CHIEF COMPLAINT: Admit from ED for respiratory distress in setting of volume
overload

PRESENT ILLNESS: 71 yo woman presenting from NH with ESRD due for dialysis today
who had acute onset of SOB at NH with O2 sat 81-89% tachypnic to
30s. She is on home O2 2L. Last HD was Friday. No CP, no back
pain.
.
In the ED, she was Tachypnic to 50s on arrival and started on
Bipap with sats 100%. She had a UTI on U/A treated with
Levoquin, Hyperkalemia to 6.5 was treated with Insulin/D50,
kayexalate. She was given 40mg IV Lasix for volume overload. She
had pulmonary edema on CXR with ? widened mediastinum. She had
Hyperkalemia treated with Insulin and D50. She was also
hypertensive to the 170s and placed on Nitro gtt. Just ptior to
transfer, BP 193/60, slightly tachypnic on bipap sating 100%.
EKG showed q waves in III and AVF. She is being admitted for
dialysis for difinitive treatment in unit.

MEDICAL HISTORY: DM II
HTN
ESRD on HD
L Hemiarthroplasty s/p L femoral neck fx
PNA
Pulm Sarcoidosis
AR
Obesity
Vent Hypertrophy
Nontoxic multinodular goiter
LUE AVF
Cystitis

MEDICATION ON ADMISSION: Novolin Insulin SS
Metoprolol 50mg [**Hospital1 **]
Zoloft 75mg Daily
ASA 81mg Daily
Amlodipine 10mg Daily
Captopril 100mg q T, Th, Sat, Sun (non-HD days) [**Hospital1 **]
Lipitor 80mg
Nephrocaps
Protonix 40
Colace
Ibuprofen
Pulmicort 200mcg 2 puffs [**Hospital1 **]
Renagel 800mg 3 tabs TID
Mirtazapine 15mg QHS
Senna 2 tabs QHS
1000ml Fluid restriction
Humalog 75/25 22 U Qam, 10 U qPM
Lactulose 30ml PRN
Tylenol PRN
Oxycodone 5 PRN

ALLERGIES: Penicillins / Sulfa (Sulfonamides)

PHYSICAL EXAM: PE: 96.7 64 178/61 --> 130/44 93 20 100% O2 Sats on BIPAP
Gen: AA woman on Bipap mask in NAD in bed
HEENT: Deferred (Bipap)
NECK: Supple, large, No LAD, Cannot assess JVD with Bipap mask
CV: RR, NL rate. NL S1, S2. Loud 3/6 systolic murmurs heard best
at LUSB, radiates to carotids, no rubs or [**Last Name (un) 549**]
LUNGS: Soft BL LL crackles, No W/R
ABD: Soft, NT, ND. NL BS. No HSM
EXT: 1+ edema. 2+ DP pulses BL
SKIN: No lesions
NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact. Preserved
sensation throughout. 5/5 strength throughout.
PSYCH: Pleasant

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives at [**Hospital3 537**]. Daughter [**Name (NI) 2659**] is her HCP
Sarcoidosis,Lung involvement in other diseases classified elsewhere,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Nontoxic multinodular goiter,Congestive heart failure, unspecified,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Hyperpotassemia,Urinary tract infection, site not specified,Pneumonia, organism unspecified,Aortic valve disorders,Diseases of tricuspid valve
Sarcoidosis,Lung involv in oth dis,DMII wo cmp nt st uncntr,Nontox multinodul goiter,CHF NOS,End stage renal disease,Hyp kid NOS w cr kid V,Hyperpotassemia,Urin tract infection NOS,Pneumonia, organism NOS,Aortic valve disorder,Tricuspid valve disease
Admission Date:  [**2181-6-25**]              Discharge Date:   [**2181-6-27**]

Date of Birth:  [**2110-3-19**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins / Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 398**]
Chief Complaint:
Admit from ED for respiratory distress in setting of volume
overload

