CHIEF COMPLAINT: Tylenol PM overdose

PRESENT ILLNESS: Mr. [**Known lastname **] is an 18-year old gentleman with history of
schizoaffective disorder, multiple suicide attempts in the past,
who was admitted to [**Hospital 1474**] Hospital on [**2161-7-27**] after being
found down. Per report, patient had stolen his car from his
mother on [**Name (NI) 1017**] and driven from [**Doctor First Name 5256**] to [**State 350**]
to visit his girlfriend. [**Name (NI) **] had taken a large bottle of Tylenol
from his home. Poliec were contact[**Name (NI) **] by mother, and they were
searching for him both in [**Doctor First Name 5256**] and [**State 350**]. The
next afternoon, he found police waiting at his girlfriend's
house, and he ran. He left his car and called his mother at 2:19
PM, and told him that he had ingested approximately 200 Tylenol
PMs and wanted to die. He was found behind a dumpster by the
police (reportedly 2 hours after consumption) and brought to
OSH. At the OSH, he was given Narcan and intubated given
somnolence. A 4-hour Tylenol level was > 200, and he was treated
with NAC (loading dose) followed by 17.5mg/kg continous
infusion. CXR revealed infiltrate and he was started on Zosyn.
LFTs were initially in 200s and have remained in that range
through his MICU course; however, INR has trended up to 2.4 this
morning, and patient has progressively become profoundly
acidotic, with most recent ABG 7.18/45/167. On admission, his
bicarbonate was 11, and he was given a NaHCOs infusion and
aggressive IV fluids with good urine output. Creatinine was
normal on admission and has increased to 1.9 now. Lactate 4.0.
He is being transferred for considerations of transplant.
.
On arrival to the MICU, patient's VS were 98.6 Ax, HR 112, BP
111/55; RR 19; O2 97% AC TV 500, RR 18; FI02 1.0, PEEP 12.
A-line was placed for pH monitoring. NAC drip was continued,
cultures were drawn, and Zosyn was continued. Patient's sedation
was changed to Fentanyl/Versed.

MEDICAL HISTORY: 1. Multiple suicide attempts in past
2. Bipolar discorder
3. Schizoaffective disorder

MEDICATION ON ADMISSION: HOME MEDICATIONS: Lamictal, has weaned himself off other
psychotropic medications over last 6 months
.
MEDICATIONS ON TRANSFER
1. Albuterol/Atrovent
2. Zosyn 4.5g IV q6h
3. Fentanyl
4. Midazolam
5. Propofol
6. Heparin 5000 SC TID
7. Protonix 40 IV qd
8. Chlorhexidine 5 q8h
9. Nystatin
10. Artificial Tear

ALLERGIES: Cefaclor

PHYSICAL EXAM: VS: 98.6 Ax, HR 112, BP 111/55; RR 19; O2 97% AC TV 500, RR 18;
FI02 1.0, PEEP 12
GEN: sedated, intubated,
HEENT: Pupils round, reactive 3 -> 2mm. ET tube in place.
LUNGS: CTA B/L anteriorly
HEART: RRR No MRG.
ABD: soft, NT/ND. +BS
EXT: No CCE. Syymetric DPs
NEURO: intubated. PERRL. Downgoing toes. Sluggish patellar
reflex. No no response to verbal or painful stimuli. No clonus.
No myoclonic activity or muscle rigidity. Sluggish biceps
reflex, symmetric B/L.

FAMILY HISTORY: Father committed suicide.

