CHIEF COMPLAINT: Altered mental status

PRESENT ILLNESS: Hx per family and patient

MEDICAL HISTORY: 1) HIV, acquired by sexual contact, diagnosed 12 years ago
follow by Dr. [**Last Name (STitle) **], CD4 376. On Viread, Lexiva, and Norvir.
No known history of opportunistic infections.
2) Hep C cirrhosis, recently has developed ascites and has been
started on spironolactone. Hep C VL 6,090 IU/mL in 8/[**2121**]. Has
yet to follow up at [**Hospital 3585**] clinic.
3) Rectal CA , followed by Dr. [**Last Name (STitle) **], [**First Name3 (LF) **] her note "invasive
squamous cell carcinoma harbored by an external anal wart,
status post radiation therapy, no chemotherapy."
4) Chronic peripheral neuropathy

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillins / Bactrim / Lamivudine

PHYSICAL EXAM: VS tm 96.9, tc 96.9, 120/58, 81, 16, 97%RA.
[**Name (NI) 2420**] Pt lying in bed, appeared cachectic. NAD. Cooperative but
lacked recollection of events over the last week.
HEENT- No observed lesions in head. Nonicteric sclera. PERRL.
EOMi. No thrush or erythema in throat.
Mouth- dry
Neck- No JVD appreciated
CV- RRR. Nl S1S2. No m/g/r's.
Chest- CTAB. No c/w/r.
Abd- Distended. No fluid wave shift noted. N/T, N/D. No
hepatomegaly. + splenomegaly. No caput medusa.
Ext- 2+ pitting edema bilaterally up to mid calves. 2+ DP's.
Skin- No rashes/lesions, ecchymoses.
Neurol- AOx2 (identified person, knows where he is. MSK [**4-1**]
bilaterally t/o.   + Asterixis.
Psych- As mentioned has trouble recalling events from last week.

FAMILY HISTORY: Grandparents with colon cancer. Mother recently diagnosed with
diabetes.

SOCIAL HISTORY: Formerly worked in insurance, not working currently. Lives
alone. Not sexually active, is bisexual. No illicit drug use
including IV per family.
Septicemia due to escherichia coli [E. coli],Spontaneous bacterial peritonitis,Septic shock,Acute respiratory failure,Acute kidney failure, unspecified,Cirrhosis of liver without mention of alcohol,Unspecified viral hepatitis C without hepatic coma,Hyposmolality and/or hyponatremia,Thrombocytopenia, unspecified,Severe sepsis,Asymptomatic human immunodeficiency virus [HIV] infection status,Unspecified hereditary and idiopathic peripheral neuropathy,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus
E coli septicemia,Spontan bact peritonitis,Septic shock,Acute respiratry failure,Acute kidney failure NOS,Cirrhosis of liver NOS,Hpt C w/o hepat coma NOS,Hyposmolality,Thrombocytopenia NOS,Severe sepsis,Asymp hiv infectn status,Idio periph neurpthy NOS,Hx-rectal & anal malign
Admission Date:  [**2123-8-15**]              Discharge Date:   [**2123-8-18**]

Date of Birth:  [**2078-9-26**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins / Bactrim / Lamivudine

Attending:[**First Name3 (LF) 3561**]
Chief Complaint:
Altered mental status

Major Surgical or Invasive Procedure:
central line
intubation
paracentesis

History of Present Illness:
Hx per family and patient

This is a 44 year old gentleman with HIV on HAART (CD4 376 vl
6000 in [**8-2**])hepatitis C cirrhosis who was brought in to ED by
family after he was not returning phone calls for 6 days. His
father and brother found him lying in bed, with soilage around
him--the house was in disarray. The patient appeared "out of
it". The patient does not recall any precipitating events. Pt
reports having diarrhea for last week, reports some temperature
elevations, and mild associated nausea w/one episode of vomiting
a few days before presentation. Has had chronic diarrhea with
some abdominal pain and distention over past several months. Per
mother, his health has been declining over the past two months
and he has had increasing abdominal distention and LE edema. He
was scheduled to see the Hepatology division at [**Hospital1 18**] but did
not keep appointments. In [**Name (NI) **], pt somnolent with asterixis.
Creatinine at 9.8 and BUN 91. K of 6.2. EKG with some peaked T
waves on V4-V6. Pt given Ca and insulin. Also given lactulose
for question with out po intake. Per ED the patient was somewhat
somnolent, but [**Name (NI) 3584**] and oriented. VS afebrile, P 74, BP 124/80,
RR 13 O2 98 on room air.
Pt says he does feel better currently, his appetite had been
poor but now requesting a sandwhich.


