CHIEF COMPLAINT: 

PRESENT ILLNESS: Patient is a 42-year-old white
male with past medical history significant for alcoholic
cirrhosis, chronic pancreatitis resulting in pancreatic
insufficiency, and insulin dependent-diabetes mellitus,
chronic renal failure with baseline creatinine of 4.0,
chronic thrombocytopenia, who has a recent admission to the
[**Hospital1 69**], who presented on
[**2155-8-13**] with acute onset fatigue, worsening dyspnea on
exertion, increased lower extremity edema, and decreased
urine output x3 days.

MEDICAL HISTORY: 1. Chronic alcoholic pancreatitis complicated by pseudocyst
in 10/99, resulted in pancreatic insufficiency and insulin
dependent-diabetes mellitus.
2. Insulin dependent-diabetes mellitus with nephropathy and
neuropathy:  Insulin dependent x3 years.  He had episodes of
diabetic ketoacidosis with an Intensive Care Unit admission
in 08/[**2154**].
3. Chronic renal failure with baseline creatinine of 4.0.
4. History of alcohol abuse, resulting in cirrhosis.
5. Hypertension.
6. Obstructive-sleep apnea on BiPAP at home.
7. History of bilateral nephrolithiasis, complicated by
development of pyelonephritis and urosepsis.
8. Anemia secondary to renal failure.
9. History of thrombocytopenia secondary to Haldol.
10. History of multiple perirectal abscesses, status post
multiple incision and drainage procedures.
11. History of ARDS in 10/99 with tracheostomy for six weeks;
developed ARDS during pancreatitis episode.  Complicated by
Pseudomonas pneumonia, pancreatic necrosis, Clostridium
difficile colitis, line sepsis, left lower extremity DVT,
Haldol induced thrombocytopenia.
12. History of left lower extremity DVT.
13. History of Clostridium difficile colitis.
14. History of right vocal cord paralysis.
15. Gastritis.
16. History of diabetic foot ulcers.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient reports allergies to Haldol resulting
in thrombocytopenia.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Former real estate [**Doctor Last Name 360**], current
unemployed.  Lives alone.  Smokes 1-1.5 packs per day x20
years.  Currently admits to five drinks of alcohol per week.
Denies any IV drug use or any recreational drug use.
Divorced with no children.
Acute kidney failure, unspecified,Methicillin susceptible Staphylococcus aureus septicemia,Other pulmonary insufficiency, not elsewhere classified,Alcoholic cirrhosis of liver,Disseminated candidiasis,Defibrination syndrome,Other shock without mention of trauma,Hepatic encephalopathy,Pneumonia, organism unspecified
Acute kidney failure NOS,Meth susc Staph aur sept,Other pulmonary insuff,Alcohol cirrhosis liver,Disseminated candidiasis,Defibrination syndrome,Shock w/o trauma NEC,Hepatic encephalopathy,Pneumonia, organism NOS
Admission Date:  [**2155-8-14**]     Discharge Date:  [**2155-8-17**]

Date of Birth:   [**2112-9-15**]     Sex:  M

Service:  [**Hospital1 **]

HISTORY OF PRESENT ILLNESS:  Patient is a 42-year-old white
male with past medical history significant for alcoholic
cirrhosis, chronic pancreatitis resulting in pancreatic
insufficiency, and insulin dependent-diabetes mellitus,
chronic renal failure with baseline creatinine of 4.0,
chronic thrombocytopenia, who has a recent admission to the
[**Hospital1 69**], who presented on
[**2155-8-13**] with acute onset fatigue, worsening dyspnea on
exertion, increased lower extremity edema, and decreased
urine output x3 days.

The patient was recently admitted at [**Hospital1 190**] from the period of [**2155-7-12**] to [**2155-7-16**] for
refractory lower extremity edema x2 weeks.  This admission
was also associated with a 25 pound weight gain with
increased abdominal girth and exertional shortness of breath,
and fatigue.  He was discharged home with decreased edema on
Lasix dose of 80 mg po bid, hydrochlorothiazide qod, along
with levofloxacin for urinary tract infection.  He now
returns reporting return of the fatigue, exertional dyspnea
on exertion, lower extremity edema for the past few days, and
decreased urine output.

On presentation, he denied any chest pain, fevers, abdominal
pain, cramps, or cough.  He reports baseline diarrhea which
is not changed.  He denied bright red blood per rectum,
melena, nausea, vomiting, hematemesis.  His last alcohol
intake was 24 hours prior to this admission.

