CHIEF COMPLAINT: Fever, cough, transient hypotension

PRESENT ILLNESS: This is a 47 year old female with HIV (last CD4 159, not on
HAART), recent Enterobacter pneumonia s/p course of meropenem,
cardiomyopathy EF 20%, recent PE on anticoagulation; admit with
fever and found to have abscess vs. empyema. Recently admitted
from [**3-31**] to [**4-8**] during which time she had a stay in the [**Hospital Unit Name 153**]
and was intubated for respiratory distress. CT showed PE in
addition to dense consolidation. Bronch washings showing
Enterobacter and was treated with 8 day course of meropenem
after initial broad coverage. Discharged on heparin gtt and
coumadin also. She had completed meropenem on ?[**2191-4-10**] via PICC
line and had been doing well since. On [**4-20**] AM she spiked to
102.5 with fatigue. Here endorses cough with brownish-red
(?[**Month/Year (2) **]) sputum and dyspnea with pain in R lateral chest wall.
States all symptoms started on [**4-20**] AM (per notes, have been
going on since [**4-19**]). Also + hoarse voice. Denies HA, sore
throat, dysphagia, aspiration, abdominal pain, diarrhea, urinary
sx, change in leg swelling, rash, bleeding.

MEDICAL HISTORY: 1. HIV/AIDS, diagnosed [**2176**], off HAART.
- acquired via heterosexual intercourse.
- CD4 184, VL 254k [**2190-12-5**]
- nadir CD4 69 [**6-11**]
2. HCV antibody+
3. [**Doctor First Name **] [**1-/2182**] - was not complaint with Rx.
4. Oral thrush
5. Recurrent episodes of pneumococcal pneumonia.
6. Lymphocytic pneumonitis - diagnosed by trans-bronchial bx.
7. Dilated cardiomyopathy-EF20-25%, last echo [**4-13**].
8. LV thrombus
9. Antiphospholipid antibody syndrome
10. Lower extremity arterial thrombus
11. Asthma/bronchiectasis
12. Myocardial infarction [**2184**], clean coronaries at that time
13. L MCA stroke, residual right hemiparesis
14. Cocaine abuse
15. Pulmonary Nodules on chest CT
16. Zoster
17. Cholelithiasis
18. Recent PE and Enterobacter pneumonia as per HPI.

MEDICATION ON ADMISSION: 1. Carvedilol 6.25 mg Tablet Sig: One (1) Tablet PO BID
2. Ipratropium Bromide 0.02 % Solution TID
3. Guaifenesin 600 mg [**Hospital1 **]
4. Lisinopril 2.5 mg daily
5. Warfarin 7.5 mg daily
6. Heparin, Porcine (PF) 100 unit/mL Solution Sig: titrate to
PTT of 60-80 Units, current at 700 units/h
7. Polyethylene Glycol 3350 100 % Powder Sig: 17 grams grams PO

ALLERGIES: Zidovudine

PHYSICAL EXAM: On admission:
General: Sitting up in bed, NAD, alert and oriented. Hoarse
voice.
[**Year (4 digits) 4459**]: PERRL, slight conjunctival pallor, no icterus, MMM.
Neck: supple, no LAD.
Heart: Borderline tachy, regular, soft SM at LLSB appreciated.
Lungs: Bilat inspiratory wheeze, expiratory ?pleural rub on R,
very diminished at R base with coarse crackles. Refuses
percussion. Tenderness to mild palpation of mid R back.
Abdomen: +BS, + TTP on RUQ and flank, no current TTP of LLQ.
Extrem: warm, 2+ pulses, 3+ bilat pitting edema. RUE PICC in
place, appears benign.
Neuro: CN II-XII intact, strength 5/5 in L hand but refuses
strength testing in LUE.