Past Medical History:
1) HIV, acquired by sexual contact, diagnosed 12 years ago
follow by Dr. [**Last Name (STitle) **], CD4 376. On Viread, Lexiva, and Norvir.
No known history of opportunistic infections.
2) Hep C cirrhosis, recently has developed ascites and has been
started on spironolactone. Hep C VL 6,090 IU/mL in 8/[**2121**]. Has
yet to follow up at [**Hospital 3585**] clinic.
3) Rectal CA , followed by Dr. [**Last Name (STitle) **], [**First Name3 (LF) **] her note "invasive
squamous cell carcinoma harbored by an external anal wart,
status post radiation therapy, no chemotherapy."
4) Chronic peripheral neuropathy


Social History:
Formerly worked in insurance, not working currently. Lives
alone. Not sexually active, is bisexual. No illicit drug use
including IV per family.

Family History:
Grandparents with colon cancer. Mother recently diagnosed with
diabetes.


Physical Exam:
VS tm 96.9, tc 96.9, 120/58, 81, 16, 97%RA.
[**Name (NI) 2420**] Pt lying in bed, appeared cachectic. NAD. Cooperative but
lacked recollection of events over the last week.
HEENT- No observed lesions in head. Nonicteric sclera. PERRL.
EOMi. No thrush or erythema in throat.
Mouth- dry
Neck- No JVD appreciated
CV- RRR. Nl S1S2. No m/g/r's.
Chest- CTAB. No c/w/r.
Abd- Distended. No fluid wave shift noted. N/T, N/D. No
hepatomegaly. + splenomegaly. No caput medusa.
Ext- 2+ pitting edema bilaterally up to mid calves. 2+ DP's.
Skin- No rashes/lesions, ecchymoses.
Neurol- AOx2 (identified person, knows where he is. MSK [**4-1**]
bilaterally t/o.   + Asterixis.
Psych- As mentioned has trouble recalling events from last week.



Pertinent Results:
[**2123-8-15**] 08:15PM   GLUCOSE-97 UREA N-91* CREAT-9.8*# SODIUM-125*
POTASSIUM-6.2* CHLORIDE-92* TOTAL CO2-18* ANION GAP-21*
[**2123-8-15**] 08:15PM   ALT(SGPT)-30 AST(SGOT)-69* ALK PHOS-114
AMYLASE-100 TOT BILI-1.2
[**2123-8-15**] 08:15PM   LIPASE-46
[**2123-8-15**] 08:15PM   CALCIUM-7.1* PHOSPHATE-5.2*# MAGNESIUM-2.8*
[**2123-8-15**] 08:27PM   LACTATE-2.3* K+-6.3*
[**2123-8-15**] 07:50PM   AMMONIA-71*
[**2123-8-15**] 07:50PM   WBC-8.1# RBC-3.74* HGB-12.0* HCT-33.8* MCV-90
MCH-32.1* MCHC-35.5* RDW-17.4*
[**2123-8-15**] 07:50PM   NEUTS-70.5* LYMPHS-20.1 MONOS-8.0 EOS-1.2
BASOS-0.3
[**2123-8-15**] 07:50PM   PLT COUNT-67*
[**2123-8-15**] 07:50PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2123-8-15**] 07:50PM   CK(CPK)-54

