CHIEF COMPLAINT: Respiratory failure

PRESENT ILLNESS: Mr. [**Known lastname **] is a 51 year-old male with a medical history of anemia,
anxiety and depression, bipolar disorder, hypertension, gout and
a right quadriceps tendon rupture and reconstruction ([**10-16**])
complicated by infection, irrigation and debridement x2 ([**11-15**]).
Revision quad tendon reconstruction, ([**2145-3-7**]). He was
originally admitted on [**2145-8-25**] after a suicide attempt by
consuming 70 Klonopin tablets. While he was awaiting placement
in a psychiatric unit, he began to experience abdominal pain,
cramps, explosive diarrhea. His CT scan abdomen was essentially
negative. He developed at acidosis with a bicarbonate of 8 but
ABG of 7.31/38. The acidosis was a non-gap acidosis, with a WBC
count of 39. The patient's C. diff toxin test was negative but
he had WBCs in his stool. The patient was slightly tachycardic
but no fever. He was started on fluid resuscitation. He has a
long history of smoking and was coughing up a white sputum. The
patient was placed empirically on flagyl, Avelox, and
solumedrol. His knee was examined by Orthopedics who would not
perform any operations; on the other hand, they also did not see
drainage or pus.
In the morning of [**2145-8-28**], the patient was more tachypneic and
had a bicarbonate of 9. The patient was started on a bicarbonate
drip; his renal function was normal at that time. In the
afternoon, his blood pressure dropped to the 50-60s systolic.
His ABG was 7.02/38. The patient was intubated, ventilated, and
received large volume resuscitation and bicarbonate drip. The
patient's antibiotic coverage was broadened to vancomycin,
flagyl, and a carbapenem. His troponins rose to 11, then 17. An
Echocardiogram was ordered but could not be completed. The
patient's liver function tests also skyrocketed, with
transaminases SGPT 3000s, SGOT 6500. The patient is now anuric,
with a creatinine of 5.7. He is hemodynamically stable, having
been weaned from Levophed. His ventilation has been assist
control 16, tidal volume 550, PEEP 5, FiO2 40%. The patient is
not requiring sedation but is somnolent.

MEDICAL HISTORY: Anemia
Anxiety and depression
Bipolar disorder
Hypertension
Gout
Right quadriceps tendon rupture and reconstruction ([**10-16**])
complicated by infection, irrigation and debridement x2 ([**11-15**]).
Revision quad tendon reconstruction, ([**2145-3-7**]).

MEDICATION ON ADMISSION: ARIPIPRAZOLE [ABILIFY] - (Prescribed by Other Provider) - 30 mg

ALLERGIES: codiene

PHYSICAL EXAM: On admission
Vitals: T: 38.6 BP: 95/60 P: 136 R: 22 O2: 99%
General: sedated, intubated, toxic appearance
HEENT: Sclera hemorrhagic and edematous
Lungs: Clear to auscultation bilaterally
CV: Irregular rate and rhythm
Abdomen: soft, non-tender, bowel sounds positive
GU: foley in place
Ext: cool, no palpable pulses, no clubbing, cyanosis or edema
Skin: mottled, non-blanching purpura present

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Retired carpenter. He is a current smoker, smoking approximately
two packs of cigarettes a day. He drinks approximately 6 to 14
beers a week. No recreational drug use.
Unspecified septicemia,Acute respiratory failure,Septic shock,Acute kidney failure with lesion of tubular necrosis,Acute and subacute necrosis of liver,Other and unspecified coagulation defects,Acidosis,Poisoning by uric acid metabolism drugs,Severe sepsis,Poisoning by benzodiazepine-based tranquilizers,Suicide and self-inflicted poisoning by other specified drugs and medicinal substances,Encounter for palliative care,Anemia, unspecified,Dysthymic disorder,Gout, unspecified,Bipolar disorder, unspecified,Unspecified essential hypertension,Tobacco use disorder
Septicemia NOS,Acute respiratry failure,Septic shock,Ac kidny fail, tubr necr,Acute necrosis of liver,Coagulat defect NEC/NOS,Acidosis,Pois-uric acid metabol,Severe sepsis,Pois-benzodiazepine tran,Poison-drug/medicin NEC,Encountr palliative care,Anemia NOS,Dysthymic disorder,Gout NOS,Bipolar disorder NOS,Hypertension NOS,Tobacco use disorder
Admission Date:  [**2145-8-29**]              Discharge Date:   [**2145-8-30**]

Date of Birth:  [**2093-11-17**]             Sex:   M

Service: EMERGENCY

Allergies:
codiene

Attending:[**First Name3 (LF) 2565**]
Chief Complaint:
Respiratory failure

Major Surgical or Invasive Procedure:
Placement of central venous catheter
Placement of dialysis catheter
Received renal replacement therapy

