CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 44 year-old male with
a history of AIDS (CD4 count of 149 and viral load of 591),
diffuse Kaposi sarcoma diagnosed in [**2142**] and hepatitis C
presents with nausea, vomiting and fever since [**2151-7-1**].
He was hospitalized on [**2151-7-8**] at [**Hospital3 **] Hospital and
his chemotherapy for the Kaposi (last treatment [**2150-7-29**])
was withheld on [**2151-7-9**].  On the weekend prior to
admission the patient developed a distended abdomen.  One day
prior to admission he developed noticeable jaundice.  He also
experienced a distended abdomen, but was able to have a bowel
movement while at [**Hospital **] [**Hospital **] Hospital.  Studies at [**Hospital **]
[**Hospital **] Hospital were an ultrasound, which revealed trace
ascites, hepatomegaly, splenomegaly, spleen of greater then
20 cm, enlarged gallbladder with sludge and wall thickening,
peripancreatic and periportal lymphadenopathy and increased
size in the kidneys.  On [**2151-7-16**] CT of the abdomen
revealed ascites, bilateral pleural effusion, pericardial
effusion, abdominal anasarca and no small bowel obstruction.
[**2151-7-22**] a barium enema showed a normal colon without
obstruction.

MEDICAL HISTORY: HIV/AIDS diagnosed in [**2142**] with
current CD4 of 149 and viral load 591.  Kaposi sarcoma
diagnosed in [**2142**] with extension to the legs, stomach, rectum
and lymph nodes.  Hepatitis C and colonic obstruction and a
questionable PCP diagnosed back in [**2150-10-29**].

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillin, Abacavir, D4T, tetanus toxoid, sulfa
and coal 3.

PHYSICAL EXAM: 

FAMILY HISTORY: Paternal grandfather had leukemia.  Maternal
grandmother had lung cancer and dad had melanoma.

SOCIAL HISTORY: He lives alone and smokes one pack per day.
The patient denies any alcohol use.
Human immunodeficiency virus [HIV] disease,Kaposi's sarcoma, unspecified site,Acute respiratory failure,Acute and subacute necrosis of liver,Chronic hepatitis C without mention of hepatic coma,Unspecified pleural effusion,Unspecified disorder of kidney and ureter
Human immuno virus dis,Kaposi's sarcoma NOS,Acute respiratry failure,Acute necrosis of liver,Chrnc hpt C wo hpat coma,Pleural effusion NOS,Renal & ureteral dis NOS
Admission Date:  [**2151-7-21**]     Discharge Date:  [**2151-7-25**]

Date of Birth:   [**2106-7-22**]     Sex:  M

Service:  [**Company 191**]

HISTORY OF PRESENT ILLNESS:  This is a 44 year-old male with
a history of AIDS (CD4 count of 149 and viral load of 591),
diffuse Kaposi sarcoma diagnosed in [**2142**] and hepatitis C
presents with nausea, vomiting and fever since [**2151-7-1**].
He was hospitalized on [**2151-7-8**] at [**Hospital3 **] Hospital and
his chemotherapy for the Kaposi (last treatment [**2150-7-29**])
was withheld on [**2151-7-9**].  On the weekend prior to
admission the patient developed a distended abdomen.  One day
prior to admission he developed noticeable jaundice.  He also
experienced a distended abdomen, but was able to have a bowel
movement while at [**Hospital **] [**Hospital **] Hospital.  Studies at [**Hospital **]
[**Hospital **] Hospital were an ultrasound, which revealed trace
ascites, hepatomegaly, splenomegaly, spleen of greater then
20 cm, enlarged gallbladder with sludge and wall thickening,
peripancreatic and periportal lymphadenopathy and increased
size in the kidneys.  On [**2151-7-16**] CT of the abdomen
revealed ascites, bilateral pleural effusion, pericardial
effusion, abdominal anasarca and no small bowel obstruction.
[**2151-7-22**] a barium enema showed a normal colon without
obstruction.

