CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 48-year-old male, with
hepatitis C cirrhosis, who was initially admitted on [**2130-6-6**] five days after a fall with some lightheadedness and
confusion.

MEDICAL HISTORY: Hepatitis C cirrhosis.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Hepatic encephalopathy,Acute and subacute necrosis of liver,Other specified septicemias,Other shock without mention of trauma,Complications of transplanted liver,Chronic hepatitis C without mention of hepatic coma,Congestive heart failure, unspecified,Acute kidney failure with lesion of tubular necrosis
Hepatic encephalopathy,Acute necrosis of liver,Septicemia NEC,Shock w/o trauma NEC,Compl liver transplant,Chrnc hpt C wo hpat coma,CHF NOS,Ac kidny fail, tubr necr
Admission Date:  [**2130-6-6**]       Death Date:  [**2130-8-18**]

Date of Birth:   [**2082-5-12**]       Sex:  M

Service:  TRANSPLANT SURGERY

HISTORY OF PRESENT ILLNESS:  This is a 48-year-old male, with
hepatitis C cirrhosis, who was initially admitted on [**2130-6-6**] five days after a fall with some lightheadedness and
confusion.

PAST MEDICAL HISTORY:  Hepatitis C cirrhosis.

MEDS AT HOME:
1. Paxil.
2. Tamoxifen.
3. Protonix.
4. Aldactone.
5. Lasix.

ALLERGIES:  No known drug allergies.

EXAM ON ADMISSION:  Temperature 98.7, pulse 84, blood
pressure 113/60, respiratory rate 18, sat 96% on room air.
GENERAL:  Pleasant, jaundiced-appearing man in no apparent
distress, speaking fluently but occasionally needing to
correct himself.
HEENT:  Sclerae are jaundiced.  Pupils equal, round and
reactive to light.  Extraocular movements intact.  Oropharynx
slightly dry.  Small ecchymosis right temple.
CHEST:  Dull at left base, otherwise clear to auscultation
bilaterally.
CARDIOVASCULAR:  Regular rate and rhythm, normal S1, S2, no
murmur.
ABDOMEN:  Obese, mildly distended, soft with positive bowel
sounds.
EXTREMITIES:  No edema.  There is a large ecchymosis along
the right lateral thigh, and a medium ecchymosis along the
lateral left upper arm.
NEURO:  Cranial nerve exam normal.  Finger-to-nose normal.
He has flap when his arms are extended.

LABS ON ADMISSION:  White count 5.7, hematocrit 33.3,
platelets 76.  PT, PTT 18.9 and 45.1, INR 2.4.  Sodium 129,
potassium 5.2, chloride 97, bicarb 26, BUN 6, creatinine 0.7,
glucose 399, ALT 24, AST 73, alk phos 131, amylase 50, T-bili
6.1.  CT head on admission - very small subdural hematoma
along the right cerebral hemisphere, appears subacute or
chronic, minimal mass effect.  Chest x-ray on admission -
moderate new left-sided pleural effusions.

INITIAL HOSPITAL COURSE:  The patient was admitted to the
medical service for follow-up of his newly diagnosed subdural
hematoma.  Over the course of the next few days, he developed
some fevers and a Staph aureus bacteremia which were treated
with broad-spectrum antibiotics.  Work-up for the source of
fever and bacteremia revealed only bilateral apical lung
consolidations.  Due to these complications, he demonstrated
decompensation of his end-stage liver disease, and on [**6-16**]
was found to have a liver donor.  At that point, he was
already afebrile, and there was no clear acute infection.  He
was still on broad-spectrum antibiotics.  On [**2130-6-16**], he
underwent an orthotopic liver transplant which he tolerated
well.

POSTOP COURSE SUMMARIZED AS FOLLOWS - 1) NEURO:  For most of
his hospital stay, since he was vent dependent, he was kept
sedated, and was on a dilaudid drip.  As his lung function
deteriorated, he was paralyzed as well.

2) CARDIOVASCULAR:  The patient had recurrent episodes of
sepsis in which he was hemodynamically unstable and required
significant pressor support to maintain blood pressure.

3) RESPIRATORY:  Since early postop, the patient developed
significant ARDS.  He failed early extubation on
postoperative day #5 and thereafter remained intubated,
severely hypoxic, and with bilateral patchy infiltrates on
chest x-ray.  Over the course of his hospitalization, due to
the low compliance of his lungs and the high pressures which
were required on the vent, he developed multiple
pneumothoraces on both sides, and multiple chest tubes were
placed to a total of five drains on the right and two chest
tubes on the left.

4) GI:  During his hospitalization, he received nutritional
support in the form of TPN, later tube feeds.

5) GU:  He developed renal failure, and two points during his
prolonged hospitalization attempts were made to place him on
CVVH.

6) ID:  During the course of his hospitalization, he grew
[**Female First Name (un) **] from a line, as well as yeast from the sputum, and
was treated with AmBisome.  He was kept on broad-spectrum
antibiotics with the ID service following.  CT chest/abdomen
demonstrated bilateral pneumonias, and no intra-abdominal
source of infection.

In the days prior to his death, he demonstrated worsening
renal function with increased vent pressures, in addition to
hemodynamic instability which required maximal pressor
support with levo, neo, vasopressin.  In view of a prolonged
and complicated course, and worsening multiorgan failure, his
family chose to withdraw care and make him comfort measures
only.  This was done on [**2130-8-18**], and he expired
shortly after.




                            [**Name6 (MD) 1344**] [**Name8 (MD) 1345**], M.D.  [**MD Number(1) 1346**]

Dictated By:[**Dictator Info 42841**]
MEDQUIST36

D:  [**2130-9-4**]  10:31
T:  [**2130-9-4**]  09:41
JOB#:  [**Job Number 42842**]
{'Hepatic encephalopathy,Acute and subacute necrosis of liver,Other specified septicemias,Other shock without mention of trauma,Complications of transplanted liver,Chronic hepatitis C without mention of hepatic coma,Congestive heart failure, unspecified,Acute kidney failure with lesion of tubular necrosis'}


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: 

PRESENT ILLNESS: This is a 48-year-old male, with
hepatitis C cirrhosis, who was initially admitted on [**2130-6-6**] five days after a fall with some lightheadedness and
confusion.

MEDICAL HISTORY: Hepatitis C cirrhosis.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Hepatic encephalopathy,Acute and subacute necrosis of liver,Other specified septicemias,Other shock without mention of trauma,Complications of transplanted liver,Chronic hepatitis C without mention of hepatic coma,Congestive heart failure, unspecified,Acute kidney failure with lesion of tubular necrosis'}
