CHIEF COMPLAINT: ARF, hypoglycemia, SBO

PRESENT ILLNESS: 57 yo male with h/o EtOH cirrhosis s/p Liver Tx in [**2118**] c/b 2
cardiac arrests and biliary leak.  On routine MRI screening in
[**5-20**], pt was noted to have mult liver lesions and dx'd with HCC.
 Now s/p 2 chemo rx (cisplatin and gemcitabine) most recently 9
days ago. Pt c/o 2 days of n/v, "26 episodes in 30 hrs."  Unable
to tolerate any POs x 2 days.  Decrease stool output, most
recent BM 1 day ago. + flatus.  Continued to take medications as
prescribed, went to OSH and found to have FS 12 and briefly
unresponsive.  Pt describes several episodes of hot flashes over
past 24hrs.  Per pt [**Name (NI) 13866**] x 2 days 80-90s.
.
-- Had KUB with dilated loops at OSH today. episode of
unresponsiveness with FSG of 12 in ER at OSH. Started on D10
gtt, octreotide gtt, and given 1g ceftriaxone in [**Hospital1 18**] EW.
.
Admitted to the [**Hospital Unit Name 153**], evaluated by Transplant Sx. and Hemo Onc.
and toxicology.  All agreed that he had SBO and that his
hypoglycemia was likely due to sulfonylurea toxicity in the
setting of diminshed clearence from renal insufficiency.  He was
maintanined NPO, with NG tube to suction, and placed on a D20
gtt.  He underwent paracentesis to evaluate for SBP and result
is negative, but cultures pending.  Tox. recommended
alkylinization of the urine, and he was gently hydrated.  His BG
normalized, and the SBO resolved.  At the time of transfer to
the OMED service, he in normo to hyperglycemic, being covered on
a sliding scale.  His diet has been advanced to low sodium
solids, and he is ambulating and moving his bowels.  Finally, he
has experienced a drop in hct from baseline with Guaiac positive
stools, without evidence of [**Known firstname **], active bleeding.

MEDICAL HISTORY: PAST MEDICAL HISTORY:
1.  OLT in [**2118**] [**2-17**] EtOH cirrhosis
2.  Diabetes Mellitus II.
3.  Chronic renal failure.  In [**2118**], his creatinine by the
patient's report was up to 5 or 6 he was considered for a joint
kindey/liver transplant.  As the kidney was not available at the
time of transplant, he only recieved a liver.  His creatinine
more recently has been 1.3-1.7 range.
4.  Hypercholesterolemia
5.  A fib/a flutter status post ablation.
6.  EF=70%.
7.  EGD [**8-19**] showed a three- to four-millimeter nodule at 35 cm
in the esophagus.  Biopsy showed squamous papilloma.

MEDICATION ON ADMISSION: 1. Tacrolimus 1 mg Capsule Sig: Two (2) Capsule PO BID (2 times
a day).
2. Fludrocortisone 0.1 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Mycophenolate Mofetil 500 mg Tablet Sig: Four (4) Tablet PO
BID (2 times a day).
4. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Lansoprazole Oral
6. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
7. Clonidine 0.1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 97 88 163/70 13 96 RA
NAD
Obese
Alert, oriented, pleasant - sitting on edge of bed
EOMI, non-icteric
Habitus makes evaluation of JVP difficult
RRR 3/6 HSM no rubs or gallop
Poor air movement throughout, diffuse expiratory wheezes
Abdomen obese, distended, but non-tender.
Trace LE edema
Ambulatory independently.

FAMILY HISTORY: Mother had coronary artery disease. Sister has
diabetes. Father had diabetes and esophageal cancer (smoker).

