CHIEF COMPLAINT: Overdose

PRESENT ILLNESS: Patient is a 22 year old HIV positive man with history of
polysubstance abuse and bipolar d/o who presents from home,
brought in by EMS. Police were called to apartment and found
patient in residence surrounded by drug papaphranalia. Patient
reportedly stated that he took a bottle of seroquel as well as
cocaine. On arrival to the ED he was somnolent but arousable to
stimuli. Initial VS were HR 170s, SBP 160s, 100% RA. He was
intubated for airway protection and charcoal administration via
NGT. He was given a total of ativan 2mg x3, 2L IVF and placed on
propofol gtt. Toxicology was consulted for + tox screen for
TCAs, they felt this was likely related to seroquel and did not
recommend bicarb.
.
Of note the patient was recently discharged from jail for
indecent assault and battery. He also has been hospitalized ~90
times related to his substance abuse and/or suicidality. Most
recent hospitalization [**2174-2-3**] at [**Hospital1 2025**] after he was retrieved from
[**Hospital1 62342**]by police. Reportedly was unclothed at CVS after
cocaine use, when he became paranoid and jumped in the [**Hospital1 **].

MEDICAL HISTORY: 1. HIV, dx [**2173-3-12**], not on HAART, last CD4 in 500s per OMR note

MEDICATION ON ADMISSION: Outpatient meds:
Seroquel 100 mg daily
Vistaril prn
Celexa 40 mg daily
Trazadone 50 mg qhs
.
MEDS on transfer from MICU:
1. Heparin SC
2. Ativan prn anxiety

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 97.5 BP 125/73 HR 96 RR 20 O2 sat 97%
General: Intubated, sedated
HEENT: PERRL, ETT, NGT in place
Neck: supple, no JVD
Heart: RRR, nl S1/S2, no m/r/g
Chest: CTA anteriorly
Abdomen: soft, NT, ND, +BS
Ext: no edema, 2+ pedal pulses
Skin: shaved, no lesions or rashes, no track marks
Neuro: Sedated, not responsive to voice or sternal rub, moving
upper ext. spontaneously

FAMILY HISTORY: Father: drug/alcohol abuse; grandmother (maternal) alcoholism.

SOCIAL HISTORY: Per prior ED psych note [**6-6**] and [**Hospital1 2025**] note [**2174-2-3**]: Pt is
currently unemployed, lives alone in section 8 housing in
apartment on [**Location (un) 3307**] ave. Pt admits to engaging in homosexual
prostitution to obtain drugs, and that he has had unprotected
sex. He had been incarcerated for indecent assault and battery.
Family consists of Mother who lives in [**Name (NI) 2251**] with her
"controlling boyfriend...she doesn't talk to me much." Father
lives in [**Location **]. He has a brother, [**Name (NI) **], one year older, whom
he feels closest to. Pt last employed from [**8-6**] to [**2-4**] as a
security guard with Securitas. Pt also attended [**Location (un) 6188**]
Community College in the [**2174**]7 semester.
Poisoning by other antipsychotics, neuroleptics, and major tranquilizers,Acidosis,Other specified cardiac dysrhythmias,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Asymptomatic human immunodeficiency virus [HIV] infection status,Diarrhea,Bipolar disorder, unspecified,Cocaine dependence, unspecified,Iron deficiency anemia, unspecified
Poison-antipsychotic NEC,Acidosis,Cardiac dysrhythmias NEC,Poison-psychotropic agt,Asymp hiv infectn status,Diarrhea,Bipolar disorder NOS,Cocaine depend-unspec,Iron defic anemia NOS
Admission Date:  [**2174-3-4**]              Discharge Date:   [**2174-3-7**]

Date of Birth:  [**2151-3-26**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 30**]
Chief Complaint:
Overdose

Major Surgical or Invasive Procedure:
Endotracheal intubation with subsequent extubation


