CHIEF COMPLAINT: Fever, seizure.

PRESENT ILLNESS: The patient is a 39 year old male, baseline nonverbal with
mental retardation, cerebal palsy, seizure disorder, history of
recurrent aspirations on a modified diet who presented to the ED
on [**7-20**] from his [**Hospital **] nursing home with seizure x 2 on day of
presentation ( 7 pm, 8:15 pm) with a fever to 102. Status post
seizure, the patient was found to be hypoxic to 89% on RA per
EMS report. His seizure spontaneously resolved. The patient has
a history of multiple aspirations in the past. [**Name (NI) **] HCP,
sister, [**Name (NI) **] requested no central lines, LP or femoral stick.

MEDICAL HISTORY: 1. Cerebral palsy
2. Mental retardation
3. seizures
4. aspiration
5. dysphagia
6. depression

MEDICATION ON ADMISSION: Bisacodyl prn
Remeron 15 mg PO QHS
Diazepam 5 mg IM prn
Trazadone 25 mg PO Q6 prn
Albuterol neb rpn
Omeprazole 20 mg PO QD
Depakote 250 mg PO QD-> 500 mg PO QHS
Aspirin 325 mg PO QD
Folic acid 1 mg PO QD
Colace
Dilantin 100 mg PO QD
Trazadone 50 mg PO BID
Keppra 500 mg PO BID
Ativan 0.5 mg PO TID

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE:
Tc = 97.4 Tm = 103.8 P = 120 BP = 154/110 RR = 15 100% O2 sat on
2 Liters
.
Gen - Nonverbal, opens eyes to voice, does not follow commands
HEENT - Anicteric, atraumatic, dry MM
Heart - Increased rate, regular rhythm
Lungs - Right basilar crackles, o/w clear
Abdomen - Soft, NT, ND + BS
Ext - No C/C/E, spastic, flexed
Skin - No rashes noted
Neuro - Nonverbal, down-going Babinski's bilaterally, does not
follow commands

FAMILY HISTORY: Father with CAD

SOCIAL HISTORY: Lives at [**Hospital1 **].
Mom ([**Doctor First Name **]) is guardian
Sister [**Name (NI) **] is HCP
Pneumonitis due to inhalation of food or vomitus,Hypoxemia,Epilepsy, unspecified, without mention of intractable epilepsy,Unspecified intellectual disabilities,Depressive disorder, not elsewhere classified,Infantile cerebral palsy, unspecified
Food/vomit pneumonitis,Hypoxemia,Epilep NOS w/o intr epil,Intellect disability NOS,Depressive disorder NEC,Cerebral palsy NOS
Admission Date:  [**2194-7-20**]              Discharge Date:   [**2194-7-22**]

Date of Birth:  [**2155-5-17**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 398**]
Chief Complaint:
Fever, seizure.

Major Surgical or Invasive Procedure:
None

History of Present Illness:
The patient is a 39 year old male, baseline nonverbal with
mental retardation, cerebal palsy, seizure disorder, history of
recurrent aspirations on a modified diet who presented to the ED
on [**7-20**] from his [**Hospital **] nursing home with seizure x 2 on day of
presentation ( 7 pm, 8:15 pm) with a fever to 102. Status post
seizure, the patient was found to be hypoxic to 89% on RA per
EMS report. His seizure spontaneously resolved. The patient has
a history of multiple aspirations in the past. [**Name (NI) **] HCP,
sister, [**Name (NI) **] requested no central lines, LP or femoral stick.

.
In the ED, a CXR was obtained which showed no evidence of
infiltrate. His temperature in the ED was 103.8 for which he was
given tylenol. Given a concern for aspiration, the patient was
given vanco 1 gm, ceftriaxone 2 gm, and flagyl. His pulse was
noted to be up to 146, BP 152/98 and he was sat'ing 100@ liters
->96-99% on RA.
.
A dilantin level was checked in the ED and was 12.6. A valproic
acid level was subtherapeutic at 37. He was given 2 mg IV ativan
in the ED given his recent seizure. His WBC was elevated at
12.4. A UA was checked which was negative for signs of
infection. A lactate was checked and was 3.7->4.4.
.
An EKG was checked which showed sinus tachycardia at a rate of
141 bpm. No acute ischemic changes. He received a total of 2
liter IVFs with a net I/O of 1.4 liters positive.
.
The patient is documented as being DNR/DNI and the patient's
sister [**Name (NI) 382**] asked that no femoral sticks, central lines, or
other aggressive measures be pursued. He was admitted to the ICU
given his tachycardia and elevated lactate as it was felt he
would trigger on the floor.
.
ROS:
.
Unable to obtain.