SOCIAL HISTORY: He has a 46-pack a year smoking history. He was
a prior heavy drinker.  He quit in [**2115**].  He is married, with
three children.  He was in [**Hospital1 1474**].  He is on disability. He
was
a former [**Hospital1 **] carpenter.
Acute kidney failure, unspecified,Unspecified intestinal obstruction,Atrial fibrillation,Complications of transplanted liver,Malignant neoplasm of liver, primary,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Asthma, unspecified type, unspecified,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use
Acute kidney failure NOS,Intestinal obstruct NOS,Atrial fibrillation,Compl liver transplant,Mal neo liver, primary,DMII oth nt st uncntrld,Anemia NOS,Abn react-org transplant,Asthma NOS,Adv eff antineoplastic
Admission Date:  [**2123-8-1**]              Discharge Date:   [**2123-8-3**]

Date of Birth:  [**2065-9-23**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2186**]
Chief Complaint:
ARF, hypoglycemia, SBO

Major Surgical or Invasive Procedure:
None

History of Present Illness:
57 yo male with h/o EtOH cirrhosis s/p Liver Tx in [**2118**] c/b 2
cardiac arrests and biliary leak.  On routine MRI screening in
[**5-20**], pt was noted to have mult liver lesions and dx'd with HCC.
 Now s/p 2 chemo rx (cisplatin and gemcitabine) most recently 9
days ago. Pt c/o 2 days of n/v, "26 episodes in 30 hrs."  Unable
to tolerate any POs x 2 days.  Decrease stool output, most
recent BM 1 day ago. + flatus.  Continued to take medications as
prescribed, went to OSH and found to have FS 12 and briefly
unresponsive.  Pt describes several episodes of hot flashes over
past 24hrs.  Per pt [**Name (NI) 13866**] x 2 days 80-90s.
.
-- Had KUB with dilated loops at OSH today. episode of
unresponsiveness with FSG of 12 in ER at OSH. Started on D10
gtt, octreotide gtt, and given 1g ceftriaxone in [**Hospital1 18**] EW.
.
Admitted to the [**Hospital Unit Name 153**], evaluated by Transplant Sx. and Hemo Onc.
and toxicology.  All agreed that he had SBO and that his
hypoglycemia was likely due to sulfonylurea toxicity in the
setting of diminshed clearence from renal insufficiency.  He was
maintanined NPO, with NG tube to suction, and placed on a D20
gtt.  He underwent paracentesis to evaluate for SBP and result
is negative, but cultures pending.  Tox. recommended
alkylinization of the urine, and he was gently hydrated.  His BG
normalized, and the SBO resolved.  At the time of transfer to
the OMED service, he in normo to hyperglycemic, being covered on
a sliding scale.  His diet has been advanced to low sodium
solids, and he is ambulating and moving his bowels.  Finally, he
has experienced a drop in hct from baseline with Guaiac positive
stools, without evidence of [**Known firstname **], active bleeding.


Past Medical History:
PAST MEDICAL HISTORY:
1.  OLT in [**2118**] [**2-17**] EtOH cirrhosis
2.  Diabetes Mellitus II.
3.  Chronic renal failure.  In [**2118**], his creatinine by the
patient's report was up to 5 or 6 he was considered for a joint
kindey/liver transplant.  As the kidney was not available at the
time of transplant, he only recieved a liver.  His creatinine
more recently has been 1.3-1.7 range.
4.  Hypercholesterolemia
5.  A fib/a flutter status post ablation.
6.  EF=70%.
7.  EGD [**8-19**] showed a three- to four-millimeter nodule at 35 cm
in the esophagus.  Biopsy showed squamous papilloma.


Social History:
He has a 46-pack a year smoking history. He was
a prior heavy drinker.  He quit in [**2115**].  He is married, with
three children.  He was in [**Hospital1 1474**].  He is on disability. He
was
a former [**Hospital1 **] carpenter.


Family History:
Mother had coronary artery disease. Sister has
diabetes. Father had diabetes and esophageal cancer (smoker).


Physical Exam:
97 88 163/70 13 96 RA
NAD
Obese
Alert, oriented, pleasant - sitting on edge of bed
EOMI, non-icteric
Habitus makes evaluation of JVP difficult
RRR 3/6 HSM no rubs or gallop
Poor air movement throughout, diffuse expiratory wheezes
Abdomen obese, distended, but non-tender.
Trace LE edema
Ambulatory independently.


