CHIEF COMPLAINT: shortness of breath and leg swelling

PRESENT ILLNESS: Ms. [**Known lastname 68459**] is a 49yo woman with h/o HCV cirrhosis s/p TIPS who
was directly admitted from clinic on [**9-7**] with shortness of
breath and LE edema. Prior to presentation, her home lasix had
been stopped due to hyponatremia. She also notes that her
dyspnea has increased since her aldactone was stopped in
mid-[**Month (only) **] because of hyperkalemia. She was therefore
initially felt to be fluid overloaded and given lasix and then
albumin/lasix [**Hospital1 **] for diuresis.
.
The team obtained LE ultrasound and CTA chest, which were
negative for DVT or PE. Because of concern for possible
pneumonia on her CXR, she started treatment with vancomycin and
ceftriaxone on [**9-13**] (switched to vanc/ceftazidime [**9-14**]).
.
She has had a complicated hospital course, and has been followed
by ID, Orhopedics, and Psychiatry. The team obtained plain films
of her knee and hips because of a known h/o hip infection and
persistent leukocytosis. [**Month/Day (4) 1957**] was consulted and MRIs obtained,
concerning for right hip infection (where she has hardware from
an arthroplasty). She was found to have E coli from her right
hip aspirate, and zosyn was started on [**9-15**]. Because of
difficulties with hypoglycemia, she was started on stress dose
steroids given concern for adrenal insufficiency.
.
The night prior to transfer, Ms. [**Known lastname 68459**] was triggered for acute
hypoxia. She was found to be blue with pulse ox in the 50s in
RA. She improved with lasix and oxygen. Per report, she had an
episode of scant hemoptysis (not witnessed by MD). However, she
continued to have an increasing oxygen requirement through the
day and was transferred to the MICU for further care.
.
Upon arrival to the ICU, she continued to feel somewhat out of
breath.

MEDICAL HISTORY: 1.HCV Cirrhosis s/p TIPS [**11-9**] for ascites. Complicated by
encephalopathy, thrombocyotpenia, ascites, and hydrothorax.
Currently on [**Month/Year (2) **] list.
2.Hyponatremia baseline 128-133
3.Secondary adrenal insufficiency
4.asthma
5.DM
6.GERD
7.Anxiety
8.h/o UTI's
9.Hip fx and L4 compression Fx on [**2157-11-6**] s/p ORIF of hip fx.
10.Prolactinoma

MEDICATION ON ADMISSION: Albuterol nebs q6hrs PRN
Ergocalciferol 50,000units PO QMWF
Fluticasone-Salmeterol 250mcg-50mcg [**Hospital1 **]
Insulin: glargine 40units QAM, lispro SS
Lidoderm patch daily
Singulair 10mg daily - Holding
MVI daily
Omeprazole 20mg daily
OxyContin 15mg QAM, 10mg QPM - MODIFIED
Oxycodone 5mg PO Q6hrs PRN - Holding
Prednisone 5mg PO daily
Rifaximin 400mg PO TID
Bactrim DS 800mg-160mg PO TID - Holding
Venlafaxine 75mg PO daily
Calcium carbonate 1000mg PO TID
Folic acid 1mg PO daily
Off her diuretics (spironolactone and lasix [**1-7**] hyponatremia)

ALLERGIES: Shellfish / Flexeril / Tricyclic Compounds

PHYSICAL EXAM: VS - 97.8 104 126/69 27 95% 6L
GENERAL - frail-appearing woman who appears anxious, she is
mildly tachypneic and has some distress when speaking.
HEENT - Pupils equal, EOMI, sclerae anicteric, MMM, OP clear,
+spider angiomata
NECK - supple, +JVD to angle of jaw when sitting at 45 degrees
LUNGS - crackles throughout lung fields b/l
HEART - Regular tachycardia with systolic murmur
ABDOMEN - +BS, soft/NT, no rebound/guarding
EXTREMITIES - warm with 2-3+ pitting BLE edema to above knees
R hip is tender to palpation and with movement at hip joint (leg
roll)
SKIN - spider angiomata
NEURO - awake, appropriate, A&Ox3, slight asterixis present

FAMILY HISTORY: Mother w/ DM2, HTN, and hyperlipidemia.
Father w/ COPD and EtOH cirrhosis

