CHIEF COMPLAINT: sob

PRESENT ILLNESS: Mr. [**Known lastname 15225**] is a 40 year old man with AIDS (criteria of CD-4 counts
and opportunistic infections) who is being admitted for dyspnea,
fevers, and hypoxia.

MEDICAL HISTORY: 1. AIDS dx [**2142**]: [**5-1**] VL 23K; [**3-31**] CD4 1 VL 47K- initially on
monotherapy starting in [**2144**], now with variable degrees of
resistance to HAART.
2. PCP x5: [**2146**](intubated) c/b perirectal HSV and pancreatitis
from pentamidine and/or steroids, [**1-/2155**] c/b LUE axillary vein
thrombosis, [**5-/2155**], [**7-/2155**], [**3-/2157**]
3. Disseminated MAC bacteremia [**2148**]
4. Didanosine associated pancreatitis [**6-/2150**]
5. Aseptic meningitis [**1-/2154**] secondary to TMP/SMX
6. Cerebral MAC (diff from [**2148**] organism) c/b seizures [**3-/2157**]
7. Necrotic HSV L chest wall lesion resistant to acyclovir and
ganciclovir and treated with Foscarnet [**3-30**]
8. Acyclovir resitant HSV R chest wall lesion [**5-1**] treated with
Foscarnet (to stop [**2161-7-2**])
9. Neurosurgical drainage of a R sided subdural fluid collection
[**11-27**] c/b post-op seizure and intubation for airway protection
10. HTN
11. Chronic peripheral neuropathy (legs>arms)
12. Systolic CHF (Echo [**9-30**] EF 50% w/ 1+AR, [**11-28**]+MR, 1+ TR)
13. Coagulopathy [**12-29**] lupus anticoagulant c/b DVT/PE [**4-28**] and
[**9-30**], on anticoagulation with IVC filter in place
14. IMI [**4-28**] (presumed [**12-29**] hypercoagulable state) s/p RCA
stenting
15. Aflutter s/p ablation [**12-31**]
16. Thrush-resistant to fluconazole (now tx w/ voriconazole)
17. Asthma
18. Chronic renal failure
19. Hyperkalemia

MEDICATION ON ADMISSION: (per OMR on [**2161-8-4**])

ALLERGIES: Bactrim

PHYSICAL EXAM: OBJ: T 99.9  BP 142/104 HR 97 R 20 98% on 1.5 L
GEN: emaciated gentleman, in mild respiratory distress
HEENT: OP clear, no evidence of thrush, no cervical
lymphadenopathy
CV: RRR with systolic murmur
LUNG: crackles auscultated on Left base
ABD: +BS/NT/ND, no organomegally, no rebound, no guard
EXT: no edema/cyanosis/pulses intact, skin dorsum of hands is
red-purple in color right greater than left
NEURO:[**1-8**] intact, upper extremity, lower extremity strength
symmetric and intact
Skin: normal skin tone, no erythema/rashes

FAMILY HISTORY: Mom-mild HTN and hypercholesterolemia; brother- asthma, HTN. 3
sisters-alive and healthy

SOCIAL HISTORY: -Divorced; contracted HIV from his ex-wife after their child
died of AIDS. They were subsequently tested and found to both be
HIV+ and wife admitted to IVDU. She has since died.-Lives alone
with dog, [**Month/Year (2) 15233**]. Lives in studio apt rented from his
mother.-Smoked 1 ppd x 2 years (on job). Quit 5 mths ago when he
stopped working as a an operations manager in scrap metal.
-EtOH- occas wine; Marijuana occas for nausea; Exercises
5x/wk-H/o asbestos exposure
Human immunodeficiency virus [HIV] disease,Pneumonia, organism unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Other convulsions
Human immuno virus dis,Pneumonia, organism NOS,Hyp kid NOS w cr kid V,CHF NOS,Acute kidney failure NOS,Convulsions NEC
Admission Date:  [**2161-8-27**]              Discharge Date:   [**2161-9-3**]

Date of Birth:  [**2121-2-5**]             Sex:   M

Service: MED

Allergies:
Bactrim

Attending:[**First Name3 (LF) 15241**]
Chief Complaint:
sob

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Mr. [**Known lastname 15225**] is a 40 year old man with AIDS (criteria of CD-4 counts
and opportunistic infections) who is being admitted for dyspnea,
fevers, and hypoxia.

