CHIEF COMPLAINT: hypotension in addition to cough and green sputum

PRESENT ILLNESS: Ms. [**Known lastname **] is a 47F with AIDS, HCV, cardiomyopathy, and
antiphospholipid antibody syndrome who presents with cough and
green sputum, subjective fevers at home. She is circumferential
as a historian, but it seems that she never recovered to her
baseline functional status after admission in [**Month (only) **]-early [**Month (only) **], in
terms of feeling tired all the time and complaining of mild
dyspnea.

MEDICAL HISTORY: 1. HIV/AIDS, diagnosed [**2176**], off HAART.
- acquired via heterosexual intercourse.
- CD4 184, VL 254k [**2190-12-5**]
- nadir CD4 69 [**6-11**]
2. HCV antibody+
3. [**Doctor First Name **] [**1-/2182**] - was not complaint with Rx.
4. Oral thrush
5. Recurrent episodes of pneumococcal pneumonia.
6. Lymphocytic pneumonitis - diagnosed by trans-bronchial bx.
7. Dilated cardiomyopathy-EF20-25%, last echo [**4-13**].
8. LV thrombus
9. Antiphospholipid antibody syndrome
10. Lower extremity arterial thrombus
11. Asthma/bronchiectasis
12. Myocardial infarction [**2184**], clean coronaries at that time
13. L MCA stroke, residual right hemiparesis
14. Cocaine abuse
15. Pulmonary Nodules on chest CT
16. Zoster
17. Cholelithiasis

MEDICATION ON ADMISSION: Medications--she reports that she filled a 2 week supply of
these in early [**Month (only) 1096**], then ran out until 2 days ago:
Lorazepam 0.5 mg PO BID
Fluconazole 100 mg PO Q24H
Senna 8.6 mg [**Hospital1 **]
Digoxin .0625 mg one half Tablet PO DAILY
Warfarin 5 mg Daily
Metoprolol Succinate 12.5mg Sustained Release PO DAILY
Lisinopril 2.5 mg PO DAILY
Atovaquone 1500 mg PO once a day

ALLERGIES: Zidovudine

PHYSICAL EXAM: Vitals: T:97.0 BP:92/69 HR:98 RR:30 O2Sat:98% RA
GEN: chronically ill appearing woman
[**Year (4 digits) 4459**]: anicteric, edentulous except for lower incisors, + oral
thrush
NECK: No JVD, carotid pulses brisk, no bruits, no cervical
lymphadenopathy, trachea midline
COR: no M/G/R, normal S1 S2, radial pulses +2
PULM: Lungs scattered crackles, but esp at the L lower [**1-8**],
where there are also rhonchi
ABD: Soft, NT, ND, +BS, no HSM, no masses
EXT: No C/C/E, no palpable cords
NEURO: alert, oriented to person, place, and time. CN II ?????? XII
grossly intact. Moves all 4 extremities. Strength 5/5 in upper
and lower extremities. Patellar DTR +1.
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses.

FAMILY HISTORY: mother with DM

SOCIAL HISTORY: smokes "occassionally" X many years, no recent alcohol, h/o
cocaine abuse, but none recently, and has been homeless in the
past
Pneumonia, organism unspecified,Acute kidney failure, unspecified,Human immunodeficiency virus [HIV] disease,Other primary cardiomyopathies,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Candidiasis of mouth,Chronic hepatitis C without mention of hepatic coma,Cocaine abuse, unspecified,Other and unspecified nonspecific immunological findings
Pneumonia, organism NOS,Acute kidney failure NOS,Human immuno virus dis,Prim cardiomyopathy NEC,Late ef-hemplga side NOS,Thrush,Chrnc hpt C wo hpat coma,Cocaine abuse-unspec,Oth unspcf nspf imun fnd
Admission Date:  [**2191-1-25**]              Discharge Date:   [**2191-1-30**]

Date of Birth:  [**2143-7-12**]             Sex:   F

Service: MEDICINE

Allergies:
Zidovudine

Attending:[**First Name3 (LF) 2745**]
Chief Complaint:
hypotension in addition to cough and green sputum

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Ms. [**Known lastname **] is a 47F with AIDS, HCV, cardiomyopathy, and
antiphospholipid antibody syndrome who presents with cough and
green sputum, subjective fevers at home. She is circumferential
as a historian, but it seems that she never recovered to her
baseline functional status after admission in [**Month (only) **]-early [**Month (only) **], in
terms of feeling tired all the time and complaining of mild
dyspnea.

