CHIEF COMPLAINT: Multidrug ingestion

PRESENT ILLNESS: Pt is a 30 y/o F with unknown PMHx who was admitted following
multidrug ingestion. Per report, patient was found somnolent at
home yesterday evening by her sister and brought to OSH. She is
believed to have ingested propranolol, chlorpromazine,
quetiapine, sertraline, and alcohol in a suicide attempt.
Ingestion is reportedly suspected to have occured at approx
[**2108**]. At the OSH, she was intubated for airway protection. She
also developed hypotension to the 70's systolic and was started
on peripheral levophed. In the [**Hospital1 18**] ED, her blood pressures
were generally in the low 100's. She had a right IJ placed. She
was bolused 5 mg versed and placed on propofol for sedation. Tox
was consulted. Labs were significant for Na 147, HCO3 17. Serum
tox positive for EtOH, urine tox positive for benzos. ABG
7.20/47/156/19. Lactate 0.8. FS 114. VS prior to transfer 103/72
79 20.

MEDICAL HISTORY: Hypothyroidism
ALCOHOL ABUSE, UNSPEC
ASTHMA
? bipolar

MEDICATION ON ADMISSION: Sertraline (ZOLOFT) 100 mg Oral Tablet 2 pills daily
Gabapentin (NEURONTIN) 300 mg Oral Capsule 2 capsules twice
daily
Quetiapine (SEROQUEL) 300 mg Oral Tablet 1 pill at bedtime
Quetiapine (SEROQUEL) 50 mg Oral Tablet 1 pill twice daily
Disulfiram (ANTABUSE) 250 mg Oral Tablet 1 pill daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission exam:
Vitals: BP: 132/65 P: 82 R: 21 O2: 100% (FiO2 40%, PS 10, PEEP
5)
General: Intubated, sedated
HEENT: Sclera anicteric, ETT in place, PERRL
Neck: supple, JVP not elevated
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
Ext: warm, well perfused, 2+ pulses
Neuro: sedated, squeezes both hands on command

FAMILY HISTORY: Father - alcoholism

SOCIAL HISTORY: Smoking: Current Everyday Smoker 1 ppd, 10 pack-years. Smokeless
Tobacco: Never Used. Alcohol: Yes.
Poisoning by cardiac rhythm regulators,Acidosis,Alcohol withdrawal delirium,Poisoning by phenothiazine-based tranquilizers,Suicide and self-inflicted poisoning by other specified drugs and medicinal substances,Home accidents,Unspecified acquired hypothyroidism,Asthma, unspecified type, unspecified,Bipolar disorder, unspecified,Acute alcoholic intoxication in alcoholism, continuous,Opioid abuse, unspecified
Pois-card rhythm regulat,Acidosis,Delirium tremens,Pois-phenothiazine tranq,Poison-drug/medicin NEC,Accident in home,Hypothyroidism NOS,Asthma NOS,Bipolar disorder NOS,Ac alcohol intox-contin,Opioid abuse-unspec
Admission Date:  [**2191-6-9**]              Discharge Date:   [**2191-6-11**]

Date of Birth:  [**2160-10-8**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 2782**]
Chief Complaint:
Multidrug ingestion

Major Surgical or Invasive Procedure:
None

History of Present Illness:
Pt is a 30 y/o F with unknown PMHx who was admitted following
multidrug ingestion. Per report, patient was found somnolent at
home yesterday evening by her sister and brought to OSH. She is
believed to have ingested propranolol, chlorpromazine,
quetiapine, sertraline, and alcohol in a suicide attempt.
Ingestion is reportedly suspected to have occured at approx
[**2108**]. At the OSH, she was intubated for airway protection. She
also developed hypotension to the 70's systolic and was started
on peripheral levophed. In the [**Hospital1 18**] ED, her blood pressures
were generally in the low 100's. She had a right IJ placed. She
was bolused 5 mg versed and placed on propofol for sedation. Tox
was consulted. Labs were significant for Na 147, HCO3 17. Serum
tox positive for EtOH, urine tox positive for benzos. ABG
7.20/47/156/19. Lactate 0.8. FS 114. VS prior to transfer 103/72
79 20.

On arrival to the MICU, the patient was in no acute distress.
ROS was unable to be obtained, as patient is intubated and
sedated.


Past Medical History:
Hypothyroidism
ALCOHOL ABUSE, UNSPEC
ASTHMA
? bipolar

Social History:
Smoking: Current Everyday Smoker 1 ppd, 10 pack-years. Smokeless
Tobacco: Never Used. Alcohol: Yes.