Mr. [**Known lastname 15225**] says that he was in his usual state of (chronically
poor) health until about 3 days ago when he began to have more
fatigue than usual. He then began to have fevers up to
99.0-100.0
and yesterday started to develop left sided chest pain that came
on with deep breaths and coughing, and fevers up to 103 degrees
with chills but no rigors. He is coughing up scant, thick yellow
sputum, without any blood in the sputum.

He came to the Infectious Disease Outpatient Clinic this morning
and was found to have a temp of 102 degrees, and an oxygen
saturation after walking down the hallway that was 71.%. He was
brought to the Emergency Room and admitted from there.

He was last hospitalized here from [**6-29**] -> [**2161-7-6**] for persistent
pain from a right-sided kidney stone. During the hospital-
ization, he had a stent placed into the right kidney to help
remove the stone. The stent was removed prior to his discharge.
A chest X ray during that admission revealed a faint opacity in
the left lower lobe that obscured the left hemidiaphragm on the
lateral view. He was, therefore, put on cefpodixime for 7 days."

In ER VSS were temp of 101.7 HR of 99 BP 112/72  R24, 74% on RA,
99% on 2L.  Cxray notable for LLL infiltrate. EKG notable for
sinus tach at 92, negative axis, R wave transition in v3, flat T
waves V5-V6, q3T3, q in [**12-30**]/avf (no change from baseline). INR
was 0.9. Cr of 1.6. Blood cultures were sent. In ed received
tylenol, ceftriaxone 2mg iv, MS contin and heparin IV.
40 M w/AIDS (CD4 count of 9 on [**2161-4-23**]) admitted [**8-27**] for
dyspnea, fevers to 103, and hypoxia. (In [**Hospital **] clinic with
temperature of 102 degrees and ambulatory o2 sat of 71%. Please
see ID admit note in OMR for complete HPI/history.) In short,
patient was in his usual state of health until three days prior
to admission when he experienced more fatigue, fevers up to
99.0-100.0, pleuritic chest pain and cough. (Patient was last
hospitalized at [**Hospital1 18**] from [**6-29**] to [**2161-7-6**] for persistent pain
from a right-sided kidney stone, a stent was placed and
removed.)

In ER on admission: VSS were temp of 101.7 HR of 99 BP 112/72
R24, 74% on RA, 99% on 2L. Chest xray was notable for LLL
infiltrate. EKG notable for sinus tach at 92, negative axis, R
wave transition in v3, flat T waves V5-V6, q3T3, q in [**12-30**]/avf
(no change from baseline). INR was 0.9. Cr of 1.6. In the ed the
patient received tylenol, ceftriaxone 2mg IV, MS contin and
heparin IV.

ROS: Man with HIV/AIDS last CD4 count of 9.  On transfer to the
[**Hospital Ward Name **] patient continues to express sharp chest pain in
left sternal area radiating to left shoulder [**5-7**] in intensity
worse with inspiration, patient also reports not some SOB.
Patient reports intermittent hematuria. He denies abdominal
pain, diarrhea, melena, headache, sore throat, dysuria, lower
extremity swelling or pain, orthopnea.


Past Medical History:
1. AIDS dx [**2142**]: [**5-1**] VL 23K; [**3-31**] CD4 1 VL 47K- initially on
monotherapy starting in [**2144**], now with variable degrees of
resistance to HAART.
2. PCP x5: [**2146**](intubated) c/b perirectal HSV and pancreatitis
from pentamidine and/or steroids, [**1-/2155**] c/b LUE axillary vein
thrombosis, [**5-/2155**], [**7-/2155**], [**3-/2157**]
3. Disseminated MAC bacteremia [**2148**]
4. Didanosine associated pancreatitis [**6-/2150**]
5. Aseptic meningitis [**1-/2154**] secondary to TMP/SMX
6. Cerebral MAC (diff from [**2148**] organism) c/b seizures [**3-/2157**]
7. Necrotic HSV L chest wall lesion resistant to acyclovir and
ganciclovir and treated with Foscarnet [**3-30**]
8. Acyclovir resitant HSV R chest wall lesion [**5-1**] treated with
Foscarnet (to stop [**2161-7-2**])
9. Neurosurgical drainage of a R sided subdural fluid collection
[**11-27**] c/b post-op seizure and intubation for airway protection
10. HTN
11. Chronic peripheral neuropathy (legs>arms)
12. Systolic CHF (Echo [**9-30**] EF 50% w/ 1+AR, [**11-28**]+MR, 1+ TR)
13. Coagulopathy [**12-29**] lupus anticoagulant c/b DVT/PE [**4-28**] and
[**9-30**], on anticoagulation with IVC filter in place
14. IMI [**4-28**] (presumed [**12-29**] hypercoagulable state) s/p RCA
stenting
15. Aflutter s/p ablation [**12-31**]
16. Thrush-resistant to fluconazole (now tx w/ voriconazole)
17. Asthma
18. Chronic renal failure
19. Hyperkalemia