Laboratories on admission were significant for a
BUN-creatinine ratio of 58/8.6, a troponin-T of -.42 with a
CK of 64, and a hematocrit on admission of 28 that dropped to
23.6 12 hours later.  Electrocardiogram was unchanged.
Rectal examination showed heme-negative stool.  Urine
electrolytes were not consistent with a prerenal etiology of
acute or on chronic renal failure, but of note, he had been
getting Lasix at home.  On examination, he was euvolemic.

PAST MEDICAL HISTORY:
1. Chronic alcoholic pancreatitis complicated by pseudocyst
in 10/99, resulted in pancreatic insufficiency and insulin
dependent-diabetes mellitus.
2. Insulin dependent-diabetes mellitus with nephropathy and
neuropathy:  Insulin dependent x3 years.  He had episodes of
diabetic ketoacidosis with an Intensive Care Unit admission
in 08/[**2154**].
3. Chronic renal failure with baseline creatinine of 4.0.
4. History of alcohol abuse, resulting in cirrhosis.
5. Hypertension.
6. Obstructive-sleep apnea on BiPAP at home.
7. History of bilateral nephrolithiasis, complicated by
development of pyelonephritis and urosepsis.
8. Anemia secondary to renal failure.
9. History of thrombocytopenia secondary to Haldol.
10. History of multiple perirectal abscesses, status post
multiple incision and drainage procedures.
11. History of ARDS in 10/99 with tracheostomy for six weeks;
developed ARDS during pancreatitis episode.  Complicated by
Pseudomonas pneumonia, pancreatic necrosis, Clostridium
difficile colitis, line sepsis, left lower extremity DVT,
Haldol induced thrombocytopenia.
12. History of left lower extremity DVT.
13. History of Clostridium difficile colitis.
14. History of right vocal cord paralysis.
15. Gastritis.
16. History of diabetic foot ulcers.

MEDICATIONS PRIOR TO ADMISSION:
1. Insulin-sliding scale.
2. Calcium carbonate 500 mg po tid with meals.
3. Nephrocaps one cap po q day.
4. Protonix.
5. Epogen 5,000 units subQ 2x/week administered on Tuesdays
and Fridays.
6. Folic acid 1 mg po q day.
7. Pancrease three caps po tid with meals.
8. Sodium bicarbonate 1300 mg po tid.
9. NPH 10 units q am.
10. Hydrochlorothiazide 12.5 mg qod.
11. Lasix 80 mg po bid.

ALLERGIES:  The patient reports allergies to Haldol resulting
in thrombocytopenia.

SOCIAL HISTORY:  Former real estate [**Doctor Last Name 360**], current
unemployed.  Lives alone.  Smokes 1-1.5 packs per day x20
years.  Currently admits to five drinks of alcohol per week.
Denies any IV drug use or any recreational drug use.
Divorced with no children.

PHYSICAL EXAM UPON ADMISSION:  Vital signs:  Temperature of
96.3, blood pressure 116/70, heart rate 96, respiratory rate
12, oxygen saturation 100% on 2 liters face mask.  General
appearance:  Supine, well-developed white male in no apparent
distress, disheveled, peeling skin.  HEENT:  Normocephalic,
atraumatic.  Skin on face scaly, pupils are equal, round, and
reactive to light and accommodation.  Extraocular eye
movements intact.  Eyes and sclerae icteric.  Oropharynx
clear.  Pulmonary examination:  Bibasilar rales, occasional
expiratory wheeze.  Coronary examination:  Regular, rate, and
rhythm, no murmur.  Abdominal examination:  Positive bowel
sounds, nontender, distended, positive fluid wave, liver and
spleen not palpable.  Extremities:  [**1-23**]+ edema to knee
bilaterally.  Neurologic:  Cranial nerves II through XII
intact, moves all four extremities, no asterixis noted.

PERTINENT LABORATORIES AND OTHER STUDIES:  Complete blood
cell count showed white blood cell count 12.1 with
differential of 71.6% neutrophils, 16.5% lymphocytes, 5.5%
monocytes, 1.2% eosinophils, 0.6% basophils.  Hematocrit is
28.1, platelets 89.  Serum chemistries showed sodium 138,
potassium 3.5, chloride 101, bicarbonate 13, BUN 56,
creatinine 8.6 (creatinine was 3.9 on [**7-23**]), glucose 304.
ALT 23, AST 30, amylase 25, ALT 254, LDH 218, total bilirubin
0.9, albumin 1.8, total protein 6.4, lipase 5.  Coagulation
profile showed a PT of 14.5, PTT 45.1, INR 1.4.  Alcohol
level was 35.