FAMILY HISTORY: mother with DM

SOCIAL HISTORY: smokes "occassionally" X many years, no recent alcohol, h/o
cocaine abuse, but none recently, and has been homeless in the
past, now at Heb Reb.
Pneumonia, organism unspecified,Other primary cardiomyopathies,Human immunodeficiency virus [HIV] disease,Chronic systolic heart failure,Atrial fibrillation,Chronic hepatitis C without mention of hepatic coma,Other and unspecified nonspecific immunological findings,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants
Pneumonia, organism NOS,Prim cardiomyopathy NEC,Human immuno virus dis,Chr systolic hrt failure,Atrial fibrillation,Chrnc hpt C wo hpat coma,Oth unspcf nspf imun fnd,Hx-ven thrombosis/embols,Long-term use anticoagul
Admission Date:  [**2191-4-20**]              Discharge Date:   [**2191-4-22**]

Date of Birth:  [**2143-7-12**]             Sex:   F

Service: MEDICINE

Allergies:
Zidovudine

Attending:[**First Name3 (LF) 30**]
Chief Complaint:
Fever, cough, transient hypotension


Major Surgical or Invasive Procedure:
None.

History of Present Illness:
This is a 47 year old female with HIV (last CD4 159, not on
HAART), recent Enterobacter pneumonia s/p course of meropenem,
cardiomyopathy EF 20%, recent PE on anticoagulation; admit with
fever and found to have abscess vs. empyema. Recently admitted
from [**3-31**] to [**4-8**] during which time she had a stay in the [**Hospital Unit Name 153**]
and was intubated for respiratory distress. CT showed PE in
addition to dense consolidation. Bronch washings showing
Enterobacter and was treated with 8 day course of meropenem
after initial broad coverage. Discharged on heparin gtt and
coumadin also. She had completed meropenem on ?[**2191-4-10**] via PICC
line and had been doing well since. On [**4-20**] AM she spiked to
102.5 with fatigue. Here endorses cough with brownish-red
(?[**Month/Year (2) **]) sputum and dyspnea with pain in R lateral chest wall.
States all symptoms started on [**4-20**] AM (per notes, have been
going on since [**4-19**]). Also + hoarse voice. Denies HA, sore
throat, dysphagia, aspiration, abdominal pain, diarrhea, urinary
sx, change in leg swelling, rash, bleeding.

In the ED, T100.9, BP 94/61, HR 52, R20, 94% RA. Lowest SBP
recorded as 88, HRs in low 100s. 99-100% on 4L. Got vanco,
levoflox, cefepime and 2 L NS. Heparin gtt continued. Some LLQ
pain in ED as well. CXR with RLL pneumonia. CT abd/pelvis
performed showing abscess vs. empyema at R base of lung.
Thoracics consulted, no intervention planned currently but want
contrast chest CT study for better eval of abscess vs. empyema
(held off until tomorrow due to just getting contrast for abd
study).

Past Medical History:
1. HIV/AIDS, diagnosed [**2176**], off HAART.
- acquired via heterosexual intercourse.
- CD4 184, VL 254k [**2190-12-5**]
- nadir CD4 69 [**6-11**]
2. HCV antibody+
3. [**Doctor First Name **] [**1-/2182**] - was not complaint with Rx.
4. Oral thrush
5. Recurrent episodes of pneumococcal pneumonia.
6. Lymphocytic pneumonitis - diagnosed by trans-bronchial bx.
7. Dilated cardiomyopathy-EF20-25%, last echo [**4-13**].
8. LV thrombus
9. Antiphospholipid antibody syndrome
10. Lower extremity arterial thrombus
11. Asthma/bronchiectasis
12. Myocardial infarction [**2184**], clean coronaries at that time
13. L MCA stroke, residual right hemiparesis
14. Cocaine abuse
15. Pulmonary Nodules on chest CT
16. Zoster
17. Cholelithiasis
18. Recent PE and Enterobacter pneumonia as per HPI.

Social History:
smokes "occassionally" X many years, no recent alcohol, h/o
cocaine abuse, but none recently, and has been homeless in the
past, now at Heb Reb.

