CHIEF COMPLAINT: Ethylene glycol intoxication.

PRESENT ILLNESS: This is a 45 y.o. female with history of alcohol abuse and
depression who presented to the ED after attempting suicide by
ingesting over a pint of ethylene glycol (Prestone antifreeze
(93.8% ethylene glycol)) around 2:30 PM on the day of admission.
She also drank about 1.5 pints of vodka overnight prior to the
day of admission. Approximately 30 mins after ingesting the
antifreeze, she states that her vision was blurry, with
decreased level of alertness and orientation. She was brought to
[**Hospital1 18**] by EMS about thirty minutes thereafter.
.
In the ED, her vital signs were stable: HR=99, BP=95/63, RR=17,
O2sat=100%onRA.  She had one episode of clear-yellow emesis. She
had a measured serum osmolality of 449, calculated Osmolality
358 (with EtOH),osmolal gap = 90.8, serum alcohol level of 273,
anion gap of 16, and creatinine 0.7. She was seen by toxicology
and renal in the ED and given 15mg/kg fomepizole x 1, and had
right femoral hemodialysis line placed in case urgent
hemodialysis was needed. Per renal fellow, no oxalate crystals
were noted on urinalysis.
.
In the MICU, her anion gap and measured osmolality gradually
decreased overnight and she was hemodynamically stable. She was
transferred to the medicine service for further care. She
continues to be on suicide precautions. She currently denies any
suicidal or homicidal ideation. Otherwise mentating well, and
pleasant in conversation. Today [**7-22**] she is feeling well,
ethylene glycol level 59, no evidence of ETOH withdrawl. HD line
and femoral line pulled.

MEDICAL HISTORY: 1. Alcohol abuse
2. Hepatitis C - unknown how she contracted, never received
blood transfusion or used IV drugs.  Discovered incidentally
from annual blood donations.  She has had biopsy in New
[**Location (un) **] that did not demonstrate cirrhosis.  Interferon
therapy has been discussed in the past but precluded due to
history of alcohol use and depression
3. Depression - Not currently treated.
4. Tobacco abuse

MEDICATION ON ADMISSION: Occasional multivitamin
No herbal supplements.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: 98.2, 75, 140/80, 18, 99% on RA, Weight=115 lbs
GEN: NAD, well-appearing, appears stated age
HEENT: EOMI, PERRL 4mm=>2mm, sclera anicteric, moist mucous
membranes
NECK: Supple, no JVD, trachea midline, thyroid non-enlarged
CARDIAC: regular rate & rhythm, 1+ systolic decrescendo murmur
heard best at upper left sternal border, normal S1 S2, no rubs,
no gallops
PULM: Lungs CTAB, no wheezes/rales/rhonchi
ABD: Soft, mild tenderness in her left epigastrium, +BS in 4
quadrants, no HSM appreciated
EXT: No C/C/E. 1+ peripheral pulses (DP/PT)
NEURO: A&O x 3, CN II-XII grossly intact, moves all 4
extremities
SKIN: No jaundice, no ecchymoses
Groin: Right dressing in place with dried blood, strong DP
pulse.

FAMILY HISTORY: Family history of stroke, father.

SOCIAL HISTORY: She works as a part-time bartender. She lives with husband,
step-son, and and is primary caretaker of her father who has had
a stroke.  She has smoked tobacco, 1ppd since age 18. She drinks
1 pint of vodka daily. She has attempted to quit drinking by
seeking rehab services in [**2149**]. She reports that she has
attempted to suicide once in the past (slit her wrists). She
denies being subject to any domestic abuse.
Toxic effect of other nonpetroleum-based solvents,Chronic hepatitis C without mention of hepatic coma,Phlebitis and thrombophlebitis of superficial veins of upper extremities,Thrombocytopenia, unspecified,Suicide and self-inflicted poisoning by other and unspecified solid and liquid substances,Other and unspecified alcohol dependence, continuous,Depressive disorder, not elsewhere classified,Esophageal reflux,Other specified diseases of blood and blood-forming organs,Other abnormal glucose,Tobacco use disorder
Toxic eff nonpetrol solv,Chrnc hpt C wo hpat coma,Phlbts sprfc vn up extrm,Thrombocytopenia NOS,Poison-solid/liquid NEC,Alcoh dep NEC/NOS-contin,Depressive disorder NEC,Esophageal reflux,Blood diseases NEC,Abnormal glucose NEC,Tobacco use disorder
Admission Date:  [**2155-7-20**]              Discharge Date:   [**2155-7-25**]

Date of Birth:  [**2110-7-2**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 358**]
Chief Complaint:
Ethylene glycol intoxication.

