CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 45 year old
male with a long history of alcohol dependence, remote
history of opiate addiction treated with Methadone until four
months ago and possible depression, who was released from his
section 35/jail confinement one week prior to admission.  The
patient reports living in a hotel and picking up drinking
immediately, drinking daily a quart of scotch. The patient
ran out of money and contact[**Name (NI) **] his sister who drove him to
the primary care physician's office after finding him
intoxicated with several empty bottles of alcohol.  The
primary care physician directed the patient to the Emergency
Department for evaluation.  In the Emergency Department, the
patient had an alcohol level of 338 and a ketoacidosis.  He
was treated with fluid replacement, potassium supplement and
Valium per CIWA scale.  The patient denies a depressed mood
and says that one week ago in jail he was sleeping poorly
requiring Trazodone.  He otherwise denies symptoms of poor
appetite, interest, energy.  He does report that while
drinking he does not eat or sleep well and has poor energy.
He denies suicidal ideation, but per report of mother and
sister, the patient has made comments that he will "drink
himself to death".  The patient cannot remember saying this.
He denies hallucinations, mania, delusions or use of other
substances.  The patient denies chest pain, cough, shortness
of breath, abdominal pain, no urinary symptoms, positive
diarrhea times one week with no melena, no bright red blood
per rectum, no change in skin color.

MEDICAL HISTORY: Hepatitis C diagnosed three to four
years ago.

MEDICATION ON ADMISSION: None.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: He believes mother may be depressed and has
mood swings but does not believe that she is in treatment.
He denies any diseases in the family although per report of
family, mother had breast cancer and had a heart attack in
[**Month (only) 116**] witnessed by the patient.  His sister has brain cancer.

SOCIAL HISTORY: The patient was raised in [**Location (un) **],
graduated high school, and started his own body shop business
which he lost because of drinking.  The patient has never
been married and has no children.  Currently, he is homeless
and jobless.
Acute alcoholic intoxication in alcoholism, unspecified,Acidosis,Acute hepatitis C without mention of hepatic coma,Unspecified drug dependence, unspecified,Alcohol withdrawal,Bipolar I disorder, most recent episode (or current) unspecified
Ac alcohol intox-unspec,Acidosis,Hpt C acute wo hpat coma,Drug depend NOS-unspec,Alcohol withdrawal,Bipolor I current NOS
Admission Date:  [**2174-10-13**]       Discharge Date:  [**2174-10-15**]

Date of Birth:   [**2129-8-28**]       Sex:  M

Service:  [**Doctor Last Name 1181**]/MEDICINE

HISTORY OF PRESENT ILLNESS:  The patient is a 45 year old
male with a long history of alcohol dependence, remote
history of opiate addiction treated with Methadone until four
months ago and possible depression, who was released from his
section 35/jail confinement one week prior to admission.  The
patient reports living in a hotel and picking up drinking
immediately, drinking daily a quart of scotch. The patient
ran out of money and contact[**Name (NI) **] his sister who drove him to
the primary care physician's office after finding him
intoxicated with several empty bottles of alcohol.  The
primary care physician directed the patient to the Emergency
Department for evaluation.  In the Emergency Department, the
patient had an alcohol level of 338 and a ketoacidosis.  He
was treated with fluid replacement, potassium supplement and
Valium per CIWA scale.  The patient denies a depressed mood
and says that one week ago in jail he was sleeping poorly
requiring Trazodone.  He otherwise denies symptoms of poor
appetite, interest, energy.  He does report that while
drinking he does not eat or sleep well and has poor energy.
He denies suicidal ideation, but per report of mother and
sister, the patient has made comments that he will "drink
himself to death".  The patient cannot remember saying this.
He denies hallucinations, mania, delusions or use of other
substances.  The patient denies chest pain, cough, shortness
of breath, abdominal pain, no urinary symptoms, positive
diarrhea times one week with no melena, no bright red blood
per rectum, no change in skin color.

PAST MEDICAL HISTORY:  Hepatitis C diagnosed three to four
years ago.

PAST PSYCHIATRIC HISTORY:
1.  Four inpatient detoxifications at the [**Hospital1 **], [**Hospital1 882**],
and [**Location (un) 22870**], most recently this spring.
2.  Section 35 times two, most recently this summer to
[**Location (un) 1475**] times three days.
3.  Threatened his mother this spring and she took out a
restraining order against him.
4.  Reports being dependent on alcohol "most of my adult
life" without any length of sobriety except when sectioned 35
or in prison.  Admits to blackouts and tremors but no
seizures.
5.  Has abused intravenous Heroin and Percocet in the past.
Reports fifteen years of Methadone maintenance, but did not
receive Methadone for the past four months in jail.  Did not
want to go back on Methadone.  Briefly involved with
Alcoholics Anonymous.
6.  He has been diagnosed with bipolar disorder which the
patient says was in the context of drinking.  He denies
suicide attempts, psychiatric medications except Trazodone
for sleep.
7.  He denies Cocaine addiction, marijuana use, current
opiate abuse.

