CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 34-year-old man with
alcohol intoxication and an upper gastrointestinal bleed.  He
is a patient with a history of alcohol abuse and history of
several detoxifications in the past who presented on [**2113-12-25**], with hematemesis and was found on EGD to have an
area of active bleeding in the lower third of his esophagus
consistent with a possible Dieulafoy's lesion which was
injected with epinephrine and cauterized.  The patient was
started on a proton pump inhibitor and discharged home, but
apparently has not continued the proton pump inhibitor.  On
the night of admission this year he was brought to the
Emergency Department by his roommate after a three to four
day drinking binge.  He was retching in the Emergency
Department, tachycardic at 123, but normotensive at 140/85.
He vomited about one liter of mixed liquid and coffee
grounds.  An NG tube was passed and an NG tube lavage cleared
after 300 cc of water.  The patient was given two liters
normal saline and Zofran.  Three peripheral IV's were placed.
On further history, the patient admitted that he had been
drinking for about four days.  He had been vomiting for about
three days and had noted bloody vomiting during this time.

MEDICAL HISTORY: 1.  Alcohol abuse.
2.  History of upper gastrointestinal bleed as per history of
present illness.
3.  Depression/anxiety.
4.  Hypercholesterolemia.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Mother has hypertension and
hypercholesterolemia.  Father has alcohol and tobacco abuse.

SOCIAL HISTORY: The patient works as a security guard.  He
has a positive alcohol history with history of detoxification
in the past.  The patient has a history of delirium tremens
in the past.
Hematemesis,Alcohol withdrawal,Acute alcoholic intoxication in alcoholism, unspecified,Drug-induced delirium,Benzodiazepine-based tranquilizers causing adverse effects in therapeutic use
Hematemesis,Alcohol withdrawal,Ac alcohol intox-unspec,Drug-induced delirium,Adv eff benzodiaz tranq
Admission Date:  [**2114-3-17**]       Discharge Date:  [**2114-3-26**]

Date of Birth:   [**2079-7-15**]       Sex:  M

Service:  MICU

HISTORY OF PRESENT ILLNESS:  This is a 34-year-old man with
alcohol intoxication and an upper gastrointestinal bleed.  He
is a patient with a history of alcohol abuse and history of
several detoxifications in the past who presented on [**2113-12-25**], with hematemesis and was found on EGD to have an
area of active bleeding in the lower third of his esophagus
consistent with a possible Dieulafoy's lesion which was
injected with epinephrine and cauterized.  The patient was
started on a proton pump inhibitor and discharged home, but
apparently has not continued the proton pump inhibitor.  On
the night of admission this year he was brought to the
Emergency Department by his roommate after a three to four
day drinking binge.  He was retching in the Emergency
Department, tachycardic at 123, but normotensive at 140/85.
He vomited about one liter of mixed liquid and coffee
grounds.  An NG tube was passed and an NG tube lavage cleared
after 300 cc of water.  The patient was given two liters
normal saline and Zofran.  Three peripheral IV's were placed.
On further history, the patient admitted that he had been
drinking for about four days.  He had been vomiting for about
three days and had noted bloody vomiting during this time.

PAST MEDICAL HISTORY:
1.  Alcohol abuse.
2.  History of upper gastrointestinal bleed as per history of
present illness.
3.  Depression/anxiety.
4.  Hypercholesterolemia.

MEDICATIONS:
1.  Effexor 75 mg p.o. b.i.d.
2.  BuSpar 15 mg p.o. b.i.d.
3.  Seroquel 25 mg q. hs.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  The patient works as a security guard.  He
has a positive alcohol history with history of detoxification
in the past.  The patient has a history of delirium tremens
in the past.

FAMILY HISTORY:  Mother has hypertension and
hypercholesterolemia.  Father has alcohol and tobacco abuse.

PHYSICAL EXAMINATION:  The patient's physical examination was
notable for vital signs stable and afebrile with the
exception of tachycardia at 118 beats per minute.  In
general, he was intoxicated, nauseated and uncomfortable.
His sclerae were injected with micro hemorrhages.  He was not
icteric.  His parotid gland seemed enlarged.  His heart
examination was significant only for tachycardia.  His lungs
were clear to auscultation and percussion bilaterally.  His
abdomen was distended but soft and had bowel sounds.  He had
no hepatosplenomegaly or caput medusae.  His extremities were
without edema, clubbing, cyanosis.  His neurological
examination revealed no asterixis and was essentially
nonfocal.