History of Present Illness:
Mr. [**Known lastname **] is a 51 year-old male with a medical history of anemia,
anxiety and depression, bipolar disorder, hypertension, gout and
a right quadriceps tendon rupture and reconstruction ([**10-16**])
complicated by infection, irrigation and debridement x2 ([**11-15**]).
Revision quad tendon reconstruction, ([**2145-3-7**]). He was
originally admitted on [**2145-8-25**] after a suicide attempt by
consuming 70 Klonopin tablets. While he was awaiting placement
in a psychiatric unit, he began to experience abdominal pain,
cramps, explosive diarrhea. His CT scan abdomen was essentially
negative. He developed at acidosis with a bicarbonate of 8 but
ABG of 7.31/38. The acidosis was a non-gap acidosis, with a WBC
count of 39. The patient's C. diff toxin test was negative but
he had WBCs in his stool. The patient was slightly tachycardic
but no fever. He was started on fluid resuscitation. He has a
long history of smoking and was coughing up a white sputum. The
patient was placed empirically on flagyl, Avelox, and
solumedrol. His knee was examined by Orthopedics who would not
perform any operations; on the other hand, they also did not see
drainage or pus.
In the morning of [**2145-8-28**], the patient was more tachypneic and
had a bicarbonate of 9. The patient was started on a bicarbonate
drip; his renal function was normal at that time. In the
afternoon, his blood pressure dropped to the 50-60s systolic.
His ABG was 7.02/38. The patient was intubated, ventilated, and
received large volume resuscitation and bicarbonate drip. The
patient's antibiotic coverage was broadened to vancomycin,
flagyl, and a carbapenem. His troponins rose to 11, then 17. An
Echocardiogram was ordered but could not be completed. The
patient's liver function tests also skyrocketed, with
transaminases SGPT 3000s, SGOT 6500. The patient is now anuric,
with a creatinine of 5.7. He is hemodynamically stable, having
been weaned from Levophed. His ventilation has been assist
control 16, tidal volume 550, PEEP 5, FiO2 40%. The patient is
not requiring sedation but is somnolent.


Past Medical History:
Anemia
Anxiety and depression
Bipolar disorder
Hypertension
Gout
Right quadriceps tendon rupture and reconstruction ([**10-16**])
complicated by infection, irrigation and debridement x2 ([**11-15**]).
Revision quad tendon reconstruction, ([**2145-3-7**]).


Social History:
Retired carpenter. He is a current smoker, smoking approximately
two packs of cigarettes a day. He drinks approximately 6 to 14
beers a week. No recreational drug use.

Family History:
Non-contributory

Physical Exam:
On admission
Vitals: T: 38.6 BP: 95/60 P: 136 R: 22 O2: 99%
General: sedated, intubated, toxic appearance
HEENT: Sclera hemorrhagic and edematous
Lungs: Clear to auscultation bilaterally
CV: Irregular rate and rhythm
Abdomen: soft, non-tender, bowel sounds positive
GU: foley in place
Ext: cool, no palpable pulses, no clubbing, cyanosis or edema
Skin: mottled, non-blanching purpura present


Pertinent Results:
[**2145-8-29**] 07:28PM   ALT(SGPT)-3048* AST(SGOT)-6612*
LD(LDH)-[**Numeric Identifier **]* CK(CPK)-6296* ALK PHOS-1103* AMYLASE-379* TOT
BILI-1.9*
[**2145-8-29**] 07:28PM   CK-MB-19* MB INDX-0.3 cTropnT-1.52*
[**2145-8-29**] 07:28PM   ALBUMIN-2.8* CALCIUM-6.3* PHOSPHATE-7.2*
MAGNESIUM-1.6
[**2145-8-29**] 07:28PM   WBC-6.4 RBC-4.15* HGB-13.0*# HCT-39.5*#
MCV-95 MCH-31.5 MCHC-33.0 RDW-16.9*
[**2145-8-29**] 07:28PM   NEUTS-60 BANDS-0 LYMPHS-36 MONOS-2 EOS-2
BASOS-0 ATYPS-0 METAS-0 MYELOS-0
[**2145-8-29**] 07:28PM   PT-27.5* PTT-59.9* INR(PT)-2.6*
[**2145-8-29**] 07:28PM   PLT SMR-VERY LOW PLT COUNT-97*#
[**2145-8-29**] 07:43PM   TYPE-CENTRAL VE TEMP-38.6 PO2-36* PCO2-56*
PH-7.18* TOTAL CO2-22 BASE XS--8 INTUBATED-INTUBATED
[**2145-8-29**] 08:52PM   PT-34.1* PTT-71.6* INR(PT)-3.4*
[**2145-8-29**] 08:52PM   PLT COUNT-71*
[**2145-8-29**] 08:52PM   WBC-5.3 RBC-3.36* HGB-10.6* HCT-31.3* MCV-93
MCH-31.7 MCHC-34.1 RDW-16.7*
[**2145-8-29**] 08:52PM   ALBUMIN-2.2* CALCIUM-6.0* PHOSPHATE-7.4*
MAGNESIUM-1.4*
[**2145-8-29**] 08:52PM   ALT(SGPT)-2397* AST(SGOT)-5293*
LD(LDH)-[**Numeric Identifier 88183**]* ALK PHOS-930* TOT BILI-1.5
[**2145-8-29**] 09:09PM   LACTATE-10.7*

