CHIEF COMPLAINT: transfer from OSH for management of c. diff/hiv

PRESENT ILLNESS: Mr. [**Known lastname 84644**] is a 81 year old male with past medical history of HIV
(CD4 215 [**10-31**], HAART stopped [**10-30**]), C. Difficile infection,
Chronic hepatitis B, adrenal insufficiency, MDS, and esophogitis
who was transferred to [**Hospital1 18**] from [**Hospital1 392**] for management of his
care. Mr. [**Known lastname 84644**] previously had no medical illnesses until [**Month (only) 205**] of
this year. At that time, he presented to [**Hospital6 **]
with complaint of weakness. At that time, he was diagnosed with
MDS and placed on steroids. He required transfusions of PRBCs
and platelets as needed. Additionally, he was treated with
antibiotics for fever. At the time of transfer, records are not
available and history is via patient's son. [**Name (NI) **] was discharged
home after approx a 1 week stay only to return ~4 days later
with complaint of chest pain.
.
Per his son, he did not suffer a heart attack, but instead was
diagnosed with esophogitis by EGD. He was treated with
sucralfate and lidocaine. During this hospitalization, he was
diagnosed with HIV and hepatitis B (listed as chronic in
transfer paperwork from [**Hospital1 392**]). He was not started on HAART at
this time. Additionally, his son states that there was a CT Head
during this admission that was consistent with a previous
stroke. After discharge, Mr. [**Known lastname 84644**] was doing well for 1 to 2 days
before developing fever, diarrhea and vomitting.
.
He was again admitted to [**Hospital1 2177**] with hypotension and had a
prolonged, 5[**Hospital **] hospital course. He required 2 transfers to
the ICU--one for SIRS in setting of RLL infiltrate requiring
vasopressors. During this admission, his steroids had been
decreased, however, he developed adrenal insufficiency and
required re-titration of his steroids to appropriate levels with
appropriate improvement in his blood pressure. During this
admission he was started on HAART and Bactrim, but developed a
rash 3 days later. Bactrim was discontinued, Dapsone started
instead for prophylaxis. Mr. [**Known lastname 84644**] was eventually discharged home
on [**2194-10-11**] with intent to get a second opinion at [**Hospital1 2025**]. After
arriving home, he developed worsening diarrhea and decline over
a span of days. His son states he was basically non-responsive
and he was taken by ambulance to [**Hospital6 10353**] on
[**2194-10-20**] for evaluation.
.
On admission to [**Hospital1 392**], he was hypotensive and tachycardic. He
was admitted to a partial care unit where he was resuscitated
with fluids. On [**2194-10-21**], he was started on vancomycin and flagyl
for treatment of C. Diff (unclear if he was diagnosed at [**Hospital1 2177**]
with C. Diff). CT A/P at that time showed colitis. For his
adrenal insufficiency, he had been taking Dexamethasone 1mg qam
and 2mg qpm as an outpatient. He was briefly started on
Florinef, however he developed anasarca and was placed back on
Dexamethasone 1 mg qid with stable hemodynamics. During the
course of the admission, his creatinine was noted to increase
from 1.3 to 1.76. Additionally, patient became increasingly
thrombocytopenic with platelets of 20 on day of transfer.
Heme/Onc felt thrombocytopenia may have been due to HAART. Due
to crystals in urine, renal felt HAART may account for ARF. On
[**10-30**], HAART was discontinued in the presence of 2L positive with
UOP of 4mL noted. He also had worsening anasarca. Also noted on
admission to [**Hospital1 392**] was oral thrush for which he was treated
with a 2 week course of fluconazole (possibly 3 weeks
treatment). LFTs were apparently stable and hepatitis B was not
considered an acute issue.
.
ROS: positive for edema, diarrhea, fatigue, weakness. denies
headache, change in vision or hearing, sore throat, chest pain,
abdominal pain, numbness in his extremities.

