CHIEF COMPLAINT: Confusion

PRESENT ILLNESS: Briefly, this is a 53 year old male with AIDS (last CD4 91, VL
15,500 on [**10-18**]) and HCV cirrhosis, recently discharged from
[**Hospital1 18**] on [**12-2**] after admission for hematemesis and melena with
non-bleeding stage 1 esophageal varices and portal hypertensive
gastropathy on EGD, presenting now with a complaint of dizziness
while standing up, noted to be confused.  He had one episode of
1 teaspoon of hematemesis yesterday that followed epistaxis.  He
denies any fevers, chills, CP, SOB.  He denies abdominal pain,
nausea, or vomiting.  He says his appetite is chronically poor.
Denies any neck stiffness, headache, photophobia.  Says he has
been taking his medications, and has not used any illicit drugs
recently.

MEDICAL HISTORY: 1) HIV - Diagnosed 10 years ago.  Recent CD4 and VL as above.
Pt. has had kaposi's sarcoma 10 years ago, but no other known
OIs.  CD4 nadir was 30 in [**2159**] with Kaposi's sarcoma.

MEDICATION ON ADMISSION: Bactrim 160/800 [**Hospital1 **]
Dranabinol 5 mg [**Hospital1 **]
spironolactone 100 qday
lasix 20 qday
abacavir 300 qday
lamivudine 150 [**Hospital1 **]
Saquinavir 600 TID
Diflucan 150 qday
Protonix 40 qday

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS:  97.7, 113/66, 88, 18, 99% RA  Weight 66 kg
Gen:  Slim, discheveled, severely cachectic caucasian male,
curled up in bed, appearing comfortable.
HEENT:  PEARL, tongue beefy red, dried blood around mouth.
Severe temporal wasting with prominence of zygomatic arch.
Aniceteric sclerae.  Dry mucous membranes.
Neck: No LAD, supple, non-tender, no JVD.
CVS: RR, normal rate, no m/r/g.
Lungs: CTA b/l, no w/r/r.
Abd:  Large midline hernia, reduces on its own.  NABS.  Mild
guarding in RUQ.  Non-tender.  + distention.  + shifting
dullness.  No fluid wave appreciated.
Rectal: Guaiac positive, per ED.
Neuro: Alert and oriented to person and place, not time (says
it's [**2161**]).  Spells WORLD forwards but not backwards.
Perseverates:  When asked to perform subtraction, begins
spelling world again.  Easily distractible.  Answers questions
appropriately.  4/5 strength upper and lower extremities.

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Works as a ticket salesperson for the Red Sox; not married -
lives with his partner. [**Name (NI) **] pets. Does not smoke and has not had
ETOH for several years, although used to be a heavy alcohol
abuser. No IDU recently, but used to abuse IVD and intranasal
cocaine.
Human immunodeficiency virus [HIV] disease,Grand mal status,Alcoholic cirrhosis of liver,Chronic hepatitis C with hepatic coma,Acquired coagulation factor deficiency,Iron deficiency anemia secondary to blood loss (chronic),Hemorrhage of gastrointestinal tract, unspecified,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Paralytic ileus,Hyperosmolality and/or hypernatremia,Other and unspecified alcohol dependence, in remission,Portal hypertension,Esophageal varices in diseases classified elsewhere, without mention of bleeding
Human immuno virus dis,Grand mal status,Alcohol cirrhosis liver,Chrnc hpt C w hepat Coma,Acq coagul factor defic,Chr blood loss anemia,Gastrointest hemorr NOS,Acute respiratry failure,Food/vomit pneumonitis,Paralytic ileus,Hyperosmolality,Alcoh dep NEC/NOS-remiss,Portal hypertension,Esoph varice oth dis NOS
Admission Date:  [**2168-12-5**]              Discharge Date:   [**2168-12-11**]

Date of Birth:  [**2115-11-14**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 562**]
Chief Complaint:
Confusion

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Briefly, this is a 53 year old male with AIDS (last CD4 91, VL
15,500 on [**10-18**]) and HCV cirrhosis, recently discharged from
[**Hospital1 18**] on [**12-2**] after admission for hematemesis and melena with
non-bleeding stage 1 esophageal varices and portal hypertensive
gastropathy on EGD, presenting now with a complaint of dizziness
while standing up, noted to be confused.  He had one episode of
1 teaspoon of hematemesis yesterday that followed epistaxis.  He
denies any fevers, chills, CP, SOB.  He denies abdominal pain,
nausea, or vomiting.  He says his appetite is chronically poor.
Denies any neck stiffness, headache, photophobia.  Says he has
been taking his medications, and has not used any illicit drugs
recently.

