CHIEF COMPLAINT: Overdose.

PRESENT ILLNESS: 44 yo F h/o depression, SA in '[**30**] p/w OD/SA. Pt last spoken to
by her mother last night at around 8:30 pm. Pt gave no
indication that she was planning to kill or hurt herself.
However, her mother does note that she has been recently
depressed, particularly in regards to her job. This morning her
sister was unable to reach her by phone and called EMS. When EMS
arrived pt's VSS, though, by report, pt was minimally
responsive. A suicide note was found at the pt's home as well as
a list of the pt's medications. Pt transported to [**Hospital1 **].
.
In the ED, vitals: 98.6, hr 104, bp 127/80, rr 18, 98% ra. Pt
was somnolent, opening eyes to voice. wbc 13.8. lytes wnl. CEs
negative. U/S tox negative. U/A negative. EKG: ST@107 bpm, qtc
422. Pt given 1 L NS and 1 amp of bicarb. Pt was given seen by
tox who recommended 2 amps of bicarb and repeat EKG. Repeat EKG
essentially unchanged. Pt given benadryl 25 mg, ativan 2 mg for
CT head which was negative. Pt transferred to MICU for further
management.

MEDICAL HISTORY: Admission to [**Hospital1 **] '[**30**] for overdose
s/p meningioma resection
PCOS and adrenal incidentaloma
Migraine and tension headaches
Chronic cholecystitis, s/p lap cholecystectomy

MEDICATION ON ADMISSION: MEDICATIONS ON ADMISSION(per EMS; list unavailable):
clonazepam
lamictal
topamax
ditropan
spironolactone
cymbalta

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM:
========================
Temp 97.7
BP 125/76
Pulse 104
Resp 26
O2 sat 100% ra
Gen - somnolent, not opening eyes to name
HEENT - pupils sluggish 4 to 3 mm, mucous membranes dry
Neck - no JVD, no cervical lymphadenopathy
Chest - Clear to auscultation bilaterally
CV - tachy regular, no murmurs
Abd - Soft, nontender, nondistended, with normoactive bowel
sounds
Extr - No clubbing, cyanosis, or edema. 2+ DP pulses bilaterally

FAMILY HISTORY: mother and sister with depression

SOCIAL HISTORY: Per pt's mother: no etoh, tob, or illicits. Lives alone with
cat. Has no friends. Sister [**Name (NI) **] ([**Telephone/Fax (1) 108584**] lives in
[**Location **]. mother lived in [**Name (NI) 108**], [**Telephone/Fax (1) 108585**]
Poisoning by benzodiazepine-based tranquilizers,Pneumonitis due to inhalation of food or vomitus,Major depressive affective disorder, single episode, severe, without mention of psychotic behavior,Hypopotassemia,Poisoning by other and unspecified anticonvulsants,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Headache,Delirium due to conditions classified elsewhere
Pois-benzodiazepine tran,Food/vomit pneumonitis,Depress psychosis-severe,Hypopotassemia,Pois-anticonvul NEC/NOS,Poison-psychotropic agt,Headache,Delirium d/t other cond
Admission Date:  [**2133-4-2**]              Discharge Date:   [**2133-4-7**]

Date of Birth:  [**2088-9-27**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1666**]
Chief Complaint:
Overdose.

Major Surgical or Invasive Procedure:
None.

History of Present Illness:
44 yo F h/o depression, SA in '[**30**] p/w OD/SA. Pt last spoken to
by her mother last night at around 8:30 pm. Pt gave no
indication that she was planning to kill or hurt herself.
However, her mother does note that she has been recently
depressed, particularly in regards to her job. This morning her
sister was unable to reach her by phone and called EMS. When EMS
arrived pt's VSS, though, by report, pt was minimally
responsive. A suicide note was found at the pt's home as well as
a list of the pt's medications. Pt transported to [**Hospital1 **].
.
In the ED, vitals: 98.6, hr 104, bp 127/80, rr 18, 98% ra. Pt
was somnolent, opening eyes to voice. wbc 13.8. lytes wnl. CEs
negative. U/S tox negative. U/A negative. EKG: ST@107 bpm, qtc
422. Pt given 1 L NS and 1 amp of bicarb. Pt was given seen by
tox who recommended 2 amps of bicarb and repeat EKG. Repeat EKG
essentially unchanged. Pt given benadryl 25 mg, ativan 2 mg for
CT head which was negative. Pt transferred to MICU for further
management.


