CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname 94673**] is a 43-year-old
male with a history of hepatitis C, hepatitis D, HIV positive
three days prior to his last admission at this institution.
He presented to the Emergency Room complaining of two days of
abdominal pain.  He stated that he had been having abdominal
pain since the day he left the hospital without being able to
move his bowels.  He also noticed that he took relatively
large amount of Opiate pain medication that was prescribed to
him postoperatively in a matter of 24 hours.  According to
somehow nauseated without significant vomiting.  Upon
evaluation in the Emergency Room, a KUB was obtained and he
was found to have dilated loops of small bowel with multiple
air fluid levels.  The patient upon his evaluation in the
Emergency Room was very agitated, requiring Ativan and
Morphine for his pain and agitation.  A couple of minutes
later after these medications were given to the patient, he
became more disoriented and confused, dropping his
respiratory rate to 10/minute, requiring Narcan
administration.  He appropriately recovered but became
progressively more combative and needed 4 point restriction
on the Emergency Room bed.  He continued to be confused and
for this reason it was decided to admit him to the Intensive
Care Unit for close monitoring up until his complete work-up
and evaluation was performed.

MEDICAL HISTORY: Significant for HIV positive,
hepatitic C positive, hepatitic B positive, history of
hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He has a history of IVDA until [**2124-1-25**].
Unspecified intestinal obstruction,Other postoperative infection,Hepatic encephalopathy,Other convulsions,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Cirrhosis of liver without mention of alcohol
Intestinal obstruct NOS,Other postop infection,Hepatic encephalopathy,Convulsions NEC,Hpt B chrn wo cm wo dlta,Cirrhosis of liver NOS
Admission Date:  [**2124-8-17**]     Discharge Date:  [**2124-8-21**]

Date of Birth:   [**2081-7-8**]     Sex:  M


Attending:[**Last Name (NamePattern4) 37996**]
HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 94673**] is a 43-year-old
male with a history of hepatitis C, hepatitis D, HIV positive
three days prior to his last admission at this institution.
He presented to the Emergency Room complaining of two days of
abdominal pain.  He stated that he had been having abdominal
pain since the day he left the hospital without being able to
move his bowels.  He also noticed that he took relatively
large amount of Opiate pain medication that was prescribed to
him postoperatively in a matter of 24 hours.  According to
somehow nauseated without significant vomiting.  Upon
evaluation in the Emergency Room, a KUB was obtained and he
was found to have dilated loops of small bowel with multiple
air fluid levels.  The patient upon his evaluation in the
Emergency Room was very agitated, requiring Ativan and
Morphine for his pain and agitation.  A couple of minutes
later after these medications were given to the patient, he
became more disoriented and confused, dropping his
respiratory rate to 10/minute, requiring Narcan
administration.  He appropriately recovered but became
progressively more combative and needed 4 point restriction
on the Emergency Room bed.  He continued to be confused and
for this reason it was decided to admit him to the Intensive
Care Unit for close monitoring up until his complete work-up
and evaluation was performed.

PAST MEDICAL HISTORY:  Significant for HIV positive,
hepatitic C positive, hepatitic B positive, history of
hypertension.

PAST SURGICAL HISTORY:  Status post umbilical hernia repair
on [**8-14**].

MEDICATIONS:  On admission included Albuterol, Dapsone,
Lasix, Spironolactone, Atenolol, Didanosine, Quinine Sulfate,
Stavudine, Ursodiol and Tenofovir.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  He has a history of IVDA until [**2124-1-25**].

PHYSICAL EXAMINATION:  He was afebrile, temperature 98.3,
heart rate 94, blood pressure 130/80, respiratory rate 14,
sats 98% on room air.  In general, upset, disoriented, mildly
confused, alert but no place, no time.  HEENT:  Pupils are
equal, round, and reactive, mucus membranes were dry.  Heart,
regular rate and rhythm, no murmurs, thrills, rubs or
gallops.  Lungs clear to auscultation bilaterally.  Abdomen
softly distended, tender to palpation, positive bowel sounds.
Incision of the umbilical hernia repair was clean, dry and
intact without erythema, induration or drainage.  There was
no guarding or rebound, no palpable masses.  Extremities were
warm, well perfused, no clubbing, cyanosis or edema.  Rectal
exam was unremarkable, guaiac negative.

LABORATORY DATA:  He was found to have white count of 8.3,
hematocrit 44.8, sodium 122, with potassium of 5.5.  BUN 47,
creatinine 1.3 with glucose of 145.  INR was 3.1 with PTT of
38.2.  Urine lytes were sent.  He had a urine sodium of 1110
with calculated FENA of 0.09.  His total bilirubin was 6.8.
Radiology, KUB was obtained as stated above that showed
multiple gas and distended loops of small bowel with air
fluid levels.  There was no free air under the diaphragm.

