CHIEF COMPLAINT: somnolence

PRESENT ILLNESS: Mr. [**Known firstname **] [**Known lastname **] is a 26 year old man with a past medical
history significant for asthma, bipolar disorder and substance
abuse who was brought to the Emergency Department by his
girlfriend with sinus tachycardia to 130s, hot skin, wheezing,
and somnolence. Per his girlfriend she picked him up this
afternoon and noticed a marked difference in his mental status
consistent with prior episodes of intoxication and overdose. She
did not report any specific complaints but recognized that he
was hallucinating (believed there was another person in the car
and talking to himself). She believes that the patient overdosed
on Klonipin, Xanax and Neurontin. He denied use of heroin today.
He has a significant history of heroin and narcotic abuse but he
had reportedly been clean "9 days" prior to his presentation
today.
.
In the ED, initial vs were: T 100.1 P 138 BP 133/56 RR 16 O2 Sat
99% RA. Patient was somnolent but arousable. Per ED, he showed
evidence of increased work of breathing with accessory muscle
use and was subsequently given naloxone 0.4mg and lorazepam. He
ultimately became agitated and received haldol 5mg. Due to his
low grade temperature, respiratory effort and wheezing he was
given ceftriaxone 1 g IV, levaquin 750 mg IV, and solumedrol 125
mg IV. The patient had blood cultures drawn prior to
antibiotics. His serum tox screen was negative for
benzodiazepines, TCAs, Etoh, Aspirin, and Acetaminophen. Chest
x-ray that showed no acute lung process. Toxicology service was
consulted. Prior to transfer to the ICU patient's wheezing had
improved and agitation had resolved.
.
On arrival to the floor patient was initially awake and confused
but ultimately cooperative and able to answer simple questions.
Without interaction he quickly becomes somnolent responding to
sternal rub. Foley catheter was placed with significant urine
output (400 cc).

MEDICAL HISTORY: 1) Asthma recent hospitalization at [**Hospital6 19155**]
for asthma exacerbation
2) Bipolar disorder
3) Seizure disorder per patient report, not confirmed in prison
medical records
4) Depression/PTSD
5) Heroin abuse/dependence
6) Hepatitis C per patient report

MEDICATION ON ADMISSION: Wellbutrin
Neurontin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 99.7 P: 95 R: 20 O2: 95%
General: somnolent, arousable to sternal rub, oriented to self,
follows simple commands, inattentive
HEENT: Sclera anicteric, pupils small 2-3 mm and sluggish
response, MMM, oropharynx clear
Neck: supple, JVP elevated, no LAD
Lungs: faint end expiratory wheezes L > R, faint crackles at
bases, good air movement, nonlabored breathing
CV: Regular rhythm, tachycardic, normal S1 + S2, no murmurs,
rubs, gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: warm, well perfused, 2+ pulses, no flushing or erythema, no
clubbing, cyanosis or edema
Skin: several tattoos, follicular rash on chest, several small
<1 cm scatterd, erythematous shallow ulcers/plaques on penis
GU: foley in place

FAMILY HISTORY: Daughter: 22 month old with asthma
Otherwise non-contributory

SOCIAL HISTORY: Patient was recently incarcerated for a 2 month period of time
ending on [**2117-10-2**]. He was again released from prison in [**12-11**].
He is currently homeless. He as a girlfriend and a daughter.
[**Name (NI) 1139**]: Past unspecified history, though none in last 3 months
due to recent incarceration
EtOH: Denies
Illicits: Prior heroin abuse history, no known use in the last 9
days.
Poisoning by other opiates and related narcotics,Pneumonia, organism unspecified,Bipolar I disorder, most recent episode (or current) depressed, unspecified,Opioid type dependence, continuous,Accidental poisoning by other opiates and related narcotics,Asthma, unspecified type, unspecified,Lack of housing,Posttraumatic stress disorder,Poisoning by other and unspecified anticonvulsants,Accidental poisoning by anticonvulsant and anti-parkinsonism drugs
Poisoning-opiates NEC,Pneumonia, organism NOS,Bipol I cur depres NOS,Opioid dependence-contin,Acc poison-opiates NEC,Asthma NOS,Lack of housing,Posttraumatic stress dis,Pois-anticonvul NEC/NOS,Acc poisn-anticonvulsant
Admission Date:  [**2118-2-15**]              Discharge Date:   [**2118-2-16**]

Date of Birth:  [**2092-1-9**]             Sex:   M

Service: EMERGENCY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2565**]
Chief Complaint:
somnolence