Past Medical History:
Admission to [**Hospital1 **] '[**30**] for overdose
s/p meningioma resection
PCOS and adrenal incidentaloma
Migraine and tension headaches
Chronic cholecystitis, s/p lap cholecystectomy


Social History:
Per pt's mother: no etoh, tob, or illicits. Lives alone with
cat. Has no friends. Sister [**Name (NI) **] ([**Telephone/Fax (1) 108584**] lives in
[**Location **]. mother lived in [**Name (NI) 108**], [**Telephone/Fax (1) 108585**]

Family History:
mother and sister with depression

Physical Exam:
ADMISSION PHYSICAL EXAM:
========================
Temp 97.7
BP 125/76
Pulse 104
Resp 26
O2 sat 100% ra
Gen - somnolent, not opening eyes to name
HEENT - pupils sluggish 4 to 3 mm, mucous membranes dry
Neck - no JVD, no cervical lymphadenopathy
Chest - Clear to auscultation bilaterally
CV - tachy regular, no murmurs
Abd - Soft, nontender, nondistended, with normoactive bowel
sounds
Extr - No clubbing, cyanosis, or edema. 2+ DP pulses bilaterally

Neuro - moving all four extremities, withdraws to pain, no
response to commands
Skin - No rash

PHYSICAL EXAM UPON TRANSFER:
============================
Vitals - T 99.3, BP 122/85, HR 84, RR 20, O2 95% RA
Gen - awake, tearful, A+O x 2 (able to tell me her name and [**Hospital **] hospital), difficulty w/ word finding
HEENT - PERRL, MMM
Neck - no JVD, no cervical lymphadenopathy
Chest - Clear to auscultation bilaterally
CV - regular, no murmurs
Abd - Soft, nontender, nondistended
Extr - no c/c/e
Neuro - FROM x 4 ext, as above A+O x 2, difficulty w/ word
finding, but otherwise appropriate
Skin - No rash


Pertinent Results:
ADMISSION LABS:
=================

         12.9
 13.88 >------< 299
         37.7

MCV 88  Neuts 92.9  Bands 0  Lymphs 5.7  Monos 1.2  Eos 0  Basos
0.2

PT 11.8  PTT 24.0  INR 1.0

 140   108   23
-----|-----|-----< 136
 3.7   24    1.0

ALT 17  AST 16  Alk Phos 75  Bili 0.2

CK 19  Trop <0.01
Serum Tox: negative
Urine Tox: negative

[**2133-4-2**] 06:18PM   TYPE-ART PO2-90 PCO2-46* PH-7.39 TOTAL CO2-29
BASE XS-1
[**2133-4-2**] 06:18PM   LACTATE-1.3

PERTINENT LABS DURING HOSPITALIZATION:
=======================================
WBC Trend: 13.88 - 8.7 - 12.3 - 9.2 - 11 - 8.9
BNP 452

STUDIES:
========
CHEST (PORTABLE AP)  [**2133-4-2**]
FINDINGS: A single view shows the cardiac silhouette to be
within normal limits. There is an area of increased
opacification at the left base medially. This could represent
atelectatic change or possibly aspiration. The right lung is
essentially clear.