Major Surgical or Invasive Procedure:
None

History of Present Illness:
71 yo woman presenting from NH with ESRD due for dialysis today
who had acute onset of SOB at NH with O2 sat 81-89% tachypnic to
30s. She is on home O2 2L. Last HD was Friday. No CP, no back
pain.
.
In the ED, she was Tachypnic to 50s on arrival and started on
Bipap with sats 100%. She had a UTI on U/A treated with
Levoquin, Hyperkalemia to 6.5 was treated with Insulin/D50,
kayexalate. She was given 40mg IV Lasix for volume overload. She
had pulmonary edema on CXR with ? widened mediastinum. She had
Hyperkalemia treated with Insulin and D50. She was also
hypertensive to the 170s and placed on Nitro gtt. Just ptior to
transfer, BP 193/60, slightly tachypnic on bipap sating 100%.
EKG showed q waves in III and AVF. She is being admitted for
dialysis for difinitive treatment in unit.


Past Medical History:
DM II
HTN
ESRD on HD
L Hemiarthroplasty s/p L femoral neck fx
PNA
Pulm Sarcoidosis
AR
Obesity
Vent Hypertrophy
Nontoxic multinodular goiter
LUE AVF
Cystitis


Social History:
Lives at [**Hospital3 537**]. Daughter [**Name (NI) 2659**] is her HCP

Family History:
NC

Physical Exam:
PE: 96.7 64 178/61 --> 130/44 93 20 100% O2 Sats on BIPAP
Gen: AA woman on Bipap mask in NAD in bed
HEENT: Deferred (Bipap)
NECK: Supple, large, No LAD, Cannot assess JVD with Bipap mask
CV: RR, NL rate. NL S1, S2. Loud 3/6 systolic murmurs heard best
at LUSB, radiates to carotids, no rubs or [**Last Name (un) 549**]
LUNGS: Soft BL LL crackles, No W/R
ABD: Soft, NT, ND. NL BS. No HSM
EXT: 1+ edema. 2+ DP pulses BL
SKIN: No lesions
NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact. Preserved
sensation throughout. 5/5 strength throughout.
PSYCH: Pleasant


Pertinent Results:
[**2181-6-26**] 03:00AM BLOOD WBC-8.2 RBC-4.49 Hgb-11.9* Hct-39.4
MCV-88 MCH-26.6* MCHC-30.3* RDW-17.9* Plt Ct-210
[**2181-6-25**] 04:30AM BLOOD WBC-12.0* RBC-5.45* Hgb-14.3 Hct-49.4*
MCV-91 MCH-26.3* MCHC-29.0* RDW-17.5* Plt Ct-279
[**2181-6-25**] 04:30AM BLOOD Neuts-72.3* Lymphs-18.2 Monos-5.3 Eos-3.4
Baso-0.8
[**2181-6-26**] 03:00AM BLOOD PT-14.3* PTT-32.7 INR(PT)-1.3*
[**2181-6-26**] 03:00AM BLOOD UreaN-34* Creat-7.8*# Na-144 K-5.1 Cl-101
HCO3-29 AnGap-19
[**2181-6-25**] 06:01PM BLOOD K-3.8
[**2181-6-25**] 02:40PM BLOOD Glucose-145* UreaN-49* Creat-9.2* Na-141
K-6.8* Cl-101 HCO3-25 AnGap-22*
[**2181-6-25**] 02:40PM BLOOD CK-MB-NotDone cTropnT-0.12*
[**2181-6-25**] 04:30AM BLOOD cTropnT-0.14*
[**2181-6-26**] 03:00AM BLOOD Calcium-9.7 Phos-5.6* Mg-2.1
[**2181-6-25**] 02:40PM BLOOD Calcium-9.4 Phos-4.7* Mg-2.6
[**2181-6-25**] 04:46AM BLOOD Lactate-3.3* K-5.8*
.
[**6-25**] CT Head: IMPRESSION: 1. No evidence of acute intracranial
hemorrhage or major vascular territorial infarct. If there is
high suspicion, MRI with DWI is more sensitive for acute
ischemia.  2. Complete opacification of the right mastoid sinus
with mild opacification of left mastoid sinus, indicating
probable chronic mastoiditis. No evidence of basilar skull
fracture.
.
[**6-26**]  IMPRESSION:  1. Stable or resolving CHF.  2. Persistent
mediastinal widening warrants further evaluation with CTA of the
chest. Given multiple mediastinal calcifications, mediastinal
prominence may be related to underlying lymphadenopathy.  3.
Persistent left lung base consolidation may be related to
asymmetric pulmonary edema or an underlying consolidation. This
may also be further evaluated with CT.
.
CHEST (PA & LAT)  [**2181-6-26**] 12:45 AM