Social History:
-Divorced; contracted HIV from his ex-wife after their child
died of AIDS. They were subsequently tested and found to both be
HIV+ and wife admitted to IVDU. She has since died.-Lives alone
with dog, [**Month/Year (2) 15233**]. Lives in studio apt rented from his
mother.-Smoked 1 ppd x 2 years (on job). Quit 5 mths ago when he
stopped working as a an operations manager in scrap metal.
-EtOH- occas wine; Marijuana occas for nausea; Exercises
5x/wk-H/o asbestos exposure

Family History:
Mom-mild HTN and hypercholesterolemia; brother- asthma, HTN. 3
sisters-alive and healthy

Physical Exam:
OBJ: T 99.9  BP 142/104 HR 97 R 20 98% on 1.5 L
GEN: emaciated gentleman, in mild respiratory distress
HEENT: OP clear, no evidence of thrush, no cervical
lymphadenopathy
CV: RRR with systolic murmur
LUNG: crackles auscultated on Left base
ABD: +BS/NT/ND, no organomegally, no rebound, no guard
EXT: no edema/cyanosis/pulses intact, skin dorsum of hands is
red-purple in color right greater than left
NEURO:[**1-8**] intact, upper extremity, lower extremity strength
symmetric and intact
Skin: normal skin tone, no erythema/rashes


Pertinent Results:
[**2161-8-27**] 01:15PM   POTASSIUM-4.4
[**2161-8-27**] 12:55PM   PT-12.0 PTT-18.2* INR(PT)-0.9
[**2161-8-27**] 11:56AM   LACTATE-1.9
[**2161-8-27**] 11:54AM   GLUCOSE-92 UREA N-23* CREAT-1.6* SODIUM-135
POTASSIUM-6.6* CHLORIDE-101 TOTAL CO2-23 ANION GAP-18
[**2161-8-27**] 11:54AM   ALT(SGPT)-15 AST(SGOT)-43* ALK PHOS-73
AMYLASE-31 TOT BILI-1.3
[**2161-8-27**] 11:54AM   ALBUMIN-3.8
[**2161-8-27**] 11:54AM   WBC-3.1* RBC-3.36* HGB-11.3* HCT-35.6*
MCV-106* MCH-33.7* MCHC-31.8 RDW-16.2*
[**2161-8-27**] 11:54AM   NEUTS-71.6* LYMPHS-11.6* MONOS-12.3* EOS-3.6
BASOS-0.7
[**2161-8-27**] 11:54AM   HYPOCHROM-2+ ANISOCYT-1+ MACROCYT-3+
[**2161-8-27**] 11:54AM   PLT COUNT-223

renal u/s ([**2161-8-5**]): IPRESSION:
1.  Diffuse echogenicity of bilateral kidneys consistent with
the patient's
history of HIV.
2.  Simple cyst in upper pole of right kidney which is slightly
smaller than
on prior examination.
3.  No evidence of hydronephrosis, stones or masses bilaterally.

Ct abdomen: [**2161-6-17**] IMPRESSION:  6-mm partially obstructing
calculus within the proximal right ureter, with acute forniceal
rupture.

EKG: EKG notable for sinus tach at 92, negative axis, R wave
transition in v3, flat T waves V5-V6, q3T3, q in [**12-30**]/avf (no
change from baseline).

cath [**5-28**]: FINAL DIAGNOSIS:
1. Patent RCA stents.
2. Normal biventricular filling pressures.
3. Mild LV systolic dysfunction with dopamine infusion.