Brief Hospital Course:
A/P:
This is a 44 year old gentleman with HIV, hepatitis C cirrhosis
presents with mental status change and is found to be in renal
failure with elevated creatinine, with hyperkalemia,
hyponatremia, and AG acidosis. Currently mental status seems
improved and he is relatively [**Name2 (NI) 3584**], compared to family report.
Pt normotensive and afebrile. His abdomen is distended.
.
On [**2123-8-17**] patient underwent paracentesis. After the procedure
the patient became progressively tachypneic and complained of
diffuse abdominal pain. A blood gas showed diffuse metabolic
acidosis, patient was transferred to the MICU. Central line was
placed, patient was started on IV fluids, broad antibiotic
coverage and he was intubated. CT scan of abdomen showed diffuse
thickening of bowel walls without free air. Patient was
aggressively treated for sepsis (including three pressors) but
could not maintain adequate blood pressures. His condition
deteriorated with maximal support overnight. After a family
meeting, it was decided to pursue comfort measures. The patient
passed on [**2123-8-18**] at 9.30 AM. Family refused post-mortem
examination.

Discharge Disposition:
Expired

Discharge Diagnosis:
sepsis, multiorgan failure

Discharge Condition:
expired

Followup Instructions:
none


Completed by:[**2123-8-18**]
{'Septicemia due to escherichia coli [E. coli],Spontaneous bacterial peritonitis,Septic shock,Acute respiratory failure,Acute kidney failure, unspecified,Cirrhosis of liver without mention of alcohol,Unspecified viral hepatitis C without hepatic coma,Hyposmolality and/or hyponatremia,Thrombocytopenia, unspecified,Severe sepsis,Asymptomatic human immunodeficiency virus [HIV] infection status,Unspecified hereditary and idiopathic peripheral neuropathy,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus'}


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: Altered mental status

PRESENT ILLNESS: Hx per family and patient

MEDICAL HISTORY: 1) HIV, acquired by sexual contact, diagnosed 12 years ago
follow by Dr. [**Last Name (STitle) **], CD4 376. On Viread, Lexiva, and Norvir.
No known history of opportunistic infections.
2) Hep C cirrhosis, recently has developed ascites and has been
started on spironolactone. Hep C VL 6,090 IU/mL in 8/[**2121**]. Has
yet to follow up at [**Hospital 3585**] clinic.
3) Rectal CA , followed by Dr. [**Last Name (STitle) **], [**First Name3 (LF) **] her note "invasive
squamous cell carcinoma harbored by an external anal wart,
status post radiation therapy, no chemotherapy."
4) Chronic peripheral neuropathy

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillins / Bactrim / Lamivudine

PHYSICAL EXAM: VS tm 96.9, tc 96.9, 120/58, 81, 16, 97%RA.
[**Name (NI) 2420**] Pt lying in bed, appeared cachectic. NAD. Cooperative but
lacked recollection of events over the last week.
HEENT- No observed lesions in head. Nonicteric sclera. PERRL.
EOMi. No thrush or erythema in throat.
Mouth- dry
Neck- No JVD appreciated
CV- RRR. Nl S1S2. No m/g/r's.
Chest- CTAB. No c/w/r.
Abd- Distended. No fluid wave shift noted. N/T, N/D. No
hepatomegaly. + splenomegaly. No caput medusa.
Ext- 2+ pitting edema bilaterally up to mid calves. 2+ DP's.
Skin- No rashes/lesions, ecchymoses.
Neurol- AOx2 (identified person, knows where he is. MSK [**4-1**]
bilaterally t/o.   + Asterixis.
Psych- As mentioned has trouble recalling events from last week.

FAMILY HISTORY: Grandparents with colon cancer. Mother recently diagnosed with
diabetes.

SOCIAL HISTORY: Formerly worked in insurance, not working currently. Lives
alone. Not sexually active, is bisexual. No illicit drug use
including IV per family. 

### Response:
{'Septicemia due to escherichia coli [E. coli],Spontaneous bacterial peritonitis,Septic shock,Acute respiratory failure,Acute kidney failure, unspecified,Cirrhosis of liver without mention of alcohol,Unspecified viral hepatitis C without hepatic coma,Hyposmolality and/or hyponatremia,Thrombocytopenia, unspecified,Severe sepsis,Asymptomatic human immunodeficiency virus [HIV] infection status,Unspecified hereditary and idiopathic peripheral neuropathy,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus'}