Brief Hospital Course:
The patient arrived from outside hospital in extremis. Of his
many problems, the following were prioritized, given his overall
poor condition: For the patient's respiratory failure, he
arrived intubated and his ventilation was continued mechanically
with no attempts to wean. His primary issues appeared to be
secondary to a possible colchicine overdose and/or sepsis. The
patient had a known suicide attempt five days before
presentation. According to the patient's girlfriend, in addition
to aripiprazole and clonazepam, he took whatever was left of his
colchicine prescription. Colchicine toxicity manifests as
gastroenteritis, pancytopenias, cardiac abnormalities, and
various other issues. By the point of his admission to [**Hospital1 18**],
the colchicine would have been widely distributed to his organ
systems. In addition, the patient could have been septic. It was
not clear what the patient's source of infection is, though he
had several possible sites. His open right knee wound is
possible and could be polymicrobial if infected. He had been
treated with antibiotics for osteomyelitis in the past, but was
seen by orthopedics who did not feel that that the open area on
knee was the source of infection. There was no purulence or
fluctuance. Given the strong possibility of colchicine overdose,
bacteremia from translocation across the damaged GI mucosa was
also a possibility. His chest films were not suggestive of
pneumonia, but per preliminary radiology read, it could not be
ruled out.  The patient was started on vancomycin,
metronidazole, and meropenem to cover broad array of possible
organisms from either wound, pulmonary, or gut source.
      Once the patient arrived to [**Hospital1 18**], he almost immediately
became hemodynamically unstable. The patient was bradycardic
into the 20s without consistent femoral pulse. Epinephrine was
provided, which brought him out of the bradycardia. The
antibiotics were quickly loaded via IV. ABGs showed a
substantial acidosis, for which some bicarbonate was given as a
temporizing measure. The leading diagnoses continued to be
either colchicine overdose or sepsis. The patient's ex-wife and
his girlfriend were both notified of his poor condition, but
were informed that we would try dialysis as a last-ditch
measure. Before a dialysis catheter could be placed, the
patient's blood pressure began to drop and was unresponsive to
fluids. Pressors were started and the patient needed three
pressors to keep his systolic blood pressure above 80. He
continued to be oliguric; as he was sedated, mental status could
not be appreciated. CVVH was instituted following the placement
of a femoral dialysis catheter, though CVVH would likely not
clear colchicine, if that was the source of his shock. Several
hours of CVVH did not help the patient in any appreciable way.
During this resuscitation phase, the patient's pupils were seen
to be dilated and non-responsive to light. He was too unstable
to undergo head CT.  He continued to show acidosis on his ABGs;
the patient would have episodes of bradycardia that would
respond to an amp of bicarbonate but then quickly return. At
this point, the patient's next of [**Doctor First Name **] was then notified again
and made aware that it would be unlikely that he would have any
recovery. The decision was then made to remove pressors and stop
using bicarbonate therapy. The patient died shortly thereafter.

Medications on Admission:
ARIPIPRAZOLE [ABILIFY] - (Prescribed by Other Provider) - 30 mg

Tablet - 1 Tablet(s) by mouth
CLONAZEPAM - (Prescribed by Other Provider) - 1 mg Tablet - 1
Tablet(s) by mouth three times a day
COLCHICINE [COLCRYS] - (Prescribed by Other Provider) - 0.6 mg
Tablet - 1 Tablet(s) by mouth twice a day
OXYCODONE - 5 mg Tablet - [**4-9**] Tablet(s) by mouth q 6 hours as
needed for pain
OXYCODONE [OXYCONTIN] - 40 mg Tablet Extended Release 12 hr - 1

Tablet(s) by mouth three times a day as needed for for pain
TESTOSTERONE [TESTIM] - (Prescribed by Other Provider) - Dosage

uncertain
VENLAFAXINE - (Prescribed by Other Provider) - 150 mg Capsule,
Ext Release 24 hr - 1 Capsule(s) by mouth twice a day
ASPIRIN - 325 mg Tablet, Delayed Release (E.C.) - 1 Tablet(s) by

mouth daily for six weeks for prophylaxis
DOCUSATE SODIUM - 100 mg Capsule - 1 Capsule(s) by mouth twice a

day while taking narcotics


Discharge Medications:
Patient expired.

