CHIEF COMPLAINT: respiratory distress

PRESENT ILLNESS: 45 y/o F with hx of HIV and hepatitis C cirrhosis s/p TIPS,
ascites, SBP and encephalopathy who is transferred from the
[**Doctor Last Name 3271**] [**First Name4 (NamePattern1) 679**] [**Last Name (NamePattern1) 4869**] to the MICU for respiratory distress.  The
patient was transferred from an OSH last night for hepato-renal
syndrome and SBP.  She did well overnight except for transient
hypotension that responded to albumin infusion.  She was
continued on cipro for SBP treatment and started on vanco for
broader coverage.  This morning she was on 2L NC and had minimal
urine output.  She was transferred to radiology for CXR and
ultrasound and after transport and lying flat, became tachypneic
and desatted requiring a NRB.  She had an ABG on the floor of
7.20/40/79 and was in obvious distress.  She was given one SLNG
for BP in 160s/110s and started on her diuretics.  Her
respiratory status did not improve.
.
On the floor, she was placed on bipap and tolerated better
except for discomfort from the mask.  She put out minimal urine
to the diuretics.  She was unable to lie flat.  She continues to
complain of shortness of breath.  She denies chest pain, nausea,
vomiting, diarrhea.  She is alert and arousable, but cannot
communicate due to the discomfort from the mask.

MEDICAL HISTORY: - HCV Cirrhosis - h/o ascites/hepatohydrothorax s/p TIPS,
encephalopathy, SBP
--liver biopsy in [**2195**] at [**Hospital6 86720**]
-Hepatitis C virus - tx with ribaviron and interferon
-HIV on HAART ([**9-1**] CD4 409, VL undetectable)
-Asthma
-Anemia
-COPD
-Aortic stenosis
-s/p tubal ligation in [**2179**]
-s/p throat biopsy with polyp removal in [**2197**] and again in [**2198**]

MEDICATION ON ADMISSION: HOME MEDICATIONS:
-Amiloride 5mg twice daily
-Sustiva 600mg capsules qhs
-ethycrinic acid 25mg daily
-Lactulose 15ml 3 times a day
-Combivir 150 mg/300 mg twice daily
-Nadolol 40 mg daily
-Potassium chloride 20 mEq tablet daily
-Avelox 400mg daily
.
MEDICATIONS ON TRANSFER:
Albumin 142.5 g IV x1 at 11:20 on [**4-3**]
Albuterol MDI prn
Sustiva 600mg qhs
lactulose 20g Q12
levaquin 750mg Q48 hours
midodrine 10mg po tid
morphine 1-2mg iv q4 hours prn pain
octreotide 50mcg sq tid
vitamin k 10mg sq daily for three days (given on [**4-2**] and [**4-3**])

ALLERGIES: Sulfa (Sulfonamide Antibiotics) / Aldactone / Penicillins /
Bactrim

PHYSICAL EXAM: General Appearance: Anxious, acute respiratory distress
Eyes / Conjunctiva: PERRL
Head, Ears, Nose, Throat: Normocephalic, bipap in place
Cardiovascular: (S1: Normal), (S2: Normal)
Peripheral Vascular: (Right radial pulse: Present), (Left radial
pulse: Present), (Right DP pulse: Present), (Left DP pulse:
Present)
Respiratory / Chest: (Breath Sounds: Crackles : 1/2 up lungs,
Wheezes : throughout all lung fields, audible without
stethoscope), moving air poorly; tachpneic
Abdominal: Soft, No(t) Non-tender, Distended, Tender: diffusely,
Obese, R bag draining peritoneal fluid
Extremities: Right lower extremity edema: 2+, Left lower
extremity edema: 2+, edematous in upper extremities as well
Skin:  Cool, wrapped L leg
Neurologic: Follows simple commands, Responds to: Not assessed,
Oriented (to): , Movement: Purposeful, Tone: Not assessed

FAMILY HISTORY: Mother died at the age of 62 from atherosclerosis and a
myocardial infarction. Her father passed away at 47 due to
morbid obesity and myocardial infarction.