SOCIAL HISTORY: Originally from [**Doctor First Name 5256**]. Attended school in MA until
[**Month (only) 956**], was then living in NC with mother because of
behavioral problems/depression.
Acute and subacute necrosis of liver,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Infection and inflammatory reaction due to other vascular device, implant, and graft,Other staphylococcal septicemia,Sepsis,Acute pancreatitis,Acidosis,Schizoaffective disorder, unspecified,Poisoning by aromatic analgesics, not elsewhere classified,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics,Bipolar disorder, unspecified
Acute necrosis of liver,Acute respiratry failure,Food/vomit pneumonitis,React-oth vasc dev/graft,Staphylcocc septicem NEC,Sepsis,Acute pancreatitis,Acidosis,Schizoaffective dis NOS,Pois-arom analgesics NEC,Poison-analgesics,Bipolar disorder NOS
Admission Date:  [**2161-7-29**]              Discharge Date:   [**2161-8-14**]

Date of Birth:  [**2142-12-23**]             Sex:   M

Service: MEDICINE

Allergies:
Cefaclor

Attending:[**First Name3 (LF) 613**]
Chief Complaint:
Tylenol PM overdose

Major Surgical or Invasive Procedure:
intubation at OSH
OSH subclavian line removal
placement of RIJ central venous catheter
placement of L subclavian venous catheter

History of Present Illness:
Mr. [**Known lastname **] is an 18-year old gentleman with history of
schizoaffective disorder, multiple suicide attempts in the past,
who was admitted to [**Hospital 1474**] Hospital on [**2161-7-27**] after being
found down. Per report, patient had stolen his car from his
mother on [**Name (NI) 1017**] and driven from [**Doctor First Name 5256**] to [**State 350**]
to visit his girlfriend. [**Name (NI) **] had taken a large bottle of Tylenol
from his home. Poliec were contact[**Name (NI) **] by mother, and they were
searching for him both in [**Doctor First Name 5256**] and [**State 350**]. The
next afternoon, he found police waiting at his girlfriend's
house, and he ran. He left his car and called his mother at 2:19
PM, and told him that he had ingested approximately 200 Tylenol
PMs and wanted to die. He was found behind a dumpster by the
police (reportedly 2 hours after consumption) and brought to
OSH. At the OSH, he was given Narcan and intubated given
somnolence. A 4-hour Tylenol level was > 200, and he was treated
with NAC (loading dose) followed by 17.5mg/kg continous
infusion. CXR revealed infiltrate and he was started on Zosyn.
LFTs were initially in 200s and have remained in that range
through his MICU course; however, INR has trended up to 2.4 this
morning, and patient has progressively become profoundly
acidotic, with most recent ABG 7.18/45/167. On admission, his
bicarbonate was 11, and he was given a NaHCOs infusion and
aggressive IV fluids with good urine output. Creatinine was
normal on admission and has increased to 1.9 now. Lactate 4.0.
He is being transferred for considerations of transplant.
.
On arrival to the MICU, patient's VS were 98.6 Ax, HR 112, BP
111/55; RR 19; O2 97% AC TV 500, RR 18; FI02 1.0, PEEP 12.
A-line was placed for pH monitoring. NAC drip was continued,
cultures were drawn, and Zosyn was continued. Patient's sedation
was changed to Fentanyl/Versed.


Past Medical History:
1. Multiple suicide attempts in past
2. Bipolar discorder
3. Schizoaffective disorder


Social History:
Originally from [**Doctor First Name 5256**]. Attended school in MA until
[**Month (only) 956**], was then living in NC with mother because of
behavioral problems/depression.

Family History:
Father committed suicide.

Physical Exam:
VS: 98.6 Ax, HR 112, BP 111/55; RR 19; O2 97% AC TV 500, RR 18;
FI02 1.0, PEEP 12
GEN: sedated, intubated,
HEENT: Pupils round, reactive 3 -> 2mm. ET tube in place.
LUNGS: CTA B/L anteriorly
HEART: RRR No MRG.
ABD: soft, NT/ND. +BS
EXT: No CCE. Syymetric DPs
NEURO: intubated. PERRL. Downgoing toes. Sluggish patellar
reflex. No no response to verbal or painful stimuli. No clonus.
No myoclonic activity or muscle rigidity. Sluggish biceps
reflex, symmetric B/L.


