CHIEF COMPLAINT: shortness of breath, BRBPR

PRESENT ILLNESS: 73M with multiple medical problems including HIV (CD4 76, VL 48
on [**5-/2112**]) on HAART, atrial fibrillation (not on coumadin),
GERD, distant history of peptic ulcer disease presents with
shortness of breath, coming BRBPR, abdominal pain. Patient has a
history of chronic abdominal pain (eval by Dr. [**Last Name (STitle) 2161**] but no
episodes of bleeding in past. Reports several episodes of bloody
bowel movements starting yesterday when went to urinate. Last
episode earlier today. Denies dizziness, syncope. Also reports
that yesterday started to feel short of breath at rest (at
baseline walks with walker with dyspnea on exertion for several
months) associated with new non-productive cough. Denies fever
but feels colder than usual. Wife says has been in bed most of
the time for past couple of days, minimal PO intake.
.
In the ED, initial vs were: 98.1 110 114/66 24 97. Triggered for
respiratory distress, breathing at 35, put on NRB. Rectal with
gross blood and clots, had large episode BRBPR. Type and cross
for 2 units. Has 2PIV, started protonix GTT with bolus. No NGT
lavage given respiratory status. Plan for CT abdomen given
abdominal pain but unable to lie flat without SOB. CXR notable
for right lower lobar consolidation. He was given vancomycin,
zosyn, and levoquin for PNA. Given insulin, calcium, dextrose
for hyperkalemia. Got 3L of fluid, lactate of 3.3 down to 2.2.
Current vitals: AFIB 113 125/87 20 99% NRB. Access: 2 18G PIV.

MEDICAL HISTORY: # HIV disease, dx [**9-15**] likely secondary to heterosexual
transmission. ATRIPLA started [**12-18**]. Self-d/c meds due to side
effects. Last CD4 count last month 76 ([**5-19**]).
# Chronic kidney disease (baseline cr 1.0)
# Atrial fibrillation - off coumadin due to GI bleed
# Prostate cancer - Diagnosed 15 yrs ago, in remission s/p
hormonal and radiation therapy
# COPD, long ex-tobacco history, severe emphysema on radiography

MEDICATION ON ADMISSION: -abacavir-lamivudine 600-300mg 1 tablet QHS
-albuterol 2 puff Q4PRN
-atazanavir 400mg QHS
-diltiazem 180mg daily
-fluconazole 100mg daily
-fluoxetine 40mg daily
- mirtazapine 30mg daily
- nystatin 5ml Q6hrs
- oxycodone 10mg Q4PRN
- oxycontin 30mg [**Hospital1 **]
- prochlorperazine maleate 10mg [**Hospital1 **]
- raltegravir 400mg [**Hospital1 **]
- ranitidine 150mg daily
- bactrim 800-160 daily
- tiotropium 1 capsule daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: ADMISSION EXAM:
Vitals: T: 98 103/53 107 99%4L
General: Africal American Male sitting 45 degrees in bed NAD
HEENT: Sclera anicteric, dry membranes, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: unlabored respirations, decreaseed BS left base
CV: S1, S2 irregular rhythm, borderline fast rate
Abdomen: soft, tenderness diffusely most prominent RUQ, no
guarding
GU: foley with straw colored urine
Ext: warm, distal pulses palpable, bruising left leg above ankle

FAMILY HISTORY: No history of lung disease, cancer or CAD.

SOCIAL HISTORY: He lives with his wife in [**Location (un) 686**]. He is retired. He smokes 1
Pneumonia, organism unspecified,Acute kidney failure, unspecified,Human immunodeficiency virus [HIV] disease,Unspecified vascular insufficiency of intestine,Acidosis,Tobacco use disorder,Esophageal reflux,Gout, unspecified,Candidal esophagitis,Other emphysema,Chronic kidney disease, unspecified,Atrial fibrillation
Pneumonia, organism NOS,Acute kidney failure NOS,Human immuno virus dis,Vasc insuff intest NOS,Acidosis,Tobacco use disorder,Esophageal reflux,Gout NOS,Candidal esophagitis,Emphysema NEC,Chronic kidney dis NOS,Atrial fibrillation
Admission Date:  [**2112-7-8**]              Discharge Date:   [**2112-7-13**]