Chest x-ray showed small bilateral pleural effusions.  Left
lower lobe atelectasis.

Urinalysis showed specific gravity of 1.010, large blood,
negative nitrate.  Positive trace protein.  Moderate
leukocytes, [**12-11**] red blood cells, and greater than 50 white
blood cells, 0 epithelial cells, and no bacteria.

Renal ultrasound showed no evidence of hydronephrosis.  A
large simple right kidney cyst was noted.  It is not
significantly changed from prior studies.

SUMMARY OF HOSPITAL COURSE:
1. Acute renal failure:  Patient is a 42-year-old male with a
history of alcoholic cirrhosis, chronic renal failure,
diabetes with nephropathy, status post recent admission for
worsening renal failure, and urinary tract infection, now
presents with a [**3-25**] day history of exertional dyspnea,
fatigue, poor urine output consistent with fluid overload
secondary to acute on chronic renal failure.

The etiology of his acute on chronic renal failure is
unclear.  It is probably not prerenal given that he appeared
euvolemic on exam, and now that although his diuretic doses
had recently been increased, he was not losing any fluid
wave.  The plan was to initially hold off on any IV fluids
and diuretics.  Initially, it was felt that the patient did
not have any indication for acute hemodialysis.  Indications
for hemodialysis were to include intractable dyspnea,
uncontrolled uremic symptoms like nausea or encephalopathy,
or hyperkalemia.

Renal consultation service team was [**Name (NI) 653**], and they
agreed with the plan to not aggressively diurese the patient
initially unless his respiratory status declined.  However,
his respiratory status remained stable, and on hospital day
#2, he reported an inability to make urine.  That evening the
patient was given trial of diuretics.  Specifically, he was
given Lasix 100 mg IV, and also he was given metolazone 10 mg
po.  This also failed to result in any urine production.

The patient's BUN and creatinine continued to increase.  He
continued to complain of shortness of breath, but not to the
point that it limited activity.  He continued to remain alert
and oriented, and without any signs of uremic encephalopathy.
He was to undergo Permacath placement on [**2155-8-18**], and was to
receive hemodialysis also on that day.  The metabolic
abnormalities associated with his uremia included calcium
carbonate 500 mg po tid, Nephrocaps one cap po q day, Epogen
5,000 units subQ 2x/week on Tuesdays and Fridays, Amphojel,
and calcitriol.

2. Dyspnea:  The patient was only slightly dyspneic likely to
compensate for the underlying metabolic acidosis secondary to
his uremia.  Initially, the plan was to diurese the patient
or dialyze him if he became severely dyspneic and had chest
x-ray evidence of fulminant failure.  However, the patient's
respiratory status remained stable and his level of dyspnea
was felt not to warrant acute intervention.

Instead he was managed symptomatically with albuterol
inhalers and oxygen therapy.  Initially, it felt that some
component of his dyspnea might be due to his abdominal
ascites collection.  Therefore on hospital day #2, he
underwent a paracentesis with drainage of 2 liters of acidic
fluid.  This resulted in some resolution of his dyspnea.
Finally, the patient was to continue his BiPAP machine that
he brought from home for treatment of his obstructive-sleep
apnea.

3. Elevated troponin:  Upon admission, the patient had an
elevated troponin value.  It was felt that very possibly he
had an acute coronary event a few days prior to admission
leading to renal hypoperfusion, which might explain his acute
renal decompensation.  However, it felt that based on his
comorbidities, that there was no role for Heparin or emergent
catheterization at his initial presentation.  An aspirin was
held given patient's history of thrombocytopenia and uremia.
He was not given a beta blocker given that his clinical
status was tenuous and there was a question of unstable
hematocrit values.

Cardiac echocardiogram was obtained, which demonstrated a
hyperdynamic ejection fraction greater than 75% and mild left
ventricular hypertrophy.

4. Diabetes:  Initially patient came in on NPH 10 units q am.
However, it is felt that initially his fingerstick blood
glucose values were running low.  Therefore, his NPH was
changed to 5 units q am and he was covered additionally with
regular insulin-sliding scale.