MEDICATIONS ON ADMISSION:  None.

ALLERGIES:  No known drug allergies.

FAMILY HISTORY:  He believes mother may be depressed and has
mood swings but does not believe that she is in treatment.
He denies any diseases in the family although per report of
family, mother had breast cancer and had a heart attack in
[**Month (only) 116**] witnessed by the patient.  His sister has brain cancer.

SOCIAL HISTORY:  The patient was raised in [**Location (un) **],
graduated high school, and started his own body shop business
which he lost because of drinking.  The patient has never
been married and has no children.  Currently, he is homeless
and jobless.

PHYSICAL EXAMINATION:  His temperature is 97.8, heart rate
140, blood pressure 138/93, respiratory rate 20.  In general,
the patient is mildly agitated, alert and oriented times
three, middle age, well appearing male.  Head and neck
examination - normocephalic and atraumatic.  Mucous membranes
are moist.  Extraocular movements are intact.  Sclera and
conjunctiva nonicteric.  Cardiovascular - regular rate and
rhythm, normal S1 and S2, no murmurs, rubs or gallops.
Respiratory - a few scattered rhonchi, otherwise clear to
auscultation.  The abdomen is soft, nontender, nondistended.
Bowel sounds are positive, no masses.  Skin nonicteric, no
rashes.  Extremities - no lower extremity edema, no stigmata
of chronic liver disease.

LABORATORY DATA:  On presentation, white blood cell count was
13.6, hematocrit 49.3, platelets 349,000.  Urinalysis showed
30 mg/deciliter of protein, greater than 80 ketones, [**1-25**] red
blood cells, 0-2 white blood cells.  Sodium 138, potassium
4.0, chloride 94, bicarbonate 19, blood urea nitrogen 22,
creatinine 1.0, glucose 159, anion gap 29.  Toxicology screen
is positive for alcohol 338 and otherwise negative.

HOSPITAL COURSE:  The patient was admitted to the Medicine
service with a diagnosis of alcoholic intoxication and
ketoacidosis.  The patient was given intravenous fluid
hydration as well as thiamine and folate.  His anion gap
slowly closed.  The patient had his electrolytes repleted,
most notably magnesium which was suppressed at 1.4.  His
liver function tests were drawn which showed a mild
transaminitis with an ALT of 183, AST 214, LDH 266, alkaline
phosphatase 111, amylase 37, lipase 56, albumin 3.6, total
bilirubin 1.8.  The patient was continued on Valium per CIWA
scale of 10 mg for CIWA greater than ten.  At first, this was
adequate for the patient's symptoms, however, he was
requiring p.r.n. Valium doses q.hour for CIWA greater than
ten, namely, for agitation and headache.  The patient was
evaluated by psychiatry who recommended to continue with the
current withdrawal monitoring and treatment.  B12, folate,
RPR and TSH were requested which were pending at the time of
discharge.  It was felt that there was not a clear
psychiatric diagnosis other than alcohol withdrawal based on
his history and examination.  They did not feel that the
patient was currently showing features clearly suggestive of
depression or suicidal ideation.  However, a more meaningful
rule out for mood disorder should be done in the setting of
sustained sobriety.  The family was currently pursuing a
section 35 commitment for alcoholic treatment, but the
patient was amenable to going to detoxification.  Prior to
his discharge, given that the patient was requiring frequent
doses of Valium, he was given additional p.r.n. dose of
Ativan 1 mg intravenously as well as started on Haldol p.r.n.
for agitation.

DISCHARGE DIAGNOSIS:   Alcohol intoxication and withdrawal.

CONDITION ON DISCHARGE:  Stable.

MEDICATIONS ON DISCHARGE:
1.  Diazepam 10 mg p.o. q1-2hours p.r.n. CIWA scale greater
than ten; for agitation, hallucinations, fever greater than
101, heart rate greater than 120, systolic blood pressure
greater than 180.
2.  Diazepam 10 mg p.o. four times a day standing.
3.  Tylenol 325 mg to 650 mg p.o. q4-6hours p.r.n.
4.  Haldol 2 mg p.o. q4hours p.r.n. agitation.




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 10491**], M.D.  [**MD Number(1) 1019**]

Dictated By:[**Last Name (NamePattern1) 9296**]
MEDQUIST36

D:  [**2174-10-15**]  09:45
T:  [**2174-10-15**]  10:27
JOB#:  [**Job Number 99334**]


Name:  [**Known lastname 15903**], [**Known firstname 126**]                   Unit No:  [**Numeric Identifier 15904**]

[**Numeric Identifier 15905**] Date:  [**2174-10-15**]       Discharge Date:  [**2174-10-17**]

Date of Birth:   [**2129-8-28**]       Sex:  M
Service:  MICU
use.

