CHIEF COMPLAINT: hypoxia, myalgias

PRESENT ILLNESS: 43 yo M with HIV (CD4 52 [**2-25**]) who presents with diffuse body
pains.  Patient is poor historian and reports pain in head,
chest and abdomen x 3 days.  Also reports N/V, and cough.  Had
been smoking crack cocaine hours prior to ED visit.
.
Presented to the ED T 103.2 P 132 BP 133/75 R 32 O2 100% on RA.
Elevated lactate 5.5 came down with IVF to 2.5.  Elevated LDH
(329).  Started on Vanc, CTX, Bactrim in ED for multifocal pna.
.
On presentation to floor, the patient reported total body aches
especially in his back, joints, head, throat, and abdomen.
Reports severe cough producive of green sputum.

MEDICAL HISTORY: HIV (CD4 52 [**3-26**])
H/O +PPD treated for two months 3.5 years ago (was inpatient for
entire treatment).
PCP PNA [**Name Initial (PRE) **] 2, last 4.5 years ago
Depression with suicide attempt
Hep C
h/o Cdiff
h/o MRSA

MEDICATION ON ADMISSION: bactrim

ALLERGIES: Penicillins / Latex

PHYSICAL EXAM: VS - 99.2  83  117/73  16 100% on RA
Gen - A+Ox3, lying in bed
HEENT - OP clear, no thrush
Neck - supple, painful palpation of throat
Chest - diffuse ronchi mild, greater in bases
Cor - RRR
Abd - diffusely tender
Ext - w/wp, no edema, +2 DP

FAMILY HISTORY: NC

SOCIAL HISTORY: He resides in the [**Location (un) 4398**] with his girlfriend of 26 years. He
states that he consumes a fifth of vodka daily. He snorts
cocaine when it is available to him. He denies any h/o IV drug
use. He states that he became infected with HIV in the 80's
after he accidentally ran into a friend who was holding a needle
in a dark alley.
Human immunodeficiency virus [HIV] disease,Bacterial pneumonia, unspecified,Cocaine abuse, unspecified,Chronic hepatitis C without mention of hepatic coma
Human immuno virus dis,Bacterial pneumonia NOS,Cocaine abuse-unspec,Chrnc hpt C wo hpat coma
Admission Date:  [**2108-3-21**]              Discharge Date:   [**2108-3-23**]

Date of Birth:  [**2062-8-8**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins / Latex

Attending:[**First Name3 (LF) 1148**]
Chief Complaint:
hypoxia, myalgias

Major Surgical or Invasive Procedure:
None

History of Present Illness:
43 yo M with HIV (CD4 52 [**2-25**]) who presents with diffuse body
pains.  Patient is poor historian and reports pain in head,
chest and abdomen x 3 days.  Also reports N/V, and cough.  Had
been smoking crack cocaine hours prior to ED visit.
.
Presented to the ED T 103.2 P 132 BP 133/75 R 32 O2 100% on RA.
Elevated lactate 5.5 came down with IVF to 2.5.  Elevated LDH
(329).  Started on Vanc, CTX, Bactrim in ED for multifocal pna.
.
On presentation to floor, the patient reported total body aches
especially in his back, joints, head, throat, and abdomen.
Reports severe cough producive of green sputum.

Past Medical History:
HIV (CD4 52 [**3-26**])
H/O +PPD treated for two months 3.5 years ago (was inpatient for
entire treatment).
PCP PNA [**Name Initial (PRE) **] 2, last 4.5 years ago
Depression with suicide attempt
Hep C
h/o Cdiff
h/o MRSA


Social History:
He resides in the [**Location (un) 4398**] with his girlfriend of 26 years. He
states that he consumes a fifth of vodka daily. He snorts
cocaine when it is available to him. He denies any h/o IV drug
use. He states that he became infected with HIV in the 80's
after he accidentally ran into a friend who was holding a needle
in a dark alley.

