CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 22-year-old
female who presented to the Emergency Department requesting
detoxification.

MEDICAL HISTORY: 1.  Delirium tremens; hospital admission from [**7-7**] to [**7-13**].  The patient was admitted for alcohol withdrawal and
required Intensive Care Unit care including administration of
diazepam (per the CIWA protocol).  She had no seizures but
did have acute pancreatitis with a lipase up to 2422 and an
amylase to 505.  ALT up to 158, AST up to 408, and alkaline
phosphatase to 356.
2.  Alcohol abuse; the patient reports drinking heavily in
the past four months without known cause or trigger.  She
admits to drinking four to five 40-ounce beers each day in
addition to a half pint of vodka each day.  Her alcohol abuse
has led to alcoholic hepatitis and alcoholic pancreatitis (as
documented in the past).
3.  Recent pancreatitis from an admission from [**7-7**] to
[**7-13**]; lipase up to 2422.
4.  Anemia.
5.  Question of domestic abuse; as the patient was admitted
with multiple and extensive bruises over her body on the
admission on [**7-7**].  However, the patient denied physical
abuse by her boyfriend.

MEDICATION ON ADMISSION: None.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: The patient reports having multiple family
members with drug problems.  She is not in contact with her
parents or her two siblings.

SOCIAL HISTORY: The patient lives with her boyfriend over
the past three and a half years.  She recently attended a
computer education institute.  She has a history of tobacco
use (half pack per day for the past 10 years).  She has an
extensive history of alcohol abuse which has increased in the
past four months, but her alcohol use started at the age of
12.  She most recently was drinking three to four 40-ounce
beers per day and a half pint of vodka.
Alcohol withdrawal,Acute pancreatitis,Other and unspecified alcohol dependence, unspecified,Anemia, unspecified
Alcohol withdrawal,Acute pancreatitis,Alcoh dep NEC/NOS-unspec,Anemia NOS
Admission Date:  [**2156-7-21**]     Discharge Date:  [**2156-7-23**]

Date of Birth:   [**2133-11-23**]     Sex:  F

Service:  Medicine, [**Location (un) **] Firm

HISTORY OF PRESENT ILLNESS:  The patient is a 22-year-old
female who presented to the Emergency Department requesting
detoxification.

The patient had a recent admission to [**Hospital1 190**] for delirium tremens from [**7-7**] through [**7-13**] requiring an Intensive Care Unit stay for alcohol
withdrawal and pancreatitis (with a lipase of 2422).

The patient said that she started drinking on the day of
discharge ([**7-13**]) because of continued shaking, sweating,
and anxious feelings.  She has been drinking two 40-ounce
beers and a half pint of vodka each day (the last time being
yesterday).  The patient said that she had requested
detoxification, and her aunt brought her to the hospital;
however, she was unsure if she wanted to go ahead with
detoxification at the time of presentation.

She denied suicidal ideation.  She said she has had increased
drinking frequency over the past four months, but did not
give a clear explanation as to why.  She said she has
withdrawal symptoms each Sunday.  She was unsure if she has
had any seizures in the past with her withdrawal.  She said
several weeks ago she had a body shaking/jerking episode when
she cut down on her drinking.  However, she was aware of the
episode the entire time, was not incontinent, and was able to
ease it by trying to relax.

She denies any history of physical or sexual abuse/being hit.
She also denies fevers, feeling ill, headache, abdominal
pain, nausea, vomiting, problems with her bowel or urine,
chest pain, cough, or shortness of breath.  She does complain
of bilateral toe pain for one month without known cause or
injury.

In the Emergency Department, she was tremulous and said that
she could not tell dreams from reality.  In the Emergency
Department, her blood pressure was controlled but her heart
rate did accelerate to the 130s.  The patient remained
tremulous but did receive benzodiazepines and fluid
hydration.

PAST MEDICAL HISTORY:
1.  Delirium tremens; hospital admission from [**7-7**] to [**7-13**].  The patient was admitted for alcohol withdrawal and
required Intensive Care Unit care including administration of
diazepam (per the CIWA protocol).  She had no seizures but
did have acute pancreatitis with a lipase up to 2422 and an
amylase to 505.  ALT up to 158, AST up to 408, and alkaline
phosphatase to 356.
2.  Alcohol abuse; the patient reports drinking heavily in
the past four months without known cause or trigger.  She
admits to drinking four to five 40-ounce beers each day in
addition to a half pint of vodka each day.  Her alcohol abuse
has led to alcoholic hepatitis and alcoholic pancreatitis (as
documented in the past).
3.  Recent pancreatitis from an admission from [**7-7**] to
[**7-13**]; lipase up to 2422.
4.  Anemia.
5.  Question of domestic abuse; as the patient was admitted
with multiple and extensive bruises over her body on the
admission on [**7-7**].  However, the patient denied physical
abuse by her boyfriend.

