CHIEF COMPLAINT: Hypothermia, altered mental status

PRESENT ILLNESS: 49M with HBV, HCV and ESRD [**1-11**] HIV on dialysis for 25 years
presents with purulent drainage from around the peritoneal
dialysis catheter with an exposed cuff.  He dialyzes himself at
home and follows up at [**Hospital 4029**] Clinic sporadically.  He presented
to [**Hospital 4029**] Clinic today and was sent to [**Hospital1 18**] ED for the exposed
catheter cuff and exit site infection.  The peritoneal dialysis
catheter is working and he reports clear output.

MEDICAL HISTORY: * HIV
- diagnosed HIV+ in [**2178**] while he was in Guantanamo Bay.  He
received political asylum.  He feels his HIV infection was the
result of receipt of blood transfusions as a result of injuries
sustained while being interrogated in a jail in [**Country 2045**]. He
sustained several gunshot
wounds and lacerations, as well as blunt trauma. He reported
having CMV retinitis of the R eye that was diagnosed in [**2186**]. It
was treated with a ganciclovir implant, but was further
complicated by chronic pain that resulted in enucleation.  He
also had a work up for a pulmonary nodule in [**2178**], that
ultimately was felt to be consistent with latent TB infection,
and he was treated with 6 months of INH therapy in one report,
up to a year in another.  He also had pneumococcal sepsis in
[**2185**]."
* Hepatitis B
* Venous thromboembolism
* Depressive disorder & anxiety
* CMV infection
* History of tuberculosis
* chronic kidney disease stage V due to HIV, on peritoneal
dialysis, followed at [**Last Name (un) 4029**] in [**Location (un) **] on [**State **] St.
* Chronic constipation
* h/o XRT at MEEI for SCC in his left ear
* Hypertension
* Syphilis [**Month (only) **] l993 c/b neurosyphilis, treated with IV
penicillin x10days
* Hepatitis C antibody positive
* s/p PD catheter placement [**2190**], numerous HD catheters and AV
fistulas; all failed

MEDICATION ON ADMISSION: Calcium Carbonate 600''
Lamivudine 50'
Epoetin Alfa [**Numeric Identifier 389**] monthly SQ
Gentamicin cream apply daily to the exit site
Lisinopril 10'
Norvasc 10' (hold for hypotension)
PhosLo 3 tabs with meals 667'''
Potassium Salts 10'
Prilosec 20'
Rocaltrol 0.5 mcg'
Sensipar 150'
Viread 300 PO Qweek
Zerit 15'
Zyprexa 5'

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On admission:
Vitals: 96.7 (92.8 on repeat) 66 156/98 22 100% 3L
GEN: A&O, NAD
HEENT: No scleral icterus, mucus membranes moist
CV: RRR, No M/G/R
PULM: bilateral crackles at lung bases R>L, decreased breath
sounds
ABD: Soft, nondistended, nontender, no rebound or guarding,
normoactive bowel sounds, some purulence produced with milking
of
skin around catheter, no surrounding cellulitis, no palpable
masses
DRE: patient refused
Ext: RUE/LUE AVF sites thrombosed per patient, LLE/RLE
(?removed)
AVG sites

FAMILY HISTORY: Noncontributory to HIV/MS changes

SOCIAL HISTORY: Tobacco [**12-11**] PPDx 20 years, no ETOH, unemployed and lives alone
in an apartment and he has CMA nursing help at home. No crack
use
or other drug use.
Human immunodeficiency virus [HIV] disease,End stage renal disease,Pneumonia, organism unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Viral hepatitis B without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta,Complications of transplanted kidney,Dementia in conditions classified elsewhere with behavioral disturbance,Hypothermia not associated with low environmental temperature,Constipation, unspecified,Personal history of noncompliance with medical treatment, presenting hazards to health,Eye globe replaced by other means,Personal history of other infectious and parasitic diseases,Hyperparathyroidism, unspecified,Accidents occurring in other specified places,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Anemia in chronic kidney disease,Other specified cardiac dysrhythmias,Other encephalopathy,Procedure not carried out for other reasons
Human immuno virus dis,End stage renal disease,Pneumonia, organism NOS,Hyp kid NOS w cr kid V,Hpt B acte wo cm wo dlta,Compl kidney transplant,Dementia w behavior dist,Hypothrm-wo low env tmp,Constipation NOS,Hx of past noncompliance,Eye replacement NEC,Prsnl hst oth nfct parst,Hyperparathyroidism NOS,Accident in place NEC,Abn react-org transplant,Anemia in chr kidney dis,Cardiac dysrhythmias NEC,Encephalopathy NEC,No proc for reasons NEC
Admission Date:  [**2197-5-16**]              Discharge Date:   [**2197-5-19**]

