CHIEF COMPLAINT: Confusion, Nausea

PRESENT ILLNESS: 58 Y.O. man with HCV/EtOH cirrohosis, 3 recent admissions for
encephalopathy of unclear precipitant, p/w increasing
somnolence, fatigue.  Pt was most recently admitted on [**7-31**] and
discharged on [**8-3**] for hepatic enceph.  At that time, there was
no clear precipitant and he was treated with more aggressive
lactulose therapy.  He has been very fatigued since discharge
but per his wife there was no change in MS until this afternoon.
 He became very somnolent and disoriented and was brought in to
the ED.  Per his wife, he has not been complaining of increasing
abdominal girth, abdominal pain, nausea, vomitting.  He has been
taking his lactulose, and has been stooling.  Though he takes
morphine chronically, his dose has been less over the last week.
 Denies F/C, cough, SOB, dysuria, or any other focal symptoms of
infection.  Has been on cipro for SBP ppx and lactulose,
rifaximin. In [**Name (NI) **], pt noted to have GCS of [**4-10**], minimally
responsive.  He received PR lactulose without much change.
Then, due to increased hypoxia (93% on NRB), pt intubated for
airway protection.

MEDICAL HISTORY: 1.HCV cirrhosis: Contracted HCV from blood transfusion in [**2131**].
No prior treatment. Per report, has ulcers found on prior EGD.
On the liver tranplant waiting list-- being seen by Dr. [**Last Name (STitle) 497**].
Several recent admits for altered AMS. INR peak 2.9 on [**2162-4-8**],
with several measurements above 2.0 in the last several months.
Albumin nadir 2.4 on [**2162-4-8**]. ALT levels are all below 40 over
the last several months.
2. DM2: On inuslin. Diagnosed [**2160**].
3. Rheumatoid Arthritis
4. Alcoholism.
5. Ascites.
6. Group B Strep Bacteremia [**4-8**] s/p 1 month of IV Zosyn .

MEDICATION ON ADMISSION: Lactulose titrated to 4BMs per day
Morphine 15mg q4 hours
MS Contin 15mg q8h
Rifaximin 200mg tid
Lasix 40mg PO bid
Aldactone 100mg [**Hospital1 **]
Protonix 40mg daily
Cipro 250mg daily
Insulin NPH 18U + 14U
Nadolol 20mg daily
Magnesium Oxide 800mg daily

ALLERGIES: Ceftriaxone

PHYSICAL EXAM: T=99.0---P=78---BP 140/74---RR 27---O2 94% on 2L
Gen:  somnolent, decerebrate posturing.
HEENT: NCAT, PERRL, anicteric. OP clear with ETT in place.
Neck: supple, no LAD.
Lungs:  CTA b/l
CV:  Tachy and regular, nml S1S2, no m/r/g
Abd:  soft, distended, NT, naBS, dullness at flanks
Ext: no edema, 1+ dp pulses b/l.
Neuro: decerebrate posturing.
Skin: abrasion on LUE, multiple spiders on trunk.

FAMILY HISTORY: Family History:
Father-alive,84
Mother died of lung cancer.
Uncle and Aunt- died of cancer.

SOCIAL HISTORY: Lives with wife. Disabled veteran.
+tobacco currently.
+etoh previously.  Used to drink 6-12 beers/day.  Now, no drinks
since [**Month (only) 958**]. Used Marihuana and intranasal cocaine in the remote
past.
Baseline of moderate activity.
Chronic hepatitis C with hepatic coma,Alcoholic cirrhosis of liver,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Rheumatoid arthritis,Other specified disorders of stomach and duodenum,Tobacco use disorder,Personal history of alcoholism
Chrnc hpt C w hepat Coma,Alcohol cirrhosis liver,DMII wo cmp nt st uncntr,Rheumatoid arthritis,Gastroduodenal dis NEC,Tobacco use disorder,Hx of alcoholism
Admission Date:  [**2162-8-9**]              Discharge Date:   [**2162-8-12**]

Date of Birth:  [**2104-7-1**]             Sex:   M

Service: MEDICINE

Allergies:
Ceftriaxone

Attending:[**First Name3 (LF) 1491**]
Chief Complaint:
Confusion, Nausea

Major Surgical or Invasive Procedure:
Diagnostic Paracentesis under Ultrasound guidance
Central line placement
Intubation

History of Present Illness:
58 Y.O. man with HCV/EtOH cirrohosis, 3 recent admissions for
encephalopathy of unclear precipitant, p/w increasing
somnolence, fatigue.  Pt was most recently admitted on [**7-31**] and
discharged on [**8-3**] for hepatic enceph.  At that time, there was
no clear precipitant and he was treated with more aggressive
lactulose therapy.  He has been very fatigued since discharge
but per his wife there was no change in MS until this afternoon.
 He became very somnolent and disoriented and was brought in to
the ED.  Per his wife, he has not been complaining of increasing
abdominal girth, abdominal pain, nausea, vomitting.  He has been
taking his lactulose, and has been stooling.  Though he takes
morphine chronically, his dose has been less over the last week.
 Denies F/C, cough, SOB, dysuria, or any other focal symptoms of
infection.  Has been on cipro for SBP ppx and lactulose,
rifaximin. In [**Name (NI) **], pt noted to have GCS of [**4-10**], minimally
responsive.  He received PR lactulose without much change.
Then, due to increased hypoxia (93% on NRB), pt intubated for
airway protection.


