CHIEF COMPLAINT: Found Down
EtOH intoxication

PRESENT ILLNESS: This is a 59 year old man with a history of EtOH abuse who
presented to the ED with hypoglycemia. History per records, as
pt is unable to give history. He was found by workers in the
subway tunnels, apparently intoxicated/unresponsive and with an
empty bottle of vodka. EMS was called, and FSBG was in the 40s
in the field. Unclear whether he received dextrose in the field.

MEDICAL HISTORY: 1) EtOH Abuse: Several ED notes describe visits for EtOH
intoxication. Pt apparently administers vodka and listerine via
PEG.
.
2) s/p PEG and trach placement: unclear etiology
.
3) Evidence on previous ED labs of macrocytic anemia. No work-up
here.

MEDICATION ON ADMISSION: None

ALLERGIES: Aspirin

PHYSICAL EXAM: VS: 96.4 (axillary), 94/51, 102, 12, 93% on TCM at 4L
Gen: NAD, lying in bed, breathing comfortably
HEENT: PERRL, MM dry, OP clear
Neck: trach in place with trach collar mask, yellowish mucus
Lungs: not cooperative with exam, but grossly clear
Heart: RRR, no m/r/g
Abd: +BS, soft, NT/ND, PEG tube in place
Extrem: no edema, 2+ DP pulses

FAMILY HISTORY: unknown

SOCIAL HISTORY: +EtOH abuse, homeless.
Acute respiratory failure,Acute alcoholic intoxication in alcoholism, continuous,Hyposmolality and/or hyponatremia,Hypoglycemia, unspecified,Tracheostomy status
Acute respiratry failure,Ac alcohol intox-contin,Hyposmolality,Hypoglycemia NOS,Tracheostomy status
Admission Date:  [**2137-12-6**]              Discharge Date:   [**2137-12-9**]

Date of Birth:  [**2078-8-10**]             Sex:   M

Service: MEDICINE

Allergies:
Aspirin

Attending:[**First Name3 (LF) 465**]
Chief Complaint:
Found Down
EtOH intoxication

Major Surgical or Invasive Procedure:
None

History of Present Illness:
This is a 59 year old man with a history of EtOH abuse who
presented to the ED with hypoglycemia. History per records, as
pt is unable to give history. He was found by workers in the
subway tunnels, apparently intoxicated/unresponsive and with an
empty bottle of vodka. EMS was called, and FSBG was in the 40s
in the field. Unclear whether he received dextrose in the field.

.
Of note, he has had multiple ED visits in the past for
intoxication, and he takes vodka and listerine via PEG. He was
most recently admitted to [**Hospital1 18**] in [**2137-8-20**] with hypotension
and hypothermia, due to an old right clavicular fracture which
had eroded through the skin and became infected with
corynebacterium and MRSA. He was treated with vancomycin and the
bone was debrided. Clean-margin resection of the infected bone
plus long-term antibiotic therapy were the recommended course of
treatment, but the patient did not agree with these plans and
left the hospital AMA.
.
In the ED, he aroused to voice, but was not speaking. VS: 98.8,
90, 140/80, 13, 96% on RA initially. FSBS 40s on arrival. He
received D50, as well as a banana bag with D5NS. His FSBG have
been improved. His EtOH level was noted to be 454, and the
remainder of his tox screen was negative. He has a poorly
maintainted trach and PEG (for unclear reasons) and he began
coughing mucus from the trach. He reportedly had a brief
respiratory arrest in the ED, which resolved with deep
suctioning and was presumably due to mucus plugging. He became
violent when a foley was attempted, so foley was not placed.


Past Medical History:
1) EtOH Abuse: Several ED notes describe visits for EtOH
intoxication. Pt apparently administers vodka and listerine via
PEG.
.
2) s/p PEG and trach placement: unclear etiology
.
3) Evidence on previous ED labs of macrocytic anemia. No work-up
here.


Social History:
+EtOH abuse, homeless.