SOCIAL HISTORY: The patient is single with one child, she was living in a
chronic care facility, [**Hospital1 **] [**Hospital1 3894**] Nursing Facility in [**Location (un) 29158**] prior to admission. She is currently on disability,
formerly a waitress.
Illicits: Past IV drug use with needle sharing, last use 7 years
ago. Past drug-snorting.
Alcohol: Past alcohol use, last drink at age 46.
Tobacco: Past smoker with 10 pack-year history
Chronic hepatitis C with hepatic coma,Acute respiratory failure,Other ascites,Infection and inflammatory reaction due to internal joint prosthesis,Hyposmolality and/or hyponatremia,Glucocorticoid deficiency,Aseptic necrosis of bone, other,Acquired coagulation factor deficiency,Blood in stool,Cirrhosis of liver without mention of alcohol,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Hip joint replacement,Other sequelae of chronic liver disease,Asthma, unspecified type, unspecified,Anemia of other chronic disease,Benign neoplasm of pituitary gland and craniopharyngeal duct,Personal history of tobacco use,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Hypotension, unspecified,Pain in joint, lower leg,Backache, unspecified,Other chronic pulmonary heart diseases
Chrnc hpt C w hepat Coma,Acute respiratry failure,Ascites NEC,React-inter joint prost,Hyposmolality,Glucocorticoid deficient,Asept necrosis bone NEC,Acq coagul factor defic,Blood in stool,Cirrhosis of liver NOS,Abn react-anastom/graft,Joint replaced hip,Oth sequela, chr liv dis,Asthma NOS,Anemia-other chronic dis,Benign neo pituitary,History of tobacco use,DMII oth nt st uncntrld,Long-term use of insulin,Hypotension NOS,Joint pain-l/leg,Backache NOS,Chr pulmon heart dis NEC
Name:  [**Known lastname 11763**],[**Known firstname 511**] M                 Unit No:   [**Numeric Identifier 11764**]

Admission Date:  [**2158-9-7**]              Discharge Date:   [**2158-10-2**]

Date of Birth:  [**2109-1-23**]             Sex:   F

Service: MEDICINE

Allergies:
Shellfish / Flexeril / Tricyclic Compounds

Attending:[**First Name3 (LF) 4091**]
Addendum:
Mrs.[**Known lastname 11776**] fluid overload was secondary to low serum albumin
which was secondary to hepatitis C cirrhosis.

Discharge Disposition:
Extended Care

Facility:
[**Hospital **] rehab

                             [**First Name8 (NamePattern2) 1558**] [**Last Name (NamePattern1) **] MD [**MD Number(1) 2301**]

Completed by:[**2158-10-19**]

Admission Date:  [**2158-9-7**]              Discharge Date:   [**2158-10-2**]

Date of Birth:  [**2109-1-23**]             Sex:   F

Service: MEDICINE

Allergies:
Shellfish / Flexeril / Tricyclic Compounds

Attending:[**First Name3 (LF) 1377**]
Chief Complaint:
shortness of breath and leg swelling

Major Surgical or Invasive Procedure:
removal of hardware from right hip


History of Present Illness:
Ms. [**Known lastname 68459**] is a 49yo woman with h/o HCV cirrhosis s/p TIPS who
was directly admitted from clinic on [**9-7**] with shortness of
breath and LE edema. Prior to presentation, her home lasix had
been stopped due to hyponatremia. She also notes that her
dyspnea has increased since her aldactone was stopped in
mid-[**Month (only) **] because of hyperkalemia. She was therefore
initially felt to be fluid overloaded and given lasix and then
albumin/lasix [**Hospital1 **] for diuresis.
.
The team obtained LE ultrasound and CTA chest, which were
negative for DVT or PE. Because of concern for possible
pneumonia on her CXR, she started treatment with vancomycin and
ceftriaxone on [**9-13**] (switched to vanc/ceftazidime [**9-14**]).
.
She has had a complicated hospital course, and has been followed
by ID, Orhopedics, and Psychiatry. The team obtained plain films
of her knee and hips because of a known h/o hip infection and
persistent leukocytosis. [**Month/Day (4) 1957**] was consulted and MRIs obtained,
concerning for right hip infection (where she has hardware from
an arthroplasty). She was found to have E coli from her right
hip aspirate, and zosyn was started on [**9-15**]. Because of
difficulties with hypoglycemia, she was started on stress dose
steroids given concern for adrenal insufficiency.
.
The night prior to transfer, Ms. [**Known lastname 68459**] was triggered for acute
hypoxia. She was found to be blue with pulse ox in the 50s in
RA. She improved with lasix and oxygen. Per report, she had an
episode of scant hemoptysis (not witnessed by MD). However, she
continued to have an increasing oxygen requirement through the
day and was transferred to the MICU for further care.
.
Upon arrival to the ICU, she continued to feel somewhat out of
breath.


