CHIEF COMPLAINT: Stupor

PRESENT ILLNESS: 65 yo lady w/ DM, depression here w/ likely TCA overdose, etoh
use. Patient is poor historian, but reported taking a handfull
of pills w/ some liquor. Husband found her somnolent, called
911. Upon EMS arrival, sugar 160, narcan w/ some effect, VSS, ST
to 108. NRB placed for somnolence. Patient easily arousable in
ED but lethargic, babbling. Denies suicidal intent, but says she
was so anxious that she "couldn't take it anymore." Names elavil
as one of the meds, but cannot name others. In ED, given narcan
0.4 mg x 2 with some effect, bicarb given and drip started, qrs
to 120 ms so concern for TCA toxicity. Called MICU. Of note,
also had ST depressions in I and AVL w/ negative 1 st enzymes-
cards consulted. Toxicology also consulted and recommended ICU
admit.

MEDICAL HISTORY: PCP at [**Name9 (PRE) 2025**] (Dr [**Last Name (STitle) 104922**] [**Telephone/Fax (1) 104923**])
-DM A1C 8.5% per PCP
[**Name9 (PRE) 104924**] right great toe w/ admit to [**Hospital1 **] [**4-23**] (d/c summary
faxed)
-? osteo of left foot
-depression
-detox admits
-no etoh until now for 6 months
-?bipolar: psychiatrist is Dr. [**Last Name (STitle) **]
[**Name (STitle) 104925**] humeral fracture
-peripheral neuropathy
-no cad

MEDICATION ON ADMISSION: Lexapro 30 daily
Amitryptiline 100mg qHS
Insulin NPH 40 units AM/PM
Lamictel 50mg daily
Gabapentin 900mg daily
zolpidem 5mg qhs
ASA 81 daily

ALLERGIES: Penicillins

PHYSICAL EXAM: t 98.8, bp 125/60, hr 70, rr 14, spo2 98%ra
gen- well appearing f, looks age, in nad
heent- anicteric sclera, op clear with mmm
cv- rrr, s1s2, no m/r/g
pul- moves air well, no w/r/r
abd- soft, nt, nd, nabs
extrm- no cyanosis/edema, warm/dry
nails- no clubbing, no pitting/color changes/indentations
neuro- a&ox3, cn 2-12 intact, motor [**5-23**] distally and proximally
in all extrm, no focal sensory deficits

FAMILY HISTORY: NC

SOCIAL HISTORY: Pt lives with her husband.  She has a long h/o etoh abuse.
Alcohol abuse, unspecified,Alcohol withdrawal,Other convulsions,Accidental poisoning by antidepressants,Depressive disorder, not elsewhere classified,Bipolar I disorder, most recent episode (or current) unspecified,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Unspecified hereditary and idiopathic peripheral neuropathy
Alcohol abuse-unspec,Alcohol withdrawal,Convulsions NEC,Acc poison-antidepressnt,Depressive disorder NEC,Bipolor I current NOS,DMII oth nt st uncntrld,Idio periph neurpthy NOS
Admission Date:  [**2182-7-5**]              Discharge Date:   [**2182-7-9**]

Date of Birth:  [**2117-6-21**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
Stupor

Major Surgical or Invasive Procedure:
None

History of Present Illness:
65 yo lady w/ DM, depression here w/ likely TCA overdose, etoh
use. Patient is poor historian, but reported taking a handfull
of pills w/ some liquor. Husband found her somnolent, called
911. Upon EMS arrival, sugar 160, narcan w/ some effect, VSS, ST
to 108. NRB placed for somnolence. Patient easily arousable in
ED but lethargic, babbling. Denies suicidal intent, but says she
was so anxious that she "couldn't take it anymore." Names elavil
as one of the meds, but cannot name others. In ED, given narcan
0.4 mg x 2 with some effect, bicarb given and drip started, qrs
to 120 ms so concern for TCA toxicity. Called MICU. Of note,
also had ST depressions in I and AVL w/ negative 1 st enzymes-
cards consulted. Toxicology also consulted and recommended ICU
admit.

Past Medical History:
PCP at [**Name9 (PRE) 2025**] (Dr [**Last Name (STitle) 104922**] [**Telephone/Fax (1) 104923**])
-DM A1C 8.5% per PCP
[**Name9 (PRE) 104924**] right great toe w/ admit to [**Hospital1 **] [**4-23**] (d/c summary
faxed)
-? osteo of left foot
-depression
-detox admits
-no etoh until now for 6 months
-?bipolar: psychiatrist is Dr. [**Last Name (STitle) **]
[**Name (STitle) 104925**] humeral fracture
-peripheral neuropathy
-no cad


Social History:
Pt lives with her husband.  She has a long h/o etoh abuse.

