CHIEF COMPLAINT: seizure

PRESENT ILLNESS: 62 yo F with PMH etoh abuse p/w withdrawal seizures. History
provided by partner, [**Name (NI) **], who lives with pt and has known her
for 2.5 years. He reports that pt drinks daily, usually vodka
with sprite. He cannot estimate how much she drinks because he
is at work all day. He does report that she has insomnia and
will often drink alcohol early in the AM if she cannot sleep.
She has been "sick" for a few weeks, characterized by nausea,
vomiting, and inability to tolerate any po. This led pt to stop
drinking about 3 days ago since she would vomit up anything she
drank anyway. She reportedly has an abd pain at baseline [**3-1**] an
ulcer but partner denies any report of increase in baseline
pain. She had a witnessed seizure at 1am and at noon the day of
admission characterized by "tightening up" and biting her
tongue, causing bleeding. No incontinence of bowel or bladder.
Pt did not remember seizure and was reluctant to come in.
ROS unable to obtain but [**Male First Name (un) **] says that pt has been c/o dizziness
for several weeks and says that she frequently reports a fear of
falling because she is clumsy. She bruises easily on aspirin,
which she takes at home, and has bruises on her legs from
falling when trying to walk up stairs. He does notice gait
instability which has occurred when she is both sober and
inebriated. He also reports she has poor po intake. No other
notable sx per partner.

MEDICAL HISTORY: insomnia
etoh abuse

MEDICATION ON ADMISSION: "aspirin powder"
omeprazole 20mg daily
pharmacy - CVS in [**Location 18268**]

ALLERGIES: environmental allergies / Oxycodone / Tylenol / Tylenol

PHYSICAL EXAM: ADMISSION EXAM:
Vitals: 98.4, 140/87, 95, 23, 100% RA
General: somnolent, arousable to sternal rub but not to voice or
shaking. speech unintelligible - slurred combination of random
syllables and gibberish
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: difficulty following commands. opens eyes to voice with
effort after multiple prompts. CN grossly intact [**3-11**]. PERRL,
moves all four extremities. tremor in UE with dystonic-like
non-purposeful movements. picking at air near me - unclear if
she was trying to touch me and was dysmetric or if she was
hallucinating something there.

FAMILY HISTORY: unable to obtain

SOCIAL HISTORY: lives with partner of 2.5 years [**Male First Name (un) **]. daughter [**Name (NI) **] lives
nearby. other daughter lives in [**State **]. father in [**Name2 (NI) **].
smokes cigarettes, quit one week ago. No illicit drug use. +
daily etoh use (unable to quantify)
Alcohol withdrawal,Paroxysmal ventricular tachycardia,Urinary tract infection, site not specified,Other and unspecified manifestations of thiamine deficiency,Other convulsions,Abnormality of gait,Hypopotassemia,Other and unspecified alcohol dependence, continuous,Tobacco use disorder,Other and unspecified Escherichia coli [E. coli],Unspecified gastritis and gastroduodenitis, without mention of hemorrhage
Alcohol withdrawal,Parox ventric tachycard,Urin tract infection NOS,Thiamine defic NEC/NOS,Convulsions NEC,Abnormality of gait,Hypopotassemia,Alcoh dep NEC/NOS-contin,Tobacco use disorder,E.coli infection NEC/NOS,Gstr/ddnts NOS w/o hmrhg
Admission Date:  [**2198-9-1**]              Discharge Date:   [**2198-9-3**]