Past Medical History:
1.HCV Cirrhosis s/p TIPS [**11-9**] for ascites. Complicated by
encephalopathy, thrombocyotpenia, ascites, and hydrothorax.
Currently on [**Month/Year (2) **] list.
2.Hyponatremia baseline 128-133
3.Secondary adrenal insufficiency
4.asthma
5.DM
6.GERD
7.Anxiety
8.h/o UTI's
9.Hip fx and L4 compression Fx on [**2157-11-6**] s/p ORIF of hip fx.
10.Prolactinoma


Social History:
The patient is single with one child, she was living in a
chronic care facility, [**Hospital1 **] [**Hospital1 3894**] Nursing Facility in [**Location (un) 29158**] prior to admission. She is currently on disability,
formerly a waitress.
Illicits: Past IV drug use with needle sharing, last use 7 years
ago. Past drug-snorting.
Alcohol: Past alcohol use, last drink at age 46.
Tobacco: Past smoker with 10 pack-year history


Family History:
Mother w/ DM2, HTN, and hyperlipidemia.
Father w/ COPD and EtOH cirrhosis

Physical Exam:
VS - 97.8 104 126/69 27 95% 6L
GENERAL - frail-appearing woman who appears anxious, she is
mildly tachypneic and has some distress when speaking.
HEENT - Pupils equal, EOMI, sclerae anicteric, MMM, OP clear,
+spider angiomata
NECK - supple, +JVD to angle of jaw when sitting at 45 degrees
LUNGS - crackles throughout lung fields b/l
HEART - Regular tachycardia with systolic murmur
ABDOMEN - +BS, soft/NT, no rebound/guarding
EXTREMITIES - warm with 2-3+ pitting BLE edema to above knees
R hip is tender to palpation and with movement at hip joint (leg
roll)
SKIN - spider angiomata
NEURO - awake, appropriate, A&Ox3, slight asterixis present


Pertinent Results:
[**2158-9-11**] MRI hip
1) Very limited study for reasons stated above.

2) Small residual or recurrent fluid collection within the soft
tissues
lateral and superior to the proximal aspect of the right hip
prosthesis
contiguous with the prosthesis, though intra-articular extent
cannot be
established on this study. Susceptibility artifact from the
prosthesis limits
evaluation for a hip joint effusion, though no large effusion is
directly
visualized.

3) Severe diffuse subcutaneous edema/anasarca as well as deep
interfascial and
muscular edema throughout the right thigh. No deep abscess/focal
fluid
collection.

[**9-8**]
bilateral hip xray
Since the prior study, interval continued periostitis and
erosion of the
lateral aspect of the proximal femur. This is worrisome for
continuing
infection