Date of Birth:  [**2039-4-17**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 832**]
Chief Complaint:
shortness of breath, BRBPR

Major Surgical or Invasive Procedure:
Left sided PICC placed [**7-12**]


History of Present Illness:
73M with multiple medical problems including HIV (CD4 76, VL 48
on [**5-/2112**]) on HAART, atrial fibrillation (not on coumadin),
GERD, distant history of peptic ulcer disease presents with
shortness of breath, coming BRBPR, abdominal pain. Patient has a
history of chronic abdominal pain (eval by Dr. [**Last Name (STitle) 2161**] but no
episodes of bleeding in past. Reports several episodes of bloody
bowel movements starting yesterday when went to urinate. Last
episode earlier today. Denies dizziness, syncope. Also reports
that yesterday started to feel short of breath at rest (at
baseline walks with walker with dyspnea on exertion for several
months) associated with new non-productive cough. Denies fever
but feels colder than usual. Wife says has been in bed most of
the time for past couple of days, minimal PO intake.
.
In the ED, initial vs were: 98.1 110 114/66 24 97. Triggered for
respiratory distress, breathing at 35, put on NRB. Rectal with
gross blood and clots, had large episode BRBPR. Type and cross
for 2 units. Has 2PIV, started protonix GTT with bolus. No NGT
lavage given respiratory status. Plan for CT abdomen given
abdominal pain but unable to lie flat without SOB. CXR notable
for right lower lobar consolidation. He was given vancomycin,
zosyn, and levoquin for PNA. Given insulin, calcium, dextrose
for hyperkalemia. Got 3L of fluid, lactate of 3.3 down to 2.2.
Current vitals: AFIB 113 125/87 20 99% NRB. Access: 2 18G PIV.


Past Medical History:
# HIV disease, dx [**9-15**] likely secondary to heterosexual
transmission. ATRIPLA started [**12-18**]. Self-d/c meds due to side
effects. Last CD4 count last month 76 ([**5-19**]).
# Chronic kidney disease (baseline cr 1.0)
# Atrial fibrillation - off coumadin due to GI bleed
# Prostate cancer - Diagnosed 15 yrs ago, in remission s/p
hormonal and radiation therapy
# COPD, long ex-tobacco history, severe emphysema on radiography

# 2mm LUL lung nodule detected on CT chest [**9-15**]
# GERD
# PUD, Had 'surgery' 40 yrs ago, likely a Billroth
# Anemia
# Lumbar radiculopathy, spinal stenosis
# Left shoulder rotator cuff tear with repair in [**10/2105**]
# Trichomonas
# Gout
# Hx of esophageal candidiasis
# Chronic left-sided abdominal pain, follows with GI here,
extensive negative workup as an outpatient
# Infrarenal abdominal aneurysm, measuring 3.6 cm on [**2111-12-31**]
# pulmonary nodule


Social History:
He lives with his wife in [**Location (un) 686**]. He is retired. He smokes 1

ppd (smoking since age 7). Denies alcohol or drug use. Uses a
walker recently, but using a cane before that.


Family History:
No history of lung disease, cancer or CAD.

Physical Exam:
ADMISSION EXAM:
Vitals: T: 98 103/53 107 99%4L
General: Africal American Male sitting 45 degrees in bed NAD
HEENT: Sclera anicteric, dry membranes, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: unlabored respirations, decreaseed BS left base
CV: S1, S2 irregular rhythm, borderline fast rate
Abdomen: soft, tenderness diffusely most prominent RUQ, no
guarding
GU: foley with straw colored urine
Ext: warm, distal pulses palpable, bruising left leg above ankle