Family History:
NC

Physical Exam:
t 98.8, bp 125/60, hr 70, rr 14, spo2 98%ra
gen- well appearing f, looks age, in nad
heent- anicteric sclera, op clear with mmm
cv- rrr, s1s2, no m/r/g
pul- moves air well, no w/r/r
abd- soft, nt, nd, nabs
extrm- no cyanosis/edema, warm/dry
nails- no clubbing, no pitting/color changes/indentations
neuro- a&ox3, cn 2-12 intact, motor [**5-23**] distally and proximally
in all extrm, no focal sensory deficits

Pertinent Results:
[**2182-7-5**] 11:40AM BLOOD WBC-6.9 RBC-4.61 Hgb-14.4 Hct-39.8 MCV-86
MCH-31.3 MCHC-36.2* RDW-13.4 Plt Ct-238
[**2182-7-7**] 03:30AM BLOOD WBC-11.0 RBC-4.52 Hgb-14.3 Hct-40.4
MCV-89 MCH-31.7 MCHC-35.5* RDW-13.6 Plt Ct-202
[**2182-7-5**] 11:40AM BLOOD Glucose-78 UreaN-14 Creat-0.6 Na-142
K-3.7 Cl-106 HCO3-24 AnGap-16
[**2182-7-7**] 03:30AM BLOOD Glucose-140* UreaN-7 Creat-0.6 Na-136
K-3.7 Cl-104 HCO3-21* AnGap-15
[**2182-7-5**] 11:40AM BLOOD CK(CPK)-125
[**2182-7-5**] 11:40AM BLOOD cTropnT-<0.01
[**2182-7-5**] 09:40PM BLOOD CK(CPK)-188*
[**2182-7-5**] 09:40PM BLOOD CK-MB-6 cTropnT-0.07*
[**2182-7-6**] 04:27AM BLOOD CK(CPK)-131
[**2182-7-6**] 04:27AM BLOOD CK-MB-5 cTropnT-0.04*
[**2182-7-5**] 11:40AM BLOOD ASA-NEG Ethanol-67* Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-POS

Brief Hospital Course:
65 yo lady w/ DM, depression here w/ likely TCA overdose, etoh
use.

1.)Overdose: Apparently her overdose is not a suicide attempt,
but rather a reaction to an unmanagable level of anxiety.  The
distinction between her actions and a frank suicide attempt,
however, seems unclear, so she was treated as a potential
suicide attempt with a 1:1 sitter and a psychiatry consult.  In
the ED she was given charcoal and IV D5 with bicarb for a goal
ph 7.50; her QRS narrowed to 108 and she remained
hemodynamically stable.  Once this issue and her withdrawal
seizures had been managed (as below), she was felt ready for
transfer to the psychiatry service.
2.)Seizures -- The patient developed seizure like activity
approximately 36' after being in the hospital.  She was noted to
have facial twitching, unresponsiveness, hypertension, and
tachycardia.  This resolved after approximately thirty seconds,
but the patient remained rather disoriented following the event.
 A similar episode occured ten minutes later, at which point
neurology was consulted.  Their feeling was that this
represented an alcohol withdrawal seizure, despite the fact that
her CIWA score had never exceeded 10.  She was loaded with and
the placed on a diazepam taper and covered with a lorazepam ciwa
dose.  An EEG showed no epileptiform activity.  No further
seizure activity or post-ictal behavior was observed.
3.)Hypoglycemia: Possibly the patient took insulin prior to
overdose- no access to sulfonylureas.  Her blood sugars were
stable, without excessive hypoglycemia during her MICU stay, and
her NPH dosing was gradually brought back to her home levels of
40 units [**Hospital1 **]; she was also covered with a regular sliding scale.
4.)EKG changes: Pt with aVR elevation, ST-dep in I/aVL, inf Q
waves (old) and QRS 100-120. aVR elevation and QRS widening [**2-20**]
TCA overdose, with old EKGs which show QRS around 100.
Cardiology consulted who recommended giving ASA and ruling-out.
She had a slight bump in her troponins, though it never reached
a level to signify an MI, and her CK's were not elevated.  The
troponins began to quickly trend down and were felt to likely be
due to high metabolic demands, not an acutal acute coronary
event.

Medications on Admission:
Lexapro 30 daily
Amitryptiline 100mg qHS
Insulin NPH 40 units AM/PM
Lamictel 50mg daily
Gabapentin 900mg daily
zolpidem 5mg qhs
ASA 81 daily

Discharge Medications:
1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
2. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Potassium & Sodium Phosphates [**Telephone/Fax (3) 4228**] mg Packet Sig: One
(1) Packet PO TID (3 times a day).
5. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
6. Lamotrigine 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Zolpidem Tartrate 5 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
8. Diazepam 2 mg Tablet Sig: Per taper Tablet PO three times a
day: On [**7-9**] 2 pills tid, [**7-10**] 1.5 pills tid, [**7-11**] 1 pill tid,
[**7-12**] 0.5 pills tid, then stop. .
9. Insulin NPH Human Recomb 100 unit/mL Cartridge Sig: Forty
(40) units Subcutaneous twice a day.
10. Insulin Regular Human 100 unit/mL Cartridge Sig: Per sliding
scale  Injection four times a day.
11. Multivitamin     Capsule Sig: One (1) Cap PO DAILY (Daily).

