CHIEF COMPLAINT: hypotension

PRESENT ILLNESS: Pt is a 31 yo with pmh significant for pulmonary hypertension,
active Heroin use, HIV, Hepatitis C, seizures related to heroin
use, recent MRSA soft tissue infection, who presented to the
[**Hospital Unit Name 153**] from direct transfer from OSH ED where had nl wbc count but
40% bands, hypotension to systolic of 50's requiring Levophed,
elevated AST, ALT, T.Bili, RUQ ultrasound showing edematous
thickened GB but no stones or CBD dilation.  Pt was presumed to
have acute cholangitis, and sent to [**Hospital1 18**] for emergent ERCP.
During a recent hospitalization from which she was discharged
one week prior, she was found to have elevated AST and ALT
(isolated) which was thought due to either shock liver or toxin
(drugs or medications).  RUQ pain radiates from just right of
the xiphoid process along the costal margin to the back.  No
alleviating or exacerbating symptoms.  No cp, sob, cough, ha,
fever, diarrhea, constipation.

MEDICAL HISTORY: Heroin abuse
Hepatitis C
Seizures associated with heroin use
HIV - on HARRT
pulmonary htn

MEDICATION ON ADMISSION: At Home:
Epivir
Naprosyn
Videx
Stavudine
*
From OSH ED:
Ceftriaxone
Tequin
Dilaudid
Morphine
Cefepime
Protonix
Vit K

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 99.0 HR 88 BP 98/62 RR 15 O2 sat 94%
Gen: lethargic, mild distress, skin without jaundice
HEENT: PERRLA, EOMI, sclera anicteric
Neck: no JVD, supple
Card: RRR, nl S1, loud S2, mild right sided heave, 4/6 SEM
loudest at LSB, no r/g
Lung: Soft rales at lung bases b/l
Abd: soft, mildly tender along right costal margin, no
rebound/gaurding; no [**Doctor Last Name 515**] sign; no ascites
Ext: wwp, no cce
Neuro: AAOx3, strength 5/5 throughout, 2+ reflexes throughout

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives with parents in [**Location (un) 5503**].  Has three children.
Previously worked at child care facility.
Pneumococcal septicemia [Streptococcus pneumoniae septicemia],Cardiac arrest,Congestive heart failure, unspecified,Opioid abuse, continuous,Unspecified viral hepatitis C without hepatic coma,Acute kidney failure, unspecified,Acute and subacute necrosis of liver,Acquired coagulation factor deficiency,Pneumococcal pneumonia [Streptococcus pneumoniae pneumonia],Other convulsions,Cardiogenic shock,Severe sepsis,Other chronic pulmonary heart diseases,Asymptomatic human immunodeficiency virus [HIV] infection status
Pneumococcal septicemia,Cardiac arrest,CHF NOS,Opioid abuse-continuous,Hpt C w/o hepat coma NOS,Acute kidney failure NOS,Acute necrosis of liver,Acq coagul factor defic,Pneumococcal pneumonia,Convulsions NEC,Cardiogenic shock,Severe sepsis,Chr pulmon heart dis NEC,Asymp hiv infectn status
Admission Date:  [**2169-9-29**]              Discharge Date:   [**2169-10-3**]

Date of Birth:  [**2138-7-30**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 99**]
Chief Complaint:
hypotension

Major Surgical or Invasive Procedure:
Right IJ and Swan-Ganz catheter placed

History of Present Illness:
Pt is a 31 yo with pmh significant for pulmonary hypertension,
active Heroin use, HIV, Hepatitis C, seizures related to heroin
use, recent MRSA soft tissue infection, who presented to the
[**Hospital Unit Name 153**] from direct transfer from OSH ED where had nl wbc count but
40% bands, hypotension to systolic of 50's requiring Levophed,
elevated AST, ALT, T.Bili, RUQ ultrasound showing edematous
thickened GB but no stones or CBD dilation.  Pt was presumed to
have acute cholangitis, and sent to [**Hospital1 18**] for emergent ERCP.
During a recent hospitalization from which she was discharged
one week prior, she was found to have elevated AST and ALT
(isolated) which was thought due to either shock liver or toxin
(drugs or medications).  RUQ pain radiates from just right of
the xiphoid process along the costal margin to the back.  No
alleviating or exacerbating symptoms.  No cp, sob, cough, ha,
fever, diarrhea, constipation.

