CHIEF COMPLAINT: transferred from [**Location (un) **] after presenting with altered mental
status

PRESENT ILLNESS: The pt is an 81M w/ CAD, hypercholesterolemia, who was brought
to [**Location (un) **] by his son for altered mental status. Yesterday he
reportedly had several episodes of vomiting but this improved
somewhat by this morning. When his son came home ~3:30pm he
found the pt on the floor, staring into space and minimally
responsive. He brought him to [**Location (un) **] where he was tachycardic
and hypotensive to 70/60. He was given Vanco/Levo/Flagyl/gent
and Decadron for presumed sepsis and was intubated, presumably
for airway protection and for sedation for scanning (according
to his daughter). Head CT was negative. Abd CT showed a
distended colon with fluid and fecal material, no bowel wall
thickening or edema and no pneumatosis; mild pericolic fat
induration in the left lateral mid abdomen and proximal to mid
descending colon; and fecal impaction in the rectum. He received
6L IVF resuscitation and peripheral dopamine was started for
hypotension to the 70s. He was then Medflighted to [**Hospital1 18**] for
further management.
.
In the ED, a RIJ central line was placed. He received further
fluid resuscitation and was disimpacted. Peripheral dopamine was
continued and he was transferred to the [**Hospital Unit Name 153**] intubated and
sedated. On arrival, an axillary arterial line was placed in the
right arm and dopamine was changed to Levophed and vasopressin
was added.

MEDICAL HISTORY: HTN
IBS
hernia repair
hip Fx [**9-14**]
hypercholesterolemia
MI s/p stent at [**Hospital1 2025**] [**2162**]

MEDICATION ON ADMISSION: ASA
Crestor
lisinopril

ALLERGIES: Heparin Agents / Penicillins / Iodine Containing Agents
Classifier

PHYSICAL EXAM: VS: 97.0, 122, 86/57, 14, 96% 100% FiO2
Vent: AC, PEEP 5, FiO2 1.0, TV 550, RR 14
Gen: intubated, sedated, not responsive to commands
HEENT: pupils equal, round, sluggishly reactive to light, EOMI
Lungs: CTAB
CV: tachycardic, RR, nl S1S2
Abd: hypoactive bowel sounds, markedly distended, soft,
tympanitic
Ext: cool, mottled, no clubbing

FAMILY HISTORY: unknown

SOCIAL HISTORY: lives with son
Unspecified septicemia,Septic shock,Acute kidney failure, unspecified,Acute respiratory failure,Other impaction of intestine,Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction,Other and unspecified hyperlipidemia,Irritable bowel syndrome
Septicemia NOS,Septic shock,Acute kidney failure NOS,Acute respiratry failure,Impaction intestine NEC,SIRS-noninf w ac org dys,Hyperlipidemia NEC/NOS,Irritable bowel syndrome
Admission Date:  [**2170-1-13**]              Discharge Date:   [**2170-1-14**]

Date of Birth:  [**2088-12-20**]             Sex:   M

Service: MEDICINE

Allergies:
Heparin Agents / Penicillins / Iodine Containing Agents
Classifier

Attending:[**First Name3 (LF) 2485**]
Chief Complaint:
transferred from [**Location (un) **] after presenting with altered mental
status

Major Surgical or Invasive Procedure:
None

History of Present Illness:
The pt is an 81M w/ CAD, hypercholesterolemia, who was brought
to [**Location (un) **] by his son for altered mental status. Yesterday he
reportedly had several episodes of vomiting but this improved
somewhat by this morning. When his son came home ~3:30pm he
found the pt on the floor, staring into space and minimally
responsive. He brought him to [**Location (un) **] where he was tachycardic
and hypotensive to 70/60. He was given Vanco/Levo/Flagyl/gent
and Decadron for presumed sepsis and was intubated, presumably
for airway protection and for sedation for scanning (according
to his daughter). Head CT was negative. Abd CT showed a
distended colon with fluid and fecal material, no bowel wall
thickening or edema and no pneumatosis; mild pericolic fat
induration in the left lateral mid abdomen and proximal to mid
descending colon; and fecal impaction in the rectum. He received
6L IVF resuscitation and peripheral dopamine was started for
hypotension to the 70s. He was then Medflighted to [**Hospital1 18**] for
further management.
.
In the ED, a RIJ central line was placed. He received further
fluid resuscitation and was disimpacted. Peripheral dopamine was
continued and he was transferred to the [**Hospital Unit Name 153**] intubated and
sedated. On arrival, an axillary arterial line was placed in the
right arm and dopamine was changed to Levophed and vasopressin
was added.

Past Medical History:
HTN
IBS
hernia repair
hip Fx [**9-14**]
hypercholesterolemia
MI s/p stent at [**Hospital1 2025**] [**2162**]

Social History:
lives with son

Family History:
unknown

Physical Exam:
VS: 97.0, 122, 86/57, 14, 96% 100% FiO2
Vent: AC, PEEP 5, FiO2 1.0, TV 550, RR 14
Gen: intubated, sedated, not responsive to commands
HEENT: pupils equal, round, sluggishly reactive to light, EOMI
Lungs: CTAB
CV: tachycardic, RR, nl S1S2
Abd: hypoactive bowel sounds, markedly distended, soft,
tympanitic
Ext: cool, mottled, no clubbing