CT HEAD W/O CONTRAST  [**2133-4-2**]
FINDINGS: The study is limited by patient motion. There is no
evidence of hemorrhage, edema, mass effect, hydrocephalus, or
acute vascular territorial infarct. The ventricular and sulcal
prominence may be slightly more than expected for age. There has
been a left frontal craniotomy. The visualized paranasal
sinuses, mastoid air cells, and middle ear cavities are clear.
Soft tissues are unremarkable.

IMPRESSION: Limited study due to motion. No evidence of
hemorrhage or mass effect. Please note for the detection of
acute brain ischemia, MRI with diffusion weighting is more
sensitive than CT.

CHEST (PORTABLE AP)  [**2133-4-4**]
New areas of confluent opacification have developed in the
perihilar and basilar regions, and may be due to the provided
history of acute aspiration, but a component of pulmonary edema
from fluid overload is likely, and there are also bilateral
scattered septal lines in the lung periphery. Heart is upper
limits of normal in size. Small pleural effusions have developed
bilaterally.

EKG [**2133-4-2**]
Sinus tachycardia. Baseline artifact makes interpretation
difficult.
RSR' pattern in lead V1 is non-specific. Compared to the
previous tracing
of [**2130-5-15**] sinus tachycardia, RSR' pattern and artifact are all
new.
TRACING #1


Brief Hospital Course:
Ms. [**Known lastname **] is a 44 y.o. F with a history of depression, two
prior suicide attempts, admitted for medication overdose s/p
suicide attempt.

# Medication overdose:  Initially, it was unclear what
medications the patient had taken and quantity.  On arrival, her
vital signs were stable, but she was unresponsive.  Head CT was
negative.  She was never intubated.  She received bicarbonate x
2 in the ED per Toxicology, who was consulted.  She was admitted
to the MICU for altered mental status.  As the patient was on
Ditropan, this was concerning for anticholinergic toxicity, and
she was given physostigmine, which did not change her mental
status.  Urine tox and serum tox were negative.  Serial EKGs
were followed for conduction disorders, which remained
unremarkable during her hospitalization.  Her mental status
improved, and she was called out to the medical floor.  While on
the medical floor, her mental status returned to baseline per
the patient's sister.  Ms. [**Known lastname **] was able to recall the
events surrounding her suicide attempt and recalled that she
took both Klonopin and Lamictal.

# Depression: On admission to the MICU, the patient's
psychiatric medications were all held and continued to be held
on the medical service per psychiatry.  Psychiatry followed the
patient during her hospitalization and recommended that all her
outpatient psychiatric medications continue to be held.  She had
a 1:1 sitter during her hospitalization.  Of note, on [**2133-4-7**],
the patient was noted to have more pressured speech and was
slightly manic.  Per Psych, clonazepam 0.5 mg TID prn agitation
and haldol prn were given.

# Leukocytosis: Initially, noted in the MICU.  UA negative.  CXR
with ? RLL opacity with atelectasis vs. aspiration vs. fluid.
The patient remained afebrile and without respiratory symptoms.
Her leukocytosis resolved without any antibiotics.

# Hct Drop: Noted to have Hct drop of 37 --> 31.  Repeat Hct was
37.

# Headache: Fioricet and Tylenol prn

# FEN: regular diet, monitor and replete lytes PRN

# PPX: heparin SQ, bowel regimen

# FULL CODE

# Dispo: Transfer to inpatient psychiatric facility.

Medications on Admission:
MEDICATIONS ON ADMISSION(per EMS; list unavailable):
clonazepam
lamictal
topamax
ditropan
spironolactone
cymbalta

MEDICATIONS ON TRANSFER:
Ondansetron 4 mg IV Q8H:PRN nausea
Heparin 5000 UNIT SC TID
Lorazepam 1-2 mg IV Q2H:PRN agitation


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] Hospital - [**Location (un) 10059**]

Discharge Diagnosis:
Primary Diagnosis:
1. Medication Overdose
2. Depression

Secondary Diagnosis:
1. Headache


Discharge Condition:
Stable.  Afebrile.