PHYSICAL EXAMINATION:  On physical examination blood pressure
160/80.  Pulse 90.  Respiratory rate 20.  Temperature 100.4.
Sating 97% on 4 liters of oxygen.  General, this is a
jaundice male lying still in bed and appears to be in
distress.  HEENT the patient has jaundice conjunctiva and
oropharynx.  Pupils are equal, round, and reactive to light
and accommodation.  Extraocular movements intact.  Neck
examination there is a mobile, rubbery, supraclavicular lymph
node.  No jugulovenous distention noted.  Cardiovascular
regular rate and rhythm.  Normal S1 and S2.  2 out of 6
systolic ejection murmur at the right upper sternal border.
Chest decreased breath sounds and dullness to percussion at
both bases.  Abdomen was quite distended and tympanic.  A
possible hepatomegaly was noted.  However, the finding was
not clear due to the distended abdomen.  Extremities were 2+
pitting edema to the ankles bilaterally.  Skin was jaundice
over an entire body.  There were purple patches resembling
Kaposi sarcoma on the shins bilaterally.

ALLERGIES:  Penicillin, Abacavir, D4T, tetanus toxoid, sulfa
and coal 3.

MEDICATIONS AT HOME:  Zithromax 700 mg Sunday and Thursday,
Dapsone 100 mg po q.d, Diflucan 150 mg po b.i.d., Protonix 40
mg po q.d., Retrovir 100 mg po b.i.d., 3TC 150 mg po b.i.d.,
Dilaudid 1 mg q 2 prn pain, Tenofovir 800 mg po b.i.d.

PAST MEDICAL HISTORY:  HIV/AIDS diagnosed in [**2142**] with
current CD4 of 149 and viral load 591.  Kaposi sarcoma
diagnosed in [**2142**] with extension to the legs, stomach, rectum
and lymph nodes.  Hepatitis C and colonic obstruction and a
questionable PCP diagnosed back in [**2150-10-29**].

SOCIAL HISTORY:  He lives alone and smokes one pack per day.
The patient denies any alcohol use.

FAMILY HISTORY:  Paternal grandfather had leukemia.  Maternal
grandmother had lung cancer and dad had melanoma.

LABORATORIES ON ADMISSION:  White blood cell count 2.9,
hemoglobin 6.3, hematocrit 18.6, platelets 25, sodium 137,
potassium 3.7, chloride 108, bicarb 21, BUN 26, creatinine
1.2, glucose 91, haptoglobin was 255, LDH was 210, fibrinogen
was 699, FDP was 0 to 10, D-dimer was less then 500.  ALT 80,
alkaline phosphatase 70, AST 71, total bilirubin was 18.7,
directed bilirubin 14.4.  PTT 37.6, INR 1.4.  Albumin 1.6,
calcium 6.9, phosphate 3.6, magnesium 2.0, ammonia 13.
Urinalysis showed large blood and bilirubin.  Past studies on
[**2151-7-20**] LDH was 252 and haptoglobin was 334.  Bone
marrow biopsy was negative.  [**2151-7-12**] echocardiogram
showed no vegetation.  [**2151-7-15**] showed negative
H-pylori.  [**2151-7-12**] esophagogastroduodenoscopy revealed
a Zenker ring.  The patient after receiving 6 units of blood
had a total bili that went from 1.5 to 10 and direct
bilirubin 0.5 to 8.5.

HOSPITAL COURSE:  1.  Hematology:  The patient remained
pancytopenic and anemic despite 2 units of packed red blood
cell transfusion.  An ultrasound that was done here revealed
splenomegaly.  At this time heme/onc was consulted and they
felt that the anemia is most likely due to hemophagocytosis.
The treatment at this time would be a splenectomy.  The
patient is in no condition for surgery at this time.  We will
continue with blood transfusion in the MICU and consider
possibility of splenic embolization.

2.  Pulmonary:  The patient's saturation on 4 liters of
oxygen became worse and dropped off from the 97%.  It was
felt that this was likely secondary to the profound anemia.
Arterial blood gas showed respiratory alkalosis so the
patient was transferred to the MICU where he was intubated.
Chest x-ray during this hospitalization showed no infiltrate,
but revealed some bilateral pleural effusion and pericardial
effusion.