SOCIAL HISTORY: Ms. [**Known lastname **] lives in [**Hospital1 40198**], [**State 350**] with her 26-year-old
Spontaneous bacterial peritonitis,Unspecified viral hepatitis C with hepatic coma,Hepatorenal syndrome,Acute kidney failure, unspecified,Acute respiratory failure,Toxic encephalopathy,Pneumonia, organism unspecified,Unspecified septicemia,Severe sepsis,Septic shock,Coma,Other ascites,Urinary tract infection, site not specified,Delirium due to conditions classified elsewhere,Acidosis,Aphasia,Other and unspecified coagulation defects,Paroxysmal supraventricular tachycardia,Glucocorticoid deficiency,Jaundice, unspecified, not of newborn,Cirrhosis of liver without mention of alcohol,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Awaiting organ transplant status,Chronic kidney disease, unspecified,Asymptomatic human immunodeficiency virus [HIV] infection status,Anemia in chronic kidney disease,Chronic obstructive asthma, unspecified,Aortic valve disorders,Tobacco use disorder,Cocaine dependence, in remission,Thrombocytopenia, unspecified,Unspecified acquired hypothyroidism,Other and unspecified anticonvulsants causing adverse effects in therapeutic use,Encounter for palliative care
Spontan bact peritonitis,Hpt C w hepatic coma NOS,Hepatorenal syndrome,Acute kidney failure NOS,Acute respiratry failure,Toxic encephalopathy,Pneumonia, organism NOS,Septicemia NOS,Severe sepsis,Septic shock,Coma,Ascites NEC,Urin tract infection NOS,Delirium d/t other cond,Acidosis,Aphasia,Coagulat defect NEC/NOS,Parox atrial tachycardia,Glucocorticoid deficient,Jaundice NOS,Cirrhosis of liver NOS,Klebsiella pneumoniae,Await organ transplnt st,Chronic kidney dis NOS,Asymp hiv infectn status,Anemia in chr kidney dis,Chronic obst asthma NOS,Aortic valve disorder,Tobacco use disorder,Cocaine depend-remiss,Thrombocytopenia NOS,Hypothyroidism NOS,Adv eff antconvl NEC/NOS,Encountr palliative care
Admission Date:  [**2200-4-3**]              Discharge Date:   [**2200-5-6**]

Date of Birth:  [**2154-8-13**]             Sex:   F

Service: MEDICINE

Allergies:
Sulfa (Sulfonamide Antibiotics) / Aldactone / Penicillins /
Bactrim

Attending:[**First Name3 (LF) 99**]
Chief Complaint:
respiratory distress

Major Surgical or Invasive Procedure:
Intubation and Mechanical Ventilation
Continuous venovenous hemodialysis

History of Present Illness:
45 y/o F with hx of HIV and hepatitis C cirrhosis s/p TIPS,
ascites, SBP and encephalopathy who is transferred from the
[**Doctor Last Name 3271**] [**First Name4 (NamePattern1) 679**] [**Last Name (NamePattern1) 4869**] to the MICU for respiratory distress.  The
patient was transferred from an OSH last night for hepato-renal
syndrome and SBP.  She did well overnight except for transient
hypotension that responded to albumin infusion.  She was
continued on cipro for SBP treatment and started on vanco for
broader coverage.  This morning she was on 2L NC and had minimal
urine output.  She was transferred to radiology for CXR and
ultrasound and after transport and lying flat, became tachypneic
and desatted requiring a NRB.  She had an ABG on the floor of
7.20/40/79 and was in obvious distress.  She was given one SLNG
for BP in 160s/110s and started on her diuretics.  Her
respiratory status did not improve.
.
On the floor, she was placed on bipap and tolerated better
except for discomfort from the mask.  She put out minimal urine
to the diuretics.  She was unable to lie flat.  She continues to
complain of shortness of breath.  She denies chest pain, nausea,
vomiting, diarrhea.  She is alert and arousable, but cannot
communicate due to the discomfort from the mask.