Pertinent Results:
Labs:
[**2112-7-8**] 02:00PM BLOOD WBC-13.3*# RBC-4.30* Hgb-13.4* Hct-40.9
MCV-95 MCH-31.1 MCHC-32.6 RDW-20.3* Plt Ct-204
[**2112-7-13**] 05:19AM BLOOD WBC-7.0 RBC-3.47* Hgb-11.0* Hct-33.8*
MCV-98 MCH-31.7 MCHC-32.5 RDW-19.4* Plt Ct-274
[**2112-7-13**] HCT-31.4
[**2112-7-8**] 02:00PM BLOOD Neuts-91.4* Lymphs-6.4* Monos-1.9* Eos-0
Baso-0.1
[**2112-7-8**] 02:00PM BLOOD PT-14.4* PTT-23.9 INR(PT)-1.2*
[**2112-7-8**] 02:00PM BLOOD Glucose-124* UreaN-55* Creat-3.7*#
Na-132* K-6.0* Cl-95* HCO3-18* AnGap-25*
[**2112-7-13**] 05:19AM BLOOD Glucose-85 UreaN-10 Creat-0.9 Na-137
K-3.5 Cl-107 HCO3-22 AnGap-12
[**2112-7-8**] 02:00PM BLOOD ALT-55* AST-56* AlkPhos-79 TotBili-0.7
[**2112-7-11**] 05:30AM BLOOD ALT-35 AST-49* LD(LDH)-265* AlkPhos-47
TotBili-0.8
[**2112-7-8**] 11:11PM BLOOD Calcium-8.3* Phos-4.8*# Mg-2.1
[**2112-7-13**] 05:19AM BLOOD Calcium-7.9* Phos-2.8 Mg-1.9
[**2112-7-8**] 11:11PM BLOOD Hapto-349*
[**2112-7-8**] 04:35PM URINE Blood-LG Nitrite-NEG Protein-25
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG
[**2112-7-8**] 04:35PM URINE RBC->50 WBC-0-2 Bacteri-FEW Yeast-NONE
Epi-[**2-12**] TransE-0-2
[**2112-7-8**] 04:35PM URINE Color-Yellow Appear-Hazy Sp [**Last Name (un) **]-1.012

Imaging:
CT A/P [**2112-7-9**]:
1. No apparent etiology to abdominal pain.
2. New right pulmonary consolidation and extensive ground-glass
opacity with a background of emphysema. These findings suggest
possible pneumonia and should be correlated to clinical
presentation and followed to resolution by imaging.
3. Unchanged thickening of the left adrenal gland. This could be
correlated to serum biochemical markers if clinically indicated.

4. Unchanged abdominal aortic aneurysm.

CXR [**2112-7-8**]:
1. Large area of ground-glass, airspace opacity projecting over
the
mid-to-lower right lung, consistent with consolidation, which
could be
secondary to infectious process, hemorrhage, or infarct.
Clinical correlation advised. 2. Possible trace right pleural
effusion.

LENI LLE [**2112-7-10**]: IMPRESSION: No DVT.

[**7-12**] CHEST PORT LINE PLACEMENT: Dense stable right lower lobe
consolidation and moderate cardiomegaly.  Clinical correlation
is suggested as to the cause of this dense consolidation, as
mentioned in a previous report, the differential diagnosis
includes infection, infarction or hemorrhage.
The peripherally inserted central catheter is projected over the
right atrium and should be retracted by approximately 5 cm.

Micro:
[**2112-7-9**] 4:31 am SPUTUM      Source: Expectorated.

                            **FINAL REPORT [**2112-7-11**]**

   GRAM STAIN (Final [**2112-7-9**]):
      >25 PMNs and <10 epithelial cells/100X field.
      2+   (1-5 per 1000X FIELD):   GRAM POSITIVE COCCI.
                                    IN PAIRS AND CLUSTERS.
      2+   (1-5 per 1000X FIELD):   GRAM POSITIVE ROD(S).
      2+   (1-5 per 1000X FIELD):   GRAM NEGATIVE ROD(S).

