d., Protonix
40 mg p.o. q.d., albuterol MDI, Atrovent MDI.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She drinks about five to eight beers a day.
Has a tobacco history.  On disability.  Children live close
by.  She lives alone, but is close to her children and
grandchildren.
Congestive heart failure, unspecified,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Alcoholic cirrhosis of liver,Acute alcoholic intoxication in alcoholism, continuous,Alcohol withdrawal,Hepatic encephalopathy,Hyposmolality and/or hyponatremia
CHF NOS,Acute kidney failure NOS,Urin tract infection NOS,Alcohol cirrhosis liver,Ac alcohol intox-contin,Alcohol withdrawal,Hepatic encephalopathy,Hyposmolality
Admission Date:  [**2151-2-12**]       Discharge Date:  [**2151-3-8**]

Date of Birth:   [**2102-5-27**]       Sex:  F

Service:  [**Hospital1 3253**]

CHIEF COMPLAINT:  Nausea, vomiting, shortness of breath.

HISTORY OF PRESENT ILLNESS:  This is a 48 year old woman with
a history of alcoholic cirrhosis, congestive heart failure,
asthma, diabetes, hypertension, pancreatitis, recently
admitted to [**Hospital1 69**] from [**1-28**]
to [**1-31**] for an asthma exacerbation, who now presents with
a one day history of fever, chills, nonproductive cough, sore
throat and increased wheezing.  She denies headache,
abdominal pain, dysuria or diarrhea.  She also complains of a
two week history of dyspnea on exertion with severe bilateral
lower extremity edema and increased abdominal girth.  She
denies chest pain, lightheadedness or palpitations.  She
reports low back pain secondary to abdominal girth and
tightness.  In the emergency room bedside ultrasound revealed
little ascitic fluid to tap.  In the emergency room she was
given 1 gm of Tylenol, 40 mg of IV Lasix, 500 mg of
levofloxacin p.o.

PAST MEDICAL HISTORY:  Alcoholic cirrhosis with no history of
varices.  Asthma with recent flare treated with prednisone.
Patient has just finished with her prednisone taper.
Diabetes mellitus on insulin.  Hypertension.
Anxiety/depression on Celexa.  Congestive heart failure with
an ejection fraction of 37%.  Post traumatic stress disorder.
Gastritis.  Alcoholic pancreatitis.  Status post cataract
surgery on [**2151-2-3**].

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:  Diltiazem 60 mg p.o. q.i.d.,
Klonopin 1 mg p.o. b.i.d., Celexa 30 mg p.o. q.d., Protonix
40 mg p.o. q.d., albuterol MDI, Atrovent MDI.

SOCIAL HISTORY:  She drinks about five to eight beers a day.
Has a tobacco history.  On disability.  Children live close
by.  She lives alone, but is close to her children and
grandchildren.

PHYSICAL EXAMINATION:  Temperature was 102, blood pressure
115/60, heart rate 108, respiratory rate 26, 98% in room air.
She had an odor of alcohol on her breath.  She was obese,
[**Year (4 digits) 3584**], oriented times three, in no acute distress.  She had
scleral icterus with slightly dry oropharynx.  Extraocular
movements intact.  She had a left eye patch on.  Right pupil
was equally round and reactive to light.  Heart was
tachycardiac, regular rhythm without murmurs appreciated at
that time.  She had diffuse wheezing throughout her lung
exam.  Abdomen was obese with mild distension, soft,
nontender, no fluid wave appreciated, no shifting dullness
appreciated.  She had 2+ pitting edema bilaterally to the
knees.  She had mild asterixis, but was [**Year (4 digits) 3584**] and oriented
times three.  No hemangiomas, palmar erythema or caput medusa
were appreciated.

LABORATORY DATA:  On admission sodium was 137, potassium 4.1,
chloride 101, bicarbonate 28, BUN 7, creatinine 0.7, glucose
155.  ALT 42, AST 86, amylase 150, alkaline phosphatase 144,
LDH 424, lipase 83, total bilirubin 5.6.  White count 5.6,
hematocrit 30.1, platelets 34, 73% neutrophils, 1% bands.  PT
was 16.5, INR 1.8, PTT 34.1.  Urinalysis showed trace blood,
positive nitrite, small bilirubin 1 urobilinogen, small leuk
esterase, 21 to 50 white blood cells, 0 to 2 red blood cells,
many bacteria, no epithelial cells.  Chest x-ray showed mild
congestive heart failure.  EKG showed sinus tachycardia at
120 beats per minute, no acute ST-T wave changes.

