CHIEF COMPLAINT: Tongue Swelling

PRESENT ILLNESS: t is a 54 yo male with a h/o Hep C, currently on pegasys,
telaprevir and ribavirin (started on [**2156-2-3**]), HTN on lisinopril
and CKD who went to bed at midnight and woke up two hours later
with tongue swelling. According to the wife he had an uneventful
day prior to admission and went to bed about midnight. He woke
up around 2:30AM complaining of a funny sensation of his tonigue
and some swelling. He tried to go back to sleep but felt as if
his tongue was continuing to get swollen therefore he decided to
drive to the ED for further evaluation. He has never experienced
anything like this before. He has some pruritis associated with
Hep medications but no overt allergic reactions. The wife denies
any wheezing or difficulty breathing and did not note a rash. He
has previously had a reaction to hair dye where he broke out in
hives and ?pustules. Of note, he has been on lisinopril since at
least [**2152**] and does not appear to have ever had a reaction.
.
In the ED, initial VS were: Pulse: 100, RR: 18, BP: 142/84,
Rhythm: Sinus Tachycardia, O2Sat: 99%, O2Flow: RA, Pain: 4. He
was given epinephrine auto injector, methylprednisolone 125mg,
diphenhydramine 50mg and famotadine 20mg. His tongue swelling
was noted to be getting worse and it was decided to intubate the
patientfor airway protection. He was given midazolam, ketamine
and propofol.
.
On arrival to the MICU, he was sedated and intubated. He was
moving all extremities and appeared agitated therefore his
propofol was increased as was his fentanyl. He was noted to have
a large protruding tongue.

MEDICAL HISTORY: Hep C- currently being treated with telaprevir, peggylated
interferon and ribavirin ([**2156-2-3**])
Hypertension
CKD Stage III

MEDICATION ON ADMISSION: HYDROCHLOROTHIAZIDE - 25 mg Tablet - 1 Tablet(s) by mouth once a
day - No Substitution
LISINOPRIL - 30 mg Tablet - 1 Tablet(s) by mouth once a day
Ribavirin 600 mg [**Hospital1 **]
Telaprevir 750 mg tid
Pegasys 180 mcg weekly injections

ALLERGIES: Ace Inhibitors / [**Last Name (un) **]-Angiotensin Receptor Antagonist / Precedex

PHYSICAL EXAM: Admission Exam:
Vitals: BP: 147/87 P: 79 18 O2: 100
Vent: 500/14/5/100 FiO2
General: intubated and sedated
HEENT: large edematous tongue that was protruding out of his
mouth
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Rhonchi noted bilaterally, no wheezes, good air movement

FAMILY HISTORY: No h/o liver dz or CA.  [**Name (NI) 1094**] Father had an MI at age 62. Mother
and 8 sibs in good health. No history of significant allergic
reactions.

SOCIAL HISTORY: He lives in JP and is married. He worked as a personal care
attendant but is currenlty unemployed.  No ETOH, alcohol or
illicit drug use.  Pt. has 1 child with this partner, 2 others
with other partners.
Angioneurotic edema, not elsewhere classified,Other drug-induced pancytopenia,Acute respiratory failure,Acidosis,Chronic hepatitis C without mention of hepatic coma,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Hypotension, unspecified,Other specified cardiac dysrhythmias,Antiviral drugs causing adverse effects in therapeutic use,Long-term (current) use of other medications,Other sedatives and hypnotics causing adverse effects in therapeutic use,Other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use,Leukocytopenia, unspecified,Anemia, unspecified,Intravenous anesthetics causing adverse effects in therapeutic use
Angioneurotic edema,Oth drg indcd pancytopna,Acute respiratry failure,Acidosis,Chrnc hpt C wo hpat coma,Hy kid NOS w cr kid I-IV,Chr kidney dis stage III,Hypotension NOS,Cardiac dysrhythmias NEC,Adv eff antiviral drugs,Long-term use meds NEC,Adv eff sedat/hypnot NEC,Adv eff cardiovasc NEC,Leukocytopenia NOS,Anemia NOS,Adv eff intraven anesth
Admission Date:  [**2156-4-21**]              Discharge Date:   [**2156-4-26**]