CHEST (PA & LAT)

Reason: Please compare to prior film for improvement of edema
and pr

[**Hospital 93**] MEDICAL CONDITION:
71 year old woman with ESRD admitted pre HD with respiratory
distress
REASON FOR THIS EXAMINATION:
Please compare to prior film for improvement of edema and
progression of PNA
INDICATION: 71-year-old female with end-stage renal disease
admitted pre- hemodialysis with respiratory distress.

COMPARISON: AP upright portable chest x-ray dated [**2181-6-25**].

AP SUPINE PORTABLE CHEST X-RAY: Bilateral interstitial edema is
stable or slightly decreased since prior exam. Mediastinal
widening persists, unchanged, and requires further evaluation
with cross-sectional imaging. Punctate calcifications projecting
over bilateral hila are related to prior granulomatous
infection, and could be accounting for the mediastinal widening.
Increased opacification in the left lower lobe may be related to
asymmetric pulmonary edema; however, an underlying consolidation
is not excluded. The surrounding soft tissues are unchanged.

IMPRESSION:
1. Stable or resolving CHF.
2. Persistent mediastinal widening warrants further evaluation
with CTA of the chest. Given multiple mediastinal
calcifications, mediastinal prominence may be related to
underlying lymphadenopathy.
3. Persistent left lung base consolidation may be related to
asymmetric pulmonary edema or an underlying consolidation. This
may also be further evaluated with CT.
.
CT HEAD W/O CONTRAST  [**2181-6-25**] 8:58 PM

CT HEAD W/O CONTRAST

Reason: MENTAL STATUS CHANGE

[**Hospital 93**] MEDICAL CONDITION:
71 year old woman with ESRD, sarcoid presented with hypoxia now
with ? mental status change after hypotensive episode during
hemodialysis
REASON FOR THIS EXAMINATION:
Please assess for stroke
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: End-stage renal disease and sarcoid, presenting with
mental status changes and hypotensive episode after
hemodialysis. Assess for stroke.

No prior examinations.

NONCONTRAST HEAD CT: There is no acute intracranial hemorrhage,
shift of normally midline structures, or major vascular
territorial infarct. There are chronic-appearing lacunes in the
basal ganglia, bilaterally. [**Doctor Last Name **]- white matter differentiation
is preserved. Dural calcifications are noted. There is extensive
calcification of the vertebral and cavernous carotid arteries,
related to underlying renal disease. The right mastoid air cells
and middle ear cavity are completely opacified, with a small
amount of fluid in the dorsal aspect of the left mastoid apex
and clear left middle ear; however, there is no evidence of
basilar skull fracture. The visualized paranasal sinuses are
clear.
.
IMPRESSION:
1. No evidence of acute intracranial hemorrhage or major
vascular territorial infarct. If there is high suspicion, MRI
with DWI is more sensitive for acute ischemia.
.
2. Complete opacification of the right mastoid process and
middle ear, with small amount of fluid in the left mastoid apex,
indicating probable chronic left otomastoiditis, which should be
correlated clinically.
.
No evidence of basilar skull fracture.
.