Past Medical History:
- HCV Cirrhosis - h/o ascites/hepatohydrothorax s/p TIPS,
encephalopathy, SBP
--liver biopsy in [**2195**] at [**Hospital6 86720**]
-Hepatitis C virus - tx with ribaviron and interferon
-HIV on HAART ([**9-1**] CD4 409, VL undetectable)
-Asthma
-Anemia
-COPD
-Aortic stenosis
-s/p tubal ligation in [**2179**]
-s/p throat biopsy with polyp removal in [**2197**] and again in [**2198**]


Social History:
Ms. [**Known lastname **] lives in [**Hospital1 40198**], [**State 350**] with her 26-year-old

daughter. She is now on disability; however, she used to work in
a cafeteria at [**Hospital1 40198**] Public School. No ETOH for 5 years, prior
was a social drinker. Tobacco: currently 3 cigarettes per day,
prior 1PPD since [**03**] yo. She states that she has never used any
intravenous drugs but she did smoke marijuana and experimented
with intranasal cocaine in her teens and early 20s.

Family History:
Mother died at the age of 62 from atherosclerosis and a
myocardial infarction. Her father passed away at 47 due to
morbid obesity and myocardial infarction.

Physical Exam:
General Appearance: Anxious, acute respiratory distress
Eyes / Conjunctiva: PERRL
Head, Ears, Nose, Throat: Normocephalic, bipap in place
Cardiovascular: (S1: Normal), (S2: Normal)
Peripheral Vascular: (Right radial pulse: Present), (Left radial
pulse: Present), (Right DP pulse: Present), (Left DP pulse:
Present)
Respiratory / Chest: (Breath Sounds: Crackles : 1/2 up lungs,
Wheezes : throughout all lung fields, audible without
stethoscope), moving air poorly; tachpneic
Abdominal: Soft, No(t) Non-tender, Distended, Tender: diffusely,
Obese, R bag draining peritoneal fluid
Extremities: Right lower extremity edema: 2+, Left lower
extremity edema: 2+, edematous in upper extremities as well
Skin:  Cool, wrapped L leg
Neurologic: Follows simple commands, Responds to: Not assessed,
Oriented (to): , Movement: Purposeful, Tone: Not assessed


