CHIEF COMPLAINT: Altered mental status

PRESENT ILLNESS: History obtained via pt.'s family at bedside as pt. sleeping and
unable to answer questions with any consistency. This is a 83
year-old man with a history of myeloma who presents from [**Hospital 100**]
Rehab with fever to 100.1, lethargy, tachypnea. He has been on
vanc/zosyn for known health-care associated PNA since [**10-18**] and
flagyl for C. difficile colitis, which was restarted [**10-18**] after
a period off of it. He received one dose of imipenum at [**Hospital1 5595**]
prior to being sent to [**Hospital1 18**]. Apparently had known C. diff.
treated for two weeks, with recrudescence of diarrhea about a
week after flagyl stopped. His family reports confusion,
difficulty putting sentences together, lethargy, decreased
appetite and diarrhea over the last week. Diarrhea has improved.
He has had a stable unproductive cough, only associated with
taking pos over the last few weeks. Wife [**Name (NI) 19913**] multiple
episodes of liquid-associated coughing. In addition, he has
sacral decub stage 2 on coccyx. He received one dose of imipenem
and was transferred to ED.
.
In the ED, he had initial vitals of 98.6 BP 134/76 HR 110 RR 32
96% on 3L, 91%RA. He had WBC to 17.9 with 3% bands, Cr to 1.3
(nl BL<1.0), lactate 3.2 and had blood cx. drawn. U/A negative
and received 2L IVFs and stress-dose steroids given chronic
prednisone for myeloma.
.
ROS: + weight change (weight loss over last year), no nausea,
vomiting, abdominal pain, + diarrhea, as above that is
improving, constipation, melena, hematochezia, chest pain, mild
shortness of breath. no orthopnea, PND, lower extremity edema,
urinary sx. no HA rash.

MEDICAL HISTORY: - Hypertension
- BPH
- Hypercholesterolemia
- B12 def dx'd 2y ago by PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 311**]
- Grade I diastolic dysfunction by echo in [**10-26**]
- Myeloma/MDS: Kappa light chain myeloma. Presented with MGUS
[**2100**] without evidence of end organ damage. Initially observed
until [**2102**] when monoclonal protein rose and patient treated with
6 cycles melphalan/prednisone. Patient remained stable until
[**2104**] when protein rose again and was treated with 8 cycles
melphalan/prednisone finishing [**9-25**]. He then remained off
treatment until [**9-26**] when began to develop anemia/bone pain.
Found to have smear consistent with MDS involving all 3
lineages. Began treatment with velcade/revalmid and epo, then
mephalan/prednisone d/c'd earlier this year due to inability to
tolerate. Also had T9 and T11 involvement s/p radiation in [**2107**].
He was receiving treatment for his Myeloma until [**Month (only) **]
[**2108**]/dexamethasone/revlamide/alkaran but it was dc'ed [**12-22**] to
inability to tolerate regimen.
- h/o hyponatremia
- h/o multiple PNAs requiring hospitalization
- h/o C.Diff.

MEDICATION ON ADMISSION: - vancomycin IV 1gq12h
- zosyn q6h, switched to imipenem as above
- flagyl 500tid
- prednisone 15mg qdaily
- lactobacillus
- Caco3 650 [**Hospital1 **]
- VitD 1000 U qdaily
- cyanocobalamin 500mcg qod
- atrovent
- lactobacillus
- Mg oxide 400bid
- Megace 400 [**Hospital1 **]
- omeprazole 40bid
- KCL 20meQ tid po
- NaCl 1g qdaily
- Bactrim DS 1 tab q MWF
- tylenol PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 97.8 BP: 96/47 HR: 94 RR: 19 O2Sat: 98%/3L
GEN: elderly man, sleeping, cachetic, follows commands, AA&Ox1.
Answers some questions clearly, but mumbled rambling for others

FAMILY HISTORY: No FH of malignancies.