Date of Birth:  [**2148-5-10**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 613**]
Chief Complaint:
Hypothermia, altered mental status

Major Surgical or Invasive Procedure:
none

History of Present Illness:
49M with HBV, HCV and ESRD [**1-11**] HIV on dialysis for 25 years
presents with purulent drainage from around the peritoneal
dialysis catheter with an exposed cuff.  He dialyzes himself at
home and follows up at [**Hospital 4029**] Clinic sporadically.  He presented
to [**Hospital 4029**] Clinic today and was sent to [**Hospital1 18**] ED for the exposed
catheter cuff and exit site infection.  The peritoneal dialysis
catheter is working and he reports clear output.

The patient denies fevers, chills, nausea, vomitting, abdominal
pain, diarrhea. He does not recall last bowel movement. He
reports decreased appetite and weight loss but unsure how much.
He was dialyzed last night.

The patient is a very poor historian.  There is a note in his
paperwork from [**Last Name (un) 4029**] that he was admitted to [**Hospital1 336**] from [**2197-5-4**]
to [**2197-5-9**] but it does not state why.  The patient reports that
it was for infection of his peritoneal dialysis catheter and he
was treated with antiobiotics.

On initial evaluation in the ED, the patient was reportedly very
somnolent and unresponsive to sternal rub but then aroused
without intervention and was able to answer questions.  CD4
count was 273 2 years ago and the patient is reportedly
non-compliant with his medications.

Past Medical History:
* HIV
- diagnosed HIV+ in [**2178**] while he was in Guantanamo Bay.  He
received political asylum.  He feels his HIV infection was the
result of receipt of blood transfusions as a result of injuries
sustained while being interrogated in a jail in [**Country 2045**]. He
sustained several gunshot
wounds and lacerations, as well as blunt trauma. He reported
having CMV retinitis of the R eye that was diagnosed in [**2186**]. It
was treated with a ganciclovir implant, but was further
complicated by chronic pain that resulted in enucleation.  He
also had a work up for a pulmonary nodule in [**2178**], that
ultimately was felt to be consistent with latent TB infection,
and he was treated with 6 months of INH therapy in one report,
up to a year in another.  He also had pneumococcal sepsis in
[**2185**]."
* Hepatitis B
* Venous thromboembolism
* Depressive disorder & anxiety
* CMV infection
* History of tuberculosis
* chronic kidney disease stage V due to HIV, on peritoneal
dialysis, followed at [**Last Name (un) 4029**] in [**Location (un) **] on [**State **] St.
* Chronic constipation
* h/o XRT at MEEI for SCC in his left ear
* Hypertension
* Syphilis [**Month (only) **] l993 c/b neurosyphilis, treated with IV
penicillin x10days
* Hepatitis C antibody positive
* s/p PD catheter placement [**2190**], numerous HD catheters and AV
fistulas; all failed


Social History:
Tobacco [**12-11**] PPDx 20 years, no ETOH, unemployed and lives alone
in an apartment and he has CMA nursing help at home. No crack
use
or other drug use.


Family History:
Noncontributory to HIV/MS changes


Physical Exam:
On admission:
Vitals: 96.7 (92.8 on repeat) 66 156/98 22 100% 3L
GEN: A&O, NAD
HEENT: No scleral icterus, mucus membranes moist
CV: RRR, No M/G/R
PULM: bilateral crackles at lung bases R>L, decreased breath
sounds
ABD: Soft, nondistended, nontender, no rebound or guarding,
normoactive bowel sounds, some purulence produced with milking
of
skin around catheter, no surrounding cellulitis, no palpable
masses
DRE: patient refused
Ext: RUE/LUE AVF sites thrombosed per patient, LLE/RLE
(?removed)
AVG sites

