CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 60-year-old
gentleman well known to the Neurosurgery Service.  In [**2122**] he
had a T10 fracture and has been paraplegic since.  The
patient had been using an intrathecal pump for many years
with Dilaudid for back pain.  The pump was refilled on [**2133-4-9**].  The patient did well until [**2133-4-14**], when the
patient was noted to be confused and somnolent.  He was taken
to the [**Hospital **] Hospital and then transferred to the [**Hospital6 37588**].  He was given Narcan, and his mental status
improve.  He was transferred back to the VA on [**4-15**].  CT
scan done at the [**Hospital6 1597**] was reportedly normal.

MEDICAL HISTORY: The patient has been paraplegic since
[**2122**].  He is status post laminectomy in [**2122**].  He has had
bilateral carpal tunnel release in [**2128**].  He has had a DVT
and is on Coumadin.  He is status post colostomy.  He is
status post urostomy.  He is status post carcinoma of the
prostate.  He is status post transurethral resection of
prostate.  He has a history of recurrent urinary tract
infections.

MEDICATION ON ADMISSION: 

ALLERGIES: INTRAVENOUS PYELOGRAM DYE, POVIDONE IODINE.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Unspecified septicemia,Fitting and adjustment of other devices related to nervous system and special senses,Colostomy status,Other artificial opening of urinary tract status,Long-term (current) use of anticoagulants,Paraplegia
Septicemia NOS,Adj nerv syst device NEC,Colostomy status,Urinostomy status NEC,Long-term use anticoagul,Paraplegia NOS
Admission Date:  [**2133-4-19**]       Discharge Date:  [**2133-4-21**]

Date of Birth:   [**2073-9-15**]       Sex:  M

Service:  NEUROSURGERY

HISTORY OF PRESENT ILLNESS:  The patient is a 60-year-old
gentleman well known to the Neurosurgery Service.  In [**2122**] he
had a T10 fracture and has been paraplegic since.  The
patient had been using an intrathecal pump for many years
with Dilaudid for back pain.  The pump was refilled on [**2133-4-9**].  The patient did well until [**2133-4-14**], when the
patient was noted to be confused and somnolent.  He was taken
to the [**Hospital **] Hospital and then transferred to the [**Hospital6 37588**].  He was given Narcan, and his mental status
improve.  He was transferred back to the VA on [**4-15**].  CT
scan done at the [**Hospital6 1597**] was reportedly normal.

On the morning of [**2133-4-19**], the patient was found very
somnolent and difficult to arouse.  He was given Narcan
intermittently when he became more awake but also more
agitated.  The patient was also being treated for urinary
tract infection with Gatifloxacin.  He also had a sacral
decubitus.

The patient was transferred to the [**Hospital6 649**] with the diagnosis of narcotic intoxication
and for pump recalibration.

PAST MEDICAL HISTORY:  The patient has been paraplegic since
[**2122**].  He is status post laminectomy in [**2122**].  He has had
bilateral carpal tunnel release in [**2128**].  He has had a DVT
and is on Coumadin.  He is status post colostomy.  He is
status post urostomy.  He is status post carcinoma of the
prostate.  He is status post transurethral resection of
prostate.  He has a history of recurrent urinary tract
infections.

MEDICATIONS:  Baclofen, Carbamazepine, Docusate, Furosemide,
Gabapentin, Lisinopril, Lovastatin, Metformin, Nystatin,
...................., and ....................

ALLERGIES:  INTRAVENOUS PYELOGRAM DYE, POVIDONE IODINE.

HOSPITAL COURSE:  When the patient arrived at the [**Hospital6 1760**] he was arousable.  At times
he was agitated.  He was oriented only to person but not to
place.  Pupils were equal, 2-3 mm.  He was moving his upper
limbs freely.  He is paraplegic in his lower limbs.  He had a
small decubitus ulcer in the sacral region.  He was afebrile.
Vitals signs were otherwise stable.

The Pain Service was called to recalibrate the pump to make
sure that his mental status changes were not due to the
narcotic.  The pump was recalibrated, and he was reduced to
Dilaudid 0.75 mg/hr intrathecally from 1 mg/hr intrathecally.
The patient was also pancultured to rule out etiology for
sepsis.  All cultures have been negative so far.  The gram
stain from the swab of his decubitus was gram negative
bacilli and gram positive cocci on the gram stain smear.  The
patient was also started on Ciprofloxacin for his urinary
tract infection.

The patient's neurological status improved until he reached
his baseline neurological status.  He continued to have back
pain and was supplemented with intravenous Dilaudid.

On the morning of [**4-21**], the rate of the intrathecal pump
was raised again to 1 mg/hr, and as the patient had
stabilized neurologically, it was decided that he would be
transferred back to the VA for further treatment of his
decubitus ulcer and other issues.  At the time of transfer,
this patient was in a stable condition, and he was
transferred back to the [**Hospital **] Hospital.

DISCHARGE DIAGNOSIS:  Mental status changes, probably due to
sepsis.






                            [**Name6 (MD) 6911**] [**Name8 (MD) **], MD  [**MD Number(1) 6913**]

Dictated By:[**Doctor Last Name 103264**]
MEDQUIST36

D:  [**2133-4-21**]  12:37
T:  [**2133-4-21**]  12:42
JOB#:  [**Job Number **]
{'Unspecified septicemia,Fitting and adjustment of other devices related to nervous system and special senses,Colostomy status,Other artificial opening of urinary tract status,Long-term (current) use of anticoagulants,Paraplegia'}


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: 

PRESENT ILLNESS: The patient is a 60-year-old
gentleman well known to the Neurosurgery Service.  In [**2122**] he
had a T10 fracture and has been paraplegic since.  The
patient had been using an intrathecal pump for many years
with Dilaudid for back pain.  The pump was refilled on [**2133-4-9**].  The patient did well until [**2133-4-14**], when the
patient was noted to be confused and somnolent.  He was taken
to the [**Hospital **] Hospital and then transferred to the [**Hospital6 37588**].  He was given Narcan, and his mental status
improve.  He was transferred back to the VA on [**4-15**].  CT
scan done at the [**Hospital6 1597**] was reportedly normal.

MEDICAL HISTORY: The patient has been paraplegic since
[**2122**].  He is status post laminectomy in [**2122**].  He has had
bilateral carpal tunnel release in [**2128**].  He has had a DVT
and is on Coumadin.  He is status post colostomy.  He is
status post urostomy.  He is status post carcinoma of the
prostate.  He is status post transurethral resection of
prostate.  He has a history of recurrent urinary tract
infections.

MEDICATION ON ADMISSION: 

ALLERGIES: INTRAVENOUS PYELOGRAM DYE, POVIDONE IODINE.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Unspecified septicemia,Fitting and adjustment of other devices related to nervous system and special senses,Colostomy status,Other artificial opening of urinary tract status,Long-term (current) use of anticoagulants,Paraplegia'}