CXRAY ([**2161-8-27**]): IMPRESSION: Patchy bibasilar opacities
consistent with pneumonia.

Lower extremity u/s:IMPRESSION:  Chronic deep venous thrombosis
extending from the proximal left superficial femoral vein to the
left popliteal vein, with multiple collaterals.


Brief Hospital Course:
40 M w/ AIDS (CD4 of 9), multiple medical problems presents with
dypnea and fever.

SOB - On the floor antibiotic was changed to cefipime. One day
following admission, patient developed additional chest pain and
hypoxia initially read in o2 sat of 70s requiring 10L of O2 at
which patient was 93% (abg was 7.35/34/90 on 10L face-mask),
patient's systolic blood pressure was also in 100s compared to
baseline of 130s. Unclear if relative hypotension was secondary
to pain medications, dehydration, developing heart failure from
possible PE, verus worsening PNA, therefore patient was
transferred to unit.

In [**Hospital Unit Name 153**] supportive measures were continued. The patient was
provided with IV fluid.  Empiric treatment for PCP [**Name Initial (PRE) **]
(primaquine) but then discontinued.  CT on [**8-29**] showed: LLL
PNA, effusion, enlargement of nodule at left lung apex and new
nodule in the medial LUL nodule, possibly representing
differences in slice selection compared to [**9-30**]. Patient will
need to follow up with Dr. [**Last Name (STitle) 2148**] regarding further work-up of
these findings.  (A contrast CT was not performed secondary to
the patient's CRI.) Labs on [**8-31**] notable for HCT 25.5, Retic
0.7, LDH normal, INR of 1.6,  Cr at 1.6 (down from elevated 1.9
on admission), of note Trop maximum at 0.83 and an echo was
performed on [**8-29**] which demonstrated normal systolic function,
therefore felt to represent possible RV strain. Patient's
respiratory status improved on antibiotics and patients
transferred out of unit. Of note cryptococcal antigen was
negative.  Nasopharyngeal culture for ADENO,PARAINFLUENZA 1,2,3
INFLUENZA A,B AND RSV was negative. CMV DNA was negative.
Patient o2 sat was 94% while ambulating on discharged but with
subjective feeling of intermittent dyspnea we discharge with
oxygen.  Patient will also be discharged on Lovenox SC, until
INR is therapeutic.  A picc line was placed on discharge for
outpatient cefipime.

2. Fever - Patient with AIDS, history of fever and chest
xray/chest CT notable for PNA. Blood cultures / urine cultures
in-house were negative.  Patient without diarrhea.  Reticulocyte
low, LDH normal, D bili was slightly elevated.

3. CRI/Hematuria - Patient with a history of renal stones,
recent admission for kidney stone and urthethral stent presents
with elevated CR compared to baseline. The etiology was likely
prerenal as patient responded to fluids. On discharge CR was 1.3
(baseline 1.3-1.8).

4. Cardiac/CAD - Of note patient with a history of RCA stent,
IMI in past, q waves on inferior leads on EKG. Patient is not
maintained on cardiac medications secondary to concerns
regarding drug interactions (discussed with attending). Patient
experienced elevated troponins during episodes of chest pain. An
echo demonstrated intact systolic function. Patient discharged
on aspirin.

5. HIV - Patient on antiretroviral medications tonofovir,
stavudine, ritonavir, Fuzeon, Emtricitabine, Atazanavir. Patient
is on empiric AIDS coverage with cipro, azithro, acyclovir.

6. Neurology/History of seizure - Maintain on kepra. Seizure
thought to be due to a focus from scar of a prior brain abscess.
Patient reports using gabapentin for neuropathic pain.

7. Anemia - Patient presented with a hematocrit of 34, wide
variation in baseline (34-44). Throughout hospitalization
hematocrit went down to 25 but stabilized.  This decrease likely
reprented fluid shifts from hydration.  The differential for
anemia includes low production given anemia of chronic disease,
low reticulocyte count. Iron studies demonstrated low iron, low
b12. Therefore b12 was provided. Patient has history of procrit
use which will be resumed on discharge.