Pertinent Results:
[**2200-4-4**] 12:15AM BLOOD WBC-4.3# RBC-2.63* Hgb-8.3* Hct-25.4*
MCV-97# MCH-31.4 MCHC-32.5 RDW-21.7* Plt Ct-64*#
[**2200-4-4**] 12:15AM BLOOD PT-19.8* PTT-50.8* INR(PT)-1.8*
[**2200-4-4**] 12:15AM BLOOD Glucose-98 UreaN-51* Creat-2.9*# Na-127*
K-5.0 Cl-103 HCO3-17* AnGap-12
[**2200-4-4**] 12:15AM BLOOD ALT-16 AST-29 LD(LDH)-196 AlkPhos-65
TotBili-1.5 DirBili-0.7* IndBili-0.8
[**2200-4-4**] 12:15AM BLOOD Albumin-3.0* Calcium-8.2* Phos-7.2*#
Mg-1.6
[**2200-5-6**] 02:43AM BLOOD WBC-16.2* RBC-2.59* Hgb-8.6* Hct-24.8*
MCV-96 MCH-33.2* MCHC-34.7 RDW-29.2* Plt Ct-30*
[**2200-5-6**] 02:43AM BLOOD PT-85.0* PTT-116.8* INR(PT)-10.3*
[**2200-4-15**] 03:19PM BLOOD Fibrino-73*
[**2200-5-5**] 03:26AM BLOOD Glucose-165* UreaN-100* Creat-2.0* Na-143
K-4.0 Cl-118* HCO3-13* AnGap-16
[**2200-5-5**] 03:26AM BLOOD ALT-34 AST-110* LD(LDH)-589* AlkPhos-258*
TotBili-19.8*
[**2200-5-5**] 03:26AM BLOOD Calcium-8.5 Phos-7.9* Mg-2.2
.
Abdominal Ultrasound [**2200-4-4**]
IMPRESSION:
1. Patent TIPS shunt. Full assessment with velocities could not
be obtained
due to the patient's breathing difficulties. The left portal
vein is patent
with hepatopetal flow, with a large a patent umbilical vein.
2. No hydronephrosis; however, imaging of the kidneys is very
limited.
3. Small bilateral pleural effusion. No ascites identified.
.
ECHO [**2200-4-7**]
IMPRESSION: Mildly thickened trileaflet aortic valve with
minimal aortic stenosis. Mild symmetric left ventricular
hypertrophy with preserved global and regional biventricular
systolic function. Moderate tricuspid regurgitation. Mild
pulmonary artery systolic hypertension. Dilated ascending
aortal.
.
ECHO [**2200-4-25**]:
The left atrium is elongated. There is mild symmetric left
ventricular hypertrophy. The left ventricular cavity is mildly
dilated. Regional left ventricular wall motion is normal.
Overall left ventricular systolic function is normal (LVEF>55%).
The estimated cardiac index is high (>4.0L/min/m2). Right
ventricular chamber size and free wall motion are normal. There
is mild aortic valve stenosis (valve area 1.2-1.9cm2). The
mitral valve leaflets are mildly thickened. There is no mitral
valve prolapse. Mild to moderate ([**1-25**]+) mitral regurgitation is
seen. Moderate [2+] tricuspid regurgitation is seen. There is
mild pulmonary artery systolic hypertension. There is no
pericardial effusion.
IMPRESSION: Mild symmetric left ventricular hypertrophy with
normal global and regional biventricular systolic function. Mild
aortic stenosis. Mild to moderate mitral regurgitation. Moderate
tricuspid regurgitation. Mild pulmonary hypertension
.
EEG:
IMPRESSION: This is an abnormal video EEG study due to slowing
and
suppression of the background with GPEDs at approximately 1 Hz.
These
findings are suggestive of severe cortical and subcortical
dysfunction
and may be seen associated with non-convulsive status
epilepticus;
however, there was no evidence of non-convulsive status
epilepticus in
this study.
.
CT HEAD:
There is no evidence of hemorrhage, edema, masses, midline shift
or
infarction. The ventricles and sulci are normal in size and
caliber. The
[**Doctor Last Name 352**]-white matter differentiation is preserved. The previously
described
inspissated mucus in the right maxillary sinus is not seen on
the current
study. The paranasal sinuses are clear and well aerated. The
mastoid air
cells are clear bilaterally. No fractures or soft tissue
abnormalities are
detected. IMPRESSION: No acute intracranial process.
.
Abomdinal U/S:
1. Patent TIPS shunt with velocities in a reasonable range.
Three-month
followup is suggested. Flow in the left and right portal veins
is away from
the TIPS shunt. Patent umbilical vein is again noted.
2. Scant trace of ascites, insufficient for marking for
paracentesis.
3. Mild splenomegaly.
4. Gallbladder sludge. No biliary dilatation and no focal liver
lesion.


Brief Hospital Course:
This is a 45 year old female with Hep C cirrhosis, HIV on HAART,
admitted to [**Hospital1 18**] on [**2200-4-3**] with respiratory distress
due to volume overload requiring intubation and oliguric acute
renal failure likely due to hypotension and hepatorenal
syndrome.  She had a prolonged hospital course complicated by
seizures likely secondary to her hepatic failure and uremia,
progressive deterioration in her liver and renal function,
coagulopathy, respiratory failure requiring intubation, and
hypotension requiring multiple vasopressor support. Multiple
services were involved in her care including renal for her renal
failure, liver for her hepatic failure, and neurology for her
seizures. Her condition deteriorated with multi-organ failure
and in agreement with the wishes of her family the goal of her
care was transitioned to patient comfort. She expired with her
family at her side. A post-mortem was offered and was declined.
.

