CHIEF COMPLAINT: drug overdose, respiratory failure

PRESENT ILLNESS: 55yo woman with psychiatric history and previous suicidal
ideation
presented to ED after being found unresponsive.  Likely
overdose on ativan, seroquel and risperdol.  On presentation to
the ED,
was unresponsive and unstable [**Company 5249**] 104.8, 148, 16, 88% RA.  Glc
was 123.
She was intubated and given charcoal as well as dantrolene for
potential
NMS; NMS was felt to be unlikely given lack of rigidity on exam.
 Labs
also significant for increased CK's; hydrated with fluids +
bicarb
for potential rhabdomyolysis.

MEDICAL HISTORY: 1) schizoaffective disorder
2) bipolar
3) h/o suicide attempts
4) hyperlipidemia
5) TAH, h/o uterine CA
6) l. knee surgery
7) chronic bronchitis

MEDICATION ON ADMISSION: seroquel 25mg
risperdol 1mg
lorazepam 1mg
pravachol 10mg
ASA 325
MVI, vit C, folic acid
colace [**Hospital1 **]

ALLERGIES: Lithium / Depakote / Neurontin

PHYSICAL EXAM: initially hyperthermic and hemodynamically unstable in ED.

FAMILY HISTORY: significant for FH of bipolar disorder

SOCIAL HISTORY: smoker 1.5 packs for years
divorced
Poisoning by benzodiazepine-based tranquilizers,Acute respiratory failure,Unspecified chronic bronchitis,Schizoaffective disorder, unspecified,Acute kidney failure, unspecified,Acidosis,Rhabdomyolysis,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Other and unspecified hyperlipidemia
Pois-benzodiazepine tran,Acute respiratry failure,Chronic bronchitis NOS,Schizoaffective dis NOS,Acute kidney failure NOS,Acidosis,Rhabdomyolysis,Poison-psychotropic agt,Hyperlipidemia NEC/NOS
Admission Date:  [**2176-12-11**]              Discharge Date:   [**2176-12-16**]

Date of Birth:  [**2121-12-5**]             Sex:   F

Service: MEDICINE

Allergies:
Lithium / Depakote / Neurontin

Attending:[**First Name3 (LF) 759**]
Chief Complaint:
drug overdose, respiratory failure

Major Surgical or Invasive Procedure:
placement of right IJ

History of Present Illness:
55yo woman with psychiatric history and previous suicidal
ideation
presented to ED after being found unresponsive.  Likely
overdose on ativan, seroquel and risperdol.  On presentation to
the ED,
was unresponsive and unstable [**Company 5249**] 104.8, 148, 16, 88% RA.  Glc
was 123.
She was intubated and given charcoal as well as dantrolene for
potential
NMS; NMS was felt to be unlikely given lack of rigidity on exam.
 Labs
also significant for increased CK's; hydrated with fluids +
bicarb
for potential rhabdomyolysis.

Past Medical History:
1) schizoaffective disorder
2) bipolar
3) h/o suicide attempts
4) hyperlipidemia
5) TAH, h/o uterine CA
6) l. knee surgery
7) chronic bronchitis

Social History:
smoker 1.5 packs for years
divorced

Family History:
significant for FH of bipolar disorder

Physical Exam:
initially hyperthermic and hemodynamically unstable in ED.

On admission to [**Hospital Unit Name 153**], 98.0, 91, 140/70, 18, 100%
on AC (600 x 18, 0.4, 5)

intubated and sedated
pupils minimally responsie
rrr, no m/r/g
coarse breath sounds bilaterally
soft abdomen
neuro exam limited, but no evidence of rigidity on exam