12. Lorazepam 2 mg/mL Syringe Sig: Two (2) mg Injection Q2H
(every 2 hours) as needed: for ciwa > 12.


Discharge Disposition:
Extended Care

Discharge Diagnosis:
Tricyclic antidepressant overdose
Suicidal ideation
Secondary:
-DM A1C 8.5% per PCP
[**Name10 (NameIs) 104924**] right great toe w/ admit to [**Hospital1 **] [**4-23**] (d/c summary
faxed)
-? osteo of left foot
-depression
-detox admits
-no etoh until now for 6 months
-?bipolar: psychiatrist is Dr. [**Last Name (STitle) **]
[**Name (STitle) 104925**] humeral fracture
-peripheral neuropathy
-no cad


Discharge Condition:
Improved, hemodynamically stable

Discharge Instructions:
Call your PCP or return to the ED for palpitations, dizzinness,
shortness of breath, or other concerning symptoms.

Followup Instructions:
Once discharged, please see your PCP, [**Last Name (NamePattern4) **]. [**First Name (STitle) 3924**], in one to two
weeks; call [**Telephone/Fax (1) 104926**] to make an appointment.

See your psychiatrist in the next week.
{'Alcohol abuse, unspecified,Alcohol withdrawal,Other convulsions,Accidental poisoning by antidepressants,Depressive disorder, not elsewhere classified,Bipolar I disorder, most recent episode (or current) unspecified,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Unspecified hereditary and idiopathic peripheral neuropathy'}


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: Stupor

PRESENT ILLNESS: 65 yo lady w/ DM, depression here w/ likely TCA overdose, etoh
use. Patient is poor historian, but reported taking a handfull
of pills w/ some liquor. Husband found her somnolent, called
911. Upon EMS arrival, sugar 160, narcan w/ some effect, VSS, ST
to 108. NRB placed for somnolence. Patient easily arousable in
ED but lethargic, babbling. Denies suicidal intent, but says she
was so anxious that she "couldn't take it anymore." Names elavil
as one of the meds, but cannot name others. In ED, given narcan
0.4 mg x 2 with some effect, bicarb given and drip started, qrs
to 120 ms so concern for TCA toxicity. Called MICU. Of note,
also had ST depressions in I and AVL w/ negative 1 st enzymes-
cards consulted. Toxicology also consulted and recommended ICU
admit.

MEDICAL HISTORY: PCP at [**Name9 (PRE) 2025**] (Dr [**Last Name (STitle) 104922**] [**Telephone/Fax (1) 104923**])
-DM A1C 8.5% per PCP
[**Name9 (PRE) 104924**] right great toe w/ admit to [**Hospital1 **] [**4-23**] (d/c summary
faxed)
-? osteo of left foot
-depression
-detox admits
-no etoh until now for 6 months
-?bipolar: psychiatrist is Dr. [**Last Name (STitle) **]
[**Name (STitle) 104925**] humeral fracture
-peripheral neuropathy
-no cad

MEDICATION ON ADMISSION: Lexapro 30 daily
Amitryptiline 100mg qHS
Insulin NPH 40 units AM/PM
Lamictel 50mg daily
Gabapentin 900mg daily
zolpidem 5mg qhs
ASA 81 daily

ALLERGIES: Penicillins

PHYSICAL EXAM: t 98.8, bp 125/60, hr 70, rr 14, spo2 98%ra
gen- well appearing f, looks age, in nad
heent- anicteric sclera, op clear with mmm
cv- rrr, s1s2, no m/r/g
pul- moves air well, no w/r/r
abd- soft, nt, nd, nabs
extrm- no cyanosis/edema, warm/dry
nails- no clubbing, no pitting/color changes/indentations
neuro- a&ox3, cn 2-12 intact, motor [**5-23**] distally and proximally
in all extrm, no focal sensory deficits

FAMILY HISTORY: NC

SOCIAL HISTORY: Pt lives with her husband.  She has a long h/o etoh abuse. 

### Response:
{'Alcohol abuse, unspecified,Alcohol withdrawal,Other convulsions,Accidental poisoning by antidepressants,Depressive disorder, not elsewhere classified,Bipolar I disorder, most recent episode (or current) unspecified,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Unspecified hereditary and idiopathic peripheral neuropathy'}