Date of Birth:  [**2136-7-20**]             Sex:   F

Service: MEDICINE

Allergies:
environmental allergies / Oxycodone / Tylenol / Tylenol

Attending:[**First Name3 (LF) 2712**]
Chief Complaint:
seizure

Major Surgical or Invasive Procedure:
none


History of Present Illness:
62 yo F with PMH etoh abuse p/w withdrawal seizures. History
provided by partner, [**Name (NI) **], who lives with pt and has known her
for 2.5 years. He reports that pt drinks daily, usually vodka
with sprite. He cannot estimate how much she drinks because he
is at work all day. He does report that she has insomnia and
will often drink alcohol early in the AM if she cannot sleep.
She has been "sick" for a few weeks, characterized by nausea,
vomiting, and inability to tolerate any po. This led pt to stop
drinking about 3 days ago since she would vomit up anything she
drank anyway. She reportedly has an abd pain at baseline [**3-1**] an
ulcer but partner denies any report of increase in baseline
pain. She had a witnessed seizure at 1am and at noon the day of
admission characterized by "tightening up" and biting her
tongue, causing bleeding. No incontinence of bowel or bladder.
Pt did not remember seizure and was reluctant to come in.
ROS unable to obtain but [**Male First Name (un) **] says that pt has been c/o dizziness
for several weeks and says that she frequently reports a fear of
falling because she is clumsy. She bruises easily on aspirin,
which she takes at home, and has bruises on her legs from
falling when trying to walk up stairs. He does notice gait
instability which has occurred when she is both sober and
inebriated. He also reports she has poor po intake. No other
notable sx per partner.

Pt brought to [**Hospital3 6592**] where she was found to be
hypokalemic to 2.2 and in torsades. trop 0.06 (high). She was
given Mg with some improvement but was experiencing intermittent
NSVT. Had a long QTc. Received valium 5mg iv and ativan 8mg iv.
Thiamine and magnesium repeleted. Potassium infusing at time of
transfer. No seizure there. Transfer here for multiple issues.

In the ED, VS 98.9 64 124/78 16 100% 3L. alert, AAOx [**1-29**]
(hospital, self, not time or reason here). EKG showed sinus tach
at 103, NA, QTc appears prolonged >450, NS ST depressions
II/III/F, laterally. She was monitored on tele and had
intermittent NSVT. K 2.8 on arrival to [**Hospital1 18**]. She was given K,
Mg, phos. K came up to 3.9 prior to transfer. head CT - no acute
intracranial process. VS on transfer 96 116/84 16 100%.

On arrival to the MICU, VS 98.4, 140/87, 95, 23, 100% RA. pt
sleeping and snoring. unable to provide history. speech
unintelligible.

Past Medical History:
insomnia
etoh abuse

Social History:
lives with partner of 2.5 years [**Male First Name (un) **]. daughter [**Name (NI) **] lives
nearby. other daughter lives in [**State **]. father in [**Name2 (NI) **].
smokes cigarettes, quit one week ago. No illicit drug use. +
daily etoh use (unable to quantify)

Family History:
unable to obtain

Physical Exam:
ADMISSION EXAM:
Vitals: 98.4, 140/87, 95, 23, 100% RA
General: somnolent, arousable to sternal rub but not to voice or
shaking. speech unintelligible - slurred combination of random
syllables and gibberish
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: difficulty following commands. opens eyes to voice with
effort after multiple prompts. CN grossly intact [**3-11**]. PERRL,
moves all four extremities. tremor in UE with dystonic-like
non-purposeful movements. picking at air near me - unclear if
she was trying to touch me and was dysmetric or if she was
hallucinating something there.

DISCHARGE EXAM:
General: Alert and oriented x 3
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: no foley
Ext: No edema. No rash

Pertinent Results:
ADMISSION LABS:
[**2198-8-31**] 07:49PM BLOOD WBC-8.3 RBC-3.40* Hgb-12.0 Hct-35.0*
MCV-103* MCH-35.2* MCHC-34.1 RDW-16.6* Plt Ct-167
[**2198-8-31**] 07:49PM BLOOD Neuts-84.6* Lymphs-9.6* Monos-5.7 Eos-0.1
Baso-0
[**2198-9-1**] 02:46AM BLOOD PT-11.2 PTT-23.5* INR(PT)-1.0
[**2198-8-31**] 07:49PM BLOOD Glucose-90 UreaN-6 Creat-0.8 Na-142 K-4.7
Cl-100 HCO3-27 AnGap-20
[**2198-8-31**] 07:49PM BLOOD ALT-15 AST-55* AlkPhos-156* TotBili-0.5
[**2198-8-31**] 07:49PM BLOOD Lipase-15
[**2198-8-31**] 07:49PM BLOOD Albumin-3.0* Calcium-7.6* Phos-2.4*
Mg-1.9
[**2198-8-31**] 08:11PM BLOOD Lactate-2.9* K-2.8*