Pertinent Results:
ADMISSION LABS
--------------
[**2197-5-16**] 03:30PM BLOOD WBC-3.5* RBC-2.66* Hgb-7.6* Hct-24.0*
MCV-90 MCH-28.6 MCHC-31.6 RDW-22.4* Plt Ct-57*
[**2197-5-16**] 03:30PM BLOOD Neuts-88* Bands-0 Lymphs-10* Monos-2
Eos-0 Baso-0 Atyps-0 Metas-0 Myelos-0 NRBC-2*
[**2197-5-16**] 06:47PM BLOOD PT-11.9 PTT-29.5 INR(PT)-1.0
[**2197-5-17**] 04:00AM BLOOD  WBC-3.1* Lymph-12* Abs [**Last Name (un) **]-372 CD3%-75
Abs CD3-278* CD4%-14 Abs CD4-52* CD8%-58 Abs CD8-214
CD4/CD8-0.2*
[**2197-5-16**] 03:30PM BLOOD Glucose-101* UreaN-30* Creat-8.9* Na-137
K-4.9 Cl-98 HCO3-30 AnGap-14
[**2197-5-16**] 03:30PM BLOOD ALT-78* AST-90* LD(LDH)-516* AlkPhos-251*
Amylase-104* TotBili-0.2
[**2197-5-17**] 04:00AM BLOOD Calcium-7.5* Phos-5.3* Mg-1.9
[**2197-5-16**] 03:30PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
.
MICROBIOLOGY
------------
[**2197-5-16**] 02:00PM ASCITES  WBC-3* RBC-0 POLYS-0 LYMPHS-68*
MONOS-0 MESOTHELI-16* MACROPHAG-16* OTHER-0
[**2197-5-16**] 03:30PM   WBC-3.5* RBC-2.66* HGB-7.6* HCT-24.0* MCV-90
MCH-28.6 MCHC-31.6 RDW-22.4*
.
[**2197-5-16**] 2:00 pm PERITONEAL FLUID

   GRAM STAIN (Final [**2197-5-16**]):
      NO POLYMORPHONUCLEAR LEUKOCYTES SEEN.
      NO MICROORGANISMS SEEN.
      This is a concentrated smear made by cytospin method,
please refer to
      hematology for a quantitative white blood cell count..

   FLUID CULTURE (Preliminary):    NO GROWTH.

   ANAEROBIC CULTURE (Preliminary):    NO GROWTH.
.
Blood cultures [**2197-5-16**] x 2: pending, no growth to date
.
[**2197-5-17**] 12:55 am SPUTUM     Site: INDUCED

   GRAM STAIN (Final [**2197-5-17**]):
      >25 PMNs and >10 epithelial cells/100X field.
      Gram stain indicates extensive contamination with upper
respiratory
      secretions. Bacterial culture results are invalid.
      PLEASE SUBMIT ANOTHER SPECIMEN.

   RESPIRATORY CULTURE (Final [**2197-5-17**]):
      TEST CANCELLED, PATIENT CREDITED.

   LEGIONELLA CULTURE (Preliminary):    NO LEGIONELLA ISOLATED.

   Immunoflourescent test for Pneumocystis jirovecii (carinii)
(Final
      [**2197-5-17**]):    NEGATIVE for Pneumocystis jirovecii
(carinii)..

   FUNGAL CULTURE (Preliminary):
      GRAM STAIN OF THIS SPECIMEN INDICATES CONTAMINATION WITH
      OROPHARYNGEAL SECRETIONS AND INVALIDATES RESULTS.
      Specimen is only screened for Cryptococcus species. New
specimen is
      recommended.

   ACID FAST SMEAR (Final [**2197-5-17**]):
      NO ACID FAST BACILLI SEEN ON CONCENTRATED SMEAR.

   ACID FAST CULTURE (Preliminary):
.
[**2197-5-17**] 4:00 am IMMUNOLOGY      Source: Venipuncture.

                            **FINAL REPORT [**2197-5-18**]**

   HIV-1 Viral Load/Ultrasensitive (Final [**2197-5-18**]):
      88 copies/ml.
.
[**2197-5-16**] 2:00 pm SWAB      EXIT SITE DRAINAGE.