10. Code - DNR/DNI.


Medications on Admission:
(per OMR on [**2161-8-4**])

ACYCLOVIR 400MG--One capsule by mouth twice a day
ALBUTEROL 90MCG--2 puffs every 4 hours as needed for coughing
not relieved by serevent.
ATAZANAVIR 150 MG--Two capsules (300 mg) by mouth once (one
time) daily.
AZITHROMYCIN 250MG--One capsule by mouth twice a day
CIPROFLOXACIN HCL ORAL 500 MG TABLET 500MG--One tablet by mouth
twice a day
COUMADIN 5MG--Take 7.5 mg/day until further notice.
DILAUDID 2MG--One tablet every 3 hours as needed for pain not
controlled with morphine contin.
EFFEXOR XR 75MG--One capsule daily.
EMTRICITABINE  200 MG--One capsule by mouth daily.
ETHAMBUTOL HCL 400MG--One tablet by mouth three times a day
FLONASE 50MCG--Two sprays each nostril twice a day
FUSEON 90 MG--Inject one vial (90 mg) sq [**Hospital1 **].
ITRACONAZOLE 10MG/ML--20 cc (200 mg) swish and swallow daily.
KEPPRA 500MG--One tablet by mouth twice a day for suppression of
seizures
LOVENOX 120MG/.8ML--One injection sq daily.
NEUPOGEN 300MCG/0.5--Inject one cc every other week (every 2
weeks).
NEURONTIN 100MG--Two capsules three times a day with two of the
400 mg capsules for 1000 mg by mouth three times a day for
control of discomfort from peripheral neuropathy.
OPIUM 10%--One cc by mouth four times a day as needed for
diarrhea
OXANDROLONE 10MG--One tablet (10 mg) by mouth twice a day for
weight loss.
PENTAMIDINE ISETHIONATE 300MG--Given by aerosol monthly
PERCOCET 5-325MG--One to two tablets every 4 hours as needed for
pain not controlled by morphine contin.
PROCRIT [**Numeric Identifier **] U/ML--One cc every other week (every 2 weeks).
RITONAVIR 100MG--One capsule once daily, with two capsules of
atazanavir (reyetaz).
SEREVENT DISKUS 50MCG--Two puffs [**Hospital1 **].
STAVUDINE 15MG--One capsule by mouth twice a day
SYRINGE/SAFETY GLIDE 25GX0.625"--Use one cc 25 g x 0.625"
syringes for procrit and g-csf injections.
TENOVOFIR 300 MG--One tablet daily
ULTRASE MT 18 59-18-59--Two capsules by mouth with each meal
ZOFRAN 4MG--One tablet by mouth q 6 hours as needed for nausea /
vomiting
MEGACE 40MG--One tablet daily, for enhancement of appetite.

-per patient he does not take albuterol/dilaudid/itraconazole
-he does take gabapentin and amphotericin