In the ED, arrival vital signs 95.3, 89, 75/50, 36, 95% RA;
received 4L IVF, refused central line for hypotension. Received
levofloxacin and vancomycin for pna.

ROS: The patient denies any fevers, chills, weight change,
nausea, vomiting, abdominal pain, diarrhea, constipation,
melena, hematochezia, chest pain, shortness of breath,
orthopnea, PND, lower extremity oedema, cough, urinary
frequency, urgency, dysuria, lightheadedness, gait unsteadiness,
focal weakness, vision changes, headache, rash or skin changes.


Past Medical History:
1. HIV/AIDS, diagnosed [**2176**], off HAART.
- acquired via heterosexual intercourse.
- CD4 184, VL 254k [**2190-12-5**]
- nadir CD4 69 [**6-11**]
2. HCV antibody+
3. [**Doctor First Name **] [**1-/2182**] - was not complaint with Rx.
4. Oral thrush
5. Recurrent episodes of pneumococcal pneumonia.
6. Lymphocytic pneumonitis - diagnosed by trans-bronchial bx.
7. Dilated cardiomyopathy-EF20-25%, last echo [**4-13**].
8. LV thrombus
9. Antiphospholipid antibody syndrome
10. Lower extremity arterial thrombus
11. Asthma/bronchiectasis
12. Myocardial infarction [**2184**], clean coronaries at that time
13. L MCA stroke, residual right hemiparesis
14. Cocaine abuse
15. Pulmonary Nodules on chest CT
16. Zoster
17. Cholelithiasis


Social History:
smokes "occassionally" X many years, no recent alcohol, h/o
cocaine abuse, but none recently, and has been homeless in the
past


Family History:
mother with DM


Physical Exam:
Vitals: T:97.0 BP:92/69 HR:98 RR:30 O2Sat:98% RA
GEN: chronically ill appearing woman
[**Year (4 digits) 4459**]: anicteric, edentulous except for lower incisors, + oral
thrush
NECK: No JVD, carotid pulses brisk, no bruits, no cervical
lymphadenopathy, trachea midline
COR: no M/G/R, normal S1 S2, radial pulses +2
PULM: Lungs scattered crackles, but esp at the L lower [**1-8**],
where there are also rhonchi
ABD: Soft, NT, ND, +BS, no HSM, no masses
EXT: No C/C/E, no palpable cords
NEURO: alert, oriented to person, place, and time. CN II ?????? XII
grossly intact. Moves all 4 extremities. Strength 5/5 in upper
and lower extremities. Patellar DTR +1.
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses.



Pertinent Results:
[**2191-1-25**] 07:06PM   GLUCOSE-82 UREA N-56* CREAT-1.6* SODIUM-139
POTASSIUM-3.1* CHLORIDE-114* TOTAL CO2-15* ANION GAP-13
[**2191-1-25**] 07:06PM   MAGNESIUM-1.8
[**2191-1-25**] 07:06PM   PT-99.5* PTT-54.3* INR(PT)-13.2*
[**2191-1-25**] 02:25PM [**Month/Day/Year 14246**]  HOURS-RANDOM UREA N-828 CREAT-107
SODIUM-37 POTASSIUM-23 CHLORIDE-14
[**2191-1-25**] 02:25PM [**Month/Day/Year 14246**]  [**Month/Day/Year 3143**]-TR NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2191-1-25**] 02:25PM [**Month/Day/Year 14246**]  RBC-[**3-10**]* WBC-0-2 BACTERIA-FEW YEAST-NONE
EPI-0-2
[**2191-1-25**] 01:04PM   GLUCOSE-79 LACTATE-1.4 NA+-135 K+-3.5 CL--102
TCO2-20*
[**2191-1-25**] 01:04PM   HGB-11.3* calcHCT-34
[**2191-1-25**] 01:03PM   ALT(SGPT)-27 AST(SGOT)-55* LD(LDH)-430* ALK
PHOS-52 TOT BILI-0.7
[**2191-1-25**] 01:03PM   ALBUMIN-2.6*
[**2191-1-25**] 01:03PM   DIGOXIN-0.4*
[**2191-1-25**] 01:03PM   WBC-3.4* RBC-3.46* HGB-10.6* HCT-29.5* MCV-85
MCH-30.7 MCHC-36.0* RDW-15.7*
[**2191-1-25**] 01:03PM   NEUTS-74* BANDS-0 LYMPHS-23 MONOS-3 EOS-0
BASOS-0
[**2191-1-25**] 01:03PM   PLT COUNT-143*

ECG: SR LVH by voltage, TWI II, III, flat in aVF, V4-V6; no
significant change from [**2190-11-28**].