Pertinent Results:
RADIOLOGY:
CT abd/pelvis ([**8-1**]):
1.  A few prominent loops of small bowel consistent with partial
small-bowel obstruction.  G-tube is in place.
2.  Heterogeneous appearance of the liver, consistent with the
given history of liver cancer.  Assessment of disease
progression cannot be made due to the lack of IV contrast.
3.  Interval increase in the ascites

[**2123-8-3**] 06:15AM BLOOD WBC-4.6 RBC-3.24* Hgb-9.0* Hct-27.5*
MCV-85 MCH-27.7 MCHC-32.6 RDW-15.7* Plt Ct-141*
[**2123-8-2**] 10:33PM BLOOD Hct-26.2*
[**2123-8-2**] 04:17AM BLOOD WBC-4.2 RBC-3.25* Hgb-9.0* Hct-26.9*
MCV-83 MCH-27.8 MCHC-33.6 RDW-15.4 Plt Ct-95*
[**2123-8-1**] 08:14AM BLOOD WBC-3.2* RBC-3.56* Hgb-9.8* Hct-29.8*
MCV-84 MCH-27.4 MCHC-32.8 RDW-15.1 Plt Ct-71*
[**2123-8-1**] 06:40AM BLOOD WBC-3.1* RBC-3.53* Hgb-9.7* Hct-29.4*
MCV-83 MCH-27.4 MCHC-32.9 RDW-15.3 Plt Ct-65*
[**2123-7-31**] 10:32PM BLOOD WBC-3.1* RBC-3.44* Hgb-9.7* Hct-28.7*
MCV-83 MCH-28.2 MCHC-33.8 RDW-15.3 Plt Ct-60*#
[**2123-8-1**] 08:14AM BLOOD Neuts-55 Bands-3 Lymphs-34 Monos-6 Eos-1
Baso-0 Atyps-1* Metas-0 Myelos-0 NRBC-5*
[**2123-8-1**] 06:40AM BLOOD Neuts-61.8 Bands-0 Lymphs-34.7 Monos-2.9
Eos-0.4 Baso-0.3
[**2123-7-31**] 10:32PM BLOOD Neuts-67 Bands-1 Lymphs-25 Monos-4 Eos-0
Baso-0 Atyps-0 Metas-0 Myelos-1* Hyperse-2* NRBC-1*
[**2123-8-1**] 08:14AM BLOOD Hypochr-1+ Anisocy-1+ Poiklo-NORMAL
Macrocy-2+ Microcy-NORMAL Polychr-1+
[**2123-8-1**] 06:40AM BLOOD Hypochr-NORMAL Anisocy-3+ Poiklo-NORMAL
Macrocy-2+ Microcy-2+ Polychr-1+ Target-1+
[**2123-7-31**] 10:32PM BLOOD Hypochr-1+ Anisocy-1+ Poiklo-NORMAL
Macrocy-NORMAL Microcy-1+ Polychr-NORMAL Ovalocy-OCCASIONAL
Target-OCCASIONAL
[**2123-8-3**] 06:15AM BLOOD Plt Ct-141* LPlt-1+
[**2123-8-2**] 04:17AM BLOOD Plt Smr-LOW Plt Ct-95*
[**2123-8-2**] 04:17AM BLOOD PT-13.3 PTT-23.6 INR(PT)-1.2
[**2123-8-1**] 08:14AM BLOOD Plt Smr-LOW Plt Ct-71*
[**2123-8-1**] 08:14AM BLOOD PT-12.9 PTT-20.9* INR(PT)-1.1
[**2123-8-1**] 06:40AM BLOOD Plt Smr-LOW Plt Ct-65*
[**2123-8-1**] 06:40AM BLOOD PT-13.9* PTT-21.2* INR(PT)-1.3
[**2123-7-31**] 10:32PM BLOOD Plt Smr-VERY LOW Plt Ct-60*#
[**2123-7-31**] 10:32PM BLOOD PT-12.3 PTT-20.2* INR(PT)-1.0
[**2123-8-1**] 08:14AM BLOOD FDP-10-40
[**2123-8-1**] 08:14AM BLOOD Fibrino-576* D-Dimer-5958*
[**2123-8-3**] 06:15AM BLOOD Glucose-110* UreaN-53* Creat-1.8* Na-134
K-4.6 Cl-99 HCO3-23 AnGap-17
[**2123-8-2**] 04:17AM BLOOD Glucose-130* UreaN-59* Creat-2.1* Na-133
K-4.3 Cl-98 HCO3-23 AnGap-16
[**2123-8-1**] 03:37PM BLOOD Glucose-202* UreaN-61* Creat-2.2* Na-128*
K-5.3* Cl-93* HCO3-22 AnGap-18
[**2123-8-1**] 12:35PM BLOOD Glucose-227* UreaN-62* Creat-2.1* Na-129*
K-5.2* Cl-94* HCO3-20* AnGap-20
[**2123-8-1**] 08:14AM BLOOD Glucose-143* UreaN-63* Creat-2.0* Na-130*
K-3.8 Cl-95* HCO3-21* AnGap-18
[**2123-8-1**] 06:40AM BLOOD Glucose-32* UreaN-64* Creat-1.9* Na-131*
K-3.5 Cl-95* HCO3-21* AnGap-19
[**2123-7-31**] 10:32PM BLOOD Glucose-43* UreaN-69* Creat-2.0* Na-133
K-3.8 Cl-96 HCO3-21* AnGap-20
[**2123-8-2**] 04:17AM BLOOD ALT-108* AST-156* LD(LDH)-307*
AlkPhos-341* Amylase-33 TotBili-1.0
[**2123-8-1**] 08:14AM BLOOD ALT-101* AST-185* LD(LDH)-300*
AlkPhos-348* TotBili-1.1
[**2123-8-1**] 06:40AM BLOOD ALT-106* AST-191* AlkPhos-368* Amylase-40
TotBili-1.1
[**2123-7-31**] 10:32PM BLOOD ALT-97* AST-178* AlkPhos-354* Amylase-41
TotBili-1.0
[**2123-8-3**] 06:15AM BLOOD Calcium-8.2* Phos-2.9 Mg-1.5*
[**2123-8-2**] 04:17AM BLOOD Albumin-3.0* Calcium-8.2* Phos-4.0
Mg-1.3*
[**2123-8-1**] 03:37PM BLOOD Calcium-7.9* Phos-4.4 Mg-1.3*
[**2123-8-3**] 06:15AM BLOOD FK506-2.8*
[**2123-8-1**] 08:14AM BLOOD FK506-3.1*
[**2123-8-1**] 08:06AM BLOOD FK506-3.9*
[**2123-8-1**] 06:40AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG
[**2123-8-1**] 07:06AM BLOOD Lactate-1.9
[**2123-7-31**] 10:56PM BLOOD Lactate-3.1*
[**2123-8-1**] 07:59AM BLOOD C-PEPTIDE-PND