OTHER LABS:
[**2198-8-31**] 07:49PM BLOOD cTropnT-<0.01
[**2198-9-1**] 02:46AM BLOOD CK-MB-3 cTropnT-<0.01
[**2198-9-1**] 09:26AM BLOOD CK-MB-2 cTropnT-<0.01
[**2198-9-1**] 02:46AM BLOOD HCG-LESS THAN
[**2198-8-31**] 07:49PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG

DISCHARGE LABS:
[**2198-9-3**] 06:00AM BLOOD WBC-10.5# RBC-3.12* Hgb-10.9* Hct-33.2*
MCV-106* MCH-34.9* MCHC-32.9 RDW-17.1* Plt Ct-212
[**2198-9-3**] 06:00AM BLOOD Glucose-89 UreaN-6 Creat-0.7 Na-135 K-3.4
Cl-99 HCO3-29 AnGap-10
[**2198-9-3**] 06:00AM BLOOD Calcium-8.3* Phos-3.0 Mg-1.8
[**2198-9-1**] 10:12AM BLOOD Lactate-1.0
[**2198-8-31**] 10:18PM BLOOD K-3.9

URINE:
[**2198-8-31**] 07:49PM URINE RBC-0 WBC-22* Bacteri-FEW Yeast-NONE
Epi-0
[**2198-8-31**] 07:49PM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.5 Leuks-MOD
[**2198-8-31**] 07:49PM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.004
[**2198-8-31**] 07:49PM URINE bnzodzp-NEG barbitr-NEG opiates-NEG
cocaine-NEG amphetm-NEG mthdone-NEG
[**2198-9-2**] 02:01AM URINE bnzodzp-NEG barbitr-NEG opiates-NEG
cocaine-NEG amphetm-NEG
[**2198-8-31**] 07:49PM URINE UCG-NEG

[**2198-8-31**] 7:49 pm URINE

                            **FINAL REPORT [**2198-9-2**]**

   URINE CULTURE (Final [**2198-9-2**]):
      ESCHERICHIA COLI.    >100,000 ORGANISMS/ML..
         PRESUMPTIVE IDENTIFICATION.
         Piperacillin/tazobactam sensitivity testing available
on request.
         Cefazolin interpretative criteria are based on a dosage
regimen of
         2g every 8h.

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             ESCHERICHIA COLI
                             |
AMPICILLIN------------   <=2 S
AMPICILLIN/SULBACTAM--   <=2 S
CEFAZOLIN-------------   <=4 S
CEFEPIME--------------   <=1 S
CEFTAZIDIME-----------   <=1 S
CEFTRIAXONE-----------   <=1 S
CIPROFLOXACIN---------<=0.25 S
GENTAMICIN------------   <=1 S
MEROPENEM-------------<=0.25 S
NITROFURANTOIN--------  <=16 S
TOBRAMYCIN------------   <=1 S
TRIMETHOPRIM/SULFA----   <=1 S

IMAGING:
CT HEAD: No acute intracranial hemorrhage or mass effect. Study
slightly limited due to rotated position and artifacts.
Correlate clinically to decide on the need for further workup.
Empty sella.

CXR:
1.  No focal infiltrate to suggest aspiration or pneumonia.
2.  Possible mild cardiomegaly, with upper zone redistribution,
but no overt
CHF.
3.  Prominence of the right mediastinum, ? due to unfolded
aorta.  Recommend
PA and lateral view when the patient is stable to confirm this.


