CHIEF COMPLAINT: Seizure, now intubated

PRESENT ILLNESS: Pt is a 79 yo man with h/o BPH, HTN, left CEA 1 month ago, and
hypothyroidism who presents from OSH after having seizures.

MEDICAL HISTORY: 1. BPH
2. HTN
3. left CEA 2 months ago here without problems
4. hypothyroidism

MEDICATION ON ADMISSION: 1. Levothyroxine 25 mcg daily
2. [**Month/Day (1) **] 75 mg daily
3. Tamsulosin 0.4 mg capsules daily
4. Trimazole 10 mg q.i.d.
5. valsartan 160 mg b.i.d.
6. aspirin 325 mg daily
7. Captopril 25 mg t.i.d.
8. Lopressor 25 mg t.i.d.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals:97.4, 59, 110/54, 12, 100% on RA
Mental Status:Intubated and unresponsive

FAMILY HISTORY: Unknown.

SOCIAL HISTORY: Patient is a former smoker. Has not smoked for 50 years. Drinks
a 6 pack of beer nightly. Lives with spouse.
Other convulsions,Pneumonitis due to inhalation of food or vomitus,Urinary tract infection, site not specified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Unspecified essential hypertension,Unspecified acquired hypothyroidism
Convulsions NEC,Food/vomit pneumonitis,Urin tract infection NOS,BPH w/o urinary obs/LUTS,Hypertension NOS,Hypothyroidism NOS
Admission Date:  [**2201-8-9**]              Discharge Date:   [**2201-8-15**]

Date of Birth:  [**2122-1-6**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5831**]
Chief Complaint:
Seizure, now intubated

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Pt is a 79 yo man with h/o BPH, HTN, left CEA 1 month ago, and
hypothyroidism who presents from OSH after having seizures.

He had a prostate procedure(cryotherapy) for BPH 2 weeks ago.
He then last night had hematuria, then passed blood clots and
had difficulty urinating this am, so he went to [**Location (un) **].  There,
they gave Cipro, placed foley, and were going to send home.  He
then started speaking in Polish(was speaking in English
initially) and then had a 90 sec GTC seizure.  He got Ativan 1
mg, was awake, but combative for 30 minutes. Head CT neg by
report.  Then, had another 30 sec seizure.  He was confused
afterwards and less responsive. Got another 1 mg Ativan, and
then was intubated and sedated.  Had another ? seizure en route
and got additional 2 mg ativan and 100 fentanyl.  Also had
received 4 additional ativan, 800 acyclovir, ctx 2 g, andcipro
500 mg at the OSH.  No one has been able to reach family for
further history.

Here, he remains intubated and unresponsive, but did try to pull
at his tube twice.  He has been afebrile.  CXR was neg.

ROS: Patient unable.

Past Medical History:
1. BPH
2. HTN
3. left CEA 2 months ago here without problems
4. hypothyroidism


Social History:
Patient is a former smoker. Has not smoked for 50 years. Drinks
a 6 pack of beer nightly. Lives with spouse.

Family History:
Unknown.

Physical Exam:
Vitals:97.4, 59, 110/54, 12, 100% on RA
Mental Status:Intubated and unresponsive

CN:
Pupils:Pinpoint, but reps.
Nasal Tickle:Grimace bilat
Gag/Cough:+ gag
Corneal Reflex:Present bilaterally
OCRs:Resists head turning. No BTT or movement of eyes.

Motor:Moves LUE and RUE spont, L>R. No LE movement spont.  Tone
inc in LEs, L>R.  Tone in UEs normal.  Left hand clenched
slightly.  No mov't of LEs to nox, some mov't UEs to nox.

Toes:Mute bilaterally

DTRs:  [**Name2 (NI) **] Tri Br Pa [**Doctor First Name **]
     R 3  3  3  3   0
     L 3  3  3  3   0

Respiration:Pt is overbreathing ventilator.


Pertinent Results:
Lactate 2.4

141  107  15  154
-------------<
3.9  25  1.0
CK: 50  MB: Notdone  Trop-*T*: <0.01

Ca: 7.9 Mg: 1.9 P: 3.0
ALT: 9 AP: 67 Tbili: 0.3
AST: 17
[**Doctor First Name **]: 42 Lip: 23

Serum [**Doctor First Name **], EtOH, Acetmnphn, Benzo, Barb, Tricyc Negative
Comments: 80 (These Units) = 0.08 (% By Weight)

Phenytoin: 9.5

13.3\11.3/210
    /32.4\
 N:90 Band:4 L:2 M:4 E:0 Bas:0
Hypochr: 1+ Anisocy: 1+ Poiklo: OCCASIONAL Macrocy: 1+ Ovalocy:
OCCASIONAL Fragmen: OCCASIONAL

PT: 12.9  PTT: 21.8  INR: 1.1

UA 3-5 WBCs

Head CT:Normal


Brief Hospital Course:
This is 79 man with history of benign prostatic hypertrophy,
hypertension, left carotid endarterectomy 2 months ago and
hypothyroidism who presents from OSH after having 2 seizures. He
was loaded with dilantin, intubated and sedated prior to
transfer. On inital exam, his cranial nerves were intact and he
had some increased lower extremity tone. He was purposeful with
his upper extremities trying to pull out his tube. Possibly
etiologies included stroke, CNS infection (possible seeding from
urine/prostate given recent procedure), alcohol withdrawal or
hemorrhage. Patient received empiric antibiotic treatment
(ceftriaxone, acyclovir, vancomycin). Head CT was negative for
intracranial hemorrhage or mass. MRI of head was negative for
acute stroke/abscess but showed chronic microvascular ischemic
changes and mild intracranial atherosclerosis but patent
vessels. Patient drinks a 6 pack of beer daily but unclear
whether he acutely stopped drinking. Patient was admitted to the
Neuro ICU with tele. A lumbar puncture was negative for
infection. EEG showed a single left posterior temporal
epileptiform discharge. Urology was consulted and recommended
treating urinary tract infection with levofloxacin x3 days.
Continued [**Last Name (LF) 4532**], [**First Name3 (LF) **] 325 and ace-i, but intially held BB and
valsartan given low BP currently. TSH was within normal limits
and continued levoxyl. Patient was started on multivitamin,
folate, thiamine and CIWA protocol with ativan PRN given alcohol
history. Patient was extubaeted [**8-11**] without complication.
Patient was transferred to floor for further care.
Patient did not show withdrawal signs