Pertinent Results:
[**2161-7-29**] 10:59PM   TYPE-ART TEMP-37.8 PO2-112* PCO2-48* PH-7.21*
TOTAL CO2-20* BASE XS--8 INTUBATED-INTUBATED
[**2161-7-29**] 10:59PM   LACTATE-4.9*
[**2161-7-29**] 09:53PM   TYPE-ART TEMP-38.1 PO2-92 PCO2-56* PH-7.15*
TOTAL CO2-21 BASE XS--9 INTUBATED-INTUBATED
[**2161-7-29**] 09:53PM   LACTATE-5.2*
[**2161-7-29**] 09:53PM   freeCa-1.11*
[**2161-7-29**] 09:30PM   estGFR-Using this
[**2161-7-29**] 09:30PM   ALT(SGPT)-213* AST(SGOT)-114* LD(LDH)-261*
CK(CPK)-751* ALK PHOS-49 AMYLASE-64 TOT BILI-1.3
[**2161-7-29**] 09:30PM   LIPASE-21
[**2161-7-29**] 09:30PM   WBC-13.7* RBC-4.39* HGB-13.6* HCT-40.1 MCV-91
MCH-31.1 MCHC-34.0 RDW-14.0
[**2161-7-29**] 09:30PM   WBC-13.7* RBC-4.39* HGB-13.6* HCT-40.1 MCV-91
MCH-31.1 MCHC-34.0 RDW-14.0
[**2161-7-29**] 09:30PM   PLT COUNT-193
[**2161-7-29**] 09:30PM   PT-27.0* INR(PT)-2.8*
*
Blood culture [**8-6**]:
AEROBIC BOTTLE (Final [**2161-8-9**]):
      REPORTED BY PHONE TO [**Last Name (LF) 54657**], [**First Name3 (LF) **] @0013 ON [**2161-8-7**].
      STAPHYLOCOCCUS, COAGULASE NEGATIVE.
         OF THREE COLONIAL MORPHOLOGIES.  ISOLATED FROM ONE SET
ONLY.
         SENSITIVITIES PERFORMED ON REQUEST..
ANAEROBIC BOTTLE (Final [**2161-8-9**]):
      STAPHYLOCOCCUS, COAGULASE NEGATIVE.
         OF THREE COLONIAL MORPHOLOGIES.  ISOLATED FROM ONE SET
ONLY.
         SENSITIVITIES PERFORMED ON REQUEST.
*
Sputum culture:
RESPIRATORY CULTURE (Preliminary):
      OROPHARYNGEAL FLORA ABSENT.
      STENOTROPHOMONAS (XANTHOMONAS) MALTOPHILIA. MODERATE
GROWTH. SENSTITIVE TO BACTRIM
*
Central venous catheter culture: No significant growth:
*
AST [**8-10**]: 21 (332 on admission)
ALT [**8-10**]: 54 (1410 on admission)



