CHIEF COMPLAINT: mental status changes

PRESENT ILLNESS: 47yo M with extensive past medical history, including HIV/AIDS,
Hepatitis B & C, Cirrhosis, Seizures, and Schizophrenia,
presented to [**Hospital1 18**] ED from NH with mental status changes. FBS
was 50 during ambulance transport, he was given 1 amp of
dextrose and arrived to ED lethargic, with red RLE and FBS in
the 170s. In the ED, US (-) for DVT, CTOH (-) for hemorrhage, CT
abdomen / pelivs revealed: markedly distended gallbladder with
cholelithiasis and significant intra- and extrahepatic biliary
dilatation, likely related to choledocholithiasis and CBD
obstruction. No CT evidence of gallbladder wall thickening or
perforation, though free fluid was noted. No associated
pancreatic ductal dilatation. Probable hepatic cirrhosis and
portal hypertension with varices and mild splenomegaly. As a
result of these findings, he underwent an ERCP with stent
placement and stone removal at the lower third of the common
bile duct, and was transferred to the SICU upon completion of
the procedure.

MEDICAL HISTORY: HIV, last CD4 91 in [**2174**], not on HAART
Polysubstance abuse.
S/p gunshot wound to the head resulting in schizophrenia,
seizures and left sided weakness.
History of migraines.
H/o cirrhosis secondary to hep B with mild transaminitis
HCV positive.
History of anemia
Recurrent LLE DVT x2, was previously on Coumadin.
H/o cellulitis and MSSA bacteremia.
Recurrent bacterial pneumonia.
Chronic neuropathic pain.
History of typhlitis with neutropenia.
Inflammatory colitis without a diagnosis.
Dementia
s/p pelvic fracture
Rectal sinus tract

MEDICATION ON ADMISSION: 

ALLERGIES: Compazine

PHYSICAL EXAM: gen:
heent:
cv:
pulm:
abd:
ext:
neuro:

FAMILY HISTORY: He has one brother who had an MI at the age of 39 and who also
has a history of polysubstance abuse. One sister. Mother died
from a stroke. Father died from colon cancer.

SOCIAL HISTORY: The patient was born in [**Location (un) **], [**State 350**]. Previously
homeless, currently resides in [**Location (un) **] Manor. Has previously
stayed in multiple shelters. History of smoking 2ppd x20 years.
Prior alcohol use, quit 5 years ago. Past IV heroin use, now on
methadone for maintenance, clinic is [**Location (un) 583**] Marine.
Cholangitis,Calculus of bile duct without mention of cholecystitis, without mention of obstruction,Intestinal infection due to Clostridium difficile,Hyposmolality and/or hyponatremia,Human immunodeficiency virus [HIV] disease,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Cirrhosis of liver without mention of alcohol,Unspecified schizophrenia, unspecified,Opioid type dependence, continuous,Epilepsy, unspecified, without mention of intractable epilepsy
Cholangitis,Choledocholithiasis NOS,Int inf clstrdium dfcile,Hyposmolality,Human immuno virus dis,Hpt B chrn wo cm wo dlta,Cirrhosis of liver NOS,Schizophrenia NOS-unspec,Opioid dependence-contin,Epilep NOS w/o intr epil
Admission Date:  [**2180-7-19**]              Discharge Date:   [**2180-7-25**]

Date of Birth:  [**2133-1-5**]             Sex:   M

Service: SURGERY

Allergies:
Compazine

Attending:[**First Name3 (LF) 668**]
Chief Complaint:
mental status changes

Major Surgical or Invasive Procedure:
ERCP stent placement and stone removal


History of Present Illness:
47yo M with extensive past medical history, including HIV/AIDS,
Hepatitis B & C, Cirrhosis, Seizures, and Schizophrenia,
presented to [**Hospital1 18**] ED from NH with mental status changes. FBS
was 50 during ambulance transport, he was given 1 amp of
dextrose and arrived to ED lethargic, with red RLE and FBS in
the 170s. In the ED, US (-) for DVT, CTOH (-) for hemorrhage, CT
abdomen / pelivs revealed: markedly distended gallbladder with
cholelithiasis and significant intra- and extrahepatic biliary
dilatation, likely related to choledocholithiasis and CBD
obstruction. No CT evidence of gallbladder wall thickening or
perforation, though free fluid was noted. No associated
pancreatic ductal dilatation. Probable hepatic cirrhosis and
portal hypertension with varices and mild splenomegaly. As a
result of these findings, he underwent an ERCP with stent
placement and stone removal at the lower third of the common
bile duct, and was transferred to the SICU upon completion of
the procedure.