Pertinent Results:
[**2176-12-11**] 10:49PM   TYPE-ART TEMP-37.2 RATES-/15 PO2-161* PCO2-36
PH-7.24* TOTAL CO2-16* BASE XS--11 COMMENTS-QNS TO VRI
[**2176-12-11**] 09:27PM   TYPE-ART TEMP-37.2 PO2-506* PCO2-46* PH-7.17*
TOTAL CO2-18* BASE XS--11 INTUBATED-INTUBATED
[**2176-12-11**] 09:27PM   freeCa-1.01*
[**2176-12-11**] 09:27PM   GLUCOSE-218* LACTATE-2.6* NA+-141 K+-3.6
CL--122*
[**2176-12-11**] 07:35PM URINE  HOURS-RANDOM CREAT-183 SODIUM-69
[**2176-12-11**] 07:35PM URINE  HOURS-RANDOM
[**2176-12-11**] 07:35PM URINE  GR HOLD-HOLD
[**2176-12-11**] 07:35PM URINE  bnzodzpn-POS barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-POS
[**2176-12-11**] 07:35PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.024
[**2176-12-11**] 07:35PM URINE  BLOOD-LG NITRITE-NEG PROTEIN-30
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-NEG
[**2176-12-11**] 07:35PM URINE  RBC-[**3-1**]* WBC-0-2 BACTERIA-FEW YEAST-NONE
EPI-0-2 TRANS EPI-0-2
[**2176-12-11**] 07:35PM URINE  AMORPH-MOD
[**2176-12-11**] 07:27PM   GLUCOSE-181* LACTATE-3.5* NA+-144 K+-4.6
CL--110 TCO2-23
[**2176-12-11**] 07:25PM   UREA N-30* CREAT-2.2*# SODIUM-145
POTASSIUM-4.5 CHLORIDE-111* TOTAL CO2-20* ANION GAP-19
[**2176-12-11**] 07:25PM   ALT(SGPT)-84* AST(SGOT)-148* LD(LDH)-337*
CK(CPK)-4764* ALK PHOS-71 AMYLASE-40 TOT BILI-0.4
[**2176-12-11**] 07:25PM   CK-MB-6 cTropnT-0.07*
[**2176-12-11**] 07:25PM   ALBUMIN-4.6 CALCIUM-9.8 PHOSPHATE-0.9*#
MAGNESIUM-2.3 URIC ACID-5.9*
[**2176-12-11**] 07:25PM   OSMOLAL-317*
[**2176-12-11**] 07:25PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2176-12-11**] 07:25PM   PLT COUNT-152
[**2176-12-11**] 07:25PM   PT-14.4* PTT-25.7 INR(PT)-1.3
[**2176-12-11**] 07:25PM   FIBRINOGE-395

ECG:  Sinus tachycardia, Modest right ventricular conduction
delay pattern
Diffuse ST-T wave abnormalities with right precordial lead
downslying ST
segment elevation - consider acute injury/ischemia or possible
"Brugada-type ECG" pattern Clinical correlation is suggested
Since previous tracing of [**2176-4-4**], sinus tachycardia and diffuse
ST-T wave abnormalities present

TTE: The left atrium is mildly dilated. No atrial septal defect
is seen by 2D or color Doppler. Left ventricular wall thickness,
cavity size, and systolic function are normal (LVEF 60-70%). The
right ventricular cavity is dilated. Right ventricular systolic
function is borderline normal. The ascending aorta  is mildly
dilated. The aortic valve leaflets (3) appear structurally
normal with good leaflet excursion and no aortic regurgitation.
The mitral valve  leaflets are mildly thickened. There is no
mitral valve prolapse. Mild (1+) mitral regurgitation is seen.
The pulmonary artery systolic pressure could not be determined.
There is no pericardial effusion.


Brief Hospital Course:
In ED:

Patient was intubated for airway protection, as she was
unresponsive
secondary to overdose.

Overdose:

 she was given charcoal by NG and toxicology
was consulted.  She was also given dantrolene due to concern for

NMS.

rhabdomyolysis:

managed with IVF hydration and alkalinization of the urine.  She

did have acute renal failure, but FeNa was most consistent with
pre-renal
azotemia, likely secondary to hypotension.

increased anion gap acidosis:

this was likely secondary to both lactic acidosis and uremic
acidosis. Also
had acute respiratory acidosis secondary to hypoventilation.
The metabolic acidosis resolved with hydration, and the
respiratory acidosis resolved after mechanical ventilation.

acute renal failure:

Concern for ATN with rhabdomyolysis, but FeNa consistent
with pre-renal azotemia, secondary to hypotension. This
trended downward with IVF hydration. Potential
rhabdomyolysis was managed with aggressive ivf hydration
with alkalinization of the urine.