SOCIAL HISTORY: Retired accountant, lives at [**Hospital **] rehab. No tobacco now or
previously, no etoh now or previously.
Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Multiple myeloma, without mention of having achieved remission,Candidiasis of mouth,Chronic diastolic heart failure,Intestinal infection due to Clostridium difficile,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Other B-complex deficiencies,Hypercalcemia,Pressure ulcer, lower back,Thrombocytopenia, unspecified
Food/vomit pneumonitis,Acute kidney failure NOS,Mult mye w/o achv rmson,Thrush,Chr diastolic hrt fail,Int inf clstrdium dfcile,Hypertension NOS,BPH w/o urinary obs/LUTS,B-complex defic NEC,Hypercalcemia,Pressure ulcer, low back,Thrombocytopenia NOS
Admission Date:  [**2109-10-25**]              Discharge Date:   [**2109-10-31**]

Date of Birth:  [**2025-12-15**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5119**]
Chief Complaint:
Altered mental status

Major Surgical or Invasive Procedure:
none

History of Present Illness:
History obtained via pt.'s family at bedside as pt. sleeping and
unable to answer questions with any consistency. This is a 83
year-old man with a history of myeloma who presents from [**Hospital 100**]
Rehab with fever to 100.1, lethargy, tachypnea. He has been on
vanc/zosyn for known health-care associated PNA since [**10-18**] and
flagyl for C. difficile colitis, which was restarted [**10-18**] after
a period off of it. He received one dose of imipenum at [**Hospital1 5595**]
prior to being sent to [**Hospital1 18**]. Apparently had known C. diff.
treated for two weeks, with recrudescence of diarrhea about a
week after flagyl stopped. His family reports confusion,
difficulty putting sentences together, lethargy, decreased
appetite and diarrhea over the last week. Diarrhea has improved.
He has had a stable unproductive cough, only associated with
taking pos over the last few weeks. Wife [**Name (NI) 19913**] multiple
episodes of liquid-associated coughing. In addition, he has
sacral decub stage 2 on coccyx. He received one dose of imipenem
and was transferred to ED.
.
In the ED, he had initial vitals of 98.6 BP 134/76 HR 110 RR 32
96% on 3L, 91%RA. He had WBC to 17.9 with 3% bands, Cr to 1.3
(nl BL<1.0), lactate 3.2 and had blood cx. drawn. U/A negative
and received 2L IVFs and stress-dose steroids given chronic
prednisone for myeloma.
.
ROS: + weight change (weight loss over last year), no nausea,
vomiting, abdominal pain, + diarrhea, as above that is
improving, constipation, melena, hematochezia, chest pain, mild
shortness of breath. no orthopnea, PND, lower extremity edema,
urinary sx. no HA rash.




Past Medical History:
- Hypertension
- BPH
- Hypercholesterolemia
- B12 def dx'd 2y ago by PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 311**]
- Grade I diastolic dysfunction by echo in [**10-26**]
- Myeloma/MDS: Kappa light chain myeloma. Presented with MGUS
[**2100**] without evidence of end organ damage. Initially observed
until [**2102**] when monoclonal protein rose and patient treated with
6 cycles melphalan/prednisone. Patient remained stable until
[**2104**] when protein rose again and was treated with 8 cycles
melphalan/prednisone finishing [**9-25**]. He then remained off
treatment until [**9-26**] when began to develop anemia/bone pain.
Found to have smear consistent with MDS involving all 3
lineages. Began treatment with velcade/revalmid and epo, then
mephalan/prednisone d/c'd earlier this year due to inability to
tolerate. Also had T9 and T11 involvement s/p radiation in [**2107**].
He was receiving treatment for his Myeloma until [**Month (only) **]
[**2108**]/dexamethasone/revlamide/alkaran but it was dc'ed [**12-22**] to
inability to tolerate regimen.
- h/o hyponatremia
- h/o multiple PNAs requiring hospitalization
- h/o C.Diff.


Social History:
Retired accountant, lives at [**Hospital **] rehab. No tobacco now or
previously, no etoh now or previously.


Family History:
No FH of malignancies.

Physical Exam:
Vitals: T: 97.8 BP: 96/47 HR: 94 RR: 19 O2Sat: 98%/3L
GEN: elderly man, sleeping, cachetic, follows commands, AA&Ox1.
Answers some questions clearly, but mumbled rambling for others

HEENT: EOMI, PERRL, sclera anicteric, no epistaxis or
rhinorrhea, MMM, OP with thrush
NECK: No JVD, carotid pulses brisk, no bruits, no cervical
lymphadenopathy, trachea midline
COR: RRR, no M/G/R, normal S1 S2, radial pulses +2
PULM: Lungs with decreased BS at R base., sl. crackles at bases,
improve with cough
ABD: Soft, NT, ND, +BS, no HSM, no masses
EXT: No C/C/E, multiple ecchymoses over arms and legs
bilaterally
NEURO: CN II ?????? XII grossly intact. Moves all 4 extremities.
Skin: stage 2 decub over coccyx