Past Medical History:
1.HCV cirrhosis: Contracted HCV from blood transfusion in [**2131**].
No prior treatment. Per report, has ulcers found on prior EGD.
On the liver tranplant waiting list-- being seen by Dr. [**Last Name (STitle) 497**].
Several recent admits for altered AMS. INR peak 2.9 on [**2162-4-8**],
with several measurements above 2.0 in the last several months.
Albumin nadir 2.4 on [**2162-4-8**]. ALT levels are all below 40 over
the last several months.
2. DM2: On inuslin. Diagnosed [**2160**].
3. Rheumatoid Arthritis
4. Alcoholism.
5. Ascites.
6. Group B Strep Bacteremia [**4-8**] s/p 1 month of IV Zosyn .

Social History:
Lives with wife. Disabled veteran.
+tobacco currently.
+etoh previously.  Used to drink 6-12 beers/day.  Now, no drinks
since [**Month (only) 958**]. Used Marihuana and intranasal cocaine in the remote
past.
Baseline of moderate activity.


Family History:
Family History:
Father-alive,84
Mother died of lung cancer.
Uncle and Aunt- died of cancer.

Physical Exam:
T=99.0---P=78---BP 140/74---RR 27---O2 94% on 2L
Gen:  somnolent, decerebrate posturing.
HEENT: NCAT, PERRL, anicteric. OP clear with ETT in place.
Neck: supple, no LAD.
Lungs:  CTA b/l
CV:  Tachy and regular, nml S1S2, no m/r/g
Abd:  soft, distended, NT, naBS, dullness at flanks
Ext: no edema, 1+ dp pulses b/l.
Neuro: decerebrate posturing.
Skin: abrasion on LUE, multiple spiders on trunk.

Pertinent Results:
[**2162-8-9**] 07:45PM BLOOD WBC-7.4# RBC-3.99* Hgb-12.5* Hct-36.6*
MCV-92 MCH-31.4 MCHC-34.2 RDW-15.1 Plt Ct-114*#
[**2162-8-9**] 07:45PM BLOOD Neuts-74.4* Bands-0 Lymphs-17.5*
Monos-5.5 Eos-2.2 Baso-0.4
[**2162-8-9**] 07:45PM BLOOD PT-15.4* PTT-35.0 INR(PT)-1.6
[**2162-8-9**] 07:45PM BLOOD Plt Ct-114*#
[**2162-8-9**] 07:45PM BLOOD Glucose-143* UreaN-29* Creat-0.9 Na-137
K-4.9 Cl-105 HCO3-23 AnGap-14
[**2162-8-9**] 08:43PM BLOOD Ammonia-234*
[**2162-8-9**] 07:45PM BLOOD Albumin-3.1* Calcium-8.3* Phos-3.0 Mg-1.9
[**2162-8-9**] 07:45PM BLOOD Lipase-101*
[**2162-8-9**] 07:51PM BLOOD Lactate-2.2* K-5.0

Brief Hospital Course:
In the MICU pt was given aggressive Lactulose with improvement
in MS.  [**Name13 (STitle) **] was extubated in the afternoon on [**8-10**], with stable O2
sats and vitals after extubation.  A diagnostic paracentesis was
performed on [**8-11**] which showed 622 WBCs and 12% PMNs, no evidence
of SBP.  Cipro was continued for SBP prophylaxis and as his MS
was stable and he was afebrile and hemodynamically stable he was
transferred to the floor for further care.
.
On the floor pt. was monitored overnight.  As he was
hemodynamically stable, with no further changes in mental status
he was discharged with f/u by Hepatology outpatient.

Medications on Admission:
Lactulose titrated to 4BMs per day
Morphine 15mg q4 hours
MS Contin 15mg q8h
Rifaximin 200mg tid
Lasix 40mg PO bid
Aldactone 100mg [**Hospital1 **]
Protonix 40mg daily
Cipro 250mg daily
Insulin NPH 18U + 14U
Nadolol 20mg daily
Magnesium Oxide 800mg daily

Discharge Disposition:
Home

Discharge Diagnosis:
Primary: Hepatic Encephalopathy
Secondary: Hepatitis C, Hepatic Cirrhosis


Discharge Condition:
[**Name (NI) 14658**] pt. was alert and oriented with no further change in
mental status.  Paracentesis showed no evidence of infection and
pt. was afebrile.