Date of Birth:  [**2101-7-13**]             Sex:   M

Service: MEDICINE

Allergies:
Ace Inhibitors / [**Last Name (un) **]-Angiotensin Receptor Antagonist / Precedex

Attending:[**First Name3 (LF) 2006**]
Chief Complaint:
Tongue Swelling

Major Surgical or Invasive Procedure:
Intubation and Mechanical Ventilation

History of Present Illness:
t is a 54 yo male with a h/o Hep C, currently on pegasys,
telaprevir and ribavirin (started on [**2156-2-3**]), HTN on lisinopril
and CKD who went to bed at midnight and woke up two hours later
with tongue swelling. According to the wife he had an uneventful
day prior to admission and went to bed about midnight. He woke
up around 2:30AM complaining of a funny sensation of his tonigue
and some swelling. He tried to go back to sleep but felt as if
his tongue was continuing to get swollen therefore he decided to
drive to the ED for further evaluation. He has never experienced
anything like this before. He has some pruritis associated with
Hep medications but no overt allergic reactions. The wife denies
any wheezing or difficulty breathing and did not note a rash. He
has previously had a reaction to hair dye where he broke out in
hives and ?pustules. Of note, he has been on lisinopril since at
least [**2152**] and does not appear to have ever had a reaction.
.
In the ED, initial VS were: Pulse: 100, RR: 18, BP: 142/84,
Rhythm: Sinus Tachycardia, O2Sat: 99%, O2Flow: RA, Pain: 4. He
was given epinephrine auto injector, methylprednisolone 125mg,
diphenhydramine 50mg and famotadine 20mg. His tongue swelling
was noted to be getting worse and it was decided to intubate the
patientfor airway protection. He was given midazolam, ketamine
and propofol.
.
On arrival to the MICU, he was sedated and intubated. He was
moving all extremities and appeared agitated therefore his
propofol was increased as was his fentanyl. He was noted to have
a large protruding tongue.


Past Medical History:
Hep C- currently being treated with telaprevir, peggylated
interferon and ribavirin ([**2156-2-3**])
Hypertension
CKD Stage III


Social History:
He lives in JP and is married. He worked as a personal care
attendant but is currenlty unemployed.  No ETOH, alcohol or
illicit drug use.  Pt. has 1 child with this partner, 2 others
with other partners.

Family History:
No h/o liver dz or CA.  [**Name (NI) 1094**] Father had an MI at age 62. Mother
and 8 sibs in good health. No history of significant allergic
reactions.


Physical Exam:
Admission Exam:
Vitals: BP: 147/87 P: 79 18 O2: 100
Vent: 500/14/5/100 FiO2
General: intubated and sedated
HEENT: large edematous tongue that was protruding out of his
mouth
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Rhonchi noted bilaterally, no wheezes, good air movement

Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

Physical Exam on discharge:
General: AAOx3, NAD
HEENT: tongue normal in size, MM dry
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: CTAB
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema


