CHIEF COMPLAINT: drug overdose

PRESENT ILLNESS: HISTORY OF PRESENTING ILLNESS

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: none

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: PHYSICAL EXAMINATION

FAMILY HISTORY: nc

SOCIAL HISTORY: Social History: Just arrived from [**Location 89033**]
Acquired hypertrophic pyloric stenosis,Paralytic ileus,Hypotension, unspecified,Other conditions of brain,Atrial fibrillation,Foreign body in stomach,Poisoning by cocaine,Foreign body accidentally entering other orifice,Accidental poisoning by central nervous system stimulants,Poisoning by heroin,Accidental poisoning by heroin
Acq pyloric stenosis,Paralytic ileus,Hypotension NOS,Brain conditions NEC,Atrial fibrillation,Foreign body in stomach,Poisoning by cocaine,FB entering oth orifice,Acc poison-cns stimulant,Poisoning-heroin,Acc poison-heroin
Admission Date:  [**2123-6-4**]              Discharge Date:   [**2123-6-10**]

Date of Birth:  [**2094-1-18**]             Sex:   F

Service: SURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 4691**]
Chief Complaint:
drug overdose

Major Surgical or Invasive Procedure:
Exploratory laparotomy, gastrotomy


History of Present Illness:
HISTORY OF PRESENTING ILLNESS

This patient is a 29 year old female who complains of OD.
Patient was transferred from an outside hospital. Patient
initially presented with both lethargy and new onset atrial
fibrillation. During the course of the patient's visit it
was found that the patient had ingested multiple packets of
unknown substance believed to be either cocaine or heroin in
[**Location (un) 13366**] approximately 5 days ago. The patient was noted to
have a functional gastric outlet
obstruction, and was transferred to our facility for further
management. The patient was started on a diltiazem drip for
management of atrial fibrillation.

En route to our facility, the patient was given
benzodiazepines to protect against seizures. Following this,
the patient developed respiratory depression and
hypotension. She was intubated and started on peripheral
Levophed

Past Medical History:
none

Social History:
Social History: Just arrived from [**Location 89033**]


Family History:
nc

Physical Exam:
PHYSICAL EXAMINATION

HR: 120s BP: 88/60 Resp: 18T O(2)Sat: 97% Normal

Constitutional: Intubated
HEENT: Normocephalic, atraumatic
OP with endotracheal tube
Chest: Breath sounds bilateral
Cardiovascular: Normal first and second heart sounds,
tachycardic
Abdominal: Soft, Nondistended, absent bowel sounds.
Skin: Warm and dry
Neuro: GCS 3T


Pertinent Results:
[**2123-6-9**] 04:50AM BLOOD WBC-11.8* RBC-3.64* Hgb-11.5* Hct-33.1*
MCV-91 MCH-31.6 MCHC-34.8 RDW-13.4 Plt Ct-258
[**2123-6-8**] 06:10AM BLOOD WBC-10.1 RBC-3.49* Hgb-11.2* Hct-32.8*
MCV-94 MCH-32.0 MCHC-34.1 RDW-13.3 Plt Ct-216
[**2123-6-7**] 06:00AM BLOOD WBC-14.9* RBC-3.75* Hgb-12.0 Hct-34.1*
MCV-91 MCH-32.0 MCHC-35.2* RDW-13.3 Plt Ct-196
[**2123-6-4**] 03:30PM BLOOD WBC-22.0* RBC-4.15* Hgb-12.9 Hct-39.8
MCV-96 MCH-31.1 MCHC-32.4 RDW-13.3 Plt Ct-288
[**2123-6-9**] 04:50AM BLOOD Plt Ct-258
[**2123-6-8**] 06:10AM BLOOD Plt Ct-216
[**2123-6-5**] 03:52AM BLOOD PT-14.7* PTT-37.0* INR(PT)-1.3*
[**2123-6-4**] 03:30PM BLOOD Fibrino-264
[**2123-6-9**] 04:50AM BLOOD Glucose-98 UreaN-4* Creat-0.4 Na-135
K-3.5 Cl-99 HCO3-26 AnGap-14
[**2123-6-8**] 06:10AM BLOOD Glucose-121* UreaN-4* Creat-0.6 Na-137
K-3.5 Cl-100 HCO3-30 AnGap-11
[**2123-6-4**] 08:38PM BLOOD Glucose-79 UreaN-6 Creat-0.5 Na-139 K-3.7
Cl-110* HCO3-21* AnGap-12
[**2123-6-5**] 03:52AM BLOOD CK(CPK)-574*
[**2123-6-4**] 08:38PM BLOOD CK(CPK)-263*
[**2123-6-5**] 03:52AM BLOOD CK-MB-11* MB Indx-1.9 cTropnT-<0.01
[**2123-6-4**] 08:38PM BLOOD CK-MB-13* MB Indx-4.9 cTropnT-<0.01
[**2123-6-9**] 04:50AM BLOOD Calcium-7.8* Phos-3.1 Mg-1.7
[**2123-6-8**] 06:10AM BLOOD Calcium-7.6* Phos-2.4* Mg-1.9
[**2123-6-4**] 03:30PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2123-6-4**] 08:47PM BLOOD Lactate-1.9
[**2123-6-4**] 08:47PM BLOOD freeCa-1.01*