   RESPIRATORY CULTURE (Final [**2112-7-11**]):
      SPARSE GROWTH Commensal Respiratory Flora.
      ENTEROBACTER CLOACAE.    SPARSE GROWTH.
         This organism may develop resistance to third
generation
         cephalosporins during prolonged therapy. Therefore,
isolates that
         are initially susceptible may become resistant within
three to
         four days after initiation of therapy.  For serious
infections,
         repeat culture and sensitivity testing may therefore be
warranted
         if third generation cephalosporins were used.

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             ENTEROBACTER CLOACAE
                             |
CEFEPIME--------------   <=1 S
CEFTAZIDIME-----------   <=1 S
CEFTRIAXONE-----------   <=1 S
CIPROFLOXACIN---------<=0.25 S
GENTAMICIN------------   <=1 S
MEROPENEM-------------<=0.25 S
PIPERACILLIN/TAZO-----   <=4 S
TOBRAMYCIN------------   <=1 S
TRIMETHOPRIM/SULFA----  =>16 R




Brief Hospital Course:
`73M with multiple medical problems including HIV (CD4 6, VL 48
on [**5-/2112**]) on HAART, atrial fibrillation (not on Coumadin),
distant history of peptic ulcer disease who  presented with
hematochezia, pneumonia, acute renal failure, hyperkalemia.

#Ischemic colitis: Bright red blood per rectum with suspicion
higher that lower GI source was thought to be due to ischemic
colitis (in setting of dehydration). He had no diverticula on
prior colonoscopy. AVM was also in the differential. Also
considered in HIV immune compromised patient was lymphoma, CMV,
or histoplasmosis but these seemed less likely. He was given 2
units of blood and monitored in the ICU. GI was consulted and
the pt refused colonoscopy after speaking with both the floor
attending and GI attending. He was alert and oriented and had
decisional capacity to do so. His bleeding resolved except for a
small amount on [**7-12**] that did not require transfusion. He was
started on a H2 blocker due to PPIs interacting with his HAART
medications. Abdominal CT without contrast did not show a source
of bleeding.
.
#Pneumonia: Found to have a right lower lobe consolidation on
imaging c/w lobar pneumonia. Differential considered in HIV
patient with CD4<50 would be bacterial vs. fungal vs atypical.
He was initially treated with vanco/zosyn/levaquin. Later as pt
improved levo was stopped. Sputum cx grew ENTEROBACTER CLOACAE
sensitive to zosyn. Urine legionella was negative. Pt has a PICC
for abx, and is on day 5 of a 8 day course on discharge, last
day on [**2112-7-16**]. Will have follow up with Dr. [**First Name (STitle) **] from ID.
.
# Acute renal failure: Baseline creatinine of 1.0 with increased
creatinine to 3.7. Most likely due to pre-renal in setting of
decreased renal perfusion in setting of dehydration. ATN
considered although has been hemodynamically stable. Pt was
given aggressive IVF and cr improved to 0.9. Bactrim was
initially held and then restarted for PCP [**Name Initial (PRE) **].
.
#HYPERKALEMIA: Patient with potassium of 6, no EKG changes in
setting of acute renal failure. Resolved with IVF.

#ATRIAL FIBRILLATION: Was controlled on dilt.
.
#HIV: Viral load suppressed on HAART. Continued HAART.
.
#[**Female First Name (un) **] ESOPHAGITIS: On fluconazole for 14 day course (day 1
[**2112-7-2**]). Also on  nystatin swish and swallow.

Communication: [**Name (NI) **] (wife) [**Telephone/Fax (1) 102538**]

Pt was discharged to rehab.


Medications on Admission:
-abacavir-lamivudine 600-300mg 1 tablet QHS
-albuterol 2 puff Q4PRN
-atazanavir 400mg QHS
-diltiazem 180mg daily
-fluconazole 100mg daily
-fluoxetine 40mg daily
- mirtazapine 30mg daily
- nystatin 5ml Q6hrs
- oxycodone 10mg Q4PRN
- oxycontin 30mg [**Hospital1 **]
- prochlorperazine maleate 10mg [**Hospital1 **]
- raltegravir 400mg [**Hospital1 **]
- ranitidine 150mg daily
- bactrim 800-160 daily
- tiotropium 1 capsule daily