Medications on Admission:
1. Levothyroxine 25 mcg daily
2. [**Month/Day (1) **] 75 mg daily
3. Tamsulosin 0.4 mg capsules daily
4. Trimazole 10 mg q.i.d.
5. valsartan 160 mg b.i.d.
6. aspirin 325 mg daily
7. Captopril 25 mg t.i.d.
8. Lopressor 25 mg t.i.d.


Discharge Medications:
1. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Levothyroxine 25 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Captopril 25 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day).
Disp:*90 Tablet(s)* Refills:*2*
5. Lansoprazole 30 mg Capsule, Delayed Release(E.C.) Sig: One
(1) Capsule, Delayed Release(E.C.) PO DAILY (Daily).
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
6. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. Multivitamin     Capsule Sig: One (1) Cap PO DAILY (Daily).
Disp:*30 Cap(s)* Refills:*2*
9. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 5 days.
Disp:*15 Tablet(s)* Refills:*0*
10. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours) for 5 days.
Disp:*5 Tablet(s)* Refills:*0*
11. Keppra 500 mg Tablet Sig: One (1) Tablet PO twice a day:
Increase dose of Keppra to 1000mg [**Hospital1 **] as intructed (by 500mg
every 3 days-see schedule).
Disp:*120 Tablet(s)* Refills:*3*
12. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1)
Capsule PO three times a day for 10 days: Please taper and
discontinue dilantin once Keppra is therapeutic
(see dosing schedule below).
Disp:*30 Capsule(s)* Refills:*0*
13. Medication schedule
KEPPRA
[**Date range (1) 67855**]: Take 500mg twice daily
[**Date range (1) 19502**]: Take 500mg in the morning and 1000mg at night
[**8-22**] and beyond: Take 1000mg in the morning and 1000mg at night

PHENYTOIN
[**Date range (1) 45316**]: Take 100mg twice daily
[**Date range (1) **]: Take 100mg once daily
Then stop


Discharge Disposition:
Extended Care

Facility:
[**Hospital 16844**] Hospital - [**Location (un) 1157**]

Discharge Diagnosis:
Seizure
Urinary Tract Infection
Pneumonia


Discharge Condition:
stable/improved.  No further seizures.


Discharge Instructions:
1. Please take your medications as listed below.
You will increase the dose of the Keppra as follows:
[**Date range (1) 67855**]: Take 500mg twice daily, then
[**Date range (1) 19502**]: Take 500mg in the morning and 1000mg at night, then
[**8-22**] and beyond: Take 1000mg in the morning and 1000mg at night
and continue at this dose.

Decrease the dose of phenytoin as follows:
[**Date range (1) 45316**]: Take 100mg twice daily, then
[**Date range (1) **]: Take 100mg once daily, then stop
-You should complete the antibiotics for pneumonia as listed
below (for a total of 10 days).
2. By law, you may not drive until you have been seizure free
for at least 6 months. You should not engage in other activities
(such as climbing ladders, swimming alone, etc) which would be
dangerous if you were to have a seizure
3. Please call [**Telephone/Fax (1) 541**] to make an appointment in neurology
clinic to see Drs. [**Name5 (PTitle) 7994**]/[**Doctor Last Name **].
4. Please call Dr. [**Last Name (STitle) 7994**] ([**Telephone/Fax (1) 8717**]) or come to the
emergency room if you have another seizure, feel confused, or
have any other concerning symptoms.

Followup Instructions:
Please call [**Telephone/Fax (1) 541**] to make an appointment in neurology
clinic to see Drs. [**Name5 (PTitle) 7994**]/[**Doctor Last Name **]

Please follow up with your outpatient urologist next week
{'Other convulsions,Pneumonitis due to inhalation of food or vomitus,Urinary tract infection, site not specified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Unspecified essential hypertension,Unspecified acquired hypothyroidism'}


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: Seizure, now intubated

PRESENT ILLNESS: Pt is a 79 yo man with h/o BPH, HTN, left CEA 1 month ago, and
hypothyroidism who presents from OSH after having seizures.

MEDICAL HISTORY: 1. BPH
2. HTN
3. left CEA 2 months ago here without problems
4. hypothyroidism

MEDICATION ON ADMISSION: 1. Levothyroxine 25 mcg daily
2. [**Month/Day (1) **] 75 mg daily
3. Tamsulosin 0.4 mg capsules daily
4. Trimazole 10 mg q.i.d.
5. valsartan 160 mg b.i.d.
6. aspirin 325 mg daily
7. Captopril 25 mg t.i.d.
8. Lopressor 25 mg t.i.d.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals:97.4, 59, 110/54, 12, 100% on RA
Mental Status:Intubated and unresponsive

FAMILY HISTORY: Unknown.

SOCIAL HISTORY: Patient is a former smoker. Has not smoked for 50 years. Drinks
a 6 pack of beer nightly. Lives with spouse. 

### Response:
{'Other convulsions,Pneumonitis due to inhalation of food or vomitus,Urinary tract infection, site not specified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Unspecified essential hypertension,Unspecified acquired hypothyroidism'}
