CHIEF COMPLAINT: asthma exacerbation

PRESENT ILLNESS: 28 year old male with a hx. of asthma, Hep. C with polysubstance
abuse, antisocial personality disorder as well as malinger for
admissions to avoid incarceration admitted for acute asthma
exacerbation.
  As per patient he presented to his pulmonologist's office c/o
increased dyspnea for the past week.  His peak flow in office
was 275 after 2 clinic albutrol nebulizers (baseline 500-550).
Patient does not relate a clear history leading up to these
events, but as per ED note, he was hospitalized at [**Hospital1 2025**] last week
for a few days, seen at [**Hospital1 2177**] yesterday and started on prednisone.
He presented to [**Hospital1 **] from his PCPs office today for continued SOB
with no relief from home neb treatments. Peak flow at best 500,
currently 200.
  Has hx of frequent hospitalizations for asthma and has been
intubated in the past. He has had 2 hospitalizations in the last
month and multiple po courses of prednisone; recent IV steroids
[**Date range (1) **].  Vital signs: BP 118/87, hr 83, O2 98% wt 224 ht 69.

MEDICAL HISTORY: 1) Asthma; has history of 4 prior intubations
2) Bipolar disorder
3) Seizure disorder, thought to be related to drug withdrawal
4) Depression/PTSD
5) Polysubstance abuse, has history of heroin abuse/dependence,
cocaine, and other substances
6) Hep C diagnosed in [**2118-1-31**]
7) antisocial personality disorder
8) History of malingering with multiple admissions determined to
be faking symptoms to avoid incarceration

MEDICATION ON ADMISSION: 1. Albuterol Inhaler 2 PUFF IH Q6H
2. Quetiapine Fumarate 200 mg PO HS
3. Gabapentin 800 mg PO QID
4. Clonazepam 0.5 mg PO TID
5. BuPROPion 200 mg PO BID
6. CloniDINE 0.1 mg PO BID
7. PredniSONE Dose is Unknown  PO Frequency is Unknown

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Asthma, unspecified type, with (acute) exacerbation,Bipolar I disorder, most recent episode (or current) depressed, unspecified,Undiagnosed cardiac murmurs,Cocaine dependence, unspecified,Anxiety state, unspecified,Posttraumatic stress disorder,Lumbago,Unspecified viral hepatitis C without hepatic coma,Antisocial personality disorder,Person feigning illness
Asthma NOS w (ac) exac,Bipol I cur depres NOS,Cardiac murmurs NEC,Cocaine depend-unspec,Anxiety state NOS,Posttraumatic stress dis,Lumbago,Hpt C w/o hepat coma NOS,Antisocial personality,Person feigning illness
Admission Date:  [**2120-7-26**]              Discharge Date:   [**2120-7-27**]

Date of Birth:  [**2092-1-9**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 3565**]
Chief Complaint:
asthma exacerbation

Major Surgical or Invasive Procedure:
none

History of Present Illness:
28 year old male with a hx. of asthma, Hep. C with polysubstance
abuse, antisocial personality disorder as well as malinger for
admissions to avoid incarceration admitted for acute asthma
exacerbation.
  As per patient he presented to his pulmonologist's office c/o
increased dyspnea for the past week.  His peak flow in office
was 275 after 2 clinic albutrol nebulizers (baseline 500-550).
Patient does not relate a clear history leading up to these
events, but as per ED note, he was hospitalized at [**Hospital1 2025**] last week
for a few days, seen at [**Hospital1 2177**] yesterday and started on prednisone.
He presented to [**Hospital1 **] from his PCPs office today for continued SOB
with no relief from home neb treatments. Peak flow at best 500,
currently 200.
  Has hx of frequent hospitalizations for asthma and has been
intubated in the past. He has had 2 hospitalizations in the last
month and multiple po courses of prednisone; recent IV steroids
[**Date range (1) **].  Vital signs: BP 118/87, hr 83, O2 98% wt 224 ht 69.

  In the ED, initial VS were:  97.5  76   126/80  16  100% RA
He apparently became somnelent and dyspneic with 02 sats -->low
90s, and his peak expiratory flow rate was 200 (baseline 500).
He received solumedrol 125 mg, 3 stacked nebs then continuous
nebs, Mg, azithromycin x1, as well as 1mg IV ativan.

ABG showed: 7.45 37 197

On arrival to the MICU, patient was in some respiratory distress
with waxing and [**Doctor Last Name 688**] mental status (somnolence) and variable
compliance with interview and exam. VS with sinus tachycardia
(109) BPs 122/62, O2 96% on continuous nebs.


Past Medical History:
1) Asthma; has history of 4 prior intubations
2) Bipolar disorder
3) Seizure disorder, thought to be related to drug withdrawal
4) Depression/PTSD
5) Polysubstance abuse, has history of heroin abuse/dependence,
cocaine, and other substances
6) Hep C diagnosed in [**2118-1-31**]
7) antisocial personality disorder
8) History of malingering with multiple admissions determined to
be faking symptoms to avoid incarceration