Brief Hospital Course:
[**Known firstname **] [**Known lastname **] is an 18-year-old gentleman who was transferred from
OSH after acetaminophen/benadryl overdose with worsening liver
and respiratory status. The following issues were addressed
during his MICU stay:
.
# Acetaminophen overdose with worsening hepatic function
Patient received loading dose NAC within 1st 6 hours of
ingestion and was continued on NAC drip for > 72h and
discontinued when INR was less than 2. Hepatology service was
consulted and they followed patient actively. Patient not in
fulminant hepatic failure, with peak INR 2.0, Cr 1.8. LFTs
ranged from 200-500. Transplant surgery was consulted for
considerations of liver transplant, it was felt that patient's
liver injury was not sufficient to warrant transplant at this
time.
.
# Respiratory Failure
Patient's mental status poor, likely from benadryl overdose as
part of Tylenol PM, intubated given mental status changes. CXR
at OSH showed significant RML infilatrate, patient was continued
on Zosyn for presumed aspiration PNA. Given temeprature spike
while in MICU, sputum culture was obtained which showed Gram +
cocci, and he was started on Vancomycin. It was difficult
ventilating patient, and he required high minute ventilation
with FIO2 0.1-1.0, PEEPS [**12-11**], RR in 20s. He was started on
ARDSnet ventilation. Chest CT was obtained which showed
multifocal pneumonia.
.
# AMS
Patient with depressed mental status and functioning, presumed
[**1-30**] benadryl overdose as part of Tylenol PM. Head CT negative at
OSH on presentation. Given no improvement and subsequent
development of positive Babinski bilaterally, Head CT was
repeated here, which showed no intracranial pathology. Patient
also received EEG to r/o nonconvulsive status.
.
# Lactic Acidosis
Etiology mutlifactorial, improved with increasing MV and
supportive care. Likely combination of direct effects of
acetaminophen overdose, liver injury, tissue hypoperfusion, and
hypermetabolic state.
.
Upon transfer to the medical floor, the following issues were
addressed:
.
# Pneumonia: This was thought to be an aspiration pneumonia from
his overdose complicated by a ventilator-associated process.
The patient was continued on IV vancomycin and zosyn, which he
will need to complete a ten day course of.  Double strength
bactrim was added to the regimen to cover for the
ventilator-associated pathogen stenotrophomonas, which grew out
on his sputum culture.
.
# Bacteremia: This was likely a skin contaminant as the only
positive cultures were found on [**8-6**] where [**12-30**] tubes showed
coagulase negative staphylococcus of mixed morphologies.  A
catheter tip culture showed no significant growth, and
surveillance cultures after [**8-6**] remained negative.
.
# Thrombocytosis: This is likely a reactive process, as the
patient has infection and multiple inflammatory conditions
including resolving transaminitis and pancreatitis.  No
treatment is necessary at this time.
.
# Psychiatric problems, including bipolar disorder vs.
schizoaffective disorder: The patient will be transferred to a
psychiatric floor for further management as he is medically
stable.
.
# Transaminitis: The patient's LFT's were monitored daily, and
trended downward daily.
.
# Propofol-induced pancreatitis: the patient was monitored
clinically throughout his hospital stay.  He improved and is
able to eat and drink without pain or nausea.


Medications on Admission:
HOME MEDICATIONS: Lamictal, has weaned himself off other
psychotropic medications over last 6 months
.
MEDICATIONS ON TRANSFER
1. Albuterol/Atrovent
2. Zosyn 4.5g IV q6h
3. Fentanyl
4. Midazolam
5. Propofol
6. Heparin 5000 SC TID
7. Protonix 40 IV qd
8. Chlorhexidine 5 q8h
9. Nystatin
10. Artificial Tear


Discharge Medications:
1. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1)
Tablet PO BID (2 times a day) for 3 days: This regimen will be
over on [**8-18**].
Disp:*3 Tablet(s)* Refills:*0*
2. Vancomycin in Dextrose 1 g/200 mL Piggyback Sig: One (1) gram
Intravenous Q 12H (Every 12 Hours) for 3 days: This dose will be
finished on 8/219.
Disp:*3 dose units* Refills:*0*
3. Piperacillin-Tazobactam 4.5 g Recon Soln Sig: 4.5 grams
Intravenous Q8H (every 8 hours) for 3 days: This course will be
over on [**8-16**].
Disp:*9 dose units* Refills:*0*
4. Risperidone 1 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Extended Care

Discharge Diagnosis:
aspiration and ventilation-associated pneumonia
acute hepatic failure secondary to acetaminophen overdose
Pancreatitis secondary to propofol


Discharge Condition:
Improved


Discharge Instructions:
You were admitted after you overdosed on tylenol PM.  You stayed
in the intensive care unit until you were more stable for the
general medical floor.  Here, we diagnosed you with a pneumonia,
and started you on antibiotics, which you will need to take for
awhile after you leave here.  You will be taking vancomycin and
zosyn through your IV  until [**8-17**], and bactrim orally until
[**8-19**].  You pancreatitis and liver irritation have resolved.