Family History:
mother with DM

Physical Exam:
On admission:
General: Sitting up in bed, NAD, alert and oriented. Hoarse
voice.
[**Year (4 digits) 4459**]: PERRL, slight conjunctival pallor, no icterus, MMM.
Neck: supple, no LAD.
Heart: Borderline tachy, regular, soft SM at LLSB appreciated.
Lungs: Bilat inspiratory wheeze, expiratory ?pleural rub on R,
very diminished at R base with coarse crackles. Refuses
percussion. Tenderness to mild palpation of mid R back.
Abdomen: +BS, + TTP on RUQ and flank, no current TTP of LLQ.
Extrem: warm, 2+ pulses, 3+ bilat pitting edema. RUE PICC in
place, appears benign.
Neuro: CN II-XII intact, strength 5/5 in L hand but refuses
strength testing in LUE.

Pertinent Results:
Labs on admission:
[**2191-4-20**] 01:45PM [**Month/Day/Year 3143**] WBC-3.7* RBC-4.10* Hgb-10.2* Hct-32.3*
MCV-79* MCH-24.8* MCHC-31.5 RDW-17.3* Plt Ct-156
[**2191-4-20**] 01:45PM [**Month/Day/Year 3143**] Neuts-62.8 Lymphs-34.7 Monos-2.2 Eos-0.1
Baso-0.3
[**2191-4-20**] 01:45PM [**Month/Day/Year 3143**] PT-22.4* PTT-77.4* INR(PT)-2.1*
[**2191-4-20**] 01:45PM [**Month/Day/Year 3143**] Glucose-99 UreaN-24* Creat-1.1 Na-131*
K-4.8 Cl-98 HCO3-23 AnGap-15
[**2191-4-20**] 01:45PM [**Month/Day/Year 3143**] ALT-11 AST-27 CK(CPK)-41 AlkPhos-104
TotBili-0.6
[**2191-4-20**] 01:45PM [**Month/Day/Year 3143**] Lipase-43
[**2191-4-20**] 01:45PM [**Month/Day/Year 3143**] CK-MB-NotDone cTropnT-<0.01
[**2191-4-21**] 05:58AM [**Month/Day/Year 3143**] Calcium-8.0* Phos-3.6 Mg-1.5*
[**2191-4-20**] 01:51PM [**Month/Day/Year 3143**] Lactate-1.3

CT abdomen/pelvis, [**2191-4-20**]:
1. Interval development of large right lower lobe mixed air and
fluid collection concerning for lung abscess/necrotizing
pneumonia.
2. No acute abdominal or pelvic pathology identified.
3. Cholelithiasis without acute cholecystitis.
4. No significant short interval change in the appearance of
lymphadenopathy in the mesentery and retroperitoneum.
5. Sequelae of prior renal and splenic infarcts

Chest x-ray [**2191-4-20**]:
1. Right lung airspace opacity consistent with pneumonia.
2. Resolution of previous right lower lobe collapse. Persistent
bibasilar atelectasis.


Brief Hospital Course:
This is a 47 year old female with HIV not on HAART, recent
Enterobacter pneumonia status-post 8 day Meropenem course,
readmitted with fevers and empyema vs. lung abscess on CT.

# Lung abscess vs. empyema. Given very recent previous admission
for HAP, concerning for continued presence of Enterobacter as
the causative organism, vs. other bug as superinfection.
Unlikely PCP or atypical/fungal/mycobacterial. Chest CT with
contrast for further characterization of RLL area suggests a
possible necrotic process in the area of her previously treated
pneumonia. Thoracics did follow the patient, however surgical
intervention is not indicated at this time. She was placed on
Meropenem and Vancomycin after consultation with the ID consult
service. She will continue this regimen for 21 days.  Pt was
afebrile x36 hours on discharge.
.
# Hypotension. This was transient and responsive to IV fluids.
She had an isolated SBP < 90, and then she returned to her
baseline SBP in the 90's.
.
# Hypoxia. The pt was continued on a heparin gtt for her recent
PE. She was able to breathe comfortably on room air on day 1 of
admission, so hypoxia was extremely transient. On discharge the
pt's O2 sats on room air were 99%.
.
# PE/APS. On admission the pt was on coumadin with heparin drip
bridge. On admission, the Coumadin was held in case of thoracic
surgery intervention and she was placed on a heparin drip.
Because of her antiphospholipid syndrome, her goal INR once back
on Coumadin is [**2-8**]. On discharge the pt's coumadin was
restarted.
.
# HIV. Not on HAART due to adherence issues. Last CD4 159. On
atovaquone for prophylaxis for PCP due to [**Name9 (PRE) 101144**] while on
bactrim.