MEDICATIONS ON ADMISSION:  None.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  The patient lives with her boyfriend over
the past three and a half years.  She recently attended a
computer education institute.  She has a history of tobacco
use (half pack per day for the past 10 years).  She has an
extensive history of alcohol abuse which has increased in the
past four months, but her alcohol use started at the age of
12.  She most recently was drinking three to four 40-ounce
beers per day and a half pint of vodka.

SUBSTANCE ABUSE HISTORY:  She admits to a history of crack
cocaine, ectasy, and mushroom use in the past; but not in the
past few years.  She denies intravenous drug use.

FAMILY HISTORY:  The patient reports having multiple family
members with drug problems.  She is not in contact with her
parents or her two siblings.

PHYSICAL EXAMINATION ON PRESENTATION:  Vital signs revealed
temperature was 99.1, heart rate was 105, blood pressure was
110/62, respiratory rate was 17, and oxygen saturation was
99% on room air.  In general, a tremulous young female who
was well-nourished.  Alert and oriented times three.  Awoken
easily.  Somewhat agitated when alcohol abuse topics brought
up.  Head, eyes, ears, nose, and throat examination revealed
pupils were equal, round, and reactive to light.  Extraocular
muscles were intact.  Normocephalic and atraumatic.  The
mucous membranes were moist.  The neck was supple.  No
lymphadenopathy.  Heart revealed tachycardia with a regular
rhythm.  No murmurs, rubs, or gallops.  The lungs were clear
to auscultation bilaterally.  The abdomen revealed positive
bowel sounds in all four quadrants.  Soft, nontender, and
nondistended.  No masses.  No hepatosplenomegaly.  Extremity
examination revealed extremities were warm.  No clubbing,
cyanosis, or edema.  All toes were tender to touch
bilaterally.  Sensation was intact to light touch, pinprick,
and proprioception.  No gross abnormalities noted.  Skin
examination revealed multiple blue/purple/yellow bruises on
her back and shins.

PERTINENT LABORATORY VALUES ON PRESENTATION:   Laboratory
data on admission revealed white blood cell count was 5.8
(differential revealed neutrophils of 42.2%, lymphocytes of
48.4%, monocytes of 5%, eosinophils of 3.8%, and basophils of
2.6%), hematocrit was 36.8, and platelet count was 689.
Electrolytes revealed sodium was 143, potassium was 4.2,
chloride was 106, bicarbonate was 22, blood urea nitrogen was
5, creatinine was 0.5, and blood glucose was 90.  Calcium was
9.4, phosphate was 6.4, and magnesium was 2.3.  Urine
toxicology was negative.  Serum alcohol level was 394.  Serum
benzodiazepines were positive.  Serum aspirin, acetaminophen,
barbiturates, and tricyclic antidepressants were negative.
Urinalysis revealed specific gravity was 1.012; negative for
leukocytes, nitrites, blood, red blood cells, or white blood
cells.  A few bacteria were present with 3 to 5 epithelial
cells.  ALT was 103, AST was 187, alkaline phosphatase was
201, amylase was 118 (previous was 643), lipase was 737
(previous was 2422), and total bilirubin was 0.5.

HOSPITAL COURSE BY ISSUE/SYSTEM:   In the Emergency
Department, the patient received multiple doses of Ativan
(totalling approximately 8 mg), librium 25 mg, and Valium 5
mg.

1.  ALCOHOL WITHDRAWAL ISSUES:  The patient was admitted to
the Medical Intensive Care Unit on [**7-21**] and was placed on
Valium to control her withdrawal symptoms; per the CIWA
protocol for delirium tremens prophylaxis given her history
of delirium tremens.

She continued to receive Valium 10 mg by mouth as needed;
however, this requirement did slowly decrease during her
hospital stay.  On [**7-23**], she was transferred to the
medical floor for continued management of her alcohol
withdrawal symptoms.  She did continue on the CIWA protocol.
The patient did receive thiamine, folate, and multivitamins
to replete any possible deficiencies.

The patient did initially refuse to speak with a social
worker, but was eventually seen by [**Name (NI) 2411**] [**Last Name (NamePattern1) 51086**] for an
addiction counseling consultation.  Multiple options for
detoxification centers were discussed with the patient;
however, it was unclear if the patient was willing to admit
herself to one of these institutions for continued treatment
of her withdrawal symptoms.

The patient was often agitated and reluctant to interact with
the hospital staff.  She became insistent on leaving the
hospital on [**7-23**].  A Psychiatry consultation was ordered
to assess the patient's competency to be discharged against
medical advice.  Psychiatry did deem her to be competent to
make that decision.

The patient was given an extensive list of detoxification
centers that she could potentially go to over the weekend;
however, no free care beds were available at the time of the
patient's departure from the hospital.  She was also given a
list of telephone numbers for centers related to the
management of alcohol abuse; including Alcohol Anonymous and
alcohol and drug referral hot lines.  The patient said that
she had plans to attend a detoxification facility that coming
Monday.

