CHIEF COMPLAINT: suicidal attempt

PRESENT ILLNESS: 46 yo F with a history of depression admitted after intentional
overdose of benzodiazepines, fluoxetine and phenytoin.
.
By verbal report, at 8AM the patient ingested (based upon pill
bottles) an estimated 30 lorazepam, 30 prozac, 35 clonazepam, 3
unisom and 4 dilantin. She was reportedly suicidal and her
husband had to break down the door to get to her. The patient
reports that she had depressed mood for several months. She
recalls taking 'like a handful' of clonazepam, fluoxetine and
phenytoin. She states that she has a great deal of stress at
home related to her children and husband and the only way to
deal with this difficulty is to 'leave this world.' She denies
ongoing thoughts of wanting to hurt herself.
.
In the ED, 98.6 72 138/64 14 99% RA. She developed hypotension
with a single bp measurement of 80/50 pulse 62. She received
1.5L NS with improvement in the blood pressure back to >100/60.
There was verbal report of the patient being responsive only to
sternal rub at some point in her ED stay however on arrive to
the ICU, the patient is alert and oriented.
.
ROS: Denies headaches, blurry vision, neck stiffness, chest
pain, shortness of breath, abd pain, nausea, vomiting, diarrhea,
dysuria, hematuria, rashes, arthralgias.
.

MEDICAL HISTORY: -elective arachnoid cyst fenestration with right craniotomy
[**2157-2-22**]
-seizures due to recent operation on Dilantin
-glaucoma
-depression
-GERD
-asthma

MEDICATION ON ADMISSION: Albuterol 90 mcg 2puffs inh four times daily as needed
Clonzaepam 0.5mg twice daily
Fluoxetine 20-40mg Daily
Fluticasone furoate 27.5mcg inh daily in AM
Latanoprost 0.005% 2 drops in each eye daily
Omeprazole 20mg Twice Daily
Phenytoin 200mg in AM, 300mg in PM
Cyanocobalamin 500mcg daily
Lysine 500mg daily
Magnesium

ALLERGIES: Codeine / Compazine / Zofran

PHYSICAL EXAM: Gen: NAD. Comfortable. Sedated. Answering appropriate to
questions.
HEENT: Pupils mildly dilated, equal, round and reactive to
light. Pink, moist oral mucosa without lesions.
CV: RRR. Normal S1 and S2. No M/R/G.
Pulm: CTA bilaterally.
Abd: Soft, nontender, no organomegaly.
Ext: No edema.
Neuro: A&Ox3. Slightly delayed in response to questioning. CN's
II-XII intact. Brief, rapidly distinguishing horizontal
nystagmus. Strength 5/5 in the deltoids, triceps, wrist and
finger extensors. 4+/5 in the proximal left lower extremity
flexion, [**6-13**] in the right proximal and bilateral lower
extremities. Sensation intact in all fields. Reflexes 2+ in the
patellas bilaterally. No clonus.

FAMILY HISTORY: no hx breast, ovarian, or colon Ca

SOCIAL HISTORY: married, lives with husband and children
denies tobacco and drug use; occasional social EtOh
Major depressive affective disorder, recurrent episode, severe, without mention of psychotic behavior,Esophageal reflux,Unspecified glaucoma,Asthma, unspecified type, unspecified,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Epilepsy, unspecified, without mention of intractable epilepsy,Poisoning by benzodiazepine-based tranquilizers,Poisoning by antiallergic and antiemetic drugs,Poisoning by hydantoin derivatives,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Home accidents
Recur depr psych-severe,Esophageal reflux,Glaucoma NOS,Asthma NOS,Elev transaminase/ldh,Epilep NOS w/o intr epil,Pois-benzodiazepine tran,Pois-antiallrg/antiemet,Poison-hydantoin derivat,Poison-psychotropic agt,Accident in home
Admission Date:  [**2157-7-25**]              Discharge Date:   [**2157-7-28**]

