CHIEF COMPLAINT: Weakness and fatigue

PRESENT ILLNESS: The patient is a 57 year old male with end stage liver disease
secondary to Hep C cirrhosis and alcohol abuse.  He was
discharged one day prior to this admission after being treated
for hepatic encephalopathy.  He slept well that night, but then
became weak and lethargic.  He vomited twice on the day of
admission and as per his wife, he [**Name2 (NI) **] poor urine output.  He
has been taking his lactulose and has been having watery stools
every 2 hours.  Denises hematemesis, hematochezia, dysuria, SOB,
or CP.

MEDICAL HISTORY: -Hepatitis C Cirrhosis (diagnosed in [**2100**]) - no liver bx done;
risk factors: suspected unprotected sex, tattoo; No
interferon/ribavirin due to insurance reasons. Variceal bleeding
in [**February 2106**] (7 units required), EGD revealed Grade-II varices but
no acute bleeding. Encephalopathy and mild ascites; [**2106-11-17**]
EGD: 4 cord varices (one was Grade III), 3 bands placed; MELD
score 29 ([**2106-11-24**]); 19 ([**2106-9-1**])
-COPD - [**2106-11-16**] PFTs normal
-Surgeries for Hernia (bilateral), Varicose veins
-cellulitis
-chest pain [**2100**] - cath: minor CFx, LAD disease

MEDICATION ON ADMISSION: atrovent, albuterol, flovent, protonix, flonase, quinine,
lactulose, lasix, aldactone

ALLERGIES: Percocet / Codeine / Aspirin

PHYSICAL EXAM: VS- 97.0, 75, 105/58, 12, 100% RA
Gen: overweight, jaundiced, palmar erythema, spider nevi
Lungs: CTA B/L
Heart: RRR, Grade 2 SEM heard best at apex
Abd: mildly tender RLQ, no rebound or guarding, liver mildly
enlarged, guiac negative
Ext: 1+ pedal edema
Neuro: + asterixis, CN 2-12 grossly in tact, + full body tremors

FAMILY HISTORY: No hx of liver disease in family

SOCIAL HISTORY: Patient has not drank alcohol since [**2106-3-9**].  Prior
alcohol intake since adolescence, 6-7 beers/day; period of
abstinence from age 34-44; does not like AA.  Currently denies
tob, OMR states 3 packs /day for 30 yrs; quit within last year.
No IVD abuse
Tattoos +
Lives w/ his girlfriend [**First Name4 (NamePattern1) **] [**Name (NI) **]) of 13 yrs in [**Location (un) 7661**], MA
MassHealth insurance; disability income - does not work
currently, former painter
Does not drive
Hepatic encephalopathy,Hemorrhage, unspecified,Other shock without mention of trauma,Acute respiratory failure,Acute and subacute necrosis of liver,Alcoholic cirrhosis of liver,Chronic hepatitis C with hepatic coma,Acute kidney failure with lesion of tubular necrosis,Acquired coagulation factor deficiency,Acute posthemorrhagic anemia,Unspecified septicemia,Dehydration,Chronic airway obstruction, not elsewhere classified,Unspecified pleural effusion,Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction,Other and unspecified alcohol dependence, in remission,Orthostatic hypotension
Hepatic encephalopathy,Hemorrhage NOS,Shock w/o trauma NEC,Acute respiratry failure,Acute necrosis of liver,Alcohol cirrhosis liver,Chrnc hpt C w hepat Coma,Ac kidny fail, tubr necr,Acq coagul factor defic,Ac posthemorrhag anemia,Septicemia NOS,Dehydration,Chr airway obstruct NEC,Pleural effusion NOS,SIRS-noninf w ac org dys,Alcoh dep NEC/NOS-remiss,Orthostatic hypotension
Admission Date:  [**2106-12-11**]              Discharge Date:   [**2106-12-18**]

Date of Birth:  [**2049-4-15**]             Sex:   M

Service: MEDICINE

Allergies:
Percocet / Codeine / Aspirin

Attending:[**First Name3 (LF) 943**]
Chief Complaint:
Weakness and fatigue

Major Surgical or Invasive Procedure:
none

History of Present Illness:
The patient is a 57 year old male with end stage liver disease
secondary to Hep C cirrhosis and alcohol abuse.  He was
discharged one day prior to this admission after being treated
for hepatic encephalopathy.  He slept well that night, but then
became weak and lethargic.  He vomited twice on the day of
admission and as per his wife, he [**Name2 (NI) **] poor urine output.  He
has been taking his lactulose and has been having watery stools
every 2 hours.  Denises hematemesis, hematochezia, dysuria, SOB,
or CP.