She left against medical advice with her boyfriend on the
evening of [**7-23**] after a full explanation of the risks of
leaving the hospital given her current medical problems.

2.  PANCREATITIS ISSUES:  The patient presented with elevated
lipase levels; however, not to the extent of her previous
admission.  They did continue to decrease during her hospital
stay.  She did tolerate full meals without any nausea,
vomiting, or abdominal pain on [**7-23**].  The patient reported
never having any abdominal symptoms despite the evidence of
pancreatitis related to her extensive alcohol abuse.

3.  ALCOHOLIC HEPATITIS ISSUES:  The patient has a history of
elevated transaminases that had trended toward the normal
range but were still mildly elevated on [**7-23**].  She denied
any history of jaundice or a history of right upper quadrant
abdominal pain.

4.  FLUIDS/ELECTROLYTES/NUTRITION ISSUES:  On admission, the
patient received intravenous fluids as well as folate,
thiamine, and multivitamins to replete any possible
deficiencies.  The patient did eventually tolerate a full
house diet.

5.  PSYCHOSOCIAL ISSUES:  The patient said that her boyfriend
of three and a half years was supportive.  However, she did
present with multiple bruises on her body on the prior
admission which were suggestive of possible physical abuse;
however, the patient denied this.

The patient did express some interest in attending a
detoxification facility.  She was given information regarding
multiple centers in the area where she could go for
detoxification.

CONDITION AT DISCHARGE:  Condition on discharge was stable.

DISCHARGE STATUS:  The patient left against medical advice
but had no active symptoms related to pancreatitis or alcohol
withdrawal at the time of departure.  She was medically
stable and deemed by Psychiatry to have the capacity to leave
against medical advice.

DISCHARGE DIAGNOSES:
1.  Alcohol withdrawal.
2.  Alcohol abuse.
3.  Pancreatitis.
4.  Transaminitis.
5.  Anemia.

MEDICATIONS ON DISCHARGE:  None.

DISCHARGE INSTRUCTIONS/FOLLOWUP:
1.  The patient was strongly advised to enter a
detoxification facility over the weekend.  She was supplied
with a list of multiple local centers that could provide
detoxification for her; however, no free beds were available
on [**7-23**].
2.  The patient did have a follow-up appointment scheduled
with Dr. [**First Name8 (NamePattern2) 7810**] [**Last Name (NamePattern1) 3315**] in [**Hospital6 733**] on [**8-9**].






                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 24755**]

Dictated By:[**Last Name (NamePattern1) 1615**]

MEDQUIST36

D:  [**2156-8-4**]  13:13
T:  [**2156-8-12**]  14:00
JOB#:  [**Job Number 51087**]
{'Alcohol withdrawal,Acute pancreatitis,Other and unspecified alcohol dependence, unspecified,Anemia, unspecified'}


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: 

PRESENT ILLNESS: The patient is a 22-year-old
female who presented to the Emergency Department requesting
detoxification.

MEDICAL HISTORY: 1.  Delirium tremens; hospital admission from [**7-7**] to [**7-13**].  The patient was admitted for alcohol withdrawal and
required Intensive Care Unit care including administration of
diazepam (per the CIWA protocol).  She had no seizures but
did have acute pancreatitis with a lipase up to 2422 and an
amylase to 505.  ALT up to 158, AST up to 408, and alkaline
phosphatase to 356.
2.  Alcohol abuse; the patient reports drinking heavily in
the past four months without known cause or trigger.  She
admits to drinking four to five 40-ounce beers each day in
addition to a half pint of vodka each day.  Her alcohol abuse
has led to alcoholic hepatitis and alcoholic pancreatitis (as
documented in the past).
3.  Recent pancreatitis from an admission from [**7-7**] to
[**7-13**]; lipase up to 2422.
4.  Anemia.
5.  Question of domestic abuse; as the patient was admitted
with multiple and extensive bruises over her body on the
admission on [**7-7**].  However, the patient denied physical
abuse by her boyfriend.

MEDICATION ON ADMISSION: None.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: The patient reports having multiple family
members with drug problems.  She is not in contact with her
parents or her two siblings.

SOCIAL HISTORY: The patient lives with her boyfriend over
the past three and a half years.  She recently attended a
computer education institute.  She has a history of tobacco
use (half pack per day for the past 10 years).  She has an
extensive history of alcohol abuse which has increased in the
past four months, but her alcohol use started at the age of
12.  She most recently was drinking three to four 40-ounce
beers per day and a half pint of vodka. 

### Response:
{'Alcohol withdrawal,Acute pancreatitis,Other and unspecified alcohol dependence, unspecified,Anemia, unspecified'}