MEDICAL HISTORY: - HIV, dx ~[**7-31**], CD4 215 [**10-31**], HAART (emtricitabine-tenofivir,
atazanavir, ritonavir) discontinued [**10-30**]. c/b esophogitis.
- MDS, diagnosed [**7-31**] at [**Hospital1 18**], required PRBCs
- Adrenal Insufficiency, diagnosed [**8-31**]
- C. diff colitis, currently undergoing treatment
- Hepatitis B
- DM type 2
- HTN

MEDICATION ON ADMISSION: ON transfer from OSH
- Bicitra 30 ML PO BID
- D50W 50 mL IV prn
- Decadron 1 mg PO qid
- Diflucan 200mg Po qday (12 day course)
- Flagyl 500 mg PO tid
- Glucagon 1mg IM prn
- Glutose 15g oral prn
- Lactinex 1 packet TID
- Prilosec 20 mg PO
- Regular Insulin Sliding Scale
- Vancomycin solution 125mg PO q6h

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VITALS: T: 98.7 BP: 104/D HR: 80 RR: 18 O2:98 2L
GENERAL: elderly male in NAD, lying in bed, responsive,
anasarca.
HEENT: NC/AT, PERRL, dry mucous membranes, EOMI, oropharynx
clear - no visible thrush. sclera anicteric. conjunctival
injection in Left eye.
NECK: No LAD, no thyromegally.
CHEST: inspiratory crackles at bilateral lung bases. o/w CTA
bilaterally with no wheezing.
CV: RRR, no m/g/r. s1 and s2. no s3 or s4.
ABD: soft, mild tenderness to palpation diffusely. No guarding
or rebound tenderness. No suprapubic tenderness.
EXT: all 4 extremeties with generalized anasarca, in legs L>R.
radial pulses difficult to palpate with edema.
NEURO: Alert. CN II-XII intact. strength 4/5 in all 4
extremities. Sensation intact throughout. Gait and cerebellar
function not assessed.
SKIN: mottled appearance over extremities. no rashes or
petechiae noted.

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Immigrated from [**Country 38213**] in [**2190**] with permanent residency, son
states his infectious workup at that time was negative. No known
HIV risk factors, son not able to answer sexual history
questions. No alcohol history. Started smoking at age 45, 1 ppd
x 40 years. No drug history.
Intestinal infection due to Clostridium difficile,Unspecified septicemia,Acute respiratory failure,Acute kidney failure, unspecified,Hepatic infarction,Acute pancreatitis,Severe sepsis,Glucocorticoid deficiency,Acidosis,Acute venous embolism and thrombosis of unspecified deep vessels of lower extremity,Thrombocytopenia, unspecified,Asymptomatic human immunodeficiency virus [HIV] infection status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Myelodysplastic syndrome, unspecified,Unspecified essential hypertension
Int inf clstrdium dfcile,Septicemia NOS,Acute respiratry failure,Acute kidney failure NOS,Hepatic infarction,Acute pancreatitis,Severe sepsis,Glucocorticoid deficient,Acidosis,Ac DVT/embl low ext NOS,Thrombocytopenia NOS,Asymp hiv infectn status,DMII wo cmp nt st uncntr,Myelodysplastic synd NOS,Hypertension NOS
Admission Date:  [**2194-10-31**]              Discharge Date:   [**2194-11-8**]

Date of Birth:  [**2113-2-3**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2763**]
Chief Complaint:
transfer from OSH for management of c. diff/hiv

