CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 27-year-old
admitted with a history of bipolar disorder on Seroquel and
Lamictal who presented to an outside hospital on [**4-29**] with
ETOH intoxication and multiple superficial injuries.  The
patient said he broke up with his girlfriend on [**4-29**] and
went on a drinking binge.  Later that day, the patient was
out driving while intoxicated, and trying to shovel snow,
when he had multiple falls which were witnessed by a
neighbor.  EMS was called.

MEDICAL HISTORY: Bipolar.

MEDICATION ON ADMISSION: 

ALLERGIES: Ampicillin.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is a body builder.  He uses
ephedra.  ETOH - 4-5 beers qd.  No drugs.  No history of IV
drugs.  No history of seizure.  No history of DTs.
Toxic effect of ethyl alcohol,Alcohol withdrawal delirium,Drug withdrawal,Other and unspecified alcohol dependence, continuous,Poisoning by benzodiazepine-based tranquilizers,Nonspecific abnormal findings in stool contents,Other disorders of muscle, ligament, and fascia,Other bipolar disorders,Poisoning by other and unspecified solid and liquid substances, undetermined whether accidentally or purposely inflicted
Toxic eff ethyl alcohol,Delirium tremens,Drug withdrawal,Alcoh dep NEC/NOS-contin,Pois-benzodiazepine tran,Abn find-stool contents,Muscle/ligament dis NEC,Bipolar disorder NEC,Undeter pois-sol/liq NEC
Admission Date:  [**2172-4-30**]       Discharge Date:  [**2172-5-7**]

Date of Birth:   [**2144-11-3**]       Sex:  M

Service:

ADMISSION DIAGNOSIS:  ETOH intoxication/withdrawal.

HISTORY OF PRESENT ILLNESS:  The patient is a 27-year-old
admitted with a history of bipolar disorder on Seroquel and
Lamictal who presented to an outside hospital on [**4-29**] with
ETOH intoxication and multiple superficial injuries.  The
patient said he broke up with his girlfriend on [**4-29**] and
went on a drinking binge.  Later that day, the patient was
out driving while intoxicated, and trying to shovel snow,
when he had multiple falls which were witnessed by a
neighbor.  EMS was called.

The patient was treated at an outside hospital with Haldol 5
mg, ativan 2 mg, Benadryl 50 mg IV, cogentin 1 mg IV, Reglan
10, Anzemet 12.5 mg, thiamine banana bag, tetanus shot, IV
fluid.  While at outside hospital, the patient spiked a
temperature to 101.3.  There was concern for neuromalignant
syndrome versus serotonin syndrome.  The patient was also
found to have rhabdo.  The patient was transferred to [**Hospital1 18**]
for further evaluation.

In the Emergency Room here, the patient was given ativan 4 mg
IV x 2, Tylenol 1 gm, dantrolene 200 mg po, D5 [**2-13**] with
bicarb.  The patient denies getting into altercation.  The
patient is currently without complaints.  Denies any
ingestion other than alcohol.  A Foley was placed.  Of note,
the patient is a body builder.  He uses ephedra and Ripfuel.

The patient was admitted to the MICU for ETOH withdrawal,
CIWA-A scale and monitoring.  In the MICU, it was felt that
the patient's continued agitation and symptoms were
consistent with ETOH withdrawal requiring benzodiazepines.
After being given 750 mg of benzodiazepine, the patient still
continued to be agitated, tachycardic and hypertensive.
Toxicology was consulted.  Given the lack of control of
withdrawal, the patient was electively intubated in unit, and
the patient started on a propofol drip on [**5-1**], and
extubated on the same day.  Panculture was performed and a
chest x-ray showed possible aspiration pneumonia.  The
patient was initiated on antibiotics including Keflex and
clinda.

In MICU, a head CT was also performed which showed a possible
right basal ganglion density thought possibly to be a CVA.
Therefore, a follow-up MRI had to be performed which was
negative.  In his hospital stay in the MICU, the patient was
reevaluated by toxicology.  It was then felt that his
symptoms might be consistent more with benzodiazepine
withdrawal versus ETOH withdrawal.  Therefore, his benzos
were held.  The patient's mental status gradually cleared,
and he was transferred to the medicine floor on [**4-30**].

PAST MEDICAL HISTORY:  Bipolar.

MEDS:  1) Seroquel 600 qd, 2) Lamictal 100 [**Hospital1 **].

ALLERGIES:  Ampicillin.

SOCIAL HISTORY:  The patient is a body builder.  He uses
ephedra.  ETOH - 4-5 beers qd.  No drugs.  No history of IV
drugs.  No history of seizure.  No history of DTs.

