CHIEF COMPLAINT: altered mental status

PRESENT ILLNESS: 83-year-old woman with a history of tongue cancer on
chemoradiation, most recent cisplatin dose on [**2178-3-13**], presents
with altered mental status. Per his wife, the patient took his
oxycodone-acetaminophen for the first time the night before
admission, [**2178-3-24**]. He woke up the morning of admission,
[**2178-3-25**], confused and somnolent. No other complaint. Patient was
brought to the ED.
.
Of note, patient has been hyponatremic lately, per Atrius
records:
.
Date   Na
[**2-20**]   115
[**2-22**]   126
[**2-24**]   133
[**3-5**]   130
[**3-19**]   124
.
In the ED, T 98.9, HR 95, BP 142/59, RR 18, 97%RA. His neuro
exam was nonfocal. Head CT showed no acute abnormality. CXR and
urinalysis unremarkable. His labs were notable for Na 117, Cr
0.8, WBC 2.3 with 66% neutrophils, Hct 22.0, plt 194. He
reportedly became more awake and mental status almost returned
to baseline after some hydration in the ED. Admitted for further
management.
.
On the floor, patient was oriented to name, date, and US
president, but not location. He was unable to name months
backwards.
.
Review of Systems: not obtainable due to patient's mental status

MEDICAL HISTORY: ONCOLOGIC HISTORY:
# Stage [**Doctor First Name 690**] T4aN2cM0 squamous cell carcinoma of the tongue:
diagnosed in [**2177-12-10**]. Started on radiation and
chemotherapy with cisplatin on [**2178-2-12**].
.
OTHER MEDICAL HISTORY:
HTN
DM2
Hyperlipidemia
BPH

MEDICATION ON ADMISSION: terazosin 5 mg [**Hospital1 **]
omeprazole 20 mg daily
morphine 10 mg oral solution q3h prn pain
ondansetron prn
prochlorperazine prn
lorazepam 1 mg q8h prn anxiety/insomnia
metformin 500 mg [**Hospital1 **]
glipizide 10 mg [**Hospital1 **]
aspirin 325 mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS: T 99.8, BP 160/70, HR 102, RR 16, 95%RA
GEN: Elderly man sleeping in bed but easily arousable, in NAD
HEENT: EOMI, sclera anicteric, conjunctivae clear
NECK: Supple
CV: Regular, slightly tachycardic, normal S1, S2. No m/r/g.
CHEST: Resp unlabored, no accessory muscle use. CTAB, no
crackles, wheezes or rhonchi.
ABD: Soft, NT, ND, no HSM, bowel sounds present
MSK: normal muscle tone and bulk
EXT: No c/c/e, 2+ DP/PT bilaterally
SKIN: No rash, warm skin
NEURO: oriented to name, date, US president but not location,
unable to name months backwards. CN II-XII intact, 5/5 strength
throughout, intact sensation to light touch

FAMILY HISTORY: Mother had a [**Last Name **] problem. Father had alcoholism. Son had a
kidney transplant. One [**Last Name (un) **] died of lung cancer. A maternal
uncle had leukemia, and another maternal uncle had lung cancer.

SOCIAL HISTORY: Quit smoking in [**2155**] after 20 pack-years. Rare alcohol. used to
work in the gun business then in a sporting goods store. Has 5
children, 15 grandchildren, and 2 great-grandchildren.
Other alteration of consciousness,Acute edema of lung, unspecified,Pneumonia, organism unspecified,Drug-induced delirium,Hyposmolality and/or hyponatremia,Malignant neoplasm of other sites of tongue,Other stomatitis and mucositis (ulcerative),Abnormality of gait,Do not resuscitate status,Anisocoria,Other specified cardiac dysrhythmias,Anemia in neoplastic disease,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Other opiates and related narcotics causing adverse effects in therapeutic use
Other alter consciousnes,Acute lung edema NOS,Pneumonia, organism NOS,Drug-induced delirium,Hyposmolality,Malig neo tongue NEC,Stomatits & mucosits NEC,Abnormality of gait,Do not resusctate status,Anisocoria,Cardiac dysrhythmias NEC,Anemia in neoplastic dis,Hypertension NOS,DMII wo cmp nt st uncntr,Pure hypercholesterolem,Adv eff opiates
Admission Date:  [**2178-3-25**]              Discharge Date:   [**2178-3-28**]

