CHIEF COMPLAINT: Altered Mental Status

PRESENT ILLNESS: 46 yo female with history of poorly controlled HIV/AIDS ([**2120-11-26**]
CD4: 3; VL: >100,000), not on HAART who presents from her
nursing home with decreased mental status.  Finished cipro 500mg
[**Hospital1 **] on [**2121-1-12**].  Patient was recently admitted to [**Hospital1 18**]
[**Date range (1) 71533**] for a clogged PEG tube.  Patient was recently
admitted to [**Hospital1 18**] 1/1-14-07 for UTI and ? meningitis.
.
In the ED the patient was afebrile and hemodynamically stable.
Blood glucose was off range and patient was started on an
insulin gtt.  Patient given 4L NS, flagyl 500mg, levoflox 750mg.
 Seen by PCP who was concerned for pancreatitis and/or
infection.
.
On arrival to the MICU patient was confused.
.
MICU COURSE:
[**1-15**]: LP overnight.  broad abx and antifungals given.
[**1-16**]: RUQ ultrasound only sig. for sludge in GB.  narrowed
coverage.  will d/w id re haart and pelvic abscesses (seen on
CT).  will d/w pcp and hcp re code status. Started on gentamycin
for better GNR coverage. GI- MRCP shows HIV cholangiopathy, will
not do ERCP. R/O for TB started per ID. d/c ambisome, acyclovir,
bactrim. Restarted on prophylactic dose of bactrim.
.
ABX:
[**1-16**]: started on gentomycin and levaquin d/c'd
ambisome d/c'd (no crypto in CSF), acyclovir d/c'd (no HSV in
CSF).
.
[**Hospital **] transferred to the floor for continued care.

MEDICAL HISTORY: HIV/AIDS: CD4 3, VL >100,000 not on HAART
- ? AIDS dementia/FTT
- PPD negative [**2120-11-3**]
- Pneumovax [**2120-10-24**]
Seizure Disorder
S/p Right MCA CVA [**2116**]
Pancytopenia
GERD
Bladder Incontinence

MEDICATION ON ADMISSION: 1. Ascorbic Acid 500mg [**Hospital1 **]
2. Azithromycin 600 mg PO QThurs
3. Bisacodyl 10 mg qhs prn
4. Ciprofloxacin 500 PO Q12H 7 days (finished [**1-12**])
5. Hyoscyamine Sulfate 0.125 mg QID
6. Keppra 500mg [**Hospital1 **]
7. Magnesium Hydroxide 400mg/5mL - 30ml q6h prn
8. MVI
9. Senna 8.6mg qhs
10. Zinc Sulfate 220mg qday
11. Bactrim 80-400mg qday
12. Humalog Insulin per sliding scale
13. Jevity 1.2 goal 60cc/hr
.

ALLERGIES: Penicillins / Ceftriaxone

PHYSICAL EXAM: VS - 95.7(ax) 108  131/85  17  100@ 3LNC
Gen - confused, agitated, patient extremely uncooperative with
exam.  Flailing and contracting.
HEENT -  dry MM
Neck - supple, + cervical LAD
Cor - tachy, no murmurs
Chest - clear but poor airmovement and moaning
Abd - tender to palpation, + BS, no rebound, no guarding
Ext - no edema, R heel with decub ulcer, decub on coccyx and
breakdown of skin around labia.
Neuro - L hemiparesis, unable to eval pupils because patient is
clamping eyes down.  seems to be neglecting L side.
.

FAMILY HISTORY: NC

SOCIAL HISTORY: The patient is a resident at [**Hospital **] [**Hospital 731**] nursing home. She is
reported to follow commands but have altered communication at
baseline.
Tobacco: Previous use, unknown
ETOH: Previous abuse, amount unknown
Illicits: None reported
Human immunodeficiency virus [HIV] disease,Pneumonia, organism unspecified,Urinary tract infection, site not specified,Acidosis,Pressure ulcer, heel,Acute pancreatitis,Unspecified protein-calorie malnutrition,Dementia in conditions classified elsewhere without behavioral disturbance,Epilepsy, unspecified, without mention of intractable epilepsy,Chronic or unspecified parametritis and pelvic cellulitis
Human immuno virus dis,Pneumonia, organism NOS,Urin tract infection NOS,Acidosis,Pressure ulcer, heel,Acute pancreatitis,Protein-cal malnutr NOS,Dementia w/o behav dist,Epilep NOS w/o intr epil,Chronic parametritis
Admission Date:  [**2121-1-15**]              Discharge Date:   [**2121-1-24**]