Discharge Medications:
1. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q4H (every 4 hours) as needed.
Disp:*1 30* Refills:*0*
2. Atazanavir Sulfate 100 mg Capsule Sig: Three (3) Capsule PO
QD (once a day).
Disp:*90 Capsule(s)* Refills:*2*
3. Azithromycin 250 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
4. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours).
Disp:*60 Tablet(s)* Refills:*2*
5. Venlafaxine HCl 75 mg Capsule, Sust. Release 24HR Sig: One
(1) Capsule, Sust. Release 24HR PO QAM (once a day (in the
morning)).
Disp:*30 Capsule, Sust. Release 24HR(s)* Refills:*2*
6. Emtricitabine 200 mg Capsule Sig: One (1) Capsule PO qd ().
Disp:*30 Capsule(s)* Refills:*2*
7. Ethambutol HCl 400 mg Tablet Sig: One (1) Tablet PO TID (3
times a day).
Disp:*90 Tablet(s)* Refills:*2*
8. Enfuvirtide 90 mg Kit Sig: One (1) Kit Subcutaneous [**Hospital1 **] (2
times a day): 90 mg SC injection.
Disp:*60 Kit(s)* Refills:*2*
9. Levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
10. Morphine Sulfate 15 mg Tablet Sustained Release Sig: Three
(3) Tablet Sustained Release PO Q8H (every 8 hours).
Disp:*4 Tablet Sustained Release(s)* Refills:*2*
11. Gabapentin 800 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
Disp:*90 Tablet(s)* Refills:*2*
12. Oxandrolone 2.5 mg Tablet Sig: Four (4) Tablet PO BID (2
times a day).
Disp:*240 Tablet(s)* Refills:*2*
13. Ritonavir 100 mg Capsule Sig: One (1) Capsule PO QD (once a
day).
Disp:*30 Capsule(s)* Refills:*2*
14. Salmeterol Xinafoate 50 mcg/Dose Disk with Device Sig: One
(1) Disk with Device Inhalation Q12H (every 12 hours): (50 mcg)
2 INH IH Q12H
.
Disp:*60 Disk with Device(s)* Refills:*2*
15. Tenofovir Disoproxil Fumarate 300 mg Tablet Sig: One (1)
Tablet PO QD (once a day).
Disp:*30 Tablet(s)* Refills:*2*
16. Stavudine 30 mg Capsule Sig: One (1) Capsule PO Q12H (every
12 hours).
Disp:*60 Capsule(s)* Refills:*2*
17. Amphotericin B 50 mg Recon Soln Sig: One (1) Recon Soln
Injection QID (4 times a day): DOSE: 20 mg.
Disp:*120 Recon Soln(s)* Refills:*2*
18. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO QD (once a day).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
19. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
Disp:*30 Tablet(s)* Refills:*0*
20. Polyvinyl Alcohol 1.4 % Drops Sig: 1-2 Drops Ophthalmic  PRN
(as needed).
Disp:*1 30* Refills:*2*
21. Multivitamin,Tx-Minerals     Tablet Sig: One (1) Tablet PO
QD (once a day).
Disp:*30 Tablet(s)* Refills:*2*
22. Cyanocobalamin 500 mcg Tablet Sig: Two (2) Tablet PO QD
(once a day).
Disp:*60 Tablet(s)* Refills:*2*
23. Aluminum-Magnesium Hydroxide 225-200 mg/5 mL Suspension Sig:
15-30 MLs PO QID (4 times a day) as needed.
Disp:*15 ML(s)* Refills:*0*
24. Warfarin Sodium 5 mg Tablet Sig: 1.5 Tablets PO at bedtime.
Disp:*45 Tablet(s)* Refills:*2*
25. Enoxaparin Sodium 80 mg/0.8 mL Syringe Sig: One (1)
injection of 0.8 ML Subcutaneous Q12H (every 12 hours) for 4
days.
Disp:*8 injection of 0.8 ML* Refills:*0*
26. Dilaudid 4 mg Tablet Sig: 1-2 Tablets PO four times a day as
needed for pain for 7 days.
Disp:*20 Tablet(s)* Refills:*0*
27. Outpatient Lab Work
Please obtain INR value on [**2161-9-6**]
28. Cefepime HCl 2 g Piggyback Sig: One (1) Piggyback
Intravenous  Q12H (every 12 hours) for 10 days.
Disp:*20 Piggyback(s)* Refills:*0*
29. Other
Please continue procrit administration as prior to
hospitalization. Normally given every other Tuesday.
30. instruction
Please take pentamadine as prior to hospitalization.
(dose provided in the hospital on [**8-28**])
31. Outpatient Lab Work
Please obtain INR as an outpatient.
Please send results to Dr. [**Last Name (STitle) 2148**]

32. Oxygen
Oxygen 2L via nasal cannual

PRN dyspnea

33. oxygen
2 liters continuous


Discharge Disposition:
Home With Service

Facility:
Staff Builders-TLC-[**Location (un) 1456**]

Discharge Diagnosis:
PNA


Discharge Condition:
stable

Discharge Instructions:
Please return if you experience increasing shortness of breath,
chest pain or pressure

Please continue procrit and pentamadine as prior to
hospitalization.

Followup Instructions:
Follow up with Dr. [**Last Name (STitle) 2148**] within 2 weeks. ([**Telephone/Fax (1) 457**])
Appointment made Tuesday at 3:00 pm.