Pertinent Results:
Admission Labs:
[**2156-4-21**] 05:50AM BLOOD WBC-2.4* RBC-3.08* Hgb-10.2* Hct-30.5*
MCV-99* MCH-32.9* MCHC-33.3 RDW-14.6 Plt Ct-234
[**2156-4-21**] 03:00PM BLOOD PT-11.4 PTT-27.7 INR(PT)-1.1
[**2156-4-22**] 03:15AM BLOOD Gran Ct-4190
[**2156-4-21**] 05:29PM BLOOD Ret Aut-1.8
[**2156-4-21**] 05:50AM BLOOD Glucose-135* UreaN-20 Creat-1.8* Na-124*
K-4.3 Cl-87* HCO3-24 AnGap-17
[**2156-4-21**] 03:00PM BLOOD ALT-38 AST-50* CK(CPK)-103 AlkPhos-69
TotBili-0.7
[**2156-4-23**] 01:45PM BLOOD CK-MB-1 cTropnT-<0.01
[**2156-4-23**] 08:12PM BLOOD CK-MB-1 cTropnT-<0.01
[**2156-4-21**] 03:00PM BLOOD Albumin-3.3* Calcium-8.7 Phos-3.5 Mg-1.7
[**2156-4-21**] 05:29PM BLOOD Hapto-<5*
[**2156-4-22**] 03:15AM BLOOD Triglyc-87
[**2156-4-21**] 05:50AM BLOOD Osmolal-260*
[**2156-4-21**] 03:00PM BLOOD C3-105 C4-30
[**2156-4-21**] 09:20AM BLOOD Type-ART Temp-36.1 Rates-14/14 Tidal
V-500 PEEP-5 FiO2-100 pO2-505* pCO2-39 pH-7.43 calTCO2-27 Base
XS-2 AADO2-172 REQ O2-38 Intubat-INTUBATED
[**2156-4-21**] 09:20AM BLOOD Lactate-1.0
[**2156-4-21**] 10:24AM BLOOD TRYPTASE-3

CXR ([**2156-4-21**]):
As compared to the previous radiograph, the patient has been
intubated. The tip of the endotracheal tube projects 3 cm above
the carina.  Relatively low lung volumes. Borderline size of the
cardiac silhouette, mild retrocardiac atelectasis. The presence
of a minimal left pleural effusion cannot be excluded.
.
TTE ([**2156-4-23**]):
The left atrium and right atrium are normal in cavity size. Left
ventricular wall thickness, cavity size and regional/global
systolic function are normal (LVEF >55%). Right ventricular
chamber size and free wall motion are normal. The aortic valve
leaflets (3) appear structurally normal with good leaflet
excursion and no aortic stenosis or aortic regurgitation. The
mitral valve leaflets are mildly thickened. Mild (1+) mitral
regurgitation is seen. There is borderline pulmonary artery
systolic hypertension. There is no pericardial effusion.

IMPRESSION: Normal global and regional biventricular systolic
function. Mild mitral regurgitation.
.
DISCHARGE LABS:
[**2156-4-26**] 07:50AM BLOOD WBC-4.5 RBC-2.58* Hgb-8.5* Hct-26.2*
MCV-101* MCH-32.9* MCHC-32.5 RDW-15.0 Plt Ct-192
[**2156-4-26**] 07:50AM BLOOD Glucose-128* UreaN-13 Creat-1.4* Na-134
K-4.3 Cl-95* HCO3-30 AnGap-13
[**2156-4-26**] 07:50AM BLOOD Calcium-9.2 Phos-4.9* Mg-1.8
[**2156-4-25**] 01:37AM BLOOD ALT-28 AST-28 AlkPhos-57 TotBili-0.3
[**2156-4-25**] 01:37AM BLOOD VitB12-819 Folate-11.8
C1 esterase inhibitor assay: >100 (WNL)