History of Present Illness:
Patient is a 22 year old HIV positive man with history of
polysubstance abuse and bipolar d/o who presents from home,
brought in by EMS. Police were called to apartment and found
patient in residence surrounded by drug papaphranalia. Patient
reportedly stated that he took a bottle of seroquel as well as
cocaine. On arrival to the ED he was somnolent but arousable to
stimuli. Initial VS were HR 170s, SBP 160s, 100% RA. He was
intubated for airway protection and charcoal administration via
NGT. He was given a total of ativan 2mg x3, 2L IVF and placed on
propofol gtt. Toxicology was consulted for + tox screen for
TCAs, they felt this was likely related to seroquel and did not
recommend bicarb.
.
Of note the patient was recently discharged from jail for
indecent assault and battery. He also has been hospitalized ~90
times related to his substance abuse and/or suicidality. Most
recent hospitalization [**2174-2-3**] at [**Hospital1 2025**] after he was retrieved from
[**Hospital1 62342**]by police. Reportedly was unclothed at CVS after
cocaine use, when he became paranoid and jumped in the [**Hospital1 **].


Past Medical History:
1. HIV, dx [**2173-3-12**], not on HAART, last CD4 in 500s per OMR note

2. h/o MRSA skin infection, recently completed course of clinda

3. h/o polysubstance abuse including meth, injected cocaine,
alcohol, GBH, heroin via IV once
4. h/o bipolar d/o s/p SA in ?[**2171**] w/ingestion of Motrin
5. h/o homosexual prostitution to obtain drugs
6. Herpes


Social History:
Per prior ED psych note [**6-6**] and [**Hospital1 2025**] note [**2174-2-3**]: Pt is
currently unemployed, lives alone in section 8 housing in
apartment on [**Location (un) 3307**] ave. Pt admits to engaging in homosexual
prostitution to obtain drugs, and that he has had unprotected
sex. He had been incarcerated for indecent assault and battery.
Family consists of Mother who lives in [**Name (NI) 2251**] with her
"controlling boyfriend...she doesn't talk to me much." Father
lives in [**Location **]. He has a brother, [**Name (NI) **], one year older, whom
he feels closest to. Pt last employed from [**8-6**] to [**2-4**] as a
security guard with Securitas. Pt also attended [**Location (un) 6188**]
Community College in the [**2174**]7 semester.

Family History:
Father: drug/alcohol abuse; grandmother (maternal) alcoholism.

Physical Exam:
VS: T 97.5 BP 125/73 HR 96 RR 20 O2 sat 97%
General: Intubated, sedated
HEENT: PERRL, ETT, NGT in place
Neck: supple, no JVD
Heart: RRR, nl S1/S2, no m/r/g
Chest: CTA anteriorly
Abdomen: soft, NT, ND, +BS
Ext: no edema, 2+ pedal pulses
Skin: shaved, no lesions or rashes, no track marks
Neuro: Sedated, not responsive to voice or sternal rub, moving
upper ext. spontaneously


Pertinent Results:
[**2174-3-4**] WBC-5.5 RBC-4.87 Hgb-14.2 Hct-40.0 MCV-82 MCH-29.2
MCHC-35.6* RDW-14.4 Plt Ct-219
[**2174-3-7**] WBC-6.7 RBC-4.73 Hgb-13.6* Hct-38.4* MCV-81* MCH-28.7
MCHC-35.4* RDW-13.7 Plt Ct-299

[**2174-3-4**] PT-13.9* INR(PT)-1.2*

[**2174-3-4**] Glucose-117* UreaN-18 Creat-1.1 Na-140 K-5.4* Cl-104
HCO3-20* AnGap-21*
[**2174-3-4**] Glucose-100 UreaN-15 Creat-0.8 Na-143 K-4.3 Cl-111*
HCO3-23 AnGap-13
[**2174-3-5**] Glucose-93 UreaN-15 Creat-0.8 Na-142 K-3.9 Cl-109*
HCO3-25 AnGap-12
[**2174-3-6**] Glucose-107* UreaN-10 Creat-0.8 Na-143 K-4.0 Cl-110*
HCO3-22 AnGap-15
[**2174-3-7**] Glucose-105 UreaN-7 Creat-0.8 Na-137 K-4.1 Cl-103
HCO3-22 AnGap-16

