CHIEF COMPLAINT: Liver and Renal Failure

PRESENT ILLNESS: 47 year old male with hx HCV, EtoH abuse and cirrhosis
transferred from OSH for worsening liver and renal failure.
Presented [**7-14**] with abd pain, n/v, fever and decreased PO.  On
exam he was febrile and had marked ascities and jaundice.
Started on flagyl and cipro for presumed SBP.  Paracentesis
showed neutrophils of 477.  During that hopsitalization he
developed coagulopathy with INR increasing from 2.7-->3.9, bili
12-->21.6, Cr 2.1-->8.1.  Transferred to [**Hospital1 18**] for transplant
evaluation,  hemodyalisis, and HD support.

MEDICAL HISTORY: HTN
HCV
IVDU
EtOH abuse
Cirrhosis
Depression

MEDICATION ON ADMISSION: albumin 12.5 g IV q6
lopressor 25 mg po BID
norvasc 2.5 mg po qD
Protonix 40mg po qD
Midodrine 10 mg po TID
flagyll 500 mg IV q6h
Octreotide 100mcg IV TID
cipro 200mg IV q12

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pt expired at end of hospital stay.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: + IVDU, Tob, EtoH
Alcoholic cirrhosis of liver,Hepatorenal syndrome,Acute hepatitis C without mention of hepatic coma,Acute kidney failure, unspecified,Hyperpotassemia,Cocaine dependence, unspecified
Alcohol cirrhosis liver,Hepatorenal syndrome,Hpt C acute wo hpat coma,Acute kidney failure NOS,Hyperpotassemia,Cocaine depend-unspec
Admission Date:  [**2103-7-19**]              Discharge Date:   [**2103-7-29**]

Date of Birth:  [**2056-6-20**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 398**]
Chief Complaint:
Liver and Renal Failure

Major Surgical or Invasive Procedure:
Intubation
R IJ
CVVHD

History of Present Illness:
47 year old male with hx HCV, EtoH abuse and cirrhosis
transferred from OSH for worsening liver and renal failure.
Presented [**7-14**] with abd pain, n/v, fever and decreased PO.  On
exam he was febrile and had marked ascities and jaundice.
Started on flagyl and cipro for presumed SBP.  Paracentesis
showed neutrophils of 477.  During that hopsitalization he
developed coagulopathy with INR increasing from 2.7-->3.9, bili
12-->21.6, Cr 2.1-->8.1.  Transferred to [**Hospital1 18**] for transplant
evaluation,  hemodyalisis, and HD support.

Past Medical History:
HTN
HCV
IVDU
EtOH abuse
Cirrhosis
Depression

Social History:
+ IVDU, Tob, EtoH

Family History:
non-contributory

Physical Exam:
Pt expired at end of hospital stay.


Pertinent Results:
[**2103-7-28**] 02:12AM BLOOD WBC-7.3 RBC-3.20* Hgb-9.9* Hct-28.5*
MCV-89 MCH-31.1 MCHC-34.9 RDW-18.5* Plt Ct-45*
[**2103-7-27**] 03:03AM BLOOD Neuts-84.0* Lymphs-8.4* Monos-5.0 Eos-2.2
Baso-0.3
[**2103-7-27**] 03:03AM BLOOD Anisocy-2+ Poiklo-1+ Macrocy-1+
[**2103-7-28**] 02:12AM BLOOD Plt Ct-45*
[**2103-7-28**] 02:12AM BLOOD PT-23.2* PTT-58.3* INR(PT)-3.6
[**2103-7-28**] 02:12AM BLOOD Fibrino-125*
[**2103-7-28**] 08:25AM BLOOD Glucose-125* UreaN-24* Creat-2.5* Na-128*
K-3.6 Cl-90* HCO3-25 AnGap-17
[**2103-7-28**] 02:12AM BLOOD ALT-97* AST-176* AlkPhos-132*
TotBili-42.7*
[**2103-7-26**] 02:45AM BLOOD Lipase-114*
[**2103-7-22**] 04:26AM BLOOD Lipase-1536*
[**2103-7-28**] 02:12AM BLOOD Calcium-11.6* Phos-1.7* Mg-3.1*
[**2103-7-20**] 04:08AM BLOOD Albumin-2.8* Calcium-9.0 Phos-7.7*
Mg-2.9*
[**2103-7-20**] 07:35AM BLOOD calTIBC-116* Ferritn-GREATER TH TRF-89*
[**2103-7-21**] 04:15PM BLOOD AFP-5.3
[**2103-7-28**] 07:07AM BLOOD Type-ART Temp-36.2 Rates-/18 Tidal V-400
PEEP-5 O2-40 pO2-110* pCO2-43 pH-7.34* calHCO3-24 Base XS--2
Intubat-INTUBATED Vent-SPONTANEOU
[**2103-7-25**] 10:19AM BLOOD Lactate-2.2*
[**2103-7-22**] 05:37AM BLOOD Lactate-3.7*