Pertinent Results:
Admission Labs
[**2109-10-25**] 03:50PM
PT-17.6* PTT-32.1 INR(PT)-1.6*
PLT SMR-VERY LOW PLT COUNT-53*#
HYPOCHROM-NORMAL ANISOCYT-1+ POIKILOCY-NORMAL MACROCYT-NORMAL
MICROCYT-NORMAL POLYCHROM-1+
NEUTS-55 BANDS-3 LYMPHS-29 MONOS-0 EOS-0
BASOS-0 ATYPS-10* METAS-1* MYELOS-2*
WBC-17.9*# RBC-3.51* HGB-10.7* HCT-30.3*
MCV-86# MCH-30.5 MCHC-35.4* RDW-16.8*
OSMOLAL-312* ALBUMIN-1.9* CALCIUM-9.3
PHOSPHATE-3.0 MAGNESIUM-1.9
LIPASE-18
ALT(SGPT)-7 AST(SGOT)-30 ALK PHOS-45 TOT BILI-0.4
estGFR-Using this
GLUCOSE-144* UREA N-35* CREAT-1.3* SODIUM-138 POTASSIUM-4.9
CHLORIDE-112* TOTAL CO2-21* ANION GAP-10
LACTATE-3.7*

[**2109-10-25**] 04:54PM URINE
AMORPH-MANY CA OXAL-OCC
RBC-0 WBC-0 BACTERIA-MOD YEAST-NONE EPI-0
BOOD-NEG NITRITE-NEG PROTEIN-30 GLUCOSE-NEG KETONE-TR
BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 LEUK-NEG
COLOR-Yellow APPEAR-Cloudy SP [**Last Name (un) 155**]-1.017

CXR [**10-25**]
IMPRESSION: Moderate pulmonary edema and more focal
consolidation in the
right lower lobe, which may represent superimposed pneumonia


Brief Hospital Course:
Altered mental status:   Patient initially admitted to ICU for
close monitoring before being transferred to the inpatient floor
the following day.  Initially it was thought the patient may
have a worsening pneumonia.  Patient was noted to be aspirating
with copious secretions.  The patient failed speech and swallow
evaluation.  Work up for altered mental status was done,
including cultures, head CT, metabolic problems was all
neagtive.  In the end the altered mental status was believed to
be a result of severe deconditioning from multiple acute medical
problems on top of his multiple myeloma/MDS.  There was not much
else that we could do for the patient.  The family did not want
to put the patient through any uncomfortable procedures such as
an LP.  They did not want a feeding tube placed.  The patient
was not a candidate for any treatment for his myeloma.
Palliative care consult was obtained and after careful
discussion the family made the decision to make the patient CMO.
 All nonessential meds were stopped and the patient expired
peacefully on [**2109-10-31**].
.


Medications on Admission:
- vancomycin IV 1gq12h
- zosyn q6h, switched to imipenem as above
- flagyl 500tid
- prednisone 15mg qdaily
- lactobacillus
- Caco3 650 [**Hospital1 **]
- VitD 1000 U qdaily
- cyanocobalamin 500mcg qod
- atrovent
- lactobacillus
- Mg oxide 400bid
- Megace 400 [**Hospital1 **]
- omeprazole 40bid
- KCL 20meQ tid po
- NaCl 1g qdaily
- Bactrim DS 1 tab q MWF
- tylenol PRN


Discharge Medications:
Patient expired

Discharge Disposition:
Expired

Discharge Diagnosis:
Patient expired

Discharge Condition:
Patient expired

Discharge Instructions:
Patient expired

Followup Instructions:
Patient expired

                             [**First Name7 (NamePattern1) 1569**] [**Initial (NamePattern1) **] [**Name8 (MD) **] MD [**MD Number(2) 5122**]

Completed by:[**2109-11-3**]
{'Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Multiple myeloma, without mention of having achieved remission,Candidiasis of mouth,Chronic diastolic heart failure,Intestinal infection due to Clostridium difficile,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Other B-complex deficiencies,Hypercalcemia,Pressure ulcer, lower back,Thrombocytopenia, unspecified'}