PERTINENT LABORATORY FINDINGS AND DIAGNOSTICS ON ADMISSION:
The patient's CBC revealed a white count of 20.9 consisting
of 80% polys.  His hematocrit was 51.  His platelet count was
474,000.  A serum alcohol was 314.  Drug toxicology screen
was otherwise negative.  The patient's Chem-7 revealed a
sodium of 137, potassium 3.6, chloride 84, bicarbonate 28,
BUN 23 and a creatinine of 1.3 with a glucose of 142.

ASSESSMENT AND PLAN:  This is a 34-year-old male with a
history of alcohol abuse and possible esophageal Dieulafoy's
lesion now with acute intoxication and hematemesis.  The
patient was admitted for close observation for alcohol
withdrawal as well as for evaluation and treatment of his
upper gastrointestinal bleeding.

HOSPITAL COURSE:  The following is a summary of the [**Hospital 228**]
hospital course by system:

1.  Gastrointestinal:  The patient was started on intravenous
Pepcid.  IV access was maintained so that proper hydration
and transfusion support could be given in the case of a major
re-bleed.  The patient was given Zofran and Ativan for
nausea.  Serial hematocrits were followed throughout the
[**Hospital 228**] hospital stay in the Intensive Care Unit.  He
required no transfusion support while he was in the MICU.
The patient received consultation from the Gastroenterology
team while in the MICU.  They suggested conservative
management given the fact that he was not actively bleeding
when they visited him.  The patient was kept NPO for a few
days but then, with improvement of his mental status, as
described below, his diet was started and advanced as
tolerated.  The patient's hematocrit remained stable
throughout the rest of his hospital stay.  He was switched
from IV Pepcid to p.o. Protonix towards the end of his MICU
stay.  He had no further bleeding issues while in the
hospital.

2.  Alcohol withdrawal.  The patient was monitored for signs
of withdrawal with the CIWA scale.  He received Ativan at
first, but this was replaced with Valium afterwards.  The
patient required massive doses of benzodiazepines during his
withdrawal period.  His liver function tests and coagulation
profiles were checked serially for signs of acute hepatitis,
which he did not show.  The patient required, in addition to
benzodiazepines, Haldol for agitation related to his
withdrawal.  He was started on IV thiamine, folic acid and
multivitamins.  He was weaned off the benzodiazepine regimen.
There was concern for propylene glycol toxicity secondary to
massive Ativan administration.  However, the patient did not
show any signs of renal failure throughout his hospital stay.
Towards the end of his stay in the MICU, the patient was not
exhibiting signs of alcohol withdrawal, although his mental
status was still not at baseline.

3.  Infectious Disease.  The patient had an elevated white
blood cell count on admission but no focus for infection
could be found.  When the patient started producing sputum
toward the middle of his hospital stay, the patient was
started briefly on levofloxacin, but this was discontinued
given that he was no longer febrile and that chest x-rays did
not indicate any sign of pulmonary infection.

4.  Psychiatry.  The patient appeared to have a psychiatric
history given his outpatient medications.  The decision was
made to request a Psychiatry consult when the patient left
the floor.

Peripheral access was achieved by using Pneumoboots to
prevent deep venous thrombosis, as well as intravenous
famotidine and later p.o. proton pump inhibitor.

Based on his improved condition, the patient was deemed ready
for transfer to the floor for continued care.  The patient
was transferred to the Bloomgard firm, who are responsible
for the continuation of this dictation.  The rest of the
patient's dictation will be covered by the Bloomgard intern
who took care of the patient and will be described in a
future discharge summary dictation.