[**2123-6-4**]: chest x-ray:

IMPRESSION:

No acute cardiopulmonary pathology.

Distended stomach full of heterogeneous material, rounded
opacities may
represent drug packets, in keeping with clinical history.

[**2123-6-4**]: x-ray abdomen:

FINDINGS: The NG tube tip is in the stomach. Lateral decubitus
film
demonstrates some air-fluid levels in the colon. Supine film
shows gas in the colon. No free air is visualized. Skin staples
are seen in the mid abdomen

[**2123-6-5**]:  EKG:

Sinus tachycardia. Otherwise, tracing is within normal limits.
No previous
tracing available for comparison

[**2123-6-5**]:  chest x-ray:

FINDINGS: The ET tube is 4 cm above the carina. Left IJ line tip
is in the
SVC. NG tube is still slightly high with proximal port at the GE
junction.
There is increased opacity measuring 3.7 cm centered around the
tip of the
left IJ line projecting over the region of the distal SVC. There
is also
increased opacity in the right upper lung. This finding was
called to the
trauma team at the time of dictating this report (Dr. [**Last Name (STitle) **].

IMPRESSION:
1. New increased opacity in the right upper lung of unclear
etiology.
2. NG tube still slightly too high.

[**2123-6-5**]:  chest x-ray:


FINDINGS: Lobulated opacity seen on the film from earlier the
same day is no longer visualized. There is increased opacity
bilaterally consistent with effusions layering posteriorly and
some alveolar edema. There is bilateral pulmonary vascular
redistribution. NG tube tip is in the stomach. ET tube tip is
0.8 cm above the carina. Skin staples are again seen projecting
over the upper abdomen.

[**2123-6-7**]:  echo:

The left atrium and right atrium are normal in cavity size. Left
ventricular wall thickness, cavity size, and global systolic
function are normal (LVEF>55%). There is mild regional left
ventricular systolic dysfunction with probable mild basal to mid
inferior hypokinesis. Transmitral and tissue Doppler imaging
suggests normal diastolic function, and a normal left
ventricular filling pressure (PCWP<12mmHg). Right ventricular
chamber size and free wall motion are normal. The diameters of
aorta at the sinus, ascending and arch levels are normal. The
aortic valve leaflets (3) appear structurally normal with good
leaflet excursion and no aortic stenosis or aortic
regurgitation. The mitral valve appears structurally normal with
trivial mitral regurgitation. There is no mitral valve prolapse.
The estimated pulmonary artery systolic pressure is normal.
There is no pericardial effusion.

IMPRESSION: Suboptimal image quality. Assessment of regional
wall motion abnormalities is difficult. The basal to mid
inferior wall is probably mildly hypokinetic. The apical
segments are not well seen. No significant valvular abnormality
seen.




