CHIEF COMPLAINT: Respiratory failure

PRESENT ILLNESS: This is a 42 year old with a PMH significant for HIV diagnosed
in [**2164**] with last CD4 count of 312 and VL of 88,000 on [**2170-9-11**],
asthma, who presents with shortness of breath, non-productive
cough for the last 4 days.  History is limited as patient is
intubated upon arriving to the MICU.  Per history obtained by ED
physicians, patient has had dyspnea for the last 4 days.  Has
complained of intermittent fevers and chills.  Was evaluated by
Dr. [**Last Name (STitle) **] at [**Hospital1 778**] today and referred to ED due to RR 28 and
pO2 of 88%.  He was seen in the ED 3 days prior for similar
symptoms and discharged home due to clear chest radiograph;
symptoms have worsened since that time.  Patient was started on
advair one month prior and has been recently initiated on
atripla antiretroviral therapy.

MEDICAL HISTORY: 1. HIV, patient unsure of current CD4 count. Per OMR, last CD4
count was 511 on [**2166-4-2**]
2. Asthma
3. GERD

MEDICATION ON ADMISSION: (per [**Hospital1 778**] records)
- albuerol 2 puffs PO QID PRN
- verapamil CR 240mg PO daily
- claritin 10mg PO daily
- klonapin 1mg PO 5 times per day
- seroquel 100mg PO QID; 400mg PO qhs
- sertraline 200mg PO qhs
- benadryl 25mg qam and 75mg qhs
- advair diskus take 1 puff [**Hospital1 **]
- omeprazole 40mg PO daily
- flonase
- bentropine 0.5mg PO daily
- atripla [**Telephone/Fax (3) 567**] (efavirenz/emtricitab/tenofovir) 1 tab PO
daily
- zofran 8mg PO q8h PRN
- ibuprofen 800mg PO QID

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: Temp: 101.1, BP: 156/88 HR: 118 -> 72 RR: 30 O2sat: 93% on
AC
GEN: intubated
HEENT: PERRL, EOMI, anicteric
RESP: rales from the right lateral chest (auscultated from
anterior chest)
CV: RR, S1 and S2 wnl, no m/r/g
ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly
EXT: no c/c/e
SKIN: scratch marks located on left arm.
NEURO: PERRL, EOMI.

FAMILY HISTORY: Unknown, as patient is adopted.

SOCIAL HISTORY: SUBSTANCE ABUSE HISTORY: (As per prior OMR note).
* Discharged from prison one month prior (?cocaine possession)
* Smokes 1.5 PPD of cigarettes
* Cocaine: Used $100 worth in the past, was previously sober for
8 months. First use when teen.
* ETOH: Drank 6 beers, was previously sober for 8 months. Denies
history of Alcohol withdrawal sz, DT's.
* denies past or current use of any other illicit substance.
Denies history of IVDU.
Acute respiratory failure,Influenza with pneumonia,Major depressive affective disorder, recurrent episode, severe, without mention of psychotic behavior,Hyperpotassemia,Human immunodeficiency virus [HIV] disease,Asthma, unspecified type, unspecified,Esophageal reflux,Agoraphobia with panic disorder,Tobacco use disorder,Other alteration of consciousness
Acute respiratry failure,Influenza with pneumonia,Recur depr psych-severe,Hyperpotassemia,Human immuno virus dis,Asthma NOS,Esophageal reflux,Agoraphobia w panic dis,Tobacco use disorder,Other alter consciousnes
Admission Date:  [**2170-12-18**]              Discharge Date:   [**2170-12-25**]

Date of Birth:  [**2128-10-5**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 11892**]
Chief Complaint:
Respiratory failure

Major Surgical or Invasive Procedure:
Intubation
Bronchoscopy

History of Present Illness:
This is a 42 year old with a PMH significant for HIV diagnosed
in [**2164**] with last CD4 count of 312 and VL of 88,000 on [**2170-9-11**],
asthma, who presents with shortness of breath, non-productive
cough for the last 4 days.  History is limited as patient is
intubated upon arriving to the MICU.  Per history obtained by ED
physicians, patient has had dyspnea for the last 4 days.  Has
complained of intermittent fevers and chills.  Was evaluated by
Dr. [**Last Name (STitle) **] at [**Hospital1 778**] today and referred to ED due to RR 28 and
pO2 of 88%.  He was seen in the ED 3 days prior for similar
symptoms and discharged home due to clear chest radiograph;
symptoms have worsened since that time.  Patient was started on
advair one month prior and has been recently initiated on
atripla antiretroviral therapy.