Past Medical History:
1) HIV - Diagnosed 10 years ago.  Recent CD4 and VL as above.
Pt. has had kaposi's sarcoma 10 years ago, but no other known
OIs.  CD4 nadir was 30 in [**2159**] with Kaposi's sarcoma.

2) HCV, cirrhosis - Diagnosed in [**2164**].  Has had freqent episodes
of ascites requiring paracentesis.  Grade 1 varices by EGD on
recent admission for hematemesis, melena, as above.

3) Esophageal varices - Grade 1.

Social History:
Works as a ticket salesperson for the Red Sox; not married -
lives with his partner. [**Name (NI) **] pets. Does not smoke and has not had
ETOH for several years, although used to be a heavy alcohol
abuser. No IDU recently, but used to abuse IVD and intranasal
cocaine.

Family History:
noncontributory

Physical Exam:
VS:  97.7, 113/66, 88, 18, 99% RA  Weight 66 kg
Gen:  Slim, discheveled, severely cachectic caucasian male,
curled up in bed, appearing comfortable.
HEENT:  PEARL, tongue beefy red, dried blood around mouth.
Severe temporal wasting with prominence of zygomatic arch.
Aniceteric sclerae.  Dry mucous membranes.
Neck: No LAD, supple, non-tender, no JVD.
CVS: RR, normal rate, no m/r/g.
Lungs: CTA b/l, no w/r/r.
Abd:  Large midline hernia, reduces on its own.  NABS.  Mild
guarding in RUQ.  Non-tender.  + distention.  + shifting
dullness.  No fluid wave appreciated.
Rectal: Guaiac positive, per ED.
Neuro: Alert and oriented to person and place, not time (says
it's [**2161**]).  Spells WORLD forwards but not backwards.
Perseverates:  When asked to perform subtraction, begins
spelling world again.  Easily distractible.  Answers questions
appropriately.  4/5 strength upper and lower extremities.

Pertinent Results:
CT head [**12-4**]:  There is no acute hemorrhage, mass effect, or
shift of normally midline structures. The ventricles and basal
cisterns are patent and symmetric. There is no CT evidence of an
acute major territorial infarct. The visualized osseous
structures appear unremarkable. The visualized paranasal sinuses
and mastoid air cells are normally aerated.  IMPRESSION: No
acute hemorrhage, mass effect, or hydrocephalus.

CXR [**12-4**]:  The heart size and pulmonary vascularity are within
normal limits. Right lower lobe atelectasis remains similar in
appearance. There is no evidence of pneumonia or failure. There
is no pleural effusion or pneumothorax. The visualized osseous
structures are unremarkable. IMPRESSION: Minimal right basilar
atelectasis. No significant change since [**2168-11-28**].

[**2168-12-5**] 05:00PM ASCITES  WBC-70* RBC-1390* POLYS-2* LYMPHS-31*
MONOS-40* MESOTHELI-2* MACROPHAG-25*
[**2168-12-5**] 12:35PM   HCT-35.0*
[**2168-12-5**] 06:30AM   GLUCOSE-76 UREA N-34* CREAT-2.0* SODIUM-138
POTASSIUM-4.7 CHLORIDE-109* TOTAL CO2-19* ANION GAP-15
[**2168-12-5**] 06:30AM   ALT(SGPT)-46* AST(SGOT)-91* LD(LDH)-223
CK(CPK)-70 ALK PHOS-82 TOT BILI-3.9*
[**2168-12-5**] 06:30AM   CALCIUM-8.4 PHOSPHATE-3.0 MAGNESIUM-1.6
[**2168-12-5**] 06:30AM   WBC-2.7* RBC-3.25* HGB-11.0* HCT-31.3* MCV-96
MCH-33.7* MCHC-35.0 RDW-19.4*
[**2168-12-5**] 06:30AM   PLT COUNT-43*
[**2168-12-5**] 06:30AM   PT-17.6* PTT-48.0* INR(PT)-2.0
[**2168-12-4**] 09:30PM URINE  HOURS-RANDOM
[**2168-12-4**] 09:30PM URINE  bnzodzpn-NEG barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2168-12-4**] 09:30PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.010
[**2168-12-4**] 09:30PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-SM UROBILNGN-1 PH-6.5 LEUK-NEG
[**2168-12-4**] 09:12PM   AMMONIA-158*
[**2168-12-4**] 06:25PM   GLUCOSE-100 UREA N-32* CREAT-2.0* SODIUM-136
POTASSIUM-4.6 CHLORIDE-107 TOTAL CO2-19* ANION GAP-15
[**2168-12-4**] 06:25PM   ALT(SGPT)-53* AST(SGOT)-105* CK(CPK)-75 ALK
PHOS-99 AMYLASE-89 TOT BILI-3.8* DIR BILI-1.5* INDIR BIL-2.3
[**2168-12-4**] 06:25PM   ALBUMIN-2.9*
[**2168-12-4**] 06:25PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2168-12-4**] 06:25PM   WBC-3.1* RBC-3.61* HGB-12.4* HCT-34.8* MCV-96
MCH-34.3* MCHC-35.6* RDW-19.5*
[**2168-12-4**] 06:25PM   NEUTS-63.7 LYMPHS-24.5 MONOS-9.2 EOS-2.5
BASOS-0.1
[**2168-12-4**] 06:25PM   ANISOCYT-2+ MACROCYT-2+
[**2168-12-4**] 06:25PM   PLT COUNT-45*
[**2168-12-4**] 06:25PM   PT-17.0* PTT-43.8* INR(PT)-1.8