Date of Birth:  [**2110-12-29**]             Sex:   F

Service: MEDICINE

Allergies:
Codeine / Compazine / Zofran

Attending:[**First Name3 (LF) 1674**]
Chief Complaint:
suicidal attempt

Major Surgical or Invasive Procedure:
none

History of Present Illness:
46 yo F with a history of depression admitted after intentional
overdose of benzodiazepines, fluoxetine and phenytoin.
.
By verbal report, at 8AM the patient ingested (based upon pill
bottles) an estimated 30 lorazepam, 30 prozac, 35 clonazepam, 3
unisom and 4 dilantin. She was reportedly suicidal and her
husband had to break down the door to get to her. The patient
reports that she had depressed mood for several months. She
recalls taking 'like a handful' of clonazepam, fluoxetine and
phenytoin. She states that she has a great deal of stress at
home related to her children and husband and the only way to
deal with this difficulty is to 'leave this world.' She denies
ongoing thoughts of wanting to hurt herself.
.
In the ED, 98.6 72 138/64 14 99% RA. She developed hypotension
with a single bp measurement of 80/50 pulse 62. She received
1.5L NS with improvement in the blood pressure back to >100/60.
There was verbal report of the patient being responsive only to
sternal rub at some point in her ED stay however on arrive to
the ICU, the patient is alert and oriented.
.
ROS: Denies headaches, blurry vision, neck stiffness, chest
pain, shortness of breath, abd pain, nausea, vomiting, diarrhea,
dysuria, hematuria, rashes, arthralgias.
.


Past Medical History:
-elective arachnoid cyst fenestration with right craniotomy
[**2157-2-22**]
-seizures due to recent operation on Dilantin
-glaucoma
-depression
-GERD
-asthma


Social History:
married, lives with husband and children
denies tobacco and drug use; occasional social EtOh


Family History:
no hx breast, ovarian, or colon Ca

Physical Exam:
Gen: NAD. Comfortable. Sedated. Answering appropriate to
questions.
HEENT: Pupils mildly dilated, equal, round and reactive to
light. Pink, moist oral mucosa without lesions.
CV: RRR. Normal S1 and S2. No M/R/G.
Pulm: CTA bilaterally.
Abd: Soft, nontender, no organomegaly.
Ext: No edema.
Neuro: A&Ox3. Slightly delayed in response to questioning. CN's
II-XII intact. Brief, rapidly distinguishing horizontal
nystagmus. Strength 5/5 in the deltoids, triceps, wrist and
finger extensors. 4+/5 in the proximal left lower extremity
flexion, [**6-13**] in the right proximal and bilateral lower
extremities. Sensation intact in all fields. Reflexes 2+ in the
patellas bilaterally. No clonus.


Brief Hospital Course:
1)Suicidal attempt: Will require inpt psychiatric admission, no
anti-depressants at this time per psych

2)Benzodiazepine dependence: CIWA with benzo for evidence of
withdrawal

3)Dilantin overdose: Pt reports overdosing, levels not toxic,
tele without arrhythmia

4)H/o seizure: Dilantin restarted, with correction for low
albumin, dilantin therapuetic on [**7-27**]

5)Hepatitis: Likely due to low level ischemia in setting of
hypotension on arrival to ER. Will need recheck of ast/alt/alk
phos on [**8-2**]. If higher than [**7-28**] results would consult
medicine.

6)Palpitations: EKG and tele without arrythmias, tsh and lytes
normal.  No further follow up needed.

Medications on Admission:
Albuterol 90 mcg 2puffs inh four times daily as needed
Clonzaepam 0.5mg twice daily
Fluoxetine 20-40mg Daily
Fluticasone furoate 27.5mcg inh daily in AM
Latanoprost 0.005% 2 drops in each eye daily
Omeprazole 20mg Twice Daily
Phenytoin 200mg in AM, 300mg in PM
Cyanocobalamin 500mcg daily
Lysine 500mg daily
Magnesium


Discharge Disposition:
Extended Care

Facility:
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1675**] [**Last Name (NamePattern1) **] 4

Discharge Diagnosis:
benzodiazapine overdose


Discharge Condition:
stable


Discharge Instructions:
[**Name8 (MD) **] MD [**First Name (Titles) 151**] [**Last Name (Titles) 1676**] pain, seizure, or other concerning
symptoms.