Brief Hospital Course:
62 yo F with PMH etoh abuse p/w withdrawal seizures with exam
findings concerning for wernicke's encephalopathy.

# EtOH withdrawal: completely disoriented and speaking gibberish
on admission exam. in setting of poor po intake, etoh abuse, and
history of gait disturbance, behavior was concerning for
wernicke's [**3-1**] thiamine deficiency so treated empirically for
this with high dose thiamine 500mg IV x 1 after which patient
improved and switched to 100mg thiamine daily. She was also
treated with IVF, multivitamin, and folate. CXR neg for acute
process. Maintained on CIWA scale in house q2h with diazepam
10mg po for score >10 and scored four times. Electrolytes
repleted aggressively. AAOx3 on discharge. Social work consulted
and recommended therapy, which pt was open to and expressed
desire to stop drinking. Unable to arrange therapist prior to
discharge but PCP is aware she needs this and is willing to
assist with it. PCP states that her office will call to schedule
a follow up visit in one week if patient does not call.

# hypokalemia: Upon review of prior EKGs, findings on the EKGs
that were provided were not consistent with torsades. Therefore,
it is possible that she was not in torsades but rather having
runs of Vtach. On arrival to [**Hospital1 18**] she continued to have runs of
NSVT. Her hypokalemia was aggressively repleted and her rate
normalized. Also checked cardiac enzymes which were neg x 3.

# UTI: WBC and bacteria on u/a. unable to obtain ROS so were not
sure if pt symptomatic or not. Awaited UCx results (pansensitive
E. coli) and then treated with Bactrim for 3 day course. Pt
later denied dysuria.

# gait instability: per partner, pt has had multiple falls and
often expresses fear of losing her balance. She was evaluated by
PT who recommended home with PT. They also noted a 3/5 strength
with left dorsiflexion and 5/5 strength in all other muscle
groups. PCP aware of this and will work it up when she comes in
for follow up.

# pos urine bHCG at OSH: neg at our ED. serum bHCG done to
confirm and was also neg

TRANSITIONAL ISSUES:
- PCP follow up in one week
- arrange for therapy as outpatient
- outpatient PT for gait instability
- evaluate LLE weakness on dorsiflexion
- complete 3d course of Bactrim for UTI

Medications on Admission:
"aspirin powder"
omeprazole 20mg daily
pharmacy - CVS in [**Location 18268**]


Discharge Medications:
1. FoLIC Acid 1 mg PO DAILY
RX *folic acid 1 mg 1 tablet(s) by mouth Qdaily Disp #*30 Tablet
Refills:*0
2. Multivitamins W/minerals 1 TAB PO DAILY
RX *Multi-Vitamin HP/Minerals   1 capsule(s) by mouth Qdaily
Disp #*30 Tablet Refills:*0
3. Omeprazole 40 mg PO DAILY
RX *omeprazole 20 mg 1 capsule(s) by mouth Q daily Disp #*30
Tablet Refills:*0
4. Sulfameth/Trimethoprim DS 1 TAB PO BID Duration: 3 Days
RX *Bactrim DS 800 mg-160 mg 1 tablet(s) by mouth Q daily Disp
#*3 Tablet Refills:*0
5. Thiamine 100 mg PO DAILY
RX *thiamine HCl 100 mg 1 tablet(s) by mouth Q daily Disp #*30
Tablet Refills:*0
6. Outpatient Physical Therapy
Eval and treat balance disorder


Discharge Disposition:
Home

Discharge Diagnosis:
Urinary Tract Infections
Alcohol withdrawl seizures
gait instability


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
It was a pleasure to care for you in the hospital.
.
You were admitted because of alcohol withdrawl seizures. Your
symptoms improved with supportive care. You were found to have a
urinary tract infection.Please complete 3 days of antibiotics
for this. You were also unsteady on your feet and physical
therapy recommended outpatient physical therapy. Please stop
drinking alcohol.
.
You were started on:
Multivitamins 1 tab daily
Thiamine 1 tab daily
Folic acid 1 Tab daily
Omperazole 40mg daily
Bactrim 1 Tab daily for 3 days.

