CHIEF COMPLAINT: hypotension, respiratory failure, unresponsive

PRESENT ILLNESS: 23 yo f w/ h/o depression transferred from [**Hospital3 2737**] w/
hypotension and respiratory failure.  By report patient was
found down in her home this morning by her 7 yo son, who awoke
the patient's boyfriend.  EMS called. p120, r4, 118/p, sao2 88%.
Pupils noted to be constricted.  Pt noted to have to have agonal
resp of approx 4/min. rec'd IV narcan 2mg x4 w/ some improvement
in resp rate to 10.  Had ongoing resp distress, was clinching
teeth, and was subsequently nasally intubated.
.
In [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], vs:97.9, p138, bp119/87, "intubated". Maintained
on dopamine was switched to levophed.   Noted to have elevated
transaminases 574, 614.  Tox screen +benzos, +opiates. , neg
acetaminophen. CT head neg, LP performed (neg).  Rec'd 5L NS,
7mg vecuronium, vancomycin 1g, ctx 2g, acyclovir 800mg iv.
Transferred to [**Hospital1 **].
.
[**Hospital1 **] ED, tm 99.8, hr 125, bp 111/65, r 17, 100% intubated,
unknown settings. IV nac started, and fentanyl bolus.  CT abd
performed.

MEDICAL HISTORY: depression

MEDICATION ON ADMISSION: (per tox note)
lexapro 10mg
flagyl 250 [**Hospital1 **]
clonazepam 0.5 [**Hospital1 **]
effexor 75 mg qday
citalopram 200mg [**12-14**] tab qday
trileptal 300mg [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: t 100.5, 100/66 (0.2 mcg/k/min norepinephrine), 88,
Intubated, sedated.
pupils 1mm b/l.  minimally reactive
op clr
trachea midline
regular s1,s2. no m/r/g
lca b/l
+bs. soft. nt. nd.
no vaginal discharge.  no masses/tampons/foreign bodies on
bimanual examination.
in ed, brn stool, guiac pos
no le edema.

FAMILY HISTORY: unknown at this time.

SOCIAL HISTORY: Lives with 7 yo son.  Boyfriend intermittently stays over.
Brother recently attempted to commit suicide.  Works at bakery
in afternoons, attending college, studying psychology.  No pets.
 No etoh.  +smoking.  Stopped cocaine (inh, intranasal) and
percocet use approx one month ago, although boyfriend does not
believe that she had any access to perocet recently.  No history
of IVDU.  No recent travel. No outdoor exposures.  No
tick/mosquito bites.
Acute respiratory failure,Hepatitis, unspecified,Shock, unspecified,Poisoning by opium (alkaloids), unspecified,Accidental poisoning by aromatic analgesics, not elsewhere classified,Depressive disorder, not elsewhere classified
Acute respiratry failure,Hepatitis NOS,Shock NOS,Poisoning-opium NOS,Acc poison-arom analgesc,Depressive disorder NEC
Admission Date:  [**2112-8-31**]              Discharge Date:   [**2112-9-5**]

Date of Birth:  [**2089-4-3**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 348**]
Chief Complaint:
hypotension, respiratory failure, unresponsive

Major Surgical or Invasive Procedure:
intubation
central venous catheter


History of Present Illness:
23 yo f w/ h/o depression transferred from [**Hospital3 2737**] w/
hypotension and respiratory failure.  By report patient was
found down in her home this morning by her 7 yo son, who awoke
the patient's boyfriend.  EMS called. p120, r4, 118/p, sao2 88%.
Pupils noted to be constricted.  Pt noted to have to have agonal
resp of approx 4/min. rec'd IV narcan 2mg x4 w/ some improvement
in resp rate to 10.  Had ongoing resp distress, was clinching
teeth, and was subsequently nasally intubated.
.
In [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], vs:97.9, p138, bp119/87, "intubated". Maintained
on dopamine was switched to levophed.   Noted to have elevated
transaminases 574, 614.  Tox screen +benzos, +opiates. , neg
acetaminophen. CT head neg, LP performed (neg).  Rec'd 5L NS,
7mg vecuronium, vancomycin 1g, ctx 2g, acyclovir 800mg iv.
Transferred to [**Hospital1 **].
.
[**Hospital1 **] ED, tm 99.8, hr 125, bp 111/65, r 17, 100% intubated,
unknown settings. IV nac started, and fentanyl bolus.  CT abd
performed.


Past Medical History:
depression

Social History:
Lives with 7 yo son.  Boyfriend intermittently stays over.
Brother recently attempted to commit suicide.  Works at bakery
in afternoons, attending college, studying psychology.  No pets.
 No etoh.  +smoking.  Stopped cocaine (inh, intranasal) and
percocet use approx one month ago, although boyfriend does not
believe that she had any access to perocet recently.  No history
of IVDU.  No recent travel. No outdoor exposures.  No
tick/mosquito bites.