Past Medical History:
Heroin abuse
Hepatitis C
Seizures associated with heroin use
HIV - on HARRT
pulmonary htn

Social History:
Lives with parents in [**Location (un) 5503**].  Has three children.
Previously worked at child care facility.

Family History:
non-contributory

Physical Exam:
T 99.0 HR 88 BP 98/62 RR 15 O2 sat 94%
Gen: lethargic, mild distress, skin without jaundice
HEENT: PERRLA, EOMI, sclera anicteric
Neck: no JVD, supple
Card: RRR, nl S1, loud S2, mild right sided heave, 4/6 SEM
loudest at LSB, no r/g
Lung: Soft rales at lung bases b/l
Abd: soft, mildly tender along right costal margin, no
rebound/gaurding; no [**Doctor Last Name 515**] sign; no ascites
Ext: wwp, no cce
Neuro: AAOx3, strength 5/5 throughout, 2+ reflexes throughout

Pertinent Results:
[**2169-9-29**] 08:46AM   WBC-27.8* RBC-5.09 HGB-11.7* HCT-38.7 MCV-76*
MCH-23.1* MCHC-30.4* RDW-19.8*
[**2169-9-29**] 08:46AM   NEUTS-67 BANDS-12* LYMPHS-4* MONOS-5 EOS-2
BASOS-0 ATYPS-0 METAS-8* MYELOS-2*
[**2169-9-29**] 08:46AM   ALT(SGPT)-1551* AST(SGOT)-1578* LD(LDH)-557*
ALK PHOS-114 AMYLASE-89 TOT BILI-4.2*
[**2169-9-29**] 08:46AM   GLUCOSE-85 UREA N-38* CREAT-1.6* SODIUM-133
POTASSIUM-5.6* CHLORIDE-106 TOTAL CO2-15* ANION GAP-18

CT abd/chest/pelvis:
IMPRESSION:
1. Slightly limited examination for pulmonary embolus due to
suboptimal bolus timing, with no pulmonary embolus identified.
2. Extensive bilateral pulmonary parenchymal consolidation and
bilateral pleural effusions, consistent with diffuse infectious
process.
3. Small pericardial effusion. Contrast refluxes into the
hepatic veins and IVC, consistent with right heart failure.
4. Anasarca and ascites.
5. No definite infectious source visualized in the abdomen.

U/S Abdomen:
IMPRESSION: 1) No evidence of acute cholecystitis. Gallbladder
wall thickening and echogenicity, consistent with AIDS
cholangiopathy. No intra or extrahepatic biliary ductal
dilatation. If there is persistent clinical concern, a HIDA scan
could be performed for further evaluation.
2) Enlarged and echogenic kidneys, consistent with HIV
nephropathy.
3) Small amount of ascites, not sufficient to mark for tap.
4) Small right pleural effusion.
5) Limited Doppler examination of the liver is grossly
unremarkable.

Blood Culture at OSH: 4/4 bottles with pneumoncoccus


Brief Hospital Course:
Pt was admitted and placed on vasopressors. She was found to be
septic with high wbc count, bandemia, hypotension, tachycardia,
hyperthermia, and blood cultures from OSH found to be positive
for pneumococcus. Pt was treated with broad antibiotic coverage
upon arrival. Repeat abdominal ultrasound with doppler at [**Hospital1 18**]
again showed no sign of bile duct obstruction and no portal
hypertension.  Further review of the abdomen showed elevated
LFTs which trended down, thought secondary to shock liver vs.
effects of toxins.  In work-up of abdominal pain there was no
abscess, no significant ascites.  CT scan of chest showed no PE,
was positive for pneumonia. As patient continued to be
hypotensive on vasopressors, a swan-ganz catheter was placed and
she was found to have severe pulmonary hypertension with
systolic pulmonary artery pressure in 150's.  A nitrous oxide
inhalation trial was without response. The patient had increased
work of breathing and eventually required intubation for
respiratory exhaustion.  After several days of worsening heart
failure and elevated pulmonary hypertension the patient had a
cardiopulmonary arrest with PEA and despite efforts to
resuscitate, died.