Brief Hospital Course:
Primary Reason for Admisson: Pt is a 54 yo male with a h/o Hep
C, currently on pegasys, telaprevir and ribavirin, HTN (on
Lisinopril) and CKD who went to bed at midnight and woke up two
hours later with tongue swelling.
.
Active Problems:
.
Angioedema: His angioedema primarily affected his tongue.
Potential causes of his angioedema included lisinopril,
Hepatitis C treatment or food ingestion.  Lisinopril is
certainly the most well known cause of angioedema and can occur
even many years after initiation of therapy.  Peggylated
interferon is also a rare cause of angioedema.  No reports of
ribivirin or telepravir causing angioedema, but telepravir is
newly on the market and could be a potential cause.  No unusual
ingestions or new foods. Also on the differential includes
C1-inhibitor deficiency; an assay was sent for this and the
result was normal. Pt was intubated via fiber optic nasal scope
in the ED and upon arrival to the MICU was sedated and
paralyzed. He was started on Propofol/Fentanyl gtt with RASS
goal -5. The pt required high dose Propofol for sedation and
became bradycardic to the 30s, though he was never hypotensive.
His propofol was stopped and he was started on Dexmetetomidine.
Adequate sedation could not be achieved with Dexmetetomidine and
he was transitioned to a Versed gtt. He was given
Methlyprednisolone 80mg IV q8h, Benadryl 50mg IV q8h and
Famotidine 20mg IV q12h. All home medications were held. His
tongue swelling improved and he was extubated [**2156-4-24**] without
incident.  He was transitioned to po prednisone, benadryl and
famotidine on the day of transfer to the medical floor. On the
floor he remained stable, so was discharged with a prednisone
taper and continued on fexofenadine while on the taper. Benadryl
was stopped due to complaints of somnolence.  Outpatient follow
up arranged with allergy department.
.
# Pancytopenia: Present on admission, most likely drug effect,
would favor Telaprevir associated bone marrow suppression. There
are also rare reports of Captopril causing Angioedema and
Pancytopenia; unclear if this happens with Lisinopril.  WBC and
platelets rebounded to normal limits after all medications were
held.  Anemia persisted, unclear etiology, potentially [**3-4**] renal
disease.  Haptoglobin was decreased raising concern for
hemolysis, but coombs test was negative, no schistocytes seen on
smear and t bili was normal. Recommend PCP follow up.
.
# Hyperkalemia:  Pt had intermittent hyperkalemia (potassium
between 5.3 and 5.9).  Renal consulted given hyperkalemia,
metabolic acidosis and hyponatremia intially on admission.
Renal recommended obtaining transtubular potassium gradient.
TTKG returned at 6.27, which was consistent with
mineralocorticoid deficiency. However, for this test to be
valid, UNa should be >25, and his was <10.  As such, the test
characteristics are unclear. However, given the clinical
context, would favor mineralocorticoid deficiency and recommend
formal [**Last Name (un) 104**] stim testing once no longer on steroids (renal did
not recommend starting fludricortisone).  Another potential
etiology of the hyperkalemia was heparin-induced type IV RTA, as
he developed hyperkalemia whenever SQ heaprin was re-started.
Electrolytes were stable and creatinine at baseline at the time
of discharge so he was given script for outpatient CHEM-7 to be
faxed to his PCP for continued outpatient follow up of renal
function.
.
# HTN: Pt has been hypertensive since weaning sedation and
d/c??????ing Lisinopril.  On the day of transfer from the ICU we
started Amlodipine 10mg po qday and labetalol 100 mg tid.  On
the floor pressures were well-controlled on this regimen,
ranging from SBP 130-160s.  Due to concern that prednisone was
contributing to hypertension, anti-hypertensives were not
further uptitrated (as prednisone will be tapered on discharge)
and he will follow up with his PCP regarding further
hypertensive management. Pt instructed not to take ACE-I or ARBs
in the future. If down-titration of anti-hypertensives is
indicated in the future, recommend discontinuing labetalol in
favor of a once daily medication.
.
# NSVT: Had a small run of NSVT on [**2156-4-23**] which was self
limiting in the setting of precedex.  Precedex was therefore
added to his allergy list.
.
Chronic Problems:
.
# CKD: Cr remained at baseline throughout the admission.
Lisinopril was discontinued [**3-4**] angioedema.
.
# Hepatititis C:  Currently being treated with triple therapy.
We held all Hep C meds per liver. He will follow up with Dr.
[**Last Name (STitle) 10924**] in 2 weeks regarding further management of HCV.