Major Surgical or Invasive Procedure:
intubation
bronchoscopy

History of Present Illness:
Mr. [**Known lastname 84644**] is a 81 year old male with past medical history of HIV
(CD4 215 [**10-31**], HAART stopped [**10-30**]), C. Difficile infection,
Chronic hepatitis B, adrenal insufficiency, MDS, and esophogitis
who was transferred to [**Hospital1 18**] from [**Hospital1 392**] for management of his
care. Mr. [**Known lastname 84644**] previously had no medical illnesses until [**Month (only) 205**] of
this year. At that time, he presented to [**Hospital6 **]
with complaint of weakness. At that time, he was diagnosed with
MDS and placed on steroids. He required transfusions of PRBCs
and platelets as needed. Additionally, he was treated with
antibiotics for fever. At the time of transfer, records are not
available and history is via patient's son. [**Name (NI) **] was discharged
home after approx a 1 week stay only to return ~4 days later
with complaint of chest pain.
.
Per his son, he did not suffer a heart attack, but instead was
diagnosed with esophogitis by EGD. He was treated with
sucralfate and lidocaine. During this hospitalization, he was
diagnosed with HIV and hepatitis B (listed as chronic in
transfer paperwork from [**Hospital1 392**]). He was not started on HAART at
this time. Additionally, his son states that there was a CT Head
during this admission that was consistent with a previous
stroke. After discharge, Mr. [**Known lastname 84644**] was doing well for 1 to 2 days
before developing fever, diarrhea and vomitting.
.
He was again admitted to [**Hospital1 2177**] with hypotension and had a
prolonged, 5[**Hospital **] hospital course. He required 2 transfers to
the ICU--one for SIRS in setting of RLL infiltrate requiring
vasopressors. During this admission, his steroids had been
decreased, however, he developed adrenal insufficiency and
required re-titration of his steroids to appropriate levels with
appropriate improvement in his blood pressure. During this
admission he was started on HAART and Bactrim, but developed a
rash 3 days later. Bactrim was discontinued, Dapsone started
instead for prophylaxis. Mr. [**Known lastname 84644**] was eventually discharged home
on [**2194-10-11**] with intent to get a second opinion at [**Hospital1 2025**]. After
arriving home, he developed worsening diarrhea and decline over
a span of days. His son states he was basically non-responsive
and he was taken by ambulance to [**Hospital6 10353**] on
[**2194-10-20**] for evaluation.
.
On admission to [**Hospital1 392**], he was hypotensive and tachycardic. He
was admitted to a partial care unit where he was resuscitated
with fluids. On [**2194-10-21**], he was started on vancomycin and flagyl
for treatment of C. Diff (unclear if he was diagnosed at [**Hospital1 2177**]
with C. Diff). CT A/P at that time showed colitis. For his
adrenal insufficiency, he had been taking Dexamethasone 1mg qam
and 2mg qpm as an outpatient. He was briefly started on
Florinef, however he developed anasarca and was placed back on
Dexamethasone 1 mg qid with stable hemodynamics. During the
course of the admission, his creatinine was noted to increase
from 1.3 to 1.76. Additionally, patient became increasingly
thrombocytopenic with platelets of 20 on day of transfer.
Heme/Onc felt thrombocytopenia may have been due to HAART. Due
to crystals in urine, renal felt HAART may account for ARF. On
[**10-30**], HAART was discontinued in the presence of 2L positive with
UOP of 4mL noted. He also had worsening anasarca. Also noted on
admission to [**Hospital1 392**] was oral thrush for which he was treated
with a 2 week course of fluconazole (possibly 3 weeks
treatment). LFTs were apparently stable and hepatitis B was not
considered an acute issue.
.
ROS: positive for edema, diarrhea, fatigue, weakness. denies
headache, change in vision or hearing, sore throat, chest pain,
abdominal pain, numbness in his extremities.

Past Medical History:
- HIV, dx ~[**7-31**], CD4 215 [**10-31**], HAART (emtricitabine-tenofivir,
atazanavir, ritonavir) discontinued [**10-30**]. c/b esophogitis.
- MDS, diagnosed [**7-31**] at [**Hospital1 18**], required PRBCs
- Adrenal Insufficiency, diagnosed [**8-31**]
- C. diff colitis, currently undergoing treatment
- Hepatitis B
- DM type 2
- HTN

Social History:
Immigrated from [**Country 38213**] in [**2190**] with permanent residency, son
states his infectious workup at that time was negative. No known
HIV risk factors, son not able to answer sexual history
questions. No alcohol history. Started smoking at age 45, 1 ppd
x 40 years. No drug history.

Family History:
Unknown

Physical Exam:
VITALS: T: 98.7 BP: 104/D HR: 80 RR: 18 O2:98 2L
GENERAL: elderly male in NAD, lying in bed, responsive,
anasarca.
HEENT: NC/AT, PERRL, dry mucous membranes, EOMI, oropharynx
clear - no visible thrush. sclera anicteric. conjunctival
injection in Left eye.
NECK: No LAD, no thyromegally.
CHEST: inspiratory crackles at bilateral lung bases. o/w CTA
bilaterally with no wheezing.
CV: RRR, no m/g/r. s1 and s2. no s3 or s4.
ABD: soft, mild tenderness to palpation diffusely. No guarding
or rebound tenderness. No suprapubic tenderness.
EXT: all 4 extremeties with generalized anasarca, in legs L>R.
radial pulses difficult to palpate with edema.
NEURO: Alert. CN II-XII intact. strength 4/5 in all 4
extremities. Sensation intact throughout. Gait and cerebellar
function not assessed.
SKIN: mottled appearance over extremities. no rashes or
petechiae noted.

Pertinent Results:
Please see OMR for evaluation of extensive medical workup
completed during patient's hospitalization.