   WOUND CULTURE (Preliminary):
      CORYNEBACTERIUM SPECIES (DIPHTHEROIDS).    HEAVY GROWTH.
.
IMAGING
-------
Chest X-ray on admission: IMPRESSION: Right perihilar hazy
opacity which may reflect asymmetric pulmonary edema, but
infection also is in the differential. Small bilateral pleural
effusions. Limited evaluation of the right lung apex.
.
CT head on admission:
1. No acute intracranial process.
2. Near-complete opacification of the bilateral mastoid air
cells, unchanged on the left, but new on the right.
3. Increased size and number of lucencies within the calvaria
should be
correlated clinically with any history of malignancy, and a bone
scan can be obtained for further evaluation. This finding was
communicated to Dr. [**Last Name (STitle) **] [**Last Name (STitle) **] Dr. [**Last Name (STitle) 4033**] at 12:20 a.m. via
telephone on [**2197-5-17**].
4. Extensive paranasal sinus disease, as described above.
5. Extensive chronic small vessel ischemic disease, not
significantly changed compared to [**2195-3-11**].
.
CXR [**2197-5-18**]:
As compared to the previous radiograph, there is increased
parenchymal opacity in the right perihilar lung areas. Although
unilateral pulmonary edema would be more likely than pneumonia,
pneumonia cannot be excluded on grounds of the radiologic
appearance.  Unchanged size of the cardiac silhouette. Unchanged
vascular stent.


Brief Hospital Course:
49 year old Haitian male with poorly controlled HIV (last CD4
count 273 in [**2194**], in-house level 52), HBV coinfection and a
history of longstanding peritoneal dialysis who presented [**5-16**]
with mental status change, hypotension, and hypothermia.
.
ACTIVE ISSUES
-------------
# Pneumonia: community acquired pneumonia vs. PCP pneumonia,
patient is on prophylactic Bactrim at home.  He presented with
hypothermia and altered mental status.  CD4 count was noted to
be 52.  Patient was initially on vancomycin/zosyn for empiric
coverage, then switched to PO moxifloxacin for planned five day
course after blood cultures remained negative.   Chest X-ray
showed perihilar opacity.  Patient will continue bactrim
prophylaxis upon discharge.  Sputum cultures were obtained but
were contaminated.  Infectious disease was consulted and
recommended the above antibiotic therapy, as well as continuing
prophylactic Bactrim.
.
# HIV: CD4 count measured at 52 during admission, viral load 88
copies.  Patient was continued on his home HAART regimen, as
well as prophylactic Bactrim.  Patient will likely require
re-evaluation of his HAART regimen upon discharge.
.
# Pancytopenia: patient was noted to be pancytopenic during his
hospital stay, and it is unclear if this is chronic.  This may
be related to his HIV, or other etiology, however this was not
worked up further due to patient's insistence to be transferred
to [**Hospital **] Hospital.
.
# Bradycardia: on [**2197-5-17**] patient had a pause on telemetry (8
seconds) with transient hypotension to the 80s and hypoxia to
the 80s which recovered within seconds.  Later in the evening he
had two episodes of bradycardia to the high 20s which was
self-limited within seconds and asymptomatic.  Electrolytes,
cardiac enzymes and EKG were within normal limits; a cardiology
consult was obtained and no further evaluation or intervention
was recommended.
.
# Head imaging abnormality: patient was noted to have lucencies
in the calvarium on head CT.  This was not worked up further due
to patient's insistence to be transferred to [**Hospital **] Hospital.
.
# End-stage renal disease on peritoneal dialysis: patient
presented with concern for peritoneal dialysis port site
infection, with purulent fluid coming from the site.  Cultures
were obtained via diagnostic paracentesis and were preliminarily
negative upon discharge.  Patient is on Calcitriol 0.5 and
sinacalcet 150 mg daily.  Renal was consulted for performance of
peritoneal dialysis while patient was hospitalized.  CBC should
be trended for further signs of infection.
.
# Anemia: likely combination of bone marrow suppression as well
as chronic kidney disease.  The patient recieved one unit RBCs
for Hct 22.9 with an appropriate bump to 26.9.  Epoeitin was
held given concern for possible malignancy on head CT.
.
INACTIVE ISSUES
---------------
# Hypertension: patient is on lisinopril and amolodipine at
home.  His home blood pressure medications were resumed after
they were initially held due to his presenting sepsis-like
picture.
.
TRANSITION OF CARE
------------------
# Follow-up: patient will be discharged to [**Hospital **] Hospital per
his request.  Patient will require antibiotics to finish course
of antibiotics for community acquired pneumonia.  Blood cultures
and peritoneal cultures are currently pending and will need to
be followed up.  There was also concern for malignancy of CT
head that will need to be followed up.  This was not addressed
during the [**Hospital 228**] hospital stay given his refusal for further
work-up.  He should receive CBC and Chem10 every day for
monitoring.  Epoietin is being held at the current time due to
the concern for malignancy on CT head.  This should be
re-evaluated in the near future.
.
# Code status: presumed full
.
# CONTACT: patient, [**Name (NI) **] (HCP) [**Telephone/Fax (1) 4034**]
.