Date of Birth:  [**2094-5-27**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 3326**]
Chief Complaint:
altered mental status

Major Surgical or Invasive Procedure:
None

History of Present Illness:
83-year-old woman with a history of tongue cancer on
chemoradiation, most recent cisplatin dose on [**2178-3-13**], presents
with altered mental status. Per his wife, the patient took his
oxycodone-acetaminophen for the first time the night before
admission, [**2178-3-24**]. He woke up the morning of admission,
[**2178-3-25**], confused and somnolent. No other complaint. Patient was
brought to the ED.
.
Of note, patient has been hyponatremic lately, per Atrius
records:
.
Date   Na
[**2-20**]   115
[**2-22**]   126
[**2-24**]   133
[**3-5**]   130
[**3-19**]   124
.
In the ED, T 98.9, HR 95, BP 142/59, RR 18, 97%RA. His neuro
exam was nonfocal. Head CT showed no acute abnormality. CXR and
urinalysis unremarkable. His labs were notable for Na 117, Cr
0.8, WBC 2.3 with 66% neutrophils, Hct 22.0, plt 194. He
reportedly became more awake and mental status almost returned
to baseline after some hydration in the ED. Admitted for further
management.
.
On the floor, patient was oriented to name, date, and US
president, but not location. He was unable to name months
backwards.
.
Review of Systems: not obtainable due to patient's mental status

Past Medical History:
ONCOLOGIC HISTORY:
# Stage [**Doctor First Name 690**] T4aN2cM0 squamous cell carcinoma of the tongue:
diagnosed in [**2177-12-10**]. Started on radiation and
chemotherapy with cisplatin on [**2178-2-12**].
.
OTHER MEDICAL HISTORY:
HTN
DM2
Hyperlipidemia
BPH

Social History:
Quit smoking in [**2155**] after 20 pack-years. Rare alcohol. used to
work in the gun business then in a sporting goods store. Has 5
children, 15 grandchildren, and 2 great-grandchildren.

Family History:
Mother had a [**Last Name **] problem. Father had alcoholism. Son had a
kidney transplant. One [**Last Name (un) **] died of lung cancer. A maternal
uncle had leukemia, and another maternal uncle had lung cancer.

Physical Exam:
VS: T 99.8, BP 160/70, HR 102, RR 16, 95%RA
GEN: Elderly man sleeping in bed but easily arousable, in NAD
HEENT: EOMI, sclera anicteric, conjunctivae clear
NECK: Supple
CV: Regular, slightly tachycardic, normal S1, S2. No m/r/g.
CHEST: Resp unlabored, no accessory muscle use. CTAB, no
crackles, wheezes or rhonchi.
ABD: Soft, NT, ND, no HSM, bowel sounds present
MSK: normal muscle tone and bulk
EXT: No c/c/e, 2+ DP/PT bilaterally
SKIN: No rash, warm skin
NEURO: oriented to name, date, US president but not location,
unable to name months backwards. CN II-XII intact, 5/5 strength
throughout, intact sensation to light touch

Pertinent Results:
[**2178-3-25**] 01:12PM   GLUCOSE-202* UREA N-22* CREAT-0.8 SODIUM-117*
POTASSIUM-3.7 CHLORIDE-77* TOTAL CO2-31 ANION GAP-13
[**2178-3-25**] 01:12PM   WBC-2.3* RBC-2.36* HGB-8.1* HCT-22.0*# MCV-93
MCH-34.4* MCHC-37.0* RDW-15.4
[**2178-3-25**] 01:12PM   NEUTS-66 BANDS-2 LYMPHS-11* MONOS-18* EOS-3
BASOS-0 ATYPS-0 METAS-0 MYELOS-0
[**2178-3-25**] 01:12PM   PLT SMR-NORMAL PLT COUNT-194
[**2178-3-25**] 01:12PM   PT-12.9 PTT-24.2 INR(PT)-1.1
[**2178-3-27**] 06:28PM BLOOD Type-ART pO2-86 pCO2-71* pH-7.31*
calTCO2-37* Base XS-5

IMAGING:
Head CT [**2178-3-25**]:
1. No acute intracranial process. No evidence of intracranial
hemorrhage.
2. Small vessel ischemic disease. Prominent sulci and
ventricles, most likely age-related involutionary changes.
3. Sinus disease, as detailed above.