In the ED, initial vital signs were: T: 98.2, BP: 112/88, HR:
91, O2sat: 89%RA.  Oxygen found to desaturate to the high 80s
despite 4L NC.  Chest radiograph demonstrated right sided
diffuse patchy infiltrate concerning for multifocal pneumonia.
ID service was curbsided in ED, and patient was started on abx
for CAP and possible PCP.  [**Name10 (NameIs) **] on ceftriaxone 1g IV X 1,
azithromycin 500mg PO X 1, bactrim DS 2 tabs PO X 1, prednisone
40mg PO X 1.  Nebs were given.  Patient with worsening tachypnea
and was electively intubated in the ED.  No ABG was collected
prior to intubation.

Of note, was recently discharged from prison 1 month prior.

Past Medical History:
1. HIV, patient unsure of current CD4 count. Per OMR, last CD4
count was 511 on [**2166-4-2**]
2. Asthma
3. GERD

PSYCHIATRIC HISTORY:
* panic disorder with agoraphobia
* Patient cannot remember exat diagnosis, but reports suffering
from anxiety and 'inability to leave his house'. These hav been
present for the past 6-7 years.
* 10 inpatient psychiatric hospitalizations, last one 8 months
ago at [**Hospital1 1680**]. Reports being hospitalized at [**Hospital1 18**], [**Location (un) 1157**],
and [**Hospital3 **].
* past med trials: imipramine, klonopin, paxil, zoloft, proza,
ativan.
* Admits to five suicide attempts, all by overdose, some
requiring charcoal administration.
* Denies history of violence
* Current psychiatrist is Dr. [**First Name8 (NamePattern2) 61904**] [**Last Name (NamePattern1) 34017**] at [**Hospital1 61905**] ([**Telephone/Fax (1) 61906**]).

Social History:
SUBSTANCE ABUSE HISTORY: (As per prior OMR note).
* Discharged from prison one month prior (?cocaine possession)
* Smokes 1.5 PPD of cigarettes
* Cocaine: Used $100 worth in the past, was previously sober for
8 months. First use when teen.
* ETOH: Drank 6 beers, was previously sober for 8 months. Denies
history of Alcohol withdrawal sz, DT's.
* denies past or current use of any other illicit substance.
Denies history of IVDU.

SOCIAL HISTORY: (As per prior OMR note).  Patient reports being
born in [**Location (un) 31315**], MA. He is adopted. His adoptive family
lives in [**Location (un) **]. Graduated High school, worked as a waiter.
Received SSDI for anxiety and agoraphobia. Currently lives in
[**Location 2312**] with his partner and two friends. Denies current
legal history, but admits to prior problems with the law
(refuses to disclose information).


Family History:
Unknown, as patient is adopted.


Physical Exam:
VS: Temp: 101.1, BP: 156/88 HR: 118 -> 72 RR: 30 O2sat: 93% on
AC
GEN: intubated
HEENT: PERRL, EOMI, anicteric
RESP: rales from the right lateral chest (auscultated from
anterior chest)
CV: RR, S1 and S2 wnl, no m/r/g
ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly
EXT: no c/c/e
SKIN: scratch marks located on left arm.
NEURO: PERRL, EOMI.


Pertinent Results:
Admission labs:
[**2170-12-18**] 10:45AM   GLUCOSE-91 UREA N-13 CREAT-0.8 SODIUM-138
POTASSIUM-3.3 CHLORIDE-102 TOTAL CO2-26 ANION GAP-13
[**2170-12-18**] 10:45AM   CALCIUM-8.8 PHOSPHATE-4.0 MAGNESIUM-2.1
[**2170-12-18**] 10:45AM   WBC-6.2 RBC-4.05* HGB-12.1* HCT-34.8* MCV-86
MCH-30.0 MCHC-34.9 RDW-14.1
[**2170-12-18**] 10:45AM   NEUTS-75.4* LYMPHS-20.1 MONOS-3.4 EOS-0.2
BASOS-0.9
[**2170-12-18**] 10:45AM   PLT COUNT-236
[**2170-12-18**] 10:45AM   PT-14.7* PTT-30.6 INR(PT)-1.3*
[**2170-12-18**] 10:59AM   LACTATE-1.6
[**2170-12-18**] 03:25PM   LACTATE-1.0
[**2170-12-18**] 03:25PM   TYPE-ART RATES-/20 TIDAL VOL-500 O2-100
PO2-110* PCO2-65* PH-7.23* TOTAL CO2-29 BASE XS--1 AADO2-561 REQ
O2-90 INTUBATED-INTUBATED VENT-CONTROLLED