Medications on Admission:
Calcium Carbonate 600''
Lamivudine 50'
Epoetin Alfa [**Numeric Identifier 389**] monthly SQ
Gentamicin cream apply daily to the exit site
Lisinopril 10'
Norvasc 10' (hold for hypotension)
PhosLo 3 tabs with meals 667'''
Potassium Salts 10'
Prilosec 20'
Rocaltrol 0.5 mcg'
Sensipar 150'
Viread 300 PO Qweek
Zerit 15'
Zyprexa 5'

Discharge Medications:
1. lamivudine 10 mg/mL Solution Sig: Fifty (50) milligrams PO
DAILY (Daily).
2. calcium carbonate 600 mg (1,500 mg) Tablet Sig: One (1)
Tablet PO twice a day.
3. lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

5. PhosLo 667 mg Capsule Sig: One (1) Capsule PO three times a
day: Please give with meals.
6. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
7. calcitriol 0.5 mcg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
8. cinacalcet 30 mg Tablet Sig: Five (5) Tablet PO DAILY
(Daily).
9. tenofovir disoproxil fumarate 300 mg Tablet Sig: One (1)
Tablet PO 1X/WEEK (MO).
10. stavudine 15 mg Capsule Sig: One (1) Capsule PO Q24H (every
24 hours).
11. olanzapine 2.5 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
12. sulfamethoxazole-trimethoprim 800-160 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily).
13. moxifloxacin 400 mg Tablet Sig: One (1) Tablet PO daily ()
for 5 days.


Discharge Disposition:
Extended Care

Discharge Diagnosis:
Primary diagnosis:
Community-acquired pneumonia
Bradycardia

Secondary diagnosis:
delirium/ metabolic encephalopathy
HIV/AIDS
chronic kidney disease stage V, on peritoneal dialysis
Anemia of chronic disease
Hypertension


Discharge Condition:
Mental Status: Confused - sometimes.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Dear Mr. [**Known lastname 122**],

It was a pleasure caring for you at the [**Hospital1 827**].  You came for further evaluation of altered
mental status and hypothermia.  Further testing showed that you
had a pneumonia, for which you are being treated with
antibiotics.  There was also concern for infection of your
peritoneal dialysis insertion site.  Cultures were obtained from
this area, and revealed no evidence of infection.  You are now
being discharged to [**Hospital **] Hospital for further treatment.
Dr. [**First Name (STitle) 4035**] at [**Hospital **] Hospital was contact[**Name (NI) **] and accepted the
patient for transfer.

The following changes have been made to your medications:

We STARTED Bactrim
We STARTED moxifloxacin, which should be taken for five days
total
We STOPPED Epoeitin for the time being, which should be further
re-evaluated in the future

Followup Instructions:
Please call Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] office at [**Telephone/Fax (1) 673**] to
schedule a follow-up appointment in ~2 weeks after discharge.