Past Medical History:
1. Cerebral palsy
2. Mental retardation
3. seizures
4. aspiration
5. dysphagia
6. depression


Social History:
Lives at [**Hospital1 **].
Mom ([**Doctor First Name **]) is guardian
Sister [**Name (NI) **] is HCP


Family History:
Father with CAD

Physical Exam:
PE:
Tc = 97.4 Tm = 103.8 P = 120 BP = 154/110 RR = 15 100% O2 sat on
2 Liters
.
Gen - Nonverbal, opens eyes to voice, does not follow commands
HEENT - Anicteric, atraumatic, dry MM
Heart - Increased rate, regular rhythm
Lungs - Right basilar crackles, o/w clear
Abdomen - Soft, NT, ND + BS
Ext - No C/C/E, spastic, flexed
Skin - No rashes noted
Neuro - Nonverbal, down-going Babinski's bilaterally, does not
follow commands


Pertinent Results:
[**2194-7-20**] 09:47PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.013
[**2194-7-20**] 09:47PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-8.0
LEUK-NEG
[**2194-7-20**] 08:55PM   WBC-10.3# RBC-4.20* HGB-14.7 HCT-42.2
MCV-101* MCH-35.0* MCHC-34.8 RDW-13.6
[**2194-7-20**] 08:49PM   LACTATE-3.7*
.
CHEST (PORTABLE AP)  [**2194-7-21**] 3:32 AM
Marked scoliosis distors the chest. Right hemithorax is small
and there is some decrease in aeration at the base, either
atelectasis or conceivably effects of recent aspiration.
Followup advised. Mild pulmonary vascular engorgement persists,
but heart is normal size. Pleural effusion if any is minimal, on
the right. No pneumothorax.

Brief Hospital Course:
The patient is a 39 year old male with a history of cerebral
palsy, mental retardation, seizure disorder on dilantin, keppra,
and depakote as well a history of aspiration presents after 2
seizures at NH on the day of presentation with fever to 103.8
with ?aspiration on vanco/CTX/flagyl.
.
Plan:
.
# Seizure disorder
- Valproic acid level subtherapeutic at 37. Dilantin level
therapeutic at 12.6. Neurology was consulted and agreed with
continuing current medications at current doses. Seizure likely
in setting of subtherapeutic medications but also may occur in
the setting of infection. There was no evidence of infection.
- Ativan prn for seizure.
- No further seizures during admission.
.
# Fever
- Elevated WBC to 12 from 10 on presentation in the setting of
recent seizure and possible aspiration during event with
transient hypoxia and now RLL crackles.
- Repeat CXR showed no evidence of pneumonia. Fever likely
occurred in setting of seizure or aspiration pneumonitis.
- The patient was started on vancomycin, ceftriaxone, flagyl in
the ED. These were discontinued shortly after arriving in the
MICU.
- Given IVF in ED.

.
# Hypoxia
- Now resolved. Sat'ing 99% on RA, 100% on 2 liters for comfort.
Likely occurred in setting of aspiration during seizure.

.
# Mental disability
- Continue psych home medications.
.
# History of aspiration
- Maintain aspiration precautions. He was re-evaluated by speech
and swallow with no change in his aspiration risk/diet. He is on
a modified diet at NH: regular diet, pureed consistent with
honey thickened liquids and yogurt with each meal with 1:1
supervision.
- Aspiration precautions.
.
.
#Code - DNR/DNI
.
#Dispo - Discharged to [**Hospital1 **] from MICU.
.
#Communication - With sister, [**Name (NI) 3508**] [**Name (NI) **]. [**Telephone/Fax (1) 3509**].