Discharge Disposition:
Expired

Discharge Diagnosis:
Expired.

Discharge Condition:
Expired.

Discharge Instructions:
Expired.

Followup Instructions:
Expired.
{'Unspecified septicemia,Acute respiratory failure,Septic shock,Acute kidney failure with lesion of tubular necrosis,Acute and subacute necrosis of liver,Other and unspecified coagulation defects,Acidosis,Poisoning by uric acid metabolism drugs,Severe sepsis,Poisoning by benzodiazepine-based tranquilizers,Suicide and self-inflicted poisoning by other specified drugs and medicinal substances,Encounter for palliative care,Anemia, unspecified,Dysthymic disorder,Gout, unspecified,Bipolar disorder, unspecified,Unspecified essential hypertension,Tobacco use disorder'}


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: Respiratory failure

PRESENT ILLNESS: Mr. [**Known lastname **] is a 51 year-old male with a medical history of anemia,
anxiety and depression, bipolar disorder, hypertension, gout and
a right quadriceps tendon rupture and reconstruction ([**10-16**])
complicated by infection, irrigation and debridement x2 ([**11-15**]).
Revision quad tendon reconstruction, ([**2145-3-7**]). He was
originally admitted on [**2145-8-25**] after a suicide attempt by
consuming 70 Klonopin tablets. While he was awaiting placement
in a psychiatric unit, he began to experience abdominal pain,
cramps, explosive diarrhea. His CT scan abdomen was essentially
negative. He developed at acidosis with a bicarbonate of 8 but
ABG of 7.31/38. The acidosis was a non-gap acidosis, with a WBC
count of 39. The patient's C. diff toxin test was negative but
he had WBCs in his stool. The patient was slightly tachycardic
but no fever. He was started on fluid resuscitation. He has a
long history of smoking and was coughing up a white sputum. The
patient was placed empirically on flagyl, Avelox, and
solumedrol. His knee was examined by Orthopedics who would not
perform any operations; on the other hand, they also did not see
drainage or pus.
In the morning of [**2145-8-28**], the patient was more tachypneic and
had a bicarbonate of 9. The patient was started on a bicarbonate
drip; his renal function was normal at that time. In the
afternoon, his blood pressure dropped to the 50-60s systolic.
His ABG was 7.02/38. The patient was intubated, ventilated, and
received large volume resuscitation and bicarbonate drip. The
patient's antibiotic coverage was broadened to vancomycin,
flagyl, and a carbapenem. His troponins rose to 11, then 17. An
Echocardiogram was ordered but could not be completed. The
patient's liver function tests also skyrocketed, with
transaminases SGPT 3000s, SGOT 6500. The patient is now anuric,
with a creatinine of 5.7. He is hemodynamically stable, having
been weaned from Levophed. His ventilation has been assist
control 16, tidal volume 550, PEEP 5, FiO2 40%. The patient is
not requiring sedation but is somnolent.

MEDICAL HISTORY: Anemia
Anxiety and depression
Bipolar disorder
Hypertension
Gout
Right quadriceps tendon rupture and reconstruction ([**10-16**])
complicated by infection, irrigation and debridement x2 ([**11-15**]).
Revision quad tendon reconstruction, ([**2145-3-7**]).

MEDICATION ON ADMISSION: ARIPIPRAZOLE [ABILIFY] - (Prescribed by Other Provider) - 30 mg

ALLERGIES: codiene

PHYSICAL EXAM: On admission
Vitals: T: 38.6 BP: 95/60 P: 136 R: 22 O2: 99%
General: sedated, intubated, toxic appearance
HEENT: Sclera hemorrhagic and edematous
Lungs: Clear to auscultation bilaterally
CV: Irregular rate and rhythm
Abdomen: soft, non-tender, bowel sounds positive
GU: foley in place
Ext: cool, no palpable pulses, no clubbing, cyanosis or edema
Skin: mottled, non-blanching purpura present

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Retired carpenter. He is a current smoker, smoking approximately
two packs of cigarettes a day. He drinks approximately 6 to 14
beers a week. No recreational drug use. 

### Response:
{'Unspecified septicemia,Acute respiratory failure,Septic shock,Acute kidney failure with lesion of tubular necrosis,Acute and subacute necrosis of liver,Other and unspecified coagulation defects,Acidosis,Poisoning by uric acid metabolism drugs,Severe sepsis,Poisoning by benzodiazepine-based tranquilizers,Suicide and self-inflicted poisoning by other specified drugs and medicinal substances,Encounter for palliative care,Anemia, unspecified,Dysthymic disorder,Gout, unspecified,Bipolar disorder, unspecified,Unspecified essential hypertension,Tobacco use disorder'}