# CHF, systolic dysfucntion, chronic. Has known EF of 20%.
Lisinopril was continued on discharge. Carvedilol was stopped
due to pt's chronic cocaine use.
.
# Hoarseness. She reported this symptom for 1 day prior to
admission. The ear, nose and throat service examined the pt and
thought that this is likely candidal, and fluconazole was
restarted.
.

Medications on Admission:
1. Carvedilol 6.25 mg Tablet Sig: One (1) Tablet PO BID
2. Ipratropium Bromide 0.02 % Solution TID
3. Guaifenesin 600 mg [**Hospital1 **]
4. Lisinopril 2.5 mg daily
5. Warfarin 7.5 mg daily
6. Heparin, Porcine (PF) 100 unit/mL Solution Sig: titrate to
PTT of 60-80 Units, current at 700 units/h
7. Polyethylene Glycol 3350 100 % Powder Sig: 17 grams grams PO

DAILY (Daily) as needed.
8. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q6H (every 6 hours) as needed.
9. Atovaquone 750 mg/5 mL Suspension Ten (10) mL PO DAILY
(intermittently compliant)
10. Meropenem 500 mg Recon Soln Sig: Five Hundred (500) mg
Intravenous Q6H (every 6 hours) for 2 days: through [**2191-4-10**] then

can stop. PICC line can be removed once this and heparin drip
have stopped.
11. Bisacodyl 10 mg daily
12. APAP prn
13. Albuterol nebs Q6H prn

Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - LTC

Discharge Diagnosis:
Multifocal pneumonia
Pulmonary embolism
Pleuritic chest pain RLL
Antiphospholipid antibody syndrome
Atrial fibrillation
Remote history of stroke
Pancytopenia when takes trimethoprim/sulfamethoxazole
AIDS (CD4 in [**3-14**] 160s)


Discharge Condition:
Good, breathing comfortably on room air.


Discharge Instructions:
Ms [**Known lastname **]: You were admitted with fever, cough and hoarseness.
You were found to have worsening of your pneumonia, and you were
restarted on antibiotics. You improved on antibiotics. The ear,
nose and throat service saw you for your hoarseness, and they
recommended that you restart your fluconazole for thrush.
.
Some of your home medications have been changed:
1. Carvedilol has been STOPPED
2. Ipratropium has been CONTINUED
3. Guaifenesin has been CONTINUED
4. Lisinopril has been CONTINUED
5. Warfarin has been CONTINUED
6. Heparin has been CONTINUED
7. Polyethylene Glycol has been STOPPED
8. Oxycodone-Acetaminophen has been CONTINUED
9. Atovaquone has been CONTINUED
10. Meropenem has been CONTINUED
11. Bisacodyl has been CONTINUED
12. Albuterol has been CONTINUED
.
The following medications have been STARTED: senna, colace,
vancomycin, fluconazole, and cepacol lozenges
.
If you develop chest pain, shortness of breath, bloody vomiting
or any other concerning symptom, please call your primary care
doctor or return to the emergency room.
.
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
Adhere to 2 gm sodium diet
Fluid Restriction:

Followup Instructions:
Infectious disease follow up:
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 7443**]
[**2191-4-27**] 12:00pm
.
Rehab: please schedule pt for follow up appointment with her PCP
within one week of discharge from rehab.
{'Pneumonia, organism unspecified,Other primary cardiomyopathies,Human immunodeficiency virus [HIV] disease,Chronic systolic heart failure,Atrial fibrillation,Chronic hepatitis C without mention of hepatic coma,Other and unspecified nonspecific immunological findings,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants'}


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: Fever, cough, transient hypotension