Major Surgical or Invasive Procedure:
None


History of Present Illness:
This is a 45 y.o. female with history of alcohol abuse and
depression who presented to the ED after attempting suicide by
ingesting over a pint of ethylene glycol (Prestone antifreeze
(93.8% ethylene glycol)) around 2:30 PM on the day of admission.
She also drank about 1.5 pints of vodka overnight prior to the
day of admission. Approximately 30 mins after ingesting the
antifreeze, she states that her vision was blurry, with
decreased level of alertness and orientation. She was brought to
[**Hospital1 18**] by EMS about thirty minutes thereafter.
.
In the ED, her vital signs were stable: HR=99, BP=95/63, RR=17,
O2sat=100%onRA.  She had one episode of clear-yellow emesis. She
had a measured serum osmolality of 449, calculated Osmolality
358 (with EtOH),osmolal gap = 90.8, serum alcohol level of 273,
anion gap of 16, and creatinine 0.7. She was seen by toxicology
and renal in the ED and given 15mg/kg fomepizole x 1, and had
right femoral hemodialysis line placed in case urgent
hemodialysis was needed. Per renal fellow, no oxalate crystals
were noted on urinalysis.
.
In the MICU, her anion gap and measured osmolality gradually
decreased overnight and she was hemodynamically stable. She was
transferred to the medicine service for further care. She
continues to be on suicide precautions. She currently denies any
suicidal or homicidal ideation. Otherwise mentating well, and
pleasant in conversation. Today [**7-22**] she is feeling well,
ethylene glycol level 59, no evidence of ETOH withdrawl. HD line
and femoral line pulled.

Past Medical History:
1. Alcohol abuse
2. Hepatitis C - unknown how she contracted, never received
blood transfusion or used IV drugs.  Discovered incidentally
from annual blood donations.  She has had biopsy in New
[**Location (un) **] that did not demonstrate cirrhosis.  Interferon
therapy has been discussed in the past but precluded due to
history of alcohol use and depression
3. Depression - Not currently treated.
4. Tobacco abuse

Social History:
She works as a part-time bartender. She lives with husband,
step-son, and and is primary caretaker of her father who has had
a stroke.  She has smoked tobacco, 1ppd since age 18. She drinks
1 pint of vodka daily. She has attempted to quit drinking by
seeking rehab services in [**2149**]. She reports that she has
attempted to suicide once in the past (slit her wrists). She
denies being subject to any domestic abuse.

Family History:
Family history of stroke, father.

Physical Exam:
Vitals: 98.2, 75, 140/80, 18, 99% on RA, Weight=115 lbs
GEN: NAD, well-appearing, appears stated age
HEENT: EOMI, PERRL 4mm=>2mm, sclera anicteric, moist mucous
membranes
NECK: Supple, no JVD, trachea midline, thyroid non-enlarged
CARDIAC: regular rate & rhythm, 1+ systolic decrescendo murmur
heard best at upper left sternal border, normal S1 S2, no rubs,
no gallops
PULM: Lungs CTAB, no wheezes/rales/rhonchi
ABD: Soft, mild tenderness in her left epigastrium, +BS in 4
quadrants, no HSM appreciated
EXT: No C/C/E. 1+ peripheral pulses (DP/PT)
NEURO: A&O x 3, CN II-XII grossly intact, moves all 4
extremities
SKIN: No jaundice, no ecchymoses
Groin: Right dressing in place with dried blood, strong DP
pulse.


Pertinent Results:
[**2155-7-20**] 03:25PM   WBC-5.3 RBC-3.67* HGB-13.5 HCT-38.5 MCV-105*
MCH-36.7* MCHC-35.0 RDW-14.0
[**2155-7-20**] 03:25PM   PLT COUNT-191
[**2155-7-20**] 03:25PM   NEUTS-31* BANDS-0 LYMPHS-54* MONOS-7 EOS-6*
BASOS-2 ATYPS-0 METAS-0 MYELOS-0
[**2155-7-20**] 03:25PM   GLUCOSE-98 UREA N-10 CREAT-0.7 SODIUM-145
POTASSIUM-4.5 CHLORIDE-105 TOTAL CO2-24 ANION GAP-21*
[**2155-7-20**] 03:25PM   CALCIUM-8.7 PHOSPHATE-4.3 MAGNESIUM-2.2
[**2155-7-20**] 03:25PM   OSMOLAL-449*
[**2155-7-20**] 03:25PM   HCG-<5
[**2155-7-20**] 03:25PM   ASA-NEG ETHANOL-273* ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2155-7-20**] 03:49PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-NEG
[**2155-7-20**] 03:49PM URINE  bnzodzpn-NEG barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2155-7-20**] 03:49PM URINE  HOURS-RANDOM
[**2155-7-20**] 06:50PM   TYPE-ART PO2-91 PCO2-42 PH-7.42 TOTAL CO2-28
BASE XS-2
[**2155-7-22**] Ethylene glycol = 59