[**2174-3-4**] ALT-63* CK(CPK)-206* AlkPhos-97 TotBili-0.5
[**2174-3-5**] ALT-50* AST-30 LD(LDH)-150 AlkPhos-86 TotBili-0.4
[**2174-3-4**] Lipase-27
[**2174-3-5**] Calcium-8.6 Phos-3.4 Mg-2.0 Iron-35*

[**2174-3-4**] BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG
Barbitr-NEG Tricycl-POS

[**2174-3-4**] 07:30PM BLOOD Type-ART Rates-/16 Tidal V-600 PEEP-5
FiO2-60 pO2-215* pCO2-42 pH-7.38 calTCO2-26 Base XS-0

[**2174-3-4**] URINE bnzodzp-NEG barbitr-NEG opiates-NEG cocaine-POS
amphetm-POS mthdone-NEG

Studies:
Head CT ([**3-4**]): 1. No acute intracranial process. 2. Moderate
amount of secretions in the visualized nasopharynx.

CXR ([**3-4**]):  ET tube 1.3 cm from the [**Month/Day (4) **]; suggest retraction
by 3 cm.

CXR ([**3-5**]): 1. No focal infiltrate. 2. Tip of ETT is 2 cm from
the [**Last Name (LF) **], [**First Name3 (LF) **] be withdrawn 1-2 cm for better positioning.

EKG ([**3-4**]): Sinus rhythm. Compared to the previous tracing the
rate is slower. TRACING #3
  Intervals Axes
Rate PR QRS QT/QTc P QRS T
94 148 86 384/443 39 78 48



Brief Hospital Course:
Mr. [**Known lastname 65983**] is a 22 year old HIV positive man with history of
polysubstance abuse and bipolar d/o, s/p medication overdose.
.
# s/p overdose/SA - The patient's tox screen was initially + for
cocaine, amphetamines, and TCA's. Per toxicology, + TCA likely
due to seroquel interaction with assay. Stable intervals on EKG
and telemetry x 24 hours. Initially all psychiatric medications
held per Psych team. Ativan (0.5 mg to 2 mg) and seroquel (50 mg
TID prn) restarted on [**3-7**]. Patient was maintained with a 1:1
sitter. He is stable for transfer to inpatient psychiatric
facility for further treatment.
.
# Bipolar d/o - As above, patient's medications initially held
and seroquel/ativan reinstituted on an as needed basis.
.
# HIV - not on HAART, last CD4 counts > 500 with low VL. Will
need follow-up as an outpatient.
.
# Diarrhea/abd cramping - The patient experienced some diarrhea
following charcoal administration with a reassuring exam.
.
# Anemia - Hct decreased from 41 to 33 after admission but
increased back to 38 at time of discharge. Can be rechecked as
an outpatient.
.
# F/E/N - Patient tolerated a regular diet. Initially received
IVF due to dehydration.
.
# PPX - 1:1 sitter as per above. Received SC heparin while
non-ambulatory.
.
# Code - Full
.
# Dispo - To inpatient psychiatric facility for further
treatment.


Medications on Admission:
Outpatient meds:
Seroquel 100 mg daily
Vistaril prn
Celexa 40 mg daily
Trazadone 50 mg qhs
.
MEDS on transfer from MICU:
1. Heparin SC
2. Ativan prn anxiety


Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain, fever: Maximum 4 g daily.
2. Seroquel 50 mg Tablet Sig: One (1) Tablet PO three times a
day as needed for agitation: hold for sedation.
3. Ativan 0.5 mg Tablet Sig: 1-4 Tablets PO every 4-6 hours as
needed for agitation.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 **] [**Hospital3 **]

Discharge Diagnosis:
Primary:
- Overdose; cocaine, amphetamine, seroquel
- Supraventricular tachycardia NOS

Secondary:
HIV
H/o MRSA skin infections


Discharge Condition:
Afebrile, ambulating, comfortable on room air


Discharge Instructions:
You have been evaluated for your overdose and thoughts of
killing yourself. You were intubated to protect your airway and
then extubated.