Transitional Issues:
- outpatient follow up with Allergy; consider scratch testing
for interferon, ribavirin, or telaprevir
- pt at risk for recurrent episodes of angioedema in the near
future. Will complete prednisone taper as instructed per allergy
and take fexofenadine while on steroids as well.
- Severe reaction thought to be [**3-4**] lisinopril. NO ACE-I or ARBs
in the future
- question of heparin induced hyperkalemia (unsure of this was
incidental)
- follow up BP on new regimen of HCTZ, labetalol, amlodipine
- follow up repeat electrolytes on [**2156-4-29**]
- follow up anemia

Medications on Admission:
HYDROCHLOROTHIAZIDE - 25 mg Tablet - 1 Tablet(s) by mouth once a
day - No Substitution
LISINOPRIL - 30 mg Tablet - 1 Tablet(s) by mouth once a day
Ribavirin 600 mg [**Hospital1 **]
Telaprevir 750 mg tid
Pegasys 180 mcg weekly injections


Discharge Medications:
1. hydrochlorothiazide 12.5 mg Capsule Sig: Two (2) Capsule PO
DAILY (Daily).
2. prednisone 10 mg Tablet Sig: as directed Tablet PO once a day
for 8 days: TAPER instructions:
4 tabs on [**4-27**]; 3 tabs on [**4-28**]; 2 tabs on [**5-7**]; 1 tab on
[**4-14**]; then stop.
Disp:*16 Tablet(s)* Refills:*0*
3. fexofenadine 180 mg Tablet Sig: One (1) Tablet PO once a day
for 8 days: take while on steroids; can stop after steroid taper
is complete.
4. labetalol 100 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day).
Disp:*90 Tablet(s)* Refills:*0*
5. Outpatient Lab Work
CHEM-7

Diagnosis: Type IV RTA

Please fax results to PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 11616**] (fax #[**Telephone/Fax (1) 13238**])
6. amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis:
angioedema

Secondary Diagnoses:
hypertension
hepatitis C cirrhosis


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You came to the hospital because you had swelling of your
tongue. You were admitted to the ICU and intubated to protect
your breathing. An Allergist was consulted and felt this was
likely an allergic reaction to lisinopril, though other causes
could also be possible.  You were given steroids and the
swelling improved so you were extubated. You should never take
lisinopril again, and you should also avoid similar medications,
which includes all drugs called "ACE inhibitors" and
"Angiotension Receptor Blockers."  These are drugs used to treat
hypertension.  While you were in the hospital your kidney
function was found to be abnormal. Due to concerns that your HCV
medications could be related to your kidney dysfunction or to
your tongue swelling, these were stopped.  Your kidney function
improved. Since your lisinopril was stopped, you were started on
two new medications to control your blood pressure in its place.
You should follow up with Dr. [**Last Name (STitle) 10924**] to determine when or if it
is safe to restart the HCV medication.

The following changes were made to your medications:
STOPPED lisinopril
STOPPED peggylated inferferon
STOPPED ribivirin
STOPPED telepravir

STARTED prednisone 10mg tablet - this will be tapered as
directed: take 4 tabs on [**4-27**]; take 3 tabs on [**4-28**]; take 2 tabs
on [**5-7**]; take 1 tab on [**4-14**]; then stop.
STARTED fexofenadine ([**Doctor First Name **]) 180 mg once a day while on
steroids; can stop after steroid taper is complete
STARTED amlodipine 10mg daily for hypertension
STARTED labetalol  100 mg three times a day for hypertension

Followup Instructions:
The following appointments have been made for you:

Department: [**Hospital1 7975**] INTERNAL MEDICINE
When: THURSDAY [**2156-5-6**] at 9:40 AM
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD, MPH [**Telephone/Fax (1) 7976**]
Building: [**Hospital1 7977**] ([**Location (un) 686**], MA) [**Location (un) **]
Campus: OFF CAMPUS     Best Parking: Free Parking on Site
*Please note, your appointment for [**4-27**] has been rescheduled to
the date above.