Past Medical History:
HIV, last CD4 91 in [**2174**], not on HAART
Polysubstance abuse.
S/p gunshot wound to the head resulting in schizophrenia,
seizures and left sided weakness.
History of migraines.
H/o cirrhosis secondary to hep B with mild transaminitis
HCV positive.
History of anemia
Recurrent LLE DVT x2, was previously on Coumadin.
H/o cellulitis and MSSA bacteremia.
Recurrent bacterial pneumonia.
Chronic neuropathic pain.
History of typhlitis with neutropenia.
Inflammatory colitis without a diagnosis.
Dementia
s/p pelvic fracture
Rectal sinus tract

Social History:
The patient was born in [**Location (un) **], [**State 350**]. Previously
homeless, currently resides in [**Location (un) **] Manor. Has previously
stayed in multiple shelters. History of smoking 2ppd x20 years.
Prior alcohol use, quit 5 years ago. Past IV heroin use, now on
methadone for maintenance, clinic is [**Location (un) 583**] Marine.


Family History:
He has one brother who had an MI at the age of 39 and who also
has a history of polysubstance abuse. One sister. Mother died
from a stroke. Father died from colon cancer.


Physical Exam:
gen:
heent:
cv:
pulm:
abd:
ext:
neuro:

Pertinent Results:
[**2180-7-19**] 10:57PM   GLUCOSE-60* UREA N-21* CREAT-0.8 SODIUM-131*
POTASSIUM-4.6 CHLORIDE-106 TOTAL CO2-20* ANION GAP-10
[**2180-7-19**] 10:57PM   ALT(SGPT)-77* AST(SGOT)-98* LD(LDH)-257* ALK
PHOS-103 AMYLASE-124* TOT BILI-6.0*
[**2180-7-19**] 10:57PM   LIPASE-154*
[**2180-7-19**] 10:57PM   ALBUMIN-2.8* CALCIUM-8.4 PHOSPHATE-2.7
MAGNESIUM-1.9
[**2180-7-19**] 10:57PM   WBC-6.8 RBC-4.10* HGB-11.1* HCT-32.7* MCV-80*
MCH-27.2 MCHC-34.1 RDW-21.2*
[**2180-7-19**] 10:57PM   PT-22.9* PTT-47.1* INR(PT)-2.3*
[**2180-7-19**] 12:12PM URINE  bnzodzpn-NEG barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-POS
[**2180-7-19**] 11:40AM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.016
[**2180-7-19**] 11:40AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-SM UROBILNGN-NEG PH-7.0
LEUK-NEG
[**2180-7-19**] 11:20AM   LACTATE-1.7
[**2180-7-19**] 11:00AM   GLUCOSE-79 UREA N-29* CREAT-0.9 SODIUM-129*
POTASSIUM-4.9 CHLORIDE-102 TOTAL CO2-22 ANION GAP-10

Brief Hospital Course:
Admitted to SICU following ERCP with stent placement (6cm by
10Fr Cotton-[**Doctor Last Name **] biliary stent) and stone removal. He tolerated
the procedure well with no complications. He was initially
placed on vancomycin and zosyn IV, and ID was consulted to
provide further recommendations regarding antibiotic therapy. He
was switched to unasyn IV on [**7-21**], to complete 10d total course
of IV antibiotics. He remained hemodynamically stable while in
the ICU. Total bilirubin was noted to decrease from 6/0 to 4.1
following stent placement. HIV viral load (955), CD4 count, CMV
viral load (not detected), stool (including Cdiff) and urine
cultures were taken. Cultures, except for Cdiff, were negative.
Due to postive Cdiff the patient was started on po Flagyl on
[**7-21**]. He received a workup for ?diabetes insipidus or SIADH due
to Na=128, workup was negative. He remained in the SICU x48h and
was then transferred to the floor. He remained on cethadone and
fentanyl patch for pain control, continuing previously
prescribed dosages for these medications. He also continued on
antiretroviral regimen. On the floor, he tolerated a regular
diet, was able to ambulate independently, urinate without
difficulty, and reported adequate pain control. Per ID
recommendations, the patient will receive a total of 10days of
IV antibiotics. On discharge ([**7-25**]), he has thus received [**6-20**]
days. He will be discharged to [**Location (un) **] Manor with a peripheral
IV and will receive IV unasyn x3 more days. He will continue
Flagyl 500mg po tid until [**8-11**] (14 days after unasyn is
completed). His coumadin will be managed by PCP Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5762**]
[**Telephone/Fax (1) 608**]. He will continue methadone and fentanyl patch for
pain management.