[**2155-7-23**] wbc = 4.4, HCT = 34.6, platelets = 166
[**2155-7-23**] Na=139, K=3.8, CL=103, CO2=29, BUN=3, Creat=0.5,
Glucose= 104
[**2155-7-23**] Ethylene glycol < 10

[**7-21**] Cxr: Normal chest. Possible slight hyperexpansion


Brief Hospital Course:
45 y.o. female with history of depression & alcohol abuse who
presents with ethylene glycol intoxication after an attempted
suicide. Likely co-ingestion of EtOH was protective in light
markedly elevated osmolality gap but moderately elevated anion
gap.
.
# Ethylene glycol intoxication: The patient remained
neurologically, hemodynamically stable throughout her
hospitalization. She was followed by the toxicology, renal and
psychiatry teams. She was started on fomepizole, finishing her
last dose on [**7-23**].  Her ethylene glycol level was measured daily
and fell from 444 to 59 ([**7-22**] AM) to less than 10 ([**7-23**] AM).
Measured osmolality has fallen from 449 to 330 over first 12
hours of admission.  On admission a right femoral HD catheter
was placed in case dialysis was needed, but her electrolytes and
renal function remained normal and she continued to have good
UOP throughout her stay.  Her HD catheter was removed on [**7-22**]
without complication. She was continued on folate and pyridoxine
for ethylene glycol metabolite elmination and [**7-23**] her ethylene
glycol level was <10.

# ETOH abuse: She had no clinical evidence of withdrawal. She
was monitored on a valium CIWA scale ut did not require any
doses.  She was started on thiamine, folate and a MVI given ETOH
abuse and macrocytosis.
.
# Depression: The psychiatry team followed the patient
throughout her stay. She was maintained on a 1:1 sitter and
suicide watch during her stay. She denied any further suicidal
ideation.  She is agreeable to psychiatric hospitalization.

# Hepatitis C - Stable, no active issues.  She should follow up
with her liver doctor as needed as an outpatient.

#Mild Transaminitis: No previous record in OMR but is likely
secondary to chronic Hep C or acute Etoh ingestion. They
continue to trend down during her hospitalization.

# Smoking: She was maintained on a nicotine patch.

# Superficial phlebitis: She developed redness and pain in the
area of a peripheral IV in her left upper extremity.  Warm packs
were applied and her arm was elevated with improvement in the
erythema and induration.  she remained afebrile with a normal
WBC, so no ultrasound was pursued.

# Social issues:  While the patient was on the medical floor her
husband asked to take her off the floor multiple times and
became angry when limits were set.  He had to be asked to leave
the room when speaking with and examining the patient and at
times was resistant to this. The social worker and nurse manager
were involved and limits were set.

# Code status - FULL


Medications on Admission:
Occasional multivitamin
No herbal supplements.

Discharge Medications:
1. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
2. Nicotine 21 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily).
3. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).



Discharge Disposition:
Extended Care

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

Discharge Diagnosis:
Primary
1. Ethylene Glycol Intoxication
2. Depression
3. Alcohol Abuse
4. Superficial phlebitis

Secondary
1. Hepatitis C


Discharge Condition:
HD stable, tolerating PO, ethylene glycol level <10


Discharge Instructions:
You were admitted to the hospital because you ingested ethylene
glycol (antifreeze).

You are now medically stable and your levels of ethylene glycol
are undetectable. You are being transferred to a psychiatric
facility for further management.

However, if you should start to have extreme pain on urination,
blood in urine, swelling in your legs, chest pain, shortness of
breath, fevers, chills, worse pain or redness in your arm or any
other concerning syptoms you should call your doctor.

Please take all your medications as directed.

Please keep all of your follow up appointments.

Followup Instructions:
You should schedule an appointment with your PCP [**Name Initial (PRE) 176**] [**11-26**]
weeks following discharge from the hospital.

You should follow up with your Liver doctor.

