CHIEF COMPLAINT: Altered mental status

PRESENT ILLNESS: 58M hx ETOH abuse & HTN, found wandering T station by his
sister, said he wanted to come to [**Hospital1 **] for psych help. Patient
admits to drinking today, claims no other drugs. Found
hypotensive SBP to 50s, somnelent.
.
Of note, patient eloped from [**Hospital1 **] yesterday [**2170-7-31**] @ 11:30am. He
had been admitted for acute alcohol intoxication and withdrawal
following trauma and assault. CT head and C spine were negative
for fracture or bleed. He was quite agitated in the ED,
requiring chemical sedation and transfer to the MICU. Treated
with valium for withdrawal. Though he endorsed suicidality on
presentation, this resolved with resolution of his intoxication.
He remained mildly sedated due to medications. Social work was
consulted. Though he was clinically improving, patient did not
complete his medical treatment. He was to be followed by PCP as
outpatient, who dispenses his Methadone.
.
Today, at triage noted to have BP in 50's, initially awake and
talking. By the time pt arrived in room, he was somnolent,
minimally responsive to sternal rub, pinpoint pupils. He smelled
of ETOH. Intial full vitals were 91 61/38 14 92% RA. He denied
ingestion of pills or other substances than alcohol. He was
given 1mg narcan and aroused with improvement of blood pressure
without any IVF. It was decided to start a narcan drip but
before a drip arrived from pharmacy, he was noted to maintain
pupils 3-4mm, good ventilation and good urine output so narcan
drip was deferred. FSG 83.  Tox screen was sig for ETOH 260
He also received thiamine 100mg IV. EKG showed SR 89, NA/NI,
poor baseline.;
Toxicology was consulted for hypotension and altered mental
status with hx of alcoholism and opiate abuse/dependence. In
addition to EtOH, possible opiates, CCB (on prior med list)
entertained. Suggested bolus PRN hypotension and checking q1h
fingersticks, to give high dose insulin tx for BS>200. VS: 77,
103/61, 15, 98% 2L prior to transfer.
.
Upon arrival to the ICU, patient appeared awake and agitated.

MEDICAL HISTORY: 1. alcohol abuse with multiple detox attempts
2. polysubstance abuse
3. chronic pain
4. h/o [**Month/Day/Year 8751**] with multiple traumatic injuries and subsequent
surgeries including splenectomy, fracture repairs, skin grafts

MEDICATION ON ADMISSION: MEDICATIONS: As per [**7-31**]
1. Toprol 25 daily
2. folic acid 1 mg Daily
3. methadone 10 mg TID as needed for pain.
4. thiamine HCl 100 mg daily
5. albuterol Inhaler 1-2 puffs every 4-6 hours prn SOB or
wheezing.
6. nicotine 21 mg/24 hr Patch daily
7. MVI

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Patient refused physical exam

FAMILY HISTORY: Parents were alcoholics. He notes a significant family history
of cancer in his mother and father as well as his siblings. He
thinks most were esophageal cancer.

SOCIAL HISTORY: Currenlty homeless. Smokes 1ppd for the past 40 years. Drinks
about a pint of vodka daily with history of withdrawal. He
denies any IVDU.
Hypovolemia,Metabolic encephalopathy,Lack of housing,Tobacco use disorder,Acute alcoholic intoxication in alcoholism, continuous
Hypovolemia,Metabolic encephalopathy,Lack of housing,Tobacco use disorder,Ac alcohol intox-contin
Admission Date:  [**2170-8-1**]              Discharge Date:   [**2170-8-3**]

Date of Birth:  [**2111-9-22**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1185**]
Chief Complaint:
Altered mental status

Major Surgical or Invasive Procedure:
None

History of Present Illness:
58M hx ETOH abuse & HTN, found wandering T station by his
sister, said he wanted to come to [**Hospital1 **] for psych help. Patient
admits to drinking today, claims no other drugs. Found
hypotensive SBP to 50s, somnelent.
.
Of note, patient eloped from [**Hospital1 **] yesterday [**2170-7-31**] @ 11:30am. He
had been admitted for acute alcohol intoxication and withdrawal
following trauma and assault. CT head and C spine were negative
for fracture or bleed. He was quite agitated in the ED,
requiring chemical sedation and transfer to the MICU. Treated
with valium for withdrawal. Though he endorsed suicidality on
presentation, this resolved with resolution of his intoxication.
He remained mildly sedated due to medications. Social work was
consulted. Though he was clinically improving, patient did not
complete his medical treatment. He was to be followed by PCP as
outpatient, who dispenses his Methadone.
.
Today, at triage noted to have BP in 50's, initially awake and
talking. By the time pt arrived in room, he was somnolent,
minimally responsive to sternal rub, pinpoint pupils. He smelled
of ETOH. Intial full vitals were 91 61/38 14 92% RA. He denied
ingestion of pills or other substances than alcohol. He was
given 1mg narcan and aroused with improvement of blood pressure
without any IVF. It was decided to start a narcan drip but
before a drip arrived from pharmacy, he was noted to maintain
pupils 3-4mm, good ventilation and good urine output so narcan
drip was deferred. FSG 83.  Tox screen was sig for ETOH 260
He also received thiamine 100mg IV. EKG showed SR 89, NA/NI,
poor baseline.;
Toxicology was consulted for hypotension and altered mental
status with hx of alcoholism and opiate abuse/dependence. In
addition to EtOH, possible opiates, CCB (on prior med list)
entertained. Suggested bolus PRN hypotension and checking q1h
fingersticks, to give high dose insulin tx for BS>200. VS: 77,
103/61, 15, 98% 2L prior to transfer.
.
Upon arrival to the ICU, patient appeared awake and agitated.