HOSPITAL COURSE:  The patient was admitted for a urinary
tract infection and fluid overload.  Her hospital course was
long and complicated.  Patient was treated with levofloxacin
times 14 days for her urinary tract infection with negative
followup urine cultures and resolution of her fever.  She was
found to be extremely volume overloaded.  Her weight was 220
pounds in-house.  Her baseline weight, according to her
clinic notes, is 180 pounds.  It was unclear whether her
volume overload was due to cirrhosis or congestive heart
failure.  It was thought to be likely due to both.  She
received a repeat echocardiogram that showed suboptimal image
quality secondary to poor echo windows, mildly dilated left
atrium, mildly depressed left ventricular function.  Systolic
function could not be reliably assessed due to suboptimal
image.  There was trace aortic regurgitation, 2+ tricuspid
regurgitation and 1+ mitral regurgitation.  Left ventricular
function was improved compared with [**2150-2-23**].  At that
time an echo showed less than 25% EF with severe global left
ventricular hypokinesis.

She was aggressively diuresed with Lasix and Aldactone.
Diuresis had to be stopped secondary to acute renal failure.
Creatinine climbed from 0.7 to a high of 3.7.  Diuretics were
stopped when creatinine was 1.2.  However, creatinine
continued to climb.  Initially a Swan-Ganz catheter was
deferred for assessment of her intravascular volume status
due to positive heparin induced thrombocytopenia antibodies.
However, with the worsening creatinine and uncertainty about
her volume status, patient was transferred to the medical
intensive care unit with a plan to place a Swan-Ganz catheter
for assessment of her volume status.  Renal consult was
called.  Her urine electrolytes and urine studies showed
pre-renal azotemia.  The renal consult team recommended
giving intravascular repletion along with packed red blood
cells for colloid repletion.  Patient responded with
resolution of her acute renal failure.

After a four day intensive care unit stay, patient was
transferred back to the floor team with continued monitoring
of her renal function.  While in the medical intensive care
unit she was positive 3.7 liters and more grossly volume
overloaded than prior to transfer to the medical intensive
care unit.  Cardiovascularly upon admission patient had
tachycardia with demand ischemia and a troponin leak of 1.1.
Subsequent troponins were done.  She was initially continued
on diltiazem for heart rate control, but diltiazem was weaned
off due to heart failure.  Hydralazine and Isordil were
started.  With resolution of her renal failure, hydralazine
and Isordil were then switched to an ACE inhibitor.  With
resolution of her acute renal failure, Lasix was also
restarted with effective diuresis.

Hospital course was also significant for alcoholic cirrhosis
with coagulopathy and encephalopathy.  Patient was continued
on lactulose for her encephalopathy.  For her coagulopathy,
she was given vitamin K without any effect.  The liver
service was consulted who recommended vitamin K and diuresis.
She also had baseline thrombocytopenia thought to be due to
both alcohol toxicity and hypersplenism.  However, during the
hospital course her platelet count continued to drop.  A
heparin induced antibody was sent off which came back
positive twice.  All heparin flushes and subcutaneous heparin
were stopped with stabilization of her platelet count.
However, Protonix was increased to b.i.d. due to trace guaiac
positive stools and hematocrit that was slowly drifting down.
Patient's platelet count continued to decrease thereafter.
Protonix was discontinued with stabilization of her platelet
count.  Two abdominal ultrasounds were obtained.  The first
one on [**2-15**] showed a mild amount of ascites, patent flow
with appropriate direction in all hepatic vessels.  A
subsequent abdominal ultrasound was obtained on [**2-25**]
showing a small amount of ascites unable to be tapped.  Due
to some complaints of abdominal discomfort, a gallbladder
scan was obtained on [**2-24**] showing no acute cholecystitis.

Her hospital course was also significant for alcohol
withdrawal for which she was on Ativan and continued on her
home regimen of Klonopin.  She was seen by the addiction
service who helped with the Ativan taper.  She was also
continued on Celexa for depression.  Patient was at time
tearful and depressed, but her mood substantially improved by
the end of her hospitalization with resolution of some of her
symptoms.

Her pulmonary status remained stable.  She was continued on
nebulizer treatments and her inhalers for asthma.  Her oxygen
saturation level remained stable throughout the hospital
stay. As mentioned above, her acute renal failure was thought
to be over-diuresis combined with poor forward flow due to
congestive heart failure.  Her hemodynamics were optimized
with an ACE inhibitor.  She was also given intravascular
repletion with packed red blood cells and normal saline in
the intensive care unit.  For her diabetes she was continued
on NPH insulin and regular insulin sliding scale.  She
complained of leg pain during the hospital course due to
edema.  Lower extremity Dopplers were negative for deep vein
thrombosis.