Brief Hospital Course:
82 yom with adrenal insuficiency, MDS, and new HIV diagnosis who
presentwed with generalized illness and hypotension.  His
symptoms were thought to be due to C dif colitis initially
however his hypotension was severely out of proportion to his
diarrhea and did not respond adequately to fluid boluses.  He
was started on pressors and also given pulse dose steroids given
his history of adrenal insufficiency.  His mental status was
poor and remained that way, he continued to do more poorly each
day failing to wean off of pressors or improve his mental
status.  His renal function did not improve despite improved
renal perfusion and patient was not a candidate for dialysis.
Decision from his family was to reduce the level of care and
patient was made CMO.  He passed away peacefully with family at
the bedside after a prolonged and unsuccessful medical
evaluation to assess for factors that may be contributing to his
illness.


Medications on Admission:
ON transfer from OSH
- Bicitra 30 ML PO BID
- D50W 50 mL IV prn
- Decadron 1 mg PO qid
- Diflucan 200mg Po qday (12 day course)
- Flagyl 500 mg PO tid
- Glucagon 1mg IM prn
- Glutose 15g oral prn
- Lactinex 1 packet TID
- Prilosec 20 mg PO
- Regular Insulin Sliding Scale
- Vancomycin solution 125mg PO q6h


Discharge Disposition:
Expired

Discharge Diagnosis:
adrenal insufficiency
myelodysplastic syndrome
sepsis
HIV
thyrombocytopenia
acute renal failure

Discharge Condition:
deceased

                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 2764**]

Completed by:[**2195-3-26**]
{'Intestinal infection due to Clostridium difficile,Unspecified septicemia,Acute respiratory failure,Acute kidney failure, unspecified,Hepatic infarction,Acute pancreatitis,Severe sepsis,Glucocorticoid deficiency,Acidosis,Acute venous embolism and thrombosis of unspecified deep vessels of lower extremity,Thrombocytopenia, unspecified,Asymptomatic human immunodeficiency virus [HIV] infection status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Myelodysplastic syndrome, unspecified,Unspecified essential hypertension'}


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: transfer from OSH for management of c. diff/hiv

PRESENT ILLNESS: Mr. [**Known lastname 84644**] is a 81 year old male with past medical history of HIV
(CD4 215 [**10-31**], HAART stopped [**10-30**]), C. Difficile infection,
Chronic hepatitis B, adrenal insufficiency, MDS, and esophogitis
who was transferred to [**Hospital1 18**] from [**Hospital1 392**] for management of his
care. Mr. [**Known lastname 84644**] previously had no medical illnesses until [**Month (only) 205**] of
this year. At that time, he presented to [**Hospital6 **]
with complaint of weakness. At that time, he was diagnosed with
MDS and placed on steroids. He required transfusions of PRBCs
and platelets as needed. Additionally, he was treated with
antibiotics for fever. At the time of transfer, records are not
available and history is via patient's son. [**Name (NI) **] was discharged
home after approx a 1 week stay only to return ~4 days later
with complaint of chest pain.
.
Per his son, he did not suffer a heart attack, but instead was
diagnosed with esophogitis by EGD. He was treated with
sucralfate and lidocaine. During this hospitalization, he was
diagnosed with HIV and hepatitis B (listed as chronic in
transfer paperwork from [**Hospital1 392**]). He was not started on HAART at
this time. Additionally, his son states that there was a CT Head
during this admission that was consistent with a previous
stroke. After discharge, Mr. [**Known lastname 84644**] was doing well for 1 to 2 days
before developing fever, diarrhea and vomitting.
.
He was again admitted to [**Hospital1 2177**] with hypotension and had a
prolonged, 5[**Hospital **] hospital course. He required 2 transfers to
the ICU--one for SIRS in setting of RLL infiltrate requiring
vasopressors. During this admission, his steroids had been
decreased, however, he developed adrenal insufficiency and
required re-titration of his steroids to appropriate levels with
appropriate improvement in his blood pressure. During this
admission he was started on HAART and Bactrim, but developed a
rash 3 days later. Bactrim was discontinued, Dapsone started
instead for prophylaxis. Mr. [**Known lastname 84644**] was eventually discharged home
on [**2194-10-11**] with intent to get a second opinion at [**Hospital1 2025**]. After
arriving home, he developed worsening diarrhea and decline over
a span of days. His son states he was basically non-responsive
and he was taken by ambulance to [**Hospital6 10353**] on
[**2194-10-20**] for evaluation.
.
On admission to [**Hospital1 392**], he was hypotensive and tachycardic. He
was admitted to a partial care unit where he was resuscitated
with fluids. On [**2194-10-21**], he was started on vancomycin and flagyl
for treatment of C. Diff (unclear if he was diagnosed at [**Hospital1 2177**]
with C. Diff). CT A/P at that time showed colitis. For his
adrenal insufficiency, he had been taking Dexamethasone 1mg qam
and 2mg qpm as an outpatient. He was briefly started on
Florinef, however he developed anasarca and was placed back on
Dexamethasone 1 mg qid with stable hemodynamics. During the
course of the admission, his creatinine was noted to increase
from 1.3 to 1.76. Additionally, patient became increasingly
thrombocytopenic with platelets of 20 on day of transfer.
Heme/Onc felt thrombocytopenia may have been due to HAART. Due
to crystals in urine, renal felt HAART may account for ARF. On
[**10-30**], HAART was discontinued in the presence of 2L positive with
UOP of 4mL noted. He also had worsening anasarca. Also noted on
admission to [**Hospital1 392**] was oral thrush for which he was treated
with a 2 week course of fluconazole (possibly 3 weeks
treatment). LFTs were apparently stable and hepatitis B was not
considered an acute issue.
.
ROS: positive for edema, diarrhea, fatigue, weakness. denies
headache, change in vision or hearing, sore throat, chest pain,
abdominal pain, numbness in his extremities.