Family History:
unknown

Physical Exam:
VS: 96.4 (axillary), 94/51, 102, 12, 93% on TCM at 4L
Gen: NAD, lying in bed, breathing comfortably
HEENT: PERRL, MM dry, OP clear
Neck: trach in place with trach collar mask, yellowish mucus
Lungs: not cooperative with exam, but grossly clear
Heart: RRR, no m/r/g
Abd: +BS, soft, NT/ND, PEG tube in place
Extrem: no edema, 2+ DP pulses


Pertinent Results:
CXR [**2137-12-6**]
Mild pulmonary vascular congestion. No overt pulmonary edema.
Possible vague bibasilar opacities. Further evaluation could be
performed with a dedicated PA and lateral view of the chest.
.
CXR [**2137-12-7**]
No acute pulmonary process.
.
CXR [**2137-12-8**]
Blunting of both costophrenic angles. No evidence of aspiration
pneumonia.
.
[**2137-12-6**] WBC-5.2 RBC-4.46*# Hgb-12.5*# Hct-36.7 Plt Ct-181
[**2137-12-7**] WBC-9.2# RBC-3.98* Hgb-11.0* Hct-33.2* Plt Ct-210
[**2137-12-8**] WBC-4.6 RBC-3.83* Hgb-10.7* Hct-32.1* Plt Ct-217
[**2137-12-9**] WBC-5.9 RBC-3.73* Hgb-10.8* Hct-30.9* Plt Ct-234
[**2137-12-6**] Neuts-63.8 Lymphs-30.7 Monos-3.2 Eos-1.9 Baso-0.4
.
[**2137-12-6**] Glucose-160* UreaN-9 Creat-0.7 Na-134 K-4.3 Cl-94*
HCO3-24 AnGap-20
[**2137-12-6**] Glucose-69* UreaN-7 Creat-0.7 Na-142 K-4.1 Cl-103
HCO3-29 AnGap-14
[**2137-12-7**] Glucose-93 UreaN-10 Creat-0.5 Na-130* K-4.1 Cl-93*
HCO3-27 AnGap-14
[**2137-12-8**] Glucose-95 UreaN-7 Creat-0.5 Na-132* K-4.1 Cl-95*
HCO3-31 AnGap-10
[**2137-12-9**] Glucose-110* UreaN-8 Creat-0.6 Na-128* K-4.2 Cl-91*
HCO3-29
[**2137-12-6**] ALT-74* AST-113* LD(LDH)-359* CK(CPK)-245* AlkPhos-80
Amylase-15 TotBili-0.2
[**2137-12-7**] ALT-56* AST-60* LD(LDH)-167 AlkPhos-74 TotBili-0.5
[**2137-12-8**] ALT-40 AST-36 LD(LDH)-143 AlkPhos-69 Amylase-14
TotBili-0.4
[**2137-12-6**] Lipase-42
[**2137-12-8**] Lipase-32
[**2137-12-6**] CK-MB-12* MB Indx-4.9 cTropnT-0.01
[**2137-12-6**] CK-MB-9 cTropnT-0.01
[**2137-12-6**] CK-MB-8 cTropnT-<0.01
[**2137-12-8**] Albumin-3.2* Calcium-8.4 Phos-2.7 Mg-1.9
[**2137-12-6**] ASA-NEG Ethanol-454* Acetmnp-NEG Bnzodzp-NEG
Barbitr-NEG Tricycl-NEG

Brief Hospital Course:
This is a 59 year old man with a history of EtOH abuse who
presents with hypoglycemia and with brief respiratory arrest in
ED. The patient was transferred to the MICU for respiratory
monitoring. The patient was then moved to the medicine floor
after becoming stable from a respiratory standpoint. The
following issues were addressed during this hospitalization.
.
1. Hypoglycemia
The pt was admitted with hypoglycemia which resolved after
getting dextrose. His glucose was monitored and there were no
further epidoses of hypoglycemia. He was hydrated with D5NS. By
the time of discharge, he was utilizing his PEG tube for
nutrition. He was maintained on thiamine and folate as well. The
hypoglycemia was most likely [**2-21**] to poor PO intake and alcohol
use. By the time of discharge, the pt was euglycemic.
.
2. Respiratory arrest/distress
The pt had some apparent respiratory arrest in ED, which was
most likely due to mucus plugging/? aspiration event. He was
maitained on aggressive pulmonary toilet with deep suctioning as
needed. CXR with no clear pneumonia, no fevers, no leukocytosis.
Repeat CXR was also clear of PNA. He was given ABx briefly for 2
days, and diagnosis of tracheobronchitis was considered. There
was no clear evidence of PNA, fever, or elevated WBC, ABx were
D/C. His sputum was positive for GPC's and GNR's on gram stain.
Sputum culture also grew Pseudomonas. Initially, the pt had
increased secretions which required more frequent suctioning
which resolved by the time of discharge. He was not felt to need
any specific additional respiratory care on follow up based on
RT assessment. He was instructed that if secretions increase
further, he may have bacterial tracheobronchitis which may
require further treatment with antibiotics. He was instructed to
[**Name6 (MD) 138**] [**Name8 (MD) **] MD or return to the hospital if this happens.
.
3. EtOH abuse
EtOH level 454 on admission. Unclear how much he drinks or when
last drink was, but clearly at risk for withdrawal. He was
placed on a CIWA scale with valium prn. He was maintained on
thiamine, folate, and MVI. He was discharged on the above
vitamins. Social work was consulted and the pt declined any
further intervention for his alcohol abuse. He receives some
form of counseling [**Street Address(1) 29735**] Shelter and that is where he
was discharged. He will follow up with services and his PCP [**Name9 (PRE) 65673**] upon discharge. The pt's PCP [**Name9 (PRE) 29735**] was
notified that Mr. [**Known lastname 5621**] was here and the pt will follow up
with him upon discharge.
.
4. Elevated CK
Mildly elevated CK with normal MB index, normal Tn. EKG with no
ischemic changes. Patient did ROMI with 2 negative sets CEs.
There were no further issues.
.
5. Hyponatremia
The pt was found to be hyponatremic with the lowest sodium of
128. Pt has a long h/o hyponatremia per discussion with his PCP
which is most likely [**2-21**] to his alcohol abuse. His sodium will
be followed by his PCP upon discharge.