Family History:
NC

Physical Exam:
VS - 99.2  83  117/73  16 100% on RA
Gen - A+Ox3, lying in bed
HEENT - OP clear, no thrush
Neck - supple, painful palpation of throat
Chest - diffuse ronchi mild, greater in bases
Cor - RRR
Abd - diffusely tender
Ext - w/wp, no edema, +2 DP

Pertinent Results:
[**2108-3-20**] 10:55PM   PT-12.5 PTT-28.5 INR(PT)-1.1

[**2108-3-20**] 10:55PM   PLT COUNT-363#
[**2108-3-20**] 10:55PM   NEUTS-69.3 LYMPHS-23.5 MONOS-6.8 EOS-0.2
BASOS-0.1
[**2108-3-20**] 10:55PM   WBC-9.4 RBC-4.05* HGB-10.5* HCT-31.9* MCV-79*
MCH-25.8* MCHC-32.8 RDW-14.1
[**2108-3-20**] 10:55PM   ASA-NEG ETHANOL-69* ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2108-3-20**] 10:55PM   ALBUMIN-4.0 PHOSPHATE-2.1*# MAGNESIUM-2.0
[**2108-3-20**] 10:55PM   CK-MB-2 cTropnT-<0.01
[**2108-3-20**] 10:55PM   LIPASE-31
[**2108-3-20**] 10:55PM   ALT(SGPT)-14 AST(SGOT)-33 LD(LDH)-329*
CK(CPK)-171 ALK PHOS-129* AMYLASE-100 TOT BILI-0.6
[**2108-3-20**] 10:55PM   GLUCOSE-89 UREA N-7 CREAT-0.9 SODIUM-142
POTASSIUM-3.9 CHLORIDE-101 TOTAL CO2-25 ANION GAP-20
[**2108-3-20**] 10:56PM   LACTATE-5.5*
[**2108-3-21**] 12:23AM   LACTATE-2.5*
[**2108-3-21**] 04:25AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0
LEUK-NEG
[**2108-3-21**] 05:50AM   CK(CPK)-183*
[**2108-3-21**] 05:27PM   WBC-5.4 RBC-4.25* HGB-11.1* HCT-34.1* MCV-80*
MCH-26.1* MCHC-32.5 RDW-13.7
[**2108-3-21**] 05:27PM   CALCIUM-8.5 PHOSPHATE-3.2 MAGNESIUM-1.9
[**2108-3-21**] 05:27PM   GLUCOSE-101 UREA N-5* CREAT-0.9 SODIUM-135
POTASSIUM-3.5 CHLORIDE-100 TOTAL CO2-24 ANION GAP-15
.
CXR: PORTABLE AP CHEST RADIOGRAPH: The lungs are clear. The
pulmonary vasculature is within normal limits. No pleural
effusions or pneumothorax is seen. The soft tissue and osseous
structures are stable.
.
CT chest/abd/pelvis: FINDINGS:
Consolidation is present at both lung bases, involving a small
portion of the lateral and posterior basal segments on the left,
and minimal involvement in the posterior basal segment on the
right. The distribution suggests aspiration as a possible cause;
there are no features to suggest that this is anything other
than bacterial pneumonia. Central lymph nodes are numerous
ranging in size up to 8 mm in the left lower paratracheal
station and the subcarinal space as well as well as many smaller
nodes in both axillae. Thymus is physiologic. There is no
pleural effusion.

This study is not designed for subdiaphragmatic diagnosis.
.
CT HEAD WITHOUT IV CONTRAST: No intracranial hemorrhage or mass
effect is identified. The ventricles are symmetric, and there is
no shift of normally midline structures. The [**Doctor Last Name 352**]-white matter
differentiation is preserved. The osseous structures are normal.
Partial opacification of posterior ethmoid air cells and the
left sphenoid sinus is noted.


Brief Hospital Course:
43yo male h/o AIDS/HIV, ?mild dementia, Hep C admit after
cocaine use with myalgias and hypoxia, ?aspiration PNA.  Also
sinus inflammation.  Patient initially admitted to MICU for
question of early sepsis with elevated lactate.  Never required
oxygen or pressure support.  Remained afebrile.  Ruled out for
TB with 3 negative AFBs.  Transferred to floor and on arrival
announced wanting to leave the hospital.  No firm reasons to
stay longer so discharged and encouraged strongly to arrange
follow up.
.
1) Pneumonia, bacterial: Likely CAP vs aspiration.  With HIV at
higher risk strep infection.
Given 10 days total levo/flagyl at discharge.
Recommend repeat CT scans to follow progression lymphadenopathy
after treatment of infection.
.
2) + Lactate: Likely element hypotension from cocaine use,
improved with hydration.  Encouraged patient to get help for
substance abuse.  Social work met with patient as well.
.
3) Etoh use: Never triggered CIWA.
.
4) HIV/AIDS: Most recent CD4 count 52.  Patient apparently not
on HAART.  Said he got his HIV care at [**Hospital1 2025**] but when called
clinic there they said patient never had been to an appt (always
was not kept by patient).  Given azithro and bactrim for
prophylaxis and encouraged patient to access care.  He reported
plans to move to [**Location (un) 7349**] and then out of the country to enjoy his
last days.  Patient may have element early HIV dementia but was
competent to make own decisions and appeared to understand the
consequences of his decisions.