CXR [**2178-3-25**]:
1. Left lower lobe opacity could be atelectasis; however, cannot
exclude
superinfection.
2. Possible bilateral small pleural effusions.
3. Cardiac silhouette top normal.

CTA chest [**2178-3-27**]: (prelim)
1. No PE or acute aortic pathology.
2. Moderate-to-large bilateral pleural effusions, with subtotal
atelectasis of the lower lobes.
3. No PNA.
4. Mild septal thickening compatible with mild pulmonary edema.

CXR [**2178-3-27**]: (prelim)
Bilateral moderate sized pleural effusions. No pneumothorax.
Pulmonary edema, cardiomegaly. Bibasal atelectasis. Findings
similar to earlier CT chest.

Brief Hospital Course:
83-year-old man with squamous cell carcinoma of the tongue,
ongoing chemoradiation, presents with altered mental status.

1. Hypoxic respiratory failure: Patient had been in sinus
tachycardia to ~120 since admission despite 2L IVF and 2 units
pRBC. Given this and his 2L O2 requirement, he went for CTA
chest, which showed no PE, but large bilateral pleural effusions
with atelectasis. He was agitated since the CTA, and around 6pm,
he looked cyanotic and had a desaturation to 60% on 2L, improved
to 93% on NRB. He was given 20mg lasix IV with brisk urine
output, as well as 0.5mg IV haloperidol and 10mg IV hydralazine
(BP ~180/90) and transferred to the ICU. Stat CXR showed diffuse
pulmonary edema, and with his concurrent hypertension, he was
started on a nitroglycerin drip. His BP improved and overshot
transiently down to 70/30, but rapidly improved to ~130s/80s
with cessation of drip. His O2 sats remained in the 90s on
high-flow oxygen mask. He was sent for CT head given his altered
mental status and possibly new anisocoria. While being
transported, he developed bradycardia down to 20, desaturation,
and apnea requiring bag ventilation. On evaluation, there were
no palpable pulses and no obtainable blood pressure. Given his
confirmed DNR status, he was not resuscitated and expired.
Post-mortem exam was declined.

2. Altered mental status: Cause not entirely clear, but possible
contribution from opioids at home, as well as hyponatremia. He
was also treated with levofloxacin for a possible pneumonia,
given left basilar opacity, mild hypoxia (93% RA), low grade
temps (99.7) and cough. When the patient became agitated as
noted in the events described above, he was treated with 0.5mg
IV haloperidol prn (total 1.5mg given) with good effect. CT head
with no acute process on admission and was planned to be
repeated given anisocoria, but aborted given above events.

3. Hyponatremia: Treated with IV fluids with improvement from
117 to 127.

4. Tongue cancer: On cisplatin and radiation, with radiation
received during this admission.

5. Anemia: Hct 22 on admission. Transfused 2 units PRBCs with
improvement to 30.7.

Medications on Admission:
terazosin 5 mg [**Hospital1 **]
omeprazole 20 mg daily
morphine 10 mg oral solution q3h prn pain
ondansetron prn
prochlorperazine prn
lorazepam 1 mg q8h prn anxiety/insomnia
metformin 500 mg [**Hospital1 **]
glipizide 10 mg [**Hospital1 **]
aspirin 325 mg daily

Discharge Medications:
Expired

Discharge Disposition:
Expired

Discharge Diagnosis:
Expired

Discharge Condition:
Expired

Discharge Instructions:
Expired

Followup Instructions:
Expired


Completed by:[**2178-3-28**]
{'Other alteration of consciousness,Acute edema of lung, unspecified,Pneumonia, organism unspecified,Drug-induced delirium,Hyposmolality and/or hyponatremia,Malignant neoplasm of other sites of tongue,Other stomatitis and mucositis (ulcerative),Abnormality of gait,Do not resuscitate status,Anisocoria,Other specified cardiac dysrhythmias,Anemia in neoplastic disease,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Other opiates and related narcotics causing adverse effects in therapeutic use'}