Past Medical History:
1. alcohol abuse with multiple detox attempts
2. polysubstance abuse
3. chronic pain
4. h/o [**Month/Day/Year 8751**] with multiple traumatic injuries and subsequent
surgeries including splenectomy, fracture repairs, skin grafts

Social History:
Currenlty homeless. Smokes 1ppd for the past 40 years. Drinks
about a pint of vodka daily with history of withdrawal. He
denies any IVDU.


Family History:
Parents were alcoholics. He notes a significant family history
of cancer in his mother and father as well as his siblings. He
thinks most were esophageal cancer.


Physical Exam:
Patient refused physical exam

Pertinent Results:
[**2170-7-31**] 06:35AM BLOOD WBC-8.3# RBC-4.47* Hgb-14.7 Hct-42.8
MCV-96 MCH-32.8* MCHC-34.4 RDW-14.6 Plt Ct-194
[**2170-8-1**] 02:35PM BLOOD Neuts-67 Bands-0 Lymphs-28 Monos-3 Eos-1
Baso-1 Atyps-0 Metas-0 Myelos-0
[**2170-7-31**] 06:35AM BLOOD Glucose-91 UreaN-7 Creat-0.7 Na-144 K-4.5
Cl-102 HCO3-34* AnGap-13
[**2170-8-1**] 02:35PM BLOOD ASA-NEG Ethanol-260* Acetmnp-NEG
Bnzodzp-POS Barbitr-NEG Tricycl-NEG
.
NON-CONTRAST HEAD CT: Motion artifact limits evaluation of the
posterior
fossa. Within this limitation, there is no intracranial
hemorrhage,
parenchymal edema, mass effect, or CT evidence of territorial
infarction
identified. Scattered periventricular and subcortical white
matter
hypodensities are unchanged and again likely reflects sequelae
of chronic
small vessel ischemic disease. There is mild sulcal and
ventricular
prominence, compatible with a degree of global atrophy. There is
no midline
shift, and the basal cisterns remain patent. The mastoid air
cells are
normally aerated, though under-pneumatized on the left. There is
ethmoid
mucosal thickening. There is evidence of prior left orbital
fracture.
IMPRESSION: No acute intracranial process. White matter
hypodensities,
compatible with sequelae of chronic small vessel ischemia,
unchanged from
prior studies.
.
CXR:  Stable exam with linear densities in the lower lungs
thought to
represent scarring or atelectasis.
.
EKG: Baseline artifact. Sinus rhythm. Late R wave progression.
Minor ST-T wave abnormalities. Since the previous tracing of
[**2170-8-1**] the rate isslower. Precordial ST-T wave abnormalities may
be less prominent but there isconsiderable artifact on the
previous tracing as well. Clinical correlation
issuggested.Baseline artifact. Sinus rhythm. Late R wave
progression. Minor sT-T wave abnormalities. Since the previous
tracing of [**2170-8-1**] the rate is slower. Precordial ST-T wave
abnormalities may be less prominent but there is considerable
artifact on the previous tracing as well. Clinical correlation
is suggested.
.
[**2170-8-3**] 07:13AM BLOOD WBC-8.6 RBC-4.31* Hgb-14.4 Hct-41.1
MCV-95 MCH-33.4* MCHC-35.1* RDW-14.6 Plt Ct-202
[**2170-8-3**] 07:13AM BLOOD Glucose-109* UreaN-9 Creat-0.7 Na-139
K-3.7 Cl-100 HCO3-30 AnGap-13
[**2170-8-3**] 07:13AM BLOOD Calcium-9.7 Phos-2.8 Mg-1.7
[**2170-8-3**] 07:13AM BLOOD Calcium-9.7 Phos-2.8 Mg-1.7
[**2170-8-1**] 02:35PM BLOOD ASA-NEG Ethanol-260* Acetmnp-NEG
Bnzodzp-POS Barbitr-NEG Tricycl-NEG.
.
No micro from this admission
.