Followup Instructions:
follow up at inpt psychiatric treatment


                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 1677**]

Completed by:[**2157-7-28**]
{'Major depressive affective disorder, recurrent episode, severe, without mention of psychotic behavior,Esophageal reflux,Unspecified glaucoma,Asthma, unspecified type, unspecified,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Epilepsy, unspecified, without mention of intractable epilepsy,Poisoning by benzodiazepine-based tranquilizers,Poisoning by antiallergic and antiemetic drugs,Poisoning by hydantoin derivatives,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Home accidents'}


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: suicidal attempt

PRESENT ILLNESS: 46 yo F with a history of depression admitted after intentional
overdose of benzodiazepines, fluoxetine and phenytoin.
.
By verbal report, at 8AM the patient ingested (based upon pill
bottles) an estimated 30 lorazepam, 30 prozac, 35 clonazepam, 3
unisom and 4 dilantin. She was reportedly suicidal and her
husband had to break down the door to get to her. The patient
reports that she had depressed mood for several months. She
recalls taking 'like a handful' of clonazepam, fluoxetine and
phenytoin. She states that she has a great deal of stress at
home related to her children and husband and the only way to
deal with this difficulty is to 'leave this world.' She denies
ongoing thoughts of wanting to hurt herself.
.
In the ED, 98.6 72 138/64 14 99% RA. She developed hypotension
with a single bp measurement of 80/50 pulse 62. She received
1.5L NS with improvement in the blood pressure back to >100/60.
There was verbal report of the patient being responsive only to
sternal rub at some point in her ED stay however on arrive to
the ICU, the patient is alert and oriented.
.
ROS: Denies headaches, blurry vision, neck stiffness, chest
pain, shortness of breath, abd pain, nausea, vomiting, diarrhea,
dysuria, hematuria, rashes, arthralgias.
.

MEDICAL HISTORY: -elective arachnoid cyst fenestration with right craniotomy
[**2157-2-22**]
-seizures due to recent operation on Dilantin
-glaucoma
-depression
-GERD
-asthma

MEDICATION ON ADMISSION: Albuterol 90 mcg 2puffs inh four times daily as needed
Clonzaepam 0.5mg twice daily
Fluoxetine 20-40mg Daily
Fluticasone furoate 27.5mcg inh daily in AM
Latanoprost 0.005% 2 drops in each eye daily
Omeprazole 20mg Twice Daily
Phenytoin 200mg in AM, 300mg in PM
Cyanocobalamin 500mcg daily
Lysine 500mg daily
Magnesium

ALLERGIES: Codeine / Compazine / Zofran

PHYSICAL EXAM: Gen: NAD. Comfortable. Sedated. Answering appropriate to
questions.
HEENT: Pupils mildly dilated, equal, round and reactive to
light. Pink, moist oral mucosa without lesions.
CV: RRR. Normal S1 and S2. No M/R/G.
Pulm: CTA bilaterally.
Abd: Soft, nontender, no organomegaly.
Ext: No edema.
Neuro: A&Ox3. Slightly delayed in response to questioning. CN's
II-XII intact. Brief, rapidly distinguishing horizontal
nystagmus. Strength 5/5 in the deltoids, triceps, wrist and
finger extensors. 4+/5 in the proximal left lower extremity
flexion, [**6-13**] in the right proximal and bilateral lower
extremities. Sensation intact in all fields. Reflexes 2+ in the
patellas bilaterally. No clonus.

FAMILY HISTORY: no hx breast, ovarian, or colon Ca

SOCIAL HISTORY: married, lives with husband and children
denies tobacco and drug use; occasional social EtOh 

### Response:
{'Major depressive affective disorder, recurrent episode, severe, without mention of psychotic behavior,Esophageal reflux,Unspecified glaucoma,Asthma, unspecified type, unspecified,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Epilepsy, unspecified, without mention of intractable epilepsy,Poisoning by benzodiazepine-based tranquilizers,Poisoning by antiallergic and antiemetic drugs,Poisoning by hydantoin derivatives,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Home accidents'}