HISTORY OF PRESENT ILLNESS:  Patient is a 45-year-old male
with a history of heroin, alcohol abuse and hepatitis C who
The patient reported to have used three bags of IV heroin and
Scotch (please see previously dictated discharge summary for
hospitalization).

Patient had been admitted to [**First Name (Titles) **]
[**Last Name (Titles) **] on [**10-13**], his alcohol level was 338 and he had
ketoacidosis.  He was treated with fluids, potassium and
however this did not take effective until Monday.  The
patient left against medical advice on Saturday morning to
return several hours later.

Of note, per witnesses the patient is yelling at individuals
who are not there and not cognizant of his surrounding.  He
is argumentative, agitated and combative.

In the emergency room his vitals were a temperature of 98.6
F, heart rate of 123, blood pressure 154/92, respiratory rate
of 16, O2 saturations of 96%.  Due to agitation, the patient
had to be placed in four point restraints and
an IV line and a uurinary catheter placed.  He was admitted to
the MICU
given risk of DT development and initially placed on an
Ativan drip.  He was then switched to Valium.  On exam
patient does not report chest pain, shortness of breath,
abdominal pain or headache.

PAST MEDICAL HISTORY:
1.  Hepatitis C.
2.  History of IV heroin use.
3.  History of Methadone use until approximately four months
ago when he was placed in prison.
4.  History of depression / bipolar (patient reports these
diagnosis were all under intoxication).
5.  Last HIV test was noted to be negative in [**2170**].

ALLERGIES:  None.

MEDICATIONS:  None.

SOCIAL HISTORY:  Patient raised in [**Location (un) 382**], graduated from
highschool.  Worked as a mechanic.  Currently jobless and
homeless.  Not married with no children.  Patient has a
sister who is involved in his care.  Mother has a restraining
order.

FAMILY HISTORY:  Father died of cardiac arrhythmia years
ago.  Mother has a possible history of depression.

PHYSICAL EXAMINATION:  Vitals 98.6 F, heart rate 123, blood
pressure 154/92, respiratory rate 16, O2 saturation 96%.
Neuro:  Patient is alert to name and place.  No evidence of
seizures.  Cranial nerves II through XII intact.  General:
Patient is slightly diaphoretic, no evidence of
tremulousness.  Head, eyes, ears, nose and throat:
Nasopharynx clear and moist, no evidence of head trauma.
Cardiovascular exam:  Tachycardic, no murmurs, rubs, or
gallops.  Lungs are clear to auscultation.  Abdomen:
Positive bowel sounds, nontender, nondistended.  Extremities:
No edema or cyanosis.  Pulses intact.  Patient is restrained.

LABORATORY:  From [**10-13**] ethanol of 338, [**10-15**] ethanol level
of 122.  Tox screen is notable for positive benzodiazepine,
positive opiates.

Labs on [**10-15**] with a white blood cell count of 9.3,
hematocrit 45.5, platelets 169.  Electrolytes panel:  Sodium
140, potassium 3.1, chloride 99, CO2 21, BUN 10, creatinine
0.7, glucose 136.  Urinalysis was negative.  Calcium 9.5,
phosphorus 2, magnesium 1.7.  ALT 183, AST 214, alkaline
phosphatase 117.

EKG showed tachycardia at 122, no acute ST changes.

HOSPITAL COURSE:
1.  ETHANOL WITHDRAW:  Patient was admitted to the MICU and
initially started on Ativan drip, however this was
transferred to q. one hour Valium with Haldol for agitation.
Patient responded well. Given history of alcohol abuse we
provided fluids, potassium, replaced folate, MVI thiamin,
magnesium and phosphate.

2.  PSYCHIATRY:  Patient was evaluated by Psychiatry
in-house.  Patient was felt not to be competent to leave
against medical advice.  Patient's plan will to be sectioned
on Monday.  Question of Axis I disorder was raised, but in
the acute setting of intoxication, difficult to diagnosis.

3.  HEPATITIS C:  Patient with a history of hepatitis C and
elevated LFTs considered of IV.  Of note, LFTs are in line
with prior baseline levels of ALT 128 and AST of 115 to 117
from [**2170**].  Consideration of Interferon and antiviral
therapy as an outpatient.

4.  DRUG ABUSE:  Patient should be discharged to a
rehabilitation facility for treatment of his drug use.
Patient has case management closely working with this for
discharge to [**Location (un) **].

5.  COMMUNICATION:  Patient's history discussed with PCP and
discussed with family.  Code status:  Full.
Patient had a peripheral line placed.