Medications on Admission:
Bisacodyl prn
Remeron 15 mg PO QHS
Diazepam 5 mg IM prn
Trazadone 25 mg PO Q6 prn
Albuterol neb rpn
Omeprazole 20 mg PO QD
Depakote 250 mg PO QD-> 500 mg PO QHS
Aspirin 325 mg PO QD
Folic acid 1 mg PO QD
Colace
Dilantin 100 mg PO QD
Trazadone 50 mg PO BID
Keppra 500 mg PO BID
Ativan 0.5 mg PO TID


Discharge Medications:
1. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
2. Mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
3. Albuterol Sulfate 0.083 % (0.83 mg/mL) Solution Sig: One (1)
Inhalation Q6H (every 6 hours) as needed.
4. Divalproex 250 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO QHS (once a day (at bedtime)).

5. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
6. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
8. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule
PO DAILY (Daily).
9. Trazodone 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
10. Levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
11. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
12. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q4-6H
(every 4 to 6 hours) as needed.
13. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.


Discharge Disposition:
Extended Care

Facility:
[**First Name4 (NamePattern1) 3504**] [**Last Name (NamePattern1) **] Rehabilitation & Nursing Center - [**Location (un) 538**]

Discharge Diagnosis:
Mental retardation
Cerebral palsy
Recurrent aspirations


Discharge Condition:
Stable, at baseline. Nonverbal.


Discharge Instructions:
The patient should be monitored for seizures. If one seizure
occurs, this may not necessitate re-admission. Please contact
the patient's physician or neurologist for further evaluation.


Followup Instructions:
Please follow up with your neurologist, Dr. [**Last Name (STitle) 2442**], in 4
weeks.

Please have patient seen a physician [**Last Name (NamePattern4) **] 1 week for follow up.
{'Pneumonitis due to inhalation of food or vomitus,Hypoxemia,Epilepsy, unspecified, without mention of intractable epilepsy,Unspecified intellectual disabilities,Depressive disorder, not elsewhere classified,Infantile cerebral palsy, 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: Fever, seizure.

PRESENT ILLNESS: The patient is a 39 year old male, baseline nonverbal with
mental retardation, cerebal palsy, seizure disorder, history of
recurrent aspirations on a modified diet who presented to the ED
on [**7-20**] from his [**Hospital **] nursing home with seizure x 2 on day of
presentation ( 7 pm, 8:15 pm) with a fever to 102. Status post
seizure, the patient was found to be hypoxic to 89% on RA per
EMS report. His seizure spontaneously resolved. The patient has
a history of multiple aspirations in the past. [**Name (NI) **] HCP,
sister, [**Name (NI) **] requested no central lines, LP or femoral stick.

MEDICAL HISTORY: 1. Cerebral palsy
2. Mental retardation
3. seizures
4. aspiration
5. dysphagia
6. depression

MEDICATION ON ADMISSION: Bisacodyl prn
Remeron 15 mg PO QHS
Diazepam 5 mg IM prn
Trazadone 25 mg PO Q6 prn
Albuterol neb rpn
Omeprazole 20 mg PO QD
Depakote 250 mg PO QD-> 500 mg PO QHS
Aspirin 325 mg PO QD
Folic acid 1 mg PO QD
Colace
Dilantin 100 mg PO QD
Trazadone 50 mg PO BID
Keppra 500 mg PO BID
Ativan 0.5 mg PO TID

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE:
Tc = 97.4 Tm = 103.8 P = 120 BP = 154/110 RR = 15 100% O2 sat on
2 Liters
.
Gen - Nonverbal, opens eyes to voice, does not follow commands
HEENT - Anicteric, atraumatic, dry MM
Heart - Increased rate, regular rhythm
Lungs - Right basilar crackles, o/w clear
Abdomen - Soft, NT, ND + BS
Ext - No C/C/E, spastic, flexed
Skin - No rashes noted
Neuro - Nonverbal, down-going Babinski's bilaterally, does not
follow commands

FAMILY HISTORY: Father with CAD

SOCIAL HISTORY: Lives at [**Hospital1 **].
Mom ([**Doctor First Name **]) is guardian
Sister [**Name (NI) **] is HCP 

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Hypoxemia,Epilepsy, unspecified, without mention of intractable epilepsy,Unspecified intellectual disabilities,Depressive disorder, not elsewhere classified,Infantile cerebral palsy, unspecified'}