Medications on Admission:
bactrim

Discharge Medications:
1. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 8 days.
Disp:*8 Tablet(s)* Refills:*0*
2. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 8 days.
Disp:*24 Tablet(s)* Refills:*0*
5. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1)
Tablet PO Tiweek: Take three times a week M-W-F.
Disp:*15 Tablet(s)* Refills:*2*
6. Azithromycin 600 mg Tablet Sig: Two (2) Tablet PO once a
week.
Disp:*8 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Pneumonia, bacterial
Cocaine use


Discharge Condition:
Stable


Discharge Instructions:
You were admitted with muscle aches and found to be hypoxic.  We
are concerned that the muscle aches may have been secondary to
cocaine use.  You were also found to have a small pneumonia.
Please take the antibiotics as prescribed.  Please return if you
develop worsening trouble breathing, fevers, worsening muscle
aches.
.
You also have HIV/AIDS and it is very important that you arrange
follow up care.  You would benefit from starting treatment for
your HIV.  For now please take the bactrim and the azithromycin
as perscribed.
.
Please try to stop using cocaine/alcohol as well.

Followup Instructions:
 You should call [**Hospital3 **] at [**Hospital1 18**] to establish
yourself with a new primary care physician. [**Name10 (NameIs) **] schedule an
appointment, please call [**Telephone/Fax (1) 250**].
.
You have been recommended to follow-up with in the Division of
Infectious Diseases for management of your HIV/AIDS. Please call
[**Telephone/Fax (1) 457**] to schedule your appointment. Or please follow up
with your previous doctors [**First Name (Titles) **] [**Last Name (Titles) 2025**].
{'Human immunodeficiency virus [HIV] disease,Bacterial pneumonia, unspecified,Cocaine abuse, unspecified,Chronic hepatitis C without mention of hepatic coma'}


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: hypoxia, myalgias

PRESENT ILLNESS: 43 yo M with HIV (CD4 52 [**2-25**]) who presents with diffuse body
pains.  Patient is poor historian and reports pain in head,
chest and abdomen x 3 days.  Also reports N/V, and cough.  Had
been smoking crack cocaine hours prior to ED visit.
.
Presented to the ED T 103.2 P 132 BP 133/75 R 32 O2 100% on RA.
Elevated lactate 5.5 came down with IVF to 2.5.  Elevated LDH
(329).  Started on Vanc, CTX, Bactrim in ED for multifocal pna.
.
On presentation to floor, the patient reported total body aches
especially in his back, joints, head, throat, and abdomen.
Reports severe cough producive of green sputum.

MEDICAL HISTORY: HIV (CD4 52 [**3-26**])
H/O +PPD treated for two months 3.5 years ago (was inpatient for
entire treatment).
PCP PNA [**Name Initial (PRE) **] 2, last 4.5 years ago
Depression with suicide attempt
Hep C
h/o Cdiff
h/o MRSA

MEDICATION ON ADMISSION: bactrim

ALLERGIES: Penicillins / Latex

PHYSICAL EXAM: VS - 99.2  83  117/73  16 100% on RA
Gen - A+Ox3, lying in bed
HEENT - OP clear, no thrush
Neck - supple, painful palpation of throat
Chest - diffuse ronchi mild, greater in bases
Cor - RRR
Abd - diffusely tender
Ext - w/wp, no edema, +2 DP

FAMILY HISTORY: NC

SOCIAL HISTORY: He resides in the [**Location (un) 4398**] with his girlfriend of 26 years. He
states that he consumes a fifth of vodka daily. He snorts
cocaine when it is available to him. He denies any h/o IV drug
use. He states that he became infected with HIV in the 80's
after he accidentally ran into a friend who was holding a needle
in a dark alley. 

### Response:
{'Human immunodeficiency virus [HIV] disease,Bacterial pneumonia, unspecified,Cocaine abuse, unspecified,Chronic hepatitis C without mention of hepatic coma'}