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Mr. [**Known firstname **] [**Known lastname **] is a 26 year old man with a past medical
history significant for asthma, bipolar disorder and substance
abuse who was brought to the Emergency Department by his
girlfriend with sinus tachycardia to 130s, hot skin, wheezing,
and somnolence. Per his girlfriend she picked him up this
afternoon and noticed a marked difference in his mental status
consistent with prior episodes of intoxication and overdose. She
did not report any specific complaints but recognized that he
was hallucinating (believed there was another person in the car
and talking to himself). She believes that the patient overdosed
on Klonipin, Xanax and Neurontin. He denied use of heroin today.
He has a significant history of heroin and narcotic abuse but he
had reportedly been clean "9 days" prior to his presentation
today.
.
In the ED, initial vs were: T 100.1 P 138 BP 133/56 RR 16 O2 Sat
99% RA. Patient was somnolent but arousable. Per ED, he showed
evidence of increased work of breathing with accessory muscle
use and was subsequently given naloxone 0.4mg and lorazepam. He
ultimately became agitated and received haldol 5mg. Due to his
low grade temperature, respiratory effort and wheezing he was
given ceftriaxone 1 g IV, levaquin 750 mg IV, and solumedrol 125
mg IV. The patient had blood cultures drawn prior to
antibiotics. His serum tox screen was negative for
benzodiazepines, TCAs, Etoh, Aspirin, and Acetaminophen. Chest
x-ray that showed no acute lung process. Toxicology service was
consulted. Prior to transfer to the ICU patient's wheezing had
improved and agitation had resolved.
.
On arrival to the floor patient was initially awake and confused
but ultimately cooperative and able to answer simple questions.
Without interaction he quickly becomes somnolent responding to
sternal rub. Foley catheter was placed with significant urine
output (400 cc).

Past Medical History:
1) Asthma recent hospitalization at [**Hospital6 19155**]
for asthma exacerbation
2) Bipolar disorder
3) Seizure disorder per patient report, not confirmed in prison
medical records
4) Depression/PTSD
5) Heroin abuse/dependence
6) Hepatitis C per patient report

Social History:
Patient was recently incarcerated for a 2 month period of time
ending on [**2117-10-2**]. He was again released from prison in [**12-11**].
He is currently homeless. He as a girlfriend and a daughter.
[**Name (NI) 1139**]: Past unspecified history, though none in last 3 months
due to recent incarceration
EtOH: Denies
Illicits: Prior heroin abuse history, no known use in the last 9
days.


Family History:
Daughter: 22 month old with asthma
Otherwise non-contributory

Physical Exam:
Vitals: T: 99.7 P: 95 R: 20 O2: 95%
General: somnolent, arousable to sternal rub, oriented to self,
follows simple commands, inattentive
HEENT: Sclera anicteric, pupils small 2-3 mm and sluggish
response, MMM, oropharynx clear
Neck: supple, JVP elevated, no LAD
Lungs: faint end expiratory wheezes L > R, faint crackles at
bases, good air movement, nonlabored breathing
CV: Regular rhythm, tachycardic, normal S1 + S2, no murmurs,
rubs, gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: warm, well perfused, 2+ pulses, no flushing or erythema, no
clubbing, cyanosis or edema
Skin: several tattoos, follicular rash on chest, several small
<1 cm scatterd, erythematous shallow ulcers/plaques on penis
GU: foley in place

Pertinent Results:
ADMISSION LABS [**2118-2-15**]:
LACTATE-2.2*
GLUCOSE-85 UREA N-15 CREAT-0.9 SODIUM-141 POTASSIUM-3.9
CHLORIDE-103 TOTAL CO2-26 ANION GAP-16
ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG
tricyclic-NEG
WBC-7.0 RBC-4.60 HGB-13.6* HCT-39.9* MCV-87 MCH-29.4 MCHC-34.0
RDW-13.6
-----
MICROBIOLOGY:
Blood Culture [**2118-2-15**]: pending
Urine Culture [**2118-2-15**]: pending
-----
IMAGING:
CXR:
Low lung volumes result in bronchovascular crowding and
accentuate the cardiac silhouette. Streaky retrocardiac and
right perihilar
densities are likely atelectasis. The cardiac and mediastinal
contours are
normal.

Brief Hospital Course:
Mr. [**Known firstname **] [**Known lastname **] is a 26 year old man with a past medical
history significant for asthma and substance abuse who presented
with altered mental status consistent with
intoxication/overdose. He was admitted to the MICU, given
intravenous fluids and monitored overnight. He was clearly
intoxicated likely with multiple substances- urine tox positive
for benzodiazepines, barbituates and opiates. Serum tox screen
negative. Patient admitted to taking 10 of his prescribed
neurontin and denied any other ingestions. He was initially
somnolent though able to protect his airway without intubation.
Mental status cleared fully overnight and he was alert and
oriented to person, place and time in the morning. Patient
insisted on leaving AMA as he had a hearing with dept of social
services to determine custody of his daughter. The team
explained risks of leaving including life threatening worsening
of his medical problems, in particular we explained that we were
concerned about his overdose, the fact that his liver enzymes
were elevated, and findings on his CXR were concerning for an
evolving pneumonia. Patient demonstrated understanding of these
risks and was able to communicate that the risk of leaving the
hospital included life threatening worsening of these
conditions. Patient also denied any suicidal or homicidal
ideation and denied that his overdose was an attempt to harm
himself. He was given an Rx for levofloxacin 750mg for 5 days
prior to leaving given concern for evolving PNA. He was also
encouraged to make an immediate appointment with his PCP.