Brief Hospital Course:
58M yo M w/ frequent visits to ED over the last 2 weeks, recent
admission for PNA and recently admitted to the MICU for EtOH
intoxication, now readmitted with intoxication and hypotension
after having eloped from the [**Hospital1 **] yesterday.
.
Hypotension: The etiology was not clear and resolved in the
Emergency Department with intravenous fluids.  Toxicology was
consulted for possible ingstion. There was no clear infectious
etiology identified with clean UA, blood cultures no growth at
discharge, and pulmonary imaging without pneumonia. His
anti-hypertensive medications were held and gradually added
back.
.
Alcohol abuse: He had a positive alcohol level on admission. He
was placed on a CIWA scale, supported with thiamine,
multivitamin and folate. He eloped prior to withdrawing from
alcohol significantly.
.
AMS/Suicidal ideation: Initially non-cooperative with
psychiatric interview to further assess SI.  When acute
intoxication resolved, he was seen by psychiatry and it was
determined that he was not an immediate threat to himself or
others.  When he was informed that there was no section [**Street Address(2) 45393**] and 1:1 sitter was discontinued, he eloped from the the
medical floor.
.
As he eloped, there was no follow-up arranged for him, no
medication reconciliation performed, and no prescriptions given
at the time of discharge.
.

Medications on Admission:
MEDICATIONS: As per [**7-31**]
1. Toprol 25 daily
2. folic acid 1 mg Daily
3. methadone 10 mg TID as needed for pain.
4. thiamine HCl 100 mg daily
5. albuterol Inhaler 1-2 puffs every 4-6 hours prn SOB or
wheezing.
6. nicotine 21 mg/24 hr Patch daily
7. MVI

Discharge Medications:
pt eloped

Discharge Disposition:
Home

Discharge Diagnosis:
Alcoholism
Hypotension, etiology unclear


Discharge Condition:
Prior to eloping, he was noted to be normotensive, with
unremarkable neurologic exam. Alert and oriented x 3,

Discharge Instructions:
Pt eloped without discharge instructions.

Followup Instructions:
Pt eloped without follow-up instructions.

                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**Doctor Last Name 1189**]

Completed by:[**2170-8-6**]
{'Hypovolemia,Metabolic encephalopathy,Lack of housing,Tobacco use disorder,Acute alcoholic intoxication in alcoholism, continuous'}


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: Altered mental status

PRESENT ILLNESS: 58M hx ETOH abuse & HTN, found wandering T station by his
sister, said he wanted to come to [**Hospital1 **] for psych help. Patient
admits to drinking today, claims no other drugs. Found
hypotensive SBP to 50s, somnelent.
.
Of note, patient eloped from [**Hospital1 **] yesterday [**2170-7-31**] @ 11:30am. He
had been admitted for acute alcohol intoxication and withdrawal
following trauma and assault. CT head and C spine were negative
for fracture or bleed. He was quite agitated in the ED,
requiring chemical sedation and transfer to the MICU. Treated
with valium for withdrawal. Though he endorsed suicidality on
presentation, this resolved with resolution of his intoxication.
He remained mildly sedated due to medications. Social work was
consulted. Though he was clinically improving, patient did not
complete his medical treatment. He was to be followed by PCP as
outpatient, who dispenses his Methadone.
.
Today, at triage noted to have BP in 50's, initially awake and
talking. By the time pt arrived in room, he was somnolent,
minimally responsive to sternal rub, pinpoint pupils. He smelled
of ETOH. Intial full vitals were 91 61/38 14 92% RA. He denied
ingestion of pills or other substances than alcohol. He was
given 1mg narcan and aroused with improvement of blood pressure
without any IVF. It was decided to start a narcan drip but
before a drip arrived from pharmacy, he was noted to maintain
pupils 3-4mm, good ventilation and good urine output so narcan
drip was deferred. FSG 83.  Tox screen was sig for ETOH 260
He also received thiamine 100mg IV. EKG showed SR 89, NA/NI,
poor baseline.;
Toxicology was consulted for hypotension and altered mental
status with hx of alcoholism and opiate abuse/dependence. In
addition to EtOH, possible opiates, CCB (on prior med list)
entertained. Suggested bolus PRN hypotension and checking q1h
fingersticks, to give high dose insulin tx for BS>200. VS: 77,
103/61, 15, 98% 2L prior to transfer.
.
Upon arrival to the ICU, patient appeared awake and agitated.

MEDICAL HISTORY: 1. alcohol abuse with multiple detox attempts
2. polysubstance abuse
3. chronic pain
4. h/o [**Month/Day/Year 8751**] with multiple traumatic injuries and subsequent
surgeries including splenectomy, fracture repairs, skin grafts

MEDICATION ON ADMISSION: MEDICATIONS: As per [**7-31**]
1. Toprol 25 daily
2. folic acid 1 mg Daily
3. methadone 10 mg TID as needed for pain.
4. thiamine HCl 100 mg daily
5. albuterol Inhaler 1-2 puffs every 4-6 hours prn SOB or
wheezing.
6. nicotine 21 mg/24 hr Patch daily
7. MVI

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Patient refused physical exam

FAMILY HISTORY: Parents were alcoholics. He notes a significant family history
of cancer in his mother and father as well as his siblings. He
thinks most were esophageal cancer.

SOCIAL HISTORY: Currenlty homeless. Smokes 1ppd for the past 40 years. Drinks
about a pint of vodka daily with history of withdrawal. He
denies any IVDU. 

### Response:
{'Hypovolemia,Metabolic encephalopathy,Lack of housing,Tobacco use disorder,Acute alcoholic intoxication in alcoholism, continuous'}