Discharge Medications:
1. Fluconazole 100 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 3 days.
2. Piperacillin-Tazobactam-Dextrs 4.5 gram/100 mL Piggyback Sig:
One (1)  Intravenous Q8H (every 8 hours): Please take for 3 more
days from [**7-13**] .
3. Vancomycin in D5W 1 gram/200 mL Piggyback Sig: One (1)
Intravenous Q 24H (Every 24 Hours): Please take for 3 more days
from [**7-13**] .
4. Diltiazem HCl 120 mg Capsule, Sust. Release 24 hr Sig: One
(1) Capsule, Sust. Release 24 hr PO DAILY (Daily): Please start
at 6PM on [**7-13**] .
5. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID
(4 times a day).
7. Atazanavir 200 mg Capsule Sig: Two (2) Capsule PO HS (at
bedtime).
8. Abacavir 300 mg Tablet Sig: Two (2) Tablet PO QHS (once a day
(at bedtime)).
9. Lamivudine 150 mg Tablet Sig: Two (2) Tablet PO QHS (once a
day (at bedtime)).
10. Raltegravir 400 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
11. Bactrim DS 800-160 mg Tablet Sig: One (1) Tablet PO once a
day.
12. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q6H (every 6 hours) as
needed for SOB.
13. Fluoxetine 40 mg Capsule Sig: One (1) Capsule PO once a day.

14. Mirtazapine 30 mg Tablet Sig: One (1) Tablet PO once a day.

15. Prochlorperazine Maleate 10 mg Tablet Sig: One (1) Tablet PO
twice a day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] Healthcare Center - [**Location (un) **]

Discharge Diagnosis:
Ischemic Colitis
Pneumonia
Acute Renal Failure
Hyperkalemia


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Lethargic but arousable.
Activity Status: Out of Bed with assistance to chair or
wheelchair.


Discharge Instructions:
It was a pleasure to care for you as your doctor.
.
You were brought to the hospital because of a intestinal bleed
and pneumonia. We felt like your intestinal bleed was due to
dehydration which caused damage to your intestines. During your
admission your blood level remained stable and we gave you
intravenous fluids. We wanted to do a colonoscopy to possibly
see a origin of your bleeding however you declined this
procedure. For your pneumonia we gave you intravenous
antibiotics and you improved clinically. You would need to
continue these intravenous antibiotics as an outpatient.
.
We made the following changes to your home medication list:
We changed decreased your long acting diltiazem to 120 mg from
180mg which will help control your heart rate.
We added 2 intravenous antibiotics Vancomycina and Zosyn, which
you must keep taking for 3 more days after discharge.
.
Please follow up with the following outpatient appointments
below:

Followup Instructions:
Provider: [**Name10 (NameIs) **] Clinic
DATE: Monday  [**7-18**] 4:30PM
Location: LMOB 8E/West
Phone Number: ([**Telephone/Fax (1) 451**]
.
Date: [**2112-7-15**]  11:30a
Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) 2324**] [**Name12 (NameIs) 2323**]
Telephone Number: ([**Telephone/Fax (1) 4170**]
Location:  LM [**Hospital Ward Name **] BLDG ([**Doctor First Name **]), BASEMENT   ID WEST
(SB)
.
Department: PULMONARY FUNCTION LAB
When: FRIDAY [**2112-7-15**] at 10:10 AM
With: PULMONARY FUNCTION LAB [**Telephone/Fax (1) 609**]
Building: [**Hospital6 29**] [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
.
Department: PFT
When: FRIDAY [**2112-7-15**] at 10:30 AM
.
Department: MEDICAL SPECIALTIES
When: FRIDAY [**2112-7-15**] at 10:30 AM
With: [**First Name8 (NamePattern2) **] [**Name8 (MD) **], M.D. [**Telephone/Fax (1) 612**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Pneumonia, organism unspecified,Acute kidney failure, unspecified,Human immunodeficiency virus [HIV] disease,Unspecified vascular insufficiency of intestine,Acidosis,Tobacco use disorder,Esophageal reflux,Gout, unspecified,Candidal esophagitis,Other emphysema,Chronic kidney disease, unspecified,Atrial fibrillation'}