Brief Hospital Course:
Pt is a 49-yo woman w/ HCV cirrhosis s/p TIPS, c/b ascites,
encephalopathy, thrombocytopenia, and hepatic hydrothorax,
currently on [**Month/Day (4) **] list w/ MELD 15, directly admitted from
clinic w/ worsening BLE edema and SOB in setting of being off
diuretics due to hyperkalemia and hyponatremia. Transferred to
MICU [**2158-9-16**] for progressively worsening hypoxia and dyspnea
(See MICU course below)
.
#. SOB and BLE edema - Likely [**1-7**] fluid overload in setting of
being off diuretics. CXR does not reveal pulm edema or pleural
effusions as expected. Improved significantly w/ diuresis and
addition of albumin. She improved for several days w/ diuresis
but then her platelet count dropped and she developed
hemoptysis, after which her O2 sats dropped, CXR demonstrated
alveolar and interstitial opacities and she was transferred to
the ICU for further management of her hypoxia. She was intubated
in the ICU and diuresed for several days after her sugery, her
oxygenation slowly improved and she was extubated and
transferred to the floor. By the time she was transferred back
to the floor her edema was significantly improved.
.
#. Septic arthritis: Pt. had been on bactrim suppression for
CONS infxn of hardware, but got increasing hip pain and low
grade temps. Hip was tapped and grew E. coli resistant to
everything except pip/tazo and amikacin. Dr. [**Last Name (STitle) 497**] held long
family meeting w/ pt. and discussed her poor prognosis w/ her
and code status. She decided to go ahead w/ all interventions
and to be full code. She recieved a right hip explant of all
hardware w/ placement of an abx spacer and continued on
vancomycin and meropenem per ID for a total 6-week course.
.
#. Hyponatremia - Hypoalbuminemia vs. adrenal insufficiency. She
was given albumin along w/ hydrocortisone for combination of
persistent hypoglycemia and hyponatremia.
.
#. Headache - Pt. complained of pain and locking of her jaw
while chewing. She was seen by dentistry who suggested that it
might be TMJ and that she should avoid chewy foods and possibly
get a night guard for her mouth.
.
#. Anemia - Appears anemia of liver disease, Hct trended slowly
downward and on day of transfer to MICU was 21.1. An NG tube was
placed in the ICU and she hemorrhaged from her nose and required
multiple transfusions before it stopped.
.
#. HCV cirrhosis - Pt w/ HCV cirrhosis s/p TIPS, c/b
encephalopathy, thrombocytopenia, ascites, and hepatic
hydrothorax. Currently on [**Last Name (STitle) **] list, will need to complete
antibiotic treatment and have hip replaced before she can get a
[**Last Name (STitle) **].
.
#. Pain: Oxycontin with oxycodone for breathrough was continued.
 Lidoderm patches were also continued.
.
#. Asthma - was continued on her montelukast and advair along w/
albuterol and ipratropium nebs.
.
#. Diabetes: Glargine dose was cut from 40U on admission to 20 U
QD because the pt. presented w/ persistent hypoglycemia. She
will be discharged on 25 units at bedtime and a humalog sliding
scale.
.
#. Secondary adrenal insufficiency - continued home prednisone,
started stress dose hydrocortisone for persistent
hypoglycemia/hyponatremia which was tapered back to home dose
after 2 doses of stress dose.
.
#. GERD - home PPI was continued.
.
#. Depression / anxiety - continue home Effexor psych was
consulted per [**Last Name (STitle) **] coordinators request.
.
#. Osteopenia - continue home Vitamin D and Calcium carbonate
.
#. FEN - diabetic low-protein diet, albumin tonight then resume
diuresis, electrolyte repletion
.
MICU Course
Patient transferred to MICU on [**9-16**] for progressively worsening
hypoxic respiratory failure requiring intubation [**9-16**]. Chest CT
and CXR c/w diffuse airspace consolidation which was thought to
be multifactorial secondary to ARDS/[**Doctor Last Name **], pulmonary edema +/-
infection. BAL [**9-18**] was negative for infection. She was
intermittently diuresed on Lasix gtt and with Lasix IV prn and
was continued on antibiotics (Vanc/[**Last Name (un) **] for hip infection). She
was continued on standing and prn ALbuterol and Atrovent MDIs
while intubated with improvement in respiratory exam but
persistent R pleural effusion which will be tapped by IP
[**2158-9-27**] prior to transfer. Pt extubated on [**2158-9-23**] and is
currently satting in high 90s on 2L nasal cannula, continued on
home inhalers and Advair.

On [**2158-9-16**] she developed severe epistaxis when placement of NGT
was attempted with drop of HCT to 17 requiring 5 units PRBC to
maintain stable HCT. She was seen by ENT who performed anterior
nasal packing which was removed after 5 days. She was transfused
to keep patelets >[**Numeric Identifier 1871**] due to h/o bleed. There were no further
episodes of bleeding.

Meropenem and Vancomycin were continued for hip infection and
had removal of hardware with explant and replacement with
antibiotic spacer on [**2158-9-19**].  She will need total 6 week
course of ABx after procedure. Intraop cx grew Enterococcus
sensitive to Vanc and Coag neg staph. She was afebrile during
MICU course. Periprocedure was given stress dose steroids which
were tapered to home PO prednisone. PLanned removal of stitches
after 3 weeks and was restarted on home PO pain medication
regimen after extubation.