Family History:
unknown at this time.

Physical Exam:
t 100.5, 100/66 (0.2 mcg/k/min norepinephrine), 88,
Intubated, sedated.
pupils 1mm b/l.  minimally reactive
op clr
trachea midline
regular s1,s2. no m/r/g
lca b/l
+bs. soft. nt. nd.
no vaginal discharge.  no masses/tampons/foreign bodies on
bimanual examination.
in ed, brn stool, guiac pos
no le edema.


Pertinent Results:
140  109  10 / 116    AGap=13
4.1  22  0.6 \
CK: 696
Ca: 7.2 Mg: 1.5 P: 3.3
ALT: 781 AP: 47 Tbili: 0.2 Alb: 3.3
AST: 858 LDH: 678 Dbili:  TProt:
[**Doctor First Name **]: 934 Lip: 36
HCG:<5
.
            94
15.5 \ 12.3 / 231
     / 35.2 \
 N:Pnd L:Pnd M:Pnd E:Pnd Bas:Pnd
PT: 15.2  PTT: 29.9  INR: 1.4
.
LP: gram stain: poly none, epithelial none, organisms none
                wbcc 0, rbc 0, poly 0, mono 0, prot 33, gluc 74
.
ecg: 120 bpm, nl axis, nl int, twf v3, no st-tw changes.
.
cxr: ett 3 cm from carina, LIJ in place. no infiltrates/edema.
.
ct abd:(initial radiology read) liver appearance c/w acute
inflammation
.
ucx: pending
bxcx x2: pending

Brief Hospital Course:
23 yo f transferred from OSH with respiratory failure,
hypotension and elevated transaminases.
.
1) hypotension- following admission was rapidly titrated off
levophed. initial concern for sepsis given low grade fever, elev
wbcc w/ bandemia, and hypotension.  low suspicion for cardiac
etiologies w/ nl ecg. possible sources remained negative.   cxr
clr, ua neg, no rashes.  once extubated patient had no
localizing symptoms.  There was a ? of colitis based on CT but
patient was w/o symptoms either before or after intubation.
Initially covered w/ vancomycin/ctx 2g/flagyl but were
discontinued after cultures remained negative x 48 hours. Pt
remained ASx with SBP in 90-100, most likely her baseline.
Random cortisol normal.  In the end no clear diagnosis but
presumed [**1-14**] OD.
.
2) resp failure- cxr clr.  history and tox screen c/w narcotics
as etiology.  low RR, warm dry skin and rapid improvement.  on
admission was overbreathing ventilator on pressure support.
rapidly titrated down fiO2 and extubated the afternoon following
admission without difficulty
.
3) transaminitis- Unclear etiology most likely 2/.2 ischemic
(hypotensive/hypoxic) vs unknwon toxin.  Hep serologies all
negative.  Given unclear ingestion Hx was maintained on IV NAC
x48h despite negative APA level.  LFTs continued to decreased
substantially during hospitalization.  No Si/Sx fo heaptic
failure.  Pt instructed to follow up with PCP end of week for
repeat LFTs.
.
4) OD: unclear ingestion history. Pt adamently denies SI.  Says
effects [**1-14**] to a few tylenol PM and morphine for HA.  Pt seen by
SW during hospitalization.
.
5) Depression: Pt to continue Effexor.  Pt to restart Trileptal
once LFts normal.

Medications on Admission:
(per tox note)
lexapro 10mg
flagyl 250 [**Hospital1 **]
clonazepam 0.5 [**Hospital1 **]
effexor 75 mg qday
citalopram 200mg [**12-14**] tab qday
trileptal 300mg [**Hospital1 **]

Discharge Medications:
1. Venlafaxine 75 mg Capsule, Sust. Release 24HR Sig: One (1)
Capsule, Sust. Release 24HR PO DAILY (Daily).


Discharge Disposition:
Home

Discharge Diagnosis:
respiratory failure
shock
hepatitis
overdose


Discharge Condition:
good


Discharge Instructions:
please take all medications as prescribed; I would not start
Trileptal until you see your PCP and make sure your liver tests
are back to normal.

Do not take tylenol or drink alcohol until told so by your PCP.

Please call your PCP or return to ED with abdominal pain,
persistent nausea or vomitting, blood in stool or vomit,
yellowing of skin or any other concern

Followup Instructions:
please call your PCP tomorrow and make an appointment for the
this week to have your bloodwork checked.