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: 83-year-old woman with a history of tongue cancer on
chemoradiation, most recent cisplatin dose on [**2178-3-13**], presents
with altered mental status. Per his wife, the patient took his
oxycodone-acetaminophen for the first time the night before
admission, [**2178-3-24**]. He woke up the morning of admission,
[**2178-3-25**], confused and somnolent. No other complaint. Patient was
brought to the ED.
.
Of note, patient has been hyponatremic lately, per Atrius
records:
.
Date   Na
[**2-20**]   115
[**2-22**]   126
[**2-24**]   133
[**3-5**]   130
[**3-19**]   124
.
In the ED, T 98.9, HR 95, BP 142/59, RR 18, 97%RA. His neuro
exam was nonfocal. Head CT showed no acute abnormality. CXR and
urinalysis unremarkable. His labs were notable for Na 117, Cr
0.8, WBC 2.3 with 66% neutrophils, Hct 22.0, plt 194. He
reportedly became more awake and mental status almost returned
to baseline after some hydration in the ED. Admitted for further
management.
.
On the floor, patient was oriented to name, date, and US
president, but not location. He was unable to name months
backwards.
.
Review of Systems: not obtainable due to patient's mental status

MEDICAL HISTORY: ONCOLOGIC HISTORY:
# Stage [**Doctor First Name 690**] T4aN2cM0 squamous cell carcinoma of the tongue:
diagnosed in [**2177-12-10**]. Started on radiation and
chemotherapy with cisplatin on [**2178-2-12**].
.
OTHER MEDICAL HISTORY:
HTN
DM2
Hyperlipidemia
BPH

MEDICATION ON ADMISSION: terazosin 5 mg [**Hospital1 **]
omeprazole 20 mg daily
morphine 10 mg oral solution q3h prn pain
ondansetron prn
prochlorperazine prn
lorazepam 1 mg q8h prn anxiety/insomnia
metformin 500 mg [**Hospital1 **]
glipizide 10 mg [**Hospital1 **]
aspirin 325 mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS: T 99.8, BP 160/70, HR 102, RR 16, 95%RA
GEN: Elderly man sleeping in bed but easily arousable, in NAD
HEENT: EOMI, sclera anicteric, conjunctivae clear
NECK: Supple
CV: Regular, slightly tachycardic, normal S1, S2. No m/r/g.
CHEST: Resp unlabored, no accessory muscle use. CTAB, no
crackles, wheezes or rhonchi.
ABD: Soft, NT, ND, no HSM, bowel sounds present
MSK: normal muscle tone and bulk
EXT: No c/c/e, 2+ DP/PT bilaterally
SKIN: No rash, warm skin
NEURO: oriented to name, date, US president but not location,
unable to name months backwards. CN II-XII intact, 5/5 strength
throughout, intact sensation to light touch

FAMILY HISTORY: Mother had a [**Last Name **] problem. Father had alcoholism. Son had a
kidney transplant. One [**Last Name (un) **] died of lung cancer. A maternal
uncle had leukemia, and another maternal uncle had lung cancer.

SOCIAL HISTORY: Quit smoking in [**2155**] after 20 pack-years. Rare alcohol. used to
work in the gun business then in a sporting goods store. Has 5
children, 15 grandchildren, and 2 great-grandchildren. 

### Response:
{'Other alteration of consciousness,Acute edema of lung, unspecified,Pneumonia, organism unspecified,Drug-induced delirium,Hyposmolality and/or hyponatremia,Malignant neoplasm of other sites of tongue,Other stomatitis and mucositis (ulcerative),Abnormality of gait,Do not resuscitate status,Anisocoria,Other specified cardiac dysrhythmias,Anemia in neoplastic disease,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Other opiates and related narcotics causing adverse effects in therapeutic use'}