LABS ON ARRIVAL/DATA FROM OUTSIDE HOSPITAL:  Sodium 140, K
4.2, chloride 94, bicarb 27, BUN 16, creatinine 1.9, glucose
133, calcium 9.3, T-bili 0.3, albumin 4.7, alk phos 100,
total protein 8.2, ALT 40.  Serum ETOH at outside hospital
was 352 on [**4-29**].  Amylase 180, AST 72, ALT 40, lipase 27,
white blood cell count 15.9, hematocrit 42.9, platelets 432,
N 93, L3, M3, E1.  UA - trace ketones, trace blood, trace
protein, RBC 0-2, WBC 0-5, a few epis/bacteria.  Urine
negative for amphetamines, cocaine, opiates, benzos,
cannabinoid, PCP.  [**Name10 (NameIs) **] for TCA.

A right ankle x-ray was negative.  C-spine was negative.
Head CT was negative.  Chest x-ray was negative.  CK was
2248, MB 14.2, and troponin 0.03.

At 5:00 am on [**4-30**], labs notable for hematocrit of 30.9, CK
3258, amylase 220, AST 93.

HOSPITAL COURSE - 1) MENTAL STATUS:  The patient's
presentation mental status was felt to be consistent with
ETOH intoxication, then benzodiazepine overdose/withdrawal.
The patient's mental status cleared with cessation of all
benzos.  The patient will be discharged on his Seroquel dose
and prn 1 mg po bid of Haldol.  The patient was followed by
psychiatry and toxicology in-house.  The patient will be
discharged to rehabilitation center for management of
intoxication.

2) ID:  Patient with a history of fever.  A chest x-ray
notable for possible aspiration pneumonia.  Subsequent blood
cultures were negative.  The patient's antibiotics were
discontinued.  The patient was afebrile 48 hours prior to
discharge.  No evidence of acute infection.

3) ORTHO:  Patient with a history of trauma to right ankle.
X-ray films were negative for fracture.  Patient was seen by
PT, evaluated in-house, and provided with crutches.

4) ANEMIA:  The patient had a history of anemia.  Iron
work-up was negative.  The patient also had guaiac positive
stools.  The patient should be evaluated with a colonoscopy
as an outpatient.

5) RHABDO:  Patient with a history of rhabdomyolysis.  The
patient showed no evidence of kidney dysfunction.  The
patient's CK levels declined while in-house.  The patient was
well-hydrated.

6) GI:  Patient with slightly elevated LFTs.  ALT on [**5-6**]
was 96, AST 96, alk phos 150, T-bili 0.4.  LFTs were likely
due to ETOH.  However, hepatitis panel was obtained to
evaluate, and this should be followed up as an outpatient.

RECOMMENDATIONS:  1) The patient discharged to rehabilitation
center for management of drug use.  2) The patient should be
followed by psychiatry to evaluate.  Of note, the patient was
evaluated here by psychiatry and there was a question as to
the basis for his bipolar disorder.  There was recommendation
for the patient not to continue to use his ephedra.  3) The
patient should be followed as an outpatient for his guaiac
positive stools with a colonoscopy.

DISCHARGE MEDICATIONS:  .................... PRN x 3 days.

CONDITION:  Fair.

DISCHARGE DIAGNOSES:  1) Benzodiazepine overdose with
benzodiazepine withdrawal.  2) Alcohol intoxication with
alcohol withdrawal.  3) Rhabdomyolysis.  4) Bipolar.


                  DR.[**First Name (STitle) 2515**],[**First Name3 (LF) **] 12-927



Dictated By:[**Last Name (NamePattern1) 201**]
MEDQUIST36

D:  [**2172-5-7**]  11:28
T:  [**2172-5-7**]  10:30
JOB#:  [**Job Number 49651**]
{'Toxic effect of ethyl alcohol,Alcohol withdrawal delirium,Drug withdrawal,Other and unspecified alcohol dependence, continuous,Poisoning by benzodiazepine-based tranquilizers,Nonspecific abnormal findings in stool contents,Other disorders of muscle, ligament, and fascia,Other bipolar disorders,Poisoning by other and unspecified solid and liquid substances, undetermined whether accidentally or purposely inflicted'}


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: The patient is a 27-year-old
admitted with a history of bipolar disorder on Seroquel and
Lamictal who presented to an outside hospital on [**4-29**] with
ETOH intoxication and multiple superficial injuries.  The
patient said he broke up with his girlfriend on [**4-29**] and
went on a drinking binge.  Later that day, the patient was
out driving while intoxicated, and trying to shovel snow,
when he had multiple falls which were witnessed by a
neighbor.  EMS was called.

MEDICAL HISTORY: Bipolar.

MEDICATION ON ADMISSION: 

ALLERGIES: Ampicillin.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is a body builder.  He uses
ephedra.  ETOH - 4-5 beers qd.  No drugs.  No history of IV
drugs.  No history of seizure.  No history of DTs. 

### Response:
{'Toxic effect of ethyl alcohol,Alcohol withdrawal delirium,Drug withdrawal,Other and unspecified alcohol dependence, continuous,Poisoning by benzodiazepine-based tranquilizers,Nonspecific abnormal findings in stool contents,Other disorders of muscle, ligament, and fascia,Other bipolar disorders,Poisoning by other and unspecified solid and liquid substances, undetermined whether accidentally or purposely inflicted'}