She was started on Captopril for HTN. She was tolerating PO diet
at time of transfer with clear mental status. RIJ which was
placed [**9-20**] was DC'd [**9-27**]. PICC placed [**9-17**].

ID, [**Month/Year (2) 1957**], and Hepatology continued to follow.


Medications on Admission:
Albuterol nebs q6hrs PRN
Ergocalciferol 50,000units PO QMWF
Fluticasone-Salmeterol 250mcg-50mcg [**Hospital1 **]
Insulin: glargine 40units QAM, lispro SS
Lidoderm patch daily
Singulair 10mg daily - Holding
MVI daily
Omeprazole 20mg daily
OxyContin 15mg QAM, 10mg QPM - MODIFIED
Oxycodone 5mg PO Q6hrs PRN - Holding
Prednisone 5mg PO daily
Rifaximin 400mg PO TID
Bactrim DS 800mg-160mg PO TID - Holding
Venlafaxine 75mg PO daily
Calcium carbonate 1000mg PO TID
Folic acid 1mg PO daily
Off her diuretics (spironolactone and lasix [**1-7**] hyponatremia)


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] rehab

Discharge Diagnosis:
primary:  septic arthritis, hepatitis C cirrhosis
secondary: asthma, diabetes mellitus, GERD


Discharge Condition:
stable


Discharge Instructions:
You were admitted for shortness of breath and lower extremity
edema.  You were found to have an infection in your hip joint.
The hardware was removed. You will require 6 weeks of IV
antibiotics for treatment at which point you will return for
replacement of your hip joint. At that time, you can be relisted
on the tranplant list.
.
Please return to hospital for fevers/chills or other concerning
signs or symptoms of infection.

Followup Instructions:
Provider: [**Name10 (NameIs) **] XRAY (SCC 2) Phone:[**Telephone/Fax (1) 1228**]
Date/Time:[**2158-10-19**] 10:50
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 457**]
Date/Time:[**2158-10-27**] 10:00
Provider: [**Name10 (NameIs) **] [**Hospital 1389**] CLINIC Phone:[**Telephone/Fax (1) 673**]
Date/Time:[**2158-10-18**] 2:20


                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(1) 1379**]

Completed by:[**2158-10-3**]
{'Chronic hepatitis C with hepatic coma,Acute respiratory failure,Other ascites,Infection and inflammatory reaction due to internal joint prosthesis,Hyposmolality and/or hyponatremia,Glucocorticoid deficiency,Aseptic necrosis of bone, other,Acquired coagulation factor deficiency,Blood in stool,Cirrhosis of liver without mention of alcohol,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Hip joint replacement,Other sequelae of chronic liver disease,Asthma, unspecified type, unspecified,Anemia of other chronic disease,Benign neoplasm of pituitary gland and craniopharyngeal duct,Personal history of tobacco use,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Hypotension, unspecified,Pain in joint, lower leg,Backache, unspecified,Other chronic pulmonary heart diseases'}


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: shortness of breath and leg swelling

PRESENT ILLNESS: Ms. [**Known lastname 68459**] is a 49yo woman with h/o HCV cirrhosis s/p TIPS who
was directly admitted from clinic on [**9-7**] with shortness of
breath and LE edema. Prior to presentation, her home lasix had
been stopped due to hyponatremia. She also notes that her
dyspnea has increased since her aldactone was stopped in
mid-[**Month (only) **] because of hyperkalemia. She was therefore
initially felt to be fluid overloaded and given lasix and then
albumin/lasix [**Hospital1 **] for diuresis.
.
The team obtained LE ultrasound and CTA chest, which were
negative for DVT or PE. Because of concern for possible
pneumonia on her CXR, she started treatment with vancomycin and
ceftriaxone on [**9-13**] (switched to vanc/ceftazidime [**9-14**]).
.
She has had a complicated hospital course, and has been followed
by ID, Orhopedics, and Psychiatry. The team obtained plain films
of her knee and hips because of a known h/o hip infection and
persistent leukocytosis. [**Month/Day (4) 1957**] was consulted and MRIs obtained,
concerning for right hip infection (where she has hardware from
an arthroplasty). She was found to have E coli from her right
hip aspirate, and zosyn was started on [**9-15**]. Because of
difficulties with hypoglycemia, she was started on stress dose
steroids given concern for adrenal insufficiency.
.
The night prior to transfer, Ms. [**Known lastname 68459**] was triggered for acute
hypoxia. She was found to be blue with pulse ox in the 50s in
RA. She improved with lasix and oxygen. Per report, she had an
episode of scant hemoptysis (not witnessed by MD). However, she
continued to have an increasing oxygen requirement through the
day and was transferred to the MICU for further care.
.
Upon arrival to the ICU, she continued to feel somewhat out of
breath.

