CHIEF COMPLAINT: Altered mental status

PRESENT ILLNESS: Ms. [**Known lastname **] is a 47F with AIDS, HCV, dilated cardiomyopathy, afib,
and antiphospholipid syndrome who is presenting to the [**Hospital Unit Name 153**] w/ a
new PE, probable PNA, and intubated after respiratory distress.
Pt intially presented to the ED complaining of R shoulder pain
and RUQ abdominal pain. Pt denied any trauma and said the
shoulder pain began yesterday and was making her SOB. ?
hemoptysis. Pt also described RUQ pain, which was sudden and
sharp. The abd pain did not radiate anywhere and was worse w/
oral intake. Pt's initial vitals were T 97.9, BP 141/94, HR 56,
RR 20 and 100% on RA. She became tachypneic to 44 and stayed in
the 30s-40s. CT torso and CTA to eval for PE was ordred. The CTA
showed heterogeneous opacities in the lungs with areas of
confluent consolidation c/w infection: most likely bacterial;
pneumocystis infection is less likely. Filling defect in
segmental branch supplying right lower lobe c/w PE. The CT
abdomen showed gallstones in a collapsed gallbladder without
cholecystitis. She was started on heparin gtt w/ bolus, and
given Vanc 1gm/ Ctx 2g/ Flagyl 500mg and later given levaquin
750 IV x1. Pt's 02 requirement increased from 4L N/C, to NRB.
Her hyperventilation continued and her ABG showed 7.47/ 26/ 91/
19 with a temp 103.8. She was intubated w/ etomidate/succ and
propofol. She then developed hypotension to 85/63 given a 500cc
bolus, and her heparin was stopped after devloping [**Hospital Unit Name **] tinged
sputum in the ET tube, aprox 50cc. Her propofol was changed to
fentanyl/versed after low BP and eventually required a total of
2.7L in the ED. Also pt's utox was also positive for cocaine.
.
Of note the patient was recently hospitalized from [**Date range (1) 86279**] for
LE edema and DOE, and treated for CHF exacerbation (EF 25%) with
furosemide and dig. It was thought this exacerbation may have
been precipitated by cocaine use. Her afib remained rate
controlled throughout the admission. She was also started on [**Date range (1) **]
given her h/o anti-phospholipid syndrome.
.
ROS: unable to obtain since intubated

MEDICAL HISTORY: 1. HIV/AIDS, diagnosed [**2176**], off HAART.
- acquired via heterosexual intercourse.
- CD4 184, VL 254k [**2190-12-5**]
- nadir CD4 69 [**6-11**]
2. HCV antibody+
3. [**Doctor First Name **] [**1-/2182**] - was not complaint with Rx.
4. Oral thrush
5. Recurrent episodes of pneumococcal pneumonia.
6. Lymphocytic pneumonitis - diagnosed by trans-bronchial bx.
7. Dilated cardiomyopathy-EF20-25%, last echo [**4-13**].
8. LV thrombus
9. Antiphospholipid antibody syndrome
10. Lower extremity arterial thrombus
11. Asthma/bronchiectasis
12. Myocardial infarction [**2184**], clean coronaries at that time
13. L MCA stroke, residual right hemiparesis
14. Cocaine abuse
15. Pulmonary Nodules on chest CT
16. Zoster
17. Cholelithiasis

MEDICATION ON ADMISSION: Largely non-compliant.

ALLERGIES: Zidovudine

PHYSICAL EXAM: VS: 97.3, 95, 18, 93/60, 97%/3L
GEN: AOx3, appears comfortable
[**Year (4 digits) 4459**]: NAD
NECK: No JVD, carotid pulses brisk, no bruits, no cervical
lymphadenopathy, trachea midline
CV: no M/G/R, normal S1 S2, radial pulses +2
PULM: Exp wheeze on right side
ABD: RLQ tenderness, no g/r, no masses
EXT: RUE 1+ edema, PICC in RUE
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses.