5. Cirrhosis:  Upon admission, the patient had large volume
ascites.  He had a diagnostic tap on his previous admission
in [**2155-6-22**] with no evidence of spontaneous bacterial
peritonitis.  He underwent a therapeutic paracentesis on the
afternoon of [**2155-8-15**] with removal of 2 liters of acidic
fluid.  At the time of this dictation, culture results on
that fluid were still pending.

6. Anemia:  On the day of admission, patient had a drop in
hematocrit from 28 to 23.6 in 12 hours.  He was therefore
transfused 1 unit packed red blood cells.  His stool was
checked for occult blood and was heme negative.  He was given
his regular outpatient dose of Epogen 5,000 units subQ on
[**2155-8-15**].  He was additionally to receive Epogen during his
dialysis sessions.

7. Dermatological:  Patient had a two week history of
erythematous, excoriated rash on his legs, back, face, and
arms.  Throughout the course of his hospital stay, the rash
became more erythematous and excoriated.  Therefore
Dermatology was consulted.  Per their recommendations,
multiple topical ointments and moisturizing regimens were
added to the patient's previous medication list.  In
addition, wound consult was obtained secondary to patient's
history of diabetic foot ulcers.

After initiation of this dermatological regimen, the patient
experienced mild improvement in his skin rash and
excoriation.

8. History of alcohol abuse:  Patient was placed on Ativan
and CIWA scale monitoring for alcohol withdrawal symptoms.

The remainder of the hospital course, discharge status,
condition, medications, and followup plans will be dictated
as a separate addendum to this report.



                          [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 8873**] [**Name8 (MD) **], M.D.  [**MD Number(1) 8874**]

Dictated By:[**Last Name (NamePattern1) 257**]

MEDQUIST36

D:  [**2155-8-17**]  17:57
T:  [**2155-8-28**]  08:27
JOB#:  [**Job Number 9133**]

cc:[**Name8 (MD) 9134**]

Admission Date:  [**2155-8-14**]     Discharge Date: [**2155-9-15**]

Date of Birth:   [**2112-9-15**]     Sex:  M

Service:  TELIS MEDICINE

HISTORY OF PRESENT ILLNESS:  Patient is a 42 year-old male
with a history of alcoholic cirrhosis, chronic pancreatitis
and pancreatic insufficiency, chronic renal failure, alcohol
abuse with a recent admission for worsening renal failure,
ascites, lower extremity edema.  Patient is a poor historian
and presents with a history of dyspnea on exertion, fatigue,
exhaustion and reportedly increased lower extremity edema.
He states since he left the hospital on [**7-16**] he has noticed
increased swelling.  He also states that he has increased
shortness of breath over the past several days. He denies
chest pain.  He also complains of decreased urine output over
the last several days, denies fevers, abdominal pain,
cramping, cough.  Does have some baseline diarrhea which he
states has not changed.  He denies bright red blood per
rectum, melena, vomiting, hematemesis.  He has a long history
of alcohol abuse and states that his last drink was 24 hours
prior to admission.

EXAMINATION:  Temperature 96.3, blood pressure 116/70, heart
rate 96, respirations 12, oxygen saturation 100 percent on 2
liters nasal cannula.  General:  Patient is in no acute
distress.  He has some scaling on his face.  Eyes:
Extraocular movements intact, pupils equal, round, reactive
to light.  Cardiovascular:  Regular rate and rhythm, no
murmurs, rubs or gallops.  Pulmonary:  some bibasilar rales,
occasional expiratory wheezes.  Abdominal: normal active
bowel sounds, nontender.  Has some distention, positive fluid
wave.  Liver and spleen are not palpable.  Extremities: 1 to
2+ edema to the knees bilaterally.  Neurological cranial
nerves 2 through 12 intact.  Moves all extremities well and
has no asterixis.

LABORATORY DATA:  White count 12.1, hematocrit 28.1,
platelets 89, 76 percent neutrophils, 16 percent lymphocytes,
5 percent monocytes, 1 percent eosinophils.  Sodium is 138,
potassium 3.5, chloride 101, bicarbonate 13, BUN 56,
creatinine 8.6, glucose 304.  ALT is 23, AST is 30, amylase
is 25, alk phos is 254, LDH is 218, total bilirubin is 0.9,
albumin 1.8, total protein 6.5, lipase is 5.  PT is 14.5, PTT
is 45.1,INR is 1.4.  Alcohol is 35.  Chest x-ray shows small
bilateral pleural effusions with left lower lobe atelectasis.
Arterial blood gases is 7.37, 28, 114, and 17.