Imaging:
CXR: AP supine, compared to [**2190-11-28**]. LLL opacity, concerning
for infection. Reticulonodular pattern relatively unchanged from
[**Name (NI) **]. Slightly enlarged cardiomediastinal silhouette,
unchanged from [**Month (only) **].


Brief Hospital Course:
Assesment: Ms. [**Known lastname **] is a 47F with AIDS, HCV, cardiomyopathy,
and antiphospholipid antibody syndrome who presents with ~6
weeks of fatigue and dyspnea, now worse in the last 3-4 days,
with productive cough
.
Plan:
# Pneumonia: SIRS criteria of hypotension (note that
outpt/ambulatory [**Known lastname **] pressures have been 100-110s), T95.3 on
arrival, RR 36; plus symptoms of resp infection and infiltrate
on CXR. She was covered initially for CAP with CTX and azithro.
She was ruled out for TB by 3 negative AFBs. DFA was negative
for [**Known lastname **]. Bronch was considered but as she improved on this
treatment, it was not done. She was followed by ID who
recommended changing CTX to cefpodoxime on discharge to complete
a 10-day course and to complete a 5-day course of azithro.

# HIV: not on HAART [**2-7**] poor compliance. Has been taking
atovaquone sporadically (reports taking for 2 of last 6 weeks);
this was restarted in-house. Social work was consulted to help
identify barriers to outpatient followup and compliance, and she
was set up with a food program.

# antiphospholipid syndrome: Her INR was supratherapeutic on
admission, so coumadin was held. The importance of compliacne
with INR monitoring was emphasized to her, and she was
discharged on coumadin 5 mg to be restarted on [**2-1**] with close
ouptaient monitoring.  Of note, closer monitoring of the INR in
a patient with APA syndrome is required.

# cardiomyopathy: held ACE-I, BB, digoxin [**2-7**] hypotension,
infection.

# ARF: likely prerenal in setting of febrile illness. This
improved with volume resuscitation.

# oral thrush: continued fluconazole 100mg po daily

# Depression/anxiety: continued ativan
.
# Social: asked SW to see re: poor social supports, difficulty
with outpt med compliance. As she reported she had difficulty
getting food at home, she was set up with a food program.


Medications on Admission:
Medications--she reports that she filled a 2 week supply of
these in early [**Month (only) 1096**], then ran out until 2 days ago:
Lorazepam 0.5 mg PO BID
Fluconazole 100 mg PO Q24H
Senna 8.6 mg [**Hospital1 **]
Digoxin .0625 mg one half Tablet PO DAILY
Warfarin 5 mg Daily
Metoprolol Succinate 12.5mg Sustained Release PO DAILY
Lisinopril 2.5 mg PO DAILY
Atovaquone 1500 mg PO once a day


Discharge Medications:
1. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
2. Fluconazole 100 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours).
3. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
4. Atovaquone 750 mg/5 mL Suspension Sig: One (1)  PO DAILY
(Daily).
5. Cefpodoxime 200 mg Tablet Sig: One (1) Tablet PO every twelve
(12) hours for 4 days.
Disp:*8 Tablet(s)* Refills:*0*
6. Coumadin 5 mg Tablet Sig: One (1) Tablet PO once a day:
Restart this medication on [**2-1**].


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
Primary: pneumonia
Secondary: HIV, anxiety, cardiomyopathy, hypertension

Discharge Condition:
good, stable, ambulating independently, not requiring oxygen

Discharge Instructions:
You were evaluated for shortness of breath and cough and found
to have a pneumonia. This is improving with antibiotics.

It is VERY important for you to follow up with your outpatient
providers to be sure you are improving. Several of your
medications were stopped during the admission, and you must
follow up with your doctors to know when to restart them. Do not
take your digoxin, metoprolol, or lisinopril for now as your
[**Location (un) **] pressure is low-normal. Finish your antibiotics as
prescribed.