Brief Hospital Course:
57 y/o M with HCC s/p liver transplant in [**2118**], transferred from
[**Hospital Unit Name 153**].  Pt admitted w/ hypoglycemia from sulfonylurea toxicity
[**2-17**] [**Doctor First Name 48**], SBO (resolved), HCC (on chemo), and OLT (on immune
suppression).
.
1) Hypoglycemia ?????? BS down to a min of 12 at OSH, received
multiple amps D50, octreotide. Best theory is that w/decreased
PO, N/V patient became pre-renal and had increased increased
serum sulfonylurea [**2-17**] decreased renal clearance. Pt was DCed
from [**Hospital Unit Name 153**] to OMED normo- to hyper-glycemic, and covered on SSI
to which he again became hypogylcemic to 26 on the day of
admission.  The OMED team discussed at length with the patient
the importance of remaining inpatient for further titration of
his DM regimen, but he insisted on departure.  He is not open to
insulin.  We suggested instead DCing all anti-hyperglycemics
until his appointment on Fri; he was not open to this as he
feels that other providers will use his ensuing hyperlycemia as
justification for parenteral insulin.  He did agree to decrease
his glyburide to 2.5 QD and to call Dr. [**First Name (STitle) **] immediately for
any BG <50.  He complained that he sometimes cannot reach a
doctor [**First Name (Titles) **] [**Last Name (Titles) **] clinic; his PCP will serve as a backup-call
for hypoglycemia and I have given him my phone number as another
backup.
.
2) Anemia ?????? baseline Hct 34, drop from 29.8 to 26.9 since
admission, but then stable.  Did have guaiac (+) stools.  [**Month (only) 116**]
also have component of anemia [**2-17**] past chemo. Hemolysis labs and
tbili normal.  Remained stable until DC; to be rechecked in
clinic on Fri
.
3) HCC ?????? S/P liver transplant, s/p chemo for HCC, now with
recurring ascites. Diagnostic / therapeutic paracentesis on [**8-1**]
no SBP by cell counts & chemistries, cultures ngtd on DC.
-- RUQ U/S scheduled as outpt on [**8-12**]
-- ascites fluid cultures to be followed at clinic on Fri
-- continue immunosuppresant meds
.
4) CRI ?????? baseline Cr 1.2-1.7, to peak 2.2 then decreased to 1.8
on DC.  Likely combo of nephropathy, chemo and pre-renal.  Will
recheck chemistries in clnic on Fri.
.
5) Asthma - Managed inpatient on nebs of atrovent standing and
PRN albuterol.  Pt was anxious for DC and did not wait for
scripts for OP bronchidaltors.  Recommend standing inhaled
steroid or ipratropium puffers at OP appt Fri.
.
6) N/V ?????? likely [**2-17**] past chemo, though did have dilated loops of
bowel by abd film. Now tol PO intake, moving bowels, and flatus.
.
7) FEN ?????? low Na diet ad lib given; lytes repleted PRN
.
8) Proph ?????? PPI, pneumoboots were used while inpatient
.
9) Access ?????? 1 PIV, removed on DC
.
10) Dispo ?????? Home on [**8-3**] per compromise between patient and
attending.  Pt and family voiced agreement to call for any
hypoglycemia.  Pt and family verbalized understanding of the
risks of DC at this time given hypoglycemia and renal failure.
.
11) Code: Full throughout hospital stay
.
12) Comm ?????? pt and wife