Brief Hospital Course:
ASSESSMENT: The patient is a 71 yo woman presenting with ESRD
due for dialysis today who had acute onset of SOB.
.
PLAN:
.
# Respiratory Distress:  Was on Bipap on admission in setting of
volume overload. Pt underwent HD and henceforth did not require
non-invasive ventilation and returned to her baseline of 2
liters of oxygen. There was also a suggestion of a left lower
lobe pneumonia on CXR.  CT Chest showed a left pleural effusion
and enlarged right mediastinal LAD that was c/w her hx of
pulmonary sarcoidosis.  There was no evidence of any aortic
pathology.
A course of Levofloxacin 250 mg PO Q48 was initiated during her
stay.  She was to continue to complete a 10 day course.
.
# ESRD: Pt is on q MWF HD schedule with fistula (mature) in L
arm.
- MWF HD  - received dialysis (3 kilos off on Monday) and also
underwent HD on day of discharge. Captopril was held on HD days
given propensity for hypotension.
Continued nephrocaps, renagel.
.
# UTI: Found on UA in ED but cultures negative.  Will be covered
by Levaquin for CAP as above.
.
# Troponin Leak: Unclear of baseline, probably [**2-16**] ESRD.
- Felt to be secondary to chronic renal insufficiency versus
acute ischemia. They remained flat in the setting of a normal
EKG.
.
# Heart murmur: The patient has moderate AS as well as TR and
mild MR seen on TTE obtained from [**Hospital1 2177**] records.
.
# Thyroid mass:  Incidental note was made of a thyroid mass on
his CT scan.  Please arrange for outpatient thyroid U/S and f/u.

.
# HTN: To 190s in ED. 200/100 on arrival to ICU and received
Hydral 15mg. Was on Nitro gtt in ED but this was D/C'd as BP
improved to 120s. Home BP meds added on HD#1. On Captopril 100
mg [**Hospital1 **], Norvasc 10 mg PO QD, Lopressor 50 mg PO BID.
- BP remained stable throughout the remainder of her stay.
.
# DM II: Longstanding.
- Cont'd Insulin as Humalog SS and giving home 75/25
.
# FEN: DM/Renal Diet
.
# PPx: SC heparin; PPI
.
# CODE: Presumed full
.
# COMM: With daughter [**Name (NI) 2659**] ([**Telephone/Fax (1) 101578**] who is the HCP.
.
# DISP: to [**Hospital3 537**]

Medications on Admission:
Novolin Insulin SS
Metoprolol 50mg [**Hospital1 **]
Zoloft 75mg Daily
ASA 81mg Daily
Amlodipine 10mg Daily
Captopril 100mg q T, Th, Sat, Sun (non-HD days) [**Hospital1 **]
Lipitor 80mg
Nephrocaps
Protonix 40
Colace
Ibuprofen
Pulmicort 200mcg 2 puffs [**Hospital1 **]
Renagel 800mg 3 tabs TID
Mirtazapine 15mg QHS
Senna 2 tabs QHS
1000ml Fluid restriction
Humalog 75/25 22 U Qam, 10 U qPM
Lactulose 30ml PRN
Tylenol PRN
Oxycodone 5 PRN


Discharge Medications:
1. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
2. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
3. Sertraline 50 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily).
4. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
5. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
6. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO Q8H (every
8 hours) as needed.
8. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q4-6H
(every 4 to 6 hours) as needed.
9. Albuterol Sulfate 0.083 % (0.83 mg/mL) Solution Sig: One (1)
Inhalation Q4-6H (every 4 to 6 hours) as needed.
10. Captopril 25 mg Tablet Sig: Four (4) Tablet PO Q T, TH, SAT,
SUN (NON HD DAYS) [**Hospital1 **] ().
11. Beclomethasone Dipropionate 80 mcg/Actuation Aerosol Sig:
One (1)  Inhalation [**Hospital1 **] (2 times a day).
12. Sevelamer 800 mg Tablet Sig: Three (3) Tablet PO TID (3
times a day).
13. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q48H
(every 48 hours) for 7 doses.
14. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

15. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
16. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
17. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
18. Insulin Regular Human  Subcutaneous
19. insulin
22 units humalog 75/25 in am, 10 units QHS
20. oxygen
2 liters oxygen by nasal cannula.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 537**]- [**Location (un) 538**]

Discharge Diagnosis:
Fluid overload
End stage renal disease


Discharge Condition:
Stable. On 2 liters oxygen (baseline).