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: shortness of breath, BRBPR

PRESENT ILLNESS: 73M with multiple medical problems including HIV (CD4 76, VL 48
on [**5-/2112**]) on HAART, atrial fibrillation (not on coumadin),
GERD, distant history of peptic ulcer disease presents with
shortness of breath, coming BRBPR, abdominal pain. Patient has a
history of chronic abdominal pain (eval by Dr. [**Last Name (STitle) 2161**] but no
episodes of bleeding in past. Reports several episodes of bloody
bowel movements starting yesterday when went to urinate. Last
episode earlier today. Denies dizziness, syncope. Also reports
that yesterday started to feel short of breath at rest (at
baseline walks with walker with dyspnea on exertion for several
months) associated with new non-productive cough. Denies fever
but feels colder than usual. Wife says has been in bed most of
the time for past couple of days, minimal PO intake.
.
In the ED, initial vs were: 98.1 110 114/66 24 97. Triggered for
respiratory distress, breathing at 35, put on NRB. Rectal with
gross blood and clots, had large episode BRBPR. Type and cross
for 2 units. Has 2PIV, started protonix GTT with bolus. No NGT
lavage given respiratory status. Plan for CT abdomen given
abdominal pain but unable to lie flat without SOB. CXR notable
for right lower lobar consolidation. He was given vancomycin,
zosyn, and levoquin for PNA. Given insulin, calcium, dextrose
for hyperkalemia. Got 3L of fluid, lactate of 3.3 down to 2.2.
Current vitals: AFIB 113 125/87 20 99% NRB. Access: 2 18G PIV.

MEDICAL HISTORY: # HIV disease, dx [**9-15**] likely secondary to heterosexual
transmission. ATRIPLA started [**12-18**]. Self-d/c meds due to side
effects. Last CD4 count last month 76 ([**5-19**]).
# Chronic kidney disease (baseline cr 1.0)
# Atrial fibrillation - off coumadin due to GI bleed
# Prostate cancer - Diagnosed 15 yrs ago, in remission s/p
hormonal and radiation therapy
# COPD, long ex-tobacco history, severe emphysema on radiography

MEDICATION ON ADMISSION: -abacavir-lamivudine 600-300mg 1 tablet QHS
-albuterol 2 puff Q4PRN
-atazanavir 400mg QHS
-diltiazem 180mg daily
-fluconazole 100mg daily
-fluoxetine 40mg daily
- mirtazapine 30mg daily
- nystatin 5ml Q6hrs
- oxycodone 10mg Q4PRN
- oxycontin 30mg [**Hospital1 **]
- prochlorperazine maleate 10mg [**Hospital1 **]
- raltegravir 400mg [**Hospital1 **]
- ranitidine 150mg daily
- bactrim 800-160 daily
- tiotropium 1 capsule daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: ADMISSION EXAM:
Vitals: T: 98 103/53 107 99%4L
General: Africal American Male sitting 45 degrees in bed NAD
HEENT: Sclera anicteric, dry membranes, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: unlabored respirations, decreaseed BS left base
CV: S1, S2 irregular rhythm, borderline fast rate
Abdomen: soft, tenderness diffusely most prominent RUQ, no
guarding
GU: foley with straw colored urine
Ext: warm, distal pulses palpable, bruising left leg above ankle

FAMILY HISTORY: No history of lung disease, cancer or CAD.

SOCIAL HISTORY: He lives with his wife in [**Location (un) 686**]. He is retired. He smokes 1 

### Response:
{'Pneumonia, organism unspecified,Acute kidney failure, unspecified,Human immunodeficiency virus [HIV] disease,Unspecified vascular insufficiency of intestine,Acidosis,Tobacco use disorder,Esophageal reflux,Gout, unspecified,Candidal esophagitis,Other emphysema,Chronic kidney disease, unspecified,Atrial fibrillation'}