3.  Infectious disease:  Regarding the patient's AIDS, he was
not given any anti-retroviral therapy at this time due to the
fact that he could not take anything po.  No clear infectious
source was found to explain his FUO.  All of the following
tests were negative, Bartonella, toxoplasma, cryptococcus,
hepatitis, and histoplasmosis.  The cytomegalovirus results
were indeterminate.

4.  Cardiovascular:  The patient is hemodynamically stable.
regarding the pericardial effusions found on CT of the chest
and chest x-ray the patient would have been considered for an
echocardiogram and drain if overall conditions merits
aggressive therapy.  However, the patient became too sick to
undergo any of these treatments.

5.  Overall, the patient was treated on the floor with 2
units of packed red blood cells, but his hematocrit still was
hovering around 18 to 20.  Also the patient became quite
short of breath and started experiencing respiratory
alkalosis.  At that time the patient was transferred from my
care to the MICU.  He was intubated there and the family
decided that the patient would be put on comfort measures
only due to the fact that his condition was deteriorating.
He was then transferred back to the floor under Dr. [**First Name4 (NamePattern1) 4468**]
[**Last Name (NamePattern1) **] care where he shortly thereafter expired.






                         DR.[**First Name (STitle) **],[**First Name3 (LF) **] 11-575

Dictated By:[**Last Name (NamePattern1) 3796**]

MEDQUIST36

D:  [**2151-8-13**]  17:22
T:  [**2151-8-20**]  09:02
JOB#:  [**Job Number 21102**]
{"Human immunodeficiency virus [HIV] disease,Kaposi's sarcoma, unspecified site,Acute respiratory failure,Acute and subacute necrosis of liver,Chronic hepatitis C without mention of hepatic coma,Unspecified pleural effusion,Unspecified disorder of kidney and ureter"}


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: 

PRESENT ILLNESS: This is a 44 year-old male with
a history of AIDS (CD4 count of 149 and viral load of 591),
diffuse Kaposi sarcoma diagnosed in [**2142**] and hepatitis C
presents with nausea, vomiting and fever since [**2151-7-1**].
He was hospitalized on [**2151-7-8**] at [**Hospital3 **] Hospital and
his chemotherapy for the Kaposi (last treatment [**2150-7-29**])
was withheld on [**2151-7-9**].  On the weekend prior to
admission the patient developed a distended abdomen.  One day
prior to admission he developed noticeable jaundice.  He also
experienced a distended abdomen, but was able to have a bowel
movement while at [**Hospital **] [**Hospital **] Hospital.  Studies at [**Hospital **]
[**Hospital **] Hospital were an ultrasound, which revealed trace
ascites, hepatomegaly, splenomegaly, spleen of greater then
20 cm, enlarged gallbladder with sludge and wall thickening,
peripancreatic and periportal lymphadenopathy and increased
size in the kidneys.  On [**2151-7-16**] CT of the abdomen
revealed ascites, bilateral pleural effusion, pericardial
effusion, abdominal anasarca and no small bowel obstruction.
[**2151-7-22**] a barium enema showed a normal colon without
obstruction.

MEDICAL HISTORY: HIV/AIDS diagnosed in [**2142**] with
current CD4 of 149 and viral load 591.  Kaposi sarcoma
diagnosed in [**2142**] with extension to the legs, stomach, rectum
and lymph nodes.  Hepatitis C and colonic obstruction and a
questionable PCP diagnosed back in [**2150-10-29**].

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillin, Abacavir, D4T, tetanus toxoid, sulfa
and coal 3.

PHYSICAL EXAM: 

FAMILY HISTORY: Paternal grandfather had leukemia.  Maternal
grandmother had lung cancer and dad had melanoma.

SOCIAL HISTORY: He lives alone and smokes one pack per day.
The patient denies any alcohol use. 

### Response:
{"Human immunodeficiency virus [HIV] disease,Kaposi's sarcoma, unspecified site,Acute respiratory failure,Acute and subacute necrosis of liver,Chronic hepatitis C without mention of hepatic coma,Unspecified pleural effusion,Unspecified disorder of kidney and ureter"}