Her hospital course was also significant for hyperkalemia
secondary to renal failure and hyperphosphatemia.  Both were
treated with Kayexalate and Amphojel and resolved with
resolution of her acute renal failure.  Other laboratory data
from the hospital course included a vitamin B-12 level that
was normal at 1784.  Albumin was 2.4.  Thyroid stimulating
hormone was 2.0.  Digoxin level was 0.7.  Patient was started
on digoxin for her heart failure.  Alpha fetoprotein was 2.2.
She required some magnesium repletion thought due to
diuresis.  She was also hyponatremic which resolved with free
water restriction.  Over the hospital course patient received
four units of packed red blood cells with stable hematocrit
after [**3-2**].  Patient remained stable with good diuresis.
She was evaluated by physical therapy who felt that patient
required short term rehab.  Patient was discharged in stable
condition to short term rehab with the following diagnoses.

DISCHARGE DIAGNOSES:
1.  Heparin induced thrombocytopenia.
2.  Alcoholic cirrhosis.
3.  Diabetes mellitus.
4.  Hypertension.
5.  Asthma.
6.  Congestive heart failure.
7.  Urinary tract infection, treated.
8.  Resolving acute renal failure.

DISCHARGE MEDICATIONS:
1.  Klonopin 1 mg p.o. b.i.d.
2.  Celexa 30 mg p.o. q.d.
3.  Albuterol MDI one to two puffs q.four hours p.r.n.
4.  Atrovent two puffs q.i.d.
5.  Prednisolone 1% ophthalmic suspension, one drop OS b.i.d.
status post cataract surgery.
6.  Digoxin 0.125 mg p.o. q.d.
7.  NPH 50 units q.a.m., 30 units q.p.m.
8.  Regular insulin sliding scale.
9.  Multivitamin one cap p.o. q.d.
10. Thiamine 100 mg p.o. q.d.
11. Lisinopril 10 mg p.o. q.d.
12. Lasix 40 mg p.o. b.i.d.

DISCHARGE INSTRUCTIONS:  Chem-7 is to be checked in two days
as well as platelet count.  Patient is to follow up with
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4569**], her primary care physician.  [**Name10 (NameIs) **] phone number
is [**Telephone/Fax (1) 7976**].  Patient is to follow up with the liver
service as an outpatient.






                            [**Name6 (MD) 7853**] [**Last Name (NamePattern4) 7854**], M.D.
[**MD Number(1) 7855**]

Dictated By:[**Doctor Last Name 229**]
MEDQUIST36

D:  [**2151-3-8**]  12:36
T:  [**2151-3-8**]  12:14
JOB#:  [**Job Number 11804**]
{'Congestive heart failure, unspecified,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Alcoholic cirrhosis of liver,Acute alcoholic intoxication in alcoholism, continuous,Alcohol withdrawal,Hepatic encephalopathy,Hyposmolality and/or hyponatremia'}


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: Nausea, vomiting, shortness of breath.

PRESENT ILLNESS: This is a 48 year old woman with
a history of alcoholic cirrhosis, congestive heart failure,
asthma, diabetes, hypertension, pancreatitis, recently
admitted to [**Hospital1 69**] from [**1-28**]
to [**1-31**] for an asthma exacerbation, who now presents with
a one day history of fever, chills, nonproductive cough, sore
throat and increased wheezing.  She denies headache,
abdominal pain, dysuria or diarrhea.  She also complains of a
two week history of dyspnea on exertion with severe bilateral
lower extremity edema and increased abdominal girth.  She
denies chest pain, lightheadedness or palpitations.  She
reports low back pain secondary to abdominal girth and
tightness.  In the emergency room bedside ultrasound revealed
little ascitic fluid to tap.  In the emergency room she was
given 1 gm of Tylenol, 40 mg of IV Lasix, 500 mg of
levofloxacin p.o.

MEDICAL HISTORY: Alcoholic cirrhosis with no history of
varices.  Asthma with recent flare treated with prednisone.
Patient has just finished with her prednisone taper.
Diabetes mellitus on insulin.  Hypertension.
Anxiety/depression on Celexa.  Congestive heart failure with
an ejection fraction of 37%.  Post traumatic stress disorder.
Gastritis.  Alcoholic pancreatitis.  Status post cataract
surgery on [**2151-2-3**].

MEDICATION ON ADMISSION: Diltiazem 60 mg p.o. q.i.d.,
Klonopin 1 mg p.o. b.i.d., Celexa 30 mg p.o. q.d., Protonix
40 mg p.o. q.d., albuterol MDI, Atrovent MDI.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She drinks about five to eight beers a day.
Has a tobacco history.  On disability.  Children live close
by.  She lives alone, but is close to her children and
grandchildren. 

### Response:
{'Congestive heart failure, unspecified,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Alcoholic cirrhosis of liver,Acute alcoholic intoxication in alcoholism, continuous,Alcohol withdrawal,Hepatic encephalopathy,Hyposmolality and/or hyponatremia'}