Date of Birth:  [**2074-4-6**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins / Ceftriaxone

Attending:[**First Name3 (LF) 3507**]
Chief Complaint:
Altered Mental Status

Major Surgical or Invasive Procedure:
None

History of Present Illness:
46 yo female with history of poorly controlled HIV/AIDS ([**2120-11-26**]
CD4: 3; VL: >100,000), not on HAART who presents from her
nursing home with decreased mental status.  Finished cipro 500mg
[**Hospital1 **] on [**2121-1-12**].  Patient was recently admitted to [**Hospital1 18**]
[**Date range (1) 71533**] for a clogged PEG tube.  Patient was recently
admitted to [**Hospital1 18**] 1/1-14-07 for UTI and ? meningitis.
.
In the ED the patient was afebrile and hemodynamically stable.
Blood glucose was off range and patient was started on an
insulin gtt.  Patient given 4L NS, flagyl 500mg, levoflox 750mg.
 Seen by PCP who was concerned for pancreatitis and/or
infection.
.
On arrival to the MICU patient was confused.
.
MICU COURSE:
[**1-15**]: LP overnight.  broad abx and antifungals given.
[**1-16**]: RUQ ultrasound only sig. for sludge in GB.  narrowed
coverage.  will d/w id re haart and pelvic abscesses (seen on
CT).  will d/w pcp and hcp re code status. Started on gentamycin
for better GNR coverage. GI- MRCP shows HIV cholangiopathy, will
not do ERCP. R/O for TB started per ID. d/c ambisome, acyclovir,
bactrim. Restarted on prophylactic dose of bactrim.
.
ABX:
[**1-16**]: started on gentomycin and levaquin d/c'd
ambisome d/c'd (no crypto in CSF), acyclovir d/c'd (no HSV in
CSF).
.
[**Hospital **] transferred to the floor for continued care.


Past Medical History:
HIV/AIDS: CD4 3, VL >100,000 not on HAART
- ? AIDS dementia/FTT
- PPD negative [**2120-11-3**]
- Pneumovax [**2120-10-24**]
Seizure Disorder
S/p Right MCA CVA [**2116**]
Pancytopenia
GERD
Bladder Incontinence


Social History:
The patient is a resident at [**Hospital **] [**Hospital 731**] nursing home. She is
reported to follow commands but have altered communication at
baseline.
Tobacco: Previous use, unknown
ETOH: Previous abuse, amount unknown
Illicits: None reported


Family History:
NC

Physical Exam:
VS - 95.7(ax) 108  131/85  17  100@ 3LNC
Gen - confused, agitated, patient extremely uncooperative with
exam.  Flailing and contracting.
HEENT -  dry MM
Neck - supple, + cervical LAD
Cor - tachy, no murmurs
Chest - clear but poor airmovement and moaning
Abd - tender to palpation, + BS, no rebound, no guarding
Ext - no edema, R heel with decub ulcer, decub on coccyx and
breakdown of skin around labia.
Neuro - L hemiparesis, unable to eval pupils because patient is
clamping eyes down.  seems to be neglecting L side.
.


Pertinent Results:
Reports:
EKG: sinus tach 120 NA/NI, peaked T's V2-4 with <1mm ST elev
.
CT Chest/Abd/Pelvis:
1.  Bilateral pneumonia, in a pattern suggesting aspiration.
(tree and [**Male First Name (un) 239**])
2.  Multiple small abscesses in musculature of pelvis.
3.  Hypoenhancing pancreatic tail, without focal fluid
collection.  Evidence of background chronic pancreatitis, with
diffuse pancreatic calcifications and dilation of pancreatic
duct to 4 mm.
.
CT Head:
1.  Left mastoid air cell opacification, indicating probable
mastoiditis.
2.  Limited study, but no gross intracranial hemorrhage.
.
CXR: Unresolving left lower lobe/retrocardiac opacity.  Given
stability of findings dating back to [**2120-11-25**], A CT
examination is recommended to rule out a postobstructive
process.
.