ID:

empirically started on levaquin/flagyl in ED with
fever and hypotension.  Not continued in ICU; follow up
cultures.

Spiked to 102.2 on [**2176-12-14**].  Cultures sent, CXR with no
frank infiltrate, and central line removed with cath tip sent
for
culture.  No empiric antibiotics started - awaiting culture
data.

CV:

Presented with new 2mm ST depression in 2,3,avF as
well as lateral pre-cordial leads.  This was likely
a rate-related ischemia as she was tachycardic in the 140's on
presentation.  These ST depressions trended back
to baseline with rate decreasing.  She did have positive
troponins; felt to be demand ischemia. The EKG changes
resolved, and cardiac enzymes trended down.


Medications on Admission:
seroquel 25mg
risperdol 1mg
lorazepam 1mg
pravachol 10mg
ASA 325
MVI, vit C, folic acid
colace [**Hospital1 **]

Discharge Disposition:
Extended Care

Discharge Diagnosis:
drug overdose


Discharge Condition:
To [**Hospital1 **] 4, resolving rhabdo/CK levels

Discharge Instructions:
1. Please follow up: Blood culture data

2. Please f/u HIT ab as outpt

3. Please follow-up with appointments as below

Followup Instructions:
Provider: [**First Name4 (NamePattern1) 247**] [**Last Name (NamePattern1) 248**], MD Where: [**Hospital6 29**] [**Hospital **] Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2177-1-10**] 3:20
Provider: [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 5250**], M.D. Where: [**Hospital6 29**]
CARDIAC SERVICES Phone:[**Telephone/Fax (1) 5251**] Date/Time:[**2177-1-22**] 10:30
Provider: [**Name Initial (NameIs) **] PAIN MANAGEMENT CENTER Where: PAIN MANAGEMENT
CENTER Date/Time:[**2176-12-16**] 1:30
{'Poisoning by benzodiazepine-based tranquilizers,Acute respiratory failure,Unspecified chronic bronchitis,Schizoaffective disorder, unspecified,Acute kidney failure, unspecified,Acidosis,Rhabdomyolysis,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Other and unspecified hyperlipidemia'}


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: drug overdose, respiratory failure

PRESENT ILLNESS: 55yo woman with psychiatric history and previous suicidal
ideation
presented to ED after being found unresponsive.  Likely
overdose on ativan, seroquel and risperdol.  On presentation to
the ED,
was unresponsive and unstable [**Company 5249**] 104.8, 148, 16, 88% RA.  Glc
was 123.
She was intubated and given charcoal as well as dantrolene for
potential
NMS; NMS was felt to be unlikely given lack of rigidity on exam.
 Labs
also significant for increased CK's; hydrated with fluids +
bicarb
for potential rhabdomyolysis.

MEDICAL HISTORY: 1) schizoaffective disorder
2) bipolar
3) h/o suicide attempts
4) hyperlipidemia
5) TAH, h/o uterine CA
6) l. knee surgery
7) chronic bronchitis

MEDICATION ON ADMISSION: seroquel 25mg
risperdol 1mg
lorazepam 1mg
pravachol 10mg
ASA 325
MVI, vit C, folic acid
colace [**Hospital1 **]

ALLERGIES: Lithium / Depakote / Neurontin

PHYSICAL EXAM: initially hyperthermic and hemodynamically unstable in ED.

FAMILY HISTORY: significant for FH of bipolar disorder

SOCIAL HISTORY: smoker 1.5 packs for years
divorced 

### Response:
{'Poisoning by benzodiazepine-based tranquilizers,Acute respiratory failure,Unspecified chronic bronchitis,Schizoaffective disorder, unspecified,Acute kidney failure, unspecified,Acidosis,Rhabdomyolysis,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Other and unspecified hyperlipidemia'}