WBC Lymph Abs [**Last Name (un) **] CD3% Abs CD3 CD4% Abs CD4 CD8% Abs CD8 CD4/CD8

5.2  5*      260   60     155*   21    55*    37     97*   0.6

Labs on Discharge:
[**2170-12-25**] 10:45AM
137  104  9
-------------< 117
4.4  24  0.6

Ca: 8.5 Mg: 2.4 P: 4.2

     12.4
5.1 >---< 347
     35.8

Micro:
[**2170-12-18**] 10:45 am BLOOD CULTURE negative
[**2170-12-18**] 5:08 pm MRSA SCREEN negative
[**2170-12-18**] 4:42 pm BRONCHOALVEOLAR LAVAGE

   GRAM STAIN (Final [**2170-12-18**]):
      1+    (<1 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      NO MICROORGANISMS SEEN.

   RESPIRATORY CULTURE (Final [**2170-12-20**]):    NO GROWTH, <1000
CFU/ml.

   LEGIONELLA CULTURE (Preliminary):    NO LEGIONELLA ISOLATED.

   POTASSIUM HYDROXIDE PREPARATION (Final [**2170-12-18**]):
      Test cancelled by laboratory.
      PATIENT CREDITED.
      This is a low yield procedure based on our in-house
studies.
      if pulmonary Histoplasmosis, Coccidioidomycosis,
Blastomycosis,
      Aspergillosis or Mucormycosis is strongly suspected,
contact the
      Microbiology Laboratory (7-2306).

   Immunoflourescent test for Pneumocystis jirovecii (carinii)
(Final
      [**2170-12-19**]):    NEGATIVE for Pneumocystis jirovecii
(carinii)..

   FUNGAL CULTURE (Preliminary):    NO FUNGUS ISOLATED.

   ACID FAST SMEAR (Final [**2170-12-19**]):
      NO ACID FAST BACILLI SEEN ON CONCENTRATED SMEAR.

   ACID FAST CULTURE (Preliminary):

   VIRAL CULTURE: R/O CYTOMEGALOVIRUS (Preliminary):
      No Cytomegalovirus (CMV) isolated.

[**2170-12-18**] 4:42 pm Rapid Respiratory Viral Screen & Culture
      SPECIMEN POOLED WITH #313-8710B [**2170-12-18**].

                            **FINAL REPORT [**2170-12-19**]**

   Respiratory Viral Culture (Final [**2170-12-19**]):
      Refer to respiratory viral antigen screen and respiratory
virus
      identification test results for further information.
      TEST CANCELLED, PATIENT CREDITED.

   Respiratory Viral Antigen Screen (Final [**2170-12-19**]):
      Positive for Respiratory viral antigens.
      Specimen screened for: Adeno, Parainfluenza 1, 2, 3,
Influenza A, B,
      and RSV by immunofluorescence.
      Refer to Respiratory Virus Identification for further
information.

   Respiratory Virus Identification (Final [**2170-12-19**]):
      REPORTED BY PHONE TO DR [**Last Name (STitle) **].[**Doctor Last Name 3689**] [**2170-12-19**] 1115AM.
      POSITIVE FOR INFLUENZA A VIRAL ANTIGEN.
         Viral antigen identified by immunofluorescence.
[**2170-12-18**] 4:42 pm BRONCHOALVEOLAR LAVAGE

   GRAM STAIN (Final [**2170-12-18**]):
      2+   (1-5 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      NO MICROORGANISMS SEEN.

   RESPIRATORY CULTURE (Final [**2170-12-20**]):    NO GROWTH, <1000
CFU/ml.

   ACID FAST CULTURE (Preliminary):

   ACID FAST SMEAR (Final [**2170-12-19**]):
      NO ACID FAST BACILLI SEEN ON CONCENTRATED SMEAR.

   VIRAL CULTURE: R/O CYTOMEGALOVIRUS (Final [**2170-12-19**]):
      PLEASE REFER TO CULTURE # [**Numeric Identifier 61907**] FOR RESULTS.
      TEST CANCELLED, PATIENT CREDITED.

   FUNGAL CULTURE (Preliminary):    NO FUNGUS ISOLATED.