Brief Hospital Course:
Mr. [**Known lastname 730**] is a 53 year old male with AIDS, HCV cirrhosis, with
recent admission for hematemesis last week with finding of grade
1, non-bleeding esophagel varices on EGD, discharged 2 days ago,
presenting now with confusion and dizziness.

1) Confusion:  The differential in this patient includes hepatic
encephalopathy, meningitis, and infection of any sort - possibly
spontaneous bacterial peritonitis.  He is afebrile, though his
chronic disease may impair an immune response.  He lacks
meningeal signs, however, and this, combined with being
afebrile, without a high white count, makes bacterial meningitis
less likely, though it should be kept in mind should the patient
deteriorate.  An LP was not done last night due to low concern
and the feeling that this is hepatic encephalopathy.  It is
unclear what could have caused an exacerbation of his
encephalopathy, and ammonia levels do not correlate well with
degree of encephalopathy, though his ammonia level is high.  He
denies any benzodiazepine use, and serum tox was negative.  As
mentioned above, could have sbp.  Additionally, patient appears
dry on exam, with decreased PO intake.  Could be dehydrated.
--cover empirically for SBP with levaquin 250 mg PO daily
--monitor wbc count, temperature
--hold diuretics for now
--lactulose titrated to frequent BMs
--paracentesis today
--albumin 1.5g/kg (50g now, then 25 later with procedure)

2) AIDS:  Continue [**Last Name (LF) 2775**], [**First Name3 (LF) **] pharmacy doses.  Greatly
appreciate pharmacy input.

3) Cirrhosis/varices/hemoptysis:  Patient's INR chronically
elevated, currently at baseline.  T-bili actually down from last
admission.  Transaminases stable, though transaminases not a
good marker for HCV activity.  Don't think pt's small episode of
hematemesis warrants another EGD, as just had one last week,
showed grade 1 esophageal varices.  Sounds like hematemesis was
post-epistaxis, wich was likely from his coagulopathy (elevated
INR plus low platelets from liver dysfunction).
--hold diuretics for now given dry state on exam
--monitor for further hemoptysis

4) Anemia:  Pt's baseline is mid-30s.  Currently at baseline.
Was elevated on last admission because he received a blood
transfusion.  He is guaiac positive, however, and likely has
some chronic GI blood loss (varices, portal hypertensive
gastropathy?).
--follow GI recs.

5) CRI:  Etiology?  Could be secondary to AIDS.  Not likely
hepatorenal given chronicity.  Patient at baseline creatinine
currently.  Will monitor.

6)  FEN:  NPO for now.

7) PPx:  PPI, pneumoboots (no heparin).

8) Code: Full

On [**12-9**] patient's family and medical team met. It was decided
to change of goals of care to comfort. The patient was made CMO.
He was placed on Ativan and Dilaudid drips. He did not have any
further seizure activity. He passed on [**12-11**] 5:31 am. Patient's
family was notified.

Medications on Admission:
Bactrim 160/800 [**Hospital1 **]
Dranabinol 5 mg [**Hospital1 **]
spironolactone 100 qday
lasix 20 qday
abacavir 300 qday
lamivudine 150 [**Hospital1 **]
Saquinavir 600 TID
Diflucan 150 qday
Protonix 40 qday

Discharge Medications:
n/a

Discharge Disposition:
Expired

Discharge Diagnosis:
1) HIV - Diagnosed 10 years ago.  Recent CD4 and VL as above.
Pt. has had kaposi's sarcoma 10 years ago, but no other known
OIs.  CD4 nadir was 30 in [**2159**] with Kaposi's sarcoma.