HOSPITAL COURSE:  The patient was admitted to the surgical
Intensive Care Unit for close monitoring.  Upon some of his
issues there was a profound hyponatremia that was corrected
with normal saline.

The next day after his admission he was noted to be still
confused and disoriented and at that time there was a concern
about his airway protection and the patient was electively
intubated.  The liver team evaluated him at that time and
there was a question of spontaneous bacterial peritonitis
since the patient underwent the umbilical hernia repair a
couple of days before.  He was tapped looking for infected
ascites and the liver team that performed the procedure
noticed that once they did the tap they absorbed fecal
material making them think that they had entered the bowel.
This puncture was done with a 25 gauge needle so he was
started on the appropriate coverage.  Overnight and over the
subsequent two days, Mr. [**Known lastname 94673**] continued to deteriorate.
Even though his electrolyte abnormalities were thoroughly
corrected, his mental status progressively deteriorated.  He
had episodes of tachypnea with respiratory rate in the mid
30's, low 40's becoming progressively more acidotic.  In an
attempt to correct his respiratory issues, he was started on
Propofol thinking that he might need some sedation.  His
ammonia levels were checked and he was found to have a level
of ammonia in the 300's.  Lactulose was started both through
the NG tube and in enemas and over the course of the next 24
hours mildly decreased to a level of 250's.  That morning his
Propofol was stopped in order to evaluate him neurologically
and he presented a tonic clonic seizure.  An emergent
neurology consultation was obtained and an EEG was performed.
At that time there was no obvious foci of irritability and
this seizure was attributed to the hepatic encephalopathy.
Head CT and abdominal CT was obtained and was read as
unremarkable head CT with dilated loops of small bowel in the
abdomen.  There was no obvious source of perforation or major
intra-abdominal collections that could be drained.

The next recommendation of neurology was to obtain an MRI.
This study was done as the patient was started on Dilantin to
prevent further seizures.  Infectious disease was also
consulted and they agreed with the antibiotic coverage
suggesting to add Fluconazole to the antibiotics just to
cover a potential fungal infection.

All along close communication was maintained with the
patient's family and at this point they expressed concerns
about his prognosis.  A detailed discussion was had with them
and the prognosis of this patient was explained to the
family.  They manifested that it was the patient's desire not
to be maintained on critical care support as well as
ventilatory support in the event that he would have a
complication related to his disease.  The Intensive Care Unit
staff as well as the surgical staff discussed this with the
family and they decided to extubate him and put him on
comfort measures only.  Shortly after this was carried out,
at 1:05 p.m., [**2124-8-21**], the patient was pronounced dead in the
Surgical Intensive Care Unit on the [**Hospital Ward Name 517**] at the [**Hospital1 1444**].  The patient's family
declined post mortem examination.  The case was reported to
the medical examiner and it was rejected.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**], M.D.,Ph.D.  02-366

Dictated By:[**Last Name (NamePattern4) 26544**]

MEDQUIST36

D:  [**2124-8-21**]  14:13
T:  [**2124-8-26**]  17:23
JOB#:  [**Job Number 94674**]
{'Unspecified intestinal obstruction,Other postoperative infection,Hepatic encephalopathy,Other convulsions,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Cirrhosis of liver without mention of alcohol'}


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: Mr. [**Known lastname 94673**] is a 43-year-old
male with a history of hepatitis C, hepatitis D, HIV positive
three days prior to his last admission at this institution.
He presented to the Emergency Room complaining of two days of
abdominal pain.  He stated that he had been having abdominal
pain since the day he left the hospital without being able to
move his bowels.  He also noticed that he took relatively
large amount of Opiate pain medication that was prescribed to
him postoperatively in a matter of 24 hours.  According to
somehow nauseated without significant vomiting.  Upon
evaluation in the Emergency Room, a KUB was obtained and he
was found to have dilated loops of small bowel with multiple
air fluid levels.  The patient upon his evaluation in the
Emergency Room was very agitated, requiring Ativan and
Morphine for his pain and agitation.  A couple of minutes
later after these medications were given to the patient, he
became more disoriented and confused, dropping his
respiratory rate to 10/minute, requiring Narcan
administration.  He appropriately recovered but became
progressively more combative and needed 4 point restriction
on the Emergency Room bed.  He continued to be confused and
for this reason it was decided to admit him to the Intensive
Care Unit for close monitoring up until his complete work-up
and evaluation was performed.

MEDICAL HISTORY: Significant for HIV positive,
hepatitic C positive, hepatitic B positive, history of
hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He has a history of IVDA until [**2124-1-25**]. 

### Response:
{'Unspecified intestinal obstruction,Other postoperative infection,Hepatic encephalopathy,Other convulsions,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Cirrhosis of liver without mention of alcohol'}