6.  PROPHYLAXIS:  Patient placed on heparin subcu and
Protonix.

DISPOSITION:  Patient will be discharged to rehabilitation
facility once medically stable.

DISCHARGE DIAGNOSES:
1.  Ethanol intoxication / withdrawal.Delerium Tremens
2.  Heroin abuse.
3.  Hepatitis C.

CONDITION ON DISCHARGE:  Fair.

DISCHARGE STATUS:  Discharged to rehabilitation facility.
Attending [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 593**] [**Name8 (MD) 304**], M.D.

DISCHARGE MEDICATIONS:
1.  P.r.n. Haldol 1 to 2 mcg q. one hour for agitation.
2.  Valium 10 mg q. one hour p.r.n. CIWA greater than 10.




                            [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 88**]

Dictated By:[**Last Name (NamePattern1) 3021**]
MEDQUIST36

D:  [**2174-10-17**]  02:19
T:  [**2174-10-17**]  12:51
JOB#:  [**Job Number 15906**]











Name:  [**Known lastname 15903**], [**Known firstname 126**]                   Unit No:  [**Numeric Identifier 15904**]

[**Numeric Identifier 15905**] Date:  [**2174-10-13**]     Discharge Date:  [**2174-10-19**]

Date of Birth:   [**2129-8-28**]     Sex:  M

Service:
Upon transfer from the Intensive Care Unit, to the Medical
Floor, patient was started on Haldol 0.5-1 mg po q1h prn
agitation and Benadryl 25-50 mg po q6h prn
anxiety.  There were no events overnight prior to
the patient leaving for court and detox center.
DISCHARGE DIAGNOSES:
1. Alcohol intoxication.
2. Heroin use.

DISCHARGE MEDICATIONS:
1. Haldol 0.5-1 mg po q1h prn agitation.
2. Benadryl 25-50 mg po q6h prn agitation.
4. Thiamine 100 mg po q day.

DISCHARGE CONDITION:  Stable.

DISCHARGE STATUS:  To detox center.



                        DR.[**Last Name (STitle) **],[**Doctor Last Name **] 12-626


Dictated By:[**Last Name (NamePattern1) 4387**]

MEDQUIST36

D:  [**2174-10-21**]  12:54
T:  [**2174-10-25**]  04:13
JOB#:  [**Job Number 15907**]
{'Acute alcoholic intoxication in alcoholism, unspecified,Acidosis,Acute hepatitis C without mention of hepatic coma,Unspecified drug dependence, unspecified,Alcohol withdrawal,Bipolar I disorder, most recent episode (or current) 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: 

PRESENT ILLNESS: The patient is a 45 year old
male with a long history of alcohol dependence, remote
history of opiate addiction treated with Methadone until four
months ago and possible depression, who was released from his
section 35/jail confinement one week prior to admission.  The
patient reports living in a hotel and picking up drinking
immediately, drinking daily a quart of scotch. The patient
ran out of money and contact[**Name (NI) **] his sister who drove him to
the primary care physician's office after finding him
intoxicated with several empty bottles of alcohol.  The
primary care physician directed the patient to the Emergency
Department for evaluation.  In the Emergency Department, the
patient had an alcohol level of 338 and a ketoacidosis.  He
was treated with fluid replacement, potassium supplement and
Valium per CIWA scale.  The patient denies a depressed mood
and says that one week ago in jail he was sleeping poorly
requiring Trazodone.  He otherwise denies symptoms of poor
appetite, interest, energy.  He does report that while
drinking he does not eat or sleep well and has poor energy.
He denies suicidal ideation, but per report of mother and
sister, the patient has made comments that he will "drink
himself to death".  The patient cannot remember saying this.
He denies hallucinations, mania, delusions or use of other
substances.  The patient denies chest pain, cough, shortness
of breath, abdominal pain, no urinary symptoms, positive
diarrhea times one week with no melena, no bright red blood
per rectum, no change in skin color.

MEDICAL HISTORY: Hepatitis C diagnosed three to four
years ago.

MEDICATION ON ADMISSION: None.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: He believes mother may be depressed and has
mood swings but does not believe that she is in treatment.
He denies any diseases in the family although per report of
family, mother had breast cancer and had a heart attack in
[**Month (only) 116**] witnessed by the patient.  His sister has brain cancer.

SOCIAL HISTORY: The patient was raised in [**Location (un) **],
graduated high school, and started his own body shop business
which he lost because of drinking.  The patient has never
been married and has no children.  Currently, he is homeless
and jobless. 

### Response:
{'Acute alcoholic intoxication in alcoholism, unspecified,Acidosis,Acute hepatitis C without mention of hepatic coma,Unspecified drug dependence, unspecified,Alcohol withdrawal,Bipolar I disorder, most recent episode (or current) unspecified'}