MEDICAL HISTORY: - HIV, dx ~[**7-31**], CD4 215 [**10-31**], HAART (emtricitabine-tenofivir,
atazanavir, ritonavir) discontinued [**10-30**]. c/b esophogitis.
- MDS, diagnosed [**7-31**] at [**Hospital1 18**], required PRBCs
- Adrenal Insufficiency, diagnosed [**8-31**]
- C. diff colitis, currently undergoing treatment
- Hepatitis B
- DM type 2
- HTN

MEDICATION ON ADMISSION: ON transfer from OSH
- Bicitra 30 ML PO BID
- D50W 50 mL IV prn
- Decadron 1 mg PO qid
- Diflucan 200mg Po qday (12 day course)
- Flagyl 500 mg PO tid
- Glucagon 1mg IM prn
- Glutose 15g oral prn
- Lactinex 1 packet TID
- Prilosec 20 mg PO
- Regular Insulin Sliding Scale
- Vancomycin solution 125mg PO q6h

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VITALS: T: 98.7 BP: 104/D HR: 80 RR: 18 O2:98 2L
GENERAL: elderly male in NAD, lying in bed, responsive,
anasarca.
HEENT: NC/AT, PERRL, dry mucous membranes, EOMI, oropharynx
clear - no visible thrush. sclera anicteric. conjunctival
injection in Left eye.
NECK: No LAD, no thyromegally.
CHEST: inspiratory crackles at bilateral lung bases. o/w CTA
bilaterally with no wheezing.
CV: RRR, no m/g/r. s1 and s2. no s3 or s4.
ABD: soft, mild tenderness to palpation diffusely. No guarding
or rebound tenderness. No suprapubic tenderness.
EXT: all 4 extremeties with generalized anasarca, in legs L>R.
radial pulses difficult to palpate with edema.
NEURO: Alert. CN II-XII intact. strength 4/5 in all 4
extremities. Sensation intact throughout. Gait and cerebellar
function not assessed.
SKIN: mottled appearance over extremities. no rashes or
petechiae noted.

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Immigrated from [**Country 38213**] in [**2190**] with permanent residency, son
states his infectious workup at that time was negative. No known
HIV risk factors, son not able to answer sexual history
questions. No alcohol history. Started smoking at age 45, 1 ppd
x 40 years. No drug history. 

### Response:
{'Intestinal infection due to Clostridium difficile,Unspecified septicemia,Acute respiratory failure,Acute kidney failure, unspecified,Hepatic infarction,Acute pancreatitis,Severe sepsis,Glucocorticoid deficiency,Acidosis,Acute venous embolism and thrombosis of unspecified deep vessels of lower extremity,Thrombocytopenia, unspecified,Asymptomatic human immunodeficiency virus [HIV] infection status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Myelodysplastic syndrome, unspecified,Unspecified essential hypertension'}