PRESENT ILLNESS: This is a 47 year old female with HIV (last CD4 159, not on
HAART), recent Enterobacter pneumonia s/p course of meropenem,
cardiomyopathy EF 20%, recent PE on anticoagulation; admit with
fever and found to have abscess vs. empyema. Recently admitted
from [**3-31**] to [**4-8**] during which time she had a stay in the [**Hospital Unit Name 153**]
and was intubated for respiratory distress. CT showed PE in
addition to dense consolidation. Bronch washings showing
Enterobacter and was treated with 8 day course of meropenem
after initial broad coverage. Discharged on heparin gtt and
coumadin also. She had completed meropenem on ?[**2191-4-10**] via PICC
line and had been doing well since. On [**4-20**] AM she spiked to
102.5 with fatigue. Here endorses cough with brownish-red
(?[**Month/Year (2) **]) sputum and dyspnea with pain in R lateral chest wall.
States all symptoms started on [**4-20**] AM (per notes, have been
going on since [**4-19**]). Also + hoarse voice. Denies HA, sore
throat, dysphagia, aspiration, abdominal pain, diarrhea, urinary
sx, change in leg swelling, rash, bleeding.

MEDICAL HISTORY: 1. HIV/AIDS, diagnosed [**2176**], off HAART.
- acquired via heterosexual intercourse.
- CD4 184, VL 254k [**2190-12-5**]
- nadir CD4 69 [**6-11**]
2. HCV antibody+
3. [**Doctor First Name **] [**1-/2182**] - was not complaint with Rx.
4. Oral thrush
5. Recurrent episodes of pneumococcal pneumonia.
6. Lymphocytic pneumonitis - diagnosed by trans-bronchial bx.
7. Dilated cardiomyopathy-EF20-25%, last echo [**4-13**].
8. LV thrombus
9. Antiphospholipid antibody syndrome
10. Lower extremity arterial thrombus
11. Asthma/bronchiectasis
12. Myocardial infarction [**2184**], clean coronaries at that time
13. L MCA stroke, residual right hemiparesis
14. Cocaine abuse
15. Pulmonary Nodules on chest CT
16. Zoster
17. Cholelithiasis
18. Recent PE and Enterobacter pneumonia as per HPI.

MEDICATION ON ADMISSION: 1. Carvedilol 6.25 mg Tablet Sig: One (1) Tablet PO BID
2. Ipratropium Bromide 0.02 % Solution TID
3. Guaifenesin 600 mg [**Hospital1 **]
4. Lisinopril 2.5 mg daily
5. Warfarin 7.5 mg daily
6. Heparin, Porcine (PF) 100 unit/mL Solution Sig: titrate to
PTT of 60-80 Units, current at 700 units/h
7. Polyethylene Glycol 3350 100 % Powder Sig: 17 grams grams PO

ALLERGIES: Zidovudine

PHYSICAL EXAM: On admission:
General: Sitting up in bed, NAD, alert and oriented. Hoarse
voice.
[**Year (4 digits) 4459**]: PERRL, slight conjunctival pallor, no icterus, MMM.
Neck: supple, no LAD.
Heart: Borderline tachy, regular, soft SM at LLSB appreciated.
Lungs: Bilat inspiratory wheeze, expiratory ?pleural rub on R,
very diminished at R base with coarse crackles. Refuses
percussion. Tenderness to mild palpation of mid R back.
Abdomen: +BS, + TTP on RUQ and flank, no current TTP of LLQ.
Extrem: warm, 2+ pulses, 3+ bilat pitting edema. RUE PICC in
place, appears benign.
Neuro: CN II-XII intact, strength 5/5 in L hand but refuses
strength testing in LUE.

FAMILY HISTORY: mother with DM

SOCIAL HISTORY: smokes "occassionally" X many years, no recent alcohol, h/o
cocaine abuse, but none recently, and has been homeless in the
past, now at Heb Reb. 

### Response:
{'Pneumonia, organism unspecified,Other primary cardiomyopathies,Human immunodeficiency virus [HIV] disease,Chronic systolic heart failure,Atrial fibrillation,Chronic hepatitis C without mention of hepatic coma,Other and unspecified nonspecific immunological findings,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants'}