Medications on Admission:
1. Tacrolimus 1 mg Capsule Sig: Two (2) Capsule PO BID (2 times
a day).
2. Fludrocortisone 0.1 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Mycophenolate Mofetil 500 mg Tablet Sig: Four (4) Tablet PO
BID (2 times a day).
4. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Lansoprazole Oral
6. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
7. Clonidine 0.1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. Atorvastatin Calcium 20 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
9. Glyburide 2.5 mg Tablet Sig: One (1) Tablet PO once a day.
10. Lisinopril 10 QD
11. Amitryptiline 50 QD
Prograf 2 [**Hospital1 **]
cellcept [**2118**] [**Hospital1 **]
lasix 120 qd

Discharge Medications:
1. Tacrolimus 1 mg Capsule Sig: Two (2) Capsule PO BID (2 times
a day).
2. Fludrocortisone 0.1 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Mycophenolate Mofetil 500 mg Tablet Sig: Four (4) Tablet PO
BID (2 times a day).
4. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Lansoprazole  Oral
6. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
7. Clonidine 0.1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. Atorvastatin Calcium 20 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
9. Glyburide 2.5 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Home

Discharge Diagnosis:
Acute renal failure, hypoglycemia

Discharge Condition:
Fair

Discharge Instructions:
Please take all medications as directed.  Please take your blood
sugars at each meal and at hour of sleep and record in a log
which you should take to appointments with doctors.  At length,
we have advised you to stay one more day to monitor your blood
glucose and kidneys; you have agreed to call Dr. [**First Name (STitle) **] with any
blood glucose less than 50 and to decrease your glyburide to
once per day.  You have agreed to discuss your blood glucose
further with your PCP.

Followup Instructions:
Provider [**First Name11 (Name Pattern1) 396**] [**Last Name (NamePattern4) 397**], MD Where: [**Hospital6 29**]
HEMATOLOGY/[**Hospital6 **] Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2123-8-6**] 12:15

Provider [**Name9 (PRE) **],HEM/ONC HEMATOLOGY/[**Name9 (PRE) **]-CC9 Where: [**Hospital 4054**] HEMATOLOGY/[**Hospital **] Phone:[**Telephone/Fax (1) 22**]
Date/Time:[**2123-8-6**] 12:15

Provider [**Name Initial (PRE) 4426**] 17 Date/Time:[**2123-8-6**] 1:00

Please call your PCP: [**Name10 (NameIs) 29982**],[**Name11 (NameIs) **] [**Name Initial (NameIs) **]. [**Telephone/Fax (1) 29983**] immediately
for a followup appointment within three days to evaluate your
glycemic control regimen.
{'Acute kidney failure, unspecified,Unspecified intestinal obstruction,Atrial fibrillation,Complications of transplanted liver,Malignant neoplasm of liver, primary,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Asthma, unspecified type, unspecified,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use'}