Name:  [**Known lastname 11505**],[**Known firstname 11746**]                Unit No:   [**Numeric Identifier 11747**]

Admission Date:  [**2112-8-31**]              Discharge Date:   [**2112-9-5**]

Date of Birth:  [**2089-4-3**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1775**]
Addendum:
LFTs

Pertinent Results:
[**2112-8-31**] 03:10PM BLOOD ALT-876* AST-906* AlkPhos-61
Amylase-1232* TotBili-0.3
[**2112-8-31**] 09:51PM BLOOD ALT-781* AST-858* LD(LDH)-678*
CK(CPK)-696* AlkPhos-47 Amylase-934* TotBili-0.2
[**2112-9-1**] 04:32AM BLOOD ALT-760* AST-773* LD(LDH)-595* AlkPhos-45
Amylase-871* TotBili-0.3
[**2112-9-1**] 04:45PM BLOOD ALT-924* AST-778* LD(LDH)-662*
CK(CPK)-1085* AlkPhos-50 Amylase-764* TotBili-0.5
[**2112-9-1**] 10:00PM BLOOD ALT-906* AST-691* LD(LDH)-586*
CK(CPK)-926* AlkPhos-47 Amylase-610* TotBili-0.6
[**2112-9-2**] 04:16AM BLOOD ALT-926* AST-618* CK(CPK)-700* AlkPhos-48
TotBili-1.0
[**2112-9-2**] 04:11PM BLOOD ALT-917* AST-485* LD(LDH)-495* AlkPhos-47
TotBili-0.7
[**2112-9-3**] 04:08AM BLOOD ALT-770* AST-305* AlkPhos-42 TotBili-0.6
[**2112-9-4**] 06:35AM BLOOD ALT-578* AST-125* AlkPhos-44 Amylase-60
TotBili-0.6

Discharge Disposition:
Home

                             [**First Name11 (Name Pattern1) 1034**] [**Last Name (NamePattern1) 1778**] MD [**MD Number(2) 1779**]

Completed by:[**2112-9-5**]
{'Acute respiratory failure,Hepatitis, unspecified,Shock, unspecified,Poisoning by opium (alkaloids), unspecified,Accidental poisoning by aromatic analgesics, not elsewhere classified,Depressive disorder, not elsewhere classified'}


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: hypotension, respiratory failure, unresponsive

PRESENT ILLNESS: 23 yo f w/ h/o depression transferred from [**Hospital3 2737**] w/
hypotension and respiratory failure.  By report patient was
found down in her home this morning by her 7 yo son, who awoke
the patient's boyfriend.  EMS called. p120, r4, 118/p, sao2 88%.
Pupils noted to be constricted.  Pt noted to have to have agonal
resp of approx 4/min. rec'd IV narcan 2mg x4 w/ some improvement
in resp rate to 10.  Had ongoing resp distress, was clinching
teeth, and was subsequently nasally intubated.
.
In [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], vs:97.9, p138, bp119/87, "intubated". Maintained
on dopamine was switched to levophed.   Noted to have elevated
transaminases 574, 614.  Tox screen +benzos, +opiates. , neg
acetaminophen. CT head neg, LP performed (neg).  Rec'd 5L NS,
7mg vecuronium, vancomycin 1g, ctx 2g, acyclovir 800mg iv.
Transferred to [**Hospital1 **].
.
[**Hospital1 **] ED, tm 99.8, hr 125, bp 111/65, r 17, 100% intubated,
unknown settings. IV nac started, and fentanyl bolus.  CT abd
performed.

MEDICAL HISTORY: depression

MEDICATION ON ADMISSION: (per tox note)
lexapro 10mg
flagyl 250 [**Hospital1 **]
clonazepam 0.5 [**Hospital1 **]
effexor 75 mg qday
citalopram 200mg [**12-14**] tab qday
trileptal 300mg [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: t 100.5, 100/66 (0.2 mcg/k/min norepinephrine), 88,
Intubated, sedated.
pupils 1mm b/l.  minimally reactive
op clr
trachea midline
regular s1,s2. no m/r/g
lca b/l
+bs. soft. nt. nd.
no vaginal discharge.  no masses/tampons/foreign bodies on
bimanual examination.
in ed, brn stool, guiac pos
no le edema.

FAMILY HISTORY: unknown at this time.

SOCIAL HISTORY: Lives with 7 yo son.  Boyfriend intermittently stays over.
Brother recently attempted to commit suicide.  Works at bakery
in afternoons, attending college, studying psychology.  No pets.
 No etoh.  +smoking.  Stopped cocaine (inh, intranasal) and
percocet use approx one month ago, although boyfriend does not
believe that she had any access to perocet recently.  No history
of IVDU.  No recent travel. No outdoor exposures.  No
tick/mosquito bites. 

### Response:
{'Acute respiratory failure,Hepatitis, unspecified,Shock, unspecified,Poisoning by opium (alkaloids), unspecified,Accidental poisoning by aromatic analgesics, not elsewhere classified,Depressive disorder, not elsewhere classified'}