You are being discharged to an inpatient psychiatric facility
for further treatment.

Please contact your primary care physician or call EMS if you
have any further thoughts of harming yourself or others.

Followup Instructions:
Follow up to be determined by psychiatric treaters.



Completed by:[**2174-3-8**]
{'Poisoning by other antipsychotics, neuroleptics, and major tranquilizers,Acidosis,Other specified cardiac dysrhythmias,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Asymptomatic human immunodeficiency virus [HIV] infection status,Diarrhea,Bipolar disorder, unspecified,Cocaine dependence, unspecified,Iron deficiency anemia, 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: Overdose

PRESENT ILLNESS: Patient is a 22 year old HIV positive man with history of
polysubstance abuse and bipolar d/o who presents from home,
brought in by EMS. Police were called to apartment and found
patient in residence surrounded by drug papaphranalia. Patient
reportedly stated that he took a bottle of seroquel as well as
cocaine. On arrival to the ED he was somnolent but arousable to
stimuli. Initial VS were HR 170s, SBP 160s, 100% RA. He was
intubated for airway protection and charcoal administration via
NGT. He was given a total of ativan 2mg x3, 2L IVF and placed on
propofol gtt. Toxicology was consulted for + tox screen for
TCAs, they felt this was likely related to seroquel and did not
recommend bicarb.
.
Of note the patient was recently discharged from jail for
indecent assault and battery. He also has been hospitalized ~90
times related to his substance abuse and/or suicidality. Most
recent hospitalization [**2174-2-3**] at [**Hospital1 2025**] after he was retrieved from
[**Hospital1 62342**]by police. Reportedly was unclothed at CVS after
cocaine use, when he became paranoid and jumped in the [**Hospital1 **].

MEDICAL HISTORY: 1. HIV, dx [**2173-3-12**], not on HAART, last CD4 in 500s per OMR note

MEDICATION ON ADMISSION: Outpatient meds:
Seroquel 100 mg daily
Vistaril prn
Celexa 40 mg daily
Trazadone 50 mg qhs
.
MEDS on transfer from MICU:
1. Heparin SC
2. Ativan prn anxiety

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 97.5 BP 125/73 HR 96 RR 20 O2 sat 97%
General: Intubated, sedated
HEENT: PERRL, ETT, NGT in place
Neck: supple, no JVD
Heart: RRR, nl S1/S2, no m/r/g
Chest: CTA anteriorly
Abdomen: soft, NT, ND, +BS
Ext: no edema, 2+ pedal pulses
Skin: shaved, no lesions or rashes, no track marks
Neuro: Sedated, not responsive to voice or sternal rub, moving
upper ext. spontaneously

FAMILY HISTORY: Father: drug/alcohol abuse; grandmother (maternal) alcoholism.

SOCIAL HISTORY: Per prior ED psych note [**6-6**] and [**Hospital1 2025**] note [**2174-2-3**]: Pt is
currently unemployed, lives alone in section 8 housing in
apartment on [**Location (un) 3307**] ave. Pt admits to engaging in homosexual
prostitution to obtain drugs, and that he has had unprotected
sex. He had been incarcerated for indecent assault and battery.
Family consists of Mother who lives in [**Name (NI) 2251**] with her
"controlling boyfriend...she doesn't talk to me much." Father
lives in [**Location **]. He has a brother, [**Name (NI) **], one year older, whom
he feels closest to. Pt last employed from [**8-6**] to [**2-4**] as a
security guard with Securitas. Pt also attended [**Location (un) 6188**]
Community College in the [**2174**]7 semester. 

### Response:
{'Poisoning by other antipsychotics, neuroleptics, and major tranquilizers,Acidosis,Other specified cardiac dysrhythmias,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Asymptomatic human immunodeficiency virus [HIV] infection status,Diarrhea,Bipolar disorder, unspecified,Cocaine dependence, unspecified,Iron deficiency anemia, unspecified'}