Followup Instructions:
Please follow up with your primary care physician in the next 1
week (#[**Telephone/Fax (1) 3183**]). Please call and schedule an appointment
with a therapist of your choosing. If you need assistance
finding a therapist, please call your primary care doctor.
{'Alcohol withdrawal,Paroxysmal ventricular tachycardia,Urinary tract infection, site not specified,Other and unspecified manifestations of thiamine deficiency,Other convulsions,Abnormality of gait,Hypopotassemia,Other and unspecified alcohol dependence, continuous,Tobacco use disorder,Other and unspecified Escherichia coli [E. coli],Unspecified gastritis and gastroduodenitis, without mention of hemorrhage'}


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: seizure

PRESENT ILLNESS: 62 yo F with PMH etoh abuse p/w withdrawal seizures. History
provided by partner, [**Name (NI) **], who lives with pt and has known her
for 2.5 years. He reports that pt drinks daily, usually vodka
with sprite. He cannot estimate how much she drinks because he
is at work all day. He does report that she has insomnia and
will often drink alcohol early in the AM if she cannot sleep.
She has been "sick" for a few weeks, characterized by nausea,
vomiting, and inability to tolerate any po. This led pt to stop
drinking about 3 days ago since she would vomit up anything she
drank anyway. She reportedly has an abd pain at baseline [**3-1**] an
ulcer but partner denies any report of increase in baseline
pain. She had a witnessed seizure at 1am and at noon the day of
admission characterized by "tightening up" and biting her
tongue, causing bleeding. No incontinence of bowel or bladder.
Pt did not remember seizure and was reluctant to come in.
ROS unable to obtain but [**Male First Name (un) **] says that pt has been c/o dizziness
for several weeks and says that she frequently reports a fear of
falling because she is clumsy. She bruises easily on aspirin,
which she takes at home, and has bruises on her legs from
falling when trying to walk up stairs. He does notice gait
instability which has occurred when she is both sober and
inebriated. He also reports she has poor po intake. No other
notable sx per partner.

MEDICAL HISTORY: insomnia
etoh abuse

MEDICATION ON ADMISSION: "aspirin powder"
omeprazole 20mg daily
pharmacy - CVS in [**Location 18268**]

ALLERGIES: environmental allergies / Oxycodone / Tylenol / Tylenol

PHYSICAL EXAM: ADMISSION EXAM:
Vitals: 98.4, 140/87, 95, 23, 100% RA
General: somnolent, arousable to sternal rub but not to voice or
shaking. speech unintelligible - slurred combination of random
syllables and gibberish
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: difficulty following commands. opens eyes to voice with
effort after multiple prompts. CN grossly intact [**3-11**]. PERRL,
moves all four extremities. tremor in UE with dystonic-like
non-purposeful movements. picking at air near me - unclear if
she was trying to touch me and was dysmetric or if she was
hallucinating something there.

FAMILY HISTORY: unable to obtain

SOCIAL HISTORY: lives with partner of 2.5 years [**Male First Name (un) **]. daughter [**Name (NI) **] lives
nearby. other daughter lives in [**State **]. father in [**Name2 (NI) **].
smokes cigarettes, quit one week ago. No illicit drug use. +
daily etoh use (unable to quantify) 

### Response:
{'Alcohol withdrawal,Paroxysmal ventricular tachycardia,Urinary tract infection, site not specified,Other and unspecified manifestations of thiamine deficiency,Other convulsions,Abnormality of gait,Hypopotassemia,Other and unspecified alcohol dependence, continuous,Tobacco use disorder,Other and unspecified Escherichia coli [E. coli],Unspecified gastritis and gastroduodenitis, without mention of hemorrhage'}