FAMILY HISTORY: mother with DM

SOCIAL HISTORY: smokes "occassionally" X many years, no recent alcohol, h/o
cocaine abuse, but none recently, and has been homeless in the
past
Acute respiratory failure,Other pulmonary embolism and infarction,Pneumonia due to other gram-negative bacteria,Acute kidney failure, unspecified,Chronic systolic heart failure,Human immunodeficiency virus [HIV] disease,Other primary cardiomyopathies,Atrial fibrillation,Chronic hepatitis C without mention of hepatic coma,Other and unspecified nonspecific immunological findings
Acute respiratry failure,Pulm embol/infarct NEC,Pneumo oth grm-neg bact,Acute kidney failure NOS,Chr systolic hrt failure,Human immuno virus dis,Prim cardiomyopathy NEC,Atrial fibrillation,Chrnc hpt C wo hpat coma,Oth unspcf nspf imun fnd
Admission Date:  [**2191-3-31**]              Discharge Date:   [**2191-4-8**]

Date of Birth:  [**2143-7-12**]             Sex:   F

Service: MEDICINE

Allergies:
Zidovudine

Attending:[**First Name3 (LF) 1990**]
Chief Complaint:
Altered mental status

Major Surgical or Invasive Procedure:
None

History of Present Illness:
Ms. [**Known lastname **] is a 47F with AIDS, HCV, dilated cardiomyopathy, afib,
and antiphospholipid syndrome who is presenting to the [**Hospital Unit Name 153**] w/ a
new PE, probable PNA, and intubated after respiratory distress.
Pt intially presented to the ED complaining of R shoulder pain
and RUQ abdominal pain. Pt denied any trauma and said the
shoulder pain began yesterday and was making her SOB. ?
hemoptysis. Pt also described RUQ pain, which was sudden and
sharp. The abd pain did not radiate anywhere and was worse w/
oral intake. Pt's initial vitals were T 97.9, BP 141/94, HR 56,
RR 20 and 100% on RA. She became tachypneic to 44 and stayed in
the 30s-40s. CT torso and CTA to eval for PE was ordred. The CTA
showed heterogeneous opacities in the lungs with areas of
confluent consolidation c/w infection: most likely bacterial;
pneumocystis infection is less likely. Filling defect in
segmental branch supplying right lower lobe c/w PE. The CT
abdomen showed gallstones in a collapsed gallbladder without
cholecystitis. She was started on heparin gtt w/ bolus, and
given Vanc 1gm/ Ctx 2g/ Flagyl 500mg and later given levaquin
750 IV x1. Pt's 02 requirement increased from 4L N/C, to NRB.
Her hyperventilation continued and her ABG showed 7.47/ 26/ 91/
19 with a temp 103.8. She was intubated w/ etomidate/succ and
propofol. She then developed hypotension to 85/63 given a 500cc
bolus, and her heparin was stopped after devloping [**Hospital Unit Name **] tinged
sputum in the ET tube, aprox 50cc. Her propofol was changed to
fentanyl/versed after low BP and eventually required a total of
2.7L in the ED. Also pt's utox was also positive for cocaine.
.
Of note the patient was recently hospitalized from [**Date range (1) 86279**] for
LE edema and DOE, and treated for CHF exacerbation (EF 25%) with
furosemide and dig. It was thought this exacerbation may have
been precipitated by cocaine use. Her afib remained rate
controlled throughout the admission. She was also started on [**Date range (1) **]
given her h/o anti-phospholipid syndrome.
.
ROS: unable to obtain since intubated


Past Medical History:
1. HIV/AIDS, diagnosed [**2176**], off HAART.
- acquired via heterosexual intercourse.
- CD4 184, VL 254k [**2190-12-5**]
- nadir CD4 69 [**6-11**]
2. HCV antibody+
3. [**Doctor First Name **] [**1-/2182**] - was not complaint with Rx.
4. Oral thrush
5. Recurrent episodes of pneumococcal pneumonia.
6. Lymphocytic pneumonitis - diagnosed by trans-bronchial bx.
7. Dilated cardiomyopathy-EF20-25%, last echo [**4-13**].
8. LV thrombus
9. Antiphospholipid antibody syndrome
10. Lower extremity arterial thrombus
11. Asthma/bronchiectasis
12. Myocardial infarction [**2184**], clean coronaries at that time
13. L MCA stroke, residual right hemiparesis
14. Cocaine abuse
15. Pulmonary Nodules on chest CT
16. Zoster
17. Cholelithiasis


Social History:
smokes "occassionally" X many years, no recent alcohol, h/o
cocaine abuse, but none recently, and has been homeless in the
past

Family History:
mother with DM


Physical Exam:
VS: 97.3, 95, 18, 93/60, 97%/3L
GEN: AOx3, appears comfortable
[**Year (4 digits) 4459**]: NAD
NECK: No JVD, carotid pulses brisk, no bruits, no cervical
lymphadenopathy, trachea midline
CV: no M/G/R, normal S1 S2, radial pulses +2
PULM: Exp wheeze on right side
ABD: RLQ tenderness, no g/r, no masses
EXT: RUE 1+ edema, PICC in RUE
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses.