HOSPITAL COURSE:  1)  Infectious disease.  Patient with MRSA
sepsis and Candidemia.  Patient became septic on [**8-22**] with
fever, hypotension and blood culture which was positive for
MRSA.  Patient was started on Vancomycin for a full 20 day
course.  His Medical Intensive Care Unit course was also
complicated by Candidemia treated with intravenous
fluconazole times 11 days. He was then finished on his course
with p.o. Fluconazole for a total of 28days.  Patient will be
discharged home with oral fluconazole to finish out his
course for a total of 28 days.

2) Renal.  Patient with end stage renal  disease on
hemodialysis.  Patient presented with uremia and initiated
hemodialysis. He had a Permacath placed for permanent
hemodialysis access. He will continue on PhosLo and Epogen.
He is followed by the renal team.

3)  Pulmonary.  Patient with respiratory distress on [**2155-8-22**]
with saturations in the 70s on nonrebreather mask. He was
transferred to the Medical Intensive Care Unit and intubated.
He was extubated on the 7th and put on  CPAP but underwent a
bronchoscopy to look for mucous plugs. On [**8-31**] he was then
reintubated and subsequently extubated on [**9-5**].  He has
remained stable respiratory-wide on the floor and he has a
history of obstructive sleep apnea.  He has been continued on
BiPAP on the floor.

4)  Gastrointestinal.  Alcoholic cirrhosis with diarrhea.
Patient with history of encephalopathy, continued on
lactulose.  He has had no hepatic synthetic dysfunction this
admission. His lactulose was held on [**9-13**] for some ongoing
diarrhea.  His mental status remained clear on he floor.  He
was continued on a proton pump inhibitor and the
gastrointestinal team was consulted on the 23rd for work up
of his diarrhea.  His work up including stool culture and C.
difficile remained negative except that his diarrhea improved
on a lactose free diet.  Patient is to have a lactose
hydrogen breath test as an outpatient and can follow up with
Dr. [**Last Name (STitle) 9135**] [**Name (STitle) **] for this test.

5)  Endocrine.  Type 2 diabetes.  Patient was poorly
controlled. Blood sugars on sliding scale insulin when he was
transferred to the floor. We consulted the [**Hospital1 **] Diabetes
service and he was started on sliding scale insulin and
nighttime Lanta with some improvement of his blood sugars.
Patient will be maintained on the current regimen.

6) Dermatology.  Patient presented initially with
maculopapular painful rash on all of his extremities on sun
exposed areas.  Dermatology was consulted and felt this was a
photo sensitivity reaction while on hydrochlorothiazide.  The
patient was treated with topical steroids and his
hydrochlorothiazide was held.  His rash is much improved
today.

7)  Hematology.  [**Hospital **] Medical Intensive Care Unit course
is complicated with  diffuse intervascular coagulation and
heparin-induced thrombocytopenia.  He had elevated PT and PTT
and thrombocytopenia thought secondary to diffuse
intervascular coagulation from sepsis in the Medical
Intensive Care Unit.  He gradually improved with supportive
therapy and normalized his coagulations on the floor.
Patient also had thrombocytopenia thought secondary to
heparin in the Medical Intensive Care Unit.  His heparin was
discontinued and his platelets remained borderline low but
improved to the low 100s. His platelets again began to drop
on [**9-13**] to [**9-14**] and his cimetidine was changed to Protonix as
cimetidine with known adverse hematologic effects.

8)  Prophylaxis.  Patient was maintained on a proton pump
inhibitor and Venodynes.

9)  Code status.  Patient is full code.

10)  Disposition.  Patient is very weak and will be
discharged to a rehabilitation facility as he may benefit
from continued physical therapy to regain his strength.

DISCHARGE STATUS:  Stable.

DISCHARGE DISPOSITION:  Patient is full code.

FOLLOW UP PLANS:  When patient is discharged the patient will
follow up with his primary care provider, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Name (STitle) 1683**]
in the next two to three weeks.  Patient is also to follow up
with Dr. [**Last Name (STitle) 9135**] [**Name (STitle) **] of gastroenterology to be bested for
lactose intolerance in the next month.