Discharge Instructions:
Monitor electrolytes with hemodialysis and daily weights. [**Name8 (MD) **]
MD if weight increases by > 2 kgs.

You were admitted with shortness of breath from fluid overload.
You were dialyzed and improved.  Please continue to go to your
scheduled hemodialysis sessions.


Followup Instructions:
Please follow up with your nephrologist as scheduled or in 2
weeks.

Please follow up with your primary care doctor in 1 week.



Completed by:[**2181-6-27**]
{'Sarcoidosis,Lung involvement in other diseases classified elsewhere,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Nontoxic multinodular goiter,Congestive heart failure, unspecified,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Hyperpotassemia,Urinary tract infection, site not specified,Pneumonia, organism unspecified,Aortic valve disorders,Diseases of tricuspid valve'}


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: Admit from ED for respiratory distress in setting of volume
overload

PRESENT ILLNESS: 71 yo woman presenting from NH with ESRD due for dialysis today
who had acute onset of SOB at NH with O2 sat 81-89% tachypnic to
30s. She is on home O2 2L. Last HD was Friday. No CP, no back
pain.
.
In the ED, she was Tachypnic to 50s on arrival and started on
Bipap with sats 100%. She had a UTI on U/A treated with
Levoquin, Hyperkalemia to 6.5 was treated with Insulin/D50,
kayexalate. She was given 40mg IV Lasix for volume overload. She
had pulmonary edema on CXR with ? widened mediastinum. She had
Hyperkalemia treated with Insulin and D50. She was also
hypertensive to the 170s and placed on Nitro gtt. Just ptior to
transfer, BP 193/60, slightly tachypnic on bipap sating 100%.
EKG showed q waves in III and AVF. She is being admitted for
dialysis for difinitive treatment in unit.

MEDICAL HISTORY: DM II
HTN
ESRD on HD
L Hemiarthroplasty s/p L femoral neck fx
PNA
Pulm Sarcoidosis
AR
Obesity
Vent Hypertrophy
Nontoxic multinodular goiter
LUE AVF
Cystitis

MEDICATION ON ADMISSION: Novolin Insulin SS
Metoprolol 50mg [**Hospital1 **]
Zoloft 75mg Daily
ASA 81mg Daily
Amlodipine 10mg Daily
Captopril 100mg q T, Th, Sat, Sun (non-HD days) [**Hospital1 **]
Lipitor 80mg
Nephrocaps
Protonix 40
Colace
Ibuprofen
Pulmicort 200mcg 2 puffs [**Hospital1 **]
Renagel 800mg 3 tabs TID
Mirtazapine 15mg QHS
Senna 2 tabs QHS
1000ml Fluid restriction
Humalog 75/25 22 U Qam, 10 U qPM
Lactulose 30ml PRN
Tylenol PRN
Oxycodone 5 PRN

ALLERGIES: Penicillins / Sulfa (Sulfonamides)

PHYSICAL EXAM: PE: 96.7 64 178/61 --> 130/44 93 20 100% O2 Sats on BIPAP
Gen: AA woman on Bipap mask in NAD in bed
HEENT: Deferred (Bipap)
NECK: Supple, large, No LAD, Cannot assess JVD with Bipap mask
CV: RR, NL rate. NL S1, S2. Loud 3/6 systolic murmurs heard best
at LUSB, radiates to carotids, no rubs or [**Last Name (un) 549**]
LUNGS: Soft BL LL crackles, No W/R
ABD: Soft, NT, ND. NL BS. No HSM
EXT: 1+ edema. 2+ DP pulses BL
SKIN: No lesions
NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact. Preserved
sensation throughout. 5/5 strength throughout.
PSYCH: Pleasant

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives at [**Hospital3 537**]. Daughter [**Name (NI) 2659**] is her HCP 

### Response:
{'Sarcoidosis,Lung involvement in other diseases classified elsewhere,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Nontoxic multinodular goiter,Congestive heart failure, unspecified,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Hyperpotassemia,Urinary tract infection, site not specified,Pneumonia, organism unspecified,Aortic valve disorders,Diseases of tricuspid valve'}