2) HCV, cirrhosis - Diagnosed in [**2164**].  Has had freqent episodes
of ascites requiring paracentesis.  Grade 1 varices by EGD on
recent admission for hematemesis, melena, as above.

3) Esophageal varices - Grade 1.

Discharge Condition:
deceased

Discharge Instructions:
none

Followup Instructions:
none
{'Human immunodeficiency virus [HIV] disease,Grand mal status,Alcoholic cirrhosis of liver,Chronic hepatitis C with hepatic coma,Acquired coagulation factor deficiency,Iron deficiency anemia secondary to blood loss (chronic),Hemorrhage of gastrointestinal tract, unspecified,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Paralytic ileus,Hyperosmolality and/or hypernatremia,Other and unspecified alcohol dependence, in remission,Portal hypertension,Esophageal varices in diseases classified elsewhere, without mention of bleeding'}


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: Confusion

PRESENT ILLNESS: Briefly, this is a 53 year old male with AIDS (last CD4 91, VL
15,500 on [**10-18**]) and HCV cirrhosis, recently discharged from
[**Hospital1 18**] on [**12-2**] after admission for hematemesis and melena with
non-bleeding stage 1 esophageal varices and portal hypertensive
gastropathy on EGD, presenting now with a complaint of dizziness
while standing up, noted to be confused.  He had one episode of
1 teaspoon of hematemesis yesterday that followed epistaxis.  He
denies any fevers, chills, CP, SOB.  He denies abdominal pain,
nausea, or vomiting.  He says his appetite is chronically poor.
Denies any neck stiffness, headache, photophobia.  Says he has
been taking his medications, and has not used any illicit drugs
recently.

MEDICAL HISTORY: 1) HIV - Diagnosed 10 years ago.  Recent CD4 and VL as above.
Pt. has had kaposi's sarcoma 10 years ago, but no other known
OIs.  CD4 nadir was 30 in [**2159**] with Kaposi's sarcoma.

MEDICATION ON ADMISSION: Bactrim 160/800 [**Hospital1 **]
Dranabinol 5 mg [**Hospital1 **]
spironolactone 100 qday
lasix 20 qday
abacavir 300 qday
lamivudine 150 [**Hospital1 **]
Saquinavir 600 TID
Diflucan 150 qday
Protonix 40 qday

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS:  97.7, 113/66, 88, 18, 99% RA  Weight 66 kg
Gen:  Slim, discheveled, severely cachectic caucasian male,
curled up in bed, appearing comfortable.
HEENT:  PEARL, tongue beefy red, dried blood around mouth.
Severe temporal wasting with prominence of zygomatic arch.
Aniceteric sclerae.  Dry mucous membranes.
Neck: No LAD, supple, non-tender, no JVD.
CVS: RR, normal rate, no m/r/g.
Lungs: CTA b/l, no w/r/r.
Abd:  Large midline hernia, reduces on its own.  NABS.  Mild
guarding in RUQ.  Non-tender.  + distention.  + shifting
dullness.  No fluid wave appreciated.
Rectal: Guaiac positive, per ED.
Neuro: Alert and oriented to person and place, not time (says
it's [**2161**]).  Spells WORLD forwards but not backwards.
Perseverates:  When asked to perform subtraction, begins
spelling world again.  Easily distractible.  Answers questions
appropriately.  4/5 strength upper and lower extremities.

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Works as a ticket salesperson for the Red Sox; not married -
lives with his partner. [**Name (NI) **] pets. Does not smoke and has not had
ETOH for several years, although used to be a heavy alcohol
abuser. No IDU recently, but used to abuse IVD and intranasal
cocaine. 

### Response:
{'Human immunodeficiency virus [HIV] disease,Grand mal status,Alcoholic cirrhosis of liver,Chronic hepatitis C with hepatic coma,Acquired coagulation factor deficiency,Iron deficiency anemia secondary to blood loss (chronic),Hemorrhage of gastrointestinal tract, unspecified,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Paralytic ileus,Hyperosmolality and/or hypernatremia,Other and unspecified alcohol dependence, in remission,Portal hypertension,Esophageal varices in diseases classified elsewhere, without mention of bleeding'}