Please keep all of your psychiatric appointments as recommended
by the psychiatry service.
{'Toxic effect of other nonpetroleum-based solvents,Chronic hepatitis C without mention of hepatic coma,Phlebitis and thrombophlebitis of superficial veins of upper extremities,Thrombocytopenia, unspecified,Suicide and self-inflicted poisoning by other and unspecified solid and liquid substances,Other and unspecified alcohol dependence, continuous,Depressive disorder, not elsewhere classified,Esophageal reflux,Other specified diseases of blood and blood-forming organs,Other abnormal glucose,Tobacco use disorder'}


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: Ethylene glycol intoxication.

PRESENT ILLNESS: This is a 45 y.o. female with history of alcohol abuse and
depression who presented to the ED after attempting suicide by
ingesting over a pint of ethylene glycol (Prestone antifreeze
(93.8% ethylene glycol)) around 2:30 PM on the day of admission.
She also drank about 1.5 pints of vodka overnight prior to the
day of admission. Approximately 30 mins after ingesting the
antifreeze, she states that her vision was blurry, with
decreased level of alertness and orientation. She was brought to
[**Hospital1 18**] by EMS about thirty minutes thereafter.
.
In the ED, her vital signs were stable: HR=99, BP=95/63, RR=17,
O2sat=100%onRA.  She had one episode of clear-yellow emesis. She
had a measured serum osmolality of 449, calculated Osmolality
358 (with EtOH),osmolal gap = 90.8, serum alcohol level of 273,
anion gap of 16, and creatinine 0.7. She was seen by toxicology
and renal in the ED and given 15mg/kg fomepizole x 1, and had
right femoral hemodialysis line placed in case urgent
hemodialysis was needed. Per renal fellow, no oxalate crystals
were noted on urinalysis.
.
In the MICU, her anion gap and measured osmolality gradually
decreased overnight and she was hemodynamically stable. She was
transferred to the medicine service for further care. She
continues to be on suicide precautions. She currently denies any
suicidal or homicidal ideation. Otherwise mentating well, and
pleasant in conversation. Today [**7-22**] she is feeling well,
ethylene glycol level 59, no evidence of ETOH withdrawl. HD line
and femoral line pulled.

MEDICAL HISTORY: 1. Alcohol abuse
2. Hepatitis C - unknown how she contracted, never received
blood transfusion or used IV drugs.  Discovered incidentally
from annual blood donations.  She has had biopsy in New
[**Location (un) **] that did not demonstrate cirrhosis.  Interferon
therapy has been discussed in the past but precluded due to
history of alcohol use and depression
3. Depression - Not currently treated.
4. Tobacco abuse

MEDICATION ON ADMISSION: Occasional multivitamin
No herbal supplements.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: 98.2, 75, 140/80, 18, 99% on RA, Weight=115 lbs
GEN: NAD, well-appearing, appears stated age
HEENT: EOMI, PERRL 4mm=>2mm, sclera anicteric, moist mucous
membranes
NECK: Supple, no JVD, trachea midline, thyroid non-enlarged
CARDIAC: regular rate & rhythm, 1+ systolic decrescendo murmur
heard best at upper left sternal border, normal S1 S2, no rubs,
no gallops
PULM: Lungs CTAB, no wheezes/rales/rhonchi
ABD: Soft, mild tenderness in her left epigastrium, +BS in 4
quadrants, no HSM appreciated
EXT: No C/C/E. 1+ peripheral pulses (DP/PT)
NEURO: A&O x 3, CN II-XII grossly intact, moves all 4
extremities
SKIN: No jaundice, no ecchymoses
Groin: Right dressing in place with dried blood, strong DP
pulse.

FAMILY HISTORY: Family history of stroke, father.

SOCIAL HISTORY: She works as a part-time bartender. She lives with husband,
step-son, and and is primary caretaker of her father who has had
a stroke.  She has smoked tobacco, 1ppd since age 18. She drinks
1 pint of vodka daily. She has attempted to quit drinking by
seeking rehab services in [**2149**]. She reports that she has
attempted to suicide once in the past (slit her wrists). She
denies being subject to any domestic abuse. 

### Response:
{'Toxic effect of other nonpetroleum-based solvents,Chronic hepatitis C without mention of hepatic coma,Phlebitis and thrombophlebitis of superficial veins of upper extremities,Thrombocytopenia, unspecified,Suicide and self-inflicted poisoning by other and unspecified solid and liquid substances,Other and unspecified alcohol dependence, continuous,Depressive disorder, not elsewhere classified,Esophageal reflux,Other specified diseases of blood and blood-forming organs,Other abnormal glucose,Tobacco use disorder'}