Pertinent Results:
[**2170-1-13**] 10:30PM   GLUCOSE-196* LACTATE-3.9* K+-4.2
[**2170-1-13**] 10:22PM   GLUCOSE-233* UREA N-46* CREAT-1.6* SODIUM-144
POTASSIUM-4.3 CHLORIDE-116* TOTAL CO2-15* ANION GAP-17
[**2170-1-13**] 10:22PM   estGFR-Using this
[**2170-1-13**] 10:22PM   CK(CPK)-165
[**2170-1-13**] 10:22PM   cTropnT-0.08*
[**2170-1-13**] 10:22PM   CK-MB-9
[**2170-1-13**] 10:22PM   WBC-3.6* RBC-5.03 HGB-15.1 HCT-43.4 MCV-86
MCH-30.1 MCHC-34.8 RDW-14.5
[**2170-1-13**] 10:22PM   NEUTS-36* BANDS-18* LYMPHS-28 MONOS-7 EOS-0
BASOS-1 ATYPS-10* METAS-0 MYELOS-0
[**2170-1-13**] 10:22PM   PLT COUNT-129*
[**2170-1-13**] 10:22PM   PT-16.5* PTT-38.7* INR(PT)-1.5*
[**2170-1-13**] 10:22PM   FIBRINOGE-422* D-DIMER-1450*
[**2170-1-13**] 10:22PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.013
[**2170-1-13**] 10:22PM URINE  BLOOD-LG NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-TR BILIRUBIN-SM UROBILNGN-1 PH-6.5 LEUK-NEG
[**2170-1-13**] 10:22PM URINE  RBC->50 WBC-21-50* BACTERIA-FEW
YEAST-NONE EPI-1
[**2170-1-13**] 10:22PM URINE  GRANULAR-0-2
.
CT Abdomen/Pelvis
IMPRESSION:
1. Dilated loops of large bowel with air-fluid levels suggestive
of [**Last Name (un) 3696**] or large bowel obstruction. Small amount of
intraperitoneal fluid in the pelvis.
2. Small bilateral pleural effusions and associated atelectasis.
3. 1.2 cm hypodensity in the spleen, which is not characterized
well on this non-contrast study, but likely a hemangioma.
4. Cholelithiasis, without CT evidence of cholecystitis.


Brief Hospital Course:
This in an 81 yo M with a pmh of CAD, [**Hospital **] transferred from OSH
for sepsis. The source of sepsis was unclear. However, bowel
etiology was likely given the abdominal distension on physical
exam. Other possible etiology considered were PNA or urosepsis.
He was started on broad coverage antibiotics, vasopressors and
fluids were continued.  The patient was evaluated by surgery for
possible intervention, however the decision was made not to go
to the OR immediately as there was no clear indication and the
pt. performance status was poor and was high risk for surgery.
The patient also needed respiritory support with a ventilator.
After discussion with his daughter (HCP) and other family
members the decision was made to focus on comfort measures.
Vasopressors, fluids, antibiotics were stopped, ventilator
support was withdrawn in accordance with the wishes of the
family. The patient expired peacefully. The family agreed to a
autopsy to further investigate the cause of death.


Medications on Admission:
ASA
Crestor
lisinopril


Discharge Medications:
expired

Discharge Disposition:
Expired

Discharge Diagnosis:
expired

Discharge Condition:
expired

Discharge Instructions:
expired

Followup Instructions:
expired


Completed by:[**2170-1-16**]
{'Unspecified septicemia,Septic shock,Acute kidney failure, unspecified,Acute respiratory failure,Other impaction of intestine,Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction,Other and unspecified hyperlipidemia,Irritable bowel syndrome'}


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: transferred from [**Location (un) **] after presenting with altered mental
status

PRESENT ILLNESS: The pt is an 81M w/ CAD, hypercholesterolemia, who was brought
to [**Location (un) **] by his son for altered mental status. Yesterday he
reportedly had several episodes of vomiting but this improved
somewhat by this morning. When his son came home ~3:30pm he
found the pt on the floor, staring into space and minimally
responsive. He brought him to [**Location (un) **] where he was tachycardic
and hypotensive to 70/60. He was given Vanco/Levo/Flagyl/gent
and Decadron for presumed sepsis and was intubated, presumably
for airway protection and for sedation for scanning (according
to his daughter). Head CT was negative. Abd CT showed a
distended colon with fluid and fecal material, no bowel wall
thickening or edema and no pneumatosis; mild pericolic fat
induration in the left lateral mid abdomen and proximal to mid
descending colon; and fecal impaction in the rectum. He received
6L IVF resuscitation and peripheral dopamine was started for
hypotension to the 70s. He was then Medflighted to [**Hospital1 18**] for
further management.
.
In the ED, a RIJ central line was placed. He received further
fluid resuscitation and was disimpacted. Peripheral dopamine was
continued and he was transferred to the [**Hospital Unit Name 153**] intubated and
sedated. On arrival, an axillary arterial line was placed in the
right arm and dopamine was changed to Levophed and vasopressin
was added.

MEDICAL HISTORY: HTN
IBS
hernia repair
hip Fx [**9-14**]
hypercholesterolemia
MI s/p stent at [**Hospital1 2025**] [**2162**]

MEDICATION ON ADMISSION: ASA
Crestor
lisinopril

ALLERGIES: Heparin Agents / Penicillins / Iodine Containing Agents
Classifier

PHYSICAL EXAM: VS: 97.0, 122, 86/57, 14, 96% 100% FiO2
Vent: AC, PEEP 5, FiO2 1.0, TV 550, RR 14
Gen: intubated, sedated, not responsive to commands
HEENT: pupils equal, round, sluggishly reactive to light, EOMI
Lungs: CTAB
CV: tachycardic, RR, nl S1S2
Abd: hypoactive bowel sounds, markedly distended, soft,
tympanitic
Ext: cool, mottled, no clubbing

FAMILY HISTORY: unknown

SOCIAL HISTORY: lives with son 

### Response:
{'Unspecified septicemia,Septic shock,Acute kidney failure, unspecified,Acute respiratory failure,Other impaction of intestine,Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction,Other and unspecified hyperlipidemia,Irritable bowel syndrome'}