Provider UROLOGY UNIT Where: [**Hospital6 29**] SURGICAL
SPECIALTIES Phone:[**Telephone/Fax (1) 164**] Date/Time:[**2161-9-23**] 9:00

Provider [**First Name11 (Name Pattern1) 610**] [**Initial (NamePattern1) **] [**Last Name (NamePattern1) **], MD Where: [**Hospital6 29**]
CARDIAC SERVICES Phone:[**Telephone/Fax (1) 285**] Date/Time:[**2161-9-28**] 1:15


                             [**Name6 (MD) **] [**Last Name (NamePattern4) 15242**] MD, [**MD Number(3) 15243**]
{'Human immunodeficiency virus [HIV] disease,Pneumonia, organism unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Other convulsions'}


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: sob

PRESENT ILLNESS: Mr. [**Known lastname 15225**] is a 40 year old man with AIDS (criteria of CD-4 counts
and opportunistic infections) who is being admitted for dyspnea,
fevers, and hypoxia.

MEDICAL HISTORY: 1. AIDS dx [**2142**]: [**5-1**] VL 23K; [**3-31**] CD4 1 VL 47K- initially on
monotherapy starting in [**2144**], now with variable degrees of
resistance to HAART.
2. PCP x5: [**2146**](intubated) c/b perirectal HSV and pancreatitis
from pentamidine and/or steroids, [**1-/2155**] c/b LUE axillary vein
thrombosis, [**5-/2155**], [**7-/2155**], [**3-/2157**]
3. Disseminated MAC bacteremia [**2148**]
4. Didanosine associated pancreatitis [**6-/2150**]
5. Aseptic meningitis [**1-/2154**] secondary to TMP/SMX
6. Cerebral MAC (diff from [**2148**] organism) c/b seizures [**3-/2157**]
7. Necrotic HSV L chest wall lesion resistant to acyclovir and
ganciclovir and treated with Foscarnet [**3-30**]
8. Acyclovir resitant HSV R chest wall lesion [**5-1**] treated with
Foscarnet (to stop [**2161-7-2**])
9. Neurosurgical drainage of a R sided subdural fluid collection
[**11-27**] c/b post-op seizure and intubation for airway protection
10. HTN
11. Chronic peripheral neuropathy (legs>arms)
12. Systolic CHF (Echo [**9-30**] EF 50% w/ 1+AR, [**11-28**]+MR, 1+ TR)
13. Coagulopathy [**12-29**] lupus anticoagulant c/b DVT/PE [**4-28**] and
[**9-30**], on anticoagulation with IVC filter in place
14. IMI [**4-28**] (presumed [**12-29**] hypercoagulable state) s/p RCA
stenting
15. Aflutter s/p ablation [**12-31**]
16. Thrush-resistant to fluconazole (now tx w/ voriconazole)
17. Asthma
18. Chronic renal failure
19. Hyperkalemia

MEDICATION ON ADMISSION: (per OMR on [**2161-8-4**])

ALLERGIES: Bactrim

PHYSICAL EXAM: OBJ: T 99.9  BP 142/104 HR 97 R 20 98% on 1.5 L
GEN: emaciated gentleman, in mild respiratory distress
HEENT: OP clear, no evidence of thrush, no cervical
lymphadenopathy
CV: RRR with systolic murmur
LUNG: crackles auscultated on Left base
ABD: +BS/NT/ND, no organomegally, no rebound, no guard
EXT: no edema/cyanosis/pulses intact, skin dorsum of hands is
red-purple in color right greater than left
NEURO:[**1-8**] intact, upper extremity, lower extremity strength
symmetric and intact
Skin: normal skin tone, no erythema/rashes

FAMILY HISTORY: Mom-mild HTN and hypercholesterolemia; brother- asthma, HTN. 3
sisters-alive and healthy

SOCIAL HISTORY: -Divorced; contracted HIV from his ex-wife after their child
died of AIDS. They were subsequently tested and found to both be
HIV+ and wife admitted to IVDU. She has since died.-Lives alone
with dog, [**Month/Year (2) 15233**]. Lives in studio apt rented from his
mother.-Smoked 1 ppd x 2 years (on job). Quit 5 mths ago when he
stopped working as a an operations manager in scrap metal.
-EtOH- occas wine; Marijuana occas for nausea; Exercises
5x/wk-H/o asbestos exposure 

### Response:
{'Human immunodeficiency virus [HIV] disease,Pneumonia, organism unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Other convulsions'}