   POTASSIUM HYDROXIDE PREPARATION (Final [**2170-12-18**]):
      Test cancelled by laboratory.
      PATIENT CREDITED.
      This is a low yield procedure based on our in-house
studies.
      if pulmonary Histoplasmosis, Coccidioidomycosis,
Blastomycosis,
      Aspergillosis or Mucormycosis is strongly suspected,
contact the
      Microbiology Laboratory (7-2306).

   LEGIONELLA CULTURE (Preliminary):    NO LEGIONELLA ISOLATED.

   Immunoflourescent test for Pneumocystis jirovecii (carinii)
(Final
      [**2170-12-19**]):    NEGATIVE for Pneumocystis jirovecii
(carinii)..

   Respiratory Viral Antigen Screen (Final [**2170-12-19**]):
      PLEASE REFER TO CULTURE # 313-8703B FOR RESULT.
      TEST CANCELLED, PATIENT CREDITED.

   Respiratory Viral Culture (Final [**2170-12-19**]):
      PLEASE REFER TO CULTURE # 313-8703B FOR RESULT.
      TEST CANCELLED, PATIENT CREDITED.

Imaging:
- EKG: normal sinus rhythm with rate of 88, normal axis, normal
intervals.  No ST changes or T wave changes concerning for
ischemia.

- Chest radiograph ([**2170-12-18**]): IMPRESSION: Multifocal pulmonary
opacities in the right lung concerning for multifocal pneumonia.


- CHEST (PORTABLE AP)	Study Date of [**2170-12-18**] 2:58 PM
IMPRESSION: Bilateral pulmonary airspace opacities, more
pronounced on the
right, concerning for pneumonia. Followup chest radiograph
following
treatment is recommended. Endotracheal tube in situ as outlined
above.

- CHEST (PORTABLE AP)	Study Date of [**2170-12-19**] 3:57 AM
Moderate right pleural effusion has developed since [**12-18**],
accompanying mediastinal vascular engorgement, so this could be
a reflection of volume overload, but would need to be evaluated
clinically to exclude empyema. The fusion overlies and partially
obscures the right lung, but there does seem to be some
improvement in the extent of what was severe right lung
consolidation. Left upper lobe shows mild vascular congestion
and heart size is larger today than it has been on this
admission.   With the chin down, the tip of the endotracheal
tube is at the upper margin of the clavicles and can safely be
advanced to 0.5 cm. Nasogastric tube passes into the stomach and
out of view. No pneumothorax.

- ECG	Study Date of [**2170-12-20**]  2:38:12 PM
Sinus rhythm. Findings are within normal limits. Compared to the
previous
tracing of [**2170-12-18**] there is no significant diagnostic change.

- CHEST (PORTABLE AP)	Study Date of [**2170-12-20**] 3:30 AM
As compared to the previous radiograph, the nasogastric tube and
the chest tube are in unchanged position. Improving right lung
opacities.
Unchanged left perihilar opacity. Presence of a small right
pleural effusion cannot be excluded; on the left, there is no
evidence of pleural effusion.

Brief Hospital Course:
# Hypoxic respiratory failure: Likely secondary to right sided
multifocal pneumonia.  Initially covered broadly given HIV
status with Vanc, CTX, Azithro and Bactrim (for PCP). Also
received Prednisone 40mg [**Hospital1 **] for treatment of severe PCP. [**Name10 (NameIs) **] the
day after admission the patient's flu swab came back positive
and he was started on Tamiflu. He underwent Bronchoscopy on
[**12-18**], which revealed the presence of Influenza A, but did not
came back positive for PCP, [**Name10 (NameIs) **] treatment doses of Bactrim and
steroids were discontinued. His respiratory status slowly
improved with lower FiO2 requirements until he was successfully
extubated on [**12-21**]. He remained stable on 4 liters nasal cannula
for the rest of the time he was in the MICU. Upon transfer to
the floor, the patient was continued on CTX, Azithromycin, and
Oseltamivir. He completed a total 7 days course of CTX and
Azithro, and completed a 5 day course of oseltamivir while in
the hospital. Upon discharge, he was satting well on room air.
We started him on Bactrim DS daily for PCP prophylaxis given his
CD4 count of 55.

# Hypotension: Felt [**1-9**] sepsis from his MF PNA and increased
insensible losses from diaphoresis/fevers. Responsive to IVF
boluses with resultant improvement in UOP.