Past Medical History:
-Hepatitis C Cirrhosis (diagnosed in [**2100**]) - no liver bx done;
risk factors: suspected unprotected sex, tattoo; No
interferon/ribavirin due to insurance reasons. Variceal bleeding
in [**February 2106**] (7 units required), EGD revealed Grade-II varices but
no acute bleeding. Encephalopathy and mild ascites; [**2106-11-17**]
EGD: 4 cord varices (one was Grade III), 3 bands placed; MELD
score 29 ([**2106-11-24**]); 19 ([**2106-9-1**])
-COPD - [**2106-11-16**] PFTs normal
-Surgeries for Hernia (bilateral), Varicose veins
-cellulitis
-chest pain [**2100**] - cath: minor CFx, LAD disease

Social History:
Patient has not drank alcohol since [**2106-3-9**].  Prior
alcohol intake since adolescence, 6-7 beers/day; period of
abstinence from age 34-44; does not like AA.  Currently denies
tob, OMR states 3 packs /day for 30 yrs; quit within last year.
No IVD abuse
Tattoos +
Lives w/ his girlfriend [**First Name4 (NamePattern1) **] [**Name (NI) **]) of 13 yrs in [**Location (un) 7661**], MA
MassHealth insurance; disability income - does not work
currently, former painter
Does not drive


Family History:
No hx of liver disease in family

Physical Exam:
VS- 97.0, 75, 105/58, 12, 100% RA
Gen: overweight, jaundiced, palmar erythema, spider nevi
Lungs: CTA B/L
Heart: RRR, Grade 2 SEM heard best at apex
Abd: mildly tender RLQ, no rebound or guarding, liver mildly
enlarged, guiac negative
Ext: 1+ pedal edema
Neuro: + asterixis, CN 2-12 grossly in tact, + full body tremors

Pertinent Results:
[**2106-12-10**] 05:00AM [**Month/Day/Year 3143**] WBC-4.7 RBC-2.60* Hgb-9.8* Hct-27.9*
MCV-108* MCH-37.6* MCHC-35.0 RDW-17.6* Plt Ct-74*
[**2106-12-15**] 12:50PM [**Month/Day/Year 3143**] WBC-5.2 RBC-2.02* Hgb-7.1* Hct-22.4*
MCV-111* MCH-35.5* MCHC-31.9 RDW-17.9* Plt Ct-98*
[**2106-12-15**] 07:56PM [**Month/Day/Year 3143**] WBC-4.9 RBC-1.72* Hgb-5.3*# Hct-15.6*#
MCV-91# MCH-31.0# MCHC-34.0 RDW-25.9* Plt Ct-50*
[**2106-12-15**] 10:10PM [**Month/Day/Year 3143**] WBC-4.7 RBC-2.02* Hgb-6.2* Hct-18.2*
MCV-90 MCH-30.5 MCHC-33.9 RDW-20.1* Plt Ct-29*
[**2106-12-15**] 11:24PM [**Month/Day/Year 3143**] Hct-25.2*# Plt Ct-91*#
[**2106-12-16**] 01:00AM [**Month/Day/Year 3143**] Hct-27.5* Plt Ct-153#
[**2106-12-16**] 05:39PM [**Month/Day/Year 3143**] Hct-29.7* Plt Ct-81*
[**2106-12-17**] 02:00AM [**Month/Day/Year 3143**] WBC-5.5 RBC-1.78*# Hgb-5.4*# Hct-15.4*#
MCV-87 MCH-30.4 MCHC-35.1* RDW-16.8* Plt Ct-40*
[**2106-12-17**] 02:27AM [**Month/Day/Year 3143**] WBC-4.7 RBC-1.32*# Hgb-4.0*# Hct-11.5*#
MCV-88 MCH-30.3 MCHC-34.6 RDW-17.3* Plt Ct-27*
[**2106-12-18**] 09:33AM [**Month/Day/Year 3143**] WBC-9.9 RBC-3.21* Hgb-10.2* Hct-26.6*
MCV-83 MCH-31.7 MCHC-36.9* RDW-16.3* Plt Ct-46*
[**2106-12-18**] 02:30PM [**Month/Day/Year 3143**] WBC-6.4 RBC-1.95*# Hgb-5.9*# Hct-16.4*#
MCV-85 MCH-30.1 MCHC-35.6* RDW-17.2* Plt Ct-86*
[**2106-12-18**] 03:30PM [**Month/Day/Year 3143**] WBC-6.0 RBC-1.78* Hgb-5.4* Hct-15.1*
MCV-85 MCH-30.6 MCHC-36.1* RDW-17.9* Plt Ct-76*
[**2106-12-10**] 05:00AM [**Month/Day/Year 3143**] PT-20.7* PTT-150* INR(PT)-3.0
[**2106-12-18**] 03:30PM [**Month/Day/Year 3143**] Plt Ct-76*
[**2106-12-10**] 05:00AM [**Month/Day/Year 3143**] Glucose-106* UreaN-42* Creat-1.5* Na-127*
K-4.3 Cl-98 HCO3-20* AnGap-13
[**2106-12-10**] 05:00AM [**Month/Day/Year 3143**] ALT-87* AST-91* LD(LDH)-268* AlkPhos-106
TotBili-7.5*
[**2106-12-17**] 02:00AM [**Month/Day/Year 3143**] ALT-311* AST-709* AlkPhos-72 Amylase-82
TotBili-6.8*
[**2106-12-18**] 01:20AM [**Month/Day/Year 3143**] ALT-819* AST-2104* AlkPhos-124*
TotBili-12.8*
[**2106-12-11**] 05:15PM [**Month/Day/Year 3143**] Osmolal-283
[**2106-12-13**] 05:35AM [**Month/Day/Year 3143**] Ammonia-55*
[**2106-12-17**] 12:31AM [**Month/Day/Year 3143**] Cortsol-55.9*
[**2106-12-18**] 02:35PM [**Month/Day/Year 3143**] Type-ART pO2-127* pCO2-31* pH-7.39
calHCO3-19* Base XS--4
[**2106-12-18**] 08:28AM [**Month/Day/Year 3143**] Type-ART pO2-112* pCO2-42 pH-7.35
calHCO3-24 Base XS--2
[**2106-12-18**] 02:35PM [**Month/Day/Year 3143**] Glucose-50* Lactate-11.7* K-4.5 Cl-96*
[**2106-12-18**] 08:28AM [**Month/Day/Year 3143**] Glucose-73 Lactate-6.5* K-4.5
[**2106-12-18**] 06:06AM [**Month/Day/Year 3143**] Glucose-108* Lactate-6.2*