Discharge Instructions:
You were admitted after a medication overdose.  You were
originally in the medical intensive care unit as your mental
status was altered.  You were then sent to the medicine floor
after you mental status cleared. The toxicologists and
psychiatrists followed you during your hospitalization.

Please keep all your medical appointments.  Please take all your
medications as prescribed.  Your psychiatric medications were
held during your hospitalization.  You were restarted on
Klonopin as needed.

You will be transferred to an inpatient psychiatric facility for
further psychiatric management.

If you have any of the following symptoms, please call your
doctor or go to the nearest ER: fever>101, chest pain, shortness
of breath, abdominal pain, increased thoughts of suicide or
homidcide, or any other concerning symptoms.

Followup Instructions:
Inpatient Psychiatric Facility


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1672**] MD, [**MD Number(3) 1673**]

Completed by:[**2133-4-7**]
{'Poisoning by benzodiazepine-based tranquilizers,Pneumonitis due to inhalation of food or vomitus,Major depressive affective disorder, single episode, severe, without mention of psychotic behavior,Hypopotassemia,Poisoning by other and unspecified anticonvulsants,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Headache,Delirium due to conditions classified elsewhere'}


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: 44 yo F h/o depression, SA in '[**30**] p/w OD/SA. Pt last spoken to
by her mother last night at around 8:30 pm. Pt gave no
indication that she was planning to kill or hurt herself.
However, her mother does note that she has been recently
depressed, particularly in regards to her job. This morning her
sister was unable to reach her by phone and called EMS. When EMS
arrived pt's VSS, though, by report, pt was minimally
responsive. A suicide note was found at the pt's home as well as
a list of the pt's medications. Pt transported to [**Hospital1 **].
.
In the ED, vitals: 98.6, hr 104, bp 127/80, rr 18, 98% ra. Pt
was somnolent, opening eyes to voice. wbc 13.8. lytes wnl. CEs
negative. U/S tox negative. U/A negative. EKG: ST@107 bpm, qtc
422. Pt given 1 L NS and 1 amp of bicarb. Pt was given seen by
tox who recommended 2 amps of bicarb and repeat EKG. Repeat EKG
essentially unchanged. Pt given benadryl 25 mg, ativan 2 mg for
CT head which was negative. Pt transferred to MICU for further
management.

MEDICAL HISTORY: Admission to [**Hospital1 **] '[**30**] for overdose
s/p meningioma resection
PCOS and adrenal incidentaloma
Migraine and tension headaches
Chronic cholecystitis, s/p lap cholecystectomy

MEDICATION ON ADMISSION: MEDICATIONS ON ADMISSION(per EMS; list unavailable):
clonazepam
lamictal
topamax
ditropan
spironolactone
cymbalta

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM:
========================
Temp 97.7
BP 125/76
Pulse 104
Resp 26
O2 sat 100% ra
Gen - somnolent, not opening eyes to name
HEENT - pupils sluggish 4 to 3 mm, mucous membranes dry
Neck - no JVD, no cervical lymphadenopathy
Chest - Clear to auscultation bilaterally
CV - tachy regular, no murmurs
Abd - Soft, nontender, nondistended, with normoactive bowel
sounds
Extr - No clubbing, cyanosis, or edema. 2+ DP pulses bilaterally

FAMILY HISTORY: mother and sister with depression

SOCIAL HISTORY: Per pt's mother: no etoh, tob, or illicits. Lives alone with
cat. Has no friends. Sister [**Name (NI) **] ([**Telephone/Fax (1) 108584**] lives in
[**Location **]. mother lived in [**Name (NI) 108**], [**Telephone/Fax (1) 108585**] 

### Response:
{'Poisoning by benzodiazepine-based tranquilizers,Pneumonitis due to inhalation of food or vomitus,Major depressive affective disorder, single episode, severe, without mention of psychotic behavior,Hypopotassemia,Poisoning by other and unspecified anticonvulsants,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Headache,Delirium due to conditions classified elsewhere'}