[**7-20**] ECHO:  The left atrium is mildly dilated. Left ventricular
wall thicknesses are normal. The left ventricular cavity size is
top normal/borderline dilated. Overall left ventricular systolic
function is normal (LVEF>55%). Right ventricular chamber size
and free wall motion are normal. The ascending aorta is mildly
dilated. The aortic valve leaflets (3) appear structurally
normal with good leaflet excursion and no aortic regurgitation.
There is no aortic valve stenosis. The mitral valve appears
structurally normal with trivial mitral regurgitation. There is
no pericardial effusion. There is mild to moderate pulmonary
artery systolic hypertension.

[**7-24**] CTA abd:  Cirrhosis, with changes of portal hypertension.
Normal vascular anatomy, with patent portal and splenic veins.

[**7-25**] CXR:  NGT with tip coiled in the stomach. No other
significant
interval change in the appearance of the chest with continued
mild congestive
heart failure and multifocal patchy opacities within the left
upper and right
lower lobes, likely representing pneumonic infiltrates.


Brief Hospital Course:
1.  Cirrhosis:  Pt with severe Child's C class cirrhosis with
hepatorenal syndrome.  Severe encephelopathy, hypoabluminemia,
edema, coagulopathy.  Started on midodrine, octreotide and
lactulose.  FFP given for coagulopathy.  He was put on fluid
restriction to 1L per day.  Biliruben increased to 42.7 at end
of hospital stay.  Pt removed from transplant list and made DNR
with major goal of care comfort--he was extubated [**2103-7-29**] and
passed away that day.

2.  Renal Failure:  Pt with hepatorenal syndrome.  He was put on
CVVHD during most of hosptial course in anticipation for
possible liver transplant, which unfortunately was not feasible.


3.  Infection:  Pt initially presented with SBP, treated with
numerous antibiotics including ceftriaxone, zosyn, vancomycin.
Pt also developed yeast in sputum while on ventilator.

4.  Respiratory:  Pt intubated for aspiration risk [**7-22**].
Maintained on pressure support during part of hospital course.
Extubated for comfort [**2103-7-29**].

5.  Pancreatitis:  Peak lipase 1536.  Made NPO, and eventually
cleared.

6.  Hypotension:  Pt required dopamine transiently.

Medications on Admission:
albumin 12.5 g IV q6
lopressor 25 mg po BID
norvasc 2.5 mg po qD
Protonix 40mg po qD
Midodrine 10 mg po TID
flagyll 500 mg IV q6h
Octreotide 100mcg IV TID
cipro 200mg IV q12

Discharge Medications:
pt expired

Discharge Disposition:
Expired

Discharge Diagnosis:
Hepatorenal syndrome
Cirrhosis
Pancreatitis
Respiratory Failure

Discharge Condition:
Expired

Discharge Instructions:
expired

Followup Instructions:
expired


Completed by:[**2103-10-31**]
{'Alcoholic cirrhosis of liver,Hepatorenal syndrome,Acute hepatitis C without mention of hepatic coma,Acute kidney failure, unspecified,Hyperpotassemia,Cocaine dependence, unspecified'}


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: Liver and Renal Failure

PRESENT ILLNESS: 47 year old male with hx HCV, EtoH abuse and cirrhosis
transferred from OSH for worsening liver and renal failure.
Presented [**7-14**] with abd pain, n/v, fever and decreased PO.  On
exam he was febrile and had marked ascities and jaundice.
Started on flagyl and cipro for presumed SBP.  Paracentesis
showed neutrophils of 477.  During that hopsitalization he
developed coagulopathy with INR increasing from 2.7-->3.9, bili
12-->21.6, Cr 2.1-->8.1.  Transferred to [**Hospital1 18**] for transplant
evaluation,  hemodyalisis, and HD support.

MEDICAL HISTORY: HTN
HCV
IVDU
EtOH abuse
Cirrhosis
Depression

MEDICATION ON ADMISSION: albumin 12.5 g IV q6
lopressor 25 mg po BID
norvasc 2.5 mg po qD
Protonix 40mg po qD
Midodrine 10 mg po TID
flagyll 500 mg IV q6h
Octreotide 100mcg IV TID
cipro 200mg IV q12

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pt expired at end of hospital stay.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: + IVDU, Tob, EtoH 

### Response:
{'Alcoholic cirrhosis of liver,Hepatorenal syndrome,Acute hepatitis C without mention of hepatic coma,Acute kidney failure, unspecified,Hyperpotassemia,Cocaine dependence, unspecified'}