CURRENT MEDICATIONS:  1) Sliding scale Humalog with seven
units regular h.s.  2) Erythropoietin alpha 5,000 units
subcutaneously two times per week Tuesdays and Fridays to be
given at dialysis.  3) hydroxyzine 50 mg p.o. q 4 to 6 hours
p.r.n. itching.  4) Bacitracin ointment one application
b.i.d.  6) triamcinolone 0.1 percent cream one application
b.i.d., 7) Aquaphor one application b.i.d., 8) PhosLo 1336 mg
p.o. t.i.d. with meals, 9) Calcitriol 0.5 mcg p.o. q. day,
10) Tylenol 325 to 650 mg p.o. q. 4 to 6 hours p.r.n. pain.
11) albuterol 1 to 2 puffs inhalation q. 6 hours p.r.n., 12)
albuterol ipratropium 1 to 2 puffs q. 6 hours, 13) calcium
carbonate 500 mg p.o. t.i.d. with meals. 14) Nephrocaps 1
tablet p.o. q day.  15) Pantoprazole 40 mg p.o. q. day, 16)
folate 1 mg p.o. q. day, 17) Pancrease 5 caps p.o. t.i.d.
with meals, 18) fluconizole 200 mg p.o. q. day.




                          [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 8873**] [**Name8 (MD) **], M.D.  [**MD Number(1) 8874**]

Dictated By:[**Last Name (NamePattern1) 5819**]

MEDQUIST36

D:  [**2155-9-14**]  20:31
T:  [**2155-9-14**]  20:44
JOB#:  [**Job Number 9136**]
{'Acute kidney failure, unspecified,Methicillin susceptible Staphylococcus aureus septicemia,Other pulmonary insufficiency, not elsewhere classified,Alcoholic cirrhosis of liver,Disseminated candidiasis,Defibrination syndrome,Other shock without mention of trauma,Hepatic encephalopathy,Pneumonia, organism 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: 

PRESENT ILLNESS: Patient is a 42-year-old white
male with past medical history significant for alcoholic
cirrhosis, chronic pancreatitis resulting in pancreatic
insufficiency, and insulin dependent-diabetes mellitus,
chronic renal failure with baseline creatinine of 4.0,
chronic thrombocytopenia, who has a recent admission to the
[**Hospital1 69**], who presented on
[**2155-8-13**] with acute onset fatigue, worsening dyspnea on
exertion, increased lower extremity edema, and decreased
urine output x3 days.

MEDICAL HISTORY: 1. Chronic alcoholic pancreatitis complicated by pseudocyst
in 10/99, resulted in pancreatic insufficiency and insulin
dependent-diabetes mellitus.
2. Insulin dependent-diabetes mellitus with nephropathy and
neuropathy:  Insulin dependent x3 years.  He had episodes of
diabetic ketoacidosis with an Intensive Care Unit admission
in 08/[**2154**].
3. Chronic renal failure with baseline creatinine of 4.0.
4. History of alcohol abuse, resulting in cirrhosis.
5. Hypertension.
6. Obstructive-sleep apnea on BiPAP at home.
7. History of bilateral nephrolithiasis, complicated by
development of pyelonephritis and urosepsis.
8. Anemia secondary to renal failure.
9. History of thrombocytopenia secondary to Haldol.
10. History of multiple perirectal abscesses, status post
multiple incision and drainage procedures.
11. History of ARDS in 10/99 with tracheostomy for six weeks;
developed ARDS during pancreatitis episode.  Complicated by
Pseudomonas pneumonia, pancreatic necrosis, Clostridium
difficile colitis, line sepsis, left lower extremity DVT,
Haldol induced thrombocytopenia.
12. History of left lower extremity DVT.
13. History of Clostridium difficile colitis.
14. History of right vocal cord paralysis.
15. Gastritis.
16. History of diabetic foot ulcers.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient reports allergies to Haldol resulting
in thrombocytopenia.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Former real estate [**Doctor Last Name 360**], current
unemployed.  Lives alone.  Smokes 1-1.5 packs per day x20
years.  Currently admits to five drinks of alcohol per week.
Denies any IV drug use or any recreational drug use.
Divorced with no children. 

### Response:
{'Acute kidney failure, unspecified,Methicillin susceptible Staphylococcus aureus septicemia,Other pulmonary insufficiency, not elsewhere classified,Alcoholic cirrhosis of liver,Disseminated candidiasis,Defibrination syndrome,Other shock without mention of trauma,Hepatic encephalopathy,Pneumonia, organism unspecified'}