Discharge Disposition:
Extended Care

Facility:
[**Location (un) **] Manor

Discharge Diagnosis:
acute cholangitis
HIV/AIDS
Cdiff


Discharge Condition:
stable


Discharge Instructions:
Please call Dr.[**Name (NI) 670**] office [**Telephone/Fax (1) 673**] if fevers, chills,
nausea, vomiting, jaundice, abdominal pain.
Continue IV unasyn x3more days ([**2089-7-26**], 17), then stop.
Continue Flagyl 500mg po tid until [**8-11**] (2 wks after unasyn
stops)
Coumadin dosing to be managed by PCP [**Name Initial (PRE) **] [**Name10 (NameIs) **] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5762**]
[**Telephone/Fax (1) 608**]
Patient will continue on methadone and fentanyl patch for pain
control

Followup Instructions:
X SUITE GI ROOMS Date/Time:[**2180-9-28**] 9:00
[**Name6 (MD) 1948**] [**Last Name (NamePattern4) 1949**], MD Phone:[**Telephone/Fax (1) 463**] Date/Time:[**2180-9-28**]
9:00
[**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1330**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2180-8-4**] 3:00



Completed by:[**2180-7-25**]
{'Cholangitis,Calculus of bile duct without mention of cholecystitis, without mention of obstruction,Intestinal infection due to Clostridium difficile,Hyposmolality and/or hyponatremia,Human immunodeficiency virus [HIV] disease,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Cirrhosis of liver without mention of alcohol,Unspecified schizophrenia, unspecified,Opioid type dependence, continuous,Epilepsy, unspecified, without mention of intractable epilepsy'}


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: mental status changes

PRESENT ILLNESS: 47yo M with extensive past medical history, including HIV/AIDS,
Hepatitis B & C, Cirrhosis, Seizures, and Schizophrenia,
presented to [**Hospital1 18**] ED from NH with mental status changes. FBS
was 50 during ambulance transport, he was given 1 amp of
dextrose and arrived to ED lethargic, with red RLE and FBS in
the 170s. In the ED, US (-) for DVT, CTOH (-) for hemorrhage, CT
abdomen / pelivs revealed: markedly distended gallbladder with
cholelithiasis and significant intra- and extrahepatic biliary
dilatation, likely related to choledocholithiasis and CBD
obstruction. No CT evidence of gallbladder wall thickening or
perforation, though free fluid was noted. No associated
pancreatic ductal dilatation. Probable hepatic cirrhosis and
portal hypertension with varices and mild splenomegaly. As a
result of these findings, he underwent an ERCP with stent
placement and stone removal at the lower third of the common
bile duct, and was transferred to the SICU upon completion of
the procedure.

MEDICAL HISTORY: HIV, last CD4 91 in [**2174**], not on HAART
Polysubstance abuse.
S/p gunshot wound to the head resulting in schizophrenia,
seizures and left sided weakness.
History of migraines.
H/o cirrhosis secondary to hep B with mild transaminitis
HCV positive.
History of anemia
Recurrent LLE DVT x2, was previously on Coumadin.
H/o cellulitis and MSSA bacteremia.
Recurrent bacterial pneumonia.
Chronic neuropathic pain.
History of typhlitis with neutropenia.
Inflammatory colitis without a diagnosis.
Dementia
s/p pelvic fracture
Rectal sinus tract

MEDICATION ON ADMISSION: 

ALLERGIES: Compazine

PHYSICAL EXAM: gen:
heent:
cv:
pulm:
abd:
ext:
neuro:

FAMILY HISTORY: He has one brother who had an MI at the age of 39 and who also
has a history of polysubstance abuse. One sister. Mother died
from a stroke. Father died from colon cancer.

SOCIAL HISTORY: The patient was born in [**Location (un) **], [**State 350**]. Previously
homeless, currently resides in [**Location (un) **] Manor. Has previously
stayed in multiple shelters. History of smoking 2ppd x20 years.
Prior alcohol use, quit 5 years ago. Past IV heroin use, now on
methadone for maintenance, clinic is [**Location (un) 583**] Marine. 

### Response:
{'Cholangitis,Calculus of bile duct without mention of cholecystitis, without mention of obstruction,Intestinal infection due to Clostridium difficile,Hyposmolality and/or hyponatremia,Human immunodeficiency virus [HIV] disease,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Cirrhosis of liver without mention of alcohol,Unspecified schizophrenia, unspecified,Opioid type dependence, continuous,Epilepsy, unspecified, without mention of intractable epilepsy'}