MEDICAL HISTORY: 1.HCV Cirrhosis s/p TIPS [**11-9**] for ascites. Complicated by
encephalopathy, thrombocyotpenia, ascites, and hydrothorax.
Currently on [**Month/Year (2) **] list.
2.Hyponatremia baseline 128-133
3.Secondary adrenal insufficiency
4.asthma
5.DM
6.GERD
7.Anxiety
8.h/o UTI's
9.Hip fx and L4 compression Fx on [**2157-11-6**] s/p ORIF of hip fx.
10.Prolactinoma

MEDICATION ON ADMISSION: Albuterol nebs q6hrs PRN
Ergocalciferol 50,000units PO QMWF
Fluticasone-Salmeterol 250mcg-50mcg [**Hospital1 **]
Insulin: glargine 40units QAM, lispro SS
Lidoderm patch daily
Singulair 10mg daily - Holding
MVI daily
Omeprazole 20mg daily
OxyContin 15mg QAM, 10mg QPM - MODIFIED
Oxycodone 5mg PO Q6hrs PRN - Holding
Prednisone 5mg PO daily
Rifaximin 400mg PO TID
Bactrim DS 800mg-160mg PO TID - Holding
Venlafaxine 75mg PO daily
Calcium carbonate 1000mg PO TID
Folic acid 1mg PO daily
Off her diuretics (spironolactone and lasix [**1-7**] hyponatremia)

ALLERGIES: Shellfish / Flexeril / Tricyclic Compounds

PHYSICAL EXAM: VS - 97.8 104 126/69 27 95% 6L
GENERAL - frail-appearing woman who appears anxious, she is
mildly tachypneic and has some distress when speaking.
HEENT - Pupils equal, EOMI, sclerae anicteric, MMM, OP clear,
+spider angiomata
NECK - supple, +JVD to angle of jaw when sitting at 45 degrees
LUNGS - crackles throughout lung fields b/l
HEART - Regular tachycardia with systolic murmur
ABDOMEN - +BS, soft/NT, no rebound/guarding
EXTREMITIES - warm with 2-3+ pitting BLE edema to above knees
R hip is tender to palpation and with movement at hip joint (leg
roll)
SKIN - spider angiomata
NEURO - awake, appropriate, A&Ox3, slight asterixis present

FAMILY HISTORY: Mother w/ DM2, HTN, and hyperlipidemia.
Father w/ COPD and EtOH cirrhosis

SOCIAL HISTORY: The patient is single with one child, she was living in a
chronic care facility, [**Hospital1 **] [**Hospital1 3894**] Nursing Facility in [**Location (un) 29158**] prior to admission. She is currently on disability,
formerly a waitress.
Illicits: Past IV drug use with needle sharing, last use 7 years
ago. Past drug-snorting.
Alcohol: Past alcohol use, last drink at age 46.
Tobacco: Past smoker with 10 pack-year history 

### Response:
{'Chronic hepatitis C with hepatic coma,Acute respiratory failure,Other ascites,Infection and inflammatory reaction due to internal joint prosthesis,Hyposmolality and/or hyponatremia,Glucocorticoid deficiency,Aseptic necrosis of bone, other,Acquired coagulation factor deficiency,Blood in stool,Cirrhosis of liver without mention of alcohol,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Hip joint replacement,Other sequelae of chronic liver disease,Asthma, unspecified type, unspecified,Anemia of other chronic disease,Benign neoplasm of pituitary gland and craniopharyngeal duct,Personal history of tobacco use,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Hypotension, unspecified,Pain in joint, lower leg,Backache, unspecified,Other chronic pulmonary heart diseases'}