Medications on Admission:
At Home:
Epivir
Naprosyn
Videx
Stavudine
*
From OSH ED:
Ceftriaxone
Tequin
Dilaudid
Morphine
Cefepime
Protonix
Vit K

Discharge Medications:
N/A

Discharge Disposition:
Home

Discharge Diagnosis:
Pulmonary Hypertension
HIV
Hepatitis C
Heroin Use


Discharge Condition:
N/A

Discharge Instructions:
N/A

Followup Instructions:
N/A


Completed by:[**2169-10-16**]
{'Pneumococcal septicemia [Streptococcus pneumoniae septicemia],Cardiac arrest,Congestive heart failure, unspecified,Opioid abuse, continuous,Unspecified viral hepatitis C without hepatic coma,Acute kidney failure, unspecified,Acute and subacute necrosis of liver,Acquired coagulation factor deficiency,Pneumococcal pneumonia [Streptococcus pneumoniae pneumonia],Other convulsions,Cardiogenic shock,Severe sepsis,Other chronic pulmonary heart diseases,Asymptomatic human immunodeficiency virus [HIV] infection status'}


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: hypotension

PRESENT ILLNESS: Pt is a 31 yo with pmh significant for pulmonary hypertension,
active Heroin use, HIV, Hepatitis C, seizures related to heroin
use, recent MRSA soft tissue infection, who presented to the
[**Hospital Unit Name 153**] from direct transfer from OSH ED where had nl wbc count but
40% bands, hypotension to systolic of 50's requiring Levophed,
elevated AST, ALT, T.Bili, RUQ ultrasound showing edematous
thickened GB but no stones or CBD dilation.  Pt was presumed to
have acute cholangitis, and sent to [**Hospital1 18**] for emergent ERCP.
During a recent hospitalization from which she was discharged
one week prior, she was found to have elevated AST and ALT
(isolated) which was thought due to either shock liver or toxin
(drugs or medications).  RUQ pain radiates from just right of
the xiphoid process along the costal margin to the back.  No
alleviating or exacerbating symptoms.  No cp, sob, cough, ha,
fever, diarrhea, constipation.

MEDICAL HISTORY: Heroin abuse
Hepatitis C
Seizures associated with heroin use
HIV - on HARRT
pulmonary htn

MEDICATION ON ADMISSION: At Home:
Epivir
Naprosyn
Videx
Stavudine
*
From OSH ED:
Ceftriaxone
Tequin
Dilaudid
Morphine
Cefepime
Protonix
Vit K

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 99.0 HR 88 BP 98/62 RR 15 O2 sat 94%
Gen: lethargic, mild distress, skin without jaundice
HEENT: PERRLA, EOMI, sclera anicteric
Neck: no JVD, supple
Card: RRR, nl S1, loud S2, mild right sided heave, 4/6 SEM
loudest at LSB, no r/g
Lung: Soft rales at lung bases b/l
Abd: soft, mildly tender along right costal margin, no
rebound/gaurding; no [**Doctor Last Name 515**] sign; no ascites
Ext: wwp, no cce
Neuro: AAOx3, strength 5/5 throughout, 2+ reflexes throughout

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives with parents in [**Location (un) 5503**].  Has three children.
Previously worked at child care facility. 

### Response:
{'Pneumococcal septicemia [Streptococcus pneumoniae septicemia],Cardiac arrest,Congestive heart failure, unspecified,Opioid abuse, continuous,Unspecified viral hepatitis C without hepatic coma,Acute kidney failure, unspecified,Acute and subacute necrosis of liver,Acquired coagulation factor deficiency,Pneumococcal pneumonia [Streptococcus pneumoniae pneumonia],Other convulsions,Cardiogenic shock,Severe sepsis,Other chronic pulmonary heart diseases,Asymptomatic human immunodeficiency virus [HIV] infection status'}