                             [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**]
{'Acute and subacute necrosis of liver,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Infection and inflammatory reaction due to other vascular device, implant, and graft,Other staphylococcal septicemia,Sepsis,Acute pancreatitis,Acidosis,Schizoaffective disorder, unspecified,Poisoning by aromatic analgesics, not elsewhere classified,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics,Bipolar disorder, 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: Tylenol PM overdose

PRESENT ILLNESS: Mr. [**Known lastname **] is an 18-year old gentleman with history of
schizoaffective disorder, multiple suicide attempts in the past,
who was admitted to [**Hospital 1474**] Hospital on [**2161-7-27**] after being
found down. Per report, patient had stolen his car from his
mother on [**Name (NI) 1017**] and driven from [**Doctor First Name 5256**] to [**State 350**]
to visit his girlfriend. [**Name (NI) **] had taken a large bottle of Tylenol
from his home. Poliec were contact[**Name (NI) **] by mother, and they were
searching for him both in [**Doctor First Name 5256**] and [**State 350**]. The
next afternoon, he found police waiting at his girlfriend's
house, and he ran. He left his car and called his mother at 2:19
PM, and told him that he had ingested approximately 200 Tylenol
PMs and wanted to die. He was found behind a dumpster by the
police (reportedly 2 hours after consumption) and brought to
OSH. At the OSH, he was given Narcan and intubated given
somnolence. A 4-hour Tylenol level was > 200, and he was treated
with NAC (loading dose) followed by 17.5mg/kg continous
infusion. CXR revealed infiltrate and he was started on Zosyn.
LFTs were initially in 200s and have remained in that range
through his MICU course; however, INR has trended up to 2.4 this
morning, and patient has progressively become profoundly
acidotic, with most recent ABG 7.18/45/167. On admission, his
bicarbonate was 11, and he was given a NaHCOs infusion and
aggressive IV fluids with good urine output. Creatinine was
normal on admission and has increased to 1.9 now. Lactate 4.0.
He is being transferred for considerations of transplant.
.
On arrival to the MICU, patient's VS were 98.6 Ax, HR 112, BP
111/55; RR 19; O2 97% AC TV 500, RR 18; FI02 1.0, PEEP 12.
A-line was placed for pH monitoring. NAC drip was continued,
cultures were drawn, and Zosyn was continued. Patient's sedation
was changed to Fentanyl/Versed.

MEDICAL HISTORY: 1. Multiple suicide attempts in past
2. Bipolar discorder
3. Schizoaffective disorder

MEDICATION ON ADMISSION: HOME MEDICATIONS: Lamictal, has weaned himself off other
psychotropic medications over last 6 months
.
MEDICATIONS ON TRANSFER
1. Albuterol/Atrovent
2. Zosyn 4.5g IV q6h
3. Fentanyl
4. Midazolam
5. Propofol
6. Heparin 5000 SC TID
7. Protonix 40 IV qd
8. Chlorhexidine 5 q8h
9. Nystatin
10. Artificial Tear

ALLERGIES: Cefaclor

PHYSICAL EXAM: VS: 98.6 Ax, HR 112, BP 111/55; RR 19; O2 97% AC TV 500, RR 18;
FI02 1.0, PEEP 12
GEN: sedated, intubated,
HEENT: Pupils round, reactive 3 -> 2mm. ET tube in place.
LUNGS: CTA B/L anteriorly
HEART: RRR No MRG.
ABD: soft, NT/ND. +BS
EXT: No CCE. Syymetric DPs
NEURO: intubated. PERRL. Downgoing toes. Sluggish patellar
reflex. No no response to verbal or painful stimuli. No clonus.
No myoclonic activity or muscle rigidity. Sluggish biceps
reflex, symmetric B/L.

FAMILY HISTORY: Father committed suicide.

SOCIAL HISTORY: Originally from [**Doctor First Name 5256**]. Attended school in MA until
[**Month (only) 956**], was then living in NC with mother because of
behavioral problems/depression. 

### Response:
{'Acute and subacute necrosis of liver,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Infection and inflammatory reaction due to other vascular device, implant, and graft,Other staphylococcal septicemia,Sepsis,Acute pancreatitis,Acidosis,Schizoaffective disorder, unspecified,Poisoning by aromatic analgesics, not elsewhere classified,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics,Bipolar disorder, unspecified'}