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: Altered mental status

PRESENT ILLNESS: History obtained via pt.'s family at bedside as pt. sleeping and
unable to answer questions with any consistency. This is a 83
year-old man with a history of myeloma who presents from [**Hospital 100**]
Rehab with fever to 100.1, lethargy, tachypnea. He has been on
vanc/zosyn for known health-care associated PNA since [**10-18**] and
flagyl for C. difficile colitis, which was restarted [**10-18**] after
a period off of it. He received one dose of imipenum at [**Hospital1 5595**]
prior to being sent to [**Hospital1 18**]. Apparently had known C. diff.
treated for two weeks, with recrudescence of diarrhea about a
week after flagyl stopped. His family reports confusion,
difficulty putting sentences together, lethargy, decreased
appetite and diarrhea over the last week. Diarrhea has improved.
He has had a stable unproductive cough, only associated with
taking pos over the last few weeks. Wife [**Name (NI) 19913**] multiple
episodes of liquid-associated coughing. In addition, he has
sacral decub stage 2 on coccyx. He received one dose of imipenem
and was transferred to ED.
.
In the ED, he had initial vitals of 98.6 BP 134/76 HR 110 RR 32
96% on 3L, 91%RA. He had WBC to 17.9 with 3% bands, Cr to 1.3
(nl BL<1.0), lactate 3.2 and had blood cx. drawn. U/A negative
and received 2L IVFs and stress-dose steroids given chronic
prednisone for myeloma.
.
ROS: + weight change (weight loss over last year), no nausea,
vomiting, abdominal pain, + diarrhea, as above that is
improving, constipation, melena, hematochezia, chest pain, mild
shortness of breath. no orthopnea, PND, lower extremity edema,
urinary sx. no HA rash.

MEDICAL HISTORY: - Hypertension
- BPH
- Hypercholesterolemia
- B12 def dx'd 2y ago by PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 311**]
- Grade I diastolic dysfunction by echo in [**10-26**]
- Myeloma/MDS: Kappa light chain myeloma. Presented with MGUS
[**2100**] without evidence of end organ damage. Initially observed
until [**2102**] when monoclonal protein rose and patient treated with
6 cycles melphalan/prednisone. Patient remained stable until
[**2104**] when protein rose again and was treated with 8 cycles
melphalan/prednisone finishing [**9-25**]. He then remained off
treatment until [**9-26**] when began to develop anemia/bone pain.
Found to have smear consistent with MDS involving all 3
lineages. Began treatment with velcade/revalmid and epo, then
mephalan/prednisone d/c'd earlier this year due to inability to
tolerate. Also had T9 and T11 involvement s/p radiation in [**2107**].
He was receiving treatment for his Myeloma until [**Month (only) **]
[**2108**]/dexamethasone/revlamide/alkaran but it was dc'ed [**12-22**] to
inability to tolerate regimen.
- h/o hyponatremia
- h/o multiple PNAs requiring hospitalization
- h/o C.Diff.

MEDICATION ON ADMISSION: - vancomycin IV 1gq12h
- zosyn q6h, switched to imipenem as above
- flagyl 500tid
- prednisone 15mg qdaily
- lactobacillus
- Caco3 650 [**Hospital1 **]
- VitD 1000 U qdaily
- cyanocobalamin 500mcg qod
- atrovent
- lactobacillus
- Mg oxide 400bid
- Megace 400 [**Hospital1 **]
- omeprazole 40bid
- KCL 20meQ tid po
- NaCl 1g qdaily
- Bactrim DS 1 tab q MWF
- tylenol PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 97.8 BP: 96/47 HR: 94 RR: 19 O2Sat: 98%/3L
GEN: elderly man, sleeping, cachetic, follows commands, AA&Ox1.
Answers some questions clearly, but mumbled rambling for others

FAMILY HISTORY: No FH of malignancies.

SOCIAL HISTORY: Retired accountant, lives at [**Hospital **] rehab. No tobacco now or
previously, no etoh now or previously. 

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Multiple myeloma, without mention of having achieved remission,Candidiasis of mouth,Chronic diastolic heart failure,Intestinal infection due to Clostridium difficile,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Other B-complex deficiencies,Hypercalcemia,Pressure ulcer, lower back,Thrombocytopenia, unspecified'}