Department: LIVER CENTER
When: MONDAY [**2156-5-10**] at 10:00 AM
With: [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 30913**], PA [**Telephone/Fax (1) 2422**]
Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) 858**]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage

Department: DIV OF ALLERGY AND INFLAM
When: TUESDAY [**2156-5-11**] at 11:00 AM
With: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 9316**]
Building: One [**Location (un) **] Place ([**Location (un) **], MA) [**Location (un) 895**]
Campus: OFF CAMPUS     Best Parking: Parking on Site
{'Angioneurotic edema, not elsewhere classified,Other drug-induced pancytopenia,Acute respiratory failure,Acidosis,Chronic hepatitis C without mention of hepatic coma,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Hypotension, unspecified,Other specified cardiac dysrhythmias,Antiviral drugs causing adverse effects in therapeutic use,Long-term (current) use of other medications,Other sedatives and hypnotics causing adverse effects in therapeutic use,Other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use,Leukocytopenia, unspecified,Anemia, unspecified,Intravenous anesthetics 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: Tongue Swelling

PRESENT ILLNESS: t is a 54 yo male with a h/o Hep C, currently on pegasys,
telaprevir and ribavirin (started on [**2156-2-3**]), HTN on lisinopril
and CKD who went to bed at midnight and woke up two hours later
with tongue swelling. According to the wife he had an uneventful
day prior to admission and went to bed about midnight. He woke
up around 2:30AM complaining of a funny sensation of his tonigue
and some swelling. He tried to go back to sleep but felt as if
his tongue was continuing to get swollen therefore he decided to
drive to the ED for further evaluation. He has never experienced
anything like this before. He has some pruritis associated with
Hep medications but no overt allergic reactions. The wife denies
any wheezing or difficulty breathing and did not note a rash. He
has previously had a reaction to hair dye where he broke out in
hives and ?pustules. Of note, he has been on lisinopril since at
least [**2152**] and does not appear to have ever had a reaction.
.
In the ED, initial VS were: Pulse: 100, RR: 18, BP: 142/84,
Rhythm: Sinus Tachycardia, O2Sat: 99%, O2Flow: RA, Pain: 4. He
was given epinephrine auto injector, methylprednisolone 125mg,
diphenhydramine 50mg and famotadine 20mg. His tongue swelling
was noted to be getting worse and it was decided to intubate the
patientfor airway protection. He was given midazolam, ketamine
and propofol.
.
On arrival to the MICU, he was sedated and intubated. He was
moving all extremities and appeared agitated therefore his
propofol was increased as was his fentanyl. He was noted to have
a large protruding tongue.

MEDICAL HISTORY: Hep C- currently being treated with telaprevir, peggylated
interferon and ribavirin ([**2156-2-3**])
Hypertension
CKD Stage III

MEDICATION ON ADMISSION: HYDROCHLOROTHIAZIDE - 25 mg Tablet - 1 Tablet(s) by mouth once a
day - No Substitution
LISINOPRIL - 30 mg Tablet - 1 Tablet(s) by mouth once a day
Ribavirin 600 mg [**Hospital1 **]
Telaprevir 750 mg tid
Pegasys 180 mcg weekly injections

ALLERGIES: Ace Inhibitors / [**Last Name (un) **]-Angiotensin Receptor Antagonist / Precedex

PHYSICAL EXAM: Admission Exam:
Vitals: BP: 147/87 P: 79 18 O2: 100
Vent: 500/14/5/100 FiO2
General: intubated and sedated
HEENT: large edematous tongue that was protruding out of his
mouth
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Rhonchi noted bilaterally, no wheezes, good air movement

FAMILY HISTORY: No h/o liver dz or CA.  [**Name (NI) 1094**] Father had an MI at age 62. Mother
and 8 sibs in good health. No history of significant allergic
reactions.

SOCIAL HISTORY: He lives in JP and is married. He worked as a personal care
attendant but is currenlty unemployed.  No ETOH, alcohol or
illicit drug use.  Pt. has 1 child with this partner, 2 others
with other partners. 

### Response:
{'Angioneurotic edema, not elsewhere classified,Other drug-induced pancytopenia,Acute respiratory failure,Acidosis,Chronic hepatitis C without mention of hepatic coma,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Hypotension, unspecified,Other specified cardiac dysrhythmias,Antiviral drugs causing adverse effects in therapeutic use,Long-term (current) use of other medications,Other sedatives and hypnotics causing adverse effects in therapeutic use,Other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use,Leukocytopenia, unspecified,Anemia, unspecified,Intravenous anesthetics causing adverse effects in therapeutic use'}