Pertinent Results:
[**3-31**] CT Abdomen/Pelvis, CTA Chest
IMPRESSION:
1. Segmental pulmonary embolus in pulmonary artery supplying the

the right lower lobe.
2. Multifocal consolidation within the lungs is most consistent
with
bacterial pneumonia. Pneumocystis infection is a much less
likely
consideration.
3. Cholelithiasis without acute cholecystitis.
4. Stable hemangioma in the left lobe of the liver.
5. Stable sequelae of prior renal and splenic infarcts.
6. Slight interval increase in lymphadenopathy within the
mediastinum, hila, and mesentery.

[**3-31**]  CT Head
FINDINGS: There is no acute intracranial hemorrhage, edema,
shift of normally midline structures or evidence of major
vascular territorial infarct. Encephalomalacia in the left MCA
distribution is unchanged, along with exvacuo dilatation of the
anterior [**Doctor Last Name 534**] of the left lateral ventricle. Otherwise,
ventricles and sulci are normal in configuration and size. The
[**Doctor Last Name 352**]-white differentiation is otherwise preserved. Basilar
cisterns are seen.

There is no fracture. The mastoid air cells and paranasal
sinuses are well
aerated. Soft tissues are unremarkable.

IMPRESSIONS:
1. No intracranial hemorrhage.
2. Stable encephalomalacia in left MCA distribution.

[**Known lastname **],[**Known firstname **] [**Medical Record Number 101142**] F  47  [**2143-7-12**]

Radiology Report CHEST (PA & LAT) Study Date of [**2191-4-6**] 9:25 AM



[**Last Name (LF) **],[**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] 11R [**2191-4-6**] 9:25 AM
CHEST (PA & LAT)   Clip # [**Clip Number (Radiology) 101143**]
Reason: eval for interval change, please



[**Hospital 93**] MEDICAL CONDITION:
   47 year old woman with pna, pe, rml and rll collapse,
effusion rt. with
   ongoing dyspnea
REASON FOR THIS EXAMINATION:
   eval for interval change, please



Final Report
HISTORY: 47-year-old woman, with pneumonia, pulmonary embolism,
right middle
and lower lobe collapse, and right-sided pleural effusion. With
ongoing
dyspnea.

COMPARISON: [**2191-4-4**], and [**2191-4-5**].

AP AND LATERAL CHEST RADIOGRAPHS: Right lower and probable
middle lobe
collapse persist. Small to moderate right pleural effusion is
unchanged. Mild
pulmonary edema has increased. There is no pneumothorax. The
right subclavian
PICC line still ends in the lower SVC. In the imaged upper
abdomen,
borderline dilated bowel loops are unchanged.

IMPRESSION:
1. Unchanged right lower and probable middle lobe collapse and
small to
moderate right pleural effusiosn.
2. Mild pulmonary edema, increased.