Family History:
Father - alcoholism

Physical Exam:
Admission exam:
Vitals: BP: 132/65 P: 82 R: 21 O2: 100% (FiO2 40%, PS 10, PEEP
5)
General: Intubated, sedated
HEENT: Sclera anicteric, ETT in place, PERRL
Neck: supple, JVP not elevated
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
Ext: warm, well perfused, 2+ pulses
Neuro: sedated, squeezes both hands on command

Discharge exam - unchanged from above, except as below:

Pertinent Results:
Admission labs:
[**2191-6-9**] 04:20AM BLOOD WBC-4.4 RBC-3.51* Hgb-11.9* Hct-36.0
MCV-103* MCH-34.0* MCHC-33.1 RDW-14.4 Plt Ct-161
[**2191-6-9**] 04:20AM BLOOD Neuts-54.7 Lymphs-37.5 Monos-4.8 Eos-2.2
Baso-0.8
[**2191-6-9**] 04:20AM BLOOD PT-13.1* PTT-27.5 INR(PT)-1.2*
[**2191-6-9**] 04:20AM BLOOD Glucose-116* UreaN-7 Creat-0.4 Na-146*
K-4.2 Cl-120* HCO3-17* AnGap-13
[**2191-6-9**] 04:20AM BLOOD ALT-18 AST-36 CK(CPK)-77 AlkPhos-87
TotBili-0.1
[**2191-6-9**] 04:20AM BLOOD Lipase-14
[**2191-6-9**] 04:20AM BLOOD Albumin-3.4*
[**2191-6-9**] 04:20AM BLOOD VitB12-525
[**2191-6-9**] 04:20AM BLOOD Osmolal-331*
[**2191-6-9**] 04:20AM BLOOD ASA-NEG Ethanol-156* Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2191-6-9**] 04:28AM BLOOD Lactate-0.8 K-3.9

Discharge labs:
[**2191-6-10**] 04:26AM BLOOD WBC-6.9# RBC-3.70* Hgb-12.6 Hct-36.2
MCV-98 MCH-33.9* MCHC-34.7 RDW-13.9 Plt Ct-180
[**2191-6-10**] 04:26AM BLOOD PT-11.5 PTT-28.9 INR(PT)-1.1
[**2191-6-10**] 04:26AM BLOOD Glucose-89 UreaN-5* Creat-0.6 Na-142
K-3.5 Cl-104 HCO3-25 AnGap-17
[**2191-6-10**] 04:26AM BLOOD TSH-3.0

Imaging:
-CXR ([**2191-6-9**]): IMPRESSION:
1.  Standard positioning of support tubes and lines.
2.  Low lung volumes, without acute chest abnormality.

Micro:
-RPR ([**2191-6-9**]): Negative

Brief Hospital Course:
HOSPITAL COURSE:
This is a 30 year old lady with unknown PMHx who was admitted
following multidrug ingestion. She was treated with valium for
alcohol withdrawal. Psychiatry was consulted who recommended
admission for dual diagnosis.
.
# Drug Overdose: Pt presented initially with overdose of
multiple drugs, including propranolol, quetiapine, sertraline,
chlorpromazine, and EtOH. Toxicology consulted in the ED and
recommended holding psych medications.  Pt required intubation
for one day, was extubated day prior to discharge.   After
extubation psychiatry team was consulted and patient was placed
under section 12 and 51a for intentional overdose while
intoxicated with high potential for re-attempt and recommended
bed search for dual diagnosis and 1:1 sitter.  Zoloft restarted
on day prior to discharge but seroquel and gabapentin continued
to be held at discharge, can be restarted while in psychiatry
unit as tolerated.  BP was stable off pressors during admission.
 Serial EKGs were done and showed no QRS or QTc prolongation.
.
# EtOH withdrawal: After extubation, patient exhibited symptoms
of alcohol withdrawal including shaking, diaphoresis,
hypertension and tachycardia.  Initially on CIWA scale with
diazepam 10 mg Q2H PRN CIWA >10 which was changed to lorazepam 4
mg PO Q2H PRN CIWA >10 per patient request.  She was [**Doctor Last Name **] >10
on CIWA frequently and CIWA protocol should be continued on
discharge.  MVI, folate and thiamine were started on admission
and should be continued on discharge.
.
# hypothyroidism: per report, however patient not on thyroid
medication with TSH of 3.0, follow up as outpatient
.
Transitional Issues:
# code: Full
# transition to dual diagnosis facility.