Pertinent Results:
[**2120-7-26**] 01:00PM BLOOD WBC-8.0 RBC-5.05 Hgb-15.1 Hct-45.0 MCV-89
MCH-30.0 MCHC-33.7 RDW-13.8 Plt Ct-275
[**2120-7-27**] 05:38AM BLOOD Glucose-214* UreaN-11 Creat-0.8 Na-137
K-4.4 Cl-105 HCO3-22 AnGap-14
[**2120-7-27**] 05:38AM BLOOD Calcium-9.1 Phos-3.3 Mg-1.9
[**2120-7-26**] 02:12PM BLOOD Type-ART pO2-197* pCO2-37 pH-7.45
calTCO2-27 Base XS-2
[**2120-7-26**] 06:44PM BLOOD Type-ART pO2-99 pCO2-34* pH-7.37
calTCO2-20* Base XS--4

Brief Hospital Course:
#Asthma Exacerbation: There was no clear precipitant, although
thinking was likely [**1-4**] erratic inhaler usage adn allergen
exposure. Patient had several exacerbations and admissions
including multiple intubations in the past. CXR was performed
which did not reveal an acute process. He was improved on
nebulizers adn solumedrol. Given severity of disease, patient
was advised to stay and be transferred to floor. However,
patient refused to stay despite our stating the risks of
premature discharge from hospital. He ripped out IV and left
AMA.

# Murmur: Given his history of polysubstance abuse concern does
exist for endocarditis. However, patient was afebrile and has a
previously documented murmur. Blood cultures were drawn, which
were negative as of [**2120-7-28**] but still pending. The day after
admission, murmur was no longer apparent on auscultation,
suggesting high flow state was likely driver.

#Polysubstance abuse: Reported last drug usage 3 days ago,
though the substance was unkown. Somnolent on exam during
arrival to ICU.  Held sedating medications and CIWA protocol was
started. Patient left AMA.

#Antisocial personality disorder: Sedating medications were held
in context of respiratory distress. Patient left AMA.

Medications on Admission:
1. Albuterol Inhaler 2 PUFF IH Q6H
2. Quetiapine Fumarate 200 mg PO HS
3. Gabapentin 800 mg PO QID
4. Clonazepam 0.5 mg PO TID
5. BuPROPion 200 mg PO BID
6. CloniDINE 0.1 mg PO BID
7. PredniSONE Dose is Unknown  PO Frequency is Unknown


Discharge Medications:
1. Albuterol Inhaler 2 PUFF IH Q6H
2. Quetiapine Fumarate 200 mg PO HS
3. Gabapentin 800 mg PO QID
4. Clonazepam 0.5 mg PO TID
5. BuPROPion 200 mg PO BID
6. CloniDINE 0.1 mg PO BID
7. PredniSONE Dose is Unknown  PO Frequency is Unknown


Discharge Disposition:
Home

Discharge Diagnosis:
Asthma exacerbation

Discharge Condition:
Patient left AMA

Discharge Instructions:
Patient left AMA

Followup Instructions:
Patient left AMA


Completed by:[**2120-7-28**]
{'Asthma, unspecified type, with (acute) exacerbation,Bipolar I disorder, most recent episode (or current) depressed, unspecified,Undiagnosed cardiac murmurs,Cocaine dependence, unspecified,Anxiety state, unspecified,Posttraumatic stress disorder,Lumbago,Unspecified viral hepatitis C without hepatic coma,Antisocial personality disorder,Person feigning illness'}


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: asthma exacerbation

PRESENT ILLNESS: 28 year old male with a hx. of asthma, Hep. C with polysubstance
abuse, antisocial personality disorder as well as malinger for
admissions to avoid incarceration admitted for acute asthma
exacerbation.
  As per patient he presented to his pulmonologist's office c/o
increased dyspnea for the past week.  His peak flow in office
was 275 after 2 clinic albutrol nebulizers (baseline 500-550).
Patient does not relate a clear history leading up to these
events, but as per ED note, he was hospitalized at [**Hospital1 2025**] last week
for a few days, seen at [**Hospital1 2177**] yesterday and started on prednisone.
He presented to [**Hospital1 **] from his PCPs office today for continued SOB
with no relief from home neb treatments. Peak flow at best 500,
currently 200.
  Has hx of frequent hospitalizations for asthma and has been
intubated in the past. He has had 2 hospitalizations in the last
month and multiple po courses of prednisone; recent IV steroids
[**Date range (1) **].  Vital signs: BP 118/87, hr 83, O2 98% wt 224 ht 69.

MEDICAL HISTORY: 1) Asthma; has history of 4 prior intubations
2) Bipolar disorder
3) Seizure disorder, thought to be related to drug withdrawal
4) Depression/PTSD
5) Polysubstance abuse, has history of heroin abuse/dependence,
cocaine, and other substances
6) Hep C diagnosed in [**2118-1-31**]
7) antisocial personality disorder
8) History of malingering with multiple admissions determined to
be faking symptoms to avoid incarceration

MEDICATION ON ADMISSION: 1. Albuterol Inhaler 2 PUFF IH Q6H
2. Quetiapine Fumarate 200 mg PO HS
3. Gabapentin 800 mg PO QID
4. Clonazepam 0.5 mg PO TID
5. BuPROPion 200 mg PO BID
6. CloniDINE 0.1 mg PO BID
7. PredniSONE Dose is Unknown  PO Frequency is Unknown

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Asthma, unspecified type, with (acute) exacerbation,Bipolar I disorder, most recent episode (or current) depressed, unspecified,Undiagnosed cardiac murmurs,Cocaine dependence, unspecified,Anxiety state, unspecified,Posttraumatic stress disorder,Lumbago,Unspecified viral hepatitis C without hepatic coma,Antisocial personality disorder,Person feigning illness'}