Brief Hospital Course:
47yo F p/w AIDS, HIV, dilated cardiomyopathy, and antiphsopholid
syndrome who p/w R shoulder pain and tachypnea.
.
# RESPIRATORY DISTRESS- Resolved.  Pt devleoped tachypnea [**2-7**] PE
and Pneumonia causing respiratory alkalosis. Patient's PE
causing shunting, and pt's probable PNA creating some dead
space. Pt's ABG initally 7.47/26/91/19 and was started on AC
Ventilator.  Patient was successfully extubated on Day 2 of
hospitalization and remained on 3L NC.  Pt. slowly improved.
Her small to moderate pleural effusion was reviewed by
interventional pulmonary who stated it was to small to tap, and
should be followed clinically.
.
# Enterobacter Pneumonia:  Stable.  On admission, patient
complained of shortness of breath.  CTA showed b/l lower lobe
infiltrates, along with Pulmonary embolism.  Pt has been
non-complaint w/ HAART therapy in past. Patient had a BAL
specimen that was grew Enterobacter, sensitive to Meropenem.  Pt
at risk for opportunistic infections given low CD4 count.
Negative for acid fast and PCP.  [**Name Initial (NameIs) **] Glucan negative.
- Continued Meropenem for planned total 8 day course.
.
# PE- Patient with a history of antiphospholipid antibody
syndrome.  Pt's filling defect on CTA was at center of
infiltrate.
- Heparin drip to therapeutic warfarin.  Will need warfarin
anticoagulation indefinately.
.
# Pleuritic pain - improved with dilaudid IV then percocet.
.
# HEMOPTYSIS- Resolved.  Unclear if before or after heparin use
in ER. Pulmonary hemorrhage syndrome in setting of PE most
likely etiology.  Patient's BAL negative for acid fast bacteria.
 Self limited.
.
# HIV- not compliant w/ HAART in past. CD4 159 this admission.
Resumption not pursued given long history of non complaince as
well as severe acute illness.
.
# HYPONATRREMIA- due to siadh.  TSH and cortisol normal.
Resolved with free water restriction.
.
# CHF = pt has dilated cardiomyopathy ?[**2-7**] cocaine. Pt has EF
25%.  Occasional slight pulm edema on CXR, however, this
improved clinically with the free water restriction initiated
for SIADH.
.
# ANTIPHOSPHOLIPID SYND: goal INR [**2-8**].

Medications on Admission:
Largely non-compliant.

Discharge Medications:
1. Carvedilol 6.25 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
2. Ipratropium Bromide 0.02 % Solution Sig: [**1-7**] neb Inhalation
Q6H (every 6 hours).
3. Guaifenesin 600 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO BID (2 times a day).
4. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
5. Warfarin 5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4
PM: titrate to INR 2.0 to 3.0.  Overlap therapeutic dose with
therapeutic level of unfractionated heparin drip for at least 48
hours, then d/c heparin drip.
6. Heparin, Porcine (PF) 100 unit/mL Solution Sig: titrate to
PTT of 60-80 Units, heparin Intravenous continuous: Until
therapeutic INR on warfarin (2.0-3.0) for at least 48 hours.
Current rate of heparin infusion in hospital for therapeutic
range is: 900 UNITS/HOUR.
7. Polyethylene Glycol 3350 100 % Powder Sig: 17 grams grams PO
DAILY (Daily) as needed.
8. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q6H (every 6 hours) as needed.
9. Atovaquone 750 mg/5 mL Suspension Sig: Ten (10) mL PO DAILY
(Daily).
10. Meropenem 500 mg Recon Soln Sig: Five Hundred (500) mg
Intravenous Q6H (every 6 hours) for 2 days: through [**2191-4-10**] then
can stop.  PICC line can be removed once this and heparin drip
have stopped.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - MACU

Discharge Diagnosis:
Multifocal pneumonia
Pulmonary embolism
RML and RLL collapse
Rt sided pleural effusion with only small quantity free flowing
Pleuritic chest pain RLL, felt c/w known PE, effusion
Antiphospholipid antibody syndrome
Atrial fibrillation
Remote history of stroke
Pancytopenia when takes trimethoprim/sulfamethoxazole
AIDS (CD4 in hospital 160s)


Discharge Condition:
Stable.  Having pleuritic chest pain but improving.  Room air
saturation of 97%.


Discharge Instructions:
Return to [**Hospital1 18**] for: worsening sob, fevers

Followup Instructions:
term acute care facility
{'Acute respiratory failure,Other pulmonary embolism and infarction,Pneumonia due to other gram-negative bacteria,Acute kidney failure, unspecified,Chronic systolic heart failure,Human immunodeficiency virus [HIV] disease,Other primary cardiomyopathies,Atrial fibrillation,Chronic hepatitis C without mention of hepatic coma,Other and unspecified nonspecific immunological findings'}