Medications on Admission:
HOME MEDICATIONS:
-Amiloride 5mg twice daily
-Sustiva 600mg capsules qhs
-ethycrinic acid 25mg daily
-Lactulose 15ml 3 times a day
-Combivir 150 mg/300 mg twice daily
-Nadolol 40 mg daily
-Potassium chloride 20 mEq tablet daily
-Avelox 400mg daily
.
MEDICATIONS ON TRANSFER:
Albumin 142.5 g IV x1 at 11:20 on [**4-3**]
Albuterol MDI prn
Sustiva 600mg qhs
lactulose 20g Q12
levaquin 750mg Q48 hours
midodrine 10mg po tid
morphine 1-2mg iv q4 hours prn pain
octreotide 50mcg sq tid
vitamin k 10mg sq daily for three days (given on [**4-2**] and [**4-3**])

combivir 300/150 one tab [**Hospital1 **]


Discharge Medications:
Deceased

Discharge Disposition:
Expired

Discharge Diagnosis:
Liver failure
Acute renal failure
Coagulopathy
hepatic enceaphalopathy
HCV
HIV

Discharge Condition:
Deceased

Discharge Instructions:
Deceased

Followup Instructions:
Deceased
{"Spontaneous bacterial peritonitis,Unspecified viral hepatitis C with hepatic coma,Hepatorenal syndrome,Acute kidney failure, unspecified,Acute respiratory failure,Toxic encephalopathy,Pneumonia, organism unspecified,Unspecified septicemia,Severe sepsis,Septic shock,Coma,Other ascites,Urinary tract infection, site not specified,Delirium due to conditions classified elsewhere,Acidosis,Aphasia,Other and unspecified coagulation defects,Paroxysmal supraventricular tachycardia,Glucocorticoid deficiency,Jaundice, unspecified, not of newborn,Cirrhosis of liver without mention of alcohol,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Awaiting organ transplant status,Chronic kidney disease, unspecified,Asymptomatic human immunodeficiency virus [HIV] infection status,Anemia in chronic kidney disease,Chronic obstructive asthma, unspecified,Aortic valve disorders,Tobacco use disorder,Cocaine dependence, in remission,Thrombocytopenia, unspecified,Unspecified acquired hypothyroidism,Other and unspecified anticonvulsants causing adverse effects in therapeutic use,Encounter for palliative care"}


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: respiratory distress

PRESENT ILLNESS: 45 y/o F with hx of HIV and hepatitis C cirrhosis s/p TIPS,
ascites, SBP and encephalopathy who is transferred from the
[**Doctor Last Name 3271**] [**First Name4 (NamePattern1) 679**] [**Last Name (NamePattern1) 4869**] to the MICU for respiratory distress.  The
patient was transferred from an OSH last night for hepato-renal
syndrome and SBP.  She did well overnight except for transient
hypotension that responded to albumin infusion.  She was
continued on cipro for SBP treatment and started on vanco for
broader coverage.  This morning she was on 2L NC and had minimal
urine output.  She was transferred to radiology for CXR and
ultrasound and after transport and lying flat, became tachypneic
and desatted requiring a NRB.  She had an ABG on the floor of
7.20/40/79 and was in obvious distress.  She was given one SLNG
for BP in 160s/110s and started on her diuretics.  Her
respiratory status did not improve.
.
On the floor, she was placed on bipap and tolerated better
except for discomfort from the mask.  She put out minimal urine
to the diuretics.  She was unable to lie flat.  She continues to
complain of shortness of breath.  She denies chest pain, nausea,
vomiting, diarrhea.  She is alert and arousable, but cannot
communicate due to the discomfort from the mask.