Discharge Instructions:
Please take all medications as prescribed.

Please continue your Lactulose at your normal home dose.

Please call your PCP or go to the ER if you have any confusion,
fatigue, abdominal pain or distention, fevers, chills, nausea,
vomiting, coughing up blood, blood with bowel movements, or any
other symptoms that concern you.

Followup Instructions:
Please call your PCP Dr [**Last Name (STitle) **] to set up an appointment in the
next week.  You can reach his office at [**Telephone/Fax (1) 13148**] to make an
appointment.

Provider: [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] Where: LM [**Hospital Unit Name 7129**]
CENTER Phone:[**Telephone/Fax (1) 2422**] Date/Time:[**2162-8-17**] 1:00
- Dr. [**Last Name (STitle) **] will check your hemocrit at this visit, as it was
low in the hospital



Completed by:[**2162-8-14**]
{'Chronic hepatitis C with hepatic coma,Alcoholic cirrhosis of liver,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Rheumatoid arthritis,Other specified disorders of stomach and duodenum,Tobacco use disorder,Personal history of alcoholism'}


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: Confusion, Nausea

PRESENT ILLNESS: 58 Y.O. man with HCV/EtOH cirrohosis, 3 recent admissions for
encephalopathy of unclear precipitant, p/w increasing
somnolence, fatigue.  Pt was most recently admitted on [**7-31**] and
discharged on [**8-3**] for hepatic enceph.  At that time, there was
no clear precipitant and he was treated with more aggressive
lactulose therapy.  He has been very fatigued since discharge
but per his wife there was no change in MS until this afternoon.
 He became very somnolent and disoriented and was brought in to
the ED.  Per his wife, he has not been complaining of increasing
abdominal girth, abdominal pain, nausea, vomitting.  He has been
taking his lactulose, and has been stooling.  Though he takes
morphine chronically, his dose has been less over the last week.
 Denies F/C, cough, SOB, dysuria, or any other focal symptoms of
infection.  Has been on cipro for SBP ppx and lactulose,
rifaximin. In [**Name (NI) **], pt noted to have GCS of [**4-10**], minimally
responsive.  He received PR lactulose without much change.
Then, due to increased hypoxia (93% on NRB), pt intubated for
airway protection.

MEDICAL HISTORY: 1.HCV cirrhosis: Contracted HCV from blood transfusion in [**2131**].
No prior treatment. Per report, has ulcers found on prior EGD.
On the liver tranplant waiting list-- being seen by Dr. [**Last Name (STitle) 497**].
Several recent admits for altered AMS. INR peak 2.9 on [**2162-4-8**],
with several measurements above 2.0 in the last several months.
Albumin nadir 2.4 on [**2162-4-8**]. ALT levels are all below 40 over
the last several months.
2. DM2: On inuslin. Diagnosed [**2160**].
3. Rheumatoid Arthritis
4. Alcoholism.
5. Ascites.
6. Group B Strep Bacteremia [**4-8**] s/p 1 month of IV Zosyn .

MEDICATION ON ADMISSION: Lactulose titrated to 4BMs per day
Morphine 15mg q4 hours
MS Contin 15mg q8h
Rifaximin 200mg tid
Lasix 40mg PO bid
Aldactone 100mg [**Hospital1 **]
Protonix 40mg daily
Cipro 250mg daily
Insulin NPH 18U + 14U
Nadolol 20mg daily
Magnesium Oxide 800mg daily

ALLERGIES: Ceftriaxone

PHYSICAL EXAM: T=99.0---P=78---BP 140/74---RR 27---O2 94% on 2L
Gen:  somnolent, decerebrate posturing.
HEENT: NCAT, PERRL, anicteric. OP clear with ETT in place.
Neck: supple, no LAD.
Lungs:  CTA b/l
CV:  Tachy and regular, nml S1S2, no m/r/g
Abd:  soft, distended, NT, naBS, dullness at flanks
Ext: no edema, 1+ dp pulses b/l.
Neuro: decerebrate posturing.
Skin: abrasion on LUE, multiple spiders on trunk.

FAMILY HISTORY: Family History:
Father-alive,84
Mother died of lung cancer.
Uncle and Aunt- died of cancer.

SOCIAL HISTORY: Lives with wife. Disabled veteran.
+tobacco currently.
+etoh previously.  Used to drink 6-12 beers/day.  Now, no drinks
since [**Month (only) 958**]. Used Marihuana and intranasal cocaine in the remote
past.
Baseline of moderate activity. 

### Response:
{'Chronic hepatitis C with hepatic coma,Alcoholic cirrhosis of liver,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Rheumatoid arthritis,Other specified disorders of stomach and duodenum,Tobacco use disorder,Personal history of alcoholism'}