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: Ms. [**Known lastname **] is a 47F with AIDS, HCV, dilated cardiomyopathy, afib,
and antiphospholipid syndrome who is presenting to the [**Hospital Unit Name 153**] w/ a
new PE, probable PNA, and intubated after respiratory distress.
Pt intially presented to the ED complaining of R shoulder pain
and RUQ abdominal pain. Pt denied any trauma and said the
shoulder pain began yesterday and was making her SOB. ?
hemoptysis. Pt also described RUQ pain, which was sudden and
sharp. The abd pain did not radiate anywhere and was worse w/
oral intake. Pt's initial vitals were T 97.9, BP 141/94, HR 56,
RR 20 and 100% on RA. She became tachypneic to 44 and stayed in
the 30s-40s. CT torso and CTA to eval for PE was ordred. The CTA
showed heterogeneous opacities in the lungs with areas of
confluent consolidation c/w infection: most likely bacterial;
pneumocystis infection is less likely. Filling defect in
segmental branch supplying right lower lobe c/w PE. The CT
abdomen showed gallstones in a collapsed gallbladder without
cholecystitis. She was started on heparin gtt w/ bolus, and
given Vanc 1gm/ Ctx 2g/ Flagyl 500mg and later given levaquin
750 IV x1. Pt's 02 requirement increased from 4L N/C, to NRB.
Her hyperventilation continued and her ABG showed 7.47/ 26/ 91/
19 with a temp 103.8. She was intubated w/ etomidate/succ and
propofol. She then developed hypotension to 85/63 given a 500cc
bolus, and her heparin was stopped after devloping [**Hospital Unit Name **] tinged
sputum in the ET tube, aprox 50cc. Her propofol was changed to
fentanyl/versed after low BP and eventually required a total of
2.7L in the ED. Also pt's utox was also positive for cocaine.
.
Of note the patient was recently hospitalized from [**Date range (1) 86279**] for
LE edema and DOE, and treated for CHF exacerbation (EF 25%) with
furosemide and dig. It was thought this exacerbation may have
been precipitated by cocaine use. Her afib remained rate
controlled throughout the admission. She was also started on [**Date range (1) **]
given her h/o anti-phospholipid syndrome.
.
ROS: unable to obtain since intubated

MEDICAL HISTORY: 1. HIV/AIDS, diagnosed [**2176**], off HAART.
- acquired via heterosexual intercourse.
- CD4 184, VL 254k [**2190-12-5**]
- nadir CD4 69 [**6-11**]
2. HCV antibody+
3. [**Doctor First Name **] [**1-/2182**] - was not complaint with Rx.
4. Oral thrush
5. Recurrent episodes of pneumococcal pneumonia.
6. Lymphocytic pneumonitis - diagnosed by trans-bronchial bx.
7. Dilated cardiomyopathy-EF20-25%, last echo [**4-13**].
8. LV thrombus
9. Antiphospholipid antibody syndrome
10. Lower extremity arterial thrombus
11. Asthma/bronchiectasis
12. Myocardial infarction [**2184**], clean coronaries at that time
13. L MCA stroke, residual right hemiparesis
14. Cocaine abuse
15. Pulmonary Nodules on chest CT
16. Zoster
17. Cholelithiasis

MEDICATION ON ADMISSION: Largely non-compliant.

ALLERGIES: Zidovudine

PHYSICAL EXAM: VS: 97.3, 95, 18, 93/60, 97%/3L
GEN: AOx3, appears comfortable
[**Year (4 digits) 4459**]: NAD
NECK: No JVD, carotid pulses brisk, no bruits, no cervical
lymphadenopathy, trachea midline
CV: no M/G/R, normal S1 S2, radial pulses +2
PULM: Exp wheeze on right side
ABD: RLQ tenderness, no g/r, no masses
EXT: RUE 1+ edema, PICC in RUE
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses.

FAMILY HISTORY: mother with DM

SOCIAL HISTORY: smokes "occassionally" X many years, no recent alcohol, h/o
cocaine abuse, but none recently, and has been homeless in the
past 

### Response:
{'Acute respiratory failure,Other pulmonary embolism and infarction,Pneumonia due to other gram-negative bacteria,Acute kidney failure, unspecified,Chronic systolic heart failure,Human immunodeficiency virus [HIV] disease,Other primary cardiomyopathies,Atrial fibrillation,Chronic hepatitis C without mention of hepatic coma,Other and unspecified nonspecific immunological findings'}