Brief Hospital Course:
29 year old female admitted to the acute care service from an
outside hospital with increased lethargy and new onset of atrial
fibrillation.  She reported ingestion of drug packets.  She was
intubated upon transport related to increasing somnolence and
hypotension. She required pressor support and an anti-arrhythmic
[**Doctor Last Name 360**] for control of her rapid heart rate.  Upon admission, she
underwent radiographic imaging and was found to have a distended
stomach full of heterogeneous material and few rounded opacities
representing drug packets. [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]-gastric tube was placed for
stomach decompression.  Because of her clinical story and
presentation, toxicology and gastroenterology were consulted and
made recommendations for her management.  She was emergently
taken to the operating room where she underwent an exploratory
laparotomy, gastrotomy and removal of narcotic packets. Her
operative course was stable.  She was monitored in the intensive
care unit after her procedure and required additional
intravenous fluids.  She had placment of a central venous line
for additional access. Her pressors were weaned off.  She was
extubated on POD #1. She underwent a bedside echocardiogram
which showed a stunned myocardium (EF 30-40%) likely due to
large catecholamine release. She had a repeat echocardiogram
done which raised the suspicion of myocardial dysfunction,
EF=>55%.
She was transferred to the surgical floor on POD #2. Her cardiac
status was monitored because of her history of atrial
fibrillation upon admission to the hosptial.  She has had
occasional episodes of increased heart rate to 100, which have
resolved spontaneously. Her [**Last Name (un) **]-gastric tube was discontinued
on POD# 3 and she slowly regained bowel function.  She
progressed from clear liquids to a regular diet.  Her foley
catheter was discontinued and she is voiding without difficulty.
She was seen by the Social worker who provided her with
additional support.
Her vital signs are stable and she is afebrile.  She is
tolertating a regular diet.
Her abdominal wound is clean with intact staples.  She is
preparing for discharge with instructions to follow up in the
acute care clinic in 2 weeks for removal of the staples.


Medications on Admission:
none

Discharge Medications:
1. hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain.
Disp:*10 Tablet(s)* Refills:*0*
2. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day:
hold for loose stool.
3. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain.


Discharge Disposition:
Home

Discharge Diagnosis:
polysubstance overdose


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


Discharge Instructions:
You were admitted to the hospital after ingestion of drug
packets.  You were taken to the operating room for an
exploratory laparotomy and gastrotomy.  You are now preparing
for discharge with the following instructions:

Please call your doctor or return to the emergency room if you
have any of the following:


 * You experience new chest pain, pressure, squeezing or
 tightness.

* New or worsening cough or wheezing.

* If you are vomiting and cannot keep in fluids or your
 medications.

* You are getting dehydrated due to continued vomiting,
 diarrhea or other reasons. Signs of dehydration include dry
 mouth, rapid heartbeat or feeling dizzy or faint when standing.

* You see blood or dark/black material when you vomit or have a
 bowel movement.


* You have shaking chills, or a fever greater than 101.5 (F)
 degrees or 38(C) degrees.

* Any serious change in your symptoms, or any new symptoms that
 concern you.

* Please resume all regular home medications and take any new
meds
 as ordered.

Activity:
No heavy lifting of items [**9-25**] pounds for 6 weeks. You may
resume moderate
exercise at your discretion, no abdominal exercises.

Wound Care:
You may shower, no tub baths or swimming.

If there is clear drainage from your incisions, cover with
clean, dry gauze.


Followup Instructions:
Please follow up with in the acute care clinic in 2 weeks for
staple removal.  You can schedule your appointment by calling #
[**Telephone/Fax (1) 600**]
{'Acquired hypertrophic pyloric stenosis,Paralytic ileus,Hypotension, unspecified,Other conditions of brain,Atrial fibrillation,Foreign body in stomach,Poisoning by cocaine,Foreign body accidentally entering other orifice,Accidental poisoning by central nervous system stimulants,Poisoning by heroin,Accidental poisoning by heroin'}


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: drug overdose

PRESENT ILLNESS: HISTORY OF PRESENTING ILLNESS

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: none

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: PHYSICAL EXAMINATION

FAMILY HISTORY: nc

SOCIAL HISTORY: Social History: Just arrived from [**Location 89033**] 

### Response:
{'Acquired hypertrophic pyloric stenosis,Paralytic ileus,Hypotension, unspecified,Other conditions of brain,Atrial fibrillation,Foreign body in stomach,Poisoning by cocaine,Foreign body accidentally entering other orifice,Accidental poisoning by central nervous system stimulants,Poisoning by heroin,Accidental poisoning by heroin'}