Brief Hospital Course:
The patient was admitted to the hepatobiliary service on
[**2106-12-11**].  His encephalopathy was thought to be baseline as well
as due to dehydration.  A RUQ ultrasound revealed no portal vein
thrombosis.  He was afebrile with a normal WBC, but was
pan-cultured anyway.  UA was negative.  Hematocrit was stable at
30.  Ceftriaxone was started empirically for possible peritoneal
infection. Lactulose was continued.  He was aggressively
hydrated.  He also had a createnine of 2.1 (baseline 1.5) and a
sodium of 124 (baseline 132).  His FeNa was < 1%, so this was
likely pre-renal.  He could not have a feeding tube placed due
to recent bleeding, and required supervised oral feeding.  His
MELD on admission was 31.  Ceftriaxone was discontined HD 2 (no
signs of infection).  Lactulose was titrated so as to get [**4-9**]
BMs daily.  On HD 2, createnine was down to 1.6.  Physical
therapy saw him and felt he should progress to be discharged
home.  On HD 5, he became lightheaded and dropped to his feet
while walking.  Denied loss of consciousness.  Thought to be due
to orthostasis.  His BP was 60/palp and HR was 110.  He was
helped back to bed and his HR and BP returned to [**Location 213**] (SBP
100, HR 90).  His CMV viral load was negative.  His Hct was 22,
so he was transfused 2 units RBCs for [**Location **] loss anemia.  His
INR was 3.0, so he was transfused 3 units of FFP to correct his
coagulopathy.  A CT scan revealed a right-side retroperitoneal
hematoma.  At that time, he was transferred to the trnasplant
surgery serivce and sent to the ICU.

On HD 6, the patient was intubated.  A central venous catheter
and arterial line were placed.  From this point on, this patient
required aggressive transfusion of RBCs, FFP, platelets and
Cryo.  Over the night, his Hct dropped to 15, then rose to 18,
then 25, then 27. His platelets went fro 50 to 29 to 91 to 153.
His INR went from 3.3 to 2.8 to 2.5 to 0.6.  He required 11
units of RBCs, 2 of platelets, 4 of FFP, 1 of cryo and 1 of
factor 7.  On HD 7, his Hct dropped from 28 to 11 over 3 hours.
He did not have guiac + stools and hig NG tube outpuit was
[**Last Name (LF) 63675**], [**First Name3 (LF) **] his [**First Name3 (LF) **] loss anemia was though to be entirely
due to his retroperiotneal hematoma.  TIPS and surgery were
considered, but the mortality was thought to be too high.  Over
the day, he reuired 9 units of RBCs, 2 platelets, 4 FFP, 2 cryo
and 1 of factor 7.  A dialysis catheter was placed for CVVHD.
Vancomycin, levofloxacin, and fluconazole were begun
empirically.  The goal was to transfuse [**First Name3 (LF) **] products to keep
Hct > 27, Plt > 75, and INR < 2.0.  He required maximum pressor
support (neosynepherine, vasopressin and levophed).  Despite
extremes in transfusion of [**First Name3 (LF) **] products, we were not able to
stop his bleeding.  A family meeting was arranged and the
decision was made to hold all pressor support and [**First Name3 (LF) **]
products.  He died later that night.