# HIV: Patient was on HAART therapy prior to admission however
CD4 count here was only 55. Bactrim DS daily ppx for PCP was
started.  He was continued on atripla.

# Asthma: No wheezing on exam.  Patient was written for nebs
prn.

# Psych history: Initially while intubated difficult to assess
but did cont sertraline.  Held Klonopin and Seroquel initially
in setting of intubation and fentanyl/versed gtt, however these
were restarted with hopes of weaning his sedation. Upon
extubation, the patient made reference to suicidal ideation, and
wish to leave the hospital. Psychiatry was consulted, who said
that the patient did not require 1:1 sitter on transfer to the
floor, but that he could not leave AMA without repeat
psychiatric evaluation. Upon arriving to the floor, the patient
once again voiced his desire to leave the hospital AMA, saying
that the hospital had stolen his jacket and shoes, and that he
would not stay in a place where things were stolen from him.
Psychiatry was called to evaluate again, and again said that the
patient did not understand his medical illness and did not have
capacity to leave. We treated him with IV antibiotics as best we
could as he would take PO medication intermittently while
in-house. His mood improved, and he ultimately ended up being
compliant with his medications.

# Code: FULL

# Pending studies
- None

# PCP [**Name9 (PRE) 702**] issues:
- Please reassess CD4/VL in a setting where the patient is not
acutely ill
- Consider the need for PCP prophylaxis based on current CD4
count
- Consider sending toxo serologies given that the patient is
approaching the need for OI prophylaxis for MAC

Medications on Admission:
(per [**Hospital1 778**] records)
- albuerol 2 puffs PO QID PRN
- verapamil CR 240mg PO daily
- claritin 10mg PO daily
- klonapin 1mg PO 5 times per day
- seroquel 100mg PO QID; 400mg PO qhs
- sertraline 200mg PO qhs
- benadryl 25mg qam and 75mg qhs
- advair diskus take 1 puff [**Hospital1 **]
- omeprazole 40mg PO daily
- flonase
- bentropine 0.5mg PO daily
- atripla [**Telephone/Fax (3) 567**] (efavirenz/emtricitab/tenofovir) 1 tab PO
daily
- zofran 8mg PO q8h PRN
- ibuprofen 800mg PO QID

Discharge Medications:
1. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
Two (2) puffs Inhalation four times a day as needed for
shortness of breath or wheezing.
2. ATRIPLA [**Telephone/Fax (3) 567**] mg Tablet Sig: One (1) Tablet PO once a
day.
3. quetiapine 100 mg Tablet Sig: One (1) Tablet PO QID (4 times
a day).
4. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
5. Zofran 8 mg Tablet Sig: One (1) Tablet PO every eight (8)
hours as needed for nausea.
6. quetiapine 200 mg Tablet Sig: Two (2) Tablet PO QHS (once a
day (at bedtime)).
7. sulfamethoxazole-trimethoprim 800-160 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
8. clonazepam 1 mg Tablet Sig: One (1) Tablet PO FIVE TIMES PER
DAY ().
9. sertraline 100 mg Tablet Sig: Two (2) Tablet PO at bedtime.
10. ibuprofen 800 mg Tablet Sig: One (1) Tablet PO four times a
day.
11. bentropine  Sig: 0.5 mg  once a day.
12. Flonase 50 mcg/Actuation Spray, Suspension Sig: One (1)
Nasal once a day.
13. Advair Diskus 250-50 mcg/dose Disk with Device Sig: One (1)
Inhalation once a day.
14. Benadryl 25 mg Capsule Sig: One (1) Capsule PO QAM.
15. verapamil 240 mg Cap,24 hr Sust Release Pellets Sig: One (1)
Cap,24 hr Sust Release Pellets PO once a day.
16. Claritin 10 mg Tablet Sig: One (1) Tablet PO once a day.
17. Benadryl 25 mg Capsule Sig: Three (3) Capsule PO at bedtime.



Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis:
- Influenza A
- Pneumonia
Secondary Diagnosis:
- HIV/AIDS


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 of cough and trouble breathing.
You were found to have a serious infection in your lungs called
pneumonia and required mechanical ventilation (a breathing tube)
to help you breathe.  You were treated with antibiotics and
medications for HIV. Additionally, you were found to be positive
for Influenza A meaning you have the flu. You were treated with
an anti-flu medication called Tamiflu. You required oxygen and
were asked to stay in the hospital while we treated you until
the point at which you no longer needed oxygen. You had sought
to leave AGAINST MEDICAL ADVICE, and we explained to you the
serious consequences of leaving against medical advice, with a
life-threatening illness, oxygen requirement and HIV/AIDS with a
very low CD4 count. Our psychatrists evaluated you, and thought
that you did not have the capacity to make decisions regarding
your own health in this circumstance. After two more days, you
completed your course of both the antibiotics as well as the flu
medicine, and you did not have an oxygen requirement, and so we
felt safe discharging you home.