                             [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**]
{'Human immunodeficiency virus [HIV] disease,End stage renal disease,Pneumonia, organism unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Viral hepatitis B without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta,Complications of transplanted kidney,Dementia in conditions classified elsewhere with behavioral disturbance,Hypothermia not associated with low environmental temperature,Constipation, unspecified,Personal history of noncompliance with medical treatment, presenting hazards to health,Eye globe replaced by other means,Personal history of other infectious and parasitic diseases,Hyperparathyroidism, unspecified,Accidents occurring in other specified places,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Anemia in chronic kidney disease,Other specified cardiac dysrhythmias,Other encephalopathy,Procedure not carried out for other reasons'}


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: Hypothermia, altered mental status

PRESENT ILLNESS: 49M with HBV, HCV and ESRD [**1-11**] HIV on dialysis for 25 years
presents with purulent drainage from around the peritoneal
dialysis catheter with an exposed cuff.  He dialyzes himself at
home and follows up at [**Hospital 4029**] Clinic sporadically.  He presented
to [**Hospital 4029**] Clinic today and was sent to [**Hospital1 18**] ED for the exposed
catheter cuff and exit site infection.  The peritoneal dialysis
catheter is working and he reports clear output.

MEDICAL HISTORY: * HIV
- diagnosed HIV+ in [**2178**] while he was in Guantanamo Bay.  He
received political asylum.  He feels his HIV infection was the
result of receipt of blood transfusions as a result of injuries
sustained while being interrogated in a jail in [**Country 2045**]. He
sustained several gunshot
wounds and lacerations, as well as blunt trauma. He reported
having CMV retinitis of the R eye that was diagnosed in [**2186**]. It
was treated with a ganciclovir implant, but was further
complicated by chronic pain that resulted in enucleation.  He
also had a work up for a pulmonary nodule in [**2178**], that
ultimately was felt to be consistent with latent TB infection,
and he was treated with 6 months of INH therapy in one report,
up to a year in another.  He also had pneumococcal sepsis in
[**2185**]."
* Hepatitis B
* Venous thromboembolism
* Depressive disorder & anxiety
* CMV infection
* History of tuberculosis
* chronic kidney disease stage V due to HIV, on peritoneal
dialysis, followed at [**Last Name (un) 4029**] in [**Location (un) **] on [**State **] St.
* Chronic constipation
* h/o XRT at MEEI for SCC in his left ear
* Hypertension
* Syphilis [**Month (only) **] l993 c/b neurosyphilis, treated with IV
penicillin x10days
* Hepatitis C antibody positive
* s/p PD catheter placement [**2190**], numerous HD catheters and AV
fistulas; all failed

MEDICATION ON ADMISSION: Calcium Carbonate 600''
Lamivudine 50'
Epoetin Alfa [**Numeric Identifier 389**] monthly SQ
Gentamicin cream apply daily to the exit site
Lisinopril 10'
Norvasc 10' (hold for hypotension)
PhosLo 3 tabs with meals 667'''
Potassium Salts 10'
Prilosec 20'
Rocaltrol 0.5 mcg'
Sensipar 150'
Viread 300 PO Qweek
Zerit 15'
Zyprexa 5'

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On admission:
Vitals: 96.7 (92.8 on repeat) 66 156/98 22 100% 3L
GEN: A&O, NAD
HEENT: No scleral icterus, mucus membranes moist
CV: RRR, No M/G/R
PULM: bilateral crackles at lung bases R>L, decreased breath
sounds
ABD: Soft, nondistended, nontender, no rebound or guarding,
normoactive bowel sounds, some purulence produced with milking
of
skin around catheter, no surrounding cellulitis, no palpable
masses
DRE: patient refused
Ext: RUE/LUE AVF sites thrombosed per patient, LLE/RLE
(?removed)
AVG sites

FAMILY HISTORY: Noncontributory to HIV/MS changes

SOCIAL HISTORY: Tobacco [**12-11**] PPDx 20 years, no ETOH, unemployed and lives alone
in an apartment and he has CMA nursing help at home. No crack
use
or other drug use. 

### Response:
{'Human immunodeficiency virus [HIV] disease,End stage renal disease,Pneumonia, organism unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Viral hepatitis B without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta,Complications of transplanted kidney,Dementia in conditions classified elsewhere with behavioral disturbance,Hypothermia not associated with low environmental temperature,Constipation, unspecified,Personal history of noncompliance with medical treatment, presenting hazards to health,Eye globe replaced by other means,Personal history of other infectious and parasitic diseases,Hyperparathyroidism, unspecified,Accidents occurring in other specified places,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Anemia in chronic kidney disease,Other specified cardiac dysrhythmias,Other encephalopathy,Procedure not carried out for other reasons'}