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: ARF, hypoglycemia, SBO

PRESENT ILLNESS: 57 yo male with h/o EtOH cirrhosis s/p Liver Tx in [**2118**] c/b 2
cardiac arrests and biliary leak.  On routine MRI screening in
[**5-20**], pt was noted to have mult liver lesions and dx'd with HCC.
 Now s/p 2 chemo rx (cisplatin and gemcitabine) most recently 9
days ago. Pt c/o 2 days of n/v, "26 episodes in 30 hrs."  Unable
to tolerate any POs x 2 days.  Decrease stool output, most
recent BM 1 day ago. + flatus.  Continued to take medications as
prescribed, went to OSH and found to have FS 12 and briefly
unresponsive.  Pt describes several episodes of hot flashes over
past 24hrs.  Per pt [**Name (NI) 13866**] x 2 days 80-90s.
.
-- Had KUB with dilated loops at OSH today. episode of
unresponsiveness with FSG of 12 in ER at OSH. Started on D10
gtt, octreotide gtt, and given 1g ceftriaxone in [**Hospital1 18**] EW.
.
Admitted to the [**Hospital Unit Name 153**], evaluated by Transplant Sx. and Hemo Onc.
and toxicology.  All agreed that he had SBO and that his
hypoglycemia was likely due to sulfonylurea toxicity in the
setting of diminshed clearence from renal insufficiency.  He was
maintanined NPO, with NG tube to suction, and placed on a D20
gtt.  He underwent paracentesis to evaluate for SBP and result
is negative, but cultures pending.  Tox. recommended
alkylinization of the urine, and he was gently hydrated.  His BG
normalized, and the SBO resolved.  At the time of transfer to
the OMED service, he in normo to hyperglycemic, being covered on
a sliding scale.  His diet has been advanced to low sodium
solids, and he is ambulating and moving his bowels.  Finally, he
has experienced a drop in hct from baseline with Guaiac positive
stools, without evidence of [**Known firstname **], active bleeding.

MEDICAL HISTORY: PAST MEDICAL HISTORY:
1.  OLT in [**2118**] [**2-17**] EtOH cirrhosis
2.  Diabetes Mellitus II.
3.  Chronic renal failure.  In [**2118**], his creatinine by the
patient's report was up to 5 or 6 he was considered for a joint
kindey/liver transplant.  As the kidney was not available at the
time of transplant, he only recieved a liver.  His creatinine
more recently has been 1.3-1.7 range.
4.  Hypercholesterolemia
5.  A fib/a flutter status post ablation.
6.  EF=70%.
7.  EGD [**8-19**] showed a three- to four-millimeter nodule at 35 cm
in the esophagus.  Biopsy showed squamous papilloma.

MEDICATION ON ADMISSION: 1. Tacrolimus 1 mg Capsule Sig: Two (2) Capsule PO BID (2 times
a day).
2. Fludrocortisone 0.1 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Mycophenolate Mofetil 500 mg Tablet Sig: Four (4) Tablet PO
BID (2 times a day).
4. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Lansoprazole Oral
6. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
7. Clonidine 0.1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 97 88 163/70 13 96 RA
NAD
Obese
Alert, oriented, pleasant - sitting on edge of bed
EOMI, non-icteric
Habitus makes evaluation of JVP difficult
RRR 3/6 HSM no rubs or gallop
Poor air movement throughout, diffuse expiratory wheezes
Abdomen obese, distended, but non-tender.
Trace LE edema
Ambulatory independently.

FAMILY HISTORY: Mother had coronary artery disease. Sister has
diabetes. Father had diabetes and esophageal cancer (smoker).

SOCIAL HISTORY: He has a 46-pack a year smoking history. He was
a prior heavy drinker.  He quit in [**2115**].  He is married, with
three children.  He was in [**Hospital1 1474**].  He is on disability. He
was
a former [**Hospital1 **] carpenter. 

### Response:
{'Acute kidney failure, unspecified,Unspecified intestinal obstruction,Atrial fibrillation,Complications of transplanted liver,Malignant neoplasm of liver, primary,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Asthma, unspecified type, unspecified,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use'}