Medications on Admission:
Wellbutrin
Neurontin

Discharge Medications:
1. Levofloxacin 750 mg Tablet Sig: One (1) Tablet PO once a day
for 5 days.
Disp:*5 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Intoxication

Discharge Condition:
Stable, though pt left AMA

Discharge Instructions:
Patient left AMA. He was given an Rx for levofloxacin for a 5
day course given concern for an evolving pneumonia.

Followup Instructions:
Patient left AMA. He was urged to make an appt with his PCP
[**Name Initial (PRE) 2227**].


Completed by:[**2118-2-16**]
{'Poisoning by other opiates and related narcotics,Pneumonia, organism unspecified,Bipolar I disorder, most recent episode (or current) depressed, unspecified,Opioid type dependence, continuous,Accidental poisoning by other opiates and related narcotics,Asthma, unspecified type, unspecified,Lack of housing,Posttraumatic stress disorder,Poisoning by other and unspecified anticonvulsants,Accidental poisoning by anticonvulsant and anti-parkinsonism drugs'}


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: somnolence

PRESENT ILLNESS: Mr. [**Known firstname **] [**Known lastname **] is a 26 year old man with a past medical
history significant for asthma, bipolar disorder and substance
abuse who was brought to the Emergency Department by his
girlfriend with sinus tachycardia to 130s, hot skin, wheezing,
and somnolence. Per his girlfriend she picked him up this
afternoon and noticed a marked difference in his mental status
consistent with prior episodes of intoxication and overdose. She
did not report any specific complaints but recognized that he
was hallucinating (believed there was another person in the car
and talking to himself). She believes that the patient overdosed
on Klonipin, Xanax and Neurontin. He denied use of heroin today.
He has a significant history of heroin and narcotic abuse but he
had reportedly been clean "9 days" prior to his presentation
today.
.
In the ED, initial vs were: T 100.1 P 138 BP 133/56 RR 16 O2 Sat
99% RA. Patient was somnolent but arousable. Per ED, he showed
evidence of increased work of breathing with accessory muscle
use and was subsequently given naloxone 0.4mg and lorazepam. He
ultimately became agitated and received haldol 5mg. Due to his
low grade temperature, respiratory effort and wheezing he was
given ceftriaxone 1 g IV, levaquin 750 mg IV, and solumedrol 125
mg IV. The patient had blood cultures drawn prior to
antibiotics. His serum tox screen was negative for
benzodiazepines, TCAs, Etoh, Aspirin, and Acetaminophen. Chest
x-ray that showed no acute lung process. Toxicology service was
consulted. Prior to transfer to the ICU patient's wheezing had
improved and agitation had resolved.
.
On arrival to the floor patient was initially awake and confused
but ultimately cooperative and able to answer simple questions.
Without interaction he quickly becomes somnolent responding to
sternal rub. Foley catheter was placed with significant urine
output (400 cc).

MEDICAL HISTORY: 1) Asthma recent hospitalization at [**Hospital6 19155**]
for asthma exacerbation
2) Bipolar disorder
3) Seizure disorder per patient report, not confirmed in prison
medical records
4) Depression/PTSD
5) Heroin abuse/dependence
6) Hepatitis C per patient report

MEDICATION ON ADMISSION: Wellbutrin
Neurontin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 99.7 P: 95 R: 20 O2: 95%
General: somnolent, arousable to sternal rub, oriented to self,
follows simple commands, inattentive
HEENT: Sclera anicteric, pupils small 2-3 mm and sluggish
response, MMM, oropharynx clear
Neck: supple, JVP elevated, no LAD
Lungs: faint end expiratory wheezes L > R, faint crackles at
bases, good air movement, nonlabored breathing
CV: Regular rhythm, tachycardic, normal S1 + S2, no murmurs,
rubs, gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: warm, well perfused, 2+ pulses, no flushing or erythema, no
clubbing, cyanosis or edema
Skin: several tattoos, follicular rash on chest, several small
<1 cm scatterd, erythematous shallow ulcers/plaques on penis
GU: foley in place

FAMILY HISTORY: Daughter: 22 month old with asthma
Otherwise non-contributory

SOCIAL HISTORY: Patient was recently incarcerated for a 2 month period of time
ending on [**2117-10-2**]. He was again released from prison in [**12-11**].
He is currently homeless. He as a girlfriend and a daughter.
[**Name (NI) 1139**]: Past unspecified history, though none in last 3 months
due to recent incarceration
EtOH: Denies
Illicits: Prior heroin abuse history, no known use in the last 9
days. 

### Response:
{'Poisoning by other opiates and related narcotics,Pneumonia, organism unspecified,Bipolar I disorder, most recent episode (or current) depressed, unspecified,Opioid type dependence, continuous,Accidental poisoning by other opiates and related narcotics,Asthma, unspecified type, unspecified,Lack of housing,Posttraumatic stress disorder,Poisoning by other and unspecified anticonvulsants,Accidental poisoning by anticonvulsant and anti-parkinsonism drugs'}