It is VERY important to have your INR checked so that your
coumadin can be dosed appropriately.

If you have fevers, chills, shortness of breath, chest pain,
lightheadedness, worsening cough, episodes of loss of
consciousness, or any other concerning symptoms, call your
doctor or seek medical attention immediately.

Followup Instructions:
You have an appointment with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] of Infectious
Disease on [**2191-2-11**] at 11:00am. Call his office at [**Telephone/Fax (1) 457**]
with any questions.
{'Pneumonia, organism unspecified,Acute kidney failure, unspecified,Human immunodeficiency virus [HIV] disease,Other primary cardiomyopathies,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Candidiasis of mouth,Chronic hepatitis C without mention of hepatic coma,Cocaine abuse, unspecified,Other and unspecified nonspecific immunological findings'}


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: hypotension in addition to cough and green sputum

PRESENT ILLNESS: Ms. [**Known lastname **] is a 47F with AIDS, HCV, cardiomyopathy, and
antiphospholipid antibody syndrome who presents with cough and
green sputum, subjective fevers at home. She is circumferential
as a historian, but it seems that she never recovered to her
baseline functional status after admission in [**Month (only) **]-early [**Month (only) **], in
terms of feeling tired all the time and complaining of mild
dyspnea.

MEDICAL HISTORY: 1. HIV/AIDS, diagnosed [**2176**], off HAART.
- acquired via heterosexual intercourse.
- CD4 184, VL 254k [**2190-12-5**]
- nadir CD4 69 [**6-11**]
2. HCV antibody+
3. [**Doctor First Name **] [**1-/2182**] - was not complaint with Rx.
4. Oral thrush
5. Recurrent episodes of pneumococcal pneumonia.
6. Lymphocytic pneumonitis - diagnosed by trans-bronchial bx.
7. Dilated cardiomyopathy-EF20-25%, last echo [**4-13**].
8. LV thrombus
9. Antiphospholipid antibody syndrome
10. Lower extremity arterial thrombus
11. Asthma/bronchiectasis
12. Myocardial infarction [**2184**], clean coronaries at that time
13. L MCA stroke, residual right hemiparesis
14. Cocaine abuse
15. Pulmonary Nodules on chest CT
16. Zoster
17. Cholelithiasis

MEDICATION ON ADMISSION: Medications--she reports that she filled a 2 week supply of
these in early [**Month (only) 1096**], then ran out until 2 days ago:
Lorazepam 0.5 mg PO BID
Fluconazole 100 mg PO Q24H
Senna 8.6 mg [**Hospital1 **]
Digoxin .0625 mg one half Tablet PO DAILY
Warfarin 5 mg Daily
Metoprolol Succinate 12.5mg Sustained Release PO DAILY
Lisinopril 2.5 mg PO DAILY
Atovaquone 1500 mg PO once a day

ALLERGIES: Zidovudine

PHYSICAL EXAM: Vitals: T:97.0 BP:92/69 HR:98 RR:30 O2Sat:98% RA
GEN: chronically ill appearing woman
[**Year (4 digits) 4459**]: anicteric, edentulous except for lower incisors, + oral
thrush
NECK: No JVD, carotid pulses brisk, no bruits, no cervical
lymphadenopathy, trachea midline
COR: no M/G/R, normal S1 S2, radial pulses +2
PULM: Lungs scattered crackles, but esp at the L lower [**1-8**],
where there are also rhonchi
ABD: Soft, NT, ND, +BS, no HSM, no masses
EXT: No C/C/E, no palpable cords
NEURO: alert, oriented to person, place, and time. CN II ?????? XII
grossly intact. Moves all 4 extremities. Strength 5/5 in upper
and lower extremities. Patellar DTR +1.
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses.

FAMILY HISTORY: mother with DM

SOCIAL HISTORY: smokes "occassionally" X many years, no recent alcohol, h/o
cocaine abuse, but none recently, and has been homeless in the
past 

### Response:
{'Pneumonia, organism unspecified,Acute kidney failure, unspecified,Human immunodeficiency virus [HIV] disease,Other primary cardiomyopathies,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Candidiasis of mouth,Chronic hepatitis C without mention of hepatic coma,Cocaine abuse, unspecified,Other and unspecified nonspecific immunological findings'}