[**2121-1-16**] 03:03AM BLOOD calTIBC-164* VitB12-1508* Folate->20
Hapto-99 Ferritn-GREATER TH TRF-126*
[**2121-1-15**] 01:55PM BLOOD Lipase-260*
[**2121-1-16**] 02:10PM BLOOD Lipase-666* GGT-1138*
[**2121-1-21**] 08:20AM BLOOD Lipase-240* GGT-1298*
[**2121-1-15**] 01:55PM BLOOD ALT-188* AST-499* AlkPhos-1400*
Amylase-258* TotBili-0.6
[**2121-1-15**] 01:55PM BLOOD Glucose-685* UreaN-40* Creat-1.1 Na-139
K-4.7 Cl-104 HCO3-25 AnGap-15
[**2121-1-22**] 05:00AM BLOOD Glucose-221* UreaN-8 Creat-0.4 Na-141
K-3.7 Cl-114* HCO3-19* AnGap-12
[**2121-1-17**] 08:05AM BLOOD Fibrino-407* D-Dimer-2757*
[**2121-1-15**] 01:55PM BLOOD Plt Ct-166
[**2121-1-15**] 01:55PM BLOOD WBC-6.0# RBC-2.60* Hgb-9.3* Hct-27.3*
MCV-105* MCH-35.8* MCHC-34.1 RDW-17.5* Plt Ct-166
[**2121-1-22**] 05:45PM BLOOD WBC-5.7# RBC-2.04* Hgb-7.1* Hct-20.9*
MCV-102* MCH-34.6* MCHC-33.7 RDW-18.7* Plt Ct-118*
[**2121-1-16**] 12:34AM CEREBROSPINAL FLUID (CSF) WBC-1 RBC-0 Polys-0
Lymphs-100 Monos-0
[**2121-1-16**] 12:34AM CEREBROSPINAL FLUID (CSF) TotProt-104*
Glucose-228
.
FINDINGS: The examination is limited due to patient motion.
There is bibasilar airspace disease which may be atelectasis or
infection. Again seen is trace pericholecystic fluid which was
seen on CT scan. There is no evidence of gallstones. There is no
intra- or extra-hepatic biliary ductal dilatation. No focal
intrahepatic lesions are demonstrated. There is no evidence of
choledocholithiasis. There is a slight strandy increased T2
signal intensity surrounding the tail of the pancreas, most
consistent with pancreatitis as seen on CT scan. No focal mass
is demonstrated, although the images are limited due to patient
motion. There is no evidence of pancreatic duct dilatation. The
adrenal glands and left kidney are unremarkable. There is a 5-mm
cyst at the interpolar region of the right kidney. There is no
lymphadenopathy. A transpyloric tube is seen which is coiled in
the duodenum as seen on CT scan.

Edema is seen within the musculature of the lower extremities
bilaterally, only partially imaged. There is normal bone marrow
signal intensity.

IMPRESSION:
1. No evidence of intra- or extra-hepatic biliary ductal
dilatation. No evidence of choledocholithiasis.
2. Trace pericholecystic fluid without evidence of gallstones or
gallbladder wall thickening or distention.
3. Findings consistent with edema in the region of the
pancreatic tail, most likely secondary to pancreatitis. The
examination is limited due to patient motion; however, no
definite pancreatic mass is demonstrated.
4. Bibasilar airspace disease, atelectasis or infection.
5. Bilateral edema within the lower extremity musculature.


Brief Hospital Course:
The patient was initially admitted to the ICU for further
workup, had multiples studies done including MRCP, CT head, LP.
Workup disclosed ?AIDS cholangiopathy and pancreatitis.
Eventually called out to floor.  Family meeting held between PCP
(Dr. [**Last Name (STitle) 5762**], Dr. [**Last Name (STitle) 1299**] and Family.  Decision was made to make
pt [**Name (NI) 3225**] given extremely poor prognosis.  Pt expired at 16:05 on
[**1-24**]/7.

Medications on Admission:
1. Ascorbic Acid 500mg [**Hospital1 **]
2. Azithromycin 600 mg PO QThurs
3. Bisacodyl 10 mg qhs prn
4. Ciprofloxacin 500 PO Q12H 7 days (finished [**1-12**])
5. Hyoscyamine Sulfate 0.125 mg QID
6. Keppra 500mg [**Hospital1 **]
7. Magnesium Hydroxide 400mg/5mL - 30ml q6h prn
8. MVI
9. Senna 8.6mg qhs
10. Zinc Sulfate 220mg qday
11. Bactrim 80-400mg qday
12. Humalog Insulin per sliding scale
13. Jevity 1.2 goal 60cc/hr
.