MEDICAL HISTORY: - HCV Cirrhosis - h/o ascites/hepatohydrothorax s/p TIPS,
encephalopathy, SBP
--liver biopsy in [**2195**] at [**Hospital6 86720**]
-Hepatitis C virus - tx with ribaviron and interferon
-HIV on HAART ([**9-1**] CD4 409, VL undetectable)
-Asthma
-Anemia
-COPD
-Aortic stenosis
-s/p tubal ligation in [**2179**]
-s/p throat biopsy with polyp removal in [**2197**] and again in [**2198**]

MEDICATION ON ADMISSION: HOME MEDICATIONS:
-Amiloride 5mg twice daily
-Sustiva 600mg capsules qhs
-ethycrinic acid 25mg daily
-Lactulose 15ml 3 times a day
-Combivir 150 mg/300 mg twice daily
-Nadolol 40 mg daily
-Potassium chloride 20 mEq tablet daily
-Avelox 400mg daily
.
MEDICATIONS ON TRANSFER:
Albumin 142.5 g IV x1 at 11:20 on [**4-3**]
Albuterol MDI prn
Sustiva 600mg qhs
lactulose 20g Q12
levaquin 750mg Q48 hours
midodrine 10mg po tid
morphine 1-2mg iv q4 hours prn pain
octreotide 50mcg sq tid
vitamin k 10mg sq daily for three days (given on [**4-2**] and [**4-3**])

ALLERGIES: Sulfa (Sulfonamide Antibiotics) / Aldactone / Penicillins /
Bactrim

PHYSICAL EXAM: General Appearance: Anxious, acute respiratory distress
Eyes / Conjunctiva: PERRL
Head, Ears, Nose, Throat: Normocephalic, bipap in place
Cardiovascular: (S1: Normal), (S2: Normal)
Peripheral Vascular: (Right radial pulse: Present), (Left radial
pulse: Present), (Right DP pulse: Present), (Left DP pulse:
Present)
Respiratory / Chest: (Breath Sounds: Crackles : 1/2 up lungs,
Wheezes : throughout all lung fields, audible without
stethoscope), moving air poorly; tachpneic
Abdominal: Soft, No(t) Non-tender, Distended, Tender: diffusely,
Obese, R bag draining peritoneal fluid
Extremities: Right lower extremity edema: 2+, Left lower
extremity edema: 2+, edematous in upper extremities as well
Skin:  Cool, wrapped L leg
Neurologic: Follows simple commands, Responds to: Not assessed,
Oriented (to): , Movement: Purposeful, Tone: Not assessed

FAMILY HISTORY: Mother died at the age of 62 from atherosclerosis and a
myocardial infarction. Her father passed away at 47 due to
morbid obesity and myocardial infarction.

SOCIAL HISTORY: Ms. [**Known lastname **] lives in [**Hospital1 40198**], [**State 350**] with her 26-year-old 

### Response:
{"Spontaneous bacterial peritonitis,Unspecified viral hepatitis C with hepatic coma,Hepatorenal syndrome,Acute kidney failure, unspecified,Acute respiratory failure,Toxic encephalopathy,Pneumonia, organism unspecified,Unspecified septicemia,Severe sepsis,Septic shock,Coma,Other ascites,Urinary tract infection, site not specified,Delirium due to conditions classified elsewhere,Acidosis,Aphasia,Other and unspecified coagulation defects,Paroxysmal supraventricular tachycardia,Glucocorticoid deficiency,Jaundice, unspecified, not of newborn,Cirrhosis of liver without mention of alcohol,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Awaiting organ transplant status,Chronic kidney disease, unspecified,Asymptomatic human immunodeficiency virus [HIV] infection status,Anemia in chronic kidney disease,Chronic obstructive asthma, unspecified,Aortic valve disorders,Tobacco use disorder,Cocaine dependence, in remission,Thrombocytopenia, unspecified,Unspecified acquired hypothyroidism,Other and unspecified anticonvulsants causing adverse effects in therapeutic use,Encounter for palliative care"}