Medications on Admission:
None

Discharge Medications:
1. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO once a day:
Please place in PEG tube.
Disp:*30 Tablet(s)* Refills:*2*
2. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
Alcohol Intoxication
Alcohol Abuse
Chronic Hyponatremia
.
Secondary:
s/p trach (had on admission)
s/p PEG tube (had on admission)


Discharge Condition:
The patient was discharged hemodynamically stable afebrile with
appropriate follow up.


Discharge Instructions:
Please call your PCP (Dr. [**Last Name (STitle) 11435**] at [**Location (un) **] at [**Telephone/Fax (1) 30392**]
or seek medical attention in the emergency department if you
experience any chest pain, shortness of breath, nausea,
vomiting, diarrhea, fever, chills, abdominal pain, or any other
concerning symptom.
.
Please take all medications as prescribed. Please take your
vitamins.
.
Please see Dr. [**Last Name (STitle) 11435**] at [**Street Address(1) 5904**] facility in follow
up.

Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) 11435**] at the [**Location (un) **] facility in
[**1-21**] weeks by calling [**Telephone/Fax (1) 30392**].


                             [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 472**]

Completed by:[**2137-12-13**]
{'Acute respiratory failure,Acute alcoholic intoxication in alcoholism, continuous,Hyposmolality and/or hyponatremia,Hypoglycemia, unspecified,Tracheostomy status'}


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: Found Down
EtOH intoxication

PRESENT ILLNESS: This is a 59 year old man with a history of EtOH abuse who
presented to the ED with hypoglycemia. History per records, as
pt is unable to give history. He was found by workers in the
subway tunnels, apparently intoxicated/unresponsive and with an
empty bottle of vodka. EMS was called, and FSBG was in the 40s
in the field. Unclear whether he received dextrose in the field.

MEDICAL HISTORY: 1) EtOH Abuse: Several ED notes describe visits for EtOH
intoxication. Pt apparently administers vodka and listerine via
PEG.
.
2) s/p PEG and trach placement: unclear etiology
.
3) Evidence on previous ED labs of macrocytic anemia. No work-up
here.

MEDICATION ON ADMISSION: None

ALLERGIES: Aspirin

PHYSICAL EXAM: VS: 96.4 (axillary), 94/51, 102, 12, 93% on TCM at 4L
Gen: NAD, lying in bed, breathing comfortably
HEENT: PERRL, MM dry, OP clear
Neck: trach in place with trach collar mask, yellowish mucus
Lungs: not cooperative with exam, but grossly clear
Heart: RRR, no m/r/g
Abd: +BS, soft, NT/ND, PEG tube in place
Extrem: no edema, 2+ DP pulses

FAMILY HISTORY: unknown

SOCIAL HISTORY: +EtOH abuse, homeless. 

### Response:
{'Acute respiratory failure,Acute alcoholic intoxication in alcoholism, continuous,Hyposmolality and/or hyponatremia,Hypoglycemia, unspecified,Tracheostomy status'}