                            [**First Name11 (Name Pattern1) 734**] [**Last Name (NamePattern1) 735**], M.D.  [**MD Number(1) 736**]

Dictated By:[**Last Name (NamePattern1) 1595**]
MEDQUIST36

D:  [**2114-4-9**]  14:37
T:  [**2114-4-9**]  14:02
JOB#:  [**Job Number 34396**]


Name:  [**Known lastname 6066**], [**Known firstname **] A                      Unit No:  [**Numeric Identifier 6067**]

Admission Date:  [**2114-3-17**]     Discharge Date:  [**2114-3-26**]

Date of Birth:   [**2079-7-15**]     Sex:  M

Service:

ADDENDUM:  This is a Discharge Summary Addendum for hospital
course from [**2114-3-23**] to [**2114-3-26**].  Please
see prior Discharge Summary by Dr. [**Last Name (STitle) **] summarizing the
patient's Intensive Care Unit hospital course.

The patient was maintained on a one-to-one security sitter
after transfer from the Intensive Care Unit to the medicine
floor.  The patient remained fairly anxious.  The patient was
given Valium per CIWA scale.  The patient received sedation
in the Intensive Care Unit and had baseline agitation
anxiety, also with a depressed mental status secondary to
sedation in the Intensive Care Unit.

The patient was followed by the Psychiatry Service who
recommended continuing standing as needed Haldol and security
sitter.  The patient's home dose psychiatric medications were
held given his mental status.  His home dose psychiatric
medications included Effexor, BuSpar, and Seroquel; and these
were not given to the patient during this time period.

The patient remained stable from a medical point of view;
however, the patient remained on the Medicine Service and was
followed by the Psychiatry team.  Consideration for transfer
to inpatient psychiatric facility was recommended by the
medical team.

The patient was requesting to leave repeatedly.  The patient
felt somewhat slowed but did not feel confused and was less
agitated.  However, the Psychiatry Service recommended
maintaining the one-to-one sitter and as needed Haldol.  His
Effexor was restarted as well as his BuSpar; however,
Seroquel was still held.

Given that the patient was at risk of elopment, a discussion
with Psychiatry resulted in discontinuation of the one-to-one
security sitter, Haldol was discontinued, and the patient was
deemed ready to be discharged to home with follow up with his
primary care physician.

Per report, the patient did elope even though he was
medically ready to be discharged.





                          [**First Name11 (Name Pattern1) 27**] [**Last Name (NamePattern1) 28**], M.D.  [**MD Number(1) **]

Dictated By:[**Name8 (MD) 6068**]

MEDQUIST36

D:  [**2114-4-10**]  17:05
T:  [**2114-4-10**]  17:00
JOB#:  [**Job Number 6069**]
{'Hematemesis,Alcohol withdrawal,Acute alcoholic intoxication in alcoholism, unspecified,Drug-induced delirium,Benzodiazepine-based tranquilizers causing adverse effects in therapeutic use'}


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: 

PRESENT ILLNESS: This is a 34-year-old man with
alcohol intoxication and an upper gastrointestinal bleed.  He
is a patient with a history of alcohol abuse and history of
several detoxifications in the past who presented on [**2113-12-25**], with hematemesis and was found on EGD to have an
area of active bleeding in the lower third of his esophagus
consistent with a possible Dieulafoy's lesion which was
injected with epinephrine and cauterized.  The patient was
started on a proton pump inhibitor and discharged home, but
apparently has not continued the proton pump inhibitor.  On
the night of admission this year he was brought to the
Emergency Department by his roommate after a three to four
day drinking binge.  He was retching in the Emergency
Department, tachycardic at 123, but normotensive at 140/85.
He vomited about one liter of mixed liquid and coffee
grounds.  An NG tube was passed and an NG tube lavage cleared
after 300 cc of water.  The patient was given two liters
normal saline and Zofran.  Three peripheral IV's were placed.
On further history, the patient admitted that he had been
drinking for about four days.  He had been vomiting for about
three days and had noted bloody vomiting during this time.

MEDICAL HISTORY: 1.  Alcohol abuse.
2.  History of upper gastrointestinal bleed as per history of
present illness.
3.  Depression/anxiety.
4.  Hypercholesterolemia.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Mother has hypertension and
hypercholesterolemia.  Father has alcohol and tobacco abuse.

SOCIAL HISTORY: The patient works as a security guard.  He
has a positive alcohol history with history of detoxification
in the past.  The patient has a history of delirium tremens
in the past. 

### Response:
{'Hematemesis,Alcohol withdrawal,Acute alcoholic intoxication in alcoholism, unspecified,Drug-induced delirium,Benzodiazepine-based tranquilizers causing adverse effects in therapeutic use'}