Medications on Admission:
atrovent, albuterol, flovent, protonix, flonase, quinine,
lactulose, lasix, aldactone

Discharge Disposition:
Expired

Discharge Diagnosis:
cirrhosis, retroperitonel hematoma, death

Discharge Condition:
dead


Completed by:[**2107-4-1**]
{'Hepatic encephalopathy,Hemorrhage, unspecified,Other shock without mention of trauma,Acute respiratory failure,Acute and subacute necrosis of liver,Alcoholic cirrhosis of liver,Chronic hepatitis C with hepatic coma,Acute kidney failure with lesion of tubular necrosis,Acquired coagulation factor deficiency,Acute posthemorrhagic anemia,Unspecified septicemia,Dehydration,Chronic airway obstruction, not elsewhere classified,Unspecified pleural effusion,Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction,Other and unspecified alcohol dependence, in remission,Orthostatic hypotension'}


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: Weakness and fatigue

PRESENT ILLNESS: The patient is a 57 year old male with end stage liver disease
secondary to Hep C cirrhosis and alcohol abuse.  He was
discharged one day prior to this admission after being treated
for hepatic encephalopathy.  He slept well that night, but then
became weak and lethargic.  He vomited twice on the day of
admission and as per his wife, he [**Name2 (NI) **] poor urine output.  He
has been taking his lactulose and has been having watery stools
every 2 hours.  Denises hematemesis, hematochezia, dysuria, SOB,
or CP.

MEDICAL HISTORY: -Hepatitis C Cirrhosis (diagnosed in [**2100**]) - no liver bx done;
risk factors: suspected unprotected sex, tattoo; No
interferon/ribavirin due to insurance reasons. Variceal bleeding
in [**February 2106**] (7 units required), EGD revealed Grade-II varices but
no acute bleeding. Encephalopathy and mild ascites; [**2106-11-17**]
EGD: 4 cord varices (one was Grade III), 3 bands placed; MELD
score 29 ([**2106-11-24**]); 19 ([**2106-9-1**])
-COPD - [**2106-11-16**] PFTs normal
-Surgeries for Hernia (bilateral), Varicose veins
-cellulitis
-chest pain [**2100**] - cath: minor CFx, LAD disease

MEDICATION ON ADMISSION: atrovent, albuterol, flovent, protonix, flonase, quinine,
lactulose, lasix, aldactone

ALLERGIES: Percocet / Codeine / Aspirin

PHYSICAL EXAM: VS- 97.0, 75, 105/58, 12, 100% RA
Gen: overweight, jaundiced, palmar erythema, spider nevi
Lungs: CTA B/L
Heart: RRR, Grade 2 SEM heard best at apex
Abd: mildly tender RLQ, no rebound or guarding, liver mildly
enlarged, guiac negative
Ext: 1+ pedal edema
Neuro: + asterixis, CN 2-12 grossly in tact, + full body tremors

FAMILY HISTORY: No hx of liver disease in family

SOCIAL HISTORY: Patient has not drank alcohol since [**2106-3-9**].  Prior
alcohol intake since adolescence, 6-7 beers/day; period of
abstinence from age 34-44; does not like AA.  Currently denies
tob, OMR states 3 packs /day for 30 yrs; quit within last year.
No IVD abuse
Tattoos +
Lives w/ his girlfriend [**First Name4 (NamePattern1) **] [**Name (NI) **]) of 13 yrs in [**Location (un) 7661**], MA
MassHealth insurance; disability income - does not work
currently, former painter
Does not drive 

### Response:
{'Hepatic encephalopathy,Hemorrhage, unspecified,Other shock without mention of trauma,Acute respiratory failure,Acute and subacute necrosis of liver,Alcoholic cirrhosis of liver,Chronic hepatitis C with hepatic coma,Acute kidney failure with lesion of tubular necrosis,Acquired coagulation factor deficiency,Acute posthemorrhagic anemia,Unspecified septicemia,Dehydration,Chronic airway obstruction, not elsewhere classified,Unspecified pleural effusion,Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction,Other and unspecified alcohol dependence, in remission,Orthostatic hypotension'}