Discharge Medications:
N/A

Discharge Disposition:
Expired

Discharge Diagnosis:
AIDS Dementia
HIV
?AIDS cholangiopathy

AIDS Dementia
HIV
?AIDS cholangiopathy


Discharge Condition:
expired


Discharge Instructions:
N/A

Followup Instructions:
N/A
{'Human immunodeficiency virus [HIV] disease,Pneumonia, organism unspecified,Urinary tract infection, site not specified,Acidosis,Pressure ulcer, heel,Acute pancreatitis,Unspecified protein-calorie malnutrition,Dementia in conditions classified elsewhere without behavioral disturbance,Epilepsy, unspecified, without mention of intractable epilepsy,Chronic or unspecified parametritis and pelvic cellulitis'}


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: 46 yo female with history of poorly controlled HIV/AIDS ([**2120-11-26**]
CD4: 3; VL: >100,000), not on HAART who presents from her
nursing home with decreased mental status.  Finished cipro 500mg
[**Hospital1 **] on [**2121-1-12**].  Patient was recently admitted to [**Hospital1 18**]
[**Date range (1) 71533**] for a clogged PEG tube.  Patient was recently
admitted to [**Hospital1 18**] 1/1-14-07 for UTI and ? meningitis.
.
In the ED the patient was afebrile and hemodynamically stable.
Blood glucose was off range and patient was started on an
insulin gtt.  Patient given 4L NS, flagyl 500mg, levoflox 750mg.
 Seen by PCP who was concerned for pancreatitis and/or
infection.
.
On arrival to the MICU patient was confused.
.
MICU COURSE:
[**1-15**]: LP overnight.  broad abx and antifungals given.
[**1-16**]: RUQ ultrasound only sig. for sludge in GB.  narrowed
coverage.  will d/w id re haart and pelvic abscesses (seen on
CT).  will d/w pcp and hcp re code status. Started on gentamycin
for better GNR coverage. GI- MRCP shows HIV cholangiopathy, will
not do ERCP. R/O for TB started per ID. d/c ambisome, acyclovir,
bactrim. Restarted on prophylactic dose of bactrim.
.
ABX:
[**1-16**]: started on gentomycin and levaquin d/c'd
ambisome d/c'd (no crypto in CSF), acyclovir d/c'd (no HSV in
CSF).
.
[**Hospital **] transferred to the floor for continued care.

MEDICAL HISTORY: HIV/AIDS: CD4 3, VL >100,000 not on HAART
- ? AIDS dementia/FTT
- PPD negative [**2120-11-3**]
- Pneumovax [**2120-10-24**]
Seizure Disorder
S/p Right MCA CVA [**2116**]
Pancytopenia
GERD
Bladder Incontinence

MEDICATION ON ADMISSION: 1. Ascorbic Acid 500mg [**Hospital1 **]
2. Azithromycin 600 mg PO QThurs
3. Bisacodyl 10 mg qhs prn
4. Ciprofloxacin 500 PO Q12H 7 days (finished [**1-12**])
5. Hyoscyamine Sulfate 0.125 mg QID
6. Keppra 500mg [**Hospital1 **]
7. Magnesium Hydroxide 400mg/5mL - 30ml q6h prn
8. MVI
9. Senna 8.6mg qhs
10. Zinc Sulfate 220mg qday
11. Bactrim 80-400mg qday
12. Humalog Insulin per sliding scale
13. Jevity 1.2 goal 60cc/hr
.

ALLERGIES: Penicillins / Ceftriaxone

PHYSICAL EXAM: VS - 95.7(ax) 108  131/85  17  100@ 3LNC
Gen - confused, agitated, patient extremely uncooperative with
exam.  Flailing and contracting.
HEENT -  dry MM
Neck - supple, + cervical LAD
Cor - tachy, no murmurs
Chest - clear but poor airmovement and moaning
Abd - tender to palpation, + BS, no rebound, no guarding
Ext - no edema, R heel with decub ulcer, decub on coccyx and
breakdown of skin around labia.
Neuro - L hemiparesis, unable to eval pupils because patient is
clamping eyes down.  seems to be neglecting L side.
.

FAMILY HISTORY: NC

SOCIAL HISTORY: The patient is a resident at [**Hospital **] [**Hospital 731**] nursing home. She is
reported to follow commands but have altered communication at
baseline.
Tobacco: Previous use, unknown
ETOH: Previous abuse, amount unknown
Illicits: None reported 

### Response:
{'Human immunodeficiency virus [HIV] disease,Pneumonia, organism unspecified,Urinary tract infection, site not specified,Acidosis,Pressure ulcer, heel,Acute pancreatitis,Unspecified protein-calorie malnutrition,Dementia in conditions classified elsewhere without behavioral disturbance,Epilepsy, unspecified, without mention of intractable epilepsy,Chronic or unspecified parametritis and pelvic cellulitis'}