When you leave the hospital:
1. START sulfamethoxazole-trimethoprim  800-160 mg Tablet: Take
One (1) Tablet PO DAILY (Daily)

We did not make any other changes to your home medications, so
please continue to take them as you normally do.

Followup Instructions:
You have an appointment with Dr. [**Last Name (STitle) **] at [**Hospital1 778**] Health on
Wedneday  [**2171-1-2**] at 10:30 AM.


                             [**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] DO 12-BDU
{'Acute respiratory failure,Influenza with pneumonia,Major depressive affective disorder, recurrent episode, severe, without mention of psychotic behavior,Hyperpotassemia,Human immunodeficiency virus [HIV] disease,Asthma, unspecified type, unspecified,Esophageal reflux,Agoraphobia with panic disorder,Tobacco use disorder,Other alteration of consciousness'}


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: Respiratory failure

PRESENT ILLNESS: This is a 42 year old with a PMH significant for HIV diagnosed
in [**2164**] with last CD4 count of 312 and VL of 88,000 on [**2170-9-11**],
asthma, who presents with shortness of breath, non-productive
cough for the last 4 days.  History is limited as patient is
intubated upon arriving to the MICU.  Per history obtained by ED
physicians, patient has had dyspnea for the last 4 days.  Has
complained of intermittent fevers and chills.  Was evaluated by
Dr. [**Last Name (STitle) **] at [**Hospital1 778**] today and referred to ED due to RR 28 and
pO2 of 88%.  He was seen in the ED 3 days prior for similar
symptoms and discharged home due to clear chest radiograph;
symptoms have worsened since that time.  Patient was started on
advair one month prior and has been recently initiated on
atripla antiretroviral therapy.

MEDICAL HISTORY: 1. HIV, patient unsure of current CD4 count. Per OMR, last CD4
count was 511 on [**2166-4-2**]
2. Asthma
3. GERD

MEDICATION ON ADMISSION: (per [**Hospital1 778**] records)
- albuerol 2 puffs PO QID PRN
- verapamil CR 240mg PO daily
- claritin 10mg PO daily
- klonapin 1mg PO 5 times per day
- seroquel 100mg PO QID; 400mg PO qhs
- sertraline 200mg PO qhs
- benadryl 25mg qam and 75mg qhs
- advair diskus take 1 puff [**Hospital1 **]
- omeprazole 40mg PO daily
- flonase
- bentropine 0.5mg PO daily
- atripla [**Telephone/Fax (3) 567**] (efavirenz/emtricitab/tenofovir) 1 tab PO
daily
- zofran 8mg PO q8h PRN
- ibuprofen 800mg PO QID

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: Temp: 101.1, BP: 156/88 HR: 118 -> 72 RR: 30 O2sat: 93% on
AC
GEN: intubated
HEENT: PERRL, EOMI, anicteric
RESP: rales from the right lateral chest (auscultated from
anterior chest)
CV: RR, S1 and S2 wnl, no m/r/g
ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly
EXT: no c/c/e
SKIN: scratch marks located on left arm.
NEURO: PERRL, EOMI.

FAMILY HISTORY: Unknown, as patient is adopted.

SOCIAL HISTORY: SUBSTANCE ABUSE HISTORY: (As per prior OMR note).
* Discharged from prison one month prior (?cocaine possession)
* Smokes 1.5 PPD of cigarettes
* Cocaine: Used $100 worth in the past, was previously sober for
8 months. First use when teen.
* ETOH: Drank 6 beers, was previously sober for 8 months. Denies
history of Alcohol withdrawal sz, DT's.
* denies past or current use of any other illicit substance.
Denies history of IVDU. 

### Response:
{'Acute respiratory failure,Influenza with pneumonia,Major depressive affective disorder, recurrent episode, severe, without mention of psychotic behavior,Hyperpotassemia,Human immunodeficiency virus [HIV] disease,Asthma, unspecified type, unspecified,Esophageal reflux,Agoraphobia with panic disorder,Tobacco use disorder,Other alteration of consciousness'}