Medications on Admission:
Sertraline (ZOLOFT) 100 mg Oral Tablet 2 pills daily
Gabapentin (NEURONTIN) 300 mg Oral Capsule 2 capsules twice
daily
Quetiapine (SEROQUEL) 300 mg Oral Tablet 1 pill at bedtime
Quetiapine (SEROQUEL) 50 mg Oral Tablet 1 pill twice daily
Disulfiram (ANTABUSE) 250 mg Oral Tablet 1 pill daily

Discharge Medications:
1. Acetaminophen [**Telephone/Fax (1) 1999**] mg PO Q6H:PRN pain
2. FoLIC Acid 1 mg PO DAILY
3. Lorazepam 2-4 mg PO Q2H:PRN CIWA > 10
Hold for Sedation, RR<10
4. Multivitamins 1 TAB PO DAILY
5. Nicotine Patch 14 mg TD DAILY
6. Sertraline 200 mg PO DAILY
7. Thiamine 100 mg PO DAILY


Discharge Disposition:
Extended Care

Discharge Diagnosis:
Primary diagnoses:
Alcohol intoxication
Multidrug ingestion

Secondary diagnoses:
Bipolar d/o


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Dear Ms. [**Known lastname **],

You were admitted to the ICU after ingesting multiple drugs and
with alcohol intoxication.  You were briefly intubated but the
breathing tube was successfully removed prior to discharge.  You
will be discharged to a dual diagnosis facility for further
treatment.

The following changes were made to your medications:
STOP Seroquel (quetiapine)
STOP Neurontin (gabapentin)

Followup Instructions:
Follow-up will be arranged by your dual diagnosis facility.
{'Poisoning by cardiac rhythm regulators,Acidosis,Alcohol withdrawal delirium,Poisoning by phenothiazine-based tranquilizers,Suicide and self-inflicted poisoning by other specified drugs and medicinal substances,Home accidents,Unspecified acquired hypothyroidism,Asthma, unspecified type, unspecified,Bipolar disorder, unspecified,Acute alcoholic intoxication in alcoholism, continuous,Opioid abuse, 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: Multidrug ingestion

PRESENT ILLNESS: Pt is a 30 y/o F with unknown PMHx who was admitted following
multidrug ingestion. Per report, patient was found somnolent at
home yesterday evening by her sister and brought to OSH. She is
believed to have ingested propranolol, chlorpromazine,
quetiapine, sertraline, and alcohol in a suicide attempt.
Ingestion is reportedly suspected to have occured at approx
[**2108**]. At the OSH, she was intubated for airway protection. She
also developed hypotension to the 70's systolic and was started
on peripheral levophed. In the [**Hospital1 18**] ED, her blood pressures
were generally in the low 100's. She had a right IJ placed. She
was bolused 5 mg versed and placed on propofol for sedation. Tox
was consulted. Labs were significant for Na 147, HCO3 17. Serum
tox positive for EtOH, urine tox positive for benzos. ABG
7.20/47/156/19. Lactate 0.8. FS 114. VS prior to transfer 103/72
79 20.

MEDICAL HISTORY: Hypothyroidism
ALCOHOL ABUSE, UNSPEC
ASTHMA
? bipolar

MEDICATION ON ADMISSION: Sertraline (ZOLOFT) 100 mg Oral Tablet 2 pills daily
Gabapentin (NEURONTIN) 300 mg Oral Capsule 2 capsules twice
daily
Quetiapine (SEROQUEL) 300 mg Oral Tablet 1 pill at bedtime
Quetiapine (SEROQUEL) 50 mg Oral Tablet 1 pill twice daily
Disulfiram (ANTABUSE) 250 mg Oral Tablet 1 pill daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission exam:
Vitals: BP: 132/65 P: 82 R: 21 O2: 100% (FiO2 40%, PS 10, PEEP
5)
General: Intubated, sedated
HEENT: Sclera anicteric, ETT in place, PERRL
Neck: supple, JVP not elevated
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
Ext: warm, well perfused, 2+ pulses
Neuro: sedated, squeezes both hands on command

FAMILY HISTORY: Father - alcoholism

SOCIAL HISTORY: Smoking: Current Everyday Smoker 1 ppd, 10 pack-years. Smokeless
Tobacco: Never Used. Alcohol: Yes. 

### Response:
{'Poisoning by cardiac rhythm regulators,Acidosis,Alcohol withdrawal delirium,Poisoning by phenothiazine-based tranquilizers,Suicide and self-inflicted poisoning by other specified drugs and medicinal substances,Home accidents,Unspecified acquired hypothyroidism,Asthma, unspecified type, unspecified,Bipolar disorder, unspecified,Acute alcoholic intoxication in alcoholism, continuous,Opioid abuse, unspecified'}
